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HomeMy WebLinkAboutMiscellaneous - 4 OAK AVENUE 4/30/2018/ 4 OAK AVENUE 210/059.0-0043-0000.0 i Location Al OA A ✓ "y— b r� tr No. fZ48 Date NORTH TOWN OF NORTH ANDOVER 3? . O0 # ; . Certificate of Occupancy $ ACK t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t7 qqj Check # �0 . A s � 73G ._� v IV ( 6L, Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. �6 DATE ISSUED. ic SIGNATURE: Building Commissionerfl for of Buildings Date Z SECTION I-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 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 Required Provided R red Provided v 1.7 Water Supply M.G.LC.40. 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 iistu"iG iS CICt: Yes NO M 2.. r1 Owner of Record LL-yy// I SG ��a 1`/ Aeyv4 Name(Print) Address for Service: I Signator ALL"— Te one � 2.2 Owner of Rec rd: N enPnt Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 censed Construction SSup_ervisor: j Not Applicable ❑ yVsktc Licensed struction Supe sor: �.� �f O d / S S�✓ License Number Wn Address At > 6(�' ,, / ) p ^ I t 2 -P l� �A.Dd ei` Expiration Date �(� Mne Telephone r 3.2 Re red Home Improvement Contractor Not Applicable ❑ v Company.Name f �! y c M 1 �n 6 Registration Number N� 19/ll��'y L��: 1 A Ad s t z( Expiration D to V ^� Telephone V f 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 check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be - OFFICIALUSEUNLY Completed by permit applicant 1. Buildingj �� e-0,10-00 (a) Building Permit Fee Multiplier 2 Electrical Q 0/0 (b) Estimated Total Cost of ®0D Construction 3 Plumbing Building Permit fee tel X M4 Mechanical HVA /J 7 —� 5 Fire Protection 6 Total 1+2+3+4+5 o Check Number SECTION 7a OWNERAMORIZATION 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 Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T vfl3ERS iST 2 ND 3 RD SPAN DMIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlVINEY IS BUILDING ON SOLID OR FILLED LAND t IS BUILDING CONNECTED TO NATURAL GAS LINE u a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 7n'G�M S�lb 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 I am an employer providing workers' compensation for my employees working on this job. tn Company name: �^ '�SS's fL. U r- 1-1 CZ /A/C Address r p City_-- )Q A A D10 U r. M Phone#: �/ �h 6,R Insurance Co. G- r% 17-c– S i .T'C t tis, Policy# W C :29,-,? 9 z OL/ Company name: Address City: Phone#: Insurance Co. l 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_well_as_civil.penaltiesin-theform-of-a_STOP WORK.ORDER..and_a.fine-of.(.$1DO.DA)_arlay 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date d -- Print name Q (j Phone 9,6 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing I] Building Dept ❑Check if immediate response is required E] Licensing Board r-1 Selectman's Office Contact person: Phone#: Health Department Other 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 c 11, S 150 A. The debris will be disposed of in: U JA f)SE b C o s (Location of Facility) �-&glture of Fkerniit Applicant ,d9 104- 'E/a t NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR r Number: CS 022988 S Birthdate: 10/31/1943 Expires: 10/31/2005 Tr.no: 6077 ii Restricted: 00 �! JOHN GRASSO 865 TURNPIKE ST NO ANDOVER, MA 01845 Administrator j a ✓yte 'C00'rI7/I77,ryI2CUEQAA/2 O�il�Gaadac�iccJef,�6 . Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 113130 Expiration: 5/18/2005 Type: Private Corporation GRASSO CONSTRUCTION CO., I I ZHN GRASSO j 865 TURNPIKE ST N.ANDOVER,MA 01845 Administrator s 1 NORTH Town of Andover No. 7yR v flhi 7 C% '-A K 6 0 dover, Mass., COCHICHEWICK ATED P? C7 ST BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT............ ............CO-e-4...VA ... ...CrlfA.P.So........co A0 BUILDING INSPECTOR /4 ............................ Foundation has permission to erect .............. buildings an..... ....................................... Rough .S I A-0-** to be occupied as..!.......................7.1....... ........ .................................................... Chimney .... .. .... ... ..... provided that the person acceptifl'g 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 17 B'- s La relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. s-11ya PLUMBING INSPECTOR s / VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR Rough A,.......... ........ ..... . ... .>....'* Service.. . ... 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 DEPARTMENT Until Inspected and.,Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location � �,4/` 14C'6, No. 1`71 Date MaRT� TOWN OF NORTH ANDOVER F e A • ; : Certificate of Occupancy $ ACMUS Building/Frame Permit Fee $ 5 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ I S D Check #15 U D� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ;11to seco >a for QPfIciaT Use 410 - M BUILDING PERMIT NUMBER. DATE ISSUED: p, ic SIGNATURE: G � Building Commissioner/1for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: -� 2!�- 41 Map Number Parcel Number 1.3 Zoning Information: `0 ` l 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided R aired Provided v 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ _J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record (4 6N Name(Print) Address for Service: N1< J�_ Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number mn Address D Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name m Registration Number Address r Z Expiration Date Q Signature Telephone Y� 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 Descri tion 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: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee r (/V U 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 I, as 0 er/Au orized 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 Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST 2ND 3FD SPAN DIMENSIONS OF SILLS DIMENSIONS 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 Town of North Andover :t Building Department 27 Charles Street North Andover, MA. 0184.5 D. Robert Nicetta -4 =::.._ �• . .Building Commissioner . � �'46FHJ5 Shy (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPT,() Please print DATE IOB LOCATION Number Street Address Map/lot 4 fOMEOWNER Name � Home Phone V I I•'I I Work Phone ESENT MAILING ADDRESS City Town State Zip Code The current exemption for-homeowners"was extended to include owner of tvHo units or less and.to allow such homegwners to engage individ -mcu�ed dwellings not possess a license,.provided that the owner acts as n ualforhire who does. Pervisor. (State Budding Code�� 1'08.3.5_-t l DEF)NITION OF HOMEWOWNER= Person(s)who owns a parcel of land on which he/she resides or intends to reside. on which there is, or is intended to be a one or two cesso y to such use and/or farm S&Uc res.A dwelling attached or detached shXtur . Person who co es ac- two year Period shall not be'considered a hoirieawnere one,home in a The undersigned"hom owner"assumes responsibility for co Applicable codes, by-laws. rules and regulations, mP�nce with the State Building Code and other The undersigned "homeowner"certifies that h(Vshe and Building Depaftentminirnum inspection understands the Town of No Andover P procedures and requirements and that he/she will ' empty with said procedures and requirements_ HOMEOWNER'S SIGNATURE 'PROVAL OF BUILDING OFFICIAL 4 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 will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NQRT►y Town of A ; ' Andover LA� HiccQdower, Mass. co� rrEwl � f �d QDRATED P? C5 S 4 BOARD OF HEALTH PERMIT T, D Food/Kitchen Septic System �I BUILDING INSPECTOR THIS CERTIFIES THAT..... ._...1.�'N...............s.. ►.......r. ....................................................................... Foundation has permission to emt..../.IV +c^ /0/'"buildings on . ... ,.,,,,,, ,. ,... Rough to be occupied as7 0NI .S / /j� y . . . ...................46................................. .................................................................. mne 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 r lating to the action, Alteration and Construction of Buildings in the Town of North Andover. s q/y3 In sm- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR Rough ......... ........ .................................. ..... ...... .......... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finalh No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. 4258 Date.......`.....�/......a........ t NOR7M TOWN OF NORTH ANDOVER f PERMIT FOR WIRING �,SSACMUS� This certifies that ................................ ......y -........................................... has permission to perform ... :.:. ................................................................. wiring in the building of....:.....:-... ..'. ......................... .................................... , at.../...!..:.............:::.............................................. ,North Andover,Mass. Fee....... ............. Lic.No..-.../7- ............... ELEcrRICALINSPECTOR Check # Z,— M THECOMMOATHE LTHOFMAS 4CHUSETTS Office Use only ' DEPARTIVIENTOFPUXJ'CSAFETY BOARDOFFIREPREVzmoNREGUTA770NS527C�IIZl2.W Permit No. / Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date_ Town of North Andover The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location (Street&Number) .�/ a K Q Owner or Tenant Ktqzem G T Owner's Address_ -y O A jk:� zq V Is this permit in conjunction with a building permit: YeSE71 No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ./00 Amps�,R0 Volts Overhead Under Underground S�• No. of Meters New Service Amps/ Volts Overhead Under round No.of Meters g Number of Feeders and Ampacity --� Location and Nature of Proposed Electrical Work Lt)/dL 1p 9(3 O m -T1- 1 /V Ct;L C SAM U / euSC No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures Swimming Pool Above BelowKVA Generators KVA round No.of Receptacle Outlets round �O No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch / No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS Tons No.of Zones No.of Disposals / No.of Heat Total Total No.of Detection and No.of Dishwashers Pumps Tons KW Initiating Devices Space Area Heating Key No.of Sounding Devices No.of Self Contained _ lVo.of Dryers Detection/Sounding Devices Heating Devices KW Local Municipal Other ---� VNo.of o.of Water Heaters KW No.of Connections El Jo.Hydro Massage Tubs Si ns BailasisNo.of Motors Total HP [TIER O�✓7-' C S(iJ I -rC S 4 / C//rS- &q i/4e-02M j9 Al C u A N 6E- too AMP . PRO► EC. , ttanoeCovt�P►1�t�dletagtritar�aysofMassitdxlsei�GenaalLaws matma2dva dproo ofsai iDthmf50-_ ES COwrWcritsMbWctWegttivadat[ YES t�estltxntlmdvalidptoofofsameA�theOffice YES NO icingthe box ED g-Au hawdrdmd YES,Plemindr&thetypeofcowr-W by URANCEE BOND OTHER (P1easeSpec&y) EVha6MD& kto StattEMmabd Vakieof 3xfiigd Wotk$ hpeCfi xlunda•MieRnalliesofpffiw- DateRewes&ed Rough Fsral 4NAME LiXMNo. E- N C/S �� 'T ^IQ Signature LrmseNo R if C) S�Y� CIYEl,SEA yy> B Te1No- � � a 8 a� �o ' � S` Oaf/JO �°O . �/� /S� 0 y�'� IER SINS'URANCEWARIER,IamawatethattheLic� A1tTel No License valetas atmysiglahueonthispermitapphcationwaivesftrequken-ot mqbyMa%whtscZC>enedLa%s se check one) Owner Agent 71 .rte Telephone No. 96� Igna ure o caner or gen PERMIT'FEE$ 1' u W The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 e Workers'Compensation Insurance Affidavit Name Please Print Name: V/ C f 5 .Z&Q / Al Q iz rte. Location: y 9 -T;� -P City1c & V E z / 14�-S Phone # aI am a homeowner performing all work myself. 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. Policy# Company name: Address City: Phone# Insurance Co. Polligy# 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$1,5oo.00 agd/or one years'imprisonment.as_well_as.civil.penaltiesinthefnrmnf-a_STOP.WORK_ORDFR,and.a.fine.of.($1DOM)-ariay.againstme. I understand that a copy of this statement may be fo arded to the Office of Investigations of the DIA for coverage verification. l da hereby certify under the sins d penalties perjury at the Drina ' provided above k true and correct. Signature ^ Date Print name d A(C - U-) ( A t Phone,# ,Fl Y,6 �a Official use only do not write in this area to be completed by city or town official' City or Town PermWILicensing � ❑Check if immediate response is required Building Dept 0 Licensing Board E] Selectman's Office Contact person: Phone#: F1 Health Department (] Other i Building Inspector Town of North Andover April 29, 2003 Dear Inspector MacGuire We are writing because we are very concerned about the status of the building project at 4 Oak Ave. For the past month,we have seen no sign of the owners or of any contractors, and it appears that the project and the property have been abandoned. 4 weeks ago we put a note on the door requesting that the owner ask his contractors to take better care of the yard and how they dispose of building trash. The note disappeared, but the yard remains a mess--rotting building materials and supplies are strewn around, including siding, bits of insulation, lumber, and masonry materials. On windy days some of these end up blowing around the street and our yards. We're not sure what recourse we have as neighbors, but we wonder if you've had an opportunity to inspect the progress of the work. Last year we were excited about the prospect of a new owner improving the property at 4 Oak Ave,but from what we can discern,4 Oak Ave is in much worse shape than it was before work started. We just want to make sure the lot isn't a hazard to our neighborhood. Thanks for your attention to this matter, The residents of Oak Avenue I L 1,1,11 (0CVUrr a pen Mit P�ll��) he 5-41a . Ja��a3 cjPok� w1r � I Saha avtr `Fa A S {,A Gu y,ei-- r- 71v,v f /).e �/yy Ike �rOPvi JY W/1$ Jet �r Q .e,r KS '�.0 pr<OSec`f h.e Sfa'/y� N•e I&A y.r,.ei^,c ury�, .,, y�.,.e PkS'f Z W �- e/•clti+-� / F vA dv � �vrri Rev,s,+ 7�+� s;fie ; d A Y C s-zn-a a) aL c4(r M u. 5 v�� Au,-P,- RECEIVE D APR 2 9 2003 9A t-� 66r)V U o-k �,,A-- BUILDING DEPT, 6AK AW) 0 E Location q �� K ki No. 300 Date 1-2 2 _U NORTH TOWN OF NORTH ANDOVER O:i . o .�11•C F? •. • `9 Aw - ' Certificate of Occupancy $ cNus Building/Frame Permit Fee $ sw Foundation Permit Fee $ a Other Permit Fee $ _ TOTAL $ Check # �/f S 16 -U40 ' Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING PIOSOC"for Offkw--Uk 010 ; BUILDING PERMIT NUMBER. 5©oDATE ISSUED: T X ic SIGNATURE: C� Building Commissioner/Ing=tor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: y L/ I U� 'C �� r , d Map Number Parcel Number 1.3 Zoning hrformation: 1.4 Property Dimensions: (�A V Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 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 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service K P---- Signature Telephone (� 2.2 Owner of Record: Name Print Address for Service: 0 Z rn Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Collstruction Supervisor: O License Number Address D Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name rn Registration Number r Address r Z Expiration Date /1 Signature Telephone Y� ,/t 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 building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building 0 Repair(s) 11 Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFiCIALUSE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee CI(!v Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(s)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 I, <asa0cr/A?qorized 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 n Signature of 0e/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVIBERS 1 ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 11EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f %AORT#1 q pet±itD of ti0 Town of North Andover Building Department 27 Charles Street �SSACHUSE` North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. i DATEZ- JOB LOCATION .:!' a(A /C A// ✓� �D J✓�' � P'` Number Street Address Section of Town "HOMEOWNER ((1 )7"11 L( uJ6 7/� 9y 1 71 G 0 Number Home Phone Work Phone PRESENT MAILING ADDRESS V City Town tate Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and req�u/irements. HOMEOWNER'S SIGNATURE 1� APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. s 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 will be disposed of in: (Location of Facility) Signatur0bT Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector r1pRTly ® o 6Andover 0 No. 3.00 _ der, Mass. O cocriicH i � ov � , ADRATED p'P�G\,��� S G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.......ka.26.1� BUILDING INSPECTOR ..M............... ` e� .... ................................................................ Foundation has permission to erect.....1 1 � .a.�1....... buildings on ......4........v 44..K...... .V, I i..................... Rough to be occuied as... pi �p W tv Ow 00�� , Chimney ........... �. provided that the person accepting this permistdit sha I 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 relatingto the In action, Alteration and Construction of Buildings in the Town of North Andover. Cjg 01 /4 %6%61 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Perma Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR 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 Street No. } SEE REVERSE SIDE Smoke Det. Location 4 CAtc. �Yt� ` �!Zv g No. Date e 40R71y , TOWN OF NORTH ANDOVER p t: V7,90 pL p Certificate of Occupancy $ Building/Frame Permit Fee $ ssACNUSE�� Foundation Permi Fee $ i Other Permit Fe $ ZJ ` 1. Sewer Connection Fee $ Water Connection Fee $ i' TOTAL $ r t � Building Inspector -9. 25.40 PAID 875 Div. Public Works PERA11T NO. 42� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP ;DATEBOOK ;PAGE ZONE I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING ^ 1 �+ OWNER'S NAME NO. OF STORIES SIZE T- OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME V6�LAZ 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 ol IS BUILDING ALTERATION. 5 rl�o� 1,-004.- v`,LC IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE V 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 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST :37.an PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED ftw-0-- I - 'T� BUILD INSPKCTOR SIGNATURE-OF OWNER ORA TH ED AGENT F E E OWNER TEL.# PERMIT GRANTED I'al-2-Q CONTR.TEL.# 19 CONTR.LIC.# 1 n, A H.I.C.# L"► T�r. BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I_ STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION r 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY MALL _ UNFIN. 3 BASEMENT il AREA FULL FIN. BM'T AREA _ '/ '/2 1/1 FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDIN D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR II POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) , GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &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 _ ELECTRIC 1st 13rd NO HEATING ORT Town of s - over Nom-. < <� o = r: o port dover, Mass., LJ& 2n 1 y1ic COLI/IC C"L L WICK AOR e o PPS\ �� BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THISCERTIFIES THAT.. .... Q: �............................................................................................................ Foundation has permission to .,............... buildings on ... ..... ....AYE.,................................................. Rough to be occupied as`a�,. ..... . .... . . ! !........� ......L ... �.. Chimney provided that the person a-ccep ing 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 Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final L 4 !'"YTERMIT EXP =IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS T - - -- Rough ........... Service BUILDING INS CTOR 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 DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEW, ER FINAL DRIVEWAY ENTRY PERMIT 7� The Commonwealth of Afassachuserts - - Department of lndun:rial Accidents 5 �dl�f'�atllars 600 Washington Street Boston,.Nass. 02111 Workers' Compensation Insurance Afridavit riam e �4 O N Inr Bien: 'e, A I I11J ►�^ -7 / �5 f ^none �iC/ 7, 1 am a homeowner renorming all work musellf I am a sole proprietor and have no one works nz in ani capaciry G t am an emotover zroviding workers' comnensanon for my e=viovees working on this job. - address' city shone insurance co poliev I am a sole proprietor general contractor• or homeowner one) and have hired•u.e contractors listed below who have e foilowing workers' compensation polices: company name- address: amity• shone dr insurance co. it comnanv name* — address. ciry phone d.. insurance-co. noEiev'#' '�es'33ons ee necessary Failure to secure coverage as required under Section—'4A of-NIGL 1:5--can leza to the imposition of criminal penalties of a tine up to SI-400.00 and/or one years'imprisonment as well as civil penalties in the fora of s STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement may be rorwarded to the Ofrice of Investigscioms of the DIA for coverage verification. 1 do herebv certify under thains and n ties of per,-urs sh=:he Ln1lornsationt provided above is true and correct eVj Signature 4 Date t ` ^ Print name e vQ� P'sone# Afotfieial use only do not write in this area to be completed by city or awu official city or town: persit/lieease 4 _Building Department [Licensing Board C check if immediate response is required CSelettmen's Ogee [Health Department contact person- psoee.!; r^Other (n,-W Los Ptw) t • w *" LEE MALKAVANAUGH --- PELDR HAM NH 03076 • 05:p� 49 05KHL49031 . =i i IIC� RATOR{' 5.1993 'L OPERAT 1�3- �� �tP ('Glit)lf6HlUCQ�I/t.C��`�C�1C�fRlGS<'�1 ( �s HOME IMPROVEMENT CONTRACTOR! =? Registration 119745 Type - INDIVIDUAL Expiration 08/23/97 t LEE F KAVANAUGH _ LEE F. KAVANAUGH 10 MAPLE DR ac"AINiSTRATCR PELHAM NH 03076 OFFICES OF: °� "' Town of 120 Main Street NORTH ANDOVER North Andover, APPEALS '' Massachusetts O l 845 BUILDING CONSERVATION DIVISION OF HEALTH - PLANNING PLANNING & COWNIUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR r In accordance with the proviSiC.^.5 Of titGL c 10, S Ss, a condition of BuiIding Permit Number g > — '-'-j is that the debris resulting from this work shall be disposed of in a properiv licensed solid waste disposal facility as defined by MGL c 111, S 156A- The debris will be disposed of in: (Location of Faciiity) Signature of snit Applicant A., 01 .s/ ate :TOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. PROPOSALUM ONE N PROPOSAL NO. . f .. nrl SHEET NO. N ra DATE INSURE! EXPERIENCE -700 MUCH PROPOSAL SUBMITTED TO: 693-S9P9-0056 PELHAM,Nn WORK TO BE PERFORMED AT: j J NAME ADDRESS i �reel AL- ADDRESS a fV- ,��JJ DATE OF PLANS Ale, 151 J PHONE NO. � ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of I I r e. Y as •/ yric i r .o ' All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and scfi-f,� cations submitted for above work and completed in a substantial workmanlike manner for the sum of —� -- s '�Cbnllars ($ with payrrfents to be made as follows. Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order,and will become an extra charge Per over and above the estimate. All agreements contingent upon stnkes, ac- cidents,or delays beyond our control. Note—This proposal may be withdrawn by us if not accepted within2=days.. ..ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date Signature -X2_- NC 3818-50Proposal MADE M USA `f ... - PROPOSAL o ONES Al _ PROPOSAL NO. . / SHEET NO. F +1 ,� rim 3� la- n f CJ� ra DATE ` INS,.W, 0.21W4fi E 207 MUCH 7 PROPOSAL SUBMITTED TO: 603-i)i.u0S6 -IEIHAM. Nm WORK TO BE PERFORMED AT: N AME "'ADDRESS Aa { r► ,��� ADDRESS c l ca �� DATE OF PLANS 410, PHONE N , .-- ARCHITECT J t ; Y C;'Y We hereby propose to furnish the materials and perform the labor necessary for the completion of t - v .PZ 5x - 114 - ✓ ` 17 — All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings qnd specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of -+It I?. o ..iGDollars ($ with payments to be made as foftows. U`l.. / 4 Respectfully submitted Any alteration or deviation from above specifications involving extra costs J –� will be executed only upon written order-and will become an extra charge- Per over and above the estimate. All agreements contingent upon stnkes.ac- cidents,or delays beyond our control. Note–This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF.PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date Signature 'M Ada— NC 33.3-SO Proposal MADE N USA TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� This certifies that ...: .. . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . at . . . f!. .�. -'.�`"Z. . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee, . . . . . . .Lic. No.. . . . . . . . . . - . . -:` `.?. . . . . . . . . . PLUMBING INS�EF CTOR Check # G 5422 I 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS j v Z —ri L �k �J� �� -f� �' Date Building Location G Owners Name Permit# Amount Type of Occupancy New Renovation Replacement 1:1 Plans Submitted Yes No FIXTURES d Cn Cn H a� F ALn C �+ x 04 M x as SW-FRME lASEMEvr R IMM 4M KCM 5M HfM _ sMHj" 8M IMM L- (Print or type) Check one: Certificate f Installing Company Name �' / G Corp. Address ; �� tel/ Partner. v Business Telephone X 1� 64 ff-FiLCO. Name of Licensed Plumber: h Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policyElOther type of indemnity 11Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner El Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac setts State ing Code and Chapter 142 of the General Laws. 5 By: Signature or 1-icensea FlumBer Type of Plumbing License Title City/Town iceSe INUMD017 Master ❑ Journeyman APPROVED(OFECE USE ONLY x tU ViM H + - x �9 NCHU15 CERTIFICATE OF USE & OCCUPANCY ,TOWN OF NORTH ANDOVER Building Permit Number q` BDate `Y-off 3 y-0 �f THE BUILDING LOCATED ONTHIS CERTII�`IES THAT�( A ►� ,Q U MAY BE OCCUPIED AS 31^;' f E =,cl.+n �5( �Z� .•�-vc r2 Nes 1 .134 IN ACCORDANCE WITH THE pROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Building Inspector I NC17'T►'r own of And No. �y$ � T C'O _�-� l A K E O over, Mass., 6 � 9' o'?00 Co C MIC ME WICK �� RATED F' �� S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........../�..!�.&0 0.0 .......... .r ..s. .. ... ... .. .s t0....... 1 a 5........ """""' Foundation has permission to erect..... ..1401...I.............. buildings on ....." ...m. ....K......AV-L...................................... Rough" d��o N r .G� tobe occupied as... . .�....... ....... .. .......�. .. �►. v..r.....:.R.......i►.�...6.................................................... Chimney provided that the person acceptlIgnts 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-La relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. rSPECTORe �� �0 PLUMBING IN 1 VIOLATION of the Zoning or Building Regulations Voids this Permit. R&W1 G l Final PERMIT EXPIRES IN 6 MONTHS, ELECTRICAL INSP R UNLESS CONSTRUCTION STAR . ........... .... .... ...��......... . Service BUILDING INSPECTOR • Occupancy Permit Required to Occupy Building GAS INSPECTOR 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 O 0 • Street No. SEE REVERSE SIDE Smoke Det. NO`TFf � E . . - Tovm. o F over 11% qo dover, Mass, �`IRATED PPa\ �S G� 4 BOARD OF HEALTH e, Food/Kitchen • ;,�` Septic System PERM ,s �I BUILDING INSPECTOR ' THIS CERTIFIES THAT.....: ... ...!a�..' �.: �. .. . .......� �' 44,1 ................................ Foundation � ibr:u ft�s permission to e�eet....I./ ......... ,._ k.. actings on . .......... . ....................... ... ..... ...................... .... Rough #0 �'8occupied aS... M ... ,,... /..;,* .... ......................... ........ LTr�..�................. � mn y e provided that the person accepting Woermit shit,in every respee�;t Conform to the terms of the applic:.'; nai this office, and to the provisions of Abe Codes and By-Laws r latirig�to the Icy action, Alteration and Construction of Buildings in the Town of North Andiver. q/di fe PLUMBING INSPE#GfOR L/ VIOLATION of the Zoning or Building Regulations this ou PERMIT EXPOS L`,�•6i -`AONTHVi L 1S ma _/ \ UNLESS CONSTRUCTION ST TS � " TRICc § 4,, ou ............�.. ....... /...... Service t BUILDING INSPECTOR q/�A17fl - Fina Occupancy Permit Required. to Occu,� Maui,_r wl IT �lG�Ar S INSPEC V11 �✓� Display in a Conspicuous Place on thePremises — iso Not Remove Ph C/, 9_ - Y No Lathing or Dry.Wali 4� Be Done FIRE DEPARTMENTUntil Inspected and Approv d: by the Building Im�, 1-ctor . , E-;rner Street No. SEE REVERSE SIDE smoke Det. Date. . . . . !. . .. . . ! NORTH 3 TOWN OF NORTH ANDOVER O � A ' PERMIT FOR GAS INSTALLATION SACMUSEt i This certifies that . . . has permission for gas installation inthe b Udin s of !� � . . . . . . . . . . . . . . . . . . . . . . . at <.?:A�X . . . . . . . . . ., North Andover, Mass. Fee. .jt0 . Lic. Nol.�f,' . . . . . . . . . . . . . . . . . . . . . . . . . . 2 GAS INSPECTOR Check# 4770 MASSACHUSETIS UNIFORMAPPUCATONFO j rPERMIT TO DO GAS70vo (Type or print) j Date NORTH ANDOVER,MASSACHUSETTS Building Locations '/ o is`�� Permit# Amount$ Owner's Namer���SS T New❑ Renovation Replacement ❑ Plans Submitted ❑ w a W ^9� W O OU z O W e,' Ri 0 ] 0 z EW., W C z a p a z a a F. H 0 0 ° z z W ° a ow a U °x a ate. H o [8T B -BASEM ENT BASEMENT T. FLOOR D . F L O O R D . F L O O R H . FLOOR H . F L O O R H . FLOOR H . FLOOR H . FLOOR (Print or type). Check one: Certificate Installing Company NameOr�r�l.�\ �Ro�e rc 1�e`Z ❑ Corp. Address Ue v� �� ❑ Partner. l \2 t Business TelephoneFirm/Co. C� � Name of Licensed Plumber or Gas Fitter Q iJALk\ \�\rZQ\kh , .k1 COVERAGE Check o[INSURANCE have a current liability Insurance policy or it's substantial equivalent. Yes No❑ f you have checked des,please dicate the type coverage by checking the appropriate box.iability 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 . ❑ Agent p 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 insta io s performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach etts Gas Code and Chapter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitt r By: ❑ Plumber 6 Title ❑ Gas Fitter icense Number Master JOLlrneymaI] APPROVED(OFFICE USE ONLY) � City/Town • Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACHUSE� ,{ f 1 D This certifies that c. /1�� ` �L� has permission to perform . k h 01. .J. . . . . . . . . . . plumbing in�thee,builJdings of . . . . ._. . . .Gt 1 `)— l at . .�� / C-, �l. .Z�-�: . . . . . . . . .. North Andover, Mass. Fee. Lic. No..( (�J .�F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D PLUMBING INSPECTOR Check # 6 " 6J' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PL UMBIlV (Type or print) 1 NORTH ANDOVER,MASSACHUSETTSaVjtq y / Building Location ©1�1� C Owners Name Date `/ \ C�� Permit# Amount Type of Occupancy New Renovations Replacement Plans Submitted Yes No ❑ FIXTURES E~ sem» M>— zaFL" 3MHDM 4M sMFLOCIR 7MFWM sM11-OCIR (Print or type) � Check one: Installing Company Name j�(anlygt� C\iOV�SnC�nPSZ �,� my?,.[.� �pt�n [I Corp. Certificate Address Flpartner. \ 0 il 0 Business Telep one ElFirm/Co. Name of Licensed Plumber: i?n,J V14U\ 2 2!ZJQhC k tt Insurance Coverage: Indicate th type of insurance coverage by checkingthe appropriate box: ` Liability insurance policy Other type of indemnity Bond92 0 ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner F-1 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 . ns performed under Permit Issued for this application will be in compliance with all pertinent provisions of the as c State Plumbing Code and Chapter 142 of the General Laws. By: SignaEure or Licenseau r Title ! ���b Type of Plumbing License City/Town icense um er Master Journeyman APPROVED(OFFICE USE ONLY t Date... ..................... t NORTH 1 3:°.,�`'°.:•�."�0� TOWN OF NORTH ANDOVER PERMIT FOR WIRING •I.--,-`SSACMUSE� This certifies that ..................................C..�..e..../.......................... ......................... has permission to perform ..... ....`....P.`.e.P,4..t... ..................`... . .. .. ..... ..... wiring in the building of......� t.... S S v ......`....................................................................... at..........4......0!4.1.......ST............................. .North dover,Mass. Fee..YAT,!.......... Lic.No....3 5.�a6........... (.C,- �_ �© ELECTRICALI PECTOR Check # 5316 THE C0MM0N9E4LTH0FM4SS4CHUSE7TS , Office Use only DEPARDIENTOFPUBLICSAFEIY Permit No. BOARDOFFIREPREVE MONREGUTAHONS527CMRI2.VO C Occupancy&Fees Checked APPUCATTONFOR PERMIT TO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAUODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) f Date6�1__ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) b eqv n�, Owner or Tenant Owner's Address ` Is this permit in conjunction with a building permit: Yes[ZI No (Check Appropriate Box) Purpose of BuildingUtility Authorization No. Existing Service /00 Amps 1a�Volts Overhead Underground No.of Meters New Service Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW Np,of Sounding Devices Nok of,Self Contained Detiiction/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydrp Massage Tubs No.of Motors Total HP THER; A-< tc—SSPd �Ya►'�.S , T%✓i/,SlA rc)e-5ic.T r► c. ROU$h (Eiyroy2ro 6LV)d Device r I uanoeComYdge.Pwaianttodtemgmermysof Laws 11 1 aveaameniLiabltyltmo= bhcymch fingComple$E� Covaageoril atstanUop alert YES NO awsubmittedvalidproofofsametothe Offim YES IfyouhavedleclodYES,pleaseindicatethel)TOfcovtrageby g SURANCEE BOND r7 OTHER F1 (PleaseSpa*) EviratimDale Estirnated ValueofEkftical Wo>ic$ xktoStart ��,' -G kLTecionDa>eRapcsled Rough FffA nedmdcrTr esofpajury. :MNA1V>E — L P T�t e- • IiNo. - 6 0?6, msee sem✓ h 1_ n s�'c o C 1 e e S Signature LimwNo _/L - S 6,,;2(:-> Burn css Tel No. -7-70 hers/,lei►2c1-i H;LL IQ.> C, t ey'►, N14- 0*3n-7 9 1 Alt Tel No. HZ'S II`JS2JRANCE WAIVER;I am aware that the Lice does nothm-e the insurar=coverage orits substantial ecpmlent as regtlired byMassachuscts Galelal Laws that my signature on this pe mt application waives this wgmenrnL ,ase check one) Owner ® Agent Telephone No. PERMIT FEE$ Ignature of Owner or jen G The Commonwealth of Massachusetts . I d Department of Industrial Accidents Office of Investigations Boston; Mass. 02111 S�1b Workers'Compensation insurance Afdavit 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 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance Co. Policy# 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 of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment-as ve➢_as_civil.penaltiesin.fhelnrm of-a..STOPWORKORDFR..and_a.fine_of_(.$1DO.DD)-adayagainst.me. I (, understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. r 4. !do hereby certify under the pains and penalties of perjury that the infonnation provided above is true and correct Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept ❑Check if immediate response is required Licensing Board r-1 Selectman's Office Contact person: Phone#. ❑ Health Department Other i ���*�`� ���® 603-898-4089 WASTE FOOD 603-898-4089 F�1c 603-898-5599 � PR®��'SSI��i P�►I�� ✓��Ax 603-898-5599 PROCESSING PLANT / - ( 30 87 LOWELL ROAD. SALEM.NH 079 87 LOWELL ROAD / — . SALEM,NH 03079 _vv Date- 19 Date 19 To If;)JV To �� t�`—��?t)l— t 'y Address AddrAs�' n /✓G //- /c%�✓!�C. ��1���' DATE DESCRIPTION CHARGES CREDITS BALANCE DATE DESCRIPTION CHARGES CREDITS BALANCE 6L,g ss , -2 v � S Roly r ^G I I 3Vc :7 C .(c zz PAY LAST AMOUNT IN BALANCE COLUMN PAY LAST AMOUNT IN BALANCE COLUMN STATEMENT FIFF-0105 i STATEMENT VIPFarmv 101 WASTE WOOD 603-898-4089 �a�f B�p/� &� FAx 603-898-5599 AST Vlv"000 603-898-4085 PROCESSING PLANT 1 s ��� F(�' PROCESS!NG w;.A€�9� FAx boa-898-55sy 87 LOWELL ROAD. SALEM,NH 03079 U LOWELL ROAD, SALEM,NH 03079 Bate J 19-- +..- � D[efIV 2 19� To C_ To ✓ . Address Address " City Sovr�`,� t r�uc;� CiiPCF 0 DATE DESCRIPTION CHARGES CREDITS BALANCE DATE DESCRIPTION CHARGES CREDITS BALANCE S S =� d i - V r I J T,�s Cyd �� h �i PAY LAST AMOUNT IN BALANCE COLUMN PAY LAST AMOUNT IN BALANCE COLUMN STP'-,.TE PiPPv . STATEMENT PIPFwm•�D,