HomeMy WebLinkAboutMiscellaneous - 120 CANDLESTICK ROAD 4/30/2018 (2) r� In CANDLESTICK ROAD -
J 210/106.A-0098-0000.0 7
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1 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed
on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L.c.143,§3L.
Permits shall-be limited as to the time of.ongoing construction activity,and may be-deemed by theJnspector_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 concerning the use or development of real property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was
"in effect or existence'during the qualifying period beginning on August 15,2008 and extending"through August 15,2012.
t,
V-Rule 8—Permit/Date Note:Reapply for new permit
0 Permit Extension Act—PermitMate Closed:
4_ Date 40.!2—
#�je' eta
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that . C164 .6L.,,q7
has permission to perform . . ./ �X�`,<. . . . . . . . . . . . . . . . . . . . . .
wiring in the building of . . e./. �f?�f'!c).
at . . . .,l�o�a , /.P. �'._,1�... . . . . . ,North ndover, Mass.
1
Fee'. Lic. No3.%p.5" . .A/A. . . . .
ELECTRICAL INSPECTOR
Check#
11228
,'/I Official Use Only
Commonwaair'h o��a9eac�iwa�lf 99
c� Permit No. l'G Z-'2—
2eparintenl o`.}Jiro Servica9
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/99) (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to he performed in accordance with the Massachusetts Electricnl Code(NIEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPEALL INFORMATION Date: /I - ( ( — a,o I
City or'Town of: j\J0A p)�b 0 J&a To the Inspector of 11ires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street & Number) I d-v 69 Y-�bi-,L-5 L I eK R 0 A0
Owner or Tenant 10 I) Telephone No.
Owner's Address
Is this permit in conjunction with n building permil? Yes No ❑ (Clieck Appropriate Box)
Purpose of Building N!r� s l®I M Utility Authorization No.
Existing Service I tl 6 Anq>s _ 1 Bl ,a, f�VOlts Overliend tlndgrd ❑ Nu. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of deters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: R47 2 -:r:g p 12 Liir u) S L i0 t r►7 G
Cum lesion of the iollowing table uta),be waited b•the Ins crior of 11111-es.
No. of 'Total
No.of Recessed Fixtures No.of Ceil:Susp.(1'nddle) Fans Transformers KVA
( No.of Lighting Outlets No.of Ilot Tubs Generators KVA
Above Itt- o. o mergency ig r ing
No.of Lighting Fixtures Swimming Pool end. ❑ end. ❑ BatteryUnits
No.of Receptacle Outlets No.of Oil Burners FIRE ALARA•IS No.of Zones
, o.o Detection and
No.of Switches No.of Gas Burners Initiating Devices
Total
No.of Ranges No.of Air Cond. Tons No. of Alerting Devices
No.of Waste Disposers Feat Pump i umber• 'Tons__..,....[KY.......... No. of Self-Contained
P Totals: Detection/Alerting,Devices
Space/Area Healing KW Local ❑ hlunicipa ❑ Other
No.of Dishwashers SP g Connection
Heating Appliances KN`; Security Systems:
No.of Dryers No. of Devices or Equivalent
No.of Water No.o No.of Dntn Wiring:
t
flenters KW Signs Ballasts No.of Devices or Equivalent
Telecommunications Wiring:
No.Hydromassage Bathtubs No.of Motors Total UP No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required br the Inspector of Wires.
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 exhibi ed proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER (Specify:) L'i ia l'1 / —y 17 —S'a®l
(Expiration Date)
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.
I certify, tinde•the pains and penalties of perjury,that the information on this application is true and complete.
FIIUM NAME.: 0 LIC.NO.:
Licensee: f q 15 NWOS �S+Ettaturc L1C.NO.: J
(if applicable, enter -e- enrptth
' ui e license n�iber line.) Bus.Tel.No.: I'7�' 7/
Address: Alt.Tel.No.:
OWNER' 1NSUIt:wCE 1VA1VE12: I am aware/hat the Licensee trots not/rare the liability insurance co�era_.e normally
required by By my signalme below, I hereby%vaive this requirement. 1 am the(check one) ❑owner ❑ owner's agent.
Owner/Agent FPj;RAIIT FLF.: S
Signature l'cicphoitc\u.
{
The Commonweakh of Massachusetts
Department of Industria
l Accidents
Office of Investigations
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/EI please Print L b blyr
A Ucant Information
2 ,�fits s .�
Name(Business/organizatian/fndividast): �"�t(�(� 1 -
Address: �1 ( f S S �y- A U t
Ci /StatelZi
j hi A- d l S' Phone#• o0- 7 l
Are you an employer?Check the appropriate box: Type of project(required):
4. Q I am a general contractor and I 6 Q New construction
1.[]I am a employer with * have hired the sub-contractors ,r
ployea(fitll and/or part-time). meted on the attached sheet. 7. ❑Remodeling
2, I am a$ole proprietor or partner- .ham sub-contractors have g, []Demolition
ship and have no employees employees and have workers' 9. Q Building addition
working for me in any capacity. comp,insurance.t
• o workers'comp,instuunce 10.Q Electrical repairs or additions
[N 5. Q We are a corporation and its
• required.] officers have exercised their 1 I.❑Plumbing repairs or additions
® 3.❑I am a homeowner doing all work right of exemption per MGL 12.Q Roof repairs
myself.jNo workers'comp. c. 152,§1(4),and we have no
I` ti insurance required.]t employees.[No workers' 13.0 Other
comp.insurance required-]
*Any
appiiant thatehecka box#1 must also fill out the section below showing their workers'compensation policy information.
+p
t ny RpPl nus who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
tConftctors that chock this box must attached an additionsi shoot showing the namo of the sob-co,ntractors and state whether or not those entities have .
they omployees. if the sub-contrattanr have employaw. must provide their workers'comp.policy number.
Iam employer that is providing workers'compensation Insurance for my employees Below is the policy and fob site
Information.
Insurance Company Name:
„
3 1a
Expiration Date. D� 1 i
Policy#or Self-ins.Lie.#: -
" (`A r�D City/State/Zip:X11 T A Np
Job Site Address: .
. Attach s copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
under Station 25A of MGL c. 152 can lead to the imposition of criminal penalties of a.
+ Failure to secaine coverage as ties in the form of a STOP WORK ORDER and a fine
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penal
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
. e verification.
ce coverag
IA for insuran
Investigations of the D -
hat thein ornudion provided above Is true and correct
t do herieb
under the airs and enalties o u t
Date
r=uie only. Do not write in thfs area,to be completed by city or town official
Permit/License#
City_"7
r Town•
Issuing Authority(circle one): for 5.Plumbing for
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector SPce
6.other -
Phone#:
Contact Person:
I
Location _ A A212.1 F S
No. Date C>-)
3?O
40R, TOWN OF NORTH ANDOVER
ti°
Certificate of Occupancy $
bis°" Eta Building/Frame Permit Fee $
sACNUs
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #�t �
t�
Building Inspector
TOWN OF NORTH ANDOVER,
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
q 'Y�:.: �,�7" 1
,;,�., ^ 'zyV?'`...: 't,`'' w,e � �: .._SC,�I�EIF # ' .� s `icK ,'.' ` �n> .s -
BUILDING PERMIT NUMBER: 36 DATE ISSUED: / 49_ a
C
SIGNATURE:
Building Conunissionerh for of Buildings Date
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Zo cal'44.s�i'Lk Rd .
N � �� Map umber Parcel Number
d n��ve.�- n16N5
1.3 Zonirg info mat:an: 1,4 Property[limpnginnc:
Zoning District Proposed.Use Lot Areas Frontage ft
1.6 BUII.DING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide —Required Provided Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage-Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHMAUTHORIZED AGENT M
2.1 Owner of Record
Anil0(-% t) I ZD Ce,S� ocdk
Nae(Pt) Address for Service
� rin
CAALA n OV(Ir Vi a,. o 15 LIs
Signature Telephone
2.2
Polok VeI I (t- 3 w S
Name Print (� Address for Service:
50e 756i66 D AVr Ha. 01601 M
Signature Telepho'lfe
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed CSP struction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
1 ` Registration Number
Gomm
Ad ss
Y� �3 ozZ
C-Sovi)) 5 L Expiration Date
3i nature Tele hone
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 buildin rmit.
Signed affidavit Attached Yes....... No.......0
SECTION 5 Description of Proposed Work check all applicable)
! New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition 0
Accessory Bldg. .❑ Demolition'.. ❑ Other,` ❑ Specify.
Brief Description of Proposed Work. _ qq
06
S- f L�v CaIN
-.cEC,T.-I�fB1��,6:_FS'I'Ilo:%I,�TFLI-'CONuTI:JC7'I^I":-CvSTS=- ..�. _,,.-_�......_�-� ..�_....----.F ,..a • _.z _
Item Estimated Cost Dollar
( GL USEO Y.
Completed b permit a licant
)to be .. IN
HIM A
1. Building 0 ot) (a) Building Permit Fee sp
1
Multiplier `
2 Electrical (b) Estimated Total Cost of
Construction v
3 Plumbing-_ Building Permit fee(a)X(b)
4, Mechanical(HVAC) �-
5 Fire Protection
6 Total 1+2+3+4+5 000, Check Niiinber
SECTION 7a OWNER AUTHORIZATI10 TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize �„/"�!'� 4o"Q.,.. S.u%)!C O E , to act on
My behalf,in all ma ers rela ive to w k authorized by this building permit application.
- .00N��& *) 1. 2H,62.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
V as Owner/Authorized Agent of subject
property µ
Herebv declare that the statements and information•,on the-foregoing application are tnle.an .accurate,to the best of my knowledge
and belief - h.
Print Name
Si ature of Owner/A ent Date
IN; M 11,111 loll imisillislillillilli
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 sr 2ND 3RD
SPAN
DIMENSIONS 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
f �+o► F .
5ne ComraarrweaCth o,fJIfaSS=Faae=
p � oepan=nt of.fnd=tridAxide=
�. offue of Frtvestigatioru
W a - 600 Wasag=,Street
Boston, WA 02111
Workers'Compensation insmm+ce Arnbvii F
APPLICANT B14 FORMATION Please PRINT Legibly
Name: PQ��� VIL fy4',rf,. on ���et�� �� �,M� ncU o rk o
Location: 110 C&,%Cm , -S I ro<
Telephone M 1AM 66 3— 6 L44 3
❑I=a homeowner performing all work myself.
D ]am sole proprietor and have no one working in my capacity,
1 am an employer providing workers' compensation for my employees working on this job
' Company Name: 1-1 A LS Ir�.¢ . _ .._a._...
Address: 3100 C o b b ' a l e f,cv
City: A41 Co r e". 1' tom..A. Telephone#:. C80� 6 5 7--
Insurance Company: Policy#: 1^/ Z-
41
•
ED I am(eircle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following.
workers' compensation policies:
Company Name:
Address:
City: Telephone#:
Insurance Company: Polity#:
Company Name:
Address:
City: Telephone#:
Insurance Company: ` Policy F.
Attach additional sheet if necessary
Pailure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to 51,500,00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me. I
understand that.a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
Ido hereby cern under thypns and penalties of perjury that the information above is true and correct
Signature: Date: Z H • 0 Z
Print Name: PA.-A V t e rt, Phone#
Official Use 0NL,Y..Do not write in this area
o Building Department
Clty or Town: Permit/License#: o Licensing Board
❑Selectmen's Office
M Health Department
0 Check if Immediate response is required n Other
)' HOME iMPItUVEMLN'!'INS'T'ALLATION CONTRACT
Date: r�7 / Sold,Fu+ ;;shed&Installed by
Branch Name: /n — The Home Depot Installed Sales
Branch Number:^I Job#' �` --( V 3(8 Greenwood Street,Unit t 6 6; Fe ler,MA 01607
28
Toll Free(800)657-518:'; (508)756-6646; F1tx:508-756-2859
Federal IUM 75-.-;99460 pi cont.Licit 164'7 CT Lic#126897
5522
MA Home immpriovement Conuactot Reg_
_h~<(1`• Installation Address: State Zip
Cityi
e,4L* 31 60 SSp; Driver's License: Ion. Phone: Home Phone:
purchaser(s): fu.
Home Address: e Zip
(i1'different from Installation Address) City LIC(fen(I-1 (—,6 a 9,?
79�'-Sl1
Project laformatfon IAVe(`Purchase Depot'th ')toowners Famish, p deliver and arrange forpert� located at e)bunt*natal. ioalldt aterial:,'as described
contract with The Home Depot(
on the attached Spec Sheet#I ,incorporated herein by reference and made a purl hefcction ,f the job,.Humt Depot deter
Home Depot reserves the right to cancel this contract Jr,upon re-inspection that It
cannot perform Its obligations due to a structural problem with the home or because wt,;k reyvired to col:plate the jab
1
was not included in the contract. DEPOSIT PAYM1?NT(RTIONS
(Subject to twtd verification:nd x c+edit approva;.l
SALE AMOUNT S I' {made payable Cashiers
he. Homs Depot).
Service Money Orde1
CONTRACT AMOU NT $ Credit Cerd•and or o:,er payment option:-Circa^One Below
*DEPOSIT S_ _ Visa Mastercat.: Discover An.crieanExr•ress
oma Imorrvemsll�� H�,.ne Depot Credit C:rd
13ALANCE DUE ' UidLY)
ON COMPLETION S— Available Credit:S I:OHIL HDC•,
•25%of Cc tract Amount due upon executbn of
Acctit: ��;'j`f I ��7"-v exp.Date:_.
this contra,i (unless project is financed through Name as it appears on card
Chevy Cha..e,in which case no deposit is required).
•By mylour signature be!,w.Uw'e agree tc•�,.,x The Home',)�.:pt'to,Naito the
Indicate Payment Method For ve re ;n ed
credit cwQ for namount.:,alrated above-
f y!
BALANCE DUE ON COMPLETION
/+ ers Signature
If this is a fit:ance ransactiou,the agreement for financing is contained in a separate document,which is incorporated here;n by
Terence,and maor a part hereof. A(-Home Se ices Credit/Loan plication Ref.##
(A, a a..,
/}') .7t completion t'^rtificate and pay
urchaSer al a es that,I-, III *rely upon a isfactor c mpleuon o(the w r , r *ser will execute'u`fi ate Homc k of will be paid i t
S Completion Cam P
A submission of the executed p
balance due{w.less the lue 1s fu,a„ced,in which case,upon submts
full by the lana r). Purchaser.Isu agrees to be jointly and severally ob?;gated and liable hereunder.
For 1gs.Res dents Onay: t'mtractor,at owners expense, shall procure all permits required by law as follows: Owners who
secure their o% perrnits will a excluded from the guaranty fund provisions of MSL Chapter 142A. Unless otherwise noted
within this docs.anent,this cont-ct shall not imply that any lien or other security interest has been placed on the residence.
Entire A2reemet,._,_ Thi;agrees,:int and its attachments,including any financing agreement,contain the complete agreement
or modified unless in writing in a separate agreement signed by both parties.
between the partie> and can not be amended
NOTICE TO P15RCIIASER
Do not sign Itis conn act b.l'ore)ou read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep
it to protect our rights. Du not sign any'CO
Certificate or agreement staling that you are satisfied with the entire project
before this prujcct is complete. I aw prohibits home repair contractors from requesting or accepting it Completion Certificate signed
by the owner pi for to the actual cuatptetion of the work to be performed under the contract.
You may cancel this hansactiw:at any time prior to midnight of the third business day after the date of this contract. See Notice o
Cancellation for ar, explanation of tttis right. There will be a service charge equal to 25%of the contract amount if the job is
0 Z,',00 cancelled by Purchase.r A"'ER the third business day.
By Oa ACOPI
I )of THIS CONTRACT CANCELLATION.
GREE TO BE BOUND BY THE TERMS OF THIS CONTRACT, I/WE KNOWLEDGE
AND TWO COMPLETED COPIES OF THE NOTICE OF
RECEIPTO
BY MYlOL'iz SIGNAT, RE L
BELOW, 'WE UNDERSTAND THAT THE AGREEMENT iS SUBJECT TO REVIEW OF MY/OUR
CREDIT His TORY ANi,1,1 NE AUTHORIZE HOME DEPOT AND RMA HOME SERVICES,INC.,A HOME DEPOT AUTHORIZED
CON"TRACTOR, 'f0 Vi.RIF� AND REVIEW MYIOUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING
AGENCY ANI)REL ASEfA�.LL ABILITY iNCI!RRED FROM INADVERTENT OMISSIONS OR ERRORS.
SUBNIIT1 rD iiYDate: �� 7
Sales 'on
01-03-02PO4: 00 RCVD
ACCEPTED Date:
S1; ,
hl"`r
Date:
C)1-0:3- 79pprr,,
NOT'1C.E:Al.AITIONAL TERMS,CONDITIONS AND WARRANTIES�?E STATED ON THE REVERSE SIDE AND AR�tAR44)lr�SC0'PCT
Whin-Branch File Yellow-Cusw••-er Pink-Sales Consultant
10;15/01 SA-SC
WI DOW SPECIFICATION SHEET - Spec. Sheet#: 112A1 Sheet: of
Customer: t; 1dPk0 Job N: Consultant:
Date: c
Existing Window New Window Original Measurement Grids- Pattern' Hinge Locations 2
ft ` by Sales ConsultantT111 :21 Window a Glass Misc. Csmt,CPC,Bay,Bow,
LU ocation Style metal Style Series o Rou h Opening Size m o ;� Options !tams Paco a carder Moors(Room/floor) "Code" Y/N "Code" "Code" V width Height UI v "Code" "Code" viewed from wide,Lt to ret
-Av r io 4- I�
Z D 4 30- i,w14 C)-
3 �� a.)
4fi*nI(-tyN ,D R- 6,160 3d- S�
If--.-jo 19 ' Jit -v Jy r
ra; fOtt -�
8 0H. D a I
9 s L
10
11 A ) t7' lY O
13
14
For every window sold with grids,the Grid Pattern MUST be indicated. Color of r-
= For Csmts,CPC,Bay or Bow,use"L","W or"S"(Stationary). For Patio&Garden Doors,use"S"(Stationary)or*)C(Operating). Window/Door Wraps
BAY/BOW WINDOW GARDEN WINDOWS
Projection Angle: (Bay:300 or 430) Top of Window to Soffit (inches) WALL THICKNESS41 (inches)
Bay Window Flankers-DH or Csmt. Width of Overhang (inches) SEATBOARD MATERIAL
Seatboard Material-Birch or Oak If tied to Soffit,color of Soffit material Specify Birch or Oak Veneer or White Pionite
New Interior Casing(Bay/Bow/Garden/Patio Doors) Construct Roof 3 (Yes 1 No) 4 Additional charge for wall thickness of 6"or more.
Clamshell(CL)or Colonial(CO) F There is no guarantee that new shingles will match existing color-
I have reviewed and agree with all of the job
SPECIAL CONSIDE 'IONS: Jj r ,, — a?,3L_ �— specifications described above.
e 4
xe
f1p 11 710. i
CustorrW Signature Date
,� • 9-01-01 SA-W-SO Li /
a
lugBoard of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Rpistratlon: 126893
EXPlra4ion: 08!0312002
TYPO. Supplement Card
Homo Depot At-Home Swvkes
PAUL VENTRE
3200 COBB GALLERIA PXWY#t26
ALTANTA,GA 30339 "`''
Administrator r
G
12-0E46 124-9-oi M woo. 's Licen>�
0o D �101i0i11SG
+arar+
VENTRE
PAUL A i
v w L4au
` E BOSTON, NAA
02129
7?
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i
a'
AUG-1 t-fb 1 09 :40 PM P. 01
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5/t �Al2/200i
352$EVE NTN AVENUE-SUITE 805 �-Y ANO CONFERS NO MOWS UPON ' Or NFI Q� %TION
IIQt.DER. THIS CER11FtGATE ODES NOT Ah;END C Y1F�caTC
NE'rJYOf;►� NEWYORK 10007 ALTER THB COVERAGE AFFORbEO BY Tt{p ppLlciES gNO O;
INSURERS AFFORI�jN(;COVERACIF
f:luA HOME SLRVIGk.'S, W�; �.x'�ron ACN1ikk INSOAANM C�YANY
:tor,CU6t3 GALLERIA PARKf�rsu y: TR.�VEIERS ih1l7EMN1TY®r it �_. ._ _�
•'VAY -- J.iNOlS
AT':-WA. GEORGIA 3049 a�ulltrc: CONTINENTAL CASUAIJ'T,INSt,1R�^vfvCt CO -
r ws� no AMERe5A INT�RP1A714NA
RICPOLcl[::c(1r LINS 'fWXe:[ll u>T LOW
AraY RE00Pi-MEhl,TERM CH CilNORtON OF' W aieN ISSUED TO TME IMSUREID"yEJ Xpgyg F(ka T71E POItC AY FKKYS ua�tG1TE0.N
IRA's PERTe1; "?iE lNSUR/WCE ASF+ ANY t:ONTFif.C7 S OTHER QflCUMt;14T 1'NTH RZSKCT TQ Wl"YHIS CCATTICATE MAY 8 f$s�i OF
LR�cO er THE►'EN RE:S WESGRll3ED 61Ex€7rT IS SUWECT TALL T)tE T�nMS.E7tCLUSt+)►aS Arae CONDtTt�Hs OF
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ZYIFICATr H2OL1IJH
_nr,•,svrec.1.sgt tm[R CANCELLAMN
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Roo o� INSURANCE s v RAN c E SIM6 lQ MXirfM 00 uAaUM OF M y a,No Vega r0&I+a¢ gfl�ITS AMOS 00
!M'AlIVEt.
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S 0 ACORO CORPORA'M4 IS"
NORTH
Tf d
ov�m 0 over
No.
oc�' o2-�,ps 1
dover, Mass.,-
c
"ATED P"
H 4 BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
• BUILDING INSPECTOR
0 Foundation
THIS CERTIFIES THAT...............if
has permission to erect............/..cZ................. buildings on ...... a0.....0A 1S/<....... Rough
to be occupied as.............l?ep/CJ.45....e......M..4e.......-L. o........—/ ...........&..... .......Ao;//V......Z).4....0.......W....5...................................................... 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 the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. ID6 R1 018 (3 q, 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
Service
............. .... ...........................
.. ... ... ...............
. ......... ..............BUILD.IN.G iNspic; 6 R**' 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.
Smoke Det.
SEE REVERSE SIDE
-�, ,-...-_tea.-^ .�- e - .,e,v,.n.....F.+--^-a�-.n'•-�-.,.,-r.r'^'S.a-..��-"-^-r�,,....rv:-�'d...- ,.r+'.'".^ti^�"-�.�.�_..,..,,. ,.ns,..Y;:...::
Location OV
No. 3 Date
,.ORTh TOWN OF NORTH ANDOVER
F R
A
.'a Certificate of Occupancy $
Building/Frame Permit Fee $
sic"usa
Foundation Permit Fee $
F
Other Permit Fee $
TOTAL $
Check # 5 7-3
1
17774
`/ v'guilding Inspecd�
F TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
m
BUILDING PERMIT NUMBER: �� DATE ISSUED: q/�q_,,,. /' � �I
SIGNATURE:
Buildin Commissiond—/InELWor of Buildings Date
SECTION 1-SITE INFORMATION Z
1.1 Property Address: 1.2 Assessors Map and Parcel Number. O
/aU -7e,<
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sf) Frontage(ft
1.6 BUILDING,SETBACKS ft
Front Yard Side Yard Rear Yard
ReqWred. Provide 'red Provided R red Provided
1.5. Flood Zone Information: ys v
1.7 water Supply M.G.L.C.40. 54) 1.8 Sewerage Disposal System:
Public ❑ Private ❑ zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1 j, . 5 r", rn
2.1 Owner of Record
/'c 6-A/T- Al'b/0' Pio /9 CAA16 I E577C'K
Name(Print)) Address for Service
r / `0/VTP,46% 7
G/lS_6113 — 6�
Signature ,Telephone
i
2.2 Owner of Record:
NamePrint Address for Service: O
z
Signature Tele hone m
SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address
m Expiration Date
Signature Telephone e
� r
3.2 Registered Home Im rovement Contractor
Not Applicable ❑ 0
Company Name 6' 9 3
3 yS GR L�i1 JlV 02�;� �% Registration Number rn
Add s r
SIMON
Z
Expiration Date
.Signature Tel ^hone Y'
1
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......X No.......0
SECTION 5 Description of Proposed Work check all a cable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 4� Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify r,
Brief Description of Propos W k:
,FFL4if 4f- / a — o 7-1?4C7uOet (A0tiC'zF_
w
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building / U G� (a) Building Permit Fee
/
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbin Building Permit fee(.)x(b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION'7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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 r
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, �/it�_ as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are tnte and accurate,to the best of my knowledge
and belief
Print u m
Si ature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2 ND 3 RDp
SPAN �P
DIMENSIONS 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
NORTH
Town of Andover
No.3 /8LA
o over, Mass., '
COCMICMEWICK _
ADRATED PP�t"`C
S ` BOARD OF HEALTH
Food/Kitchen
T D
Septic System
PERMi BUILDING INSPECTOR
THIS CERTIFIES THAT...
log
................. ..............�................ Foundation
..................
has permission to erect........................................ buildings on . ....... Rough
.. .... .. ........ ..
to be occupied 8 Chimney
provided that the person cepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the
or
isions 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
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
J1" ough
............................. Service
........
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. Burnet
Street No.
SEE REVERSE SIDE Smoke Det.
� y I
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11, S150A.
The debris will be disposed of in:
(Location of Facility)
Signature of i Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
Nov 02 04 09: 19p Michael Bedard 1 -401 -246-2868 p. 1 E
POhi :_KIMBLY FAX NO. : 6033629679 Oct. 18 2004 08:26PN P4
d 1101IN:II I I'H,11:1A1 LINT Iy.STA I.I,A'HON C'UN'f RAI
Hrsneh Name: 57b�• ]late: _��l« � Snlct,Fun»shot Xc Installed by
I The I Ionic Delim Insiulled Sale,
Cl1ranch Number; 31 _.lul)Ik ��6f�� 345A(irecnwooLl Shccl.Worcester.MA 01607
'I'(d1 Five(00)657.51?{'_; (51M)'156-6690; Vim:508-75A-2859
rc&rul 1DW 71410Ad60 Ml:I.ic h C'tr4419 RI Civil.Licr 1642) C•T Lica S6SS22
�� R� MMAA'..rola.improvement coolmoor ltcg.ll 26s'))
InslnllntMnAddreas: j�� „•- �77�_..IV
Gity Stan' Zip
Pnrchuxcrls: __ ,•, xwl:
Driver's Llc.H y. .I , hpe Work]'bone: Flomc.Phone:
_-.
0 10 7�s?- _ `� 7.... - of -I
Home Address:
(ifdiffierentfrom instullmiou.Ad(hcas) — (:!Ly Stale Zip
Prajeet lnformalion UWc("Purchaser,).the owners of the property InciAed A Illc ahnve instnpalicm address,ollCr lO contract with t
The Ilome Dcpot 'llomi;Ueput')io furnish,deliver and Hnango for the installation of all riutcriiiis as]described nn the attached Spec
Sheaf!101585,incorporated herein by rufererce and ltlalle a part hereof.
Home Depot reserves lbs right to cancel this contraet if,upon ve inspection of the jub,Home Depot determines that it connol
perform Its ohOQRtions dive to a Alruelural problem with the]bottle or becrtuse,work required to complete the Joh was not
included in 1110 contract.
DF,PUSI'1'[tAYMLN'I'Ol'TIUN6
lSuhjcal In linnl milicarioo tmtl4,t erCfhl nPPt•nc nl.l
}�Q I. Chuck.Casbicrs Clack or US('swol Raviuc Money(leder
(:ON'1•RAC:1'AMO LINT t ntedc pa rahlc tuThc l b alk M11.11)•
1
*f.Pss prroslT s, 2. (`relit ford'atiewir ouxr payment uptidn5•Clrcle One Itetmv
f
Visa M05 'I Iliy.nvcr American L•apn,.
BALANCE FIVE
C IlnnhtpupravemenlLoen IlounUdxllCrcdilC'ard
ON COMPLIETION
A•nila4lc(:rrrllrtl (IIILS IIIII:C ONLY)
"25%orContrnct Amnnnt dnetrltrin cauctilton nCthit
caalrucl.One-third(1/3'r)of Contract(Antormt ix negi ired AccUl: 7 a 0 I's p.1100:_
for 61AMACHIISRITS IZFSIDKNTB,S)„bll X
. Nntttetot it:Iprv:lr:.o„x:lltr:
Indic0lc ltnyrllem Metllnd For `Ily n,yluursi.nualrt bciotr•vwe nprcc at h1low,nia final:Uapul In clrlrec the
0I)AL•ANCXTAIR0N OM f:TIC)N next.-or` :ilajclilcnnl6a•IhcAapnsilindicated.
CheCK
+ HDQf-4r $939 CLr n dcro Si�nalnre -_ u;nc
1f this is a finance tralbsletidn,the 11RrcItipon
t for financing is contained in a separalo dixtillicin.which is incorporated hercin by
Kcference,anld'madt:uu part hereof. le Serviced C'rtditll.oan Application Ref.4 / ��f
Ytuehox-er agree�ai,'inti bd ately ponSsvery co pµif�ftIIL work,Parch s rwiill execute a Compin�rCerti cl at/ 14 Oy ahy l,alahee
drie(onleyx Ifle jolt is financed.III which subtalyyfoD of the Cilegrited(,:tltnpleliern C;erlifiCalo,Hnlne Depot will be paid in full by Clic
lender). Parchnscr:rico alter.s lit be jointly and severally obligated and liable.hereunder.
Ep"llal.Rcatdrrtlx Only! Contractnr'shall prOenro all permits required by law acting as(lie nwner's agent. Owners who Secure their
own permits will be excluded from (lie evoritnty Hind provisimss of MGL Chaplor 142A. Unless otherwise noted within this
document,this contract-111011 not imply that tiny lira or 011ier wearily interest has ken placed tin the rizidenee.
L•'nfire Agreement- This agtrctnent and its ettachments,including tiny finrulcing agrrenmtt,contain the complete agreement
between the parties and can not be amended or modified unless in writing in a septirale ugrcemenl Signed by bout P.allies.
NOTICE.TO PURCHASER
On riot sign this contract before Yen rend it. Yon are entitled to a completely Oiled-In copy of the contract at Ills time yntr itign. Keep it to
protect your righty. Do not sign any CompicPwn C.erlificote or agreetnerlt stating that you are satisfied with the enlireltmlect before this
prolcet Is complete, l.nw pr0hilihs Imure repair contractors from requesting or nca:ptirip to(:nmpledon Certificate signod by the uwncr
prim to the actual completion of the worts to he performed ander the contract.
Ynu may eancol VILc transaction a1 any lime prior ht nrinnieltt of Ilia(bird business day after the date of this atntrucl. Sae Notice of
Conicellstlott for an rrpbtnnfinn orlhis right. Thtre will be to service chonTo equal to 251/4 of tbo cuatrael alBOunl If the Jolt Is cancelled by
Purchaser AFTER the third bltsincss day.
BY MYR)UR SlUNAT1.11w. fita.0w, ME AORF.E TO BF BOUND BY TIM PERMS Of-'Iluti(`ONTRArf. 1114E ACKNOWLEDGE
RECEIPT OF A COPY U1"1-14Is CONTRAt'I'ANO TWO COMPI_ETF.D COPIES OF THE NOTICE OF CANCELLA710N.
i)Y MY/DDR SIGNATURE BELOW,VWE- UNOERSTANU'I11M 'I'lli:AORF.FMr-NT IS SURJFCT TO REVIEW OF MY/OUR CRIiUIT
ItISTORY AND IM;Atrt'i10107T.HOME DEPOT AND RMA HOME SER VICES,In'(,:.,A 110Mlt ORPCIT AUTHORIZED CONTRACTOR,
1'0 VFRIFV AND RI{VIIiW MY101JR CREDIT RECORD W1TR AN INDEPENDENT CRFINT IMPI)RT1Ntt MiENC;Y ANI) RVIXASE
1 HI{M I%RUM nl.l.I.IAlIl1 l'I'Y C:U FR M ADVERTENT OMISSIONS OR ERPORS,
SUBMITTED BY: _!=' (!'&Z. _.. -- Date:
les 'r4lte Alit
ACCI1PTED BY- Vale:
nrcn.vltcr
Dam
I Inmenwncr
NOT(CE:AulnY 10YA 11'ERNI8.CONDITIONS ANDtiV'AtInANI'If_c ARE sl'ATr:nnN THE REVER1x Slur.ANI)ARE PARTOp THIS CONTRACT
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