HomeMy WebLinkAboutMiscellaneous - 243 HICKORY HILL ROAD 4/30/2018l
Date, ......
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6 TOW NORTH ANDOVER
0
• PERMI(TFOR GAS INSTALLATION
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This certifies that .. ��. :T . .'-" . 1�t� f� t, ...... ...............
has permission for gas installation
in the buildings of .... ......................
at North Andover, Mass.
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FeA.?��.... Lic. No.. . .... Aj /�� .......
GASINSPECTOR
Check # 31
5854
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MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations a y 3 IV l `C k6f,4-::� l�/
Date /2—/240 (�
Permit #
Amount $
Owner's Name C6 UX�C S- . -f --e ("t-1
New D Renovation Replacement 0 Plans Submitted
(Print or type)
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Check one: Certificate Installing Company
Name /
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Corp.
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Partner.
Business Telephone
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[3-Firm/Co.
Name of Licensed Plumber
or Gas Fitter ►
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20.
SUB-BASEM ENT
BASEM ENT
IST. FLOOR
2ND. FLOGR
3RD. FLOOR
4 T H. F L O O R
5TH. FLOOR
6T Ii. FLOG R
7TH. FLOOR
-8T H. F L O O R
(Print or type)
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Check one: Certificate Installing Company
Name /
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Corp.
Address S� a jt
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Partner.
Business Telephone
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[3-Firm/Co.
Name of Licensed Plumber
or Gas Fitter ►
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INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Ov-- No O
If you have checked Les, please indicate the type coverage by checking the appropriate box. 13
Liability insurance policy 0' Other type of indemnity 13 Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 13 Agent
I hereby certity that all ofthe details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massach=tate Q3ts Code and Chapter 142 91the Gey/ral Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed `dumber Or Gas Fitter
Plumber 0 3 Z
Gas FitterIcense um er
Taster
❑ Journeyman
N2 2902 Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... R..Ob:tEt ...... c --.. .................
has permission to perform ......... &c(. ...............................
wiring in the building of .... C
.......... .......... .......................
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........ ....... � ...... ort
h dover
at ........ A../ ....
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Fee.. .........
/ ................. Lic. No. ........ . .............
ilLECTRI& NS;E&rdk
Checr"
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
TDEOOM41'OAffE11.THOFMAYS4Ch'US i TV O ce Use only
' DEPARTItflM'OFPUBLICSAFETY "
Permit No.
BOARD OFFIREPREVHVIONREGUTATIONS 527CMR 120
Occupancy &Fees Checked
APPUCATION FOR PEP"F TO PE ?FORM ELECTr4CAL WORK
( ALL WORK TO BE PERFORMED IN ACCORDANCE INITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 I
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date '
Town of North Andover To the Inspector of Wires:
The undersigned applies or a permit to perform the electrical work describ below.
Location (Street & Number) 6 (C 1. I � t
Owner or Tenant j-rBv 9- ab O�Vinf, CD G. e t
c C
Owner's Address , LJH tC r4f Y �_� t /
Is this permit in conjunction with a building permit: Yes r" No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
E;cisting Service Amps /a volts Overhead O Underground 1 No. of Meters 7
New Service Amps / Volts Overhead [:3 Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures/
Swinuning Pool Above
Below
Generators
KVA,
and
ground
F No. of Receptacle Outlets
c7
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges }
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Wtiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
ED
Other
No. of Dryers
Heating Devices KW
Connections
"No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
/A/ 1
OTHER vy r %e r CiJe%%2 e�'L
Ir>St==Comr Laws
Ihawaa utLmbtk'ybsum=PbfxymdudmgCm#,& CovaagaAsabslar>ba o4wakyt YES En NO
IhawRhnftdvalidptoofofsa<netutlrOff E YES n NO IfjtuhavediedcedYFSpimeadc*thetWofe wrWbyd,3imIgthe
IN NCE BOND OniER a (PleaseSpedy) r Z be U fillIfD
workiDSart ' �c7 —0 1 hmpec6mD*RegxsW Estirr dvah�ecfFlr tticalwork $
FIRM NAMEFid
I�talhesaFpegtay et -Leif L LioenseNa C ZA Lir
Licc z k Ober+-y11lG Vlc-- s,_
Lioa>SeNo ,[ qR 7r
BrsirmTel.Na SCd$
AkTeI
OWNER'SINSURANCEWANE[t,lamawaredxtftLioamedioes�theirtstaaneea orAssr ir>balegtrivalatasrt3cpmtdby)V set>sCanalLaws
artdthatmyseonthis p�app6c�onwai�sthis regt�rxst.
(Please check one) Owner ® Agent El
Telephone No. PERMIT FEE $
P / /
i
(Location r_; /�-�'•� �%�. ,%�.
Date
NORTH
TOWN OF NORTH ANDOVER
? + 1 • ow
� a
Certificate
of Occupancy $
�,SJACNUStt�
.i��
Building/Frame Permit Fee $ �
/
Foundation Permit Fee $
Other Permit Fee $
TOTAL
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Check #14517
1
,y -Building Inspecf4D
i
TOWN OE NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
This Section for oincid use 50T77
BUILDING PERMIT NUMBER: ISIS—
DATE ISSUED: e () co
SIGNATURE:
Building Commissioner/I for of Buildings Date
SECTION I- SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Fronts ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required I Provide Required IProvided Required Provided
1.7 Water Supply M.G.L.C.40. `§ 34) 1.5. Flood Zone Information: / 1.8 Sew Disposal System:
Public .0 Private 0 Pone Outside Flood Z.. �B' Municipal On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
S�1�V-A
e �loHNI�E �aoi�f2S�Erf� Z�� �7"�`c��£Rtf
Name (Print) Address for Service:
Signature
2.2 Owner of Record:
Name Print
- /n? 2 --
Address
Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
JLS.NI,Ett S. VEeo
,[Licensed Construction Supervisor:
J
TT 69J E
Address
N. 14" u z11
Signa Telephone
L
3.2 Registered Home Improvement Contractor
On14atILUG+I,z1,,j
Company Name �/
2 R 1 ILM i Tr l4 tl 6 -
Address
Address /1
PIP
BUILD
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Not Applicable ❑
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License Number
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Expiration Date
0
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Not Applicable ❑
ia'33 g 3
Registration Number
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Expiration Date
F %
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 atlidavit will result
in the denial of the issuance of the buildin permit.
Signed atlidavit Attached Yes ...... No ....... 0
SECTION 5 Descri tion of Proposed Work check all a licabte 0 Alterations(s) Addition ❑
New Construction 0 Existing Building ❑ Repair(s)
Accessory Bldg. 0 Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
E✓Y14 14-
t2 c �► 3b ��
SECTION 6 - ESTIMATED CONSTRUCTION COSTS OFFICIAL USE ONLY
Item Estimated Cost (Dollar) to be 6
Completed by pengit a licant
1. Building eo wgi
rmit Fee
� � otal Cost of2 Electrical ont fee (a) x (b) n
3 Plumbin
4 Mechanical (HVAC
5 Fire Protection Check Number
6 Total (1+2+3+4+5)
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
al , as Owner/Authorized Agent of subject property
to act on F
{j Hereby authorize
^o
MN- behalf- in all matters relative to work authorized by this building permit application.
Date f
natASECTJCi
AUTHORIZED AGENT DECLARATION
1, 1� 4 1l1 rill E � i. t3 ���'
,aspu:c/Authorized Agent of subject
._ property application are true and accurate, to the best of my knowledge
Hereby declare that the statements and information on ,foregoing
and belief
t C�
Print Na •Z
Si of (,lwNcr/A ent
Date
SIZE
NO. OF STORIL•'S
BASEMENT OR SLAB Isr 2 3
SIZE OF FL(>UR TIMBERS
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS 11IICI(NESS
l ll:I(it I'l' (x FOUNDATION X
SIlE OF FOOTING
MAtERIAL OF CI -"EY
IS IMILDINC, ON SOLID OR FILLED LAND
IS IMILDING CONNECTED TO NATURAL GAS LM-,
KEEN CONSTRUCTION CO.
21 HEWITT AVE.
N. ANDOVER,'MA 01845
(978) 691-5201
Cooperstein, Joanne & Steve
243 Hickory Hill Rd.
N. Andover, MA 01845
(978)682-4639
Contract # 1506, Appendix A Date: 01/30/01
Remodel Basement:
• Frame, insulate & sheetrock walls creating approx. 500 sq. ft. of finished area
• Tape & seam walls
Create closet under stairs
• Create closet at end of room
• Upgrade handrail to match upstairs (C6010 -oak) (1 side only)
• Install one 2.6 x 6.6 smooth hollow core masonite door to laundry area
• Install one 2.0 x 6.6 smooth hollow core masonite door to sprinkler control area
• Install one 2.6 x 6.6 smooth hollow core masonite door to closet under stairs
• Install one 5.0 x 6.6 unit pair smooth hollow core masonite door unit to new closet at end of room
• Install 2' x 2' revealed edge suspended ceiling as high as possible
• Replace back window with vinyl window (hopper type)
• Install carpet throughout finished area and stairs ($1170.00 installed allowance)
• Install ceramic the at entrance from garage ($120.00 material allowance)
• Install trim on doors to match upstairs (all paint grade)
• Paint walls and trim (2 coat finish, 2 neutral colors)
Electrical:
• Install 16 recessed light fixtures in ceiling (switched on dimmers)
• Install outlets to code
• Install one phone outlet and two cable outlets
• Install make-up air unit in boiler room
Plumbing:
• Move sprinkler manifold up as high as possible
• Install one zone of baseboard heat
Price does not include price of permits or beat in boiler room
All extras to be paid in full when ordered.
Total price: $16,150.00 (sixteen thousand one hundred fifty dollars)
Payment schedule: $5400.00 due when contract is signed
$5400.00 due when rough framing & electrical is Complete
$2000.00 due when Sheetrock is installed
$2000.00 due at completion of contracted work except flooring
$1350.00 due at completion of contracted work
Customer
Kenneth B. Keen
Date Date
name: Li C-*; Oj
- L
location: 77— ./7` e bu f.
city A/& 9xjd61Jjej j&. phone# 272 6 71-S Zol
rj I am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any capacity
companyname:
. .... .....
official use only do not write in this area to be completed by city or town official
city or town: permit/license # nBuilding Department
C]Lkaising1oard
check if immediate response is required
oSelcctmCn'3 Office
E]Health Department
contact person: phone #; ----00ther
(revised j/95 PIA)
F
The Commonwealth of Massachusetts
Department of Industrial Accidents
t
-Mm
Office of/noestigatioos
600 Washington Street
,9---� ------
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
name: Li C-*; Oj
- L
location: 77— ./7` e bu f.
city A/& 9xjd61Jjej j&. phone# 272 6 71-S Zol
rj I am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any capacity
companyname:
. .... .....
official use only do not write in this area to be completed by city or town official
city or town: permit/license # nBuilding Department
C]Lkaising1oard
check if immediate response is required
oSelcctmCn'3 Office
E]Health Department
contact person: phone #; ----00ther
(revised j/95 PIA)
'�"ra ✓ltP �oarvino-ruuea�i a�:/%�aaur,�.`z�u�eda
'�• , BOARD OF BUILDING REGULATIONS
a License: CONSTRUCTION SUPERVISOR
Number: CS 058245
a
Birthdate: 03/24/1943
Expires: 03/24/2002 Tr. no: 18312
Restricted To: 00
KENNETH B KEEN
21 HEWITT AVE
N ANDOVER, MA 01845 Administrator
FA
MOM -
HOME IMPROVEMENT CONTRACTOR
Registration: 108383
Expiration: 8/18/02
Type: 08A
KEEN CONSTRUCTION CO.
Kenneth Keen
21 Hewitt Ave
ADMINISTRATOR
No. Andover MA 01845
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