HomeMy WebLinkAboutMiscellaneous - 267 BOXFORD STREET 4/30/2018 (2)Ova
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TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
40 This certifies that ... //� e� ..................
has permission to perform ... r r ....................
plumbing in the buildings of ... f"*
at .... ?. e�. .) ..... P ( / 1, .�.
........... . . North Andover, Mass.
Fee..�� ..... Lic. No.. A '?.1 ... ........
PLUMBING INSPECTOR
Check # 11 1 � �
5441
-?-(- 7 --
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
("79) /aj&�L�M ass. Date Permit#
(r6's Narne
Building Location")V-06 Bn—x
TypeofOccupancy Residential
New Renovation D Replacement L4 Plans Submitted: Yes El No El
FIXTURES
Installing Company Narne Ile r i tag e Htg.&Plg. Co. Inc.
Address __3_5_-JUe as a n t 'S t r e e t
--Stonehain, Ma 02180
Business Telephone .j81
Name of Licensed Plumber Gordon Switzer
Check one:
EX Corporation
Partnership
F] Firm/Co.
Certificate
714
INSURANCE COVERAGE:
I have a current liability insuiance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N- No []
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy M Other type of indemnity 1.1 Bond El
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 El
e or Uivnsr or
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 the permit issued for this application will be in compliance with 311
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 ol the General Laws.
By
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Title Type of Licunse� Master Journeyman 0
City/Town—
APPROVED TOWIMLJSE—Ur�[-Y) License Numbor-8-3.2 2
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Installing Company Narne Ile r i tag e Htg.&Plg. Co. Inc.
Address __3_5_-JUe as a n t 'S t r e e t
--Stonehain, Ma 02180
Business Telephone .j81
Name of Licensed Plumber Gordon Switzer
Check one:
EX Corporation
Partnership
F] Firm/Co.
Certificate
714
INSURANCE COVERAGE:
I have a current liability insuiance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N- No []
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy M Other type of indemnity 1.1 Bond El
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 El
e or Uivnsr or
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 the permit issued for this application will be in compliance with 311
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 ol the General Laws.
By
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Title Type of Licunse� Master Journeyman 0
City/Town—
APPROVED TOWIMLJSE—Ur�[-Y) License Numbor-8-3.2 2
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Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........... 1110k woe'6 &-- 7 —
............................... . ........ / .. ................
has permission to perform ... /�
wiring in the building of ........ A013 ....... .................
at ....... . _Z(P.7 ...... ....... 1,21) ........ . North Andover, Mass.
Fee ... 3 Lic. No. ��7Y!. 4-.14 ........... IfIlls �-C;i;
Check# qz-07
6860
Commonwealth of Massachusetts Official Use Only
Permit No. 49'& 0
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfonried in accordance with the Massachusetts Electrical Code (MPC), 5 7 CMR 12.00
(PLEASE PPJNT IN INK OR TYPE ALL INFORMA TION) Date: XaG
City or Town of: Al. &rj,�24, e r To the Inspectorlof Wires:
By this application the undersigned giv6s notice of his- or her intention to perform the electrical work described below.
Location (Street& Number) 2-(6-7 6 a X.); (-.4 S -7t --
Owner or Tenant
Owner's Address
Is this permit in con ' junction with a building permit? Yes
Purpose of Building
Telephone No.
No El (Check Appropriate Box)
Utility Authorization No.
Existing Service2fa-0 Amps /fJ—/236Volts OverheadF-1 Undgrdf�
New Service . Amps I Volts Overhead [:] Undgrd F-1
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
No. of Meters
No. of Meters
Completion of the following ble may be waived by the Inspector 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
Swimming Pool Above Ei I n-
grnd. grnd. El
. of Emergency Lighting
Battery Units
No. of Receptacle Outlets _3
No. of Oil Burners
FIRE ALARMSTNo.
of Zones
No. of Switches
No. of Gas Burners
No. of Detect I
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
J.N7uiii��.r
I
Tons
IRT77
No. of Self -Contained
iDetection/AlWing Devices
No. of Dishwashers
Space/Area Heating KW
M ' W1 E] Other
LocalEl Counnn'ect ion
No. of Dryers
Heating Appliances KW
Security SVstems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
I No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: �;- /—/ 41 /6 / Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COV`ER9GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECKONE: INSURANCE g]—BONDE] OTHER [] (Specify:)
I certify, under lite pin and penalties ofperjuty, that the information on this application is true and complete.
FIRM NAME: wos;,7110 LIC. NO.: Al2- V
Licensee: Signature LIC. NO.:C-2-7ilY-
(If applicable, enter "exempt in the license numb r line. A
Bus. Tel. No..9,7,C- S�jtj-- It
Address: V S� Ae-,Z;%bJ:t, 49" - 4) (1) c C� Alt. Tel. No.:
*Security System Contractor License required for this Aork; if applicable, enter the license number here:
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)E] owner [I owner's agent.
Owner/Agent
Signature Telephone No._ PERMIT FEE. $
01
lK
I
Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # (��q .
9 3'11
Building Inspector
Permit NO: 2D
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
DateReceived
I IMPORTANT: ADDlicant must comDlete all items on this Da2e I
LOCA
PROP]
MAP NO
PARCEL:
TYPE AND USE OF BUILDING
Print
ZONING DISTRICT:
HISTORIC DIRTRICT VF.q F1
TYPE OF IMPROVEMENT—
PROPOSED USE
Residential
Non- Residential
0 New Building
11 Addition
4AIteration
6 One family
0 Two or more family
No. of units:
0 Industrial
>(Repair, replacement
0 Demolition
0 Assessory Bldg
[I Commercial
Moving (relocation)
El Other
11 Others:
t0
o Foundation only
I)ESCRIPTION OF WORKTO BE P
OY�NER: N
( d r -AM I'L� 12�2m --IZ-r, I
Identification Please Type or Print
Y)
Phone: Q-1 V49%)"
Address: --2(o 5�f�zi>
CONTRACTOR Name:
Address:
Phone:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: —Reg. No
FEE SCHEDULE. BULDING PERMIT. $12.00f;ER$1000.00 OF THE TOTAL ESTIMATED COST BASED 0 $125.00PERS.F.
Total Project Cost:$ - C. xl2.00=FEE:$
Check No.: Receipt No.:
Page I of 4
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be
obtained.
Roofing, Siding, Interior Rehabilitation Permits
• Building Permit Application
• Workers Comp Affidavit
Lj Photo Copy Of H.I.C. And/Or C.S.L. Licenses
• Copy of Contract
• Floor Plan Or Proposed Interior Work
Addition Or Decks
o Building Permit Application
ca Surveyed Plot Plan
Li Workers Comp Affidavit
• Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Contract
• Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
Lj Building Permit Application
• Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
• Workers Comp Affidavit
• Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Copy of Contract
o Mass check Energy Compliance Report
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the
Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds.
One copy and proof of recording must be submitted with the building application
DGe: INSPECTIONAL SERVICES DEPARTMENT:RPFORM05
Noe 4 nf4
TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art
Swimming Pools El
Public Sewer F
Well
Tobacco Sales
Food Packaging/Sales El
Private
Permanent Dumpster on Site El
(septic tank, etc.
Electric Meter location to
project
IN 01E: Persons contractm"g with unreg do not have access to the guarantyfund
Signature of Agent/Owne " L7 Signature of contractor
Plans Submitted El Plans Waived 11 Certified Plot Plan El Stamped Plans F1
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT 11
COMMENTS
CONSERVATION
COMMENTS
DATE APPROVED
F11
E]Water Shed Special Permit
El Site Plan Special Permit
11 Other
DATE REJECTED
11
HEALTH El
COMMENTS
Zoning Board of Appeals: Variance, Petition N
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
DATE APPROVED
in]
DATE REJECTED DATE APPROVED
Comments
Comments
I
Water & Sewer connection/Sii!nature & Date Drivew Permit
Temp Dumpster on site ye *Y \ \ 0_ Fire Department signature/dater-
T, 4
Building Setback (ft.
Front Yard
-7 Provi
�d
Dimension
Number of Stories:_
Total land area, sq. ft.:
Side lard, Rear Yard
Pro
quired Provides JRe uired Provided
Total square feet of floor area, based on Exterior dimensions.
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411
Gerald A. Brown
Inspector of Buildings
Please 12rint
DATE:— C*
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-64
North Andover, Massachusetts 0 1845
HOMEOWNER LICENSE EXEMPTION
Telephone (978) 688-9545
Fax (978) 688-9542
JOB LOCATION:
Number Street Address Map/Lot
HOMEOWNER
f0-0mv, § q_7 g
Home Phone Work Phone
PRESENT MAILING ADDRESS .9):t&
City Town
State
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to 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 HOMEOWNER
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 structures. A person who constructs more that one home in a two-year period shall not be
considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the of North Andover Building Department
minimum inspection procedures and/r quiremcnts and t he/she wi mply with said procedures and
requirements. A I/ rt. I Co
HOMEOWNERS SIGNATURE I IA I AX -Yv,A V V - - - —V V
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Fonn Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-
9535
I
60'10 Date .....
...... .... ... ...... .. ..
TOWN OF NORTH ANDOVER
At
PERMIT FOR WIRING
This certifies that .1Q)T //:� ... 3- A�Zr ...............
has permission to perform ....... 57p-.C-
*,�524...0.1 ............
7
wiring in the building of ....... 41PAIF"r .......... ................
at ....... a.4 ... 7 ... 6?,KF�e,6 ...... 5.!f ............. . North Andover, Mass.
00 .....
Fee..v ..... Lic. No..1.53.�.Y . ............
ELEMICAL INSPECTOi
Check# 00,57 -7zl 7Z
V
Commonwealth of Massachusetts Official Use. nly
Permit No.
Department of Fire Services
Occupancy and Ofchecked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99]
ave blank)
APPLICATION FOR PERMIT TO PERFORM ELECWCAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CJY12.00
AV
(PLEASE PREW TN TNK OR T YPE IrZ�:�f D
City or Town of- To the Inspector of Wires:
By this application the undersiAngives notice of* or hei, intention to perform the electrical work described below.
,!!�;g /
/7,
Location (Street & Nwher)
Owner or Tenant Telephone N
Owner's Address -,F16
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service Amps Volts
New Service Amps Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of Security system
._'Yes -NO
Utility,
OverheadO
Overhead El -
P�:V (Check Appropriate Box)
.uthorization No.
UndgrdF_1 No. of Meters
UndgrdE:l No. of Meters
C'nmnlptin" �fth, f�71i fhla — A, -;—d A,, il,.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above o In-
Swimming Pool grnd. grnd.
No. of Emergency Lighting
Battery Units -
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
No. o� rid
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Number
Tons
KW
No. of Self -Contained
Totals:
Detection/AIerting Devices
No. of Dishwashers
Sphe . e/Area Heating KW
Local F1 Municipal [I Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent,45-
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Felecommunications Wiring:
No. of Devices or Equivalent
OTHER -
Attach additional detail it desired, or as required 6 ' v the Inspector oJ Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [I BONDEI OTHER El (Specify:)
(Expiration Date)
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.
I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete.
FIRM NAME: ADT Se"r-ity Services 18 r'
I iiq+An py- Hnj I i q LLLL LIC. NO.: 1
Licensee: John S. Bassett Signature 4A LIC. NO.: 1533C
(If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603 594 59 8
Address: I/ Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licl6see does not have the liability insuiance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) [] owner El owner's agent.
Owner/Agent
Signature Telephone No. FEE: Sx�,
M
Commonwealth of Mas'sachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Offi ial,.Use Only
/7
Permit No.
7 -
Occupancy and Fee Checked
[Rev. 11/991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CN 1200
(PLEASE PR11VT 11V 17VK OR TYPE AV J� Z.RM,�TION) Date: __1 __1
/7- e!5
City or Town of- d0)J_Vt_, To the Inspector of Wires:
By this application the undersignECTgives notice o ' or he intention to perf the elect *cal work described below.
Location (Street & NuMber) 12 2
Owner or Tenant
Owner's Address
Telephone
Is this permit in conjunction with a building permit? .'Yes'. [I No tjP (Check Appropriate Box)
Purpose of Building U . tility kuthorization No.
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: —Installation of Security system
h 77-4-- -L1_ ___ L - __ - - I , , , 1 -1.
��A
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above o In-
grnd. Und.
0. of Emergency L-ig iing
Battery Units -
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS !
o. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
I. I
Ton
I
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
S I pace/Area Heating KW
Local E3Municipal [I Other
Connection
No. of Dryers
Heating Appliances KW
—
-5.0T
Security Systems:
No. of Devices or Equi alent
No. of Water
Heaters KW
N No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Uelecommuii—cations Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required ky the Inspector o * / Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [] BOND El OTHERE] (Specify)
Estimated Value of Electrical Work: M, Lqr - (When required by municipal policy.) (Expiration Date)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete.
FIRM NAME: A.0T Sa"r-ity Servires 18 r3iiAtAn ng- Hol ] 1,z LIUL LIC. NO.: I
Licensee: John S. Bassett Signature LIC. NO.: 1533C
(Ifapplicable, enter "exempt" in the license number line.)
Bus. Tel. No.: 603 594 5928
Address: Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Lic'Qfisee 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 11 owner's agent.
Owner/Agent
Signature Telephone No.— PERMIT FEE: S
j
N4
PV
I"
.Z)cation 7
N o. 0? Date
f
TOWN OF NORTH ANDOVER
0 Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
Sewer Connection Fee $
Water Connection �Fee $ ----------
TOTAL op C-)
OL-
Buildin6'lnspector
A/W—� ao--� I c%-00 PAID
7346 Div. Public Works
PER'liff NO.
-14
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
I/P/AGM I
MAP 4-40. 4
LOT NO.
12 RECORD OF OWNERSHIP IDATE
BOOK ;PAGE
ZONE
SUB DIV. LOT NO.
I F -
v
LOCATION �' 6 7 r,�O',e
1�c
PURPOSE OF BUILDING
OWNER'S . NAME -ro lby I- A kll�
z -le #4wA6z 6w
w - OF STORIES SIZE
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME Yz L&IJL'44-4
SIZE OF FLOOR TIMBERS IST 2ND 3RD
8 U I L D E R - S N A M E
"#,,SPAN
DIMENSIONS OF SILLS
DISTANCE TO NEAREST BUILDING
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES
REAR
GIRDERS
AREA OF LOT
FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
IS BUILDING ADDITION yx
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF fO6E
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 3
PAGE 2 FILL OUT SECTIONS 1 12
--A ELECTRIC METEPS, MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
D E F
A.
SIGNATU
F E E
IZED
PERMIT GRANTED
19
73
Offl,!ER TEL, #-
CONTR.TEL.#
CONTR. LIC. #--52A-g6o
M4
3 PROPERTY INFORMATION
LAND COST
EST. SLOG. COST %
, 00
EST. BLDG. COST PER 96/ FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF IIIELECTMEN
�Z-4U&ILDINS INSPECTOR
ol;/-
BUILDING RECORD
OCCUPANCY 12
SINGLE FAMILY
;ORIES
S—
S "'
MULTI. FAMILL::�—
—
�l F I'C ES
—
APARTMENTS
CONSTRUCTION
2 FOUNDATION
CONCRETE
8 INTERIOR
FINISH
PINE
HAROW 0
PLASTER
DRY —VVALL
a
1
2 13
CONCRETE BL K.
BRICK OR STONE
PIERS
3 BASEMENT
AREA FULL
FIN. B M T AREA
'/' 1/1 1/1
ATTIC AREA
t!O 8 M T
-FIN.
FIRE PLACES
HEAD ROOM
KITCHEN
-MODERN
4 WALLS 9 FLOORS
CLAPBOARDS
CONCRETE
--EAPTH
7—
HARDNIJ D
COMIACN
TILE
B
1
2
3
DROP SIDING
WOOD SHIN ES
GL
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
STUCCO ON mkSONRY
STUCCO ON FRAME
BRICK ON W-A—SONRY
ATTIC STRS. & FLOOR
BRICK ON FRAME
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR POOR
jl-�DEQUATE NONE
5 ROOF 710 PLUMBING
GABLE
GAMBREL
I
A
HIP
B TH (3 FIX.)
MANSARD
TOILET RM. (2 FIX.)
FLAT
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINCES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL_
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING 11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COILS.
STEAM
STEEL EMS. & COLS.
HOT W T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T G
UNIT HEATERS
7 NO. OF ROOMS
AS
OIL
B'M'T 2 1
lo 1 3 nrd 11
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
ot
um
-0
FORM U — LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdictic-n
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*****************
APPLICANT: -q(3 li" Z,4k11Y'_ V10 &Vlllc- Z-��a Phone
LOCATION: Assessor's Mar) Number
Subdivis4l.on
Parcel
Lot (s 1)
-7
S treet St. Nu-,,=er '�L !�- /
Use only************************
RECOMMENDATIONS OF TOWN AGENTS:
Cons ervaz ion Administrator
Cc=en4.,,-,=
Town Planner
C o-mrn e n t s
Fco' 1nsr_eC:-_or-;-ealth
SemzLc Insrec-=-Hea-ItIn
Cc=en,:=
Pu_' -_--_4c Wcr.*-Is - sewer/water connect -;:.ons
- driveway pernit
Fire Demartment
Received by Building Insmector
Date Ancroved
Date Re-iectad
J
Date Approved
Date Re-jec--ed
Data Approved
Date Re'� ec,:ed
Date Approved /17
Date Rejeczed
JUN
;,:FAffTMENT
Date
S, y f, 4 ��ee_�
ELEVATIONS
TAKEN AT
TOP OF PIPE
DWELLING ELEV.:
TANK IN:
m -j?'
TANK OUT:
IS5.61
tA_�_
D -BOX IN:
15 15 1/0 5
.\ N
D -BOX OUT:
I q -5
END OF DISTRIBUTION
LINE A:
B:
C:
D:
A
AS -BUILT SEWAGE DISPOSAL
SYSTEM PLAN
IN
AS PREPARED FOR
THIS IS TO CONFIRM THAT I HAVE
INSPECTED THE CONSTRUCTION OF THE
SAID DISPOSAL SYSTEM LOCATED ON
LOT elf -
THE S SPECIFIED IN THE
D S ATIONS DATED
P L AAA
Y cmmt4UA SSOC., INC.
J.
RDSAI I
NO. 654
DATE
MARCHIONDA & ASSOC., INC.
ENGINEERING AND PLANNING CONSULTANTS
62 MONTVALE AVE., SUITE I
STONEHAM, MA. 02180
(617) 438-6121
SCALE: ilo' DATE: 7 10 q[
M & A FILE No.:
COMMONWEALTH DEPARTMENT OF PUBLIC SAF
OF ONE ASHBOATON PLAC ETY
E
MASSACHUSETTS BOSTON, MA 02108
LICENSE C I AUTION
EXPIRATION DATE CONSTR. SUPERVISOR
FOR PROTECTION AGAINST -
04/20/1994: EFFECTIVE DATE LIC -NO.
FIESTRICTIONS..':.'' THEFT, PUT RIGHT THUMB
06/30/1993- 008828
:':-.PRINT IN APPROPRIATE
NONE
685-1 BOX ON LICENSE,
VAL.J LANZA
34 BI-XBY BLASTING OPERATORS
'L2151
Y :SS A 022�4'6. 6424 IREVERE"MA
Z MUST INCLUDE PHOTO.
PHOTO (BU�STING �OPR ON�L PAID
oo NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
STAMPED - OR - SIGNATURE OF THE CC)MMISSIONER
HEIGHT:
DOB: JUN .9 1993
04 / 20 119 51
THIS DOCUMENT MUST BE 7;(. SIGN . 14AME IN F IGQURE LINE
TURE OF LICENSEE
..CARRIEDON THE PERSON OF
THE HOLDER WHEN EN--
GAGEDINTHISOCCUPATION. SSIONER
OTHERS - RIGHT THUMB PRINT
HOME IMPROVEMWt T ACTOR
7 on
Registrati
RPORATION
Type � PRIVAtE*:'CO
EXPira V/02/��-N
tion
New England Cuiidm besign, In
Val Lanza
5 Billerica Paf;'�,_fol BilleriCA
ADMIN161HA1011 Billerica MA Or�21'.
A
DEPAF"�NT OF PUBLIC SAFETY
COMMONWEALTH 60MMONWEALTH AVE.
i1olo.
ECK,OR MONEY ORDER
OF BOSTON, MASS. 02215 ENCLOSE CH
MASSACHUSETTS
FOR REQUIRED FEE,
LICENSE
SUPERVISOR
CONSTR. BLE TO
N'DA E
PykTt MRAID
EXPI, t T
97. LIC -NO.
r6 ', ,COMMISSIONER OF PUBLIC SAFETY"
EFFECTIVE DATE
RESTRItTIONS
006/30/1991, 008828
SH).
'NONE, %PNI ?EAPA
J LANZA
'VAL
ST t) OFV I INCREAS-E
'34 B I XEB 'M A 2151 PLEASE NO T
SS 0 022-36-6424 R.EVER 0 so
1989
FEE, E ftCTIVE. FEB.
PHOTO (BLASTING OPR ONLY)
100. 00
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
OF THE COMMISSIONER
HEIGHT: STAMPED - OR SIGNATURE
LICENSE STUB��
DOB: D NOT
04/20/1W I -r SIGN NAME IN FULL -ABOVE SIGNATURE LI N E
--f LICENSEE
_ATURE OF
THIS DOCUME�NT BE
MUST
CARRIED ON T HIERSON
THE HOLDER W EN ENGAG- OmmISSIONER
PRINT ED IN THIS OCCUPATION. 1s4
OTHERS - RIGHT THUMB uor,
X.
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NEW ENGLAND CUSTOM DESIGN, INC.
FIVE BILLERICA PARK * 101 BILLERICA AVENUE
NORTH BILLERICA, MASSACHUSETTS 01862
(508)667-3600
Home Improvement Contract Registration No. 102467
RESIDENTIAL HOME IMPROVEMENT AGREEMENT
This is a legally binding contract Make sure you read this agreement and understand it before signing it Do not sign this contract
if there are any blank spaces.
NOTICE: All home improvement contractors and subcontractors, unless specifically exempted by Massachusetts Law, must
be registered with the Commonwealth of Massachusetts. All inquiries about registration should be directed to:
DIRECTOR- HOME IMPROVEMENT CONTRACTOR REGISTRATION
ONE ASHBURTON PLACE, ROOM 1301
BOSTON, MASSACHUSETTS 02108
TELEPHONE (617)727-8598
This Agreement is made on 19 9 el by and between New England Custom Design, Inc. (hereinafter,
"Contractor") and owner -77 o&� �iqk7X( (hereinafter, "Owner"), of
City / Town /-�, 19 & �).d Ve /< State. z0cL Zip e),2 -W 5� hone
Billing Address (if different):
job Address ("The Pren-tises"). 2 z�o Xz77, V. XA.ID,,) o:2
New England Custom Design, Inc. Salesperson V/1 4vi-y?4
A. DETAILED DESCRIPTION OF THE WORK TO BE PERFORMED.
The Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following.
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(-Z� r V-C� S, rl I z I O—Z 12—// �`7 1E L,,- 6P 4�1)-
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TotalContract Price $ ................ 0 ..... ..............................................................................
Payment Schedule
$ ......... ..... ................ S/
................................................................................................
oo
?
................................... .............. ......... ...... at, ........
0 Cf
$ ........ 1.�20.0 .................... . ..............
.................................. i5,22��J.h .....
. .............................
$ ....... 4,::�W ..................... ................ ........ ......... .
$ ............................................... BALAN.C.E..DUE.UPON..COMPLETI.ON..O.F..WOR.K ............................
............... .. .. ......... ............ ....................... ...... .. .. .......... ...
RIGHT TO CANCEL
The Owner may cancel this agreement if it has been signed by the Owner at a place other than the address of the Contractor which
may be his main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office or branch by
ordinary mail posted, by telegram sent or by delivery, not later that n-ddnight of the third business day following the signing of this
agreement. See attached Notice of Cancellation. A cancellation fee representing 30% of the contract price will be in effect if cancellation
is requested after the legally allotted time has elapsed.
A ON HOM W NOT SIGN THIS CONTRACT IF THERE ARE ANY K SPACES.
W
Owner's ignature l5ate' NeN� Englan�,6�t�o
Date
(9
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A - I
FORM U - LOT RELEASE FORM (r-.')%
INSTRUCTIONS, This form is used to verify that all necessary approvals/perrnits, ft
Boards and 2--partments, having
jurl Ict,on have been obtained. This does n
ot relift
the applicant and/or landowner from compliance with any applicable or requirenlients.
"**APPLICANT FILLS OUT THIS SECTION*V*****"**"**,"
,4 L
A./ Z,
-/APPLICANT M�kli_ZW&�_,4AIo (2v&7 -e,._7 1), 4 -Al 4
PHONE
1"10CATION: Aswswes Map Number 10�,A
VSUBDIVISION_ -8,A --- - - -M.— PARCEL__j,
�STREET 7 /51 LOT (S) _IL A
--- Mow---- ST. NUMBER-2zi 7
"**A - -OFFICIAL USE
11ENDATIONS OF TOWN AGENTS:
ATION ADMINIST_I�T_OR
COMMENT4_ —VUtflD /I ( �7
TnW1j 01 ALjLt=rj
C^Ar%
DATE AP_PROV�D
DATE REJECTED-
- ( I
DATE APPROVED
DATE REJECTED
--------------
.NTS
"Pu I WWIMAL I H
R -HEALTH
DATE APPROVED
DATE REJECTED
DATE APPROVEI)---------------
DATE REJECTED
COMMENTS
PU13LIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
L,,ZFIRE DEPARTMENT- 0 C4 ;k —;7z
RECEIVED BY BUILDING INSPECTOR
-7- nATC
Isd 16A,
az�
Office* Use Only
Permit Nq—a- �-2!— �cp
_k
Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
AJI work to be performed in accordance with the Massachusetts Eectrical Code 527 CMR 12:00
(Please Print in ink or type all information)
Town of North Andover
Date s-//2-/ or
To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number pcso,!�:f
Owner or Tenant AI V Lo
Owner's Aoddress
Is this pen -nit in conjunction with a building permit Yes C�' No [I (Check Appropriate Box)
Purpose of Buildin 6a�q
C.e a,, -7d I-Glnd-1 JXt7—) Utility Authortmdon No.
[Existing Service —Amps —Voits Overhead C1 Undgmd 0 No. of Meters
New Service _Amps__________Yort5 Overhead C3 Undgmd C1 No. of Meters.—
Number of Feeders and Ampacity
Location and Nature of Proposed Eectncal Work
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a cu.. en Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = if you have chec�ed YES please indicW type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER = (Please Specify) 7-:4
(Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Resquested L"'t Rough ali Cl (4/(—Flnal
Signed underthe Penalties of perfury,
FIRM NAME LIC. N10,�
9RXtrS1F/rAAV17&W
LIC. NO.
Bus TelNo.
Address /s, :5," I'a fl4e- 60 6�w, Alt"Tal. No.
OWNER'S INSURANCE WAJVER: I am aware that thdkicanses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Uw5. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No, PERMIT FEE $—E -SL
(Signature of Owner or Agent)
Total
No. of Ught8nq Outlets
No. of Hot fuse
No, of Transformers KVA
Above C:
In M
No. of Lighting Fixtures
Swimming Pool gmd C:
gmd C
Generators KVA
No. of Emergency Ugnting
No. of Receat3des Outlets
No. of Oil Bumers
Battery Units
No. of Switch Outlets
No of Gas Burners
FIREALARMS No.ofZone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Oio6sai
No. lumas
Tons
KW
No. of Sounding Devices
Nod of Self Contained
No. �of Dishwashers
SoacetArea Heating
KW
oetecdoruSounding Devices
C: Municipal C2 Other
No. of Orvers
Heating Oevicas
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Baflases
Wiring
No. Hvdro Massage Tuds
No. of Wtors
Total HP
I
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a cu.. en Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = if you have chec�ed YES please indicW type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER = (Please Specify) 7-:4
(Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Resquested L"'t Rough ali Cl (4/(—Flnal
Signed underthe Penalties of perfury,
FIRM NAME LIC. N10,�
9RXtrS1F/rAAV17&W
LIC. NO.
Bus TelNo.
Address /s, :5," I'a fl4e- 60 6�w, Alt"Tal. No.
OWNER'S INSURANCE WAJVER: I am aware that thdkicanses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Uw5. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No, PERMIT FEE $—E -SL
(Signature of Owner or Agent)
N2 ],,2 6
* . a 0, - .4
Date..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Ar
This certifies that ................... .............. . ........................................
has permission to perform ...................... ( .. ...... ............... ................................
wiring in the building of .............. /
* �- —.-I .... ; ....................................................
-e4 . ..............
at .... ... ..... .. ............. . North Andover, Mass.
Fee..... Yr. Lic. No . ............. ...............................................................
ELECTNICAL INSPECTOR
()5/12/98 12:20 85- 00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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Building permit Number 237
Date JULY 30, i991
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 267 BOXFORD STREKI__(LO�
MAy BE OCCUPIED As .. . ........ SI'' F F,!1,jjA1.LY--.D..UE'LL1 IN ACCORDANCE
SSACHUSETTS STATE BUILDING CODE AND SUCH
WITH THE PROVISIONS OF THE MA
OTHER REGULATIONS AS MAY APPLY -
CERTIFICATE ISSUED TO FLINTLOCK, INC
�—ox 5-31
r MA
Kth dOver Ma
ADDRESS An
SACHU5 uilding Inspector
Location
No. Date
40RTOI TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 3
$ I (,-U
A W Foundation Permit Fee
Other Perm ift%e� & $
Sewer,2onpection Fee $
Water Connection Fee $
TOTAL $ 3
Buiiaing Inspector
Div. Public Works
Location f
No. Date
TOWN OF NORTH ANDOVER
*!. �. .- " '6'V
aiingd0i Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
CHU
Other Permit Fee $
Sewer Connection Fee $
A IVA I �' �, ". #"
:2, 1 Water Connection Fee $ /V//�-
TOTAL $ /uu
9-16-
Buildin spector
M10. Arx'i)m cxl!cdoy
Div. Public Works
PF,inirit N& -21*111
APPLICATION FOR PERMIT TO BUILD —NORTH ANDOVER, MASS. 1�ezzlv / e a, V/ PAGE I
MAP'iq
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK "PAGE
I
ZONE I<J
�UB.DIV..LOT NO.
LOCATION
PURPOSE . OF BUILDING
OWNER'S NAMI-F-
NO. OF STORIES
OWNER'S ADDRESS
z�z
BASEMENT OR
ARCHITECT'S NAME
BUILDER'S NAME Xllwlzl�
z2L,��&Z-
2ND 3RD
SIZE OF FLOOR TIMBERS I Sjn8XI
SPAN
-
DISTANCE TO NEAREST BUILDING
DISTANCE FROM STREET
DIMENSIONS OF SILLS
POSTS
DISTANCE FROM LOT LINES - SIDES
7 REAR f
et",IV � J
GIRDERS
AREA OF LOT
FRONTAGE
HEIGHT OF FOUNDATION THICK EBB
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS
OF CODE �Ief
IS BUILDING CONNECTED TO TOWN WATER VKW -
BOARD OF APPEALS ACTION. IF ANY
meg
IS BUILDING CONNECTED TO TOWN SEWER
If%o,
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS OUNDATION ONLY
SEE BOTH SIDES L.�:,ILDSYPARIAHAC-
PAGE I FILL OUT SECTIONS I - 3 4 arD
PAGE 2 FILL OUT SECTIONS I - 12 ML __ J FEE PAR 02 &-v --
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUJT BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE F1'!:E'D-/Wx& "Ake
SIGNA'9UWr OF OW
F E El )v
PERMIT GRANTED
JUA)C 4 /
&I^
PERilhfT FOR MOUNDING
DRATI E: - FEE PAP...
, CI.
BLDG, PERMIT FEE
I ESS FDA FEE_�
FRAME PERMIT 8
2-7 0
3
3 PROPERTY INFORMATION
LAND C06T
EST. BLDG. Cost
---
EST. BLDG. COST PER -SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
SUILDIWO �INSPECTOR
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FORM U 10
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
SUBD`IVISION
AS!ESSORS MAP
:S Ze
SUBDIVISION LOT(S) z�
PERMANENT ADDRESS (A8SIGNED BY D.P.W.)
STREET
APPLICANT PHONE
f -g -
DATE OF APPLICATION
TOWN USE BELOW THIS LINE
PL-A.NNfG BOARD
A _ -h I
AM DATE APPROVED ZJvS
TOtteVtA-NNER, DATE REJECTED
CONSERVATION COMMISSION
CONSERVATION ADMIN.
DATE APPROVED
DATE REJECTED
BOARD OF HEALTH -
DATE APPROVED
EALTR SAN TARIAN'---- DATE REJECTED
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PER111T E!Ajxj�4
SEWER/WATER CONNECTIONS
."2 1" d'
FIRE
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and Ilealth Boards,
the Co'nservation Commission prior to the issuance of any building permits
f6r the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
Any.aPpeal shall be filed
With
d a -t,,-, s after the
of "iVthis Notice
in tile Office 0 the
Clerk. YOWn
0
A 1L7TV
C U5
"VTVw'4'
TOWN OF NORTH ANDOVER
MASSACHUSETTS
BOARD QF APPEALS
NOTICE OF DECISION
30
Anthony & Frances Szelest June 26, 1990
Date............................
PefiVion No.. . . . 110-. 8 9 ...........
May 1, 1990
Date of Hearing. J-une. 12,. 19-90 ...
June 25, 1990
Petition of .... Anthony . & Frances S . zelest ...............................................
....... ....... ......
Premises affected Lots. 4.,.6,9,10. and .11. Boxford. Str.eet ................................
Referring to the above petition for a variation from the requirements of the . Section. A..2,..
Paragr.4p.h.j thr.0 .8 of. the, Zoning. Bylaw .................................................
so as to permit construction. of. single. f amily. res.idences. on .10. lots in. a 12. lot
sub-Aivision .............................................................................
After a public hearing given on the above date, the Board of Appeals voted to GRAN.T ..... the
Variance ... as -requested ........ and hereby authorize the Building Inspector to issue a
permit to Anthony - Frances. Sze.lest, - F.l.intlock-,. -Inc ...............................
Signep
..........
Walter Soule, Clerk
..........................................
Raymond Vivenzio
Antia, 01-Co-n-n'o'*r*
Louis. Rissin ........................
.................................
Board of Appeals
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THIS PLAN IS INTENDED FOR ZONING
PURPOSES ONLY. IT WAS COMPILED
FROM EXISTING PLANS AND RECORDS
WITH BUILDING LOCATIONS CONFIRMED -
IN THE FIELD. IT SHOULD NOT BE
USED FOR PROPERTY LINE DETERMIN—
ATION.
THE BUILDING IS NOT LOCATED IN AN
ESTABLISHED FLOOD HAZARD AREA.
ZONING:
REQUIRED SETBACKS:
FRONT: '30
SIDE: so
REAR: 30
CERTIFIED PLOT PLAN
IN
NOZT44 Ajv0v&7<AA
AS PREPARED FOR
PAyE
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M & A FILE No.: 351-C>l
WE HEREBY CERTIFY THAT WE HAVE EXAMINED
THE PREMISES AND THAT ALL EASEMENTS,
ENCROACHMENTS AND BUILDINGS ARE LOCATED
AS SHOWN. ALL BUILDINGS SHOWN CONFORM
TO THE,��LAWS OF THE MUNICIPALITY
WHEN C
PAUL
MARCHIONDA
No. 30015 1
T,
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,Aa,P_E. f)ATE '
MARCHIONDA & ASSOC., INC.
ENGINEERING AND PLANNING CONSULTANTS
80 MAPLE STREET
STONEHAM, MA. 02180
(617) 438-6121
SCALE: 1"= q0' DATE: 6- JZ -9 I
�Ocation --,-7 6,
No. Date
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Q4
us
Other Permit Fee $
Se%Wer Connection Fee $
Water Connection Fee $
��4
TOTAL $
N2 iM4
Building Inspector"
Div. Public Works
Location
Date
No.
TOWN OF NORTH ANDOVERcE
0
4L
% Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
4
Water Connection Fee $
TOTAL $
Building Inspector
Div. Public Works
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HOME IMPROVEMENI- '.-,ONTROCI-ORS REG]"I'R(I I
Board of Builclino Regulations ancl Stail(-k-t'l
Room 1301
one A-shbLirt,(.;n Place
Boston, Mal.-!.:z;ac hu set ts 02100
HOME IMPROVEMEN'r CON'1-F-',A.(-.'1-0R
Registration 102467 ir-xpii-ation 07/02/'),*i
I'ype - PRIVA'1"E CoR,.PoR(-)-1'-10N.
NEW ENGLAND CUSI'OM DESIGN, INC.
Val Lanza
10i Billerica Ave Bld 5
N. Billerica MA 01822
R�!�tricted To: 00
OEPARTMENT Of PUBLIC SAFETY
8 None
CONSTRUCTION SUPERVISOR LICENSE
Number; Expires: Birthdate: A Masonry only
C s .058828 041H11998 I & 2 family HOM -ent edition of OP
Restricted To: 00 ;a; lure to possess a curi
4.a;sachusetts state 86ilding Code
i!! cause for revocation of this license.
�F4)dJJW'A 4011 VAL J LANZA
34 BIXBY ST
REVERE, KA 02151
51988
it -
ell
'L, / . ..
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/per" frcrm
Boards and 2--partments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requireffwnts.
APPLICANT FILLS OUT THIS SECTION
VA L Z'A Z-4
PLICANT M��kl J'P164-,4,V,0 C-
AP PHONE 099�
t'LOCATION: Asseswes Map Number J 0 A PARCEL__j_
VSUBDIVISION LOT (S)
�STREET ST. NUMBER 7
IIENDATIONS OE TOWN AGENTS:
- , A 4 ( i � A �
TION ADMINISMATOR
COMMENTS VUWO_Alf� '7
USE ONLY��",__**_ -IM
DATE APPROVED - --,fj to
DATE REJECTED— T__T
- i I A
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
TH
COMMENTS
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERiWATER CONNECTIONS
DRIVEWAY PERMIT I
1 ,""'FIRE DEPARTMENT V�� a /�X /-/' '?
RECEIVED BY BUILDING INSPECTOR DATE
s
GLORAL-
REGISTERED LAND SURVEYOR 0 REGISTERED PROFESSIONAL ENG -ER
24 VERNON S r. -1ELD, MA. 0/880 r- 246-9345 6-9338
WAKEF
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LOT I IA
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SIGNATURE DATE
— --------------
0
ALb
A.
MANO
1307 7
PLOT PLAN
IN r
NORTH ANDOVER, MASS.
w
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OWNED BY
SCALE I"t. 60' . DATE 3-19-98
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PRODUCER
CERTIFICATE OF I-N---S-*--*---------'---'--'"-----------'I
URANCE f.,DATE (MM/DD/YY)
KILG�DRE INSURANCE GROUP
33 C�INTENNIAL DR
PEAB:-)DY, MA 01960
(978,',; 531-655_Q____FAX:
i§U_FlffD__ �
NEW ENGLAND CUSTOM DESIGN, INC.
t226 LOWELL STREET UNIT B4 -A
WILMINGTON,MA 01887
__T_HI`SI�Ehfl�_lCAjt- -is
ONLY AND CONFERS Is S bt b_4§ -4-M A�ftt Fi-
NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICI
ES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY
A
_ COMMERCIAL UNION COS.
COMPANY
B SAFETY INSURANCE
COMPANY
C
_ TRAVELERS INSURANCE
COMPANY
D
_iHIS IS TO' CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN 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
CERTIFIC ATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE A;:FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY 14AVE BEEN REDUCED BY PAID CLAIMS.
Y EFFIE IVE 'POEXP �RATIYON
CT LICY I
Y) (MM/ /Y
POLIC
CO
LTR IYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIV POLICY EXPIRATION
DATE (MrvVDD/YY DATE (MM/DD/YY) LIMITS
LGENER f L LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [X OCCUR
A —OWNER'S & CONT P�OT RENEWAL OF
FBLP04167 0
1 AUTOMOBILE LIABILITY
Al\ . AJITO
AL, OWNED AUTOS
�X_ SCIEDULED AUTOS
B HIFILD AUTOS 62853
I-) NON OWNED AUTOS T6 2 8 5.3
_�ARAGE I �li BILITY
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EXCESS 1, Z' IiLITY
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C THE PROP -"',I[ TOR/
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INCL 12 6 3X3 7 2 6
OFFICERS ARE:
EXCL
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ACORD 25-S (3/_q
GENERAL AGGREGATE
PROD UCTS-COMP/OP AGG
PERSONAL & ADV INJURY
/99
M/14/98 �03/14 EACH OCCURRENCE
I
FIRE DAMAGE (Any one fire)
M M '.P
ED EXP lAny one person)
COMBINED SINGLE LIMIT
BODII-Y INJURY
(Per person)
ll_0_0'_0_0_0___ I
104/05/97 104/05/98 BODILYINJURY 1 250,000
04/05/98 04/05/99 (Per accident) f $
! 50_0_,_0_0__0____
PROPERTY DAMAGE $
10
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY-
EACHACCIDENT I$
AGGREGATE $
EACH OCCURRENCE $
LB
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Per accd
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$
X STATUTORY LIMITS
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103/14/98 03/14/9 DISEASE
9 POLICY LIMIT
1$50 - 0' 0_00__
DISEASE -EACH EM LOYE -1 r) r% r%
t P E Sl r) ()
CANCELLATl0__N'---------�
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS On REPRESENTATIVES.
AUTHOR I * ZED R�_PRi.jENT__A__T_lV_E_
Cc--
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: (0 IN
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print.
PROPERTY OWNER npj_ t— g I , . _; --"- .
Print Old -Structure
MAP NO: PARCEL ZONING DISTRICT: Historic District
Machine Shop Villa
yes no
yes no
ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Reside -*9f
Non- Residential
0 New Building
e family
El Addition
El Two or more family
El Industrial
0 Al ion
No. of units:
El Commercial
R'Aepair, replacement
El Assessory Bldg
0 Others:
[I Demolition
0 Other
El Septic 1 11 Well,
0 'Floodplaih 0 1 We t1a I ncl�
0 Waterth edibisirict
El Watef/Sewer
: � �191,
RIPTION OF WORK T0,1if- FEaORIVILL),
1�9 0 0/75y_ /T:L� /i:� 00
T LL '01N\/L 5�:(Dt
C C_: -:!3
OWNER: Name
I a 0 L) e- R_ '7
_jUgntification Please Type or Print Clearly)
Q b 0 N 1-0/
Address: V
CONTRACT -OR NaffiO:
Address: zs�a z, -e D__
Supervisor's Construction License: Exp. bate:
Home Improvement License: Exp. Pate:, -7
ARCH ITECT/ENGI NEER Phone:
Address: Reg. No.
�A�
-1 IW\_
0.-3 -Z;S-_-007&Y
FEE SCHEDULE: BULDING PEROPT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
2
St: (00
Total Project Co FEE: $
Check No.: Receipt No.: 2 -
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Plans Submitted 1] Plans Waived 11 Certified Plot Plan [I Stamped Plans 11
Building Department
�-Thefoh'-jw1ng*iv-a*]i'stof the r6�ujfed forms to be.filled out'for the appropriate permit to, be obtained.
Roofh�g, Siding, Interior Rehabilitation Permits
B,uilding Permit Application
Workers Comp Affidavit
Photo Copy Of H. 1. C. And/0'r G. S. L. Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for E . ngineered products
NOTE: All dumpster. permits require sign off from Fire prior to issuance of Bldg Permit
Addition Or Decks
Lj Building Permit Application
• Certified Surveyed Plot Plan
• Workers Comp Affidavit
E3 Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Contract
• Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Mass check Energy Compliance Report (if Applicable)
• Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
Ej Building Permit Application
L3 Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
• Workers Comp Affidavit
• Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Copy of Contract
• Mass check Energy Compliance Report
• Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp tfie,decision from the Board of Appeals
that the apt).?al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Building Permit Revised 2012
Location2-Q;:,I J S44A+
No. C, I (� (P
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee $ E!� I 2,0D
Foundation Permit Fee $-
Other Permit Fee $-
TOTAL $
Check #
2'/ 679
BuildAg Inspector
..Plans Subm itted 'Plans-Waive'd-11.2;
..'.,--.Certified Plot Plan
Stamped Plans' F1
TYP
?R-0F;.SEWE-RAGE_DlSP_0SAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools 0
Well
Tobacco.Sales
Food Packaging/Sales El
Private.�(,sep'tic ta*, ete.-
rmaiidnt DUmpster Gn�site El
THE- FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
-.-,.--DATE REJECTED.--_. DATEA PPROVED
PLANNING & DEVELOPMENT' D
COMMENTS
-CONSERVATION Reviewed on
Si6nature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature -
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comme
..Comments
Water & Sewer Con nection1Signature & Date Driveway Permit
DPW Tow;! Engineer: Si
Located 384 Osgood Street
:.FIRE 'Dump,
steroh site . no
A
re do-aft—merl A-N--,-%
e d44
COIVIMEN'TS`�
--Dimenston
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
-Total land -area,, sq. ft.*
-ELECTRICAL: Movement of Meter, location-, rriast or service drop requires approval of
'.Electrical Inspector -Yes No
DANGERZONE LITERATURE: Yes No
MGL-Chapter166. Section 21 A �F and G min.$100-$1000 fine
NOTES and DATA — (For clepartment use
I
El Notified for pickup - Date
Doc.Building Permit Revised 2010
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CS # 022680
HIC# 103358
� Propiosol ===
A. J. Walsh & Sons
55 Pleasant Street
.North Andover, MA 01845
of - pages
978-688-6737
or
1-866-AJWALSH
Proposal Submitted To Job Name Job
Job Locationji
Address
Date —17Z�olf Plans
A --
Phone #
Ojr- I Fax # Architect
We hereby submit specifications and estimates for
M
11 /-�) ,,
4
V
C. 11
->46440 -7
or We propose hereb(to fumish material and labor complete in accordance With the above specifications for the sum of:
010
$ Dollars
with payments to be made as follows: OJV t2 �- LI)O, L40 0
Any alteration or deviation from above specifications involving extra cost will be Respectfully
executed only'upon written order, and will become an extra charge over and
Wes, accidents, or delays
ab theestim' a. All Agreements contingent upon ate submitted
ove
beyond our c6hirol. Note — this proposal may be withdrawn by us R not accepted within _ 4days.
2cceptance of Prop ' oo
The above prices, specifications and conditions are satisfactory and are --- �aignature
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above
Date of Acceptance — --- ?/.? / /Z Y— Signature
I- LV I J I L . I/-, 1%VVVV Lit I t.V lll%JVI%rl]VVL
I CERTIFICATE OF LIA
THIS CERTIFICATE 13 13SUED AS A MATTER OF INFORMATION ONLI
,#ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN
OF -LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIT�.
REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER.
, MPORTAINT: If the certificate holder Is an ADDITIONAL INSURED, the
he terms and conditions Of the Policy. certain policies may require an a
;ertIfIcate holder In lieu of such endorsement(s).
)bUrFR 00775 - 001
orso & Jankowski Insurance Agency Inc
8 Mass Ave Suite ims
)rth Andover, mA ams
)RED
thurWalah
J Walsh &Sons
Pleasant stmet
)rth Andover, MA 01845
)VERAGES CERTIFICATE NUMBER: -
HIS IS TO CERTIFY T14AT THE POLICIES OF JNSURANCI
IDICATED. NOTWITMSTANDINQ ANY REQUIF.Emrr'l 1, It:
ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE I
XCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS
IVV. LVIU I- - I )
kBILITY INSURANCE DATE(MMIDDIMY)
1 1210412013
r AND CONFERS NO RIGHTS UPON THE CERTIOICATE HOLDER. THIS
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
rE A COhTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
POIICY(185) MUSt be endorsed, If SUBROGATION1 18 WAIVED, subject to
ridorsement. A statement on this certificatis does not confer rights to the
RAeCT
FX8.1o. EXH! - (07!).682.5175 No.1 (976)794-0313
101680:
INSUR VERAGE
,Nsugffg A. A.I.M. Mutual insurance Company 33758
INAURCR a i
INSUSER Q -
INSURERD!
LibIGURER E 6 1 1
I INSURPR F -
45 INSURED NAMED ABOVE FOR THE POLICY PERIOD
t OTHER DOCUMENT WITH RESPECT TO WHICH THI$
)ESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS,
r-LAIM-A
TYPE OF INSURANCE
OFENERAL LIABILITY
COMMERCAL OENERAL LIABILITY
CLAIMS-MADP 17 OCCUR
VOW
POLICY NUMBER
MA—MUMN
ARM
LIMITS
E�CH OCCURRENCE
DAMAGE ED
PAEMISSS Ilia Q=LMM91
MED EXP (Arty one peraon)
PER13ONAL & AQV INJURY 3
GENFRAL AGGREGATE 41
MENPL AGGR4GATE UmIT APPLIES PER:
RO 10
::J-0LJCy F—Wi [ C
PRODUCTS - COMPIO;k AGG $
AUTOMOBILE.
LIABILITY
ANYAUTO
ALL 0 SC EDULED
S
AUTOS AUTOS
HIRS "':S NON-OVMEO
D AU qAUTOS
COMBINED
(Fa n=1de
BODILY INJURY (Per poldon) S
BODILY INJURY (Per wmenk) S
PROPERTY DAMAGE
UMARELLA LIAB
EXCESS LIA-8
OCCUR
CLAIMS woe
EACH OCCURRENCE
AGGREGATE
OED RETENVON S
YIN
9�10 TAI�WPA�
PIM -MbWECLfrfVEFN
(Mandalmy In NH)
91RA!90-955RATIONS bei.
MIA
AWC-400-7014648-2013A
1111412013
-T
1111412014
X
E.L EACH ACCIDENT 100,000.00
F -L DISEASE - F.A EMPLOY�� 100,000.00
IL DISEASE -POLICY LIMIT 8 600,000.00
'RIPTION OF OPERATIONS I LOCATIONSI VEHICLES (Anieh Acoao 101, AdC11IIoA41 Romarks SchadLdt, If more 4pace In required)
in Of North Andover
) Osgood Street
:h Andover. MA 01846
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES OE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE VALL BE DELIVERED IN
ACCORDANCE MTH THU POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ORD 25 (2010/05) The AGORD naMe and logo are registered marks ;�i66WD'
TZ
ss Regulation
Consumer Affair, &.gu,i-
Office of
—M
OME IMPROVEMENT CONTRACTOR
-201 R,egistration: 103358 Type:
Xpiration: 7/7/2014
Private COrporati(
A. J. WALSH & SONS,INC.
Arthur Walsh,Jr.
55 Pleasant St
N Andover, MA 01845
UnderSeCretal.3,
Massachusetts .. Department of Pubkc. Safety
Board of Building Regulations and Standards
Construction SuperviNor
�_icense: CS -022680
ARTHUR J WALSH JR
159A WAVERLY-RD
N ANDOVER AM 01845
06/09/20
Office of Investigations
600 Was1iington Street
Boston, JVA 02111
wwMinassgovIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluinb . ers
plicant Information Please Print Legibil
lie (Busiiiess/Orgariization/Individual):
iress: 16� 0- W ft e -k L
//State/Zip:_,�.() . "p 0 1) ep
f 'V)— Phone#:
,;Vo �mployer? Check the appropriate box:
0
I �ama employer with 4. E] I am a general contractor and I
employees (Rill and/or part-time).* have hired the sub -contractors
I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub -contractors have
working for rne in any capacity. employees and have workers'
[INo workers' comp. insurance comp. insurance.!
required.]
I am a homeowner doing all work
myself [No workers' comp.
insurance required.] T
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'
comi). insurance reauired.1
--z� 73
Type of project (required):
6. E] New Construction
7. E-R-emodeling
8. F -I Demolition
9. n Building addition
10.n Electrical repairs or additions
ILEI Plumbing repairs or additions
12.[] Roof repairs
13.0 Other
)1icant that checks box #1 must also fill out the section below showing the:ir workers' compensation policy information.
wners �vho submit this Widavit indicating they are doiiig all work and then hire outside contractors must submit a new affidavit indicating such.
tors that check this box must attached an additional sheet sh - owing die name of the sub -contractors -and state whether or not those entities have
.s. If the sub -contractors have employees, they must provide their workers' comp. policy number.
i employer that isproviding workers' compensation insurancefor my employees. Below is the policy andjoh site
qtion.
ce Company Name-_ Mai WAL /A G 0
V or Self -ins. Lie. 4: -7 0 ly(e
- C> D Expiration Date: ---/Z— /4/
�Address:,),,(,-7 eoy, City/State/Zip: jVO /1-1V /0 41-Jele /4*74
a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
to $1,500.00 and/or one-year imprisonment, as well ascivil penalties in the form of a STOP WORK ORDER and a fine
� $2SO.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
,ations of the DIA for insurance coverage verification.
PebY cerdi"derthepains andpenalties ofperju'Y that the information provided above is true andCOMOCI,
A . . . I
MR.
M
4al use only. Do not write in this area, to be completed by city or town official
or Town:
Permit/License #
41112
ng Authority (circle one):
)ard of Health 7. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
'her
Phone 4 -
act A-.r.Ron-
MASSACHUSETTS HOME IMPROVEMENT CONTRACT
This form. satisfici-all basic:roquirements ofthe states Home ImPlOvernentContmettir Law (MGL chapter 142A), lint doei not iriclude siandkYd
language to protect homeowners. Seek.legal advice ifn h,
ecessary. Any person planning ome pp ' ints sho4d: b M*m* ticopy 0
rovern 0
Massachubeftconsumer.guide to home,improvethent" before agreeing to any work on yourresidince, you may obtain -a freecopy by'calling the
Office ofConsumcr Affairs and Business,Regulation!s Consulner Information Hotline at617-9734787 or 1#888*283.3.751.
Homeowner Information
Contractor Information
Name
;Mpany Naoi.
Street Address (do not use.a Post Office, Box address)
Z671)1�09
�;mitractorl Name
5w p -w Own
-,F4,7 D �;T
Cityfrown side Zip Code
Business Address (mast include a streetarl")
1/41/0 )91V10 6 10 e R_ /w/T
Daytime Ph e Ev * cn4ftonti.
Ntyn own State�/ Zip Code
Mailing Addross (It different bom above)
3usiness Phone Sederal Employer ID or S.S. Number
L.. ftq� ual m" h" i�
The Contractor agrees to . d . o the following work for the Homeo*ner-
W1 Me Wro 0 com I
Required Permits - The following building p ermits are required
and will be secured by the contractor as the'liomeouter's stgcnt�
(Owners who',secure. . their own permits wiH be
excl��ed.,.fromthe�Guar.antyFiind'provisionsof
MGL chapter 142A.)
Total Contract Price and
Proposed Start and Cprerpletl'
on-Sibeelate - The following schedule will
be adhered todfiless. circumstances beyondthe coritractriesi control arise
when contractor will begin contractied work.
when ..contractid -work willbesubstandidly rompletrA
PcH�Xm We wGrX, n11111411 Me Material and labor specified above for the.total sum -. "(,OWL -V 4
of M
Payments will be made according to the Mowing schedule:
upon,signing contract (notto, exceed 0 of the total.exintract price gr the costaf Spec
ial order whichever is. greater)
S 00by / or upon corn�lction of
$J608,00 by / or upon completion of
s 7 A upon completion of the contract (Law forbids denumelitig full payment until.contract is cc th party!s. satisfaction)
no following matmial/equipment must be special paid for
ordered before the contracted work*izLs in order �_,7
to meet Elie completion s&edule.(**) to be.paid for
mance charges (**) Law requires tbat any deposit or down -payment required by the contractor before work begins may
NOTES: (0) including all f
noVexceed The greater of (a) one-third ofthe total ormtract: price or (b) the actual cost of any special equipment or custom made material
which must be special ordered in advance to race the completion wbedule.
Express Warranty -Is an exyress warranty hing:provided by the toretractor*9 No Ys! terms 21 1111BI, =2.,�eo to tbuollrjrp�
Subcontractors The contractor agrees to be solely responsible for cd*lction of the work &a ad iegardles ons;ofany thiid
parly/subcontramr utilized by the contractor. Ile contractor further agrees to be solely responsible for all payments to all subcontractors-f6i
matrrialsandla rund . ent
Contract Acceptance - Upon signing, this document becomes a binding c
contract WWI not imply that any lien or other security intercstlas been ontract under law. Unless otherwise noted within this document the
carefully before signing this contract placed on the residence. Reviaw.the following cautions and notices
0 Don'tbepressured into sighingthe contract. Taketimeto readaindfully unticestandit, -Ask-eluestions ifist-&Iiiiijisimelear.
Make sure the contmamha&a valid Home ]in - Reiristration Ile Wv; requires most home improvement contractors and
subcontractors to be registered with the Director ofHome Improvement Contrite Regi tion. you may u
.One Ashburton Place, Room 1301.,.Boston, -MA 02 108 orby. calling 617-727-3200 or
registration by writing to the Director it tdir Itim inquire abo t contractor
1-800-223-0933.
• Does the contractor have insurance? Check to ScOth.11t Your.coutractor is properly insured.
• Know your rights and responsibilities. Read the ImportainfInformation an the ireverse side ofthis 116 'copy of the Consumer
Guide to the Home hhProvement Contractor Law. rin and get a
You may cancel this agreement if it has been Signed at a Pl&c& Other than the C011131IL161's normal place oftnisineas provided you notify the
contractor in writing at his/her main offlic or branch office by ordinary mail POStCA by telegram sent or by delivery, not later than midnight ofthe.
thiid business day following.the signing ofthis agreement. . See the-auched notice of cancellation form for an explanation of.this right
DO NOT ST r.N 7741.R rnN'rD A f -r TV q�rrvirs im A " " A — — . - — __ � __ - - - -
Twoideatice copies �rbecon,19WRACIS400i Onscopy.ftuldplothe
COW WMW be kept by ft coaftlaFter.
�HOmcownc S Ignature '2_
Contractor
or S i Store
gn
Date
�Datc
Contractor Arbitrdii6ns
The Home Impovement-Contractor Law:provitips.-homeowners with4he-right'-to-initiate an arbitration action (as an
ion'
alterrui ve ' Wbourtacti - �ihhi.w.havea-. 'with a contractor. Thesame iig'hfis m Lok' automatically afforded toa
Contractor,. lt�wevei_fi� contricW would haveAp resolve any,tiftputi �cVshe.has.witb a homeowner m' courtul fless.
�oth parties agree to the optionall clause provided below.. This clause m6uldgive & contractor the. satlle.rfght 16
arbitiaiion As is afforded to the homeowner. -by the Home Improvement Contractor Law. i
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute -
concerning this contract, the contractor may submit the dispute to aprivaie arbitration firm which hag been Approved by
the S ffi f Consumet Affairstrid Business Regulation andihe consur I ner shall be required
1;,cre, oFfhthe ecuti ce 0
to sl mitt c i itrati provided In -Massachusetts General LawsyMpter 142X
Hqy(eojW;er`i; Sigrulture Contractor's Signaturi
TIOPM I The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution
"ated by the contractor..::.,The�:homeDwner.may initiate altenc.Ativedispute resolution even where this sectipAis not
tpnArAt6lvsiLyn�diw'.th6nmties,.,..-
Homeowner's Rights
A homeownees rights w . A *OAboe.-Improvement Contractor Law (MGL chapter 142A) and other consumer
protection laws (i.e. MOL c6p� 9Sk) may not be waived in any way, ev6 by agm=ent: However, homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowneq who secure their.own building permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contractor Law. The -contractor is responsible -for completing the work as described, in a
anner Homeowners may be entitled to other specifir. legal rights if the contractor guarantees,
timely andmorkmanlikem, r.
or provides . an. express . warranty for workmanship oir materials. In addition toguarantees.�or warranties provided by th ' e
contractor, all goods sold in Massachusetts carry an implied warranty of merchantability And fitness -for a particular
purpose. An enumeration of other matters on which.the homeowner and contractor lawfully agree may be Added to the.
terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions. about
your c . onsurner/homeowner rights, contact the Consumer Information Hotline (listed �elow).
Execution of Contract
The contract must be executed in "gicate and should not be signed until a copy of all exhibits and referenced
documents have been attached. Parties are also advised not t6 sip the document until all blank sections have been
filled in or marked as void, deleted, or not applicable. One original signed copy of the c�ontract with attachments is to
be given to the owner and the other kept by.. the contractor. Any modification. to the gfiginal*o6niract must be in writing
and agreed to by both parties. Contracted m;ork may not begin until both parties have received a fully executed copy of
the contract and the three day recission period has expired.
Accelerated Payments
A contractor mpy not demand payments in advanceof the dates specified on the payment schedule in cases where the
homeowner deems him/herself to be financially insecure. However, in instances wherta contractor deems him/herself
to be financially insecure, the contractor may require that the. balance of funds not yet due be placed in a j oiij� escrow
account as a prerequisite to. continuing the contracted work. Withdrawal of funds from said account would require the
signatures of both parties.
Additional Information
If you have general questions ormeedadditional information about the Home Improvement Contractor Law or other
consumer "A Consumer Guide to the Home.Improverrient Contractor
Law, contact:
Cqnsumer-Information Hotline
Office -of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
(617) 973-8787 or 1-(888) 283,1757
If you want to verify thelegistration of a contractor or if you havequesti6ns or need. -additional inftirmation specificahy
about the contractor registration component of the Home Improvement ContractorLaw, contact:
Director of Rome Improvement Contractor Registration,
Bureau of Building Regulations and Standards
One Ashburton Place, Room 1301, Boston, MA 02108
4-800-223-0933
(617) 727-3200:or
For assistance With informal mediati tin: of diisputes or to- register f,ormal complaints against alyas j-dift,
Co ee0bimplaint'Settion:
Office of the Attorney General
(617) 727-8400
AND/OR
Better Business Bureau
(508) 652-4800
(508) 755-2�48
(413) 734-3114