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HomeMy WebLinkAboutBuilding Permit #306-2011 - 60 WINDSOR LANE 10/14/2010 BUILDING PERMIT pORT{i OF�tLe0 ,bq•�, TOWN OF NORTH ANDOVER Fr ,_•, ., o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �RATlD 4`�* �� l �SSACH►1s Date Issued: y IMPORTANT:Applicant must complete all items on this page LOCATION; Pnnt• a PROPERTY OWNER._'r C1 oc k 1 MAP2210 -PARCEL 07/' :ZONING DISTRICTlHistoric District yes no Machine Shop Village yes -no TYPE OF IMPROVEMENT P USE esidential Non- Residential New Building One family Addition Two or more family Industrial -AT&036`5No. of units: Commercial pai replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District• Water/Sewer DESCRIPTION'Fe WORK TO BE PREFORMED: 'Fe 126c P Qo Lu iNJoWT �2 :21 Identification Please Type or Print Clearly) ' OWNER: Name: Phony.. e Address: (---)U l N U Qom( .G 1�G Jed C) A&, d. , CONTRACTOR- Name jam:.tiL5 CQ 3 Jr SIN Phone: Address ,, .N. ! .(YC Supervisor s Cgnstruction,License: !_ Exp. Date: Hoipe,tIm.provenerrtFLicense .__- _ ._ Exp Date: ARCHITECT/ENGINEER Phone: w Address:--' v _ _ - Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ `�bR16 FEE: $ � Check No.: /S-20 Receipt-No.: 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty and Signature of Agent/Owne = Signature&766nttaetoi Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on.Site THE FOLLOWING SECTIONS.FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U 'FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT a ' COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition-No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con necti on/sin nature& Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARt* N -' -- - _ T Temp Durnpster ontsite'6 yes Located Osgood Street 6bated'at 124k'�Mai"t�eet no Y. Frye Department signature/date COMMENTS I Dimension f 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.$1oo-s1000 fine NOTES and DATA— (For department use I I ❑ Notified for pickup - Date I Doc.Building Permit Revised 2010 r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 Location 90 zall/l No. �0 -�cii Date HORTh TOWN OF NORTH ANDOVER 3?O�ft`•O °,hO O to w A Certificate of Occupancy $ �'�s•Ar Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0 7 23554 ' ,Building Inspector NORTFI o 0 over No. 3 _ ,0 r/ x - �` -o dower, Mass., ,a iL i 6?O -- L A K E 1. CoCHICMEWICK V ADRATED P'P � S ` BOARD OF HEALTH Food/Kitchen PERM IT T D Septic System r BUILDING INSPECTOR THIS CERTIFIES THAT...........r ......... as./o. ......................................................................................... . Foundation has permission to erect........................................ buildings on ..a....0/,.v..... ... ..azw............................. Rough C/ G F.s�'� ✓l �/' / .. Chimney . . ............. ..to be occupied as..............S10.. �M .................................�.......... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS TS Rough ..... ..e .,4.... 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. NORTH TO" of No. 3av _ o rl �`y o dover, Mass., T O LAKE COCHICHEWICK �Vt ATED v BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .......z '1..�0. ..1.......................................................................................... Foundation has permission to erect........................................ buildings on�.J .b/.........�/"� -fid:'A.../.4�ZyV6............................. Rough to be occupied as..............e ... e�(.�Xdlrt.�: .. .r ...%��c�lllt.G .. ......./..��f/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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS TS 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. MOYNIHAN-NORTH READING LUMBER, INC. "QUALITY BACKED BYA DESIRE TO PLEASE" 164 Chestnut Street FEIN:04-2261995 North Reading, MA 01861 Contractor Reg No.: 978-864-3310/781-944-8500 Exp. Date:_//— Salesperson(s): HOMEOWNER INFORMATION Name Daytime Phone ., �i r Street Address(Not P.O.Box) Evening Phone 1U �� 5 f?I r City/Town State Zip Code Mailing Address(if different from Street Address) WORK TO BE PERFORMED AND MATERIALS TO BE USED Moynihan-North Reading Lumber, Inc.agrees to perforin the work set forth in Exhibit A for Homeowner and to use such materials in connection therewith as set forth also in Exhibit A, attached hereto and made a part hereof. The following schedule shall be adhered to unless circumstances arise beyond Moynihan-North Rea ing Lumber, Inc.'s control:Work scheduled to begin: �/rL4c9v Expected date of completions /�V May be based upon arrival of special order material TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE Moynihan- North Reading Lumber, Inc. agrees to perfotm the work, and furnish the material and labor set forth in Exhibit A for the Total Contract Price of: $ _r' � " �."-(which amount includes all finance charges). Payments shall be made by Homeowner accing to the following payment schedule: $ /(Vlpitial deposit upon signing this Contract(the initial deposit shall not exceed the greater of one-third(1/3)of the Total Contract Price as set forth above; OR the Total Cost of Special/Custom Orders as set forth below). $ ?" �,:6y_/ / or upon completion of delivery of materials $ �by_//or upon completion of install $ upon completion of the Contract In order to meet the completion schedule set forth above,the following materials/equipment must be special ordered before the Contract work begins,for a Total Cost of Special/Custom Orders of$ $ to be paid for buildings permit `:', 1�_ L.{".' $ to be paid for — $ ''to be paid for !' rZzr., J" .r,l !77 Lf. t- DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES .-- -_; r.� Moynihan-North Reading Lumber,Inc. ri Homeowner'signature Date Contractor Dale Fulte[, Date By: instaned Sales Coordinator Homeowner's Name(Printed) Name(Printed)and Title of Signatory You may cancel this Contract if it has been signed by a party thereto at a place other than an address of Contractor,which may be its main office or branch thereof, provided you notify Contractor in writing at its main office or branch by ordinary mail posted, by telegram sent or by delivery, no later than midnight of the third business day following the signing of this Contract. See attached notice of cancellation for an explanation of this right. See reverse side for additional Homeowner Terms and Conditions 1057-NR 4/09 White-Office Yellow-Sales/Service Pink-Customer Page 1 of 5 -HOMEOWNER TERMS AND CONDITIONS The following terms and conditions are an integral part of this Contract between Moynihan-North Reading Lumber,Inc.("Contractor)and Homeowner. 1• All payments are due upon presentation of billing,and a late charge of one and one-half percent(11/2%)per month will be applied to past due charges. Homeowner shall pay Contractor court costs,attorneys'and paralegals'fees,and any other expenses incurred in the collection of past due accounts. 2. If Homeowner is borrowing money from a construction lender to perform the work,Homeowner represents that the construction loan fund is sufficient to pay Contractor and any other contractors performing work on Homeowner's property. Homeowner irrevocably authorizes Contractor to communicate directly with the construction lender regarding payments and loan balances,and authorizes the construction lender to make payments directly to Contractor. 3. Homeowner shall be in default if it breaches any provision of this Contract;if any warranty or statement to Contractor in connection with this Contract or Contractor's extension of credit to Homeowner is false or misleading when made;if any statement to a lending institution in connection with financing for this Contract is false or misleading when made;or if Homeowner becomes insolvent,makes and assignment for the benefit of its creditors,or files or has filed a petition for bankruptcy. 4. If the Total Contract Price includes allowances,and the cost of performing the work covered by an allowance is either greater or less than the allowance,then the Total Contract Price shall be increased or decreased accordingly without the need for a signed Change Order. Unless otherwise requested by Homeowner,Contractor shall use its judgment in accomplishing work covered by an allowance. 5. If Contractor agrees to do any installation work,Homeowner will procure at its expense and before the commencement of work hereunder"all risk"insurance with construction,theft,vandalism,and mischief endorsements attached,the insurance to be in a sum at least equal to the Total Contract Price. The insurance will name Contractor and any subcontractors as additional insured. If the project is destroyed or damaged by accident,disaster or calamity such as fire,flood or storms,Homeowner shall pay for work done by Contractor in rebuilding of restoring the project as extra work. 6• If Homeowner defaults under any of its obligations under this Contract,Contractor may: a• Stop work until any payments are received or defaults are otherwise cured. b• Terminate work upon seven(7)days written notice and recover as damages,at its option,either the reasonable value of the work performed through termination,or the balance of the Total Contract Price plus any other damages including reasonable attorneys'and paralegals'fees Contractor suffers as a result of the default. 7. Contractor shall be excused for delay in completion of the Contract caused by contingencies out of its control,including acts or delays of Homeowner or other contractors,acts of God,labor trouble,acts of public agencies or inspectors or public utilities,extra work,breaches of this Contract by Homeowner,problems obtaining materials from suppliers,or other contingencies unforeseen by Contractor. Under no circumstances will Contractor be liable for monetary damages caused by delays as set forth above. 8. If Contractor encounters unforeseen conditions that were not reasonably anticipated by Contractor,Contractor shall call the conditions to the attention of Homeowner and the Total Contract Price and schedule will be adjusted by the extra work necessitated thereby. No installation, plumbing,electrical,flooring,decorating or other construction work is to be provided unless specifically set forth herein. In the event Contractor is to perform the installation,it is understood that the price agreed upon herein does not include possible expenses incurred in addressing hidden or unknown contingencies found at the jobsite. In the event such contingencies arise and Contractor is required to furnish labor or materials or otherwise perform work not provided for or contemplated by Contractor,the actual cost of such additional unexpected work plus fifteen percent(15%)thereof will be paid by Homeowner. Contingencies include but are not limited to:inability to reuse existing water,vent and water pipes,air shafts,ducts,grilles,louvers and registers;the relocation of concealed pipes,riser,wiring or conduits,the presence of which cannot be determined until the work has started;or imperfections,rotting or decay in the structure or parts thereof necessitating replacement. 9• Homeowner shall be responsible for the coordination of any work performed by itself or other contractors,and shall be responsible to have the work site ready for contractor to proceed. If installation is involved,with its work through the completion date.Any work performed by Homeowner or other contractors shall not hinder Contractor's schedule. Contractor does not warrant any work performed by Homeowner or other contractors not working for Contractor as its subcontractor. 10. Homeowner understands that some products described in this Contract may be specially designed and custom built,and as such Contractor will take immediate steps upon execution of this Contract to design,order and construct those items as set forth herein. Except as provided on page one of this Contract,this Contract is not subject to cancellation by Homeowner. 11. The delivery date,when given,shall be deemed approximate and performance is subject to delays caused by strikes,fires,weather conditions,acts of God or other reasons not under the control of Contractor,as well as the availability of the product at the time of delivery. Once the delivery date is determined,Homeowner agrees to accept delivery of the product(s)within one(1)week. 12. The risk of loss,damage or destruction,shall be upon Homeowner upon the delivery and receipt of the product. If Homeowner is not ready to accept the product,the delivery payment will by made as agreed upon and an extra storage fee of Fifty Dollars($50)per week will be charged. 13. Title to the items sold pursuant to this Contract shall not pass to Homeowner until the full price as set forth in this Contract is paid to Contractor. 14. Contractor agrees that it will perform this Contract in conformity with customary industry practices. Homeowner agrees that any claim for adjustment shall not be reason or cause for failure to make payment of the purchase price in full. 15. This Contract sets forth the entire understanding of the parties. Any and all prior contracts,agreements,warranties or representations made by either party are superseded by this Contract. NOTWITHSTANDING PARAGRAPH 4 NO CHANGES SHALL BE MADE TO THE WORK DESCRIBED OR TO THE CONTRACT PRICE UNLESS AND UNTIL HOMEOWNER AND CONTRACTOR SIGN A WRITTEN CHANGE 1057-NR 4/09 White-Office Yellow-Sales/Service Pink-Customer Page 2 of 5 1 Y' ORDER. No agent of Contractor,unless authorized in writing by Contractor,has any authority to waive or amend this Contract,or to make any new or substituted agreements,warranties and/or representations. 16. Copctor warrants that the work will be free from faulty materials,constructed according to the standards of the building code applicable to the omite rcatidh,constructed in a skillful manner and fit for habitation or other appropriate use. The warranty rights and remedies set forth in-tkgMassachusetts Uniform Commercial Code apply to the Contract. Contractor does not make any express warranties regarding the work,except for those which may be attached to this Contract as an exhibit. f //,(//. 17. REQUIRED PERMITS.The following building permits are required.It is the obligation of Contractor to secure such permits as Homeowner's agent,unless Homeowner wishes to procure such building permits:[List any and all necessary construction-related permits] NOTE:Homeowners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c.142A. 18. All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:Director,Home Improvement Contractor Registration,One Ashburton Place,Room 1301,Boston,MA 02108,617-727-8598. 19. Unless otherwise noted in this Contract,this Contract shall not imply that any lien or other security interest has been placed on the residence. 20. ACCELERATION OF PAYMENT.Homeowner's Financial Insecurity-A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where Homeowner deems him/herself to be financially insecure. Contractor's Financial Insecurity--In instances where a contractor deems itself to be financially insecure,contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require the signatures of both parties. ARE PLANS ATTACHED AS AN EXHIBIT: ESO (Circle Response) ARE EXPRESS WARRANTIES ATTACHED AS AN EXNIAITi�l NO (Circle Response) /0 /0 d&O DOES HOMEOWNER ELECT TO PURCHASE PRODUCTS ONLY FROM CONTRACTOR. DOES HOMEOWNER UNDERSTAND THAT CONTRACTOR IS NOT RESPONSIBLE FOR THE INSTALLATION QUALITY OF PRODUCTS WHEN NOT INSTALLED BY CONTRACTOR. DOES HOME W ER UNDERSTANDS THAT IMPROPER INSTALLATION MAY NEGATE PRODUCT WARRANTY. ZESJ NO (Circle Response) ARBITRATION Contractor and Homeowner hereby mutually agree in advance that in the event Contractor has a dispute concerning this Contract, Contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Cao- sumer Affairs and Business Regulations and the consumer shall be required to submit to such• ion a rc5 rid d��i M.G.L. . 142A. ' ��i f' �a Moynihan-North Reading Lumber, Inc. -I A) „eHomeowner's. Ignature Date Date _ Dale-Fuller. By. Instatted Sales Coordinator Homeowner's Name(Printed) Name(Printed) and Title of Signatory NOTICE:THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. 1057-NR 4/09 White-Office Yellow-Sales/Service Pink-Customer Page 3 of 5 HOME IMPROVEMENT CONTRACT �- EXHIBIT A r OTHER MATERIALS 1. MERCHANDISE ORDERED FROM FACTORY CANNOT BE RETURNED FOR CREDIT 2. NOT INCLUDED IN INSTALL-PAINTING, STANDING OR FILLING NAIL HOLES 3. MOYNIHAN LUMBER CONTRACTOR WILL REMOVE ALL WASTE MATERIALS FROM JOB SITE 4. ALL WORKMANSHIP GUARANTEED FOR 1 YEAR FROM DATE OF JOB COMPLETION PER MASSACHUSETTS LAW 5. IF WE ARE TO REHANG CURTAINS IT WILL BE DONE NO LATER THAN LAST SCHEDULED DAY AT SITE 6. ANY UNFORSEEN PROBLEMS OR EXTRA WORK WILL BE BROUGHT TO YOUR ATTENTION BEFORE WORK IS PERFORMED �L r /7S " v-,o r crn f r-7 s� - 1057-NR 4/09 White-Office Yellow-Sales/Service Pink-Customer Page 4 of 5 4 _ _ You may cancel this Contract if it has been signed by a party thereto at a place other than an address of Contractor, which may be its main office or branch thereof, provided you notify Contractor in writing at its main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the Contract. NOTICE OF CANCELLATION Date of Contract: / YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION,WITHIIN THREE (3) BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS FOLLOWING RECEIPT BY CONTRACTOR OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO CONTRACTOR AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD.fCONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF CONTRACTOR REGARDING THE RETURN SHIPMENT OF THE GOODS AT CONTRACTOR'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO CONTRACTOR AND CONTRACTOR DOES NOT PICK THEM UP WITHIN TWENTY (20) DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO CONTRACTOR, OR IF YOU AGREE TO RETURN THE GOODS TO CONTRACTOR AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM, TO MOYNIHAN-NORTH READING LUMBER, INC. AT 164 CHESTNTITSR-11b ET, NORTH READING, MASSACHUSETTS 01861, NO LATER THEN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Homeowner's Signature Date t Homeowner's Name (Printed) 1057-NR 4/09 White-Office Yellow-Sales/Service Pink-Customer Page 5 of 5 i The Commonwealth ofMassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Glen Sargent Address: 18 Chandler Circle City/State/Zip:andoye r, Ma. 01810 Phone#: 978-809-0352 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E3 I am a sole proprietor or partner- listed on the attached sheet.t �• E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box q I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Tewksbury Insurance Policy#or Self-ins.Lic.#: B P-110 0 015 Expiration Dater 5 Z 01 Z 2 011 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is tru and correct Signature: z — Date: Phone#: 978-809-0352 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ti 08:'17/2010 15:52 9788514848 SULLIVAN INS PAGE 01/81 DATE(MMIDDlYYYY) ACORD- CERTIFICATE OF LI1 131L ITY INSURANCE 8/17/2010 PRODUCER ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Tewr kvbuy Insurance ONLY AND CONFERS NO RIGHTS �JPON THE CERTIFICATE 1 885 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Tewksbury, MA 01876 ALTER THE COVERAGE AFFORDED HY THE POLICIES BELOW. i 979-851-9600 INSURERS AFFORDING COVERAGE NAIC# INSURED arge Co Remo e a ngI INSURER a, Vermont Mutual Group. I Glen Sargent INSURER B: P ymOut Ock Assurance 18 Chandler Circle INSURER C: Zurich Insurance ompany Andover, MA 01810.2805 I. INSURER D: INSURER E: I COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED. iJ THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ; ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT C I OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DEE �iIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDMON3 OF SUCH POLRLIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED( I PAID CLAIMS. (raft A00'L POLILTri > I CYFFEG 4aro K INS POLICY NUBMMDDY TPIRATI N E LIMITS " GENERAL I_IARILITY EACH OCCURItENCL -$ S00,000 3C COMMERCIAL GENganI LIABILITY rsR>=MISES Ea oceurence $ 50,000 CLAIMSMADE OCCUR MED EAP(A_I pneperoon) $ 5,000 A I BP-11000115 1! 05/01/10 05/01/11 PERSONAL&ADVINJURY $ 500,000 II ! 'GENERAL AGGREGATE $ 1,000,000 — j GEN'L AGGREGATE LtMrT APPLIES PERI PRODUCTS^COMP/OP AGG S 1,000,000 POLICY�1 JEI LOC AiJTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ " (_ ANY,-.UTO ? (Ea accident) + ,ALL OWNED AUTOS I BODILY4NJURY $ 50,000 SCHEDULED AUTOS ( I (Per Parton) B I HIRED AUTOS PRA100089959; III 07/14/10 07/1.4/11 -- 0DIILLYJNJURY $ 100,000 NON,OWNEDAUTOS " I — PROPERTY DAMAGE s 100,000 000 ' , (Pprsccidenll I I GgRA.GE LIABILITY �� I AUTO ONLY-EAACOIDENT !$ ANYAUTO I ! II OTHERTHAN BAACC $ i 7j j AUTOONLY: AGG S j i I EXCESS/UNISRELLA LIABILITY EACH OCCURRENCE $ �i i ;OCCUR � J GLAIMSiAAAE AOOREOATs' $ I �i DEDUCTIBLE •.S j —�RETENTIQN WORKERSCOMPENSATION AND XTORYT U- ER T1-! EMPLOYERS'LIABILITY 6ZZU]3-0605X1 4- 06/09/10 06/09/11 E.L.EACH ACCIDENT $ 100,000 .�Nr rnorn"tl'Or'iPAkTNERIEXECUTIVE C I Orr ICeR'uEM9ER EXGLtICgU? 10 j E.L.DISEASE-EA EMPLOYEf $ 100,000 - f Y9G,CIeiiC;l>1V 4I?(Yb( I' ;PecIALPRCVL51oNsnerow I IE.L.DISEASE-POLICY LIMIT ,$ 506,000 OTHER j D`=SCP.;PTION OF OPERATION$(LOCATIONS l VEHICLES/EXCLU3IONSADOED E IrNDORSEMENTI SPECIAL PROVISIONS - Glen Sargent is not covered under thisl17orker's Comp policy, { I I! I 1 I CERTIFICATE HOLDER ' -CANCELLATION Moynihan Lumber SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION I" 164 Chestut Street DATE THEREOF'THE ISSUING INSURER WILL ENDEAVOR TO MAO— DAYS WRITTEN j North Reading,, MA 01864 I I NO�O� E TO THE CERTIFICATE HOLDER NAMED 70 THE LEFT.OUT FAILURE TO DO 9U SHALL! 4 I NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR ENTATIVES, I I EJTH ] REPRESENTATIVE L 978-664-9078 I ACORC)2612001!08) QACORD CORPORATION 1988 i r' )� �'ta.�suchu.+etfs- Department of Pultlic Safety I yam) Board of 13tiildin-, �--- l Construction Superv'isior � � License License: CS 70913 i Restricted to: 00 GLEN SARGENT 1B CHANDLER CIRCLE i ANDOVER, MA 01810 .. II — — Expiration: 5/4/20{1 - <unuul.�'�iuucr Tr-#: 14814 I 1 i 1 , '1 HIC Registration Complaints Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation Home> Consumer> Housing Information > Home Improvement Contractor Program > ... ......................................................................._.I--..................._......................................................................................................................_.............. HIC Registration Complaints Registration# 131640 Registrant GLEN SARGENT Name GLEN SARGENT Address 18 CHANDLER CIR. City, State, Zip ANDOVER,MA,01810 Expiration Date 8/17/2012 Status Current No complaints found for this registrant. You can also view arbitration and Guaranty Fund.history. Back To Search ®2010 Commonwealth of Massachusetts r http://db.state.ma.us/homeimprovement/licdetails.asp?txtSearchLN=31795 9/21/2010 ;` OW ArX'Agh MA At AFT MOYNIHAN LUMBER Co. Moynihan Lumber of Beverly Inc 82 River Street Moynihan North Reading Lumber Inc. Moynihan Lumber P.O.Box 509 164 Chestnut Strest �f Plarstow LLC. Beverly, MA 01915-0509 P.O.Box 128 12 Old Road (978)827-0032 FAX:(978) 927-8668 North Reading,MA 01864-0128 Ro 80x 1160 (978)664-3310 (781)944-8500 Plaistow, NH 03865-1160 El FAX: (978)664- 72 (603;382-1535 FAX_(603)382-1935 D Subcontractor -Workers, Couapeasation Wa-%,er contractor; have been, asked b ; hereby a�0-�rledge that I, as an independent y Moynihan Lumber Co- to provide it with a Certificate Of 'Workers' Compensation Insurance coverage for myself. Based on the Provided by the workers' Compensation Insurance coverage exemption a sole proprietor without em la TPA erage for myself because I am. related organizations and the_Arcadia IrLsuran e and Id 1v10 Ynihan Lumber Co. and it's Association, .Ir1c. total or Self Insured Lumber Business _harmless for any injuries or cost of injuries iricurxed b - because I have Voluntarily j y mvself y chosen to exclude myself from coverage by engag�g eemption provided under theTorkers' Corripensation Laws. I have taken-this option of my own free w , WITNF-SS SIGNATL7EE DATE: 6— White: —White: Momih2n Xell0a,-: .1rula Red Sales Pink: Contract Ii05 0r. /- 54 Date..... ... 2. .:../.. i NORTF, TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACHUS This certifies that d T has permission to perform ....... ......................................... wiring in the building of................. ..�f?�/.,C-,���fj,............................. at.. �.! r �1r/�.......C 2./.....PrL4ECTRICAL .North Andov r,Mass. Fee..��0.���'". Lic.No.7s` 3,r�....... INSPCTOR + Check # 4"75-Z- Commonwealth of Massachusetts Official Use only Permit No. _�, 'Z� Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07]IVleave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ZV// City or Town of: NORTH ANDOVER To the Insp ctor of Wires: By this application the undersigned gives notice of his or heZitention top rform the electrical work described below. Location (Street&Number) loll t7 C)rZ ki Owner or Tenant -' Telephone No. Owner's Address t-�!&On�e I Is this permit in conjunction with a builping permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 114c; Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �- l AKp Completion of the ollowing table may be waived by the Inspector o Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No,of Hot Tubs Generators KVA Above In- o.o Emergency Lighting rn No.of Luminaires Swimming Pool rnd. ❑ d. ❑ Battery Units No.of Receptacle Outlets /© No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: –� Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of E ectr�al Work: (When required by municipal policy.) Work to Start: IVZ, Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C ERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in Prce,and has exhibited proof of same to the pe rt issuin office. CHECK ONE: INSURANCE BOND [I OTHER F1 (Specify:) O k lnld�om I cern ,under the ai nd enal 'es n e 'u tlra he ' tnation on thiselc ti truelete. fy P fP rJ'� .t fj PPP FIRM NAME: (J �j i lL � LIC.NO.: Licensee: 0, S' nature LIC.NO.: / (If applicable, enter "e t"i e icens number line) Bus.Tel.No.: Address: 4 Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work req ' es bepartment of Public' Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's Owner/Agent Signature Telephone No. PERMIT FEE. $ i 9064 Date.$-ZZ -\1. . NORTq °„•.',4, TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SSACMUS� This certifies that f .' ). . . ./-� ?. . !. . . .. . . . . . . . . has permission to perform plumbing in the buildings of . .Z:,!b. �.0.e, k.:. . . . . . . . . . . . . . . . at. f v. . ' ticl.furc . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee?47.'.. .Lic. No.. . . . .g. v. 3. �. . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # /0 4 -1- I I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING c+ City/Town.-- Z V /��u ,.c MA. Dater �,. C _ Permit# Building Location: (,� v Lv t'.v �( {,vt/ Owners Name:_ } Q f�7 C , Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional 0 Residential[g- New:❑ Alteration:❑ Renovation: ❑ Replacement:[,] Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED H z SYSTEMS z z W Y U WULU Z to V1 Q W C7 14 Q' z Q m oNc W F- w z FQ- Ln Cn z Q y a Q z p o: z in U ii X Q N F- Q LL. pC W L] a W N JLn 0 z LL x + ¢ Q m m p p LL 2 Y z Q �- Ln F' 3 3 �° En Ln FQ- 3 3 3 o a 3 SUB BSMT. BASEMENT 1sT FLOOR ' f 2ND FLOOR 3"FLOOR 4T"FLOOR ST"FLOOR 6T"FLOOR ^ 7T"FLOOR 8T"FLOOR `�– Installing CvlzipGny Name: �l S�f f�� ®� `� Check One on!y Ccrtificate Address y� r� rporation r ❑Partnership Business Tel: 7� jy QT-2"0 _ Fax: El FirmlCompany Name of Licensed Plumber: S'",,Q.c1 � � ,t.�-L INSURANCE COVERAGE: 1 have a current liab___ i __lite insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes [tjNoE1 ff you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy.�' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 14 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i By— Type of License: _ Title L7 Plumber bignature of License lumber �ity/Town ErMaster APPROVED(OFFICE USE ONLY) ❑Journeyman License Number: �j Date. TOWN OF NORTH ANDOVER I- 'A PERMIT FOR PLUMBING �,SSACNUS� . .. , c� �1ii��� This certifies that . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform t,:.ell.l� {` -'�. . .'. . . . . . . plumbing i/n/ the buildings of . .f.-'. . . . . . . . . . . . . . . . . . . . . . . at . .eK/ . ".u. . . . . --'�-. . . . . .. North ndover, Mass. n Fee-AM�. .Lic. No.. . . � _/K/ - .�f.-<j '11�- . . . � PLUMBING INSPECTOR / Check * 3z/ �' 647 1 MASSACHUSETTS UNIFORM APPLICA ON FOR-PERMIT TO DO PLUMBI 06 {Print or T pe) NG 41 — ass. Date 2U /� Permit # 7 Building Location /91 Owner' me r Y Type o Occupancy New 0 Renovation 0 Replac men Plans Submitted: Yes 0 No 0 F XTURES B.P. # SEWER SEPTIC # Fz {cn. Z W to z Z Ln Ln z LnELI Q w VO ~ Ln p cn w LU U �' m c=n ~ v vi 0 z a z a a . 0 � ,� LzLI �O w Q .� ¢ � z a IW- U ¢ = a Z = Y a' p Imo- ¢ t2 0 w ' L W m o o i ¢ o o ¢ � a oo ¢ .o SUB-BSMT Ln LL" D ¢ m o p BASEMENT 1ST.FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR ' 8TH FL00 Installing Company Name Check one: Certificate 4ddress 0 Corporation 3usiness Telephone Z ❑ Partnership lame of Licensed Plumber or Gas Fitter � Firm/Co. INSURANCE COVERAGE: have a current ii bllity insurance policy or Its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes No . 0 Ifyouhave checked I ves, pleas.ee indicate the type of coverage by checking the appropriate box. ' A liability insurance policy'ff Other type of Indemnity ❑ Band ❑ OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 0 Agent 0 ereby certify that all,of the details and information I have submitted (or entered)In above•applicatlon are true and accurate to the best of knowledge and that all plumbing work and Installations perforZLJ r the permit Issued for thi a plication will be in compliance with pertinent provisions of the Massachusetts State Plumbing Codee 5Gera l Law . By Title of Licensed Plum er Cjyrfown APPROVED(OFFICE USE ONLY) Type of License CAlIfster 0journeyma:n 4. License Number_ �� �j • BELOW Poll OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO* APPLICATION FOR PERMIT TO 00 FLUM91NO NAME i TYPE OF @UILDIIIG LOCATION OF BUILDING PLUMBER PERMIT GRANTED ` DATE PLUMING INSPECTOR Location l%'(,2 o f,4 `--- No. C;?6,611 Date 6 - 7- 00 O:�O�TM TOWN OF NORTH ANDOVER • �ao a'�h.O Certificate of Occupancy $ _ 'Ss�cMusEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check # a { J 7 •� Building Inspector TOWN OF NORTH ANDOVER Q BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. ^ DATE ISSUED. g O X SIGNATURE: /vU� (�✓ ic Building Commissioner/I i for of Buildings Date Z SECTION 1-SITE INFORMATION O LI Property Address: / 1.2 Assessors Map and Parcel Number: t1,0 A/9 / 7 / Map Number{p 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 0 Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record <�f sial, ' Name(Print) Address for Service: X53-$ sa tgna a Telephone Q 2.2 Owner of Record: Name Print Address for Service: O z M nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ w Licensed Construction Supervisor: License Number M" Address Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name M Registration Number r Address r ^z Expiration Date Signature Telephone Y' 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 Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / I / y Jo x ao &V C-QcrlPn'fr„7 sf14r-6 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be QFFICIAL USE;ONLY Completed by permit applicant 1. Building (a) Building Permit Fee �r 1 C7 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, rt/ Z—�- w64-'' Lx}L/ ,as Owner/ of subject property Hereby authorize /"t Y sez-F- to act on My bel i m tive to work authorized by this building pennit application. ff /� I Al laG/Do t re of O r Date SECTION 7b WNER/AUTHORIZED AGENT DECLARATION 1, 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 t and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR MMERS iST2ND 3RD SPAN DDAENSIONS OF SILLS DINIENSIONS OF POST'S DIMENSIONS 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 hORTF# Town of North Andover Building Department ANN& n 27 Charles Street North Andover, MA. 01845 °•,�°�''`{g D. Robert Nicetta ,SSwn+use` Building Commissioner (978) 688-9545 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print�/ DATE HAY cQG J08 LOCATION 60 W rND�r� L SC:= 1017( 7� Number Street Address Map/lot „HOMEOWNER Z5,-,)Azt> &�s3'-1a11�02 �Go3�IW —6t, S Name Home Phone Work Phone PRESENT MAILING ADDRESS --SAM LG City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATUR APPROVAL OF BUILDING OFFICIAL FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. .......Nunn............OEM.................■.....now memo MEN.......SEE...... APPLICANT 5�WtyQ-�, PHONE ASSESSORS MAP NUMBER /06 LOT NUMBER SUBDIVISION / LOT NUMBER STREET I^ tx5DP— �^'�= STREET NUMBER OFFICIAL USE ONLY f 9 S RECONINIENDATIONS OF TOWN AGENTS �..... .._.....r..,.,0e.aa...........■.......................moi....■ ........... � DATE APPROVED �� Q ✓✓✓ CONSERVATION ADMINISTRATOR / DATE REJECTED CONUVIENTS I�J L� V° C 1`\�^ S C1 [ DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED Q (/SEPTT41NSCTOR-HEALTH DATE REJECTED ,L, COMMENTSAL h-� V�Y 1c134-, 5 O u L"('I- c� (fill//[ _ J ��? e 1)-2 ` PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE 'I J ),4r .. Job No. -V, ao 5 • iu\ r 15 / O.cvo OF Pte- r+ o J. N �.9vG.a.✓r r7' ��-'.T. C ta. ?._ N gyp This pian was not prepare d from an instrument. MORTGAGE LOAN 1NSPECTI©.N survey. Offsets and distar.,.os shOvrn should not LOCATION:_� �✓.�vso,� `-�,� . be used to establish propert,• lines. This plan is intended for rnnrt.- ge-purposes , only. SCALE: DATE. certify that the structure ___... _sn��..'vn cn this ''EGIStRY: Plan in conformanc vith ',�e zoning � E r T�-i•. [= R�I-EREI�CE:• setbacks in effect at the time f c�r .3t1.tr:lio 1. PLA ,! REFER ENCE- I certify that the parcel shown is located within a flood hazard arc- 'as :.'cp'icted on FEMA Flood Insurance Rate t�lap� `or COn�lrREY y- DONAHUE. IN.C. ccis S Suzvcyc+ri Community No: C3K��?E _„ :98 C 7nbTid9c ROAD,Woburn, hSA 01801 NORTH Town of 74Andover No. LA o dover, Mass., COCHICHEWICK ADRATED O5 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 4FO&A Pod `• BUILDING INSPECTOR THIS CERTIFIES THAT................................................ ........ Foundation has permission to erect......10 ......... buildings on .. ..�........10104%QJC..........Z.A.40�& ............. Rough . broN w.►rChimneto be occupied as......8.................�............�. ......R......................................�.......................................... 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T S Rough . .......... ................. .............................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.