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HomeMy WebLinkAboutMiscellaneous - 511 WINTER STREET 4/30/2018/r "I N°_ 34.:0 ./I",✓ Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ...::.. has permission to perform ' _ • - : , I , �--- .... E .............................................. wiring in the building of. '. .......:... '...... n ..........:.................................... — �- ... , North Andover, Mass. at .: �../�....:�....'.......�............ ��........................... Fee. ..........Lic. No ....................., ............. .................:....:...................... ✓ ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer s� Oak o The Commonwealth of Massachusetts Perms, Na• Q �,-- Occupancy fee Checked 4-57), Department of Public Safety 3/90 (k.ve blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK. All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Al ^ ;2 -?—CPI City or Town of- ()� f � LTo the Inspector of Wires: Tile undersigned applies for a permit to perform the electrical work described below. Location (Street &Number) s -'a V" t �/--�r l �78 Owner or Tenant VJ l L-L/A� �� �E � /"►�r Owner's Address Yes ❑ No (Check Appropriate Box) Is this permit in conjunction with a�lbuilding [ permit: �y 2 �7 Purpose of BuildingcSl t!"�1LY `1 11t Utility Authorization NO. V -3 / 33 8 Existing Service 1C � Amps 1 vZi, / �7 �% Volts Overhead 12�A Undgrd ❑ No. of Meters New Service_Amps 2© / �-�� Volts Overhead T Undgrd ❑ No. of tSeters C�� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work r o +'o Acro A M !' 5 No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges A No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro Massage Tubs OTHER: No. of Hot Tubs Swimming Pool G l��E NGL �SE2 fl F2aM �v IC. Total No. of Transformers INA Above ❑ In ❑ Generators KVA grnd. grnd. No. of Emergency Lighting Nu. of Oil Burners No. of Gas Burners Total No. of Air Cond. tons No. of Heat Total Total Pumps Tons KW Space/Area Heating KW Beating Devices KW No, of No. o KW Signs Ballasts No. of Motors Total HP Battery Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal ❑ Other Connection Low Voltage Wirine INSURANCECOVERAGE: CC ERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current L ability Insurance Policy including Completed Operations Coverage o tts substantial f same to this equivalent. YES NO ❑ aindicave tetthe typeted dofroof coverage by checking thece. appr pS NO ate box. If you have checKed YES, please91 6 0:0 INSURANCE ]0 BOND ❑ OTHER ❑ (please Specify) (Expiration ate Estimated Value of Elecrrical Work S RC_AP?` tJQW Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME CONTINO ELECTRIC & CABLE, INC. LIC. 11'1_ A11983_ Licensee LOUIS CONT I NO SignatureLIC. N0. Bus. Tel. No. -363 Address , Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S' Signature of Owner or Agent M - M Location ,3 /% R No. Date Cf -Q to -w TOWN OF NORTH ANDOVER �. 9 Certificate of Occupancy $ If^J Building/Frame /Frame Permit Fee $ �Q s+cMusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # "17618 Building 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: _ SIGNATURE: Building Commissioner/I for of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 60j j?/12�12 `S7- 44 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Maid Proposed Use Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R fired Provided 1.7 Water Supply M.GL.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 HistbricDistrict: Yes 0 2.1 Owner of Record Name (Print) Address for Service: 97F� 69J -9a77 Y Signature Telephone 2.2 Owner of Record: Name Print x Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 15—I) /rl/ 0 Licensed Construction Supervisor: License Number 7z- S De J �� ��! C!� Y Address l� Expirationzv" za�r ate Sign atu ' Telephone ` z� Y__ Yn __ / _�_ 3.2 Registered Home Improvement CoActor Not Applicable ❑ Company Name � /�� n _� a i��J� C Registration Number (/ p� (� C J `�///G d Address1zl�� ExpiratioA Date / Si nature Tel hone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 2506) 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 emit. Signed affidavit Attached Yes .......0 No ....... ❑ SECTION 5 Description of Proposed Work check alt applicable) New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Shy i&'Cl C/C/S7/IW 5 S'/%Jilti�s / d �LrvJ � lli� ,sjl�ilitJ ' ay5 Yly �G zl/�IU�D w�S SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant t }CIAI, USE UNLY NR .M, 1. Building krej 1.::7 V i k; /1) 6—eel) OOD (a) Building Permit Fee Multiplier 2 — �iVoOws /j� QOO (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) f / u�-- 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 b (>0 Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUHAING PERMIT yr � • /5"7 f V as Owner/Authorized Agent of subject property Hereby authorize to to act on Myhalf n all matters r ve t ork authorized by this building permit application Si ature of O r Date( I SECTION 77b ?)WNER I A 11T-ff0RTZVD AGENT DECLARATION I, AV, -It -e /'�—• L)Gz✓l� 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 Print e" ' O Si ature of Owner/A t Date NO. OF STORIES : `� SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS. DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I( North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Sign ure of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 . Workers' Compensation Insurance Affidavit //, , k--) s i2f- V-- city i. Please Print City Phone # % Te I I am a homeowner performing all work myself. I vl I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job Comoanv name: Address City: Phone # Insurance Co. Policv # Company name: Address City: Phone # Insurance Co. Policy # 9P g 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_weU-as_civil.penattiesinlhe form d a,.STOP WORK_ORDPR..arnd_a fine .of ($140.00)-1iay against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify Print that the information provided above is true and correct. AS Official use only do not write in this area to be completed by city or town official' %/9 / Z& City or Town PermitiLJcensina ❑ Building Dept []Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other Town of North Andover Building Department ' 27 Charles Street M 1 ' North Andover, MA. 01845 1SS�cNusE� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map / lot "HOMEOWNER Name PRESENT MAILING ADDRESS City Town Home Phone State Work vnone The current exemption for "homeowners" 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) 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 one home 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 requirements. HOMEOWNER'S SIGNATU APPROVAL OF BUILDING OFFIC Zip Code Mark A. Jenkins 35 Clinton Averse Chelmsford, MA 01824 Builder General Contractor Roofing Specialist Free Estimates 25 Years Experience PROPOSAL Customer Name: Audrey Salemi 511 Winter Street No. Andover, MA 01845 Job Location: same Proposal: Roof replacement Job Cost: $11,500.00 Downpayment: $5,750.00 Completion: $5,750.00 Start Date: September 2004 Completion Date: September 2004 This proposal is valid for a period of 60 days. Workmanship guaranteed for a period of S years. Customer Acceptance: t ceche retW-n, SPECIFICATIONS *Remove existing roof material *Re -nail loose roof sheathing as necessary *Replace up to 100sq. feet of any roof sheathing *Install GAF Weatherwatch ice and watershield to bottom 6 ft of roof edge *Install 8 inch aluminum drip edge to all rakes and eaves *Install GAF Timberline Ultra -Shingles to roof surface *Reflash vent pipes as necessary; counter -flash chimneys as necessary *Install shingle over ridge vent to all ridge areas *Remove existing skylights and replace with Veleux or Roto brand skylights (per availability) *Add 10 inch overhang to sunroom gable *Remove all debris Mask A. jerkins 35 Clinton Avenue Chelmsford, MA 01824 Builder General Contractor Roofing Specialist Free Estimates 25 Years Experience PROPOSAL Customer Name: Audrey Salemmi 511 Winter Street No. Andover, MA 01845 Job Location: same Proposal: Vinyl window replacement Job Cost: $18,000.00 Downpayment: $3,000.00 Window delivery: $5,000.00 Start Date: September 2004 1 !ewc— 1GLU1 ►v Window Order: $5,000.00 Completion: $5,000.00 Completion Date: October 2004 This proposal is valid for a period of 60 days. Workmanship guaranteed for a period of S years. Dater-" V, . f lease, qtU rvL, SPECIFICATIONS *Remove existing window sash *Install Paradigm vinyl replacement windows with molded grilles and screens 21 double hung, 6 sliding units without grilles, 6 sliding basement windows *Insulate windows as necessary *Remove existing slider; replace with two 6 ft. Paradigm sliding units *Frame box window opening; install two replacement windows with interior and exterior trim *Install Therma True steel insulated door to basement walkout *Remove all debris T yea re-form Mark A. Jenkins 35 Clinton Avenue Cbelnssiosd, MA 01824 Builder General Contractor Roofing Specialist Free Estimates 25 Years Experience PROPOSAL Customer Name: Audrey Salemmi 511 Winter Street North Andover, MA 01845 Job Location: same Proposal: Vinyl siding replacement Job Cost: 31,000.00 Downpayment: $7,000.00 2/3 Complete: $8,000.00 Start Date: Sept/Oct 2004 1/3 Complete: $8,000.00 Completion: $8,000.00 Completion Date: Oct/Nov 2004 This proposal is valid for a period of 60 days. Workmanship guaranteed for a period of S years. ank Y , Mark . Jenkins Customer Acceptance:A Ali ate:_ T wope I eTU r rL SPECIFICATIONS *Remove existing vinyl siding, soffits and aluminum trim *Remove existing Masonite siding *Install %" Styrofoam to sunroom if necessary *Re -nail any loose sheathing; replace up to 32 sq. ft. damaged sheathing as necessary *Replace damaged garage door casing and jambs as necessary *Install Tyvek to all sidewall area *Install Certainteed monogram siding to all sidewall area *Install white vinyl fluted corner posts *Install vinyl perforated soffit panels to all overhangs (Cut back existing soffit to create necessary airspace) *Install vinyl gable louvers *Install aluminum coil stock to rakes, fascias, windows and door casings *Install vinyl window pediments to first floor front windows *Install vinyl shutters to all front and driveway side windows *Install .032 seamless aluminum gutters with screens and downspouts *Remove existing front door *Install Therma True Classic Craft CC77 door with sidelight 5 . U��-�' Viwy/ .oEv/ Jv'yt- Ri✓, Sim /-P/ W, *Remove all debris y M M M M y M v M CA) az C. O� of p.F CL acc o p a� c� !D O E Oto CD CO) CD 0 v COD .p U O Cos 0 y CD CO)CD CD w 10 W* - 0 m = z dO Qm y o do m m • CM n n Z m��� som o CL PO CL y m won Co > > y cLq : O pr E VJ m m co - c 1 a m Ls n y o is e� O co go co) d or Q C/) N m : ,b US r ^ =r0 V J CA mm a ON 000 ro Zrte- � o C � � •a� 'N� `� :� ♦ — y oar° 1ir; CD .WON m z AL � co w MCL b: 20 CD A v Cf) 0 cn O O O O 0 0=3 0 9 ppppxpp- Location No. 02 DateC/ 40*Th TOWN OF NORTH ANDOVER t f O .° 1 Certificate Occupancy $ of �� s"••°' E<�' �C NUS Building/Frame Permit Fee $ -2 3 d Foundation Permit Fee $ Other Permit Fee $ TOTAL $ c. Check # r '17766 Eldilding 17766Bwlding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING - t{ L. BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissionefflatstor 6rBildings Date SECTION 1- SITE INFORMATION - 1.1 Property 1.2 Assessors Map and Parcel Number: /Address: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ZoningDistrict Proposed Use /. eZ fA Area sf) Frontage(11) 1.6 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Reqttired. Provide Required Provided Required Provided 7 1.7 Water Supply M.G.L.C.40. S4) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT histurt District: Yes 2.1 Owner of Record Ao� P i q 6�/ � ) �f ujjrt�ql N(Print) rint)� V Address for Service e 7e/1 f Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 1 Signature Telephone SECT!2N 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ �/� C✓.lam T � ��,�r�y S Licensed Construction Supervisor: y� A, CS o � g��� License Number �/ SCJ /C 3Z j� M. Address 12 (� ��cs•— 73 &67 )9j y Expiration Date Sign lure Telephone W ' 3.2 Registered Home Improve nt Contractor Not Applicable ❑ Company Name y/��� Registration Number Y2_5-�`' • /C Address b2 -41 Expimtiqfi Date + v�^ Signature Telephone .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 buildiAg permit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Description of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 91-' Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: R��o��� ► �'- PoKT S --4a,5 R-,,io ►�� r,� 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building ZZ 5 C7b (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 2 ;k 73 Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize /f �/Vl ! (�1�1�i to act on Myalf, in all matters[relive to work auth ' ed by this building permit application. S7 A4Vk i ature of O me Date SECTION 7b OWNER/AUTHO%RIIZED AGENT DECLARATION 1,<Afrne�� (/ L�7?�� ��f as Owner/Authorized Agent of subject a property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief �%� ►,, Print Name ' Si ature of Owner/A ent NO. OF STORIES Date T— SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION TT-ffCKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE , r ;\,V L%k. i' s FORM U - LOT RELEASE FORM � CP is 0� 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�LG�/T i� ?f l/ PHONE Ve- LOCATION: Assessor's Map Number. y PARCEL�� SUBDIVISION LOT (S) STREET 1411/512�—2— ST. NUMBER **** *********************OFFICIAL USE ONLY CO COMM RVATION ADMINISTRATOR DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS TH DATE APPROVED DATE REJECTED R -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm Q c wAiK wAy � a o X o✓ S154e, m 5600 coNImkk., o t� - ��) \ Q�-e c '��7 Stewart's Septic Service (978) 372-7471 ❑ Andover Septic ❑ Stratham HH1 Septic ❑ Roto -Ram (978) 475-2593 (603) 772-5548 (978) 452.9022 20 South Mill Street, Bradford, MA 01835 °`i'�� 4 PAY FROM THIS BILL Customer Name: -L Service Location:S ❑ Reg. Nature of Service ❑ WC ❑Reg. Maint. ❑ Emergency ❑ Day O Night Septic Tank Pumping and Cleaning "Done the Right Way" Phone: Contact: Billing Address: City: Zip: Special Instructions ❑ Completed ❑ Incompleted Reason: Per: - - - AM/PM Services Rendered \t Vacuum Pumping ❑ Septic Tank Observations O Good Condition Drain Cleaning ❑ Main Line 0 Drywell ❑ Leechfield Runback ❑ Toilet Bowl..! J O Leech Pit / Overflow ❑ D -Box ❑ Riding High {liquid level) ❑ Kitchen $ink i 0 Bathtub/ Shouter I ❑ Pump Chamber ❑ Grease Trap O Catch Basin ❑ Full to CoverO O Excessive Solids Top / Bottom Vanit#r ❑Floor Drain ❑ Ven> -- ❑ Portable Toilet ❑ Other ❑ Use No Powdered Soap ❑ Heavy Grease ❑ Sewbr Jet O Other", Qty: ❑ Roots Footage. Size: ❑ Suggest Electric ❑ Under 1000 gallons ❑ 1000 gallons ❑ 1500 gallons Rootering 0 2000 gallons 0 3000 gallons ❑ 4000 gallons ❑ Van Called ❑ 5000 gallons ❑ Other O Other Misc. ❑ Digging Charge * ❑ Backhoe O Inspection O Location Uin. O Consultion hrs. ❑ Certification: PIF ❑ Service Call 0 Estimate Reason: ❑ Labor O Portable Toilet Rental ❑ Pump Repair O Waiting Time ❑ Baffle ❑ Repair * Digging Charge is Per Driver ❑ Chemical Treatment Discretion O Other Description of work t CN;�MA C \ ; A Recomm'tn)ations Terms of Payment Parts Vacuum Pumping Drain Cleaning Yr. Month Yr. Month NET� � �� Tax Terms & ConditionsDiscount ❑ Cash O Check ❑Credit Total , } 1. Not responsible for damage beyond curb line. 3. 1.5°k per month will be charged to accounts past due. 2. All complaints shall be reported within 48 hours. 4. The purchaser agrees to pay all cost of collection. YM• ( J /// . , - I- LOT.��o Ao. anoover, nassaceiuseLLs Scale: 1" _ 4o' Date: May 28, 1976 s •-a moc i 1 I I t + iib+ + + T ,-®,.reser ra ..i d.p .o �•®-� �'td3 ; + r.� err I I hereby certify that the building on this property is loca as shown on plan aid couplies wit the Building and Zoning laws of t Town of North. Andover. CHARLES E. CYR �Tvi,—MGI Bt- I.AWRENa, MSS. ?),�,.� 9 za 3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Location: ��� ��/✓�� c7f• /V•dGi/b,� City Phone # 0 I am a homeowner performing all work myself. El --I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job Comoanv name: Address City. Phone # Insurance Co. Policv # 'C/lti�v City: �f /�ls�v/ A� Phone* Insurance Co. (ll2zhv/ Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment.as welLas_civiLRenaltiesjnlbefwnda..STOP WORK.0RDER..and_a.fine.d.(.$100.00)-allay against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under paing, and pnpalties,efmury that the information provided above is true and correct G . r T Print name i`C �� //—`7'1���, 5 Ph WA# 9/ O 7 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept ❑Check if immediate response is required ❑ Licensing Board p Selectman's Office Contact person: Phone #.• Health Department Other D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax Please print. DATE JOB LOCATION Number "HOMEOWNER Name PRESENT MAILING ADDRESS Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION City Town Street Address Horne Phone A State Map / lot Work Phone The current exemption for "homedwners" was eyfended to include owner -occupied dwellings of two units or less and to allow such homeowriers, to engage an individual for hire who does not possess a license, provided that the own acts as supervisor: (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER. Person(s) who owns a parcel of land on hick he/she resides or intends to reside, on which there is, or is intended to be, a one or family dwelling, attached or detached structures ac- cessory to such use and/or farm st ures. A person who constructs more than one home in a two-year period shall not be considpted a homeowner. The undersigned "yminium sumes responsibility for compliance with the State Building Code and other Applicable codes, and regulations, The undersigned "hornertifies that he/she understands the Town of No. Andover Building Departmespection procedures and requirements and that he/she will comply with said prequirements. HOMEOWNER'S APPROVAI.IOF BUILDING OFFICIAL Zip Code North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: -� �J,. 0-, - , " & (Location of Facility) Sign ture of Permit Applicant /Z,- // v /6/, y Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Mark A. Jenkins 35 Clinton Avenue Claelansford, MA 01824 Builder General Contractor Roofing Specialist Free Estimates 25 Years Experience PROPOSAL Customer Name: Audrey SaIemi 511 Winter Street North Andover, MA 01845 Job Location:same Proposal: Farmer's Porch and Side Entrance Overhang Job Cost: 22,500.00 Downpayment: $2,500.00 Completion: $10,000.00 Start Date: Sept/Oct 2004 f lwt MUM Upon delivery of materials: $10,000.00 Completion Date: Oct/Nov 2004 This proposal is valid for a period of 60 days. Workmanship guaranteed for a period of S years. Th You, Mark A. Je 'ns Customer Acceptance Date:_ _D,p iR ;I',:, Z -F, is; t 1) 1 .a I.;, . V 0 :n r N�)t f..{ ? . t f lease ff tum SPECIFICATIONS Farmer's Porch: *Frame 35'x7' deck with pressure treated 2"W' floor joists *Install Weatherbest Woodgrain decking to floor and stairs *Frame hip roof using ID rafters and ceiling joists *Use %" CDX plywood for roof sheathing *Install V solid vinyl trim to all rakes, fascias, beams, stair skirts and risers *Install 6 recessed lights *Install white vinyl lattice with 3/a" solid vinyl trim *Install Weatherbest vinyl colonial posts, rails and balusters *Install concrete footings as necessary *Shingle roof to match existing roof (GAF Timberline Ultra) *Install vinyl beadboard to ceiling area *Rework brick walk as necessary Side Entrance Overhang: *Construct overhang using all materials quoted above to specifically match Farmer's Porch IT; 173 it himl m]"vol dho Alai) '071voum I 'i ul guihob nit qLC I IF v p4glog If "Wiol oul. '�w)' ,I Ai gKoll bqu Tsbn T! 2& a Wl yd suN 110, f . -pit Wrio A 700 "At jo f, W1 "A A":; "In W I i a I, murvii an; on v! johi if{, o I "T;"; I I 4 -ii' "I' mil I As hqu: 'It TO, ovilint I qj I Wo r, 11vie"V mbiHod bon J% .""al 104"oolo)", i tid f t6tw? '�' : 1mr. WAN Q 4—Ne 14 Wol 0: W le a lit gulki W 4 m alaw, i nd I HOW l'u" Won, sin"19int" MR ah" Inn," v i W1, "r CO) m m m x m CO) v m av to CD CO) CD 0 ) Cos d O CO) O CO) CD O CD CD CO)a. CD 0 CD C CD e?�O S O -• V! O Q y _ac 5.m co) O CL m n o cCln� 3 m Z == h -1 O� 7 .ft O ,y c o Er �o a 02p y NJ � s' IE 0 o CO) a o mo 00 O J y !O! .� O m W C y 13 O C '�A �c =r /cn W m m y r CO mCD j1 l l °._3 ra 3. • Ce , O O1 y CO) CL C/) n 0 = A COD 4 y A oCD o O O v o y COD • o m CD • c rCD C •o ons 4F. -4 cn cn 4 : v 0 O m p T R O -o5 p x O p C O O ro t7l n � W W v O C �s