Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 419 BEAR HILL ROAD 4/30/2018
419 BEAR HILL ROAD 210/064.0-01140000.0 Date...... ........................ NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU . ... .... I..!. ......n This certifies that ...... ....... n ....................... A-� �1R'�� VL-C,' , t has permission to perform ....... ..................... ...*.�... ........ . ....... wiring in the building of . Y,R ........... ....... .................... .... .N rth Andover,Mass. at.....9B.......� Q --3"e(.01A.j iNk(Cu If,,. Fee...�567�.. Lic.No..P;��....J--3 ...a.................... ......................... ELECTRICAL INSPECTOR Check # 7 5 C �$4Gcri b'�Fan NORTH ANDOVER)BUILDING DEPARTAENT 1600 Osgood Street Nort4 Andover Tel: 97.8-698-9545 - - Fax: 979-688-9542 Busmss FORM FOR TO ME-CLEW . MMS: Z- ONUSTGNSTPUTCE.- 4,= TYPE OF33USMW-1 1i4 P BUILDIN `r LAYO T PROVIDED: YES NO ZONINGBYLAWUNACTE., YES NQ J3UM Jii8j C'fGE.SIGN .TUBE EUS] ES)FORMFORTMMMERX • w 2.40 Ronne Occupa don(1959132) An accessory use conducted vvilbi . a dwelling by a regdga� who resides k the dwelling as his principal address, which is clearly gecondmr r to the use•of the building for lift puuposes. Home occupations shall include,-b6.t not Tmited to the following uses; personal services such as fiuiushed by an artist or instzuotor, but not occupation involved with motor vehicle repairs, beaa4r parlors, animal kennels, or flie conduct of retail business,or the xxmufad risig agoods,which impacts the residmtial nature of the neighborhood; d. For use of a dwelling inn any residential district or multi-famffy district for a home owup6#ion,t-ho following conditions shall apply. a. Not more`loan a total of three(3) peopie may be.employed- t1;e,home occupation, ono of whom.shallbeifievownerofthehomecic u ationandresiding%usaiddwelling, b. The use is carried on si dly vffiin.The,principal bmlding; c. Thwo shall be no exterior alterations, accessory buildings, or display which are not customaW with residential buildings; . d. Not more than.-twm-t r five(25)percent of the wd t+ng gross flocs area of 1ho dwelling unit. so used, not to exceed one thousand (1000) square feet, is devoted to'such use. fn connectionwith such use,there is to be kept no stoop in.trade, comnodiftes or products which occupy space beyond these Jimits; e. There wM be no display.ofgoQds or wares-visible from the streei; f The building or premises occupied shall not be rendered objectionable or detrimental to Ifia xesideWal charactex of the neighborhood due to the motor appearance, oassiort of odor, . gas, smoke, dust, noise, disturbancq, of in. any other way become objectionable or d&hmtalto anyTresidentialuse wifiathe.neighborhood; g. AnyT such buildirsg shall include no fofeatuzes desi not oust�maxy in bulc�ir�gs for.resident7�1 �ignatare • Date S t -4 North Andover MIMAP June 28, 2016 . #300 #358Jj r 7r�064.0-0025064.0-0026 064.0-0033 . Ar DalOF 001, 064:0 0014; - 4 ier',.r/ #311 � •!��� J.`.f ' �, J r ���, ,, #299 # 4.323 y x064'.0=002 ' Ole ' B ./N. / � d • f a�f s�F� J d r 64:0-0015 � � f r� r . 06Orr -F 4:0-01�1�1 > #45�7' ' 064.0-0112 � r 064.0-011°4 �,/' RZ"1 064.0-0115 064 -0099 / 064. 0 X #470 #450 / 064:0-OY19 f l/ .064.0- 1.1 08 � 01 1 64:0-0098 ` 0117 / „!� ;- y.. #410 f,� 0,64.0-0120 x'06�-0102 r� #395 a01 064.0-01.17 �O e. 060-009, / = #1 o aA , '''' 7 s JJJ� �e, o0r,06 x,64.0-0103 #400 ae�d� s t- #15 064.0-0096 >0d ! - per�/;+r ,r 064.0-0104 #380 � Ja 064.0-0122 #100,x+ 64:0=0095 064.0-0105 #349 / s® 064c0-00 094 a'+' 064.0-0106 Q MVPC So Zoning Overlay Zoning Municipal Boundary ©Adult Entertainment Distric Businei s 1 District ❑Machine Shop Village Ove : Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, — Rail Line 2 Watershed Protection Dist D Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Interstates 0 Historic Mill Area 0 Busine s 4 District NORTil Valley Planning Commission(MVPC)using data provided by the Town of —I 0 Medical Marijuana O Genera Business District Ot t sae a q� North Andover.Additional data provided by the Executive Office of —SR B Downtown Oveday District a Planne Commercial Dev ? eft �e OQ Environmental Affairs/MassGIS.The information depicted on this map is Roads 0 Historic Distdct Conidc Development Dist j. ( for planning purposes only.It may not be adequate for legal boundary Osgood Smart Growth(40 C ComicDevelopment Dist Q .-, to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER t r Easements a Corrid Development Dist t- A =.Hydrographic Features MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Industri I 1 District ❑Parcels Streams THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Industri 2 District n �r OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands is Industri 3 District *�° f ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF D Industri S District 9q' Exempt Lands Reside ce i District '11,9 °��reo• 4y THIS INFORMATION Reside ce2District SSACMUS� R—idei ce 3 District d de ce 4 District 1"=188 ft d yrde ce 5 District TTS de ce 6 District ,a a esidential District THECOAMONWE4LTHOFMA,SS4CHUSE77S office Use only DEPARTAIEffOFPUBIICS4MY Permit No. ` BOARDOFFIREPREVENTTONR C,UL4HONS527CMRI2(Xf' Occupancy&Fees Checked APPUCATTONFOR PERMIT TO PERFORMELECTRI®R12.-:COWL O ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,S27 C (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 4 d Town of North Andover To the Inspector of Wire,, The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) L/I 9 ReAx, A l/ Owner or Tenant !, Owner's Address Ae0kA1,11 &( W, � — Is this permit in conjunction with a building permit: Yes F771 No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps �Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work _ "flo _ No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting FixturesSwimming Pool Above Below Generators KVA round round No.of Receptacle Outlets � No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW 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 a OTHER• 1� y IrMW=CoMage.PUMO trothelegmmleMofMassacln>s MGMI!Iliaws IhaveaamatlAdgyhmuarrePbhLyinchxWCCon4)lep,- ' Cowageorilsst>t:sU%alWvalaI YES ®— NO IhavewhnriuedvabdpmofofSa=tDdCOffice YES r-q) Ifyoubawdrd®BYES,pleascuxbcatethetypeofeovtrageby drd>he Lebox INSURANCES BOND mum Spdy) Evirafim Dae Estin>&d Vakcofl7ectrical Wotk$ WolktoStatt O bspectiMD&Red Rough Fiml Signedunderthieftallies f gt>� Olu'y FIlZMNAME . d •� / i�6� LimmNo. ;.36110 L Licer e rnn Slgnatute �^+�' LiarmeNo BusirmTel.No.41o3 Artifirec .ail /I"ll� .��/L Y�� /f 037 AkTelN�l�� OWNURSINSURANCEWAIVFRIamav, cmdattheLi=IsedoesnothavethemtranoemvaageoritsatsUtialegwvalentasieWmdbyMasmdimU.sGa)alLam and that my signatiue on this peurritapplication waives this legttiterrertt (Please check one) Owner Agent s Telephone No. PERMIT FEE$ Signature ot_Owner or Agent Z The Commonwealth of Massachusetts Department of Industrial Accidents F Office of investigations w� Boston, Mass. 02111 See Workers'Compensation Insurance Affidavit Name Please Print Name: Location. Cites Phone # I am a homeowner performing all work myself. E] I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for nny employees working on this job. Company name: Address Cid- Phone#: Insurance.Co. __ Policy# Companv 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$1,5oo.00 and/or one years'imprisonment.as_wetLas_civil.penattiesinlhelmn-d aSTOP W-ORK ORDBIAW_a.fine-f-isliMm)ailay.againstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone.# f Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina O Building Dept []Checkif immediate response is required .0 Licensing Board p Selectman's Office Contact person. Phone#: ❑ Health Department F1 Other i Location No. S Date g 3 T NO 0 TOWN OF NORTH ANDOVER 0 • • Ow 9 }-a Certificate of Occupancy $ ;7 sACMUs Building/Frame Permit Fee $ `� G Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ t Check # 6 5 ; 14 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING for BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: //V At. 16 Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 4 V) �3�tdr►rte. —1�1 t_1_ `(k�A (114 O11 � Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required 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 Float Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic®isdc: Yea ...kqo M 2.1 Owner of Record In B�2a�n�tt R ����ue SM��� �-�� �a2 ��CrL Y2A A✓� � Name(Print) o Address for Service: x 97t- 7g¢- f7Crj !' Signature Y Telephone 2.2 Owner of Record: W Name Print Address for Service: ati z M Si nature Telephone M SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 'CvOy C. L.4% e. Yk,.ts Licensed Construction Supervisor: I 1 t'4z,4- S`X pjot,4� License Number Pa sm4 6c�'3 nraNv ct_c..� , yYy os I c9 mn Address �, � �.� Z7o4 DLA (6 0 3-3 8 - (0 3 Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �F5 -amu SYsMWs, 1ZTIC. ,, Company Name IV) 4 1 m Registration Number �. Addr L\ A.:M�p (003 3 X- 77 7, L /o Expiration Date Signature Tele hone 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 bulding permit. -Signed affidavit Attached Yes.......9 No.......❑ SECTION 5 Description of Proposed Work chec all applicable) New Construction Ef Existing Building Repair(s) ❑ Alterations(s) IVAddition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Z1 Multiplier 2 Electrical (b) Estimated Total Cost of 7 6 Ss ' Construction cP 3 Plumbing 30 -- Building Permit fee(a)X (b) � 1 4 Mechanical HVAC /N'61-it of U 5 Fire ProtectionVVA, 6 Total..- 1�-2-�+.4+ �t� -4�2' Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH DING PERMIT I, as Owmer/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 ,aer/Authorized Agent of subject a. 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 of14Ymw/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TFVMERS 1 2ND 3 RD + 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 BUILDIN2 CONNECTED TO NATURAL GAS LINE _ w The Commonwealth of Massachusetts d Department of Industrial Acciden,is . Office of Investigations Boston, Mass. 02 911 `''°+M 5�•'' Workers'Compensation Insurance Affidavit Name Please Print Name: b y.S 4 c..o ra S%4 s-r W.Y►-% Location: \21� r—ft 6 fi y 0%Q& City ft"Vi1't-mL !a4 Phone # I am a homeowner performing all work myself. 1 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 CRY: Phone#7 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 mn-as_chd...l.penaltiesjn tbe-fmn-daSTOP WORK ORDFRand a fne401A.0M)atiay.againstme, I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. y I do hereby certify under inand penalties of pedury at the information provided above is true and correct. Signature Date % Aft 01h Print name AeV G S-A, Phone. Q0-'I (a Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing 0 Building Dept []Check if immediate response is required .0 Licensing.' Board p Selectman's Office Contact person: Phone#. ❑ Health Department Other FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary a Boards and Departments having jurisdiction have been obtained. This does not relf eve from the applicant and/or landowner from compliance with any applicable or requirements. *APPLICANT FILLS OUT THIS SECTION APPLICANT SEs- capes SYS`i',r,,h„ S PHONE 16— LOCATION: Assessor's Map Number G q, PARCEL SUBDIVISION LOT(S) STREET ST. NUMBER_ 416 OFFICIAL USE ONLY*** * ** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS st 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 IRE DEPARTMENT D rrs S o�e_(e A4C. �l�- �I�� RECEIVED BY BUILDING INSPECTOR k9 4/�� �'l�l✓dew DATE Revised 9197 jm a .' fie -r�anvnza�zauea�c a��«aaacleuaelta ' i Y`. BOARD OF BUILDING REGULATIONS 1 ; l License: CONSTRUCTION SUPERVISOR i 1 Number: CS 057622 Birthdate: 02/27/1950. �` •- k x. Expires: 02/27/2004 Tr.no: 16718 y Restricted: 00 a DOUGLAS P YASIKA 12 COLBY RD/PO BOX 698 , DANVILLE, NH 03819 Administrator t Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: -_ Board of Building Regulations and Standards Registration: 100426 One Ashburton Place Rm 1301 Expiration: 6/18/04 Boston,Ma.02108 Type: Private Corporation DES-CON SYSTEMS,LTD. Douglas Yasika 12 Colby Rd Danville, NH 03819 Administrator Not valid withou ig ature J 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Permit App cant %� \A��' Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector -ORTH Town of Andover 0 No. VL _q 0 COCHICINP1 \11 dover, Mass., 0RATED P? H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT........z............................................ ........................................................................ Foundation has permission to erect....�+R A.'a 41a!.... buildings on .......V.4.4Y.... .......... Rough ..... ............. .. tobe occupied as........RA nqp.��.......................................................................................................................... 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-Lawsr lating to the I pection, Alteration and Construction of Buildings in the Town of North Andover. 40. 41,7// Yg0 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 y�, ...................................... ""____.c...................... ... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Date.7-P. . ri .3 TOWN OF NORTH ANDOVER a PERMIT FOR PLUMBING SSA�NUS� ! X / This certifies that . . i/.l.!+.? . .�!.A S.G. . .. . . . . . . . . . . . . . . . . . . . has permission to perform . . . . .R.(-/�L.w 4a I . . . . . . . . . . . . . . plumbing in the buildings of . . 5�a.,.,/el�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . C,, North Andover, Mass. Fee. _�. ,-. . Lie. No../.�. 1/ . . . . . .`�. . . . . .; . . . . '�. . . . . . . . . . PLUMBING IN PECTOR Check # l J 56U"4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDO VER,MASSACHUSETTS R. r Date /-� / — c } Building Location Owners Name Permit# �'y Amount );C Type of Occupancy New rl Renovation ®� Replacement r-1 Plans Submitted Yes ❑ No El FIXTURES z rZ H a � wGn p� dCn A E+ W a • a � En W a a a N -14 SLR1M BASUV EP r Ise 110CR M ROCR 3M FIJaR 4IR FUKIR sIH FIDM 6'1H FIOM 7IH HAOt SIH FLOdt (Print,or type) Check one: Certificate Installing Company Name L Corp. Address ' El Partner. Business Telephone _ 3 -Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box: Liability insurance policy 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 El Agent E] 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 IssuejJor this applicah_'pq will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapf 1 ws. 4x;;1�141W �l t-� By 1 a e oi 17censeaer Type of Plumbing License Title AV CityfFown Ercense Numoer Master Journeyman APPROVED(OFFICE USE ONLY Location 14,/1 C/ 2-e_ I;-h r / ` / le�� No. 7 z S Date ORTH TOWN OF NORTH ANDOVER O,N60 , 1 ?.• • OR 9 Certificate of Occupancy $ • o ; i NusE<�' Building/Frame Permit Fee $ Vo Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� Check # ( �( � � uJ Building Inspector S TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING This�"fbr tDftu al Use qjo BUILDING PERMIT NUMBER. , f/ DATE ISSUED: ic SIGNATURE: v C Building Commissioner/1for of Buildings Date SECTION 1-SITE INFORMATION pPropeRy Address: 1.2 Assessors Map and Parcel Number: <� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ 1Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Ownerof Record .4A� . J✓til,w T Name(Print) Address for Service Signature f Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Tele hone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address ' i Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 L V C0 [-0 IVOK Iels Company Name r Z m n Registration Number Address ZLY70 .�-u� C`vZ 6 Expiration Datey ©� � Signature Telephone 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 buildin rmit. —Signed affidavit Attached Yes....... No.......0 SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: /�(�l!?ifs-r! S cl• '��7 94- SECTION fSECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee C-0 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 02 Y / &`'U1 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ✓J/�i'!.f-{�,�iYy as Own /Authorized Agent f subject property Hereby authorize to act on My=er el ive to k authorized by this building permit application. Signature of weer Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I1 Z�z"c `KX y as Owner uthorized Age of subject property Ir Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief // 6/e/ A % Pri Name ? 47` Signature of Own r/ Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVMERS 1 ST2ND 3 RD SPAN DIlvIENSIONS OF SILLS DM ENSIONS OF POSTS DIW--NSIONS 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 CERTIFICATE OF LIABILITY INSURANCE OPID DDATE(MWDDIYY) ILEYBR 11 06/27/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dan Hurley Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Chestnut Green, Suite 24 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Seven Federal Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Danvers MA 01923-3620 Phone: 978-777-9394 Fax: 978-777-3306 INSURERS AFFORDING COVERAGE INSURED INSURER A: Granite State Insurance INSURER B: Kiley Brothers Construction Bartholomew Kiley DBA INSURER C: 56 Conant Street INSURER D: Danvers MA 01923 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR POLICYEFFECTIVEPOLICY EXPIRATION LIMITS LTR TYPE Of INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ RO 117 POLICY 7 ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ � SCHEDULED AUTOS I HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ i EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND TORY LIMITS ER A EMPLOYERS'LIABILITY WC2164260 06/20/02 06/20/03 E.L.EACH ACCIDENT $ 100000 E.L.DISEASE-EA EMPLOYE $ 100000 E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION 0000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOr DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL .1Q—DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT IMMMOCHOMOSOMALL Old Colony Builders IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 70 Humphrey Street REPRESENTATIVES. Marblehead MA 01945 AUTHORIZED REPRESENTATIVE Daniel J Hurley ACORD 25S(7197) CACORD CORPORATION 1988 HIC # 126-356 ®YDS Coloup jhilbm' Int. 0 4 13 SEWALL STREET �. PEABODY, MA 01960 `h�Ecnirv.ca>�y+ /j1+ OFFICE: 978-922-6120 1' 1 SPECIFICATION SHEET �7 Home Phone: Owners Nam . . Work Phone: . . . . . . . . . Home Addres 9A*44 . . . . . . . . . . . State � . . . Zip. . . . . . . . . Job Address. . . . . . . . . . . . . . . -V-4. . . . . . . . . . . . . . . . . . . City. . . . . . . . . . . . . . . . . . . . State. . . . . . . . . Zipa SIDING 1. Siding Type Width. . . . . . . . . . . . Color. . . . . . . . . . . . . . . . 2.Area to be done. Main House Breezeway Garage. �, Additions. Dormers Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Insulation ./x'11,,-Q. . fir. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Trim cover Z-Yes 0 No Color. . . . . . . . . . . . . Trim to be done: So tts. '. . . d-�_ Fascia. . .'��. . . . . . . Rakes. 4 ��-- . . . . . . . . . . . . Ceilutgs. -. . . . . . . . . . . . . i. . . . . . . . . . . . . . . . . . . . . . . . . . 5. Casings.—j 6. Gutters and spouts ®'Yes No p . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Shutters 0 Yes a0o Gl .. . . . . . . ,. . . . . . . . . . . . . 8. Windows and Doors �!7!Q� ' .?. . . ,2 , ROOFING � - IF I. Material Type. . . . /CUJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Color. . . . . . . . . . . . . . . . . . . . . . . Areas to be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remove existing shi0 No I5 lb.felt. . . . . . . . . . . . . . . . . . . . . . Metal Edging. . . . . . . . . . . . . . . . . . .Chimney gij vetz . . . . . . . . . . . . . . . � . . . . . . . . . . . . Otl .. . . . . (� NOTES ���-�_.. .G�?'?4l. . L . . . . . . . r ,: . . . . . . . . . . . . . . . . . . . . �p ... . . . . . . . . . . . . . . . . . . . . . . . . . U104�f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . `'( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 $. .7.0.0.-. . . . .Deposit Material and labor to cost . . . . . . . . . . .payable as follows: $. . 777777= .Ist Installment $. . . . . . . . . . . .2nd Installment OG $JD. . Q. . . .Balance on completion Contractor will do all said work in a good workmanship manner: You nwy cancel this agreement if it has behn consummated by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by deliven•, not later than midnight of the third business da)-following the signing of this agreement. IN WITNE THEREOF, the arties have hereunto signed their names this. . . . . . . . .. . . . , day of. 4ld�" . . 2pc1 AcceptedC:!�'�l Signe . . . . Owne-- - .r j ®Yb oYorip �uilbem �1t. Signed. . . . . . . . . . . . .Owner Per. . . . t� . . . t'—C� . . . . . . . . . . . . . . . . . . . . . . . Rep`)•esentative Authorized Rep. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Strikes, labor disputes, inclement weather, or material supplier delays resulting in work stoppage are beyond the control of the company. The company guarantees all workmanship for a period of I Tear from the date of installation. Guarantee of workmanship assunres petformance of product installation under normal wear and tear conditions and does not guarantee against storm damage, acts of God or nature, neglect of proper maintenance or malicious damage or vandalism. Material guarantees are the.role respornsibilih•of the manufucturec NvR � ry E � Town ofdover y (05 4` C" 0� CoCHIC LA * dover, Mass., y a 3 7�A0RATE0 S H � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.......3 BUILDING INSPECTOR � OlI�� {, � ................ ............ Foundation ,e .............. buildings on '� r q ..., ghas permission to erect...v� ..........................................� ....... Rough to be occupied as.. �.... p.. ......Aff..C' If' 4.r at 'O. !f�.y....RrA&.W4d.. .�.`.....- 3himney provided that the person accepflfig this permit shall in eve respect conform to the terms of the application on file in P everyPP Final this office, and to the provisions of the Codes and By-Ljws relating to tly Inspection, Alteration and Construction of Buildings in the Town of North Andover. 6 Cf /leta yo 400` PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough .................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner t Street No. SEE REVERSE SIDE smoke Det.