Loading...
HomeMy WebLinkAboutMiscellaneous - 189 BRADFORD STREET 4/30/2018 (4)N O_ o0 �_ W 0 0 O T O O � o m o � This certifies that has permission to perform . ? � � ................... wiring in the building of ......4.-X .q �? s � p . . ............. . at ..../F� .. ..... , No Andover, Mass. Fee Y .2.. Lic. No.......... ../1'%v��-- . . ELECTRI AL INSPECT Check 4213PO Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 1 t--(, S-75 Occupancy and Fee Checked [Rev. 1/071 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 ININK OR TYPE ALL INFORMATION) Date: & - 30— / '�, City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of hisor er intention to perform the electrical work described below. Location (Street & Number) j9 � "Vo r-4 S l Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes ❑ Purpose of BuildingS i P q Lg— o VY% Telephone No. 178 to W.504 No X1 (Check Appropriate Box) Utility Authorization No. Existing Service Zoo Amps ( ZO / d110 Volts Overhead K Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: c-117 10� No. of Meters P No. of Meters Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans TransTotal Trsformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Batter Units Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. In Detection and of InDetection Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: Number 1.19ns KW ......... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Cyyonnection No. of Dryers Heating Appliances KW SecNo. uritof Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: 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 A< BOND ❑ OTHER ❑ (Specify:) I certify, under the aims and penalties of perjury, that the information on this application is true and complete. FIRM NAME: " . 6 rF t U . LIC. NO.: Licensee:�tqC-pp Signature ��,�_ LIC. NO.: -14210 14 (If applicable, enter "exempt" in the license n"tuber li e.) Bus. Tel. No.: 910 37230 t `d Address: Id -7 kAI-Tc L R 01&30 Alt. Tel. No.: a- 978qd3bl31I *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I 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. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ r Y ' •.�+NJL•1\l.+S.S-�.+.'V�.+(�i�.�.�-IT%J-ir.�J4..et��•.®�iy� - �•Q�j{y;�p,r'iy-�'j'�fj .+.�.{1.rJV.L'1�sJ4.R�J.7 .�a+'+J. IiJ-��i r • �2�sseiX , j'aiieH j ] Re-inspeet�on xequzXed'($O.OQ) j 3ns,�ecfoxs' copamte�afs: [Cuspecfoxs5 Sigaatuxe -uo :71111iiffi) Pate 8, ii )TR GROUND lUgR ;CTXOZY: I'assetl--j � I?+aile�--j ] Xte-�s�eefZouxet�uireti(��0.40)�j � %n.s�ectoz's' comments: • (Inspectors"sign atoxe•-).o ini- ials) ]ate F.e-inspectfon required ($50.00) - j s�pecfbxs9 eoynxn.eufs; (XZtsp eetoxs'fgt�atnxe bioniiials) Data �ecl•—[ � �`afler��-j ]- 'fie xnspeciion.xequfz'ed ($50.00) •-[) �eetors' coxs�xae�.fs: ' �lusp ectoxa' Winatuxe •• no xniffals) Pate OR T'.A GJ5 .ARE TO BF B'MiFD 0'91'AM IEFT ON 191TF N . IVA TO BEoTECT.B+ D XONOT 3'asserl • • �'aileti-•j � • �e-#�nspecizo�,xet�nixeci ($�0.00)w j � . �n�iecta' ommiextfs: . I , 2 l2 (.itisXiecfoxs' atux •• o xxtzffals) Slate 8, ii )TR GROUND lUgR ;CTXOZY: I'assetl--j � I?+aile�--j ] Xte-�s�eefZouxet�uireti(��0.40)�j � %n.s�ectoz's' comments: • (Inspectors"sign atoxe•-).o ini- ials) ]ate F.e-inspectfon required ($50.00) - j s�pecfbxs9 eoynxn.eufs; (XZtsp eetoxs'fgt�atnxe bioniiials) Data �ecl•—[ � �`afler��-j ]- 'fie xnspeciion.xequfz'ed ($50.00) •-[) �eetors' coxs�xae�.fs: ' �lusp ectoxa' Winatuxe •• no xniffals) Pate OR T'.A GJ5 .ARE TO BF B'MiFD 0'91'AM IEFT ON 191TF N . IVA TO BEoTECT.B+ D XONOT �, I:- ..I The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): ) - Address: IJ -1 U%Ste, City/State/Zip:J-awer 1..L Mn Phone #. 9-70 Are you an employer? Check the appropriate box: 1. RI am a employer with_ 4. ❑ I am a general contractor and I employees (full and/or part-time).` have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. T ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ( Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they Lire doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. X am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/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 DTA for insurance coverage verification. X do hereby c��dery, the paj s an"altles of perjury that the information provided above is true and correct. a 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 i 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 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-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 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 fature 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: The Commonwealth of Massachusetts Department oflndustriai Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 Tel, # 61772.7-4900 ext 406 or 1-877:MASSAFB Revised 5-26-05 Fax # 617-727-7749 www-mass,govaa This certifies that . �. . �� �� . ; lr✓� IZtN� has permission to perform .. ... .......... ....... wiring in the building of .. �[ at ..l ....f! �-r 11 .iv✓`G�.. ...... Nort Andover, Mass. Fee .. � . Lie. No. 74.48.4 . . ..... ... �-i . ELEC RICAL I eTOR Check # A / 11014 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 11 rjON, Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code W , 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: g'I`� 201 Z City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) `�' Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 21*1� (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts a Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: (z ( ICwir►.v..�;C bpi °1SQ(`P l�.�drd' Cmmnletion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans v s Total Trsformers KVA Tran No. of Luminaire Outlets No. of Hot Tubs Generators KVA l No. of Luminaires Swimming Pool Above ❑ In- El rnd. rnd. o. o -Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers P Totals: '­ . .­ ............................................... Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW S P g Local El El Other Connection No. of Dryers y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: 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 thepains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAM LIC. NO.: Licensee: ell SignatureQ'I"'.4c)LIC. NO.: 21 W&A (If applicable, me �"e�x�em4tt in the license nzi ber line.) Bus. Tel. No.: Address: 3=_ �� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, secure work requires Department of Public Safety "S" License: Lic. No. � OWNER'S INSURANCE WAIVER: I 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. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. f 4 .- • �J-�1Utll.�Ciw.A.'U�'�t/�'�.fl�_7iJ].��-'l(l'fMi J�'��•�®���+t'p^yx�'(�j':J'� (� ,,U•'1{.7.R �`U.•..R�+R7 J.bJ�J. ii�J. i • , _ �e rn'L.l..�a.9.31.f�-i.s-i.11�A.�'+slJ.l. i1,C9. r. � .... 'r •. � • •• - )2Osseo•=•[+'alIeft-��)e-xnspecizoxt3re[wixed�(��Q.DQ)�� Aspectoxs' commots: ' (nspeeaxstiz�naiu�Ce�noiitta7s) Pate �u�pectoxs' coxnm.eJxts; - -'Viii rte• Qi%� ,. .i r / �.�'J� Ps&ctors' gzgnatuxe - 3io 7xuiials) J Slate ` 'assed--�' � �'a�Ieti--j � ate-anspee�.o��•ec�uixe���sO.OQ)�[ ] aspectozs' colaments; , _ [lnspectoxs' �zgnatuxe �aoiaTs) ]ate -- w6TY1t;T.COx--REWIMP: �+'aileci-- �,pectbxs' eoynz�.ep�fs; (cuspeciors, fta�turo- io j01278) • r �e �nspectZo: Data 'Re -Ins pecitox+.xPukedMGM)�[ ) Betas, C4)Tib7ents: asp ecioxa'zgnaiure n o xni�f a!s} Plate ' ;i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1r S&,CkQ, �, f -kA S1u0,L_QS X nCcy Por Address: City/State/Zip:'( Qn E /1-x,0 0 (FsLILI Phone #: '�_?is 3(00 ­'�'I&-T°) Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have wgrking for me in any capacity.� w�kers' comp. insurance. [No workers' comp. insurance 5. We are a corporation and its E required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ of repairs 13. Other (Id LL0C')'P,1QZ Ac C *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and 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: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: 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. [do hereby certto under tnams ndpenalties of perjury that the information provided above is true and correct. Signature: Date: 2 0 Z Phone #• C� 1 — :SU Ci' ::Y �� 1 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 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-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 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. Anew 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: The Commonwealth. of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass,gov/dia Robert A. Sammataro P&H, Inc. 8 Dunraven Rd Windham, NH 03087 603-893-0515/978-682-9971 N.H. Lic. 3595- Mass. Lic. 9333 BILL TO Mr. Salvatore Marchese 189 Bradford St. No. Andover, Mass. 01845 ould °II Igl I Z I nvoice DATE INVOICE # 9/13/2012 2955 DATE ITEM DESCRIPTION AMOUNT BALANCE 9/13/2012 Permit I, Robert A Sammataro P&H, Inc. would 0.01 0.01 like to cancel a electrical permit taken out by Prestige Electrical Services at 189 Bradford St. Attn: Electrical Insp. Thank you for your business. TOTAL MATERIAL & LABOR $0.01 Date ... 4? ........ TOWN OF NORTH ANDOVER 0 • PERMIT FOR GAS INSTALLATION This certifies that /!.o.......has permission for gas installation vr .... ..................... in the buildings of ... ... ........................ at ... 145:1Y. :%.7 .............. North over Mass. Fee.Lic. No... � GAS INSPECTOR Check # AgW 82'10 .�. MASSACHUSETTS UNIFORM APPLICATIOOF —OR PERMIT TO DO GAS FITTING City/Town: MA. Date.IV —ffffIWI Pel Building Location: �11 Owners Nam4k�- Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [� New: ❑ Alteration: ❑ Renovation: ❑ Replacement: 4Q Plans Submitted: Yes ❑ No ❑ n�•7VrVyrYVC �.VVtKAC7 t: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes [lNo ❑ If you have checked Yes. please indicate the type of coverage by checking the appropriate box below. A liability insurance policy P Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner's A ent Owner ❑ Agent ❑ By checking this box ; I hereby certify that all of the details and information i have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be d compliance with all Pertinent provision of the Massachusetts State Plu ing Code and Chapter 142 a General Laws.In By Type of License: ❑ Plumber Title �❑�Gd�ss Fitter ter a ure of Licensed lumber/Gas Fitter Ly'Mas City/Town ❑Joumeyman % APPROVED OFFICE USE ONL LP Installer License Number: / n mmmm MM MwmmmmmmmInstalling ���i MM M M MM .. / /. ` / i� I �1 l� 11Check : . nly Certific—ate Address: �i t �/' P 'Corporation . i GI i //� 7 Business Fax: to ■ Partnership Name of :. Plumber/Gas n�•7VrVyrYVC �.VVtKAC7 t: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes [lNo ❑ If you have checked Yes. please indicate the type of coverage by checking the appropriate box below. A liability insurance policy P Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner's A ent Owner ❑ Agent ❑ By checking this box ; I hereby certify that all of the details and information i have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be d compliance with all Pertinent provision of the Massachusetts State Plu ing Code and Chapter 142 a General Laws.In By Type of License: ❑ Plumber Title �❑�Gd�ss Fitter ter a ure of Licensed lumber/Gas Fitter Ly'Mas City/Town ❑Joumeyman % APPROVED OFFICE USE ONL LP Installer License Number: / n r-- Q�"� The Commonwealth of Massachusetts Department of Industrial Accidents ' t Office of Investigations 600 Washington Street Boston, MA 02111 e www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/individual): Address: x 'oil Yl ra 1).610 City/State/Zip:_ �) / n d V� 7 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on. the attached sheet. Y ship and. have no employees These sub -contractors have working for me in any capacity.workers' _ comp. insurance. [No workers' comp. insurance 5. a are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] �a Type of project (required): 6. ❑ New construction 7. 094remodeling 8. [] Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 1 1. ' 'lambing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks boi # 1 must also fill out the section below showing their workers' compensation policy information, T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 4Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 DCA for insurance coverage verification. / do hereby cefy under the paip and pen s o erjury that the information provided abpve is true and correct 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 #: 4. Location No. c9. 1 / Date TOWN OF NORTH ANDOVER f ;o Certificate of Occupancy $ sA�MUs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $� Check # / 17728 'Building Ins tutor `C TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONCE TWO FAMILY DWELLING bOR BUILDING PERMIT NUMBER: f DATE ISSUED: j SIGNATURE: Buildin ommissi n ildings Date SECTION 1 -SITE INFORMATION 1.11 Property Address: % j Z2 L / 1.2 Assessors Map and Parcel Number: Clio 61,0z Map Number Parcel Number 1.3 Zoning Information: 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 R 'red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Nafne�( er) Address for Service Sigi ature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licenq6d Construction Supervisor: Address n / o� v( �ofG� ure Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor z ran46 ei�` /`l�G Not Applicable ❑ Com an Name � 2z n� ` Regl�a ontt Numher Address 0 CN,7 Expiration bafe Signw le hone Ma M ic z O O z M 90 0 ic r v r z G) / SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work check all a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: IaM�4��Oz SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed bpermit applicant OC USEQY„ „ 1. Building <O (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) i 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 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 4�./ , P -� Print Name/ Si ature o er/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Castricone Roofing & Siding REPAIRS FREE ESTIMATES Telephone (978) 682-4266 MARIO CASTRICONE 31 Court Street, North Andover, Mass. 01845 Aare MICCA is tq pcoviae j4�c�tf �' workMUA'S c0ryPM5,:4;�arr Ih U'vc4tite QfI rcrFf�'`���ha� I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish II necessary I materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and I' �� ` + conditions, on premi below -described: )7 (UA (0 me.Owner's Na........6............. ..... ............................................................ Job Address ......... 1� ...)d�J51.. .....:....' ........................City. 11 �0�.. State..................... SPECIFICATIONS ...........V/�' � 2 - � ......... ........... ..�'/ ..... ..,............... �.... �....... ,....................... �,�., .... -...� ... ..... ...r:.... .................... . ..... �' . .�d....� Com. ..... ..... .........G...,��.. ..c�.,..........or/�...................................................................................................................... ............................................................................................................................................................................................................................................................. . ... ....... &d................................................................................I.......... ...........( .. ....1%.%.�1 �?-....r ......................................................................... Materials and labor to cost $.........tl�............................ Payable ...... on ................................and balance in............ monthly installments of $ .........................................each, payable on ........................................day of each and every month thereafter until paid in full (..............% charge per year is to be added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Cover attic storage cleaning not included. Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in operation. IN WITNESS WHEREOF, the parties have hereunto signed their names this ................... day of ... .. .........1�.sX,ClQY Accepted: W... Signed...........................14t.................................... Owner (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Per.......... ... ... f�,,-�.... ........ ,.............. Representative Signed...................................................................................... Owner Signed...................................................................................... ALVR, Mica( .s �9 ptoviJe prof 0-F work mun's compeiry54,i4h ;v5„ion aail()pnecessary rcff.e ;gho1 . materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and I I I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all {i3' Ji T conditions, on prem( i,s below described: Castricone Roofing & Siding REPAIRS FREE ESTIMATES Telephone (978) 682-4266 MARIO CASTRICONE 31 Court Street, North Andover, Mass. 01845 �// i15" gun c� Owner's Name a �a ..//4,6-a32-,, n/��/J� Job Address /6$ 0..1 A City. /� . .. State... ,% ..C6f::Kl..{�,,.. SPECIFICATIONS 6 6f)t- 6-7)71-L,AtO a Materials and labor to cost $PlQ Payable fir.•.. on and balance in monthly installments of $ each, payable on day of each and every month thereafter until paid in full ( % charge per year is to be added to above cost of labor and materials and is included in monthly payments.) • Contractor will do all of said work in a good workmanlike manner. Upon completion of above work; all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Cover attic storage cleaning not included. Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in operation. �j IN WITNESS WHEREOF, the parties have hereunto signed their names this day of.L...• , 1.. ic%Q./ Accepted: (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Per Representative Signed Owner Signed Owner Signed � The Commonwealth of Massachusetts Department oflndustrialAccidents 1";._ -- office oflnuestigations 600 Washington Street, 241, Floor Boston, Mass. 02111 A - -, _� Workers' Compensation Insurance Affidavit Building/Plumbing/Electrical Contractors Applicant informatlon':'; Please PRINT legibly name: t 6 - address: Z& city & state: ! ` w zip: 6 yU phone # work site location (full address): ❑ I am a homeowner performing all work myself. Project Type: ❑ New Construction ❑Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition„ I am an employer - providing ❑rprrovidin�g[workers' compensation for my employees working on this job. company name: address: city: /` SS hone #: 600 —CQ insurance co. / r^Aei^pohcv #77,7 C✓ / / U ��/ �� ❑ I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address city. phone #: insurance co. policy # r company name address city phone #: insurance co. policy # Attach additional sheet if.necessary Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. l Signature r Date �Q/G�%d� Print name � Phone It " official use only do not write in this area to be completed by city or town official�� } city or town: permit/license #❑Building Department ❑Licensing Board l ❑ check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone #; ❑Other (revised Sept. 2003) .� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of .the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to thecontracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pen -nit 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 member listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,71h Floor Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406 • O H c c CD o O H I--Cl� C a C7 y O CLC m m O A a v E O w m o� Ea a w CaL H a a � V CD CL H A EE :gym u d cm 11 ca S � CO2 U w c_ oCL l 1; w ` O o Z' fA 3 a � m� z o O H E h t H 0 ro c 12, m 0 cm c c N ID O Z O 5 mo O v cm wI+ O _� W y � � �E m co a F-= 3� CD L Q ca GO � c ev CL. cl as c z m C..) vs c C c_ C c CL 0 LLILLIU) W W W N c c CD o O H I--Cl� C CC3 V C7 y O CLC m m O m o� Ea o CaL H V CD CL H EE :gym :oma d cm 11 ca S zag CO2 r ts c" c_ oCL l 1; h *V ` O o Z' fA 3 C=M m� .m w N cc :.Z" to 16. o : CLU :SCD zo E h t H 0 ro c 12, m 0 cm c c N ID O Z O 5 mo O v cm wI+ O _� W y � � �E m co a F-= 3� CD L Q ca GO � c ev CL. cl as c z m C..) vs c C c_ C c CL 0 LLILLIU) W W W N coQ N O C7 y O C.2 Z ea m c via ID o CaL H Zo W=LS C WE v'oay d cm 11 ca S zag CO2 m a4..m E h t H 0 ro c 12, m 0 cm c c N ID O Z O 5 mo O v cm wI+ O _� W y � � �E m co a F-= 3� CD L Q ca GO � c ev CL. cl as c z m C..) vs c C c_ C c CL 0 LLILLIU) W W W N ✓fie U� omrr�novz o�✓f/�aaaac/ucaella Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 103317 Expiration: 7!72006 Type: DBA CASTRICONE ROOFING & SIDING CO. Mario Castricone 31 Court St. N. Andover. MA 01845 Administrator License or registration valid for individul use only before the expiration date. Hfound return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 r ? Not valid without signature LocationpL N. o. i/nes ` / Datea�' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ cN! Other Permit Fee $�' Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Ie for r� 49/21/98 11:44 3n nn MDP 12{, Q o Drv. Public Works At . . Location No. _ Date TOWN OF NORTH ANDOVER o� Certificate of Occupancy $ D Building/Frame Permit Fee $ sACMUs <� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ N TOTAL $ Building In&ctor 09/21/98 11:()0 30.00 PAID Div. Public Works s� r1 I < a C LU m u u :;aw L i C .irk, U Q LyfJ W W VW1 'f _ u J N C C W z c z < Li Z ✓] �-W t C W n Z ¢ y �z s Zy r G Z G Z n - - a W 2 i - c LLI Q N d Cl) O S d N � O - z LLI C 3 C w _ Z C } JCS W W M Z Z W N n u _N O _ < - n L N z z ;n 'r- N U C u u cm w�j z :n v < NG I�1 O � � Z i O .. Z IV - 0 -0 G G _ W u z < W �5 W 5 ¢ N z i z W — z } Z n u � N C z_ V W < z W ~ d Z Z QcC� z z Z Lu _ < < < a C LU m u u :;aw L i C .irk, U Q LyfJ W W VW1 'f _ u J N C C W z c z < Z ✓] �-W t C W n Z ¢ y J. e9 Zy r G Z G Z n - - a W 2 i - Town of North Andover BUILDING DEPARTMENT Homeowner_ License Exemption Wlease print) LATE e JOB LOCATIO�<� �r0r-cl ! t"re +- Nu ber treet ddress Section of own HOMEOWNER"_ I U D( -C -GDi 5t1-,ee+- % C� �5— mak./ Name home Phone 5 Work Yhone PIPEENT MAILING ADDRESS 6 "46 5 wee v / �. City Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwell- ing, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit' to the Building Official, on a form acceptable to the Bulding Official, ' 1.hat he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 1'he undersigned "homeowner" assumes responsibility for compliance with the Mate Building Code and other applicable codes, by-laws, rules and 1,29ulations. ,e undersigned "homeowner" certifies that he/she understands the Town of , Lh Andover Building Department minimum i P inspection procedures and ..:quirements and that he/she will comply with said procedures and requirements. '�)MEOWNER' S SIGNATURE '1 PROVAL OF BUILDING OFFICIAL ate: Three family dwellings 35,000 cubic feet, or larger, will be t.-equired to comply with State Building Code Section 127.0, Construction Control. Is ON F 0400 � c o .m x 0 c x a 0 60.: O c4 V +>)' �� a+ w L3 t w a w a°G o w w PQ C/) o V) F 0400 � E N C 73 C" CD C: Q� C m O cm C_ �C N CD L 0 Z 0 zoo 6'Z7 z wo w 0 Clco E O i � O v Z O d O y �tm i O �� CD .E tA m m 0 co CL � O � 3� co O � i ca �Q Cco 0 CL C3 Na C c o .m c .oma 0 60.: •dam CLc M :L o Ea C d •r Es Cc m C_ O N cm o� � c _ m a ev v L c N W N m E� m 0 nv N m O N L A O : c O H Q � y O c = o m ._. p CL 0 1— p yr N m W •N A C (... �E dL , ca 1 N Ll V m p O C_ CO) d O O = A "32 L � �O L06 L E N C 73 C" CD C: Q� C m O cm C_ �C N CD L 0 Z 0 zoo 6'Z7 z wo w 0 Clco E O i � O v Z O d O y �tm i O �� CD .E tA m m 0 co CL � O � 3� co O � i ca �Q Cco 0 CL C3 Na C Location No. Z Date _ TOWN OF NORTH ANDOVER Certific of Occupancy $ Building/pPermit Fee $ s� FounddWermf e $ Oermi�lg9 °��iJ/,, $ Sewer ctioee $ Water Conned Fee $ TOTAL - $ Building Inspector w ti .ci 9 3 u Div. Public Works i W J LU J LU V f � J W 3 o o U 0 0 0 = l7 < IL Y 0 m W Z I Y u W r ° x r x W Z < N C C J a o N Z < < 3 W a J < 3 O 3 O IN J Z W ^ U. 0 0 0 Z 3 C m www OZ m NINQ WO rW rW rZ WJ 4 ° t m N° Z i J oZ Z O o J W J a 4 0 Z 3 O Z u Z Z u Z ou Z u m o o p 00 O o p a Z 4 O O p 0 ZZZZ 0 0 U w w r N r W 4 O O J OQ 0 W 4 O N Z r I 4 ow j > > > C a W N Z < W �_ l% W W N P < m m m m N d Z m N L O I W i a aIto N N O f W Z ih V ` O W zo J �LIr 4 O U 4 O sca H Q 1 Z w I> W �. m Z Z lam%CC O Z ° N Q W 4 < 4 J I O Z m F Wr Z 0 K 0 r a w x r O r 0 a yl N C f W Z E < a Z f J f 3 W ° ° FW- J V U' < < O N Z O w W Z O < O < l7 p Q < Z Z < u a J ZZZJ 4 O T O N N W K F W W U U W u 4 0 ° J ° J ° J m 0 ° IL W Z <W U Z W Z ° u J < r < r < r W m m m J < I N J 0 0 < m < N N a 3 m 0 \ 0 (� f 2 8 L L w I.- r W O � u pu � r i 1-: M j W W W C It Q10 A l0 V + J LU J LU V f � J W 3 o o U 0 0 0 = 0 0 C D 2 /n 1 SON N (mryrN zm a0 yZz �X-Nj D 0�0 NC:E mim m -qzD ion N0-1 ;az- m03 'o0Z mN M 0 Wsz Or - Soo Zr •ANO aha z_z I 0-1 :0D oz, 10 mm 00 D0 3 N F mm �A AO TG)G1 � l AvvD D F r Z Or)wc.�OO D m AOO D<Oo r;iNzOp D8 w m D m m n NDO A n n y � x m ZZp ZZ00v=D O ;y3 C mvT m D N; O O A A O i A cO NZ D{ 3 Np D D D N � n ZO CL m 0 T O zO Z0>v m y Z _ N p 0 LL I I I I I I I z m OZxmGZ� O ON D Cy Z ApxpDxO-�y° N D Vr A T—m ti -a N Zv O. 7, DFmO <D O D 0C D D nS ODDOI^OAZ 3.�Z x0 TT THti Z ZA 2 D _� I 0) O Olu NF OF QT p D Im yp xfT A ZO TZ y Z D Z C Z O D Oyn H Z Z D ( >T 0 N N m A -i O O OTO p XF Z Z D A z N O O Z A D D Z A n �1 A A ~ T A T G n Z A D D m D Ie I I I I I la O V T Z m Z N x Z Z y Z M Z J II fo N T Z I I 1 Imo' V A 10-0 I I I I I I IW I I I( I4) l I I I I 0 0 C D 2 /n 1 SON N (mryrN zm a0 yZz �X-Nj D 0�0 NC:E mim m -qzD ion N0-1 ;az- m03 'o0Z mN M 0 Wsz Or - Soo Zr •ANO aha z_z I 0-1 :0D oz, 10 mm 00 D0 3 N vJ �i r c� ova( X� C vv"� qw ;/,r x 3 "I C w,h�ow Office �-13 11 x 3 s i TC,� rwoN. w. I be %-4 Se a's a born 3. S q s15 �►�c��'► 9 ►� W-111 I1 be he h e&J4 b j -Fore ec% kot o�-�rCe IA seri i n wc�CS Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 May 1, 1996 Patricia & David Ghikas 186 Bradford Street North Andover, MA Re: 186 Bradford Street Dear Mr. & Mrs. Ghikas: \Vc hl -PA, 6ccii made aware that you arc work at subject premises without a Building Permit. Please contact me immediately upon receipt of this letter in order to resolve the issue and avoid the necessity of any further action by the Town. S/g BOARD OF APPEALS 688-9541 Very truly y rs/ / Kenneth Surette., Local Building Inspector BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Fl 5 E - c c u o� V c v w� �J ItF+ p G 1� „f ; o v 5 E - c c u c v O L Q ; o v _•� 0 r z C r O CD A o E.' C C,0 d C rL... �l O O v ' V Of m C a a CD d C L ` c 3N m Of c m C = �L : •�'[\moo\\ J i co w O U w ' w iv � rr C, w co CD cE M^. C CD co _y C �E m m i O C CD O i G� L CD Q. C. co C 'C CD cc Ca V J .Q O CD co C N Q �. V C .0 C C. C c c m c c v O L Q ; o v _•� r C r O CD C2 O. N E.' C C,0 d C rL... O O ' V Of m C a CD d C L ` c 3N m Of c m C = �L : •�'[\moo\\ Cc -X3 L C ' N W L N 'Q :Em 4. 'o m o :ave N m m cm—C O Q CO) aC.0 d C : U j Z � C O a H y d C _ =CD C6 W O w N E dL C o.. v-Mw� CO v c o H L rO+ CL.*.. m J i co w O U w ' w iv � rr C, w co CD cE M^. C CD co _y C �E m m i O C CD O i G� L CD Q. C. co C 'C CD cc Ca V J .Q O CD co C N Q �. V C .0 C C. C Location No. Date i- NORTq RTOWN 4,0 OF NORTH ANDOVER p i4. Certificate of Occupancy $ + • Building/Frame Permit Fee $ t SSACNUS t� Foundation Permit Fee $ - ii;; Other Permit Fee $ — t: Sewer Connection Fee $ Water Connection Fee $ co o TOTAL $� - Building Inspector t 8728 Div. Public Works IA wl a a Y 0 0 m w H Q LL I a w z 0 IL 0 Q IK 0 w N S ---4- O Z N Vi X ... " l7 m Z w f` J O m f ` J m W "Ir LL0 E1 0 0 ° ° z WN Z LL O LL w Lo 0 W O Z W Z W C N N < E EL Z m N N [] IwI i M 0 z p 00 LL LL 0 W N_ N z 0 f a E fr 0 g z C 6 d Q' W t IL 0 U U U n 01- 0 D O O U m m m 0 Ih j W W W N z 0 H U Ir H N Z m� rq Z W � O w O W y i U W C < w Wz < Z Ir < N 0 O? o> li z © LL M < v m LL_ W 4 d o 1 I w 0 W 0 m r to w LL O W tt S D j I J w 0 t H Z F' i l H Wcd z 0 f a E fr 0 g z C 6 d Q' W t IL 0 U U U n 01- 0 D O O U m m m 0 Ih j W W W N z 0 H U Ir H N Z m� rq Z W � O O W y i U W � m < N 0 O? oa li z © _o N M < Er O m LL_ W 4 d o I w 0 W 0 m r to w LL O W tt S D j I J w 0 t H Z F' i Z 0 H Wcd 1!l /� m F F W Z J co 3 z O F Er 0 F U< W m L) 0 0IL h p J 1"11 W 4 w W N J 3 0 H U t Z< t a O < N H Z 0 F M LL w LL O O O z_ O Z_ _2 p< N W N C W U W U W U J w _Z O O O J j LL O C F W Z Z Z O J J J m O I 0 O C O < N N N ; m z 0 f a E fr 0 g z C 6 d Q' W t IL 0 U U U n 01- 0 D O O U m m m 0 Ih j W W W N z 0 H U Ir H N Z m� rq Z W � O W y i U W � I �_ N 0 oa o i V M < Er O W 4 EC Z 30 w 0 W A� V ' m r to w LL O W Z < EC j I J 0 t H V F W W F H Wcd J /� W ad co 3 o o 0 L) u x r m Z W � O W y i U W I �_ N 0 I 2 o i V Z C J f • m I y I m Z W � W y O <L 1 �_ o t V < Er O W 4 EC Z 30 w 0 W m r to w LL O W Z < EC j I J 0 t H f t F W 4 , O 0 iA W m L 6 - mp n Z n Z N V gmm o 01 n 7C fl p r p p m p T D Zn Q m P cn ti A Non P T v D D N O s 100 c !D 3 3 3 N m T Z C O v I� m r� C O Tp O G)C JO D x y T� z N? p 0 m A�ym r p D A n r mzo n �_ m� m x 0 m 0 rZO ciO Z Y N G1ZO m D Z '^ cm N A < 2 a W mp n Z n Z N D D ;fn cIGZi .. A N n 7C fl y I m p T r rn O y p m m m w Z D D y ;z c !D 3 3 T m T Z C O v < m r� C O Tp y F) z 0 A�ym z Z n �_ m� Z N ti rZO Z Y -_� 3 O 0 >01 C) N Nrtn Zn I'M, D0 NZZ "U C: ;aX-4 D 040 Np* mim mx -1 Z D Ion moo �z— MN3 T M M av 5�N C m0°0 .— N -N v_ F r°O ' 2 ��r, r '- Day of ?�Z A IO 0 0 v mD 0 Z In mm !n-n �m DO 3 I J10, D vDi O D v;nAZ D O !D n omZZ m T C Z{NAZI O v x v l /Y� Fy r� C O Tp N D F) xs4=m A�ym z pm n �_ m� Z N ti rZO Z Y -_� 3 D A 0 N A < N T Z I I D D Ir I I Iw A O 1 O Z >01 C) N Nrtn Zn I'M, D0 NZZ "U C: ;aX-4 D 040 Np* mim mx -1 Z D Ion moo �z— MN3 T M M av 5�N C m0°0 .— N -N v_ F r°O ' 2 ��r, r '- Day of ?�Z A IO 0 0 v mD 0 Z In mm !n-n �m DO 3 ... _ —1 . _ " _. _,. — — . z� LWINO U m � H �mo om m � c w CL cc cm a a � cm 'D o . x m, ~ �+ 40 uiP occ . S -- - Z vs a' 'mom o� ca a p w = p x ea oCL cla _l y c r- O z 0 i O rr t+ Z v c �� co C CO) C Qq I O Om O O- ` o aC ' C �tN Occ •e O O LU J mm Q V C3 aCc CX. . m m O - O O m c •r o - o i CD o, Q+ m G o L Q V O �. o- cma ja C=2 q., C ... o a Cos CJ ev ea m CD as c� 0C.D Cl cm m c E r• c� j4 cn o H a CD Z CD CD cc w cn w a U w n: w LWINO U m � H �mo om m � c w CL cc cm a a � cm 'D o . x m, ~ �+ 40 uiP occ . S -- - Z vs a' 'mom o� ca a p w = p x ea oCL cla _l y c r- O z 0 i O rr t+ Z v c �� co C CO) C Qq I O Om O O- ` o aC ' C �tN Occ •e O O LU J mm Q V C3 aCc CX. . m m O - O O m c •r o - o i CD o, Q+ m G o L Q cc O �. o- cma ja C=2 q., C ... o a Cos CJ ev ea m CD as c� 0C.D Cl cm m c E r• �• a+. = o a H CD Z CD CD LWINO U m � H �mo om m � c w CL cc cm a a � cm 'D o . x m, ~ �+ 40 uiP occ . S -- - Z vs a' 'mom o� ca a p w = p x ea oCL cla _l J O z CD i O rr t+ Z v c O D CO) C Qq I O Om z O o aC C H •e O O LU mm z O - O O CD o, Q+ CD 5 G o L Q cc O �. o- cma q., C CJ ev ea CD as ev cc H CD Z Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (P -I ease print) DA -7- 0(--�) JS 95 ics Stree_ Address Sec:ion or tcWn (5o trL a-� Holme Phone Work Phone kl9V-e-- State Z_p �cc_ "home wners" was ex tended to include OW7Er or six units or Less and to allow such homec•,tine=- .t for hire who does not possess a License, prov12:-C E~- ac_� as su_ erviscr. (State Building Code Sec`_on Wl. i''O ' • - _..E o _ V i y r .:._ J I'l lel F owa parceL of Land on which he/she resides or in__..as t- o: wh_ t Ere is, or is intended to be, a one to six EuT-_ or , to such use ac:di/c;r fa -:I t.- at_ac^ed or dEtac:zEd structures accessor _ -��a _s Ape_Scn who constructs more than one home in a t�..c-•�-= oer s�.a1l r,c be considered a homeowner. Such "homeowner" sil s�lc - _o 3uildi..c Official, on a form acceptable to the Buid_nc Uff_ -• De res-onsiblE for all such `.work.. perforne^_�u'.; _- -••_ __on D1-- y for Cc„ — _ — ...` `. �e ar-...-I's vEC_10^ _v _ _ Or Larer TOWN of NORTH ANDOVER AFFIDAVIT ..11- 111. . eli. RE. laW '."F -MALI -te• 1 r 1 - e•• ■ w • 5►: w • S • w • ..:1 IIN e:• 1 /: ■ • •• e: wY • n. 41—:11-11 tul• •ell• w • • ••t--iwoLll Oore •: .••r w • 1• • . • ••• n _• • 1 • • e..Y •� •: .1 •1 •- •• • e.•J �• •• I■Y. r.w 1 r •e: .1 :; •4.•w• • 1 t •'r =• 1 ell - Type of Work: TO do (Q vi Gc (`f ;Q k/ Est. Cost Address of Work [ q G $ r G (1- `Fa QQ I (j� �� Owner Name: 3CL G Date of Permit Application: a I hereby certify that: Registration is not required for the following reason(s): Far affin-theOnly Work excluded by law Job under $1,000 Building not owner-occupied —Owner pulling awn permit Other (specify) Notice is hereby given that: Feadt Nb. Dir e OWNERS PULLIM THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANIY FUND UNDER MGL c. 142A. Signed ux3er pa- l.ties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the owner of the above l? 95 Date above notice, I hereby apply for a permit as the property: ,P.,4 ner Name i A/ RTGAGE INSPECT/CSN PLAN AT c� /86 BRADFORD STREET NORTH TH ANDO VER, MA. v) 1,N ESSEX REGISTRY OF DEAN .NO 5607PG 83 CERT/F/ED TO.' GREAT WESTERN MORTGAGE CORPORATION SCALE.' I"t 50' DATE.' APRIL 9, 1992 l✓'x,Sf:r,c, 293.34 deck. t -v �e wi��- hev✓ SON Sir �� ��, OVl LOT 9 + 44, 000 s. f. . 293.34 ZONING.' R2 NOTES: ALSO SEE S0. EST8SHPROPERTY / 7 88* LINES /) DO NOT USE OFFSETSO EST A 8L I OR TO ERECT ANY STRUCTURE. FROM 2)PROPER T Y LINES ARE FOR MORTGAGE PURPOSES LONLY. INFORMATION TO BE USED 6. W CER T/F/CAT/ONS: BASED ON MY KNOWLEDGE, /NFA'�MAT/ON AND BEL/EF A E NOT HEREBY CERT/FY THAT THE PERMANEMATELY AS Nr SHOWN l ANDE AR Yl ARE LOCATED ON THE GROUND ,APPROX COAFCWM/NG TO T/-iE ZON/NG` SESqACK AND RH��THNPA CE THE S� W IUV NO. : ANDOVER WHEN CONSTRUC TE ZONE.' LOCATED IN A FLOOD. HAZARD1EFFECT/VE DATER 06-45-83 AP COMMUNITY N0. 250092 SURVEYORS JOHN ABA GIS & I37 ' CHANDL ER ASSOCIATES, PROFESS/ONAL LAND ROAD, A NDOVER, ' MA. (508) 688-4899 r, , rXI,5 G 2/' , REDUIRED 30 'Wood.,. eck � I � O o mlo I ZONING.' R2 NOTES: ALSO SEE S0. EST8SHPROPERTY / 7 88* LINES /) DO NOT USE OFFSETSO EST A 8L I OR TO ERECT ANY STRUCTURE. FROM 2)PROPER T Y LINES ARE FOR MORTGAGE PURPOSES LONLY. INFORMATION TO BE USED 6. W CER T/F/CAT/ONS: BASED ON MY KNOWLEDGE, /NFA'�MAT/ON AND BEL/EF A E NOT HEREBY CERT/FY THAT THE PERMANEMATELY AS Nr SHOWN l ANDE AR Yl ARE LOCATED ON THE GROUND ,APPROX COAFCWM/NG TO T/-iE ZON/NG` SESqACK AND RH��THNPA CE THE S� W IUV NO. : ANDOVER WHEN CONSTRUC TE ZONE.' LOCATED IN A FLOOD. HAZARD1EFFECT/VE DATER 06-45-83 AP COMMUNITY N0. 250092 SURVEYORS JOHN ABA GIS & I37 ' CHANDL ER ASSOCIATES, PROFESS/ONAL LAND ROAD, A NDOVER, ' MA. (508) 688-4899 r, , t304 -40m Dec � . ce 1\ _r —; I ..,a ®Mlpm Tn0 Z P(Ic r s �Q-1 oo a :< N d � 2 \� 2 � • V4) _ S _ a; f•_ __ __._._ .� Top d e�<<_ __ -5__. _.$--_-o6vl__ o� r S �X © n J J S s _ •- S r s �Q-1 oo a :< N d � 2 \� 2 � • V4) _ S _ a; f•_ __ __._._ .� Top d e�<<_ __ -5__. _.$--_-o6vl__ r S �X © n J J r s �Q-1 oo a :< N d � 2 \� 2 � • V4) _ S _ a; f•_ __ __._._ .� Top d e�<<_ __ -5__. _.$--_-o6vl__ .......+ter+..•. ..,, .-.w— .,-.__...rte'-Z-'- 'L C� Ltd' � ✓• ISI