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Home My WebLink AboutMiscellaneous - 1435 SALEM STREET 4/30/2018 1435 SALEM STREET 210/106.A 032_0000.0 ��'No' 3116 Date... VtORT" 4, '66. 0- TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING u This certifies that ............................ . ..................... ....... has permission to perform ................................................. wiring in the building of ........6�................................................................. at........................... .1................ ,North Andover,Mass. / /�C)' ................ Fee Lic.Ni- 2f�72�9 . ............. o.. .... /ELECTRICAL INSPECTOR Check # �- 7 2--1 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer IL\ W Tice Use Only The Commonwealth of Massachusetts r— PerriU No. - Department of Public Safety _ Occupancy b Fee Checked--.2.1..� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12fl0 3/90 heave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE INFO ION) Date J3 - City or Town of 6AVQC To the Inspector of Wires: The undersigned applies for a permit to d&�tperformelectrical wo described o . Location (Street & Number) SQlle Owner or Tenant ! (� c Owner's Address SJ e Q J 0, O-J Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building 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 Ufa ! No, of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No, of Emergency Lighting p p J` No. of Oil Burners Batter Units No. of iSwitch Outlets No. of Gas Burners FIRE ALARMS No. of Zones 7 Total No. of Detection and No. of Flanges No. of Air Cond. tons Initiating Devices No. of Disposals No. of Heats Total Total No. of Sounding Devices Tons KW No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal 11 ❑Other Connection No. of ,Water Heaters KW No, of No. of Low Voltage Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requiremengs 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 c eked YES,-please indicate the type of coverage by checking the appropriate box. INSURANCE OND ❑ OTHER ❑ (Please Specify) Z Lem 9,Q a 4-102- Expiration Date Estimated Value'of Electrical Work $ Work to Start Inspection Date Requested: Rough Final Signed under the Pena ties of perjury: �— r FIRM NAME 6 ( 1 Q� L/ LIC. N0. Z Z C_ � Licensee a10Q<-t Signature LIC. N0.1 q q Address. /¢ avid <c,(e Bus. Tel. No. 56K-Y51 —Lllffl Alt. Tel. No. OWNER-S'INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ Signature of Owner or Agent L rn Do Not Write In Here. D c71�i� For Electrical Inspector Only M m n , Street and No. n_ DName ........................................................... Z Electrician PermitNo. .................................................... Comments .................................................... `I Location No. y�y Date NORTIy TOWN OF NORTH ANDOVER � 9 • s • � ; , Certificate of Occupancy $ ss cMuE<� Building/Frame Permit Fee $ r- s Foundation Permit Fee $ Other Permit Fee $ del TOTAL $ � Check # /6 / 14185 Building InspeeAr :- TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE; OR DEMOLISH A ONE OR TWO FAMILY DWELLING ^Y':�,� BUILDING PERMIT NUMB DATE ISSUED: rn SIGNATURE: aw Building Commissioner/I2spector of Buildings Date _oo SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWrcd Provided I Flood ood Zone Information: 1.8 Sewerage 1.7 Water SmmpplyM.G.L.C.40. 54) � Disposal System: Public ❑ Private ❑ Zone outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record An CJ Name(Print) Address for Service: 1 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Signature Tele hone M SECTION 3-CONSTRUCTION SERVICES 00 3.1 Licensed Construction Supervisor: Not Applicable ❑ a Jr tj le- Licensed Licensed struction Supervisor: 6 �t T(5 77 O C Zn License Number mn Expiration Date T mgna re Telephone I.., 3. ered Home Improvement Contractor Not Applicable ❑ �Pr � co,moany Y6e t-02 t Registration Number �+ .� ess _ Q 7/��i�a 7 7 Expiration Dates �� ^ i ture Tee hone !i SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 7ition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify t; Brief Description of Proposed Work: ' SECTION 6-ESTIMATED CONSTRUCTION COSTS Item $= Estimated Cost(Dollar)to be F' r OFFICIAL IISE,ONLY Completed by permit applicant 1. Building ^ (a) Building Permit Fee S r— Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Ovner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,,to the best of my knowledge and belief Print Name Si ature of Owner/A ent Date 1;15 91ENE 117 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 2 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DM ENSIONS 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 xAORTH lovm - of4Andover C'° LA o z lover, Mass ' COC MICMEWICK x.95°RATE° APy BOARD OF HEALTH PER T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... . ................. ............................................................. .. ....... . ........................... . . .. .. ' Foundation has permission to or Idi s on .�� . ... ..... ......................... ........................ Rough to be occupied a Chimney .. . . .. . .. . ... .. . .............. ..:................................................................. provided that the person acc ting this perm' sh in every respect co to the terms of the application on file in Final this office, and to the provisi ns of the Code an By-Laws relating to t Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR �, Rough 404,04- ........................................................1�!! .. ...................................... Service LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous -Place on the Premises — Do Not Remove Rough Final No_Lathing or--Dry.Wall To Be Done - - -- - - - - - -FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner ♦ J Street No. SEE REVERSE SIDE smoke Det. .i z..: ;. � `' ✓�zt,; �amrmrafuueall o�✓ � + BOARD OF BUILDING REGULATIONS i License: CONSTRUCTION SUPERVISOR 1 '"" • Number: CS 035867 Birthdate: 12/15/1941 Expires: 12115/2001 Tr:no: 11507 'Res rtcted To. 00 RAYMOND V BERUBE 361 CHICKERING RD . N ANDOVER, MA 01845 Administrator 1 �t,i1o��trnostamll�z ot'./f�aauz�ufc�/J"� III"OVEHEN1 CONTRACTOR Registration: 145523.. .� Expiration: 07/17/2002 Type* Individual ' RAYHON0 4. BERUBE Rayuond Berube Chickering Rd AOM.INISTRAmR H Andover H0 0145 i I i d it I I The Commonwealth of Massachusetts R Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name:' e r L Location:�� ,c C City rot �/�- +r Phone am a homeovmer performing all work myself Asoleoprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on job. ob. Company name: Address City: Phone#: Insurance Co. Policy# Companyname: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposrbon of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cert' unde a pains and penalties of perju at the information provided above is true and correct. I Signatur Date Print name Phon # :? r< / Official use only do not write in this area to be completed by city or town official' Building Dept []Check if immediate response is required Building Dept E] Licensing Board p Selectman's Office Contact person. Phone#.• F1 Health Department Other j FORM WORKMAN'S COMPENSATION l I q Town of North Andover a¢ tAORTH LED Building ,a Building Department o 27 Charles Street North Andover Massachusetts 01845 41 (978) 688-9545 Fax (978) 688-9542 °4 lb '04'reD 111'°°~� �• gcaus��y DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, anda condition of B"uilding permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility locatio 10 V 4ignat Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Date.... N2 2226 16 TOWN OF NORTH ANDOVER 40 0 PERMIT FOR WIRING CL % ,SsA W This certifies that L) .................................................................................... 59 ec J) has permission to perform ......'.+J.Ps.0A......................................... wiring in the building of......o-cor.��......(,,-, ................. at.....LUJ.......ScOf.m.......&—i ..... ................... orth Andover,Mak Fee... Lic.NoA;QA.0.....'* ........�. . .. .... ,"VLEMICAL INSPECTOR C � t* AW WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only o �Ije C�ommunur>:ttltl� of Maggoc4uattorit No. 39eparttnent of Public bafcta pancy,&Fee Checked (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR :0 (PLEASE PRINT IN INK OR TYPE ALL INF RM TION) nate City or Town of ;/A �- d �Y � To the Ins actor of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street& Number ! V L J Owner or Tenant Owner's Address Is this permit in conjunction with at building permit: Yes ❑ No (Check Appropriate Boz) Purpose of Building Utiftly Authorization No. Existing Service Amps_-1 Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps_J Volts Overhead ❑ ' Undgmd ❑. No. of,Meters Number of Feeders and Ampacity .Location and Nature of Proposed Electrical Work I ToEE t No.of Lighting Outlets No.of Hot Tubs No.of Tianslormers K Swimming Pool Above In- No. of Lighting Fixtures g grnd. ❑ grnd. ❑ Generators No.of Emergency Lighting No. of Receptacle'Outlets No.of Oil Burners Battery Units 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 --t No.of Heat Total Total No.of Sounding Devices No. of Disposals Pumps Tons KIN I No.of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal ❑Other -_� No. of Dryers Heating Devices KIN Loc onnection No.of No.of low Voltage l No. of Water Healers KW Signs Ballasts Wiring (� Aw- No. Hydro Massage Tub� Na.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 G NO O 1 have submitted valid proof of same to the Office.YES O NO O It you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE C' BONO. G OTHER O (Please Specify) (EJitln Date) Estimated Value of Ete Arical for $ / � Final Work to Start Inspection Date Requested: Rough Signed undor the Penalties of perjury: LIC. NO. FIRM NAMEnsLIC. NO. Tel. No. r Licensee nnal d A Sroflk —Signature Signare _ Bu (413) 737-4400 . Address 111 Morse Street. Norwood. MA All.Tol.No. OWNER'S INSURANCE WAIVER: I am aware that the Liconseo does not have the Insurance coverage or Its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent (Please chock ono) Q ...Telephone No. _..—. PERMIT FEE $. - (Signature of Owner or Agent) x•65ri5 �t Lo6ti6n3 No t 2tiDate (6 N0RTh TOWN OF NORTH ANDOVER $ c G Certificate of Occupancy $ r Building/Frame Permit Fee $ b'�no �ssACMus Foundation Permit Fee $ m ` s Other Permit FIE11 $ � 1 X Sewer Connection Fee $ �, Water Connection Fee $ s TOTAL $ C) Building Inspector { � p b Div. Public.Works 82, 8 PERMIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4d0. LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK 'PAGE + _ ZONE SUB DIV. LOT NO. I � LOCATION ALI7c� PURPOSE OF BUILDING OWNER'S NAME r NO. OF STORIESSIZE OWNER'S ADDR S - BASEMENT OR SLAB - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD I BUILDER'S NAME SPAN DISTANCE TO NEAREST BU LDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES-SIDES REAR '" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION � LAND COST :AGE EE BOTH SIDES EST. BLDG. COST 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PE Q. PT. V PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM 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 ED 5 J DUILDING INGPRCTOR S URE O OWNER OR Aqf4QjjZED AGENT F E�� OWNER TEL.# PERMIT GRANTED CONTR.TEL.# oqI9 CONTR.LIC.# H.I.C.# a BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ S"ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 (3 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UN FIN BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/1 r/r r/, FIN. ATTIC AREA NO BMT FIRE PLACES _ HEAD ROOM _ MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _------y77_ ASPHALT SIDING HARDV4 D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. &FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I I HIP - BATH 13 FIX.( _ GAMBREL MANSARD TOILET RM. (2 FIX.( _ FLAT SHED WATER CLOSET • _ ASPHALT SHINGLES LAVATORY I __ 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 FORCED HOT AIR FURN. r TIMBER BMS. &COLS. STEAM - STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING NORT#q own ofF A L dover No. T f - dMrnO 199S coC�"cjf-ICK i ORATED BOARD OF HEALTH P IMF— ERMIT Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...AA.M.b....�-��V�-- Foundation has permission to ....p buildings on ..1. ��....5.��'MSI- 1zotjgh ............. .................................................................... to be occupied as. ...C)�l��Z......./.Qe! X...?� ..5.. A . .... �k + ............. Chimney �..... 1 e provided that the person accepting this permit shall In every respect conform tot the terms of the application on file in l;in.tl 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 WEXI' 6 MONTH tS ELECTRICAL INSPECTOR UNLESS CO STRU Rough ......................... ....... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Builditig GAS INSI3ECTOR Rough P Display in a Conspicuous Place on _the Premises --- Do Not Remove Final No Lathing or Dry Wall To Be Done Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Until Ins p Burner PLANNING FINAL CONSERVATION_ FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY- PERMIT_ is t .. ._ � Nab#ti ' a .� :CNSE .V+.r +.,.r+•�+-�..� ac c" x - �Es�t /t 99.9" f11R•.�S��E �IISBR TRI noNs � .'�' i I NONE ,�FFECTII(E DAA E s f r �� M _ �. - ._._—_,- �.. ►, � j TTM , o6i3a� 993 a3s86� Y ND RAYAO Oi4-32-3921 . 361 "CHICKERIl�6 r -.-AN DO D �. PHOTO(8LltiSTTNG OPR ONLY)I FE - R .4 A a 1.8.4 S- . aa` - I HEIGHT: .N07V ISIGNED BY LICENSEE AND .. - .. .. � REOF ED'OR SIGNATUOFFICIA(LY' DOB: 1HE COMMISSIONEq �2i CARR MUST e :r ?THE3SON -t t THUMB PRINT ROWER.WHEN EN - _ GAGEDINTgSpCL�jPA IGNATUREOFUc A _ r � ti-,ill 4 L � ! C IT T ft "`fFL1° _ �. fca 1Gty' rdtt1 Tya. s LC y ADtv1MISTRATOR t } F 't Location /Z-12 lleU4 I No. _f Date q-30-0/ V40 Th TOWN OF NORTH ANDOVER ' n 9 Certificate of Occupancy $ 1'�s' •E<�' Building/Frame Permit Fee $ s�CHus ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 14793 C / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING This Swim for OfTichd Use 0aI `- BUILDING PERMIT NUMBER: 171 DATE ISSUED: � X SIGNATURE: Building Commissioner/1for of Buildings Date zSECTION I-SITE INFORMATION I 1.l Property Address: 1.2 Assessors Map and Parcel Number: LOS Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: l Zoning Nslric! Proposed Use Lot Area Frontage fl v 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided u v 1.7 Water Supply M.G.L.C.40. 34) 1.3. 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 A Name(Print) Address for Service �� • 62 3 - o Signature Telephone 2.2 Owner of Record: O Name Print Address for Service: z M Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 7� 3.1 Licensed Construction Supervisor: Not Applicable ❑ AJ' L11; ��xt k l� -k,-2t 12 A] tsg z�s � Licensed Construction Supervisor: License Number if t ti '11 ti Lul Address �+ Expiration Date or a re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name (8 :S M —21- 1[\ ��[[I_(-iW i TT Aj f= A ' • n N (� r Registration Number Address rJ C� r iA, M- J 7 k- 6!� I Expiration Date 0 S•� t Tele hone �/ SECTION4-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 build*' rmit. Signed affidavit Attached Yes...... No.......0 SECTION 5 Descri tion of Proposed Work checkaUnapplicableAddition ❑New Construction ❑ Existing Building ❑ air(s) :Ot. Alten ations(s) Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: � JJu 3s'sgs�+� • , 'I?, 'Ll- SECTION LiSECTION 6-ESTIMATED CONSTRUCTION COST Om USE ONLY Item Estimated Cost(Dollar)to be Com leted b rmit a licant ' 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction Building Permit fee(.)x (b) 3 Plumbing / 4 Mechanical(I iVAC 5 Fire Protection Check Number 6 Total (1+2+3+4+5) SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property I, to act OIl Hereby authorize My behalf.in all matters relative to work authorized by this building pennit application. Date Signature of 0%vner SECTION 7b OW NER/AUTHORIZED AGENT DECLARATION � ,as Owner/Authorized Agent of subject property formation on the-foregoing application are We and accurate,to the best of my knowledge Hereby declare that the statements and in and belief " If'rin a Date of Owner/A_ent SIZE NO. OF STORIES 13ASE ENT OR SLAB I 2 3 SIZE OF FLOOR TIMBERS SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 1']IICKNESS I ll a(il fl•OF I OIJNDA'1'ION X SITE OF 1.,OOTING MATERIAL OF CHDANEY IS 111,11 1L.DIN(; 1011J .: OLID OR F1LLL'D LAND is 111JU.DING CONNI CTI:D 12 NATURAL GAS LINE KEEN CONSTRUCTION CO. 21 HEWITT AVE. - N.ANDOVER,MA 01845 (978)691-5201 Gaul,Tim&Edie 1435 Salem St.\, N.Andover,MA 01845 (978)683-0776 Contract#1510,Appendix A Date: 04/26/01 Remodel deck • Double all joists of existing 12'x 40'deck • Remove all handrail&stairs • Build new stairs centered on same end of deck • Replace all support posts adding 2 new posts and adding brackets • Supply&install new cedar handrail(2"'x 6')and balusters at 41"from deck surface • Supply&install outdoor carpet on deck surface 3 season room: • Create 12'x 16'three season room at far end of deck • Supply&install 1"x 6"T&G v-groove pine on walls and cathedral ceiling • Supply&'install(2)4"x 6"exposed fir collar ties • Supply and install(6)rolling storm windows with tempered glass&full screens • Supply&install one Harvey Ind "Hollywood"aluminum storm door • Supply&install outdoor carpet in room • Supply&install vinyl siding&roofing on exterior of room to match existing • Urethane pine on interior(2 coats) Electric: • Install customer supplied paddle fan • Supply&install switching for fan • Supply&install three electrical outlets in room • Supply&install one cable outlet&one telephone outlet • Supply&install one switched flood light on outside of room --- ;Move or eliminate existing floodlights on back of house F Price does not include cost of permits or paddle fan. ,T l'Price:$24,155.00(twenty four thousand one hundred fifty five dollars) Payment Schedule:$8000.00 due upon signing contract C 14 $8000.00 due when deck is reinforced and room is framed $6000.00 due when work is completeexcept ring $2155 due at completion of contracted w rk Customer --lkneth B.Keen Date / 7 ` 1 Date a ✓ IJOOIYIlt0�2!!/P.CLGC/L O�✓G(•C[O:1CL(,{tll(1C�6 r•<- BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 058245 Birthdate: 03/24/1943 Expires: 03/24/2002 Tr.no: 18312 Restricted To: 00 KENNETH B KEEN 21 HEWITT AVE N ANDOVER, MA 01845 Administrator HOME IMPROVEMENT CONTRACTOR _._ Registration: 108383 Expiration: 8/18/02 Type: 08A KEEN CONSTRUCTION CO. Kenneth Keen ADMINISTRATOR 21 Hewett Ave No. Andover MA 01845 The Commonwealth of Massachusetts )�: e Department of Industrial Accidents ==- Office ol/nsestigaliens 4V�. 600 Washington Street Boston Mass. 02111 Workers' Compensation Insurance Affidavit A I ant-, .. low r lease? fLi at name: I�FP-w C.ONS�i2�1 e.'�'iDrl l ��C NN 64 location .77—/ — situ phone# 0 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity r-1 I am an employer providing workers' compensation for my employees working on this job. company name• gess: city phone# insurance co. policy# T .r. T,.-.wrr..i..,.: ..,..�...._.,.,�_...rr+9-...au.�r�r3�w....�..^'+1`imt��w��♦+r7`_.s��"`s..`-i��1'e f' .. .r,,,�l'�' :s + "1""�t�� I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers'.compensation polices: company name: dress: city: phone# insurance co policJill y# company name: address city'' phone# insurance co p lacy# At(1et�adJilitiorral sheof�Lnecessary"' as K Y Failure to secure coverage as required under Section 25A of NIGL lag 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 penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 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 Any and penalties of perjury that lite information provided above is true and correct. 19%Signature 9; Date Print name EAJ All E t e-61] ._. ._._. hone# 777'6 zoo official use only do not waste in this area to be completed by city or town official,..., ... , city or town: ermit/license# Aga M1` p ilding Department QLicensinkloai Q check if immediate response is required QSelectmen's Office QHealth Department contact person phone#; -Other 3; ....tea.>'.d:':- " 5 .....: c •.•�":::„s”- (revised 3/95 PIA) x.10 R T►y own of1. 4 Andover 0 No. 177 Al 3® / O ��=-= lover, Mass., .. LA COC HIC HF WICK � 1 ADRATED pPa5 S H E PE BOARD OF HEALTH M MW= Food/Kitchen R IT I.W D Septic System �` BUILDING INSPECTOR THIS CERTIFIES THAT...C.,.�W ....*. ..// ..... :.V..`.. ........................................................ Foundation has permission to erect...�P ..�.�.. buildings on n/ Rough to be occupied as S��! ®� �� y � t�1 Y>rC-� r A h D�� Chimney p ............ 4............................. . ......................................... ............................ 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. VVI ( O P PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST S ELECTRICAL INSPECTOR C Rough ...... ....................................... ...... ....... ... . . ......... ...... ........... ...... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough al No Lathing or Dry Wall To Be Done_ Until Inspected-and -Approved -by" the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE smoke Det.