Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 19 HOLLY RIDGE ROAD 4/30/2018
19 HOLLY RIDGE ROAD 210/038.0-0259-0000.0 } 10444 OF NORriy,� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that... .................................................... has permission to perform..... ....... ....................... plumbing in the buildings of......ou .................................................................. at.....1.9....kAdJflif..... ............. North Andover, Mass. ti Fee?IIJ ...Lic. No. ...... ............. ............v... ...... ............................. PLUMBING IN�PE6 Check# V MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK N y CITY 16 _ MA DATE ,3 / _ ( PERMIT#. JOBSITE ADDRESS / P OWNER'S NAME OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL pJ EDUCATIONAL © RESIDENTIAL Q' J PRINT CLEARLY NEW: M RENOVATION:Ell REPLACEMENT: PLANS SUBMITTED: YES® NOQ 3 FIXTURES Z FLOOR--> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB .-� CROSS CONNECTION DEVICE �— DEDICATED SPECIAL WASTE SYSTEM ___j _ _1 DEDICATED GAS/OIL/SAND SYSTEM __ ! ( DEDICATED GREASE SYSTEM _.._.I DEDICATED GRAY WATER SYSTEM l L._ ( ( DEDICATED WATER RECYCLE SYSTEM i ._._._J __—_( _.___1 .__._1 DISHWASHER 1 _._..__( DRINKING FOUNTAIN _( ..---...._{ _...._ (. _._._( _i i _._._...__(. . .___.1 ._-.--_f -._--.J _---.__.f 1 -a_ 1 ._....._._1 FOOD DISPOSER L I .._..._.1 ( ._..__i ( I l _....____( ._�( FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) f ( ._ __j ._--.J ._.,_I ......_i __._.-1 KITCHEN SINK —! ---._.I _--� _—I __ A --.__ LAVATORY __( ROOF DRAIN .I SHOWER STALL SERVICE/MOP SINK TOILET --I :_--.. .E URINAL WASHING MACHINE CONNECTION t ! -.-...__.S _.____I J1 _._.__I WATER HEATER ALL TYPES 6 [ i WATER PIPING I --I OTHER ( INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY ' BOND Q 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: OWNER _i AGENT SIGNATURE OF OWNER OR AGENT 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 bei-�o liance with�N Pert': nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �J PLUMBER'S NAME . �y� LICENSE# 3 1 SIGNATURE r IMP 0i JP CORPORATION R1# PARTNERSHIP Q# _ LLC z COMPANY NAME T 5,� —. ---. o e l +�� ; ADDRESS D / �x CITY v10 i!/v� 1. _.....__. 1 STATE ZIP g _ TEL JCELL FAX J EMAIL l 3 7- J'� R UGH PLUMBING INSPECTATON NOTES BELOW FOR OF{FICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE' $ PERMIT# PLAN REVIEW NOTES i z t 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 Applicant Information -� Please Print Legibly Name(Business/Organization/Individual): {��1 &ILo�1 4&=:c .cf Address: I0 6,0 Y j City/State/Zip: -U i,4, ✓1J.Kx,, t44 4 Phone#: 9 7 Fal Are you an employer?Check the appropriate box: Type of project(required): 1.[lfam a employer with 3— 4. ❑ I am a general contractor and I 6. ❑New construction employees(fall and/or part-time).* have hired the sub-contractors 7. Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t ❑ g ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.[]Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they aie 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 thepolicy and job site information. Insurance Company Name:- Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: j ,' - City/State/Zip: Attach a copy of the workers'co pensation po icy 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'. Ido hereby cert un er thepains andpenalties ofperjury that the information provided above is true and correct. Simature: Date: Z-`Y Phone#: �(�o �Z ' 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#: Informati®n and Instructions s rncti®ns ! 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, i 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have ! employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth o:PMassaclausetts Department of Industrial Accidents Off,00 of Investigations 600 Vashington Street Boston.,MA,02111 Tel,#617-7274900 ext 406 or 1-877rMASSAFF Revised 5-26-05 Fax#617-727.7749 wvvv�.natass,go�fdia I Division of Professional Licensure: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ..................................................................................._.................................:..................................:_...............- .............................. Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency More... .LICENSEE Name:ROBERT J. SALEMME REFERENCES& GILFORD, NH RELATED INFO Disclaimer Regarding **This Licensee has additional Licenses, click here to view them.** Website License Searches Enforcement Process Glossary UMBERS l3 GASFITTERS Licensing Board: PL Glossary of License Status License Type: MASTER PLUMBER Codes Status. CURRENT. LICENSE SCHEDULED TO BE PRINTED Expiration Date: 5/1/2016 Issue Date: Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday,March 24,2014 at 10:17:59 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicenseQ.asp?board_code=PL&type class=_M&li... 3/24/2014 j Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 57,360.00 m $ - $ 688.32 Plumbing Fee $ 86.04 Gas Fee 100 comm. $ 100.00 Electrical Fee $_ 86.04 Total fees collected $ 960.40 19 Holly Ridge Road 691-13 on 4/23/2013 Second Floor Remodel 9397 Date, , . . 3 TOWN OF NORTH ANDOVER _ PERMIT FOR PLUMBING SCMUSE� so, 42 This certifies that . . . ... . . . . . .� _1MVV). . ... . . . . . . . . . .... has-permission to perform �kt`/M��? '. ° . . . . . plumbing in t e ildin sof . . . . . . . . . . . . . . . .'. , . , . . . . . a . . . at. . .I . - . J �'. i.c� Er. , . : . , North Andov. i, Mass. Fee. .1. Lic. No 1 PLUMBING INSPECTOR Check # __. g �✓ /,per , . - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERIFORM PLUMBING WORK .` 'CITY 7r d A-41-1p v.lo'� I MA DATE I y/Z 3//V I PERMIT H _415P.61 JOBSITEADDRESS I JS 1 � /2,1� `OWNER'S.NAME yu P OWNERADDRESS JFAXI I TYPE-011 OCCUPANCY TYPE COMMERCIAL EDUCATIONAL d RESIDENTIAL , PRINT -'CLEARLY NEW:( '1 RENOVATION:( I REPLACEMENT:V j PLANS SUBMITTED: 'YES NO] FIXTURES-1 FLOOR-' USM 1 2 3 4 5 s 7 n 9 10 11 12 13 .14 BATHTUB GROSSCbNNECTIONbEVICE I .... . 1 .. ..: . DEDICATED SPECIALWASTEZY$TEtit _ .:i ......... ..: ..I�:k.. .._. .;......,I ..__ 1 __...i DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM + ,` + _ ,_ DEDICATED GRAY WATER SYSTEM j DEDICATED WATER RECYCLE SYSTEM DISHWASHER 1 j DRINKING FOUNTAIN i . . . FOOD DISPOSER FLOOR!AREA DRAIN INTERCEPTOR(INTERIOR) :.--..• _ .. I- -'; KITCHEN SINK f 1 LAVATORY : ROOF DRAIN SHOWER STALL $ERVIOElMOP SINi( j :'f - _ _. ..-: TOILET URINAL _ .. I . . :, . ., -------- -- ----•--- ' l I ...... ..i I WASHING MACHINE CONNECTION J WATER HEATER ALL TYPES WATER PIPING4r e I I l i . . Y- INSURANCE COVERAGE: have a ctirrent,liabilii iilsltrStice policybr its S111084rial equivalent which meets the regttirements of MGL Ch.142. YES t( NO IF YOU CHECKEO YES,PLEASE INDICATE THE TYPE OF CO{1FRAGE BY C14ECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYL-K OTHER TYPEOF INDEMNITY I BOND(, { OWNER'S INSURANCE:WAIVER:I am aware tlfat the licensee.rloes not have ihe•insurance coverage required by Chaptei 142 of file Massachusetts Genera!'Laws,and that my signature ctt this permit epplication syives this regttiretnent. CHECK-ONEONLY:. OWNER AGENT - - - SIONATURE OF OWNER OFt AGENT I hereby certify that all of the details and Infonnalion I havesbbntilled of eniered recdardingafiis application ate, and accurate to the bestof y knoedddge and that all plumbing worn and installalions performed under(fie permit issued for[his application twill be in fan vAlh all ertine ro ion of the Massachusetts State'Plumbing Code and Chapter 142 of the General Lags. PLUMBER'S NAME S N tie �t "r(4 LICENSE!! �!� I /SIGNATURE MPI I JPI l CORPORATION) }c(C 1PARTNERSHIPf 111f JLLCJ 111 COMPANY NAME I V, Al I ADDRESS I P 0{joys �l7'!y "yi D ` ` t I9/FYS✓ �Z I I - 1 ZIP 1.191 . . � TEL CITY STATE FAX ]CELL I I EMAIL I I I , .LC� `LTXL.JC�Y.117ll.lUL1V'44'Jl4VO�11'i6..Jl IR.Y1V 1V'oI 's.. '8FIL JAW r©LS:©/ / '3...J1`.i YJSrr, Awwr.� JC Y1V[1Y.e 1LlV SJC.t+CYSON lYOTYn7 Vet No INis APPLVCATIOM'.SERBS AS THE PERNIT9' C FEE:'� PERI rr 9 P LATN1 RXVM.VV-Noa7GS � j Date. AORTM - 3�01i TOWN OF NORTH ANDOVER _ O 1 9 -- PERMIT FOR GAS INSTALLATION SACHU5Ett This certifies that . ..:...•. . . . . . . i-� has permission for gas installation . . . . .�. . . . . . . . . in the buildings of . . . .M:40 ®. . . . . . . . . . . . . . . . . . . at . . . . � � � ss,,e. . . .e0. .r• , North Andover, Mass. Fee'�&��. . . Lic. No.�� GAS INSPECTOR Check# 8i � � a■► y , T MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Townf �/�f�v -- MA. Date: Z / -u Permit# G n 4f Building Location:__ ` / /�D� 2ctd� Owners Name:U _� , �� Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional❑ Residential 8� New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES - - - - - - - - - -� W x a co U) C) m Z 0O W W U c 0 = W Z H Z W z W R F LU CO w 9 m O a a. F- o w X W 1> W 0 W CO Z = W IW- O - LL Z 0 W Z O' J H h O Z J 0 u. v1 _ W W W W 0 2 � Q w w - < > O Z O W Z >Z W Q H 0 0 0 W 0 0 Z = Q O M F- > > > 1O SUB BSMT. BASEMENT 151 FLOOR 2 FLOOR 3 FLOOR it 4 FLOOR 5 FLOOR 6Tff FLOOR ' 7 FLOOR 8 FLOOR - I I I --F— i i� { Check one Only Certificate# Installing Company Name: �1 � /p vLLrvt 2 (�Corporation Address:.D� D)C 4 44/ City/Toww"Y11) �yC44,t-State: ❑Partnership Business Tel: Fax: ❑ , Firm/Company Name of Licensed Plumber/Gas Fitter: �'l`— << INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes['No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ['� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 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 Agent Owner El Agent El By checking this box❑,1 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 in compliance with all Pertinent provision of the Massachusetts State Plumbing de a d Chapter 142 of the General L ws. Type of License: By ETPlumber Title ❑Gas Fitter S' nature of Licens Plumber/Gas Fitter ["Master Cityrrown ❑Journeyman License Number: APPROVED OFFI E USE 0NLY ❑LP Installer The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Uf www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information !Z,, PleasePrint LegibName(Business/Organization/Individual): f Address: �V City/State/Zip:?j U L4,A— Phone Are you an employer?Check the appropriate box: Type of project(required): 1.2 1 am a employer with ?/ 4. ❑ I am a general contractor and I ' 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7 modeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]it employees. [No workers' comp.insurance required.] 1311 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #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:. c-- Policy Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: "City/State/Zil): Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert' u de t e pains and penalties f perj that the information provid`e/dab ve is true and correct. Si ature: Date: `i 7), 1 �� Phone#: ! � 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 ofhire, 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum 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:MASSAaFB Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia tocation No.. - Date ' 01H°"r" TOWN OF NORTH ANDOVER` A Certificate of Occupancy 4 Building/Frame Permit_ Fee-.$op " 4Ss�cMuSEt Foundation Permit Fee �,$ U40ov"go/Ui/b( Other Permit Fee 5,s%§§connection Fee AL , $ Water Connection Fee. TOTAL / , / Building Inspector ',:` 6270 Div.Publlc works PER-MIT NO.—s . APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE I SUB DIV. LOT NO. -I LOCATION PURPOSE OF BUILDING Gf rah P �cQ OWNER'S NAME /� NO. OF STORIES SIZE (�0 OWNER'S ADDRESS CL. Gf BASEMENT OR SLAB J� ARCHITECT'S NAME �7 l SIZE OF FLOOR TIMBERS IST 2ND 3RD , BUILDER'S NAME 9le I SPAN DISTANCE TO NEAREST BUILDING /O©/6tc".l CJL DIMENSIONS OF SILLS DISTANCE FROM STREET ?nig..f. POSTS DISTANCE FROM LOT LINES SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW AeS SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED � // / G aL 1� BOARD OF HEALTH SI T E br-OW14CR OR HOR ED AGENT FEE PLANNING BOARD PERMIT GRANTED OWNER TEL. CONTR.TEL. ° Z' 19 �— CONTR.LIC.# _q BOARD OF SELECTMEN ' tI BUILDING INSPECTOR � � BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d t 2 I3 CONCRETE BL'K. PINE - BRICK OR STONE HARDWD PIERS PLASTER _ _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ 1/1 1/1 r/ FIN. ATTIC AREA _ NO SMT FIRE PLACES _ HEAD ROOM _ MODERN KITCHEN _ 4 WALLS I 9 FLOORS y CLAPBOARDS B 1 2 3 j DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD\PJ'D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR - BRICK ON FRAME CONIC. OR CINDER BLK. STONE ON MASONRY WIRING Y, STONE ON FRAME _ SUPERIOR I� POOR 1 11 ADEQUATE NONE 5 ROOF 11 10 PLUMBING GABLE HIP BATH (3 FIX.) - GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER , ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO I+I 6 FRAMING, 11 HEATING WOOD JOIST PIPELESS FURNACE I FORCED HOT AIR FURN. I TIMBER BMS. &COLS. STEAM ` STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING r•J. RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd. ELECTRIC ;� 1 1st 13rd I NO HEATING 'it I r NORTFI ( � E Town of ` ��� X over � ;.;y ;-.• `,:�irk,`''«k4:�1:',Y: � �, °i ;f No. 33 r= �A �o,�,� Q,� dower, Mass., DRA-rE D PPR -J BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ .......... � � ... ..�..4*.0............................................................... Foundation has permission to erect.000*4W........ buildings on .l .ov..... .�.4A -of.4 Rough to be occupied as......Gtr.Q.. .. ....♦ft.WAM"a. �...w. 4� .. Chimn y e provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough AA epro 0. ... . . .... ................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR gh Display in a Conspicuous Place on the Premises — Do Not Remove F nal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINALO0' CONSERVATION FINAL street No. Smoke Det.. COMM MIATCR FIKIAi � � 2 b DRIVFWAY ENTRY PERMIT-- 5 Date.... .............. NOR� °� ` Al ° '°'"� TOWN OF NORTH ANDOVER 3et Ate.-... !e °L o p PERMIT FOR WIRING M i � SACiluS� �/ amu'! This certifies that`-w4t......�............... �......._......................; ......................» . . LfG has permission to perform ' wiring in the build'ng of...;: ...... 1.4:(`.l: :................................................ at./// /C T. .. ................. .../ .... ...........:.......... ,North Andover,Mass. Fee. �.......... Lie.No .. ............................................................ ELECTRICAL INSPECTOR Check # U " 147 THE COMMONWEALTH OF MASSACHUSETTS' Office Useonly DEPARTAIMTOFPUBIICSAFEIY Permit No. BOARDOFFMEPREVEMONRFGMUONS CM12.W Occupancy&Fees Checked APPLICA77ONFOR PERMIT TO PERF ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE w THE MASSACHUS ,S ELECTRICAL CODE,527 CMR 12:00 / /— (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / o j Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical wo d scri .d below. Location(Street&Number) , �%. Owner or Tenant M Owner's Address a S at c� DV Is this permit in conjunction with a building permit: Yes rM No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ZOO I Amps/2,0j.ZY0VoIts Overhead Underground �� No.of Meters New Service Amps olts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work (A 5 /" 6 e,1,1e-r� No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets j No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipala Othe Connections No.of Water Heaters KW No.of No.of- Signs Bailasis No.Hydro Massage Tubs c No.of Motors Total HP OTHER h.l% =Courage.Puusml:lodie mpienu sofNbmchtsetsGerlralIaws Ihawaczn mtLiabilityknrxwPblicyinchxkg CDmpletp,Opupli6nsCo or its abstff AaloWimla t YES NO Ildvest>bmiwdvalidproofofsanetotheOffioe.YES ff)ouhawdrelTdYES,plea9 mdicatethetypeofoover.Wby INSURANCE BOND ORIIER ( Spe*) f'OC���( 4�y ( EvivationDate EsluratDd Value ofElec"Wolk$ WoiktoStxt hmaclionDaleReWested Rough Final SigiWurxkrMR aIftesofper W FfRMNAME !E'er % LicenseNo. Liarlsee �(3�.(il �I (r�U�'c�lC� Signaw LiccmNo 2f T/72 -77 BusaiessTel.No. Ari Iir'cc p ! UQ x C S ZL SO���! 116� / AltTel.No. OWNER'SINSURANCEWAIVER;IamawarethattheL,mwdoesnothavetheit>,st o=oovwageoritssubstantialequivalentasrogmWbyMassacho,tsGeneralLaws and that my signature on this pennit application waimN this tegtmerrlent (Please check one) Owner Agent o Telephone No. PERMIT FEE$ Signature ot Owner or Agent +. Location �l � C) s t : No. � ' Date R - ^TM TOWN OF NORTH ANDOVER 16. 9 • i .' # Certificate of Occupancy $ Building/Frame Permit Fee $ /76) s•►CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ — 6 7 4 / Check #_� 17182 fes`. Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT ; APPLICATION TO CONSTRUCT RE PAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER DATE ISSUED: SIGNATURE: - Building Commissioner/I ctor of Buildings Date. SECTION I-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number:. " /7/0 11V 2C) Map Number Parcel Number 1:3 Zoning Information: 1.4 Property Dimensions: 1 Zoning Dislr ct Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard 'Rear Yard Required Provide Required— Provided Required Provided Q 1.7 Water Supply M.G.L.C.40. 34) LS. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal SAtem ❑ SECTION 2-.PROPERTY OWNERSE IP/AUTH.ORIZED AGENT M 2.1 Owner of Re ord Name(Print) V Address for Service 1 Signature Telephone O 2.2 Owner of Record: Name Print Address for Service: O R z M Signature Telephone StACTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 0 6 K6E Licensed Construction Supervisor. ��� ' I n ' License Number 711 1 �( �( Address 621 't) 210Expiration Date re Telephone �. 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r Address r Expiration Date re telephone t SECTION 4-WpRKERS COMPENSATION (NL G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed andsubmitted with.tis:a lication. in the denial of the issuance o PP Failure f the bui a r. to provide de this rmit. P affidavit will result Si ned affidavit Attached Ye SECTION 5 Descri tion of Pi o osed Work check all a Ucable New Construction ❑ Existing Building 0 Re u s p . Pa O -Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated•Cost(Dollar)to be Com leted b erTriit a licant to t Y 1. Building / (a) Building Permit Fee 2 Electrical Multi lier (b) Estimated Total Cost of 3 Plumbin Construction 4 Mechanical HVAC Building Permit fee t,l x_(b) / 5 Fire Protection 6 Total 1+2+3+4+5 / Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WREN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 4 , as Owner/Authorized Agent of subject property Hereby authorize ';�', ` � � ' , My behalf,in all matters relative to work authorized by this building permit application, to act on Si nature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date .property ,as- Authorized Agent of subject Hereby declare that the statements and information on the foregoing application are true and accurate, est of my knowledge and belief to the bg k F Prin e Si tre of er/A ent. f Z ^0 Date NO..OF STORIES BASEMENT OR SLAB SIZE SIZE OF FLOOR TIMBERS SPAN l 2 3 DIMENSIONS OF SILLS DIMENSIONS OF POSTS DJAIF 'SIONS OF GIRDERS HEIGtIT OF FOUNDATION l SIZE OF FOOTING THICKNESS MATERIAL OF CHIMNEY X IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �i,;� � � �/W I(JO�IiAY7.Q7tCIJP�G%G O�✓U(.�Q�C�Cf9.CI.6P.�6 `�� . BOARQ'4OF BUILDING'�REGULATIONS . License CONSTRUCTION SUPERVISOR t Nuinber�-CS, 058245 LY m Bidt di 03/24/1943 j= Mi re-v-:4/24/20b6 Tr.no: 21'031 r rte` t —. ;Rest'cte�d ;KENNEThI8,KEEN� 21:HEWITT AVE :; 'N!ANDOVER,�dMA"'01845--'` 3 Acting C. `mis_. oner" J. 5 l � -- ✓1ze �o.�vrno�u �./�«aaaclueaelta I _Board of Building=Regulations-and Staida'rds . HOME IMPROV".EMENT CONTRACTOR i Registration x08383 RExpiration 8/18/2004` -. --•fi. _ DBA T� ? j f YR,e BA KEEN CONSTRUCTIONACO } Kenneth Keen 21 Hewi t Ave 5. No Andover,MA-01t.4-5- 9�iq��nistraXor _ The Commonwealth of Massachusetts _= ie Department of Industrial Accidents r:— f' _ _ -_- F4 office nl/nrrestigat/ops a 600 Washington Street e• �:s��cs ' Boston,Mass. 02111 ~-- Workers' Compensation Insurance Affidavit hean 'intormafionn" �. - r=� ,� . lease>;yIZL••:� eai 1, name: £ Ar N 166, J�a-Ej w_ cation: ZL 441Ieaj i hlo city lwft phone# I am a homeowner performing all work myself. l E�,l am a sole proprietor and have no on221 e working in any capacity F� I am an employer providing workers' compensation for my employees working on this job. company name. e: city # insurance co policy# 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: comnan.v name. Address: city: phone# .in co. ohc # company name: address: phone# insurance co. pohcv'# AtacicTJitionals�ieef;fne�cssar) 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 ford:of a STOP WORK ORDER and. fine of$100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the ns and penalties of perjury that the information provided above is true and correct. Signature , ,(e Date Print name lj�L A [? :CGr,.� .. . .. :.._._ ._ .._.._. . Phone#.9 '7"1! ' 69V. l official use only do not write in this area to be completed by city or town official__.,... city or town: permitAicense# -Building Department oLicensingBoard _.__..... O check if immediate response is required , pSelectmen s Office OHealth Department contact person: phone#; -Other �'::;.lt ..6i.,.'ial....r�� .:.: -'�.,z n.r_�.;�..:i: +:.t`�,.::.... s:..,r.::i:.• .a.:_>?SiL..vx+... .. . .. — ar• �. .� i waro mKs iso-�z (revised 7/95 PIA) KEEN CONSTRUCTION CO: 21 HEWITT AVE. N. ANDOVER, MA 01,845 (978);691-5201 'Mel-to, Jim &-Mary 19-Holly Ridge Rd._ N. Andover, IVIA-01845 (97,8).6.88-1888 Contract#1-601; Appendix A Date: 4-7-04 Finish Basement: Frame partition wall's in basement to create approx. 520"sq;'ft: offimshed area including one finished closet next t6boiler Build. full wall on garage side of stairs& 1/2 wall on other side • Move vacuum:pipe from garage to basement acid add orie"outlet in basement • Supply& install R43 insulation ri exterior walls with vapor"barrier • Supply& install 6-panel hollow`core doors as follows: • 5'0" x 66"(unit pair) at boiler • 2'6"x 66" at closet next to boiler room 3'0" x 66" into unfinished area • Supply& install trim on,base, doors; &window to.match existing, Supply.& install 2' x T revealed edge suspended ceiling throughout finished area • ''Paint Walls.&;trim(2 coat'fimsh 2"neutral colors). Supply-,& install approx. 65 sq. ft. ceramic tile at entry way($3:00 sq. ft;.tile,allowanee) Su l &.install carpet throughout-remainder of finished area($13000Q installed pP Y allowance including.stairs) Electrical: • Supply& install 12 recessed light fixtures in.ceiling, switched"on dimmers Supply& install outlets to code - Supply$c install two<cable:outlets<&one-phone outl'et(Cat.5 wiring) Supply&install wiring for'vacuum outlet&thermostat forheat Plumbing: • Supply& install"-one zone of forced hot water baseboard heat off of existing boiler Move existinggas pipe to gain more ceiling height 1 KEEN CONSTRUCTION CO. 21 HEWITT AVE N. ANDOVER,-MA 01845 . (9U)-691-52011 Total Pree:$17310.00-(seventeenthousand'three`huridredaen dollars) Price does notJ-nclude cost of permits;-15 lite door at,top of".stairs:or repair of foundation-cracks. All extras to be paid in full upon ordering. Payment schedule:$6000.00 due upon-si nin contract Yrn _ p -signing 6000. e' 00 du u on com Teton of rough framin -&electrical p . -P g g _ $4000.00�due after blueboard is hung I-310.00 due at,completidh of contracted work ustomer > ne h. . Keen Date " / Date ;14 Y G , .,,,�-- v�� ►�' � _ � � � � � � -�. o �-� � ,� r 1 �Z,�� ►,���7 - _...._.___--___-�_�___--- � ...._ �..5'�O� �- ��Z� � `�,�� l " 16 1 KEEN CONSTRUCTION CO. n 21 HEWITT AVENUE Ar 'm ruSA L NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978) 682-3231 specifically exempt from registration by Provisions of P 9 must be registered with _ Chapter 142A of the general laws, Submitted j�� t1f '} ` the Commonwealth 6f.'Massachusetts. Inquiries about To: -.. _J 1 . .... ► " _ a �'q �.__J_ 1 .__-_ .___ ceTstration and status should be made to the Director, r .._ Home Improvement Contract Registration,One Ashburton Place, Room 1301, Boston,.MA.02108 (617) 727-8598. Owners who secure their own construction related �,}, / ' 1 . �.'i7aU permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. F LID.NO. MA. H.I.C. 108383 04-325-8052 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and'materials to be used: n t \.. t - - -- - -_- - c. _ ` . � . k - ' v ... ........... .- -..__._ __..m .._ ._..... ..........._..........------- — _........ -- > Construction related permits: ..._....................................................................................._....._........................................,...........................;,...........................................................................................................................................................,.....,..:...................................... WORK SCHEDULE Contracrt r will not begi�the work or order the materials before the third day following the signing of this Agreement,unless specified here in writ' g. Contractor will begin the work on or about (date). Barring delay caused by circumstances.beyond Contractor's control,:the work will be completed by -C° (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects.in materials and workmanship for a.period of r_" following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contractor,his subcontractors,employees or agents,is discovered within one year after completion"of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications, for the sum of Payment to be made as follows: dollars($ )' % ($ ) upon signing Contr ct: KENNETH B. KEEN Name of Contractor/Designated Registrant % ($ )1 on 'r��r inn o \ 21 HE1lVITT AVE. ` Street Address ( ) upon com\pletion of N. ANDOVER, MA 01845 l City/State $ shall be made forthwith upon (978) 691-5201 (978) 682-3231 ( ) completion of work under this contract.. Phone Fax , Notice: No agreement for,home improvement contracting.work,-5hall require >down payment(advance deposit) of more than one-third of the total contract price. Name r�Sal sman or the total amount of all deposits or payments which the contractor must snake, in , advance, to order and/or otherwise obtain delivery of special order materials-and Au)p6rize`d�gnaluiri w ,� — r- \ equipment,whichever amount IS greater. Note: This proposal may be withdrawn by us if not accepted within days. Acceptance Of Proposal -I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. ,- DON T SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature `- L`/'UVJ Date- ! ( Signature. Date IMPORTANT LNFORMATION>ON BACK ,,•c �-- '..� _ N.._.. -�.G. e6:.v ..� ..� � _..—;_.._.._._.c.._....,�:,:..—_..���_....s....,..i..u.r:Y_�e..._isf:1__�_ '9np7HMn+E. tx • �. , -.... .. �.h� "'5 ��'�+fr,r,�R.S'Rr ... . : ].Y�fa, ,'3s 9i..es ,. ^M9 YSA, ,.MX`;',k �, �. +�W£ FORTH Town of Andover ....AVT ® +, _.F.~ ti.,,,.4.. •'�;i.�.vSt"�"• .. .. .. o. 0 + LAK O dover� Mass., �� D COC MIC MEwICK � A0RATED `S �J BOARD OF HEAL'T'H PERMIT T D Food/Kitchen Septic System s� BUILDING INSPECTOR THIS CERTIFIES THAT...... .A y �. V I � .. I*' """"' Foundation has permission to erect... ............ buildings on ..... .. ...... ,. y.................�. �r .... .. Rough r to be occupied as.......... " .L.! ................................................................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Lacus relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. g 40o70 �� PLUMBING INSPECTOR AP VIOLATION of the Zoning or Building Regulations VoidT t is Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough ., C ............. ....... .. ...................C.&.0.0.40 ......................... ................ . Service . . .. BUILDING INSPECTOR Final Occupancy Permit Required to ®copy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. EESEE REVERSE SIDE Smoke Det. % J 7} Location Nb. Date 1-1,5`25' �OR7M TOWN OF NORTH ANDOVER A Certificate of Occupancy $ rJ/f1'L �- i Building/Frame Permit Fee $ s - s undation Permit Fee �M Other Permit Feed $ 6 Sewer Connection Fee $ ��� .z- 1 4 19Water Connection Fee 1; p,N TOTAL �. $- l ' Building inspector c ;► Div. Public Works '12 Location Date / -,-2,?-2. N�RTh TOWN OF NORTH ANDOVER Oft�ao :�1ti00 kertificate of Occupancy $ i in /Frame Permit Fee $ t///12,.-sem ra` Foundation Permit Fee $ Other Permit Fee $ ' Seyv WConnection Fee $ 2 Water Connection Fee $ G TOTAL $ ,/Zo—, /f Building Inspector Y Div. Public Works j location I I 1,1a al21ro-O / Date 40R, TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ SACM�s�� Foundation Permit Fee $ Other Permit Fee $ j3?.Sewer Connection Fee $ 0Water Connection Fee $ NOV 61992A 'BBulllding In/sprecto_r No.Andover Coffe tG- Div. Public Works Location /�' f• s �-f ��- - '. E No. 1 f.�r Dated"/y.Z is ,ORTM TOWN OF NORTH ANDOVER -' p Certificate of Occupancy $ !�'�, d * '• : Building/Frame Permit Fee $ n Fgindation Permit Fee $ S+CHuse 'Y Otf r,,Rermit Fee $4gyper � ection Fee $ Water4w' ee $ Vq1- OTAL Z, l Aja/� '�J % �/I 1 r i A r•�/ Building Inspector Div. Public Works aa1l'f+ i'v. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. L/jf� -5�` 1 PAGE 1 MAP,+40. LOT NO. / 2 RECORD OF OWNERSHIP jDATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. F— — LOCATION/9 f IV ���� PURPOSE OF BUILDING ��� e aln/ OWNER'S NA 7E tlovb7NO. OF STORIES rL/� SIZE 1;0 X OHOdo ,^ OWNER'S ADDRESS � 1� •, %�_ .�j�/� BASEMENT OR SLAB /,.felnelii A ARCHITECT'S NAME YJ SIZE OF FLOOR TIMBERS GIST 2XIO 2ND +�1(1�0 3RD 2X/b BUILDER'S NAME /, ,,, /� �,( 1D n SPAN 131 DISTANCE TO NEAREST BUILDING J�UO �Lp7! e/ DIMENSIONS OF SILLS DISTANCE FROM STREET '+e' ! - .POSTS Al)X 4 T DISTANCE FROM LOT LINES-SIDES 50 REAR _ 0 -cee " GIRDERS 1C� ✓ `D �r� �rn O� r t, AREA OF LOT 5-6,o y,/ s/c FRONTAGE lSo a lee,f HEIGHT OF FOUNDATION ` � THICKNESS /0 1 e-' Prj IS BUILDING NEW ye,! J SIZE OF FOOTING V /O" X :;20 mak } IS BUILDING ADDITION n0 MATERIAL OF CHIMNEY ���'��/� IS BUILDING ALTERATION /Jo IS BUILDING ON SOLID OR FILLED LAND ��' /4 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �/gs IS BUILDING CONNECTED TO TOWN WATER y�S BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER yes IS BUILDING CONNECTED TO NATURAL GAS LINE es INSTRUCTIONS3 PROPERTY INFORMATION LAND COST //D'000 - r SEE BOTH SIDES ed, . --9- t� ST. BLDG. COST - PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER 8Q. FT. c PAGE 2 FILL,OUT SECTIONS 1 - 12 e" EST. BLDG. COST PER ROOM t ( ly d f U o SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING + -��� I 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS riipi�►'iD� o PLANS MUST BE FILED AND APPROVED BY BUILDING'INSPECTOR • ' ?� DATE FILE_ BOARD OF HEALTH SIGNAT E NER OR AUF O IZED AGENT FEE O oZ SD CONTR.TEL.# 8 � D' C� PERMIT GRA T D CONTR.LIC.#._SISI,3'34/ PLANNING BOARD t' 19 r BOARD OF SELECTMEN t 'I P NOV - 2 9992 - ' BUILDING INSPECTOR �-�F BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ SiOkIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE-FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ 3 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE HARDW — PIERS PLASTER _ DRY WALL s UNFIN. 1' 3 BASEMENT � Ir AREA FULL FIN. B M'T AREA _ Y. 1/I 3/. FIN. ATTIC AREA — i NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �— ' WOOD SHINGLES EARTH ASPHALT SIDING HARDVI D _ ASBESTOS SIDING COMMON VERT. SIDING -A-SPH. TILE _ STUCCO ON MASONRY Cure - _ STUCCO ON FRAME 6TICK75N MASONRY ATTIC STRS. & FLOOR IV_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING _ t STONE ON FRAME VIA SUPERIORPOOR 1 s ADEQUATE I� NONE —w . + ma o 5 ROOF 10 PLUMBING - i : 5 .Gan r....� GABLE HIP BATH (3 FIX.) 'GAMBREL MANSARD TOILET RM. 12 FIX.) I i FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY - WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING 11 HEATING `i WOOD JOIST q PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G ` UNIT HEATERS j 7 NO. OF ROOMS GAS i 1 OIL,. f B'M'T 2nd ELECTRIC 1st G{ 13rd I NO HEATING cr v DEPARTMENT OF PUBLIC SAFETY COMMONWEALTH 1010 COMMONWEALTH AVE. i OF BOSTON,MASS.02215 MASSACHUSETTS ^; Q1 LICENSE CONSTR. SUPERUI'SOR EXPIRATION DATE 07/31 /1993 o EFFECTIVE DATE LIC-NO. RESTRICTIONS NONE z 07/31 /1 991 044334 � n mNICHOLAS G KALERGIS m 2 LAWSON ST SS 4 017-46-6381 WESTFORD MA 01886 PHOTO(BLASTING OPR ONLY) FEE: 100.00 HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ,STAMPED-OR -SIGNATUR OF THE COMMISSIONER DOB: D 05/31 /1955 THIS DOCUMENT MUST BE SIG URE F LICENSEE CARRIED ON THE PERSON OF THE HOLDER WHEN ENGAG" COMMISSIONER OTHERS-RIGHT THUMB PRINT ED IN THIS OCCUPATION. '/,(.t(:,�I.'q.'✓�/C 20OM-2.87-81429 � �11600infllOMIAtQIIR�v��QSJ1/flldJv��J ` DRIVER'S LICENSE 017466381 08-31-95 05-31-55 6-05 3 I� KALERG I S V NICHOLAS U 11 _ 12 LAWSON RD WESTFORD MA FORM U - IAT RELEASE FORK INSTRUaPIONS: This form is used to verify that all necessary epprovals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or ,andowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant gills out this section***************** APPLICANT: _ J©e and ��l✓1 J � Phone LOCATION: Assessor's Map NumberParcel Subdivision T��/✓ /G�t �� Lots) �n�.� Street St. Number RECOMMEwoATIONS OF TOWN AGENTS: iDate Approved f%��ase-rvation Administrator Date Rejected Comments Date Approved �- wn Planner Date Rejected Comments Date Approved Health Agent Date Rejected C-mments Public Works - sewer/water zcnnection l/ 4: driveway permit Fire Department C� _ " Received by Building Inspector ; t. � , Date NOV 1992 ,A / /NY'y99.90 NV 96.25 _ PROP. �� ,\ pa 5 / INV.=97./2 _ ——— / — Ito /. A-43,5(6+.5:F. . + •�,--- — _ ' — �,/�O.�j �'P L� PROPER s `. apt #� ' COQ. �� ` oo •���/ F� (OP u X � 7cxXXxTX xxAY SAC `/ ---- +K D NES�� E / ' too A-/S � +}�}xxxxf PROP S A LOT 4-4 x}t}'"+/ ''/ ',�• ! •• �� I f - a� / OFn'ET q_ I QP '+—z I A J �'t •3"•STAKES o 0 CG''B.VIC y ------------------- a A k r ' CERTIFIED PLOT PLAN r :$ S 24'31 '13" E Q' ' 253.43' CLIENT. . JOSEPH QUINN N _ � THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. o� I CERTIFY THAT THE STRUCTURE SHOWN CONFORMS TEMP.SEDIMENTATION 4v LOT 1 FOSS eco ���/ TO THE DIMENSIONAL REQUIREMENTS OF THE EASEMENT � 56,057. sq. ft. �w TOWN OF. NORTH ANDOVER ZONING BY—LAWS 1.28 acres WHEN CONSTRUCTED. ti OFFSETS SHOWN ARE FOR ZONING DETERMINATION 35.91' ONLY AND ARE NOT TO BE USED TO ESTABLISH 53.93' PROPERTY LINES 'OR TO DETERMINE LOCATIONS S 0�Sg• OF FUTURE BUILDING ADDITIONS. 3Sry •o ; v TO THE BEST OF MY KNOWLEDGE AND BELIEF F,��� ,5190, i THE PRIMARY STRUCTURE- SHOWN ON THIS PLAN P :� IS NOT LOCATED WITHIN A FLOOD HAZARD ZONE SEWER / J AS SHOWN ON FEMA .FLOOD INSURANCE RATE MAP �� EASMT. / COMMUNITY NO.: 250098 0010 B DATE. 6/15/83 � o is ,� ZONE (IF APPLICABLE) UTILITY ^a ^C tyo of � qc EASMT.. r/ y� V') / ! o MICHAEL: J.S s Pct 10. Q CHRISTIAN SEN & SERGI INC. DEC $ jgg 160 SUMMER ST. HAVERHILL,MA. SCALE. 1 - 40DATE: 12/92 O TII!'{ Town ofover o� No. 51 - - / M o : orth � dover, Mass., p coc c..:,. . w DATED AP \ -\�. u � BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System N/hl • BUILDING INSPECTORR THIS CERTIFIES THAT Q .......� ..g..� . .. ....... ............................... Foundation has permission to ere ct.b)0 ildings on .1.g. . . ..... � Rough e/ �t.E/ +��1.�.. . E..L. �►�Mc....... to be occupied as. �� ,,..��,,��.. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the appllt'�lion 1n� Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PERMIT FOR FOLOAM ONLY PLLTYBIYG I SPECTOR REGULATED .-S. B.G. � 2 8� VIOLATION of the Zoning or Building Regulations Voids this Permit. vgio g � l'E RT',A I_ EXPII�S IN 6 MCbkj- _ t T r - - 0 C- ELECTR CAL INSPECTOR UNLESS CON ) I I�11LJC 'ION STARTS Rough .... .. .... . .. .. ... . Service PE IT FOR FRAMUBUILDING BUILDING INSPECTOR i ^n /} �t-'—- Final Clf��111c- Pc)-iii 't ll (t -(.d t0 Occtil-y Bitildirig GAS INSPECTOR s DATE: — FEE PAID....------ — ---—----— -- -- ----- in a Conspicuous Place on the Premises — Do Not Remove Rough Display P No Lathingor D Wall To Be Done ` i I s ected and roved b the Building Inspector. FIRE EPARTMENT U nt Approved y 9 P Burner PLANNING rINAL CONSERVATION17�i5 q3 , Street No. Smoke De SEWER/WATER ? f`f'`''`T F �1 I NAL l DRIVEWAY ENTRY PERMIT Date. . . NORTN o= °` TOWN OF NORTH ANDOVER F A ' PERMIT FOR GAS INSTALLATION .•`sh 'SACHUS' This certifies that . . .; £ ;C�. , , f '1 �1: . . . . G•L' has permission for gasinstallation1 .1� r .. . . . . . . . . . . . . in the buildings! 'f . . . . . . . . . . . . . . . !�. . . . . . . . .. . . at, f! rD . . : . . . . . . ., North Andover, Mass. Fee. .'. . Lic. No. j. . . . . . . . . . . . . . . . . . . . . . . . . . . f GAS INSPECTOR Check# t 4790 MASSACHUSE�Tv UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or TypeL r tev k Z P rmd05 Building L ion Owners Nam Jd4w Type of Occupancy__ R I E) N T i O New C] Renovation ❑ Re cement Plans Submitted: Yes❑ No p N S yfQ N c O O H S F- WUj W x O J rp z O W F- < ), 0_ Z K ca o t- W z r W rr N O < = Z #- fA j W W z V = Q N W < = Q H a 1� S W y�j 1f1. J < Q v Q W W Vcc O ~ W J < C ~ t•r N m 2 0 2 W O to x z U. <W < W > = W O z. < Q < < O O W O W f- s x o d Y v. 3 c c7 a > 0 1- o i SUB—BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTH FLOOR STH FLOOR Installing Company Name "f Cj -,(Z T I :AM AlA T A Vii✓ Check one: Certificate Address 3 0 CnA c H iy1.A ry -`A(. ❑ Corporation 111 E 7H UE iy 01 A 0 ❑ Partnership Business Telephone -9 9-7 ( 2--Firm/Co. Name of Licensed Plumber or Gas Fitter -' o E f`T A 5AM4111`1TJI?L) INSURANCE COVERAGE: I have a current f biltty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.. Yes No ❑ If you have checked ye, please Indicate the type coverage by checking the appropriate box A liability insurance policy 0 Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe • i ed for this applicatio;or be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne laws. IBY T of License: Gz Plumber n ure of cen u Gas atter Vale tter er License Number Val) City/Town O IC ONL Journeyman 13ELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING + i NAME S TYPE OF BUILDING LOCATION OF BUILDING , PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED F• DATEx...19.__ OAS INSPECTOR Date. . 3?�.<"O RT:'goo` TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 'SSACwus J This certifies that �'.. . .. . . .. .. has permission to perform �. . / !. /f plumbing. in'the -uildjiigs off`.' k� ,/� f/C- t `- . at /. �. ! !: !. � North Andover, Mass. Fee.11 �U 22 . . . .LI/C. No..I .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ��� / PLUMBING INSPECTOR Check # f! 6103 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING {Print or Mas. D 200; -�- Permit BuAding es N Type of Occupancy ��tS+ �C N tl r-1 New 0 Renovation 0 e meat 2"" Plans Submitted: Yes 0 No O URES x A mF- m J z m = W 1- a! > V < a� z a W WN 5L J N O Z 4A d Z N CM < Z 2 �. J �+ Y Q f V W of x d i7 ` 0• Q 3 x U Z a m H W } f' m = a < rA SrH C x < =aGe: O W n a O•+ WW Y yp2O Y z f It- 1- Z o a y m 1 'a u < F- < < = xn < < O < J .j < Z ¢ Z < O < E- 3 ie m fA a o .j 3 x r- m W o Zia < et m o SUB--es MT. BASEMENT !ST FLOOR 2ND FLOOR 3RD FLOOR ATN FLOOR STH FLOOR eTH FLOOR 7TH FLOOR STH FLOOR Installing.Company Name / 1komeT ,- s Am,"Azaean Check one: Certificate Address t? C0 A Nma 1 A AJ O corporation Rl E i 4 o g-N.-Y? Ay 11VI.,l py PP�arrrttrwr-131P Business Telephone Name of Licensed Plumber INSURANCE COVERAGE: I have a current kY insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No O ' If you have checked y p. please Indicate the type coverage by checking the appropriate box A liability Insurance policy ld Other type of Indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner p Agent C3'gnature of Owner or Owners!gent 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations Womted under the pemtit hamd for this application will be in compliance with all pertinent provisions of the Massachusetts State and Oppt®r of the al taws. o mom rue r Type of License: Master Joumeymah 0 �OMm license Number q3 3 `� BELOW FOR OFFICE USE ONLY I FINAL INSPECTIONS §KETCHES PROGRESS INSPECTIONS FEE ` NO. APPLICATION FOR PERMIT TO DO PLUMBING � r 1 NAME i TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 1 si PLUMBING INSPECTOR CERTIFICATE OF USE & OCCUPANCY Town ®f North Andover Building Permit Number 515 (1992) Date MAY 4, 1993 THIS CERTIFIES THAT THE BUILDING LOCATED ON 19 HOLLY RIDGE ROAD (LOT #1) MAY BE OCCUPIED AS SINGLE FAMILY DWLELING W/2 CAR GARAGEYN ACCORDANCE & DECK WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.. CERTIFICATE ISSUED TO JOE & SUSAN QUINN Q t ..o ,tiQ �? •` ` °� Atlantic Ave. r: ADDRESS Seabrook, N. H. ♦ o _ �, ,' a 1, r� //%/�� X0,.,.0✓'`.�i Uv �'C.G«(/L �4J3ACMUS� Building Inspector