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HomeMy WebLinkAboutMiscellaneous - 25 ANNIS STREET 4/30/2018 (2)N O O O fD O O O_ N O O O O O Date. /..? G O ,S..... . A, TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION s h I .4 SSAG MUSEtS This certifies that ....,,�.<4!�1-711. �.L.... l��. ......... has permission for gas installation ... l .................. in the buildings of .... C. .............. .......... . at ...... , North Andover, Mass. Fee.. 70.'Lic. No../.3/. S.'*: '-Ilk-.... . G1�INSPECTOR Check # 3 K 6709 G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or 1'ype) � Q t , Mass. Date 2009 Permit # �?o Building Location Q� Nvo\ S Owner's NamAf \ cw) L oe V Owner's Tel # <67 - G Type of Occupency (�(� �' 1 New F1 Renovation Replacement Plan Submitted: Yes No Installing Company Name Addario's Plumbing & Heating LLC. Check one: Certificate Address 20 Cooper Street x Corporation 2720 Lynn, MA. 01905 Partnership Business Telephone 339-440-8100 Firm/Co. Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr. Insurance Coverage : I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑x No M If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑x Other type of indemnity 1:1 Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner 0 Agent Signature of Owner or Owner's Agent I hearby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Title X Plumber / City/Town . Gasfitter Signature of Licensed Plum0 R.r Gas Fitter Approved (OFFICE USE ONLY) X Master Journeyman License Number 13106 a�° ' - - :� • Installing Company Name Addario's Plumbing & Heating LLC. Check one: Certificate Address 20 Cooper Street x Corporation 2720 Lynn, MA. 01905 Partnership Business Telephone 339-440-8100 Firm/Co. Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr. Insurance Coverage : I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑x No M If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑x Other type of indemnity 1:1 Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner 0 Agent Signature of Owner or Owner's Agent I hearby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Title X Plumber / City/Town . Gasfitter Signature of Licensed Plum0 R.r Gas Fitter Approved (OFFICE USE ONLY) X Master Journeyman License Number 13106 a�° U) z O U W (L U) z_ W 0' O iL J z O w N W U LL O w O U. O J W m U) W s U F- LU Y co CO) z O H U w IL z_ J Q z M 6 z W LU LL 0 z p H CO Q C7 O 0 O H H w CL O LL z O H a U J CL CL Q a z D J_ m LL O W a F- F- 08 LU Q z a z O J_ m LL O z O Q U O J w w m J IL 0 LU F z C7 F- LU CL LU f - Q 0 Location S /Ny r No. 3 q ce Date //_ / 8 MORTM TOWN OF NORTH ANDOVER Oi tt�•o !,h�0 ' Certificate of Occupancy $ Building/Frame Permit Fee $ �? D ^C MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /,70 Check # 7v D ( 6 8,/'3 / 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: SIGNATURE: Building Commissiolier/Igspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: a AnniS S -h / Map Number Parcel Number NAM aye r 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSEIP1AUTHORIZED AGENT Historic District: Yes No . 2.1 Owner of Record Aryip—Lfo, Obuabbn QS ^ n n i s S-ir. N. Andover -- Name (Print) Address for Service 'tCi4-G-1IT Signature Telephone 2.2 Owner of Record: N me Print Address for Service: Sig. ature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable t02(tenn V inH L &6kvia Licensed Construction Supervisor: r !" I �Q� lU License Number Add ss E on Date. r na a Telephone 3.2 Registered Home Improvement Contractor Not Applicable �e�IPrNn UInuLSi<_i+nCi mpany Name Registration Number _ fo[(s (aL( : S < —C r p 1 `^ ^ ! Lv� � (� \ nscq�,l T 1 v �C�l Iy A�1 e C�1 8aa�i Expiration Date J Si'jnaturA3 Telephone T rn X Z O rn It 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 it. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ns+a Lia EJ av\, 0� 4 L Q rnQ n t 1,' enc( o wS SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFk'IC TI'S (;EN1E.� - 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) J `�- 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 * S ':150 Check Number 7 t SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as OwneruthoriL'Agent f sect property 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 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 Own er/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHD NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ' ACORD CERTIFICATE OF LIABILITY INSURANCE PBL$R DATE (MMIDWYYYY) 10/23/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AND CONFERS NO RIGHTS UPON THE CERTIFICATE Pollack Insurance Agency 12 Parmenter Road ONLY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. T. NSR. Londonderry NH 03053 Phone: 603-432-2011 Fax: 603-432-6096 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A, Liberty Mutual INSURER B: HOLYOKE MUTUAL INS COMPANY INSURER C: Pellerin Vinyl Siding & 354 No. Broadway INSURER D: Salem NH 03079 B INSURER E: Vc�vtrwvta THE POLICIES OF INSURANCE USTED 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 POUCIES. AGGREGATE LIMITS SHOWN MAY HA BEEN REDUCED BY PAID CLAIMS. INSR LTR T. NSR. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDONY) POLICY EXPIRATION DATE (MMIDDNY) UMRS EACH OCCURRENCE 5 300000 B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 801718431000 DAf1A0E TO RENTED $ 50000 PREMISES(E.xwwice) MED EXP (My an P-) $ 5000 CWMS MADE ElOCCUR PERSOIhM&AO INJUFJY S S Business Owners 10/28/03 10/28/04 GENERAL AGGREGATE 5 600000 . PROOIlGTS - coAvloP ACG f GENL AGGREGATE LIMIT APPLIES CSLI 300000 PCIJCv JJECT Loc AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f (E. KdIMM) ANY AUTO ALL OWNED AUTOS BODILY INJURY f SCHEDULED AUTOS HIRED AUTOS BODILY INJURY f (Pa.xWMI) NON -OWNED AUTOS � a PROPERTY DAMAGE S (Pa aWEeM) AUTO ONLY - EA ACCIDENT f GARAGE LABILITY ANY AUTO EA ACC $ OTHER THAN AUTO bNLY: AGO S EACH OCCURRENCE f EXCESSIUMBRELLA LIABILITY 1 AGGREGATE f OCCUR ❑ CLAIMS MADE f f DEDUCTIBLE f RETENTIONI WORKERS COMPENSATION AND IVIG STATLL OTH• TORY UMRS ER E.L. EACH ACCIDENT f 100000 A EMPLOYERS'U"IUTY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMSER EXCLUDED? WC731S335689013 06/29/03 06/29/04 E.L. DISEASE - FA EMPLOYEE $ 100000 E.L. DISEASE - POLICY LIMIT 5 500000 II yea, e.aOm. U WK SPECIAL PROVISIONS b -1 -- OTHER DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 6 ....�.. r-1 I Arinu ULKIINWalc nvL-UQn DINaL$P I SHOULD ANY OF TME ABOVE DESCRIBED POLICIES BE CANCE IED SEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAJL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDERTO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OSUGATION OR LIABILITY NY MIND UPON 4W IRER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRES ACORD 25 (ZUU1/ut$) CORPORATION 1988 r � Visit Our Showroom At: PELLERIN Famous Brand Names 354 N. BroadwayVINYL SIDING Y Certainteed Salem, NH 03079 Mastic Weds. - Fri. 12 - 4 Alcoa Sat. 9 - 12 ;0Inc. Andersen Tel. (603) 898-2259 Harvey Fax (603) 898 - 2816 Proposal - Agreement Therma-Tru PROP L SUBMITTED T PHONE .7G _ (� D7� DATE �l rcLjl r STREET JOB NAME �' CITY, STATE d ZIP CODE JOB LOCATION We hereby propose to furnish all materials and labor necessary for the completion of the following products in accordance with the specifications and drawings 6L) n.�4 S �: - G �J N l LI Q t� �> 5 S a G G✓ - div �, . C�� U �� , �lc vz',l<� %� �t.(,�C� � � ✓�'-t^-� G�.: l� i �.,; t/c� �Lau•L� G-� �j 4'L �/�""i� l" L`�. Total contract price is, �`P� %���sG� �i,1,,,/.& <4 �i. S%r� dollars ($ PAYMENTSS� TO BE MADE AS FOLLOWS: ( / ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED. ALL WORK TO BE &mPLETED IN A AUTHORIZED=) WORKMANLIKE MANNER ACCORDING TO SPECIFICATIONS PER STANDARD PRACTICES SIGNATURE L ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COST WILL BE EXECUTED ONLY UPON WRITTEN ORDERS AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE. ACCEPTANCE OF PROPOSAL -THE ABOVEPRICES, SPECIFICATIONS ANDCONDmONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENTS WILL BE MADE AS OUTLINED ABOVE. CUSTOMER HAS THE RIGHT TO CANCEL THIS CONTRACT UP TO THREE (3) DAYS AFTER SIGNATU DATE OF ACCEPTANCE. DATE OF ACCEPTANCE �(1//SIGNATURE T' n - - - - - - �ixe Voava��uvea/Cia a` iuczeaac/uiaelta for individul use License or registration Board of Building Regulations and Standards before the expiration date.` If found return toonly HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards i Registration: 100286 One Ashburton Place Rm 1301 lug Expiration: 6/15/2004 Boston, Ma. 02108 Type: Supplement Card' PELLERIN VINYL SIDING LYNN BROTHERS _ --- 354 N. Broadway—'i JTNo�—t valid without signature , Salem, NH 03079 Administrator a 0, 7f U` �' rim O F=4 W O T v p E a 0 w z A Uw°� Cd is w a p U W ao' u cn w a p a ono ao' _ cz w z w A v «� cin m LLI M z co Cl ai O O Cs 0. O co � O w+ s W CM COD w O W M� .ca m �.s./ co CL �� co co ®co O M o a CL C! y O= C O C.3 'p .C:L O co ca Zco CD CLH .0 C O � N! f U) W W w LLIw U) o m C o : C L O CO) O V C-3 O W • m C •+: Ea L CFO • = V ca N r : � O m O� T _cm � � m c 3y� E � m mm O E m O v Wim O CID.Lr : Z O Of «� -cc, o� m y O Z G cm C CDL Ci N m C C _ ® a CL*- CO2 G .y 'fly Cw � °c 'E CL.=m -E C N 2 O n co, am o CO3 .:o H g 0 � � O C":L co Cl ai O O Cs 0. O co � O w+ s W CM COD w O W M� .ca m �.s./ co CL �� co co ®co O M o a CL C! y O= C O C.3 'p .C:L O co ca Zco CD CLH .0 C O � N! f U) W W w LLIw U) O z 0 Z a E X L 0 z O U to a' O CD O Z °o Q. O CO) 1= O C C O■� C 0 H co m m co CD co R }v. 3 C) Co O`5 O i e_�v C a c o C• vCc J .� O .0 Z O C..2 N2 c C C _c Q. F 0 Cn Cn w W LL LL U. c o :m c o O y C : t 1 Ci �d'fl CL C O A C +-' y c O W y CD = E a L v CL t'om CL mm a OCDy � ti = cm zip in 1 c y C Go O o :mac CD 0 CL CM CD ✓�: :c O CD rr c o� � r cc C O cm c H a m �z3 N COO z •H. O •E dt C wLLJ v y Z O 93 CM y a CD � _ ` y O O =4-a5m51. 0 z O U to a' O CD O Z °o Q. O CO) 1= O C C O■� C 0 H co m m co CD co R }v. 3 C) Co O`5 O i e_�v C a c o C• vCc J .� O .0 Z O C..2 N2 c C C _c Q. F 0 Cn Cn w W LL LL U. 0 Date ........... . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ................ C..... � • ........ . ,,V has permission to perform ...... . plumbing in the buildings of . L::L'�'�'�'-�� `� at ........ y " ` `......':-L........... , North Andover, Mass. J PLUMBIN IN ECTOR r, v fi Check # 50U-9 10 MASSACHUSETTS UNIFORM APPLICATION FOR (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Owners Name DO PLUMBING Date 169 isd —Clk Kermit # Z)d mount v� Type of Occupancy New ❑ Renovation Replacement ❑ Plans Submitted Yes No FliT11RES • .J I • ` � ,.,` 1 m------------------------- `1 D mmmmmmmmmmmmmmmmmmmmm-mmmm 1/' MMMMMMMMmmmmmmmmmmmmmmmm m 1 11.' mmmmmmmmmmmmmmmmmmmmm-m-�M • I 11' MMMMMMMMMMMMMMMMMMMMMMMMM 11.' mmmmmmmmmmmmmmmmmmmmmmmmm /1'mmmmmmmmmmmmmmmmmmmmmmmmm 1!' MMMMMMMMMMMMMMMMMMMMMMMMM 11.' MMMMMMMMMMMMMMMMMMMMMMMMM (Print or type)Check one: Certificate �— Installing Company Name (f i Z_ ❑ Corp. Address ' Al A rIPartner. usines�ep one o/j 3 _ �(� z — 177/7 �Firm/Co. Name of Licensed Plumber: % f { YI n (� Insurance Coverage: Indicate the type of insur n to coverage by checking the appropriate box: Liability insurance policy 11A 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu tts StaW PIVInbing Code and Chapter 142 of the General Laws. By SignaLure M-7censecrmmuer Type of Plumbing License Title Z 7441 City/Town iceuse Numoer Master Journeyman ❑ APPROVED (OFFICE USE ONLY N2 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to perform ....................... .. ............................................. wiring in the building of .............. ......... I ........... ........................................... at ................... ........................................................ North Andover, Mass. ............................................................... Fee .... �7 ............ Lic. No........... .... - ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer THECOMMONWF.ALMOF1l1A&4OWE TIS Office Use only DEPARTMF.IV1'OFPUBLICS4FM Permit No. BOARD OFMEPREVEMONRWUTATIOAN527CMR12-M Occupancy & Fees Checked VAPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /,(, -- =)a • 6 f Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street Owner or Tenant To the Inspector of Wires: Owner's Address 2Y ./ahri / 5 ,S'y Is this permit in conjunction with a building permit: Yes [No (Check Appropriate Box) Purpose of Building 4111c, 5AIe e f7� ��fi/Z�/�yf Utility Authorization No. Existing Service OD Amps 1,2 / ,-2rf Volts Overhead � Underground No. of Meters a New Service Amps / Volts Overhead r,-1 Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work G S -ew Uva e S r T� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures / Swimming Pool Above Below Generators KVA groundground No. of Receptacle Outlets © 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 Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Connections Other No. ofD Dryers ry Heati Devic s KW .Z t 'law tv w No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER UmranoeCovetage Ptast>irYblhetagt�enat��GaraalLaws Iha%eaamertLi biltyfin==Pbbcymdu&gCmTW CovwdWcritsmbstr6aleWh-dalt YES [D' NO Iha%esthnftdvMptoofofsarnetotheOTv-- YES � - If}uuha%edtedWYES,pleMEdCA�thetypeofane'debYdakirglhe bcix NKRANU [a BOND OTHER ftwe) ! 6e fi/o-r rpcy_ie1, Fstalk*d VA e We ° {b 6a workmStwt�%— �?3� G r �... it> WmD&RatlesWd Roth /0 X-,- e(/o, Zg,-.4 _ Final AD 6e �edtaxier�iePt�llfiesof ` RW NAME ����o. G, U ,�/�� �'/G Lioa>seNa 357038 C J .1I i - anddvtmysigri+ minis peter atv&itsddste*tnat (Please check one) Owner M Agent Iioa>seNo BtsaltssTdNa `pl7- PlP AlLTeLNa ?S1/-� "&Wl 6e=r IDTelephone No. PERMIT FEE 3� Location Q? No. Date ©- - v l Y TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL ' Check # 163-5 1556 C Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s , „"yi ,r. ,'•"^ .€ � .� � a �.?, .; Y dlC ,9 'x, 51 ,�r m,�x.N '�, �,,,_ -w i 111-0-0 BUILDING PERMIT NUMBER: DATE ISSUED: b / SIGNATURE: C Building Commissionerfl for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Map Num Number: t 97: Parcel Number /��� y� �j^ /J- /a �,�`• rt„%� 0' (/% C✓ u [ 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.C.L.C.40. 54) 1.3. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zane ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ I SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record ltmin/) S--- 1 me ( i �• n Vic:ress for Service: Signature a Telephone 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: 1 Address d Signature Telephone 3.2 Registered Home Improvement Contractor Company Name Address Address for Service: Not Applicable ❑ License Number Expiration Date Not Applicable ❑ Registration Number Expiration Date SECTION 4 - WORKERS COMPENSATION (1VLG.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 a licable New Construction ❑ Existing Building ❑ Repair(s) 0 TAlterations(s) V Addition ❑ to . Accessory Bldg. 0 Demolition ❑ Other ❑ Specify, Brief Description of Proposed W rk: , //1191" D/w O I SECTION 6 - FSTTMATIM C0NCT1Z1TCTTnN M.RTc I Item Estimated Cost (Dollar) to be Completed by permit appI'001icant �, ii11 LyilS.E 'O&L-fpfnm a� ?. (a) Building Permit Fee Multiplier 1. Building Z yo 2 Electrical SConstruction (b) Estimated Total Cost of f ^ ` — l v! .J 3 Plumbing Building Permit fee (a) X (b) 2 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number a��,iivi� ra vwi�rxAutnvxi.c"A11V1� 1V IfLC,VMYLLlEll Wt1N:iV OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I I, / \ y 1 co u as Owner/Authorized Agent of subjecr proper,;( , Hereby authorize to act on behalf; i all {Matters relativ o ork authorized by this building permit application. Signature of Owner Date SECTION 71b OWNER/AUTHORIZED AGENT DECLARATION 1, Mme, ' �" 1' as Owner/Authorized Agent of subject property C� Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge id belief i:� %, (� U t Name of Owner/Agent Q Date NO. OF STORIES SIZE , BASEMENT OR SLAB r SIZE OF FLOOR TEVIBERS I ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DINIENSIONS 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 µ0R71# Town of North Andover �0 VC.- -.,q+ ... •.` + N. " � e Building Department p 27 Charles Street # North Andover, MA. 01.845::,;e',;.�{,' G. Robert Nicetta Building Commissioner (978) 688-9545 .`(978) 688-9542 Fax Please print. DATE q-30 —0 JOB LOCATION 0( r(s/ Number "HOMEOWNER Name PRESENT MAILING ADDRESS I f L--- k City Town HOMEOWNER LICENSE EXEMPTION 41 I S Street Address C00,GfV I? ff— Home Phone 9)!�/s State Map / lot Work Phone Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two 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 108.3.5.1) 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 or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. 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. A _ HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (-/2I-- ( (-L (Location of Facility) ("C Signature of Pefmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a alkb0 0 z cd w o CQ u o w° cn a cn U z W o i a w° a�' C U ro w a w ?a c� a�' w a w W pG cn w p H w z w�' w w w a G CQ o b cn 0 o cn c c m c o � L CN O C V V Q, c A O o v L M _ �•s r V �1 y' O CL . Q r.+ CO) B:E�� • U o S u cm MA8 rn e C � : m N �O vv N '= C C N R O ' ca A 3 V:aCO3` o CoCL a V: O cl t m Iszip cm C . •.: C a CC* C m C •O = m myt••,p N ~ r0+ h mr~' m LL •N COD � to W C O Co. •cr - 2 omjE s g = cyv CO) CL �0mo) O p aim a 0 O co Z O D H 0 MAE CL as r C O co R CL CO2 O V .y C O C..7 0 C cc Cl) L O Q CD C. CO) C CO CM C 0 �C CO CO 0 co ev � 3.0 Eft 0 O L CL Q. cnQ � C ev ca J .0 O CO Z C. Cl) C 0 COW CO LULU cr LUw U) Locations-�� ,4NNfS No. 6 83 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ '�s'^•E<�' Building/Frame Permit Fee $ swCHUs Foundation Permit Fee $ Other Permit Fee TOTAL Check # �, (- J 156411 (e. l Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIa, RENOVIA�T,.E,,. OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,4 BUILDING PERMIT NUMBER: DATE ISSUED: ct 0 SIGNATURE: 44 LQ -c - Building Commissioner/12gwor of Buildings Date SECTION 1- SITE INFORMATION Ll. PropertyAddress: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: 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) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record e \ V Name (Print) s R Address for Service : Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES Supervisor: 3.1 Licensed Constru/ctue)o . �� Licensed Construction S perviso : ress ignature �l Telephone Not Applicable ❑ License Number -7 Expiration Date 3.2 R gistered Home Improveme t Contractor UA� t Not Applicable ❑ Company Name Registration Number Address J�.atureT Expiration Date Telephone T R 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 appficahle New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify I SECTION 6 - ESTIMATED CONSTRUCTION COCT3 I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building j (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction -- 3 Plumbing Building Permit fee (e) X (b) ��- 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR C9 qTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pennit application. -Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A 5 ent Date NO. OF STORIES SIZE / BASEMENT OR SLAB RD SIZE OF FLOOR TINIBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS IIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFMVWEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris 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 Mario Castricone, Prop. Y��'a bi � CASTRICONE ROOFING & SIDING CO. 31 Court SL, No. Andover, Mass. 01845 Tel, 682-4266 20 /e� 260 1 :.t � C�tranartwea£tn• ��as�fttts�ta Qi�amrzer� of .Fnrfustrial�• OCE Df 17LTIr'S'f:7.g6tiDlLt 600 W=fsircgtom Street 9 OZ111 wcm.e., c=p=stcm insmz= Ain-uVtt cl, Telephone M D 1 am ahorneow�p�orm'�+g aIl workraysel£ • D I am sole protniemr and have no ono woradng in my capacity D I am an Mnplo)r�r prolaing workers' com�oensatim jar my employees woridng m this job Cbmpzny Adar=ss: Telephaae �: FOR Please?= LePibly imsuaace Comps"• Policy 13 f Z d � 2" D �1 S D I am (circle one) sole pmpriowr, general conaacmr or homeowner and have h =d tnc contractors fisted oelaw wrap have tb. mllowmg. worms' comp=sation policira: Comnaay Nam. Address: . �„' Teleehono #: Iast�ce Coz .paay: Policy n Campan) Ad�ss: City Inst,�nce Co=g Tel.,-phone W: Polly Tr At-acb additioaai sheet if necessazy raiiure to secure: coverage as required under Section �A of MGL 1SB can lead to the imnositioa of criminal penalties of a Ent. tin to 150 0.00 and/or orae years' imprisonment as well as civil pcaalti-.s in the fomn of a STOP WOP.It ORDER gad a nnc of '"100,00 a pay against understand that a copy of this stsx=ent may be forwarded to the Office of inves iptions of the DIA for coverage v=cat m I do h r-m*y under i' ains rad enalfies of perjury that the information above i true and corr SimlatmV Date: Pimm Nzm:. 1 U (� Phone �7t /, d 0 Official UseOI rwY - Do not write in this arez o Bulldino Denanmenf CFermttlLicense n: o Licensino Board ffY or i own: n Selectman's Omoe D Health Denanmsrt D Other m Check if immediate response is required s V rA as OE� A O W aC -d O w v v) o v z a a � G O w O w C ^C U C x a O U w p G x x ° w U W "a w bo p w v V cn G Vi � O z m p a: C W. z w w W G cn z " cn Q cn z CLM O w P-4 �O :U :w z� :(h Cf) C� z 0 z 0 U f W O F� 40 H .® ct O O V CL 0 0 t� .Q H C O O G y 0 U) LU U) W W W LU C0 c o m c O ' O L O N O CJ V CLC ev o CD c • :t o om Z : N = E a c v[� CL o H �_ 0 CM vai v E ma r.+ N cm �� ' O y do CN �` O cc H C C AS O Em O ev m Q y O > Q c lei c o a m 0 m w hZ z0 L Co. a o c Q y O C O = m :moo N •H .. c F. 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