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Miscellaneous - 127 BRIDLE PATH 4/30/2018 (2)
��DLE PATH / 2101104�0000�!`,�' � `l I I I II 1 Date.1.l�/. .� .>. ... ... . t NORTH { pE „io 32 °` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION t SACHU5Et t R1 I This certifies that .�! ? f !?. . �it !���' ". . . . . . . . . . . t 4 f has permission_ for gas installation . .7.�?. `l. r.f% . . . . . . . . . . . . . . . in the buildings of C at /��j /l , North Andover, Mass. 3 Fee. ..) G Lic. No./,.? 'A* GAS INSPECTOR t Check# ?/C _ 5LIJ MASSACHUS'E S UNIFORMAPPUCATONFOR PERM TO DO GAS FrMNG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations � Permit# Amount$ 30 Owner's Name NewElRenovation ❑ Replacement Plans Submitted ❑ off v; w W o U H �' z 0 a o O a o W E. C x 0 H z a0pq � o �Z U o H � O t� D 3 A th a U a a N O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR .r 2ND . FLOOR 3RD . FLOOR i 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR ELL (Print or type) tt Che one: Certificate Installing Company Name �ta In FP f MCc,b'1 H Corp. Address ❑ Partner. v Business Telephone —1 q- -a-&AD Firm/Co. Name of Licensed Plumber or Gas Fitter La,, FrefA IM INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ®' 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: Signature of Owner or Owner's Agent 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 Massachus (ts ate Gasde and Chapter 142 of the General Laws. A T,I -Alylsy,h— Signature of Licensed Plumber Or Gas Fitter Title Plumber Tit City/Town ❑ Gas Fitter License f14umber aster APPROVED(OFFICE USE ONLY) Journeyman 00 Location 7 ' �` -x No. � Date 9 �Z TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ?U �t.Us Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #5864 I� _Building Inspector t L' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING " il$ for OffI�1tE ,I1SE` w. BUILDING PERMIT NUMBER: DATE ISSUED. m SIGNATURE: Building Commissioner/1for of Buildings Date ,O . Z SECTION i-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ff/eDL e lP 41 Map Number Parcel Number 1.3 Zoning Information:v(• 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 Required Provided Required Provided v 1.7 WaterSupply M.G.L.C.40. 54) 1.5. blood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone- Outside Flood Zone ❑ Municipal X On Site Disposal System ❑ SECT ON 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record GeO/?G e Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z m -Signature Tele one M SECTION 3-CONSTRUCTION SERVICES 7� 3.1 Licensed Construction Supervisor: Not Applicable ❑ �TO2s� /? Rr1r� Ops-o�y o Licensed Construction Supervisor: 3�i �r�i��Gl'7� cs T L�,A/' ylO/��� License Number Mn Address r , /_-�? 113 ic Expiration Date tgna Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address / /A — O� r f�— e J ExpirationCOate ^Z rA natur 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. -Signed affidavit Attached Yes......K No.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building [IRepair(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 !�69 ©O Multiplier 2 Electrical n (b) Estimated Total Cost of o?i ��(�' Construction 3 Plumbing 7 Q Building Permit fee(a)X (b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 az OOeq, Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .� I, OJ4,4w le as Owne uthorized Agent f subject property Hereby authorize_ .f O54, /_�� Tj ZP to act on My be ;in all m tters ive ork authorized by this building permit application. S ure er Date / /11 � D� CTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date 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 IIEIGIIT OF FOUNDATION TFRCKNESS SIZE OF FOOTING X MATERIAL OF CHI1v1NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a The Commonwealth of Massachusetts r_ d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: � � Location: /o?2 Z�212)z e A'7-2-1 City"W d&,�a 1/eve- Phone # / ?fl I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name Address..2y,4, T CityPhone# Insurance Co. (r U�/2b �/U�S Policy# t Company name: Address City Phone#: Insurance Co. Polic(# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment_as well_as_civil.penaltiesinfhefnrmof-aSTOP WORK_ORDFRand_afiine of l;$1-00M)-allay againstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. L 1 do hereby certify under the pains and penalties of Roqury that the information provided above is true and correct. Signature Date Print name Official use only do not write in this area to be completed by city or town official' City or Town PermitiLicensina ❑ Building Dept ❑Check if immediate response is required Q Licensing Board ❑ Selectman's Office Contact person: Phone#. ❑ Health Department ❑ Other gal 24 381 — 3 36T©ILET ------ �Y R OWE $4 VD KKA 114 • ------------- - ?8 98 --------------- 42 0 AD' 3880-21 llfllkjjj $3# IMPERIA CABt ERY DELUXE PLYWOOD CONSTRUC-nON GROWN MON4RCH DOOR CMERRYICOLC1PilAL FINISK CEILING HEIGHT 93 Ilor DOOR PULLS- IC-CCPB PousHEO BRASS HANGING HEIGHT—W DRAWER PUL. S--qscC?Pg PoLlawim)®RASS SOLID STOCK&20 f� " CROWN MLOG TO CEILINGCA t/.im S` l{ �' ABMWOM saSimdowomobis 7fdsismaatyna►ddpnanamrea ohm" sea%:!n-rt Of :Q,nlm p;ven�s s�jvdm vreuk n ec+ ea D�er�rssd aeap�as mak" s Cjueahentm��oe f sei t«ruseo.•w�$ioe 12?SFW PATH NORTH ANOOVEP,MA, w_ I • N0M rH own o _ ED over 0 No. Ito �` z . " 9 .► 2ar�Z ��,y dover, Mass., ' ORATED ►'PCS S H E BOARD OF HEALTH PER IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... ....... • .................. ' �'�........ ........................ ...�**ii.*.* .......... Foundation .................. buildings on .)�.7.... has permission to erect ..... Rough to be occupied a 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTJQN STARTS ELECTRICAL INSPECTOR C Rough .............................. 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. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. / f jv2 3 G. v Date.......... ... ..... h j NORTI� O � TOWN OF NORTH ANDOVER . PERMIT FOR WIRING t AcNuSh This certifies that .......... ......... . has permission to perform ... �. .. / r. `.. wiring in the building of...... ................................................... qat.�:..... ..�� - /...{ �r .....,North Andover,-Mass. ELECTRICAVINSPEc-m Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer C,ommonwaa[Lh o�/i/a��ae�cr�a/�i Official Use Only Perrot No._ 3 � ¢Par menl o j tre �ervica� L BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 11,99] (ica�eblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in aticordance with the Massachusetts Electrical Code(i'OEC),527 CMR 12.00 (PLEASE PRINTININK OR TYPE-,4LL INFORMATION) Datc; City or Town of: �iJ a , AA C d 0 OA To the Iltpctor of Yires: By this application the undersigned gives nohcc of his or her intention to perform the electrical ivo described below. Location (Street&C Number) Owner or Tenant _ 1'10�rTelephone No. Owner's Address Is this permit in conjunction with a building permit'. Yes ❑ No LCJ (Check Appropriate Box) Purliose of Building Utility Authorization No. Existing Service Amps / bolts Overhead ❑ Uudgrd ❑ No. of Meters . New Service Anips / Volts Overliead❑ Undgrd ❑ No.of Meters.' Number of Feeders and Anipacity Location and Nature of Proposed Electrical York: Conn letion or the foUoivil table inav be ivaived b•the!ns cctor o('Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total 'Transformers KVA No. of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures SwimmingPool Above ❑ In- No. ❑ i o.o mergeticy to itmg grad. rnd. Battery Units No..of Receptacle Outlets Pio.of Oil Burners FIRE ALARiIIS No.of Zones No.of Switches No.of Gas Burners No.o Detection and Initiatina Devices No.of Ranges No.of Air Cond. Total No of Alerting Devices Tons o No.of Waste Disposers Heat Punip I Number "Tons KW No.of Self-Contained Totals: _ -- - Detection/Alertino Devices No. of Dishivashers Space/Area Heating KIV Local ❑ Municipal [I Other Connection No.of Dryers Heatin„Appliances Key Security Systems: No.of Devices or Equivalent No. of Nater No.of No.of Heaters KW Signs Ballasts Data;firing: No.of Devices or Equivalent No.Hydromassage Batlitubs No.of Motors Total HP Telecommunications Wiring: No.o Devices or Eg uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of lYires. INSURANCE COVERAGE: Unless v,aived 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 Ur BOND ❑ OTHER ❑ (specify:) C� Estimated Value of Electrical Work:' //C (When required by municipal policy.) (Expiration Date) Work to Start: P Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under th pants acrd penalties of perittly,that the infortrtation on this application is true and cotrrplete. FI RM NAIME: a - d LIC.NO.: Jr Co //!> Licensee:��ka a�=/-j/o� Signature L1C.AVO.: vZ� '�(If applicable, enter e.-cmpt"in the license number line.) Bus.Tel.No.:-,9- �� — Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I ani aware that the Licensee does not have the liability insurance coverage normally required by lacy. I3y my signature below, I hereby valve this requirement. I am the(check one) ❑ owner ❑ owner's agent. Owner/Aocnt �C Signature 1'elcphonc\o: PI�RISIIT FEE: UOJ a NORTH TOWN OF NORTH ANDOVER a L PERMIT FOR GAS INSTALLATION � s SS.4u CHS Et S O This certifies that . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . .o has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . .J: . %:!. . . . . . .. North Andover, Mass. Fee. .'. . . . . . . Lic. No.. . . . ..'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO (Pint or T DO GASFITTING - RD /YX 71mil'VA4 Mass. Da 19� ermit # Building Location211�1 &Ll I ' wner o's Na c Type upanty New C3 Renovation ❑ Replacement (� cup Submitted: /Yes❑ No ❑ � W N Y Z Q N N V ¢ h S H N / 0 J W � ' N U m h S 71 ` O u ¢ Q O ? O r W a1 N hO y W O — a ,� h 1 H W z V W z N W < rt O a W W W h J < z S M c Q W h W h S Z < W J < a ~ f' } W m Z p = W J < W a W Z < = < < O O W a u h 0 s U. M 3 n 0 J ¢ > o aO r 0 SUB—BSMT. BASEMENT ! I 1ST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR STH FLOOR GTHFLOOR TTHFLOOR STH FLOOR Installing Company Name heck one: Certificate , Address ❑ Corporation Partnership Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter A INSURANCE COVERAGE: 1 have'a currentliability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 1 22. I N . If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity❑ gond ❑ 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: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered)in above apotication are and accurate knowledge and that all plumbing work and installations performed under the ccu ate to the best of my pertinent provisions of the Massachusetts State Gas Code and Chapter 142 ofptheGeneue (aoris,2ppl� ' will be in compliance with all T of License: Title mbar Signature of Licensed.RLU bar or G Atte fitter City/Town ster License Number O I NL Journeyman BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPEC710N FEE NO. APPLICATION FOR PERMIT TO DO GASFITTItIG NAME, A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE 19 GASINSPECTOR AM . Location .,No. Date F MORTN TOWN OF NORTH ANDOVER i Affm p Certificate of Occupancy $ ..� Building/Frame Permit Fee $ �'�s'CHus • E<�' Foundation Permit Fee $ s�cM Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ F Z,T� r, p31L Building Inspector 0:4110133 10:09 Div.Public Works �. 41,00 PERMIT NO. _/APPLICATION FOR PERMIT TO BUILD"******NORTH ANDOVER, MA SIAPNO. LOT.NO. OC? 2. RECORD OF OWNERSHIP DATE BOOK PAGE Qr 70NE SUB DIV. LOT NO. LOCATIONPURK)SEUFBUILDING Main, J 2Z Bridle Path OWe & K' Chatson NFR'S NAME NO.OF STORIES SIZE OWNER'SADDRFSS 127 Bridle Path BASF.MF.NTORSLAB ARC'I IITEC r'S NAME NIA_ SIZE OF FI.00R TIMBERS I 2 3 BUILDER'S NAIVE Mike Antoon Construdion SPAN DISTANCE 10 NEARESTBUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS Of POSTS DISTANCE FROM LOI LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOFF FRONTAGE 1 IEIGI IT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF F(X)rING X IS BUILDING ADDI TION MATERIAL lF C111MNLiY d IS BUILDING ALTERATIONh& Kitchen Renoyationc IS BUILDING UN SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMEMS OF CODE IS BL/1I.DINGCONNECTED 7-07'OWN WATER Yes BOARD OF APPEALS ACTION,IF ANY IS BUILDING CONNF.CI'EDTO'1'OWNSEWER Yes ISRUILDINOCONNECTED TO NATURAL GAS LINE E INSTUCFIQNS 3. PROPER-1-1'INFORMATION I.AND COST EST.BLDG.COST $32,000.00 PAGE I FI LL our sEc noNs 1-3 ESL BLDG.COST PER SQ.F I EST.BLDG.COST MR ROOM ELECTRIC METERS MUST BE ON OUTSIDEOF BUILDING SEPTIC PERMIT NO. op A'rrACl IFD GARAGES MUST CONFORMTO STATE FIRE REGULATIONS 4. APPROVED BY: 4 PLANS MOST BF FII FD ANI)APPROVE+ BY BI III INi INSPF('TOR 11 ING IN .0'011 0 //7� Q OWNERS TF.LN DAl'D:FB.r D 978 687-9133 CONTR.11:11 978 688-6272 i CYlNTR.LtC9 026645 S1C,'NAIURE Or OWNER ORAL;Il N)itIZED AGENT FEE S n.lr..# 102658 I'FRM IY6RAN'1 H) 19 The Commonwealth of Massachusetts Department of Industrial Accidents DI�6C0//aJ2Slf,+�005 600 Washington Street Boston,Mass 02111 Workers'Compensation Insurance Affidavit name! Mike Antoon Construction location. 127 Bridle Path guy North Andover, MA 01845 ohone# 978 687-9133 [] I am a homeowner performing all work myself. [] 1 am a sole proprietor and have no one working in any capacity ® I am an employer providing workers'compensation for my employees working on this job. demY name Mike Antoon Construction. r • 14 Bearse Ave. Methuen, MA 018443409 #, 978-688-6272 phoneirseesraec�co, The Maryland,Commercial Group. nolialm: TC8 00957854.66 . 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: coniQgBy flame- address' city. Rhone# - idsurance co SopPany name• address: dix: Rhone#: t:�aC11IlS4��4 Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a line 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 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office orInvestigations of the DIA for coverage verification. I do hereby certify un r e p ins d penalties of perjury that the information provided above is true and correct Signature Daze 4/9/98 Pgnt name Mieha J.Antoon Phone# 978 688-6272 Ccheck nly do not write in this area to be completed by city or town official_ ermitAicense# MBuilding Department : P e P �Lieensing Board - mmediate response is required ❑Selectmen's Office[]Health Departmenton: phone#; nOther(revised 1/95 P1A) i • r t1ORTy 0VM Of - over * _ - �a dower, Mass., 1910 COCMICMEWICK ix E �'�^ �S o'94 E 0PP`y E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................G...0a ce.................. . ... .4 .d../ ..................................... Foundation has permission to creel....Ar.. --'�`.�. .,.., buildings on .....tZ..?i.........47 f-D.IL.,!.#r�.........p!¢ "" •••• Rough J# to.be occupied as.......................................... ..'� .�(T ' ! ........"IL.. ................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final thit 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 Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUC nON S ___ __ ELECTRICAL INSPECTOR i Rough ... . ... . . . ... .. ... . . .. . ...... . Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove " Rough { No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. BFIRE DEPARTMENT umer Street No. Smoke Det. DateC� .410 3727 { I gOR71� 3��.<��•°;•;;�oo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . , . . . . . . . . , . has permission to perform . . ��.�� �? . .��? ,l�!�: .5. . . . . . . . . . . . plumbing in the buildings of 4y'. :C-./. .. . . . . . . . . . . . . . . . . . . . at. .p.7 .(� I . . . . . . . . . . . . . ., North Andover, Mass. 1 Fee..?<P.-. . .Lic. No.F?C3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 06/16/48 08:44 30.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT T 0 PLUMBING (Print or Type) �� yU T�7 , Date ate .l. ` - D 1 g Permit # 3 l T Building Location ' is Name ..�� Type of Occupancy _ J New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES P z rn z i N Z Y Q N O Z !- N W Y J N } U Q N Z V W Z N Q M a ~ Z O O N C o y W t- W N o N F U W Y a m U. o 2a ~ N d LC W 0 7 Q d W Q Q W ? D Q N Z a Q X W F- U Qx x 0 Z x Y a Q F- F- O N N H Z O 00 N = z W F 0 Y W a a x Q a o x 3 Y J m N Q x 1z G J 3 x F N LL. 0 O O 4 3 m O 1 SUB-BSMT. (J BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company a4ne heck one: Certificate Address Corporation ❑ Partnership Business Telephone - ❑ Firm/Co. Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ 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: �i Signature of Owner orOwner's Agent Owner ❑ Agent ❑ 7 I hereby certify that all of the details and information I have submit entered)idabove application are true and accurate to the best of my dge and that all plumbing work and installations perform knowleunder pertinent provisions of the Massachusetts State Plumbing Co an ter per of t� Generaliued for h�wspl ' tion will be in compliance with all By Title Signature License umb City/Town Type of License: Master Journeyman ❑ APPROVED(OFFICE USE ONLY) License Number 9�`� 1 � BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME do TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR Date. 1•! 3729 NORTH TOWN OF NORTH ANDOVER 41 A PERMIT FOR PLUMBING 'IS CHUS This certifies that . . . ) t. . . .T'. I r L .r has permission to perform . . .> L!? .� ~ .T`. , G plumbing in the buildings of . .. . . . . . . . . . . . . . . . . . . . at. 1 ac. .13m1 lq. . . . . . . . ., North Andover, Mass. Fee. Lic. No.5'' s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 06/18/98 08:36 92.04 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICAT ON /RPERMIT TO DO PLUMBING e orprint) NORTH ANDOVER,MASSACHUSETTS , Date , l - Building Locations / R' _ Ef Permit aW .� Amount �--- 6U&RiL Owner's Name I New Renovation Replacement Plans Submitted ri FIXTURES Cn a I W � W d ►.a A A F AC W SISBm B4SB"M 1S)L FIDQ2 I 2ND FUM 1 { IM RfM 4M FUM 5IH FUM 6IH III= 7IH FLOCR SIH FLOM (Print or type) i Check one: Certificate Installing Company Name �_ � r( ! . Corp. Address 99 ?5� , nom;, ��,� Partner. Busi�ess a ephone P Firm/Co. Name of Licensed Plumber: Insurance Coveraee: Indicate the type of insurance coverage by checking the appropriate box: ❑ Liability insurance policy n Other type of indemnity El Bond Insurance Waiver: I,the undersigned,have been maderaware 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 abov plication are true and accurate to the best of my knowledge and that all plumbing work and' s llations prformed under Pe it slued for this application will be in compliance with all pertinent provisions of the Massa s State lum ng C e an apter 142 of the General Laws. By: i a e ice m f Plumbin icense Title ��9 City/Town LicenseMOOR Master El Journeyman APPROVED(OFFICE USE ONLY Zn 6 6 Date.......... .�.. ...lJ. 1 f OR7M q 3:;•_`�`` . TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING o LSSA USES i This certifies that :. .................X ......... has permission to perform .......L!.......�...'. .°?........1�..{..1.:?.'.�!.... ........... wiring in the building of �� % �' at......, r:.. ............ ............... ICorth Andover as` as Fee.... JLic.No.. :..r �o .. . _...l�.... ...... ECTRAL INSPE R Check # urrlclal use unly Permit No. 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 i1�/ei dzi "IA To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number d C�(C- Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes [9-' No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity LocatioAnd Nature of Proposed Electrical Work + Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures =9 r7 Swimming Pool gmd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets is 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. n Dis_hwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of rs Heating Devices KW Local Connection 1 No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring 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 = have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER =.(Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough01 Final Signed under the Penal'es of perj FIRM NAME LIC.NO...Signature Lrkensee,la'C/y ^�JrC�GL/�J Signature / J LIC.NO. C q� -! l `2 r �W el No. Address � � � L� f1G�� Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ � (Signature of Owner or Agent) IIIIIIIIIIIIIIIIIIIIII I 111111111 111111111111 Staple aidels OIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII t i TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION o ,t6, 0 6 O L 0 r Permit N0: Date Received 1 l e Ar!° p�R 9 t Date Issued: SSACHU5� IMPORTANT: Applicant must complete all items on this page LOCATION I o�rI d r i d I e ?c,+ Pript PROPERTY OWNER t (Y� �"rSUn. Print MAP NO.: o tf PARCEL: qg ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building W One family Addition ❑Two or more family Ci industrial Alteration No. of units: XRepair, replacement ❑ Assessory Bldg ❑Commercial E Demolition Fi Moving(relocation) ❑ Other ❑ Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED 6+-rilp re shimic n,-AE Identification Please Type or Print Clearly) OWNER: Name: Kim C n Phone: Address: 13r I d I-?- PA.+h IUO AMA 0 V f WA_ 61 � CONTRACTOR Name: Phone: 3 '3 VZ O Address: 200 S046 S+Tiect surZZ 0 T!f�Cl.o�l�°/ M V FO Supervisor's Construction License: Exp. Date: Home Improvement License: 16 4 .5�o 9 Exp. Date: -7 0 t'O ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost S FEE:$ Check No.: Receipt No.: Io 2 Paige W4 Location No. o Date Ct° . 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ KU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1956 `U Bung Inspector "� f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i ..-TYPE�OF-:SEWERAGE-DISP:OSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales E Food Packaging/Sales ❑ Private.(septic tank, etc... ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATEAPPROVED V ELOPM ENl` ElP PLANNING & DE COMMENTS .CONSERVATION Reviewed on Signature j COMMENTS HEALTH Reviewed on Signature COMMENTS CO j Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Water & Semler Connection/Signature& Date Driveway Permit DPW To`,Yi" Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT =-Temp Dumps ter on side yes.. .. :.. no Located"at 124 Mair Street. Fire ®epartmer-it signatdrefdate- COMMENTS N0RTH 0 0 _. 4Andover No. o L A .E dover, Mass., " 'pA COCMIC MEWICK\y� DRArED PQP '4S BOARD OF HEALTH Food/Kitchen Septic System - BUILDING INSPECTOR PER IT T D THIS CERTIFIES THAT........ ...... .. ........ A . ... ...................... ........ ................... ...... ... ......... .......... Foundation has permission to erect........................ .............. buildings on..... .•• ...... ................. Rough to be occupied aftoeoii�onciii Chimney provided that thti this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provision 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 Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUT ELECTRICAL INSPECTOR Rough ........................................................... 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 Until Inspected and Approved by the Building Inspector. BurnerFIRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. DAVID CASTRICONE ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS '.. HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 10456 200 SUTTON STREET,SUITE 226,N0.ANDOVER,MA 01845 7 HILLSIDE ROAD,BOXFORD,MA 01921 Z5 �/ In Nords Andover 978-683-3420 In Boxford 978-887-6147 SEP 1 In Haverhill 2 a er/el!!9 - 78 374-7314 ZUlfp Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to8,wY'tti4l�liaeees materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below describ : Owner's Name....... . . ................................................. lephone#.....�. .........9 ... ./w. ......... Job Address.... 3.1.*':..,rX x..........................city.... /.��A...1.7 f Y '.................State......IMA........ Specifications: � ........ ti5trip existing shingles, t.Apply new drip edge to all edges.w�;� g o ........................................................................... g .......................................................... PPIY feet lee and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. Q............................................................ 1 felt a er under ment. nstall rid event to "'.""""""""" .. .. ........................................` g r e .1.ro rD?t: l��.%•. �_y............................. ..................ty................................... ✓Reroof using - shingles with a 3 year warranty. ✓�ounterflash chimney. eco vent pipe flashing. K,egaI disposal of all debris. ..............................................................3. :....... ................................. Area(s)to be worked on: // r.. (c.1.... .Q. ..........� .Li. ...... .b..t��.,R,.i.i. ............................................. .............................................. 1. . .►> .....V.ct�r .......V.�� � .... .0 ...ca.:V-el...... ................................................ ...................................................................................................................................................................................................................... ................................................................................................................................................... One Year Workmanship W ransferable Manufacturer's Warr s/specified by m ufacturer Materials and Labor t ....... Payable... .Q,,.,.,,,on..2 Payable............................. ................ Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property,including preexisting conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above(i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces,water stains when roofing shingles have not had adequate time to cure). Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation as requested by contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and payable, it is agreed that,if permitted by law,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith. It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates, The undersigned warrant(s)that he is(they are)the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(.). There arc no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and sighed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place Room 1301,Boston,MA 02108 Tel:617-727-8598 Any and all necessary construction-related permits shall be obtained by the Contractor.Any Owner who secures his own construction-related permit or deals with unregistered contractors shall be excluded from access to the Guarantee Fund. Approximate starting date of work..................................................................... Completion date.............................................................. Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said patties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Owner has three business days to cancel this contract and incur no penalty. IN WITNESS WHEREOF,the parties have hereunto signed their names this /.�...........day of...��...............20,�....... Accepted: /T Signed...... ..... .......................... ,,................... ..Owner ..........Owner Owner Representative Town of North AndoverOf NORTH tt ,AD , 6 Building Department o 27 Charles Street ~ North Andover, Massachusetts 01845 :' ^ '� (978) 688-9545 Fax (978) 688-9542 *A 4 40R�` --K TtD . �` 7 4S-3 C1•IUSE( DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: ` j S� Y F Facility location Z 3 J Signature of Applicant Date i NOTE- A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. j The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations 600 Washington Street Boston,MA 02111 _ www.mass.gov/dia J' S. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibl'y Name (Business/Organization/Individual): U(b "Ah s TP—I Uri kp o FW�j, + J i- IJ -� l Address: •200 S u�D/1� Sr Sture A q(o City/State/Zip:fyo 4.00(414 MA b f NS. Phone #: q7? W24AO i Are you an employer? Check the appropriate box: Type of project(required): 1,9 I am a employer with 4. E] I am a general contractor and I El employees(full and/or part-time).* have hired the sub-contractors 6 New construction 2. I m _ 7. a a sole r ❑ proprietor or partner listed on the attached sheet. � ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition in ❑ molition working for me in any capacity. workers' comp. insurance. g, Buildin addition ' ❑ g o workers comp. ins 5. insurance We ar Cl`1 mp ❑ e a corporation and its required.] officers have 10.❑ Electricalr airs ave exercised or additions their repairs 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' co C. 152 comp. 1 4 and w § O, e have no insurance r required.] t 12.[] Roof repairs eq ed] employees. [No workers' comp. insurance required.] 13•❑ Other *Any applicant that checks box#I must also fill out the section below showing wm their t g eu workers co ensation policy info Homeowners who submit this affidavit indicating the are doing all w po Y trnahon Y g 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Y WC ('p06 14 E06 I f O D 4 Expiration Date: ' a 3 ' LoL Job Site Address: ' n JQ P4 G City/State/Zip: M o . A( ��/+d 1 0 T f 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 ) fine position of criminal penalties of a up to$1, 00.00 and/or one-yearImprisonment, 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 certify under the pains and penalties of perjury that the information provided above is true and correct: Si ature: �. Co.e�..,,,. Date: Phone#: Oficial 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): 1.Board of Health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Pe son: Phone#: f I i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No i MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine I NOTES and DATA— (For department apse) i ® Notified for pickup Call Email Date Time Contact Name 3 Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract - ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I New Construction (Single and Two Family) i ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets-of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) --- ❑ Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application - I Doe:Building Permit Revised 2014