Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 149 BEVERLY STREET 4/30/2018
/ 149 BEVERLY STREET i 2101006.0-0001-0000.0 J I I I I i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 9Z7 _ Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LQCATION_.�I' G C� V 7�L�1.- I RlZrt 2► 1- Iry _ - -= r Print / + PROPERTY OWNER TASD�. Print r_ 100"Y. r®Id Structure: yes• no MAP NO: . PARCEL: ZONING,DISaTRICT. __ - .___ Historic District yes 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 hbof ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other d Septic ❑Well 'b Floodplain E Wetlands ❑. Watershed'District :Water/Sewer. DESCRIPTION OF WORK TO BE PERFORMED:`S MIA R.00OFo 01)1Eus Ca 00 A16,,DUROTAM Lt CCU M G sfhW6� &-aF/isms,4 S r41 AJc tz . Iden 'fication Please Type or Print Clearly) Phone: f OWNER: Name: �,�5 GJr�-�Md�-RO � � � a y Address: T M/1 S 1 It IA)O CONTRACTOR Name:. _ a Phone Address:'/ l�'r�MO`TTt Ex Date: dOl�a Supervisor s-Construction'License:CIS" a�g P= , Home Improvement License:_ / b� _._ Exp, pate;.. off__ v 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: $ C19-i6t OD FEE: $ A?0- Check No.: Receipt No.: !2 7f Fr NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Ad6nt/Nvner' igo a of contractor ., F1 Prone 1A/alvari FI C:prtifipd Plot Plan ❑ Stamped Plans ❑ Location No. Date A) 4 i . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# OW 279 ,r8 .Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TI'PE OF°:SEWERAGEDISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. . .,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 l Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Comments lConservation Decision: Comments 14►ater & Sewer Connection/Signature& Date Driveway Permit DPW TowL, Engineer: Signature: Located 384 Osgood Street FIRE tPARTfill;ENT Temp Dempster on site yes no Located-at 124 Main Street Fire Departmerit sigriatifte/dae tI G- 1 �/ COMMENTS NORTH own of E ndover No. �h ver, Mass,LAK Z/ �p coc"Ic"IWICK y1. 0RA TE o Fk? t1 BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....... .....�:!�. .`...n`1f BUILDING INSPECTOR ,/� / Foundation has permission to erect .......................... buildings onf�.. ...,,v .�. ��::/.. .......�� ............................... Rough to be occupied as �'�. ....... ................................... Chimney .............. . .......................................................... provided that the person accepting this permit shall in every respect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S ARTS Rough Service .......... ........ .. .4:`<+++................... 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. a- NuW contract ` =2 JT i /7 C7 7& K To 7)939 353 QUINN'S CONSTRUCTION E 27 1639714 (978) 265.2390 868 Mammoth Road • Dracut, MA 01826 tom@quin'nsconsbuction•com www.quinnscons&wtion.com Page i of 3 i Property Owner Information Name Street Address(Not Post Office Box) Date City/Town State Zip Code Job Name Home Phone Cell Phone Email 3 Job Location Mailing Address(If Different From Above) i Salesperson(s): C-iL1//C.l1 Contractor Registration#: CS-039732 Ex.Dater S/ REQUIRED PERMITS The following building permits are required. It is the obligation of the contractor to secure such permits as the homeowner's agent: List any and all necessary construction-related permits. Note: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. Is an EXPRESS WARRANTY being provided by the contractor? NO YES **All terms of the warranty must be attached to the contract** NOTE:All home improvement contractors and subcontractors shall be registered and any inquires about a contractor or subcontractor relating to a registration shouldbe direEted to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,MA 02108 617-727-8598. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c.142A. Homeowner: . .., Contractor: Date: /�`^) �c? f Date: /V 1 NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR.THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES.. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity-A Contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.. Contractor's Financial Insecurity-In instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal from said account would require the signatures of both parties. THE CONTRACT MUST ALSO CONTAIN: 1. A Complete Description of any other documents which are part of the agreement; 2. A List and Description of other matters upon which the contractor and homeowner lawfully agree; 3. Any Other Provisions otherwise required by applicable laws of the Commonwealth. Remember,the Contract must be the Complete Agreement Between the contractor and the homeowner. Contract Tom(617)939-1353 QUINNuinn 'S CONSTRUCTION E 27-1639714 (978) 265-2390 868 Mammoth Road • Dracut, MA 01826 tom@quinnsconstruction.com www.quinnscons&uction.com Page 2 of 3 Modifications There shall be no modification, amendment, or change order made relative to this Construction Contract, Contractor's Work, or the Plans and Specifications without the express mutual modification signed by Owner and Contractor. a. Required Change Orders: The Specifications represent Contractor's best effort to be complete in detailing the scope of work to be performed.However,this contract is based solely on observable conditions of the structure in its status at time of Contract preparation. If additional concealed unknown conditions are discovered in the course of construction,Contractor shall point out these conditions to Owner so Owner and Contractor can execute a signed Change Order for any additional work. Such orders shall specify additional fees, materials, labor and services, and become part of this contract. Additional costs, if any, shall be paid for by Owner in advance of execution of work specified in said Change Order.Failure of Contractor to request such payments in advance shall not be deemed a waiver of,payments_due. Any delays in Contractor's Work caused by required change orders shall not be deemed the responsibility of Contractor,and shall automatically extend the time of completion.Additional time required shall be stipulated within the Change Order. b. Additional Work Authorizations: In the event that required work cannot be priced in advance of completion of such work, (i.e. discovery of rot needing repair), an Additional Work Authorization shall be executed. Such orders shall describe work to be completed, and shall specify method of calculating additional fees,materials, labor and services to be charged upon completion,and become part of this contract.Payment shall be due upon presentation of Contractor invoice.-,Any delays in Contractor's Work caused by required change orders shall not be deemed the responsibility of Contractor, and shall automatically extend the time of completion. Additional time required shall be estimated and stated within the Additional Work Authorization. I,the Homeowner have read and understand the above mentioned modification section and agree to the terms. Homeowner's Signature,-, Contractor's Signature Date Date The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work Scheduled To Begin: 1Expected Date Of Completion: 53 / '?b /4-Q�Lv`' (Date Contractor will begin contracted work) (Date when contracted work will be substantially completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE - G The Contractor agrees to perform the work,furnish the material and labor specified above for the SUM o£ $ ;7 7S 0 (*I�n-c-luud-e-�alll finance charges in this amount*) yine tsXill ade according to the following SCHEDULE: on signing contract(*Not to exceed I/3 of the total contract price OR the cost of special order items, hichever ' eater*). by 1 /. or upon completion of $. /I by / / or upon completion of U $ &kklL G/61pon completion of the contract(*Law forbids demanding full payment until contract is completed to both parties'satisfaction*) In order to meet the completion schedule,the following material/equipment must be special ordered before the contracted work begins(*Law requires that any deposit or down payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule*): $ "" to be paid for DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeowner and the contractor. Homeowner's Signature Contractor's ignature % `7 20 i Date Date You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. 3i�95UX'l Contra Tom Quinn QUINN'S CONSTRUCTION /t/`.9—X WZ ployer ID# (617) 939-1353 27-1639714 (978) 265-2390 868 Mammoth Road • Dracut,MA 01826 �'Page tom@quinnconstruction.com wwiaquinnsconstruction.com 3 of 3 WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor agrees to do the following work for owners Contractors agrees install a premium Owens coming duration lifetime shingle roof systems(scope of work) Contractor to obtain building and other permits as needed. Customer to pay for permits at cost. Schedule the delivery of all materials, dumpster, cleanup. 0 Proper protection of property. Proper removal and disposal of 1 layer of roofing, additional layers removed for 5K a Square Foot per Layer. f eRun Magnets-at end of day. �e,nailing of roof decking as needed eplacement of up to 100 square or lineal feet of roof decking above this replaced for$2.80 a foot. ® Installation of F8 Mill, white or broom wn Drip edge on all roof edges. ❑ (Optional) Installation of custom Heavy Duty F8 color of choice single and double drip edge. Installation of Owens Coming Weather Lock Flex High Temperature Ice and water barrier 3,6,9 Feet wide and as needed in critical areas of roof. u Installation of Owens Corning Deck Defense for shingle underlayment. 111/1 Installation of vent pipe boots, step, base and counter flashings as needed. Installation of a Owens Comings Duration Lifetime Shingle Roof using 6 nails per Shingle Exceeding the Manu- facturers Specifications. ❑ (Optional) Installation of Owens Comings Duration Designer Shingles. ❑ (Optional) Installation of Owens Comings Energy Star Duration Shasta White Shingles. Installation of Owens Comings Ventsure strip ridge vent with wind baffles and caps on ridges. rA7Installation of 12 inch lead flashings on the chimneys#. ❑ Installation of continuous circular, rectangle, or Facia Vents for Eave Ventilation as needed. ❑ Block off Gable Vents as needed. Roof System to be covered by Owens Comings System Advantage Preferred Non-Prorated Lifetime 50 year material Warranty and 10 year workmanship protection. ❑ Installation of PVC Trim, Facia & Rake Boards $20.00 a Lineal foot. Other Specifications and Conditions 8zual/6/ C_.1 AJC J 9 '7 r OP ID-WC CERTIFICATE OF LIABILITY I NCEDA �s OM -- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, MCI-END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS71TUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR= REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the csrfficate holder is an ADDITIONAL INSURED,the pol(cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,cerin policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 97875-4300 cr Segreve&Hall lnsur.Assoc Inc978-975-7596 PHONN FA.. No 305 North Main St Andover,MA 01810 E-MADDRESS: Edward Ramirez PRDD h , ,,.THOMA-3 INSURER(S)AFFORDING COVERAGE NAIC S INSURED IrIOMEIS I~f Inn INSURERA-Aflantic Casualty insurance 42846 dba Quinres Construction INsuRERB:Hartfford Ins Co. � 860 Mammoth Road Draeuf IIIA 04826 wuRERc:Arbella Protection Ins.Co. 149360 INSURER D• INSURER I- tt INSURER F• i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 1 P EFF POLICY EXP LSR , TYPE OF INSURANCE S POLK:YNirMBER PAr�4D LIMITS I GENERALLIABILITY ( EACH OCCURRENCE IS 91000,0 A COMMERCIAL GENERALLIABILnY IPA02100022T 01195114 09195/15 �1UET Ma s 900,0o0 CLAIMS-MADE OCCUR j 1 (MED EXP(Arty one person) S 5,00 1 PERSONAL&ADV INJURY Is 1,000,000 1 { f GENERAL AGGREGATE S 2,000,00 GENtAGGREGATE WAIT APPLIESPER: PRODUCTS-COMPIOPAGG 1 S 2,000,000 MPOLICY! i PRO IAC !S AUTOMOBILE LIABILITY i i COMBINED SINGLE LIMIT S '(,000,00 p I ANY AUTO (Ea aaccident)4 , ALL OWNED AUTOS INJURY(Per pmson) 5 `t BODILY INJURY(PeraWderd) S C I X SCHEDULEDAUTOS 9420002331 05/07114 05107115 PROPERTY DAMAGE HIRED AUTOS (Pere) 5 NON—O NEDAUTOS Underinsured S 90Q130 ! {{{ , Uninsured s 106130 UA(BRELLALIAB OCCUR ( I f EACHOCCURRENCE S "CESS LLAB 1 CLAIthS MADE 4 l� (! AGGREGATE 5 i tU DEDucnSLE 1 �RETESVSIpid S � 1 y S WORKERSCOMPENSATION 1 ! 1 WCSTATU- tOTH AND EMPLOYERr LIAML17Y YIN ORE M { T #3 ANY PROPRIETORIPARTNEREItECUTIVE(� NtA! 411SP704 01195114 091951'15 Et EActracclDENr — 106,ODQ IO�CEFUMBIBEREXCLUDED? LJ }(thandatM in NH) ; E.L DISEASE-EA EMPLOYE4 s 900,000 t 0 CR1PTIa OOPERAT7ONSbans EL DISEASE-POLICY LIMIT S 500,00 DESCRiPTiou OF OPERATIONS I LOCATIONS I VMCLES(Allot ACORD 10i.Additional Rernaeks Schedule,if more space is rgvtred) Sole Proprietor Thomas Guam;; is Encluded under fforkers Coup CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEUM BEFORE THE EXPIRATION DATE THEREOF. NOTICE VWLL BE 13ELMERED IN ACCORDA(C;F-M RSH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i fJ ©9988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Print Form - Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/lndividual): S (�Vs O0 Address:gjoF I*)) kim i1- J,_n� City/State/Zi r ,n 6 oygjj , Phone #: _ - C�c7 D� Are you an employer?Check the appropriate box: Type of project(required): 1. I am a emplo er with 1-9 4. ❑ I am a general contractor and I employeesfull nd/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.n Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: ✓S ao Job Site Address: 9 9�1/LV W SCA,60 City/State/Zip:Al _X0 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. I do hereby certif v under the pains and enalties geer'u that the information provided above is true and correct Sianature: ✓ Date Phone#: q 1zFf 9�67 d 6�c6 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#: V�YGti Q�C=)/l Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 121604 Type: DBA Expiration: 5/24/2016 Tr# 250393 QUINN'S CONSTRUCTION = THOMAS QUINN - =N 868 MAMMOTH RD. DRACUT, MA 01826 Update Address and return card.Mark reason for change. SCA 1 0 2CM-05/11 � Address n Renewal n Employment E] Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration• 121604 Type: Office of Consumer Affairs and Business Regulation xpiration• .5/24/2616 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 QUINN'S CONSTRUCTION THOMAS QUINN 868 MAMMOTH RD. DRACUT,MA 01826 Undersecretary Not valid withou signature Ul;re�5--LTS ad—>7i- s:rn�(� Gil.`t�� C-Se S-1011-0 T'hiC. � S'Et�•TL.���U LJ LLU� ^ QO�S3'� ar �j �i SS.vL(�i _z Of _ c"�LC;OS'PaLi air_aCaG. _ �--'CS439732 .. !err..-. .. IHO" 8681VMAMM©TEIRD DRACUT MA 111426 iejlorezo peso a current a-Mon a:tie itrr�chuss�L- S.La Bt ldIng Code-isc-Line gar rinJoca€3on a.Li&hens, for DPS Ucen;5ngWormation ist ti r iir-ss favf{lg5 03125=16 CERTIFIED VINYL SIDING INSTALLER ASTh'1 J�'S6 SMrssarld by tl!Vinyl Sisiis�fuUNEe Quinn,Thomas Expires:4/1/2017 868 Mammoth Rd ID#:17412 Dracut,MA 01826 Certified Since:2014 II --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 crop 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 i i E) Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department >the fol;swing is-a-list of the required forms to be filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan La Workers Comp Affidavit o 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) ❑ 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 ❑ 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 ❑ 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 apn,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doe: Doc.Bui?ding permit Revised 2012 Location No. a G Date "ORT►r TOWN OF NORTH ANDOVER Of, �•o ,•,ti O T • Certificate of Occupancy $ Building/Frame Permit Fee $ Uo sACHUSt �. Foundation Permit Fee $ Other Permit Fee $ f TOTAL Check #1434- 4 . w I / Building In v ator t � TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 7,77 BUILDING PERMIT NUMBER. �j DATE ISSUED. ic SIGNATURE: Building Commissioner for of Buildings Date - - 0 Z 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 Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Reqwrcd Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record N2)--e _-Jp�-� G�h 1AP\ Q�f e t Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Tel hone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: �L-33 O License Number Address Expiration Date Signature Telephone 3.2 egistered Home Improvement Contractor Not Applicable ❑ v Company Name m ---a 1 C-V �)f r A- �, --- Registration Number Address �— Expiration Date ^� Si nature Telephone i t 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 building permit. Signed affidavit Attached Yes.......❑ No.......0 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: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USI'a+,;ON_ LY Completed by permit applicant 1. Building (a) Building Permit Fee 1 Multiplier 2 Electrical J (b) Estimated Total Cost of Construction 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 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 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 Si�gnafiure of Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS D1IvIENSIONS 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 A RTH Town of over 0 D L A o dover, Mass.,—// 400 COCMICMEWICK V ADRATED P'?a�,�Gj S H Q BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT.......... ................................................................... Foundation has permission to erect.... ..................... buildings on oN9....... ......................... ....................................... Rough t0 b8 OCCURIed as..... ,�/�„ , Chimney . .. ......................................................................................... provided that the person accept! this permit shall in eve respect conform to the terms of the application on file in Final this office, and to the provisions f the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final. UNLESS CONSTRUCTION T S ELECTRICAL INSPECTOR ty Rough ............................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. '_ SEE REVERSE SIDE Smoke Det. Th e Commonwealth of Massach usetts D q)artment o Industrial Accidents == Mice of Inyestly.711ons 600 N'ashinulon Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit t �... M P t x name: ; �. Qeati n' • cit ---phone 75` �q `� [] I am a homeowner performing all work rnyself. 0 1 am a sole proprietor and have no one working in any capacity 0 1 am an employer providing workers' compensation for my employees working on this job. company name r 1 F C° > � address t n ran j` otic "➢. ,*. C] 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 nine::, i phone#. in3urancc i Address. city y phone 11 :insurance co ! : `nolicx# i Failure to secure coverage as required under Section 25A of MGL 152 can lend to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S109.00 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. I do hereby certify under the pains and irralties of perjury that the information provided above is true and correct. i� Signature � 1'�y�%' _.-=�.,�Z/G�.f.�.`�%'�� Date Print name Phone# official use only do not write in this area to be completed by city or town otTcial city or town: permit/license# nBuilding Department pLicensing Board 0 check if immediate response is rtquired OSelectmen's Office 011calth Department contact person: phone#; 00ther t (revised 3195 PIA) s j NOME •IMPROVEMENT CONTRACTOR Registration 103317 a Type - DBA Expiration 07/07/00 CASTRICONE ROOFING & SIDING C Kar4to T. Castricone &WQknurt St. ADMINISTRATOR N. Andover MA 01845 ,,,zoo BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR R y Number: CS 034049 f il Birthdate: 12/08/1923 Expires: 12/08/2001 Tr.no: 10391 Restricted.To: 00 MARIO T CASTRICONE � % 31 COURT ST N ANDOVER, MA 01845 Administrator t Mario Castricone, Prop. Tel, 681-4266 CASTRICONE ROOFING & SIDING CO. 31 Court Sc, No. Andover, Mass. 01845 CA M z I n r�� s Location No. ]� C) ` Date it pORTq opt«,° .,ti ! j'TOWN OF NORTH ANDOVER w � Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ �J stcMus Other Permit Fee $" Sewer Connection Fee $ 1 Water Connection Fee $ TOTAL $ + --9 � Building Inspector 11901 ' Div. Public Works f _ _t ira<' AtIR"mw me Mum To Iwo-MORT!!-ANOOVW-MAS •- - _ - -. .::� -� _ tiQ�`N01r�•� ;•�:.�-�.- ,.� -�.- �aer= Tr� .-'e.3 BOGIES.. 'PAalE- s r-. �_. t>F�=RtC01! OFOWNERZNt Oil► ZONE:: sue Div.LOT NOL / rDZ. R Lon= ---- OT- N& Ott►BTOINEfE - t OWNtl1'B NAME" tom,•_���'� C'n O:J�V S '. r R�i` o OWNtA•f..AOORtsi � �1�\ 7CA } MRiMiNTO�pA� -r• _ _ ARCMRECT'R NAME(' - l- SIZE OF FL00111 TUS"NW 1!!s _'iNQ .IRO BUILDER'S NAMS DISTANCE TO NEAREST SUILOING CJ -:r, OIMENSNN/S OF SILL* DISTANCE FROM STREET / POSTS - - •� DISTANCE FROM LOT LINE*—LADES ` / REAR / GIRDERS - A*6A Of LOT SIPI FRONTAGE C7� 5� "EIGHT OF FOUNDATION• - TNICKNp0 Zia BVILOING NEW • • SIZE Of FOOTING, .. X IS BUILDING ADDITION MATERIAL Of CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LANK r WILL BUILDING CONFORM TO REQUIREMENTS Of CODE IS BUILDING CONNECTED TO TOWN WATER S BOARD OF APPEALS ACTION. If ANY 18 BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS s PROPERTY INFORMATION LAND COST $EE BOTH SIDES Ear. SLDG.COST Z PAGE 1 FILL OUT SEC710NS I •i EST. BLDG.COST SER SQ FT. PAGE i FILL OUT SECTIONS I. I! toy. SLDO.COST EER IIOOMI SEPTIC►ERMIT N04 ELECTRIC 1ICTEPS MUST BE ON OUTSIDE Of SUILDIN*' 4 APPROVED sY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST■t FILED AND APPROVED SY BUILDING INSPECTOR DATE LE lQ-aO` •UILDLL INSPBCToA SIGNATURE OF OWNER OR AUTHORIss AGENT FEE OWNER TEL PERMIT GRANTED CONTE.TEL I 62 92 CONTE.LIC.0 ( l H.I.C.f ,r .2UIIDING RECORD-- OCCUPANCY . TI. FAMItr —' OFF IES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE PROMI APART MENrf LOT LINES'AND EXACT DIMENSIONS OF BUILDINGS. WITH rORCHEG.. GA- Y - :- RAGES. ETC. SUPERIMPOSED.THIS REPLACES PLOT PLAN. CONSTRUCTION :.. , s FOIMIOATNRII - B RrrTlRIDR ►INIt11 - `.. - COPCHTE sur- T OR T IIARDIN O _ - IlA3� AREA FULL SIN. R' 'f'AREA FIN. Af FK AREA M'T FIRE PLACES HEAD ROOM _ A40DERN KI 1EN 4 = WALLS 9 FLOORS 11 `2�ICSST=1VCo ARos R ! 2 s Wt Gg2�i�� DOW tO1►'Ri CONCRETE � Q , 1 tES EARTH ASPHALT SIDING HAWV.I*D— AsusTos sipwo COIAMON J VERT. 310ING ASPM.TILE ON MASONRY r� STUCCO ON FRAME ATTIC STRS,i FLOOR \cy IMICK ON FRAME COM OR R OLK. STOW ON MASONRY WIRING ON FRAME t Cole ADEOVATE H NONE " !i Rooff o nuMRINa SlI HIPSAT" FIX. R t TOILET RM. 17 FIX.1 f T SHED WATER CLOSET _ ES LAVATORY KITCHEN SINK Two NO PLUMBING IM GRAVEL STALL SHOWER sott. Room* MODERN FIXTURES ,- TILE FLOOR TIME DADO w000 JOIST FIFFLus RN D HOT AIR FURN. __.. ._—._.._.-_._..__—__._.._.._. -• TIMBER RMS i LOIS. TEAM ! Et MMS.i COIL. HOT 'T-R OR V WOoO RAFTERS AIR CONDITIONING RADfIWT T' T UNIT. no. OP RDDMS ASi M'i El T - _ I NO HEATING OR + Town Ft ` of g _ Andover .1 No. 302 ° M iLAKE dover, Mass., 2,6 190 . �j r q4 T E D BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System // THIS CERTIFIES THAT Q`- n� Qfi ( til BUILDING INSPECTOR Foundation has permission to erect..................... buildings on /...f.9 .. I .. to be occupied as..................................................... �...K..�. ............J.-I (-`z........... .t.c/.C.............................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Fital 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 CONSTRUCTION ST TS Rough ......................... ..... Service ..... .... .... .. .. ..... ................................ B 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 T - FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Tpr. r� oe� o S -6e-- a N emirs 1 FORM U - LOT RELEASE FORM i 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 j landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �`NaG, t-7�ckx)VR_\ —'Uvc CSS Phone C"�S_��C0R LOCATION: Assessor's Map Number Parcel Subdivision . Lot(s) Street St. Number ********************** *Offi Use Only************************ RETIO A . Date Approved Owl Conservation Adm ini rator Date Rejected Comments r Date Approved i Town Planner Date Rejected Comments l Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments i Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date MORTGAGE INSPECTION PLAN 111}% ITED DATA SERVICES INC 20 BLANCHARD RD. • BURLINGTON, MA 01803 95/00394 TEL (617) 272-9100 • FAX (617) 2Y2-6900 APPLICANT. DANIEL C. &LINDA R. BURNS DEED/CERT. 3692/1 LOCATION: 149 BEVERLY STREET PLAN REF: 173/600 CITY, STATE., NORTH ANDOVER, MA PREPARED: 3/8/95 1101?'1'10N 52 & 51 i GARAGE rAu 7- 1.11) 1.G STORY a 50.52 BEVERLY STREET SCALE. 1 inch =20 feet CERTIFIED TO: MEDFORD 00OPERATIVE BANK 1994(c)05910 1591 Puy 35110111" The permanent structures are approximately located on the According to Federal Emergency Management Agency ground as shown. They either conformed to the setback �tA OF Q45� aps,the major improvements on this property fall in an requirements of the local zoning ordinances in effect at L'y the time of construction,or are exempt from violation en- .�� CARMEN G' ea designated as Zone L forcement action under M.G.L.Title VII.Chapter 40 A, A. Community Panel No: ZS-0© q r O O©3 fi Section 7,and that there are no encroachments of major CJ 'TESTA �• improvements either way across property lines except as Effective Date: (D — z- -0 X7'3 -o No. 18467 e:Zone C is areas of minimal flooding(no shading). This shown and noted hereon. 90,E '9 C >, �Q1 i etion is not based on an elevation certificate. NOTE:This is not a boundary or title insurance survey. This plan wa, ep, ocedural and technical standards for Mortgage Loan Inspections as adopted by the Massachusetts Board of Registration of professional engineers. ( rs,250 CMR 6.05,and use for any other purpose is prohibited. This plan is not to be used for recording,preparing deed descriptions,or construction Location No. U Date '" ���- ,.ORTp TOWN OF NORTH ANDOVER Certificate of Occupancy $ 51) , 4 ij * ; Building/Frame Permit Fee $ ,/��•,� t� Foundation Permit Fee $ swCHust eV. e Permit Fee $ a ^ L � Sewer Connection Fee $ Water Connection Fee $ TOTAL Building inspector Div. Public Works PE&�iIT4Y0. �� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. ���3 1C R - PAGE 1 MAP h40. I LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK ;PAGE — ZONE 11 A— SUB DIV. LOT NO. + LOCATION -^ PURPOSE F I D � rg �L L &Irl��s// OWNER'S NAME NO.A . fC __� � NO. OF T IE 1�SIZE & a OWNER'S ADDRESS /u /� 6 _r n �I Y I[/ BASEMENT OR SLAB ARCHITECT'S NAME 7 7 rJ '/A 1,! VJ� !` L SIZE OF FLOOR TIMBERS 1ST . 2ND s� 3RD BUILDER'S NAME ��( ,/ /) < SPAN /� mot' ,��/ �'�I — it DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS � S') t Y �LoL P DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS « AREA OF LOT J' 7-3Ac FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY 4sO /14If�/` IS BUILDING ALTERATION YES IS BUILDING ON SOLID OR FILLED LAND So/_ i ar) 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 SEE BOTH '_^)ES EST. BLDG. COST / /// a ) PAGE 1 FILL-OUT SECTIONS 1 - 3 EBT. BLDG. COST PER 6 . FT.v _ 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 FILEND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OR HEALTH SIC; ATURE OF OWNER OR AUTHORIZED AGENT FEE /SdiS D oi, �o•'O 0 OWNER TEL.#xo'e-W PLANNING BOARD PERMIT GRANTED / - CONTR.TEL.# .5� 19 _ CONTR. LIC.#_f;ZJ BOARD OF SELECTMEN LK � RUILDINO INSPECTOR `nING DEPAff-TIVIEN I f BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I STORIES 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 j t 2 FOUNDATION 8 INTERIOR FINISH d 1 /! J(f too �"'j- V CONCRETE _I d I 3 bbb✓✓✓✓ tt�ell ` i/F../ CONCRETE BIL K. PINE ' — 3 BRICK OR STONE HARDWD PIERS PLASTER of /',F/j !� � o _ DRY VJALI 1!{�"��( UNFIN. J- 3 BASEMENT AREA FULL FIN. B M AREA _ a �j"'j-F •� (}s+ # �"}� l[r��`J�y f:F/•/� '/. '/: l/ FIN. ATTIC AREA j t� M A 1 � f 1 Fav t- l Tr I+ • ' NO B M FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 - PIE E / Vd � DROP SIDING CONCRETE — WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D / ASBESTOS SIDING COMMON vz r (� VERT. SIDING ASPH. TILE �T'- t Jj/ ..•+' FFF.....--- STUCCO ON MASONRY l� STUCCO ON FRAME •V j/y1R.S/ L � BRICK N MASONRY ATTIC STRS. 8 FLOOR '(^"� (�(�J "�� ;�• /� Y BRICK ON FRAME j J3'°"�1y,- CONC. OR CINDER BLK. STONE ON MASONRY WIRING ''j`' fpr-°_ ptl��7 STONE ON FRAME SUPERIOR POOR 5 ,• ( l0 ADEQUATE I--i NONE 5 ROOF 10 PLUMBING /t, (le GABLEHIP BATH (3 FIX.) 1191- '/'" GAMBREL MANSARD TOILET RM. 12 FIX.( ` 4-- FLAT SHED WATER CLOSET " �,f/(/ ,,, ff� ,,,ppp►►► ASPHALT SHINGLES LAVATORY WOOD $HINGES KITCHEN SINK ( r SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER It u pr ROLL ROOFING MODERN FIXTURES TILE FLOOR * ' J }aa, i , TILE DADO � �[ !! t(�/,(Ef �(„e/ ^' 6 FRAMING PE HEATING �'' � I s tea, f t �.r��f ou WOOD JOIST PIPE LESS FURNACE J1,� �l # FORCED HOT AIR FURN. 3 TIMBER BMS. &COLS. STEAM "TTL �!Dom'} II �`' r, A" �67 j� 1/rlRl / 3 1/► STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR 70 'A [-� f ISfi .. _ 1 I'P"'If i, / ap WOOD RAFTERS AIR CONDITIONING – atl RADIANT H'T'G {i6Cji FT UNIT HEATERS Gf 7 NO. OF S OILAS B'M'T 2ndELECTRIC ,1 . L Ate ` 1st 1ISA 3rd I NO HEATING rs . is I Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE l �j JOB LOCATION Number Street Address Section of town "HOMEOWNER" 0,49k A � ���U ,eq l � Name Home Phone Work Phone PRESSE/NT MAILING ADDRESS 5,0go 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 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 to six family dwell- ing , attached or detached structures accessory to such use acid/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 , on a form acceptable to the Bulding 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 North Andover Building Department minimum inspection procedures and requirements and that he/she will compl with said procedures and requirements . HOMEOWNER' S SIGNATURE . APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 , 000 cubic feet , or larger , will be required to comply with State Building Code Section 127 . 0 , Construction Control . I + �r - V' E 3a J_Nt®`i€1,(�1 A3j Ti 1 1 nn t sb7� Z 4-40 9N/A 1-1 i �1 { hMOC ,' O -tea,yo u©d� _ - N vacs rr�o7 -?f ove Q .. hl 0.1�oro sd J d cep - " �N,N Nl CJ d,3 v f Ci70 Stve �/C7 . - _ _��_ �+FJr✓Q ...oS l�� 070 p l Off, d7 /V 7 -�y 00 7-1 �` � �� �� ?�� 'crN 7 �� 04D L aG r 3 C v J-� ov Iv, LA- opo 3k b ®r lvf— a je AfT .57 ou LA Ll 4 1 y �..1 �^ (Y�^, Y OFFICES OF: . Town of 120 Main Street APPEALSNORTH ANDOVER North Andover. BUILDING � Mi1tiS:1<'1111ti(:lIS O Iti43 CONSERVATION s, "" 01VISION OF Iii 17)6Hi;•4i i i H EALI'H PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECI"OR In accordance with Elie provisions of MGL c 40, S 54, a condition of Building Permit Number /qq 15??Y 11 t�/ u that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11I, S 150A. , The debris will be disposed of in: -- fF,460):57 (Location of Facility) Signatur 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. IS � - C01-r7 ok.? i FORM U - LOT RELEASE FORM 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �� k A, 'Iy U� i A2 � Phone102 LOCATION: Assessor's Map Number ,L Parcel Subdivision Lot(s) Street _ /.,)rde L �' St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Food Inspector-Health Date ApprovedDate Rejected Date Approved Septic Inspector-Health Date Rejected Comments -Public Works - sewer/water connections - driveway permit( � Fire De a p rtment�� Received by Building Inspector Date NORTH Town of o O o� o,H, , dover, Mass., 19 ORATE0 j BOARD OF HEALTH Food/Kitchen PERMIT., . T D Septic System BU IN THIS CERTIFIES THAT./y ... ...j� �i� F ..............................•...........•....... oundatonDlNG SPECTOR Al has permission to•eroOr..l ...... ...... buildings on./ *.1.j8Ar04F4e4, ..Xf.......•••• Rough Chimney to be occupied as......��.�. ��.o.�w��....�t..�........�... . .... ...�.1!. ................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finalh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL d# CONSERVATION FINAL street No. �R FINAI �y ' '6 Smoke Det. CCU= /%AinT DRIVEWAY ENTRY PERMIT _ Location No. Date L/ NaRTM TOWN OF NORTH ANDOVER 3? e •SOL � 9 • :� ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 6" / Building Inspector I r a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEM.OL,IIS�H�A ONE OR TWO FAMILY DWELLING 777,77 rs T BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I ctor of Buildings Date SECTION 1-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: (^ Zoning District Proposed Use Lot Area(sf) -Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide EEMired. Provided Recpired 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 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record le(Prfdt) Address for Service Signature Telephone W 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES ' ] 3.11Licensed Construction Supervisor: Not Applicable ❑ 7 Licensed ConstructionS upervi or: / 23 1 ! ^ License Number Address ( Expiration Date i natu•e Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 VON Company Name M 1 C� ��n _� Registration Number rom ERM essLAZ�;w A / Expiration Date S nature Telephone 6 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 building permit. Signed affidavit Attached Yes.......0 No.......0 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: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beflC VWOlti'L : Completed by permit applicant 1. Building ,� (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical(HVAC ] �- 5 Fire Protection (YY v 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 OWNE AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject pro erty Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 0 da if ae) ft Print ailie Si nature o�(5'AA '/A e Date NO. OF STORM=S SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE glie Commo=e dtfi of Massachusetts Department of IndustriafAccidents N; off=of Investigations 600 Washington Street Boston, W.02111 Workers'Compensation Insurance Affidavit APPLICANT LNIORMATLON Please PRINT Lesibly Name: Location: `G ( City' ��- /���' /`� L Telephone#: ❑ I am a homeowner performing all work myself. 13 I am sole proprietor and have no one working in my capacity 13 I am an employer providing workers' compensation for my employees working on this job Company Name: ~ Address: Telephone City: �_ �y �3 / Insurance Company: 0y""`policy#: 1� �� eL d %` 0 I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following workers' compensation policies: Company Name: Address: City: Telephone#: Insurance Company: Policy M Company Name: Address: City: Telephone In: Insurance Company: Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand.that e.copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do here rtify under the sins a penalties of perjury that the information above is true andZi rre ,q i ature: Date. v S gn Da /J Print Name: GL " e? Phone# ZfS LTJ Ll �, – — Official Use ONLY-Do not write in this area o Building Department M ❑Licensing Board Permit/License City or Town: c Selectmen's Office 0 Health Department 0 Check if Immediate response is required ❑Other INFORMATION &INSTRUCTIONS Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law" 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 section 25 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, 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 in the workers' compensation affidavit completely, by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Fax # (617) 727-7749 Telephone# (617) 727-4900 ext. 406, 409, or 375 Castricone Roofing & Siding REPAIRS FREE ESTIMATES Telephone (978) 682-4266 MARIO CASTRICONE 31 Court Street,North Andover,Mass. 01845 I/we,the owner.(s)of the premises mentioned below, hereby contract with and authorize you as contractor,to furnish all necessary naterials, labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and ,onditions,on p emises below described: t )wner's Name..... y ............. . . .............: .....................:.................. ............................................................................................................. lobAddress.... ../ ........ ....................�... ............................................City ... ......State.... kli ........................... SPECIFICATIONS r1 �zl ... ........... .. P4.... . ........... ............ . .........:� ...�` a .... .. . .......... . :��ic; -cam'...... ..��! .... �..... . ... ............ J �-- l . . . ..................................................................... � .... . .....................:....,... ..... -..... .... ............. ..... ........................................................................................ . T �,.... � .... � u.. ... ..... .. ..................... ........... .. . . ...... ....... .. .. .......................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................. ......................................................................................................................................................................................................:...................................................... .... .......................... ... Materials and labor to cost$ . ... . . `0............................. Payable.........................................on ..1 .. ............. ...and balance in............ nonthly installments of$.........................................each,payable on ............... .........................day of each and every month thereafter until paid n full(..............%charge per year is to be added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation and a bmpletion as requested by the contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid mmediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs,attorney fees and expenses, in addition to the amount due and unpaid,that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor;and also that the obligations hereof shall bind and apply to their heirs,successors or estates If the parties. The undersigned warrant(s)that he is(they are)the owner(s)of the above mentioned premises and that legal title thereto stands of record in his(their)name(s). PROVISO:This contract shall be void and of no effort if credit approved of owner(s).is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this :ontract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed ,y all parties. Cover attic storage cleaning not included. Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and he contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and inderstandings of said parties are contained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in operation..' N WITNESS WHEREOF, the parties have hereunto signed their names this ..............0'//A..-day of.. C_ 1- accepted: Signed......`....I..f...... .... Owner (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Signed...................................................................................... Owner ler... . . . ... .............. ... . ............................................. Signed...................................................................................... .......................................................... epresentative xkORTH . Townof over No. 4 5 _ : h 03 00 SOC LAHic y � dower, Mass., ADRATED S G` f/ BOARD OF HEALTH Food/Kitchen ijERMIT T Septic System .j. BUILDING INSPECTOR THIS CERTIFIES THAT....V.. /!!/!!��... !..L.. ..r =!.....................................�I !v............................................ Foundation has permission to erect..viv-� buildings on......� 9 4V Rough ..................... ' to be occupied as............$.... ..... ... . ...... .... .... . .... .... . . ..... ... Chimney Provided that the person accepting this perd shall in every respect conform to tterms o.f..t.h..e. ap.p.l.i.cat.ion.o.n..file.m Final this office, and to the provisions of the Codes and By-Laws relatingInspection, Alteration and Construction of Buildings in the Town of North Andover. I &�. / tote is v .00� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR Rough ........... .... - ..... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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.