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HomeMy WebLinkAboutMiscellaneous - 155 BEACON HILL BOULEVARD 4/30/2018 155 BEACON HILL BLVD lS� 210/045.8-0058.0000.0 INDEPENDENT CLAIMS SERVICE, INC. Service • Integrity • Experience Notice of Casualty Loss to Building Under Massachusetts General Laws,Chapter 139,Section 3B 12/06/2017 North Andover,MA Building Inspector 120 Main Street North Andover,MA 01845 North Andover,MA Board of Health 120 Main Street North Andover,MA 01845 North Andover,MA Fire Department 124 Main Street North Andover,MA 01845 INSURED: Ruth Caisse -ADDRESS: 155 Beacon Hill Blvd,North Andover,MA 01845 LOCATION OF LOSS: 155 Beacon Hill Blvd,North Andover,MA 01845,US COMPANY: The Commerce Insurance Company POLICY#: Bhcyvm CLAIM#: 17-73952 DATE OF LOSS: 12/06/2017 TYPE OF LOSS: Fire Dear Sir or Madam: Independent Claims Service is the insurance adjusting firm hired by the above referenced client to handle the captioned loss on behalf of their insured. A claim has been made involving loss, damage, or destruction of the above-captioned property which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please bring it to our attention, and include a reference of the captioned insured: Location,policy number,and/or date of loss. Sincerely, INDEPENDENT CLAIMS SERVICE,INC. 22 Water Street • Westborough,MA 01581 • 508.366.8535 • FAX 508.366.091 7 • www.icsclaims.com f5 �/lLocation f!/�O/7 No. Date !/ j I 1 • - TOWN OF NORTH ANDOVER . _ Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#TZ� 27093 Building Inspector i I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO. Date Received Date Issued: ti C I' PORTANT:Applicant must complete all items on this page -- ip4d LOCATION. _ _._ P};'nt PROPERTY OWNER Zl � -- Print 100 Year Old:Structure yes n661 MAP NC�PARCEA ZONING DISTRICT Historic District yesMachine Shope yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building a-One family El Addition El Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic 0 Well D Floodplain D Wetlands: ❑ Watershed District - D Water/Sewer- DESCRIPTION OF WORK TO BE PERFORMED: r� rob a r Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: . ,= 1_ _ P CONTRACTOR Name: v Phone:__ S-1 74 �fiL T I Address: Supervisor'sConstruction License:-, ' 0 J`t Exp. Date: HomeImprovementL-icense: 1dC � _ _ Exp. Date- ARCH ITECT/ENGI NEER ate;ARCHITECTIENGINEER 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: $ �� J</ t0C) FEE: $ Check No.: Receipt No.: O NOTE: Persons contracting wath 4nregistered contractors do not have access to a uaran fund A Signature of=°Agenf/Owner _ . - Slg�ature of contractor - _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Sta ed Plans ❑ Building Department The fol'owing is=a'li'st of the required forms to be filled out for the appropriate permit to:be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit D Photo Copy Of H.I.C. And/ 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 o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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 o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.ted with the building application Doc: Doe.Bui?ding permit Revised 2012 I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ -TYPE OF-SEWERAGE DISPOSAL Public Sewer ❑ Tg/lvlassage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private.(septic tank,etc._ F Permanent Dumpster on Site ❑ HE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING &DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature I COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Tow:. Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT =Temp Dump'ster,on site yes -.no Located*at 124,Mair,,Street - 'Fire-Depa""rtme�if signature/date'' ? COMMENTS �a ..Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. .Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL-Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use ® Notified for pickup - Date Doc.Buildin e g P rrrtit Revised 2010 NORT1� Town of Andover I o L.K. h ver, Mass, L J11 COC NIC R­CK �,4 4�R'�TE D ►.P�,,�'�y S l! BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THATA..U4L.......Ifu,.s, - BUILDING INSPECTOR .......... ............. ...................................:............................. ' Foundation has permission to erect .......................... buildings on .... !........ ..}} Rough tobe occupied as ... ......i✓1.....(14on"O...... �• ......................................................... Chimney provided that the person acc/cepting 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIgT TS Rough Service ............... . ....... ......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE The Commonwealth of Massachusetts - Department oflndustrr'til Accidents Office of Investigations IMF 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le tbl t Name(Business/Organizationgndividual): PAddress: - City/State/Zip: Phone Are you an employer?Check the appropriate box: Type of project(required): 1.V31 am a employer with J 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g. ❑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,kloof repairs insurance required.]r employees.[No workers' 13.❑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 aie doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that checkthis box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: lD l l A � Job Site Address: t/ Pity/state/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Izereby cert' er the pains a d penalti of erjury that the information provided above is 714 and correct. Si afore Date: Zj Phone#: Official use only. Do not write in this area,to he completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express 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 adeceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any'given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho Commonwealth,of Mossachuseutts Department ofJndustrial Accidents Office ofInvcstigatimus 600 Washington Street Boston,UA 02111 Tei,4 617-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia I WOOSTFR ROOFING PROPOSAL Id ALL TYPES OF ROOFS DATE: 4/26/13 &ROOF RELATED SERVICES Always Hand Nailed License Numbers: Charlie and Steve Wooster Construction Supervisors 54268 One - 1-888 ROOFIN-1(766-3461) Home Improvement Contractor Main:978 251-7181 Registration 100712 Serving MA&NH since 1984 Fax:978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Ruth Caisse Name Company Name Company Name Street 155 Beacon Hill Blvd. Street City No.Andover State MA Zip Code 01845 City State Zip Code Home#978 688-4250 Mobile# Work# Fax# We hereby propose to furnish the materials and perform the labor necessary for the completion of the following job. Strip the entire house roof to the roof deck. 1. Renail any loose decking and replace any rotted at$2.00 per foot. 2. Install 8"white aluminum dripedge. 3. Install 6'of Grace Ice and Water Shield on all eaves. 4. Paper remainder of roof with Grace Tri-Flex roofing underlayment. 5. Install Certainteed Landmark Lifetime shingles,hand nailed. 6. Install new lead flashings on chimney. 7. Install new vent pipe flanges. _J 8. Replace skylights with Velux M02 with+k*Kvut blinds),;;WL-40 411.Sc' �C 9. Install Shinglevent H ridge vent. 10. Clean and dispose of all debris. Workmanship guaranteed for 10 years.We are fully insured with workers'compensation as well as liability insurance.- Please nsurance.Please return copy of proposal: All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications submitted.All work will be completed in a substantial workmanlike manner for the sum of Dollars($9,750.00), with payments to be made as follows:Job paid uppn completion. Respectfully submitted Note-This proposal may be withdrawn b&if not a6cepted within A da s. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted_You are authorized to do the work as.specified_ l /J Payment will bema as outlined above. �te .F if — /3isn�afe /1 P Mailing Address: P.O. Box 8051 -Lowell, MA 01853 Location: 525 Woburn Street-Tewksbury, MA 01876 E-Mail:Info(@Wooster-RoofinjZ.com Website:www.Wooster-Roofing.com t •.Y j 1 L r � �tl�*,�tk} ,rr '1� ' "y4y � .' a•}a� !.t a , {'' 1 p� ,` ._ :r <:.1 c� dt/k;��IS 1 ,. 't DATE IINM/001YYYY) ICATE OF L.{ SLIT INSURANCE 10121/2013 tHIS CERTIFICATE IS ISWO A5 1A MATTER k§iOF INFORMATl60 ONLY-IAND'COiJF�fIS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS iFiCATE NOES NOT AFPiRMATIVtLV OR WE TIVELY AfaiI3 K, EX'C IIb OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IgELO'k Tkl6.CtFm0id, OF MURAkE lbOEi'rNOT to"w ? A 0000A& BETWEEN THE ISSUING INSURER(S), AUTHORIZED AS &I+ktENTAtIVE 60 PhOT�W64 Alibi THE d'wriPIptA`► 0!4F�r_ IMPORTANT: If the Certifiobtit holder is it ADDITIONAL INSUREDf the cy(les)Must be endorsed. If SUBROGATION IS WAIVED,subject to Oht,ti lns and 66rlditI6M bf the 0;p i6V,eertatti odlleles iney ret)Lth- :# bttski tl•nt, A statement on this certificate does not confer rights to the UF 1''���#fI 3•�, bi �`r In'liii+t�'b#atii tt'�K`aft�rli , flt}� *�3 :'>, '� ,r•+� -7-7, Ar. sy �''31ry1' = aid MC VY �lOy s RIlei i11s11f�tic'�a, " f } ,t } (^1 �c1 ! - FAX 4I,;Vhlntbn StIu1 I )I L 81 00 Ac No: 81-8 3- 07 P l coif i$7984 i * Lt$* b Ire` I C' eene rl I Com I -yi t' J z INSURERS)AFFORDING COVERAGE NAIC 6 3 5+ 31' S , nsurance Cornoan 1325 _ INSURED WOOST„1 INSURER 6:Star surance Corrny Charles J Wooster dba Wooster INSURERC: Roofing I IJRER 0: PO Box 8051 Lowell MA 01853 iNbUll E: viN$1lF: COVERAGES CERTIFICATE NUMBER;125526(g REVISION NUMBER: THIS IS TO CERTIFY THAT HE POLIC ES OF NS R N E LISTED LOW E BE ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUTAEMENT,TERM OR CONDITIONbF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY.PER'TAIN, THE INSURANCE Aftbildibi BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXGL05IONS AND coNOrnoWs OF SUCH PC_3LiCt�S.LUITS SHOWN MAY;HAViiE ftE'N REDUCED BY PAID CLAIMS. INSR �- POUCYEFF POLICY EXP LTR TYPEOFINSURANCE D POLICY UMBE MDDIYYYY /DDI LIMITS A GENERAL LIABILITY PA0003583 0/1712013 10/1712014 EACH OCCURRENCE $1,000,000 DAMAGE TO HEN It X commERCiALGENERALUAbIUTY . PREMISES aoccurrenoe $250000 CLAIMS-MADE I_-„I.0CCUrt , MED EXP(Any ore person) $5,000 PERSONAL&ADV INJURY $1,000,000 +' GENERAL AGGREGATE $2,000,000 Y .Ir i ri1 i�Fra€3tC#AT1 LkFa111Ufi3t1t31 #� r - , C w I PRCNri)CTS-COMP/OPAGO $2,000,000 $ COMBINED Sill LIMI I A Al T(W0141.9 UAsiiJtY iv1A t3bi9ib4 's '` t1117l8U1 i 10117/2014 a t Ea accldet3l $1,000,000 t a , Ix r t. ANY f}k1!ft7 ' t 1` a a T 4 1 ' 3+1 .'r°' aI{ U” i{i l k d i. BODILY INJURY}Per pert $ rr AtLt?tVNEFTi 34^.Fi1=t111L1d1 s 1 b,,..?;! 4 ... 3 r i f AWVt. Y � BODLV INJURY(F'er acciilerd) t z, tNtl�l- s''�N ,,3gg' a 'l j:' t �" t � r�I>fCs T�r 1 r i PROPEflTY DAMAGE '- ----- i H* 03d17f30.} A 431 �''. ; +s' $ ! eL J , +fi s Sw 1' sit ( 1 l � F'graccklenl $ a �i B �� o '.i ')i°� .'iM �,�ti� I , ,tRr-•.'t r +. � . r.1 °�sl /(w •sL' I $ `t A-'.J;Irl 01a1tlri&LLA11A0' x ' '. C111#,;1A.+as;r:,d 1„ilii #9fi7 ,' is '3.', ',,, 11i/til 1)13' ', 0/17!2014 EACH OCCURRENCE $1,000,000 sr K r r- - .s�,r ``-rr e 4 / r 7 q y- z �f"+^5�r1'yr• ALurlt�Alt �I,000,000 } WC STATU TH- 1 ra 1�q RrKrEf4B I,i A�gavp {�y- 4—s w 1{3••� r .w ..w uw ,, t)/17t20i i 0/17/2014, X .. w ^X'�t"d+Ip:i►YR�L1AiN1r E.L.EACH ACCIDENT $2,000,000 is 4d4t%',t it ihE.L.DISEASE-EA EMPLOYE $2000 000 it t{Bff pLr "+-,.. +, -^ ELDISEASE-POLICY LM IT $2000000 S Yj dts4 t�l � ar� 1f �tM 1 ? # 1 1131 181 r'4't $ i `+ 1L17J2013 10117/20i4 tr i . .. .�'-"r-' <�-.'t i S•�e a ;re Jr --”tl '�.k'$9t�i �'�� i r .:;1:j'. 4tr.60I,ibi,16i ERlkT10NeiLOCATibm/V€HILL€SIAIth6hAGOhbibl Asldillohatl;tflntkE FsL°IAli ;tlirioreObcelsrequired) 6 4 ' r' . . P,F,...,..its •d„ M , (,' - dA..' 3 Ott "kl $ R t N t?• 1 '3 ti.pj S . t r '� •�,. �'.� 3� T4YV 1�y '� r }It'�;''l r � "It"��r 4 , i�ANdE LATION .. `—T..'.;1r1b' t ' SHbUW ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ` k 1 4 n l TNl t;XOIRAIION DATE; THEREOF, NOTICE WILL BE DELIVERED IN n v �� x'= to,, I L , Y , Y rhpli3 I t A i NUANCE WITH THE POLICY PROVISIONS. 1 @ f4 wN r• t 1 ''t'` ,i . . A_a H.._ � F, q 3 _ is • o, %`.;" o11i'rH11n11~Eb I7Ef51iES`ENTATIVE �t J$4 Ea".,{re wrmdi1 d,g+- f �� '. wT +r lro +• y/,. + ..,,, is Ffi .? I > -� �' G 'ad' ik S Ire. ' •§ - °4 1 'i 1131'' s L RisdF+l4 r w t g , p -t 1988-2010 ACORD CORPORATION. All rights reserved. � "t§ � a t 1 , , ` i Ira i �i t*aj h 13 L �J�llSai tlaltte h►'sf (b a I ajf fl d iVks of AdbRD +'s t aaa r 1 d�y 5 r J t yrw f3 1 a{ + , 'f .>x r111• f{a ay li .lY a, ,.➢J 'tJ, n 'Y''4+i� a t § t•, ' ., 't',1 r" b , Lit j. 31 g( I t r3 °" e x #� -; . . I I. 'Y4 td �' +t•{•. .�- tp , Mal tA.��4 -:, �J•� •5� }�1�" �-# 1 tel: +�•. , it '•S "}r } C ,1.,' a/' 1 n.°,e., 3 ta,;..;� ' �'",� I �'n { t,:. i �. .�• a :+.,t,,tsa�yEK� sy,r:-ts',c aa �+, I ) E �=~0 Office of Consumer Affairs d Business Regulation Fi Lr`' 10 Park Plaza - Suite 5170 'may Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100712 Type: Supplement Card CHARLES J. WOOSTER ROOFING Expiration: 6/23/2014 STEPHEN WOOSTER 525 WOBURN ST TEWKSBURY, MA 01876 Update Address and return card.Mark reason for change. I1 •:; 20M-05111 E] Address [] Renewal E] Employment [,I Lost Card �.._� '✓ ��Li' �Cy7/2'�!G'if'/ii��GLi'G'�� V'' l.'�%�����e�'WC�(/WJ'C/VL'J' - ---1• Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 100712 Type: DBA Expiration: B12312014 Tr# 227218 CHARLES.J. WOOSTER ROOFING Charles Wooster - - P.O. BOX 8051 - - LOWELL, MA 01853 Update Address and return card.Mark reason for change. 0 Address ❑ Renewal Employment n Lost Card SraSSa:�si.SnC._'s_ ��^.e;i":';`C:". .., ;ubi'.Safety . fied'iud.^s'.''+�- €�L�:'L: e :.iu:'i ^d Standards (•)T6[r"c!i0n Super-,isur _ca se: CS-054268 CHARLES J WOQSTER - PO BOX 8051 _ LOWELL MA OW3 �c-•r,r�tssi�r<er 05/11/2014 9273 Date. TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSACHUS� 1 /� This certifies that . . . . . . . . . . . . . . . . . has permission to perform .eeen6Us �a?/I plumbing in a buildings of . �/. � .egss�(' at .S,S- �Gn . . . orth Andover, Mass. Fee.q!!: . .Lic. No.. . . . . . . . . llee-,14A PLUMBING INSPECTOR Check # .x MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I 104-ry N� MA DATE I lle3//Z. [PER # JOBSITEADDRESSI 1 �;— �c�I`n, ��f���r� IOWNER`SNAME i, OWNER ADDRESS 1/53-4FE,'Xo A) /�� /�•� TEE 97b' w98- y7.Sb IFAX I I TYPE OR OCCUPANCY TYPE COMMERCIAL( { EDUCATIONAL { RESIDENTIAL V4 PRINT _ CLEARLY NEW.( RENOVATION:V,� REPLACEMENT:( ( PLANS SUBMITTED: YES( { NOf .( FIXTURES 7 FLOOR BSM 1 2 s 4 5 s 7 a s 10 11 12 t3 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK �....� .�_ _ — LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOPSINK TOILET URINAL I -- i I I .I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES v - — — —--- - - WATER PIPING i _ l OTHER (�- ' equivalentINSURANCE whichmhavea current liabiitY insurance otic .or its substantial eets the requirements of MGL Cha142. YESf� NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY( OTHER TYPE OF INDEMNITY[ ( BOND(•_ OWNER'S INSURANCE WAIVER:Ian)aware Olathe licensee does not have the insurance coverage required by Chapter 142 of 1he Massachusetts General Laws,and that lny signature on this permit application waives this require(nent. _ CHECK ONE ONLY: OW ER _ AGENT I SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information l have submitted or entered regarding this application are true and a ra to the best of my knowledge and that all plumbing%vork and Installations performed under the permit issued for this application will be in compliance i Pertinent provision of the Massachusetts State Plumbirrg Code and Chapter 142 of Ute General Laws. PLUMBER'S NAME I,f7-t-Ye'n/ LICENSE 01 /,_34 I SIGNATURE i MP&0 JP( CORPORATION1 lit 1PARTNERSHIP1 ($j LLC( 411 COMPANY NAMEISle 0/A,-977^) IADDRESSI /0 fpNC,,&4 ,557- f p CITYI 1/ �._.. I STATE I t7.4I ZIP O/�c/�_ TEL 19,a �� �3 77yV v t7 G I I FAX CELL 6EMAIL I_si GPl O k/cnj Z c.,nId e 7 i I ROUGH PLUMBING INSPECTION NOTES BELOW roR®m + CE USE:ONLY FINAL INSPECTION NOTES Yet No THIS APPLICATION!SERVES AS THE PERMIT ❑ ❑ FEE:,$ PER FT 9 )02 /3 PLAINT REVIZw.NO EI S i �e.e,-A _ II'I f i t I 1 . 1Yr�Cv�tti!io>>It�e�lili v,�M`ciss(cctricst'dfs DePONNIM(o�}`Ittr 6filalAccideitts �,.-. 'Q,,,�fceoJ"Xilt'esfigirfimrs � 6�0�l�irsftlrtgtorrSifr�et I Bos`loa;MA 92111 # '� IViPCV.tlrtess�ov/rffrf. routers'°Cant,'etistiti�n[t+ uttiC� fitl>iE�it°BifII(CcrSlConfLYtTO�SII�t� rtein�I�I�'lltlifi�} 1i� { �nitIi'cntttiitfortltti(ioi[• ... .. . . .. P�e�s��r`rrf)(.'•tCr.t ctttt�tl3ttsutc,�t�Uiytni'�ition7udividualj`J•lfC. �f✓ril /iJa 7Z � o(�( i A►'Cyote neittj�Calxr2Cf►ccir(tteoppropriatebor•: 7}'pi`bftoojeet E itLeil): C.Q[antttempto'Ycruittt rl.DIIalit ngeneeaicoidcdctormttt! �' Netvt6ljftriietion ,�, tuitTo}ees{fi(Ii aactf0E pat-t i»C):e ittit'e ftirccl tltt s»G corilrnclora 2f1,1�)fauttsafeproptictorotEtar�ncr listed 61ittiolawite(isl(cal 7. . tcmo(wing j !� btup mtd'havouo c(npto}ices Wim'"stib•co(itm6mrs have 8 E]De»totflfon E lotting for�ntsConnycnpactty. 4vorl,•er'cot»p:ittsitrnttee. '� q [['ptt7fding'nitditioa [Aoteoi ets cgtilp:Jnstm(nce 5:❑ slid 11T ►ivCttiretE] gtticersltavocxereFsecllltetr LOQI[e clricalteltaics.oradctttio»s 3.Ol,irntalinnieote(icrttoii�nritC�Xo[X itdlitof��wnptionperlvtOL ; 'I �I.Q1'ituttbt»gtt*�airsoradditiouS E tttWCIQNO%yorRav comp. 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'. . :-irif>ititt{tinUate,: •' � f t 3vbSiia�,trd�cs�• Cili�lStSte)Zii)... t Lt(rtciinmpjsofElie�4oiirets'cotuJte5isnitoitiiblicyitectnrntFaupage(sftot5ingtlietiaTiet finflube(ot(ttCsfif[tIIJ liffir& r�ilttrotoaasurato�e►tigeitster)u'ad:uncterSectiott 5lSolM(3F;c.t52c(infeacttotGctitipoaitton.oFcriiititiatpeltaf(tes:Ora hitttrpfo'$C,5btlAQaudforoi►e ar nprsontnent;.astrctlasci�itpettti[fiesta(liefonttaFitSTOP:WORKORIMR'onti'alii* ofupfo52S0.OQndayi.ngafits to ►ofn[ns: llondtiiscit[laititcap aFtl►iss[atenteti[inaS+Gefoniweritettto11moffito0f tttvestigaiiol ofifieDlAf In mitcecoverageveelffeatfon. ttlntrereG��cert, t F/l JrQtI1.Pf/((!1(lt'!f(ll�lt'SO�fjJCJtf(/I!(i(/l!L*(1j 01 Jlt(flTblCllfbl lTc(Iff�lO'C(it! .(fiti,cdcreiti • . Citta affeehtfixsaarrft:#armf(i+eiRiiialPSarea,tobaVol riliteleit41.cl(ro►-toIhIojffcTnl• H � Cf[jrot-`C'aii��s_ .--. •1'ci�i(i![lLSceiisetb` IsmiitigAVffioii (cireteoite); I.A.'atctofficai[it 2.Ruitding CDeCtotlntc»t 3.C-110rovvi 60 0( 4.CfFe[t tca1l»spceto►'t I'IntnLfng ins)ie lo( 6.offte►^ I I G-itifactii'ei�oi�i - - 1'tiotit`!l: II I4lassstcliuSt:Fts".Geuemt Lattis ehapferX52 OVA ctiln)O) pt oit forlbelr omployees.. Pui'stiattt to f'nlSstafitte;an eii�ro�+�P.i��'efiitetfas.`;.,ti�es�•porsoq•3n{jte�en�ica ofanothcr ritider�►,ycontragt o£Lire,. 4309 orititplied;-Oral or written ` ?:e�tpfo3er"ist#e�'►tlettas'°auiniiiviclttai,patittetsl'tipi,assti�Iatioh,cpjp�r�tibnorothor��ggalertdCytotYaayif�t05iriiorz ' ti€titeforegoingengaged'0tajomFentefprise,an<lfytliccliugtheIeg'at c�prascn[alWeS.o a'tleceasedempltS}�et;or{I�e >ieceir�r-fir[rztsteeo£etrincicvidtiat,lla[[ttEFsLi�,:asSocfat►on:oroUtarlegal'entity ,pttid5lo}�ing;cnipIrzyees Hoive1erttie oivngr ofA�ItvellLtglioiise•having ttoti►tbrz'ihan titreeaparttitents:aud'ivho resides Iltereiu;or-the occnpant-of-ti►e tli�•el(iitg hon�ofnnotlter-ivho entployspetsons to doanafntenance,eonsfnictiet►of rtpairivoti:on such ciiFelliughtiitstt brnit:thl;grotmdsorbnildiitg 9ltputienitufthereto„�halGnobbecause+of snclt.einployn►entbt=cTeentetl'fd lie au eatpldyer: MGL-chapterI52,-23G{8)ase'statesthat``everi�atsifeuKtoenl licensingngeney'.s11alCivItliFtolcithtf sstiat►cent^ lttetidlol n lieea�s{`ot iierrniEfo operatt z btisutesso►>to cottsti lief buildingsin the connttoitnea[fh fol any ,rtp�]icanf it��Jtas-tiot protlueecl atcepfstblec�i2lence of co►ugl(attce>U•itittltehtstiriiucetoxerage tegttired” Additionally;lYIGEbf 4ptorl52,4,256(2)states"Neither the eonimornvr:altlworaay ofits potitit atsubctivisions sizafl (00r into any contract for keperfom)aiito ofpublic ivorl;until aece(itnUTeevidence ofr ampliaucetvltl►flip-Insurance r�itiretttents ol'[tis cltapterjtat'c 6eEupreszttteato thccorillrticthig autltorlty" i EfEase ftl iota titY iti'oldeIs''calupeitsafioupffTilxi�►t Ctinil3Ir<toi�,lji3�.c:Siec1;►tg ilia dotes ih�tappiy�(your sllaattitt t�id,if • neGessfltysnppl�,�sttb-contraetot'(s)itatue(s),ttdtlress(es)'atidphonenuil►t,�t(s)alongiviththeu•car#iticaleis}pf in'stirattce f,mitedVibilityCompatues(LLC)or—MinkEclLialtllilyfaitne�hlpsMP)With I'D etttp1gygesother'tiiatritte titeAibersoi•partners;are notrequired tocartiyivoricrs'cotpptnsationinsuti+nce. Tfan)LLCorLLPdoeslmte esnplttyaes,apolicy is required.-I3�itdvised tttat lhisiiifidaeltutay be sitbmittetl to tite:Deptrtnient o£IndustriAi - � Accidents forconfirntatiottofi..nsutnnctooveiago. Aobesutefosign slid(late the aftidavif. Tho riftidavieshould ! be returned to the.cj4,or town that the npplicatiou for the peratit or l icon se is being tegt►estcd,trot iite Dclhitinieul of Intit�tttel Aceidet►ts. Should yotthai at►y�ileStlott5 regarding-the law brifyoit nye.requited to obiah a workers' apipe}i atlonpulic};pleasecall file'D�jiaifineittutthe-number-figledhetosv. elFltist»ail.colttpattlessitoulclentertiteir Calf-insntanee license numberatttlte appropriate line. G►tF or Tptvit Officials �'letisehe�nt•etliattheafGctavttTscoin lett;anct- tntlCttieol6 71ie1]e atiuientltas rovidetiat: �esntfh�botttint M"Ilie,affidavitforyoittofitlbiffin11meve►tthe Ofltcetiffnvestigationshas tocoutief your ntzlai► ihen licane, j 9,.....g pit Masebosurdtofillinthepertnit/ttcensetntmbertivhlclt�vil{-beusedasa:refereuc2tiltntbet;Inadtluiat,anppplic�3ut { liar mustsub»tit nudiipta perntit/ficeiut appticatiotis is as}Sgiveii year,need'only submit one affidavit indicating current )tolicy infomtation(ifnecessary)and mider"Job Sito/lddress"the applicant "air locations in - - (clfj-or f #b�vit}"Acppyoftlteafi►de itthathasbeenofficiallyslampedorntarkedbythecityortownuta:}be-proWdedto[lie ` alsplicantosproofiltatavafidal'tic!avid'otiflleforfittureperutitsoriicenses.Arietiffidavitnmst6cfilled out each I year.1t'ttele►t(:oatEou°nerorcitizenisobfaiiimga]icettseoiperntltuotielafeclfofln��busi,tessorconnnerclalvet►htie f (i:e.a du license or peengt to bnm i-aves etc.)said person is NOTrquu-ect to coinpleteflils t!ffidai it. fE,et�o€Iti �fegafiotsieouYtlliE;ettatliRtl3�otrinailvancefoty�otuc6apgrfiotstitdshtitfldy'oti.Ini�eatt «estiotts i ,do not wSitafe to AW nS A 501- '�� ! I T►tebrparltn�ttt'sa<tdress,tElcpltoncatn'tfasntinlTier —�— _ Tfie CorztttlttLst��ftlt p�.l��tss7,.�ltt�sel�s - :4 ..)3e�iat•lmettt of Ittt�us[r)it�Aacietestts t t)�fice of-Inf'esTigfif'lolt� 60Q�Vasittigtbti Siteel- Boston,IMA 021 U Tc1.#617-727-4poo Ot.406 of 1-877-IVIASSAM I govised 2G-t)5 A,19 IN UY-727 4'749 , 1t�t��;i�irass,gof'Iclia Date... r. l —. �aORTM TOWN OF NORTH ANDOVER F P PERMIT FOR WIRING �ss�cHusE� This certifies that ... .... ......./ .... ................................................ has permission to perform ........ .................................................... wiring in the building of.............L.�..%5/.F................................................. at..1.—~� ... .. . . , _. � �... t1 ..........PAL NAnd;R� r,M G E Fee.......... .. Lic.No.f.u.!. ......... .. EC I Check # ' 0609 Cam,,,ltliaf.4 o f M66ae"t`.fa Official Use Only mom �' Permit No. l L �UalrarfiturtE o��irQ�arvicas BOARD OF FIRE PREVENTION REGULATIONS Revc 1/07] and Fee Checked leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /f Z YZ/� City or Town of: AL09W AV To the Inspec or of Mres,-- By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 15-6— Owner Owner or Tenant A�5171l'.,4 S<i Telephone No. . Owner's Address ' t Is this permit in conjunction with a building permit? Yes eJ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampaeity t Location and Nature of Proposed Electrical Work: ��_ Completion o the ollowin table maybe waivedby the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans r ° oral Transformers KVA No.of Luminaire Outlets 1 No-of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above n- o,o mergency ig ng g rnd. grnd. 11 Battery Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS* No,of Zones No.of Switches 3 No.of Gas Burners o.of Derection an Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump I_um er ons -_�_ o.oSelf-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal [IOther Connection No.of Dryers Heating Appliances KW SecuritySystems:* No.of Devices or Equivalent No.of Water Kms, o.o o.or Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Tota!HP a ecommunications�-iring: No.of Devices or Equivalent P OTHER: �,(,-> �,,� W� LIG�H-r Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Elee 'cal Work: (When required by municipal policy.) Work to Stan: / /2- Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this plication Is true and complete. FIRM NAME:-DAV t Q CLEC`rRi C A L 0D0JT4ZAC.-r1P LIC.NO.: Licensee: I>A\l 10 14A66At, Signature IC.NO.: I b 3 A (!(applicable enter"exempt"in the license numberline.) Bus.Tel.No.:g96't,$2•6%W� Address: _ .7 BELIy►t Om-r161- igORM At4yo gZ Bi Alt.Tel.No.:R?0•-5 7 S'-UM 'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. 1 am the(check one)❑owner ❑owner's agent. Owner/Agent -- Signature Telephone No. PERMIT FEE: $ `L +� S .. .t 1 .._ �� ®�� � C :� -- C Z '`liu i .� } i ' The Commonwealth of Massachusetts Department of Industrial Accidents Qfjlce oflnvestigations 600 Washington Street Boston,MA 02111 www mas&gov/dna Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Bus iness/Organizadon/Individual): ib Address: � lf,9,-n..Qr ST City/State/Zip: ;W 64ZVt,e7<', /4 Phone#: gIY4 U—6262 Are G262Are you an employer?Check the appropriate box: Type of project(required): i. 1❑ I am a employer with_7 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).4' have hired the sub-contractors 2.f_1I am a sole proprietor or partner- listed on the attached sheet.t 7. C]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working forme 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.�lectrical 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.❑Roof repairs insurance required]t employees.[No workers' 13.❑Other comp.insurance required.] •Any applicant that checks box#I 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 hit outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contiactors and their workers'comp.policy information. I am an employer that is providing workers'compensa#on insurance for my employees. Below is the policy and job site information. Insurance Company Name: z42tfC,v1 Policy#or Self-ins.Lic. Q/ 2 Expiration Date: 3112— Job Site Address:�/� City/State/Zip:A10,2/ 41. ,ee 4* 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 forins ce coverage verification. I do hereby certify under A pai a ' s of perjury that the information provided above is true and correct. Signature: Date: — l Phone#: cl g Z Z 6 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#: Location-B� Apee� /50/ No. Z Date NORThTOWN OF NORTH ANDOVER 3 o F s a Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ . Other Permit Fee $ TOTAL $ i "y- Check #&-r 24924 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION- /�5� " tie� 1,e Val ZPrint PROPERTY OWNER. Print MAP NO: PARCEL: ZONING:DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition Two or more family Industrial Alteration L/ No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other S Well Floodplain Wetlands Watershed District Water/Se DESCRI TI N OF WORK TO BE PERFORMED: dentification Please Type or Print Clearly) OWNER: Name: y�`z ��rJfi-e. Phone: Address: CONTRACTOR Name:. h C&, Phone: Address: Supervisor's Construction Licenser . Exp. Date: .✓ ,. . Home Improvement License:: p p � � Ex Hate: ARCHITECT/ENGINEER ,�-�- Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.0`0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 'L76 - FEE: $ ,J Check No.: S 3 I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature of Agent/Owner Signature of contractor 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 a 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) a 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL — fub:1ic:Se;D Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signaturefdate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21 A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 NORTH Town of No. LAKE/.� dover, Mass., 1 - a • I L �A COCHICHE WICK '11,9 oRgrePPt.(C S BOARD OF HEALTH Food/Kitchen . .PERMIT T D Septic System BUILDING INSPECTOR_ THIS CERTIFIES THAT...........RVA............ .. .......... ....... ................................................. Foundation has permission to ere p buildings on.. S............ ..... .. .G. ? ...6�.. .1........K�.................... Rough to be occupied as......... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Finai this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of ; Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final (�3 . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS OONSTRUCTIO TS Rough ........................J..... ............................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing, or Dry Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. AUG-24-2011 WED 04:09 PM FAX N0, 9784750303 P. 05 II_ _ Cl;e : + Qry ^E� 93248 ODUCER AteTwOMEY8 CERTIFICATE OF LIABILITY 1NSU 11 DATE fMM100/YYYY) Marty Insurance q$ency,Inc. THIS CERTIFICATE is IS00124111 �-sox? SUED A&A MATTER OF INF RMAT ON 985 ONL AND CONFERS NO RIGHTS UPON THE CERTIFICATE 21 Elm Street HOL ER.THIS CERTIFICATE DOrtS AL�R THE COVERAGE AFFORDED BY TAHpEIEPOO ICIEEND OR dover,MA Q1810S BELOW. IN UREO INSUR RS AFFORDING COVERAGE Twomey&Legere Cotracting,Inc- INSURER NAlC Contracting, N R = Arbelta Protection ins Com an PO Box 366 INSURER North Andover,MA 01845 INSURER ; INSURER : C ERAGES INSURER •• E POLICIES OF INSURANCE LISTED BELOW ANY CONTRACT ONT ISSUED TO THE INSURED NAMED 13OVE FOR THE POLICY PERIOD IN 1 Y REQUIREMENT•TERM ORCONDITION)i;;; EL OF RAV Y rERTAIN.THE INSURAI AFFORDED MYTH[POLICIES DESCR18E0 HEREIN IS SUBJE T TOAll THE TERMS.EXCLU$�ONS AND CONDITIONED CONTRACT OR OTHER DOCUMENT WIED ESPECT TO WpIGH THIS CE IFI MAY 8E ISSUED 0(Z LIc IGS.AG4REGATE UMITS SHOWN MAY MAVE BEEN REDUCED BY PgID CLAIMS. D GATED,NOTWITHSTANDING L N TYPEOFINSURANCE SUCH A GENERAL LIA01UrY POUCYHUMBER FO IC EF EC POA E%PIRATION A COMMERCIAL GENERAL LIABILITY 8500043255 06122111 LIMITS06/22112 EACM OCCURRENCE CLAIMS MADE )I OCCUR DAMAGE TO RENTED S1 080 000 $100000 MED CAP(Any ene Berson) $5000 GEML AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV WJURy $j()00000 X POLICY GENERAL AGGREGATE s2 OOO ODO Pp O7 LOC PRODUCTS- cDMPropACG s2 000 000 AUTOMOBILE LIABILITY ANY Auto ALL OWNED AUTOS COMBINED SINGLE LIMIT Me accident) S SCHEDULEOAUTOS HIREDAUTOS BODILY INJVRY (Per par:onj S NON•OWNEO AUTOS BODILY INJURY (Per acptlent) S GARAG PROPERTYOAMAGE E IIADILITY (Par ac&idenU S ANY AUTO AUTO ONLY-FA ACCIDENT g EXCESy)UMBRELLA UA81Lr►y OTHER THAN EA RCC S AUTO ONLY: OCCUR 0AGG S CLAIMS MADE EACMOCCURRENCE S DEDUC'nBLF AGGREGATE RETENTION S S Wl RNERS COMPENSATION AND S E LOYERS'LIABILITY S A PHOP;iIETOWPAHTNERIEXZCVTIyE WC SrATU. OTM,. OF ICCRIMEMSER EXCLUDED? S S.CIue:w[beunder E-L.EACHACGOENT N PROVISIO Sbekw S OT ER E.L.DISEASE-EA EMPLOYEE $ E.L OISEAt$E•POLICY LIMIT DE6CRIP NOF OPERATION&/LOCAT alt'! g/yC}I+CLESIEXCLUSIONSADDEDBYENDpRSEMEHY/SP):CIALPROtS10Nfi Coven g operations Usual to Twomey g Legare Contracting,Inc... CE TIFIl ATE HOLDER CANCELLATI N Town of North Andover SHOULD ANY OF T E ABOUS DESCRIBED POLICIES 13E CANCELLED 1600 Osgood DATE THEREOF. ISSUING INSURER WILL ENDEAVOR TO/,TAIL FORE THE EXPIRATION 8 Street Q_ DAYS WRITTEN North Andover,MA 01848 NOTICE TO THE CE TIFlCATE __in_HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OB( us riON OR LIA131LRY OF ANT KIND UPON THE INSURER,ITS AGENTS OR REPAESENTATNES - AUTHORIZED REPR r NTArIVE ACORf]2 (zoottosJ 1 of 2 XS27512IM27508 DML 0 ACO CORPORATION 19ga �ghtFax NI-110/8/2010 8=54:54 A-M PAGE 2/002 =ax Serve: j i i ACORD. CERTIFICATE OF LIABILITY &SURANCE DATE(fawlYYYY) �ol0aI2010 THIS CEP HFICATE IS ISSUED ASA MATTER OF fNFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Apr7RMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOYI. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIi-ICATc HOLDER. "-.IPORTAN T:1-the c=Yi;fcate Folder is an AODMO7 JAL INSURED,the pollcy(ias)must be endorsed, II SUBROGATION IS WAIVED;subjeet to the terns and conditions o/the Potion certain poIIciss may,e.;u'aa and endorsement to the sement R statement on this certificate does not confer r certificate holder in[IOU of such endarsemehf(s}. PRODUCER CONTACT NAME: DOHERTY Iii)S AGENCY WIC PHONE FAX (AIC,No,Ext): FAY, PO BOX 1985 E-MAIL (A/C,14o): ADDRESS: A1IDOVM,A4A 01810 PRODUCER 22yMx CUSTOMER 10 f: INSURED INSURER(S)AFFORDING COVERAGE NAICr INSURER A: TRAY-ELERStl MEitINT y GO!MpAN,y I VOMEY cE LEGARE COitirlRAcnNIG R C INSURER B: INSURER C_- PO :PO BOX 365 INSURER D: NORTH ANDOVER,MA Ulgaj INSURER E: COVERAGES CERTIFICATE NUMBER: INSURER F: TPJS IS TO CERTIFY 7HAT TH-E POLICIES OF C45URAN-CE USTID BELOV.,HAVE SEEN ISSUED TO THEE 6'.ISUP.ED NAMED ABOVE FOR THE POLI REVISION NUMBER, NOT4`AY PERTAIN. THE INSURANCE AFFO zPg OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT 1YirH RESPECTTO Y.gaCHTHIS CICY C TER4DIC TED. D OR A1AY?ERTNR.THE E EiEE NCE AFFOP.DED BYTHE POLICIES DESCRIBED HEP.EIN IS SUBJECTTO ALL THETERMS,EXCLUSIONS AND CDNDITiONS U SUCH SSUCIES. LR,'1T5 SHOL:'N 7dAY HAL>_BEEN REDUCED BY PAID CI.AIIJiS. INSR TYPE OF INSUP,ANCE ADDLSUBR POLICY EFF DATE POLICY EXP DATE LTR POLICY NUMBER (W-my" (WOMYYYY1 GENERAL LIAB1LiTY f:15R t.1rD LIMITS COMMERCIAL GENERALUABILffY eACHOCCURRENCE j CLAILIS MADE OCCUR. DAI,•,AGE TO RENTED S PRE*USES(Ea oecu,rer-,Ce) MED EXP(Any oz parson) S GEN'LAGGREGATEUW APPLIES PER: PERSONAL&FADV INJURY S POLICY PROJECT LOC GENERALAGGREGAic c PRODUCTS-CON,P.'OP AGG S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINCL= S UiCS ALL OWNEDALIMITIEaacc,ej , SCHEDULE AUTOS BODILY IN-JURY S HIRED AUTOS (Perperscr) BODILYINJURY S Nora-oavNED AUTOS t'sr2ccid3nt) PROPERTY DAMAGE c_ (Per P=dsnt) UMBRELLA LIAS OCCUR EKGESS UAS CLAIMS-MADE EACH OCCURRENCE S DEDUCTl8LE AGGREGATE S PE-1 EN'i 10n S WORKER'SCOMPENSATIONANO WCSTATUToavutalTS CTHeR` EMPLOVEMS LIABILITY YIN UB0290FJS9�-iG U3I7&/2DtU c ANYPROPc'rdiC:�:FRTNeretXECUTP.IE Y � 9_118.40>i E.L EACH ACCIDeNT S 500,000 OAC=-Rr=.EI.1SSR EXCLUDED? E.L DISEASE-EA EMPLOYEE S 500,000 (RlandatoryinNF) - It,,a;, E.LDISEASE-POLICY LIMIT S j00,C0C 'OESCRIPTION OF OPERATIOt.S be!o-r. DESCRIPTION OFOPEP,AM014S/LOCATIONSIVEHICLESIRESTRICTfONS/SPECIAL ITEMS rUS KEPI ACLS u\�P 230R C 7?ctCA3E ISSUED Tfl_r-CERTIP Ain 30L7E11 Ai~"c(TTG t40R3i S CO[dR C01T GERTIFICATE HOLDER CANCELLATION TOW\'OF NORTH ANVIDOAFER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD STRErT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE FORTH�,itIBOVE_�,MIA 013-1-5AUTHORIZED �C131'ji ACORD 25(2008109) 1988-2009 ACORD CORPORATION- All rights reserved. i ;Massachusetts- Department of Public SafetN Board of Buildin±a Regulations aril Standards x Construction Supervisor License License: CS 67560 SHAUN M TWOMEY 61 PATROIT ST N ANDOVER, MA 01845 � Ly �. - Expiration: 10/25/2013 {'omm��ioncr Tr#: 4913 llasstcbusetts- Dep!i-trtleot ol'Public ti:i€rte Boxr{I of Building' Rc cul ttion.;rrrd Standar'{Iti "--' Constru:.icn Supervisef License sF; License: CS 55108 DOUGLAS J LEGARE 79 GARY AVE HAVERHILL, MA 01830 Expiration: 902012 {'upnli4cci=flier Tf--: 2766 J/ ClII9'791i lZ�t ���' f Office of onsumer.e�Y�i"�ZBrfsiness cgulai'lon ti HOMEIMPROVEMENT CONTRACTOR Registration:. ..136779 Type: -W Expiration: 8/2612012 Partnership TWbMEY+LEGARE:CONTRACTING INC. SHAWN TWOMEY 87 BELMONT ST. g _ N.ANDOVER,MA 01845 Undersecri an The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4 ,02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ///Z4ff Address: 27 , c City/State/Zip:.�jD, ypf— e Phone#: Are ygu an employer? Check the appropriate box: Type of project(required): 1.FI am a employer with 4. ❑ I am a general contractor and I 6. ❑N construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- Iisted on the attached sheet.t 7 emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. rkers' comp.insurance. 9. F-1 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.[1 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 131-1 Other comp.insurance required]. *A.,y a-yplicam that checks box nl r..l:st r1sr.fdl out the section below showing their -_____-'onWr n r , wnrt:Pra r mngr+catin -ol;-_Y 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ��`/e, Policy#or Self-ins.Lic.#: Expiration Date:0, Z__/Z_ Job Site Address-/-525— AY7 t, City/State/Zip Z, 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 certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: /?2� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of.a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who bas not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability.Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. .The affidavit should be return,ed to the city or town*.hat the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog Iicense or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Iike 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 Investiptions 640 Washington.Street Boston,MA.02111. Tel. 4 617-7274940 ext 446 or 1-8,77-MASSA-FE Fax 4 617-72.7-7749 Revised 5-26-Q5 wvv A7.mass.gov/dia A A4664 �/,�la Lo, Proposal Twomey & Legare Contracting Inc. Building& Remodeling 87 Belmont Street North Andover Ma 01845 Phone 978-685-7447 Fax 978-685-7446 Fax 978-685-7446 To: Ruth Cassie November 16,2011 155 Beacon Hill Boulevard North Andover Ma. PH.978-688-4250 Ref: I"Floor full bath Thank you for the opportunity to quote the following project. The TWOMEYAND LEGARE CONTRACTING price is based on our discussion. On November 16,2011 The following is a description of work as discussed. 0 l"" floor Full bathroom. 1. Remove fixtures and demo walls down to studs. 2. Pull floor to subfloor. 3. Existing door to remain. 4. Build closet with matching door,and shelving. If false ceiling in shower can be removed do not replace 5. Insulate all walls in bath. 6. Drywall to be blue board plaster with sand light skip trowel ceiling. 7. Install new fixtures and cabinets in bath. 8. Install new tile over durarock on floor/walls above tub surround and shower ceiling. 9. Replace any trim removed during demo match existing. 10. Install shutoffs for new toilet and sink and shower. All new fixtures.Replace baseboard heat behind pedestal sink. 11. All painting by contractor. 12. Electrical to code and 1-new ceiling light/fan combo.By contractor(newtone QT) No vanity light. 13. Shower door is an option not in price of project. 14. All p9mts an inspections by contractor and disposal of all debris. Date w Job total & Payment schedule $13,600.00 ls`payment on signing $4,000.00 $9,600.00 2nd payment based on demo of bath and completion $5,600.00 $4,000.00 Of electrical/plumbing rough. 3rd completion of drywall and file $3,000.00 $1,000.00 Final substantial completion of project with final inspection. $1,000.00 Allowances 1.Bath fixtures Pedestal sink&faucet$830.00 Toilet$360.00 Tub& walls$900.00 Shower valve& head$375.00 Drain assembly$200.00 Total for bath fixtures$2,665.00 2. Tile&grout-$400.00 3. Fan4ight combo----$200.00 �s Thank you for considering Twomey&Legare Contracting Inc.for your u Project.Please feel free to call with any questions or concerns @ Office 978-685-744.7 U Cell 978-479-8174 ��' Respectfully, Shaun Twomey Sign le � � Date //oZ9 / lu L `I Date. No- 4722 "oRT" TOWN OF NORTH ANDOVER �? •` oL - p PERMIT FOR PLUMBING SSACMUSE� This certifies that .. • . . . . . . . • . . . . . has permission to perform . . . 7. . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .:. :?. . . . . ... . . . . . . . . . . . . . . . . . . . . at. ./. . . .%. . . ./�a� >.'. . . . . . .! . . . . . . . . . . . . . . North Andover, Mass. Fee. . .. . .Lic. No.. . . . . . : . . . . . . . . . . . . . . . . . . . . . . ..,. . . . . . . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) i a4rj::h '�jnd tike/ lass. Date // � Permit # � r) x u �/� lVd. Owner's Name � ��Imn '1'a zC Building Location r �/'on _�., Type of Occupancy Residential ^4y New ❑ Renovation ❑ Replacement (4 � Plans Submitted: Yes El No 11 FIXTUff S UU z n = r1 N O z h O ul W Y J N n z of a o - w r w N w z ¢ N – n _ – rd «i h v x a – o. a} z o a a w Ir s a w �, ❑ -j ? o a a x M x M rI w z a i 3 3 o z = 3 X a o h a Y a W LL k f1 H U > h O = a D w r- z o o to z z w F' O c) N ri z a a o a J J a Cr rr rr a c a +► }(((�]]�. Y J (0 0 U ❑ J 3 = h- Vl LL a a O a L: a, A J� SUB—BSMT, BASEMENT 1ST FLOOR 2ND FLOOR 9RD FLoon � 4TH FLOOR 5TH FLOOR 6TH FLDOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg. &Pig. Co. Inc. Check one: Certificate Address 35 Pleasant Street EX Corporation 714 Stoneham, Ma 02180 ❑ Partnership Business Telephone 781 38-7776— l-] Firm/Co- Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent,which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stale Plumbin Code and Chapter 142 of the General Laws. By — Signa we o Licensed lumber Title Type of License: Master[X Journeyman❑ City/Town 8322 APPROVED(Oi:FICE-31 SE ONLY) License Number.___ BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR �e x Location No. ^27/ Date /" G- � NORT1y TOWN OF NORTH ANDOVER 3? � �OOG p Certificate of Occupancy $ 41 i Building/Frame Permit Fee $ -� 4 N, `.-...s. , �.�s'•�°'E<� Foundation Permit Fee $ s�cHus Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ � v TOTAL w Building lAspector 12671 07/06/98 10:38 25.00 PAID Div. Public Works Location . No. Date As NpRT� TOWN OF NORTH ANDOVER p Certificate of Occupancy $ 41 Building/Frame Permit Fee $ Foundation Permit Fee $ JACMUSE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector ulia�•;� tl�.� .:. . �r11U Div. Public Works PIiONaT N0q?7� APPLICATION FOR PERMIT TO BUILT) *****NORTH ANDOVER, MA hl%p NO. LOT.NO. 2. RE(ORDOFOWNI_RS1111' MATE BOOK PACE ZA IN E SUB Di\'. LOT NO. {/ I.UI A I TUN /f PURMSE 19:111111 DI N6 /j No.(YSIORIES fSIZE OWNER'S NALIE OWNER'S ADDRESS BASEMENT OR SLAB ST Hn Rn ARCI 11'1-ECI'S NAME SIZE OF FLOOR TIMBERS 2 - 3 HI BI DER'S NAME SPAN DISI-ANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DIS LANCE I:ROM STREET DIMENSIONS OF POS I S DISTANCE FROM I.OT LINES-SIDES REAR DIMENSIONS OF GIRDERS AR FA()I-I or rR(N--ACE I IEIGI IT 01 F(AINDATION THICKNESS Si ZE OF FOO'lINC, X rlS IILDINO NEW UILDING ADUITI(XJ MATERIA].OF Cl IIMNEY UILDING ALTERATI(NN IS BUILDINGOJ SOIJDOR FILLED LAND T.BUILDING CONFORM TO REQ IIREMEN"I'S Or CODE IS BL IILDI NG C(NJNECIED T O T OWN WAI ER BOARD OF APPEALS ACTION, IF ANY IS BUILDING COJNECI ED TO TOWN SEWER IS BUILDING CONNECTED TO NA'TLIRAI.GAS LINE INS'I'U('IIONS 3. PROPER 1'V INFORMATION LAND COST EST. BI lx;.COST \ PAGE I FII.I.()I IT SEC1lONS 1-3 FST'. BLDG.COST 1'ER So . FT. y EST. BLD-i.COS IVER ROOM L=LEC"TRIC METERS MUST BE ON(XITSIDE OF BUII-DING SEIq IC PERMIT NO. AF1ACIIEDGARAGESMUST CC)NFOR&ITOSrATEFIRE RUR LA IONS d. APPROVED Bl': PIANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BII11.1)ING INSPECTOR DA I E FII 1:1) OWNERS I El.d CONIR.IEI H CC*n R"1.1 Cb SIGNAII IRE(X:OWNER OR Al I'll IORI"ZT?D AGENT PERMIT GRANIED 19 x40RTy Town of _ Andover o M * z - 19 POO s dower, Mass. * O L1AX 9CO CHICHEWICK OA•17E0 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.-.4... ........... AoV . .................. ...............................................................................0.............. Foundation has permission to erect,. *4 0 uildings on .....1..ou+....... .. Rough to be occupied as... .... ........... Chimney r........................................ . . . provided that the person acc ting this permit all in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR • VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final UNLESS EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION ART U Rough Service....... ING INSPEETOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. � Burner Street No. Smoke Det. Lobation No. I Date r � cL 0. of Ngo, TOWN OF NORTH ANDOVER c? o? Certificate of Occupancy $ Building/Frame Permit Fee $ •�o � i s,CMusE`� Foundation Permit Fee $ Oxtaef Permit Fee $ L I: _ f0d Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector i = - 2- 9683 Div. Public Works PER311T NO.... L APPLICATION FOR PERMIT TO BUILD— NORTH ANDOVER, MASS. to/ PAGE 1 MAP a-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE 20NE I SUB DIV. LOT NO. F — LOCATIONPURPOSE OF BUILDING Q ^ ()� /(�E/JLAC�i✓G feo L 7 f` !C lsidd/Y� OWNER'S NAME S f e vem * tt /A , ,y S C�, NO. OF STORIES SIZE OWNER'S ADDRESS 1,5:5- J3 eA�/7 j�/" l/ !//�`-��.i/J� A BASEMENT OR SLAB ARCHITECT'S NAME ✓✓ /.J !7 / !J �/ �N SIZE OF FLOOR TIMBERS IST 2ND 3RD i BUILDER'S NAME �;m/N 1'n a, DD I 1SPAN DISTANCE TO NEAREST BUILDING / DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES /© /_ REAR ja •' ° GIRDERS AREA OF LOT LFRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING % IS BUILDING ADDITION MATER:AL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE V�S. IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY ./n / IS BUILDING CONNECTED TO TOWN SEWER �V C/ IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 1 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 3ieov PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ,DATE ILED �� � 4 �{ Wil_/ �� WILDING INSP[CTOR ­911GNATURE OF OWNER OR AUTHORIZED AGENT FEE OWNER TELA • PERMIT GRANTED -CONTR.TEL.# m 19 _ 1 CONTR.LIC.# H.I.C.k BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ S"ORIEs THIS SECTION MUSTSHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B t 2 13 CONCRETE BL'K. BRICK OR STONE H,RDW PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ FIN. ATTIC AREA _ N_O B M'i FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD"J'D ASBESTOS SIDING COMMON VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 6 FLOOR I_ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 11 10 PLUMBING GABLE I HIP BATH(3 FIX.) _ GAMBQELMANSARD TOILET RM. 12 FIX.) FLAT I I SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. ! TIMBER BMS. 6 COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G T UNIT HEATERS 7 NO. OF ROOMSGAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING a �o r Town of N.. oL dover No. Nortl%.rAdover, Mass., Y—/ tl 19 pc� FU y BOARD OF HEALTI-I PERMIT TO Food/Kitchen B Septic System ,.� BUILDING INSPECTOR THIS CERTIFIES THAT /` ./... ...5' ...... ................... .............. ...... .... ..... / ` Foundation has permission to Afect......... O.t�h. . . .7.. n ........... . �.S.- e.Q.N...... l.F�-.h,...�.�-.v Rough p I to be occupied as............................. .1...v. .!-- . ............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of s Buildings in the Town of North Andover. PLUMBING INSPECTOR OR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough �E; �� `; Final .7! 10} � STA..`= �.l— ELECTRICAL INSPECTOR Rough ....................................... .............. .. .............. ............. ..... Service B DING INSPECTOR Final C - ;pa '`.m.. , �:: . :� tc - c ' tiilding GAS INSPECTOR Rou Display in a Conspicuous Place on the Premises — Do Not Remove Finagh No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. -µ Burner rk Street No. Smoke Det. TOWN OF NORTH ANDOVER "BUILDING DEPARTMENT i APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR:TWO FAMILY DWELLING BLUDING PERNIIT NUMBER: DATE ISSUED: . SIGNATURE: Building Commissionerfinspector of Buildings Date SECTION 1-SITE INFORAIATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 4115- 43 Map Number Parcel Number 1.3 Zoning Infomrafion: 1.4 Prapelty Dkiensions: Zoning District Use' Lot Ariea Fmnta ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Provided ReWimd Provided 1.7 water Supply KQLC.40. 54) 1.5. Flood Zone 7nformi iou:. 1.8 S--w Disposal system Public ❑ PrMft ❑ zone outside Flood zone ❑ Municipal., 0On S6:Disposal-system ❑ SECTION 2-PROPERTY OWNERSHIP)AUTHORMED AGENT 2.1 Owner of Record -$'7'L v r✓ �`/�/S r.� / S�S -`°'1>z A. Name(Print) Address for Service: F221'C ture Telephone runer of Record: me Print Address for Service: Sr ature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor Not Applicable ❑ Licensed Construction Supervisor. License Number Address.. Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable D Company Name Registration Dumber Address Expiration Date Signature Telephone r" SECTION 4-WORKERS COMPENSATION(MG.L.C 152.§ 25c(6) Workers Compensation Insurance affidavit must be completed Pnd sunmitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buil ding rmit. Signed affidavit Attached Yes SECTION 5 Description of Proposed.Work check all applicable), New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ j Accessory Bldg. ❑ Demolition . ❑ Other ❑ Specify Brief Description of Proposed Work: � . Coy�,lruc7't 2 a�/ ' xa� ' a Sall �a✓'d� � SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit,applicant 1. Building (a) Building Permit Fee ;. Multi lier 2 Electrical (b) Estimated..Total Cost of Constnrctiion 3 Plumbing Building Permt.fee(a)x(d) 4 Mechanical AC 5 Fire Protection 6 Total,.(] 3+4+5). . . CheckNwnber 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 attire of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TUMERS 1 2 3kD SPAN DEVIENSIONS OF SILLS DRAENSIONS OF POSTS DEVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE iNORTi Zoning Bylaw Denial .. o w^ Town Of North Andover Building Department ,no•%'"aryr 27 Charles St. North Andover, MA. 01845 C US Phone 979-488-9545 F" iIS.`8=9 42 Street, _ Ma /Lot: mss'Z3 B Applicant: u�� A LS s -777-77—! Request: IVoZ 6 )•e *19 c a/ a r a e Da 3 Please be advised that after review of your Application and Plans that your Application is DENIED for the followinq.Zoning Bylaw-reasons: Zonin iz-H Item Notes Item Notes A Lot Area - F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting y>° S 2 Frontage Complies 3 Lot Area Complies 3 Preexisting frontage Ll e S 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed -7G Contiguous Building Area ,� 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 1 Complies 4 Special Permit Required y z° S 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 1 Complies 3 Left Side Insufficient 3 Preexisting Height . 4 Right Side Insufficient 1) e S 4 Insufficient Information e S 5 Rear Insufficient i Building Coverage 6 Preexisting setback(s) tj e cDuktI 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed -1 e-S 4 Insufficient Information 2 In Watershed j Sign �� a 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district e S 2 Parking Complies e 3 Insufficient Information 3 Insufficient Information 4 Pre-existing Parkin Remedy for the above is checked below. Item # Special Permits Planning Board Item# Variance Site Plan Review Special Permit Setback Variance Access other than Frontage S ecial Permit Parkina Variance Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Perm�it Special Permits Zoning Board Independent Elderly Housing Special Permit Special Permit Non-Conforming Use-ZBA Large Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Development District Special Permit .Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permit Special Permit preexisting nonconforming Watershed Special Permit The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled"Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above rile.You must rile a new building permit application form and begin the permitting process. / Building Department ficial Signature Application Received Application Denied Denial Sent: If Faxed Phone Number/Date: Plan Review Narrative The following narrative is provided to further explain,'the:reasons for denial for.the application/ permit for the property indicated on the reverse side: . NOiF'RIO EAR i � Eciv� mI /co c i G �k�Sr/ i< /1,JNCU�tJ ✓rliiiv /C 7 IN 6),A-),5 7 r tic- CO iG C ! A21A/L;C>✓ r 2, .: Jde Referred To: Fire Health Police onin Board Conservation Department of Public Works Otter PlanningHistorical Commission Other BUILDING DEPT DATE: SCOTT L. GILES F "0 ES LEGAL REFERENCES THE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR FEBRUARY 24, 2002 ��``� ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CAISSE, S REVISIONS: FRANK S. GILES r oho F N Map , S Parcel58 EN P CONFORMITY OR NON-CONFORMITY WHEN CONSTRUCTED. SURVEYING - " 1Stj 713 y RUTH CAISSE 50 DEERMEADOW ROAD SSI � Bk. 3140 Pg. 34 O�P Year of Sale=1954 THE ZONING DISTRICT IS R4 SCALE: 1 INCH= 20 FEET NO. ANDOVER, MA 01845 gtio SURV EY 20' 49 TEL: (978) 683-2645 FEBRUARY 24, 2002 MIN.AREA— 12,5,00 S.F. MIN. FRONTAGE= 100 FT. E-MAIL: FrankGilesSurvey@mediaone.net DATEMIN. FRONT SETBACK—30 FT. M.I.N.SIDESETBACK= 15-FT. PLOT PLAN OF LAND / MIN. REAR SETBACK=30 FT. 155 BEACON HILL BLVD. N 89°39'08"E SUB7EtCT-PROFER'TY NORTH ANDOVER, MA X62°� 9 25.-50 5 155 BEACON HILL BLVD. NORTH ANDOVER,MA Map 45.13,Parcel 58 CAISSE,STEVEN P �G� LOT 173 RUTH CAISSE ��� 0 4,208 S.F. area=0.27 Bk. 3140,Pg. 3 Year of Sale=1954 p,S Tel. (978)688-4250 � C MAP-45..8 PARCEL 5 9 > �+ 0�„ "o DECK�^ lb' _ •D N 145 BEACON HILL BLVD b'Z S6 p3 55 21' j / o CERRETANI, STEVEN E / 1 HSE.#1 TROPOSE - CHERYL M CERRETANI G ARAGF/ 14' LOT 174 46.5' 7,555 S.F. N TOTAL AREA T=40.00' 11,763 S.F. R=9.72' v' L,=75_ ' x,25 .10 L=25.90' L 20.17 91.5' L=3 0.36' S 89039'30"W R=318.49' BEACON MLL BOULEVARD C:\CLIENTS\CAISSE, STEVEA55.BEAC0NHILLBLVD.DRG Location No. Date �aRTN TOWN OF NORTH ANDOVER 3�O�tt`•D I• Moc O F p Certificate of Occupancy $ sCN Building/Frame Permit Fee $ ■ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 10 Check # 5 1 b 15823 Ce"- , ,X Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCr.REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING. OWN W,MI. , BUILDING PERMIT NUMBER: /+ DATE ISSUED: SIGNATURE: Building Commissionefgwj=for of Buildings Date SECTION I-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �r Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimmsious: . Zonin g District ProposedUse Lot Area From ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re ed Provided 1.7 Water Szrpty M.iaLC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:.:, Public 0 Private ❑ Zone Outside Foal Zone ❑ Municipal ❑ on Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record faMc(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Si ature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature + Telephone 3.2 Registea Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Si nature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......O, No.......0 SECTION 5 Descritionof Proposed Workcheckalla iicable> New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: l SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beV. Completed by permit a licant; 1. Building (a) Building Pcimit Fee ed 0 . Multi,lieu 2 Electrical r,. (b) Estimated Total Cost of a!' Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5 / AO 11. ✓ Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, � 4Own uthorized Agent of subject property Hereby authorize to act on My behalf,in allm tt re�s relative to work authorized by this building permit application. A= 6 —V.2 Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby_declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of-Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIWERS l sr 2ND3 SPAN DMIENSIONS OF SILLS DE\dENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover ja0RT#j Office of the Zoning Board of Appeals C. - . - Z- 0 0 L LE�R�K' 'A Community Development and Services Division 1-Ul, I 27 Charles Street lull 2-2 A North Andover,Massachusetts 01845 D. Robert Nicetta Telephone (978)688-9541 Building Commissioner This is to certity that twenty(2=0 ,% have elapW from date of de W8)688-9542 without filing of a ✓al., Date � Any appeal shall be filed Notice of Decision Joyce kVradshaw within(20)days after the Year 2002 Town Clark date of filing of this notice in the office of the Town Clerk. Property at: 155 Beacon Hill Boulevard NAME: Steven Caisse DATE: July 16,2002 ADDRESS: 155 Beacon Hill Boulevard P Tr PETrrION: 2002-025 North Andover,MA 01845 DATE: 719/02 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday,July 9,2002 at 7:30 PM upon the application of Steven Caisse, 155 Beacon Hill Boulevard,North Andover,MA requesting a 61 Variance from Section 7,Paragraph 7.3 and Table 2 for front and right side setbacks;and for a Special Permit from Section 9,Paragraph 9.2 to allow.for the construction of a proposed detached garage within the R4 Zoning District. C-: The following members were present: William J.Sullivan,Walter F. Soule,Robert P.Ford,Scott A. Karpinski, Ellen P.McIntyre,George M.Earley,and Joseph D.LaGrasse. d Upon a motion made by Scott A. Karpinski and 2 by Ellen P.McIntyre,the Board voted to GRANPO ;j t''Z PNZ,- -7 dimensional Variance petition for relief of 2' front setback and F right side setback in order to construct the proposed 24'x 36'detached garage,not to exceed 20'in h'eight,as shown on the Plot Plan of Land 155 Beacon Hill Boulevard,North Andover,MA dated February 24,2002 by Frank S.Giles II,Professional Land Surveyor #41713, Scott L.Giles,Frank S. Giles Surveying,50 Deermeadow Road,No.Andover'MA 01845. The Board — finds that the petitioner has satisfied the provisions of Section 10; paragraph 10.4 of the Zoning Bylaw and that the granting ofthese variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Voting in favor of the Variance: William J.Sullivan,Walter F.Soule,Robert P.Ford,Scott A- Karpinski,and Ellen P.McIntyre. Upon a motion made by Scott A.Karpinski and 2d by Ellen P.McIntyre,the Board voted to allow the petitioner to WITHDRAW HIS SPECIAL PERMIT PETITION WITHOUT PREJUDICE. Voting in favor of the withdrawal of the Special Permit: William J. Sullivan,Walter F. Soule,Robert P.Ford,Scott A.Karpinski,and Ellen P.McIntyre. Furthermore,if the rights authorized by the Variance are.not exercised within one(1)year of the date of the grant, it shall lapse,and may be re-established only after notice,and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two(2)year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice,and a new hearing. Town of North Andover Board of Appeals, ATTRRP; A True Copy LV Decision2002-025 Town Clerk- William J. ullivan,Chairman BO-.--\RDOF.Ai'PE.,kLS6-SS.9541 BULDITJG5tt8-9545 CONSERVATION 688-9530 HEALTH688-9540PLA-1 !ING688-9535 ESSEX NORTH RES>TRy flI' IDEEDS LAWRENCE, MASS. A TRUE COPY:"ATTEST: FmamnlR OF Dm i L Registry of Deeds Northern District of Essex County Laurence, mA 01840 08/15/02 CAI55E JG 12 Rec: Type PLAN 16.00 20.00 Inst 3972 Cies 1.50 # is Reca Type CERT 10.00 lr; t 3?877 C. P. 20.00 Total 67.50 # 14 Payment Check 67.50 THARK yOU! Thomas J. Burke Register of Deeds Town of North Andot "4RT ver � .•T �- Building Department w 27 Charles Street North Andover, NIA. 01845 D. Robert Nicetta .Building Commissioner (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print ,+� DATEt+t 7 3 "' f! ',�. 41 p R`j rl�S`�Q /0�/4 G' .5 JOB LOCATION/2q-1:1- q hC p4l Ni,4 4 /.3Zd.P umber Street Address �e 7� Map/lot "HOMEOWNER975-e. 97 1? �y2 Name Home Phone Wor1c Phone 'RESENT MAILING ADDRESS S i✓" '--'p— ,. City Town State Zap Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homecmners to engage an individual for hirewho does. not possess a license, provided that the owner acts as supervisor. (State Budding Code Section 1o8.a 5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling,attached or detached struc to cessory to such use and/or farm structures_ A person who more 0M one borne es c a two-year period shall not be'considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Budding Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner"certifies that h0she understands the Town at No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements- HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL i North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant 9-.93-OA Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FORM U LOT RELEASE FORM � - INSTRUCTIONS: This form is used to verify that all necessarya approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ****************************APPLICANT FILLS OUT THIS SECTION APPLICANT-S1'!¢,1,e,41 �. PHONE Zig-- 6,A,1,f— LOCATION: Assessor's Map Numbery PARCEL S"4 SUBDIVISION LOT(S) j 7 3 STREET_ ea,y A/iLA LV0 ST. NUMBER >S"S' *****************************************OFFICIAL USE . ONLY*********************************** �RECONDATIONS OF WN AGENTS: CONSERVATION ADMINISTR OR DATE APPROVED_ O� DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 jm NORTH Town of Andover 117 3 - `' -- � dower, Mass. � D DOCHIC RATE D S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT........ .. ..,,,,,,,0A I s 't BUILDING INSPECTOR AJY Foundation g ....... �1/ has permission to erect. 07. ......... buildin s on...... ��.4..0.....................•,,,, „•V.. Rough to be occupied as....... `.4' , A r4 // �' N { Chimney ................. .................. ................................................ .. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws elating to the Ins pe ion, Alteration and Construction of Buildings in the Town of North Andover. vs J)'re /10 s -WW- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR r 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. 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'1 J''MwM'.'YY.'�`l'i611F^1d'a1Y,(elLC,1�e�'A'J�+fi�'�,(}�r.F'Mr.':^b^q'!Yl X2:4 fjff: S??Mb�.jn�'k6Vd- R:.�'MNti t';�. �r ., A a».£a- !Jw.v?f •�,eOw' I,M •,.rv,'^:.aroVs . - .. .. .H<'A,}Vt:",AAW..:JYR:ih`.w•:.��.�+h"�'�f;,h•��sr6'4,�f�..� -,r"'�tIF'9�'' 'Yfl:'G"'�S1sr`vye+.^..^,'iisX.'�i"eY7xY"'sri�SY"?`A-'�."i'S`!'kU:Re?.K:�iY�wx.Fatf�f Y!K ncwr+.,,;ru..ua,ns..�..r..e.-o..�,:saarr�-a.•............<-..,,.. ..,. 4205 Date.....�l.. .. .1...� �T �ti0 }_ °L TOWN OF NORTH ANDOVER a p PERMIT FOR WIRING - ��ss�cMusEt This certifies that .........`.� .�. ;.Vt... d .�...: ...1:. ....PC......... ,,has permission to perform .........5..fevsJ� :.:f......�'h,���y-�J................... wiring in the building of..... .............................................. er �w .� � !f..a'"..... '� .............'.... .,North Andox ,Mats.� '. Fee./..4�s.. Lic.No/U/*U�YS.......... ... ...t-U . ` ELECCRICALINs EP CrOR Check # 5 THECOMMONWEALTHOFA ASSACHUSEnS Office Use only DEPAi V7'OFPUBHCS4FT7Y BOAROOFFIREPREVEMONREGULMONS527CM12.M Permit No. Occupancy&Fees Checked ' APPLICATIONFOR PERMIT TO PERFORMELECMCAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,521 CMR 12-00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) _ � Date C� Town of North Andover c� �0�� The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location(Street&Number) Owner or Tenant Le r Owner's Address Is this permit in conjunction with a building permit: Yes MNo (Check Appropriate Box) I Lrqg- Purpose of Building ;r'r� Utility Authorization No. Existing Service Amps �C} /gf Volts Overhead Under round g No.of Meters / New ServiceV� Amps_ZIQ L2t(v Volts Overhead �L�•---- �V'Underground J= No.of Meters Number of Feeders and Ampacity lbs .. ry ^J JZ Crt�r�-cL Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures Swimming Pool Above Below KVA Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones No.of Disposals No.of Heat Total TonsTotal No.of Detection and Pum s Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices & No.of Self Contained No.of Dryers Detection/Sounding Devices Heating Devices KW Local Municipal Other��� No.of Witer Heaters KWNo.of of Connections ED No. Si ns Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• Grnu&=Covaaga Rnu><'mttothe leVMnsntsofMa tSMGnralUM [hawaOXUEMlIdAtyhmuanoePblicyffrkx ngCotnPie Covaageoritsstfl alegtuvalai YES `.havesubmkdvafidpoofcfsaQrrOdle0l�YES NO ED Irdangtlebox li}r//,rlhave curkedYFS,plrsseinclit�teX ofcov�geby [aa NSURANCE BOND OTHiz a (Pk�espop) 1 b • UodctoStatt hPXhMDaleRNuesteJ Rouffi ValwofFJad>icaiWoik$ ignadundArputalliesofP411y. Final IRMNAME ioa�ee iii,� I/t✓ �t:/r'».J�re, Signahne LicetwNo O / f BtuirmTel No. � AltTel.No. W'WSINSURANCEW amawarethattlrLxerL--doesnothavethenLauancemveaWorit a*st balegmvalentastapredbyMa%achuscmClff=Wl-aws dthatmysig><v monthispemmapplicationwat,,mthist2L7tTIlmut 'lease check one) Owner 71 Agent _ l Telephone No. PERMIT FEE NignaLtlre Of wner or Agent