HomeMy WebLinkAboutMiscellaneous - 70 OAKES DRIVE 4/30/2018 (2)r
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Location 9 O _OINV, e 5 4-�)R tV
No. �� 3 Date q- 1 S_ 0 4
TOWN OF NORTH ANDOVER
• OL
_
S
Certificate of Occupancy $
CHU
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Y
Check #
17194
S/100-
6 /&0 —
Building Inspector
I
S56013' 12"E
42.69'
o
0
rn
ca
L = 150.00'
R = 90.00'
954°13'35"E S4604.0'39"E
114.60'
155.58'
1
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w co
A.SSESS(DRS MAA' 1 0,%t' , ,,.; nt
j PARC; -L 1 L5
76, 7 58±Std F� �
.752 AC
OAKES DRIVE
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' 1,D DA K.'-, -,S 1� Zl L-5- r_'
DEED REFERENCE: 7986, ?AGE 10. ESSEX NORTH REGISTRY OF DEEDS,
PLAN REFERENCE: PLAN # 6,254. ESSEX NORTH REGISTRY OF DEEDS.
THIS PLAN IS FOR THE USE OF THE BUILDING INSPECTOR OF THE
TO'R'N OF 14ORTH .ANDOVER FOR `HE=URPOSE OF DETERMINATION DF
ZONING COMPLIANCE.
THIS PLAN IS TH= RESULT OF LIMITED FIELD SURVEY PERFORMED, AND
MONUMEN7ATION "OUND IN APRIL, 2004. BASED U°ON MLANS AND
OCEDS FOUND ICJ THE REGISTRY OF DEEDS.
THIS PLAN DOES NOT REPRESENT A 80UNDARv SURVEY AND SHOULD
NOT BE USED FOR CONVF-MANCE.
FOUNDATION AS BUILT
70 OAKES DRIVE
NORTH ANDOVER; MA
PREPARED FOR SCOTT & BARBARA TALBOT
70 OAKES DRIVE
NORTH ANDOVER, NIA 01845
SCALE: I = 50' APRIL 12, 2004
NEW ENGLAND ENGINEERING SERVICES, INC.
60 BEECHWOOD DRIVE
NORTH ANDOVER. MASSACHUSETTS
!1 (978) 686--1.768
DRAVN Ot ECKED
BY. '.a. BY• 6:.0. Jr.
FILE r.1ia�aFAf3 LES;C:N
BY: .�.�.i , d Y.C.0, Jr,
Date..7-.
-. �5=
�;<; •.:��Q TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
a This certifies that .'�{:.. ........................
has permission to perfor ` `? ........ I ..............
�x� . 7"
plumbing in the buildings of r,..
at. .7!? . � � ._._ !................ North Andover, Mass.
Fee. /.9P:... Lic. No..:.. .✓h�j�.............
..PLUIV17G INSPECTOR
Check # 55V v (J
6115
I
6
MASSACHUSETTS UNIFORM APPLI
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
New
NameGa% T
of
ION FOR PERMIT TO DO PLUMBIN
r-- Date o� 7 by
�/f L 3a 7^ Permit #
Amount
Renovation Replacement Plans Submitted Yes No ❑
(Print or type)c/ Check one: Certificate
Installing Company Name l �"(— Corp.
l ❑
Address ���� S tU�%Gs��a'�G �� 0��79 Partner.
Business Telephone
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy u�/ 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 n
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 installation erformed under Permit Issueq>f this application will be in
compliance with all pertinent provisions of the Massac ate Plum 'ng Code 142 of the General Laws.
By: Signature or Licenseaum er
Title
Type of Plumbing License
�9
City/TownLicense um er Master Journeyman
APPROVED (OFFICE USE ONLY E3--
a G
� � � -�-
t
Location d OA PTS ../ RIO
p ; n ' i3 f'30 _0d
No. Date T
Sao, TOWN OF NORTH ANDOVER
3? •. • O
F A
Certificate of Occupancy $
CMUs Building/Frame Permit Fee $
Foundation Permit Fee $ O
-' Other Permit Fee $
TOTAL $J
3
Check # oZo2��
17642 �(
Building Inspector
I
,TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
"PLICATION TO CONSTRUCT RET'eRKNOVATL OR DEMOLISH A ONE OR TWO FAMILY DWFI.LINC
BUILDING PERMIT NUMBER: DATE ISSUED: /
SIGNATURE:
Comraissioncr/IM25W of Buildings Date
SECTION I- SITE INFORMATION
1.1 Property Address:
1.2 Asseeom Map and Prod Number.
I Ll
Map Number Parod Nu
1.3 'Zoning Infornunica:
1.4 Propaty lhmmsicnr
a {�eStdeh�e
-7C..9 � \V50�
Zoning Distria Provesed Use
I [A Ares Frau Il
1.6 BUILDING SETBACKS B
Front Yazd Side Yard Rear Yard
Required Provide 'redhorded Required Provided
,. ` R V? t— f.Z 1-7 l
1.7Wna SepplyM.aLCAAD. 541 13. Floa{Tesalurocmnioa: l.i Se�rergeDlpasdsyste�
zoo 061" FUW zoos 0 MUL-4 l n On Site D'upad Syd=
Public X Rivefe 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Nam Print) A111:
213 --7ZS
S' lure Telepbone
2.2 Owner of Record:
N a Prin Address for Service:
not a Tel bone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Con'sstt+ruction Supervisor.
Not lte
Applicab/o
�
�1; 70
0-7 t7
C
Licensed C+ onstruction Supervisor:
Luau Number
Address
/t)5
I
.5'll
Fxpiratfon Date
Signature Telephoner
3.2 Rcgistenal Homo Improvement Contractor
Not Applicable 0
Company Name,
Registration Number
Wyh
8Z f
Address
47-7e)y 33 ? �'`t Z
Expirati Daw
Signature Tckpbone
Ma
M
Z
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 it.
Signed of idavit Attached Yes ...... No ....... 0 .
SECTIONS De'scri tion of ProWork dKckaq Me
New Catts1n1cGon $t Existing Building 0 Repairs) B Altetaticns(s) 0 Addition D
Accessory Bldg. C DemolitionQ!9 Other C Specify
Brief Description of Proposed Work:
�mZ�i��c•n d� e.X.���Tn�c S�"H.c�v.re ��nc�. Con) ���a
CDrnnN r _ vcTmiAwn rnivgmlimm r wn
Item
EsWr atte�dJCost (Dollar) to be
Completed •ta �
dWR YC.i
•` OR US£'QNI.Y ; `s
X. yR i A•xu
11��
1.
Building
a� t�V
(a) Building Permit Fee
Multi tier
2
Electrical
(b) Estimated Total Cost of
ConshwAon
t
3
Plumbing
d
L
Building Permit fix t.l :. (b)
4
Mechanical 11VAC
5
Fine Protection
I -L
6
Total 1+2+3+4+5
Check Number
GROWTH MANAGEMENT BYLAVi/ EXEMPTION STATEMENT
TOWN OF NORTH ANDOVERB UTI,DPVG DEPARTMENT
Tlus form shall be used to assist the Building Department in their determination of exemption tinder section
3.7.6 of the Town of North Andover Growth Management Bylaw, The applicant shall provide all of the
necessary information as requested below.
Permit Applicant v '1
pp Property address Map / Parcel
Applicant's Phone Number Single Family Two Family
I the undersigned applicant for the above property attest that the attached building permit for which this form is completed
does comply with the E.lT-\IPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not
absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building
permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only
officially accepted when the building permit is issued.
Based on section 8.7.6 of the North Andover Growth Bvlaw the above lot and the work as applied for on the above lot, in the building
permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark.
This is an application for a building permit for the enlargement. restoration or reconstruction of a dwelling in existence as
Of e effective date of this bylaw, provided that no additional residential unit is created.
The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of lite Zoning Bylaw.
This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions
of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens
through a properly executed and recorded deed restriction running with the land. For purposes of this section "senior" shall mean
persons over the age of 55.
This application is part ofa development project which voluntarily agreed to a minimum 40 % permanent reduction in
density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions ofthe tract, with the
surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall
be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town. or other
similar mechanism approved by the planning board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent
parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and
Development Scheduling provisions for thepurpose of constructing one single family dwelling unit on the parcel.
This application represents a lot which is ready for a building permit ( all other permits from all other boards and
commissions have been received and the project is in compliance with those permits), and the Development Schedule does not
accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as
the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this
E..UMPTION.
PLEASE PROVIDE A.NY AND ALL INFORMATION THAT WOLLD ASSIST THE BUILDING DEPARTMENT IN MAM G A
DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS.
BY SIGNING BELOW I ATTEST TO THE ACCLRACY OF THE INFORifATION PROVIDED AND THAT THE A17ACHED
BUILDING PERIM IS ALLOWED AN EXT—MPTION AS CITED ABO�R.
FURTHER I LTNDERSTXND THAT THE SU MITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE
CHECKING OFF OF A A130 VE EM✓ivfMON WHICH DOES NOT COMPLY, WHETHER DONNE TO MY KNtO\k,T,EDGE OR
4�0
OL��S FOR REFUSAL, BY THE BLlLDING DEP,IRT\tENT TO ISSL,F A B11LDItiG PER\IIT.
MS SIGNttT�t_TRE
TI IIS FORM TO BE ATTACHED TO TIS BLTLDIVG PERMIT APPLICAI ON T
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
****************c***************APP``L''ICANT FILLS OUT THIS SECTION***********************
APPLICANT �S �Q��C�' PHONE 9�� 7Z'j �, Z G
LOCATION: Assessor's Map Number �V� PARCEL Lt S
SUBDIVISION LOT (S) Z�3
STREET ST. NUMBER
********** ***********OFFICIAL USE ONLY****************************'t******
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD rPECTOR-HEALTH DATE APPROVED
7 r __ DATE REJECTED
INSPECTOR -HEALTH
COMMENTS U
e S o +,,4 7ajL-
a ^1'
(-PUBLIC WORKS - SEWERIWATER COI
DRIVEWAY PERMIT
DATE APPROVED (Z,111,10-5
DATE REJECTED -T—
c
nS+rU�dIvn
)old
Ip,20 -03
FIRE DEPARTMENT �� 6 AJ-Bc,-A .'n (�0�1 d�� S t�(c tel• <<ti� l IO�Z7�� 3
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 Jm
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
Numberis that the debris resulting from this work shall be disposed of in properly
licensed solid waste disposal facility as defin'-d by MGL Chapter 111, S 150 A.
The debris will be disposed of in:
A S W 4t si 944uza-Gck, A /-/
(Loc =ion of Facility)
9�&�Sllignature of Permit Applicant
T Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
3�v'Ateo .°6N<
60 :,
0 � _
Town of North Andover e
0
Building Departmenty�°''
I 0 Ar- 1fFy�G
27 Charles Street �SSA�HUSES
North Andover MA 01845
Tel: 978-688-9545
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE tO tz-z'03
JOB LOCATION \ _71, 2 � i
Number Street Address Section of Tc
"HOMEOWNER C(—)b -?2'S C.&C,CIL 657 r1cl8D 2x+ 3ry�
Number Home Phone Work Pho
PRESENT MAILING ADDRESS
City Town
State
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of 1 or 2 units and to allow such homeowners to engage an individual for hire who does
not possess a license, provided that the owner acts as supervisor. (State Building Code Section (108.3.5.1)
DEFINITION OF HOMEWOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which of two
there is, or is intended to be, a one family dwelling, attached or detached structures
accessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 108.3.5.1)
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned "homeowner" certifies that he/she understands the Town of No. Andover
Building Department minimum inspecti n procedures and requirements and that he/she will
comply with said procedures and requir�emegts
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
Revised 4.30.03
Home owner Exemptions Form
Name
Name:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
City . (" 44 g P y A A Phone
I am a homeowner, performing all work myself.
I am a sole proprietor and have no one working in any capacity
Please Print
1 am an employer providing workers' compensation for my employees working on this job.
ii:
33 �Q
Z
Insurance. Co. fro' r Sc� � �nS` 1, cy Policy # C ' 3 S -73 3 F'. -
Company name. ,
Address
Phone*
Failure to secure coverage as required: under section 25A or MGL 152 can lead to the imposition of criminal penal of afrne up:to S1,Si
and/or one years' Imprisonment.asLas_civel.penaltlessio2heSamad a-STDPYAD.RKDRDERmd�a.fine-dA$ XM)ajdWaj�tme
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
penalties of perjury that the MormaUon provided above is bw and c onect
-t 72
Official use only do not write in this area to be completed by city or tam ofliciar
City or Town Perrnit/Lit�nsi
C]Check if immediate response is reguved D Building Dept
0 Lk:enWrig Board
.0 Selectman's Office
Contact person. Phone # D Health Department
D Other
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Date .....
TOWN OF NORTH ANDOVER
This certifies that../,Z//,;t
has permission to perform -
wiring in the building.pf]21
at ... 7
Fee ...�5.:P. Lic. No..
Check #
54 li 3
PERMIT FOR WIRING
........................... ...............................
... ..... .. . 4
et� J
�e ... ...... ................... / ....... - .........
......... ............... . North Andover, Mass.
Iq............ ..iLi A**L* 1* N**S*P'*E* C -M- * R- * * * * * * - * ... -
f � r�JIf
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The Commonwealth of Massachusetts
Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR
Office Use Onlyj/
Permit No. `�
Occupancy & Fee Checked 1
3/90 (leave blank)
APPLICATION FOR PERMIT TQ PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Mas chusetts Electrical Code, 527 CMR 1r2/00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) k Date
City or Town Of A/L19r aN70 U& 15 To then pector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
ea kSS /D /?J
Is this permit in conjunction v44 a building permit- Yes ❑ No� (Check Appropriate Box)
Purpose of Building YES, DE/< bn r G!/f~���tS Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd ❑ No. of Meters ❑
New Service Amps / Vohs Overhead ❑ Undgrd 0 No, of Meters ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work _/1-57/9-1,1.47`I w �� fF� G!/? 0- �/ �� S
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total KVA
No. of Lighting Fixtures
A v Grd
Swimming Pool In Grd 0
Generators KVA
No. of Receptable Outlets
No, of Oil Burners
No. of Emergency Lighting
Battery Unit
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local 0 Municipal Connection ❑ Other 0
No. of Ranges
No. of Air Cond. Total Tons
No. of Disposals
Heat Total Total
No. of Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devics KW
No. of Water Heaters KW
No, of Signs No. of Ballasts
Low Voltage Wiring G�
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 0 NO 0 1 have submitted valid proof of same
to this office. YES 0 NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box.
y INSURANCE k BOND 0 OTHER 0 (Please Specify)
Estimated Value of Electrical Work $ 1"'14—
Work to Start Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM NAME ,S PW7% ' A,, 1.)E �E��t.tR 1 7`Y 2/?() -QC7 '( 0 N �_ Lic. No.
Licensee,��L C4 ;�70/-217U A j a -� o , Signature J� �+ Lic. No. J Q
Address e2 �/�� /71.1 0� Bus. Tel. No. , �� !p 3a —�c�7 a Alt. Tel. No.
rrn C,. --
OWNER'S INS/ ANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Law),4nd that my signature on this permit application waives this requirement. Owner 0 Agent 0 (Please check one)
S -k3-;' --)-x-50 - $ ys, 610
10
Date... �..�.. 3.....3.....
t �40RT' '1
°;•�."�, TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
7oti{�/jv --
This certifies that ..................................... l% 5.............. .. f. ...................
has permission to perform.......Te M P S ;P,- v i c •e
....................................................................
wiring in the building of .........7::a.) ...�J..: P j .. f .............................................
0 69
at .......� ....... .!4... f .......... � i� ................. , North Andover, Mass.
t Fee... . ?.. .... Lic. No G. 3{�D ... �e Co .... I .M M (. �......
P ELECTRICAL INSPECTOR
Check # / '`
47GJ
THECOtMMONWEALTHOFM4SSACHUSETTS Office Use only
DEPA)UA1EVT0FPUX1CSAFE7Y Permit No.
BOARD OFFIREPREVEN170NREGUL9TlONS527 CMR 12,V 0
Occupancy & Fees Checklt
APPLICATTONFOR PERMIT TO PERFORMELECTTZICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date�/,,—�
Town of North Andover To the Inspector of Wire:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 70 no k P S n r
Owner or Tenant All Aoy &o -
Owner'sAddress `70 C3a1CeS nl
Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box)
Purpose of Building Utility Authorization No. _
Existing Service %[)0 Amps//=Volts Overhead E3 Underground M No. of Meters
New Service Amps�Volts Overhead M Underground 1:3 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work l e wi=PI'V I C
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
round
round
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency 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
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
�.
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER;
14
hmu =Commge. Pmao ttothemgtmar)vsofM tsGerlfalIaws
o IhaveacmlattI�ahWImnanoeR)hcyinchrlmgComplele CDwWoritswbszlialegt dbtt YES NO
of
Ihaveabmodvandptoofsametotheoffic>w YES j� Ifyouba edrdodYES,ple"i rficatethetypeofco by
drddngdr, box L�-
INSURANCE BOND or1HQt (PleaseSpec yy)
E#aliml)ale
Edd VahteofFJe�acal Wolk $
Wo&toStadl fIT 4-Roquesied Rao rpt -n - --lJ
Simted turner tTie pmaltie c of rem mr
I' I i�s/]11'�Yntrii7i'
OWNER'S INSURANCE WAIVER; I am aware that the Lx)mw- does not have i
and da inysiguhr<eonthispeunitapplicationwat*MNthistegtmart l
r (Please check one) Owner F-1 Agent
Signature o , wner or Agent
UccmeNo
Bitsitte`csTel. No. 9 7A'.2l -7S
I/ — Id LIT- Alt Tel. No.
Grits a bsla"equivalent as required by Massacbusets Geneaal Laws
Telephone No. PERMIT FEE $
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
Name:
Location:
City Phone #
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
City: Phone #
Insurance. Co. Policv #
Company name:
Address
City: Phone#:
Insurance Co. Policy #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,5oo.00
andfor one years' imprisonment.as well_as_civil.penaltiesin-theJnrm-faSTOP WORK ORDER.arad_a.fine_of.($1D.O.DD)-atlay.againstme I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
l do hereby certify under fhe pains and penalties of perjury that the information provided above is true and correct
Signature Date
Print name Phone.#
d
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
El Building Dept
E]Check if immediate response is required [] L cenS09 Board
p Selectman's Office
Contact person: Phone #: E] Health Department
Ei Other
Date...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4�
This certifies that ... ........ ZfXjf:_.......................
has permission to perform ....mss . -...:1..../---) .............................................
wiring in the building of .................................................
/�"
at.... ....... ................................................. n ............. . North Andover, Mass.
Fee ... ................. Lic. No ...: e4zy ....... . ...............
ELECTRICAL INSPECTOR
Check #
5353
THECOMMONWFALTHOFMA,SSSACHUSLTIS Office Use only
DEPARTVIDVT0FPUBIICS4FEIY ,
Permit No.��
BOARDOFFMPREVEM OINREGUlA770N 527CYII1120 cfv
Occupancy & Fees Checked ` f
APPUCATTONFOR PEI�T TO PERFO' ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -7-R-(3 4 -
Town
Town of North Andover
The undersigned applies for a permit to perform the electrical work
Location (Street & Number) 7 Q (Do l
Owner or Tenant �'i-r; +1- Tr-, 1
Owner's Address
To the Inspector of Wires:
Is this permit in conjunction with a building permit: Yes IMP E3 (Check Appropriate Box)
Purpose of Building —Mew 11 h nth e Nw
Utility Authorization No. 9�
Existing Service Amps �Volts Overheada Underground No. of Meters
New Service Amps.ZJ2ZZtaVolts Overhead M Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work N P_ ►:t) AA D m n GL/s.�t.y r=o
No. of Lighting Outlets
No. of Hot Tubs
No. f Transformers
Total
No. of Lighting Fixtures
Swimming Pool
Above
0
Below
El
Generators
KVA
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
FIRE ALARMS No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local � Municipal �
Connections
Other
No. r of ers
Heating Devices KW
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER-
hmuanaeQmmW. RmalttDft e4mmlcr&4MassadxBMGffnalLaws
Iharea=fftliabl7itIN==PbkymchxiTCm CDwWoritsmbsWrialequiAdt YES10 NO
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Licensee_ 1 CA n M as An Sigtiatuue
=-
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AItTeLNo.
OWNER'SINSURANCEWAVER;IamawarethattheLicensedoesnothavethems.ItarloeODIUI eoritssttbstatdWAvalentasmgttitedbyMassaclalseMG=n dLaws
and dAmystgna treonthispemritapplicatimwai es thismgtlueml
(Please check one) Owner M Agent
Telephone No. PERMIT FEE
Signature o caner or gen
1d-,
It
Location /70 DA KFS I? No. a
Check # -�g 16 i
i
t
16676
Date /-"� ` -3
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee A -2e $ 60
TOTAL
Building Inspector
I
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: 3 DATE ISSUED: ,
�C �-
SIGNATURE:
Building Commissioner for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
11 0 f�Information: �C V
Map Number Parcel Number
l.3 Zoning
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
keguir,ed I Provide R 'redProvided
Reqtlired Provided
N4
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public Private ❑ Zone Outside Flood Zone ❑
Municipal ❑ On Site Disposal System
SECTION 2 - PROPERTY OWNERSHIP/AUTHOR I)lAGENT
Historic District: Yes No
2.1 Owner of Record
�C°-vr- (�
Name (Print) Address for Service:
n
, r
Si re Teleplgne
YY �S
2.2 Owner of Record:
,a
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
-D A(") JCn A111-)
Licensed Construction Supervisor:
o (p /
I k A . k &fit � 4
l
License Number
Address
CC
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
IN
Registration Number
Address
Expiration Date
Signature Telephone
T
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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 aermit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check ad applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
"kf�-2L-bU"--.01,N&I
I SECTION 6 - F.STiMATVD CnNCTR11TVT1nN VncTC I
Addition ❑
Item
Estimated Cost (Dollar) to be
Completed brmit applicant.��
UFC 1TSE {NIxY= ��:
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
Q ,
3 Plumbing
Building Permit fee (a) x (b)
60,
4 Mechanical HVAC
5 Fire Protection
6 Total (1+2+3+4+5)Check
Number
-3M%—iiv11 1V L$h q—UMFLL' JEV WHEf4
OWNERS AGENT OR CONTRA/JC/TOR APPLIES FOR BUILDING PERMIT
lG2la. • ����2�� 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 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
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1sr 2ND 3 RD
SPAN
DIMENSIONS OF SILLS
DEVIENSIONS OF POSTS
DEVIENSIONS 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
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro
Boards and Departments having jurisdiction have been obtained. This does not retie
the applicant and/or landowner from compliance with any applicable or requirements.
"------""""APPLICANT FILLS OUT THIS SECTION
APPLICANT S O -fl 1.A .� bo PHONE
LOCATION: Assessor's Map Number b PARCEL '4Y
SUBDIVISION LOT (S)
STREET O [. R l b ST. NUMBER
----
USE
RECgMMENDATIONS OF TOWN AGENTS:
CONSERVATION AD
COMMENTS
l
TOWN PLANNER
TOR DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE -REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9W jm
r
3MARK: SPIKE IN 18" OAK \ �'
184.50 (assumed datum)
\ 2" SCH 40 PVC \ a
1 \ FORCE MAIN \
1000 GALLON
\ 'R MP CHAMBER
1500 GALLON _
SEPTIC TANK
y/ TP 2
ov
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OA
0
1116-00
0
'x`.00
O9
i
_ 0' PRESSURE
�W�AT�R SERVICE
lb Q
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I�7 03
' 1
' 1
0
+ PejOO Ci t (uA) -(0
M e�(CS ] o T S ._A, ,may v Vie
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*4***************************APPLICANT FILLS OUT THIS SECTION*********************** �
APPLICANT c �Q� PHONE 9'�Q -7 Z.'> C, G
LOCATION: Assessor's Map Number V� PARCEL f S
SUBDIVISION LOT (S) 773
STREET�o,_� , ST. NUMBER O
USE ONLY***********************************
REW41MENDATIONS OF,'WWN. AGENTS:
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
41 SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS .
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197Im
Town of North AndoverOo oTh qti
Building Department �= y`:''_ '- :°6'° 0
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
,- �9SSAC
Buildine Demolition Affidavit NUS����
DATE C '
S / r
OWNERS NAME &ADDRESS C'.b w►� C� J� Cc. 0
i
PROPERTY LOCATION `7�O A k . r V'
DUMPSTER- ON/ OFF STREET
41
DIG SAFE NUMBER
BLDG. INSPECTOR �I/l U� �9-�-�— _ DATE ACT
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 properly
licensed solid waste disposal facility as defn,, ;d by MGL Chapter 111, S 150 A.
The debris will be disposed of in:
S W Ai si �Lcel ��/ .(����T fA-Cot,
-- (Location of Facility)
Signature of Permit Applicant
i'
� t
i
I
8' 63 '
Date
i
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
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Location
No. 1,, 5 � Date
�,. TOWN OF NORTH ANDOVER
i
• ; . Certificate of Occupancy $
�'�s • °'�t�'
Building/Frame /Frame Permit Fee $ .
,4CMusE 9
Foundation Permit Fee $
• Other Permit Fee $
TOTAL $
Check # 5
/ Building Inspector
1.1 Property Address:
14 Vey
4411,
1.2 Assessors Map and Parcel
2 -co
Map Number
Number:
poi
Parcel Number
Signature Telephone
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (so
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Required
Provided
Expiration Date
3.2 Registered Home Improvement Contractor
Aie v�0 dl%)O
1.7 Water Supply M.G.L.C.Q. 54)
Public ❑ Private ❑
1.5. Flood Zone Information:
Zone Outside Flood Zone 0
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
D P 6 /214 of 1�'
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Tele hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
-
Address
Signature Telephone
Not Applicable
❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Aie v�0 dl%)O
Not Applicable
❑
Company Name
/, 0 C��'
Kl l'� It'�t— G/G
Registration Number
Addles
-/&/ SDI?
Expiration Date
Stature 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 buildA armit.
Signed affidavit Attached Yes ....... V No ....... ❑
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify j'���/f,.,
Brief Description of Proposed Work:
1 SECTION 6 - F,STIMATFI) CONSTRUCTION MRTC l
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
t)FFICdAL USE ONLX
>f 3
1. Building
,a
r 'V
(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
b Total 1+2+3+4+5)
Alrl
Check Number
�a:�,11Vi� is Vrrl�l.11 t1U 1Y1V1C1GH11V1`I iV lTi', LV1VlYLiilLl1 W11E1V
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, A( (-AW
Date
to act on
Owner/Authorized Agent of subject
property I
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print N
Ownier
5
7-1V I
Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlVIBERS 1 ST 2 ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHNINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
i
0
JUL-20-01 FRI 3:03 PM
P. 2
is ❑
17 t1
GUT TERS/LEADEnS - remove existing and replace with new custom seemlece gutters and readers. White--- Drown -
- t ' F.I.D. No. 11-Z320[4J49
%r MIA&
ME Lfc. No. 001693
l
.lob A' �j `� ` (� 1 �
/LC`C ,/, lel
NH LiC. No.
FOR ALL
HomeCentral"
MA Lie. No. 120400
NewSALES! York Consumer
New York! SERVICE/FISPAIRS
❑
Aus
Allaire LIC. No.
. No. F
800.942 -Gill PLEASE CALL
The Service Side of Sears
H20041
Naeseu No, H27tl415tx2ao
Boston: 888.245.7294
190 Cedar HILI Road
IO.
Suffolk L1O. No, 2111941,11
Yonkers 1397
800 -SEARS -31
Marlboro, MA 01752
Wemcheattr wco813,fteT
Hartford Area:
800 -SEARS -99 SIDING CONTRACT
New Jersey Lla, No. L011604
ConnsLie.No. .02774 lnor
Providence Area- sola,FbrM1tsAelaMshlledeyelll-Rardiennnumai4lneCorp. atgdlene,Inc.
Affairs Lie Lie. No. g05a277e
VTLIc,No,.___,.,_,
888.732.7151
880 -SEARS -51
A siert Aulhenttd Centnidu
to Elrtiol Reed, Elroenl NY 11003
_
ghoda Island Llc• No, 197tY7r
LD
TO'"
DATE
10 Oft.E_A0pnESS ,�!
( /�PHONE (Nome) (p
�)
CITY STATEL� ZIP018—If
PH N ---
0 E (Work) ( )--_,..._......,.,,,..�_...
JOS SITE ADDRESS (II different)
APPLIED VINYL & ALUMINUM SIDING y
General bescriptio of Work at Above Address: Approx. Start Date
Typo of Nouse Frame; ❑ Masonry Approx. Completion Date 7.�sL✓ V �_ _
SPECIFICATIONS
Sears approved materials will be lurnlarred and Insfattod to time specification$:
YES NO PLEASE READ CAnFFULLY: ONLY THE rrEMS CHECKED "NES" Ani: INCLUDED iN voun ORDFR
1, rJ SOLIb VIN L lr c er 44My natwall rens designated for aiding, ex se areas designated below. Size
Color/ rllxlC lt/ sfrPacoa w(! L _ Package —S 4 Custom corner posts colo.
1A. ad' ❑ SIDING Mir be applfod to the following areas on
,V;. Front Elevation % Right Elevatlon 0 Entire Details:
Apar Ebvmlon fd"'LeR Elevation WPArlial (Sts OtTARa)
❑ Other ❑ (SEE OFTAiLS)
2. (j INSULATION - cover only 110wall areae designated for siding with ED_ inch Irrsvlallon.
3 Pq ❑ Use Soars approved GALVANIZED STEEL STRIP whore contractor deems necessary. (Not avaNabte with Nainto.)
4. rJ 9 Slding to be appnod over exlaling foendato.
5 Use Soars approved DERMA ZAGS AND FINISH SYRIP where contractor dooms 1100e90ry In same color as siding. (Not avalla()t0 will, NeA1(e,)
9DOW OPENINGS
Custom wrap with Sears approved vinyl clad aluminum Color oi, ee q
❑ Jump over castings with siding and -J" channel a Color��
❑ Channel existing window only (00. Andersen type or previously wrapped) A Cotor .__^,, _
Botallo
7. Gil ❑CttULK - aA ellla cutin rubbariied color co-ordInsied caulking.
B, p3f CI DOORS - cuafbnr wrap with SEARS approved VINYL CLAD ALUMINUM, R of Doore`�_ Colnr LQ -v n
g• Int" ❑ GARAGE DOOR FRAMES - custom wrap with SEARS IlWavod V(NYL CLAD ALUMINUM. color e✓ ,
❑ Single n Double With Mon O Double No Mull
t g. jG I'1 FASCIA - custom wrap with SEARS approved VINYL CLAD ALUMINUM. Color
11 Gi Rr SOFFIT .
(eavos/ovorhange) cover with $EARS approved SOLID VINYL SOFFIT SYSTEM. Ex opt area noted below. 1/3 Vented.
Cnior_
12. * ❑ 1201 TEN WOOD - win only be repaired or replaced where spooned on nne item y27 listed below. Any additional areae needing a
1`001? OAR be eatlrnated upon their discovery and priced accordingly. (Does not include wood studs, or exterior shootlring.)
13 E7 yC I'lamovo existing material on extortor of house.
❑ Vinyl Gil Aluminum 0 wood Shingle ❑ Wood Siding O other
Does not Include any asbestos removal.
14 (,I g PORCH CEILINGS -cover with SEARS approved SOLID VINYL CEILING MAIIEWAL O the following areas
Cash Sato Total $14dVi0,'S _ Less deposit 33% $ Cash Balance $ mJ��I Cher Payment (il any);
C1 GASITYfINANCED does not Include interest palance on Substantial Completion
11 financed, balance P"Oble In V LIINnthly nstallmonls of approximately S _a.6ar month, payable by "Ownae' to oo,ltraetor, but
If anpnced by Owner Ilion Owner win pay saki noun) to the lending Institution plus such In erest and credit service Cher" of sold lending Insutunon
payOle Oracily to the terlcnng InsliMlon loaning such monies to "Owner" and will execute a tan Installment obligation and any,iocumgnts roldrod by
such lending InsWO nn N T to b tan With Said toah�l �
26 Cl (� W011K NOT t0 be
27. pro' r,') 001011 Or non-strvcfural Carpentry Included.
Notice: If financed, any holder of ibis consumer credit Cohtract It Sub-
sect to all clalms and delahses which the debtor could assert against
he seller of goods or services obtained pursuant hereto or with the
proceeds hereof. Recovery by the debtor shall not exceed amounts Dold
by debtor hereunder.
"OWNER REPRESENTS TO HAVE READ AND RECEIVED A DUPLI-
CA1E ORIGINAL OF THiS AGREEMENT AND TO BE THE AUTHO-
RIZED AGENT OF ALL "OWNERS" OF THIS PROPERTY UPOt4
WIIIC14
SUPPLIED.
NOTICE TTHE OW EE(GUAANTOR($), LFSSEE(S),
CO•SIGNER(S).
Contractor, al 1ha expense of owner, shall procrlre all per111113 requiraa
by law as follows.
1. Owners who secure their own permits will to o1clud9d from the
guaranty land provisions of MSL Chapter 142A.
21 Any persen who chill have co-signed, guaranteed at Signed any
credlt application or not$ Foisting to this agreement hereby aecepls
to be bound by this agreement.
3, Own$r(s) representS that the contents on the back of This agreement
Is a true part hereof and has been reed and accepted by Owner•
4. All INSTALLATION LABOR GUARANTEED i (ONE) YEAR,
Print t✓� (�/� �/Ui �/ (/�
snimsrnon'e Na,ne
Snlorn von's
L1canS4 No,
Slgnalutw)(
ANT REFRESENiA IONMAN HAS NO S (10ITY Ito OTHER 711ANIICONTAINED ANGE ANY IIII MHIS AGTIEF
MENT ANO "OWNER" REPRESENTS TIIAT NONE HAVE GLEN MADE TO
OR RELIED UPON BY "ONtNEh-. YOU ARE ENTIiLED 10 A COMPI.FTK-
tY FII,LFO IN OIIPI.ICAIE DRIGIIIAi- Or TH15 AOhLtmFNT.
"YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY
TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY
AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED
THIS RIGTICE HT. ON ALL ORDERS CANCELLATION CANCELLED AFTLR TFOR AN HERIc`ICISIDN
PERIOD, CUSTOMERS WiLL BE RESPONSIBLE FOR A 20%
ADMINISTRATIVE AND RESTOCKING FEE,
THE COMPANY WILL DEPOSIT ALL MONIES RECEIVED ritOM
IN AN ESCROW ACC_ NT AT CHASE MA TTA BANK 1105-1-
062069 WITHIN FIVE BUSINESS DAY$ OF ITS RECEIPT.
Dale
bo not Sign this agreement balers you rood it or if 11 contains any blank
space or 1111 does not contain everything agreed upon.
DATE "0 -C j
(cuutaMar Sign slams ----
SEE REVERSE SIDE FOR ADDITIONAL TERMS AND CONDITIONS Rev 3/01
BEAMSICOLUMNS- wrap with SEARS approved VINYL CLAD ALUMINUM (No circular or round columns). Cott
is ❑
17 t1
GUT TERS/LEADEnS - remove existing and replace with new custom seemlece gutters and readers. White--- Drown -
iN N
r j
SI IUTI ERs - provide and install pair SEARS approved polystyrene shutters. Coot
MASiEA MOUNTS -provide and Install for , e x:�:' aL eras ons olor 1 fro 1Y
19 GQ
I 1
. .;;: .
GABLE VENTS • provido and install _— ._ vonls, Color fAl I `W., °�
20 1�1
11
No Grcu(or or Ulanylq vents.
CLEAN UP plopony At cornpleFon or work,
21. 61
❑
INSURANCE - an redUlmd WORKMANS COMP. AND LIABILITY to be maintained
I int Ix,.:, ns,rm
22 i>Y
23. 1
❑ /WAnRANTY - mall to customer aller completion and full paymerA IS received.
Di' PAYMENTS -On NON -FINANCED orders InsiaRar 1s authorized to
, „ a nrnn n�un,I
24.
O
collect progresabe Payments.
ALU DISCOUNTS APPLIED.
25
❑
-•-__--....._ _..... _. „ ., .
ADDITIONAL WORK, not specioed above.
Cash Sato Total $14dVi0,'S _ Less deposit 33% $ Cash Balance $ mJ��I Cher Payment (il any);
C1 GASITYfINANCED does not Include interest palance on Substantial Completion
11 financed, balance P"Oble In V LIINnthly nstallmonls of approximately S _a.6ar month, payable by "Ownae' to oo,ltraetor, but
If anpnced by Owner Ilion Owner win pay saki noun) to the lending Institution plus such In erest and credit service Cher" of sold lending Insutunon
payOle Oracily to the terlcnng InsliMlon loaning such monies to "Owner" and will execute a tan Installment obligation and any,iocumgnts roldrod by
such lending InsWO nn N T to b tan With Said toah�l �
26 Cl (� W011K NOT t0 be
27. pro' r,') 001011 Or non-strvcfural Carpentry Included.
Notice: If financed, any holder of ibis consumer credit Cohtract It Sub-
sect to all clalms and delahses which the debtor could assert against
he seller of goods or services obtained pursuant hereto or with the
proceeds hereof. Recovery by the debtor shall not exceed amounts Dold
by debtor hereunder.
"OWNER REPRESENTS TO HAVE READ AND RECEIVED A DUPLI-
CA1E ORIGINAL OF THiS AGREEMENT AND TO BE THE AUTHO-
RIZED AGENT OF ALL "OWNERS" OF THIS PROPERTY UPOt4
WIIIC14
SUPPLIED.
NOTICE TTHE OW EE(GUAANTOR($), LFSSEE(S),
CO•SIGNER(S).
Contractor, al 1ha expense of owner, shall procrlre all per111113 requiraa
by law as follows.
1. Owners who secure their own permits will to o1clud9d from the
guaranty land provisions of MSL Chapter 142A.
21 Any persen who chill have co-signed, guaranteed at Signed any
credlt application or not$ Foisting to this agreement hereby aecepls
to be bound by this agreement.
3, Own$r(s) representS that the contents on the back of This agreement
Is a true part hereof and has been reed and accepted by Owner•
4. All INSTALLATION LABOR GUARANTEED i (ONE) YEAR,
Print t✓� (�/� �/Ui �/ (/�
snimsrnon'e Na,ne
Snlorn von's
L1canS4 No,
Slgnalutw)(
ANT REFRESENiA IONMAN HAS NO S (10ITY Ito OTHER 711ANIICONTAINED ANGE ANY IIII MHIS AGTIEF
MENT ANO "OWNER" REPRESENTS TIIAT NONE HAVE GLEN MADE TO
OR RELIED UPON BY "ONtNEh-. YOU ARE ENTIiLED 10 A COMPI.FTK-
tY FII,LFO IN OIIPI.ICAIE DRIGIIIAi- Or TH15 AOhLtmFNT.
"YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY
TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY
AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED
THIS RIGTICE HT. ON ALL ORDERS CANCELLATION CANCELLED AFTLR TFOR AN HERIc`ICISIDN
PERIOD, CUSTOMERS WiLL BE RESPONSIBLE FOR A 20%
ADMINISTRATIVE AND RESTOCKING FEE,
THE COMPANY WILL DEPOSIT ALL MONIES RECEIVED ritOM
IN AN ESCROW ACC_ NT AT CHASE MA TTA BANK 1105-1-
062069 WITHIN FIVE BUSINESS DAY$ OF ITS RECEIPT.
Dale
bo not Sign this agreement balers you rood it or if 11 contains any blank
space or 1111 does not contain everything agreed upon.
DATE "0 -C j
(cuutaMar Sign slams ----
SEE REVERSE SIDE FOR ADDITIONAL TERMS AND CONDITIONS Rev 3/01
NOW-
��, .fir
;OM=1'czGVS'l"cM I CON i rACTaP= R ----
F
--
ccDa L C,;- E Ging i�call� c�.101-f5 and �L.cI C -I '-
One ,=A=ntur tan P1 -=c= -
Room 101
O_ 1 0 E .
H C M E 0 V E M rEN I C IN T R. C 1 O
01 /01 /02
L -P.^ ;SLUM- S_n NC CORP
JOHN O'Nc_L
40 ELMON i FC,
EL` CNT NY 1100
VQLI L -V �uu, 11VIY ur.jc nI
,. .._
IUhEfe
t'HX NU. I'. Ul/01_
06/25/2001 14;30 5168295057
SCSAGENCY PAGE 02/62
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13 CONFERS NO RIGHTS UPON THE aFMFICA'TE
ix Grace avnt�ue5000
sni t4
THIS CERTIFICATE DOES NOT AMEND, EMND OR
HE
ar�at Naok :PSt 11032-13493
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COVERAGB AFFORDED BY THE POLICIES 9ELOW.
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ei1-Ray Alin= siding Corp.
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Scott2daia znauranea Company
40 Shoat load
Bl=nt NY 12.003
I COPA
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TH13 q TO Cr;MFY THAT T= POL)CEa OF (MbURANCt Ly'TLD BQI.OW flavC SEN ISOV&DTD 7 E N
RIDICATE3 , NOTWITTIVANDING ANY RJiQUIFZ%"ff, TERM OA CONDITION OF ANY CaYTRAf,T 0 CT
:L1tT1FICATt NAY BE ISMZD OR MAY PERTAIN, 7-K INSURAN-2APPOICEID eV rK POLIC= Opq
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ANY AUTO
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WORKERS COMmNSAT70H AND
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INS.
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IUhEfe
08/25/01
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CACH OCCURRENCE
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PIRt OAMACS (Any om Aro)
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aujr r TQ MAIL bucrl NOTlCH sMAI.L N.Ircde NO DwGATI[M oR L).sJLrrY
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% Date. & -/, . r)� .....
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies ....................
as permission for gas installation ............................
in the buildings of ........
At .
.......... ..' North Andover, Mass.
Fee"R5. —6i ... Lic. No:� Y,71. ..........
/1 -GAS INSPECfiQFi
Check #
45'34
At
k
i
MASSACHUSEI'IS
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations =
1�1Q
New 31*' Renovation ❑
s Name
A
PE &ff TO DO GAS Ff FMG
Date j (� (� 30014
Permit #
SC. --t ' - 3I;,rb 6r,a, Amount $ dS , u c)
Plans Submitted ❑
(Print or type)
Name
1 Pim +- 4g �
Address �l -92 11'3 S IS O G`
714,\Sborc> M (:N- oIff `f
Name of Licensed Plumber or Gas Fitter k e r) n J Vl m C5 i— r1
Chec e: Certificate Installing Company
Corp.
❑ Partner.
❑ Firm/Co.
INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked yes, please to to 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 aetatts ana miormaaon i nave suuuu«Gu kUl UJILGICU) in auvvc QFFJ1 auw, — Ll— -- --- w
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 Massachi4setts StatGas Code and Chapter 142 of the General Laws.
KA-4� 5 P, r-', r\
jjy:
Title
City/Town
OVER (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
❑Plumber Qo: q 7q
❑ Gas Fitter License Number
94��
teourneyman
AM 0; OAS PER I
(Print or type)
Name
1 Pim +- 4g �
Address �l -92 11'3 S IS O G`
714,\Sborc> M (:N- oIff `f
Name of Licensed Plumber or Gas Fitter k e r) n J Vl m C5 i— r1
Chec e: Certificate Installing Company
Corp.
❑ Partner.
❑ Firm/Co.
INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked yes, please to to 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 aetatts ana miormaaon i nave suuuu«Gu kUl UJILGICU) in auvvc QFFJ1 auw, — Ll— -- --- w
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 Massachi4setts StatGas Code and Chapter 142 of the General Laws.
KA-4� 5 P, r-', r\
jjy:
Title
City/Town
OVER (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
❑Plumber Qo: q 7q
❑ Gas Fitter License Number
94��
teourneyman
FA
J, /
CERTIFICATE OF USE &OCCUPANCY
TOWN OF NORTH ANDOVER
L{,alluulg Permit Number /-/ 173 Date - % - a 47 -
THIS CERTIFIES THAT
THE BUILDING LOCATED ON '% O O /g Ac £ .5 DIR iy E -
MAY BE OCCUPIED AS
c, i)62y m S/ 2 / 3,q -rh s . 3 S 4—, // .A 61A c 4
IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO -SC O % �o
17 d
Building Inspector
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