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HomeMy WebLinkAboutBuilding Permit #364 - 1132 SALEM STREET 11/9/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on thisage m r _ ` LOCATION � PROPERTY OWNER (,. Print Print MAP No:APARCEL:' ZONING DISTRICT: Historic District yes no 5 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition more family Industrial eration No. of units: Commercial replacement Assessory Bldg Others: Demolition Other Septic- Well Floodplain Wetlands Watershed District Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: /� 1 ,--qrA/ cru V ©�A 1 � QCMd :1 a STVnS �o A. & ploog- a (r 44-Q yv Identition Please Type or Print Clearly) r OWNER: Name: IJe�?U'/7S� S�t��y Phone: n'9'3(-2-z6vd Address: 3 �- RG&y✓1 5 T CONTRACTOR Name d M A-Z:L0 L Phone L_ Address; t l pr�f2 �,• Supervisor's Construction L�cense: Exp. bateA. Home Improvement License: 0 Exp. 'Date: r)-7— 6 ' , C 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: $ 22_(5.0 0 ,I!Z FEE: $ Check No.: /D Receipt No.: r;1 a e0 NOTE: Persons contracting with unregistered contractors do not have access to e u an fund ignature of Agent/Owner Y Signature�of contractor 1 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 ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: 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 ❑ Copy Of Contract ❑ Floor/Crossection/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 NOTE: 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 ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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: Doc.Building Permit Revised 2008' Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS 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 Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: + Located 384 Osgood Street FIRE DEPARTMENT Tema Dumpster on site yes: no Located at 124 Main.Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA- For department use ❑ Notified for pickup - Date ............ ----_...._..................................................._..............._....------._..._..:__._....._....._...-................................._..._............_...._._..-.......-------........__..._............._.__. ......-.............. _ Doc:.Building Permit Revised 2008 Location .// No. �& Date HORTq TOWN OF NORTH ANDOVER F P .y + Certificate of Occupancy $ sACMUS t� Building/Frame Permit Fee $ 2- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # IO 226US Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AL4 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): 4_O Address: 2 City/State/Zip: 403 Phone #: ??8-77/36/ V6 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction Mloyees (full and/or part-time).* have hired the sub-contractors ,_,/2. a sole proprietor or partner- listed on the attached sheet.t 7. 1✓J Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.]. t ay applicant that checks box#I 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.. tContractors 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 jab site information. Insurance Company Name: Policy#or Self-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 $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 certi a pa d na les erjury that the information provided above is true and correct Si atur69 Date: I"Jr-6 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers toprovide 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 number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us�a call. The Department's address,telephone and fax number: The Commonwealth. of Massachusetts Department of Industrial Accidents. Office of Investigations 600 Washington,Street Boston, MA.021.11 Tel. # 617-7274900 ext 406 or 1-8.77-MASS AFE Fax# 617-727-7749 Revised 5-26-05 I w—ww.mass.gov/dia i p� 71. P� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registratip' :; 130248 !QM--,-217/2010 Tr# 263302 µaDBvA- f,,; Lorenzo Construction x Peter Mazzola 2 Richard Drive Derry, NH 03038 Administrator Massachusetts - Dep:a-tment of Public Safety Board of Building Re"ulations and Standards Construction Supervisor License License: CS 76063 Restricted to: 00 PETER T MAZZOLA 2 RICHARD DR DERRY, NH 03038 Expiration: 5/21/2011 (uum�isiuncr Tr#: 15049 LORENZO CONSTRUCTION From Minor Repairs to Major Renovations INN, Construction Supervisor, Lic. No. 076063 Peter Mazzola, General Contractor Home Improvement Lic. No. 130248 978-771-3646 (MA) 603-434-5692 (NH) Customer: Glen Aspeslagh Sothy Orn Location: 1132 Salem St. N. Andover, MA Kitchen Pro oral ' Tear-out and Removal: Provide dump trailer for all jobsite waste Demo existing kitchen, all cabinets, counters, appliances, walls, ceiling, and floor coverings. Open up sub floor for crawl space access All plumbing and electrical systems r Move any items being re-used or donated to the back room. Rough and Finish plumbing and electrical- Upgrade all plumbing to code Rough in new sink location and new laundry location as per plan Run gas line from new supply to gas range and gas dryer Finish hookups for all fixtures Upgrade all electric to code New electrical outlets and circuits as per,plan Rough in new lighting as per plan (ceiling fixture, wall sconces) Install owner supplied wall and ceiling lighting Finish hookups for all new fixtures and appliances Rough in new Pex lines for future 2nd floor bathroom renovations and 1 q. PVC pipe for future sump "(Additional price shall be figured after floor and walls are opened) ' Drywall: Insulate exterior walls and floor to code Supply& Install new blue board and plaster to kitchen walls and ceiling (Finish smooth) ' Flooring: Install hardwood throughout kitchen prior to cabinet installation if unfinished wood is used, floor shall be sanded and one coat of sealer and one coat of poly shall be applied prior to cabinet installation. A final sanding and poly finish shall be applied after completion of construction (All flooring shall supplied by homeowner) Cabinets: Install new Shiloh all-wood cabinetry as per plan Install cabinet accessories as per plan (All cabinetry and accessories shall be supplied by homeowner) Trim Paint and Appliances: Supply and install new base, window, and door trim Prime and paint all walls, ceilings and trim in the kitchen Install appliances, run duct for new range hood Run new duct for dryer Permits: Pull general building permit for project All sub contractors to be MA licensed, have general liability insurance and pull Permit (Homeowner shall be responsible for the cost of building permit only). Misc. Any unforeseen structural damage caused by water, insect, prior construction excreta shall be evaluated at time of discovery and an additional price shall be presented to the homeowner Estimated start time early November 2009. Estimated completion mid December 2009 Payments Deposit prior to construction............................... .............................. $2000.00 Four additional payments of$4500.00 shall be distributed at the request of the contractor through the course of construction. Final payment upon completion of construction............................................ $2000.00 TotalCost .................................................................................................$22,000.00 The above estimate is provided following initial review/consultation. A non-refundable deposit is required upon signing of contract, and will be applied toward the balance of the account. Unpaid accounts over 30 days are subject to a$100.00 monthly charge.Any checks returned for insufficient funds are subject to a $50.00 fee. Lorenzo construction is not responsible for delays caused by cabinet delivery, countertop fabrication and installation, inspection delays other than a failed inspection.The client's signature below certifies understanding and agreement of the statements of this document. Customer's Signature /� Date: 1 G G Ger Contractor's Signature 104 Date: I r10RTly Town of vAndover . 0 No. 3 (ey 0 LAKE dower, Mass., I co C.'C..".C. ORATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR ...........f .................... .................................................... . THIS CERTIFIES THAT....... ........ ­5.1111?.!�.� /e Foundation has permission to erect.............................. buildings on ... ........n5'q.. .......et:.................. Rough .0 f a s v,0 or-44 , Chimney to be occupied a ... ...............A..................................................................................................................... provided that the person accepting this permit shall in every respect conform to 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 CONSTRU S Rough 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. XAORTH Town of 4LAndover . No. 3 ` - dover, Mass., RV LAKE COCHICHE"'.C" PS` o'c?ATE D PC7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System Aj BUILDING INSPECTOR THIS CERTIFIES THAT.......6�. ./c ........ ...... ... ............................................................................................... Foundation buildings on 0i .................. has permission to erect.............................. ...1/14........ ...... ... Rough to be occupied as........ A........... _]� 1 4D Chimney ............................................. ....................................................................... provided that the person accepting this permit shall in every respect conform to 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 CONSTRU S Rough .......................................................................... 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 3a %N-em zy is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL C 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: SALEM (Location of Facility) Signature of Pe ' Applicant II A s ag Date 206 a" duct new range hood 7811 852 38•• T7Ljq596e8'*5EK55 W3330 W ZZ 836-3 3 L36-55-PH- 1 alp N .O 00 v < new disposal = N k.. O I� and HW dispenser M d N mi v Siw %0 00 0 N ►-' M V E(cc—:") O i ew washe 0 N nd dryer 411 00 .O AIS ; 3h+b U1�� (31 TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 4 Print Rte_ I PROPERTY OWNER I, NCS1�4 Print MAP NO: PARCEL. ZONING.DISTRICT Historic District yes no Machine Shp Village yes n TYPE OF IMPROVEMENT PROPOSED USE ResiWaLl Non- Residential New BuildingOne famil ditiorr tlo �i��ca►.cQ� ,vg Two or more family Industrial Alteration No. of units: Commercial Repai rep acemenae� Assessory Bldg Others: Demolition Other Septic Well Floodplain ;Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: n(2 C3 i ��iz pn �-t.2t 9�P ,t L Q CF, :Ei2 M a C-P 9� -1- P T • \ c� 0,9CQiQ ��-c�c f 15 0-­& SRu u Es e(�eci'QfC tAr� kerb Lft (? %ANIoz�k dJ1��-tnEcgt by p�Kr1-- 4c�SPk1 Ctw} I`�� Identification Pte-ase Type or Print Clearly) J OWNER: Name: �' ex AS pest �4l_ Phone: 6 -f00 Address: CONTRACTOR Name: `� U Phone: Address: _ c - Supervisor's Construction License: C, ' 18'360y_ Dater ? - Home Im rovement license: p Exp. Date; ARCHITECT/ENGINEER N p'" Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ CSO FEE: $ 4A1 Check No.: 1124 Receipt No.: 224/7/4' NOTE: Persons contracting with unregistered contractors do not have access to the quara7lfund Signature of Agent/Owner Signature of contractor Q 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 L- ❑ Floor Plan Or Proposed Interior Work yter ❑ Engineering Affidavits for Engineered products NIA- NOTE: 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 ❑ Copy Of Contract ❑ Floor/Crossection/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 NOTE: 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 ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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: Doc.Building Permit Revised 2008 1 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools t Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site M THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on . Signature COMMENTS i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 'V,:planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpsteron site yes no Located at 124 Main Street Fire Department signature/date " COMMENTS Dimension Number of Stories: Totals square feet of floor area based sed on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date ._._....__.._..._...__..................._............_.................._...............--- --— ----.---...-._............_.........._..__.._.---.._.----.-------------_._................_....._....._...._. _.__._.................................... + Doc:.Building Permit Revised 2008 Location No. .2��' Date 40RTN TOWN OR NORTH ANDOVER ?o�...o :•��e Fo. c9 ` Certificate of Occupancy $ Ar t— �'�J'•^�'t<� Building/Frame Permit Fee $ �??S wcMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22474 �BUding Inspector XAORTH Town ofAndover ._ '' No. -_ Im o E = dover, Mass., COCHICHEWICK ADRATE D PI? �y `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... . ............................: Foundation has permission to erect..................................:..... buildings onj.a . ..... . . ..................................... Rough to be occupied as......... y�'.�� :....��C•�•�`f!Cl?G.. .... ,��...f�' .... �. .0 !.'.. :` P... /f.. .t .l'c' rye-° Chimney provided that the per accepting this permit shall in �ery respect conform to the terms the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, A oration 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 MONS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOTARTS Rough . .. .. .. .... 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 Be Done FIRE DEPARTMENT' Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. NORTH ® of : 4Andover . No. T4-7 O '- LAKE - dovel, Mass., COCMICI WICK ADRATE D P? IT BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... ,9. .. Foundation has permission to erect........................................ buildings onj............................ ....�.."'Z„�--�,...........................,.`......... Rough to be occupied as......... y�'1.I:.....�t.�f�?I �. ,e_e..... r��. �'."'.... °. :7. .. �... Chimney provided that the persorf accepting this permit shall inery respect conform to the termshe application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Aeration 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 TARTS Rough 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. IF_7S7E7E REVERSE SIDE Smoke Det. TOWN OF NORTH ANDOVER 1600 OSGOOD STREET Building 20 Suite 2-36 NORTH ANDOVER MA 01845 FURNACES BOILERS ROOF TOP UNITS AIR CONDITIONERS EMERGENCY GENEREATORS 30 wow0i The undersigned applies for a permit to install the following at: Location 1132- SQ l°eA ST. Owner of premises O l'es`I k-5(fie44i6f �Q� Address (13a Sq L, St, �(•AA�e Name of mechanic `�a►� a��Ewa (�,, klfe C1VT ddressY,� h33y sr�{Sie�oft nn nn otgaj Building occupied(fou�r t�e51'(1C P�l� e Material of buildingL3bo& u Kind of fuel ca►S Chimney tj JK No. Of flues Size-3 51se Oat Chimney Thickness tj Lining If steel stack location Diameter Height DESCRIPTION OF HEATING APPARATUS n Kind of heater00 0,5 how many make \` yA BTU Input Location in building Ba-<e P"-eyjct Protected against fire as required How protected See the State Code(Pertaining to Chimneys, Smokestacks and Heating Apparatus) ROOF TOP UNITS O� R EMERGENCY GENERATORS Make Sa- o- t}eo't `��.�..o 6+ ( 2Weight , �& 5 Dimension Length r7` Width 1 a'' Height 3 Location of building RP-arL 44 " how supported 5(CC a c- Size of roof timbers Material of roof timbers Span of roof timbers Distance on center Protected against fire as required How protected AIR CONDITIONS Kind of apparatus_Q"k-IflO0-Z 4a4 Pu•.,c make S HVAC FORM REVISED 11.04 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 Anplicant Information Please Print Legibly Name(Busine ss /Organization/Individual): Q(fit �1(1�L1� U-Pr Address:.... , City/State/Zip-Du"1 a 6 e Mgt- a� g' Phone#: Are you an employer?Check the appropriate box: Type of project(required): I.❑ 1 am a employer with 4. ❑ 1 am a general contractor and I d. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. 0 Demolition working for me in any capacity. workers' comp. insurance. q, Fj Building addition [No workers'comp, insurance 5. dWe area corporation and its 10Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL I LZ 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.j 13.(�Other &d-a.applicant that checks bo)t#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner$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.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 e. 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 DCA for insurance coverage verification. I do hereby cetr thp andpenaies ofperjuthat the information provided ove is true and correct Sip-nature: 7DOat Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 11assachusctts - Depal-tnicnt of Puhnc S arts Board of Building Regulations and , alid t-ds Construction Supervisor License License: CS 83004 ' Restricted to: 00 T" PAUL E OLOUGHLIN PO BOX 290 t DUNSTABLE, MA 01827 Expiration: 7/23/2010 Tr#: 28405 91-7e &--.a a�✓�aarat�ticvPlld jpBoard of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 163372 Expirations 6/9/2011 Tr# 285222 Type: Partnership MAIN STREET HVAC INC. PAUL OLOUGHLIN - 310 MAIN STREET DUNSTABLE,MA 01827 Administrator Ili 'ROPOSAL PROPOSAL NO MAIN STREET IWAC, INC. P.G. BOX 334 s0EET NO: DUNSTABLE, MA 9'1827 DATE - - ----- - ---- - a/ 0 'ROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME AbDR=SS ADDRESS rt3� DATE OF PLANS° PHONE N0. _ / O ARCHITECT f tie hereby propose.tc.#urnish.he,rna#enals end perf, rm the;labor necessary for the completion of fes. . wir.41-A lo 4 iTvi%✓1 77777777777 All material is ;guaranteed to be as,:specified, and the .above work to be performed in accordance with the drawings and.specifi cations submi ed for ab a work and completed in� substantial workmanlike manner for the sum of W o� � �, ic '�r• � Dollars with payments to be mode as follows. ii DD Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become.an extra charge Per over and above the estimate. All agreements contingent upon.strikes,r ac- cidents,or delays beyond our control. Note—This proposal may be withdrawn by us if not accepted within 5—days. ACCEPTANCE;0F�PE�OP0&� The above prices, specifications and conditions are satisfactory and are hereby.accepted. You .are authorized to. do .the work as specified. Payments will be made as outlined above Signature Date D Signature NC 3818-50 PROPOSAL RCG NORTH ANDOVER MILLS LLC LEASE AGREEMENT DATA PAGE LANDLORD: East Mill Tenant LP ("Landlord"), its successors or assigns, with an address of: c/o RCG LLC 17 lvaloo Street, Suite 100 Somerville, MA 02143 TENANT: Seren Elizabeth Laponius d/b/a Serenity Massage LEASE TERM: One (1) year as further defined herein. RENEWAL OPTION: None PREMISES: Suite 305A at East Mill North Andover 21 High Street, North Andover, MA 01845 COMMENCEMENT October 1, 2009 DATE OF LEASE: USE AND RESTRICTION: To be used as a licensed massage therapy office. RCG STANDARD COMMERCIAL LEASE initial 1 of 9