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Miscellaneous - 119 KARA DRIVE 4/30/2018
119 KARA DRIVE J 210/098.A-0082-0000.0 1 I i I I Date '3�2- . . . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . o�� wiring in the building of . . -? ? `l`!`.G . . . . . . . . . . . . . . . . . . . at . . . . . . . "INSPECTOR Fee���.•�� . Lic. No.��� b �. . . . . 'W ELE :Check# 101; 31 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: in accordance-with theprovisions 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,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 shail_be limited as to the time ofongoing construction.activity,and maybe.deemed_bythe.Insp.ectox.of-Wires abandoned.and.invalid ifhe—. 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 conceming the use or development ofreal 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 extending1hrough August 15,2012. ule —Permit/Date Closed: Z / "Note:Reapply for new permkk� ❑Permit Extension Act—Permit/Date Closed: J Commonwealth of Massachusetts Official Use Only �.- aJaw Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 IN INK OR TYPE ALL INFORMATION) Date: 3 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) OAel't)r' Owner or Tenant Telephone No. Owner's Address S/9tnj' Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 'ey-la.1 L Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity ,p Location and Nature of Proposed Electrical Work: FCR of U,q T' j1Da /"I S Completion of the following table may be waived by the Inspector of Wires. of No.of Recessed Luminaires 6 No.of Ceil: TransSusp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above EiIVE-OT Emergency Lighting rnd. rnd. 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 No.of Alerting Devices g Tons No.of Waste Dis posers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection d No.of Dryers Heating Appliances KW Security Systems:* Y 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: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 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 andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: . K>�CC %" f G � px� LIC.NO.: Licensee: ����,,�r/ /, 4er Signature LIC.NO.: (If applicable,enters"exempt"in the license number line.) Bus.Tel.No.: 228' Address: M,,�T /lw Alt.Tel.No.: 97 8 771-00I`I *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. r J'UIJJLttilyd�lrl��+{{����{((([•fes■7([C��9��1e{F�1�{�l ®� P^QQ{(a�(' �(}�� }Jd.LreL.SCI.�J�JL�tJ'J�®RT , Morss: ctorOStgu tune-)ao tjals) _ Slate 3'08se --j .tcinspectionrequired($60.00)-[ � xuppeeton,comments: ---------------- (Tzis�adoxs'ftnature-)10 Wftals) Slate ' �'asset�--� � �'ai�et�-•[ � �te�fuspectio�,�•et�ui�ret�($�O.UO)�[ ] inspectors'comments: [ pectoxs� tgnatuxe��ozniffas) Pate ATE CALLUM rn NI± 'AON'AI►C-R-113: N•A3IM:. assec��•-[ ) �`ailec��-•j � rhe-�nspectionxequixe�(�50.00)�j � tspectors"comm.ep:fs: . (�tusectozs', tgu�ture��aotials) Date WSPECTTON OMER ' RexnspeetionYqutrea050.00)•-[ pectora'cozubaents: , • S ' Vitus ectora' tgnature xto znifia�s) date ' 3ORT.AG$.AFSTODYMUD PUT AMMTOff'91TRIFTE.APXATOMINUEC ED 10 NOT The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv Name(Business/organization/Individual): Address: 4 v) City/State/Zip: � � y /°P� ,g o��3a Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.1.I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.E] I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions y myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they aie 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. lam an employer that 1s providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:, G J; Policy#or Self-ins.Lic.#: Expiration Date: 6//2/ -Zc,/0 Job Site Address: City/State/Zip: y 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 certt&under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: ��'p— Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitUcense# 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#: f y 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 producedacceptable 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 i 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 Com onwoalthofMassachusetts Departinent of Industrial.Accidents Office of Intvestigations 600 Wasbington Street Boston}MA 02111 Tel,#617-727-4900 oxt 406 or 1-877rMASS.A.FB Revised 5-26-05 Fax#617-727-7749 www.lnass,gov/Glia ♦ Date...��.. .C,Z........ �aORTq "� TOWN OF NORTH ANDOVER OL p PERMIT FOR WIRING SS4cHusf� This certifies that -- has permission to perform . `" -�--`' ...................................... wiring in the building of - �- ................................................................................... at......... .....:..... ........AECTZ�CAL NorthAndover,Mass. Fee y ............ Lic.No.�-.•51,4 h5 ......... *IiNSPE�� Check # 7787 %ou...islutiwcairn uTMBssacnusetts Official Use Only ate• Department of Fire services Permit No. 77�9r BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked,—' �-✓ [Rev. 1/071 eave 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 IN INK OR TYPE ALL INFORMATIO 1�q Date:_ //- oV-p-7 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) /l Owner or Tenant _ U� �� �Q --��� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes LY No Purpose of Building ❑ (Check Appropriate Bog) ---���� Utility Authorization No. Existiing Service Amps / Volts Overhead ❑ Und d �' ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the ollowin tkGenerators blaybe waived b the Ins ector o Wires. No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Total formers KVA No.of Luminaire Outlets No.of Hot Tubs KVA No.of Luminaires Swimming Pool Above In- mergency tg g rid. d. ❑ BatteryUnits No.of Receptacle Outlets 3 No. of OR Burners FIRE ALARMS No. of Zones ' No.of Switches 6 No.of Gas Burners o.of etection an No.of Ranges No.of Air Cond. °tal Initiatin Devices Tons No.of Alerting Devices FNo.of Waste Disposers eat Pump Number Tons EEEp Totals: �"......�'".."�'. �.-.-.-. o.of elf- ontained �� Detection/Alerttn Devices Dishwashers Space/Area Heating ICW ❑ MunicipalEj Connection ��o.oDryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters ' °•°f Data Wiring: Si s Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No. of Motors Total Hp Telecommunications icing: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: a®(}�`n (When required by municipal policy.) Work to Start: �,_(Oq0- 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 4 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 [!J' BOND ❑ OTHER ❑ (Specify:) I certify,under the pains es o andpenalties ry,that the information on this application is true and complete. P fP�.lu FUM NAME: CCt3L / S LIC.NO.: Licensee: ��F..i'��/(��" (tom/�/ice �QiSt Signature I (If applicable, enter`tempt"in the license number line. l LIC.NO.: Address: A A Bus.Tel.No.. *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.$ v, The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations till �' 600 Washington Street i' Boston, MA 02111 www nzassgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pinmbers A.tinlicant Information Please Print LeAbiv Name (Business/Organization/Individual); QAC�� 11 1�i�I/Q /r, Address: City/State/Zip: /L14 /.ZPhone#: . Are you an employer?Check the appropriate box: Type of project(required): 1. I'am a employer with�_ 4. ❑ 18111 a general contractor and i L (full and/or part-time),* have hired the sub-contractors 6• ,❑,`LNew construction 2.Q I amA-sole proprietor or partner- Iisted on the attached sheet I ? [ 'Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me 9n any capacity, workers' comp. insurance. [No workers'comp. insurance 5. 9, Q Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.[1 Electrical repairs or additions 3-El I am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repairs or additions myself, [No-workers'comp. c. 152, §I(4),'andwe have no insurance aired. t 12.[:] Roof repairs �I ]. .employees. [No workers 13.❑Other comp. insurance required.] "Any applicarrt that checks boi i must also fill out the section below showing their wotkorc'iiompensetion policy information 1 Homeowner¢who submit this affidavit indicating they are doing all work and then hire outside oonttactors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the new of the sub-contactor;and their workers' 01 UP.Policy information I am an employer that is jproviding.workerscompensation insurance for riry employees Below is the Policy licy tmd job site Insurance Company Name: ° Policy 9 or Self-ins. Lic,#: Expiration Date: Job Site Address: City/State/Zip: Attach;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 crinal penalties of a im fine up to$1,500,00 and/or one-year imprisonrnent,as well as civil penalties in the form of s STOP Of enm 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 de hereby cert `under the iris and p aLdes of a 'try that the infar»tation provided above is true and correct Si tore: a Date: r� Phone#: D///;7 O 3 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 6.Other 5. Plumbing Inspector 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 individuals 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.. "a.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' oo .pensation policy,pleasccall the Department at the number.listed below. Self-insured companies should enter their self insurance'license number on the appropriate tine. 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/iicense 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 be- en" 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 funic 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 r Department of Industrial Accidents Office of Investigations 600 Washington Street ' Boston, MA 0:2111 Tel. #617-7274900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia Date.' TOWN OF NORTH ANDOVER 3? OL ....,.,• PERMIT FOR PLUMBING 40 ,SSACMUSE� f I / This certifies that .. . z-c t- -� . . . . . . . . . . . has permission to perform . . ...-- ?+- . . . . . . . . . . . . . plumbing in the buildings of . . . . . ..`" . . .�-. . .. .-!`.`--. . .. . at. . . . . . . .. North Andover, Mass. Fee' .,74.Lic. Nw. ";.,.V '. . . . . . . . . PLUMBING INSPECTOR Check # ��- 7563 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS v Date Building Location Owners Name �- Perm it# $ Amount Type of Occupancy New Renovation ® Replacement 1:1 Plans Submitted Yes ❑ No ❑ FIXTURES H H w a a W W O 3 W A a00A 0 A w Fx a a H W w x C40 CC � O Cr � &��1VII�iT IST HDM M HAQR MILOOR ` 4M HiOQR M MOOR 6M Hj0CR - 7M H100R SIH FLOOR / (Print or type) yy�����,(� l� Check one: Certificate Installing Company Name �?K/y`rJ/S OZl1` 'j ❑ Corp. AddressL Partner. y usmess Telephone -. 32 -6syP rl Firm/Co. Name of Licensed Plumber: e5�wY AWIJ/ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: `Liability insurance policy ® Other type of indemnity ❑ Bond ❑ 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 Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have sub itted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and instal t' s performed der Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu State PI u bi 2odc n Chapter 142 of the General Laws. l By: ign ure o sea Plumber Title Type of P mbing License ��_ City/Town 12&icense um eTi r Master ❑ Journeyman APPROVED(OFFICE USE ONLY ® �� J Date. . . HORTp 1�0 p TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION s a ' SSACMUSEtty This certifies that . /. . . . . . . . . . . . :'`. . . . . . . . . . . . . . . has permission for gas installation - fes-- in the buildings of . . . .`. . '- ........ . . . . . . . . . . . . . . at North Andover, Mass. Fee:: `.?. .. . .. Lic. No... n� /.. - �►}�,,�C.�. . : . . . �i GAS INSPECTOR .- Check# 6,/'/ 6 2 't 0 MASSACHUSETTS UNIFORM APPUCATON FOR PERM TO DO GAS FITTING (Type or print) Date 14`y07 NORTH ANDOVER,MASSACHUSETTS Building Locations /> � �— Permit# Amount$ LL�;- cl?�- Owner's Name New Renovation D Replacement Plans Submitted � a U W o a 16" � o z o° z � un x z u W x �- c a > w C7 F z F d x W C W w F" w F 0: U v� Z Q W Q F. O > tr, Z O ti x a x o fz 3 c .�a o z W o a H o SU B -8ASEM ENT B A S E M ENT 1ST. FLOOR r" 2ND . FLOGR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOGR 7TH . FLOOR 8TH . FLOOR (Print or typ���� /�� t� Check one: Certificate Installing Company Name 11 Corp. Address �d Gvz /Y cl Partner. Bus—iness a ep one 86 Firm/Co. ' Name of Licensed Plumber'or Gas Fitter �/ lokli v� INSURANCE COVERAGE Check one: r I have a current liability Insurance,policy or it's substantial equivalent. Yes ® NoO If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity D Bond 1 Owner's Insurance Waiver: lam 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: Signature of Owner or Owner's Agent Owner 13 Agent 13 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 installations rformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse a Gas Code andC r 14 of the General Laws. By: Signatur of Licensed Plumber Or Gas Fitter Title LL ® Plumber City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman Location / "`e� �� n Date 6- v/ No. NORT„ TOWN OF NORTH ANDOVER R Certificate of Occupancy $ • ��_ ' ;,S •Eta Building/Frame Permit Fee $ sic s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ----- Check # r Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �q BUILDING PERMIT NUMBER: n DATE ISSUED: _ / SIGNATURE: Vju Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number 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.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record &Ak A 1,,PAA &epby I/y)I), 4 12 4 1312. I Name(Print Address for Service: Q� g8' Sig re Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ V Licensed Construction Supervisor: (��p 3)7 � 7/ )a.-% 3A AUT A),�1,j-cR License Number Wn Address 7 / 3 Si afoe Telephone J r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Com any Name y m 1 ) ` 1,T ` ,n�� y y AA) Registration Number r Address e — -0(262"d� o ate ^� Si ature Telephone v' 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.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: r e S SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of 0 0 Construction 3 Plumbing p p, Building Permit fee(a)X(b) 4 Mechanical HVAC 5 Fire Protection ell 6 Total 1+2+3+4+5 O Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize / to acton My behalf,i utter o work authorized by this building permit applicatio Signature fOwner Dat SECTIO N 7b OWNER/AUTHORIZED AGENT DECLARATION I, /)2elQ A Q�e� 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 Owner/A ent D e NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3 RD SPAN DMIENSIONS OF SILLS DIMENSIONS 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 BOARD OF BUILDING REGULATIONS J License: CONSTRUCTION SUPERVISOR I Number. CS 063173 Birthdate: 01/21/1968 Expires:01/21/2002 Tr.no: 15958 Restricted To: 00 + FREDERICK A PAPPALARDO 71 BRIGHTWOOD AVE (..+t_� / "`X-4V4 ' N ANDOVER, MA.01845 Administrator i Board of Building Regulations and Standards 1 j HOME IMPROVEMENT CONTRACTOR L,L Registration: 123349 Expiration: 32/03/2003 Type: DBA PRO•BUILDERS&DESIGN CO FREDRICK PAPPALARDO 71 BRiGHTW00D AVE `y , N ANDOVER,MA 01845 Adrririsirator The Commonwealth of Massachusetts WI Department of Industrial—k ;cents I Cftice of Investigations Boston, Mass. 02 111 Werkero' Compensation Insurance,41fTdavit Name Please Print Flame: Location: Cita, Phcre T I am a hcmecwrer pertcrming all work myself. I am a sole proprietor and have no one wicrkino in any c.=pa&j CI am an employer providing workers' compensation for my employees werkina on this job. Comoanv name Nk/e a tceu LL�_ Address 71 13�!�>~ u on 4 AW CiN: iy�B4J `JY2 4-A • Phone T Insurance Co. G, Pclici I Comoanv name: Address CiN: Phcne r' Insurance Co. Pclicl Failure to secure coverage as recuirec under Sactien 25A or VIGL 152 can lead to the imposition er cnmiral penalties cf a fine up to sl,500.e0 andlor one years'imprisonment as'Ne:l as c:vii penalties in the f.crm a a ST CF`NCRK ORCER and a rine cf(x100.00) a day against me. I understand that a cdpy dr;tris statement may ce fcraarced to the Office ct Investigations cf:he GIA fcr coverage verinc2ticn. I do hereby ce.rtiy and the pains and penalties or perjury that'he information provided accve is rue and ccrrec.. Signature Date Print name n-epi-y kJ9i`P1yIAY2-2-3 _Fhcne l'r Offic:al use oniy do not wnte in this area to ire completed by c::y cr tcron cffic:ai City or Tc,vn P=rmit/Ucensirc Building Dept ❑Check.f immediate response is required ❑ Licansing Board Se!ectman's Office Contac:person Fhcne T C Health Department BUILDING DEPARTY1-1i T DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: r-?A,J)< Location of Facility v--- - Signature of Permit Applicant r y II Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i M � 1 NORTH 01M . f 0 dover 0 VA No. ojqP �Ml—x-W 7 PFT!i-7 dover, Mass., 6 OA?ATED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System ...M A k IL .%�=...La OR%*%a Qk%ot A.Aj BUILDING INSPECTOR THISCERTIFIES THAT ........................... ........ ........................................................................................ Foundation has permission to erect....MASI!9,P�.... buildings an ......I.I..!(......pea.iR6 etv-,4, , ........ ........... Rough ............................... ayS� d to be occupied as....Bo ...... ........................................................ Chimney provided that the person accepting this permit shall in every resiled,conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 7 0--A 4%a..,*0/, PLUMBING INSPECTOR • VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS ;CONSTRUCTION ST&:S ELECTRICAL INSPECTOR C Rough 060� ............AW. .. . ....................................................................... Service 1 BUILDING INSPECTOR 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. T s N° 3 , 5 Date...........-.................... NOR7/, ,``°;° - TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING ACMUsE� This certifies that Y has permission to perform wiringin the building of.......................................:........................................... v _ . at .................... .North Andover,Mass. F Fee. ................ Lic.No.............. ................................................................ ELECTRICAL INSPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Jim W1VXVJ(J1YY►"GHLJ1TUrJV111aJ.."4L 1UJC11/3 Uulceuse oruy DEPARMENTOFPUBLIMEETY Permit No. _ J//13 BOARD 0FFIREPREYEN770NRECUMT10AN5270R 12.00 w ' Occupancy&Fees Checked - yV APPLICATION FOR PERMIT TO PERFORMaECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �_J�h—43; A00 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) �� y' �(�i�l-� 4,>-l",t_ Owner or Tenant 14 o r e-- fee,"a n Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building � i'� T Utility Authorization No. Existing Service Amps / olts Overhead Underground M No.of Meters New Service Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work &a S7a r 154,gh4o%n -qL No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 1:3round No.of Receptacle Outlets i 7 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets119-` No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones _ Tons Ab.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs / No.of Motors Total HP OTHER htstttarreCove�Ftrtsuattbthenagtlaatlal��Genaallaws IhataamtLibifdyhsut' =PbhymdLxUrgCm#gL- C ywdWcr9saksWttdeVvakt YES NO Iha,,e%bTWtedva praiofsa=lot41eOti-YES Ifjmha%ecfwdWYBS,PiMSeirtdC*ft peofWVWdWbydukirgthe WSURANCE [D' BOND MIER F7 Estia&d ValuedUXft cal Wcik$ WotktoStart hq)ac6mD*RoVcsted Rwgh Fttlal Sighed taxia�ie P�alaes ofpegtay. / -��- FWM NAME Sigr� Bt mmTdNV Addrms 773 LLeo-S�!Oh 7,—h 111'A� AkTdNa OWNM'S INKRANCE WAIVER;I.amaw=dr tt cLoer>9edM nuthM lhelc>s<ranoeaMWa-#s%*&rttalegtmaiatas m*redbyNjwdnsetls Gateral Laws and fat my soon thlS petma<aI]pti�ai wdi�thi,S t�H'rlat. (Please check one) Owner a Agent 1:1 �"'—�+ Telephone No. PERMIT FEE$ �� Date . . . :.:. . . . No . �, 5 TOWN OF NORTH ANDOVER ° A PERMIT FOR PLUMBING � s ,SSACHus� This certifies that . . . . . . . has permission to perform . . . ?. . . .�. . plumbing in the buildings of . .��!.r. �!! • • • • •� at . . . . . . . . . . . . North Andover, Mass. I Fee. . . . ... . . .Lic. No../'., . . `. . . . . .. . . . :-.. . . . . . . . PLUMBING INSPECTOR Check # { WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) L.`� p J� NORTHANDOVER,MASSACHUSETTS U f Date 0 Building Location 1/e Owners Name �� Permit# ? , D � 0 �� T e of Occu anc 1 Amount ov7 New Renovation Replacement Plans Submitted Yes Noj FIXTURES r w a x x w c w w a x w r w I a. A A <w SME&W )i3�4IVII�II' d F FM MOM R= ROM ROM 5M ROM 6IH RDM 7M ROM MM (Print (Print or type) �t Check one: Certificate Installing Company Name [j Corp. Address r�r1 ullel4✓e. _NQ/i°lt _ Partner. Business Telephone � _ 7 G k ❑ Fiim/Co. Name of Licensed Plumber. ij , `j Q/' o b1 Insurance Coverage: Indicate the type of insurance coverage by—cheding the appropriate box: _. s Liability insurance policy M, Other". (tarmaenulii�, ?'"') r ' 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 Signature Owner Agent 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts tate lumping Cod and ghapter 142 of the General Laws. By: 6ignature ut 11censeaum er Title Type of Plumbing License City/ tcense um er Master Ioumeyman APPROVED(OFFICE USE ONLY f i,r&3,trr NO. APPL"TION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 • MAP-NO. LOT NO. 4 2 RECORD OF OWNERSHIP DATE (BOOK ;PAGE O .ZONE I SUB DIV. LOT NO. O LOCATION PURPOSE OF BUILDING N OWNER'! NAME RA/2 (1_ �� J NO. OF STORIES 017E 0 s OWNER'S ADDRESKSwtD � AA)0UJC BASEMENT OR i ./ !` OCA TIM SIZE OF FLOOR TIMBERS IST 2ND ARD ARCHITECT'S NAMEA- ifa Jr,) SPAN BUILDER'S NAME Zv e -, DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES —SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW - - SIZE OF FOOTING x 16 BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION ��/1ALL..1,� wf�S tJSlA��!•�ICC� 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 A ! ' 19 BUILDING CONNECTED TO NATURAL GAS LINE I of s PROPERTY' INFORMATION INSTRUCTIONS LAND COST SEE BOTH SIDES EST. BLDG. COST �/�-foa P d EST. BLDG. COST PER SO. FT. PAGE I FILL OUT SECTIONS I - EfT. BLOC. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR Of DATE FILED 600-16 f.41 •UILDINS INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGE i - - - � PEE ,OWNERTEL! 3 IKRM IT GRANTED _ SONTR.TEL _—_ %cONTFLAJ f MR,-W� " • - s i ✓lre �ommarrfi�e��/� n��-1�a.�ar�ivanll,� r DEPARTMENT OF PUBLIC SFi ET'i. CONSTRUCTION SUPERVISOR LICENSE Nueber: Expires: Birthdate: CS 063113 O1/2i/i"?O vJ'/',1?ci Restricted To: 00 FREDERICK n PA Pir",ROO uo,wem�f1�� S42 PROSPECT METHUEN, Mn G1844 ""R I00�![9NMIt�Mo�/II n�_//iIJJ�rp��.le//1 HOME IMPROVEMENT CONTRACTOR Registration 123349 TyPe - DBA EXPiration 02/03/99 i PRO-BUILDERS & DESIGNS FREDRICK A. PAPPALAR00 4 �drl BRIGHTWOOD AVE ADMINISTRATOR N. ANDOVER MA 01845 J _— , /, �asiricted ia� Q6 r.nf, •.,,, ...,>.=r D0 One Ip - hasonrY'onlY IG 16 2 f a�ily hoes It License or registration valid for individual use only before expiration date. if fund return to:One Ashburton Place Rm 1301 Boston Ma.02108 1 tAOR T Town of _ Q _ Andover s . dover, Mass., 19 $7 pA rEo Pp,��' 9_t1 � p v �G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................60.,4..........,�,�:C�2.,s.�/...................................... .................................................. Foundation has permission to erect.....��4Z. '1.............. buildings on ........&?....ArRie.Q......PR..'....................................... Rough to be occupied as..........SJ.�l.SeAr........./••Gi./MIF1../. Chimney provided that the person accepting this permit shal in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final 07Iz/ ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS Rough ........................... .... . ...... ...................�1.....[............................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous .Place_ on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. Date.�..�� ......... f NORTH 1 :°•_';�`` �';."°o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSEA This certifies that ...............e) ...................... ......... .��............ has permission to perform ......... �� �............... .. � G ''� ............... .. ..... . .......... wiring in the building of......4::'.`.f�qrq.......1. ...................... at........................ ....................... ..... . ................ North Andov <<_ _ U - Fee.. 7 �..V. Lic.No.lX l��. ...,r.................. LECTRICALINSP$CTOR � Check # 5362 THECOMMONwFALTHOFMASSACHUSEris' office Use only_ DEPAM3fi 'OFPUBIICSgFM Permit No. BOARDOFFREPREVF.M ONRECAUHONSR7. MR12.0 Occupancy&Fees Checked ' APPLICATIONFOR PERMIT T2descrnibbelow. ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat_/_ 2 D Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical wor� Location(Street&Number) g Owner or Tenant to Owner's Address SOlwve of S CtdvP-- k.! Is this permit in conjunction with a building permit: Yes M No EJ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 00 Amps120/y�Volts Overhead M Underground No.of Meters New Service .... 00. Amps /�Yo Volts Overhead M Underground ®' No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Ale 77 dLt/ ilaaeStfl/v/ G� No.of bighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.o{Lighting Fixtures Swimming Pool Above Below Generators KVA round 0 ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of r Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• htstttanocOntrW Aeamtmthere4mmiatsoflvlassxh]MGffnWLaws IhneaarnatLiabt7iyhmnanoeAblicyincktdmgCor Compg oritsmbanatequivalent YES 0 NO lbaNembroedvaidpfOOf5pfflfiDthOOffiM YES ffycuh�axeched®dYES,pleas hdcaedrvA eofc vwVby INSURANCE F71BOND 0 OTi�x p (PleaseS�ecify) f�!� �� 1?Zt/�l O� G .5— EqihimDwe EMmamd ValreofDWaca1 Wc1k$ WodcloShat htspectiMD&ROVested Rot# Final FI.RRMMNAMEE LiaenseNo. Z '17 7.2 cl- I�certsee _116 J � �i� C�/�— Sigrtaaae fpt'� Li�tseNo ?'2 G' Business Tel No. i P.D. 80Y (572 0,/V © 3 v 2 I AltTelNa OWNER'S INSURANCEWAIVER;IamawarethattheLmisedotsnothawthem uameoovmWoritsatstctialepvAMas[1 plWbyMassadusetlsGeedLaws andel atmysigrnhaecn dm pennt*pbcabm waivmdu m4mmut. (Please check one) Owner Agent 1:3 (/ Telephone No. PERMIT FEE Signature ot Uwner or Agent Location �� / �r'a :/:�)/?- No. Date N�RTM TOWN OF NORTH ANDOVER 9 It Certificate of Occupancy $ Mus`�' Building/Frame Permit Fee $ a0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �a — Check # "! g "i 6551 ( -u- Building Inspector s 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/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number Q 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'red Provided Required Provided O 0 D 1.7 Water S ly M.G.L.C.40. 54) 1.5. Flood Zane Information: 1.8 Sew a Disposal System: D Public Private 0 Zane Outside Flood Zone ❑ Municipal ( On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes fro STI 2.1 Owner of Record / io'�✓� ���d�9G✓�' ��� L�,/�ry✓o cid Name(Print) Address for Service: Signature Telepho I 2.2 Owner of Record: Name Prin Address for Service: z rn Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 4z (p V o j /�og xel� ti-- j .1�` ��Lc,[� License Number Mn Address ��'J �y/� D 7 o oy d3 z5a�ff, � Expiration D ic Q Ware Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name 476 7% rn `� '41Registration Number r Address r Expiration Difte ^� S nre Telephone v• S 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.......❑ SECTION 5 Description of Proposed Work check aU applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 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 a �- 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZA ON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, l?✓ eu.,l as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by th' building permit application. Signature of Owner Date Ir SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 �yv S Print ame Si ature of Owner/Agent "Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIIMENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS r SIZE OF FOOTING X MATERIAL OF CHIMNEY , IS BUU DING ON SOLID OR FILLED LAND , IS BUILDING CONNECTED TO NATURAL GAS LINE ( 63 y C (o • FORM U - LOT RELEASE FORM b al hA y INSTRUCTIONS: This form is used to verify that all necessary approvalI S 103 rorin Boards and Departments having jurisdiction have been obtained. his does not eve the applicant and/or landowner from compliance with any applicable or requirements ve *APPLICANT FILLS OUT THIS SECTION APPLICANT Ay—�L T"��e�p,Q VjA O PHONE � � l LOCATION: Assessor's Map Number � A PARCEL�— SUBDIVISIONv LOT(S) STREET_ ST. NUMBER .OFFICIAL USE ONL * *** * REC ENDATIONS OF TOWN AGENTS: CONSERVATION AD ISTRATOR DATE APPROVED p y DATE REJECTED COMMENTS s� TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED S`e u l DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm I—r4o r.wvc r"4Uf •>/•.o� M • +tea �q•�, •s�wv •nom • •v.•• ' t NAY STATE NURVEYINIy ASSOCIATES 300 CUMMINGS CENTER, SUITE#3151,NEYERLY,MA.,01913 LOCATION i.Ni.®".i.�..'./....�::L/40Y.MEe. MA. li®nS: SCALE : 1" 040 BATE :..�f 1. .�.1�.��. .............. 1)This is a mortgage inspection survey and not an lnatrurraent survey,thefetbro this plot pian Is for REFERENCE:" .Q .� .# G�7 i�..r.�`/3g mortgage inspection purposes only. »... . Z)This survey is based on survey marks of tabors. 1.. . 3}Bush",shrubs,fences mead tri lines do net . .. �.. .. necessarily Indicau property lines. A p� �� � 4)Whenever an ofl�et Is 1'*-or less. an instrument TO,""°� p ••• •••.•R .... survey Is m ommanded to detarnq$no prop&rty The locatfon of than building(s)as shown,either linos,and any Possible eeacraachments. 4ampfied wins the boost VAIng setbacks at time of bj Offssts shown ars approximate,and are a be conssatiwtion or is oser:aiat from violatlen used only far the detwmina#cn of zoning.Not to 0010n Ment ssatlon tender Mass.C.d..Titter ltll'i, be used to establish propwy ones. chapter 40A an 7 ti}In my profWwiaaxal stpiation the buitdinQ(x)we not 10681ad In the special flood haurd steno.as ,r seined by Fi.U.Ti. M,4P025009$ a • r J R i V 7�P179 Inelf ( y ye /06 fix$ PROPOSAL NO. P0304 DATE: 6/9/03 TWOMEY& LEGARE CONTRACTING Building& Remodeling SHAUN T'WOMEY Kitchens-Baths- Custom Woodwork DOUG LEGARE (978)6$5-7447 Complete Interior/Exterior Carpentry (978)55!,-1547 NAME OF OWNER: Mark Freedman ADDRESS OF-JOB: 119 Cara Drive North Andover, MA 01845 TEL: (978)852-1940 DATE OF PLANS: NONE �[re hereby submit estimates for: 16x22 P. T. Deck Price Breakdown: -Deck, Permit, &Disposal $ 9,200.00 -Door& Storm Door $ 925.00 -Wrap under side of deck- pine&vinyl lattice with 2 doors $ 1,600.00 Total $11,725.00 Payment Schedule: -1st Deposit of$6,000.00 -2nd Payment- Completion of Frame&Decking$4,000.00 -Final Payment-$1,725.00 on completion *Extra $600.00 for Plot Plan We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of ($11,725.00)dollars Paymmtto bemadeas follows: See above for breakdown of payment schedule All material is guaranteed to be as specified All work to be completed in a wojkr=hl e n mrcr aeowdingto standard practices. Airy alteration or Authorized deviation from above specifications involving extra costs will be executed signature_ ] only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon sftikcs,accidents,weather or delays beyond our control. Owner to carry fire,tornado and other necessary NOTE:This proposal may bewithdrawn insuranot Our workers are fully covered by Workman's C.ompe rsation by us if nat accepted within 29 days. Insurance. A AA Acceptance of Proposal - The above prigs,specifications and conditions are satisfactory and are hereby accepted You are authorized to do the work as specified. Payment will be made as Signature outlined above. Date of Acceptance: Signature N, W The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02919 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: 4el PZ-0 City Phone # Or;:: ���✓� am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity U�( I am an employer providing workers'compensation for my employees working on this job. Company name: /`✓a/�'j l-�'-�i�r�-� G'Oi1�/�� �✓y'� Address CityPhone# 1'07.� Insurance.Co. Policv# Company name: Address City Phone* Insurance Co. Policy# Failure to segue coverage as required under section 25A or MGL 152 can lead to the imposition of aiminal penalties of.a fine up to$1,500.0D and/or one years'imprisonment_as vmiLas_ciWimaltiesjosheSa m-dAST9P]IYDMDRDER.and_aline-f.($Imm)-ajdaysgaiosime. i understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification. I do hereby cert y under rhe pphs and penalties of perjury that lute infarmaborr provialsd above is Gree and correct. Signature pate ,���JGj--� Print name1-��-� �� Phoned s Official use only do not write in this area to be completed by city or town officiar City or Town Permft/Licensing Q Building Dept []Check if immedate response is required -[] Licensing Board E] Selectman's Office Contact person: Phone#: E] Health Department Ei Other eo'NORTH Town of Andover O _ No. o� toc�,� dover, Mass., ADRA7ED pPF` 5 S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ���� BUILDING INSPECTOR THIS CERTIFIES THAT...... ✓.... . .`!.T..P..)?I� /V .......................................: Foundation has permission to erect... A.. ........ buildings on .....�� ... ..... ' �. ,,,,,,,,,,,,, Rough to be occupied as 0 �! N A& C /� slo�/� �tiM/` &*to ffiI � Chimney ............ ....................................................O.N.................... .......... ....................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspect! , Alteration and Construction of Buildings in the Town of North.Andover. 9F.0 'V/ 0oA PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough Ae ...... ............................... .................................... 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.