HomeMy WebLinkAboutMiscellaneous - 5 ANDREW CIRCLE 4/30/2018 5 ANDREW CIRCLE
210/047.0"0045-0
J � 000.0
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North Andover Board of Assessors Public Access Page 1 of 1
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NORTff North Andover Board of Assessors
i
seE roperty Record Card
Click Seal To Return Parcel ID:210/047.0-0045-0000.0 FY:2013 Community:North Andover
SKETCH PHOTO
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Summary -
Residence '
Detached Structure — �-
Condo 6 ANDREW CIRCLE
Commercial
Location: 5 ANDREW CIRCLE
Owner Name: DOYLE,SHAUN D
Owner Address: 5 ANDREW CIRCLE
City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood: 5-5 Land Area: 0.09 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area: 1224 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 208,700 214,800
Building Value: 75,200 77,700
Land Value: 133,500 137,100
Market Land Value: 133,500
Chapter Land Value:
LATEST SALE
Sale Price: 1 Sale 12/06/1999
Date:
Arms Length Sale F-NO-CONVNIENT Grantor: RAYMOND DOYLE
Code:
Cert Doc: Book: 05626 Page: 0225
http://csc-ma.us/PROPAPP/display.do?linkld=2253372&town=NandoverPubAcc 3/26/2013
Residential Property Record Card
PARCEL ID:210/047.0-0045-0000.0 MAP:047.0 BLOCK:0045 LOT:0000.0 PARCEL ADDRESS:5 ANDREW CIRCLE FY:2013
PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 05626 Road Type: T Inspect Date: 05/04/2011
Tax Class: T Sale Date 12/06/99 Page: 0225 Rd Condition: P Meas Date: 05/04/2011
Owner: Tot Fin Area: 1224 Sale Type: .P..,, i` Cert/Doc 3 Traffc. M Entrance: - C _
DOYLE,SHAUN D Tot Land Area: 0.09 Sale Valid: F Water: Collect Id: RRC
Address: Grantor: RAYMOND DOYLE Sewer:. Inspect Reas: C
5 ANDREW CIRCLE
NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% /
RESIDENCE INFORMATION LAND INFORMATION
Style: RM Tot Rooms:. 5 Main Fn Area: 612 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R4
Story Height: 2.00 Bedrooms: 2 Up Fn Area: 612 Bsmt Area: 612 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class
Roof: ,.G,,. Full Baths: 1 Add Fn Area: Fn Bsmt Area: 372 1 P 101 S 3000 0.070 133,346
Ext Wall: AV Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0 0.020 152 '
Masonry Trim: Ext Bath Fix: 0 Tot Fin Area. -1214- VALUATION INFORMATION
Foundation: CN Bath Qual: T RCNLD: 93962 "A Current Total: 208,700 Bldg: 75,200 Land: 133,500 MktLnd: 133,500
Kitch Qual: T Eff Yr Built: 1976 Mkt Adj: _ _0.800 Prior Total: 214,800 Bldg: 77,700 Land: 137,100 MktLnd: 137,100
Heat Type: ER Ext Kitch: Year Built: 1974 Sound Value:
Fuel Type: E Grade: A Cost Bldg: 75,200
Fireplace: 1 Bsmt Gar Cap: 1 Condition: A Att Str Val 1:
Central AC: y _
Y Bsmt Gar SF: Pct Complete: Att Str Val2:
Att Gar SF: %Good P/F/E/R: /100/100/77
Porch Type Porch Area Porch Grade Factor
W 144
SKETCH PHOTO
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8 144 Sq.Ft 8
FM/B
612 Sq.Ft — b
34 34 1
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5 ANDREW CIRCLE
is
Parcel ID:210/047.0-0045-0000.0 as of 3/26/13 Page 1 of 1
Location a, —
No. — (� Date
• - TOWN OF NORTH ANDOVER
• yti�.rc.ra�,t.46�
R
Certificate of Occupancy $
Building/Frame Permit Fee $
3
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
�L-
26410 1 /Building Inspector
TOWN OF NORTH ANDOVER GbD Io
APPLICATION FOR PLAN EXAMINATION
Permit NO: I ` Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION .
._. P int
PROPERTY OWNER
Print 100 Year Old Structure yes o
MAP NO: PARCEL: ZONING DISTRICT: :Historic District yes no
Machine Shop Village yes no
. . . . . . . .
TYPE OF IMPROVEMENT PROPO§K USE
Resid ial Non- Residential
❑ New Building k6ne family
❑Ad ion ❑Two or more family ❑ Industrial
❑PXeration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
El Septic 0 Well El Floodplain ❑Wetlands ❑ Watershed District,
El Water/Sewer
DE I TIO. WOUK T E P RFOR
Iku) -�
Identification P ease Type or Print Clearly)
OWNER: Name: Ain IOU4 Phone:
Address: &k�ae -
CONTRACTOR Name: Phone:
Address:
Supervisors Construction License:, Exp. Dater
11 _
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ( FEE: $
Check No.: qI W'97 Receipt No.: 2-C.9 L�(C
NOTE: Persons contracting with unregistered contractors do not have access t he gua anty fund
Signature^of Agerit%Owner Signature of contrac
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
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
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
i
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Tow Engineer: Signature:
* Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located 2t'124 Main tStreet
Fire Department,signature/date
COMMENTS
i
� NORTfi
own
Of E ndover
O .:;.. 0
No.
I:h ver, Mass, GG
COCHICNIWICN
J9 A�R�ITED PPP,�A
S V
BOARD OF HEALTH
PE MIT -T LD Food/Kitchen
Septic System -
�u� ��q.fr.g
BUILDING INSPECTOR
THISCERTIFIES THAT .......... .....:... ............. .......................................................................
has permission to erect ........................... buildings on Cine..��
Foundation
,Q - .. Rough
to be occupied as 1o�a�� 2' iP/�''i..:� �I !ate���.c "•'S 3QA`"�� �'�� � Chimney
.................... ..........1.................... .... .................. ..1.................,......................
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
.. Service
... �,,`;.......................... Final
4 BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
SEE REVERSE SIDE
The Commonwealth of Massachusetts
Department of Industrial Accidents
u Office of Investigations
+ 600 Washington Street
Boston,MA 02111
www.mass.govfdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le-OW
Name(Business/Organization/Individual): .
Address
City/State/Zip: ��� (. , )� ; 'hone-#:
Are you an employer? Check the appropria oz: Type of project(required):."
1.❑ I am a employer with 4. I am a general contractor and I 6 E]New construction
employees(full and/or part-time).* ave hired the sub-contractors
2.❑ I am a sole proprietor or partner-
listed on the-attached sheet. 7. E] Remodeling
ship and have no employees Tnese sub-contractors have g. E]Demolition
working for me in any capacity. employees and have workers' 9 E]Building addition
[No workers' comp.insurance comp.insurance.$
required.] 5. F1 We are a corporation and its 10.[] Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their ME]Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Ro repairs
insurance required.]t c. 152,§1(4),and we have no.
employees.[No workers' 13. Other !!1
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 11ame of the sub contractors and state whether 6r 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. C-7
Kkl, .. I-
Insurance Company Name: - —
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: A A City/State/Zip:
Attach a copy of the workers'compensatiori'pblicy 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'$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for in ane coverage verification.
Ido hereby certify under the ains nd en ies o perjury that the information provided above , tr., a and correct.
Si ature: Date: —
Phone#: .
Official use only. Do not write in this area,tb be completed by.city or town official
City or Town: Permit/License#
Issuing Authority(circle one): _
A.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector
6:Other
Contact Person: Phone#:
- I
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CA�1;:i�iF Qlr'��iI NT C€NTRA'CTOR
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169C CU�tEi�RLJ1 R� tt►A�°S .�•� ,6-�'�••-_— ,. s� "� s '� ' _
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,�31'"iT��. � -I0>=,Ocl�
CERTiFiCATE IS ISSUED AS A MATTER OF INFCR�JLATIO�i C�iL�!AI4Ir COf if ,�a �� >Yr y!_:FrE � , �R S.
CERTIFICATE GOES NOT AFIri"IRMATIVEL-f OR NS :r 117
,�Y TL,eS�„L' C �N J1� .
CERTIFI .THIS CERTIFICATE.OF INSURANCE DOES ivOT CpNSTiTIJTE A CCNTRACT EETv�lEti1 THE ;SSLIi'i� IIIb
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDEP. ”'""'�='�r 73 a
EL P Ali y(
1:a1PtOfRTANT: IT the t,9 f caIE.ilClder{$ar,b117D3T(tDl`IAL)%�e3L''r rl QST„)�7 .-i..nient on 6110
Ire terms and conditions of the policy,certain DONCies;Il
I
s• --I,n 1 . 11
1das 1.. n,iace_Of Sur�r h endDrsesTaeni(s) _�___ -•-- •=CONIA -- `
NAME: _ --- -- F>
PRODUCER PHONE _
MARSH USA,INC. rAJC No.=�L-- -- ----
77 . ..
T190.LLIANCECENT-R E-MAIL -
3550 LENOX ROAD,SUITE 2400 ADDRESS' — NPIC s
A T LAPITA,GA 3032b V INSURcR S AFFORDING COVERAGE __— —126307
INsuRER a:Steadfast Insurance Company - —
1()Nc2-HcmeD-GAW-13-14 (16535
INSURER 3:Zurich nmerican Insurance Co ,
INSURED t;Erl Hampshire Ins Ce 2384
THE HOME DEPOT INC: INSURER C: 23817
HOME DEPOT U.S.A.,INC. INSURER D,Illinois National Ins Co �
2455 PACES FERRY ROAD,NW
BUILDING C-20 INSURER E
ATLANTA,GA 30339
INSURER F
COVERAGES ,- CERTIFICATE NUMBER:
ATL003159545-04 REVISION NUMBER:?
THIS IS TO CERTIFY THAT THNG ANY`REOUIREMENTNTERM OR CONOITLON'OF, ANY CONTRACTT OR OTHER DOI:AVE BEEN 1SS ED To THE INS CUMENT WITH RESPECT LL ThifWHICH'ABOVE-FOR THETOLICY TINOIS
INDICATED. NOTWITHSTANDI �EDI BY THE POLICIES
CERTIFICATE MAY BE ISSUED Oct MAY POR CIES.T.I E IN SHOWN MAY HAVE BEEN REDUCED BY?AID CLAIMS.
EXCLUSIONS
HEREIN IS SUBJEOT TO ALL 7HE TERMS
EXCLt1SIONS,AND CONDITIONS OF S L Mot! EFF .I P LI Y EXP } LIMITS
ILTSRR TYPE OF1NSURANCE V, I POLICY NUMBER r — 9,000000
103rO1f2013.' 0310112014 EACH OCCURRENCE S L000
GLod.887714-03 AMA E T ENT 0
A GENERALItABIURY,_ 1 tI PREMISES Ea war ncel 15
I X.y COMMERCIALGENERALLIAOILITY j E EXCLUDED
LIMITS OF POLICY XS 1 i MED EXP(An one person)
1 -CLAIMS?AAD. .�-OCCURPERSONAL 1 &ADV INJURY S
. OF:SIR:tIN,PER DOC, ` 9,000,000
t GENERAL AGGREGATE
' I ( 9000 000
AGGREGATE LI .1T APPLIES PER:
! UCS COY1P OP AG
', -
PRODUCTS
1 G S
PRO 1
. •., , . COM BINED SINGLE LIMIT 1;000 Ob0 I
X 11`PoLICY
LOC i I o0 0310112013 03101,2914 IEaacudent
BAP 2....8863.10
B AUTOM081LE LIABILITY, _ BODILY INJUP.Y(Per person) 5
X ANY AUTO. BODILY INJURY(Per accident) S
ALL OWNED , SCHEDULED., SELF INSURED AUTO PHY DMG ' PROPERTY DAMAGE S
AUTOS AUTOS Per accident
NON-OVl5VE0:
$
HIREDAUTOS AUTOS
EACH OCCURRENCE ($
UMBRELLA LIAR i OCCUR AGGREGATE 5
`EXCESSLIAB CLAIMS-MADE ( S
DEO RETENTIONS0310
000033575314(AOS} 11201 f 03101)2014 X WC STATU- OTH-
C WORKERS COMPENSATION ! Ii
03/01!2013 1,000,000
AND EMPLOYERS'LIABILITY YIN WC033575315(AK,AZ) 03101!2014 E.L.EACH ACCIDENT S 10.0
C ANY PROPRIETORMARTNERIEXECUTIVE _NiN 1 A 0310112013 103!0112014 E.L.DISEASE-EA EMPLOYE 5
OFFICERIMEMSER EXCLUDED? 000033575316(FL) 1,000,000
D (Mandatory In NH) E.L.DISEASE-POLICY LIMIT S
If yes,describe under I 1000,000
1 DESCRIPTION OF W
OPERATIONS below
C IWO)21(ERS COMPENSATION C033515311(KY,NC,NH,VT) 0310112013 10310112014 (EL)LIM{T
I WC033575318(NJ) 0310112013 1010112014
i
ATIONS 1 VEHICLES,(Attach-ACORQ 101,Additional Remaft Schedule,If more space Is required)
DESCRIPTIOMDF-OPERATIOtr'L`LOC
EVIDENCE OF COVERAGE
CERTIFICATE HOLDER
CANCELLATION
THE HOME DEPOT INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE HOME DEPOT INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
HOME DEPOT
USA. R X.
NW f — ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING 420
ATLANTA,GA 30339 AUTHORIZED REPRESENTATNE
of Marsh USA Inc.
Manashi Mukherjee -
__ r�no�noeTlrlN All riahts reserved.
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HOME IMPROVEMENT CONTRACT
PLEASE READ THIS
Sold,Furnished and installed by:
Branch Name: Boston bate: THD At-Home Services,inc.
d/b/a The liolue Depot At-Hnme Services
908 Boston Turnpike Unit I,Shrewshury,MA 01545
Toll Free(800)657-5182;Nan(508)845 6011
Branch Ntunber.31 Federal 11.)11/S 264$460-Mr T it 4(-n2119,R1 Cont-l.ic#16427
Cl Lic#I11C.0565522.MA Home lmprovcmctil Contractor Reg.If 126843
Installation Address: ' _&9 ti11VCX_e1/V G LVC\Q , ►vo�� SNOOyQr 1 M;4 a 184.x"
City state, Zip
Pnrrhawr(s):
Work Prune: HumC Phone-- Ce111'hone:
--v r i
Holm Addresv:
(if different!'torn Installation Address) City "-- Staattc Zi
E i1 Addtrss(to rcccivC prujoct ccrmmunicatinns amt home Depot updates) �,�+�I���CSLj 1 �G�MAt I • am
1X)NC)T wish to receive any uuulutittg cnutits form 7}tc Home Lkpttt
Yrniecl Infnrmnfinn: Under signcxl("Cuslumrr'`).the owners U(the property located at the above installation address,agrees to hay,
and TIII�AL Hume Services,Ito.{"73te Hone llepol )ngrccx ui furnish,deliver and arrange lar the installation("Installation")of
all nuttr,ials du uTibeel tm the below trod nn the rcicrenee[i tipee 5heel(s}, all of which are incorporated Into Ibis Contract by this
refeieace,along with any applicable Siete 5npplement and Payment Summary attached hereto and any Change Orders(collectively,
`Contract"k
Job#: nanmW serensai Prctdttet�: S •Shrel(s)#: Prided Amuunl
❑Rulr s ❑Bilin endows ❑lnsula[ion 1 ,Ciuners(foyers ❑Nuns!),sets ❑ 6 a $ `7 b b Z
Ronfing []Siding ❑Winthiws ❑Innirlation FT
❑fianrn/Covers ❑Entry Doors Lj
ltwfmg Siding Windows ❑Insolation n
n utters/Covers ❑!rorty Ikiors❑ $
❑Roofing ❑Sitting ❑Windows ❑Insulaliun
❑Gad(vrx/Covers Flratry 1?oors ❑
Minimtm 7S 96 Deparst of Caotrad Anwx d sin uW,Q=ptien or rho cwnlracr.
Ms®c Purshintt�rr may not deposit more than tnte-Ihird of tht,Cordrntt AmtatnL Total Contract Anwunt $ '7 y
Customer agrees that,nnntrtiiatcly upon completion of the work Cor each Product,Customer will execute a Completion Certificate
(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Custumet under this
Contract agrees to bejointly and severally obligated and liable hereunder.
The Home;Depot reserves the right to issue a Change Order or terminate this Contract or any individual PTodnct(s)included herein,at
its discretion,il'The Home Depot or its authorized service provider determines that it cannot periorm its obligations due to a structural
problem with the home.environmental harards such as mold,ashrstns or lead paint,other safety concerns,pricing emirs or because
work required to complete the job was not included in the Contract.
Payment Summary: The Payment Summary It ._.&Z-14 D included as pari of this Contract., sols iurth lite total
Contract amount and payments requued for lite deposits and final payments by Product(as applicable).
NOTICE TO CUSTOMER
Year are entitled to a completely filled-in copy of the Contract at the tine you sign. Do not sign it Completion Certificate(note:
there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product
is complete.
in the event of termination of this Contract,Customer agrees to lay The Home Depot the costs of materials,labor,expenses
and services provided by The.Home Depot or Authorized Service Provider through the date of termination,plus any other
amounts set forth in this Agreement or allowed under applicable law. THE HOME,DEPOT MAY WITI1II01.1)AMOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MAT)F, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Accelitance and Authorization: Cattomcr agrees and rmderxtands that Ibis Agreement is the entire agreemcnl between Customer
and l'hc Home Depot with regard to the Products and Installation services and supersedes all prior di%enssiom and agreements,either
oral or WTittrm,[elating to said Products mrd Installation.This Agrecinent ctoutot be assigned or amended except by a writing si}ned
by Customer and The Honte Depex.Custunter acknowledges and agrccs that Custotuci has lead,understands,voluntarily accepts the
terms of and has n rived a copy of this Agreement.
ACCt Snhmfitted h �G�2�,Q�
x �-l0 `13 x
Customer's Siguantnc Date Sales Consultant's Signature Date
X 1'elcphonc No_ (07>—6 z �sl�-1 _
custonre'1'S Signature Date
Sales Cnnsuttant License No. _
CANCELLATION: CUSTOMER MAY CANt'El, THIS (a-appllcnble)
AGRFFMENT WITHOUT PENALTY OR OBLIGATION
BY DELIVERING WRITTEN NOTICE-1'0 Till+: HOME
DEPOT BY MIDN1GMY ON THE THIRD BUSINESS
DAY ANTER SIGNING THIS AGREEMENT. THE
9rATE SUPPLEMENT ATTACHFD HERICTO
CONTAINS A NORM T() USF iF ONE IS
SPECIFICALLY PRF.W.R)BED BY LAW IN
C'USTOMER'S STATF_
NOTICE!ADDM0NAI-•rFKMS AND CUNPtT1ONS ARE STATED ON THE,REV V IL51?SIDE AND ARE PART OF THIN CON I KAC T
'10-11-12 White-Branch File Yellow-Qjstomer
L�i'd SHU 10d-U awoH:01 92L8 28L 209 Mid TC3CNUS N3)I:woa3 t7b:02 ET02-90-AUW
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.$10041000 fine
NOTES and DATA— For department use
i
i
0 Notified for pickup - Date
E
L
Doe.Building Permit Revised 2010
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
o Building Permit Application
❑ Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o. 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
L3 Certified Surveyed Plot Plan
o Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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)
o Building Permit Application
Li Certified Proposed Plot Plan
Li Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affldavlt
Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
Li Mass check Energy Compliance Report
o 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: Doc.Building Permit Revised 2012
Date. ...f.. .. . ... .
,,ORTp
o� TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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This certifies that . . . .�. /.'.�`?.�:'. . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . c. . . . . . . . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . l North Andover, Mass.
Fee.3Ut Lic. No..
GASINSPECTOR r M
Check#
6805
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Cityffown. North Andover :, MA. Date: 5/22/09 erniit#
Building Locafon.--6�,„a,.o.,,Qr Owners Name:I Bobby Latch
Type of Occupancy: Commercial Educational I–] Industrial Institutional L] Residential
New: Alteration: Renovation: Replacement:M Plans Submitted: Yes No .
FIXTURES
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BASEMENT
1 FLOOR
214u FLOOR
3 FLOOR
—
4m FLOOR
5 FLOOR
—6'r—FLOOR
7 FLOOR
8 FLOOR
Installing Company Name: ey pan ore
Check One Only Certgte#
Address:
{ ; l Corporation --
f2 Second Avenue City/Town• Burlington State:H,. —
Partnership l
Business Tet: _ _ Fax: 781-359-2745
Firm/Company
Name of Licensed Plumber. Andrew W.Fleming
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 Yest lNoF
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy El X Other type of indemnity Ll Bond D
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
Sr nature of Owner or Owner's 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 compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 the General Laws.
r
By�— Type of License:
Titie1 i ✓ Plumber t9 a ure of Licensed lumbe
�"�''
�412
city/TownMaster l Journeyman License Number. -S'$ 5
7 /
APPROVED OFFICE USE ONLY
FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS)
FEE: S PERMIT#
APPLICATION FOR PERMIT TO Dp GAS FITTING
Q A
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
SKETCH
PLUMBER,GASFITTER_LP INSTALLER
LICENSE NUMBER:
PERMIT GRANTED D DATE:
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GAS FITTING INSPECTIOR