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Building Permit #444 - 134 BERKELEY ROAD 5/1/2018
F TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:A licant must complete all items on this page LOCATION 13� �� Icy ' Print PROPERTY OWNER ro Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic istrict yes Machine DShop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building One family Two or more family ❑ Industrial ❑Addition ❑Commercial ❑Alteration No. of units: ❑Assesso Bld ❑ Others: Repair, replacement rY g Demolition ❑ Other - Floodplain ❑Wetlands= ❑ Watershed District Septic Dwell P ❑Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: khllOqiriplake ND e s (Identification Please Type or Print Clearly) Phone: 17k-31 —3 y_fD3 OWNER: Name: V1r t, T Address: I a, CONTRACTOR Name: -Phone: 617_ 387-9713 Address: �S L�n�.3 S-� FVk A02149 Supervisor's Construction License: 6 1119p. Date: 10127 I3 Home Improvement License: 102Ig7 Exp. Date: 7h3 la 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- 3 19-7-72, FEE: $ 38 37 Check No.: I i Receipt No.: NOTE: Persons co ra ing with unregistered contractors do not have aceq �7rantyfund r Signature of contractor ntlO Signature of_Agewner- - — �sh { y z rt� •-r'r.. z'r [3-R ^+� r ^z•¢ d ,r �Y -n.• s .�'•�f "'�tiT.. �'.� £ A^^r�. C '�' Wu �""g'w,y t- ':u,�i," 4.«tom '�` x r 1`dn.,•x arn.F ,�y,r 2.d: •g a x�sr' a ..��g ..� �, ,-z.:aa ti, .,� 'G-f. .'s mss" a,C r r r,�.- r #'i1 � -El-x` rK' : •r `�*h y„ 'A'' "` '2nh4 a ix 4'� y Nils} +;.ey5, fi5"� { a � r 3�3i1 .'r ss ,�'c" q ar'-•nom 1j'��„ a `v',+, n^ri-r,,`?y 7L µ �f... a'S. C. Sire r 3 CONTRACT#00013 31 '� >' rN s.¢a.. r t�ka `` �',�.r si" '`�d• ..,ryy�aa ` `"R ':7tt �'S i` �'f{ •5e. * 1• '#S f y. 'a Yr: ,'�fi 55 yny�. xs;• �$'2, may{.^ ASS SE iSc A d©1\ 51 �4V.. � I�UT��]5 INSb SALES` � {a� � 4s3 S R. x8&-= ' TALLEDS�ALES '. ST RE STREETA D SS NUMBER, _ .. „.:... .. e, u_ ...�...4.- _ � STR ApORES .• !,'k CITY CITY ST A ,.: ZIP � % �T/A�TE�. .Z ci ✓`i'�"`+ �xf"1�/ ............_ U [ TELE N LOWE S HOME CENTERS INC.'s MA HRC NO 148688 ` m• cnsH - enNN t <� FEIN 56-0748356 {x ; , t.0 r a EG i=r+•si'h.. 4 3 'r+F tf �0a'" �,.:•�'� iq"+rs��s�t'f+3r�,`Ts °� -.` e'f` ' s. } �y-,� 9 �,°'k�._i�'�`��j t .ihS 756nlyarquote Edythe me�Chanil; and sere ces noted below aTfi sipacymes;ans r€€mentp o mext•_ '`+- �•y `°�` '£� ;.,%r 'S 9 P D�ta .0 G»gdq�riir"�'ent the'TermsanQ CCndrtionsaxladedWt�this d'bch entanE,an gtfi4r atl AAtj'a�a allechmentshe6tp spa yment the e�6re[ayree>nent,mctddl'�g,lrespe Awj[y cOtnpieted paggsbt343 -« FASEsREAQALCTEIjM�, NDONpITJONS-LITHE REyERS�gIOU ©)=T11IS•QA D7fOLhOWfNGrP GhESr-Or 'SIGNIN r+as{hl egCORUa `�"{`'d'. 'x .F�� [ y"�.ty' r [ se ti w K ` fir. .� v w A a:r. . f'vi°ptia ",, z.s: ..-. rs..AXt {5.1.,`. '' ',z '.a3,y t'." •4' a-X�::, FY nr;` aK€� k r'`^�- r Sc,"�' £x to[I INS TIO TREE RESS - `,+.- M-.k=.*' +F'•+R.." r.,,,ri'.. x. S 3 O TY STATE ZIP rr r_ - z 1 Are permits required for this installation? Contract Total 7'1 K] )Yes [ ]No applicable tax included 7 . NOTICE TO CUSTOMER: Federal law requir Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this Contract,and irrevocably grants to Lowe'sall right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such Photographs for any lawful purpose, including,but not limited to,marketing, advertising, publicity, illustration, training and Web content. By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Worki o comence up IT sonable availability of Contractor and/or any special d r or ustomer m d Good(s)which is anticipated to be [title in date].Estimated completion date is Said mated substantial completion date is not of the essence.A statement of any contingencies that ould materially chlange sl in ,d estimated substantial completion date is as follows: (if applicable,insert-a statment of such contingencies). IF THE CO CT TOTAL IS$1,000.00 OR LESS Customer must pay in full. ;0 TE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [ Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)Deposit $ to be paid upon siging contract.Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment Of$100.00 to be paid upon completion of the installation and both parties'satisfaction. E G 9131IRATION AGREE E T CL OVE ED'B M G.L .142 -WA16R.HERJ=6.Y- TIDAL-J_Y,('A6R,F,FI.r DVANEE IN-'lI., ENT-LOWS`S/hIASA-0ISRUT�,80NG�ERNfiO`fFfISGDTYTKP;CY;°LfH - 10WE'S Zu'amh SU CHb UTE TO I�PRIVAT BITRA ERVICE"WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IV E OF CONSU I FAIRSA D BUISN S E TIO S AND THE OWNER P DIN G. C.1 HALL B REQUIRED TO SUBMIT TO SUCH ARBITRATION . I 'we tern, nc.- Date: / By. Date: /l Owner Signature THE SIGNATURES OF THE PARTIESABOVE'APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON HE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU AR CKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SE F TH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONT CT. OU ARE ITL D ACOP F THIS CONTRAC T THE TIME OF SIGNATURE. WITNE SO HAND(S)AN SEAL(S) ELO THIS DAY OF � o s me S ciali t.orAbove Owner Co-owner orWRtness Customer acknowledges receipt of a.true copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third b9siness day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right 490981(Rev.12110) FILE COPY ®2004 by Lowell®�?7,,and Lhe yab•,de,;nn 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 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 Siqnature 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: FIRE DEPARTMENT - Temp Dumpster on site yes Located384Osgood Street Located at 124 Main Street Fire Department signature/date COMMENTS i — -- 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 2011 June/mi r 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 o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 2008mi �ORTM� Town of 0 No. 7 z •3� •Il o o dower, Mass., COCHICMEWICK V S RATED Apa��S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......�p{, 1 ............ Love= ............•/.. ................. ............... .... .................... ................... Foundation has permission to erect..............................I.......... buildings on .....l3.. ......g ... .. ............ ............. Rough to be occupied as............ . �� �r1.�Apw1 Chimney ............ .......... .................... ................................................................................................... provided that the person accepting this perm shall in every respect conform to the terms of the application on file in Final- this inalthis 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 . 3 PERMIT EXPIRES IN b NT'HS ELECTRICAL INSPECTOR T UNLESS CONSTRU 1 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information t Please Print Leidbly Name(Business/Organization/individual): Address: 1�z; City/State/Zip: wf jTt�` 11 C 1 Phone#: Are you an employer?Checke appropriate box: Type of project(required): 1. I am a employer 4. ❑1 am a general contractor and 1 6. ❑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.t ? ❑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 ]0] officers have exercised their ❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l LE]Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t errtployees.[No workers' comp.insurance required.] 13.[]Other *Any applicant that checks box tl l 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 subruntractm 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. E t §! 1 Insurance Company Name: ' lutl C ni 9° (� r? y gr}�j• i� Policy#or Self-ins.Lie.#: —7`4 244 Expiration Date: i] Job site Address: ] 3 7 T:�e r�e ky K0 City/State/zip: �. )dbUk M,} 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 imprisorunent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.. Ido hereby ce>Yify under the pains and penalties of perjury that the information provided above is tale and correct i. Signature: �1°`'�t3�b ); Date: ..y jo;!'s l ° Phone#: ks , m �d , `i -f", Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• �lasachu.eth Dclrutrncnt of Public safct% BOW-d of Buildint Re,-,ulaturns and SCtndat•d< Construction Supervisor License One-and Two-Family Dwellings License: CS 61719 RONALD A GREENE 10 RITA DRIVE MEDFORD, MA 02155 Expiration: 10/27/2013 c inmi..;,,,,•'' Tr`: 5199 61719 1G RONAL REEVE 10 RITA DRIVE MEDFORD, MA 02155 c— ,-------- Expiration: 10/27/2011 Tri: 6717 Office of Consumer 1�fars dcfRu§iness eRulahoo`' , HOME IMPROVEMENT CONTRACTOR Registration: 102957 Type: Expiration: 713/2012 Private Corporatior GREENE INSTALLATION CO.,INC. Ronald Greene 165 Bow Street Everett,MA 02149 Undersecretary xr From: 05/0912011 10:35 #913 P.001/001 ACORD CERTIFICATE OF LIABILITY INSURANCE F DATE(MWDDMYYY) 05/09/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(es)must be endorsed. I(SUBROGATION IS WANED,subject to the terms and condnions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in leu of such endorsement(s). PRODUCER CONTACT New England Heritage Insurance A NAME!Agency Group, Inc. H NE . 781.43$.5000 No:781.438.5028 335 Main Street E�MA0. ADDRESS: _ Stoneham, MA 02180 PR ER $T INSURED ---- --- tNSU S AFFORDING COVERAGE _NAiC If _ INSURERA: Safety Insurance Company 39454 Greene Installation Co. Inc. 1NSURERB: Safety Indemnity Ins. Co. 33618 165 Bow Street --- rtrSURER C: Everett, MA 02149 INSURER D INSURER E: COVERAGES dIStIRER F CERTIFICATE NUMBER:Master 11-12 Revised 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 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR LTR TYPE OF INSURANCE INSR wVD POLICY NUMBER MIYIrD LIMITS GENERAL LIABILrTY I BMAOOOS S1 06/08/2011 06/08/2012 EACH OCCURRENCE $ 1,000,000 X 1 COMMERCIAL GENERAL LIABILITY �PREMISES RENTED e o=mxwel $ 100,000 -- -,—_I CLAIM6-NtADE L OCCUR MED EXP(Any one Person) S ].Q QQ A t- PERSONAL&ADV INJURY s 1,000,000 - GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER I POLICY SERC LOC PRODUCTS-COMPJOP AGG s 2,000,000 If AUTOMOBILE LIABILITY 620893 01/3012011 01/30/2012 COMBINED SINGLE LWI7 $ ANY AUTO I Ea aaddent) S 11000,000 ALL OWNED AUTOS I BODILY INJURY(Per person) S B J(�SCHEDULED AUTOS I i BODILY INJURY(Par at:cAenq S HIRED AUTOS PROPERTY DAMAGE S (Peracodem) X i NON-OWNEDAUTOS I 5 I S (UMBRELLA LIAB - I OCCUR EXCESS UAB CUOOO SO 01!3012011 01130/2012 EACH OCCURRENCE S 1,OOO,OO A —� I I CLAIMS-MADE AGGREGATE $ 1 _ DEDUCTIBLE i $ 1,000,00 X RETENTION 5 10,00 $ WORKERTION AND VERS'LLA3LJT SEPARATE CERTIFICATETORVTATU IOTH- AND EMPLOYERS•LIABILITY y�N S ANY PROPMETORMARTNEWEXECUTIVE TO BE PROVID E.LEACHIA.T8ACCIDENT S OFFICERRAEMBER EXCLUDED'? Q N f A l (Mandatory in NH) BY CARRIER E.L.DISEASE-EA EMPLOYEE: $ n yes,describe under I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIDNS/LOCATIONS I VEHICLES(Attach ACORD 1ID1,Additional Remark$Schedule,if morn apace Is required) Installation of doors and windows. ubject to the terms, conditions, endorsements, and exclusions of the policies. CERTIFICATE HOLDER CANCELLATION FAX: 791.537.5464 -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LOWES HONE IIMPROMENT ATTN.: RICHARD AUTHORIZED REPRESENTATIVE fly COMBNERCE WAY WOEJURN, KA 01801 _..... ....-. William Kel i JAL ACORD 26(2009/09) ----61-99&2009The ACORD name and logo are ACORO CORPORATION. All rights reserved. registered malice of ACORD IS CERTIFICATE IS ISSUED AS A MATTER OF INF q MATION ONLY AND CONFERS NO RIGHTS UPON THE ERTIFICATE HOLDER.THIS�CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED Y THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN E ISSUING INSURERS AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. MPORTANT: If the C8rKMts holder is an ADDITIONAL INSURED,the policy(ies)must be endoreed. If SUBROGATION S WAIVED, sut�ect to the terms and conditions of the policy,certain policies may require and endorsement A statement this certificate does not confer ri hts b the certit'icats holder in lieu of such endorsement PRODUCER New England Hadtage Ins Agency 336 Main St Stoneham, MA 02180 COMPANIES AFFORDM Q INSURANCE INSURED COMPANY A GRANITE STATE INSURANCE COMPANY Greene lnftgatbn Cc Inc 105 Bow Street EVenrtt.MA 02149-0000 THISIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSLIRD NAMED ABOVE FOR THEi: PSD INDICATED,NOT WITHSTANDING ANY REOUIRENEW,TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMrre SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L1rd WIFE OP moumoE POLIdr NUselR P011alrlrRC11V!DAT! FOLIDIf 11QM710N OM! A COMP 0 EMPLOYERS'LYiBIL1iY E PROPRIETOR! L�t�Tg PARTNERSIE7ECUTNE OFFICERS ARE: OTHER NCL❑EXCL Eli 742"58 3/04/2011 &04/2012 AMORYLBrIrB CaareBoApplwtoMA OpaatlowOr�. H ACCIDENT $ , MAN POLICY LIMIT S 500.00 OPERATR N EMPLOYE 5 50 CERTIFICATE HOLDER CANCELLATION LOWE3 HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATTN:RICHARD WRATION DATE THEREOF,NOTICEWLL BE DELIVERED BI ACCORDANCE 16 COMMERCE WAY WnTETHE POLICY PROV1=N& WOBURN. MA 01801 AUTHORIZED REPRESENTATIVE Date �2 NORTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SSCHUS This certifies that . . . . . . . . . . . . . . . . . . . . has permission to perform . . . -Ut- 11�,;... . . . . . . . . . . . . . . . . plumbing in the buildings of . ��o ``. . . . . . . . . . ... . . . . . . . at . . . North Andover, Mass. Fee,.).).-. . .Lic. No.. .?ty.f. . . . . . . . . . y: . . . . . . . PLUMBING INSPE OR Check +' 8342 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) JJ � oZ01 d mass. Date, i Permit#, Budding Location-L Owner's Name Type Of Occupancy Z5 L New D Renovation O Replacement 0/ Pians SubmRted: Yes13 No Q FIXTURES . z z m z YP * • al m m m O 2 > W t� NJ > V < y O W ¢ y y < ¢ < ~ 0 z V z ¢ m b m W Y < !� 0 z O < 09 = ft C ¢ 0 Y. ¢ W 0 y¢j < m ¢ < W fa ¢ J p ¢ p r H < x < F < < = Yl m < < O < J < ¢ ¢ ¢ < O < I— is � m m p p � 3 = r-• �+ �. a � a < 3 ¢ m o sus—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR ARD FLOOR 4TH FLOOR STN FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR t� Installing Company Name r Check one: Cefficate, Address I It ,✓er y,1--6-1 D Corporation Partnership Business Telephon ❑ hrm/Co. Name of licensed Plumber G�C�r dos o�C INSURANCE COVERAGE: I have a current(}'ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142: Yes Cr No ❑ If you have checked yo, please indicate the type coverage by checking the appropriate box A liability insurance policy Ind' Other type of Indemnity O 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: Owner D Agent D' Signature of Owner or Owner's Amt I hereby car*that all of the details and information 1 have submitted(or entered)in aban application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit is,cued for this aWication will be in compliance with all Pertinent provisions of the Massachusetts State Plumeand Chapter 142 the General taws. By gnature of Licen umber Title City/Town Type of License:Master❑ Journeyman . � L License Number 3 1 $?I' � i Date. .//. Vi a.... ... NORTH 3� 6 TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION ACHUSESt °This certifies that . . . .1. !1 h! .4. . . . . . . . . . . . . . . . . . . . . . has permission for,gas installation . . .l c .ff . . . . . . . . . . . . . . . . . . . in the buildings of . . .l .� .. . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . North Andover, Mass. Fee. . Lic. No..? . . . �ASINSPECTOR Check# 7275 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) a, c - c—, Ue< , Mass. Date ©� A_ 0 Permit # ` Building Location141 Owner's Name Type of Occupancy New ❑ Renovation ❑ Replacement 90 Plans Submitted: Yes❑ No❑ N H W N Y Z ¢ N N N V ¢ N I !- N G O N ¢ W ¢ O V m t = Jl f7 J ¢ Ct f. .4 �' Z Z O ► W z o W ¢ < m N H y W 0 O N 0. CZ I- W < ¢ N O V W N W -C ¢ 0 0 h' = W W J Z t Z W ¢ 0 0 > IL F- V J H W L7 F Z J F- Z W O Z O 2 W O IA S O o W lo- cc¢ 'S SUB—BSMT. BASEMENT ' ISTFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5THFLOOR 6TH FLOOR 7TH FLOOR BTHFLOOR Installing Company Name U04 ` Check one: Certificate Address 6,mU, iet ❑ Corporation Cl. Partnership —T, Business Telephone rf n qac &G—CO ❑ Firm/Co. Name of Licensed Plumber or.Gas Fitter ro,� F — INSURANCE COY AGE: I have a current ' billy insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checkedrtes. 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 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: Owner❑ Agent❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application w' be in compliance with all pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of the Ge�ws.ByT of License: Plumbergnator Gas tter Title Gasfirier —2 I ►, ,..,,Master License Number n City/Town )oumeyman APPHCNED l0 1 S. NL ro Date... i O� NORTI, TOWN OF NORTH ANDOVER O F PERMIT FOR WIRING SSA US� This certifies that .................... .7 ............................. r � has permission to perform _ wiring in the building of... ................................................................ . at.. 3 .....�.`.�.:...................... �.,:...� ... ,................... .North Andover,Mass. v*� Fee, ..U......�...... Lic.No-,5:..'.'/. .R ................................................. f r ELECTRICAL INSPECTOR Check # 7 / 65 commonwealth of Massachusetts official Use Only Department of Fire Services Pemut No. Occupancy and Fee Checked ��t BOARD OF FIRE PREVENTION REGULATIONS 'Rev. 1/07] eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeC),127 CMR 12.00 (PLEASE PRINT IN NK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice,of is or her in Location(Street&N ber) 3 -k Z ntion to perform the electrical work described below. i at(�/ Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes EamK No ❑ (Check Appropriate Bog) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No,of Meters New Service Amps / Volts Overhead❑ Unil rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ff r Completion of the ollowin table ma be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No,of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above in o,o mergency ig g B nd. rnd. ette Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMSNo.of Zones r No.of Switches No.of Gas Burners No.of Detection an Initiatin Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat ump Number Tons o.o Se -Contained Totals: w.........._.....-........._._. Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Mer No.of Dryers Heating Appliances K, Security Systems:* No.of Water No.of No.of Devices or Equivalent Si Heaters ' l of Data Wiring: Signs Ballasts. No.of Devices or E111 uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent AUach 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 [I (Specify:) Li�,i Ccrr1�. I certify,under the pains and penalties of perjury,that the information on this app ' anon is true and complete. FIRM NAME: LIC.NO.: -= Licensee: �✓��� -• �• .�, Signature s -LIC.NO.: c � a' (If applicable,a ter" e pt"int icens number ire.) c 316 4 Address: t4 Bus.TeL No.:�'7J`32' -aU�3 �S .,. , v9v�r-1Alt.TeL No., *Per M.G.L c. 147,s.57-61,s6burity 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 normalI 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:$ h` t �tt ,. 4 Y' �. The Canmanwealth of Massachusetts' ' ! Department of Industrial Accidents Office of Investigations 600 Washington Street / Boston,MA 02111 www.n:ass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print UAW Kz,;k'-t Name(Business/Organivation/Individuat): Address: GJ L ()rj,, S c city/state/zip: r4 Phone#: . I Are you an employer?Check the appropriate boz: Type of project(required): 1.Q I•am a employer with 4. Q 1 am a general contractor and I 6. Q Naw 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._ 7• ❑Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me m any capacity, workers' comp.insurance. g, Q Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its 10 Q-Electrical repairs or additions required.] officers have exercised their 3.Q I am it homeowner doing all work right of exemption per MOL 11.Q Plumbing repairs or additions myself.[No-workers'comp. c, 152, §I(4),and we have no 12,Q Roof repairs insurance required.]t employees.[No workers' comp. insurance required] 1.3.Q Other *Any applicant that checks b must aiao fill out the section below showing their workers''oompensation policy information. �r 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 mustattached an additional sheet showing the name of the su&conttactors and their workers'comp.policy infomtation. I am-an employer that is..providing.workers'compensation insurance for my employees: Below is the policy mid job site informafion. Insurance Company Name: • 'L.rl`t, u +,4c Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: f3 Z 644 i C, City/State/Zip:_ Attach a copy of the workers'compeasa a policy declaration page(showing the policy number and expiration date Failure to secure coverage as.required trader 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerfi unndeef the airs apdpenaldes of perjury that the information provided a7/v/ a a and correct Signarate: WG Date: �� /(/ Phone#. Offlciat ase only, Do not write in this area,to be completed by city or town official City or Town: PernsWLieense# 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 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 compliancewith the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or.Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign and date the affidavit. The affidavit should y 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 requir-ed 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'appropri to lme. City or Town Officials - 1 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.When 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 r Offiee of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-7274900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.gov/dia I Im uuYunuiv vvrkiu n yr ivH•"eivnv.>sl.u ��' •� DEPARI Mpff OFPUBUCSAFM Permit No. BOAROOF rREVF1YITONRf�t?70NMS17a21200 � Occupancy&Fees Checked F �� APPUCA71ONFOR ATO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00Dat (PLEASE PRINT IN INK OR TYPE ALL ORMATION) Town of North Andover To the Inspector of Wires: The undersigned ap ies for a permit t perform the electricalworkdescribed below. Location(Street&N ber) Owner or Tenant L6.Aro,., Owner's Address Is this permit in conjuncts w' a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps I Volts Overhead Underground 1:3 No.of Meters New Service Amps I Volts Overhead M Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work r-1rl oN. t^ \j s4�,4r^ No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round 1:1and No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of des Burners AIo.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained DetectiordSounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Sixns Bailasis No.Hydro Massage Tube No.of Motors Total HP CoNaar.PutamiDt teteglme imbd bmdiuMC,ataalLaws Liabt&y)it�rraeEb6cYitrk�rgCmiple>e � ailssut�rtialagtm►eialt YES NO va5dpRdo(s=oDdle0lli=YES ff)ouhmedrdledYES,p)tmmk*dletypeefeom-Vby boc 1---1 Borm r7 mm 0 ,,,dy) �41,k i� E dVArofEMh]CdWak$ __ �D*� " Rao Phr>aMiescfptijllty Liww% signt>Dine Liomm;o Btts¢>es Td Na G)T-3 D -D-a I _ >j 0 F'32 A1tTtINo. q29-25V 6292 ISNSURANCEWAPotL-IammmdriftLioffwdoesriot the' aAa*oritsqkmkmr WeglnvaialtasrtqxedbyMassaftgMCmidLam sgrahue on Itis pewit aQp)tcalial vrai�s d>is'°gl>iterrt�nt heck one) Owner ID Agent ED Telephone No. PERMIT FEE$ Signalu or Ownerg Date c� T:��o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s ,� • ,SSACMUS� This certifies that . -�. . .�. �" 5.�. ...... . . . . . . . . . . . . . . . . . . . . .. has permission to perform . . . . P-C.'O .P u 01•�!°.''• • . • . • • • • • • • • plumbing in the buildings of . . .(f('. � . . . . . . . . . . . . . . . . . . at. . . . 7fkF.�. .�- . .�?.�. . . . . . . . . ., North Andover, Mass. Fee. Lic. No.! . . .? 4 . . . . . . . . . . <. .f-L. . . . . . . PLUMBING INSPECTOR Check # 6925 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /� / Date ���✓ Building Location /� ��r°✓ �e� .�� Owners Name O�yI%&Clc0i4d'ip!2 Permit# L�^ ' Amount Type of Occupancy ,ee�10)&19 fig �jr�y�� New Renovation Replacement Plans Submitted Yes No FIXTURES d Cr Cr Z F w O w w xccIn O ►.� U zG F d d u' a SLsBRa B4SffV]ENr M FLOOR m F>ioat �. 3M MOOR 4M F-OM 5MHAXR supH-OM 7M IWM sIH FvO� (Print or type) / Check one: Certificate Installing Company Name �u -�i n 5 �'��`/n Corp. Address Partner. n-3 E3 Business Te ep one �o0 3 yy— gam,ZX Firm/Co. Name of Licensed Plumber: ,,,��/'�,d��vy S f Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner El Agent El I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code awl Cha ter 142 of the General Laws. By: StgnaCare01ci ense�um ear Type of Plumbing License Title �3 S City/Town icense iNumDer Master Journeyman APPROVED(OFFICE USE ONLY �.- +. 4419 CJ PLUMBING & HEATING P.O. BOX 618 PH, 603.434-8322 DERRY, NH 03038 53-7054/2113 a / �iJr�©d s— �,= E' AY TO THE w PORDEROF ©✓ j1 P $ �S o N DOLLARS 8 � BANKNORT MASSACHUSE S 370 MAIN STREET WORCESTER,MA 01608 FOR — —� — --- � -----"r 1120044 L90 -A: 2113 ?054Si: 19032939011' �. - 77-77-7 777=1777 ENDORSE HERE s DO NOT WRITE. STA:-;P OR SIGN AELOV? THIS LINE y, PEDENi L i-i4$LAV_l —J-AD OF CG.-JL. R i PLC.CC Location No. Date NORTh TOWN OF NORTH ANDOVER Certificate of occupancy $ Building/Frame Permit Fee $ CH S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 5qyo 7 Check # 17899 Building Inspector TOWN OF NORTH AN-DOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a� .7 71 s -:.._.Y„_.:.3 r.....,,," Z; ._._ .n ,.._...,..,...,a. ,: rlSb.,-,T.lk � Q,:�'�; iT1,y sx,-k , y✓'., ,., �'Y+a.. �. "4, 6:iv�� »F BUILDING PERMIT.NUMBER: YODATE ISSUED. X cc X SIGNATURE: Building Commissioner ns for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 (ZoningInformation: 1.4 Property Dimensions: V _ I a 20 I �a ZoningDisj SPr Proposed Use Lot Area sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard. Required Provide Required j Provided Required Provided 30 30 / o b 1 .55- 0 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood a Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSEIPIAUTFIORIZEDAGENT �IS7C�1"I{% St(ICt; Yes No 2.1 Owner of Record wad el �; ©1Ugerklg� / -- �` Address for S toeName(Print) Lf(:1440L5 Signature 0 Telephone 2.2 Owner of Record: r Name Print Address for Service: Signature Telt hone SECTION 3-CONSTRUCTION SERVICES 3.1 L'censed Construction Su�rvisor,.,. Not Applicable ❑ UAj Licensed Construction Supervisor: l� S �O Gy 6�1 P// 03 d 3� License Number ?, r ( 02 I V 10 J� J Expiration Date (� Signature a Telephone 3.2 Retet Im rHo ove ent Contractor Not Applicable ❑ � � Co. any Name E� 0/v1 �� berm � � Registration Number rM rM Add ssV, / (1 �lO� mmm Sz A lfb:-� 1i1�/c> &V Expiration Date Signature Telephone J SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) 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.......0 SECTION 5 Description of Proposed Work check au appbcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alteratiorl ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify_ Brief Description of Proposed Work: r G coot 2 `�l a`7�� o go 0of' oy"i ex oS tA) SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFIIA .II E ONLY Completed by germit applicant 1. Buildingn�i �� (a) Building Permit Fee C Multiplier 2 Electrical 2 (b) Estimated Total Cost of 2 / Construction O Q ~ 3 Plumbing D Building Permit fee(a)x(b) 4 Mechanical HVAC 30 - 5 Fire Protection 6 Total 1+2+3+4+5 34,5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN i OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMT as Owner/Authorized Agent of subject property Hereby authorize__ k-u a— a.)45e-J to act on My btlf,in all matt lative work authorized by this building permit application. P z Zc. Q Si tature UOwner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION � I> (ik O b R cscw as Owner/Authorized Agent of subject tt property Hereby declare that the statements and information on the foregoing application are tn:e and accurate,to the best of my knowledge and belief Print Nam � V� Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGIrI'OF FOUNDATION THICKNESS SITE OF FOOTING G X MATERIAL OF CHIMNE`f ---- __ IS BUILDING ON SOLID OR FILLED LAND TS BU',DING CONNECTED TO NATURAL,GAS LINE �� The Commonwealth of Massachusetts > Department of Industrial Accidents d OMCG of Investigations .� Boston, Mass. 02111 Workers'Compensation Insurance AMawt Name Please Print Name: IVAv S O Location: 3 ^W c oaf S C' er © Phone # 3 177 T I am a horrkwner 6eftiming all work myself. I am a sole proprietor and have no one working in any capacity �am an employ providin worke 'compensation or my employees working on this job. Com n Q F �Dh/ Address o IMMMz°� SSS tig POI # G �� 3 Company name: Address City: Phone# Insurance Co. PoAcv# Failure to secure coverage as required under Secdon 25A or MGL 152 can lead to the impoeftion of criminal penaftlea of,a fine up to$1,500.00 andfor one years'imprisonment.ae.wd.ae.cM pmaltlminlhetmncfe.ST_OP ViORI(_ORDER,anda.flrro of.(;100.GMAj y egaioat.me, I understand that a copy of this statement may be forwarded to he Office of Investigation;of the DIA for coverage verification. I do hereby CW* ► s Req information provided above is true and correct 7 Signature p6)4 Print name &Ik-olt WiTsow Phwe s 603 'V615"d Offldal use only do not write in this area to be completed by city or town a del' City or Town — -- Permit�acensirw Building Dept []Check d immediate response is requked ❑ LiicerWng Board ❑ Selectmen's Office Contact person: Phone#. ❑ Health Department Other 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 Number 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. The debris will be disp sed of in: MA, (Locatio of Facili ) Signature of Permit Applicant l 2.-A � - Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a r i I 1 MORTGAGE INSPECTION PLS Thio 'aa mortgage loan lnpection. for mortgage purposes only I LOCATION NO. ANDOVER MA City or Town Butt DATE April 27, 1993 SCAM l r l Certification in hereby rade to THE CO-OPERATIVE BANK OF CONCORD D Gr that ttM MIAMI structures shown on this plan e sltuatad on Bality e at does noted !n coeplfance wlt7 b r setback senta f the apt table zorffnD 6y whim ono r uc ed,or xenc %:1018 ttct on !on metton under�i e.�. T C 0 no* on 7. (y w6 p�hhis nspoe !onn was raparoAA !n accordance with y f�OR �EA 61�ITIO1� technaee� attenCards�orsIprfgapo Loan Insppesct U W ��M adopted by the Commonweal of Messachusetcs nr �a3 DEED AND PLAN REFERENCE l00 Qa. ESSEX NORTH DIST. wylatry of Doe do Deed Book 1859 Pape 0271 Plan Book N/A plan, #7778 teebritltll!eaat a8n !7�a hereby rade hat the ptreeture Area eiaae iniete4�ttho mapIof psefal Flood community No. 2500980010B MUM* Date: .lune 15, 1983 Br the U 8.urance Adr nDepart rena ofietHout+ration.lnp B Urban Devslc Federal ins 1H of-rqV JEAN :�L o NYSTEN No 26099 MORTGAGE SURVEY CONSULT 126A PLEASANT VALt Ey TELST.— SUITE 7 — HE i JUL 2 T'19957' I' � J �x`5 9 ------ -43'-0518'- --12'-83/4" 43'-05/8'12'-83/4" 30'-3 7/8" 0 g-4„ —T o iv iN e .n o> 12'-4 5/8" 0 Q / , i c (V O O n 3-10"= - -- --- — 26-41/2" - -- — 43'-0 5/8"—- LIVING AREA 1353 sq ft �(P o \, lz 2x ��I sU�G (\\' / u ----------— i i j I UP i ' I I L — — — — — — — — — — — — — — — — — — — — — — — — - -- — — — — — — — — — — LIVING AREA 1246 sq ft n OAA `- �L 1 NORTH Town of Andover 0 0 No. co,Io y . '� dover, Mass., /o?-/A C OC MICMEWICK �d ADRATED Ike �5 S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT �N N Y N BUILDING INSPECTOR OJ. ........................................................ ...... ...... Foundation has permission to erect.. ... buildin s on 1. �. ��'Q �'� � Rough ... to be occupied as.........�.. ...................... ................ ... 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 relatin to the I pection, Alter�3tion and Construction of Buildings in the Town of North Andover. y4.*r lb ^Y4 � /�� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ( Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUA ON TARTS ELECTRICAL INSPECTOR Rough .. '................... Service u BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. Location No. Date 3 S • N°"'M TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Q Foundation Permit Fee $ SACMUSE -a.r Other Permit Fee $ Sewer Connection Fee $ 0 Water Connection Fee $ TOTAL $ g U �W Building Inspector !' 8614 Div.Public Works �i PERMIT NO. (AP(P APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP i4O. I LOT NO. 2j 2 RECORD OF OWNERSHIP DATE BOOK PAGE — ZONE SUB DIV. LOT NO. LOCATION -B�Q�` �a PURPOSE OF BUILDING C„n (� � lex, ,\ tOx,% OWNER'S NAME /� A I ea--�ner�� NO. OF STORIES ,�� •N SIZE �K f�� VJ 'T OWNER'S ADDRESS V� 1�J (v e-.. ` BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2xlc� 2ND 3RD BUILDER'S NAME CA`_.SA sd,^ SPAN \A./ DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET `�X/ POSTS DISTANCE FROM LOT LINES-SIDES REAR _.)`z5 l ”Ca GIRDERS AREA OF LOT .J FRONTAGEHEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING `SOW Still X IS BUILDING ADDITION SVr\ m, e` MATERIAL OF CHIMNEY J IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ye J IS BUILDING CONNECTED TO TOWN WATER Yc5 BOARD OF APPEALS ACTION, IF ANY 1 IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE IVB, INSTRUCTIONS 3 PROPERTY INFORMATION / LAND COST It t$0 SEE BOTH SIDES EST. BLDG. COS 2� tio0,OO 3 LI 1Yb PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER 94. FT. Y 3 PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC 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 1 6 DATE FILED 7— NUICDING IN6rRCTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT y� F E E t30'50 OWNERTEL.A iPERMIT GRANTED CONTR.TEL.A l CONTR.LIC.11 t2�3_L�-�n 118 8 4 �l JUL 1995 E '- � - J BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY N S"ORIES THIS SECTION MUSTSHOW EXACT DIMENSIONSOF LOT AND DISTANCE FROM MULTI. FAMILY — OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED.THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH , CONCRETE d 1 2 I3 CONCRETE BL K. PINE BRICK OR STONE HARDW D — —— PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. BM T AREA _ 1/ 1/2 'L FIN. ATTIC AREA _ N_O BMT tf FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD\'✓'D _ ASBESTOS SIDING _ COMMGN VERT. SIDING ASPH.TILE STUCCO ON MASONRY ILr� V STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS.& FLOOR I_ BRICK ON FRAME CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE rj OOF 10 PLUMBING GABLEHIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY , WOOD SHINGES f KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST V PIPELESS FURNACE FORCED HOT AIR FURN, TIMBER BMS.&COLS. STEAM I - STEEL BMS. &COLS. HOT W'T'R OR VAPOR 1 WOOD RAFTERS _ AIR CONDITIONING ' RADIANT H'T'G UNIT HEATERS `7 NO. OF ROOMS GAS OIL B'M'T 2 d ELECTRIC 1st 13rd NO HEATING ORT Tovm Of - Andover , S1 •• NO. J 36-6 F r : port dover, Mass. 3 19 R S COC MIC KEWICK\y ORATED '9 E BOARD OF HEALTH _-- R. M IT T D Food/Kitchen t P1. Septic System e . C BUILDING INSPECTOR, THIS CERTIFIES i . .dTNAT KJ ........................................................................................................ Foundation haspermission to erect..� .... lrVl�.. buildings on ...� 4.... K.1. .. ............................... Rough to be occupied as... .i.�.*A...."......k � WI'lQ �. . � .�......� Chimney .. . . . provided that the person accepting this permit shall In every respect conf rm 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 s- , Buildings in the Town of North Andover. PLUMBING INSPECTOR i VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final . PERMIT EXP MONTHS ELECTRICAL INSPECTOR UNLESS CO STR T S - --- Rough .... . .............. . ... .... .................. .............. ........ ......... Service BUILDIN NSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR f Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done " Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL . DRIVEWAY ENTRY PERMIT FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. plicalnt+ 1fills out this section***************** APPLICANT: ` 1 y`'�y� w���ot'V Phone 66,3 �37_.(,//3M LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street _L34 berkllc,4 VJ St. Number ************************Official Use Only************************ RECO DATIO S F WN GENTS: Date Approved S� Conservation Administ ator / Date Rejected kLr��CommentsS _/ S CK( -1 ep Y� i Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date MORTGAGE INSPECTION PLS This is a mortgage loan inpection for mortgage purposes only �evT Ag GOr'/7 LOCATION NO. ANDOVER MA City or Torn state DATE April 27, 1993 SCAM i 2� Certification is hereby made to THE CO-OPERATIVE BANK OF CONCORD m ; that the exlstlnI etrueturee shown on this Plan e situated on ha lot deal noted n cgsplionce Nit? setback rou rements of the sCCp fen le zonin0 by' of the mun�c Palitty when eonatweted.or aro xea[ Gar 20 2s�-oQy G4T'�"2 �CnaptecoAOVfoS.ct 0,7°snt action under N.e.�. T. 1!/oon x'�4i1�' Thfs inapecttlop Mas ropared in accordance with QI Div�ouu� 1�Fb�EA lSDt7�Tloti-1 technical stendarde�or Na t0aps Loan Inspection- adopted by the Comonweaith of Maeaachuaette ti tee-d, --d'-�" .. _..- by- aro,1 Land AVM# 3a3'� DEED AND PLAN REFERENCE _ JDO:od' ESSEX NORTH DIST, penfatry of Deeds Heed Book 159 Pape 0271 Plan Book N/A Plan. #7778 Certiffcat l!on is hereby mace that the structure this plan I9 NOT located within a spacial Flood Aroa as dellineated on.the map of community No. 2500980010B Effective Oates, June 15, 1983_ By the U B. Department ays of Housing 8 Urban Dlc Federal Insurance Ads nistration. ASH OF/.I / �yG JEAN 6 f o NYSTEN No 26099 / MORTGAGE SURVEY CONSULT 126A PLEASANT VALLEY ST.—) ITE 7 00 ME TEL. 150r j JUL T'1995 r r i Fv., ' ...-. `v..- ',: '- -e...., ^v�.R _,;M1 �. 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DEPARTNENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Neaber• Expires: Birthdate CS 063168 02/12/1998 02/12/i9 estrkted To. i6 ARTHUR F 9ATSON 3 ED6E110NT ST' OIRRY, NH 03038 -- -• � J6P ro„,„�o,,..�41r�ad lGlw.:�6�,.,�t,, HOME IMPROVEMENT-COMM-TOR Registration '118848 Type —. 084 —ift 4 Expiration 04/27/97 JUL i 199 A.F. WATSON GEN COMTRACTING ARTHUR F. WATSON 3IDGEMOMT ST ADVINISTRA:, DERRY NH 03038 t : i 1 i t� — :� I f �6 A.F. WATSON GENERAL CONTRACTING 3 EDGEMONT STREET DERRY, NH 03038 (603)437-6134 Wayne &Robin Gendron 134 Berkley Road 7-20-95 North Andover, Ma . 01845 RE: SUN ROOM & DECK Dear Wayne & Robin: The following is my estimate to build the sun room and deck per drawings by G.J. Bruno Associates , ,with the changes discussed and outlined below. WORK OUTLINE: 1 . Demo of existing deck and removal to dumpster to be done by owner. 2. Contractor will supply dumpster for all debrees. - 3. Install concrete footings and sono tubes per draw- ing. 4. Install hlacicplastic weed stop and stone under room and deck to be done by owner contractor will supply materials with 2" to 3" of stone over the area. 5. Frame sun room and deck per drawings except the room will be 141x 181 . 6. Interior walls and ceiling will be blue boards with plaster skim coat. 7. Exterior will not be per drawings, but will be clap boards to match existing. 8. Doors and windows will not be per drawing, but will be vetter casement windows simular in size to the Anderson' s. 9. Five quarter by six cedar boards will be used on deck floor. 10. Deck framing would be. pressured treated wood. 11 . Two by two cedar balusters will be used on deck rails 12 . Pressure treated lattice will be used to close in A.F. WATSON GENERAL CONTRACTING 3 EDGEMONT STREET DERRY, NH 03038 (603)437-6134 the perimiter of the room and deck with one access door. 13. Cover bottom side of sun room floor joist with 4" lauan plywood close in insulation. i 14. All painting or staining to be done by others. 15. Electrical wiring would be done to code plus six recess lighting fixtures in room. 16. There is no heating figured in this room the heat would be moved from in front of the bay window to allow door to be installed. 17. Sun room floor carpeting or tile to be done by others. 18. Install four. velux (V S 101 ) venting sky lights. This work would be done for the sum of $19,950.00. v PAYMENT SCHEDULE: C6L_71UE l!i PAYMENT BALANCE: $19,950.00 ACCEPTANCE OF CONTRACT: $450.00 $19,500.00 FIRST DAY ON JOB: $6,500.00 $13,000.00 AFTER FRAME IS COMPLETE: $6,500.00 $6,500.00 EXTERIOR COM- PLETE: $4,000.00 $2,500.00 UPON COMPLET- TION: $2,500.00 0.00 Owner and contractor agree to the above by s gning below. OWNER: � t,�, ,,_,CONTRACTOR