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HomeMy WebLinkAboutMiscellaneous - 63 MARTIN AVENUE 4/30/2018 63 MARTIN AVENUE 210/045.G-0007-0000.0 Date. � z.. ..... . NORTH °Ft�.ao 3? TOWN OF NORTH ANDOVER O � 9 • PERMIT FOR GAS_INSTALLATION SAC MusEt� This certifies that . . . . . . . . . . . . . . . . . ' has permission for gas installation ... . . . .��. . . . . . . . . . 1 in the buildings of . ! ! .�' !I��.. . . . . . . . . . . . . . . . at . . . l v4 . . . . . . . ., /North over, vt�ass. Fee 37x5. . Lic. No..2J�'� /7!ChG•;c. r" ,�I. . . . GAS INSPECTOR Check# 2 7- 8086 8086 w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY � J MA. DATE PERMIT# JOBSITE ADDRESS OWNER'S NAME GOWNER ADDRESS: TEL: = FAX 7-71 TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL�] PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO'z] FIXUTRES 1 FLOOR- Bsmt 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER + ROOM/SPACE HEATER r ROOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER �1 E INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ] NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY © OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:l am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERIGASFITTER NAME: Peter J . Cranes LICENSE# 21805 SI�URE COMPANY NAMEJ Crane's Plumbing & Heating ADDRESS: 70 Douglas Street CITY: I Haverhill STATE: 11A ZIP: 01830 FAX TEL: 1 978.771.1155 CELL: 978.771.115 EMAIL: annacrane.ac@verizon.net MASTER❑ JOUR EYMAN® INSTALLER❑ CORPORATION❑#=PARTNERSHIP❑#®LLC❑#0 A ,a The Commonwealth of Massachusetts Department of Industrial Accidents Z Office of Investigations d 600 Washington Street W= Boston,MA 02111 ,. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A Please Print Tie ibl Name.(Business/Organizatiordlndividual): Address: City/State/Zip: a6 ��� 1y�2 Phone.#: Are you an employer?Check the appropriate box: T e of ro ect re uired 1.F-1I am a employer with ` ; 4. E] I am a general contractor and I Yp J ( q ) employees(full and/or part-time)-.* have hired the sub-contractors 6. ❑New construction 2.M 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. employees and have workers' comp. insurance.$ 9. F]Building addition [No workers'comp.insurance P• ' 5. We are a corporation 10, Electrical repairs or additions on and its bons required.] ❑ � ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.El Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do 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 cityor 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined 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 a 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-contractor(s)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 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,not the 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 number listed 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 burn 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: The Comunonwealth of MassaQhusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext.406 or 1-877-MASSAFE Fax#617-727-7749 Revised 1122-06 w.mass.gov/dia &ORTH - - pf �.ro ,•1tiO TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION y,SSACHUSES This certifies that . .,f#. p. ` ` !. .. ` . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . r . . . . . . . . . . . . . . . . . . . in the\buildings of . .,,�.!/?. Lr.c A II H./. . . . . . . . . . . . . . . . . . . . . at . . .\ . .,�'�IfA ! s. - , North Andover, Mass. 1 Fee.& L-. Lic. No..2 �R'1.7. \v?�` ... . . . . . . . GAS INSPECTOR Check# G 6409 MASSACHUSETTS UNU ORM APPUCAT'ON FOR PERMIT TO DO GAS FITTING (Type or print) Date C� NORTH ANDOVER, MASSACHUSETTS Building Locations Permit# 6 d AZ lore! re a f �o� �7��J� Amount$ LG � � �J Owner's Name New D Renovation Replacement ® Plans Submitted U O U z O W F F• Z ZF � w � w � o � a O w H eF a d H z F z x w w GW7 °G w u y x ¢z w > m x F d ti z O F C O O x ti 3 Aa 0 r01 > A o0. cW., G i SUB-BASEMENT BASEM ENT 1ST. FLOOR r 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . F L 0 0 R 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Check one: Certificate Installing Company Name__ N4 eL)M P3 "A) Corp. Address P ® (3 Partner. Business Telephone Firm/Co. Name of Licensed Plumber'or Gas Fitter 7,-,ft? INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes 0 No� If you have checked Les,please indicate the type coverage by checking® theappropriate box. 13Liability 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 1 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 States Gas Code and Cha ter 142 of the General Laws. f� By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber a 1711?3 3 City/Town. Gas Fitter License um er Master _ APPROVED(OFFICE USE ONLY) ® Journeyman Date ?' . 1e- : NOR71y t •��o TOWN OFORTH ANDOVER o � PER T FOR PLUMBING U SSACNUS� t/ This certifies that . . . �.e- e/6 L . . �. .7;... . . . . . . . has permission to perform . . . .w . . . . . . . . . . . . . . . . plumbing in the buildings of . . . �: .�!. . . . : . . . . . . . . . . . . at. 3 ? !` . �'!.` -� . . . . .. North Andover, Mass. �.jam. Fee. G. . . . . .L.ic. No.: . Y 3 . . . . . . PLUMBING INSPECTOR Check # - 7718 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location i J / i f6 %%t/ lfd'e Owners Name ��a�/`1 Y'i rz('4 -VsPermit Amount Ec Type of Occupancy D j C-(11',U dq,- Or New Renovation Replacement ® Plans Submitted Yes No a FIXTURES rAF Gn W A F P c.TgggVIC BASRW SII' r ]ST EUM M KDR 3MRaR 41H ROM SIB FUM 61 R001t 71H KDCR 91H HDD (Print or type) Check one: Certificate Installing Company Name 114//-0/Po9!✓ �l fl M���✓� Corp. Address S`71 11 M i4rl Partner.' .�.� Business Telephone g S--- 14 J`ej f E] Firm/Co. Name of Licensed Plumber. 7f%11d/d J Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy a Other type of indemnity ❑ Bond ❑ Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent 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 Plumbing Code and Chapter 142 of the General Laws. By: 'Signature of Licenseaum er Type of Plumbing License Title & Y 3 City/Town icense Numoer Master Journeyman APPROVED(OFFICE USE ONLY Date.... ............................. LORTN -0iL TOWN OF NORTH ANDOVER 0 " 0 PERMIT FOR WIRING --row- SACHUS This certifies that ...... ........ .......... 77) has permission to perform ........s,��A&4E....9�.5"--,e.AaW wiring in the building of................/L./ ........................................... at...... R9Vf.I-I.Ye:......4,OPr.......................North Andover,Mass. 00 Fee.f�F........... Lic.NoAnv.;Y-57..................f-:, . . .. ELECAICAL INSPECTOR Check q 7540 r.� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 75zle Occupancy and Fee Checked 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 IN INK OR TYPE ALL INFORMATION) Date: 7A'36107 07 City or Town of: NORTH ANDOVER To the Inspector 4Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) C3 /)1g4,),i AV Owner or Tenant _ So✓7e AJO vo,,< Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead PT 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: 1'1'70 $17a O V er /_--��rt•�P Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and TotInitiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons K No.of Self-Coinntaed Totals: ...._ __ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent KW Data Wiring: Heaters Si ns Ballasts No.of Dvices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring. No.of Devices or E uivalent 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: 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 pain and pe allies of er•ury,tha the information on this application is true and complete. FIRM NAME: �✓� , LIC.NO..4 c-�G5_ Licensee: Signature LIC.NO.;�yO � (If applicable,enter "ex nit"in tl license number line.) Bus.Tel. No.r17 - l"70 y Address: _/_ f','✓ '!5T � d��j /1/// 0307 Alt.Tel. No.: *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: $ i rl The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeQ>tbly Name(Business/(lganizahon/Individual): 4:J Address: -7— City/State/Zip: ,-����,� /�/ phone.#: ��• 6-c) Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. ❑ I am a general contractor and IF[] ect(required);. employees(full and/or part-time).+ have hired the sub-contractorsNewonstruction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. delingship and have no employees These sub-contractors havelition working for me in any capacity. employees and have workers'[No workers'comp,insurance comp,insurance.t ng addition 3.❑ required.] 5. We are a corporation and its cal repairs or additions I am a homeowner doing all work officers have exercised their � 11.0 Plumbing repairs or additions myself [No workers comp. right of exemption per MGL i insurance required.]t C. 152,§1(4),and we have no 12.❑Roof repairs 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 in they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheat showing the name of the sub-=tractors and state employees. If the subcontractors have employees,they must provide their workers comp,policy number. whether or not those entities have 't lam an employer that is providing workers'compensation insurance information. for m y employees Below Ls the policy and job site Insurance Company Name: O Policy#or Self-ins.Lic.#: y g 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 ofMGL 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 i Investi ations of the DIA for insuran a covers a verification. I do hereby certify under the pains and penalties of perjury tl he information provided above, trueand correct. Si slur Date Phone#; — F6�..O.ther only. Do not write in this area,to be completed by city or town offlclaL n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector on: Phone#: Location A ( A) a No. Date 1 b— a ct-U 3 "ORTM TOWN OF NORTH ANDOVER � A Certificate of Occupancy $ Building/Frame 9/Frame Permit Fee $ b U— s�cHust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 4D Check # `(' 16844M A C`.� " Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIE,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING V ff 7 t a �� rra BUILDING PERMIT NUMBER: DATE ISSUED: 0^oho?07, SIGNATURE: C Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number �J 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Area(so Fronto 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'redProvided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone. Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No rn Owner of Record L Name(Print) Address for Service: �� ) (�$S Sli Z Signature Telephone Q 2.20wner of Record: Oy Name Print Address for Service: z M Signature Telephone M SECTION 3-CONSTRUCTION SERVICES R� 34 Licensed Construction Supervisor: Not Applicable ❑ ` Q Licensed Construction Supervisor: �n ! ! / y O 2�-j G--^- S+ License Number mn vt_ Address S Expiration Date ic a_ Signature Telephone r 3.2 Registered Home Improvement ContractorNot Applicable ❑ dompany Name G) m VZ SCA' �C� 1 ���V _,� Registration Number r Iv r Addr i Gy 4C r \ l � ` Expiration Date r Signature-- --- • • Telephone �+, SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Pro osed Work check all a ncabte New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 1 Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify no Dcscn tion of Proposed Work: Crux SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit a licant �� . 1. Building O Cab (a) Building Permit Fee Multiplier 2 Electrical (o (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC G<� 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owne/Authorized Agent f 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 Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT SIZE OF FLOOR TIMBERS 2� 1 2 1 2 (2-1 0c, 3RD SPAN DIMENSIONS OF SILLS 7- to R} DIMENSIONS OF POSTS p� DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION ° THICKNESS SIZE OF FOOTING ,o4 1_0 X MATERIAL OF CHIMNEY N A IS BUILDING ON SOLID OR FILLED LAND p\, IS BUILDING CONNECTED TO NATURAL GAS LINE ( i �o(Ox E Ti Gi iv lD 4 i'� FORM U'- LOT RELEASE FORM . INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fry Boards and Departments having jurisdiction have been obtained. This does not retie, the applicant and/or landowner from compliance with any applicable or requirernents * '*************************APPLICANT FILLS OUT THIS SECTION***** �**--- Co �4 -ate q7 . . �z APPLICANT U4A* � PHONE (a`�S-3��� CQ71) LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT_(S) STREET0 ST. NU , ** *OFFICIAL USE RE MMENDAT10W OF TOWN AGENTS: ---------------- C NSERVATION ADMI ATOR DATE APPROVED DATE REJECTED :t COMMENTS TOWN PLANNER DATE APPROVED DATE REJECT ED COMMENTS ------------ FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVE. DATE REJECTED COMMENTS IIBLIC WORKS SEWER/WATER CONNECTIONS DRIVEWAY PERMIT RE DEPARTMENT CEIVED BY BUILDING INSPECTOR DATE_ ✓ised 9W jm t� 4 'n r; 4 Y � \v oa o fig± 4 63 I i ' BUYER: Fitzgibbons, Lita MORTGAGE INSPECTION PLAN LOCATED 111 10 111E PI/UI Lrt 1A -T�,, I�OZI-0 A d DOVE� ACID ITS 1111E BISURERS. I,CERIIFY THAT i IIAVE EXAMIIIED 111E PREMISES AIIII 111E IIIIIIUIII(m SIIUKiI m) ( MASSACNUSETrS C0111`/11M IU 'IIIE 201!1110 LAWS AND AMEIIDLIEIIIS, i.• FRUITY, SIDE, d: BEAR YARD SEiDACK 0!!LY.OF NG2Z-{ I /SP�L�c�l�G� T41!E!1 COI1S, !?UCIE!?. I,fURI11ER CEIIIIFY MAT TINS PROPEIIIY IS NOT I.UCAIEU III 111E ESIADIISIU) ILUUI) IIAIARU AREA UEI.0 ZOO oma}8-OO�oSf3 (c-I S-�3 uuulc EXAMPIA11011 OF 111E RECORDS IS MADE,OIILY SUUSEQ11E111 10 111E IiE(:UIlU1U llAlf. 11F 111E LATEST OEM AIIU OKS HOT IIICI.IIUE YERIF'11110 111E ACCIIIIACY UI' 111E UELU DEIE Of!III I PACE PREVIOUS 1O ITS DATE OF IIECDIIU. TINS CONPAIIY IS NOT RESPOIISIIIIE FOR AIIY IIIUERIURES MADE SUUSEQUEM. 10 111E RECORDED !.till. IED. DATE Of 111E LAIEST DEED OF RECORD, "IEIIEVER 8111100I0S ARE SIIOWII LESS 111A11 OIIE FOOT FROM 111E PROPERTY 1111E,IT IS ADVISED I'I-AII IIK- PACE IIIAT A MORE PREC35C SURVEY BE MADE TO VERIFY 1IIESE 11EASUREl1E111S. JIVIE; ITAII l ~�`y) DAIED 11NS CERTITICAIIOII IS BASE 011 111E LOCATION OF SURVEY MARKERSOF OIIIERS, AIIU DOES TWT REPRISEAPP—IL 1E,IIT A PROPERTY SURVEY, 1111S CERIIFICAT1011 TO BE USED FOR MORTGAGE PURPOSES 0111.Y. . 19 SCAIE: I*- ?jp� AS E HOT TO BE USED FORFT IESESTAOUSI I BENT oi.,PROPERTY LIIIES BRADFORD 1'NGINEERING CO. P.O. BOX 1244 11AVO TILL MA. 01031 R.I:S:,�103p7 i lEL (506) 313-4396 r a, t ,�$ ll2( [O�Irdflt49LtT l�1t 'I"Aajwd"4e&r' BOAR®OF BUILDING REGLiLAT1OtdS License: CONSTRUCTION SUPERVISOR Number: CS 071946 ~ i Birthd te: 02/0411970 Expires-OVO4/2004 Tr.no: 20807 — Restricted: 00 RALPH A RIZZO ..-� LAWRENCE, MA 01843 . Administrator t T t3oard of Building fieaulaUous gncl Still)"es z 3 HOME IMPROVEMENT CON!RACTOR Regi: tfatlon: •126059, Exolration: 413104' • #1 . Type. Individual Y . ttlkl-PH A.RIZZO r;ALPH RIZZO I.A`NRENCE,MA01843.` t :,�i5tratfrr PATRONS MUTUAL INSURANCE COMPANY OF CONNECTICUT h4C�T ..... GLASTONBURY, CONNECTICUT — -:-' --:- ARTISAN CONTRACTORS POLICY DECLARATIONS — —- Policy Number: CTR0003893 NEW Effective date: 06/12/03 NANIED INSURED AGENT 8640 _.. .. RALPH RIZZO T A SULLIVAN INSURANCE AGCY, INC 14 VERNON ST 369 MERRIMACK ST BRADFORD, MA 01835 METHUEN, MA 01844 (978)681-8200 Policy Period: from 06/12/03 to 06/12/04 12:01 a.m. Standard Time at vour mailing address shown above. Insured is: INDIVIDUAL Business Classification: CARPENTRY- RESIDENTIAL Code: 10030 ::LIABILITY:COVERAGE COVERAGES LIMITS OF INSURANCE L. Bodily Injury and Property_ Damage Liability $1,000,000 Per Occurrence $2,000,000 Aggregate M. Medical Payments $5,000 Per Person N. Products/Completed Work $1,000,000 Per Occurrence $2,000,000 Aggregate 0. Fire Legal Liability $50,000 Per Occurrence P. Personal and Advertising Injury Liability $1,000,000 Per Occurrence .. PROPERTY COVERAGE DESCRIPTION AND LOCATION OF PROPERTY Loc. 1: 14 VERNON ST BRADFORD, MA 01835 COVERAGES LIMITS OF INSURANCE Loc. # Building# Limit ACV A. Building I B. Business Personal Property 1 1 $2,500 C. Loss of Income ACTUAL LOSS SUSTAINED, NOT TO EXCEED 12 MONTHS. WAITING PERIOD: 72 HOURS Increased Property Off Premises: Automatic Increase— Coverages A& B: 0% ANNUALLY Property Deductible: $250 SUB;IECT TO TIDE FOLLOWING FORNIS AND ENDORSEMENTS AP-100 Ed. 2.0 AP 0611 01 99 AP 0643 12 99 AP-432 Ed. 2.0 GL-895 Ed. 2.0 AP 0700 12 02 .: . . . ..... .. PR IVIIUM AND BILLING INFORMATION..; ANNUAL POLICY PREMIUM: $493 $450 Minimum Earned Premium Regardless of Term ENDORSEMENT PREMIUM: BILL TO: Direct Bill To The Insured TERRORISM PREMIUM: $11 .. 1VIORT(TAGEES PRINTED: 06/17/03 INSURED COPY THIS IS NOT A BILL ' ZZO '.Rdc ec ac age �e era or i Grace Report,j Vatkagc Generator A City: tl<AvQ1t--o•w :'.Massachusetts Construction Type: Single Family Heating System Type: Other (Non-Electric Resistance) Code: Massachusetts Energy Code HDD: 6322 Builder Name !rizzo building Date jj11.o103 Builder Address 14 vernon street bradford mass Building Address 1. 1;4_�5 f' A'12�C-►r� U N' Ah?�°�1Et2 .Submitted By Iralph a rizzo Phone Number 978-375-0758 PROPOSED REQUIRED Glazing Area C Glazing Area Up 10.0% To 10.0 % Maximum • 100 F-0 _ FGl6 __ r�,Lk'l% Glazing Area Calculate Value X Glazing Gross Wall Proposed Area Area Glazing Area R-Value I' Description Comments Proposed R-Value Minimum R- Value Ceiling 12x8 R-130.0 R-30.0 Wall Cavity 12x6 R-1010 R-1,9 '0 Wall Continuous j2x4 R-0.0 R-0.0 Floor 12x12 R-130.0 R-30.0 U-Factor lj�' Description Comments -Proposed U-Factor Maximum U- Factor Window jail vinyl exterior U-10.35 U-0.35 Door IFront door exempt U-0.35 U-0.35 Statement of Compliance:The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. h //bld code. nl. ov/REScheckP /10/2003 ttP� g P g � � 9 r Y 1 Phone (978)374-2464 Fax (978) 683-5894 i �A NE 1 -_a -Mil , ,xv, _ �. f R• UILDL-fl" . . ..... t Ax tam l�i-,v ` , r ii , t gi�p:-- �� .,• �, � ���,` , .aati,tibov 'rx..�saa»,:.:.a ,r..:A�� �.. . 'hone (978) 374-2464 €�� �7 ) 683-5894 -...- RJZZO. UILD1V1 �' R ' OD......... E' ca lit r__j MUM— Y • � i t � 1 �— a clp d ee 1 i..... ..... -__---- .-......,r� ti I .i�..Li' ax .�• F r { � 9 Y R-� J ' y�'Tf f Kar - m i to - -.+.-.--..-++m.�Y.....+r k::.a�.-..-,.-y ....«_b",w.c,«'.-.x.,ai-�...�� kr�_c. .rz v ,1. -*!. .,i2tr C.-d�•:Az.r3 '�irz .s. -A- ILI, x tN Et -.1 au I.)D --- ' N 9 r,\ v Q a , e . 'Y Fax (978} 683-5894 Phone (978) 374-2464 U/?e�4 217'VIVO r oy i j� O AMA RUZZO, B, ILINNE t� tv �1 � �-.3��+++...l..r•..•-.au..>w.Yaiu+"eimcyPK":c'taa. si.R-naa.f:f±+Y9�r-r+H4WIW:bi?�^.vn--:i.--�Y - � "'^�•'*� (f/�, .... ..<...e�.u.�w�4/+��wn®-- ie 4 a-rYaiN�i�y,�.++cxsi•.'+ycr+wFe+r -!+'virl'a8ays.'.Jrz F✓ -.�• _ b'.4'sany4'rtel.Y.t�/nlrr:-'�yeaY.i4+r,rt:e':vamiY�-.Ti�m.��W`A+._..:t :.. - E •gyp/ `� ..(� / r a -K' e-Z3 .- P uXIU� _ ,• �.� Y s� . .asvb-.rt':.ii. �� ` _ 1 N `U ,r, ENQu t n ' DI ID 'Out ........ . . .... r 07 'of A-PIG 0(1 qo4 19, 77, r �� VA f I/ ome Id f .z J.w.'f5 oicw.0 l-m wr Phone (978) 374-2464 Fax (9718) 683-5894 �� 4 BUILDINIa U.MODELINEi V\ Estimate to construct 20x18 addition Lita fitzgibbons N.Andover Ma Remove existing deck on rear of home to be reinstalled again.Excavate area on back of home to receive new four-foot frost wall foundation.Pour new floor in foundation for basement floor additional room. Construct new two-story family room on foundation.Walls to be 2x4 studs 1/2"pine sheathing on exterior. Floor joists to be 2x10 pine 12' on center with 3/4't/g plywood for sub floor.Headers for windows to be 2x8 doubles with plywood.Roof to be 2x10 rafters with%x"cdx plywood for sheathing.Ceiling to be cathedral for second floor and flat for the basement.Cut hole in existing foundation to allow access from basement to new addition.t on.Faces boards and soffit to match existing home.Electrician to wire upper and lower addition to code specs.Plumber to extend the heating on upper and lower rooms to conform to room size.Providing the current unit can handle the extra output.Roof the new addition to match the existing roof with 30yr iko three tab shingles with ice and water shield on the first three feet.Drip edge to be installed on rakes.Install new insulation to the correct r-values through out addition.Install windows for addition approx.five and one slider(the existing one in home will be reused).Install new vinyl siding on exterior of addition,color to be picked by homeowner from samples provided by Rizzo's.Install needed corner boards for siding as well as new vinyl soffit to allow roof to breathe.Install blueboard through out addition to be plastered. Finish will be customer's decision.All moldings and finish work to match existing home.Frame in new closet in basement blue board and plaster.Install new doors for the closets and basement entry.Install new hardwood flooring on upper floor to tigh into old floor. The allowance for the new floor will be 5 dollars per square foot for material.The deck will be re-installed on the left side of addition.New footings will be dug to support relocation of deck girder.New stairs will be constructed to conform to new deck placement. The stairs will be constructed from pressure treated lumber.And the railings will match the old. Entire home will be stripped of its old siding and new vinyl will be installed.Customer will select corner boards, All rake boards and facia to covered with aluminum.Rizzo's will be responsible for all permits and needed drawings to complete job providing nothing needs to be engineered. <� �W— �- Responsibility of customer kle,w•.2 W +L-� f faZ '� P kPC I. painting or staining LO 14K ac r1�tb a�, l 2, windows/purchase 3. finish flooring for the lower level 4. Any work asked to be performed not in this estimate labor/material Rizzo's does not book work on OK's just on signed contracts,we like to stay on schedule for you an our other customers,so please contact us as quick as possible if you decide to do the work,we do book up weeks to months in advance thank you Total cost to do job mentioned forty six thousand eight hundred $ 46,800.00 Payments will be 10%upon agreement(refundable for any reason on the day work would have started) ea Additional 20%upon installation of foundation -- ��.�-j Additional 20%when addition is framed Additional 20%roofed sided 41$� Remaining balance on completion of job - ----- --------- -------- Ralph A Rizzo Homeo er } ...�'�'h ck Phone `(9.78);374=2464 °=Fax (978)-683M94 Y y ' - �'n'i.:.•.•.'-..- -...-.;..'4_ - t,,,.,,'.',3'„t. 4.t ���--s �-�<:: 'y,,.w��'.'K„"`�,�`,„��wt__y�1�„_.,.�r U"�.t-a�*« mr�{' t�'� ,a'f-�` t .rw# .-, w k�, y ;, -,Y' � J'� '� NORTH E ®ver Town of � 4 {� 0 No. a 8 -1M., _.'7 O o dover, Mass., T �� S P R 2 COC MICR WIC �t %pADRATED PP -`I S 4 BOARD OF HEALTH PERMIT .T D Food/Kitchen Septic System / L L BUILDING INSPECTOR THIS CERTIFIES THAT......../ ./.../...d.......... .................................................................... Foundation has permission to erect.......��!.....ya. ...... buildings on ...` 3tVA IQ IYA .... ..... V t c /� _/ ................... Rough &.4r ....... . .r...../`! f • ~....................................................................... .. .. Chimney to be occupied as.... ........ `� t..... I.... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes andB -Laws relating to the Ins ction, Alteration and Construction of Buildings in the Town of North Andover. ,ISG *7 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. T Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR � Rough ..........:...... Service 40 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.