HomeMy WebLinkAboutMiscellaneous - 27-29 Gilbert4.11;
A
Location C��, k-p—�
No. -,—/SO Date
14ORTOI TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ o
-S CHUS
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check #
17 S, 6 4
'e�
4Buji6inag fInspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT K!Mj RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Aw low -
Air a!
BUELDING PERMIT NUMBER: /7 , 150 rDA5LT1E ISSUED:
SIGNATURE:
Building CommissionEj&ESLor of Eru-ildings Date
aM_ I IV14 I- a]LJL r, In r%JKMA I AM
. 1. 1 Property Address:
z f, -4 -
1.2 A-nessors
Map Number
Map and Parcel Number
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
FA-A—rm (sf) Frontage (11)
1.6 BURDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
ReqWred Pmvi& ReqWrW Provi&d
ReqWred Pmi&d
k54)
1.7 Water Supply M.G.LC.40. 1.5. Flood Zone Infonnation:
Public 0 . private 0 zone Outside Flood Zone 0
1.11 SawerageDisposalSystm
mu", 0 OnSiteDkposal System D
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
121i��tricf:
2.1 Owner of Record I
R'0V5JAJj A',,4A.A4�( ON
Name(Print) Address tbr Service
Signature Telephone
2.2 Owner of Record:
Nfve Print Address for Service:
Signature Telephone
SEC71ON 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
/'s 'A .3
Licensed Construction Supervisor:
-7 S L:75!jAc WA-( f4 u �,s-zN
Address
TIP0 17,15 7(Lij
Sign 7 re Telephone
Not Applicable 0
07 <50, (-Y
License Number
Expiratio� Date
3.2 k1gistered Home Improvement Contractor
Not Applicable o
Company Name
Registration Number
Address
Expiration Date
Signature—. Telephone
T
M
SECTION 4 - WORKERS COMPENSATION (rvLG.L C 152 § 2506) 1
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.
Siltned affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Description o Proposed Work (cl�wck
appkable)
New Construction 0
Existing Building 0
Repair(s) 0
Alterations(s) 0 T�
0
Accessory Bldg. 11
Demolition 0
Other 0 Specify 4'�
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by pennit applicant
OMCIAL USE ONLY
I . Building (a -3 4:z
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plurnbing
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
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature ot'Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are Lrue and accurate, to the best of my knowledge
and belief
Fr—intNai�e—
Si ature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TRVlBERS I Fir 24D 3RD
SPAN
DINMNSIONS OF SULS
DIMENSIONS OF POSTS
DItylENSIONS OF GII�DERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERLAL OF CHRANEY
IS BUILDING ON SOLD) OR FILLED LAND
IS BUILDING CONNECTED TO NATU11AL GAS LJNE
DIN
:T'ON SUPERVISOR
175914
Tr. no: 5004.0
BRIANM DIAS
V
7 SIR SAA x
I
NOS
ON, 03
Co"'Missioner
00.35,000
Cf enclosW Space
(MGLC-112S-G0L)
1A - masonryb,ty
I G - I & 2 Family Homes
Failure to possess a current edition Of the
Massachusetts State a .
Is cause for reocation u"d'ng Code
of this license.
2
DIG SAj:g CALL CEN
T64: (888) 344-7233
Jan 13 2065 9:33AM MEADOWS COMSTRUCTION 9784991700 P.2
—C4
Commonwealth of Massachusetts
DEPARTMENT OF HOUSING &
COMMUNITY DEVELOPMENT
Min Romney, Governor * Kerry Healey, IA. Governor * Jane Wallis Gumble, Director
December 9, 2004
Mr. Michael Meadows
Meadows Construction Co. Inc.
166 Middle Road
Byfield, MA 0 1922
RE: Low -Hid AoDroval - North Andover Housing Authorft-v
Operating Reserve Prqject� D14CD FISH # 196021
Developments Involved: 1962001
Atchitect/Engineer: DHCD
Scope of Work. 200-1 roof replacement
Dear Mr. Meadows;:
Pending receipt of the Housing Authority Board vote, your company will be awarded the abovo-captioned contract
in the amount of S25,392.00 As the fimding and approving agency, we have required documents which you, as
the General Contractor, must prepare. Once these documents are prepared and fully executed, please present
them to the Housing Authority fbr execution. 17hey w ill then submit these documents to DHCD for final review
and approval. Your company most complete the enclosed contract documents and present them to the
housing authority wfthin ten (10) days of receipt.
In order to assist, you in the preparation of these documents, we have enclosed a checklist outlining the required
documentation, along with. the enclosed fbrms for your use. If you have any questions regarding thew
requirements, please contact Linda Larnont, Project Manager, at (617) 573-1176.
Sincerely,
.54441 A44� d iot
Stan Kruszewski, Director
Project Development Unit
Enclosures
100 Cambridge Street, Suite 300 bttp://www.sbft.ma.tWdhcd
BosWn, MmacbumM 02114 617.573.1100
I
Jah 13 2005 St25AM MEADOUS CONSTRUCTION 9784991700 p.3
,12/2912004 15:38 FAX 19786322217 B K MCCARTRY e 002/003
ACO CERTIFICATE OF LIABILITY
INSURANCE
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THIS CERTIF"TE 15 IMMIED AS A MATTER OF WORMATION
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SHOULD ANY OF Im AIM 01111CIIIIIIIII0, POLICIES In CA"CeLLED m0cm Two
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wswm CLECTRONCLASEN PON&. INC -101101327415
Pa"19ft
The Commonwealth of Massachusetts
Department of Indushial Accidents
Ofte of Invesdgadons
Boston, Mass. 02111 ,
WOrkers'COMPensaUm Insumnce Affldavit
Narm Please Print
Name: 4,
Location: 3 31 2 C',
I
-1 - - IJW bDv-e-� -
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
1 78
. 9 t IF, S -7/
I arn, , an employer providng workers! compensation for my employees vmrldng on this job.
comoafly r-mme:- MeAbpw-s .-CO"jy U C-� 0 11)
Address Le M, b ts L L --/Z..)
city* C-4 P14 Phone 9 -1 �9 G 7
--� I - -
,�r,v 5. 6,
CompaMf oln:
Ck. Phone
"15 35Z Li:3-3 - v
Failure to secure coverage as required under Sedan 25A or MGL 152 can lead to #a Wiposition of "hind panattift
d.a fine up to $1,5w.w
anWor one yon'lmpriawwraffl.o.wW.n-dvlpnomin be in= dA STOP V.VDW.oR0Ep_apd.8 NO Of ($IaD.GD)-aj* agabW.M& I
understand that a copy of this statement may be forwarded to the office of Investigationg d ft DjA for coverage verification.
I do herWw cortly under Me pairs and penalfieqaf pediny that the infwmeffm provjded above is &W rid
& coned.
Print
4 A)
IIJ7
k -27-99S 7,(C(�
01ficial use only do not write In this am
to be Canpleted by city or town dftw*
City or Tom P
0 Builbft Dept
[]Check if immediate msponse /a requked [3 LkefWng Board
Contact perso Phone C] Selectmen's Office
0 Heafth Department
0 Other
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposei-o—f in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
The debris will be disposed of in:
(Lo�ation of Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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Location c2f- @ 3
No. Date
TOWN OF NORTH ANDOVER
61
Certificate Occupancy
of $
CH
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
0182f
Check #
W4�
17567 ///w
Building Inspector
1.1 Property Address;
-Z-3
1.2 Assessors Map and Pared
Map Number
Number-
Pared Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (sf)
Frontage (it)
1.6 BIJUDING SETBACKS (ft)
Ront Yud
Side Yard
Ror Yard
ReqWmd PMvide Regaind
Provi&d
RegWred
Pmi&d
1.7 Water SWly NMI -C.40. 34) 1.5.
Public 0 Private 0 zom
Flood Zone Infounation:
Outaide Flood Zow 0
1.8
Monicipal
Saw-pl)*—ISystem
0 OnSiteDisposal System 0
SECTION 2 - PROPERTY OWNERSBUIP/AUTHORIZED AGENT
2.1 Owner of Record
NOVS;;0:7 Mnre S, I �A eAlo W5.
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
'A
N�me Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUC77ON SERVICES
3.1 Licensed Construction Supervisor: Not Applicable 0
Licensed Construction Supervisor:
Number
-5-44c P4::x S at,� "A)H,
Address cT
Expiration Di
Signature Telephone
3.2 Regii.1.1red Home Improvement Contractor Not Applicable 0
Company Name I
Registration Number
Address
Expiration Date
Signature Telephone
I
n
2
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rf
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2
rr,
PC
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1'"a"
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MOM
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0
SECT -ION 4 - WORKERS COMPENSATION (MG.L C 152 § 25c(6) I
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.
7aneA —affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Description o Proposed Work (check appBcable) I
New Construction 0
Existing Building 0
Repair(s) 0
Alterations(s) —6-7
ition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIM[ATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed permit applicant
OMCIAL USE ONLY
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (b)
4 Mechanical (HVAQ
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 BUELJDING PERAHT 7—
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this buildbig permit application.
Signature of Owner Date
F—sECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I ft
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
Si ture of Owner/Agent --5-a—te
NO. OF STO S SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TRvIBERS I Fr 2'NL] 3RD
SPAN
DMNSIONS OF SELLS
DIMENSIONS OF POSTS
DMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CH26NEY
1S BUILDING ON SOUD OR FELLED LAND
IS BUELDING CONNECTED TO NATURAL GAS LINE
License: CONSTRUCTIO 4EGULl,4l/T1=lO-,ft,,,-
CS N SUPERVISOR
Number
A 075914
09/28/19.,
ex� 0- q ,,
9128/20%
R Tr. no: 5004.0
estficted: oo
BRIANM DIAS
7 SIR ISAAC WA
y
�UD,SON, NH o30sf,l,-."--:>,l-,,,
Commissioner
0
00 35,000 cf enclosed . Pace I
(MGL C 112 S -60L) S
1A - Mason�bnl,
I G - 2 Family
Fail Homes
ure to Possess a current edition Of the
massac,usetts State Building Code
is cause for
revocation of this license.
DIG SAFE CALL CENTER: (888) 344-7233
Jan 13, 2005 9:33AM MEADOWS CONSTRUCTION 9784991700 p.2
Commonwealth of Massachus&s
DEPARTMENT OF HouSING &
COMMUNITY DEVELOPMENT
Nfit Romney, Governor. 0 Kerry Healey, IA. Governor * Jane Wallis Gumble, Director
December 9, 2004
Mr. Mchael Meadows
Meadows Construction Co. Inc.
166 Middle Road
Byfield, MA 01922
RE: Low -Did Aipproval - North Andwer Housing Autho
Operating Reserve Project, DHCD FISH # 196021
Developments Involved: 1962001
Architect(Engineer: DHCD
Scope of Work: 200-1 roof replacement
Dear Mr.'Meadows;:
Pending receipt of the Housing Authority Board vote, your company will be awarded the above -captioned contract
in the mnount of S25,392.00 As the fimding and approving agency, we have required documents which you, as
the General Contractor, must prepare. Once these documents are: prepared and ftlly mmuted, please present
them to the Housing Authority fbr execution. They will dm submit then documents to DHCD for final review
and approval. Your company most complete the enclosed contract documents and present them to the
housing authority wtthin ten (10) days of receipt.
In order to assist you in the preparation of these documents, we have enclosed a cbecklist outlining the required
documentation, along with. dw enclosed fbrms for your use, If you have any questions regarding then
requirements� please contact Linda Larnont, Project Manager, at (617) 573-1176.
Sincerely,
54A41
Stan Kruszewski, Director
Project Development Unit
Enclosures
100 Cambridge Suw, Suite 300 bttp://www.staft.ina.usldhcd
BoMn, MandwoM 02114 617.573.1100
Jan 13, 2005 9:25AM MEADOWS COMSTRUCTION 97H455l'fUU P.j
12/29120'Ci 15:58 FAX 10786322217 B 9 MCCARTRY It 002/003
ACO&D. CERTIFICATE OF LIAS
s.r. Wcaft Vic **By. If K
IN C"**Mm Orin
hobo* , IM olm
074 521 -um
No WomsConstmoVem Compmy-LLr,
166 Middle Rood
Now", MA 01021
MEMO
LITY INSURANCE
TMG==jrMtr7M 0FW=v0:zF2E
CM7�
MY a convull
"mm Ms comwAm am wr mumt uww =
—ALTO TIM OOVMW W0RVfD By,"* p0UGIj Snow,
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Oft Momuld M—doW OANtMbMP.IftlggU"WAMAMVALLL4$0"Vonntg%L --A- IIAVAVMi.
mmato Or NAM low a". WIMAVOTOUDID
NWh AmdoW. MA 0105 om No QP*jml"VMW"LMKfMA$&M0M
I Ora 046772
LES
lotil
The Commonwealth of Massachusetts
Department of Indusbial Accidents
OMCS of Invesdg9kins
Boston, Mass. 02111 -
W01'*ers' Cw"Mdw Insumince AiNdavit
I Narne . Please Print I
Narni:
Locaflon: 3- 3 L 31 Z -7 S_
City 1 "SD'-e_z Pftie # 9 -1*'8
F� I am a homeowier performing all work mysdf.
F-1 I am a sole propdelor anc:1 have no one woricing in any capa*
I am an employer provicling workers' compensaUon for nrY employees working on this job.
QornRqMf name, L-1-4 �VD W _S CDAi 7 t?Z U
Address Ce rs LE- /Z..)
Cft N'e r�:j V�4 '-Y 7
__1: I - -
5. Co
5 -35Z Lf -3-3 -oi,-
Address
Cft Phone it
insrave Co. Pokv a
Fdkm to seewe covenip as reciulred undw SecUon 26A or MGL 152 can 1W to—" invo" d aWW POnaffin of.@ fine up to $1,5W.00
andfor am yam, Imprisonn -o.wd.u-cbA4nmMm]nlnfmmdABMp.VAOW.ORDERmdA rem cf.(S1a0.a0)_gAW agekW�M& I
undwatend that a copy of this stdaroft may be kr*wded to ft Office of InvSdgWcM of ft MA for camsp vWftvWn.
I do hwvby cw* undor ft pains and penaffl",of poijuty thM the k*FMOMM Pwded ebmv Is &w wid Car I
/b.7
Print name_ J�) 4 /U PhM # 'PY 07 S 7 f
Official use only do nat write In this am to be ccnVWW by city or town
CRY or
0
Building Dept
OCheck Y Immediate response Is requked
13
LkenskV Board
13
Selectinen's Ofte
Contectpamon-
0
H&Wh DVarth*nt
C]
Other
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
in accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposejof in a properly licensed solid waste disposal facility as defined by IVIGL
c 11, S 150 A.
The debris will be disposed of in:
QAAd-C-s
of Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
J
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