HomeMy WebLinkAboutMiscellaneous - 276 ANDOVER STREET 4/30/2018e
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North Andol,xx Boavd of Assessors Public Access
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Summary
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I , a Page I of I
North Andover Board of Assessors
iz�roperty Record Card
Location: 276 ANDOVER STREET
Owner Name: HOLMAN, JOAN M
CHARLES A HOLMAN
Owner Address: 276 ANDOVER STREET
City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood: 5 - 5 Land Area: 0.29 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area: 2561 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 364,400 344,500
Building Value: 198,400 174,200
Land Value: 166,000 170,300
Market Land Value: 166,000
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkld=225335 I&town=NandoverPubAcc 3/26/2013
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Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ...................
has permission to perform ... R e A- . L) " A -'q' -// ,, . L�-: . . . . . . . . . . . . .
plumbing in the buildings of . --� ...................
at . -,2 -9et . ,4 k-. J.4. E'. r ... I North Andover, Mass.
Fee.077- . Lic. No. t7o 3 �7p. k
....... ...... -It' - �- ..........
-)PLUMBING INSPECTOR
Check #
7449
it
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS Date
Building Location 4yidoye v- 5 'tc ownesName �0 Permit #-2—V i" c7
Amount L/,)
Type of Occupancy
New rl Renovation Replacement El Plans Submitted Yes No
FIXTURES
V-1:31-1014
1775�303
I M of; I III
pl� )] � re a I
F., a; 171
r, I I . I � FT1
ki I I. I Ice
V1 R I ro
(Print or type) Check one: Certificate
Installing CompanyName Rec�vq,��Jl( [:] C),
Address — /�/)y S-6 9, Partner.'
4,4Z&v-\ ' Al*
Business Telephone 47 7 77 11firm/Co.
"" "L
Name officensed Plumber ONO
Insurance Covemge: Indicate Le type
,4 insurance coveragi by checking the appropriate bo)c
Liability insurance policy Ey Other type of indemnity Bond
Insurance Waiver L the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent
I hereby certify that all of the details and in1brmation I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installati ex-form"der Permit Issued for this application will be in
10
I p,
compliance with all pertinent provisions of the Mass eral Laws.
By: SigriftTure orri—censEuriumur.,
Title e Plumbing License
City/Town
APPROVM (OFFICE USE ONLY r7cense Numner master Journeyman
2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall -be limited as to the time of ongoing construction activity, and may be -deemed -by the Jnspector-of Wires abandoned.and -invalid-ifhe---
or she has determined that the aufhorized work has not commenced or has riot progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 20 10 and extended by Sections 74 and 75 of Chapter 23 8 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence'4 during the qualifying period begffi�ingon August 15, 2008 and extending -through August 15, 2012.
• Rule 8 — Permit[Date Closed: ***Note: Reapply for new permit 4"
• Permit Extension Act — Permit,9Date C1 ed:
Date....
4,
0 TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
SS us
iI C Hebl k- I. 7-&,-Tlztc
his certifies that .......... P! ............................................................................
has permission to perform ......
wiring in the building of ........ ... e�� .............................................
at ....... � 76 A169414—,K -5-,—
....................................................................... . North Andover, Mass.
Fee .... z9 tC7 :3 c16 2-4� o5 ..........
.............. Lic. No . ............. ...... -i�JRI;/��L E�E
Check #
7768
.40
4
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. )7/65
Occupancy and Fee Checked
[Rev. 91051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NlEC), 527 CMR 12.00
(PLEA SE PRflVT IN INK OR TYPE ALL MFORAM TIOA9 Date: k -,3 /— J,2
City or Town of- N. All d, 4 Aje To the Inspector of Wires:
By this application the undersigned gives notice of his or her intenti t f4 the electrical work described below.
Location (Street & Number) 6? 7 (a +q/1 6 o per orm
OwnerorTenant joa-oz- Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes No El (Check Appropriate Box)
Purpose of Building Utility Authorization No. A�W3146a?41w-
Existing Service Amps Volts OverheadEl UndgrdF� No. of Meters
New Service 2 00 Amps JZ0- Z- 46 Volts Overhead Undgi-d No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
9 &A, � h -, 16 dn e t& A VL,
441(0 �AAi,�X-v -040w- -
V V Completion of the following table may be waived bv the Inspector of Wires.
No. of Recessed Luminaires Itp
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires f)
Swimming Pool Above Fi In- E]
grnd. - grnd.
No. of Emergency Lighting
!ja�nits
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. 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:
I Number
I Ton�
.... .....
...........
J.KW ...........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
E] municipal
Local Connection 0 Other
No. of Dryers
Heating Appliances KW
Security Systems:*
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: 0C a 1-t 0 /,L— t a,
U Attach additional detail ifdesired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
]INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability 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 F] BONDE] OTHERE] (Specify:)
I certify, under thepains andpenaldes ofperjury, that the information on this application is true and complete
FIRMNAME: R(C&rc�,l 4�F (R r- r, LIC. NOAWQ6W A.
Licensee: ;,? i'm 4 c6L�ld I Signature LIC. NO.: 3 J 0oll IT
(If applicable, enter "exempt " in the license nu ber line.) Bus. Tel. No.: 404
Address: J Ll iliA (4 AS X(IL S�a4Atu.6 A41f 444Ce Alt. Tel. No.:' =uy
*Security System Contractor License required for this work�-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 E] owner's t
Owner/Agent - $
Signature Telephone No. PE" !t
H FEE.
9'1 54
.0
'TS
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
ACHU
.............
This certifies that
has permission to perform
plumbing in the buildings of A/`-I.P.7 ................
at ... ......... North Andover, Mass.
Fee,5�'PP. Lic.
PLUMBING INSPECTOR
Check #
1
4155,
I � V - C11- C!, One Qj-�I,,.
I�Istt!!Hrlg Crin-'P&III., biame:Vl
Address ILt El COrPO1*atIon
C
itY/Town: A�d_/_s State: if/
Business Tel: Partnership
Fax:
Name of Licensed Plumbe ��444,d /�__1'1;14 110 IDA"rm/Company
I INSURANCE C(:)VFPA(Zl=-
I have a current
uranCe policy or its substantial equivalent which meets the' requirements of MGL. Ch. 142 Yes El No El
If You have checked )Les, please indicate hetype Of coverage by checking the appropriate box below.
A liability insurance policy- Other type of indemnity D
Bond E]
OWNER'S INSURANCE WAIVER: I am aware that t6 licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this pe—rmit application waives this requirement.
Check One Only
0 wrier or Owne s Agent Owner E] Agent D
ereby certify that all of the details and information I have submit( 11 1,ir —ent,
Knowledge and thatal! plLim
bl-_0 Work and installallons Performed under the perm! application are true and accurate to the best of rily
it issued for this application will be in compliance with all
Pertinent Provision of the ma7chu tts State Plumbing Code and Chapter 142 Ofthe General Laws.
11 - - - 7- —
3y Type of License:
.itle In re of Llc�ense
atu�
El Plumber SI nature o Icensed Plumber
fty/Town
PPRO um
_Ff_1_C E—U S _E0 N _LY) Pd-Oumeyman License Number:
F tl�3`z
MASIACHUSETTS UNIFORM APPLICATION
FOR PERMIT TO DO PLUMBING
City/Town-:
MA. Date.
0
Building Location.
-a 76 4
Permit#
Owners
Type of occupancy:
Name:
CommercialEl Educational
Industrialn Institutional [j
Residential
Renovation: MZReplacement: Plans Subm . itted: Yes [j NoEj
FIXTU ES
LU
DEDICATED
F_
SYSTEMS
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BASEMENT
.1' FLOOR
2 ND FLOOR
3RD FLOOR
e FLOOR
5' FLOOR
eH FLOOR
7' FLOOR
3TH FLOOR
I � V - C11- C!, One Qj-�I,,.
I�Istt!!Hrlg Crin-'P&III., biame:Vl
Address ILt El COrPO1*atIon
C
itY/Town: A�d_/_s State: if/
Business Tel: Partnership
Fax:
Name of Licensed Plumbe ��444,d /�__1'1;14 110 IDA"rm/Company
I INSURANCE C(:)VFPA(Zl=-
I have a current
uranCe policy or its substantial equivalent which meets the' requirements of MGL. Ch. 142 Yes El No El
If You have checked )Les, please indicate hetype Of coverage by checking the appropriate box below.
A liability insurance policy- Other type of indemnity D
Bond E]
OWNER'S INSURANCE WAIVER: I am aware that t6 licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this pe—rmit application waives this requirement.
Check One Only
0 wrier or Owne s Agent Owner E] Agent D
ereby certify that all of the details and information I have submit( 11 1,ir —ent,
Knowledge and thatal! plLim
bl-_0 Work and installallons Performed under the perm! application are true and accurate to the best of rily
it issued for this application will be in compliance with all
Pertinent Provision of the ma7chu tts State Plumbing Code and Chapter 142 Ofthe General Laws.
11 - - - 7- —
3y Type of License:
.itle In re of Llc�ense
atu�
El Plumber SI nature o Icensed Plumber
fty/Town
PPRO um
_Ff_1_C E—U S _E0 N _LY) Pd-Oumeyman License Number:
F tl�3`z
BOARD
PL
TYPE
-i
756575
IMPORTANT NOTICE
PERMITS FOR PLUMBING AND GAS FITTING
INSTALLATIONS ON STATE OWNED OR USED
FACILITIES MUST BE FILED AT THE
OFFICE OF THE STATE BOARD.
I
w
M
the provisions of M.G.L. c. 143, § 3L, the
2012 Massachusetts Electrical Code Amendments 527 CM 12.00 § Rule 8: In accordance-Y.n
permit application form to provide notice ofinstallation ofwiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion ofthe work as required in M.G.L. c. 143, § 3L.
Permits shall -be limited as to the time of.ongoing construction activity, and may be.deemed-by theInspector-of-W.ires abandoned-and-invalidifhe—
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request ofeither the owner or the installing entity stated on the permit application.
El The Permit Extension Act was created by Section 173 ofChapter 240 ofthe Acts of201 0 and extended by Sections 74 and 75 of Chapter 238 of
A the Acts of2012. The purpose ofthis act is to promotejob growth and long-term economic recovery and the Permit Extension Act furthers this
puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development ofreal property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence4 during the qualif�iiig period beginningln August 15, 2008 and extending'through August 15, 2012.
YS, Rule 8 — Permit/Date Closed: '57911 Note: Reapply for new permit
Pf t
96permit Extensigq Act — Permit/Date Closed:
-t
41"R
A
10
I
Date../F—..?n.7 .. ... //.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......................................... .........
has permission to perform ..... A?� .....................................................
wiring in the building of ............... Alp K I., . . . ...........................................
at ..... �.7 67 A,�,bajA&
.......................... . _e .... :�� ...................... ... Aorth Andover, Mass.
Fee..:7M�e� Lic. No6h�.99..'04
.I ............. . . .... . . ..........
ELEcmicAL INSPEcroe
Check #
10416
-wealth of Massachusetts Official Use Only
Common
Permit No.
Mz / &7
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveb] - ank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLE-4 SE PRIWT IN IATK OR YYPE ALL XFORALI TION) Date:
City or Town of: NORTH ANDOVER To the InspeqtLr of Tbres:
By this application the undersigned gives notice of his or her intention to perfotm the electrical work described below.
Location (Street &Number) 9q(0 Ay\ooyp�t s*
Owner or Tenant 70cv., ylc)��M Telephone No.
Owner's Address
Is this permit in conjunction with a building permit?
Yes
No [:1 (Check Appropriate Box)
Purpose of Building -S-1
Zwe-1k, ,(\ 5 UtWty Authorization No.
E)dsfing Service Amps
Volts
Overhead El
UndgrdF_1 No. of Meters
New Service Amps
Volts
OverheadEl
UndgrdF] No. of Meters
Number of Feeders and.Ampacity
No. of Gas Burners
No..of Detection and
Initiating Devices
No. of Ranges
Location and Nature of Proposed Electrical
Work:
No. of Waste Disposers
Heat Pump
I �Nyptg
RC)C)
nos -et
Vc�
Completion ofthe following table may he waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceff�-Scusp. (Pauddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above El
Swimming Pool rnd. grnd. J]
2
IN o. of Emergency Lignting
Battery Units
No. of Receutacle Outlets Z
No. of Oil Burners
_Ff P E AZ RM8TQNo.
.A
of ZGnes
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
I �Nyptg
J.:1!!M J.KW...._.
...........
No. of Self -Contained
Totals:
I
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal Other
Local [:1 Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
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
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail ifdesired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability 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 6 BOND [I OTHER* F] (Specify:)
I certify, under t-hepains andpenalties ofperjury, that the information on this application is true and complete.
FIRM NAME: �3icc M-),, F=ft LIC. N0.:Ar_o5;,-c>
Licensee: Signature LIC. NO.: J�- ?0-1q
(Yapplicable, enter "exempt" tn the licensg4umber h e) Bus. Tel. No r,. i - 13?2
Address: \-\- Gicl -"O,,)e- \ci) CYN %ICN Alt.Tel.No.:1(fY T'44-7coi
*Per M.G.L c. 147, s. 57-61, security work requires DeVartinent of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) [] owner Elowner's agent.
Owner/Agent
0--�_ WT. PERUTT FFF,! .9
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Waykington Street
4 U,
Boston, MA 02111
www."wss.go v1dia
Workers' Compensation Insilrance Affidavit: Builders/Contr.actorsxlec.tricians/Plumbers
A�p-licant Information
Nania (Business/organization/Individual):
Address':
City/State/Zip:
Phone
Are you an employer? Cheek.the appropriate _b
a
)X:
a e Type of project (required):
1.0 I-Iim-aemployeT With- 4. El I am a general contractor and f
e emPloYees (full and/or part-time),* have hired the sub -contractors 6. E] N*ew cotistruction
2 m
a E
F2.0 I am -asole proprietor. or partner- listed ori. the attached sheet I F1 Remodelig
ship and. have no employees 7bese sub -contractors have 013emol I ition-
working fior me.in, any capacity. workers' comp. insuran
[No workers, comp. insurance 5. We are a corporation anedeits 9. El J3uilding addi.tion
required.] 10.0
'pr'
-w
Ty;�p
6
7. � Remo'
3. El officers have exercised tl�eir Electrical repairs or additions
I din a homeowner doing all work right of 'exemption per MOL I I E3 Plumbing repairs or additions
Myself. [No-workirs'comp. 1.52, § 1(4),* and we have no
insurance -required.) t employees. [No workers' 12.[] Roof reipairs
comp. insurarice required.] 13.M.Other
*Any applicant that checks bo)t,# i aSt also fi [I out the sectiDnbelow showing theirworkeWbompetis
ation policy information,
t 140me0wnirs who submit this affidavit Indicating they am doing all work and then hire ot9sidr Contractors must submit a new affidavit indicatin- such.
�ContraCtorS t�St ChMC thiS bOX MUStr-ftneFed an Pdditiona) sh�-gtshowin Lhe rame of the sub -contractors and tjg,,'
v,,Lrke:,_'cor.,p. p-�Iiv/ - r
Mum .. ation.
Lid aft eMP,19P2r that iSP-v,?r!d1ng:wDrJj_-rs P coi',Vensadon insurancefor jW. eiWloyees;
infim-madom BelOw is tile Policy- andjoh she
Insurance Company
P0li0.Y # or Self -ins. Lie, #:.
Expiration Date:
Job Site Address:
City/Stafe/Zip:
Attach a copy of the w0rkers'.*compensation policy de'claration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposit o of c m na p a ti s of a-
fi i n ri i I en I e
ne UP to .$1,500.00 and/or one-year imprisonmenti as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy ofth-Is t mentm b f d d t th 0-15ce of
Investigations of the DIA for insurance coverage verification. sta e ay e arwar e . o e
Ido hereby certify underthepains andpenafties ofperiurY that tile MfOrmatiOHNOrMedabove is true andco
Simature: ate:
Phone
=latuse Only. Do not wrfte hi LUS a.`ea� to L -e comP19ted by cky or town officiaL
City or Town:
Permit/License #
Issuing Authority (circle one):
L Board of Health 2.13uilding Department 3. City/Town -Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone
1A
Date.
0 0
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that :�-� .................
,has permission to perform
.... ............
Diumbine in the buildines of . ...... ..........
at. .... 6Z �.—
Fee Lic. No..".�/I� . .
Si6
Check # �
7409
.—life ...... North Andover, Mass.
.............
P L U M B/IN/d/l N S P ECTO R
MASSACHUSETTS UNIEFORM APPLICAYOfi FOR PERMIT TO DO PLU . MBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Lo �tiqn
0 0 tf-e_� � Owners Name(
New [] Renovation []--" Replacement [:]
FIXTURES
Date (� I 14 f
[VnA.,, Permit#
Amount
Plans Submitted Yes E] No El
(Print or type) Check one:
Installing Company Name Corp.
Address Partner.'
Business Telephone �c Firm/Co
Name of Licensed Plumber
Insurance Coverage: Indicat�
Liability insurance policy
Insurance Waiver 1, the unda
threeinsurance
A e— /,---
insurance coverage by checking the approp;rate bo)c
Other type of indemnity 11 Bond
Certificate
have been made aware that the licensee of this application does not have any one of the above
Signature , . Owner [:] Agent
I hereby certify that all of the details and information I have submitted (or entered) in abo-v
best of my knowledge and that all plumbing work and installations ed !tdeje�di
compliance with all pertinent provisions of the MassachusettV_S1j77b g Q&-arAC1
By: 4 LZ& 7i F
Signaulre or-Licensea riumSer
Title jTVe of Plumbing License
C?� 19 1 *0
City/Town License Num5er' Master FM
-APPROVED (OFFICE USE ONLY IRT
=0
application are true and accurate to the
�ssued for this application will be in
pter 142 of the General Laws.
Journeyman 11
` -/- e7 .....
Date ..............
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation ...........
in the buildings of ........ ..................
at T� ...... A., North Andover, Mass.
Fe&:�� Lic. Noi&�� ..... ...........
�G;
/�7
Check #
6031
MASSACHUSETfS UNHORM APPUCATUN FOR PERM To Do GAS FErM,
(Type or print) j Date 0
NORTH ANDOVER, MASSACHUSETTS
-A
Building Locations oo k L,/-� - — Permit # �,r,31 -
......Pwner's Name Amount $ %4v
New Renovation Replacement Plans Submitted
SU B -B A SEM E
BASEM ENT
IST.
F L 0 0 R
2ND.
3 R D .
4TH.
FLOOR
F L 0 0 R
FLOOR
5TH.
FLOOR
6 T H .
F L 0 0 R
7 T H .
ITH.
F L 0 0 R
F L 0 0 R
(Print or type
Name —� �—*"a r
z
z
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z z n
z
Name of Licensed Plumber or Gas Fitter SA9 I z -I-- - . - - /-
Chc.Qk one: Certificate Installing Company
L1 Corp.
Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 1:3 No[D
If you have checked ves. please indicate the type coverage by checking the appropriate box.
Liability insurance policy a Other type of indemnity 13 Bond 13
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:
Signature of Owner or Owner's Agent Owner Agent C3
I hereby certify that all of the details and information I have submitted (or entered
VAn ab "reap icafi*Ware true and accurate to the
"ic
_it
Is
best of my knowledge and that all plumbing work apd installations rf, ed t. 'e Z( this application will be in
S';
!4 -
compliance with all pertinent provisions of the Massachusetts State e C hl= 2 he General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber
Gas Fitter License Number
Master
Joumeyman
I IL
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLIC,ANT: 6 0 AJ A6 Lt Phone W 7 —37_Q3
.:rAi v;, A10 . qO C
LOCATION: Assessor's Map Number Parcel 17
_D E- -�-b B00)e_ 30 7 L/ QCA AJ A) 0. -z,3
Subdivision Lot(s)
Street St. Number
************************Official Use Only************************
RECOMI�,ENDATIQNP OF TOWN AGENTS:
TO Date Approved 7
conservation idielnistrator Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspec'tor-Health Date Rejected
Date Approved
Septic Inspector -Health Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector
0
Date
Suggested Affidavit for Home Improvement Contractor Permit Application
For OMce Use Only NAME OF CITY/TOWN
Permit No.
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, inprovement, removal, demolition.
or construction of an addition to-anypre-existingowner-occupied building containing at least one but not more than four dwelling units .... or
to structures which are adjacent to such residence or building" be done by registered contractors, with certain exceptions, along with other
requirements.
DECII�-
Type of Work: Est. Cost 90-D,62�.)
Address of Work 2--7(r) Rk)DOVEL?_ �S
Owner Name:i:__JCX
Date of Permit Application: E-11IN3
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000
Building not owner -occupied
Zowner pulling own permit
—Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date
r
363A
Contractor Name
Registration No.
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
,61 ( 11 � 3- QMa���� -
Date U Owner Nlame U
MORTGAGE INSPECTION PLOT PLAN
LOCATEDIN: ;:Irrr
BUYER: A -LL —nC-5"4XLL-CL
SCALE : �%\ =4-n ,
DATE:.- mi�
/vw — , —
-7
"I -DING DFPARTHi2-Nl'
�odr,+V
�2 Isl(o 4 -r
2-S7y
NJ
do
�j
(n
0
DEED BK. PG.
PLAN NO. UO-) Z-71,
BK. 7Q PG.
INV. NO.
ttA
r TI(n
Z S -Ty
-TV -L-T
N�oc)Nv--Z L '1=
Tb.��\Ij tAI-Z4AULSrr— k�M-TGIP�Z E L. and its title insurers: I hereby certify that I have examined the
premises and that all buildings are located on the ground as shown, and that they do ( ) conform to the zoning by laws
when constructed. I Also certify that this property is (k�-T ) located in the flood hazard area.
NOTE: This certification is based on the survey markers of others, and does not represent an actual survey. For
mortgage purposes only.
1A Of
Ar
0 ES 6A
Northstar Co.
P.O. Box 131
Newburyport, MA 01950
AV I C^n A�� �A^ SU 4
40
Location a r7 (.o AA) dou-e r- S4.
No. 1.0 3 Lf Date
TOWN OF NORTH ANDOVER
4L
4o
11 A -
Certificate of Occupancy $
Building/Frame Permit Fee $ 0c)
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # O -S Cr
1647'1 44 P
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUELDING PERNHT NUMBER: ATEISSUED:
D 0 3
SIGNATURE: /M/W 1
Building Commissioner/12awKr of Buildings Date
SECTION I- SITE INFORMATION
LI Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning hiformation:
1.4 Property Dimensions:
)e-zl A-5 . -
Zoning District Proposed Use
Lot Area (sf) Frontage (ft)
1.6 BUILDU*4G SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Recpired Provide Required Provided
Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public 0 Prhate D Z..e Outside Flood Zone D
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSEIIP/AUTHORIZED AGENT
2.1 Owner of Record
),0,4/
— aa,(a J-,
", /
Name (Print) Address for Service:
7 Aa
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
- kt&r—� �V&s ()
Licensed Construction Supervisor:
aLicense
Number
Address
— -?
Expiration Date
SignaL- Telephone
Z�/
-4
3.2 Registered Home Improvement Contractor
Not Applicable 0
" rl�4;r "(
Company Name
Registration Number
Address
Epiratwn Date
-Signa ure-.;1 Telephone
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SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application.' Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ...... Ar No ....... 0
SECTION 5 Description o Pyoposed Work (check applicable)
New Construction 0 Existing Building X Repair(s) Alterations(s) 0
Accessory Bldg. 0 Demolition 0 Other 11 Specify
Brief Description of Proposed Work:
-n
.a--= -- - - - , I
I SECTION 6 - FSTIMAT-F.-n CONST-RUrTInN rn-�T.Q, I
Item Estimated Cost (Dollar) to be
Completed by permit 2pplicant
I � 1 1, 1 1 1 1 1 %,., I'll �, 17
0 FFICIALUA ONLY—
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
-3 Plumbing
Building Permit fee (a) x (b)
-4 Mechanical (HVAC)
-5 Fire Protection
6 Total (1+2+3+4+5)
r - -�O.
Check Ntunber - 57P
.3 &5
IaE%-ijiuiN/aVWfNJItKAUIHUJKILAIIU.N 10HECUM-PLETEDWHEN
7OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner
SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION
Date
a
1, -. VAI uf-#� &20 as Owner/Authorized Agent of subject
property i
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
Date
NO. OF SM)RIES SIZE
BASEMENT OR SLAB
S17 -E OF FLOOR TINIBERS Or 2 ND 3 RD
SPAN
DIWNSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Name
The Commonwealth of Massachusetts
Department of Industfial Accidents
Office of investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Location: ;226 A&,a,- 3/-,
F-1 I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
Please Print
I am an employer providing workers' compensation for my employees working on this job.
ComDanv name:
Address
citc. Phone
Insurance.Co. Policv
Company name:
Address
CME. Phone,*
Insurance Co. Policv #
Failure to secure coverage as required under Section 25A or ML 152 can teed to the imposition of criminal penalties of.a fine up to $1,500.00
and/or one years' imprisonment-as-wefl-as-chdiowattiesin-theinim-dASTDP.W-ORK-ORD.ER-arid-afine4t$1-00-00)-ajdWagaimtmw_ I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification.
do hereby certify under b)e ga!�s and penalties of perjury that the intbrmation provided above is true and correct.
Print
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Ucensin_q
El Building Dept
El Check if immediate response is mquir ed .0 Licensing Board
E] Selectman's Office
Contact person: Phone #.- E] Health Department
Ei Other
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is-that.the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by IVIGL
c 11, S.1 50 A..
The debris will be disposed of in:
12,
(Location of Facility)
re oT i-ermit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through. the Office of the Building Inspector
0/ 1 /471;1;ar/1e/`;C&.�
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 069505
Birthdate: 03/26/1973
Expires: 03/26/2003 Tr.no: 9692
Restricted To: 00
VINCENT J GRASSO
274 MIDDLESEX ST
N ANDOVER, MA 01845
Administrator
HOME IMPROVEMENT CONTRACTOR
Registration: 129047
/Z
Expiration: 6/28/02
Type: Privite Corporatio
construction & Development
/Vincent Grasso
ZAI tal
ADMINISTRATOR 104 Castlesere Place
N Andover MA 01845
6-3'1 2�8 / 2 I� 0 2 1 -1 : 2 1 '978--63 7-0149 PNTEPNE:-l' 11,4SURANCE PAGL 62
A RD
CO CERTIFICATE OF LIALB-ILITY INSURANCE
Nllo�tll-a— THIS CERTIFICATE IS ISSUED AS AMAT7ER 89-PINP5RIA-ATION
INTERMT ZNSUKMCZ AGENCY, r14C ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
522 CKlCXZRlll0 ROAD HOLDER. THIS CERTIFICATE DOES NOT AMEND, PEXTEND OR
ALTER THE OOVERAGE AFFORDED SYTHEPOLICIES BELOW,
Nor -TA Ajv:k-MXRI b% 01845 INSURERS AFFORDING COVERAGE
�UR iW ARRS WOTZr-TT0N
STRI;CTION & D3VZL0?bWNT rife 114BL-RERB: AnflLia P=Tmr.TT0V
733 ruPNPIXX STREET, #223 INSURERC 1,3MINATY MUTUAL
NORTH Amovz?, MA 03-045- 1 r InUR.ER D:
f0AEUREA I
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To" OF MRTH AMOVER 14A SHOULD ANY OF THE APOVP DMIC-0114 III fl()UCIES se CANCELLph aLvopkp T64C pXp#AAllom
BUILDING DEPART11IMNIT DATE THEREOP, TNi! 118SON47 MOURER WILL ENWAV014k TO 14,ML 9119 DAYSWRITTIN
120 M&IN STREET NOTWE TO THE CERTIFICATE HOLDRIP NAMED TO THE LerT, 13UT PAILURC TO 150 AO SMALL
OAPOSS NO OBLIGATION Oft L"ILMY 'JF ANY KNO 'UPOW THE INftneg, rrS AGE047B OR
NORTH ANDOWR KA 01845 -
OR
jFAlflTlORI=DXZPj*SENTft%F
RPORAT;ON 1992
S:
THE POLICIES OF INSURANCrz L;,.TF0 09LOWHAVE 9EEN ISSLEUTO THENSUPeO NAMED ABOVE FOR THE POW,:�Y PER!oD INDICATED. NOTIMT;-�$TANt)*&�
- 'p
ANY PECUIREMENT, TERPA OR CONDI�ji�!rj OP ANY COKrRA.rT OR GTHER D0CIJ'MEMT1A(ITM REaPECTT0 WHICH THIS CP-RTIF((' ATE MAY 2E iSSUCC)
OA
MAY PERTAIN, THE INSURANCE AF170RDED BY P4E POUQ115-3 C)ESCRI�)E[; HEREIN IS SUBJECT TOALL THE TERMS. EXCLUSIONS AND CONDITIONS OF -;Ucm
POLICIES -AGGREGATE LIMITS SHOWN MAY HAVE agFN PEDUIgD By P.m]) amn.
YPS CF INSURANcra POLICY NUMBER
I..P,?CtjC-'f PPRIL,
M22
POLICI 8
DATE tZmm!
LIFAITS
41KNIM UAMUTY
;36000'�3542
07.101/2001
-'A NCE S
EACH or
1
FIRE DAM
50, oco
C'NAMERCIAt GICNIERALLLABiLlry 07 /0112002
CLAIM6 MADE Im
01;CUR
VFD EYS Arl *no pgmofl) Is
5, orj()
PPR
GENERAL AGGREGATE is
1 o0a, 000
0F.WL AGGREGATE LIMIT APPLIrf PrA�
PRO- r
"IV
ovem - Complop A(33 16
11000,000
I LOC
JFQT 3
LAW110MORILIF bAI%IUTV
COMEEK0 SIHGU� LIMIT is
�Q. I ANY AUTO
1,000,000
&L OWNED AUT03
06/01/2001
08/01 i2oo." BGDkY IN.'jRY
8011EDULWAVY06
HIRED AUTOS
N014 -OWNED AUTOS
BODILY INJURY
Eli
I
PROOERTYDAMAGE
(per qma")
ANY AUTO
AUTO ONLY - EA Ar CI ERNT -t
�ACCS
OTH5R -HA EA
AM ONLY. AGG Is
LWESS LAINLITY
CTI 04.CUR
RACH OCCUPRENCE
L -J I CLAIMS MADF
ACGAGOATr:
I
M.DUUTIBLE
jRETEf4TFJk
WOR%ff(S COMPENSATION AND
EMPLOYEAS'LIA910TY
GIB lFR
I
r I. -BIS -312772-039
j E -L. III ACCIDENT
100.000,
10/20/2001 10/20/2002 —5
El, DIMAGE - LA EMPLO Y'FE $
—r:
100,0001
L. 01SEA3E - P01 llY I tMrr $
500,000!
i OTHER
OESCRIPTION 6V OPtRAnrJN8/LOCATIONSiVrtWICLES)RXCLV$ZOMO AVQ9p iry ENPORSEMENT/13PFCAAL PROmioNs
-A
� m � -I, M. �9- L�j k I i �vl"4
To" OF MRTH AMOVER 14A SHOULD ANY OF THE APOVP DMIC-0114 III fl()UCIES se CANCELLph aLvopkp T64C pXp#AAllom
BUILDING DEPART11IMNIT DATE THEREOP, TNi! 118SON47 MOURER WILL ENWAV014k TO 14,ML 9119 DAYSWRITTIN
120 M&IN STREET NOTWE TO THE CERTIFICATE HOLDRIP NAMED TO THE LerT, 13UT PAILURC TO 150 AO SMALL
OAPOSS NO OBLIGATION Oft L"ILMY 'JF ANY KNO 'UPOW THE INftneg, rrS AGE047B OR
NORTH ANDOWR KA 01845 -
OR
jFAlflTlORI=DXZPj*SENTft%F
RPORAT;ON 1992
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Date .... ...................... . ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ " ............................
.......................................
A
has permission to perform ....... ...........
i wiring in the building of ...... ...............................................
at. .................. . North Andover, Mass.
...............................................
\6�-) 0- 111 - /1
Fe AL' ...................
e ..................... Lic. Ec . rRICAL INSPECTOR
Check # ' 5?9(4 —
0
4 5 7 U
Official Use Only
Permit No.
Vo-e,-� S44 Occupancy & Fee Checked( -O
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Ail work to be performed in accordance with the Massachusetts Electrical Code 527 R 1 :00
(Please Print in ink or type all information) Date__A 70Z
To the Inshectof of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
4
Location (Street & Number .2 7(o ::�W Atkcje,,r— 97
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit Ye, El,'� No 0 (Check Appropriate Box)
Purpose of Building /_ &� - Utility Authorization No.
Existing Service 1W Amps 0,7�0 Voits Overhead 0 Undgmd El No. of Meters
New Service —Amps ........... yoits
Number of Feeders and Ampacity_
Location and Nature of Proposed Electrical
Overhead El Undgmd 0 No. of Meters
OTHER: lc,2 - 1?ece_<-_Te_d eci A 15 , A u) a& e- oueA
INSURANCE COVERAGE. Pursuant to the requireman6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalen PYES NO
h. , c."
Iii b Jtted valid proof of same to the Office YES - NO - If you have checked YES please indicate t e�yp coverage by checking the appropriate box
(Expiration Date)
FIstimated Value 9f EJL-ctrical Work$ ... 4,24,
Work to Start W-9-711-6 Inspection Date Resquested Rough Final
Signed u
FIRM NA
LIC. NO.
LIC. NO.
Bus. Tel No.
Address Aft Tel. No.gg;!�)_3
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as requiredby Massachusetts
General Laws. And that my signature on this permit application waives this rvWlrement. Owner Agent (Please Check one)
Telephone No. PERMIT'FEE $
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above
0 In 0
No. of Lighting Fixtures
Swimming Pool gmd
0 gmd 0
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of 0 i I Burners
Battery Units
N,C4 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
�9. of Diposal
No. Pumps
Tons
KW
No- of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
El Municipal El Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage -
n4
No. of Water Heaters KW
Signs
Bailases
Wiring T
No. Hydro Massage Tuds
No. of Motors
Total HP
OTHER: lc,2 - 1?ece_<-_Te_d eci A 15 , A u) a& e- oueA
INSURANCE COVERAGE. Pursuant to the requireman6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalen PYES NO
h. , c."
Iii b Jtted valid proof of same to the Office YES - NO - If you have checked YES please indicate t e�yp coverage by checking the appropriate box
(Expiration Date)
FIstimated Value 9f EJL-ctrical Work$ ... 4,24,
Work to Start W-9-711-6 Inspection Date Resquested Rough Final
Signed u
FIRM NA
LIC. NO.
LIC. NO.
Bus. Tel No.
Address Aft Tel. No.gg;!�)_3
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as requiredby Massachusetts
General Laws. And that my signature on this permit application waives this rvWlrement. Owner Agent (Please Check one)
Telephone No. PERMIT'FEE $
(Signature of Owner or Agent)
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
F�ame Please Print
Name:
Location:
Citv Phone #
F-1 I am a homeowner perfon-ning all work myself.
F-1 I am a sole proprietor and have no one working in any capacity
a m an employer providing workers' compensation for rrry employees working on this job.
Company name:
Address
CLt)E. Phone #.
Insurance. Co. Policv
Compggy name:
Address
cibc Phone
Failure to secure coverage as reqUired under Section 2M or MGL 152 can lead to -the knposition 4 criminal penafties of.aAne up to $I,-k;Woo
andfor one years'imprisonment-as well as cnM4aenakies-m-tbelcim-d-aBTOPYOOM-OFtDJER-md-afini---c(A$I-OD-M-ajday,-mjamistme- I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do her-eby cerbfy undar Vm pains and penahlies of pegury th& the offiwmabon provided above is true and correa
Signature Date
Print name Phone.#
Official use only do not write in this area to be completed by city or town officiar
City or Town Perrnittlicensing,
El Building Dept
E] CJ)eck Y immediate response is requi-ed Licensing Board
E] Selectman's Office
Contact person: Phone E] Health Department
Ei Other
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 7� 1 1 ., Date Rece
Date Issued-, 9 11 )
IMPORTANT: Applicant must complete all items on this page
LOCATION 7_�!_�- h,,_ j,
Print
PROPERTY OWNER J �D
Print 100 Year Old Structure Pe:7 na-
MAP -NO- Q'--( PARCELOUZZZONING'DISTRICT: :.Historic District yes 1z
Machine Shop Villaqe yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
El New Building
_60ne family
0 Addition
11 Two or more family
El Industrial
4AIteration
No. of units:
El Commercial
-t*epair, replacement
El Assessory Bldg
El Others:
El Demolition
El Other
EI.Septic D Well
El Floodplain El Wetlands
0 Watershed Districtj
-AWaterl8ewer
DESCRIPTION OF WORK TO BE PERFORMED:
— h,. -r L,-- !nt
Identification Please Type or Print Clearly)
OWNER: Name: t-4 Phone: c,,-1
-I � r
Address: C., L 14 .11 A _V_� N
CONTRACTOR Name: Phone:
Address:
00
Supervisor's Construction License: Exp,, Date: Uv",
�3
k
Home. Improvement License: kV��' \-k —Exp. Date:.
ARCH ITECT/ENG I NEER t-.Vv,� Phone:
Address: Reg. No
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ �'_) 00 0 FEE: $ 0 �-i -1) -D
Check No.: tj&51 Receipt No.:_ZLI� a Kp
q�:� 4he guarantyfund
NOTE: Persons contralcting with unregistered contractors do not have access to
L gnature� o.��gqnlltQ nor,.J ractor
Sig_Dafu,re of..cont
Plans Submitted Plans Waived Certified Plot Plan 11 Stamped PlanYr]
3
E
Location. n7777749 Al A161 7Y
47 -
No. Date
Check# //� ?/
26400
TOWN OF NORTH ANDOVPER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Building Inspector
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The Commonwealth ofHassachusetts
02 Department of IndustrialAccidents
Off -we of Investigations
600 Washington Street
N4i9t7/ Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Buffders/Contractors/Electiricians[Plumbers
Applicant Information Please Print Legibly
Name (Businesstorganizationandividual):
Address:- 0�lb Y Ir-- .
City/State/Zip: ,\V,-�- Phonek �71V- LTI-5-375
Are you an employer? Check the appropriate box:
I I am a employer with 4. F1 I am a general contractor and I
empl ces (full and/or part-time).* have hired the sub -contractors
OY +
2.0 1 am a sole proprietor or Partner-
ship and have no employces
working for me in any capacity.
[No workers' comp. insurance
required]
3. F1 I am a homeowner doing all work
myself. [No workers' comp.
insurance required] t
listed on the attached sheet
These sub -contractors have
workers' comp. insurance.
5. El We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, §1(4), and we have no
employees. [No workers'
comp. insurance required]
Type of project (required):
6. New construction
7--Q Remodeling
8. Demolition
9. Building addition
10.0 Electrical repairs or additions
I LF1 Plumbing repairs or additions
12.0 Roof repairs
13.F-1 Other
*Any applicant that checksbox#1 must also fill out the section below showing their workers' compensation policy information.
f Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such.
an th ke omp policyinf rmati n.
tContractors thaf check this box must attached an additional sheet showing the name Of the sub-COntractors d eirwor rs'c 0 0
lam an employer that isproviding workers'compensation itzsurancefor my employees. Below isthepolky andi�b site
informadorL
Insumce Company Name: Expiration Date: -3
Policy # or Self -ins. Lic. M
Job Site Address: 7711 City/State/Zip: tl/-
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for insurance coverage verification.
I do h erelyl cerfify u n der th e p ains an d p9talfiles ofp erjury th at th e information pro vided ab ove is i true and correct.
Official use only. Do not write in this area� to be completed by city or town offkjaL
City or Town:
PermitUcense
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
98 Forest Street
i(sevin M ph yr 0 North Andover, MA 01 U5
0 PH: 97"88-M35
Building Contractor FAX: 978-688-7207
Proposal
TO. Chuck & Joan Holman
276 Andover Street
North Andover, Ma 01845
From: Kevin Murphy
CQ
Date- 5/15/2013
Job. Porch
Date of pllailm- None
Archkect None
Location: Same
Section I - Work Schedule
AN Horne impovernent Contractors and Subcontractors
ergaged in home ffnprovement oDntactirg, untess;
specrfically exerno from regishation by P- of Chapter
142A of bee general laws, must be registered with Me
Cornrnonweafth of Massachusetts. InqLfines aboLd
registration and Status shoLdd be made to the Diredor, Home
hipwernent Cor� Registn� One AshbLuton Place,
Room 1301, Boston, MA 02108. (617)-727 8598
Contractor will begin the work or order the mate6als before the third day following the signing of this agreement unless specified here in
writing contractor will begin work on or about 5/15(13.
Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 611/13. The owner hereby acknowledges
and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as
violations of this agreement.
Section 11 -Warranty
The Contractor warrants that the work fumished hereunder shall be free from defects in materials and workmanship for a period of 1 year
following completion and shall comply with the requirements of this Agreement In the event any defect in workmanship or materials, or
damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job,
including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair conrect, replace, or cause to be remedied, repaired, or
replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in
connection with the agreed-upon work.
Section III - Scope of Work
Page 1 of 4
Kevin Murphy
Building Conftwtor
98 Forest Street
North Andover, MA 01845
PH: 978j6BB,5335
FAX, 97&4588-7207
Page 2 of 4
General
Proposal is to rebuild exisitng front porch. Building permit to be obtained by contractor.
Demolition
Exisitng floor, posts and rails will be removed.
Building
New 2x8 pressure treated floor joists will be provided. New decking will be 5/46 Cedar. Eight inch round
columns to match exisiting. New railings to match existing. Miscellaneous rotted brim on house will be replaced.
Painting
Painting of trim that is replaced, will be provided. No allowance has been made to paint new porch area.
Waste Removal
All demolition / construction debris will be disposed of.
A .
Kevin Murphy
Buflding Conftwtor
98 Forest Street
North Andover, MA 01845
PH: 9784688,1,3W
FAX: 978-688-7207
Section IV - Price Schedule
Page 4 of 4
We hereby propose to furnish material and labor — complete
in Accordance with above specifications for the sum of ..................................... $$7000
Payment to be made as follows:
**Notice: No ageement for Horne improvement contracting work shall reqL&e a da4m payment (advance deposit) of more that one4urd of the total conh'act price ofthe total amount of all deposits or
payments mhich the ountractor must make, in advanoe, to order ancl/or otherwise obtain delwery of special order materials aid equipment, whichever is greater
Contractor: Kevin Murphy
98 Forest Street
No. Andover, MA 01845
Registration No: 101874
Section V — Acceptance
Acceptance of Proposal — I have read this document and accept the prices, specifications, and conditions stated. I
understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified.
Payment will be made as outlined above.
You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this
transaction cancellation must be done in writing
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Signature Da
Signature Date
Plans Submitted 0 Plans Waiv—eZj1- Certified Plot Plan 11 Stamped Plans 11
TYPE OF SEWERAGE DISPOSAL
Public Sewer 1:1
Tanning/Massage/Body Art F1
Swimming Pools
Well El
Tobacco Sales El
Food Packaging/Sales El
Private (septic tank, etc. El
Permanent Dumpster on Site 11
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMEN
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
11
DATEAPPROVED
0—
Reviewed on Signature
Reviewed on Siqnature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
W,ater & Sewer Connectionisignature & Date Driveway Permit
DIVW Towp- Engineer: Signature:
Located 384 Os000d S�reet
FIRE DEPARTMENT - Ternp Dumpster on site yes
no
Located at 24 Main'Str6et
Fire Departffib'*n'f-s�i§na-tb�tiD/daitti
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21 A —F and G min.$100-$1000 fine
NOTES and DATA — (For department use
D Notified for pickup - Date
Doc.Building Pennit Revised 20 10
Building Department
The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
u Building Permit Application
Li Workers Comp Affidavit
• Photo Copy Of H. 1. C. And/Or C. S. L. Licenses
• Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Li Building Permit Application
u Certified Surveyed Plot Plan
c3 Workers Comp Affidavit
c3 Photo Copy of H.I.C. And C.S.L. Licenses
c3 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)
• Building Permit Application
• Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
Li 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 Ener y Compliance Report
'g
• 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 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 subm"Ated with the building application
Doc: Doc.Building Permit Revised 2012
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:,qcj:,� /Z— Date Received
Date Issued: IP14-111
RTANT: Applicant must complete all items on this
LOCATION fa V �r-.
--Print
PROPERTYOWNER Jt/pt'j �kq(",�Ji unit #
Print
MAP NO: ( ;i�-6 PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village y s n
_�L_ $
100 year-old structure 0yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
El One family
El Addition
0 Two or more family
El Industrial
�Mlteration
No. of units:
El Commercial
El Repair, replace��e—nt
El Assessory Bldg
11 Others:
El Demolition
El Other
0 Septic El Well
D Floodplain 0 Wetlands
0 Watershed District
0 Water/Sewer
"h�iUKIF I 1UN UF WORKTO BE PERFORMED:
, (Identification Please Type or Print Clearly)
OWNER: Name:— SAa Phone: '�7� V';� -7 -3 -7 4 5 -
Address:— 2-716 6-4,, ,j-, S,'�� N& , 1%
CONTRACTOR Name: k��iwL-P-U (�N� Phone: c,, -n -% 6T � S-3 3 75�-
Address
M
Supervisor's Construction License: O�S-3 0 0\?k, Exp. Date: 16 � Lq" � � -I-
Home Improvement License: V1z)V,%--1
Exp. Date: � � in- k V-.-?
ARCH ITECT/ENGI NEER KA .1—k Phone:
Address
Reg. No
FEE SCHEDULE.BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ ZB �Z 0 D FEE:$_ 339 .00
Check No.: ' /�) 6"3 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have i
LocatlonrQ 76
No. 9�2 - Date �,4
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check q
24666 Building Inspeclor
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Kee v i n M - w-, - p h, y
Building Contractor
Proposal
TO: Chuck & Joan Holman
276 Andover Street
North Andover, Ma. 01845
From: Kevin Murphy
CC.,
Date: 6/27/2011
Joir Bath remodels / closet reconfiguration
Date of planm 5/11
Architect: Steve Foster
Location: Same
Section I - Work Schedule
169 Boxford Street
North Andover, MA 01845
PH: 978-688-5335
FAX: 978-688-7207
All Home improvernent Contractors and Subcontractors
engaged in home improvementoontra ng,unless
sPedficallY exempt from regL*aton by Provisions of Chapter
142A of the general laws, must be registered with to
Commonweardl of Massachusetts. Inquiries about
registration and Status should be made to the Director, Home
Improvement COM Registration, One Ashburton Place,
Room 1301, Boston, MA 02108. (617).727 8598
Contractor will begin the work or order the materials before the third day followring the signing of this agreement, unless specified here in
writing contractor will begin work on or about 8/1/11.
Barring Delay caused by circumstances beyond Contactors con'tioll, the work will be completed by 10115/11. The owner hereby acknowitedges
and agrees that the scheduling dates are ap M-y-imate and that such delays that are not vvoi�h!e -by the Contractor sha!! no be cons!dered as
violations of this agreement.
Section 11 -Warranty
The Contractor wa.-; ants that the work kmished Iereunder shag be fr—_ from de" -.-s in mateAlIs and workirarship for a period of 1 year
- ' - *
164uoia-ig c4yn-*p�.ei.on and sriall conn
1.1 1;7qW='1R;:fits of Mis Agmse-n-tent. In the event any defect in workmanship or materials, or
damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job,
including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair correcit, replacte-, or cause to be rearriadieU, repaired, or
replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall sunihme. any inspection performed in
cornWAion Ulte
sec"on III - lscmn�r' -- eff Wof k
Page 1 of 4
Kevin Murphy
Buflding Conh—actor
169 Bcodord Steel
North Andover, MA 01845
PH: 978-r�
FAX: 9786W)O=
General
Page 2 of 4
Proposal is to renovate two second floor bathrooms, replace / plaster ceilings in first floor office, foyer, and
second floor hallway. Second floor closet walls / doors to be reconfigured as shown on plans. Main bathroom
wil be completely gutted and expanded as shown on plans. Three quarter bath will just have fixtures and floor
replaced.
Demolition
Existing main second floor bath will be completely gutted. Ceilings will be removed as required. Walls and
ceiling in three quarter bath to remain.
Building
Existing window in second floor hallway will be replaced with new Harvey replacement unit. Any framing
materials to relocate bath / closet walls will be supplied as required.
Plumbing
Plumbing required to renovate existing second floor baths will be provided. Fixtures to be relocated in main bath
as shown on plans. Fixtures in three quarter bath to remain in same locations. An allowance of $1600 has been
included for plumbing fixtures ( $150 per shower valve, $500 for main bath tub / shower, $200 per toilet $200
,per faucet, copper pan for three quarter bath will be supplied).
Electrical
Electrical -work required to renovate existing baths will be provided. Bath fan / light units will be supplied and
installed. Surface mounted fixtures (vanity light) to be supplied by owner.
HeatingAir Conditioning
Baseboard heat in bath areas will be replaced. Forced hot water heating will be added in existing kitchen area
and second floor bedroom. One toekick heater will be supplied and installed in kitchen area off of existing first
fl,nnr 7n 1Q_ RP4Z boprd he;!t will be supplied / insta
MR - ___e lled in second floor bedroom area off of existing zone.
Insulation
Second floor bath area will be insulated *,P- m-& c -.--d--.
Plaster
Second floor bath, first floor office ceiling, first floor foyer ceiling, and second floor hallway ceiling will be
i-i�d �--iis all J ceil- iouih. Three quartei, baih will be paiched as
C&; IV �ki I ictoLv. VVC3 U 111119ti will Ue bil
required.
Interior Trim/Doom
Interior trim Ml be stipplied and installed to match existing. New pre -primed intKior door units will be supplied
and installed as shown on plans. Doors to match existing as close as is available.
Flooring
Kevin Murphy
Buflding Cortractor
169 Boxford Street
North Ardover, MA01845
PH: 97846886335
FAX 978-68&)OO(X
Page 3 of 4
Tile floor will be provided in second floor baths. Tile shower will be provided in three quarter bath. An allowance
of $5 per square foot has been included for tile materials.
Other Allowances
An allowance of $1500 has been included for main bath vanity / countertop. An allowance of $1000 has been
included for vanity / top in three quarter bath.
Waste Removal
All demolition / construction debris will be disposed of by contractor.
Painting
No allowance has been made for any painting.
'�k 1) %
Kevin Murphy
Buflding conuwtor
169 Boxk)rd Steel
North Andover, MA 01845
PH: 9784688-5335
FAX: 978-688-X)O(X
Section IV - Price Schedule
I Total
Page 4 of 4
We hereby propose to furnish material and labor - complete
in Accordance with above specifications for the sum of ..................................... $28,200
Payment to be made as follows:
Percentage/item
Description
Amount
1
Permit obtained
3000
2
Demolition complete
$5000
3
Rough plumbing / Electric complete
$6000
4
Plasteling complete
$5000
5
Tile complete
$5000
6
Job 100% complete
$4200
�6—
1$28,200.0-0
-Nofice: No agreement for Home improvement contracting work shall reqLffe a dam payment (advance deposit) of am that one#rd of to toted contract price of the total amourd of ail deposits or
payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and eopment, whichevw is greater
Contractor Kevin Murphy
169 Boxford Street
No. Andover, MA 01845
Registration No: 101874
Section V — Acceptance
Acceptance of Proposal — I have read this document and accept the prices, specifications, and conditions stated. I
understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified.
Payment will be made as outlined above.
You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this
transaction cancellation must be done in writing
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Signature Date 4��
-E�M�—A I I V
Signatunp._(—� OL -�12(
Date -21
Are you an employer? Check the appropriate box., Type, -of project (required):
4. Vain a general contraClOr-and 1 16. E] New constniction
I _31 am a emoloyer 11�iffi N ,
employees (full and/or jart-tinie).* have hired 1he sub -contract -ors;
7. 05Remodeling
2- 1 am a s616 proprietor -or partner- listed on the attached.sheet. I -, 4-- -
ship and have no employees These sub -contractors have 8. Demolition
working for me in any capacity- workersi comp. insuMM 9. Building addition
EIV&are a--cbrWration and its
[No workers' comp7 ms.w=cf- 10.0 -Electrical repairs or additions
of ficeis ha*e exercised their
required-]
1113
per MGL- Plumbing rcpairs OT additions
3 El I A m a homeowner, doink. all work -right-of exemption
c- 112, §-1(4), and we have no 12.0�Robf
myself- [No workers' comp- rVaUS
insurance t employees. [Noworkers'
-required-] 13.F-1 Otbei
con1p. msurance rtnuiraiwl
-Any applic"I that chedm box #I Mnst at% fin out the section below showing fimir woftW cmmpenssti0nV0licYin&MM0ti0W
doing gffl work and a= him outside conttactors nrast sabimit a new affidavit indicatmP- SUCIL
t Honwo-ners wbo submit ibis affida.vit indicating they we
tContnicton That check this box umst mm:hcdr;M additional sheet showing -&e name offlm sub.-coubuctors and their woAme camp policy tufarniabou,
lam:onemp*,ei-&idispr.ovhffiig-ivorkers'compmsadon.'msurwweformyemployem Below.isth4oficylillndjob, site
inyonnadam
insurance Company Name: C411.
Expiration Dabo.
Policy# Or Self-ifts. Lic- #: VS 3-77!r
Job Site Ad I city/Stateow t,�,&
Attach a copy of the workers' compensation policy declaratib I n page (shOWi]3g . the poficy. number and expiration date).
Failure to secure coverage a - s required under Section 25A of -MGL c- 152 can lead -to the impo, of criminal penalties,of a
fine up to $1,500-00 and/ordne-ye2r iMpTisOmment; -as well as civil Penalties. Jn the form of,.a,, STOP WORK ORDER.'and a �Ine
Of Up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwaded to 11he Office of
Investigations of the DIA for insurance coverage Verification -
I do.herebir cer%po,�tnder the -us andpenafties ofperjuiy that the infornmdon provided above is true and co�rrect,
O)Twjd use only. Do not write in tkis area, to be compleed by� city ort6wmofficiaL
City or Town: PermitUcense
Issuing Authority (circle one):
1. Board of Health 2- Building Department 3- CityMoww0erk 4.� lKlettrical-Anspector 1�lumbiug Inspector
6. Other
Contact Person: Phonel#:
07/11/2011 07:45 9786833147 PAGE 01/01
F—oA-mm*m"m
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CERIF"TE EKES NOT AfFIRIIIIATIVMY OR t&QATIV&Y AMEW MaM OR ALWA THE COVERAGE AFFORDED BY IM POUM
geLow. THIS CER711FICATE OF INSURANCE WES "OT CONSTIMIM A CONTRACT BETWEEN THE 9MM IINSURMM AMCRIM
OR PRODUCER, AND THE CERTWICAM HOLDER.
WpaRrANT. 'nffipklf IfSU8R0"'WN'SWAIVED,Su%%dto
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IRODUCER NAME ---
N P ROBERTs nqs A=T. mc ExW (976) 623-8073 JaZigi
1060 Osgood Street asandiftWrobertalmourance.cm
North Andover, MR 011845 MWOM) AFFORM C&AMM,
["vim . KXVIN HIJEWRY BUILDWO & R129MEMMIG nomm o: 961101WO &c40wxLn"%.&
169 BOXW%W STMET INSUFM C: IWAMW
INWRER0;
NORTH ANDOVER, MA OILS45 Immmme-
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COVERAGES CwnMCATE NUMBER* REVISION NUMBEk
T141S is To CEKrFY -HAT THE POLICIES Of INSURANCE LWW BELOW KAVe BEEN ISSUED TO THE INSURED NAWD ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUAJyffiNT TERM CYR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC44 THIS
CFfmFr-ATr; MAY Be ISSUED OR MAY PERTAIN. THE ImBUWCE AFFORDED 13Y THE POLIW8 DESMIRED HEWN is suejwr To ALL Tm TERMS.
MMUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE WIM RM=D BY RAID CLANS
f,*. I IM OF 'NSURANCE = i=L POLICY mumom IMMUPArr IMEW LIMITS
CCRIMERClift jouiIEp.& UAgnny
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MRSMM A AW INJURY 5
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SMILY puuffy QW pfflu"I I
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=�MPOFSRATKMIS beow I I EL DIWASE - PCLW LIMIT 1 $ 500,000
DESCRII'TION OF OPERATIONS I LDCATM /VEHICLES is qqmxo
TOM OF NORTH ANDOVER SHOULD AW OF THE ABOVE DESCRIBED POUCES BE CANCELLED BEFORE
NOR= AMOVIIM, NX 03.845 THE EXPMATION DATE THERWF. NOTICE WLL BE OWWRED IN
ACCORDANCE WffH THE POUCY PROVISION&
A
AUTHORIM;0in
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0 19W2010 ACORD CORPORATION, AllrloftmservW.
ACORO25(20110" The ACOM nam and top am Nolsund muft of AOM
Plans Submitted 11
Plans Waivedb
Certified Plot Plan 11 Stamped Plans El
TYPE OF SEWERAGE DISPOSAL
Public Sewer
TanningIN4assage/Body Art F]
Swimming Pools
Well El
Tobacco Sales 0
Food Packaging/Sales 11
Private (septic tank, etc. 11
Permanent Dumpster on Site F1
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLANNING & DEVELOPMENT F1 11
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
.�A
Com
Conservation Decision: Comments
t
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes.
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Located 384 0,,�goqd Street
no
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$l 000 fine
NOTES and UATA — (For deDartment use
LJ Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
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
Photo Copy of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition or Decks
• Building Permit Application
• Certified Surveyed Plot Plan
• 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)
Ei 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)
u Building Permit Application
Lj 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
Lj Mass check Energy Compliance Report
o 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 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
imust be submitted with the building application
Doc: Doc.Building Pennit Revised 2008mi