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HomeMy WebLinkAboutMiscellaneous - 55 COVENTRY LANE 4/30/2018 (3) U, , 1 �l i Certuse Adjustment, Inc. 200 Chauncy Street,Suite 201,Mansfield,MA 02048 (508)337-6066 (401)272-50411(800)280-6066 Fax: (508)337-6065 1(401)272-8222 24 Hr.Emergency Pager: (978)445-0431 Email: Claims(a)Certuse.com �"�v.Certuse.com June 15, 2015 Tax Collector's Office Town or City Hall North Andover, MA 01845 (xx) Building Commissioner or Inspector of Buildings (xx) Board of Health/Board of Selectmen Insured : Kristen&Michael Thelen Address . 55 Coventry Lane Insurer : Bay State Insurance Company Loss Type and Date : Water/02/10/2015 We have received a claim involving loss, damage, or destruction of the above indicated property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chanter 143 Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate, please direct it to the attention of the undersigned and include a reference to the captioned insured, location, policy number, date of loss and claim number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Certuse Adjustment, Inc. /06/15/2015 S ignature/Date Date :. ,►oR'M TOWN OF NORTH ANDOVER o �a ,. o PERMIT FOR PLUMBING ,SSACMUS� / i This certifies that . . . . . . . . . . . . has permission to perform . .�- -���. . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . at . .-6.S ,�-�. . ��.�_ . . . . . ., North Andover, Mass. Fee,,3�. . . . .Lic. No Y . �S. ��LUM / � -tz .. . . . . . . . . . . . L� J�INSPECTOR Check # / � 85ua MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUME (Type or print) NORTH ANDOVER,MASSACHUSETTS /PDate Building Location /� �wners Name 17*1''1tll� 1A 1S Permit Amount C' Type of Occupancy 1)rve�l a%1 New rl Renovation 0 Replacement Plans Submitted Yes No Q FIXTURES rA z rA H a � En tc w w � A a SLRBM R4S&Wf ls>c>�Ina� M BOOR 3M FUM 4M Fi.0CR 5MFIDM 6M Foat 7IH FtOCR M ILOOR y (Print or type) Check one: Certificate Installing Company Name 11,41-1-01PAA/ �l tfM lf/t4:g El Corp. Address 802& Pale S%- rl Partner. Business Telephoneq7� !i8 S— %5 1-3 Firm/Co. Name of Licensed Plumber: %On? Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ❑ Liability insurance policy ® Other type of indemnity El Bond Insurance Waiver: L the undersigned,have been made aware that the licensee of this application does not have any one of the ab( three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to tl best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stat Plumbing Code and Chapter 142 of the General Laws. By: NignatureotLicens um er Type of Plumbing License Title 9 1/833 City/Town License Numoer Master Journeyman APPROVED(OFFICE USE ONLY �d Date. . .... . HpRT01 pf TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION 09 ' SSACHUSEt�y This certifies that . . . .:`��r.:'.� �.:n... . ,��.,, . . . . . . . . has permission for gas in the buildings of . . f'�:. . . . . . . . . . . . . . . . . . . . . . at . �s . . :. .-. ` , North Andover, Mass. Fee-.%�. °% . . Lic. No y . . -:�-�r�',� ..�... . . . . . . . . . / GAS INS JPEY{OR Check# % (' 7136 MASSACHUSETTS UNIFORM APPUCATON FOR PIIiMPT TO DO GAS FrrnNG (Type or print) Date Z—Z NORTH ANDOVER,MASSACHUSETTS Building Locations S:r ������`1 Permit# Nellie o c Amount$ ',y 'o 1� ellie!!'e #4 e //t/,// S Owner's Name New❑ Renovation ❑ Replacement Plans Submitted El � W 94 H CW7 a OF U H low o GW W v� z d g' g W 9 a O W U x dz O A wo 0 U a a H O w SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) )/ �pA� Check once: Certificate Installing Company Name /Y / G ✓,� rP 11 Address /�/��p� Partner. Ala, // /moi✓D�L i(� I//t�L�.7r i rus ni es�elep one G$S-- / Firm/Co. * Name of Licensed Plumber or Gas Fitter '7,-It �/ llo/tg INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 121No If you have checked Yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy In Other type of indemnity 13 Bond ❑. 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 or Owner's Agent Owner 13 Agent ' I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter By. © Plumber Title City/Town 0 Gas Fitter License Number 0 Master APPROVED(OFFICE USE ONLY) ® Journeyman Location No. 5f Date MO0 TOWN OF NORTH ANDOVER F? ° • OA 9 Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check #- 15463 15463 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T. BUILDING PERMIT NUMBER: ��, DATE ISSUED: Al / A X SIGNATURE: l � Building Commissioner/Ifispect uildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: l Map Number Parcel Number 1.3 Zoning Information: I IJV 1.4 Property Dimensions: Zonin District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard . Side Yard Rear Yard Required Provide ReTAred ded ed Provided 1.5. Flood Zone Information: 8 S � l on: 1. ew S 1.7 water Supply M.G LC.40. fo s4) }5taw Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.10 "er of Record 5 �'O��GL So �OWi✓LL �J S Cov�� `! NE me(Print) Address for Service: -a-S9 0`746 t Signatu Telephone O 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number MT1 Address; Expiration Date Signature Telephone ra 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name M Registration Number r Address Expiration Date Signature Telephone 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 building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 DesciA tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit applicant 1. Building (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 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , _ p L as Owner/A orized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this'building permit application. 'C . �sz1 Q Q 57 /19 /0-. Si nature of er Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,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 Name Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U LOT RELEASE FORM 2 g N tiwf INSTRUCTIONS: This form is used to verify that all necessarye ^© a erm Boards and Departments having jurisdiction have been obtained. Th s doovalses notIreliroe eve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT PHONE_ LOCATION: Assessor's Map Number PARCEL.��--�_� SUBDIVISION LOT(S) STREET ST- NUMBER USE ONLY RECO E DA O S OF TOWN AGENTS: CONS VATION DMINISTRATOR DATE APPROV91) Z DATE REJECTED COMMENTS r N Pask LANK DATE APPROVED DATE REJECTED Z COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS- SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 jm Nich6las Iain Powell A \,o N 1011 (IV / yo / LOT 7 LOT 6A ' 44,076 S.F. LOT SA o� N O (J� i. ,5o-T'RY LANE C 0v E Chase Manhattan ) "'ID "TLS MORTGAGE INSPECTION PUN I CERTIFY THAT THE BUUMM SHONN DO ( ) Cq*11R,N TO SETBACK REq � LOCATED IN LE DE,(FRONT. S4 REAR SETBACK ONLY) OF TTorth Andovei 11 0 R T IT A N T) n ;* r "*N CONSTRUCTED. OR ARE EXEMPT FROM VIOLATION ENFORCEMENT ACT" UNDER MASS. QL TITLE VII, CHAPTER 40A, SECTION 7, UNLESS 07HERWM NOTED. MASSACHUSETi yS Zone X outside I FURTHER CERTIFY THAT THIS PROPERTY IS Not LOCATED IN THE ESTABLISHED FLOOD HAZARD AREA. COMMUNITY PANEL NO.: 250098 0('07C DATE: 6-2-93 DEED 265K THIS COMPANY IS NOT RESPONSIBLE FOR ANY pia?N1tp o MADE SUBKQUFNT TO THE RECORDED BOOK DATE OF THE LATEST DEED OF RECORD. 1, PAGE NHQ+EVER BUIL.DWG$ ARE SHOW LESS THAN ONE FOOT FROM ANE PROPERTY LINE IT IS ADVISED OSA MORE PRECISE SURVEY BE MADE TO VERpV THEE MEASUREMENTS. CERT. NO. O THIS CERTIFICATION IS BASED ON THE LOCATION OF SURVEY MARKERS OF 0 OES NOT PLAN BK. PAGE REPRESENT A PROPERTY SURVEY. VERIFICATION OF SURVEY MARKERS U SHOW, 10936 MAY BE ACCOMPLISHED ONLY BY AN ACCURATE. INSTRUMENT SURVEY, D ON THIS PLAN. ICTED PLAN / DATED THIS CERTIFICATION TO BE USED FOR MORTGAGE PU S JON-P. �`� -4 vG l7 ,.Zoo/ OFFSETS AS. SHOWN ARE NOT TO BE IOUKAS USED FOR THE ESTABLISHMENT OF PROPER No.9629 SCALE: I 4 0' BRADFORD l 08UR��y� ENGINEERING CO. TA.. ! � "�+ . P.O. BOX 1244 JAMES W. BOUGIOUKAS� R.L.S. #9529 HAVERHILL MA. omi TEL ()T8) 373-2398 _ NORTH Ove r Town of No. �9 * - _ _ 0 = 0 dover, Mass., cocMlc NE WICK BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System , ko BUILDING INSPECTOR THIS CERTIFIES THAT..../t) C;1 .... . ............................................................................................... ..I0............................................ Foundation I/e_A..))(01-1 has permission to erect...4... MC— S."o....... buildings on .... ...................... .4 AJ V__ ......................... ..... . ......................... Rough C . j or sct4tw4j r Chimney ............................................... to be occupied as.....?9.............X.......................................................................... .......P�c 'a/V--j I 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 7BLaws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 6 Y /5/-2- Irl I It 0d"1 * I PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIQN S3ARTS ELECTRICAL INSPECTOR 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. SEE REVERSE SIDE I Smoke Det. I--- — e Date.`.5. .?. . . . .rr,�„ pOR711 �? <��•°;•�"o TOWN OF NORTH ANDOVER 49 o p PERMIT FOR PLUMBING s ;' �O•�r�o�A�qy ,SSACMus� r This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . .. . :. has permission to perform `. . . . . . . . . . . . . . . ... . . . . . . . plumbing in the buildings of . . . g �; • • • • • • • . . ...North Andover, Mass. Fe . . . . . .Lic. No.. . . . . . . ,: . . . . . . PLUM-I G4NSPECT0R Check # 5246 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ,, Date t,� 0 L ew Building Location ,S S C 0 u r y T 1Z`/ 1, if Al e Permit# c3 ' 41 Owner Amount— New Renovation Replacement Plans Submitted Yes ❑ No ❑ FIXTURES cn w04 Cn a A a A w BASE >M M 1HIDM zn 11" a 2M 4M HDM 1 5M KDM 6II3 HDM 7II3 HDM SM H" (Print or type) Check one: Certificate Installing Company Name 04WO .j. A OJ r, t 9- ❑ Corp. Address 34 /1y;ot. STANv-T ❑ pier. Ym CyCy , /M 4f Rusin Telephone '17&* Ali•7 11 L?h �Firm/Co. Name of Licensed Plumber: 00-j 140 A L;,11ar+S 14-4 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy IT Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent F1 I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse is Stayte Plurg]�i and Chapter 142 of the General Laws. BY igna ure o1 I-WeIISW rIUMDer Type of Plumbing License Title I�.v 5-& City/Town icense MOW Master ❑ Journeyman APPROVED(OFFICE USE ONLY Date. 11�/ TOWN OF NORTH ANDOVER 3a •�'` '�• oc ° PERMIT FOR PLUMBING -IS ACMUS� l/� ja ///I// •L�Ww 6t 1"� . . . . . . . . . . . . . . . . This certifies that /x.11. . .x: . has permission to perform ?�l �!�/f� `LfC plumbing 'ti the buildi gs of T. .�. .. t� . . . . . . . . . . . . . � T � . . . . . ., North Andover, Mass. Fee_: G .Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f Check !/ PLUMBING INSPECTOR 5t 5 � MASSACHUSETTS UNIFORM APPLICATION/FOR PERMIT TO DO PLUMBING (Print or Type _ • —, mass. Date ' GCC:3 Permit # b Building Location Ue' r Owner's Nam l' Type of Occupancy '�tS+ l7 E I 1 TI w1 L_„ New ❑ Renovation ❑ Replacement Y Plans Submitted: Yes ❑ No ❑ FIXTURES 2 m 2 x P 0 0 z W Y J 0 } V a Z O N 2 N Q Cr CC _ ¢ N U.1 Z 2 Z a F- J N W 0 N x Q H V W N x a Q a C x_ ¢ m a z c7 D: W O O �. Q co S a W y O j = '� C cc W W = < S 3: O Y S x a 0 H a x Q W W x W Q F- Q• Q = - 2x IL a _Q 0 a .1 J a Gc aF- Y J m N G C J 3 z 1- N W c7 a Q S 'm o SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing.Company Name ome-r A cjI�l(rm,4TAeCheck one: Certificate Address ��r;) Co/4C hi MF}f) J�:nJ ❑ Corporation /r E TN o c-`n1Al A 01s, ❑ Partnership A Business Telephone �(4 L-5Jq-7 I C -ri"/Co. Name of Licensed Plumber '�4 f;6 F)e T INSURANCE COVERAGE: I have a current(lability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes L�' No ❑ ' If you have checkedrimes, please /indicate the type coverage by checking the appropriate box. A liability insurance policy id 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations ormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum 'ng a and apte?j of the eral Laws. By vt;U re o Licensed Plum er '\ Title ' Type of License: Master jam/ Journeymah ❑ City/Town APPROVED(OFFICE USE ONLY) License Number 13 3 5 1 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES 4 PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR � Location No. Date - qs' "c*Tot TOWN OF NORTH ANDOVER A • ; ; Certificate of Occupancy $ �'�s''••°'Eta' Building/Frame Permit Fee $ +cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 8 G f, C,, j Building lnspecto-Y c. i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT SH A ONE OR TWO FAMILY DWELLING A'Y BUILDING PERMIT NUMBER. DATE ISSUED. m SIGNATURE: Building Commissionerfl or of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: S��Cv 'p Num 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 Required Provided Recpimd Provi&d 1.7 W ❑�Private AG.L.C. 34) Zone 1.3. Flood Zane lnf Ovide Flood Zone ❑ Municipal nation: 1.8 S Disposal Syst- 1.7 Site Disposd Syst— ❑ SECTION 2—PROPERTY OWNERSHW/AUTHORIZED AGENT YC..;; ,%2.1 Owner of Record '?;lame(Print) Address for Service S' re Pd-VAZ Telephone 2.2 Own _ d'c d: Name Print Address for Service: Signature Telephone go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 0 License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v C mo pany Name % M � 2 �9 ��'c ^ dtRegistration Number r Address J r J ,Gj r 21110 Ems' Dte� z Si atrire Tel horn ✓., 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 building it. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check ae a ble New Construction ❑ Existing Building 8o" Repair(s) 0 Alterations(s) Addition ❑ Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: ` ,�79 e-CZJT . 1 Cl SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building / �; �� (a) Building Permit Fee i Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(,)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT mat t}e Z as Owner/Authorized Agent of subject property ` Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. ' Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION L ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are Lrue and accurate,to the best of my knowledge and belief r Print Name i Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMMERS 1 2' 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH 0VVn Of Andover 9 No. I LA over, Mass., 19k COCHICHEWI BOARD OF HEALTH Food/Kitchen PER Septic System BUILDING INSPECTOR T D ............ .. .................................... ........... ... THIS CERTIFIES THAT....... .. ................. 04 od . ................... .................. .. ................................. .......... Foundation has permission to erect........ buildings on ...S4 ....... . ............... .......... ..........Nor..7F........=..... . ...... ... Rough tobe occupied as..... ................................................................... ....................... Chimney provided that the person accepting this permit shall In every respect conform to the terms of the application on file Jn 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 CONSTRUCTIO ELECTRICAL INSPECTOR Itay f 'W 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. SEE REVERSE SIDE Smoke Det. 'i Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR =_ Registrati`orr;\136974 i.EXplratfan: 9/23/2006 My rf DBA HOUSE DOCTOR`HANDs'iVAAN�St-' ELMN COLLARDS 127 EASTERN AVE°F�MB'.152 ,__ . GLOUCESTER,MA 01931 Administrator North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with�e 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 c 11, S 150 A. The debris will be dispos of in: f � (Location of Facility) ' Signature of Permit Appli ant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector J -60 Board of Building Regulations and Standards One Ashburton Place- Room 1301 Boston. Mask- usetts 02108 Home Improvement` a 1tractor Registration _ - Registration: 136974 Type: DBA - Expiration: 9/23/2004 HOUSE DOCTOR HANDYMAN SERVli EDWIN COLLARD - - PO BOX 8008 - - -- GLOUCESTER, MA 01931 -- ---- Update Address and return card.Mark reason for change. Address F-1 Renewal Employment i--i Lost Card lopThe Commonwealth of Massachusetts Department of Industrial Accidents- Of a of Investigatlons Boston, Mass. 02111 Workers'Ccmpensatbn Insurance AM" Nanta Please Print Name: location: Chi y Phone � 1 am a homeowner perforMng all work myself. am a sole proprietor and have no one working in any capacity I am an employer providng workers'compensation for my employees worldng on this job. rift if,2 1�0 T Irts�uanos.Co. Potkv# Corr mw rlatrte: Address Cft -- Phan#: Inurana C� Palm# FeUe to sam cbverrape•requlrod under Sedlon 2511 ar MGL 152 can lead to the kr;=N n d ak,* pwwN=d.a fine up to$1,500.00 andtarone yens'IngrYomceot_n.wd.ridAsnelleelntwhmdAB730PVUDRKDRDERao Aflmd.(,$IWAMAAiVagMW.ma 1 understand that a copy d IN@ statement may be forww(W to the Office d Invedgebm d Me DIA for coverage verNballon. 1 db hereby arty uncia the pefn6 and peroftfae d perjury that Me kdbrmeft provtd od above/a true and caned Signature Date Print name Phone# Offal use only do not wrke in this area to be campkcted by city or tarn affk�si' City or Town PermltllL �m ❑ Bu11a(Ing DW []Check I immediate response/a mquked ❑ Lkwwft Bosid s ❑ Seled"W s Ofte Contact person: Phone ❑ f/eaO D"&Vnt ❑ Other NOTICE NOTICE TO a TO w EMPLOYEES EMPLOYEE The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 - http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 &30, this will give you notice that I (we) have provided for payment to our injured employees under the above-mentioned chapter by insuring with: GRANITE STATE INSURANCE COMPANY NAME OF INSURANCE COMPANY 70 PINE ST. , NEW YORK, NY 10270 ADDRESS OF INSURANCE COMPANY WC 431-70-22 05/14/04 - 05/14/05 POLICY NUMBER EFFECTIVE DATES CARROLL K. STEELE INSURANCE AGENCY, 32 PLEASANT ST. , GLOUCESTER;: MA (978) 283-5100 NAME OF INSURANCE AGENT ADDRESS PHONE# E&D AFFORDABLE HANDYMAN SERVICES 20 LOCUST ST. , DANVERS, MA (978) 777-7081 EMPLOYER ADDRESS EMPLOYER'S WORKERS'COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Worker's Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER WC 75068(2-02)UNIFORM HOUSE DOCTORS° HANDYMAN SERVICE I 20 LOCUST STREET DANVERS, MA 01923 : U-191 z I P # 7 6G WVLOI A.f Date INVOICE 1 Customer Name ,� . Street Address 5 J C c V P^,4 v., L A w e City, State, Zip Code /\/a V-4 k A c/r3 t— � Home Phone Work Phone E-Mail Address ITEM # JOB DESCRIPTION AMOUNT i �o di2 S i i r I l , C I accept the work described above and acknowledge that the same SUBTOTAL $ j � o O,oG was performed to my satisfaction and that upon payment of the Total COUPON OR DISCOUNT $ Amount Due, it carries a One Year Warranty on labor. TAXABLE AMOUNT $ CREDIT CARD#: TAX $ EXP. DATE: TOTAL AMOUNT DUE $ i CUSTOMERS SIG TURE DATE OF ACCEPTANCE V/SA' 1,21-11e S RK P FORMED BY: 20 LOCUST S7RF- T • DANVERS, MA 01923 • (978) 777-7081 Rev 4/02 Each office independently owned and operated. v 1 . r t f t -�ano� k Location /,7,j -n No. If Date f °RTM, TOWN OF NORTH ANDOVER 3? • oL F s 9 F • • + � ; . Certificate of Occupancy $ MuS Building/Frame Permit Fee $ , i< Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 9`U 19540 Building Inspe s: