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Miscellaneous - 40 WENTWORTH AVENUE 4/30/2018
..+ Date . .iOAA .................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION j, This certifies tha .........�� G- has permission for gas Installation ..�� ...... ...�.......P`.�... t......... in the buildings of. ......../'6��.rJ.�.......................................... at ...... .... �' .. �`"!. `.......................... North Andover, Mass. Fee ...(ih.! ..... Lic. No.. 3 I x'... . .......................................................... /. GAS INSPECTOR Check # (P� 9574 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY .OMA DATE I 12014 PERMIT # 5 JOBSITE ADDRESS OWNER'S NAME GOWNER ADDRESS I Same TE IFAXI 71 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES Z FLOORS, BSM 1 2 3 4 5 6 7 8 1 9 10 11 12- 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Re lace 1 Gas Meters x and Associa ed Piping INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c pliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Marino LICENSE # 8736 SIGNATURE MP 0 MGF ❑ JP E]JGF ❑ LPGI ® CORPORATION Q# 3285C PARTN SHIP[ LLC ❑#� COMPANY NAME] RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 TEL508 832-3295 FAX 508-926-4347 I CELL 508-832-4614 EMAIL JMarino@RHWhite.com Al It �5� w H O z 0 H U W P. d � O GL a z ❑ z o d❑ } w � ~ w o o W W cn a a W W d cn o a a Q J H d d co Cd 2 W F- lL W z H U w a. c�7 0 a This certifies that ... 47.G? !-. `.. rl N . `"'..................... . d has permission to perform ....fl'C t:-. S), '&.4f .7.......... . plumbing in the buildings o >~. �. — ........................... at ... , North Andover, Mass. Fee #? ? Lic. No....rJ � . `. ?. y ..... 'r PLUMBING INSPECTOR Check # 6a, t' 66U6 5/' Date "pR'M TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that ... 47.G? !-. `.. rl N . `"'..................... . d has permission to perform ....fl'C t:-. S), '&.4f .7.......... . plumbing in the buildings o >~. �. — ........................... at ... , North Andover, Mass. Fee #? ? Lic. No....rJ � . `. ?. y ..... 'r PLUMBING INSPECTOR Check # 6a, t' 66U6 Zl. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS L1,9 / W c�+2 1� r Date %1131 S L _., Building Location ,% wC� T Owners Name �� U V NJir Permit # G Amount NV A/U t AX4-✓ /11/18l -r Type of Occupancy New Renovation Replacement Plans Submitted Yes No F FIXTURES (Print or type) f, Installing Company Name Check one: Certificate 11 Corp. 0 Partner. M-AIMI/Co. Name of Licensed Plumber. 0 4-0 10 0 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy MOther type of indemnity Bond LO 0 11 Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above thr nce Signature Owner Agent El 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 Mas=ettse Plue d Chapter 142 of the General Laws. By: SignaEUre or Licensea.NUMDer Type of Plumbing License Title 40 S—� City/ Town ricense TNum5erMaster ❑ Journeyman 121 APPROVED (OFFICE USE ONLY Date �,. c . ? ....... Of NORT/y Ail TOWN OF NORTH ANDOVER S 0 � A PERMIT FOR GAS INSTALLATION This certifies that . �!%%'"�'! S �`/ �?�....................... has permission for gas installation .. ! ..................... in the buildings of ..XP.' . ............................. . at ............... . North Andover, Mass. Fee.. v Lic. No. ... .. :... :.. ...... . ! GAS INSPECTOR < Check # e ! L } 5236 I MASSACHUSETTS UNIFORM APPUCATON FOR PERMPT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations (�(% !.J f yVT�,✓ 0 tiL I t4 ,S / Permit # •S� r Amount $ �1 u No, /f /.)) A)C4 , 44 2qfOwner's Name New RenovationElReplacement ® Plans Submitted ❑ (Print or type)Chec one: Certificate Installing Company Name— f2 V%/& Corp. Address oZ �� ❑ Partner. Business Telephone 7 e7 Firm/Co. Name of Licensed Plumber or Gas Fitter 1) 1 y cate the t coverage by checking the appropriate box. If you have chec a yes, p ease m ype ❑ Liability insurance policy Other type of indemnity ❑ Bond INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D No ❑ k d 1 ' d'i 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 ❑ 1 hereby certify that all of the aetaits ana tnrormauon i nava suvnnucu k.,. �.«.��� ■., u.,.,.. ��.Y••��•.�.. »•�»» » »»»» » » best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with ail pertinent provisions of the Massachu�etEs-S �e Gas CodeChapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber %/QS� Gas Fitter License Num0er ❑ Master ® Journeyman Location No. Date TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ w TOTAL $ d` Check # c;;D 18737.�-- %/--Building Inspeeter TONM OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,� ,. BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: 21fi—, Building Commissioner/I r of Buildings Date SECTION 1- SITE INFORMATION i�1.1 Property Address: 1.2 Map and Parcel Number: l0w®� /Assessors /� / V ��J `-' €" Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: f�7 Zoning District Proposed Use IeaFrarta� 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Rapired Provide Required Provided Re4pired Provided 1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 qwner of Record 4 k, mi"t-"n"t ven)m Name (Print) Address for Service Signature Telephone 2.2pwner of Record: Nsame Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction r. / Superviso��r>< t ^ -f Supervisor: _ License Numr .. ._. I Address Expiration Date Signature Telephone 3.2 Registergd lflom jet Improvement C/ ontractor Not Applicable ❑ Company Name 'I Registration Number ` It Address Expiration Date Signature Telephone 00 M X z O rn z M O r M Z G) SECTION 4 - WORKERS COMPENSATION (XG.L C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 7ddition 9 - Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Pr posed Work: U i 4 cc 5 yi lu T015A41l dVV- PQ 4 0 d 06'r AJ I rlo d1 �hySWt�� �(� acv 6 ra4e, 'DeG� `�<< X x,16 r SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant 1. Building ;—C) ` 00 15,10 "P" OFi+' CIA111 w... (a) Building Permit Fee Multi lier SE0.ONLY P� 2 Electrical 400,00 (b) Estimated Total Cost of Construction 3 Plumbing L 3-773 � O 0 Building Permit fee (a) X (b) �0. '5J 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 s - Check Number SECTION 7a OWNER AUTHORIZATIOK 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 1, k a CA- G u I,Pn f to ,as G�/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 'ba(14 Print Name Signature of Comer/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS - A 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS X DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING U 1 DU 4' ✓� X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE W ;04 4. O Poo I � JER � W U a a a a ' I� •'i.. .1 J I rIFCl"�� O r�• Q %N C � C �1 O C� OW C vV •C CL C O A C =o o C3 Ce Ea r0+ C O O � Q E Go o� cm mC.+ E to sV L m m it y y 0 3 NJ cm m y zip _ .0 y y C C O O NJ rC , CLU m N m co .00 C y Q C3 'a Z o o oCD a C 'C ism CL N H WCOD r.+ O = m D W O fir.. C=.. •� H .y CLSO C = W .E U o .y O ci m O O CIO CLCO2 d 00 O� Z40 Z e O P- m s CLI m �. f i�I .T 2 0 O E � L O CL O CO) 0 C cm I O a O O 'E m m CD 0 3� CL as � 0 0 L cc CD CL C Q ca 0= C O CL 0 V �'p ca 0 CL C Z � U y O C C C c y LU LLI Y/ W W W U) W U a a a a r�• m � w r�4 u a w aG w rx rL. c� cn E cn C � C �1 O C� OW C vV •C CL C O A C =o o C3 Ce Ea r0+ C O O � Q E Go o� cm mC.+ E to sV L m m it y y 0 3 NJ cm m y zip _ .0 y y C C O O NJ rC , CLU m N m co .00 C y Q C3 'a Z o o oCD a C 'C ism CL N H WCOD r.+ O = m D W O fir.. C=.. •� H .y CLSO C = W .E U o .y O ci m O O CIO CLCO2 d 00 O� Z40 Z e O P- m s CLI m �. f i�I .T 2 0 O E � L O CL O CO) 0 C cm I O a O O 'E m m CD 0 3� CL as � 0 0 L cc CD CL C Q ca 0= C O CL 0 V �'p ca 0 CL C Z � U y O C C C c y LU LLI Y/ W W W U) 1:ZZ, 60 ... � . �,, 1\ :i�, � x a'd A The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 *N.,www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: Y���(�iL City/State/Zip: AjWd olf, ' W*,45 W96-- Phone # Are you an employer? Check the appropriate box: 1. ❑ I am a employer with `3 4. ❑ I am a general contractor and employees (full and/or part-ti►ne).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required) 6.ElNew construction 7. E]'femodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # I must also till out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ,Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I um an employer that is providing workers' compensation insurance for my employees. Below is the policy rind job site information. 4i, G Insurance Company Name: Policy # or Self -ins. Lic. #: J 7C1_ Expirati n Date:_115 d10 �iy/Stlate, vim. Job Site Address: /Zip: t • v-[ -_2�2 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under a pains and penalties of perjury that the information provider/ above is true and correct Signature: Date: U /e Phone #: Y_ 6(l � Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be dee►ned to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to till in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to- the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia 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 at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL ,;11,S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: U4 -c? c;:79(vm �/fi (Location of Facility) ignature of Permit Applicant Fire Department Sign off"- art" Dumpster Permit &�- oc)5- Date DG CONTRACTING INC. Kitchens, Baths, Additions, Home repairs, Finished basements, Decks, Excavation work David Gulezian President 428 Pleasant Street, North Andover, Ma. 01845 OFFICE; (978) 689-4797 HOME; (978) 683-0397 FAX; (978) 686-6337 MA LIC # 001821 INSURED Home Imp # 120199 Installer of Sportcourts October 2, 2005 Kim and Mike Young Build a deck with pressure treated wood. The deck will fit outside the kitchen but will not extend beyond the back of the back room or any closer to the left side lot line than the existing house. Remove the window. Install a new vinyl patio door for access to the den. $ 6,875.00 This price does not include any painting, or ceramic tile if needed. This price inc. moving the elec. And removing the baseboard heat. O� T') k '^'U" 'JDA o-v�l� rUKm U - LU 1 KCLC^Qc r%imm _o 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. APPLICANT FILLS OUT THIS SECTION APPLICANT _y - PHONE ��oo LOCATION: Assessor's Map Number V Ov 1 PARCEL.00 SUBDIVISION LOT (S) STREET /`� 0 Y`ih ST. NUMBER OFFICIAL USE ONL OF ADMINISTRATOR DATE APPROVED 1( L -19T Aa J-77— DATE REJECTED 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 7ECEIVED BY BUILDING INSPECTOR DATE ROVINd 9197Im • i t • >. oc. }� S e C� �$ 61 U6 Date....... ......... .... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... -�-n 44 'T ............................ has permission to perform .... ...... xel ........................ wiring in the building of ....... ..... ... ................................... at..... ".w . ...... . North Andover, Mass. 7A....... LEcrRICAL INSPEC 0 rO Fee ..3r 99;7 ... Lic. No.1.7-Y7494.0 ........... . a , �S�I� �72 110.4 Check# W S?— �.41 04t (Iommonwtalth of Massac4nortfiq Department of Ptcblic Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERF( All work to be performed in accordance with the Massachusetts (PLEASE PRINT IN INK OR TYPE ALL City or Town of _ 0,4 d'Z Office Use Only Permit oto. & Fee Checked (leave blank) A ELECTRICAL WORK Code, 527 CMR 12:00 � �-0r Date (9 To the Inspector of Wires: The undersigned applies for a permit to perform le cj7 ��'� m)the electrical work described below. Location (Street & Number) V 1O� ®A� e J< Owner or Tenant J` t fA t + ke �J 0 J IV CV Owner's Address A Is this permit in conjunction with a building permit: Purpose of Building Existing Service Amps New Service Amps —J— No Volts Volts (Check Appropriate Box) Aility Authorization No. Overhead ❑ Undgrd Overhead ❑ Undgrd ❑ No. of Meters ❑ No. of Meters Number of Feeders and Ampacity {� r n _ Location and Nature of Proposed Electrical Work `JL�%t7Ckf'✓C i%k _ OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO ❑ ! have submitted valid proof of same to this office. YES O NO ❑ if you have checked S, please indicate the type of coverage by checking the appropriate box. INSURANCEBOND ElOTHER❑ (Please Specify) ' /-0 6 i goo, co Date) Estimated Value of Electrical Work $ _./ Work to Start q �:gq—or Inspection Date Requested: Rough Final �/✓�/� Com'' Signed under the enalties of perjury: ��� /� FIRM NAMEt7��. L.�cz.`�� LIC. NO. 191112 .Licensee •�'r' �� Z 2't Signature �' LIC. NO. Address �� d CAUI4�dk ST VeA& • 1M , , e 71 dem M� Bus. Tel. No.. 9X9 Alt. Tel. NoV J— / � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts .General Laws, and that my sigtmture on this permit application waives this requirement.. Owner Agent (Please check one) TPlPnhnnP No PFRMIT FFF t TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In - No. of Lighting Fixtures Swimming Pool gmd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Bumers Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Conditioners Tons Initiating Devices No. of Sounding Devices. Heat Tota Tota No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection/Sounding Devices No. of Dishwashers Space/Area Heating KW Municipal 11 Other No. of Dryers Heatin Devices KW Local[], Connection No. o No. of Low Voltage No. of Water Heaters KW Signs Ballasts nL Wiring No. Hydro Massage Tubs No. of Motors Total HP — ,h OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO ❑ ! have submitted valid proof of same to this office. YES O NO ❑ if you have checked S, please indicate the type of coverage by checking the appropriate box. INSURANCEBOND ElOTHER❑ (Please Specify) ' /-0 6 i goo, co Date) Estimated Value of Electrical Work $ _./ Work to Start q �:gq—or Inspection Date Requested: Rough Final �/✓�/� Com'' Signed under the enalties of perjury: ��� /� FIRM NAMEt7��. L.�cz.`�� LIC. NO. 191112 .Licensee •�'r' �� Z 2't Signature �' LIC. NO. Address �� d CAUI4�dk ST VeA& • 1M , , e 71 dem M� Bus. Tel. No.. 9X9 Alt. Tel. NoV J— / � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts .General Laws, and that my sigtmture on this permit application waives this requirement.. Owner Agent (Please check one) TPlPnhnnP No PFRMIT FFF t 011e igummunturttltil of i 'tt.00ttOffice Use Only UcJ)Qt'llT7Pltl n/ 1'rrblrr ,Srrjety Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 q�3 r )(uipam y R Fee Checked ---- 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD All woik to he performod in accurdanrr with the &tesla, hu,Nk Flecbiral Code. 'i27 c't.1R 12:00 (PLEASE PRINT IN INK OR TYPE ALI. INFORMATION) (�,11e Cit or Town of V �4 //�� N V VJ� QZ __ Y �--�-�—J_7 �--.--_------ - - ---------._.----------------To the Inspector of Wires: The undersigned applies for a permniitt to perform the electrical electrical work described helow. ,l Location (Street & Number) V C liT_ V_�_ © 1 _ _ A_,,% e — — Owner or Tenant— Owner's Address Is this permit in conjunction with a building permit: ---- Yes<+ No ❑ ----- (Check ApI of ate Box) Purpose of Building --__— - Utility Authorization No. — — Existing Service New Service Amps -----/-- — Volts --.Amps ---- Volts Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No, of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work &eii't(.YUt?�C OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws 1 have a current Liability Insurance Policy including Completer) Operations Coverage or its substantial equivalent. YES LI NO F.l ! have submitted valid proof of same to this office. YES 0 NO F] If you have checked ES, please indicate the type of coverage by checking the appropriate box. — — L INSURANCE De'BOND ❑OTHER❑ (Please Specify) _—— yv J46 t! i Estimated Value of Electrical Work $ � � 00_ (Expiration Date) i Work to Start /, Inspection Date Requested: Rough f/`J'A Cdl Final Signed under the penalties of perjury: FIRM NAME . 1 tvL Gyc.t is �� �' ---- ----------- -- LIC. NO, Licensee __T__ [� _ �/t0'N 2 Z't Signature ''_ �" 'z — LIC. NO. Address 1 / o "Icl1� oS .:.S; " Veto- � e I -A a e.,_7�'i� -�--- 9X9 av ! �j ---- — — _Bus. Tel. No. ' ! J All. Tel. No(/ )_6%x'9/ ss / OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have Tile insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my sigitature on this permit application waives this requirement. Owner Agent (Please check one) Tolnnhnnn No PFRMIT FFF T, TOTAL No. of Lighting Outlets No. of Fiot Tubs No. of Transformers KVA Above In - 1:1 ❑ No. of Lighting Fixtures g Swimming Pool grrid. grid Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of ZonesTota No. of Detection andInitiating Devices No. of Ranges No. of Air Conditioners Tons Heat Total Tota No. of Disposals No. of Pumps Tons KW No, of Sounding Devices No. of Self Contained No. of Dishwashers Space./Area Heating KW Detection/Sounding Devices Municipal 11 11 of Dryers KWNo. Heatin Devices K Local Connection Other No. o No. oT Low Voltage No. of Water Heaters KW Si ns Ballasts r h� irin No. Hydro Massage Tubs I No. of Motors Total HP C, OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws 1 have a current Liability Insurance Policy including Completer) Operations Coverage or its substantial equivalent. YES LI NO F.l ! have submitted valid proof of same to this office. YES 0 NO F] If you have checked ES, please indicate the type of coverage by checking the appropriate box. — — L INSURANCE De'BOND ❑OTHER❑ (Please Specify) _—— yv J46 t! i Estimated Value of Electrical Work $ � � 00_ (Expiration Date) i Work to Start /, Inspection Date Requested: Rough f/`J'A Cdl Final Signed under the penalties of perjury: FIRM NAME . 1 tvL Gyc.t is �� �' ---- ----------- -- LIC. NO, Licensee __T__ [� _ �/t0'N 2 Z't Signature ''_ �" 'z — LIC. NO. Address 1 / o "Icl1� oS .:.S; " Veto- � e I -A a e.,_7�'i� -�--- 9X9 av ! �j ---- — — _Bus. Tel. No. ' ! J All. Tel. No(/ )_6%x'9/ ss / OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have Tile insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my sigitature on this permit application waives this requirement. Owner Agent (Please check one) Tolnnhnnn No PFRMIT FFF T, m 0 0 Location No. Date ,►ORTM O�t.ao ,HO TOWN OF NORTH ANDOVER y F A a s Certificate Occupancy + ; , of $ s,aMuse Building/Frame Permit Fee $ VVO O Foundation Permit Fee $ Other Permit Fee $ t- /1(0 / TOTAL $ 4 ^^7� Check # tic, ays 18536 a Building Inspector c TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: l/�� DATE ISSUED: C Lae--� SIGNATURE: Building Commissioner/InEeEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: —L10 6-7 Map Number Parcel Number a � -2,0 —coon' —0,900,0 101 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 Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT istoric District: Yes NO 2.1 Owner of Record Mi ie V,"ng LlVyy/►YV wo ty, Name (Print) Address for Service 7 �F Q 5-u� Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 65 go�Uc� (cJfez�cr�► Not Applicable ❑ nl Dal Licensed Construction Supervisor: � r1_9 n� License Number Address— i zj— 7 y' D L o g �-� Expiration Date Signature Telephone P 3.2 Registered HomeI rovemfent Contractor Not Applicable 0 V 6UIe—roto j Company Name Registration Number Address oil Expiration DAtV Signature Tele hone NI M '6 Mill r M� rM 2 G) 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 0 Repair(s) Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: //(� (� ,_ I SECTION 6 - FSTIMATFD CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit a licant WFICIALUSE O.Y�� 1. Building) (a) Building Permit Fee Multiplier 2 Electrical l7 ' e v (b) Estimated Total Cost of Construction 3 Plumbing}.00,00 Building Permit fee tel x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATIOY TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR WELDING 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 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 k. 64wa Print Name lev�" /6 O Signature of Owner/Agent Date A777 7WI. NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS isr2 ND 3 RD SPAN DIMENSIONS 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 IS BUILDING CONNECTED TO NATURAL GAS LINE J Department of InduaWd Accidents Office of Invesdgedons kv 600 Washington Street Boston, MA 02111 www.massgov/die Workers' Compensadon Insurance Affidavit: Builders/Contractors/Electridanw?lumbers Name (Bu&ms/orpnizatiowIndividual): P U 6 6-dkownv Address: 0S-9ka�am- o- r, Phone #• ��S %\7 4S" Are you as employer? Check the appropriate box: 1. ❑ I am a empbya with? —part7-time— 4. F_]I am a general contractor and I employee§ (full and/or ).• have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(41 and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 I .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other -^ny appncanxom cm=w oox w l T u tint ml ow IDE @Mon below ahowft their wof'tlota' �� policy int�R t Homeowners who submit this aliidavit lodicwht they an dome all work and then hire outside ton man mint submit a new affidavit is�a wck tConvoctors that dwck this bout naw attached m edditiond sheet showiq the name of the sub-ooneactors and thew wo&=, oonp• policy mfornu ti m I am an employer dot h providing workers' eompensadon liu�nee for my em p/oyees' Below is the poJlq+ andjob �s Information. A a „ Insurance Company Policy #i or Self -ins. Lie. Job Site Address:__ .V vhf WO > W Expiration Date: 37/ V166 do — City/Stateail): JII OLl Ir /11 01�s J/14/57 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Faffin to secure coverage as requffef under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year bVrisoament, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage vCrification. I do hereby certify under tete 9 penahles of perjury that the lnfwmadoa provided above b dere and comet Si tur ®aaW i.. �&M Of ficial use only. Do not write In this area, to be completed by c4 or town ojlelal City or Town: Permttli.iceuse 0 Issuing Authority (circle one): L Board of Health 2. Building Department 3. Cky/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone 0: 1111W 111atavli, Seaa%a iaacv%,a %a%,WAL%.AL.... Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their enVloyees. pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of all individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,125C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who hu not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, MGI- chapter 152,125C() states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants , Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to alga and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Depardnent at the number lisped below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permitnicensc number which will be used as a reference number. In addition, an applicant that must submit multiple permittieense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit � been officially starved or marked by the city or town may be provided to the applicant as proof that a valid a is on fie for future permits or licenses. A new affidavit most be filled out each year. Where a borne owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves ctc.) said person is NOT required to complete this affidavit The office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26.05 grww mass. gov/dia .v 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 at: 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: Fire Department Sign off: Dumpster Permit (Location of Facility) Signature of Permit Applicant av� (6 if Date .V D.G. CONTRACTING INC. Kitchens, Baths, Additions, Home repairs, Finished basements, Decks, Excavation work David Gulezian President 428 Pleasant Street, North Andover, Ma. 01845 OFFICE: 978689-4797 HOME: 978683-0397 FAX: 978 686-6337 MA Lic. # 001821 INSURED Home Imp. # 1.20199 Installer of Sportcourts April 27, 2005 Kim and Mike Young Wentworth Ave. No. Andover Garage/Heat project Plumbing: Install a new wall hung high tech furnace. This furnace is a high efficient furnace and will be vented to the outside thru the wall vs. the chimney. Domestic hot water will be taken off this furnace. Remove and dispose of the existing furnace and hot water heater. Install heat in new area off the existing cellar zone. Plumbing: $ 6,800.00 Build a cement block wall along the line of the existing garage door up to grade height. Damp proof the block wall. Install a perforated pipe along the new block wall and tie the pipe into the existing drain. Put crushed stone around the pipe and cover it with landscape fabric. Remove the existing driveway and fill the driveway area in. Loam and seed the disturbed area. Install 3 windows in place of the garage door. Make a new entrance (opening) from the old finished area (near the bathroom) to the new area. Build a closet in front of the electrical panel. Build walls to cover the foundation, sofit in pipes, insulate the new walls. Re- sheetrock over the existing walls and the new walls. Install 3 V colonial baseboard and trim around existing door and all windows. Price :$ 10,800.00 Electrical: Install receptacles to meet code. Replace the electrical panel, install 1 cable and 1 phone jack. Electrical: $ 1,950.00 This price does not include floor covering, cleaning out of the space, painting, flooring, light fixtures, changes required by the town or repairs to hidden damage. of �I A, E Cd rj, O z O U iCD cm O C13 = Col CD mCD CD CD m = Z O� 3.0 a� Cl 0 CD L CLI L- CL CL C Q o�� ev ,w � •v CO2 z CD CL v y c C C cc- CO3 0 0 N U) W W 19 W N -� o :`1 x c o x a ' �•O C UW a �C O H o �, C O �Aa"o U w a' -a w w" ' o c c 1 o O z O U iCD cm O C13 = Col CD mCD CD CD m = Z O� 3.0 a� Cl 0 CD L CLI L- CL CL C Q o�� ev ,w � •v CO2 z CD CL v y c C C cc- CO3 0 0 N U) W W 19 W N -� :`1 c o ' �•O C �C O H : C O �Aa"o ev � m C O +.:. caC o Ea 1 • �... � r m� Ecot `11 wL '44* m C E y.v vi cmm �3 O : .3 •• y IA V O • mom -c y �a�� m v0 : � CD O cm tidCD O 2: =IAt m .mom US 0 (� A ` w Q V: 0 CL C �C m m NaC ID=3: S :a CD CIO wts m r=... ~ •� C= m C Z CC cm � y _ a �- m O O =o- O CLis F O z O U iCD cm O C13 = Col CD mCD CD CD m = Z O� 3.0 a� Cl 0 CD L CLI L- CL CL C Q o�� ev ,w � •v CO2 z CD CL v y c C C cc- CO3 0 0 N U) W W 19 W N CS rA W R;" 4-) co O O• CD Z a• O CO) � C CD cm •ECDCD CD m m CS CD o mo a CL Ca c= c cv O CO2C Z ts CD �..� y —_ C C ccc .y 0 uj Y+ Y/ W W cz W CA � a ' �•O C •; 1� \ w° N `n u V)) Cd a b w° ° U ro w a a a cd a a W W u ac ev � a ' m c s o z vi O cn 4-) co O O• CD Z a• O CO) � C CD cm •ECDCD CD m m CS CD o mo a CL Ca c= c cv O CO2C Z ts CD �..� y —_ C C ccc .y 0 uj Y+ Y/ W W cz W CA � a ' �•O C nkO ao 0 c ac ev � ' m c s o o� to 3Ayr m a h 40 o o It C-3 r '3 CA m C mi ca cc �3 o� Z'3 vi c CMD. Q `� �• a 1c a z N Co. c O t` E y d1 �aw o 2 ',mc ";R= o cm -4b ;� c Q C m mOLr a h z O ca =9- � oa= = m WA $ o,; aa~ m z .E a mum— CLIj.m o yI m H = w M 3.g= O =aaM COO � 4-) co O O• CD Z a• O CO) � C CD cm •ECDCD CD m m CS CD o mo a CL Ca c= c cv O CO2C Z ts CD �..� y —_ C C ccc .y 0 uj Y+ Y/ W W cz W CA Location v No. C/ Date NORTH TOWN OF NORTH ANDOVER 3? � • OL ti 9 x Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ _ Other Permit Fee fir"PIA `Y $ S .-- TOTAL $ Check # b Building Inspector N- TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING n , BUILDING PERMIT NUMBER: DATE ISSUED: Q SIGNATURE: A1191 Building Commission - for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: q0 C.a£wr too"-- qVI W -7 OO I ap Number Parcel Number Nuc �-rd�� Mq ©l�`lS 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 RegWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record M1C*�L Yooda4 K,40. A. yovs � 40 wj-, �OEri �� . Na Print) Address for Service `�7S-1v�3 Signature Telephone 2.2 Owner of Record: ko TL"jOpw£ Name Print Address for Service: Si nature Telephone SECTION 3 - CONSTRUCWWSERVICES 3.1 Licensed Construction Supervisor: .0 �c /- c" /,R � /,-gf� �� / Not Applicable ❑ o&32,7 � Licensed Construction Supervisor: / 5- License Number Address L51� /x002 0at Expiration Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ rr Company Name Registration Number 7 Address ? Expiration Date Signature Telephone O z M O M ro E G1 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: xt 3 Flus �Z� �X l2 C1) �'n f; ��� �t�� �c A /0 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIALUSE ONLY 1. Building J Oot0 ,� / (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (@) �- S` 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 COIN CONTRACTOR APPLIES FOR BURDG PERMIT (�/ I, ` i I C �/ A Pi-tL �. -1 oy 0/as Owner/Authorized Agent of subject property Hereby authorize ;f t 7J` V pw A f to act on My beha f in a i tter relative to work authorized by this building permit application. b//q /2,,:>o0 Si natur of Owi Date SECTION 7b O ER/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 TEVIBERS 1 ST2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAI, OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE V Town of North Andover NORTH OFFICE OF i�O11 COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street ` t WII LIAivI J. SCOTT North Andover, Massachusetts 01845 �9SSAc►+uSE�<`� Director (978) 688-9531 Fax (978) 688-9542 CHIMNEY APPLICATION AND PERMIT DATE & l ?� LOCATION OWNER'S NAME M 1 m c� BUILDER'S NAME MASON'S NAME MASON'S ADDRESS MASON'S TELEPHONE MATERIAL OF CHIMNEY I 1411p�i 178 71 / PERMIT # INTERIOR CHIMNEY EXTERIOR CHIMNEYy NUMBER AND SIZE OF FLUES '- 2, 8 X 12 / c�d THICKNESS OF HEARTH Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE ~y �v/ialo� SIGNATURE OF MASONjc° CONTR. LIC. # ©(�► O� EST. CONSTRUCTION COST/CONTRACT PRICE Zc'--V^ ® C-0 C2 PERMIT GRANTED ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS .'5;1? D FEE SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 U Q O 1 C*b 0 z W W) x W-4 A O O w T D v cn o w z z "a o C O w 7 O a: T U Cd O w o w U O n: is G w a a ¢ w 7 O c4 U v) ie O w x p U z O c4 id G w z w w C CO o Z cn O O V) o Jl O N : At ; �p O CI V p, O_ C �: O O i m C • +� it A ` O y EQQ :- c m := v H � O m • O O O CD C 2 : c= fd lV m m y co Cr m m � �LC y O N m CD C>D !l v►: * a go.mor m yZ moo CL N m C = m CD p O dOH N " A m r WLUo ���� r L3 co 0-0 C#* d m O 6 Ocop .0 ` h 0 0 h -V 0 ICD CC_ COD :2 QM� W iii .M�y� •g i O CD C ~ ♦r Ccs � Q � O �CL) co Q L O O a CL cma y C O r=te+ C C cc ZCD 0 CL V CO) ccC C C m H 0 Location No. Date � (6 _ br-) TOWN OF NORTH ANDOVER i.10 - - ' Certificate of Occupancy $ s i • sCHUs Building/Frame Permit Fee $ -� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ) i�, 3 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:DATE ISSUED: SIGNATURE: Building Commissionerflns=tor of guildings Date CT /TiA1 aavl� 1-111 L` 11\l VR�111tg11V1\ 1.1 Property Address: 1.2 Assessors Map and Parcel Number: HU Atf`-W0(-yh o y co 1 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zona Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT 2.1 Owner of Record q-- l�Iwt. ka v Name (Print) q Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTIO 3 - CONSTRUCTION SERVICES 3.1 Licensed Cons ctio Su rvisor: Not A licable ❑ r� �} PP j ( 60/ � f� Licensed Construction/Supervisor: , *) �I,p,/ ,i/�`� (�" License Number Address l.•K, / � � � �y� Expiration Dat Signature Telephone 3.2 Registered H me, Impr ue nt Contractor Not Applicable ❑ Company Name /L'T ,�'�%t Registration Number Address � V 7L Expiration Date Si nature Telephone 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) XV' Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: c� VC. +0 oh/*'" Lac, e Q t o din n 4-- � k l e a f0 b -p- f2ilk*W, � t� +0 F41(2ce `r+ ash SECTION 6 - ESTIMATED CONSTRUCTION COST Item Estimated Cost (Dollar) to beK Completed by permit applicant �i3OFCIAL U15E OILY 1. Building 00 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction '�- 3 Plumbing Building Permit fee (a) X (b) / v UU 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 Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all hatters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUT((HORIZED AGENT DECLARATION I, hc)y VJ 6U -a�Tco-? 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 Paine Signature o Owner/A ent Date WE -; 11"All"I'ME EMU F-3 ME NO. OF STORIES SIZE BASEMENT OR SLAB S17 -E OF FLOOR TIMBERS ` X $ 2 3 SPAN DPAENSIONS OF SILLS DIN ENSIONS OF POSTS DEVENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING I/ p X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS I3UILDING CONNECTED TO NATURAL GAS LINE e f �nt�maxra� e ilc�srzr.'jtC°�``� BOARD Of SUlWV4G REGULATIONS ; ucena: CONSTWOT10% SLIPEI?V1 CiR Number CS 00821' s 4 Expimr4: IMW,001 Tc no. 4 1 RortdctedTot -00 1 t DAVID P GULEMAN 428 PLEASANT ST N ANDOVER, MA •011 15 AdmrfttmtOr �4r _` � i.. f�unE 3tt�R(FVENEYt-iONiRACtt±R Aa�ivtrat�a� 12�1�9 4P .� Exlratlon. iU1l41 type: Individual (y DAVID 6ULEZIAN _ $*LEASANt st AMINtSTRATCQ NORTH ANDOV HA 01645 The -Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Location: Citv /1l r`I'Y l_do-6 r`(_ Phone `T ��_� �� � `� 42 Oam a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity F-T--IA'am an employer providing workers' compensation for my employees working on this job. Company name: Address 0 Y) Company name: Address # W C A) 1l S -96 City 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 well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day 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 herby certify under the Sig �rld pe 'e of perjury that the information provided above is true and correct.v 7 . r/ ` / �j % Date (.0 I `� 6 Print name CI V l �-C(o V1 Phone # �' 7 77 4V S� Official use only do not write in this area to be completed by city or town official' f --Building Dept ❑Check d immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Cd K�� z O p U z O U -"I O Om I p � h � � CD � _ �3 e� C� G L _O O a CL C Q Csem-+ C �� v .J efl CL C3 O CA C Z OOi C CL C.3 y c C eee� e cc 0. .y 0 U) LU U) w W ccw LU vJ w U)a u v Cf) o or. co -10a p p aG U G w p c�. G w, a w W p aG v cn w a p x G w z a w CO o z U) Q v /) z O p U z O U -"I O Om I p � h � � CD � _ �3 e� C� G L _O O a CL C Q Csem-+ C �� v .J efl CL C3 O CA C Z OOi C CL C.3 y c C eee� e cc 0. .y 0 U) LU U) w W ccw LU vJ 'moo : m c O »� 1 C N O C i.:. O O m ra44 c -m � iso c s = 87E •� v Ra NJ go E c c� cm16, CD c O me m 3 _ r C f : m C CO dp R O fCLLJ m � a c • � acr oc. m O � y O cc C Q CJ p O m cm C o = ID m :mooc N � COD 40„ ymoF- m Lai 0 •tyA fl r o =CD r �-. O �... O.S C v .y Z 2 L=�E L.2 CD Q VD C' m:s O; `n eyo Z. CL.=..e z O p U z O U -"I O Om I p � h � � CD � _ �3 e� C� G L _O O a CL C Q Csem-+ C �� v .J efl CL C3 O CA C Z OOi C CL C.3 y c C eee� e cc 0. .y 0 U) LU U) w W ccw LU vJ Location No. �—�� Date !NORTH TOWN OF NORTH ANDOVER .. 9 Certificate of Occupancy $ I%S',^° • Eta'' Building/Frame Permit Fee $ sACHU`� Foundation Permit Fee $ Other Permit Fee $ TOTAL $f Check # 16102' Building Inspector 0- f �z C) 6 0CIO i -epa0 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT and Parcel Number: �� Parcel Number tPPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,. t t�?k'i'I,i,,Sti�','or .+r)i",.� ra •, z N' 1.3 Zoning Information: '.oning District Proposed Use 3UILDING PERMIT NUMBER: DATE ISSUED:7 � Z� 1 Side Yard Rear Yard >IGNATURE: Required Building Commissioner/IEseEt of Buildings Date Reqwred Provided )EC, I IMIN 1- Jl 1 h 11v r 0KMArlv1N 1 I.l Property Address: C,/d 1.2 Assessors Map 06 Map Number and Parcel Number: �� Parcel Number 1.3 Zoning Information: '.oning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft .6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Reqwred Provided .7 Water Supply M.G.L.C.40. § 54) 1.5. ublic ❑ Private ❑ Zone Flood Zone Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System D ;ECT1ON 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT ..I Owner of Record *�yo 9 Jame (Print) JAddress for Service signature Telephone '.2 Owner of Record: Name Print el Address for Service: ii nature Telephone >EU11UN .s - 1.M1Nb1KUU11M1N btKV1C,'ES 1 Construction Su r r: ,icensed Construction ��— \ddre`s4� W? V5-77�5— ;igwdure Telephone i7�u Home improvegent Contractor t6, 6 o',"f vl :ompany Name address/ ( �i��! ✓ � ` l Not Applicable ❑ License Number �E/nDate Not Applicable ❑ I � 0/(? � Registration Number (./ , 7 Expiration Date T M X ic z 0 v m 0 z M 0 ic r 0 r _r z 0 r� SECTION 4 - WORKERS COMPENSATION (MLG.L. C 152 & 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check allapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: c 17 w �' 4do SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pern-ut applicant QFFICIAL; USE, OM:Y 1. BuildingQ` C% 0� (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 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 pennit 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 A / �p 'n 2) Print Name 46��z Signatureer/A ent Date Jill NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I IF IGHT OF FOUNDATION THICKNESS S17_E OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r 4h NJ O z I o A w° c� O E� z z r.a oG cu w° w°' U G m G O z ° w co° w a O U U W ° w C� C w p: u: c w W A x Qi ~ o L cn E c n 2 H CO) W_ LL H W V N F— t5 CD m 0 C O N CIOE O CL N W _ J CD O s N O O O E L O coV z d O CO) O C CD C C y Q :2 O •E m m co 0 co CL ~ r=.0 O � CLI D O � L �C O a 13- om < y C c 4.0 c cv ev v J •p C CD V y c C _m C. 0 LU C) U) W cr W