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HomeMy WebLinkAboutMiscellaneous - 520 BOSTON STREET 4/30/2018 / 520 BOSTON STREET \ 210l107.D-0080-0000.0 \ i I I i I Alk Commerce Insurances- The Commerce Insurance Cempanysm CSC Citation Insurance Cempanysm Members of The Commerce Group,Ines" CLAIMS DEPT. SM 11 Gore Road,Webster,Massachusetts 01570 (508)949-1500 www.Commerceinsurance.com October 31, 2011 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall N ANDOVER MA 01845 RE: Our Insured: GORDON ROBERTS/DORIS P ROBERTS Property Address: 520 BOSTON ST Policyk MN8073 Date of Loss: 10/29/2011 Filek XYC956-VVCJ39 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. VIRGINIA GERVAIS Telephone: (508)949-1500 Ext: 11422 Claim Specialist, Casualty Toll Free: 1-800-221-1605, Ext: 11422 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above,by first class mail. October 31, 2011 CcmmCr0 Companies ....COME GROW WITH us CIC 254 (Rev.4/95) MAIL I38 6296 Date... .......... RTH "o 0- TOWN OF NORTH ANDOVER PERMIT FOR WIRING ss^cHUS This certifies that ............... .. has permission to perform.... . ...................................... wiring in the building of. ............................................... ......................... .North Andover,Mass. Fet Al................ Lic.No.............. ..... ............ ELECTRICAL INSkcro Check # j orlicial use only Commonwealth of Massachusetts t _ - Permit No. �. 2� Department of Fire Services Occupancy and Fee Checked 35 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code)EC). 52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 T fel City or Town of: AfIle-,L To the Inspector of'Wires: By this application the undersigned gi es notice of his or her intention to perform the electrical work described below. Location (Street& Number) ,S�Q �3 Owner or Tenant ���j 5 �s- G � ��co/-�{�n Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No [Z (Check Appropriate Box) Purpose of Building iJ&ik_V-, Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of thefi)llowing table may be waived by the hts ector of Hires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total i Transformers KVA No.of Luminaire Outlets No.of Not Tubs Generators KVA 1 I Above in- o. o Emergency Lighting No.of Luminaires ! Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FiRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I.Number Tons J.KW No.of Self-Contained' Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* �• No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or cis required by the Inspector of 6Vires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: i 7 jr- ()6 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"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 9 BOND ❑ OTHER ❑ (Specify:) I certify,under the pairs and penalties of perjury,that Nue information on this application is true and complete. FIRM NAME: LIC. NO.: v, Licensee: M-Mo y � �G�� Signature ,iLIC. NO.:,a/a A 3 7 (I%applicable,este rapt the licens my m�ber lin.) f Bus. Tel. No.•�T�'9�`t� -346 Addres!f tip Q r��-%s' 1 `�c� �I- Alt.Tel. No.: *Security System Contractor License required for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: 1 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 �v Signature Telephone No. PERMIT FEE: =gw Commonwealth of Massachusetts Official Use Only \ N. Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) -APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ' All work to be performed in accordance with the Massachusetts Electrical Code( EC). 52 CMR 12.00 m (PLEASE PRINT IN INK OR TYPE ALL INFORA1 TION), Date I - / `- City or.Town of � �f_ ,� �- - Tb.the Inspector cif YVit es: By this application the-undersigriWgi*s nold bf his or her intention to,perform the electrical work described below. Location(Street&Number) ' a o Owner or Tenant . . e Owner's Address Is this permit in conjunction with - pe a building permit? Yes ❑ No M (Check Appropriate Box) Purpose of Building Utility Authorization No. F:Existing Service Amps / Volts Overhead ❑ U'ndgrd ❑ No.of Meters New Service, Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the. ollowin ablemay be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ced. 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- ❑ o.o mergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No. of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained" Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail iit'desired, or cis required by the Inspector oj'Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: J—.9- 0 6 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"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 penaNies of perjury,that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: 4 Signature e--LIC. NO.:,g,�/L3,A 3 (lfappliccabl enter " xtmpt' i the licens number lin .) Bus.Tel. No.:9>; `�S`/ �� � Add resf 1 ZX�-i 0 dy AH. ' Alt.Tel. No.: Y *Security System Contractor License required for this work; if applicable, enter the license number here: 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 $ av- Signature Telephone No. PERMIT FEE. ,�S _ Location No. /yDate 1?- 1 o MORTq TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ Building/Frame Permit Fee $ � J�CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /J,b J 1886` Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAW,RENOVATf2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: r GREEN SIGNATURE: Building Commissioner/I r of Building—s Date Z SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: V 6 6 0Si o V 57- - ,n�-��/D1)vL-,- � tic Number Parcel Number 1.3 Zoning Information: , ! 1.4 Pry Dimensions: \ eFSUE*-(-f'1 r L 1(6 /so Zoning District Pr Use I Lot Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Rapired Provided —+ v 1.7 Water Sapp G L CAM0.1 54) 1.5. Flood Zone lnfonnation: 1.8 SOW96 Disposal System: Public 0 Zone Outside Flood Zone ❑ Municipal 1 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M 2.1 Owner of Record Name(Print) Address for Service W 6W a-O--) Signature Telephone 2.2 Owner of Record: • Name Print Address for Service: o0 M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ GkP,t-76o/<, � 14-' LS C��aS Licensed Construction Supervisor. O , / / License Number M Address y U �� o /JP� Exprrahon Date / Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v 11 � Company Name M Registration Number r Address O /I '... t� � o Aw� — 6© /��� Expiration Dae Z Si ature Telephone G) NORTH own of _ ; RAndover VA No. q44r --: E - dover, Mass., Z COCMICKEWICK 5 y�. 7,9 ADRATED pP�� `T BOARD OF HEALTH OtRMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT........... o.....��............. ... Tel r.. ... .. .. ........................................................ Foundation � has permission to erect........................................ buildings on ........ �.. ...... �.. ..., ..........pe4 Rough to be occupied as.............AR� ..�.. .�...... ..�.♦ Q� Chimney rovided that the erson his ermt hall in very respe confor- t terms of the application on file in Final P P this office, and to the provisions of the Codes and By-Laws relating to the pection, 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough ..................... Service B LDING TOR —.� Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Propo5al Page# of pages F Proposal Submitted To: Job Name Job# Address Job Location Q Date Date of Plans •��l�vtIF Phone# ax# Architect a We hereby submit specifications and estimates for:/ _______ _ _ ........... .—�/ == 7101 ..._.._..__-_��lo._.1L�me¢�.-, �u�.A-__1..S����./�-_.�1�a1�-_-.........,�-�1._._.I_�%�.f..��_____.��.5e.��-,z-�-.__�..��.�..-_�-__�._.._ •- v We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum $ Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and submitted above the estimate.AII'agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. Ofcceptance of Propont The above prices,specifications and conditions are satisfactory and are Signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance / x / S Signature. I >'NC3819 MADE IN USA Y ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J Applicant Name: Dopy� /i✓ GREG ,AI✓ Site Address: S�b �dS'j oN S'r • i own: il/ y UC'IC Sid b 5 j©�J 5 r Use Group: C—S7_06i Date of Application: 1 p Applicant Phone: Applicant Signature: Compliance Path (check one): ❑ Prescriptive Package(Limited to 1-or 2-family wood frame buildings heated with fossil fuels only) Package(A through KK from Table J5.2.1b): Heating Degree Days(HDD65)from Table J5.2.1a: (For items d.through i., fill in all values that apply from Table J5.2.1 b:) a. Gross Wall Area t� � sq.ft f. Wall R-value R- 13 b. Glazing Areal _sq.ft. g. Floor R-value R- 9 c..Glazing%(100 x b_a) °o h. Basement wall R- d. Glazing U-value U- a f i. Slab Perimeter R- e. Ceiling R-value R- .12A I K VAA( J g Heatin AFUE ❑ Component Performance: "Manual Trade-Off'(Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet, if applicable]' ❑ MAScheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher) ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wall +Ceiling Area�sq.ft. b. Glazing Arealj 9 ? sq.ft. c. Glazing% (100 x b-a) H% ❑ ADDITION with Glazing % (c.) up to 40% may use.780 CMR Table J1.1.2.3.1 below: MAXIMUM IJ-value MINIMUM R-daIUCS Fenestration' I Ceilin 3 Wall Floor Basement Wall lab Perimeter Depth 0.392 R-37 R-13 R-19 R-10 8-10.4 ft I Glazing Area may be either Rough Opening or Unit dimensions. 2 Based on NFRC Iisting. Applies either to every unit,or to area-weighted average of all units. 3 R-3.0 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceilin-area (i.e.-not compressed over exterior walls, and including any access openings.) 0 "SUNROOM"addition (greater than 40% glazing-to-wall and ceiling gross area) Attach "Consumer Information Form"from 780 CMR Appendix B. Official's Name: Official's Signature: I k I SNOW LOAD: 30 WIND LOAD: 90 NEW PROFILES owG� SPRINT APPROVAL U.S. HOME IMPROVEMENT / PETERKIN Pienae indicate your sppro�al l of this deeian by signing belowP and returning to. CATHEDRAL r N# §..746 SLS SLE 500 .SL E SW HEIGHT s� F 19.A64 1 19164' 12-3/8 12-3/8 12-3/8 192.000 SIDE 1 (tL0) DRAWING: INSIDE LOOKING OUT. I -- ..— - ---- - - - �_- — ' NEW--3200 PR—OF-IL—ES m DWGSNOW DAD:—.30 - WIND LOAD:_ 90 PRINT APPROVAL 2R01c(2N5 � I U . S . HOME IMPROVEMENT / PETER < IN Hie Plenac indicate your approval of this 10jign by meninQ t>nloo and returni" W CA T-� E C RAL if i yt�,on4tt� b-to `) 496 6. 146 6 /46 S-`- 500 SLE 500 r�EIGHT I; 70-5 / 16 5/ 6 N s6sC X x IS'F F1 ')GORI P'RL HANG ' 51 `I 19.564 1 19 564 192.000 SIDE 3 (ILO) DRAWING: INSIDE LOOKING OUT. i J .�/'fT<•�.art rrr�.rrusn.�f t�. �J'+r.t.:�rt�riov.�d BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR F Number: CS 082543 1 Birthdate: 08/08/1967 Expires: 08/08/2006 Tr.no: 82543 Restricted: 00 GREGORY K LAW 11 SOUTH MERRILL ST (C4--Al- BRADFORD, MA 01835 Administrator __- -board of Building Regulations and Standards } 6 HOME IMPROVEMENT CONTRACTOR Registration: 144 i i7 „ Expiration: 9/9/2006 Type: DBA GREG LAIN GENERAL CONST. GREGORY LAW 11 SOUTH MERRILL ST BRADFORD.MA 01835 Administrator Account Number 1348154-00( '— Page 2 - -f NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: Sao &SToN S 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 11, S 150 A. Also, note Permits are required under Fire Prevention laws'Chapter 148 Section 10A. The debris will be disposed of in: Um P57L-`YL_ d L-To1-- /U Mee (Location of Facility) Signature of Permit Applicant Fire Department Sign off Dumpster Permit Date FORM U - LOT RELEASE FORM • INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION t� APPLICANT WL6D� / Y l� < (�/ PHONE��o N(3 LOCATION: Assessor's Map Number p PARCEL SUBDIVISION Al� LOT(S) STREETD DS 1 (V ST ST. NUMBER �J OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROV DATE REJECT COMMENTS TOWN PLANNER TE APPROVED TE REJECTED COMMENTS /pA FOOD INSPECTOR-HEALTH Z DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEAL DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERNVATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE The Commonwealth of Massachusetts Department of Industrial Accidents • �)' ;(� Office of Investigations 600 Washington Street 'M� Boston, ,VA 02111 �( www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Hanle (Business/()rganiration/In(liviclual): CCc6 O� Address: If City/State/Zip: 6GJ&01`1 0�0 87 Phone #: 66 Are you an employer?Check the appropriate box: Type of project(required): I Rrl am a employer with�_ 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ t am a sole proprietor or partner- listed on the attached sheet. ; 7• temodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ i am a homeowner doing all work right of exemption per MGL 1 I.[] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12,❑ Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] "Any applicant that checks box#I must also til(out the section below showing their workers'compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy .4 or Self-ins. Lic. #: 33146% —dO Expiration Date:#9 f 0 6 Job Site Address: Sdb 96 City/State/Zip:-,k Qez/ 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 line 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 tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provider/above is true and correct. Si mature: Date: aS Phone 'k: OJlicial use only. Do not write in this area,to be completed by city or town g1ficial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Hcalth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: i --� 1: -1 ��� { � r r 8 ' _ � r � 11 � , c , � �� � {I ` � � � �� I � f i I t � F i r { � (. '1 , �I � I Y i' I I i �. � �-- `� �--� � Location 5 a ,�'�rye 1� No. -VIE Date i p NaR,h TOWN OF NORTH ANDOVER O? • • OOR F 9 Certificate of Occupancy $ CN � Building/Frame Permit Fee $ ©s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18931 .� Building Inspector V-A i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAK RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BU11DING PERMIT NUMBER9 DATE ISSUED:S m law - X SIGNATURE: Building Commissioner/I r of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Mip Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regaired. Provided Required Provided v 1.7 water Supply M.CLIX.40. 54) 1.5. Flood Zone lnfmmation: 1.8 Sewerage Disposal System: Public 0 private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT -Historic District: Yes_ No_ M 2.1 Owner of Record law fL-7&-KK Sr Name(Print) Address for Service Signature/ 7 Telephone 1.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Gft-6on Y K, 4Lw LS ���5� Licensed Construction Supervisor. O LLicense Number Address z/31111> 6 o fl 1OG Expiration Date/ z Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v C?/�L G �A-w G�iUt�[_ �NSTi?vGTsa� y Company Name L Gly f )Co ti-I ��� �f/ Registration Number AddressL� f J a rM' 41 E Date / l z Signature Telephone i � II NORTH 2 Town Of 0 .­ 4 No. = - - MOP30LA � o dower, Mass., IM /70P Q� COCHICHEWICK y1. 7,9 A"ATED PP�� �5 `s BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 90� 1 ��t � 1 BUILDING INSPECTOR THIS CERTIFIES THAT.. re...Y� ... ........ .. •• •I.1A......................................... Foundation obwhas permission to erect..... !f.��....4.... b longs n .. .. ....... ..... t ..•.. Rough 1 � t0 be Occupied as..... ►1.... ... .�.... ��r1 .1.. ...... ..V�s ..11... .... ................................................................ Chimney ' e provided that the person ac tmg this permits in every respect confo o the terms of the application on file in Final this office, and to the provisions of the Codes an By-Laws r ating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 'O's D/140 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS . ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. FSEE REVERSE SIDE Smoke Det. �N�O�FR S,o0R SM _ 4 •1g��'� 5629:3 � N C��e S�$ 6�� 8�4•g SNC r 3 N I PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS- DRAWN ASSACHUSETTSDRAWN FOR I HEREBY CERTIFY THAT THE BUILDING IS LOCATED ON THE JOHN CARROLL 0 LOT AS SHOWN US HOME IMPROVEMENT CO. 27 HAMILTON ROAD PEABODY MA 01960 SCALE: 1"=50' DATE: JANUARY 10, 2006 0 25' 50' 100' 150' � i MERRIMACK ENGINEERING SERVICES 1110106 66 PARK STREET STEPHEN E. TAPINSKT R.L.S. DATE ANDOVER, MASSACHUSETTS 01810 r i EYIS n F �3 a 3"O/ _ 4 v �� i i55 S qi f 9-,x f -- - 'A I }. �� 11,x �- a ENS SvAl i • rDP05al Page# of pages 1 ) r -7 11119411-1104-1 577-5-3 S o ff 2- Proposal Submitted To: Job Name Job# Address Job Location sc7C� 665 AY. / '-, /�u 5 Date Date of Plans _ Phone# Architect ��� '" Fax# i We hereby submit specifications and estimates for: ._ ____. -_-._ ........... . _._.._____.__._. _...._.._.._.__...._.__ _._. Dec- 1 . _ �C �•___._...__ v .......... X......... / 9 c 5 --._______....__._____._._ - . ... _____..___.— . _ ; t _ ............ ___..........____ _______ _. _ ______.__ i7proposehereby to furnish material and labor—complete in accordance with the above specifications for the sum of: Dollars jwith payments to be made as follows: , I I Any alteration or deviation from above specificationsinnvotvirtg extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. acceptance of Proposal The above prices,specifications and conditions are satisfactory and are Signature hereby accepted.You are authorized to do the work as specified. i Payments will be made as outlined above. Date of Acceptance Signature ' 1 Cff -.-NC3819 MADE IN USA �I i .'��a �-f-rirriir:ruiPrrf./f n/, /�i�s.xir�✓rwv(l�c BOARD OF BUILDING REGULATIONS g, License: CONSTRUCTION SUPERVISOR Number: CS 082543 Birthdate: 08/08/1967 Expires: 08/08/2006 Tr. no: 82543 Restricted: 00 GREGORY K LAW 11 SOUTH MERRILL STS, BRADFORD, MA 01835 Administrator ✓�fF �tm�-�nrirurxral.I� nf. ,��assrrr�rr„e�4 i;vard of 13uilding Regulations and Standards I HOME IMPROVEMENT CONTRACTOR Registration: 144117 Expiration: 9/9/2006 Type: DBA. GREG LAW GENERAL CONST. GREGORY LAW 11 SOUTH MERRILL ST _,, BRADFORD MA 01835 Administrator r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ^u. :... t ; www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Narne 113usincss/Urganizalion/Individual): «� Q v� �,,� Address: L C/y/ eo City/State/Zip: w lti10,LlAm &H 0-poy Phone #: Ko ? Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I 6. Y'New construction employees(full and/or part-time).* have hired the sub-contractors 2N I am a sole proprietor or partner- listed on the attached sheet. * 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their t0.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.E] Roof repairs insurance required.] employees. [No workers' comp. insurance required.] 131-1 Other *Any,applicant that checks box#I must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy ,4 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do ltereby certif,under the pains and penalties of perjury that the information provided above is true and correct 4i nature: / Date: 111 716) v � � Phone It: 6o n1_4 -- — – t)llicial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Hcalth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Date. . G.t "•ORT:'tio TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING +O++r,°SSACMUS� s This certifies that .C�. .t. .. `. . . . `. . . . . . . . . . . . . . . . . . . . has permission to perform . . . . .,.W. ... . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . P . . . . . . . . . . . . .. North Andover, Mass. Fed.): .:. . .Lic. No../U�. . . .1; . . . . . . . . `�-. . Cf-�':�?: �. . . . . . . . PLUMBING INSPECTOR Check # t c 5209 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING �(Print or Type) //����1pp�� Mass. Date `Z. �_._20..02 Permit # ^'kO Building Location Ownees Name DOC,-$ /'et��.l�;A� -7�3 —6 kP ,-9D��'/ T .. Telephone Type � pc�p�cy r 7 New Q Renovation ❑ Replacement; Plans Submitted:-Yes 0 Nq; ( FIXTURES V z w Z Y < y Z N < a ¢ x ~ = O 2 y 4 JO y W N W N F V ¢ Y < N W z a F� Q s m N r 4 ►W- r�r z c a. o < < 3 x = 0 v a: W < W v W o x J O = �' Kd H < x W W W W f V > to O Y d a h }. z O O N = _ < � k W SU13—BSMT. BASEMENT 1ST FLOOR 2140 FLOOR 3RO FLOOR 4TH FLOOR •5TH FLOOR 6TH FLOOR 7TH FLOOR STK FLOOR Installing mpany Name L)f ir�� 5 Check one: Certificate Address-Lo. Corporation _ 0 Partnership Business Telephon � Frm/co. Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YesV ' No O It you have ecked yo, please indicate the type coverage by checking the appropriate box A liability Insurance policy Other type of Indemnity C3, Bond [1 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner Ag w Owner's Agent Owner ❑ Agent ❑ -f -3 —' -J I hereby certify that all of the details and information I have submitted(or entered)in above application are true and a=J of the best my knowledge and that all plufibing work and installations performed under the permit issued for this ap pertinent provisions of the Massachusetts State Plumbing Code nd Chapter 142 of the'General tawsspl tion will be in compliance with all By Title S+gnature of Lrcensed Plumber City/Town Type of Ucense: Master Journeyman 0 APPFQVED(D IC USN!_ Ucense Number 0 f 3 7 Date... .. .... . .... 1 NOR71{ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING AcmUS This certifies that ���)�'................................... fY .................................... ; has permission to perform U'S w�. P 2 wiring in the building of �Fi� .. t v `, firth Andover s st S fid, ....`J .GYM..... ..... �/)W3 ..... ...................... �, �................ Lic.No. ......... .................. .�'�^:.... ....... ....... -Z (T INSPECTOR Check # N Commonwealth of Massachusetts fficial Use only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7— 7A6 Zr City or Town of: �WrAla A400yer 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) Owner or Tenant S t- Telephone No. ff__6,9AP_,A9y ' Owner's Address 0 Is this permit in conjunction with a building permit? Yes❑ No Ix (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ rio.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: sf � ly +_ dl-A1 �(ewm iL Completion of thefollowing table may be waived by the Ins ector of Wires. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Lighting Outlets No.of Hot'Ibbs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- El 0. o Emergency Lighting rud. rnd. atte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o eteng D an Initiating Devices a No. of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers eat p __.._....... ...ons o.oSelf-Contained Totals: _..............__.. Detection/Alerting Devices Municial 1 No.of Dishwashers Space/Area Heating KW Local ❑ C nnection ❑ Other No.of Dryers Heating Appliances KWS stems: No.of De ces or Equivalent No.o atero.o No.o Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications iring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 9 BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and n completion. I certify,under the pains and penalties of perjury,that the information on t is application is and complete FIRM NAME: : Kapriel Arakelian ,%' LIC.NO.: 15893A Licensee Signa LIC.NO.: 31702E (If applicable, enter"exempt"in the license number line) Bus.Tel.No.: 508-261-1141 Address: P.O Box 466 Mansfield MA 02048 Alt.Tel.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/Anent I r„ns ern TTT .� 1