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HomeMy WebLinkAboutMiscellaneous - 29 MAGNOLIA DRIVE 4/30/201800 Cil r- 9 > Oo 0 0 0 < m This certifies that ..... f'4-:� P,9777Z-7— -- -/�- ..... has permission to perform ... SMV6-k4TOle 77-4-e /0 ...... wiring in the building of .. 5C'44-4�1/ ...................... at f� ....... I N h Andover, Mass. Fee 670 �5--! Lic. No. 137. ......... ELECTRICAL INSPECTO Check 6Z72- 11038 S�l Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ), 5 7 CMR 12.00 (PLE,4SEPRfluiNINK OR YYPE ALL INFORMATION) Date: --- �7.,�zc,, �/ 2�- City or Town ofi NORTH ANDOVER To the InWectoloY Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant 47 -A Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service New Service Amps Volts Amps Volts Number of Feeders and Ampacity Yes No utility. Overhead Undgrd Overhead Undgrd Telephone No. '72Y -6g -2 - (Check Appropriate Box) [tion No. No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators p � KVA No. of Luminaires Above Ei In E] Swimming Pool grnd. grnd. No. ol Emergency JIgnting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating evices f& of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I.NYMP.�K]XTI� KW ........... ........... No. of Self-Containerl Detection/Alerting Devices - No. of Dishwashers Space/Area Heating KW oca, D Municippl El Other FL Connection 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 111P Telecommunications Wiring: No. of Devices or Equivalent OTHER:/ f Attach additional detail Y desired, or as requirea by the inspector oj Prtres. Estimated Value opEle9trical Work: (When required by municipal policy.) Work to Start: 2— Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE ICOVIERAGE: 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 coyero is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE VYBONDE] OTHER 0 (Specify:) I certify, under th7ns andpenal 'es ofper* at the information on this application is true and complete. Jury, 'LIC. NO. FIRMNAME:. Licensee: Sipmature (1fapplicable, enter "exempt" in the license number line) Bus. Tel. No.: A Y�7 Address: Alt. Tel *Per M.G.L c. 147, s. 57-61, security work requires Department 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) [I owner [] owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ F SA4 plso�d Asp actors, coxmexts. -no �_011als) :,- 7se 'bum ruqectorp, c As�adorsl me-ature -n ERIS) 'Ali YEW — ELI] WOO CO)IMents. Clrkvpcfors�'Rjgnatuxe-)iD H -CT 21s) Pate NMI CAI r_l_,rlq D ,Soa—f I Ite-:Tn&p ectl;n requRea ($60.0 0) - f I Betorg, ftwit ure - 0 WU als) Pata Y)Rte The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 J&14 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib Name (Business/Organization/Individual): ttle�ri (_ Address: V, 0 . City/State/Zip: A�efiv,,_ Phone #: 9;F — 3,Pc� ---C7 fj�� Are you an employer? Check the appropriate box: El I am a employer with 4. El I am a general contractor and I [ loyees (full and/or part-time).* have hired the sub -contractors 2.PrI aim,,p a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. El We are a corporation and its required.] officers have exercised their 3. 1 am a homeowner doing all work E] right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] f employees. [No workers' comp. insurance required.] Type of project (required): 6. F1 New construction 7. E] Remodeling 8. E] Demolition 9. F1 Building addition 10. Electrical repairs or additions 11. Plumbing repairs or additions 12.E] Roof repairs 13.n Other 'Any applicant that checks box# 1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. rain an employer that is providing workers' compensation insurancefor my employees. Below is the policy andJo'b site nformation. I nsurance Co�hpany Name: lolicy # or Self -ins. Lie. #: Expiration Date: 'ob Site Address: City/State/Zip: Utach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ,ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of a,vestigations of the DIA for insurance coverage verification. do hereby certify tinder thepains Zandp nalfies of jury that the information provided b ve is trite and correct. dLznature��� Dn t e - 2,F --�? J�y - o t9,9 �z Official use only. Do not write in this area, to he completed by city or town officiaL City or Town: Pcrmit/License # 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1,877-MASSAFE evised 5-26-05 Fax # 617-727-7749 www,mass,gov/dia �- o� Date :q? . ...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that �J!�.40. .-S7ivej-,f44.� ................... has permission to perform . &'r, :7� jawz .. A . . . . . . . . . . . . . . plumbing in the buildings of "q at ................. . North An over, Mass. Lic. Noz;�.Cli.��' .... Fee LUM ING �INSCTOR Check 7266 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 PLUMBING SIX (Print or Type) MasL Date Permit Building Owner's Na=4 7111,Wcl 19(— <!!�W; N, 2"42 �22'1 Type of Occupancy, -,I/� IF . O�� C�11 Now Rermallon Replacement 13 Plans Submitted: Yes 0 No 0 FIXTURES Installing Company Business Telephone Name of Ucensed Plumber Check one: 0 corporation '0 Partnership 13 hrm/Co. INSURANCE COVERAGE: I have a current liability insuraince policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes P No 0 If you have checked yW. please indicate the type coverage by checking the appropriate box A liability Insunince policy P Other typed Indemnity 0 . Bond 0 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 ipplication walves this requirement. Check one: Sionatute of Owner or Owner's Aaent Owner 0 Agent 0 I 116410Y ON* that all of the details and information I have submitted (of entered) in above application we true and accurate to #* bad of my knmWge and that all plumbing work aM installations performed under the permit issued for this application vAll be in compliance with d pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the Laws. F 'y 01 LXNMM Muffv� r rdle 10 Type of License: Master JOUMOM54EP C�APAI ljoense Number_C2QEZ2e2,, a 0 zi P 0 tu z w 5 -1 w Z m 46 cc ug IL lu IL 96 z lam -1 w Z m 46 a Sw % Quadruple 1-3/4�,,, x 1 j -7/81, VF.RSA-LAM@)' , BC CALCO 9.3 Design Report - US span I NocanUlMrr,10112 slope Build 057 F;Ile Name: BC job NamI SCARAGGI Dewription'. FBI Address: *2� MAGNOLIA OR Specifier City, State, Zip: NO.ANDOVER, MA Designer Customer Company. Code reportw, ESR -1040 Mise CA BO LL 3740 lbs DIL 1134 lbt 77-77 Total of HchmAtal Unf. Area (PSf) I 3100 SP Floor BeamI Wednesday, November 15,2006 11-41 'C Prow 44. 'ING BEAM LL 3740 The j, li 0L 11134 Ibs pans T-00-00 snow Wind Roof Live 1 i � 1� 1� Mi :11,, End IGO* 133% 125116 Trib. 1 1-00-n 17-00-00 4&' 10 n 1 Disclosure Controls Surnmary Value % �Iowaplf!-. w -) --- Pos. Moment 20713 - 1 - Internal --"�WQT Comola*mass and acturacy of input must be verified by a a who would relY on_ End Sbear 4285 lbs 27-00% 1 100% L/370 (0-55� 20) 64.9%. Lek of as evidaMn itabil output su t ity for particular applic2fion, Outiput here based Total Load Defl. Live Load Dell. U482 (0.42V') 74.7%: 55.2% on building cod"=epted design *psydes and analysis methods Max Defl. 0.552' n1a Inmnation of BOISE en&eer(d wood Span / Depth 17.2 ? prod ucts must be in aoc&danca WM current installation Guide and spiplicable 1 Notes building codes. To obtain Installation Gu Ide Design meets Code minimum u24o) Total load Id on afteda. V360) Live load deft"on criteria. or ask questions. pwase 0811 oo)232-0788 before installaI ; � Design meets Code minimum Design meets arbit rary (J") Maximum load deflection crdeda. SC CALCO, BC IFF ILAME", AJSm. M; for BO is 1-1m. nimum beating length Minimum bearing length for 51 Is 1-1/2". ALLJOIFM, BC RIM soARD-, SCIV, BOISE GLU LAm-. SIMPLF FRAMING EntereditNsplayed Horizontal Span Length(s) Cieiiir Span,-+ 1/2;mln. end bearing + SYSTEMO,VERSA.LAMS. VF.RSAA 112 intermediate beaflng PLUSV. VitkSA-RIM0, Vr=RSASTRANDS, VERS"TUDS Ore MSG Wood PftAuGts, tradanI of ConneqVion DIIIIS111`111111111 b 4-s- d page I of I Imi Date ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... 7 ........................ has permission to perform W'A"-rz7 .............. nl ................................. .1 wiring in the building of -'4, . ............. s 't ... &Iz.I'.* .... ........................... . North Andover, Mass. Fee../.���. Lic. No.Pe-.734 .......... P�� A."O. ELECMI&L INSPECT91t Check # 4 8 Official Use Only Commonwealth of Massachusetts Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS l[Rev.9/051 (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ( EQ, 527 CMR 12.00 (7. (PLEASE PPJNT IN INK OR TYPE ALL INFORAM TION) Date: Id /9 7 City or Town of: NORTH ANDOVER To the ipfspect& of Wires: By this application the undersignedgives n ice of his or her intention to p�rform the electrical work described below. Location (Street & Number) 1�v Z', >� -dAl�z Telephone No.i��— Owner or Tenant c2 �' A,1, -z Owner's Address 1��& rz_� Is this permit in conjunction with a building permit? Purpose of Building Existing Service/�P_ Amps . a 1AKdVolts New Service pz__� Amps /,XJ -Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Ft7r Yes 4J No (Check Appropriate Box) Utility Authorization Nod- 7 - 3 FT1,1 Overhead L1_3 Undgrd No. of Meters Overhead P---' UndgrdE:l No. of Meters �Z21­4 dle— Vt Z, Compleftflon'of thefollowing table t4ay be waiv� the Inspector bf Wires. No. of Recessed Luminaires /Z No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires 13 Swimming Pool Above In- grnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches No. of Gas Burners No. 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 Number I Tons KWI No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local El Municipal El Other Connection No. of Dryers Heating Appliances KW Security SXstems:* No. of Devices or Equivalent No. of Water KW No. o No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equiva ent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 1 0 J Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Elec rical Work: (When required by municipal policy.) t Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE��O 4ERAGE: 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 0 BOND [I OTHER [] (Specify:) I certify, under the pains andpenalties ofperjuiy, that the information on this application is true and complete. FIRM NAME: 15:e_d�-_6e -c- LIC. NO.: Licensee: (_ Signature LIC. NO.: (If applicable, liter "exempt "in the license lilt iber line) Bus. Tel. No.: Address: _(q_ 40,k- zz,:� 4ZE�41�! 4,!�!4_1 d/R0 Alt. Tel. No.:�'ZP- 2_J_r-­P071 *Security �ystem Contractor License r'equired for this v0rk; 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)Elowner [:1 owner's agent. Owner/Agent ERMIT FEE: $ Signature Telephone No. FP I -1 a ,�,.ocation No. Date 9 M Check # k 14 '/- P, 6 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building lnspectdr--� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING W BUILDING PEFMT NUMBER: DATE ISSUED. (e. SIGNATURE: - Building Commissioner/Inspector of Buildings Date �7- SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 53? umber Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage (ft) 1.6 BUIELDING SETBACKS (ft) Front Yard . Side Yard Rear Yard Required Provide Required rovided :�:p Required Provided I L 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: Public D Private D zone Outside Flood Zone 0 .. 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSELIP/AUTHORIZED AGENT 2.1 Owner Qf Record &*�* Z�, 94A P?M__ V Name (Print) V C/ Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone J SECTION 3 - CONSTRUCTION SERVICES 1 3.1 Licensed Construction Supervisor: C)&,/o q �eou� &I Licensed Construction S . upervisor: ,2 7 Al Less -7 &t�� y / Telephone Not Applicable 0 License Number Expiration Date royement Contractor Not Applicable 0 Company Name -7 -y&- �.w Registration Number 1 �al �e Expiration Date I IA_Xddress . u r Telephone M I SECTION 4 - WORKERS COMPENSATION (KG.L C 152 8 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 ....... 0 No ....... 0 -SECTION 5 Description o Proposed Work (check applicable) New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify B Description of Proposed Work: V -SECTION 6 - ESTMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant SE, 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 (HVAQ 5 Fire Protection -6 Total (1+2+3+4+5) 4 Check Number SECTION 7a OWNER AUTHORWNION TO BE COMIPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUIULDING PERMIT L as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building peniiit application. Signature of Owner Date -SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of 0 N111.111, gerient Date -NO. OF STORIES SIZE -BASEMENT OR SLAB SIZE OF FLOOR T11VIBERS OT 2ND 3M -SPAN -DIMENSIONS OF SULS -DIMENSIONS OF POSTS -DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X -MATERIAL OF CHIMNEY -IS BUILDING ON SOLD) OR FILLED LAND [ IS BUILDING CONNECTED TO NATURAL GAS LINE 11 .1 Castricone Rooring & Siding REPAIRS FREE ESTIMATES Telephone (978) 682-4266 MARIO CASTRICONE 31 Court Street, North Andover, Mass. 01845 I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on premises below described: Owner's Name .................. ............. ...... ----- .......................... cd....................................................................... Job Address . ...... .......... ...... ........... .. ...... .................................. City� ..... ................... State ... 2ff .. q ............................ SPECIFICATIONS ... . ........... ... ..... ---------------------- ------------------------------------ ............................................................................................... X ;; . . . ..................................... IS 5 Malerials and labor to cost $ ......................... and balance in ............ ........................... Payable ......................................... on-' ................... monthly installments of $ .......................................... each, payable on ........................................ day of each and every month thereafter until paid in full ( .............. % charge per year is to be added to, above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this coAtract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Cover attic storage cleaning not included. Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in operation ... IN WITNESS WHEREOF, the parties have hereunto signed their names this ................ day ofc ... = ......... Accepted: (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Per--44� ... ....... ........................ Representative Signed ... �-k�,Ze . . ................. Signed...................... L;< .......................................................... Owner Signed...................................................................................... 12�e Com=nweafth ofWassachusetts Departvtant, of Indust= qccidents qfte oflnvest�qations ;V 'Tton Street 600 Washinb Mostoi; 9KA 02111 Workers' Compensation Inmirarice Affidavit Please PRINT Ledbh, . 1 am a homeowner Performing all work myself. C, .Telephone M 13 1 am sole proprietor and have no one working in my capacity E)Iamanempl erprovi a workers' c5Tpensation for my employees working on this job Company Name: = Address: City: Insurance Company: Telephone M 64 Policy#: o0c- 13 1 �og ?w I am (circle one) sole proprietor, general contractor or homeowner and have hired the contractors listed btlow who have the following workers' compensation policies: Company Name: Address: I City: Telephone #: Insurance Company: . Policy VI: Company Name: Addxess: City: Telephone 4: Insurance Compan Policy #: Attach additional sheet if necessary Failure to secure, coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to S1,5DO.00 and/or one ye -ars' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine. of S 100.00 a day against ine. I understand that i an .a copy of this statement maybe forwarded to the Office ofInvestig ions of the DIA for coverage verifi cation, I do hereby certify under 7the . pins andpenalties ofperjury that the information above is true and qpfrrectl Sipatur Date: (59--) Print Name: Phone 0 Cl- V,; Official Use ONLY - Do notwrite in this 2rea City or Towm 0 Check if Immediate response is required Permit/License 4: o Building Department E) Licensing Board C) Selectmen's Crffic:e M Health Department ED Othe-, Cl) m m M m m m Cf) m U) 0 m a t W rA, CA Cl) "0 0 CD az CA CD = . 06 0 CL cz CD CD CL cr CD Sr CD 0 CD ww 9. CD co) CD CL CA CO CD S- CA CD z a CD CD 0 r) Qot� A cn cn n 0 z cn 0 z cn cn cn 2 0 z cn 44 C3 z 0 CO co c C2 9 CO) cr CA CD MCL 0 D 0 CD C2 CL C-) CD �* c =r -o Im go =r CL CL CD =r Im C CA D CD CD 3E W -4 C,) 0 -00 0 Z -C C2 c 0 0 C2 C 0 CD 3,0 CL 0 CD a cc CL CD co) ca =r: CL cr CL CCD to 3E 4D co CA 0 CD B: C) 0 =r CD CD C2 CD CD co CD CD 0 CD ca 03 C-) 0 0 CA 0 CD CO) Cl) m CO)m C/) 0 C/) td 111 91 ql C/) ;z 0 Jr-, A �v n Pi 0 r_ Irl 0 r- :I C/) rD C/) al 0 rL ri E I I onq 0 44� CD ol U) m m M m m m U) m Cl) 0 m 0 CO) 10 0 CD a z CA CD 0 -0 CL C2 CU co) '00 C2 CD 0 dc CD CL cr =r SU CD CD 0 CD c CD CO) — CD CL a) co) co CD CO) 0 10 z CD CD CD 0 cn cn n cn cn 2 all 0 z cn CD z 0 =r co co 0 CL a' co CO co EL 0; ca Go cr cop dc CD SCE uo =t CD C CD 0 CL C-) ca CD — CL CL 0 CD Cj) 0 co) 0 =r CD CD ;; : -00 CR z :5. C2 0 c c co c c c 0 C2 C 0 CD Er =,a: =Iffr CA CL. 0 .c CD a CA 0 CD CL CD Ca ;W: Cc CA =r: CL cr CL C.CD :E; CS - C4) SCD CA CD A =r CD 0 CA ;:F C42 co 0 CIF. 62-: --i 2E CA Cl) 0012 cn cn w III cn 91 x n �o 71 cn III g, 9z �j 0 C 0 C 0 0 0 X, OQ �3 a * r) CL X CL z C/) tz 0 C) 0-4 z smic omi PERlirr NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I mi ;�40. LOT NO. 2 RECORD OF OWNERSHIP PATE BOOK "PAGE ZONIt- SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAM v NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME�� SPAN DISTANCE TO NEAREST BUILDIN43� 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 MATERIAL OF CHIMNEY IS BUILDING ALTERATION -As BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 4t-' 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 SEE BOTH SIDES PAGE I FILL OUT SECTIONS I - 3 PAGE 2 FILL OUT SECTIONS I - 12 INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST -2CCO EST. BLDG. COST PER SQ. FT. 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 DA W�- iIGNATURE OF C AUTHORIZED AGENT F E E PERMIT GRANTED w2 19 co EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY Ik BUILDING INGPZCTO#t OWNERTEL.# CONTR. TEL# CONTR. LIC # H.I.C. # hl) 3p - BUILDING RECORD OCCUPANCY 12 SINGLE FAMILY SIORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH a 2 13 PINE CONCRETE CONCRETE BL K. BRICK OR STONE -HARDW D PIERS PLASTER DRY WALL I -5NFIN 3 BASEMENT AREA FULL FIN. B'M'T' AREA__ '/' 72 FIN. ATTIC AREA t!O 8 M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALL$ 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES -�ONCRETE EARTH 8 1 2 3 ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY HARDNWD COMIACN ASPH. TILE STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STIRS. & FLOOR CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I I POOR 7WO JE ADEQUATE I NE 5 ROOF _10 PLUMBING GABLE I dip BATH 13 FIX.) GAMBREL A MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES ILAVATORY,. WOOD SHINGES KITCHEN SI'NK SLATE NO PLUMBING, TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES_ TILE FLOOR TILE DADO 6 FRAMING 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 I AS I 2nd 3rd ELiCTRIC 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. A 0 77, rD I C3 ra, cop) n CD Z co) 0 C36 CL C.) CD CD CL cr =r CD CD 0 CD w w . a C. CD FoF CD CL CD CO) CD S7. 1= CO) 10 CD z CD CD M F As 0.71 tx Cf, Cf, ON K 0 z C/) W. PO S "X (-) -Ca a cr 4c 0 0 EL- ow 3 CD CD 0 0 Cl CL CM2 =ric CA go FD- !! =r COL CL a 0 a .4 a 0 -w'O 3E St c.D c=Dr U2 Z go CC22 CD t7l =r 7a co) ..Cl 9 CL C* PO S "X (-) -Ca a cr 4c 0 Con EL- ow 3 CD CD 0 0 Cl CL CM2 =ric CA go FD- !! =r COL CL a 0 a .4 a 0 -w'O 3E St c.D c=Dr U2 Z go CC22 CD =r 7a co) ..Cl i CL C* C=Dr 0 CD IL C& L 6c ca CD to X m CA 0 CD 0) CA g "cc, cc 0 CD 0. CD co CD Co CL'S: C-) C2 0 CA 0 c 0. C2 PO "X (-) PJU '71 0 :� x 0 0 0 cl) m -4 :2 m CA C) W, cn T , CL ft 0 z 90 W M k . I offmi 0 411 CD ol Office Use 0 of 4r Cfammunwralth of M05#1MEff9 Permit No. Ipmtment af Vublic —Aafttg Occupancy Fee Checked 0eave blank) 3M BOARD OF FIRE PREVENTION REGULATIONS 527 013 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 C4R 12:0P (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) olate or Town of NORTH ANDOVER To the inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant C- FA co tv Owner's Address 77. Is this permit in ccniunction with a building permit: Yes — N o (Check Appropriate Box) Puroose of Suildina Existing Service loo Amps /20 Z YO Vofts New Service - Amps -Vaits Utility Authorization No Overnead'Xi Undgrnd Overhead Uncg,,nc Number of Feeders ancl Ampacity Location and Nature of Pr000sed Eiec-ricai Work 6 vi I;% VuGcz F a -S 6 P pe ry L --L 0 No. of Meters No. of Meters No. of Lighting Outlets No. of Hot 7---s I lotal No. of 7ransformers KVA No. of Lighting Fixtures Atcve— Swimming Pcol grf_.C. in - cmc. Generators KVA No. of =--nergency Lighting No. of Recectac:e Cutlets No. of Oil Burners Barery Units No. of Switch Outlets No. at Gas Burners FiRE ALARMS No. at Zones otai I No. of Detection aric No. of Ranges No. of Air Coma. initiating Devices No. of Discosals No.ot Heat -.otai Pumcs Tons iotai KW No. at Scunaing Devices �jo. of Seit Containea No. of Dishwashers ScaceiArea Heatirto KVI Oe:ec*;oniSouncing Devices No. of Dryers Heating Devices KW Munic;oat Local I I Other Connec::on No. of No. at Low Voltage No. of Water Heaters KW Signs Baiiasts Wirenc No. Hvaro Massaqe iubs No. of Motors 7otal HP OTHER: jj�,T(1900N INSURANCE COVERAGE: Pursuant Zo the reautrements at '.IassaC.-.Lser*s general Laws - NO I have a current Liacifity Insurance Policy inciucing Ccrrio:etec Ccerations Coverage or its suoslantiai eauivaient. YES - have suomirtea valid proof of same to the Office. YES Z NC if you have cheCKeci YES. --lease inaicate tMe type of coverage cy checking the aoprooriate oox. /41 INSURANCE BOND Z OTHER :: (Please Scec:fy) L) Nf I Qv,, — ------ r_—_ - (Exoirati6n Datei Estimatea Value of E!ec-ricat Work S Work :a Start inscec-!on Date Recues-zec: Rougn Final Signea uncer -zhe Penalties at pe4Lury: LIC. NO. FIRIM NAME 0V G -L051% LIC. NO. r -*l F. L -Kc, -4)( Ucensee &nP �..SignaturO Bus. 7a 1. N 0. gc>df 53 1 - f 7 9-2� ACCress 3 FC-74:roj -T-WMTkC-C-- 2 L ---TA 93ee tj 9 C, 0 Alt. 7'el. Na. OWNER'S INSURANCE WAIVER: I am aware that the Ucensee coes not nave me insurance coverage or its suostantiat ecuivalent as re, quirea tay Massachusetts General Laws, aria mat -my signature an :nis Lermit aoloiication waives this reautrement. Owner Agent (Please check one) 7eiecnone No. PERMIT FEE S iSignalure at Owner or Agent) X-6565 71 TO Da te ... .... 0 * 40RTI-i TOWN OF NORTH ANDOVER. 64 C PERMIT FORV=.INS ALLATION This certifies that ... MIF ..................... W I k;tJ 6 has permission for Minst lation in the buildings of �4z. ................ I ........ at ..... qp�. I ... ..... North Andover, Mass. & Fee. . N .... 40. jZP= INSPECTOR 00 PA WHITE: Applicant CAM. BuilIg Dept. PINK: Treasurer GOLD: File Date ... 14-�- no ...... 622 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING R 8 A-11 This certifies that ........ has permission to perform ..... .... . .... wiring in the 'buillding of ...... . W ............................................. 4F >-�/ at.!��f ...... CU n . ... . dy ....... .... ......... . North Andover, Mass. ..67 W Fee ... ... :� .... Lic. N 1%. . ....................................... &d4-- ELEcTRiCAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 01, Permit No. Occupanq & Fee Checked &;JZJJtMZM Of 3190 (leave blank) (7, BOARD OF FIRE PREVENTION REGULATIONS 527 VJR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacrjusetts Electrical Code, 527 C�RJ2: 0 E PRINT IN INK OR TYPE ALL INFORMATION) Date ), 4 7 A (PLEASC TO lrl�pe t4r of Wires: the In c or Town of NORTH ANDD-OGYER The udersigned appiies for a permit to per -form tne eiectrical wark described be(ow. Location (Street & Number) Owner or Tenant C V1 G N V Cvvner's Address rooriate Sax, - buildinri permit: Yes 1,40 — k — . H - is "his permit in conjunck an Purqcse of Suildina Existing Service Amps New SerAce Amps /—Voits Numcer of F ecers ana Amcacity I-ccaucr. ana Nature of Prcoosed Elec-,`Cal 1.1/cn< ,\4c. at 1-:qn-ing Cutiets No. of Licriting F;xtures No. C, �cl �---s — Utility Authorization No Overinead Unagrnd Overhead U n r- grr' a I At)cve— SWIMMIMg Z-01 grnc. — gn1c. No. of Ciececzacie outlets C 1 No. at Cil Surners No. of Meters No. of Nleters - ictat 1 No. of 7ranstarmers KVA Generators KVA 14c. at Switcrt Outlets No. cr Gas Surners lotat No. of Ranges No. at Air Ccnc. Heat ocai socat No. of Oiscosais No.af P um C s 7a n s No. of Cisnwasners ScaceiArea Heating No. of Irvers Hea-unip Cewces KW N . a. V \40. of No. of Water Heaters KW Signs Sailasts 11 No. Of Motors Iota: HP CITHE:': No. of Emergency Lighting Bar-ery Units FIRE ALARMS No. of Zones No. at Cetection ana initiating Oevices ,No. -at Scurtaing Cevices No. of Sait ContairieC Oetec-:cniSouncing Devices Local Munic�cai other Connec'.;On Low Voltage Winnip INSURANCE CCVERAGE: P--,rsuant ;a the recuirements at %1assac.-.,_-ser-s general I-awS 140 :: I I have a current Liaoiiity insurance Policy inclucing C,;rn--:ecetp Cceraticris �-,:;veraqe or ;is sucstandal ecuivaient. Y ES 7- ver ge C ics. YES :: N(D -:-- if yCU nave C7IeCKe(p YES. piease inaicale zMe Of cc have suornineca valiC proof Of same to the Off crieC.xing .Me atopfOoriate Cox. INSURANCE 3CN0 :: OTHEP ]: (P!ease Spec:ly) C'&—a---� V (E aira on OaEe) Esumatec: value at E!ec'ncal Work S insipec,ion Date i,",acueszec: Rougn Ja 9 —Grm Finai Work :a Start Signeo uncer the Penalties at perjury: U C. 'No. =iRkl .14A.ME —LIC� NO. Ucensee S; gn a vu r �e���� Bus. 741. No. AcCress ri A c -c- c:> Alt. 7ei. No. 7 -L --a a coverage or its Suostantiai eaulvalent as re - OWNER'S INSURANCE INAIVEq: I am aware triat me L:censee aces r1at ,lave the insuranc this reautrament- owner Agent auirea z:v Massachusetts General Laws. anO *�nat my signature On :n:s permit acialication waives tP!ease crIecK one) 7aiecnane NO. 09ERMIT FEE 5 --------- (Signature at C-ner cr Agerill