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HomeMy WebLinkAboutMiscellaneous - 30 OAKES DRIVE 4/30/2018 (2)C) m cn 0, < 4 I Town of North Andover, MA 20668 �"Umbft perw&— jLqKm3bWAIWrafmVA0rjon raftmes ard" AWfiarAmS (Commmial or ReWenfiA 77MELINE ��Rceiwed GPlumbingReview in pms- 0 PernsitFee P.".efo 0 Perritt is nce C--- Tuesday, Jun 21, 2016 08:19 AM ck sea.. -Ch. Your request is in progess Well letyau lawwafany updatesvia emA �ml kemtodpeckltw s=n a's any firne by coffmig back tD this pzg-- G40 wxent josephdexKwnps oky�� . . C.P- . I . I 30 OAKES DRIVE, NORTH ANDOVER, MA a-- HEDSTRONLRAIWAMS Why.m I seeing this? Di � E- =---- N r Town of North Andover, MA Q See, �-h 20668 77MELME PlumbingReView 0 pit: - 0 z a e ! La- I Tuesday, Jun 21, 2016 08:19 AM Ymw fewiest ks fn prugess — ---------- - i F�St�la--eUIMSF MEW CGWN,.kt EIC 30 OAKES DRIVE, NORTH ANDOVER, MA Cl.— EFE�BAREAMB This document was sentto the printer6 x TF.—R0MAWrl0zM I Q--iV W A The Commonwealth ofMassachusetts Department ofIndustrialAccidents 1 Congress Street, Suite 100 Boston, AM 02114-2 017 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansIplumbers. TO BE FILED WITH THE PEPJYHTTING AUTHORITY. NaMe (Business/Organization/Individual): Address:r_�.�_ City/State/Zip: Are you an employer? Check &e appropnaie box: Phone#: OK ifIlarnaemployerwith - — ! employees (full and/or part-time).* 2.FJ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.FJ I am a homeowner doing all work myself. [No workers' comp..fi-isurance required.] t 4. F1 I am a homeowner and will be hiring contractors to conduct all work on my property. Iwill ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.FJ I am a general contractor and I have hired t ' he sub -contractors listed on the attached sheet. Thes'e sub -contractors fiav� er�ploye,e's and have workers' comp. insuranceJ *f711W,e are a corporati n and its officers have exercised their right of 'exemption per MGL c. .9 1 . ill 11 . 152, § 1(4), and we have no Fpploye�s. fN!D workers' comp. insurance required.] Type of project (Tequired): 7. F1 New construction 8. El Remodeling El Demolition 10 Building addition 11. E] Elect rical repairs or additions 12. FJ Plumbing repairs or additions 13 E] Ro 'of rep airs 14. E] Othbr *Any applicantthat checks b6x#1 must also fill outthe section liclowshowing their workers' compensation policy inform.ation. t lfomeowners,;�ho submit t�is affidavit indicating they are doing all work and then hire outside contractors must s0mit a new affidavit indicating such. tContractors that check this box must -attached an additional sheet showing thq name of the sub -contractors and state whether or not, those entities have employees. If the sub-cion6ci&s tave 6m`ploy*ees, icy' must provide their workers' comp. policy number. lam an employer that is providing workers' compensation insuranceformy employees.' Below is thepolicy andjobsite information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' c . ompensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerf* under th epainser4penalties ofperjury that th e information provided above is trqe and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License 9 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, expres's or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or' any two or more of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.'.' Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill- out -the workers' compensation affidavit completely, by checking the'boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and -phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees -other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. lie advised that this affidavit may be submitted to the Depaftment of Ifidustrial Accidents fb� confirmation of insurance coverage. Also be sure to sign and date the aftidavit. 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 r6qu�ired to obtain a workers' compensatioit'policy, please call the Department at the number listed below. Self-ib:sured 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 pennit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in _(city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia P F4 ),I ) Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... 1 7—, c . ........... .2'va has permission to perform wiring in the building of ..... .................................... at ............ ........ 0. .......................... . North Andover, Mass. Fee.. Lic. No. ......... P"." ..... ELEcrRICAL INSPECTOR Check # 8267 J I Lommonwealth of Massachusetts Offici I Use 011-1y Department of Fire Services Permit No. 92-67 -r 1 FOccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Elev. 110 3 — �ev, 1/071 7 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacbusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRW.DV DX OR TYPE ALL E&ORMA TION). Date: City or Town of. NORTH ANDOVE-R- To the Ins ector q Wires: r ---- ------------ By this application the undersigned]*ve-s ---t-i f —on to noc- -1 -- or her intenti perform the electrical work described below. Location (Street & Nun;�er) k" Owner or Tenant YAt) �0 A -A. A^ Owner'sAddress Telephone No. Is this Permit in conjuncti wi h builling Perm—it? Yes No F-1 " t� I (Check Appropriate Box) Purpose of Building WOe- J A d I - ( V1- -- Utility Authorization No. ExistingService 106 Amps (RW/Mhoits Overhead 0 Undgrd No. of Meters New Service Amps volts Overhead Undgrd No. of Meten Number of Feeders and Ampacity Z Location d N ture of Proposed Electrical Work: 11; ipl P/ COM letiono thefollowin table may be waived b the Ins ector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total No. of Luminaire Outlets No. of Hot Tubs Transformers KVA Generators KVA No. of Luminaires No. of Receptacle Outlets No. of Switches -- No. of Ranges No. of Waste Disposers iNo. of Dishwashers No. of Dryers No. of a er Heaters KW No. Hydromassage Bathtubs OTHER: Swimming Pool Above d. No. of Oil Burners No. of Gas Burners No. of Air Cond. NEU-- Tons Jur-mr UMP I I'N um To Is- - ...Rber- Ton.s Space/Area Heating KW Heating Appliances KW No. of No. ot Signs Ballasts No. of Motors Total HP ALARIMS INo. of Zones Of Alerting Devices 11 C`=cpt 0 other Lo. -of bei A Wiring: No. of De,% of Devices or Estimated Value of Electrical Work --fl Attach additional detail if desired, or as required by the Inspector of Wz7r-e-s. /M - - ('When required by municipal policy.) Work to Start: 7-,� Inspections to be requested in accordance with MEc Rule 10, and upon completion. .INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation- coverage or its substantial equivalent The under -signed certifies that such coverage is in force, and has exhibited proof of same to the permit issuing ofnce.. CHECK ONE: INSURANCE 0 BOND F-1 OTHER 0 (Specff�.-) ]"cm*fy, under the,"ns !qdpenaldes aClyrjur F1RM NAO i y, that the information On this application is true and complete. M- "n r A LIC. NO.: Licensee: (If applicabl Signature e� filer exemvt in the Jicense pumber 1z;01 LIC. NO.-3j��114 Address: Le9 (e, A s. Tel. No. *Per M.G.L c. 147, s. 57-61, security *efrk requires D AkLelv--� t. Tel. No.�� epartment of Public Safety I'S License: Lic OWNER'S INSURANCE WAATR: I am aware that the Licensee does not have the liability ins . No. required by law. By my signature below, I here . by waive this requirement I am the (c urance coverage normally Owner/Agent heck one) 0 owner M owner's agent Signature Telephone No. PERMT FEE: S PY/A qp64-9A eq�Z ;7-;�,o- e§ PV 0 + - e - ?-25- - 0 B Az,,,P- Vill 1 VU The Conumnwea&k of Ajossachusetir D epartnte nr of In dustrial A ccidents QJf1ce of Investigations 600 Wzwkinoton Street 1, Bovton, MA 02111 . 0 . www-nwssgov1dia Workers, COMPensation Inskrance Affidavit-. Builders/ContmctorslMectrician Rolicant Information 9/Plumbers Plea fhh �e Print Lem NaM'e fRmin&_qdr) . � I ' A -A,-_ Ad&ess:'j0() City/State/Zip-_&_&TY_) �7c_ Phone k- 27 5 99q Are you an employer? Check�l�e appropriate box: .l.al'arnatmPloyerwith q 4. 1 am IL general contractor and I employees (full and/or part-time).* 2. [3.1 am,asole proprietor or have himd the sub -contractors listed partner_ an the attached sheet ship and have no employees 7bese suj�_contractors have working f6r me in any capacity. [No workers' comp. insurance workems' comp. insurance.. 5. We are a corporation and its required.) 3, 1 am a homeowner doing officems have exercised their all work right of exemption per MCM MYse1E [No-workers'comp. C. - L5Z § 1(4),'and we have no insurance required.) t employees, [No workers' COMP. insurance rei3uhd-1 Type Of Preject (required): 6. New construction 7. Remodeling 9. Demolition 9. Building addition 10. Electrical repairs or additions I 1 -11 Plumbing repairs or addifions 12. koof repairs. 1317 Other *Any applicant that checks boie # I MUM RISD f9l out the seetion beioW C their worked' compensation I policy in . formatiotL T HomeownOn who submit this alffidavit indicati 'Contractors that chcok this bo I ng they art doing R11 wO* and then hire -outside contructon must submit a new affidavit indicating such. K Must &=Chad an additional sheet showing the: munc of fie sub_m� and their work=' COMP. Policy infDMIdliaft. am an emplo .per j*ai.js.prqvidj, inforwzadom in workers'COMperzsadoninsuranceforngenployeeL Below iS. the peficy andjob *e 7 k (\ I insurance Company Nam Policy 9 or Self -ins. Lie.. #: ExPirlition Date: Job Site Address city/statezip _-A-4 -4 �� Attach a copy of the workerst com tion poll &Z:4�e 4 . Penn . . cy declaration page (showing the policy number and expiration date� Failure to secure coverage as required under Sextion 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 R STOP W0RK ORDER and a fine of up to $250.00 a day against the vioiatDr. Be advised that a C. investigations of the DIA for insurance coverage verification. OPY Of this statement may be forwarded to the Office of I do hereby th Pam= p I en OfPerjurYXhar the informafion oWded above is true and corre Pr Date. - "hone 4: 12 Offichd use only. Do not wrile Mi thk area I , it be conrleted by do or town official City or Town: ---------- Permit/License 9 Issuing Authority (circle one): 1. Board Of Health 2_ Building Department 3. CitY/Town Clerk 4. Electrical Inspector 5. Plumbina 6. Other Inspector Contact Person: Phone #: Information. and Instructions Massachusetts General Laws chapter 152 requires all emp I oyers to provide wor* ken' compensation for their employees. Pursuant to this statute, an enployee is defined as "...evcr_v person in the service of another under any contract of hire, express or implied, oral or writt=" An employer is defined as "an individual, partnership, assaidiation, corporation or other logal entity, or any two ormore of the'fantgoing engaged in ajoint enterprise, and including the legal mprftcritatives of a deceased employer, or the receiver or trUStCe 'of an individual, partnership, association or other legal entity, employing employees. 'However the owner. of a dwelling house having not more than thr= apaxtmants and who resides thereK or the occupant of the dwelling house of another who employs persons to do ma-intarmce, construction or repair w&k on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be dcemed to be an employer." MGL chapter 152, PC(6) also states *mt 'every state oir local fic6using agency shall withhold the issuance or renewal of a license or permit to operate a busmiess or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance wilth the insumnce coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither t3he commanwe� nor any of its political subdivisions shall enter into any contract for the pcifornmee 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 complotely, by checking the boxes that apply to your situation and, if ri=essary, supply sub-contradtir(s) name(s), address(es) Emd phone number(s) along with their certificate(s)'of insumnee. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' corripensation 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 Accident for confmation 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 pe m*it or license is being requested, not'the Department of industrial Accidents. Should you have any questions regm-ding the law or if you.we requirted to obtain a workers! compensation policy, plzastcall the Delmirtment at the-nurnber listed below. Self-insured companies should enterther self-insuranc'e'licenst ziumber on ffie'approjoriate. li=. City or Town Officinis Please be sure that the affidavit is complete and printed legibly. The Department his provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to cont= you regarding the applicant Pie= be sure to fill in the parnittlicense number which will be used as a reference number. In addition, an a0plicant that. in ust submit multiple permitAicanse applications in any given yW, need only submit one affidavit indicatiripcurrertt policy information (if necmary) and under "Job Site Address" the applicant should write "all locations in city or town)." A copy ofthe affidavit that has been officially starnped or marked by the cit y or'town may be provided to the applicant as proof that a valid affida,& is on file for futum permits or licenses. A new affidavit must be filled out each yew. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture 0-C. EL dog license of permit to burn leaves etc.) said person is NOT required to complete this affida-A The Offica of Investigations would Itle 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, Wephone and. fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Mee of Investiggations 600 Wadiington Str�et Bosion., MA 0211*1 TeL # 617-7274900 6xt 406 or 1-977-MASSAFF- P.evised 5-26-05 Fax # 617-727-7744 wwwman.gov/dia Date .... z TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies ........................ has permission to perform ............... plumbing yinhe buildings of ............................... ......... .......... North Andover, Mass. Fee'4��. Lic. Nor)'� OLUMBIN6,11Y P'ECTOR Check # -3901 L/ L� 7792 MASSACHUSETTS UNIFORNI APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOvER, MASSACHUS=S D Building Location. k,� Owners Name Amount C Type of Occupancv New RenovationNVPD Replacement Plans Submitted Yes No . 1:1 11 (Print or type) I j4agk-_o�e: Certificate Installing Company Name 14��ZA Partner. Firm/Co. Name of Licensed Plumber: Insurance Coveracre: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of I indemnity Bond F1 Insurance Waiver: L the undersigned, have been made aware that three insurance the licensee of this ' application does not have any one of the above Signature — owner I hereby certify that all of the details and information I have subm�*i best of my knowledge and that all plumbing work and ins compliance with all pertinent provisions of the Massac US S By: bign re 0�'Ljomse Title 5�f Plumbb r City/Town P2- 1�0 1,APPROVED (omm usE oNLY T7;enSt114UMDtr — 0 Agent ri ted (or entered) in above application are true and accurate to the ?erformqdAtrrffe?Pqrmit Issued for this application will be in 5W"6I-ng Cyfe-�OCtapter 142 of the General Laws. Master C17 Journeyman Location e - N o%' Date ft TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Iry Other Permit Fee,/�,,- $ Sewer Connection Fee $ -------------- Water Connection Fee $ '49 TOTAL $ Building ln��� Div. Public Works �r� 7 r') 7 r) 7- m m M. Ln :rt �M 7 r') 7 r) 7- m m M. r- C)=Zzz 7 z rn M ;v r) I) n rn C) C) -i z 0 Z r� z 7 r') 7 r) 7 r) m m M. r- C)=Zzz 7 z rn M ;v r) I) n rn C) C) -i z 0 Z r� z 7 r') t� Ll I I 17� A C) C)=Zzz n C) C) C) 0 Z r� z t� Ll I I 17� A C) CD C C— < L CD — 0 CO3 S, CL cl, co -1 m CA Q CL C -J CD �. c 9. =0 =-o co) IM M — CD CL m CD M3 CA -40 CD C4) CD CD c5D st qqz C43 CD 0 C) co 0 s cw, CO) r) 0 Ce C-3 CD CD ca C') Z co) P-* CD CD C/) CD CD C/) co 0 CD CL CL E CD Cl) CO) n col m w 0 m =0 CA C40 CL cr CD w RL: n z 0-- ca C/) 0 "C m CD CL OCCD CC < CO2 m CD CD CL r S CD cf) =r CD W C42 m CD CD C/) E; =r C.) 0 CD 0 CD CD CO) CD CL CD CO) iRK" .11 CD Q rr: CD CD CD C3 CO) ;w Cos CD CD C2 =r CD Im W C) CD CL C-) C-) CD CD M: C, 0: z 0 of ri W D 0 Cn - z -rl 5' -,o 0 r- aq cp b F: (IQ ::r M Z 110 0 r- 0 cn C) x z n �r pd 0 r- qQ ri 0 r- rL 0 z "4 C) cn U) (D ll� r) C/) -< rb 0 r) =r- z o > tl WE I omq 0 P=h 0 44� CD ol -Z I 0 Castricone Roofing & Siding E W " -\kj REPAIRS FREE ESTIMATES Telephone (978) 682-4266 MARIO CASTRICONE 31 Court Street, North Andover, Mass. 01845 I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on.Dremis b low described: ...... ... CKXJ1 . ......... Owner's Name ......... .............. ....... — .. .... ....... .. ........ ..... ......................... * ..... ....... ...... Job Address ..... In ....... �Q.C.—.. vi� �X r-�Ackao ... . .............. 0".&t ..... ...State ....... . ..... . ............................... KIES SPECIFICATIONS ..... ....... .AdQ� ........... . ....... ............ ....... .... ........ . ........................ ............... .......... ....................................... ...................................... ........... .. .. ....... . .......... ....... .... ................ ... . .. ...... \A .......................... ............. .............. *IAA�� .................. .... ... .... . ............ ..... .... .... ... ............... ....... ............................. .................................. ........ ji ........ V .................................. *** .................................................................... ....... ... .................. ....... ... . .. ........ y .... .......... ** ...... ............ .............. . t� ........ ....... . .. . . ............. ................ .. Ty . ........... ....... ................................................................................................................ i . .... .......... Q ................. . ...... ... ..... Y ... ................... . V. .. ... ........ Y- C . . ................ ............................................... ........................................................................................................... . ..................................................... ... ...................................................................................... . .................... Materials and labor to cost $ .... illcvl ........................... Payable e -.'y\.. .............................. and balance in ............ monthly installments of $ .......................................... each, payable on ........................................ day of each and every month thereafter until paid in full ( .............. % charge per year is to be added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms.and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Cover attic storage cleaning not included. Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agree mient not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in operation IN WITNESS WHEREOF, the parties have hereunto signed their names this .................... X. ...day Ofo.. ... I ...... ..... ........ Accepted: ��Z' Signed........ .. ... . .. .................. .................. 4: Owner (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) &,)1_ #&--D -QR201-,� Signed...................................................................................... Owner .. .................. ......... ....................... ....... Signed ...................................................... .................. �— zw—�Clcp .... Representative 4' Location � 2 -7 No. Date 401tTpI TOWN OF NORTH ANDOVER -4 Certificate of Occupancy $ - Building/Frame Permit Fee $ 2 S AC #bundation Permit Fee $ Othe� Permi,t,F,ee $ Sewer Connect , ion Fee $ Water Connection Fee $ TOTAL $ -024 L) 4i -I. Building IrTspector Div. Public Works PE:Rlfff N(�.. 1 P/ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP +40. "Ilk ZON E INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 3 PAGE 2 FILL OUT SECTIONS 1 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING .ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED hIA-Y 2-1 1 -7 ra4cf-, SIGNATURE OF OWNER OR AUTHORIZED AGENTV pen F E E w V� '!�� PERMIT GRANTEW* WL&A4,311 9 G OWNER TEL. #-- CONTR. TEL. CONTR. LIC. 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. IrT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ly A , 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN c5L LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE SUB DIV. LOT NO. LOCATION 30 Allzs (Z- PURPOSE OF BUILDING im-Nen AL. 6 0 KA OWNER'S NAME MuL- HE&�17?-P&l NO. OF STORIES s lzk 2-4— Z OWNER'S ADDRESS ; o 0,4i<es D BASEMENT OR SLAB 5AS&14eN*r ARCHITECT'S NAME c- 4L)4:!,K- -rl+vq SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME J -AV ' AUZK6 SPAN --n DIMENSIONS OF SILLS IV DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR 44 r GIRDERS AREA OF LOT q FRONTAGE 3aa HEIGHT OF FOUNDATION 0 THICKNESS IS BUILDING NEW SIZE OF FOOTING I, x IS BUILDING ADDITION MATERIAL OF CHIMNEY IR I c ic- IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND o WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER \/ BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER 0 IS BUILDING CONNECTED TO NATURAL GAS LINE A MAP +40. "Ilk ZON E INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 3 PAGE 2 FILL OUT SECTIONS 1 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING .ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED hIA-Y 2-1 1 -7 ra4cf-, SIGNATURE OF OWNER OR AUTHORIZED AGENTV pen F E E w V� '!�� PERMIT GRANTEW* WL&A4,311 9 G OWNER TEL. #-- CONTR. TEL. CONTR. LIC. 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. IrT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ly A , 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN c5L *NV-Icl 10-ld S3:)V'ld3U SIHI :)13 s3vvii H.LlAA 'SE)NICYlins AO SNOISN3wia L::)VX3 aNV S3NM 10-1 WOMA 3::)NV.LSia aNY10-1 i0SN0lSN3WJC I.:)VX3 MOHS.LsnW N01103S SIHI Iwo- ON033V DNia i i n a ZL I AONvdn000 L- 0NIlV3H ON PIC 1 4-L P -z I w 9 DIND313 110 SWOON 40 'ON 4 svo S83IV3H IlNn 0.1.H INVICIV8 �:)NINO1110NOD a1V Sd31JVd GOOM dOdVA 80 d.l.M IOH 'Sioz) IR SM 1331S v3is N�nj d1V IOH (19DdOl 3:)VNdnj SS313dld 'sio:) v 'swe b39WIl isior coom ONIMH i L DNIWVNI 9 Oavo 3111 doolA 3111 s3dnixil NdKOW ONHOO� 1106 UMOHS 11VIS C)Niawnld ON 13AV�9 T dVl 31vis NNIS N3HDIDI S30NIHS GOOM ANOIVAVI 3310NIHS IIVHdSV 13SOID 431VM (�T(j-ZF WN �131 10i (16VSNVW 4 IVII GWV -fg ba Vo 36 —31WG ('M C) HIV9 d1H V 0 ONiewnld ot looll LNON 3lVnO3GV 11 400d aOId3dnS DNINIM 3WVdJ NO 3NOIS kNNOSVW NO 3NOI� >119 d3(3NID 60 ':)NO:) ZJOO1J 7 'SdiS DlliV 3WVdA NO )iDlag kNNOSVW NO )IDId9 3WVMA NO OMMS ,kdNOSVW NO ODDnlS 9111 'HdSV ON101S 'Id3A NO—WWO:) —ONIOIS t'-OiS39SV GA\GNVH ON1013 IIVHdSV HAV3 S310NISS CIOCM 313ZIDNOD 0�,!11S dOZIG SC)dVOI@dVlD SHO011 6 -N�HXIN Nd�CIOW S3DVld 3dlJ V3ZIV DUIV *NIJ WOOM (JV3H I.W 9 ON 1/1 l/. 1/1 iinA vgd�y V3dV_.I.W 9 NIA IN3W3SVO 6 1 2 NIANn llvtA kd(l �IiSVld Sd3ld (I.N\(JaVH 3NId 3NOiS 80 NDIH ')I. 19 3138:)NOD 319dDNOD HSINld HOINUNI 8 NOUVONnoj NOuonHISNOD SIN13WIMV S 75 -1;A-0 kiiwvi iiinw 31do2s I I AIIWVJ 31!5N -I -S ON033V DNia i i n a ZL I AONvdn000 L- Wo POO eb CL rt-, E. C :,z a: = :;7 — 5' to --e fmcL % AA OS tv wu eD eD > Ma wo (ID ep CA (n a) -n :D -n co m Do C) m 3 si 0 0 0 :r 0 0 c (D c rm c j. I ua CD =r r- r- :3 =r CD FM (D C: 0 C) 0 > "M m m m 0 m rm m > r, M 0 0 0 X m END -1 c omq 0 OMMA QD 940 i N -.00 , l Mwl FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADDRESS STREET 0 8IGNED BY D.P.W.) (A APPLICANT ?Cu� PHONE DATE OF APPLICATION 1 I/Y(11 TOWN USE BELOW THIS LINE PLANNING BOARD Y4LOzo"� DATE APPROVED TOWA LANNER DATE REJECTED CONSERVATION COMMISSION Tlm-�ff ,oe D4TE APPROVED Le CONSERVATION ADMIN. /11'ATE REJECTED BOARD OF L DATE APPROVED HEALTH SiUITARXn DATE REJECIED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT (+ SEWER/WATER CONNECTIONS FIRE DEPT. kP_0tj I ke�, Smo P 0 ) � �M�A I -� L,�e, 12, -TL-S RECEIVED BY BUILDING INSPECT10N DATE Ar)fL—i I r,%,o 4.,,, 1� This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from tile compliance of any applicable Town requirement or Bylaw. i's CER TIFIED FOUNDA TION PL AN LOCATED IN Ooi--riA 4,j -,Dv SCALE.7"-- (.o' DATE.-_-* �,sg. S L. GIL ES R. L. S. LAWRENCEa NORTHANDOVER 5 AJ 1 -J 5 BA -J K.. .-rk's L -0-r is. �Ja-r �j F Fx- A. Al t ci THE CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE OF OFFSETS SHOWN THE SUIL DING INSPECTOR O1VL Y, 8 SUCH CONFORM TO THE USE IS FOR DETERMINATION OFZ01VING ZONINGS Y L A W OF CONFORMITY OR NON CONFORMITY WHEN TAKEN. "/, -W kOe) I (c e i&:T lluet LO*f - TOWN OF NORTH ANDOVER, MASSACHUSETTS OFFICE OF DIVISION OF FINANCE 120 MAIN STREET. 01845 KEVIN F. MAHONEY FINANCE DIRECTOR November 14, 1991 Mr. James V. Carroll 100 Johnnycake Road North Andover, MA 01845 Dear Mr. Carroll: f:C7 TELEPHONE 682-6483 Please be advised that check #278 issued by you on August 2e, 1991, in the amount of $27.50 has been returned by your bank and cannot be redeposited. Under Chapter 432 of the acts of 1989, Commonwealth of Massachusetts General Laws Chapter 60, Section 57A, the PENALTY FOR TENDERING AN INSUFFICIENT FUNDS CHECK AS PAYMENT FOR A MUNICIPAL ASSESSMENT OR SERVICE is $25.00. Please remit a bank check for $52.50 to the above address in payment of this charge. If payment is not received within seven (7) days, this matter will be referred to the North Andover Police Department to issue a complaint. Should you have any questions, Please call 682-6483, extension 16. Sincerely Kevin F. Mahoney Treasurer V cc: R. Nicetta Building Inspector :L t, Gallagher 0. . ' Andover Police Dept. NW151991 1� JILDI NG DEPARTW z fil z 0 c C. X 0 < W Pa --TT 0 N Qo c C: tL z > z 3 tr cn > ru --j Ln 0 LW 7 (a D a I.- o z o ,D rn N o C, 0 :) m 0 C- CD � ;o n 7q ID < (n ::r m z 0 'D — 0 rz (n c (D cn ej Z Cl CD > (D 0 >> r,u mm > m --\3 CD ru Ln 0 S� 0 :T c (D 0 zr 0 (D 00 C: --40 (D cn > CD or m 5.0 x CD cl :3 CD 0 CL 0 =r (D U) (D U) 0 U -0 CD (D Z) 3 c 0 (D ri M (D M cx > U) (D m 0 Z 0 (D !� w -n (n 0 0 m O'D C') 0 rn c i CL c z CL cu m CL �D CD 0 cu (a (D cl cr w 0 > X, K U 0 c z ,j >1 m m < 0 m %r -n I -- m m 1. '7 1. 4' a [33 N 0 0 ru --j Ln 0 LW 7 0 z X- 0 0 C- Lri � ;o 7q m z 0 rz ej Z -�3 > ;E Z. m -< 0 0 0 >> r,u mm > m --\3 ru Ln [33 N 0 0 ru --j Ln 0