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HomeMy WebLinkAboutMiscellaneous - Catalda Drive-Bldg 16Q5 Q 6- Q 4 LIN Date ..... ".).4Z .. .................. TOWN OF NORTH ANDOVER =-RMIT FOR GAS INSTALLATION a has permission for gas installadon .......::.........C....... t / inthe.buildings 9f .. ........................................................................................... at ........... r. , North ndover, Mass.. ...... Lic. No.?.x.. �............................ A INSPECTOR Check # 9829 10 8Ox55098 3oston, MA 02205-5098 i17-951-0600 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N. ANDOVER, MA 01845 N. ANDOVER, MA 01845 RE: Insured: PATRICIA A LAVOIE Property Address: 1603 CATALPA DRIVE, N. ANDOVER, MA Policy Number: HMA 0373081 Claim Number: BOS00047863 Date of Loss: 2/9/2015 Company: Safety Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may�either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Connor Donovan Claim Examiner 2/11/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 5362 Fax: (617)'603-4926 Email: Connorponovan@Safetylnsurance.com -`1 f GOWNER TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY G MA DATE2 JOBSITE ADDRESS 6�r_:.-__-,- �OWNER'S NAME ADDRESS TEI FAX OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL RESIDENTIALff NEW: El RENOVATION: D REPLACEMENT: PLANS SUBMITTED: YES[_J1 NOR APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERA Y CHECKING THE APPROPRIATE BOX BELOW - LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E] BOND BOOSTER LJ Lmmj SIGNATURE OF OWNER OR AGENT '5A 7 CONVERSION BURNER PLUM BER-GASFITTER NA LICENSE # G SIGNATURE MP ED MGF JP El JGF 0 LPGI CORPORATION nr� PARTNERSHIP 0#[ LLC E]# COMPANY NA 4- ADDRESS CITY STATE z I P TEL COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE I FRYOLATOR FURNACE F GENERATOR GRILLE INFRARED HEATER J LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT ILL -- TEST UNIT HEATER 41 I NVENTED ROOM HEATER I 111 ntrc..... .. . .............. . I ...... . ... .... L__1 J INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent .. hich meets the requirements of MOL. Ch. 142 YE Ell I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERA Y CHECKING THE APPROPRIATE BOX BELOW - LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E] BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CH�KONEONLY: OWI EN SIGNATURE OF OWNER OR AGENT '5A 7 n are true and acc et Kebe o y no edge I hereby certify that all of the details and information I have submitted or entered regarding this appliwill and that all plumbing work and installations performed under the permit issued for this application 1 11 bei complian e mA neI-ision e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NA LICENSE # G SIGNATURE MP ED MGF JP El JGF 0 LPGI CORPORATION nr� PARTNERSHIP 0#[ LLC E]# COMPANY NA 4- ADDRESS CITY STATE z I P TEL FAX CELLF qKi EMAIL C' U LOD z z 0 H` U yW � A W � o z W %- � W �cn O a Z U w �* W w Q a W W w a a a a U J a a a N W x w F- LL H z H U a C�7 °a A The Commonwealth of Massachusetts Department ofIndustrigl Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 www.massgov/dia Workers' Compensation Insurance .Affidavit: Builders/Contractors/Electricians/Plumbers City/State/Zip:, Phone #: 9,-? �_ - �& 1432 (O Are you an employer? Check the appropriate box: Type of project (required): 1. ZH am a employer with _ g 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. # Remodeling ship and'haveno employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition [No workers' comp. insurance required.] officers have exercised their 10.❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] q ] employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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 checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. V l C»f Policy # or Self-ins.Lie. 9: Expiration Date: L�� Job Site Address: V City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Y do hereby certo under the pains and penalties of perjury that the information provided above is true and correct. Simature: 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 Information and Instructi®ns 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 employee, 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, not the Department of T" 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 theirs " self-insurance license number on the appropriate line. City or Town Officials Y Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Dopartmmt oflndustdal Accidents Office of Investigations 600 Washington Stxeet Boston, MA 02111 TO, # 617-727,4900 ext 406 or 1-877:MASSAFE Revised 5-26-05 Fax ## 617-727-7749 www.wass,govldia Safety Insurance �0 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner;or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N. ANDOVER, MA 01845 N. ANDOVER, MA 01845 RE: Insured: Property Address Policy Number: Claim Number: Date of Loss: Company: PATRICIA ALAVOIE 1603 CATALPA DRIVE, N. ANDOVER, MA HMA 0373081 BOS00044439 7/28/2014 Safety Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Allan Leavitt Claim Examiner Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3213 Fax: (617) 531-8891 Email: AllanLeavitt@Safetylnsurance.com 7/29/2014 Location 16 0/ ������� - ���� Jf �3 /zA< .No. 3 Date t Nom,. TOWN OF NORTH ANDOVER F w A • •/O 0 Certificate of Occupancy $ CMUst<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23794 Building Inspector NORTN 3? ,•..r. `. • of a 354CNUSE4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 233-2011 Date: December 16, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1601 Catalpa Drive, North Andover, MA 01845 VRD Acquisitions, LLC MAY BE OCCUPIED AS dwelling unit IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: 100.00 Receipt: 4868 VRD Acquisitions, LLC —A'11--A.-- Building Inspector CA m X X m N m Q CD C7 Z N! CC . C2• . r _� CZ = CO) � O � CD CD Q d CD CD C2 CD C CD FA - CD CD CL. O CO) Cc CD I cD CD CA O CD 'a Z C) CD 3 C .CD 0 R I CT] VI n 0 cn n 0 cn G� VJ 0 C_ O Q co CL m F =® p m CO) n 0 N O C O � to ndi C H T O O N O S m m = CA CD O O 2c:5- O O y, m ?7R :040 N CD a,....' O O n'fl V aCD , CO) so N C C g o :\ ca CO) m O �: N .dirt CA Oo. .. �o 0 Cyr IV O m' a N o � = o Z: 4 a c-) C o � C2 CD �o o '� x A. cd H Its t° C � CA Q CD C7 Z N! CC . C2• . r _� CZ = CO) � O � CD CD Q d CD CD C2 CD C CD FA - CD CD CL. O CO) Cc CD I cD CD CA O CD 'a Z C) CD 3 C .CD 0 R I CT] VI n 0 cn n 0 cn G� VJ 0 C_ O Q co CL m F =® p m CO) n 0 N O C O � to ndi C H T O O N O S m m = CA CD O O 2c:5- O O y, m ?7R :040 N CD a,....' O O n'fl V aCD , CO) so N C C g o :\ ca CO) m O �: N .dirt CA Oo. .. �o 0 Cyr IV O m' a N o � = o Z: 4 a c-) C o � C2 CD �o o m y 0 0 c '� x A. cd R� Its t° w o y O CA m y 0 0 c 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. �� c��• Walls at stair stringers. Windbrace corners and center bearing partitions. Size rid a to rovide full bearin9 at rafter cuts r � r6v6 1601- Hip and Valley rafters -watch bearing at walls. C6 U Ridge & Hip - Provide proper connections. ,. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie ttha t�. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. U i 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. �ertified calculations. required for Beams/LVL's Trusses. olid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams r� 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. DECKS: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5" 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 - $30.00 (Be Ready). Certificate of occupancy required prior to occupying structure. 'VI ' t,-- 603 -2)V 736sl, <da h' V®RBACH ARCHMCfiLIRE : x59'Mfiirchesfer Street, Nashua, N.H. 03d64-2114 ROBMT J. VORBAC H ARCHITECT. Tel: 803 - 886 - 4738 FINAL'AFFIDAVIT. On this day ofc- . rb 1 0 before me, a Notary public duly commissioned and qualified for the Commonwealth of Massachusetts, personally appeared who inspected the construction of (Property Name) (Street Address under Permit # - and that this structure conforms to the submitted plans and to the codes of the City/Town of Nl,-_�A, %,,and the. Commonwealth of Massachusetts. Further, that all required approvals.and materials affidavits have been submitted, and that there are no pending violations of Law of Orders of the Department of Public Buildings. 7 1, as t e Archite ngineer who is signing the affidavit hereby certify that I -have- it date I o er © inspected the .property located I (v Q 1 (Street Address) and find that the locus comply with my plans and specifications and all Rules and Regulations of the codes of the City/Town of Commonwealth of Massachusetts. THEREFORE, I REQUEST A CERTIFICATE OF OCCUPA .._ � Tib OVE ADDRESS. ���S No. OF hh SUBSCRIB De2, MLs - RE THIS -IQ _DAY i Notary Public SEAL moi 0 Commonwealth of Massachusetts •�'1M �o My Commission Expires Feb 8, 2013 Q Gbd/ NOTARY PUBLIC APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION Building Permit # ADDRESS/LOCATION OF. PROPERTY: IoSA Ma -c, Parcel 33 Lot Number SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL Permit Issued t®: Address SIGNED 4 , R 111 CONSERVATION v� PLANNING A/e' DPW - WATER. METER SEWERMATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW Signature Fife: Application for OC form revised Jan 2007 w Location ! V No. Date ORTq ss�+cMus<< TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #_ 2 c 4 I Building Inspector POwrM , • v 0 ` CERTIFICATE E OF USE & OCCUPANT TOWN OF NORTH ANDOVER Building Permit Number 233 Date: July 20, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1602 Catall a Drive North Andover, MA MAY BE OCCUPIED AS a residential town house IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: $100.00 Receipt: 23122 VRD Acquisition, LLC 100 Andover Bypass, Suite 203 North Andover MA 01845 Building Inspector ,0 Location No. 3 ? Check # 66, !2.L Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ to O Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 237L5 wilding Inspector U o Or �.' •OTN 1 } s r �sS�cNUSE� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 233 Date: November 15, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1604 Catalpa Drive, North Andover, MA MAY BE OCCUPIED AS Town -house IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: $100.00 Receipt: 23 705 Valley Real-estate Development a/k/a VRD 100 Andover By-pass, Suite 203 North Andover, MA 01845 Building Inspector 0 APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION Building Permit ADDRESS/LOCATION OF. PROPERTY: 1 (o b 4 c-, Maw i o b L Parcel -5-3,36 3q Lot Number �.► t ��1, SUBDIVISION.-�'1,�1� DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUM IRF Permit Issued to: -)r --� b3 Address tom .�►,.t."A 01 (2'+S SIGNED R TI CONSERVATION PLANNING i DPW -WATER METER SEVYERlWATERCONNECTION FG4q W/ 10 NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW o1 Signature File: Application for OC fomti revised Jan 2007 r a•'� m m x C M m mm A c y CD a Z CO) O O = CL r- n C d = y n� -v 0 � O v CD CD O CLQ WC9 CD CD Q CD w a c `D r CL O y O t0 O CD � v y O CD O CD O C CD C` I l cn n ®e! cn cn CT 4L 'i cn cn � p1 V C O O Z CD O m O c U2 O m C .0� 0 N C 0 n N m C SICO o% N N ad a �N ` m CDCO ® CA C2 Cn al oO ^ a N®ate a. = N gr M. mH � �.� N �1 T9 tc ro ® n m W p .o7_.r N C= os o m N C 0 0 ®CA O O _ =r ® O ® CC41-00 0 Zc.N;O O N KA m � CD: G� c C C* 0 o��: m m N R ®m \�Q \vJ N m - W ^ O N ad a ro O- `7 O nO O P7 r- r x a. G7 Cn al oO ^ a I oTf 3E ® N N tc ro 4 W p .o7_.r N C= \ 0 0 ®off' �_��: 0 KA � CD: G� it C* R 00 C O O O CD: W ^ O - �C 2L S. ar-a Cii x� ro O- `7 O nO O P7 r- r x a. G7 Cn al oO ^ a I oTf n �~ tc ro 4 W p O 0 KA it vz rJ H 0 Sill plates 2-2X6 (1PT) vis/sill seal. d dk 7 %—1fP,11 Girts - solid brick or steel plate bearing at foundations % " air space at sides in foundation pockets. Lateral bracing at ends, ertified calculations. required for Bearns/LVL's Trusses. olid bearing support for Headers/Seamus etc. Check headroom clearances - stairways, under beams ra Attic Access. (rain. 22x30 w/3' headroom above). Crawl space access. (main. 1824). ,✓�/ Bath exhaust fens to have metal duct to exterior (not fn soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves indow Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. r, C' /P-91-01 'f of required glazing shall be openable. ` Bedrooms required main. 20x24 egress. window or door. f" -tom 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. DECKS: Lag to house, provide flashing. Rails main. 36 " high, Baluster max space 5" 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 - $30.00 (Be Ready). Cerrtafacate of occupancy mquiued oraaP to =upu ang strructum . GENERAL BUILDING NOTES/CHECKLIST- MOT 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 Kermay Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor baits or straps Damuproofing Foundation drain - pipelstone/fabric filter/cover and outlet connection., , FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. walls at stair strangers. Il 6 Cj fi Windbrace corners and center bearing partitions. full Size ridge to provide bearing at rafter cuts. Hip and Valley rafters - watch bearing at galls. �� n Y :x. ��� �� Ridge & Hip - Provide proper connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie t ti Stair stringers - watch cuts and heal support. Joist hangers fully hanger - nailed w/ nails. Sill plates 2-2X6 (1PT) vis/sill seal. d dk 7 %—1fP,11 Girts - solid brick or steel plate bearing at foundations % " air space at sides in foundation pockets. Lateral bracing at ends, ertified calculations. required for Bearns/LVL's Trusses. olid bearing support for Headers/Seamus etc. Check headroom clearances - stairways, under beams ra Attic Access. (rain. 22x30 w/3' headroom above). Crawl space access. (main. 1824). ,✓�/ Bath exhaust fens to have metal duct to exterior (not fn soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves indow Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. r, C' /P-91-01 'f of required glazing shall be openable. ` Bedrooms required main. 20x24 egress. window or door. f" -tom 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. DECKS: Lag to house, provide flashing. Rails main. 36 " high, Baluster max space 5" 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 - $30.00 (Be Ready). Cerrtafacate of occupancy mquiued oraaP to =upu ang strructum . t Location .lJ — 13 'g i ie Date ' No. - TOWN OF NORTH ANDOVER Certificate of Occupancy $ /A -h '. Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #010,00 : �d 234;? BuildingInspector Q/ ,,ORT .dry ] 9 3�8S1C NUS 4�9 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 233 Date: September 24, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1605 Catalpa Drive, North Andover, MA MAY BE OCCUPIED AS Town -house IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: $100.00 Receipt: 23487 Valley Real-estate Development a/k/a VRD 100 Andover By-pass, Suite 203 North Andover, MA 01845 i� Building Inspector m m X m YI m y mm v, C � CO) C7 10 CD CD n Z H CDO'v a6 r n' CD d CO) o C-) O v CD CD o r c CDoCD CZ O CO)CD co)CD CC C 0 � v CO2 O CD � Z a a O CD O CCD O CL CD cr H ati IS.o ti 7=C n N m n �. O .= ' = -� r� ca CL -4-m mCD C/] ca N I= TD3 -400 N co O x CD mCD Co m O y C', CD y. n � O 1 o g: n W N O o cn CC CL d O n� � o o; r.L cn CD C _ o CD o co � O cn bi O C 0 CD LOCO V CL CD cr H ati IS.o ti 7=C n N m n �. O .= ' = -� == CDCLT ca CL -4-m mCD ca N I= TD3 -400 N co O x CD mCD Co m O y C', CD y. n � O 1 o g: OZ W N o o o a � CC CL d O n� � o o; r.L CD C _ CD LOCO V CL v ny rD O O om N d y nn8l O ,7'0 b� CL d ; c �C i �1 ® H CO) mCD ca N I= TD3 C) 0 00 CDo ^ ro C', � O 1 o g: W N d o CC CL d O n� � o o; o CD o co Cn C/) to ' p •� ti C `! ea jJ O v ny rD O O om O 'a nn8l O ,7'0 b� CD °� rt F �- d C) O _- y ro c r� x M z O y 0 9 0 c GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY 0K)..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 ,(J Foundation drain - pipe/stone/febric filter/cover and outlet connection t� ild� j FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elect etc. Walls at stair stringers. G .�C Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. X1,0 Hip and Valley rafters - watch bearing at walls. R'd & H' P 'd f r. � e) r66 160 � d/ ge ip - rovi a proper connec ions. �j Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie tV"a') t�. Stair stringers - watch cuts and heal support. 2 Joist hangers - fully nailed w/ hanger nails. tzu Sill plates 2-2X6 (1 PT) w/sill seal. 7 /tom -pO. 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. olid bearing support for Headers/Beams etc. f' Check headroom clearances - stairways, under beams G.� 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 ae combust. DECKS: Lag to house, provide flashing. Rails min. 36 ` high, Baluster max space 5" 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 - $30.00 (Be Ready). Certificate of occupancy required prior to occupying structure. 6 TM ikhchesier Stmet, Nashua, N.H. 03064-2114 ROBERT J. VORBACEi ARCEIlTE(:T.. Tel: 603 - 886 -1738 FINAL AFFIDAVIT On this ,, 02 day of before me, Q_/a Notary public duly commissioned and qualified for the Commonwealth of Massachusetts, personally appeared j— , who inspected the construction of (Property Name) (Street Address) under Permit # c2 -2)?>and that this structure conforms to the submitted plans and to the codes of the Cityfrown of V+c,.,k_ and the Commonwealth of Massachusetts. Further, that all required approvals .and materials affidavits have been submitted, and that there are no pending violations of Law of Orders of the Department of Public Buildings. 1, as the Architect/Engineer who is signing the affidavit hereby certify that I?iave orrt�s date ;Z i- I 10 inspected the.property located I c,, cZG e - (Street Address) and find that the locus comply with my plans and specifications and all Rules and Regulations of the codes of the City/Town of 2, .Vt_ ,.,rte and the Commonwealth of Massachusetts. THEREFORE, I REQUEST A CERTIFICATE OF ADDRESS. ORIGI c2ft No. 9085 SUBSCRIBED AND S BErmom jillsim " DAY OF W Notary Public Commonwealth of Massachusetts My Commission Expires Feb 8, 2013 f NOTARY PUBLIC ----------------- —-------------- -------------------------------------- ------ --- - --- - -- . ii W,> ev`7p�nlXla n�SXN uyXju. i.otXb <i �SGFn—— --- —— _.__ V O O O - {t " O 0'�• THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER i; .�, � , .Enterprsie Bank , VRD Acquisition, LLC High Street 53-274 0000444 100 Andover By -Pass Andover, MA 01810 113 Suite 203 7/14/2010 North Andover MA 01845 978-687-5300 PALE Town of North Andover ********Q 0RD�:d7F $ .p1��.�0 One Hundred and 00/.100*****************************************~********************************** DOLLARS i Xia( �Xh QoiXaQgXhG*Xa� fnQ THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK—HOLD AT AN ANGLE TO VI Ee EO 11'000044411' 1:0 1 130 274 21: 503 64611' Location//OZ- ef*%1� dll Date - _ /V No. Check # `L `C 2 31 22 TOWN OF NORTH ANDOVER Certificate of Occupancy $� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Building Inspector Town of North Andover Main Street North Andover, MA 01845 MEMO VRD 1602 Occupancy Permit g. s Xia( �Xh QoiXaQgXhG*Xa� fnQ THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK—HOLD AT AN ANGLE TO VI Ee EO 11'000044411' 1:0 1 130 274 21: 503 64611' Location//OZ- ef*%1� dll Date - _ /V No. Check # `L `C 2 31 22 TOWN OF NORTH ANDOVER Certificate of Occupancy $� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Building Inspector t O� UP o. i .t :�(r ® y CA� C � r cn Gd AC-,• n �o (� O o, CD n Z CO) CD O = . 3 �r � y "V mc a m CD _ O� CO) ro aUM =� - m CD O v � � 0 x N c�=rm O % CD o o, CD CD m CD yCD. b• CLO CO) O =O CO CD �r � CO) v O 'vCD .0 Z ^� O � O ac CD t C_ 0 O CD O _ _ CQ O W c a _ <O CD c e: 0 H C 0 a CA N CD C ? a O CV Z �. N O CTca a o do y � ® 0 m Cl) yC2a� �, =-c N .=i� �•►d �' T CD _ =r = m =r CL CD O y O m ' CD 2 CD y O O v Z�•� C O y CD ate.+:, CD CD CA 'om m 9 �: CA ., d y . Rdccr O� UP o. i .t :�(r ® CA CA� 9 MCD r cn Gd AC-,• n �o (� O o, CD cn moo: 3 n � y "V o rn CD _ O� ro O n C� � o o; aCS ci o = = CD Q d� O: b• O �r C_ 0 O CD O _ _ CQ O W c a _ <O CD c e: 0 H C 0 a CA N CD C ? a O CV Z �. N O CTca a o do y � ® 0 m Cl) yC2a� �, =-c N .=i� �•►d �' T CD _ =r = m =r CL CD O y O m ' CD 2 CD y O O v Z�•� C O y CD ate.+:, CD CD CA 'om m 9 �: CA ., d y . Rdccr O� UP o. i .t :�(r ® CA CA� 9 MCD r 03 CA Gd AC-,• �o (� o, CD moo: 3 � y "V o CD _ ro n C� � o o; aCS ci o = = CD Q � C/).sN�� O T." O� G_ O G b O 0 C�7 o t n r O o Gd ro o ro z 0 H 0 0 c GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW '04 POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY 0K)..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 - filter/cover and outlet connection. pipe/stone/fabric �J P) 1 FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. 6 (j Walls at stair stringers. Windbrace corners and center bearing partitions. t16,0 Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters - watch bearing at galls. C� Ridge & Hip - Provide proper connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie t tt. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. u 7 �� Sill plates 2-2X6 (1 PT) w/sill seal. 7 /r`y—�'©Q�j 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 O 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. DECKS: Lag to house, provide 9 rovide flashin . Rails min. 36 " high, Baluster max space 5" 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 - $30.00 (Be Ready). OCertificate of occupancy required prior to occupying structure. '04 APPLICATION FOR CERTIFICATE OFOCCUPANCY/INSPECTION Buildincl Permit # a33 ADDRESS/LOCATION OF PROPERTY : Map Parcel Lot Number SUBDIVISION �-A--cAsle,L, ac,Q A DATE REQUESTED FILED/READY FOR INSPECTION_? CLOSING DATE ON PROPERTY: I ®I L 0 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES_ OPermit Issued to: 0 A e -,:g 7c, , Lel Address i oolos -.�1��,� g,0��� ��.,:1c� SIGNED ROUTING CONSERVATION PLANNING F-1 DPW - WATER METER Oil 0/16) SEWER/WATER CONNECTION- 0l� a� NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYIINSPECTION REQUEST O DPW Signature File: Application for OC form revised Jan 2007 0 - m (A m m x m m m m CO) Cl) CD CO) Cl) CD CL u CJ CO) >CC2 "o CD CD CD CL CC cr c =r WCCD CDC CD w w a CD co) CD CL CO) CD CO) 0 nCD cm CD CD =r O CA cr W cv -1 C"3 0 CLO m 0 a CCD:, -0 =0 a45 0 CO2 o V) -CP . C, =r CL CL Q= CD 7 CD D) CA CD 114 O -*==' -\ CD CD - O C2 co a o a no =r �:l C2 CD 2L CA OCO CL co r Cl. c=,,, K � I �- , CD . . . I -TJ CD 7 n=: o CD: n C'D 9 K 4>1 mmi 0 to =: CD ca Er cn w CL C CD E . ' CO2,Q Go CD CD ji FrC-7 Lk U 0"( r mn CD Imo cn wi !Z> Cn (n 5 Eg - 0 bq 0 -,n g, :cp i� o 0 n C, )al tz 0 0n rD Ra r cn O Gam. C rD C. C-4 riO4 < 4 Oil M FO y 0 m CA m m m m CO) m CA mm y .0 C � CD ei Z N1 CCD O CL CDC d CO) 0 CD CD o CLQ CD CD CD 0o v a. C CD y CD CL O y C=D Vl n O cn n O cn ro n � y G O 0-4 1.1 H p C/ �, a- tt�CD cr SCy do O � m y CO —® Q H d O �� :� n O CD CA C H O d 01-O cay ..+ m =r a •+ n co , T m �O m H oo. CO) O Sm o = m CA Cl) m O CD C.,., .� 0• CD a � O =r E: "CII CD CO2 N m� N CM Cn � to i ., - • N a�Rrr p C/ �, a- tt�CD W -� a �� :� CD CA C H CD co , CD oo. CD CA CD C.,., I V CD 1 V W H o C cm M f� C-) C.) OW. Ca Qs 2 cD Cn � to i ., - • O (ro p C/ �, a- tt�CD n, tna- a b7 C/) al FL x d CD O w H 0 c PW AM VORBACHARCIH "Manchester Street, Nashua, N.H. 0 ROBERT J. VORBAC H ARC=C'T. . Tel: 603 - 886 -1738 114 FINAL AFFIDAVIT On this) X -5 -fl. day of before me, M Ct (I .�S a a N ry- blic duly commissioned and qualified for the Commonwealth of Massachusetts, personally appeared who inspected the construction of -r (Property Name) (Street Address) under Permit # vZ3 and that this structure conforms to the submitted plans and to the codes of the City/Town of iJ -. Ar,o1 b and the Commonwealth of Massachusetts. Further, that all required approvals and materials affidavits have been submitted, and that there are no pending violations of Law of Orders of the Department of Public Buildings. I, as the Architect/Engineer who is signing the affidavit hereby certify that Fhaae-orrtliis date 10 inspected the.property located I(o 6- . r� (Street Address) and find that the locus comply with my plans and specifications and all Rules and Regulations of the codes of the City/Town of A,-%Avand the Commonwealth of Massachusetts. THEREFORE, I REQUEST A CERTIFICATE OF OCCUPANCY ADDRESS. SUBSCRIBED AND LINDA SAITTA NOTARY PUBLIC (� COMMONWEALTH OF MASSACHUSETTS MY COMMISSION EXPIRES 03/29/2013 O• sN���ya.yy����IN1N.�MM Y J. OF ARY PUBLIC CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 233 Date: July 15, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1603 Catalpa Drive, North Andover, MA MAY BE OCCUPIED AS a residential town house IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: $100.00 Receipt: 23109 VRD Acquisition, LLC 100 Andover Bypass, Suite 203 North Andover MA 01845 11—zloe /4 -- Building Inspector C' Z 0 wo 3a :1 m , Z c �O vat O PO :r c N a o m C) W 7 �_ ( 2� p m S — = w� ;��,0 _ y ° z. x a m aL 13 m 1'11 c t �v c Q c @ .., O Rt E< -�� WE ;� ♦r TO y E' ° C7 3. wti QUI f71 �D 3 J d �� �07N� 0 z C7 U3 aj ^i f1 ....E ° (p � = o �x •. � .♦ Q rr ��' n O C 7 n� Al b CL o CD o r,;Ox! �_ O k m C::, 0 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Lx� M 4 . - THIS Section for Official Use Ont ~ BUILDING PERNU NUMBER: DATE ISSUED: _ Ae Adz 44" Buildin Commissioncr/Inspedor Qf Buildin Date 5� 1.1 Property Address: 1.2 Assessors Map and Pared Number. /o8 24 ��--33-.�8 :3I Map Number Parcel Number 1.3 Zoning Information: a Loo? _ 03 V 1.4 Property Dimensions: T,—) e R Zonin District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yazd Required Provide Required Provided R Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Public ❑ Private ❑ Zone Outside Flood Zone ❑ Mmicipal On Site Disposal System ❑ ,J0' i i'M ict: es 1140 2.1 Ownnerroof Record 10;/ C/ 1?�4#r ,lam Name (Print) 7— Address for Service : olow Signafurc Telephone 2.2 AoKfized t f Name PrintAddress for Service: Signature Telephone 3.1 LicensedConstruction Supervisor Not Applicable ❑ Address License Number / �S /G'Gt�G�(E✓N ice.( �O D��jQS—. Licensed Constructs Superviso . � /4: -761-1W- Exp on to Signatu Telephone 3.2 Reotered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone I, as Owner/Authorized" Ager//— Herd6y declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Nam - -v Signa , of Owner/Agent Date Item Estimated Cost (Dollars) to bes��MY c Completed b t a licant 'L �h P Y permit PP S.. _. �., :>�., ,h 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC)n1V)A FO n a , 6 ✓1 y, 1-1 5 Fire Protection 6 Total (}1+2+3+4+5) Check Number )k.,. i1ri 9W2 �bm3r;�-,.P,t. .:.lr.l it', : ` ) ,?.�fi3trT-`: 1kii'Di*�. : J.6:.'d24r s tS1;. Wl^.-z�. . '+f. . T 5,>., uF#F�fi'it�',i`^,5.;....:.�%..{bS.fJ,,v.rn:v�7n?S=t�4 3t `.i fi'r-�.q�.:,`��,;:,:.u Y%S�!%kAY.rt i<o.,tbSj kt)A .F,Y,R'Jh.._ '00 A.! �7y�'i:..'. /3�E ;.tJJCu a:5f .tev.- ;��:�{. A }.�#,Y.. k,;"�Z,Yp ..t.5.�,F ^w3.j4:,:q F1es F"�Z.3 F''.9`.�1i..YW.r.,^, ."lt17 9t't�h!/k„ i�k Rn� e..{r Ey ' s+,; fp2Y� tyFoqVyi+ /h�/�_..p�5.�pi5.:.�4NJ�/:4a+,. c; ��•f ,t.+x;u .urY».,_.< ?,�. %F ..•x,R}�a2 `xN.`�9-l , {,. . yC�..:Y1Jr...�.d).„,:.�4. ✓.�7vS'dY"UM.A �c' r„.,Yfr'.S.'i.:r,H,.i�V.d.A+7�'"jU}...1y..i r,tF"„i.!:%,.�..S''I ,. e.�-f4rtY4..' ��t$* .I,/ (iY��' ! �J'{`'` :,.3str �.Yl,..la:.,?. 7�e�, rt'yy.6U.'�l. - .�. j. f1±�,J}1T{,.)f1TL.Y,fi.4:.�a . p(fY _>,,'t?sCi%s '. SS. ''';.�..',\1N?..yC£ ,$)i.Z..ai..�.%. « ?Li1:xz���>}{ . �� `} `.`�.i; M �fr . 3 .,W .�M` ,$t�,.( ., ✓!.. ,,.,..1.,..A y33,. 1�Cf,3i ..C<)ARYiI� 'Y ..Y'V;� .L ,!'a}y ��._�YAis � i'i° � Y.n�, %.1:.,i. ���?er.4 '��� �� -;it �gl .>..� Fh}At�i�l ,'} \YS'.�,+,{"��b 3f.�_.,Y�;��.17J�i U'r, fR`x aF�<{"'';• NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CBIM NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ��'� < : St at `fy r;��'�r !na�.3 n4•t `F'x �'q:t Kb�-,6.-..,,.].,'���,,t:: �? �; :.. `` _. + a`�: �,.y!RS ���',ti,r�i _ r. �:. ,.� °. ,'?i.%ti<,z7, :..,� s?)1+" , x w iti*- ;...�"��.' � x.: �"��-•b'"^,F.' ` ,�'t ...cam ,. ��.r'��z .ar,.:�. �-s ''�r,�., ; � e 4y``�'. z { �,-c. s,�-�` i.�`�.+ ,�, ,a Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the l issuance of the building permit. / jl Siened affidavit Attached Yea ....... ❑ No....... 5.1 Registered Architect: Name: Address Signature Telephone 41�- Company Name: Responsible in C of Construction Not Applicable ❑ Area of Responsibility _ Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility ` A , Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility _ Registration Number Expiration Date Name . Address Signature Telephone 41�- Company Name: Responsible in C of Construction Not Applicable ❑ �� , .Ems" E ;. ate;_; ,� s JJit ; a New Construction 9V Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: CONSTRUCTION TYPE A Assembly BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height (ft) Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Hereby authorize 4 My behalf, in all matters Owner of the subject property work authorized by this building permit application -"6'0 F�Jwtuk of Owner Date act on USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ IA 1B ❑ ❑ B Business ❑ 2A 2B 2C ❑ 0 ❑ C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ U utility M Mixed Use S Special Use ❑ ❑ ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height (ft) Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Hereby authorize 4 My behalf, in all matters Owner of the subject property work authorized by this building permit application -"6'0 F�Jwtuk of Owner Date act on Date Z'. :r -R TOWN OF NORTH ANDOVER PERMIT FOR PLUMJMNG This certifies that has i-rrniccinn tr% plumbing in the buildings of at ... North Andover, Mass. Fee'.a. . —Lic. No.. %.......... PLUMBIdd',INSPECTOR Check # 8271 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS o /A b 3 i Building Location C AI Oil p q ;/t Owners Name of Date Permit # Amount New JjT Renovation [:] Replacement 0 Plans Submitted Yes ❑ No ❑ (Print or type) Check one: Installing Company Name �) I't1�C.r„J Certificate 1:1 Corp. Address �I� 1�Sk" P<f-04 S cin Q � ElPartner. Business Telephone G — _ 17 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the t insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threuranceAp `ate'_'" / ignature 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 Massac efts State Ju Code and Chapter 142 of the General Laws. IMW By. SignaLure oi Zice se um er Title Type of Plumbing License L City/Town icense um er Master ❑ APPROVED (OFFICE USE ONLY journeyman i /I • .i DO Bel MMMMM NWit mom --�-----_------------_--_ I'm I 1 10M.----- -.---- (Print or type) Check one: Installing Company Name �) I't1�C.r„J Certificate 1:1 Corp. Address �I� 1�Sk" P<f-04 S cin Q � ElPartner. Business Telephone G — _ 17 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the t insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threuranceAp `ate'_'" / ignature 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 Massac efts State Ju Code and Chapter 142 of the General Laws. IMW By. SignaLure oi Zice se um er Title Type of Plumbing License L City/Town icense um er Master ❑ APPROVED (OFFICE USE ONLY journeyman The Convwnwealeh of A:fassachusefts Department of Industrial Accident' D, fie of Investi; ations I ' 600 Washino l`on Street , Boston, MA 02111 c www_masxgov/dia . Workers' Compensation Insitrance Affidavit. Builders/Co A • licant nformation ntractors/Eieatriciaas/piambers I Please Print Lm --b Name (Business/Orpaim6on/Individual): Address: City/State/Zip: Phone #: . F re you an employer? Cbeek.the appropriate box: ❑I titn a employer with 4 Type of project (required): Q 1 am a general contractor and Iemployees (full and/or part-time).* have biired the sub -contractors 6' ❑ Now construction❑ I am.a.sole proprietor or partner_ listed on the attached sheet. 3 7• Q Remodeling M* and have no employees These soli -contractors have working for me ht 8 Q Demoiidon any capes workers' comp. insurance. [No workers' comp. instaanoe 5. ❑ We are a corporaiitm.� its 9. [] Building addition required.) officers have exercised their i0•Q Electrical 3. Q 1 am a homeowner doing all work right Of exemption per MOL 11.0 Plumbing �� m' addj myself [No•worker's' comp. c t52, § 1(�F),'and we have no g' or add insurance required.] t employees.12•Q Roof repairs [No workers' COMP. insurance required.] 13•Q.Other *Any applicant cheeks boa' # t mast also fill out the section beiow showing their workers' oompensetiori policy information t Homeowners who submit this affidavit indicating they ars Bain arF ;Contractors that check this box must atm g wof and them hue outside contractors must submit a new affidavit indi abed an additiaosl sheet showing. the Hunte ofthe sub -contractors and their woriamm, cam ; . colic, >r fi o� j I am an employer brat islsrgw4v:workers' con pensatu n ena'uraare or informadon f mY employees. Below is the Policy arrd job site . Insurance Company Name - Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip. Failure to s Attach a copy of the workers'. compensation policy deelar-atiou page (showing the policy number and expiration da* fine up ecure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal to $1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and of fine Of up to 5250.00 a day against the violator'. Be advised that a coement may be forwarded to the Office a Investigations of the DIA for insurance coverage verification.py of this stat I do hereby certify under the pains and penalties of p.erjury that thein ormalioR ra ' f p Hided above is true and correct Si tt[rC: Date: Phone #: Qfj°IcW use only. Do not write in this area, ro be complete b or town o 3' cky fciaL City or Town Permit/License # Issuing Authority (circle one) 1. Board of Health ? Building Department 3. CitYtTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp ioym 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." 1` An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the'fomgoing engaged in a joint enterprise, and includi"g the legal representatives of a deceased employer, or the receiver ortrustce-of an individual, partnership, associatiain or other legal entity, employing employees. 'Howeverthe owner -of a dwelling house having not more than three apa3-tments 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 evideuce.oV compliance with the insurance 'coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither t3he commonwealth nor any of its political subdivisions shall enter into any coriftet for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have bean presented to the coxtracting authority." . Applicants Please fill out the workers' compensation• affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractWs) name(s), address(es). mind phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, an not required, carry workers' ccwsnpensafion insurance. If an LLC or UP 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 Ese sure to sign and date the affidavit. The affidavit should be returned to the city or town that the .application for.the permit or license is being requested, not tine Department of Industrial Accidents. Should you have any .questions rrgai-ding the law or if you are required to obtain a workers' compensation policy, please call the Department at the nurarber.listed below. Self incLre.d c-- paniec should ent--them self -insurance -license number on the'appropriatz 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 af5davit 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 permitlliceme number which v -ill be used as a reference number. In addition, an applicant that must submit multiple permit/iiccnse applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of -the affidavit that has been .officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be fined out each year. Where a home owner or citizen is obtaining a license or permitnot related to any business or commercial venture (i.e. a flog license or permit to bum leaves etc.) said pers6r3 is NOT required to complete this affidavit The Office of lnvestigptions would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give as a =11. The Department's address, telephone and fax number: The Commonwealth of IvMassachusem Department of Indmst W Accidents Office of 13mvestiipt ions 600 Washington Street Rasion, MA 02111 TeL 9 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised s-26-05 Fax 4 617-727-7749 www-mass.gov/dia Date A..... TOWN OF NORTH PERMIT FOR GAS INSTALLATION This certifies that. ........................ . has permission for gas installation in the buildings of�......... . at ,North Andover, Mass. Fee: Gt:? `�' Lic�..`....... vGAS INSPEGTO,R' L Check #` 7000 i MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date 10-9-6 -� NORTH ANDOVER, MASSACHUSETTS Building Locations L "+ �� Or yv-c Permit # �L 3 .3 Amount $ Owner's Name New 01_� Renovation Replacement Plans Submitted ❑ (Print or type Check one: Certificate Installing Company Name i ✓1 d `C.c/ Corp. Address Partner. �av� aa�.i► , I-4. ��k73 Fusin aep one ,,D37-1772 Firm/Co. Name of Licensed Plumber or Gas Fitter 'II14SURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes �� No 13 If you have checked Les, please indica 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 MasCreneral s that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 Massach44�etts State Sias Cid Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber —� t qo q Gas Fitter Icense um er ❑ Master �6urn 3eyman 1�1 GA' a cdFLz o ° z Ga U z w a x x x z W W �a � W o W �" x �z a w < �a Q � ° z o z o a. x w> w z x ¢ o o � O x o w 3 o t7 a v cC w > .. o o°, H O ,UB-BASEM ENT / `ASEM ENT / '1ST. FLOOR 2 N D. F L O O R i 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type Check one: Certificate Installing Company Name i ✓1 d `C.c/ Corp. Address Partner. �av� aa�.i► , I-4. ��k73 Fusin aep one ,,D37-1772 Firm/Co. Name of Licensed Plumber or Gas Fitter 'II14SURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes �� No 13 If you have checked Les, please indica 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 MasCreneral s that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 Massach44�etts State Sias Cid Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber —� t qo q Gas Fitter Icense um er ❑ Master �6urn 3eyman 1�1 GA' 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/Electneians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate bog: 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 \1 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working forme in any capacity. workers' comp, insurance. J. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t -employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other ".r,y applicant that checks box #I lin;st also fill icy information out the section below showing their workers' compensation policy t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, xContractors 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 isproviding workers' compensation insurance for nzy employeex Below is thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. Expiration Date: /'i�Jtob 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 GL 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 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): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract 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 apartrnents 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 f requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability.Partnerships (LLP) with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. _. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington. Street Boston, MA 0.21.11 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax 4 617-72.7-7749 v,,"-A,.mass. Dov/dia a3s> 'T(4 Y, p,'ke.. Location It 0 1 _ 1,a%% + No. ! _ Date �'• C6 w�S ,. TOWN OF NORTH ANDOVER Certificate of Occupancy $ ,'Ss�►cNusEtt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 7 Check # D Building Inspector ��� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A A�ONE OR TWO FAMILY D_Wl ELLING y. SectionN .J TWJ for Official Use Oni �.v'd. k'ey ��� •�M ..'�•._..rr �`q•��ia .'i�S,f�RZ�A .t� .{1.: ry. BUILDING PERMTr NUMBER: ly DATE ISSUED: j _ c6 _0- /hod / �6142z #/�oU � Building Comnlissioner/Ins or of Buildings Date Adage SECTkiD7Y 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 ZonnQing Information: •.� 00?` vy , 1.4 Property Dimensions: T�' Y_'j��/' �- Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Requimd Provided 1.7 Water Supply NLG.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Public ❑ Private Outside Zone ❑ Municipal On Site Disposal System ❑ y❑��yy yry�k+�g�zona {Flood T,7� 'ipn _ 16 17i. O tr'✓. {,7 � �n +r 5 1i:v L.JI IL Li tJ tI CA: deb f\C ..- . T 2.1 Owner of Record Name (Print) % Address for Service Z Signa re Telephone 2.2Arized A66t Name Print Address for Service: I -. �640 �r Signature Telephone I PAP, 3.1 Licensed Construction Supervisor Not Applicable ❑ Address License Number �S ,Oc��N ���___����•c/ i' %0. Dom--.. Licensed Constructi Supervisor. Tff Exp' 'on to Signatu Telephone 3.2 Re ' •tered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature a Telephone -0 2C 0 M DOe a 0 M z 0 z M 90 0 m r �1 J I, ,as Owner/Authorised Age He declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Nam Signa of Owner/Agent Date SECTiO 11,5 i`IM�!')E`Ei C(DN'S`ltl(il£t1S Item Estimated Cost (Dollars) to be €IIAT.1[IS$.Q1�I%� Completed by permit applicant rm 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC) FO n d ✓I S . 5 Fire Protection 6 Total (1+2+3+4+5) Check Number �� i r � i � � } 1 t Y t t Ir• � � 1S f} ( J J' � f t +`. )� _A't C '� d 77 Y NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr 2 ND 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MA'T'ERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE S'ECTIt)N 4 - WORKERS COMI'F,NSA'3E'ION.(M d; fw C iSZ � : (5� T' Workers Compensation Insurance affidavit must be 71711'7e7 711 submitted with this application. Failure to provide thisaffidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea ....... 1Y No ....... ❑ SECTION 5 - PROFESSIONAL DESIGN AM, CONSTRUCTION SEdtVICES, FOR BURDINGS AND STRUCTURES .,SUBJECT:.Tt? EONSTRUCTIUN CO1�iTlEtOI. PURStIA1�tT TO 7$Q CMR II6 (+COIVTATNING MORE TIIAND,5,(IOO C F OF: EAiCLQSED SPACI 5.1 Registered Architect: / / f 0,4 +[.0 Name: Address Signature Telephone S.7.Rarrtefn�.f if.Y.ge..i.,.ai`�....:�.::.✓ �: ; Name. Area of Responsibility Address: Registration Number Signature Total Expiration Date Not applicable ❑ Name: Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 5,3. G��seraD':.Cetetraetat� >n '',: ;, Company Name: Not Applicable ❑ Responsible in Charge of Construction c ' S I1Q1!+t b 11E R)I ' �►1+I d I+ ROI�t3SF. 3 '+FDRt (cite�lc a[I applica New Construction Existing Building 0 Repair(s) ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: Alterations(s) ❑ ( Addition 0 BUILDING AREA EXISTING if applicable) PROPOSED USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 ❑ A-2 0 A-3 ❑ IA ❑ A4 ❑ A-5 ❑ 1 B 0 B Business ❑ 2A 2B 2C 0 0 0 C Educational ❑ F Factory ❑ F -I ❑ F-2 ❑ H Hig Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ I-1 ❑ I-2 ❑ 1-3 ❑ M Mercantile ❑ 4 0 R residential ❑ R-1 0 R-2 0 R-3 0 5A 5B ❑ ❑ S Storage 0 S-1 ❑ S-2 ❑ U utility ❑ Specify: M Mixed Use 0 Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUIIAING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s T..a..T TT --'—L, /A\ - .• Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Owner of the subject property Hereby authorize My behalf, in all matters ati o work authorized by this building permit application $6wture of Owner Date to act on J P 1 I CA as K mo, �r- 1 z g O M�1 U P4 0 U O = a C -0 ad in C A 3 O u t 10 ai ai ' u O C Cl _ +� O E 1' a) 0- c 0 m ° •a oE U_ a► a tn m O C"ai u� z� a 0 U) LLIN W W W 0 I I cd 0 am tot Cid ��Z � Z C O ®� O � iAU Q�s � Q, � o C30 LL 0 = d coot: CL LL c lop ift m r 0 �g lu kn z ,,._t lou Ea" Sc .0 0c O O • 0 2 4N- EinCaj S cn 'CL U0. 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