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Miscellaneous - 96 MARBLERIDGE ROAD 4/30/2018 (2)
1 'IV ) Date......... A... ...... .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ........ .... . . ..... ................ ... has permission to perform ..... . . ...... wiring in the building of ........ I ...... .............. at ...... /�� North Andover Mass. i�11A .... ... ............ Fee le,�61 ....... ..................... Lic. No. ��fff* ........... .... . ELECTRICAL INSPE 0 Check # 7702 ..e �-� Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. rf 7v z Occupancy and Fee Checked 0 :ev. 1/07] (IP.aVP hlanlr\ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:/0 �/ Q -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 theelectrical work described below. /r l Location (Street & Number) at- Ple ate 1 &,, K/, Owner or Tenant Tfu Owner's Address C/A, Telephone No 9 7� (y� a' q Oy Is this permit in conjunction with a building permit? Yes Q-�No ❑ (Check Appropriate Box) Purpose of Building Oj (i _ p GZ, Q .{ Utility Authorization No. 2-0 3 I —,L--7 Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service �J C- Amps 124/1 K0Volts Overhead ❑ Undgrd U No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Q cc ✓a. To ,f /. o f-Fi r -P a 0-e c� ComDletion ofthe fnllnwi.., mm. ,.,,.,, t, No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans .l r o rytres. No. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires SwimmingAbove In- Pool [Irnd. ❑ o. o Emergency ig g rnd• BjqeM Units No. of Receptacle Outlets No. of OR Burners FIRE ALARMS No. of Zones No. of Switches C, No. of Gas Burners , No. of Detection and Initiatin Devices No, of Ranges No. of Air Cond. TonsTotal No. of Alerting Devices No. of Waste Disposers eat Pump Number .................._............................. Tons KW o. of Se -Contained Totals: Detection/Ale rtin Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of WaterNo. of o. N No. of Devices or Equivalent Heaters KW of Signs Ballasts Data W f Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E aivalent�--1 OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: fp G 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VE GE: 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 covers 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 andpenalties ofpeeu2, that the information on this application is true and complete. FIRM NAME: (� k � eC /? ` CU LIC. NO.: Licensee: �/ { Gtr Signature LIC. NO.: (If applicable, enter "exempt" 'n the license n tuber line.) qn Bus. Tel. No.: q� t7 Address: t /G' ( %ty U e -t, ;G, Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage 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: $ �� Rd-zt� 0/-L l0 .3)_o7 5 2v e9/f— fin -3)-97 P --,Ll I I ��j Ok �- 11�7 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 C-1 www massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name (Business/Organization/Individual): Address:- City/State/Zip: Phone #: . Are you an employer? Check the appropriate box: 1. ❑ 1 aro a employer with 4. E31 am a general contractor and I T of re . r YPe P j (equi red): employees (full and/or part-time).* . 2.❑ l: am.a.sole proprietor. or partner- have hired the sub -contractors listed on the attached sheet. # 6 New construction 7• ❑ Remodeling ship and have no employees These su&contractors have 8. ❑ Demolition working for mein any capacity, [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its g, ❑ Building addition required.] officers have exercised their 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself, [No -workers' comp, c. 152, § 1(4),' and we have no 12.❑ Roof repairs insurance required.]"t employees. [No workers' 13.❑ Other comp. insurance required..] —1.r-PP"64"' uuu cu=Ks oox IF t must also fill out the section below showing their workeni' oompensatioa 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. $Contactors that check this box must attached an additional sheet showing, the name of the sub -contractors and their workers' comp. policy infonnmdon. lam -an employer that is.providing workers' compensation insurance for my employees: Below is the policy and job site information. Insurance 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 required under Section 25A of MGL c. 152 can lead to the imposition of cr-iminal 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 thepains andpenalties ofperjury that the information provided above is true' and correct Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other 4. Electrical Inspector 5. Plumbing Inspector 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 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 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required. to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of 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, nofthe 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 tine. 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 permitnicense applications in any given year, need only submit one affidavit indicating•cutrmit 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 fifture 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. # 617-727-4906 ext 406 or 1-877-MASSAFE Fax # 617-727-7744 Revised 5-26-05 www.mass.gov/dia �l I r 1 i AK STRUCTURAL ENGINEERING _ 8 Coleman Street Peabody, MA 01960-4104 EIK Tel. & Fax 978 531-5927 November 16, 2007 Mr. William Balkus William Balkus Associates 10 S. Main Street Topsfield, MA 01983 REF: Garage at Daly Residence, North Andover, MA Dear Mr. Balkus: The design of the above garage building meets the requirements of the Massachusetts Building Code. Sincerely, r- N oF�. y� { Andrew Kuchinsky, P.E. IN l lQ �i a r b I e- t� d e. O0. 9 11/171LGGf 1L: .70 7th:JAl'J7Lr nn,��nuvi�.+i.�� ••-•- -- -- AK STRUCTURAL ENGINEERING 8 Coleman Street Peabody, MA 01960-4104 Tel. & Faux (976) 531-5927 November 10, 2007 Mr. William Balkus William Balkus Associates 10 S. Main Street Topsfield, MA 018$3 REF: Garage at Daly residence, North Andover, MA _ Dear Mr. Balkus: The design of the above garage building meets the requirements of the Massachusetts Building Code. Sincerely, CL AMMW UCN e K Andrew Kuehinsky, .P.E. Date. TOWN OF NORTH ANDOVER Siam. PERMIT FOR PLUMBING -'SSACMUS� y This certifies that .. l!H%y... 1��.!? ................ has permission to perform ....................... plumbing in the buildings of ...sAl . .................... F at ... r..l?!/s?!�. �� _ . 4 �a. .7 .. . , North Andover, Mass. Fee. 3. .... Lic. No. A.U.. �� �. ....... ` , •� ....... _ F ' PLUMBING INSPECTOR Check # 6') 7571 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING .ype or print) Dunding New L.:.! Renovation Date I I !14-? - �u Permit 4 ?.c?/ p Amount Owner's Name Replacement FIXTURES Plans Submitted n (Print or type) Check one: Certificate Installing Company Name Galinskv Plumbing & Heating El Corp. 190 Address P . O .Box 1701 ❑ Partner, RavPrhill_ MA niRif Business Telephone 978-374-1743 Firm/Co. Name of Licensed Plumber: Stephen C. G a l i n s k y Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy® Other type of indemnity Bond ri Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner a Agent 0 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts SftP �be and Chapter 142 of the General Laws. By: igna re o c se um er Type of Plumbing License Title City/Town LI&4h um er Master [3 Journeyman ❑ APPROVED (OFFICE USE ONLY Date //`M`�*- 4. ;;, ....... TOWN OF NORTH ANDOVER 49 PERMIT FOR GAS INSTALLATION SACHU PThis certifies that. h ......... ........ has permission for gas installation .r� o e, -k ........ . ............. '0 in the buildings of ... k/ ............................... at North Andover, Mass. Fee.R. Lic. No -AM .t. ...... AS INSPECTOR Check # e) .,) MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING _- _-- (Print or Type) , D- t,� / �j _ �u Mass. Date i l - I 1 Permit # C� L 1'O 0 Building Location -lb�' I`r� ��" Owners Name Type of Occupancy New 0311' Renovation ❑ Replacement El Pians Submitted: Yesp No ❑ Installing Company Name Ga 1 n S k -N I Usr Check one: Certificate Address "�70 i�iC ��% ( ❑ Corporation i L (K A n II y,31 ❑ . Partnership Business Telephone Cf i �� _ �� 3 D Firm/Co. Name of Licensed Piumber or Gas Fitter INSURANCE COVERAGE: I have a currentfiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes B, No D If you have checkedrtes. please indicate the type coverage by checking the appropriate box. A liability insurance policy (� Other type of indemnity D 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 D Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above lira ion are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued ap i tion will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genera $y. T •cense: umber Signature of Licensed lumber or Gas Fitter Title fitter ster license Number Ciip'Town f�urneyman l l NL SOMEONE MO 'SEEN N mommossmon on IMMMISSEEMESEMENES son MEN MESS MEMEMEMEMEM, 050110010 MENOMONEE ONENESS SENSE MEN SEE MRSEMEMSEEN Installing Company Name Ga 1 n S k -N I Usr Check one: Certificate Address "�70 i�iC ��% ( ❑ Corporation i L (K A n II y,31 ❑ . Partnership Business Telephone Cf i �� _ �� 3 D Firm/Co. Name of Licensed Piumber or Gas Fitter INSURANCE COVERAGE: I have a currentfiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes B, No D If you have checkedrtes. please indicate the type coverage by checking the appropriate box. A liability insurance policy (� Other type of indemnity D 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 D Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above lira ion are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued ap i tion will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genera $y. T •cense: umber Signature of Licensed lumber or Gas Fitter Title fitter ster license Number Ciip'Town f�urneyman l l NL Date... . �7.7:P-5-- e-) 7 ...................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... fnwK .... CLtC-M�................. has permission to perform .............. In' . ........... W! C-1 ......... wiring in the building of .................... 0/ L-.. v............................................... ............................................... at ....... 0/.A ... 11.1#IIA_ I (. F.... P... 1. J).,� F ........... & . .......... . North Andover, Mass. Li c. .... T ............. Lc. No. . . .............. ........... .... ELECTRICAL INSPECTOR Check# 7542 -\Commonwealth of Massachusetts Official Use Only 7s--� Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (M C), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: --712 $f G.> 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) I Owner or Tenant S Te u-2 Owner's Address t'/f1n-Z Is this permit in conjunction with a building permit? Yes 41, Purpose of Building ;,7G/,e Existing Service�6PC1 Amps / `c6 Volts Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd L=J 11 No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ccs, -i-c4 e Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. grnd. o. of Emergency Lighting Batteri Units No. of Receptacle Outlets / No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 3 No. of Gas Burners No. o Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons K ...._.... No. o elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection ❑Other No. of Dryers Dr y Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters 0. 10 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: Attach additional detail if desired, or as required by the Inspector of Noires. Estimated Value of Electri al Work: (When required by municipal policy.) Work to Start: % G 7 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 cover is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) /certify, under the pains and penalties of perju , that the information on this application is true and complete. FIRM NAME: �_/Itv e f NL= —_ L C�f-G]1-,-+ C „ ^ LIC. NO.: Licensee: C�gpr( tl,t-6 rp'cA-C--i (If applicable enter "exen y11 in the I* nse n Address: �%,?i�/�t% i r%p LIC. NO.: I q % Bus. Tel. No.: UY -360 71Y9'2 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: 1 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: $71 tel-� Dec (-g,(-r- 10-:51-0 '7 f* t, 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 Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 21-11 am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no 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 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # l 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. Insurance Company Name: Policy # or Self -ins. Lic. #: 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 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 andpenalties of perjury that the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone M Date ......Z...:7 41`.�.. � ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that /r! .. L has permission to perform F�js // �r �� .......... ....................................................... wiring in the building of L � .................................................. at .........t.f..... ` , North Andover, Mass. Fee �,.a..:".�_. Lic. Not !. 9q 7�..... .................... '' � ELECTRICAL INSPECTOR Check # �iff � 7347 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. /3 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME ), 527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 4;1 4 07 City or Town of: NORTH ANDOVER To the Insp ctor of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 176 Ma -r 3/.e �t ��� � l-4tiV V W - Owner or Tenant 67-, Lv C Telephone No.q?p 6 000c, w y Z/ Owner's Address S4 M 4P Is this permit in conjunction with a building permit? Yes Ff Purpose of Building S / H til P /✓w �f� ,,uG, Existing Service Amps off• / cze Volts Overheac New Service Amps Number of Feeders and Ampacity No ❑ (Check Appropriate Box) Utility Authorization No. ❑ Undgrd. No. of Meters Volts Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: F, ;, Completion of thefollowing table may be waived by the Inspector of Wires No. of Recessed Luminaires No. of Ceil: Susp. (Paddle)_Fans.--� No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets 10 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 7 No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number. Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water KW Heaters 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: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: VZ2G7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE OV AGE: 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 cove is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the -information on this application is true and complete. FIRM NAME: U -rt//, eyice _ 1:�, �% GP2C C A LIC. NO.: I % C/1? 7/111 Licensee: Sign •EIC. NO.: (f applicabl enter "exem t/" in the license numberl�n .) / Bus. Tel. No.:ef7r� �O7 4 Address: G/ �7e��r,� s6i ii'� %d/ �-C vlCi{vo• Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ SignaturetoreTelephone No. (L,tk oit � - ;�- 7 , 0-7 Arl � Cj �-�%o --3 I a 1` Date .... J/c-- / ..................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................................................................................. has permission to perform ............................................................................ ...................... wiring in the building of ........ 0/92V ............................................ at ...... &IAAVA&itft�-North Andover, Mass. " . .................................. Fee. g. .... Lic. No... ...... /;,,*k'. ......... iLECTRICAL INSPECTAOR Check# -7 847 A IN - Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 2Ya'7 s 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 (MEC), 527 CMR 12.00 (PLEASE PRINT IN&K OR TYPE ALL INFORMATION) Date: / j— / %' ?-ZTR City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention Iperform the electrical work described below. Location (Street & Number) Owner or Tenant 0Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No �� L� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service_ Amps /22/2-Y6 Volts Overhead ❑ Und rd f g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /4/,,h Completion of the following table may he wawnd h„ th. -,r EX Total Transformers KVA No. of Recessed Luminaires No. of CeiL-Susp. (Paddle) Fans FIRE ALARMS No. of Luminaire Outlets No. of Hot Tubs No. of Alerting Devices No. of Luminaires Swimming Pool Above ffrnd. Lyrn Security Systems:* No. of Devices or Equivalent No. of Receptacle Outlets No. of Oil Burners No. of Switches No. of Gas Burners a No. of Ranges No. of Air Cond. TTot onal No. of Waste Disposers Heat ump Number ons I No. of Dishwashers Space/Area Heating KW No. of Dryers No. of Water KW Heaters Heating Appliances KW No. of No. of Si s Ballasts . No. Hydromassage Bathtubs No. of Motors Total HP OTHER: EX Total Transformers KVA Generators KVA o. o mergency ig Batte Units FIRE ALARMS No. of Zones No. of Detection and Initiatin Devices No. of Alerting Devices No. of Self -Contained Detection/Aleiling Devices Local ❑ Municipal ❑Other Connection Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent Telecommunications icing: No. of Devices or E uivalent OG Attach additional detail if desired, or as required 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 in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties o perjury, that the information on this application is true and complete. FIRM NAME: — '��0 IAI Q /19, f `j LIC. NO.: — / 9 7 Licensee: Signature � (If applicable, enter "exempt " in the license n ber line. 4 LIC. NO.: Address: ���7' Bus. TeL No.: �,Z— S1S7— *Per M.G.L c. 147, s. 57-61, security work requires Departmen of Public Safety "S" License: Alt L cl. 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 (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ F� M-0) i i t k- ! ns. a � The Commonwealth of Afassachusetts Department of Industrial Accidents Dice of Investigations 600 Washington Street Boston, MA 02111 { www.mass.gov/dia Workers' Compensation Insurance Affidavit: piiBuilders/Contractors/Electritians/pi�be POP Informatinn Nang a (Business/Organiza6on/individual)- Address: 297. Phone #:. Are you an employer? Check the appropriate box: 1. 111: am a employer with 4, ❑ 1 am a general contractor and I em i (foil and/or part-time).* . 2.a2r _ have hired the sub -contractors 1 am•a.so►e proprietor. or partner- ship and have no employees listed on the attached sheet. x These subcontractors have working for me .in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their right all work of exemption per MGL myself. [No•workers' comp, c. 152, § I(4),'and we have no insurance required.] t .employees, [No workers' COMP. insurance required.] 'may applicant that checks bot(# I t Homeo must also fill out the section below showing their workers' bon set' Type Of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition g. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑Roof repairs 13.M Other $Contr wears who submit this affidavit indicating they are doing all work and then hire outside c nnictots must submit a new affidavit indicating such. actors that check this box mustattached an additional shanshowing the name of the sub,conttactocs and their workers' comp. policy information. 1 ant an employer 440 -is prq"ng:workers' compensation insurance for my employees: Below cs. the policy and job site inforntalion. Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the .workers' cotnpeasation policy declaration page (showing the policy number and expiration date}. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500:00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of pedury that the iuformadon provided above is true and correct A7_' �- - Of j`lcial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing laQrxr4nr 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 In ee is defined as "...every person in the service of another under any contract of hire, Purs enrp y 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 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 insumnce'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 tmtil acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation. affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. if an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of 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 peFmit or license is being requested, not'the Department of Industrial Accidents. Should you have any questions regarding the law or ifyou.are required to obtain a workers' compensation policy, please call the Department at the numberlisted below. Self-insured companies should enter their self insuranae"license number on the appropriate tine. 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 wilI be used as a reference number. In addition, an applicant that.must submit multiple perinit/iicense 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 L. . 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 Bosfon, MA 42111 Tel. 9 6I7-7274900 ext 406 or 1-877-MASSAFE Fax 4 617-727-7741 Revised 5-26-45 www.ma.ss.govldia Location /0 ,444, Prdqv J �d No. -2 IV Date �r O TOWN OF NORTH ANDOVER ti Certificate of Occupancy $ _ b'•"°' t `' Building/Frame Permit Fee $ ,SJACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 6/�" Check #14611 6 / Building Inspector M TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:. DATE ISSUED: �Q J / SIGNATURE: Building Commissioner/IT&or of Buildin2 Date I On4,11VIN 1-011E 1114rUXIVIAlivlN 1 yrAddress: .f 1.11/Property 1.2 Assessors Map and Parcel Map Number Number: Q 0`...3 Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BY,-.LDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide' Required Provided Required Provided 1.7 l5'ater Supply M.G.LC.40. 54) Public Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: A On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHW/AUl'MORIZEI) AGENT 2.1 Owner of Record /- OW Na e (P Ant) Address for Service: 2.2 Owner of Record: J Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ,61' ,qAl ,God (- Licensed Construct?on Supervisor: Address Sign,#Gre Telephone 3.2 Registered Home Improvement Contractor Addressress for Not Applicable ❑ r License—Number Expiration Date Dy E JW pplicable 0 FEB 21 20ul Registration Number --.J BUL�y-� SEPT. Expiration Date SECTION 4 - WORKERS COMPENSATION (MG.L C 152 § 25c(6) 0 Workers Compensation Insurance aejdavit mint be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all a Hcable New Construction ❑ Existing Building X Repair(s) ❑ Alterations(s) Addition , Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �e� d �✓ �y� -k eW � hake,mc- w4h SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Building Estimated Cost (Dollar) to be Com leted bpermit applicant /J l � ov (a) Building Permit Fee Multi Tier 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, as Owner/Authorized Agent of subject property He /yautho'rize to act on My half, In all n tt ative tq4crk authorized'by this building permit applica grt e of Owner 4 Date d SWTION 7b OWN AUTHORIZED AGENT DECLARATION I, As Owner/Authorized Agent of subject property Hereby eclare that /estatements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print N me Si anrre of Owner/A ent Date Im NO. OF STORIES SIZE - BASEMEN' OR SLAB SIZE OF FLOOkTIIVIB RS-�~; --- .... _ IT 2ND 3 SPAN I)IMENSIONS OF STI,L•S" — ----�-.--.=.: l, !11 DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 7 HEIGHT OF FOUNDATION THICKNESS SIZE OF F0C1'ING __ x MATERIAL OFiCHMNEY F •.r. -,.` ,, j IS BUII1DINCi ON,SOLID OR,F.U,LED LAND IS BUILDING CONNEfTED TO NATIJRAI; FORM - U - LOT -RELEASE FORM . INSTRUCTIONS: This form is used to verify that all -necessary approval /permits from Boards and Departments having jurisdiction have been obtained..' This cion: not relieve the applicant and' or landowner from compliance with any applicable requirements. s............................................................................ APPLICANT /� PHONE ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET LdqP STREET NUMBER I.......make . ......... ..■..............■..............................■ OFFICIAL USE ONLY .............................' ..............■ RECO ATIONS OF TOWN AGENTS ,song. ■ ■....■ ■.■■.............r........■....�................,✓.........■ DATE APPROVED Z S 0i ONS V TION ADMWISTRAT R DATE REJECTED Co... UU D l��S � � � �- ( U' 6 / �� � U� �U�� �✓D� C1--1 TOWN FOOD INSPECTOR -'HEALTH SEPTIC INSPECTOR - HEALTH PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED -ED-------'"j I. i F E B 2 1 2001 BUILDING DEPT R F ?0 -530 � 30 f AV j,1J6,ACmj"v �7s-Avii MORTGAGE INSPECTION PLAN.. 96 MARBLERIDGE ROAD NORTH ANDOVER , MASS. MIDDLESEX SURVEY INC. LAND SURVEYORS 131 PARK STREET NORTH READING, MA. 01864 SCALE: 1"- 70' DATE.• OCT. 30, 1999 CERTIFIED TO." WAKEFIELD CO-OPERATIVE BANK fw .1 229.12' �� •°''°K 0 �r- 1.45 acres N Q u00 fA . C14 I 3 I NOTE: WAY SHOWN ON PLAN NO. 1934 RIGHTS TO BE DETERMINED BY OTHERS. iM I i ` (2 2SN2) W. im NO.96 I � 3 ! 0 1 212.50' MARBLE.RIDGB RD �P�( H OF Oil O�yG A S N 0 m NOTES: H Y I. OFFSETS ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES. 2 2. LOT LINES ARE COMPILED INFORMATION. REGISTRY OF DEEDS ( ESSEX ) DEED BOOK 4266, PAGE 252 1 HEREBY CERTIFY BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF THAT THE STRUCTURES ON THIS PLAN ARE LOCATED ON THE GROUND APPROXIMATELY AS SHOWN AND CONFORMS WITH THE TOWN OF NORTH ANDOVER ZONING SETBACK REQUIREMENTS AT THE TIME OF CONSTRUCTION AND THE PARCEL IS NOT IN A FLOOD HAZARD AREA AS SHOWN ON F.E.M.A. MAP. COMMUNITY NO. 250098C ZONE: X EFFECTIVE DATE: 6/2/93 P10832 I _- �le ina�rvm4�uueal� o� •l'�tzoaa�./zt BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 056501 Birthdate: 06/15/1965 Expires: 06/15/2001 Tr. no: 1545 Restricted To: 00 BRYAN A LONG 536 NORTH AVE` WAKEFIELD, MA 01880 Administrator BOARD OF BUILDING REGULATIONS :w License: CONSTRUCTION SUPERVISOR Number: CS 056501 Birthdate: 06/15/1965 Expires: 06/15/2001 Tr. no: 1545 Restricted To: 00 BRYAN A LONG 536 NORTH AVE�`� .4 WAKEFIELD, MA 01880 Administrator DEBRIS_ DISPOSAL FORM The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print City 66 A I (A0 .- 77 Phone # F1. am a hompowner!performing all work myself. I am a sole proprietor and have no one working in any capacity F7 I am an employer providing workers'- compensation for my employees working on this job. Comoanv name: Address - - Citv: Phone #: Insurance Co. PoliCV # Comoany name: Address Citv: - - - Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section.25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of (5100.00) a day against me. I understand that a copy of this statement may.be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature l `— uaic I J "' "" Print name - _ Phone #3 Official use only do not write. in this area to be.completed by cibf or town official': City or Town Permit/Licensina Building Dept V ~i �• r: Ar���7r •' tags �is'�s�•.... •_e C TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS 77 NOTICE OF DECISION M_ .J Any appea! s'ha!I be filed W. in (^^) the r L. -Js T,Jotice in th 0- ice of the Town Clea. Date ...February .14, . 19.9.2 ...... Petition No... 005-92 Date of Hearing ... Fgbruary..11, .1.992 Petition of ..Jean.T..Gray .............................................................. Premises affected .100. Marblerzdge .Road....... . Referring to the above petition for a variation from the requirements of the . S e c t ion .7. , .... . Paragraph. .7...1 .and. 7..3, Table. .2 .of. the. .Zoning. Bylaw ................................ so as to permit .the. sub. -division .of . land .into. twa .lots... Lot JI. requires. a .side-. . line dimensional variance of 23.ft and area variance of 23,838 sq.ft. Lot #2 requires. a .sideline. dimensional .variance. of. 25 -ft..,. a .frontage .variance .0£.18.7 ft. and area variance of 47,742 sq. ft. After a public hearing given on the above date, the Board of Appeals voted to . GRANT ..... the variances ................................... and hereby authorize the Building Inspector to issue a permit to .. Jean. T.. Gray........ . for the construction of the above work, based upon the following conditions: The zone noted on the plan be changed from R-2 to R-1. Lo Signed Frank SefCh.,ice io, Jr., airman ........................................... Walter Soule, Clerk ....... John Pallone ......................................... Robert Ford ...................................... Louis Rissin ................................. Board of Appeals fir$-'•�"►.°' . TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Any ap,oea' wit"in hied („�• i.n .h� o +', ;lice Me 0-:,.'*'-' ri ice of the Town Clerk, Jean I. Gray * Petition #005-92 100 Marbleridge Road * DECISION North Andover, MA 01845 * ************************* The Board of Appeals held a public hearing on February 11, 1992 upon the application of Jean I. Gray requesting a variance from the requirement of Section 7, Paragraph 7.1 and 7.3, Table 2 of the Zoning Bylaw so as to permit the sub -division of land into two lots. Lot #1 requires a sideline dimensional variance of 23 feet and area variance of 23,838 sq. ft. Lot #2 requires a sideline dimensional variance of 25 feet, a frontage variance of 18.7 feet and area variance of 47,742 sq. ft. on the premises located at 100 Marbleridge Road. The following members were present and voting: Frank Serio, Jr., Chairman, Walter Soule, Clerk, John Pallone, Robert Ford and Louis Rissin. The hearings was advertised in -the Eagle Tribune on January 30 and February 5, 1992 and all abutters were notified by regular mail. . Upon a motion made by Mr. Pallone and seconded by Mr. Soule, a majority of the Board voted to GRANT the variances with a condition that the zone noted on the plan be changed from R-2 to R-1. The vote went as follows: for; Serio, Soule, Pallone and Ford, against; Rissin. The Board finds that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Dated this 14th day of February, 1992. BOARD OF APPEALS Frank Se io, Jr. Chairman C S- +; +.l Q —4 4- 4- O .F') p +3 4- Q 4— Q i• U N N 1, 4- C 1� N N 00 N N CO U') •4 U M eF r- N U C 00 1� -4 td 4- c+') f� d) L N �t O (C1 N C O +•; +•; .+ 4- 4- N LY C +� 4) Q CT 4- w E N +; N . f 4- (T) +•) (n fm N 00 4- 00 1l_ t\ O J 4•) N M LO LO C ^ r m Q N N (h C)l N N t0 M Z w U O C i - Q IL t0 A O T- 2 ea G!3 Q � N L 4- Q +3 +� LL. O O C +•; 4 - LL. C O 4- O O R! E +- N v CT Z N f- Q +; N d +� m 0) ..-I N 4- 4- 4- O O O U- u Q O O N In O 0) N O N cr) .- 1-I M O Q CCC O f� Z N 3 00 m c aJ 3 N _J E 1 O •+ A n m rJ a) v C7a to +-) (o ro +3 C >,4- +-) - >1 4 -- co to C N N C O TJ •-� v O 'O •--• N Q (n Q LA. N (n `i3 N 'L3 M t4 O a V a � v >1 Vv +v 41 > �4 o v o v vra a r o wKc a�rtsc Nr� �� 41 0 k 0 00 0 �-lmz a�z m m m m 0 m CO) co az O O d a� .p o p CL r.r� C o O CC CD a) CO2 d NU - CD O CD co 3, y CA 0 C� CD 0 CD p eyocr CA EL o � CD a y v memo m m A O H CC; .nc W Z ' " �'p. Vi � o O � � CUD o 1=0 y � ti + � � o Z�•n:r o0�:' C CA'= . Wim; X C ri cn m :� O off,. H Oo Imm N ;� �-• . ��•• H a m y c ccnn �- a V cn H ,2 0= 0 Cl �0 =r n Z � � a� cn Wr :• cn Hcn a tz m o �. o ? r : = CD Z a� CO) C? o GG = o .9 y 0 0 c O C� O :3O O .?� O CCE o b N O n Q d � y►� 7d � � C) y 0 0 c a -i < z C o o � o � (pCLA %4m M- zG 3 o O g a, ? a� L 3 y rn A N 0 N = (D fD (D Ci o p 1 dH-p m ? '.i �?1 3 K O• O� C M 0 (D 7 y 0_ c 0 -« O D O fD Q O k > Q D � n 0 d o �O . Culm �� a m 3' �C L .► CD O c '� c �� O • �m O N O b O (D p < _. = _M 2 E E CL 730 * 0 ro►ti N ID. ti C fD O O nlc= D S O r'. Ilu a (i " ^ "S F 0 ® m z a FL n m -� C ➢ n `� i O r« (D L 3� s' GSW *a� F4 M N �J ` O O n v O a . o z Z o z � O :E Petition of ..Jean 1 �.. Gray, TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION Any appea! shall be filed V as -e; the cu s "otice in th- Of ice of the Town Clerk. Date ...February -14,.199.2 ...... Petition No... 0-Q5 792 .............. Date of Hearing. - Yqbr;1ary.J1,. 1992 Premises affected .100. Marbleridge Road Referring to the above petition for a variation from the requirements of the Section I ...... Paragraph. .7...l.and. 7..3, Table. .2.of . the. .Zoning. Bylaw ................................ so,as to permit .the. sub -division of . land Into. two .lots... Lot .#I. requires. a..sidenr. - line dimensional variance of 23ft and area variance of 23,838 sq.ft. Lot #2 requires. a. -sideline. -dimensional .variance -of. 25. -ft.. .a -frontage, -variance- of .18.7 ft. and area variance of 47,742 sq. ft. After a public hearing given on the above date, the Board of Appeals voted to . GRANT ..... the yATiances .............. issue a .............. and hereby authorize the Building Inspector to . ...... permitto Jean . T Gray ....................... ...................... I ................ for the construction of the above work, based upon the following conditions: The zone noted on the plan be changed from R-2 to R-1. Signed Frank Se_i�ojr-) Chairman ........................................... Walter Soule, Clerk ............................................. John Pallone ....................................... Robert Ford ...................................... Louis Rissin .............................. Board of Appeals NOTES: \ L) H EY 1. OFFSETS ARE NOT TO BE USED TO' ESTABLISH PROPERTY LINES. s a 2. LOT LINES ARE COMPILED INFORMATION. , c�' REGISTRY OF DEEDS ( ESSEX ) DEED BOOK 4266, PAGE 252 �A� nr� I HEREBY CERTIFY BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF THAT THE STRUCTURES ON THIS PLAN ARE LOCATED ON THE GROUND APPROXIMATELY AS SHOWN AND CONFORMS WITH THE TOWN OF NORTH ANDOVER ZONING SETBACK REQUIREMENTS AT THE TIME OF CONSTRUCTION AND THE PARCEL IS NOT IN A FLOOD HAZARD AREA AS SHOWN ON F.E.M.A. MAP. COMMUNITY NO. 250098C ZONE: X EFFECTIVE DATE 6/2/93 P10832 .A \ { | . ■ $§ | | , s � . f 2 LU . � Lu k . zLi , | \ fL),3 3 > ` .,0a [' C3 ( | � z� |§e$ � LLI /\ uj uj �co 0 � | \j � | | | §` zE - k� LLI, =S I o § 0 , - £ LL§ _ o \ & ± . . m . . | . � !LI 0 z. . : / \ /} � \ \ § o \ § £ . _ { } _ � E Date ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........ .... . haspermission for gas installation � . .......... . in the buildings of .... :: ............................... ANorth Andover, Mass. Fee ... Lic. No..!!/..... '..'-. 7 ...... . GAS INSPECTOR/ Check # 3745 MASSACHUSETTS UNIFORM APPUCATON FOR PERNIlT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations ! Permit # 217 eO G)� Amount $ 057"�- 66 Owner's Name New ❑ Renovation Replacement ❑ Plans Submitted fD (Pript or type)��. / / C k o stal�in om Certificate pany Name /� C /7` Corp. Address ❑ Partner. & 0777 Business Telephone - F/ - 3, 5- Uyo ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked M, please indi to the type coverage by checking the appropriate box. 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. of Owner or Owner's Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State gas Code and Vhapter ,4bf the Geppral La,,ws. (OFFICE USE ONLY) Q Gas Fitter Master ❑ Journeyman Or • • (Pript or type)��. / / C k o stal�in om Certificate pany Name /� C /7` Corp. Address ❑ Partner. & 0777 Business Telephone - F/ - 3, 5- Uyo ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked M, please indi to the type coverage by checking the appropriate box. 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. of Owner or Owner's Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State gas Code and Vhapter ,4bf the Geppral La,,ws. (OFFICE USE ONLY) Q Gas Fitter Master ❑ Journeyman Or Date. No 4i50 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING L This certifies that /t ... .'.......... rl... '''.".................... . 1 ` has permission to perform .......................... ............... . J -.01umbing in the buildings of,-.;`'�.... . ................... . at .:� .... z. .. .. .... . ... . , North A'nd'over, ...... � .... �.)��Mass. Fee /.?/ ..... Lic. No.......... . �. / .......- ...... . •7 PLUMBING INSPECTp Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS b Building Location / � / CAMwners Name Type of Occupancy Date Permit # J Amount New Renovation Replacement Plans Submitted Yes No ►' 1 • (Print or type) Check oae Ce 'ficate Installing Company Name ACorp. Address / Partner. Business Telephone _ _ / 3 Firm/Co. Name of Licensed Plumber Insurance Coverage: Indicate of insurance coverage by checking the appropriate box: Liability insurance policyIT Other type of indemnity R Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above 14fthree insurance Signature Owner r-1Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ins llations performed der Perm19asued for this application will be in compliance with all pertinent provisions of the Mass setts Stip ode a C pter 142 of the General Laws. By nse -/ Title Typefaff Bing Li City/Town icense i um er APPROVED (OFFICE USE ONLY Lice Master Journeyman ❑ C, Nt 2 3344 Date .... 2 '511 ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... 12T ................................................................... has permission to perform .... ................................................. wiring in the building of ........ ............ I .............................................. at ............. r ..... .......................... . North Andover, Mass. Fee��' ............... Lic. No . ............. ................. (,.;-4 . . ................................. . . ....... ... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts - - — Department of Fire Services 9. BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. c 33 7 `z Occupancy and Fee Checked - [Rev.11/99J cave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (IvIEC 527 CMR 1200 (PLEASE PRINT ININK OR T*YPf ALL INFORMATIO?t Date: q " -7-01 City or Town of. I� Q • Antic ver. To the Inspector o Wires: B this application the undersi f By pp gt�d groes no ce of i}rs r her intention to pe�po the work described below. Location (Street &Amber) G� Q r b le. rl � e (ti� ad Owner or Tenant Owner's Address Telephone Na (- Is this permit in conjunction with a building permit' Yes ❑ No [N (Check Appropriate Bos) Purpose of Building Utility Authorization Na Existing Service Amps I Volts Overhead ❑ Undgrd ❑ Na of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ Na of Meters Number of Feeders and Ampacity 'M Location and Nature of Proposed Electrical Work ar► (1 ��»,»tee„» ,.r.r... r n_.___ •-Lr- -- �----_- -� L -1 , No. of Recessed Fixtures INo. of Cet1-Susp. (Paddle) Fans No�ofMum"UVLneluvecl rof rrtres. Transformers KVA No. of Lighting Outlets INo. of Hot Tubs Generators KVA No. of Lighting Fixtures ISwimmingPoot Above ❑ in- ❑ rnd. grnd. o. o mergcncy t;nung Battery Units No. of Receptacle Outlets INo. of OR Burners FIRE ALARMS No. of Zones No. of Switches INo. of Gas Burners No. of Detection and Initiating Dcvices No. of Ranges . . Total Tons No. of Alerting Devices b No. of Waste Disposers Vicat Pump Totals I Number Tons IKW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/ArmHcating P , KW Municipal Local ❑ Connection Other No. of Dryers Heating AppliancesK-W ecurity Systems: No.of Devices or Eauivalentiq No. o atero. Heaters ICiW o No. o Sims Ballasts Da t of Devices or Equivalent No. Hydromassage Bathtubs No. of iviotots Total HP Telecommunications Wiring: Na of Devices or Equivalent OTHER Artacii additional detail if desired, or as required by the Inspector of Ifires. 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 bas aehtbited proof of same to the permit issuing office. CHECK orris: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (.� Estimated Value of Electrical Work 5-957 J C (When required by municipal policy.) (Expiration Date) Work to Start " "1- Q I Inspections to be requested in accordance with MEC Rule 10, and upon completion. Ica*, under the pains and penalties of perjury, that the information on this application is trite and complete: FIRM NAME: ADT Security Services _ Dt; •• 0.1 ] is NA 03049 LIC. NO.: 1533C Licensee: John S. Bassett Signatu C .• (Ifapplicable, enter "exempt"indre license numberlsN01533C iea Bus. Tel No.. -503 O.:15 594-5900 Address: Alt. TeL No.:_603 594-5928 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. Owncr/Agent Signature Telephone No. PERMIT FEE: S3,s • (�� Y'YA so <u CE I IFY THAT T"S LOT tS NOT 94 THE FA A LQOO HA7ARO Zct4e, THIS CERT&FICA71ON IS• BASED N-l"E SURVEY MARKERS OF OTHERS, At4() IS NOT PROPERTY SURVEY, FOR MORTGAGE PURPOSES ONLY. :l,CERTiPY THAT 7HF- BU(LDhc..S ARE LOCATED AS SHOWN, 1; ND THAT THEY CC)WORWO TO 0 THF- 20"G BY-LAWS ;OF THE CITY/TOWN OFlJr e A 4,07.1 .')iEN CONS7RUCTI!D. r v 41 1SCALE F P IEFD BOOK 4Zqo PAGE 5o I 3, 2, C� 2. 5 a F: 7' ;ASSESSOR MAP Lb C K CER71FIED PLOT PLAN OF LAND IN AS DRAWN FCR \j V R.A.M. 16 0 M A�JNN G, NEERING STREE 7 l s0 —S_jlINT, 0 AA 161 FLOOR >14 Loan >1118 FLOOn 4THPtoo" i STH LOOK aTN ►OOIt ?TK LOOK IYN LOON Instaning Company Business telephone Name Of Ukensed P INIIJRANCE: COVE I have acurrent Ilabi It you have checked A Ctabllty Ing ursnce OWNER'S INSURA Ater 142 of the, •"�•,••'+�� yr owner or Q 1 hereby terllty that aU of � e and that al! ppII Prorhlona of ih� Tt� AI"KK-D torr'= usE Scott LaF l eur15086894861 02 J P.03 ����Permit , Owner'a ` Name Replacement ® Plan= Submltled; Taj No Renovation 0 sme l • • i .. � Check one: r l��'n 1�d l l.� f . e ate . { Corp. ' } d Partnership f O Firm/Co. nber or Gas Fitter Insurance policy or Is aubelentlqal a uhndent. Check one i s, please Indicate the Yea IJ No p type coverage by checking the APProPrlele box icy Other type of Indernnny (❑ ; . Bond D E: WAIVER; I am aware that the licenee�!RV{ s. General Lewa,•and that my aiflnalure on this Perm#. the Insurance covers I tie ta**W = . it appl cellon nraNe• this regylranient.'y •� ,�' a °nt Owner 0 Check one: Agent 0 } lingdetails and Idformalall f hens submitted for entered) In above application are ? Isla work and ate Oatlonsperfotmsd under the�e MR t�sued for this issashusetta Slate t3a� God Irue end accurate b Mtn Mit of my ' =send Chapter 142 of 1t�a p °PPgcallon +eltl i» kt oorrtp".e wiN aN �-- T of Ueense: Plumber ---- Qaeltlter ane e o nes um e4arsZo Master _., VOpn Jnumsyrnan � .Yl S. f 0 hK tl J e/A W ~ tl V MF'x ! < IC O • tl« M F- t .t y K ry 0 0 O 0� F• p t.. K er M W ,� N t QA; ; X, r > A {r�:it M i3 q w L F` Y s 0 a a aAi -101y sme l • • i .. � Check one: r l��'n 1�d l l.� f . e ate . { Corp. ' } d Partnership f O Firm/Co. nber or Gas Fitter Insurance policy or Is aubelentlqal a uhndent. Check one i s, please Indicate the Yea IJ No p type coverage by checking the APProPrlele box icy Other type of Indernnny (❑ ; . Bond D E: WAIVER; I am aware that the licenee�!RV{ s. General Lewa,•and that my aiflnalure on this Perm#. the Insurance covers I tie ta**W = . it appl cellon nraNe• this regylranient.'y •� ,�' a °nt Owner 0 Check one: Agent 0 } lingdetails and Idformalall f hens submitted for entered) In above application are ? Isla work and ate Oatlonsperfotmsd under the�e MR t�sued for this issashusetta Slate t3a� God Irue end accurate b Mtn Mit of my ' =send Chapter 142 of 1t�a p °PPgcallon +eltl i» kt oorrtp".e wiN aN �-- T of Ueense: Plumber ---- Qaeltlter ane e o nes um e4arsZo Master _., VOpn Jnumsyrnan � .Yl S. f .» Date. W-.- �r...... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 4 /8 1�/�'e!GG UC 5c GLi. This certifies that . . f • has permission for gas installation ..13�. � � . • • • • in the buildings of ........................ . at �'� . lf�:�1 � P • •%?•r cry. �........ North Andover, Mads. CM CM Lic. No..212i. . ....................... .. GAS INSPECTOR 0 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 11 N2 3 2'L 9 Date../..-. - tkORTN .6 TOWN OF NORTH ANDOVER 0- 0 PERMIT FOR WIRING ,SSo 4cmus This certifies that ... ......................................................................................... h,wrpermissionto/perform wiring in the building of ..... /1 at ....................................... .. ............................. . North Andover, Mass. Fee. /Y,Z/ ..... . ..... Lic. No/ ............. ..I-; ..... ............. ELECTRICAL MpEcm Check # o i4z5— WHITE: Applicant CANARY: Building Dept. PINK: Treasurer DEPARTMENTOFPUBLICS MY BOARD OFFIREPREVEN770NRE9)L47101 N527C UR 12.00 Permit No. o Occupancy & Fees Checked—/ -7 PPUCATTONFOR PERMIT TO PWORMELEClRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 -r (PLEASE PRINT IN INK OR TYPE ALL INFORM LION) Date 4 S /Y D I Town of North Andover The undersigned applies for a permit to perform the electrical ork describgd below. v(CJ Location (Street & Number)\ G lC F j2 Owner or Tenant 6 d �-/ o.n L o /,x_R Owner's Address 5t.-1 I- Is Is this permit in conjunction with a building permit: i Purpose of Building S , ,,sf l e R-4 i1 Existing Service 1 6 D New Service a00 Amps 1 Z/ a UDVolts AmpsUO 4 /olts Yes M No Overhead Overhead M To the Inspector of Wires: (Check Appropriate Box) -- UtilityNo. Underground No. of Meters j Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Ce p., Dv,, -h-- /,Y7A�A ro 6 5e + LI/ AV Nni of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones .....� No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total- Pum s Tons KW Initiating Devices No.. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Oth,7r � No. of Dryers Heating Devices KW Connections _ No. of Water Heaters KW No. of No. of Signs Bailasis No.. ydro Massage Tubs No. of Motors Total HP OTHER hstrdnoeC:o Haarantbmeregimana>�aRlvl�aau�Lia�aa[Laws Iha%eaamotLmbtkyhst m=Pbhymdx&gCanpi& Comecrzaksw ate*mdat YES r7l NO ED Iha%eahnnedvabdpafofSnebthe0ffmYES U NO ff}cuhaeedxckedYEpimmdclethetypeofwArwbydWaigthe U dG I Estir i*dVakiectl3eeftW WWak $ U D WotkiDSwt J hpecIotiD*RgzWd Rao Fad FIRMNAME Licerr9ee I C,J( .. e �. K n n SS- -47 traw` Lj=wis o �� 3 3 L4a I mumTel.Na - 6 777 OWMR'SMJRANCEWAIVER;Iatnawmethatthelxwmdmnib r� andthatmysgnattasmftpemitWplieMmva'N sthiste*mattat (Please check one) Owner Q Agent A 0 1��� AILTdNa �eil>StTractoet��eorRsstllecgrivdktrtast�¢adbyM�ds�GertaalLaws F Telephone No. PERMIT FEE - TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING •: '.` � ,:shT J'!' �:.. 3 S� ��'���T« "� `k 1_��� .a ��F �Y Y'ai '. � k .E .. �yga�j,,.,: �1. BUILDING PERMIT NUMBER: p DATE ISSUED: �7 a /, r S SIGNATURE: �/V/* Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: P 1.2 Assessors Map and Parcel Number: (o -d 3 39no Am 0 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (OD �, S Zon Pr os + Lot Area Frontage ft 1.6 BUILDING SETBAC ft Front Yard Side Yard Rear Yard Required o ide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. § 5 LL 71.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ZB?7 I'rD) A, l_C) lV is r/ Gt(G 1 Vl ✓ dqe Name (,P{it11 `� Address for Service Signature Telephone I /������1�Cn 2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 10 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ✓�Q,;�v�txre, a � �iasie� � I e� 6n �.� u w� ,�oaw, � d-► v� � v.�, vr�c5-�•tf, wrc.� is G �dGV �Q.w 1►�1�u1� ivv� Ince, t.vti w .1 Lw SECTION 6 - ESTIMATED CONSTRUCTION COSTS' Item Estimated Cost (Dollar) to be Completed by Ennit a licant CIAL USE O i �f I . Building (a) Building Permit Fee Multi lier 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+55 i Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My be f, m all r tatters r la ive to work thorized by this building permit application. `/ ��� 4--- ---Si tature of Owner Date Signature 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/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3RD SPAN DRAENSIONS OF SILLS DMIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Cl) m m m V! 0 CA 10 CD a Z CD CLW d nco -0 O 0Ic v a� ., r CD O .- :. CA .O CD 0 H 10 03 d O CA O CO) -1 d C) CD O �M CD CD a vi , CD H 0 CD 0 CD O -• N O CS H _G O O 1 y O �m m n O N A d 0 m Z ?Io CO _•1 O „O• to Q3 m H T S m CLCL �d ' y CD -40 O N O -i N ohm? m 2 o 9 0 D o n O co .O•.. G O ..� Oi CD CC,=r O O C ? =a iH CL m 0 ? v' mow V ^ CD 1 C•'%� J2 CD m CO) O D1 CA EL Lr cr N CCD?� m D O \11�11J�, f0 ?ca s CD Di CA CD o z Jy� D o CD o n cn P 9 Ar n Im H 4 ? d WR ncm s? C CD d C o W d 'z O G) (O y J Oy r O g w z (nCn C/' 'rf O 7C m 7 d o V 1 iI` O C �t. Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print} DATE 513D (© U JOB LOCATION q(0 f' I &VVjV—r-) CttC- •luil r) o ftyl yl daw-� Number Street Address Map / lot "HOMEOWNER Home Phone Work Phone PRESENT MAILING ADDRESS �ylC a a•LZ V6 „ City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE r "` APPROVAL OF BUILDING OFFICIAL Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM Of �10RTH q O �t_Ito 16x tiO 0 TO Q_ CO[KKMIWKM 1' In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: VVA Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. C/) m m m m C/) 0 C y C � 'v O CD C2 z CO) CD =� r � SU o d= CO) O C-) v CD CDCL o .r �< d CD CD o CD C eD yCD� d O y C I � v yO -oCD z o � CD 3 0 CD C 0 0 Z o, CD O 2. �. d N y C Q Rco tTj z CAC2 d C1 O y d O1.0 CO) CL CL 0 m C) � O H O 0 CD r M ^o -0O !�9 C d =r H a CL I a y ICD CCD CDCA W, Q NWN 1 y C! m T Mn CA z Q J�-Jtjs ° rb tTj z O y 7d aac C) � � � , � � � g � r M ^o n x x C) O o J�-Jtjs GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain - pipe/stone/fabric filter/cover and outlet connection. FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters - watch bearing at walls. Ridge & Hip - Provide proper connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. Sill plates 2-2X6 (1 PT) w/sill seal. Girls - solid brick or steel plate bearing at foundations " air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36 " high, Baluster max space 6" on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re -inspection fee - $25.00 (Be Ready). Certificate of occupancy required prior to occupying structure. ER � H P 64 T N It 7 toot 90 414 ° Z 3 C c N� t c rn m lk�al 04 Ln D C 3 ai a ° `l Ln` aj z 0 E-0�`, a� c ? �� m O L"*, U- �' E nqj V V m b m Q F4 °gig a a`i a u h t�p�7 m�V� 0 Q ° Z 3 C c N� t c rn m lk�al 04 Ln D C 3 ai a ° `l Ln` aj z 0 E-0�`, a� c ? �� m O L"*, U- �' E nqj V V m b m Q F4 °gig � a`i a u h t�p�7 m�V� NORT►q 3rOe � �.0 4� gyapL 41 t � # w^ • �SS4CRV`��S CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number /02 Date 6 - 6 --a OAR, pTHIS CERTIFIESTHAT THE BUILDING LOCATED ON / (0 _ 9 I `i A2h l /e - )C ! of q r,. kt GC. MAY BE OCCUPIED AS/Nfr---FAA1Avj .4- /,s IN ACCORDANCE WITH THE PR SIGNS OF MASSA CHUSE S STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. l.3 R" M 3 3 :L Q-41-4 S CERTIFICATE ISSUED TO '3I'% d A -P 40V Building Inspector I IIN C/) m DO C/) Cl) m H CDO 0 Z H C -* d ._► O o ? o CL Co s rF Q ` "C - CD CDo CD C CD y �. CD CZ ® y —• o cc CD I a CA O 1 CD A CCD O CCD I 9= O O Vi O ; VS no fie® ca =U2 a mom mnm Z e O ?� N —4 0. * = w m ? ® ca O O O � ® n C a _ ®CL, is O s cl c�� U2 c a /�,, m� lb ca Fa ads ti O ` i0 Go N � � m y O m '0XV no 1c CD O CD0 :• Z I do Rte. own co: � C cn 07 ca r.o o �S. tpi A �� Ray+ w '�-`.o �. S O• w C�" vR o � R 'T 1� 1 • •� ,n�••Rj z � e io .l v GlobeSpec 09:41AM October 09 2003 Photo Attachments HS -9 S-2 DECAYED SILL SUSPECTED MOLD 11 Schiavoni Photos.alb Page 9 of 11 Palm -Tech Picture Album, Copyright 1998-2001, PDmB, Inc. ",-