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Miscellaneous - 56 ELM STREET 4/30/2018
56 ELM STREET 210/042.0-00140000.0 56 Elm Street North Andover,MA 09845 July 28, 2010 Machine Shop Village Neighborhood Conservation District Commission c/o Curt T. Bellavance, AICP Director of Community Development 1600 Osgood Street North Andover, MA 01845 Dear Commission Members, We recently purchased 56 Elm St, which falls into the Machine Shop Village NAighborhood Conservation District. We have been making several improvements to the interior of the home over the past few months and would like to turn our attention toward replacing the windows before the upcoming winter. Some of these windows are cracked in several panes, some no longer open, and some are beginning to leak. We would like to replace the windows and are committed to keeping the original character of the home intact. We would like permission to replace the existing windows with vinyl while keeping the number and arrangement of panes the same (six over one). We would also like to replace one window in the kitchen with a garden window. This window faces the backyard and is not visible from any public way. We have included a plot plan and have indicated the location of the window we would like to replace for your reference. Thank you for your consideration. You may contact us at by phone, email or mail at: David& Stephanie Hirst 56 Elm Street North Andover, MA 01845 dhirst gmail.com 617-775-8070 We look forward to hearing from you. Sincerely, P. 1 David M. Hirst Stephanie L. Hirst cc: Brian Leathe, Local Building Inspector Enclosure b i 56 Elm Street North Andover, MA 01845 12W 10 120 Sq.10 lip Location of window we would like to replace with a garden wind 22 FM 433 Sq.ft dr iv 15 15 Cross e 67 W 62 Elm Street Street 54 Elm Street ay 4 q.ft a 45 105 Sq.ft 750 Sq.ft 30 30 E S 184 Sq.ft 8 Elm Street Daft: ........................... 14ORTp °f�"'°;•�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING • 1 �n � •01�T.0��•"� ,SSACHUSE� I This certifies thatL�' G .5....................... ................................................... has permission to perform �.!�"`^. .:.. ......... ..... wiring in the building of.. ........................................................... at................m...-ST......................................P .North Andove,,Mass. Fee..�.5 ... Lic.No..�. ....�......'�... ... .... EICAL IrrsrecroR4 . Check # � �� 0 / f i. 0 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 9x BOARD OF FIRE PREVENTION REGULATIONS lank Occupancy and Fee Checked [Rev. 1/07] (leave b APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PMT EV OR TYPE ALL INFOR&L4TION) Date: 3/ City or Town of: NORTH ANDOVER of Wir 0 By this application the undersigned gives notice of his or her intention to perform the Inspector electrical workldescribed below. Location (Street&Number) !Dy., S* Owner or Tenant _ t�� Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No n Check A Purpose of Building ( ppropriate Bog) Utility Authorization No. B'43841�� Existing Service 16t) Amps lZd /2�0_Volts Overhead ® Undgrd❑ No.of Meters New Service ?°'b Amps 120 Volts Overhead t ` © Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ZVI F1 &44 Com letion o the ollowin table may be waived b the Inspector of Wires. FNo. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total of Lnmiusire Outlets Transformers KVA No.of Hot Tubs Generators KVA of Luminaires Swimming Pool AboveIn- o.o mergency d. ❑ nd• Batte Units g No.of Receptacle Outlets No,of Oil Burners E Fly,ALARMS No.of[.ones No.of Switches No.of Gas Burners No.of Detection and No.of No.of Air Cond. Ranges Total Initiatin Devices Tons No.of Alerting Devices Totals: No.of Waste Disposers eat Pnm: Number Tons__._._ o.of elf-Contained `..._.._._..... _.__.._....... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* r No.of Water o ofNo.of DeviceEs or uivalent Heaters ' No.of Data Wiring: Si s Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications icing: OTHER: No.of Devices or E covalent Attach additional detail!if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Stark (When required by municipal policy.) 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 penalties ofperjury,that the information on this application is true and complete. FIRM NAME: S(Gct 6illxrl- L�acl�ila Licensee: _ $ c G i(( .1— LIC.NO.: ESbS2 g' (If applicable, ente,{_s exeyppt"in the licens number line.) Statute LIC.NO.: Address: //'��' /ht x 55 YM (31, Bus.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Dafety Alt.Tel.No.: o. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have 1the liability insurance License: Lic. 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 Signature Telephone No. PERMIT FEE. $ 7f CJv The Commonwealth of Massachusetts 1 Department of.Industrial Accidents Ogee of Investigations lift. a 600 T'f�irshington Street J/; Boston, MA 02111 t www.massgov/dta . Workers' Compensation Insurance Affidavit: Builders/Con Applicant Information tractors/Eiectriciiaas/Piumbers Please Print LeQibl Na]3le (Business/0rgenization/Individual): Vtly Address: Pa- City/State/Zip: �COasv�(l MA (M63 Phone Are you an employer?Check the appropriate box: 1.IB I am a employer with 4, Type of Project(required): ❑ I am a general contractor end I employees(full and/or part-time).* have hired the sub-contractors 6• []*New construction 2.El i am.a.sole proprietor or partner- Iisted on,the attached sheet x 7• ❑Remodeling ship and have no employees These sub-contractors have !1 working for me in an g Q Demolition y capacity. workers comp.insurance. [No workers'comp.insurance 5. 9. []Building addition P ❑ We are a corporation and its required-) officers have exercised their 10.0 Electrical repairs or additions t 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions rrayself. [No-workers,comp. c. 152, §I{4},'and we have no insurance required.) 12.[]Roof repairs ] .employees. [No workers' comp. insurance required_] 13 []Othar *Any applicant that checks bot:#t must also fill out the section below showing their workers'oompensation policy information. t Homeowners who submit this affidavit indicating they am doing all work and then ham outside conmwtcm must submit a new affidavit indica* �Commtctors that chhwk this box mustattaahed an additional shemtshow'. . catia6 succi infi the mmic of the sub-contnict� --•, =�N.y,vucy inromiation. i ant an employer that is pmni ft:workers'compensation insurance for my employem Below is the policy mid job site information. +' Insurance Company Name: ' -H-•t I�cu t"f fnci Policy#or Self-ins. Lie.# Expiration Date: *3 ecl li Job Site Address: Sl_ 8_11 S(. Attach a copy of the workers' compensation Policy dectara • City/Statelzip: �` ' Y taon 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 in Investigations of the DIA for insurance coverage verification. ay be forwarded to the Office of I do hereby certify u der the pains �tdd penalties of perjury that the in nrmation Provided —'G�� ' f P vrded above is true and coney Si tune; Date: 3 i 4 �v l o Phone#: _?4- 5`3 r3---a [Contact :A & ly. Do not write in this area,to be completed by city or town ofciaL Permit/License# rity(circle one): alth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector n• Phone#: Date. 2 c .`�.! ... t NORTH, "�,� TOWN OF NORTH ANDOVER '0 PERMIT FOR WIRING SACMUS� Thiscertifies that ............................................................................................. has permission to perform .................. �:.T�........................................... wiring in the building of. u. '. `-j'A 5k ......... .................................................... Pt............ ...... .....................................................�. .. ,North Andover,Mass. 2 1 Fee..J.5�..:IT.... Lic.No-��2SE............. .0 -..... ..... ILECPRICAL NSPE C F bR Check # 10703 r Commonwealth of Massachusetts Official Use Only - a , Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS [ROccupancy ea a blank) ed (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT XN1NK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER 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) SVt, it.1 S+ Owner or Tenant_ Q1�,t) H;I{- Telephone No. Owner's Address �9Mr Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 20b _ Amps lZo / 2u0 Volts Overhead IN 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: &A41 kno Com letion o the ollowln table maybe walvedbv the Insvector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total To. KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 2. Swimming Pool Above ❑ In- ❑ o.o mergency ig ing rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 No.of Gas Burners No.of Detection and InitiatingDevices No,of Ranges No.of Air Cond. Toonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: __...__.._ ..._._.._. DetectionfAlertine Devices No.of Dishwashers Space/Area Heating KW Local❑Municipal ❑ Other Connection- No. onnectionNo.of Dryers Heating Appliances KW Security Systems:*. No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: 5y1h,3i No.of Devices or Equivalent �h Attach additional detail ifdesired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 [N BOND ElOTHER E] (Specify:) Icertify,under the pains and penalties ofperjury,that the information on this application is true and coni ete. FIRM NAME: S�le� i f1 - tn� LIC.NO.: C S 572g Licensee: S)icl, Edit(f Signature LIC.NO.: (If applicable,enter"exemp "inthe license number line.) R -�S3SSy7i Address: P0. 13ci s-;y A P AM p«16Bus.Tel.No.:3 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department ofPublic Safety"S"License: Lie.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)El owner El owner's a ent. Owner/Agent — Signature Telephone No. PERMIT FEE:$ The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations UV 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): S(-,,-e Cr(1rf F(�I►,it��, Address: PG' S 3y City/State/Zip: qfAwo n4/"+Qg63 Phone Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with 1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 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. 9, ❑Building addition [No workers'comp.insurance 5. ElWe are a corporation and its required.] officers have exercised their 10.®Electrical repairs or additions .3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.E]Roof repairs insurance required.]t employees.[No workers' comp,insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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.Lie.#: 1i, LA/e5 I'% Expiration Date: 6)1 3 rIJob Site Address: SE 047 S=t City/State/Zip: IJ A ockzi *A 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 hereby certify under the 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#: Date. 3PS. /it • <".��':'�, TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING 4g ,SSACows i � r This certifies that . . . .1 . .�. ! . . . . ' . . . . . .`. . ).. . . . . .'. . . . has permission to perform . . . . .•... . �-.. . . :Se. a�•. . . .'Y..�.r ,: -=� plumbing in the buildings of . . . . � . . . . . . . . . . . . . . . . . . .. at . . . . . . . . . . .. North Andover, Mass. Li c. No.a�a.3)'/. . . . . . . . . . . . . . . . . . . 1�} PLUMBING INSPECTOR Check x Ccx ! i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS c, � Date Building Location 5ta lr\n `�{ Owners Name 0C'VJ+ `n�p�Ydv�te H�(st Permit# Amount Type of Occupancy S,-a Q Taal New Renovation d Replacement Plans Submitted Yes No e FIXTURES z d z F > a s U z o z ° W4 d `� 0 3 Fj W as x Q x Q z a z ° w w x H W 3 a a a A A w 3 x a z z z w 3 x a F � A A a 3 0 o SLBM R4SE\1vr Is><.HMR mRom 3MHj0M 4M HIM 5M Hf= 6M ILOOR —7MHDM T-1 sm HJ CR (Print or type) Chec one: Certificate Installing Company Name ?„ S C' lu�1�'1 Corp. i UUU Address �� ��-f ��tl si r alken 1,44 C316t< Partner. Business Telephone (;I7 _�3 1 Y)7: Firm/Co. Name of Licensed Plumber: ?,,.1 _j Cy 4 Insurance Coveraee: Indicateethle ype of ins ranee coverage by checking the appropriate box: Liability insurance policy �./� Other type of indemnity ❑ Bond a 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 a 1 hereby certify that all of the details and information I have.,submitier�j entered)in ove application are true and accurate to the best of my knowledge and that all plumbing work and installations =eD ed unde ermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Pl ng Co and i6apt 142 of the General Laws. By: agnaure o icensecl FlumbeT Type of Plumbing License Title a(�331 City/Town License Number Master Journeyman APPROVED(OFFICE USE ONLY , The Commonwealth of Massachusetts 1 Department of Industrial Accidents Office of Investigations 600 Washington Street 111M. f Boston, MA 02111 t www nwssgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): gtl� v j' I V M6►n1 . Address: `6`( Lrde.ite ?,Cc City/State/Zip: 2ow 6&,A M4 0I5Q5 Phone #: (P — '6643 —`PDa3 Are you an employer?Check the appropriate box: Type of project(required): 1.[1 1 am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction mployees(full and/or part-time),* have hired the sub-contractors , 2. I am a sole proprietor or partner- listed on the attached sheet.t ? Ld'Kemodeiing ship and have no employees These sub-contractors have 11. ❑Demolition working for mein any capacity. workers' comp. insurance. q, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ i am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 15Z§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 bort#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 than 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. I am an employer that is providing workers'compensation insurance for my emlployees. Below is the policy and job site information. Insurance Company Name: Policy#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 A for insurance coverage verification. I do hereby91 ify and the pains and penalties of perjury that the information provided above is true and correct Si ature: D • Pho 7 - JA3 ' 10a3 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#: • • f 4n C011pIVf(TNiNEA�TH .1 PLUMBERS AND GAarl i�R� t LICENSED AS JOU.RNEYMAN..PLUMBE , ISSUES.THE ABOVELICENSE TO :-'PAUL- J CYR 1 BROOKE RD 3 i BOY.LSTONMA 01505-2043 yy 26331 y�^ 05/01/12 - `803579" I Fold,Then Detach Along All PeAorailons f }j 9309 Date. . �•<".��':1� TOWN OF NORTH ANDOVER . o PERMIT FOR PLUMBING C US This certifies that . ./�/QU.4 . .J. . .(. ,Y/l. . . . . . . . . . . has permission to perform . . /�Pno. . . 1h F[ jz—,/�. . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . at. . $S3/. . /!�. . `�T. . . . . . . . . . . . . . . . .. North Andover, Mass. Fee.�11,.SP.Lic. No.. �.33� . '�. ... . PLUMBING INSCPE TOR Check # 6' Z(" f "d MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Z Building Location 5 Eim S Owners Name '0qv2 {51e niL �A, Permit# Amount Type of Occupancy 51;4 eiil/I New Renovation Replacement 0 Plans Submitted Yes 0 No Y FIXTURES r F 2 , .4 U W 12 O O U v' O O O 3 S1BEME BAS9* 1W MELOat M E10CR 3M>� 4M EWM 5MHDM 6niHDM 'In,RfM s�>�toat (Print or type) I T Check o Certificate Installing Company Name orp. Addracq /(./I MA-11 0 Partner. Businessi elephone Firm/Co. Name of Licensed Plumber. Insurance Covera¢e: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [� Other type of indemnity a Bond Insurance Waiver/I,the undersign/d,�have been made aware that the licensee of this application does not have any one of the above We three�'7ai/Zc.( Signg ii a Owner Agent I hereby certify that all of the details and information I have su or en )in above application are true and accurate to the best of my knowledge and that all plumbing work and' ations Permit Issued for this application will be in compliance with all pertinent provisions of the has tum g and Chapter 142 of the General Laws. Signature or 1 Type of Plumbing License�. Title _ % City/Town License NUMDer Master 0 Journeyman PPROVED(OFFICE USE ONLY 1 S • lYre•G'btjtitioFFt��etrflG p•�If�trssuchtrs��fs Deji�i�lirr�rrta,fltttfrasE�Cal�EechAeitfs b t�,,,f�fe�aflFr��e��fttrou� 6l)!f#�astifag[ott Silc�eet Btjamr,'KA.021 • :4viPit.fnFrs�soC/�tt '•�+�tQF�€Ci'S��F}1}}},C115tf�ROlt�l!$Itk'ttil�� t�i[l'tr� Bttifc�c�sf�ou���t�to�EI3ie��ctcts��tsC�'l`u���ei�s� • it tlit::Yf -Titfori}tnlio}t' i ... .. .. - - .. •- .)f'leais��Priuft•`lI '� - �titltC•�prt;uE��Oighni�itio'n�ludi4idt�}jam �©„1. .�E,( .-.. t ff Q� t Arc}�otttEuei:tirlEiyxE•?G�EccfE th�tiJiinrofiria[c1roY: - - bbf ne ceF tdt�it � �m . 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VAR, 4),all(' "0 _ I2.[3 R1Dotrepa6— hrsumneorcgairrd t eE6J?layccs.[ltlotsrotkeis' i comp.tusuEoaccrcgidred.f 0,13 Other "�tly'i•,top[;cit!([L[th,ctx[>.s.CtlncitcF�ofi4ttrtEGC:�itiz:tE,tetsatx�l�il�UhtcEtrlt�,ts axn�i:ualionr,titytefdiulitiat � t E �tt+vn aiw:t5\r[tasethiitIli;eff-RAUthid iczlin IIitithhedaGtdt(CAI ra:tcislnti;taut+lliia641roff,141 1itJk4skgsiteII HClpta�fa.ttiutct:;.i.ltislerialt,ta`ia.hzd rnr.•ididogtlaEc�EtLsuel tk.n;,ltr tE3fis[rt,-co 41R111-rune_ (1111(tit u,E•ee�s.IJcnt>=lsflrcErulletartrtJoGs1(� ' r{fbnrratlarl. - � E 1100raltce Congsaay.j,'djtc: r _Noticy<lForS>~[Cias.Lic:tl:- • _ �ejiirak�ui>ite•- 36Si1dllcicess. AttnclEncopgf(itetcotlteEs'coiotrpage fsJr4tstagf6citotrc5°tfuttihel:dtt�cYJit4oEtopSRCtI< ratf�ro�Qsasiurz.t6c�e>'tree'tisieEyntlzdtutcttrSectioti2511 o�hRt3T,•c.t52c�n i'ead,ttttAc i”inJtaslliatpt'criiitiEiE►tpertal�csQfa , fiito upFa"S1,500.00 audlpi QiE�yearinlpriswin)eut,.as Melt es cI itPORatdcs fn flee form of it 8TOR WORK Ott,DBR iirdia fiA tifEEtYfo52S0.6Qaday'ag:EEns[the tiotator ttoacTtiscif[flatsEcolryttlJttixslatemcEiiEtapfrefonyarttedlcsthcOfticeof hteestigaTiansd(heDfA for insmmicecorerageeerifica[fon. Itlo/rereGj•cer1� • de'r[ltelrrrtircwrrtpc•irnflfesoerJrrnVlrrrfl/rs*frtjomxrrt/birtisOXitFirlrr/rorelsarreylrifivrce�! $it(i ttnfd" - /� • ll,�t�t>a�ti;srrarTii;Ido rev!1v1•eifi'tti tirTc ttrcrr,to trr3 cail�lCrrul Lftt{C o1•fatrrr a,JJtctrrf. of3•oE•1 oisjt. _ •I craittfLlccitse8 3 Iss.6hi>;Afi ftorlt'y(dedeoi►c); 1.1ioar(tot•Wcat"I 2,[TEEitJtngDrf:arfutettt 3.Cffyll'ouuCfetic �3.RtpctrtcnFTnslltctai° :1>IuEEtG(ngiiulie foto 6.Otfter Cptifacl l'ci�ofti 1'fiop�f�: J ; G Date.../. S //.... HORTN Of ° p o� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 9 SACMU5ESA ' r This certifies that . . . t v.I. . . . .<). . . . . . . . . . . . . ....! !. . has permission for gas installation . . . .!� -wr`�Q . . . . . . . . . . . . . . . 5 in the buildings of . �r( . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . 5. ?. . . . Jm. . . . ..� . . . . . . . .' North Andover, Mass. Fee. . Lic. No. -.L ?.-3�. . ::.:1:. . . .... GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations !J(o E.\rh 4's� Permit# Amount$ • Owner's Name New❑ Renovation ✓ Replacement ❑ Plans Submitted ❑ U z a o W H a Ucc t x x z x H �' z z 0 F x z ° w e a o o z F W W z U W a z O W 0 q F x z Q w Q a F H w p > 0 z W a F� w 9 m z o z o x W o w 3 a `a' ° °a > a o°. H o SUB -BASEM ENT B A S E M ENT 1S1' . FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 15TH . FLOOR 6TH . FLOOR 7 T H . F L O O R 8TH . FLOOR (Print or type), n \\ Chec one: Certificate Installing Company Name �Ctu' S Cv t �,v.�117��� Corp. Address __ �, �J: ltd(? �d La)LI 1 MA (;ISLb Partner. Business a ep one _ _ Firm/Co. Name of Licensed Plumber or Gas Fitter QUv� LVA INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes I W I No E] If you have checked yes,please ' dicate the type coverage by checking the appropriate box. 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 Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner F-1 Agent I hereby certify that all of the details and information I have submitted_(or entered)in abovg application are true and accurate to the best of my knowledge and that all plumbing work and instaiiatio performaunder Pe it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas o e and Cha�t 42 of the General Laws. C B Signature of Licensed Plumbe r Gas Fitter Title Plumber 110311 City/Town Gas Fitter License Num5er Master APPROVED(OFFICE USE ONLY) Journeyman Date.. .`.F/!.?hZ ...... NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION • a h SACMUSEtS This certifies that . . .az4w,4 . 5 j f has permission for gas install do in the buildings of . . . .!.:rs.. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . G. . .�1m. . Sr. . . . . . . . . N rth Mynd ver .Mass. Fee. .T---S'. Lic. No...3IVS. . �1 . . -! . . GAS INSPECTM Check# .?0/SSG 8 12 8 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ROTA Mass. Date Q ZbZZ Permit # Building Location 56 ELN SY Owner's Name QM 1b IZS7' Type of Occupancy SiAjQc 69HI LK New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ m W N N U x cc N tL �- m W i O ta 0 x !- J (!� m Y !A z p w ►" a ¢ O Z Z O }_' w a m y F- to Q LU O O ~ N a N 0 v W x = �" fn C. W W = N W Q OC a 0 F. 2 J F- 2 s W W cc 0: 0 0 > U. Fcc WW- U J W z < W d C - )+ N ® - O 2 W O W Q > W z. < a ¢ 'X o c7 5 U. 3 c tl Qi V Y e a o SUB—BSMT. BASEMENT 1 ST FLOOR N 2ND FLOOR Q 3RD FLOOR _ 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name COLUMBIA G&S Gf= MASSACHU.56TTS Check one: Certificate # Address 55 MARSTON STREET SCJ Corporation 1862 LAWRENCE, MA 01841 - 291Z ❑ Partnership Business Telephone 9 7B-69 1- 640 6 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I I have a current liability insurance ce policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If you have checked res, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement.- Check one: Signature of Owner or Owner's Agent , Owner[] Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)in ab pplication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n ompliance with all pertinent provisions of'jie Massachusetts State Gas Code and Chapter 142 of the Gene s. (/ T e of license: Plumber Signature of Licensed Plumber or Gas Title Gasfitter City/Town Master License Number 37q" Journeyman APPROVED O FICE SF ONLY M°RTM Or��r�e r�740 Town of North Andover Machine Shop Village Neighborhood Conservation District Commission 1600 Osgood Street North Andover,MA 01845 ss�ee Application For EXCLUSION From Certificate to Alter Certain alterations are excluded from rePiew by the Machine Shop Village Neighborhood Conservation District Commission in accordance with the Bylaw. Applicants for exempt projects must fill out the form below and submit to the Commission Chairperson(contact info below). Date: 12/11 Z11 Contact Name&Address: — 66 A .......... .. Al fs§ r,,cd►a i1,r.M. (417 5~ CCo70 Project Address:. � Project Description(attach additional pages,if needed): -�Wu 60 ao', Aoor W IV)a W!, I-Ah ys141 Exclusion From Review Requested For. maAawL CXAv\� G/( -pane rt�%c)r ❑ 1.Interior Alterations existing conditions including materials, design and dimensions. E32.Storm windows and doors,screen �/ windows and doors. lif 9.Replacement of existing substitute doors,substitute siding or substitute ❑ 3.Removal,replacement or installation of windows with new materials that are gutters and downspouts. substantially similar to the existing condition. L34.Removal,replacement or installation of window and door shutters. ❑ 10.Replacement of original fabric windows or doors with substitute ❑ 5.Accessory buildings of less than 100 windows or doors that maintain the square feet of floor arm architectural integrity with respect to form,fit and function of the original ❑ 6.Removal of substitute siding. windows or doors. ❑ 7.Alterations not visible from a public ❑ 11.Reconstruction,substantially similar in way. exterior design,of a building,damaged or destroyed by fire,storm or other disaster, ❑ 8.Ordinary maintenance and repair of provided such reconstruction is begun architectural features that match the within one year thereafter. MSV NCDC Pagel Current Chair.Liz Fennessy,77 Elm Street,lizrttafennessyCo�vwihpa coni,978-688-2915 0 l O L V A Date.... ... 1 NORTI� °ft"`°:• "° TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACMUS, This certifies that ................................................................`:................f...... has permission to perform .........r �- t T�'�"'�&-7-U. 1,. ................................................................ wiring in the building of......../'l 2 S ............................................................................ at..........5�... �•�(........5 ....................,;N h Andover,Mass. Fee....�-�.®� Lic.No.`5 52..�....... ... ....... LEC MCAL INSPEC Mi Check # c Commonwealth of Massachusetts Officiial Use Only Department of Fire Services Permit No. s' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] ---- leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH AND To the Inspector of By this application the undersigned gives notice of his or her intention to perform the electrical o dzescribed below. Location(Street&Number) Owner or Tenant ,� Telephone No. Owner's Address as Is this permit in conjunction with a building permit? Yes LK Purpose of Building NO EJ (Check Appropriate Box) Utility Authorization No. Existing Service a70 Amps (?op Volts Overhead © Undgrd❑ No.of Meters New Service Amps _/ _Volts Overhead Number of Feeders and Ampacity ❑ Undgrd No.of Meters Location and Nature of Proposed Electrical Work: t ^ nth Kna�(k1�► d Completion of thefollowing table ma be waived by the Inspector o Wires. No.of Recessed Luminaires /0 No.of Ceil.-Susp.(Paddle)Fans No.of Total No.of Luminaire OutletsTransformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In_ 0.0 mergency ig ting rnd. rnd. ❑ Batte Units No.of Receptacle Outlets /6 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 7 No.of Gas Burners No.of Detection and No.of Ranges C-0Total InitiatingDevices 5 No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers I Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems: No.of WaterNo.of No.of Devices or E uivalent , Heaters No.of Signs Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Devices or Equivalent g No.of Motors Total HP it Wiring: ' OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 M BOND ❑ OTHER ❑ (Specify:) I cert,under thepains andpenald ofperjury,that the information oat this application is true and complete. FIRM NAME: � 6,t. r 1-- fTpc�s�'<r�g Licensee: S h (; ►�,�- LIC.NO.: ,t_`Zb28 Signature LIC.NO.: (If applicable, enter " p mpt" 'n the license nu er line. Address: P- r.3 "(f / 0LI-tb3 Bus.Tel.No.: 9X 3 Y 2 I *Per M.G.L c 147,s 57 61,security work requires Department of Public Safety"S"License: 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 Owner/Agent the(check one)❑owner El owner's agent. Signature Telephone No. PERMIT FEE. $ '95__OT � a The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations , 'i lit, 1 600 Washington Street ,Z / Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / r Please Prinf Legibly Name(Business/Organization/Individual): Address: p° 0�l X � City/State/Zip: tM c)i1(6 Phone#: 97f-MS'S FrI2 Are you an employer?Check the appropriate box: Type of project(required): 1.® I ama.employer with ( 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition ' working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[0 Electrical repairs or additions 3.El am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12,❑Roof repairs insurance required.]i 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 information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ,, r Insurance Company Name: -T4 -flNr-!-&rJ Policy#or Self-ins.Lie.#: W In F 4 Expiration Date: /I Job Site Address: S'G �f Jeh Sf City/State/Zip: ( �hJOL� 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 maybe forwarded to the Office of Investigations of the DIA for insurance•coverage verification. I do hereby certify under the pains and penalties ofpejjury that the information provided above is true and correct.' Sif4nature: 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#• 56 Elm Street North Andover,MA 01845 July 28, 2010 Machine Shop Village Neighborhood Conservation District Commission c/o Curt T. Bellavance, AICP Director of Community Development 1600 Osgood Street North Andover, MA 01845 Dear Commission Members, We recently purchased 56 Elm St, which falls into the Machine Shop Village Neighborhood Conservation District. We have been making several improvements to the interior of the home over the past few months and would like to turn our attention toward replacing the windows before the upcoming winter. Some of these windows are cracked in several panes, some no longer open, and some are beginning to leak. We would like to replace the windows and are committed to keeping the original character of the home intact. We would like permission to replace the existing windows with vinyl while keeping the number and arrangement of panes the same (six over one). We would also like to replace one window in the kitchen with a garden window. This window faces the backyard and is not visible from any public way. We have included a plot plan and have indicated the location of the window we would like to replace for your reference. Thank you for your consideration. You may contact us at by phone, email or mail at: David& Stephanie Hirst 56 Elm Street North Andover, MA 01845 dhirstgRmail.com 617-775-8070 We look forward to hearing from you. Sincerely, David M. Hirst Stephanie L. Hirst cc: Brian Leathe, Local Building Inspector Enclosure 56 Elm Street North Andover, MA 01845 12W 10 120 Sq.tO Location of window we would like to replace with a garden wind 22 FM 433 Sq.ft 11 2c; dr iv 15 15 e 67 Cross W 62 Elm Street Street 54 Elm Street ay L q.ft s 45 IM5 Sq.ft 750 Sq.ft 30 30 E 8 184 Sq.ft 8 24 Elm Street Date....'....:::. ................ NORTIN °f<<``°:•�"� TOWN OF NORTH ANDOVER r0 PERMIT FOR WIRING ,SSACHUS� , This certifies that .....................................':..�—.............`.:t::............. has permission to perform wiring in the build' g of......: ............................................................... -� G' � ,North Andover,Mass. Fee:Z..... ,....... Lic.No �S! �1` .......... - ..... ... . ...... .... ELECTRICALINSPECTO Check # i .3J1 C � Commonwealth of Massachusetts Official Use Only Department of Fire Services Penn"No. �v? G BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _af�� [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRWflV INK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Iector o By this application the undersigned gives notice of his or her intention to perform the electrical work idescribed below. Location(Street&Number) .�G i_11" S 1— Owner or Tenant rv,"(d N"rS f' Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building � (Check Appropriate Box) Utility Authorization No. Existing Service 2W Amps (2o / 24o Volts Overhead K g ❑ No.of Meters New Service Amps / Volts ❑ Una d ❑Overhead Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: N� n70'hS M�ftl gore) _Ap(Ree e"61,1(t W; The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: po City/State/Zip: /460t q( Phone Are you an employer?Check the appropriate box: Type of project(required): 1.[� I am a employer with— 1 4. ElI am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers comp. insurance 5. 9. Building addition ' p ❑ We area corporation and its required.] officers have exercised their 10Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 111-El 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' comp.insurance required.] 13.[1 Other *Amy applicant that checks box#i must also fill out the section below showi g their work='comp--satioc policy i-for-matio t Homeowners who submit this a`Hdavit indicating they are doing all work and then hire outside contractors must submit a ne xContractors that check this box must attached an additional sheet showing the name of the w affidavit indicating such. sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ -1 f2 h-1 Policy#or Self-ins.Lic.#:_ 7(o Wt G<�'X � Expiration Date: Job Site Address:_ lq L 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 hereby certify under the pains a Vpen ies of perjury that the information provided above is true and correct Si afore: Date.: S-129 {U Phone#: fficial use only. Do not write in this area, to be completed by city or town official ity or Town: Permit/License# [[I. suing Authority(circle one): Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: • Date. . . . . . .. . . . . N2 . % 1 MORT„14 TOWN OF NORTH ANDOVER 00 PERMIT FOR PLUMBING ,SSACNuSE� This certifies that . . . . . . . . . . . . . . . . . . . l. ./. . . . . . . . . . . . . . . . . has permission to perform . . . . ;:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. . . . :.I:. . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. .Lic. No.. . . . . . ...'. . . . . . . . . . . . . . . I. .... . . . . . . . . . . PLUMBING.INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS J � Date Building Location �if // Owners Name !�'a In Permit# 4 7 Amount T e of Occupancy New Renovation Replacement ❑ �ansSubmittqd-,Yes No FIXTURES r z Er Un a x d A A Q S03-EE C RASM f ]S)C;FIfJ(R 41H FLOOR 5II R.O R t off FLOOR 7IH R OCR gIH HCR (Print or type) Check one: Certificate Installing Company Name-V/5Corp. Address ,a' Lovl El Partner. ` Business Telephone / Ll El Firm/Co. Name ofLicensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy �� 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 El 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 Plumbin e d Chapter .2 o neral Law . By: igna ot Licensedum Type of Plumbing License Title Z 5' City/Town icense Tqumoer Master ❑ Journeyman I �' APPROVED(OFFICE USE ONLY u Location - No. / Date TOWN OF NORTH ANDOVER f 1 49 � 9 Certificate of Occupancy $ cMusE<A Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �a Check # 5 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: �a DATE ISSUED: SIGNATURE: � C Building Commissioner/1for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 6 �G .s-- ��--- coy Map Number Parcel Number -WO 04A Inn 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record ,J (�iei4,t�C � Name( rint) Address for Service CA644c— Sqature Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ C� Sl 3 Q Z Licensed Construction Supervisor: � 9�_ License Number Aicdd S 73 7 4 Expiration Date ignature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ L Company ame z zo-S Regis-�trhon Number led Address rM �7/ 7r 2 7 t Z J r/ Expiration Date S' na re Telephone The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass, 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: CityAjo i"a&oe Phone is J Z7 <-7- am Lam a homeowner performing all work myself. �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. Company name: ��A-L-►� �c.�.J r4 Address 11e7> > Cit} d AD V!/t(17- Phone# QT 1 737`1r Insurance Co. .L_.l&ag-ry �Z�- Policv# Company name: Address City: Phone# Insurance Co. 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 well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify UnKer�thepains and penalties f ury that the information provided above is true and correct Signature Date /0 0 / Print name 0.,j4r- tOccJ Phone# 9& 73 7 7 Official use only do not write in this area to be completed by city or town official' Building Dept ❑Check if immediate response is required Building Dept C1 Licensing Board p Selectman's Office Contact person:_ Phone#: El Health Department Other FORM WORKMAN'S COMPENSATION ° Replace bathroom fixtures: Toilet, tub, sinks Replace underlayment and flooring 01 X N Residence: John Crane `-�-/ 56 Elm Street ao 00 2'-2" North Andover, Ma. Contractor: Donald Kelloway 41 Tedesco Road Methuen, Ma. (918) 915-1314 w Town of North Andover NORTH qw. Q 4S4lO /61 "YO 6 O Building Department o 27 Charles Street * _ North Andover, Massachusetts 01845 ?, e4 (978) 688-9545 Fax(978) 688-9542 SSACHU`�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in/at: i A Q G D&a) Facility location ignature of Applka /0— / 9— ©o Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. TORTH Andover4 own of ..., l 0r'' .0 No _N' �A o � dower, Mass., o C OCHICKEWiCK ADRATED P? Cl S H BOARD OF HEALTH I Food/Kitchen - ERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..—T,.. A.. .., .... ...'k ... .. ...........CRA.Me. .... .. .................................................. Foundation has permission to erect. . ........... buildings on ....... ® .....M......... ., ............ Rough 2 A �& to be occupied as... ..... . ... ....... ...............vi f ............e................................. 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, eration and Construction of Buildings in the Town of North Andover. M Y a j4po ,. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voi s this Permit. 96 Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS GONSTRUCTI SAD 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 Smoke Det. r Fir, ' — J t`-ana manor a�!/a t . `��ra urcu rens BOARD OF BUILDIREGULATIONS License: CONSTRUCT-ION SUPERVISOR Number: CS 040392 Birthdate: 07/10/1947 Expires: 07/10/2001 Tr.no: 3223 Restricted To: 00 0 DONALD L KELLOWAY 47 TEDESCO RD (•�'^ METHUEN, MA 01844 Administrator