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NORTH ANDOVER BUILDING DEPARTAENT
W11 -
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TED 1600 Osgood Simet
NorthAndover
Tel: 97-8-698-045
Fax: 978-698-9542
B MESS FORM FOR TO WN CLEW
DATP,-.—
NAME:
ADDREM, -�7
,0NMGDlSTB—fC"-':
TYM OF W81088-.- -�Z- /S� no NO2
BUMI)INGLAYOUTPROVIDED: YES
MAMA -MR, PARMG SPAMS-,
ZONINGBYLAWMAGE., N -O
BUMDING INSPECTOR SIGNATM
MUSMSSFORMFORTOWNGLERX
2.40 Rome Oceupa&n (1989132)
An accessmy uso conducted vvithin a dwelling by a rqjd�4t wh� resides ia the, dwalling as his principal
address, which is clearly 8econdarylo tho we -of the -b. Oft for living �Iuposes. Home Occupations
"lacli0q, -b6t jiotlimfted to the fbJ]owkg uses; personal servicos such as farnished by an ark or instlaotor,
but not o-ccupation involved wah motor Whicle; repairs, teaii4r paxlomq, aMMI kemels., or fho conduct of
orthemaauflhdud�g agoods, wbichimpacts 6oxosldeatialmtureof thDneighborhood,
4. For -use of a dwelliag ia py residential district or multi-&nily distdct for a home occup6lion, thG
foll owipg conditions " agly.
a. Not more than a total of f4pq (3) ppople, may �9. qrppjoy4, �R tojtoy�p occupation, one of
a-qd
-whom shall b5ihe.-ovoior of fl'id pooppation residingift
b. nousoi.-caniedonWotl3rviffiintop:dnripalbddiug;
o, Ifiare " be no exteiior alterations, accessoty bdfta., or &play which arotot customaw
with rcsidaiitial buildings, -
d. Not more. Ilm fwm�r-f Ive, (25) por=t of the e�dgtiqg gross f toor area offhe, diveft ITit.
so us4 not to Pxcced aue, thousand (1000) squato Rd, is devoted to'such vso. Jh,
comectionwith
mch use, thero is to be kept no dock in trade, commodifies or products which Gocupy,9paca
bkyondthesoWts;
Tfiizie will be. no display ofgo6& or wares -visible from the, stred;
f no bdding or premises mcqpied sh9 mt be rendared objectionable, or ddrhnmfd to the
reside-nVal charadox of Ihe, neighboyhood due to the extedor appearance, emission of odor,
gas, amoko, dust, noisq, &h6anc-q. or in any other way become objeotionablo or
deftimental to any residential. use. vviihin. the neighboyhood;
g. Aky sach bWdmg shOl moludo no leataws of dosip not aust&naW in bidi dings for residential
Signature
N
ClaL.
CUSTARD
INSURANCE ADJUSTERS
5/19/2015
Gerald Brown Inspector of Buildings
1600 Osgood Street
Building 20, Suite 2035
North Andover, MA 01845
Claim Number:
Policy Number:
Company Name:
Date of Loss:
Insured:
Property Location:
033588678
03486400004
Arbella Mutual Insurance Company
3/30/2015
James Kachulis
268 Massachusetts Ave
North Andover, MA 01845
To Whom It May Concern:
Claim has been made involving loss, damage, or destruction of the above captioned property,
which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6,
to be applicable.
If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please
direct it to the attention of the writer. Kindly include a reference to the captioned insured,
location, date of loss and claim number.
Very truly yours,
Arbella Mutual Insurance Company
PO Box 699225
Quincy, MA 02269
CC: City/Town Fire Dept, City/Town Health Dept
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... 5.—.A //-, �� ......................
has permission to perform . . '.-P. L-1 .............................
plumbing in the buildings of . .1k ...................
at. . -IA'14 J -J. //7-:-: ............ North Andover, Mass.
Fee. L i c. N o. . 'F1 . .........
PLUMBING INSPECTOR
Check #
6695
MX
A
lViAbSACHUSETTS UNIFORM APPLICATION FOR -PERMIT TO -DO PLUMBING
(Print or Type)
xt_4a4�_11 �,ass. Date 20 Pe mlt 4
Building Locatio
Ownerl,�,�m
Pe Of Occupancy
New 0 Renovation o Replacement/ Plans Submitted: . Ya_Q n pai
B.P. #
SUB-BSMT
BASEEMEINT
4T
1ST FLOOR.
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
9M FLOOR-
nstalling Company Name
kd
usiness Tilephone
ame of Licensed P1
FIXTURES
�SEWER #
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INSURANcF: rnvco.,�.
Check one: Certificate
0 Corporation - ------------
0 Partnership
tr-'Firm/Co.
I have a curr;en�t �Jljl billty insurance policy or Its substantial equivalent. which meets the requirements of MGLCh. 142.
Yes No
If you have checked Yes, please Indica
k liability . insurance policy . te the type of coverage by checking the appropriate box.
Other type of Indemnity o Bond 0
)WNERIS INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage r . equired by Chapter
42 of the Mass. General Laws, and th . at my signature on tWis 139r_Zi�a�pllcatlon waives this requirement.
;ignature Of Owner or Owner's Agent
Check one:
Owner 0 Agent [I
reby certify that all of the details and -information I have submitted (or entered) In above'applicatlon are true and, accurate to the best of
w.. comp" c
ca a n w
knowledge and that all Plumbing work and Installations Performed u r the perml asued for t�h�l a Plication will be Incom with
ZL Z pilance
t I
e
3ertinent Provisions of the Massachusetts State Plumbing Code and h t 42 of a G eral La
By
Sig of Lic
n Plum er
Title Sign re of Licensed P u er
own
APPROVED (UFFICE USE ONLY) Type of License:
0.lourneym�an
License Number_��3�.
.SEPTIC #
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Check one: Certificate
0 Corporation - ------------
0 Partnership
tr-'Firm/Co.
I have a curr;en�t �Jljl billty insurance policy or Its substantial equivalent. which meets the requirements of MGLCh. 142.
Yes No
If you have checked Yes, please Indica
k liability . insurance policy . te the type of coverage by checking the appropriate box.
Other type of Indemnity o Bond 0
)WNERIS INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage r . equired by Chapter
42 of the Mass. General Laws, and th . at my signature on tWis 139r_Zi�a�pllcatlon waives this requirement.
;ignature Of Owner or Owner's Agent
Check one:
Owner 0 Agent [I
reby certify that all of the details and -information I have submitted (or entered) In above'applicatlon are true and, accurate to the best of
w.. comp" c
ca a n w
knowledge and that all Plumbing work and Installations Performed u r the perml asued for t�h�l a Plication will be Incom with
ZL Z pilance
t I
e
3ertinent Provisions of the Massachusetts State Plumbing Code and h t 42 of a G eral La
By
Sig of Lic
n Plum er
Title Sign re of Licensed P u er
own
APPROVED (UFFICE USE ONLY) Type of License:
0.lourneym�an
License Number_��3�.
I
F!
a
2
I
2
z
Location 2 & 0 MASS �114
No. r,;� (o F3 I Date
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
1-2 0
CH Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ /C� 0
Check #
15943 1pf & (
Building Inspector
1.1 Property Address:
1-2 01
Number
1 AL-
Parod Number
LMap
1.3 Zoning Information:
Zoning Dii;id hWosedUse
1.4 hqmty Dimettsions:
Lot Area Fwatage(ft)
1.6 BUHMING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Provided
Rewired
T Provided
1.7 We. SWP�-MMW $0
Public 0 Private 0
13. Flood Zone hiforention-
Zone outside Road Zone 0
1-9 Sawetap
Municipal a
Disposal System
OnSitel)4osal SW= 0
SECMON 2 - PROPERTY OW14EKSHWIAU 1110KILED AUFA-41 I
2.1 Owner of Record
7�3-
Name (Print)
2.2 Owner of Record:
Name Print
SECTION 3 - CONSTRUMON SERVICES
3.1 Licensed Construction Supervisor:
Sornp:5 C (AA)1A:M6Ln
Licensed Constructio—n SuDemsor
Address for Service :
Address for Service:
3.2 Registered Home Improvement Contractor
Company Name
Addre
/Iss
Not ADDliCable 0
0— S 0 `13 9 oc-)-
9)pq Li(zM--VUKnb"
S ql� q Id
�wn /Mft
Not Applicable 0
133 (9 9,L3-'
Registrafm Number
ill 1--- .1-1 1 5? /,4r, /:� 00-72��
�7y-6�h)V(Z3 Exoirafio� / -
I
I Cigr�MAV A - WniRICRUS MMPlRNSATION (KG.L C 152 6 25"6) 1
Workers Compensation insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
the denial of the issuance of the building PMMIL
-in
Signed affidavit Attached Yes ....... 0 - No ....... 0
Lit&
L&!_
SECTION5 Description tgosedWoyk(!�
ppfic"
New Construction 0
Ficisting Building 0
Repair(s) 0
Alterations(s) 0
0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIM[ATED CONSTRUCTION
COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit appliquAt
Sx�� ft
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
Jt am P.
P12TLml
Building Permit fee (a) x (b)
.3
4 Mechanical QffAC2
Fire Protection
.5
6 Total (1+2+3+4+5)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING PERAUT
L as Owner/Authorized Agent of subject property
Hereby authorizeMC -,On n+C& NA— to act on
My behalf, in all matters relative towork authorizeAy this building permit applicatiom
Signatureof Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, as Owner/Authofized 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
SiULULe of Date
NO� OF STORIES SIZE
BASEN4ENT OR SLAB
isr ND
SIZE OF FLOOR TRABERS 2 3
SPAN
DINENSIONS OF SELLS
DWENSIONS OF POSTS
DRvIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION TIRCKNESS
SIZE OF FOOTING x
MATFRLAL OF CBRANEY
IS BUUDING ON SOUD OR FILLED LAM
Tc ny m niku-_ tnxrKTPrTPn Tn MA" TP Al rIAR, T ThM
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by IVIGL
c 11, S 150 A.
The debris will be disposed of in:
& H V—
J't� SOA—
(Location of Fa'cilityj
10
Net��—�
Signature of Permit Applicant
1-7
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
M1,01U). �,:,`CERTTI -A
FIC 'T
PRODUCER . � 'L � -1 ! � �, - '. , '. . E -OF
DATE (MWDD/YY)
RA � 7 _'� " .�-
INW NCE
1, 1 . - �. i "" ' ' �:`i _' ' , 7 �/ 25/02
THIi'Mii*16ATE IS ISSUED'AS 'A' MATTER 0_'F INFORMATION
Noyes Insurance A ency
9
73 Front St - PO Box 1248
Shirley, MA 01464-1248
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
'COMPANY
A Vermont Mutual I nsurance Company
INSURED
M.C. Contracting, Inc.
62 Constantine Drive
Tyngsboro, MA 01879
COMPANY
B Pilgrim Insurance Company
COMPANY
C AIG Insurance Company
COMPANY
D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE
LTR
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DDIYY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
A XX] CO ] MMERCIAL GENERAL LIABILITY
I ADE [j� OCCUR
CLAIMS M
OWNER'S & CONT PROT
BP17028963
11/29/99
11/29/02
GENERAL AGGREGATE—
1 2
,-OU GOO --
PRODUCTS-COMP/OP AGG
$ 2,000,000
PERSONAL & ADV INJURY
$ 1,00moo--
EACH OCCURRENCE
$ 1,000_000
FIRE DAMAGE (Any one fire)
$ 50.00 -
MED EXP (Any one person)
$ 5,000.
AUTOMOBILE
LIABILITY
I
B� X
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
PMC7131468
06/28/02
06/28/03
COMBINED SINGLE LIMIT
$ 500,000.
BODILY INJURY
(Per person)
$
J
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
$
GARAGE LIABILITY
7 ANY AUTO
AUTO ONLY - EA ACCIDENT
1$
OTHER THAN AUTO ONLY:
EACH ACCIDENT
1$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
UMBRELLA FORM
AGGREGATE
$
OTHER THAN UMBRELLA FORM
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
_FSTATUTORY LIMITS
EACH ACCIDENT
$ 100,000-
C�THE
PROPRIETOR/
PARTNERS/EXECUTIVE INCL
12/27/01
12/27/02
DISEASE - POLICY LIMIT
$ 500,000 -
DISEASE -EACH EMPLOYEE
$ 100,000 -
OFFICERS ARE: EXCL
OTHER
—
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
CERT11FICATE HOLDER
ANCELLATION,,...,,.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
A%r% Kachulig
268 Massachusetts Avenue
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Andover, MA 01810
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
ACORD 25-6 (3/93)
JUTHOFIIIZED REPRESENTATIVE
A�COR
D CORP RATION 1993
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Location
No. -30Y Date
3,�. 5 0
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ (7;)
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
Building Inspeci—or
. L -15A 25. 00 PAID
Div. Public Works
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Town of North Andover
OFECE OF
COMMUNITY DEVELOPMENT AND SERVICES
27 Charles Street
North Andover, Massachusetts 0 1845
WILLIAM J. SCOTF
Direcfor
(978) 688-953 1
T�q
Ito
0
U,
SAC -
Fax (978) 683-9542
In accordance with the provisions of MGL c 40 S 54, a condition of Building
Permit
Number is that the debris resulting from this work shall be disposed
X
0, in a properly licensed solid waste disposal facility as defined by MGL c 11, S
150 A.
The debris will be disposed of in: I
(Location of Facil
Ea&t.-' /V " *1
--4
Signature r f Permit Appli I nt
q --
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project throug-h the Office of the Building Inspector
N
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IQ
B0AJZD OF.AIPPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PL.kNNING 68S-9535
Town of North Andover Zi; 7, 10
OMCE OF
COMMUNITY DEVELOPMENT AND SERVICES
(978) 688-9531
Please print
DAT
E
JOB LOCATION_
Number
"HOIMEOWNFER" k
--Name
PRESENT IMAILING. -ADDRESS.-
HO`y1EOW'NER LICENSE EXEMPTION
Street address
,qf 4(p—
Home chone
Fax (978) 688-9542
Citv/Town S tate __-�ZiiD code
The current exe'niption for "homeowners" was extended to include owner -occupied dwellin-s
of six units-or-jess and to allow such homeowners to engage an individual for hire' who does
not possess -a lic6nse_�rovided that the owner acts-a7s-u-p-er-vis—�r.-P-aTe-Bu-lEl-n--.7-o-cre-
f-io-in 10 9. 1. 11
DEFINITION- OF-440MEOWNE' R:
Person(s) who m��.s�a_�azc_eil of land on which he"/she resides or.intends to reside, on'Which
there is, or -is intended to be, a on I e to six familv d�vellina, attached or detached structures ac-
cessory to such use.and/or-farm structures. A person who constructs more than one home in a
two-year period shall not be. considered a homeowner . Such "homeowner" shall submit to -
the Buildina Official,. --on a form- acceptable to the Building Official, that he/she -shall be
responsible for-all,such work_performed under the -building permit. (Section 109.1.1)
The undersianed..'�cmeowne, assumes responsibility for compliance with the State"Buildiza
a I L 11
Code and -other applicable codes, by-laws, rules and regulations.
The undersi-ned- "homeowner" certifies that he/she understands the
Town of No. Andover
Building Department minimum'insiDection procedures and requirements and that he/she will
comply with "said. procedures and requirements.
--- \11A 17 - �._ 4 . IL 'Ll, I.
A
HOMEOW1%, FS SIGNATURE
APPROVAL OF BUILDING OFFICL-�L
Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0, Construction Control.
0
BOARD OF APPEALS 688-9541 BUILDrNG 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNrNG 688-9535
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Location
No.
Date Cd -L574
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
'Building/Frame Permit Fee $
rev
Ss cmu�
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
�: �t
v6ter connection Fee $
TOTAL $
Bulldihvj4sp�c—tor
i N J2 7516
Div. Public Works
PERMIT NO.- APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I
MAP-;ko.N
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK :PAGE
ZONE
SUB DIV. LOT NO.
LOCATION 4
PURPOSE OF BUILDING IS,
OWNER'S NAME VE 040-
70 / �
NO. OF STORIES SIZE
OWNER'S ADDRESS .26Y llk<� AvF-
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME z:-zwge,�
SPAN
DIMENSIONS OF SILLS
POSTS
DISTANCE TO NEAREST BUILDING
DISTANCE FROM STREET
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
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
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 t 12
ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS,
PLANS MUST BE ED AND APPROVED BY BUILDING INSPECTOR
5— cy
�r 5&T_E
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E
OWNER TEL. #
PERMIT GRANTED CONTR. TEL. # 0970
-7
9
3 PROPERTY INFORMATION
LAND COST
44
EST. BLDG. COSV7
,7
.o,n:,o C25t_
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
MANNING BOARD
BOARD OF GELECTMEN
OCCUPA
�.INGLE FAMI Y 5_0
MULTI. FAMILY 0 FFI
APARTMENTS
CONSTRUCTION
2 FOUNDATION
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8 INTERIOR FINISH
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RADIANT H'T'G
UNIT HEATERS
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BUILDING RECORD
12
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
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RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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6-1
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
t/ /PA G E I
P +40.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK ;PAGE
ZO,NE
SUB DIV. LOT NO.
CATION AV&
PURPOSE OA=WW=MS -------
OWNER'S NAME
NO. OF STORIES lZk
eWNER'S ADDRESS ffwwooe-�) /Vo
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
_':U�IL�DEFVS N ME
�A
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
POSTS
DISTANCE FROM STREET
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
MATER:AL OF CHIMNEY
I -S BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
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
ELEC R IC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTA HED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
-ANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FIL
AGENT
F E E --l' ol'�'l do( , L/ L-/
PERMIT GRANTED
-7
ooe!WNER TEL.
CONTR. TEL,
CONTR. LIC. N
3 PROPERTY INFORMATION
LAND COST
,NAf' BLDG. COST 7 5co
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
BUILDING INGPECTOR
I.,
BUILDING RECORD
I OCCUPANCY 12 v
�.INGLE FAMILY I—ISTORIES
MULTI. FAMILj:::::::�_j
OFFICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
CONCRETE
PINE
a
1
2 13
CONCRETE BL K.
BRICK OR STONE
HARDW D
PIERS
P LASTER
_�RY WALL
, UNFIN.
3 BASEMENT
AREA FULL
F N. B M T AREA
114 1/2 1/1
ATTIC AREA
NO B,M T
-FIN.
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS 9 FLOORS
CLAPBOARDS
B
1
2
3
DROP SIDING
CONCRETE
WOOD SHINGLES
EARTH
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
HARDW D
COMIACN
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STIRS. & FLOOR
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
jj_�DEQUATE
STONE ON FRAME
SUPERIOR POOR
NONE
I
5 ROOF
10 PLUMBING
GABLE
GAMBREL
11
HIP
MANSARD
BATH 13 FIX.)
TOILET RM. [2 FIX.)
FL—ATI
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMIN6
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
B'M'T 2nd
I st I 3rd
-OIL
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.
H HOME
0
VEM
IMPROVEMENTS
e / /\
Registration No 0 —I_ �_
t. * I lt�
License No. 040394
8 Country Village Road, Windham, NH 03087. NH (603)434-6819 MA (5o8)688-4107
RESIDENTIAL CONTRACTING AGREEMENT —
for MA & NH
Read this agreement and make sure vou understand it before signing it.
This agreement has legal force and effect and binds those who sign it.
ot ce for Massachusetts Properties:
All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from
registration by provisions of Chapter 142a of the general laws, must be registered with the Commonwealth of Massachusetts.
Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton
,,,P, ace, Room 1301, Boston, MA 02108.
Designated Registrant's Name: 13 E t� Rr k kj A)
s Name:
Salesperson
8NOiA �q-qq between �A V P /I
-This agreement is made o
I F) ON�RAUI OR)
0- niA:61
Of- 9 . P. __p 1A )JAIA �Iv
41� (ADDRLSS) I/ 0111ONE N[:MBI:R)
hereinafter called "Contractor" and ke)
_1OWNLR)
of
I -ss)
hereinafter called "Owner".
I �', 4 Ir 11
(11HON1. NUMBLKY
1. DETAILED DESCRIPTION OF WORK TO BE PERFORMED AND MA TERIALS USED
Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work and materials consists of the following:
L. rim I %_r, A 11411 rA I Mr,114 1
Contractor agrees to do all work described in Section I for the total price of$ C) 0
(Ell L Z ,,--`u�pon signing Contram
and the remaining $ t) 0 C) 00 upon verification ofthe
4-_
work by Owner and Contractor as having been satisfactorily completed, which ve'rification shall take place promptly after completion.
Notice: No agreement for home improvement contracting work shall require a down payment (advance deposit) of more than one
third of the total contract price or the total amount of all deposits or payments which the contractor must make, in
advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is greater.
3. COMMENCEMENT AND COMPLETION OF WORK
Contractor will not begin the work or order the materials before th third day following the signing ofthis Agreement, unless specified in
writing. Contractor will begin the work on or abou (11 �k�-t / -'3— (date). Barring delay caused by circumstances beyond Contractor's
control, the work will be completed by (J L A. 9 1 1 R11_ n'f_ (date). The Owner hereby acknowledges and agrees that the scheduling
dates are approximate and that such delays that are$ot av"'Oidable by the Contractor shall not. be considered as violations of this Agreement.
4. CONSTRUCTION -RELATED PERMITS
The following construction -related permits will be necessary in order to complete the scope ofwork included in this Agreement:
The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction -related permits.
The Contractor shall not be deemed'i-esponsibic for delays in the work dcscr:lbcd in this Agre-cment caused by regulatory, permit, granting or
li I �wa inspectional agencies, authorities or individuals.
Notice for Massachusetts Properties:
If the homeowner obtains his own construct ion- related permits for the work described under this agreement, the homeowner is
hereby advised that in the event of a dispute, judgment and nonpayment of the contractor, the homeowner will not be entitled to
make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L.
"Irylilirliry qpdll Irl A M.—Iry
The owner may cancel this agreement if it has been signed by the owner at a place other than an 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 than midnight of the third business day
following the signing of this agreement. See attached Notice of Cancellation. Homeowner acknowledges receipt of (2)
copies of Notice of Cancellation.
. H0:MEOWNER:__
DO NOT SIGN THIS CONTR , ACT -IF THERE A.RE-,kNV BLANK SPACES.
q q
�v2t, %AA
0%An1cr_'s Sio�t6'rc, Daw-signcd
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ConVactor's signattl�lc Dat� Signed
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Location N. a-,
Mko
Date �\
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
i iosGa Building/Frame Permit Fee $
*Arm, A o ndation Permit Fee $
C US 16
OtArype 'tlre $
/tRewer-Co!nnection , ee $
4, C, j
A10. All Water 6tion Fee $
6- $
kOl/ecto,r
Building ih�pector
Div. Public Works
PER111yeo'. 2LA APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGE 1
MAP +40.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK PAGE
ZONE
SUB DIV. LOT NO.
LOCATION
M149S 19ilc
PURPOSE OF BUILDING jeCplhCe 7 WIXAJOI,) L;A� i
OWNER'S NAME SIhA)-rV
NO. OF STORIES SIZE
OWNER'S ADDRESS e-
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
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
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
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
I
SEE BOTH SIDES
i
PAGE I FILL OUT SECTIONS 1 3
PAGE 2 FILL OUT SECTIONS 1 12
INSTRUCTIONS
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
DATP-MED , 2- d 3 - -91 -
TiIGNATUAE OF OWNER OR AUTHORIZ ��GENT OWNER TEL.
GUNIR. IEL
F E E =Z2 CONTR. LIC.
PERMIT GRANTED
n - SL 3 19
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST T000, PC
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
A
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