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Home My WebLink AboutMiscellaneous - 691 GREAT POND ROAD 4/30/2018 �--- 691 GREAT POND ROAD 210/063.0-0018-0000.0 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Oniv 18001392-6108,FAX(800)851-8424 3/3/2015 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.36 NORTH ANDOVER HEALTH DEPT. i NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: RADU PASOVSCHI&JULIE ROGOWSKI Property Address: 691 GREAT POND ROAD,NORTH ANDOVER, MA 01845 olicy Number: 1244413 Type Loss: Ice Dams Date of Loss: 03/02/2015 Claim Number: 332934 Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location, policy number,date of loss and claim or file number. MPIUA Claims Division CMA00021 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings North Andover, MA 01845 RE: Insured: Radu Pasovschi and Julie Rogowski Property Address: 691 Great Pond Road Policy Number: ZS8943 Date/Cause of Loss: 1/25/2005, Frozen Pipes Burst File or Claim Number: 14461-C Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Chris Town On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Signature and Date ANDERSON ADJUSTMENT CO., INC. 54 Stiles Road, C-106 Salem, NH 03079 R.ECOJED APR 2 2 2005 BUILDING DEPT. Location No. Date NORTH TOWN OF NORTH ANDOVER i Certificate of Occupancy $ ''�sfo•"'•Et� Building/Frame Permit Fee $ 4C Mus Foundation Permit Fee $ Other Permit Fee $ • TOTAL $ Check # � 17470 -Buildin, `g Inspec a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: f! M d- 0 SIGNATURE: Building Commissioner for of Buildings Date acs e SECTION 1-SITE INFORMATION_,,_ 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 62q I Crea4 P n tOc�! j 06-3 /00/00 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use I Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft ! Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water SupplyM.GL.C.40. 54). 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ _! SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT r 2.Alner of Record ?, j 4/ a SCS V'il) (/J �Cf �r�C� AQ� Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licetsed Construction Supervisor: License Number mn Address Expiration Date Signature Telephone 3.2 Registered c me Improvemen. ntractor Not Applicable ❑ Com pan Name bjO/�De(�j egistration Number Address Expiration Date Si nature Telephone r 7 SECTION 4-WORKERS COMPENSATION(M.G.L• C 152 § 25c(6) Workers Compensation Insurance affi it must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the i ih rmit. . Signed affidavit Attached Yes..(...0 N .......0 SECTION 5 Description of Pro sed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alteration ) ❑ Addition ❑ I Accessory Bldg. ❑ Demolition ❑ Other P Specify A � N Brief tion of Proposed Work: �. •e�idU - 1)2 e111 126L. S G Gv SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be -77 OFFICIAL USE,Q Y ;; Completed b ernut a lican 1. Building /� (a) Building Permit Fee C1 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC 5 Fire Protection j OCA 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUnDING PERMIT 4 1, as Owner/Authorized Agent of subject property , Hereby authorize to act on My behalf,in all matter relative to work authorized b this building permit application. Signature of Owner Date SECTI N 7b OWNFWAUTHORIZED AGEN DEC TION 1, / ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the regoing application are true and accurate,to the best of my knowledge anZf� JJJ f Print Name Si afore wner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS OT 2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvWEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 9w Boston, Mass. 02111 Workers'Compensation.lnsurance Affidavit Name Please Print Name: Location: V l Pal) City l L12M Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one worldng in any capacity, I am an employer ro�riding workers'compensation for rry employees working on this job. Com name: A '7— /? Address. y / G7G�JlQ . citz, o/ Ol�a`7 3�- Z�7 Insurance Co. 1 C GUC 99 1 verlPoli # Pr rC�t f-/z P"'e CornpM name: A�cfdreas . ph ne-k Insurance.Co. Policy# Failure to secure coverage as required:under seebon 25A or MGL 1512 cart lead to'the k posh m of« p of a�fine upr to.s and/or one Years'Wgxbonment-as weR.as�ngi peoaC�.s�lheSarm�ofss$JS understand that a copy of this statement maybe forwarded to the Ofria:e of Investigations cf the t3tAfor � e mon. /cin hereby cerffY wonderpem�ofIeJLNX hWbho intarmaffmpriovided above is&w anal cw Signature G Bate � G Print name tel. P1uinE — � aG7 Offidat use only do not write in this to be conby city or town dficiar Gdy or Town - � Btrr7c:linc� 1 ®Check if immediate response is requked LimndhgQ Contact person: Phone# Selechmr, El Health Del E] Other i North Andover Building Department 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 willbedisposed of in: I (Location of Facility) Signature of Permit Applicant 7/ Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector '.. AT-HOME installed SERVICES Siding and Windows To Whom It May Concern: f i l- I hereby authorize Bunmeun Chhouy to secure permits on my t ehalf under HRC Registration number 126893. Sincerely, C' Michael Bedard Wj% =dsmma�now —mw CONT1110cmnn 126M Type: Supplement Card r Home Depot ANiome SeNces MICHAEL BEDARD j 3200 COBB GALLERIA PKWY M ALTANTA,GA 30339 Admialdrator License or reglad atlon vatld for lndividul use only before the exPkmtlon date. 1f found return to: Board of Buildiug Regulat ons and Standards One Ashburba Place Rm 1301 Boston,Ma.02108 &NotvaWwimoat r Proudly sold,furnished and installed by RMA Depot authorized contractor. 345 Greenwood St. Unit 2•Worcester,MA 01607•508-756-6686 Fax 508-756-2859•Toll Free - 800 657-5182 11-11 mill low• cXliTsieaiERwREA �-. --;}•�- ATL-00091030T�1 PRODUCER - 1N0 CER TtICATE IA ISRI(D AS A WRITER OF MFQRATION DAY MD COMFERS • MARSH USA INC. RO RR1NT!U►oF THE enwirms NOLDER OTNER TNM TNompA01110m Y TME ATTN-BRENDA BOOKER POLICY.MY GERTIFICAIE DOE!ROT ANESo,EXTEND OR ALTLI INC COYERAOE 3475 PIEDMONT ROAD,N E. AFFORDED M THE POLTCIESDESCIIIMEO NEREDI. (404)9952594 OFFICE (404 760.5766 FAX COMPANIES AFFORDING COVERAGE ATL TA30305 CC AIn 100492-MASTR-RMA. RMA A STEADFAST INSURANCE COMPANY INSURED COMPANY , TMD AT-HOME SERVICES INC. 8 N/A', D13A THE HOME DEPOT AY-HOME SERVICES 2455 PACES FERRY ROAD NW CoapmY BUILDING C-a C AMERICAN HOME ASSURANCE COMPANY ATLANTA,GA 30339 COMpANY D ••TMS IS TO CERTIFY THAT PCIpEE CF INSURANCE:OSS E9011BET)HERRN NAbE BEEN IJEO TONNE INSJIIED-NAMEO HEREIN FOR THE PQelm INDICATED ICY-pf [:ATED • NOTw THSTANDw6 ANY REQAREMENT•TERM OR 0"1104 CF ANY C04TRAC F OR OTAN DOa1GENT VA74 REWFCT TOwyCx TNF CERTIFICATE YM E ISSUED OR MAY ffgi/YN.THE INSURANCE AFFORDED BY THE POUOES DEM MBEp MERSN IS SIBJECr TO A L THE Teltms�OIYDTa7 s AND EXCLUSICIYS OF SUCH PCXIOES AGGREGATE LIM TS 9+OVW MAY NAW BEEN REDUCED BY PAD CAMS Cb TY►E Of IIISURMCE ►CAUCYRUIMER POLXYEFFECTWE PooLv EXput 01 LTM DATE(MIMIOOPJT) DATE(mmlow Y) LIMITS Of NERAL LIABILITY GENERAL ACOIEGAIE PSEXCLUDED 000 A X COIMEROA GENERAL LIABILITY IPR 3757605-M 02/01/04 02101/0S PRODUCTS. 000 QAMSMUOE 0 Op3JR 11MITS OF POLICY ARE EXCESS• PERSONA A ADVIN�URY 000 0-NWMSlC:04TRACT0RSPROr OF SIR. 51,000,000 PER OCC' EAG/OCCURRENCE 000 . •�• FIRE DAMAGE(ArIYa•4y 000 MEpEXp m• TIMI AU IGNOBLE TWILIT/ ' COABINEDSNGLEUMIT S UNY AUTO AL OAMED UUTOS BODLYINIIRY s 004EDLAEO AUTOS lPs Pse+) "RED AUTOS 90DILYIN.URY s NOJ•ONNED AUTOS (➢s O=dov) PROPERTYOAMAGE f CAR AGE LWKm AUTOONLv.EAACODENT f MY AUTO OTHER THAN AUTO ONLY' 'c'.'�� --t`••'::?a•✓' EACH ACOOENT s EXCESSLIAALITY AGGREGATE IS EAOI OCMJRRENCF Is UMBRELLA ORM AGGREGATE f Cif HER THAN UMBRFLL A FORK f Q r• - EYpLOYEiYLYRLrTYX �'�'- "'-•`••" - TCRY LIMITS ER ►�:c l.:++u+•+..•.•.•.e, EL EACH AC OOENT f 1,000,000 C THE PRORiIF.TCIR/ INCL RMWC2981992 ADS 02/01/04 02/01/05 EL DISEASEPC IGIr LIMIT f 1.000,000 D PARTNER9EIEGUTIVE frFICERSARE REXQ EI OISEASE£AOIEMPLOYEE f 1,000,000 C WORKERS COMPENSATION DESCRIPTION O 0UA7fD11 SULDCATNTNLVEMICLELSp[CIA.ITEM! RE:LOCATION NO.RMA. . ""OLD AIM OF TIE Palo"DESCIOFD WRFA+/F CiANERLFD RF+CISF THE/ANAATIONDATE VWMfCF. THE WINAEM M►DTOING OOWRAIN MAL FM*AdCn to NYL_,U OAT!YAIrTEN MorWE To TIE a+l+•Nwwre"MA".w.Ee NeAeAa euT"AILI/1e To WA alo%NDna&ML I.-O=No CMICA"c"D% uASA 7Y OF AMI CPO VON TIE INSA 9A YIMOMG CO/FAAOF•IlS AOFNTS OA%EMF OIAATIII S OM IIS IIIA OF TMSOFAP14CAM BAR 1-4 USA MCL T Frank Knned �=;:Z=="}: ._...VAUD AS.OF x_02/102J04. . . ... _ _ ...,;... .�.I..+..:-'"'y.�-�_.:.�-..::�..�..�� ....- .....h......�:�..�-..-......._..:...._ — — � _ _ — _ .sl.: ...tom—,•.,i•_- aY[:�.t.Lj—�W.•t.cr•�•.I..i•.it.i NpRT,H TONM Of RAndover No. 04S WXm o LA E dover, Mass., ' COCMICMEWICK V RATED S BOARD OF HEALTH PER IT T - D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT9 ...... ........ .......... ...111121 . Foundation has permission to ere buildings on ... to be occupied as. . . . „ Chimney provided that the person cep g 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 and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T Rough ............................................................. ...... .............. ................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. Date.... .. e pORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING * c +w r f fj This certifies that . .... ...... .. ..... f E -' has permission to perform ..- : fes ........................... wiring in the building of.. ... ... ., :.,., ' 1, at.. .......... ......... North Andover,Mass. Fee .......t........... Lic. ............................................................. //�� ELECTRICAL INSPECTOR Check # /v 5331 TR COAMONREALYHOFAU,,S,ACHUs M Office Use only DEPARTAflE\T0FPUXJCS4FL7Y '33/ Permit No. BOARDOFFNEPREVENHONREGULAHONS527CMRI2010 Occupancy&Fees Checked APPLICATTONFOR PERMIT TOPERFORM ELECTRICAL WORK , ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHOSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ~� G r Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work desribed below. � Location(Street&Number) 6 // GRc-, n A7 !f� d/y-6 Owner or Tenant ?AS hy Sc 14 Owner's Address SttYMSI E Is this permit in conjunction with a building permit: Yes® No (Check Appropriate Box) Purpose of Building b W C L`1 N 6 Utility Authorization No. Existing Service Amp Volts Overhead ® Underground M No.of Meters New Service Amps / Volts Overhead Underground No.of Meters �� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work FA 141200 M (2E N 6 VA T"/6 Al No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures /' Swimming Pool Above Below Generators KVA (� round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER.- J Cu f4 AoST f't4N Courage.Nusuanttothe iequWnfflsofMassaclnlseilsGffalLaws IhaveaamaiLmbkyltsnancePblicyinch>dingCompletE� ornCoNaageoritssu�egtuvalart YES NO 111,4e submilled vand pmofofswm 10 the Offim YES r F)whave chedodYES,plea9eindicale,ftt peofoovuaWby cheddtig the atebox INSURANCE BOND OTHER r-1 (Please specafy) Lu�w�1 Expiration Dale EsgValuecfl�echi Wolk$ Wotktosalt �'�/�y h>spectionDateRe luesled 'ougt, Fmal Signed underlie Puialties of perjury: FIRMNAME 5i m, C ieAS'co C-L EC , LiomseNo. Li=Lee .f �y Iil. C t2lIS C o Sigtahue '.�). LomseNO Bt>,Sn%TeLNo. C( 7'�,J'S-S9 d o A>tTelNo. 7511- Y7a-D e6-? OWNER'SINSURANCEWAIVER;IamawarethattheL cffwdoesnothavetheinsut =CourageoritssubsfantialeTwalentasIegmedbyMassad a tsCoalLaws ! and hatmysignahlteonthispenmtappficafionwmvesth rxpim ncl t (Please check one) Owner r-1 Agent Telephone No. PERMIT FEE$ Igna ure o wner or gen Location No. - Date �r �oRTM TOWN OF NORTH ANDOVER 0 9 }i Certificate of Occupancy $ y�s''•°'E<�' Building/Frame Permit Fee $ a swCHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ L Check # 17427 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .i; Age &� s.� s`-"�, s = �.•.i �i`" . �� =y�1'Ift� ;�� ,� � s 3 � �,�. ,� �, �., BUILDING PERMIT NUMBER: DATE ISSUED: 17Lc� ILO )� ic SIGNATURE: 69�� —1 Buildin Commissioner/1for of Buildings Date z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number �-I 1 1.3 Zoning Information: 1.4 Property Dimensions: (� Zoning District Proposed Use Lot Areas Frontage ft - 1 1.6 BUILDING SETBACKS ft I Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2-1_Owner of Record v �q 1 keQ,t l rj —Roar -- Name( rint) Address for Servic e Sign re Telephone i 2.2 Owner of Record: Name Print Address for Service: Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ _ v- &O'na e Licensed Construction Supervisor: W G�Ste? ! O License Number Mn Xi'ggnatur�e 1I gs l - % 'd-` o o Expiration Dat� I d ic Telephone i 7 3.2 Regfstered Home Improvement Contractor Not Applicable ❑ �n�c �Ctf'1G1� c- ( nc . lo7y7� �q Company Name 1�1 1A qrl naf�e' -P-eo-6 I hA AAA Registration Number rM Address L/(� C)V Expiration Daten Si na r Telephone ®- f SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must mpleted and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin rmit. Signed affidavit Attached Yes....... No.......0 SECTION 5 Description of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 40 t its e-tom Gv�� SECTION 6-ESTIMATED CONSTRUCTIO-N-COSIN Item Estimated Cost(Dollar)to be " OF [CIAL USE`QNLY Completed by permit applicant 9 �; ' 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENTc OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby auth ize C to act on My behal,in al iatter dative t ork au orized by this building permit application. K` C_ n u of Ownr/ Date SE ION 7VQWNER/AUTHORIZED AGENT DECLARATION r I, 04 1G Gt - as Owner/Authorized Agent of subject property J 6 Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief ( (_C C_ o Print ame r 1(111„ Si ature Owner/A en Dat— e 22 ImOul NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 SPAN t DIMENSIONS OF SILLS DIMENSIONS OF POSTS y 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 The Commonwealth of Massachusetts � == -"; Department of Industrial Accidents ...... t office of/oeesmoo ions . � 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: Rad ! a a(!, location: 1,1-7 // U/16-Lf 1917d city AIA 1Ay a/ S-(/SI phone# 617f' &k I Z M ❑ I am a homeowner performing all work myself. ❑ I am a sole ro rietor and have no one workin in any ca achy % / ///%%%/�/%/ /%/ %%//%%%// %%%%%%%%%�/O�%%%%%%%%%��%%%%%%///, ❑ I am an employer providing workers' compensation for my employees working on this job. _ ��company name. 7 --� address.. / p n,� fl /` ,�' U shone#. �, 0 �l�J jr . ctty `7 insurance co. C.�- oi�# { '`Dv3`9� 5: 930 v" WE / ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have _ the following workers' compensation polices: comnany:name. .address.., .:.::..:..::;. _r_..i...i..v..._..:.........._.. ............:..:..............._...........:.,..............:............ .._....'... ...... ... ....... . ....... . . ...-.... h_o. .. . ..... _. .. ne #> : : _...... .. _ . .: ... . , .:;:: : .. .:..:: .. . . > s :: . ?:<:. . ::i>}�}i�<i:>ii>.. ii:. :::::::: ::: ::::: :: _ .. . .insnrante ca ... : s .... caamanv name, address. cityphone# insnrance:co. olicv# ::.; ;;: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crirdnal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.08 a day against me. I understand that a copy of this statement may forwarded to the Office of Investigations of the DIA for coverage verification. I do herebycern un rhe airs o e 'u that the information provided above is true and correct fY P fP rJ rY f _ 13C)16 y Signature Date Print name Old)/!)C 10/7 y G� Phone# ��/ y' �' �� official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revixd 9/95 PJA) BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 025991 Birthdate: 02/07/1941 Expires: 02/07/2006 Tr. no: 14600 Restricted: 00 LOUIS GRANDE 11 DEBORAH DR READING, MA 01867 Administrator C , A i Ir + ✓1ct Uc/JL//cC/clUGCLt/l� !`.-IU(OJlcc�lcJr��: Bu::rd of Buitdiue Revulatiuus and Standards HOME IMPROVEMENT CONTRACTOR i•.• Registration: 107478 Expiration: 8/3/2004 Type: Private Corporation TANGO PLUMBING HEATING ix C Dn1TP/rTnl/� ominic Tango 545 MAIN STREETf�. Reading, MA 01867 Administrator p Dominic Tango Company Inc. P Y 545 Main Street Reading, Massachusetts 01867 (781) 944-8100 MV. June 24, 2004 Rad&Julie Pasovschi 691 Great Pond Road North Andover, MA 01845 978409-1750 DESCRIPTION OF WORK: Re: Master Bath A. PLUMBING 1. Install new drains, vents, hot and cold water pipes where needed for the new fixtures. 2. Install all new valves, traps and supply lines for all of the fixtures, which will be installed. y4wres not included) 3. Remove the existing shower stall. 4. Build a new custom shower stall approximate size 4'x 5'. 5. Install(1) mixing valve for the shower with body sprays. 6. Purchase and install a copper pan and mud floor for the shower. 7. Draw all permits that are needed, and have theg lumbin inspected petted by the town inspector. The custom glass door is not included in the price. B. ELECTRICAL 1. Install new wiring for a new ceiling light and fan, a wall light, a G.F.I. plug and all switches needed. 2. Purchase and install a shower light. 3. Ins tallO 2 wall plugs near the sink area. 4. Purchase and install(2)recessed ceiling lights. 5. Install (4)recessed ceiling lights. 6. Draw all permits that are needed, and have the electrical inspected by the town inspector. 1 C. CARPENTRY 1. Install new wonder board and green board inside the tub area up to the ceiling. 2. Install new blue board outside the tub area on the walls and the ceiling. 3. Install new plywood on the floor. 4. Install new casings for the doors and window. f 5. Remove the existing block window; close up the outside of the house. 6. Purchase and install a new window over the toilet area. 7. Cut in a new door going into the existing new closet, purchase and install the door. 8. Remove the existing door in the closet, close up and plaster the opening on both sides of the room. * This wall may not be wanted; it will eliminate the second shower valve. D. PLASTERING 1. Plaster all of the walls outside the tub area with a skim coat of plaster. 2. Plaster the ceiling with either a sand finish or a skim coat of plaster. E. TILE 1. Tile the walls, ceiling and floor inside the shower. 2. Tile the wall outside the shower area up 4' high. 3. Install a new tile floor(tile cost not included). F. DISPOSAL 1. Disposal of all debris from the job. COMPLETE LABOR AND MATERIALS: $16,675.00* Any work not listed in the categories above is not included in this price. Any additional work requested will be at an additional charge. Not included — Fixtures and the cost • If installing tile on the diagonal, it will be$2,00/square foot more. • If installing a whirlpool the approximate cost will be$200.4300.00 • U the whirlpool has a heater the cost will be an additional$200.-$300.00 • If wiring needs to be upgraded it will be at an additional charge • Any additional electrical work not listed will be at an additional charge • If installing any accessories, cost is$20 per piece • H installing a shower door,additional cost will be approximately$200 • If the tub or shower door is heavy custom glass installation price will be determined after selection. 2 • Two-Year Guarantee on All Workmanship Tango Brothers Plumbing & Heating, Dominic Tango Company Inc. and Bathrooms Etc. will not be responsible for removal and/or reinstallation of any manufacturer's defective product. 3 • If installing tile on the diagonal, it will be$2.00/square foot more. • If installing a whirlpool the approximate cost will be$200.-$300.00 • If the whirlpool has a heater the cost will be an additional$200.-$300.00 • Any additional electrical work not listed will be at an additional charge • If wiring needs to be upgraded it will be at an additional charge • If installing any accessories, cost is $20 per piece If installing a shower door, additional cost will be approximately$200 • If the tub or shower is heavy custom glass installation price will be determined after selection Two-Year Guarantee on All Workmanship Tango Brothers Plumbing & Heating, Dominic Tango Company Inc. and Bathrooms Etc. will not be responsible for removal and/or reinstallation of any manufacturer's defective product. i Page 2 of 2 Dominic Tango Company Inc. 545 Main Street Reading, Massachusetts 01867 (781) 944-8100 MEMBER June 24, 2004 Rad&Julie Pasovschi 691 Great Pond Road North Andover, MA 01845 978-409-1750 DESCRIPTION OF WORD: Re: Kitchen Work Rip out all of the upper and lower cabinets Remove all of the existing counter tops Rip out the walls and the tile backsplash Install new board on the walls Install a new tile backsplash Remove the two ceiling lights Patch the ceiling where the lights were Replace ep ace(11)recessed ceiling fights * Cost of the lights not included Install approximately 25' of upper and lower cabinets Install a new sink, faucet, dishwasher and disposal Disposal of all debris COMPLETE LABOR AND MATERIALS: $79500.00* Any work not listed above is not included in this price. Any additional work requested will be at an additional charge. • *Not included — cabinets, counter tops, plumbing fixtures, all lights and tile cost Page 1 of 2 Contract ............... June 24, 2004 Between Dominic Tango Company Inc. Dominic Tango, Owner 545 Main St., Reading, Massachusetts 01867 781-944-8100(Contractor Registration#107478/Plumbing License#10578) And Rad& Julie Pasovschi 691 Great Pond Road North Andover, MA 01845 1-978-409-1750 Dates The work shall begin on June 25th&will finish in approximately 15 working days Description of Work Master Bath—(see detailed estimate, which precedes this contract). .Payment The total cost to be paid by the owner to the contractor for performance of the work described and includes all materials e als and related e ated services, unless specified herein shall P , total $16,675.00. ,T�hhe payment schedule is as follows: `'$3,335.00 - 20% at contract signing $5,002.50 - 30% at start of job $5,002.50 - 30% when boarded in $3,335.00 - 20% at completion Workmanship & Warranty Dominic Tango Company Inc. shall perform the work described below in conformance with all applicable building codes, and will use first grade materials unless other wise specified. All work shall be done in a workmanlike and professional manner and shall be free of defects. All work is warranted for a period of two year. Statement of OOd Falth Both Dominic Tango Company Inc. and the owner desire to complete the subject work in a quality manner and without undue delay. Each shall use his or her best efforts and cooperate on this project. Page 1 of 2 Page 2=Tango Associates,ag ang es,Inc.Contract Insurance & Liability Dominic Tango Company Inc. is fully licensed and insured with adequate insurance to cover any damage due to negligence on the part of the contractor. The contractor warrants that he, his employees, all of his agents and subcontractors, etc. who are to work at this site are duly licensed in conformance with the laws of the Commonwealth of Massachusetts and this city or town. All home improvement contractors and subcontractors shall be registered by the Director of Home Improvement Contractors. Any inquires about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301, Boston Mcg 02108 Permits Dominic Tango Company Inc. will be responsible for obtaining all permits as are required by the Commonwealth of Massachusetts for the work to be performed under this contract. Owners who secure their own construction-related permits or deal with unregistered contractors will be excluded from access to the guaranty fund. Arbitration The contractor and homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and d Business Regulations and the consumer shall be required gu q to submit to c arbitration as provided in MGL c.142A. Owner Date Contractor� Date NOTICE. The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate an alternative dispute resolution even where this section is not signed separately by the parties- Property arties. Pro e L �I rty len within the terms of this contract, Dominic Tango Company Inc. cannot place a lien on the owner's property as a result of non-payment for work performed. -DO NOT SIGN THIS CONTRACT IF IT IS NOT COMPLETED IN FULL- - The owner has the right to cancel this contract within (3) business days after the signing date- - s o�� Owner Date Contractor Date Page 2 of 2 a Contract June 24, 2004 Between Dominic Tango Company Inc. Dominic Tango, Owner 545 Main St., Reading, Massachusetts 01867 781-944-8100(Contractor Registration#107478/Plumbing License#10578) And Rad & Julie Pasovschi 691 Great Pond Road North Andover, MA 01845 1-978-409-1750 Dates The work shall begin on June 25h&will finish in approximately 10-12 working days Description of Work Kitchen Work—(see detailed estimate, which precedes this contract). Payment The total cost to be paid by the owner to the contractor for performance of the work described and includes all materials and related services unless specified herein shall P , total $7,500.00. The payment schedule is as follows: $1,500.00 - 20% at contract signing $2,250.00 - 30% at start of job $2,250.00 - 30% when boarded in $1,500.00 - 20% at completion Workmanship & Warranty Dominic Tango Company Inc. shall perform the work described below in conformance with all applicable building codes, and will use first grade materials unless other wise specified. All work shall be done in a workmanlike and professional manner and shall be free of defects. All work is warranted for a period of two year. Statement of Good Faith Both Dominic Tango Company Inc. and the owner desire to complete the subject work in a quality manner and without undue delay. Each shall use his or her best efforts and cooperate on this project. Page 1 of Page 2—Tango&Associates,Inc.Contract a Insurance & .Liability Dominic Tango Company Inc. is fully licensed and insured with adequate insurance to cover any damage due to negligence on the part of the contractor. The contractor warrants that he, his employees, all of.his agents and subcontractors, etc. who are to work at this site are duly licensed in conformance with the laws of the Commonwealth of Massachusetts and this city or town. All home improvement contractors and subcontractors shall be registered by the Director of Home Improvement Contractors. Any inquires about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301, Boston Mcg 02108 PerMits Dominic Tango Company Inc. will be responsible for obtaining all permits as are required by the Commonwealth of Massachusetts for the work to be performed under this contract. Owners who secure their own construction-related permits or deal with unregistered contractors will be excluded from access to the guaranty fund. Arbitration The contractor and homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to suokarbitration as provided in MGL c.142A_ W, __ Owner `GS `f Date Contracto G Date NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate an alternative dispute resolution even where this section is not signed separately by the parties. Property.Lien Within the terms of this contract,Dominic Tango Company Inc. cannot place a lien on the owner's property as a result of non-payment for work performed. -DO NOT SIGN THIS CONTRACT IF IT IS NOT COMPLETED IN FULL- e owner has the right to cancel this contract within (3) business days after the signing date. - J 6-0 �, c Owner Date Contractor bate Page 2 of 2 NORTH Town of And No. 00 T 0 ++ LAK -O dover,- Mass., C OCMICHEWICK ADRATE D PPa��S S U BOARD OF HEALTH PERMIT T D I Food/Kitchen Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT......T'11> ..�►.i�.�.. �i�r ..I........... ...................... ....... .... .... ....................... .. Foundation has permission to erect..:. ........ .. buil ings on ....fr �� ar."A �...�� Rough to be occupied as............ ........ �� .............. 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 La elating to the Ins ction, Alteration and Construction of Buildings in the Town of North Andover. e. ;s 2 row� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRLJCT'I®N 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 No and Approved by the Building Inspector. Burner t Street No. SEE REVERSE SIDE Smoke Det. Date. . . . . . . . . . r NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ♦ o ' 1 CHUS `)z This certifies that .lil ., Z -. . . . has permission to perform .R7d a.1.t.IX . . . . . plumjbin ,in/tht buildin g s of at.l'. 11/ � lL .!�� North Andover, Mass. Fee�,1� :`. .Lic. No..�! ��JQ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . // >> PLUMBING INSPECTOR Check # /✓'�-'� 6V75 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Lnta Type) Mass. Cate 1� Permit# ' Building Locat)or,U I� 6 O �On� ROGL Owner's Name � 1`Q 1�`4S Type of Occupancy New O Renovation 0.- Replacement Oe-r Plan Submitted: Yes O No CT'� FIXTURES N O y 0 'Z t > ¢ gW W Y J H 44 ¢ Z N < CC ¢ •� C N Z 0 = Z � a 1' 0 N W = Cl �. U W Y < in 6 K ¢ < Z c 4 C < < ° • � J O < S ; = Z 3e d O < W k Y W O < J j < ¢ ¢ ¢ < O < h sua—BSMT. BASEMENT IST FLOOR 11 I 214D FLOOR Z 3 9RDFLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTHFLOOR 8TH FLOOR / Installing Company Name 2e� -��2/i Check one:. Certificate _ Address cS� dation �-- ❑ Partnership Business Telephone �/� �� U�� ❑ hnn/Co. Name of Vicensed Plumber - GU x INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ It you have checked yej, please indicate the type coverage by checking the appropriate box A liability Insurance policy ❑ Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner O Agent O Signature of Owner or Owner's Agent I hereby oer*that all of the details and infomution 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 the permit issued for this application wits be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chanter 142 of the General Laws. �A--t- -4 ignatur o umber Title 4, Type of License:Master[g-- ' Journeyman ❑ Rowe L� �` ( INL license Number r Date..��./��c�.A 1 2 33Ci1 NORTH TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING IL �l s CNUSEt i This certifies that .. has permission to perform er��.. r ........:....j................................................................ i wiring in the building of......... ..f} /? t' ....... . / I at.......to t. / .......:. North Andover Mass. Fee...., j Lic.No. ... / r L....... f f .................. ................ �ELECTRICALINSPECTOR Check # -3 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer i The Commonwealth of Massachusetts FOR OFFICE USE ONLY 3 3Y7 - Department of Public Safety PennitNo. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Receipt No. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work will be performed in accordance with the Massachusetts General Code.527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /(J1 �0) City or Town of NOy-' '4 Atn- oy4 r To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: i Location (Street and Number) C7/ C !'L 06 111'�O O., d Map: Lot: Owner or Tenant LC-e t/j J -3>o I/' Zone: Owner's Address J q Is this permit in conjunction with a building permit? Yes❑ No COY (Check Appropriate Box) Purpose of Building tu�� Irh"� Utility Authorization No. 3b S Exis+ service 0?0 Amps IR /� Volts Overhead ED ' Underground El No.of Meters New vervice Amps / Volts Overhead❑ Underground ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work S ct PCa 1'rf No.of Lighting Outlets . No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above grnd. ❑In-grnd.❑ Generators KVA No.of Receptacle Outlets No.of Oil Burners No.of Emerg.Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones No.of Ranges No.of Air Cond. Total Tons No.of Detection and YNo.of Total Total Initiating Devices No.of Disposals Heat Pumps Tons KW No.of Sounding Devices No.of Dishwashers Space/Area Heating KW — No. of Self-Contained No.of Dryers Heating Devices KW Detection/Sounding Devices No.of Water Heaters KW No.of Signs No.of Ballasts Local❑ Muncipal Connection❑ Other No.of Hydro Massage Tubs No.of Motors Total HP Low Voltage Wiring OTHER: INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts GeneraLLaws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES O❑ I have submitted valid proof of same to this office.YES ENO❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE E510ND❑ OTHER❑(Please Specify) (Expiration Date) Estimated Value of Electrical Work$" Work to Start C�l erg/y� Inspection Date Requested:Rough Final /Z Signed under the penalties f perjury: FIRM NAME A.W&/ Elf C_#ic LIC.NO. Licensee Signature LIC NO. 6,2576 / Address by-a Bus.Tel.No. 97i-73D`6e100 Alt.Tel. No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement. Owner❑ Agent❑ (Please check one) G Telephone No. PERMIT FEE$ J (Signature of Owner or Agent) A `9HU§ETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ;O NORTH ANDOVER, , Mass, Date Bullding /, Permit # ? 3 y Locatlon_(vck\ C v u�� w t��, . Owner's Name Gem\zT New ❑ Renovation Replacement [I Plans Submitted: Yes ❑ NoIK ❑ n b V st h et h W h t Q 7 M = h C .1 h w h ZpIt l., t >• z = aC b Mh p 0 0 0 H at A d M t X i h O �p 0 ICX00 1 O h R "r F st d ~ ?r d > K m t .4 O O C p h ss o d w � ile. o 3 v 1091 > o a o >sue—esa+IT. • ®AaeMENT � � 1sT FLOOR lND,FLOOR I 3RD FLOOR 4THFLOOR STH FLOOR 0TH FLOOR TTHFLOOR ATH FLOOR Check one: Certificate Installing Company Name`CA-,�,,,o:t• Corp. Address_;?,, [� �^ �.d�.�� d Partnership t34irm/Co. Business Telephone a Vl - : N.Lj'3 Name of Licensed Plumber or Das Fitter INSURANCE COVERAGE: Chec +e have a current IlabMity Insurance policy or its substantial equivalent. Yes LTJ No [] it you have checked res, pleaseIndicatethe type coverage by checking the appropriate box. A(lability Insurance policy L'7 Other" 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: %nature o Owner or Owner's Agent Owner L1 Agent 13 (hereby certify that ah of the details and information I have submitted(or entered)M above 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 mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. eY TypeAl License: umber Signature of Ucensedum a or Gas Fitter Title Gastilter City/Town � Master Ucense Number_2 Q Ll�oumeyman APf'tKyvED(OFFICE USE ONLY) d BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING 4 � NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER -•- LIC NO. PERMIT GRANTED DATE x_19 GASINSPECTOR i *. .� Date.-' . . . . . . . . . .. . . . . "T 834 rte. NORTH 9 WN OF NORTH 1'ANDOVER. - 0*t,,E ,..9+ o� 5t PER R GAS INSTALLATION + 114* Qkey This certifies that � � � f } r has permission for gas installation ... . . . :. . . . . . . _ . . . . . in the buildings of . '"./ `. : . . . . . . . . . at . . . I. :./.'. �`Y. .1• . . . : . .. . . . . . , North;!Andover; Mass. Fee. .l `. Lic. No.. . . . . . . . . . . .. . . . . . . . . GASINSPECTOR WHITE:Applicant CANARY: Building Dept. PINK.,Treasurer GOLD: File Locations No. a_ Date NORTH TOWN OF NORTH ANDOVER p? •'1 n OL p Certificate of Occupancy $ Building/Frame Permit Fee $ . S 41 s ; Foundation Permit Fee $ Other Permit Fee $ r Sewer Connection Fee $ 1�1�1aer Connection Fee $ TOTAS9 $? Co jje ;�'eC-Building Inspector Div. Public Works _. _ ..-_. :r.) �a+.+..:,gy.acv.� --Y.Y.'C�. .�,..�-..^}I�y�.�%f.Y',Ytsl+..?:iiyl...•x�;7ii.. ^-_ w.a-.s..c:sem,,,.:...¢ Location No. Date T v 40RN, TOWN OF NORTH ANDOVER Certificate of Occupancy $ *iBuild ng/,Frame Permit Fee $ Foundation Permit Fee $ �- ?ACHU J� 1 a ,C,, t;Oer Permit Fee $ /S-ewer Connection Fee $ Vlfater Connection Fee $ a ®• '5t?J TOTAL $ �C t''C�C � Building Inspector Div. Public Works PEk*IITgo.� � APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. ;y" LOT NO. 2 RECORD OF OWNERSHIP DATE (BOOK PAGE .st _ ZONE ` I SUB DIV. LOT NO. u LOCATION 9 E C PURPOSE RaW a.1 0� ,AZA / OWNER'S NA`�ME ;�/� �� ra'1� NO. OF STORIES SIZE ,,,A �L �1/ ,11' v V _ OWNER'S fDDRESS �� ( 6�Qje �. BASEMENT OR SLABdA..�_�., ARCHITE i 'S NAME „/�. �� S z�vL /Cr(I SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDE NAME �V C�/� v" fLL E -Icy r p33 SPAN - DISTAN TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW o SIZE OF FOOTING X IS BUILDING ADDITION 0 MATERIAL OF CHIMNEY IS BUILDING ALTERATION L/C-S +A)'TI✓�(o/` `OA)L, IS BUILDING ON SOLID OR FILLED LAND CaD LI WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 1 .�� IS BUILDING CONNECTED TO TOWN WATER✓ Lf L� QOARD OF APPEALS ACTION. IF ANY `� `J IS BUILDING CONNECTED TO TOWN SEWER /L) IS BUILDING CONNECTED TO NATURAL GAS LINE Lf INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST * 2�0/D� PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY y ATTACAIED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ,DAT F D 42 BOARD OF HEALTH SIGNATURE OF OWNER OR UTHORIZED AGENT OWNER TEL.# F E E V CONTR.TEL.# CONTR.LIC.# Oq PLANNING BOARD PERMIT GRANTED �. It 19 BOARD OF SELECTMEN l WE— BUILDING INSPECTOR j BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY srORIES 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 —I $ INTERIOR FINISH - CONCRETE B 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D _ _ PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN..-BMJ AREA '/. 1/1 V..'',i FIN.j ATTI'G AREA' _ NO 8"M'T FIRE,iPLACES HEAD ROOM MODERN KITCHEN ' Y 4 WALLS, I 9 FLOORS CLAPBOARDS - B 1 2 3 DROP SIDING `A CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDY✓'D ASBESTOS SIDING _ COMMCN - VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR XI) _ ADEQUATE NONE 5 ROOF 10 PLUMBING t _ GABLE HIP BATH (3 FIX.) .3 GAMBRELMANSARD TOILET RM. 12 FIX.) FL - AT 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 PIPELESS 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 - UNIS HEATERS ' 7 NO. OF ROOMS GAS OIL B'M'T 2nd 1 st 3rd I NO HEATING a d k FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORA SUBDIVISION ASSESSORS MAP f. SUBDIVISION LOT(S) PERMANENT ADDRESS ASSIGNED B D.P.W. STREETS APPLICANT l bs �� PHONE -3-3/9' ; DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COMMISSION p vll � C 2( DATE APPROVED CONSER ATION MIN. U DATE REJECTED BOARD OF HEALTH DATE APPROVED HEALTH SANITARIAN DATE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERk1IT SEWER/WATER CONNECTIONS � FIRE DEPT. e^ •. 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. s FORM U. TOWN OF NORTH ANDOVER . r. LOT RELEASE FURM SUBDIVISION ASSESSORS MAP c SUBDIVISION LOT(S) PERMANENT ADDRESS (ASSIGNED BY D.P.W. STREET APPLICANT ��s�= '�'� PHONE DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COPIXISSION DATE APPROVED ' CONSERVATION ADMIN. DATE REJECTED BOARD OF HEALTH -"5�4�llA'i'E APPROVED HEALTH SANITARIANDATE REJECTED //��. DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE 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. rOf HOH IH,�C • , KAREN H.P.NELSON Town Of 120 Main Street, 01845 , D`'e``°r NORTH ANDOVER c508> 682-6483BUILDING f 9A e CONSERVATION DIVISION DIVISION OF r PLANNING PLANNING & COMMUNITY DEVELOPMENT f S i r# S �yy f• t G�p £J£ L September 17 , 1991 i Louise I. Borke E 691 Great Pond Road i North Andover ,MA Dear Ms . Borke: Enclosed find your check # 10 which we are returning, as per our telephone conver ion. Your plans remain in this office and should be picked up as soon asssible. We are not responsible for plans that are lost or misplaced. Thank you for attending to this matter in a timely fashion . Yours truly, Gilda Bl-ackstock, Secretary J Enclosure (1) c/K. Nelson, Dir. r �' 'n*T'•J� R^. + d v a _ � x„�'�7 �� •�- aY"a"r.a nn*.a+.1.LCkX"`.w,r: .0 r .:.:'1"x �cis '�•.�a'�"`o'`,.:."S'�7: T,�°�1""'”" x ... F, __ . Equality - 2 010 *� LOUISE I. BORKE ° 691 GREAT POND ROAD NORTH ANDOVER, MA 01845 F 7-_ 19 Pay to the order of Dollars BAYBANK BAYBANK BOSTON, MASSACHUSETTS NA. •—t r -• ;> q -y e..kwal-et-e n}, .�.^,. .,. i....-,.•-_ ^�^" - '.': The state of'being equal - - ;, - -• -~ - , •` �� • • � � `having the'same'rights�'"' �'°�" *cpriviieges;opPo�1 sties and compensation, c For vm mr 1:0,1 100 174 21: :308 95 1 70 20 1_,. '� = a , Y' u, s .. 1• 1 ! .ty, 1 , ! r•� l I 1 f.. , 1 t r � •, 4 ,1 r x t ` t .f �, ,� •'.• - .i i t' L 0. own of . .. Andover . 0 ti rr+ )RIVEWAY ENTRY PERMIT — er, Mass., BOARD OF HEALTH aAft : - �, x Q a THIS CERTIFIES THAT..... ... ........ ...... ........ BUILDING INSPECTOR has permission to er ............... buildin s on Rough AS o Chimney tobe occupied as......... ... .. ..... .... Final provided that the person ac epting this permit shall in every resp ct conform to the terms a application on file in oPLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ® ELECTRICAL INSPECTOR Rough UNLESS CONST Service Final .. .. .... .................... UILDING INSPECTO GAS INSPECTOR Occupancy Permit 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 Smoke Det` Building Inspector i hl-t�L� �C--n7' LJ.0 L /'U v✓-- NORTH BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 �99OgA E°rPP`y.�y 9SSgCHUNORTH ANDOVER, MASS. 01845 Ext. 32 or 52 i M E M O R A N D U M I TO: Building Department FROM: Michael Rosati, Health Agent §1 RE: Building Permit Application 691 Great Pond Road DATE: August 27, 1991 Please be advised that the building application for the conversion of the garage to living space at t69-Ir Great7P,,ond _�Road does not have Board of Health approval. Until it can -be demonstrated that the existing system is adequate to handle the potential increase in flow or until the dwelling is connected to a sanitary sewer, this department cannot allow the construction (310 CMR 15. 02 (7) ) . MJR/cjP A AUG 2 7 1991 , MG1cSSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIn(3 (Print or Type) l NORTH ANDOVER Mass. Date �'- kuilding Location GG�k (mss c N o ,.Z Permit # 5\q f . Owners Narne New "-1 Renovation Replacement �] Plans Submitted FIXI IIP-:Q N W N N 0 CC W Q p U r✓ x t- a r z =- a m 0 tw- w w o a W LU N o W a x t- N y 4 o w w W (n w z a x a cc w a W t-' W t- x f= z 1. (W� w o a > ky Iw- W Kt w 4 w 1- tJ .� tJ .w y a w o z a x a ¢ o o w Ei o w t- cc z O o a t— o Susi—RSIAT. BASEMENT IsT FLOOR I 2ND FLOOR 31113 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTK FLOOR -; STH FLOOR (Print or Type) Check one: Certificate Installing Company Name wkotiG C' o (_] Corp. Address `o-� ��,iz` S,{-._ Partner. yy\-� V\N , Firm/Co. Business Telephone: iz�o t Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: _ Liability insurance policy []� Other type of indemnity Q 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 coverages. Signature of owner/agent of property Owner I _] Agent 1 hereby certify that all of the devils and Information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that aU plumbing work and InstrUadons petfornsed under Permit issued lo.- this application will be In compliance with all pertinent provisions of the Massachusetts State Cas Code and chapter 142 of the Genual Laws. By T PE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town: Master Plumber or Gasfitter urneyman APPROVED (OFFICE USE ONLY) License Number / ❑ Date. . � ` ,� .�'D. TZ 40RTH � TOWN OF NORTH tA66OV', IR o� y�s Eo PERMIT FOR GRAS INST/�LLA Tim F A 1 2 (70- 4,746 1 1 yJ CO�9SSUSES� This certifies that . . ... . .. . . . . . . has permission for gas installation . . :. : . . . . . . . . in the buildings of . . - . . -.r. . . . . . . 57. . . ... . . . . . . . at . .{ a . . .':. `.- . . . . . . . . ., North Andover, Mass Tee. . . 4 n. Lic.. No-. . .,k. A', . GAS INSPECTOR zs� WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File%