HomeMy WebLinkAboutMiscellaneous - 317 MIDDLESEX STREET 4/30/2018 - -- - _ _ - - �3DGl! MioDG� Oc�a6c .s' �
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TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIJ RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING
i ?a, sta •. 3^ s +,'.'"� ::5. � "i
BUILDING PERMIT NUMBER: DATE ISSUED: rn
SIGNATURE:
Building Commissioner/lEN.Wor of Buildings Date
SECTION 1-SITE INFORMATIOhT
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
l
vrk Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sf) Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
1.5. ood Zone Information: ' 1.8 Sewer aosal System:'
1.7 Water Supply M.G.L.C.40. 54) P
Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M
2.1 Owner of Record
�o Q&LD 7 1Ht 00 krz- a �T
Name(Print) Address for Service:
Signatur Telephone
g- g2_ 3011 el I A
2.2 Owner of-Record- O
r
Name Print Address for Service:
W,
4
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES 00
3.1 Licensed Construction Supervis r: Not Applicable ❑
I 1
Licensed Construction Supervisor: 4)/-1z.
' License Number
ALssIT
/
Expiration D e
tgnature Telephone r
i
3.2 Register Home Improvement Contractor _ Not Applicable ❑
y
Company N me /0 �(
Registration Number
/a
GEM=
Ad&es bO 2..—i7 7"7 6 Expiration ateS
Telephone
_ '7L-
_ , ,-
1
SECTION 4-WORKERS COMPENSATION(KG.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 DescHiplion of Proposed Work check all applicable)
New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
64, AJ
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to bes g y (}k'FT
CIALS4ONhyn
b ermit
Completed applicant
x-
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(e)X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 O Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
Signature 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
Print Name
Si ature of Owner/A ent Date
t=
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 ST 2ND 3RD
SPAN
DIMENSIONS OF SILLS
DINIENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NA'T'URAL GAS LINE
FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from
Boards.and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
............................................................................
APPLICANT Ong)j412 E--. F141QI@y PHONE
ASSESSORS MAP NUMBER_ LOTNUMBER
SUBDIVISION LOT NUMBER
STREET 141,120 STREET NUMBER 317
i...........■w........................■■■...■■......�........-ME
............■
OFFICIAL USE ONLY
RECOMMENDATIONS OF TOWN AGENTS �'J_►yL�,�r(/�q
r.............................son WOMEN...............■ ....................
DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE REJECTED
COMMENTS
DATE APPROVED
TOWN PLANNER
DATE REJECTED
COMMENTS
DATE APPROVED
FOOD INSPECTOR-HEALTH DATE REJECTED
DATE APPROVED
SEPTIC INSPECTOR-HEALTH
DATE REJECTED
COMMENTS
PUBLIC WORKS-SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR DATE
• Town of North AndoverNORTH
o�tt,20 1611
0
6ao
Building Department o �►
27 Charles Street
North Andover Massachusetts 01845
LL
(978) 688-9545 Fax (978) 688-9542 �� °°" � K•
�9SSgcHus���y
i
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL 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 by MGL cl 1, sl 56a.
The debris will be disposed of in/at:
Woo p PA q►w i SA 4EM ti h} .
Facility location
Signature of Applicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector. j
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BOOK 1041 PAGE Z5z
PLAN: . ,OF LAND PLAN NO. _ I -
-FY- 1T3 PG lvo�
LOCATED IN
SCALE 111 = 20` _ �EPr if 11983
NO - AN DOV��f� , LASS
1
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BUYER 1 ��f-KQ W._. - - - LOCATED 0
MASSACHUSETTS
TO THE I jzs-�_may I;x__�A�4...._�AnIK. AND ITS TITI[ INSURERS
I HEREBY CERTIFY THAT 9 HAVE CIIAMIN90 THE PRCMI9tS AND ALL EAKM[NTf+
"ENCROACHMENT! AND BUILDINSO ARE LOCATED ON THE MOUND AS SHOWN.
I FURTHER CERTIFY THAT THE BUILOINO SHOWN 00( )CONFORM TO THE
ZONIN9 LAWS ANO AMENDMENTS, Lt. (FRONT90I0[ IS NEAR YARD SR BA ONLYIOF �D '�QJ��2
WHEN CONSTAUCT90. ( FURTHER CERTIFY THAT THIS PROPERTY IS
LOCATED IN THE ESTABLISHED FLOOD WA=ARO AREA. rr DEED
NOTE : THIS CERTIFICATION M BASED ON TH9 LOCATION OF 1URV9Y MANNERS Of OTHERS. AND BOON
oo[S NOT AtPA[fCHT A MOP[RTY eURV9V
[1(AMINATION OF TN9 RECORDS 19 MADE ONLY wB/LOU[NT TO THE ACCORDED DATE OF THE PASS
LAY92T 0910 AND DOE/ NOT INCLUDE VERIFYING THE .A000ACT OF THE 0910 OE/CRIPTION
PREVIOUS TO IT/ OAT[ OF RECORD. PLAN
rH11 OI w
COMPANY IS NOT A[SPONSIeL[ ,/OA ANY INOlNTYA9G MA9/[DUCHY TO TN! N0. _ -.._... ._
ACCORDED OATS OF THE LAT91T 0990 OF RECORD. y
WHENEVER 9UR.OINSe ARE SHOWN IBIS THAN ONE FOOT FROM THE PMW94TV LIN[ IT I/ 9OON A/ -•---
ADVISED THAT A MORE ►R[C:lE SURVEY GE MAOI TO VERIFY TH[KMpUR[M[NT/. PASO .AQ.0___
THIS CERTIFIMIJ,OR TO BE USED FOR MONTOAOL PVRPOUES ONLY CERT. NO.
u-- .1946
`M`N
Of �� ;t, dRADFORD ENGINEERING CO. SCALE I r 0-
P.O. BOX 1244
:r JuGAfA U Haverhill, Mos! 01431
Jamas W. BOUGIOUKAS RLS It1.'' I4AA9
\ OS[9 TEL. ITS teSe
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Zoning Bylaw Review Form
,�' 'tip.. ;•'; L
Town Of North Andover Building Department
27 Charles St. North Andover, MA. 01845
�ssACNU3Q4 Phone 978-688-9545 Fax 978-688-9542
Street: ` e- 5 e - S�-
Ma /Lot:
Ap licant• (4,l` .4r.ro e
Request:
Date:
Please be advised that after review of your Application and Plans your Application is
/DENIED for the following Zoning Bylaw reasons:
Zoning
Item Notes Item Notes
A Lot Area F Frontage
1 Lot area Insufficient 1�e.S 1 Frontage Insufficient Lf S
2 Lot Area Preexisting e S 2 Frontage Complies
3 Lot Area Complies 3 Preexisting frontage 4Q-5
4 Insufficient Information 4 No access over Frontage
B Use 5 Insufficient Information
1 Allow d''; Ll e-
GContiguous Building Area
2 Not Allowed 1 Insufficient Area
3 Use Preexisting 2 Complies
4 Special cial Permit Required p
q 3 -Preexisting CBA
5 Insufficient Information 4 Insufficient Information
C Setback H Building Height
1 All setbacks comply 1 Height Exceeds Maximum
2 Front Insufficient e 2 Complies
3 Left Side Insufficient 3 Preexisting Height
4 Right Side Insufficient Insufficient Information
5 Rear Insufficient ( Building Coverage
6 Preexisting setbacks) yE S 1 Coverage exceeds maximum
7 Insufficient Information 2 Coverage Complies
D Watershed 3 Coverage Preexisting
`( S
1 Not in Watershed 'Lee _S 4 Insufficient Information
2 In Watershed Sign
3 Lot prior.to 10/24/94 1 Sign not allowed
4 Zone to!be Determined 2 Sign Complies
5 Insufficient Information 3 Insufficient Information
E Historic District K Parking
1 In District review required N
q 1 More Parking Required
2 Not in district K 2 Parking Complies
3 Insufficient Information 3 Insufficient Information
Remedy for the above is checked below.
Item # Special Permits Planning Board Item# Variance
Site Plan Review Special Permit _= Setback Variance
Access her than Fronta e Special Permit _Parking Variance
Frontage Exce tion Lot S ecial Permit Lot Area Variance
Common Drivem S>ecial Permit Height Variance
--Congregate Housin S ecial Permit Variance for Sign
Continuing Care Retirement Special Permit Special Permits Zoning Board
Independent Elderly HousingS ecial Permit Special Permit Non-Conforming Use ZBA
Lar a Estate Condo Special Permit Earth Removal Special Permit ZBA
Planned Devefo ment District Special Permit
Planned Residential Special Special Permit Use not Listed but Similar
Permit Special Permit for Sin
R-6 DensitySpecial Permit Other
Watershed-Special Permit Su I Additional Information
PICI-IF j5EPt1C_1,)t epm% Pfle L_V P
The above review and attached explanation of such is based on the plans,request for or information submitted. No definitive
review and or advice shall be based or verbal explanations by the applicant nor shall such verbal explanations by the applicant
serve to provide definitive answers to the above reasons for this action. Any inaccuracies,misleading information,or other
subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion
of the Building Department.The attached document titled"Plan Review Narrative,shall be attached hereto and incorporated.
:,in by rence. a buil `ng depart f will retain all plans and documentation for the above file.
y_a� f aoG
n Department g p ment Official Signature Application Received Appl'cati n Denied
Denial Sent: If Faxed Phone Number/Date:
Plan Review Narrative
The following narrative is provided to further explain the reasons for the action on the property
indicated on the reverse side:
r�4^v v�,f p -f L �`•. 1• ,+ _.i+� q 1,
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o,�e "S A.7OU —C G.v'J'Gr^ rtii/ v
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Referred To:
Fire Health
Police
Zonina Board
Conservation De artment of Public Works
Planning Historical Commission
Other BUILDING DEPT
Zonin lawDe
gBy rna12000
!MASSACHUSETTS UNIFORM APPLICATION:FOR.PERMITTO`p0
�. (Type or Print)
NORTH ANDOVER ,Mass. 4 . Date''
Building Location Permit
Owners Name
v New D Renovation Replacement Pians Submitted
FIXTURES
Z
on
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N 203 Q ¢ it z h W Z O = W 0. a .
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AW 0 Qa f.- 0. ~a X W
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< Q Q -j J cc tG O < Ia-
;F,,:!j•'',
Y = tr tD Q •: .
SUB—BSIyIT. •.. i
BASEMENT I
1ST FLOOR
2ND FLOOR
Y.
3RD FLOOR
4TH FLOOR
STH FLOOR ! ;
6TH FLOOR
TTH FLOOR
STH FLOOR
(Print or Type) /r Chec . one: Certificate
�
C�Installing Company Name Corp.
Address � zz; i � -
til � Partner.
Firm/Co.
Business Telephone 0 2
Name of Licensed Plumber:
j Insurance Coverage: Indicate the type of insu ance coverage by checking the
appropriate box:
Liability insurance policy F--j Other type of indemnity El Bond
Insurance Waiver: 1 , the undersigned, have been made aware that the licensee of #i .
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner Agent`'-\•
I hereby certify that all of tlrc details and information t have subiniticd(or ensued)in aMove application are true an 4 Crr#ate to the best of my
—• knowledge and that all plumbing work and installations fterformed undcr renmit icsucd for this application will be in Compliance with all pettinept pro..,
Visions of the Massachusetts Stale Plumbing Code and Chapter 142 of tic(:casual ws• „
By
Title Signature of �=3;-- "icense
ed Plumber
City/Town• e of
APPROVED (OFFICE USE ONLY) Liven a Number Master ❑ Journeyman
x :
Date` �9
112 3487
NaR,M TOWN OF NORTH ANDOVER
49 PERMIT FOR PLUMBING
�,SSAcmus��
A
This certifies that . . .1�.!? !`!�-•?r , , , , , , , ,
has permission to perform J39.1. !41. . . . . . . . . . . . . . . . 8
u�
plumbing in the buildings of . . ��?/�t?t.o..... . . . . . . . . . . . . . . . . . .
at. .:3/. .7,d.•�-i r �.c���, s<,�, .,..�, North Andover, Mass.
Fee. Lic. No.. .9.0 L.?. �.-c!LAT
?!j� : . . . . . . . . . . v
PLUMBING INSPECTOR w
m �
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer m
Q .
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NORTH ANDOVER 44ass. Date a1q
> uilding Location �-�( G� i�� _ Permit # ol& Y/
Owners Name %
• New Renovation D Replacement Plans Submitted D
FIXTURc(z
N
� W to
N t» 0 Z � •
Orf
ul a pJ Q d V N r t Z M
tu Ir-
Z o to IW- a cc cc O 0 Q Z tu
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to tr W a cwi us x m W 4 cc o c > W
w W of d x a •- 1'- x
O t-. Z J f' z f, W W C3 O ? It 1+ V .t H Cr
Z Q W < a .. f' }- N m Z O Z 5 us
O S
Q W > C W 2 d cz 4
a x 01 is z W a o j 0 W > Q 0.. 11--- o
SUR-13SMT.
BASEMENT f I
IST FLOOR
2ND FLOOR
3110 FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
TTK FLOOR
8TH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name ~ ` 6� Corp. ,
Address j7hV - Partner.
i Ott A Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter l
Insurance Coverage: Indicate the type of insurance cove age by checking the
appropriate box:
Liability insurance policy Q Other type of indemnity D 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 coverages.
Signature of owner/agent of property Owner ❑ Agent M
1 hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my
knowlcdge and tlat all plumbing work and instillations performed under Permit issued for this application wiU_be in compliance with all patinent
provisions of tho Massachusetts State Cas Code and Chapter 142 of tho General Laws.
r
By TYPE LICENSE:
Title Plumbeter SignaEure"Of censed
GasfiCity/Town: .aster Plumb r or G fitter
Journeyman L/v
APPROVED (OFFICE USE ONLY) License tuber
i
'2641
2 6 4 q I Date 1. . .I? ... ....
NORTN TOWN OF NORTH ANDOVER
a PERMIT FOR GAS INSTALLATION
F 9
t
l ♦ o •
SSQACHU`'E
I
l X
This certifies that .'( :. . �? �1�. . . . . . . . . . . . . . • • . • . • • $
has permission for gas installation . . . . . . .
in the buildings of .D . . . . • . • • • • • • • • • • • • • • • •
l
at � . . . . . . . . . . . . .. North Andover, M s.
E ; . . . . . . . . . . . . . . . . . . . . . . . .
� Fee.3�� Lic. No.���7 • �
GAS INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
Date... 4.. /1...
N-o 2056
.719
1 NORTH
°ft °:•�"° TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
SA USES
This certifies that ... / .Ct ?.. ...................................
has permission to perform ......... r'
, r.f!.1.!.�........ .................................
wiring in the building of
..J.../... �5 ....................................................
31.7 '.�fC�f lt".�PY.. ................... .North Andover,Mass.
.at..... ...
Fee..� !V. . Lic.No.. ..��
..... ... .............................-L*I* ........O'*R*' ..............
ELECTRICAL INSPECTOR
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
Office Use only ,�--
Pernit No.
ss4le"" 45411 i7s
°� S°ai
Occupane/&Fee Cheated
BOARD OF FERE PREVENTION GULATIONS 527 CMR 12:40
APPLICATION FOR PERMIT PERFORM ELECTRICAL WORK
All work to be performed in accordance with a Massachusetts E!ec:hcal Code 527 C. 12:09
(Please Print in ink or type all information) Date .2� g—
To the Inspector df Wires:
Town of North Andover
The undersigned applies for a permit to perform the electhcal work/described below.
Location(Street&Number ,?/
Owner or Tenant --T)d/✓qk' )
Owner's Address 311 '11we"0
Is this permit in conjunction with a building permit Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead G Undgmd ❑ No.of Meters
New6Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Propped E'.ectical Work
Total
No.of Lightfing Outlets No.of Hot fuse No.of Transformers KVA
Above C In C
No.of Lighting Fxtures I Swimming Pool gma Q grid C Generators KVA
No.of Emergency Lignting
No.of Receptacles Outlets No.of Oil Burners Battery Units
No.of Smtcn Outlets No of Gas Bumem FIRE ALARMS No.of Zone
Total No.of Detection and
No.of Aarges No of Air Cond Tons Initiating Devices
Heat Total Total
No.of Oiposal No. Pumas Tons KW No.of Sounding Devices
No.l of Self Contained
No.of gisnwasners I SoacerAres Heating KW OetectiorvSounding Devices
C Municipal C Other
No.of Dryers HeatingDevices KW Local Connection
No.of No.of Low Voltage
No.of Water Heaters KW Signs Sallases Winn
No.Hvdro Massage Tuds No.of Motors Total HP
OTHER: SJ j�j AtJ110��
INSURANCE COVERAGE. Pursuant to the reguiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO =
have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER = (Please Soeafy)
(Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the Penattles of perjury:
FIRM NAME LIC.NO.
Ucensee Signature LIC.NO.
Bus.Tel No.
Address Alt Tel.No.
OWNER'S INSURANCE WAIVER: 12m aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Maesacnuserts
General Laws. that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
el
Telephone No. (l •� D PERMIT FEE 5 ��—
I (Sign ture of Owner or Agent)
Location -3i
No. 311 Date �
0
NORTFTOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
y�s'•• E<�' Building/Frame Permit Fee $
sAC 14
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # U /�
ap
17776
Building Insped&
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: /?
DATE ISSUED:
SIGNATURE: da
Building CommissionedI for of Buildin Date
SECTION 1-SITE INFORMATION IO
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
o2 /0 O0T .O — G0 -3S-
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide R red Provided R red Provided
1.7 Water Supply M.G.L.C.Q. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn
2.1 Owner of Record
Name(Print) Address for Service
ASL b JE .
~ ignatur Ix*qTelephone f n j�p— /(L r 2
2.E Owner of Record: 7 ( j(
Name PrintO
Address for Service:
M
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES go
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: Duval R-O-Ofifig- o
P.O.Box 637 License Number
uos�R�liding
Address 01$64
ic7 ��aSS Expiration Date
' tgfiature Telephone r
3.2 Registered Home Improvement Contractor Not Applicable ❑ 10
Company Name f1
P.O.Box 637 Registrat on Number m
North RN Mpn MA r
Address 01864
r
.'. '7 Expiration Datd'
P
Sr nature Telephone ^1
w
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 buildin rmit.
Signed affidavit Attached Yes....... No.......❑
SECTION 5 Description of Proposed Work check all licable
New Construction�D, , Existing Building ❑ Repair(s) ❑ Alterations(§) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other Specify
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USS C3NLY = `'
Completed by permit a2plicant
I. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
e as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application..
Signature of Owner Date p
SECTION 7b OWN R/AUTHORIZED AGENT DECLARATION
I, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and int cfteftforegoing application are true and accurate,to the best of my knowledge
and belief P.O.BOX 637
North Reading,MA
Print Name 01864ryry
Si ttue o . caner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2ND 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
DIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE .� t
NORTH
Town of Andover
0
No.j /;r
LA dower, Mass., op
0 LAor
COCHICH,FWICK
0 ATE
WARD OF HEALTH
Food/Kitchen
PERMIT TSeptic System
THIS CERTIFIES THAT...S....... do Co..�.&000008....................................................................................
BUILDING INSPECTOR
............ .. .............. Foundation
43 06
...........
... ........
has permission to erect........................................ buildings on.. . ........ Rough
tobe occupied asoo-�.-- -'. ......................................................................................................................... Chimney
provided that the person accepting thi ormit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of th Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings In the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES N 6 MONTHS
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
01 Service
..........
...............................................IPX—�==.....................................
BUILDING INSPECTOR
Final
Occupancy Permit Required to 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,DEPARTMENTUntil Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
✓�e yr an�uuecc�C ���sac�ucae�a �-
BOARD OF BUILDIN REGULATIONS
License: CONSTRUCTION SUPERVISOR
Nurri6e�: CS, 058443 1.
f Birthdate; 12/10/1,966 � '
r — Expires; 12/10/2005 Tr.no: 10052
I' Restricted 00 .^ !
1
KENNETH59' DU AL
PO BOX 190/72 NORTH
N READING, MA 01864 Administrator
�lze Uioorunw�reu�ea,�� ��/�r4a¢c` .�,
Board of Building Regulations and Standards
HOME IM;;�ROVEMENT CONTRACTOR
sRe9 iistr\aibon:_109288
�
Expiratione g/9/2006
--=�B'A
'TYP � ;
DUVAL ROOFING
Kenneth Duvalfl r
72 NORTH ST - ,- ---
N.READING,MA 01864 Administrator
e
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11, S150A.
The debris ill be disposed of in:
(Location of Facility)
I
Signature of Permit Applicant
l� y
Date
t
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
4
The Commonwealth of Massachusetts
d Department of Industrial Accidents
Ofrice of Investigations
Boston, Mass. 02111
y WOrkers'Compensation Insurance Affidavit
Name Please Print
Name:
Location:
City Phone #
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
am an employer providing workers'compensation for my employees working on this job.
Company name
Address
Ci Phone# ?�'�r✓
Insurance.Co. Poli # 8 7 30 x-5 -3, i
j Com2anv name:
Address
Ci Phone#
Insurance_Co. Policy#
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of•a fine up to$1,500.00
and/or one years imprisonment-as weti_as_chril.penalNes inlhelmn-fa.STOP WORK ORDPR..and_a.fine of.(3100.00)-ajd y.against_me, I
understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification
I do hereby ce F i d peneWas of perjury that the information provided above is true and correct.
Signature Date Cl
Print name P.hone#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit Ucensi
❑
[]Check if immediate response Is required Building Dept
0 Licensing Board
❑ Selectman's Office
Contact person: Phone#. ❑ Health Department
❑ Other
NOTICE H NOTICE
TO a TO
EMPLOYEES EMPLOYEES
O,�M
NJ 1b
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900 — http://www.mass.gov/dia
As required by Massachusetts General Law, Chapter 152,Sections 21,22&30,this will give you notice that
I (we) have provided for payment to our injured employees under the above mentioned chapter by
insuring with:
THE TRAVELERS INSURANCE COMPANIES
NAME OF INSURANCE COMPANY
ONE TOWER SQUARE
HARTFORD, CT 06183
ADDRESS OF INSURANCE COMPANY
(7PJUB-73OK535-4-04) 02-17-04 TO 02-17-05
POLICY NUMBER EFFECTIVE DATES
ARGEROS INS AGCY INC 360 MAIN STREET
READING MA 01867
NAME OF INSURANCE AGENT ADDRESS PHONE#
DUVAL, KENNETH P DBA 184 PARK STREET
DUVAL ROOFING
NORTH READr44G
MA 01864
EMPLOYER ADDRESS
EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will 6e paid by the insurer, if the treatment is necessary and reasonably
connected to the work related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
006208 W20P1G02
TO BE POSTED BY EMPLOYER
t
Page ' � of` 1 Pages
Builders License # 58443
Home Construction Reg. # 109288
CertainTeed/Certification # 1911
(V To GAF Certified Master Elite
THE
RCDFI G
COLLECTO
0 (951) 944-9994 (995) 664.2559
"The Areas Oldest Roofing Company
CertainTeed Q� "
P.O. Box 637, North Reading, MA 01864
PROPO L'SUB An ZO M�. W
"') DATE I
STREET 77 y Cr )f JOB NAM
CITY,STATE�Dq�'IP CJOB LOCATION
V0- OD tl 0 n/
We hereby submit specifications and estimates for: Recommended Optional
t71`r� ,Qpd (Included in price) (Not included in price)
y Rip&Remove all shingle debris from roof&job site: ❑ 1 layer A 2 layers ❑3 layers or more
i� Repair/or Replace any roof decking; not to exceed 50sq.ft.
Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill,white or brown
Install ICE&WATER underlayment along horizontal eaves,valleys,sidewalls and sky-lights&chimneys
•�'� Install 30#felt underlayment between roof deck and roofing shingles
V
Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year
Install 30yr CertainTeed/GA /Tamko or Owens&Corning architectural roof shingles
❑40 year ❑50 year
I
❑60 year
L)Lifetime
*See manufacturer warranty policy for more details
Install new aluminum vent-pipe flange(s)
Chimney(s)-counter-flash and re-step existing flashing
❑Cut&Install new lead1lashing
• Tkidge-vent/exhaust vent with low profile design, hidden by shingle caps
I
❑Soffit-ventilation ❑ Roof louver-vents
I ..
• Seamless style aluminum gutters-custom fabricated at job site
❑downspouts ❑aluminum leaf guards tt j
Other ! fi r, d+R . : 1 t4 t l Lit.^, rr P�..) 1 /td p A /% J 4t rX 14
I
Price includes all items above that are checked only/others may be priced separately upon request.
Pe Prapase hereby to furnish material and labor-complete in accordance with above specifications,for the sum of:
C23W Total price not including options. dollars($ (4 � f V ).
Payment to be ma a as follows:
30%deposit required before ordering materials.Balance due in full upon day of completion.
Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864
Late charges of$50 per week for all outstanding bills due upon day of Authorized "'
completion. Signature 'h
-Accepting_proposal means agreeing to the terms of the enclosed binder Note:This proposal may be
contract. Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted within_____3( days