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Home My WebLink AboutMiscellaneous - 3 ANDREW CIRCLE 4/30/2018VE North Andover Board of AsNessors Public Access ir, Click Scal To Retum Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial 4 Page 1 of I North Andover Board of Assessors 03riL '�Zbroperty Record Card Parcel ID :210/047.0-0043-0000.0 FY:2013 Community: North Andover SKETCH Click on Sketch to Enlarge PHOTO Click on Photo to Location: 3 ANDREW CIRCLE Owner Name: SATRIALE, LYNN M Owner Address: 3 ANDREW CIRCLE City: NORTH ANDOVER State: MA Zip: 01845 Neighborbood: 5 - 5 Land Area: 0.09 acres Use Code: 101-SNGIFAM-RES Total Finished Area: 1224 sqft ASSESSMENTS CURRENTYEAR PREVIOUS YEAR Total Value: 208,700 214,800 Building Value: 75,200 77,700 Land Value: 133,500 137,1 00 Market Land Value: 133,500 Chapter Land Value: I http://csc-ma.us/PROPAPP/display.do?linkId=2253370&town=NandoverPubAcc 3/26/2013 LL LU z C/) '0 U) �5 w () Of 20 00 C.) ly -j W (D a 2 CL Ca C3 in C� a) 0 -i L) 0 -j Co 9 Cl) V C14 w L) 0 (D 0) Co a. ce) (D Q�j C1) Co 9 CO 'IT C:) 9 C=) 2 Co a- C) a CD 0 LO 14!�! . 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Z-e�.c . ..................... /-(, 7-e- qq�/ has permission to perform ...................... . ............................................... wiring in the building of ......... lye . . ................................... at ...... u North Andover, Mass. ../ ....... 4�? ..................... Fee.' ... 3.75. ............... Lic. No. . . ... ..... . ICAL INSP Check , —M!, 8387 of Commonwealth of Massachusetts Official Use Only 0 Permit No. B 5 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS . [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (A4EC), Y27 CMR 12.00/ (PLEASE PRINT JTN INK OR TYPE ALL INFORMATION) D a t e: City or Town of: NORTH ANDOVER To the In�pectorf of Wirels - Z- , By this application the undersigned gives notice of his or her intention to- perform the electrical work,described below. Location (Street & Number) A�az)p� C� 0a -:F— Owner or Tenant —L.Y NL 114- A- T -CA C k - 0�. Tel�phone No.' Owner's Address 1-5AL)-Ar- Is this permit in conjunction with a building permit? Ye)P&_ No [:] (Check Appropriate Box) Purpose of Building (DEN�1CF, . , Utility Authorization No. Existing Service 2XVAmps 00 Z44OVolts Overhead [:] Undgrd No. of Meters New Service Amps Volts Overhead 0 Undgrd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cnmnlpfinn nfthr fnIl—imm t�W� —, 1- �L- No. of Recessed Luminaires ------ No. of Ceil.-Susp. (Paddle) , Fans If lur E�/ rr1rc%N- Y — vv— uY "&� li4o� �al No. ii— Transformers K -VA No. of Luminaire Outlets No. of Hot Tubs Generators K -VA No. of Luminaires Swimminc, Pool el — nd. El No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches Z No. of Gas Burners No. of—Detection and Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: umber 1--** *- * I Tons I ................. DKW77 No. -U—S—elf-Contained Detection/Alerting Devices No. of Dishwashers t Space/Area Heating KW Local F-� Municippl. Connection 0 Other No. of Dryers No. of Water Heaters KW Heating Appliances KW No. of No. of ' Signs Ballasts Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wirina: "I No. of Devices or Equivaient [OTHER: Estimated Val Z 1 C*—?--) Attach additional detail Y -desired, or as required by the Inspector of Wires. ue of Electyical W A-11� - (When required by municipal policy.) Work to Start. Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE VEPff-A"'! J: 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 sue �V-Verage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCX/J.'!�BONDE] OTHER 0 (Specify:) I certi fy, under thepains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME:, W)EFUJANJ L kC - e LIC. NO.:( Licensee: ;L-C�-I-T 1-40FFW Is%" Signature -CY LIC. NO,., (Ifapplicable, enter "exempt in the license number line.) Bus. Tel. No.: Address: E�;:JjtA t�-e� (I�L e:a -L L — - 06 Luc-, �� - -W f�� r -3T --r Alt- Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department ofPublie 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)E] owner E] owner's agent. Owner/Agent E"IT FEE. $ Signature Telephone No._ P -F I L-� lb- 3 - 2 -7-o, C94 -- k- 9 R, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 "W�Wl www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer? Check the appropriate Vox: 1. 1 am a employer with 4. F-1 I 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. I ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. 1 am a homeowner doing all work myself [No workers' comp. insurance required.] f These sub -contractors have workers' comp. insurance. 5. El We are a corporation and its officers have,exercised their right of exemption perMGL c. 152, § 1 (4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. E] New construction 7. Remodeling 8. Demolition 9. Building addition 10-0 Electrical repairs or additions ILEI Plumbing repairs or additions 12.M Roof repairs 13.0 Other -Any appncant mat cnecics t)ox 4;j must also till 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. I am an employer that isproviding workers'compensation insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy 4 or Self -ins. Lic. 4: fob Site Address: Expiration Date: 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 required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Sijznature: Date: Phone#: Qfjlcial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3 Cifv/Tn�n ri 1, A V1 6. Other ech cal Inspector 5. Plumbing Inspector Contact Person: Phone #: Date. ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTACLATION B ';�/' 'i This certifies that e? ... .............. has permission for gas installation ..... . ............. in the buil dings of ... ........................ I . /V at ..... North Andover, Mass, Fee s;Z� .... Lic. No. ;1 ........ INSPECTOR Check # S 6553 F MASSACHUSETrS UNIFORM APPUCATON FOR PERM TO DO GAS FrrnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Loqations 6OWWS C,(IZ Permit # --Y- Y&A-) V Amount$ 2 C00 ..... . Owner's Name New Renovation Replacement Plans Submitted 1:1 El 1:1 (print or type), Name- 6W,4/2 P4,4IIiIq4,g 1&)g 14Z 77A.)O; Check one: Certificate Installing Company - — 1:1 Corp. Address .06 dto),c r�q,/ —E]Partner. brl" y A.)14 OJ0316 ness 1 elephone 7,-Va�- - vz n ;> Firm/Co. Name of Licensed Plumber�or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. YesEj No[3 If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance poli ' "I cy AQL Other type of indemnity ED Bond 13 Owner's Insurance Waiver: I -am aware that the licensee 920es .90thave the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: I here Owner 13 Agent 13 by certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installati IRS P rformed under PelThit Issued for this application will be in compliance with all pertinent provisions of the Massac"tts 10 e C a h _pter 142 of the General Laws. Title City/Towm I , i 1APPROV, ED (OFFICE USE ONLY) Signatu�Vbf Licensed PlumbelooOr Gas Fitter Plumber [3 Gas Fitter Meense Number Master Journeyman SU B-BASEM ENT BASEMENT I S T F L 0 0 R TN D F L 0 0 R 3RD. FLOOR 4 T H IF L 0 0 R 5 T H IF L 0 0 R 6 T H F L 0 0 R 7 T H F L 0 0 R ST H IF L 0 0 R U rA C4 0 Z EA 1% 0 E� U ca go z C: U z > Z Z, > z - k. 0- z U W .4 0 (print or type), Name- 6W,4/2 P4,4IIiIq4,g 1&)g 14Z 77A.)O; Check one: Certificate Installing Company - — 1:1 Corp. Address .06 dto),c r�q,/ —E]Partner. brl" y A.)14 OJ0316 ness 1 elephone 7,-Va�- - vz n ;> Firm/Co. Name of Licensed Plumber�or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. YesEj No[3 If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance poli ' "I cy AQL Other type of indemnity ED Bond 13 Owner's Insurance Waiver: I -am aware that the licensee 920es .90thave the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: I here Owner 13 Agent 13 by certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installati IRS P rformed under PelThit Issued for this application will be in compliance with all pertinent provisions of the Massac"tts 10 e C a h _pter 142 of the General Laws. Title City/Towm I , i 1APPROV, ED (OFFICE USE ONLY) Signatu�Vbf Licensed PlumbelooOr Gas Fitter Plumber [3 Gas Fitter Meense Number Master Journeyman SU B-BASEM ENT BASEMENT I S T F L 0 0 R TN D F L 0 0 R 3RD. FLOOR 4 T H IF L 0 0 R 5 T H IF L 0 0 R 6 T H F L 0 0 R 7 T H F L 0 0 R ST H IF L 0 0 R (print or type), Name- 6W,4/2 P4,4IIiIq4,g 1&)g 14Z 77A.)O; Check one: Certificate Installing Company - — 1:1 Corp. Address .06 dto),c r�q,/ —E]Partner. brl" y A.)14 OJ0316 ness 1 elephone 7,-Va�- - vz n ;> Firm/Co. Name of Licensed Plumber�or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. YesEj No[3 If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance poli ' "I cy AQL Other type of indemnity ED Bond 13 Owner's Insurance Waiver: I -am aware that the licensee 920es .90thave the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: I here Owner 13 Agent 13 by certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installati IRS P rformed under PelThit Issued for this application will be in compliance with all pertinent provisions of the Massac"tts 10 e C a h _pter 142 of the General Laws. Title City/Towm I , i 1APPROV, ED (OFFICE USE ONLY) Signatu�Vbf Licensed PlumbelooOr Gas Fitter Plumber [3 Gas Fitter Meense Number Master Journeyman '14 '�61210 �- Date.. � .7. ...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING '%;;� 0 IW"q /1 . )1- 1/ -'- This certifies that ... 713 ........... ........................ has permission to perform ..... ................... plumbing in the buildings of .... 13 A t I 'C- .............................. I 1A ....... North Andover, Mass. Fee. ic. No.. ))Y.� . .. ...... 9".'. PLUMBING INSI41ECTOR Check # 7861 ,A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 3 OwnersNarne ILV14q �SAT- Date 01 OC,7-C)8 Permit # Type of Occupancy Amount - 32, st� New 1:1 Renovation El Replacement ' El FDffURES Plans Submitted Yes No . 11 0 (Print or type) Installing Company Name_j66A4,qP_ 101-0A4,6jV,6 Check one: Certificate Corp. Partner. Firm/Co. Name of Licensed Plumber: dZO4&tC7— *�1242 1L.,og Insurance CoveragE. Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E] Other type of indenirlity n Bond n Insurance Waiver I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner El Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and mstallation�s �6do under Permit Issuedtfor this application will be in compliance with all pertinent provisions of the Mas a0se St . _ 7 and,��te 142 of the General Laws. By: ignaLUre 01 1-1censp- Title Type of PlumbiWg License City/Town '-/ ?- "r— APPROVED (oFmcE usE oNLy NumDer - Master Journeyman TOWN OF NORTH ANDOVER 10 law PERMIT FOR WIRING This certifies that../ ......................................................................................... has permission to perform-. ................................................................... wiring in the building of .... at 3 ... ..... ............................... . North Andover, Mass. 1120 . I - /' Fee --'.S .............. Lic. No . .......... ................. ......... ......... ELECTRICALINSPECMi� Check # 7222 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. -7 -z- z 2 - Occupancy and Fee Checked ,[Rev. 1/071 (1,aye blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfortned in accordance with the Massachusetts Electrical Code (M 5 2 YQ 23CMR 12.00 (PLEASEPRINTIN INK OR TYPE ALL INFORMATION) Date: ' 17- i / r) /7 City or Town of: NORTH ANDOVER To the Inspe'ctor Cf( Wires: By this application the undersigr Ad gives notice of his or her intention to perform the electrical work described below. Location (Street & T Owner or Tenant Owner's Address Is this permit in con Purpose of Building Existing Service — Amps I / —Volts OverheadEj Undgrd F] No. of Meters New Service — Amps Volts Overhead [] Undgrd [_1 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cnmnlptinn nf thp fnllnwina tghl, —, A�, th, 1--t— _f W; No. of Recessed Lu ' * 'a mmaires I __ _ No. of Ceil.-Susp. (Paddle) Fans __ .— -- I— _ - 1 - Y' No. of i �oa Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming pool Above Ei In- E] grnd. grnd. IN o. 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 I No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pu p m Totals: I Numlier I Tons I KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local 0 Municippi El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivaleat— OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of 91ect,,ca17Work,: (When required by municipal policy.) Work to Start nspections, to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that su co erage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: JNSUR 1z BOND [I OTHEREI (Specify:) Icertify, under thepains andpenalties ofperjury, that the informat this application is true and complete. FIRM NAME: L I C. NO.: //zt�l 7 Licensee: Signature 4� LIC. NO.: (If applicable, enter "exe n t the lignse number line.) s. Tel. No. LA; "p' Address: 57 e,� 9 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 coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) 0 owner E] owner's agent. Owner/Agent Signature Telephone No. FPERMIT FEE: $ -P -r�, --'7 Date .............. . . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......... tl: �t(. has permission to perform plumbing in -the buildings of .................. ....... North Andover, Mass. Fee .... Lic. No. ........... -?7 i� . .... .. ....... �'B PLUM IN/(;3INSPECTOR Check # 7294 WSACHUSETTS UNIFORM APPLICATION FOR PER OWntwTy* MIT TO DO PLUMBING -A-0,27d 4A'00g-'e MUL Building W ca W "I AA2 L4 —6d 1W Now 0 Renovation 0 sua-esuT. BASEMENT IST FLOOR 2)dD FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR GTH FLOOR 7TH FLOOR STH FLOOR Peffre *--2�� ?-/ Ownees Nam- - SdT&4 L C, Ar—Type of 0ocuWr-Y—&LL-... P4=9ubmftt6d: Y680 No 0 FIXTURES Installing COmP&nY Name Address PO Box 59 Chec* one:. CerUfk.-ate 0 corporguo'n Methuen, MA 01844 Busirw= Telephone (9781689-7474 0 Nam Of Licensed Plumber Ro0a Frazier I URANCE COVERAGE: ha" a currW IWANY Insurance policy or Its substantial cQuWad which meets the I yes GI No 0 requirements of MGL Ch. 142 - If YPOU have checked y". Please, indicate the tYlX Coverage by dw*ft th e* appropriate box A 141blifty hsUr&nCe policy M Ottw type of Indemnity 0 - Bond 0 OWNER'S INSURANCE WAIVER: I am awme #W the lkmnft dog al twe #* insum c ge u by Chapter 142 Of the Mass. General Laws, arid that my signature - nce ovem req fred n this it tj Perm aPPIka On waives this requirement. Check one: nature o or Owner 0 AgeM I hweby CW* b%g MA Of ft detaft w4 infMatim I haw submkW (of wbreW in above we Mm and aacurate knowWge NW tUt d Plwnbing work and ftWWk= pedwmed undw Va pVMIt iuuW Irthris It PftWt P(QVWWW of Me MusgdWsft Statq to the bad of my "Il be in compliance with jdI Tme uto 0 Type of Uce JOUMTW 0 UmnseNu mbe �13425�. z X a Z , U am W z C C z C 0 U C Im. a. 3: Z C Z C X C W 0 'C a - 0 44 a z 9 IL sc 0 Im cc -2! 3r a J a U2 z C -C 2 &6 X IL WZ z z I dc z a J a P. .4 a OC -C a 10 *I Installing COmP&nY Name Address PO Box 59 Chec* one:. CerUfk.-ate 0 corporguo'n Methuen, MA 01844 Busirw= Telephone (9781689-7474 0 Nam Of Licensed Plumber Ro0a Frazier I URANCE COVERAGE: ha" a currW IWANY Insurance policy or Its substantial cQuWad which meets the I yes GI No 0 requirements of MGL Ch. 142 - If YPOU have checked y". Please, indicate the tYlX Coverage by dw*ft th e* appropriate box A 141blifty hsUr&nCe policy M Ottw type of Indemnity 0 - Bond 0 OWNER'S INSURANCE WAIVER: I am awme #W the lkmnft dog al twe #* insum c ge u by Chapter 142 Of the Mass. General Laws, arid that my signature - nce ovem req fred n this it tj Perm aPPIka On waives this requirement. Check one: nature o or Owner 0 AgeM I hweby CW* b%g MA Of ft detaft w4 infMatim I haw submkW (of wbreW in above we Mm and aacurate knowWge NW tUt d Plwnbing work and ftWWk= pedwmed undw Va pVMIt iuuW Irthris It PftWt P(QVWWW of Me MusgdWsft Statq to the bad of my "Il be in compliance with jdI Tme uto 0 Type of Uce JOUMTW 0 UmnseNu mbe �13425�. Location \3 -. � q n 41A e C14-t6f— No. :5W Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Ar, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # D5 1 41 19 9U` 0 Building Inspector Permit NO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received -2--L 07 F— IMPORTANT: Applicant must complete all items on this page I re Andove4 LOCATION Y-ae, . /4 6Y7 Print PROPERTY OWNER sq�f� q -(,e— .101 Print MAP NO.: H 'I P TVPF. AND USE OF BURMING ZONrNG DISTRICT:, IUSTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE n n a (,a— Phone- (?7R-6 5--/39,57- Residential Non- Residential 0 New Building 0 Addition 0 Alteration Bf3ne family 0 Two or more'family No. of units: 0 Industrial 94epair, replacement 0 Demolition 0 Assessory Bldg 11 Commercial 0 Moving (relocation) 0 Other 0 Others: 0 Foundation only DESCRIPTION OF WORK TO BE PREFORMED roorn rw at rs and u. Identification Please Type oirl"rint Clearly) OVIINER: Name: t-1, n n a (,a— Phone- (?7R-6 5--/39,57- Address: 3,d -e, M-7 7% 4 Ale,41- CONTRACTOR )9 Son V/11'S'upervisor's Construction License: Exp. Date: V'Horne Improvement License: Exp. Date: ARCHITECUENGINEER Name: Phone: a A Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12. 00 PER $1000. 00 OF THE TOTAL ESTIMA TED COST BASED ON $125.00 PER S. F. Total Project Cost:$ 1�1 FEE:$ -26.— Check Receipt No.: Pap lof 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art Swimming Pools 0 Public Sewer 0 well 0 Tobacco Sales Food Packaging/Sales 0 0 Permanent Dumpster on Site El Private (septic tank. ex. Electric Meter location to I I project_ NOTE: Persons contracting with unreghtered contractors do not have access to the guarantyfund gent/�w=4 ZtCZ;� Signature of A Signature of contractor Plans Submitted Plans waived El Certified Plot Plan �;mped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT El COMMENTS CONSERVATION CON04ENTS FIFUR"M COMMENTS DATE REJECTED DATE REJECTED I IN] DATE APPROVED DATE APPROVED El DATE REJECTED DATE APPROVED FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: _Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Slansture & Date Driveway Permit I rP,-: i GRAVENER & SON HANDYMAN SERVICE (603) 339-2468 * CONTRACT * 12 WILKELE ROAD SANDOWN, NH 03873 NAME:1 Lynn Satriale 1PHONE: 1(978) 886-3M I REQUESTED INSTALL DATE: I I LOCATION- 1 3 Andrews Circle, North Andover, MA I SQUARE FEET: I SPECIAL COMMENTS: Contractor pick-up, delivery and removal of all materials is included in the contract price. Plumbing (tub & shower valves), electrical services (heat coils, lighting, fan) and glass panel installation to be provided by licensed contractors. Installation planned dates are dependant on signed contract and town permit (permit to be obtained by customer). Subsequent dates upon township availability of inspectors. MODEL # CONTRACT SCOPE OF WORK CONTRACT PRICE MATERIALS: Sq Ft I -Sq Ft Standard Tub $250.00 Standard Toilet $120.00 Vanity $240.00 Bath Fbdures (Tub & Sink Faucets etc) $160.00 Tub Drain & Stopper $80.00 Shower Doors $200.00 Cabinet Insert with Mirror $90.00 Lighting Fixtures $100.00 Ceiling Area Prune & Paint 48 $2.00 $96.00 Wall Area Prime & Paint 190 $2.00 $380.00 Wall Area Tile 100 $2.00 $200.00 Wall. Area Boarder 30 $3.00 $90.00 Floor Tile 45 $2.00 $90.00 Sheet Rock ($14.00 X 6 sheets) $94.00 Hard Rock (10.89 X 5 sheets) $54.45 Installation Accessories - (Grout, nails, thin flex, tape, caulk, plastic etc) $200.00 $2,434.45 $2,434.45 LABOR: Option # 1 - Installation Equals Materials Cost ELECTRICAL: Provided by licensed electrician - estimate $900.00 PLUMBING: Provided by licensed plumber - estimate $600.00 CONTRACT PRICE $6,368.90 Variable Payment Terms are as follows: > 50% Material cost upon contract acceptance $1,217.23 > 50% Material cost upon contractor request (approx 50% job completion) $1,217.23 > 50% of total Labor Due upon 50% Installation $1,217.23 > Remainder of 50% due at 100% Installation - Job Complete $1,217.23 > 100% Electrical Installation - Job Complete $900.00 > 100% Plumbing Installation - Job Complete $6W.00 The conditions of this contract cannot be changed without prior written consent of both parties. Discrepancies or omissions in this contract, site conditions and anywork and/or materials requested in the variance of this document are considered an extra to this contract and are not included in the contract price. Any additional work required due to site conditions not disclosed to the contractor, or which could not be reasonably anticipated, are not included in the contract price and shall be an extra to the contract price. The contractor is responsible for site cleanup and the packing, transportation, and handling of hazardous materials in accordance with applicable Federal and State regulations. Signatures indicate agreemeWo the terms/d�l c?nditions of the above contract: Customer Signature I'Lax't,10 Date z-1, V57 Z ./ Z - Contractor Signature Date zk"d7 02 L — ...Ogrf ---00 * Fully Insured 9 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: 1Z 04- 114 &*1 City/State/Zip: _71ozleylt, //. &. arr;1,y _ Phone.#: 09'4 r Are you an employer? Check the appropriate box: 1. 1 am a employer with 4. El I 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 required.] comp. insuranceJ 5. E] We are a corporation and its 3 E3 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' comp. insurance required.] Type of project (requireft. 6. 0 New construction 7. Remodeling 8. Demolition 9. E] Building addition 10. [1 Electrical repairs or additions I I. El Plumbing repairs or additions 12.E] Roof repairs 13.E] Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who subtrdt this affidavit indicating they are doing all work and then hire outside contrsctors must subrnit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing die 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' corrq). policy number. I am an employer that isproviding workers'compensation insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy # or Self -ins. Lic. M 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. required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certift under thepains andpenaldes ofperjury that the information provided above is true and correcit Si e: Date. zzx Phone 0: Official 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 #: Information and Ins'tructions Massachusetts General Laws chapter 152 requires all employdrs 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 a joint 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 havingnot 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 his 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 permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense 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 Fmc # 617427 -7749 -- Revised 11-22-06 www.mass.gov/dia TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Buildirig')O, Suite 2-64 A, North , kndover, Massachus'etts 0 1845 Gerald A. Brown Inspector of Buildings DATE: Telephone (97,S) 6, M-9 5z HOMEOWNER LICENSE EXE% Fax (978)6,S,9-954 JOB LOCATIO&:__2_�_qnd_raj elrclt, Number __�t�rcetAddress HONTEOWNER. n S 4�Ly-/ C, [" Name Home Phone PRESENT MAIUNG ADDRESS 3, City Town YS7-1:7, 9C- 0 -7 — H& o Stat - The current exemption for "homeowners" was extended to include owner Zip Code — to allow such homeowners to engage an individual for hire hodoesno . -Occupied dwellings to two units or less and acts as supervisor). State Building (Code Section 108.3.5. w) t Possess a license, Provided that the owner DEFINITION OF HOMEOWNER Person(s) who Owns a parcel of iand on which he/she resides or intends to reside, on ixhich there is, or is intended to be, a one or two ftimily structures. A Person who constructs more that one home in a two-year Period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other ipplicable codes, by-laws. rules and regulations. The undersigned "homeoxvner" certifies that fie, she understands the Tc%n Of'North Andover Building Department ininimum inspection Procedures and requirements and that he'she requirements. will c0MPlY Withsaid Procedures and [IOMEOWNERS SIGNATL RE_ WROViv. OF RUH. DING OFFICI,ki- Work Phone 0 73 ,00 Jau C4 0 U x go 0 —co U) o V) ,00 0 0 FM4 LLJ 0 CL z CD _5 CC C Ci As C.3 ts IN E.S ID 3: co 4 COO 0 CC 6:5 S cm :-NOV.: ID 0 0 cm lr,,N. cc, R 0 c 0 4- "; co M CD LU 0 0:5,=o JEE "Croo - MIL M :� a Ll 4D!l CO2 4D CM C L C=o 0 U) z 0 u C/) C/) CD E z CL. 0 CO2 CD cm 0.— 0O2 CD Co CD -E- cc cm 4D CL G3 CD CL cc Q CL. M: cmdc C* cc C) 4D ca Z IS CD Q CL L.3 CO2 cc cc "a CO2 cm LLI uj LU uj U) f, Building Setback( Front Yard Side Yard Rear Yard Required Provided Required Provides Required— —Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: Building Department The following Is a list of the required forms to be filled out for the appropriate permit to be obtained. Rooflng, Siding, Interior Rehabilitation Permits u Building Permit Application u Workers Comp, Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract a Floor Plan Or Proposed Interior Work Addition Or Decks • Building Permit Application • Suri;eyed Plot Plan • Workers Comp Affidavit • Photo Copy of H.I.C. And C.S.L. Licenses • Copy Of Contract • Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) • Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) • Building Permit Application • Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses • Workers Comp Affidavit • Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) • Copy of Contract • Mass check Energy Compliance Report In all cases if a Variance or special permit was required the Town Clerks ofte must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry Of DeedL One copy and proof of recording must be submitted with the building application Doe: INSPECTIONAL SERVICES DEPARTMENT:BPFORMOS Page 4 of 4 MAS!�ACHUSETTS UNIFORM APPLICATION FOR PEWIT TO DO GASFITTIN'G (Print or Type) NORTH ANDOVER Mass. Date 40 A A 0" Ouilding Location -1- AZ15�-�5 ao� Permit # Owners Nam New -P--k-'enovation Replacement Plans Submitted El (Print or Installing Address Business Check one: Certificate E�4�corp. = Partner._ Ej Firm/Co. ANO 'Iqzyz�o Llw.-Ole_ Telephone: Name of Licensed Plumber or Gas Fitter Insurance Coverag Indicate the type of ins- ra�lce coverage by checking the appropriate box: Liability insurance policy Ee�r—Other type of indemnityF-1 Bond Ej Insuraqce Waiver: 1, the undersigned, have been made aware that the licensee of this a0plication does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner F] Agent F1 i hereby certify that all of (he detAils and information I have submitted (or entercd) in above application are true and accurate to the best of my knowledge and that all plumbing work and LnicAdations performed under'Pt(mit iuucd for this applicaaon will -be -la compHance with an PCXtlA-( provisions of the fKassachusetts State Gas Code and Chapter 142 of tha General LAws. By TYPE LICENSE: Plumber Title asfitter Signature of Licensed ster Plumber or Gasfitter City/Town:- Journeyman 'OV/ APPROVED (OFFICE USE ONLY) -Ui�cfanse Number on MENEENNEEMEN ME FEE 00 SEE 1��WIINMNN NNEENEE1 MEEME mgm-MR, MEMSEENSEENNE NI'ME NOMMENE 1"W6 ENEEMEN NUENEEMENEEMENEEN (Print or Installing Address Business Check one: Certificate E�4�corp. = Partner._ Ej Firm/Co. ANO 'Iqzyz�o Llw.-Ole_ Telephone: Name of Licensed Plumber or Gas Fitter Insurance Coverag Indicate the type of ins- ra�lce coverage by checking the appropriate box: Liability insurance policy Ee�r—Other type of indemnityF-1 Bond Ej Insuraqce Waiver: 1, the undersigned, have been made aware that the licensee of this a0plication does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner F] Agent F1 i hereby certify that all of (he detAils and information I have submitted (or entercd) in above application are true and accurate to the best of my knowledge and that all plumbing work and LnicAdations performed under'Pt(mit iuucd for this applicaaon will -be -la compHance with an PCXtlA-( provisions of the fKassachusetts State Gas Code and Chapter 142 of tha General LAws. By TYPE LICENSE: Plumber Title asfitter Signature of Licensed ster Plumber or Gasfitter City/Town:- Journeyman 'OV/ APPROVED (OFFICE USE ONLY) -Ui�cfanse Number 2318 Date. 1pl!09 41 ........ tORTPI TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATI This certifies that ..6,0.4 K44'9". < ............. has permission for gas installation . R .5;.: . —. F�% 14 in the buildings of lei / C ............................ at a. e t i j � ........ North Andover, Mass Fee. . � P� .... Lic. No.. 3. kt.Y c V Y, SINSPEC'TdR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File , To..F "�.. Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform ............. .......... A. - plumbing in -the buildings of ................................ at A-/. .(�w ............ North Andover, Mass. Fee:_� ..... Lic. No .......... .. ............ PLUMBJNG INSPECTOR Check # �/ 5319 It El 19 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETFS Date 2(3le 2 - Building Location Permit # Amount Owner --11 - a ) 65/ - New Renovation V-8-I&WIJIM Replacement 1:1 FIXTURES Plans gubmitted Yes No 1 0 (Print or type) Check one: Certificate Installing Company Name Corp. r7 -1L Partner. E] Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0-1;-, Other type of indemnity 11 Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance ignature Owner Agent El . E I I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued fQr this ap lication will be in compliance with all pertinent provisions of the Massachus 'umbiw �p U of General Laws. By: Signature of 1-7censea riumDer TXU of Plumbing License Title City/Town APPROVED (OFFICE USE ONLY UlCenSe INUMDer Master 8r Journeyman -,/ ,, 2., Date... 2'. :-71: . . . . . . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that A_4 ........... Z. . . . . . . . . . . . . . . . . . . . has permission for gas i allation in the buildings -of . .. ........................ at ... North Andover, Mass. Fee: -:,,o . Lic. No.. .?x d.,F. . ............. Check # / /' ,I 4093 NL4%ACHUSETTS UNNORM APPLICATON FOR PERNIrr TO DO GAS HUNG (Type or print) NORTH ANDOVER, MASSACHUSETIM Date -7. 3 /� e_) -z_ Building Locations Permit # — Amount $ —Owner's Name NewF7r Renovation Replacement Plans Submitted L -ma El 1:1 (Print or W one: Certificate Installing Company Name Li Corp. [aPartner. 2-zl- / I f Narnz.1 of Licensed Plumber or Gas Fitter 1:1 Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ff�' Noo If you have checked M, please indicate the type coverage by checking the appropriate booL Liability insurance policy U, Other type of indemnity [:] B-ond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner [I Agent 0 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plurnbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts StaqteS_Qj9,% g* angGfiapW 142 otthpfieneral Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter EJ—Plumber Z! �14 2 Gas Fitter Mcense Nurn6er aster Journeyman Vkf� FLOOR my-go"Irl �W (Print or W one: Certificate Installing Company Name Li Corp. [aPartner. 2-zl- / I f Narnz.1 of Licensed Plumber or Gas Fitter 1:1 Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ff�' Noo If you have checked M, please indicate the type coverage by checking the appropriate booL Liability insurance policy U, Other type of indemnity [:] B-ond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner [I Agent 0 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plurnbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts StaqteS_Qj9,% g* angGfiapW 142 otthpfieneral Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter EJ—Plumber Z! �14 2 Gas Fitter Mcense Nurn6er aster Journeyman