HomeMy WebLinkAboutMiscellaneous - 5 GREENWOOD EAST LANE 4/30/2018 5 GREENWOOD EAST LANE
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"ORT„ TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SSACNUSE�
This certifies that
has permission to perform .����,�,��;� E �r. .,�G�+ . . . . . . .
plumbing in the buildings off . . . . . . . . . . . . . . . . . . . . . .
at. _ North North Andover, Mass.
Fee. 1�.�4
PLUMBING INSPECTOR
Check #
AMASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
/(Print or Type)
CitylTown•; ,I v -Ar Aj Date: ?//6/11 Permit#
Building Locatio .__ S- &reer)WA--._E
Owners Name:
Type of Occupancy: Commercial,' Educational Industrial Institutional Residential;
Now:. Alteratiom Renovation; Replacement:)( Plans Submitted: Yes No •
FIXTURES t
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SUB-BSMT.
BASEMENT X
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Check One Only Certificate 0
Installing Company Name:;Central Cooling&Heating,Inc. ,
V/ Corporation '2806C
Address-.J 9 North Maple Street 'City/Town Woburn Stater MA
Partnership
Business Tel: :781-933-8288 Fax: 781-932-9017
Firm/Com
Pant
Name of Licensed Plumber/Gas Fitter,._Mike Bemasconl
INSURANCE COVERAGE:
I have a current liability hmursnce policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 Yes 1(:No
N you have checked Yes,please Indicate the type of coverage by checking the appropriate box bebw.
A liability Insurance policy Other type of 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 walves this requirement
Check One Only
Owner Agent
Signature of Owner or Owners Anent
By checking this box ;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the beat of my Knowledge and that all plumbing work and Instal no perfomwd umler the permit Issued for this application will be In
compliance with all Pertinent provision of the Massachusetts state Plug Code anCha ftll of tim General Laws.
Type of License:
By' Plumber I V L'o. ILA
True' ' Gas Fir ; SignatAre of Licensed umber/Gas Fitter
City/Town.., _ Journeyman License umber: ` 15137M
I
APPROVED OFFICE USE ONLY) LP Installer j,. -
f., NO_ z
APPLICATION ICOR PERMIT TO DO PLUMBING
i
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
i
PLUMBER
PERMIT GRANTED
PLUMBING"INSPECTOR
�� s
The Commonwealth ofMassachusetts
Department of Industrial Accidents
Office of Investigations Map# Lot#
600 Washington Street Addnm:
Boston,MA 02111 Permit#
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information. Please Print Legibly
Name(Business/Organization/Individual): ynq + C
Address:.. 9 AI or� a p la af,±
City/State/Zip: VJ oS,j-rn - mA 6101 Phone#: -7$I - 933-Fca $�?
Are you an employer?Check the appropriate bog: Type of project(required);
1.N I am a employer with_�� 4. E] I am a general contractor and I
employees(full.and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am as(
proprietor or partner- listed on the attached sheet. 7. El Remodeling
ship and have no employees These sub-contractors have g• ❑Demolition
working for me in any capacity. employees and have workers'
[No workers'comp. comP•insurance# 9. ❑Building addition
required.], 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their
3.❑ I am a homeowner doing all work 1 I.❑Plumbing repairs or additions
myself. [No workers'comp. right,of exemption per MGL i2.❑Roof repairs
insurance required•]t c. 152,.§1(4),and we have no
employees.[No workers' 13.®OtherTLjy.
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 subcontractors 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 employeex Below is the policy and job site'
information.
Insurance Company Name: GLOBAL XN Sk SR A N CE . N 67W O RK. SNC
Policy#or Self,ins.Lic.M L5-0602 9 (a 3(,, Expiration Date: )) Z3 O 12 0/1
Job Site Address:_ &r en uJUS Lay—fi- /(p pts City/State/Zip: l J_ /-{4d4dy`e(-I
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited 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 coverase verification.
Ido hereby cerditunder the pains and penalties of perjury that the Information provided above is true and correct
Sisnature. . F3 Date
Phone#: g�-
Offieial use only. Do not write in this area,to be completed by chy 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)'or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,.are not required to.carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that.this affidavit 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
y 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 permittlicense 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-proofthata valid affidavit is on file for fioure permits or licenses. A new affidavit must be filled out each
year.Where a,home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to 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
Departmcat of Industrital Accidents
Office of Investigations
600 Washin&n Street
Boston,MAA 02111
TeL#617-727-4900 ext 406 or 1-$77 MA- SSAFE
Revised 11-22-06 Fax#617-727-7749
vvww.mass.gov/dia .
ti
COMMONWEALTH OF MASSACHUSETTS
IN PLUMBERS AND GASFITTERS
LICEN§gRA&EAb8vgy,Mi VMAN PLUMBER
MICHAEL C BERNASCONI
58 ALBATROSS RD
QUINCY MA 02169-2658
04i
COMMONWEALTH OF MASSACHUSETTS
I LCE LUMBERS AND GASFI TEES R /
VARMJ&P
MICHAEL C BERNASCONI
58 ALBATROSS RD
t
QUINCY MA 02169-2658
LICENSE NO. EXPIRATION ATE SERIALN
COMMONWEALTH OF MASSACHUSETTS
:.• -. .
BOARD OF SHEET METAL WORKERS
AS A MASTER-UNRESTRICTED
ISSUES THE ABOVE LICENSE TO:
MICHAEL C BERNASCONI
58 ALBATROSS RD
QUINCY MA 02169-2658
LICENSE.NO. EXPIRATION DATE SERIAL NO.
3 27
L.
Ein #51-05033313 TG, �PSSERN MqS-s'
MA Reg. Hic# 149221 be I0
MA Lic. # UCS 078130
iftoting W BBB
Single-ply Lic. # 1711 C, i 932
G MEMBER
265 Winter Street,Haverhill,MA 01830
We are: V Licensed ✓ Insured V Factory Trained ✓ Factory Certified Installers
,(J -
Estimate for: P- t't_1 V,�v.i�_ :�_
Date: 1 /
Telephone 1: q 7F 6-F/ 1_0 Telephone 2: 9�7R TZ)6 "69
Add ress:,�Sl_ vio.31', City/Town: Y PL Stater'i zip:
Job Location:— 1 r City/Town: State:—Zip:—
L.R.C. agrees to commence described work on/or about 12 and described work will be completed in about e-f!_ working days. L.R.C. shall not be heli
liable for delays due to circumstances beyond our control. L.R.C. shall not be liable for any damage to landscape,attics,interior walls or ceilings and/or fixtures due to circum
stances beyond our control. L.R.C. can not and will not be held liable for any damage to the surface that the disposal container is placed on. L.R.C. shall not be held liable for pre
existing conditions including but not limited to mold and/or wood rot,defective,faulty,rotted or worn building counterparts such as but not limited to siding,gutters,masonry,plumb
ing,and windows that jeopardize the watertight integrity of the building and are not covered under the roofing warranty.
The following work includes all permits,labor and materials needed to complete your job in a professional workmanship like manner.
Steep slope Quick-quote proposal to furnish and install the following: Approximate roof area F"
® New Roof Ll Re-roof Ll Gutter L) Repair Ll Ventilation
0 Prepare for re-roofing by ensuring all safety measures are taken in accordance to OSHA standard regulations and landscape is properly protected.
LI Remove existing layers of shingles down to roof deck and dispose of in a legal fashion from the job site.Inspect wood deck,if we discover any rotted wood,
replacement will be performed at$ per LF for roof deck boards.If substantial deck rot is discovered,re-sheathing of roof deck can be performed at
$42 per SE If inclividualsheets are found to be rotted and/or delaminated,removal,disposal and replacement will be performed at S
per sheet. If any trim boards are rotted,replacement will be performed at$ e,�'?- *per LF for new pre-primed pine(not to exceed I"x 8").If wood is
sound,we will re-nail any loose wood to rafters,.sweep deck and prepare for roofing.
0 Irfstall B" Drip edge ZI Install 5" Drip Edge L) Install Hug edge(Re-roofs only) 'i-Z
/ --- Color
L) App,ly ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and or
W'Kpp I y #felt paper(UNDERLAYMENT)to the balance of the exposed wood deck.
ZI Reflath all stack pipes,tie-ins,chimneys and/or any roof penetrations as required and dictated by good roof practice to ensure watertightness.
C3 If upon inspection,we discover chimney to be worn or deteriorated,replacement will be performed at$ per chimney for single flue and
per chimney for multi Ge—s.-1. L.(-5A 1-
U Install a new '21 Year B/Traditional 0 Architectural style shingle roof system Color M a n f.
6"'Furnish and Install a new shingle over style ridge vent system F1 Soffit vent system $
All debris generated by Lambert Roofing Co.,Inc. will he cleaned up and disposed of from the job site in a legal fashion. Under no circumstances will the
watertight integrity of the building be compromised.
Special Notes: .1,1-4') Z
Warranty options: Er",Standard LRC Ll Manufacturers Upgrade $
* Denotes additional costs above the total estimated price.
UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF TEN YEARS HONORED AND ISSUED BY THE LAMBERT
ROOFING COMPANY AND Z,. ; YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER.
This document can serve as a contract,however if a more elaborate contract is desired we will issue it at the owners request.
Please sign and return one copy upon acceptance. NOTE.•if this contract is not accepted in ;`y days,it maybe withdrawn by LR(.
Financing is available
A finance charge of 1.5%per month(18%per year)will be charged on post due accounts over 30 days.
Total Estimate Price: $ 7;/o, Date of Acceptance I It I 'D
.-,
Payment to be made as follows: 415 T)" r..-l 4J (Home/Business owner)
f Signature
(LRC)
Signature
Haverhill MA 978 374-9224 • Lawrence MA 978-687-7339 • Atkinson NH 603-362-9500 • 1-888-SOS-ROOF (767-7663) - Fax: 978 5211-579'
"Our Proof is on Your Roof"
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THIS CBitTIFICATB IS ISSURD A9 A ► �OF IxP01tMATION ONLY AND
rPRODUCER CONFERS No R)tlH7'3 UPON T8B CERTIFICATE lIOLPM THIS CERTIFICATE
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a� Board of Building Regulations and Standards License or registration valid for individ l use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found retarn to:
Board of Building Regulations and Standards
Registration: 149221 One Ashburton Place Rm 1301
Expiration: 12/6/2009 Tr# 262486 Boston, Ma.02108
Type: Private Corporation
LAMBERT ROOFING CO
RICHARD LAMBERT `
265 WINTER STREET Not vat wit out signature
HAVERHILL, MA 01830 Administrator
r Ions an
tan ards
�lat
Boar o u1ldlnl, gu
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 149221
Type: Private Corpration
Expiration: 12/6/2009 Tr# 262486
LAMBERT ROOFING CO
RICHARD LAMBERT
265 WINTER STREET
HAVERHILL, MA 01830
Update Address and return card.Ma reason for change.
E] Address I—] Renewal Empl ment E] Lost Card
DPS-CAI C� 50M•07/07-PC8490
J
Board of Building ReCJulations
U9
One Ashburton Pace, fpm 1301
Boston, Ma 02108- 1616
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate 06/02/1972
Number: CS 078130 Expires: 06/02/2008 Restricted To 00
RICHARD 1 LAMBERT
95-MAPLE AVE
ATMNSON, NH 03811
Tr, no: 27100
Keep top (or receipt and char a of address nooflcatlo
OPS-CAI n 50�4/OS-f CII JI
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
d 600 Washington Street
Boston, MA 02111
°r www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please.Print Legibly
Name (Business/Organization/Individual): .
Address: �T �✓� G s
City/State/Zip: GG oIgF36 Phone.#:
Are you an employer? Check the appropriate box: Type of project(required):
�
1.$LI am a employer with 4. E] I am a general contractor and I
* have hired the sub-contractors 6. ❑New construction
employees(full and/or part-time).
2.❑ I am a sole proprietor or partner- listed Remodelingon the attached sheet, 7. ❑
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' g ❑ Building addition
[No workers' comp, insurance comp. insurance.#
required.]
5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised.their 11.❑.Plumbing repairs or additions
myself. [No workers' comp. Tight of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no
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 infomiation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subrnif 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:
Policy#or Self-ins. Lic. # (Y�(� -7 46O Expiration Date: F—geF—ed
Job Site Address: i �E'L's!el� City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and a/xp-iration 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 u er a pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone# �
Official use only. Do not write in this area, to be completed by city or town official
City or Town: _Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
_ocation �
No. ly CJ Date
N°Rr� TOWN OF NORTH ANDOVER
Certificate of Occupancy $ "") o
vo
; Building/Frame Permit Fee $ SIP,` Foundation Permit Fee
Other Permit Fee $
Sewer Connection Fee $
(S�P� z �9 Water Connection Fee $
l
TOTAL $
Building Inspector
W6 6523 Div. Public Works
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE i
MAP 4-40.• LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK .'PAGE
ZONE I SUB DIV. LOT NO. F- I
LOCATION PURPOSE OF BUILDING far
i
OWNER'S NAME ,LhL NO. OF STORIES , SIZE
OWNER'S ADDRESS BASEMENT OR SLAB ��
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST2X1 Q 2ND 3RD
BUILDER'S NAME...y,-__ I /r _ _` SPAN
DISTANCE TO NEA_RLESSTY 13 UU`IILDD-IN`G / DIMENSIONS OF SILLS
DISTANCE FROM STREET �? / "' POSTS
sf
DISTANCE FROM LOT LINES-SIDES Jy REAR GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION ` p �r IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Crr G) IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES EST. BLDG. COST
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS t - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED Q
n-/ 4 BOARD OF HEALTH
SIGNA E90 O R OR AUTHORIZED AGEIAT
FEE
'�' `S—v • `� OWNER TEL.A Sil k 2.i—rg� C
PLANNING BOARD
PERMIT GRANTED ool
1/tONTR.TEL. sS'� �
_..
19 0 XONTR.LIC.#
L c
BOARD OF SELECTMEN
if`
� I" _. ! � BUILDING INSPECTOR
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY StORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE B 1 2 13
CONCRETE BL K. —{ PINE
BRICK OR STONE H— D
PIERS PLASLAS TER
_ DRY VJALL
UNFIN.
3 BASEMENT
AREA FULL FIN. 8'M'TAREA _
14 '/f °/. FIN. ATTIC AREA _
'NO 8 M FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS 8 1 2 3
DROP SIDING CONCRETE
WOOD SHINGLES EARTH
ASPHALT SIDING HARDY✓'D _
ASBESTOS SIDING _ COMMON
VERT. SIDING ASPH.TILE —{I_
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BIK.
STONE ON MASONRY WIRING
STONE ON FRAME
SUPERIOR i__j POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE I HIP BATH 13 FIX.) _
GAMBREL MANSARD TOILET RM. (2 FIX.)
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY _
WOOD SHINGES KITCHEN SINK _
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER -
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING i l HEATING
WOOD JOIST PIPELESS FURNACE r •'
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR ` r
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC trr�I y,5
1st 13rd I NO HEATING C 1
Tel(50"ti'745-0909 FAX(508',)45-8349
IMPACT CONSTRUCTION, INC.
Sheldon W.Frisch 17 Front Street
President Salem,MA 01970
FORM U - IAT 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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: ��„ - r� ,L_ �� C,,r.0y' Phone !QP) 7�5;
LOCATION: Assessor' s Map Number Parcel
Subdivision Lot(s)
Street �� ��e�� ub) 'L�sU�' St. Number
************************Official Use Only************************
RE OMMENDATIONS OF TOWN AGENTS:
i� Date A roved (01
1� PP
Conservationi istrator Date Rejected
Comments
i
!� Date Approved
Town Plann
e Date Rejected
Comm
ents
Date Approved
Food Inspector-health Date Rejected
Date Approved
Septic Inspector-Health Date Rejected
i
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
�i `;•_"
r,Receiv;ed by Building Inspector Date
il. _i4
G O
Tovvn of 43 Andover
O
No. 39O ._� _,?. .
h 4
jell
-N ,. Vdover, Mass., 19
cOCMI C.MEWICK
0A`ATED
'9S . BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.... ....s�. 4`.. .. ?. .. ►.. •• I��� •••••o••••••••••••••••• Foundation
has permission to e ., , ....... buildings on . ... .r ' .. ..... Rough
to be occupied as.4.A ... .. ..t ..... 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. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
• i x Rough
......... - :. .......t` ................ 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
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT
Burner
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SFWFR /WATFR __ _____FINAL DRIVEWAY ENTRY PERMIT
woo
+,;. -- _ --- - - - - - -- --- -- _
4
COMMONWEALTH I. DEPARTMENT OF PUBLIC SAFETY =�
OF 1010 COMMONWEALTH AVE.
MASSACHUSETTSBOSTON, MA 02215
p
LICENSE � CAUTION
EXPIRATION DATE V'000'( CONSTR. SUPERVISOR
05/31 /1 994FOR PROTECTION AGAINST
EFFECTIVE DATE LIC—NO.
RESTRICTIONS THEFT, PUT RIGHT THUMB
�'
NONE .s 05/31 /1992 051135 PRINT IN APPROPRIATE
E' BOX ON LICENSE.
�o SHELDON W FRISCH It
114 L OT H R O P ST BLASTING OPERATORS
SS N 033-44-0$$4 + Z BEVERLY MA 01915 MUST INCLUDE PHOTO.
PHOTO(BLASTING OPR ONLY) FEE;��yy ,''
1 0 0.00 'y�, NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ly I tJ' ••\ j j ', ,
HEIGHT:
STAMPED-OR IGNATURE OF THE COMMISSIONER i
07/14/1931-
THIS
19/(1-x?
THIS DOCUMENT MU91,"it SIGN NAME IN FULL ABOVE SIGNATURE LINE
' CARRIEDONTHEPEf3�J0 SIGNATURE OF LICENSEE , r
• THE HOLDER WH(A1, Y / Acting
W+�.... OTH RS-RIGHT THUMB PRINT GAGED INTHISOGCUPP T COMMISSIO -
�R
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ii}777 '0 " ' I ADMINISTRATOR I
MA 0ii7u
OFFICES OF:
U.-S
. . . 120 Main Street
North Andover.
APPEALS NORTH ANDOVERMassachuseas o ts4s
BUILDING (6171685.4775 - -CONSERVATION
DIVISION OF
HEALTH
PL.-iNNINc PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
In accordance with the provisions of MGL c 40, S 54, a,'condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S
150A.
The debris will be disposed of in:
(Location of.Facility)
` nature of Permit Appli nt
Pate
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
Y'
Cff'V ORPO
MOMAOE
August 30, 1993
Citicorp Mortgage, Inc
Mr. Sheldon Frisch The Meadows Office Bulloing
fifth Floc(
President 161 Worcester Poad
Ii-apact Construction, Inc. Framingham, Massachusetts
17 Front Street 01701
Salem, MA 01970 508 875.067-2
1-600-446.007'v
Dear Sheldon:
This is to inform you that your comnY Impact Construction Inc. has been
awarded a contract to renovate 5 Greenwood Lane; No. Andover, MA, Renovations
to include but not limited to:
Rebuild rear deck to code.
LIP,
Replace rotted sills and sheathing at rear deck.
Repoint front steps.
Contract amount $8,340.00.
I
Si cerelY,
,,,
Rick Rush
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CERTIFICATE "OF USE & OCCUPANCY
Town of North Andover
Building Permit Number 390 Date OCTOBER 22, 1993
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 5 GREENWOOD EAST LANE
MAY BE OCCUPIED AS REPAIR DECK & SILLS & SHEATHING IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
ca,",�oT;�tio CERTIFICATE ISSUED TO Citicorp Mortgage Inc.
St. Louis
ADDRESS MIssouri
Building Inspector
�I
i
Nit-
To%� 0 nor f_: over
V.
K�r�r
,`ATort ' ?" 91 *
0
dower, Mass., �`= 19
O !CVC Ii1C.ME WICK
r� A
E
SBUILD
z BOARD OF HEALTH.
PE .RM IT To Food/Kitchen
Septic System
THIS CERTIFIES THAT....+ .... .. .. .�C.., .. + ,> XA411 .................... Rt,Z_ "C'INS TOR
R v
`dat on
has permission to e ., �'e*Jq....... buildings onl ..... Rough
- w 'S
to be occupied as. f .*X. ..., A.. .. .. .. .. .. '> ..... Chimney 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 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'FRMF F E�/d' DJRES IN C MON'T'HS
UNLESS CONS'TI, UC_110t-] S'-FA-
- A- RI,S ELECTRICAL INSPECTOR
e r-.J�r V Rough
` .. :: .:> ....T �� `:� ............... Service
BUILDING INSPECTOR
Final
Occupancy 1 cii 3 ii.t 1-_Zeqm h P.d to OCCLi j.')' J 3Lti h117 l(j GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
P Y P Final
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT
Burner
1
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT