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Miscellaneous - 80 CAMPBELL ROAD 4/30/2018 (2)
L, 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time ofongoing construction activity, and may be.deemed-by.the . Inspector_of_Wires abandoned.and-invalid,if he—.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending"through August 15, 2012. Rule 8 — Permit/Date Closed: ❑ Permit Extension Act — Permit/Date Closed: 2 zl—I�K *** Note: Reapply for new 7 4' i Date . . . � ...... r !! NORTry TOWN OF NORTH ANDOVER oil , PERMIT FOR GAS INSTALLATION _.. This certifies that ...,l,-�......1�..f..#.................. has permission for gas installation .. & ,j .,.: '.. ; l"... . in the buildings of .... , 0411,. t' . .. ....................... . at ..?.... e.�m.P.b,0 1 ...% .. , North Andover, ass. 4:25.b.0. Lic. No../3?.5(.�!. f� SINSPECTOR Check # 9404 6-- d Date.................................. °`,"' "I'to ' G. + TOWN OF NORTH ANDOVER 0.- PERMIT FOR WIRING This certifies that ....... has permission to perform .............................................. wiring in the building ..................................................... at ....... ...... ....................... NrthAndovei, Mass. Fee ... $7�. Lic. CAL INSPECTOR JIt Check # Commonwealth of Massachusetts Official Use Only Department of Fire Services VPermit No. tC'Z/ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code Qv1EC , 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: , j //1WO City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or , r inteAon to perform the electrical work describo,�elow. Location (Street & Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes40 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service6b0 Amps %Volts Overhead Undgrd ❑ New Service _ Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Completion of the following table may be waived by the Insoector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans r o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches '`3 No. of Gas Burners o. o Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat PumpNumber Totals: -- ons ._........_.... __......__....__.._... KW No. o Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local [:] u [1 Other Connnectiecti on No. of Dryers Heating Appliances KW ecNo. Systems: No. of Devices or Equivalent No. of Water KWNo. Heaters of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Te ecommumcahons inng: No. of Devices or Equivalent OTHER: U Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Ele ical Work: (When required by municipal policy.) Work to Start: 2 /fir � 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 liRBONDE] 'nsurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such ca is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OTHER ❑ (Specify:) I certify, under the ins andpenalfiegof rjuty, that the information on this application is true and complete. FIRM NAME: ' LIC. NO.: Licensee: (, Signature LIC. NO.: 1� (If applicable, enter "exempt" in the license number line) Bus. Tel. No. y� Address: Alt. Tel. No.: 79.2— *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 4 4 i. Date .. /j ` ......... pORTIy pf .ao ,°,tip n 3� ' TOWN OF NORTH ANDOVE p 9 41 a,z PERMIT FOR GAS INSTAL TION This certifies that ....:-ra 1,,.f has permission for gas installation . k� . 67 .................. in the buildings of ...� ........... . . . . . . .. . .... . . at 4I!k� .. . c� ... , oath Mdover, Mass. ./.' �>.�. r .... ..L� Fee. l.. Lic. No. . t ��; G S INSPECTOR Check # L. / y TO DO GA.qVrrrlKG own=3a tl 0 Plans Subnmitted: Yes 0 No _ F5 J;D •V ilii ;\i;�t,:1 ���������������������� V y - • • • 0 LJ Busmmss T'elepho� `� /6 —b� ! d Yb t0 Name a Licensed Phmber or Gm Fuer i til .a, i Ir a \ntivn- ' n \\laitinn : as I hme aacz am Policy grits i ivate whichs tbsreq r I► Cii: Ch 142. Yes m KW mhave-cft&edM&pm_ &-_bydcking:ffwsMmp bcm Odwrt"CaUmdenwity Bomd OWNERS MURANCE W Iamavmeththe at=Eln-at havethemsumaoecove rage zegaired byeI42aftda NWm Cvcnmmllmm almd tbamysigmw=eoamspcm&appF=atimwaimttdsreqvkenmmrL Checkow ovmer p Aunt I hemeby certify tbai a ofihe details and iaGnmefianI have submitted (or ) is above appEcation are true and accucabe to the bestofmy aadlbAaU �gvQarlc p ma�timpem kimmedfor@ms appficationmMbein campiienuce vd& all partite provisioms offtMassachmetft Sh t+e Cas Code and Clatpter 142 ofthe general km& 8746 Date. TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SACMOs� / / 4r-- This certifies that ..�!...... ` ...,f.�✓.t......................... has permission to perform ... X''.fl!q y .. `-..'................ . plumbing in the buildings of .. F.!':r: �..................... . at ...G� ........ ;North -Andover, Mass. Fee.. C?..... Lic. No.). .......... PLUMBING INSPECTOR Check # q IL r �--� it—• • —• �-, 1 • � • �ii'T.i� NOW �- =��?= - -.� Iii ,/i' • ,,1 0 ■��<t0MEMO EMESEEMEMEEMiFEii SENSE 00MEMENEEMEMEmossuiml .. MENNENMEEMENE»MEMEMENSsMI _i - - - r •, •it,t ■ ■ Io�tlat�dtLsiM�icaed dor�fm tis ae'+b�i�dior_iwd b ias_a�pEo�io■ a�!■�rsad aoc�elstbs tNstd � r z • s .. w w w Z O Y 2 ~ t r O ae JI i • -O < � a tl c o= •ws taw a e- 3t ndwY< w� • x `ss 3 x -- 40 de W CC 0 Y r t0- r r t 3 0 o -. �< w c c .t o c r w s c lO s<_ = s ac i O~ Z Z< s ac r le < t< x!! O! J 1< c Q •G O! F 40 ■��<t0MEMO EMESEEMEMEEMiFEii SENSE 00MEMENEEMEMEmossuiml .. MENNENMEEMENE»MEMEMENSsMI _i - - - r •, •it,t ■ ■ Io�tlat�dtLsiM�icaed dor�fm tis ae'+b�i�dior_iwd b ias_a�pEo�io■ a�!■�rsad aoc�elstbs tNstd � r ?6) Location No. 0 5 Date 1' NORTIy TOWN OF NORTH ANDOVER • • w ; , Certificate of Occupancy $ �sf,�cMust<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # A' ?fes 19830 Building Inspector New Replacement 0 TO DO GA cFTTTING Owners Name Type of Occupancy �___, E3� Plans Subnmitted: Yes Installing Company Name Address : Business Telephone ' /74� Es Name of Licensed Plumber or Gas Fitter Cell ?-rl'SldfL" No Check One: Certificate Corporation ;Partnershi irn�/Co. LNSTJR---NCE COVERAGE I have a currants VabilityNo its substantial equivalent which meets the requirements of MGL Ch 142. If you have checked 3es, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of imdemnity n Bond OWNERS INSURANCE WAIVE I am aware that the licensee oes 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 Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with all pertinant provisions of the Massachusetts State Gas Code and Chapter 1 2 of the general laws. Type of License Bergh OK Fer i e o i um er or atteroSinai0K yrmn o Underground LicenseNtmiber Total No. I Total fee r • • • V • • "26 0� ;"gere■■■■■■■■■■■■■■■■■■■■■■a 01, •• ■■■■■■■■■■■■■■■■■■■■■■i "NIM, ... ■■■■■■■■■■■■■■■■■■■■■■ Installing Company Name Address : Business Telephone ' /74� Es Name of Licensed Plumber or Gas Fitter Cell ?-rl'SldfL" No Check One: Certificate Corporation ;Partnershi irn�/Co. LNSTJR---NCE COVERAGE I have a currants VabilityNo its substantial equivalent which meets the requirements of MGL Ch 142. If you have checked 3es, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of imdemnity n Bond OWNERS INSURANCE WAIVE I am aware that the licensee oes 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 Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with all pertinant provisions of the Massachusetts State Gas Code and Chapter 1 2 of the general laws. Type of License Bergh OK Fer i e o i um er or atteroSinai0K yrmn o Underground LicenseNtmiber • ' Commonwealth of Massachusetts • ��-<ac�n iia- • Y' North Andover BOARD OF HEALTH 1600 OSGOOD STREET BUILDING 20; SUITE 2-36; South NORTH ANDOVER, MA 01845 DATE PRINTED: 03/09/2012 ESTABLISHMENT NAME: Karen E. Hamill File Number: BHF -2004-000153 Karen E. Hamill 80 Campbell Road NORTH ANDOVER MA 01845 LOCATED AT: 80 CAMPBELL ROAD ,MA Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes Animal Permit BHP -2012-0512 Mar 1, 2012 Feb 28, 2013 $35.00 5.65 Acres; Equines: 3; Private / Contact: Cell: 978.697.4421; Home: 978.794.3864 Total Fees: $35.00 PERMIT EXPIRES IFebruary 28, 2013 BOARD OF HEALTH Page 1 b O` MORT :,y • i Town of North Andover SSgCNU5tt CHECK #: LOCATION: H/O NAME: 6024 CONTRACTOR NAME: T ff f Permit or License: (Check box) Animal $ �� ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ >, ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Tras4lSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer '� t pOR7q TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT'S 1600 'S ACNU`� 1600 OSGOOD STREET; Building 20; Suite 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540 -Phone Susan Y. Sawyer, REHS/RS 978.688.8476 -FAX Public Health Director healthdeptntownofnorthandover.com Animal Permit Form www.townofnorthandover.com The undersigned hereby applies for a permit to "KEEP CERTAIN ANIMALS AND BIRDS" within the Town of North Andover, in accordance with Chapter III, Section 23, 131 and 143 of the General Laws, and subject to the rules and regulations of the local Board of Health and Zoning Bylaws. -I ADDRESSILOCATIONOFANIMALS:.Vl OWNER'S NAME: i4ven l OWNER'S ADDRESS/LOCATION IF DIFFERENT. Dealer: Yes No 1'/ Adult Young (number of) 1. Cattle (Adult = 2 years & over) Dairy Beef Steers/Oxen 2. Goats (Adult = 1 year & over) 3. Sheep (Adult = 1 year & over) 4. Swine: Breeders Feeders 5. Llamas / Alpacas 6. Equines: Horses / Ponies Donkeys / Mules z PaIZ-7 : Boarding C Training O LessonsO 4(er) Ham, Name of Applicant (PLEASE PRINT) TOTAL ACREAGE: 7.Poultry: Chickens Turkeys 8. Rabbits: 9. Other: S ' 2 F vaax�__ &M,,�' Signature of Applicant Contact Phone Numbers (indicate cell; home; work, etc.) q-7 8 - & ~ q T a FEE:3$ 5.00 Please make check payable to: Town of North Andover (mail to above of North Andover (mail to above address) IF NOT RENEWED BEFORE MARCH 1sT. THE FEE WILL BE DOUBLED TO $70.00 Information requested by the Department of Agricultural Resources Bureau of Animal Health — Form 74- 500 BKS — 7103 — 4DBSBBI- y Commonwealth of Massachusetts BOARD OF HEALTH North Andover 1600 OSGOOD STREET BUILDING 20; SUITE 2-36; South NORTH ANDOVER, MA 01845 DATE PRINTED 02/16/2012 ESTABLISHMENT NAME: Karen E. Hamill File Number: BHF -2004-000153 RE: 2012/2013 PERMIT RENEWAL LOCATED AT: 80 CAMPBELL ROAD ,Commonwealth of Massachusetts OWNER: Karen E. Hamill RENEWAL FEE DUE: $35.00 ANIMAL LICENSE Karen E. Hamill 80 Campbell Road NORTH ANDOVER MA 01845 PHONE: (978) 794-3864 PERMIT TYPE FEE DURATION ANNUAL SEASONAL TEMPORARY Animal Permit $35.00 ❑ ❑ NOTES: Contact: Cell: 978.697.4421; Home: 978.794.3864 Total Fees: $35.00 This is a COURTESY RENEWAL REMINDER .......... if you currently hold an active Animal Permit, your permit expires annually on February 28th, and your new permit becomes effective each year on March 1 st. . In order to renew your permit, you must complete the enclosed application and return it along with the renewal fee of $35.00. Please fill out the enclosed form completely, since applications submitted without the necessary completed information will delay the issuance of your permit. Please return your application and fee to: North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845. Please make check payable to the Town of North Andover. If you have already sent in your application with payment, thank you, and please disregard this notice. If you have any questions, please call the Health Department at 978.688.9540. In addition, you may e-mail us at: healthdept@townofnorthandover.com. Thank you for your cooperation during the renewal process. Enc: Animal License Application Form Location CC, �^ ✓� �� q - J No. �^ � Date HpRTh TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ • i # J�CNus Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ a TOTAL $ Check # Building Inspector Z k / i Z /k * / % ƒ Z. »ij / o \, co t� :� � ,: ���<�.■ � � : C E 0 n/� ƒ 2 � � z \ \ CA) \ m q ¥ I (. / { I In E_ E/ : m$ k2 E 9 3� .®. \ \^ 0 . > R 8 k /: . C) -0 § �f#, D t test I c�2 2\� }, m § 2 \ \ 7 2; § / \ May 14 10 09:45a 19782084716 P.1 ACORD. CERTIFICATE OF LIABILITY INSURANCE DAT114/20DrYYYn as1a/2a10 PRODUCER Michael Emond 857 TuMike Street Suite 133 l North Andover, MA 01845 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC INNsURERA Farm Family Casualty Insurance —^ INSURED ` HRH Construction 57 Chase Street Methuen, MA 01845 ' INSURER B: i INSURHtG INSURER D: -- INSURER E: COVERAGES 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 G SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDLY BY PAO CLAIMS. ;NSR POLICY NUMBER I POLICY EFFECTEYE ;POLICY EXPIRATION DAZE MME1011M LITS A { TYPrOFINSURANCE GENERAL LIABILITY COMMERCIAL GENERAL tUUl1LITV COMMERCIALs MADE M CCCUR _ `I ! 2005XD775 EACH OCCURRENCE I PREMISES IEa I MED EXP (Any one person) I V2012008 11=2010 PERSONAL a ADV INwRY GENERAL AGGREGATE 1,000,000 SOAMAGETORENTuEo _ 50,000 S •_ 5.000 s 1,000,000 S 2,000,000 —��2,000,000 PRODUCTS - COMPIOP AGG ! GEN LAGGREGATE LIMIT APPLES PER: S X pOUCV PRO- LOC AUTOMOBILE LIABLITY COMBINED SINGLE LIMIT (Ea ecddeM) s ANYAUTO ALLOWNEDAUTOS BODILY ,URY i SCHEDULED AUTOS HFWD AUTOS BODILY INJURY (per aecwent) : NOWOWNEO AUTOS - 1 PROPERTY DAMAGE (peraeeident) s — WIRAGE LIABILITY I AUTO ONLY -FA ACCIDENT 6 FAACC AUTOONNLY. AGG i F I ANYAUTO i EXCESSAIMBRELLA UASLITY EACH OCCURRENC _ S AGGREGATE t_ S OCCUR L1 CLAIMS MADE S DEDUCTIBLE -• - 10 S VIC STATU16a RETENTION S WORKERS w MPENN O TION AND EMPLOVERrLUUNLRY E.L. EACH ACCIDENT S 5DD,000 A iOffyic.i MEMBPROPRIETEREXCLU I� 2W5W8B27 SPEGAL PRAOI/IS ON5 Celow 12/DT12009 12107/2010 EL DISEASE -CAEMPLOYe S 500,000 EL DISEASE- POLICY LIMIT S `�O,OOO OTHER I DESCRIPTION OF OPERATIONS LDrATIORS I VEHICLES I EXCLUSIONS ADDED BY EBDORSEYENTfSPECIAL PROVISIONS Operations by named insured Town of North Andover 120 Main Street North Andover, MA 01845 f 978.888.9542 SHOULD ART OF THE ASOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER "ILL ENDEAVOR TO MAIL 30 DAYS WRMM NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LER, BUT FAILURE TODD 50 SHALL IMPOSE BO OBUGATION OR LrABIInY OF ANY KIND UPON THE INSURER, ITS AGEMS OR ACORO 25 (2001108) `' '—' ' Q ACORD CORPORATION 1988 x O u0�� � b w N a cn o U 0 w° a U G w w a c7 a a'b O wl a O w r w W wl c% is w O C7 �b a w i.i z cn v o o cn 000-0 CLCR R o c ' o ,yam .fit .1Q u W O 7 z _ u Q � 0 O x O u0�� � b w N a cn o U 0 w° a U G w w a c7 a a'b x ca w a O w r w W x c% is w O C7 �b a w z a w w CL w z cn v o o cn ., r• ; r Q y - o m CD m c z y■■�doCOJ y C.'D 3 ._.. O a y C O •O # C m O a • z y y A =0 E m Tv C CD o � acs m tcm COCD Q �_ o Y rt �. ce C • O m b, ci 0' O ca• -Z o ,r c ` o C ~ o. O N m C C = m 03 N ~ mH m ID S `I,W 0 .0•...ME WCL= . "5 z •E 0 •yam o • W V O Ci C. m CD C = W = O O_ 9 R U, 0 ML--. .1.1 C6 > C-11 0 2 V 0 CD cm CD i Q h 0O W MWO CD 0 CD CO a� O cmi e_cv o a MQ cma co CD c ev ev co C Z ai V Cie O C C c CA D LLI CA N uj 0) W W 19 W U) g o C H O .:g C O CJ 62 .Cc CLCR R o c o - Cc CD y Ea E c Aj ., r• ; r Q y - o m CD m c z y■■�doCOJ y C.'D 3 ._.. O a y C O •O # C m O a • z y y A =0 E m Tv C CD o � acs m tcm COCD Q �_ o Y rt �. ce C • O m b, ci 0' O ca• -Z o ,r c ` o C ~ o. O N m C C = m 03 N ~ mH m ID S `I,W 0 .0•...ME WCL= . "5 z •E 0 •yam o • W V O Ci C. m CD C = W = O O_ 9 R U, 0 ML--. .1.1 C6 > C-11 0 2 V 0 CD cm CD i Q h 0O W MWO CD 0 CD CO a� O cmi e_cv o a MQ cma co CD c ev ev co C Z ai V Cie O C C c CA D LLI CA N uj 0) W W 19 W U) The Commonweizjth o, fMassachusetts Department of rndustrial _accidents Office of Investigations 600 YVashinbton Street Boston, Mq 02_711 www-mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers �plicant Information Name (Business/organization/Individual): Address: City/State/Zip: �`�i ��"?{ (NS k d �'� Phone #: C Are,ybu an employer? Check the appropriate box: 1. I am a employer with �- 4. ❑ I am a general 2. ❑employees (full and/orpart-time).* I contractor and I have hired the sub -contractors am a sole proprietor or partner- ship and have no employees listed on the attached sheet I working for me in any capacity. These sub -contractors have workers' comp. insurance. [No workers' comp. ffi. .,ce 5. ❑ We are a coipgration 3. ❑required ] I a homeowner doing and its officers hake exercised their all work mysys elf. [No workers' comp. right of exemption per MGL c. 152, § I (4), and insurance required.] t we have no employees. [No workers' comp, insui-au Type of project (required): 6. �❑INew construction 7. C Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs oradditions .11.0 Plumbing repairs oradditions 12-❑ Roof repairs ce regtured ] I 13 0 Other : E- Y aPPli-Ilt that check, box El mnsi also a, Out the sectio^ beiaw W.aY.^,r•+ Homeowners who submit this affidaindicating the;, ate doing all work and cr worl:e s' camp—'s- Vit ac ^^ LLc as +Contractors thatch k this box must cd an additional sheet showing then In- outside contractors mu-:^ submit a acw the same of the sub -con �rna� indicating such. r _ uactora and their wnrk-r , __,__ _ •- "" ".°PN..ver ""a ss provuttng workers' compensation insurance for my e -r r-�� � formation. employees. Below is the policy and job site Insurance Company Name:/ �►q, i r Policy # or Self --ins. Lic. Expiration Date: — Job Site Address: Attach a copy of the workers' compensation policy declaration page (sho City/State/Zip: ©/44- Farlure to secure coverage as required under Section 25A of MGL c. 152 can lead to e policy os umber and expiration date). fine up to $1,500.00 and/or one-year imprisonment, as well as civil Penalties in the foam o1 f a STOP WOof RK p� pities of a Of up to $250.00 a day against the violator. Be advised that a co ORDER and a fine Investigations of the DIA for insurance coverage verification, PY °f statement may be forwarded to the Office of I do hereby certify undo- the Official use only. City or Town: ofPerjury th4rt the information Provided above is true and correct -.Date. _- �M.J /j_ 1 Do not write in this area, to be completed 1, c j, or town ff aL permit/I,icense # Issuing Authority (circle one): L Board of Health 2. Building Department .3. Ci Town lerk6. Other4. Electrical Inspector S. Plumbing Inspector Contact Person: Phone #.- a uaz •coca des ati bathe rogue bagaw to Prat b"Mawmem 30ek Cons=wGradea the BMW brPovemr 0uia9ftOffioeofCbRMM.. AW.S - ph=bwb �'p�oapme aKi° �adard r.a016 ei�b►aolwakao�oor�aideaoe You ° RCOWof'A � onAoQuetQ�727-7IdQ,� afiaeoopyby Address (Lt d finer• above) _r M�� �� y'�ot£ulloJ'�IDarSS.PTa.ober tee�aeaa�.o,�1De0a�e i-a..�`" 1 f� 1 7d" c �.a.dg,,ieoftaae,;r�atK - � � U2 �,�q,�,t -� ,�-�; �tL.t.S L.1Csti1��5 = ix�sts�(y�u� a,d wt7l be a,e mtawigg big I its oar n* seosad by me aaiftmmras the im,eowuftage "Foe's who secure their ower Pmft WM be Cmduded from the G>as:taw" lid in,gislosa it MGL chapter 147A.) -Q-A L-f�"U16 The Conpactor � __...�..� N= nV= to Perfoim the work &rum 6e afQanedcuElmshown�� cb sed,ie wffi cocftmmft � r� � � 1 t�.� mot arose -`�9—=--fir wwhOw bcaoha*--M bei.oo=.Md _ and Labor specified above for the total Payme�nts-(wiu be meds wmt mg to the fouownig srhedut. 1 f S i b�_ U'OII Al'g wemaa (trot to exceed W ofdml fetal � 1tice SM the cost of $ special txderitemt; whicheves is grearrr) $ cutk- by / J artipop' Pietion of =- lam( E"r S by orupm eompkdom of / S-F-�L1L.L upon-IMPlation oftbeconb'act. (LIL-fiwWd i dig fdl p �! cow is The folloniag I �p�ed to both pirty's saisfaaim) ordered befm � a� � in CWa s% to be paid for 11t 1 to meet the edp1P>�orrse6ednle (�-=-F�-- as bQ D�fOr -- NO' S. (•) hictudhtg dl fatenoe charges (*�Law requim gem, not exceed the gtewr of (10 tme•fihd ofee tm eplmd whicb mars be speebd ordered in advmw to deet the cc 1�Y/att�modiiys6eeotu;,er� 'iLeaa trials and tabor d this CotTena Aeoepbanee - Upon s'pft& G& docuum comma amu not imply &= a" He, or otberseramty carefiiuY Wbm s ptag this contract. Da dt be.paamed imo signbTg the eaaftaiL Taim ' Makezmeil.scaottars�t.ue�.JidH®e7man W be affi t -W with SeDheewra "*6026= by vnWmg 10 2k DJmx*w at OwAsM Do=*eh eb=moe7 Cii*wsm ' Kwwy0w'WM=dreRwG=lWdm geedtocb Guide to theiiome3ragirvvattemr,�tr�rLaw: you »trytaTiod this aSifitbtabeeu tagoedtr ��athislhw follaariep,j... °�OCariaaeeitag Axys►u� www�a 1 �'� r�pnnr • i .M K Ci011Dfitf.! /s or N) -b.u.cgw m oy tae aon&adw befte war bepas mm. rscMdcmOfaqspedd cquipmcritorCusum nude nutuW greesti. q; er. &t"ar mvftuaaio-ofaoytbird sodoomaum Tor g ooubmat amaer law: UUU= othetwlse toted vnQM this doatmem, the Pfd on the ttsidmx Review the fallowiBg rm dow and notices toffy mdmMod it AskgocsWm ifsomodimg is tatdms rRgifti.. The hwnqob=moothome' �oaemeat yrs nerd 19617-7ZY-320(t ext 25105 IZeta copy ofineCoummw be Mal��bl�stacar ydcli mww& tclii ut biddtval. taottatattrae tt ofthe WdmkCefcaetodla6O fm=form afg&tight. TSIRB ABL ANY BLANK SPACES!•• axor'sSte,atnre" Contrxdcr ArWfmfiw- • - The Home Impiane ComiaborLlw paprdes hameowans with riR a uiiAiamaaatiaa t�lioa (ac an.. ltarmiiaeti0000rtadim)f!lddpulat�ano�aeiat 'ties�mosiaum almlicany .af6aodedtna e oonTracmc,hoaaeum 1�SecoeaaeIo l w nW6rnabtesotiaagy sh elnsw� aLo�ieowse�iaao�Ruakst � P060 � ro the opllosod otaaseproNided betbeisr 'flus cbsbse wadd gree tlra ooatrscca�tbe � Wim. ,�,dotc as is aBbtded to the bameeawaer by lire Boma , . �» Im:coaamoraodthehawwwnerbi mbya_aeieadwnosantin�aacme000 orlmaargyle e0acemindsis emmoract,l6e eaaAcaelae taq aobea�a elu iprivsas ariorrSw►wlds6 Las bex� agpraired Gocaast=wshallbe hy,ba �a�aWy oFffio siceaeedsc oliiees of caaanma Affirm; aaa x+► _and oqu �to to such arbitrstioII as peovidw InMass�s titaeeral . : Coobaa:lots . a a! NOlca lie sib of hew�ir ltv bof �e peatiea to abterareia dispe . . s �cnt reaoistiaa arsm whtaes thus NesoWrkn i d&ftd bl►os eooecaelo' �c a 6a eowaezma iai�' ea steeamisnotsepmamb i�edbp�sprties. Hameswse:'s 8 b A bomeowmfa ri&" Mdeer•1 tum me Coduaw'Aow gM l42Q =d a&w caosume r pcoteed , bows C.e: 9m) nmol ant l estmW in atq "y: area by ht s may beremevded froi>gt igt6e oosoctbsycbooae is natpeeperty as pra+en'bed 1r!► lrar Iiasuec� �r6c � z cswse: ** OFN!R bWt&g pes�ls ace mtehdesi Mesta mBGow=W Feed pcorisioes of thaHeroe�iidrmmteo�t�oaos:c�or%iw Itleeseoraic�ocaretpomiefaroaacpleticp�110r1satde�er�ed,m! dowdy mdvml I �N Hoe�eaiwttas may be emtitied to a8cer speedo tell ii t iPtM aoorraelot: ex P waastiRytorvtoiia ososii� ar mtsl b add'itioab aewaaaeties pravidedbytbeooaMaedesr;allgoods WNinM6masfaea�7►m '�°�a£Hra�ei�H9►aodfiio� i farapattiodsrputposa. Aa cnaldiermelieisenwhiah itoeaeownmascdooabaaioc arm W" beaddedlotali msaf6eaotiAcrataalosP6Wdliydo>tattest�eta sbtstsiaooessa®er Ifjoa�a q�abamyam CO, L�ats ahHotl'ta�e.(Gs�d1>e1u�►} E�osxadsa of Centrad Tha eoabaet most be eae�d in and:thanN aotbe siyeei mdil s copy ofaH a add t+eGebeaoed dOcomw is haven bG= aUwft3. Parte wepbo aelvised natio apthe do miff 8Abbd[ tadt Gare beat filled in ar n - I 4 pis void, ddeftd, ac wa app One a vod arced cmy oflo.00mwift ma mChanamm is to beghmIothe:awcterauddwatL kq*bytbeaantteratce.,AvYMM=d=lodrsQrj&ldiaetractaae;dIbsawriting and aamed to by bath portico. CQ*md ed wmtmsY aest6eBiII om'I bo�C poetics Isa�e tegesiue_ d a fi�9 a copy of - lite coatracE, and the three. day n�sianpaiod bas expired. 1bG icbedola is cases where lba AeoetratoteemWvII*ftmcemdpteYueeassiaadvameoftbrddalesspeeded . . plymeet htmce►ner Beams bsimlhmsdf m be utseeAle� s io;meaeoesaitele tt o0atsactior ebnmas WmihMBOW . m be Smemt�fijl msOCeleO, tI1C aoofmdor amayl[Qelieertbd&o bmhmD a£fi mdM u*yet die be piaeed >n a� estsvw a00e1eStaS ! praegetli to td as LO B ' aFP fmsaid aocaetat would nxpi C the sWafta of bolh partlas. - AdMoud Mop motion. If you Gave Swaal.quesbons or need aM,6ond its cmatiem about the Rome Impcovemeat Contractor I:assr at other cseaner slots, or if you wish to obtain a from cW of 'A Consumer (i" to the Home Imprcvaaemt Coatzaetor on Law,' comiaet: s _ - Minna ._ Fmootdi eOfaccefcomesmerAffairsandBeiReqpdmioe Ona AdAudm Pbree, Rom1411. Boston, MA 021" - (617)UIL7780 Ifyou want to verify lice re smtri" of a cmmft aif you hxvi gaestiaas a need addilios�l iafOrcnatioe spea5sally abort the eaadactar cegbttatiaa oompaoescss oftiie RomahV n v Cairaeiiir r; =went Dhad rofliocoeimpv4=mwdCaterRgbbitim Bts , of RbxAd oos.aod SMadatde OwAAbntmul'Ieoe,Boow M.Boftm MA0210a-. . (617).727-bDQ, cit. 2Ss 05 Fenassistancewish informal medirtion of dispatss ac ro formai tamPleiMs apsinst a buses. calk Com merComphmmtSeectiaa Office of the AttarmyPeaaal (617) 727-840 Information an- d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including t1he legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association o$ other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do mainte ice, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or 10►cal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to c onstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of c9impliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with.no employees other than the members or partners, are not required to carry workers' comp ensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be ..,rr^ried to the city or town that the application far the piit or License is be - .r reauesfed, not the .Depa*m:e it of Industrial Accidents. Should you have any questions regardiriLg the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies. should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space. at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemiiVlicense number which will be used as a -reference number. In addition, an applicant that must submit multiple p=-mit/license applications in any given year, need only submit one affidavit indicating current policy infommation (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business. or commercial venture (i.e. a dog license or permit to burn leaves et r.) said person is NOT required to complete this affidavit - The Office of Investigations would like to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address; telephone and:fax-number._ .. The Cammonvcaltbt of Massachusetts DePartment of Industrial Accidents Office of imvestigtrations 640 Washington Strt✓et Boston, IMA 02111. Tel. # 617-727-4900 eoxt406 or 1 -977 -MASSA -FE Revised 5-26-05 Fw, ## 617-72.7-7749 vrvrw.mass._gov/dia. BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: LOCATION Date Received IMPORTANT: Applicant must complete all items on this paize PROPERTY OWNER Print i/Z W � I LL Print MAP 210 1 C O(b G PARCEL:( ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ves no TYPE OF IMPROVEMENT of Residential Non- Residential New Building q 1• PROPERTY OWNER Print i/Z W � I LL Print MAP 210 1 C O(b G PARCEL:( ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: r.;���:����-s�r.�r��.c.,�� ����i:����r��rr�c���l�.��r.•.r��f�•�c�r��.c!4-�fi `•�► i Identification or i Phone:1:1t6 `7q4 2616-' Address: CONTRACTOR Name: fJI42 H� 112�'��2 i iCS �,Ue Phone: Gi-t� 3)4- X26.3 Address: 15 Supervisor's Construction License: !S-IHS4 Exp. Date: 3 Home Improvement License: 10 Exp. Date: Z I2 I ;cl0 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ Cb FEE: $ Check No.: J��P Receipt No.a Sr� NOTE: Persons contracting with unregistered contractors do not have access to the guarantvfund Signature of Agent/Owner _ Signature of contractor o � � �� .. ~ ���� ��� ������ ������� ...... --~ °_---_-- '-' =-- -_'------ ..��..'........''...'....... ----- '''''''''''''''''''''''''''' o1 .... �8auo. ---'_...... _'-' '.--.'.—'. ....'. ......'... /7�—�� �, - ���[� .»��� MASSACHUSET'T'S UNIMRM APPUCATON FOR PERMIT TO DO GAS FTMNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations C/* C -.C- Owner's Name New Renovation Replacement 0 Date /� Permit # IX711 `71(r 6 Amount $ 6 Plans Submitted El (fit or type)F/P - 1 .Q one:, Certificate Installing Company Corp. Nome of Licensed Plumber or Gas Fitter S7XPW ieZ INSURANCE COVERAGE 0 Partner. 0 Finn/Co. I have a current liability Insurance cy ctir it's substantial equivalent. Yes No E3 If you have checked 3, please ' cate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity E3 Bond 0 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 requiheuml Check one: Signature ofOwner or Owner's Agent Owner 0 Aevent ca ify that and in&rmation I have submitted (or best of my knowledge and that all plumbing work and compliance with all pertinent provisions of the Massac (OFFICE USE ONLY) red) in above application are true and accurate to the under Permit Issued for this application will be in er 142 of the General Laws. fture ofLicensed Plumber Or Gas Fitter aber 5�:;7- Fitter License Number Journeyman Date ... 7.—..c? . . a-... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. N.. ©.. `AN ..... ................. has permission for gas installation in the buildings of .. ....``' .P .'i .. .............. . at ..�'. o �`� `'`' (' i ,North Andover, Mass. Fee ... `� Lic. No. �. v Y .S^ � . � � 0-0Z � /,Y. _ GAS INSPECTOR Check # .29 '! � 41:68 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or T ) � fw&w . Mass. Date %'� 20 OZ Permit # Building Location r"d �. 4( ieG� j Owner's Name .-d� b9fs-P � �. Type of Occupancy r� New ❑ Renovation)Replacement ❑ Plans Submitted: Yes❑ NO INSURANCE COVERAGE: I have acu eDt liabilityinsurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If you have checkedrtes, please Indicate the type coverage by checking the appropriate box A liability Insurance pol)cyV Other type of indemnity O Bond O 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: OwnerO Agent O Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted (o( 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 State Gas Code and Chapter 142 of the General lacus. BY T of license: Plumber Signature of Licensed Plumber or Gas Fitter Title itter Master License Number City/Town Journeyman 0 I NL In '@E MR. EMEN■1/NEEN■11111111111111 INSURANCE COVERAGE: I have acu eDt liabilityinsurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If you have checkedrtes, please Indicate the type coverage by checking the appropriate box A liability Insurance pol)cyV Other type of indemnity O Bond O 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: OwnerO Agent O Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted (o( 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 State Gas Code and Chapter 142 of the General lacus. BY T of license: Plumber Signature of Licensed Plumber or Gas Fitter Title itter Master License Number City/Town Journeyman 0 I NL FORM U.- LOT RELEASE FORM b iso o f G-13 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Department-4havieg jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT ---W. I , PHONE 3I4 -4-243 LOCATION: Assessor's Map Number I O PARCEL SUBDIVISION LOT (S) STREET ST. NUMBER8c) *****************************************OFFICIAL USE ONLY*********************************** RES, MENDATION F OWN AGENTS: CONSERVATION ADMIN TRATOR DATE APPROVED I DATE REJECTED COMMENTS � O q-6 p mon t3 No Lao r k --I`L 100 weer of 4t a_ We,+�A as TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH _ c ►� � n --S I SEP IC INSPECTOR -HEALTH COMMENTS JD a � I7 DATE APPROVED DATE REJECTED DATE APPROVED _ DATE REJECTED_ PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm Q - 1.1_tYL w DATE TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/IREREtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: n o CAMPS&C �OC 106 006 ` Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS B Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record -�A)ebi /mo b CA-?-rYPgASzC Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construccttiio�nn Supervisor: Not Applicable ❑ V • 11 OY G Licensed Construction Supervisor: os :,-7-S 4 License Number P. O ,a Address 09 /6-412-po4 3 723 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ lf7e#Ic sr�e�,C ;zesavi Company Name Registration Number P+ Q' 2oR s I6 a,t 4 &� ` �/°` Address � 3 ( �ZG3)Ate 2 2r3o 2 Expiratio ate D Signature Telephone T M X Z O v n m O Z M 90 O ro M rM _r ^Z Q ,5l/ 7/ 99 CD ati a ��,00yeirrf� �G`o7lDi� rx�Stl/` z27 , �f► X66 � 72 c'�S Z C4 Aid r INSURANCE BINDER Bi MER IS A TEMPORARY INSURANCE CONTRACT.SuwEGr s Catalano Insurance Agency 251 Broadway Methuen MA 01844 �� HRH Construction Dave Hope P.O. Box 5164 Andover, MA 01810 COVERAGES TYPE OF sURANCE PROPERTY CAUSES OF LOSS COMMERCIAL GENERAL LUAenM ICLAIMS MADE ® OCCUR ANY AUTO ALL OWNEO AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS -•- • •. ...+ww..ac DEDUCTIBLE COLLISION: OTHER THAN COL - GARAGE LIABILITY ANYAUTO UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKEWS COKPENSATKIN AND EMPLOYER'S LIABILITY Sus CODE OP ID L8DATE I 11/2 THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORK c�ANY elmL�s 44902 COVERAcWORles Personal. Property Unscheduled Tools Installation Coverage RETRO DATE FOR CLAIM MADE: ,M .h - T. I=.I;F RETRO DATE FOR CLAIMS MADE PROTECTION IPTSURANCE AM X 1201 11/20/01 A" 12/20/01 Nol HIX TUTS eile7ER N4 TO BINDER COVERAGE as THE ABOVE NAMED COMPANY PEREXPeBOMCsPOl1CYt. BIZIDER . Carepentry - residential SPECIAL ns wed Tool Coverage $25.000 ($500 per iter) and C iONSN M age $50,000 ($25,000 per loss) COVERAGES MAAn9t & AWKESS - LIMITS DEDUCT113LE COINS % _ AMOUNT 250 5000 --.,250.. --25000 250 50000 EACH OCCURRENCE $500000 FIRE DAMAGE (Am —fee) $50000 MLS EXp (Arg pm Pte) $ 5000 PERSO NAL & AOV INJURY $ 500000 GENER LAGGREGATE $1000000 PRODUCTS-COMPIOPAGG 51000000 COMBINED SOME LIMIT $ BODJ.Y oNIURY (Per perspn) S BODILY RNARY (Per ecadenq S PROPERTY DAMAGE S MEDICAL. PAYMENTS $ PERSONAL INJURY PROT $ U NIMM.IRED MOTORIST S s STATEDAMWUNT IdACTUAL CASH VALUE OTHER AUTO ONLY-F.AACCIDENi $ S OTHER THAN AUT0 ONLY: EACHACCIDENT S AGGREGATE $ --- EACH OCCURRENCE s AGGREGATE $ SELF4NSURED RETENTION S WC STATUTORY L YYLUTS EL EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S EL DISEASE -POLICY LIMIT $ FEES S TAXES $ E A.m ALPREMIUM S OAIA1A^ if— 3 6,9 2 Date.... ......................... NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that 2-�,v ....... 4..........:- ......... ................ has permission to perform ... z ..—1--le—I ................................................. wiring in the building of ................................................... .. .. ................ . North Andover, Mass. Lry Fea.............. Lic. No .............. ELECTRICAL INSPECTOR Check # Jun•10, 2002 9:24AM DIRECT SWIMMING POOL PRODUCH _Z IL 0 0O �a J No 7323 P• _W a� Ws WS •,w0 a cn I p ^4 4 ' I Z m N z p W I I i � o ' z -' U w lma Z o I z Im3 w D J Q I � W I I I I i Oo �m I I. I LL, J I^ 8 a LO a r z� F • 1-11 3muuoa au Basic requirements or me state's Home Improvement Contractor Law (MGL chapter 142A). but does not include standard language to protect homeowners. Seek legal advice if necessary. My person planning home improvements should first obtain a cer, <11 Consumer Guide to the Home Improvement Contrv.ctor Law" before agreeing to any work on your residence. You may obtain a free copy h calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-727-7780. nomeowner twormarion Contractor Information Name �r RKPP't Company Name �� dw Street Address (do not use a Post Office Box add Contractor/ Salesperson/ Owner Name City/Town State Zip Code Business Address (must include a street address) l-rA 012.4s P -o • Rng S 16 Daytime Phone Evening PPh�ho�nnee City/rown State Zip Code TT Mailing Address (It different from above) Business Phone Federal Employer ID or S.S. Number Lar r•puire Nn mut Iwme ,m• Home mpmvement Conmctor Rea. Numher EzV—Eele prv.gnea oontneon have e The Contra tc or agrees to do the following work for the Homeowner,. W h� / `-'/ 2–'? 12M (Describe in detail the work to completed, specifying `.: type, brand, and grade of materials to be used, use additional sheets if necessary.) JALG mvx cs Pam- pidw_ ATx ft S iC. &-c-H Required Permits - The following building permits are required Proposed Start and Completion Schedule - The following schedule will and will be secured by the contractor as the homeownees agent, be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will beZ excluded from the Guaranty Fund provisions of 114 2D c when contractor will begin contracted work. MGL chapter 142A.)1.2 4 ?-,date when contracted work will be substantially completed. The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of: 1f ISM -0-0 (• ) Payments will be made according to the following schedule: SAJf C)M•Tipon signing contract(notto exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) 55�Cbyj? –12 file n' S O O by t�� �O / 2C�upon completion of /X/ smiL W ALt i� Q5OL S upon completion of the contract (Law for dem ding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special S to be paid for ordered before the contracted work begins in order S to be paid for to meet the completion schedule.(**) NOTES: (•) Including all finance charges (••) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty - Is an express warranty being provided by the contractor? No Yes (ail terms of the warranty must be attached to the contract, Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200, ext. 25205. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her'main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy sh uid I t by the contractor. Q.Gi � • CT MILL Homeowner's Homeowner's Signature Date Contractor's Signatu e �zle�i 12.4- Soca i Date N2 17 b" 5 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.. .. .. ............. .... . ....................... has permission to perform Z.... . ...... ...... ..... .......................................... wiring in the building of .......................................................... ........................ at ... ?'� ................ lope -OL ............ ,North Andover, Mass. Feel. -."'..'4 ............... Lic. X�' ............ ae: ......... AL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 08/04199 11:30 25.00 PAID e6" Office use only TRE CPMMONWEALTH®FM4-VSACf DFPAR7ME\TOFPUBLICS4,F= Permit No. / 6 BOAtD OF FIRE PREVEMONREGUL4770M527CMR 12.00 u� - Occupancy & Fees Checked APPLICATION FOR PERA/Tl TO PERFORM ELECTRICAL, FORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRLN7 IN INK OR TYPE ALL INFORMATION) n're 77 12b Sli Town of North AndoverFnp A,�n� MAP- /U (o the Inspector of Wires: The undersigned applies for a f�f'' e bT�f the electrical w described belto PARCEL D O!a Location (Street & Number) F2::5� � CI Owne. or Tenant t — -n Owner's Address CAs. it Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building �er\ Utiliry Authorization No. Existing Service Amps / Volts Overhead a Underground No. of Meters New Service .Amps / Volts Overhead underground � No. of Meters Number of Feeders and Ampaciry Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total K V .A No. of Lighting Fixtures Swimming Pool Above Below Generators K VA Smuynd ¢round No. of Reecptscie Outlets No. of Oil Bttrners No. of Emergency Lighting Battery Units No of Switch Outlets No. of Gas Burners FIRE ALARMS No of Zones No of Ranges No. of Air Cond. Total Tons No. of Detection and No of Disposals Nod of Hear Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices —�— No of Dishwas:-iers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal ��J Other No of Dryers HeatingDevices KW ® Connections No of'.Vater He3fer5 KW No. of No. of Stens Bailasis No HlvCro ,bfassaee T uos No, of Motors Total HP 0 T TIER 11 Jill • : • 1 :• n :.� r wit• .:. • .• nr.• /• • •• r � • 1 - • it - 0. � • • - • :• :• A • :rto- � o•e:- 1V L,wec:.11 Dw Rxpested Sim tasi-T e Pe-taties 8fp� FIRM NA,� V Q L,0L — - t5e111�'--T Li See Sk=xe Est>rrmd Valu dEel Wccc S Ra.tgh Fail LietseNa 3S 159' LI, rtsi c5s t59 £ Btrrf s Tei \14a 9 p �® 1 ..7`' o?S� ` 1 \�(L� G4 �18� 1 AlTd\a OWNER'S P\0 TRANCE WAIVER, I art auate 3 u el-=sc does act htne the r<suanc o 9f:igaaal ecnvdir.as tie i by a � Gam Labs and tl� rrty s�granae aI tirs p� �Qoc�at Mises ttzs rix. (Please check one) Owner ® Agent F7 Telephone No, PERMIT FEE 5 3692 .�l Date .. . ......2...- ..- ................ TOWN OF NORTH ANDOVER 0 - PERMIT FOR WIRING This certifies that. ... ........................ ................. ... .... has permission to perform ......... ...................................... wiring in the building of ....... ........................................... at.Y . .................. //�.. . ....... North Andover, Mass. Fee— ......... 1 c. �No . ............. ..... ELECTRICAL INSPECTOR Check # E T1M009H"V0 WE4LTHOFh14S► CHL('S M Office Use only DLPARTMZ V!'OFPUBLTCS4FEFY Permit No. ,— BOARDOFFMPRF.i'F. W0NRFaGUL4T101 V7GMt 1Z -W .� Occupancy & Fees Checked c R` APPLICATION FOR PERMIT TO PERF'ORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMIt 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Kiat Owner's Address _ SAMA Is this permit in conjunction with a building permit: Yes Callo M (Check Appropriate Box) Purpose of Building Existing Service Amps. --L I Volts New_Service Amps __L.Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work' �/ No. ofLivhtin¢ Outlets I nn:. -ru— T. Utility Authorization No. Overhead Underground Overhead Underground No. o t tiog Fixtures No. of Receptacle Outlets ' Swimmioa-Pool No. of Oil Bum is AboveBelow andyound ra4Ganefstars ..:.. : ..: ..—. .. .: Na of Emergency Lighting Batt No. 3F Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS Tons No. of Disposals No. of Hem Total Total Na ofDelectima d Eme Tdn KW Jo. of Dishwashers Space Am Hewing RW g s Na ofSmWinE:DCriees. No, ofSetfCGodained to. ofDryers �y Heating.Devices KW DetecfiM%oWdtng E*vim LocalMunkipal lo. of Water Heaters KW No. of No. of 0 Connections Signs Bailasis o. Hydro Massage Tubs No. of Motors Told HP No. of Meters No. of Meters No. ofZonds L3^, other rdlOE.�•01�g� Arstratttb>fletatltaartaiq�(iataalIao►a eaamentUd*yk=mn epb&yinckxing��Dm s �}� � � NO mri tghrau �aGdptxfdsaneb4te06 Y>+5 aiai�hrsc vo6.,wupm,=aasrequffca1DYty4aSftGeaedLam tm5'mthsParnt � tt�tec��x. ;e check one) Owner Agent Telephone No. PERMIT FEE L �/� Location No. R„ Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Qther Permit Fee ASewer Connection Fee Water Connection Fee TOTAL Building Inspector Div. Public Works PERMIT NO. 7 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAGE 1 MAP fi-40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK '.PAGE I ZONE SUB DIV. LOT NO. I LOCATION PURPOSE OF BUILDING -f, !J t� y / 0\/9 / De' �, pn O cos OWNER'S NAME ` I�ziz�r -1-- Kareo� 1-I:zlm NO. OF STORIES SIZE l / 1ALIA709 OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD UILDER'S NAME lnf, I AJ Qn (-�..l�,,y�� l I SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TONATURALGAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST, BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR TE FILED 1.013o 19 klra'Azln 9. f {G✓rn r lL SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE �%T.4+U U PERMIT GRANTED 3 D 19 1 OWNER TO if CONTR. TEL. #— CONTR. LIC. # 3 PROPERTY INFORMATION L D COST EST. BLDG. COST 1 ©QO O O *,w, EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN ■UILDINO INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY I I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS I I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 1 si h CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D _ PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/ 1/1 l/, FIN. ATTIC AREA _ NO BM T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING - _ B _ 1 2 �_ ---{I_ �— 3 _ CONCRETE EARTH HARDW'D COMMON ASPH. TILE VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STIRS. & FLOOR _ CONC. OR CINDER BLK. I WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I�POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC _ 3rd NO HEATING 1 si h r� z LL. O 0 z 0 CL ItT co 02 0 z S °C 0 cc 09 0 0 cc W W d H O O z Z Z WLU d 0 z z LLI o z u cc m - v10, m L C L L L V W ` L O m Y ` O O L C O C C C 14 a:U ii oC ii Q i co i Q ii m M Irw z w .rWi. Cn L LJ —j ZD M H •y E w in a s Z� A U •c .o. Iml ti. w a c c G m to s J � r T�IAl40�1� r_XIST"tAl.� '�;S,b 1 r -Trrrt� x�-- x 3 -r--f– �- $aolq—m �f x -� ��a--�T—�� .r.�.�-�kl�_s► 2x 33�i4_"' X 3%�r-°a--b,--�--��--�>--�---+-_.���,-� T- _6-2 �__r¢ � .-.T-t---i.--�f=-.� _n�-sat�r>♦ n n 2x�3G x- 60 __�__ .--r-----�.__.�- .-�----�--: -1--� — - f —,--. X l- �fiPic.e.A.c � +,,21_�— X x JT l i -Flt - 1 1 Ga►- r :-xr_tT7 t-- _ g6°. I k � E ' C.tts=��_`_r Prtsr� 1 x____ '�2." x �� �ec.n��e_�,e�}�-22X ►2�x 8o s+oeu�r .,GC_cr�rffi!�- s —��i —?. e��__�� ��• --�.--f— � S��',._.—�_lr^ ��� � y �_ �C.% �'Ot�. `�. LiDC—�(LJ^�.-�.-... _ _�. _— - _I _— Fix b - 60 kG-r ---lex -- r- � --ice—i- I --•r =,�. __--- �� � -- -- –-��� - -,-'� -- -1 _ SNoar 'j$�Fole D - W�G.K IUP • �..A " I f C.AA f i l X �� ;X-4_�T- 31�f� tffifrff� } —+---�— _ - _ r - 1 }_ fi----I 14- r +- -- - - �_ I! I 7-1 _ a i - I I I 1 1 tffifrff� } —+---�— _ - _ r - 1 }_ fi----I 14- r +- -- - - �_ I! I iz 41, i__ A_ (Please print) DATE 6130 �9 a - JOB LOCATION "HOMEOWNER" s r r Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption Lampbe,l/ oeal r Street Address ,,ff 79z{- s&,q ection of town ivame dome ehone Work Phone PRESENT MAILING ADDRESS so 6enetl /I - aAao lle� A& , oo8 2/ 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. r. (State Building Code, Section 109-1.1) DEFINITION OF HOMEOWNER: 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 dwell- ing, attached or detached structures accessory to such use acid/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, on a form acceptable to the Bulding 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 North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and ,requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. d Location No. / 7 % Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ �r Building/Frame Permit Fee $ —5--_ — s US�t Foundation Permit Fee $ �1SJACN---- Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL �,-� "" Building Inspector lQ�196 09:02 91.00 PAID 9645 Div. 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I I -al N 3: m Z r r m > z A A 7 mQ r " i N z > m m x G G M a W G 00 _ A X o I > O I m .a 1 OCCUPANCY . SINGLE FAMILY I i l HEATING S;OkIES FORCED HOT AIR FURN. MULTI. FAMILY STEAM OFFICES HOT W'T'R OR VAPOR . - -- -- APARTMENTS RADIANT H'T'G UNIT HEATERS CONSTRUCTION 2 FOUNDATION ELECTRIC NO HEATING 8 INTERIOR FINISH CONCRETELl— 2 I3 CONCRETE BL K. PINE _ _ BRICK OR STONE HARDW D _ _I _ UNFIN. I I I I 3 BASEMENT AREA FULL FIN, 8'M T AREA _ y, '/r V. FIN. ATTIC AREA _ NO 8 M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD"✓'0 ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE ---{I_ STUCCO ON MASONRY STUCCO ON FRAME .. ERIC N MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME - - CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) _ GAMBRELJ MANSARD TOILET RM. (2 FIX.) FLAT I SHED Jr WATER CLOSET _ _ ASPHALT SHINGLES / LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. �I 6 FRAMING WOOD JOIST ,. TIMBER BMS. 6 COLS. STEEL SMS. & COLS. WOOD RAFTERS _ 7 NO. OF ROOMS _ _ g M•T 2nd _ - 1st 13rd — I TILE DADO _I I i l HEATING PIPELESS FURNACE FORCED HOT AIR FURN. STEAM HOT W'T'R OR VAPOR AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS ELECTRIC NO HEATING _62 -Jr lugIA raI -Y ord. to 2 Fail, Y. -,es HOPE CA, HELL 'Nu k 1,'�- P, WOW - MA 01845' J 1A Location `�*w No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundatio Permit Fee ��� e�j Z'k ) Sewer Connection Fee Water Connection Fee TOTAL 613 7480 /2/94 �56 $ /?), ,-Building Inspector 71.5) FID Div. Public Works PEbtlitT X0.� —307 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP iq0. LOT NO. I 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. LOCATION C?.� 1<lC\ •`cam LJ�y .PURPOSE OF BUILDING OWNER'S NAME dTI cr 11" L� NO. OF STORIES V2— -- SIZE . OWNER'S ADDRESS � p�,.. 6�� :p6� L BASEMENT OR SLAB (Z„ e�,�n a,"� ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 'r•.1•STX f� 2ND "L) 3RD `7 v �^ `- O BUILDER'S NAME SPAN 13 IF , DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES — SIDES REAR "' GIRDERS AREA OF LOT--; /_/ /1 �� FRONTAGE _/ K c. HEIGHT OF FOUNDATION - THICKNESS -- IS BUILDING NEW - SIZE OF FOOTING. X , IS BUILDING ADDITION MATER:AL OF CHIMNEY .`c IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND SO i— (� WILL BUILDING CONFORM TO REQUIREMENTS OF CODE UGF S a IS BUILDING CONNECTED TO TOWN WATER ^b BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER jvQ IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE TLED - /2-1 /q y SIGNATUREjpF OWNER OR AUTHORIZED -AGENT FEE =� c OWjjN��ER TEL. PERMIT GRANTED 19 3 PROPERTY INFORMATION LAND COST EST. BLDG.,COSFT Q EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD SELECTMEN BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION CONCRETE I 8 INTERIOR FINISH PINE HARDWD d ---{I_ 2 to _ CONCRETE BL K. BRICK OR STONE PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL '/, 1/1 3/, FIN. B M"T' AREA FIN. ATTIC AREA _ _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE EARTH B _ 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING HARDW D COMMCN ASPH. TILE ASBESTOS SIDING VERT. SIDING. STUCCO ON MASONRY _ STUCCO ON FRAME _ BRICK ON MASONRY ATTIC STRS. 8 FLOOR BRICK ON FRAME I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR 11POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH )3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 10 13rd I ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 2 Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DAT g/z/9L{ 12dK-D JCB LOC.ITION 8C Cc, -p- `/ Num%er Street Address Section of town „`.- � rr Kokery-1- PEiEA2 Na7"e Home Phone ?= BAIT I N G ADDRES , Work P!,,one Cit;:jTo'.an State Zip coati c;lrrent exemption for homeowners was extended to include owner - oc��piec d::ellinLs of six units or less and to allow such homeowners to e Z= an individual for hire who does not possess a license, provided the owner acts as supervisor. (State Building Code, Section 109.1.1; DE: _:,j1I:-ON OF HOMEOWNEE. Persons) who owns a parcel of land on which he/she resides or intends to res ice. on which there is, or is intended to. be, a one to six farm'_', dwE «- i:;� attacher? or detached structures accessory t0 such use and/or farm stract::ras. A person who constructs more than one home in a two-year DEr'-od shall not be considered a homeowner. Such "homeowner" shall sub;-= to the Building Of=ficial, on a form acceptable to the Bulding Official, t -at he/sine shall be responsible for all such wor''— perrorme l undEr the bu__cf.ng permit. (Section 109.1.1) r� pliance _..c a^:Ce�Si�nE� :CrTie^.`.Jiier asSumies responsibllltJ for COm ry �ui_Gin`• Ccda and other applicable Codes, by-laws, rules arc =---:ions n, __ - n0,miecwn,e'" ce_ _-Lies that he/sne understands the ail O_ De�artme..t minimum inspection procecu-es an=: a t a_ nE/S%e ti��! 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''' � `:,.fit\ *,` ,� F � w 4 ! � y I ._ _ - -. -. -- .. - -�.,.. --'-- .r. -�_ ,..v..z_,;:•.. to .... t\>. �y t., •�\y t }3 -.�- Z — - �. ..a -- _---._ .. _._.. � � I -- ---< 2 �z..�r`l. _- - i � � a; r �� a ^� c a 2g' _ t O b �� _'4 f , SC,.n y _ - - - - - - - - -- - - ,?.z 7+�LLc�X�r e Location No.� �n �� Date �oRTM TOWN OF NORTH ANDOVER a Certificate of Occupancy $ ' • i • Building/Frame Permit Fee $ Ss�cMu"•.a°''<�' • sE Foundation Permit Fee $ ` Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ _ TOTAL $ �— / Building Inspector 'I 3 12 7 05/27/99 14:51 97.00 PAID Div. Public Works w Q �r (� ❑ w c C d O a w O N x 0 F ' V] N a G ❑ o z W d F w U o F J h� � W F z C i 0 P- C W c (� ❑ w c C d O � O N x 0 y< I R 0 z 0 cn z W ci 3 W^ F z w u � O N x 0 F ' C \ C 1 C `(J W a G ❑ o z W d F � U o F J h� � W F z C C o w 0 C z w � n w M d F ` i c -- , W L C ,2 i a o e v Rim n z c V W .! � w � 7 G d z d ¢ o F W w z U v ZZ U �- O y ❑ c .] C ia/. Z cCrd G i ❑ w F z w u � O N x 0 F ' C \ C 1 C `(J W a G ❑ o z W d F � U o F J � W F z C C o w C z w � n w M d F ` i c -- , W L C ,2 i w F z w u d G Cn.r �q N x 0 ON ' C \ C 1 C `(J W a G ❑ o z W d F � U rn F J � W F F v C C o w F z w u d G N x 0 Jr - ' C \ C 1 C `(J W a G ❑ o z W d F � U rn F J � W F F v C C o w F z w u d G N x 0 Jr - ' C \ C 1 C `(J W G ❑ o z W d F+ ❑ z w Cd rn � a = FORM.)J - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** ��APPLICANT ���� lel- PHONE -7ctq-3 toL4 LOCATION: Assessor's Map Number 5 fi L6T ILP PARCEL SUBDIVISION LOT (S) L STREET i fZd ST. NUMBER (3"D USE ONLY***************************** ;5 � a3arti RECOMMENDATIONS OF TOWN AGENTS: 3 o2 4 -3 CONStRAVATIdWADMINISTRA COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH �C SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED_ l S CJ1ti. DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED r PUBLIC WORKS - SEWERIWATER CONNECTIONS LI MAY 0 10 4 DRIVEWAY PERMIT FIRE DEPARTMENT/ Q� J, .2 ! St�t� h✓1�� ��/���� RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm f �j %; 1 q a❑ m m w w V L. C w F L z rn G x O z C i ) d U F Wo O x M C c O � O w con d O F O L- M Ck © w W A o 1 � d xj A x x vP x k � ❑ F � k^ a � _ d w O 1� M w Zu' m � � ❑ F Z x � U O O d ... F' 14 aw C1 O c`• O m w x cA a x CE cti O O O O � O U w O O U O U U y ❑ o VI o FO �, z z z rw. O ."7 z z w G O w o z zzzF_waco w w w C7 o F WN 0. O m rn rGi) ❑ ❑ .� rn L �. � FSI a o � z o •- �7b VI N w o F x � F• Z i z z o w � w x G C rn C m w Z L � ❑ �, d wz C d .] d Z z Z rn n U w a w v. w O C7 Cr V ❑ y" 7- Z rd. Fes.' � :7 ❑ �" _ _— ,cam.. `n `n �j %; 1 q a❑ m m w w G LN L. C w F L z rn G x O z C i ) d U F Wo O x M C c O � O w con d O F O L- G LN V C\ w F a w U rn F J w O o V C\ Town of North Andover 0* NORTH TLD OFFICE OF 3? y°t n O L COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT SSACHUS� Director (978) 688-9531 Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please print. DATE 9 1 1®11 Q) JOB LOCATION So CrMP be—ti Number Street Address Section of Town "HOMEOWNER lqy- 361.I Lt So o a Number Home Phone Work Phone PRESENT MAILING ADDRESS 89 Com''`P Q I QO a N- anatueC 1�401 _ 0184 5 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 HOMWOWNER: 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 requirement. HOMEOWNER'S SIGNA APPROVAL OF BUILDING OFFI Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. 'BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Y �O �1 F r !V o rr� v/ O'. � L�1 Ci Y �O � F r !V o � L�1 Ci Y �O � F r o � L�1 r, q 46( 1 � THE HnFE FNMILti, TA t•� a `r Ll t•1 W.'-0'_+-99 0 i :48 Pt•1 THE HOPE FAMILY 561 467 1224 F. of �-0 I b x rl PY- 09 -9 9 87:49 P r-1 THE HOPE FAMILY Nil \j j 561 467 1224 x.02 14 w .:,? 61 0 V7 9 Y) N 0 z q �q cz A c� v u' 0 o A 0 0 U G w" x a r� ii a U w o w CQ CJ c w Z o r�G co w w A cA cn cn LU g O_ 5 •a ON O 2 0 0 U) ui w w w U) c � O o C O h C CQ CJ C m C C, O E a 11; m o 0 a c .00 i:co:,$ 00 f' u rm • m c_ 00 e �• m C N Qf m C_ Ly� : � N m E� �oo x 2 A a L 4D M� 1 "J: 100 : '� Z = m i CL. G +ON W CO4;w O fl _ �N m N /V C H H W .E CL= V mC2 ��c"�Q, m 2 eyv ap`ti� .C.. CLrm g O_ 5 •a ON O 2 0 0 U) ui w w w U) SA H 4- O v 12 Ilk Wei O C m ,o m o in 0 Q C I r Q � 4.j. T i iv E cl U O C o Z Wei