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Building Permit #311-2011 - 23 BEECH STREET 10/15/2010
I BUILDING PERMITof N°RT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ^ ' o , Permit NO: Date Received 4��-`�-�-�• Date Issued: f�? /�/d sgcHus���� v� y MPORTANT:Applicant must complete all items on this page --; M •�.1[;...'S._ r_ ^4.�-.. +c+M r_N'_� '�+�T�i:.....'1J....P':•t'�'i4"i+'-�7!% -- - _ ;S i ¢� _i.'_.'.�•_rn = cA_1:'Fa' _ ..'�-.t-'cw�_a�`,-„.._. N '-Y” ....., k _..t"•:- -_�:-.�;f.�y._.'z"•� _ _ _Lra -='r._:a'._-. "_'.'JS - _ _ _ -T'J•_. a.?1:'-�-� �.�e-..Li,.:�'.y"y`1d��... _ .��.�.a3nt:a .+.__.:1 i4.YG'::t:ti+ _-_ t1"_i.4iC=::.:_.. .• _s.if.' 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'�{eYv? �-L�.y:�.1,�aj� �;^'� YN -nr ":l,� :?':. :FJ,tr'kl_�g'. ac.���aa-.��� �,' Pte,,J'' .�:; ga e'�jv'li;rp—... !-i__c` _ 7..:s�'fyL•=F'q,?'%r:S `L:+;-�aie•. .L• a.:Y�� >r. �.1.-'^�.'-_ F J�am, �F` '6%• �Y.. � n ���'��:s�;;i'�,,�,-�„`�,�<.yr•� i� �•�...-.,� ..a�� ^x— ,.,,s•. F��- � �'_���"se ���'D;fvIL-' 1S�i-I��,±-���._.�.; .,�J,xb-.� - ,`.y_ :f z'�,_.,"^,_,,3�°"it.��i+�.� _ ar .''F �a _?�' -2-� �ua-���'��} � .r.S�;'vc+_•,e,u,-�-t�.k`a �.r�.!' r� �, f.x-n_ Rx. ._-�`-y �"�z-v.��._, -`.=.�3;,+�.4�'-�'�rt.�`�y:fG3��.r�; ?*.-,.L�`,�.T� - ..TC����'._-,,y�-�'�'hi;! SaF- - .,.ar rr�;5•�r,:�E:, 'f'�rrl�ti,y-_3i�'�c ��-=•h�:. �e:dr:: s � 1 _.�' '%�y s�,:a ¢., tK /+ £}��a-/� �i'. 1u. �"'� s' J i'ir o� :..1•^ .Y•1. ern'-Si.ituu.:i�=T-=�='r_.I ..isy.XF�'}ii:=7r.'?i��`'{=-',-�•�. 3'S>'� }iG` ��lS � � 3>�� JL\Sa dN'� ,t:'.wl}...(] �4rf -d4,�• TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: emolition Other - y :-c„�a_•.. ��� t �{�tr"rvr�'cF� :h-j ,,r- ^'' �.�a spa �� i Sesr "` T�T36 -'� ��� ,p,,�� ��.. t -�^�t�V'-" z �: �) �,��w7-T-� ax"rs" y..� � s,L'-•"t+a'-�• �„� Ta''�-',�1h7 �5��[ -;E�s`��� �;` �-��')F;.'�`�G�' ��'"`''� ' r"� �4' .�"rC�'K�4... ���•���,�sl�'U+z�,rl�ll��� 1.'�do--•-�. ,•-,.Y,: .� �•f �t:, � �_j�'-�"-'a .�.?^Y' c Z-..�-, r2--r�ar�� F. -,>����•_; .-��,����-;,�,..=��t'�. .�,r',;i�`�_�-�fi-��•s-�vti�'hY,e „"...r'�"'`c� � �4��z�"�� �.�`4?tti� �� ' DESCRIPTION OF WORK TO BE PREFORMED: i OWNER: Name Identification PIease Type or Print Clearly) : ; Address: 6 �3•. .�.4?w.-� _. '"-s"+""r"�,�Gz, -.-C_'. .� yT•�,"ri�2K'?'3�;==�'.��'-`•y�=�-: �-` :,ric>-m' i''ev 5 ,yam - y. ta N -r I 'M>sF`�,Y�. �"�4 a "-•�*£.rc' ':'1.i„ -+,.. - . .sr •+Fri, `s•Ft'xs� ffl"r- 'x,'t-c>v-,�..,T'' s.E,�,aL'.--rt.e+=" 1_..f'u -r�.� -5'11'•`�'st N ~~�. .`4� .. - a! W d wk rS 'tcx+, a y .... •tiys- 41� `t �xSG,z`f --.sS MID� ..F 'C nt- i s F ¢' rd•1T: n'i.-d".—ra?:"7' `�, er.r_',•",3,5.';<. 'y' rr,.as'-Yrc •c .K, 5-'-_ n -a c=r.. HIM ..A, ' ',W J ,. .Gs-'•r �. y � : 5 z 09 r '1+' tlsi.L-n,.,l,. x ao � , M1r y p 4'V'4ty' uY.vv •. <H t�f>_'. C� C1Ri� o-a N p IP-� ?c > I:.L..,: auY� o >'� '{ 'c J-1 ca .rG�.4�.C4d��p � f•�`y��' � �.rJ_ F �''.: r. f, , � Y�- � nrr' •.a^ 'r 'i .0 N a' '• "rte i n_ a'* �-wiCcy e M' -, _ , .rr1�-` .'lr 4 .�, i �., '�5 •_ ''-'��ia�,i` � wry �'•�, �asM1.,.rs�• ��Y+• - 1- e 2��.,"S�v�-r4c�r�sp'�1`��'�t- j .,rs�=r•-•r.�L,c�4".r 3`N>. �r�s�r��� `t�iy-�' `�" uT� n-u�rv--r5`'..fit so r., fpa9•-9 � �` `1Eri'_`�,� v~3,�; '�". -�..,t ' _ , - _ aac-r.�'•*"'M-�ra :::�.,1f'-E_,1"���Y` � 4'�`�.- _ �'.�., ti r 3^:a-.r��x" � �"`I%IK.';y��� •'t .-�'-r.-,- :�'�,�"T:32� e±-,k', ai.`_t�3�-���t��i___.. ' �D �a.T•,�}•��'-Y�]Jt�'�'.I]��:�11���T1?5�'>��� }/ -•`-r,�,13w_>;.�,.�_ .�-�ar;�:��•�,.:�',. �•~���'���-� t�� _..6 �a w�" _�,�a �' :x t�'v:,:s.�-•.- i1;y11 ,I�t Ev+i._.»'...-,..;n-�..__.�e ew•-_•m.,y...�:.fi�SY1-��'� _ - ,..�`1t1�'�5.�1 `�=�'��3�ja}7 '>�,T{'� -b�r� y y��• "Y:: .i� 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: $ �O®. 0 0 FEE: $ `4P. ) Check No.: �.��/ Receipt No.: NOTE: Persons contracting with unreg-istered contractors do not have access to a guar- �_��-�'R---� � tJ' and __naruner . �' :agnaiaecov Location No. � Date NORTH TOWN OF NORTH ANDOVER F s D Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ 7? s,+cNust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �52� 2355; ilding Inspector Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools -Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent 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 Cl.!'11(IMEN 1 0 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: Signattire: Located 384 Osgood Street � - s =ye-:...�• n..: � Y�•tY r..,......�1_:.-�.:5. ...�L`: H S��,K'1�:..-•-I�a:K:k'!:.r.. .r..::•i+'�.iK`:�nsem=- is i'W-^-_ --'rt�_=�"w;:.:_�:_;s Dur ; - '-1i^ ated.�f.512��H + _ .�:. .. ..:.-... . .�...'fi'_c_ _ . .. . "'•'.:i+o`: .:.��;�'"�"' f>+:':C.$:^•:;F. _ . r�E•1�E71�,S7� ll��i 1�iirze• - �.��.a,: f-.����...;;•:_. _ _ .. .-<._ _..a�. ..__._...... ._._.._Aj'!i�/ .. .. ... �-�.--r--�,.. .:.--.:.:. ism; - -•z- _ .,t...., 'r'•.:>:t'_... _."`."-i�.,;•cs:v9- ...�. ...r_.._.�- .t.f ^ter...,:..:.._a.�_T: �5':�. - -' _ _ _ _ _-- __ T.T:Y,..- -- ...I .. ..,. �•. ..u..r a+,., -: ...r v .. ...,• _ •� .. r ' C :Fcc- T�S. _ i NORTIy 0 o 6 over 3// _ v dower, Mass. Q LAK COCMICMEWICK %S RATED U BOARD OF HEALTH PERM IT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT...................... '.XG.1.u........ ... ................................................................................. Foundation .. , has permission to erect........................................ buildings on . . .�. ... . �..�..��.. ... . ..1J4:.......................................... Rough to be occupied as V9rfr'!f ... .:.. t' ��n ! 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 CONSTRUCTION TARTS Rough Service BUILDING INSPECTOR Final ` Occupancy Permit Required to Ocmpy 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. From:Julie Dortona FaxID:Santo Insurance Page 2 of 2 Date:10/15/2010 02:48 PM Page:2 of 2 OP ID: JD A�RO� E(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 710115/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONT PRODUCER 603-912-5646 NA ERCT PHONE Planright Insurance-Salem 603-912-5647 (AIC. A1C No, o Ext): A/c,No): 224 Main Street Suite C E-MAIL Salem, NH 03079 ADDRESS: PRODUCER EDMUN-1 James A Santo CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Edmunds General INSURER A:St Paul Surplus Lines Ins Co Contractor LLC INSURER B:Riverport Insurance Company PO Box 2214 INSURER C Salem,NH 03079 INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 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. INSR TYPE OF INSURANCE ADL SU8 POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CP572203 11/11/09 11/11/10 pREMENTED "El Ea occurrence $ 50,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AG GREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PJECTRO LOC $ AUTOMOBILE LIABILITY COMBINED S IN GLE L IM IT $ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ H[RED AUTOS (Per accident) N ON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE WC288300042503 04/03/10 04/03/11 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) WC: 3A:NH 1 David Edmunds has elected to be excluded from coverage. Job:23 Beech Ave No Andover MA/Strip&Re-roof CERTIFICATE HOLDER CANCELLATION TOWNNOA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. Inspectional Services 166 OSGOOD STREET AUTHORIZED REPRESENTATIVE NO ANDOVER, MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 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: 23 BeeCln 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 1 OA. The debris will be disposed of in: T (Location of Facility) Si ature of Permit Applicant tol l / Date NORTH To" Of ..4: YAndover No, 3 - ao _ LAK dower, Mass., 40 �I COCMICMEWICK 7,950RgreD PP�,��(5 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......................155..!`�%.1.�/........ ...j. ................................................................................ Foundation has permission to erect........................................ buildings on .aJ .C..C.-/ .., 1J�.......................................... Rough tobe occupied as................S� r,� ... .... �''. e' ......................................................................................... 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 CONSTRUCTION TARTS Rough ..................................N---�,� --. ........................... BUILDING INSPECTOR Service 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. j ✓faea�� ac�ucaelta Office of Consumer Affairs&B smess Regulation HOME IMPROVEMENT CONTRACTOR Registration:- 166661 Type: Expiration: ,.6/21/2012. Corporation ED UNDS GENERAL CONTRACTING,LLC. its t _:--t ^'}y(. ___. DAVID EDMUNDS: i�Y = a 1 SHAKER LN j HAMPSTEAD,NH 038'4,1::_5,r Undersecretary *= �Lissathiis(tYs,1:Dc.lvar•tment (if'Puhl'iciS;tt't`f� L: 13'6artl` )f•_Bllildin*- Reiilations and'Sta'da`rJ' d C&nstructton Supervisor License Licenser CS....194290.;.; I GREGORY'BUCHANAN 23 EAST NASHUA RD WINDHAM, NH 03087' Expiration: 11/29/2013 ( nn�ui..i ucr Tr#: 104290 _. . _ r Fully Licensed and Insured Member of MA Better Business Bureauro qµft Member of NH Better Business Bureau GAF-ELK Cert.ME16226 HIC Reg#159028 •� `�' jW . General Contracting - ___._ 10 Stevens Street#141 •Andover, MA 01810•(978)475-0095 PRSALSUBMrrTEDTO t c,-,v\ PHONE DATE STREET E-MAIL 2 beef A CITY,STATE,AND ZIP CODE JOB LOCATION , .& _d _e A 01%4 e= . NV a Completely protect home with tarps to catch falling debris.Respect and protect shrubbery and flower beds. Strip off existing roofing material down to the bare roof deck. Inspect roof deck for structural defects and to determine the condition of underlying plywood or boards.Repair and replace as necessary`. Inspect roof ri�dgg for proper 1 b4"spicing on either side of ridge for maximum exhaust ventilation.Cut in if necessary. Install 6'of W''�lTAk_•I�fU1Gt'•EGIce and Water Shield at roof eaves. Install 3'of Ice and Water Shield centered in all roof valleys. Install . Ice and Water Shield around all existing skylights. Install _ Ice and Water Shield*around chimney base. Carefully remove existing siding,from cheek walls.Inspect sidewall deck for structural defects and to determine the condition of underlying plywood or boards.Repair and replace as necessary:'.�� Install wea � C --acil" Ice and Water Shield 11/2'from roof deck and 11/2'up sidewall. Install a 2'x2'collar of / ice and water shield around all existing vent pipe penetrations. Install new vent pipe penetration boots to all existing vent pipe penetration. Install D&_- breathable`ro f deck protect: n to remainder of the roof deck. Install rip 8"L and R 4 mm heavy gauge F�1 (color) �tJ drip edge at roof eaves and gable rakes. Install starter st at roof eaves gable rakes. Install - L 4 desired color _(color) Install new alu :num step flashings an apron fla hings.Counter flash chimney. Install_(feet)of GAF LK7 Cobra I ridge vent at roof ridge for maximum exhaust ventilation.Hand nail to ensure proper fastening. Install F–(feet)ofV1M.P, distinctive hip a d ridge cap.Hand nail to ensure proper fastening. Thoroughly clean up Ind dis ose of all rtootin debris on property.M gnetically swgep property.for n s. No _ S�v, ') N�VV IPA ©(� QXds�{t �L �N�:��dGe�( i� Edmunds General Contracting will: a aCJ ��,V� lti�"`v 3 v o0 @/d •Obtain all necessary permits to complete roof replacement work. L��1 �l �� G�C)� f •Furnish and install all necessary materials to complete roof replacementL� •Perform work as efficiently as possible without sacrificing quality V}b.{4e � ct,01 V2,00 .– $j�}, •Provide a thorough clean up and disposal of all debris generated during roof replacement uJ \ •Remove all roofing debris generated daily using our own dump trucks.NO LARGE CONTAINERS will be used t �q aQ� �Q �a'w I(y e •Recycle all asphalt roofing debris generated during roof replacement. "V , •Thoroughly clean existing gutters of roofing debris. Edmunds General Contracting guarantees all workmanship performed for the life of the roof system.We will include an exclusive GAF-ELKyear Weather Stopper System Plus factory enhanced warranty. ADDITIONAL NOTES:.Edmunds General Cpntracting prohibits smoking on customer's property.Offers hand nail roofing services at no additional charge.(Yes/No) 'Edmunds General Contracting will replace up to 2 sheets of COX mol decking and 20of fascia at no addilional cost to me.customer.Any additional replacement or repairs will be brought to the attention of the customer and additional arrangements will be made to address repairs. Shy Ask me about Smart Money financing."Root Now,Pay Later" Thank you for the opportunity to bid on your roof replacement work. 3e1 Ouse hereby to furnls material and labor co�m�jplete i accord nee with above specifications, for the sum of: " - �i dollars ($ Paymen o b,'"ade as t w ' I '• ' '� � f \ 11 Alt material is guaranteed to be as specified.All work to be completed in a workmanlike manner Authorized Signatu according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes, accidents or delays beyond our Note:This proposal may be with', Wn control.Owner to carry fire,tornado and other necessary insurance-Our workers are fully covered by us if not accepted within �� days. by Workmen's Compensation Insurance. . E •2Cleptfl11Le Of VTOpO5d1 -The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to Authorized Signature: V do the work as specified.Payment will be made as outlined above. �— Date of acceptance: 10 77a^' Authorized Signature: ___ ON The Commonwealth of Massachusetts Department of Industrial Accidents 1. i Office of Investigations ULt °I !u 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �� Please Print Legibly Name (Business/Organization/Individual): DOUy�� �cjfy►vN115�Lu��S �L'�C'Jt Address: City/State/Zip: J�c,,iy►p5�ea Phone#: 60 36s— 7732-- Are 732--Are you an employer?Check the appropriate box: Type of project(required): 1.;V I am a employer with 3 4. ❑ I am a general contractor and I 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. $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions thyself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sullcontractors acid 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: Z- 04-vgL 7 .st c' Ce Policy#or Self-ins. Lic.#: N-pj C oZ 3� 9 S��(�C) Expiration Date: L 63 Z2a Job Site Address:r_,,./_5 (qe qci,\ AOS City/State/Zip:/). AtuUoucfL 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 forth 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 cer ' under the ai and penalties of perjury that the information provided above is true nd correct.' Signature: Date: /0 / I Phone# C 3(,57— 77 J 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 to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 confinnation 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 pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the 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 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 pen-nits or licenses. A new affidavit must be filled out each year. Where.a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 5-26-OS www.mass.gov/dia i 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) i ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 1 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ "ass check Energy Compliance Report (If Applicable) a ❑ 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 fl y%e__L:tiCiropcsea Plot 'I. an.- ILI1. 0 r ❑ 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:Building Permit Revised 2008 Date �a,�1 ... 1 LJ : r� Of"°pT" TOWN OF NORTH ANDOVER ° 9 PERMIT FOR PLUMBING • ate:,• • This certifies thatv...0. .d... . /... �, has permission to perform......<. ..�.. .P ......X.<............................................... plumbing in the buildings of....... 2..4.1... .1e. ................................... .......................^� .North Andover, Mass. Fee 4 (�... Lic. No.zc 47 N4 Check# 4--72 K PLUMBING INSPECTOR s 77�- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY d �z MA DATE EC 2-2 ,,' y(i PERMIT JOBSITE ADDRESS 'L� �'$� ►� J/� , I OWNER'S NAME �'"'1 GScC /C1zy P OWNER ADDRESSy/.J-01 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW: Ell RENOVATION:0 REPLACEMENT: D PLANS SUBMITTED: YES Q NO 01 FIXTURES 7. FLOOR--> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ! DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ED DISHWASHER DRINKING FOUNTAIN _..--I ---_-� ---.-- 1 _____--I .----._i _-_i __...-_f ----------I ---_--1 _----_j .._ .__[ __.._-1 __j FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) i KITCHEN SINK _—_- LAVATORY ROOF DRAIN [ SHOWER STALL _( SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION i i __. -J' _ _-_ ._..__._ 1 W TER HEATERALL TYPES WATER PIPING -- --. "THER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ,Q NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY[ OTHER TYPE OF INDEMNITY 0 BOND D OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q-'XGENT ID SIGNATURE OF OWNER OR AGENT I h y certify that all of the details and information I have submitted or entered regarding this 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 will be in compliance with all Pertinent provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME �_ ' �- LICENSE# 2G l zI SIGNATURE (VIP 0I JP U-' CORPORATION FJj# PARTNERSHIP®# I LLC 0� COMPANY NAME SSC c ,ti /�C�STATE ZIP_1 A -11 ADDRESS 7d �v .� l CITY �/ u ` 'i v �- I (oo a ��� � C� �G '`� � TEL FAX L CELL��EMAIL ----- --- -- ----- - -- - _--- -- --- ------- - - _t ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: PERMIT# PLAN REVIEW NOTES Date.....�&.Av................ �NOwTiy, TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 8`4ACMU5�t A). l�P ,� Thiscertifies that ...................................................... .... ............�...................................... 6k 4-�` h A. has permission for gas_installation ............................................................................ in the buildin s of......e�e..���? / ,c .. ..... ...........................................................:............ '3 PPe,Cr P../"*: , North Andover,Mass. Feea O..... Lic. No.2('312..... ^� GASINSPECTOR Check# �� i3vi MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 77-- CITY 60 �- MA DATE J PERMIT# An C.r/r/Z ✓G JOWNER'S NAME OBSITEADDRESS OWNER ADDRESS 2'� /�-�� �1, /�-VZ , TEL TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL®� PRINT CLEARLY NEW: RENOVATION:E] REPLACEMENT:® PLANS SUBMITTED: YES E-jj NO Q APPLIANCES 7 FLOORS- BSM' 1 1 2 3 4 5 6 7 8 1 9 10 1 11 12 13 14 BOILER BOOSTER - - - - -�-- -- - - l CONVERSION BURNER _=-- - -i COOK STOVE �1 DIRECT VENT HEATER _._ 1j" DRYER FIREPLACE J _� __._ I FRYOLATOR FURNACE GENERATOR GRILLE - INFRARED HEATER LABORATORY COCKS �! _..._ d__._._f _ I-- I�_ I --_- _-1. MAKEUP AIR UNIT - - - -- OVEN -- i _ - -. l -- -- -i--1 �. I�.��. � . POOL HEATER ROOM/SPACE HEATER OOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER . ....... ............_............_......_ - r _ - - --- —�i-- —�__...._ INSURANCE COVERAGE W have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E3-' OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. /I ?--- ---- CHECK ONE ONLY: OWNER �AGENT OJ St-NATURE OF OWNER OR AGENT here certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge an at all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE# Z / SIGNATURE MP El MGF DI JP Q'JGF LPGI© CORPORATION©# PARTNE SHIP 0#L-:: ,1 LLC E3# COMPANY NAME: j c,�l� / �1L � ADDRESS �_70w )el/l/1 teL- CITY _ -� STATE ZIP _o TEL FAX j�CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No S' THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES - The Commonwealth ofMassachusetts - r- .fment o Department IndustrialAccidents P Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information Please Print Le0bly Name(Business/Organization/Individual): ? ✓l r �� �¢ Address: 3-?Q 1>v 4 tLc� City/State/Zip: AtAxi/c^ aTl Phone#: K,O FS3 <3 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction pployeas(full and/or part-time).* have hired the sub-contractors 7• ❑Remodeling 2 I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its officers have exercised their 10.n Electrical repairs or additions required.] 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.❑Roofrepairs insurance required.] employees.[No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie 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 job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: 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 ofMGL 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. X do hereby certio under the pains and penalties ofperjury that the information provided above is true and correct. - Si ature: Date: y 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 Instruct iolm's 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 Iicense 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 ofpublic 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 maybe submitted to the Department of Industrial Accidents for confnmation of insurance coverage. Also be sure to sign and date'the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the 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 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. Anew 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 burn 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 anal fax number: The COM- of Massachwetts Departmeut of.Jndustdai&cxdents OfAce of havestigation's 600 WashiVoa Street Boston}MA 021 Z X TO,#61.7-727-4904 ext 406 or 1-877MMASSAFE Revised 5-26-05 Fax#617-727;7749 I v ::.COMMG,4WEALTH OF MASSACHUSETTS >; Kol • • - • oillf—lim IR 144:10 SAO!a] BOARD:QF PLUMBEPIS AND GASFITTERS ISSUES. .THE FOLLOWING LICENSE LICENSED'AS A JOURNE�MAN'Pi�1MBER !z GAMES A WILDER Z 370 BUNKERH I LL AUBURN AiH 03032-3532 I 26?12 g3�l:�e\I05/0U,1] 1'6< . 240 77 Date`.'. "°R'" TOWN OF NORTH ANDOVER oq �tio PERMIT FOR PLUMBING ,SSACNuS� i This certifies that .:�__ f 'G� f�('' L " f . . ... . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .(.. .1t. - r North Andover, Mass. Fee, J .Lic. No.. _J� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . / PLUMBING INSPECTOR Check it 5i 40 MASSACHUSETTS UNIFORM APPLICAION FOR PERMIT TO DO PLUMBING0 (Print or Type) ass.. at Permit # Building Location Owner's Name ,�C' Type of Occupancy Residential New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ FIXTURES ZY h !A N y O Z (Q h 0 J > v a 0 o rIW+ W Y J N a h Z Z O Z N d cc X JOW N Z NCC h U0. ac m a ¢ U Z O 7 Uj W a W a W y O Q J = O O LL �••l �••l �w"l ��•'l N U a 2 0 = a 3. Z S h Z 0_j d 0_j O y 2 Z W h O O a r" Q Q N N Q Q O J J 4 rt rt I a O a = u O a 3 c w rd rd rIS rd N 7 J m O O J SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR- eTHFLOOR Installing Company Name Heritage Htg. &Plg. CO. Inc. Check one: Certificate Address 35 Pleasant Street IX Corporation 714 Stoneham, Ma 02180 0 Partnership Business Telephone 781 —438-7776 n Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: s I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 93 No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability In policy IN 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 will be in compliance with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapter 14 of the$3eneral Laws. nature of Licensedr • Title Type of Ucense:Master IX Journeyman❑ City/TownLicense Number 8 3 2 2 APP O y BELOW FOR OFFICE USE ONLY J FINAL INSPECTIONS SKETCHES JPROGRESS INSPECTIONS FEE - - NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE_1g PLUMBING INSPECTOR PERMIT NO. APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS.. MAP iVG LOT NO. Q D L/6 2 RECORD OF OWNERSHIP DATE T a BOOK PAGE ZONE SUB DIY. LOT NO. �I I — LOCATION PURPOSE OF BUILDING { OWNER'S NAME NO. OF. STORIES SIZE OWNER'S ADDRESS �S BASEMENT OR SLAB ARCHITECT'S NAME � ' SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING --- DIMENSIONS OF SILLS - DISTANCE FROM STREET - POSTS -- DISTANCE FROM LOT LINES-SIDES REAR ' " GIRDERS ' AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x ' IS BUILDING ADDITION MATERIAL OF CHIMNEY ' IS BUILDING ALTERATION \ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH SIDES LAND COST EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE.2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING, SEPTIC PERMIT NO. 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED A14P APPROVED BY BUILDING INSPECTOR ' DATE FILED 42 AI� SIGNATU1 OWNER R THORI D AGENT BUILDING INSPECTOR FEE �— OWNER TEL# b 1 ! g-3 PERMIT GRANTED CONTR.TEL# fl- WY- 9('-3Z 19 2 . CONTR.LIC.I /� H.I.C.# l d ��Cc �_ f BUILDING RECORD 1 OCCUPANCY 12 I1 LE FAMILY SiORI $ MULTI. FAMILY OFFICESTHIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM APARTMENTS — LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA. CONSTRUCTION RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 2 FOUNDATION 8 INTERIOR FINISH CONCRETF B t ? I3 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER - _ DRY WAIL _ UNFIN. 3 BASEMENT I AREA FULL FIN. B'M'T' AREA _ FIN. ATTIC AREA - NO B m, 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-I D _ b ASBESTOS SIDING COMMON VERT. SIDING ASPH.illE t STUCCO ON MASONRY STUCCO ON FRAME BRICK ON FRAME Y ATTIC STRS. 8 FLOOR CONC. I— OR CINDER BLK. STONE ON MASONRY WIRING SUPERIORSTONE ON FRAME �.f ADEQUATE I I NONE S ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.1 GAMBREL MANSARD TOILET RM. 12 FIX.1 FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK ` SLATE NO PLUMBING _ TAR 6 GRAVEL STALL SHOWER ' ROLL ROOFING MODERN FIXTURES ' TILE FLOOR TILE DADO B FRAMING 11 HEATING VOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. ` 1 7M BE BMS. 6 COLS. STEAM TEEL BMS. 3 COLS. HOT W'T'R OR VAPOR VOOD RAFTERS AIR CONDITIONING RADIANT H'T-G ��� UNIT HEATERS 7 NO. OF ROOMS OIL 1 'M'T _2nd _ ELECTRIC •t 13rd IIf NO HEATING / S, • . NORT Town . of. t _e_ over No. 3 , s dover, Mass., 19 tel' w �9'�-cocHCHEWICK`�'�'►� �S OR's r E C►pA`y ,�� BOARD OF HEALTH PERMI :T T Food/Kitchen Septic System � BUILDING INSPECTOR THISCERTIFIES THAT..............................................;.��1 M.cff............ ..... Q.. .................................................... Foundation has permission to sect:.....14..L.,T.CY. ..... buildings on........2.3.............X� 1..C.�h. ..............:.....? ....... Rouvl, tobe occupied as..................................is................... ...f'ly.�/...( ..J.. ........................................................... Chimney th provided that the person accepting permit shall in dvery 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR TS Rough ............................ ..... ....... Service .... .... .. . . ...... ................................ BUILD G INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. DEPARTMENT Burner Street No. Smoke Det. Location No. `' ' Date N°RT" TOWN OF NORTH ANDOVER aimilik-mMillkp Certificate of Occupancy $ Building/Frame Permit Fee $ GMU Foundation Permit Fee $ --- ��,�� Other Permit Fee $ �G Q 2h ,\_e�ewer Connection Fee $ 41 ',�O Water Connection Fee $ TOTAL $ r' Building Inspector Div. Public Works PER-2�11T NO. 4 Y:7 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 * MA* KJO. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK iPAGE . ZONE I SUB DIV. LOT NO. I LOCATION „OJ �J PURPOSE OF BUILDING ��'tY� ✓c EA OWNER'S NAM NO. OF STORIES SIZE OWNER'S ADDRESS L"„ _'-/`CIU BASEMENT OR SLAB ARCHITECT'S NAME •J`"'YLLJ,i SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING , DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST!3/7 id+ PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. 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 DATE FILED BOARD OF HEALTH SIGNATURE OF OWN OR THORIZED AGENT OWNER TEL.# FEE 4a U . CONTR.TEL.# 66 CONTR.LIC.# ' PLANNING BOARD PERMIT GRANTED i 19 A BOARD OF SELECTMEN MUILDING INSPECTOR �.- BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF 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 13 CONCRETE ECK. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ y, '/� '/ FIN. ATTIC AREA _ NLP B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDY✓'D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH.TILE I _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I IP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st 13rd 11 NO HEATING O,..Owry OFFICES OF: . loom '. Town of ` I2O Main Street 7 APPEALS �::aVNORTH ANDOVER Ncirth Andover' 11t111.DING, - M.1Stiac'lius(;ItSUtii4ri , C:UNSLiItVA'1'tUN S'.c..una' UIV1S1ONU(' (617)(i8fj-477 i H EALI'H PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON. DIIIEC-1-011 In accordance with the provisions 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 111, S 150A. The debris will be disposed of in: Location of Facility) G Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Castricone Roofing & Siding ; REPAIRS FREE ESTIMATES c. Telephone: (508) 682-4266 MARIO CASTRICONE 61 Water Street, No. Andover, Massachusetts 01845 I/we, the owners) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship,to install, construct and place the improvements according to the following specifications, terms and conditions, o.(n premises below described: Owner's Name Job Address .....4?"`-'... ��pp .. .. ...........................................City State ; . ............ SPECIFICATIONS .. .. .... .. . . ............................... . .............. . .. ..... .. ......... .. ......................................... . . ........ ............... C .......................................................................................... . Z. ......................................................................................................................... ..... .................. ,.............................................. . ......................... ................................................................................. . . Materials and labor to cost .Q.�.................... Payable ........................ on ... ... .. and balance in ................ t m=onthly installments of $ .................... each, payable on ........................ day of each and every month thereafter until paid in full (............% charge per year is to be,added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accord- ance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s),all reasonable costs,attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any sub- sequent agreement in reference hereto shall be binding only if in writing and sighed by all parties. Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not here- in contained shall be binding upon the parties and that all of the agreements and understandings of said parties are con- tained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in opery�' IN WITNESS WHEREOF, the parties have hereunto signed their names this ...,/. .....aday o .... ...... ........ 19..(. Accepted: (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Signed ......� � !1frw . ��1 .. .................................... 9 weer Signed ..... .. Owner Per .... ...................... Signed .............................. ...................................................... . .... . Representative ®m r,o . c.� .. u.►♦ Mrrr .rrr`w r rIfirlr.r �:). ' o' w' n o � �o : �� n over 44 ,1 o ' DRIVEWAY ENT MIT 4��!;��� gver, Mass � 19S'� BOARD OF HEALTH PERM I I LD THIS CERTIFIES THAT..140.0f I ... . . ................................................... •.• •• . •• BUILDING INSPECTOR has permission Ajsr*t ••.04 ••••••••A.S V � *•••f �1• • Rough to be occupied as........is.1 .A04.kC.A4401AChimney Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTION STARTS Service Final .. .. . . .... ........ BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector