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Building Permit #576 - 5 KIERAN ROAD 3/6/2007
BUILDING PERMIT of "°oT" TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ 5 Permit NO: Date Received Argo �SSAC HUr'��� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION r /� /C,� .l � �C7 / �il�L Print PROPERTY OWNER 1J(,41e'1tV Print MAP NO: PARCEL: ZONING DISTRICT;. HISTORIC DISTRICT yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building F�One family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ,9 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Public Sewer ❑Water D Flood Iain : [ Wetlands } 0 Watershed,District i. DESCRIPTION OF WORK TO BE PREFORMED: �JG/c��✓�/C� Gr�/'l��O�G�S' Identification Please Type or Print Clearly) OWNER: Name: /� Phone 9ZL 6? 7� Address: IVA5k A 0(l) O CONTRACTOR Name:- "JI- L 0,910000 Phone .Address: -� Supervisor's Construction License J. �� Exp Date` y Home Improvement License C)'� Exp. Date: ,R. C� b i ARCHITECT/ENGINEER `"� Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ "p fig`® FEE: $ ID'? � Check No.: / Receipt No.: C)d '0 ';L/ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty f d Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑_ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS i DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ I COMMENTS i DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS i TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ I°Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ w Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si nature& Date DrivewavPermit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date 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 a 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 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 New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan L3 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 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:BPFORM07 Revised 2.2007 NORTH Town of . t. 4Andover 0 - Pr - LAKE over, Mass., • COCMIC ME WICK y�. A�RATEO J.,v -`C7 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........ ..... .!#. .......*......� .. D�,r .... .... ��. ................................. ..... ............ Foundation has permission to erect........................................ buildings on...5....... /... .w.M........... ... R.......... Rough /'i to be occupied as..... .4..�..........jReeN...'4o. ......... ..... Q 1...A..+Q'*.:/V..........•....................:...:. 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 ( 0�' PERMIT EXPIRES IN 6 MONAL� ELECTRICAL INSPECTOR UNLESS CONSTR . . ... ST 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,nPlease Print Legibly Name(Business/Organization/Individual): 6'er'-E-CY7 Address:_ 7 VI-PT Arl- A—e City/State/Zip: ee�2 /zl� a/ /Phone#: 6Z, 7e,-P Are you an employer?Check the appropriate box: Type of project(required): 1.[1I am a employer with 4. E] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.bl I am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [N comp.insurance comp.insurance.t 9• Building addition o workers' required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑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 sub-contractors and state whether or not those entities have employees. if the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee& Below is the polley 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 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 co of this statement PY may be forwarded to the Office o Investigations Y f ns of the DIA for insurance covers a verification. ee I do hereby cceert�ify er;he pat nd penalties of perjury that the information provided above is true and correct Si ture� / Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers 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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitnicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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-$77-MASSAFE Fax#617427-7749--_ Revised 11-22-06 www.mass.gov/dia Jauolsstmmo3 I,Z610 VW'0NO=IXOG } IIIH SNAV13 VLZ 13ON 813VHOIW � 9ZZ8 #J1 60��Z/trJf' litti> ! s % 0961/t+/l'�e� py}t[8 I £6L05 esueal-I joslAiedng uopon,tsuoo y ` sPjgPn> S Pas suopulnSag Salpling jo p nm >: ,per �/ce �ovs�rcoouuecr�,lyz o�,x�aaw.c�ueelta ~ ._ �\ Board of Building Regulations and Standards License HOME IMPROVEMENT CONTRACTOR before Registratlon- -1.07835 Board Expiration: 8/7/2008 One Ai Typeis'DBA 4 Boston CLASSIC CONSTRUCTION'CO:r, Michael Robidoux 27A BAYNS HILL RD BOXFORD,MA 01921 Deputy Administrator r Q_`o s a 1 Page No. of Pages CLASSIC J CONSTRUCTION CO. ANDOVER, MA (978) 475-5033 PROPOSAL SUBMITTED TO PHONE DATE STREEETT� JOB NAME ] / CITY,STATE and ZIP CODE JOB LOCATION - ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: �i�I LL �d�� �` L G�'�� i L C� /���'� ff�/•!/i Y /�/ ��c�` � �L O Gi L '41 11NI i, `� St/l� vG"2 �/f=�� �/ %+OIL — 4410 /1/✓�-� S l/•//,� a ,/C G G '�,�I ✓ l�i C j 1-c//7-/ , 62/7 k1fiz l S il'5 4v6-C/D6 - `'jj ,E'rn0 L�L1 UUrv� � C� / Gs /,%3/s G�✓[ f� ;'�!c C V/ / 'y1/G�L. � I Wf propoSf hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: dollars($ A � ). Payment to be made as follows: ,5 D ==�r�G� wo�� ,C�c��.✓s All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized ` involving extra costs will be executed only upon written orders, and will become an extra Signature ✓� / .,! e ' charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. Acceptance Of proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature i ;= To P=rdar: 800,V5-O59 or rtc!==n 11rap a s a i Page No. of Pages V 1 i CLASSIC J CONSTRUCTION CO. d ANDOVER, MA (978) 475-5033 PROPOSALSLIBMITTEDTO PHONE DATE STREET JOB NAME CITY,STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: SAV G'107i©1Z A/o i i We prDpNrhereby to furnish material and labor—complete in accordance with above specificattiionns,f iJfor the sum of: " �y /V� lll�41V !!"w6 �l�/Zi/ 6�4) S1 X yl dollars($ �!bl�! ) Payment to be made as follows: GC/[� �5 �Cf /9C4l i All material is guaranteed to be as specified. All work to be completed in a workmanlike _ manner according to standard practices.Any alteration or deviation from above specifications Authorized Signature involving extra costs will be executed only upon written orders,and will become an extra Si g charge over and above the estimate. All agreements contingent upon strikes, accidents IT or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. t A cceptance of Proposal —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. � Date of Acceptance: Signature I Location x No. Date 3'• (�' o ""'_ NaRTM TOWN OF NORTH ANDOVER Of t. o ,•�,y /C 9 i Certificate of Occupancy $ �7S''••°'E<� Building/Frame Permit Fee $ S�CMus Foundation Permit Fee $ Other Permit Fee $ - - TOTAL $ Check # t Building Inspector Location No. ! Date („ • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ tIL1) � ° TOTAL $ Check# 2 V j Building Inspector NORTH own oAndover Oa . - .� No. z h ver Mass • O twK• � 7 '� cocH�cHew.ck RATED ll BOARD OF HEALTH Food/KitchenPERMIT LD . Septic System THIS CERTIFIES THAT .................. S ......... BUILDING INSPECTOR r1.5 1 �,��` ' ..... Foundation has permission to erect .......................... buildings on ...... ........... ............................... ....... if ...... Rough to be occupied as ..........��..... ... .. .................. 7- .. Chimney provided that the person accepting this permit shall in every respe t onform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Law elating 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 Oh PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 1� UNLESS CONSTRUCTION TART Rough Service .................... .. .... .. .... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE C I SMA H.I.C.REG#157288 R J Talbot Roofing & Contracting, Inc. Salesman: tick �• LICENSE#CS SL 101775 Residential,Commercial&Condominium Roofing Solutions FED ID#26-0661197 1-888-755-1535 / 603-755-1535 www.talbotroofing.com NAME: nm alsf W ADDRESS: HOMEPHONEM ��U ! 1 CELL#: 4 — q/7—�� EMAIL: A1 s 1. Contractor agrees to do the following work: e-N'1 t4.. yipuv&C_ 2. Install tarps from roof to ground to protect the house&landscaping. 3. Remove existing layers of shingles and dispose of them properly. 4. Inspect for rotted wood.Will replace roofing boards at$3.75 per foot and 1/2"plywood atre foot." 5. Apply feet of&W— " W��i�lce&Water Shield to all eaves and 3. feet to all valleys/openings. 6. Apply Synthetic Fiber Reinforced paper to remaining area.Name: q�9f V61EX p 7. Install Heavy Duty 8 inch drip edge to all eaves and rakes.Color to be: kite Mill—Brown—Copper 8. Install new pipe flanges to all existing pipes. lum /Copper 9. Install Certainteed or GAF Architectual Shingles to manufacturer's specifications,to in ude swVt_of pro starter shingles o all e 10.Shingle Name &14P �Color: ,J �y 11.Install Shadow RidgeTimbertex stomed Capon all ridges and hips. 12.Install Shinglevent Two Ridge vent to all ridges to ensure proper ventilation. 13.Re--Lead Chimney NO.New lead will be sealed with Geocel. --- -. 14.Worksite will be cleaned on a daily.basis and all areas will be gone over using a 3—foot magnet. 15.All necessary permits will be the responsibility of Talbot Roofing&Contracting. 16.Talbot Roofing&Contracting will supply customer with Liability and Workers Compensation Insurance Certificate prior to any work being performed. 1 17.Upon completion and payment in full,your new roof will have a workmanship warranty for a period of I0 years issued by Talbot Roofing& Contracting and ,M years honored by the shingle maufacturer for material defects. 18.Any changes to the specification will be executed by a written change order and will become an extra above and beyond the original contract price. Talbot Roofing is NOT responsible for attic debris. Note:This proposal may be withdrawn by Talbot Roofing,if not accepted within 30 days! Comments: ��-'off£ flt%C.�•U S i is �l-r .%1�i'� f 7 l`T VUJZ CSN 7t M01P liey3e The Contractor agrees to perform the work, furnish the materials and labor specified 14;Worksite will be cleaned on a daily basis and all areas will be gone over using a 3 foot magnet. ,F 15.All necessary permits will be the responsibility of Talbot Roofing&Contracting. 16.Talbot Roofing&Contracting will supply customer with Liability and Workers Compensation Insurance Certificate prior to any work being performed. 17.Upon completion and payment in full,your new roof will have a workmanship warranty for a period of 10 years issued by Talbot Roofing& Contracting and years ho y g honored b the shingle maufacturer for material defects. 18.Any changes to the specification will be executed by a written change order and will become an extra above and beyond the original contract price. Talbot Roofing is NOT responsible for attic debris. Note:This proposal may be withdrawn by Talbot Roofing,if not accepted within 30 days! Comments: P°LAQ V Cq'j 7M, AMP 1`k3e The Contractor agrees to ppeform the work,.furnish the materials and labor specified above for the sum of: $ .� 0'0 • Payments to be made as follows: $ upon signing contract(not to exceed 1/3 of total contract price.) $ by_/� or upon completion of halfway point. $ — / by_/_f or upon completion of work specified. Contract AcceptalaxOC26,this document becomes a binding contract under law. S N CTHERE Owner Signature Contractor's Signature Date: Date: Talbot Roofing Contracting o 8 Joan Ave, Hudson NH 03051 .603-755-1535 or 1-888-755-1535 Contractor ArbitratioH ids, The contractor and the homeowner hereby mutually agree in advance that in at]event the contractor has a dispute Concerning C the dispute to a private arbitration fiyal which has been approved try the secret2n!of the Contract,.the contractor anay,submit d to sulunit- 1- such a.rbitration as Executive Office of COnSunier Affairs and Business Regulation ant the consumer shall be require 0 provided in IMassacilusetts General law,chapter 142A. Contra,ctar's Signature fjomeij],ners Signature 1. Tile Proposal pertains to services provided by Talbot Rooffilor&cop tract!tic, Payment is due upon completion at our office in Hudson, NH. Paynient not received. .30 days ilial bedeemed in defy-ulu, M the event of a default;iriterest shall from thw dateof default at the lesser of a rate of 1,5"/o per month ANN LIM,)of the maximitin -alloyedflylaw.with anlinin-11.1111 Cmare.of($51'0)per monih. C-uslomer kgreje-, COY aY all necessary cost,experises. fFes and amounts due if this accountis tendered tbr collection. 3. Proper installatiou ofthe roof systerr,may require replacement of eMsting,Oasblingg.During such.re-placenient.Siding ad;ncerit to th"I'S fj<jsjjing. which has deter-lorateo, may crack. breal. or tear.Talbot Roofin.:S`]ll imtje evet-N., yeasoritir,&effort to avoid da.mage-S. but �v-jll licit be held responsible 1�,,,)r any cons eq Lien tj al dairina.to the isiding. o 4. During,tl,,,e ap th -im the roof ruay, be transinitted throughout the.lhouse.Th cirrist MeE plication of+ e roof syste.m.vibration frc responsibility for all objects hung from exterior and interior walls and fro,.ii ceilings gild s, 5. Talbot Roofing is considerate or the customers gardening. flower bels, and landscaping. but due the, nature. of at roof tyslernj sb installation. some dalnaL"��may occur.We atterapt to rriluill-Lize any damage,and will N(.),r be held respor, ii le if any dani re occur,i. on the gr( a 5. Custon-ter-S shall 1101 w�..dk unde. w(--�rk area while roof work in progress, ConsiructIO" site is',t.(I�juge 1,t€? rg--,1,s front fsdling obiects. vent that'ralbot RooCing reoves a satellite-dish or antexin.a firoul.Said I-00f t,-,)complete work ,t! l 11 besoie, I'D the e �r m a qualified technician to re-insiall and,jligjj such equipment.An ,V costa�risiji,,r fro- C e jesponsible For hiring. tn sudh work shall b 1h s le reil-orisibility ofthe-horrleova'0-11. Talbot . )ofing warrants its roof swstem to be free of leaks for the duration specified. Talbot Rocifin.-I assumes lilibili Y I'Or rCP.'IU` or 'Fri g-ees to hold Talbot Roofing harinfless for any intei . oj' -tny inistallation work-'riconship clere-et., causing leakkge. Romeov, er a al ,,--,, i vt 10 'moldresulting fi-om water leakage. T,,!I)ci',' Roofing hu H M -nLal ITICILIdIng " dama—ge.. to include erw inini, liability beyond'repair of said roof Roofing material is Warratited by the manufact-wrt-n-under a separate warrant-v N'.ill k" is t the customer upon pwyment in t"I'll. ft"n,I 1,e loss tlirough windows and orskylij,its.as 61.11tion in your atlic. M All 3- arrantiesare Itshallbe theabligalbonf)f tile Contiviefor 110 Permits: The vantrat,too shail hi.torns the G1Pner a, aig and cf., -pt � j perr,:j.pv he exelp(led,ftom rhe guaranty,P11,011,sions 6yf'i ke Houne Jivprereynea t Hoineolvae"S�1,110 Secure thei?owr Contractor La;V 93A. AddiViopal In—f6unatiOR If N-7011 have a'gentral question or need additional infl�orniation about the ljojjjt- vemet nContraCLOV LaW or o(ber c(nsut inipro or if you.xvish to obtain.a fr ee ec)py of"A 14`eiSSHCli.ettietts'oDstaner Guide to Home 1131,Proveluej'C'011tilct: onsauter Infc)rinatiort Hotline office of C.-Onsuiner Affairs and Business re-gulall"M 1.0 Park Plaza..Rooxn 5171.;.Boston. MIA 02 116 61.7-973-8787or visit the OCABR.wvbshe [ wl f you ant to verify the registration ocontractorf contractoror. have a question or need We'dfic.:Illy abom th", contractor:,contact. The Commonwealth of Massachusetts Print For Department of Industrial Accidents -- Office of Investigations ' 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.g ov/dia Workers Compensation Insurance Affidavit. Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):RJ Talbot Roofing&Contracting,Inc. Address: 8 Joan Ave City/State/Zip: Hudson, NH 03051 Phone#: 603-755-1535 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. .2 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no re-roof employees. [No workers' 13.M Other comp.insurance required.] *Any applicant that checks box A 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. lContractors 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 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 of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern un he pains and genalties of pe*2that the in ormation provided above is true and correct Si naturel Date 06/17/2013 771 Phone#: 603-755-1535 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#: 91te _C04 Office of Consumer Affairs and Efusiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 � ntractor Registration Home Improvement C .� g _ Registration: 157288 Type: Ltd Liability Corporation x Expiration: 9/20/2013 Trt/ 217012 RJ. TALBOT ROOFING & CONTR. -14,G ROBERT TALBOT 8 JOAN AVE. HUDSON; NH 03051 A f- (' C Update Address and return card.Mark reason for change. EjAddress [:] Renewal [] Employment Ej Lost Card DPS-CAI 0 50M-W044101216 Massachusetts -Department of public Safety Board of Building Regulations and Standards Construction Supen-isor Specially r, License: CSSL-101775 ROBERT J TALBOT ,J 8 JOAN AVE '� _ � �� • HUDSON NH 03851 r Expiration Commissioner 1211312014 AC(:>R©® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlOD/YYYlt) 512/2013 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(les)must be endorsed. If SUBROGATION IS WANED,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 endorsements). PRODUCER GLOBAL HELP CENTER INC CONTACT NAME: 19 MILL ST 2ND FLOOR PHONE tgt (AIC.NO LOWELL, MA 01852 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Libedy Insurance Corporation INSURED INSURER 8: ROGERIO AUGUSTO TRENTO SR DBA ROYAL CONSTRUCTION&ROOFING INSURER C: 139 RIDGEWOOD DRIVE INSURER o: LEOMINSTER MA 01453 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 16214331 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 A L POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MM/DDlYM GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PREMISES EaEom rrence 5 CLAIMS-MADE D OCCUR MED EXP(Any oneperson) 5 PERSONAL&ADV INJURY S GENERALAGGREGATE $ GEN'-AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY PECTRO LOC $ AUTOMOBILE LIABILITY Ea amdED .1?N LE LIMIT S ANY AUTO BODILY INJURY(Per person) $ ALL �O NEO SCCHHO ULED BODILY INJURY(Per accident) $ NON-OWNED PPR08ERdT1 DAMAGE S HIRED AUTOS AUTOS S S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LI18 CLAIMSQAOE AGGREGATE $ DED RETENTIONS $ $ A WORKERS COMPENSATION YIN WC2-31 S-364518-023 4/24/2013 4/24/2014 WC 'a STA OETt AND EMPLOYERS'LIABILITY ORY LIMIT ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT S 100000 OFFICERIMEMBER EXCLUDED? ❑Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 100000 dyeaaescrid 7ttder DESCRIPTION OF OPERATIONS below y E.L.DISEASE-POLICY LIMIT;s 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Rearks Schedule,N more apace Is required) THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR ROGERIO AUGUSTO TRENTO SR. Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RJ TALBOT ROOFING THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 8 JOAN ST ACCORDANCE WITH THE POLICY PROVISIONS. HUDSON NH 03051 AUTHORIZED REPRESENTATIVE Jeff Eldridge Ud ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i1S certI cate ca ceCOls`ani °superseci°es91 L1,/2�2reviously lssaiFecit coertificates. ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: / DATE ISSUED: rn SIGNATURE: Building Commissioner/1for of Buildings Date z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: e tr l Gt rJl' n /T Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 _J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record � use l��s��l� 5- �� o Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0.�a b Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ t Li used C�,onstruction Supervisor: ��Sob , 27 A ` License Number Mn Address "f � 2,� 0-3 14, zi Expirati n Date ignature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ WW,LLAJ� 14 Company Name M Registration Number AddressAl-le- ~�/, L� a ��/ Expi io t Dati Signature Telephone f SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result •` in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ . No.......❑ SECTION 5 Description of Pro osed Work check au applicable) New Construction ❑ Existing Building Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �. ten.t.+?,.., (..), s Q L til � I +noh� Cd(5U� ON �e� r \ N1 #. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIAL_USE ONLY Completed by permit applicant 1. Building � (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) / 4 Mechanical HVAC C r� '�- 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, o ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. -Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, th.)�LL( �`— �— ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 04 N` Print Name 62 Si ature of-01=#/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TD/MERS IST 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS -HE,IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAI,OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Location /j Xe r l a ti 1 � No. C/6 Date —� �d 0 MORTq TOWN OF NORTH ANDOVER to 9 • s Certificate of Occupancy $ CMEtn Building/Frame Permit Fee $ JAU`� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a6 0 Check # -6/). 159113 Building Inspector y I I w i i � -' �tt� U-lf'73P3Ylfl�tl3�(LL(1t-[�C"��L73d[Z�fdit..'£-F� — _ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR - Number; GS 075061 Birthdate: 07/2811974 Expires:0712812003 Tr.no: 75{#61 Restricted To: 00 t WILLIAM R ROWE r � PO BOX 395 METHUEN. MA 01844 Administrator -_ � f¢„ ?It7lt4fZU�r Lt{/L� �lG�#�2f f1fl:1P=fs Boare of L'uilding Reguladonv antiiguil0w.ti HOME IMPROVEMENT CONTRACTOR Registration: t .� 134053 ,Explratlon_ 00/18/2p0 ` 4 Type: Individual WILLIAM R,ROWE WILLIAM ROWE 8 GILES ST. kIEZNUEN,ttA 01844 -- _ s North Andover Building Department i 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: (Location of Facility) 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 An ED Town of dover NO. /9 * - - h 0 `A dower, Mass. COC HOC > > ADRATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....DAVA............>1_4444.80W Foundation has permission to erect../ lAL�,Mr!!+' ' buildings on ......��....1 !�I�..�..��ti.....,, �� Rough w�I�I �0�I s ��� Chimney to be occupied as...... .... ....... .............................. .............rS............................................................................................ 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. 1914 Q4 jC1 own,, PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION S ARTS ELECTRICAL INSPECTOR Rough ......... ...... . .......................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner _ Street No. SEE REVERSE SIDE Smoke Det. t, PEWNTIT NO. /l APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP NO. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE I SUB DIV: LOT NO. � � LOCATION % > PURPOSE OF BUILDING �C�' ��Jf� f2 o' J� OWNER'S NAME NO. OF STORIES / SIZE OWNER'S ADDRESS J�) E n' 1�N BASEMENT OR SLAB jA/0 ARCHITECT'S NAME ,` SIZE OF FLOOR TIMBERS IST ]J �0 2ND 3RD BUILDER'S NAME 30 N A/ I r3 U Iq fff SPAN // n DISTANCE TO NEAREST BUILDING (00 DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS X A DISTANCE FROM LOT LINES—SIDES ®; REAR GIRDERS AREA OF LOT FRONTAGE �r HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW -.p SIZE OF FOOTING / J( J 7 X A IS BUILDING ADDITION ! X /6 �a I�C MATERIAL OF CHIMNEY }� IS BUILDING ALTERATION 's IS BUILDING ON SOLID OR FILLED LAND ySOL J.A WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY 1 IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDESa EST. BLDG. COST PAGE I FILL OUT SECTIONS I - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS I - 12 SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILEDr1 AND APPROVED BY BUILDING INSPECTOR DATE FILED `/ �� 47 e BOARD OF HEALTH SIG URE OF OWNER OR AUTHORIZED AGENT FEE PLANNING BOARD PERMIT GRANTED a J Is BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ STORIES I 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 _ _ 3 1 2 13 CONCRETE BUK. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'TAREA _ '/, '/a '/, FIN. ATTIC AREA _ 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 HARD\N'D ASBESTOS SIDING COMMON _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. _ STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR --d POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH I3BATH 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 II 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 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING � I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �$IS •for b w)!iC BUILDING PERMIT NUMBER: DAATE4SSf JED: a X 3 Zo ic SIGNATURE: Building Conunissio er/In , of Buildings Date SECTION 1-SITE INFORMATION t O 1.1 Property Address: ��) 1 1:22 Assessors MaD and arcel Number: IVYA ' L`� ✓- Map _timter arcel Number 1.3 Zonin labs oration: "' 1.4 Property Dimensions: r ZoningIhstrist Proposed Use Lot Area F ft 1.6 BIJ"ING SETBACKS 00 � i Front Yard :Side Yard Rear Yard Required Provide R red— 47 Provided Re Provided 1:7 Water Supply M.G.L.C.40.t f 5. Flood ZOO Mormstion: 1.8 Sewerage Disposal System: Public ❑ \.;Private 0 Zone s Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2+''PROPERlY O RSIiIPP,°AU IORIZED AGENT 2.1 Owner of Record 0) 1 ,410 Name(Print) Address for Service: `V 9714 Signature / Telephone C Y 2.2 Owner of Record: l Doq,11.D )s w -S- 11(61--/2641 �? Name Print Address for Service: Signature Tele one 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 M(C �4,A (5C- —C ) g ,3 Licensed Construction Supervisor: 0 �� ��•/�S /�`� � �J 2�/�� License Number Ad sX 1 ze-/� Explrahon/ Date tgnature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 0z-1qff1(f �it/Sirn Company Name S rI Ao �Xlf�� /W Registration Number r 7-6 Expiration Date Ar'� i nature Telephone �1� SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildiog permit. Signed affidavit Attached Yes....... ' No.......❑ SECTION 5 Descri tion of Proposed Work check all appHcablel New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: � L Pit/( Gy/iylyoGJ �J/U�0 �Al L5 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building / 0 (a) Building Permit Fee Multiplier 2 Electrical �_ (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNEERRS�AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Y // /� J��OV as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. 0,9-021_4z- Signature ,x-071Si iature of Owner Date SECTION f7b OWNER/AUTHORIZED AGENT DECLARATION I, l/—//C� rLI. ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print N e �r Sig4ture of Owner/A ent Date NO.,OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I' 2415 3RD SPAN DIMENSIONS OF S:[LLS DIlvIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE o��.. The Commonwealth of Massachusetts > Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compens UW Insurance Affidavit Name Please Print Nam: cihr � rr�lJo�'�� Ing Phone IFam a homeowner performing all work myself. I am a sole proprietor and have no one working in any capes ity 0 1 am an employer providing workers'compensation for my employees working on this job. ComDaMt name: Address City: Phone ' Irlstaramcs Co. Poticv! Commw name: Address CUE Phone Insurance Co. POYatt S Failure to secure coverage as requirod under Sec dm 25A or MOL 152 can lead to tha Nnpmbm d aimi, pe wMft of.a Ana up to$1,5W.W andfor one years'imprhom�ent.as rsa0.as_ch�N panakies In]hs lmn d�STAP WDRK ORCtER ands}ioa d.p1A0.t> dg apalost.ma 1 understand that a copy of this statanrsrct may be forwarded to the Office of Invudgabons of the DIA far coverage veraFlcoon. I do hereby certly under&Q pains end of pedury that ft Information provfded above Ia true and calect. Signature Date_ CSC Print name_ 44 c Pkonee -79 2 OfRdal use only do not write In this area to be completed by city or town Ader Chy or Town Pemwtireraing 13 Building Dept []Check M Immediate response In required ❑ L kerm ft Board ❑ Selectmen's Office Contact person: Phone# ❑ Health Department ❑ Other 1 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) , Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Page No. of Pages � iT7 CLASSIC % CONSTRUCTION CO. PROPOSAL SUBMITTED TO PHONE !�(%[ DATE STREET' JOB NAME CITY,STATE and ZIP CODE JOB LOCATION ILI, 1 / jm- ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: -r z),1/--22 Z- ,w 0/\,' ,civ �4 �iyDJ�' HIP propU f hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: ). Payment to be made as follows: dollars($ All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra. Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. ,�CCP�ltttnre Of proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature ["�/ 1-000-226-6380 1 1 ✓tie �arvnzauoealbi o�✓�aaaac�zuaella BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR t;y Number CS, 050193 Birthdate: 01/04/1960 Expires:01/04/2005 . Tr.no: 5981 Restricted: IG--. MICHAEL R ROBID(= r, 180 SALEM ST ANDOVER, MA 01810 Administrator i ��e Vanvnwiuueal� o�✓�aaacLivael!a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 107835 Expiration=..6/7/2006 Type: D6A CLASSIC CONSTRUCTION-Co-,'' Michael Robidou)=\ 27A BAYNS HILL RD BOXFORD,MA 01921 �- Administrator NORTH T Andown ooverf No. sol 0 L4 L C% over, Mass., d2 0 RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 54 4*101 ................ 4 400 ......... BUILDING INSPECTOR THIS CERTIFIES THAT..................................... . 45 *............................................................................. ...... Foundation has permission to etwet..k.!PJW.1r4L...... buildings on .....6..... ..........*Q40............. Rough to be occupied as.............../.....&W 1AP D Ivaco 406 J)dpdp I& 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 B Ins action, 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 CONSTRUCTI S ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit. Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on' the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDEl Smoke Det. r GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips'tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations '/"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. . Check headroom clearances-stairways, under beams Attic Access. (min.22x30 w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. 'A of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber-Finish Smooth parging, clean joints, 8"solid @ combust: Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure. V40RTH Town of 4 over ,'� zo LA o over, Ma 3 z- I� COCMICMEWICK 7�ADRATED P'PC BOARD OF HEALTH PERMIT T Food/ it hen Septic ystem A BLDING INSPECTOR THIS CERTIFIES THAT4w a vi ................. .......................... FoundnL t r IQ has permission to mer.. .gpf�d.... ...... buildings on .....r...... ..4.......... �:....... ............................ .... Rough to be occupied as wjf" Dd0K� 4 Ad 0� chi ey .............../......................................................................................... ffrtq .. ....... � provided that the person accepting this permit shall in everyrespect conform to the�terms of the application o file in Final' this office, and to the provisions of the Codes and By-Laws relating o the Ins action, Alte tion and Const uction of Buildings in the Town of North Andover. 8 PLUMBING INSPECTOR u VIOLATION of the Zoning or Building Regulations Voids this Permit. 7 gh Final PERMIT EXPIRES IN 6 MON - S ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough ............................� ...... ... Service LD�G}\I�I�TS C)_ R Final Occupancy Permit Required to Occupy Bui GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner �) Street No. SEE REVERSE SIDE Smoke Det. GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip- Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations '/"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min. 22x30 w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. '/of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber-Finish Smooth parging,clean joints, 8"solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure.