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HomeMy WebLinkAboutMiscellaneous - Exception (194)M.C. ANDREWS CO., INC. GENERAL CONTRACTOR - CONSTRUCTION MANAGEMENT - DESIGN / BUILD - ENGINEERING 11 June 12, 2001 Mr. Robert Nicetta Building Inspector Town of North Andover N. Andover, MA 01845 RE: rBrooks:School //+0- Summer Day Camp Dear Mr. Nicetta Enclosed you will find the Architectural Field Reports, as you requested. Andrew C. Matses President 200 Sutton Street - North Andover, Massachusetts 01845 - Tel: (978) 557-7532 - Fax: (978) 685-2357 CHARLES GOLDSTEIN AIA/ARCHITE91URAI ENERGIES 200 Sutton St. North Andover, MA 01845 T 978-681-0055 FAX 978-681-1144 June] 1, 2001 Mr. Robert Nicetta Building Inspector Town of North Andover North Andover, MA Re: Brooks School Summer Day Camp Building Dear Mr. Nicetta, In accordance with the Commonwealth of Massachusetts Building Code, 6Th Edition, as regards Control Construction, please accept this periodic report relative to the above noted Project. This writer has inspected the work in progress from its inception. As of this date, the Base Building has been completed as follows: Foundation: All slab work, footings and walls, including retainingwall, and their required reinforcement(s), have been.installed in accordance with the approved Construction Documents. Framing: All framing, other than minor adjustments, has been installed in ' accordance with the approved Construction Documents: All palling and other connections have been applied in a workmanlike manner, in accordance with appropriate industry standards and Codes. Root'g/Slding: All roofing/siding/cupula have been installed in accordance with the approved Construction Documents and manufacturer's recommendations. Girl's Lay.:' Girl's lavatory is 90% complete Boy's Lay.: Boy's lavatory is 809'0 .complete, finish plumbing and "Kemlite finish remaining to be finished. As the building nears completion, i am pleased to write that. all work to date has been installed to the highest standards of construction. If you have any questions, please do not hesitate to contact this writer. Energies t. Gdd�f4i\AIA4C-ARB usetts Re_ 's eyed Architect No. 2547 Location )1(00 CO 1 ?y ti co, CP No. 0a r; Date 1M0RTh Ih TOWN OF NORTH ANDOVER Ot.•o • O i • OL S Certificate of Occupancy $ ',s•Eta' CNUS Building/Frame Permit Fee $ A16, JA Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector TOWN OF NORTH ANDOVER BUHDING DEPARTMENT COWROL =Rom APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Section for Official Use Ont sams- tomigg-g-mb YEENIM• Mt BUILDING PERMIT NUMBER: kov-r-t. A-4aiP0Q% JDATE ISSUED: SIGNATURE: Building Commissioner or of Buildings Date ROOMp '.11. Property Address-: V.: 1.2 Assessors Map and Parcel Number. 70 Parcel - 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot I 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard S tear Yard Required Provide Required Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Info tion: ral System: Public 0 Private D zone Outside FIc On Site Disposal System 0 2.1 Owner of Record Name (e6t) Address for Service X n - Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable 0 �o 1Y1\16. Alvcz�� es - Addressr License Number Y4/'V Licensed Co ction Supervisor: Yh 3A Z Expiration Date Agnatu Telephone g, 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name'. Registration Number Address Expiration Date Signature Telephone Uv M 3� 4 0 M Z 0 Z M 90 0 In M r - r Z G) r _ Via.. WO a7" •. I, e �% 7tv' � ,as Owner/Authorized Agent Hereby 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 ame Z9 rj tgnature of Owner/Agent Date Item Estimated Cost (Dollars) to be Completed by applicant. permit 1. Building p (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing A Building Permit fee (a) x (b) d� o A / 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Q v c) d _ -- Check Number �FA2,v'4a�''t ``. w{.Ftk+•i.,( 1. t 4 f45y 9.%(Si ��G«�.�y�'Fi)4ifi 1 j V f IF y r.i i� ��. is q. v4°-kt.'..<xh+ gid,.l:;�� Y.::-j•�.kk`fT � i' yi' ;.}.;Jg t l).�fi i.,. A' &3 . 4. ) S-:;'� i ! #`fLis i. ,fy= 4 .b iS 4 pC /, .F 1. .t•ry.. lY/ •a `F �� �fYl��'3 .a. '°P2i' a t dTk i sy�1 k a✓� a h +`1s tt�� ,",7 y, 1 1.+. 4 ,sw,. .SS r'h �, -,�• ��v;'h. .:�. u' .c i t NO. OF STORIES O SIZE Sd BASEMENT O S SIZE OF FLOOR TIMBERS S . lS 1 � 2 D 3RD SPAN z�•— r DEMENSIONS OF SILLS X DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION // r THICKNESS SIZE OF FOOTING ! 2 . �� X MATERIAL OF CHUVINEY IS BUILDING ON SOLID OR FILLED LAND a c IS BUILDING CONNECTED TO NATURAL GAS LINE -.T TOWN OF NORTH ANDOVER BUILDING DEPARTMENT CONTMOL CMRUCM APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING for Official Use Onl p BUILDING PERMIT NUMBER: Rer ' i �`�"' S DATE ISSUED: ^. dO5Z8 Cfla p% Pe ft tt 107 /yJ SIGNATURE: Zero Buildina Commissioner/I or of Buildings Date ' 1.1, Property Address: 1.2 Assessors Map and Parcel Number. V�iiq% /�LO q® C / dCD / Y �• �/�/1JQi/G�. /�1/�� M-0um Parcel 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BU1 DING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide R ed Provided ReqWrW Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Irfounation: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record e s c 04>4 j/ oZ® ���r lN_n X'/7. Name ( nt) Address for Service 696, Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ zao C..5- SAddress AddressLicense Number Licensed-Coq4truction Supervisor:ExpA) iration Date Date -7 -T-3 Agnatu, Telephone e. 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone I 1, as Owner/Authorized Agent Hereby 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 Maine -SSitature of Owner/Agent Date Estimated Cost (Dollars) to be Item Completed by applicant permit 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of ro Construction from (6) do 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) IAI C- 5 Fire Protection 6 Total (1+2+3+4+5) 3,0 C,-0,0. Check Number RON u NO. OF STORIES"SIZE BASEMENT Of !I�A SIZE OF FLOOR TIMBERS iST 2ND 3PD SPAN 7j— r DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION v THICKNESS SIZE OF FOOTING f�C2,S x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND 19 IS BUILDING CONNECTED TO NATURAL GAS LINE VI - IRA SECTION 4+ORLoD ENiAIitR+TtG�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.' Signed affidavit Attached Yea .......❑ No SECTION 5 PROI�ESSIQIAL �E&TtNNStiC11IC�N SYJ�C"lSt,Z1N SAd ii'lY3KE i C©NSTRiCiEf iN $Ttti!7 l€1' Ci! i1xl$iA►s5 + iCt)SI�i'A �b 5.1 Registered Architect: ED y Name: ame: =No. 2547!2 'a GV �ff • " eosront. $ Address �� MA a OF Signa a Telephone Name: Area of Responsibility Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Name Registration Number Expiration Date Address Signature Telephone Not Applicable 0 Company Name: Responsible in Charge of Construction New Construction tEr- Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: iWUflZ`ts2or,.-77 v i 4. — ccFsS w ' xT A-1 0 A4 ❑ A-2 ❑ A-3 A-5 ❑ BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels O%/& Floor Area per Floor (sq iZ s L 1 Total Areas Total Hei¢ht (ft) Independent Structural Engineering Structural Peer Review Raluired Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,as Owner of the subject property Hereby authorize 1/I.l �4No,,z tvs `� rG_, /, yj pQ,� rp /'yi�4 i3��S , to act on My behalf, in all rel ve two work authoriz by this building permit application x_ X S'- 29 - 01 Signature ol Owner Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A4 ❑ A-2 ❑ A-3 A-5 ❑ ❑ IA IB ❑ ❑ B Business ❑ 2A 2B 2C 0 0 ❑ C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B 0 ❑ IInstitutional ❑ 1-1 ❑ I-2 ❑ I-3 0 M Mercantile ❑ 4 0 R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility Specify: M Mixed Use ❑ Specify: S Special Use ❑ 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 O%/& Floor Area per Floor (sq iZ s L 1 Total Areas Total Hei¢ht (ft) Independent Structural Engineering Structural Peer Review Raluired Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,as Owner of the subject property Hereby authorize 1/I.l �4No,,z tvs `� rG_, /, yj pQ,� rp /'yi�4 i3��S , to act on My behalf, in all rel ve two work authoriz by this building permit application x_ X S'- 29 - 01 Signature ol Owner Date O b 21 O �•N O Q CA Cn n C2 CL m Z y' n,o Nle _1 O "� .d.► CDCL CL m y TI � omd o y 101 O ? m m i > >CA CD -00 cc O G y. n O C � O y � 1 CL Co ono : a• • iP OCD N Co to p m CA Sit. p d ti :A N O n � C y Co sowco p C CD O p Go w� moo' Co ... n . O OCD . a3 to _ CO dl i n� GoO W z ocn r Ct7 \q, o hY I w o G w G 03 rA c � QZZ _i x O U� =CA o n 70 (ACD O C,ZCO) O =. O. r CO � CL o y >= —Z � 0 � o p CD CD o cr d CD CD O CD C CD y. =L. C2 y s■ O I CD � CO) v O 'o C° Z .a ao o CD 0 CD O b 21 O �•N O Q CA Cn n C2 CL m Z y' n,o Nle _1 O "� .d.► CDCL CL m y TI � omd o y 101 O ? m m i > >CA CD -00 cc O G y. n O C � O y � 1 CL Co ono : a• • iP OCD N Co to p m CA Sit. p d ti :A N O n � C y Co sowco p C CD O p Go w� moo' Co ... n . O OCD . a3 to _ CO dl i n� GoO W z ocn r Ct7 \q, o hY I w o G w G 03 c o b O r x O n C cn d O GO GO O —Z =1 z O ti tj Op 0 c C/) DO C m 0 •Ac CP S� G O d = O = vi O crH CLO :9.0 y -� O � m O m C9 y O HCSaC m v Z s-. y y oma, 03 °: m yCL o' • C � homy o y lel O m : CD 2 v' �• _ = m-1 CDn cc Z�O CO) n C) a CD H a :J CL mCD H . cC ?� a!4� nd ��:r• . cd� :r cm CD m o: CCD p = �o: ti '% CL �• U' H tia vO C7 =r m dy 'C d CD O oo CD p o z C=D _. G CD y O 5 3 N ,..� CL. v y mCD O � C2=: co. CD CD .i CO) CO2 p c7 oq � ' cO-.i Cp'� p.••� _ W: CCD Z. C-3 MCCA C,*�. CD '�CC3 CSD O O CD IJ M M v � ^n (tip arA x ; x r O x It z ? z O x Tm G a � G7 r U O Z 0 0 c Town of North Andover of t�°RTH y" �Q Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 ' 'T D 4 LSSA [ Nl] DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit 9 the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: Facility locatio ignature of Applicant Date 5-29_ 0/ NOTE: A demolition permit from the Town of North Andover must be oained for thi �s project through the Office of the Building Inspector. Office of Investigations Boston, Mass. 62111 Workers' Compensation Insurance Affidavit Name C. � U t-ew C-0 (�C Location: 2 UCS U TT•OnJ S t2LZ� City o(2, AtiL0MA 0 18Y 5Phone ��� ' S S(� 7E 3 � am a homeowner performing all work myself. El am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. AridfeSS W�ou I n2-, �^ Pa r k A A)5 c 5 L&'?-tO Phone #: C� -7 ov 0 v-e,,j 5 J ti S L,/( -r, �-L-o Comoan name: Address # WC.066(Lo 0 Citv: Phone n - Insurance Co Policv # Failure to secure coverage as required under Section 25A or NIGL 152 can lead to the imposition cf criminal penalties of a fine up to $1,5GJ.00 andlor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a rine cf ($100M) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations cf the DIA forco,,srage verification. 1 do herby cert,r/ under Signature, of perjury that the information provided above is true and ccr- ct CJS f' dYr A7s� �-, Z Print name._ Phone M �� - 5�7 --7 5 O- iQial use only do not vrite in this area to be cemoiete-d by cit/ or to ;n or;cial' ❑ Building Deo ❑Ohe<--k rr imr„edlate resoonse is requir - Building Dept ❑ Licensing 80 ❑ Selectman's C: ----, G,nt-•ct person:_ Phone:: ❑ Health Depar':- ❑ Other zopsf ,v0RXV,',y'S co.UP-NS1TION /te �ana�nai�ureal!/c cf',.11vx,ac/zu�e� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 055435 I e Birthdate: 09/23/1965 Expires: 09/23/200 ^ Restricted To: 00 ANDREW C MATSES 200 SUTTON ST N ANDOVER, MA 01845 2 Tr. no: 828 I� i Administrator J A N2 2063 Date .... y .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING T Q -,?— This certifies that ....... ...... I ...... 1/1/(( Z' ,;W/ ... ............................. has permission to perform... ****"* fl r. 1-2 wiringin the building of .................................... ........................................... at ....... / N ........................................................ ... orth Andover, Mass Fee LZ Lic. �.!� .`l .obi / G�' ELECTRICAL INSPECTORCheck # W.(E- WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Rough Service 01 41 (�IIIItmvniuralt4 of MaSsar4ulutis • Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Final Office Ux Only Permit No. / Occupancy b Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of id ftivkh t"'"A 6 � ,� The undersigned• applies fora permit to perform the electrical war Data pl/"r " ` 501ao To the Inspector of Wires) Location (Street b Number) 116 "CC G-afa Vbl',r, (60" Owner or Tenant K7 S c (doL - < cUm �t el -I 09,m Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building StJytV'tW CAVAV "7a1Vr_)UUtility Authorization No. N OIve— Existing Service Nope, Amps / Volts Overhead ❑ Undgrd °❑j No. of Meters 000C -New Service "_Amps —I zo I Volts Overhead ❑ Undgrd !tel No. of Meters Number of Feeders and Ampaciry Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receatacle Outlets No. of Switch Outlets No. of Ranges No. of Dispersals No. of Dishwashers No. of Drvers No of Water Heaters , KW No. Hvdro Massage Tubs OTHER: 1 l% 3 TOTAL No. of Hot Tubs No. of Transformers KVA Above In - Swimming Pool Rrnd. ❑ grnd. ❑ Generators KVA No. of Oil Burners No. of Gas Burners FIRE ALARMS No. of Zones —�.-- No. of Detection and 7727— No. of Air Conditioners Tons Initiating Devices No. of Sounding Devices. Heat oral total No. of Pumas Tons KW No. of Self Contained Detection&unding Devices 5oace/Area Heating KW Municipal Local❑. Connection ❑Other Heating Devices KW No. or No. of Signs Ballasts Low Voltage Wirin No. of Motors Total HP - INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YESNO ❑ !have submitted valid proof of same to this office. YES U NO U If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ;9 BOND ❑ OTHER❑,,((P/Please Specify) (Ex)iration Date) Estimated Value of Electrical Work $ h Work to Start AYYil.- 2,200) Inspection Date Requested: Rough Final Signed under the penalties cif perjury: + �2A FIRM NAME W ,, ►VnilO ZZI A/c- LIC. NO. w1u ,�NM4zZ Signature LIC. NO. " Licensee (�� 6 Address 'tel rk "'" a tPlK 11I O — Bus. Tel. No. Q All. Tel. No. INSURANCE W shat t atio not thsethe insurance coverage ori substantial required tredMassachusettsGGeneral Lasand that my signature on this perm application wagvesirequirement OwaAgP�c�one Telephone No. PERMIT FEE (-7I/ M.C. ANDREWS CO., INC. GENERAL CONTRACTOR -CONSTRUCTION MANAGEMENT - DESIGN/BUILD //G� TRANSMITTAL LETTER Sc (4, Date: 'j - Job: S� k n.`c-✓ 1 C v` - _ Architect: TO Ay_ c . f U � 'n G r iv V ��- � b �'. Trade Contractor. F 211" WE ARE SENDING HEREWITH ❑ WE ARF RETURNING HEREWITH ❑ FOR APPROVAL ❑ FOR REVISED APPROVAL ❑ APPROVED ❑ FOR FIELD USE ❑ FOR YOUR FILES ❑ FOR PROGRESS -ORDERING NLA-NWACTUR NG ❑ APPROVED AS NOTED d' AS PER YOUR REQUEST ❑ RESUBMIT FOR APPROVAL ❑ RESUBMISSION NOT REQUIRED FOLLOWING (Drawings — Specifications — Schedules): Z COPIES Cz V S a�a t-.� E' I _ (7A I-C-�2 -Z - -0 f: RE iv1ARK S : E, r� VERY TRULY YOURS, M. C. ANDREWS CO., INC. 200 Sutton Street North Andover, Nfassachusetts 01845 —Tel: (978) 557 -7532 -Fax: (978) 685-2357 1 Location I I( Len Ozc,� i \ aN> ._ g t--) No. I D9 Date r r NORTol TOWN OF NORTH ANDOVER • L D Certificate of Occupancy $ vv 01 ; sACHUSEt� Building/Frame Permit Fee $ V6 S i v -A Foundation Permit Fee $ Other Permit Fee $ TOTAL $ v� 6 E Sa Check # ol r 14 5 - `�' Building Inspector cown TOWN OF NORTH ANDOVER BUILDING DEPARTMENT WIWARVU11WIT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING S Section for Official Use 0 WELDING PERMIT NUMBER: DATE ISSUED: C, SIGNATURE: zz Building Commissioner/lardor of Buildings Dae W, Tx NPz1fV 1.1 Propert Address: 1.2 Assessors Map and Parcel Number. 170d 4 /oz Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage (f L) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required— Provided Requimd Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 private 0 zone - Outside Flood Zone 0 Municipal On Site Disposal System 0 2.1 Owner "ofRecor N (Print ,---. Address for Service: Signature Telephone 2.2 Authorized ent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable 0 Address License Number z— Supervisor: Co ction Ly Exl5iration Date ,&nature Telephone 3.2 Regiitffed Home Improvement Contractor Not Applicable 0 Company Name- Registration Number Address Expiration Date Signature Telephone as Owner/Authorized Agent Hereby 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 /��C✓ t? S gture of Owner/Agent ' Date Item Estimated Cost (Dollars) to bePl Completed by applicant z� permit 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) Co 5 Fire Protection -ro -3,5% o0 6 Total (1+2+3+4+5) G e7 r Check Number o2� ,C �: S trce°i3' 1,:,,' f'. jJ �i41. ,"kY A iii i k}��l.• f1 -! -. if .., ink '�'. FV v. �4 ('.(tYt•.-�' 4y -i�y, :{'. :s fit y 'YS'J. a,• :k5i .; ,�.Y4 �'.; '..y G :... .r 1. •,ks ^{: ii fs % 5�. h."", ks$c i �-� S �, 't�p ,� 1.(„1i r tFc�, ... .?�x�i• Y'�+7ha+S Y :c:58"1 .a .:., a 7Ffe�f.t irt•� ea r" ..4�>n"'1 e� :aft t y .;G �Y... - X45 Kr. t�'.-`?GkXt 'f_Tl+() +Y%�•4 C.'+it {7�1�t _{> /�4 iE d 41',�i{6t �'d �x3. "�'."�S."dX t }M�fX t. ;�i.,v� 9 �+�'�.I ��$,qJ yQ �,. '�ayy' tnST �f /iy 1 4\ f �'. kt_`+.: �� 'i c;l;.�:.t5!.y ,rk.�h x.',iL� i�„d %5.. �34 R ,.'�1qE _j4ti trYi nx i. oq � tf1 s✓ �R K S .. SC, ,. Ll (S , i�. 4{`yy 4'./I:�;�tvf�s `Y.•� A4. rPd >1r! fi, •/1h? : l 3i'"ti.c .41: NO. OF STORIES BASEMENT !(SLAB SIZE OF FLOOR TIMBERS s 1 2ND 3RD SPAN -?S r DEMENSIONS OF SILLS 2 DEMENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS to l/ SIZE OF FOOTING �Z S X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND & L, IS BUILDING CONNECTED TO NATURAL GAS LINE �p ;:a -• i q '€,,yj'`"�1`� r�2 tri, aikmfi'7',°a '~.fes'. J �� s �r•�'. fF S i r r:_ 9 3s - U . 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. Signed affidavit Attached Yea ....... No ....... ❑ SECTION 5 -TROIFMONAL If SIG t A1Y 9rzC tST CSC ISN SI ItVIC1LS F4R I3I3I D NG3 Atm CON�TgUC�TION CQAIiIi I'[�7AN�`'�'CY �8Q C 1 t� (�i�TTA�t'I1�1 11�Q� �Al�D�3�, C~�, 31` E�bSL1D`51PA 5. I Re istered Architect: Name: Addr Signature Telephone/ , &C� " Name: Area of Responsibility Registration Number Expiration Date Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone yyy ��yti ISI. [p-A/5/Lt k1S �O �y1/L Not Applicable ❑ Corw=y Name: Responsible in Charge of Construction U,840000,40 New Construction Z' - Existing Building 11 Repair(s) ❑ CONSTRUCTION TYPE Alterations(s) 0 Alterations(s) Addition 0 Accessory Bldg. 0 A-2 0 A-3 A-5 0 Demolition 0 Other 11 Specify B Business Brief Description of Proposed Work: 1 5, -, 9!- 1, 2A 2B 2C 0 0 0 3 F Factory -0 F -I 0— F-2 0 H High Hazard .0 3A BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor (sf) Total Area (sf) Total Height (ft). Independent Structural Engineering Structural Peer Review Required Yes 0 No -E] SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,as Owner of the subject property Hereby autho to act on MY in all ;=�a relative two work authorized by this building permit application X_: � _� r� �. - I 'k_3-20-01 Signature of Owner Date - ,WJ, jill, 11 ill - J­JWW,'1J,J J 1, USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 0 A4 0 A-2 0 A-3 A-5 0 ❑ IA 113 0 0 B Business 0 2A 2B 2C 0 0 0 C Educational 0 F Factory -0 F -I 0— F-2 0 H High Hazard .0 3A 0 0 1 Institutional 0 1-1 0 1-2 0 1-3— 0 M Mercantile 0 _313 4 0 R residential [] R-1 0 R-2 0 R-3 0 5A- 5B u --*,- 0 S Storage, 0 S -I 0 -S-2 0 U utility 'V Specify: M Mixed Use 0 Specify: S Special Use, 0 Specify: COMPLETE THIS SECTION IF EXISTING BUH DING 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 (sf) Total Area (sf) Total Height (ft). Independent Structural Engineering Structural Peer Review Required Yes 0 No -E] SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,as Owner of the subject property Hereby autho to act on MY in all ;=�a relative two work authorized by this building permit application X_: � _� r� �. - I 'k_3-20-01 Signature of Owner Date CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number Date THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS ._ ti, 4 ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILD9G CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO e -i Cs ADDRESS Building Inspector 1 CD /�z/�c / � , Q E x yr cn y F.. -. Cn _ AR .� rte^ � C C U 0 O "Cat', y m m y T Ci. R Mn N �. * /CD �� uJ J.... R O E. to At � y a� .1Y T, coo, �r J :Y � - 4 fi � � S •{ ^* � .moi - + VT ``� �,_. J 4 `.; �! •Y. "�, �` .-4 ,S esti.-'^4. �• «,* ".y ..i ''3;. ! l'. , k 45 CD /�z/�c / � , Q E x yr cn y F.. -. Cn _ AR .� rte^ � C C U 0 O "Cat', y m m y T Ci. R Mn N �. * /CD �� uJ z O J.... CA � y z O MAP Town of 1s �° NORTH ANDOVER PARCEL �DulL3cy LDt72 BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT: �uYVMC!fZ A(Dl- INSPECTION DATE: UNIT NO.: FLOOR: WING: BUILDING NO.: t i I.�c� �3C �C o ►�t� S C - , rn =.usu%_04, A)0 P& r-Wfssl; t Vt� J� 'j -b '��w►�-�-C. k�c"kior2-" /�-LL 7/lw wp-erL �='2v.�-t�j�7ZioC tales-LLs S��I � ° � d- `�` ►'�� ire-amt-�o� ovr�¢,�y rg-n.� ra- -'� Goz2� ALC �'ra�Ittit CeD w�-t /fir- too r� ip Gt-t 57 k-ewc-a Y_ ZL-'71 11 OHM U LO 1 KL+ LL+ ASL P OKIVI INSTRUCTIONS: This form is used to verify that all -necessary approval /permits from Boards ant ' Depar mments having jurisdiction have been obtained. This does not relieve the - applicant and or landowner from compliance with any applicable requirements. liJ, G : �NQ2Ews �'c� .LTC APPLICANT vie .J' Sc {�o C)Z --_ PHONE 970 ASSESSORS MAP NUMBER 4d0410S LOT NUMBER SUBDIVISION LOT NUMBER STREET�'— STREET NUMBER 116,0 ....................■................................................. ....■ OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS COMMENTS DATE APPROVED � d - FOOD INSPECTOR -HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS p DRIVEWAY PERMIT 1 b* 'BO -7 bo FIRE DEPARTMENT --E)P- 4,. ort is LCK CONSENTS DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE r�Iplll -,?,6 -C 1054, APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. / "' �[i 1-91— Application by the undersigned is hereby made to connect with the town water main in dfegd, - /,I Street, subject to the rules and regulations of the Division of Public Works. _ The premises are known as No. or subdivision lot no. Owner 4- 13 le Contractor Address Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants pen to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. f Street A Inspected by Date Board of Public Works t By See back for rules and regulations 11652, APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. AaIC4 19� Application by the undersigned is hereby made to connect with the town sewer main in 01YStreet, L4 subject to the rules and regulations of the Division of Public Works. „ �• n The premises are known as No. or subdivision lot no. fl � G'�1.��9I �J ✓tf.r1��T Owner R/7 Contractor J Address A Street PERMIT TO CONNECT WITH SEWERAIN AlJ,/% The Division of Public Works hereby grants permission to /'( C_ 41-4Yl id&12`7 to make a connection with the sewer main at �42� ✓el�2I�'� Street subject to the rules and regulations of the Division of Public Works.. Inspected by Date Division of Public Works See back for rules and regulations liy6'zu, See back for rules and regulations Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance At>!davit Please Print Name: : C• �ti�r2W C-0 Location: 2 00 cU T-rOr,,l S-FqC=�T "A 0 18 1/ ; I am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees r-nrnnanv name: �-78 - SSS - 7E 3 on this job. 1vy I'US U'z{rUC(-F- Address i O S �0 City' ��y �X � �i n10 �a r 14 A Aj 5 R' S �`zu0 Phone*.- Insurance Co. SL�t SU(� �V Policy.# LU 0 66 ( (-o()-:7 Company name: Address City -- Phone #: Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a rine of (5100.00) a day against me. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the infnnnation provided above is true and correct Sign Print name Oficial use only do not write in this area to be completed by city or town official' ❑Check d immediate response is required Building Dept Contact person:_ .=OR,W WORKMAN'S COMPENSATION ZO/ v hone # `�l 7e, - ss% --7 S 3L Building Dept p Licensing Board Q Selectman's Office C] Health Department 0 Other m M m W 0 m O O co CD y CD O I y d O O CA O CCD CD y CD CO) 0 CD 0 CD O cn Q y m !OY m A Z H � Sm NR 0 �-►_ �O H at.. o C L 0 CD O m H G o o m m o0 = m C � cc y co), � C SH a 8 CL Cfl O CD CD y CD n -o a m _ CD O H � N co H = CS d d C N < _ s �m y y y CD 1 " a S 3 �A cg 0 CD r. S �_ r 'RiA ^I gs • O C3 C IM sm CO3 C'! m T m CA x 531 m o z o o o cn f0 r o•� d 0 . n O .��. 0 z cn r ^ V/ �• CT1 i �p b' I O cn Q y m !OY m A Z H � Sm NR 0 �-►_ �O H at.. o C L 0 CD O m H G o o m m o0 = m C � cc y co), � C SH a 8 CL Cfl O CD CD y CD n -o a m _ CD O H � N co H = CS d d C N < _ s �m y y y CD 1 " a S 3 �A cg 0 CD r. S �_ r 'RiA ^I gs • O C3 C IM sm CO3 C'! m T m CA x 531 m W z 0 O )mq 0 9 o o o o o o•� d Uj . n .��. O oil W z 0 O )mq 0 9 k CHARLES GOLDSTEIN AIA/ARCHITECTURAL EN RGIES 200 ; stton St. North Andover, MA 01845 EW 18481.0055 FAX 971-1144 March 20, 2001 Mr. Robert Nicetta Building Inspector Town of North Andover North Andover, MA Re: Brooks School Summer Camp Building Code Review Use Group U Construction Type 5B ELEMENT REQUIRED P ROVIDED Exterior Walls 0 0 Fre Separation Assemblies N/A /A Fire Walls & Party Walls N/A t` /A Fre Partitions 0 0 Smoke Barrien N/A IN /A Interior Load Bearing Walls 0 1 Floor Construction Incl. Beams 0 C Roof Construction 0 C HC Accessibility Yes Y -'s Egress Required 3'-0" -0" Respectfully submitted, Charles Goldstein AIA/Architectural Energies Charles H. Goldstein AIA NCARB Principal Town'of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM f �yOitT}{ O �tLto �6 t o OL CO[wCywKw ��SSgcNos���y In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # J DI the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: Facility locati Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. s... _,,,�.,.y-:: ✓!LC lid'IIL%)Ld'fiflJCCiGI/L d�✓�qQ����^ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ,. Number: CS 055435 Birthdate: 09/23/1965 Expires: 09/23/2002 Tr. no: 828 Restricted To: 00 ANDREW C MATSES 200 SUTTON ST N ANDOVER, MA 01845 Administrator i J ra—. (GUI) I U 1-4.J4U L/GIC. JI/ -Ulu 1 VZ1.4 1 /11YI r-dIjc G VI .3 O AC ORD CERTIFICATE OF LIABILITY INSURANCE OP ID D7 DATE (MIA 1 L MCAND-1 03/20/20/ 01 PRODUCER THIS CERTIFICATE IS ISSUED AS A (MATTER OF INFORMATION POLICY NUMBER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Catalano Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 251 Broadway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Methuen MA 01844 Phone: 978-688-4667 Fax: 978-682-9037 INSURERS AFFORDING COVERAGE INSURED INSURER A. COMMERCIAL UNION INSURER a SAVERS PROPERTY & CASUALTY CO. 02/11/01 INSURER C M C Andrews Company Inc 200 Sutton St No Andover MA 01845 INSURER INSUP.EP. 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MlkDO/YY POLICY EXPIRATION DATE MIWDO!YY LIMITS CENERALLUABILITY EACH nrrLIPPENCE S 1000000 A B COMMERCI-LGENERALLIABIUTY ABR625921 02/11/01 02/11/02 FIRE DANArE(A"yonehrei ¢ 100000 -1 MED Exp (—i one perecn) 5 SDDD CLAIMS MADE FX PERSONAL L AO`: RAJUPY S 1000000 GENERAL AGGREGATE S 2000000 GEIt AGGREGATE Un9T APPLIES PEP: PRODUCTS CCr,1P�_F A_r. ¢ 2000000 _UCY JEC7 LOC P ; PR0.El AUTOMOBILE LIABILITY APPY AUTO COMBINED SINGLE UMIT S (Es azcioenti ALL OWNED AUTOS SCHEM4E0 AUTOS SONNY INJUR'.' S (Perperionj HIRED AUTOS NCIN-O=VNED AUTOS BODILY INJUP� S (Per ao:ioentj PROPERTY DAMAGE ¢ (Per awoerrj GARAGE LIABILITY .AUTO ONLY - E=ACCIDBIT ¢ E- ACC S OTHER THAN MJYAI!TO .e.UTOONLY AGG ¢ EXCESS LIABILITY EWCHGCCIIPP"cro.E ¢ 5000000 A AIM OCCUR CLAIMS MADE CBDV04288 02/11/01 02/11/02 AGGREGATE S 5000000 S $ DEDUCTIBLE ¢ RETENTION ¢ B WORKERS COMPENSATION AND EMPLOYERS' LUABILITY WCOOO1607 02/11/01 02/11/02 WC ST=DTI+ TGRY ITU•nTS ER L' EL EACH Ac -:*,ENT ¢ 100000 ELDISEASE - EA. EMPLOYEE ¢ 100000 E L. DISE-SE- POLICY OMIT S 500000 OTHER r DESCRIPTION OF OPERATIONSILOCATIONSVEHICLES;EXCLUSIONS ADDED BY ENDORSEMENLSPECUIL PROVISIONS RE: SumTrner Day Camp Building V crtllrwnlc nvLVcrc I N I ADDITIONAL INSURED; INSURER LETTER: A.MI'4"LLN I I%JIV Brooks School Great Pond Rd N Andover MA 01845 BROOK01 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 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. C/) m ''m VJ 0 c y C � � 0 C'1 Z y O CL �• y � o CD o p CD o CL cr s r* CD CD O CD C CD y. —• CD CL v CO) —• o c� CD n � t 0 C/) O, ^ � l J O c .n . cn OK zo Hz VJ ,.d r.:: Q 5 � �O _y �` O co! d O O O y'm .n► C �o�a d d m y CD > > m C 0 o Z�.C-21 O , d Om m o=g � Oa y CD c CCDL m O y � d y H CLW C o ,i = . C36 CCD CO m � lco 'M y 9 oC 0 ~ C90 ACD o 1 d C e 2-0 n'o of CA n m T T CO) _ v m �o C o •ro o ro o Sr - \9/ a ox � no o � CA O o � � z z 0 O y 0 O C CD N � L + t 00 W