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Building Permit #446 - 66 HERRICK ROAD 12/27/2007
pORT)l BUILDING PERMIT o�<t�eO �bq"o e U TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Rq co[rn[ww Permit NO: Date Received ��SSgcH PY", C.) Date Issued: IMPORTANT:Applicant must complete all items on this page a is .'bbbAT10"NI a , AZ, ' vS '�#+r _ syq�r r.♦ •e'" a� s f a.�. ♦.,/� d „r x r °P '�?ll '� b1l���R 5 '1f "P.ARZEL `' Z fNG I1STR :T� k AMC D+street k yes no 8`. "x1 n u.. TYPE OFIMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building &.Ohe family ❑ Addition ❑ Two or more family El Industrial C416ration No. of units : 0 Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other © SetiCell� Fl�dplsitr~� 5Itietlarlds lfatersheda+qtr+c yza Dater/Se1er b. a DESCRIPTION OF WORK TO BE PREFORMED: :r ✓17�sf�� [3�a�iioo on S/Ce coer P9 w 0 L 11 Identification Please Type or Print Clearly) OWNER: Name: T;�a a /�e9a114.1 M AC/V�i'n, Phone�'l'7? Address: C9 6 H6lL R 1 c `e r CflNTRIGT3R Nrne� g ip 1ian � n x 9 Y�SY-�s4'pr W�.ery+BUYs., tyUCt���►`r £L��- �'S %or5DGpJS r domeIm �-ovprn-a vhicei /, Exp late ,+ y 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. d0 �- O Total Project Cost: $ ?,�[� FEE: $ S Check No.: 7r Z/9 Receipt No.: C� NOTE: Persons contracting with unregistered contractors do not have access to heSla4r ,4y1fund S gnatureMof Agent/flwner Signature o 'contr_c. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales 11 Food Packaging/Sales El(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING &.-DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS -DATE REJECTED + DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: variance, Petition No: L Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer,Connection/Signature & Date Driveway Permit Located at 384 Osgood Street F�RpmsiAeptrapsteran I 1_ocatecl at 124 J1YfanStreet a f'^ N 13 l I ``=F']Ilre �epartrnent s>Igrature/date. , x ` `� i N it i OM,ME'NTS' 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.$10041000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date ......................................................................................................._..........................................................................._..................................._....._........_................_... Doc.Building Permit Revised 2007 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 i ❑ 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) j ❑ 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 7 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 i Location /lx�t4 No. Date iaRZ _�' NORT" TOWN OF NORTH ANDOVER F • C� D >41 ; : Certificate of Occupancy $ ��s"'•• Eta Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20879 Building Inspector IAORTH '9 TO" of :_tAndover No. �,f LA O '� dover, Mass., A- COCHIC MEWICK 7� ORATED F"f SCC S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • A � ` AQ ' **Z BUILDING .INSPECTOR THIS CERTIFIES THAT .a......................................................... ""' Foundation 4 has permission to erect........................................ buildings on (& : � Rough ........... to be occupied as .......*.......J,Z.��..4.I..4.....4./... .. .. chimney provided that the person accepting this permit shall in every respect conform to the terms of the applic n 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 5S PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTR CTI S Rough .............................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occi cpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the P Premises — Do Not _Remove Final- - - -No Lathing or T Dry Wall 1 o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. -a KEEN CONSTRUCTION CO. ss Ad 21 HEWITT AVENUE PROPOSAL 44ko NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978)682-3231 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with Submitted --' J ) - / r? 1 , the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton .................._ _L_.i_........ f f J ` / �~ ; ,!`_..C- .._..___...__.................................... Place, Room 1301, Boston, MA 02108 (617) 727-8598. J t �l f Owners who secure their own construction related ---...._...._....-_.._......._...._—..._l_Z........_....................._C.............-......................................._�'f�s_f. ,_.. _ permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. F.I.D.NO. y MA. H.I.C. 108383 r C/S = Customer Supplied S + I = Supply + Install j We hereby submit specifications and estimates for workto be performed and materials to be used: s �[ �Ct � U`' rCI tea �;r=11� r." �/y 0� / r [ /� _r / �J .__....___ ___ __._._._._. E ...... . .......... .1_._____.__-__ _._ __... . .__._..___.` .7....... ............... �7....r --`l(/r I__--- �— ...f { 7 �' r'</� ... ..... ................... .____ ...._ _ ._ _._ _._._ .... .... . _..__.......... i _.._._...............................__---....__ _ _._...___ _.._..._.__...__..._....._......__._...._...-...�._ _, _. ................................ ._......_ -- ___..__..._.— .. .. ................................ --------------...._.. _ --___.___........... I _... __..__....____.._.................................... _._..............................-_....__ _ _ —_ .................................. _ _ __..........._._.......... _.._..__..___._.... -------_._._ .._._ _—__________ __._ __ _...._.. > Construction related permits: .....�............................................................................................................................................................................................................................................................_..,........,.............. ....................................................._....................................................................,...................,.,.......,,.................................................1.1..1.1............. WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contractor,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications, for the sum of c> J jr//u j7 y/�'/•f � t1�� tZ� t ��� dollars($ Payment to be made as follows: ) % ($ ) upon signing Contract; KENNETH B. KEEN Name of Contractor/Designated Registrant ($ ) upon completion of 21 HEWITT AVE. Street Address % ($ ) upon completion of ; -N. ANDOVER, MA 01845 Ely/Stale % ($ shall be made forthwith upon (978) 691-5201 (978) 682-3231 completion of work under this contract. Phone r Fax Notice: No agreement for home improvement contracting work shall require a >down payment(advance deposit) of more than one-third of the total contract price Name nl Salesman, or the total amount of all deposits or payments which the contractor must make, in 1 / / '. i advance, to order and/or otherwise obtain delivery of special order materials and Z AuthonkEd ignamre! i l equipment,whichever amount is greater. ✓ Note: This proposal may be withdrawn by us if not accepted within days. Acceptance Of Proposal -I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made e as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. - r Signature Date Signature Date IMPORTANT INFORMATION ON BACK ► Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR t RegistrAtio ; 108383 E�s� ttttto]l- 3f18/2008 i TYPeDAA i KEEN CONSTRON�Q Kenneth Keen 21 Hewitt Ave No.Andover,MA 01845`' '' Deputy Administrator j i ' 1i ��r�1�O:ylT//YGO'YIC(C ,y � BOARD OF BUILDIN REGULATIONS f i �nsq CONSTRUCTION SUPEF�VIS�R' b NtSmberS 058245 a s irthdate X3124/1943 {.S 1' xpd3�2d1b08 Tr no:. 13436 t,�r,'�,+.,,� r N ANfs?O "4 CQmri stoner' VU/49/LVV1 LL.JO fM 1VL OKL GGGV alnJVa\ANVu wj vV& PRODUCER 9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Gilbert Insurance Agency Inc HOLDER_ THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 137 Main St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Reading,MA 01867-3922 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Kenneth Keen&Robert Keen 21 Hewitt Ave North Andover, MA 01845-0000 IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,IVOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER .oOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBCD HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY P+CLAIMS, LTR TYPE OFINSURANCE POLK11muMB POLICY EFFECTNEDATE POUCYEXPIRATION DA ATMPE TDN EMPLOYERSILNBLRY LIMITS PROPRETORI M TTNERNEXECUTME FFICERS ARE: NCL 0 EXCL O 1 6360688 1 8/03/2007 1 8/03/2008 ATUTORYLIMRS OTHER Mepe MNlae I o MA OPaANms Oey. ACCIDENT 7611001010) ISEASE POLICY LINK IS E•EACH EMPLOYEE DESCRIPTION OF OPERATIONIUV C GAL ITEMS ROBERT KEEN IS COVERED BY THE WORKERS COMPENSATION POLICY AND KENNETH B KEEN IS NOT COVERED By THE WORKERS COMPENSATION POLICY. CERTIFICATE HOLDER ANCELLA11ON JOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HECANCELLED BEFORETHE EXPIRATION DATE THEREOF,THE ISSUWG COMPANY WILL ENDEAVOR TO hub 1Q ••:1600 OSGOOD ST DAYS WRRTEN NOMA TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT `NORTH ANDOVER,MA 01845 FAILURE TO MAL SUCH NOTICE SHALL r►POSE NO OBLIGATION OR L"ILITY OF ANY KIND UPON THE COMPANY,IIS AGENTS OR REPREGEWATMES. AUTHORIZED REPRESENTATIVE i j var a.vr rvv, civ.sr rna► ,va via. a.rry vaaruua.a aa...va�n,�vu W-j ,�D= CERTIFICATE OF LIABILITY INSURANCE 09,13/200 PRODUCER (781)942-2225 FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 137 Main Street ALTER THE COVERAGE AFFORDED BY THE POLI IES BELOW. Reading, MA 01867-3922 INSURERS AFFORDING COVERAGE NAIC# iNSUREo Kennet 0. een Rou'I:rt Keen INSURER A; NORFOLK & DEDHAM INSURANCE 23965 DBA: Keen Construction Company INSURER B: 21 Hewitt Ave. INSURER C: North Andover, MA 018.145 INSURERD: INSURER E OMERAGES THE POLICIES OF INSURANCE LISTED 3ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTW ITHSTANDI(W ANY REQUIREMENT,TERM OR CONDII QN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORLIED 13Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM$,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWPI:MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DOL TYPE OF INSURANCE POLICY NUMBER PO Y E iECTIVE P LICY EXPIRATION LIMITS GENERAL LIABILITY ND-P-010078/000 03/13/2007 03/13/2008 EACH DCCURRENCE 6 1,000,0001 PGEN COMMERCIAL GENERAL LIABILI TY DAMAOE TO RENTED S 50,00 CLAIMS MADE a OCCL R MED EXP(Any one person) $ S10001 A PERSONAL II ADV INJURY S 11000,000 GENERAL AGGREOATE S 2,000 00 'L AGGREGATE LIMIT APPLIES F ER; PRODUCTS•COMP/OP ACG S 2 000.00 POLICY JEC UX: AUTOMOBILE LIABILITY COMBINED SINGLE UMIY ANY AUTO (EB accident) b ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Pot person) 6 HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) 6 PROPERTY DAMAGE S (Peraccident) GARAGG LIABILITY AUTO ONLN-EA ACCIDENT $ ANY AUTO OTHER THAN FA ACC S AUTO ONLY: AGO S EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $ OCCUR FJ CLAIMS MATE AGGREGATE S S DEDUCTIBLE S RETENTION 6 S WORKERS COMPENSATION AMD W C STATU• 0TH EMPLOYERS'LIABILRY E.L.EACH ACCIDENT 9 ANY PROPRIETORIPARTNF.RIEXECUTIVE OFFICERIMEMBER rXCLUDED4 E.L.DISEASE-EA EMPLOYEE S "'Y" Yes describe under SPEGIIAL PROVISIONS below r.L.DISEASE•POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VI.HBCLES/EXCLUSIONS ADDED BY ENDOR39MEW I SPECIAL PRDVISIONS CERTIFICATE HOLDCANCELLATIQU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover,' BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Osgood Street OF ANY KIND UPON THE INSURER S AGENTS OR REPRESENTATIVES. North Andover, MA 021:45 AUTMORIMP REPRESENTATIVE Dawn Cram ACORD 2S(2001/08) FAX: (978:i68Z-3231 6ACOR0 CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 r' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /1 Please Print Legibly Name(Business/Organization/Individual):_ KI'Eal �QNs `�vC�c n Address:_ 7, �_ �t c1 i 71— dC', City/State/Zip: p Vl AP da 0 Ct,, MA Phone.#: 7 Z - 6 4 75 z O 1 Are,you an employer?Check the appropriate box: Type of project re uired ' 4. I am a general contractor and I yp p J ( q )•'� 1.® 1 am a employer with g 6. ❑New construction � employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [Remodeling sub-contractors have ship and have no employees These 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance. $ 9. ❑Buildingaddition required.] 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 11.❑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 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: G a a e t't c Policy#or Self-ins. Lic. Expiration Date: d Joh Site Address:. bf7 e1z rC �C ��� City/State/Zip:A. 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 u er the in a penalties of perjury that the information provided above is true and correct Si ature: Date: 2—'6 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#: Date......q.v...7......��.Y.<!d 3 � t pORTI�1 o?;.<�``°.;•.."ooh TOWN OF NORTH ANDOVER I- , 9 PERMIT FOR WIRING �SSACMUS� This certifies that .l.�A./.-Lae. . 4=......................................... has permission to perform ...... ./................... r wiring in the building of 7T:�:Q g l v m.gi............................ ...... .. ............ ......... A at......k.....� .'...........................North Andover,Mass. Fee A :✓-"O.. Lic. .... fes.- " . ... ELECTRICAL INSPECTOR Check # e/115-1 4838 HE COAMONREALTH OF A1ASS4C1qUSE-7TS Office Use DEPARTNIFNN 0FPUBUCSAFhY - e Permit No. BOARDOFFREPREVEMONREGULAHONSR7CMRI2.VO /� Occupancy&Fees�hfCl a APPEICATIONFOR PATO PERFORMELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WTTH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIQN) Date —03 Town of North Andover ` To the Inspector t The undersigned applies for a permit to perform the electrical work des ' ed below. Location(Street&Number) ��'(` C Owner or Tenant Ill/ o` MOL C r dL Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization.No. Existing Servic`, Amps/Zo /7i Volts Overhead Underground No. of Meters,2 New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers To No.of Lighting Fixtures Swimming Pool Above Below Generators K\ K\ ground ground No.of Receptacle Outlets 2, 1 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones. Tons No.of Disposals 1 No.of Heat Total Total No.of Detection and / Pumps Tons KW Initiating Devices No.of Dishwashers i Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER l o AtheAl, r� `c f .- hrurranceCovetagt;Purstmtit�theta�>it�r�r�of�C�eaaalLaws Ihawaomentlmb&ylnuaa=Pol ya C%aaWtxitslmpi%, lat YES 21 NO a Ihayssubrnil�dvafidptoof btheC YES Ifyouhawd� dodYFS;pkmmd�thetAxcfoo � �' 0" If�SURANCE : BOND OUIER ftaseSpecfy) E ava1wofEbchxalWc&$ Woii�toStart h rDa1eRffJW" RwcFinal 5ignedurx��iePtrlaltiesof _ qo _ FWMNAME u�c /�j ,C— LiceneeNo Z C ! 7 1 ;�,O ,4- Sigrrdaue 2-7-772 L� Bt>s�ressTei No: �j'7�7 q� //�� At Tel.1% )WNER'S INSURANCE WAIVER;Iam aware thntthelio=doesnothavetheinstuar>cecoverageorits sulstmtialequivalent asrequitedbyMassachusetts Geral Laws nd that mysigrMtre on thispermit application waives alisrecgmerner t Please check one) Owner O Agent Telephone No. PERMIT FEE ,00 Signature ot Uwner or Agent _ The Commonwealth of Massachusetts R4 ;. , . d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 5�0'' Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City. Phone#: Insurance.Co. Policv# Company name: Address City Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,5C and/or one years'imprisonment_as_well_as.civil.penaltiesjn.thelorm4a_STOP WORK_ORDERand_a.fine_cf..G$1D0_00.)-arlay against.me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 !do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Signature Date Print name Phone.# ` Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dep; F-ICheck if immediate response is required Ucensin . BOc E] Selectman's C Contact person: Phone#: F-1 Health Depari Other r r Location No. I/7 Date L� NORTIy TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ T �s•,cHusEs Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ -3 3�.r� pati Building Inspector _ C 7159 Div. Public Works PERJtIT NO. I APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP KqO. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE SUB DIV. LOT NO. F i LOCATION T 1 lGf 6 PURPOSE OF BUILDING ,c _ OWNER'S NAME Cn NO. OF STORIES SI OWNER'S ADDRESS r BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ^ C) SPAN -- T.t DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES- SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE ¢ INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST F-RC=,13TH SIDES EST. BLDG. COST vO PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS i - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR TE ILE 0 BOARD OF HEALTH SIC;NXTURE OF OWNER OR Ati-THONITED AGENT FEE /u/ PERMIT GRANTED OWNER TEL.# (/ a `® U PLANNING BOARD CONTR. TEL. 2� is 9 CONTR. LIC.# BOARD OF SELECTMEN CA sL / � BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 I 2 I3 CONCRETE BL K. ---III PINE BRICK OR STONEHARDw D PIERS PLASTER — DRY WALL UNFIN 3 BASEMENT AREA FULL FIN. BM'T AREA _ V. 1/1 3/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMtACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME ti BRICK N MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR 11 ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 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 1-3'dNO HEATING NORTiy Town of Andover 0 No.117 " oAor Andover, Mass., L I q�� 14y COC Ht:�v iCn �A')RATED BOARD OF HEALTH PERMIFood/Kitchen Septic System TT(�6 BUILDING INSPECTOR THIS CERTIFIES THAT............... .. ........... MAtffdr...................... Foundation has permission to a ....69.... ..... buildings on .......&&........H ..... Rough . • • • • to be occupied as................... .. ......;5� . ......4m/.ST/.� /.,!� Chimney provided that the person acce tin t ermit shall in ever respect conform to the rms of the lication on flow p p p g p y p pp Final this office, and to the provisions of the Codes and By-Laws relating to the Inspectio , 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 Fina' ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T& Rough • Service ................ ............... .. . .... ... BUILDING OR 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 Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT DAY # RE REIVIUIIELIN dc�BUI DING INC. t -A Jhce Bdis c7t7�21Q• 7t�it'l�ta4s P.0.Box 396 . 56 Pleasant Street Methuen,MA 01844 (508)088-3944 4113 94 PEOrOSAL* �iJiirS I'•, R.,° tARSA. LEC.IA.RRE RE: Siding HERRICK F.D. NO. r'INE)CI ER. hlu',: x1:845 Taw: 1 down when Jab is started and ma.teriai delivered, 508-r; �;:?5iJ I i ! s 1r 3 ba a tba-o Mance ori wmpleflon. We here-by submit specifications and estimates for work to be corr,,plete-d at civ Herrick Road :a5 desaibed beloT/c SCOPE OE Wim: • reside e terror walls �,T t t:';rt Tl�. -Li l�oi �r'1Ti-?L`, EI II.1E+ olid hrM ksddirt�T incl�?c Irl;n:r.` rE ,. with_l i� 1 i]Li11i�1I1; apel rt der 3ldirt; tl ? All tI"irtt, including r?;Tlrtdt�5'? lllls, ';4'lnt t7", casings, door casirt S•, fascia oarCIS. I"uK uoarLIS, e�C., %�v re covered with alumi?aum - • All ouerhart us'rill be covered with *Tian;;1 p rforated soffit material • � l electrical fixtures will be removed and replaced properly • Awning will be removed and replaced properly • ;aL3le vent will be replaced with vinyl-qTe • er deck will be properly flashed prior to vinyl installation 1 • ltilrt area ort S.j1rt,rL)rclt 5�rillbe cLi!Tere t wiL-h vine l p-rforated Si,,L X("t Lei lei 7hree (3) T`in;0 l Slht'utterc,will be installed on lett side of propert�i C1.ARt T] S: TDTl"1L 1-1BOVE PRICE, OFTIONAi..I'R, MIG i Resspecthulh,,-Submitted, SiC=Nr'l:'UIiE: ' 511GNATUR'E: e R e i t a n o �• O,11Kt'Vlrl , SHIP COhIPLETELY GUARANTEED/ROBERTS AND CATZIL.t NO INSUR II*r PLEASE SIGN .SND RETURN DNE CDP�� SKiri� , Ll tram �,�ya c 'x,• ` t ' ',Its "� 1- +� �r3i�, }v�ka��•'��'`1' Ll �`itr� �y `� "'���?:��,?lr�� �a1- �§A •�� �,y e 'is �,+ ''Sy :i - �'J i,;; ?�1�'"}{i�'F'•.� �'�, :�+ :�?k���F.T��;y��„"'�,�•,Y� '��i+ i ��Ov��'�`"��� ., �{� :;?�'� .'�a`-��•.y� '''i'.v'�71. .�i i 'iJ1 ,V \1• j!S .A A, tt .y`7}151;��,,,:� ,e`�h •.� a ::L , � �: `.?� ;r . ' �i' ' s Y i 34 x :n .v 7 .�.. �h,�liYli��"3i.,G .�, �•�.'`�.:"'1'Y:'l�'11:� �.[ctp�t,• ,�'j� ,��. v � `:J r,{r,•.(,{,,§lr�t�k•. ,F,. ` t1 �. ttv`t+�41 �c R �sti.vsi��t:! •,� k:1� s� �? 1 � I \•?.; } s.1.,!r.t,, t v,4 l�C, i, .�'; .�•,1'�\,�• :1 �''�tii�.t��'D:,. i Y J.['1t� I nZt Irl t t� yilr.`�'�, `� MM f ti a' t.� �• it.tt !V t ,q Ir r ` .e:� �.}.:t ' 7t.�1 DEPARTMENT s. \aAC}1Cl3 ONE:AS OF PUBLICS AFETY .6 T . ORT N PLACE F EXPIRA7jON ' ON,MA 02108 DATE. ' �a n aA�{ l I 2 �. CU�$TR $UPERVISQRRSRITCONS EFFECTIVE DATE' LIC-N0. s , 06/30/1997 i 1 � . 3 SS - ST 44'3 DAVID REI I Cg S6 PLEA.S;wThO PHOTO(BLASTING OPR Ongy� F '. s m IV iM E T H U E N M A 18 4 4 Q 0 . •Z��_' ...HEIGHT: NOT VALID UNTIL L SIGNED BY LICENSEE AND OFFICIAL-yDOB: STAMPED OR-SIGNATURE OF THE COMMISSIONER 12/04/ic '. . _ .. THIS DOCUMENT Mu - HE IEDONTHEPERS F INT THE HOLDER HE, OF OTHERS.RIGHT THUMB PR .. GAGEOIN THIS OC�R, N GNATURE OF LICENS IONS 1 , Location No. Date ,kOR, TOWN OF NORTH ANDOVER Certificate of Occupancy $ +� # Building/Frame Permit Fee $ �►�s',"°''t� Foundation Permit Fee $ s�CHust ;E Other Permit Fee $ { Sewer Connection Fee $ 1 Water Connection Fee $ ------- TOTAL �i $ z S �) �) 09:3 Building Inspector 15.Q"J PAID 7069 i Div. Public Works F PERAI[IT NO. ZQ1_�z APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP i-40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES IZE OWNER'S ADDRESS _�q� BASEMENT OR SLAB ARCHITECT'S NAME ��/�,�c SIZE OF FLOOR TIMBERS IST 2ND 3RD oq ` BUILDER'S NAME & _' SPAN --- DISTANCE TO NEAREST BUILDING / DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST �/•)' v( �' �� PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. Q PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY j ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED /AND APPROVED BY BUILDING INSPECTOR DATE FILED__j/ /sl?z BOARD OF HEALTH NATURE OF OW ORA THORIZED AGENT r F E E PLANNING BOARD PERMIT GRANTED 19 OWNER TEL.# BOARD OF SELECTMEN CONTR.TEL.# G .� CONTR.LIC.#1:q, t-4;' D / BUILDING INSPECTOR e II f BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYSTORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OF LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE B l 2 13 CONCRETE BL"K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. BM"TAREA _ 1/1 1/1 '/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS II 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD",/D _ ASBESTOS SIDING COMt,ACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING ' STONE ON FRAME _ SUPERIORI-]I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 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 ( 3rd I_11 NO HEATING i 4 IXORTf-f 0VM Of �o over L � --No 1VJ}1 O LAKE dover, Mass.,/fit sF`��''I�r /', 19 COCHICHEWICK ' ��ADRATE D P? -S, '-1 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ��� �� � L.00 � BUILDING INSPECTOR THIS CERTIFIES THAT................................ ............... ............................0I...eI �........................................... Foundation has permission to erect�*.I��/�►G buildings on .. p .. . .. .. . ........ buildin �.�..�Z�..�.�. 0.�.'.�....w�*..�.................... Rough g to be occupied as...... /C i 1... .��..!K...4! ..�.����..1..� �!�!I�!��l.�j�7��►!'�JI 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 UNLESS CONSTRUCTION STARTS • ELECTRICAL INSPECTOR �s Rough u .. ... ... .. :.... ............. ...... .... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove _ Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT office use Only The Commonwealth of Massachusetts 3 U �. Deportment of Public Safety ' 1 Occvps.cY L ice faeetc��� 1JOARD OF FIRE PREV.0111011 REGULATIONS S2I CMR iloo 3/90 �1..�1 ' -712.3 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORI< NI wilt to lie peelotmed in accordance widrplhe Mecaschwou Electrical Code. 5210111 12:00 v (PLEASE PRIITI III INC OR TTPE ALL I11FOR1=1011) Date. 10/23/95 - City or Town of No. Andover To the Inspector of Wiress Thi undersigned applies for a permit to perform the electrical work described belov. Loe.stion (Street 6 Number) 66 Herrick Road aa,er or Tenant Marie Sullivan ' Owner's Address • Same Is this permit in conjunction with a building permit: Yes ❑ Ito ® (Check Appropriate Box) ILrpose of Building Residence Utility Authoriratlon 110. 507574 Existing Service 60 Amps 120 / 240 Volts Overhead ® Undsrd❑ ito. of Iteters__ Nev Service 100 Amps 120 . / 240 Volts Overhead INUndgrd❑ Ito. of Heters Number of Feeders and Ampacity Location and Nature of Propose&—electrical Work Emergency Service Change No. of Lighting Outlets Tota E g 110. of liot Iubs Ito, of Transformers KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑grnd. ❑ Generators KVA No. of Receptacle Outlets Ito. of Oil Burners ito. of Emergency Lighting Battery Units Ito. of Switch Outlets No. of Cas Burners FIRE ALAPJIS ito. of tones No. of Ranges Ito. of Detection and g No, of �Air Cond. Ttons Initiating Devices Ito. of bis ossls 110. of licat Total Total p PUMPS IQs KW ito. of Sounding bevices ito. of Dishwashers I Space/Area lleating KW ilo. of Sel( Contained Detection Sounding Devices No. of Dryerslleating Devices KW Local❑ Itunicipal 1—lOther Connection ito. of Water Nesters KW No, of No. of Low Voltage Signs Ballasts Wiring ito. Hydro Ilassage Tubs No. 6f Ilotors Total IIP OTHER: . j IiISURAiICE COVERAGEt Pursuant to the requirements of Itassechusetts General LaQs I have ■ current labtlit Insurance Policy Including Completed Operations Coverage o its substantial e9uivalent. YF.S 110[� I have submitted valid proof of same to this office. YESM Ito L3 it you have checked YES, please Indicate the type of coverage by checking the appropriate box. iNSURAiiCE ® BOND ❑ OTHER❑ (Please Specify) ' � xp rat on eteT Estimated Value of Electrical Work S Work to Start 10/23/95 Inspection Date Requested: Rough Final 10/23/95 ":r.-wed under the penalties of Ietjrryt FIRM It.. Landers Electrical Co. , Inc. GIC. 110. A5912 Licensee Vincent B. Landers, Pres. signator ,� ?�• DrH YLIC. ito. A5912 #Address 1000 Osgood St., No. Andover, MA 1845 Bus. Tel. No. 8-686=35'Z$-- Alt. Tel. Ito.__50T—__686-3829 OIINER'S INSURAIICE WAIVER I i an aware that the Licensee does not have the Insurance coverage or is n�— stantlal equivalent as required by Ilasanchusetts Ceneral laws, ani that my signature on this permit appiIt tion valves this requirement. Owner Ageut (Please check one) ' 35.00 Telephone Ho. � � TERNIZ FEE S Slgnatute of Owner or gent ; _ e p + TO• Date.��..�d.3...../...� 2630 pORTI{ o" TOWN OF NORTH ANDOVER 3? �a,P '• OL ♦ y PERMIT FOR WIRING 111 • � " • ,SSAC14USE� This certifies that .... . ....[s!�!. .... ... ....... ... .. ..�.... ..... . .. has permission to perfor ......... ... ........ .. ..........: } wiring in the build' g of..... ..... .. .. . ...... ............... at.... ..... .. .. ......... ,North Andover,Mass. ry Fee ................. Lic.N . ........ ..e� . ............................................................... ELECTRICAL INSPECTOR V14494 35-00 RAID WHITE:Applicant CANARY: Buildin ept. PINK:Treasurer GOLD: File Location-� & IL, C 2 CP No. ( a� Date t HORTIy TOWN OF NORTH ANDOVER O 1 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ 45 D s�cwust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check # C2!3 50 16644'4} Building Inspector m j TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: a_ SIGNATURE: Building Corarruissioner/InspecWi of Buildings Date z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 2& X15' y 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 Reqwred Provide R red Provided Required Provided Q 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System. ❑ J SECTION 2-.PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Ode- ONA, �M a? Vi�r L - Lo GG ,y��2�c. K �C i Name(Print) J Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0 z M Signature .l Tele on 90 SECTIO 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: `: 7/7 t� O License Number 7J L�6LvI 7� h4i 1 Address L , A ,, fe4f M // Zy z S'(� '� ( Expiration Date re Telephone 3.2 Registered Home IImmp'trovement Contractor Not Applicable ❑ Q 2JC r�� Company Name rn 1 , Registration Number Address Expiration Date ` re Telephone SECTION 4-WORKERS COMPENSATION(nG.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 buildin rmit. Signed affidavit Attached Yes....... No.......0 SECTION 5 Description of Proposed Work check all applicable New Construction 0 Existing Building ❑ Repair(s) Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: tnyJL (z) vtyf:h g©o, k/l!fc.hz SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost ) o be(Dollar)t "s ODIC >GTSE ON Z l 4 � #� na� w = ni rix ^zs4 �a Yrs Com feted by permit applicant tis 1. Building �O (a) Building Permit Fee 33 _Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 5 Fire Protection ! v 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, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building penmit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, /" C d�2 6 ,I h 'R • �e;6 IJ ,ae-Qmm=AAuthorized 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 l and belief AIJPri;Vn,L�A—Ca�. e g ' Z 77- Si ire of er/A Yent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS l'` 2ND 3 SPAN _ DIMENSIONS OF SILLS DIMENSIONS OF POSTS f DIMENSIONS OF GIRDERS C HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERLAL OF CHIIvMY IS BUILDING ON SOLID OR FILLED LAND 1S BUILDING CONNECTED TO.NATURAL GAS LINE Town of North Andover FORTH O� .� ebbO0 Building Department t 27 Charles Street * _ North Andover Massachusetts 01845 (978 688-9545 Fax(978 688-9542 °A° `°`"'""N"� l ) \ ) °RAT!°11 �5 A RSSACHUs� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, sl 50a. The debris will be disposed of in/at: to,A-&LA, Facility location SiSffalplure App -cant �3 - Z 'z -o3 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. i ' .:•l1�ro The Commonwealth of Massachusetts Department of Industrial Accidents lxl 4 office of/nyestigat/ons 600 Washington Street b - ? Boston,Mass. 02111 Workers' Compensation Insurance Affidavit m , name:_ /! £ at N E!t"� !�aw/.) location: 7i! 116-cu; 17 do e- ciri T7Nd O L)£l dgt >ahone# / 7d"6�� ❑ I am a homeowner performing all work myself. l Z?I am a sole proprietor and have no one working in any capacity a 1177 - M F15 =10 r [❑ am an employer providing workers' compensation form employees ees workin on ob. , company name. dress: phone# insurince co. policy# ❑ I am a sole proprietor, general contractor, or homeowner"(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name. 77777 Address: _X. phone# insurance coohc # -7E_9"072" MMMMMERM Vil comoanv name address. _ phone# insurance co pohcv'# `'A`��i r„�N�diti,c�rcal s°I�ee�if�ne�essary��, � T•°^•---�-- Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of Teri penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the its and penalties of perjury that the information provided above is true and correct. Signature - ZZ Date _ Print name ej NLtA `!-� r _._ ._. .._._. Phone# official use only do not write in this area to be completed by city or town official 7 city or town: " permit/license# -Building Department ❑LicensinkBo,rd ''"" check if immediate response is required ClSel edsing's Office 0Health Department contact person: phone#; -Other "wtin*.«X s's:a......�^• k,«..�:.r...._ ._«;:«x,t..»':-xLyk'..'i:::ia,..:.,. >.w.S.x'.J�..:3.Li:=As:fiuvi•` .. ,y ..e,.c,.n-`3d• :s.srs aW.:u,:wS�Stu.zusa:..: R (revised 3/95 PIA) KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978) 691-5201 McNaire, Daryl & Tara 66 Herrick Rd. N. Andover, MA 01845 (978) 686-9320 Contract# 1584; Appendix A; Revision 1 Date:7/15/03 Remodel 2 bathrooms, kitchen& breakfast area: • Supply& install new 200 amp electrical service to house Upgrade domestic water supply to 3/4" from meter • Supply& install future vent in basement for possible basement bath Bathrooms: • Demolish both bathrooms to studs • Remove & dispose of all debris • Upgrade electrical, plumbing and insulation to code • Remove steam radiators and cap pipes Supply& install electric baseboard heat Supply& install Harvey Classic vinyl replacement windows with obscured glass • Supply& install exhaust fan/light/heat combination • Supply& install blueboard on walls & ceiling • Skimcoat plaster blueboard to smooth finish • Supply& install trim to match existing • Supply& install all plumbing fixtures as selected by customer at Peabody Supply and agreed upon during conversation with Bob Salemme, Dick Perumba& Ken Keen on July 9, 2003 • Paint walls &trim(2 coat finish, 2 neutral colors) and ceiling (white) • Supply& install ceramic tile on floor($3.00 sq.ft. tile allowance) Kitchen&breakfast area: • Remove&dispose of existing kitchen cabinets &counters • Supply& install new entry side door(9-lite Thermatru smooth star fiberglass) • Close opening from entry to kitchen • Create opening from entry to breakfast area • Eliminate recessed area for refrigerator • Supply& install kitchen window(Andersen casement) • Remove two corner shelves in breakfast area • Supply& install electrical &plumbing as necessary(upgrade to code) • Supply&install electric toe-kick heater under kitchen sink • Repair all plaster as needed • Remove& dispose of all debris • Supply& install trim as needed to match existing 1 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N.ANDOVER,MA 01845 (978) 691-5201 • Paint walls &trim (2 coat finish, 2 neutral colors) and ceiling (white) • Supply& install underlayment on floor in kitchen&breakfast area • Install customer supplied cabinets • Supply& install all plumbing fixtures as selected by customer at Peabody Supply and agreed upon during conversation with Bob Salemme, Dick Perumba&Ken Keen on July 9, 2003 • Supply& install ceramic tile on floor in kitchen and breakfast area($3.00 sq. ft. tile allowance) • Supply& install ceramic tile on backsplash in kitchen($3.00 sq. ft. tile allowance) Price does not include cost of permits, changes required by inspectors, or unforeseen problems in walls, ceiling, floors, etc.. Total price: $44,533.00 (forty four thousand five hundred thirty three dollars) IIS 2 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978) 691-5201 Pricing schedule: $2000.00 -kitchen window is installed $3000.00 -new entry door is installed $3000.00 - 2nd floor bathroom is demolished $5000.00 - 2nd floor bathroom is roughed in(electrical, plumbing& framing) $2000.00 -2°1 floor bathroom is'plastered $5000.00 - 2 nd floor bathroom is complete $2000.00 - electrical service change is complete $6000.00 - first day of work on kitchen& 1St floor bathroom $300¢:00 - 1St floor bathroom&kitchen is roughed in i (electrical,plumbing& framing) Payment schedule:$1000.00 due upon signing contract $14,000.00 due when customer receives bank check " $14,000.00 due when pricing schedule items reach $14,000.00 $12,000.00 due when pricing schedule items reach$28,000.00 $3533.00 due upon completion of contracted work a 7A� Customer Ke eth B. Keen Date Date 3 1584 KEEN CONSTRUCTION CO. (�- a 21 HEWITT AVENUE PROPOSAL NORTH ANDOVER. MA 01845 Tel: (978)691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978) 682-3231 specifically exempt from registration by Provisions of _ Chapter 142A of the general laws,must be registered with Submitted I �- i (-& � C - • the Commonwealth of Massachusetts. Inquiries about To: ..._.........-,_.___. ..__.................._.1.........._....___. ___..-_.....-........_..__..___.____ registration and status should be made to the Director, , t-� (! ,` Home Improvement Contract Registration,One Ashburton _..._...SJ_ ..__.___` ` __\ C r!! ._._.. .`?_......_.._..___............__.............. Place, Room 1301, Boston, MA 02108 (617) 727-8598. n A COwners who secure their own construction related dovtf rl lJ permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. �HONE DATE REGISTRATION N0. F.I.D.N0. 7? (; �o -- 3 2(� - -- d MA. H.I.C. 108383 04-325-8052 > C/S = Customer Supplied S + I = Supply+ Install We hereby submit specifications and estimates for work to be performed and materials to be used: I :. -.. — _ _....I ._.- ... - --------- – 1 mm f' Milo s f� t �-C, �11 � � off'�� ��� �� �� reG� ��'� end X �_ .. .._,......._._,_ ._.-_....._.__ _ __..._.. ... _ _ ......................_........-__ __ ...._........._...................... I __.._...._.._._......................_............ .. ... ... _ ___-- > Construction related.permits: -........-..,_-„_...,._......,,-............._.......,...:,,.......,,,.,.....,.......,...........:..................................,.,...,,,...,.,..,..,..,....,..................................,.........................................................,................................,.................................................................................................................................................... ... .............................::......................................_.......................................................... . WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writ g. Contractor will begin the wgrk on nr about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants thatthe.work furnished hereunder shall be free from defects in materials and workmanship for a period of '� following completion and shall comply with the requirements of this.Agreement. In the event any defect in workmanship or materials,or damage caused by the Contracto,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Proposehereby to furnish material and labor-complete in accordance with above s ecifications, for the sum of Payment to be niade as follows: ;ter ($ KENNETH B. KEEN ) upon signing Contract; Name of Contractor/Designated Registrant ($ ) upon compljo f (`� 21 HEWITT AVE. (JV Street Address % ($ mpletion of N. ANDOVER, MA 01845 � \\ City/State . shall be made forthwith upon (978) 691-5201 (978) 682-3231. D2 completion of work under this contract. Phone Fax �._. Notice: No. agreement for home improvement contracting work shall require a >down payment(advance deposit)of more than one-third of the total contract price Name n! ales n c- or the total amount of all deposits or payments which the contractor must make, in `j advance, to order and/or otherwise obtain delivery of special order materials and AutheTzi nature equipment,whichever amount is greater. Note: This proposal may be withdrawn by us if not accepted within days. Acceptance of Proposal -I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE L NK SPACES. a C Signature^ Date Signature Date "~ -(D3 OF IMPORTANT INFORMATION ON BACK NORTH TONM Of E Andover igg as -o1003 yy �' 0^ dover, Mass., T Q C : COCMIM WIC � 7 AERATED PttC BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System �-�rBUILDING INSPECTOR THIS CERTIFIES THAT..........T'4-�4....-4'..... /....... /q.C../.. '. ..r........................................ //// Foundation has permission to see .. m .°P'�.�....... buildings on .....!l .�.........t`�'.'e r` c 2�................. Rough to be occupied as o2 ,(�t4:n ,QmD ... � /�/7`�� .o N......................................................... Chimney ....................... ... ....................................................................A 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. ��/�► ys� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT' EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR / Rough �1.. ............................................... 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' Date. ? 04 No°T:'� TOWN OF NORTH ANDOVER 0 p PERMIT FOR PLUMBING ♦ i „ • Yl •O�•no�O�,fi7 ,SSACMUsfc� This certifies that . . . .P. .J. . . 5�'�-�-. �-r-- . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . at. . . . < . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. ! Fee.(.>. . Lic. No.. .) .L. . . . . 46MBING INSPECTOR Check # 5698 W/ y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUAH (Type or print) NORTH ANDOVER,MASSACHUSETTS /f r Date 2 ) Building Location A _ Owners Name -'h-C6 -Lf Permit#��J+ Amount Type of Occupancy New El Renovation El Replacement 3-1—' Plans Submitted Yes E] No El FIXTURES z rZ P4 H CA Q dW A WaEn W d ' SZ$BgVIC � B►�g1VVIIVI' 16'1:R 9R / f 2nn Haat 1 i 4114 FUM 51H FLOC R 6114 FUM 7114PIAOR siH�>,oat (Print'or type) Check one: Certificate Installing Company Name ' �7 /� �` r f Corp. Address <-Z) [��x Fj 4, Partner. Business Telephone [p Sc�lp © Firtn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the We of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ElBond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the abi three insurance Signature Owner Agent D I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to U best of my knowledge and that all plumbing work and i stalla'•ns performed under P it Issued for this application will be in compliance with all pertinent provisions of the7tVO to Plu ing Code d Chap r142 of the General Laws. By: -Signature MUUMUU um er T e of Plumbing License Title . 0 �j City/Town License Number Master Journeyman APPROVED(OFFICE USE ONLY