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HomeMy WebLinkAboutMiscellaneous - 116 MILLPOND 4/30/2018 116 MILLPOND 2101095. -0116-0000.0 -- - - T I PIP- Location No. DateQ HOR7M TOWN OF NORTH ANDOVER r. J7 0;�.. o .•.�hG i Certificate of Occupancy $ NuBuilding/Frame Permit Fee $ sncst f Foundation Permit Fee $ Other Permit Fee $ _ t TOTAL $ � i r Check # Ir C'7 18736 `Y---—'Building Inspecto TOWN OF NORTH ANDOVER .r BUILDING DEPARTMENT APPLICATION TO CONSTRUCT WA OVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING r m' 77'7 c �,i •Y,.: tis, . . , rn BUILDING PERMTI'NUMBER: � - DATE ISSUED-./&pp.. SIGNATURE: BAfdiiig—Commissioner/-I-qrM&r of Buildings Date z SECTION 1-SI1T INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1 G A4 /JC,l A N Map Number Paroel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use I Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re4pired Provided 0 1.7 Water Supply M.G.L.C.40. 34) 1.5. FkW Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone e ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP ORIZED A55W Historic District: Yes No M 2.11 Owner of Record L //i f AdY�a� T�h'1Gd!✓�9c/� Sd G. , ��� ���/�YIo� N e( 'nt) Address for Service Signature NVI Telephone 2.2 Owner of Record: Name Print Address for Service: O z 1� „1 Signature Telephone 9 SEf'TION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor. Address �t-MU.f/ V�-'> �� A� N Al���7 C License Number aan -3 1 Expiration Date ic Signature Telephone SIMONr 3.2 Registered Horne Improvement Contractor Not Applicable ❑ Company Name / O Registration Numberluuu Address /m z E>qpimtion Date Signature Telephone G) SECTION4-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 buildigg permit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction 0xi,& tuld ❑ Repair(s) Alterationp) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 5�2 tf 2.r n C'0 f'L SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be b C' $ nu�V Completed b ermit applicant f.. k 'N" , 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC e 1 5 Fire Protection 6 Total 1+2+3+4+5 i Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BURDING PERMIT I, as er/Authorized gent of s ject property Hereby authorize to act on eh lf,in all matters r tive to work authorized by this building permit application. /� Signatuk of Owner Date SECTION 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 Print Name - Si ature of Owner/A ent Date 1 NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVMERS 1 2ND 3RD SPAN DM ENSIONS OF SILLS DMIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE rIC1 yY � Page No. of. Pages Tom. DeFusco 23 Dutton Road Pelham, NH 03076 Home Improvement Reg.# 117756 ' Tel 603-635-3017 Constr. Lic. #071037 Fax 603-635-3751. PROPOSAL SUBMITTED TO PHONE DATE I r•.cJ / r� . /ri STREET JOB NAME ` - e� / fi CITY,STATE AND ZIP CO1DE JOB LOCATION jS ARCHITECT DATE OF PLANS . JOB PHONE, We hereby submit specifications and estimates for. ' • ............... ....:...._... ti'..1_.%�._._.:. 3 :..._, l'..C-_...__...__._..__ _...._._�._: Pf`.......... . :1 ..; /r-�ff....... �.- .... tp' ........�t .. .. 1/i f ... ....._......} .. .._? ? .E.J..y � '_....'_dam ''_ f � -C ' 4 _.---� . 1 .. ..%�........................ ..............GI - t [ _{ P �/ .. _.. '�................ ..... .............................. - -...... ...._.................... ..... ..... ................ --._._... *....::. ........................ .... .......__..................-- - .....,...."�..................... °.f e ..._..... ra r".:.. .: .. t .._....i _{tee .'t7 ._:.. "".�. I "..._ .-..... l i-!i r^�le /C)r,+ j_ f ................._........ ( S...._ 1 C .,_''Qs ........... f �#ft__ r? .......I :. A.:� _._.:. <� . �'Ps.� nG, r 1._'t�....._._ J .. j . --- ............. f �J . ... .:_. . /! t/ Y ! f T P .....-- � �t �_ ........ , P 11raPOSB hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of: �'7<4, qA dollars($ Payment a 1ent to be made as follows: GC A-) t r• All material is guaranteed to be as specified. All work to;be comple a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above Signature specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be d accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted-withtl5��T w days. (.rrryfiturle Of 11rapasal The above prices;specifications .� and conditions are satisfactory and hereby accepted. You are authorized to do the Signature work as specified. Payment will be made as outlined above: Date of Acceptance: j Signature I - ✓fie Vanzoraaruvecc� a�✓Gl�aavac�ivaetta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR = Number: CS 071037 Birthdate: 06/:18/1950 Expires:06!18/2007 Tr.no: 11773 �t Restricted:,-00" THOMAS A DEFUSCO 23 DUTTON ROAD �J PELHAM, NH 03076 Commissioner e� aruuea z a�✓1���wc�zua m _ d Standards Board of Building Regulations an HOME IMPROVEMENT,ONTRACTOR Registration: 117756 Expiration: 11/15/2006 . Type: DBA TOM DEFUSCO GENERAL CONT TA609 DEFUSCO 23 DUTTON RD PELHAM,NH 03076 Administrator DATE(-MID— Y) SCO , CERTIFICATE OF LIABILITY INSURANCE o 117/loos PRODUCER (9e78)459-7744 FAX (978)459-0 88 THIS Y AND CONFERTIFICATERS Ido RID ASA rdtAi IIEROF ION RIGHTS UPON THE CERTIFICATE Wil son•Insurance Agency Inc. HOLDER-THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 6 CAurthouse Lane Suite 14 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chelmsford MA 01824 MAIC# INSURERS AFFORDING COVERAGE INSURED Tom De Osco ba Tom DeFusco General INSURERA: Scottsdale Insurance contracting sN$URERB: Liberty P9utua7 Insurance 7 Austin Street INSURER C: Methuen MA 01844 NSURER D: INSURER E: COVE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS JED TO THE INSURED NAMED ABODE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRAC OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY OLICIESTAIG,THE INSURANCE E L SHOWN ED BY LI RED CEO PAID CLAIMS. THE E BEEN RI SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH INSR%Day, TYPE OF INSURANCE POLICY NU BEA POLICY FFFECRVE POLICY EVPIRATAN LIMITS GENERAL LIABILITY CL 1753932 08/03/2005 08/03/2006 EACH OCCURRENCE 8 1,000.0 DAMAGETORENTED $ SO,QO COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX OCCUR MED EXP(A,ry omr Pelson) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 FA GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 1-0-0-0-0-0-0- X POIH-Y PJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea ALGdPmS ANY AUTO ALL OWNED AUTOS BODILYINJURY $ _ (Perpersml SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (PW aPSdenl) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accider�ti GAMGE LWMIITY AUTO ONLY-EA ACCIDENT S OTHERTHAN EAACC $ ( ARM AUTO AUTOONLY: AGG O EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MME AGGREGATE $ S DEDUCTIBLE S RETENTION i WORKERS COMPENSATION AND WCI-31538466-014 10118/2004 I0118/2005 WCSTATU oTRI —• EMPLOYERS'UAEMM E.L.EACH ACCIDENT $ 100,000 B ANY ICERIMEN®LR PXCLARUDE/D]CECUi1M/E F-L DISEASE-EA EMPLO $ 100,00 Byyeee,de=ib oder EL DISEASE-POLICY LIMIT $ 500,00 SPECWL PROVISIONS belvb OTHER it DESCRIPTION OF OPERATIONS I LOCATIONS(VEHICLES I EXC USIONSBY ENDORSEMENT SPECIAL PROVISIONS For information purposes for proof of ins rance. CERTIFIQaE HOL CANCELLATION sHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE ERPIRATMON DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL IO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IBNR UPON THE INSURER ITS AGENTS OR REPRESE"TATIVES, For Infomation Purposes AUMORIZED REPRESENTATIVE Clay& N. Lindley ACORD 26(2001108) ©ACORD CORPORATION 988 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN* G (Print or Type) t l NORTH ANDOVER Mass. " Date l4uilding Location Permit .� Owners Name Y New -7 Renovation Replacement E] Plans Submitted D FIXTUR-I N � W N zC4 41 0 x N a: N tr .0 to = H 0 v to r x to cc o Wa ¢ a o o z rw- to a W w o a sr w 4 F- in to z m a v W w O FW- x J I- Z F W w a O ? U. H l? .t tCC UA W ��- w Z d W -d Ct F' y. N m O O N x Q ,u > � W z 6 G 4 q O O W o W I.- t= x o u. 1- o SUR—BS?.IT. BASEMENT 1ST FLOOR 2ND FLOOR G1 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Chec/ one: Certificate Installing Company Name Corp. Address -�7`j� ff Partner. ///,e2 V 61glb74.�/�— � Firm/Co. Business Telephone: 0/ Yf Name of Licensed Plumber or Gas Fitter Insurance Coverage_: Indicate the type of in cov rage by checking the appropriate box: Liability insurance policy EZ/ Other type of indemnity Q Bond Ej Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent 0 I hereby certify that all of the details and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and lnstxUations perforated under Permit issued for this application wW-be in compliance with an pertinent provisions of tho Massachusetts State Gas code and Chapter 142 of tho General Laws. By TYPE LICENSE: Plumber Title zisfitter Sign LurFrCGasfitter f Licensed City/Town- Master Plumber Journeyman APPROVED (OFFICE USE ONLY) Lic4nsE5 Number _ 11, X79 Date.,. NORTH TOWN OF NORTH ANDOVER 0 � `p PERMIT FOR GAS INSTALLATION 'tet S,gciH SS y This certifies that . . . . . . . . . . . . . . . . . . . . . !. . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . ... . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . at . . . .r . . . . . . . . . . ... . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. .`. . . . . . . Lic. No.. . . . . . . . . . . . . . . . * . . !.:.. .. . :. . . 12/08/94 08:45 15.00 PAID S INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NO . ANDOVER , MA Mass. Date 4 —/V 19 — Permit Building Lccatlon LLPOND Owner's Name NO . ANDOVER , MA Type of Occupancy ' RES New ® Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No O I I f w N I F I I I e r r U y� I N U n ¢ yr rt O w _ w w ¢ o U F n J N w .O H w c d F- ¢ > W S w ¢ J H w w O I p > u. F- w J w ¢ _ O Ci 14- 7 � > O d F� O SUB—BSMT. 1 1 1 1 1 1 1 1 1 1PFF1 BASEMENT I I I I I 1ST FLOOR I I I I I I I I I I I I I 2 H 0 FLOOR BRO FLOOR ATH FLOOR STH FLOOR 6TH FLOOR I I I I I I I II 7TH FLOOR I I I I I I I I I 97H FLOOR ( I I I I I I Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate ",a Address 91 BELMONT STRFFT _ I3 Corporation N0 . ANDOVER, MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Ucensed Plumber or Gas Fitter JOSEPH KEVIN C =•LLAHAN INSURANCE COVERAGE: I have a current Ilabllfty Insurance policy or tts substantial equfvalert which meets the requirements of MGL Ch. 142 Yes RI No O If you have checked yes, please indicate the type coverage by checking the appropriate box A liability Insurance policy JD 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 Mass. General Laws, and that my signature on this permft application waives this requirement. Check one: OwnerO Agent ❑ Signature of C'wner or Owners Agent I hereby eartity that all of the details and inlorma(ion I have submitted (or entered) in ove application are true and aorurate to the best of my knowledge and that all plumbing work and Inslallatlons perlormed under the rimer-,i; "sued for this applicaU villi b In ptlance wtlh all pertinent provisions of the Massachusetts Stale Gas Code and Glapter 142 of the CeAneral Lz BY T e of License: Plumber ;-,,alur o c nse umbe or Gas tier Title asfitler 1 aster Lc�. se Number M— 3 4 4 0 i City/Tawn huineyman I AP PilC7Yf i 2 16 Date. � . .441 NORTH TOWN OF NORTH ANDOVER prop PERMIT FOR GAS INSTALLATION. Q This certifies that . . . ... . „ . . . . . . . . t� has permission for gas installation . . Vic.. t .uI c: . .C.. in the buildings of . : c��!q.�L .�! . . . .. . . . . . . . . . . . :. . . .. ' r. . at . . /./.( . . . . . . . . . , North Andover, MIs. Fee. .?.) . . . . Lic. No..? .Y. .yo . . . . . . . . . . . .9 . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File . ;.� fatrlA%"),At.HUSEfTs UNIFORM APPUCATION FOR PE IT TO OU I'LUMk11r4U �--\ (Print or Type) 3 NORTH ANDOVER, , Mass. oats 3 ._lo - Budding Permit * 3 Location .I rl � /L �-- Owner's Name New ❑ Renovation ❑ placement - Plans Submitted: Yes❑ No.❑ XTURES w ss � � u � r M « e < s fa Z 04 44 It0 a M r rj = r Fs- r r = a s ; K X u = r r s e► r r 66 ei i sus—�sM T. SAS[MtNT IST FLOOR 2NDFLOOR tlRO FLOOR 41H FLOOR sTH FLOOR 4TH FLOOR. ITH FLOOR STM FLOOR - Check one: CadVicale Installing Company Name 13 Corp. Address �{� C-L C S729,Q S7 , ❑Partnership or-Y3 ❑Firm/Co. Business Telephone"", ,Name ollicensed Plumber INSURANCE COVERAGE: ec I have a current liability Insurance policy or Its substantial equhralent. YesW No ❑ It you have checked yam, please Indicate thw type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity E3Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 off the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Nin Owner ❑ Agent ❑ a urs o et a Owners en I hereby c"ty that al of the delals and Information I have submitted la enter above are true and soeurate to the best of my It end That al umbinp work and installations performed under the Issued s tion wiw be h comp with aft podInenl provislons of Chi Massachusetts Stale PkKnbkv Code and Chapter 2 of Ow(3 1 a. ijy M urs of Limnsed Plumber TNN License Number �Pl 7 GtyRown Type of Plumbing License:Master AM411OVED(OFFICE USE ONLY) Journeyman 0 by ao�+r--"'�:i+.ai..vc�.A,s�,fi-.r ---�vr..�«r-r•�Y^--..r-...-.....^....--_..�--...+.-.--.�,..-..e-..,-.•....�.c...i�'�.''..'ti. Date. . .7. TO 2983 pOR71y TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 4 ♦ i �� ^ • Ss�cMus� This certifies that � C_ C�tt,r, , , , `'!• / has permission to perform a W,., , , , ; , pIumbIn in the buildings of �- . +s. . . . . . . . . . . . . . . . . ; North Andover, Massa Fee�S. . . .Lic. 11-7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ����� PLUMBING INSPECTOR 07/10 f '25.00 PAID WHITE:Applicant, CANARY: Building Dept. PINK:Treasurer GOLD: File