HomeMy WebLinkAboutMiscellaneous - 295 CANDLESTICK ROAD 4/30/2018 (2)�-
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10483
Date .... q.040q ..........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certi I fies that.j-)Av�l
vJ r il
has permission to perform ........... U .....
plumbing in the buildings of ..............................................................................................
at.M.1 ..... 0AII.I..K.C2 ..0 .� ,
.................. North Andover, Mass.
ob
Fee 4Q . . ....... Lic. No. ..... ..... t.1.6'
.................................................................
Chec . kl PLUMBING INSPECTOR
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY MA DATE PERMIT#
JOBSITE ADDRESS OWNER'S NAME
P
OWNER ADDRESS TEL FAX
TYPE OR
OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIA
PRINT
CLEARLY
NEW: Ell RENOVATION)d- REPLACEMENT: 01 PLANS SUBMITTED: YES 01 NOD
FIXTURES'l FLOOR- 13SM
1 2 3 4
5
6
7 8 9
10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OILISAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER.SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREADRAIN
INTERCEPTOR (INTERIOR�
KITCHEN SINK
LAVATORY
ROOF DRAIN I F I
SHOWER STALL
SERVICE / MOP SINK
TOILET
—J
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER ---.-J-F-- -j
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES*NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D BOND El
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER 0 AGENT IE -11
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and Installations performed under the permit issued for this application will b��'mpliance w 11 Peitinelit prol of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
11
W/"o
- - � I F "�- -
PLUMBERS NAME LICENSE # 9IGNXrURE
MPA JP CORPORATION Fj # PARTNERSHIP P-1 LLC
COMPANY NAMEF-/7,;�,j ADDRESS
CITY 11STATE ZIP TEL
FAX L EMAIL
o rl
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LU
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LU
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The Commonwealth of Massachusetts
Department of IndustrialAccidints
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
NaMe (Business/Organization/Individual):.
Address:
City/State/Zip:
t/ -0 '7 9117
,)/e
Phone #:
Are you an employer? Chec� the appropriate box:
I a employer with 49 4. F1 I am a general contractor and I
-V�mzoyees (fall and/or part-time).* have hired the sub -contractors
2. El I am a sole proprietor or partner- listed on the attached sheet.
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. El I am a homeowner doing all work right of exemption per MGL
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. n New con straction
7. F1 Remodeling
8. n Demolition
9. E] Building addition
10. F1 Electrical repairs or additions
1LE] Plumbing repairs or additions
Un Other.
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
i Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that isproviding workers I compensation insurancefor my employees. Below is thepolicy andjob site
information.
Insurance Company Name;
Policy # or Self -ins. Lic.
Expiration Date;
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up tcf $1,500.00 and/or oner-year imprisoriment, 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 hereby cert&pqer the pains andpenalties ofperjury that the information provided above is true and correct.
f -/, f --;;z -
Official use only. Do not write in this area, to he completed by c4 or town official
City or Town:
Permit[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#:
0
Information and Instruction -S
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 emploYei 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 notmore 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 l6callicensing 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
meTffbers or parmers, are not requYe-d 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'Iegibly. 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.
Pleas ' e 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 pennit/license applications in any given year, need only submit one affidavit indicating current
policy information (ifnecessary) 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 p* ermit 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
6 00 Washington Street
Boston, MA 02111
TO, # 617-727-4900 oxt 406 or 1-8777MASSAFF,
Revised 5-26-05 Fax# 617-727-7749
--www-mass,gov/dia
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DAVID I
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05101/2014 -
304623
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Date.............................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ---------- b Rog I "U 5 .6 U
...........................................
has permission to perform ..................... 4 . .. 4 eAiW
. ...... ........ ........ k .......................................................
wiAng in the building of .............. K 0 _—S k?
...................... I ........................................................................
at 4��.Ak�..S7'cl .......... North Andover, Mass.
oe
. .......... 0
Fee..5'.S . ........ Lic. No... .... .... .. . ............ .... .....
/ELEcrRicAL INSPECTO.e
Check #
12302
(f.nwnweahk ol Mamac4u4elb Offitial Use Only
Permit No.
2eparb"nt 015i,. S.ryice3
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATION Rev. 1/07] !e::_:
S �J,av, blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfonned in accordance with the Massachusetts Electrical �qj (MEC) 527 CMR 12.00
(PLEA SE PPJNT IN INK OR TYPE ALI, INFORMA TION) Date: 9 1 Z� I tq
City or Town of. NO tV%A 14J 0 dVUL To the Inspector bf Wires. -
By this application the undersigned gives notice of his or her jitrntion tgerform thelelectrical work described below.
Location (Street & Number)_ Q -t -yk4
te-1. - (a
Owner or Tenant
Owner's Address
Is this permit in conj
Purpose of Building
h a building permit? Y
Existing Service 2-C-)C/Amps 12��olts
New Service _ Amps Volts
Telephone No.
No F� (Check Appropriate Box)
-U Q -L Utility Authorization No.
Undgrd 0
Overhead "r'
Overhead [] Undgrd
Number of Feeders and Ampacity i
Location and Nature of Proposed Electrical Work: Ybn% Kbot4--v
C) +-
No. of Meters
No. of Meters
Coni leflon fi- --y - ---- -
No. of Recessed Luminaires LA
C ... �;
No. of Ceil.-Susp. (Paddle) Fans
1— Muy Dc wul m" by the irispectur uj YY tres.
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators K -VA
No. of Luminaires
Swimming Pool
nd.
No. of Emergency Lighting
BatterV Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
,3
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
Totals:
I
KW ...........
N -o. of Self-Contafined
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Localo Municip�l
Connection El Other
No. of Dryers
No. of water
Heaters KW
Heating Appliances KW
No. of No. —of
Signs Ballasts
Security S sterns:*
No. of evices or Eguivalent
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring..
No. of Devices or Equivalent
OTHER:
(A aacn additional tail Y desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 'When required by municipal policy.)
Work to Start: V%�D & P Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERXGE: 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 El BOND [:1 OTHER 0 (Specify:)
I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete.
FIRM NAME: — e--_ - - LIC. NO..
Licensee: Dwz 5011,� S i gn a tu re LIC. NO.:
(If applicable, P r "e I" * *licensezin 1. k
Ct Bus. Tel. No..
Address: L,..;l Fj 0 11T -W Alt.Tel.No.:—
*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 coVer—age no-r-mallyi
required by law. By my signature below, I hereby waive this requirement. I am the (check one) El owner Ej owner's agent.
Owner/Agent
Signature Telephone No.
1�3
R�
%J
-4
I
The Commonwealth of Massachusetts
Department ofIndustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual): V CCU ) (3(- 1 C(f 15 1 P -_-Q IJ
Address: c-2) (_ �_o C_ -3 -t- W JEJ o r.-
City/State/Zip:
Phone.#: C?r'[!�- '�>C/3-5YV/
A e you an employer? Che -1, the appropriate box:
9
1. 1 am a employer with
4. 1 am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. 1 am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.t
required.]
5. We are a corporation and its
3. 1 am a homeowner doing all work
officers have exercised their
myself [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comv. insurance required.1
Type of project (required):
6. F New construction
7. E] Remodeling
8. EJ Demolition
9. [:] Yuilding addition
I O.YElectrical repairs or additions
11. E] Plumbing repairs or additions
12.E] Roof repairs
13.R Other
*Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy inforination.
f 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 state whether Or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjob site
in rmation.
fio
Insurance Company Name:
eQQ A4
Policy # or Self -ins. Lic. #: %-.W Expiration Date: t 1
Job Site Address: r2- toS qrJ_ k CA City/State/Zip: _Aj&l�
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Fa�lure to secure coverage as rcquired under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
firt,,� 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
lnv�estijzations of the DIA for insurance coveraue verification.
Ido hereby certify underthepains andpenalties ofperjury thatthe information provided qboveis�ue andcorrect.
Phone #: 4��f- Z_, 5 1-t ZA4
use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/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 #:
r
� r
�.� ti
Date ... (�- . -.. A.7.. 6 - -
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
":�� ........................................
This certifies that ...... r ..........
has permission to ................................................
.... ........
wiring in the building of ... !Z ..................................................
at ............. .,A . ................... . NOqh Andover, Mass.
............... .... ......... ....
Fee.�� ............ Lic. Naz -: ............ INSPECTOR .11 ..............
Check # &/ 52?
4576
Official Use Only
Permit No.
619 _OV
Pm&& s4aq Occupancy & Fee Check
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number.
Owner or
1-\ Ko c �toc
Owner's Address sc'y'_�
Is this permit in conjunction with a building permit Yesz�: No [I (Check Appropriate Box)
Purpose of Building tv �)U"L Utility Authorization No.
EAsting Service_______________AmpS Voits Overhead 0 Undgmd 0 No. of Meters
New Service —Amps____---yoits
Number of Feeders and
Location and Nature of Proposed Electrical Wo
0—\ V Rr') r -c) -N
Overhead 0 Undgmd El No. of Meters
HER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I.have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
NSURANCE = BOND = OTHER = (Please Specify)
N' OQ JExpiration Date)
fttimated Value of Electrical Work -2 (11-Y �:�
Work to Start Inspection Date Resquested —Rough Final
Signed under the Penalties of pedury: LIC. NO.
FIRM NAM
Lkensee C�' cd Signature LIC. NO.
,js.TeINo.-?q/
Address ___"Alt Tel. No. I -/ :Z .1, 72
OWNER'S INSURANCE WAIVER: I am aware that the Ciceris'Crs- does not have the insurance coverage *bYfts substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this reWirement. Owner Agent (Please Check one)
:relephone No. PERMITTEE $
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
No. of Lighting Fixtures
Above 0 In 0
Swimming Pool gmd 0 gmd 0
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
"No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diposal
No.
Pumps Tons
KVV
No. of Sounding Devices
No.1 of Self Contained
No. of Dishwashers
Space/Area Heating
KVV
Detection/Sounding Devices
0 Municipal 0 Other
No. of Dryers
Heating Devices
KVV
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KVV
Signs
Bailases
Wiring
No. Hydro Massage Tuds
No. of Motors
Total HP
—
HER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I.have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
NSURANCE = BOND = OTHER = (Please Specify)
N' OQ JExpiration Date)
fttimated Value of Electrical Work -2 (11-Y �:�
Work to Start Inspection Date Resquested —Rough Final
Signed under the Penalties of pedury: LIC. NO.
FIRM NAM
Lkensee C�' cd Signature LIC. NO.
,js.TeINo.-?q/
Address ___"Alt Tel. No. I -/ :Z .1, 72
OWNER'S INSURANCE WAIVER: I am aware that the Ciceris'Crs- does not have the insurance coverage *bYfts substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this reWirement. Owner Agent (Please Check one)
:relephone No. PERMITTEE $
(Signature of Owner or Agent)
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston ' Mass. 02111
Workers'Compensation Insurance Affidavit
Name Please Print
Name:
Location:
CitV Phone #
F-1 I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for rrry employees working on this job.
Compapy name:
Address
C Lt) E, Phone #:
Insurance. Go. Policv #
Company name -
Address
Phone #7
Insurance Co. Policv #
Failutre to secure coverage as required under Section 25A or MGL 152 can;ead to the im;xmition ofairrinW penalties
WARMW
of.afine to $1.500.00
andfor one years'imprisorwnent-as-vMLas-cLApenakiesinJthelam-dABTDPYiK)RKjDFtDBIAW-afine-of-($IjDD-OD)-ajdayagainstmi-- I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DRA for coverage verification.
do hereby certify under Me pains and penaffies ofjoerjury that the kdbrmabon provided above is trw and coffee
Signature Date
Print name Phone.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/1-icensing
El
13uilding Dept
E]Cher-k if immediate response is requked
Licensing Board/
E]
Selectman's Office
Contact person: -Phone E]
Health Department
F,
Other
Location
No. Date
TOWN OF NORTH ANDOVER
'A
Certificate of Occupancy $
s Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ /Z/- 4
Check #
6�57
Building Inspe(cfor
TrA,
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATI)C)N TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TwO FkMILY DWELLING
[BUEL
TD:11NI�G:PIERNUT NUNMER.-
DA TEISSUED:
SIGNATURE:
Buildinp- Commissioner/IrsI)ector of Buildings Date
SECTION I- SITE INFORNIATION
I Property Addressi:
9 " j it -S
1.3
L2 Assessors Map and Parcel Number:
233
,Ylap Number Parcel Number
.4 Property
Zoning Dimict 6oposed Use Frontage (R)
1.6 BUTLDING SETBACKS (ft)
. Front Yard Side Yard Rear Yard
Remired I Provide Required I i�o �ided Required Provided
I — 1 1 M /0 1,R lib -t 1,4 -� r I jo 1 .9-'' 1
1.7 Wager SupptyM.G.LC.40. �1 54) 1(5. Flood Zone lahrmation: f 1.8� Saw"t Disposal System:
Public 0 Private 0 Zone . Outside Flood Zone 0 'Municipal Iq On Site Disposal Sys(eng C
SECTION 2 - PROPERTY OWNIRSEIIPIAUTHORIZED AGENT
2.1 Ownerof Record
e *16.� + ko 5 ff ar-P Z'q,�- C,�Lo d&- olzk (zd
Name Arint) N III Address ror Service:
7 2 Owner o
Name Pnnt
T
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
icen Construction Supervisor:
'70 �Qo
Addre s
Ig naLre Telephone
3.2 Registered Home Impro ement Contractor
VIDO L.S
Company
So 2y -0,j W—z- L"Irot
— Aqq - qf,�-1
Address for Scrvice�
Not Applicable 0
0 (0,3 -To
License Number
o-7 — (q— 03
Expiration Date
Not Applicable 0
1197,04
Registration Number
Expiration Date
gD !S'
a
r
a
0
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✓ '
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7
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L_e
� G��-� s,e '� �'_.�� �
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-SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 2506)
Workers Compensation Insurance affidavit must be completed and submitted with this
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes No..
Failure to provide this affidavit will result
New Constmction
Existing.Building 11
Reim
�rations(s) 0
Addition 0
Azcessory Bldg. 0
Demolition 0
Other 0 Specif�,
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
VIgq qg
0�n 4"m
.1S
I 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)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
tAl� k
V__ - 4 1 -
tho vvq,,4
eby al, 4 — F-CLVVf —
behalA,, in I matters relati4to work authorized by this I
�,_ A M
A
1, US I
properly co
Hereby declare t at the statemeT
and behet'
CAI f_ A. A
AGENT
as Owner/Authorized Agent of subject property
to act on
permit application.
Date
TION
I as Owner/Authonzed Agent of subject
and information on the foregoing application are true and accurate, to the best of my knowledge
fl
Pr J J 04 (mew e)3
rA
SiXatulre of Owrier/Ager�' Date
NO. OF STORIIES SIZE
BASENENT 09 SLAB
SIZE OF FLOOR TINIBERS I 2ND
SPAN
DD,4ENSIONS OF SILLS
DgvENSIONS OF POSTS
DDAENSIONS OF GIRDERS
REIGHT OF FOUNDADON 711ICKNESS
SIZE OF FOOTING x
MATERIAL OF CFHNfN_BY
IS BMDING ON SOLID OR FELLED LAND
IS BUUDING COINNIECTED TO NATUkbL GAS LD;E-
3
(Oy"5�> kP-3Ar-.,1
FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
APPLICANT CiVU� 4-, 10 LtA 6S dE59,,�: PHONE -1?8- -.6.99� S -J—/
ASSESSORS MAP NUER 106A —LOTNUMBER Q 33
SUBDWISION -LOT NUMBER
STREET 00_0d�14��L JQ vas 0- STREET NUMBER ZqS'
**"� ......... .................
OFFICIAL U E ONLY
a a N a a a 01 a 0 a a a a a N N 0 a a 0 a 0 a a 0 0 a 4 = a a a a 0 a 0 8 0 a a N a W 0 a a a a
RECOMA41ENDATIONS OF TOWN AGENTS
ass
an we waffiessams ONE 060was E ONSOONEWN MEESE Nunn a was 6 0 0 mass on a
DATE APPROVED._��
C61qSERVAX1ON ADMrSTRATOR DATE REJECTED
COMMENTS (2 ZL,�.-t
DATE APPROVED
TOWN PLANNER
DATE REJECTED
COMMENTS
FOOD INSPECTOR - HEALTH
SEPTIC INSPECTOR - HEALTH
Al'
PUBLIC WORKS - SEWER / WATER COININECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
CONEVIENTS
DATE APPROVED
DATE REJECTED
DATE APPROVE.
Z_z
DATE REJECTED
DATEAPPROVED
DATE REJECTED
RECEIVED BY BUILDING INSPECTOR DATE
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SEPTIC SYSTI'M Z/
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The Commonwealth of Massachusetts
Department of Industrial Accidents
MICS 01IMS09.7LUM
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
narne* C WA'S 1- -1 Ll OS FIC
location: zfi"�- 64"
CIN 0.0 4^J r, -�-Q-r - qb= 0
C] I am a homeowner performing all work myself.
0 f am. a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employets working on this job.
V 111 . Be: P01 -1-S It- Pel-"
address, ....S.
city: 94�� AkA S i phone 4-, 19 9- -03 6 '7
in5urnncrco. Wflicy f$ e— 10 1 g3q, 3 0
1 am a sole proprietor, gener-al contractor, or homeowner (circle one) and have hired the conEracrors listed below who have
the following workers' compensation polices:
address:
-ftw�
I I ,
-
IWO. 17. LM47
city- phonc 4:
in5aminct cu. 1; cy
Failure to secure cover2ge is required under Section 25A of* NIG L 152 can lead to the impo3idon of criminal p-en2lnc3 of a fine up to SI—M.00 and/or
one years' imprisonment as well 23 civil penalties in the form of;a STOP WORK ORDER and a fine of S100.00 a day against me- I under3t2nd tbgt a
copy of this statement m2y be forwarded to the Office of' Invesugacions of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the infiormation provided above is true and correct
Signature IL A LE --L-- V,
Print name
atc
ione 9 S-- 6&P 4�3 a7
I offici2l use only do not write in this area (a be completed by city or (own ufficial
ci(y or town: permit/licen3c 9 f7 Building Depar-Truent
C]Licen3ing Board
ri check irimmcdi2te response is required CSciectmen's Office
F—MC21th Department
contact person: phone ;1: r7,Othcr
(r"tmd 1195 PIA)
DATE jMM0Dn-fyy)
AC -ORD- CERTIFICATE OF LIABILITY INSURANCE I
cadd.
: FAM -54' 01/17/0.3
PRODUCEn
THM CERTIFICAT9 Is ISSUED A4 A MATTER OF INFORMATION
ONLY AND CONFERS NO AIGHT,-S UPON THE CERTIFICATE
O.J. MOGarthy insurance Agency, Inc.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
C/O Piazza insurance Agency, Inc.
ALTER THE COVERAGE AFFORDED By THE POLICIES BELOW.
Ono Elm Squaro, Andover3 KAA 01810
OTH THAN 'EtAACC
ALUVCNLY�
INSURERS AFFORDING COVERAGE NAIC #
INSURED
AGG
5
INSURER&
FAM:Lly Pools & Patio Inc.
INSURER 8: American Intaxnational Grour
16 11 S Cindi Gianopoulos
INSURER 0-. I
2 Broadwav .
— ..
Lawr;ftce MA 01843
INSURER D:
INSURER E'
COVERAGES
THE POLICIES OF)NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABovr FOR TWE POUCY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM Oft CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W141CH THIS CERTIFICATE MAY 8;- ISSUED 09
MAY PERrAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
POLICIE& AMPECATE LIMITS SHOWN MAY)4AVr- 9GFN PtEDUCED BY PAID CLAIMS,
TERMS, EXCLUSIONS AND COND"ITIONr OF.SUCH
NS L
LTR NSRE TYPE OF INSURANCE POLICY'NUMBE
r.Y r:r I Ni
ATF (Mwoor"fyl IIIAL [A LIMITS
GENERAL
LIABILITY
EACH OCCURRENCE
1000000
A
COPMMERCLAL GENERAL LIABILITY
C1098398230
12/31/02
12/31/03
CLAIMS MADE IV I OCCUR
PD
NiD Dad $2K
MED EXP (Afy one pe=m)
$10000
s-1000000
X X
'31ank'
Blanket Addl lns�
PINII.RONAL & AQV INJURY
GENERAL A0Gfkt0ATE
s2000000
A�OGREGATE LIMITAPPLIES PhFL
s2000000
0 Y PRQ
POLICY
PRODIUCTS-comf"10PAGr
Oc
A AU
UTOMOBIILE
OB 13
40 12 LIABILITY
A
tGEWL
y UTO
AINY AUTO
TEM
12/31/02
12/31/03
140LF LIMIT
$1000000
ALL OWNED AUTOS
X
SCi4EDULEDAUTOS
BOCILY INJURY
(Per Pffman)
—
HIRWAUTOS
NIREQ LIT
x
X
0, .0
NOW-OWNE DAUTOs
8001, IN,
LY NJURY
/Per
GARAGE UABIIjrr
7 ANY AUTO
5XCFSSMM5RELLA LIABILITY
OCCUR CLAMS MADE
DEDUC71RI,2
RETENTION S
WOnKI5n6 COMPENSATION AND
EMPLOYERS' LIARrUTY
ANY PR0PRIFTOIVPARTNER19X9CVTWE
OFFICEFVMEM13ER EXCLUDED?
If vem dczaribe uriftr
For info=a2tional purpose* only.
1,2/31/02 12/31/03 E.L.'-:AGHACdII)ENT: S10000'0
M.L. 75EASF -EA EMPILOY5E $ 1.0000 0
E. L.-3:5GASE-POUCYUMrr 1).500000
HOLDER CANCELLATION
NOMORT* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Or; CANCELLED BE]PORE THE EXPIRArO
DArj THERr:uF.THF jssuiNG INSURER WILL RNDEAVORTO MAIL 10 DAYSWAITTEN
NOTIOETO THE CERTIF91' ATE HOLDLrR NA1f9IP TO THE LEFr, BUT FAILURE TO 00 60 SHALL
IMPOSE NO 08LICA'"ON OR LIAERUrY�wr KIND UPON r49 IN I SURIR, ITS AWIM OR
REPRESENTATIVES.
ACORD 25 (2001/08)
R
C.j.
PROPERTYDAMAOE
AUTO ONLY - EA ACCIDENT
S
OTH THAN 'EtAACC
ALUVCNLY�
3
.......
AGG
5
EWN OCCVRfkENCE
I
AGGRECATE
1,2/31/02 12/31/03 E.L.'-:AGHACdII)ENT: S10000'0
M.L. 75EASF -EA EMPILOY5E $ 1.0000 0
E. L.-3:5GASE-POUCYUMrr 1).500000
HOLDER CANCELLATION
NOMORT* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Or; CANCELLED BE]PORE THE EXPIRArO
DArj THERr:uF.THF jssuiNG INSURER WILL RNDEAVORTO MAIL 10 DAYSWAITTEN
NOTIOETO THE CERTIF91' ATE HOLDLrR NA1f9IP TO THE LEFr, BUT FAILURE TO 00 60 SHALL
IMPOSE NO 08LICA'"ON OR LIAERUrY�wr KIND UPON r49 IN I SURIR, ITS AWIM OR
REPRESENTATIVES.
ACORD 25 (2001/08)
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Location &) � E C ..N r) J I le CIZA ( C K F&
No S6 -,S- Date -,S--6Z7-00
TOWN OF NORTH ANDOVER
0
0
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Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
164'13
Building Inspector
Al
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONARUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
7,77
BUU,DING PERNUT NUMBER: �-5-6 6- DATE ISSUED: 5`c� D —6Z 0 0 3
SIGNATURE:
Building Commissioner/Inswtor of Buildings Date
SECTION I- SITE INFORMATION
1.1 Property Address:
1.2 Amessors Map and Parcel Number:
Map Number Parcel NumbeF'
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area (sf) Frontage (11)
1.6 BUHDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required :�=Provided
Required Provided
-3 D (UL) R -0 1 ?1 L)
-W tq),r
1.7 WateQupply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public E> Private 0 -,Zone Outside Flood Zone
—
1.9 Sewerage Disposal System:
municipal 0 On Site Disposal Syste
SECTION 2 - PROPERTY OWNERSF[[P/AUTHORIZED AGENT
2.1 Owner of Record
N e (Pri t) U/ Address for Service
S nature Telephone
S -J, 15-7
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
Licensed Construction Supe'rvisor: \1
b q,
License Number
k�-�
A ldress
(
Expiration Date
Signature 0 Telephone
3.2 Registered Home Improvement Contractor
Not Applicable 0
L
Company Name U
1�
\A—
RegistraGon Number
6� I � D \-t
_Q�
!ddress
-n-
Expiration Date
,ig Telephone
00
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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 ....... ?!!� No ....... 0
SECTION 5 Description of Proposed Work (check all appUcable)
New Construction 0 1 Existing Building 0 1 Repair(s) 0 Alterations(s) 0 1 Addition
Accessory Bldg. 0 1 Demolition 0 1 Other 0 Specify
Brief Description of Proposed Work:
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to
Completed by permit applicant
-BASENENT OR SLAB
I . Building
-U
(a) Building Permit Fee
Multiplier
SPAN t -t \
2 Electrical
DIMENSIONS OF SILLS V'Jo
(b) Estimated Total Cost of
Construction
0 C9
5
-3 PlumbinZ
-DINENSIONS OF GIRDERS
Building Permit fee (a) x (b)
/5-0
-4 Mechanical (HVAC)
S17 -E OF FOOTING
-5 Fire Protection
MATERIAL OF CHEVINEY
-6 Total (1+2+3+4+5)
L) 1)
Check Number
bECIlUIN'/aqJWAJEKAUIHUKILA'IIUIN TO HE COMPLETED WREN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
V V
H4ebv authop6e k �� to act on
111111di, atters; relative to work authorizedby t19 building permit applicati 1,63
'�gna-t-ur-e K-071ner Date
I SECTION7b OWNER/AUTHORIZED AGENT DECLARATION I
Owner/Authorized Agent of subject
property A U
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
of Owner/.
1 1,3
Date
NO. OF STORIES
SIZE k V
-BASENENT OR SLAB
S17 -E OF FLOOR T11VIBERS
IST 2 ND 3 RD
SPAN t -t \
DIMENSIONS OF SILLS V'Jo
*--�
DMENSIONS OF POSTS k4
*,-I-
-DINENSIONS OF GIRDERS
*4-4%
-1- MIGHT OF FOUNDATION
THICKNESS
S17 -E OF FOOTING
X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE &�q3
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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 or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT 60 M Y06 &I PHONE (a�9-533 -s'
LOCATION: Assessors Map Number 1011b, A J PARCEL -213-3
SUBDIVISION LOT (S) 2-5
'2 Q
STREET C�OA KPOCC CC ST. NUMBER
************************************OFFICIAL USE
RECOftNDATIONS OF IQWN 4AGENTS:
—>, Z&6A4 4
CON VATION ADMINISTRATI& DATE APPROVED
F DATE REJECTED
COMMENTS Fv-Q.S�oo COntrcA6 O.PG all 64.
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FTP 11SPE LTH DATE APPROVED
DATE REJECTED
E�EIPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 Jm
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 Perrnit
Number -is that.the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S.1 50 A..
The debris will be disposed of in:
C3,
(Location of Facility)
Signature
!rt
Date
NOTE: Demolition permit from the Town of North Andover must be obtained, for
this project through. the 0ffice of the Building Inspector
Name
The Commonwealth of Massachusetts
Department of Industfial Accidents
Office of Investigations
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
Please Print
Name:
Location:
Ci1Y \,J Phone
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for nTy employees working on this job.
Comr)anv name: k - - k AL - - ('- 4, ,
CL�E- Phone#-. (�l (J 1,�6 -S'3?5-
ComDanv name:
Address
Cft Phone
Insurance Co. Poliev
Failtwe to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of crirninal Penalties 00 fm up to $1,500.00
and/or one years'impmonment as-mHLas ciyA�pmabesjn-tbelarm4-a-STOPYVDWDPJ)Ep-and_aline_dA$lOD_OD)_ajdWagaimtnv,- I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do heneby V&W and peni?#-s ofpe,7wy that the fffformabon provided above is trw aW correct.
Print name V:�& , -
Official use only do not write in this area to be completed by city or town cfficial�
�03
City or Town
DCheck if immediate re-Vonse is required El Building Dept
-0 bcensi�V Board
Contact person: E] Selectman's Office
Phone #.- E] Health Department
F-1 Other
-a
14- LA
U)
I
Az.
May 2, 2003
Mr. Brian Lagrasse,
Board of Health
Town of North Andover, MA
Dear Mr. Lagrasse,
Per our conversation yesterday, this letter is to certify that the Screen Porch we plan to
add to our house at 295 Candlestick Road in North Andover will be used solely as a
Screen Porch. The Screen Porch will not be changed to any other type of room and will
not increase or affect the actual or design flow to the septic system, therefore not
requiring a Title 5 inspection and meeting your approval for the building permit.
Sincerely,
Kris'&� Koshef
295 Candlestick Roo
North Andover, MA
01845
cc: Kevin Murphy
Builder
�219101-1)061'
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... ....... ... .... ...........
has permission to perform ........ ....... . ....... .... .......................................
wiring in the building of V .....
..............
/4roAndover,Mas
at.j ........ ... ................................. 0,
.. ............
�7
Fee..'Y)"��C-). Lic.
..........
...... �--— -Ale
ii��Rc SPEC*TOd*/
Check # q_/j
4 5
TBECOMMONWEALMOFAWS4CHUSETIS Office Use
DEPA)M117V0FPUX1CS4FE7Y Permit No.
BOAM OFFREPREVEVHONREGUL4HONSM7 C1M 12VO
Occupancy & Fees Checked
APPUCATIONFOR. PERAIRT TO PERFORM ELECMCAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street �
Owner or Tenant
Owner's Address
To the Inspector of Wires:
Is this permit in conjunction with a building permit: Yes [EyNo (Check Appropriate Box)
Purpose of Building e-<-1A0e"f 6 -e Utility Authorization No.
Existing Service Amps 'Volts Overhead 1:3 Underground 1:3 No. of Meters
New Service Amps Volts Overhead Undefground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work k, /R7 //,-2 Aal�oz
No. of Lighting Oudets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting 1�-tures
Swimming Pool Above
Below
Generators
KVA
0
ground
E]
eround F47T
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
mps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municip�
F1
Other
No. of Dryers
Heating Devices KW
0 Connections
No. ofWater Heaters KW
No. of No. of
Bailasis
No. Hydro Massage Tubs
I I
No. of Motors
Total HP
I
OTHER.-
lbaveaoxotLkixkykarmxPobeynrixkigConplm OpwationsCover,�poritsabsuldeIrmlat YES NO
lbawaftiiwdvandpmdofsan-etotbeOffim YES r—q) F)mlnNedrckcdYESplwxmdr?&drtyWofcovara�pby
drddngtheappo
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INSURANCE BOND OTIIER r7 ftasc Speaty)
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WbjktO StMt kWecfimDateReWested Rao Fmal
FIRM NAME 114- LicefiseNo.
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and ffiamy sigm0mon ftspwMffl*cabcnwatNesftwWffemcnL
(Please check one) I Owner F-1 Agent F-1 Telephone No. PERMIT FEE
Signature ot Uwner or Agent
Name
Location:
The Commonwealth of Massachusetts
Department of Industrial Accidents.
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
cily Phone #
F-1 I am a homeowner performing all work myself
F-1 I am a sole proprietor and have no one working in any capacity
F-1 I am an employer providing workers' compensation for my employees working on this job.
Companyname:
Phone 4
Insurance. Co. Policv #
Company name:
Address
Cily: Phone;ft
Failure to secure coverage as required.under Section 25A or MGL 152 can lead to the imposition of criminalpenardes of,a fine up to $1,50C).06
andfor one years' irrprisonment-as-welLas-cixal.penaltiesinAhe-fonm-dA�STOPYA)RK-ORDBi-md-afm.-d.($IjDDM)-ajJW,-against-m. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certdy under Me pains and penalties of perjury that the Wbm)afion provided above is true and correct.
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 Permit/Licensing
Building Dept
E]Check Y immediate response is requked .0 Licensinq Board
E] Selectman's Office
Contact person: Phone #.- [1] Health Department
Ei Other
Location
t
No. Date Z2 — ? 0
of,
TOWN OF NORTH ANDOVER
--------------
Certificate of Occupancy $
Building/Frame Permit Fee $
ACHUS
Foundation PerTit Fee $
Ir ) '�7
Other Permit- �ee
Sewer Connection Fee $
Water Connection Fee $
TOTAL ;,2
Building Inspector
6840
12/30193 14:18 25.00 PAID
Div. Public Works
Locatior �2 '9,5 -
No. Date
0 f 40wT, TOWN OF NORTH ANDOVER
&,rii-fiCate of Occupancy
$
A
Building/�rame Permit Fee
$
Foundation Permit Fee
$
4 9
Other Permit Fee
$
ilowr
Connection Fee
$
Water Connection Fee
$
TOTAL
$
/-7 j1j,4 Cj
ng nspector
6313
Div. Public Works
llocation
Wo. Date
1
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy
$
49
Building/Frame Permit Fee
$
Foundation Permit Fee
$
rj
Other Permit Fee
$
Sewer Connection Fee
$
onnection Fee.
$
$
6 1 U'S
/1511,11 If,
Building Inspector
Div. Public Works
TAL
/I')- VO 48
6412
1993
$ 060,00
Building Ins ector
,& Age
DN!Pubfic Works
if P,
�Olejj��k
25
Location
No.
Date
&ORT
TOWN OFNORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee $
.o—A:
"4 Hu
Foundation Permit Fee
$
1?W4t'-PL1Tmjt -Fee
$
bW, RctiGn Fee
$
Water Connec'ti oni Fee
$
TAL
/I')- VO 48
6412
1993
$ 060,00
Building Ins ector
,& Age
DN!Pubfic Works
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number 186
Date DECEMBER 30, 1993
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 295 CANDLESTICK ROAD (Lot #25
MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/3 CAR IN ACCORDANCE
GARAGE & DECK
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO Jonathan R. & Kris Kosheff
498 North Ave.
ADDRESS Wakef ield, MA
Building Inspector
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Ms Karen Nelson
Director of Planning
Town of North Andover
120 Main Street
North Andover, MA 0 1845
Dear Ms. Nelson:
December 16, 1993
As you know, we are currently building a house in North Andover. The house is located
at 295 Candlestick Road (Lot 25 ). Construction has taken significantly longer than we
anticipated. As a result of the delays, two items do not appear to be able to be completed
this Fall. These items are as follows:
1) Loam and seed front and back lawn - I've consulted a landscaping firm and they have
said it is far too late in the season to seed. He has strongly recommended performing all
lawn work in the Spring.
2) Pave driveway - Again because it is so late in the season our builder has strongly
encouraged paving in the Spring. He will not guarentee paving at this late a date and
given the size of the drive ( 550 feet ) and associated cost I would not like to take the risk
of having to pave twice. In an attempt to minimize erosion and mud build-up we have
used re -cycled pavement as a surface material on the entire drive.
At this time however, I will agree to complete both the above items no later than June
30, 1994. It is my �ntention to complete them as soon as possible.
Kosheff
GBS Development Corp.
December 21,1993
Mr. Walter Cahill
Town of North Andover
Building Dept.
120 Main St.
North Andover, MA 01845
Dear Mr. -Cabill:
Please accept this letter as confirmation of our conversation of
earlier today. As you requested, herein I am outlining the remaining items
that we are required to address at 295 Candlestick Lane (lot #25):
Replacing keyed dead -bolt with latched dead -bolt.
Installation of fire block around cellar stairs.
Installation of fire block in four sections between floor joists
above main carrying beam.
Sheetrock gaps between concrete wall and ceiling at sill plate,
and at duct ends - in garage.
Verify that Chimney Permit has been issued(if not, pay $25.00).
As we discussed, when these items are complete, the homeowner will
provide you with a letter of confirmation.
On behalf of GBS Development, Corp. it has been a pleasure
working with you and your department. If there should be any questions
please don't hesitate to contact me.
cc: file
John Kosheff
Very truly yours,
, NO
YA
Michael C. Colburn
P.O. Box 444
Derry, New Hampshire 03038
(603) 432-4144 - FAX: (603) 432-2165
/\I 'PHALS
(7:()NSI'I(VA*1'1()N
AT E
Yown ol
NORTH ANIJOVE It
111VINIIIN(IF
I'Li".NNING. k1c (-'M1r%1LjN1'1"Y
KAHWHI I I.P. NELSON. (M
CHIMNEY APPLICAHON ANO PERM I'
)CATION oq95-
UNER'S NAME:
1ILDERIS NAME: ('64,0-
kSON IS NAME:
kSONIS ADDRESS: 0 ,t;—
PERHil'. #
�SOWS TELEPHONE: c/
JERIAL OF CHIMNEY:
iFERIOR CHIMNEY: 41E: LXILRIOR CHIMNEY:
11�WER AND SIZE OF FLUES: V X �7K i—
1-41 m 111 "a it It 1\ I
M.I!v4;
fICKNESS OF HEARTH:
�U cUnney olL ()i/LepCace con(jaAm to 41te Acqu,i./temelit-6 vO thc cude and have "Luce.6 alld
,gutatiom6 been /Lece-bed:
.TE: -73
-GRATURE OF MASON:
FLL
MIT GRANTED: e�F
'BERT NICETTA
'ILDING INSPECTOR Z��A
SPECTEV:
'MARKS:
SOLLD BLOCK RLQU I It ED
THIS PERMIT MLISF GE UISPLAM) 014 IHE PUMISES
; DET ENT I
P C)
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2 4 FA I:Mrnl
EASEMENI
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.01
14-025. 87
p 26
BOX PAD 27
(Please print)
DATE_n,&j
JOB LOCATION
Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
Number . Street Address
Section of town
"HOMEOWNER" ��hexlll_ rig 17 �;14(& - 01SX0 ((DY 7) -7.13 -/360 Y
Name Homd-Prione 'W6rk Phone
PRESENT MAILING ADDRESS qqg ribC4, , NV e_
City/'rown State . Zip code
The current exemption for "homeowners" was extended to include owner
-occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does not possess a license, provided
.that'the owner acts as supervisor. (State Building Code, Section 109.1.1)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside, on which there is, or is intended to be, a one to six family dwell-
ing, attached or detached structures accessory to such use and/or farm
..structures. A person who'constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
.to the Building Official, on a form acceptable to the Bulding Official,
that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the
.State Building Code and other.applicable codes, by-laws, rules and
regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
.North Andover Building Department minimum inspection procedures and
requirements and that he/she will comply with said procedures and
re(�Iulirements. A
HOMEOWNER'S SIGNATURE -
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
Control.
K; G� Fs 9 T L�
MAY 2 1 9M
FORM U - IA)T 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*****************
APPLICANT: ly=,,� ?.,. 4 Kr�. -, N - KoS65�� — Phone (w7) 2.4(o - o/,5 -(o
LOCATION: Assessor's Map Number /o(V - Parcel Z-33
Subdivision J�4mA Lot(s) 2S_
Street St. Number 7�15
************************Official Use Only************************
RECOM)kENDATIONS OF TOWN AGENTS:
Date Approved
conservation Adn�iffiistrator Date Rejected
Comments
kXiAVQ L4 Z&Qd_&�A Date Approved tE�:211 Ca
Town Planner Date Rejected
Comments
Food Inspector -Health
__& Z_Z_
'ZTQ_,�Vln
Septic Inspector -Health
Comments
Date Approved
Date Rejected
Date Approved
Date Rejected
Works - sewer/water connections _OL
- driveway permit (�7
Fire Department LL91L
Received by Building Inspector
A r2. r" r,
K - _�Dat5e___
MAY 2 1 PM
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