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HomeMy WebLinkAboutMiscellaneous - Foulds Terrace 30MetLife Auto & Home® Homeowner Operations Field Claim Office Mail Processing Center P.O. Box 2201 Charlotte, NC 28241 (800) 854-6011 OA August 1, 2014 North Andover Building Inspection 1600 Osgood St Suite 2035 North Andover, MA. 01.845 Our Customer: Neff Casaburri and Joyce Casaburri Claim Number: JDE53608 4X Date of Loss: July 24, 2014 Dear Sir or Madam: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has -_ been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten (10) days if there is a pending or existing lien against the property as provided by M.G..L. I39 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 30 Foulds Ter, North Andover, MA Sincerely, Larry Branco – FLD - DR Metropolitan Property and Casualty Insurance Company Senior Claim Adjuster (800) 854-6011 Ext. 7177 —_ Fax: (866) 958-0736 Email: lbranco@metlife.com MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates, Warwick, RI. MPL MA-REGDEPT Printed in U.S.A 0698 9408 Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ....... .. ....... j.. .... 4-�,� .. ).... qe has permission to perform ..... aA .............................. .......................... wiring in the building of .. ... , ............................ ...... ..... . r ....... . Nqrth Andover, Mass. ) - Fee Lic. No. . ...........►k Check 113�L- ELECTRICAL INSPECTOR Lou""///V//WCQ/!.// VI Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: i ?—to City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. LL Location (Street & Number) 3 U Fou I d S r -e rr-o-c-' Owner or Tenant J0,- c A CCt.s l brrr! 1 Telephone No. Owner's Address s cx M Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- Elo. rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pum P Totals: Number .......................................................................... Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection 7 No. of Dryers Heating Appliances KW Security Devi es or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsNo. of Devices or Equivalent OTHER: Pori' Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pat a d penalties of perjury, that the information on this application is true and complete. FIRM NAME: T I r J i e F C LIC. NO.: Licensee: ;:w Signature LIC. NO.: t5 -3d -q;? (If applicable, enter "e mpt" in the lice n a number line) Bus. Tel. No.: — 65 S- be a,? Address: �9/K�'r�n Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's Owner/Agent Signature Telephone No. PERMIT FEE. $ i=q-lb P-ul '7_r�-ick Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... [441F:T�� K...... 4e<.Zn . ................. has permission to perform ...... I)AP'171—exv ........................................... wiring in the building of ..... 0, S A2. A. UX 9—II ..................................... at ...... .........J !t ./C!en ...... J!t./Cle .............. morth Andover, Mass. Fee.3:7•'�©:.. Lic. No..(�.1'9 ......... .. .... . . ...... ... INSPECTOR Check # 7605 -C\- Commonwealth of Massachusetts Department of Fire Services UV BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 71a 5 Occupancy and Fee Checked tev.1/07] P.aVP 1,lanlri APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: �� 3052 O 7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number& r ay LT>-%. T gUARt. t Owner or Tenant _Mo' CPf� �� / Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Q No ❑ (Check Appropriate Boz) Purpose of Building 12,C5 t n &L— Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ Location and Nature of Proposed Electrical Work: (- No. of Meters No. of Meters rmmnlotinn nftho t ll.....;-- #-m- .... . i— _-y i_..c _ z__ No, of Recessed Luminaires -- • •���••� •••.• No. of Ceil: Susp. (Paddle) Fans .au« rrruy ne wutveu u ane ins ector oJ Wires. No• of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ o. of Emergenc-y-ighting rnd. grnd. BatteKy Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 4No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pump I Number Tons KW.... No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Water No. of No. of No. of Devices or Equivalent Heaters KW Si s Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attacn additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Elec 'cal Work: (When required by municipal policy.) Work to Start: O Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability ins ce including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the a.ns and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: �� lr 11 f L LIC. NO.: �8 Licensee.- t1 ,,,q-tZ!!� Pwz-L%2T-)yj9— Signature LIC. NO.: 94S --7A (If applicable, enter "exempt" in the license numbgr line.) Bus. Tel. No. %'( Address: '-7( �-011 �iT LR-+�� g-� c E of.4 , -O&�y Alt. Tel. No.• - *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Q0.4-4* o 6 7 �� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 3 www.nwss.govA a . Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibiy Name Address: S/ e City/State/Zip: 1�� ,` , ^4 Phone #: Are you an employer? Check the appropriate box: I . ❑ I a employer with 4. ❑ I am a general contractor and i ployees (full and/or part-time).* have hired the sub -contractors 2. I am.a-sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub -contractors have working for mein any capacity. workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its required.) officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No -workers' comp. c. 152, § I (4),'and we have no insurance required.] t employees. [No workers' comp. insurance required-) f7 Type of project (required: 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9.❑ Buil ' dition 10. lectrical repairs or additions 11.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑ Other 'Any applicant that checks bolt # 1 must also fill out the section below showing their workers' compensation policy information. t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ,Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers' comp. policy information. I am an employer that is.providing workers' compensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: Policy # or SeIf-ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $4500.00 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 cgi# under the _/ that the information pro viW d ove ' true and correct Date: O �/ Official use only. Do not write in this area, to he completed by city or town ofciai City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing 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 apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also.states that "every state or local licensing agency shall withhold the issuance or renewal ,of a license or permit to operate a business or"to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance 'coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-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 numberlisted 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 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. it dog license of 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: Y The Commonwealth of Massachusetts Department of Industrial Accidents 0-ff ce of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Date..................... � YM F ,,ORTN 6 w NOF NORTH ANDOVER O�tt�ED ., 9'Yo z. PERM 'DFOg INSTALLATION QDA�TE Dn [EP `'�y �E IE This certifies that ... .........................:.............. . has permission for gas installation ............................ in the buildings of .......................................... at .................................. . North Andover, Mass. Fee...'...... Lic. No........... ......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File SSACHIUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN (Print of Type) �/ NORTH ANDOVER —.Mass. Date Y Building Location—;'?(-/) S Permit #_ 3 , S Owner t - s S /// Name y tc�c New ❑ Renovation p Replacement ❑ Plans Submitted: Yea ❑ No C1 ,�/ Check one: Certificate " � VV/VAAI Installing Company.off, AddressJgj/ s d Partnership ❑ Firm/Co. Business Telephone Name of Licensed Plumber or Gas Fitter �' INSURANCE COVERAGE: Check ne I have a current liability Insurance policy or its substantial equivalent. Yes No ❑ tf you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee doge not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: %nature of Owner or Owner's Owner 11 Agent 11ant . 1 hereby certify that all of the details and Information I have submitted (or entered) M above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the ppermit Issued for this application will be In "Hance with all pertinent provisions of the Massachusetts State Gas Oode and Chanter 1�12_nf�e-Aer�iwwy / ..� eY THIS Cfty/Town Af""TO (OFFICE USE ONLY) T of License: Plumbergna ure o nae Hummer er r ME Gasfitter --Ku astermeyman License Number I rrrrrrrrrrrrr�rrrrrrrrrrrrrrr rrrrrararrrr�rrrArrrrrrrrrrrr = rrrrrrrrrrrrNNNNNrrrrrrrrrrrr NNNNErrrrrrNNNNONrrrrrrrrrr■ rrrrrrrrrrrrrrrrrirrrrllrrrrr■ . rrrrrrrrrrrrrrrrr,rrrrrrrrmum ,. rrrrrrrrrrrrrr rrrrrrrr ■rrr■ CM rrrrrrrrrrrrr�r rrrrrrrrrrrrr■ rrrrrrrrrrrra��r�rr�rrrrrrrrr■ rrrrrrrrrr�rrrrrrr�rrrrrrrrr■ ,�/ Check one: Certificate " � VV/VAAI Installing Company.off, AddressJgj/ s d Partnership ❑ Firm/Co. Business Telephone Name of Licensed Plumber or Gas Fitter �' INSURANCE COVERAGE: Check ne I have a current liability Insurance policy or its substantial equivalent. Yes No ❑ tf you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee doge not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: %nature of Owner or Owner's Owner 11 Agent 11ant . 1 hereby certify that all of the details and Information I have submitted (or entered) M above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the ppermit Issued for this application will be In "Hance with all pertinent provisions of the Massachusetts State Gas Oode and Chanter 1�12_nf�e-Aer�iwwy / ..� eY THIS Cfty/Town Af""TO (OFFICE USE ONLY) T of License: Plumbergna ure o nae Hummer er r ME Gasfitter --Ku astermeyman License Number I ,9 O Q m m N N Z N b m n -1 • o • r 41 h• t y� • z � N m O �c • z `• . j.. N in • n z m i N i .. i r O n > m � ' o 0 v m n > w ca •` C O �t O p i r o p ;•. a 7D � m • � O fA o m O Q O 2 M N ,9 O Q m m N N Z N b m n -1 • o Date./.' ..... . 0 %ORTH TOWN OF NORTH ANDOVER Oy 11�E�b 0 A PERMIT FOR GAS INSTALLATION o # RECEIVED PAYMENT qqac -•i i <- } Qg1TEU 'QPyS y9SSA���s�t JAN 2 8 1992 This certifies that. f�- d!XeO.Vbr. Colled0l.......... . has permission for gas installation ............... in the buildings of CU �•........................ . at .. °. f....... �...................... . North Andover, Mass. Fee.,�3 Lic. No.--2a/c.6.... ...................:..... . GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File SETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print ot Type) �lv NORTH_ ANDOVER, , Mass. Building �Z Permit #_ d `% Owner's " / ' — " -6 Name s q VA New ❑ Renovation ❑ Replacement p Plans Submftted: Yea ❑ No p installing Company Name Address Business Telephone 69S—D59 L Name of Licensed Plumber or Gas Fitter Check one: ' Corp. d Partnership ❑ Firm/Co. Bei c�� Certificate INSURANCE COVERAGE: a Check ne have a current liability Insurance policy or its substantial equivalent. Yes No ❑ If you have checked res, please Indicate the type coverage by checking the appropriate box. A liability Insurance pollcy*-�'. Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: %nature of owner or Owner'sAgent Owner 11 Agent C1 1 hereby certify that all of the details and Information I have submitted (or entered) knowledge and that all plumbing work and Installations performed under 1�e p�e�� pertinent provisions of the Massachusetts State Gas Oode and Chaptw 142 0( the I� Title City/Town APPnONED (OFFICE USE ONLY) true and accurate to the best of my on will be Ip c9fnpliraace with all T of License: j Plumber Signature o nae um e(or asFil h 8 aasfltter Master License Number/� Plumber ■■■■■■ENO ■■■■IN■■■■■■■■ -NINE ■■ Ifjf ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ '. ■■■■■■■■■■■■■■Ear■■■■■■■■■r■■ installing Company Name Address Business Telephone 69S—D59 L Name of Licensed Plumber or Gas Fitter Check one: ' Corp. d Partnership ❑ Firm/Co. Bei c�� Certificate INSURANCE COVERAGE: a Check ne have a current liability Insurance policy or its substantial equivalent. Yes No ❑ If you have checked res, please Indicate the type coverage by checking the appropriate box. A liability Insurance pollcy*-�'. Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: %nature of owner or Owner'sAgent Owner 11 Agent C1 1 hereby certify that all of the details and Information I have submitted (or entered) knowledge and that all plumbing work and Installations performed under 1�e p�e�� pertinent provisions of the Massachusetts State Gas Oode and Chaptw 142 0( the I� Title City/Town APPnONED (OFFICE USE ONLY) true and accurate to the best of my on will be Ip c9fnpliraace with all T of License: j Plumber Signature o nae um e(or asFil h 8 aasfltter Master License Number/� Plumber m b 1 • E: v p r c p , W m � O � q > 1 A r • z � 1 rn N 1 ' 7 • i ' • 1 • ' F • F z � > �. r • z � N q m �. n -1 o • z i E N • m n . s m N . � r o n 0 z � � y r •n m O v n ao C O r -1 C in O .. M ' -� c o W o m 0 0 , r Q N Z � ' • q s 0 A 33 , N N N q m 0 -1 a 7 Location No. Date TOWN OF NORTH ANDOVER lid. Aildv', r " Building Inspector p Certificate of Occupancy $ Building/Frame Permit Fee $ 'SsAcHustt Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Wateronnection Fee ,. ..._. . $ rOz- ... _ TOTAL $ DEC 1 S 1991 lid. Aildv', r " Building Inspector Location s G% �-IMYW..Y l , �' e -z Com. Lei- l No. -.5,116 Date r ,aORTN TOWN OF NORTH ANDOVER ptt�ao ,a�•y0 Certificate of Occupancy $ 5U > Building/Frame Permit Fee $ri • Ana Eta MuFoundation Permit Fee !$� ► Z U 3 `y s�cs Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ t4A _r U� + TOTAL ( $ iJ`tl 1 8 1991 Jr�> l —Building Inspector "' Div. Public Works Location— C oil ( y ✓ �.. No. Date NORTFTOWN OF NORTH ANDOVER Certificate of Occupancy $ # Building/Frame /Frame Permit Fee $ 9 • o tea.. � � Foundation Permit Fee $ //fin oC� sACMUS Other Permit Fee $ ,� *8 Sewer Connection Fee $- �.Z 37 water Connection Fee $ l lIV'V- a TOTAL /�$ oZZ/a0-,0 Q T/ inspErctor f Div. Pub11c Works Plit-MIT NO. -5 J � APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PJL"d 3,21 V'-' PAGE 1 MAP K40. q' d LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE �O y SUB DIV. LOT NO. j Z �vl-Ii 7 LOCATIIOIN�O��J`��le irr PURPOSE OF BUILDING � OWNER'S NAME C,U��-1 � `1 ,� A NO. OF STORIES ' -L SIZE OWNER'S ADDRESS gVd CJ�C�FJ �� BASEMENT OR SLAB 169^ erke.vv+ ARCHITECT'S NAME A ! `CJL �eC r SIZE OF FLOOR TIMBERS 1STRRi �/ 2ND w 1 3R6 •v BUILDER'S NAME �.l SLl N(t �CMii �n vlG��`S-U� K• SPAN DISTANCE TO NEAREST BUILDING �y �y DIMENSIONS OFF SILLS DISTANCE FROM STREET POSTS .30", DISTANCE FROM LOT LINES - SIDES L (J -r" REAR T " GIRDERS W AREA OF LOT 17-C) G FRONTAGE '00 HEIGHT OF FOUNDATION THICKNESS � v IS BUILDING NEW V�G� SIZE OF FOOTING ' X / IS BUILDING ADDITION MATERIAL OF CHIMNEY ry�Gi'V�PI7 IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND &V 1f, WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATERS BOARD OF APPEALS ACTION. IF ANY N T IS BUILDING CONNECTED TO TOWN SEWER s IS BUILDING CONNECTED TO NATURAL GAS LINE �ES INSTRUCTIONS SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY PAGE 1 FILL OUT SECTIONS 1 - 3 REGULATED PARA: 112.7 S.B.C. A20 —IN PAGEtZ FILL OUT SECTIONS 1 - 12 DATE: as FEE PAID: ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANE MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILE< SIGNATURE OF OWNER OR AUTHORIZED AGENT OWNER TEL. # F E E `�f � J -0 C) PERMIT RANE C, 19 PERMIT FOR FRAME/BUILDING DATE: FEE PAID. 4 t0 W -t 5`7% 474���ry CONTR. LIC. # G L31 -Y -f e-&,fttel 6W)Q BLDG. PERMIT FEE LESS FDA FEE ._.._. DUE FRAME PERMIT L r q 3 PROPERTY INFORMATION LAND COST / o my EST. BLDG. COST tg:t�.� ! D (7 . EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. n/( -x+ 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD ---w yr snj-aa.. mmm J NV1d d S30V1d3H SIHl•'a3 ^OdW183df1S '013 'S30VU 'V°J 'S3H0LlOd H11M'S9NIO7dR8-ee-sN0LjSN3WIC,-.,3.:5VX-3;- 'NV. 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FORM U. TOWN OF NORTH ANDOVER LOT RELEASE FU1Zf1 SUBDIVISION ASSESSORS MAP O SUBDIVISION LOT(S) L or PERMANENT ADDRESS (ASSIGNED BY D.P.W.)(� STREET APPLICANT e-d--';)kvtkQt- Sw PHONE DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANN CONSERVATION CObIHISSION --;�, v CONSERVATION ADMIN. DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS 2r4i-c TIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE DATE APPROVED 41c DATE REJECTED DATE APPROVED 11 ' DATE REJECTED t ? llA'TE APPROVED I DATE REJECTED 'i %/l y/9/ (r,�ct o9i441411— ■11 This form shall be signed by the agents of the Planning and Ilealk the Conservation Commission prior to the issuance of any building permits ,for the subject lot. This form.shall not releive the applicant from the Compliance of any applicable Town requirement or Bylaw. - N2 0 848 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 19 Application by the undersigned is hereby made to connect with the town sewer main in treet, subject to the rules and regulations of the Division of Public W rks. The premises are known as No. -30 z/( Q 62-, or subdivision lot n N4 ni lug Owner pc,VJWP vl•,� Address Contractor Address F Applican s +gnature PERMIT TO CONNECT WITH /SEWER �MAIN The Division of Public Works hereby grants permission to-lv to make a connection with -the sewer main at subject to the rules and regulations of the Division of Public Works. By Inspected by Date See back for rules and regulations k - �S eet on of P, Iic Works {. 1t, 4 RULES AND REGULATIONS FOR -GOVERNING THE INSTALLATION OF SEWER SERVICES 1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer or appurtenance thereof without first obtaining'a written permit from the Division of Public Works. 2. All.costs and expense incident to -the installation, and connections ofthe building sewer shall be borne by the owner. The owner shall indemnify the (town) from any loss or damage that may directly or indirectly be, occasioned by the installation of the building sewer. 3. A separate and independent building sewer shall be provided for every building; except where one building stands at the rear of another on an interior lot and no private sewer is available or can be constructed to the rear building,through an, adjoining alley, court, yard, or driveway, the building sewer from the front building may be extended to the rear building and the whole considered as one building sewer.. 4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by -the (Superintendent), to meet all requirementsof this ordinance. 5. The size, slope, .alignment, materials of construction of a building sewer, and the methods to be used in excavating, placing.of.thepipe;:jointing;•testing;and- backfilling the trench, shall all conform to the following requirements. The sewer shall be -6" diameter^SDR 35, PVC pipe. Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift. 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such building drain shall be lifted by an approved means and discharged to the building sewer. 7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer. 8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for inspection and connection to the,public sewer.The connection shall -be made under the supervision of the (Superinten- dent) or his representative. 101 9. All excavations for building sewer installation shall be adequately guarded with barricades and lights so as to protect the public from hazard. Streets, sidewalks, parkways,,_and other public property disturbed in the course of the work shall. be restored in a manner satisfactory to the (town). A, APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. PC) v 13 191 Application by the undersigned is hereby made to connect with the town water main inf6tll I --MQ subject to the rules and regulations of the DivisionofPublic Works. The premises are known as No. J� `I b v `�� Street or subdivision lot o. I Ma1z'mac, Owner V Address Contractor Address Appl' ant's Signature PERMIT TO CONNECT WITH WATER MAIN _ The Board of Public Works hereby grants permission to to make a connection with the water main at _ ___ 6�0 (&t— subject to the rules and regulations of the Division of Public Works. oard of ublic Works By lv Inspected by Date See back for rules and regulations x RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No person shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall be installed a minimum of Hive feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be 1" type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall ,be installed at the property line and shall be of the Erie Type with 41/2 foot rod and brass plug type cover. 1 t �oG lATc--, p t ►.j y o, MRCS ' SGAL.E;'• li1 = 3a' . pA-c'E.: 12,� 5 �4l 41 LOT It r " � I I i i gg 11 I I I o SGoo L7 �.s- 7" A U D lTS i-lT�� I U S V tG.E.2. Tl-!lS �C�T l S IloT 1►-} 1� lz1---,1-1 1 �tHOfb THE, OFFSETS USE. oF' THE. SUtt-Ott..tG'iti1S?EGToz, ��tA s SNowij C=)MPIy oL-A L,-,/ AuD SuLH IL-3 ►S �oT�. g4 \4-J I- - VA T 16.4 E sa-r-t o u o f ZA �-1 t k..t (sw ILES H � y l,Aws oF- �dvp'os�ti►c-fy o2. 1...10 C�ot..+T`o2iM- O. 13972 q UO2T64 \T C --CN- W-ALAVAID lz1---,1-1 1 H Ma A Dm m C m y m D N • v 0. O Z m z m m K n d:* R a a� i E7 O O O � O y z y Vf y Q ti [�J d rn -rl w o K rA H G r - A rn r- rn r- M Z A H G7 n a Z c 3 g w 0 '•Armpop n H C C 7 a O� m T m O C z v O zr— Z.. (A m m m z m �o CT -M Cal 3.cw m o o x m ' 1 < T S _ O M T rn D O • C 0 z o Location v C"IM, ! �� No. �`--S 5 Date TOWN OF NORTH ANDOVER F _ L Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ sACHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� Check # " 13 6 S Building Inspector StAl TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATOR DEMOLISH A ONE OR TWO FAMILY DWELLING .«.enx w �,,, . _ 'i 5i';k a .n 2H„ • • Fi.r -h - q, lµF- F �a \x;:v k k„ �, .wr. �"' ,. :.a'M"✓i... .. ..::..._ : si.. 6. .4,iih' , .�d.,a�< �a ,. eS ,, .�'k.,'�* , 1 t �,�xQax�',i.+• BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Igs wor of Buildings Date SECTION 1- SITE INFORMATION Address: � u le evr, 1.1 Pr7-,I�, 1.2 Assessors Map and Parcel Number: 6P Map Number Parcel Number N o v �' n `� Y� �o ✓ r ✓� y o l dp � 1.3 Zoning Information: Zoning Distrid Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 /Owner o�f1 Record r f p 4 X Name (Print) Address for Service - i Signature Telephone 2.2 Owner of Record: Name Print Address for Service: $i nature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 5--,3,0 —0D 1 z M 90 O Mn M a® ^^z V SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... ❑ SECTION 5 Description of Proposed Work check au a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. Demolition ❑ Other ❑ Specify Brief Descri Ftion of Proposed Work: + f�dVFgc ��1�� �In1"�a llc R u h -4c SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant bI?ICIAL USE UNLY 1. Building / I o o / (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, Oil up V v C4 Ta b 4 v t-` as Owner/ of subject property Hereby authorize M % re /� to act on My behalf,iki all matters relati to work authorized by this building permit application. ev �)-3� - (Signature of Owneir Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, As Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date Boom illillogimim NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T VIBERS 1 2 ND3 SPAN DIlv ENSIONS OF SILLS DIMENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. o` �a fad a b ti !r �-' /PHONE ! �/ APPLICANT 0,� ASSESSORS MAP NUMBER 011 LOT NUMBER 0-000Y SUBDIVISION /LOT NUMBER STREET rd In I Ir e v a cSTREET NUMBER 0 ........ 3 0 - o c ......... OFFICIAL USE ONLY ......� o ................... A RECONM ENDATIONS OF TOWN AGENTS ...........��...r ®z.-�d� • ■ ■ ■ • • DATE APPROVED 5r Q CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMNfENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONUV[ENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE S I is EXHIBIT D 1`� IoQ,TGAG�E, SUMVC—,—/ LoG ATtG c> l 1`J U sz,!-N SGAL.E: l'r = 30' ATE.; 12j S �R! I�,t c T Fi A U O OY �. 1�. r t q 'r✓' �S . I I 77 C GG.JZT 1 Fy TtiA O F F S E.TS S Fd o �,.,,1 U A G P 'Fo1�T�-F E, THE. oFP�'SE.TS USS oF' THE Pau«-Orw.�G��SPEGTo� .S4iOw►1 �AMPLy vUC..1/ Aun Suc_H u�E, tS �oT�� kJ 1T µ T K E Z�j►.1 i� E�T�Q,w�l 1 �t A"T"r o �J o F Z� ►.,� 1 �y G. �1- 1.jo 2Th1 Au a��rr✓ \T y �c...N E. ►,..t C -o �.�► S'T iZi J C.T � p, W K e.►.� F� U t �.T. 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