HomeMy WebLinkAboutMiscellaneous - 173 MAIN STREET 4/30/2018r�
�
Date......(. ' .. 1.�/Z�.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
1has permission to perform �� f we
/
................................................................................
'jviring in the building of ......�%.... �'.�' ."....`. ��
: .... ............................................
ii��. ,t r
at ........
...;........... ...................................................... ., ;North Andover/Ns'i
�I_r-
Fee ...:................. Lic. No-/./........ .........�..;............�.
.. ...........:.:.........
ttECTRICAL INSPECTOR
Check #
Commonwealth of Massachusetts Official Use Ont
E= Department of Fire Services Permit No. d3
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/991 (leave blank)
Z -A PLICATION 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: S ^ 3/ p
City or Town of: , ZOPFy IJ/)gt04 To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
(Street & Number)
? vner or TenantA C 4, U I L d Telephone No. g?2-1S 1619
Owner's Address 5A 02 12
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
-'-^^se of Buildingl�S����j/�� /�L, Utility Authorization No.
r -:.fisting Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: AIM tyN--
j %Cf/ ���� �y %L,/•� �
Completion of the followine table may be waived by the InsnPrtnr of Wiroc
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
,. j ;J`,.
b�atiag Fixtures
Swimming Pool Above ❑ In- El
rnd. rnd.
o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
'No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
n'
�. Waste Disposers
Heat Pum
Number
........................................................
Tons
KW
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
` �. of Water
KW
No. of No. of
Data Wiring:
_ '[eaters
Signs Ballasts
No. of Devices or E uivalent
INo. Hydromassage Bathtubs
No. of Motors Total HP
TeleN
alent
of Devices or E�►ui
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
I?`NSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
ice^see 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:
Estimated Value of Electrical Work:
(Expiration Date)
(When required by municipal policy.)
o Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
-:-t J , under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: Express Electric Unlimited
Licensee: Yan Kener
Signature
LIC. NO.: A 12757
LIC. NO.:
(IJ applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 877-263-2500
,A,'dress: PO Box 1169 Everett, MA 02149-1169 Alt. Tel. No.:
` _P'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
::uired by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
Location % J
No. r Date
M� TOWN OF NORTH ANDOVER
�.
u Certificate of Occupancy $
�ssACMUSE<� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # _ "o " ,
1 5 '1 1 2 Building Inspect'bor
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
PPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
100 NO W-11
UELDING PERMIT NUMBER: DATE ISSUED:
:GNATURE: liali
Of
3CTION 1- SITE INFORMATION {
Date
1.1 Property Address:
1.2 . Assessors Map and Parcel Number:
Map Number
Number
Parcel
1.3 Zoning Information:
1.4 Property Dimensions:
ning District Proposed Use
Lot Areas
Frontage R
i BUILDING SETBACKS ft
Front Yard . Side Yard
Rear Yard
Required Provide Required
Provided
Required Provided
1
Water Supply M.G LC.4ll. 54) LS. Flood Zone Information:
1.8
Sewerage Disposal System:
,lie 0 Private ❑ Zone
Outside Flood Zone ❑
Municipal
❑ On Site Disposal System 0
:CTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
Owner of Record
me (Print)
Address for Service
y77-17—
10
—
nature Telephone
Owner of Record: A
c
a
Address for Service:
22
nature Telephone
U11014 3 - COINSIRUC'fI0.N SERVICES
Lic ed Construction Supervisor:
�a fd
:nsed Construction Supervisor:
ress
7 7� r
.lure �Telephone
2egistered Home Improvement Contractor
t1ure
Not Applicable ❑
7/5s�
License Number
l� D /,/ CJ
Expiration Dae
Not Applicable ❑
1�o ys�
Registration Number
a/ -a :�> -Q2
Expiration Date
SECTION 4 - WORKERS COMPENSATION (1VLG.L. C 152 § 25c(6) I
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 buildingjehnit.
Signed affidavit Attached Yes ......Z / No ....... 0
SECTION 5 Description of Proposed Work check ail applicable)
New Construction ❑ Existing Building ❑ Repair(s)Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work: „� t
..mss14
�'-&✓IGL<-p
1 SECTION R - F.CTTMiATWD VnPJQTV11T9-T1rnM VA-ICTC
'Item Estimated Cost (Dollar) to be
Completed by permit applicant
. _ :..
a Building Permit Fee
Multiplier
3
,.•x
1. Building �—
.:.
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plurnbmg
Building Permit fee (a) X (b)
4 Mechanical AC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
...a.... i —11 1 a v ♦v r SGA Au l I1 Vn■z-a 1 luf`I 1 V nz (,1U1YWLh I Ell W MEN
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
Signature of Owner/Agent Date
i
OCT -18-01 THU 11 06 AM
maledale Win be hlrniah40 and millallod to these sipeclilostlone:
40
YES
F.I.D. No. 11.2320449
SEAM
Job x , 3",
it 3
SALES:
FOR ALL HomeCentral'"
New York:
SERVICE/REPAIRS The Service Side of Sears
800.942-6111
PLEASE CALI,
00910".
088-245.7294 t90 Cedar Hili Road
000 -SEARS -31
Marlboro, MA 0111752
Her800-SEAford RS
-9:
Boo•s�ARs•as
WINDOW CONTRACT
Provldenee Area:
Sold, FurnleAed a Inf►11ed ey BNI•aay Alreillim Sldlne Cors. el Oveens, Ine.
888-732.7751
A Seem Aplh44red Coniwder
Boo -SEARS -511
40 Elmonl Road, Elmore, VY I IMS
�V
ME Lie. No. DD1S/3
NH Lie. No, --- - _-
MA Lie. No, 120456
New York Dept. of Coosumer
Affairs Lie. No. 0730666
Nassau Lie. No. 112704$50000
Suffolk tip. No. 21194111
Yonkers 1391
Westchester WC11,113•H87
New Jersey Lto• No, LOOMIS
connecileul Dept. of Ctsnsulner
Antilles Lie. No. 00532714
VT Lie. No. _
Rhode Island Lie, No, 13701 m
sole���,
TO /y(/ e / 7�!�k �e �l/!�� �G� � ! "% 1 ����� �byATrE �/2/- /--
ADIDnESS I�C�� / L!/�� ✓r f
PHONE (Home)
�CITv STAT ZIP,2///��PHONE(Work)i/OI/Xd;GZn2x_,�-
JOB ' G�^�
_
SITE ADDhESS (it different)
APPLIED VINYL. WINDOW SYSTEMS
Genoral Dascriptlon of Work at Above Address: Approx. Stara Date
Typo of Mouse 0 Frama; Cj Masonry Approx, Completion bale
SPECIFICATIONS
SOafs OPprovod
maledale Win be hlrniah40 and millallod to these sipeclilostlone:
Removal of Mctal or other units roQtilring modified Instanae0n f openings N d urills - _
YES
NO
r'I,FASF PrAD CAnFFULLY- ONLY I HE Ii F„M5 CH[CKED'YSS" ARF. iNCLVr)E01N Youn onorn.
1. O
2. t7
0
K
FTamove wlndowa Iron openings where x,ey no ox", On:
FIR ST LEVEL M Openings
l
1F Now Windows -J
3. U
t�
SECOND LEVEL f OponMga
p New Windows
4. 0
0
THIRD LEVEL N Openings
4 Now Windows
5, ❑
d
BASEMENT LEVEL R aponlhos
d Now Windows
6. CJ
p
OT)ICR A Openinge
N New uuMdows
7. U
tJ
Removal of Mctal or other units roQtilring modified Instanae0n f openings N d urills - _
U. 0
0
Install now polniable Mouldings Inside Slope N of Openings - Clamshell or Casing Y of Openings --r-_--•-
9. 13
D
install new Master Frame i of Openings
10,
Broceedshoraol.ReeeuarybyNtedebtnrehaI nolexceedamounlspaid
Y dohlat hereunder.
Now window unlls to have double strength Insulated glees 7/8' total lhicknese
11.
CJ
New window unne to have fusion welded sash N _
RELIED UPON BY "OWNER". YOU ARE FN iIi I f D TO A COMPI ETF(Y
ME ORIGINAL OF THIS AGREEMENT AND TO BE THE AUTHO-
New Window unite to have fvtioh welded frame N
13.
0
Now window unlle to have ClIme•Tech packpgo Consisting of Low -E coated,
TIME PRIOR TO ✓<lIIDNIGHT OF THE THIRD BUSINESS DAY
AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED
CO.5IGNEB(S)•
Argon hilod IneWated glass I of units -4 -
14. 6d
❑
New window unite to have Cam Lock(s) or Latch Lock(s)
15. I(_j
[7
Now window Units to have Obscured Glass p Hall _ Full
16 0
❑
New window units to have hall (1/21 SCraen (FULL "rean on casement type window)
17. T;1
❑
tnslon PVC coniod aluminum to window frames Color -_ # of Openings
IS. 0
0
Caulk and seal windows with 3 ON syslem
19. 0
❑
Remove and dispose of existing windows andror storm windows
20. 0
C)
Color of windows to be While_ Belge -
21. tJ
0
Windows to have Grids colonial _ Diamond 0 Full ❑ 1/2
Additional info
22. ❑
Lj
Total a of Double I lungs Total X d Hoppers
Tolat Y of Casements - Total A of Awnings
Total N or Two Ula Slider; _ 7 Total r of Three Ute Gliders Std.,.,..,,. or Equol.'...,-
Totol a of Dead UtarPictures Total a of Basement Sliders
23. f7,11
n
Special ardor Windows (in Addition to Above)
24. 0 fJ Clean up -All lob retaled debris will be removed from propar(y on completion of wont.
25 C Cl lnsuranCe-All workmana compensation and liability is maintained,
26. U CJ Warvanly-Mailed to Customer upon eornpletion and full payment Is recolvod [ _ )Ar Oiaaunto 114vr nenn h Violl
27. (-j Cl Payments -(On non financed orders) is payable to installer on day of Installenon. tw i.„en rmn•nn a>� �.r mn n•rn n
28. f:1 0 All Discovnls have titer. applied, __ _ _
Cash SaloTo I Less deposit 33% S _ Cash Balance $ Other Payment (it arty)
0 CASH rF ANCED $�yydoes not include Interest Balance on Substantial Completion
yl--4/1
-,(�
It flnhnced, baloncs poyoblo In _ monthly Installments of appro%imately $--.per month, payable by 'Owner' to contractor, but
4 hnnncod by Owner Own Owner will ray said amount to the tending InstItutlon plus such Interest and cel service charge of Sold lending InaOlulion
pny,pbld directly to the lending institution loaning such monies to "Ownef and will sYeooto to Aete4ImAWlmont obngallon and any documents required by
such IOnding inedlution in oonnoction wilh 6aid loan, � T�
29 f'1 1'J Additional Inlonnallon---_.%,(,G-Yo..,L.4.,�G.,...,...�,.�,.-------
30 C1 17 W,
'('.ONTRACvon I$ NOT RE,"ONSMLE FOR ANY EXISTING SECURITY SYSTEMS, PLEASE REMOVE ALL SHADES, VER1*104S.
CURTAINS, DnAr)ES On WINDOW MOUNTED Ain CONDITIONERS, PRIOR TO THE INSTALLATION OF YOUR NEW WIN,
00W , ir,ISTALI FRS ARF NOT' he'$PONSIDLE FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF I'TFM3,
Notice: It 111lanced, any holder of this C11", er Credit Contract is tub,
CONDENSATION INSIDE TIfE DOUSE DOES NOT INRIf,ATE A WARP,
Jett 10 all Claims and delartses efhlch the a�ter could assert aggainst
the seller of goods or services obtained pu can[ Aerelo or wllh the
TY PR09t EM.
Broceedshoraol.ReeeuarybyNtedebtnrehaI nolexceedamounlspaid
Y dohlat hereunder.
SALESMAN $IAS Ile M111T11ARITY TO CHANGE ANY IYF.M3 DR A1AkE ANY
REPRESENtATlON3 01lIER THAN GQNTAUIEO IN THIS ACRFEh1FNF
AND "OWNER" REPRESENTS THAT NONE. RAVE OLEN MADE.. TO OR
"OWNER REPRESENTS TO HAVE READ AND RECEIVED A DUPLI-
RELIED UPON BY "OWNER". YOU ARE FN iIi I f D TO A COMPI ETF(Y
ME ORIGINAL OF THIS AGREEMENT AND TO BE THE AUTHO-
FILM IN QUPL1CATE PRIGINAI OF IIIiS AGRI I'MrN1.
RITED AGENT OF ALL "OWNERS" OF THIS PROPERTY UPON
WHICH THE WORK Oil THE MATERIALS ARE TO BE SUPPLIED.
"YOU THE BUYER MAY CANCEL THIS TRANSACTION AT ANY
NOTICE TO THE IIOME OWNER(S), GUARANTOR($), LESSEEM,
TIME PRIOR TO ✓<lIIDNIGHT OF THE THIRD BUSINESS DAY
AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED
CO.5IGNEB(S)•
NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF
Contractor, at Iiia expense of owner, Shall procure all permits required
THIS RIGHT. ON ALL ORDERS CANCELLED AFTER THE RECISION
by law as follows.
PERIOD CUSTOMERS WILL BE RESPONSIBLE FOR A 45%
1. Owners who secure their own permits will be excluded from the
ADMINISTRATIVE AND RESTOCKING FEE.
2. Ruoranly Fund provisions of Ms Cbapter 142A.
ey person who shall have co•SlIfned, guaranteed or signed any
credit application of note relating to this agteemenl heteby aeeepts
to bo ectlnd by this agreement.
3. Dwnor(a)pprepresents that the contents on the back of this a9reamers
III a4. ALL NSTALLlATION LABOR GUARANTEED 1(ONE)pYEAR. Owner.
arinl >/
Salesmen'$ Na 74 4-. �ro_
Solesmnn's / / t
Llcpnoe No .....
SEE REVERSE SiOE FOF
THE COMPANY WILL DEPOSIT ALL MONIES RECEIVED FROM
IN AFI BROW ACCOUNT AT CHASE MAMIIA�PAN SANK 1I0S'1
062089 WITHIN FIVE BUSINESS DAYS OF t.3 RECEIPT.
Date
Do not sign this agreement before you re .11 or It It c0 Ins Any blank
space or II if does not celdaln everyytl agreed ypo0f
Revised 4101
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, 06/28/208I 16:*2 5168285857 SCS4GENCY PACE 02/02
F'_1H
qLy
Qt IS CE
P.C. Box 2204S3 HOLDER, THIS CERTIFICATE DOE,9 AMEND, EXTEND OR
COWAW
13 Cla-meacLan Nation-ul Ins Co
-D/B/.X Sears Home Contral
C Scottsdale I:UUZAmc* Company
40 Zl=nt Road
Zl=nt NY 11003
COMP14NY
TKS is TO CERTIFY THAT THE POLICIES OF INSLAMC' , SELM RAVE dff!!N)33LI=1 To TME INVVSEI:l rQUED FOR THU POLICY PelbOD
EXCLUSIONS AND CONOM" OF 1A)CH POUC199. LIMITS 6HCWN M6kY HAVE UMN RMUCLO IFY PAID CLAUS.
CLAIM 1AAZE C=UR
SchtnuLro Auras
QARACC LIABILITY
A= ONLY - EA A—;�T7
OrHa THAN uuWk5_L.A FORM
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING �
(Print or Type)
NORTH ANDOVER Mass. Date
4uilding Location %75 IW14t0 9- Permit #
Owners Name SJU14
• - New Renovation j] Replacement Plans Submitted =]
T r'
`e -
(Print or Type) Check one: Certificate
Installing Company Name Corp.
Aj
Address y�.'� ili -
36DWPartner.
ffii1184 n I'YII4SS` Firm/Co.
Business Telephone: %� too-659-Od5�
Name of Licensed Plumber or Gas Fitter ��eS
Insuranct' Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnity Q Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of
th lication does not have any one of the above three insurance coverages.
ignature of owner/agent of property Owner ❑ Agent El
1 hereby certify that all of the detaUs and information 1 have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that aU piumbing worst and installations pctfomsed under Permit issued fo: this application WW be in eompiiance with all pertioeat
provisions of the Massachusetts State Cast ode and ChAPter 142 of the Genetaf Laws.
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
PE LICENSE:
Plumber
Gasfitter Signature of Licensed
Ma ter Plumber or Gasfitter
ourneyman���
License Number
MEN
No
ME
SERUM
MEN
MEMENNEEN
MEMO
��onn�v��u��■�m�u���
NNEMMIMIMMMMIMMMEM
ME
mommmommmonso
Nunn
El
(Print or Type) Check one: Certificate
Installing Company Name Corp.
Aj
Address y�.'� ili -
36DWPartner.
ffii1184 n I'YII4SS` Firm/Co.
Business Telephone: %� too-659-Od5�
Name of Licensed Plumber or Gas Fitter ��eS
Insuranct' Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnity Q Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of
th lication does not have any one of the above three insurance coverages.
ignature of owner/agent of property Owner ❑ Agent El
1 hereby certify that all of the detaUs and information 1 have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that aU piumbing worst and installations pctfomsed under Permit issued fo: this application WW be in eompiiance with all pertioeat
provisions of the Massachusetts State Cast ode and ChAPter 142 of the Genetaf Laws.
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
PE LICENSE:
Plumber
Gasfitter Signature of Licensed
Ma ter Plumber or Gasfitter
ourneyman���
License Number
1 70.Date ......................
1 "
TOWN OF NORTH ANDOVER
i \'� PERMIT FOR GAS INSTALLATION
XM
This certifies that...........................
has permission for gas installation .......................
in the buildings of ...... -.�. .....................
at .... �L-
.......... North Andover, Masi
....
Fee... Lic. .
No.:?! '
.........................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINO �
(Print or Type)
NORTH ANDOVER Mass. Datejt12
Ey y
uilding Location t % Permit # /
41 a --U>
Owners
Owners Named L
• Y _ New ^ Renovation Q Replacement Plans Submitted D
�SF I Y 7 TIR17(.
(Print or Type) Check one: Certificate
Installing Company Name[ i�1�c-�lG.,i�c„ ( Q Corp.
Address --7t �e4 r,G D, Q Partner.
EfFirm/Co.
Business Telephone: &(7 UY -7j U,
Name of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnity Q Bond Q
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner Q Agent Q
I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of mY
knowledge and that aU plumbing work and Installations petfomud under' Permit iueed for this application will -be in Compliance with an Pertinent
provisions of tho Massachusetts State Gas Code and Cisapter 142 of the General Laws.
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
er
Plumbb
Plumer Signature of Licensed
GasMaster Plumber or Gasfitter
ourneyman
License - Number
t,
•
•
•
■
•
Y
Y
•
J
MEN
MEMO
SEENn����lt�st���/let�»�■
(Print or Type) Check one: Certificate
Installing Company Name[ i�1�c-�lG.,i�c„ ( Q Corp.
Address --7t �e4 r,G D, Q Partner.
EfFirm/Co.
Business Telephone: &(7 UY -7j U,
Name of Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Other type of indemnity Q Bond Q
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner Q Agent Q
I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of mY
knowledge and that aU plumbing work and Installations petfomud under' Permit iueed for this application will -be in Compliance with an Pertinent
provisions of tho Massachusetts State Gas Code and Cisapter 142 of the General Laws.
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
er
Plumbb
Plumer Signature of Licensed
GasMaster Plumber or Gasfitter
ourneyman
License - Number
Date.....................
menti
r'
3
s
CF Ho DT eTOWN OF NORTH ANDOVER A
PERMIT FOR GAS INSTALLATION R
P p
This certifies that ................. .......................9;
has permission for gas installation ......................... :8
19
in the buildings of .........................................
CU
at .... , North Andover, Masi
Fee./—I- !�F Lic. No........... ...............
j� Z -Z 2j GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
COMPLAINT NUMBER DATE:
COMPLAINTANT : i,� � C. L' cam_
CLOSE DATE: Ca �
ADDRESS: 14Pt3 PHONE: S
OWNER: PHONE # :
ADDRESS :
INSPECTION DATE:
COMPLAINT;
ORDER�DATE:
t�v�Q A
J�`" ICS-,,.
/� /10/0 /N60"Y'6�",
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI VATE2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/IEEpeStor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
/73-/7u ��A
1.2 Assessors Map and Parcel Number:
30
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimansions:
Lot Area (sf) Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
Owner of Record
c�A.2 ,-,S P1 P,,�.LL
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
—�• �� —,�e�
Licensed Construction Supervisor:
_
Address/
/�
%-�;Lf z, ?
Sire I elephone
le
/ g
Not Applicable ❑
License Number
Expiration *Date-'
3.2 Registered Home Improvement Contractor
Z- � /�60 e tJ 4�b �✓�
Not Applicable ❑
�/ -,S' 7 697
Company Name
Registration Number
Address /?
S,9S %% G 2,A
Expiration Date
Signature Telephone
ou
M
z
O
z
M
90
0
wn
M
r
z^^
Y/
SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check alta licable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item Estimated Cost (Dollar) to be
Completed by permit applicant
QI+CIAI„USE ONLY
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (e) x (b)
4 Mechanical HVAC
5 Fire Protection �Qb
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, , 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
1, 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/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TMMERS iST 2 ND 3 RD
SPAN
DRv1ENSIONS OF SILLS
DINIENSIONS OF POSTS
DM ENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHBVMY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
EA. Genera[Contracting
Specializing in Additions/Roofmg/Paindng/Renovations & General Carpentry
Telephone: 978-459-1578
PRO=D TO:
'
PHONE #:
Fax#:
DATE:
STREE�SO
JOB LOCATION:
CITY, STA ZIP CODE:
�
ES
7TACI:
We hereby submit specifications for:
WO pivpOSe hereby to furnish material and labor — complete in accordance with above specifications, for the sum of.
DOLLARS
$ ��
Payment to be made as follows: -
Authorized
Signature
,X CCeptanCe Of PMPOSaf The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment
will be made as outlined above.
Date of Acceptance: Signature:
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications
involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements are contingent upon strikes, accidents or
delays beyond our control. Owner to cam fire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance.
N; T
A -COM. '
imam mYm+-.mr„�rv.�co:: ;:>av:.'¢:�.....�\CQ♦ .:�,a � ti�\'`:c:,c,?:a
RDUUCER
THE HOWE INS AGENCY
MURED
4 PUNCHARD AVE
ANDOVER MA 01810
ROBERT EMMONS JR
DBA E B GENERAL CONTRACTING
16 PHILLIPS STREET
LOWELL MA 01854
t , !�
F• c - • ,�, 1 t F� •
F• 7� 't t C h• �'
COMPANY
A NATIONAL GRANGE: '
COMPANY
B MISCELLANEOUS COS
COMPANY
c
c olumm
D
............................
THIS 15 TO CERTIFY Tt1AT THE POLipES OF INSURANCE USTED EIELoYY HAVE BEEN mmm To Tw INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWTIHSTANDING ANY REQUIRE MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMIM WIITH RESPECT TO WEUCH THIS
CERTIRCATE MAY BE ISSUED OR MAY PERTAIN. THE MURANCE AFFORDED BY THE POLICIES DESCHMED HEREIN IS SUBJECT TO ALL THE TERMS.
___--- --.-------_.. ... .................�� tttusc• mwimm uev usuC RCCN iaiMVS:n RV PAID GLARM.
DEBCRIPTIOTE OF OPERATEDNSILOCARONSMEEBCLSISPEML "EM5
- ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE TIE
E7tPRWIION DATE THOMOP TIE [SSUDEG COMPANY WALL ENDEAVOR TO TRAIL
iR
TYPE OF DiSURANCE
POLICY NIANBEt
POLICY MgqwnvF-
00 DIMM
POLICY EXPMATIO"
PM (YMfDMIYYI
L>aIRS
emiff A1. I D,Bam
X COMMERCIAL MERAL fin,
MADE oCGDR
TBD
4/16/03
4/16/04
GENERAL. AGGREGATE s2,000,000
PRODIMM - COMP/OP AW 21,000,000
PERSONAL & AM DLIURY $1,000,000
EACH OCCURRENCE $1,000,000
CLAIMSOWNERS a �NrRacroR s PROs
aRE DAMAGE tAry — fire) s 500,000
MED EV (" ab P wwn) s 15,000
AUTOMOH@E
LIANSM
COMBINED SINGLE uMEr s
ANY AUTO
ALL OWNED AUTOS
SCHEOULED AUTOS
BODILY I"URY S
(Pw pommy
HIRED AUTOS
BODILY DUURY S
cp_m
NO"WN® AUTOS
PROPERTY DAMAGE S
GARAGE LlABBliY
AUTO ONLY - EA ACCIDENT S
-
ANY AUTO
OTHER THAN AUTO ONLY --
EACH ACCIDENT s
AGGRES;;ATE S
EXCESS LIABRM
EACH OCCURRENCE S
UMBRELLA FORM
AGGREGATE S
S
OTHER THAN UMBRELLA FORM
3
WoRIERs coMPE mmoN Arcs
EPHILOYERS• LIABsm
74 4 SA017
4/18/03
4/18/04
X �Y L>MrTs ER
EL EACH ACCIDENT S 100,000
EL DISEASE -POLICY LTMTT S 500,000
THE PROPRIETOR INa
PARTNERS
OFFICERS ARE EXCL
EL DME&SE-EA EMPLOYEE S 100,000.
OTHER
DEBCRIPTIOTE OF OPERATEDNSILOCARONSMEEBCLSISPEML "EM5
- ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE TIE
E7tPRWIION DATE THOMOP TIE [SSUDEG COMPANY WALL ENDEAVOR TO TRAIL
Location
No. Date Iz 9- ° y
Nom,. TOWN OF NORTH ANDOVER
# Certificate of Occupancy $
��'� s'••°;<�#
MUS Building/Frame Permit Fee $
AC
•� Foundation Permit Fee $
Other Permit Fee $
TOTAL $
n
Check #
i
17882,...
Building Inspects,
1.1 Property Address:1.2
Assessors Map and Parcel Number:
cq iz�
Map Number Parcel Number
1.3 Zoning Information:f/c
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54)
Public ❑ Private ❑ - Zone
1.5. Flood Zone Information:
Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2- PROPERTY OWNERSffW/AUTHORIZEDAGENT r11sLUnC uisinct: Yes NO
2.1 Owner of Record
Name (Print) Address for Service
Signature Telephone
2.1 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTI N 3 - CONSTRUCTION SERVICES
3.1 LicAnsed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: Q ?(0
d
�-- k License Number
Ad. ess
;1v Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name b
l 0 t � � �'�/1aC� Registration Number
Addr
�P C Expiration Date
Signa'Telephone
Ma
M
X
z
O
O
z
M
90
O
mn
ic
r
v
M
r
zz
SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Descri tion of Proposed Work check atl applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑ JAddition
❑
AccessoryBldg. ❑
Demolition ❑
Other ❑ . Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by 2ennit applicant
QFFICTAEOiVY .
.
1. Building
ca�2—
C
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
cs
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application..
-Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
,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 /�,,
# 6 C l ci
Print 14ame
i/ y
Signature of Owner/A e Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 ST2ND 3
SPAN
DIMENSIONS OF SILLS
DEvIENSIONS OF POSTS
13Ilv1ENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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RICHARD FLUET CONTRACTING INC.
10?, Bridle Path Ln.
METHUEN, MASSAdHUSETTS 01844
(978) 685.7010
TO Meghan Nickerson
173 Main St.
N. Andover, Ma. 01845
Page No. 1 of 1 Pages.
497
.'PHONE
TDATE978 688-17840/5/2004
JOB NAME 7 LOCATION
..WINDOWS AND SLIDER
JOB NUMBER
PHONE
INSTALL.AARVEY WHITE CLASSIC MECHANICAL DOUBLE HUNG VINYL REPLACEMENT WINDOW:
WITH LOW "E" GLASS,1/2 SCREENS AND INGLASS GRIDS.$350.00 EACHjZraf'�'
L
AVAILABLE CREDIT ON WINDOWS DEDUCT $100.00
x1444=-00 TOTAL
130-0
INSTALL ONE ANDERSON PERMASHIELD SLIDING DOOR UNIT WITH SCREEN, WHITE HARDWARE
AND FOOTBOLT. $1500.00
WORK TO INCLUDE;INSTALLING,INSULATING CAULKING AND TRASH REMOVAL.
WE LOOK FORWARD TO INSTALLING -YOUR NEW WINDOWS AND DOOR FOR YOU!!!
Extras or changes to be completed at a rate ofd per hour, per man.
Unpaid balances subject to 1'!x% finance charge per month.
WE PROPOSE hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of:
Three Thousand One Hundred Fifty and 00/100 Dollars dollars ($ ,
Payment to be made as follows: V
1/2 WITH ACCEPTANCE, BALANCE UPON COMPLETION. ll
All material is guaranteed to be as specified. All work to be completed in a professional
manner according to standard practices. Any alteration or deviation from above specifica- Authorized -'
tions involving extra costs will be executed only upon written orders, and will become an Signature -- f
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Note: This proposal may be
Our workers are fully covered by Worker's Compensation Insurance. withdrawn by us if not accepted within 30 days.
ACCEPTANCE OF PROPOSAL —The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Signature
Date of Acceptance:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Ofilce of Investigations
Boston, Mass. 02111 -
Workers' Compensation Insurance Affidavit
Name Please Print
Name: Vk-', G& t�1V
Location: 113 ► S�
city Phone
F-1 I am a homeowner performing all worts myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
n t L�-0 Fyy ,C� l�
Comtrarn name: / c-( C -
Address o d_
city VkA- L 4- g4qPhone � (J to
MEM
Phone;*
t, -/C— 7 CIO V(� -?
Failure to seem coverage as required under section 25A or MGL 152 can lead to the imposition d criminal penalties d,a Ane up to $1,500.00
arxYorone years, Imprisonment_as_vaeU.as_chili4=dtimJnbof=.dASTOPV*VMORDER.and_a.Aced.(,:100.OD).aAWBankat-mei I
understand that a copy d this statement may be forwarded to the Office d Investigations of the DIA for coverage verification.
I do hereby certiy under the pains and penalties of P06MY that the information provided above is true and convict.
Signature Date
Print name Phone #
Official use only do not write In this area to be completed by city or town d5dif
City or Town P ami
no
[]Check X immediate response !D requiFed ❑ Building Dept
❑ Licensing Board
Contact person: Phone #. C] Selectmen's Office
❑ Health Department
❑ Other
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
1 z 0
Dat
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
,per ✓lee �omvnzanure¢lda a�✓Glaaaa•T/ucart7d
�\ Board or Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 106620
Expiration: 7/24/2006
Type: Private Corporation
RICHARD FLUET CONTRACTING INC.
Richard Fluet
102 Bridle Path Lane ?er.-
Methuen, MA 01844 Administrator
r��P .tnamnea�ur�ea/
' 3 ,
BOARD OF BUILDING REGULATIbN§' '
License: CONSTRUCTION SUPERVISOR
?'V Number: CS 050710
Birthdate: 04/22/1956
Expires: 04/22/2005 Tr. no: 9641
Restricted: 00
RICHARD A FLUET
102 BRIDLE PATH LNC -�
METHUEN, MA 01844
Administrator