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Home My WebLink AboutMiscellaneous - 316 SUMMER STREET 4/30/2018 316 SUMMER STREET i S��f � 210/107.A-0175-0000.0 � - - -- _ -.--- --_____ _ ----------- _.-___.-- I ,. . MetLife Auto&Home® Homeowner Operations Field Claim Office Attention:Claims P.O.Box 6040 Scranton,PA 18505 (800)854-6011 Mieftife" April 13, 2015 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: John B. Jr. and Joan F. Blottman Claim Number: JDF07119 OG Date of Loss: March 16, 2015 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has =_ been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten (10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 3B, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 316 Summer St, North Andover, MA Sincerely, Home Ops CAT Team Sarah Lackey Metropolitan Property and Casualty Insurance Company Claim Adjuster -- _- (800) 854-6011 Ext. 7440 Fax: (855) 411-6689 Email: MetLifeCatTeam@metlife.com MetLife Auto&Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates,Warwick,RI. MPL MA-REGDEPT Printed in U.S.A 0698 Location s /7,Me No. f 3�..— Date NOR, TOWN OF NORTH ANDOVER � _ 9 • Certificate of Occupancy $ Building/Frame Permit Fee $ ' ` s�cMu:sE Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check # ` �' f VBuilding Inspector - Y TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMITy � NUMBER: � JmDATE ISSUED:F .. �� , SIGNATURE: / C Building Commissioner/Ifor of Building-s- Date SECTION 1-SITE INFORMATION z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: k I b Q Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Rapired Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record o Name rint) Address for Service Sig re Telephone 04 2151 Owner oT Record: Name Print Address for Service: z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 347L,A 1 ensed Construction Supervisor: Not Applicable ❑ -� j Licensed Construction Su rvisor: CJ ��0 License Number CS Y Address JV ��G�� J(v `i�� Expiration Date Signature lephone 3.2 Registered Home Improvement Contractor Not Applicable 0 cc Company Name &6�0 Registra ion Number M A s Expiration Date Si nature Tele hone V, SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. —Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work c ec applicable New Construction 0 Existing Building V Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: &Je(&J ()(L &1AC bd( o� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be , x OFFICIAL USKIONLY Completed by permit applicant r J' 1. Buildin g (a) Building Permit Fee U UV U Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 5 Fire Protection LJ 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 as Owner/Authorized Agent of subject property Hereby authorize �j/pQQ� to act on My bel alt;in all n aln ai tters relative to work authorized by t is building pennit application. Z�/O Si tore of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, " as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and`belief/ A 117 Print Ne Si e of O vner/A ent Date ti IBM.111111 ORION NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHI1VINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Building Department �'� 5 " Y6 ° 0 0� 27 Charles Street North Andover, Massachusetts 01845 4 (978) 688-9545 Fax.(978) 688-9542 .. �4 o?.4,rEU NPS` s'SACHU,S�� 1 i DEBRIS DISPOSAL FORM In accordance with the provisions ofMGL c 40 s 54, and.a condition of Building permit-# the debris resulting from the work shall.be-disposed of in a properly licensed solid waste disposal facility as defined posed by I1i1GL cl 1, s e e-dis The debris will be disposed of in/at: Facility location Signature ofApplicant Date NOTE.- A demolition permit from the Town ofNorth Andover must be obtained for this project through the Office of the Building Inspector. 5 �i�1�11 II��fl11• �VDO�V _ �zpTdibO: 7/2�10� RJ 1000 COSST1t0CTI01 - 1iphard SIM AUMMTRAM* 5aleo 111 03079 II f - U 140s— viii—ow Ag"R . .CERTIFICATE OF LIABILITY INSURANCEa1ltE�MIfY! 04 V0942001 TH*COMT{FICATE MUO AS A NATM OF INFOFMATM Matthews insurance Agency ONLY &AD CONFM NO 0" UPON TME COTIFI A79 182 Parker Street HOS' IM CERTIFICATEMW ' EXTEM OR ALM94 COVEWUW AFFO 8Y THE POLMS Wtow. Lawrence, MA 01893 i WSURMA"0P0MCOVERAGE Richard Smith Zurich I DHA A J Wood „ , }= 86 shore Rd i x"WC. Salem, NH 03079 �wspc COVWAGU THE POLIM of WSURAkCE i.t6TW BELOW HAVE VAN O TO THE MM NMM AROVE FOR INE POLICY PERIOD VMrAM NOR►SffflU;AWNG auatr RECUWEIiEKf,TEAM/OR CON XT"OF ANY=ff*=OR ODM DOMMM M VM REP=TO YYMIClt THIS Cr7iTV"TE NO BE 4HR"OR AiAe PGWAM TH6 wCuhmoc Arrorwco ov not reLame oCearwm r�0 ouwcar To wti n MIXTONX atoLuOrww AHD 0014orrr040 or ou011 POt i<3SE8 A EG3lTE tH�IrQ SNCNM MY HAVE SSW MUCED BY PRBC CIAPAL rMOF40UP008 MU6YIIIM�lNUweUna" ; EACMOCCl/tMMgE sl 000,000 x acnOtA►wmanr I t�tEtr unyaw 00 OQ 00 i ❑aCun; ben u�m�.oM+om $10,000 1e4e1291 ; 02/21/01 02/21/02 'P4RWML&AW#AW S11000 000._ __ ' cEnst+au Aoo�oAec $2,000,000 ctE+r. tE�r^vvcEg,�R + I Lac v+too,,cia-COMPAPAOG $2 000 000 WtNAsnm AW AM ; ._tCrta^uroe s _ EOAUTaa i tOOOLPRO"Te i + TV"Wo d+uwioe j s a+wrotuas�m _... At TOOKY.EAACMW s 01"M Twit � l1111EMr1Y i AROCMLY 7 006YNt DEACMOCC> E CtAp�MASE ; I 2 AGGAtE 4 • I t i TlOIIIINO .r A + 'I 1 WC. 376939/9 00 !02121/01 02/21/02 te.LEACNACCOM *100,000 x _.. . I i6.�oM -WEMK�E $100 000 101M zL.oe E-PCUCYLNAR irJ00 000 , I III aoarartorosorarAr Aoe�reMr oYu,vwpar�xe CATS HO�ONt �omTrwuLSON^MAM"rw. CAW-VAATM �noao iwr a�M AWYt waaNMo rouraet�R c+u MPptt TK tveNnpr Richard Smith CRA AJ Wood DAM TWNW,TIIS awry owuw WILL SINUUM To WA a►vs Mur�r 86 Shore Salem NH 03079 TOTOoalOMMm um�TOsotar,wrFA&MTogo eortu" 475 MOM aoOSMAN*auAramrasAWNiroWMTN! tofAarOR ACGAD:ss(7Rtn 0 ACM CO MPATIO:M IM Town of Andover C O� t- LM W,9 dover, Mass., AE11 RATED PPS` 5 H ,9S •� BOARD OF HEALTH PERMIT T . D � Food/Kitchen Septic System -?XM/W. BUILDING INSPECTOR THIS CERTIFIES THAT.................. r/'{ ...... ............ d.. Foundation has permission to erect. e.....8/ .............. build' s on ....l..�......................0 / v.VM.�..�.r.....�.�.............. Rough to be occupied as.......V.1.... !ti m N �t a 'V G w Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Const uction of Buildings in the Town of North Andover. ,7�5-- `� - T � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough ...............................:.............................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner r Street No. SEE REVERSE SIDE smoke Det. Date. . . . . . ... No I. ON/M TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ♦ o �1 +O++ ••'�qh US This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform 1s plumbing in the buildings of ... . . . . . . . . . . ... . . . . . . . . . . . . . . . .,,North Andover, Mass. Fee '. . . . . .Lic. No :` . . 6. . . . . . . . . ., PLUMBING.INS E&OR Check it WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) S-�- NORTH ANDOVER,MASSACHUSETTSatr— Building Location ,�!C 1 h Owners Name !. �' C Permit# q3s Amount jj Type of Occupancy Co New rq'i enovation Replacement Plans Submitted Yes No FIXTURES Cn z ' Cn w w x rA d a Cf)F Q a s Q � A E., E� a z F" U d Z A A d d A SERBEW BASE" T M FWM 21-Il HaR �� 4ffl HIM 5TH FLOM 6TH H_00R 7IH FLOCK SIH FIDQt ., (Print or type) l r Check one: Certificate t Installing Company Name + Ins g P Y Address {r v Partner. s Telephone d D Firm/Co. Busines Name of.Licensed Plumber: Insurance Coverage: Indicate the type o-insurance coverage by checking the appropriate box: ❑ Liability insurance policy � Other type of indemnity ❑ Bond 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 ignature Owner 0 Agent f 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 anrk'i UAati serf ed er P it s for this application will be in compliance with all pertinent provisions of the Maesachuettstafe iti' ode ter 142 of the General Laws. By: o nsed VIe Type o lumbing3;icense Title v City/Town icense Number er Master (s Journeyman APPROVED(OFFICE USE ONLY MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO DO GASFITTING ' (Print or Type) Mass. Date—&, Building Permit # Location _3 (_o I>oa �,� . (///��//, V ♦ �/J Af >4� Owner's -,� ;� � 77//" IT Name IMI � ,,I_=a!°��Cl t;�YVI C New ❑ Renovation ❑ Replacement ta/" Pians Submitted: Yes ❑ No . a a ¢ Y W a � S ¢ O y¢j e = 0 f' ¢ ,7 W < o a y ¢ O ° ¢ s o W < _ = h a o ¢ t W W A J < s ¢ ¢ 10C > W Y i W < C O > 1� f. W '00 at ¢ < W > ¢ tJ S < ¢ < t O O W ¢_ O a 2 ¢ s SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 2R0 FLOOR 4TH FLOOR STN FLOOR •TN FL60R TTM FLOOR eTM FLOOR , WEWRT A. SAI!lflMAT'ARO Check one: Certificate Installing Company Name ar_1TK4RTNG & HEATING ❑ Corp. Address 30 COACHMAN LANE d Partnership METHUEN, MA 01844 Firm/Co. Business Telephone 1�9 FZ -9 9 7 ( nn Name of Licensed Plumber or Gas FitterZT�P � FF S,3�61 Al A-rA e._ INSURANCE COVERAGE: Check on I have a current liability Insurance policy or Its substantial equivalent. Mese No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity ❑ Bond ❑ 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 C3 Agent❑ 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 the permit' ued for this application will be' compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of n al Laws. BY T of Ucense: Title Plumber g ure o cense um er fitter Master License Number City/Town C,Journeyman APPROVED(OFFICE USE ONLY) 1 1 1 1 i 1 Cr t iBELOW FOR OFFICE USE ONLY 1 I 1 PROGRESS INSPECTION _ F5rs1 7r1�a1 � e . 1 FEE 1 1 1 i � t 1 1 i 1 APPLICATION FOR PERMIT TO DO GASFiTTlNG ; '1' 1 j � t a 1 1 1 0 1 1 1 1 1 NAME A TYPE OF BUILDING i 1 =' i W 1 1 x LOCATION OF BUILDING 1' b p - � r PLUMBER OR GASFITTER � 1 1 � 1 i LIC. NO. a 1 � 1 0 j i PERMIT GRANTED 1 t 1 t 1 1 DATE 9B 1 1 1 . 1 GAS INSPECTOR , t Date. . . . . .. .. . . . . . . ... . . . „ORTH TOWN OF NORTH ANDOVER e94,oL o p PERMIT FOR GAS INSTALLATION pogATE o'PP`�y �9SSACHUS This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File N2 Date... �I N_ 2J66 NOR71{ - '`°''��66 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACHUS� This certifies that ... ` has permission to perform ...�(.. ......................................................... wiring in the building of ............... at......3./�........ ....... ........................ .North Andover,Mass. ...................... Fee....1�_ ......... Lic.No.....':......... ............................................................... ELECTRICAL INSPECTOR 0120/98 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer q J Tie The Commonwealth of Massachusetts Office use only LL�iL Depart (� rt ment o!Public Safety Permit No. v - ,� Occupancy tl Fee Checked_ BOARD OF FIRE PREVENTION REGULATION CMR 12:00 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK MI work 10 t*p rimed In-ccgdarwa with ow Meaeacfwwtle Elecu"Code,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date r 6 NORTH ANDOVER To the Inspector of Wires: City or Town of The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 316 SUMMER STREET _.. CURRAN CONSTRUCTION Owner or Tenant 8 STONE POST ROAD SALEM, NH Owner's Address is this permit in conjunction.wi!h a building permit yes ❑ no ❑ (Ch-•;k Appropriate Box) Purpose of Building Utility Authorization No. Existing Service _-1mps_J Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps_____—_J Volts Overhead ❑ Undgrd ❑ No. of Meters ___ !� Number of Feeders and Ampacity Location and Nat- 10 Recess Fixtures & 1 'Switch e of Proposed Electrical Work ._ No.of Hot Tubs No. of Transformers TOTAL No. of li htin Outlets KVA Above In No. of Lighting Fixtures SwimmingPool rnd.❑ rnd❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Batt2a Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones TOTAL No. of Detection and No. of Ranges No. of Air Conditioners TONS Initiating Devices ON HEAT TOTAL TOTAL No. of Sounding Devices _ No. of Disposals No. of Pumps TONS KW No. of Self Contained Detection/Sounding Devices No. of Dishwashers Space/Area Heating KW Devices Municipal (-� No. of D ers Heatin KW Local 11Connection lJOlher No. of No. of Low Voltage No. of Water Heaters KW SI 'ns Ballasts Wiring No. of H dro Massa a Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy Including Completed Operations Coverage or Its substantial equivalent. YES O NO O 1 haave eubmitlou valid proof of same to this office. YES O NO O If you have checked YES, please Indicate the type of coverage.by checking the appropriate box. INSURANCE ❑ BOND ® OTHER ❑ (Please Specify) _. (Expiration Dela; Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME CITY WIDE ELECTRIC , LIC. No. 578MR ANTHONY LEMIRE S(gnature E16650 LIC Licensee . NO. _ Address 4 JACKSON DRIVE HUDSON, NH 03051 Bus. tel. No.603/886-9640 Alt. Tel. No.Same OWNER'S INSURANCE WAIVER: I amaware that the Licensee does not have the Insurance coverage or its substantial equivalentas requirod C.: Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent (Please check one Telephone No. PERMIT FEE 1-" (Signature of Owner or Agent) ......... -^ Date. . r .rrrrrr ... .. ,FORTH Of TOWN OF NORTH ANDOVER 9 _ PERMIT FOR GAS INSTALLATION �9SSACHUSEt .:. This certifies that . . . . . . . — 1!. . . has permission for gas installations in the buildings of . .. �! =•!-l'r / : //.1-17 . .1�. . . at . . . . .�:� .. . . . .. North Andover, Mass. Fe �� Lic. No../-��-3 GASINSPECTOR Check# U J� 4791 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING � i (Print or Type) , Mass. Dat t" Building Location k*44 Owners Name r C j2 Type of Occupancy I�eSl I")CN T1 New ❑ Renovation ❑ /Replacement 2" Plans Submitted: Yesp No p N N W N N N V rn0: N Q O = N = W W Q O V m t- _ 0 N Y O W ~ < C Z O 01 O r < m 0y W o o d < fA d W < _ _ ~ N O W W ZW 4C O S H W < W � W !- S G7 I- U.J f' 2 ►' }lu Nm Z O 2 W 0 Q = < .W > W O 2. < rL < < O O W O W H x O tl x . �. a 3 G -0 J V o= > a o. M- O SUB—BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name 'j e--,A (ZT `gym MA Told�O Check one: Certificate Address 30 C'DA C H 1h A r `NI. ❑ Corporation 111 E T H U E O 01 rl 01 k �l ❑ Partnership Business Telephone �n g!—(7 9-7 f 2--'Firm/Co. Name of licensed Plumber or Gas Fitter :f 0 8 E P T A- ',A M m 14 F A RL-) INSURANCE COVERAGE: I hive � a current�I ability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.. Yes [�' No ❑ If, j have checked yes, please Indicate the type coverage by checking the appropriate box A liability insurance policy , Other type of Indemnity❑ Bond ❑ 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: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and aw rate to the best of my knowledge and that all plumbing work and installations performed under the pe i ed for this applicatioZnb,,in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne LawsBy T of License:Plumber n ure of cen u otter Title tter er License Number 933' City/Town Journeyman O IC NL i BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE, NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME d TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR OASFITTER LIC. NO. PERMIT GRANTED +- r DATE 19 OAS INSPECTOR Location No. l - Date �^JC) HpRTiy TOWN OF NORTH ANDOVER OV �•o ,•''h,0 F s A Certificate of Occupancy $ C14US Building/Frame Permit Fee $ Foundation Permit Fee $ I. Other Permit Fee $ TOTAL $ o� Check # 15554 t/ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISS1 112,7a SIGNATURE: Building Commissioner/Inawor of Buildings Date SECTION 1-SITE INFORMATION 0 1.1 Property Address,., 1.2 Assessors Map and Parcel Number: c� S Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Pnnt) Address for Service:ice: Signature Telephone t 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1L' a ed Construction Superv� Not Applicable 0 tr �1 mac- Licensed Construction Supervisor: Xh'C O C_4E�fhLicense Number Addie Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor te Not Applicable 0 4- �r% Company Name /1 i� Gj�,� M X Registration Number ttt fff 4 j tcL•r/ t (t! Address 2 2,140, z a L5G Expiration Date Signature Tele hone v SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) 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.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Descril io of Proposed Work: C (J)e SECTION 6-ESTIMATED CONSTRUCTION COSTS ;2 t:Sn°f=d 4p x y s z 3M 4 Item Estimated Cost(Dollar)to be ti I? A >tIS €}NL �� Completed by pgrrut.applicantx E v... �Fff '. 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number _T SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �� `� V �e ''/ M� as Owner/Authorized Agent of subject property Hereby authorize to act on My belial fiii all matters re,lativ�e to work authorized by this building permit applicatio . Signature of Owner Date SECTION 7 OWNER/AUTHORIZED AGENT�DECLARATION ✓ LA"' as Owner/Authorized Agent of subject property 14 Hereb eclare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and elie �a rC J U�ik lCJ Print ame _ 2 Z 2,- Si ahue of Owner/A ent Date NO. OF STORIES SIZE r BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FULLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE _ , � �vigmneonurarr�IQ ✓��a1orJA�irtJe�i;. HOE 16PROUEME'NT,CONTRACTOR !. Registration: . 106603 } Expiration: 7/21/02 s s Type: 08A ` AJ 1000 CONSTRUCTION . ' Richard -Stith 85 Shore Drive ' ADMINISTRATOR' Sales HN 03619 BOARD OF BUILDING REGULATIONS i -License:.CONSTRUCTION SUPERVISOR Number CS 070882 Birthdate: 07/28/1956 Expires-.07128/2003 Tr.no: 11727 jL Restricted To: 00 #' RICHARD J SMITH 86 SHORE DRIVE � ! + SALEM, NH 03079 Administrator Commonwealth of Massachusetts Division of occupational Safety Robert J.Prevow,Deputy Director Deleader-Contractor e RICHARD SMITH Eff.Date 05103/01 Exp.Date 05102/02 DC001721 02 , Member of C.O.N.E.S.T. BO BOSTON-RENEW North Andover Building Department Tel: 978-688_954 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of BuildingPermit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid.waste disposal facility as defined b c 11, S 150A. Y MGL The debris will be disposed of in: Cis (Location Facility) Signature Permit Applicant Date NOTE: Demolition permit from tF a Town of North Andover must be obtained for this project through the Office of the Building Inspector i 1-603-898-4468 CONTRACT No. 1-800.458-4468 AJ. WOOD CONSTRUCTION 86 Shore Drive-Salem,New Hampshire 03079 ROOFING-SIDING-VINYL REPLACEMENT WINDOWS-DECKS Workmen's Compensation and Public Liability Carried on All Work Date 5 = , 199 I(we),the undersigned, hereby accept your proposal to furnish Labor and Material to perform the following work on premises located at the following address: (� No. - LbAner J f A4 (Street (City) 0 (State) Owner's Name A Tel. f�&5_ 6d d Z Address In accordance with specifications given below: SPECIFICATIONS OF CONTRACT SIDE WALLS—Kind of Material Avx& _Iwlc 4,,z Color SLOPE ROOFS—Kind of Material Color NOTE: No flat surfaces will be covered unless so specified. Perpendicular surfaces are covered only when expressly specified under"Side-Walls". RECOVER THE FOLLOWING AREA ONLY ezrayio/ < i I REMARKS: For the sum of$ Additional work at Deposit$ The undersigned property owner agrees upon completion of said work,to pay cash(if any)$ and execute a promissory note for the balance of$ PLUS TIME DIFFERENTIAL OF Payable in equal monthly installments of$ Owner agrees that the title or equity in this property is his and is security for this contract. IN WITNESS WHEREOF the undersigned has(have)hereunto set his(their)hand(s)the day and year first above written. j Buyer(s)Acknowledge Receiving a Completed Legible Copy of This Contract. This contract may be avoided by the Owners giving written notice to the contractor by ordinary mail within three full business days following the date hereof. t L L.S. (Legal owner of property to be improved) By L.S. (Authorized Agent) (Husband or wife of legal owner) f Jul 17 01 03:58p Town of Merrimac 878 346-0522 .p.. P. 2 ?Fre Conmmirsm ai ofA&Uacfiusetts Oq�ur�t of hidstnda-Acci47& Ofikz of•I'rcves*ataons Isco W"*tonSbeet Boston,9KA 02127 Wad='Compensation Iana:arace ASdavit APPLICANT ORMATION Please PR Leena Name: iocasion: City Telephone . D I am a honseowner parf inning all work myself. D I apfsole proprietor and have no one working in my capacity el am an employer prove g workers'compuffAimr for my employees working on this job . c Company Na=: Address: AL CC Telephone#.---( l CA/1- W1 IDMISUM Company: =---�e'-''..7 C�. Policy#: 3 -7/,.=C� d 6 I am(circle cine) sole proprietor.goal Contractor or homeowner and have hired the connectors nsted below who.have the following wotkare' compensation policies: Company Name: Address: City: Telephone#: Iuattrance Company: P013cy# Coaipaay Nage: •.+ Address: City:_ _ Telephone#: Bunzmace CoRapany: Policy 4: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MOL 15B can lead to the imposition of criminal peaabiws of a fine up to$1,500.04 and/or one years'imprisonment as well as civil pmalti:a is the form of a STOP WORa ORDER and a Sine of T it34.A0 a day agaiatst me. T understand th copy of this swtoment msy be forwarded to the Office of Investigations of the DNA for coverage verification. 1 do hereby c u the pairs and p df edurY that Me Inforetadon.above is trice and correct - Signature: Date: /A i PriutName: Phone#,_,,„ Official Use ONLY•Do not wrca in this area i City or TnH n: Perm /License# 0 Building Denatt nanto Licensing Bdard a Selectmen's Office t ECheok if Immediate response is required is Heattn Department / Other Nv rc � ►y Town . of 4 ndover o A o dover, Mass., COC MIC KE WICK V ADRATE D I Pa,`iC� S BOARD OF HEALTH PERMIT D Food/Kitchen Septic System %.1.6 BUILDING INSPECTOR THISCERTIFIES THAT................{�....... .�.................. .. ........................................................................................................... Foundation has permission to erect.... ..a .... ...... build! son .... ......�. .. ..... ........ Rough f to be occupied as.............................................. 1 r co ID W �` 1 Chimney provided that the person accepting this permit shall in every respect conform tot a terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relati1 g to the Inspection, Alteration d Construction of Buildings in the Town of North Andover. ' O /' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARELECTRICAL INSPECTOR CwagRough ................... ..... _ Service 600.A.. .. .. BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner s Street No. SEE REVERSE SIDE smoke Det'