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HomeMy WebLinkAboutMiscellaneous - 58 COLGATE DRIVE 4/30/2018 /( 58 COLGATE DRIVE 210/081.0-0025-0000.0 f i I� Date....... .............. OF T TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION sS�CHU This certifies that J�Ill-Y... .... 6--U-J�.............. has permission for gas installation ............................................................................ inthe buildin7s 4....A......................................................................................................... .1 40, rf 04L. .......... No h Andover, Mass. . .. ..... .. ..... '0 Fee4�!�y........ Lic. No. ...... ............. . . .............................. GA INSPECTOR Checkoo-6-61( U I U"I s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY baa': a.aa.os�ecc MA DATE _ io ►� jrE7jPtRmrr# JOBSITEADDRESS St Ica—C-ka-K 100_ -OWNER'S NAME —77 G OWNER ADDRESS FAX RI TYPEOCCUPANCY TYPE : COMMERCIAL[]. y EDUCATIONAL.® RESIDENTIAL, . CLEARLY NEW:Q RENOVATION:Q REPLACEMENT: PLANS SUBMITTED: YES® NO Q APPLIANCES 1 FLOORS- BSM 1 2 314 5 6 7 t31 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER - - - - DRYER FIREPLACE, FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER - LABORATORY COCKS - MAKEUP AIR UNIT OVEN POOL HEATER - ROOM!.SPACE HEATER - ROOF TOP UNIT - TEST UNIT HEATER UNVENTED ROOM HEATER - — - - - WATER HEATER - - — - OTHERF - -_ - -- - — — - INSURANCE COVERAGE have a current fabil' Li insurancepolicy or itssubstantial equivalent which meets the i u rements of e9 MGL Ch. 1 42 YES �l 2]NO Q I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIAB(LrrY INSURANCE POLICY® OTHER TYPE INDEMNrrY Q BOND Q 1 , 1 OWNERS INSURANCE W ANER:1 am aware that the licensee does not have the insurance coverage required Ch 1 9 req by Chapter 42 of the Massachusetts General Laws,and that Snatum on this permit application waives this requirement. CHECK ONE ONLY: OWNER© ,AGENT Q SIGNATURE OP OWNS OR AGENT 1 hereby certify that all of the detatis and" I have submitted or entered regarding this application are true and accurate to the best of my Iviowtedge and that all plumbing work and installations under the permit issued for this application anl!be in c ornptia with P Massachusetts State Plumbing Code and ter 942 of ffre General laws. Provision of tris PLUMBER-GASFiTTER NAME -SCo IEFi'�Ft_A LICENSE#120-6-Z SIGNATURE MP EZ MGF Q JPE] JGF© L GIEJ CORPORATION Ej# 380 PARTNERSi IPE] LLC - COMPANY NAME F vtiLES ADDRESS �o L�.P►KTaN S-�C CITY 'Oohcta s-c`a STATE tf1elv- ZIP TEL FAX CELL 9R 7r 3 EMAIL - — Date................. ,......... i Of HORT1�,� ? . .-,•_•6 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 32 CHU This certifies that ........ ....... � ............................ has permission to perform•...... * .................................................... wiring in the building of ........................................... r1 at... ......... /-%' -a..s� .......... ....... .North Andover,Mass. Fee... ................. Lic.No ?�I3 ......... 6�1 �INS��E001( • Check # y� 763 i f Commonwealth of Massachusett Official Use Only Department of Fire Services Permit No. , Occupancy and Fee Checke ' Q=- BOARD OF FIRE PREVENTION REGULATIONS [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 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) Owner or Tenant 4e, Telephone No. Owner's Address Giyr�_ Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building_ �'f�<,' 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: G�iVi� Completion o theollowin table may be waived b the Inspector of Wires. No.of Recessed Luminaires 5 No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA r No.of Luminaires Swimming Pool Above ❑ In- E3o.o mergency ig g 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. TotaTonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW.... No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ �� Connection No.of Dryers Heating Appliances KW Security f Devices or E uivalent No.of Water No. KW No.of BNo.al of Data Wiring: 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 as required by the Inspector of Wires. ' Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: G- f—& Inspections to be requested in accordance with MEC Rule 10,and upon completion. Y 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 cove 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 of perjury,that the informatio on this ap l' ation is true and complete. FIRM NAME: LIC.NO.: r Licensee: LL dr�rl Signature LIC.NO., 6,3 22 (Ifapplicable, enter"ex pt"i he ice a uuane) Bus.Tel.NO.: Address: a of -p Alt.Tel.No.: q_7�e-k 147�?_I'J *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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/Agent Signature Telephone No. PERMIT'FEE: 1 r' AN The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 00 ' Washington ton Street g " i� Boston, MA 02111 t�i www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A Please Print URN Narrie(Business/Organization/Individual): J Address: City/State/Zip: ,� Phone#: . Are you an employer?Check the appropriate box: T of project(required): I.Vla employer with 4. ❑ 1 am a general contractor and 1 6 ❑New construction y'es(full and/or part-time).* have hired the sub-contractors 2. sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition, working for me.in any capacity. workers' comp. insurance. g ❑ Building addition [No workers'comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑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. 1.52, §1(4),and we have no 12.❑ Roof repairs insurance required.)t employees. [No workers' comp. insurance required.] 13.[]Other *Any applicant that checks bort*I must also fill out the section below showing their workers'compensatiori 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. ;Contractorsthat check this box must attached an additional sheet Showing,the name of the subcontractors and their workers'comp.policy infnmutdon. I am an employer that is.providing workerscompensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: 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 cove7 verification. ' I do hereby certif der i and pe 's of perjury that the information provided above is true and correct •{ Si afore: Date: �/� �� Phone#: l 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.Plumbin]Jlngs',,pector 6.Other Contact Person: Phone#• f Information and Instructions 1 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is def �.red as ...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. 'However the owner-of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance'coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,notate Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the numberlisted below. Self-insured companies should enter their self-insurance license number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. in addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-7274900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.govldia Date. �a. . . . TH Of NOR ,4, ' 3� '' °•° o 0 TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SACMUSE� This certifies that . . . . . has permission for gas installation ... . . . .�: . . . . . in the buildings of . . .'` . . . '. . . ... . .. . . . .. . . . . . . . . . . . . . . at . . :...... . . � ff.� '�, . ., North Andover, Mass. Fee-, " . . Lic. No. . . .?. . _ . . . � GASINSFEC A Check# Z. 0/ 6170 MASSACHUSETTS UNIIMRM APPUCATON FOR PERMIT TO DO GAS FiTT1NG (Type or print) NORTH ANDOVER,MASSACHUSETTS Date c3 �� " Building Locations Permit# /v�, iVc�aZA ount$' ��y�O Owner's Name k6) b.e ( �� t New Renovation Replacement LV Plans Submitted � a w U von � o z W Z U W z dFd Cx 0 > W G7 F z dA W �' w a w F W I., yr Z C w E, va m z O F > o 3 c a ° a° > a a w c SU B-BA SEM 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) - -^ Name Check one: Certificate Installing Company Z0,�J Corp. Address Ad L Partner. usmess Telephone -,5_ 77 , Firm/Co. • Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check,one: I have a current liability Insurance,policy or it's substantial equivalent. Yes Noo If you have checked}_es,please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity D Bond 13 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: D � 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 Stat as d and Cha t�r 142 of the General Laws. By: Signaturef Licensed PIm er Gas Fitter Title Plumber '/ Id,---176 City/Town Gas Fitter License NUMDer ® Master I APPROVED(OFFICE USE ONLY) 13 Journeyman t �r Location No. �' ~� Date NORTH TOWN OF NORTH ANDOVER OL uu p Certificate of Occupancy $ 1- * Building/Frame Permit Fee $ 4 �' ,SSACMUSE�� Foundation Permit Fee $ D //��Otther Permit Fee $ �SUe nection Fee $ Water CoWQ n Fee $ W J ' I TOTAQ J $ v rs� ,r Building Inspector Lir Div. Public Works Location No. Date &ORTN TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ ` Y Building/Frame Permit Fee $ Foundation Permit Fee $ a� s�cMust `t Other Permit Fee $ `• AS ewer Connection Fee $ Mter Connection Fee $ f TOTAL v`�• l Building Inspector Div. Public Works PERO.• MIT NAPPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. & %"/PAGE i MAP d40. LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK 'PAGE ZONE t� f� SUB DIV. LOT NO. F 142 No 337 LOCATION PURPOSE OF BUILDING SII��Clllz �� 1��A4t7L�{�11� OWNER'S NAME n p r� 1 . t — NO. OF STORIES .L ANtyQ^SIZE vw OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME �1n1 y) i� y�dJ�"1 SPAN Gt --- DISTANCE TO NEAREST BUILDING08eplrc:oa -z- DISTANCE DIMENSIONS OF SILLS - DISTANCE FROM STREET r� I POSTS DISTANCE FROM LOT LINES-SIDES —� REAR GIRDERS S"cs AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS Iy IS BUILDING NEW SIZE OF FOOTING /OIOtt X 216 LI IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER •7 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION f Rlaw A)Gr6 LAND COST SEE BOTH SIDES 1I, EST. BLDG. C08T 71joo. PAGE 1 FILL OUT SECTIONS 1 - 3 tp'elvi�]c yY-��5 ,�_p�� EST. BLDG. COST PER SQ. FFTT.`'I PAGE 2 FILL OUT SECTIONS 1 - 12 1 4J�.1C' ! �►As /'rt ��C�3" EST. BLDG. COST PER ROOM PERMIT FOR FRAME/BUILDING SEPTIC PERMIT ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INQ41L� FEE PAID ■' DATE�,FILED !sl C BOARD OF HEALTH SIGNATURE 6F OWNER OR AUTHORIZED AGENT FEE �� C. O�. Z> �o (� �^ PLANNING BOARD PERMIT GRANTED / �t7 uw.p �� Fm ff MOTh,L (I to --Al t Ci v � BOARD OF SELECTMEN Ll�lvl�i FOR FOUNDATION ONLY • OWNER TEL.# %G REGULATED BY PARA. 11�4..CO& B.C. �--=� DATE: �Aji' FEE NO. 2.0 0 �c � CONTR.TEL G au1LDINa IN6PECTOR CONTR.LIC.# o Z _. BUILDING RECORD 1 OCCUPANCY UL + 1 12 , SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION $ INTERIOR FINISH �rl CONCRETEd I 2 3 CONCRETE BL'K. PINE I 1 Ht. Ck►. L ` BRICK OR STONE HARDW D __ __ 1 s �` r PIERS PLASTER ` c111 ¢ _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ FIN. ATTIC-AREA _ N_O 8 M . FIRE PLACES _ HEAD FpOM MODERN KITCHEN 4 WALLS • 9 FLOORS CLAPBON.RDS B1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDV)D ASBESTOS SIDING _ COMAACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBRELMANSARD TOILET RM. 12 FIX.) — FLAT A SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPE LESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GASOI L B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING a Ks ��k �L - � � A�+ - �_ PLANNING FINAL- 0 iVAI., ...w.w,..�.......�...........- $ TJ °1 Town ® = 6 n over 0 No. 250 RY - - - - - �C er, Mass..,- 1 MI KE WICK oRPERMIT T LD Qa SS BOARD OF HEALTH THIS CERTIFIES THAT.... .........!.?.wm .. �I.��1� ........ ....... .............. .... .., .i egk �� bilding Pn � BUILDING INSPECTOR 4.4haspermission to ere � uo � Rough to be occupied as.. ��. �! ... ... „WO•,��,• �,,,,, Chimnerd# y • Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough PERMIT FOR FOUNDATION ONLY Buildings in the Town of North Andover. REGULATED DY PARA: 114.8-5. B.C. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. pplD:��-0 PERMIT EXPIRES IN 6 MONIED ELECTRICAL INSPECTOR UNLESS CONSTRU Se N ARTS ugh Service PERMIT FOR FRAMEIBUILDiNG Final BUILDING INSPECTOR DATE: ��'�' �� FEE PAID: tid � GAS INSPECTOR Occupancy"_71oirmit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by SM keTNO. Building Inspector JOB CONSTRUCTION ENGINEERING SERVICES SHEET NO. OF 12 Pleasant Street CALCULATED BY DATE C? NEWBURYPORT, MASSACHUSETTS 01950 (508) 4652216 CHECKED BY DATE SCALE S8 iI .......... ...................... ................................ ..........«..........I ...... ..................... ........................... .......... ...................... ........... ........... . .......... .......... ........... ........... ........... .......... 1 7. ....................... .......... .......... ................................ ............I .......... ......................................................... .......... .......... ........... ...................1..........i...................................................... .......... ........... ................................................................. .....................I.. .. !.\- ..................................... ................................................... ....................................................... ............................. 11*111,11,. .......... 7' 173 XJ1 ...........1 .......... ............................................................................................ ...... ....... ..... ............ ............i....../............. ............. .......... ........... 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F......... ...... ..... F-v- PRODUCT 206-1�Inc..Giom,MIWLToO *.PiaEf ........ A JOB of CONSTRUCTION ENGINEERING SERVICES SHEET NO. z OF z - ' 12 Pleasant Street / CALCULATED BY NEWBURYPORT, MASSACHUSETTS 01950 L DATE (508) 465-2216 CHECKED BY DATE SCALE 'S12 4S4 G`9 -D42 VC, N, ANoove,Z ! ! i I i t : t ...........f...........:..........i..........'...........;...........;...........l.......... ..........�....... : .... .... { ..... .... .... ..... .... .... ..... ..... !......................i ! .... .... .... - : II , I ! ...........t..........:/.. ,... ... y�..:. ...... .........{........... 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I I I �.... i I I ! ! ,..........' .... ..... ...i....... .... .... .... .... .... ..... .... .. ...........l .... .... ..:...........I. ..}..........� : PRODUCT X5.1�pK,GM-Nat 01171.To O"W PHONE TOLL FREE 14OD*.6300 I [LIETTEM of VRUBETTUL EOCinc. OW �ADOWS �� ttl1J<.Dt71C DATE+.. I /yj JOB NO. r1 _ M7 0111 rW STM IIOAD TOPMELD 01[03 Gflf Vr/ CA 1 (508)-887-906— ATTENTION 5 21J ^a� S rr 4AWE - AJ 94A- WE ARE SENDING YOUAttached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION V t CAW AN THESE ARET13�fNSMITTED as checked below: L�(/For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑;/As your use ❑ Approved as noted ❑ Submit copies for distribution ; ' As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS J,D,U_E_ / 19 ❑ PRINTS RETURNED RAFTER LOAN TO US REMARKS t1A UAt 4rQ,, COPY TO SIGNED: PRODUCT IAG7a Inc Gma 01471wa oi If enclosures are not as noted, kindly notify us at once. c_� i i FORM U E TOWN OF NORTH ANDOVER LOT RELEASE FORM i i SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADDRESS (ASSIGNED BY D_.P.W. STREET S�3 C�1�C�� �2i V� APPLICANT I0 r�b�s��- W r A� t PHONE DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD /4- DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COMMISSION 11r - DATE APPROVED CONSERVATION ADMIN. DATE REJECTED BOARD OF HEALTH DATE APPROVED HEALTH SANITARIAN DATE REJECTED i DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS 44IRE DEPT. c � n RECEIVED BY BUILDING INSPECTION DATE " 13 i This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADDRESS (ASSIGNED BY D.P.W. ASTREET /APPLICANT PHONE ,-DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD / DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COMMISSION DATE APPROVED CONSERVATION ADMIN. DATE REJECTED BOARD OF HEALTH VIR DATE APPROVED HEALTH SANITARIAN DATE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT I— S WER/WATER, CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. ty � t �'#)Y•" '+TIF F 5 R -!wr hXry��a�TT a1Pv'^ '".P 'f7 ' P� ��fA'.al atj 5 r -� •t �4�" A. fk�.1tY. i L �t ho 3t NOWx «•4�£JF'!,t y 94�'�'t,i7.-!'c~I +A }'ta'° f '1 GZi/ xi� k'i � .,. 'tib L r tif14 MCITOO yi•it r,�'X� r+ f .+'i •7,f.t*a°." `�}�J�h y.irk��+} '� £tt tx 1t.•'441 nr is+t�£�1�,. �."_ �\ \ ` A 41;'''''rJ`�„'N P <•�7/ d_,,{ ty , .r t N PM ! J 2' C / ,�..� 1 t f4—,.+.5 Itis #'. \J � r '✓L. ' �'.v/Ny�I - /� A k:+%� ��'M.t�^� K.+>t' ; 1 ,It, Illi «`+ .. 0e. f f 9k«+qtr�-fi �� �� t�r • ���ytti�c �,ytf � • (\�//✓L�/)r I 'O�Q..�� A f �,� f R �,r � .o "�— ' errtr 1;1'��l�"5✓frT ��� v 1 s t�� +£r � . 1 {f...(,.►�/- �''� far `�1 a W t�Y:* ner / , �(...� Q JV I �'1 � .f �4 t h Su�'yf�•) 2�. ' t {.�eri�xNrl rltlirt•/is�+i+'a .•v 1 L[� � '-key 7}5t:���°f�,�f+c M Tii '7�j1'..f a I t �' '3't ♦4 .,,,�1 + - t~ 4 ;-. £ '" t t4 4 ttj4.K+f�9�{'a }4j ,.,p�'��)x 1S'� �F2«t f+#• t t.� v i � -.. y v'� .1. ;^ ' w y t ��1 �y7I by „ Wk �' i P *}«w } •" r pr"#, ? t3+r i c 4' .,,x�t '7�, yS ":STi�C/ '•sl,«.t c� r Y. f r '.;�+� r $ w a: r,;i^ g .ep ry n tt�f•. ;F ' '� f. t t.'1 }( t�.6ti M r wtit n '47::tF�.ty''£ �,P :'( ,a. t , �,�• .�fa v t.: tI asr t y • Oyu° r i - A �vL� l SS c-, L r#.f'.r2, Pf`;r �•4 SR 1« f r , IV�I. `� Quet lO&.X- ' iti7aY { ' y,ft rr•.f A r aj•,Jri+. 1 1... Y 1 �"�`' \ i ..� f# � �'�f�f,� �'t�� sl— {c s yY?r yf r,S1, { ,,� 1` �`�+I .` 1�\) +, £♦ 1• Ja Y f�F r;. , J�¢�. + ON }/-�� (� IV J W��c' ✓ �•,Y t t�gpY t 4y, v~ tl r.'., ltit a �� , I k'ara�t. + £ { x..Y: ,t•T q,b +7y}y`,}t J� i. „� .rt�.a �: �/ ��y) � {U l. c;t 1... j i �!'•y t s wrl� rettY��N t ��y�i'f� ( // ,t l l.� ,/J/�. "/ •tit{ + �{Y� f 1 £Lr-+• k./`✓/ 1 .. * 1 1� e � , � . � r t y tt ,•tE4� ' of V•'�(+ ,i 1/ .i.{ '� r tfr YY• �.4 ly.� tf6f rte' y, '�3 , r t �'+: L 4 R � - ; M�' i ! ,''« � �t 1�7 1.� Y l 4• y }. 3, �t .� Location No. Date �` _6 d f TOWN OF NORTH ANDOVER O�tt.•o ,•1�.0 F? • O41 � 9 Certificate of Occupancy $ �'ss,cM�stt�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �l Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: � � ` DATE ISSUED: SIGNATURE: AACC a� Building Commissioner/I ctor of Buiidin s Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: CoL9�Tc /elVe 00 / 00;1-5, Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R aired Provided 1.7 Water Supply M.G.L.C.40.t 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: . Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record RdSaG,)d GJjAJAvC_ -4,cp Cdtqq-fie Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: �1 Name Print Address for Service: z Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Conytruction Supervisor: Not Applicable ❑ Licensed ConstruVinn Supervisor: o a 7 g p q License Number Addres �2� 1�2�Zo722�� � ic __�eaExpiration Date Signaturg Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name /o/ye/ �p V Q- Registration Number Address Y Expiration Date Si nature Telephone SECTION 4-WORKERS COMPENSATION(NLG.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 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) TJ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ti2�1'�.dve � �,c�,rT,�g �oyfi[e 1�.v4 c.��,✓dows �-.r•� -�+' ,ye w *i AAeAS`�F A7 �Vv l'Le /4 !L/q — S��a,e 912 e SECTION 6 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed b pertriit applicant 1. Building (a) Building Permit Fee "719 3 T, o o 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 �/9 3 S, Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,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. r of Owner Date 7b OWNER/AUTH/JORIZED AGENT DECLARATION .� e W4 P jJ ��(s 1 rA) G as Owner uthorized A�entpf subject lare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge P14 ,�etS6,af Owner/Agent' Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DtIvIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE _..._. _.—.—____.._.......,....r....,.,,......_,,..........-•___.._._ ._.. ._...-- Cr.. w,..H_............._...w.,.,..ww..ww..�,..«a,�w,.w.N�.W.MYW. Page No. of Pages STEPHEN PA. KEISLING Building & Remodeling 68 Glencrest Drive NORTH ANDOVER, MASSACHUSETTS 01845 MA Lic. 027489 Home lmpv. 101846 Phone 682-2072 i PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME CITY,STATE and ZIP CODIf JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates fora .. �-Q,H`T�•`� i���-�y G�-Du�C�'K few•-,.`� INS^'��-�OLtJ C.r..v�..t/�r:7 O� .cam ��i�s,-c�,-/-z?Tr».-� T-•.-`',.� .. f t.c-v-'G ' ,.�t4 cr��. :7-r'4R _.��2/.�LNN. i<.rL-.f--h• /0cr- ��G+r.-/-� i.-C./1-I ^+r (1�, .,,:r�..�+-c�✓ LLz^z�ir,L,.�J cit Z ��-.t-i" c':.�'�t.i ::.1-d. (C-( i Or pr0POSC hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: dollars($ )• Payment to be made as follows: All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Signature Authorized involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements.contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be withdrawn by us if not accepted within days. Our workers are fully covered by Workman's Compensation Insurance. ' Arreptaurr of Proposal —The above prices,specifications , and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. i c I � ✓fie'tpo�nanon�aeal(�i o f�-���•�«*��� HONE WROVENENT CONTRACTOR Registration: 101846 Expiration: 6/21/01 Type: Individg1 STEPHEN N. KEISLING Stephen Keisling aA 68 Glenncrest Or. F ADMINISTRATOR N. Andover HA 01845 I ' r BOARD OF BUILDING REGULATIONS j License: CONSTRUCTION SUPERVISOR "} Number. CS 027489 II Birthdate:x.07/16/1953 1. Expires:07/16/2001 Tr.no: 11352 Restricted To: 00 STEPHEN M KEIS LING _ 68 GLENCREST DR N ANDOVER, MA 01845 Administrator + j I I i I I rr • 1 WaDLCLARATIONSp�l'YI PAGE 1. 9 CONTRACTORS ADVANTAGE SPECIAL Family POLICY NO. 2005XO431 Casualty Insurance Company Q Glenmont,New fork NAME OF INSURED AND BAILING ADDRESS: AGENT NO. 2591 OFFICE NO. 2591 STEPHEN KEISLING JAMES W UGONE 68 GLENCREST DR FARM FAMILY INSURANCE N ANDOVER 'MA 01845-.315 10 S MAIN ST, STE 208 TOPSFIELD MA 01983-1832 978-887-8304 RENEWAL TRANSACTION EFFECTIVE 03/21/01 POLICY PERIOD FROM 03/21/OL TO 03/21/02 12:01 A.M., STANDA:3D TIKE AT THE LOCATION OF THE DESC",IBED PREMISES THE NAMED INSURED IS: IN' IVIDUAL BUSINESS OF THE NAMED INSU (ED: CARPENTRY-NOC �.00ATION OF DESCRIBED ( 3 GLENCREST DRIVE PLOTECTION CLASS IS: 04 PREMISES NO. 01: N ANDOVER MA 01845 CC'NSTRUCTION IS: FRAME PREMISES 01 BLDG 01 BUIL dNG MATERIALS / EQUIPMENT STORA3E BUSINESS PROPERTY COVERAGE- LIMITS OF TERM ADDL/1,TN INSURANCE PREMIUMS PREMIUMS BUILDING 0 0 0 BUSINESS PERSONAL P1,OPER1 5,000 46 46 3USINESS INCOME AND EXTRA ACTUAL LOSS SUSTAINED N�: :EXPENSE EXCEEDING 12 MONTHS INCLUDED INCLUD►ED T..USINESS LIABILITY COVERAGE: BUSINESS LIABILITY - PREMIUM IS SUBJECT TO AUDIT BODILY INJURY/PRO°ERTY DAMAGE 500,000 PER OCCURRESCE 1,000,000 AGGREGATE 500,000 AGGREGATE )+OR PRODUCTS - COMPUTED OPERATIONS HAZARD MEDICAL EXPENSE 5,000 PER PERSON FIRE LEGAL LIABIL::TY 50,000 PER OCCURRENCE CODE DESCRIPT;.ON PAYROLL TERM PREM ADDL/RTN 91342AA CARPENTR '-NOC 20,000 .379 ' 379 ,I I THE LIMIT OF INSURANCE FOR THIS BUILDING SHALL BE AUTOMATICALLY INCREASED BY -'i% ON AN ANNUAL BASIS DURING THE POLICY PERIOD. ACTUAL CASH VALUE (.,CV) - BUILDING OPTION DOES NOT APPLY. 6 DEDUCTIBLE: $250 DEI+UCTIBLE APPLIES EXCEPT WHERE NOTED IN THE POLICY OR I'.NDORSEMENTS. COUNTERSIGNED BY: i BF 30 05 01 93 INSURED COPY PROCESSED DATE: 02/13/01 NORTH E Town of over 0 �oC LAAN dover, Mass., 7�p AORATED CO S H � BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT O `e,R 40...........0a...� �� .................................... Foundation has permission to erect.........4.......................... buildings on SS........0IQ..��14* Ike............ Rough........ .. ....... ....... to be occupied as....'R ....I�c.. +......... iNef0 w 5............................................................... Chimney provided that the person acLepting 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 r latmg to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. �?� mss•. $ .3*70 dwwu� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina' UNLESS CONSTRUCTION START 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. t SEE REVERSE SIDE Smoke Det.