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Miscellaneous - 74 PRESCOTT STREET 4/30/2018
l I ,r TOWN OF NORTH ANDOVER Office of the Building Department Community Development and Services 27 Charles Sheet North Andover, Massachusetts 01845 D. Robert Nicetta, Building Commissioner October 18, 2004 RE: 74 Prescott. Street North Andover, MA 01845 To Whom It May Concern: Telephone (978) 688-9545 FAX (978) 688-9542 Please be advised that the above referenced property has the required certificate of occupancy for the additional dwelling unit as required under the Mass State Building Code. Regrettably, it has been misplaced or misfiled but the assessor's office did have it as issued on 9/5/03. I hope that this letter will serve your needs in this manner. Respectfully, Michael McGuire Local Building Inspector Date... ...... ........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION . ' V CThiscertifies that .... . I ...... ......... ................. ........................................ Fhd's permission for ga stallation ..... ...... ... C-14 . ........ ...... in the buildings q .... . A.,�.N ............... ............................................................... at .... 7.19 . ............... .............................. North Andover, Mass. Fee ..(P.0.......... Lic. No....V.51145. ..M.I ............................................... GASINSPECTOR Check #� 098�8 G TYPE OR PRINT CLEARLY BOOSTER MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY IJoRt 4� fa i�MA -DATE (S ° PERMIT: -O' `> JOBSITE ADDRESS - rescort OWNER'S NAME `C)WNER ADDRESS TEL FAX'i OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL NEW: El RENOVATION: 1 FLOORS— COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LAB ORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM MPACE HEATER ROOF TOP UNIT TESL' { UNIT HEATER UNVENTED ROOM HEATER WATER HEATER REPLACEMENT: PLANS SUBMITTED: YES © NO a - 2 3 1 4 1 5 1 6. 1 7. 1 8 1 9 1 10 I 11 I 12 I 13 i 14 INSURANCE COVERAGE 1 have a current liabilily insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [w0 El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND F OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. +' CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT . 1 hereby certify that all of the detalls.and information I have submitted or entered regarding, this application are true a jaurate to es of y knowledc and that all plumbing work and installations performed under the permit issued for this application will be in co analli t sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. A PLUMBER-GASFITTER NAME ] LICENSE # IS -6q ATUR MP [3'MGF © JP ® JGF QI LPGI © CORPORATION36( PARTN7SHIPFE-3# LLC [] COMPANY NAME: ee 6ro SE2�1 e� _ ADDRESS b LLs s to CITYL�e�.JrQ. STATE' fl1 ZIP Z i Z 2 TEL FAX CELL s°� rjd6-14QQ EMAIL. eeNe _ u 0zf!+5�0 �.... V' 3c M77'. Mt":* I M Z y �, `3 IA213S tS�#3FI1021 1�3N338 13.1 IM Mt�hC (�llltld:. ,19Wi1`id tl St1 032{ LS�Ir`3� 3SN33 I'll JN IM01103 3H S3fISS l :> S 52!31311 �S _J 4<I�%,osm3Swni.d ._ , _ J FEENBRO.01 SMORAN OF LIABILITY INSURANCE DATE (M&VDDNYYY)- 1/3012015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed, if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Rogers & Gray Insurance Agency, Inc. 434 Rte 134 South Dennis, MA 02660 CONTACT NAME: PHONE FAX 877 816-2156 ac No Ext : Arc No): ADDRESS: INSURERS AFFORDING COVERAGE NA1C @ A2CG0750150i iNsuRERA:OId Republic General Insurance Corp. 24139 02101/2016 INSURED INSURER e Feeney Brothers Services LLC 103 Clayton St PO BOX 220801 INSURERC• INSURER D: INSURER E: Dorchester, MA 02122 INSURER F: $ (N1VFRAriFN CFRTIFI(-ATF NIIMRFR' RFVIRIr)1J IJIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. y7R TYPE OF INSURANCE DD S 8R POLICY NUMBER t�UDDYIYYI Y MM/PCP E P LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-AV\DE a OCCUR A2CG0750150i 0210112015 02101/2016 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 90,00 PERSONAL&ADV INJURY S 1,000,00 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY�JECT LOC OTHER: GENERALAGGREGATE $ 2,000,00 PRODUCTS -COMPlOPAGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALLOANED SCHEDULED AUTOS AUTOS NON-OV%NEO HIREOAUiOS AUTOS COMBINED SINGLE LIMIT $ Ea accident) BODILY INJURY (Par person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accide t $ UMBRELLA LIAROCCUR EXCESS LIAR HCLASMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENT(ON$ $ A WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTNE YIN OFFICER(MEMSEREXCLU0E0? (Mandatory In NH) If yyes describe under DESGIRIPTIONOFOPERATIONS tVaN NIA � 2CW07501501 02/0112015 02/01/2016 PER OTH- STATUTE ER E.L. EACH ACCIDENT S 1,000,00 E.L. DISEASE -EA EMPLOYEE $ 1,000,00 E.LDISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached It more space Is required) tr ©1988-2014 ACORD CORPORATION. All rights reserved. 4. ACORD 25 (2014101) The ACORD name"and logo are registered marks of ACORD., SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover 1600 Osgood And THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE�//JJj/////JJt/AJ tr ©1988-2014 ACORD CORPORATION. All rights reserved. 4. ACORD 25 (2014101) The ACORD name"and logo are registered marks of ACORD., Date.— TOWN ate..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ......�...:P.p.....!.Q' ........ ..........5 ........................................ has permission for gas installation .. — �.'�. .................................. . iri-the bu lding of...............1A2�.�-�..�...........-........................................ at.................p.�e..04.................................... North Andover, Mass. Fee ... V.'.... Lic. No. I.�..��... M. :.................................................... CC GASINSPECTOR Check #SI t G TYPE OR PRINT CJXA,RLY BOOSTER MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -CITY _, : MA DATE L3 ! � - PE.RMIT JOBSITE ADDRESS— r SG oiT OWNER'S NAME GWNER ADDRESS TEI f — ��FAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL'' NEW: 0 RENOVATION: D REPLACEMENT:"' FLOORS - PLANS I BSM' l -1 _.L.......2 �I-�s ��. DIRECT VENT HEA DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/ SPACE HEATER ROOF TOP UNIT TESL' UNIT HEATER UNVENTED ROOM HEAT PLANS SUBMITTED: YES 0 NO [9- 5 1 6 1 7 1 8 1 9 .1 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES WO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Lg' OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNERL3 AGENT 0 SIGNATURE OF OWNER OR AGENT } hereby certify that all of the details and Information I have submitted or entered regarding this application are true and a rate best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compii al nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASATTER NAME �Dw� �� LICENSE# 156K IGNATURE MP DMGF © JP ® JGF D LPGI ® CORPORATIONf;q-130'. 3(a( PARTN RSHIP 0#E= LLC E30= COMPANY NAME: ee - 8l o� Se,+ v e ADDRESS �--- — _ CITY �' a�-� .. I�. _ ( STATE' f�'I �0 ZIP 2 12 2 TEL FAX CELL s°� �a6-14Q4 EMAIL � . . .... . .. �. :�© . .. . _ a «»bMMdNWL H OFA A#BkUSE > ~ (Uma R y + » + 9 .. 0; ISSUES. /" f0 0W :nUf\ Z k& $tea$ #fesMBƒ ,o \D W G Rf4{ D. O SER¥Kƒ- 21, WIt T ~ ? » . . 7ka3}_w,►, FEENSRO.01 SMORAN A,C"J?L101 ---- CERTIFICATE OF LIABILITY INSURANCE -DATE(M&VDDNYYY) F 1130/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Rogers S Gray Insurance Agency, Inc. 434 Rle 134 South Dennis, MA 02660 CONTACT NAME: PHONE FAX 877 816-2156 C No Ex:: arc No): ( } ADDRESS: INSURERS AFFORDING COVERAGE NAICA 02/01/2015 INSURERA:OId Republic General Insurance Corp. 24139 EACH OCCURRENCE S 1,000,00 INSURED INSURER B Feeney Brothers Services LLC 103 Clayton St PO BOX 220601 INSURERC: INSURER D: INSURERE: Dorchester, MA 02122 IN SURER F : COVERAGES ICERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1LTR TYPE OF INSURANCE DD S B POLICY NUMBER MMJPOLDD� MMND EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR A2CG07501501 02/01/2015 02/01/2016 = EACH OCCURRENCE S 1,000,00 DAMAGE TO RENTE PREMISES Ea occurrence S 300,00 MED EXP (Anyone person) S 10,00 PERSONAL&ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: HPOLICYLn JEC M LOC OTHER: GENERALAGGREGATE S 2,000,00 PRODUCTS -COMPIOPAGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALLO"NEO SCHEDULED AUTOS AUTOS NON-0Y�SlED HIRED AUTOS AUTOS ,. w, COMBINED SINGLE LIMIT $ Ea accident BODILYINJURY (Per person) $ BODILY INJURY Peraxidlen$ ( ) PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAROCCUR EXCESS LIAB HCLAMIS-MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONSWORKERS $ A COPENSATION D ANIPLO ERS`LIABILIITY YIN 0 YPRO RI ETOREXCLUDE�ECUTIVE � (Mandatory In HH) If yyes, describe under DESCRIPTIONOFOPERATIONS WWN NlA 2CW07501601 02/0112015 02101/2016 X STATUTE ER'* E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -FA EMPLOYEE 1,000,00 E.I_DISEASE- POUCYLIMIT S 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached It more space Is required) L"a■M Town of North Andover 1600 Osgood Street North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED �REPPRHESS EENTATIVE ?e g ©1988.2014 ACORD CORPORATION.,All rights reserved. ACORD 25.(2014101) The ACORD name and logo are registered marks of ACORD r Douglas & Cynthia Berube 14 Summit Street North Andover, MA 01845 (978) 688-5511 April 9, 2002 Town of North Andover Department of Zoning Charles Street North Andover, MA 01845 Re: Property being developed behind 72 Prescott St. Dear Sirs, We understand that the Robert Rockwell property, 72 Prescott Street, North Andover, is up for sale. It appears that they are preparing"to-build•houses in his back yard. Our major concern is that there is an underground spring that travels underground that is not associated with the culvert pipe on the property close to the barns. This spring will actually geyser up in our front yard during a heavy rainstorm and we have standing water in our front yard from this spring also. We have had to deal with water drainage problems since we bought out home in May of 1979. Our concern is that building on the above stated property will cause more flooding and water on our property. Summit Street has no catch bins until you reach the comer. We have had to put up berms, etc., to keep the road water from flooding us out. Please, is there anything that can be,. done to make sure the builder takes this into account and places an underground water diversion system and a catch basin to prevent the spring water from our property? Thank you, Mr. & Mrs. Douglas Berube Location 7q f�%t' ('gip Srk�� No. ' 7 Date TOWN OF NORTH ANDOVER . s Certificate of Occupancy $ Building/Frame Permit Fee $ CH Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 16087 Le .�11" L r Building Inspec TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIJ RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ✓ , G _ C9 �\ BUILDING PERMIT NUMBER: DATE ISSUED: /,;Z-O SIGNAL: Building Commissioner/IRECEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 74/ fres f4 r I)( U Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 1 /�o�i� fob Zoning District Pr osed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required -30, / 5' tProvided 36-�� r 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: Zone X 1.8 Sewerage Disposal System: Public X Private ❑ Outside Flood Zone Municipal )K On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Tam/j e5 A ►�tz pj, Name (P t) Address for Service Oae , atu Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction,4gupervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone 00 M Z O SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ' Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition `bi( Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Aj� I , A)DYI SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant t3FICIALIISE {}NLy u ` 1. Building (a) Building Permit Fee Multiplier �� t 36' 0,P 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbinZ Building Permit fee (a) x (b) / / V 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 / 76 66,0 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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, J 4Cgad''( 460d 40 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 Jo— Print ame is AL4.a .. AtUred Owner/A ent Date NO. OF STORIES SIZE LIDC a BASEMENT OR SLAB 60e SIZE OF FLOOR T VIBERS ISFaC o " 2 )C 3RD " SPAN 14, DIMENSIONS OF SILLS DIMENSIONS OF POSTS 3 A ' O CX M r, 5" DIMENSIONS OF GIRDERS I-IEIGI ff OF FOUNDATION THICKNESS /p " SIZE OF FOOTING /a, X _O ' X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND so IS BUILDING CONNECTED TO NATURAL GAS LINE Ye,s FORM U. - LOT RELEASE FOR INSTRUCTIONS: This form is used to verify that all necessa a ro va�l�/perm IromBoards and Departments having jurisdiction have been obtain d kPhis c;6s not rev the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SEC In U.;�**t"w*WxM APPLICANT c- e.s 0,1'(.4 PH0Nq���9-863S� LOCATION: Assessor's Map Number PARCEL Jia SUBDIVISION /l 1 LOT (S) STREET _re—SCeo-# S�re�-� ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECOAII ENDATIONS OF TOWN ENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERAVATER CONNECTIONS Fel."WA FIRE DEPARTMENT RECEIVED BY BUILDING INSPE Revised 9\97 jm TE I'% The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Location: !F1 ueS 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. Policy # 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 $1,500.00 and/or one years' imprisonment_as_weD_as_civil,penattiesinsheinrm.-da_STOP.W. __ORK_ORDER.,and_afine _of-(.$1DO.00)-ajday.againstme. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Y i do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature / Date Print name L 411 &-s/�//f�f`c{, c.v�r� Phone 6rda'�� 3S Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept Check ff immediate response is required Licensing Board E] Selectman's Office Contact person: Phone #. F-1 Health Department Ei Other December 19, 2002 Jacques and :Laurian Marchand 72 Prescott Street North Andover, MA 01845 Mr. Robert Nicetta Building Inspector Town of North Andover North Andover, MA 01845 Dear Mr. Nicetta, I am writing to request that you issue a permit for the proposed addition at 72 Prescott Street. On December 12, 2002, you suggested that I scale down the size of the addition. After consulting with my wife, we have decided to pursue the original proposed plan. We had considered including a two car garage but felt that would make the house appear too large. If you look at the floor plans there is not much room for down sizing. The addition will be approximately 1,540 square feet which is quite modest. The addition, deck and existing house will comprise only 16% of the lot area which is less than many properties in the neighborhood. We have attempted to make the addition look as appealing as possible in the design process. For these reasons we request that you issue the permit. Your prompt attention to this matter will be appreciated. Sincerelv. Laurian Marchand 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 will be disposed of in: (Location of Facility) QG �' 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 Tel: 978-688-9545 Town of North Andover Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. DATE' JOB LOCATION Number Street Address / Section of Town "HOMEOWNER �uiuP-5 ��aMatid ` 2- �,-e.sc� C✓�TA�� %%e 6i� 363S— l LGc�J5lf% Number ��)J Home � Phone Work Phone PRESENT MAILING ADDRESS %� 're5Zul7' S�b�cz� r. Loy- Ar►4ve-f - M4 - City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less 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 109.1.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory 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 109.1.1) 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 inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNAT APPROVAL OF BUILDING OFFICI Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I ) I I 1 Checked by/Date 1 i I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 11-22-2002 DATE OF PLANS: 11-22-02 TITLE: DUPLEX ADDITION PROJECT INFORMATION: JACQUE MARCHAND 72 PRESCOTT ST. N. ANDOVER, MA. 01845 COMPANY INFORMATION: GERARD E. WELCH, INC. P.O. BOX 248 N. ANDOVER, MA. 01845 COMPLIANCE: PASSES Required UA = 279 Your Home = 275 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value ------------------------------------------------------------------------------- U -Value UA CEILINGS 768 30.0 0.0 27 WALLS: Wood Frame, 16" O.C. 1579 13.0 0.0 130 GLAZING: Windows or Doors 188 0.340 64 GLAZING: Windows or Doors 15 0.320 5 DOORS 47 0.280 13 FLOORS: Over Unconditioned Space ------------------------------------------------------------------------------- 768 19.0 0.0 36 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date 0 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 DUPLEX ADDITION DATE: 11-22-2002 Bldg.l Dept.l Use I I CEILINGS: ( ] I 1. R-30 I Comments/Location I I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-13 Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.34 For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes ( ] No I Comments/Location [ l I 2. U -value: 0.32 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location I DOORS: I l I 1. U -value: 0.28 I Comments/Location I I FLOORS: [ ] 1. Over Unconditioned Space, R-19 I Comments/Location I AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture j shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can ( be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R -values and glazing U -values must be clearly I marked on the building plans or specifications. I I DUCT INSULATION: [ 1 Ducts shall be insulated per Table J4.4.7.1. I DUCT CONSTRUCTION: [ ] All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing air and water systems. I TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CHR 1310 and J4.4. I [ l SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I [ ] I HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I I PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 I 100-130 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)---------------------- --.Q,}—, MOTE LOCAYMN AND EiEVAT/nW OF EXs7/IIIG VMTER AND SEINER AMW ARE rO RE DEIEAMNAFED IIV TME FM& cw 0 ��dor�d YM LOT AREA = 15,500 S.F. UAIIC LOT FRS WAW = 100 Fr. &W n Wr SETBACK = 30 FT MM SW SERSU K = 15 t7: &M SM SEMW ow colldl a "W = m: M BAR sE mff = 3o FT. OFF SIBW P.440M6 2 PER DWEUMV ilWlT. PAWI *123' SUMMIT AVE 072 PRE "IT S1:` car MU 13,090 SF SITE PLAN FOR f72 PRESCOTT STREET -# 7y IN NORTH ANDOVER, MW SS. PREPARED FOR JACQUES MARCHAND SCALE 1 = 20' DACE NOVEROR 8. 2002 REV. O m 4WR CHRISTIANSEN $,SERC/ 'lummall sm S� sc ,mi t. m � TAL app-ams-mio ®am er ammumm :sic W. am sa Noaar C/) m m U) 0 v. C � CO) n CD n Z CO) CD O CL n' � C O. _• y aCO -0 O w CD v CD CDCL O cr •C CD CD o CD C CD ra CD O. tm O y O toCD CO) o 1 Z CD O CD O C CD J O C y O 0 _ n0 m ti � m m C) CL C.) m Z NCD =r-o co 0 „=y .di m N T ? a ,� n O =r CDo m 0 C y N 0 =' m m m a CD n O 0 N• 0 ' � � :,�,Hpe ci W o m : Y C =r N r' C� a a cl 4/ C/) ///) m N 0 CD O N '4 Vo CL W: o�Cl) =3 a ►Q n m .rt � CO) ��C vCD -m, C J o � CD 0 0� 00 CD z C Z m 7C ON �. W N f �. a o .-. '-� C7: c = cn 0 O -+ Z o 07 �n o' 7d o r -w O:1r U) -x p °? 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TOWN OF NORTH ,ANDOVER PERMIT FOR PLUMBING ,SSACHUS This certifies that ...D (-n • � '..... • • • • ....... • ... . has permission to perform .. ,. �... �?�4 ` . `............. plumbing in the buildings of ................ at .../,. .. �.'!? �r .. ................. .North Andover, Mass. Fee Lic. No.. f iJ) U. `.� .......�< ... . . . . 1-csy—..... . PLUMBING INSPECTOR Check # 132 C L 5613 A 0 tire S MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING iP nn! or Type) y win adGVL 2 --- • Mass. DateOS- 30...-.ao.Q3 Permit;, Building Location --.%_(_rL SSG017`_r'_. . Owners Name �l�lJ� �� FA �"���� Type of Occupancy New 1. f Renovation Replacement Pians Submitted Yes _ No `. FEATURES Installing Comp�aany/'N,ame_ VU�-���-� o _—__.________ Check one _' Address ,�E�r�DQ %� 91�e Corporation pGt��%q �, O/�"Z— --- Pannership Business Telephone_/ a SST* Firm/Co Name of Licensed Plumber___"'5"1"C5 J, Certificate INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requi,,ements of MGL Ch 142. Yes 5?1 No .. If you have checked yes• please indicate the type of coverage by checking the appropriate.,boz A liability insurance policy � Other type of indemnity 7 Bond OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance ..overage required by Chapter 142 of the Mass General Laws and that my signature on this permit application .—rives mis requirement. Check one Owner Agent L Signature Ot Uwner or Uwne' S "igenr _--- -- 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts tate Plumbing Code and Chapter 142 of the General Laws. By -- -----gna re o kens fum�er— Title Type of License: Master Journeyrnan City/Town. license Numbor-/x1-/,0,S-0C/ _ ,cnr„�r. �rcrr. • • I z Z U) F cn O Z z > W W Y J (n Q F¢- Z OLL (j Z to - a 2 U) Z 0 cn W H cn W w 2 x � 2 tr ¢ W rn cn Y e o -a Z a Z Q� x U Z¢ m m 0 ¢ W >- 2 g F U)Z ¢ o¢ 0O Z S a- W O W W W S O Q w 2_ 0 W Y U) d O 2 1-- -' ¢ Y 0 rr LL t2 Q Q OS O W Z_ Z w ¢ U S fU- Y Q J m v) c_n D c_n D Q J ¢ O Q S H -J rn LL ¢ C7 2 W 0¢3� rr O W ¢ co � 0 SUB-BSMT. BASEMENT IST FLOOR 2ND FLOOR OC 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR TTH FLOOR 8TH FLOOR Installing Comp�aany/'N,ame_ VU�-���-� o _—__.________ Check one _' Address ,�E�r�DQ %� 91�e Corporation pGt��%q �, O/�"Z— --- Pannership Business Telephone_/ a SST* Firm/Co Name of Licensed Plumber___"'5"1"C5 J, Certificate INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requi,,ements of MGL Ch 142. Yes 5?1 No .. If you have checked yes• please indicate the type of coverage by checking the appropriate.,boz A liability insurance policy � Other type of indemnity 7 Bond OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance ..overage required by Chapter 142 of the Mass General Laws and that my signature on this permit application .—rives mis requirement. Check one Owner Agent L Signature Ot Uwner or Uwne' S "igenr _--- -- 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts tate Plumbing Code and Chapter 142 of the General Laws. By -- -----gna re o kens fum�er— Title Type of License: Master Journeyrnan City/Town. license Numbor-/x1-/,0,S-0C/ _ ,cnr„�r. �rcrr. • • I 110.0 T -- � . �� -. 1;w� .3 .... Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION IT). �� 4�. F(- -<- ) )'), 141 This certifies that . . ................................ has permission for gas installation ... ....... in the buildings of Z ...................... at ..7 ....... North Andover, Mass. Fee.5-�� ..... Lic. No.. ..... ..... � &S INSPECTOR Check# 1"IR ) 4370 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Typo) Nor �iV�®11C - , Mass. Date 9 30 A®_P3 PermltN_ Bullding Locallon 17vc Pre -S560#- S%a Owner's Name Type of Occupancy New ®"'� Renovation O Replacement O Plans -S ed Yes 0 No O Installing Company Name _Vo R f Cl _ PDQ �l1%G Address V E Business Telephone O g ti a i� 5SS- Check one: Certificate O Corporation O Partnership -,-� ❑ Firm/Co. _ Name of Llcensed Plumber or Gas Fitter_ SA In INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch 142. Yes M--' NoCD If you have checked yes, please Indicate the type of coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity O Bond ❑ OWNERS 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 ❑ Agent ❑ 1. I(7 n'.itl lfH M Clwnar nr (loin nr a Annnl -- -- -- --- _----- -''- ...._...._.._...�,,,�,o�r ,,, ovvvv aNNuuauun urti true ano accurate to the best -of rn knowledge and that ail plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws. By Tyype. of License I�-Mumber Title ❑ Gasfitter t nature of Lic s d Plumber o as Fitter- City/Town ❑Journeyman cense Numbor_ �% O.S'O APPROVED FFI NL • 1 ST FLOOR mom MEN ME M ME MMEN M mom . ... M®�No0====momma mom Installing Company Name _Vo R f Cl _ PDQ �l1%G Address V E Business Telephone O g ti a i� 5SS- Check one: Certificate O Corporation O Partnership -,-� ❑ Firm/Co. _ Name of Llcensed Plumber or Gas Fitter_ SA In INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch 142. Yes M--' NoCD If you have checked yes, please Indicate the type of coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity O Bond ❑ OWNERS 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 ❑ Agent ❑ 1. I(7 n'.itl lfH M Clwnar nr (loin nr a Annnl -- -- -- --- _----- -''- ...._...._.._...�,,,�,o�r ,,, ovvvv aNNuuauun urti true ano accurate to the best -of rn knowledge and that ail plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws. By Tyype. of License I�-Mumber Title ❑ Gasfitter t nature of Lic s d Plumber o as Fitter- City/Town ❑Journeyman cense Numbor_ �% O.S'O APPROVED FFI NL le, n 4& Date...............// ................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to perform ..... . .............. ..... . ... ....... ........ ..... 41 wiring in the building of .... .................................................................... at ... .. ....... (A .............................. . North Andover, Mass. Fee l.--.�`.3.......-Lic. No . ............. &AU ........................................ ELECTRICAL INSPECTOR Check # 455) Official Use Only Permit No. Y3T Occupancy &Fee Check'f it BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date (a--//- -0�y To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. ee Location (Street & Number / G is Co 71-- �1-- Owner or Tenant_1,7 Ir^^� Owner's Address 7 �5�� - `7 Is this permit in conjunction with a building permit Yes 0�0 No ❑ (Check Appropriate Box) Purpose of Building (16AIbO 4 %f -7-10 Al Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service .20 c i Amps ifd Voits Overhead Undgmd ❑ No. of Meters J Number of Feeders and Ampacity®`" �/f Location and Nature of Proposed Electrical Work INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including ComlaLeted Operations Coverage or its substantial equival YES = NO = ed valid proof of same to the Office YESNO If you have checkedxESS please indicate the type o7 coverage by checking the appropriate box I. SURANCE BOND = OTHER = (Please Specify) ®® IPrDate Estimated Value obElectrical Wo &$ / Work to Start Inspection Date Resquested 4� -43 Rough Final Signed under FIRM NAME LIC. NO. - � /N0�Nt/ s. Tel No. �R / 3? / 17 J Address Fqq� ��G/%% /�C /� W Alt Tel. No.� 4 �`7 E ri OWNER'S INSURANCE WAIVER: I am aware that the Licerfs6f d6es not have the insurance coverage or its substantial equivalent is required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) No. PERMIT'FEE 5 c:�3. / (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets .. No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat TotalTotal o. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers ce/Area Heating KW Devices ❑ Municipal ❑ Other No. of D rs Heating Devices KW Local Connection ° No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including ComlaLeted Operations Coverage or its substantial equival YES = NO = ed valid proof of same to the Office YESNO If you have checkedxESS please indicate the type o7 coverage by checking the appropriate box I. SURANCE BOND = OTHER = (Please Specify) ®® IPrDate Estimated Value obElectrical Wo &$ / Work to Start Inspection Date Resquested 4� -43 Rough Final Signed under FIRM NAME LIC. NO. - � /N0�Nt/ s. Tel No. �R / 3? / 17 J Address Fqq� ��G/%% /�C /� W Alt Tel. No.� 4 �`7 E ri OWNER'S INSURANCE WAIVER: I am aware that the Licerfs6f d6es not have the insurance coverage or its substantial equivalent is required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) No. PERMIT'FEE 5 c:�3. / (Signature of Owner or Agent) Name Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print 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 rry employees working on this job. Company name: Address City -Phone #: Insurance. Co. Poliev # Compam name. , Address City Phone.* Insurance .Co. Policy _# Failure to secure coverage as required under Section 256A or MGL 152 can lead tathe irnposition of criminal penalties of.a fine up to $J.*, ,W and/or one yeare irnprisorw -as v mdLm-ciW-penaltiesialheiam-daa ST PYjK)W-ORDER:and afine-"'I o.0A3-ajdWtme. understand that a copy of thin statement maybe forwardedto the Office of Investigations of" DA -for coverage verification. ect Officiar use only do not write in this area to be completed by city or town official' City or Town Permitil icensinq E]Check if immediate response is requbed Contact Z 1 ?9 r, El Building Dept t 0 Licensing Board E] Selectman's Office Health Department Other 14 Date. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,� �S/1C RUSE ,This certifies that ...... ...... has permission for gas installation ........................... . in the buildings -of................... .......�.. at .. ...�„ - a-�r p—A...,orth Andover, Mass. Fee.?Lic. No. ......... GAS INS E OR Check # 4175 MASSACHUSETTS UNnuRM APPLICATON FOR PERMIT TO DO GAS nTnNG 41 7,S' (Type or print) Date (DC -T2-5, 2,C6-2— NORTH ANDOVER, MASSACHUSETTS Building Locations ?,RC-0 k- Owner's Name New ❑ Renovation 0--� Replacement ❑ Permit # ount $ Plans Submitted ❑ (Print ortype�one: Certificate Installing Company Name Li Corp. Address q q,5 ! e t X41 t1 S ire,a�6c ' MCI 0t9,7 Name of Licensed Plumber or Gas Fitter IRA— D e" Is 1-0 ❑ Partner. ❑-R�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 indica type coverage by checking the appropriate box. Liability insurance policy © Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusttate�es Code and Chapter 142 of the General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter [[3,l''lumber Z�- ®was Fitter (cense um er �Iaster ❑ Journeyman Date. ��. ?z3 . Uz` TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SACHUS� i rfis cei•tifies--that . ��... ....... . h s permission to perform " plumbing in -the buildings ofY....`.:: "..` ..`....... ...... • • .. . / at. ..�}: �.�- :- :.... .....• • • • • • •�• , North Andover, Mass. Fee. Lic. No.�✓ .......... . ��, 'PLUM B4 �fINSPECTOR Check # �Q���� �! 5414 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS / Date Building Location +L 1 Owners Name 3G(,� MQJL N4 Permit #�SD n Amount New Ke Ir of Renovation 1:1 Replacement FIXTURES Submitted Ye 13 No (Print or type) f Installing Company Name f�F�lb� Q�-�" Check one: Certificate Corp. Address `LJ5 Mq i n S f Partner. C it wCo. Busines�ep one 93%'5oil x Name of Licensed Plumber: Insurance Coverage: Indicate the typeof insurance coverage by checking the appropriate box: 0ability insurance Other type indemnity Bond policy L� of ❑ ❑ 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 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 for this application will be in compliance with all pertinent provisions of the sac us !s!tatePlumbing Chapter 142 of the General Laws. By:Signature of Licensecium er Type of Plumbing License Title I I� City/Town I Eicense TNumDer Master Journeyman ❑ APPROVED (OFFICE USE ONLY 4167 Date .... IPI.. 7415 a TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... Tq..Pq.f5 ..... /� ....... .................... has permission to perform ..... Z ................................... ,riring in the building of ........ . ............................................... ,at ......... 7.� ...... . P ... ........... ............... orth Andover Fee ..... 7,�'�..O .. Lic. No/ .......... . . ..... ............... .>4 IMPE R Check # 5706 L MICAL S -X TB'COMMOAMUTHL `�—�1uJET� Office] eonly DEPARTMEAT OFA-11aCw5F BOARD OFFIREPREVEVH0NREGUZATIONS527C�1IIZ12. Permit No. VOccupancy & Fees Checked APPLICATIONFOR PERA4ff TO PERFORMELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 52'7 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �(� • t9 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street c Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes Purpose of Building S (iLL WfI Existing Service Amps / olts New Service Amps / Voj;s Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 1 ITS I No. of �ighting Outlets No. of Lighting Fixtures No. of A.ceptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro Massage'I No. of Hot Tubs Swimming Pool No. of Oil Burners No. of Gas Burners No. of Air Cond. / J No. of Heat Pumps Space Area Heating I Heating Devices KW No. of Si ns No. of Motors )TN, o, C ,�. (Check Appropriate Box) t�Al 6- Utility Authorization No. Overhead underground =1 No. of Meters Overhead M Undergiound 1:3 No. of Meters No. of Above " Below j7 Generators No. of Emergency Lighting Battery Total FIRE ALARMS 4al Total No. of Detection and ons KW Initiating Devices Kw No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Municipal Connections No. of Bailasis Total HP KVA KVA No. of Zones Other��' rmaa =CUVW— - Pum=tDthetegtrita xmdM2&xh�sMG=alLaws .havcaomeuLikgkykmu noeFbi ymdxkgCortVlCO,-Covag-,oritsmbsUM privalff t YES NO ham&bn&dvalidpro0fofsametothe0fflm YES j—Inp ff bavedledod hedangthe x. LL��JJ Lam( ' S,Plea9eindic ihetypeofmvaageb3' VSURAN(:EFWBOND OTHER (P)aSeSpedy) EvirafimDoic �odctoStart htsl�ec�or►Da>ERecptestedEs�na�dV of�calWotk $ C ignedutxler� Rnakiesof ' Ratgh �� _ �� - Final U/ RMNAME C' ��,�q�, LmwNo. Urr Sigr>ahue LimnseNo 2 0 1A Busn Tel.No. i• AhTeNo. % _ /7 VNQ'SINSURANCEWANER;IamawarehatheLkmsedoesnothaveheiNraecovaageoritsatso alegivaletaswqr:edbyMa%xhtmem-,C,em Laws Idlatmysigmttneonthispamitapphcatt� ftIt lease check one) Owner Agent Telephone No. PERMIT FEE Signature o caner or gen 4136 Date .....CJy! ................ t NORTI♦ , TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that P .!'! ..................... ... i:e%Z......................... has permission to perfor...................... „ „ 1G ���� ......... ........ .......... ............ i�C ff /f wiring in the building of ..........�...........`7................................................... aft 010 North S �.f ... 5.�..................... .North overt ass. _ fee. .........r. ELECTRICAL INSPECTOR Check # !_�l THE COMMONWEALTH OF MASSACHUSEM DEPAR7711W0FP1XIICW,6- Y BOARD 0FFIREPREVEM0NR6GULA770NS527CMR12.00 O ce Use n r Permit No. — Occupancy & Fees Checked APPLICA71ONFOR PERMIT TO PF,RFORMELECTRICAL 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_ I D �/ t7 f 02 - Town ZTown of North Andover To the Insaector of WirPc- The undersigned applies for a permit to perform the electrical work described below. Location (Street � Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes El No ® (Check Appropriate Box) Purpose of Building S' / A16-1, Existing Service 3 (7 Amps .�1� / -2OVolts New Service 0-0 Amps /.:2 �6Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures t No. of Receptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Waty Heaters No. Hydro Massage Tubs OTHER: No. of Hot Tubs i )1 1-1- L I Ale, Utility Authorization No. Overhead nderground No. of Meters Overhead t/ ' Underground No. of Meters Swimming Pool Above ground No. of Oil Burners No. of Gas Burners No. of Air Cond. Total Ton., No. of Heat Total Pumps Tons Space Area Heating Heating Devices KW No. of No. of Motors No. of Bailasis Total HP No. of venerators ..v. vi emergency tagnang Battery Units Total KVA KVA FIRE ALARMS No. of Zones Total No. of Detection and KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Municipal Other Connections El r�uarloeCovgage. Pt6othetegtlitarlaYso�Gar�aliaws ha�aa>aa�tliabl7dyhmlrmtcePolicyinc) Completevuaworits ale4avalalt YES �1 / NO hawsubrndledvalidploofofsametothe0> YES r—T IfynuhmdlededYES, ple?wnlhcatethe typeofmmrr-by heda<Igthe box �L�J( VSURANCE BOND OIIIFR (per SPAY) �- -ZO� of w Irl r• err �.I" :•::.r.• Fstnm4odVahteoflbctncalWotk $ Rough FSI �� M, ffi�� LicffwNb � irirPcc t �JL/I•M ,��� � //�/fP1VI�IiI/!b'Ta BusrnessTel.No. 7� / /VA 0 /9�% Alt Tel.No. c5N79 9 $ap ATNH2 S INSURANCE WAIVER;Iamawate dial d)cLifr>sedoesnothavethenauancecoverageorits st>tstantialegtrivalatas 041iredbyMassxhusells GenalL3ws J that mysigrMireon this permit appfi thistewireaIertt lease check one) Owner Agent 0 �S Telephone No. PERMIT FEE N1gnaturc-o-fTJWner or Agent$ Location rest C No. �/ L -Y- Date / 4 NORT#j 11.0 TOWN OF NORTH ANDOVER 0:�ao :a �. • Ow Fr � 9 Certificate of Occupancy $ s�CHUS � Building/Frame Permit Fee $ c�7d Foundation Permit Fee $ Other Permit Fee $ TOTAL $ C:>?C) G Check # .33) X5863 Building Inspector " TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING - 'a -:•.. � i` %d ,;y,. .,ZY � i 1� ��7r Y���r �l„V,�l� �a'3'F3T x' ,qe;-;. y. . srt..seu BUILDING PERMIT NUMBER: Cq_ DATE ISSUED: SIGNATURE: - Building Commissioner/ln for of buildiM Date SECTION 1- SITE INFORMATION 1.1 Property Address: 7a &5 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: --R4 Zoning District Proposed Use 1.4 Property Dimensions: /5,-091 Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft 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: Public Private ❑ Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Ownerof Record f —Tact Lt �� e—S / '' �a C'CyL�n 7A Name (Print) Address for Service: Sig re Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: /` Licensed Construction Supervisor: >s Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone MV M X ic z O O Z M 90 O Wn ic r v M r r 0 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... -A No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) — Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify, ' Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item . Estimated Cost (Dollar) to be Completed by permit applicant QF)HiCIAI=USEONLY,� 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 0 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , 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 I, V �rG�ie S 4Y?�t2Cc�/!G1 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 J�ues l�%ar� ��✓�d � Pri a e6� Si tur f Owner/A ent Date -°- . t. NO. OF STORIES SIZE BASEMENT OR SLAB NO SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS FIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE D. Robert Nicetta .Building Commissioner (978) 688-9545 '978) 688-9542 Fax Town of North Andover Buildings Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER UCENSE EXEMpT1pN Please print DATE 2 �- 106 LOCATION ry ui r ru er iOMEOWNER ESENT MAILING ADDRESS city Town Street Address 5 Map /lot Home Phone horse J State Zip Code The current exemption for "homeowners" w of two units or less and as extended to include owner -occupied. to allow such hornegwrters to engage an individ dWeltirigs not possess a license. provided that the owner acts as su Wfor hire who does . Pervisor. (State au►kltng Code Sermon 108.3.5.1) DEFINITION OF HOMEWOWNER_ Person (s who , o owns a parcel of land on which he/she resides or intends to reside on which there is, oris intended to be, a one or two cessory to such .use and/or farm' Felting. attached or detaches} s r ac- two-year period shall not be'oonsider � a.F n O° n'1oretha ►anehome•in a homeowner The undersigned "homeowner" assumes responsibility for o0 Applicable codes, by -taws. rules and regulations, mp a . e with the State Building Code and other The undersigned "homeowner' certifies that he/she understands the T No Building Dephrtrnent minimum inspection procedures and requirements and t �dOvwi Pry with said procedures and requirements_ that helshe wlt HOMEOWNER'S SIGNATURE ';'PROVAL OF BUILDING OFFICIAL 0 DMIM Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print l it el -6 Lt.e /v/df40/111�- ---- ----- I/ -.... Location • `7 2- )i'e�S C6 t( FAR 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. Policy # Companyname• 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 $1,500.00 and/or one years' imprisonment_as_well_as_civil..penaltiesin.2heform of -a -STOP WORK_ORDFR-and-a fine..of.(.$100.00).-aliayagainstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. V I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept ❑check if immediate response is required [] Licensing Board ❑ Selectman's Office Contact person: phone #: ❑ Health Department ❑ Other I W1536 401 PHONE NO. : 508 48I 2E328 Sep. 13 2002 01:56PM PI `i. 2 i 6 JW93�, W3036 W3021 OW422727-L ROB30 \�B 36DR NV2136L TRBO 18 :E I gw:sf- 41 144 41D818! ...... .... =� � s sit ROM DISH. 24" W DW4227 27-R W3336 412' 63 146 JACNM m onnOn fwwm & d&&VrA� "= Ttos is a i9i dwom GM MAY10WD WrCMEM MAM Doi owlZma vvm am SLD to veAlication on not be m6asod or copal unim JACOMOMARCHMO j* silo WW adAsftT atM to fitjob sWkAtftthe het bwp*4wjob � 72 PR96GoTr ST. Ur M". aster pwcod, MARRY MMGUM U) M m m 0 m CO) 10 CDZ CD O CL r O d Q =. .p O o p CL cr =� CD O p Co cc CD CO) 10 CD O 7 F �= O CO) 'O C O CO2 d n CD 0 CD CD a y CD CO) 0 O CCD O CCD i 7' ►a 0 0 C C -P-0o :r --fO -•N o cr y Sdo C ® '� y oam� m c7 =c�ao m Z CA C', .+c =rm y CL CL 0 CD m H Cm/d O m m ® 2a1 c n � O CD �� V C � U=2 a ^" ^` ras o A V I^ y N CD Cn cs-o a o c_ l l �' m Ae d N cn �'d c C vJ y y / T So CD cl y 0 S 0 W o i cn ... 5 .A Q �o cn cn W y -o n C* m o "d o CD • ro rD ZrD O w C M °� O C)C C � C O Cr1 z w ao r O w n'li j. � U) M m m 0 m CO) 10 CDZ CD O CL r O d Q =. .p O o p CL cr =� CD O p Co cc CD CO) 10 CD O 7 F �= O CO) 'O C O CO2 d n CD 0 CD CD a y CD CO) 0 O CCD O CCD i 7' ►a 0 0 C C -P-0o :r --fO -•N o cr y Sdo C ® '� y oam� m c7 =c�ao m Z CA C', .+c =rm y CL CL 0 CD m H Cm/d O m m ® 2a1 c n � O CD �� V C � U=2 a ^" ^` ras o A V I^ y N CD Cn cs-o a o c_ l l �' m Ae d N cn �'d c C vJ y y / T So CD cl y 0 S 0 W o i cn ... 5 .A Q �o cn cn W y -o n C* m o "d o CD • ro rD ZrD O w C M °� O C)C C w Cn rD O Cr1 z w ao r O w n'li j. � r- �, G C O (w r� C/) 'a r) N rrDD 91 0 a x 7' O O 1 1 g y 0 0 c Location '!02 Pr r5 ca �/s f- No.ytl Date 3 -ab u 3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee r< A;2 f— $ y .- TOTAL $ .— Check # 34 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING f ..,,, « r= ,_ „���_ � �6P � yF �Y �� �; �•�� rte: "--. �.�' :�: BUII.,DIN�J PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: i 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: qAs Pt�k.,� Zonis District Proposed Use 1.4 Property Dimensions: la, 2i y— I o© Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Re 'red Provide Required Provided Re aired Provided 3 © S --50 1 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone btformation: Public f�/ Private ❑ Zone Outside Flood Zone l/ 1.8 Sewerage Disposal System: Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record � a A �57'07cS �r�5�' �� �1��r5 C, L, N4 Name (Print`) r Address for service: V cw-16� 3 3 :Sigature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ►nes \( CAFE L C Licensed Construction Supervisor: 1 c� �l �� rS �j�.e-J� � �-►�, p�(Q 2 � rn I� , O (�j (O Address S gnature Telephone Not Applicable ❑ C 3 License Number 7 _ I � ` -)no Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone ou ■ • ■ X Z 0 M W o� 0 0 Z M 90 O ic r s® M r r z G) 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 buil ng permit. Signed affidavit Attached Yes ....... 9 No ....... ❑ SECTION 5 Description of Proposed Work(check all a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: �eO4-e C9wi. ° CV^CQ. -D S APB Ai= 5Z00 3 i --�0 i 017 8 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OF)F C:[C USEVN 'Y 1. Building U ,-- (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) Lf 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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, A 0'P as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief _ JA meS CA r -o Pri ame -�- �12S /05 Sj:ratj&re of Owner/A ent DZQf NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3Ku SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I-Il-IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 Building Demolition Affidavit DATE 3 Id, i/ d 3 OWNERS NAME & ADDRESS . / A rn CS CAP-P-oCC (Q PI Vje("S Gn L oT 3 PROPERTY LOCATION Lei4S v m m l- :5TO,2k 7 Sri) CONTRACTORS NAME & ADDRESS ZTA res CAMU I L Q PL Uen Av-J , , MRS5 , 01810 DEPARTMENT SIGN -OFFS D.P.W./WATER SEWER GAS f ELECTRI TELEPHON IL/JK0 CABLE TAXES 417'A•g1 n. 4►�� �`-- s% 3 FIRE EXTERMINATOR '3L,)- L/o3 -7!e—je� DUMPSTER- ON/ OFF STREET DIG SAFE NUMBER J©03 i 3 o+ 3-76 BLDG. INSPECTOR DATE RECD -3— Z — 7;- I.,-.- -k - P Ll Bb k '}7 CO I!} �.�w k co \ �0z . . \ k §CD .k\ LL 3k . o z R'0 0 § ® 3 .o ° 2 0 m 2 k k © 2 e 13 3 a z § I§zco / 7 § . ..� . _ >�e - co LU \ w , ^ \ \ i�J 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 will be disposed of in: <-n \4 t Je fze S e av—t C o e � IP I,,\ 6 v (Location of Facility) V Signa re 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 BK 6846 PG 1, Dolores C. ROOkrell of Ft. Myers, Florida in full consideration of $300,000.00 for consideration paid, and grant to James V. Carroll, trustee under Iden !states Trust under a Declaration of Trust of "tea Deeds Mayher23, 2002 and recorded with Essex North of 12 piper's Glen, Andover, Massachusetts 01810 MITI QUITCLAIM COofnNTs Two certain lots of land with the buildings thereon shown as Lots 2 and 3 on a plan of land entitled: "Plan of Land located in North Andover, MA Robert owner �Rockw 11 Date C May 1snt 2, 199a" Prescott d recorded Nw th Andover, MA, North Essex Registry of Deeds as Plan No. 13261. Lot 2 contains accordingto said plan n 14,072 square feet, and Lot 3 contains according to said plan uare Being part of the same premises conveyed to me and the late, Robert 'i S. Rockwell by deed from Robert S. Rockwell dated November 30, 2000 and ;252 rdTbwith id Robert S. Rockwell died District on Junof e 10, 2001kin944, P898 Methuen, Massachusetts. MAY 23'02 FN2:39 I yY a sealed instrument this 23rd da o! May, 2002. C x r Executed as Dolores C. Rockwell 73 44 3; on e` COMMONWXALTI OF M%msAC8UBZTTB M' May 23, 2002 0 Essex, ss, sli the above named Dolores C. Rockwaldeeda Then personally appeared acknowledged the foregoing inst to be her res �a before me ohn J W 11 , Jr.- -Notary Publ c -_;_ y c isaion expires: q_f:.: c, ember 29, 2006 ., J Willis e: ;3," Box 32 r I P41E 01 CERTIFICA*rE OF LIABILITY INSURANCE OATF(MMIDDIYY) AGal4®M .� 03/25/2003^� PRODUCERr THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION M.P. Roberts Insurance Agency Inc I ONLY AND CONPERS NO RIGHTS UPON THE CERTIFICATE HOUR. THIS CERTIFIOATF, DOES NOT AMEND, FXTEND OR 1060 Osgood Street ALTER THE COVERAGE AFFORDED 0Y 'THE PCLICiES BELOW. North 7,rdover KA 01845 978 683-8073 ,NW119P NORTH ANDOVER RENT -TY CORP . 100 .:'OHNNYCAKE ROAD NO. ANOOVERI MA OlPa45 (%nvCRaC3F_S INSURERS AFFORDING COVERAGE li!':•U''.ER A: NeuFERD: HANOVER INSUPANCE: CO LIMITED STAT. Z' 7 IA 3I7,ITY INSU_R721C8 --- — THFPOLICIES OP INSURANCE LISTED BELOW., MA'It ErISLsFnI 7C THE INS JFE'D 14AMED ABOVE FOR 7H& POL!GY PFRICD INblc1 `A;TI b NOIWITHSTANtiNG ANY RIMUIRFi,67, TFRV OR CONDITION rf ANY GUN'RA.CT OR OTHV; r100LMUNT WITH AEGF ECT T'l '!'!HIGH "1111U CERTIFICATE MAY EE ISSUED OR MAY PERTAIN, THE IN3JRANCL AFFORnEC' 3'1' THE cCLICIK DESCRISkD 1ERE N I,", $013JECT TC. A -L THE. TERMS, U)'CLUSIONS AND CONDITIONS OF ,iL'CH PO_IDIES, A(AGRF_GATE LIIdAT3 SHOWN VAY HAVE BEEN REDUr;ED BY PAID CLAIMS. ul�$'_..—�_ _.___� � T ~�--POLICYNUN'IAER _;-�TJL IV'�FE��rll7'E�'l+ZST�,11• — .I TYDKDFINSURANCE_ � GA7QIAM:DDIYY7 '' r + LIM!TS MERA:4IARNITY F.AC.,fx'URR:NC- 1 1, OCO, 000 (GMi? F.'Lal GEI'EPAL '.fH'ILITY I ', `fiR6 CAty?AC__Lny one fue - 50. coo `d.P1,M. t7AUE % C+CCUk I I I (91E': EXP (+V•'• X,4 Pe•.,'uo) A I TO BS ISSUED 0:';/1,3/03 03 /13/1)4ECrv,uiU' klIN, LIKY 1, 0o O, 0OD —..-.----� �--�iEIvERAL 4G�3REDATE '---, 7,000,000 hNL ltrsCRE3ATE LIMIT [,PP; ES PER.?NOGLCT3- ==Ior-10 ACG 41 1, no OOJ'•: h PCLIGY 1-11 P�C! -r- - � 4UTOCaCBILE LfABIL!T`.' -io...-.......-.-.--_......{.r...................r...�....� � {UVY r"".UTO CO!,`-NNED FIN*LE' MIT A (Ea woldem) 1, D00, OOD F--- _ ALL--ftNED AIi-•:F I XY'O5 I "Forre.-Jon) I 3wRECAi"OS �-509640 I 12/06/03 D2JOE /09 � ( J Plgic•0'nNkU AL'TUti � (Pvr rsxltivrD I I i I -- —_-- I 1 , ; I F ROPERT',' CONIABE I 'Pb; Semden"•1 S 7AA.A3E UABI�f'ry I --r'. I AUTC ON.\-EA.+CCIDFNT 5 At, YA'•;Tr, I 6.1 ACL I ALTO ONLY: �y .AQIG f E�l(:'E88 LiA.HP_ITY EACH OCCQRRENC: 8 1,000,000 j �• j GC^•uF ;:iLrr M911:,DE I ! I A06N&UAT: .$- 1,000,000 r— To BE T331TED ; U.3/:i3/03 103/).3/04 --- O I I UEGuC^�[L`c �— — r I X RETENTON $ :10,000 —•��----_�' �i WCRHPl;E C7L'M�EN6ATICN AND j --- r�lx �. ENCLCYCRE'LWDILITY ITOG C4.i)8345 _ i 33113/03 1 03/13/44,f F.CCIDEN7 g 500, 000 - :]I8`,A:SE • FJL FN,'I.C'+'EE 5 5011,000 J���� I DI6FAFE• POLICY LI AT 8 000, GOC.-� OTH:R •_ _�-. �� I - ' �2SCk'IPTf,9HDFgFE'RATION3tLvCATI0V5`J'cNIC FIEXCL418:ONDADD:CVENUOREE!CFNTiSPECIALPRO'ASION!, 2,Ax: 978-686--7724 CEPTIFICATE HOLDER ACDITIONAL !NR,R_ED; II46UFcR I.VTT-q 'CANCELLATION SHOULD AW OF THE ABOVIF PFBCRISED PLILdta 'AE t.ANc£LL£MF 0 PORE THE EY.PIRATION TOKAY OF NORTH AIIDOVfSR DATE TNGRBCF, rrIE!8SUIN0 INSURER WILL EVDEAVOR TO MAIL ID ]AY8 wpR-! EN 364 osGOov sTRFET I NOTICE TO THE CBR 1�iCATE NOI.D6R NAM;: `a THE L91F7, B'UT FPILUR TO OO SO SIA'— ' -NORTH ANDOITER, XTi 019'S Y IMmOAE NO OBLIC AT'OIl .]R L:A<Y Of ANY ?FIND L;POIi TIIG Im6J13GR, ISR A91.N16; OR AUTH_R':EC 16-3(7197) m O 1 .0 I w o m u `' z A o v x U w a w o w c:G° v cn w w a c N O w a w m' a z cn v Q o cn z O 'a a C O r4E z U 0 6 O 0 2 O y CD coL O C O m CL, y O Q .a h C O C..7 m C CL O w CD 0. y c C U) U) w LU ccw U) 0 •m �: c c N O C i.� O v V 0.0 CO C :t o CD.� ' = V 0 03 Q _/ y .�� O m oC r moi; V .0,. C �CD 0 c E ca A m �mm a a n cc2 cmy m � N _moo :L-or� y c y C COD r .L� m y cD oC s=como c CD _ ry: aCs O m or m v H O Z O 0 w � C dC 'c f' N 0 H CIOMD H y C:sW C Z ®•y O WL- u CD v m v c c w a ®:s o O 'a a C O r4E z U 0 6 O 0 2 O y CD coL O C O m CL, y O Q .a h C O C..7 m C CL O w CD 0. y c C U) U) w LU ccw U) Location qq No. Date y/3� TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ (y ss�c►wsEt Building/Frame Permit Fee $ /� O Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �fni Check # 1 89jy i 6 3 3 MA (G-, Building Inspector to w 1� 4 33/i la -z0. -C) -2- L4-50L4- 5 0 - - n3 �rpsc6 118' 36.9' 41.9' -O 70 nl NDATION n O I --1 1 y 1 � 1 rn 1 ti FOUNDATION LOCATION PLAN CLIENT.- JACQUE MARCHAND 123' SUMMIT STREET THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. 7a-'1 y Presc.H LOCA TION. 3L26 RR -ft* 'l ST., NO. ANDOVER SCALE: 1 "=30' DATE. -4-17-03 I CERTIFY THAT WE PRIMARY SnKCnW SW*W CONFORMS 117 THE HOR/ZON AL SETBACK REOWREMEWS OF WE LOCAL APPIJCABLE 2W#X B1' -LAWS N EFFECT RVIEN C0A%'nW/CIED. Mas cE1ir//FIGITRIM DOES NOT COPMUER ANY OTHER RESTRXn NS SUCH AS COYEM4NMWE1IAMD$EASEWENM ORDERS OF COND/7nnEM) IMS Omwm SHALL NOT BE IAS£D or THE CLIENT FOR ANY PURPOSE OTHER VM IMT OUTLIMEO ABOV&EXCEPT WITH THE WRITTEN PERMSSIOW OF CHRLSTUMSEN h SERGI INC: FURTHERMORE TMS DRAWW IS THE COP1 USNEO PROPBUY OF CHRIS/IAM & SERGI M AND ANY UNAUTHORIZED USE IS PRON07MCHWMUNSEN & SERd TAKES NO RESPONSIB/UTY FOR THE UIWU)NOYP M USE OF TYIS WAWM OR ANY WFOR- H4YM CONTAINED N OF Mqs, MIC j J. CHRISTIANSEN &SERGI �, RS mums Im SUMMER Sr HAVE8MI &K 01830 TEL. am-373-wro / 0 2O RY CHR/SRAMSEN i SERO/ MIIG 91 1 ¢jar• i h� Location- No. ocation No. 13 Date Check # Y/ 33 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 30— Foundation —Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3y 17857 /fiw Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ..:t s '� 4 �xd - u. -< t � �^ �� at t • y��(j>�a7 r ".:�. F r- � s c ��� � .� « ci ..r �. '� '' �r cr" "�'�"'s. ,W BUII DING PERMIT NUMBER: DATE ISSUED: SIGNATURE:..L Building Commissioner/Ins for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 771 c=o S� e e 1.2 Assessors Map and Parcel Number: ce/' Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Rered Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2- PROPERTY OWNERSIDP/AUTHORIZEDAGENT District: YDS C 2.1 Owner of Record f C &S aL�t of _ %-2- C -IH 5V!' Name (Print Address for Service: " Si tore Telephone st ru 2.2`Owner of Record: 1 _ ame Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable t111 - License Number Expiration Date 3.2 Registered Home Improvement Contractor t Not Applicable ❑ Co- any Name T Registration Number Address Expiration Date Signature _ Telephone v M z M 1 Q 0 z M 90 0 raaa z Q q' SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 6 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work(check ail applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Altua.tions(s)x T Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: DL _f �LVlVC, de.e,L . Rt-& \ t 3 rt �kv kp . SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b _permit applicant ": OFFICIAL USE gNLY; -. I . Building (a) Building PermitFee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X bbl ® �- 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 ZU , pig Check Number SECTION 7a OWNER AUTHORIZA ION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING PERMIT 1, 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/AA�U�THOR/IZED�JAGENT DECLARATION I, C A u t° s 1 i�(C U1Cyo2y s Owner/ uthorized 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 at e" Pri Name .§dAaturof Owner/A e tt Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IS 2' 3PM SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION _ _ THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY _ IS BUILDING ON SOLID OR FILLED LAND _ IS BUILDING CONNECTED TO NATURAL GAS LINE Tti 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 will be disposed of in: C/e..r'' , Sa. (Location of Facility) Signature of Per it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print / Location: �7a (-P-5c a-4 &e,� (c 1 I am a homeowner performing all work myself. �1 I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance. Co. Policv # Will lllilwilll� Company name: , Address Phone # Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition d criminal penalties of.a fine up to $1,500.00 and/or one years'Imprisonment_as.vreD_as_dx0.penaltiesinthe foanmfe..STOPWORWORDER..and_a.fine of.(3140.00)_ajday.against-me I understand that a copy d this statement may be forwarded to the office d Investigations d the DIA for coverage verification. Ido hereby ce der fire pains end penalties of perj that the information provided above is true and correct. Signature Date Id- // Xt/ 1 � Print na t�.C� e.!S Phone Official use only do not write in this area to be completed by city or town official' City or Town Permit/Ucensi ❑ Building Dept []Check if immediate response /s required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A- ❑ Health Department ❑ Other m m m x m y F, 7-.- Lu C ao�,og s s CFL,- CO 4 7 0 C O y CL O 0 do 3 T Z ?� w -+ =r a P-0 CL = m =r CD0 m go o ti 6*4 � ?m : C _ 7 O m M O Z2 oyCc C=L CA n O y d m � Q ��_ cn CD �F-Aa fA • Cn H N y o 'Cog � 0 =m s �y a �• � d d o.IO _0 �q O w EL O 7 O O 17 ro ro ro C) ro � x o H 0 O C