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HomeMy WebLinkAboutMiscellaneous - 19 MILTON STREET 4/30/2018 / 19 MILTON STREET J 210/031.0-0028-0000.0 �_ i . 7776 7i Date. .. . . .... f NO oT/y 1 o? ° TOWN OF NORTH ANDOVER s 9 - • PERMIT FOR GAS INSTALLATION . 9 �9SSACMUSEtt ' r' This certifies that . . ©W-m Ars/!x: . .66-S. . . . . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . ;�.���., ( . . . v.T, . at . . . . . . . . .. North Andover, Mass. Fee.2 ic14?. . Lic. No..3.`7((5 . . '. . . . . . . . . . . GAS INSPECTOR - Check#_3 p Date. . TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING SSACMUS� This certifies that . .�f �.< < 5 /6 �/ 4I.".'.`l. . . . . . . . . . . . . . has permission to perform . .12 . . . . .. ... . . . plumbing in the buildings of . . .. . .. !.'.v I at . . .�L�,. . ( /. N. . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . .' v. .Lic. No.. .7S 1s PLUMBING/NS CTOR Check # g 5868 MASSACHUSETTS UNIFORM APPLICATION FOUR PERMIT TO CO GASFITTING (Print or Type) AXS12fH Ala10bU6R, . Mass. Date 091,01261, Permit # Building Location Ig 14ILTOO 3T Owner's Name ff tic w Vehju I ". ISSOR.TN AI QQVE12, M.A Type of Occupancy $I MGLE New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ N H W N N N U � 5 y (A yaf N m N O C O 0 Z ~ � Zp0 NFM- =OO Wa !� m W Wo Q,¢ OW Z N OWV (n C F- S 4A of d H Z = F- Z �. W W O O > LL. }- J h Q Y a W d C f' >- N m 2 O Z w W O #A = Q W W Z, d a: Q Q O O W cc OO1yf- U. SUB—BSMT. BASEMENT I 1ST FLOOR 00 2ND FLOOR I 3RD FLOOR _ 4TH FLOOR STH FLOOR C�- 6TH FLOOR , 7TH FLOOR (` STH FLOOR Installing Company Name COLUMBIA (AS GF MASSACHUSETTS Check one: Certificate # Address 55 MARSTON STREET )O Corporation 1862 LAWRENCE, MA 01841 - 2312- E] Partnership Business Telephone 9 7 8-691- 64-0 6 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked ves, please Indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent El I hereby certify that all of the details and information I have submitted(or entered)in abo pplication are true and accuWe to the best.of my knowiedge and that all plumbing work and installations performed under the permit iss f r this application will n mpiiance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (/ % 8Y T e of License: Plumber Signature of Licensed Plumber or Gas faMkjl Title Gasfitter Master License Number 37Q City/Town Journeyman APPROVED(OFFICE USE ONLY) i. BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING 3 LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE X19 GASINSPECTOR 7773 Date.. . ... .. HORTM 3?pyo ao ,s11pL TOWN OF NORTH ANDOVER p P • PERMIT FOR GAS INSTALLATION �9SSACHUSE4t This certifies that . . . . . . . . . . . . . . . . . . has permission for gas installation � e. �c,t�k.. •!-� . �' in the buildings of . . . .c\I:e:'' . . .VIf< .5. . . . . . . . . . . . . . at . . . . North Andover, Mass. Fee.30kq . . Lic. No.i 21. . . C I GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/TownX) cby;��s NYt 40V JL-r MA. Date: '% 'Z• Permit# Building Location: \11l\ Xl() 1 ,i 5h Isk Owners Name:%kV VA\A V 0- V1�� Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No Qmds� w•le `n %, + G 0 G`i 0 322 Co FIXTURES in X in vi LU y in Z fW to U = W Lu O in 01- U.1 to W 0O J V ~ tn 0 W W Z H Z O W w = it W W 00 0 w w m 0 ~ a W O 0 W X rn > w Z F- N 0 Q w = w w I'- W Q w w w Z to = w F" W 1,- W IZW > U W Z 0 J P H O Z -� C9 LL � 2 W H w W Z w } to J a ¢ m w O Z ON > Z 2 o o � i i g o a° ►w- > > > 3 0 SUB BSMT. BASEMENT 1 FLOOR 2 NFLOOR --3-FLOOR 4 FLOOR 5 FLOOR -6'FLOOR 7 FLOOR 8 FLOOR , ` Check One Only Certificate# Installing Company Name:Gk.Cek Qkb►1,q ��p� \ p �Corporation -1 Address W�`�►�n o�n Qct City/Town: -A'e-&Ok n State:V�:L ❑ Partnership Business Tel:4,7�-% 6 3°, ►1 K l Fax: ❑ FirmlCompany Name of Licensed Plumber/Gas Fitter: r ��r�ck IM o INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes X NoEl 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: 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 ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of tho 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 Code and Chapter 142 of the General Laws. Type of License: By Plumber Title ❑ Gas'Fitter Signature of Licensed Plumber/Gas Fitter ® Master gown City ❑Journeyman License Number: APPROVED OFFICE USE ONLY ❑ LP Installer W ROVGU PLUMBING INSPECTION NOTES DELOW TOR O FICE USE ONLY MAL INSPECTION NOTES Yea No --- THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PEAMIT# rLAN REVIEW NOTES is F'x l MASSACHUSETTS UNIFORM APPLICATION FOR P MIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS / Date Building Location Owners Name f' ��/ ZQ'Qy Permit# 7` _ Amount 41A Type of Occupancy New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES Ln x a a x U O W A a z sm -ma a�ivr mlwm 2Tu HjOOR ID 170 4Ml-OOR 5M R� 6M FU)M 7M FIOCR 9M HAOOR (Print or type) Check one: Certificate Installing Company Name ��/�jf� /��l/f/� //(�G Corp. Address IZ2 45� 6_ - ❑ Partner. x Z /7 B mess Te ep one s/_��G/ - 7-7 Firm/Co. Name of Licensed Plumber: �lPTI Insurance Coverage: Indicate the t e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S mbing Co d Chapter 142 of the General Laws. By: Signature Or Licenseo number Title Type of Plumbing License .7�/ City/Town is nse NumDer Master Journeyman11 ❑ APPROVED(OFFICE USE ONLY ' Date...l...-�. ................. �be O`HORTM TOWN OF NORTH ANDOVER 3? •..!r ._ OL ' PERMIT FOR WIRING SACHUSE� This certifies that .... ...... V N VY1 A '� f`............................. . .............................. has permission to performa A / I I'`a " ............................................................................... wiring in the building of...�3.t`U f r I t/ :+ Aj a at....Lc�....A.�..U.:.1)..........S..................................... ,North Andover,Mass. 3...............s— 30Wa3 .1 .M M ' �� �i Fee...... Llc.No.............. ................................ .. r c .......... .......... ELECTRICAL INSPECTOR Check # —/� 12_7�_/ 452 vanvia� vse Permit Noy, �evrtrxart"d�rtelie$a�ty Occupanc he( BOARD OF FIRE PREVENTION REGULATIONS 527 CM 12:00 APPLICATION FOR PERMIT TO PERFORM LECTRICAL WORK All work to be performed in accordance with the Massa . usetts lectrical Code 527 MR 1,2:00 ) i (Please Print in ink or type all information) Date e7 0 To the lri&pectqrof Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street 8 Number C� 61 Owner or Tenant 18EW 8 Owner's Address 3 Is this permit in conjunctionwithabuildingpermit Yes No 0 (Check Appropriate Box) Purpose of Buildinq� 016,L6 - FAA O —V Utility Authorization No. Existing Service Amps Voits Overhead 0 Undgrnd 0 No.of Met( New Service Amps Voits Overhead 0 Undgmd 0 No.of Met( Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work t.4 VA/11167 FVA 6-A-18 6ROOM A Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA I Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FlRE ALARMS No.of Zone _ Total No.of Detection and No.of Ranges No of Air Cond Tons initiating Devices _ HeatTotal Total No.of Di 1 No. Pumps um Tons KW No.of Sounding Devices _ NoJ of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices _ r� n 0 Municipal 0 Other No.of Dryers P,L am/ Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includi mpleted Operations Coverage or its substantial equivalent E = NO = h u ed valid proof-of same to the OfficeW= NO If have checked YES please �indiicate the type. ra�je y checking the appropriate box_ N URAN - BOND OTHER - (Please Specify) ZIT /L/� L 16 61 L t V cpirati Dat Estim Val nni ' al ork$ Work to Start Inspection Date Resquested Rough Final Signed under �FIRM NAME ` /V LIC.NO:_�� Licensee Signature /lU<-'7 j <�j , LIC.NO. Address A-OBA/ � A i f f 5AO &L6 s. I No. /�7' (i V O'"'L/ 6L/ Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass j General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ C (Signature of Owner or Agent) Location No. 4 q Date -[a NORTFJ TOWN OF NORTH ANDOVER Certificate of Occupancy $ I�sswcMusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Jr� Check # baa 17004 Building Inspector Jan 07 04 10: 21a Patty DeMild 781 -942-0333 Pas TOWN OF NORTH ANDOVER BUILDING DEPARTMENT A►PLIGT)OOY?OCONS7RUCf REPAIRRENOVATE, OR DEMOLL4B AONEOR 1WOlAhIILYDWELLII\'C s BUILDING P&U ff NUIv M ` r DATE ISSUED: 0.5f SIGNATURE Btu7di Catnmussi rotBuiltlin Date Z SECTION 1-SrM INFOEMAT[ON O 1.1 8rapaty Addrat 1.2 Aima Map and Parcel Number mo-r4/3 N om"" M@P Numbs Far¢I%%M)bw 13 Zoning bffamatim: 44 Property Dimmaiau: —� Zonipg Diatict hWowdUw LatAm F R 1.6 MUDING SETBACKS n Fmw Yard Side Yazd RearYwd Required- Providc Rqimd Pswided Provided v L5. taoea zea.`dmo.nae t.s kwcnv v r,ad s� LL7 W 3.,*I&� Ser) z=aOamida tloM 7m 6 Meiidpd 0 Oa Sift Dapad Spmm ll SECTION 2-PROPERTY OWNERSIE0AUT 0R=AGENT m 11 Owner of Record ., haste(print) Address far Son=: �J 1 0+ Telephone 220woer off Rceard: �3eye,✓lei J7� 1/ev►� `_ mil- S�— O Nama Peart Addrem fr Service: Z 1 SECIION 3-CONMUC?[ON SERVICES 3.)Licensed Cona0ta6m Supervisor. Not Appfwab)e 0 I[e r t cm>i*�m Ser �G s-� O 1 rorased perv�sor Live=Number Add+c~s USA_ 7sr' l ic Srgtr.eare Telephone � 3.2 Registered Home Improvement Contactor Not ApOic" 0 v Compooyl4mc 1 r ,D /� °°�Number r yam. z Jan 07 04 10: 20a Patty DeMild 7BI -942-0333 p. 4 r SECTION 4.WoRnn COMPENSATION(KCIL C 152 §25c(6) Workers eompmsetion insurance affidavit mmt be own0 ted and submitted with tbiu application.Failure to ptervide this affidarit will result in tic dcrad of the Wunow of the buildialt Pernik S n&davit A=dmd Yes.... No......13 sEmoNspeswwon ofProposed Wont dWksX bre NewCoasfiutiov D ExistiugBuilding ❑ Repair(s) 0 Altetations(s) W Addition D Accessory Bldg. 0 Demolition ❑ 1 Other ❑ Spa* Brief Description of Proposed Work bzvt O SECTION 6-ESITMATED CONSTRUCTION COSTS _ Ilan Estimated Cast(Dollar)to be ;bSB O)9I.Y Completed by t P- 1. Badding C (a) Building Permit Fee J Mttld 6c 2 Electrical (b) Estimated Total Cost of Construction 3 Plontbing Building Permit fee(a)a(b) 4 Meclnaninl HVAC 5 Fm Protection 6 Total 1+2+3+4+5 Chedr Number SECTION 7n.OWNER AUTBORIZA'IION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUnDING PERMC[ Owner/ uthorized Agent of sobjeet pmpwty Else atnhoriu tit /•4-C to art on My behalf,in all matters relative work ttothorb d by this building permit application Si titre of Owner Date SECTION 7b OWNERIAUTHORIUD AGENT DECLARATION PSR as`ae� uthorized Agent of sttbject H de c are that the statements and information err the foregoing application are true andacaccurate.to the beat of my Itnowle* and belief Print Natree )k7 Si Owner! Date NO.OF STORMS SZE BASSENT OR SLAB SIZE OF FLOOR TZMERS t 2 3 10 SPAN DIMENSIONS OF SMIS DQulENSIONS OF POM DAENSIONT OF OWERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHB04EY IS BUILDING ON SOLID OR ELLED LAND IS BtM=G CONNECTED TO NATURAL GAS LINE Jan 07 04 10: 21a Patty OeMild 781 -942-0333 P. 6 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris willepos of in: (Locatio Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Jan 07 04 10: 21a Patty DeMild 781 -942-0333 p. 7 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone Qam a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [Z"I*am an employer providing worker s'-compensation for my employees working on this job. Company name -Q Ctt:�tln C G k S ✓��1%►� �- a C Address 7 z lg"- City -e C( 6? 1 Al,l /� Phone#: 71-?/- Insurance Co AV A Policy# Company name: Address City. Phone#: Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposdion of cnmmal 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 Tine 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 herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Ie�ii,4 kA Phone# 7:s1— n Official use only do not write in this area to be completed by city or town official' � Building Dept oChmkif immediate response isrequired Building Dept p Licensing Board C] Selectman's Office person. Phone#: I� Health Department Contact � Other FORM WORKMAN'S COMPEWSA770M I I Jan 07 04 10e20a PattB DeMild 781 -942-0333 Pe3 BOARD OF BUILDING REGULATIONS .icanse: CONSTRUCTION SUPERVISOR Number. CS 081651 Birthdate: 12/31/1963 1 w ?. Expires: 12/31/2005 Tr.no: 81651 � ��IAesWcted: 00 ROBERT H DEMILD r 15 BEVERLY RD `L READING, MA 01867 Administrator o. :��ItC"i0N11t71'4�tlIM.Q�riL 0�. !(Q:Wl7CT�U3B�4 (•, ` Board of Building Regulations and Standards �..i HOME IMPROVEMENT CONTRACTOR Registration: 136849 Expiration: 9/4/2004 Type: Private Corporation READING CONSTRUCTION INC. ROBERT DEMILD 15 13EVERLY RD. READING,MA 01867 as :..:e�_. ,• ORT#i Town � a Andover o - No. q4j - �` dover, Mass., o COCMICMEWICK SRATED P' C7 7 V ` BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT....... .. "'� l y BUILDING INSPECTOR ........................... ......... ................. ...... ........ ............ . .................................:. .............. Foundation Ahas permission to erect...... �. buildings on ..../..I.,. .. ..... Rough Ov i' to be occupied as,,..... N ...... ..../.................. ...,,.........t, Chimney provided that the person accepting this permit shall In every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating toth Inspection, Alteration and Construction of Buildings in the Town of North Andover. 43 I �4 .10000, PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. s* Rough Final �PERMIIT EXPIRES� TIN b MONTHS ELECTRICAL INSPECTOR UNLESS LESS CO V S 1 RUCTIO STARTS ♦ Rough .... .............. .......I.......... .. Service , BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector, FIRE DEPARTMENT Burner Street No. SEE REvr:RSE SIDE Smoke Det, 31761 Date... ...? ................. HORTM °f�"`°;•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ��ss�cNusE� This certifies that ....... ....... ..:�.. ...P.. ...... .`.r. .................................... ............... has permission to perform ........ ....................................................... ............. wiring in the building of U �.. ' P 2 ................................................................................... at.j..........l...L. 14 //nj" c . ,North Andover, Fee...13-:6)d... Lic.No...j. ......... .................... ELECT RI CALINSPECTOR Check # 2HEC0MM0AWFALTH0Fh14SSSAa1IISEM Office Use only U% A DEFARTMFVPOFPVBLICS9FE7Y Permit No.BOARDOFF7REPREVEWONRE'GUTAT7O1 iYD7021ZOOccupancy&Fees CheckedPPUCATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 6 6 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. / Location(Street&Number) I 9 (j5T Owner or Tenant 2, G tl 212 i e /L Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building -� uJ (!,l I t ^J 2/ Utility Authorization No. 64 Jr � Existing Service C9 Amps I c.e::,/ '' Molts Overhead Underground No.of Meters J New Service /0 Amps 1!�Volts Overhead ED Underground No.of Meters 7 Number dCFeeders and Ampacity Location a hd Nature of Proposed Electrical Work 4eP—D�9- e— ;:2 e/Z��p No.of LightiAg Outlets No.of Hot Tubs No.of Transformers Total KVA . No.of Lighting Fixtures Swimming Pod Above 0I Below Ger"aton; K VA ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Taal FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat - Tc. 1 Total Na of Detection and xobs KW initiating rwvi= No.of Dishwashers Space Area Heating KW No.ofSounding Devices No.ofSeifContained DetectimlSoending Devices No.of Dryers, Heating Devices KW Local Municipal �: Other No.of water Beaters KW No.of No.of Connections Si Bailasis No.Hydro MaXge Tubs No.of Motors Total HP OTHER ft>sv-artoeCa►�A>a�ranebthetegt�tana,lsc�vl�dssa�e3ataaliaws [ha�eataznaiL>abtTlylrntraicePblicyirJudng�P� ®tio�IsC,oM2@eeritssi t�afe�tlttitalatt yES NO [ha%eallmidedmiGdptoofifsarebtheOl6oe YES � Np If}wha►ee}tedo�dyES,p►�se�lt>l�lelttet�eef y, g bcpL NSURANXT BOND, . 01117M 0 is . .ZD 10 114 6f avdw«ks hVe&mDfftRaWe*d- tie,�tadurd��ie _ 1RMNAME ,!J V�(90-f-- Al/A J r C— Lioa�seNa I� �e ioen�e 2 ��S �v 2C9-E rL I�1J . ,- n Btrc>essTd.Na °/ �f7'S� �Q` ►WMER SII4S[1RANCEWANE sIanawmethett cLjm=4>esuotMwe$teirsitrnloet etxitsst>1 Ir alecpavala>t�tt t>Badbyl► L td that my soon this pamat epp�wain this tecptaettFs>s. 'lease check one) Owner Agent Telephone No. PERMIT FEE i �� 6_ �� Location No. /6— Date NQRT1TOWN OR NORTH ANDOVER � 9 ' Certificate of Occupancy $ MUBuilding/Frame Permit Fee $ 4C5 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14423 Building Inspector s, TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ; _ ,�..�,__ _W BUILDING PERMIT NUMBER. �r /_ DATE ISSUED. SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION o 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 031 C)Gllt Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ^ Zoning DisVid Proposed Use Lot Areas Frontage R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record fury 5 C :� 2vI -,, ti I � mt ( � S £� Name(Print) Address for Service: b 46::, � 1 Signature Telephone O 2.2 Owner of Record: �l V Name Print Address for Service: O M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O oLicense Number Address / Q Eviration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ C momr any Name / 2 / 2 M Registration Number Address _r L�-M r �S Expiration Date( �^ Signature Telephone !1f i SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Si ned affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check as a Ucable New Construction 11Existing Building Repair(s) ❑ Alterations(s) 6d Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: t SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be UF+ICIAAIj USE(f�+IL�Y Completed b ermit a licant „ 1. Building Q }/11 V . (a) Building Permit Fee V t,✓ Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlurnbjaE Building Permit fee(e)X (b) 4 Mechanical HVAC ! 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize = d)n �/1�• �.t.,� to act on My behalf,in all matters relative to work authorized by this bidding perruit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief r, Print Name Signatureof Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS Vil2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSE'S 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 rage W. ( , Free Estimates Propogat 105 Haverhill Street "'l-ully Insured Methuen, MA 01844 (978) 691-1355 THOMPSON'S ROOFING Shingles— Slate —Rubber Roof Single.Ply— Copper Work PROPOSAL SUBMITTED TO PHONE DATE Dot Currier 9-8-00 STREET JOB NAME 19 Milton Street CITY,STATE AND ZIP CODE JOB LOCATION North Andover MA 01845 ARCHITECT DATE OF PLANS JOB PHONE G We hereby submit specifications and estimates for: Strip off all roof shingles on house Renail all loose boards and if any need replacement it will be $3 . 00 a ft. . ( 1x8) Install aluminum drip edge around roof line Apply ice and water shield 3 ft. up all along edges Apply 151b. felt paper on rest of roof area Reshingle with a 25 year shingle Install new fainges around soil pipe Cut in a ridge vent Remove all work related debris c 25 year warranty on material i 10 year guarantee on labor Construction lic. #060112 Improvement #128612 'tY� X We PrOP000 hereby to furnish material and labor—complete in accordance with above specifications,for the sum of Seven thousand ------------------- dollars($$7 , 000 -00 Payment to be made as follows: $2 ,000 . 00 down, start of job $5 , 000 . 00 on completion All material is guaranteed to be as specified.All work to be completed in a workmanlike manner Authorized according to standard practices.Any alteration or deviation from above specifications involving Sign!ature extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully Note:This proposal may be covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within day Creptance of j)ropOgat—The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature 9 work as specified.Payment will be made as optlined above. Date of Acceptance: /1 „ Signature • S ' I I I C A T E OF L 1 AB I L I TY I N S U R A N C E DATE 05.08-00 (MM/C^/yY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER PELHAM :NSURANCE SVCS INC THE COVERAGE AFFORDED BY THE POLICIES BELOW. BRIDGE STREET 1 N S U R E R S AF FORD I NG COVERAGE PELHAM NH 03076 INSURER A: The Maryland `�,SURED INSURER B: Liberty Mutual _ Thomas Doyle INSURER C: DBA Thompsons Construction 8 Roofing INSURER D: 8 West St. 1 em NH 03079 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N "' 'THSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS TXCBISSUED OITRITEGTEDHISCEOHEREIN SJAL_ TNETERMS. ELUSIONSAND CNDIONSOFSUCHPOLICISS.- AGREGALIMITSSHOWNMAYHAVEBENREDUCEDBYPAIDCLAIMSS INSR POLICY EFFECTIVE POLICY EXPIRATION '? TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1.000,000 C A [X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) S 300,000 [ [ ] CLAIMS MADE [X] OCCUR SCP 34865353 04.15.00 04-15.01 MED EXP (Any one person) 5 10,000 [[[ PERSONAL 8 ADV INJURY $1,000.000 I- ] GENERAL AGGREGATE $2,000, ^0 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG 52.000 ,000 [ ]POLICY [ ]PROJECT [ ]LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Each accident) 5 ALL OWNED AUTOS BODILYINJURY SCHEDULED AUTOS (Per person) 5 HIRED AUTOS NON-OWNED AUTOS (Per accident) 5 PROPERTY DAMAGE j (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ [ ANY AUTO OTHER THAN EA ACC S [ AUTO ONLY, AGG $ EXCESS LIABILITY EACH OCCURRENCE $ [ ] OCCUR [ ] CLAIMS MADE AGGREGATE $ [ 1 DEDUCTIBLE $ ] RETENTION 5 _ 5 WORKER'S COMPENSATION AND [ ] WC STATUTORY ( ] OTHER B EMPLOYER'S LIABILITY WC2.31S•314995.019 04.21.00 04-21-01 E.L. EACH ACCIDENT $ 100.000 E.L. DISEASE-EA EMPLOYEE 5 100.000 E.L. DISEASE-POLICY LIMIT $ 500.^(10 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Roofing. CERTIFICATE HOLDER [ ]ADDITIONAL INSURED: INSURED LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPJRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOP. Don Foss TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 9 Gumpus Pond Rd. TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR >lham NH 03076 REPRESENTATIVES. AUTHORIZ REPRESENTATIVE Page 1 ^f 2 Town of North Andover p10RTly , do Building Department o 27 Charles Street * _ North Andover Massachusetts 01845 978 688-9545 Fax (978) 688-9542 i �9SSAcHus�� 5 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit.# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in/at: I Z- 12� Facility location C� { D Signature of Applicant Date � f ? II i 1 NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. a Department of Industrial Accidents Office of Investigations Boston, Mass. 62119 Workers'Compensation Insurance Affidavit Please Print Name- Location City �L, X 0-- G U �� Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name % DsG rt, c Address SCJ S City' =i- Gi Phone# ��� �.S5 Insurance Co Li, Policy.# C_Z 3 Company name - -- Address City: Phone Insurance Co Policy# Failure to secure coverage as required under Section 25A or 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. 1 understand that a copy of this statement may be forwarded to the Office of Investigations cf the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is bue and correct i Signature Date i Print name Phone# i Official use only do not write in this area to be completed by city or town official' E]' Building Dept []Check if immediate response is required Building Dept 11 Licensing Board p Selectman's Office Contact person:_ Phone#: Health Department Other FORM WORKMAN'S COMPENSATION x.10 R T!y 0 o 4 over G lip �w LA o dover, Mass., AR COCHICKEWICK V ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT. 04 v r r BUILDING INSPECTOR ..... Foundation has permission to erect...S4.��. .. buildings on .....�..7........ �.. ........,5 Rough to be occupied as............ ...... �' .n.. .......... U/..D .. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M 31 Pas PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS . Final UNLESS CONSTRUCTION ST S ELECTRICAL INSPECTOR Rough ............ .. ........................... .......................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Date.. ��:. .� .. .r Of NO oT s,ti . of �` �°� TOWN OF NORTH ANDOVER > PERMIT FOR GAS INSTALLATION 401 This certifies that . .,!` � 14�61� . . . . .has permission for gas installation . �. � . . .�'y!. in the buildings of, :7 . . . . . . . . . . . . . . . . at ./. . .!'.� ' . . / 4! . . . . . . , North Andover, Mass. Fee.—V.-� . Lic. No..,f;�ff�. . . . . . . . . . . . . . . . . . . . . . . . . . . GASINSPECTOR 4 Check# lI d 4798 MASSACttUSETTS UNIFORM APPUCATION,.FOFF O'rint or Typ.)_ P iA�T TO DO GASFITTING. 7 A I7�t9 "7� Mass•, Date �. 1 6i — Permit Bullding;LoedioQ, �'r s Name --Type of Oocupancy �� - New ❑ Renovation._❑ Re - 1 Plans Submitted: Yesp Cz w a,iJ ,s MIs Ca. C O4 C ��', m F' Z. CC 4c o W as C go ou C Owl W W O: JIU - S-: C W n 64 SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR eTH FLOOR 7TH FLOOR OTH FLOOR_ Installing Company NamOC�c�c.,�2�n U( ►tib,.r Address_5 ti 4 Do .o,,� �f Cheek-a (LDtl�i ^ 0 "rii n�lSi ❑ corporation- .Business Telephone ❑ Partnersttlp Name of Licensed Plumber or Gas Fltta; e ��co. veh S �dd� Q INSURANCE-COYER;gGE: I have a cu liability 1kwwanoe Yes No ❑ or its egalent which-meets.the r eF you -Wft-chi equirements of.MGI Ch•142.. Gas checking-the APPVGpdde.l box A liabiity insuranoe:p�y - Other-type tindemnify.Q Bond 13 OWNER'S INSURANCE_WAfVER;I am-aware that the 1 Chapter 142 of the:Massa General Laws, and-that.my sigrmtur have -the Wince.coverage required by permit-applestion waives this requirement. Signature of-Owneror Owers Check One: �Aent. Owncr❑ Agent ❑ 1 hereby certify that all of the details and inknO*isdgformation Pe t a and that f th �!r� W�ave ed u�otWm ft,f� ��n am tna and accurate.to,the best of my Provisions of the State Gas Cods and tic alim will be in compliance with all BY Chapter 142 of the General Laws. P T of License; Title Plumber ^w Gasfitter � rf r� � City/To" License Number�� 31 f 1 BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION SKETCHES FINAL INSPECTION a— FEE moo APPLICATION FOR PERMIT TO DO OASFITTINO NAME t TYPE OF BUILD 1140. LOCA ' I PLUMBER O A Ft . PEIIMIT aKA11tED DATE -�--==-20, OA3INSPECTOR