HomeMy WebLinkAboutMiscellaneous - 26 WOODBERRY LANE 4/30/2018 (2)t _
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No. / Date '-Z -a/ - 3
TOWN OF NORTH
ANDOVER
,So ,
A Certificate of Occupancy
$
* = ' Building/Frame Permit Fee
$
' AcHu< _ (-Foundation Permit Fee
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Sewer Connection Fee
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Nit td 2t Connection Fee $
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TOA $
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J' (fit ;;A, Building Inspector
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1 Div. Public Works
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OWNER(S): P—Erf0j
REGISTRY : ES f )r- Q9 -M- 6
DEED : BK_I S . p
PL LN : '#-13 '1
CERT. OF TITLE:
NOTE:
ROBERT G. GOODW7
82 •CENTRAL OTREET
ANDOVER, 3(ASY.
CERTIFICATE
I CERTIFY that the Lot shown hereon
�.tJD
that the 'D E. LLc QCT- shown
co u roz cd
(T(4 t`H present ZoQing j
of the of Koc2.'f H
The premises do
not lie within
a designated
Flood Hazard
Zone , �ot�lCl. FAfJ�L- i , ~� ;� �., 1 P.OJ�
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MEDICAL IMAGING CORPORATION
MSD, INC.
85 FLAGSHIP DRIVE • SUITE K
NORTH ANDOVER, MA 01845
611683-5901
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MEDICAL IMAGING CORPORATION
MSD, INC.
85 FLAGSHIP DRIVE • SUITE K
NORTH ANDOVER, MA 01845
611683-5901
Prowitial
Page No. of Pages
STEPHEN M. KEISLING
Building & Remodeling
31 Middlesex Street
NORTH ANDOVER, MASSACHUSETTS 01845
Mass. License 027489
Phone 582.2072
PROPOSAL SUBMITTED TO
PHONE
DATE
STREET
/
JOB NAME
CITY,STATE AND ZIP CODE 1
J
JOB LOCATION
ARCHITECT
DATE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for:
W 1-,).,.""�.'-yt,/ C.�'it�.CQ'_."' is ( f„ "'-Y'tF..w�¢-~..4:✓�"^.. r..Q •a�'1.!'- r+(.!'3-r5G'-`✓'ry i.7.'3^�-7 .e�'..'w�._�.,i.,,
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Or Fropou hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
Payment to be made as follows: dollars ($ ).
r'
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 specifica- Authorized
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tions involving extra costs will be executed only upon written orders, and will become an Signature
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be
Our workers are fully covered by Workmen's Compensation Insurance. Withdrawn by us if not accepted within days.
Arrrp#ttnrr of f ropood -
The above prices, specifications � ��✓�r' � �? �
,and conditions are satisfactory and are hereby accepted. You are authorized Signature d
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature
PRODUCT 1183 �,Ina, Groton, Matt. 01071. To Order PHONE TOLL FREE I+80O 225 6380
A.
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section******************
4/
APPLICANT: hUBe�,/ s//e/Z Phone 6dPdg"a1,.,3D
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street Gc vt�Reezy L,iNe. St. Number a�
************************Official Use Only************************ ..
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation dminis a r Date Rejected
Comments
Town Planner
Comments
Food InspeJcttoor-Health
Septic Inspector -Health
Comments __ o/C %D,e //J/ •eL�/��
Public Works - sewer/water connections
- driveway permit
Fire Department
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved /g6C
Date Rejected
.Received by Building Inspector Date
OFFICES OF:
APPEALS
I"it ILDING
(:ONSL'1ZVA'1'1UN
HEALTH
PLANNING
O
Town of
NORTH ANDOVER
DIVISION OF
PLANNING & COMMUNITY DEVELOPMENT
KARL•N H.P. NELSON, DIIIEC'1'0I1
120 plain Street
North AlldovCr,
NNISSM11USC11S01H4 i
((i 1 i) (iIi i•4 i i i
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number is that the dcbris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S
150A.
The dcbris will be disposed of in:
(Location o[ Faci icy)
Signature of Pertllit Applicant
Date
;TOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
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Location
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No. J Date
,.ORTf4
TOWN OF NORTH
ANDOVER
Of�`ao '•,�O
3?� ._ • OL
Certificate of Occupancy
$
�'�S''••° • E<�
sACNUs
Building/Frame Permit Fee
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
(�
Check
137018
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Building Insp6 ecr
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. p�
B din ominissi r/ n for of Buildings Date
SECTION 1- SITE INFORMATIOff
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map umber 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
ReTured Provided
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Privaty 0 Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
�•
Name (P -nn 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 Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
I
Expiration Date
Si nature -Telephone
x
P
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 0
Other ❑ Specify
Brief Description of Proposed Work:
CV A* NAG
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
+(3MCIAL IYSE O1i.Y M
.
1. Building(a)
V 3 V
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 BUH.DING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building pernut application.
Signature of Owner Date
SECTION 7b OWNER/AUT ZED 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
*A� i ` '
Print Name
Si ature of Owner/Agent 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 CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Dice n//nyestigatlnns
600 TVashington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
below who have
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Mcial use only do not= in this area to be completed by city or town official
city or town: permit/license N OBuiiding Department
OLicensing Board
p check if immediate response is required OSelectmen's Office
Ofiealth Department
contact person phone N;00ther
Castricone Roofing & Siding
REPAIRS FREE ESTIMATES
Telephone (978) 682-4266
MARIO CASTRICONE
31 Court Street, North Andover, Mass. 01845
I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary
materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and
conditions, on pr mises below described:
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OwnersName......1........................................................................................................................................................
Job Address.. .0 ��.-L,. Q,, .. may. ty� fr� �' `'�(�:: State. �,�
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1 SPECIFICATIONS
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Materials and labor to cost $ M1 ��� .............................. Payable �. �.. on and balance in............
.. . ................. ............ ................
monthly installments of $...........` ...............each, payable on .............................day of each and every month thereafter until paid
in full (....% charge per year is to be added to above cost of labor and materials and is included in monthly payments.)
Contractor will do all of said work in a good workmanlike manner.
` Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and a
completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid
immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in
addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith.
It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates
of the parties.
The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s).
PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused.
There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this
contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed
by all parties.
Cover attic storage cleaning not included.
Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and
the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and
understandings of said parties are contained herein.
Owner or Owners are not responsible for Property Damage or Liability while job is in opera ' . D
IN WITNESS WHEREOF, the parties have hereunto signed their names this.. ........ d y of..` .:................. 1 �� ..........
Accepted:
Signed......... 4 .................. r-: z...............................
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or
(OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT)
Per.. (;.. ....t.((..� ................
Representative
Signed..S �\- .X.�... L ...... �....................
Owner /
Signed......................................................................................
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