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Home My WebLink AboutMiscellaneous - 114 WAVERLY ROAD 4/30/2018N J Q N Date. . /M? I? ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INII This certifies that .... fl a A , . .'71-q -.'r ............... has permission for gas installation ... /-7. �? . . . . . . . . . . . . . in the buildings of ... 5-1 /11� ........................... at . . // iS,,- . . JL,-L.Al k r/i ............ North Andover, Mass. Fee. . Lic. No.. f.�: T) GAS INSPECTOR Check # 1�� 5961 .1 At 1 r MASSACHUSETTS UNIFORM APPLICATON FOR PERmrr TO DO GAS FITTING (Type or print) Date /17 A)-7 NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name Permit # 6 Amount $ 7-S-7 mwm-mmwwmw� New S - New D Renovation Replacement Plans Submitted � a w v� O O x w z a ° w w a C z $ z w a V U w x �a a > Iw- w G7 Iw• z d x w w eF rx w I- w H x z W> w a H Q °m z O z w px S w H w 3 Q .da Q z > SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND. FLOGR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR i±L-- I I (Print or type) T Name _ C - �l 1 5 !�/ G7/l GZ? -e Address (] J -417U r 777 v-� Business Telephone Name of Licensed Plumber or Gas Fitter S: -r I/ Ch k one: Certificate Installing Company ��` Corp. K. Partner. l Finn/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13— No13 If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0— Other type of indemnity ED Bond Owner's Insurance Waiver: I am aware that the licensee doesnot 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: Signature of Owner or Owner's Agent Owner 13 Agent 13 I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my 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 Coderd Chapter 142 o�.t?e General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Li umber Gas Fitter Master Journeyman sed Plumber Or Fitter License Number Location H Y No. Date /C� - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 3a Foundation Permit Fee $ Other Permit Fee $ TOTAL s Check# E�C)o - AV((Vz: �,- - 1 52G8 Building Inspector -� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 1.1 Property Address: APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1.2 Assessors Map and Parcel Number: llnnn. WOWnfil Ta BUILDING PERMIT NUMBER: 2 DATE ISSUED: 2m,". SIGNATURE:Odd `' Building Commissioner/InTecofof Buildings Date j SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 612 j Map umN b� Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R 'red Provided 1.7 Water Supply M.G.I_C.4. 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private �� ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 1/A_ q f /4 ,// q 9), 1 e, Name (Print) Ij A112 I$d a i&aL Address for Service-: I , r q °12 --- � ' _ - S Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed CAstruction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 RegisteredHome Imrovement Contractor Not Applicable ❑ 1 "9 r I;? CO r 12 tj I- -'S q Company Name 3Registration Number Ad r 2 ZIJ16 L4 .2 Expiration Date Signature Telephone 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 rmit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building Repair(s) ❑ �atiORS(s , ❑ Addition ❑ ^'' -r - Accessory Bldg. ❑ Dern`oTitioA ❑ a Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be '� Co leted b permit applicant „.. 1. Building AT�,( (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 0 D Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION h—=Itf ► r l ,Am� as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print N 'Ic 14":J Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMBERS 1 ST 2ND 3 PX SPAN DMENSIONS OF SILLS DMffiNSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED. LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector MD. CERTIFICATE OF LIABILITY INSURANCE ° RROOUCEq 10/29/2001 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY IFICATE INTERNET 2NStMMCR ArmZNCY HOLDER. T K SNFEC RTITIFI A�TIE GHTS DOES NOT AMENDUPON THE , OR 522 CHICKEMNG ROAD ALTER THE COVERAGE AFFORDED HY THE POLICIES BELOW. NC>liTK ANDOVER, DOA 0184$ INSURERS AFFORDING COVERAGE INSURED DAVID CASTRICONS INsURI<RA: AMLLA ROOFING A3aD SIDING INC. INSURERS: ARBZLLA PROTHCT1ON 200 SUTTON STREET, SVITR 226 IN8URERO: ROUE SUN ALLIANCE NORTH ANDOVER MA 01845- INSURERD: COVERAGES INSURER E: THE POLICIE6 OF INSURANCE LISTED BELDW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. p4Sq TYPE OF INSURANCEPbLiCY NUMBER POLICY EFFECTIVE POLICY EXPI N AEMERAL LIABILITY DATEImmin UMIT9 A COMMERCIAL GENERAL LIA91LITY8500012710fiACN OCCURRENCE 1 OOb 000 06/06/2001 CLAIMS MACE a OCCUR 06106/2002 FIREDAMAfis t 50 000 OE(An vna ID MED 12)(11roo (Any ons pen i 5,000 PERSONAL & ADV INJURY i 1,000,000 G6NLAQQREQATELIMITAPPLIESPER: STA GENERALAOQRCQATE f 1,000,000 POLICY PRO- jFCT fol LDC PRODUCT S-COMPtOPAOG i 11000,000 AUTOMOBILE LIABILITY ANY AUTO EaIINIDjINGLE LIMIT i To E ALI. OWNED AUTOS 44506400001 SCWr0VW0AUTOB i (Pat Oman) 280,000 HIRED AUTOS NON -OWNED AUTOS I BODILY INJURY iPsr occfdsn) 3 500,060 PRO?ERTY DAMAGE (Pvacred.nl i 100,006 GARAGE LIANUTY ANY AUTO AUTO ONLY- EA ACCIDENT S OTHER THAN EA ACC i EXCESS LIApilln' A UTO ONLY: AGG 3 OCCURCLAIM^a MAGE EACH OCCURRENCE i AGGREGATE i DEDUCTIBLE i RETENTION # D WORKERS COMPRNSA710N AND i EMPLOTtRS' LIABILITY u I Twoc d " C 791X97$A01 09/23/2001 09/23/2002 E.L. EACHACCIOENT I 100,000 E.L. DISEASE-EAENPLOYE S 500 000 OTHER Fl. DISEASE -POLICY LIMIT $ 100,000 DE¢GIkry-TION OP OPERATIONS/LOCATICN$/VEHICLESIEACLUSIONS ADDED BY INDOR9EMENTfSPEGAL PROVISIONS CERTIFICATE VOIDER ADDITIONALINSURED; INSURER LETTEk: CANCELLATION SHOULD ANY OF THE ABOVE DEgCRIBEP POLICIES BE CANCELLXp BEFORE THE WIRATIDN DATE THENEOF, THE ISSUING INIURER WILL ENDEAVOR TO MILL 010 DAYS WRITrFm NOTICE t0 TWc CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND U TWE INSURER, ITS AGENTS OR R6PR6iGNTAnv AUTHORIiED ACORD 26-S (7197) ®ACQRD CORPO►ZAfiON 1865 i DAVID CASTRICONE ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS FREE ESTIMATES HOME IMPROVEMENT CONTRACTORS REGISTRATION NUMBER 104569 In Kingston 603-642-5990 In Haverhill 978-374-7314 In North Andover 978 In Boxford 978-887-6147 613�-3'41-0 7 Hillside Road, Boxford, MA. 01921 231 R Sutton St., No. Andover, MA. 01845 1/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on premi elow described- 9 Owner's Nam ................................................ ................................ JobAddress .... .. .. ......... 99A ........................................City.. .i. - v—t—f ....... State ....... SPECIFICATIONS ............ All ...... .......... ......... 0 . ............. u e . . ......... ......................................... .................. . . ......... ....... �Z ........ ... ............................. , ID ................. . ........... ..... ...Via.... ....... ......... r ...... ... ... .. jzl� . ........ . s ....... ............. .. ....... ::....:......... ....................... 124 ................. C4.- ......... rd... ...... IV ................ ...... r-4 ......... .......... ...... ........ #rA .......... ................. ff...... I ............ . .......... .......................................................... ....OD................................................................................................................. .............................................................................. . ....................... a ...................................................................................................................................................................................................................................... .............................................................................................................................................. .e ............................ I ....... ............. ..... Materials and labor to cost $ ..... Y....O...0.....:...............:.......... Payable Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note In accordance with his on a d a/ requested (their) above , iga�b ' MPfet'lonYs I ested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no repi subject to any conditi Receipt of a copy 96ard 6f'Suilding IlegtjNtioii't-ah"dStalitlifr's understood and that i f HOME IMPROVEMENT 6 NT herein. 0 RACTb R� Owner or Ow Registration: 1104569 IN WITNESS W 14102 Accepted: Pp PAIVATE COAPORATiON DVID CASTRICONE ROOFING, 7 Hi I Ist ft�d' Boxford MA x,92' Admin'gtrator� Per.....................L ftpre-6enfatiie nt upon or Grp .7 . ' f nts thereofe reoisia lonV4 it tor irdiwuI-u- only i be& -re - the expiration date. If Touddl return t3: contained 'Board of Builling. Regulations and St-nda.-d's 0' .11ageRm ?p � A�h bk! r-Uk hoston j mit. Asl.ied� ....................................................................................... 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