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Miscellaneous - 74 WOODSTOCK STREET 4/30/2018
Of Date.......+f..:.. .!?? TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... C ...... /' // � � IV.?. ......... ......... has permission to perform ..........Cv- .S ..... ep� .. j........................ wiring in the building of ......... C /?..v. 1 r. Ir .... :5-&eeA ................... at ....... .............. . North Andover, Mass. ... ............ /4 Fee. . ... Lic. No.. �9 �2�74� ............ .... ... ELE&RICAL INSPECTOR I Check# —2-s Se ,1 7667 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS M Official Use Only Permit No. 7� [O 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 Co�dc"(MFC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �G�f ,LO , 07 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or er intention to perform the electrical work described below. Location (Street & Number) -?V (,WO6d5 G� r.. Owner or Tenant ru Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 1-1No(Check Appropriate Box) Purpose of Building $IGC e Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ayy �L (-P_ SS S,p It Contnletion ofthe following tahle niav he Wt7had by thn 112ena001- ni Wil^PR No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. rnd. o. of Lmergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. 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 Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Si ns 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 fVires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover is in force, and has exhibited proof of same to the permit issuing office CHECK ONE: INSURANC)✓ U2 BOND ❑ OTHER ❑ (Specify:) 1 certify, under FIRM NAME; and complete. LIC. NO.: Licensee:10( vt15 e /�LIC. NO.: �.%�% (IJ'crpplicab e, este e.x mpt' rn license nunrbe In ) Bus. Tel. No.:� Address: �� 7/IJn./� /' 44-17t Alt. Tel. No.:261— tLL/Y7�c4 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. v OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. M The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i�; 600 Washington Street Boston, MA 02111 I www mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PiumhPre Address:_ j 2 �L h1h CE J 14v--e- City/State/Zip: NO, oU-ed" o4.,t Phone Are you an employer? Cheekthe appropriate box: 1.0 1 am a employer with 4. ❑ 1 am a general contractor and i ployees (full and/or part-time),*. have hired the sub -contractors 2. I am a.sole proprietor: or partner- listed on the attached sheet. i . ship and have no employees These subcontractors have working for me .in any capacity, workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No•workers' comp. c. 152, § 1(4),'and we have no insurance required.] "t .employees. [No workers' comp. "insurance reguired.l ' Type of project (required): 6. ❑ New construction 1. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 1.3:❑ Other "Any applicant that checks bort # l must also fill out the section below showing their workers' 'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and than hire outside contractors must submit a new affidavit indicating such. tontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their worker;' comp. policy infornadon. lam -an employer that is.providing:workers' compensation insurance for ray employeeL- Below is the policy and joh site information. Insurance Company Name: Policy # or Self --ins. Lie.. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insyrance coverage verification. I do here c and t ns pen perjury that the information provided above is true and correct signslar C Date: d 7 Qf j`Icial use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Cleric 6. Other Contact Person 4. Electrical Inspector 5. Plumbing Inspector Phone #: Revsy ev A--, 0 0 C C _t\, Commonwealth of Mas Department of Fire BOARD OF FIRE PREVENTION APPLICATION FOR PE I All work to be performed in accord ce i (PLEASE PRINT IN INK OR TYP AL INF City or Town of: oell By this application the unde7igiTeFives notice of his c Location (Street & Number)i aDf%-'� tts Official Use /Only Permit No. ,TIONS Occupancy and Fee Checked '�� [Rev. 11/991 leave blank TO PERFORM ELECTRICAL WORK the Massachusetts Electrical Code (NEC), 527 CMR 12.00 TION) Date: /2- — q --D� To the Inspector of mires: her inten4bq to perform the electrical work described below. Owner or Tenant0'K 19ay� ' Telephone No. Owner's Address SGS Is this permit in conjunction with a building permit? Yes K No ❑ (Check Appropriate Bog) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters Com letion of the ollowin table mav be waived hv the Ins ector nf Wires No. of Recessed Fixtures Id No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ - ❑o. rnd. grnd. of Emergency Lfiglfflng Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of etection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: ,um....er. Tons o. of elf-Contain Detection/Alertino Devices No. of Dishwashers ` Space/Area Heating KW Local Elunicipa Connection ❑Other No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o atero. Heaters KW of o. of Signs Ballasts Data Wiring: f Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecoiWumcations Wiring: , No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuina office. Feb/a ow (Expiration Date) CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Z— __4 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pain and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: Kelly M. Casey Signature;;,0LIC. NO.: 37200 (If applicable, enter "exempt" in the license number line) 1 Bus. Tel. No.• 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Alt. Tel. No.• OWNER'S INSURANCE WAIVER: I am aware that the Licensee does no ave the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. Date... l " TOWN OF NORTH ANDOVER FO • PERMIT FOR GAS INSTALLATION IP �9SSAcHUSES This certifies that .... ........... has permission for gas installation in the buildings of ...:�- G �'�' ................ at North Andover, Mass. Fee...... .. Lic. No.. Al.z .. ........... GAS INSPCTOR Check # %< 6514 V MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date A d G NORTH ANDOVER, M/AS�SACHUSET/�S o Building Locations 4 Owner's Name New D Renovation Replacement Er G SU B-BASEM ENT BASEMENT 1ST. FLOOR 2N D. F L 0 0 R 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR. 8TH. FLOOR. (Print or type) Name__ Permit # Aj4--14/ ��.. n Amount $ c,— Plans Submitted w W Z U F aza'� � p dd W > m 0 x 3 x a Name of Licensed Plumber'or Gas Fitter Check one: Certificate Installing Company 0 Corp. 11 Partner. �rm/Co. - - -- ��_.. Juin in aouve application are true and accurate to the est of my knowledge and that all plumbing work and installations perfor ed under Permit lssfd for thisplication plication will be in compliance with all pertinent provisions of the Massachuse J'}•e G ode and C$/$pter 1 q%J�/u/of the Q418ral Laws. I By: I +/Town, PROVED (OFFICE USE ONLY) Sinature of LicenserPlumber Or Gas Fitter Plumber ox,;;r,7 i Gas Fitter License um er E:.3—blaster Journeyman W v, U � y Name of Licensed Plumber'or Gas Fitter Check one: Certificate Installing Company 0 Corp. 11 Partner. �rm/Co. - - -- ��_.. Juin in aouve application are true and accurate to the est of my knowledge and that all plumbing work and installations perfor ed under Permit lssfd for thisplication plication will be in compliance with all pertinent provisions of the Massachuse J'}•e G ode and C$/$pter 1 q%J�/u/of the Q418ral Laws. I By: I +/Town, PROVED (OFFICE USE ONLY) Sinature of LicenserPlumber Or Gas Fitter Plumber ox,;;r,7 i Gas Fitter License um er E:.3—blaster Journeyman W01 P 69-49 Date... X7 —.3 0- ) TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0.11 This certifies that .............. .11Y ......... ce "../............................ has permission to perform ......... ..& ..... wiring in the building of .......... 4" S!� ........................... at ................. . ........ ..... . North Andover, Mass. Fee.Y.R..'v Lic. No..37Z-PE, ......... ELECTRICAL INSPECTOR Check # ? 10 &\ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. --o BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Bate: 1.11.1.712005 City or Town of. North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 74 Woodstock Road Owner or Tenant Don Cruickshank Telephone No. 685-0539 Owner's Address same Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service _ Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: install wiring for light post, outlet for heat tape, o.d. outlet (S) Completion of the following table may be waived by the Inspector of Wires No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures 1 Swimming Pool Above ❑In- ❑ rnd. grnd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets 3 No. of Oil Burners FIRE ALARMS I No. 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 g No. of Waste Disposers Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kir Security Systems: No. of Devices or Equivalent No. of Water Kms, Heaters No. of No. of Silts 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. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File Feb/2006 Estimated Value of Electrical Work: 11/21/2005 (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: Kelly M. Casey Signature LIC. NO.: 37200 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut, Mass 01826 A1t. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ 40.00 Signature Telephone No. C Commonwealth of Massachusetts Official Use Only E--. Department of Fire Services Permit No. - ! - r BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked $L [Rev. 11/991 (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 .4LL INFORMATION) Wte: 11/1.7/2005 City +r1r'1'r,'Si n of- Forth Ando er To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below: 1.•r,CA1,011 ( tr,ct !.Y 'tiuriiher) 74 Woodstock Road Oto Iter or Ttaiant flair; Cruickshank Telephone No. 68:5-0539 Owner's Address :arae Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpi,se Utility Authorization No. Existing Service _ Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: install wiring for Light post, outlet for heat tape, o.d. outlet (s) Completion of the following table may be waived by the Inspector o 'Wires. I No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures I Swimming Pool rnd. Above ❑ In- gruel. ❑ o. o Emergency Lighting Batte Units No. of Receptacle Outlets 3 No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices No. of Waste Disposers Heat Pum Totals Number Tons .. . KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection ,No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters V y No. of No. of Si ns w Ballasts _ Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent LOTHER: Attach additional detail if desired, or as required by the Inspector of,Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File Estimated Value of Electrical Work: 11/21/2005 (When required by municipal policy.) Feb/2006 (Expiration Date) 'A :wl, to stunt: Inspections to be requested in accordance with MEC Rule 10, and upon completion. i 1 certify, under thepains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: Kelly M. Casey Signature ', LIC. NO.: 37200 (lf applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut, Mass 01826 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. r Owner/Agent Signature Telephone No. FER.A111- 1'T;E: 48. ell) Date.. ;���......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��.� This certifies that -7, lel .,... /................. ............... . has permission to perform`........ . ........................................ wiring in the building of at../ ..................,/ 4X.� r�J �i................ .North Andover, Mass. Fee ... �Z'�.... Lic. No. 3z............. �/'/ /`-71� �:............... ELECTRICAL INSPECTOR s Check # 1(f� 5486 Commonwealth of Ma. . Department of Fire BOARD OF FIRE PREVENTION APPLICATION FOR PEF All work to be performed in accord (PLEASE PRINT IN INK OR TYPEALL IN. City or Town oh. By this application the under, ' gives notice Location (Street & Number) -744 khDt fts Official Use Only Permit No. Jr43 ,TIONS Occupancy and Fee Checked 17 [Rev. 11/991 leave blank TO PERFORM ELECTRICAL WORK ith the Massachusetts Electrical Code (NEC), 527 CMR 12.00 L4 TION) Date: 12-- q —4�l To the Inspector ofWires: or her intenti to perform the electrical work described below. Owner or Tenant '1,)an j t--- f �� �� R t/i Telephone No. Owner's Address S0yA Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /044, -4- Completion 4- Com letion o the ollowin table may be waived by the Inspector of Wires. No. of Recessed Fixtures/d No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- El rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number I Tons I KW ...................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers / Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water �, Heaters No. of No. of Si ns Ballasts Data Wiring: f Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Teleco unications Wiring: , Noof Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File Feb/000--" (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:/7--/, -'� Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pain and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Licensee: Kelly M. Casey SignatureXapil� (If applicable, enter "exempt" in the license number line) Address: 700 Robbins Ave Unit 3 Dracut, Mass 01826 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. LIC. NO.: LIC. NO.: 37200 Bus. Tel. No., 978-697-4453 Alt. Tel. No.: zo ave the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. F P ERMIT FEE: $ r Location No. 3 Date fU �ORTM TOWN OF NORTH ANDOVER N? • • OA " Certificate of Occupancy $ Building/Frame Permit Fee $ s�CNUs Foundation Permit Fee $ Other Permit Fee $ / TOTAL $ Check #�` 17869 ,Mt�� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIJ RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: ,7 d ;� SIGNATURE: C ce L Building Commissioner/I ctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: j -7 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ZoningDis;�ct ProposedUse Lot Areas Frontage it 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply ZL.C.40. 54) 1.5. Flood Zone Information: 1.8' Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System. 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record C� 2i,5 -,Ddb Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Namd;Print Andress for Service: Si natuAe Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: /6 O N 6 -f -k2 . K. 6 F P Licensed Construction Supervisor: Address �agmr-e Telephone 3.2 Registe4ed Home Improvement Contractor Company Npme 2,1 zlewa� Not Applicable 0 6 - License Number Expiration Date Not Applicable 0 /o P3 Registration Number Address Q QU O ' (2) ZO Expiration Date ` SECTION 4 - WORKERS COMPENSATION (NLG -L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and .submitted ..with.this:applicprovide this affidavit will resultation. Failuie to in the denial of the issuance of the building permit. Si tied affidavit Attached Yes ....... No.......�' SECTION 5 Descri tion ofPro osed Work check all a Ucable New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost Dollar to be Y 1Building Com leted b ermit a licant . O (a) Building Permit Fee 2 Electrical Multi fuer (b) Estimated Total Cost of 3 Plumbin Construction 4 Mechanical HVAC Building Pernvt fee X. (b) 5 Fire Protection / �d 6 Total , 1+2+3+4+5 Check.Nurnber SECTION 7a OWNER AUTHORIZATION TO 13E COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize My behalf, in all matters relative to work authorized by ng permit application, this building to act on Si nature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date PEA R gee J .property ,as-Pva=AAuthorized Agent of subject Hereby declare that the statements and information on the fore and belief. going application are true and accurate, to the best of my knowledge '> r�• The Commonwealth of Massachusetts �^ -,_'—. ase - .l = ____ ;. Department of Industrial Accidents 011ieeel/nrrestigollpfls 600 Washington Street Boston Mass. 02111 Workers' Compensation Insurance Affidavit Mean to ormafion: rx: ...... ; � ..pal:!xITL,. i ;Y6 -w; t7 flu er # I am a homeowner performing all work myself. Q/I am a sole proprietor and have no one working in any capacity 3ignaturej'(L,1r'% 7 Print name �� S /,jN�..�Li ? ,%CE�.1. -.. --, Phone # official use only do not write in this area to be completed by city or town official _...... . city or town: permit/license # nBuilding Department check if immediate response is required OLicensingBoardSelectmen's Office contact person: (revised 3195 PJA) pHealth Department phone #; nOther A ` i ✓�ie toomv�naiu� o�✓�aaaaT/ucaei� f j BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR i t Number ;-CSS. 058245 Birthdate X03/24/1943 Expires 03/24/201)6 Tr. no: 21031 f -- Restricted 00' KENNETH B KEEN'; 4 21 HEWITT AVE f i N ANDOVER, MA 01845- Act g C�mlsoner t fie �arr+�zaizcirea�i a�,.�iaaaaciucoella � . Board of inildifig,Regulations and Standards r; HOME IMPROVEMENT CONTRACTOR � Redistrittio \ 1'08383 ' Exp atii5r� N1,8/2006' ` pe =D i. KEEN CONSTRUCtiOIIC©- { r �.' Kenneth Keen 21 Hewitt Ave No. Andover, MA 018,45. [t Administrator Cruickshank, Don & Chris 74 Woodstock Ln. N. Andover, MA 01845 (978) 685-0539 Contact # 1599; Appendix A KEEN CONSTRUCTION CO. 21. HEWITT AVE. N. ANDOVER, MA 01845 (978) 691=5201 Date: 12/5/04 Kitchen remodel: • Remove existing cabinets & appliances • Demolish walls, ceiling & floor (to sub floor) and dispose of all debris • Supply & install R-1.3 insulation & vapor barrier in exterior wall • Create walls around chimney ® Create larger opening between kitchen & hallway to approx. 42" • Supply& install blueboard on all walls and ceiling and skimcoat plaster to smooth finish • Install customer supplied cabinets as per drawings from Dracut Kitchen & Bath • Supply & install trim on windows and doors to match existing • Paint ceiling (white), walls & trim ( 2 coat finish, 2 neutral colors) Plumbing: • Remove and dispose of existing heat in kitchen • Supply & install toekick heater under cabinets • Relocate supply, drain & vent pipes as needed • Supply & install gas line to new stove location ( if gas is in house) • Install customer supplied appliances & fixtures Electrical: • Upgrade outlets and switching to code Supply & install switching & wiring for disposal • Supply & install six recessed ceiling lights Total Price:$15,800.00 (fifteen thousand eight hundred dollars) Price does not include cost of permits, flooring, ceiling insulation, fixtures, appliances, cabinets, counters, back door, or hallway heat. 1 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Payment schedule.- $7000, 00 due upon signing contract $2000:00 due when rough electrical is complete $2000.00 due when rough plumbing is complete $3.000.00 due when plaster is complete $1800.00 due when contacted work is complete. Customer Ke et B. K en Date Date Yr 2 KEEN CONSTRUCTION CO. a 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 /" I r Submitted C0- G' i1 '� �. r1_�.._._l__- .____`-�r-U, G To: _........_................_..._.._:..._...................-.........-......_ _. ...... :l7 .... -_..._._ -�� � � �-��C- __-:..('-V 111 f..._ ................ ...............�.......__: _�:_ ►_` ' - PHONE DATE > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be.performed and materials to be used: Construction related permits: i 1599 PROPOSAL All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and. status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. REGISTRATION NO. F.I.D. NO. MA. H.I.C. 108383 04-325-8052 _�...�_o_C�.-�..........................--..._... �.`... . c= WORK SCHEDULE Contractor will not begin t e work or order the materials before the third day following the signing of this Agreement, unless specified here in writing. Contractor will begin the work on or about y (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by — ?' I - (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall 'n t be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contracto , his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propttose hereby to furnish material and labor - complete in accordance with above specifications, for the sum o{f.,: 1 ( v"� �/� ) C'\��� E i c, ��' H OY-) J f`� �! �— !dollars ($ .) > c, C7 ) Payment to be made as follows: % ($ ) upon signing Contract; % ($) on co le ' \nom /o ($ ) kon'\c�npletion of _,� shall be made forthwith upon %`��) completion of work under this contract. KENNETH B. KEEN Name of Contractor / Designated Registrant 21 HEWITT AVE. Street Address N. ANDOVER, MA 01845 City / State (978) 691-5201 -(978) 682-3231 Phone Fax Notice- -No agreement for home ,improvement contracting work .shall requirea� = - r > down payment (advance deposit) of more than one-third of the total contract price Name n!sies rr or the total amount of all deposits or payments which the contractor must make, In j �''^� advance, to order and/or otherwise obtain delivery of special order materials and Ath uorf�d gr;a bre equipment, whichever amount is greater. Note: This proposal may be withdrawn by us if not accepted within days. Acceptance of Proposal - I have read both sides of this document and all attached documents and accept the prices, specifications and conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature' J i .<L�. �.• -=. `� i Dated r �l �, Signature Date IMPORTANT INFORMATION ON BACK 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: 12 V c (Location of Faci ) Sign t fe-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 A I%h rA O El 0 0 v c c o•— � o� y � � 'E m m Lm �3 as o 0 !a o ir cm< eCv C3CL c CD �v c Z CD CL �..� CA c C ' C cc W3 D W cl U) LO W W U) N O m c O C y O C w O a cam,, C.i a W a m C :t O a O o w° a �° U ,w a' 'b a°' ca w a°G 8 w nb 0 oG .— w" a N �' w r� z �i V)cn . i ° O El 0 0 v c c o•— � o� y � � 'E m m Lm �3 as o 0 !a o ir cm< eCv C3CL c CD �v c Z CD CL �..� CA c C ' C cc W3 D W cl U) LO W W U) N m c O C y O C cam,, C.i aC O O m C :t O O 0 C: z 8 0m V a N Es m �` mom'• • m c l E L 0 cc m=om� OZ'%" :�m Me m 3 m� cm'7 y 0 C C y C E m O v� m V 0 L o ci� m z o cmc C a = m m a -o S ♦"w Go m COD LUGo C ev = m oi w c CLM z ac'E 010 CO)0-81 a ID 1. t 73 $aqmm O � O El 0 0 v c c o•— � o� y � � 'E m m Lm �3 as o 0 !a o ir cm< eCv C3CL c CD �v c Z CD CL �..� CA c C ' C cc W3 D W cl U) LO W W U) Date.,/—.?. /3 —Po/6' TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING -�SACMUSc� This certifies that .. ^?!............... . has permission to perform ....... -? ................. plumbing in the buildings of . [V*! , ........... 1 at . 7�% .... ,North Andover, Mass. Fee.,t,p/C....Lic. No...0 �� .. ,........ PLUMBING 'INSPECTOR Check # 6263 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBP (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location �U j to C �C New 1:1 Renovation Date �%' Sl2 A"f-- --1 Permit # z'�g r Amount Type of Occupancy �(/ Replacement 0— FIXTI JR RR Plans Submitted Yes ❑ No ❑ (Print or type) y� - rte' / Check one: Certificate Installing Company NameI `� V c �L�/��e ►�L? El Corp. Address ✓Gp v d ► C%iz`'� s�� El Partner. �ti� ✓✓d - ,,.c .L,2 .,`�-sir p� � `t! s.� usmess Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy a Other type of indemnity D Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations rformed der Pernut sued for t ' application will be in compliance with all pertinent provisions of the Massachusett�lumb' C�e and Ctypter 142 e Gene Laws. APPROVED (OFFICE USE ONLY Type of Plumbing License Eicense NumDer Master Journeyman ❑