HomeMy WebLinkAboutMiscellaneous - 975 FOREST STREET 4/30/2018 (4)f THECOMMONWEALTHOFMASSACHUSEM Office Use only DEPARTAI VTOFPUBLICSAFElY Permit No. _ 7 BOARDOFFMPREVE MONREGUTATIONSS27CMRI2 00 Occupancy & Fees Checked APPLICATTONFOR PERMlT TO PERFORMELECTRICAL WORK. ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (r%EASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electric 1 work described below. Location Street &Number Owner or Tenant Owner's Address Is this permit in conjunction with a building permit:. Yes o No (Check Appropriate Box) Purpose of Building Existing Service AmpsVolts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Overhead Overhead M Utility Authorization No. Underground Underground No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Dei Total Esti TWdVahleof)~1whicalWotk$ V5Q0 .hlsp"onD&RagtxshA Rough Final KVA No. of Lighting Fixtures Swimming Pool Above Iio=No.rd Below Signattlle -_= �� Generators KVA BuskmTU No. round ground El iC:EWAM34IamawarethattheUoafedoesnotbaretheinmrecavaageoritsalbbtanialegrivalentasIagunedbyMassactxt Ckn�Laws dlis pem>it applica6m Waives No. of Receptacle Outlets No. of Oil Burners Owner Agent Telephone No. of Emergency Lighting Battery Units No. of Switch Outlets PERMIT FEE $� No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and of Disposals No. of Heat Total Total j Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Ol Connections No. of Water Heaters KW No. of No. of ro _ Signs Bailasis ro Massage Tubs No. of Motors Total HP RMWtDftWWiCn1als0fN1%Sad s0llsLaws eyhls"=PbhCyinchx MCW-0* ' Coverageori1S& ft1&legtlivalent YES NO 1ptoofoffIletotheoffice. YES I V1 riGp ffy mbavedrekedYB pleaseirl*thetArofw&rWby hattaeon lk one) BOND GIBER (Please Sp *) Dei Esti TWdVahleof)~1whicalWotk$ V5Q0 .hlsp"onD&RagtxshA Rough Final �-- Iio=No.rd Signattlle -_= �� L=wNo , BuskmTU No. Alt, TelND. iC:EWAM34IamawarethattheUoafedoesnotbaretheinmrecavaageoritsalbbtanialegrivalentasIagunedbyMassactxt Ckn�Laws dlis pem>it applica6m Waives this Wgtmemat Owner Agent Telephone O� No. PERMIT FEE $� Date... 7~ �'r.`...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....{•• .P..P.�........ It' / "" , ..................................................... has permission to perform .... ..... .......... ° ....`...`............................................ wiring in the building of ......................v b t� /s ............................................................. S''S ....... , ,,at ................. �.................................................. North Andover, Mass. Q 1 G 1 �S'r 3` ...... Lic. No. J —, Co h:/EC�TOR �j;1.; r [. dee ............. ....................................................................... ELECTRICAL INS Check # 2 Z THECOMMONNEALTHOFNIASSACHUSETTS Office Use only DEPARTAIEWOFPUBLIMFE7Y Permit No. BOARDOFFMPREVEMONREGUTATIONS527CMRI2:A9 Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electric�ork described below. Location (Street & Number) 91�75 Owner or Tenant 1 Owner's Address Is this permit in conjunction with a building permit: Yes m No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps / Volts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 56,77777777�,- No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round D 2round 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 _ Othe No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• )namar>avCovelage. PleatarYtDtheregmanailsofMa��SC�ata-flLaws Iha�eaa>Qagliabtlityhm>ru�ePbficyinchxlu�gComple� Co�aagzoritsaYialequivalai YES NO IhawmhrdWdvafidptoofof tothe011ice, YES �`� ifyuuhawd ededYES,pleMh dir thetypeofoDVaageby cltaddngdr Ae �+ INSURANCE BOND dIHER (P9ea9eSpecity) WodctoShalt SignedundaT FIRMNAME Expiration D& Esfim&dValueofElechicalWc&$ 1,5QO .hq)x imD&ReWesmd Rough Fugal I.icfflsee Signahue OWNER'v tN cl EMELF-11-72ins Tel No. Nw\Z� (, -I--/ I' 2, -ate AVER;IamawatethattheLioffwdoesmthawd-rirmuatxecov$ageoritssubstatMequival=ascetA WbyMasmdaasctsCkmalLaws and thatmy9glahueonthispelmitapplicarionwaivesthis Mqui errl i (Please check one) Owner M Agent Signature ot Uwner or Agent Telephone No. PERMIT FEE $ c Location �JS ��i•'C'.f T S�z l ,r art • ,� Na iia Date Check # s r. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ �� %h�• Ul> TOTAL $ Buirding Inspector 345 OU M Z O p\ m \l O Z M 90 O on ic r v M r r Z G) TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING M& Secdat for official Use Qql BUILDING PERMIT NUMBER: q1 0� DATE ISSUED: 07 Q SIGNATURE: Building Com—trifssioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 975 Forest Street 105—D 74 North Andover, MA Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R-1 93854 SF 156.3 LF Zoning District Proposed Use Lot Areasf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re wired Provided 30 400 30 54 30 139 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System X SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Dana and Len Dubois 975 Forest Street North Andover OB Name (Print) Address for Service: ignature Telephone `z.2 Owner of Record: I Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ./Joseph McKeown Construction Supervisor: CS 050374 License Number .0. Box 290666 Charlestown, MA 02129 (cen�ed e bii-gZ3. 10/09/04 617.242.7300 Expiration Date g a r Telephone 3.2 k4stered Home Improvement Contractor Not Applicable ❑ Starboard Builders and Homeworks 134677 C any Name Registration Number Box 290666 Charlactown, MA 92129 01/02/06 Adr 64,,.543.7 �C- 617.242.7300 Expiration Date Si na Telephone 345 OU M Z O p\ m \l O Z M 90 O on ic r v M r r Z G) I 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 ..... X1 No ....... ❑ SECTION 5 Description of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s)\ \ ❑\ Addition X JOX Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Remove existing Screened Porch and Stairs to Grade. Construct New Three -Season Room (unheated) with Landing and Stairs to Grade at Same bora inn. /a' jai +�- I SECTION 6 - F,STIMATED CONSTRITCTION COSTS I Item Estimated Cost (Dollar) to be Completed bpermit applicant OMCUL USE ONLY 1. Building 32015.00 (a) Building Permit Fee Multi lier 2 Electrical 2000.00 (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 340475.00 Check Number 'ION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN PERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Dana Dubois as Owner/Authorized Agent of subject property authorize Joseph McKeown and starboard Builders to act on t alf, in I mattgrs relative to work authorized by this building permit application. 20 January 04 , Date I SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I 1, Abseph McKeown as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge Owner/. Date 01/20/04 N. Of STORIES SIZE 25'0" X 12'0" BA :NT OR SLAB S1_/E OF FLOOR TINMERS IS7 2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS ItEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND Solid IS BUILDING CONNECTED TO NATURAL GAS LINE N o L Ar FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ****************"*****� *APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT J. McKeown for L&D Dubois —_ LOCATION: Assessor's Map Number 105=D PHONE -617. 242. 7300 — 0 PARCEL—7 4 — t 7i 3 - SCO SUBDIVISION _ LOT (S) STREET_ Forest Street —__— ST. NUMBER975 ** ********************************OFFICIAL USE ONLY********************** ******* RECOMMENDATIONS 0IF71OWN AGENTS: CONSERVATION ADMIN TOR DATE APPROVED DATE REJECTED COMMENTS I,'� e �ccrr��1�= MA eG�Y------------ - TOWN PLANNER DATE APPROVED DATE REJECTED___________—__—__ COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED TH DATE APPROVED DATE REJECTED_ COMMENTS _ oa°���3 _ z z�, ss_i� _�cl�tf-- 2t- S PUBLIC WORKS - SEWER/WATER CONNEC DRIVEWAY PERMIT FIRE DEPARTMENT. RECEIVED BY BUILDING INSPECTOR__—DATE---_ Revised 9197 jm , *co -ne I 0 n - \\� q 0 3 w m 2 0 2 = § m C) q z' m � ;a0 \..k=...MCo m \ 2 M ■ § ■ <.< 0 X E c) � 2 ƒ /k& § e '22 zg �140� ƒ 2 2 %r \ ƒ 0 I . I 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: Barry 'soothers Dispotal Co pang (dumpster) (L ca 'on of Facil' v) Signature of Permit Applicant 0 Janmary 04 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ACO -,. CERTIFICATE OF LIABILITY INSURANCE i3/17/2004 FDATE(MM/DDffYYY) 3/1 PRODUCER (781) 326-9900 Doren Insurance Agency 30 Eastbrook Road Suite 103 Dedham, Ma 02026 - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Starboard P D D G DBA Archi-Struct PO BOX 290666 2 Thompson St Charlestown MA 02129— INSURER A: ZURICH INSURANCE CO INSURERB: INSURER C: INSURER D: 1 INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FlOCCUR PAS43110510 03/03/2004 03/03/2005 DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ MED EXP (Anyone person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY 7 JECT 7 LOC AUTOMOBILE LIABILITY ANY AUTO / / / / COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS / / / / BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS / / / / BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ AGGREGATE $ OCCUR F1 CLAIMS MADE DEDUCTIBLE / / / / $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC431041182 00 03/04/2004 03/04/2005 X WCSTATU- OTH- TORY LIMITS ER _ E.L. EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 100,000 SPECIAL PROVISIONS below OTHER PROP PAS43110510 03/03/2004 03/03/2005 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CAWCFI I ATInAI ACORD 25 (2001/08) — („-,/ © ACORD CORPORATION 1988 qTn, INS025 (0108).05 ELECTRONIC LASER FORMS, INC. - (800)327-0545 Page 1 of 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Dana & Len Dubois FAILURE TO DO SO SHALL IMPOSE NO 0AT NOR LIABILITY OF ANY KIND UPON THE 975 Forest St INSURER, ITS AGENTS OR REPRESENTATIVE . 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