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Home My WebLink AboutMiscellaneous - 10 CASTLEMERE PLACE 4/30/2018 (2)4 PO Box 55098 Boston, MA 02205-5098 617-951-0600 Fearr Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner. or Inspector of Buildings City Hall NORTH ANDOVER, MA 01845 Board of Health or Board of Selectman City Hall NORTH ANDOVER, MA 01845 RE: Insured: CHARLES GEORGE, Jr. and GRETCHEN GEORGE Property Address: 10 CASTLEMERE PLACE, NORTH ANDOVER, MA Policy Number: HMA 0349537 Claim Number: BOS00062524 Date of Loss: 6/29/2015 Company: Safety Property and Casualty Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Allan Leavitt Claim Examiner 7/2/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3213 Fax: (617) 531-8891 Email: AllanLeavitt@Safetylnsurance.com 2, Date P 14 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. /V/ ............ has permission to perf6rm...(7.e/'-' e— wiring in the buildin of . . ................. 9 at .... A). A14 -t.9 ...... N h Andover, Mass. Fell,96W Lic. No. 13572— . ELECTRICAL INSPECTO r �,,heck# 11!T �1141 11235 Commonwealth of Massachusetts official U e Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PR E\1f:"--'r--ZEGULATIONS [Rev.1/07] (leave blank) rO PERFORM ELECTRICAL WORK ie Massachusetts Electrical Code (NEC), 527 CMR 12.00 01% ��ON) Date: cJ To the Inspector of Wires: By tl, ° intention to perform the electrical work described below. Local PIC, Owne�, Telephone No. (,17 20, - 1211:7 Ownei 1 Is this j v Yes ❑ No (Check Appropriate Box) Purpose ,S �p Utility Authorization No. / Z/ U OCA 1 � -1rhead ❑ rd No. of Meters Und d 1 Existing'; g New Sert rhead ❑ Undgrd No. of Meters Number c �- Location a14 ll.� •.., ar vVork: I n s � � l 3 t)0 vA S e rv; , } (, , gs ,— sr Juf c� 17� r `-cato�. t'rmmWin;? nrtha ATlnwino tnhlo mnv he waived by the InsDector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans J V No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above E]In-❑ rnd. grnd. o. o Emergency ig ting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection EndInitiating No. of Switches No. of Gas Burners Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers p Totals: .......... — Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Connection No. of Dryers Y Heating Appliances KAT Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs - Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: r rrx•_. _ Attach aaamonat aetau If aeslrea, or as requirea Dy we jubpvctvr Ui Estimated Value f Electrical Work: U 0 (When required by municipal policy.) Work to Start: I I a Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov .rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA=NCE [ BOND ❑ OTHER ❑ (Specify:) I certify, itnder the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. R \/ i J ifs a�, L, 1—krNSc c ) c+t~ c Ic•r LIC. NO.: 13 S-/ d - Licensee: I (y�ej4 j,J,�s �� Signatures U—A' LIC. NO.: / 3 s-/ z (If applicable, a ter "exempt" in the license number line.) Bus. Tel. No -79 / 73 t/ 8S 7G Address: l� Sy (Y\ CA 619-b t Alt. Tel. No.: *Per M.G.L c. 147, S. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. A* -i-7-- 6 o S's 3 D 6 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, fine or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: v Trench Inspection Pass F?] Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Passe Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed (] Re- Irispection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed M Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: If C �r Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com Commonwealth of Massachusetts Official U7�e Only 273 Department of Fire Services Permit No.� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 0M ,[Rev. 1/071 aeaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code Q\MQ), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) ID (:Aje-r`e FICIICF- Owner or Tenant C'�kat^jie– C7eO r -�W Telephone No. 6% 7) w - 171 Owner's Address C P l au Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. l t/ 0 0o l �-: - Existing Service �.uu Amps ) 10 /:M Volts Overhead ❑ Undgrd d No. of Meters New Service Sou Amps lab /a90 Volts Overhead ❑ Undgrd No. of Meters f Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: -L n s i i 360A S e ,v; . jill fi, .ns je^ st.,),Ll r _ `'o - r1.eU agr\Y-4-okUr Completion ofthe following table maybe waived by the Insnector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans V No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- Elo. rnd. rnd. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat PumpNumber Totals: "" Tons I------ I KW —* '" '"" No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs - Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value f Electrical Work: 0 0 (When required by municipal policy.) Work to Start: 1 u "4- Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coy rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [/BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. , 5 d^ Ls 1,-en5E (� ned t~ c-lcr LIC. NO.: 13s-/ d - Licensee: rfAe4 w,1s Signature. U–A' LTC. NO.: (If applicable, �e ter "exempt" in the license number line.) Bus. Tel. No.- -79 / j3 t/ l 176 Address: / Sv m �-\ SA �,� e�drn U i,kb I Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ ' Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed 1 on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed (] Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Passe Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: If 6 2— Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): E \ J1SUN, U, c-C,S�,A l 6 -A r, `(,�n Address: 7 sty h,\ t'\ 1� S_ City/State/Zip: Uub v rh M � 0) ko Phone #: 7� Are you an employer? Check the appropriate box: L ma employer with 4. F1I am a general contractor and I ployees (full and/or part-time).* V have hired the sub -contractors 2.m a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have Nworking for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. DI am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] - �3 76 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site zformation. isuranoe Company Name:. olicy i# or Self -ins. Lic. #: ib Site Address: Expiration Date: City/State/Zip: Atach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 r up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of tvestigations of the DIA for insurance coverage verification. do hereby certW tAnder the pains acid penalties of perjury that the information provided above is trite and correct. Official ttse only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # '2 6//.z 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 bum 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-MASSAFB .evised 5-26-05 Fax # 617-727-7749 www,mass.gov/dia This certifies that VYZA�n ... do /-t� ................ has permission for gas installation ... ?�7?x . .......... in the buildings of CA��6�40--ey 41 ...................... at A� (24f 7-i�eMrw- �. ........... . N rth Andovier, Mass. W''. '. 4,: ...... . ... Fee Lic. No. ��-077. . 1 1 1A69 GASINSPECTOR Check #9 --4q/ je;, 8440 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM G ORK CITY �/� °_d0 c!�/�—. -_. _ ._ .. �.._ _._ _ i MA DATE I // _ /�, / PERMIT JOBSITE ADDRESS �0C�S%7 /✓I�Q ,4�L_J OWNER'S NAME G OWNERADDRESS , +_T._��.._.. _ .__—... _� TEI�-.FAX C._.__ ._ TYPE OR OCCUPANCY TYPE COMMERCIAL L] EDUCATIONAL ❑ RESIDENTIAL[] PRINT CLEARLY NEW: RENOVATION: I- REPLACEMENT: L� PLANS SUBMITTED: YESNO] �'.. APPLIANCES1 FLOORS-+ BSM 1 2 3 4 5 6 78 9 -10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER s DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR Mt-rt roe- t GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM ! SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 0TH R INSURANCE COVERAGE MGL. Ch. 142 YES ✓ NO ❑ I have a current liabilBy nsurance policy or its substantial equivalent which meets the requirements of I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ► LIABILITY INSURANCE POLICY [a' OTHER TYPE INDEMNITY ❑' BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are accurate to the beat of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in piian with all Pertin provia of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �' �' i rC ;-/C/- LICENSE # % SIGNATURE MP EQrMGF O JP ❑ JGF [] LPGI ❑ CORPORATION OF-/ PARTNERSHIP ❑#�—� LLC []#� COMPANY NAME:_' fGj'1C 77,6 4- ?Yj 5:71ffi-� ADDRESS U G.rx h Gy/74" SPE CITY Cf b el-77/1 STATE = ZIP I 01 3.ATEL Jf .07–7 V3 FAX j � CELL��- EMAIL p i F z° o F W e a z° O C is7 � W a Z W� ULU w � d N 3 w C a W ~ � V J M a N a H x w F O a a G�7 O O a V GENERATOR DATE: LOCATION: I� OWNERS NAME: APPLICATION ,0! GENERATOR kw– NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: X�if/P' -N'c- PHONE NUMBER: ELECTRICAL (RESIDENTIAL EAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: C)G14 64 /JZ -44e, *ZONING DISTRICT: *CONSERVATION APPROVAL Town of North Andover Page 1 of 1 http://mimap.mvpc. org/NorthAndovermimapNiewer.aspx Select ..... _'. i { (show all) Owner P C GEORGE JR & G GEORGE INV TRUST 0 r- _...-.— ---- ----- --_-.___.r 1 selected To Mailing Labels To Spre: Pia Ownerl C GEORGE JR & G GEORC Owner2 C GEORGE ]R & G GEORC Address 10 CASTLEMERE PLACE PropertyID 037.A-0035-0000.0 Lot Sae 1.18 A Fiscal Year 2013 Land Use 101 Code Last Sale 11/18/2010 Date Book/Page 12289 Total $832300 Valuation Building CN Type !! Year Built 1984 11/19/2012 Town of North Andover Page 1 of 1 http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx ;Select (show all) 'Owner P C GEORGE.JR,& G GEORGE INV TRUST. 0: 1 selected To Mailing Labels To Spre; Pla Ownerl C GEORGE IR & G GEORC Owner2 C GEORGE JR & G GEORC Address 10 CASTLEMERE PLACE Propert M 037.A-0035-0000.0 Lot Size 1.18 A Fiscal Year 2013 Land Ili 101 Code Last Sale 11/18/2010 Date BookJPage 12289 Total $832300 Valuation Building CN Type Year Bw7t 1984 11/19/2012 Location 04 No. C-) Date TOWN OF NORTH ANDOVER 0 AL Certificate of Occupancy $ CHUS Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 6667 Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING hiA BUILDING PERMIT NUMBER: ® ® DATE ISSUED: SIGNATURE: lldin CommissioneE for of Buildings Date I air go SECTION 1 -SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: /►? exp e Q I / %� L/� �/� J� n ' /�� • Map Number Parcel Number 1.3 Zoning Information: / /T 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide Required I Provided I Required I Provided 1.7 Water Supply M.G.L.C.40. R 54) Zone 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ one Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ChA-R L eS C-riun,�cP /� C.9sfLe�✓1e,�e Name (Print) Address for Service Signature 2.2 Owner of Record: Name Print -7-N - Telephone Signature Telephone SECTION 3 - CONSTRUCTION SERVICES `3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Jq Addressyi ature Telephone 3.2 Registered Home Improvement Contractor e //3zz Co ny Name Address �.I 3 Address for Service: Not Applicable ❑ License Number Expiration Date Not Applicable ❑ Registration NumbeftI D Expiration Date M IV SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) b4 Alterations(s) 19 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �m6rl �l 3 R+4 Z P hEk-% SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beOFFICIAL Completed by permit applicant USE i NLY 1. Building//a f .2`1 0 , (a) BuildingPermit Fee Multiplier ` 2 Electrical (b) Estimated Total Cost of Construction a r, 3 Plumbing Building Permit fee (a) X (b) I b 1✓ 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on h in al att s relative to work authorized by this building permit application. Si i< e of Owner Date SE ON 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Pzin� me %% 46_/l go J L Si&Cgure of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIIAENSIONS OF SILLS DINIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING W, SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE '" if L- S r- �] w � 1.1 C = =zo r � r m D m o m X o m D c D CL v 0 C13 r \1 x `D DI Cr CD D o o c c Z 0 ( G Q A O n r o rn ZGi. 1mm 0 cn N N | � 10 LU�| ca OT!�. ■ 2 �} � %�, n. \\522---- -- ��. 31 §2 - 7f§ ))A X77 M 7f2 i 02/28/2000 08:13 6033824036 BEAULIEU CABINETRY PAGE 04 Ln woo 200 L Q EZM 3A C �(iLL 00 N00 d M � 02/28/2000 08;13 6033824036 BEAULIEU CABINETRY PAGE 03 02/28/2000 08:13 603382403E BEAULIEU CABINETRY PAGE 05 I 02/26/2000 08:13 6033824038 BEAULIEU CABI�ETRV PAGE 06 02/28/2000 08:13 6033824038 BEAULIEU CABINETRY PAGE 11 02/28/2000 .08:13 6023824038 BEAULIEU CABINETRY PAGE 10 O O z x A Q uo u w° cn O z z Q CA cov -o w94 G E U m w O U w a °C° co w O W aa U w ,� °C° � u v cn is ri O U w z (� 00 C4 m w W x w A w W� z ,. cn v O cn �CD C v EW o� J V R ' = C y CAM E act m C VJ G s .:s H !� E E 0 C «. ci c, :ate E CL U CIO m 7 c ca y4m3 s;�� h co y C, I V I�-� 1 Ey W 0 s �CD U d V Lm LC/) CD CM C3 o m cc c �C2c Q � �®C •0 1 = m m CS N . F— O CLC H m •.. tq m r _ yyj +L•+ 3 y... C H M Ct A Z LU E � � se o M C2.0 g N d O� O�Cos CDm 5 S 0. CO2 H CLi co C 0 as v ev ME CO2 O .a H c LD 0 O �C d H i 0 am CL CO) E CO CM O � m CD co cv � 3� O D o o a C. cma C rte•+ C O O -i •� O CO Z co CL CO) C r•r 0 LLJW w ccLU 11% U, a-3�9- e7 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING I his certifies that ......... .................................... ! ............................... has permission to perform ........... ................................................................... wiring in the building of .... ........ 4-.'r7 ................................................. ............................... . North Andover, Mass. Fe4e-4��..*'.. Lic. NoA�".�ap ............... Check # 8663 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/07] (jfavPhlanlrl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC , 527 C R 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: Stop p, City or Town of: NORTH ANDOVER To the Imp forof By this application the undersignedfres: gives notice o Phis or her intention to perform the electrical work described below. / -w Location (Street & Number) Owner or Tenant /11"P 51Z Owner's Address Telephone No. S'i(D�� Is this permit in conjunction wi a building permit? ® !/�S� ��) ,�l � � Yes No E] (Check Appropriate Boz) Purpose of Building vC._ Q 1/ Utility Authorization No. Ezisiing Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work:/�,�1 ��ylVoe)t, AVJ0 e- ,� L✓/lZ j 2 /Ud2� /u�iyi /�� I Aa!HW4/ i --••��• awirea, or as required by the Inspector of Wires. Estimated Value of lecJ 'hal ork: (When required by municipal policy.) Work to Start: 3/ (/ Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE C VE GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the p and nalties of perjury, that the information on this application is true and complete. FIRM NAME: ��/2i &C� p LIC. NO.: Jc2i,Sr %V 1 JZ Licensee: �00,0W /!�y/ yl/j D Signature (If applicable, enter "exempt " itl the license number line., LIC. NO.: Address: '7 2 7 S ce!L) R � 64 -0/,))10 O J? Z Bus. Tel. No.*17RE *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt L cl No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ I- -A 3 t7 P-7 f I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 1irashington Street Boston, MA 02111 1' 1 www.nxass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual)' EZ,o c) 2--7 -- ' '(? P-o'i 4_., City/State/Zip:(A C D n/j A/// V ' Phone 1-,31 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. Q Demolition 9. ❑ Building addition 10. Q Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑ Other s owing theirwo ers eompensatmn policy mtormatiott. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their !vorkM' co,^ p. polio intbrnation. M lam an employer that is pr'?Wing:workers' campensadon insurance for my. employees: Below is the information policy and job site Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead 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 cextafy U. under he pains and ppeenaai es of perjury hat the information provided above is tact and correct 0 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 ['lAM Contact Person: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2.� I am a.sole proprietor or partner_ have hired the sub -contractors listed on the attached sheet, t ship and have no employees These sub -contractors have working for me .in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGG myself [No -workers' comp. c. 1.52, § 1(4), and we have no insurancerequired.] t employees. [No workers' comp. insurance required.] "Any applicant that checks boil # l must also fill out the section below hrk 1-,31 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. Q Demolition 9. ❑ Building addition 10. Q Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑ Other s owing theirwo ers eompensatmn policy mtormatiott. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their !vorkM' co,^ p. polio intbrnation. M lam an employer that is pr'?Wing:workers' campensadon insurance for my. employees: Below is the information policy and job site Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead 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 cextafy U. under he pains and ppeenaai es of perjury hat the information provided above is tact and correct 0 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 ['lAM Contact Person: Phone #: b Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 'However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance; construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance 'coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not'the Department of , Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the numberlisted below, Self-insured companies should enter their S" self insurance 11license 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 permi0icense 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 bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigptions would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give as a tail. 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. # 617-727-4904 ext 406 or 1-11.77-MASSAFE Revised 5-26-05 Fax # 617-727-7744 www.mass.gov/dia Structural Response, LL, C Stt•t�c°ttn�crl Ei��i��ee3�� Seer~ti•�ces �,��°�'.s•trtrc�trrluh•es�crose.corrr CONSTRUCTION CONTROL AFFIDAVIT IN ACCORDANCE WITH THE MASSACHUSETTS STATE BUILDING CODE 7T" EDITION FINAL INSPECTION of STRUCTURAL WORK PROJECT NUMBER: 08196 PROJECT TITLE: Residential Addition PROJECT LOCATION: 10 Castlemere Place North Andover, Ma 01845 NATURE OF PROJECT: New addition and modification to ceiling in one room. Please find below the "Notarial Acknowledgment" required by the Commonwealth of Massachusetts. It attest s.to the authenticity of this document that states Scott E. Nelson, P.E. has. inspected the structural framing for the PROJECT noted above. The Final Inspection was done by Scott E. Nelson, P.E. on 4, 10, 2009. THE SCOPE OF WORK REFLECTED IN THIS AFFIDAVIT IS FOR THE STRUCTURAL DESIGN/ CONSTRUCTION OF THE LVL. RIDGE AND ASSOCIATED POST SUPPORTS, FLOOR I -JOISTS, TALL WALL FRAMING AND WIND BRACING AND CATHEDRA.L.CEILING IN BEDROOM. I, as the. Affidavited Structural Engineer of Record (SER), hereby certify that I have conducted the structural review of the above stated PROJECT and find that the framing .has been properly installed in accordance with the original structural design calculations, revisions thereto and the 7`h Edition Building Code of the Commonwealth of Massachusetts and.all applicable Codes and is functioning as intended. All required members and supports have been properly installed and meet the strength requirements of the design: �OF A44 - ORIGINAL SIGNATURE 3 SEAT-- - BATE Notarial Acknowledgment: Sscribed and sworn to before this . n day `✓f—) � 2 My Commission Expires J4 r �� i Date...................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................... ../7,/ ........... has permission for. gas installation .......................... in the buildings/of ... at ........ . . . . . . 7�? North Andover, Mass. Fee Lic. No ........... .. ...... .............. ASI 4ECTOR Check# cPc9;�-�c;2 6735 FIXTI IRFS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CitylTown: h , 'MA. Date: 3 - 2G — 0 � Permit# Building Location44 • Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: 2010' Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTI IRFS INSJJRANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 0 No If y6u have cheoked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, anil thattrty sign'atvre,on'this permit a'pplicatio`n waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box Lj; I hereby certify that all of the details and information i have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: BY E] Plumber ❑ Gas Fitter Signature of Icensed Plumber/Gas Fitter Title.._..___._.._....,_.____u...-�._:..:..........__..... 10 Master g City/Town []journeyman License Number: 8678 APPROVED (OFFICE USE ONLY) ❑ LP Installer C6 Z fnN U = U co 1-" OG F- m= z H Q Z J p w fn w W 0~Q W IX w (� w m O a. O F= - W X Q' > w N U z w W IY .. w 3 W Q F- w w I- 0 = LL IX > z V .w Z w >- t C7 (n -� P Q H Q O z m w -i O t7 z LL O y> w Z w w I-- 0 o o 0_= Lu g o W IX >>> 3 0 LL cal 1 1 as SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 1H FLOOR 5 FLOOR 6 FLOOR 7 FLOOR OOR _ Check One Only Certificate # Installintg`CompanyName: Uptack Plumbing & Heating, Inc. [9 Corporation 1415 Address: 32 Rochambault Cityfrown:Haverhill State: MA ❑ Partnership BusinessTel:978 372-8503 Fax: 978 521-1438 ❑ Firin/Company Name of Licensed Plumber/Gas Fitter: Leonard A. Hall INSJJRANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 0 No If y6u have cheoked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, anil thattrty sign'atvre,on'this permit a'pplicatio`n waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box Lj; I hereby certify that all of the details and information i have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: BY E] Plumber ❑ Gas Fitter Signature of Icensed Plumber/Gas Fitter Title.._..___._.._....,_.____u...-�._:..:..........__..... 10 Master g City/Town []journeyman License Number: 8678 APPROVED (OFFICE USE ONLY) ❑ LP Installer Date ............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..... ......................... �/ ................... has permission to perform plumbing in the buildings of ....................... at ........ ............ North Andover, Mass. Fe-ee-��' Lic. No.;�' ............... PLVMB/'(NG INSPECTOR Check #Q>'� I FIXTt1RFS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING CityfTown: /I , MA. Date: 1—;-4-09 Permit# Building Location: /0 �� A� Owners Name: 6" Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: 0O' Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTt1RFS I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes ® No ❑ If you have checked Yes. please Indicate the type of coverage by checking the appropriate box below. A liability insurance .policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Aaent entered) regarding this application are true and Knowledge and that all plumbing work and installations performed under the it issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and ChaptqK42 ofvhe General Laws. BY Type of. License: rdle ❑ Plumber Citylrown ® Master APPROVED (OFFICE USE ONLY) []Journeyman Signer of Licensed Plumber License Number: 8678 0 my z z Y � V wW CO) CO) z zN} J (J W c) W "j) \ a o:. w CO) 9 U) z ag to 1— w z m -4 z❑ O d. a U. Q N❑ W Q w� O CO) N CO) z lz� W Q _ O b 1— 3 x z a '-' �+- 3 a Y J Q x w w W W Q Q� N_5 Q p >> Op =� Q Q 'S Q Q H a m m❑❑ u. (9 x`1 IX to m P 5 3 O SUB BSMT. BASEMENT 1 3T FLOOR 2 FLOOR j'—FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check Gine "Only Certificate # Installing Company Name: Uptack Plumbing & Heating, Inc . 9 Corporation 1415 Address: 32 Rochambault cityrrown: Have rhi 11 State: MA ❑Partnership Business Tel: 978 372-85.03 Fax: 978 521-1438 ❑ Firm/Company Name of Licensed Plumber: Leonard A. H 11 I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes ® No ❑ If you have checked Yes. please Indicate the type of coverage by checking the appropriate box below. A liability insurance .policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Aaent entered) regarding this application are true and Knowledge and that all plumbing work and installations performed under the it issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and ChaptqK42 ofvhe General Laws. BY Type of. License: rdle ❑ Plumber Citylrown ® Master APPROVED (OFFICE USE ONLY) []Journeyman Signer of Licensed Plumber License Number: 8678 0 my Date 41. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................ has permission to perform .... ..... 'Ivw� ................ wiring in the building of .. .... ....................... at ... A F)PIPI-iF ....................... . North Andover, Mass. FeeC4�k..� . ..... Lic. No. . ........... (A� P-4 7 E* Check # 8568 Commonwealth of Massachusetts Official Use Only *' J Permit No. ��-7y Department of Fire Services -- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) /0 l !f s f lerne— zje-.-� Owner or Tenant Telephone No. Owner's Address ri Is this permit in conjunction with a building permit? Purpose of Building Existing Service New Service Amps / Volts Amps / Volts Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: Yes � No ❑ (Check Appropriate Boz) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters ------•--»....�..u. --, y uusirea, or as required by the Inspector of Wires. stimate Value of Electric Work: --1 (When required by municipal policy.) Work to Start: 1)I'MOT Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains aril enaldes o perjury,,ffiat the ink formation on this application is true and complete. FIRM NAME: /✓ fiQ,i C� C.t..'`.� . NO.: Licensee::COWJVI 1�/l.�y�/�� Signature (Vapplicable, enter "exempt" in the lic nny�e numb line.) LIC. NO.: Address: `i 2":7 7 .S�e N 1 G SCJ /14f�>f✓1 iA /i�i�l • (,�3 .� Bus. Tel. No. -46y-'..361-3 7 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, secunty work requires Department of Public Safety S License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. t' j www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A P icant Information Please Print Leggibiv Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: . Are you an employer? Check the appropriate box: The Commonwealth of Massachusetts k� 1 Department of Industrial Accidents Office of Investigations have hired the sub -contractors listed t 600 Nrashington Street on the attached sheet These sub -contractors have Boston, ALL 02111 workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ i am a homeowner doing all work t' j www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A P icant Information Please Print Leggibiv Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: . Are you an employer? Check the appropriate box: LEI ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am asole proprietor or have hired the sub -contractors listed t partner- ship and have no employees on the attached sheet These sub -contractors have working for mein any capacity, [Na workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ i am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No•workers' comp. c. 1.52, § I(4), and we have no. insurance required.] t employees. [No workers' tA- -t. comp, insurance required_] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑.Other t rr••-�•^ ••w. w,wR� uux n must also nu out the section below showing their workers' compensation policy information, Homeowners who submit this efiPdavit 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 additiorml sheet showing. the name of the sub-rontrar ors and their workers' comp. policy inforniation. lam an employer that is prouiding:workers' compensation insurance for my employees: B information elow is the policy and jab site Insurance Company Name: Policy # or Self -ins. Lie. #: Job Site Address: Expiration Date: City/State/Zip- Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town officiaL IF 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 #: h Information and Instructions Massachusetts General Laws chapter 152 requires all emp iti oyers 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 trusted 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 I52, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of pubiic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation. affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not1he 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 a* the nurnberlisted below. Sel,r 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 permitllicense number which will be used as a reference number. in addition, an applicant that must submit multiple permiMicense 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 fisture permits or licenses. A new affidavit must be filled out each year. When 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 bum 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 as 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 1-8.77-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www_mass.gov/dia Date. TOWN OFNORTH ANDOVER PERMIT FOR PLUMBING _7 SA US This certifies that .......................... has permission to perform !c --r7. Vq ............... plumbing in the buildings of. ................ at. North Andover, Mass. 17631�. Lic. No..,F�- ; ... ... o'.-.-;�; ...... . .. A4--> � ............. PLUMBIIIN. SPECTOR 6E Check# 7 4 2 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) x Building /0 AT: Location Date CJ — 1� Permit # Owner's ��*, Name Type of New ❑ Renovation ❑ Replacement Occupancy:_ u 1 hereby certify that all of the details and information I have submitted (or entered) in above application are ince and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Caws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Snsurwer O/Agent I have a current liability insurance polity to include completed operations coverage. Si ure of Licensed Plumber By Title City/Town APPROVED (OFFICE USE ONLY) Type of Plumbing License 8678 6 X Master ❑ Journeyman License Number FIXTURES Plans Submitted: Yes ❑ No ❑'� N 2 z O 0 N Y_ a Q in W Y z N J N Q N M J U N z N y Y m Jr- N W !� Q W F to N Z Q W N O z � X c 6 cc Occ LL ty 0 F 7 = Q F. W N z .E a W N J tY a l., Q Y z z O J W W t- Q U> F Q f O X Q 0 N a Q y a !- O Z O C Q JJ N Q tr m W I' O U Y Q O Q F 3 Y J m to c c J 3 I- 0 �+- c� � c a 3 W m 0 SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check One: Certificate Installing Company Name Uptack Plumbing & Heating, Inc 13 Corp 1415 Address 32 Rochambault Street ❑ Partnership Haverhill, MA 01832 ❑ Firm/ Company Business Telephone 978 372-8503 Name of Licensed Plumber or Gasfitter Leonard A. Hall 1 hereby certify that all of the details and information I have submitted (or entered) in above application are ince and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Caws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Snsurwer O/Agent I have a current liability insurance polity to include completed operations coverage. Si ure of Licensed Plumber By Title City/Town APPROVED (OFFICE USE ONLY) Type of Plumbing License 8678 6 X Master ❑ Journeyman License Number MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) h� r Date p— L j 2006 Permit # Vi J Building /� Owner's AT: Location0 (�f Name R GNew ❑ Renovation ❑ Plans Submitted Yes ❑ Nolte Type of Occupancy: -i42- Replacement o PERMIT FOR GA INSTALLATION ` 5 ss.4c HUSEtt This certifies that•�,........... has permission for gas (installation in the buildings of ....- .:�,.� �,,� �-. ' • • --�-t�� .. North Andover, Mass. Fee -Rn �... Lic. Nord„ GAS INSPECT Check # !/% 5738 City/ Town APPROVED (OFFICE USE ONLY) Corp. ❑ Partnership ❑ Firm/ Company 1415 Plumber or Gasfitter A. Hall lication are true and accurate to the best of my ication will be in compliance with all pertinent .y�yerations coverage. Signature of Licensed Plumber or Gasfitter :• ❑ Journeyman License Number �a N N N Y V W Z N ¢ N W W xO W F V m f Z N Z O W JC < X Z O m n O Z w F- O N W N Q W Z O I-. U) a O ¢ W > Q W N C7 xN F. Z F- V Z W= W m W O a O oc > W G ►W- W J H W Z Q Q W> W J Q= W O I. Z H Q !• 0 N q 9 0 Q Z O O O Z W W O O W Z H Z = O t1 Y U. O 3 O j U it > I O I a 1- O SUB,—BSMT. BASEMENT 1ST FLOOR 2NDFLOOR Date. f .. pORTH • TOWN OF NORT ANDOVER & One: Certificate o PERMIT FOR GA INSTALLATION ` 5 ss.4c HUSEtt This certifies that•�,........... has permission for gas (installation in the buildings of ....- .:�,.� �,,� �-. ' • • --�-t�� .. North Andover, Mass. Fee -Rn �... Lic. Nord„ GAS INSPECT Check # !/% 5738 City/ Town APPROVED (OFFICE USE ONLY) Corp. ❑ Partnership ❑ Firm/ Company 1415 Plumber or Gasfitter A. Hall lication are true and accurate to the best of my ication will be in compliance with all pertinent .y�yerations coverage. Signature of Licensed Plumber or Gasfitter :• ❑ Journeyman License Number �a V) A 4 uj W CL. 4A G LA LA W u 0 a a z O W W L6 L6 a O 3 O W m u i 1 d i z N ^J 4. V 0 0 H ~1 a z z o z: z o m i ° �. 0 L6 4 U 0 W o. m W 0 < u a0 a Z OW W LL W Z < 0 .. O Z � i 1 d N ^J 4. R.J.Huberdeau Carpenter/Builder 53 Sunrise St. Haverhill,Ma. 01830-2321 Tel. # 978-372-6948 Name: Town of No. Andover c/o Mr. Michael McGuire Local Building Inspector Address 27 Charles St. City, State North Andover.Ma. 01845 Date 10/2/2000. Dear Mr McQuire, As of Tuesday August 1 5,2000. 1 am no longer working in the capacity of carpenter at the 10 Castlemere Place residence of Mr. & Mrs. Charles George. I request that my name; license no. and Home Improvement Registration no. removed from the incompleted permits. I assume no liability after the above mentioned date. /N-00 lNspee. l"eyu'-541 l��SS, y'�t/7 7'h c�wv yrs os N G S l' y N /7`e /,M / /9 /a/? cc: Mr. & Mrs. Charles George Mr. Michael McGuire OCT 5o EN 2000 Sincerely, v, / ' kd.a'�L R.J.Huberdeau .2' -?' Date .. ) ... oz:� .......... 2254 .... .... . ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... I ................................................................ has permission to perform ........................................ ..................... wiring in the building of ......................................................................... at ........................................................................ ........ . North Andover, Mass. /"' e"Z." /) - '7 ' -/ Fee ... ... . .... Lic. No. ..... ......... 11 ...... ZI -6 .;; ................................ -F.T.RCTRWAT 1wqPiPr-mR IC:� �7'11 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Comm) 4at�t: of massac6d� orn��t u� 0121Y �� — 2aLZ (? Pet'mit No. 2fPalh 0�,7:'f Jtr6 kw � d BOARD OF FIRE PREVENTION REGULATIONS ivi1199 and Fee Checked r � jeave break APPLICATION FOR _PERMIT'TO PERFORM ELECTRICAL WORK x All mrk to be perfornwd in sieonianeo with.d.W,M==chU*1s LlOric-A Code (i EP. 527.CNIR.12.00 (PLEASE=PRINTJNINK 4RT)q_,L•ALL.IWOJ It 17lONj City:or Town of: ,Vi��i I,� = i�1 �h®�i/� T'o.the.lnspetaor of FYi�es , ty titin applicationthe uiidersigried gives notice o iris or her intention to perform the eteeftal work described below, • Location (Street & Number) Owner or Tenant L' ' iC 01cTelephone No. Owner's Address I+: this permit in canjunctiori OP �rrtir a bultdiag pernri . Yea ® ►�U t '(Check Appropriate Box) • ? Furpuse of Building &&C, t1 ai& j Utility Authorization r o. Existing Service Anips Volts Overhead ❑ Undgrd ❑ - No. of 51aters '. rfgy r 'tee _ Amps ! „�„Yalts Overheat! ❑ Undgrd ❑ No. of Meters,' i Plumber of Feeders and Ampacity Location and Nature of Proposed Electrical Work: i Co+mlett0n W &elolla%►*w tob/e Mai,be ti►etivect by the inspector JYfret. No. of Recessed Fixtures No. orCoA.-Susp. (Paddle) Fans OTHER: Attach addlaonal detail !f desired, or as required by the Inipfctor of ;Vires. INSURANCE COVERAGE: Unless Waived by the owner, no permit for the perfornsance of electrical work niay issue unless ;he licensee provides proof of liability insurance including "completed operation" coYerage or its substintial equivalent. 7I3e undersigned certifies that such covs ge is in force, and has e:dubited proof of same to the permit issuing office, CHECK ONE: lNSURANCqZj BOND 0 OTHER ❑ (Specify:) (Expiration Date] Estimated Value of Electrical Work:' {When required by municipal policy.) Wort: to Start: /Aw/ Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cerdj)y under tlhe pains arty! penaltles of perjury, that the laformadon on this appiiratdon it Ince and complete I' IRial NAME: v A/ei1,�r�,i ,�.G erklt" /,v e LIC. NO.: `7 6 3 9 Licensee: Signature L1C. NO..gQ,Z,� l (1faltPllcAblf, ewer "aertnpt" i,t file !!tensanumber lhte.) __ Bus. Tel: No�-�-?�� Address: All. Tel. No.: OWNER'S I4'gSVRANUE NVAiVER! I am aware that the Licensee does not have the liability insurance coyera$e normally :Mquired by law. By my signaticrc below, I hereby %vaivc this requirement, i am the (chs%: gone) ❑ o cr ❑ o�mer`s went. Owner/Agent o { PisRtti77"FEE: 5 /� :Signature ieIepl:orieh'u. � •� No. of It�A No. of Lighting Outlets No. of Hot Tabs - Generators XVA No. of Lighting Mtures No. ofR' ecaptacle Onticta S� Pool A d,e � rind: � o. o€Oil BvrnI" . _ P40. 01 Ae � ng Datt FSEAI.AR,iKS Yo. of ?,dues . Pio. orS'hvitches No. im".13urners 1406-01 `0Duces 'a No. of Ranges . " Y' P0.0 Tons Cama Iona No. or Alerfing Devlees No. of waste Dis oaera P T r ons o: o e ora ftectiontAlerting Revicea IINo. of Dishw"Ashers rye l No. of Dryers SpacdArea Heating KNY Head Appllances MY Local ❑�rreopti l ❑ Other ` security erns: No. orDevices or tagyalent " v. of Water' Heaters ICtiV 0.0 IN 0.4 SIMS Ballasts IiatA Wiring: No. of galLces or Equivalent No. HYdrotnasa ga Bathtubs , No. ofhotors TotalHP Telecommunications ng: va of Devices or Eaulvilent OTHER: Attach addlaonal detail !f desired, or as required by the Inipfctor of ;Vires. INSURANCE COVERAGE: Unless Waived by the owner, no permit for the perfornsance of electrical work niay issue unless ;he licensee provides proof of liability insurance including "completed operation" coYerage or its substintial equivalent. 7I3e undersigned certifies that such covs ge is in force, and has e:dubited proof of same to the permit issuing office, CHECK ONE: lNSURANCqZj BOND 0 OTHER ❑ (Specify:) (Expiration Date] Estimated Value of Electrical Work:' {When required by municipal policy.) Wort: to Start: /Aw/ Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cerdj)y under tlhe pains arty! penaltles of perjury, that the laformadon on this appiiratdon it Ince and complete I' IRial NAME: v A/ei1,�r�,i ,�.G erklt" /,v e LIC. NO.: `7 6 3 9 Licensee: Signature L1C. NO..gQ,Z,� l (1faltPllcAblf, ewer "aertnpt" i,t file !!tensanumber lhte.) __ Bus. Tel: No�-�-?�� Address: All. Tel. No.: OWNER'S I4'gSVRANUE NVAiVER! I am aware that the Licensee does not have the liability insurance coyera$e normally :Mquired by law. By my signaticrc below, I hereby %vaivc this requirement, i am the (chs%: gone) ❑ o cr ❑ o�mer`s went. Owner/Agent o { PisRtti77"FEE: 5 /� :Signature ieIepl:orieh'u. � •� f N2 4330 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING CH This certifies that ....................................... P has permission to perform ............. plumbing in the buildings of .................... at. /0. . . ... ........... North Andover, Mass. OV 0. Fee:'�' .... Lic. N .... .. ............. .. . z PLUM BING"I(NSPE'CTOR '-'4 i /j / J-/ 7 (0 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) ' Mass. Date 1 6 fi8 Permit #_ 3� �d Building Location L10 er's Name f' ;_;Type of Occupancy V New ❑ Renovation 0-' Replacement ❑ Pians Submitted: Yes ❑ No FIXTURES Installing Company Name Uptack Plumbing & Heating, Address 32 Rochambault Street Haverhill, MA 01832 Business Telephone 508 372-8503 Name of Licensed Plumber Leonard A. Hall Inc Check one: 9'�:orporation ❑ Partnership ❑ Flan/Co. Certificate 1111 INSURANCE COVERAGE: I have a curve liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy O� Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and acauate to the best of my knowledge and that all plumbing work and installations performed u the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code ter 142 of the law Signature tun TWO Type of License: Master Er Journeyman ❑ City/Town 8 6 7 8 License Number z i y � y to y z Q Y_ z W W I- W y Y J J Q3 Y < V < ~ to O O Z y ¢ ¢ y Q Z W y W < ►� m W y Q F =¢ V y Y z y W z 6 a 3 X X V S 'A m y y Q Y W !� y y ¢ G < y y z Q O. .a O W us UAU< 3 r s 3� W y d o~ z J G C D s IL z y N _z W o u s < r < < 2 y y < < 0 Q 3 O < H Ip O O J 3= r y Y. C7 >> < ¢ m O SUB—BSMT. BASEMENT 1ST FLOOR 2140 FLOOR 3RO FLOOR 4TH FLOOR STH FLOOR eTH FLOOR TTH FLOOR STH FLOOR Installing Company Name Uptack Plumbing & Heating, Address 32 Rochambault Street Haverhill, MA 01832 Business Telephone 508 372-8503 Name of Licensed Plumber Leonard A. Hall Inc Check one: 9'�:orporation ❑ Partnership ❑ Flan/Co. Certificate 1111 INSURANCE COVERAGE: I have a curve liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy O� Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and acauate to the best of my knowledge and that all plumbing work and installations performed u the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code ter 142 of the law Signature tun TWO Type of License: Master Er Journeyman ❑ City/Town 8 6 7 8 License Number I /to (,A Location s1le in to /?,f No:. e TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Z G2, Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ A4 Building Inspector 3 5 7 04/20/99 14-49 162. oo PAID Div. Public Works M I Ml= u F-' FEW �n <4 ° C7 � w x cti O O p Z U O I t � v� O i� CT � w 3 \ Q 0 Ltj rA F ° ♦ z j in w 0. H � a r w a a z a o I t � v� i� CT � 3 \ Q 0 Ltj rA F ° ♦ z j in w 0. w � O rv, AQ 0 �� \ vE, W •-� z � � U E"r °¢ z° z 0 a cU7 w s F J z z o w x w z¢ z z a z z a O w QQ w uwu w O z O F oz [s - W U G i� CT o _ 3 \ o 0 Ltj rA F ° ♦ z j in w 0. i� o _ 3 \ o 0 Ltj rA F ° ♦ z j in w 0. cic Wco - - o N uj -10 t1 ¢ CX c_J W CO O .0 m O ZE 22 �J ca �- i C~ W Q= a Jfr�' Fes-' The Commonwealth of Massachusetts Department of Industrial Accidents Office Ofmyestlgat/ons 600 Washington Street Boston, Mass. 0 111 `J Workers' Compensation Insurance Affidavit city NO . AA1 n,,)Ile, e— A ,�- - phone one # 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. city: phone #- inaarance co.. P.3 C.f Failure to secure coverage as required under Section 25A of i'YIG L 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years' imprisonment as well as civil penalties in the form of :t STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct official use only do not write in this area to be completed by city or town official city or town: permit/license Building Department C]Licensing Board C] check if immediate response is required C]Selectmen's Office QHealth Department contact person: phone a; COther (r—sd 3195 PJA) Town of North Andover NORTH OFFICE OF 3� ° �."`0 �o L COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978) 688-9531 Fax (978) 688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit // Number i! %? is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: h() eG G 1/0, 6 JLocatiph of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 cz O] x w Q o 0 U C z z � m w o 0. azo ct w x W u ca ..a W rG u C/) UG o w z L ce Gi W a Q L m cn D cn ui am O ^moo Q� CD O co crO Z O in H CD .E CDCL co C O CD V _m CL y O .y O .0 CO2 0 U) Lij C/) Cc w LL) Ccw Lli U) c Q 0 CD c • o � C H _O C ' � O vU � �; C : Q W O CD C L O �.. —ca m �L 0 c vl t m 2 L C7 V: O d y o m ! t? m� 0 0. - ca lC j m m Q C3y m m C A m y C M �r y E w o m y CD OQ y G C �� m O � O • •�O�N Q oao F) • y C = m COD w W C eOv t m �-• L '=LOC N y •y .n r.+ V o-oc m V H O ^moo Q� CD O co crO Z O in H CD .E CDCL co C O CD V _m CL y O .y O .0 CO2 0 U) Lij C/) Cc w LL) Ccw Lli U) W --O,v E) Co 143" Rear Down Orah Unit W:136 utau8� z Valence "X44" _ _ OVEN c b? KP 3391.5-25D o I SBM 27G�o 1]3024 7 In v m tfi fin❑ 0N x or, L a 0 o C Z coo (n v 0 096_Zb8 _ ? la6X,zo,zz1I; 0a i z 6.9ezvM _ ,g lfn m` 96Dde \ Z'51834n s 5 7-T-- w _(D m a QcTdN d) Q V i� ry U � m ro C �2 1 —th1 �0 minyz$ ' C? w _ } 8 N8CL r a 1� c m � U In v m tfi fin❑ 0N x or, L a 0 o C Z coo (n v 0 096_Zb8 _ ? la6X,zo,zz1I; 0a i z 6.9ezvM _ ,g lfn m` 96Dde \ Z'51834n ii 5 w _(D m a QcTdN U Nx 7G 93 rlItd minyz$ Lo a C op In Oa01w � � H Wo leu9d v B r _ U i G0 3DVd alga LpamnH 9eI9 QIPEJJ I Ul.0 IeyUYeW 1e11.`� l „vi Vzo 6 Aa13NIavo n3I-inV39 QL 3 w�l a d � Q� S 0 — d N N a m Il N di �a in tU N W X I �m x a rr J LU c� m CC Xco LU L C CU 0- C a w �N' 96Dde \ Z'51834n ii 5 w _(D 9E9 6M 9£8Z09M G0 3DVd alga LpamnH 9eI9 QIPEJJ I Ul.0 IeyUYeW 1e11.`� l „vi Vzo 6 Aa13NIavo n3I-inV39 QL 3 w�l a d � Q� S 0 — d N N a m Il N di �a in tU N W X I �m x a rr J LU c� m CC Xco LU L C CU 0- C a w �N' 96Dde \ Z'51834n 5 w r 9E9 6M 9£8Z09M a I%I..m 0 �Q d'O !` 0 Q C��. �QctiO� 'v Co� >0 6- Q�jtN'LrSU�f N C Ce—(A U Cm N rn m E ao 0 as N O Tl N-0 •= r 0—.�C Q)p lid x _° as a "D SL Q 11 LL Z_w a� c 0 Co wo �'�n'N� "C7 cDCo CN"-'U9�V.XG�'aV W > O Co M 00 . C� Ce) F- C7 CLd N -0 -0 c i AO CQ ('z -00 o 8EOVZ86609 60:PT 666T/N/60 03/62/1999 14:63 6033824038 BEAULIEU CABINETRY PAGE 07 03/02/1999 14:03 6033824038 BE4ULZEU CABINETRY PAGE 09 g w 0318211999 14.93 603382.4038 BEAULIEU CABINETRY PAGE 08 r 03/02/1999 14:03 60338224038 1f X 1 �r I BEAULIEU CABINETRY PAGE 12 II ) 11 // dr-/"t� I t 0 03/02/1999 14:03 6033824038 BEAULIEU G'ABINETRV N PAGE 13 in 03/0211999 14:03 6033824038 BEAULIEU CABINETRY RAGE 06 'SPL As 03/02/1999 14:03 60338240.3E BEAULIEU CABINETRY PAGE 10 7 j A Q u 0310211999 14:03 6033824038 BEAULIEU CABINETRY PAGE 05 03/02/1999 14:03 1 / a 6033824038 BEAULIEU CABINETRY PAGE 11 1I I I t NORTFI Town of North Andover ° IV - '• �" Building Department p # Y 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta S^CHWO Building Commissioner (978) 688-9545 .`(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION /V . + 6 z M F f Number Street Address Map / lot "HOMEOWNER_VC� ` l 't t`(� c� d C Name Home Mione /nrie Di- - PRESENT ,.,o PRESENT MAILING ADDRESS City Town State Tip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Persons) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures ', HOMEOWNER'S SIGNATUR APPROVAL OF BUILDING OFFICIAL Locatio 16 2- Date TOWN OF NORTH ANDOVER Certificate of Occupancy .7 CHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # �6 3 7 5 Building Inspol6tor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/19534aCommissioner/19534ad of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Number Parcel Number A0, /JC%yek Rif- f-'Map 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required— Provided Required Provided 1.7 Water Supply M.G1-C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record C�PRCEs _� 64e_rc#,o1y 62066e lo Cyq3-11_eMP..eP fL Name (Print) j Address for Service : S�nature Telephone .y c 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 3, T 114,S&e/}LL Licensed Construction Supervisor: // X53 SU�J�isG' �'� h"A✓JR4/GL /Nk d lr3�X3 ��l Address Q n © 1 .F , 4j,_ �-PGGI-L 7 &__? � _' 4'�p S' ature Telephone Not Applicable ❑ License Number /� ra goo Ex iration Date 3.2 Registered Home Improvement Contractor :?T /&u Not Applicable ❑ //3Z 1f Company Name o",,5e J�L: />/Aoez,liLl Anss Registration Number Address ' O Expiration Date Sig re Telephone x K SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work checker applicable) New Construction Y Existing Building ❑ Repair(s) ❑ Alterations(s) s Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: lya� X 3'Z' ZeZW6ue x ��' 01-9� add /,.,?,'Xa'Y SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b permit a licant 0MCIAL;USE ONLY . 1. Building g .4aD Fee Multiplier gPennita., (a) 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1&4jo,6;�as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. (1111-3- /.? 0 QC Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2 No 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS D11VIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE IN i r f FORM U - LOT RELEASE FORM ATRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner- from compliance with any applicable requirements. APPLICANT°l1�'� �P(1��/� PHONE Ir 17v / ASSESSORS MAP NUMBER3,,7 A- LOT NUMBER OA'S SUBDIVISIONLOT NUMBER STREET" 9"`e Z`e- %� ( c STREET NUMBER .............................................................. ............ OFFICIAL USE ONLY RECONDAENDATIONS OF TOWN AGENTSSEE "ON�SER ■ .... ■................DATE APPROVEDON ADMINISTRATOR DATE REJECTED COMMENTS l v I l,�✓� S �(� d �� DATE APPROVED &/-q/4 Tod PLANNER DATE REJECTED Fff,, A9.4 71A) "42, " Wad! 0- WAF NSA �1,44 F�RpAr�,200 11 q 10 PRP Al � I I t".• FOOD INSPECTOR - HEALTH SEPTIC INSPECTOR - HEALTH CONffVENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE o m PL 0 T PLAN �{ I HEREBY CERTIFY TO THE TITLE INSUROR AND . IN TO THE BANK THAT THE DWELLING IS LOCATED ON THE LOT AS SHORN AND THAT IT DOES CONFORM WITH THE" --I OFA/ Q , 0 o'-E'e ZONING REGULATIONS REGARDING SETBACKS FROM STREETS & LOT LINES." " I FURTHER CERTIFY THAT THIS DWELLING IS NOT DRAWN FOR LOCATED IN THE FEDERAL FLOOD HAZARD oARE A oS� 00 G G SIIQI7N ON FEMA M LAITY PANEL # 2 - z - Y3 C-y�q��-S GEo2�E ✓'e DATE s 5O �/�,✓� / 99B e VAN SKI No.�e �s jIERRINACK ENGINEERING SERVICES MIT E ,PURPOSES NOT FOR THIS N �,tf 01V�+` BOUNDARY I:.'.F ORMATICN 66 PARK STREET TARN FRO Ifl�(G;CORDS. F 2333 ANDOVER, MASSACHUSETTS 01810 11 4i 8T]9,V.EN' HPj;19i4'iE�(� ;��'p('�K9i�l]Ai �ttl]1't`hlrifi77 :,4�?� • ,',,; 6rtiried„ Soil &itciti,�t'. Site Plans °tiYctlai]d Scientist •.�ti;.'.,'.�:. WeUt<nd Ihlin�ntiont� z�l� ':,. fini�'Sext'veys WeE.land Roglicatinn ['lane 1, ,`: ptia.£ygtgr]] Deolgns , FAX CO'VE.0 SWE TO.- O »" Q' •;�J`�_^ 10, FAX r10._.», __,_..__ �k RAVE: IA FROM: 8 , ' , "gyp �'��`[''��': .'•�, COMMENTS. C.O . -.';' �' ,;�!�.;,;�", ?„ "I ,i�11' Tui►+i 11+,r'u1 ; MA (MY21 S, ,.;. 1:.k;VEN J. ll.UHSU ',<.;. '" ` M i 41.3,"►?-S1H i 2 In vin�rrtr►r. ntrr! DeQi�►lt� ?''rfl-:' r' It r SEVEN J. VURN 1Reglstered ,Pro 6mional S New-Iiampel�aGt�s Site Plana Wetland'entiet. : ;` •.. foil Teats Wetland Delineations 8011 'Burve�s Wetland Replication Plans ".Va fi, ' besi gm Charles George fy', 10 Castlemere nr. N. Andover, MP. 01845 June '17, 2DQ0 S Dear Mx George: :3>;•,^.:,..�, ' S< .. On June 17, 2000: a Wetland Site tnveati,g C 's;'',a� s conducted at the cortzex. cif Great Pond 'Road &A It... I, ere Drive (#10 Castlemere)., •An, area of 32'5' aio: {<dl �e;. ropos d decks was examined: Proposed is 'a deck n'n .t'e'yt , .. side of: the existing 'dwel'ling and another dem°F,'a.tti in an.. existing•man-made pond. The lots around 'the', proposed deck•p ',azo . .,They. are either wooded, ledgy or lawn. No wet.lari;i :,hon. adjacent lands within 32.5' Soils 'are a wel.l'.drsined non -hydric outcrops of ledge (see' pg.. 3o Essex Cbun_'tY N' � Y u eY) Also see enclosed USGS ' Law "..�` I rence� .Quadrangl.�'.:�.' -;r.`;.::^`,.,":: STEVEN J. WURSO2. Pond Road ED virvnmmW DW:�'"•,: •Boxford• MA"O'921 • ':.:.: ,:. , .. ; '.. ' 'T' 9 P` qj ;:k'91Fyi f rn i f Y° u should h a,�r�••^. �'�Y '.quest..ans :^ °.::;,•�!,a�': or;: eon°$��g'��"'+,� '.�i�e ..do` not hesitate, to call .tete,"�'�^ti 4'iP;>> :.•b?'' .gyp,^' • i . q.R 1q�+q t Entr i X+bIl� aigns cc:' Charles' George enclosure SFN �i1C� L�' r, , •7`p' • �A At ��j ,t, , �Vd E0 39dd csHnc T N3A31S ZL86ZSE809 69:80 000Z/61/90 ✓fze �onvnxoruuea;/,�� a� ��,ad�3oc/t/cJP,%`6 . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 011761 Birthdate: 10/12/1954 Expires: 10/12/2001 Tr. no. 7642 —" Restricted To: 00 RICHARD J HUBERDEAU _ 53 SUNRISE ST HAVERHILL, MA 01830/ . Administrator ih:•+ � �..�� K hi � :, - ��/Ri�� I'fDbfl►IMOME�?�Gi A6.�isRt�ni w�//A _� f J it. MV #^*i`, r`.d.�=�/nn �.♦' n� � �..-{ t wit � M1�� ''�sEidpliSt3QA r�0�/�b�fl>< � �ti ERDEAIi',CARP1$!)11 -' ceaa�oxw �aUNRIS� a, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: A' Location: 10 C aSTi f.M e&�'e llire.. City Phone am a homeowner performing all work myself. jl am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone #: Insurance Co. Policy # Company name: - Address City: Phone #: Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andlor 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. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify under the pains and penalties of penury that the information provided above is true and correct Signature, Print Official use only do not write in this area to be completed by city or town official' ❑Check if immediate response is required Building Dept Contact person: Phone #: FORM WORKMAN'S COMPENSATION 6 / 1Y hone# qW-3 -00g ❑ Building Dept ❑ Licensing Board ❑ Selectman's Office ❑ Health Department ❑ Other Town of North Andover a� Na orH qti Building Department 0 27 Charles Street _ North Andover Massachusetts 01845 2 .^ 978 688-9545 Fax 978 688-9542 ID�NITED fPay,(y �SSACHIlS�� 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 cl 1, s150a. The debris will be disposed of in /at: Facility location (?V 9� 4L-4-t.�� - Si ture of A plicant - 0'J Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. -- j.._.. __ .._..... .,_ � �. 6\ . -�-� � i� �;(�'�J l� �� i� �U ` l III' ! II h I �� I t� :`� i I � �� .. I t� I i -�- �— �I J M �-- E ____ i �._./ ;`C i `t;� ?'.� � � __ �. �� e , r, (^, -- j.._.. __ .._..... m M m m 0 m .. .. CZ O CD CO2 'O CD 5z CD 7 y 1 O y C�• c 0 c CO) c) CD 0 CD 3 y CD CO2 �71- ri CD O CD 2"V 0 0 cn n O cn C �:j Ccm C 310m S Or -• N O Q y n E:0:9.0 .0 y = =m 0 o n yn d O m CD ?-0CL V! =rm d =r0 = y O y ••► o iaCAILO m a O OZ y. C.) C3 ,44. CA a mm CL „r mC2 O m m y H c -n 4t O p� y y d d ;� Q CL CA GO C/J y y 8 1 1 m d y M m;i�. rn m"� o � C=Dr V) z a e V) W. cd too'bO y O � O d d L CJ O : O C O ` tr cn 0 Crt a 71 w 0 7x w W O Ci7 ',v °� 6 aha ►� ni °' n 5 "1y O 7 ( �^• cprD O O.rLft 0 O Ti ti In �-A Location / V , S1111vr1pr No. Date TOWN OF NORTH ANDOVER '60 Certificate of Occupancy $ ACHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /03SO� .1 z -7 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING :' "i 't d. �r��- �F 1 kPsi'k '.. i.y yY� j,�� ,�pp a'' � � 5 3�F "i 31 k•�.rB ` '�. BUILDING PERMIT NUNIBER: a J DATE ISSUED: SIGNATURE: Building Commissioner/InspEctor of Buildings Date SEC'T'ION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: a �>c V -v Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Reauired Provided 1.7 Water Supply M.G.L.C.40. St 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 1 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSI-IP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) IAddress for Service Signature 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES I 3.1 Licensed Construction Supervisor: 0 �o'JS Licens Consi'l0ttction Supervisor: jH©MAS 5-AVF Y Address Signature Telephone 3.2 Registered` Home ImprovvernAt Contractor Comp Name Address irk 3—/ Telephone Address for Service: - 17V' -20Y Not Applicable ❑ License Number M 7�— I Expiration Date Not Applicable ❑ Registration Number Expiration Date SECTION 4 - WOREERS COMPENSATION (M. G. L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work (check all applicable) New Construction ❑ I Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ I Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item I Estimated Cost (Dollar) to be Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total1 +2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGEUOR CONTRACTOR APPLIES FOR BUILDING PERMIT vv as Uwnt Hereby authorize My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date /01 86—s; :ed Agent o subject property o act on zzvv- / property as Owner/Authorized Agent of subject Hereby declare that the statements and information on the foregoing application are true and accurate, to "the best of my knowledge and belief Print Name of Owner/ Benno NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TRABERS I sn SPAN DIMENSIONS OF SILLS DMIENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Date EM SIZE 2 THICKNESS X a w l j'c/zfreel .f�e z^ottztnfarztcxz� �� a , t� . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR = - Number: CS 051635 Birthdate: 05/29/1935 E Expires: 05/29/2003 Tr. no: 10219 Restricted To: 00 THOMAS J SAYERS 116 WASHINGTON STS! GROVELAND, MA 01834 Administrator Bnard of Building Regulations and Standards _ HOME IMPROVEMENT CONTRACTOR v ,y Registration: 108503 Expiration: 08/19/2002 Type: PRIVATE CORPORATION J N R GUTTERS, INC. Jonathon Raymond 114 Hale St.� Haverhi!!, MA 01830 Administrator Client#: 13716 JNRGU DATE (MM1DDNY) �(„IM. CERTIFICATE OF LIABILITY INSURANCE 05/23/01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION B K. McCarthy Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 100 Cummings Center Suite#lO1F HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR g ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beverly MA 01915-6105 978 927-8899 ENSURED -- -------------- JNR Gutters, Inc. 114 Hale Street, Suite 204 Haverhill, MA 01830 COVERAGES INSURERS AFFORDING COVERAGE INSURER A' The Travelers Insurance Company^ INSURERS: H.T. Bailey Insurance Agency_, Inc. INSURERC: Continental Casualty Company INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH OrU lf'MC Ar2rr0crl1kT1: I IKAITSZ cunww UAV NAVE RFFN RFDtICFD RY PAID CLAIMS. LTRR TYPE OF INSURANCE POLICY+ HUMBER POLICY ATE POLICY EXPIRAMAJ DATE MID LIMITS A I GENERAL LIABILITY 1 6 8 0 8 7 7Y 616 5 INDO 0 06/12/00 06/12/01 EACH OCCURRENCE S 1_,_Q_0.0 , 0 0 0_ . X COMMERCIAL GENERAL LIABILITY Or .O O _ _ FIRE DAMAGE (Any one fre) �_3—O MED EXP (Any one person) CLAIMS MADE a OCCUR S5,000 PERSONAL a ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIM IT APPLIES PER: PRODUCTS-COMP/OP AGG' S2 f 00 0 0 0 0 POLICY jRa LOC A� oMoiwu LIABILITY I 810 8 6 5 H 6 6 5 9 I ND 0 0 07/01/00 06/21/01 COMBINED SINGLE LIMIT $500, 000 ANY AUTO I ��) — BODILY INJURY Is (Per Person) HALL OWNED AUTOS X SCHEDULEDAUTOS IRED AUTOSBODILY INJURY iSON-OWNEDAUTOS EN (Peraccidem) rive Other Ca PROPERTY DAMAGE I S _ (Peraccident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 1S ANY AUTO OTHER THAN EA ACC jS AUTO ONLY: AGO :S A LIABILITY I SFCUP8 81D13 3 2 INCO 06/12/00 06/12/O1 EACH OCCURRENCE S4 , 000, 000 AGGREGATE s4 000, 000 6EXCESS OCCUR El CLAIMS MADE s _ DEDUCTIBLE --- - _ _ —�S-- X RETENTION s 5 0 0 0 I _$ C WORKERS COMPENSATION AND WC2 2 2 812 3 0 0 09/20/00 0 9 2 O O 1 / / WC STATru UMI IOTH 9RYTSI—LER_J___— ' EMPLOYERS'UASILITY EL EACH ACCIDENT S 10 0, 0 0 0 _ _S 10 0_, 0 0 0 EL DISEASE - EA EMPLOYEE EL DISEASE - POLICY LIMIT 5 5 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONSILOCAT70NSNEMCLES/EXCLIIStONS ADDED BY ENDORSEMENWSPECIAL PROVISIONS Evidence of Insurance CERTIFICATE HOLDER AD DITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANYOFTHE ABOYE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION JNR Gutters, Inc. DATE THEREOF, THE ISSUING R R 0 AVOR TOMAILIO__DAYSWRITTEN 114 Hale Street, Suite 204 NOTICETOTHECERTIFICATE H E ELEFT, BUTFAILURETODOSOSHALL Haverhill, MA 01830 IMPOSE NOOBLIGATIONORLI BIL DUPON URERJTSAGENTSOR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE p'ItTroposa1 Free Estimates Qi-RGUTTERS' INC, Fully Insured "Your Home improvement Specialist" All Types of Home Improvement Seamless Gutters • Vinyl Siding and Trim Work www.jnrgutters.baweb.com Haverhill. MA: (978) 372-4088 114 Hale Street, Suite 204 Nashua.NH: (603) 595-2272 Wobum. MA: (781) 937-4212 Haverhill. MA 01830 Portsmouth, NH: (603) 433-1811 $niton, MA: (617) 423-3559 Manchester. NH: (603) 666-5502 Massachusetts: (800) 552-0030 FAX: (978) 372-0360 Toll Free Nationwide: (800) 966.9238 (in Mass only) PROPOSAL SUBMITTED TO PHONE DATE CHarlie George 1 6/1/01 STREET JOB NAME 10 Castlemere Road SIdin CITY, STATE and ZIP CODE JOB LOCATION North Andover MA 01845 ARCHITECT I DATE OF PLANS JOB PHONE ,VC J�MPL18C hereby to furnish material and labor - complete in accordance with specifications below, for the sum of: Twelve Thousand Eight Hundred Sixty-five and 43/100 dollars (S 1 2. 8 6 5_ 4 3 1 Payment to be made as follows: Due Upon Completion of the Job All material is guaranteed to be as specified. All work to be completed in a Authorize workmanlike manner according to standard practices. Any alteration or devia- tion from specifications below Involving extra costs will be executed only upon Signature written orders. and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our con- Note: this trol. Owner to carry fire, tornado aril other necessary Insurance. Our work- withdraw ers are fully covered by workmen's Compensation Insurance. posal may be us if not accepted within --^" CP' — _days. We hereby submit specifications and estimates for: 1) Remove existing siding and dispose of in a legal fashion. 2) Install Cedar Impression shake molded vinyl panel with high wind resistant (up to 180 mph) siding. 3) We will use regular "J" channel around the windows, the color to be chosen by the customer. 4) Cover soffit area on lower and top section with vinyl soffit. 5) Custom bend rakes and fascia with white aluminum, 6) Remove all electrical meters, lights, doorbells, cables, etc. 7) Obtain all permits requierd. 8) Clean and rake areas in a professional manner. M 9) We give a one year warranty on workmanship and lifetime warranty on materials from the manufacturer. This is to protect your expensive investment and to put your minds at ease, knwoing that I truly put forth every effort to provide all customers with the highest quality stock and professional services. I may not be the lowest bidder always in the field, but such intelligent people as yourselves also realize that the lowest price is not always the best. *The job will be handled with quality workmanship and completed to the customers satisfaction. 1:�ACCrptallrr, Of PrOPOSal - The above prices, specifications �� and conditions are satisfactory and are hereby accepted. You are authorized to do Signature the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature I t x O r� u u °o w C Cl cn O W a � b o w �°D o g v -C U io c w O U v)U �'' to o a: m x O w w a W �0D o a u „ cn G ri. p C7 �Do o n4 C w w w C PQ ° z cn Q o cn f -MI O O O O o s Z co CL O y D c 0 U) LU U) W W w ui c o CO c c o ` C H O . 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