HomeMy WebLinkAboutMiscellaneous - 29 MAGNOLIA DRIVE 4/30/201800
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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,,
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5
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46
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96
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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:
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E) Licensing Board
C) Selectmen's Crffic:e
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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.
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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