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Miscellaneous - 134 GREAT POND ROAD 4/30/2018
134 GREAT POND ROAD / 210/037.C-0006-0000.0 Location✓ y -- -�1 No. C�//) Date N . 701 TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ _ • , ��s"""°•'t�' Buildin /Frame Permit Fee $ s�c14 9 Foundation Permit Fee $ Y Other Permit Fee $ TOTAL $ �-���• �'�' Check # 15932 Building InspeG TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIJ RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s'�',f ) t BUILDING PERMIT NUMBER. DATE ISSUED. X SIGNATURE: Building Commissioner/I to Buildin Date SECTION 1-SITE INFORMATION 0 1.1 Propert Address: 1.2 Assessors Map and Parcel Number: 17 C Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record / ,r Aae SBD�S�I Q�^ /j y ldI�� Name(Print) Address for Service: 7�=to - 7SSo Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Z M Signature Telephone 9 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ��Tean Licensed Construction Supervisor. C S © ��L License Number 11 Address 7T— 7 y37f's Expiration Date 7 aaa. F xP asap ign re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company N e V 110.96 M 3 Y ti Registration Number r Address 7 ? � J o2 - 1113 7 6 Expiration Date nz §KgnaZe 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.......❑ No.......❑ SECTION 5 Description of Proposed Work(check au a iicable New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ J Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 3;00 0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X tbI 4 Mechanical HVAC 340 5 Fire Protection 6 Total 1+2+3+4+5 O(Ja Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _T i, MAIN F' Do S ha r as Owner/Autherize&-Agent of subject property Hereby authorize (;("y TE w to act on My behalf,in all matters relative to work authorized by this building permit application. `I-3o-oz Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, PAX -S PAZ 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 4 PARK F Bos HA,-L f Prir�y�Ine —Signature of Owner/A P ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DMIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY —IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE .spa V" 1 b Y ► FORM U - LOT RELEASE FORM ja-f - oZ INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. f *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT �u,K Te�el� PHONE 7r- 7-2-y3 7G LOCATION: Assessor's Map Number 3 7G PARCEL SUBDIVISION LOT(S) STREET /3 41 d/t-P.� ST. NUMBER �c�y ************************************OFFICIAL USE ONLY*********************************** I REC MENDATIONS 9F TOWN AGENTS: C NSERVATION ADMI RATOR DATE APPROVED lJa'L DATE REJECTED COMMENTS �. TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SE IC INSPECTOR-HEALTH DATE APPROVED 1,67 -' 02- DATE REJECTED COMMENTS ✓f/p�J� �il Le IUc� llet`l PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm • r North Andover Building Department Tel: 978-688-9545 I DEBRIS DISPOSAL FORM i In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) nature of Permit Applicant Date I NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i i v y —�_$-.-:.-�£ V j �hP TJ49)tJ7t4Yirt�EYll�•0�,.t`Lfl3Jlli.Yt�daf�,l` - BOARD OF BUILDING REGULATIO14So- License: CONSTRUCTION SUPERVISOR 1 Number: CS 055950 B i r th d a te: 01117/1960 Expires: 1/1 712003 Tr.no: 6450 Restricted To: 00 GUY R JEAN _ 38 SUN VALLEY DRIVE ..+ BRADFORD, MA 01835 Administrator HONE IMPROVEMENT CONTRACTOR Registration 141996 + Type - 'INDIVIDUAL Expiration 06/30/94 GUY Robert jean Guy R. jean 41 Hall Street rwi8N1STRATQR Haverhill NA 01.832 04/30/2002 12:50 -97r8�5y21277551 /� ` pp�� ` AN1HDRY AND MALCOL-M PAGE 01 �CQRDm CERTI /1.[J�.l.E V F ` TY' INSURANCE OATELMMIDWN) PRODUCER 09/30/2002 (978)_373.-ifiZ3 6 -(979}521-2751-. - THIS CERTIFICATE IS ISSUED AS AMATTER- F INFORMATION NaHW & ffAL�-�.*�Y4t INC, ONLY AND CONFERS NO RIGHTS UPON THEKRTIFICATE 3 SO. CENTRAL S.T. Pp BOX S129 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR B9ABF@W, NAA-9t83S -ALTER THE COVERAGE AFFORDEMR-YTHE ROLICIES BELOW. _ INSURERS AFFORDING COVERAGE iN&UREG W Jam- Guy'Jean 1jT .. -Fes. . +NSURERA: Hanover- 111SYE"dRCB-fpRvdMV 38 Sun Valley Dr. INstrREa�B- Bradford, W-0141-s-_ rF+SUReac_ INSURER D: - COVERAGES THEPOLICIES OF INSURANCE LISTED BELOW HAY"EEN,ISS}JEa_Fo_THE MigklRE(2,NAmEFSAR0VEFOg 1H&-ppLICy PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERMOR CONDITION-OF.ANY CONTPACT_OROT14ER--DOCUMENTWITF{-RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THE-IN$VRANGE-AFFORDED By THE-POLICIES DESCRIBED MEREWIS-SUBJECT TOALLTHEJERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGA-'E-LIMITS'SHOWN IMAY_HAVE_aESWRE9UCF0gKPAID-CLAIM&_ INSR TYPE OF INSURANCE _ POLICY-NUMBER PO Y EF--- POLICY EX IRATf0N _ D DATE I IWDD LIMITS GL-1'IERAG LMBkITY - Ov1$f�QQ� EACH OCCURRENCE i 1.000.-00 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one INe) E 50,00 CLAIMS_MADE.. OCCUR .DEXPTMynncAewon) 3 5 0O A . PERSONAL&ADV INJURY $ 1 000,00 GENERAL AGGREGATE $ 2,000.00 GEN'-AGGREGATE LIMIT APPLIES PER PRODUCTS•COMP/OP AGG E 2,000,0 --POLICY PRO-JECT kOC AUTOMOBILE LIABILITY AMN615ZS7400 ANY AUTOQS 2002 05/04/2003F COMBINED SINGLE LIMIT - - - / (EB eCCidenl) S ALL OWNED AUTOS -. SCHEDULED ABODILY INJURY S A X AUTOS (Per person) 100.0 0,0 X- IIIRED.AUTOS. BODILY X NON-OWNED AUTOS (P-acc INJURY E (Per,7CGldeni) 300.00 PROPERTY DAMAGE % - Tc,accloenl) 100.00 CaR7cGE>rIAgRITy k0TO ONLY--EA ACCED1 NT E ANY AUTO OTHERTHAR EA ACC $ AUTVONLY;. =AGG S EXCESS LIABILITY FAGH_OGOURaFti E S ..ETCH OCLAIM6 MADE .- - - AGGREGATE ] S E QFOUCSIBLL - E RETENTION $ W111'819S.G0I p12mTL_ONAMD. .... -=- -- - - -- - -. S - .EMPLOYERS'LWBILITY � � - _ [TORY LIMITS - ER _ E.L.EACH ACCIDENT $ E.1.QISEASE-EK EMPLOYEE S 0-TNER- E,l,DISEASE-•POLICY LIMIT S 7ESCRtPTION OP OPERATIONS)LOCATIONSNrHICLEvpYrl 1%IONS.ADpFp_BY-ENDORSEIMEfMSPEEIAtPROVISION$ _ 'ERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER CAId CELl1lTlON SNODUMAN-Y OF THE AROVF-DESCRWEO POLICE$BE 471N. ELLED BEFORE THE - •w EXPIRATION DATE,.THEREOF,_THEISSUIN4COMPANY WILL ENDEAVOR TO MAIL DAYS-YYRITTEIPNOTICE-1 Q-THECERTIFICATEHOLCER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE.NO OBLIGATION OR LIABILITY Ambve-WrThTtef- ZfifiSTWt0r- OFAW"W`1}UPON TNECOMPANY�IFS_AGENTS OR REPRIPENTATNES. Andover, MA AUTHORIZED REPRESENTATIVE R�edl�iC[r[Aar?cal Ilr 3r./$I t1�1Fd /N tr ICORQ29a{747)= 0AC0RD-'COIEP0RATI0PF198& a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations oW� Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name ZCa�a A,jPlease Print Name: Gy Y Te-0,1 Location: 3,P' SUn d�/le-X �O)- City GCDr'c�c��P I�JZcc� �/�35� Phone # 7,?- 372-50 ✓��6 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity i I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone#: Insurance.Co. _ Policy# Company name: 46y e �d��',,S Address 2 City �s'Gt %or°G� �l Cc Phone#: Insurance Co. Poflcy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment_as_well_as_civil penaltiesinfhefmn-daSTOP.WORK-ORDFR.and..afine af_($1,00M)-aiday.againstme, I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date /i/ ° DOR 2 Print name �� ?� /Z re A 1007 Phone#975K3 .>(Q Official use only do not write in this area to be completed by city or town official' City or Town PermNUcensina Building Dept nCheck if immediate response is required Q Licensing Board C] Selectman's Office Contact person: Phone#. Health Department Other GUY JEAN BUILDERS 38 SUNVALLEY DRIVE HAVERHILL, MASS 01835 TEL: 978-372-4376 PROPOSED CONTRACT To: Mark Boshar Date: September 30, 2002 134 Great Pond Road North Andover, MA 01845 978 682-7550 Renovate existing screened porch Replace screen units and columns;resurface ceiling;repair foundation and slab as needed; install lighting fixtures ESTIMATEDFEE.............................................................$35,000.00 uy an Guy Jean'Builders 4du �a — Mark F. Boshar R� .'!�".. " ,. t �,"'f,.~. moi. tiv.�b f• "'+Y4s •K i a Page 1 of 1 ki � 9 ZTNAu," r f Y i . C i r} R+ A. `4, , 1 F "` fly � t I 2,O d� f (v r p 97J'-Gia -7b 6e-V (l7- file://C:\WINDOWS\Desktop\DCIM\100MSDCF\DSC00029.JPG 8/30/02 Page r� 7 ro ! b• 1 It I • • I 11 / I 111 ' 8/30/02 Page I of I F P-� t' pA 4• file://C:\WINDOWS\Desktop\DCIM\I OOMSDCF\DSC0003I.JPG 8/30/02 Page t IWO 4� file:HC:\WINDOWS\Desktop\DCIMIOOMSDCF\DSCO0028.JPG 8/30/02 interior doors, wood doors, storm door Page 2 of 3 Easy-Change ULMIL Wood Combination Doors are beautiful alone or easily Victorian II Victorian III Chippendale Prairie Designer Grille customized with a Ultra-Vu Grille Grille Grille Grille Ultra-Vu decorative or designer grille. Customize your Traditional M or 450 styles with these grille designs. The Easy-Chang Door is Timeless! Prairie Montello Designer Traditional#1 Traditional#50 Grille Grille Grille Easy-Change Wood Combin An Easy-Change are beautiful alone or easily Door is with a decorative or design handcrafted with precision and LM pride. --- -- Oak Ultra-Vu #50 Circle Top Sidelight Storm Three Season Rooms - jj r The Easy-Change Door is an easy way to increase the value of your ' home. Quick changing storm & screen inserts create beauty and ccmfor Details on 3 season rooms. http://www.combinationdoor.com/combdoor.html 9/20/02 combination door designs, wood doors Page 1 of 2 ' f AfzlE r #$ � � ' s oit � } Let the summer breezes flow ' - through r the autumn sun hine - z; k , Iwarm your three season porch. Easy-Change wood _ 4 Easy Chane combination doors provide the + its 1 i �� I Comb,nationoors flexibility of quick changing t 3 Season Rooms storm and screen door inserts. ,- � Beauty& Flexibility Quit swatting flies and L.C. Schmidt mosquitos and turn that deck Si nature Door Series into a usable room. Knotty Pine -A new boki - Unlike metal doors, the wood construction gives you the freedom to Grate Top finish your 3 season room in any range of colors to fit your decor. Doors Choose from a wide range of door and grille designs. Whether you have woad" an 1800 period Cape Cod or rustic lake home there is a design to Screen Dacrs complement your home. ;r 8re+e.=.arcwy'rr,.,.�nw�•g,,-- 4fsm"``== Choose Your Door Design! Founded in 1912, The Combination Door Company knows the "ins andME- outs" of the storm door business. Contact Combination Door Co. Click on photos below to view a larger image. G Please review the suggested Stationary installation procedures before construction- E , r Cb e WOOD tOMBIWON ps'ORS Easy-Change locking devices lock storm and screen inserts in place. Now,a tight,rattle-free weather seal only requires a simple flick of your wrist. http://www.combinationdoor.com/3season.htn-1 9/20/02 door specifications, wood doors Page 1 of 2 �� rYx �} 3 p tXec canons 1 M s �e �tj51':: '`� g �' Easy-Change Wood Storm and Screen Doors `A Doors Grilles Doors Grilles Do Easy-ChangeDors I Combina [] tion ' 3 Season Rooms Beauty& Flexibility L.C. Schmidt R g Signature Door Series S m Q Q . � CL StandardV► �- — _ide.mt+.+.i:.•3P".ei.► 4i 0 0 J @ w R Ss is r ty Knotty Pine Sizes a Q 0 as 41 Q o > > 0IA P- I -A new look] - r. 2-0 x 6-9 X Circle Tap Dogs 2-0x7-1 x x 6-9 X X X X X X X X X X X ..,,. ... wood Screen Doors 2-6 x 7-1 x x x x x x x x x x x 2-6 x 8-1 x Choose Your Door Designl 2-8 x 6-9 x x x x x x x x x x x x x x Contact 2-8x7-1 x x x x x x x x x x x x x x Combination Door Co. 2-8 x 81 x 2-10 x 6-9 x x x x x x x x x x 2-10 x 7-1 X X X X X X X X X X y 3-0 x 6-9 X X X X X X X X X X X .1 X X X 3-0x7-1 X X X X X X X X X X X X X X '^ 3-0 x 8-1 X 1,4 M Ok/l �pDr 3-4 x 6-9 X $5101 3-4 x 7-1 X 3-6 x 6-9 X 3-6 x 7-1 X Layout Stile 4-1/4 4-1/4 4-1/4 4-1/4 4-1/4 ' 4-1/4 4- Top Rail 4-1/4 4-1/4 4-1/4 4-1/4 4-1/4 4-1/4 4- Middle Rail 4-1/8 4-1/8 4-1/8 4-1/8 4 Bottom Rail 6-9 9-5/8 9-5/8 9-5/8 1 1 1 9-1/2 9-1/2 9-5/8 & 7-1.8-1 113-5/8113-5/8113-5/81 1 1 113-1/2113-1/21 1 1 1 13-5/8113 Maximum Trimming . Top Rail 5/8", Bottom Rail 24/2", Stiles 1/4" ,. Stile trimming beyond 1/4" could expose core stock. If initiated, trimming 3/4" is permissible. . Custom sizes are avilable in various door and grille designs. . Circle Top Doors are 5/8" oversize. http://www.combinationdoor.conVdoot�_specs.htn-A 9/20/02 pilasters &columns 1 Page 1 of 2 Pilasters & Colums j Page 1 2. 3 Product Code: PPI101 5 Fluted Pilaster F A P�w Width: 157mm Height: 2880mm Depth: 50mm f Y M ° COMM Product Code: PPI102 10 Fluted Pilaster , Width: 307mm Height: 2880mm Depth: 50mm { http://www.classicaldesigns.co.uk/catalogue/pilasters%20&%20columns l.htm 9/16/2002 NORTH Town of E Andover No. V O dower, Mass., O �O T +- L A COC MIC w C�� ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR R THIS CERTIFIES THAT.......... ...... ..�.......�.............. ... ..5.... .�.. .......... •••••. Foundation .............................................. has permission to er1.... �......... buildings on .....13 �� ~ ..... ............ Rough .......................................... to be occupied as.. >K�.b....I~. S.Cr'�'�N....... .f��.�!�..... v ... ..... �..�............. Chimney provided that the person accepting his 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 tot Inspection, Alteration and Construction of Buildings in the Town of North Andover. 31 C A, Xt3foO �� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough .......... ... .. .. ... ... .. ............. ... Service UILDING 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. PLAN OF LAND IN NORTH ANDOVER, MASS. OWNED BY MARK F. AND MICHELE C. BOSHAR SCALE: I"=40' DATE.11/22/2000 THE ZONING DIST. IS R-2 DEED BOOK 5728 PAGE 118 LO13' 3353113 N NDCOUR�P� (!1 0"E � N 12205,8 mE N 12°49 oo'� 20.00'' z 31' N P�6#5�$$S.F L w O N � .1 p O Oc G N N o G3� � D.H-FND. o 0 Lo co � m n D - r C7 PORCN EXIST. HSE. z FND- �. #134 c0 + N' S 7501,10011 50' W 225 50, RoAD D.H.FND. .., pO ND GREAT s� 38� AES // Z7i ZED Location �3 �loll Pa (` ?0-."w R j No. 18 S�- Date '?-30 —02- TOWN U2TOWN OF NORTH ANDOVER # s • ; , Certificate of Occupancy $ CHUSE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� Check # � t 15903 << -�- ` Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING u y BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: Building Commissionen(InEeector of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: l f. ,l gefxi—, A .-I -1 3 /?(2- 4:!�- Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone 00 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number : mn Address Expiration Date Z Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name G I Registration Number r Address' Expirat n Date /y Signature Telephone !�/ SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) ' Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all a hcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify G t✓ AL3 Brief Description of Proposed Work:: y D ✓l 9a � v A/� .�„v-�-.v u.-a..�./� �' �., S ,�rvr��'�►. r ri✓ /moi' �+-e� G���.�,•�. �r/ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant ; 1. Building 4�eF, At (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (b) �o 4 Mechanical(HVAC) �- 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date –SECTION7b OWNER/AUTHORIZED AGENT DECLARATION I, "-- �S � i� ��/�L`''� 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 J � Si ature of Owner/Agent 'Aate NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 RD SPAN DUVIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date. NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i Proposal R. Belanger Roofing, Inc. 1278 Bridge Street Dracut, MA 01826 (978) 454-8918 PROPOSAL SUBMITTED TO DATE PHONE �2, .. ��'/� "► ��J C T ATE Alp 21Pf r JOB LOC ,/� A �� WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: ��try i f/ �1/f l'f/t"'^� /�d2•c h ' i�>�'k' t2i�./ t Lc t r Ve PrDpatSe hereby to complete in accordance with above specifications,for the sum of: 1 ��-'"� dollars ($.., V Payment to be m de as foll is IF fi',.-tz Z' f ��1-y'�/I'� '�'%�' �}�t�f `-� l�Ii�� .• . '� t%lsllr �l i All material is guaranteed to be as specified.All work is to be completed in a work- Authorized manlike manner according to standard practices.Any alteration or deviation from Signature specifications including extra costs will be executed only upon written orders,and will Note: This proposal may be become an extra charge over and above the estimate.All agreements contingent withdrawn by us K not accepted within days. upon strikes,accidents or delays beyond our control. Acceptance of VropogaI-The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as Signature specified.Payment will be made as outlined above. ° Date of Acceptance Signature Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 120131 Expiration: 10/22/03 Type: Individual ROBERT R.BELANGER ROBERT BELANGER 1278 BRIDGE ST pRACUT,MA 01826 Administrator ED � Town of And No. ~ dover, Mass. 3 AORATED PC5 S 4 _ BOARD OF HEALTH PERMIT D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... K ��..�................. ................. ................�........................ ............................... .... Foundation ,S. Aft /3 Y G/�� � Rough has permission to erect.. ...... buildin son to be occupied as �rp0 « , ~ .. .......................................................... 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- ws rel in to the In spe tion, Alteration and Construction of Buildings in the Town of North Andover. it q&l 000- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids thisterrnft. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST S ELECTRICAL INSPECTOR CRough ...... .. ... ..A Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. HN2 2323 Date..-~� .. ....... HORTN TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING IW ,SSACNU`�� This certifies that .. %J..0 x..................... 3' r ... .................................................. has permission to perform .._. ..:....:.:::.:- f--................................................. wiring in the building of.....a.. :�'/........................................ at............ .......... ........:................... .North Andover,Mass. Fee--.4 Lic.No.............. ........:_..<./` :........................................... / ELECTRICAL INSPECTOR Check # �'EQ C WHITE: Applicant CANARY: Building Dept. PINK:Treasurer TLIECOMMONWF.4LTHOFA14SS4CHUSE77S Office Use only DEPARTMENTOFPUBLICSAFM Permit No. ,'1J3,�3 BOARDOFFIREPREVE TIONRWUL9TIONSR7CMR12-00 Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 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) �.,Lf ��ie�. �— �� cf Owner or Tenant 9 C"CiN li, Owner's Address 3 a vtti C- _....._. Is this permit in conjunction with a building permit: Yes® No a (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Ampsi/ Volts Overhead Q Underground ED No.of Meters New Service Amps` Volts Overhead M Underground Q No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Ce de % G- 9,a*iL(rVk"1 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures c2- Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.ofRangcs 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 Nry of Dryers Heating Devices KW Local Municipal a Other Connections No.of Water Heaters KW No.of No.of Si s Bailasis Hydro Massage Tubs No.of Motors Total HP OTHER. irstrxtceCo� Pl>tsuartblheragtmattalrs�GmaalLam iha%eaomatLdAtyha==Pd ymdudrtgCanplete CoAr,Wc'dssksmnfalegiviiaR YES El NO Iha%esubm*dvdWpoofofsmnebthe0ffm YES M NO o IfjouhawdvdaadYFS,pk=ff*thetypeofoomr,g<bydrada<gthe Na ANCEU E] BOND OUTER (Pl mSpeC9fy) ExprtaUrnD& Esters VakXdP=ftX lWak$ +WO&IDSlart —G� InspaWmD*Ra1jesWd ReLo —��—c' Final Sigradutxkr'fi%r esofpetjtey ^ Lk=Na -7fFIRMNAME e� ^ �P;f�r1. Ltl4YI -e Sigr�Orue � Lioa>seNo I mo' �• +� BwirxssTd.Na faCJ Glob/—a`18� Ate__ PAD�� OWNER'SINSURANCEWANEl2;IanmmthattbeI�o mdoes� GazdLam andiatmy ecnftpamitgVka ionwaiMthsFMM*Mnlnt (Please check one) Owner Q Agent Q Telephone No. PERMIT FEE$ _� No 2375 Date...........o? .. .... ...... Noar►, °f<�``°:• '"° TOWN OF NORTH ANDOVER oL p PERMIT FOR WIRING ,SSACHUSE� Innis certifies that ............................................................................................. has permission to perform ....:.f. �^•-- ............................................................................... wiring in the building of . ..................... .................................... / �`=' �.................. .North Andover,Mass. at..... 5'..... i Fee...... ......... Lic.No ... ..... . ...... ........................... ✓ ELECTRkA{:INSPECTOR L - v Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer (� The Commonwealth of Massachusetts Office use only 3 7� Permit Vo. t� d A Department of Public Safety epQ b Fee Checked occupancy D �C BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK i ' All work to be performed In accordance with the Massachusetts Electrical Code, S27 CMR 12:00 (PLEASE PRINT IN INR OR TYPE ALL IN /JFORMATION) Date j c3OD� City or Towu of ,1,J,27 ,f%r To the Inspector of Wires: The undersigned applies for a permit to perform the electrical Work described below. Location (Street S Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building ���� i Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters I New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �ecc or-1i; Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In- No. of Lighting Fixtures Swimming Pool gznd. ❑ grnd. ❑ Generators KVA No. cf Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units � II No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Heat Total Total No. of Sounding Devices No. of Disposals Pumps Tons KW No. of Self Contained i No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipaln❑Other k,No. of Dryers Heating Devices KW Local 1:1Connectio No, of o. o Low Voltage No. of Water Heaters Si ns Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO ❑ I have submitted valid proof of same to this office. YES❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ® BOND ❑ OTHER ❑ (Please Specify) Expiration Date Estimated Value of Electrical Work S Work to Start Inspection Date Required: Rough Final Signed under the penalties of perjury: FIRM NAME AMERICAN ALARM A C MMUNIAT LIC. NO. 1,2t gr LIC. NO. Licensee RTf'HART1 T CAMPSQ11j Signature Bus. Tel. No. Address 7 CENTRAL STREET ARLINGTON MA 02476 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage ori is sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this p ermt application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S 3 Signature of Owner or Agent Date. ° 44A ".O bT:�� TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING '4 �O+�reo��•�<h ,sSACNUSf , r This certifies that has permission to perform . . . . . ,ff �.- :. . . . ..±� �. ' plumbing in the buildings /of . .... ,/.. /. . . . . . . . . . . . . . . . . . at . North Andover, Mass. c ' e�/ --OCUTAIIl Li INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date ' Building Owners Name Permit# unt Type of Occupancy New Renovation Replacement Plans Su Yes No FIXTURES , w .., C. w CX w SLBIB BASEWC 3�II FID(R .. 3M KLM 4M KBM SIS FLaR 6I ROM v 7MFLOCR SIFT ROCK (Print or type) Check one: Certificate Installing Company Name Corp. Address �1� /ZL �-� ZurltwJcA� A&A Partner. Business Teiephone?W—Z'f1 0 (( R Firm/Co. Name ofLicensed Plumber. Q� -r' Mr► 6�rl4 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boac Liability insurance polity ® 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 t three insurance i gnature Owner Agent E] 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 Mass efts Staff b' Code and Chapter 142 of the General Laws. By: y1paure 37 Licensea VIM= Type ofPlumbing License Title 4 Cigfrown License Numver Master Journeyman APPROVED(OFFICE USE ONLY .. � .� �_. {h�'.r"ht s'e -"'.;� .. �..#ter^�a:�•� -- ••-.. _ ^. Location 13!j 4-2t:1T l (�N> No. X43 Date MORTM TOWN OF NORTH ANDOVER .=ZAM6iVAbL toA Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ CHust Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ _ TOTAL $ �� v ' Building)) or WTO 8024 Div. Public Works PEWMIT NO. IA-'2- A-041CATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 x MAPh40.3 7 LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. LOCATIONt r, x cin A PURPOSE OF BUILDING t OWNER'S NAME -� ,1e�� C NO. OF STORIES _+-+I I SIVZEtA'VL F+ _ FJ•Y/\ ' OWNER'S ADDRESS +, C, VLS BASEMENT OR SLAB b ARCHITECT'S NAME S�� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN -- DISTANCE TO NEAREST BUILDING , 1 DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-`SIDES REAR " GIRDERS AREA OF LOT FRONTAGE �1�1�� O HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW t✓ �'S SIZE OF FOOTING X IS BUILDING ADDITION d MATERIAL OF CHIMNEY IS BUILDING ALTERATION Y' s--s r.7v� , IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODES` IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION On��J -iz ,tje LAND COST SEE BOTH SIDES �, •1 fltiS �.s �� N EST. BLDG. COS /iC EBT. BLDG. COST PER SQ. FT. PAGE 1 FILL OUT SECTIONS 1 - 3 � Z•r�V 1 dN•�� EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH 81 E F OWNER&AUTHORIZED AGENT FEE J PLANNING BOARD PERMIT GRANTED / I 19 ��0 � _ :5 BOARD OF SELECTMEN it rt- OWNER TEL.# CONTR.TEL. BUILDING INiPECTO - dl°G CONTR.LIC. A BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I KICF RIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY ICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 I 2 I3 CONCRETE BL K. PINE BRICK OR STONE P —_ —— PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ 1/1 1/2 3/, FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 22 f 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"J D _ ASBESTOS SIDING COMMGN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR I_ 1 BRICK ON FRAME CONC. OR CINDER ELK. ! STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE 1 NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING / WOOD JOIST PIPELESS FURNACE V FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM , STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING �� J Town o Go Andover TIN 0 No. 343 3 11�NT LAI o dover, Mass., COC MIC HE-C K CRATED P9 9- C-) S 1l BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D 'b 4. • 4 BUILDING INSPECTOR ...............Ilt ............................................ THIS CERTIFIES THAT Foundation Rough has, permission to mW.....h!l� ........... buildings on .......t.3.9 .....GW6.*T....100M-1� .....a..4.0. q 'b to be a c c u p 1 e d a s %r s ... .(.AwT,--r#;.Aft) Chimney ............*MOV4T too..... ft. . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 TAONTHS (_"_I"A.B:FS ELECTRICAL INSPECTOR UNLESS CONSJ Rough &�.�Z.................. 4........................... Service BUILDING INSPECTOR Final Ocaq)ancy Permit 1�equiwd to Occi.ipy .Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT fr "/ upSl��� k _ lava Opp ' ]„ L 1 Ts M*VK;p 20 E S cm i V661 9 l d3S f Location /3 J f No. � � Date MORN TOWN OF NORTH ANDOVER � s • y Certificate of Occupancy $ c Building/Frame/Frame Permit Fee $ � swcHust 9 Foundation Permit Fee $ ° Other Permit Fee $ TOTAL $ Check # `' "711 130737 building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER DATE ISSUED. ._ SIGNATURE: Building Commissioner/1for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 3 Lf G az e7n i D 3 7` Com` lI Map Number J Parcel Number ` 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District , Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS KS B Front Yard Side Yard Rear Yard Required; 4--,ch Provide Required Provided R 'red Provided z 1.7 Water Supply M.G.L.C.40. 54) : 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private r❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of RecordT i (� i J C.���� j G .r -�. P!z f4 A YU U-5 f.3 Y G r;t FT'4 QO it D l�tY Kame(Print) Address for Service A3 a-- Signature Telephone �!/} 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 1 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ ensed Construction Supervisor: l� /0 t q��S 11'741W //4 License Number Address le - Qdc �, Expiration Date Sig4ature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 1 l A l�(9t Ti A c� ci►� C a Company Name J i!`� e q 1 p ➢ r Registration Number Address ® C (� 603 V$ )-33f — Expiration Date A� Signature Telephone G) SECTION 4-WORKERS COMPENSATION(NLG.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 buildingpermit. Signed affidavit Attached Yes....... No...... SECTION 5 Description of Proposed Work,%eeckall applicable) New Construction ❑ ,Existing B, * ing ❑ Repair(s) ❑ Alterations( ) Addition ❑ Accessory Bldg. ❑ 'Demolition ❑ Other 1]., Spicify Brief Description of Proposed Work. C.—rpt v Qi a �. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be „ }FIAI,USE(?NLY Completed by permit applicant Multiplier 1. Building a BuildingPermitt Fee 2 Electrical (b) Estimated Total Cost of ,. Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC aw 5 Fire Protection 6 Total 1+2+3+4+5 Check Number « SECTION 7a OWNER AUTHO ATION 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. Si nature of Owner Date= SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, .J04YXS ,7 ��[(/� l�!(64 ,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 Nam ' Si ture o Owner/ nt Date NO. TORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BMDING CONNECTED TO NATURAL GAS LINE BUILDING DEPARTYIENT DEBRIS DISPOSAL FORK! In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector - •1 1 ,y � :T� Coa»v�na7uuerz�� o�✓t/�aau�uoe�d ;I BOARD OF BUILDING REGULATIONS °qq ` License: CONSTRUCTION SUPERVISOR 4 {y Number: CS 061748 i! Birthdate: 03/06/1946 i F Expires: 03106/2001 Tr.no: 7614 Restricted To: 00 JAMES DELLAGATTA t: 1 10 WEBSTER ST#1 �' ! ; i, NASHUA,•NH 03060 Administrator NORTH TONM Of And 0 No. ,y aW T �a o �` dover, Mass. 'V 0 K COCMICHEWIC ' AORATED P .(C�l S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 00` �` C BUILDING INSPECTOR THISCERTIFIES THAT..�.................... ...... .......... ....................................................... ...:.. .... ...... ......... .... Foundation has permission to erect... � buildings on ..........1. ' � y..... .... Rough ... ................... ........ ...... tobe occupied as...........%........ S. ....................................................................................... 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 Inspetion Alteration aB"ons1ruction of M Buildings in the Town of North Andover. 0) C PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION S ELECTRICAL INSPECTOR Rough Service BUILDING II�ISPECTOR 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. _ _ _ _ —' ► 1 Frr3 ��G L�?sS -- — — — — I�F/W c-4 ,-f o a /I/o 16 c - l ,Tortq-t' _ _ .� T'/Oer. i r r o tie r5, Gt/i¢C.L f - AJ if �� ,y �• n / ' = ;� F,► e �.�7C r 'c 0 sit') 2-.V ?i--y All— e-f- To �+J ALL p r�#i�3 1�f 77.0 i VC) Z dA/ ID 'ry L !At to �O 5b" L w � Af tia1 a 1/ipu . ...-_ .. i_.._.-... � _. ..__ .� 3 A L L pct . t`, - Ca, , , C ,IC 1 j ,�t �.,f/ 5 /� .— i - r S i �J Z-f1! • / .5 .a" r ..i 'w _,�/ c I A/I A .�i �R s -�'4 �j A 4238 Date... t' - '9 NONT►� <�``°;• ° TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING �,SSACMUSE� CI This certifies that ..P .4.... ...... ......... ................................... b has permission to per ......16,z-1....... ....... . ........ .................................. wiring in the building of....... . ............ ..... ........................... ��,// at......1.. . ./.... .J ra. d....... .. ........ . ,Nort��.dr Fee., vU.... Lic.NoA�� -3......... ..................... ..... ELECTRICAL INSPECTOR Check it d THE COMMONMALTHOFAMSACHUSETTS Office Use o I DEPARTMENTOFPUNICSVE7Y l � BOARDOFFIREPREVEN770N Permit No. It'�sGUTAT70NS527CMIZI2(XI Occupancy&Fees Checked Al'PLICATIONFORPFRMIT TO PERFORM ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 /J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 66G 4� Town of North Andover To the Inspe for of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 341 /i 6�-• ct' Owner or Tenant +.- Owner's Address__ %off rea f �✓� �� Is this permit in conjunction with a building permit: Yes No ED (Check Appropriate Box) Purpose of Building ; D ,-e � � �rC(SSP� Utility Authorization No.Existin Service /DD Amps/...10 ��— Overhead121 Underground No.of Meters New Service - Amps ps / Volts Overhead Underground No.of Meters Numbe;of Feeders and Ampacity L.ocati i and Nature of Proposed Electrical Work j^e �i �f - t 7. . No.of Righting Outlets "' No.of Hot Tubs No.of Transformers C�i/iN �_.. Total No.of Lighting Fixtures Swimming Pool Above Below KVA Generators KVA round round No.of Receptacle Outlets f 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 Pum s "—Tons KW Initiatin Devices No.of Dishwashers Space Area Heating KW g No.of Sounding Devices No.of Self Contained No..*)f Dryers Detection/Sounding Devices H t eating Devices KW Local Municipal Other ���' No.of Water Heaters KW [:3Connectio No.of No.of ns Si ns Bailasis No.Hydro Massage Tubs No.of Motors Total HP ''.OTHER ftU=IceCoWrdg--PW=lDt WWWnaZofMassWhuSe C=ffalLaws [havtaanxm2d abllityu4oftmrtDymchlchf_yES ]efE COmageorits alCgnvaieM YES NO [havt sttbrrrittedvalidproofofsametothe0l YES � lfyouba� cbwked gdr box YES p)eaen>dir thetypeofwvaageby NSURANCEE BOND 011E 2 0 (pawSpecify) /01/1Z CS P Eq*aficn Date Esro�rlated Vahle �Da io 7/1Z vgr&d St?dndcr ""o? D hispectionDa>eRe ZW Rough All& C' � 6 A.)/'// C grledurxler�iets pajucy. IlZMNAME / LimiseNo. IS6c)34 icansee PA uP vI I.P Signature ` A LicermNo �3 )vZ � // jJ BusirmTelNo. - a�6 ` t.2�dfgstxotf-- r f �C �va�t 1rJ rdt / Al TeL No. -3 WNER'SIINSURANCEWAIVFR,lam awatethatthetheinuuanoeco -eoriN&ts=U vabtas 8 ri that si ret)tlnecl byMassachus�ls General Laws my glatweonthispemmappfi�thisrecptirerrgrtt ,'lease check one) Owner Agent Igna ure ocaneTelephone No. PERMIT FEE (� r or gen The Commonwealth of Massachusetts r d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: /�J,e L !/i, C,e Location: SIt Al CityrGtOt f��f'O�. Nom' Phone # 9 70y� �y I am a homeowner performing all work myself. 90 I am a sole proprietor and have no one working in any capacity Yw I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance.Co. Policv# Company name: Address City: Phone# Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment_as_weU_as_cixiLpeflaltiesinlhefnm da-STDP WORK_ORDER.arid..a fine_of_($1DDM)-ariay.againstme. t understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. !do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Ay_ Date Print name /z71� f �� Phone.# ic;?3o!!� Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check it immediate response is required Licensing Board E] Selectman's Office Contact person: Phone A � Health Department Other i ri `Dv :r's License' `04'23=66 04-23& M 6 00'iD 53086,4444. i5ate 6f birtH Expires .' ex. Height Class Numl5er PAULA 49 SUN VALLEY DR' " BiiADE'ORD, M4 P 0953E-8237 � ry f � 1� i C:OMMONINEALTH QF MASSACH'USETT$" OF .ELECTRICIANS "EGtSTERED MASTER ELEC1'.RI;CIA-N- Y ISSUES THIS:LICENSE TO t PAUL A BELL VI LLE'. 4'9• SUM: 'VALLEY DRIVE m BRA'DFOhD , MA 018'35-823.7._ 15623 A` Y 07i31iO4 363669, Fold,Then.Detach Along AII.Perforations R Date.. . !.-g. . ... . /1 °F 40RTH 1ti0 TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION h ISSA MUSEtS This certifies that . . .,f 1//'° . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . Z#,.Y. `P. r . . . . . . . . . in the buildings of .V� °. 1 r. .�(. . . . . . . . . . . . . . . . . . . . . . at . . . 3 y . . G ��. . . �'". . . . . . . . IN rth A dover, Mass. 1Fee. . . .v. . . Lic. No.) 5. . . �. .�t. . . 2 GAS INSPECT6H Check# 5� � i 44 ; 3 MASSACHUSETTS UNIFORM APPLICATION FORIPERMIT TODD GASFITTING •. ` (Print or Type) 1 `N, `= �ye ,Mass. Date 610 Per" Building Location Owner's Na /1VAlel � of Occupancy New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ Y(1) Cc 0 W to V1 cc (6U co W W W o U to w = to ZQ W f- A CC O O Z w UJ CC u1 t3 W W z- co O > W W W Q P O 0 l- Z J P Z W W O 0 > LL H 0 pJ � W. Q W aC W j Z a m O O W w 0 W F- a: = O c7 = u_ n o O U ac > o a F- O SUB-BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 8TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name Hillard PlIIm' Bina & Heatina, Inc Check one: Certificate Address 995Stedman MA p018Street Unitt 6 Corporation Lawpll �V4 ,- 1'1- 51 ❑ Partnership Business Telephone T 'S`joi d ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Cie a INSURANCE COVERAGE: I have a cu,rre t liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes No ❑ If you have c ticked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNERS 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: Si nat re of Owner or Owner's Aaent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered) in above application are true and accurate to the best-of my knowledge and thatall 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 of the General Laws. By Type of License 0-Plumber �� /j,I Title DGasfitter Signature of Li used Plumber or Gas Fitter gyp\Master