HomeMy WebLinkAboutBuilding Permit #1336-2016 - 10 BONNY LANE 6/27/2016 L
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BUILDING PERMIT OF�tteo bgro0
TOWN OF NORTH ANDOVER 3
APPLICATION FOR PLAN EXAMINATION
�moo# ^y �•
Permit No#� Date Received ��SS ArEUUSG
CH 4
Date Issued:
I PORTANT: Applicant must complete all items on this page
LOCATION tO 'brAong
--ant
PROPERTY OWNER
Print 100 Year Structure yeseno
MAP W-2, PARCEL:&�ZONING DISTRICT: Historic District ye
Machine Shop Village ye
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
El Addition El Two or more family El Industrial
Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition _ ❑ Other
El Septic El Well El Floodplain El Wetlands
❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
c'� h
Identification- Pi ase Type or Print Clearly o
OWNER: Name:0�UY af)a Cly' Phone: (t�� ' (o-ql• -t0�
Address: b V I
Contractor Name: 0 KO., Phone: '�a
Email: \1\ o
Address: n4tr Ra)
Supervisor's Construction License: CS-ung 13b Exp. Date: (p' a'
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $ 221
Receipt No.: 2
d�1
Check No.: hAd�1p
NOTE: Persons contracting with unregistered contractors do not have acces uaranty fund
Location 16 46>n"`
�I
No. 1'331a Date
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
1/
C"
Check# �U !
J Building Inspector '
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL.
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dwnpster on Site ❑
i
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
I
i
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
` Conservation Decision:
Comments
Wafter& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
,FIREDEPARTMENT TempDum "
4Aster �Y s, o
. Y or �site` e _
Located OsgoodStreet
Locateat 124111/lain '.. - •�- -_ a . — �- - --�-
�StreeY
in
F`reiD'epartment signature%date -._ _ __-__._
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CQMMENTS._ - _
r1 NORTij -
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CO� h ver, Mass L*.cj C 2
Oawn[ 1
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7,9 AORgTEO NP���S
S V
BOARD OF HEALTH
Food/Kitchen
P E T Septic System
R T L D
THIS CERTIFIES THAT BUILDING INSPECTOR
has permission to erect .............. buildings on .... ....... Foundation
Rough
to be occupied as .......... .. .. ....... ..... �. . ............................................................ Chimney
provided that the person accepting th permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST TION Rough _
Service
Final }
BUILDIN ECTO
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
T.
EIN#51-050-3313 Haverhill MA 978.374.9224
MA Reg.HIC#149221 mbe
MA Lic.UCS#78130 Lawrence MA 978.687.7339
oofing Hampton NH 603.929.9224
BBB. Single-Ply License#1711 AFM Hampstead NH 603.329.8200
440 SLs t c X1932 p, Toll Free 1.888.SOS.ROOF
265 Winter Street
Haverhill MA 01830
Name:-
*Licensed *Insured *Factory Trained *Factory Certified
��rai�.✓nar(� �� L Date:
Telepho 7 !' Alt.Telephone: Email:
Billingddssj0 n City: ,�, �hpc}f(,� State:
Job Address: City: State:
Scope of Work Strip and Re-roof ❑Re-roof Approximate Roof Area:
❑ Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulations and landscape is properly protected.
❑ Remove existing layers of shingles down to roof deck and dispose of in a legal fashion from the job site.
[IInspectat Inspect wood deck,if we discover any rotted wood,replacement will will
P � 9.s� per LF for roof deck boards. If
substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$ /, Z,0_per SF.If individual sheets are found to be
rotted/or de-laminated,removal,disposal an�replacement will be performed at per sheet.If any trim boards are rotted,
replacement will be performed at*$_Z._per LF for new pre-primed pine.Inspect siding at roof line and all flashing behind siding,if
we discover any damaged flashing or siding at the roof line,replacement will be performed at*$--L If wood deck,siding,and
flashing is sound,we will re-nail any loose wood to rafters,sweep deck,and prepare for roofing.
❑ Install 8"drip edge to all rakes and eaves.Color Leh'+ Loy l ,
❑ Apply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or
❑ Apply premium(UNDERLAYMENT)to the balance of the exposed wood deck.
❑ Re-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness.
❑ If upon inspection,we discover chimney lead to be worn or deteriorated,replacement will be performed at*$
❑ Install a new: a:i ) Year ❑ Traditional Architectural ❑ Designero1C or
❑ Furnish and Install i new shingle over style ridge vent system ❑Soffit vent system*$
❑ All debris generated by Lambert Roofing Co.,Inc.will be cleaned up and disposed of from the job site in a legal fashion.Under no
circumstances will the watertight integrity of the building be co m romised.
Special Notes ' i' ry c, o
Cr
sC O fivel, , 1 ,444
G
t- rn ckr- (oe, V L-u
UPON COMPLETION A D PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP`GUARANTEE FOR A PERIOD OF�
YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY ANDYEARS HONORED AND ISSUED BY THE
SHINGLE MANUFACTURER. ❑MANUFACTURER UPGRADE *$ !!vv
*Denotes potential additional costs above the total estimated price.
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE 6D
(*)
The Contractor agrees to perform the work,furnish the materials and labor specified above for the total sum of: $410--
Q (a� --"�
14 �!.�Lj (Dollars)
Payment will be made according to the following work schedule:
4:5-
$_._deposit upon signing contract
$-.-by_/_/_or upon completion of
$-.-upon completion of contract.
(Law forbids demanding full payment until contract is completed to both party's satisfaction)
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram or by delivery,not later than midnight of the
third business day following the signing of this agreement. See attached notice of cancellation for for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES
Acceptant of the Contract Proposal
Home Owner(s)Signature(s): Date: _/
Contractor's Signature: Date:
www.lambertrnnfino-ram
Company Insurances
TGLRC Inc.DBA Lambert Roofing Company will provide certification of insurances,demonstrating that we are fully insured for worker's compensations,
general liability,automobile liability and an umbrella policy.This documentation will be sent through the US mail to the above named party if not already
provided.
TGLRC Inc.dba Lambert Roofing Company agrees to:
• Commence the described work on or about
• Complete the described work in approximately days.
• Not be held liable for delays due to circumstances beyond our control.
• Not be held liable for any damages to landscape and or fixtures due to circumstances beyond our control.
• Not be held liable and not covered under the workmanship warranty,for pre-existing conditions including but not limited to:
• Mold and or wood rot,defective,faulty,rotted or worn building counterparts such as,but no limited to:siding,roofing,masonry,
plumbing and windows,all of which may jeopardize the watertight integrity of the structure.
• Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the
residence.
• This contract is the complete contract unless a signed Change Order has been executed between TGLRC Inc.DBA Lambert Roofing
Company and the Homeowner/Business Owner or Agent.
Peanits
A building permit may be required to remove and replace your roof.It is our obligation to secure these permits if required as the home owner's agent.Note:
Homeowners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c.142A.
Accelerated Payment
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be
financially insecure.However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds
not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the
signatures of both parties.
Payment Terms
A finance charge of 1.5%a month(18%per year)will be added to all invoices on the 3151 day.All legal and or collection fees will be paid by the binding holder
of this contract.
• The law requires that any deposit or down payment required by TGLRC Inc.dba Lambert Roofing Company before work begins may not exceed
the greater of-
0 1/3 of the total contract price or:
0 The actual cost of Special or Custom made materials which must be special ordered in advance to meet the completion schedule.
Arbitration
The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this
contract,the contractor may submit such_disple to a private arbitration service which has been approved by the Office of Consumer Affairs
and Bus
in ss Regulation and the ry� r shfll,bts�required to submit to such arbitration as provided in MGL cP2A.
Owner -�. Date: a
� y
Contractor: Date: `G3 .
y
Contractor Registration
All home improvement contractors and subcontractors must be registe d,any inquiries about a contractor or subcontractor relating to a registration should
be directed to:
Contractor Registration:
Director of Home Improvement Contractor Registration
Board of Building Regulations and Standards
One Ashburton Place,Rm.1301
Boston,MA 02108
(617)727-3200
Home Improvement Contractor Law:
Consumer Information Hotline
Commonwealth of Massachusetts
Office of Consumer Affairs and Business Regulations
10 Park Plaza,Rm.5170
Boston,MA 02116
(617)973-8787
For assistance with informal mediation of disputes or to register formal complaints against a business,call:
Consumer Complaint Section
Office of the Attorney General
(617)727-8400
AND/OR
Better Business Bureau
(508)652-4800
(508)755-2548
(413)734-3114
Cancellation
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be in the main office or branch
thereof,provided you notify the seller in writing at the main office by ordinary mail posted,by telegram sent or by.delivery,no later than that midnight of the
third business day following the signing of the agreement.
NITIALS
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/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): �-
Address: acd;
City/State/Zip: )��N IN may) Phone
Arg you an employer?Check the appropriate box: Type of project(required):
LrEtTam a employer with. 9,Q) 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.1 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.F]Electrical repairs or additions
3.❑ 1 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.] t employees. [No workers'
comp.insurance required.] 13.�Other. 1'b�j
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
j 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 sub-contractors 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 Self-ins.Lic.#:f&t1D qqb-a C oggrls'a. LC. Expiration Date: '
. n_
Job Site Address: City/State/Zip: (SV W Ma t
Attach a copy of the workers'co nsation 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$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 d penalties of perjury that the information provided above is true and correct.
Signature: [� Date:
Phone#: —`� �•qa-
Official use only. Do not write in this area,to he 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#•
,acoRL> CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD-16
03/28/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER NAMMEACT Jerrold Rameras
ALLAN INSURANCE AGENCY INC. PIioNE (978) 745-5905 FAX t9�e1 T+s-sass
63 1/2 Jefferson Avenue 2nd Floor EMAIL RES§.JerroldGallaninsurance.com
P.0. BOX 511 INSURERM AFFORDING COVERAGE NNIC tt
_SALEM MA 01970-0511 INSURER A:Associated Ind Ins Co.
INSURED INSURERS-SafetyInsurance Co.
TGLRC INSURERC:National Union Fire Ins Co.
dba: Lambert Roofing co. INSURERo-Ace American Insurance Co.
265 Winter Street INSURERE:Ace American Insurance Co.
Haverhill MA 01830- INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 VNTH 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,
EXCL USIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
POLICY EFF POLICY EXP
FLTR I TYPE OF INSURANCE DL POLICY NUMBER .MtO.,YYY .MID YYY LIMITS
GENERAL LIABILITY # J J J J TACH OCCURRLNCE 5 1,000,000
X RCIAL GEN=.'RA(�- LIABILITY J / ! J ADAGE 'r) SO,000� PRG611SFS(F•a ocru,rerre�
A CIAIMS-MADE i n l OCCURAES102802t✓:1_DF.XP(Anyone 9 02 11/12/2015 11/12/2016
1 person) 5 11000
X per progect Agg National Roofers Assoc. PLR5ONALADV INJURY S 1,000,000
GENERAL AGGRFGATE S 2,000,000
GF NTAGGRCGAtLIItdiTAPPLIFSPL�I2 ) J J J J PRODUCTS-COMP/OPAGG S 2,000,000
POLICY PRO- t.00
AUTOMOBILE LIABILITY COMBINED SINGLE L!h11T
j I ICaacaJen'l _ a 1,000,000
,N e AUTO I J J I J BODILY INJURY(Ile.,$ H
�` I t''r parson; S
All Ov^1FD SCIit-DULED 6203819 I /
AUTOS I I AUTOS I (07/1612015 07,16/2016 BODILY INJURY(P4-acc:aert: S
INON-OktAQ D
I X .1Iflh'F IT AU FOS X { / /' PROKRTY DAldAGF
AUtOS
rPa•ac^�1erh x
X UMBRELLA LIAB X OCCUR / J J LACH OCCURRI'NCE = 5,000,000
C `EXCESSLIAB CtAlrs'.SbSnDE, !! E018335635 111/12/201511/12/2016 AGGREGATE
I DED RE:IENTIONS 1 J J J J 5,0001-000
S
WORKERS COMPENSATION QTH-
AND EMPLOYERS'LIABILITY YIN X
AN U
PROPRii:T'DF;IPARTt:ERrtc-CUIIVE� NIA 6S62UB-2E09875-2-16 MA 03/25/201603/25/2017 ELEld1HACCIDENT 5 1 000 000
OF-ICERJ.'Er,RBER EX0.UL"_=0^
D (Mandatory in NH) I / J J E L DISEASE.EA EMPLOYE S 1,000,000
I:yIns aesGriGe u'a:er I
DESCRIPTION OF OPERATIONS tN iw, i J J J J F 1.. DISEASE-POLICY LIMIT S 11000,000
E worker's Compensation NH ./ J / sarncv^tsas 1,000,000
f
6S62UB-BD81311-16-15 IN11 112/22/2015 12J22/2016 po,cy,ro.e 1,000,000
s I
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101.Additional Remarks Schedule,It more space is required)
CERTIFICATE HOLDER CANCELLATION
TGLRC dba: Lambert Roofing SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
265 Winter Street
AUTHORI TJ REPRE$ NTATIVE
Haverhill MA 01830-
ACORD 25(2010105) JI 1988-2010 ACORD'CORPORATION. All rights reserved.
1NS025, c,a-5,4' The ACORD name and loqo are reqistered marks of ACORD
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-078130
Construction Supervisor
RICHARD J LAMBERT
266 WINTER STREET
HAVERHILL MA 01830 /
Expiration:
'
Commissioner 06/02/2018
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 149221
Type: Private Corporation
Expiration: 12/6/2017 Tr# 273093
T.G.L.R.0 dba Lambert Roofing Company
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830
Update Address and return card.Mark reason for change.
SCA 1 Co 20M-05/11 Address E] Renewal Employment ❑ Lost Card
I
J
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanniug/Massage/Sody Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR. OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
i
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS I
CONSERVATION Reviewed on Siqnature
I
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Siqnature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street_
}FIRE�7"2�'
1TMENT Temp, pumpster on seLocate ;4 ��� MaY�_t 1,_
Fire�Departmentsgnature/date
COMMENTS:
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
a. Floor Plan Or Proposed Interior Work
4 Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
;rF Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
Building Permit Application
Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
4, Workers Comp Affidavit
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2014
!'tRltlT No. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
MAP ,fi10.4n( Z LOT NO. O 03.Z 2 RECORD OF OWNERSHIP ID#&E (BOOK ;PAGE
ZONE I SUB DIV. LOT NO. is s7 �r
r 9 Sc r I ?fey
LOCATION /JO,V� PURPOSE OF BUILDING ADD,
N �c r 4,", L /Zeci"
OWNER'S NAME NO. OF STORIES SIZE / v`/ r
OWNER'S ADDRESS �� 2� w L�yy BASEMENT OR *LAS S4 A5 -
ARCHITECT'S NAMEIV ` SIZE OF FLOOR TIMBERS 1ST g �V�r 2ND 3RD
BUILDER'S NAME �� �Fnr�>Z �Ln�/L yU� fL *PAN
DISTANCE TO NEAREST BUILDING N/p DIMENSIONS OF *ILLS _--
DISTANCE FROM STREET / POSTS
DISTANCE FROM LOT LINES —SIDES / ` REAR a O�� GIRDERS
AREA OF LOT .5-9 S90 C+•� 1['^�^• FRONTAGE j p/ HEIGHT OF FOUNDATION 1//,3 rr THICKNESS /� +r
IS BUILDING NEW "Y - SIZE OF FOOTING
'7`�" X I
IS BUILDING ADDITION Vxr MATERIAL OF CHIMNEY /J 1A
IS BUILDING ALTERATION / J IS BUILDING ON *OLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �{t('S IS BUILDING CONNECTED TO TOWN WATER yes
BOARD OF APPEALS ACTION. IF ANY I/ll'6 iv E !IS BUILDING CONNECTED TO TOWN SEWER 1r"--s
IS BUILDING CONNECTED TO NATURAL GAS LINE AO
3 PROPERTY INFORMATION
INSTRUCTIONS
LAND COOT
SEE BOTH BIDES EST. BLDG. COST �1 Sl Wt7 00
PAGE 1 FILL OUT SECTIONS I - 3 EST. BLDG. COST PER SO. FT.
EST. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS 1 - 12
SEPTIC PtRM1T NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
I
CA ILEo C11t1/l 9
•uILaINa ImmumccTOII
SIGNATURE OWNER OR AUTHORIZED AGENT
f E E I �^ DWNERTEL/�C)7? ��'��� 17
47 — ,—• —=—
i TERM IT ORAlIT[D 4.
'COHTR.TEL V..
sit
at
NORT�y _
. Townover
=
o
No.
* z dover, Mass. 19LAKE
Q
MICMEWICK.1�',•
'9 TE i
S BOARD OF HEALTH
Food/Kitchen
PERMIT T Septic System
• BUILDING INSPECTOR
THIS CERTIFIES THAT........................... .'
.....f....f��!! 7�N. .... 1t1�- T�................................ Foundation
has permission to erect........1b..................... buildings on..........1.P......
A.... .....�-.!!4�N.��.............. Rough
to be occupied as......4.�� 1,6�.....19-��•A�'t is�J..... ....�`!'�' .:L�.......^' D............................................ Chimney
provided that the person accepting"
ccepting this permit shall in every respect conform t6 the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO TS Rough
............................. ........................................ ..
...................�w.�r.... Service
BUILDING INSPECTOR Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To BeDone FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
l • `- I Z�� -,.�� Street No.
Wa•T•4:; FV �,t(�, 033`;'p Smoke Det.
� FORM O •
LOT RELEASE FORM
INSTRUCTIONS: This form
approvals/permits from BoardsIs used
to verify that all
have been obtained. patents necessary
This does not relieve the applicant
��isdiction
landowner from compliance with any applicable
regulations or re local and/or
requirements. or $tate law,
****************Applicant fills out this section**+rs**,r****#***rt#
APPLICANT:
�ULt�2.-sv f�JZ
LOCATION: Assessors Ma phone ��� - �4V 7
Map Number 0 6 •z_
Subdivision
Parcel
Street Lot(s)
- ��rU>v �Aw�
************************ St. Number JCS
Official Use
- Only*************�***�*#*s,t# ` •
RE DATIONS OF TOWN AGENTS:
� ` Conservation � Date ate Approved qLlcoll9-17
Date Rejected �
Comments
w l/A
d
Town Planner Date Approved Q
Date Rejected
Comments
c
. .Food Inspector-Health Date Approved
Date Rejected
Sep is Inspector-Health q, Date Approved
Comments Date Rejected
Public Works - sewer/water connections
q�z�g7
- driveway permit u
Fire Departmen -�
Received by Building Inspector
:;,. Date
I ✓l. U/0471/I%%007,1!/Q�C dL�.�!/LCldd(X.l,'�IIJP.I.r.J
DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Number: Expires: Birthdate:
CS 833658 98(15/1999 08/1511937
Restricted To: 90
E HAFFNER FOURNIER
16 BONNY LANE
NORTH ANDOVER, MA 81845
4
c Office Use Orly
01 4je permit No.
c�t.cked „'
Occvpattcy Fee ..
_. 3M Ceitve blank)
BOARD OF FIRE PREVEMCm REGULMONS 527 CUR 1200
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL-WORK
All warts to b 'performed in acr srdance witty the Massacnnusetts Etec ricai Code, SZ7 CMR 1 00
(PLEASE PRINT IN,INK OR TYPE ALL INFORMATION) - � Date L
(MQ or Town of NORTH ANDD To the Insp or of 1f(fires:
The udersigned applies for a permit to perform the electrical work described below. `
Location (Street & Numbed D YL�1 ( G- ' -Yl
Owner or Tenant �Ze,- r-00-//z'✓) e IZ
Cwner's Address
Is :his permit in coniunction with a,uiicir.g �errnit: Yes _ No (Check Acprocriate Box)
Pumcs2 of Suiiding Utility AuEncrizaticn No.
S-xisting Sentice Amps _J vcits Cvernead '` Uncgrna � No. of Meters
New Service Amps _J dolts Cvernead r Unagmd Q No. of Meters
Numper of Feeders and Ampacity
Location and Nature of Proposed Sec==t Wcrx
UP fe e U, kOQ
! Total
No ^f ' 'gn•tng CuCets D No. :f - _y=s i No. =r ransformers KVA
Na. or Lignt:ng =xtures L, S•"'r--:-g ~^c. _ _-c. i Generators A
JJJ No. =t Emergency Ugnnng
No. at Receotac:e Cuttets No. =f C:l mourners i 3ar:ery Units
No. of Switen Cutlets �f No. =t ^as Eurrers ( FIRE ALARMS No.of Zones
Qtat I No. =t Cetection ana
- ;,r Corc. j
No. of Ganges r.s int.
Cevtces I
=eat c:at a:at
No. of Ciscosats Na.cr=_:, =s .ons (Na. ct Sounding Cavitas
No. or Self Contatnea
i
_=aCa•Area r__.
g �,y I Cates:aniSouncing Cav,ces
No. of Cisrwasners !
f — mumc:oai --Ctrter j
__c3t Connec::on
No. of urgers '✓ea^ a_
^g Cav,cs KIN _ i
No. ar NC. c: I LCw :'ottage i
' ?3:1a5:s Winna
No. of Water Heaters KW Sig:--s
III !
No. Hycro Massage Tubs 1 No. a tteccrs —ccat i-i?
CT HE :
iNS�jPANC=— C:VEPAGE. Pursuant to :ne -ec_xerner-'s =. :tassac:%usens yer.erat Laws
I nave a current L-aotiity Insurance Pouc/ ;nc_c:rg C_-. _:etec C=e aacns Coverage or :ts su=stanttat ecutvatent. YES _ NO _
nave su=rnttteo vatic proof of same :o :re C"ice. Y=--Z _ NC _ :cu nave cnecxee Yss. --tease inctcate :he yFe at Coverage =y
Cnecxrng the apo ovate oax.
INSURANC= 3CN0 = OTHEP = :Please S=ec:'•y) (Exaranon Oater
Esumatea Value at E!ectrtcal Work 5 Final
Work to Start inscee_•en Casa nec_es:ee: . Raugn
Signea unser:rte Pe ti s of pe
FIRM NAME p UC. NO.
Ucensee S gnan-ra
Sus. :al. No.
ACCre33 Ave�•1^ Art. —dl. No.
CWNER'S INSURANCE AIVEa: I am aware Sial 7'e Lcensee aces -et nave :Re Insurance coverage or Its suostandal eautvatent a5 re
cwrea by Massaenusects General Laws. ana that c:ty s:grature an ^,s :errrtt acCticatton «awes tins reowrement Owner ' Agent
(P!ease cr+ecx oval f 6�
:ereoncne No. PERMIT Fc=S
(S;Valure at owner Cr A;*Ml t+) t]3
Date...�{, .. .. .. ...��..
NOR7M
°ft °:•'"a TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
�,SSACHUS�
This certifies that ....... ...��L e.l� . ....�.J.!�... J�.....................................
has permission to perform ......
....... ....... .................
-
wiring in the building of........`.U .
L. (� �/I f
...... ........................ ....................................
at.............tQ............. .:....�� ...... :............... ,North Andover,Mass.
Fee... I. No../
........... ...............................................................
ELECTRICAL INSPECTOR
25.04 PAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
PER3tr NO. `�L �S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
MAP 440.0t-2LOT NO. Q3.Z 2 RECORD OF OWNERSHIP- DATE (BOOK ;PAur-
• ZONE SUB DIV. LOT NO. —S1
LOCATION �U 30"u") z -,v,-- PURPOSE OF BUILDING
c �/L (2 L;c NI
OWNER'SNAME -I- • NO. OF STORIES SIZE X<6 J
�•f�i+tFGN �Z. � TUA•yNE ��,�1�7L _
OWNER'S ADDRESS �V�D .y ,� BASEMENT OR {LA{ SZ-A Q
ARCHITECT'{ NAME =.f SIZE OF FLOOR TIMBERS ISTAX/oll 21,10 3RD
J!+�✓� �ri2/sa✓cam- p
BUILDER'S NAME C, /-1y►-1�Fn/c2 Ff:C1 {PAN
DISTANCE TO NEAREST BUILDING DIMENSIONS OF {ILLS -' -
POSTS
DISTANCE FROM STREET C. L :
DISTANCE FROM LOT LINES -SIDES 7 REARi9CGIRDERS
J � �
AREA OF LOTtT9P ; FRONTAGE 1J Gi HEIGHT OF FOUNDATION �/� THICKNESS
s5 v:-F 7
16 BUILDING NEW '- f12E OF FOOTING X
a r
16 BUILDING ADDITION MATERIAL OF CHIMNEY N/A
yrs
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REOUIREMENTS OF CODE yC S - IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER y y
If BUILDING CONNECTED TO NATURAL GAS LINE till
3 PROPERTY INFORMATION
INSTRUCTIONS
LAND COST
:AGIE
EE BOTH SIDES EST. BLDG. COST �7 $/WD
EST. BLDG. COST PER SO. FT.
1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS 1 - 12
SEPTIC 1P[RM1T NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AMC) APPROVED {Y BUILDING INSPECTOR .
v C i
CA ILED / /1 '
SUILDINo IN{PUToR
•IGNATURE OWNER OR AUTHORIZED AGENT
SEE I OWNER TEL/ _9��
r--
_ COMM TEL1_
1 SP[AMIT ORANT90
PERMM No. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. pwcE 1
MAP idO.d�z LOT NO. O Q3.Z 2 RECORD OF OWNERSHIP- DATE (BOOK PAGE
ZONE SUB DIV. LOT NO. F I ��
i i µ� 1 Zf�y
LOCATION �U /J ��
PURPOSE OF BUILDING�J A�p�Tlc ,v Ic Ami /2i�n�1
OWNER'S NAME • NO. OF STORIES SIZE
�./5�•tIFGN /Z � fDAn>.yE �otl��t�YL _ f�
OWNER'S ADDRESS SIASEMENT OR SLAB SL A
' iv.B�:v,��r L�a•,�t
ARCHITECT'S NAME LICI)I'm
OF FLOOR TIMBERS 1ST aX/V�' IND 3RD
Jr+tir G;��s�.Jo�- a
BUILDER'S NAME /'
C %lt'1-IcFA/E2 �C:tl2rul>Ef:- .—.
DISTANCE TO NEAREST BUILDING AI/i1 NSIONS OFSILLS -- -
DISTANCE FROM STREET / 0/� POSTS
DISTANCE FROM LOT LINES-SIDES `3 REAR + GIRDERS
AREA OF LOT SI, rl FRONTAGE Gi HEIGHT OF FOUNDATION �{ 3 � THICKNESS
15 BUILDING NEW SIZE OF FOOTING x
If BUILDING ADDITION FMATER:ALCHIMNEY ^j/A
rIS BUILDING ALTERATION N SOLID OR FILLED LANDWILL BUILDING CONFORM TO REOUIREMENTS OF CODE ;E - ONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY ONNECTED TO TOWN SEWER
ONNECTED TO NATURAL GAS LINE ASC,
3 PROPERTY INFORMATION
INSTRUCTIONS
LAND COST
SEE BOTH SIDES EST. BLDG. COST
EST. BLDG. COST PER SO. FT. j
PAGL 1 FILL OUT SECTIONS 1 3
LOT. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS 1 - 12
SEP-TIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR .
aA ,tt.Eo
SUILalNo INBPlECTOR
SIGNATURE OWNER OR AUTHORIZED AGENT
SEE I DWNERTEL/
\ —-- - -- ZOKTR TFLt 7
1 rIRMIT CRAMTZD
'CONTRIC
.ic.s - _- --� - --- - -
t+
-- ------ -- --- - - -