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Miscellaneous - 49 BRADSTREET ROAD 4/30/2018
49 BRADSTREET ROAD 2101044.0-0002-0000.0 J � � �r Date....v...... :..�i4. f' f NORTH 3r°•`,r``�-'• �poc TOWN OF NORTH ANDOVER p PERMIT FOR WIRING b�sS^cMusE� This certifies that ..../..! , ......... w .................................. � �� : � . has permission to perform ,► wiring in the building of .......................... .. �iJ ✓ ......................................... "i. I I /a at.........F........ ......................... ....... ...... ,North Andover,Mass. Feed .............. Lic. ELECTRICAL INSPECTOR Check # U x 6732— a Commonwealth of Massachusetts Official Use only Permit No. �'� — t Department of Fire Services ; tR '�4 4; Occupancy and Fee Checked VAS BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I 0) City or Town of: Q e To the Inspec ori f Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Lj� &ko%kkee Owner or Tenant Cos I R Ctf)ye Y\ Telephone No. Owner's Address Sosf4 Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box)) Purpose of Building Sk o qp 17A W n h Utility Authorization No. ? l S?Q 9 b Existing Service Ito Amps Volts Overhead® Undgrd❑ No.of Meters New Service aQC:L Amps Overhead Undgrd❑ No.of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators K-VA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o Emergency ig mg rnd. d. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of.Switches No.of Gas Burners o.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g 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.o No.of Data Wiring• Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of M Telecommunications Wiring: otors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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. e CHECK ONE: INSURANCE�BOND ❑ OTHER ❑ (Specify.) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under thepains andpenalties of perjury,that the information on d I application is true and complete. FIRM NAME: LIC.NO.: Licensee: ;C►( TCG rdl, Signat re) LIC.NO.:,? 0;!9 C (If applicable, a ter "e empt"in the license number line.) Bus.Tel.No.. .�L C7 3?f Address: Scl/C S Alt.Tel.No.: ' 661 OWNER'S INSURANCE WAIVER: I am aware tha the Licensee does not have the liability insurance covera a 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. $,-�\6—r5 I Date x "OR Oq TOWN OF NORTH ANDOVER s PERMIT FOR PLUMBING s7 ,SSACl/USE� - This certifies that . . '� . . eel �. . . . . . . . has permission to perform ... . . �'w9�. r. plumbing in the buildings of ... pit, 'A/V . . . . . . . . . ., . . . . . . . �. . . . . . . . . . . . . N.Qrth Andover, Mass. r� i No.2a 3. Y.'5 r c. \PL UMBING INSPECTOR r Check # 1(9 7 7965 i MASSACHUSETTS UNIFORM ,APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location S d35s/I Owners Name 64�1 �j( Date Permit Type of Occupancy Amount e-�� 6 New Renovation Replacement Plans Submitted Yes � No ❑ F FDffURES U C U G O y O to q A U &1ST�11'INI' fsa 2NU I+UJCI2 �� FLOCR 3MSLUR ` 41R KJOCR 51H FLOCR 61H RiOCR SIH b7JJCgt (Print or type) Installing Company Name - r �! C(/ rl r�/��f Check one: Certificate Corp. Address l y rill ❑ Partner. usmess telephone MrFirm/Co. Name of Licensed Plumber: `F r�Gj1Ar'� ��1yjij Insurance Coverage. Indicate the f insurance coveracktng the appropriate box: Lability insurance policy ge by che LiOther type of indemni ty Bond Insurance Waiver. I, the undersigned,have been made aware that ❑ ❑ three insurance the licensee of this application does not have any one of the above Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa se State bing d Chapter 142 of the General Laws. By: ign ure of Licens umoe Title Type of Plumbing License City/Town cense um r APPROVED(O ❑FFICE USE ONLY Master Journeyman is Location No. Date b �� NpRTM TOWN OF NORTH ANDOVER O' Jo ,a,tiQ 41 � w a + Certificate of Occupancy $ J�CMUs.� Building/Frame Permit Fee $ �/ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ / Check # 7qo� c 18654 IV 0-12 .� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT MLA_%RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: o�. DATE ISSUED: rn X SIGNATURE: Building Commissioner/I r of BuildingsDate Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed UseLot Area Fronts ft 1.6 BUILDING SETBACKS tt Front Yard Side Yard Rear Yard Required Provide ReWred Provided ReqWred Provided So c5D l S 2-? v 1.7 Water Supply M.G.1—C.40.1 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood ZoneMunicipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes_ Noy rn 2.1 Owner of Record Name(°P nt) Address for Service: ZaU Irk�� Signature Telephone 2.2 Owner of Record. Name Print Address for Service: 7 Sr ature Telephone m SECTION 3-CONSTRUCTION SERVICES Qo 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supernsor: 65-3 U 01 License Number 70 Address O -5-33S- Expiration Date Signature Telephone r 1.2 Registered Home Improvement Contractor � Not Applicable ❑ 0 -Company Name Registration Number r.. Address Signa re motion Daft Si Tel hone G r SECTION 4-WORKERS COMPENSATION(M:G.L, C 152 § 25c(6) , Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes..... No.......❑ SECTION 5 Descri tion of Pioposed Work check all a livable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I`�CJS 2,0 2.2— ±,.,y S ho r,-&, Adam. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � � �O)Ft)HTCs USS QNLY ;� x� Completed by permit a licant 1. Building (a) Building Permit Fee 2,,p1D Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tg>X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 l'2z 0 0 L Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, a b \Ccs Y-. as Owner/Authorized Agent of subject property I -41E re thorizeto act on Nl6aa f in all m tt€rs relative to work authorize y this building permit application. Tf Si` afore of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ,as Owner/Authorized Agent of subject li property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief �...,J Vs�x Illi P ' tN e ) Si tore of Owner/AgenM Date NO. OF STORIES SIZE `o 4-Z, BASEMENT OR SLAB ✓L,ow 6- L.A. ND SIZE OF FLOOR TIMBERS �,- 1 2 SPAN DIWNSIONS OF SILLS I--2,i- k DEVIENSIONS OF POSTS 5 t( l l DIMENSIONS OF GIRDERS tfy-L-0— HEIGHT HEIGHT OF FOUNDATION THICKNESS p" SIZE OF FOOTING ` X MATERIAL OF CM4NEY *V- - _ IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE (�/ Date . . . t'. .. .... NORTh 3� TOWN OF NORTH ANDZO • PERMIT FOR GAS INSTALN �9SSACHUSEt This certifies that . . . .e.�Y .�. � .�'.'. . . . . . . . . . . . . . . . . . . . . has permission for gas installation l/4-11. . . . . . . . . . . . . . . . . in the buildings of . . . oG < c . . . . . . . at . . . . . �� 1�!� c� �Y`. . 14" North Andover, Mass. Fee. : . . ... . . . Lic. No.. .. . .. . . . . �r�.. . . . . . . . . . . . . . . . . f) GAS INSPECTOR Check# M� 'SSACHLIS--I?S UNIFORM .PPL1CATIDN r:)R rr_r"tMiT TD DD G�Sr,i 1 i 1:NG f✓rint ar"19P=J 2, ..i ) '9ulldinp La=tion dam/ Owner`s NZM1_' �5a0 - S? 9 0 i yp: of D=ua�aney �s New p Ftenouatiati ] eta*Zetnent Pians Sutnttted: Yes.:) NDS. N' W N C W _ a �. � � ,W �'• 'V JW ar' ,L1 C •D �� D W to ,p y U. d W a' _' W O, �', 'Q C ��;•< 'A a W D� tt. H- s.u8-•Bs�T. I II .� . �, I II , I I I .I I � : I •� I I I A •B A55 t�tBtiT .'I' I J � �( � I . •I I .I I I I ' ,I . .I I .I 'I. I . � I I isT PLOW, yht>a 'LOQR : URD PL-DDR I I I.. cm ;:, ooR I . I' I I I. ( I "•L I' I' :II I .•I, I I I. I . I I I.S.TK FL'D�R I.. I .I I I I L •. I i ( I I _J d. d `I I L 67KPLODR-;I 7TK.FL0OR .� I:...I . ,I I .•I, -I . I � I �I I 'i I I I II I I I I .I . STK PLOOP in.cwlinp �irn;any Nasse �C�1 �UI'V1e u�� C�^: �iSeeE arm. Qetftfr�ir f~7�. ✓1 i ,1�1�-, , ►rYlt� �I `�n� D Partnership NaM=f Liamn=.CS =NLJMber:or Gas.Fitier IRSURANZE CDYERAEL: I tsav: a =urrent4mbMy 4rtsuran=: poli=y or fts subztaniial e:quivatent'whieh me=ts.the raouirernertts-of M-=L Ch. iC Ys No D If you !saveeheaiced v_s, Piease irriit-ztt: the type cDv_rape by nheekino the appropriate box. A tiabflt*, irmumn=e prgiey D . I]ther typr_ of irteemntty© iscnd D DV1'KEk;'S 'lKSI1RA1lC= K'Al'v=fi: I am ev.are tt-at the h=rye- op-s not have the insumn= eovezpe by =isaptnr 142 of the'Mam. General Levu, ancs that.n}' siFrzature an this prrmft.apph=flan waives this w_quirzment. Check ane ` DwnerD Acent 1] wpnature W Cwvner ar C*wner:Anent Ihereby=eriiiv=I ail:01 the dsta!L and intonnatiDn I hay:submtlted tar r=stored)in above zanli�iian are true and z,—umie io the bez of my knowiadFe•and=1 all ptumbn0,wark and ina"taliaironS Perinrrned unser Ilse psrmf tar this a;pi=iien•wlll be m=mAimnce Kith All Periinent-prorisinns of the Mas.::ausetL'Stzte,Gas.Code•ancl i heater 142 at .,uensr.Ulrl!. i L of X", Thio iumber .irpnatlrrE 931 Licensec Pt PKEP.-r of rmei 2Fimsirner C ttvTown J Master License plumber =Journevrnan _ I i - . aEn:arr Fnn oFr-iG� usE on�Y . -� . . � RlitlilllE99lflSVE�fit7lt � , FILIAL IIISPEclloll Wlef4E9 . . FEE • -' l APPLIcAtivll t vF1.h�nMiT-110 bti do§�Itrtll(1 IIAME A'11P-IE:ur.HU1LtiUlo . incAT .ol of B.u.lLotliu PLnMBAn 011 BA9rii?.Eh Mr—Itv. • PERMIT unA/1tFb DALE 19 ' ons rrrsrEctoil_ NORTH TONNM 0Andover No. y - _ n _ LA over, Mass., C O CHICHEWICK ADRATE D S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............... ....................... Foundation has permission to erect....p7 buildings on rr�� O oO loq .�.� ... ...... o." ...................... ............ Rough to be occupied as..a... .r R ar...Ae .'......Fo.. �.... !'n.rP^ 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 relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 2t4 V Ad t-,o A- MA-1A PLUMBING INSPEC'T'OR VIOLATION of the Zoning or Building Regulations Voids this Permit. qql;t Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough � . .....� .. .................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a ConspicuousPlace 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 Sheet No. SEE REVERSE SIDE Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 4,,—,t- Us 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: (Location of Facility) Signator``o- Fire Department Sign off: Dumpster Permit N. Date i FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT � � --•�'�a �� PHONE! LOCATION: Assessors Map Number Ll PARCEL Q - D UU 2— SUBDIVISION -SUBDIVISION LOT (S) STREET ST. NUMBER OFFICIAL USE ONL O TOWN"G NTS: CON ERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS Mo odk*41 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS I FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PE MIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 JM The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): , Address: — City/State/Zip: ,, �1..�,tI . ., Phone #: fjc�V Are you an employer?Check the appropriate box: Type of project(required): 1. I am a empl er with 3 4. ❑ I am a general contractor and employees ful d/or part-time).* have hired the sub-contractors 6. E] 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.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: .o n G -�? Policy#or Self-ins. Lic. #: M.v lr L 6L-t9 M5_ Expiration Date: 'n V 3'0 D Job Site Address: t TU�\ City/State/Zip: tJy• Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: ►� Date: � V" Phone#: 1 L' 6 t f% Official use only. Do not writ ff l y ern this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a"space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia _i • 969 SOXf6 d street Porth Andover,MA 09845 • P}'1:878-888-5335 i t FAX:978888-7207 i Building Contractor Proposal Tat Peter&Karla Kooken 49 Bradstreet Road ori r�arrie Mr�roaceircenl Contradas and engaged m rbrra:Wpv ment corgrac fim,unless North Andover, Ma. 01845 atm regimen by Provi*m or chVW 142A Oahe generel laws,mat be regi mO the Conyrom O o1 MwsadweM M*M w about registration and SM"slratrh!be rraade to the DkeCW Hans Mh7prMeMt Cartrad Registration.ane Aahb AM Place. From Kevin Murphy Pom 13Dt,8oston,.MA02108.(6171-rt78M CC: Date. 9/28/2005 Job: Two story addition to rear of existing house. Date of pkm 9/05 An*l ect Steve Foster Locatl same Section #-Work SchWu le Contractor will begin the work or order the materials before the thins da follows the signing of this agreement,unless s here in Y n9 �9 �9 ag specified writing contractor will begin work on or about 10/1/05. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 1/30106.The owner hereby admowledges i -.._and agrees that the scheduling dates are.approbmate,and that.such delays that are not avoidabiebyAhe.Contractor:shall,no.be-considered:as-- violations of this agreement. Section 11-Wa maty The Contractor warrants that the work furnished hereunder shalt 1>e free from detects in materials and workmanship for a period of 1 year following completion and shall comply with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage Caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair correct replace,or cause to be remedied,repaired,or replaced, such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. SeCtiOn 111-Scope of Work Kevin LAY Page 2 of ceding eentmoox • Sted NodhArKbW,MA01M PH 978 FAX 9784W)O= General Building permit will be provided by contractor. No allowance has been made to obtain a variance if required by town.-Plans to be.provided owner. Excavating Excavation required to install crawl space foundation will be provided. Any additional fill will be removed from site. Backfilling and rough grading will be provided. No allowance has been made for any landscaping, lawn installation,sprinkler repairs,paving,removal of ledge.(if discovered) Foundation Poured concrete foundation will be provided as shown on plans.Footings will be 107)20",walls will be 'f0"thick. Rough concrete floor will be poured in new crawl space area.Access to new crawl space will be.provided from existing basement area. Building All frame, roof, and siding materials will be provided to match existing/meet building code/as shown on plans. All floor, wall, and roof sheathing will be plywood. ( 3/4 on floors, 1/2 on walls, 5/8 on roof) Roof shingles to match existing. Ice&water sheild will be installed at all roof edges and valleys. Siding will be cedar shingles to match existing over Tyvek or equivaientAnderson windows will be provided as shown on plans. Steel exterior door.unit will be Therma-tru or equivalent. Plumbing II Plumbing required to add three fixture bath in secomd floor of addition will be provided. An allowance of $850 has been included for plumbing fixtures. ($4550 for shower,$100 for shower valve,$150 for toilet,$100 for bath faucet)No allowance has been made to relocate laundry connections. Heating/Air Conditioning Two new zones of forced hot water heating will be provided off of existing steam boiler. No allowance has been made to upgrade/replace existing boiler. No allowance has been made to provided any air conditioning. + Electrical Electrical work required to wire addition to meet code will be provided. Existing electrical service will be relocated and upgraded to 200 amp. Eight recessed lights have been included. Additional recessed lights can be added at a cost of$75 per light Phone, cable, and computer lines will be roughed in by electrician, to be connected by their service provider at owner's expense.General layout to be approved by owner prior to rough. Insulation All added areas will be insulated to meet code. Exterior walls will be R-13, second floor ceiling will be R-30, crawl space ceiling will be R-19. KeVfirrn hY[ y Page 3 of nuodt"Contractow 169 Boodord SUW Nodh Andow,MA 01845 PH:9786884M FAX 978688-)000( . Plaster All added added areas will be blueboarded and skimcoat plastered.Ceilings to match existing, walls will be smooth, closets will be textured. Interior Trim/Doors Pre-primed interior trim and doors will be provided as shown on plans/to match existing. Painting All interior and exterior painting will be provided. Exterior color to match existing, interior colors to be determined. Flooring Hardwood flooring will be supplied , installed, and finished with three coats of oil based urethane on first and second floor.Tile floor will be provided in second floor bath and first floor entry area.An allowance of$1000 has been included for file materials. No allowance has been made to replace existing kitchen floor. Other Atlowances An allowance of$1500 has been included for bathroom vanity/countertop. Waste Removal All construction/demolition debris will be disposed of by contractor. Items Not Included No allowances have been made for any landscaping,kitchen flooring,or shower doors. I Kevin f YuvE&y Pageof If DulidingCowractor 169 Bo4ord Street NoM Andover,MAO/845 PH:9786885335 FAX 978.6 X)00( Section IV-Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of................... ...................$ 112,000 Payment to be made as follows: Percents e/ltem Description Amount 1 Permit obtained $3000 2 Foundation complete $10,000 3 Roof framing -com lete $30,000 4 Siding /windows installed $18,000 5 Rough plumbing /electric complete $15,000 6 Plaster complete $15,000 7 Interior trim compete $8000 8 Floorin /painting complete $8000 9 Job 100% complete $5000 Total 9 $112,000.00 *Noioe:No aqwnud for Hans shallmgweadownpaymeMtadvenwdeposd)ofmaedig or&'rdoffttoWOW&WpioedtaWWarnoutdellaepoftor pvn-t wnid,Bye cm*a=must mom,in advanw,to oder artdW otter eblam delwyd spade)ceder materials aid eq npment w udvw M greater Contractor: Kevin Murphy 159 Boxford Street No.Andover,MA 01845 Registration No: 101874 section V-Acceptance Acceptance of Proposal—I have read this document and accept the prices,specifications,and conditions stated.I understand that upon signing,this proposal becomes a binding contra-.You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature Data Si9 nature /W"te tor R DATE: SCOTT L. GILES FRANK S. GILE II JULY 7, 2005 SUBJECT PROPERTY REVISIONS: FRANK S. GILES — o MAP 44,PARCEL 2 �,a ' SURVEYING o�� NPETER&KARLA KOOKEN 50 DEERMEADOW ROAD o G L S 49 BRADSTREET RD SCALE: 1 INCH=20 FEET NO. ANDOVER, MA 01845 4379 NO.ANDOVER,MA. ol 20 a0' TEL: (978) 683-2645 oFF,It�ea� DOC.#24094 bk:4594,page 116 FrankGilesSurvey@comcast.net q�DtSEe a AREA--O.19 PLOT PLAN OF LAND ZONING DISTRICT R4 LOCATION MIN AREA= 12,500 S.F. FRONTAGE= 100 FT. 49 BRADSTREET ROAD FRONT SETBACK=30 FT. SIDE SETBACK= 15 FT. NORTH ANDOVER, MA. REAR SETBACK=30 FT DRAWN FOR PETER KOOKEN tk 1100. 6 Xp J' L MAP 71 , LL / � ��; � �y �\ f LL PARCEL 21 LLL LOT9 � / 8 240 S.F. L� / - 00 O 4 ���w� �.�w tiffs � � .�� �0��ti ��P�'s0���4 sti P'' so p D� I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BY LAWS OF NORTH ANDOVER, MA. AT THE TIME OF CONSTRUCTION. I THE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON-CONFORMITY WHEN CONSTRUCTED. i C:\CLIENTS\KOOKEN\PLOT PLAN.DRG i '.1 - Y . R0�1 _ �,. . .. r . _ 1.1. M5tN Pl'757 4 p106r; vrNT 4' ,4 O : 1' I I I I :.�:::L: ! ':��� I , , I, . ., "L 'L ',.L ' ,�.,_ .1 * E ;I L xEr X11.2 f rtJ '` % _ - ASI°NALT SNINGL�S � �1 '�F t°'cA*.'3.'1i E +�'( r t �� .� r r r r r r �� r �� r �� r �� r �� � �� °s� i.$ - - � r � 1. y., r c y k n a nth �' sar W. r r �. .�r r .� �. r r ..� r �. ..� i. ?F dtrr' a 21., ,,.- � *�,_ 7' asz,__z�i�.�`x� -_. '� :- s �.. �� r r r �. r r .� .� e r .�",�7 S. A "t ys r g,4,,,,�i 6$' s i-; l; t E1 r r .� ... r r �. �. _ _ .r ... s,.�? 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WINPC P3rnl?OOM 5INK & VANITY_ HATH ( PPDOM PeWOOM 2 WC hr NI;W WALL5 SHOWN SHA F-P TYPIC 2vnrdflr2 �P.H, wNI2OW UNIT; COpNF-P. SHz7Wl;p (MATCH HT, OF 2N2 R- WINPOW5)' V.I.F, WIvTH' MLOCA1Y- F-X15TINGi KOOK�N 51P NCa Aep1AL rL1:cTp1CA- �� C�P?At751 �1'�oAr� 5�CONP FLOOD PLAN 5FpVICF- TH15 APIA NOP\1'H-ANPOM,, MA -b- v :e/9/0y z 12J NG Fl :lJ StAIr�S r0 INlSH G�F_ VCNN LU f?I;MOvI; r-m5-nNG WALL.CL - I WOOD POSt pt:OVil�l: NSW r3FAM: I f f 1N� 1pIM �NCi,. n1NINCA PlooM • 2 - ► 3/ 4�' X -7112 MICPOLAM LVL OUTLINE D)` "IN -LINA" �.AM1NG '� I I C I 9AVE� LINF- C APOv1;> MOVI; I:X1511NG WALLS III 51r-.p t2OWN 1 1215MIZ I �A11NG <sHowN PO -P) f :::._....::..:::. :..... . _ PF-AM Ar�Ovr l}r I A1��I2 6 I �- _ ---- 1 2 P.H. WINPOW5 2 - 1 3/ " X i/ 2" 1 f I 1�t1AtCN EXI51lNG M CI?OL M LVL INTMIOp "WINPOW" StOpAG� I Or- Al2 ACF-NT NEW I I t „G�i� I MATCH SIZI; . 1 j t WINDOW AT EATING Af VA r�11=0Ln CL, r::WN-Ls GLA55 OY�p I o POOP (ww) r v11=>HAI eool� _ r 13ATH r:.. xw:. .,....: :. :: ... COAT M65 4 X 4 WOOF ro5t5 2: rc�CM ro FON. MLOW d i ANGLE IMY WtNt2OW AL-16N NrW WALLS ' 1 MAtCH EXI5TING 4t z, WITH EXI5TING I NEW rMNCH P00frZ5 \S f + I ro �1t I;xr'G. FAMILY p00M 4 � LIVINCA NrW WALLS SHOWN 5I-fAPE�P QY H�At� AI3C?V�: C rYt'ICAL> lu 2 - 2 X IO FA.<t a:sv C J 20'-O" FI5f FLOOD PLAN F� P: WAN p�5112 NCS 49 r3M5TW�f POAP NOM ANPOVM, MA 5C,v.e:/4'- ,a' 17AT;8/5/05 OUT-INF- OF I;ATiNG AMA OVF-13-IANG" r I'OUM12 CONCP�TI: PEP- F-XI5rING 5ANIrAt2Y } r WA5TF- 1'It'ING OWNM,/ 13UILC?FI;Z CONffll?M ZONING 5E�T13ACK5 } (IWICA- 5M5 & MAR) E�XI5r1N6 r-IrLt?5r0W 1~OUNC2AI1ON - •,• lu, [ NF-W r-OUNt?ATION , 30" X30" X 12" }} { VOUMP CONCMTE�FOOnNG 3 1/2" IIIA. CONCMTF- �1LLF� SQL COLUMN f j F v L _ r -AM t'OCKI<r 1 STT--p rop t=OUNnAnON WALL � A5 mQUIt2 p r-aR mrw55tit2 FLOOD LI Vi;L Ar FAMILY rM CP,-AV- 5PAO� Pk'OVIPF- CP-AWL- 5PACI� ACCE55 CONTINUOU5 r-OOTING U51 E�XI51 ING r3A5F-MF-Nr WINDOW . . . . . . . . . . . 01 -' CPAWL 5t'ACI; Vr5Nr5 ALIGN WITH WINPOW5 A30\/'I: FOZ P&5NMT PLAN �Q�_Q" FFKOOrFN R�5P�NCS NoRfH M120 I, w Si os • •, Y FM FIN45H 2Nn FL-O01? Fmh Uji LLD El FIN15H 15T K-OOp Lij PfM �L�VMON aelm ���VMON FIN6H 2NP F1-00k' FINk5H 15f r-LOOP LV F i V L� 7MF V N Mb") w FINI5H 2NI2 NLOOt? FINISH IST FL-OOP, n t Uhl CL. 00 I2INING BOOM MCH N EMNG �i • f'9 ca PRCH -F�Idl o- C3ATH HAIL ,8 5 PORCH FR,5f F�OOP PLAN DIVING DOOM MRM FOR rFKOOr,\FN X51 PW 49 L3M5fM 1f PUAP NOM, AWOM, MA 51W-U,/4'- '4' PAM B/5/O9 ol Rv NAL Ln z BATH X X Q LAl.ftV V k'Y r� ti CHUM P�nnOaM IV 5�CONp FL00P i5.AN < &MO r3Q)POOM PI."FOR FFKOMN P,,�5112 NCS 49 5M�f KOAb NOPTH ANPOW, MA VAZ 8/5/05 0* C,VX I'4YVVVVV PODP 5HEATHIN6 2 X 8 AT 16" O.C. PIDGE VENT ASPHALT SHINGLES PAPTEP TO TOP PLATE MATCH tr451IN6 PPAMING GONNECIOI:. POOP 5-or-r-- 2 X 8 Af 16 LOP-;2X8AT16" O.C. TYPICAL EAVE5 DETAIL: FASCIA & 50PP1T TO MATCH EXl5nNG f CONrlNUOU5 50PPlI VENT DO! PLE TOP PLATE P-�8 IN5ULATlONMTAL EDGE fCf WATFEPSHIELD T /PIA, cr-1, 55 5�C' nOV IN5ULATI; AT MEMWTEP PEP.IMETEP pf�ON J015r "P1�i30N JOi5r" 4" T&G PLYWOOD• NAIL & GLUE TO FRAMING a TYPICA,tXTMOI WALL: FIN15H 2ND PLOOP 5V]NG TO MACH l�X6t1NG + MIL-VIN6 VW-AP 1/2" COX PL-YWOOn 51-GAMIN64 2X4A'16" O.C. r-I3!;{C3 Ra-A5 IN5ULAT10N \,I/ 2" 6" ON POLY VAPOR DAIRI" I X 3 STPAPPING I/2" GVV>3 3/ 4" T&G ?L-YWO01. TYPICAL 51LL I rA L-: NAL & GLt r- IO PPAMING ANCHOR C40Lr5 Ar 4'O.C, P-19 IN5Lt-AT-ON 5ILL 5F-A- FOAM IN5ULAT10N--1` POUMr5 2 X 6 TMAT>;P SILL PMV6IN6 AT CONTINUOU5 RIPPON J015-r CENTEP SP�t NN15H 15r FL-00R 2X10 Ar16'' O.C. ���►az� 91on,---- �! � CRAWL SPACE � l Oif � y (V `F 2 - $*5 WIMP IOP & 1301"fOM POLY VAPOP PAPPlEP POU2FP CONCPETE POUNDAVON - PrWOVE ALL OPGANIC 501L WITHIN CPAWL PLA6FOR 7-7 n VG tPN OWNER/ PUlLPE tP CONPIPM N ANaOV��, I ADEQUATE 5011 PfAPING CAPACITY • • t hX4P05-5 (TYPICAL) it li t ( ( ( ! f DF-AM; C AT frA11N6 AlOF-A) j MAM. ! t 3 - 2X8 11 ! I ! ( ( 1 ! it MAM, li C AT OPF-NING FROM HALL INTO � { M70.PJNC4 WAN, FAMILY DOOM) ( 1 II ( I 5 Xf T 1 C R.v6ra 2ND F OOFkAMIN6 PLAN 49 sTIT-ff POAP NOFfH ANPOM, MA 5w:/4'- 'O' VAM8/9/09 e t CANA1ELEVE1: NEW rL00t2 J0151'5 2 - 2X8AT16" OC EX15TING 6 X 8 PEAM---`A E45VNG FOUWA11ON NEW CEA A,; Z 1 ri " - OU1tINr or - IL FOUNt2A-noN5 t3ELOW X 1 416' OC ANGLE; PAY WINt2OW(A130V1 ). KUWN M-, 5MNC� 49 LXAV5Tftf WAP NOM ANPCM, W & ioy Commonwealth of Massachusetts t)freiai 1 se t)nly �. Permit No, Department of Fire Services j Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS j[Rev. 9.051 (leave blank) ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .\II \ork to he performed in accordance\\illi the Massachusetts Electrical Code MEC). 53"(AIR 12.00 (PLEASE PR[NT IN INK OR TYPE ALL LVFORJLITION) Date: 106 City or Town of: /9h64vef To the luspeclor of Wire,y. By this application the undersigned gives notice of his�oor her intenti n to perform the electrical work described below. Location (Street& Number) Owner or Tenant Pe-lel- KUG K-eh Telephone No. Owner's Address Is this permit in.conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building S;t1�� �c t'�;l pk.`�1���ti, 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 Location and Nature of Proposed Electrical Work: �M�I � �'ClU�"'t ���- i9.✓`C4 p�i�iG � S1�f✓�S Coat leliwr of lhe: ollotcini (able may he a cited by Nie lis pector o/61'ire. No.of Recessed Luminaires ►o 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`- ❑ at o mergency rg mg rnd. rnd. Battery Units No.of Receptacle Outlets S' No.of Oil Burners FIRE No. of Zones No.of Switches No.of Gas Burners No. of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number TonsKW 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 Wirin Heaters — __Signs Ballasts No.of Devices or Equivalent _ No. Hydromassage Bathtubs No,of Motors Total HP Iclecommunications Wiring: OTHER: No.of Devices or Equivalent .Much addiliorrul dclai/i/'rlesired, or as ro uired hI:rlte/u.lyicc/ r r,j 11 ire:,. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with ti1EC 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"coverase or its substantial equivalent. I'lic undersigned certifies that such coverage is in 161-ce, and has c•xliibitcd proof of same to the permit is,arin;=office. C'IIEC'K ONE: INSURANCE ❑ BOND ❑ O'fIII::R ❑ (Spccily:) /cerllJj,,Iurder the pnirr.c al»rl pennNics a�J'perj»rt, ;lrut tlee;»jur»,cn/c,n a,Ihis npplicallo»is tl•tie u»d e•ve»plefe. FIRM NAME: LIC. NO.: Licensee: Kcx- Pi Coroi ;Sign: C. bC -- nl;/c. ,-Ncr ' ;rnr/a"iu Nrr iir�nsr ururrbrr iine.� kddress: L Bus. Tel. No.: r I/ X75' l Alt. Tel No.: "Security System Contractor License recluircd for thisvvor ; if applicable,inter the license number here: -� OWNER'S INSURANCE �NAIVER: lam aware that the Licensee sloes not l7cnie•the. liability insurance covcr;p—� required by law. By my signature below, I hereby waive this req uireinent. I am the(check one)❑ owhers Owner/Agent �f .Agnatur•e TcIv Rhone `lo. �p ' ftgt � E V IG S 4 I�r Date. . . . . . . I ;t TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING SA US 1. . . . . . . This certifies that � . . . . . . . . . . . . . . . . . . . . . . . . . . r C.� has permission to perform . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of atNorth Andover, Mass. j Fee. f . . .Lic. NoX�1 ,lf. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR I Check # s 6231 MASSACHUSETTS UNIFOR APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS p Date Building Location w�i�N� e,s ame Permit Amount Type oiccu anc New Renovation Replacement �, Plans Submitted Yes ❑ No ❑ FIXTURES i VJ F A W � O a A H SME BASEME r m IHIom �FI�IZ MRDM � � 4IH)HIDCJR r 5II3 KOM 6M11" '7M IMM SIS IEIDCit (Print or type) Check one: Certificate Installing Company Name, -Q ( P � 4 7 ❑ Corp. Address ��� � _ Partner. Business Telephone 7 (1 & -10 F-2- 0 ff"Fimko. t Name of Licensed Plumber: Insurance Coverage: Indicate the type 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 ignature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under.Permit Issued for this application will be in compliance with all pertinent provisions of the Massa-Ruse4 State PI u bing Co and C ter 142 of the General Laws. By: Signature o iced um er — Type of Plumbing License Title ql 3 City/Town icense INUMM MasterJourneyman ❑ APPROVED(OFFICE USE ONLY I Date. . NORT o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING '* ,SSACMUSE� This certifies that . . .FJ1. . . /. . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . P... . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . ` at. . . .�. . . .cl.J /1 - 7 . . . . . . . . , North Andover, Mass. ". . . . . . . . ` Fee. 7 . . . .Lie. No.2. . _. . . . . . . PLUMBING INSPECTOR Check 11 / 9V P� 6748 M MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS (�� n ��eed ��` Date Building Location L1 —1 43/1 Owners Name - 2�00 l��n Permit Amount Y Y Type of Occupancy New ❑ Renovation ri—V Replacement Plans Submitted Yes No 13 ❑ FIXTURES z � z � a cz W W x o z z a � ;;I- E.., 3 Z a z wW� W x W 3 a as A SLRBA Q 3 H Q q Q a �" ". RASRAM l� JSr HfM MKOOR 4UiHA" 5HiFLOOR 61H HJ00R 7MFLOM 9MFL" H7 (Print or type) /�� ��fU� r Check one: Certificate Installing Company Name ® ! ❑ Corp. j Address ' htflGfL El Partner. Business Tdlephone 0_Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond u 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 ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and in,tallati ns per d and Issued for this application will be in compliance with all pertinent provisions of the Mass setts tate ng C and ate . General Laws. By: ig a ure U1 Licenscaum er Title Type of.Qumbin ense City/Town icense um er r Master ❑ APPROVED(OFFICE USE ONLY Journeyman Date3-- ........ NORT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING �SSACMUS� This certifies that ��� C 4.11'ollee/. .......... r `P./.1.. ................. ........ � � �� �� �: has permission to perform .......�........................................................ ... ......... wiring in the building of `1° 12 � C�t ........................................................................ 4 at..'........�..7./�� ... ... ........................... e5orth Andov r Mass. f Fee ..�..... Lic.No.�+ ��t�,�� �-ter.. ..� .... LECTRICALINSPCiOR Check # l i 5092 Official Use Only Permit No. y`� Occupancy&Fee Cft BOARD OF FIRE PREVENTION REGULATIONS 527 R 12:00 APPLICATION FOR PERMIT TO PERFO ELECTRICAL WORK All work to be performed in accordance with the M' sachu s Electrical Code 527 CMR 12:01) y (Please Print in ink or type all information) Date . Z / TO the inspector of Ifr es: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Owner or Tenant v C Owner's Address L/ Is this permit in conjunction with a building permit Yes ' No a (Check Appropriate Box) Purpose of Building f�/� Utility Authorization No. Existing Service �/ Amps �/C/Voits Overhead'�� Undgmd a No.of Meters • New Strvice Amps Volts Overhead a Undgmd a No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above a In a No.of Lighting Fbdures Swimming Pool gmd a gmd a Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switd'fn Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices ) Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices a Municipal a Other No.of Dryers _.. Heating.Devices. KW Local Connection No.of No.of Low Vokage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Nbssage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the nequiremeri is of Massachusetts General Laws 1 have a current Liability Insurance Policy inn�irS mpleted Operations Coverage or its substantial equtrale�NO have submitted valid proof of same to the `YES .NO s f h�ave,�c�gck �yindindicate ecate thecoverage.bychecking the appropriate box. (SRANC BOND o OTHER o (Please Specify) Estimated Value of.Electrical Work$ (Expiration Date) Work to Start Inspection Date Resquested Rough Final Signed under the Penaltips of perjury FIRMNAME r C. /+ � �� LIC.NO. Licensee W6 Signature i a eL��17�10/� LIC.NO. p�'j `r Bus.Tel No. ! �� L�! 7% "_ l��(p Address rlr/� (/ 7�. jGLG .> 'I /"/ e/y Alt Tel.No. _ OWNER'S INSURANCE WAIVER: I am aware that the Ucenses does not have the insurance coverage or its substantial equivalent as required by Massachuse s Generai Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) / I Telephone No. PERMIT FEE $ � (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. F-1 I am a sole proprietor and have no one working in any capacity r� aI am an employer providing,workers' compensation for my employees working on this job. Company name: Address City_ Phone# Insurance Co Policy# Company name: Address City: Phone#-- Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposbw of criminal penalties of a fine up to$1,5W00 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. 1 of this statement may be-forwarded to the Office of Investigations of the DlA for verification. understandthata c yage copy I do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' E Building Dept ❑Check if immediate response is required Building Dept p Licensing Board C] Selectman's Office Contact person: Phone# Ej Health Department Other FORM WORKMAN'S COMPENSATION :.tcry,...or..r-4p•yJt.-..'`�.r...:.r�..,.:�_;(-:��.(.rr�.f....�,�,.j�,..yT..�.:,,e-f+..r.--,-.-.•wa-a.'�.-w-^--�.r��+_--/'jr•.-. 1;...�+..w� .... - ,�„. Location No. Date -7 3 L y TOWN OF NORTH ANDOVER a f A + Certificate of Occupancy $ Building/Frame Permit Fee $ 30 4CMU5 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ '� 0 Check # 17518 Building Inspector f TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENO V�A�yTI,,, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED. X SIGNATURE: ...� Building Commissione for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 4 $hh)577443 � Map Number Parcet Number• 1.3 Zoning Information: 1.4 Property Dimensions: � o 0 72 Fr - Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R ;red Provided 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record �� Name(Print) Address for Service ca ffALw- I Signature Telephone 2.2 Owner of Record: nt Address for Service: z v (. 3 m Signature Tele one SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date C Signature Telephone �. 3.2(Registered Home Improvement Contractor Not Applicable ❑ 0 Con pany Name Registration Number r Address Expiration Date ^Z Signature Telephone V/ x �Pe N FORM U v LOT RELEASE FORM c q -off INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from j Boards and Departments having jurisdiction have been obtained. This does not relieve. the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT _&VE LLA A/ PHONE_/ .j �39 LOCATION: Assessors Map Number _ PARCEL_ /2 SUBDIVISION LOT (S) STREET41i ST. NUMBER ,- ********* **** OFFICIAL USE ONLY***"********************�******** REC WNDATIONS OF TOWN.AGENTS: JCONSERVATION ADMINISIIIATOR DATE APPROVED ' DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED. DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS O I(S -SEWERMfATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm W, �?.•a,i t&oRTFr Town of North Andover � `" '°`�"° Building Department 27 Charles Street North Andover MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 .(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION`. Please print.DATE 1,4q JOB LOCATION `T EE/ D II� V1117 / Number Street Address Map/lot "HOMEOWNERS / N 7-80 6,8S- 331161 -7),Z9.2 Name Horne phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homedwners"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) . s 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 onehome 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 requires HOMEOWNER'S SIGNATUREUCAM \ APPROVAL OF BUILDING OFFICIAL N.. G The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02991 Workers'Compensation Insurance Affidavit Name Please Print Name: A7V N f i L Jq7,/V Location: �Uf4f4�S �h 7` City J- /h` 6N�VEX Phone #�978� 685-6, 3 3 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 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'imprisonment-as_well_as.civil.,penalties1n2heIn=da_STOP.. ORKORDER.aad..afine of.($1.40M)-sAN-against.me. 1 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 undA the pains and haft es of erjury that the information provided above is true and correct. Signature v� Date 7116 -044 Print name c.- I tfia Phone 3 3� Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required Licensing Board F1 Selectman's Office Contact person: Phone A- F, Health Department Other i t k MORTGAGE INSPECTION PLOT PLAN _.NORTHERN ASSOCIATES, INC. 65 5ALEN STREET,LAWRENCE, MA 01843 • Tel. 617-975-7117 3220 MAIN ST., RTE. 6A,P.O. BOX 25%6AaNSTABLE, MA 02630 • TEL 617362-8839 MORTGAGOR ANNE 6 PAUL BLAIN DEED REF. SK 1098 PS 986 LOCATIOAt 44 BRADSTREET ROAD PLAN REF. 8K 8 / 409 CITY. STATE.' N. ANDOVER. MA SCALE' 1- 20' DA TE: DECIM-leB JOB A• BS/ 96VVS LOT9 3 s4 67.84' SARA LOT S4 8400 S.F. o a w F N�RT� � 4 ToVVn of _ Andover - LAKE over, Mass., '7- 30 COCMICMEWICK � �A \V 7� ORATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT......AA;A;..e BUILDING INSPECTOR...........:.. ...I...�.I�........................................... .............. ................. Foundation has permission to erect... . buildings on .........................b � Rough to be occupied as O p8 N Ole 0 fO P t a OftO F R r a q. 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 relating the Inspection, Alteration and Construction of Buildings in the Town of North Andover. -7 W 17 J� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL, uvsPEcroR UNLESS CONSTRUCTION STARTS Rough Service ..... ............................... ...............:....................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location /a No. Date 3 �aRTM TOWN OF NORTH ANDOVER 3?o�,t`•o I•,h� f w 9 * ; : Certificate of Occupancy $ Building/Frame Permit Fee $ O�- Foundation Permit Fee $ Other Permit Fee $ p TOTAL $ IO 6 Check # 17128 Building Inspector t � TONM OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ::. .. p- 1110 m BUILDING PERMIT NUMBER: DATE ISSUED: 3- SIGNATURE: AA I Building Commissioner/Inspector of Buildings Date SECTION 1—SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 0 q ,l Map Number Parcel Number lcj 1.3 Zoning Information: 1.4 Property Dimensions: Zonin Distrid ProposedUge Lot Areas Frontage $ 1.6 BUILDING SETBACKS ft Front Yard. Side Yard Rear Yard Required Provide Required Provided Required Provided Q 1.7 Watcr_S° M.G.L.C.40. 54) 1•3• Flood Zone Information: 1.8 Sew Disposal System: Publict7 Pinata 0 Zone Outside Flood Zone 0 Municipal On Site Disposal System. 0 _J SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record L2& t Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor. O License Number 'n 4ddress g 6 // ' -5 2�p , Expiration Date 7 v > re Telephone r 1.2 Registered Home Improvement Contractor Not Applicable 0 ,ompany Name er Registration Number �w � /�✓c f�J �`j � addressIll- QU _ 1S " -S 7J0 Expiration Date ` re Tele hone ' f SECTION 4-WORKERS COMPENSATION Workers Com (MG-L C 152 § 25c(6) pensation Insurance affidavit must be completed and submitted:with.this 'on. Failure to provide this affidavit will result in the denial of the issuance of the buildin rmit. Si tied affidavit Attached Yes....... SECTIONS Descri tion of Pro os ed Work check all a licable New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be I. Building Com leted b e a licant / (a) Building Permit Fee f < r 2 Electrical 6 �D Multi lier (b) Estimated Total Cost of 3 Plumb' Construction 4 Mechanical HVAC Building Permit fee(a).x (b) / 5 Fire Protection 6 Total . 1+2+3+4+5 l r/ SECTION 7a OWNERCheck AUTHORIZATION TO BE COMPLETED WHEN ber OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Hereby authorize as Owner/Authorized Agent of subject property My belralf, in all matters relative to work authorized by this building permit application, to act on Si nature of Owner SECTION 7b OWNER/AUTHIZEDRGENT DECLARATION Date OR property ,aseAAuthorized Agent of subject Hereby declare that the statements and information on the foregoing application are true and accurate,to the best ofmy knowled aiid belief, y ge Prin e Si re of er/A ent. 13 6 Date NO. OF STORIES BASEMENT OR SLAB SIZE SIZE OF FLOOR TIMBERS 1. No SPAN 2 3 DIMENSIONS OF SELS DIMF,NSIONS OF POSTS DiNIENSIONS OF GIRDERS t HEIGHT OF FOUNDATION J _SIZE OF FOOTING THICKNESS MATERIAL OF CHIMNEY X IS J3WLDRJG ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO.NATURAL GAS LINE i A Commonwealth of Massachusetts pie Department of Industrial Accidents }� Office of/nrrestigatioos 600 Washington Street Boston,-� �- Mass. 02111 Workers' Compensation Insurance Affidavit li ah�nfformafion ;< , .... ... ,,....�_ name: X £ AtN aH, location: 4446"`W 17 ho C City N �7/►��� fJ fyt 12hone# / ❑ I am a homeowner performing all work myself. l L?l am a sole proprietor and have no one working in any capacity JUNr ❑ I am an employer providing workers' compensation for my employees working on this job. company name ,address: �f phone# insurance co otic # ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comoanv name.. address: city: . ::AIhone# insurance co. olio # company name: address: city: ; phone'# insurance co policy'# A1c,I�a�filitirlrral Sheef;ine�essary , Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or y one years'imprisonment as well as civil penalties in the forrn of a STOP WORK ORDER and a fine of$100.00 a day against me. 1 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 ns and penalties of perjury that the information provided above is true and correct. Signature , Date 3 (( 16 —Q Print name_�,� /`i���ti ?. .. CG�. _.... . ..._ ._. -. . Phone#9 '7 X b4�' �.V official use only do not write in this area to be completed by city or town official ._., .. 4 . city or town: permit/license# Building Department 77.777777777:777 OLicensingBoard (]check if immediate response is required oSelectmen's Office Health Department contact person: phone#; Other �tSt. u.L1;:,:a��?✓ .,x:,w�.,a.»: i:.,a�+�, ..r:;�:+..'�x:_:.�.kc;3„ri�,:,, (revised 7/95 P1A) .<._• .'.�•�.� -3Ai a.wr -,.i ,..;sec;G:,w an. a ..:_�,1hik'.u.t�ly` , BOARD OF BUILDING'REGULAT10NS License ,CONSTRUCTIO`N`SUPERVISO.R k � Number:--GS 05824:5 ," . n I" a Birthdate;03/24/1=943 € IEzpires 03/24/2804 Tr ho,::: 20021 �� Restricted' 00 � ` � KENiVETH�B KEEN �,.. �n � i 21 HEINITTAUE t '�a / fila! N ANDOVER :MA 01845 Adinirl stator' ,j. Board of Building_Regulations:and Stan lards HOME IMP.R�bVEMENT CONTRACTOR R.egistratton 1,©8383 Expiration 8/1$12004 ; TYI?�e DSA KEEN•C0NSTRUCTI0WC0 Kenneth:=Keen I' ry 21 Hewiilt;Ave � No.Andover MA 01845 I ' A;dtn��nastratpx ' KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978) 691-5201 Rogers, Chip &Andrea 45 Chestnut St. N. Andover, MA 01845 (978) 683-1417 Contract# 1481 ; Appendix A Date: 2/17/04 Remodel Basement: • Frame divider wall between unfinished basement and area to be finished and install 1/4" luaun on the unfinished side to allow objects to be stacked against it • Frame interior partition walls to create approx. 575 sq. ft. of finished area • Frame unfinished closet near water meter and open finished closet at bottom of stairs • Supply& install insulation& vapor barrier on all exterior walls • Supply& install blueboard and skimcoat plaster(to smooth finish) on all finished walls • Supply& install two 6-panel hollow-core door units • Supply& install all trim on doors and baseboard to match existing • Supply& install 2'x 2'revealed edge suspended ceiling throughout finished area • Supply& install carpet throughout finished area(including stairs) ($22.00 sq. yd. installed allowance) • Paint walls and trim(2neutral colors, 2coat finish) Electrical: • Supply& install ten recessed light fixtures ($85.00 for each additional light) • Supply& install outlets and switching to code • Supply&install 2 cable outlets & 1 phone outlet(Cat. 5 wiring) • Supply& install one zone of electrical baseboard heat Total Price:$15,600.00 (fifteen thousand six hundred dollars) 1 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978)691-5201 Payment schedule:$1000.00 due upon signing contract $2000.00 due when divider wall is completed $3000.00 due 1 st day of work(other than divider wall) $3000.00 due when rough framing and electrical is complete $2000.00 due when blueboard is hung $2500.00 due when plaster is complete $2100.00 due upon completion of contracted work o eerl A B. geen Date Date 2 +a AC I_ 92 ( I I I i TIIPII E 7Io, r mi ... 1481 KEEN CONSTRUCTION CO. n� 21 HEWITT AVENUE PIR"'OPOSAL NORTH ANDOVER. MA 01845 Tel: (978)691-5201 All home improvement contractors and subcontractors Fax: 978 682-3231 engaged in home improvement contracting, unless ( ) specifically exempt from registration by Provisions of M� z^ Chapter 142A of the general laws, must be registered with Submitted 1r`, �i 41 { 14 � ; the q Commonwealth of Massachusetts. Inquiries about To. . ....,._ _�..� r - - -__.-- registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton j Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related ! �! permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. F.I.D.NO. MA. H.@.C. 108383 04-325-8052 > C/S = Customer Supplied S + I Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: _..__., ..... ................. ....................... it Date. /. . .. .c/. .0' 3.. . .. NORTH TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION :- �9SSACHUSEt This certifies that . !'9�'T "". . .GT l'. ..�. . . . . . . . . . . . . has permission for gas installation . G''.f. . . c. �. . . . . . . . . . in the buildings of . . . �: ��a r1n r�_ at . .l��l. . . �. . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee �. " . . . Lic. No. ??.'s '". . . . . . . . : . . �` . . . . . GAS INSPECTOR Check# 2 L 11U 4536 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING _ (Print or Type) i�ltlt�7G1 (�(){f�. Mass. Date K 1��� Permit# )� 1 /� n 1 fir'" y��� �® �° J Building Location 4/"/ IJkad S1 t4 t°-Ir /�Gl Owner's Name Nua Id(��P&u GICS Ja.ti I�` k ,/ Type cf OccupancyLu �71� New ❑ Renovation Replacement ❑ Plans Submitted: Yes❑ Nom n s Y Z ¢ m W lu W. W F V m t: S 71 t y Z Z 0tj }. C i i m n y a¢i O d c s C 0 d W 4M Z I- 0 O . W W y�j hj Z { S Q Q a C W ~ W V Z q 0: C ~ = J }' Z F' h- } fp m Z O Z W O M S X < W tt W z Z. < < t O O W O •1 F ac 'S O d x V. 3 G O J 0 C > G 6 ►- O SUB—BSMT, BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET I$ Corporation 1 0 3 C MIDDLETON, MA 01949 ❑ Partnership Business Telephone 978-774—' 2760 C Firm/Co. Name of Ucensed Plumber or Gas Fitter WILLIAM R, -HARRIS INSURANCE COVERAGE: I have a current liability Insurance policy or its substantia! equivalent which meeOz the requirements of MGL Ch. 142. Yes CR No ❑ If you have checked Yes. please Indicate the type coverage by checking the appropriate box A liability Insurance policy 13 Other type of indemnity❑ Bored ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owned Agent C) I hereby certify that all of the details and information I have submitted(or entered)in above al)P i tics are true and accurate to the of my knowledge and that all plumbing work and installations performed under the permit. for this 11 bei 4 all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of t:gnna - Laws By T of License: Plumber ture of m r or 13as l7itter Title Gasfitter Master License Number 3785 City/Tcwn Journeyman APPROVED( NL BUILDING PERMITc "°oT" qti- TOWN OF NORTH ANDOVER o? 4tt`•- s*° o APPLICATION FOR PLAN EXAMINATION '' y Permit NO: � - Date Received �/-J3- �° 'J, ��SSAArED CHUSE��� Date Issued: 2 IMPORTANT Applicant must complete all items on this page t - rt-F ,=- ' .'r f ''" " e -•c -� _w,r� t r `� „t-t``s rTMs. x w�` h+' r u:;` s '::- +w� -. LOCATIQN ��nn�S �'e i, �- �s' -� PROPERTYOWNER1�cu-IiC�Ot� _ Y rs' PnRtrr� A MAP NO PARCEL �ZONING DISTRICT s # Historic District Yes rao" s Machine Shop Villager,„Yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 'One family Addition Two or more family Industrial Alteration No. of units: Commercial 'Repair, replacement 'Assessory Bldg Others: Demolition Other 5e t�V , ell w-4� .s.+--. r.y �,.. r Px � c Floodplain �g Wetlands Watershed Distnct> Water/Sewe .._. ... r . ...... DESCRIPTION OF WORK TO BE PREFORMED: 64,ri io and rc Sh'(m Is -�ton�k IYl�iin (1a Us� � ri d e side �� o Iola 5ec,� � on aid rew d u r mem Identification Please Type or Print Clearly) OWNER: Name: aLr la mmol Phone: 9?� X58 9af� 8 Address: oo►t� �0 Old r °� ��� '� � r^ r 3�' W+L m�r ��s ,,-�•y-e .a �a:�+�J.xiC�s*r€ sr�-*•- � .-r,�c�a.,.+^�;'�'€'r "�:+ "�. y- tx�.`N iF""a.. a a,..�s��-.s CONTRACTORNarne /� �' Addresso2D(�� Sh 5�. n�D; D �27.1c9 �sY ,p 1►vLf4 ' �� 'r�i 3 irk Y 4i ,o�r tS > t` � Supennsor s Construction License tiS 9q�J �Exp Da $ ' '` ;A •s� �-'a'"'`"'�; - T�'x *h=����s,�.,€�.$ +s€ry��' '�- :`,� 7 T "nz d. t"'�t ��.,.+"'-' -x +e� � y s ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ 6o FEE: $.Check No.: `� Receipt No.: �1�60� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner#s�'�� � ���w � ' ��,;jSignature ofcontractor s '� �� :F " ��= Location No. Date pQR701 TOWN OF NORTH ANDOVER � w f • : ; : Certificate of Occupancy $ _. cMost�A Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i ,r 2 960 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF =U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street ssx t! tia FIREDEPARTMENTY Temp Durnpsteron site yes' �� =£, y no � a Y, g orated at 124Mam Street �� �' s � �, r� :c l,.-�n,s F g A .1�{ 5' c wFire Department signature/date t A. h r k a � z aW e -, tvk t.' EN i ..fix mar 3' 's ? r fa•—ac' ._hr .€ 7„ ,��3"-t t �, v'§ #2*x Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application J ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) , ❑ Copy of Contract ❑. Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 AORTH T0q11111111i1;M . 0 t 4Andover . No. 4`,x0 *,r _ _ 4]]`(( Z dover, Mass., . T 0 LAKE . COCHICHEWICK 7d AD'QATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System i BUILDING INSPECTOR THIS CERTIFIES THAT /40o 00,0 �t ......../57.............................. .......... .......... .. ....................;:......................................... Foundation has permission to erect........................:............... buildings on ..... ...f ... � jT� !M.... ...... Rough f to be occupied as ...... .........f...., ............ ............�` ,1.� ... .. rl � Chimney ....� ......... provided that the person acce ting this permit shall in e ry respect conform tot 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 I PERMIT EMPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONS TR N STARTS 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 Be Done FIRE DEPARTMENT' Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. DAVID CASTRICONE CASTRICONE ROOFING&SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In HaverhMI 978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: Owner's Name........ el:.r ...t x,,6.0. .. t�/. ..........................................Te hone#..1 Job Address......[.....�� d,,��.Q/ ............city.... .�.. r rtc.t !`................State......... Specifrcafions: ... A .... ............ .. ......... ..... tle1. ma.r . .i �.t?r....... ....... �a.of ...... .l"yY1k. T...................... ..... .......... ......—d't r. .a .......( ...........l..f.IPL2` .�.....C?F c / �1.......... .. il��...C.RI................................................ ...... ra�,. �i .... � ..... �f.t.....la,.:S..d 1 / .......dd;,c a...... isR./�....f�.Gt .5 .rf Css J C�v !1 l aaa�......... .-.�j'r1..••..... i. . . ............. 0...... . .`...j.✓~i..I..1G.-a.aS..t• .......,fi...,.......f.l�G.l...tl.v..�'l�.l:.. .1t1..1�D..�................................................... Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specified by manufacturer agreeperform the work an ish the materials specified above for the SUM ofS..../..$4.81.'o................ The =agrees ......P.1 ...............on....S.� ........... dueler':........................on...................:.:............ alance payable on completion of job_ Owner or Owners are not responsible for Property Damage or Liability while�o—is in operation. Contractor is not responsible for any damage to the interior of property,including preexisting conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above(i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces). Items in attic may need to be covered by homeowner.All materials are property of contractor. Any dumpster placed b contractor is for his use only.U completion of v y y �° p above work,all undersigned agree to execute and deliver to contractor,then joint note in accordance with his(their)above obligation as requested by contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and payable. It is agreed that,if permitted by law,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid that shall be incurred in enforcing the tams and conditions of the contract and/or any lien in connection herewith.It is fiuther agreed that this contract may be assigned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrant(s)that he is(they are) the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(s).There are no represanations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in-writing and signed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:Director,Home Improvement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work............................................... Completion date......................................................... Receipt of a copy of this contact is hereby acknowledged,and it is fiuther acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parries are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Owner has three business days to cancel this contract and incur no penalty (see notice of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this...t!4 V ...day of.. .1y1....... 120..0.� Accepted: /f Signed. �.1.:............»............................ Owner tSigned................................................_........................... Owner i David Castricone,President n The Commonwealth of1Ylassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, NIA 02111 wwtv.mttss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LiejZibly Name (Business/Organization/Individual):_I)Gall t ti Cas tri Lo n C.. Ila S n 54 l n G Address: a LC)U S -}-d[-pn S YYL� ��A. -LI 6. City/State/Zip: N. A",fer HA 0 l lg S Phone k q`7% 183 J 4010 Are you an employer? Check the appropriate box: Type of project(required): 1.9 I am a employer with Y 4• ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑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. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 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 are 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /� Insurance Company Name: � \nSU C'd m c. 04 S- tQ �?A Policy#or Self-ins°Lie..#: W C. `7 (p Expiration Date: C1 �d3 ,0 `) Job Site Address:` 49 radsilw �(j t City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sipnature: 0— -�� Date Phone#: --A�-9 6L3 3 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/Litense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Town of North Andover OORTly � 5�t6tia00. Building Department < o m .. 27 Charles Street North Andover, Massachusetts 01845 hV. " (978) 688-9545 Fax (978) 688-9542 °� ..K" o 0 t-f (h �S$ACNU5�� I� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL e 40 s 54, and a condition of. Building permit # 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.- Facility location Signature of Applicant y �a16? Date NOTE; A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, y Massachusetts - Department of Public Saf'm r ,,p� OYIUIYLp9%C( o� Boat'd of Builtfin!, Regulations and Standards Board of Building Regulatio�5s and Standards Construction Supervisor Specialty License _- -- HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 Registration: 104569 Restricted to: RF,WS Expiration: 7/14/2010 Tr# 270265 DAVID CASTRICONE � Type: Private Corporation 31 COURT STREET t DAVID CASTRICONE ROOFING,SIDING& NORTH ANDOVER, MA 01845 David Castricone 200 SUTTON ST SUITE 226 Expiration: 12/16/2011 NORTH ANDOVER, MA 01845 Administrator t umnii..iuucr Tr-9: 99358 ACORQ. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/3/2008 PRODUCER Phone: 500-651-7700 Fax: 508-653-8009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED INSURERS AFFORDING COVERAGE NAIC# David. Castricone Roofing & Siding Inc INSUREFIA:Citation Insurance '40274 200 Sutton St INSURERB:The Insurance Co of State PA _ Suite 226 INSURER C: North Andover MA 01845 INSURER D: 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. T POLICY NUMBER POLICY EFFECTIVE POUCYEXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Eaocrurence $ CLAIMS MADE OCCUR PREMISES mon) PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE- $ GENLAGGREGATE LIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ POLICY PRO' LOC JLCI A AUTOMOBILE LIABILITY 08MMBBTNKT 8/1/2008 8/1/2009 ANYAUTO COMBINED SINGLE LIMIT (Ea ecclderd) ALLOWNEDAUTOS X SCHEDULEDAUTOS BODILY INJURY $ (Per Person) $250,000 X HIREDAUTOS X NON OWNED AUTOS BODILY 114JURY (Paraccldanl) '$500,000 PROPERTY DAMAGE (Peracclderd) $100,000 GARAGE LIABILITY ANYAUTU AUTOONLY-EAACCIDE14T $ OTHER THAN EAACC $ AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ RDEDUCTIBLE $ RETENTION $ $ B EMPLOERS Y RS�MABILITY NAND WC5877756 9/23/2008 9/23/2009 X I WC ST 7U- 2 $ ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACHACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? Ilyya,descrlbeundar E.LDISEASE-EAEMPLOYEE $100,000 SPEdIAL PRDVISIU143 bakrW OTHER E.L.DISEASE-POLICY LIMIT $ 0 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY Y,IND UPON THE INSURER, ITS AGENTS OR REPRESE14TATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) p ACORD CORPORATION 1988