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Miscellaneous - 23 MIFFLIN DRIVE 4/30/2018
23 MIFFLIN DRIVE 210/021.0-0038 0000.0 _ j 11rate... ± ......................... r►ORT#1 A TOWN OF NORTH ANDOVER f 9 , PERMIT FOR GAS INSTALLATION 4 • This certifies that .................................� � +- v 0 .................. . ........................ .............. ......4 has permission for gas installation ............::. ........:......... .... Pt,-V1v u �,� in the buildings of -1 ............................................. +�� �� J e-' ....... North Andover, Mass. at..; ............... ........ ......... ..... Fee:�?b............. Lic. No. -� .... . ................................................... I - GAS INSPECTOR Check# lP 920 X wd `�- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r CITY North AndoverMA DATE 3/2412014 PERMIT# JOBSITE ADDRESS 23 Mifflin Drive OWNER'S NAME Teera Spino OWNER ADDRESS Same I TEL 978-688-5452 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL[j PRINT CLEARLY NEW: RENOVATION:[ REPLACEMENT:® PLANS SUBMITTED: YES® NOD APPLIANCES 7 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 -11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST INIT HEATER ONVENTED ROOM HEATER WATER HEATER HER Replace Gas Meter FFT and Pi inp as Needed INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [j OTHER TYPE 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 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 be in pliance with all Pertinent provision of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JoseRh Marino LICENSE# 8736 SIONATURE MP MGF® JP® JGF® LPGI® CORPORATION 0# 3285C PART SHIPE ®# LLC®# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE=ZIP 01501 TEL (508 832-3295 FAX 508-926 4347 CELL 508-832 4614 EMAILI JMarino@RHWhite.com L ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# !J PLAN REVIEW NOTES - t `=-:GOViNao�IWEAL.TH OF IU[ASS�k�.I �l ," P URBERS AND E, -• • ='`- - I.0WS-ED AS-A._Ni-ALSTER P;L[1NfB SUES TAB:AB'QVE"LICENSE - GTON ER MA 0 i 1/14 _COMMONWEALTH OF MASSi�:C:3�#U:S:EI�i S �.:- , -- =P'LUNIBERS AND GASFITTRS AS A JOU.RNEYtVlAN=O-l:[0 ISSUES THE ABOVE LICENSE TO_= '"'' �b MARINO -ER MA OIC i - I • 04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 C ® ACORD CERTIFICATE Q DATE(MMMDNMI F LIABILITY INSURANCE Page 1 of I F08/29/2013 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policAes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rig hts to the Certificate holder in lieu of such endorsement(s), PRODUCER CONTACT willia Of Massachusetts, Inc. PHONE C/o 28 CQntuay Blvd. N0_KT?. 877-945-7378Fax_ND�. 888-467-2378 P. o. Box 305193 DMoRFLs Ceyt;ificate�5�williB.�om Nashville, TN 37230-5191 INSURERS AFFORDINGCOVERAGE NAIGN INSURED INSURERA.' The CbArtOx Oak rico Ineurance Company 25615-001 R. H. White Construction Company, Inc. INSURERS-Travol9Xs Property Casualty COXWany of Am 25674-003 41 Crantral Street INSURERC.National Union Piro Insuranco Company o£ 19445-001 P. 0. Box 257 Auburn, MR 01501 INSURER 0;Travelers Indamni,ty Company 25659-DO1 INSURER F„ INSURER F; COVERAGES CERTIFICATE NUMBER:20287680 REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED,ABOVE FOR THE:POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN Is SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYpE0FIN8URANCE DD SUB POLICY EFF POLICY EXP VVVn POLICY NUMBER LIMITS A GENERAL LIABILITY VTC2000 977X9948-13 9/1/2013 9/1/2014 EACH OCCURRENCE E_ 2,000,000 X COMMERCIAL GENERAL LIABII.ITY ppqqM ETO RENTF,p PRE� ES(Eaocw�anc,1 .R _ 300,p00 CLAIMS-MADE OCCUR MED EXP(Any onepereon) F 10�000 PERSONAL&ADV INJURY $ 2 000,000 GENERALAGGREGATE $ 4,000 000 NGEN'LAGGREGATF_LPRapPLIESPER; PRODUCTS-COMPIOPAGG $ 000,000 POLICY LOC B AUTOMOBILE LIABILITY VTJCAP 977K955A,-13 9/1/2013 9/1/2014 OM BIN�lEDSINGLELIMIT X ANYAUTO accident $ 2,000,000 BODILY INJURY(Perpemon) `S A{LO4AU HEDULED AUT0TOS BODILY INJURY(Peraccld4W) Z X HIREDN-OWNED T08 ereccldent $ X Co ll Dee 00 C UMBROCCURBE8766140 9/1/2013 9/1/2014 EACH OCCURRENCE $ 5,000,000 excEsCLAIMS-MADE AGGREGATE DED $ RETENTIONS 10,00 $ D WORKERS COMPENSATION VTRXUB 9205A105-13 9/1/2013 9/1/2014 X 0 - AND EMPLOYERS'LIABILITY Y/NTARy Ll 1) ANY PROPRIETORIPARTNFRIEXECUTIVE NIA VTC2XUB 8203A71A-13 9/7,/2013 9/1/2014 E.L.EACHACCIDENT $ 1,000 000 OFFICER/MEMBEREXCLUDW7 Menddeseib NH) E.L.DISEA9E-EAEMPLOYF_E $ 1,000,000 u���nel+ci�uN ud UF'hRATION3 below F..L,DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach Acord 101,Addltonpl Remake 3ehedula,It more eDeee Is rsequlrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Inrpuzdrice aUTHORIZEDREPRESENTATNE col1:4197604 Tp1:1694012 Cert:202676$0 ®1988-2010ACORDCORPORATION.All rights reserved. ACORD 25(2010!05) The ACORD name and logo are registered marks of ACORD TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING mil$Seciflim for - the o*j BUILDING PERMIT NUMBER: DATE ISSUED: ^— SIGNATURE: Building C mmissioner/I ctor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property.Address: 1.2 Assessors Map and Parol Number: O �/I �q n - Map Number --- Parcel Number 1.3 Zoning hrfonation: (j 1.4 Property Dimensions: zoning]>isL-nct PT-siosed Use LAX Area sn Frontage(ft)-- 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 IN atrr Supply M.G.L.C.40. 54) 1.5_ Flood lone Information: 1.8 Sewerage Disposal System. Public — Private Zone — Outside Flood Zone J Municipal D On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 21 (h`ner of Record C Name(Print) Address for Service Signature Telephone n 2-2 Owner of Record: Name Print Address for Service: p� Signature Tele hone SECTION 3-CONSTRUCTION SERVICES 3 1 1.tcensed Construction Supervisor. Not Applicable I: Licensed Construction Supervisor: License Number Address Expiration Date Signature - - - - - ---Telephone r..� 3 2 Registered Hone Improvement Contractor Not Applicable ❑ i Cumpan�Narne pqq Registration Number �1 ,Address _—______ ____ Expiration Date ^ S)ignature Telephone L SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... . No.......❑ SECTION 5 Description of Pro osed Work check all applicable) New Construction C Existing Building ❑ Repair(s) ❑ Alterations(s) CI Addition ❑ Accesson Bldg. ❑ Demolition 11 Other ❑ Specify Brief Description of Proposed Work: r� - IL SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estunated Cost(Dollar)to be OFFICIAL USE ONLY Completed b permit applicant L Building (a) Building Permit Fee Multiplier 2 Electrical _ (h) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) r (b) 4 Mechanical(IIVAC) 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 as UNvner/Authorized Agent of subject propem Ilereb' authorize _ _ _ to act on M\ behalf, in all matters relative to work authorized by this building permit application. Signature of(>hNiicr --- ----� Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1. _ _,as(honer/Authorized Agent of subject property I lereb\ declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge aild belief Si afore ofOv,ner/A ent Date NO OF STOR➢;S SIZE BASEMEN'l OR SLAB SILL OF FI.00R 11MBLRS 1 ST2' 3RD SPAN DIMENSIONS OF SILLS DI]NIE.NSIONS OF POSTS DIMENSIONS OF UM)F.RS f U'tGl 11 OF FOt,TJDA 110N THICKNESS SIZE OF FOOTING; h MA FFRIA I OF CIIIMNI:Y _ IS BUILMNG ON S01.ID OR FIl.LED LAND IS BUILDING CONNECTED TO NATURAL CCAS I,LNI: TOWN OF NORTH ANDOVER BUILDING DEPARTMENT "0 APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING M OTHER THAN A ONE OR TWO FAMILY DWELLING lrY�1.3i.i.3H4YG2 for Official Use OlL'r BUILDING PERMIT NUMBER: � C �.y i)ATE ISSUED: sT -/ T D I SIGNATURE: Buildin Commissioner/1 rfs or dBuildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: v Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning District Proposed Use Lot Area(sf) Frontage(ft) rn 1.61aUR DING SETBACKS(ft) Front Yard Side Yard Rear Yard G, Required Provide Required Provided Re red Provided 1.7 Water Supply M.GL.C.40.St 54) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 1 Municipal On Site Disposal System ❑ 2.1 Owner of Record r Name(Print) Address for Service x-77 Q7 1 - 7, 372 rn Signature Telephone F- )-` acowk 2.2 uthorized Agent Name Print Address for Service: Z �- o Signature Telephone z r *,.-+ 90 �j`'�s. .;e�.,. __til * r �'x 3.1 Licensed Construption Supervi r„ Not Applicable ❑ Address License Number O Licensed Const cti. pervisor: C-r� Expiration Date ✓ � ` r Signa re Telephone 3.2 R istered Home Imp ovem t Co tractor Not Appl,'^zble , & 0 ILO Company Name Registration Number Address — ! — - --------- I D / r �j F /, C 2 -?(/� Expiration Date z Signature Telephone J 7 � C) G) t. � 1 Y as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my j knowledge and belief. Signed under the pains and pe lties of perjury IC Print Name Signature of r/Agent Date TIM Item Estimated Cost(Dollars)to be Completed by permit applicant _ 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a) x (s) 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) 1 G-) o Check Number t f I NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE T�iCTION 4:7 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea.......❑ No.......❑ SEON S,-P �B S It21 Bf) 1 i ;G 3; C ir�1�I 5 V1� FOR'Ov. ,-0 ���+1� ES 8 MC�'16 . DAI'S'1t�UC'�I� tC�t3►�`, 11, �:11fI �`'�'�'�84 �f�� �7� ' ''�.��> �,�T>E7r�s,li ��r��lL� �J��S�p� 5.1 Registered Architect: Name: Address Signature Telephone 3.2 R�isterect i�na1��I>rt�s�' Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Not Applicable ❑ Company Name: V `� 51� �r ` A If Responsible in Charge of Construction i New Construction ❑ Existing Building Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Descn ion of Proposed Work: (�t U )il C� tl!111. P USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 0 A-3 D lA ❑ A4 ❑ A-5 ❑ IB ❑ B Business ❑ 2A 0 C Educational ❑ 2B ❑ F Factory 0 F-1 0 F-2 ❑ 2C 0 H High Hazard ❑ 3A ❑ IInstitutional 0 I-1 ❑ I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 0 R residential 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage 0 S-1 0 S-2 ❑ 5B ❑ U Utility 0 Specify: M Mixed Use 0 Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height(ft) -- — Independent Structural Engineering Structural Peer Review Required Yes ❑ No D SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date LocationNo. Date t MOR,M TOWN OF NORTH ANDOVER « s Certificate of Occupancy $ Building/Frame Permit Fee $ �CMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ _ Check # 1 Ji IJ -- Building Inspector 77 1, ,as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent Date # l STE" Item Estimated Cost(Dollars)to be tJltt�I L,US (I1�TI Y. Completed by permit applicant 1. Building (a) Building Permit Fee A Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a)X(u) 4 Mechanical(HVAC) 5 Fire Protection soc,A C6�n ts� (o lticc:E ;O�/�o 6 Total (1+2+3+4+5) Check Number r NO.OF STORIES A�IA SIZE BASEMENT OR SLAB SIZE OF FLOOR TMIBERS 1 ST 2" 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE SECTION"4 '4�+ 71 - O RS BNSNUON C 15 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea.......❑ No.......❑ SECTION S=PROF$SSIONAL DUIGN AND C�2NSTRUMON$ER'VICCES FE#�t,BUMMGS Alm►5' UC'I`MI S S "t`TO CONSUMMON CON TRUL PUR�IAI�T TO C&�t 1.16(COI�TAIl O SIO �I�ANO 35,o3�t GF Off'I NCtoS D SPACE 5.1 Registered Architect: Name: Address Signature Telephone .� �2 R�istered;Pmfessi��ai ��, AYA Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date c DI�S�TIL(.L77r71y GDTC�i"24T7014 Not Applicable ❑ Company Name: ?C7A-L 77s1/cL lt54f X.7' Responsible in Charge of Construction SJ&+C."11`�tl�'�';�`�1� "TION.+�#�P1��QPt3�) �I'IRIC {clerk all applicable New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 11 Accessory Bldg. 0 Demolition ❑ Other Specify -nrAiLEZ Brief Description of Proposed Work: LfyEZ( o.N� SET VIS OF J065i1'L Gd�.x�'1T -T1011L f7P1�14L'�. USE GROUP Check as a licable CONSTRUCTION TYPE A Assembly [1 A-1 ❑ A-2 ❑ A-3 ❑ lA 0 A4 ❑ A-5 ❑ IB 11 B Business 0 2A ❑ C Educational 0 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A 0 IInstitutional ❑ 1-1 ❑ I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R residential 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 0 5B ❑ U Utility 0 Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Dumber of Floors or Stories Include Basement levels ,V. Floor Area per Floor s Total Area s Total Height(ft) , Independent Structural Engineering Structural Peer Review Required Yes ❑ No SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT l I, as Owner of the subject property Hereby authorize to act on My behalf,in all matters relative two work authorized by this building permit application Signature of Owner Date I, as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent Date Item Estimated Cost(Dollars)to be 01 60 Completed by permit applicant 1. Building (a) Building Permit Fee /I Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a) x(b) 4 Mechanical(HVAC) 5 Fire Protection c6 � X50 ��o cA 6 Total (1+2+3+4+5) Check Number :77 77 NO.OF STORIES A SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 No 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE � r— E own of Andover 0 Z �r T O � - Ic T dover, Mass., Elf ne ftO s Aa. 7.a•t. 'Q COC MIC coT ADRA r D P5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • • THIS CERTIFIES THAT......................Plrw�' ...L��...... �I.!+A i#NR..... *R ................... BUILDING INSPECTOR Foundation has permission on ......mss!..��. C4�Il ....R1�, ............ Rough Ipto be occupied as.......................................11 !1e1Zp�4�r... r lit. ..,............................................ 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. -*— ftw%4 4t. euv)ja" /j matt ft PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. FIT~ Y'10#0W 4% � rff *. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUC'T'ION STARTS ELECTRICAL INSPECTOR Rough i .. ..Jill 001.......... Service . . ... . .......... . BUILDING INSPECTOR Final OCcuPQncy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. own . of ED w ; verndoverrr at!K'4L-*1C4 No. 2__Z _ 70 dover1 1 Mass. o�o•�t. as. 7-�.. I�� cocHic ADRATE D S 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System •�• • BUILDING INSPECTOR THIS CERTIFIES THAT.....................0,1�.,��:.�'��...�...... 11��.....�1� 1�1��i�ll�l�..........r........ Foundation has permission on ......%�f�.. N .,,,Ri 1N ....r.. Rough to be occupied as �� .... . . . . . . ... ... . .. . ......����.�Ae,��•�I��I... �ie��.�,............................................ 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. ,.*- j"1t„ fi_U"i" 049 ^ftftlft PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. F000% 1*40ow rnl� Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR MONS4 Rough ................... ... ............ ... . . ..................... BUILDING INSPECTOR Service Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP 1 AHt,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUH.DING 0 OTHER THAN A ONE OR TWO FAMILY DWELLING > 9 r riJz �fsk K zz 4 " M Section for ficial Use Onl BUILDING PERMIT NUMBER. 4 DATE ISSUED. �l J;ZeS 1 B 1"E s. �vw► Z" 1 i(_s�� Z f>aIC SIGNATURE: ems` ems_ /a�j z�z— Buildin,&Commissioner/Inspector of Buildings Date 1 } 1.1 Property Address:" 1.2 Assessors Map and Parcel Number: Roo i`h,4rtr,irg .4e0ao( 34, Y6 0 106 A� Map Number Parml'NumbcK 1.3 Zoning Information: 1.4 Property Dimensions: v ,00ror-ti Z-101ler- a7a.d 5d �G••Zsa�r s� 3�/lP.c? > Zoninj District-- PrUse Lot Area Fronta eftrn 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Raluired Provided R red Provided rz� 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 zone Outside Flood Zone 0 Municipal On Site Disposal System ❑ 2.1 Owner of Record 31 Syf�on SrrPFf rint) Addressfor ce: 97 - 6$ 7- G R 0 M Si " Telephone orued 2.2 A Agent D Name Print A s for Service: Z 0 Signature Telephone z lj 3.1 Licensed Construction Supervisor Not Applicable Address License Number 0 Licensed Construction Supervisor: Expiration Date ic Signature Telephone r- 3.2 3.2 Registered Home Improvement Contractor Not Applicable ❑ . Aa n seam, 10 v Company Name.. Registration Number M �rw�56�rti2 0076 r ,ess r 78/ Expiration Date Z -tel-�97� 0 Signature Telephone as Owner/Authorized Agent Hereby declare that the statements and rmation on the regoing application are true and accurate, to the best of my knowledge an . Si me pains nd penalties of ped >°r/a //•-e LL oma, v 5 ��i'► cam.'.Jir- 5 i�'>A hR Pr- Print Name Signatih of Owner/Agent e Item Estimated Cost(Dollars)to be ( , Completed by permit applicant f 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical(HVAC) 5 Fire Protection oa 6 Total (1+2+3+4+5) Check Number r t a NO. OF STORIES ' SIZE BASEMENT OR SLAB rQ-fa 6 7 ea % r- SIZE OF FLOOR TINIBERS 1ST 2 No 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS y �--- DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS y� SIZE OF FOOTING _ /� x MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND y IS BUILDING CONNECTED TO NATURAL GAS LINE /O Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea.......0 No.......0 f SECTION:5 PR©]tai©1lT ,1fFSIG tO'COXIMC,nOKR'VI CON51�I3C�`IUN C+EIN��RfL�AA�TCI ESQ_CR 141#fv�t�I���O � Ii�b G� Oil EN��S�O S�'A 5.1 Registered Architect: Name: Address Signature Telephone S.Z Iii�be�d:�Prc►fessi�ai�� s� Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: r� Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Not Applicable 0 Company Name: Responsible in Charge of Construction New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ t Accessory Bldg. 0 Demolition 0 Other ?' Specify %0m,Giaraq /✓'a i'��r Brief Description of Proposed Work: Zoe-a /inI u Con 5frvc/1.0n - /-A pt -/raI"der g0rck -,A leXtz fl �a � yD� on a 9rAye/ ,�a� USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 0 A-2 0 A-3 0 1 ❑ A4 ❑ A-5 0 1 B 0 B Business 0 2A ❑ C Educational 0 2B ❑ F Factory 0 F-1 ❑ F-2 0 2C 0 H High Hazard ❑ 3A 0 IInstitutional 0 I-1 ❑ I-2 0 I-3 0 3B ❑ M Mercantile 0 4 0 R residential 0 R-1 ❑ R-2 0 R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility 0 Specify: {r» roe r /q e r- M Mixed Use 0 Specify: Special Use )k Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXLSTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels y 15, Floor Area per Floors ,V L/ Total Areas Total Height ft iY A ! A.1 /.5� t Independent Structural Engineering Structural Peer Review Required Yes D No SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date Location No. -? Date �'Z tORTol TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�CMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # /' Building Insp y TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING i OTHER THAN A ONE OR TWO FAMILY DWELLING .,.. fThis Section for Official Use Onl ,.;: ,� wy �. . BUILDING PERMIT NUMBER: Zw `L � DATE ISSUED: F('Rc� ►811.tds. F2vwl � T sem.C.- a 0 SIGNATURE: (4 Buildim CommissionedIa vedor of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: I , Map Number Parcel um 1.3 Zoning Information: 1.4 Property Dimensions: v "� �'� irrporan, /.-p.��r o�7a,�Sd �G•aSarrrs� 3 6.a q > Zonin Distnd Pr Use Lot Area ft Fro-ta e m 1.6 BUR DING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ y{yyy Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record CJ r 31 S rr e F a rint) Address for ce: 77 - 69s7- <- ;Z00 M Si ' Telephone N 2.2 A orized Agent Name Print A r s for Service: Z 0 Signature Telephone m 903.1 Licensed Construction Supervisor Not Applicable Address License Number 0 Licensed Construction Supervisor: Expiration Date Signature Telephoner 3.2 Registered Home Improvement Contractor Not Applicable 110 Company Name —_ Registration Number M /°O (90/1t' 671876 r Address r 78/- —�977 Expiration Date Z �� Signature Telephone G) as Owner/Authorized Agent Hereby declare that the statements and' rmation on the regoing application are true and accurate,to the best of my knowledge an Sign pains nd penalties of ped LL Print Name SignAre of Owner/Agent e S Q 1 1E 4 TEi3 #C"COST Item Estimated Cost(Dollars)to be MME US dNLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a) X(b) 4 Mechanical(HVAC) 5 Fire Protection raj 77/ 6 Total (1+2+3+4+5) Check Number NO.OF STORIES ' SIZE / O BASEMENT OR SLAB Gra vv et ire-fa 6 Troy % r SIZE OF FLOOR THvIBERS 1 2 ° 3 RD SPAN ��/4/9- DEMENSIONS OF SILLS DEMENSIONS OF POSTS y DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION y THICKNESS SIZE OF FOOTING _ X MATERIAL OF CHIMNEY A IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A/� sEIaN4c+o413+its C?LStPBTSATiO2 (7A . :L Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea.......❑ No.......❑ SEC')C'ION 5-PROFB»SSIONAL DgSIsx CONSMUCTION SERVICES FAM BU LMGS AND SI'RU S..5L116 'T:TO CONSTRUCTION CO�TROL PURSUANT T'O 780 COIR 1.16(,1CONTAVMG MORETAI ?35,010 GPFF 1Cl OMD 4A�6 5.1 Registered Architect: Name: Address Signature Telephone 5.2 Regi W med Pr 0*11anai E in�er(s) Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature ��y�,�y��.yTelephone Expiration Date „*vn& R .e .C L ty fio' Company Name: Not Applicable ❑ Responsible in Charge of Construction 400. (check all applicable New Construction ❑ Existing Building ❑ Repair(s) E Alterations(s) U Addition F1 Accessory Bldg. ❑ Demolition ❑ Other Specify 7-49m 4 o rat cy Fo a,'/t r Brief Description of Proposed Work: Zola /ihI A Con5l�rvG f,'oh - /A /;,C � -A"le-r ogA0,rok,-,,ww/r�.�j USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA ❑ A4 ❑ A-5 ❑ IB ❑ B Business ❑ 2A ❑ C Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ IInstitutional ❑ 1-1 ❑ I-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: >or» e-rA C rq er M Mixed Use ❑ Specify: S Special Use )k Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floors ,v y Total Areasf) Vigo Total Height(ft) Independent Structural Engineering Structural Peer Review Reqwred Yes ❑ No SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property Hereby authorize to act on My behalf,in all matters relative two work authorized by this building permit application Signature of Owner Date NURIM E D 1�-34 M;% NAL Town of - over TO . ........... CON �"�b OCH NICE , . dover, Mass., oerhesm- Z�ooZ, RATED S H � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT.................... ►...�� y..�a1!C�.............................................................. Foundation has permission ........... on °..ee... . .. ..... .... ...................... Rough to be occupied as..........................7M.NtII$ aY .OFF. 4r`r... el!4.4 ........................................ 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. A Vftitz4v apo ke% / At MQft*NWS 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 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. OCT 07 2002 17:31 FR GE CAPITAL MODULAR 781 396 0207 TO 19786826473 P.03 DATE(MIIrDDM A0411to. 3-6-02 PRODUCER THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATIO RIBEIRp/DESOUSA INS. AGENCY ONLY ANP CONFERS NO RIGHTS UPON THE CERTIFICAT MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND O 1 092 CAMBRIDGE STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV CAMBRIDGE. MA 02139 COMPANIES AFFORDING COVERAGE COMPANY A LIBERTY MUTUAL INSURED COMPANY J R TRANSPORT INC. B P.O. Box 163 COMPANY TEWKSBURY, MA 01876 COMPANY D ,�`_0_,1/EFIA_GES:':,,..:.•,t..-��-.�:. : ' . . . .z,,:` �.�;•'.�r`7':�,-•�:i�z't .• - •-.-�":-:`k`:.�:,e":is;�.._h-'��,`•: ,. �:-�Y••... .•. THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUOY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CoTYpE OP INSURANCE POLICYNUMBER Pouov EFFECTIVE POLICY EXAIRATION I LARiB LTR I DATE(MUMMY) I DATE(NuDDrM dENERAL LIABILITY ; BODILY INJURY OCC Is COMPREHENSIVE FORM III BODILY INJURY AGO i PREMI8ESJOPER4TIONS t PROPERTY DAMAGE 000 $ UNDERGROUND I PROPERTY DAMAGE AGO $ ExPL0310N 8 COLLAPSE HAZARD PRODUGT=OMPLET'1=D OPER 81&PD COMBINED OCC Is f CONTRACTUAL 81&PD COMBINED AGG Is INDEPENDENTCONTRAGT'ORS I t PERSONAL INJURY AGG S BROAD FORM PRDPERTY DAMAGE PERSONAL INJURY AUTOMOBILE UABOMY BODILY INJURY S I ANY AUTO (POr person) ALL OWNED AUTOS(PrMn PASS) I BODILY ED AUTOS ' ?ODLYIJURYD $ fA{OOWN men Prtvate Pesserptrr) I MIRED AUTOS ' PROPERTY DAMAGE I $ NON-OWNED AUTOS i I GARAGE LIABILITY I BODILY INJURY& _I I IPROPERIY DAMAGE ; COMBINED 77I EXCESS LIABILITY I i EACH OCCURRENCE $ UMBRELLA FORM I AGGREGATE Is I OTHER THAN UMBRELLA FORM I i S WORKERS COMPENSATION AND i I I !STATUTORY LIMITS EMPLOYERS•LIABILITY y-. WC 2—315—2 4 210 4—0 2 8 11 4/1102 4/1 /03 EACH ACCIDENT s 10 0 l THE PROPRIETOR! INCL I I DISEASE-POLICY LIMIT $ Q r O f 1 PARTNERSIEXECUTIVE OFFICER$AAE: EXCL i I DISEASE•EACH EMPLOYEE s jj j OTHER j I i I I DESCri,PT14N CF OPERAnoNS&OCAT*IWVENICLES*MaALREMS ChRTtFlCATE HOLDER- ''�'':":`�_.���:.=:�`:._•:;..:.r: •:'.;=•.. •t:`''•-."r ,.:r;,w< EiL-CATION:^.�?'.?�'�-u'. :;�':• �".,^_•,. .. ._. ... __.,... ... ,:-r,TS'-�.:;':•.i�`�,:,ir•:�,r"-�:�F^::5,l�: :t Yk;S�+r+h::•wt,ai s�._-•.... ,! . GE CAPITAL SHOULD ANY OF THE ABOVE DESCRIBED POUCH BE CANCELLM BEFORE TH EXPIRATION DATE THEREOF, IM 18SUING CoMpANY wrce. ENDEAVOR To MA 6 YORK AVE 10 DAYS WRITTEN NOSICE To THE CERTIFICATE HOLDER NAMED TO THE LEF RANDOLPH, MA 02368 BUT FAILURE TO MAIL SUCH NOTICE$HALL IMPOSE NO OBLIGATION OR UABILII OF ANY Ksp UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVE Mli'NQR ESEKTATIYE I v:ACORD 25-N(3793) - "T ' i> AC:DRC CORPORATION•I lYc_ :..�:.r ** TOTAL PAGE.03 ** OCT 07 2002 17:31 FR GE CAPITAL MODULAR 781 396 0207 TO 19786826473 P.02 C MMS Genl - MS Unit Specs Page 1 of 1 TIP/ModSpace Choose an Application: Applicatotts -. Unit Speefficafims Search Criteria Unit NO; 1.1.84376 �ri_at Main Specifications Unit Number. 184$76 Branch ID/Name: 041/BOSTON Class: DESS•DESIGNER:TINGLE UNIT Size. 44'x 12'x 8'(L x W x H) State Seats: MA CT VA DE MD NY RI WV Serial Number: 29822 Manufacturer Name: MKI-MARKLINE INDUSTRIES Year Built: 2000 Detail Specifications Building code: BOCA/NBC-OTHER--NJ-IBC;PA L&I COM; Occupancy Class: BUSINESS Usage: GENERAL USE Electrical Panel: 1101120V-220124OV-1 PHASE-OTHER--125 AMP MAIN HVAC Type: WALL/END MOUNT A/C Rating: 21/2 TON Heat: 15 KW Mfg.: EUBANK-MODEL#-W3QCF15SI FOOD-SERIAL#-OOH-P40159W Exterior Fini$h: T-1-11 PLYWOOD Exterior Color: GREY Interior Finish. VINYL COVERED GYPSUM Interior Color: GREY Floor Covering: CARPET-OTHER-GRAY Exterior Doors: STEEL-SINGLE FRENCH DOOR Locks Hardware: KEYED ENTRY--DEADSOLT-PANIC--OTHER-(2)-DOOR CLOSURES Windows: 24"X 53"VERTICAL SLIDER-OTHER-(B)-SELF STORING STORMS Window Frame: MILL-ALUMINUM Window Glazing: CLEAR Ceiling: T-GRID/DROP Roof. EOPM/RUBBER Lighting: DIFFUSED-4-RECESSED-INCANDESCENT-EXTERIOR UGHTSV2-OTHER-(2)-EMERGENCY EXITS W/BACK-UP Water heater. TANK-ELECTRIC-SIZE--6-GALLON Frame Type: OUTRIGGER Axles= #OF AXLES-3 Hitch Type: DETACHABLE-SCREW JACK Restroom: HANDICAP-�#TOILETS-I-BASINS-I-TOILET PAPER HOLDER-•1-•MIRROFZS 1 Built in furniture: COFFEE BAR W/SINK MiscJOptions: NONE Rating: ON AVERAGE Private offices: #OF OFFICES-1 Notes: Terms And Conditions/ Privacy Pplicy I Q 2002 Transport International Pool,Inc d/b/d/GE Capital Modular Space http://gein.tip.ge.com/servlet/Premier/MSUnitSpeesDisplay?UNo=184376 10/07/2002 LDesigner Series Buildings - Modular Space Solutions, Buildings &Modular Accessories Page 1 of 2 }fit Quick eai GE Capita!Modular Space home get a quote make a reservation equipment sales sitemap contact us our locations 1-801 �W Designer Series Buildings m Whether your need is for a standard mobile office for use on a construction site, a modular ' on-line supp building as a sales office, or a larger, custom modular complex to house your engineering return eguipr and design teams, GE Capital Modular Space has the right structure and range of services to meet your needs. equipment re Our wide range of designer series buildings combined with a nationwide service and support billing inguirif program will ensure your needs are met on time and on budget. And, by clicking on the button below,you can receive a quote on any of these units.GZIEW 'products&s -mobile office. designer seri Check out the specs on our: -modular built 12'.x 32' 12'x 44' 12'_x 56' 24'x 44' One(11 office model A One(1)office model B Two(2)Office Model Three(3)Office Model -dormitories 12'x 32'One Office Model A -MODULAIRE -wireless sect y -financial sere I project mans accessories • Private offices • Recessed,diffused fluorescent lighting market segn • Display Area • Vinyl trimmed windows education • French or storefront doors • Textured wood or metal siding • Carpeted floors or high quality vinyl flooring • Heating,ventilation and air conditioning system construction • 12'x 32' healthcare • Ideal for 2-4 people commercialA Back to too 12'x 44'One Office Model B <EJ ! :1 • Private offices • Recessed,diffused fluorescent lighting • Display Area • Vinyl trimmed windows • French or storefront doors • Textured wood or metal siding • Carpeted floors or high quality vinyl flooring • Heating,ventilation and air conditioning system • 12'x 44' • Ideal for 2-6people 13ack_t�toa> http://www.modspace.com/prod_sery/designer_floor.html 8/14/2002 Location Qz 3 No. Date 5 y NORT►, TOWN OF NORTH ANDOVER p� � o : 1h f 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ �ss�cNust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0 "' Building Inspector " TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: S SIGNATURE: Building c6mmiss'ioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 ZoningInformation:'-m � V 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. blood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT iS OrIC istrict: Yes No M 2.1 Owner of Record R"2 (��a .� erR, S Pt � -0 Name(Print) Address for Service: U. Signature Telephone 2.2 Owner of Record: c Nam4te Print Address for Service: M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name t Registration Number Addrass r Expiration Date P°A Signature Telephone Y/ SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: � 30 P► L SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)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 PERNUT I, as Owner/Authorized Agent of subject property I Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief (� G-rq x-10 PrArNft X v Signature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHWTEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a The Commonwealth of Massachusetts u r d Department of Industrial Accidents Office of Investigations �R Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: , 12 i 11A-( t*� Location: n j'►1 l _n f—I V F City AJ• /��-�qn— Phone # ct I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F-1 I am an employer providing workers' compensation for my employees working on this job. Company name be vvt t -IL 1cog C N C f2 i4 1. l n���' �t k%,CI G Address CitPhone �- CPS �09�� y �ate'� �a�� �. Insurance Co Policv# 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 Hrell_as_civil,penattiesin-the form ofa..STOP WORK_ORDER..and_a.fine.of.($1D0.OA).a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature--b Date Print name 'n t t, -+-r4 n; L44-/Z.A 64na Phone# R 'Tg �r Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required 0 Licensing Board r-1 Selectman's Office Contact person: Phone#: 1:1 Health Department F1 Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance wit he provision of MGL c 40 S 54, a condition of Building Permit Number 6 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11 , S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Dimitrios General Contracting 91 High Street Lawrence,MA 01841 1 (978)685-7573 (978)618-8085 MA Contractor Registration ID: 136105 May 3 2004 Proposal To: For work to be performed: Fabio Spino Same 23 Mifflin Drive North Andover, MA Home(978) 688-5452 Cell (617)513-3232 We hereby propose to furnish materials and labor for the completion for the following work. Specifications • 24 squares of roof will be stripped. • Roof will be prepared with 3 feet of ice and water shield on eves and vallies. • 30 pound felt paper will be applied to remaining roof. • 8" aluminum white dripedge will be installed • 35 year Organic Architectural IKO shingles will be installed. • Roof ridge vent will be installed. Contractor will dispose of all debris. Customer is responsible for protecting any items in the attic from fallen dust and debris as roof is stripped. If chimney's flashing needs to be replaced it will cost'an extra $400 that is not included in this contract. This contract is based on a two layer roof. If there are any additional layers, there will be a charge of$40 per square per layer. If roof deck needs to be prepared with plywood it will cost an additional $45 per sheet of plywood. This is not included in the original contract price. Fabio Spino Roof.doc Page 1 of 2 Dimitrios General Contracting 91 High Street Lawrence,MA 01841 1 (978)685-7573 (978)618-8085 All material is guaranteed to be as specified. All workmanship is guaranteed to be for a period of 5 years from date of completion. All work areas are to be kept clean by contractor. All insurances are to be carried by contractor. Contractor is responsible for obtaining necessary permits. Cost of all materials and labor is $ 8,500. $500 is due upon signed contract. $4,000 is due upon starting. Balance is due upon completion of the roof Respectfully Submitted, Dimitrios Karagiorgos Ct� L/&�6 t) Acceptance of Proposal The above prices, specifications, and conditions are satisfactory and are accepted. Dimitrios General Contracting is authorized to do work as specified. Payment terms are accepted and will be made as outlined above. C--., --X, Signature Date S Customer /4 Signature Date r Dimitrios General Contracting Fabio Spino Roof.doc Page 2 of 2 NOR0 _n�.... TFy Tomm Of 6. Aindover No. 4S8 - :Y- 10 dover, Mass., tr" S%"e2 m a OLAKE 'A COC MICKEwICK RAT E O 'P"'? 1 L1 ` BOARD OF HEALTH PERMIT T D ' Food/Kitchen Septic System J BUILDING INSPECTOR THIS CERTIFIES THAT . ..... ...... I ...... �ti.. . ...... . .... .... ! ...... ......`...... ....... . .. isp �j......�f ......... ................. .. Foundation has permission to erect....5,4..91.................... buildings on .................................... . ............................................. Rough It's t,V 4W C R ~ &t4m Q to Chimney tobe occupied as........................................................................................................................................................................ y 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-LZN0 relating to the Inspec on, Alteration and Construction of Buildings in the Town of North Andover. a / 914) a PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR TS Rough e4Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathingor D Wall To Be Done � FIRE DEPARTMENT Until inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Dec. Date. .). . ./ . . . . . `! Of joRToj 4,, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i SS, us This certifies that . . . . . .'. . . . . . . . . . . . . .. . . . . . . . . . :e. . . . . . . . has permission to perform . . . .r. . . . . . . . . .! . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee. . . . .1. . . .Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . i . . . . . . . . . PLUMBING INSPECTOR Check Jiu a MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS r ' a j� d q Date Building Location .�t ( °1 �r Owners Nam ,.Sj�✓� 6' Permit# S—? O Amount Type of Occupancy New Renovation Replacement1:1 Plans Submitted Yes No FIXTURES F C. W W tx M1y R&SEWiT BE HDM 1 210 FLOCR 3M FIAOCIt 41H HAOCR } 5M HDCR 61H FIDC7R 71H FLOOR 81H FIOM (Print or type) p/ Check one: Certificate Installing Company Name Ki I., / /V�"+�/'► ElCorp. Address 13 W U-r -C L=J -�"ner. a 01243 Business Telephone Lit A r ff Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the t f 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 three insurance 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 installation�Iumb* C Is or 's application will be in compliance with all pertinent provisions of the Massachusetts Stapt of the General Laws. By: Sig—nature or Lacenseaumer Type of Plumbing License Title City/Town ice e um er Master Journeyman ❑ APPROVED(OFFICE USE ONLY m /I Date..O:= 0 TOWN OF NORTH ANDOVER 0 •4 infAft. 1 PERMIT FOR WIRING Ss�CHU This certifies that .... ........... ....... ...................... permission to perform /..has ...... of,....... ... ........... ............................ wiring La the building of...... . ........... ....................... at................: ........ 'n...... .. 1).......................................,North Andoyq,,-Mass. -7 - Fee. ./.........v. Lic.No,/-...zz�. .......... ...................... ELECTRICAL INSPECTOR Check # Official Use Only Permit No. vo-m"a 4;V001,sem, tr Occupancy&Fee Checked, i BOARD OF FIRE PREVENTION RE ULAT,IONS 527 CMR 12:00 APPLICATION FOR PERMIT PERFORM ELECTRICAL WORK All work to be performed in accordance with t e assachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date Z Z To the inspec or of i"ire's': Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number 9 Owner or Tenant 5-74f /y U Owner's Address i'� 91, Is this permit in conjunction with a building permitYes 0 No 0 (Check Appropriate Box) Purpose of Building G a Utility Authorization No. Existing Service Amps Voits Overhead 0 Undgmd 0 No.of Meters f New Ser,'?e Amps Voits Overhead 0 Undgmd 0 No.of Meters Number o J Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fires 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 FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposai No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained No.of Dishwashers SpacelArea Heating KW Detection/Sounding Devices 9 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bai►ases 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 including Completed Operations Coverage or its substantial equivalent YES=NO h valid proof of same to the Office YES= NO u ha v ch ked Y//ES plea indicate the type of ge b checking the appropriate box. INSURANCE BOND - OTHER - (Please Specify) `�1 7 GfiL S 141S 7 0 (E Estimated Value of_EI ctrical Work$ ✓ C/ r dC/ xpirationate) Work toStart 241 Z Inspection Date Resquested Rough Ll Final Signed under the Pe atties f AerJury: FIRM NAME o 1`� /1 L LIC.NO. L't- �y--� (�/ r/ Licensee � G of A-, � Signature G / LIC.NO. y) / - / us.Tel No. Address Gt �� �/t�/l- �� X156 5 Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that th6 Licenses does not h ve the insurance coverage or its substantial equivalent as required:yS�us, General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ s (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone 0 am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance Co. 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 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. /do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' Ej Building Dept ❑Check if immediate response is required Building Dept p Licensing Board E] Selectman's Off/ce Contact person: Phone#: Health Department Other FORM WORKMAN'S COMPENSATION Location s No. '� ��i Date U c U 3 NuoT, 41 TOWN OF NORTH ANDOVER 9 + ; , Certificate of Occupancy $ �' b'•^°''�� Building/Frame/Frame Permit Fee $ 3 U cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ U R Check # 0� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: 3 —a03 X SIGNATURE: !% Building Commissioner/I or of Buildings Date z SECTION 1-SITE INFORMATION o 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 23 P1,'-r.�``h 02 ' Map Number Parcel Number W 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No rn 2.1 Owner of Record gid,,, �, o s ree,-& Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: rn Si at re Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address _' Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number ra Address r z Expiration Date Signature Telephone Y, SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all appUcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other )• Specify_ EA e c/ g XfY Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)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 10 :/•�,"ay _,as Owner/Authorized Agent of subject property IV Hereby authorize to act on My behalf,in all matters relative to work authorized by this building pen-nit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM r z� `CA R INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fron Boards and Departments having jurisdiction have been obtained. This does not relievE the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION******.*** ** * ** * APPLICANT Q AbID PI N PHONE LOCATION: Assessor's Map Number PARCEL—q-?— SUBDIVISION ARCELSUBDIVISION �1� LOT(S) STREET 11 t �''t A, � R ST. NUMBER. ` 3 ** *************"""OFFICIAL USE ONLY RECO ENDATIONS OFT WN AGENTS: CON RVATION ADM NI TOR DATE APPROVED oZ O DATE REJECTED COMMENTS s� TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT -IRE DEPARTMENT ECEIVED BY BUILDING INSPECTOR DATE wised 9197 jm -- MAY-21-01 08 : 13 AM E K SURVEY 9784697046 P. 01JL41V JL TI^E K SURVEY INC 4 HAVERHILL,MA 4 Phone 978-4641985+ Fax 978-4&7046 MORTGAGOR W � DEED REF,,ES$ F PRINCIPLE ©UILDING PG. —y-V2 PIAN REF. 4 — OOF INSPECTION-62M vitt, n SCALE: E: 1"=fat J7 �T s Srof2�( ' aga d r f i'�IFfLt� �I'U� c T `.� RUDEL CERTIFICATION TO: Na �� �^ This Mor19age,Plot Plan was prepared specifically for o " The location of me principle structure/s 44 to be'a pr purposes only and itis not is plan intended softo represented '"Jf�o�Gi$t EFl S��iWtth the local zoning ws in effect when constructed to be'a property Ilno or land survey.This plan Is not to be used M to establish any of the proporty lines for an !.Alio and/or is exempt from violation enforcemnent respdnsibiltly Is extended to the land owner or occcupant. action under Maas B.L. Title VII,Chap, 40A. Sec, 7 This certlflcation is based on the location of survey marker is Subject building is not In a Flood Hazard Area. of otY Qrs, © Subject building is in a Flood Hazard Area. Flood Hazard determined from the FIRM map# Gated ' VO'R rLf O Town of North Andover * � Building Department 27 Charles Street �SsacmusEj North Andover MA 01845 Tel: 978-688=9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE J5 2 15` 3 JOB LOCATION -2 3 1 t '1' f- li n v /t - A„,Pf'a Ye o- Number Street Address Section "HOMEOWNER _ i78--dkk G /go Number �+ Home Phone Work PRESENT MAILING ADDRESS .2-3 /1/t,'�fi�, h !/r ,fr/oi'1Z 417Z, 1/er M.4 �71��K City Town State Zip C1 The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one to six family dwelling,attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. Location •� �''` -�-{�L �, ` No. %f DateOf NORTH TOWN OF NORTH ANDOVER O a � Certificate of Occupancy $ J�CNUsE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # i Building Inspector�'� .�j TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r. PIIV BUILDING PERMIT NUMBER. DATE ISSUED: a _ , /�-b X 7 3_ SIGNATURE: Building Commissioner/InfiWor of Buildings Date Z SECTION 1-SITE INFORMATION. . O 1-1 Property Address: 1.2 Assessois Map and Parcel Number: 23 X11 t.�jr r � r } " _ r a�- 00,32 Aftloir O 1 6 tl j^ Map Number Parcel Nurpber 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use Lot Area Frontage(ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required _-4— Provided Required Provided 1.7 Water Supply M.CLL.C.40. 54) 1.5. Flood Zone Information: 1.8' Sewerage Disposal System: Public 0 Private 0 zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SYCTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M ' 4 2.1 Owner of Record j () E13 b 'a SSPi"�y o 1�J Name(Print) Address for Service: ' Y Signature Telep$oite' 2.2 Owner of Record: O Name Print Address for Service: Z M Si nature Tel hone go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ S4::Lue-n S)DC)VVI �S �� �t-� oc� Licensed Construction Supervisor: a License Number .n S MCS+ 5�. T�©S�=i�j� , MAo ci £sem Address /e^7 G, 'LD f zoo'-� I 73 _ L �j 1� Z Expiration Date 1 Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 CaSe- 3 G, 3 31 g Company Name p M S Mesio St - -To Ps �i�1 d � J(NA/1 0� �d3 Registration Number r r Address 0 Daro• 2 Expiration lI DaZV Z Date V Z Si nature Tel hone e SECTION 4-WORKERS COMPENSATION(KG.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......A No.......❑ SECTIONS Description of Proposed Workcheekau a cable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Ar Addition ❑ Accessory Bldg. ❑ Demolition ❑' Other ❑ Specify Brief Description of Proposed Work: ;rstnir t +T rcouto The S 01%4 Kate 4''F a�'X t i 1�t�►� G a o�M . W b 1�1 1- M .t [� +ng !pLatc AepiorJet. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICULUSIONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical got (b) Estimated Total Cost of Construction 3 Plumbing 0 Building Permit fee(a)x(b) 4 Mechanical HVAC j J 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUT HORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, S � {Q xN 1a 166 Pn + as Owner/Authorized Agent of subject property Hereby authorize C L �•�'I�yM/►s..a��J lCe! /r73 �+ I IV o'`%act on M�be If,m all matters relative to work authorized by this buil g permit applic�o Signature of Owner Dat 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 Print Name Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS iST 2ND 3 PLD SPAN DINIENSIONS OF SILLS DM ENSIONS OF POSTS DB ENSIONS 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 0 TH own of Andover "k . 0 V" No. * 0 dover, Mass., 14n� 0 �-OC LAKE HICHEWICK % 0RATED IT BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 45#Vj AO lb BUILDING INSPECTOR THIS CERTIFIES THAT........ .. 4.&"'D............. ............................................................... ...... ..... ................ Foundation has permission to erect.....914 1"0.64+1buildings on ..!qP.14......0404100m.Aj > a .... ..... ................ Rough to be occupied as.............. ......... I a%doWIC 40* Chimney ............ ..... .... . ......................... - provided that the person accepting this permit shall in every respect conform to the-term.s.o.f.-the.application on-o-n file in Final this office, and to the provisions of the Codes and By-La relating to the Ins n, Alteration and Construction of Buildings in the Town of North Andover. 73-12 PLUMBING INSPECTOR 1 C/ VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERYLIT EXPMES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARCTS Rough ..... .... ..................C� ............ ............ ........... Service BUILDING iN��i&6ii 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers'Compensation Insurance Affidavit Please Print Name: Location: city Phone 0 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing.workers'compensation for my employees working on this job. Comaanv name: n Cal ('V! 1 � kx �--- J Address S�5 M r��•� S � Cites Phone Insurance Co. -tip �� Cis VG I "Yl a i/L Poligy# �3 x 1 Lh �r Comony name: Address Ci Phone#' insurance Co..— Policv# Faikwe to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of c rininal penalties of a fine up to$1,500.00 and/or one years'imprisonment as welt as c M perk-dies in the form of a STOP W M 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 verfication. I do herby certify under the pains and penalties of perjury that the information provided above is&W and Correa Signature S Date 2.1-410V Print name 54 O M Phone# I � p t �► 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 p Licensing Board p Selectman's Office Contact person: Phone# 0 Health Department 0 Other FORM WORKMAN'S COMPENSATION 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 Numberis that the debris resulting from this work shall-be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: MC C(r-r Location of Facility) Signature of Permit Applicant z3 a Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 1 G i 9k 6. a�✓ ac`iu4ea BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR R Number: CS 080737 Birthdate: 11/03/1971 s Expires: 11/03/2005 Tr.no: 80737 a i Restricted: 00 JAMES M DAROCNA 207 LOWELL ST APT#1 ' SOMERVILLE, MA 02144 Administrator } Spino Residence 23 Mifflin Drive N. Andover, MA. 01845 5-T- h L _ Pull & Replace a Existing Bath CD /.;.N CONTRACT �00 CASE HANDYMAN SERVICES L • J PROJECT NAME: Case Mr.Fabio Spino Date: 11-23-03 --- Handyman® 23 Mifflin Drive N.Andover,MA 01845 Seances Consultant: Steven Bloom 978-688-5452(H) We hereby propose to perform remodeling and/or repair work upon the above mentioned premises per the following description, scope, allowances, exclusions and general conditions. GENERAL NOTES: The homeowner is responsible for moving all valuables and breakables from the project area prior to the start of work. We assume all pre-existing conditions to be sound,any additional damage that is found will be addressed on a time and material basis. Homeowner to make plans for house pets that may be affected by the project. Building permit is included. Provide dust doors and runners as necessary to protect area. Provide entry/exit tack mats at demolition and entry areas. Area of construction to be broom cleaned at the end of each days work. All job site debris to be hauled away at the completion of work,and the construction area to be left in a vacuum cleaned condition. �,. 1.) BATHROOM REMODEL: Remodel existing bathroom per plans. DEMOLITION AND ROUGH CARPENTRY - Provide site and dust protection as practical. - Remove and save bathroom door for later reuse. - Remove existing walls, vanity cabinet, vanity top,toilet, and tub with surround, accessories, tile walls, ceiling and tile floor. • - Install Durorock substrate at shower surround and floor ** We assume existing walls contain no pipes or ducts. • MECHANICAL - Re-rough-in plumbing,to code, per plans. p i 4 11�y 0'} - Install electric,to code,per plans. — %-J 2.4tomej �+ - Furnish and install Panasonic low sone fan vented to exterior. ** No work has been included to upgrade existing plumbing service, electric service or H.V.A.C. systems. INSTALLATION AND FINISH WORK - Finish walls and ceiling with 1/2" blue board slick finished. - Install pedestal sink and faucet selected by owner, per allowance. - Install new toilet selected by owner,per allowance. - Install new tub and faucet selected by owner,per allowance. - Install new ceramic shower surround selected by owner,per allowance. - Install new ceramic floor with wood baseboard selected by owner,per allowance. - Install Robern medicine cabinet selected by owner,per allowance. - Install trim; all trim to be 1-piece,paint-grade to match existing. - All paint work to be one coat of primer and one coat of finish Benjamin Moore latex paint or equal, color selected by owner. 58.Main Street Topsfield,MA.01983 Ph.978-213-9929 Fax.978-887-3308 CONTRACT . CASE HANDYMAN SERVICES L J PROJECT NAME: Case Mr.Fabio Spino Date: 11-23-03 Handyman® 23 Mifflin Drive N.Andover,MA 01845 Services Consultant: Steven Bloom 978-688-5452(H) The following allowances are included: Area 1: TOILET,ALLOWANCE, (Provided By Case): Mat. $250.00 Area 1: TUB,ALLOWANCE, (Provided By Case). Mat. $450.00 Area 1: TUB FAUCET, ALLOWANCE, (Provided By Case). Mat. $200.00 Area 1: LAVY FAUCET,ALLOWANCE, (Provided By Case). Mat. $150.00 Area 1: PEDESTAL SINK, ALLOWANCE, (Provided By Case). Mat. $250.00 Area 1: MEDICINE CABINET,ALLOWANCE, (Provided By Case). Mat. $250.00 Area 1: CERAMIC TILE, ALLOWANCE, (Provided By Case). Mat. $300.00 1�Afi� �CCf SS + 1 Oa VL The lump sum bid price of this project as described above Seventeen Thousand Eftht Hundred and Fifteen Dollars. PAYMENT will be made as follows: 1. $5,938.00 upon signing 2. $5$38.00 upon start a1L O I t'Ly, O 3 3. $1,979.00 at start of sheetrock work 4. $1,979.00 at start of ceramic tile 5.$1,981.00 net upon completion. Construction Supervisor Number:CS-074109 Expiration Date: 4/20/04 Home Improvement Registration Number: 136331 Expiration Date: 7/16/04 ACCEPTANCE: The above prices,specifications,conditions,and`Terms and Conditions' on the attached sheets are hereby accepted. You are authorized to perform the work specified. Please refer to General Conditions on back of contract. You have the right to rescind this Contract within three days of signing. Do not sign this contract if there are any blank spaces. 0/2` p < Z -v/1 3 Steven Bloom,President DatW Owner Date 58 Main Street Topsfield,MA.01983 Ph.978-213-9929 Fax.978-887-3308 NORTH Town ofAndover No. oover Mass. /40 .3 4 070 O %p ADRATED 7 S H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... ................. ... ............ . Foundation has permission to erect...8..... ..8.............. buildings on... .3....... ., ...... ..R.�.V. .. Rough to be occupied as...S4.wr. ... �C....... ...............1 N......r%* ..r � ..... .A.k.4.......................... Chimney provided that the person acceptinthis 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 Ins ection, Alteration and Construction of Buildings in the Town of North Andover. a 1 /39 3000- 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 , ..... .......... , 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. I� Location r- No. Date -C� n ~© f MaRT� TOWN OF NORTH ANDOVER � A + Certificate of Occupancy $ ��a .•�� Building/Frame Permit Fee $ s�CH Foundation Permit Fee $ Other Permit Fee $ TOTAL $ L4"o 0 Check # (K, Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a. BUILDING PERMIT NUMBER. ` DATE ISSUED: l SIGNATURE: Building C616missioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 3 cl <:9-3 )11 l j r I A-) Map Map Number Parcel Number I"i 1. 1.3 Zoning Information: 1.4 Properly Dimensions: Zoning Dia6c_t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided -Required Provided 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT iS orlc (Strict: Yes Np rn 2.1 Owner of Record rA 6 lo CAiNv Z M � T��1L1 Q��r• y � �'1 Name(Print Address for Service. n Signature Telephone —,t 2.2 Qwner of Record: Name Print Address for Service: 0 z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: /� License Number 10A I "{`1/l CK r�EIyEfLf4 �/y�'«RC"t'//�� M Xddress 1 9 1 ' 4 , 34 CJQ--��AJ(2 Expiration Date ic Signature Telephone r V_L,11� q*z 1 zzoz kf-kegistered Home Improvement Contractor Not Applicable ❑ a Company Name m Registration Number ro Address Z Expiration Date /1 Signature Telephone to 0 ' V 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. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) . ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: /� r � " t/ j k ly I " 6t&"--N Lcg- ne a _ k rP-JF OW\ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) 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 1, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. / 2; /-d2 r Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION s 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Prin e signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS i 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 31 Dimitrios General Contracting 91 High Street Lawrence,MA 01841 1 (978)685-7573 (978)618-8085 MA Contractor Registration ID: 136105 May 20,2004 Proposal To: For work to be performed: Fabio Spino Same 23 Mifflin Drive North Andover,MA Home(978)688-5452 Cell (617)513-3232 We hereby propose to furnish materials and labor for the completion for the following work. Specifications Siding • Existing siding will be stripped. • Tyvek wrap and %2" Styrofoam will be installed on whole house . • Trims will be covered with softfit and aluminum. • 5"Fluted corners will be used for outside corners. • Vinyl siding will be installed. Customer will choose color of siding. Windows • 6 basement windows will be replaced with vinyl sliding windows. • Bay window will be replaced with window will be stationary glass. 1-)ew '141aersen lVek) 6,q S' c c • Two single casement windows will be replaced in kitchen. /�•,�{rsa-7 • Garagedoor will be replaced with a new ah#ain=white door. p tel. Front porch • Front entrance way stairs will be removed and new stairs with platform will be built using pressure treated frame and mahogany finish for decking. • 1X6 tongue and groove pine will be used for ceilings for overhang • Two posts will be installed with railings to complete stairs and platform. Contractor will dispose of all debris�� Fabio Spino Siding.doc Page 1 of 2 e � Dimitrios General Contracting 91 High Street Lawrence,MA 01841 1 (978)685-7573 (978)618-8085 All material is guaranteed to be as specified. All workmanship is guaranteed to be for a period of 5 years from date of completion. All work areas are to be kept clean by contractor. All insurances are to be carried by contractor. Contractor is responsible for obtaining necessary permits. Cost of all materials and labor is $19,000. $4,000 is due upon signed contract. $S,000 is due upon starting. Remaining payments will be made as work progresses. Respectfully Submitted, Dimitrios Karagiorgos Acceptance of Proposal The above prices, specifications, and conditions are satisfactory and are accepted. Dimitrios General Contracting is authorized to do work as specified. Payment terms are accepted and will be made as outlined above. Signature 2 Date Customer Signature Date Dimitrios General Contracting Fabio Spino Siding.doc Page 2 of 2 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 c 11, S 150 A. The debris will be disposed of in: (Location of 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 v t Baan!I)f B;i!tiit-.F;Remei zs�n,; .nd pie~.la'rds NOME IMPR&Epm:-:4li=:ONTF!A ''- , R *rubor%: 1?h105 t 3 C b5� &I ore,1 i . TR1()S GENERAL ryOial7`3w' w 7 ATRIOS KARAGit OOS ` 90 Gi?i ST. 1AVlF1 EN( ,MA 418&31 Adr-1,3;,traTor'.." License or registration valid for individul use only before the expiration date. If found return to: . Board of Building Regulations and Standards " One Ashburton Place Rm 1301 Boston.Ma.02108 1!'ot valid without signature NORTH ® of aAndover No. 7/9 - LAKE O dover, Mass., ��� COCMICMEWICK 'QA \� 0/?ATED S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR a�bi a S PI A0 CERTIFIES THAT /� � ...... ..........................................................................................//..11.................................... ................ Foundation has permission to erect.....VA.M.4..1............ b ildings on ...Q..3.....Im..I..1 /N: .,��Lj£ Rough to be occupied as...... .�.. �ningt ...... v ........ rf��!r�. �a..........� ... n y e provided that the person acceptis 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 B -Laws relating to the Inspection, Alteration and Construction of Buildings,in the Town of North Andover. RIP I��ACI MOW* wtti0n�� � �wK 100 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. dvoomom Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR TS Rough ............. .................................. ., 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 FIRE DEPARTMENT Until Inspected and-,,Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. a The Commonwealth of Massachusetts - u r d Department of Industrial Accidents Office of Investigations a Boston, Mass. 02111 �°,o,�, 5�ay�� Workers'Compensation Insurance Affidavit Name Please Print S Name: n i R, f �, rc� � Location: 2 /►� i ��� r�t� �"�'�Af City_N_ 610 f Z�f2— Phone # t� b I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. r Company name: E Address 1 1 "� t,J Ci!Y: Phone Insurance Co. T Le wt if Cdr�� y C b b. Policy fn �1 Company name: Address Citi Phone#: 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$1,50700 and/or one years'imprisonment-as-well-as-civil.,penalties in Jhe formof-a_STOP WORK_ORDFR..and.a fine_of_(.$100.00.)_abay against-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone#�� �o Q _ Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate response is required ❑ licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other