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Home My WebLink AboutMiscellaneous - 130 BAY STATE ROAD 4/30/2018 130BAY5.B STATE ROAD 210/045.8-0034-0000.0 BUILDING FILE Locationi No. f Date �f • • TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $��6 Foundation Permit Fee $ Other Permit Fee $ . TOTAL $ Check# �Z 27127 1ry Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �3 y Date Received Date Issued: f/ 12 IMPORTANT:Applicant must complete all items on this page LOCATION - PROPERTYOWNERFiVar- � Print 100 Year Old Structure yes. no MAP NO: _-.� ,.� PARCEL: _. ZONING :DISTRICT: Historic Districtyes. no _Machine Shop Village, yes no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well Floodplain. ❑Wetland`s Watershed District p Water/S,ewer _ DESCRIPTION OF WORK TO BE PERFORMED: Lc_> Identification Please Type or Print Clearly) OWNER: Name: ('J te a` A Phone:°Tb-Mol-Dgs Address: O CONTRACTOR Name: __ Phone: _ _ Address:. , Supervisor's Construction License: _ __ — Exp. Date: Home Improvement License _ Exp. Date: ARCHITECT/ENGINEER 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: $ I off, D by FEE: $ Check No.: �22" Receipt No.: A7i27 NOTE: Persons contracting with n istered contractors do not have access to the guarantyfund . 7. y..�.v. ., SignatureofSAgentJOwner� Slgature of.contractor _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department `rhe fol )wing is-a-list of the required forms to be filled out for the appropriate permit to.be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑` Bailding Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L: Licenses ❑ Copy of Contract a 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 o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application D Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) L, 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 apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doc: Doc.Buhding Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ElStampedPlans ❑ TYPEO;SEWERAGED3SPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑. . Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc._ ❑- _ -Permanent Dumpster on Site ❑ THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ...-- DATE REJECTED DATE.APPROVED PLANNING DEVELOPMENT' ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW To` o /Engineer: Signature: Located 384 Osgood Street FIRE D-EPARTKE.NT =Temp Dump'ster on site .yes no Located at 124Mair-Street , Fire"DepartrnerJtsignature/date ' ` ''`` _ "�* f }• ;�, r_ w + COMMENTS -. 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 MGL-.Chapter 166.Section 21A-F and G min.$100-$1000,fine NOTES and DATA—(For department use ® Notified for pickup - Date l Docluilding Permit Revised 2010 Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 12,000.00 m $ - $ 144.00 Plumbing Fee $ 18.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 18.00 Total fees collected $ 280.00 130 Bay State Road 453-14 on 11/21/2013 Renovate and Repair existing finished basement and bath � �tORTF� Town of 2 . s : xAndover, ver, Mass.,- BOARD ass, BOARD OF HEALTH Food/Kitchen PERMIT T . D Septic System i BUILDING INSPECTOR THIS CERTIFIES THAT ...... ..................................... .................... ........................... j� Foundation has permission to erect......................... buildings on/ ... ........................ ............................... Rough IP to be occupied as ................... ................ ............................................................ Chimney provided that the person accepting this.permit shall in every�`espect conform to the terms of the application Final on file in 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ............ .....1_ ....................................... . Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 �a�i�o ar 6s Ho ' TOVN OF NJORTH AND(7vER OPRICE OF )3M' )]NG DFPARTAWNT y`�R,no F4a y :1600QsgoodStreet$ widing 20,-Suite 2-36 �S�ACHus��t North Andover,Massachusetts 01845 Gerald A.Brown Inspector of Buildings Telephone(978)688-9545 HOMP—O'WNER'LTCENSE EXEW- PION Fax (978)688-9542 GUIDING PERMIT.APPLICATION Plea_ Sent DATE: QB LOCATION: Number Street Address � AP-o- ER Map/Lot �)� Name. Home Phone WorkPhone PRESENT MAILING ADDRESS ,State- zip Code The current exemption for`$omeowners"was extended to hZclude0wner-occupied dtvelIings to ipso units or l- and to alloys sn;h hoTnPotirers fo engage an individual.foz hire ssho does nat possess a I cense,provided that the owne acts as supervisor). Safe3uildin wna_1 g (Code Section 108.3.5.1) r DEFINITION OF HOMEOWNER Person s ()Who gwns aparceI of Land on which helshe resides or intends to reside,o be,s idered a homeowner. one or two feown structures. A person who cozrstro.ets more n Which there is,or is intended to consthat one home in atwo-year period shall not be The undersigned"homeowner"assumes responsibility foz compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"carts ies that helshe understands the Town of North AndoserBuilding De artment minimum inspection procedures and requirements and that helshe will comply with,said procedures and I requirements, p - HOMEOWN$RS SIGNATURE x APPROVAL,OF BUILDING OFFICIAL, Revised 7.2009 Form Homeowners Exemption •BOARD OF APPEALS 688-9541 C01\TSERVATI0N 686-9530 HEALTH 688-954D PLA.NNTiNG 688-9535 The Commonwealth of Massachusetis - F Department of Industrial Accidents Office of Invesfigations 600 Washington Street Boston,MA.02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/ludividual)' �� t of ' Address: City/State/Zip: �,.� p,�,� O 1°l�-1 S Phone#: 9N -SGS a -2)3-3 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. ❑Now construction employees(full and/or part-time).* have hired the sub-contractors 2.L1 am a sole proprietor or partner- listed on the attached sheet.# �• E]Remodeling ship andhave no employees These sub-contractors have 8. ❑Demolition worldng 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 3.54 I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' 13.❑Other comp.insurance required.] vAny applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.9: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 maybe forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. Ido h ereby cert u dthe T ains andpenaldes ofperjury that the information provided above is true and correct. Si 'ature: Date: Phone#• 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - 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 orimplied,or;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 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)andphone number(s)along with their certifcate(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 cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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. Anew 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 burn 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 CmxuAoilwalth of Massachusetts Department oflndustdal Accidents Office OURVestigations 600 Wasbiagton.Street Boston,MA 02111 Tel,#617-72.7=4900 est 406 or-1-877-MASSAFF Revised 5-26-05 Fax##617-727-7749 www.mass,govaa. Date...../L):7.K:7.qe.... AORTof TOWN OF NORTH ANDOVER PERMIT FOR WIRING C" S This certifies that ..............161 zPv... .............................. has permission to perform .........ec wiring in the building of............. .............................................. North Andover,Mass. iNS ......................... Fee.-�.... Lic.No...7L.':C�14.......... Pacfoe I Check # S 8 4 ?�'�. i ��.t s Commonwealth of Massachusetts Official Use Only L/ 7 Department of Fire Services Permit N°, BOARD OF FIRE PREVENTION REGULATIONS VOccupancy and Fee Checked [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 I1OU (PLEASE PRINT ININK OR TYPEA.LL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of WiYes: By this application the undersigned gives notice of his or her intention to perform.the electncal.work described below. Location(Street&Number) 13 a J�a-� &t 1} e ('`8 -/ Owner or Tenant K. 1`7v ti rf Telephone No. Owner's Address (�j t, �U tt,( S7'A c� Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boz) 4 Purpose of Building �%-,CJ; Id 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 Location and Nature of Proposed Electrical Work: C Com lesion.of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp. (Paddle)Fans N°.of Total Transformers KVA No.of Luminaire Outlets 3 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above a In- ❑ o.o mergency ig g rn& d. i Battery Units No.of Receptacle Outlets No.of Oil Burners 'FIREi ALARMS No.of Zones No.of Switches No.of-Gas Burners No.of Detection and WtiatinLy Dbvices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons _ No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWI,o�❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Sec N of Systems-* vices or E Equivalent No.of Water No.of No.of Heaters KW Signs Ballasts Data Wiring: 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 and penalti�esf of perjury,that the information on this application is true and complete. FIRM NAME: J rgvL-1 3 t�i"Q-— LIC.NO.: ? 3 Licensee: N t fill (,T` Signatur LIC.NO.: (Ifapplicable,enter"exempt"in the 1" ense umber line.) $us.Tel.No.. 8 $ -?[�3� Address: C J 2- Le a Co P4 t r 'A ASA 0 11 c j� Alt.Tel.No.: '7 � - 4 V *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 Signature Telephone No. PERMIT FEE:S i The Commonwealth of Massachusetts Department of Industrial Accidents �.. Office of Investigations 600 Washington ashinoton Street Boston, MA 02111 www_mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationPlease Print Legibiy Name(Business/Organization/individual): 't 1) (/V`li hi � L (\ T Address: t o). UP-0-co r City/State2ip: 1-N p M A Phone Z - Are you an employer?Check the appropriate box: Type of project(required): 1.ElI am a employer with 4. E] I am a general contractor and 1 employees(full and/orpb' Q' art-time).* have hired the sub-contractors �ew construction 2.P'I am a sole proprietor or partner- listed on the attached sheet # 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. [N o workers'comp, insurance 5. 9• Building addition p. ❑ We are a corporation and its required.] officers have exercised.their 10:❑ Electrical repairs or additions i 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself.[No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp, insurance required.] 13.[] Other *Any applicant that checks box#I must also fill out the section beiow showing their workers'compensation policy information. t Homeowners who submit.this affidavit indicating they arc doi-:,ail work-atld then hire-outside contractors must submit.a new amdavir indicaring such. +Contractors that check this box must attached an additional sheet showing the name of the sub contractors and their workers'com . oil P policy information. I am an employer that is providing workerscompensation insurance for n9'employees. Below is the policy and job site information Insurance Company Name: Policy#or Self-.ins. Lic.#: Expiration Date.- Job ate:lob Site Address: City/State/Zip: 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. Ido herebJ- e fy under the pains and pe aides of perjury that the information provided above is true and correct Si-onature. Date: /� d Phone#: _ 7 Z Official use only. Donor write in.this area,to be completed by city or town ogicia( City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone# Information and Instruction s � 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 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 comps etely,by checking the boxes that apply to your situation and,if necessary,supply sub-contactor(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 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. Theaffidavit 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 la,,u or if you are required to obtain a worker:° compensation policy,please call the Department at the nnmber.iisted 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/iiernse 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 fixture 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 burn 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, 1 please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26=05 Fax#617-727-7749 vrww.mass.govldia Location No. /G Date ` ✓p .I NaRT� TOWN OF NORTH ANDOVER OL 0 9 • i� ; , Certificate of Occupancy $ cMCH u•E<� Building/Frame Permit Fee $ s� s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 22207 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ` O I ORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER � 1 Print MAP NO: PARCEL: ZONING DISTRICT:�Historic-District yes o. Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne-famiI Addition Two or more family Industrial Alteration No. of units: Commercial CRjeagr)replacement Assessory Bldg Others: Demolition Other Septic Well - Floodplain Wetlands Watershed District Water/Sewer D SCRIPTIONF WORK TQ BE PERFORMED: i Identifica;�j on P�Iggase Type or Frint Clearly) OWNER: Name: 11btoul Phone: _Y66? Address: . Ardw f`t ( r CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp, Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 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: $ 2Ol� FEE: $_ 'ga Check No.: (; Receipt No.: 2 ZZ� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �-•%Signature of contractor Plans Submitted lans Waived Certified Plot Plan Stamped Plans 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 u Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy.Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li 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 ❑ 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 Doc: Doc.Building Permit Revised 2008 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMIMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water$ Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA.— For department use) ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 NORTH Town O '� �', '..,4 L Over . V" No. - �` dower, Mass., LA C' COCKIC EWICK A. 7�p ADRATED pPa` �Cy `S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT..... BUILDING INSPECTOR .........!0.6-tft.6 .................................................................................... n ".""' Foundation has permission to ere t........................................ buildings on .....I.-3.0........ . .f J,' ......... 4�....... ..... Rough I 1 t0 be Occupied as.... ... .�.�1/I..0 G �T�! [N.�....... ......... A.. ..... . �] ........ Chimney rovided that the erson acce tin this ermit shall in eve res ect conform to the term h li i n n file in p p accepting p every p t o app cat o 0 a 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 3� PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTR TARTS Rough 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. Burner :y Street No. SEE REVERSE SIDE Smoke Det. •�� The Commonwealth ofMassachusetts DePxTmenr of Industrial Accidents (Vice of Imvesti atiomv 600 Nrashinton Street Boston, MA 62111 Workers' Compensation Insitra.nce Affidavit� dav- A, 'cant Information 1t: t: Builders/ContractorsMeatricians/pfamher's ' . Please Print Lem Naffie(Business/0rgsoizaEianllndividuel): Adcjress: . City/ lZsp. 'gone# . Q' _V Are you an employer?Cbeek.the appmpriatr box: I•� Iain a employer with 4. 1] I am a Type of project(required): emplayem(full and/or* gemeral cont idor end I pertrtime). have Ind the _ 6. []Naw construction 2•�I am..a.sole proprietor or psriner• lisrzrd ship and have no em I ees cm the attached sheet, Remodeling P PY Theme sett-conflacfirs have working for me arty capecih. workers' comp.insurance. 8' Q Demoiiiion [No workErs!comp.thsurarsce S. r We are a carPOMfon and its 9' ❑Building addition sired j of ce s have exercised their 3.0 i ams homeowner da' 1 0Electrical�Pa�or additions mg all work right of exemption per MC3L Plumbin myself[No-worlds'comp, c, 15�, §1(¢),and we have n' g repaim or additions insurance required.]t .employees.[No wotioers' 12 L]Roof repairs 'Any RPOemthat �►P• insurance required.] drceice boL'ti t rafter atso fits out the sxtion brio-showing theirwoticats'iiornpensa tion poiiey infomution t Iiomeowmas who snbmh this afFdavft iadim ing they are an 4iraatraetora that cheok this box rteustaneehed sn addstioaal ahxt shote end are,hue outside connsctats must submit anew afrrrdnviE ind. wing•the trams of the su-romracto�and fneir x it-ones' 10diq suctL I e iv er F u fo�ban �' �' tha7 ra�mwara►rg►varke_' utfnr»+atson_ t+ssrarance�or trip.emolnve, Below is•she pofic-and job site . Insumcc Comparry Name: Policy#or 5el=ins.Lir.#: Expiration Date• Job Site Address: Att$dt a copy of the workers'sora CitylState2ip, Peasation policy declaration page(sho Failure m wing the policy number and expiration date) secure coveregc as required under Suction 25A of MC}L c. 152 carr lead to the imposition of cr�tinal fine up to 50.0 a and/or one-year imprisonment;as well as civil penalties in the form of a S7�7P V+/p ORDER penalties of a of up to$250.00 a day against the violatDr. Be advised that a copy of this statemenf and a fine Investigations of the DIA for insurance coverage verification, may forwarded to the C1f{ioe of I do her*set*under the palms and enalties oJpeqray d=m thein nnsatioa pro f Fcded ahmre is Si nate and COMA tta-e: � . (� Phone#: bate: ! d"= Official ase wtiy. Do not write in this ares, be compieted 4 chy or tows Gly or Town: Permit/License# Issuing Authority(circle one): 2. Board of Health L Snildirrg t)epartaneut 3.City/Town Clerk 4 Electrical Iuspeetor S.Pluns6iod Inspf r 6 Otbc'r Contact Person: Phone# l Information a lad Instructions Massa:husetts General Laws,chapter 152 requires all amp Ioy=to provide workers'compensation for their employees. Pursuant to this statute,an eneployee is defined as"..:every person in the service of another under any contract ofhire, express or implied,oral or writtm- An cmplayer is defined as"mm mdividuat partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and includi"g the legal representatives of a deceased employer,or the n=iver ortrvstee•of an individual,partnership,associatio=n or other Ipgal'cmity,employing employees.'Rowmthe owner-of a dwelling house having not more than three apa:rtsnentr and who resides therein,or the occupant of the dwelling house of another who employs persons to do maimteaance,construction ori work on such dwelfthouse or on the grounds or building appurtenant thereto shall not bemuse of such employment be deemed to be an employer." MGL chapter 152,J25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a ligase or permit to opamte a busmen or *o construct buildings is the commonwealth for any applicant who has not produced acceptable evidenceAr compliance with the-insurance coverage required" Additionally,MOL chapter I52,§25C(7)states-Neither t ie cOmmanwealfh nor eery of its political subdivisions shall errt into any contract for the limfornamm of public worie undil accaptabL-evidence of conmpliishc a with the im mea nrqua emcn!s of this chapter have beso presented to.the coTmtracting authority." Applieaats .. Please fill out the workers'compensation•affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contr zator(s)name(s),addrms(rs)and phone nrunber(s)along with their certificate(s)of insurance. Limited'Liabiky Companies(LLC)or Limited Liability Partnerships(LLP)with no empioytes other than the maabers orpamb=,are not required,to=ry workers'cflrnpensafrnn insmsnce. Van LLC or'LLP does have empioyees,a poiicy is required. Be advised that this affidavit may be submttted to the Department of lndustrW Accidents for wafirmsa6m of imtrm=coverage. Aim be sure to sign and-date the affidavit. The affidavit should be retraned to the at.or town that the application for the permtf or liceinse is being requested,not'the Department of Industrial Acoidenta Should you have any questions regia-ding the law or if you are required to obtain a wor3cers' oompensation policy,please-call the Department at tha-nui mber.listed beiow. Solf-insured comnprmi--should cntm their ., self insUrRn=ireerrse aeon=on tire•appr oprIste lire. City or Town Officiais Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at etre bottom of the afnciavit for you to fill out in the event the O zf-ice of Investigations has to contact you rWdmg the applicant Please be sure to fill in the perrmMi=ur-numberwhich w-ill be used as a reference number. in addition,an applicant that must submit multiple peermWhcm=applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"fare applicant should write"all locations in (city or tower)."A OUpY o -foe afndavit that has been.off;ic'mally siampe:d or marked by the city or town may be provided to the appti=rt as proof that a valid affidavit is on file for fid= permits or licenses. A new affidavit mu&be filled out each year.Where a home owner or citizen is obtaining a iic=e:-'or permit not related to any business or commercial vooture (i.e. a dog license or permit to bum leaves etc.)said pons* is NOT required to compiett 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 nrmmber. The Commonwzadth of Mawachusetts Derparti vt of Industrial Accidents ice Of EnVesttip ions 600 WRC�aton Street Basion, M1k 02111 TeL#617-7274900 est 406 or 1-8.77-MASSAFE R.cvised 5-26-05 Fax#617-727-7744 www-xass.govidia a 4 NORTH TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 SSAtHus� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: 3() Number Str t Address Map/Lot HOMEOWNER 6Un � qe� 101'k 0 U8- 369 , 2 Name Home Phone ( Work Phone PRESENT MAILING ADDRESS 1 :7 b S"T a W4 Andove_r , Ma 0 City Town I State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Location 130 8 P�V 1 r No. �Q( Date /g L2dZ&4 NORTh TOWN OF NORTH ANDOVER 0 A Certificate of Occupancy $ Building/Frame Permit Fee $ 30 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 30 • Check # i Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DdiELLING BUILDING PERMIT NUMBER: / DATE ISSUED: Q/>-41 d ,A M SIGNATURE: Building Commissioner/[ r of Buildings Date SECTION t-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number.. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zm°t Distad Propo use I Lot Area Framta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.GJ—C.40. 54) 1.5. Flood Zone Infomution: 1.8 Sewerage Disposal system. Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site DisposalSystem 0 I I SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes_ No_ M 2.1 Owner of Record ,,? Name(P / Address for Service ic 22 Signami Telephone Om 2.2 Owner of Record: ' F + 'Name Print Address for Service: 0 z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 4-�`I � �tr Licensed Construction Supervisor: o -7- ef License Number 7` 7 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 1 Company Name Regi strmdNumber Address aaeac — Expiration Date z Si nature 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.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repatr(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other, ❑ Specify Brief Description of Proposed Work: r— SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(s)X(b) ^ 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 a Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, .( r ..J /i IC`s as Own Auth�Agentubject property Hereby authorize to act on My behalf; 1 matt rela � uth thisbuilding permit application. Si fat of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION t 1 as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief \� Print Name Signature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB �• SIZE OF FLOOR TIMBERS ffr ",,.2NU3 RD SPAN DIMENSIONS OF SILLS , DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS \ S HEIGHT OF FOUNDATION THICKNESS } SIZE OF FOOTING X MATERIAL OF CHMTFY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE GMC CONDUCTION 104 Thornton St. Law. Ma. 01841 Tel: 978-479-4972 Gratien Michaud INVOICE TO:Kevin Dolan Date: 10/19/05 Work performed at: 130 Baystate Rd. ' N.Andover, Ma 01845 Job: *Supply labor& material to strip & put new roof on house *Reshingle garage Total Job: $3,240.00 Thank jou for jour Bu i NORTH own of _ over _ _ - -- ZO LA E dover, Mass.,S AP o 'FL- COCMICME WICK �AoRgrEDP? S\ •�� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 4V BUILDING INSPECTOR THIS CERTIFIES THAT.......... � A .......................Of 40 ........ .. .... ............................................................... . ' ' ""' AnFoundation has permission to erect..... .... .... ...... buildin s on... .. Rough ................ to be occupied as.. N r 0 Q ^P4+� � 0 at e44D 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 InspectioaL Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoningor Building Regulations Voids this Permit. Rough 9 9 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR - UNLESS CONSTRUC N ST S Rough M..................... 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. Burner Street No. SEE REVERSE SIDE Smoke Det. OCT-19-2005 04:51P FROM: TO:19782696250 P.2 ATE ACOSM CERTIFICATE OF LIABILITY INSURA CE 101/ /19/2005) T PRODUCER FAX THIS CERTIFICATE I ISSUED AS A MATTER OF INFORMATION DeAngelis Insurance Agency, Inc. ONLY AND CONFER NO RIGHTS UPON THE CERTIFICATE 283 Merrimack Street HOLDER.THIS CER FICATE DOES NOT AMEND,EXTEND OR ALTER THE COVER E AFFORDED BY THE POLICIES BELOW. Methuen, MA 01844 INSURERS AFFORDING COVERAGE NAIC 4 INSURED Graben Michaud Construction INSURERA: Vermont Mutual X nsurance Co. 38 104 Thornton Street INSURER B: Lawrence, MA 01841 INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR HE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TC WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TH TERM$,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR DO' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXP I TION LIMITS G EN ERAL LIABILITY BP17039329 11/03/2004 11/03/ 005 EACH OCCURRENCE $ 300,000 X COMMERCIAL GENERAL LIABILITY BP17039329 11/03/2005 11/03/ 006 jAMAGETORENTED $ 501000 CLAIMSMADE a OCCUR ED EXP(Any one person) S S'000 A PERSONAL&ADV INJURY 5 300,000 ENERALAGGREGATE 3 600,000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS.COMP/OP AGG S 60c),000 POLICY 7 PECT RO- LOC J AUTOMOBILE LIABILITY BIN SINGLE LIMIT 5 ANY AUTO EB aecldenl) ALL 0 W NED AUTOS T®ODILY INJURY SCHEDULED AUTOS "Per Demon) $ HIRED AUTOS 60DILY INJURY NON-OWNED AUTOS Per Bceldent) 5 PROPERTY DAMAGE S `Per accident) GARACE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC 5 PUTOONLY: pG0 S EXCESSIUMBRELLA LIABILITY ACH UCGURRE14CE 5 OCCUR a CLAIMS MADE (GGREGATE 5 I 5 DEDUCTIBLE S RETENTIONt'IS S WORKERS COMPENSATION AND WC STATU• 0TH- EMPl0YER8'LIABWTY � ANY PROPRIETOWPARTNERIEXECUTIVE T BE ISSUED BY CARRIER F.L.EACH ACCIDENT Is OFFICERIMEMBER E)(CLUDED? �.1.DISEASE•EA EMPLOYEE 5 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER I DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES I EXCLUSION&ADDED BY ENDORSEMENT I SPECIAL PROV18IONS Certificate is issued in the interest of the named insured and certificate holder below. Certificate is subject to all company condiotns and exclusions. CRTIFICATC HOLDER CANCELLATION SHOULD ANY OF THE AB VE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THEREDF,THE 15SUING INSURER WILL ENDEAVOR TO MAIL 10 GAYS WRITTEN NIIOTICE TO!THE CERTIFICATE HOLDER NAMED TO THE LEFT, Kevin Dolan BUT FAILURE TO MAIL SU H NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 130 Baystate Road OF ANY KIND UPON TME I SURER.ITS AGENTS OR REPRESENTATWES, North Andover, MA 01845 AUTHORIZED REPRESENTAT E David Segal KEC ACQRD 25(2001!08) FAX: (978)269-6250 ©ACORD CORPORATION 1988 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 at: r, 6 , is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section l OA. The debris will be disposed of in: 6w L (Location of Facility) Signature of Permit Applicant Fire Department Sign off. Dumpster Permit Date f Date. l TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING 'SS�cNusEt This certifies that . . . . . . . . . . has permission to Perform , a . . .. . . . .`. . . . . plumbing in the buildings of'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at.f C '...sem. . North Andover, Mass. Id Fee ' . .Lie. No.. . ti.. . . . . . . . . . . PLUMBING'I 6ECTOR Check # /Z "/U 5 ; 44 1V1A„AUHUJh*1"1'b UINIVUK1V1 AYYL11 A11U1V f UK JrEK1V111 1V"U YLUIVIBIM (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location 13 Owner ame / /Z Permit Amount TypeofOccipani New Renovation Replacemen Plans Submitted Yes 0 No FIXTURES SiI;HM BAS&M f IST lHIf(1<2 i 71�II)�D(IEt HiQ HIM 4IIi FIIOC�t 5M H OM 6IIi fl" 7gI1H CM gm fLCM (Print or type) Check one: Certificate lnstalling Company Name (\ 1/1/1/ LrR13(�Z I Corp. i Address 342 r0r-M-0t) Avc Partner. 14 434,TI4tIFAt, /7714. 01f 4 Business Te ep one (1'71 -- & FG Tot 3 1 Firm/Co. Name of Licensed Plumber: 16-'V l ry/ Q. CA h v ZZ i Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnityF1 Bond ❑ surance Waiver: the and have been made aware that the licensee of this application does not have any one of the above th einsur ce igna ure 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 instal 'on erfo ed rider t Issued for this application will be in compliance with all pertinent provisions of the Massac ett to Plu g Co Chapter 1,42 of the General Laws. By: signatufm4ri—censea Yjum er Type of Plumbing License Title i2-1Z City/Town icense lNumoer Master Journeyman ❑ APPROVED(OFFICE USE ONLY rrrJJJ �- _ � � � .� ��fi'� �'. ��, �f/ !�Q k 3 (22 Date............. ................. NoRTM TOWN OF NORTH ANDOVER o PERMIT FOR WIRING ,SSACMUSE� r % This certifies that.''............:�:.1. a`' f LCJ.................................................... has permission to perform ..: wiring in the building . ..................................................... 1 at..............................;..........................,....'.................,North Andover,Mass. Fee S�.............. Lic.No.............. .. ` ..:'..... t /, + IELECfRI ;Z&SPECfOR Check k 4845 1w, TH(�. MA' MCH . '�S' Office Use only ? MAPDEPARTALEYV'OFPUBLICS-4FE7Y Permit No. �y 1 OFF2 PREYEY170NREGMTI0NS527(W 12.00 Occupancy&Fees Checked a PARCEL PERAff TO PERFO�RmaECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS,EL EC7RICAL CODE,527 cmR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) *41y Date 0 -10-03 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical��described below. Location(Street&Number) QQ 1541,57A� (�� IV,ANRQ`,J'-4L- Owner or Tenant i P—A 14L7y Owner's Address SAmC ilS AftVe Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building fl/jwl Am) PSN-(RPuy" Utility Authorization No. Existing Service _ 60 Amps Volts Overhead ® Underground = No.of Meters r New Service .Amps / Volts Overhead Undemound No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Z?d Sc-,r d(51UT&)XI J� R2 UGHTZ5 �GC6PTr1C(Cr�, �lCH/JitbT � No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and around No.of Receptacle Outlets 110 No.of 0ii 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 lnitiatingDevices No.of Dishwashers Space Area Heating �s KW No.of Sounding Devices No.of Self Contained AM(1Ct01(X ,n�'ibs f.[C^! Detection/Sounding Devices No of Dryers Heating Devices KW Local Municipal Other .'I Connections No of Water Heaters KW No.of No.of Sims Bailasts No. Hydro Massage Tubs No.of Motors Total HP OTHER��f 2 _ Irmxar�Co erre Ptasuatxto the ra�tira»ads dWbss�G=al laws IhateaaxxriLraotbrylrslxx=Pchya>ilirtgCar Cueragecritsst#zsta ci:;t a YES NO Ihare9J1,m edvandprwfofsxneaothe0ffimYESNo � if}cunmed�c�YES,pixeir�ethetMmcf by the BOND � OZIE � ( ) Expamcrtf)ar Estimr VahedEacral Wade S 25CO WctkI)SW 1i-16 3 hnp=m Daie Rapsh2d Raigh U LL Cltt..C__ F11211 "LL, - Sigo txlda"U—Pataltiesofpaju -. FIRM NAME Li�rseNa Lzetsee -1'GsoCm-r'tib Sio-lahxe ro.� Li seNo7606-C BI�r�Tei Nh 508—G-v1-14(- A LEU l 0tA4V&r4UtC1,414 ©i&")o A1tTeLNa .37B�24-1187 OWNER'S MURANCE WANE?;I amatvme tits the hese dce5 t#�t a the alstrajxcoyeq�crks ah==was turned by �G==Laws aodt}r�tmvs�tsecnti�speQnita�c�twar.es tl�s t>�erte>< (Please ch(zykA o.�ne) Owner Agent i P'7 7 Telephone No. ,JL8-6FZ-Z430-�; PERMIT FEE S �-� Date.A.0 :.Y.� 40°r:��, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHO This certifies that . . . 1 .�.h.f. ". . .�t .`�. . . . . . . . . . . . . . . . . has permission to perform . . e&v f'.1.( -` . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . ff--�. . . . . . . . . . . . . . . . . at. . . North Andover, Mass. Fee. 3�.- .Lic. No..3.3.1. 1. . , .��.� !... -. . . . . . . . . PLUMBING INSPECTOR Check # 5466 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) y�7gb�e�' Mass. Date /1-0 )9 ermlt #�LL� _ Building Location /-3 !0(&tx a owner'sAameZL-4LM Ty of Occupancy Residential M M v New 1_1 Renovation f._] Replacement IN Plans Submitted: Yes L7 No ❑ FIXTURES PZ" N m n z r- O . W 1- N J W U Y J N r U .t ul 7 0 34 Q�4 1.1 n Z o4 ¢ rr z d N z u0 2 = a aL'iUj 'n — N N i Q r w m Y a z a 3 ay r>i rr1 ui rr 10 o q ¢ vi a a w 'n K 0 1 a w z i 3 O z x ' X a F a Y w w x �I 14 LI o ow O u Ql ri FU- ¢ i a N 4 Q O < OJ j Q a rt cc `� 0 4 B 3 x Go 'n o o J 3 = 1- N LL u D a i r: (a f11 rd b rd 3 � SJR—DSMT. --- — — r — — BASEMENT 1ST FLOOR _ Q 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name IIer>_tage Htg. &P1g. Co. Inc. Check one: Certificate Address 35 pj_e_ds_ant_Stl:eet [X Corporation 714 Stoneham, Ma 02180 C-1 Partnership Business Telephone 781 =7��__ 11 Firm/Co. _ Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K1 No 1-1 If you have checkedrtes. please indicate the type coverage by checking the appropriate box. A liability insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent❑ Signature of owner or(Tuner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above appiication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 f the General Laws. SignAu,6.fDti-ce,ns.i f'luri or --- Type of Liconse: Master(.Y Journeyman C1 City/Town _ _ E IHS8 3 2 2 APPROVED(OFFICE ONLY) License Number_______._^„_�__ BELOW FOR.OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE I NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME S TYPE OF BUILDING LOCATION OF BUILDING i PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR I I EIa. ' N° 3001 Date...'?..� ..G ./ NOR7/� TOWN OF NORTH ANDOVER PERMIT FOR WIRING A 14USE� This certifies that ...................... .... .. .. .. ' .......................................... has permission to perf rm ... :.... f � �-� wiring in the building of. Z�,�,�............ .....�. ...�i: ...............,...�...... at.. ��... rLt.f... ''�....................North Andover,Mass. Fee m....�...�`...... Lic.No. . ..��- G,r........................ ELECTRICAL INSPECTOR Check � �'.�i,C 2� C! WHITE:Applicant CANARY: Building Dept. PINK:Treasurer i iUrrro�ouC/L I THOFAUSS40M= Office Use only MAP DEPARTXE7VT0FPUBLICSAFETY Permit No. d d OFFVEPRLT=ONREGUL47IONS 527CMR I2.-OO Occupancy&Fees Checked c PPRINT PARCELPERA ff TO PERFORM ELE=CA.L WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH T HE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 IN INK OR TYPE ALL INFORMATION Date 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) 130 662,516-Te RLQAD NOr V4 q NDdV U(L,M A Owner or Tenant I RA KCutZ Owner's Address 130 t3Ay,5TA1 C IZ.OA-D 1160* A f0c)V L., 14A- Is this permit in conjunction with a building permit: Yes F-1 No C5q (Check Appropriate Box) Purpose of Building UPGO-ADS 50-\60E-t-0 t OO AM9S Utility Authorization No. AN Existing Service Amps Iw/2y0 Volts Overhead 'E7>< Underground ® No.of Meters l New Service 100 Amps IZU /Z40 Volts Overhead 1= Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work UP6 iWe Se7ky1CQ- M 100 AMPI No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground Sround No.of Receptacle Outlets No.of Oil Bumers No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners t 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 PUMDS 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 r Connections No.of Water Heaters KW No.of No.of Sins Bailasis No.Hydro Massage Tun, No.of Motors Total HP OT'r-IER Irna rart�Ca e Ptast��to the re4tntarers�Csuaal Lam I hm a waerl L-OdAy k-m=PohLy raxiing Ca-ropEECIn26xis Cotaagecrits sulke>LSvalas YES NO Ihaw si-b�vabdYES � Ifyaihaedt�c�l�pleaseffxh=t>rtjp�cfwxag�byd=iangthe bcx Nsu l� MER �SP�) F%pr l Da EstimatedVahedE7ectriral Wcik S 50.0 Wcdci)Start 028d� h>SpcMcnDatRege Rath WiCL CALL- Feral Wiu, Ct4-L.t! Signed tan6aute%%lis dpajw.. FIRM NAME Lio=Na Lim 376 0 S 6 Business Tel.No. 3l iAyt�2 si`- �T> J4AvEWtt,(, /YEA 01932AlCTei Na ! 7/87 OWNE--?'SIIvMR.AA EWAIVE,Iamau=iatth L=-iser Dmw egivai=as reqmrdby NizwdizeM Gmmi Lam a�thamy a tnti��ap6c�mwar.csthisrecpti a (Please ch�Lone) Ow 1.___ e- 17"AAgent —1/tCL 0 / Telephone No. `��f73L-Z�OJ PER"41T FEES t _ Date..... � ��...... f NORTH 1 ° TOWN OF NORTH ANDOVER ...•,.,• OL p PERMIT FOR WIRING SSACNUSE� \//\\ /�1 1X(jqy.,.a'1L This certifies that .�-�.....�./............ ...... . ........................... has permission to perform wiring in the building of... ................... Andover Mass. Fee ca.vLic.No/..........ee ELECTRICAL INSPECTOR Check # u 5575 1aAa:a1virur1Lf1T FrEw "Al U11 trI IIUJGIIa Vince use only DEPARIAIDVTOFP •SAFELY Permit No. �� 7,y ;BOARD OFFIREPREVFV'HON ONSR7(M�R12(�1D 4� Occupancy&Fees Checked APPLICA77ONFOR PERMIT TO ERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE M SSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Z— 2-o! Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical wor d scribed below. Location(Street&Number) /,30 � Owner or Tenant KFull-I 14 Qa t Owner's Address Is this permit in conjunction with a building permit: Yes o (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps I dolts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 4+1g7 .tJ7T�rf�/- No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round 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 � Othe_ No.of Water Heaters KW No.of No.of Connections Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• Cb Flusrantk�the vetage regrvlar>enls�GarelalLaws IhaNeaamftLiab>7i<ykmrdrxePohLY CmP Cowr,Wcr lsmbstoff lagrxralat YES NO Ihaoslftwmdva6dpicdof`m=todrOffi=YES YyvutmednixdYES,plemirdc*dletypeofovwWby INSURANCE BOND r7 O LER M (P1ea9eSP�Y) Fxpita6arDa� Estirn*dVAreofF�criicalWtxk$ Wo>ictoStatt D& Rargh Final Signedwld?rTPt�ra&s0fpajW. �,��tv�17 ��C i�'iG9�_ FIRMNAME Lioat9eNo. l`l;F,!�- Licerme Sigr=m �— Lice wNo Td No. y7a 690 6Z�Z A Sim Z�ii2c � vi�y0 A1tTdNa OWNER'SINSURANCEWANFR;IamawaledutheLloffwdoesnothawlheinstaaalceeDw*orilsmbstajalegtrivalaltasrac�titedbyM Galaallaws atxl that my signahne on dus pearrit application wanes this regtriternar (Please check one) Owner Agent Telephone No. PERMIT FEE$ Signature ot Uwner or Agent I HE LUMMUIV VYVALl n Ur II nt/JG11 J � D�OFPi1B11SAFEIY Permit No. �J �� + BOARDOFFMPREVEWON ONSR7(W 12V0 G" ++ Occupancy&Fees Checked . APPLICATION FOR PERMIT TO ERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THEM SSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 Z O LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 2 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical wor d scribed below. Location(Street&Number) 3� Owner or Tenant �1t - Owner's Address ` Is this permit in conjunction with a building permit: Yes 2 No (Check Appropriate Box) 1' � Purpose of Building Utility Authorization No. Existing Service Amps--Volts Overhead.m Underground 0 No.of Meters", New Service Amps Volts Overhead M Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work -t-7f ,LJJTcr%F/-J No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Poor Above Below Generators KVA f� ground 1:1round No.of Receptacle Outlets ` No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets (J/J 7 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 D Municipal rJ Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP iR- COVWJg!�Ans=mthete~}marbofNt%mdindisG=zWlaws IiabihYhrstaarePb�Y �P� CovesageoriVsstiairialtx}livala>< YES El NO va6dpcodOfsaritebtheC)ffi=YES ffyaihmrfted®dYES plwlrtdratethetypeoloovaageby BOND r7 O MM M (Plias **) Estim*dVWwof ArhicdWotk$ it lD&Rq gad Rough Final �i ofpt r/iv �cr-,enc LitwNo, /BGG :�v/r.� signahae _ Li�eNo Btsk=Td Na 97f 69'2- 62--6 -Z- Alt Alt Tel.Na ` W 57.5-5"73�F • SINSURANCEWAIVER;lam awaetha drLmwdmnothmtheirstaa=tmVorilswbsftMe#vaimaswg*DdbyMamhnMGffnWLaws sipahnecnthispemidfficaabmwa'mthism4x'mxft . heck one) Owner 0 Agent Telephone No. PERMIT FEE$ Signature ot Uwner or gen G'S'M Location 3D 9A C( No. d`3 Date •1 NpRT� TOWN OF NORTH ANDOVER 1 to O't..w ,•• tip 9 } Certificate of Occupancy $ HU E<�' Building/Frame Permit Fee $ 3 CMus s� f Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 3 165 ,, 3 i/ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DE�MOLISH A ONE OR TWO FAMILY DWELLING a ', s • '�, -SO,� !k; BUILDING PERMIT NUMBER. 2 DATE ISSUED. V SIGNATURE: Building Commissioner/Ia9, t OfMidings Date SECTION I-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: f 3 v6Aq s� R/9 `{ 5 3 3 Map Number Parcel Numbek 1.3 Zoning Information: 1.4 Property Dimensions: (� Zoning District Pr osed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water SupplyM.G.L.CAO.1 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District;Yes No m 2.1 Owner of Record �J�1 S� IC 'LT Li`c t 1 L1!. —L( Z Nam t) Address for Service: i 7e—OZ, Z,pd3 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Lia,nsed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number 11 Address Expiration Date Signature Telephone r i 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name m Registration Number r Address r Expiration Date ^z Signature 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.......n 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: PoVI t t4 Q ASP zzTKI IX AAili SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFF CIAL'Un ONLY Completed by permit applicant L Building (a) Building Permit Fee 2s'o d.ted Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) pp J 4 Mechanical HVAC 3 CJ 5 Fire Protection 6 Total-"1+2+3+4+5 -` ' ` ' Check Number 0 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 act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property ' Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge ; and belief Print Name Signature of Owner/A ent Date 11631241111 NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 191* 2 3RD SPAN DIMENSIONS OF SILLS DIDv1ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGITT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i NORTtt o SSLEe ,6 0 6`•A * E6 Oa1 9 Town of North Andover _ Building Department *� • �'' 27 Charles Street ��SSacHusE�� North Andover MA 01845 Tel: 978-688=9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE / r C) JOB LOCATIOI- (k) AV A 0 r M Number Street Address Section of Town "HOMEOW NEa'� J•am'°", Number Home Phone Work Phone PRESENT MAILING ADDRESS' C City Town State Zip Code The current exemption for"Homeowners"was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one to six family dwelling,attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit.(Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes,by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATUREX APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet,or larger,will be required to comply with State Building Code Section 127.0 Construction Control. 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. i 7AM ICS -t 5 4 AQMO�/-c, - I AVb-9( C,- R 7E 7-73 - 6? (Location of Facility) Signature of ermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through-the Office of the Building Inspector I ii{ I I I 1 i I l I , I 1 1 I , I , i i I I I • i , I r i i I I I i I I I i i i I I , I I I - - I i ��M PlAt N�K � M Town of over 0 No. ro =- L A o doves Mass. d COC HIC NE-ICK ' ORATED p,P�,`�� . `S H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System 4- R)", K! f- BUILDING INSPECTOR THISCERTIFIES THAT..................... ...................... .............,..........,..,........................................................................... Foundation has permission to erect......,r�. .. buildings on ......�.3�. ..A � .� .. Rough ........ ! ........... ........................... A INO'L t V p S�Ih� , Chimney to be occupied as.... .................................................................!J.........1�!�, .............. .....\ .. .. ......................... v 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 I spection, Alteration and Construction of Buildings in the Town of North Andover. %i !; ts /3 v PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S ELECTRICAL INSPECTOR Rough 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. Burner Street No. F_SEE REVERSE SIDE Smoke bet. NoRr►y Town of d®ver g> m � _. - �A o �` dover, Mass., CCICHIC HEWICK AD RATED P'PP,`�� S H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System k9#9 4. �!J f_� BUILDING INSPECTOR THIS CERTIFIES THAT: ...................................../.................... ..�� .....................................................................................: Foundation has permission to erect......,r!. �.5.. ...... buildings on ...... .30.......I ..A` .....5'�/l'E'F IZ& ................................... Rough to be occupied as....,4� a...�.•�.....3.p%*AA .N�...�r.I.....3��f.....3..� k..� ... 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 I spection, Alteration and Construction of Buildings in the Town of North Andover. %i S•• 15 /3 Lf PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIO S ELECTRICAI:IINSPECTOR Rough 9049 ................. .. ..... ............. . ..................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place o'n the Premises — Do Not Remove Final No Lathing or D' 7 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner r Street No. SEE REVERSE SIDE Smoke Det. Date. . .;7140-� "°RTk TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING 'IS us �} This certifies that . . `. /V or. • • • • '•!�• • • •7 5 has permission to perform . . . . d�P ` / pf imbin//g-�iinfftthe buildings of . . . ./T/r7. . . . . . . . . . . . . . . . . . at . . . J. . . � . . • • • . . • • •, North Andover, Mass. r Fee/ S. . . . .Lic. o.. S�/�' . . . . ../.� ,f �� PLUMBINGINSPECTO. Check # —ZI11 5659 MASSACHUSETTS UNIFORM APPLICATION.FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date TVW Building Location dr 7 Owners Name V*.L-r z, Permit# Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES H i SLB19VVE M FiffR ?SII R'd �21aI�0(R 4M ROC t 5M RUR 6M R" 7M FUM 9M FlaR i rint'or type) Check one: Certificate stalling Company Name W l'l4,1 JI_ PIUAA ,AY, i-94A-6 W=m � Corp. 11g02 Address 10--ga- �LB El Partner. "r 4A./�riyGd t� . WA, d Business Telephone, g7 g ,Qj ts'r'l/.Z9� Firm/Co. Naive of Licensed Plumber 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 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 Massachusetis State Plumbing Code and Chapter 142 of-the General Laws. ff& BY Srgnar of rcensea rjumFer Type of Plumbing License Title g•� CitylTown 1cense Nufn eb Master Journeyman APPROVED(OFFICE USE ONLY f Date* "/: . . . r 7 f MORTN, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SA HUS F This certifies that .. . ... ..�. . ?j .. . . . . . . . . . . . Thas permission to perform . . . plumbing in the buildings of . . . . . . . . . . . . . . . . - at!.'�.�� . . . . . . . . . . . . . .. North Andover, Mass. 4 Fee `i . . .Lic. No.. . . . . . . . . f -*� PLUMBING.NSPECT0R Check # K51 -� L 6323 C MASSACHUSETTS UNIFORM 4APPLAN FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date FBtia y 2�s Building Location ,30 —S Owners Nle lf OoL,� Permit#AmountT e of Occu anc New Renovation E3-"*" Replacement Plans Submitted Yes ❑ No ❑ FIXTURES Ln H4�1P 1S>r FIOCR M FLOOR M HIM 41H ft" 3II3FL" 6IH H(M 7M HF OM SIH FIOCR i (Print or type) Check one: Certificate Installing Company Name_ i9 /ilCt •Q ,g,, ,jy9 L7b, orp. Address -zz, GiPA�lGiLle ��n� ❑ Partner. Business Telephone El Firm/Co, Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverag 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 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 Plumbing Code and Chapter 143 of the General Laws. By: 11gna ure icense EMU"* um e Type of Plumbing License Title `� 9 City/Town icense Num er Master Journeyman ❑ APPROVED(OFFICE USE ONLY 'u ' Location No. Date ` - NORT„ TOWN OF NORTH ANDOVER 3? :_, ••roc 0 9 Certificate of Occupancy $ ss�CMus< Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ac) 0 Check # 17993 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLINGWo BUILDING PERMIT NUMBER: DATE ISSUED ate® "s— SIGN Building CommissKncr/IEUEtor of Buildings Date SECTION I-SITE INFORMATION 1 O 1.2 Assessors and Parcel Number: 1.1 Property Address: Map 37 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 1 Zoning District Proposed Use Lot Area s Fronts ft 1.6 WELDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Regaired Provided Required Provided v 1.7 Water SupplyMGL.C.40.1 54)- 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 zone Outside Flood Zona 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1-11 6101 iC lj`'trlCt; Yes IJo m 2.1 Owner of Record Q , ld—(74, 4 1k., Name(Print) Address for Service � f - Signature Telephone 2.2 Owner of Record: a Name Print Address for Service: Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor:� --/ �j � �r� �Q�J/�� License Number,�/O qA Address Y do Q J� Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Comp*9ny Name V M // j/6, Registration Number r a Address X /�/('o �� Expiration DateSi nature Telephone a 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.......0 SECTION 5 Description of Proposed Work check .a ucable New Construction ❑ Existing Building Repair(s) 42r I 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 I. Building (a) Building Permit Fee Multilien 2 Electrical (b) Estimated Total Cost of Construction � r 7 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 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, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION property 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 TEV BERS 1sr2 3Ku SPAN D.Uv ENSIONS OF SILLS DIMENSIONS OF POSTS DRAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS it SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND _ IS BUILDING CONNECTED TO NATURAL GAS LINE 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 Numberk� 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: (Locati of Facility) Signatur of Pe it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts > Department of Industrial Accidents OMCS of lnvesdgedons NorBoston, Mass. 02111 Workers'Compens UW Insurance Affldavit Name Please Print i Name: Location: City Phone # 0 1 am a homeowner performing all work myself. F7 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. Address t✓) 6 Cit\► Phone-* P Company name: Address Ck. Phone# naurance Co. Pokv 0 Falk ns to saran coverage as required under Sedan Mor MGL 152 can lead to the imposition d aktdnal penaltles d,a fine up to s1,5ti0.00 andlar one yews'Imprisonrnerst.aa+�ae0.as_ci>rN,panattiesln lde tmn nfa STOP.ViM ORDER.md.a.tiae d.(SIM.M)A Am agaba.ma. I understand that a copy d this statement may be forwarded to the Office d Investigatlone d the MA for coverage vera icatlon. I db hereby cergy under the Ins and Pena of pedwy that the infamatton provided above isbue end correct. Signature Date O i �J, Print name �� G✓QG�-G� Phore# �5J Official use only do not write in We area to be completed by city or town official' City or Town P si Check I immediate response!8 requiredBuilding Dept [] Licensing Board Selectman's Office Contact person: Phone#• C] Health Department 0 Other TWOMEY & LEGARE CONTRACTING Professional Building / Remodeling P.O. Box 366 Shaun Twomey North Andover, MA 01845 Doug Legare 978-685-7447 978-556-1547 CONTRACT 1. Date of Contract Signing: 2. List of documents part of this agreement: A. Contract B. Specifications(see Exhibit B) C. Drawing(see Exhibit C) D. Payment Schedule(see Exhibit D) E. Limited Warranty(see Exhibit E) F. Notice of Cancellation 3. Parties to Contract: A. Contractor: Twomey&Legare Contracting Shaun Twomey/Doug Legare Federal Id#: 04-3610112 Address: P.O. Box 366 North Andover,MA 01845 Contractor Registration No.: 136779 B. Homeowner: Kevin&Heather Dolan 130 Bay State Road North Andover,MA 01845 (978)686-4562 4. Description of work to be done and the materials to be used: See Specifications(see Exhibit B) 5. Total arrow t agreed to be paid for work to be performed undergo contract 6. Tune Sahedale of payments to be made under the contrast,finwe charges for late foes,if �Y See Payment SdIeMe(see ExluInt D) *Any deposit regrdred to be paid in advance of the sort of the work shall not amd one-third of the total conbw pace or acw d cost of wry material or eqwpmenr of a special or custom made nature, which must be ordered in advance of the start of the work to assure that the p wjed wfll p weed on wJm& & No•7nal paym w Shall be demaN&d wall dre bract Is wnrkkd to the saftisfact m of aMp rdw. 7. A. Date work is wWuled to b091W SeeNo. 14 B. Dale work is st-,sled to be subsmn&W camplebe& See No. 14 S. Notice A. All home finpovemat wdMtws and saboonl utors shall be wed and that nay inquiries about a contractor and subcontractors AM be wOsWW and Haat any inquires about a conhetor or sabcowrwbr relating to a regishition,Goold be dh=td to: Dhwctor,How ImPv COmbwcfOr RqOWmldu OjwAskbram Place,Boone 1301 AWAR ,Maramew 92368 TelepkmeN&(617) 727-8598 B. For coWWWW amber,see top of first PB#L C. Homeowner's have&a-&y mon rights under MGL c 93 f 48;MGL c 140D 10 or MGL a 255D f 14 as may be applicable(see aged Notice of Cancellation). D. For owner's waamity rights,we 780 CMR R6 and MGL c 142A. 9. There is no lig or smu ty Were it on the residence as a CMwqMw of this contract. 10.Permit Notice: A. The fonwft permits will be required in connection with the we*to be perfomted on B_ It is the obligation of do coaftactor to obtain these permits as the owner's ag n't. 2 r 4 C. owner who secures their own —related or deal with Any unregistered cogs shall be excluded fivm access to the Gumantee Fund 11.Coaf actor reserves the ngbt when he deems hof to be insecure to require as a prerequisite to continuing work that Bre balance of finds due under the contract,which are in possession of the "be placed in a joint escrow account requiring the signsuares of The home hgmyement cow and the owner for widdmwal. 12.The parties agree that no wosk droll begin pdar to tate dg ft of the contrn4 trananittal to the owner of a copy of the contract and the expiradon of any applicable rescission period 13.Arbitration Close:Ae embuctor acid dre hom mvmr hereby mutually agree In advance that in the event that the contractor has a dispute concou tg this contract;the con&actor may subndtsttch dlapvte to a private arbiaion sffvlee which bas hm gprmmd by the Office ofGv>rsraner airs and Brt umm Regulation and the cow shall be mgwred to submit to such arbitrad m as provided In MGL c 1424. 14.Other Provision: A of Work/Completion•CoakwCor agrees W proceed dOWWly with the agreed Won mark,conmuncing PAY following: • The oaRle#im of the Te V and mOm ion of come kmw by the Town, • Lmumm ofa building pennitbydoTown. • Estimated daft of ion: • Chian date droll be autom ily extended by the nwaber of days equal to those on which seller shall be prevented or hindered fivm eampledan dWW weather coaditionk other mW of Clod,inabft to obtain materials or schedule work due to delays caused by ha�meowner's sdectian process or chs r of orders, and/or faihma of h w mens to make timely payer as agrWd. B. Mind PVUW dtall be upon the offt haeneowoar. The parses agree t6attbe issuance of a certificate of occsipaacy shall be the objective standard that the conftd has bei completed and the parties are satisfied. Any punch fist items shall be rednmd to writing with a duet for oomple&a UN parries agree that to esmow will be held for pub Fiat it=& 3 C. LgW p I Deus — sbaald the homeuWW fOR W pay the conftacW m *e mom as aVV4 the ooaftector shall be aditled to stop wodt imp paid in adMm to Wfmg an d Aqm ink go pudog of a meds Bea on the p xvaiy to obtain paymoz Any hft WYmmt Wcaam at the fade of 1.5% per mona. Hommomer.Wm tv pay�olledion com end WomWs frees fins any pa moats due but not paid inadme yammm D. loulimp —C,c mundwapmto p vvideev de=oflie Ws,wwoddua's conmprnaation, and odm risk ismoea Owner a�+ees�u pavide onP9 oflsssa+d is as is required by odor to waa&NO poluaeL Ownw.. Cor: Nom:lhestmorwofda, 4*6*soor Wome ofarporam to alaernase awe reaokalon by the coxftrtor. The ammw may bairn* Apm maklm em wh"data we*n is Mt separa*bypoftL DONOTSKNTMCONTRACTNIIIIII B ABSANY SPAC. Y owe Dde Daft Owens Date Comer Date NORTH Town of Andover No. _ -C% -a o — o dover, Mass., COC MICMEWICK V ,9S°RATED � 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System r BUILDING INSPECTOR THISCERTIFIES THAT-- ..... .............................................................. ..J.�-�V...................................... Foundation has permission to o"Re.0.4.0.61 ( buildings on. 46.04 S � Rom to be occupied as WIPA.fol 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 relatin to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. q S& PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough A..W W.- ....... .t. ........................ 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. Burner Street No. SEE REVERSE SIDE__Jl Smoke Det. Location d C��I�i,STTF` Gt . No. 6",460 Date cf 2 6 1 / ` TOWN OF NORTH ANDOVER , 3 o 9 i +_ certificate of Occupancy $ sA�MUsE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ s Check # 4 Building Inspector NORTH Ot , ao a,h0 9 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ACHO I Permit NO: y / Date Received: Date Issued: —V,�,/� IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNERi✓> Print MAP NO.: PARCEL: 3V ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE Reside tial Non- Residential 0 New Building 015ne family 0 Addition 0 Two or more family ❑ Industrial 0 AI eration No.of units: epair, replacement 0 Assessory Bldg 0 Commercial ❑ Demolition ❑ Moving(relocation) 0 Other ❑ Others: 0 Foundation only ,•t DESCRIPTION OF WORK TO BE PREFORMED // > Identification Please Type or Print Clearly) OWNER: Name: –moi/>✓ % �� Phone: Address: 1131 CONTRACTOR Name: !�'U �� ✓~G ' �d' Phone. 1)0 � 6 7yN Address:Supervisor's Construction Construction License: I��o Exp. Date: Home Improvement License: /.��'�"7 Exp. Date: a� ° ARCHITECT/ENGINEER �� Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$115.00 PER S.F. Total Project Cost :$ 6 ,�'�a °� x10.00=FEE1 Check No.: 2/iS Receipt No.: Page Iof4 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 J- Building Permit Application ❑ Workers Comp Affidavit u--"Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑dopy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ 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 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 Doc:INSPECTIONAL SERVICES DEPART NIENT:nPFORN105 I'a^e 4 o1'4 TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art I Swimming Pools Public Sewer Well ❑ Tobacco Sales ❑ Food Packaging!Sales I Permanent Dumpster on Site �_� Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fiend Signature of Agent/Owner �� Signature of Contractor Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING&DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature&date Temp Dumpster on site yes—no— Fire Department signature/date Building Permit Approved and (sued by: Page 2 of 4 Building Setback Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq.ft.: I NOTES and DATA—(For department use) j Page 3 u f 4 Doc.INSPECTIONAL SERVICES DEPARTMEN CBPFORM05 l lyre;t't AW.h n._pf ib , f NORTH Town of Andover p ,. V No. y z = dover, Mass., q 2.1410C. T 0 AA _E I� COCHICHEMCK V 7�ADRATED �`s E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.. �.V1.r.0... ................. Foundation buildings on../;V .. ....... ! g has permission to erect.................. .................... g `�f/...... � .......... Rough Chimney to be occupied as.......�/ .....I`� ....� ....... .t.I�.�d�1.�.�.................................... ...... ........ y hprovided that the person accepting is permit shall in every respect conform to the terms of the application on file in Final is 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 /0" PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T S Rough 14; 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. Burner Street No. SEE REVERSE SIDE Smoke Det. PROPOSAL NO. P0604 DATE: 4/8/06 TWOMEY& LEGARE CONTRACTING, INC. Building& Remodeling SHAUN TWOMEY Kitchens - Baths- Custom Woodwork DOUG LEGARE (978)685-7417 Complete Interior/Exterior Carpentry (978)556-1.947 j NAME OF OWNER: Kevin&Heather Dolan ADDRESS OF JOB: 130 Bay State Road North Andover, MA 01845 TEL: (978) 686-4562 DATE OF PLANS: NONE We hereby submit estimates for: Replacement Windows 1. 11 New Harvey Replacement Windows with Low E and grills (Between glass) 2. Remove old windows and storms 3. Remove old metal trim and replace with new vinyl coated metal coverage 4. Install new windows - chaulk and insulate 5. Dispose of all old material Material &Labor $5,560.00 Deposit of - $2,500.00 Balance of $3,060.00 due on completion * Interior touch up paint by Owner We Propose hereby to fiunish material and labor-complete in accordance with above specifications,for the sum of: ($5,560.00)dollars Payment to be made as follows: Deposit of$2,500.00 Balance of$3,060.00 due on completion All material is guaranteed to be as specified All work to be completed in a workmanlike manner accordingto standard practices. Any 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 strikes,accidents,weather or delays beyond our control. Owner to carry fire,tornado and other necessary NOTE:Tbis proposal maybe withdrawn insurance. Our workers are fully covered by Workmen's Compensation by us if not accepted within 29 days. Insurance. Acceptance of Proposal - The above prices,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:_ ,� i- �P / � signature l BOARD OF BUILDING%R -' License: CONSTRUCTION S d � Number: CS ' '067560 Birthdate:10/25/1966 Expires: 16/25/2007 Restricted: 00 SHAUN M TWOMEY 61 PATROIT ST N ANDOVER, MA 01845 fCommissioner R.�io�u�rw�rufeall/t.o�✓t��aJ�a�usdeC� Board of Building Regulatlons and Standards FIOME IMBROVEMENT CONTRACTOR - Registration: 136779 Expiration: 812612006 Type; Partnership TWOMEY+LEGARE CONTRACTING SHAWN TWOMEY 61 PATRIOT ST. N.ANDOVER,MA 01845 Administrator