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HomeMy WebLinkAboutMiscellaneous - 80 FRENCH FARM ROAD 4/30/2018powl�— ITS bcl%i U4 bcl%i _ �� � �w w 4, E��, .. 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CL O O CD H Co CD I o S CO) v O CD Z _o CD 3 co cn cn n Q cn C�9 Q -010 -0 =r -4 ca Q' N ar a o CLv' O momma O m n • H�dC 3 Z =r -o 9 Im Erm a 06 =r = H m O m y p N 0 ? m _ m Mp ='V 1 p f/J� n a o MCM CL 0 CD m y :� m 0 CD 'Z CL ��-�y• C CD C � N o m H a =r: Q 1 d o WJE CD: CA iz a C.ID cc VJ Go y OCD CD: 1 .��•►� h C RZ y'a a0'N `CD :' .f CD ED SS * 3n� ddtl� ra IO �C2Go O 0: c o O X, C z ° w w w "X Po G n a o C 0 w CA � � x o o � �0 0 Town of North Andover NORTq , OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street > /II.LiAM 7 SCOTT North Andover, Massachusetts 01845 ,t • ;;.� Director SS C" L In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number [— is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: me,+�k�t ryi (Location of Facility) Signature of Permit Applicant -a�-IMF Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 30AM OF APPEALS US -9341 BtMDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 1 24 BROOKS Vinyl Siding a Windows • Doors C G Brooks Construction Co., Inc.:-nr.Ho 254 N. Broadway,- Breckenridge Mall SelfTm„New Hampshire 0307g -,Mass: License 026715 e t�r1�?, Near Granite State Potato Chip Company .11 1-800-427-0260 508-686-0260 603-894-4488 I/We the owner(s) of the premises mentioned below hereby contract With and authorize you to lumish all Necessary materials; labor end workmanship to install, construct andplacethe improvements according to me following specifications, term and conditions, on premises below desaibed:0 Tg?tY 7 :T i Owner's Name WtCi1 e1311` Rob'n Rpst?” n „P , Phone -C979)" -6-007- 6016" T �' Job Address r�0 Fre h'Gh Fl4rm „Role d" sty A10I'-fh Nndo<r �i`t'hI� old/�rF Owner's Home Address V. PROPOSAL •�,, . , , ;t;r r; Date ' 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 " v L"" :/ v. ^L A6C Tl'+ SPECIFICATIONS r,, ,,tt - t : �,: • f: t•-. , s . _ ,1 Appy q,11 vinyl over agtire outside �� �� a y ' ' "') area of house) Type of insulation to be applied under vinyl' x/01 Do u i' r ^t • I , .h Override casing up to aluminum windows and doors. Vinyl J Channel to be installed around all windows and doors:` Cover all coverings' in vinyl V.G. or white aluminum coil stock. Window sills to be covered in while aluminum coli stock. Ir, "�"" ' L t COveC 7rI'M g tuiytsokyS� DoofS� �Klccir , rSaTit`b r �gtoy2t, Qefi��A/� Gu t(<f`S r 1. QPrhoJc Qer nsirFll Shuf(crs i �Sfr'o dii� >al f>`titm> EyrS1(M0 ��l�tno . R�Patr or Rye A fkY a�fccl Erose tr1`4,$1 tic U. Oc Fluted Si i3Qa�;1 . /n14r<te11 . ° W • 1? Ir— /m2 A.,It, .IS' • hems not covered or Installed:t I]6eilings 0 Cellar Windows , t.• • &'&Iumns r, er1 � �, I] ails � T1�37�Y A`O Windows Frames for WE � d� O't'nside Buttress 0 Covi s `u` ' O Endow Sills �` 0 Gutters'' O Tom" ' ' "i '` " ' ` " U Shutters t�Storm Windows Mlboom*c c: 3tr3:; ri O Ffoot = t Ct M1E97 (7 Lattice Work m 'r+' 'Tt ') etf) K r^,:� o. .,f± ,.. tl�CIA 'r _. , ♦ n-, *h �Y" 7fjtYr q 21filK�''/`3t^ �(*c'( 1!kf.v'/(',t7F1fi1Q'a WORK SCHEDULE: -. -vt ., }. t� Y 9 � M �1n�han rdi ^m , .+. , t � + =q*ri n Cart Will b dme work or order the materials before Me third da l Ilene of into rt,anI, uri; spedtned he tin . _ dor wit begin Iia work on or about, (date). Barring dewy caused by circumstances beyond Contreclore control tree"wak"wa bs3enTpleted M (date). The OhrrSer hereby admowledges and agrees that the sdnedWkng dates are approximate and that such delays that are not moldable by the Contractor shat notbe considered as vidatia,s of this Agreement. The Contractor warrants that ane work furnished herou der shat be free from defects iri0 UI1, e)id waltnnarfitt'p iat f+;p§ii�d of ��" •1 i 1 Il. _A ptuyAr,�'oMnpletiCr( laid allele eonply with are requirements of tile Agreement. In the event any defect In workma� a materials, r damage caused ,by Contractor. his subconrracin, employees or agents. Is discovered within one year after conpistion of any fob, k,cludiho deMkp, the Cnlnl=ehah; it lids owh bxpense, fottrwmn�Fe6"; repelr, correct. replace. or cause b be remedied. repaired, or replaced, such damage or such defect im mateflela,orrror�rrr,areltp.The aregal!p r4anerp�es ¢ +^'!� afrp.Nfsp�CYior! perfomaed lrn_mramerllorl with One ageed-Won !4ark We Propose herebytppjumish material and labor -complete in accordance with above specifications, for the sum of: N A SERVICE CHARGE OF Itb0 THE UNPAID,KANCE PER MX[H;WILL' BE ADDEUtTO BALANCE/ IF NOT°",.::0 c fPID ,, K - 4" 4:4; ; dollars ($ �-q)• Payment to be made as follows::,...'r,YB !•Tfr,/� + rt /1 :� ii -16.f Cry" ^ "`"ok"�' % ($ 1,S -00O • tx�_) upon signing Contract; :.r;;j, ; Wt• Yltr..3: ros Vinyl §id'ling '.'Windows • Doors Name of Contractor/ Designated Registrant % i$ )upon completion of 254 N. Broadway - Breckenrldge Mall Y street Address r / i =x� b .-pruponcon dationof��jJ` M � � 4, CiSelem NH 0307 '' U 9n "r"n(603).894-�488 .. -.., ...r .. .mow �.:;' ,m•v,.. r/4 Cly/State � 1ij1"" tPhons 'tT shall be made forewith upon 101682 010-32-0692�'U ($ ) completion of work under this contract. Regletretbn No. soda) security No. Notice: No agreement for home improvement contracting work shall require, a down payment (advance deposit) of more than one-third of Ole total 6oiiiract piic { NaMaa&elarna" 1" . I r- +: V C".1 or the total amount of all deposits or payments which the'coniraclor riiustfnake, iri ' h r't r '" �'t- d advance, to order andfor otherwise obtain delivery of special order materials and Aud,odzed sigisuuri i-'. y :.. i�.f a. +:33u equipment, whichever amount is greater. f,. Note; This proposal may W withdrawn by us M not accepted wtMn _.days. Acceptance of Proposal - I have read beth sides of fhb document arLd accept,lhe pr ces; specifications and conditions stated tunderstandJT that upon signing, this proposal becomes a binding contract You are authorized tR.do the work as specified. Payment Will be r(iade as,outlined abovel�r,,. You, the Buyer, may cancel this transaction at any time prior to mldNOt of the third, businesa day aftenthe. date of this transaction. Cancellation must be done in writing. Y DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. IN WITNESS III F of 'e here have signed their names this —cL day of No ue In be r 19 % Signed Signed SSS n . as,Iam Owner C-0.111ore, am the reef am IMPORTANT INFUHMAIIVN UN VAk:R OF- kaoft_ CERTIFICATE OF LIABILITY INSURANCI QCool Doii2o� s - PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Davis, Davis & Moody HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Route 125 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Plaistow NN 0386s— NSU COMPANIES COMPANY -382-9354 FexNo. 603-382-7786 1 A Merchants Mutual Brooks Construction Co., Inc. Alfred Diprima 254 North Broadway Salem NH 03079 COMPANY B COMPANY C COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE. TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COTYPE OF INSURANCE LTR POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDIYY) POLICY EXPIRATION DATE (MM10DIYV) LIMITS moo_ GENERAL LIABILITY � GENERAL AGGREGATE $ 2000000 - COMP/OP AGG s2000000 A ' X -7 COMMERCIALGENERALLIABILITY CLAIM$ MADE 171 OCCUR 6CPS676145521 04/28/97 04/28/98 -PRODUCTS PERSONAL & ADV INJURY $ 1000000 EACH OCCURRENCE f 1000000 OWNER'S a CONTRACTOR'S PROT FIRE DAMAGE (Any 0138 W91 f 50000 MED EXP (Any ons psrs0n) $ .5000 A AUTOM013iLF LIABILITY ANY AUTO OBAC678601434 � 04/28/97, I 04/28/98 COMBINED SINOLE LIMIT $ 1000000 , ALL OWNED AUTOS BODILY INJURY (Perpsreon) X ; SCHEDULED AUTOS MIREd AUTOS BODILY INJURY : (Per eccident) l_ NON•OWNEO AUTOS C , I PROPERTY DAMAGE S GARAGE LIABILITY ` AUTO ONLY - EA ACCIDENT i OTHER THAN AUTO ONLY. ANY AUTO EACH ACCIDENT S AGGREGATE >c —� EACH OCCURRENCE i EXCESS LIABILITY UMBRELLA FORM AGGREOATE $ i OTHCR THAN UMBRELLA FORM X TORY U. pEHR• , 11 EL EACH ACCIDENT $ 100000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ELDISEASE -POLICY LIMIT s 500000 A THE PROPfiIETORI }{ INCL PARTNERSIEXECUTIVE OFFICERS ARE; EXCL I WCA6145519 1 05/16/97 05/16/98 EL DISEASE -IEA EMPLOYEE $ 104000 MM CERTIFICATE HOLDER CANCELLATION AR00001 614OULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED e9FORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. N, ANDOVER BUILDING INSPECTOR BUT F RE TO MAIL S CH NOTICE SHALL IMPOS OBLIGATION OR LIABILITY NORTH ANDOVER MA 01845 OF NY KIND UPO COM NY AG OR REPRESENTATIVES. RUTH RILED RE S ATIVE! 0,z&e_. CORD COR RATION 1988 ACORO 26-S (1196) F-- MOVARRbMStNT CONTRACTOR Registration 118668 7 Type - INDIVIDUAL Expiration 04/11/99 MARK J. DI PRIMA 8 SUNNY AVE ' �`6' " UHUEN MA 01844 ADMINISTRATOR r r Location No.' - �- ? Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ 1 Byilding/Frame Permit Fee $ Foundation, Perm Fee $ Other PerrriiUF' 6e $ ewer Connection ��/(�SFee $ W,iil�e�Connection Fee $ v �� )l 3Us. TOTAL 93 $ Building Inspector Div. Public Works P$Rlfff rJO. o`v APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. AGE 1 MAP h40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. 8/S//,?oZ — I a/y LOCATION p � PURPOSE OF BUILDINGA"k OWNER'S NAME � Ie NO. OF STORIES E�'�I -le OWNER'S ADDRESS Il"F� A� )Qeit / CYM � /'LI BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ,� Jam/ /�� SPAN DISTANCE TO NEAREST BUILDING -- DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES — SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION 1/S IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO✓REQUIREMENTS OF CODE As IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 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 I 7 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E ig;/ ^ © 6 PERMIT GRANTED 19 OWNER TEL. CONTR. TEL. # CONTR. LIC. # 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 1DD� EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD /BOARD OF GKLECTMEN ■UIL JINQ ImuracTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY Si DRIES MULTI FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE HARDW D 3 2 13 CONCRETE BL K.PINE BRICK OR STONE PIERS PLASTER DRY WALL _ UNFIN 3 BASEMENT AREA FULL FIN. BM'T AREA _ 14 1/2 '/. FIN. ATTIC AREA N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 3 �_ _ _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING HARDw D ASBESTOS SIDING COMMCN VERT. SIDING _ ;SPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME CONC. OR CINDER BLK. ATTIC STRS. & FLOOR _ WIRING STONE ON MASONRY _ STONE ON FRAMESUPERIOR ADEQUAATE I--1 NONE 10 PLUMBING $ ROOF GABLE HIP BATH (3 FIX.) GAMBQEL MANSARD TOILET RM. (2 FIX.( — FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING I I 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 GAS 7 NO. OF ROOMS OIL B'M'T2nd _ t.� _I2nd ELECTRIC NO HEATINGEd 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. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. / ****************Applicant fills out this section***************** c/ APPLICANT: ice- Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) 6 Z ************************Official Use Only************************ COMMENDATIONS OF TOWN AGENTS: - Date Approved 3 Conservation Administrator Date Rejected Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date i ' a � c rl � o � L a P Q T n iQ N s • L r - Ln ih cn C N m v rq '7;.10 = o" �O rm z m (A M ^^Z y! > Z ;u Pm� rTl rD F X TN `vim CAI o� Z O w C) Iu v 0 O g y r- H 0 �a o ii >m z OC NS Mm z >� g Rd F vD H 8 It r Q m m Za ego r o mss Zy Z y mfR � H 00 p v §g 00 8 C) RM za0z �02 mQ ggky mg D m mo m > a'.. g pi 8 v °° $ L.) R m �o c a t0 M O n R O D m r >� �m 2 z N f t 3 I e J �1 � N �x z At=, c f t 3 I e J OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING r° Town of NORTH ANDOVER DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 12o Main Street North Andover. Massachusetts O 1845 (617) 685.4775 i In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number eL :3 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: mss. (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. n Ol 0 z cn m 0 Z T_ Z D CO2 aZ CD O CL r d _ � o o p a� p- CD O C O CD d O CO) C9� O y 0 n CD O CD CD y CD CO2 0 O CCD O CD z V J n O z cnC n O z F�, Q N O Q y c m y ECD m n -'1 m O C7 R1 o y m c 3, ZCL CD 0 aid y _ O y CD O •� Cmm ca CD C d :Lc CD c ? o .+ • y gj�t ate.. so o m cm � m y 1 h-� m �.0 C d m y 06 �� ,W 0: VJ :i C vow �l 11 JJ r. :E m y ?CO2o VJ N -W O CO Cc o mco �� z �3 CO2 O O " CD om .y CD N d CD m o a's.� c')o�� CDCO CO o_ cn cn ^ to G re x7 O tz -x C/� ;z O Iz z Pd O z n O O r O CDo 0=3 0 0 c • Location No. Date 4110 o U 0 Check # 16c2 , r ;-- / -4-Bu4ding Inspectq7 TOWN OF NORTH ANDOVER f -1NORTH • �L D iage;,� Certificate of Occupancy $ y7 SA�NVS 4� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ` Check # 16c2 , r ;-- / -4-Bu4ding Inspectq7 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING DATE ISSUED: BUILDING PERMIT NUMBER: 1-1916 7 ��j SIGNATURE: A d� z e� Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION 1. l Property Address: 1.2 Assessors Map and Parcel Number: 35 �b Map umber Parcel Number 1.3 Zoning hrformation: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide Required Provided Required Provided G, a /, -30 i Z 1.7 Water Sappjy M.G.L.C.40. 34) 1.3. Flood Zone Information: Public � Private ❑ Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal `B' On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record /eQ 1n n 1 �e>lO +1�"' %%I t �C S O O ff- N C �/4► lL�„ t+ `CXR Name (Print) Address for Service Sig a Telephone ; 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: /�✓� 7_i / OE: U% / �' f7 (/E A4 �d Address Qil'a'ure Telephone Not Applicable ❑ Z �s License Number Expiration Date 3.2 Registered Home Improvement Contractor g EE 11.) oO ricS fa SIC �4 o K1 Not Applicable O /02,32-3 Company Name 0/ EW I rr cif �f d Registration Number Address Expiration Date . anature Telephone M M Z O SECTION 4 WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. in the denial of the issuance of the building permit. eiaf,Pd atlidavit Attached Yes ....... No ....... 0 SECTION 5 Descril New Construction ❑ ;roposed Work (cher Existing Building ❑ Accessory Bldg. ❑ I Demolition ❑ Brief Description of Proposed Work: n,/ ..l l./ /In to provide this � f will result Repair(s) ❑ Alterations(s) ❑ Addition �— Other ❑ Specify -40 40 _ . - �.riII 2w go cv L.41J,U� . As �/lr9w ;n S Ti4��� �-/o •oI Z/Z/n 3��ff SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item I Estimated Cost (Dollar) to be 1. Building 2 Electrical OFFICIAL USE ONLY (a) Building Permit Fee Multiplier (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical IIVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf. in all matters relative to work authorized by this building pennit application. Signature of Ovmer Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION /4—/ as 6rwi&iAuthorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief of NO. OF STORIES ' BASEMENT OR SLAB SI7F OF FLOOR TIMBERS SPAN /#__ DIMENSIONS OF SILLS 4;(6 DIMENSIONS OF POSTS DM-'NSIONS OF GIRDERS W L X 3S ,S7 HEIGHT OF FOUNDATION QS SIZE OF FOOTING Z4� ff MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS 13UII.DWG CONNECTED TO NATURAL GAS LINE o z Date SIZE Z X 2,9 2 NO3 THICKNESS /O X / Z r/ 0 FORM U - LOT RELEASE FORM `f\ja� iad L b,,� 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 �O r ©h �A} ✓% i (zE PHONE ?74 0fZ • 6,0146 LOCATION: Assessor's Map Number PARCEL o o% SUBDIVISION 1 LOT (S) STREETi"IO�4,0c� r09 fLfh l n ` A ST. NUMBER g *****************************************OFFICIAL USE ONLY*********************************** RECOMMEND NI,�S OF 1 ti ,,_SERVAT(614 ADMINIST COMMENTS l } P COMMENTS FOOD INSPECTOR -HEALTH t SEPTIC INSPECTOR -HEALTH AGENTS: ,TOR DATE APPROVED DATE REJECTED TOWN PLANNER UA i It AF'FHUvtU DATE REJECTED COM DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised M7 jm name: JLEGw 0ONSlntJG*iOrl ILENN C,t`i k,,5,l 1 location: Z/ ' onij i 1-r /;[lE Vfn A4. nhone# !72' 671-S .. address city:Rhong # insuronre en- nnlscv:'f! Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to SI.500.00 and/of one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under the of perjury that the information provided above is true and correct signature � Ol, / n Date Print name l� EA)AJ E fA I.S r:"El� . _ . _.._. _. phone # 9"7'7 ' �0 7� 'S7•C') 1 official use only do not write in this area to be completed by city or town official ,..z...... ..:...._ city or town: permitilicense # nBuilding Department pLice6sinkl3dard ' — O check if immediate response is required c3selectmen's Office _ C]Health Department contact person: phone #; nOther (revised 3/95 PJA) The Commonwealth of Massachusetts Department of Industrial Accidents '* V-- 600 Washington Street Boston, Mass. 02111 1' Workers' Compensation Insurance Affidavit name: JLEGw 0ONSlntJG*iOrl ILENN C,t`i k,,5,l 1 location: Z/ ' onij i 1-r /;[lE Vfn A4. nhone# !72' 671-S .. address city:Rhong # insuronre en- nnlscv:'f! Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to SI.500.00 and/of one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under the of perjury that the information provided above is true and correct signature � Ol, / n Date Print name l� EA)AJ E fA I.S r:"El� . _ . _.._. _. phone # 9"7'7 ' �0 7� 'S7•C') 1 official use only do not write in this area to be completed by city or town official ,..z...... ..:...._ city or town: permitilicense # nBuilding Department pLice6sinkl3dard ' — O check if immediate response is required c3selectmen's Office _ C]Health Department contact person: phone #; nOther (revised 3/95 PJA) . ✓� iJom�maouuea�la o� ��ac/zuae(X6 BOARD OF BUILDING REGULATIONS k _ License: CONSTRUCTION SUPERVISOR + Number: CS 058245 Birthdate: 03/24/1943 a Expires: 03/24/2004 Tr. no: 20021 Restricted: 00 KENNETH B KEEN 21 HEWITT AVE N ANDOVER, .MA 01845 Administrator r i HOHE IMPROVEHENI CONTRACTOR `� _ Re9islration� 108383 Expirations 8118102 ' TYPe� 08A KEEN CONSTRUCTION CO. t Kenneth Keen L� �o 0 sai 21 Hevitt Ave ADMINISTRATOR No, Andover MA 01845 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978)691-5201 Rose, Mike & Robin 80 French Farm Rd. N. Andover, MA 01845 (978) 682-6016 Contract # 1520; Appendix A Date:03/30/02 Addition: • Create addition on existing house (family room only) as per prints dated 6/10/01 (except the gable end will not be hipped) • Supply & install Harvey Ind. Vinyl windows & sliding door • Supply & install vinyl siding to match existing (Alcoa "Lake Forest Glacier Blue") • Supply & install 25 year architectural roofing on addition & main house • Supply & install interior doors and all trim to match existing • Remove existing fireplace & chimney and dispose of • Supply & install 15 -lite double door unit where fireplace was • Finish basement of addition • Supply & install three windows & walk -out door in basement • Supply & install ceramic tile in bath & laundry ($325.00 material allowance) • Supply & install blueboard & skimcoat plaster in existing FR • Supply & install perimeter drain around addition foundation • Remove all excavated earth not required for backfill Plumbing: • Supply & install new power vented boiler & oil tank in addition($5400.00 allowance) • Supply & install 2 additional zones of heat • Relocate existing heat pipes & superstore to new boiler location Total cost:$106,170.00 (one hundred six thousand one hundred seventy dollars) The following items are not included in the price of this contract: • cost of permits • water, ledge or unforeseeable problems during excavation • demo of old bath/laundry area • demo of kitchen ceiling • demo of old F/R • cleaning of jobsite (interior & exterior) daily • painting • carpet in F/R or basement • electrical work KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978)691-5201 • unforeseen changes or additions required by inspectors • zero clearance wood burning fireplace($2900.00 allowance not including trim, mantle or hearth) • fmishing any of existing basement • required framing needed to remove chimney or it's foundation • exterior decks • bathroom fixtures • removal of old oil tank All extras to be paid in full when ordered. Payment schedule:$ 1000.00 due upon signing contract $20,000.00 due first day of work(plus permit fees) $30,000.00 due after chimney demo & foundation is poured $30,000.00 due after rough framing & plumbing is complete $10,000.00 due after insulation and wallboard is installed $10,000.00 due after plaster skimcoat & ext. trim is complete $5170.00 due at completion of contracted work Customer Kenneth B. Keen Date Date 2 71,is plan reducPd+ for correct scaling see original on file in the office of DIWDFOW rNGINEE11i .G Co. a�f �dtgt: l,oT 53 ' I►ao.00' ._ dol mO-IlJ * EAyGM�F.I'(� Low . g 1 .0 11� 42 It ,ZSrv! KI -P QmEcT -To-r-zsTr-c-Tko►as, 2Esce-la-mow5. 1 Asn R>✓ST c?IoNy OF RE40IMP bA MORTGAGE INSPEC11ON PLAN LOCAtm IN BUYER: Michael and Robin Rose TO THE Assurance Mortgage Corp. of America ) A N D 0 V E R__ AND ITS TITLE INSURERS. MASSACHUSETTS THAT I HAVE EXAMINED THE PREMISES AND THE BUILDINGS SHOWN DO ( ) I CERTIFY & REAR YARD SE11BACK CONFORM TO THE ZONING LAWS AND AMENDMENTS, EN ONT. SIDE, ONLY OF ANDOVER WH I FURTHER CERTIFY THAT THIS PROPERTY IS NOT LOCATED IN THE ESTABUSHED FLOOD DEED 999n HAZARD AREA. COMMUNITY PANEL NO.: 250098 0005B DATE: 6/15/83 BOOK EXAMINATION OF THE RECORDS IS MADE ONLY SUBSEQUENT TO THE RECORDED DATE OF THE NOT INCLUDE VE:RINNG THE ACCURACY OF THE DEED DESCRIPTION PAGE 274 LATEST DEED AND DOES PREVIOUS TO ITS DATE OF RECORD. CERT. NO. �-- THIS COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT TO THE RECORDED DATE OF THE LATEST DEED OF RECORDED. PLAN BK. - PAGE --� THAT A MORE FOOT FROM THE PROPERTY UNE IT IS ADVISED PRECISE SURVEY BE MADE To VERIFY THESE MEASUREMENTS. PLAN + 8926 DATED THHIISSCCER71FICATIOH IS BASED ON THE LOCATION OF SURVEY MARKERS OF OTHERS. AND DOES August 31 , 19 92 NOT REPRESENT A PROPERTY SURVEY. THIS CERTIFICATION TO BE,-:USEQ RTGAGE PURPOSES ONLY. SCALE: f` 40' OFFSETS AS6f f'4' -AR TO BE USED FOR THE ESTAQII.ISHME�r - OF ' ., PERTY LINES BRADFORD ENGINEERING CO. • �q�(:� T EQ� i�Q 0 P.O. BOX 1214 y�r,U., HAVERHILL MA. 01631 FRED W. CHASE III R.L.S. #15755 TEL (800) 373-23N C/) m m C/) C6 O .. .. a: C= co CD y 10 CD .n+ O d C) CD O CD CD CA CD CO) 0 CCD CD0 C c? O d 2 O = d! Z Q N So ECO = y -i m o Cl) CL F.), m z 7° N T ? d •+ d O Er CDOm y C y oN �mm�m xn 0 0 0 � co -i 0 o ZS Amw CD C N F O •. R r xto . rr V/ m m ^^ N /�) O n -o VC ow s l"f O N cu C d cn CD CD no n ZSr CD ►� cncn CD C C co o MU z 3 0D 0 - a 0 o z W' o AzCL z 0.C<ntzg d � W ro GOtz tz o x y 0 0 c J 7 7 Date..... a i N°R7M °t �``° :•'"° TOWN OF NORTH ANDOVER AL 1 9 PERMIT FOR WIRING This certifies that �.�.:..�`.�..... t... �t.('(i ..::....... C (' - -C .............................................. -, l f<<<< has permission to perform ...............:..:...... f...::........................... wiring in the building of ...............� 1..U.�.................................................... ar � , North Andover, M ........... ................... ... =Fee .. �5..: �"�. Lic. No. �..1/ �.�.....�...... ... i ELECTRICAL INSP ACTOR Check N Official Use Only Permit No. X. l 9044„ Baca S-#4 Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perforated in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Insjiector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number $o r4reN Owner or Tenant t' L ( a Rp�slti\ RtS- Owner's Address Srd Vre"' &r, A�:- is this permit in conjunction with a building permit Yes &7 No ❑ (Check Appropriate Box) Purpose of Building e41rrm Utility Authorization Existing Service QIOO Amps Voits Overhead ❑ Undgrnd ❑ New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters 1 No. of Meters Number of Feeders and Ampacity Locailon and Nature of Proposed Electrical Work LOwet e.Tft4 Rasr..,o.� tlrl�i & i /i.s k� (^^- 46d 12V A., suL.14, !'u►, /u ,W vdla�a`1i f3 fs ^r..w OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of EteStripal Work$ Work to Start 6(a0/65A A Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC. NO. Lkensee Signature LIC. Bus. Tel Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insuranc�rage or its substantial equivalent as requiredby assachusetts General Laws. And that my signature on this permit application waives this requirement. ner Agent (Please Check one) .� /�, Telephone No. 01t- 6r -d `8416 PERMITTEE $73,76)cl (Signature`of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No. of Receptacles Outlets 7 No. of Oil Burners 1 No. of Emergency Lighting Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Initiating Devices No. of Ranges Total a No of Air Cond Tons Heat Total Total No. -6f Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No�of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other Nofof Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No.. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of EteStripal Work$ Work to Start 6(a0/65A A Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC. NO. Lkensee Signature LIC. Bus. Tel Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insuranc�rage or its substantial equivalent as requiredby assachusetts General Laws. And that my signature on this permit application waives this requirement. ner Agent (Please Check one) .� /�, Telephone No. 01t- 6r -d `8416 PERMITTEE $73,76)cl (Signature`of Owner or Agent)