Loading...
HomeMy WebLinkAboutBuilding Permit #522 - 372 MASSACHUSETTS AVENUE 1/29/2007TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Eo "ti\ •, o 0 z 'A Permit NO: Date Received Date Issued: " D S's CHUSS��� IMPORTANT: Applicant must complete all items on this page LOCATION > : 22' —7 7i xd-S5 P7 U PROPERTY OWNER_ MAP NO.: D qS- PARCEL: TYPE, AND USE OF BUILDING N -fa 1 9- ZONING DISTRICT: HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ane family ❑ Two or more family No. of units: ❑ Industrial C7 -Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED (21 m cJ& L V, 4c-ks..j Identification Please Type or Print Clearly) OWNER: Name: ,1 y Phone: ?71 Address: 322 /x #4 SS f� ✓c CONTRACTOR Name: k/- i N 0 ( t� tell %-41) Phone:o/ '60el �� 1 Address: Zi t7 Eta % F P9y iy • R - Supervisor's Construction License: 5 S Z y' t�, Exp. Date: 3 " C) Home Improvement License: 16 �3 ZZ 3 Exp. Date: S' In ig ARCHITECT/ENGINEER Name: Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASJD ON $125.00 PER S.F. Total Project Cost :$ Al Z 5'0 FEE:$ Z, 3/ 11 Check No.: q o S Receipt No.: t iq,S Page I of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales 11❑ Private ❑ Permanent Dumpster on Site ❑ (septic tank, etc. Electric Meter location to proj ect NO I L: Persons contracting with unregistered contractors do not have access to the guarantyfu Signature of Agent/Owner Signature of contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS IN DATE APPROVED DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH.' ❑ ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer connection/Sip-nature & Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided RequiredProvides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: IN U I LJ anct VA l A — (r or devartment use Page 3 of 4 Doc: INSPECTIONAL Created IMC. Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 Location�o"z /�iG1 S� No. r Date TOWN OF NORTH ANDOVER 9 : Certificate Occupancy $ • of <�' s�st cMu Buildin /Frame Permit Fee $ 3� 9 Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ �1 V Check # i 19 9 53 - Building Insp or O 1 W W 0% ui am o a ';m o x c oI A a� x w a � w° a 9 U w C � a o°G w U w a w .� w°' w u w � C7 .� u. � a w w C� G «� z 4.1 � cn ,� 0 cn ui am t- ro rn 0 v E Z im H O C40) 0.E a CDO rr� CA 0 .y 0 O C CL ev CO) W U) 19 NII ';m o c oI c O N C C3 V •d-0 C c m O O W Ea c m o . o a y EE Cc ... C', m c OCL.. E M yd O ?--L y 1 D 3 Z t' m C .00 1v�a _moo+ SO m mo W co av a.: m y m m Q •o cm c c oa 32 rLo93 r m B � �± v c O d. c H y O C C = o : m 6 IIIQVVV C- � a s m C,o3 W 0 Z z c •� m W. E CML = vi Z O Lu C.3 a 0-o1 y .0Iy5 g o FE, oCCLS t- ro rn 0 v E Z im H O C40) 0.E a CDO rr� CA 0 .y 0 O C CL ev CO) W U) 19 NII i KEEN CONSTRUCTION CO.. .21 HEWITT AVE. NORTH ANDOVER, MA 01845` (978) 691-5201 Quintal,: Judy Quintal, Paul 372 Mass. Ave. North Andover, MA 01845 (978) 689-2252 Contract # 1653; Appendix A Date: 1/24/07 Remodel Kitchen: • Remove & dispose of all Kitchen cabinets and counters Repairs walls as necessary (damage from cabinets and backsplash only, damage caused by electrician will be repaired at additional cost) • Install customer supplied cabinets (as per drawings from Dracut Kitchen & Bath dated 1/9/07) • Install customer supplied plumbing fixtures as selected from Peabody Supply Total price:8500.00 (eighty five hundred dollars) Price does not include cost of cabinets, counters, electrical work, painting, flooring, tile work, or permits. Payment schedule:$ 1000.00 due upon signing contract $2000.00 due the Is' day of work $3000.00 due when demo is complete $2000.00 due when cabinets are installed $500.00 due at completion of contracted work C t mer• e edb. Keen '. 2\:-� Date Date Proposal Dracut I{itche a & Bath 18 Chuck Dri`e Dracut, Ma 01826 (978) 453-3869 978-654-5239 (Fax) Date: 1-4-07 To: Keen Constru.:tion Cell: 978-479-8001 21 Hewitt Av(. N. Andover, 01845 Ptr)ne: 978-691-5201 Site: Mass Ave/ Judy Re: Kitchen project Fim: 978-682-3231 Specifications: As per layout provided Cabico cabinetry Red Birch wood species (Natural finish) 16" con.ealed framed constructior. Particleboard construction Natural maple interiors Full W shelving Solid maple dovetail drawer boxer Mum tf:ndem Full extension glides Slab E tlrawer heads Roman Arch wall cabinets Square 'ailed panel bases 36" high wall cabinets Medium: crown molding Also matching 5/8" wood toe kick Matchin 9 accessories as required for install Super Susan in corner base cab Rollout in tall cab 1. Rollouts in b 30 corner 1 tilt out so, --.Ip tray at -sink base 1 Dec wall rnd shelf 1 Tall cabinet front only for pantry CEibinetry Total as above: 510,750.00 ,p� fie io0�7iY120421!lP,2GUL o�✓�,aaarcciu�avl!d I 4\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration;, 108383 EzPirat'W = 18/2008 Type. rir ' K€EN�CONSTRUC�O`N C Kenneth Keen 21 Hewitt Ave No. Andover, MA 01'845 Deputy Adniiuistrator j ✓li�-�omvri�onr�ee �.,cu,�uure�ia BOARD OF BUILDINo> A'_ __6 TIONS jf 1e0i's0.. CONSTRUCTION,SUPER.V iK 4116er +0 058245 (' irtt5:date-b3724/4-943 i I ? p�332�4�3�}008 Tr: no 1=3436 * � `_ a NPIF 1 �z az" 21:FiE{WITT�A tY� CQmmisi:%neP The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations m ' d 600 Washington Street �t Boston, MA 02111 5" www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): ' 1 �� t� ri1 60,5 si $ G 4)0^1 co Address: z l H E w i 7T A V c City/State/Zip: do 2 M A wJ n UE/L MA Phone #:1, 1? 7$- G 9 Are ygu an employer? Check the appropriate bog: 1. fff I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance.$ required.] 5. E]We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercisedtheir myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' insurance Type of project (required): 6. ❑ New construction 7.Pemodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 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. xContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance formy employees. Below is the policy and job site information. Insurance Company Name:_ R. fl tj ; �c J T /�i % E --,7—pS �O Policy # or Self -ins. Lic. #: 00 O 192 73I Expiration Date: /^ A) p 8 Job Site Address:_ �J7 Z %l%RSS AIDC City/State/Zip: %L%, 19 l/f?09 C. -IS Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebycerti.�, rider the p insy rid penalties of perjury that the information provided above is true and correct use only. vo not write in this area, to City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other �M� or town official Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: 01/19/1007 14:91! tAA (01 V11i GLLO Vlamnnl aA�7va�n��vu .COM,.. CERTIFICATE OF LIABILITY INSURANCE ►ROOUCER (781)942-2225 FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS A MATTER Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE HOLDER. THIS CERTIFICATE DOES NOT AME 137 Main Street ALTER JUF COV GE AFFOR ED BY THE Reading, MA 01867-3922 INSURERS AFFORDING COVERAGE INSURED Kenneth B. Keen J INsuRERA: Granite State Ins. Co. DBA: Keen Construction Company INSURER B: Zi Hewitt Ave. INSURER C: North Andover, NA 011345 INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PI ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WMIC PMAY OLICIES. AGGREGATE GATE LIMITS SHOWN MTHE INSURANCE AYY THE AVE BEE REDUCED By PAID CLAIMS. SUBJECT TO ALL THE TER iR Type OF INSURANCE POLICY NUMBS POLICY EFFECTIVE PDUCY EXPIRATION GENERAL LIABILITY COMMERCUL GENERAL LIAB11 rry CLAIMS GADS [�] OCCUR GEM AGGREGATE LIMIT APPLIES'1t: POLICY 'W7 I,OC AUTOMOBILE LASAM ANY AUTO ALL OWNED AUTOS SCNEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS GARAGE IJAWLR'Y ANY AUTO FXCES"MBRELLA LLAIILaTY -1 OCCUR a CLAIMS M40E OEDuaBLO RETENTION S woRKERS COMPENSATION AND EMPLOYERS' LIANUTY A ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMSER EXCLUDED? OF OPERATIONS I LOCATIONS t None I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL OATY gI WDDMM) 0 NAIC # 0077 IIICY PERIOD INDICATED. NOTWITHSTANDINI H THIS CERTIFICATE MAY BE ISSUED OR AS. EXCLUSIONS AND CONDITIONS OF SUCH LIMITS EACH OCCURRENCE S DAMAGE T6 RENTED : MED EXP (Any one Person) S PEASONAL A AOV INJURY f GENERAL AGGREGATE s PRODUCTS -COMPIOPAOG S COMBINED SINGLE LIMIT S (Ea acddenl) BODILY INJURY g (PerPetson) BODILY INJURY $ (Per Icdorm) PROPERTY DAMAGE S tear arxid&U) AUTO ONLY. EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY: AGG s EACH OCCURRENCE L AGGREGATE S 3 t S WC ATI- O E.L. EACH ACCIDENT S 100 00 E.L. DISEASE - EA EMPLOYE1 5 100,000 E.L. DISEASE - POUCY LIMIT I s 500.00 &WOULD ANY OF YNE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THO CERARCATE BOLDER NAMED TO THE LEFT, BLIT FAILURE TO MAA SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Of ANY IGND UPON YNE INSURER. ITS AGENTS OR REPRESENTATIVES. wuY,IORITED REPR� ATIVE 'et' Dawn Cram ACORD 2S (2001/08) FAX: (978)682-3231 w ©ACORD CORPORATION 1988 KEEN CONSTRUCTION CO. 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 SubmittedTo: t r^• ti1 r"� ........... 1111.... 1.111.... 2� ('`1 AA J .......... ' - y� c A.... . ...r'...................... ...._�� ..............__.._------_-.`! PHONE [DATE__�_c',� � > . - ?fit Lt Ci ..( > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: > Construction related permits: 1653 ffDq� �* � Mffl All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. REGISTRATION NO. F.I.D. NO. MA. H.I.C. 108383 04-325-8052 "l ......-_._.__._._._:. r__1. x ......... . ...................................................................................-................................:......................._.1...11..1.................... WORK SCHEDULE............................................................................................................... Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified here in writing. Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of C,following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contrac(or, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of Payment to be mad& as follows. dollars ($ " ) % ($ ) upon signing Contract; % ($ ) upon co`wp eti6 l,2k` 1 % ($ ) upon�Iletijo1nof '�, shall be made forthwith upon ($ �— completion of work under this contract. KENNETH B. KEEN Name of Contractor / Designated Registrant 21 HEWITT AVE. Street Address N. ANDOVER, MA 01845 City / State -_-"-"— (978) 691-5201 (978) 682-3231 Phone Fax Notice: No agreement for' home 'improvement contracting work shall require a > down payment (advance deposit) of more than one-third of the total contract price NameZS�an,Z'k'��_ or the total amount of all deposits or payments which the contractor must make, in`� advance, to order and/or otherwise obtain delivery of special order materials and Au oti%d sign e equipment, whichever amount is greater. Note: This proposal may be withdrawn by us if not accepted within days. Acceptance of Proposal - I have read both sides of this document and all attached documents and accept the prices, specifications and conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 1 � s Signature Signature Date IMPORTANT INFORMATION ON BACK ► Location `-� i'!IA.SS • A t/ --c, No. Date . Ne_ TOWN OF NORTH ANDOVER Certificate of Occupancy $ '^ Building/Frame Permit Fee $ a Foundation Permit Fee $ ' Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL ; -O'L M i Building Inspector 12 10 �I,J !99 09:54 52.00 PAID Div. Public Works ,,�,,, ,�,, // —Alt— Location ' No. Date ' NaR,h TOWN OF NORTH ANDOVER n Certificate of Occupancy $ 41 (� Building/Frame Permit Fee $ ` • i Foundation Permit Fee $ SSACMUSE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ a TOTAL $ i Building Inspector l it Div. Public Works Joe �, m a z x rn = r.: _ a � r N n N _ Z Z 7 CA O x n Z Z z z zTI rzr,. i i z -! { CA 9 r m z � ' z z y m y - _ Z - m _ z r.r l n s a 0 0 N ..r �vry 77ri _ Z z z Z , X .� _ ^ z� l _ z m �F F ... D zz z d Q m mm D DS - m z LA z C .-1 _ X- m z - o N 3- m Z O X - j N Ci C N -r � T N z v. y C � d y n CD Cl)Z CA D. O n. CL= y CD o v CDCL o CD CCD O CCD C CD yCD� O CA OO I CO CD � v CA O 'O Z CD o CD 0 CD c ?9 m -,S _.y O Q44 n t o y m C0 L o m w� o o 9R.=�m d = y � O o N O -� O?m: o S = o ON o O N C') =. o r CL 0 :.-« O � itCD CD o N CL o 1 CS H .Z' d y rL o CDy 'C yz: o 1 : CD: : CD to 2 . Er o �� G CA 0 0 . a3 i� .� A .. CD : c A a -o C-) 0 c o _ C/) O 0 C/) � 0 � � Irl g W tz O �' �� 1 :z og r Ma o x O x z O �NO f� • 0 c t: A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIAIG (Print or Type) NORTH ANDOVER Mass. Date tuilding Location 7 S 1�-P Permit # A .lt Owners Name��s •�' New 77--"' Renovation II Replacement II Plans Submitted II PIY- I i0= (Print or Type)%� Check one: Certificate Instailing Company Name �J , /��l�it� .� ` Corp. Address �� ��Ujc�d�c(- 6�T' Partner. 4Firm/Co. Business Telephone: 6 9-6 - p t Z D Name of Licensed Plumber or Cas Fitter Insurance Coverace: lndic:.e :•ape of insurance coverage by checking the appropriate box: Liability insurance. policy Cvi'Cti'er type of indemnity = Bond Insurance Waiver: I, the ur.dersic.n.e,-`, have been made aware that -the licensee of this application does not have any cr.e of the above three insurance coverages.__. Signature of owner/agent of procer,y Owner U Agent Q - I h=chy certify that ill of the details and information i have subraitted (or entered) in above aopiiotion are true and accurate to the best of my k--towtedsa and that sU ;o(umbint rant and tnatattations ;afat;zLed urd= tesr..it i=td for this sppifatian rill_be in compliance with ad pctlaat pro.uions of the WA&Sachumtta Slate Cas Gide and Qw;ter :a: ai ". Ce—nem! L►ra. .. 3v T'_'P' LICC�IS� • � L'TtDer Title { Gasfitter signature of Licensee easter Plumber or Gasfitter :Ourneyman APPROVED (OFFtc:E USE ONLY) License Number m e UA ai _ N . _ Ca to C U - 92 C I ° t? = of . LU = us ut y_ w F- ;f a C - a2 C -07 �. .. U C tJ7dK- ua 0- < — — C C to w d to < C f' < >- O N — Q C ttt C > O C W = < SJ$-3S�dT. I I T I SASEME:IT I I -I� -I{ t ST FLOOR j 2`M FLOOR I I I 4 I I I I I I I I I I I f I lI. .. ! j 3RM FLOOR I I ( I I I I I I I I I ( ppI 1 ( I. _�- I� {( I I . _I - + i I 4,I.6 FLOOR ( -L i 1 I I I I` I iI I .,.t _.I ..I.._.1.`ll..._. C...I_.- 5TH FLOOR +� 6TH FLOOR TrK FLOOR aT:t FLooR (Print or Type)%� Check one: Certificate Instailing Company Name �J , /��l�it� .� ` Corp. Address �� ��Ujc�d�c(- 6�T' Partner. 4Firm/Co. Business Telephone: 6 9-6 - p t Z D Name of Licensed Plumber or Cas Fitter Insurance Coverace: lndic:.e :•ape of insurance coverage by checking the appropriate box: Liability insurance. policy Cvi'Cti'er type of indemnity = Bond Insurance Waiver: I, the ur.dersic.n.e,-`, have been made aware that -the licensee of this application does not have any cr.e of the above three insurance coverages.__. Signature of owner/agent of procer,y Owner U Agent Q - I h=chy certify that ill of the details and information i have subraitted (or entered) in above aopiiotion are true and accurate to the best of my k--towtedsa and that sU ;o(umbint rant and tnatattations ;afat;zLed urd= tesr..it i=td for this sppifatian rill_be in compliance with ad pctlaat pro.uions of the WA&Sachumtta Slate Cas Gide and Qw;ter :a: ai ". Ce—nem! L►ra. .. 3v T'_'P' LICC�IS� • � L'TtDer Title { Gasfitter signature of Licensee easter Plumber or Gasfitter :Ourneyman APPROVED (OFFtc:E USE ONLY) License Number — W-*"- ; 2 8'17 Date.`! ..... �.... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION s This certifies that,... .. . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation -e -Ac -.e, in the buildings of .... ............ at -3 ?4'.``v...-ti'`� .......... , North Andover, Mass. e. �2 Fee � .. Lic. No...3 �.... .......................... GAS INSPECTOR f WHijIfE: Applicant CANARY: Building Dept. PINK: Treasurer 7WE e0WX0W d7,41 � �ss���uss77s Dqr art 4 P -Ow S4,0 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No_ �Cl �` /o Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the (Please Print in ink or type all information) Town of North Andover Massachusetts Electrical Code 527 CMR 12:000 Date��/ To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street &Number 7 %c� /?�q-S.S Owner or Tenant �G«� Owner's Address SZ Is this permit in conjunction with a building permit Yes ❑ No L --(Check Appropriate Box) Purpose of Building 6 lc-" Utility Authorization No. Existing Service_L r� Amps Voits Overhead L5— Undgrnd ❑ No. of Meters Total New Service Amps Voits Overhead ❑ Undgmci ❑ No. of Meters No. of Transformers KVA Number of Feeders and Ampacity, Location and Nature of Proposed Electrical OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have chgcked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) t /� (Expiration Date) Estimated Value of Electrics Works oG Work to Stant Inspection Date Resquested . Rough Final rr Signed under the Pea f perjury: FIRM NAME O/ .�'Sd , �� P G✓l.P �(- UC. NO. NO. �— ii Address (9 +"tQ� BAIt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Total No. of Light8ng Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool gmd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices . Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices Nod of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have chgcked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) t /� (Expiration Date) Estimated Value of Electrics Works oG Work to Stant Inspection Date Resquested . Rough Final rr Signed under the Pea f perjury: FIRM NAME O/ .�'Sd , �� P G✓l.P �(- UC. NO. NO. �— ii Address (9 +"tQ� BAIt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Date` .- .. ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............� .. ....... .............................:'`..................... has permission to perform ....... - -) •'......................................................... wiring in the building of .........:.:��........................................ at .......... ..................................................................... . North Andover, Mass. T .ir NrY Ilk ............................................................... ELECTRICAL INSPECTOR 05/19/98 15:26 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer -w 1 Location 3 Qt:� S A S S A No. 175 - Date L-10 -0,f MORTM TOWN OF NORTH ANDOVER i • SOL 9 Certificate of Occupancy $ '� s'• E<� Building/Frame Permit Fee $ 3 MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 30 Check # ri ' Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: /ysj DATE ISSUED: SIGNATURE: Building CommissionerAmector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: f� C `AA� 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 11.T4 06)(1)4 1.3 Zoning Information: Zoning Diaiic­t Proposed Use 1.4 Property Dimensions: 1 Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT ' " ' S t 2.1 Owner of Record Name (Print) Address for Service I Signatu Telephone `—. 2.2 Owner of Record: N 4e Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: / � Ad/dress ~7 Signature Telephone Not Applicable ❑ License Number Expirationa e 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name �� �� Registration Number A�dress Expiration Date Signature Telephone 00 M X z 9 It SECTION 4 - WORKERS COMPENSATION (MGL 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 emit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 60&'Q Cela % ;' 1 zo zsL 2k-y'z& SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY.. .' 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X tbl 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 ✓' 00 Check Number SECTION 7a OWNER AUTHORMATION TO BE COMPLETED WHEN OWNERS AGENT ORCONTRACTORAPPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize! �jU 1, U L—L-0 to act on My behalf, in 11 matters` elatiKe to ork authorized by this building permit application. - j .j�c L_� .�I l4 Si ture ier Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Sip -nature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS iST2ND 3RD SPAN DM ENSIONS OF SILLS DIN ENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: 3c1 d tYTL l V I Location: Ma r,5 4-v� Citv /V/2 I Aa t2 Phone # 0 ' I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. Company name: C ae- 70�-- I/C-he, Address A W74-70ou City: �� /�/�j �y Phone #: � D � Insurance. Co. 6:;24011,0 S � C° Policy # w • 9 % Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as_well_as.civil..penaftiesintheform nfa STOP WORK_ORDER_and_a.fine.of.(.$]00..00)_aday against -me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ! do hereby certify under the pains and enalties of perjury that the information provided above is true and correct. f/ Signature D ' Date fit' 4 Print name /yL� Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other ��ie �an�nzanu�ea� ��,�auclucae� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:. CS 043156 Birthdate: _04118/1957 i Expires: 04/18/2005 Tr. no: 10260 Construction - CS. Restricted: , 00 t FRANK RULLO 14 STONEPOST RD Administrator' SALEM, NH 03079 � �lxe �aavnzo�uoea/,� o��/�/iaaaaclzuaP,tld Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 100290 ` IPWW666ix/1512006 -} TyPivate Corporation RULLO CONST R CTiQN C6INC. Frank Rullo 14 Stonepost Salem, NH 03079 Administrator 0 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 c11,S150A. The debris will be disposed of in: C,- (,n) IDOW)f r5 oz z r 9 A (Location of Facility) Signature of Permit Applicant a) L� p Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Dec(<, FORM U - LOT RELEASE FORM S --Z � -o q 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT I -A) /T% q)Q / 0 t4C PHONE LOCATION: Assessor's Map Number PARCELS-� SUBDIVISION//�� LOT (S) STREET 2,9 0) n, WE� ST. NUMBER *******'r*********************************OFFICIAL USE ONLY*************************�******** TOWN AGENTS: RVATION ADMIRATOR DATE APPROVED r DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED _ DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm YI m X m X m m ) y d C 'O O n Z y CL F. d y a� �o Co CD o v CDCL O c� % m co 0o CD w w aCD. C CD y QO y �C C cn cn 0 cn C 0 cn cn �f C W -P- p =r -1 Cy C Q N = L a Elm y O o a m Z ?� N 0... 0 0 Mm N 'n Fr o .?m y m 40 O N p bNN O gm m = OOH : a cc O 0 COO! Wm:OO S O ,�„ „ CL No m • m o0 O o C4): � CD O O N a ca♦ : d N NO Q o �,� A a C= C e9 Ip C/)..« m N N N� :O O mR �C, O CD � � 3 � • �I � O Ir: CD 1 N d �m ��o � �� a� o � c o o ~' � a cn ry cn (9 z b7 d ~�? pOFp 'rf w ;h OrOQ Cl7 Irl �. yv 2 x n g ►n 2 c d PROPERTY NORTH APPRAISALS, INC. DI AT AAAP 3i 2 l��unaaciuu�ceG s�✓e De( os ,gad" 2638 F. mFIIA PC—Plus' (800) 262-4805 PROPERTY NORTH APPRAISALS, INC. LOCATION MAP Borrower/Client Judith & Paul Quintal File No. 020215 Property Address 372 Massachusetts Avenue City North Andover County Essex State MA Zip Code 01845 Lender Stoneham Cooperative Bank, 80 Montvale Avenue, Stoneham, MA 02180 J° Summ%;; z AN 33x1 � � E °d � ��i � � •( �, •;, '� 0 1= M0110H , � 'gTA�it 1 lo°rA S ao, be v• y J ,: 3�d o 'i� •� / 1 q� b dY �;•3 '1S I Q o, a& a 3�'' J� p W Y, 1n 0: ,) r Y O CV PQ Q A, 1s�3 a0, J h Z v W ¢ �d � u r � PP �► J' ,� C Y c z PNS dd�� Q\c�'' pb 1 ` b,�J � ♦, 1 � I � AD1444 V ;.'.•.; ON d I sutT ld3e .dh VIP 74 SSP �yr1b rOv 3 d. 4,'� 4 n b1 d • a �.;?: ,:r. `• �`�� o �\� c� c +.. °y c U �� �;<.:,,•.:•�.:. ,, 1..1,.,...�.,,r 0. rte• �, rN`.1� •2' J 'i vy "•„ .. g� \. .0, • 14..!r* - 4) � a l.r r yy�' � L ►•s1 9�\ i1�.) ?(�,'�' ( V� w 1 ct g';' h r0.wl.r , �1i.�� o (S ,_ J Yil�� ♦ w 0 o,� r-�n0• °b ig `�\�6 �A. r• w ��>s ;xi �� • S- N rJry Y. w d w `+b l moi►` r�����1\ � �� � � J� °a4.� i S l— �k �m .1 ( Wry i�y 66� db Sj k r �� i�+��• v, �/ 1 n I riNU O�Wp r! a IQO A J�b! �Sgr,57 0 4 =SUNJ �3/ r/ /� D v tnFs�.s11 Q ls; i sCir�No,yk. ���, pv w r..- JOE ' :;:.'�r•. a w t 3w Y %\ SON 1 a :/ w 2638 PC-Plus'm (800) 26 -4805 w _ ..__. .- ... ~� ' � ,ice" �• i