Loading...
HomeMy WebLinkAboutMiscellaneous - 365 CHESTNUT STREET 4/30/2018V 2030 Date .....%.. t e NORTH � 3:;•�``°-.'_-."�0� TOWN OF NORTH ANDOVER Oskim P PERMIT FOR WIRING • i ^ r �,SgACHUSE� This certifies that ............ = l..p�../.!? :.. r..... rU................... has permission to perform " wiring in the building of ........ e........ s:L:................... ................................. l i c.t � - at..�... ..h.5..................../...........,../......�.................., orth Andov`er�,,Mais. Lic. No. /...i�.7 �1....... �1...;''....... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer < RECO11-41ONWEAL7HOFjVASS4GXM77' oi3iceGsi only ,N _ DER4RTjVEW0FPUBLIC&41'= BOARDOFMEP.fiEV=0NREGM7TONSS27a, IR1?G►'1 ~ p ,ttrro Occupancy & Fees Checked J APP ICA ONFOR IWT �'OPEIZFOI�M•.��'=CAL T OR r ' ALL WORK TO BE PERFORMED IN: ACCORDANCE WITHTHE MASSACHUSSTS ELECTRICAL CODE 527 CMR 32:00 ; ;(PLEASE PRIM-- IN INK OR TYPE ALL INFORMATION) Date Town of North Andover .. To the hmpector ofwires _ L: The'undersigned.applies for a permit to perform the electrical work described below. F7 PARCEL c'1 C f ____Locattorr( Street &Number) Owner or Tenant. Owner's Address `Is this pemut ru;condunction with a building permit: Yes No (Check A o nate-Box PPr P ) -- sed Buildm - Purpo g = _Utility Authorization No. Existing Service Amps / Volts Overhead Underground No. of Meters ;, New Ser4ce Amps / Volts OverheadUnderground No. of Meters Number of Feeders and Ampacity - 2 �J n Location rand Nature of Proposed ElectricaLWork No. of Lighting Outlets No. of Hot Tubs No. of Transformers -- Total "- C_ KVA_ No.ofLightingFiximes _ h Swimming Pool Above. Below Generators KVA - (-ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units _ No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges -" No. of Air Cond. Total �. _.. - - - -- Tone No. of Detectionand'�" No. of Disposals -.No. of Heat Total , Total Pumps Tons KW Initiating Devices . - . No, of Sounding Devices No. of Dishwashers Space Area Healing KW No. of Self Contained - Detection/Sounding Devices LocalMunicipaL Other No. of Dryers' Heating Devices KW Comucc[ions No. of Water Heatenu.. - KW No. of No. of - Stens Bailasis No. Hydro Massage Tubs No. of Motors Total Hp .us sell. •.� WC&I019tatt • • • •r•�:. D. cam•- nose- �.- .-.:... . .:. . �.- LJtffuafEd Y al{ldL' 6tic WC& ,D #ed Ra# Final OWNERSINSURANCE WAIVEP,Iama,kxwttiattrL>c =doestntha aril@atmysgmitaealdmpmnrta twakestherm#mia4 (Please check one) Owner Agent F ignaturc of Owner or AgLnE Lioa>'seNa i�s�z�� A1tTelNiz egiriv, l asolmuibyM3mdasesCxTmiiaws .ups PERMIT FEE S �hJ�`6 Telephone No. s Location .SbJCAZ&Mfr� � No. Date y— TOWN OF NORTH ANDOVER ,S EP 2; 3 1983 6569 Water Connection Fee $ ---------- TOTAL $ Building Inspector Div. Public Works Certificate of Occupancy $ BuildinglFrame Permit Fee $ Foundation Permit Fee $ �., �, °• �Ot er ftrt Fee $ ,..�.: C0 L L U370.1 �" Sewer Connection Fee $ ,S EP 2; 3 1983 6569 Water Connection Fee $ ---------- TOTAL $ Building Inspector Div. Public Works 4Al r-1-70- IT -% APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /'p,AGE 1 MAP +40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. �I I OCATION C / j �!S� A) it T- ST- C . ^� RPOSE OF BUILDING 1 [?vD �AJIJ `l OWNER'S NAME ,+{^� )_ ! 14LE-if oizI-- " NO. OF STORIES SIZE OW-NER'S ADDRESS 3kJS Cw��19sTn.k'�`I S'� BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD 8t71LDER•S NAME �C'A 1 _ f, 1f LL �Y�. — !T 1 U SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR '" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND 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 - IS BUILDING CONNECTED TO NATURAL GAS LINE 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 S ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR (/DATE FILED J ��� SIGNATURE OJ40WNER OR AUTHORIZED AGENT F E E 'Y 1 ./. U L, - PERMIT PERMIT GRANTED 2 19 —A OWNER TEL. CONTR. TEL. 0 CONTR. LIC. # 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER ldQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 44, Z000, BUILDING INSPECTOR I OCCUPANCY SINGLE FAMILY -ORIES MULTI. FAMILY WOOD JOIST _ OFFICES [OF APARTMENTS _ CONSTRUCTION 2 FOUNDATION STEAM 8 INTERIOR FINISH CONCRETE HOT W'T'R OR VAPOR d 1 2 13 CONCRETE BL K. PINE RADIANT H'T'G UNIT HEATERS BRICK OR STONE GAS HARDW D— B'M'T 2nd _ 1st 13rd ELECTRIC NO HEATING PIERS _ PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ Ih 11, lh FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDVJ D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME WIRING 5 ROOF � 10 PLUMBING WOOD SHINGES JI KITCHEN SINK I� BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. �I TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. G COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 1st 13rd ELECTRIC NO HEATING OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING NORTH ANDOVER DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON. DIRECTOR 120 Main Street North Andover. Massachusetts O 1845 + (617) 685.4775 In accordance with the provisions 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 property licensed solid waste disposal facility as defined by MGL c 111, S 150A. Tice debris will be disposed of in: IN, 1' &� sem¢ � . (A. l6-0 1 Sfi Q' 37�f-6�S) (Location of.Facility) ignature of Permit Applicant Date LC,� J,-, -t NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. f Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only Permit No. Date NAME OF CITY/TOWN AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, inprovement, removal, demolition, or construction of an addition to any pre-xisting owner -occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exceptions, along with other reouiremcnts. Type of 4„ Address of Work -3 b ,� GH C S Owner Name: �(, fu Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under $1,000 Bu' ding not owner -occupied !/Owner pulling own permit _Other (specify) Notice is hereby given that: 1 _ 'st. Cost A��,�{rES2 OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: F3 /` Date Owner Name �c. m D m z m Do i c = D C h C Q H = z d o C. W GO Z -I m n CD C13 z v, y0aC.) m C. W 0 0 0 N �_,� y -I o � 0 2 m '00 Cf co CO) O O o ... C -)C o z y C) T O CD'C3 O D Z Co A S. a" ��� r CD -40 CL to CO) Co cn 0 CD H a � ; o o pCL rn a '` :0 C H W caNot CD _ i W `•CL CD H cr CA Cc, to =CD C vs. O CD O CD 0 o0 00 o R a t C CD y. aC3 yJo cD C O CD CD I r� o W� 0 0 a CD Z I -" r: y CD z • a 0 o��, z=ar C/1 • VJ _ D CDD r to : C7 0 ; o cD : 77 : C2 . m ma cn B rD � ; o � C o n z o =T? C) 7z o C r C x OCOO m Poll r8r Ij i 0 c Location 3 6 15 6,i4Nu (- S No. _��� / Date l� NORTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ + ; ; Building/Frame Permit Fee $ 41 �'''•°''<�' Foundation Permit Fee $ SJACH Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ V/ Ag `$uilding Inspector X3492 Div. Public Works lE LM C w H w Op f . W a n m < m .'a m 7 M y m y Z a O O "� m Ln m rA L E -z °wtCA IISS 1 N C O Z v C a' cr 1• �! yEn ~� n O Z `w y to tD p to > N m � � �' y Y' (_WV y O ] . 0 n' -o ° o ,o bi •o .o '.- `•°o � ? '. c.._ w ' o cnF .- O.. y ` C O O O C o an = .o o �+ Z -q = > n - d o -moi n cncn L� • n lE LM C w H w 4D - TRIM - 2 1/2" COLONIAL WINDOW CASING, 3 1/2" COLONIAL BASEBOARD TRIM II. 2ND FLOOR WORK A - ADD 2X4 WALL TO CREATE HALLWAY TO STAIRWAY, PLASTER, RE- USE DOOR TO OFFICE ROOM . B - RE - WORK CLOSET IN OTHER BEDROOM - RE -USE EXISTING DOOR C - STAIRS - INSTALL STAIRS TO CODE , ADD 1 DOOR TO MATCH EXISTING TO BOTTOM OF STAIRS. STAIRS TO BE HARD PINE TREADS & PINE RISERS W/ PINE SKIRT BOARDS. D - REMOVE & PATCH PULLDOWN STAIRWAY- PATCH TO BE AS CLOSE AS POSSIBLE ,CAN'T GUARANTEE PERFECT MATCH - - E - REMOVAL OF DEBRIS NO PAINTING OR CARPET IS INCLUDED, H. PRICE: Contractor agrees to do all work in Sec. I & II, for the total price of $16400.00 SIXTEEN THOUSAND FOUR HUNDRED NO COUPONS OR DISCOUNTS AT THIS SPECIAL PRICE III. PAYMENT - Payment will be made as follows: $ 5300.00 UPON SIGNING CONTRACT $ 3000.00 AFTER STAIRS ROUGHED /PLYWOOD ON FLOOR $ 3000.00 AFTER WALLS STUDED $ 3000.00 ROUGH ELECT/ INSULATED $ 1100.00 PLASTERED $ 1000.00 UPON COMPLETION NOTICE: No agreement for home improvement contracting work shall require a down payment (advanced deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and or otherwise obtain delivery of special order materials and equipment, whichever amount is greater. IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the materials before the third day following the signing of this Agreement unless specified in writing. Contractor will begin work on or about N/A. Barring delay caused by circumstances beyond contractor's control, the work will be completed by BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the-provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility ZSignature of Permit Applicant ZY i Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i - L l�� THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM/DDNY) DATE (MM/DD/YY) A GENERAL LIABILITY / / / / GENERAL AGGREGATE s600, 000 OTHER THAN AUTO ONLY X COMMERCIAL GENERAL LIABILITY CPP 8 6 4 8 3 8 3 07/15/99 07/15/00 PRODUCTS - COMP/OP AGG s600, 000 CLAIMS MADE a OCCUR / / EACH OCCURRENCE $ AGGREGATE $ $ PERSONAL & ADV INJURY s300, 000 . WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL 6ZSUB-504X492-5-99 OWNER'S & CONTRACTOR'S PROT 03/27/00 WC STATU- OTH TORY LIMITS I I ER EL EACH ACCIDENT $100,000. EACH OCCURRENCE s300, 000 . FIRE DAMAGE (Any one fire) $100, 000 . OTHER MED EXP (Any one person) $ 5, 000 . AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Town of Reading Attn: Glen Redman, Bldg. Inspector 16 Lowell Street Reading MA 01867 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATI ,P0 GARAGE LIABILITY ANY AUTO / / / / AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM / / / / EACH OCCURRENCE $ AGGREGATE $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL 6ZSUB-504X492-5-99 03/27/99 03/27/00 WC STATU- OTH TORY LIMITS I I ER EL EACH ACCIDENT $100,000. EL DISEASE - POLICY LIMIT $ 5 0 0 , 0 0 0 . EL DISEASE - EA EMPLOYEE S100, 000. OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Town of Reading Attn: Glen Redman, Bldg. Inspector 16 Lowell Street Reading MA 01867 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATI ,P0 CD m m VJ m cn 0 m C � s =. O CD P-4. Z y 0 CL r �� c C = O 0 0 CD CD CL 2C c 1 5 CD CD O CD C CDco y. a O N O I CD CD COI) O CD Z O O .0-I. o CDCD • I. rCD D O Z O W O U2 O C to CD 0 N C O d N N CD a c?moo = Q N ao�o VJ CD O m c7 CO, m d = D DM CD CL m _i O m N O0 fn _' m 0 n O N m O .n► O o L. n j O N n O_ .o a CO) D = 3 MC. a=.�:A o =r :� !e m . N 'N d N d W G WOjCD N C4 0 N . . . CD o c C0 . COo v O CD CD: CD a) jo O m 0 O o : I . 0 c o o=: � 0 7 G G G O w y wG c ti p x r, z n z G7 G O �L y cn z 0 �© r FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ********************r*********AP'PPLICANT FILLS OUT THIS SECTION************** ** 1C ********* APPLICANT /� C ear V� a % S0 11 PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET 3 � S C� -eS �,,L ST. NUMBER OFFICIAL USE ONLY ***** R D 1, OF T_O GENTS: CO SERVATI A MINISTRATOR DATE APPROVED DATE REJECTED COMMENTS Lt. . �,�� �i AMA-- i Vl lyl. 10DAI2Go -f� h5t 6, 1, W) LlAr TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm OR. 24. LQ 3:06PMN0. 7147:,:>: P. 2. 0002 04/15/02 MON 11:54 FAX 978 356 5488 Ipswich Bank — Ra No.11P813116 Pape #11 � PLAT MAP '-�-- -- ..- Bortower/Client �,, fe 7A 7�� Flta No. lIPs13118 Address City &BM-AM20YEg_ __— 004W ESSEX —_,_ „ Shale MA_ 4p Code Lender/Client_ - MORTG'AG)E PLOT PLAN EK SURVEY INC. , .Q �p (�^,�-��_�,.I/ ■✓� epi %.� AGOR �iw we sem.++' ��,il� i1 Ci - ` ,ry pol Ii�$S pF PRINCIPLE 851WINO PLAN REF. � Y•= — DAM OF INSPE0116 . itt_ 7 M f� lo3,9 � 1 v M- a �p z, CP o yj2- 21"Nvr 4,54r 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: Building Commissionerfl or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 3� E C h Psf��— 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zonin District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private 0 Zone Outside Flood Zone ❑ 1.6 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT stut it; Minn Yes N o 2.1 Owner of Recor / 1 i ar 36 S CA -e9&, S , Name (Print) Address for Service: SignatureTelephone :± OL, ° ? S 02 " s 2.2 Owner of Record: Name Print Address for Service: Signature Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed qonstruct on Supervisor: 'CKCir q 'sor: Licensed Construction SupeTnui �V'w w AS °�- Add ess „�-o �., a s - sr Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone T M X ic e z O ii z M 0 Mn r M r r o® A SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 6 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 check all a livable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Mew S SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant QIkICIAI jiE p;y . 1. Building © �a 0 ( (a) Budding 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 1, 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 1, 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/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS in 2 ND3RD SPAN DIMENSIONS OF SII LS DM ENSIONS 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 NATURAL GAS LINE rn O (J 0) O 4f m C 0D (D 0) O W O O G7 0 CO) p N a m CD Q a N Q. (p X iD co N m — The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: r C Q V -:� 0. V) So Location: 3 � S C eo v�j City N 0 7"L -A U eV Phone # q l 9 c2 Fq 6 I am a homeowner performing all work myself. F7 I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance. Co. Policv # Company name: Address City: Phone # Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition d criminal penalties d•a fine up to s1,5w.00 andlor one years' imprisonment_as vae.as.cb i.penaklmjo ft io>m d a sT0P WDRK ORDERsnd.a fne .d.(31QO.OD)-aiday.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 cerW under t/re pains and penafBes of perjury that the information provided above is true and coMO, Print name r [ I Z t~ Lv VI v a-vt g o ,r, Official use only I do not write in this area to be completed by city or town official' City or Town PermitilLicensino ❑ Building Dept ❑Check I immediate response is required ❑ Licensing Boafd ❑ Selectman's Office Contact person: Phone # ❑ Health Department ❑ Other l�.vooagv rage 1 ut 1 McGuire, Mike From: Tryder, Steve [Steve.Tryder@valueoptions.com] Sent: Wednesday, October 20, 200410:23 AM To:'mmcguire@townofnorthandover.com' Subject: Problems with Duval Roofing Hi Mike - You may remember that I stopped by last week and spoke to you about the horrible job Duval Roofing of North Reading did on my roof. I hired a home inspector/roofing contractor team to look at the roof. I am attaching a list of all the problems. We will have to have the whole job done over. If there's any way you can prevent other North Andover residents from going through what I did, feel free to use my name and phone # and post this if possible. I am also filing complaints with the AG and the State Board of Building Regulations and Standards as you suggested. Thanks for your advice, Steve Tryder i 386 Chestnut St. N. Andover, MA 01845 978-685-2249 ***,k*****,k*mks►skit******,k,E*Mk***k**k***,F*,Ht***«..***1►,k******k kF***,k*,kk,F** This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the sender by email, delete and destroy this message and its attachments. 10/20/04 List of Grievances: 386 Chestnut Street North Andover 8/30/04 Contractor: Duval Roofing, North Reading MA • GAF Timberline 40 yr. architectural shingles not installed to manufacturer's specification over the entire roof. Shingles are all overlapping rather than butted end to end. Shingles not nailed in compliance with Building Code requirements. The shingles are not sealing and the roof has an overall bumpy and sloppy appearance. • Poorly cut and broken shingles on all roof edges. • Exposed drip edge and exposed sealing strips. • Exposed nails on shingles. • All the eaves have shingles hanging too far over the edge, without underlayment and not aligned in straight line. • All the rake edges are jagged and sticking out over the drip line. • Drip edge over garage not installed properly, creating curve at end of roof. • Exposed flashing. • Missing shingles, damaged and broken shingles. • Did not properly shingle valley area where roof lines join together. • Ridge vents are not GAF Cobra as stated in contract, are 20 year instead of 40 year shingles, and are installed unevenly. • Did not replace rotted rake boards on 2 front window gables as agreed at time of estimate. • Broke a (60 X 30) casement window. • Scratched glass on two other (60 X 30) casement windows. • Many nails left around house and on lawn that were supposed to be cleaned up. Debris thrown into trees and left there. • Overall shoddy and unprofessional workmanship. • Ken Duval did not show up on the job site to supervise the work, as he assured me he would, at the time he provided the estimate. " I always work on the job with my men". This was my main stated requirement for choosing a contractor. Assigned foreman left the job for most of the afternoon. The laborers/roofers did not speak much, if any, English. •" Duval Roofing is not a GAF Master Elite Certified Contractor as stated in