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Miscellaneous - 49 MEADOW LANE 4/30/2018
49 MEADOW LANE / 2101045.0000.0 I i Date.....1. 1.b.�..................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION a +;,. • t 88ACHug� This certifies than .............. .... ... -!..i.. ........ has permission for ga&install ion . ��`G.. ?-............... .:.�' e '� cX o.� tom► �e 1�.�'^ in the b ildings of........ c- .„1 .LtS .... ................................................ . at................................................................................................ North Andover, Mass. Fee..(P&ir-.n.... Lic. No.' !f ........ ................................................. GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I North Andover MA DATE 5122/2014 j PERMIT# JOBSITE ADDRESS 149 Meadow Ln OWNER'S NAME I 4 UA GOWNER ADDRESS Same TE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[j EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER _ CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Replace 1 Gas Meter x and associated pipincl, INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in?HIP[]# nce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` PLUM BER-GASFITTER NAME Joseph Marino LICENSE# 8736 SIVA URE MP❑ MGF® JP❑ JGF® LPGI® CORPORATION Q# 3285C PARTN LLC❑# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 TEL 1(508)832-3295 FAX 508 926-4347 CELL 508-832-4614 EMAIL JMarino@RHWhite.com 56 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES v 11241 ZZ a 1 ' 4 AL TH OF MASSr4`G.H CI_i1 . 'iFi �j� �j c ry _ AN ASF1T7` S _ [.4G, S'E® AS A-Ma7R - ^"• -'[�$UEs rH 9. -- - �- FARR.T'NGTLIN ST = --- ;873'6 05f07l4 ' `-`:i''::• :. r: C;OiVI1�II NWEALrTH OF MA.SS�C`��,5:�1 fS= PLL%N($ERS AND GASFITRS: ti> - (`CiV 'D AS A JQUftNEYM-N'(1l i?1.i7111` 4 - I TSSVES THE ABOVE'LICENSE _?3- :Fa4°RR`TNGToN S.T• _- ~ry c STE R m A 0 16`0':4;= i i _ !? ® p/► ,r DATE(MMIDDNYWW) CERTIFICATE OF LIABILITY �NSUR AN page 7. of 1 08/29/2013 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CEATIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the poliey(ios)must be endorsed. if SU 13ROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not conferrights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT willi4 of Massachusetts, Inc. PAM . C/o 26 ceaitury Blvd, No.em 877-945•-7378 PAX R. 0. Box 305I91 -MAL tIO): 886-467-2378 Nelghville, TN 37230-5191 DARER ae..xtificate�3(�w•illis.GO_xtl INSURER(S)AFFORDING COVERAGE NAICtt INSURED INSURERA:The chartor Oak rJra Saauranc9 Company 25619-001 R• g• White Construction Company, Inc. INSURERS:TraVa1Arei property casualty Cozhpax�y oi' Am 25674-003 41 Q. Box Street INSURER C:Nati=Al Union Firs) Insuranam Com an o£ P. Q. Box 257 p y 7.9445-001 AubUrnj MA 01501 INSURER D;Travelers indm=ity Company 25658-DO1 INSURER F; INSURER F; COVERAGES CERTIFICATE NUMBER:20287680 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN f$SUGD TO THE INSURED NAMED,ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. JzL INSR TMPEOF!INSURANCE DD' SUBPOLICY EFF POLICYEXP POLICY NUMBER LIMITS A GENERALLIABILITYVTC2000 977RD949-13 9/1./2013 '9/1/,2014 EACH OCCURRENCE E_ 2,000,000 X COMMERCIALGENFJ'iALLIA9ILITY r� TO RENTED ��� I�3 $(Ee oceurtncr S -,R 3 0 0._00 0 CLAIMS^MADE OCCUR MED EXP(Any one arson $ 10�000 PERSONAL&ADVINJURY 5 2 ODO,000 GENERALAGGREGATE $ e,�j 000 000 1GFJd'LAGGREGATFLIMITAPPLIESPER; PRODUCTS-COMP/OPACsG $ POLICY PRO LOC ,000 000 B AUTOMOBILE LIABILITY VT,TCAP 977R955A-13 /1/2493 9/7./20.7.4 OMBIN EDSINGLF.I-IMIT X ANYAUTO accident $ 2,000,000 ALI,OWNED SCWF.DULED BODILY INJURY(Perperson) S AUT08 AUTOS BODILY INJURY(Peraccldent) $ X HIREDAUTOS X NON-OWNED AUTOS X Co Dea X C911 Ded eraccldent ^� S C UMBRELLALIAB OCCUR SE8 666140 9/1/2013 9/7./2014 EACHOCCUFRENCE $ 5 000,000 BXCEs9 LIAR CLAIMS-MADE AGGREGATE DED I $ IRETENTIONS 10,000 $1000,000 WORKERS COMPENSATION S D AND EMPLOYERS'LIABILITY �►'Ck2RUB 8205. 185-13 9/1/2013 9/1/2014 X o YYYYY//lII NNNNN TAR,Y u, D ANY PROPRIETORIPARTNERIFXECUTIVEINjj NIA VTC2xuB 8203.A71A-13 9/1/2013 OFPICER/MEMSEREXCLUD9/1/2014 E.L.EACH ACCIDENT F 1,000 Opo ED7 �� (Mytttld eq lba n E.L.DIBE'A9E-EAEMPI,pYEE 5 1,000,00 0 IUE�VKeBIIUNU UF'F'RATIONBBelow F.,I.,DISEASE.POLICY LIMIT 9 11000,000 SE;CRIPTION OFOPERATIONS I LOCATIONS/VEWICLES(Avoch Acord 101,Addltonel RetngrKS Sehodula,If more epees la roqulrgd) ,ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERE-OF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of IntauZ&ace AUTHORIZEDAPPRESENTATNE Coll:4197604 x91:1694012 Cert:20267680 ©1988-2010ACORD CORPORATION.All rights reserved. CORD 25(2010105) The ACORD name and logo are registered marks of ACORD Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING US This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . plumbing in the buildings of .7�� . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . .X. North Andover, Mass. Fee.-//-.S Li c. N o:7�/�/ PLUMBING INSPECTOR Check # 7638 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date q` 3 Building Location Owners Name1(/r -� Permit#� B Amount Type of Occupanc '!7: fly New rl Renovation Replacement '1:3 Plans Submitted Yes1:1No ❑ FIXTURES V. h Ln w A U o H LOD w B�1VE�II' ]SlC PIpQt - 3MFL OCR 4M FLOCIR 5M80012 6M PI1lCR - 7MFIOM SII3)EIA�2 �, (Print or type) Check one: Certificate Installing Company Name Z ❑ Corp. C Address ❑ Partner. Business Telephone 0Firm/Co. 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 Signature Owner 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 wor d installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the s usetts State Plumbing Code and Chapter 142 of the General Laws. By: gTpure ol LicensecPlumber Title Type of Plumbing License ' City/Townicense NUMSET Master 13Journeyman_ APPROVED(OFFICE USE ONLY ................ T 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING irs CHUS This certifies that .. A.. 17. .................................................................. /I has permission to perform ....... ............................................... wiring in the building of........... k cc......................................................... at.... North Andover Mass .................. ................ Fee.... .. Lic.No. ......... ELECTRICAL INSPECTOR Check # 8067 Commonwealth of Massachusetts official Use Only " Department of Fire Services Permit No.�a 1r BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] Qeaveblank 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 PRINTIN NK OR TYPE ALL INFORMATION) Date: //�� • /fin � / Zook City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 4/9tti 60,t A^l Owner or Tenant MZ y 1,v,J Telephone No. Q C z �« Owner's Address � Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building "'�,r.,J.A t-4'Tc..(-A Utility Authorization No. 4"J"'V Z-2 Existing Service Aao Amps .?_Yo //zo Volts Overhead ©^ rd Und g ❑ No.of Meters / New Service Amps / Volts Overhead❑ rd Und g ❑ No.of Meters Number of Feeders and A rapacity Location and Nature of Proposed Electrical Work: Com letion of the follou4 table may a waived by the Ins ector of Wires. No.of Recessed Luminaires G 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- E] o.o mergency Lighting d• rad. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches 2 No. of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers i .Hest Pump Number Tons KW__ No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers / Space/Area Heating KW Local❑ Municipal Connection ❑ Omer No.of Dryers Heating Appliances KW Security Systems:* No.of waterNo.of No,of Devices or Equivalent Heaters KWNo.of Data Wiring: Si s Ballasts . No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total gp Telecommunications icing; No,of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: doT+ (When required by municipal policy.) Work to Stark Inspections to be requested in accordance with MEC Rule 10,and upon compleon. ti INSURANCE COVERAGE: Unless waived by the owner,no per for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: S' LIC.NO.: Licensee: �.�u 61�,z.as Signature 1 a licable, enter"exempt"in the license number line.) �� LIC.NO.: 3JS29 G (f rBus.Tel.No.: P 3P 2<S' zr/_r Address: `>'"Z �,,�, ��/ 4 Alt:Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$�Q� Alt y e 4 The Commonwealth of Massachusetts ki PP. Department of Industrial Accidents Office of Investigations lki lii�` f 600 Washington Street i Boston, MA 02111 {.1 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anpficant Information Please Print Legibly Name(Business/Organiza6on/Individual); Address: City/State/Zip: r l l�,�,a t Phone#: . Are you an employer?Check the appropriate box: L❑ I am a employer with 4, r7. of project(required): ❑ I am a general con7sheet New construction employees(full and/or part-time).* have hired the sub 2.( am,a.sole proprietor or partner- listed on the attacRemodelingship and have no employees These sub-contractors have Demolition' working for me.in any capacity, workers' comp.insurance. g Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its . required-] 10.❑Electrical red-) officers have exercised their repairs or additions 3.[❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No-worke'rs'comp. c. 152, §1(4),'and we have no 12.[]Roof repairs insurance required:]t employees. [No workers' comp. insurance required..] 13•❑Other •Any applicant that checks b-t#1 must also flit out the section below showing their workers'compansatioti policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box mustattached an additional sheet show,ing,the name of the sub conttactars and their workers'comp.policy information. t am an employer that is.provuliitg workers'compensation insurance for my entpioyem Below is the pommy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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 c i under the pains and penaltiesf perjury.that the information provided above is true and correct Si atwe Phone#: g7f 2<S ?f/S-" Ofj`iciat use only. Do not write in this area to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Otber 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,br the receiver or trusteeof 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 1 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),addresses)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 cavy 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,notthe 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-Iicense number on the appropriate iine. 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 pennitllicense number which wilI 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`tbe 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. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum 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. # 617-7274900 Ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-774 www.mass.gov/dia Location 41q Al-eA daw ZV- No. Date IN-7 _Q MORT1y TONIN OF NORTH ANDOVER 3? � 0 00 a . , Certificate of Occupancy $ SsAcMus t� Building/Frame Permit Fee $ 0740 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18 4. AM - Bui►ding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. �., DATE ISSUED. 51 a 51 D (C SIGNATURE: Building Commissioner/IEELWor of Buildings Date SECTION i-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: L4q W to d o w k.am-e.., i S-F", oo A- Map Number Parcel unlber 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 ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record > a r\4 VA 4q P ea d,* v kms_ Namneffilf)a-�--j Address for Service: Signature Telephone 2.2 Owner of Record: a Name Print Address for Service: % M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone P 3.2 Registered Home Improvement Contractor Not Applicable ❑ NAlin Company Name I_ h /� Registration Number �+ Addrrss-� l G 77 P Expiration Date f5� Signature Telephone !I SECTION 4-WORKERS COMPENSATION(MG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ✓tk-Abo� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFIGIAI,USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Lo u Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) ,-X0 4 Mechanical HVAC �f / 5 Fire Protection 6 Total 1+2+3+4+5 6 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf.in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 1)(,�,L'(� l S �'('C�- as Owner/Authorized Agent of subject property , Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief a v i d (�A Ste( cures Print Si at+ taxer en ; �.�a. Date NO. OF STORIES SIZE BASEIVIENT OR SLAB SIZE OF FLOOR THVIBERS Isr2ND 3 SPAN c DlIvIENSIONS OF SILLS Dl vIENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover ti t%ORTH Building Department 0 27 Charles Street North Andover, Massachusetts 01845 � 0"~ (978) 688-9545 Fax(978) 688-9542 �40`°`"''K ��S9C�i115E'( DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 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: �. S Salmi. Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. DAVID CASTRICONE ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER MA 01845 7 HILLSIDE ROAD,BOXFORD,MA 01921 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 I/we the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to fumish 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........� Qtr....k�-�d.,.v.....e...................................... Tel one#.....[/. Q� Job Address.... . � Vb. . ..... ..................City..... . . .. htue >.............S.t.a.–.t.e.– ...... A�.�......... . Specifications: .......... ................ ......................... ............................................ Strip ezisting shingles ) Apply new drip edge to all edges. W ;1;e, ..��+............... ............................................................................................................................................................................................ VApply _feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane In valleys and bottom edges of any unheated areas of house. ............................................I....... ............................... Apply felt paper underl went. nstall ridge vent to z S-� _mss ....IS... .n ............... ...........................`................................. V&*roof using�Qo /C b r n r .� , a o s angles with a year warranty. XO—Interflash chimney." "New vput pipepashing. P6gal disposal of all debris. ...................................................... ..Vis....4 ........ ..................................................kzui, ........................................................................... Area(s)to be worked on: Q //.............................................../...u.(.f.....�`i�v. ........... Amp.,rS.......e.�..... ...�e......................................................... ...........................I............ ....... ............................................... ( .....^........ .W +.d...l...e ......... .�r -2 ............................................ ................................................................................... .. ........................................... ............................................................................... ............................................�wa....----......�.. .. .. ............................................................................................................ One Year Workmanship Warranty Not Transferable) Manufacturer's Wa ufacturer Materials and Lab to cost Payable.... S.. .....�. . Payable........... S: .P.....on......A . .......... ........... Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property,including pre-existing 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,water stains when roofing shingles have not had adequate time to cure). Upon completion of above work,all undersigned agree to execute and deliver to contractor,their 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 terms and conditions of the contract and/or any lien in connection herewith. It is further 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. 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 representations,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 shall be excluded from access to the Guarantee Fund. Approximate starting date of work..................................................................... Completion date.............................................................. Receipt of a copy of this contract is hereby acknowledged,and it is further 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 parties 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. IN WITNESS WHEREOF,the parties have hereunto signed their names this......... . ... ..day of... `!...+�...: ........,.,20...4./4 .. Accepted: C h �FySigned.... � �.................Owner t Signed.........................................................................................Owner Per. . Representative �2, 7k a�✓G Board of Building Regniations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 104569 Expiration: 7/14/2006 Type: Private Corporation DAVID CASTRICONE ROOFING,SIDING& David Castricone 7 Hillside Road Boxford,MA 01921 Administrator NORTH own of Andover No. -0ft � �o .moi-= �A o � dower, Mass., 7q=iA07-daaj"*ft 90COCHIC KE WICK 7,9 ADRATED i'P�\,`�5 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ���Y BUILDING INSPECTOR THIS CERTIFIES THAT ........ f40%0....................................................... .......................................... Foundation has permission to erect...............q.�.t*.......... buildings on....... MVA W A Roust, S ..................................................... ...... .. ........ to be occupied as !' �..!t.r O R s a��C ` Chimne....................... ............................................................................................ y 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 In action, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Roush PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR S 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. Bumex Street No. • ' SEE REVERSE SIDE Smoke let. Date. . . r f pORTM q 1 3ra<<� •�,;..;1 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� 1 This certifies that !-! � . has permission to perform i . . �rplumbing inihe buildings of . ! ./- -.4_. k -. � . . . . . . North Andover, Mass. � �. Fee/J'. . . .Lic. No.1 ,1./D .{/' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 6 . 63 lot o � L p LV S � 101 _ WATER CLOSETS KITCHEN SINKS _ $ 0 C LAVATORIES , Z 11 BATHTUB a SHOWER STALLS V DISHWASHERS $ 9O DISPOSERS LAUNDRY TRAYS 31 ; WASH. MACH. CONN. HOT WATER TANKS TANKLESS b V $ SLOP SINKS Z FLOOR DRAINS O (0 OAS TRAPS p O URINALS p' m DRINKING FOUNTAIN a 2 Q AREA DRAIN o - WATER PIPING Ic $ N GRAINS -i r.I ROOF� �� n p S BACKFLOW PREV. ,� 0 OTHER FIXTURES: p t� BOILERMATE GREASE TRAP C SCULLERY SINK . O W g SHOWER VALVE c BELOW FOR OFFICE USE ONLY •a FINAL INSPECTION$ SKETCHES FEE PROGRESS INSPECTIONS NO. APPLICATION FOR PERMIT TO 00 PLUM91NO UNDERGROUND ROUGH COMPLETE ROUGH FINAL INSPECTION PERMIT GRANTED DATE PLUMBING INSPECTOR Date. . /.`�. .7 . •. Of AO DT#4 try 3� 6 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,SSACHUSES I This certifies that, . . . . has permission for gas iinstallati n1�/�,.,, ���'. . in the buildings of . l��f. . .�!lCs �'. . . . . . . . . . . . . . at :/��. ,// fndover, Mass. Fbe'/_� '. "Lic. No.. l. ... . . . . . . . . . . . . . . . . . . 7. GAS INSPECTOR Cheek# ! / „t} f� 4773 j MASSACHUSETTS'UNIFORM APPLICATION FM PST TO QO GASFtTTING. (Print or Type). UIF "'' Mau. Date ' 2pv=l Permit # '/ �7✓ /�j.ovBuldkVl°catlog' / Q Owner's Names V YIII+C 1� C / v � Type of pcwpancy.AJI A4 New Q Renovation.-Q Replaceme Plans Submitted: Yelp Not a Z _ a_. ri- m a v~ , = G W H < Z Z < m a r <" C o ° O rW- y WW e 111 Cm /9 tW.l. W. q <. IV j _ < x- Ic- Z .Q; fc W' O F J F Z t,.. 111 . Z < m — < a .. s.. a. m: �r o z o x E O O W. _ 0, r: Z O 1! Y n. O 3. o n3 -1, V W Y. p d O sue—BSMT. BASEMENT ST FLOOR 2H0 FLOOR 2R0 FLOOR _ ` 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Nameµ �Ac�c��.�2Cn �l �o,nc , Check.on .--. fie: , Address5N4 2D �1� �F . Q �a�_ n u IrLe ('VIA n l I ❑ Partnefship Business Telephone VSs i- -I&.q - �S�(�� Firm/Co. Name of Ucensed Plumber or Gas Fitter. AELAeh /�c�dc.,2sa �T Q . INSURANCE:COVERAGE-- I OVERAGE:1 have a 4rreAliab1ItY'lr>surac=p%cy or Its substantial, equivalent which-meets the requirements d:,MGI-Yes No 13 .Ch 142.. lflou have-cheakod plesse4ndk 4he4ype coverage by checking-the Appwpdate.box A IWA ty Insurance-.policy)( Other typetindemr#y.[I, Bond Q OWNER'S INSURANCE WAP4ER:"1 am-aware that.the Hcensee does`not:have the irts<rrance.coverage required by. Chapter 142 of the.Mass.General_taws. and!hat my signature on this-permit-application waives.this requirement Check one: Signature of-_OwnerAr.,Owner:s Agent:. OwnerO Agent.❑ I hereby corny that all of the details and information 1.have submitted(or entered)in above application we true and accurate.to.the heat of my knowledge and that all plumbing worts and instailationaperformed under the permit issued for is application 'I be in compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of t�!� BY. AT of ucense: " Plumber gni tune of Licari lumber or as,a er Title Gasfitter Maer License Number 3100. Journeyman BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO OASFITTINO NAME TYPE OF BUILDING. LOCATION OF BUILDING PLUMBER 011 DASFItTER L(C.MIO. _ PEIIMIT ORM OND DATE .20...__ OAS INSPECTOR