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Building Permit #425-13 - 97 LOST POND LANE 11/27/2012
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION E 13 Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page L®CATIONq 7_ Lo f P4nd 1Y? �o�r _Ahhov t�Yl 4t8�S - --- Print , PROPERTY-©WNER,. ra r,y- . ba u,.brQS� _ Print 100 Year�01&8tructure, yes no; MAP'N0 PARCEL:ob� ZONING DIST ZICT Historic District yes no} Machine:Shop Village yes, nor TYPE OF IMPROVEMENT PROPOSED USE Resid ial Non- Residential ❑ New Building R10ne family ❑Addition ❑Two or more family ❑ Industrial ❑ ration No. of units: ❑ Commercial epair, replacement 90F ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Welk ❑ Floodplain ❑Wetlands ❑ Watershed District�- . -Owater/Sewer, a DESCRIPTION OF WORK TO BE PERFORMED: o® .yrl ' .CL hew 30 , or-cl,i ec7-s/i `ce f-w * S1Wol©4 a!f eaves, va//els, E Pf',04t5, USQ- 30 ani AI*II ems¢-vaeo (O�cr Identification Please Type or Print Clearly) OWNER: Name: G ary ba brRsse- Phone: 97Y-69? 70Z? Address: r Ks"f .Phone. Q 20--69?:�)y CONTRACTQR Name: �r� c ,-t,{. 7 Add(ess: 3 5 0 -13 t< Al -icen e 3 Ex Date: i j Supervisor s Construction L s 0 _ _ p Home Irimprovement License. 13856q Exp`: Date: ARCHITECT/ENGINEER Phone: Address: IV Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$100 .00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ % FEE: $ ISO Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner' ,-J- 2�k- 1 Signature,,of contractor 4_ 17 - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 11 Stamped Plans ❑ 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 JB uilding Permit Application /Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses �d Copy of Contract Floor Plan Or Proposed Interior Work NOT LEngineering Affidavits for Engineered. products umpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application u Certified Surveyed Plot Plan u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) D 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) Li Building Permit Application u Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract u Mass check Energy Compliance Report u 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: Doc.Building permit Revised 2012 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 ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS l Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes y Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towp-]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at:V4.Main-Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use I ® Notified for pickup - Date Doc.Building Permit Revised 2010 Location ST AA No. Date �� e • TOWN OF NORTH ANDOVER 14r Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ Check* 25985 Building Inspector r -I r NORTIFi �� - W" i tE c . . " ver 0 - .., No. h Y �O I*- h ver, Mass, • "'�► • COCMIC"IWICK p�OA- E 0 0� S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System . THIS CERTIFIES THAT loon - BUILDING INSPECTOR .... ......... ........ . .�Q..6.r".I�..�s•, 1:............. -has permission to'erect .: .....:.. .............: buildings on ..:.: ........`�... 4 ...... i� Foundation Rough tobe occupied as ........ ... ..........::. 0. .............................. ........ ...................... Chimney - provided that the person acc tin this per shall in every resp conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and 19 Construction of Buildings in the Town of North Andover-. PLUMBING INSPECTOR A Roughs VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ��� • UNLESS CONSTRU "M S TS Rough Service ........... .......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE 11/28/2012 6:27 :13 AM PST (GMT-8) FROM: 100005-'1'0: 19/86889542 Page: 2 or 2 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDnnfYY) AD 11/28/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER T A SULLIVAN INSURANCE AGENCY INC CONTACT NAME: 344 SOUTH UNION STREET PHONE A/c No Ext: 978 683-4700 FAX WC,No: (9 78)794-8570 LAWRENCE, MA 01843 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: L'berty Mutual Insurance INSURED INSURER B SCOTT WRIGHT DBA WRIGHT GUTTERS INSURERC: 350 BERRY ST INSURER D: NORTH ANDOVER MA 01845 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: 14789700 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE D OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY (Ea acccident)SINGLE LIMIT $ ANY AUTO I BODILY INJURY(Per person) $ ALL OWNED u SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPER Re IjAMAGE $ HIRED AUTOS AUTOS (Par $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ $ A WORKERS COMPENSATION WC5-31 S-387187-012 9/30/2012 9/30/2013WC STATU- °EIS AND EMPLOYERS'LIABILITY Y/N J TORY LIMITS ANY PROPRIETOR/PARTNER/EXECU-1 E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR SCOTT WRIGHT. Workers corrivensation insurance covers e armlies only to the workers cornDensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET BLDG. 20 SUITE 2-36 NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE Jeff Eldrid e ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 14769700 CLIENT CODE: 1623570 Katherine Nicholos 11/28/2012 6:24.:33 An Page 1 of 1 This certificate cancels and supersedes ALL previously issued certificates. VitR! 6 Ir GailAregs COWSMI t r/041 Mas!!Isetts Nome ImueovementContract This form satisfies all basic requirements of the s'tate's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek Iegal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer information Hotline at 617-973-8787 or 1-888-283-3157 or on our website. Homeowner information Contractor Information Name Company Name Tacy L oui So- Da u b Terse V/a �f Gu e ss C C'oy s�I-rvc Q►-, Street Addr ss(do notuse aPost Office Box address) Contractor/Sa esperson/Owner Name ' 97 Losf Pord Ln, So AkrDiS' City/Town State Zip Code Bpsiness Address(must iikclude a street address) 14y- h Glo v 18 S No r4r Aver- oiiq vaw Daytime Phone Evening Phone City/Town State Zip Code 978— 637-7073 .SAk"C q -687- day LQ-35 59 8 Mailing Address(It different from above) Business Phone I Federal Employer M or S.S.Number Home Improvement Contractor Reg:Number Expiration date Law requires that most home improvement contractors have _ [ Q� ` '/j y/d W.? a valid registration nnmBcr / O v / `T The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) 4", Rnd re_-shim Yo4t US!'n� 3o�r� J��Q7iir,e CCrcC,'' qcf SA ,Vg I rnc1t A�uh. aLr�'1p.e�C�e� �ce 4",.-f/R)f 30 r elf A,dd Dn aI( eove5� yalleAp,, cQt,y,Heys,ahC/ve�t�s. Cuf tk r�'dge Cobv-4 vetitl Jo, b,reA+k(X611. Appro .3CS'q- a. S_ . Pr,,Lv_ inckeb R/6oeN,^'k e es,&"-d 04 . Sn_ u c(- u S USl nets ha Required Permits-The following building permits arer'equirel Proposed Start and Completion SelieduIe.'Tlfe following schedule will and wit be secured by the.contractor as-the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be exelu.ded from the Guaranty Fund provisions of I Q JA Date when contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: _y /�. 00.00 M Payments will be made according to the following schedule: $ l w 0.40 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $_ ,. yo�0Q by or upon completion of y�4(2- re®"� $�;500 00 by /c2 or upon completion of aj? �prQ o 1l $ai �Q. upon completion of contract. (Law forbids djmmding full payment until contract is completed to both party's satisfaction) . The following material/equipment must be special s3,660,00 tobepaidfor cs/l,rb4 /rla/.Q ,, JS/or„�C ordered before the contracted work begins in order to meet the completion ichedule.(��.°) $ �)oa o o to be paid for 4u W sf�'/' Rem; l�� ioto nn, NOTES:(*)Including all finance charges(211:)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. B,xpress Warranty-Is an express warranty being provided by the contractor? No❑'Yes(111 terms of the warranty must be attached to the contract), Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this a Bement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. C Don't be pressured into signing the contract.Take time to read and fuliy understand it. Ask questions if something is unclear.. Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza.Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Homme 1—riroyPmenr Contract'or L[1Yj. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent oI,'by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation forin for an explanation of this right. HO NOT"SYGN TRIES CONTRACT IF THERE ARE ANY R"LAN]K SPACES►!! Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be Icept by the contractor. ;jHower's Signature __ ontractor's Signa Z(v ZZIZ �- 'Date / Date 14 ' Contractor Arbitration The Home Impiovement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court-action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause world give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract;the contractor may submit the dispute to a private arbitration fit-ra which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, chapter 142A.. Homeowner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only-to the agreement of the parties to alternative dispute resolution initiated by the contractor: The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. v Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws (i.e.MGL chapter 93A)may not be waived in any way, even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as,described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold-in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document-until all blank sections have been filled in or marked as void,deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the.original contract must be in writing and agreed to by both.parties. Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the.payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insect-re,the contractor may require that the balance of funds not yet due be placed in ajoint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fiends from said account would require the signatures of both parties. Additional Information .If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Impiovement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at]2tp-:Hwvf"v.mass..gov/oclbi*/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park laza,Room 5170,Boston.,M. A.02116 61.7-973-8787, 888-283-3757 or visitthe H[C website at li=://www.tnass.zov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: . 11t )-//db.state.ma.us/lomeimproveinent/licenseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section ►i; Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 11/L(/LI71L 14:t7t5 0lt51�4tf0(t7 IH Z)ULLIVHIN r"HUG CIG/GL w r�1 WRIGSC2 OP ID: MO /'1CORD E(MWODNYYY) CERTIFICATE OF LIABILITY INSUMNCEE!,'112712012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and cbnditlons of the policy,certain policies may require an endorsement. A statement on thin certificate does not confer rights to the certificate holder In Ileu of such endorsamen a. PRODUCER Phone:978-683-4700 NAME T T.A.Sullivan Ins.Agcy,Inc. FaX: 344 S.Union St. 1Afcn� 1. _ nlC No Lawrence„MA 01943 ADDRESS: INBURERIG)AFFORDING COVERAGE NAIC 0 INSURER A;Worcester InsurallCe Company INSURED Scott Wright INSURERS: 350 Berry St INSURER C N.Andover,MA 01846 INBuaER 0: INgUREa P: IN9U ERF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE KEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM& ILS TYPE OF INSURANCE POLICY NUMBER MM Do MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 01 A X COMMERCIAL GENERAL LIABILITY SPPOOD0004226L 1210112011 12/0112012 TIAMAGF S_E,S Ea occurrence s 300,00 CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $ _ 50,0 PERSONAL&ADV INJURY S 1,000,00 - CENERALAGGREGATE S 2,000,00 GF-N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP(OP AGLa S 2,000,60 POLICY 7 PRO LOC $ AUTOMOBILE LIABILITY Eo acc accident) SIN�LE LIMIT nt ANY AUTO BODILY INJURY(Per person) S ALI.OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY(3AMAGE y AUTOS Paraccident) 3 UMBRELLA LIAROCCUR EACH OCCURRF-NCE S JY EXCESS LIAR CLAIMS-MADE AGGREGATE 3 DED RETENTION S - $ WORKERS COMPENSATION WC STATU• OTI'I• Y AND EMPLOYERS'LIABILITY ANY PR0PRIETOR/PARTNER14XECUTIVE Y� NIA E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDE D7 E (Mandatory In NH) ,L.DISEASE-EA EMPLOYF,p $ If yea onScrlba und DESdRIPTION On er PERATIONS below E,L,DISEASE-POLICY LIMIT 9 A Commercial Applica SPPOOODO04226L 12/0112011 1210112012: A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101,Additional Ramfift Schedule,K mora■Paca is required) Installation of gutters CERTIFICATE HOLDER CANCELLATION 1111111 i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Andover A6CORDANCE WITH THE POLICY PROVISIONS. Building Inspector 1600 Osgood St.Bldg.20 Ste2-36 AUTHORIZED REPRESENTATIVE NORTH ANDOVER,MA 01845 _ 4zoa&,� I 0 19611-2 1 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and IogO gistersd marks of ACORD Office otMIS umer ,� i arcs iciness egu a on_ HOME IMPROVEMENT CONTRACTOR j Registration: y�.138569 Expiration: 4/.341 013 Type: t_ = 2` HT GUTTERS-��- - _-- r� _ SCOTTWRIG ' HTS`' 350 BERRY ST. 1. NO.ANDOVER,MA 0.1845. 4 r I Undersecretary, Massachusetts- [epa'.r-tmcnt of Public Sufetj Board d of Btiildint, Rc'ulz+titins and Standards, Construction Supervisor License License: CS 102663 SCOTT WRIGHT ot� 350 BERRY ST (NORTH ANDOVER, MA 01845 J{� • !i 1 G' Expiration: 8/12/2013 (:ununissioncT Tr#: 3384 'F7 I r 6 I J 1 i 11/21/2012 14:08 y(8(y48bN TA SULLIVAN PAGE 01/02 FAX COVER S TT TNA, Sullivan Insurance Real State Agency 344 S:Union St Lawrence, Ma. 01843 Phone: (978) 683-4700 Fix: (978) 794-8570 To: r From: Moraima Company: Pages inn. covet sheet: Re: �J�,, , Date: i la Fax: � ��'- �Dgg` ��� .Phone: Urgent: For Review:_ As requested: Comments,: C r r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 3� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly r Name (Business/Organization/Individual):� t� (/l S Cort (, ct Y,\ , Address: 3S D ezrry �SJ- City/State/Zip: � yic61R1vr,✓ 1q O/8yS Phone#: Q 79-�0'7—),�y 7 AVI an employer?Check the appropriate box: Type of project(required): 1. am a employer with o2 4. [1 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E] 1 am a sole proprietor or partner- listed on the attached sheet.$ E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑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 I L❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ repairs insurance required.]i 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. i 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: J t- ((l` ay, Policy#or Self-ins.Lic.#: ( 3 I .. ? M-01 a- Expiration Date: MoI13 Job Site Address: ! ? LO,5+ I on d Lei. City/State/Zip:& An& WY-5— 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. Ido hereby cert f cnder thep ins a d penalties ofperjury that the information provided above is true and correct. Si nature: Date: a— Phone#: 9(9—(8?— OU y 7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www,mass.gov/dia Q BOAR[) � t Q - 3 Pl on Of d ars d - SEP I North Ar7do ver, Mass. L.Q t 9 sho wing Q Leach Trench System Three (3) Trenches, "As-Built Sanitar Dls oscl System "' "' 31' Long, Y Wide, y p y 1.5' Deep Lot 8 - Lost Pond Lane Lot 8 1 Prepared For 0. 72 A cres ' - 1pj_'_ _ _ _ �;; FII n t lock, In c. J1,574 S.F. ' - ` - _ a-� Scale: 1 " = 40' Date: Sept 13, 1996 Upland= 19,465 S.F. B D-Bax F - r G PST, 94-13A Existing 1Q' --- -- -D� _ P94-44 Found. ro� E J 10' l hereby certify that l have inspected the 1 2�• /_ _= construction of this disposal system and Top Of _ _ 6 6% 93-9 that the construction and final grading has Foundatio C been in accordance with the designer' s intent Jc Elevation 135.06' sept( LOW Pond and that the materials used conform to the L O t 7 tiOCa�' ik• TonlZ`s�94-�3 r$�e plan specifications and 310 CMR 15.00. �. fj t�/ �Water~se'vice Private — 0 50' Wide) This plan. has been prepared for the purpose 1 0a 7 1 of showing the "As—Built" conditions of the sanitary disposal system In on the Breakout Wall premises. All work was done within the Lot 7 Top El = 130.9' construction limitations expected for a job / of this type. Schedule of Tie Distances Schedule of Inverts AB = 11.7' °F Invert @ Foundation = 131. 71' AD = 26.4' AG — 58.0' AJ = 66.0' Sep tic Tank In = 131.06' CD = 22.0' CG = 628' CJ = 51.8' Sep tic Tank Out = 130.81' D—Box In = I JO.57' AE = 36. 1' AH = 60.4' Desi �`� � `� P.E, CE = 25.4' CH = 55.7' D—Box Out = 130.42' Invert @ System In = 1JO.J5' AF = 27.7' Al = 42.9' Thomas E. Neve Associates, Inc. Invert @ System Out z 130. 10' CF = 41.9' Cl = 21.9' 447 Old Boston Road — U.S. Route 1 Engineers — Surveyors — Land Use Planners Topsfield, Massachusetts 01983 (887-8586) Job No. 1276 1 j Plan of L Gn d SEP t /n r North Ando ver, Mass. Sho wing j "AS—Built " Foundation Location j Lot 8 Lost Pond Lane E Prepared For � Lot 'q Flin tlock, Inc. Scale: 1 " = 40' Date: July 15, 1996. e° MO t°,-;zed R- 1 Residence 1 -District lonaI Easement (Planned Residential Development) �Cto t 8 L a _--- Note: � Property line data taken from a Planned Residential 0. 72 Acres ^o ®, S Development plan by Thomas E. Neve Assoc., O 31,574 S.F. / Inc., � dated Sept_ 23, 1994, revised' to May 5, 1995 Upland— 1-9,465 S F In my opinion, this foundation is not Ina Flood � hazard Zone as shown on the U..S D.H.U.D. Flood � o o o - azard Boundary Maps. 2 15' __ 69,6--_ - o (Community Panel No. 250098 0007 C) 0 o - v A �Y'� .01 o o a`� l hereby certify that the foundation on this property o iloz Top Of $o co \� is located as shown on plans and complies with the Foundation A zoning requirements of the Town of North Andover, tN Elevationn e Massachusetts. 239.24 Pro feSurveyor / v 123F_24 EVE No.31724 f -01r:_ I t Thom a s E Neve Associates, Inc. Engineers — Surveyors — Land Use Planners 447 Old Boston Road — U.S. Route 1 , Topsfie/d, Massachusetts 01983 887-8586 ZZ14, 18 Na Date 40—Z5—`7'� �oRTM TOWN OF NORTH ANDOVER . ' A Certificate of Occupancy $ a i , Building/Frame Permit Fee' $ ��°'••°'''�� Foundation Permit Fee $ SSACMUSE _ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ -5a TOTAL $ ____---,.BuildY)g Inspector * YO _ 11/10/% 11:45 1,143.50 897 ppj -� . - Div./Oub{'c Works iw ' Location / /� PO01 u No. Date C � Y r� NORTH TOWN OF NORTH ANDOVER . Certificate of Occupancy $ �-' `c ^a +' Building/Frame Permit Fee $ i ay,S AGMUSES� Foundation Permit Fee $ *.Other Permit Fee $ k - r Sewer Connection Fee $ Water Connection Fee $ t, � TOTAL $ Building Inspector 4� p7 p� 1:45 150.40 PAID 1.uil Div. Public Works r i Location 6 rJ No. - Date !� f o w p" H oRTh, TOWN OF NORTH ANDOVEFF `. 3? •fir . ' ` oL $ p Certificate of Occupancy $ i •_ ^ • Building/Frame Permit Fee $ A cNus� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ —G TOTAL $ U . rr , Building inspector � s Div. Public Works o PERJtrr NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d40. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE .. loy6 _ ��Tof l�,�,�z�}»� _ ZONE SUB DIV. LOT NO. Q b,�/ occ ,,vc _� _ysyZ7Z 130 LOCATION57/ D S 1 0,,,0 1 4 A e �L PURPOSE OF BUILDING -1/N le 'OWNER'S NAM %% C NO. OF STORIES Z SIZE (� OWNER'S ADDRESS .� &d 1c S3 N, �fti>7DV-6< BASEMENT OR SLAB 1345ekCN . ARCHITECT'S NAME '�/el�Ot� DCS A-7 SIZE OF FLOOR TIMBERS IST ZxJ O 2ND fX10 3RD ZXg BUILDER'S NAME l,„,,Tl_Qc(l IAC SPAN DISTANCE TO NEAREST BUILDING 61 DIMENSIONS OF SILLS X 6 DISTANCE FROM STREET D / POSTS / �. 1) V J C DISTANCE FROM LOT LINES-SIDES 3Z" 3 f REAR 13J-1 " GIRDERS U _ 2,410 AREA OF LOT / FRONTAGE /60 / HEIGHT OF FOUNDATION l71 /Q/w THICKNESS !S BUILDING NEW c..5 / SIZE OF FOOTING /p k 3 Q X IS BUILDING ADDITION JA/0 MATERIAL OF CHIMNEY l�C�O C4eC,,LIee IS BUILDING ALTERATION �vo IS BUILDING ON SOLID OR FILLED LAND 50 , to WILL BUILDING CONFORM TO REQUIREMENTS OF CODE )1e < IS BUILDING CONNECTED TO TOWN WATER e_5 BOARD OF APPEALS ACTION. IF ANY N 0 J IS BUILDING CONNECTED TO TOWN SEWER J/V 0 IS BUILDING CONNECTED TO NATURAL GAS LINE A/0 INSTRUCTIONS �y-y- a PROPERTY INFORMATION LAND COST O U O o SEE BOTH SIDES EST. BLDG. COST l- Q T PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. V 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 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND 7APPROVED BY BUILDING INSPECTOR aDATE FILED ` /{S / / BUILDING INSP[CTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E s OWNER TEL.# G ss i! PERMIT GRANTED m MIS um CONTR.TEL.# o ^ (Y —Z719 Si51�Nl �1 NTR.LIC.# H.I.C.# `. 12 6 1996 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 'S ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FRONL MULTI. FAMILY oFFICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- - APARTMENTS I I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION S INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ '/. 1/1 % 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 COMMON VERT. SIDING ASPH. TILE ll� STUCCO ON MASONRY — STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE "HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT-11 SHED WATER CLOSET v ASPHALT SHINGLES LAVATORY 5 WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPE ESS FURNACE FORCED HOT AIR FURN`f 4 TIMBER BMS. d COLS. STEAM , STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR'"" WOOD RAFTERS _ AIR CONDITIONING P Y; TY 3S�� J RADIANT H'T'G + UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1ft 13rd NO HEATING NORTH F Tovvn of 0 d �� .� � _ A� TIM No. . :, rt dower, Mass., 2 19 9� GOC.1c ME—CK �� ADRA T E D P'01 S ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...............................7'/ .. —04 .C............. �,<p-�-... ) Foundation has permission to erect............�:�.Q..... buildings on .........� .... ........�.. ......`.../0.10. Rough to-be occupied as..........................................................&,,/.., ."/.r..��.............2 .1./C ................................... 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 0_05f 1" 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 ST ELECTRICAL INSPECTOR Rough ` ....... ... ........ ......................................... Service B DING 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. Smoke Det. Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit(below) Address of Property for Permit(below) l-,-v_JL 0"L1^N c. 9I Losi lilowo L,9N� Map and Parcel : ' Purpose of Application (check below) Phon� t�mberSff Applicant: )e Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration,or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lots)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals,where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents,where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section"senior"shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density, (buildable lots),below the density,(buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a iot which is ready for building permits,(i.e,all other permits from all other boards and _.. commissions have been received and the-project is-in compliance with.those permits), and the Development Schedule docs not accommodate issuing a bui;ding permit in that-Year,one building permit will be issued per Year per Development until such time as the Development Scheduie acrommcdaia-s issui!,g building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply,whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. Signature of Owner or Authorized Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit. - ---„- ✓�e (�cna�naiuueacCir• aG� `liiJ.;uc�[a1elC1 OEPARTMENT OF PUBLIC SAFETY _ CONSTRUCTION SUPERVISOR LICENSE Nueher: Expires: Birthdate: CS 005693 01/13/1998 01/13/1954 Restrictea` T'o- 00 DAVID A XINORED ' ...r 40 MARBLERI06E RO POBOX531 N ANOOVER, MA 01845 Restricted To: 00 17650 00 - None lA - Masonry only 1ti - 1 b 2 Fanily Noees I Failure to possess a current edition of the i Massachusetts State Buiildin Code is cause for revocation of this license. 000, 154 2 � 1996 FORM U - LOT RRTRASE' FORM INSTRUCTIONS:- This. form. is used. to verify that.. all necessary . approvals/permits from Boards and Departments having jurisdiction have, been. obtained. This. does not r 'eve- the, a eli lic ant. and or" PP landowner from .compliance with- any applicable local or state law, regulations- or requirements. ****************Applicant fills out this section****************** APPLICANT: Phone L ' r � 0 Parcel 1Z js� Z�t/7S LOCATION: Assessor's Map Number Subdivision. 6 S /oz) Lot(s) Street: d SiJ ® fl N St.. Number Use Only******:****************** RECOMMENDATI / S TO GENTS: / . Date Approved Conservation Adm' istrator Date Rejected- Comments Date Approved Town Planner° Date Rejected Comments MCIC�M Q(_CILA OCILQ/MIAi/(% 0110 to - r Date. Approved Food I�n�spector-Health Date Rejected ` ells 2L� Date Approved. /9 Septic Inspector-Health Date Rejected Comments -Public Works - sewer/water connections - drivpow,,ay permi _` Fire Department Received by Building Inspector Date M 2 611996 s + CERTIFICATE OF USE & OCCUPANCY 'own r Andover Building Permi#.Number Date THIS CERTIFIESML _. THE BUILDING LOCATED ON 92 MAY BE OCCUPIED AS �� K IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO p ADDRESS 49 r . SAcwU a Ail in spector N®RTFI F o. . J � 0 of�� over �� �L , rt " dover, Mass., �. �, y 19 COC MICHEWIGM /� ARATEP pPaC 0 5 BOARD OF HEALTH Food/Kitchen ijE , M IT T Septic System `� �.`'- -= BUILDING INSPECTOR THIS CERTIFIES THAT ................................r 7 .. i�—. ....... ... ....> -......... ..: ......\..............� "" ""' Foundation has permission to erect............ .C.?..... buildings on ......... ... ..:....., .. .' .-......1. 1/.0. to be occupied as ................................................. ....... ,/.�c .�1 ......... Gf-tl...(. ...................................... provided that the person accepting this permit shall in every respect conform to the terms the application on file in Fin this office,, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteral"IPW FaRst ction of "S' - Buildings in the Town of North Andover. ( U A.114.' OIVL PLUMB N IN ECT 9 REGULATED gy PARA. 114.E-:�. �� F��S` VIOLATION of the Zoningor Building Regulations Voids this Permit. ou 9 9 PERMIT EXPIRES IN G MONTHS DA ----FEE PAID UNLESS. CONSTRUCTION ST � ELECTt01INSPEc/ :.......:::........::. ' ........ ...�;...:... .......:...........................: Service B DING INSPECTOR Occu an Permite Required to Occupy Building�' Ri � �y Bg GAS INSPECTOR Displayin a Conspicuous Place on the Premises -- Do Not Remove Rough ,� f Odu' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the. Building Inspector. �. Burner E A Street No. jq4r, L ' 6 11L Smoke Det. ,yh n MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTI ' G , r (Print or Type) �7 g l� NORTH ANDOVER , Mass. Date 1huilding Location � ,.,�g T,�L� Permit # Owners Name () W ,� Y -- .3z1 s ! New Renovation Replacement Plans Submitted D N W us �SO ui < G O O G S W d N 1- W O W H tL W d t.. y tL s( t^ C* tL W Z V OT 4 Q 'O D F W Q7 Q t, Q W W C3 G t7 }. r J H• 2 F.. W W O O T u- Wj = O 2 � O N GI e 01c, =( Ll" � B a al-4 0 c� � Z c H o SUQ—$S*MT. I I r { I I BASEMEMT IST FLOOR I I I I I I I f 1 I 1 I I I I I 2HO FLOOR ( I I I f I I ( I I ( M ( I 3Rn FLOOR I I I I I I I I I I I I I ! I I 4TH FLOOR I I I I I I I I I I I I I I I I I 5TH FLOOR ( I ( I I I I 6THFLOOR TTM FLOOR I I I I I ! I 8THFLOOR ( I I (Print or Type) Check one: Certificate Installing Company Name �,gs� Cl^ Q Corp. Address V/J4\,� �(,��s�o,� 1� �"�� - Partner. I Firm/Co. Business Telephone: &�5� Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate t:ie type of insurance coverage by checking the appropriate box: Liability insurance policy = Other type of indemnity = Bond Insurance Waiver: I , the undersiened, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent Q i hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my ttnowtcdgc and tlat at1 plumbing worts and instAl ations ;erformed under Permit iz=cd for this application will-be in oompiianon with all pertinent provisions of the Massachusetts State Gas Cade and Cuptcr 142 of rho General L►wa. By TYPE LICENSE: . Plumber Title Gasfitter Signature of Licensla,' 14A aster Plumber or Gasfitter Journeyman ;'?01-)-- APPROVED (OFFICE USE ONLY) License Number 'IT 2265 Date.. . .. .�� a pfNORTh TOWN OF NORTH ANDOVER - ? op PERMIT FOR GAS INSTALLATION 0-4. . 'y'Iss MUSEtty _ -5 Ir y This certifies that . . . ." T tvtA. . Inv. . . . . . has permission for gas installation / rze~'► in the buildings of . . . . at . . .� . . > f. . . . . .( '! . . . . . . .. North Andover, Mas Fee. 7G Lic. No. /��-. . . . . . . . . . . . . . . . : ac 3GAS INSPECTOR WHITE:Applicant A ilY: Building Dept. PINK:Treasurer GOLD:File •L,d ((�� }} office Use Only 01 he &1MMVt1We# If ffi�0t�� U9ttlg Permit No. 9 % I11 +�E�2urtIIIEII2 of VUHC -'IIfPt9 Occupancy& Fee Checked (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:004 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date P— QM QM or Town of NORTH ANDOVER_ To the Inspector of Wires: The udersigned applies for a permit t erformtth,�eCelectrical work described below. Location (Street & Number �`�'� Owner or Tenant r NC " //� Q!/ Owner's Address O. CCI LP4 A• � ) U1 S Is this permit in conjunction with a building permit: Yes No n (Check Appropriate Box) Purpose of Building Utility Authorization No. 60 57 Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters oo Amps _J`2q Volts Overhead ❑ Undgrnd No. of Meters New Service m Number of Feeders and Ampacity Location and Nature of Proposed Electripal Work' .E Total No. of Lighting Outlets No. of Hot Tubs I No. of Transformers KVA Abover--, In- No. of Lighting Fixtures 21j Swimming Pool Arno. , Arno. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners Battery Units No. of Switch Outlets 70 i No. of Gas Burners tat FIRE ALARMS No. of Zones -3 TNo. of Detection and No. of Ranges 1 I No. of Air Cond. ion's Initiating Devices No.of Heat Total Total No. of Disposals -I Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers l I Space/Area H�ming KW Detection/Sounding Devices Municipal r- No. of Dryer Other KvV/ I Heating -)Pvices Local Connection L No. of No. Of Low Voltage Nu. of Water Heatars Y.N. I Signs_, ._ Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP - OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws _ I have a cuyent Liability Insurance Policy including Comolete5-operations Coverage or its substantial equivalent. YES have subrndted valid proof of same to the Office. YES O = If you have checked YES, please indicate the type of coverage by checking the appropn box. INSUPANCE BOND = OTHER :: (Please Specify) (Expiration Date) s Estimared Value of Electrical Work 5 w/L(� C4LL Work to Start Inspection Date Requested: Rough W�`L C�'t L Final e Signed under the Penalties of perjury: yp-,j 3A LIC. NO. (.J C L FIRM NAM C _a�z r LIC. NO. Licensee O 71 Signatu �c � ' /�SiY It //7 �f a Bus. Tel. No. Address � ��/� Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit applicaVan waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE (Signature of Owner or Agent) z•95o5 Date. .....Q.. ......:7. ' .�� 369 NORTH H.. TOWN OF NORTH ANDOVER PERMIT FOR. WIRING ,SSAcmuSEt This certifies that .........V� � .....1!. .�I'�/{ ..,.... � CtJ u has permission to perform ...... .. wiring in the4builladiof..�.. ... .. �:.,.........at... .... - .�.. .....�, . . ,North Andover,Mass. W Fe> ........... Lic.Nol-IS3..31. . .............. C RICAL INSP ECTOR x WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Date....la... ,91./. 716, z� J2 416 _ NOR71� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUSE� This certifies that s � Lt1d cJ TH � . . .. .......... .............. ....................... !' has permission to perform ........... ..:...`��.. .. ?. ,�1.......... ........................ -� � f wiring in the building of........... .......................�........ ... ............................ at... . ..e I.....................�.........,North Andover,Mass. F OA.�...�o Lic.No. .0 +tl S .. . ........... ! n ELECTRICAL INSPECTOR 3.29 7 25.40 PAID WHITE:Applicant CANARY:.Building Dept. PINK:Treasurer