HomeMy WebLinkAboutMiscellaneous - 71 ELMCREST ROAD 4/30/2018i
Date .. ..... Z 0...—/–,-?
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............T,
has permission to perform .......... /,-...7 ............•
wiring in the building of.. .. .......
.... ... ... ..... ..
at 71 ........
. ..� ...... . North Ando
y
er, Mass...... .........
Fee.. ............ Lic. No. ....... .e.... . ..........
.
AL INSPR
Check id
116,75
I
l.omnsonwea& of kaddac4weff6
2epartnud o f -7ire Serviced
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. 7
Occupancy and Fee Checked
[Rev. 1/071 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMAT ON) Date:
City or Town of: vr<i� ,,,�%, �� To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention o perform the electrical yrgrk descr,'bed below.
Location (Street & Numb ) rov,`�U`--
Owner or Tenant rtc�=/'-Fds lc�i,rC• Si�2✓> c E.� Telephone No.
Owner's Address
Is this permit in conjunction with a buil/`ding permit? Yes [� No ❑ (Check Appropriate Box)
Purpose of Building NEW Utility Authorization No.
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
Completion of the following table may be waived by the Insnector ofWire.c.
No. of RecessedLuminaires
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool A ove ❑ In- ❑
rnd. rnd.
o. o mergency Lighting
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
7No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of.Alerting Devices
No, of Waste Disposers
eat Pum
Totals
Number
I
TonsJ.
W
No. oSelf-Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No, of Dryers
Heating Appliances K
Security ystems:*KW
No. of Devices or Equivalent
No. of WaterKms,
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (>Zo (When required by municipal policy.)
Work to Start: (o/� Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cover e is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ND ❑ OTHER ❑ (Specify:)
I certify, under the pains andpenalties ofperjury, that the information on thisra�pU tion is true and complete.
FIRM NAME: =le , f,4,,"a.e , �Ll ;,-, Co - ® 11 I / LIC. NO.: /.3.t1'tA
Licensee: /AI Ci, A 6 / �,���� Signature
(If applicable, enter "exempt" in the license -number line.)
Address: C cv,i f "I 3
*Per M,G.L. c. 147, s. 57-61, security work requ' s Department of
OWNER'S INSURANCE WAIVER: I am a are that the License
required by law. By my signature below, I hereby waive this requir
Owner/Agent
Signature Telephone No.
LIC. NO.: .50,rj4
Bus. Tel. No: JPYY
v,% � Hi413V Alt. Tel. No.:
i c Safety "S" License: Lic. No.
does not have the liability insurance coverage normally
lent. I am the (check one) El owner ❑ owner's agent.
PERMIT FEE: $ �S
f -
1
The C&unonwealth ofMassachusetts
Department of Industrial Accidents
Office of Investigations
kip 600 Washington Street
Boston, MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluinbers
Apulicant Information Please Print Legibly
Name (Business/orgMization/lndividual): CJ<1 E& C- /�/
Address:
A
Phone #:-?N77
Are you an employer? Check the alipropriate box:
1. I am a employer with ./S
4. ❑ I am a general contractor and I
employees (full and/or part time).*
have hired the sub -contractors
listed on the attached sheet.
2. ❑ I am a sole proprietor or partner
These sub -contractors have
ship and have no employees
working forme in any capacity.
employees. and have workers'
[No workers' comp. insurance
comp. insurance.t
S. ❑ We are a corporation and its
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MOL .
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp, insurance required]
Type- of project (required):..
6. ❑ New construction
7. [] Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.® Electrical repairs or additions
11.El Plumbing repairs or additions
12.[] Roof repairs
13.❑ Other
*My applicant that checks box #1 must also 811 out the section below showing their workers' compensation policy information -
t Homeowners who submit this affidavit indicating they ere doing all work and then hire outside contractors must submit a new•afadavit indicating such.
;Contractors that check this box must attached an 'additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have etuplcyees, they must provide their workers' comp, policy number.
I am an employer that is providing workers' compensation insur� ante for »:y employees Below 3s lila policy and job site
information.
Insurance Company Name: c+f 24 / � � cr �A L vAg -✓ c f �� --
Policy # or Self -ins. Lie. M / 3365 (o 6 Expiration Date: 4
t
Job Site Address:
City/State/Zip: /� �%^�c�i✓. '. .
_ _._.._._ .._ _. _ _�_......____ ._.._ : �.._........__.....ti.._...........:_._......................
- j Attach-a-eol}l� a-iht:�t�or-ke s'-eompensn ion-policy-deelar-ation-page (showingthe pohc number and -expiration -date).-
Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/dr one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Ido hereby certg& ander tl:ns a d penalties of perjury that the information provided above i/s7 true and correct.
Phone :
use
area, to
.or town officiaL
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2: Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person, __ Phone #• __ _
t . I
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Date. J-.313' .
TOWN OF NORTH ANDOVER
' PERMIT FOR PLUMBING
This certifies that ..! ... t� ar! .. %�Y.� ....�. t.. '.
has permission to perform ... ... 0 `............ .
plumbing in the buildings of ..!'`�??�� ...vi `' .........
at .....)/ Yi�i. 6 ✓Led. 7.......... , Nortfi Andrerr,�,M�ass.
Fee 31160.. Lic. No.... P`. .?. y iC�?GfG!'.4,/. ...�? . ... .
PLUMBING INSPECTOR
Check .*,
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY 1 �- � �✓ MA. DATE 16�� PERMIT #
JOBSITE ADDRESS 1 C-_� OWNER'S NAME '
POWNER
ADDRESS 1 TEL FAX
TYPE OR
OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT
NEW: ❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑
CLEARLY
FIXTURES 7 FLOOR- BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYS
DEDICATED GAS/OIUSAND SYS
DEDICATED GREASE SYS
DEDICATD GRAY WATER SYS
DEDICATED WATER RECYCLE SYS
DRINKING FOUNTAIN
DISHWASHER
FOOD DISPOSER
FLOOR / AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE / MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER
INSURANCE COVERAGE:
I have a current liabilityinsurance policy or its substantial equivalent which, meets the requirements of MGL Ch. 142. Yeso ❑
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CH KING HE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 691 OTHER TYPE OF INDEMNITY ❑ BOND ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE BOX ONLY: OWNER ❑ AGENT ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the
best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in
compliance with all Pertinentprovision of the Massachusetts State Plumbing Code and Chapter 142 of t7eneral Laws.
PLUMBER NAME _ ENZ � 6 �C-0 SIGNATURE
LIC # MP ❑ JP P/ COIR�PtORATION
#1� PARTNERSHIP ❑ # LLC ❑ #
f❑I
^Y (`
COMPANY NAME a ` y �4 r) ADDRESS:
CITY �r�-� STATE ZIP ()-)6S-7 EMAIL
TEL CELL ( 6yacq--�"aq FAX
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N2 1905
OWN&
- VPWIMW
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Date ..... e)....5 7 ...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......
.......... ..... ...... r .................
V lr'
has permission to perform .........:e ........
wiring in the building of .............................................
............................
at ...... 2e......... .................... . North Andover, Mass.
a --e-'
Fee-/-/�? ..... Lic. Nof /
. ............. ................................................................
ELECTRICALINSPECTOR
10/06/99 16:21 40.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Office Use only
THECOMMONWFALTHOFAUMC HUSEnS
DEPARTA&WOFPIIBLICSAFM Permit No. 190.5
BOARDOFFIREPREVEAWONREGMTlONS5V M IZ'M s■ he
Occupancy &Fees Checked
UVAPPLICATIONFOR PERMIT TO PERFORMaECTRICAL 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) Dateo�,�_,�_,
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street A
Owner or Tenant
Owner's Address 4 i;l�"
� 111■YYI■Y ■� II I■ I�11 1 1■Y■■YYII■IYYYYYIYY■
Is this permit in conjunction with a building permit: Yes L-1 No (Check Appropriate Box)
Purpose of Building % (,c� � Utility Authorization No.,,,■
I�■�■Yi1 ■ I�Y��IYY■■I■p■I■YYY■iil IrYY�1.
Existing Service Amps / Volts Overhead r7 Underground No. of Meters
New Service Amps�Volts Overhead [Z] Underground Q No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work W1,10 441
No. of sighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
ground
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
LocalMunicipal
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
NQ. Hydro Massage Tubs
No. of Motors
Total HP
OTHER;_ I __
II eCova� Rvsu"io ttetacg�a u1so0�WsGaiealLaws
Ibmeaaa utLm iEtyh>stm=Pd ymdu&gCanpide CoArdWcritsmbstr6de* iva YES NO
Ilia%est hnAtedvalidproof,ofsatnetot rOffim YES rJ NO
BOND � 17 If}mbawdx&d dYFS,plemmdc*tttetypeofoo=Wbydxdcrgthe
INSIRANCE [D' a�._.1(> mSpeffy)
E t n"edVAxaft7ectndWbik $
�-0 �6 Fstal
WolkbStatt lIYYY�Y■Y■11■i11Y■�■ ■.I r � •`°^'6"
F!13,- • 1
6.
LioetseNa b 3 h 9 I
Lica>see S�'m /
419-� cl
/ y p BummTelNa 9%—�
Loo �70L-ni �Y ` %J, y N �a'v vy)A CJ4ti-cAlt.TeLNa
OWrgaVSP4SL RANC'EWAIVER;Ianmmt rttbeLva>Sedmsnut &msvrattoecotaagecritssu iegt wlentastetptuedltyM GenaalLaws
addi tmysguheonlhispan ttlpphcMnwaiA sftm* itentatt.
(Please check one) Owner Agent 17
Telephone No. PERMIT FEE $
w■Ir1��
Date.(".--.. .... 3
.......
OjOit..o
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .l.4&-.< r....1� .. �� .................... .
has permission for gas installation ... - :............. .
in the buildings of .... j'� 1.� �.............................
at . 7 .` :�....... . , North Andover, Mass.
Fee. 3L: .. Lic. No
GAS INSPECTOR
Check #
4371
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS WrING
(Type or print)
NORTH ANDOVER, MASSACHUSETTSL"-� -
Date ---C, 3 --a
Building Locations�� C ��� Permit # Y3
//
Amount $ o
aye–j� Owner's Name141 lee / !`i3 e- G
New ❑ Renovation ❑ Replacement 0/ Plans Submitted ❑
Name of Licensed Plumber or Gas Fitter Z54 C4�zLa.,s
Check one: Certificate Installing Company
❑ Corp.
❑ Partner.
❑ Finn/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑No❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑ Other type of indemnity ,❑ Bond ❑
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 13 Agent El
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued fbr t is application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code aro Chapter 142 of iYeGeneral Laws.
'AYYKV Y hi) (OFFICE USE ONLY) '
Signature of Licensed Plumber Or Gas Fitter
® Plumber 2 d2 S—
❑ Gas Fitter License Number
meyman
i 0 R
Name of Licensed Plumber or Gas Fitter Z54 C4�zLa.,s
Check one: Certificate Installing Company
❑ Corp.
❑ Partner.
❑ Finn/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑No❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑ Other type of indemnity ,❑ Bond ❑
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 13 Agent El
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued fbr t is application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code aro Chapter 142 of iYeGeneral Laws.
'AYYKV Y hi) (OFFICE USE ONLY) '
Signature of Licensed Plumber Or Gas Fitter
® Plumber 2 d2 S—
❑ Gas Fitter License Number
meyman
Location `71 Y1C Z T
No. ! Date ZA 4
0
v
TOWN OF NORTH ANDOVER
12
7599
Div. Public Works
Certificate of Occupancy
$
Building/Frame Permit Fee
$
�ss�cHusE<
Foundation Permit Fee
$
Other Permit Fee
_...
$ 2a
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
Building Inspector
12
7599
Div. Public Works
PEb1JilT NO.
411,
f'
MAP KJO.
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
INSTRUCTIONS ff P //)yy) /����,JJJJJ,[n/
SEE BOTH SIDES scrx I I � R•` A61�c
PAGE 1 FILL OUT SECTIONS 1- 3 J q- 's
PAGE 2 FILL OUT SECTIONS 1 - 12 / er
j ��/J p�•�
ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUSTF11/\ ^D AND APPROVED BY BUILDING INSPECTOR
DATE FILED:
TURE O3 OW
ft "OR AUjHORIZED AGENT
FEE
aE
PERMIT GRANTED PERMIT FOR FRAMUBUILDING
no- �z r 19
TE: 4- FEE PAID._�___�.__
If7srIq
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST GQ
EST. BLDG. COST PER SQ. FT. V V
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
NUILDING INSPECTOR
OWNER TEL.# &6
CONTR. TEL. # 6 A?6 _ _)o (0+
CONTR. LIC. #.
H.I.C.#
Ck4� oPfwooej
LOT NO.
2 RECORD OF OWNERSHIP ;DATE
BOOK ;PAGE
ZONE
SUB DIV. LOT NO.
LOCATION / �/ s�A%t -y.� �A
(/�
w 1►)
PURPOSE OF BUILDING
J`f4h'�l
OWNER'S NAME
NO. OF STORIES SIZE
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME
--
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME Cf //J�'S g j�o4 ,G �sl�X��
SPAN --
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
POSTS
DISTANCE FROM STREET
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING %
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS ff P //)yy) /����,JJJJJ,[n/
SEE BOTH SIDES scrx I I � R•` A61�c
PAGE 1 FILL OUT SECTIONS 1- 3 J q- 's
PAGE 2 FILL OUT SECTIONS 1 - 12 / er
j ��/J p�•�
ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUSTF11/\ ^D AND APPROVED BY BUILDING INSPECTOR
DATE FILED:
TURE O3 OW
ft "OR AUjHORIZED AGENT
FEE
aE
PERMIT GRANTED PERMIT FOR FRAMUBUILDING
no- �z r 19
TE: 4- FEE PAID._�___�.__
If7srIq
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST GQ
EST. BLDG. COST PER SQ. FT. V V
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
NUILDING INSPECTOR
OWNER TEL.# &6
CONTR. TEL. # 6 A?6 _ _)o (0+
CONTR. LIC. #.
H.I.C.#
Ck4� oPfwooej
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
STORIES
MULTI. FAMILY
OFFICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION
—I
S INTERIOR FINISH
CONCRETE
PINE
3
2 (3
CONCRETE BL K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B'M'TAREA
14 1/2 'L
FIN. ATTIC AREA
_
NO B M'T
FIRE PLACES
_
_
HEAD ROOM
MODERN KITCHEN
4 WALLS II
9 FLOORS
CLAPBOARDS
CONCRETE
EARTH
B
_
1
2
�_
3
_
_
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
HARD"J'D
COMMON
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
_
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. & FIOOR (-
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I- I POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
I HIP
BATH 13BATH I3 FIXE
_
GAMBREL
FLAT
M ANSARD
SHED
TOILET RM. 12 FIX.)
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 II
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
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 2nd _
ler 13rd
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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CLARK REMODELING,•
1SPECIFICATIONS AND ESTIMATE
BILL CLARK
16 LYNDALE AVE. -:- METHUEN, MA 01844 NO.
TEL. (508) 686-7064 -:- MA. LIC. 049212
Page No. of Pages
PROPOSAL SUBMITTED TO
Eiicl.1 c_ Koenig
STREET 71 Elmcrest Rd.
CITY, STATE AND ZIP CODE -No . Andover; MA.
ARCHITECT DATE OF PLANS
We hereby propose to furnish materials and labor necessary for the completion of:
PHONE 682-2398
JOB NAME
JOB LOCATION
Labor and material:
Strip and re -roof main house breezeway and garage
For the sum of
$2800.00
WE PROPOSE hereby to furnish material and labor— complete in accordance with above specifications, for the sum of:
Payment to be made as follows:
DATE 10/24/94
JOB PHONE
dollars ($
All material iguaranteed to be as specified. All work ar be completed in substantial workmanlike
manner according to specifications submitted, per standard practices. Any alteration or deviation from
above specifications involving extra costs will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays
beyond our control. Owner to carry fire, tornado and other' necessary Insurance.
Authorized
Signature
Note: This proposal may be
withdrawn by us if not accepted within days.
ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are
satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be Signature
made as outlined above.
Date of Acceptance: Signature
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OFFICES OF:
APPEALS
BUILDING
CONSERVATI )N
HEALTH
PLANNING
a
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Town of
a
'NORTH ANDOVER
CMUS
DIVISION OF
PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON. FAREC'FOR
120 Main Street
North Andover,
Massachusetts 01845
In accordance with
�he provisions 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 c 111, S
150A.
The debris will be disposed of in:
(Location of Facility)
_,&
&"
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
-this project through the Office of the Building Inspector.
Location 07/
No. 330 Date
ISL
,.ORTFi TOWN OF NORTH ANDOVER
09 Certificate of Occupancy $
Building/Frame Permit Fee $ -� r
Foundation Permit Fee $
s4CMU5E
Other Permit Fee $ _
Sewer Connection Fee $
Water Connection Fee $
TOTAL
1,
Building Inspector
17 U 08/16/99 14:43 52.00 PAID
Div. Public Works
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" Town of North Andover
NORTH
OMCE OFy,�Oct�io
f �
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COMMUNITY DEVELOPMENT AND SERVICES
10 x
27 Charles Street
.:
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North Andover, Massachusetts 01845
WILLIAM J. SCOTT
SA HU
Director
(978)688-9531
Fax(978)688-9542
In accordance with the provisions 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 c 11, S
150 A.
The debris will be disposed of in:
54 ,� 4- , o v,,,j ��e lj�,(Zcl e t
(Location of Facility) rlj
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
I
BOARD Of APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-95.10 PLANNING 688-9535
The Commonwealth of Massachusetts
Department of Industrial Accidents
Mice o//nyestlgaUons
600 Washington Slreei
Boston, Mass. 02111
Woruers' e.ompensatlon Insurance,•affidavit
name: . : >a ri-Ae- S �—re5 - ✓'�
location• tit• / 1 5 �-
phonc r
❑ I am a homeowner pe, rorming all work myself.
�I am a sole proprietor and have no one working in any capacity
71 I am an employer providing workers' compensation for my employees working on this job.
company nate:
iniaranr co
policy �
f-1 I am a sole proprietor, general contractor, or homeowner (circle one and have hired the coaaactors listed beiow who have
the following workers' compensation polices:
compinV name:
asidre:a:
city �7
phone
innir-Anyc co policy �k .....
company name
addre-i:
c1SY: phonc �-
Failure to secure coverage as required under Section 25A of :YIGL 152 can lead to the imposition of criminal penalties of a line up to S1 500.00 and/or
one yean' imprisonment as well as civil penalties in the form of:i STOP WORK ORDER and a fine of 5100.00 a day against me. I understaind that a
COPY of this statement may be forwardcd to the Office of investigations of the DIA for coverage verification.
do hereby terrify under the pains and penalties of perjury that the information provided above is true and corre=
Signature s / Dace -7Z, 3r Z-7
,\
Print name —Fe's} Kl Phone 4 T 7 D�j -49 "i
olTicial use only do not write in this area to be completed by city or town ufficial
city or (own:
check if immediate resoonse is required
contact person:
(rev,— )/95 PIA)
permiUlicense f i Building Department
❑ Licensing Board
CSeiectmen's Offiicc
CHeaith Department
phone k: ["'Other
FORM U - LOQ' 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.
******************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT. aA2 �7 ��i PHONE
LOCATION: Assessors Map Number 5.5 PARCEL 3 b
SUBDIVISION LOT (S)
STREET ST. NUMBER –71
USE
RECOMMENDATIONS OF TOWN AGENTS: 'FNC (OSE (� re -le z:
-
CONSERVATION ADMINISTRATOR
COMMENTS XV _ Le—K n
TOWN PLANNER
COMMENTS
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
Revised 9197 jm
DATE
Ju,
MORTGAGE INSPECTION PLAN
for mortgage purposes only
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.rcrL-TY L - cc: 3.
'Certification is hereby made to
that the existing structures shown on this plan are
situated on the tot designated in compliance with the
setback requirements of the applicable zoning bylaws
of the municipality when constructed, or are exempt
from violation enforcement action under M.G.L. Title
VII, Chapter 40A. Section 7.
'Certification Is hereby made that the existing dwelling
or principal structure shown on this plan
1. --'Is not situated within a Special Flood Hazard Area
2. Is situated within a Special Flood Hazard Area
3. Information Is Insufficient to make determination.
An elevation survey is advised.
as delineated on the FIRM Flood In urance Rate Map
Community No: ?-,5 0 0 9 8/ 000 3 C
Effective Date:- 'C" i 9 3
00
M
r%
cz:�' -""
ASC File # l3 Coo 5
0
CITY OR TOWN Qo.Avj MA
DATE -7 /1-5 A 8
SCALE: 1 inch = 3 o feet
DEED AND PLAN REFERENCE:
E S 9 rz; o rt T►� Registry of Deeds
Deed Book 41 3 9 Page Z C_ o
Plan Book Plan _ 38 c 9
'GENERAL NOTES:
A confirmatory survey is advised when structures
are shown to be situated at 1 foot or less from
property lines or required setback lines, or when
potential encroachments are noted. No responsibility
is herein extended to the property owner or occupant.
CertBicaflons and representations are on the basis
of my knowledge. Information and belief.
ALPHA SURVEY CORPORATION
126a Pleasant Valley St. - Suite 7 - Methuen. MA 01844
Telephone (978)Y975-5100 - Facsimile (978) 975-0135