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HomeMy WebLinkAboutMiscellaneous - 20 FOXHILL ROAD 4/30/2018 JI, 20 FOXHILL ROAD 210/037.C-0049-0000.0 ,_....Date....�.f�..f�...... 11305 40FITh � Of ;boom TOWN OF NORTH ANDOVER O • w: p PERMIT FOR PLUMBING p SS'�CHUSfc ...... ...:. ............................................... This.certifies that...........� � f' r � __// has permission to perform...a...-.........J...V..... ...:........ `.....................4.............. plumbing in the buildings of........ ....L-� ... at..... ..{ ....:.7 ? ... . ..... ......................... , North Andover, Mass. Fee c,2-�.`....Lic. No. ./..�, . LUMBIN INSPECTOR Check# f -r I� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _� III MA DATE — PERMIT# JOBSITEADDRESS r-^--�7.YC��+' � OWNER'SNAME POWNER ADDRESS ! TEL F TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT �.,� CLEARLY NEW: E RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB __I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM F __ __,_) .___J -__..-„J -_► _ _ �_ _ __I __ I ___. ! DEDICATED GREASE SYSTEM J _ _€, E J I -___-_ _! ._.._..___ L f DEDICATED GRAY WATER SYSTEM f ... I I _ I _ i _J _._—J ___ . I _.___ f I. I DEDICATED WATER RECYCLE SYSTEM I _._._._.J .._._._._! _..__� _.._ .._J I __.._._J .._. _I ( _.__..._f ...__J' f _I DISHWASHER DRINKING FOUNTAIN .._...._J FOOD DISPOSER —i- .______....I ._._..-._i i I FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) i I i . ..__ I _( __...__J _� ___i .__...__.I _ _1 ,._.___.1=== KITCHEN SINK I __._1 �_I 4 _. ._._..� --._.-� _I __ '_j .—.._,_f LAVATORY _!. J ! I __. _€ I _._.__..I I I .___.._J .:—__I L_ .EI ___J ROOF DRAIN E { ! _. ! I IF-771_ .......... _-_ E -----._I SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION i(VATER HEATER ALL TYPES WATER PIPING I � _ _....) I i ___...__! 6T_H _ I .._..._I _.....__.J ..,�_I _...:.4 _-...__! _..___I ....____lI ..._.__ _i _...__._! i i INSURANCE COVERAGE: 1 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 > OTHER TYPE OF INDEMNITY Q BOND M 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 F AGENT 10 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application a 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 co lance with a I P e ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' PLUMBER'S NAME LICENSE# SIGNATURE mpg/ JP D C RPORATION FJ1# PARTNERSHIPQ# LLC COMPANY NAME ADDRESS CITY Q cv ! - - i STATE _11 ZIP FAX ._ tCEL EMAIL � ---------_____...___---------------._-. _---------------- -- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL PqSPECTIO NOT S i Yes No � THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: PERMIT# PLAN REVIEW NOTES T . I The Commonwealth of Massachusetts . F Department of IndustrialAccidents v`~_ 1 Congress Street,Suite 100 d Boston,MA.02114-2017 1, M 5J'y www.mass.gov/dia ' yVarkers'Compensation Insurance Affidavit-Builder/Contractors/Electxicians/Plumbers. TO BE FILED WITH THE PPRMTT'NG AUTSORIT Y• please Print Le 'bl A ••licant Information Name(Business/Oxg anizaiion/individual): y / Address: City/State/Zips Phone 4: �zr� •} Are you an employer?Check the approprrate box: Type of project(required): em to ees full and/or part-time).' 7. ❑Nevu'donstr{ lion L[]I :employer with � • P Y 2• in a sole proprietor or partnership and have no employees working forme in 8. Remo deliiig ci [No workers'comp.insurance required.] 9, Demolition any capacity.[N 3.E]I am a homeowner doing all work myself:.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.[]Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole '`-R Plu`inbir" repairs or additions •SYj�. 'r.` proprietors with no,employees. - 110 Roof repairs 5.❑I am a general contractor and I have hired the sub contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 14.0 Other c 6.Q We area corporation and iis,officers have exercised their right of exemption per MGL c. 152,§1(4),anlWehave no empldyees:[No workers'comp.insurance required.] zArry applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: Homeowners who submit-this,affidavit indicating they are doin It gall work and then hire outside contractors must submit anew affidavit indicating such. '�; Contractors that check this box must name of the sub-contractors and state whether or not those attached an additional sheet showing the •entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. n in surance or°my employees. Below is the policy and job site compensation .f X am an employer that is providing workers' p information. Insurance Company Name- Expiration Date:. Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration.date). olation by a fflib Up to$1,)500.00 Failure to secure coverage as required a d ivill penaltiesinthe form of criminal TOP�WORK ORDER punishable cid fine of up to $250.00 a and/or one-year imprisonment,as well p be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A copy of this statement may coverage veri tion. X y cert! underthe n pe les ofperjury that the information provided above is true an correct do hereb . - Date: Si ature: Phone#: Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): l 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . e 4 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hv're, 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 enferprise,and including the legal representatives of a deceased employer,or the receivbf6j trustee 6f 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 o£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 requiired." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the'workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)uame(s),address(es)and phone number(s)along with their certificate's)of insurance. Limited Viability 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-Accidenis. Should you have any questions regarding the law or if you are required to obtain a w6rkers' 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 thai 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents - 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia C�M WEALTH OF SA ® ® M � CHUS�S PLUMBERS A_1Vb GASF I TIERS, . §ISSUES T.HE FOLL`OWI:NG E . I' �NSE33' AS NSE. A MA5TER�PLUhIBE�R t; DAk�IQ jELLEY a 1321 Wf l PPL h :; lw WKS 1ffj _ f �Z MA o 1876 3°86: \1 20435 i I Date.......l...' �.�.-0'7... NORTH °!t"`° CL TOWN OF NORTH ANDOVER p ..PERMIT FOR WIRING This certifies that � .� /V..... T� C c x, L 7, has permission to perform .............�A-.t11.k�:......... ............. wiring in the building of............... ............................................ ®X L/r at...........�.�.,�' ................. .North Andover,Mass. Fee......`...... ....""' Lic.No. f...................! ELECTRICAL INSPECTOR �. Check # t 7676 � Commonwealth of Massachusetts Official.Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 (leave blank •- - APPLICATION FOR PERMIT TO PERFORM-ELECTRICAL WORK All work to be:performed in accordance with the Massachusetts,Electrical Code.(MEC) 527 CMR 12'.00- (PLEA 2 00 ...,. .. ...T .a < s.w. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9/13/2007 2.53,pm City or Town of. North Andover To the:Inspector of.-YVires: By this application the undersigned gives notice of his or her intention to perform the electrical'workdescribed below. Location(Street&Number) 20 Foxhill Road Owner or Tenant . Abby Stern Telephone No. (978)390-1987 Owner's Address .SAME Is this permit in.conjunction with a building permit? Yes No ✓� (Check Appropriate Box) Purpose of Building Single Family Utility Authorization No. Existing Service Amps / Volts Overhead El Undgrd No.of Meters. 1 New Service Amps / Volts Overhead Undgrd No.of Meters 1 .. Number of Feeders and Ampacity: F Location and Nature of Proposed Electrical Work: install (6)customer supplied BRK smoke detectors Completion of the followingtable maybe waived by the Inspector of Wires. No.of Recessed Luminaires 0 No.of Ceil.-Susp.(Paddle)Fans 0 No.of Total Transformers 0 KVA No.of Luminaire Outlets 0 No.of Hot Tubs 0 Generators 0 KVA No.of Luminaires 0 Swimming Pool AboveIn- o.of Emergency Lighting 0 �— rnd. � rnd. El Battery Units No.of Receptacle Outlets 0 No.of Oil Burners 0 FIRE ALARMS No.of Zones 0 No.of Detection and No.of Switches 0 No.of Gas Burners 0 0 Initiatin Devices No.of Ranges 0 No.of Air Cond. 0 Total TonsNo.of Alerting in Devices 0 . No.of Waste Disposers 0 Heat Pump Number Tons KW No.of Self-Contained 0 ............................................... Totals: � . Detection/Alerting Devices No.of Dishwashers 0 Space/Area Heating KW Local ElM nnecti l �Other Connection El No.of Dryers 0 Heating Appliances 0 KW Security Systems: No.of Devices or E uivalent 0 No.of Water No.of No.of Data Wiring: u Heaters 0 K�'�' Si ns 0 Ballasts 0 No.of Devices or E uivalent 0 No.Hydromassage Bathtubs 0 No.of Motors 0 Total HP Telecommunications Wiring: 0 .0 No.of Devices or Equivalent . OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: $507.00 (When required by municipal policy.) Work to Start: 09/12/2007 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: . Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND O OTHER[:](Specify:)GENERAL LIABILITY 07/15/2008 I certify,under the pains andpenalties o j ry, (Expiration Date) p p Jper u that the information on this application is true and complete. FIRM NAME: S.A. Caron Co., Inc./DBA Caron Electric LIC.NO.: #A17039 Licensee: Scott A. Caron Signature '� G - �'`�"`- LIC:NO.: #A17039 (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: (781)270-6900 Address: 11A Cypress.Drive, Burlington, MA 01803-4907 Alt.Tel.No.: (781)389-0700 *Per M.G.L.c. 147 s.57-61,security work requires Department of Public Safety"S"License:Lic.No. Al 7039 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally . required by law. By my signature below,I hereby waive this requirement. I am the(check one)lowner 1:1 owner's agent.. Owner/Agent Signature Telephone No. PERMIT FEE: $ 55.00 '4 iJ 7 1 Date........l.qq.:..Z. . NORTN O?�e`, + s4,4 TOWN OF NORTH ANDOVER J; PERMIT FOR WIRING �SS�cHusE� This certifies that ..................... 2.................... has permission to perform .......T... 4i�.�....5...................... ......f� wiring in the building of �S�" - lr� at.....2 ....... . ... ..... .... -Q C. ................... .North Andover,Mass. .......... . . . ... Fee..................... Lic.No. .:.. 1.14............ ,.cr ...!�' tom..-- LECTRICALINSPECTOR Check #1 - 7672 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. `7 — BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: .9/10/2007 3:18 pm City or Town of North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 20 Foxhill Road Owner or Tenant Abby Stern Telephone No. (978)390-1987 Owner's Address SAME rm Is this permit in conjunction with a building permit?. YesEl No (Check Appropriate Box) Purpose of Building Single Family Utility Authorization No. Existing Service Amps / Volts Overhead El Undgrd El No.of Meters 1 New Service Amps / Volts OverheadEl Undgrd Lj No.of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: basic trouble shooting of smoke system found bad t splice repaired Completion of the. ollowin table may be waived by the Inspector of Wires. No.of l'otal No.of Recessed Luminaires 0 No.of Ceil.-Susp.(Paddle)Fans 0 Transformers 0 KVA No.of Luminaire Outlets 0 No.of Hot Tubs 0 Generators 0 KVA No.of Luminaires. 0 Swimming Pool Above In- 0 o.o mergency Lighting 0 rnd. rnd. Battery Units No.of Receptacle Outlets 0 No.of Oil Burners 0 FIRE ALARMS No.of Zones 0 No.of Switches 0 No.of Gas Burners 0 No.of Detection and . 0 Initiatin Devices No.of Ranges 0 No.of Air Cond. 0 Total No.of Alerting Devices 0 Tons g No.of Waste Disposers 0 Heat Pump Number Tons KW No.of Self-Contained 0 Totals: _ """"""'''�"���� ....""". Detection/AlertingDevices No.of Dishwashers 0 Space/Area Heating KW Local ElMunicipal Other Connection -- No.of Dryers 0 Heating Appliances 0 KW Security Systems: No.of Devices or Equi alent 0 No.of WaterKms, No.of No.of Data Wiring: j Heaters 0 Signs Ballasts 0 No.of Devices or Equivalent 0 No.Hydromassage Bathtubs 0 No.of Motors 0 Total HP Telecommunications Wiring: .0 No.of Devices or Equivalent OTHER: iI. Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: $376.00 (When required by municipal policy.) Work to Start: 09/07/2007 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may.issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies thatsuch coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ',i% BOND E] OTHER EJ(Specify:)GENERAL LIABILITY 07/15/2008 (Expiration Date) I certify,under the pains and penalties ojperjury,that the information on this application is true and complete. FIRM NAME: S.A. Caron Co. Inc./DBA Caron Electric / LIC.NO.: #A17039 Licensee: Scott A. Caron Signature G �" LIC:NO.: #A17039 (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: (781)270-6900 Address:_ . 11A Cypress.Drive, Burlington, MA 01803-4907 Alt.Tel.No.: (781)389-0700 *Per M.G.L.c. 147 s.57-6.1,security work requires Department of Public Safety"S"License:.Lic.No. A17039 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the lidbility insurance coveragenormally required by law. By my signature below,I hereby waive this requirement. I am the(check one)Elowner I owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 55.00 Location 20 f_ No. 1/ry Date T N°R7ti TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ � Building/Frame Permit Fee $ *04 Foundation Permit Fee $ Other Permit,Fee $ { �'% T.Connection Fee $ P .gR, -4 J Water Connection Fe $ r TOTAL Lori'®//� v. ,. inspector- &A Bwldinv g Ispector-- fes: { Div. Public Works PEbtIilT NO.i�y APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. AGE 1 MAP 4-0. LOT NO. 2 RECORD OF OWNERSHIP !DATE BOOK !PAGE ZONE I SUB DIV. LOT NO. I LOQ ATION PURPOSE OF BUILDING/^p��-•• �/��! tttt���f OWNER'S NAME I NO. OF STORIES fl�C'���7LC SIZE �U �0 X ��.✓bO Cyrn pY _ OWNER'S ADDRESS -�0 .�/-_ .iBASEMENT OR SLAB ARCHITECT'S NAME ,5�, SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME JI 1 L,CIYI,e� •yy► (G SPAN DISTANCE TO NEAREST BUILDING •-1 DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS ` AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING - x .IS BUILDING ADDITION MATERIAL OF CHIMNEY - IS BUILDING ALTERATION a,Q,l, .kl'—I 3 A5 G°C. 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 7 e S IS BUILDING CONNECTED TO NATURAL GAS LINE 'qf.,S •.- INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST _3 �- PAGE I FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM {k SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 `APPROVED BY ATTACHFJ)GARAGES MUST CONFORM TO STATE FIRE REGULATIONS _. t PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE ILED JJ(( BOARD OF HEALTH SIGNURE OF OWNER OR AUTHORIZED AGENT (`J( OWNER TEL.#p:7S 2- F F E E /s-y-t7 CONTR.TEL.# -6 CONTR.LIC.# lePLANNING BOARD PER ` 19/ BOARD OF SELECTMEN BU INO INSPE R BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I_I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM i MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- APARTMENTS I I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'TAREA _ '/, 1/2 '/, FIN. ATTIC AREA _ NO B-M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WAILS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDV✓'D _ ASBESTOS SIDING COMMCN _ VERT. SIDING ASPH. TILE —{I_ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR ADEQUATE I-i ONE 5 ROOF 10 PLUMBING GABLE HIP BATH Q FIX.) _ "v 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 6 FRAMING 11 HEATING - WOOD JOIST 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 i 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st ��L.3rd I NO HEATING V r FINAL 0. own o 6 nover No. -1 on -M r C HE In er, Mas v 19F OA? BOARD OF HEALTH PERMIT THIS CERTIFIES THA .. . .. ..... ......... ................ ��/�� �� ......... BUILDING INSPECTOR has permission to erect ......................... buildings on ?W.6...)Cz. y... DRough to be occupied asoe. frao.O.Per x Final Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids tlwf�ermit- PERMIT EXPIRES 6 MqNTHS ELECTRICAL INSPECTOR Rough UNLESS CON R U C110 T Service Final .. ..... .. .............. ... . . .. ............. BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector __J/ Locations No. 1&2 Date VZZAf 2, „OR*h TOWN OF NORTH ANDOVER Op Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ JSACMUst Other Permit Fee $ Sewer Connection Fee $ Water Connection Fe $ TOTAL $ wiI ding Inspect 5086 Div. Public Works Date..... .. ..r................. '{ �HORTN 3?pe,�..o"ahppL TOWN OF NORTH ANDOVER 49 PERMIT FOR WIRING sS^CHus� W This certifies that ... ..` . ....... ... ...........r.......... . ..... has permission to perform �.. �� r Ing in the building of at .... f.............. . ...... d8ve.........s. ' Fee .� Lic.No j < l ..... // ...... ................. AER INSPECTOR Check At 5219 THE COMMONWI:ALTHOFMASSACHUSETTS Office Us e only DEPARTMENl0FPUBLICSAFE7Y Permit No. BOARDOFFMEPREVF_ MONREGULAHONS527CUR12. Occupancy&Fees Checked APPUCATIONFOR PERMIT TO PERFORMEL CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS EL CTRICA ODE,527 CMR 12:00 /v IV (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the e ectrical wo described below. Location (Street&Number) ao F� Q Owner or Tenant 3-T e,r 1�1 Owner's Address -JG.m C4_5 ©� Is this permit in conjunction with a building permit: Yes No r7 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Seryice Amps / Volts Overhead Underground No. of Meters New Servije Amps / Volts Overhead Underground No. of Meters Number of'Feeders and Ampacity Location and Nature of Proposed Electrical Work 77775 �f 7777477, No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets f 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 Nq..pf Sounding Devices f Noo£Self Contained J. Detection/Sounding Devices No.of Dryers" Heating Devices KW Local Municipal Othe Connections No.of)Vatef Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP 42 )THER / /1/t/ ,lam 5 /i���r v✓ ('�` suranceComnge Ptuanitothe wquil lis ofNlassachusetts Qp&ral Laws laveacuarrttLiabiityko ancePbhcyin hdrigComplete Covelageori gkstanbalawakfA YES NG tavest.>bmia2clvalidploof9FIamtotheOffi�YES j�If}ouhavEdle�lYES,Pleaseindica�thetypeofcovet/ageby ecking ISURANCE x BOND ® 07.FER (Please SpacifY) F*ahonDale Eslir e VahaeofElachicalWolk$ odctoStatt &Rapesled Rough Final iti2�iePenahiesofpeljuty �� (� q, 2MNANVIE EZZIZ ! r/ Lia eNo. ZG �772 Signahm G Lio=No 21 'F 7-2 ��t � � � � !��P`� ,/� /T ©�D 2 � Business Tel No. � `y� /— —s 2 Alt Tel No. Vi\ER'S INSURANCE WAIVER;I am aware that tl-Licfse does nothave the imam coverage orits mbstEnbal a tmient as mWred by Ma%wh,lseus General Laws dial my signahue on this permit appEmdon waives this legmt?n-Ent 29 ease check one) Owner Agent Telephone No. PERMIT FEE signa--tur-e-ot Uwner or Agent i Z a The Commonwealth of Massachusetts u Department of Industrial Accidents d Office of Investigations Boston, Mass. 02111 Workers'Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity r I am an employer providing workers' compensation for my employees working on.this job. Company name: Address City: Phone#: Insurance.Co. Policy# Company name: Address City Phone#: 7 F, Insurance Co. Policv# 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_we➢_as_civil..penaltiesjn.theformof-a..STOP WORK_ORDFR.,and_a.fine.of.(.$1Ao.ODJ_adayagainst.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 pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name P.hone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing E] Building Dept ,. ❑Check if immediate response is required 0 Licensing Board Ej Selectman's Office Contact person: Phone#. �' Health Department Other Location c1_ p t No. Date 1 - � �oRTh TOWN OF NORTH ANDOVER + ; , Certificate of Occupancy $ cHusE�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ j Cf Q Check # 9 172306 (� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIE,RENOVATE, OR DEMOLISH A ONE.OR TWO FAMILY DWELLING o „ BUILDING PERMIT NUMBER: -a DATE ISSUED: SIGNATURE: _ Buildin C ' issioner/I ctor of BuildingSDate SECTION 1-SITE INFORMATION 1.1 PropertyAddress:1 / 1.2 Assessors Map and Parcel Number: 7, 10 f-/eX iY1l' 12eg ,. Map Number Parcel Number V 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District ProposedUse Lot Areas Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reqaired Provided Re aired Provided C 1.7 Water Supply Z.L.C.40. 54) I.S. Flood Zone Information: 1.8' Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System. 0 SECTION 2-.PROPERTY OWNERSHIP/AUTHORIZED AGENT IT 2.1 Owner of Record a L Lo zax 1 l 12c . ame (Printf Address for Service CID Signature Telephone i 2.2 Owner of Record: Name PrintAddress for Service: O 't z Si na' re Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 N6�� i Licensed Construction Supervisor. O License Number Address Expiration Date re Telephone 3.2 Registered Iyfome Improvement Contractor JJ Not Applicable 0 Company Nanfi Registration Number �w '1T /�✓c . N � � Address l 7J0 Expiration Date re Telephone SECTION 4-WORKERS COMPENSATION Workers (�G•L. C 152 Co mfthe Issuance Insurance affidavit must be completed and.subinittedsivith)ibis.application. Failure to provide this affidavit in the denial of the issuance of the buildin rmit. Si ned affidavit Attached yes; vit will result SECTION 5 Descri tion of Pro osed Work check ail a New Construction ❑ Lkable Existing Building 0 Repair(s) p Alterations(s) 0-� Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CON Item STRUCTION COSTS _ Estimated Cost(Dollar)to be Com leted b 1. Buildingemut a licant Q f (a) Building Permit Fee 2 Electrical Multi lter (b) Estimated Total Cost of 3 Pluinbin Construction 4 Mechanical HVAC Building Permit fee(a):X.(b) 5 Fire Protection 6 Total 1+2+3+4+5 SECTION 7a OWNER AUTHORIZATION TO 13E COMPLETED WHENQheck.NumOWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Hereby authorize I> _ as Owner/Authorized Agent of subject property My behalf;in all matters relative to work authorized by thisbuilding penuit application, to act on Si nature of Owner SECTION 76 OWNER/4 UTi3URIZED AGENT DECLARATION Date Property ,aeAAuthorized Agent of subject t �3ereby declare that the statements and information on the foregoing application are true and.accurate, to the b ~ uid belief, � est of my la�owledge kF rin e ire of er/A ent Date J..OF STORIES �SE1v1ENT OR SLAB SIZE . �E OF FLOOR TIMBERS AN 1., 2 3 �NSIONS OF SILLS v1F,NSIONS OF POSTS AFNSIONS OF GIRDERS -GF1T OF FOUNDATION E_OF FOOTING THICKNESS '' TENIAL OF CFEIvINEy X UILDING ON SOLID OR FILLED LAND U1L.DINU CONNECTED TO NATURAL GAS LINE N o'W 0ORTHAndover 0 0 No. AD �,o LAKE 0 dower, IViaSS., COCKICMEWICK �oRATE D �7 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System p b h � +� CL o BUILDING INSPECTOR THIS CERTIFIES THAT R ................N....... �............................ ...........�.... .................,......�..................... ..................... Foundation has permission to erect...........�!s.....,.... .. buildings on.... ............ O o. ... ...1,,.... Rough .... .............. to be occupied as............[..Yd........... . ... .....Io... M�Vp .,..4Or.....1�A. .. 000 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-La s relating to the Ins action, Alteration and Construction of Buildings in the Town of North Andover. 450; 9f? ' GO PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STNELECTRICAL INSPECTORS Rough ' ....................................................................::. Service BUILDING INSPECTOR Final Occupancy Permit Required t® Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT Until Inspected and.,Approved by the Building Inspector. Burner 3 Street No. SEE REVERSE SIDE Smoke Det. i The Commonwealth of Massachusetts Department of Industrial Accidents A = : Moffice ol/nyestigatioas Z 7 4G=.�•� 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit ag hea�-of'mafion= 1 eat name: cati : Z� TTc�'W♦ t7 fw eF cilJLrz 6V''9 r�hc�ne# / 7d ❑ I am a homeowner performing all work myself. l L�,I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. Umpany na e address: city:. phOne# �Rce c —am �&a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: address: Rhone# insurance co. " re z lic an nate address. s�tv. hone# t ur�nce c �d`diti�rcai�she,eE#�te�essar� - olio '# Failur c to sc cu .. rc v co era ea• it cd u nde rS i; «h on 2�A .X q of NIGL 1�2 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the its and penalties ofperjury that the information provided above is true and correct. Signature Date Print name hone# Z41 r -= P .7_ ' ��}� official use only do not write in this area to be completed by city or town official city or town: permit/license# nBuilding Department Q check if immediate response is required QLicensingBcard' --------------- - - QSelectme,n's Office contact person: QHealth Department phone#; ther( Other- (re ised revised 3/95 PIA) .... .. ,.., ..:,z•;,.ra„r;,.u,.,,,'"j?,�~.�'ac5*'."- ."�T t�sA`�1'c'.lS4it5,,171y BOARD"OFBUIL••'DING°REGULATIONS License CONSTRUCTION SUPERVISOR ay NUnlbe� CS.\ 058245 Birthdate 03/24/1943 Ezpire 0.3l24l200ti Tr.no: Zf031 Resti�ictetl :0� + , ,KENNETH B KEEN,F a 21 HEWITT AVE ' I N"ANDOVER,tMA 01845 Acting:.0 mis� ones I 4: z r Board of Building-Regulations and S6itedard's { . HOME IMPROVEMENT CONTRACTOR Rtie t$tratfon 108383 ira Exption 8/1.8%2004` T,Ype DBq i KEEN CONSTRUCTIONaCO , Kenneth-=Keen 21 Hewitt,Ave ` Gea/ a� W.Andover MA'0184.5 ' Aa�nistrator 1.61. 1 KEEN CONSTRUCTION CO. A&AP 21 HEWITT AVENUE `OSAL *111"t" 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 r Chapter 142A of the-general laws,must be registered with To:Submitted I t ),� the Commonwealth of Massachusetts. Inquiries about registration and.status should be made to the Director, Home Improvement Contract Registration,One Ashburton K._._�.h�._�_..___ Place, Room 1301, Boston, MA 02108 (617) 727-8598. (� � Owners who secure their own construction related unregistered or deal with permits contractors will _�_ ...,...._ p be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE i r REGISTRATION NO. F.I.D.NO. � MA. H.I.C. 108383 04-325-80 52 C/S = Customer Supplied S + I - Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be:used: .................... > Construction related permits: - --... ..... _-------�,_—,_—,�_ .......................................................................................................................................................... WORK SCHEDULE Contract r will n the int work or order the materials before the third day following the signing of this Agreement,unless specified here'n writing. Contractor dF begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by — �! ate). The Owner hereby ackno ml dges and agree 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 `c) .Ct 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. YbeT OpOse hereby to furnish material and labor-complete in accordance with above specifications,for the sum of c,;;~� _.�Cr dollars($ Payment to be made as follows: ($ ) upon signing Contract; KENNETH B. KEEN Name of Contractor/Designated Registrant ($ ) upon completion }f 21 HEWITT AVE. i 1 — Street Address ($ ) !u on crmade N. ANDOVER, MA 01845 City/State h I� forthwith upon (978) 691-5201 (978) 682-3231 completion of work under this contract. r r_ !C Phone Fax _.- _ Notice. N agreement for home improvement contracting work shall require.a down payment(advance deposit)of more than one-third of the total contract price Name°' alesman or the total amount of all deposits or payments which the contractor must make,in advance, to order and/or otherwise obtain delivery of special order materials and Autiw ize Signature I k equipment,whichever amount is reater. -� - i Note: This proposal may be withdrawn by us if not accepted within days. ACCeptaince Of ProPOSaI:-f 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. i 90 NOT I N THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Si nature �''l J ter ( f 9.. Date i !( l Signature,' Date IMPORTANT INFORMATION ON BACK R I ; . :: s-,.:'- c. :: - O ,. . .. } :. KEENy',CONS,,_ "7:, TIO.N CO.:;, 21 HEWITT-AVE.� N ANDOVER, IVIA 01845 (019)_-691'5201 , } Stem, Abby& Lloyd 20 Fox:Hill Rd J N Andover, lV1A 01845 (978)-68 6 5140 .. Y `A:i Contract# 16I1 ,Appendix A - Date 4/12/04 d - Fnish Basement II Remove 12'`of existing wall between garage and hasernent to extend finished.'room into existing,garage • Frame` nterior partition walls tocreate approximately 440 sq ft "of finished area Greate;2' x 8' closet at bottom of stairs •. Create'`approx 3'..4' closet next to boiler room , Supply& install two vinyl replacement,(hopp'er style)windows ` M , I • Supply.&install R 3 insulationvuith vapor bamer�on-', ° .extenor'7walls" i. Supply;:&install blueboard ort all finished walls and skimcoat plaster to smooth finish , • {Supply;& n 'a11 6 panel hollow core masom-e�d'oors as�follows 5'0" k'6 6" unit parr for closet at bottom of stairs ,- 2'0" x-6'6" door for other',closet s 2'6" x 6'6" door'.for boi"ler room: • ': Supply`&install trim on doors, widows& base to match existing s;" • Supply:& install marble threshold at garage door and ceramic tale entry,`(approx 66,sq ft $200.00 tile."allowanceI F = +, r • Supply& install pine on 1a11y columnsin finished'area(not in closet) •' Supply=& install ca pet`tliroughout fiiushed area mcludmgstairs a($110U 00 installed; allowance) '' r { ; • Su 1 & install 2'x 2' revealed ed e sus ended ceilin finished hei lit 6'7" a Paint walls &trim;(2 coat=finish;2 neutral colors) Electrical I Supply& install three"fluorescent troffer lighf fixtures in ceiling:' • Su 1 &,,install outlets"acid switchrn to code ,i. I?p:Y g:. Su 1 *-&Mstall one hone outlet and one cable outlet 1 pP ' p t Supply& install thermostat and`controls for zone of heat �, Plumbing . e': , Y • ; Supply& install one zoneof baseboard'heat off of existing boiler { Moue existing gas line for ceiling height i" 1 - - - - 9 ` f _ - I .. V.: ` - O ' ` .. .I F �. -. 1—��;",� . , . , . � ,; �:,%� �'. - �,� ,�,,�:----:- :� --- .11. , �11 I I - - - - - .. , �.: � -� ." � I li� �J r - �%I:,: , . . : . . - �, , - ..�- . , 1. - - �,1-1,1'1'1,1'1-1-11--1_--,-11,1.1---,-�'.", —.- — .'.�� -.,,���.- �----`�7��7 - ` KEEN C0NSTRUCTION CO. " .: -: 21 HEWITT,�AVE.. .N ANDOVER,MA 01845 (978);691 5201 Mextras to be-pa'd in full upon ordenrig , - ;y x ;, Price does not include lifting door going mto=garage(which would require new door), cost of �-UTIPONE ,or extensiue work fo hang stherapy equipment: rz Y Total pnce $1`4;048 00 (fourteem thousand forty eight ciol'lars) ,. sa' 4 t ik,' v "'1F Payment schedule $1000 00__due upon signing contract ' n� :'Lf.- �t4 a�,, 1 :� rbc �'N's� t<"- - ,I,I- k qI '1 y is 5 4 Y " , „, $400000 due,th°e,`first,da of work " `` " $4000 OOOL I due when wallsare framed `` . $2000 0i�l0`At when rough el'ectncal and insulation ar1. e complete $2`000 OO�,due when1bfueb:7 roard is, ung � � , 11 °' Sj To 40 - $1,048 00'due at comple�Izltion of contractedwork 4.1 N -t, :: k✓ yJ, '° K �,,a b� -''� 6 a _ ; R - ;l r �. 010 of t �' �; + k ,.S �,a J p "V fA F - ,C eth B' een 11 . - 1. .. r - y �{ g� S T 1 ( < 2, DateWay Date V M !� 1 �jA ' � 3 - -..W +.may Y _ t S _,§: syf,�,;.tfF`x -5,r"`�q",,"' 7al`_'. ;w v+jy'�`F I�'bWb"'�< ' }- * � �', `'4' F -^ r `'`.,> -V j au x f ` " ,.k1 � 7 � *,...,,.tet v ^f ?�,: '"'�' ,'�d'-r.n� ^a`--rwa�,rxm+. ' C`i ^�.. Ty. - r -,� �.a+nn .:.#:�,,fl".Mx.''s+:++"�tti.�:F°,,, k 4 �a � - _ .. -, - =y} .. -: a-. - t I. r 4 dp a Asks , " , , , ,,,." -;, - , .., -� -,i.I - r , W",""J 10, --.— :",_,��- 9 y sy IQ WAs f '.t. hr - K h �:; $ 'J F 2 1d5 '� ...: .. - " - - .. .. : r 5 r ,- F - - 15 q S .. _ .. _ .. _ - _-.. _ _ tW. .. ,. .-