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HomeMy WebLinkAboutBuilding Permit #748 - 34 BELMONT STREET 4/18/2012Permit NO: Date Issued:= TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this LOCATION 7 6 ee Z 7 _ Print PROPERTY OWNER �d R ® �` Print MAP NO: �` PARCEL: 7,3 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ On ily ❑ Addition wo or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition * ❑ eptic ❑�W�ezll 9 ❑ Other ®Flood lam k ®Wetlands, p� Watershed District <' Y.;., , ll 5UKW HUlV Ur w Urv& r U Dr- rr1rcrv.x ViJr1- U: % a vr4 L �'a �o o i - Type or Print Clearly) OWNER: Name: /?l/R 7e- d /C Address: \3V 34f ��L roan! S'! /Vd CONTRACTOR Name: W#J Y,9 -,e- Phone: 9%P -a -e- 6 737 Address:yJvr ��� AS %��� .f �/ jI%O f�%r/� ®G'� ✓'JI'�- s Supervisor's Construction License: 0-2-7- 6 Exp. Date: Home Improvement License: Exp. Date: % �- ARCH ITECT/ENGINEE R Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000:00 OF THE TOTAL ESTIMATED COST,BjASED ON $925.00 PER S.F. Total Project Cost: FEE: $ f 7 Check No.: 3 , �� Receipt No.:!-,'�n� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund o=r;fs�'rfarif/n1IVY:177 ;r7 -- i r� z cd O C.2 C.3 (� CL OM :Q O C ;= O C* Ea � C Cf) m O CLN E � l46_® O Su cm fti [� nmC E �+ L CO N ® LL T r^ N � H v / _ •O_ 4 ) t: co) W O O CO) W �r4DUV :moCM n m Cn o n Cf) •� '� = G.I. CO. :coQ CL ^W^ � O O I=CM ItC R � O cm = •O = O 0 m 3 N Z W C A t r.. . •ca C.ll Z A C O C= O' W m'N O .E° o.0 v cm C..3 O O .O C g • ti n m$ CL,- cc v a co 0 L V Z co O y ® C OM I c h � � 'E m m CD CD co O i:,,% � Clco 0 m o oca ma-„ CL Q o � c� cc CJ J .� co)Z CD CD CL L.i y c C CL 0 LU U) ul U) W W cz W 0 u w° w z U 5Cdv as c cn we.° w°' E x U u. W a a a°' � w w W a°' cn w p M w w z cn Q U) . O C.2 C.3 (� CL OM :Q O C ;= O C* Ea � C Cf) m O CLN E � l46_® O Su cm fti [� nmC E �+ L CO N ® LL T r^ N � H v / _ •O_ 4 ) t: co) W O O CO) W �r4DUV :moCM n m Cn o n Cf) •� '� = G.I. CO. :coQ CL ^W^ � O O I=CM ItC R � O cm = •O = O 0 m 3 N Z W C A t r.. . •ca C.ll Z A C O C= O' W m'N O .E° o.0 v cm C..3 O O .O C g • ti n m$ CL,- cc v a co 0 L V Z co O y ® C OM I c h � � 'E m m CD CD co O i:,,% � Clco 0 m o oca ma-„ CL Q o � c� cc CJ J .� co)Z CD CD CL L.i y c C CL 0 LU U) ul U) W W cz W 0 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan* ❑ - Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL -- - . - Public Sewer ❑-Tanning/Massagemody Art ❑ Swimming Pools 13 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 PLANNING & DEVELOPMENT _El COMMENTS DATE REJECTED El DATE APPROVED . CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i .. e 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 si Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No, MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits _ ❑ Building Permit Application - - - --- ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or. C.S.L. Licenses•- ❑ Copy of Contract _ ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for. Engineered products - NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan - - - - ❑ Workers Comp Affidavit - ❑ Photo Copy of H.I.C. And C.S.L. Licenses - - ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department. prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town CIerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application . Doc: Doc -Building Permit Revised 2008mi CERTIFICATE OF LIABILITY INSURANCE I DATEIZM/D2011Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Durso & Jankowski Insurance PHONE FAX Agency Inc —(A/C. Ext): (A/C. No): E-MAIL 198 Mass Ave Suite 101B ADDRESS: PRODUCER North Andover, MA 01845. CUSTOMER ID#. ' INSURED (S) AFFORDING COVERAGE NAIC i INSURED33758 INSURER A: A.Z.M. Mutual Insurance Co Arthur Walsh INSVAER B: dba A J Walsh & Sons INSURER C: 55 Pleasant Street INSURER D: North Andover, MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THISIS 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 Lcv TYPE OF INSURANCE POLICY HONKER POLICY EFF IHN/aa/YYYYI POLICY EXP cRN/oa/vrxn LIMITS GENERAL LIABILITY EACH OCCURANCE $ ❑COM_MERCIAL GENERAL LIABILITY ❑ ❑CLAIMS MADE ❑OCCUR DAMAGE TO RENTED $ PREMISES(Ea.occursence) MED EXP (Any one person) $ QPERSONAL 6 ADV INJURY $ 0 GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES ER: PRODUCTS - COMP/OP AGO $ ❑POLICY ❑PROJECT ❑LOC AUTOMOBILE LIABILITY ❑ANY AUTO ❑ALL DIME. AUTOS cOPmINED SINGLE LIMIT $ (ea accident) BODILY INJVRY (per parson) $ BODILY INJURY(per accident) $ ❑ SCHEDULED AUTOS PROPERTY DAMAGE (per accident) $ ❑ HIRED AUTOS ❑NON-O.N ED AUTOS $ El $ ❑UMBRELLA LIAH ❑ OCCUR EACH OCCURRENCE $ AGGREGATE $ ❑ EXCESS Li- ❑ CLAIMS MADE $ ❑ DEDUCTIBLE $ ❑ RETENTION WORKERS COMPENSATION ® TORYaLinirs aIEnH AND EMPLOYEES LIABILITY E.L. EACH ACCIDENT $ 100,000 THE PROPRIETOR/PARTNERS/ A EXECUTIVE OFFICERS ARE incl ® eXCl 7014648012011 11/14/2011 11/14/2012 E.L. DISEASE -POLICY LIMIT $ 800,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 COMMENTS / DESCRIPTION OF OPERATIONS OR LOCATIONS: ARTHUR WALSH IS NOT COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFICATE HOLDER TOWN OF NORTH ANDOVER 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTNOAI2ED AEPRESENTATI CS # 022680 HIC# 103358 Propool A. J. Walsh & Sons 55 Pleasant Street .North Andover, MA 01845 # of pag 978-688-6737 or 1-866-AJWALS H Proposal Submitted To• Job Name Job # l ,r s - Address � 24 � Job Location � d f} r f � Date Date of Plans Phone # (7 � � � -� % Fax # Architect ?rWe hereby f submit specifications and estimates for. a .s. L. &^4' % U ,. f (11001A c[7�66A MdC UP)1 i t• r Onkr- --U- A M/a,/ 1'�r_ c—i 0,Ci-r. r- .+- „L - , s(?var We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of: $ Dollars with payments to be made as follows:�� Any attention or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and Submitted ( L above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Note — this proposal may be withdraW/n by us R not accepted within days. �cce�tartte of o�o�a� The above prices, specifications and conditions are satisfactory and areSignature hereby accepted. You are authorized to do the work as spebified. Payments will be made as outlined above. 11.. i t✓ Date of Acceptance !!Z �` Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies -all basic requirements of the state's Home Improvement Contractor Law (MGL chapter 142A), butdoea not iaciude standard language to protect homeowners. Seek rso legal advice If necessary.- Any pen planning home �taprovernents should first obtain a copy of "a Massachusetts: consumerguide to homaimprovement" before agreeing to any work on yourresidence: You may obtain -a free copy by'calling the Office of Consumer:Affairs:and Business Regulation's Consumer Information Hotline at617-97.34787or 1488AMM757. . Homeowner Information Contractor information Name .. .... OV paw rName Street Address (do not use.aPostrOfikca Boz address) .r tractor/ Selespason/Owner, wns Name f� City/Cown State Zip Codelogin— Address (must include a street address) . Daytime Phone Evenm Phone - 49 v --s-/,5- - a S' ffawn rP tY State Z' Code / iYU N� d oe�e Iv,)R ���✓� . Mailing Address (It differ cat from above) ausiness Phone qederalTraployer IDNumber The Contractor agrees to do the following work for the Horrieo L_ rr9uin esI=Eomeiar povemcm mouset®Osws tegbdm®W Aome tC®esear ary A®pp /G3vv `- '.. 7 7 l � bpacuying Lae reit Required',Per'nrits - The -following building pemrit, are required Proposed Start aced Completion Schedule - The following schedule will and will besecured-by the contractor as the'homeowner's agent; be adhered to u'nlesa circumstances beyond1he contractoev control arise (Owners who secure their own permits will beeh, excluded:from the Guaranly Fund`provisions of Y »wh MGL chapter 142A.) ill beginconaacud work qq ✓L when contractid .work will be substantially completed. Total Contract Price and Pavmenr c.r..d..re The Contractor.agrees to perform the work, furnish the material and labor specified above for the totalsum of. (s) PUmeits will be made according to the following schedule: e �,r J S17� 0 upon.signing contract (not:to exceed 1/3 of the total:contract price. gr the cost;of special order items, whichever is greater) S by or upon completion of y / / or upon completion of a(,W, 0 $ upon completion of the contract (Law forbids demanding full payment until .contract is completed m both party: s satisfaction) The following matedaVequipment must be special Spaid for ordered before the contracted workbegins in order $ in be paid for to meet the completion schedule.(**) NOTES:(*) including all finance charges(**) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual con of any special ,equnpmeat m custom made material which must be special ordered in advance to meet the completion schedule . Subcontractors The contractor aresponsible—for e grecs to be solely responsible for completion of the work described regardless of the actions'ofany third Party/subcontractor utilized by the contractor• The contractor further agrees to be solely responsible for all payments to all subwntraetors foi materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding_ contract under.law. Unless otherwise noted within this document, the contract shall not imply that any lira or other security interest'has been placed on the residence. Review the following cautions and notices carefully before signing this contract • Dual be pressured into sighing the contract Take time to read and fully understand it Aslt'gtrestions if sontethirig is unclear. • Make sure the contra�r hes a valid Home lmtnnveme-t Contract• R 'srration The Idw requires most home improvement contractors and . subcontractors to be registered with the Director ofHome Improvement Conhwt& Registration. You may inquire about.contractor registration by writing to the Director it One Ashburton Place, Room 1301, Boston, MA 02108 or.by. calling 617-727-3200 of 1-800.223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured • Know your rights and responsibilities. Read the Important Information on the 7rverse-side of this form and get a copy of the Consumer Guide to the Home Iudprovement Contractor Law: You may cancel this agreement if it has barn signed at a place othei. than the-contractdr'snormal lace of business, Provided contractor in writing at his/her main office or branch office ordinarymail P p you notify the third business da followin the si poste by telegram sent or by delivery, not lacer than midnight of the, Y g. gning of this agreement . See the attached notice of cancellation form for an explanation of.this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANy BLANK SPACES!!! Two identical copies f the ceotraat aaun be eoWleted and surd One ropyahould ao m the hoaroaar. The othe . '/,-///"/� copy should be luyt by th/e'leoo/trag�oc Homeowner's Signature // 'G%2r�"�"��J!%`�C�/ Contraeto s Signa/tune Date dr Date T d5� Contractor Arbitraihon .. The Home Improvement Contractor Law:provides;homeowners with thenghtIo-initiate an arbitration action (as an alternanve to court—actio p) if they; have a.dispute wiih.a contractor. The same tightis not automaticslly'afforded to a. contractor, however, I.he,eontractor:would have.tp resolve any.. dispute he/she.ltas with a homeowner in court unless both parties agree to, the optional• clause provided below:. This clause would,give the contractor the same right to arbitration as is afforded to the •homeowner.by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a.private arbitration firm which has been. approved by . the Secretary of the Executive Office of Consumer'Aff ti s and Business Regulation andthe consumer shall be required Io submit to such arbitration as provided In•Massachusetts General Laws, chapt 142A. y-46 Homeowner's Siga tune_ Contractor's Signa NOTICE:"The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. :The homeowner,may initiate altmnative:dispute resolution even where this section is not QonArAfr.IV.!CiPfICd�V.tlreDarh'eS:'.._.... .. ,. Homeowner's Rights A homeowner's rights under• the Home'Improvement Contractor Law (MOL chapter 142A) and other consumer protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement: However, homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. •The•contractor is responsible -for completing the work as described, in a timely andwotkmanlike,mannei. Homeowners -may be entitled to .other specific legal rights if the contractor guarantees or provides an. express warranty for workmanship of materials. In addition to .guarantee's or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability :and fitnessffor:a particular purpose. An enumeration of other matters on whichthe homeowner and contractor lawfully agree may be added:to the. terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights; contact the Consumer Information Hotline (listed below). Execution of Contract Thecontract must be executed in plicate and should not be signed until a copy of all•exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by.. the contractor. Any modification. to the griginaf coniract must be in writing and agreed to by both parties. Contracted work may not begin until both parties havereceiveda fully executed copy of the contract, and the three day recission period has expired Accelerated Payments A contractor mgy not demand payments inadvance.of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where. -a. contractor in, him/herself to be financially insecure, the contractor may require thatthe.balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or.need additional information about the Home Improvement -Contractor Law. or other consumer fights,.or if.you wish tq: obtain a.free copy of "A Consumer Guide to. the. Home.Improvernent Contractor Law,q contact Cgnsumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 ? (617) 973-8787 or 1-(888) 283.3757 If you want to verify the:registration of a contractor or if you have questions or need :additional inforrnation specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place, Room 1301, Boston, MA 02108 T (617)727-3200 ort -800-223-0933 For assistance with informal ifrediaUon of disputes or to register formal complaints against a business; cell Cohsireier'Complaint`Sectioa Office of the Attorney General (617) 727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 . C_ -n;'' t: rww.inass.gor/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/E lectricians/Plumbers Applicant information Please Print LeobIy {,�_ NaMe(Business/Organization/Individual): 4/ 4Z_5 A 9e. ,, s Address: iy T :!�j RN PO t1Q & 1417-0- Phone #: Are yo employer? Check the appropriate box: The Coniinonwealth ofMassachusetts `t- ❑ I am a general contractor and I Department offiidustrial Accidents Office have hired the sub -contractors oflnvestigations listed on the attached sheet. 6011 Washington Street These sub -contractors have Boston, MA 02111 . C_ -n;'' t: rww.inass.gor/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/E lectricians/Plumbers Applicant information Please Print LeobIy {,�_ NaMe(Business/Organization/Individual): 4/ 4Z_5 A 9e. ,, s Address: iy T :!�j RN PO t1Q & 1417-0- Phone #: Are yo employer? Check the appropriate box: I. I am a employer with �_ `t- ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and -have no employees These sub -contractors have working for me in any capacity, employees and have workers' [No worIcers' comp. insurance comp• insurance -t required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp, right of exemption per MGL insurance required.] t C. 152, §I(4), and we have no employees. [No workers' COMP. insurance reouired-i Type of project (required): 6. New construction 7. ❑ Remodeling 8. (] Demolition 9. ❑ Building addition 1011 Electrical repairs or additions 1 I .❑ Plumbing repairs or additions 12. oofrcpairs 13.❑ Other '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. tContractors that check this box must attached an additional sheet showing the name or the sub -contractors and state whether or not those entities have employees. Irthe sub -contractors have employees, they must provide their workers' comp. policy number. 1 am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: "14 / Nl rl G/ r -o 4-L-- Policy -lrPolicy # or Self -ins. Lie. #: 7D ! �`/ria ��d� �% �� ®!f /,.;l- Expiration Date- __22 ate: //��! %L - Job Site Address: 'J- JV) ,OA/ 7 `�Z J City/State/Zip: tR % V61 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 WORD 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 certyfy, under thepains andpenalties ofperjury that the information provided above is true and correct. %� Official use only. Do not rvrite in this area, to be completed by city or town official City or Town: Permit/License # y -- Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector G. Other Contact Person: - _ - Phnnp #- & i 10ME IMPROVEMEN FCONTs'-RACTOR Type: A. V,11" LS H S 0 'N S, 1 N C, St License or regist I'll t ion valid fin. individill use oilly betbvc the e.\;pirlifion date, It' iblind return to; Office of Collsoillul. .4,31llirs alid Busilmss Re"alikitioll 1O Park Phin - Sijitu 1171) MA 02116 ol: valid without sh:w Win! :..;; 2080 AIR-T-HUR J YVALSH JR ,i59A WAVERLY RD IN ANDC.)VER. MA 01845 7 - - - - - ---- - - W9,120112 29321 — ------ ---- Location r No. Date t►OR, TOWN OF NORTH ANDOVER ? o iftn Certificate of Occupancy $ Building/Frame Permit Fee $ CM t� Foundation Permit Fee $ �+ OtherPermit Fee $ J-0 e, Sewer ConnectioVi$ Water vection & $ TOTAL$ • .; Inspector c9 ' �� Div. Public Works PERMIT,NTO. 19 O 0 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. 'PAGE I MAP h40. LOT NO. I 2 RECORD OF OWNERSHIP JDATE (BOOK :PAGE ZONE SUB DIV. LOT NO. LOCATION 15 '-� PURPOSE OF BUILDING41 l�/'1� L OWNER'S NAME -r O NO. OF STORIES SIZE OWNER'S ADDRESS 6 BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD A t )� BUILDER'S NAME , •_ �Q�f, �7 1/�7 -/ 'w ,� 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 LS INSTRUCTIONS ;i SEE BOTH SIDES �1 PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FI FDA NAAPPROVED BY BUILDING INSPE OR DATE FILED / SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E 4 C� - <© PERMIT GRANTED 19 OWNER TEL. # COFc?—S Q CONTR. TEL. #_ 7 a CONTR. LIC. 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST �+ U EST. BLDG. COST PER OO. FT. EST. BLDG. COBT PER ROOM SEPTIC PERMIT NO. . 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN B ILDINO INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY ,,,:,#lS.OkIES 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 I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION—I MODERN FIXTURES 8 INTERIOR FINISH CONCRETE PINE 3 1 2 13 CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER 6 FRAMING DRY WALL WOOD JOIST PIPE LESS FURNACE _ _ _ UNFIN. 3 BASEMENT TIMBER BMS. d COLS. AREA FULL 1 II FIN. B'M'TAREA I NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D. ASBESTOS SIDING _ COMMCN J _ VERs. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME WIRING ADEQUATE ti 5 ROOF 10 PLUMBING GABLE I I HIP BATH (3 FIX.) GAMBREL MANSARD �I TOILET RM. (2 FIX.) 1 AT SHED FWATER CLOSET ASPHALT SHINGLES LAVATORY ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 1 1 HEATING WOOD JOIST PIPE LESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d COLS. I STEAM STEEL BMS. & COLS._ HOT W`T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st 3nNOI NO HEATING �XII�IIB�i GDM WOODWORKS 7 Jasmine Drive Atkinson, N.H. 03811 (603) 362-5763 PROPO_SALSUBMITT�TO� ����r�,�.,//11 DATE, 1 [ J l jJO�ILJJ.. ......�, t i ADDRESS PHONE /, 6c�'yr� DATE OF PLANS JOB NAME AND LOCATION AA174 1Li5:�0-DEE L_ ARCHITECT JOBPHONE We hereby submit specifications and estimates, subject to all terms and conditions as set forth on both sides, as follows: t�✓Zt'C L�f ill G � � '� 6 � �r� _�x�: 92 r c,T'�t �2LcPI�� ALS .aL�1.e' � f`�/+ `J?' 3 (qtt—� �/}�, lam/!, �i1�i iy� //L�))✓ ,/! / A' � � ��� J / \1j r,.. tom' /�� �✓ V / C/l�- — V �...._..,._,.._—. %`�f.���Y,1r� We FropaSe hereby to furnish material and labor — complete in accordance with above specifications, - r for the sum of: i/./�/ E.\.i dollars is Note: This proposal may be withdrawn by us ifi ^^� Authorized / •/`J� "' '!'//' not accepted within days. 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