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Miscellaneous - 58 HOLLY RIDGE ROAD 4/30/2018
58 HOLLY RIDGE ROAD 1 210/098.B-0020-0000.0 �� Location Ay pr�� _ No. ✓Date HaRTM TOWN OF NORTH ANDOVER O��t� o i ,ti Certificate of Occupancy $ s4C,„5 Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee $ � r TOTAL $ 4110 Check # 14815 Building Inspector . TOWN OF NORTH ANDOVER UILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: /� -� DATE ISSUED: ic SIGNATURE: Building Commissionerfl or of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property ddres; 1.2 Assessors Map and Par e!Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS 00 $U t L 1 `W tl , �° Front Yard Side Yard Rear Yard Required vide Required Provided ZReqwred Provided 1.7 Water Syy��,�GJ-C.40. 54) 6 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Public is Ptrvate ❑ Zane Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 —j SECTION 2-PROPERTY OWNERSHW/AUTHORIZED AGENT M 2.1 r f Record (14, Mr' SPS ✓ sPN n Name ' t) Address for Service -Signature Telephone l 2.2 Owner of Record: Name Pring: Address for Service: . X11 Si nature Telephone ` SECTION 3-'CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: C.S ` ( yk - '~ ` License Number Mn Altress > ) _ Expiration Date !� ` Si na a Telephone 3.2 Registered Home Improvement ntractor Not Applicable ❑ �e - r Company Name / �k Registration Number �j U t" Ad s5 2..0 'Expiration Dat Signatuik 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.......0 No.......0 SECTION 5 Description of Proposed Work check a!1 applicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ 9 Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: ??CL SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Q om leted by permit applicant " x I,,. ,Bltilding Permit Fee z Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Ph unbing Building Permit fee(e)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 OW S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/AwkialkadotpoW of subject property 6) Hereby authoriz to act on (`g My h f,A. i s e tiyrfW nz d by this building pennif applicdtiOA— ...Sigrlature of Owner Date SECTION 7b OW``NER/AUTHOR`IIZED AGENT DECLARATION xI, ON e 4 L ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief ti lM L� PAName Si at ofhA ent Date NO. O ORIE SIZE BASEMENT OR SLAB t SIZE OF FLOOR TIMERS isr2ND 3RD SPAN DEVIENSIONS OF SILLS DRvIENSIONS OF POSTS DRvIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CMdNEY + IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ` FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This.does not relieve the applicant and or landowner from compliance with any applicable requirements. or moves No rrr■rOWN,WON an"was OWN soon.../O/rmoon nags DE.rrsawn..r.rrrOEM rram.Nos ass APPLICANT U i C f�. C Gy �^S PHONE 9,Y " b 6"�-3 ASSESSORS MAP NUMBER LOT NUMBER C� SUBDIVISION LOT NUMBER STREET C ( STREET NUMBER i�rrrrrrrrrrrrrr. rrrrrrrr■ rr■ OFFICIAL USE ONLY �rrrr.rrrrrrrrrrrrrNSrrarOFrrrr■■r'■rr-r■rrr■■rrrr rrrrnrrrrr-■rrrrrrsrrrrrr■r.rrrr■ . '710 � rTOWN AGENTS RECON1MENDATIO ................... .............. DATE APPROVED ��� V CONSERVATION AD TOR DATE REJECTED COIvIlvi- DATE APPROVED TOWN PLANNER DATE REJECTED COMMEN TS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED. SEPTIC INSPECTOR-HEALTH DATE REJECTED C OMDv1ENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNAENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR. DATE s r ' i I-C7r O 3 � laP,.0A) Z:c�ifs. b; i i • wel�aCIO E TO fly cA :•k:r �-. ���-j'.�i AND JMn 1, MORTEIIQE tNSPENCTt�11 ; Sr r I.:a • �f7ERiV`,'iffAi f kAVX UXAWW IN Lf#w�f1101N o0 yy = RL H( Ciloom n fEb. tq Y T"fRO ' � s 11U1lntFn tXRt1FY ntAi n// fxCM011 U ak"AAIR10 w. Nates. IWARa ANA lttY it !•I.�j lAcAtiD /t nlr ►sfAAUY(fD rt.nC11f CtiI.iMAI1fdIYY i'AtfF.t Nn.:;�.... • . ,.p:. UF.F•11 �tuwa,AttaN n� n� IKCVMs :-1•'Ri1A{itflf. >•, AI+fa. d.''ilt.aa�lsltiN.M' M'JCIIIrCYrp1p::LAFSt OM altr toOafra 0 n1E AaAAR/ I D�=RX[QA1E=: �.DO•AE.l.tEt,y•lar: na at RNi Ccaest'In1Y f/ NOt.N//MNgllE Ityt Nft'f+,Of]tRN11: HAD[!MI>�CtN71r 1O ?ilE KCallptn fit! t4 LoArE a Mt (Al"t w-rte, - wI urI[vot Mi slfa�w.UM MM all[ r Wr nlal QIIAT A /fly (MAO[ 1b 1411/'7 altlot{ ri!il[a Q ADtifltll •'TIMI f1K PACY.11F1CA11QK..Is *AM at-.lig,LOCATI[M�CO< A{�If14Y y �JYt tc-,�f4� E t.A Vl1MNOi1_ilOt/«19F PAWtea'CI 6f1� /�1 00"NOT tlAIP7► QHS Y. It All:ACC11p1At4, N>< UM AND CIT' M At /IIOgrN, nas cdc;u vaso ett'�, •` ' 1 1�'Zt_, �: ------ aH.r. ,nr- OFM 1S AS SI IpwV— i�Urnlit.1diE d°5��� ' tOFl TM t: r✓ =Aft 1 BRADFORD ENIGNEERING d,►>rtts: W. oouolowc" ^ ,. » favIlall� M Aswig Town of North Andover �� �O RTI $s `o 0 Building Department 27 Charles Street North Andover' Massachusetts 01845 +� coenigwwcK (978) 688-9545 Fax (978) 688-9542 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, s150a. The debris will be disposed of in/at: 1 Facility locati Sig tur of A plicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. i z The Commonwealth of Massachusetts Department of Industrial Accidents I Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit IQ y f y�, See Name - Please Print 4 Name: �1� c- Locatio /• VJ Phone # q`76 _(1 2�6 I am a homeowner performing all work myself. 0 0 I am a sole proprietor and have no one working in any capacity I am an employer providing w rs'compensation for my emplo ees working on this job. Z j A1C. 'l Cn name: � - ct Companyff Address I • �--- --� A.I1 Ci � l � Phone#: !, Insurance.Co. Policv# j Corn an .name: LXG; Address G rL 1 C� Phone Cid. _ lnsuranoe.Co � iS, 1 Poli # Failure to secure coverage as required under Section25A or MGL 152 can 1 d fo the imposition of criminal penalties of a ftne up to$1 560`UO and/or one years'imprisonment_as_well_as-ciaril.penattiesinlhelnrm-of SIOP_1N�RK._ORDER.grid_aline_of�$]Ilo:Oo)�s1ayBgainStme. understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification. ' I do hereby certify un r th pai d penait' of perjury that the information provided above is true and correct. Signature: Date Q � Print name ►a�fv Phone-0 official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensin4 Building Dept Check if immediate response is required 0 Licensing Board p E] Selectman's ice Contact person: Phone#: E] Health Department ElOther J� f4-rT'AC1 T0-45 f,).P A lI. (),_C- 1 Ute'l l May . 7 2001; 2 .2�ptt1 LESL f E S RAY 1 NS Pdo ,3157 P - i (MM/ODYY, AC�rxK ..A... l lC�, >` .�� ®^�liLlTY INSUl�0.NCE 3/19/2001 PRODUCER (978)927-2600 FAX (978)927-893$ Leslie S. Ray Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 129 Dodge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beverly, MA 01915 INSURERS AFFORDING COVERAGE INSURED O'Neil Remodeling & Construction Corp. INSURER A: Acadia Insurance James J. O'Neil INSURER B: Safety Insurance Co. 131 Rantoul Street INSURER C: TPA Insurance Agency Beverly, MA 01915 INSURER D: INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDIYY) LIMITS GENERAL LIABILITY CPA0.066499 01/21/2001 01/21/2002 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any ore firs) $ 100,000 CLAIMS MADE OCCUR MED EXP(Any one Person) S _ 5.000 A PERSONAL&ACV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMFIOP AGG S 2,000,000 POUCYF-j PJECT RO• LOC AUTOMOBILE LIABILITY 1506009 09/24/2000 09/24/2001 COMBINED SINGLE LIMIT $ X ANY AUTO (Eascodent) 500,ODO ALL OWNED AUTOS BODILY INJURY S $ k a .C.EDULEpAIITOS Per son} ( person) X HIRED AUTOS BODILY INJURY $ X NON-OSJNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ 250,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 924K341300 07/03/2000 07/03/2001 TORY LIMITS X I'JE'R EMPLOYERS'LIABILITY C E.L.. .EACHACCIDENT $ S00,000 E.L.DISEASE•EA EMPLOYEE $ 500,000 E.L.DISEASE-POLICY LIMIT S S00,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSPlENICLESIEXCLU IONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 Q_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 27 Charles Street OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. No. Andover, MA 01845 AUTHORIZED FUM171W NURANM AGENCY,INC. .'a c 12'-1���/ �..� �..� 7 Z ✓/ i ROME IMPROVEMENT' RAC'tRR Ni11t1 CS 054090 YP RIVATC CftRAi3RATInR A t t d2 195 ion', 24 � g31 l01 itr '6W62002 Tr.emit: O)Nel Rem, i ng, on CorF N l s James J. Ole, SII a � x'131 Rantoul St tSI"PAhtTOUL, ., ADMINL5TftATC3R eVeTIY' �1 Q1V1 SEVEP.Y. A 0191 CITY OF SALIA #2008 w BUILDING LIC t5 T this 'ss to corli$g That JAMES J. ONFUL 111 _BUUlER_aTRF.FT S#„ PSSEKMasa., Has been granlod a licen" 6 A Buildiaa8inspkfor as a ox� �tn ° NATIONAL TRUST MEMBER 51084630 11 200 1 t:ateprrr?� Individual ; , " - on lldv1 13�feAif`!aln , St BeverltjJl 011 ,1,5-4240 Nation Thist for Historic ftesexation 1785?tta sachuscca4 Avenue;N U'Washftton,D.C.20036 ,o. ✓fie TOa�r�rnaruuea�i a�✓l�Gaaaac�iude� �\ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 123648 Board of Building Regulations and Standards Expiration: 03/24/2003 One Ashburton Place Rm 1301 Type: PRIVATE CORPORATION Boston,Ma.02108 O'Neil Remodeling&tan;Corp: James O'Neil, III 131 Rantoul Sty Beverly,MA 01915 Adiiiinistrator Not valid without signature Board of Building Regulat ons and Standards One Ashburton Place'- Room 1301 Boston, Massachusetts 02108 Home Improvement C'i itractor Registration Registration: 1231348 k Type: Private Corpordtlon Expiration: 03/24/2003 O'Neil Remodeling & Con. Corp � s 1 James O'Neil, III 131 Rantoul St Beverly, MA 01915 Update Address and return card.Mark reason for change ❑ Address Renewal Employment Lost Card Remodeling & Construction Corporation CONSTRUCTION CONTRACT This contract, dated MAY 7, 2001, between the Owner and Contractor: Owner: Patrica & Pete Michaels Contractor: O'Neil Remodeling&Construction Corporation, 131 Rantoul Street, Beverly, MA 01915 Telephone: 978-927-7711 Fax: 978-927-2173 Job site address: 58 Holly Ridge, North Andover, MA 01845 L GENERAL This contract is for the following work and materials to be performed by the contractor on he property address above. This project consists of Removing and disposing of existing deck and constructing a new deck. The contract consists of this document;and the quotation, submitted in REMODELING& CONSTRUCTION CORP. proposal_letter dated May 3, 2001 to Hugh J. Collins,Jr. LandscapeDesignerJnc. Drawings are two-8% X 11 drawings and three 11 X,17 drawing all untitled and undated prepared by Hugh Collins. Change orders and modifications shall.be in writing and shall become part of this contract. 2.Price The owner shall pay the contractor the sum of TWELVE THOUSAND ONE HUNDRED FIFTY DOLLARS ($ 12,150.00). 3. PERMITS AND APPLICABLE CODES; COMPLIANCE WITH LOCAL LAW A. All work to be done under this contract will be in accordance with the applicable building codes. Contractor shall obtain all necessary permits and pay all;required Permits and plan fees. Cost of the necessary permits will be billed as an extra to the contract B. Contractor shall at all time comply with the laws of this state regarding mechanic's liens. 1 4. SPECIFIC REQUIREMENTS FOR MATERIALS AND WORKMANSHIP A. This contract will be completed by Contractor in a good and workmanlike manner, using good quality materials. The parties agree upon the attached materials specifications and work description, together with any plans or specifications incorporated herein. 5. PAYMENT"Payment due to contractor within 10 days of date of invoice" A. Timely payment by Owner of all sums due under this contract is of the essence to this contract. The parties agree to the following schedule of payments: 1. ;Initial payment upon executing contract in the amount of twenty percent (20%)of the contract price. 2. Progress Payments: Contractor shall invoice Owner on a percentage complete basis using a schedule of values form. B. Contractor may cease operations if any progress payment is not made by Owner as required herein, and proceed to any balance due with any legal remedy. Alternatively, Contractor may continue operations, as set forth in the attached General Conditions. 6. SPECIAL CONDITIONS A. Painting (prime and two coats) and sealing (one coat) of the deck is included. B. O'Neil Remodeling will assist the excavation subcontractor, hired and paid for by Hugh Collins, with the layout of the sonotube holes. 7. SIGNATURE Attached hereto are General Conditions governing the rights and obligations of the parties to this contract. The parties are further subject to the laws of this state governing contracts and mechanics' liens. IN WITNESS WHEREOF, we have here unto set our hands and seals this_Z _day of 14, j4L 2000. r. and /or Mrs. Pete Michaels m%e . O II i NORTFI Town of Andover 9� o �A E o dover, Mass., COCHICHEwICK V ADRATED C• -J S � _` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....ROVAQ-191 a..........AY44 V../. MEMOFoundation has permission to erect....�A . .!�.fiT........... buildings on ..... ..... ...f .......y.....lyc......... Rough to be occupied as... ....13..* /3 .... .{,.....A46 Ic ..��40�6r 0*4Chimney ...................................... 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, Alteration anj Construction of Buildings in the Town of North Andover. 0" qs Raw 'iftijo . 0000 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough FERMI-F EXPIRES IN U MONTHS Final UNLESS CONSTRUCTION ST 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. Location No. 6 0 v Date l �� �oRT� TOWN OF NORTH ANDOVER 3? ` ' 40 Certificate of Occupancy $ 9 NuBuilding/Frame/Frame Permit Fee $ �+ s,►csE Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ 7 Q Check # 9f r 16115 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING <,.. _ BUILDING PERMIT NUMBER: _ L® DATE ISSUED: eq , SIGNATURE: Ikq Building Commissioner/Inspector of Buildings Date z SECTION i-SITE INFORMATIONO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 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 RequiredProvided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record M, L'14 2 h35-F5 0l/N A,(Aly C,ye /1/-7 Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: OY6 5'/7 O License Number > 5-o �2r9ud d.P w �y� Qtyt 2e f5 r9�. awls/ Mn Address . 11 9/i3/0 3 ic 7el-7?/' t�0 � Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v �&A Z9d,e.0 Company Name 103' J 3 M Registration Number >yD L,1Yti/0oel �Sr/� -'!N� hIq dIT45- r rM Ad ess z %v77-4-115 Expiration Date Si n ture 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 Description of Proposed Work check all applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specifyz4 s!R/ S k%1 7-c Brief Description of Proposed Work- / O�-o X;s1r,`7y Z -e;f,/c -fs 6 4gC1 a4- R- rn Fa n__ i k/,j s T--, Q 6- .n PL. rf- 2 Xrqs/C.i -4/ se-'%.� P.,* rRAm-e G�oSe t `0 2 Nem ORL Ds� . SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be O 'ICIAl USEONLY " Completed by permit applicant 1. Buildingn (a) Building Permit Fee o -5 ,/ 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 ly SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 1, as Owmer/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 Si ature of Owner/A ent Date a NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE mar The Commonwealth of Massachusetts d Department of Industrial Accidents �., Office of Investigations Boston, Mass, 02919 Workers,CompensationInsurance Afl9davit Name Please Print Flame• Location- , CRY Phone # I am a homeowner perfomning all work myseff. a QI am a sole proprietor and have no one woridng In any capacity I am �anm"ployer�pwvld�nqwod�,e�c�oM77on for my employees working onosis job:z./n �,0 y Address I�lD k,; g woo d flt ,J �'►i4 Phone# /- y77- ASI - --- Phone..# se °e t rept d' �s e►2► t dieio . Irri�rnsi n c#. ..... ar_ anter one yam•itnpris �e�tz�s_cf�[1 ioZomnx�f� DP]�ARK OIC mid a dl ?�ougrst M. 1 tRxferstancFthat a copy of this stateaerit may be foul w%w to the Office of Inveaflgations of the WA for Mverage on. I Cb hereby +under!ho pelns And penafts•of PedwY UW the bfforrrla pl ovided above is inn and owed. Signature. . DateX=��. Pq e�I • 7� Ptlfane# 79/- �'//-Gt�S� Print name L Official use only do not wAte In this erea:;tie completed by city or town offkiar City orTovvn Pert Ncene i g Cl Building Dept [Check if immediate response is MgU&ed E3 VcenSitV fibard 0 SeJb trf W7 S Off/0 Contact parson: Phone# 0 Health Departmer, 0 Other -town 0$ 1N®rth Andover & tAO Wrh t `¢D f9 Building Department19 o �j '� L p 27 Charles Street �- North Andover, Massachusetts 01845' (978) 688-9545 Fax (978) 688-9542e� K. � �R"ITED AP¢•y S .4MU5��� 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 c1I, sI50a- The debris will be disposed of in/at: Fa . cility location Signature of Applicant to NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. } ' BOB LANDERS CORPORATION 140 Linwood Street Lynn,MA 01905 Tel: 800-310-7744 Fax: 781-477-0604 To: Date: Phone: Patricia Michaels October 28, 2002 58 Holly Ridge Rd. N.Andover,MA Email:Ppmichaels@aol.com INSURANCE: LICENSE#033139 REGISTRATION#103138 All work involved within the following proposal is covered by Workmen's Compensation,Public Liability,Property Damage,Products Liability,and Completed Operations Insurance. BEDROOMS: 1: Remove wall areas as needed to expose the framing. 2: Remove the flat ceiling area,carpet and pad. 3: Cut out roof rafters as needed. 4: Install framing for new skylight opening. 5: Install two skylights. 6: Install Ice and Water Shield, flashing,and roofing to the skylight area. 7: Frame the closet with opening for a double door. 8: Frame window seats for areas at new skylight area and existing skylight. 9: Install '/2"blueboard and plaster to the new skylight area, closet and pole and a new smooth flat ceiling blending into the existing plaster. 10: Install face trim and raised panel drawers to both window seats. 11: Install mirrored closet doors with mutting. 12: Install baseboard moldings and casings to match the existing. 13: Clean up all related work debris. PRICE: $8587.00 TO BE SUPPLIED BY OWNER Skylights and Flashing Kit. Electrical HVAC Flooring Painting. PAYMENTS TO BE MADE AS FOLLOWS: I. r , i Payment Schedule To Be Set Up All work is guaranteed to be as specified. All work to be completed in a professional Authorized manner according to standard practices.Any alterations or deviation from above Signature - specifications involving extra cost will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon NOTE:This proposal may be us if not accepted within 30 daayy strikes,accident,or delays beyond our control. withdrawn s. ACCEPTANCE OF PROPOSAL:The above prices specifications and conditions are satisfactory and are here by accepted.You are authorized to do the work as specified. Payment is out lined above. SIGNATURE �I 1 G I GUWSIGNATURE• StEa" ''ss 0r 9C 33BT j --T- N MEMBER a { _ ✓/ZB VlI)7N/J72431C(�CCCLL/L O�✓b"��J;SlQGdUtlP.I„f4 _4 (' BOARD OF BUILDING-REGULATIONS License: CONSTRUCTION SUPERVISOR Nurnber_-05 046517 Birthdate;!09113/1948 E41res:09!13/2003 Te:no: 5367 X t Restricted• 00 ROBEFtTR PERRY _ 150 GFANDVIEW AVE FORTH . 41 .0,11,11,1111ilm 0 Aindover No.j o is LA o `� dower, Mass. COCMICHEWICK > �® ORATED P'P��,�Gj g �i BOARD OF HEALTH P E n M �TTU D Food/Kitchen Septic System �R(C,� BUILDING INSPECTOR THIS CERTIFIES THAT....... ................................................�I�.............................w .......... ........ Foundation �' � � .. � has permission to est../..�✓�5.... ......:....... buildings on ......... t ..... ....... Rough �� , ��/I�C to be occupied as.... .....3.. ... . ......................... ................................. ................................................................ 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 r lating to the I pection, Alteration and Construction of Buildings in the Town of North Andover. �� � ® P PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMITEXPIRES S I 6 MONTHS Final UNLESS CONSTRUCTIONS AR S ELECTRICAL INSPECTOR Rough �I 1�.�....... ................ Service BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 3385 Date� ../S... . .:... HORTM TOWN OF NORTH ANDOVER rOy`4�,.,0 ,e 1tiOO ,...,. p PERMIT FOR GAS INSTALLATION 4. 9 �SSACNUSEt This certifies that . .5�. :`: ` . . . . . . . I� has permission for gas installation . . . . . . . . . . . . . . in the buildings of . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . North Andover, Mass. Fee. . . . . . . Lic. No..S.gU( . . . . . . �:. `� '''. . . . . . GAS INSPECTOR i WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MAS... W PARCEL. MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO AS FITTING (Type or print) Date (� a !j NORTH ANDOVER,MASSACHUSETTS Building Locations `O `' Permit# J �J Amount$ G Owner s Name << /tel. New Renovation ❑ Replacement ❑ Plans Submitted: ❑ ° � x z p Q x z = O w d >z o Fdwx E. rA � oc a � ° o ow o> o F — 1 G , > a o 1V 1 SUB-BASEM ENT B A S E M ENT I 1ST. FLOOR 2NO. FLOOR 3RD. FLOOR 4TH . FLOOR 5T! . FLOOR 6TH . FLOOR 7TH . FLOOR i STH . FLOOR (Print or type) Ok one: Certificate Installing Company Name ' e` 1/�—40�amu_ 1G zv- Corp. i3 I- (`� U �C�J ❑ Partner. Address � i Business Telephone — �, —n ®'Firm/Co. Name of Licensed Plumber or Gas Fitter e i INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑-- Nor—] ! If you have checked yes,please indicate 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: El of Owner or Owner's Agent Owner ❑ Agent [ 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 MassachuS ate C95tode and C apter 142 of G;nt Laws. 5 By: Signature of Licensed ber Or Gas Fitter Title [ Plumber � 3 City/Town ❑ Gas Fitter License Number Master I APPROVED(OFFICE USE ONLY) ❑ Journeyman NpRTH E Town of over No. q X '- - L CA dower, Mass., ® a cOc Hlc V AORATED O'Pat-`C;� (� S H E V BOARD OF HEALTH PERM T Food/Kitchen V� Septic System o BUILDING INSPECTOR .?A)THIS CERTIFIES THAT.... . C.�a..............�e.0 .... ..l... ..................................... has permission to erect-4.6kV..' .4 buildings o ..... � � at�on R ugh...MY........ Oso ���� �S �� •d Chimney to be occupied as.............. ................. ................................... .... ..................... ............. ............................. y provided that the person accepting this permit shall in every re's e c orm to the term a application on file in Final this office, and to the provisions of the Codes and BY-Law&re t the in pection, Alt and Construction of Buildings in the Town of North Andover. Cl 8 r f O PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Vo s Pef it. Rough PERMIT EV 6 MON Final UNLESS C CTION ST S ELECTRICAL INSPECTOR C Rough . ...... ., . ...................... Service ..... . .. .. . ..... .... . BUILD G INSPECTOR Final Occupancy P 't Re ired 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. GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip- Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girts-solid brick or steel plate bearing at foundations '/3" air space at sides'.in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min.22x3O w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. '/a of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber- Finish Smooth parging, clean joints, 8"solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee-$25.00(Be Ready). Certificate of occupancy required prior to occupying structure. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .yq BUILDING PERMIT NUMBER. © DATE ISSUED: n SIGNATURE: Building Commissioner/I for of Buildings Date SECTION I-SITE-INFORMATION s; O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: u Map Number Parcel Number 1.3 Zoning Information: . 1.4 Property Dimensions: Zoning District Proposed Use Lot„ a s Frontage ft 1.6 BUILDING SETBACKS ft Front Yard _de Yard Rear Yard Required Provide ReqjuLe&Z I Provide& R 'red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infortnatift ML8 Sewerage Disposal System: ,Zone Outs' - a e 0 Munic;y�,� 0 On Site Disposal System ❑ J Public ❑ Private 0 ., �1 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT- 2.1 GENT2.1 Owner of Record Nam ri) Address for ervi Signature Telephone 2.2 Owner of Record: Name Print. Address for Service: •y St nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: ,ae./`?�� O License Number mn Address > 4 Expir ti� o�e Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name m v/ 4�-Gz� �' l /_ f �%d vc<j F-�._. Registration Number r � Address r Expiration Date Signature Telephone v, I SECTION 4-WORKERS COMPENSATION(AG.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....Ate-" No.......❑ SECTION 5 Descri 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:: ,.�/i����r'l��S/�5�/�"�•-t °�� C�c,r>�/7� �" S'�1 �X:_[�'`—��tr ,�': �;�j'�g. y �- SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be@FFICIAL USEAONIY Completed by permit applicant I. Building fe (a) Building PermitFee Uv Multiplier 'F 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC Q 5 Fire Protection 6 Total 1+2+3+4+5 J Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR C N TO APPLIES FOR BUILDING PERMIT I, 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. `I Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, � j G� G� P 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 (A (k- clk6,d s Print. ne . Z- Si attire of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB ST RD SIZE OF FLOOR T.&MERS I 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE do I o 1-4 fl �� L ull 'r r A i f BOB LANDERS CORPORATION 140 Linwood Street Lynn,MA 01905 Tel: 800-310-7744 l Fax: 781477-0604 To: Date: Phone: 17 (Y Patricia Michaels October 28,2002 58 Holly Ridge Rd. N.Andover,MA Email:Ppmichaels@aol.com INSURANCE: LICENSE#033139 REGISTRATION#103138 All work involved within the following proposal is covered by Workmen's Compensation,Public Liability,Property Damage,Products Liability,and Completed Operations Insurance. BEDROOMS: 1: Remove wall areas as needed to expose the framing. 2: Remove the flat ceiling area, carpet and pad. 3: Cut out roof rafters as needed. 4: Install framing for new skylight opening. 5: Install two skylights. 6: Install Ice and Water Shield, flashing, and roofing to the skylight area. 7: Frame the closet with opening for a double door. 8: Frame window seats for areas at new skylight area and existing skylight. 9: Install '/2" blueboard and plaster to the new skylight area, closet and pole and a new smooth flat ceiling blending into the existing plaster. 10: Install face trim and raised panel drawers to both window seats. 11: Install mirrored closet doors with mutting. 12: Install baseboard moldings and casings to match the existing. 13: Clean up all related work debris. PRICE: $8587.00 TO BE SUPPLIED BY OWNER Skylights and Flashing Kit. Electrical HVAC Flooring Painting. PAYMENTS TO BE MADE AS FOLLOWS: Payment Schedule To Be Set Up All work is guaranteed to be as specified. All work to be completed in a professional Authorized manner according to standard practices. Any alterations or deviation from above Signature specifications involving extra cost will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon NOTE:This proposal may be strikes,accident,or delays beyond our control. withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSALThe above prices specifications and conditions are satisfactory and are here by accepted. You are authorized to do the work as ecified. Pa ent is out lined above. SIGNATURE: SIGNATURE: *-%N M4,� CX N J+ T y MEM■BER • � Y BOB LANDERS CORPORATION 140 Linwood Street • Lynn, MA 01905 Tel: 800-310-7744 Fax: 781-477-0604 To: Date: Phone: Patricia Michaels October 24,2002 58 Holly Ridge Rd. N.Andover,MA Email: INSURANCE: LICENSE#033139 REGISTRATION#103138 All work involved within the following proposal is covered by Workmen's Compensation,Public Liability,Property Damage,Products Liability,and Completed Operations Insurance. BEDROOMS: 1: Remove wall areas as needed to expose the framing. 2: Remove the flat ceiling area, carpet and pad. 3: Cut out roof rafters as needed. 4: Install framing for new skylight opening. 5: Install two skylights. 6: Install Ice and Water Shield, flashing, and roofing to the skylight area. 7: Frame the closet with opening for a double door. 8: Frame window seats for areas at new skylight area and existing skylight. 9: Install 1/2"blueboard and plaster to the new skylight area, closet and pole and a new smooth flat ceiling blending into the existing plaster. 10: Install face trim and raised panel drawers to both window seats. 11: Install mirrored closet doors with mutting. 12: Install baseboard moldings and casings to match the existing. 13: Clean up all related work debris. PRICE: $8587.00 PAYMENTS TO BE MADE AS FOLLOWS: Payment Schedule To Be Set Up All work is guaranteed to be as specified. All work to be completed in a professional Authorized manner according to standard practices. Any alterations or deviation from above Signature specifications involving extra cost will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon NOTE:This proposal may be strikes,accident,or delays beyond our control. withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSALThe above prices specifications and conditions are satisfactory and are here by accepted_ You are authorized to do the work as cified. Pa ent is out lined above. .,. pStgRN z¢ csd N K Y a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 S�1b Workers'Compensation Insurance Affidavit Name Please Print Name: �A-r-/ C I jr APJ (C/r el Location City /�J ����► �-e� Phone # �: �:1�� .< .j fi F-1 I am 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 Address -.�-1� �7� 6 ;) City: < (-)---�- Phone# '77d Insurance.Co. ��: Q,, ¢r �'��crr-�d� Policv# rr�C c) I Company name: Address City Phone#: Insurance Co Policv# 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$1,510.00 and/or one years'imprisonment_asyell_as_civil.penaltiesin.-thelmnd a STOP W-ORK.ORDER..and..afine_of_(.$1DOM)-a lay.againstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. y do hereby certify underth�s and penalties of perjury that the information provided above is true and correct. Signature 4 Date Print name // ` tel r - (, ,�� ^�,( Qrr P_hone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required Licensing Board p Selectman's Office Contact person: Phone#. ❑ Health Department El Other . , North Andover Building Department t Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant • Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I oll e 77 � `' •+�1/I/111111. o_ 7116 fc NORTH Town ofE Andover 0 No. aoq o ALA � dover, Mass., -CUA WOE •Z p co .1c �•9 ORATED P9aL .1 S H E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ' THIS CERTIFIES THAT.... a. /C .............. ......x? i .... BUILDING INSPECTOR s ................................................. Foundation .. .... has permission to erect............�/� �^ #�l a 4�!� ..k4W.Sbui1%ngs on .....�J...8..... ....�.......... Rough to be occupied as....f..C�OS �IV.._f � P. �_�M� � •0 N1 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 In pection, Alteration and Construction of Buildings in the Town of North Andover. 0/ 848 /9040 �0 mom PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough .. Service BUILD G 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 a Street No. SEE REVERSE SIDE smoke Det. Date. '.Z. Y. .`1. . . . . - pf NORTM .gH of ° TOWN OF NORTH ANDOVER _ � p • PERMIT FOR GAS INSTALLATION SACH h h This certifies that . . . / `!. /` !?,!?f:.. . . . . . . . . . . . . . . . has permission for gas installation . . . �. . a ?n _ . . . . . in the buildings of . ..}. . 4�.� .... . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. ..� . .`. Lic. No.l f,-C ,-. �.c .. . . . . .. . . . �LS INSPECTOR�• _ Check# f 4861 NIASSACHUSETTS UNIFORMAW11C FOR FERNIlTTODO GAS FIYHNG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS / y� Building Locations s—(U /F 1 `r� "" Permit# Amount$ '?j Owner's Name P 7 .M / ( 1-1 �,. New❑ RenovationEl Replacement n Plans Submitted w � � U a >, AQ � 1-4x o w H a z o o z w o w a � a z pa� U v� P4 o q z F Z F+ o O W O A. F10 1 C+'. U 04 SUB -BASEM ENT BASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6 T H . F L O O R 7 T H . F L O O R 8TH . FLOOR P or f —pe) � � ✓ _����� �� Check one: Certificate Installing Company� me- prp- Address , s�� !'✓ y�� � " Partner. 04 j? Business e p one Cj 27 7-717 76-777 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 ys,please indicate the type coverage by checking the appropriate box. Liability insurance.policy Eq. Other type of indemnity D 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 ❑ thereby certify that all of the details and information I have sub 'tted(or entered)in above application are tri and accurate to the best of my knowledge and that all plumbing work and installat' n performed under,. ermit Issued for this p kation w' be in compliance with all pertinent provisions of the Massachuse a e as n Chapte '142 f the G a awLL s. Signature of Licensed Plumber Or Gas Fitter By. Title Plumber -- City/Town ❑ Gas Fitter License Numoer ❑ Master APPROVED(OFFICE USE ONLY) ^^ Journeyman Date. .C/-:? . N°pTM TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION • p9 �i �,SSACHU$ - This certifies that . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . .0-'.t'/. . . . . . . . . . . . . . . . . . . in the buildings of . . . . . .G. .!"' Cf at 5:-r. . . . . . ., North Andover, Mass. Fee. Lic. No.2. 3e 6 ii . . . . . . . . . . . . . . . . . .�.. . !_. .:f�c.,�T ....; . . . . . GASINSPECTOR Check# `fy 4866 MASSACHUSETTS UNIFORM APPLIC TO R PERMIT TO DO GAS9FrrrING (Type or print) Date I T-0 y NORTH ANDOVER,MASSACHUSETTS t/ Building Locations SP Aav ^ ' Permit# T � 1 � Amount$ e)J 2 f Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ w U via W a O g x F o x a H H z X F a z pP F4 � x z -< o H ° o oogw � A a F• o 1 SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND . F L O O R 3 RD . F L O O R 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Check one: Certificate Installing Company Name 1�� 1A L 13--C-orp. ssex s f /2v Address ��G ❑ Partner. Business Telephone / + 6S'= s`y'ibQ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter O.rt �i SS Q INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes,please indicate 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 ❑ Agent ❑ i hereby certify that all of the details and information I have submitted(or tered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pe ed and ermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State s Code Cha to he General Laws. igna re of Lice ed Plumber Or Gas Fitter By. ❑ Title - Plumber �C /l S' City/Town ❑ Gas Fitter License Nurrioer ❑ Master APPROVED(OFFICE USE ONLY) M-KI'meyman