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HomeMy WebLinkAboutMiscellaneous - 250 MAIN STREET 4/30/2018 (2)N O {Qa N N o gn z m o"'-+ ' 0 Date...�........ aORT1i TOWN OF NORTH ANDOVER p PERMIT FOR WIRING J This certifies that.....Zv6 %� Z,1, 77 /( ...................................................... .............................. has permission to perform..................................../........................................... wiring in the building of..rie{/i�/�7Gi�.`...'�✓!1/......................... ..................... .... S� irlJ S ` ................................. orth Andover, Mass. Fee d.. Lic. No. S 93 / . / ............................:.....,.�......... . EL CTR CAL INSPECTOR Check # 91 97 00 R• CD C) y �J' E F a ,n � o rnhi po - pact C H rn M '""co.. tpv� .p �c1 uo, ',er Q• N H �p CD °O N Co N O O b O co 1 C, b- C] Gam°' C,CD oM 0000rno w H by r�g�:oaGo0�'a oNo o o CD ooco, w F,,00q•�o�,iO to op a r CD N H ° a F w o o N co �o rr n'p a�co `T1 EE occtiqq pp'CC-D" rn R Fy P' w C, G N {pv 0 CDcoo 0 0 '. '"O ° P O, 0 p O Up4 n G 'o. (D (CD, o. W 9-5 h N S td o C p' Ort P. M k3 � w N to a s 5' o o b ZA coo chop CD4]c`n w rn p o b 'ty Cep] n C,Ho rt p' 'off' Ci q' y t-' � s-. N. w rn rn w Hv H, a w w N l.ommonwea& of //lamac4ua4i Ap.,tment 013ire Serviced BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME), 527 MR 12.00 (PLEASE PRINT IN INK OR YTPEILL�jVF RMATION) Date: lct 2 City or Town of. _ D �To the Insper ofWires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) -Z-5-0 /I l h Owner or Tenant %LI % L U L 14 Telephone No. Owner's AddressAYL�,M Is this permit in conjunction with buildin permit? Yes E]Purpose of Building J [ hMn I Existing Service Amps / Volts Overhead ❑ New Service Amps / Volts Overhead ❑ No L[J (Check Appropriate Box) Utility Authorization No. Undgrd ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: VU drn, CR 1 No. of Meters No. of Meters Completion of the following, table may he waived by the Insnector of Wires No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires 3 1 Swimming Pool AboveEl In- g rnd. rnd. ❑ o. o Emergency Lighting Batter Units No. of Receptacle Outlets Z_ No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. ofnsges I( No. of Air Cond. TotTons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number ...... Tons � � KW '' ..'"'..."""" No. of Self -Contained Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water K`,1, Heaters No. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. f evices or Equivalent OTHER: S c CA,S (,, Attach additional detail if desired, 6r as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the. licensee provides proof of liability i urance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover a is in force, and has exhibited proof of s et�tthe//rmit'Jissug face. CHECK ONE: INSURANCE BOND ❑ OTHER [I(Specify:) /`� I certify, under the ain and ena 'e o r'u , th the i. ation on this a licaiion is true an com lete P f Jry p p FIRM NAME: t/ ee l( LIC. NO. JJ �7VLicensee: Signature LIC. NO.: (If applicable, e exe " in the cense number li .) Bus. Tel. No. Address: v bk AC Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security wor requires Departrnt f Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. 500565 Alpine Environmental, Inc 03:44:13 p.m. Department of Public: Health & Department of Labor NOTIFICA"TION OF DELEADING WORK r�� ti •i� ;�:,�;r� All sections of this form must be completed in order to comply ssith ` til the notilicatiun requirements of M.C:.1.. C. 111§197, 454 C:�1R 22.00 and 10i C,NIR 460.11011, as most recenlly amended Contractor performing projectRonald Pelk _ License # DC000663 Exp, Date 6/28/14 — a.S Dote Inspection `� �� 3 License # Exp. Date Lead faint Inspcclur� V v�"� of ADDRESS OP PROJECT: t Street Address _5_9� of Apt. Number City_ N`n "lip PropertyOwner ��a(� ��� �¢\�ro4lddress "Telephone Number Deleading Metho. Wct/Dry Scraping ❑ t(cat Gun ❑ Liquid Encapsulant ❑Demolition ❑ Caustics Replacement QCovering Other If "Otho' selected, please Check one: Dwelling is multi -family Single-family Other Start Date �� Completion Date V�N When will work he done: ANI 8 P�N1 5 (Specify times on site) Weekends? no Project Supervisor Name Toby Ferreira License # DS003598 Exp, Date 12/4/13 Worker's Compensation Policy Number UB -58985138-13 Carrier Travelers In case of emergency contact Ronald Peik Tel. I ( 978 250-2740 (Contractor's Representative) DEI.EADING CONTRACTOR 11-14-2013 1/1 The undersigned hereby states, under the pains and penalties of perjury, that lie/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00, and the Lead Poisoning Prevention and Control Regulations, 105 CIN(R 460.000, and that the inf oration c tailed in this notification is true and correct to the best of his/her knowledge and belief. Date \� Signed `✓'� �� Company Name Alpine Environmental Inc. Address 21 Progress Ave., Chelmsford, MA 01824 "Telephone Number 978-250-2740 OVER -4 500565 Alpine Environmental, Inc 12:51:24 p.m, 11-15-2013 1 11 Department of Public .Health & Department of Labor lQ;'> �1 ta �13crNOTIFICATION OF DELEADING WORK ' , ,J� 1T tll %�� All sections of this form must be completed in order to comply with W `\ �' the notification requirements of NLG.L. C. 111§197, 4• LTJ= 4i4 C1IR 22.00 and 105 CNR 460.000, as most recently amended Contractor performing project Ronald Peik —License q DC000663 Exp. Date 6/28/14 C ') �- Lead Paint Inspector v Q S Date of Inspection � � �� License # Exp. Dale ADDRESS OF PROJECT: \� Street Address `�`� 0\"N Apt. Number —� Cityv i` ��n C, Zip Property Owncr\ N-(NfiC1N-% hl=h ddress "relephone Number Deleading Method: Wel/Dry Scraping ❑ Hent Gun \� Liquid Encnpsulant [:IDemolition ❑ Caustics Replacement E]Covering Othcr Ir"Other' selected, please explain Check one: Dwelling is multi -family Single-family Others rl- Start Date o 1 Completion Date J ,�N _ v\ When will work he done: AM PM 5 (Specify times on site) Weekends': ��Q S Project Supervisor Name Toby Ferreira Liccnsc # DS003598 Exp. Date 12/4/13 Worker's Compensation Policy Number UB -5B985138-13 Carrier Travelers In case of emergency contact Ronald Peik (Contractor's Representative) DELEADING CONTRACTOR Tel. #_( 978 i 250-2740 The undersigned hereby slates, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00, and the Lead Poisoning Prevention and Control Regulations, 105 C1IR 460.00(1, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. Date �\ \S 1 Signed__��t ` Company Name Name Alpine Environmental Inc. Address 21 Progress Ave., Chelmsford, MA 01824 Telephone Number 978-250-2740 OVER -4 This certifies that Date.' :Iq jlz .... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING -q, ... ...................... 10 has permission to perform.. ..Zb<'4:.?z&V plumbing in the buildings of ............... . at ................. art Andover, Mass. Fee..? Lic. No.. 76:T/* � � ....... PLUMBING INSPECTOR Check # 7'z3G MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY J C��---Jl MA DATE L 11 PERMIT # JOBSITE ADDRESS %r� �`�'l OWNER'S NAME fh POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: En, RENOVATION:® REPLACEMENT: E] PLANS SUBMITTED: YES 0 N0[j FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE ( j DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM j DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL j SERVICE / MOP SINK TOILET URINAL 41 - WASHING MACHINE CONNECTION WATER HEATER ALL TYPESWATER PIPING OTHER <, INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES O'NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE OF INDEMNITY 0 BOND ®I 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 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 complia with all Pe nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. f PLUMBER'S NAME /�` I LICENSE # SIGNATURE MP ®I JP ®-' CORPORATION n# PARTNERSHIP©# LLC COMPANY NAME X104 J ADDRESS G✓ G, , C CITY vow ( STATE � ZIP TEL FAX CELL EMAIL H O z z 0 H U W W F� W `\ v o zof z }F o WLUo a z w I- w O a a oLUL W 3 co p z a a � w a U J a a � a � w x w f- LL W H O z z 0 H U W a z a a p O a The Commonwealth of Massachusetts .Department ofludustriglAccidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.massgovIdia Workers' Compensation Insurance Affidavit: Builders/Contractor6)ElectricianslPlumbers Applicant Information Please Print Lep-ibly Name (Business/Organization/individual): , Address: `e 61�k Ake City/State/Zip: )')'1 e�"G�+�,�i,. M- D l *y Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I — gmployees (full and/or par -time) * have hired the sub -contractors 2-qfJ 1 am a sole proprietor or partner- listed on the attached sheet. x ship andhave no employees working forme in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. lumbing. repairs or additions 12.0 Roofrepairs ME] Other 'Any applicant that checks box #i must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. ,am an employer that is providing workers' compensation insurance for my employees Below is the policy andjob site information. Insurance Company Policy # or S elf -ins. Lic. #: Expiration Job Site Address:_ & R) - 19)G 1-1 I T-City/State/Zip:.P. /J'7 Attach a copy of the workers' compensationpolicy fleclaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert under t7zf_p&P anrlpenalfie. 6, f�perjury that the informationprovidedabove is true anrlcorrect. Official use only. Do not write in this area, to be completed by city or town official. City or Town:. Permit/License it Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other - - - Contact Person: Phone #: f - Information and Instruction's Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,• express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more Of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a If cense or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. Liman LLC orLLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number whichwill be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license ofpermit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone anal fax number: The Commonwoalt of Massac,,hVsPiis Dgarterat ol`Shdustdal Accidents Wipe of Investigations 6.00 Waslabooa Street Boston, MA, 021 If Tel, # 617-727-4900 ext406 or 1.-$7WASS.AFF, Revised 5-26-05 Fax # 617"727-7749 ,wwwaxmagov/dia No -i 7'i 5 Date.....(O..F -� NORTH q ?;.,�`` .•_�.."�a� TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that............................................................................................ has permission to perform ..... ::E;....'. ...i ............................... wiring in the building of ....� .yl �.!!.: 4 a?.: (44C �, `^ t7 ( ..................................................... Qat....... r�..... ► a:.� ...... 5 .................................... . North Andove S. t Pe...�!.:�V... Lic. No. ���^........��� tit... ...........�.... r�� CALINSPECTOR C <\ 1606/!5/193 14:36 10.00 PAID WHITE:'Applicant CANARY: Building Dept. PINK: Treasurer Office Use Onh The Commonwealth of Massachusetts Pe.,.i, Nc. �►� I Department of Public Safety 3/9 w & Le 0 h lank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 120 0 hit, 4 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance With the Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN M OR TYPE ALL IN�I/ FORMEA,TION/�) Date 6-7-97 Town. City or Towof /(��� 01,96 EX To the Inspector of Wires: The undersigned applies for a permit t'o perform the electrical work described below. Location (Street & Number)}} �J v Mhaf f `"����t 0--ner or Tenant / /Q,�/(/l i �r '��11% ��%l j '� / -0/llilZ C J Owner's Address & 0 Is this permit in conjunction with a building permit: Yes U No b&4 (Check Appropriate Box) n Purpose of Building p�iC s a S } 0 U s Utility Authorization H0. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ 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 No. of Lighting Fixtures SwimmingPool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners fEmergency Lighting No. of BatteryNo. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal ❑Other Connection No. of Disposals No. of Heat Total Total P PUMDS Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW �' g No. of Water Heaters KW No, of No. o Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs_ No. of Motors Total HP OTHER: INSURANCE COVERAGE: . Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES( NO F-1 I have submitted valid proof of same to this office. YES ®. NO If you have checked YES, please indicate the type of coverage by checking the appropriate box_ INSURANCE ® •BOND ❑ OTHER p (Please Specify) 1-03-- -D3; - (Expiration Date Estimated Value of Electrical Work S 3 CK�)• "' Work to Start - 3 ~ Inspection Date Requested: Signed under the penalties of perjury: FIRM NAME Rough Final - , r, LIC. Nn. LIC. N0. 5 316 •-1Q Address% 1d"IVpffUe7N ;Ja0 G7 j3QXF6g4a " 6iq� " Bu s. Tel. No. Alt. Tel. No. 671 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S rt/ Signature of Owner or Agent Location -)A /A) S /- No. I y Date -�� 0 / MORTpy TOWN OF NORTH ANDOVER O�r.o :1'ti.G 10. 9 Certificate of Occupancy $ CMUS Building/Frame Permit Fee $ sA Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # v v !/w r Building Inspector 1.1 Property Address: 1.2 Assessors Map and Parcel c yZL Map Number Number: 00c) 4 Parcel Number ,e lm I lAell9A) Cool 01U4C14 72— A" ST2ee-r 1.3 Zoning Information: Zoning District Proposed Use Signature Telephone 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Name Print Address for Service: Signature Telephone Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided —+ -1 -2 1.7 Water Supply M.GL.C.40. 34) Public 0 Private ❑ Zone 1.3. Flood Zone Information: Outside Flood Zone 0 ].S Municipal Sewerage Disposal System 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ,e lm I lAell9A) Cool 01U4C14 72— A" ST2ee-r Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 01 Not Applicable ❑ Pfk,'J te1sLA.) � Licensed Constru,.t+on Supervisor: -1 -2 (� 00 G it lie 0-4�d/�L0�2 f�%'`/� tied License Number Address �y ? e '7 - / 6 ^ 2-6C7 Expiration Date ignature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Me tJ lLI-e /S Z/ a G Company Name Registration Number QA QQ Address Expiration Date Signature Tele hone E2 SECTION 4 - WORKERS COMPENSATION (NVLG.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 .......0 No ....... ❑ SECTION 5 Description of Proposed Work check all a Ecable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: 7 �e moc� e PLr,-iPaR,j,\ &-c rri _ ��;vs�� 11 �e w P 7 �f /� " C -ed(* A- Qi e c %. eve Zr c e A4,re !2,4 I SECTION 6 - ESTIMATED CONSTRUCTION COSTS 1 Item Estimated Cost (Dollar) to be # ..EN Comleted b permit applicant E 1. Building gp (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 CONTRACTOR APPLIES FOR BUILDING PERIVIIT 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 permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION property t Hereby declare that the statements and and belief STB P4e,� derSLi,y Owner/Authorized Agent of subject on the foregoing application are true and accurate, to the best of my knowledge Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS Isr2 ND 3 RD SPAN DIMENSIONS OF SILLS DDAENSIONS 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 4 DECLARATIONS Farm CONTRACTORS ADVANTAGE SPECIAL T® Family Casualty Insurance Company Glenmont, New York NAME OF INSURED AND MAILING ADDRESS: POLICY NO. 2005XO431 AGENT NO. 2591 OFFICE NO. 2591 STEPHEN KEISLING JAMES W UGONE 68 GLENCREST DR FARM FAMILY INSURANCE N ANDOVER MA 01845-1315 10 S MAIN ST STE 208 TOPSFIELD MA 01983-1832 978-887-8304 RENEWAL TRANSACTION EFFECTIVE 03/21/01 POLICY PERIOD FROM 03/21/01 TO 03/21/02 12:01 A.M. STANDARD TIME AT THE LOCATION OF THE DESCRIBED PREMISES THE NAMED INSURED IS: INDIVIDUAL BUSINESS OF THE NAMED INSURED: CARPENTRY-NOC PAGE 1 LOCATION OF DESCRIBED 68 GLENCREST DRIVE PROTECTION CLASS IS: 04 PREMISES NO. 01: N ANDOVER MA 01845 CONSTRUCTION IS: FRAME PREMISES 01 BLDG 01 BUILDING MATERIALS / EQUIPMENT STORAGE BUSINESS PROPERTY COVERAGE: BUILDING BUSINESS PERSONAL PROPERTY BUSINESS INCOME AND EXTRA EXPENSE LIMITS OF TERM ADDL/RTN INSURANCE PREMIUMS PREMIUMS 0 0 0 5,000 46 46 ACTUAL LOSS SUSTAINED NOT EXCEEDING 12 MONTHS INCLUDED INCLUDED BUSINESS LIABILITY COVERAGE: BUSINESS LIABILITY - PREMIUM IS SUBJECT TO AUDIT BODILY INJURY/PROPERTY DAMAGE 500,000 PER OCCURRENCE 1,000,000 AGGREGATE 500,000 AGGREGATE FOR PRODUCTS - COMPLETED OPERATIONS HAZARD MEDICAL EXPENSE 5,000 PER PERSON FIRE LEGAL LIABILITY 50,000 PER OCCURRENCE CODE DESCRIPTION 91342AA CARPENTRY-NOC PAYROLL TERM PREM ADDL/RTN 20,000 379 379 THE LIMIT OF INSURANCE FOR THIS BUILDING SHALL BE AUTOMATICALLY INCREASED BY 5% ON AN ANNUAL BASIS DURING THE POLICY PERIOD. ACTUAL CASH VALUE (ACV) - BUILDING OPTION DOES NOT APPLY. DEDUCTIBLE: $250 DEDUCTIBLE APPLIES EXCEPT WHERE NOTED IN THE POLICY OR ENDORSEMENTS. COUNTERSIGNED BY: BF 30 05 01 98 INSURED COPY PROCESSED DATE: 02/13/01 Proposal Page No. of Pages STEPHEN M. KEISLING Building & Remodeling 68 Glencrest Drive NORTH ANDOVER, MASSACHUSETTS 01845 MA Lic. 027489 Home lmpv. 101846 Phone 682.2072 PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME CITY, STATE and ZIP CODE JOB LOCA j /iJ C.�:^6i�r �"c'✓ i�%G:_. ,10N `x,11. ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: �� �� ... �l �.L .Q_: '..-tS-tr'�l^.�.i ���:�:-L'.'�J� ..%.� •�J/� � 'Ya� _•� /ff Y.w� Q-L4-'j.".j .J'..L< •i 'idf�'♦� /_Ii0 7_ :l'1,^!].'�< it !' �"-e'^LeJ J/' ¢ �' Jr /" a !' � (-•�l !G^JC. 1. �I,1..,,� �7�-::s:•�G ��t<S :.1 ;'t.� ;.... � `X (D � Y'C"�-i•� �_LG,[.r'!_/" CL•2 .�:k.Q '.`f--(�S,!)_;�iQ''_. .. �' _ .� .. _:i G`L , I �: t,. • :Jif ._ � .. C� . ;_L i , l . � ! I ".�„(7 Y"EwY.'!>C_E..liC �-f c :;> e "i�G%1""t:%i • (/f-Y•r'�- ._f � - L � Z'I'" ._ ' ' ' `E:. C"tr�d�jr a��G-, i�`�i.Uk' ._Lt�.-2J ,�,� .-t.'F�:{,,,..C:(�-CCt=+�y�' �:.c.`^':.:^f�.. .i.�•.�.� ._ -r •ni!o y'--•��.-s�.r�!'� ,!'�z:,.ti�-; �-��,-. IV c.- •1 r� `Ge' .ill""' 'tF^ �G: + ��,� ;1` /- !. .. �.•C<'f r -/'.F'• C.�g:-�-�.•G/ `[iL7'Yi � // n-Csf (.(J -t-`e .-y.�fZ�CP . < <.!C l 'O `...1' _r_� 'i a-Gl •� _ 1^K�^./Y4, � ..dc�a�!- GNU',/� i � /' . �/ OL ��' �d•..r.c� y9<c;t� �"'�D/` /..iU, / _r..n7' Ct a- O ._ �. >.._.� ,i.�_r`-: .i G,G�r�' ; f . i f -C -•J x[: � � Y;.I..Y',�' '.' G{. C.l.�l L..[% LL tG.� � . . c2� : (..! �:�+,,,� _- c. � .u� � l� ��Q J f/ /f d� / � / i.J.'i,-� ::.t:f' t�-f / { n ' `�-9 f '7K r- UJP 13rapaor hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: dollars ($ ). Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard Any alteration or deviation from above specifications Authorized practices. Signature Si g involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents Note: This proposal may be or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. withdrawn by us if not accented within days. Our workers are fully covered by Workman Compensation Insurance. Arreptanre of Proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: -� 0/ Signature��, ` Signature i. W . _ --" -_ �� -C�amxmunusea`bi o�✓tiaaaaclutoelta', "• , BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ;jNumber `CSI 027489 ! �., Bf 7F -i811953 • 1fixpies.Q p01 Tr. no: ' 11352 i STEPHENM KEISLIN j ! 68 GLENCREST DRQ", `i:} , '�' � 1 C.i...:. r . N ANDOVER,. MA 018"4'5"' 1845 Administrator -. 0/e �o�,vnanuea(!Ji �✓«rc/+�ue!!a-.° NONE IMPROVEMENT CONTRACTOR Registration: 101846 Expiration: 6/29/02 Type: Individual STEPHEN M. KEISLING f Stephen Keisling 68 Glennerest Or. ADMINISTRATOR N. Andover i MA 01845 C/) Cf) 0 m _) CO) d CO2 CM) C � -ci 'v O CD Z CO2 C* -0 ar � � o CL y 70 0 C2 op CD CD CD Cr d CL CD CD o CD 00 ov � C CDCD y Q O CO) tC C=D 0 Crn cn n O cn C LO cn � . cn o C W M� p 7' C• H 2 NJ O Q G �- 4 • 00 O.O C O10 y G �. O CD 0 m m n 06 n T CD Z y m =r"p Ni � Oma. w C to a yo' =ra MR =r CDO O . C y O Z'?m• m x > > O ti O O CA c W OZ O O :` a r E. :3 om U2 ClCL,.,..,: ?� � Z O m C O H 7 O .drt� N Z N CCA Cr C �d VALH CCDm � � O CIO H N O m�i. �7 tOA =z =m: to � CD co JU 910-4% all- ..: : C Z ate_: �� �h o�. ��+ 11 t� o G „ G �- 4 • 00 G �. 00 p w 0 G r 00 � w 7 o G ::r -EL o G w 0 5to C) 2 n C/)o 'a O .0�. y 1 1 I 0 . O H 0 9 O C Location • % f '' ` No. 5 Date Ir NaRT� TOWN OF NORTH ANDOVER O�•t.so '•,�O "Certificate t i of Occupancy $ s'•••°' E SACHUS Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / -J Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ;t ' BUILDING PERMIT NUMBER: DATE ISSUED: R-o0 f SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1..3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard . Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �iNeT ///iN eOwq C�7'��Ct1 72 ��ys S% /zPe%� Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Construction Supervisor: Acjdfe'ss Q Signat4e ` Telephone Not Applicable ❑ aP % CIP 7 License Number Expiration Date 3.2 Registered Home Improvement Contractor ,mss Not Applicable ❑ /0 /-P �/ / Company Name PRegistration �r�P,�',GRf / (� � l�J dt �O vP /L at /.t Number G�2 9 � o a Addre s 2CJ7Z Expiration Date i naWr Telephone T M Z O V� q O Z M 90 O '97 ic r v M r Z Q 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 ....... 11 No ....... ❑ SECTION 5 Description of Proposed Work check all a Hcable New Construction ❑ Exisbing Builg ❑ Repair(s) Alterations( ,4ddition ❑ IL M Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify ' Brief Description of Proposed Work: e'e"c e Fxei T t�g .vs7w w R % To/sem Qlec tL/.VS I�LVS �f}i L/n�C� -r` �14�i4S%P/LS r I SF.CTTON 6 - F,STIMATED CONSTRUCTION COSTS I Item 36 �'s & ej Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY` 1. Building 3[, S (a) Building Permit Fee Multi Tier 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 I, S%e P fir a 4te r 3 6 a as Own Authorize Agent of subject property Hereby authorize to act on 1= relative to yaork authorized by this building permit application. �.�--e� A 3 ! - OC3 Si nariue 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 ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 0? X S 2 ND 3 RD SPAN DIN ENSIONS OF SILLS DM4ENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Q 1 ►i •-¢ x Q d O GO u � T� P. v cn C/) cz O z z Ca � C 0 ° ' v U w a O U W w C4 O w U U O � w z C d � �°° m w w w A w W ° zi0 cin " O cn y uj W LL Q W F-1 CO) 2 c c m c p c � O ` O N cC O u V d� CL C A A j m C L C :.� R O m Ea .L c 'mM L c) C, n. r-. N tom L �CM m c 40 : N W :mm cc, m 3 N j C m C �, L _ m A fl N A N m E� CD o :nv� N m m TE rm _ L � C L CMD �02 Z c � o o_ m N O C i m m yL+ p W CO In -0-=L wL.+ LL D a.. C •N �O_L A C m •E V V C. O7 V m p4 C CL O _ = A a ,� N ._ F- L CL*- m E a N L �O O i CO) C O ID m Cf m o` cm c O N m L .r O Z O O z 0 w w P-4 I O � C CO2 :2 CO) O -O -g mm CD 0 CD CDCD O � C L O O d �Q C O R O CJ J •0 •C_ O CD C Z ai 0 CL V y O C C C c CLH E 0 LLJw W Ir LLJw U) COMMERCIAL - RESIDENTIAL DATE Office and Exhibit Area: 146 DASCOMB ROAD (Route 93 - Exit 42) ANDOVER, MA 01810 JOB Brockway -Smith Company Brosco Architectural Group Serving Greater Northeast Architects since 1890 800-225-7912 FAX (24 hours) 800-242-4533 1u I .:.... 7 ' ? I f�� ___—.L_ i I i i I t>j � ja,la6% 1, serve you mild 5-3uo(9e1 J�rices, &ino(ow . Deiai1 i anon cSpec ��riliny I ! ! r III I ENTRY DOOR SYSTEM Andersen "Rain Sensitized" I Wood and Steel Automatic Closing Hinged French Patio Doors ROOF WINDOWS We hereby submit specifications and estimates for: /4nv,0v`Q .e 7 �x SQL ,1.ov�/�. �c�--e��,a..cv Xp �t�a..�..e. �ix�•..� �.a �.L , ,e --...................................................... ......._c �o �e �khe.?�.e...,,� -)� irt»�t �� �, -................._...-.........................--............................ y ........... ................................ ...................... ............................ .. LQQ-1� ........... .......... `.e-4 . �,,'�e ......................._.......__....--...--- _ __ �_...... We proPOSC hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: ). Payment to be made as follows: dollars ($_ All material is guaranteed to be as specified. All work to be completed in a workmanlike Proposal Page No. of Pages manner according to standard practices. Any alteration or deviation from above specifications Authorized STEPHEN M. KEISLING Signatu _ Building & Remodeling 68 Glencrest Drive Note: NORTH ANDOVER, MASSACHUSETTS 01845 withdrawn by us MA Lic. 027489 Home lmpv. 101846 Phone 682-2072 PROPOSAL SUBMITTED TO to do the work as specified. Payent be made as outlined above. PHONE DATE Signature STREETS C �- ��. C1 a/J� d �LI Ct �n JOB — d►-� axG CITY, STATE and ZIP CODE JOB LOCATION �7 ARCHITECT DATE OF PLANS IJOBPHONE We hereby submit specifications and estimates for: /4nv,0v`Q .e 7 �x SQL ,1.ov�/�. �c�--e��,a..cv Xp �t�a..�..e. �ix�•..� �.a �.L , ,e --...................................................... ......._c �o �e �khe.?�.e...,,� -)� irt»�t �� �, -................._...-.........................--............................ y ........... ................................ ...................... ............................ .. LQQ-1� ........... .......... `.e-4 . �,,'�e ......................._.......__....--...--- _ __ �_...... We proPOSC hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: ). Payment to be made as follows: dollars ($_ All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra Signatu _ charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. Note: Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us Acceptance of proposal—The above prices, specifications and conditions are satisfactory an are ereby accepted. You are authorized ?11 Signature f to do the work as specified. Payent be made as outlined above. Date of Acceptance: ` 1&1)0 C Signature may be J within F,e 3 days. LARATIONS Farm CONTRACTORSCADVANTAGE SPECIAL PAGE 1 Family Casualty In ince Company POLICY N0. 2005X0431 sura IPM Glerunont, New York NAME OF INSURED AND MAILING ADDRESS: AGENT NO. 2591 OFFICE NO. 2591 STEPHEN KEISLING 68 GLENCREST DR N ANDOVER MA 01845-1315 JAMES W UGONE FARM FAMILY INSURANCE 10 S MAIN ST STE 208 TOPSFIELD MA 01983-1832 978-887-8304 RENEWAL TRANSACTION EFFECTIVE 03/21/00 POLICY PERIOD FROM 03/21/00 TO 03/21/01 12:01 A.M. STANDARD TIME AT THE LOCATION OF THE DESCRIBED PREMISES THE NAMED INSURED IS: INDIVIDUAL BUSINESS OF THE NAMED INSURED: CARPENTRY-NOC LOCATION OF DESCRIBED 68 GLENCREST DRIVE PREMISES NO. 01: N ANDOVER. MA 01845 PREMISES 01 BLDG 01 BUILDING MATERIALS / EQUIPMENT STORAGE BUSINESS PROPERTY COVERAGE: BUILDING BUSINESS PERSONAL PROPERTY BUSINESS INCOME AND EXTRA EXPENSE PROTECTION CLASS IS: 04 CONSTRUCTION IS: FRAME LIMITS OF TERM ADDL/RTN INSURANCE PREMIUMS PREMIUMS 0 0 0 5,000 74 74 ACTUAL LOSS SUSTAINED NOT EXCEEDING 12 MONTHS INCLUDED INCLUDED BUSINESS LIABILITY COVERAGE: BUSINESS LIABILITY - PREMIUM IS SUBJECT TO AUDIT BODILY INJURY/PROPERTY DAMAGE 500,000 PER OCCURRENCE 1,000,000 AGGREGATE 500,000 AGGREGATE FOR PRODUCTS - COMPLETED OPERATIONS HAZARD MEDICAL EXPENSE 5,000 PER PERSON FIRE LEGAL LIABILITY 50,000 PER OCCURRENCE CODE DESCRIPTION 91342AA CARPENTRY-NOC PAYROLL TERM PREM ADDL/RTN 15,600 276 27,6 THE LIMIT OF INSURANCE FOR THIS BUILDING SHALL BE AUTOMATICALLY INCREASED BY 5% ON AN ANNUAL BASIS DURING THE POLICY PERIOD. ACTUAL CASH VALUE (ACV) - BUILDING OPTION DOES NOT APPLY. DEDUCTIBLE: $250 DEDUCTIBLE APPLIES EXCEPT WHERE NOTED IN THE POLICY OR ENDORSEMENTS. COUNTERSIGNED BY: BF 30 05 01 98 IN'j?ED COPT PROCESSED DATE: 02/14/00 STEPHEN M KEISLING" 68.GLENCREST DR N ANDOVER, MA 01845 o�✓�iaaoacl,.uael�a � )ING REGULATIONS FION SUPERVISOR 27489 �i I! Tr. no: 11352 i I 00 l Administrator 71. ioom�novucea�i o�.%�amac/uaelta HOME IMPROVEMENT CONTRACTOR Registrati fi 101.846 Type INDIVIDUAL 6piT.atipn „06/29/00'F ' { STEPHENA. KEIkING 68 Glenncrest 0r. AQMINISTRAMR i.