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Miscellaneous - 410 MASSACHUSETTS AVENUE 4/30/2018
410 MASSACHUSETTS AVENUE 210/045.A-0011-0000.0 i i i I Date.......7.. ... .................—/ C( .... p10RTN TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING ss�CHUS� /d/U !/ i This certifies that ............ ....!:........... .......................... ..................... U� has permission to perform .............................................S ... ...........................�5 wiring in the building of................... .L. -......................................... at ........... ..........RXS,�.,....,........ North Andover,Mass. f.Fee...s�� Lic. No. .:/.�1�Z� ... . EL ECTRICALINSPECTORR Check# .t IL Commonwealth of Massachusetts Official Use Only Permit No. o Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT IN NK OR TYPE ALL INFORMATION) Date: 1 I City or Town of: NORTH ANDOVER To the Inspector ofMires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) , 0 � Owner or Tenant ��w - KAaky UvAAA t I I Telephone No.(o0 'r - Owner's Address �✓�.� Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity A P-19 l C-P L-WC< tb/1 S"r hIN4 M-eor-f Q.0 Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- F1o.o mergency ig ting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones t No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: """'""""' """"' """..... ' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No,of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent �. No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: ' 66- Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work:,T06 �(Z (When required by municipal policy.) Work to Start: I - -(k Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, tinder th ains andpenalties ofperjury,th the information on this application is true and complete. FIRM NAME: . /� �/ li �r LIC.N046 6 Licensee: 1' -A L ASignature LIC.NO.: _ (If applicable n er "exempt'in the license rmb r line. - f Address: � I �,� 1Cj� /1 (e) >; /�/ I�► 3r/ .� Alt.Tel.No.• *Per M.G.L c. 147,s.57-61,security work requires Department ofPubhc Safety"S"License: Lic.No. OWNER'S INSURANCE WAVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the j permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, § 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: . { Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: - Pass 0 Failed 0 Re-Inspection Required($.) ❑ L' Inspectors Comments: Inspectors Signature: Date: FINAL INSP CTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Co ents: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations kvi 600 Washington Street Boston,MA 02111 www.massgov/d'ia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Le0bly Name(Business/Orgadzationftdividual):A,�-4�-e bon , Address: L . �`I ) City/State/Zip: P-e� M/ ) Phone Are you aployer?Check the appropriate box: Type of project(required): 1.[9 am a employer with / 4. El am a general contractor and I 6 employees(full and/or part-time).* have hired the sub-contractors El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name:. Policy#or Self-ins.Lic.#: (Al r (A/ Expiration Date:3 ^/o— /(� Job Site Address:_ I fv-)A City/State/Zip:A .A 1 d10 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 imprisonment,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 verification. I do hereby certtfy under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 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#: e 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 deemed to be an employes." 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-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 maybe 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 fill in the permithicense 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,ofMassa'_,setts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston.,M.A.02111 TO.#617-727,4900 ext 406 or-1-877,MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.govaa Date. 7.l . .. .... .. NORTH w Of i..ao °,tiO �? TOWN OF NORTH ANDOVER O i 9 - PERMIT FOR GAS INSTALLATI . h Is AC'HUSEtS This certifies that . .,, A.f.d c'. f.. . . . . . . . . . . . . . has permission for gas installation .�10rj. in the buildings of . ./1�f1/4./7. f/v. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . .`lf- !. . .+ s1 fJ-. —4 . . . . . . . . ., North Andover, Mass. Fee. .?). � Lic. No d . . . . . . .. . . y. -... . . . . 16AS INSPECTOR Check# 7'T 3 56)57 MASSACHUSETTS UNIFORM ORM APPUCATON FORP`ERMU TO DO GAS FIT MG (Type or print) Date 7, 7�17 x(16 NORTH ANDOVER,MASSACHUSETTS Building Locations ,_ 401 MASS AVE--- Permit# Amount S Owner's Name :1(1HN PARKER „�� New Renovation ❑ Replacement Plans Submitted ❑ o o c o° SUB-BASEMENT BASEMENT IST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR STH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) Certifi�.�,�g�Pmy Name���, .nrinvar P1 iimhi nnn 9. yoafi nn ('n Tnr Corp, Address On Annean nr. Unit-1 -10 , ❑ Pier, Methuen, Ma, 01844 ' I3 m"'asTelephone q78-6M-838'1 ❑ Fimn/Co. Name ofLicensed Plumber or Qas Fuer George_L a Ro s e DISURANCE COVE[tAGE Check 1 have a r IIF liabft legdvaleat. Yes No❑ Ifyauhavecbwkaw,please' do"ems, moelrpchoMmSeapppbox Li"iitywscuancepoiiq 0diertypeofWmiily ❑ Bond ❑ Owner's hamance Waiver: I am a- n P Ad the L'oeasee does mt lsm tbel oe aa�veragexeqaiwed by Chapter 142 a£the Mass.Coal Taws,and flo my sig oadme enthis permit applicalion vva es"S tock ace` Signature efOwnererr Oweer's Agsat Owner ❑ Asa t ❑ t hereby am*that all aftbe derails and ifnm afm I hatee steed(or entered)in above applicafim aretrne and accurate to the best ofmy knowledge and that all plmr6M work ad kms peM med vomer Pem a Issued for this application will be in compliance with all pertinent provisions afthe MassaduseUs State GasOC^and Chi 142 ofd Laws. Title P audgrued �9eo cityri'own (� has Howcense Master APPROVED(OMM USE ONLY) 0 jou Date. � .1. . . + TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Y t ( • ,SSACMUSE� � w This certifies that �l.K �'.'. !`. . . .1. . �'�. . . . . . . . . . . . . . . .. ;has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . k plumbing in the buildings of . . .PA)P. .e /l. . . . . . . . . . . . . . . . . at.. . . . . . . . . , Nort ndover, Mass. Fee ... . .Lic. No. f'! l . . . . . . . �. . . . . . . . . . . . . . . PLUMBING IN' N PECTOH Check H 3 3U i 7029 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING i (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location 401 Mass Ave. Owners Name lnhn Pgrkar Permit# Amount T e of Occu anc si denti al New 0 Renovation Replacement Plans Submitted Yes El No FIXTURES cr Z 9z SM84VE BPS&IM t 1ST FIAQ2 3�II)�IACR 3MRDCR 4M R-OCR sm)HRM _ 6M HJDM 7MH.CM 9M Elf t (Print or type) Check e: Certificate Installing Company Name Andover P1 i mhi na R Heyti nn rn_ Tnr Corp. 2122 Address 20 Aegean Dr. Unit #10 � Partner. Business Telephone (q� r,8; - Firm/Co. Name of Licensed Plumber. George Larose Insurance Coverase: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy E Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 0 Agent 0 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 Massachuset tate PlumbingCgde an ha 142 of the General Laws. By: Signawre or"Upsm Flumuer Type of Plumbing License Title 9983 City/Town cense NumDer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Location No. 9`1 Date NORT1y TOWN OF NORTH ANDOVER b C •. AL S * 1 ; Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s+cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t ` 15657 /' Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING „''IM BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: y �. Building Commissioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Ll//o m459 At 111z 6yS oa ll .&A1Va v& Map Number Parcel 1,juinber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Rapired Provided erage oral f 1.5. Flood Zone Information: 1.8 Sew Disposal System: 1.7 Water Supply M.G.I,.C.40. 54) S tem: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System D SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record W Z L/-4m T� itis N ICL 1 ��c A Lir Naive(Print) Address for Service: 9 e - S, Signature Telephone 2.2 Owner of Record: S l30 Name Print _ Address for Service: Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ VA e I-, /'&IV ?: Licensed Construction Supervisor: �0g2 3 J-1 yjteK 7 RIC yrr �� 4 License Number Address •J —� (� M k"11 4�1 79- P-45- dl 11/1 � Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ (�fZ�1/ �itl�-C/�� G(1S✓asst ,dam Sl rcr Company Name i> ,�� ' ! /® ;L��'7 ��sst /�lY W/�LL s y/ L Registration Number r Address r Acy 0/ 71?_ 61e.!5'9- Ogg/ Expiration Date �q Signature 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.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: err t /max 5 d nrT%rLe lid s SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � OF1F'ICItL USE ON ,Y s � Completed b permit applicant 1. Buildinga ,,,, ( ) 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 f U 6 Total 1+2+3+4+5 (a — Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as O 1 Vit-property s 1 Hereby author' e to act on My be;alf,ii a Ie. VP ythis building penmit applicatio / Si nat u Date SECTION 7b OWNER/ALW90RIZED AGENT DECLARATION M x,L `l L A ��, as Own /Authorized Age of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of in,/knowledge and belief Prim N Si ature of a er/Agerit Date NESEENIM NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVMERS is 2 3RD 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 .9 8 LA i I d-i U)-Ie A21.)1-)(1 0 PI. I f; !1 IlUfll 1111TVI lit N I ONIRACIOR NEW EN(A AND 'I I{ Rete:>lraflou L Loll: 0710212002 Va L Z 2 lyf)e: Private Corporatio W1 L.P1 I N G"I-0 N IVI A 01.".31:: I11W BWANIU 0510H D(SIGIN, Val Lanza 1.01JELL SI. ADMINISTRAT0Q, Ii I NG 1011 LSA 01L3 .. ........ BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR Number: CS 008828 Birthdate.:.04/2011951 Expires:04/20/2004 Tr.no: 20132 Restricted: stricted:1 00 VAL J LANZA 34 BIXBY ST REVERE, MA 02151 Administrator 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: 7f &rg KOX;eI514` Y2K 6v,� 57— (Location 7—(Location of Facility) 4" Sig ure pplicant Date ` NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r F The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: h6 G L A-/-ir 4a- �vt N Location: 9/16 t214 51-5, Le City _ �/ .�9-o oV/z2 Phone / 79. g/• 5 >2 y am a homeowner performing all work myself. F-1 aI 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. ©'r Company name: h/ iLZ /��1�/�t�•0 G t�S�r�-` S/�,oL� Address �L6 zoWX11L L 7 City: -4 Phone Insurance Co. TIV t kk/h--� S Policy# ? P 7-vg Company name: , Address 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 pains and penalties of perjury that the information provided above is true and correct Signature Date W/ Print name_ �/ J ZAA17A Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other r FORM WORKMAN'S COMPENSATION i NORTH Town ofAndover �� V" LA O y dover, Mass r ZO�Z COCHICHEWICK V ADRATED pPa,��y S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT.. ..................... ................................................. Foundation has permission to erect........................................ buildings on .... ...... .......... Rough • to be occupied as Chimney ............................................................ provided that the person accep ' this permit shall in everyect conform to the terms of the application on file in Final this office, and to the provision of the Codes and By-Laws sting 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST jl ELECTRICAL INSPECTOR Rough ...................+................................................................ 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. SEE REVERSE SIDE smoke Det. Location �G No. `- / Date '5hr NORTH TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�CNuso 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /y /�Y�i 5 u 4 `t Building Ins ctor i TOWN OF NORTH ANDOVER t BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING . . .. ._.__.,.,.r,.4:. .;�„sem. z •,� i BUILDING PERMIT NUMBER: DATE ISSUED: aoo � SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 1.l Property Address: 1.2 Assessors Map and Parcel Number: Iia Affi Al Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: y r Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS 11 Front Yard Side Yard Rear Yard Re red Provide Required Provided Re red Provided 1.7 Water S M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: uPP� Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System Public ❑ Private 0 Pa � SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT n 2.1 Owner of Record lall,&ON 15. AIM .�.,,W A41e � ame(Print) Address for Service 978-- 70 Q, Signature Telephone 2.2 Owner of Record: Name Print Address for Service: R Signature Telephone �y SECTION 3-CONSTRUCTION SERVICES IR` 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number rn r Address r Expiration Date Sisnature Telephone i SECTION 4-WORKERS COMPENSATION (MG.L C 152 § 25c(6) � L' 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. j Signed affidavit Attached Yes....:..0 No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0Addition ❑ � I Accessory Bldg. 0 Demolition ❑ Other 0 Specify f � Brief Description of Proposed Work: I f r2-Eleoctrical 6-ESTIMATED CONSTRUCTION COSTS Estimated Cost(Dollar)to be Completed b permit applicant ing ( (a) Building Permit Fee �Ut7 Multi Tier (b} Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My ehalf, in all ma elati o work authorized by this building permit application. c�Ls�j i iature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1ST2ND 3KD SPAN DIlvIENSIONS OF SILLS DMIENSIONS OF POSTS DMENSIONS 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 TD'd ��1101 v a -1//V X� LQT �_C>T Z r,rp'xsa �c ��vcQ -� R�lvc.a���•- �.. i 5LOT L07 16 . 2 GTO FRY Q nNIE L.lr1 NCS L67 10 w loo MA55ACHU5E.-T75 Avv_wuE LAURET , 034311 LOCATION OF STRUCTURE(S) OASED ON LINES OF OCCUPATION '�• n � �� '�•.,:. ONL(: A MORE ACCURATE LOCPSIOW ` 1 WILL REOUIREANINSTRUMENT SURVEY. LAUPIETANIi F?O HENALLANGSURVEYOR, AMERICAN SURVEYING COMPANY HERE61BY' CERTIFY THAT THE `�.r_ ; DVE MORTGAGE INSPECTION �.,;= 1264 Main Street,Waltham, MA 02154 (781) 893-6477 kN WAS PREPARED FOR VNECTION WITH ANEW MORTGAGE �q ) I$ NOT INTENDED 013 REPRE• Mortgage I mect0on Pkan 4TED TO BE A LAND OR PROPERTY �.�_ `E SURVEY. NO CORNERS WERE THE LOCATION OF THE ORIGINAL RECORDED AT f- x A/ COUNTY REGISTAY OF DEED-71 f. IT U91 BE USED FOR ES. DWELLING SHOWN HEREON EITHER BOOK '-}tet l PAGE l2>� L.C. Cert.(# _ 3L15HING FENCE, HE=DGE OR WAS IN COMPLIANCE WITH THE LOCAL PLAN REFERENCE: NI Ib44 LD1NG LINES.THE LAN?AS SHOWN APPLI+DABLE ZONING BYLAWS IN EF- DRAWN PER TOWN OF ASSESSOR )EON IS BASED ON CLIENT FUR. FECT WHEN CONSTRUCTED WITH RE- MAP 4 PARCEL# DATED - HED INFORMATION AND MAY BE SPEQT TO HORIZONTAL DIMENSIONAL ADDRESS: 2-2 3 lEGT TO FURTHER OUT•SALES, REQUIREMENTS ONLY),OR IS EXEMPT --- - ---I�'c�-'7'L'•L-Akso=/ ;INGS,EASEMENTS AND RIGHTS OF FROM VIOLATION ENFORCEME,JNT AC- BORROWER:—IRWIN T Y. NO RESPONSIBILITY IS EX- TION UNDER MASS,G,L,TITLE VII,CHAP, X - IDEDHEREIN TOTHE LANDOWNER 40A, SEC. 7, UNLESS OTHERWISE SUaIECT DWELLING LIES IN FLOOD ZONE - OCCUPANT, IT IS NOT INTENDED NOTED OR SHOWN HEREON. A CON- AS SHOWN ON NATIONAL FLOOD INSURANCE PROG ,I FLOOD FIRMATORY INSTRUMIENT SURVEY INSURANCE RATE MAP DATED BF,RECORDED. IS ADVISED WHEN STRUCTURES ARE COMMUNITY_PANEL ate '` �0' SHOWN TO AE 1' CA LESS FROM ENT FIELDED DRAFTED CHECKED PROPERTY Oil REQUIRED ZONING ENT AEF.?s �f�?�C° SET®ACK LlNE`.S. BY E �-- I'' c: TO/Te'd c'inoJ I Ol AEIn1 jnS NUDI�13Wd WO�d SO:80 866T-2T-dUW TV.KIV1 U Ly 1 n EAUL`1-1.71,' V vru.vl { VC At'A-e- INSTRUCTIONS- e- INSTRUCTIONS- This form is used to verify that all necessary approval/permits from / Boards and Departments having jurisdiction have been obtained. This.does not relieve the applicant and or landowner from compliance with any applicable requirements. '■■0■■■■■mamma■10■r■■r■88■■■■0r0■■■■■e■■■■■0r■■■■■008■re■888r■e■■■■■■■■■■■■■■ j APPLICANT PHONE._97 -L9/ -,*)-7,d7,/ ASSESSORS MAP NUMBER �'_LOT NUMBER �l SUBDIVISION LOT NUMBER n� n STREET STREET NUMBER �T Io■■r■■■■■T■�r■rr■r■■r■r■r■■■■■■■r■■■■r■■.r■■r■■■■■■■■■■■■r■■■■■rrr■■r■■■■■■■■ OFFICIAL USE ONLY ■■■■■■■■■■■■■■■■■■■■a■■■■■80■'00■■■e■00■■0■■008■■■■■■■a 0■00■0■0■■0■0■■■■■■■ . RECOMNDZNDATIONS OF TOWN AGENTS err■■ 8000 ■■■■■�r■r ■■■■■■■■■■■■■■■e5 8800 ■0 0 ■000080 ■■■■■008■■■ ■a8■■■■■0■■ r"S bL DATE APPROVED CONSERVA 0MADMIPIISTRATOR DATE REJECTED CONWEN S DATE APPROVED TOWN PLANNER DATE REJECTED COIvIIv1EN'IS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED. SEPTIC INSPECTOR-HEALTH DATE REJECTED CON*AETNTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE NORTH Town of Andover 0 4 z4� No. 30( $0;1� 4 —/do,- o=? C, 0 -CO r H'I C-MR910: over, Mass.,— 0 ATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........WA#.Ile 0:�........Y.,94044A.0 ............................................................................................. Foundation has permission to erect....... ...... buildings on ....... ...... .... . . js .. ........ ................ .. .. ....................... Rough to be occupied as...... 4;*,*,* peaov- 00 Chimney Jew provided that the person accepting this permit 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. Vd . PLUMBING INSPECTOR WA. 67r VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ............ Aoe ... 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. Smoke Det. SEE REVERSE SIDE Location �f - No. Date �2 NpRTiy TOWN OF NORTH ANDOVER 3? 0 16. Certificate of Occupancy $ E��'' Building/Frame Permit Fee $ ` CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING PL D BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION1-I-SITE INFORMATION z I A Property Address: 1.2 Assessors Map and Parcel Number: 0 q10 MICSS Ave- q S r Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage(11) 1.6 WELDING SETBACKS(ft) Front Yard , Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: > Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 --1 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED�/AUTHORIZED AGENT — M 2.1 Owner of Record Uj to Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0 z !_§iEnature Telephone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: License Number 0 Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name M Registration Number r210 Address Expiration Date Signature Telephone G) i y SECTION 4-WORKERS COMPENSATION(M.G.L C 152 g 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be QlE'FIC USE t1VLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of � Construction 4 Mechanical HVAC Q/ �--- 3 Plumbing Building Perot fee(a)x(n)5 Fire Protection �3(DI 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I' 00wmner/ uthorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1' as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name r Si iature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHWINEY EISS7BUILDING ON SOLID OR FILLED LAND UILDING CONNECTED TO NATURAL,GAS LINE Town of North Andover tAoR Of�i�mo 6'9ti 11� ht' yb O Building Department o 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax.(978) 688-9542 0 10V �9SSACNUA) DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit#RUT the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Q12 W 06Je, ,ve(-e#, rn d Facility location Signature of Applicant Lo%/a Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. • Town of North Andover °.,«�� ..�+ - � a Building Department41111 a 27 Charles Street . *=a North Andover, MA. 01845 D. Robert NicettaCH"u ' Building Commissioner (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION O 144JS Number Street Address Map/lot ,HOMEOWNER C VI R I (IUA- Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two 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 108.3.5.1)' 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 or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. 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 requirements. ♦ 4 HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL NORTH ED / Town of 0 �w , No 0co':H_ dover, Mass., %S RATED H �• BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System THIS CERTIFIES THAT....C ... �.......... . ................ BUILDING INSPECTOR.. ........................................... Foundation has permission to erect... .., .. bu' ings on ... 0........1*4 ......AD *. ........ Rough to be occupied as evo /� � �� �.'• Chimney . . . . . . .. . . . . .. . . .. . ... . ........ ...................... ................................ provided that the person accepting this permit shall in every respect..conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatinp to the Inspection, Alteratio a Con str ction of Buildings in the Town of North Andover. /M A P alda PLUMBING INSPECTOR h VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS .CONSTRUCTION START ELECTRICAL INSPECTOR Rough ............................... Service BU............../... ...W.........W. .............. ILDING 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. an `�--� Office Use Only u4E &IlITIIIII Malt I Df 50sar4allfs Permit No.e� 10 r � _ � artutxzti t1f�uhlit �fttq occupancy� Fee Checked o ' 3194 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 VJR 12:00 �J,{� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK l/ All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (j)l or Town of NORTH ANDOVER To the I spetntor of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Numb2/.// �D � 5 S &e Owner or Tenant Owner's Address 507M Is this permit in conjunction with a building permit: Yes _ No r_ (Check Appropriate ?ox) Furccse of Suildina Utility Authorization No. as 32 c Existing Service UG Amps /20 �`�� VaitS Overhead,'L: Unagrnd E No. of Meters l New Service 40 Amps \/oitS Cverneae Uncgrna No. of Meters Number of Feeders ano Amcac:ty Lccaiicn anc Nature of Prccosec Electrical ."1arK Total No. at _:gr ,n Outlets I NO. Jt :jai .::bs I No. of Transformers KVA , g Allover— In- No. at Lignvng Fixtures i Swimming ?col gmc. — cmc. _ Generators KVA i No. of Emergency Lighting No. ct Recectac!e Cutters No. of Cil =urners ; Sarery Un is No. of Sw,tcn Outlets No. or Gas Burners I FIRE .ALARMS No. of Zones Total No. of Detection ano No. of Ranges I No. of Air Ccr.C. tons I initiating Davtces No. of Oiscosats No cf Hear Total Total Pu--s Tons KV4 No. of Scuneing Oev,ces li Pu.—..: No. of Sart Containea No. at Disnwasners - ScaceiArea Hearing Kw Oetec::oniSounatng Oevtces I — Muntcicai Other No. of Criers { Heartna Cev,ces KW ! Lecat Connec,:on _ No. of No. of IIIA Law Voltage No of 'Vater Heaters KN i Signs Ballasts Winnc No 'Hycro Massage ubs I No. of !.Motors Total HP OTHE 3 a f/ Z� f 1.,� 6'•.��i1 ��, /lo�.�r s ©d�'��f �.-� ^i ap'r" INSURANCE CCVERAGE: Pursuant to the reautrements at '.iassacnusars general Laws _ I have a current Liaeiiity Insurance Patio-/ Inciuctng Ccn,c:etee acerattons C,:veraee or is suostantial eauivatent. YES _ NO — have suemirtee valtd proof at same to the Office. YES _ NO _ It you nave cnec-ea YES. -tease incicate the type of coverage my chec:ung the aacrocnate pox. INSURANCE —— SCNO = OTHER = (Please Scec:ty) (Exotrauon Dater Esvmatec Value`of-Ee rncal 'Norlt S Final to Starr Inscecaon Dare Racueszec: Roug^ Signea unser the Pe ties of perjury: FIRM NAME Ci1yz. /o UC. No. Licenseer�40 Sig azure LIC. NO. Sus. 791. No. Sod-�/9-GiS Accress el S °7' � Jl�/ /1^P/. ���f 7/r Alt. ;el. No. Q19' o' OWNERS INSURANCE WAIVER: I am aware that the !:censee aces not nave :no insurance coverage or its suostanval eautvalent as re- awrea oy Massachusetts General Laws. ano :hat my signature an :n:s cerm:t aopucavon waives this reawrement. Owner Agent (Please cnecx one) —etecnone No. PERMIT FEE S (Signature or Owner or Agenv ti�5n� 1 T3Date.....i.-.. .. ..'...J...7 71G j f NOR7M 1 A TOWN OF NORTH ANDOVER - PERMIT FOR WIRING SACNUSf� This certifies that ......... .. G. c,.t".. ,�...... has permission to perform ... ..... .. . .... . ...... ........ .{... wiring in the building of....... ..... ... . ....................................� at...... .U....... '�'7....... .. . :.......... ,North Andover,Mass. Fe'= Lic.Not .^a.-Chov...........................................................ELECTRICAL INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 1 Locatic,M Q/o A,--s—z, A VE No. Date TOWN OF NORTH ANDOVER . A&L „ Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ . ° 9 �3, °s�cNus't h Foundation Permit Fee $ � t Other Permit Fee $ Sewer Connection Fee $ ik • Water Connection Fee $ TOTAL $ 2`�°O Building Inspector 10755 Div. Public Works rte•, c PEkrOffla 114, APPLIEATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 "._MAP h�0. 25 LOT NO. i'jt% �� J/ j� 2 RECORD OF OWNERSHIP iDAT�IBOOK :PAGE — ZONE SUB DIV. LOT NO. LOCATION /�I V PURPOSE OF allMWU M ti/OWNER'S NAME n NO. OF STORIES SIZE -OWNER'S ADDRESS A �- BASEMENT OR SLAB ARCHITECT'S NAME 'T SIZE OF FLOOR TIMBERS IST 2ND 3RD VBUILDER'S NAME r J 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 L_AS BUILDING ALTERATION \'G5 IS BUILDING ON SOLID OR FILLED LAND WDLL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER ..� IS BUILDING CONNECTED TO TOWN SEWER �OARD OF APPEALS ACTION. IF ANY L IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES ."EST. BLDG. COST PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. v EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS i - 12 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 TL DAATTE'' FILED BUILDING INSPKCTOR 81 NATURE OF OWNE •OR UTH E AGENT 11 F E E Xo WNERTEL.JI PERMIT GRANTED CONTR.TEL.# e 3 _» CONTR.LIC.# H.I.C.k i BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY SiOR1ES 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 I AGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 6 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PI— ME-BRICK OR STONE P —___ PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA _ '4 1/2 '/, FIN. ATTIC AREA _ NO B M T FIRE PLACES HEAD ROOM _ MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD ✓'D ASBESTOS SIDING _ —COMMON VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. d FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE f 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED_ WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & 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. d COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS OIL AS T 13rd I NOHEATING • '' MORTjy i _ _- - - L Town of o v er No. /46 m i dover, Mass., Matte&+ q 1997 L KE COCMICH E WI CK i`�",�• V S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT..........................W �.. �.1¢/vf.......��l�I.!V............................................................................. Foundation has permission to MW......... ............ buildings on .....4.1.9...N!41 Y R.0A C .......fir.... ............. Rough to be occupied as �!r'!' 4-# . T�Nl - = C .. 1'!�....�! !..!. .....0r,9�/..'NI►M... C=himney p ............ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating,to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S T Rough ....... .........................rooli� Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR ' Rough Di.splay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry !Nall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner 10 7 TT Street No. Smoke Det. a Town of - North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) /'DATE /JOB LOCATION o umber Street Address Section of town 10MEOWNER" &iS-kY10L �1 Name Home Phon Work Phone PRESENT MAILING ADDRESS J✓)') in, N� lah C�r�ti r ✓� ►4 �l�'�5 City Town State Zip code 'i'he 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 +-iat the owner acts as supervisor. (State Building Code, Section 109 . 1 . 1) -LFINITION OF HOMEOWNER: 'erson(s) who owns a parcel of land on which he/she resides or intends to eside , on which there is , or is intended to be , a one to six family dwell- i.ng , attached or detached structures accessory Lo such use and/or farm : tructures . A person who constructs more than one home in a two-year "-.�ri.od shall not be considered a homeowner. Such "homeowner" shall submit Lo the Building Official, on a form acceptable to the Bulding Official , ghat he/she shall be responsible for all such work performed under the ':uildi.ng 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 :North Andover Building Department- minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements . j 4,K6MEOWNER' S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 ,000 cubic feet , or larger , will be required to comply with State Building Code Section 127 . 0, Construction Control . 1 )Location --Z - - Flo. Date /> NORTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ �a + Building/Frame Permit Fee $ s a CK504ation Permit Fee $ I"JE1 CC&NT(Wermlt Fee $ f Sewer Connection Fee , $ Water Connection Fee $ r DEC 2 8 TOTAL $ .. .. -: Building Inspector Div. Public Works PER3,ttT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. -I LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES f E GG! OWNER'S ADDRESS / !. .� /�i�f BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME , SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 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. /r ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY f ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AN*D�APPRO EDBYBUILDING INSPECTOR DATE ED 1-2Z� Z--7 BOARD OF HEALTH SIGNATURE OF OWNS R AUTHORIZED AGENT FEE U PERMIT GRANTED OWNER TEL.# PLANNING BOARD CONTR. TEL. CONTR. LIC.# BOARD OF SELECTMEN BUILDING INSPECTOR sr a BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S-ORIES 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 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D — PIERS PIASTER _ DRY WALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'TAREA _ V, 1/7 1/. FIN. ATTIC AREA _ N_O 8 M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING COMM ASBESTOS SIDING _ —COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. d FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I- I POOR _ ADEQUATE NONE t 5 ROOF 10 PLUMBING GABLEHIP BATH Q FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT 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 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 I NO HEATING 0 xo- RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home improvement contractors and subcontractors engaged in home improvement contracting,unless specifically exempt from registration by provisions of Chapter 142a of the general laws,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MAr 02108. Designated Registrant's Name: Registration Number: d 3 Qui 'D Salesperson's Name: / This agreement is made on / "� / between &JUZ, (C ACTOR) Of ��.��('CCO �rL.G.4:�GL�Gc(�i/ /V;Fadi 6 f,, 6 -7 (ADDRESS) f� (PHONE NUMBER) hereinafter called"Contractor"and ° �` L�,�Gtt('" G{�w ``// (OWNER) of 7�� 7 �� l'��L t ,' lLu�✓ to d 0 — (ADDRESS) ' ' (PHONE NUMBER) hereinafter called"Owner". DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contr for s to,perfo a good and workmanlike manner all wok detailed below. Such work consists of the following: ", �T�G` L'L�C.G IGD DETAILED DESCRIPTION OF MATERIALS TO BE USED Materip to beruse#n performing the above described work consist of the following: II. PRICE /r /' Gv Contractor agrees to do all work described in Section I for the total price of$ Aydd III. PAYMENT Payment will be made as follows: 13,3 1/31%($ upon signing Contract; %($ )upon completion of ; �Q �dU %($ )upon completion of and the remaining %($ )upon verification of the work by Owner and Contractor as having been satisfactorily completed,which verification shall take place promptly after completion. Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, in advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever amount is greater IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the ore the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the or on r about —(date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by te). Th Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoids le by&Contractor shall not be considered as violations of this Agreement. T, �" Z, COMMONWEALTH VtrAh 1 Mcw I yr rUtsUG SAFE YY OF 1010 COMMONWEALTH AVE. s..- MASSACHUSETTS BOSTON,MASS.02215 #, .I ENCLOSE CHECK OR MONEY ORDER LICENSE EXPIRATION DAT ,tom,,, `� CONSTR. SUPERVISOR FOR REQUIRED FEE, 06/30/1993 MADE PAYABLE TO EFFECTIVE DATE LIC-NO. a, RESTRICTIONS "COMMISSIONER OF PUBLIC SAFETY" NONE �;= 06/30/1991 022680 P. I'r ARTHUR J WALSH JR j (DO NOT SEND CASH). 11 55 PLEASANT ST I SS IN 013-30-8376 N ANDOVER MA 01845 PEASE NOTE FEE INCREASE PHOTO(BLASTING OPR ONLY) FEE: 1 it 100.00 E ,:FECTIVE FEB..` 1r . 1989 HEIGHT: Nor VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED -OR -SIGNATURE OF THE COMMISSIONER DOB: l e / 06/09!1939 . �i( I�� . D ` NOT DETACH LICENSE - STUB S .,I'�,µ��;;�,1��.;�• ••' THIS DOCUMENT MUST BE! , SIGN NAME IN FULL-ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF SIGN URE OF LICENSEE I« li ,.1.'".•'•"'' � '•�' THE HOLDER WHEN ENGAGJI OTHERS:•;, IP6,/T'�THI({IB:PRINT, ED 1N THIS OCCUPATION COMMISSIONER t: I 200M•2.87.81429 ' GJ� Pmvnemuaeal/�t o�./l�aaaac%uaelta HOME IMPROVEMENT CONTRACTOR Registration 103358 Type - PRIVATE CORPORATION Expiration 07/07/94 A. J. Walsh & Sons Arthur J. Walsh 55 Pleasant St. ADMINISTRATOR N. Andover MA 01845 NORTFI Town of ��c 4 > > Andover 0f o� L A o 5 dower, Mass., 19 2cocr CnE wick AORA TE0 S S H E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ....ftoo � BUILDING INSPECTOR THIS CERTIFIES THAT ... .. .. ........:................................. Foundation has permission to erect-MAOMMS... buildings on....y�..�....ev W.Joe•••OWN••••••••••••• Rough to be occupied as... �.�i��.�. ... .�. 0 ��.��. ............. Chimney C e provided that the persoffaccepting this permit shall in every respect c form to the terms of the application on filem 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. ,f �r j PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough Service BUILDING SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Displayin a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL / 9 CONSERVATION FINAL street No. Smoke Det. CMAICQ MIATEM FINAI — O'.r ? DRIVEWAY ENTRY PERMIT Location +1 v k\A RSS k VE— No. CNo. '2'2'4-- Date . NORTN TOWN OF NORTH ANDOVER �• Ota"�D '�,�0 O? „ Certificate of Occupancy $ } 0 + Building/Frame Permit Fee $ ssAcHu" E�t� Foundation Permit Fee $ s Other Permit Fee $ Sewer Connection Fee $ f Water Connection Fee $ -AP Building In or 61%4 Div. Public Works Location 'r No. Date "GRT" TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ 41 Building/Frame Permit Fee $ S., CHus Foundation Permit Fee $ � s� E� Other Permit Fee $ .Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector y Div. Public Works R PERMIT No. 7i� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS PERMIT 1 MAP h40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. F— LOCATION �� PURPOSE OF BUILDING OWNER'S NAME / J NO. OF STORIES Gam` �(,•L�/ OWNER'S ADDRES //� �lJ /)� / BASEMENT OR SLAB -- ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BLKLDING CL, DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. C09r PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS t - 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 r PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 'R DA ILED /G .!/CJ WARD OF HEALTH SIGNATURE OF OWN,0fi OR AUTHORIZE AGENT FEE w /s — PERMIT GRANTED Ot'.`�ER TEL.# PLANNING BOARD_J�.G7� Lo eCO"ITR.TEL.H, 3 / is ig MNITR.LIC.# WARD OF SELECTMEN (CNV-� `" �ZO BUILDING INSPECTOR }.t Lf' Q x BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 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 2 FOUNDATION 8 INTERIOR FINISH CONCRETE a 1 2 13 CONCRETE BL K. ---III PINE BRICK OR STONE HARDw D — PIERS PLASTER _ DRY WA_LL _ Li—NF IN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ '/. '/x 1/. FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDSB 1 22 J 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"✓'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. d FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRYWIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK _ { SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING J1 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 NORTH ONM Of over 0 4�. --. t COCMICREWIIT. kAndover, Mass., ���� 1+ 199.3 ORATE i BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • • BUILDING INSPECTOR JTHIS CERTIFIES THAT �ak �.. �► . ...................................... Foundation has permission to a0W.....A .. buildings on ..4440......f. Ate"..... Rough .... to be occupied as...........��f ...C4.).... .ni.b Chimney ' e provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION 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 Fnagh 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. QP1Air:R /IAIATFR FINAI DRIVEWAY ENTRY PERMIT A.J. Walsh & Sons Inc. 55 Pleasant Street North Andover, MA 01945 Mass. LICENSE # 022680 Mass. I&GISTRATION # 1033.58 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and snake sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All homeImprovementcontractorsa d subcontractors In home Improvement contracting, unless specifically exempt from registration by provisions of Chapter 142a of the general laws,must be registered with the Commonweullh of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton Place,Room 1301,zu MA 02108. Designated Registrant's ame: > g Registration Number; Salesperson's Name: This agreement is made on bctwecn i ( (CONTRACTOR) (AD S) l- (PHONE NUMBER} hereinafter called"Contractor"and (0WNr-A) f of (ADD .SS) (PHONE NUMBER) hereinafter called"Owner". DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contractor agrees to perform in a good and workmanlike manner all Work detailed below. Such work consists of the following: DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in performirng the above described work consist of the following: U. PRICE .� Contractor agrees to do all work described in Section I for the total price of$__1,520 . III. PAYMENT Payment will be made as follows: f33 1/31`Yo($ upon signing Contract; %($ )upon completion of , �%($ )upon completion of , and the remainin�z 4'0($/!/�y-) pon verification of the work by Owner and Contractor as having been satisfactorily completed,which verification shall take place promptly after completion. Notice: No agreement ror home Improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract price or the total amount or all deposits or payments which the contractor must make, In advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever amount is greater. �I IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the mjateria4before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin tt�p work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoid lc ' the Contractor shall not be considered as violations of this Agreement. r � V 01 L �fi !�� Office Use Only o l 0UP L ammunwailth 1f _49ms 215 Permit No. Rett of ubiir , Occupancy&Fee Checked 1J� � �� BOARD OF FIRE PREVENTION REGULATIONS 527 C.1R 12:00 Asa (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date J f G (M& or Town of NORTH ANDOVER To the nspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant �J�� ��a✓/�/ Owner's Address ✓���r' Is this permit in conjunction with a building permit: Yes ;ZL No C (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amos _J Voits Overhead '_ Undgrnd No. of Meters New Service Amps _� Voits Overhead _ Unegrnc No. of Meters Number of Feeders ane Ampacity Location and Nature of Proposed E:ectrical Work No. of Lighting Outlets i No. of Hct T-"s I No. of Transformers iotai K`JA No. of Lighting Fixtures j i Swimming Pool in- 77 r.c. - cmc. _ I Generators KVA No. of Emergency Lighting No. of Recectac:e Cutlets 3 I No. of Cil Burners I Sattery Units No. of Switch Outlets I No. of Gas Surners FIRE ALARMS No. of Zones No. of Ranges No. cf Air C;.r.c. '0121 No. of Detection ano :ons Initiating Devices No. of Oisoosais I No.of year Tcta) To;ai ?urtvcs 7bns K:'J No. of Bouncing Devices No. of Sent Contalneq No. of Dishwashers I SoaceiArea -teatir.a K`:! Oetac::on/Sounaing Devices Devices K.! Loca) ;_ Mun No. of Orvers Heating tcieat Other i _ Connec::on No. at No. or Low Voltage No. of Water Heaters KW I Signs ?aiiasts Wirinc No. :Hvaro Massace Tubs , I No. of Motors Totai HP OTHER: INSURANCE CCVEPAGE. Pursuant to the requirements of `.tassacnusens ;enerai Laws I have a current Liaodity Insurance Policy inclucing Cemc:etec Ccerauens Coverage or its substantial eauivaient. YES = NO = I have suomittea valid Arcot of same to the Office. YES = NO = it you nave cnecxee YES. please inoicate the type of coverage cy cnecKing the aoproonate cox. INSURANCE = SCNO = OTHER = (Please Scec:f-.�) (Exc)ration Date) Estimatea Value of E!ectncal 'Norx 5 WorK to Stan I lnsoec,:on Cate Recuestec: Rough Flnai Signea unser the Pe sties of penury' FIRM NAME V- /V-, -7/0 17 10, LIC. NO. � Licensee N 2 U Signature ✓• LIC. NO. AL 19' �� !I Bus. Tei. No. Address 4 f✓fi�1 S G�f / �1•✓�S l-4 /Lri> • 0��7T_ Alt. :el. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee ^_ees not nave the insurance coverage or its suostantiai ecuivaient as re- quirea ov Massachusetts General Laws. ana that my signature on :n:s zermit application waives this requirement. Owner Agent (Please checx one) r` Tetecrone No. PERMIT FE=_ S J' (Signature of Owner or Agentt _ _ ~ Date....� .. !"" � �� 7 828 NORTI� "° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING lo . ,SgACNUSE� 1 This certifies that .... ... k�.......1.�c.�z. �........................................... has permission to perform .......kJ6.:e ...... � ....................... wiring in the building of.... ....................................................... at.... 1 ......... .R Ss.... r................ .North Andover,Mass. .467W ELECTRICAL INSPECTOR C # e F LJ°M tM11 PAID WHITE:Applicant CANARY: BuA 1.gjgt13-33 PINK:Treasurer Location No. DateOf �► NORTh TOWN OF NORTH ANDOVER A ` Certificate of Occupancy $ • i + � Building/Frame Permit Fee $ Foundation Permit Fee $ ` Other Permit Fee $ TOTAL $ (, Check # 6 6341 Building Building lnspect� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: rn X SIGNATURE: (C� Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION z 1.1 Property.Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number 1.3 Zoning Wbrmation: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage(fi) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reqwred Provided Required Provided 1.7 Water Supply M.G.L.C.40. S4) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zooe Outside Flood Zone 0 Municipal 0 On Site Disposal System SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record NAne nt) Address for Service f e kr-J 72 tgn Lure Telephone 2.2 Owner of Record: Name Print Address for Service: O z Signature Telephone MMrn SECTION 3-CONSTRUCTION SERVICES 3.1 a:ensed Construction Supervisor: Not Applicable 0 Licensed Constructt�Supervisor. Cis va�,�-7 O (fir License Number Address (J IIAA3 D Expiration Date signature Telephone r S.2 Registered Home Improvement Contractor Not Applicable ❑ 0 :ompany Name Registration Number Adress r Expiration Date ignature 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.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: e—C le ' X yb `Y Z T 6_0 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be �O wCIAl,USEONLY 1. � , ; Completed by pern-dt applicant $ z 1. Building (a) Building Permit Fee � Multiplier 2 Electrical (b) Estimated Total Cost of _ Construction 3 Plumbing Building Permit fee t,)x (b) 4 Mechanical(HVAC) 5 Fire Protection / !i 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERSAGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 TIMBERS 1 2ND 3RD SPAN r IENSIONS OF SILLS IENSIONS OF POSTS iENSIONS OF GIRDERS GHT OF FOUNDATION THICKNESS E OF FOOTING X TERIAL OF CHIMNEY UILDING ON SOLID OR FILLED LAND UILDING CONNECTED TO NATURAL GAS LINE �vvJ Iii DO tAA f 0 1 r01 D0 r3 Yutii 1:,ttiultlttr11 f1U I�JU I/Uoi MORTGAGE INSPECTION SKETCH. OF PROPERTY In N122ry .4,vOJf/f.,P ESSEX county,MA Applicant ems. 1 ,r/.✓Aa r�wi•v Book 'Y i Z-2 Page 4V L C Cert.No. ' Scale: L ~� Dale, 1OT- /FJ I • 4O75 /d rVA'u 7 4 ZO,000:"5 . FYI n o� i r1� 1' S rafry `l �o r- /4 wood O 4 at 4r0 �I 44,46.S46'11U5E773 AVENUE PetFAW FOR: 6ji�'IA,V GA_;.a.rJAN .ar/D CUGf"Syo� MANrG.oG�.t�vC. In my profesalonal opinion the buildings are approximately located on the ground as shown yy, hereon and contormod to thea applicable horizontal dlmensjonal and setback ` f+t PP y requirements of the Zoning By-laws of the ro H,n/ of n/C RTf y AA100✓sit -at the time of � ?f construction or is exempt from violation enforcement action under Mass General laws chapter 40A-Section 7,the lot tis shown does not fall within a 100 year Special flood Hazard Zone as delineated on the FEMA/FIA National Flood Insurance P 9a9►c'ct'AA h Program Map' '. Community No, Sa 09.iT Panel N o n a c Dated -2.-9-4 Zone cy ' - t m"r=c"` TNS&alcn was drawn ty metme hepect:on purpose?"v4 b roon d t to be+co .a ,ee t&'AI AN en Inelrument @Lr-Vy.It cnwld 1 1 eehnical Park Drive De rvr"r uncarslow rest tr en I rUm4n?Bur*Is acwnnof6Mo at a lav dale we wol not be raSW&Ue W any Chargee Thar oavr. WOObrook, MA 02343 Th a n+atpege roPecvm to b03ed upon tee 11Cd 616 0a ae 30010100 Dy IM Ma33aChYSeIU AisoCairon or LenO&,"*ore and C41 � &VInse/e Inc N0 Dertlecaitoh to ee0 nae Dean n1a08 tN INS Arm. V- - n\r e 1)TB7"t 400 NOT1E:.Mwao�eeoe33ory ecn,ewrvy tw nvt Handed:�me[ons carr�Aceton 0 n-eneda eDore proun0 e�rrmm�0 podsj uy✓ �" - /,,...��.Fax(781)767,5673 f� N�Oud Po e�1 • FORM - U - LOT RELEASE FORM ( 0 l INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. owns.......................................■...............................■ 11-2 APPLICANT HONE ?V-(y�'/-5 7g? ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET �:se h. A.-e--........ TREET.NUMBER..'ti<<� ....... OFFICIAL USE ONLY RECOMWNDATIONS OF TOWN AGENTS ........ ......................................................�'.r.......... DATE APPROVED CONSERVATION ADMINISTRATO DATE REJECTED COMMENTS _ DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE �1ie {.i�aninuy�z�ueaCll u��✓��.a.Q�czr�rr�Je(;rJ BOARD OF BUILDING REGULATIONS F . License: CONSTRUCTION SUPERVISOR Number: CS 002837 Birthdate: 11/30/1957 Expires: 11/30/2003 Tr.no: 8741 Restricted: 00 ROY J CHARLANDr 670 S UNION ST LAWRENCE, MA 01843 Administrator NORTH Tovm 0E . Andover O t^ No. ~ -_ 2°�A Co'wTq cQ� dover, Mass., ORATED p �CC S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • �, ,a � BUILDING INSPECTOR THISCERTIFIES THAT........................ ..............,64 ............I.�.. ..1.�........................................................................... Foundation has permission to erect... ...V4"Jt y0 buildings on ........�� ......... .AAA A V &..•.- . Rough p �� O v �.�.........P400�.......?�......�Ya r VAA410 Chimney to be occupied as.. ........ .................. 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 La s relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. A A/'� �� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. I Rough . PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR �440��I& Rough ....... . ......... ....... 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 T No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Date. A r QRaTM 1 o 3 TOWN OF NORTH ANDOVER 9 • PERMIT FOR GAS INSTALLATION SACMUSE�This certifies that . . has permission for gas install jtion . .��?9.�. . . . ' * .�.�r . . . . . in the buildings of .�h !`'.`?`�.. ... .... . ... i r`� at . . . . . . . . . ., North And ver, Mass. Fee. .o? Q Lic. No.9�. : .� A �Jr �( a,� ✓1 GAS INSPECTOR Check# C 1�6 4 1 4376 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) /y , Al)dD✓e�r , Mass. Date ' d� 19 Ci Town ry� Permit # Building `J Owner's AT: Location o /�a Name '� -7 / Type of Occupancy: C?/ New. ❑ Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ N r• Y Wy N N U Z tY N NfL N O N = W WoC O O W 0 N < m 0 N < tx O ' O F W < W W I- N d W < N C N O 0 W x N Z < a O C > W 0 ►- Z J t" Z F' W W O O > U. H W J < W > ts: W O Z < a: 4 N4 Q O O W — O W 0 rt = O L7 Y tL 3 0 t7 J U W > 0 !i. F- O SUB—BSMT. BASEMENT 1STFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check Ono: Certificate t�y' Installing Company Name pCorp. �JJDO AddressUlfWOU ! #8 Luu Ad" �' ❑ Partnership M'dIDG- MA 0 M r ❑ Firm/Company Business Telephone ilARtl"V Name of Licensed Plumber or Gasfitter 4�4 / TJ— 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 m% 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. signature of Owned Agent h I have a current liability insurance policy to include completed operations coverage. ❑ By TYPE LICENSE: Title ❑ Plumber ,gnature of Licensed Plumber or Gasfitter City/Town ..�sfitter APPROVED (OFFICE USE ONLY) ❑ Master ___�. A ❑ Journeyman License Number FORu 1243 NOBas a WARREN,INc.1989 t rr.v [r;p 0iii! r FINAL INSPECTION :i(:` i(.t1ES ;�, - —.__-- _ -- PROC:F(E. IN :PEC riON NO. -- - -- --- -- APPLICA T10N FOR PERMIT TO 00 GASFITTING NAME b TYPE OF BUILDING - LOCATION OF BUILDING - _. - PLUMBER OR GASFITTER s . UC_ NO. PERMIT GRANTED DATE t9 -- ---- --------GAS INSPECTOR r r� Date.. .... �........ ,4ORTH °f'"`°:•1"°0 TOWN OF NORTH ANDOVER O D PERMIT FOR WIRING ,SSACMUS� This certifies that ......... ......................... ..<............. .......... ..:-_ .... has permission to perform .....................J........................................................ ' wiring in the building of `�- ..`.."_.- . ................................................................................... at....../ ......: %w� ,North Andover,Mass. ..... ......................... ........................ Fee..'!.Ks............. Lic.No. C . ............. ............................................................... ELECTRICAL INSPECTOR Check N t y�� 45J � TBE COAMONWEUTHOFM4MCHUSE7TS Office Use only DEPARTNIEW0FPUBL1CS4FEIY Permit No. `fS Z f BOARD OFFMPREVEA77ONREGULA77ONS 527 CM 12 Occupancy&Fees Checked APPLICA77ONFOR 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 -,-.4-1 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) /6 Owner or Tenant A-, Y r N Owner's Address rah Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose of Building A(Q r4z— Utility Authorization No. Existing Service AmpsVolts Overhead 1:1 Underground No.of Meters New Service Amps / Volts Overhead EZ3 Underground No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work mit/ As' a v�Jr7ne�f No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round 1:1ound No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets 0 No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons 4o.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER' �hrceCover�e PtaA>antrotheiaqtmartatlsofMC'�a�a-allaws IbaNcaatLkt7dyhmaa=PokymchxlingConpl Cowrgeoritsstbgmtalegtuvabt YES ® ctmNO -IhavesubnattedvWpuofofsanletotbeOffim YES =A,,- � If oubawdledWYES pkm thetypeofcomnWby cheddrgthe ox.b111.::--�11 INSURANCE BOND r OTHER F-1 (P1easeSpedy) EVirafion D& Esturtatad Vahre ofFtl Work$ WodctoStart / 5.191° kq)ecfiMD&R0Wes1ed Rough Final Sigredundert�iePnakiesof �QQ� FIRMNAME LicamNo. Lioerme r oma+ ^14.67/�,5��l Signahue DOMSONO 95J7 BusiMTeLNo. 663 893 Arlfirc Alt Tel.No. OWNER'SINSURANCEWAIVER;IamawatedadrLi�doesnothawtheirwmmcc)wageoritsaistEg le4uvalaYasleWedbyMa%achtmMG 1Laws and thatmysignatureonthispeun tapplicationwaivesthisregtmemalt (Please check one) Owner F-1 Agent Telephone No. PERMIT FEE$ , Igna ure ot Uwner or gen Z - The Commonwealth of Massachusetts " Department of Industrial Accidents R< Office of Investigations Boston, Mass. 02911 �fO+M Sye'� 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. Company name: Address City: Phone# Insurance.Co. Policv# Company name: Address City: Phone# Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonments weU_as_civil.penattiesin.thelnrm-fA_STOPYYGRK_ORDERand_afire.0-CsI OM)-aliay.agaimtme 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 andrnaffies f perjury that the inforinaticri provided above is true and correct. Signature, pate Print name 4J Pbone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept E]Check if immediate response is required Licensing Board p Selectman's Office Contact person. Phone# E] Health Department Ei Other