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HomeMy WebLinkAboutMiscellaneous - 80 OLD FARM ROAD 4/30/201800 0 O 0" ITI 7d 0 a rm North Andover Board of Assessors Public Access t 4 O� A0 oTFf • e 'o 3t a•' �. o4L 9gSACHUSEt Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 North Andover Board of Assessors roperty Record Card Parcel ID :210/035.0-0064-0000.0 FY:2013 Community: North Andover SKETCH Click on Sketch to Enlarge PHOTO Click on Photo to Enlarge 60 OLD FARM ROAD Location: 80 OLD FARM ROAD Owner Name: JAMES, ANDREW M DEBORAH W JAMES Owner Address: 80 OLD FARM ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6 - 6 Land Area: 1.05 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2815 sqft ASSESSMENTS CURRENT YEAR .PREVIOUS YEAR Total Value: 500,300 494,800 Building Value: 291,300 287,500 Land Value: 209,000 207,300 Market Land Value: 209,000 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2251847&town=NandoverPubAcc 10/22/2013 co co 00 N N 0o U o CD CO R N (D m D m aia� a U C U U aR co O d a) N 0 c o o a S2wUS O M a O O 1-0_� co O N .. 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LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Property Address Policy Number: Date/Cause of Loss File or Claim Number: Andrew & Deborah James 80 Old Farm Road HP1686693 2/18/2014, Water/Pipe Burst 29159-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner On this date, I caused copies of this Notice to be sent to the perss named above at the addresses indicated above by First Class Mail. /J , 7 SignafurA and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 16 "I P 10,211. 1-) Date../P/3 I.... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......................... . .................................. ....... I .............. -7A // 6,,--/L �Z- has permission to perform .... ............. ...................... a . . .............. ........................................ plumbing in t e. builds of .... ell �d 74nK e., at ..... JV ....... A .............................................................................. North Andover, Mass. 0 Fee.�2.!-.... Lic. No. ZV4�� ......................................................... 7 PLUMBING INSPECTOR Check #75/,5- - P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY © I MA DATE � m,__11 PERMIT # JOBSITE ADDRESS) OWNER'S NAME OWNER ADDRESS TEL OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ETI NEW: � RENOVATION:;f- REPLACEMENT: I FIXTURES 7 FLOOR- BSM 1 BATHTUB( CROSS CONNECTION DEVICE I DEDICATED SPECIAL WASTE SYSTEM I _ DEDICATED GASIOIL/SAND SYSTEM E _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM f _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER IF— DRINKING DRINKING FOUNTAIN FOOD DISPOSERI FLOOR/ AREA DRAIN IF— KITCHEN SINK LAVATORY RC5F DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING 2 1 3 1 4 1 5 1 6 1 7 RESIDENTIAL PLANS SUBMITTED: YES EA NOQ 8 1 9 1 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES. NO M IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY— OTHER TYPE OF INDEMNITYE]1' BOND 01. OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT 01 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and that all plumbing work and installations performed under the permit issued for this application will be in compli< Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Q1C { LICENSE # IMP D JP5— to tVbest of my knowledge Went provision of the CORPORATION 0#©PARTNERSHIP ©# LLC j COMPANY NAME ; ADDRESS CITY�� STATE , _ ZIP /_ ,—� TEL FAX _ CELL119f-r-10-11 EMAIL 1 LOD H O O F U W � W r 0 z ❑ O � W w O EL Z u LLI _ ~ � � W O a w 5 a W p o Pa, w � U J d a x w Q0 F O H F U W P, r a P, p O N r� The Commonwealth of Massachusetts07 - Department ofIndustriglAccidents Office of Investigations 600 Washington Street Boston, K4 02111 Uf www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A Please Print Legibly Name (Business/Organization/Individual): X?� Address: 42 r S All, City/State/Zip: &/ t ����, ©/ 7� Phone #: Are you an employer? Check the appropriate box: Type of project (required): L ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors I Remodeling 2. 0-1 am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its y. ❑ Building addition [No workers' comp. insurance required.] officers have exercised their 10. Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL I L ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lie. Expiration Date:, Job Site Address: City/State/Zip; Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certoXtI_ er JVqf n,&4njpaua[ties ofperjury that the information provided above is true and correct. �.�_ffl� Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # -IV-/3 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone #: Information and 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 ofhire,• 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 the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or 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 maintenance, 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 local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced -acceptable evidence of compliance 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' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding 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 permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (ifnecessary) 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 etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank 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 Commonwealth. of Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston, IIIA 02111 Tel. # 617-727,4900 ext 406 or 1-877:MASSAFE Revised 5-26-05 Fax .# 617-727-7749 wwwaxtass,govldza ti M COMMONWEALTH OF MASSACHUSETTS 1.lCENSEED AS A JOURNtYmAw m-unna •� ISSUES THE ABOVE LIt;ENSE'TO: ANTHONY M LEkT. i Z M 21 PERNCROFT RD S' TEWKt+BURY ' MA 0 Z 8 ~" 7 zZt1 6 = �05i0Z/ 4. i 64` . Date..:�..�%.3 TOWN OF NORTH ANDOVER PERMIT FOR WIRING � ,S ,►J 1'e p This certifies that .......�.........�.� c _ O has permission to perform .. .. ` i. "` _ Z—�,, JI, ...... "Jo ..................................... . wiring in the building of ..... ::4 �� Q. � Y -L.., �- � orth Andover, Mass. a�.............................................................. ........................ Fee ............. 5 .... .""........ Lic. No.................. IELECTRICAL INSPECTOR Check it �(h-14 cam.. �olzl�13 Commonwealth of Massachusetts Official Use Only 9 7e `��44 Department of Fire Services Permit No. Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] peaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) ]Date: /1—/— / 3 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) t d (-:A,, Owner or Tenant -T)- 6 b r Az :UA a^ rX' Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 2� No ❑ (Check Appropriate Box) Purpose of Building t ( _4 Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity (� / Location and Nature of Proposed Electrical Work: 19-e,, moi' M 4S' 1,p IjJ-P- 4— Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- Elo. o Emergency ig ting rnd. rnd. Battei�y Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number - Tons KW ..................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW SecuritNo. o Dev stecls or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: ee:�S .l Attach additional detail if desired, or as required by the Inspector of I res. Estimated Value of Electrical Work: ESpo (When required by municipal policy.) Work to Start: / I - ( - 1 "3 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE El BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury^that flee information on this application is true and complete. FIRM NAME:. `T_ e Tr c cD LIC. NO.: f } (u a 3 / Licensee: G,+R,y?: /,y t 1,S 6,,1 Signature r LIC. NO.: (Ifapplicable, enter "exempt" in the license nu ber line.) Bus. Tel. No.- Address: �? �,� ISr, , ca.3AJ I c [ M & cD (F `l O Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work re fres 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 agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. WE 7 ❑ 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 of ongoing 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 purpose 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: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass F?1 Failed M Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ ' \\ Inspectors Comr ents: AM A --�-� Inspectors Signature: Date: FINAL INSP CTION: V Pass M Failed Re- Inspection Required ($.) ❑ Inspectors ents: Inspectors Signature: U Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts - Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www.mass:gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name T 0 1 (sa .J V Address: o� �'�-� t< -r, City/State/Zip:g gw iCU ,/nA, © t c? Sr 6 Phone #: Are you an employer? Check the appropriate box: .1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.91 am a sole proprietor or partner- listed on the attached sheet. � ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL - myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy anal job site information. Insurance Company Name:, Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: ,City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Ene up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine pf up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. t I do hereby certtfy under thepains andpenaldes ofperjury that the information provided above is true and correct. - Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #' Information and 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 the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or 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 maintenance, 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 local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance 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 -contractors) 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' compensation 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. AIso be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding 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 permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (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 etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washinpu St=t Boston, MA 02111 Tel, # 617-727-4900 ext 406 or 1-877:MASSAFB Revised 5-26-05 Fay, # 617-727-7749 www.ixtass.gov/dia P.COMMONWEAITH OF MASSACHUSETT ,ru ew Uk� Date. o7 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...................... t ............. has permission to perform -71� I ........ ........ plumbing in the build' S Of .. ( . at. .1� � ..............A ................... North Andover, Mass. Fee? /: Sd Lic. No!�aPc: . ............. PLUMBING INSPECTOR Check # 72 5,' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location O� ��� �� r cl '9 C�Owners NamSJ'/ (12 Ja'ge,s" Type of Occu an New Renovation Replacement ❑ FIXTURES A � Plans Submitted Yes Date Permit # �3 Amount ❑ No ❑ (Print or type) t Installing Company Name Address �r < Business one Check one: Certificate 13--eorp. ❑ Partner. ❑ Firm/Co. Name of Licensed Plumber. -'� Tc� C / ? Insurance Coverage: Indicate thetype of insurance coverage by checking the appropriate box: Liability insurance policy U Other type of indemnity ❑ Bond ❑ insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts — to Plu! i� Chapter 142 of the General Laws. APPROVED (OFFICE USE ONLY / Type of Plumbing License �2- License um El Master _ ourneyman Date...... ......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,, ,� This certifies that .........................................,.a..le,?`frf'.................. has permission to perform .............n.Z. T!�Y,:gF�..... wiring in the building of ........................ 7-................................... atat ..................��.a���..! 1......... , North Andover, Mass. vee Fee . /:s 77'x' Lic. No. ......... , �p ELECTRICAL IN'uncm/ Check # 7186 Commonwealth of Massachusetts Official Use Only AM Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / -a y- p !�r City or Town of: NORTH ANDOVER To the Inspector ofWires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) $O Owner or Tenant Telephone No. Owner's Address Is this permit in conju ction wit a building permit? Yes � No E] (Check Appropriate Box) Purpose of Building �%�.� , , ( Utility Authorization No. Existing Service Amps / olts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires $' No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires .f Above ❑ In- Swimming Pool ❑ rnd. grind. o. o Emergency ngnng Battery Units No. of Receptacle Outlets g No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. 3 of Gas Burners No. of Detection and Initiating Devices No. of Ranges /�' No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number Tons I KW I No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers HeatingAppliances KN' pp Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: t1n60,O Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: J0 ow (When required by municipal policy.) Work to Start: /--0?9^a7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE W1 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: ,�IC. NO.: Licensee: d ,� ,r Signatur LIC. NO.: 6330,�sr (If applicable, enter "exempt" in the license um�bJe line.) Bus. Tel. No.P_:? 7 r4 -r-4 3 Address: /4 l 7�ar� /•� // f�� !� 4,1o&—A n v3a 77 Alt. Tel. NoLd^3 8�s- 30 fr6 *Security System Contractor License require or this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent FPERMIT FEE: $ Signature Telephone No. Location No. `3`'G Date Nom,. TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $� Check # t• 4 3 '187u9 T -Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING Vol 929do to' BUII DING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Conllnissioneffl or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address; fry.. 1.2 Assessors Map and Parcel Number. 06 Map Number Parcel Number 1.3 Zoning Infomuation: Zoning District Proposed Use 1.4 Property Dimensions: LA Ara Fronto ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Re(pired Provide ReqWred Provided ReqWred Provided 1.7 Water Supply M.GL.C.40. § 34) 13. Flood Zone laf°rmstioa' 1.1 Sewerage Disposal System: public ❑ Private ❑ Zone Outside Flood Zaee ❑ Municipal ❑ ou Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSH M/AUTHORIZED AGENT '�' �'i �t% :'j Ctf!Ct: ��? ; NO 2.1 Owner of Record ,6 , wry J u w-t✓5 ,r�+-L �-� Name (Print) Address for Service: Signature Telephone 1b 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: A 1 1 , FSS a � fX l•� Address %%!k' ZG S '2,2 _�7- Sig Telephone Not Applicable p ❑ O�C d ,3 %r License Number Expiration Date 3.2 Registered Home Improvement Contractor j} Not Applicable ❑ 6 �� ompany Name AZA Z7 % L Registration Number Address 72 S Expiration Date Sign _ ___ Telephone SECTION 4 - WORKERS COMPENSATION (XG.L C 152 § 25c(6) " Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of thcAuildina vermit. Si ed affidavit Attached Yes No ....... 0 SECTION 5 Description of Proposed Work check at a ble New Construction ❑ Existing Building ❑ Repair( s).f�'' Alterati(ros(s) ❑ Addition ❑ 2k Ow ti , v \ r' Accessory Bldg. ❑'" Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: i4 « CQ S� G Z' . c,, , ) I Cw.rnm 6 - RSTIMATF.n rnNCTR1rTrTirnm rncTc Item Estimated Cost (Dollar) to be Complete by permit applicant OFI+'ICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 5--o fl • Check Number .arra.---I i- vI•a•----aaav�iAWLI aV DL' l.VD1rLL' Ar" Wrmfl OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTH O RIZED AGENT DECLARATION 1, �� i `' ,as Owner/Authorized Agent of subject r property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRADERS Isr2 3Ku SPAN DEMENSIONS OF SILLS DIlvIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X — MATERIAL OF CHININEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE m m m C m W F, C) y 'O O CD C2 Z y E; . � � o d H �Cl w oCD v CD o Q CFDCD o CD C ccl CD y. v y —• o co C S v CO2 O CD Z CD � o CD 0 CD 0 O C y o Q CLO So Cc nd0 a O fA Z Odd.. '.n = d ^� d ..r Om . O d `•i h s� Ie. > > m H OCO n O ZW: C = ='a: rn m CL C/)mm�+ Cn �U ^^ m c COL W l J � m 3 p N � 1,���C1, 01 ti . V C W= C/)s CL ^^ .... ca 0: �• � C/J ti m O y co h C/)m y CD tv go Im �Z o ". c o IS = z IS CO) O m n • y � H T co CO) m a cr a � m y O 7 s �� 4'S, o ~ 7 M - N o G - o eL W Crl � �. o m �� n g r- o rO CL R o' `cp C o ., O 69- y O C Sold To:. Address: /1./ i_fl City: Job site Address (If different): 9. 10. 11. 12. 13. 14. 15. 16. 1d Iff 91 JQ13 13 HIC Registration #129774 Federal ID #04-3277886 Pella Windows & Doors of Boston "Viewed to be the Best" ENTRY SYSTEM CONTRACT Ir State: �_ Zip: 0 fll f, Hemove ano dispose or poor in exisung upenuiy All workman's compensation and liability insurance maintained Pella Windows & Doc 45 Fondi Road Haverhill, MA 01832 PH: (800) 866-9886 Service: Ext. 124 Fax: (978) 556-0394 Sales: (866) Pella06 Date: Phone (Home) (97Sr) "7 Jq-- ty'A,1'_ Phone (Work) ( ) Phone (Cell) ( ) E-mail: Warranty mailed to customer upon completion when full payment is received. Total Project Amount $ Financed If Yes: Amount Financed $ (Reference # ys� t/1'/-7 0"`/A/,�7I1'� 7ra� �xr. O6/y�oG Deposit Received $ ��o 0 Balance on Substantial Completion $ (Payment is payable to installer at completion of job) PELLA IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS. SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE PLEASE REMOVE ALL SHADES,VERTICALS, BLINDS, CURTAINS, DRAPES ANY REPRESENTATIONS OTHER THAN CONTAINED INTHIS AGREEMENT OR WINDOW MOUNTED AIR CONDITIONERS, PRIORTOTHE INSTALLATION AND "OWNER" REPRESENTS THAT NONE HAVE BEEN MADE TO OR OF YOUR NEW ENTRY SYSTEM. INSTALLERS ARE NOT FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS. FILLRELIED IN DUPED UPONLICATE Y "OWNER". YOU ARE TITLED TO A COMPLETELY CA E OFTHIS AGREEMENT. CONDENSATION INSIDE THE HOUSE DOES NOT INDICATE A WARRANTY CONTRACT DEPARTMENT. BJECTTO FINAL INSPECTION BY PELLA CONSTRUCTION PROBLEM. This contract Is a legal document. Your Pella products will be specially made-to-order for you. UNDER NO CIRCUMSTANCES WILL REVISIONS OR BY SIGNING CAN i eTi4N BE IB B ND THE THIRD BUSINESS DAY AFTER THE CONTRACT HAS BEEN SIGNED -AND DEPOSIT . POSS ^%to rncriclreT1nNS FOR THE PELLA PRODUCTS YOU ARE ORDERING ARE CORRECT • - -� /� f 13F.LoW.WU VU Pella Rep. Signature: Date: 1 Customer Signature: 1�� Date: /� J� L (7Os r -- �1ze -�omvnanuiea/,d � v �aaac%uaelt BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 089839 Birthdate: 06/19/1972 Expires: 06/19/2008 Tr. no: 89839 Restricted: 00 SCOTT P HOUSE. 854 RROADWAY #1' HAVERHILL, MA 01832 Commissioner - - maize >°ia„vmanurea� o�✓�aaac`euaetla Board of Building Reguls'icns and Standards HOME IMPROVEMENT CONTRACTOR { Registration: 129774 Expiration: 11/2/2005 Type: Supplement Card PELLA WINDOWS AND DOORS SCOTT HOUSE 45 FONDI RD. C4 -moi r� HAVERHILL, MA 01832 Administrator X•. , '*• >.= A' ,CHUSETTS O NUMBER DRIVER'S LICENSE S69694966 DATE OF BIRTH CLASS REST HEIGHT SEX u: +,`} 06-19-1972 D 6D M EXPIRES 06-19-2006 yam.. ;"�:� '•' �y C C HOUSE SCOTT P 854 BROADWAY a APT #1 as is~ivn " j HAVERHILL, MA 01832„y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ��., ,.•' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual): PC 1(c W 1PL d 0 W S Address: YS- FO✓1 d t " . City/State/Zip: Gtt/tr �' ' l� /y/4 Ol f?.Z Phone #: ct 7 f- Z 4S5. 72 SY Are you an employer? Check the appropriate box: 1. I am a employer with Z S 4. ElI am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors 2. LJ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information.. Insurance Company ,..e d G , G 11 yr c 9-+ Policy # or Self -ins. Lic. #: 0,? tA) 91V L 52 r'! Z Expiration Date: Job Site Address: r�� l) �� r� % - City/State/Zip: IV Ax Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under ce pains and penalties of perjury that the information provided above is true and correct: Phone #: 979 U57 -72s5. ,1612-1 Official use only. Do not write in this area, to be completed by city or town offtciai: City or Town: Permit/Ucense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Location No. Date NORTH TOWN OF NORTH ANDOVER O s i Certificate of Occupancy $ Building/Frame Permit Fee $ sAcNu Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING n ;<r BUILDING PERNIIT NUMBER: DATE ISSUED: SIGNATURE: 144.1V Building Commissioner/IETxt& of Buildings Date SECTION 1- SITE INFORMATION I 1.1 Property Address: (% go0 I /} }' I� r tA4 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1.2 Assessors Map and Parcel 3S- Map Number Number: � Parcel Num 2.1 Owner of Record Y ,4 -) _,M .� CA_r�-Z� Na (Print) el Zoning information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft 2.2 Owner of Record: Name Print Front Yard Side Yard Rear Yard R 'red Provide ReqWred Provided Raluired Provided ,30 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature v 1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Y ,4 -) _,M .� CA_r�-Z� Na (Print) el C f ? � CAd Fr r rye clr c-1 Address for Service — ,7 Signature Telephone 2.2 Owner of Record: Name Print 19C CkA Address for Service: of 7 "Z4 S4 Si natureU Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work checkall a licable New Construction ❑ 1 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed I SF,CTION 6 - F.STTMATF.D C0N1.RTRFTCTF0N COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant 1. Building (a) Building Permit Fee a9E Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Ayq—t t-,-+ A- : ,�- "--e S , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date— SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, A dre-W /Y1 LL—;,6,,j., I.y - as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief d.�c-w M, J t s 17 Print Na r �` t �crre 2 00 / Signature of Owner/Agent Date—"' NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS 1 ST 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM joy -10-), S k . & • INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Boards .and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. raa0s■a■r=a■■a=■■a■■a=a■aa0a■aaa■■aaaaa9aaas= s■■ a= a a a a a0amaaaaaaaaaaasaaa00a APPLICANT Ayoraj d= nrn.hs PHONE c178"-75,- 9&Y(o ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION i-PzncL Farre LOT NUMBER YA STREET 01 C1rn i c> c ( STREET NUMBER C� ............................................................................ OFFICIAL USE ON]r Y $N=asa■■=noun s■■ss===s..s.r.■a......r.wassEd■=■■...sa...aa..=s=ass=ss.=a=saaa. RECONIlviENDATIONS OF TOWN AGENTS Is=.s.saowns aa=a=.==a=.asaassa...s■sasass.=ausage =Nassar ;f i, �. 1 �}'Z, DATE APPROVED I CONSERVATION ADMINNTRATOR DATE REJECTED COMMENTS / y '"'J IN DATE APPROVED TOWN PLANNER DATE REJECTED COIvIIv1ENTS DATE APPROVED FOOD INSPECTO - TH DATE REJECTED DATE APPROVED SEPTIC INS C R - DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPART MEN T DATE REJECTED COMMENTS RECENED BY BUILDING INSPECTOR DATE Cl) m m Cl) 0 CO) .p CDZ CD O wCLr W C n� to .p o o p CD C c CD O 14-11 _d O CO CD CO) .p CD O ,'-7 rte - N- CD CD O dc CD O END CrT7 cn V^J O cZn 0 r1►—� V dp d C1: Cil n: O: cn O rD -2,103 0 C d S d a 42 to cn O m c02 'ac�nC2 m C.� m ro G a- O m y n C C z b p m n?d m N y O i 57% p m CD O O N•O 00 c m ; d =r ='a y �a O a a !< C O N C. d y N d d C < W— N : 3E m tC CO =r N N '� CD . 14 wN �: �_ .�' o 0 v O A Sr CD 0 :v O • ;w co) :� CDC,3 ! 7 CDd: a'o o: c o CD' Q cn O rD cn O = 5CA L- 0 WVAMO�ll I APPRC SUE5DI\ LAW � DR -ILL HOLE( 0:70 .0 14; E Ft E P REPAPZED INACCORDANC T j5 5upvP-Y'AWD PLAN... .E. PLANT ."CONFORMS W I TP THE PROCEDURAL. ,,..A. MD.TECHMI I CAL 5TANDARD5 FSR 'TH .J L -AT 1'6 t -J s OF HF -N THE C ON I AMONJWEA�-TI4;t�:�-OF F>RACTICE OF LAND SURVEY,)KG I MA55AC�UZSETT"5- AEC: LAND SUPIVEroR 'C 41 KG: P,-? Location 180 0 L-� TAQ(q fe,T> No. 514- Date r°< "° eT ;�,° TOWN OF NORTH ANDOVER C i? •'� °c p Certificate of Occupancy $ Building/Frame Permit Fee $ ''+s••"^°' Eta s�cnus Foundation Permit Fee $ Other Permit Fees 04G $ S Sewer Connection Fee $ _ Water Connection Fee $ TOTAL $ Building Inspector 758 Div. Public Works PERMIT NO. r APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. LOCATION ao 1 fl'�RQM �-�•i URPOSE OF BUILDING OWNER'S NAME OWNER'S ADDRESS NO. OF STORIES SIZE BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME /� � SPAN -- DIMENSIONS OF SILLS POSTS d+� DISTANCE TO NEAREST BUILDING 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 �7 /� G �h, I �t y1i \ r- IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIRE NTS OF CO 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 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED A.ND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE C�'t'�WNE1Z OR ORIZED AGENT ��A-L,N1 I F E E PERMIT GRANTED Ij � 19 lA 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 10. r -/ U EST. BLDG. COST PER SQ. T.. i EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING OWNER TEL. # CONTR. TEL. # Sub -3sz- 0+-rl CONTR. LIC. N H.I.C. k Q45 -'ATc(z3'2--- BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE B 2 13 CONCRETE BL K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL UNFIN _ 3 BASEMENT AREA FULL FIN. B M TAREA _ Y. /� '/. FIN. ATTIC AREA NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ t 2 3 _ _ �— DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING VERT. SIDING _ COMI.ACN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. d FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR POOR -ADEQUATE ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD I 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 I 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 NO HEATING t.� 13rd 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. G s 0 z O CD O m 0 CO m W m c CL 0 N G O N CD c ?�o m =_ �.N O Q N So S m .� CO) O �'.m O m Cl) C! -1 C2 CL N O ,,.r Ca =r= Cos .-► � O'► m N T �a^+a T CD -, =r w m O O N O O � m O O N " o .� z :s. Q ' O N, C2 .� O O : +� C m m N w G CD N N N O. = r` Q O C 3 IE CD. H N Q :+ O m to co, nCD O W V ..r O ..� m OCA ICn CD O m CD �mP � N - o � �� rn � 0 03 C2 c o moo: O �• O CD z - z v C � n. O T cop) ' n O CD z Ce °= oGa r °= aCa CD O 'O n. o r CL y C d n 0 v CD ro C* x crd � CD O CD c'7 O En CD O < av CD co Z o�_ z cD cn CAv o 0 z tCD oCD o z D C CD b. M , G s 0 z O CD O m 0 CO m W m c CL 0 N G O N CD c ?�o m =_ �.N O Q N So S m .� CO) O �'.m O m Cl) C! -1 C2 CL N O ,,.r Ca =r= Cos .-► � O'► m N T �a^+a T CD -, =r w m O O N O O � m O O N " o .� z :s. 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Z O CN '0 m � t > m m =,A 3NIl ONOIV OIOd G7 N °.� 'n o G TI ►-+ C m -� Z Y; a yrr (r�Q1n D y m r c y 0 Z, �_.. m T� py: ° m 3C's r mcr, D Ip t �.� m^ C7 C m,5 o -+n n O n W D z >A i A W CJ < m � � J m .CO / IV OIOd z z z CI so t cf f Cc F ■m � O C O T c a -= k ajm° ooZ�-0 r< 0ZC� n ZDn D OMOO =� z z D Z v !MD2D M Z c co r I DENNIS GRAPPI CONSTRUCTION . Building and Remodeling Specialist Georgetown, Massachusetts 01833 ` (508) 352-6479 ''K g . Uwa3sr Phone 96 y6 Date Mr. and Mrs. Andy James : :.5•� i CONTRACT}r ' Job Name 80 Old Farm Road City State Zip Code Job Location North Andover MA 0135 iS/� Old F,,6,viZcu Submitted by Date of Plans Job Phone We hereby submit sygctl tigrt 0 d_e img'P S�,for G }.� ` t '� 3..,�' i!?r; slt,ing �� rF�rnc.�incl rct�er. mascnl �e a?.or;c founuat icn and r eplacir,a wit!' a ;deet- o1' cedar c.'_a— oa-- t - Also cutting and. r.(-:!n.ailinn Ant- i -)owed. ;rets around window: and r_pla.cinq with 4 filler, soft -nasonite .:->ction an -proximately three pieces 81 lona in back -Dove .or{ b, ar ' caul, all ar ,as o. 2. Insta'.'_ 3/3 foil wran ba' m`rbo :rd on entire hc)us�-,. c_e �. Ins 1. new QOUJ1e S" Wo verinc Be.nc"-mc)r",- "inyl SIC!ir^. 011 Page No. / ,71ti1 ccmplete, coverac-e to ^latch ex-t1nC. stvie of hou�z?. (Complete coverage includes rakcs, soffit, facia, gutters, downspouts, windowcasincs and _,ills. of i!01.. 'Proposal Submitted to Phone 96 y6 Date Mr. and Mrs. Andy James 508) 794 18-30-94 Street Job Name 80 Old Farm Road City State Zip Code Job Location North Andover MA 0135 iS/� Old F,,6,viZcu Submitted by Date of Plans Job Phone We hereby submit sygctl tigrt 0 d_e img'P S�,for G }.� ` t '� 3..,�' i!?r; slt,ing �� rF�rnc.�incl rct�er. mascnl �e a?.or;c founuat icn and r eplacir,a wit!' a ;deet- o1' cedar c.'_a— oa-- t - Also cutting and. r.(-:!n.ailinn Ant- i -)owed. ;rets around window: and r_pla.cinq with 4 filler, soft -nasonite .:->ction an -proximately three pieces 81 lona in back -Dove .or{ b, ar ' caul, all ar ,as susceptible to cvat:.er penetraticn. 2. Insta'.'_ 3/3 foil wran ba' m`rbo :rd on entire hc)us�-,. c_e �. Ins 1. new QOUJ1e S" Wo verinc Be.nc"-mc)r",- "inyl SIC!ir^. 011 ,71ti1 ccmplete, coverac-e to ^latch ex-t1nC. stvie of hou�z?. (Complete coverage includes rakcs, soffit, facia, gutters, downspouts, windowcasincs and _,ills. 4. ?nstall 17 pais: of vinvl. -,ht-`ters „r? front and tw =.ides of i!01.. S. i<e:move :-mv constructi)n/ ;ic.bris -rare nr.e-rises• 1 N 1 f Cid J . `I 1 f..� ,:' /r� yr�� i ' , V, •, �.1 i i P._ Cr ( Vr 13roplik hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: Le n '1'}"rousan� lY Hllit(.rr-{t • Payment to be made as follows: { ,, 533 .33 day job iu -,egun. $3,53 3.3-. when job s 1,alf. d^_rye, ari,! ) az c—c oay Son is ; o. -r; enc_ . A.n-,y, I crrarred `::00 *or extY pre-) work and for e,:tra cost of c:,lira For coverage. ) All material Is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner Authorized according to specifications submitted, per standard practices Any alteration or deviation from above Signature specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond Note: This proposal may be c �� our control Owner to carry life, tornado and other necessary insurance Our workers are fully covered withdrawn by us if not accepted within days. by Workmen's Compensation Insurance. 01rreptanre of Propogal - The above prices, specifications and conditions are satisfactory and are hereby accepted You are authorized to do Signature L� the work as specifed. Payment will be made asoutlined above. M ��C. ! '1,'�E°..-•-•+ w _ (J - 3 O" / y _ Signature �,t..� <:X..► 'k� •'t n.tP A—Pllfafl— S-30-9y F