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HomeMy WebLinkAboutMiscellaneous - 153 HICKORY HILL ROAD 4/30/2018 / 153 HICKORY HILL ROAD 210/0620000.0 .. . .... .... Of HORTM ,� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION -� t� n SACHUSE� ' This certifies that . . . . . . . . . . . . . . . . . has permission for gas installation in the buildings of ��. . . . . . . . . . . . . . . . . at . . . 3. . !. . 1 . . . . . .. North ndovef} Mass. Fee.30. 5?. Lic. No.45: 5' . GASINSPECTOR Check# /S/4,p77 7877 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING Ci ITown: ` \ N�Oy�� MA. Date O c�0 tY N v Permit# Building Location} Owners Name: V Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional❑ Residential New' Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No�& FIXTURES U) Lu tr Lu co Z s z I=— o W W ~ N O IY w QQ c� w W Z m 0 � W b OO Q F W 1' Q w w W z = W 1O H o = `x Z V Lu W W Z O -� 1— 1-- O Z -� (� u. Z O Q LY LU W W W m W O z 0 y F > Z I— _ 00o WOOMM O a > j > O SUBBSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7�FL OR 8OR Company �* L�,N�CN+c �p� S'y"��MS� ` Check One Only Certificate# InstallingCo1m�an` Name stn�`""" ��c S ' Corporation Addres City/Town: State: O ❑Partnership Business elq���'��{,'70'�O F �>-�3q_ ,�3 _v ❑Firm/Company Name of Licensed Plumber/Gas Fitter. 7::S INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YeAl No❑ If you have checked Yes,plea a indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ By checking this box❑;I hereby certify that all of the details and information I have submitted or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the perm compliance with all Pertine t issued for this application will be in t provision the Massachusetts state Plumbing Code and Chapter 142 of the General Laws. Type of License: [Title ` Plumber 1 Gas FitterSignature of Lic s lu r/Gas Fitter Masterown ❑JourneymanLicense Number: 3�OVED OFFICE USE ONLY ❑LP Installer 11/VG/GV11 11:oU rAA bits OdL G1.11 UXUJ5 IlNbLIXAA(1h tO002 A�`�® DATE(MM/DD/1�YYn %..-- CERTIFICATE OF LIABILITY INSURANCE 8/12/2011 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, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the poliey(ies)must be endorsed. If SUBROGATION 18 WAIVED,subject to the terms and Conditions of the policy,certain polities may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAMEDenise Cimetti : Cross Insurance-Peabody PHONE (978)532-5485 FAQ No-(978)532-2317 139 Lynnfield Street E-MAIL ,dcimetti@croaaagency.com INSURERS AFFORDING COVERAGE NAIC ai Peabody MA 01960 INSURERA:Main Street America Assur. 29939 INSURED INSURER a:National Grange Mutual Ina Co 147 B B NEW ENGLAND GAS SYSTEM INC INSURER C: 102 LOCUST ST INSURER 0: INSURER E: DANVERS MA 01923-2204 INSURER F: COVERAGES CERTIFICATE NUMBER CL1081834621 REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDPTYPE OF INSURANCE 3UeR POLICY NUMBER POLICY EFF MMInt/ EAP LIMITS LTR GENERALLIABILITY EACH OCCURRENCE $ 11000,000 _UKW�r.TO RENTED X COMMERCIAL GENERAL LIABILITY RFMl E Eaa.curm ce $ 500,000 A CUUMS•MADE %0 OCCUR MPE97478 8/18/2011 0/19/2012 MED EXP(Any one eraon) $ 10,000 PERSONAL BADV INJURY S 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMF/OP AGO $ 2,000,000 X POLICY PR0LOC $ AUTOMOBILE LIABILITY Eased SINGL LIMIT 11000,000 ANY AUTO BODILY INJURY(Per perean) $ $ ALL OWNEDSCHEDULED 9967478 a/le/2011 8/10/2012 AUTOS X AUTOS BODILY INJURY(Per aeeitlenq $ X HIRED AUTOS X NON-OWNED PROPER(Per SCOWTY DAMAGE $ Hired Car LiabilitV $ UMBRELLA LIAS OCCUR EACH OCCURRENCE Is EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS S B WORKERS COMPENSATION WC STATU- I IOTH- AND EMPLOYERS'LIARIUTY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDE07 E] NIA (Mandatary in NM) 2867478 a/18/2a11 e/19/20]2 E.L.DISEASE-EA EMPLOYE $ 100,000 iryea Cescdibe under DESCAIPTION OF OPERATIONS hclow E.L.DISEASE-POLICY LIMIT Sr 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schadule,It more apace le required) Refer to policy for exclusionary eudoraement:a and special proviniona. CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 6E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Towel of 17. Andover ACCORDANCE WITH THE POLICY PROVISIONS. Rick Danforth, Plumbing & Gas Inspector 1600 Osgood St., Ste #2-36 AUTNORIZEDREPRESENTATNE Bldg #20 N. Andover, MA 01845 y Timothy Tramonte/DCI ACORD 25(2010/05) ®1988-2010 ACORD CORPORATION. All rights reserved. INS029(201005).01 The ACORD name and logo are registered marks of ACORD _ COMMONWEALTH OF MASSACHUSETTS; { REGISTERED AS A GAS CORPORATION hh ISSUES THE ABOVE LICENSE TO: CONTROL# GU16968 I BRUCE` J LIPINSKI IMPORTANT i NEW :ENGLAND GAS. SVSTEMS IN.0 -` ; If this license is lost or destroyed, notify your Board at the: 0 2 L 0 C U S T ST' Division of Professional Licensure, 1000 Washington St., 7th Floor,Boston,MA 02118. !I -DANVERS MA 0:1923-2204 If your name or address shown is changed,notify your board 3 .99 05/01/12 784657 of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. i This license is subject to the provisions of the General Laws 1' as amended.It is a personal privilege,and must not be loaned I — — -- --- --- ---- ----- -- or assigned to any other person. Keep this license on your Iperson or posted as required by law. WARNING THIS DOL-0 ENHANCED SECURITY i:. t, ;t�, COMMONWEALTH CIF MASSACHUSETTS , .... ... CONTROL#15 11 - IMPORTANT � SWNW If this license is lost or destroyed, notify your Board at the: .LICENSED AS A MASTER,GASFITTER Division of Professional Licensure, 1000 Washington St., ISSUES THE ABOVE LICENSE TO: 7th Floor,Boston,MA 02118. i our board BRUCE J ,LIPINSKI .' If your name or address shown is changed, no y ' of next of correct name or address to insure proper licensegnurnber. i02 LOCUST STREET Renewal Application. Always refer Y This license is subject to the provisions of the General Laws as amended.It is a personal Privilege,and muslicense at not be lo nedr D A N V ERS MA 019 2 3—2 2 0 4 or assigned to any other person. Keep thisPerson or posted as required by law. `3735 05/01/12 784661 WARNING THIS DOCUIItL N?+� ENHANCED SECURI" }E -- f` � • • I 1� `i r 1`� Date.. . . . NORTH Ir TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SSACMUS' This certifies that has permission for gas installation in the buildings of .: l—�J.:� -P/ �x-,�,tPa�..�.. . . . . . . . . . . . . . . . at , North Andover, Mass. Fee�t7. . . Lic. No.A'(9/<.!. . . 1, . . . . . . . . . GAS INSPECTOR Check# U 68 *i4 IR MASSACHUSETTS UN FORM APPLICATION FOR PERMIT TO DO GAS FITTINGType or print) Date 44 NORTH ANDOVER, MASSACHUSETTS // ! / Building Locations 3 C 1�2� P; l I L) Permit 9 7 7 // Amount S � �' Owner's Name W O New❑ Renovation ❑ Replacement Plans Submitted ❑ n = y Z sua -asE .vlEN -f - BASE .vI ENT I I I 1sT. F L 0 0 R I 2.N 0111. F L O U R 3 R D . F L O U R .tilt . FL00It 5 T Ii. F L 0 u R 6 T II . F L U O R 7T It . FLUOR I ST Ii . FLOG R (Print or type)jj Ir /� �/ ! Check one: Certificate Installin Company Name 64'1 4et l r/u /y wl CJ/�r ❑ Corp. Address C) Ie o X 2-(0 ❑ Partner. ,U Business Telephone 3 q Si_ov ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter -e t�-Q 7ZT, c,-/( INSUR.-kNi CE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ Ifyou have checked ves,please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Nlass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owners Arent Owner ❑ Agent ❑ 1 hereby certifv 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 pertbrmed under Permit Issued For this application will be in compliance with all pertinent provisions of the Vfassachusetts State Co and Chdoter 142 of the General Laws. Bv: Signature of Licensed Plumber Or Gas Fitter Title Plumber >o o City/Town ❑ Gas Fitter (cense Numoer Mastery. CT6, APPRO`"ED uHrlc;:usF Ir+i.v) ❑ Journeyman Date. . . .`'.°�. . 4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �Y•,�O��r�°�I�(9 SSACNUSE� This certifies that . . . . .... has permission to perform . _. . . . . . . . :: . .: . —4.. . . . . . . plumbing in the buildings of . .�llU � �-r-�1c�r�!�. . . . . . . . . . at 1,5.:3. .4 lt.r:P:. . . ., North Andover, Mass. Feeq`--:�':. .Lic. . r.,f . . . . . . . . . . . . . PLUf�81Nii INSPECTOR Check N �n 8 ,166 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS BuildingLocation 153 I� C /Ga A `t � /� ' Date � d � Owners Name Ws7/X-41 Q.o, Permit#�Q/G G AmountSD Type of Occupancy 40 "- ?';L New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES H z z as i � A W w z 96g 3 a w A sLIB.»c RSNEvr 1E fffm. M FLOOR 3RD MOOR 4IH FLOOR SIH FIDCIR 8IH Hi" 7M H-OOR SIH FLOOR (Print or type) l Check one: Certificate Installing Compan Name 4grit/`iLk P/v L I li ❑ Corp. Address Partner. o? usmess Telephone _d OP y Firm/Co. Name of Licensed Plumber: --e /� CCC Insurance Coverage: Indicate the type of insurance coverage by checking theappropriate box: Liability insurance policy Other type of indemnity [3 . Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performeunder Permit Issued for this application will be in compliance.with all pertinent provisions of the Massachu etts St 1 Cade and Chapter 142 of the General Laws. By: Signafure o7 1-icensea rtilluer Title ype of Plumbing License City/Town /o P/o APPROVED(OFFICE USE ONLY icense Num3er Master Journeyman 6 - 1 r Location • No. Date NORTH TOWN OF NORTH ANDOVER OA p Certificate of Occupancy $ MM . s ; . Building/Frame Permit Fee $ �s04.srepuSE< Foundation P�Fee $ : Other Permit Fee Sewer Connection Fee $ Water Connection Fee z TOTAL $ i . CJ J Building Inspector 6 3 4? Div. Public Works = Location No. 2 U� Date S h a of N°oT:,tio TOWN OF NORTH ANDOVER A Certificate of Occupancy $ - > Building/Frame Permit Fee $ s o� .«�.....�'� • f� 1. �7-'^3 Foundation Permit Fee s�CHus Other Peimit Fee $ Sewer Corn�ctian Fee $ ►� { ' j 3 46 I ter Conne dn'Tee15\ $ TON $ ' Building Inspector 6250 Div. Public Works A Location • ` c No. { Date „ORTH TOWN OF NORTH ANDOVER 3?O�,?``D ••,BOOL A Certificate of Occupancy $ v + ; + Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ "Y Sewer Connection Fee $ --�----- <j " -- < TWa� nnection Fee $ QUtf 'TOTAL $ �.�i�� , a C) 3 Building Inspector 6139 Div. Public Works Location No. 0 Date s `.r - �7 NORT1t TOWN OF NORTH ANDOVER ` O� of- Certificate of Occupancy $ * ; } Building/Frame Permit Fee $ .',Foundation Permit Fee $ ACHu`aE - Other Permit Fee $ -Sewer Connection Fee $ IV.403onnection Fee $ Z r TOTAL $ Building Inspector Div. Public Works ' f L PzxitIT 4o. d 0 I APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. Alp QPAGE 1 MAP +40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE ��7 SUB DIV. LOT TNNO. I7ley ) LOCATIONAI7 / PURPOOF BUILDING Oa D(j- O'WNER'S NAME r� SE T' ' NO. OF STORIES SIZ T/��,� f x� /f7s OWNER'S ADDRESS 1 v-� I ,`/ BASEMENT OR SLAB IAA 0A*,U ARCHITECT'S NAME o� /l y„�y SIZE OF FLOOR TIMBERS pIST -� L2ND `� Flo 3RD BUILDER'S NAME r•�l SPAN 1 n/ `I (✓` � 1 G� DISTANCE TO NEAREST BUILDING .;.r) �� DIMENSIONS OF SILLS y- DISTANCE FROM STREET ✓ ,.I POSTS1� DISTANCE FROM LOT LINES-SIDES /� REAR IOD� GIRDERS /1/2��� J AREA OF LOT '? �, � (� FRONTAGE /D� HEIGHT OF FOUNDATION ` �IG THICKNESS 1G�/ r IS BUILDING NEW �0�� J_ SIZE OF FOOTING 0 �� X /) r 14 IS BUILDING ADDITION `J4 MATERIAL OF CHIMNEY IS BUILDING ALTERATION )J6 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE LieAP9IS BUILDING CONNECTED TO TOWN WATER '%�1 64 4 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER �I��e_ IS BUILDING CONNECTED TO NATURAL GAS LINE><S � INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST / C ��3 SEE BOTH SIDES ELM rowe �y/ EST. BLDG. COST *6103 PAGE I FILL OUT SECTIONS I - 3 r D Q U EST. BLDG. COST PER SQ. FT. ` PAGE 2 FILL OUT SECTIONS 1 - 12DUE ��r/ FRAME PERMIT � �' A O v EST. BLDG. COST PER ROOM �J rQ r Q SEPTIC PERMIT NO. ELECTRIC METEPS MUST 8E ON OUTSIDE OF BUILDING /y-�_�•/ 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE GULATIONS PLANS MUST BEFIILED AN p APPROVED BY BUILDIN SPECTOR DATE FILED t BOARD OF HEALTH SIG RE OF OWNER AUTHORIZED AGENT r . nn f. FEE r dV � R OWNER TEL. .]r PLANNING BOARD PERMIT GRANTED CONTR.TEL.# E7 7z t9 � _ CONTR.LIC.# WARD OF SELECTMEN C* 3 . / / �� ::------ BUILDING INiPECTOR BUILDING RECORD I OCCUPANCY 12 SINGLE FAMILYSTORIES 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 a I 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY VJAII � p UNFIN. 3 BASEMENT AREA FULL FIN. B M TAREA _ 4. 1/1 '/, FIN. ATTIC AREA _ NO B M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ t WOOD SHINGLES EARTH ASPHALT SIDING HARDW 0 ASBESTOS SIDING _ COMMON K _ t VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. 3 FLOOR _ w� •=a + S�'N' 'BRICK ON FRAME I w, f� CONC. OR CINDER ELK. __ •�.w.+.-.w-� � NONE ON MASONRY WIRING STONE ON FRAME _ - •=` � t� SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) Z GAMBREL MANSARD TOILET RM. (2 FIX.) FIAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY kWOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES t TILE FLOOR TILE DADO r 6 FRAMING -1-1 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. .r ° TIMBEFrBMS7&COLS. STEAM STEEL B COLS _ HOT W'T'R OR VAPOR WOOD RAFTERS AZ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIt B'M'T 2nd ELECTRIC 1st 13rd NO HEATING Y� 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: DVI/itS .� 7t1l� hQ� Phone b '7 ZK3S� LOCATION: Assessor' s Map Number Parcel Subdivision / ! , .faro / J Lot(s) Street St. Number IBJ 3 ************************Official Use Only************************ RECOMCMDATIONS OF TOWN AGENTS: Date Approved g Conservation Administrator Date Rejected Comments Date Approved zL Town Planner Date Rejected Comments Date Approved �` 3 Health Agent Date Rejected Comments Public Works - sewer/water connections OL - driveway pe. it Fire Department ` Received by Building Inspector Date CERTIFIED FOUNDA TION PLAN . LOCATED /N No. Ampok/ER. MA. SCALE: /"_ 'a•�` DATE �•2493 Scott L. Gi/es R.L.S. 50 Deer Meadow Road - North Andover,Mass. .�D.D o' �G 5 F JUL .8 / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE `S+ THE OFFSETS OF THE BUIL DING /NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE/S FOR THE W/TH THE ZONING DETERMINATION OFZON/NG BYLAWS OF CONFORM/T Y OR NON-CONFORMITY �' tR MA. ,_ WHEN CONSTRUCTED. um WHEN BUILT C,0_ 93 i NORTH Town ofAndover � 0% ,,(7 ♦■ C. 1\o. 0 dower, Mass. v w 19 '� COCHIC f f ADRATED ,9S H WLBOARD.OF HEALTH Food/Kitchen PERMIT T D Septic System A d 4r BUILDING INSPECTOR THIS CERTIFIES THAT .. .., V .. ./�►.� ................................................. THIS Foundation has permission to erect&49AI ... buildings an ItriA.P! 0A.S.� ....NaL..•X.0•••••. Rough to be occupied as. I..A�i. .. �. � .... .�,� .. �............. Chimn y e throvided that the person accepting this permit shall Ove respect conform to the terms of the application on file in Final is office, and to the provisions of the odes and By-Laws relating to the Inspect* Alteration and Construction of Ft a Buildings in the Town of NorthYdo; �¢p� pERh;t r svi� r vulvLat PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA 114.8-S. B.C. Rough PERMIT EXPIRES IN 6 MO. S $% Final PERMIT Fob FRAME' ?.JEE Pum d ELECTRICAL INSPECTOR SS CONSTRUCTION ��� d IN PAID • Service Rough ATEAML BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL '//3a- CONSERVATION FINAL Street No. L'��� Smoke Det.. RFWFR /WATFR ___FINAL/o/3 9 , _ 9 DRIVEWAY ENTRY PERMIT (WFICIH�s OF. Town of, NORTH ANDOVE It BUILDING ::' ••�. ' hl.i�;�cii liir. fl:t►It4i (:.()NSI I t ATION `�`� I►IVI:;u►N t iF 1 71 oii .1; !; Ilia\1:1'11 I�i.�wlvttv(; I'LANNING. (;t)(1IAWNYYY Di., VIA'or-Al . N•1• KA t1 N 11.11. NJ:I.ti( )N. I )II tl CHIMNEY APPLICA11014 ANO I'L13111' ATE PERK 11'. # )CATION co7— (y3 lrli/ UNER'S NAME: 1ILDER'S NAME: SON'S NAME: %SON'S ADDRESS: (-7)C17 vl 1 k� LA i(/ fi ler .SON'S TELEPHONE: �q y337 JERIAL OF CHIMNEY:_ IFERIOR CHIMNEY: �a^r CIA L'XI LRIOR CHIMNEY: ll*t R. AND SIZE OF FLUES: fICKNESS OF HEARTH: chun)tey arc. OiAen.Cace ca)t(unul to Mlle imiu.i)Ieme►I•ts u( the cude a)Id have Atice.3 dill .gutat.Zo us been neeetved: .TE: .G NATURE OF h1ASON: ` _RMIT GRANTED: FEE , D 'BERT NICE-TTA ILDING INSPECTOR SPECTEO: -AIARKS: SOLID BLOCK 11LQUIItE1) THIS PERMIT MUST• GE VISPLAYLO 014 111E 1'RL1,11SES r CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 4 Date THIS CERTIFIES THAT THE BUILDING LOCATED ON �651Z-- a MAY BE OCCUPIEDAS mow.- e-4IN ACCORDANCE WITH THE PROVISIONS OF TH9 MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO 0 r 7 n ADDRESS n� _ Building Inspector NORTH Town of And I dower, Mass. w� 19 19 7 A0RATE0 P'P�\�'�� '9S BOARD OF HEALTH T D Food/Kitchen PERMIT Septic System 7I9,3 A.6 Ir UILDING SPE TOa THIS CERTIFIES THAT... �.. ., .j.... �.. 1 ........................................."""" F undation o— bL , WC- has permission to or � V ... buildings on ./..,�3/. #d .....R ... �• ••• •••..• Rough�,,/WC- 7`a � � d to be occupied as.,FI..Pj.6.1!!.1r.. �. � .... ... ChimneydA/0 - d rovided that the person accepting this permit shall �ve respect conform to the terms of the application on file in Final P P P 9 P every P this office, and to the provisions of the Codes and By-Laws relating to the Inspecti Alteration and Construction of ep-4 &�c Buildings in the Town of North dov �t pIC PLUM GIN EC in Regulations Voids this Permit. REGULATED BY PARA 114.8-S VIOLATION of the Zoning or Buildg . B.C. oug PF_, IT EXPIRES IN 6 MO S _ PA'o � PERMIT FOR FRAMEAP ' SS CONSZ�IZUCTION P_d ELECT ICAL INSPECTOR • Rough r . . FEE PND+ ( ` Service BUILDING INSP CTOR Final i A— Occ-upanqyq Permit Required to OccupyBuildinglJ a*_ GA PFCTO PnaDisplay in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done FI EPARTMEN Until Inspected and Approved by the Building Inspector. Burner PLANNINGFINAL /l3a' CONSERVATIO FINAL Street No. l D r � 03 Smoke Det. CCIA/CR /IAIATGR ���) 7a/. F���A� 1, 1-317 cam--- DRIVEWAY ENTRY PERMIT61-71) Of %►ORTH 1 BUILDING PERMIT <tu•' "o TOWN OF NORTH ANDOVER 0 - of APPLICATION FOR PLAN EXAMINATION , Permit NO: � Date Received � � �,yss Arm* Date Issued: IMPORTANT: Applicant must complete all items on this page ' S������ ����+�� ��4 ��ll������I�Y' � � 6<��f � �jM����^m•.M"' �m✓3 ..�_ H'- i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ,90ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .���a •-.' � �� ��'� �'� �.r'Y� , � ,° £ 4 � X55„�.:�.�' {�� s� ��, • kYpt, x s N f.. - ^' f x e - DESCRIPTION OF WORK TO BE PREFORMED: t e. a i 1�1iD v �-- Identification Please Type or Print Clearly) OWNER: Name: ?)r i 01^ -oo 1 � n Phone: $7 - 6 (97 Address 15 �`�I G `« AI W-nf °u ➢ '. 14 4 d yfMr rt. �r� ��e�� }.+�:� ��i1��it���1�iR1r�i�ar�S'�r _ a^ � ` y � � 1iMw+� �a.L��✓r ,��.a � -e �. r,. j e § ort�1 / g 1�1ccl1 .int 1 � , sm a o ©• I F 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: $ 149 L 0 . v FEE: $ y Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund C � Sign of A ert�Owngr Signature cif.catractor 9 __ - . J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ k THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS i DATE REJECTED DATE APPROVED HEALTH ❑ a ' COMMENTS Zoning Board of Appeals: Variance, Petition No: , Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Located at 384 Osgood Street Driveway Permit I=1 ©EPARMNT TetY131tripster ah yes pr Lasted at 124-Mbirt Strut 3 till t#t Si Ott d/d dt ; llh — E.. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i ; ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A–F and G min.$100-$1000 fine No NOTES and DATA— For department use ` i ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 ,� Location / .� ol No. = i DateS�"�"7 NaRTh TOWN OF NORTH ANDOVER s A Certificate of Occupancy $ CHUSE<� Building/Frame Permit Fee $ �4• °`� .r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �. Check # Building lns ctor xAORTH Town of No. 13 • o LK o � over, Mass.,- 1104 7 COCHICHE WICK �- 0RAT E D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THATPAO ..... ... .......... ....... BUILDING INSPECTOR .......... ....................................................... ... � ........................................ Foundation , has permission to erect........................................ buildings on ..... Rough 4 .•.. ....... ... .......................... to be occupied a ....... Chimney ...................................................................... . ................................. provided that the person accep ng 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 CONSTRUCTIO TARTS ELECTRICAL INSPECTOR Rough r .......... Service BUILD IN...SPECTOR........ . Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE J1 Smoke Det. Town of North Andover tAORTp{ 16�`'O Building Department 27 Charles Street North Andover, Massachusetts 01845 ; •�yy, " A i � (978) 688-9545 Fax (978) 688-9542 Or IOCHL A K[ pDRA'r1D � SACH0 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location Signature of Applicant Date Aq NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Build ers/Contractors/Electricians/Plunabers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C� LL..c, �`(1 w ne— Rp©A6 nG 4 S i Address: r.2-00 &Al a rs SAc+ - SjAi -Z-Z(. City/State/Zip: N p. Af-&W M A d t I qS Phone#: 9"? 6 3 3`{Z o Are you an employer? Check the appropriate box: Type of project(required): 1.)6 I am a employer with % 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El 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 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]I employees. [No workers' comp. insurance required.] 13.[:] Other *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 tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy infonrnation. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1 Insurance Company Name: Policy#or Self-ins. Lic. #: VWC �OO 1 a OO o2Q 4 Expiration Date:_ 9%0? Job Site Address: ► (` /n City/State/Zip: n Attach a copy of the workers' compensa ' a policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiresi 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-yearimprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: � �' ,�' Date // / /0 c.M.. � Phone#: l Q 7 Oficial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• i 7fie �anirrzaruuecai a�✓T/`aavac�uaelta Board of Building Regulations and Standards - License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 104569 Board of Building Regulations and Standards Expiration: 9/14/2008 One Ashburton Place Run 1301 Typg; Private Corporation Boston,Ma.02108- - DAVID CASTRICONE ROOFING,SIDING& J" David Castricone 200 SUTTON ST SUITE 22.6 �p NORTH ANDOVER,MA 01845 Deputy Administrator Not valid without signature l i DAVID CASTRICONE CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In HaverhMI 978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on pre ' es below described: ribeed: y�/7 / f Q L Owner's Name.... 5 A.Ie x......(lt/. Tel one#..... 11..L..........n..�1:..1f..'�.... Job Address....l.` /.....1/.C.�o-l.`.. ...�l..l.l....l�.d�.......city..../.5,/6,—. O..yl e l ............Staie......,(.:.11.T...... Specifications: ............. ...................C�l.�C. ...., ..�.. ,../x.1.. ...............1! e**...'R••..... bt 5 --G ....tn.............. ..GYr t7.rin o.... .. /! .e................................................. ............................................ ....... ... ... ............................... �. 1 r ....�. ..J`.1. ........Ccran.�r. . r�. l......�. . a..(, .....�....5... .f: . (� .Q......�t..rt......��`t �1*1* . ......�,J�,.r.... ... ../� .. ....iti 2.. . . ......./� r.... a �.. t!.... ... .r....... .c e ...... . . , R, ...0 .:...... ...e ...v.. ...................................................P, ........ ..q. . ... ................. p r �.�.. ,�. ..................... .. ........................................... . ' .............................. .........................�........................................................................................................................................................................... �d� P W G0� s ��,ce� Far �r se,c�V �, �-� Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specified by ma ufactUZy2 The tractor agrees tpp perform the work anthe materials specified above for the SUM of S..........�... .`�lx............. (UPayable.....�Z.Jx..................on...... ..... Payable..........:=.............on.......—'*................e $alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability w e! rs Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above(i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces). Items in attic may need to be covered by homeowner.All materials are property of contractor. Any dumpster placed by contractor is for his use only.Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(thew)above obligation as requested by contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and payable. It is agreed that,if permitted by law,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid,that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith.It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrant(s)that he is(they are) the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(s).'[here are no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:Director,Home Improvement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work.. i. � /. l�1.�.1. W c Pk W I �j....o f$1 CQ( ............... ....✓.. Completion date.. .................................... 0 Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Owner has three business days to cancel this contract and incur no penalty (see notice of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this..................day of............................20........... Accepted: c� Signed...... :. ..(/:. ... ...................................... Owner Signed............................................................................. Owner ................................................................... David Castricone,President