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Miscellaneous - 117 PRESCOTT STREET 4/30/2018
117 PRESCOTT STREET 210/082.0-0011-0000.0 Date......12.-5.11.-5................ r►ORT/y ' -- o? TbWN OF'NORTH ANDOVER 0- 9 P PERMIT FOR GAS INSTALLATION ss,CHUS� -P-2,. G This certifies that ............ ......................... ...............J�...... ............................... has permission for gas install tion ...... .-e-f-A..... ,.D D. ........ I. in the buildings of............... ..1. .�.: -...... ...................................................................... at.........0 ........... P. C T..... ............... North Andover, Mass. Fee...(OQ..-.... Lic. No.� ,P ...... .............................................. GASINSPECTOR Check# �� 095G8 r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ILAt _r CITYY f+�oRzNP /�+uD© fiIIA DATEPERMIT- S`__ JOBSITE ADDRESS f co-rr S-r OWNER'S NAME GOWNER ADDRESS TELT FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL ] EDUCATIONAL[ RESIDENTIAL '' CLEARLY NEW:© RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES 0 NO APPLIANCES I FLOORS BSM 1 2 3 � 4 5 6 7 8 9 10 11 12 .13 14 BOILER BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE _ FRYOLATOR _ FURNACE GENERATOR �— GRILLE _ INFRARED HEATER _ LABORATORY COCKS _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT TESL• UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Re F(L- o-0 ._........_._...__...._....__. .._......_......__._.._. ..._.. ..... INSURANCE COVERAGE I have a current liabilify nsurance policyi or its substantial equivalent which meets the requirements of MGL.Ch.142 YES WO El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND F 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 true and accurate to the Pest o my edge. and that all plumbing work and installations performed under the permit issued for this application will be in complia wi II Pe in t pr sio e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER-GASFITTER NAME LICENSE# LEk2 GN URE MP[3,MGF® JP® •JGF E] LPGI® CORPORATION PARTNERSHIP®# ( LLC®#= COMPANY NAME:hFee ADDRESS — CITY STATE' /�A ZIP 2 ( 2 2 TEL FAX CELL EMAIL / , 9L�� P � Z� �� ��� �t�ti � s��wii, U,� �v I I COM.. MONwEAL n OF • • . . MASS;Adi ETTS . PLUMBEas •p ISSUES ASF I TTER,S, F. LIGEN THE FOL•LOWI.N� s: QED AS CENSE .. A MASTER PLUMBER f<.: DAV IQ:W GARFIELD' � _ ,T. 21 WI LL.oW;:Sj: ;w, d V! MA p�3o1 '$•. � 156.4$,: 0 14 5/01/16. 226442 COMMONWEALTH OF MASSI CHUSETTS • • ' • • BOARD OF. PLUMBERS `ANb G'ASF 1,TE=RS ISSUES THE FOLLOWINO "LICENSEs RI=G F STFRED AS A P,L.UMB I CO'Ij,P` DAV:1 D•.W GARF I ELI `'. i 1 F:EENEY BRQT:HE tS SERVICE, .,, }�# T Z 21 W I L LOW ST' A 0 2 01 ROC�KTON 3 `22141 36 T:9 . . '05/01/1.6:;nf 3 a �J FEENBRO.01 SMORAN ------ DATE(MhVDD1YYYY)- �., CERTIFICATE OF LIABILITY INSURANCE 1/30/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(fes)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ifeu of such endorsement(s). PRODUCER CONTACT g NAME: FAX 434 Rte 13aray Insurance Agency,Inc. acciio Ext: (,VC,Net:(877)816-2156 South Dennis,MA 02660 ADDRESS: INSURER(S)AFFORDING COVERAGE NA1C INSURER A:Old Republic General Insurance Corp. 24139 INSURED INSURER B Feeney Brothers Services LLC INSURERC: 103 Clayton St PO BOX 220801 INSURER D• Dorchester,MA 02122 INSURERE: INSURER F: COVERAGES 'CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, I TYPE OF INSURANCE D S B POLICY NUMBER lPf1011uDDY EFF POLICY M,DD Exp- LTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 1,000,00 CLAIMS-MADE a OCCUR A2CGO7501501 0210112016 02/01/2016 DAPAA(3t:10 RENTED' PREMISES Ea occurrence $ 300,00 MED EXP(Any one person) $ 10,00 PERSONAL BADVINJURY S 1,000,00 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY[R]JjEC LOC PRODUCTS-COMPIOPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLOVAUTOS NED SCHEDUAUTOS LED BODILY INJURY(Per accident) $ HIREDAUTOS AUTOS 4lEO Perraccide DAMAGE $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CIAIh1Sh1A0E AGGREGATE $ DEO I I RETENTION$ $ WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER A ANY PROPRIETORWARTN£REXECUTNE A2CW07501501 02/01/2015 02/01/2016 E.L EACH ACCIDENT $ 1,000,00 OFFICERAIDASEREXCLUDED? NIA (MandalorylnNH) E.LDISEASE-FAEMPLOYEE $ 1,000,00 Il yes,descnbe under DESCRIPTION OF OPERATIONS beaH E-L DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street I ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ell k4 Al ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25.(2014101) The ACORD name and logo are registered marks of ACORD Location No. l-'. Date �`p�e7j M01tT►1 TOWN OF NORTH ANDOVER Of .ao ,a'l'b 3? � •• OOL ` Certificate of Occupancy $ us t Building/Frame Permit Fee $ s�cN Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f Check # I I Building Insp4 or f•�f ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .. :.;._ , �.i.... BUILDING PERMIT NUMBER: DATE ISSUED: 8 07 SIGNATURE: /#a4w)47-a� Building Commissioner/I or of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number. /17 PZESCQ 77" ST, d g.71 � tit ND O Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Reqwred Provided 1.7 Water Supply M.G.L.C.40.§54) a. 1.5. Flood Zone Information 1.8 Sewerage Disposal System: Public 0 Private ❑" Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY'OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record MAUKEU Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name PrintAddress for Service: e zpy� M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 1 90 3.1 Licensed Construction Supervisor: Not Applicable 0 jD601? IChSTRI CDIVF &, +, SSG- , Licensed Construction Supervisor: License Number o Q s ITT-1J ST. : Al to, UEie � Address Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name 16 Regrstrahon Number .26 o S u.�o1d ST, r N'b, " z) UEk, 1 !n4141 A) 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 permit. Si ned affidavit Attached Yes.......❑ No..:....❑ SECTION 5 Description of Proposed Work check applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ' ` ❑ Other ❑ Specify ; r Brief Description of Proposed Work: —41NI STPuP bE fav SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be , C} CXAiLIISEOL Com leted by permit applicant 1. Building (a)5 Building Permit Fee 8 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 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 permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT' D1 ECLARATION I, '1 2 A-V 1.D A SSR �.(z/V ,as Owner uthorized Agen of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief ,p V C Print e Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3 5 . SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOO"ITNG X MATERIAL OF CHNINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of Andover 0 No. a y o� �o� LHICHI y dover, Mass., of fz SRATED P'P5 H 4 BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................. ..................................................................... ................................................................ • Foundation has permission to erect. ............... buildings on l...l.....7 ................ Rough to be occupied as.. .. '' Chimney ....... . : ...................... provided that the person accep mg thisfodes he application on file in Final this office, and to the provisions of theand By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 .:�vIONTHS Final UNLESS CONSTRUCTION '� '`4'��`` STARTS ELECTRICAL INSPECTOR Rough .................................... ............... Service SPECTOR Final Occupancy Permit Required to OCCUPY Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building. Inspector. Burner Street No.. SEE REVERSE SIDE Smoke Det. Building Department ' 'a o 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 0 '9e cec..<ww..ct 1��y DEBRIS DISPOSAL FORM In accordance with theprovisions o Building permit fMGL c 40 s 54, and.a condition of # the debris resulting from the work shall be-disposed of in a properly licensed solid waste disposal facility as defined by NIGL c11, sI50a The debris will be disposed of in/at: L � H Facility,locati ` 7 Signature of Applicant L,2-x�� / Date NOTE: A demolition permit from the Town of.North Andover must be obtained for project through the Office of the Building Inspector. this may. 0 '�e_ ✓lZe Z/JOmt/r/tdltllsCCi•LCIL o�✓�.vociclivael�a.• ..}"•�•� � •r , :Bi►_arBGfBuildingrRegulauons;audStanilarils'. ri d " .• �" icense or regi.:ratio *id for.irdividul--ba o71y r ROMEIMPRnVE"J�ENTCONTP.ACTOR: beforelheeipiratioddate. If fiiuni]retwnto: `: F, ?; kegs,t Alon.°,trfq=69 j. hoard i,f�ail�mb,Regulations.and St:ndards ea: nrl1+l/O? One A.sh,b.prton Place Rrp".io :> "':j', '. y; r - r- •t�s;;r'` " Boston,Ma. PRIVATs=COFtf✓ORATION: - '... ' �CfrVID`CASI..ICONE=%iOOfIRG,.`^• 3 J�HilfsiT�e Ro4�' / N' "r ,' • �Aiiniin:ytrator ` (+ <ti5t xaii witlirutigna*S"rE i• a Location ' No. Date „°RTS TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �ssACHUS� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water„Connection Fee $ L TOTAL Building Inspector Div. Public Works ERJiIT N.O. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. / PAGE 1 V MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP JDATE (BOOK 'PAGE ZONE SUB DIV. LOT NO. LOCATION Lp[ /I 0 C PURPOSE OF BUILDING / Y // e p14 eeN C OWNER'S NAME Ma1J r een I t4ar A NO. OF STORIES I " vJ SIZE OWNER'S ADDRESS Sam C/� BASEMENT OR SLAB -- A HITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD a BUILDER'S NAME •�. 'r'/';/l,► . L , SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DISTANCE FROM LOT LINES-SIDESy REA " GIRDERS '-7CREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW I `� SIZE OF FOOTING X IS BUILDING ADDITION f MATERIAL OF CHIMNEY IS BUILDING ALTERATION �/{5 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY �� IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION 0(U/l�t- � (��►/v( ��!/bN ND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY A ACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED NP APPROVED BY BUILDING INSPECTOR D E FILED ��. BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE 0d PLANNING BOARD PERMIT GRANTED Q 19 BOARD OF SELECTMEN /OWNER TEL. 9��/��,-s-- p-� - . / BUILDING INSPECTOR ONtR.TEL. _ 2- 3 . t BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILYsToRIEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY, OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR,FINISH CONCRETE _ B l 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDWD PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'T' AREA _ '/, 1/1 '/ FIN. ATTIC AREA _ NO BM'.T, FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBCTARDS B 1 22 f 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARMU D _ ASBESTOS SIDING COMMCN _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ - STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME _ CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I IHIP BATH (3 FIX.) _ GAMBRELMANSARD TOILET RM. 12 FIX.( _ FLAT 1.1 SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL 'STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE , _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G ' 11N1T HEATERS 7 NO. OF ROOMS OAls 1 �. B'M'T 2ndELECTRIC . 1st 13rd I NO HEATING tL� s�- t cv N n) ?AvcJt o VV ���btf St o •'� 17 1 Ou 4 �Ay o 34 C AN posT o4rW � U ul K h' �CONSHiV aT IONFINA PLANNING_ FttVA�. SES /y� N ATER .�_FlNAL Town of nalover 0 NO- 257 N^ ` , er, Mass., JZAje 199 / C M ME WICK A �V oR pP SS BOARD OF HEALTH PERMIT T 0M THIS CERTIFIES THAT.I�1. . .. e� �,� ............................................ . P •� •• .•••• •• RoughBUILDING INSPECTOR has permission to erect f son �� .[.�. �. Chimney to be occupied as. .. . .... ......... ................. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTR N S S • service — Final ... .. .................... ... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by Sake eO. Building Inspector t • �� II r �/J eo jam. 0 0 9 ! ! GL750 02/27/91 '"' 18.34. .18 CPU.ID=FF00002C30900000 PAGE 1 ( 10 iE PSk1= 031D200C 000797E6 O 2 GPC O-F A007970C 00079538 00061650 00060510 00060AA8 000.32100 000343C8 0003440E :Q 0300000.1 00060DEO 00079700 0005E230 A00797AO 00079A74 00071F4C 00079700 a FP u'-3 4040404C 40404040 4040404J 40404040 40404040 40404040 404040410 40404040 lei a 5 0343CJ 5C5CD4E4 E3035C5C FOF-U'FOFC FOFOOOOC OOOO0000 000000OC :::MUTL::*000000 6 34-3Et�_.. ..5C5CD4E 2 E2C25'C5C F0'FOFGFO FOFOFOF6 00000000 00000000 FOFOOOOC 00000000 'rM::`MSSB= 00000006 00 7 0344400 00000000 00000000 0000C407 C4404040 - - - -- DPD - r G 115.11 OUIMP COMPLETE 10 9 11 12 13 14 15 16 17 7 16 19 _ 'I 20 21 -. 22 231 U 24 :k5. 25 : 26 27 20 29 Y� 30 31 32 33 (� 34 �J 35 36 37 36 39 41 42 � r Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE �Q JOB LOCATION 0c LOCATION— A7> Number Street Address Section of town ."HOMEOWNER" No v C ' .7 - Z Z Name Home Phone Work Phone PRESENT MAILING ADDRESS S .p City Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided pthat the owner acts as supervisor. (State Building Code, Section 109 . 1 . 1) DEFINITION OF HOMEOWNER: Person(s) 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 to six family dwell- ing, attached or detached structures accessory 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 . Such "homeowner" shall submit . to the Building Official , on a form acceptable to the Bulding Official , ..• that he/she shall be responsible for all such work performed under the j `..'building permit . (Section 109 . 1 . 1) 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 ... .North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and ,requirements . HOMEOWNER' S SIGNATURE APPROVAL OF BUILDING OFFICIAL •Note : Three family dwellings 35 ,000 cubic feet , or larger , will be required to comply with State Building Code Section 127 .0, Construction Control . Date eZ .. . . . . N'4 ". RT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING t • ,SSACMUS� This certifies that . . .P()�.c'h f . . . . . . . . . has permission to perform . . . .P. k-". . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . / k `-. `." . . . . . . . . . . . . . . . . . . . . at . . f/7 . .PP!r�j< P.i7. . . . . . . . . . . . . . . .. North Andover, Mass. Fee. Lic. No..4i.3. . . . . . . . . . T: .`-v.' -'. . . . . . . . . . PLUMBING INSPECTOR Check # &'e'df- 5153 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Z a (Print or Type) _ , i , Mass. Date G a9 Zoa 2 P it # J J-1) Building Location �� Owner's Nam Y[ f e &cLlw t Type of Occupancy, 2t--51 17 E Q rI AL— New L- 2"" New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES 000� Z N O N O Z = > W I- N J Y Q < h Q W Q N 2 N a cc < ~ = O 2 m d 0 W I� W y �¢. _ ¢ to < N U. z I- J toN O = IZ C7 W N Y 0. V. Q a C 3 X V Z 6 m 44W Y < I- N = G < N .Q a Q 0 W W O 7 W < y Q a s W H Q J Z a ¢ a 'a Cr 1- 1- a L Q W _. J L �.. < Y I< S � � 0 Z Y n• O I- V > F- O = d N t. Z O O y W I O V S < F < < = N N < a 0 Q J J Q Q ¢ = a O < 0 Y J m y D D J 3 Y F u. t7 G Q S = m O SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Itttl Installing.Company Name /A O t'�E>°T 4 • P(r M A T A e 7 Check one: Certificate Address ? C'c;Ac N.mt4f,) l pJ ❑ Corporation l-Yl E%N o E[y - Al A 0 4aLl ❑ Partnership Business Telephone -�7 Z-�9'7 1 2-Arm/Co. Name of Licensed Plumber '��4 6 F e_T SA,�►�IdVi�] Tr4�� INSURANCE COVERAGE: I have a current I bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ 10 If you have checked ves, please /indicate the type coverage by checking the appropriate box. ,A liability insurance policy ld 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 permit application waives this requirement. Check one: Owner ❑ Agent❑ Signature of Owner or Owner's Agent 1 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 installations nerformed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e andapter of the oral Laws. By re of Licensed Plumber Title Type of License: Master � Journeymab❑ Oty/Town APPROVED OFFICE USE ONLY) License Number �q3 3� BELOW FOR OFFICE USE ONLY FINAL_INSPECTIONS SKETCHES- PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED 19 PLUMBING INSPECTOR 7y- .2,, Date.. `. .................. �10RTM °f'"`°;•�'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACHU`�� This certifies that ..:.... 4 : ..........::: ............................................ has permission to perfo. � ...................................... wiring in the building�of ? ....-�-�........ ,North Andover,Mass. ......... Fee:,i-...' ........ Lic.No.............. .....:::..: ................. ELECTRICAL INSPECTOR Check # XVI {n r %I ry f t to T tl � f(iT 1�h"N T1WCV"0AWE4LTH0FMf1SS affMM ottiee Use only DFPARTMFIV 0FP=1CSg ++7y - Permit No. BOARDOFFIREPMYEWONRWUL4770ANS27a RZZ-00 Occupancy&•Fees Checked APPLICATTONFOR PERMIT TO PFRF'ORM F-T,=CAL W- ALL WORK TO BE PERFORMED IN ACCORDANCE Wrni THE MASSACHusm ELECTRICAL CODE,527 CMR 1200 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date c Town of North Andover To the spector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant Owner's Address Avi C Is this permit in conjunction with a building permit: Yes M No (Cheek Appropriate Box) Purpose of Building !j r slue, C tlI& Utility Authorisation No. Existing Service Amps /.-. volts OverheadU� No_of Meters ---' New Service Amps . / volts Overhead MUndergrourld - No.of Metem Number of Feeders and Ampacity --- Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hat Tubs No.ofTrarrsfomrces Tota No.of Lighting Fixtures swimming PodAboveground Below - : - $.YA KVA iftm No.of Receptacle Outlets No.of Oil Burners Na of Emergency Lighting But Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.ofZonts Tons No.of Disposals• No.of Heat Total Total Na of Deteetioa-and ?obs K.WhiffialingDevicas Vo.df Dishwashers Space Area Heating RW Na of Sowdina Dprictw Na of3dfCoftiried'. 10.at ers Heating.Devicea KW LocalMraiicipal Oar No.of Na of to.of Water Heaters KW 0 Connections Signs. Bailasis o.Hydro Massage Tubs Na of Motors Total HP lanoeCot�l?Isstratrtb��tsCtataalli�u►a . eaa=tliaal;tftknrs=Pcky lttdng NO e%*n*edmMpafif=nelD#rO&=YES NU Q FjcuhatedtedwddyES,pteme JRA �; >FR _ e.Spec�yj ("�Y1;F7Zt��„y sty S affiNied WcYk S. - INArIE c I�oasertti �0 el' Bt ;Tdlgd 35 1 oLq A1tTdlga R2 SII�JRANCEWANEIt;lanawaelhattheLio�edotwnot}r�e$teirnuaroecn�a�eo�st�r� ���� >�CaraalLaws imystaecnihsptarrteppliratwthisrtz�merte�l[ .e check one) Owner � Agent Telephone No. PERMIT FEE,� � Date . . . . .. ... . r I ORT#q 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 4SSAC14USEt This certifies that . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . in the buildings of ... . . . . . . . . . . . . . . . . . . . . . . . at - //2. . . ... . . . . . North Andover, Mass. Fee,,3. Lic. No..513Jj. . . . . . . . . . Check# 4143 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ftA7or T doLMass. Dat " Za0 Z PermR t/ 8uldinp Loption owners Na r, Y� 0 ! - TYOe d Occupa . t 1 C iJ 7I 0-'%L- Now .1 L New ❑ Renovation ❑ Replacement G?-' f Submitted: Yes ❑ No C3FIXTURES V W Z Y N 1A a e O Z E- > q W Y 4 b t 61 W z C49 a1Q q = W #- W Q Z a q _ _ = L 7 J p q A S N ~ V W q aL < W Q. oZ 40 < G c 44 < ; x 11C � q � 1► a"c Ac 40 b a r Y O p h W O U Z 3 Y � o w a o .�. � ; a i � °a o 0 sus-11SUT. OASEMCNT IST FLOOR 2ND FLOOR ,RO FLOOR 4TH FLOOR STK FLOOR eTM FLOOR 7T% FLOOR aTtt FLOOR Instaling Company NaCheck one: C dmcde Actress A f-� to Corporation Business Telephone �� Name at Ucensed Plumber INSURANCE COVERAGE: I have a current dilly Insurance pocky or Its substantial equivalent which meets the requ &nw is of MGL Ch. 142. Yes U No(3 10 K you have checked yg, plesasee Micate the type coverage by checMV the appropriate boot A IWAlty Insurance policy 1d Othsr type d Indemnity O Boed o OWNER'S INSURANCE WAIVER: I ars aware that the licensee does not have the insurance coverage required by Chspter 142 Of the Mass. General taws. and that my signature On thk permit AWlestlon waives this requirement. heck one: Owner O Agent❑ or -s t I heriby ow*that d of the detach and information I have submitted for entered)in above application are true and accurate to tM bast 01 my knowledge and tint all pk,rnbir work and inataNations orefled under 110 permit ror oris application wN be in a mphom updh all pertkWd provis' of the Massadwaatts Stats ftrand of tin Laws. TRN Type or Umm: Master �� ioumeyreaA 0 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETgXE& PROGRESS INSPECTIONS FEE APPLICATION.FOR PERMIT TO,DO PLUMBING NAME A TYPE'OF BUILDING LOCATION OF BUILDING PLUMER �.�.. PERMR GRANTED PLUMBING INSPECTOR l Date.. �. Z".. HORTN TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION [ �9SSACHUSEt This certifies that . . . _ � `��*!-�. . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . in the buildings-of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at .//.7 � . . . . . . . .. North Andover, Mass. Fee Lic. No.� 3. . . . . . . . . . . . . . . . GA .SPECTOR Check# 9�/ r s 4144 p — � ir N Z $ 210 # $.IA A (7) n 3 ~i -Vi 4 '-04 � W x N s c »" C p ? x x x Z x 4 v '1 a s Z m a $ a 0 0 0 o ° o 1 W C� It � 0 •�C ❑ RANGES NEATER RANGES �� `OVENf C HEATING BOILERS FURNACES � UNIT HEATERS i� F MATER NEATENS F � �• DRYERS � s AAs GENERATORS e r LASORATOIIT COCKS 2 CONVERSION BIIRNEIIS ROOF TOS UNITS � C VENTED ROOM "TRS. , [� [, DIRECT VMIIT KSS• N a POOL MEAT! S F M 3 TESTS— OTHER BELOW ICOR OFFICE US "ONLY~ FINAL INSPECTION SKETCHES ►ROGREts INSPECTION FEE *►PLICATION f011 PERMIT TO 00 GASFITTING NAME • TYPE OF BUILDING LOCATIRN 2E BUILDING 'LtlMSER OR OASPITTER LIG NOW PERMIT GRANTED GATE�..��....1f. OAS INSPECTOR Location I� t���s Cp4 23 , O No. �� Date 6-10- HQRTq TOWN OF NORTH ANDOVER Nw9 Certificate of Occupancy $ JACHusE`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ f' TOTAL $ Check # ( oQL r) 1 5 6 1 2 a Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING Ma Nwit BUILDING PERMIT NUMmBER. DATE ISSUED: M � (9 / r c, � ^4 SIGNATURE: 6 ..,� Building Commissioner/I for of Buildings Date Z SECTION I-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: - a /• Q Map Number Parcel Vu6ber /11..(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 Rec#fired Provide Rapired Provided R red Provided Q 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record N-AUR MX4 rtFt�2r �ut� /A&" & cr*a 1/1 P2 A�SccrT Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ .14hzATM Licensed Construction Supervisor: O License Number Address', D P, 03/oq 2 bd4 262 Expiration liate Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v V/7 �8�( - t�ie� �xe�easc-nmct /al�30 Company Name M Registration Number r 8o eA,7xtiP S,� � / . �ukw&eZ r Address n / I 'm3 n Expirati n Da ^� Si nature Tel hone v• SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) y 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.......El No.......❑ SECTION 5 Description of Proposed Workcheck ad applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: J�/'Lh�iC31�Li 1XA7r_AtXM AlbQ eA/�2t t_/en'3 Al M�C,EPta-a•� .T i rl[�J�at� -r7c SECTION 6-ESTIMATED CONSTRUCTION COSTS Item ! Estimated Cost (Dollar)to be � �QFIca�ALiII$E�t}I+1Y Dollar sl Completed by permit a licant � x„ ,•, � a z. x 1. Building (a) Building Permit Fee 3 _<40 Multiplier 2 Electrical (b) Estimated Total Cost of 2 2 Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 2$ • 6O 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 permit application. 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 �' b// I Print Name Signature of Owner/Agent DatdVs NO. OF STORIES SIZE. . BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS D]MENSIONS OF POSTS DM NSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFMkANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE !its r;m satisfies all has;c requirements of the stands Home Improvement itrntractor Law(hIGL chapter!42,4 t,but does not include t,nd.0•I language to protect homeowners, Seek legal advice if necessary. Any person planning home improvements should first obtain s Cor, Consumer Guide to the item.Improvement Contractor Law"before agreeing to any work on your residence. You may obtain a ire:•;,.�,, catlmg the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617.727-7780 Homeowner Information Contractor Information Nam Company Nent Street.Address(do not use a post Office Box add ss) Contractor/Salesperson(Owner Name I r4 t jtsr T _a5/4Vrz C(ytTnwn State' Zip Code Business Address(must include a street address) �!•,� M'i� cn� s � Daytime Phone Evening Phone Cirylfown State z5p Code fS �i TS' 5 22AXkMVM W/A d� Mailing Address at di!fertnt from above) Business Phone 1 Federal Employer ID or S S Number /� L_n".-aw mtat Mara •I Home tnprnamvx Conoacrw Rea tiumnai Ecp,,.� ia„ // Pte.aata�mttawon Mara a �� ���,, rtes, „� 6 2 �2 The Contra�r ayree.to do rise fotloti ngr (Describe in detail the work to tompleted,specifying t type,brand,and grade of materials to be tied,use additional sheets if neccssa.) rlS� A17A-f- , �'�CdPr� U,Ip1et2`r Required Permits-The following building permits ane-required Proposed Start and Completion Schedule-Thefollowing schcduIt will and will be secured by the contractor as the homeownees agent, be adhered to unless circumstances beyond the contractor's conic!arse (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of !oar Date when contractor will begin contracted wcrk MGL chapter 142A.) aD to when contracted work will be substantially compleled Tota!Contract Price and Payment Schedule The Contractor agrees to perform the work famish the material and labor specified above for the total sum of: 2S, 2"4s' �t•s Payments will be made according to the following schedule: upon signing contract(not to exceed 113 of the total contract price or the �( 7 cost of special order items,whichever is greater) S�• I0 by �l�lr or upon completion of_1S' ft*T 1Q`l0� ACUO R W S •qO by _/�!� or upon completion of UttSl�lZiJETi'C 7.Z 0L &-V,1 AJM _ SSSW• Million completion of the contract (Law forbids dem"n.9 full payment until contract is completed to both pa 's satisf::c 't tton The following materisYcquipmcnt must be special $ hL I A to be paid for PA A ordered before the contracted work begins In order f to be paid for to meet the eompletion schedule.(**) NOTES:(•)Including all finance charges(••)Law requires that any deposit or down-ps ment required by the contractor before work begins may not exceed the greater of,(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an tioriss warranty begot movided by the eontraetor! No Yes (all terms of the warranty must be attached to the contract Subcontractors-The contractor agrees to be solely responsible for completion df the work described regardless of the actions of any thirc party/subcontractor utilized by the contractor. The contractor further agrees to be sorely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance=Upon signing,this document bectmtes a binding contract under law. Unless otherwise noted within this document.the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notice-: ea.fully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. a Make inimthe contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor L. registration bywriting to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727.3200,ext.25205 • Does the contractor have insurance? Check to see that your contractor Is properly insured. • Know your tights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other then the ccntractor s normal plate of business,provided you notify the contractor in writing at his/her main of$ce'or branch office by ordinary mail posted,by telegram senior by delivery,not later than midnight or(he third business day following the,signing of this agreement See the attached notice of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE AWI BLANK SP CESt!! Two tden l copies of the contract must be completed and signed.Ont copy should go to the homeowner. a other Copy shoal rcpt Sy the comra�tot ,req Home wner's Signature Contract r'S Signature Date Date v i %/X, L�aar��zaouuea�l a�✓l/�iraaac�iccaed6 i BOARD OF BUILDING REGULATIONS license: CONSTRUCTION SUPERVISOR Number-:,CS 057754 ;Birthdate: 03/04/1965 `Expiresi 03/04/2004 Tr.no: 18130 _ �'-jRestncted:'001 WILLIAM D HOPE,' PO BOX 5164 r ANDOVER, MA 01810'_,` Administrator — '_ _ - ,. ✓r!ie�rn�vnza�uuea� a�✓j/�,aQea�.uaeCld l Board of Building Regulatiens and Standards i HOME IMPROVEMENT CONTRACTOR Registration: 10.1730 i xpiration: G6/29/20u2 Type: INDIVIr)UAL WILLIAM DAVY HOPE William Hope 80 Campbell Rd N.Andover,MA 01845 Administrator • RD INSURANCE BINDER DATE OP ID L8 S BINDER IS A TEMPORARY INSURANCE CONTRACT,SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM.20/01 PRODUCER AIC•NO ; 978_688-4667 COMPANY BINDER* 44902 978-682- 0 7 n ARBEIJ PROTECTION INSURANCE Catalano Insurance Agency DATE TIME 251 Broadway DATE TIR Methuen MA AM 01844 X �r.DO 11/20/01 PM Small Business 12/20/01 Not CODE: X THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY SUB CODE: PER EXPIRING POLICY r BINDER CUSTOMER ID: HRHCO-2 DESCIBPTION OF OPERA INSURED ER7Y(IndudTng LocaBon) HRH Construction Carepentry - residential Dave Hope P.O. Box 5164 Andover, MA 01810 COVERAGES TYPE OF INSURANCE OMITS COVERAGElFORMS DEDUC71BLE COINS% AMOUNT PROPERTY CAUSES OF LOSS Personal Property BASIC ❑BROAD SPEC 250 5000 - IInscheduled Tools-- -250- - -.25000 Installation Coverage 250 50000 GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $500000 _ CLAMS MADE �OCCUR FIRE DAMAGE(Any one Tire) $50000 MED ExP(Any ona Pin) $5000 PERSONAL&ADV INJURY $500000 RETRO DATE FOR CLAIMS MAGGENERAL AGGREGATE $1000000 E AMOBILE PRODUCTS-COMP/oP AGG $1000000 UTOLJABII.TTY ANY AUTO COMBINED SINGLE LIMB $ ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ -- HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS MEDICAL PAYMENTS $ PERSONAL INJURY PROT $ UNINSURED MOTORIST $ AUTO PHYSICAL DAMAGE pEDUCTIBLE ALL VEHICLES $ SCHEDULED VEHICLES ACTUAL CASH VALUE COLLISION: OTHER THAN COL• STATED AMOUNT $ GARAGE LIABILITY OTHER ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ — - _ EXCESS LUIBILITY -- - _-- --- AGGREGATE $ UMBRELLA FORM EACH OCCURRENCE $ ' EG $ OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: AGGRATE SELF-INSURED RETENTION $ WORKER'S COMPENSATION WC STAMORY LIMITS AND E L EACH ACCIDENT $ EMPLOYER'S LIABILITY _ E.L.DISEASE-EA EMPLOYEE $ Unscheduled Tool Covers E.L.DISEASE-POIJCY LIMIT $ SPECIAL Unscheduled Covera 00 $teto ($500 »_;.�+*�+ P� item) and Inatallatio FEES M�� Coverage $50,000 ($25,000 per loss) S TAXES $ NAME&ADDRESS ESTIMATED TOTAL PREMIUM $ MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN a AUTHORIZED REPRESENT ��1I� s 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 (;6 b 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: l��Zl.fgL,� 1Mif5 i� (Location of Facility) /ZU Signature 6f Permit Applicant 2062 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORT#i o of 4Andover u, VO No. _ LA O dover, Mass. 1 COC MIC KE WICK V o'QATE D BOARD OF HEALTH PERMIT T _ . D Food/Kitchen Septic System •'� ��N � � 04.. %�O� BUILDING INSPECTOR THIS CERTIFIES THAT. . ................... ............. ......... .......... ..... .......,�..,►.. .. . .................. .......... Foundation ��� � da on has permission to erect.... buildings on . �..I..�1. �C ...... Rough ...........h�................. .........S to be occupied as........ ... .. 'e 10...' tmot-��'V M�I Chimney ...... ......................................................................... y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and BY-Laws,relating to t e Inspection, Alteration.and Construction of Buildings in the Town of North Andover. Q ai � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids t Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR Rough A A ................:.....................................................:.... Service BUILDING INSPECTOR .Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. , Burner Street No. SEE REVERSE SIDE Smoke Det. 7 6 2 Date... Of ,40RTII TOWN OF NORTH ANDOVER 0 0 PERMIT FOR WIRING AT.0 u ... This certifies that ........ ...... ............................ .......... ......... has permission to perform ............... wiring in the building ......... of Ix .......1�.. .............................. .;.I..('. ) -4 .... at.../Z /................ ,North Andover,Mass. Fee.-/' r...' ......... Lic.No. ELECTRICAL INSPECTOR Check # Official Use Only Permit No. armee-t°ar�` sQ Occupancy&Fee Checked_ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 1�ires To the Ins e Town of North Andover The undersigned applies for a permit toperformthe electrical work described below. Location(Street&Number 119 i'pRE-64,6111 Owner or Tenant MORR ECa'Ai #rki7T Fj1VD Lnryo, LoCX6" Owner's Address S R Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpbse of Building C Utility Authorization No. EAsting Service r7U Amps d Voits Overhead El-- Undgmd ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work I<,'ir.H&w KENnmz Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA U Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ rnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and` No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wirin No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = valid proof of same to the Office YES= NO —�jf you h ve checked YES please indicate the Q$c9v ra a by checking the appropriate box INSURANC BOND = OTHER =. (Please Specify) CtE6ftS'A�N /NS / (Expiiati n Date) Estimated Value o�l ctrl al W rk$ l/ / Work to Start /2 O Inspection Date Resquested Rough �3 Final Signed under theIeRlties of perju FIRM NAME ry:G R1 L" S� LIC.NO. �J L� Lensee ! �I C G�� i =n? Signature LIC.NO. yQO at y Bus Tel No. ve - l S 803a Address 8;� 26J7N iOhb1rVAV �AwREAW ft Alt Tel.No. V7FJ A- Za s OWNER'S INSURANCE WAIVER: I am aware thlit the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that myfsignature on this permit application waives this .requirement. Owner Agent (Please Check one) Telephone No. PERMIT-f EE b (Signature of Owner or Agent) Location 117 F- No. Date MOItTol TOWN OF NORTH ANDOVER Certificate of Occupancy $ �'�s''••°' MUE<� Building/Frame Permit Fee $ RGS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check # � C _ f ,� -Building InspectorU TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI3 RENOVAT5 nOR DEMOLISH A ONE OR TWO FAMILY DWELLING .,.rte� ` 1..'y � Y5"''..Y 5' ,;,';;a ,• .. r @ `'��� � BUILDING PERMIT NUMBER: DATE ISSUED: M SIGNATURE: C� Building Commis6ciii6r/ImREtor of Buildings Date Z SECTION 1-SITE INFORMATION. 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 117 • re,5c->R Map Number Parcel Number, 1.3 Zoning Information: 1.4 Property Dimensions: �\ Zoning Maid Proposed Use Lot Area Frontsge(11) lJ 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R 'red Provide Recpimd Provided ReqWred Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Prh,e ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic.District: Yes No M 2.1 Owner of Record a Uf,� Name(Print) Address for Service s- 2- z- Signature Telephone 1 f• 2.2 Owner of Record: 613 Name Print Address for Service: 0 M Signature Tele hone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Po &max Z32 Not Applicable ❑ AFJ(-&,) 1�vl��ol�a�1 �� 3 3 Licensed Construction Supervisor: O /` r_ /"_(%roV y l!f License Number mn Address,,,"/ Expiration Date icic •gnatur Telephone ti 3.2 Registered Home Improvement Contractor Not Applicable 0 0 Cotllpany Name t'I I rn Registration Number ro Address G/ _ i o _ 0 0-5, Expiration Date Signature Telephone � SECTION 4-WORKERS COMPENSATION(IVLGL 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 it. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ' t Other ❑ Specify Brief Description of Proposed Work: YL v r C4 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be CUE.ONS �` �� ,-4 Completed b permit applicant � a 1. Building (a) Building Permit Fee 9 -700 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC Ao o 5 Fire Protection 6 Total-(1+2+3+4+5 9-7-00 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT re e—v I as Owner/Authorized Agent of subject property Hereby authorize r' J ,4 C/f P A H/ �?e 4 /Pk d �.� !�'Cto act on My behalf, matters relgOve tq work authorized by this building permitplica i nZ 9 o.� Co Signature of b5iei Date y SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, / �L v✓2P y, 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 —McA v,v,,-e -Q (A 44, r Print N O / Ll Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TBABERS 1 2NRD 3 SPAN DUviENSIONS OF SILLS DEV ENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS d SIZE OF FOOTING X MATERIAL OF CBEVMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro Boards and Departments having jurisdiction have been obtained. This does not relie% the applicant and/or landowner from compliance with any applicable or requirements: J *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT PHONE ?�l Y LOCATION: Assessor's Map Number G Z PARCEL 00 SUBDIV1S10 LOT(S) STREET ST. NUMBE / / ~ *********** **********► *** *OFFICIAL USE QNLY** *** ** ** * RECL NDATI F TOWN AGENTS: CO SERVATION ADMINI ATOR DATE APPROVED G DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE-REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT = FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE --- Revised 9197 Jim f. a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers'Compensat/on insurance Affidavit � Svc Name Please Print Name: Location: City Phone # f-1 I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity 1 am an employer providing workers'compensation for my employees working on this job. GomfflM name: 14, '. Le-,r– !`r9-(j Address d- 3 .0z Inst,ran :co. L i t 1 �/ Poli> # X11 .� -7 Z C�C� CojmgM name: ' Address , Insurance.Co. Pbliq# . . Falkwe to secure coverage as required under See ion 25A or A*.L 152 can reef to the irnp6sdfon of«imirfae pis cif a rhe inti ta_ y:sa anwor one years'kr*dSorVWd as_ jCW- ieS_W d elomnxta_S79P rm-d understated that acopy of this statement may be forwarded to the Office of invetige6ons of the b1A for coverage verifiw--mon. /do hereby eerfdy of Signature that Me" tion provided above is&w and cora ct Gate Print name c/ .Ll ( P e Z t�1 7 S1 Official use�ony`.. do not write in this area to be eompleteCt by city or town ofWar A City_or Town ::Perm?/Licerisina. pcheck r7immedfate n.spanse is n,qured L.i�ris�ng Bsai [� selectman's O Contact person: Phone# Health Departs Other BULJQOARpp DIG FtVISOR CTIONSUPE t_cense: CONSTRU 063833 ` " Number: CS }i Birthdate*. pg113f1968 $3833 E%P fres:W1312006 Tr.no: ; Restricted: 00 pp.BOX?2 p1 6 Administrator S .MA "`-: R °'�p97LJi1.O1L1lIG'Q,lA1L'Q� .'.!�'t,r .,'- •AI li i y`� (Board 4 BwlIa,6'Regul0tiont aiid.Standards y HOME fMPROVEMENT GON7 dA R t,' RegiMido 138491 £iipiration: 4/,10/2005 j, ype: DBA 1 • HIGHER GROUND , + ANDREW All '1701 �i +Nl7�ST:• L(.• rr-' i ;[OCKPOt2T:,MA 01966. Administrator I 1 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 c 11, 8 150 A. 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 Qi . �s GENERAL ' . ... N CONSTRUCTION 5 k...... DATA 0 �1. TYPE: �•� 0� SQ.FT.: � Tl �. RAIL: k0ee- r' CI �, - JOIST: a X r l l.,... 11 r� POST: . ST• ' r FLOOR HEIGHT STEPS (rise/run): LATTICE Z12 z w` : do p,1cJ� SEPTIC: Z "` (� SIDING TYPE: SET BACK: , J PERMIT V .. OTHER: NOTES: ESTIMATE: CLIENT: ADDRESS: tte e PROGRESS PROJECT CONSTRUCTION PHONE: / !% / STATUS PERMIT Ej Scale: 015 R0=� Andy Mullholland,Jon Youlz P.O. BOX #2326,ROCKPORT MA 01966 Date: Phone:978.697.5987 email:am@dekdoktor.com Drawn By: 2003, Higher G-77-7@ Approved By: -77 Q. 1`IIoRTG.6.[zE: pU1�.f�oSCS - 13.h►.tK 15.E ��1L.`�C (15ASE D UPD)IL Pula G RECORDS AMD EVr DekcE ON ADDR.rcSS Z h-T SOUR.GE 4- o % p is r ./• J 3. . . . o •r.• rte: �' .o 4 �4. • o �. O 06 p %%% 75, F - .Arm= b Z/z519 3 ts CERTIFICATE • . REGISTRY. Eut_y. Kof2rl4' I CERTIFY that the Lot shown 'hereon DL'FD: SK.Z :.. that the Gl6is:LC.0 IJ Cx shown ' PLANGa2f ` CELT, OF TITLE: . �,�_ present Zonin �Y� 'NOTES of the O ►`1 of -t�0Llrl"- AKLV6ys2 : The' premises do not lie within , a designated. ,sf�LjK Of .. it • Flood Hazard �14S No hyo°c� V3s. s t 0► �tZT Lone-e0MM,P4gF_L. ! '� ��� I' ROBERT':G, -GOODWIN., -R,L,S, M �Z�O%'-oopS-G ' �FtObeAt � �` � Ctl.l> 1T w 82f•CENTRAL M. EET .�ox�,t5�`$3. �" GoodwaM ANDOVER. it ASS ... . NORTIy LE ONM of j:, Andover . No. 310 -- - - _ _ o, (' over Mass. C 1:Hic• ` 2fi �^ f f ADRATED S H BOARD OF HEALTH Food/Kitchen P. ER �M IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....jM. .V re. � ��RT �..................rr............................ ... .. Foundation has permission to erectJWM*& � O .................................... buildings on ......... ........ ...... .......... ..,..................................... Rough to be occupied as.f... a �acC.....S A AIS � .... �o��a�f�� FAQ TOS AMIN Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions-of the Codes and By-Laws relating to thenspection, Alteration and Construction of Buildings in the Town of North Andover. 84R /I I 0� /4040 00M PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION TARTS ELECTRICAL INSPECTOR C Rough .......��.... .. .. .......... ..�.....6�4� Service . . . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place o'n the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT L Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det.