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Miscellaneous - 81 MEADOW LANE 4/30/2018
_A N �� �� ri...f R1 4/27/2016 2008% This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20087 OF pORT11 qN y�= OCL h �4SSACHUS��� TOWN OF NORTH ANDOVER This certifies that Matthew T Markham PERMIT FOR WIRING Date: April 26, 2016 ❑ ❑ ❑ o has permission to perform Install solar electric photo -voltaic syste 40 panels rated 10.2 kW CCD STC- Grid Tied. On roof of existing home. wiring in the buildings of TREACY, JAMES M. JR at 81 MEADOW LANE, North Andover, Mass. Lic. 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L <: . . ............. . s. :ct: 0 0 0 W: a p W: J, a O 0 0 rp)N : .......... o 0,0 0: :0 0:0 0: '0 re) orp) 0:NOTA 0 w �o < <: �o in: o 00 00 r r q > > i Eci > >: •0 Z o o: ?< 3 ro) > n 0 > 0 T ;.T: 0 0 .0 :Z: '0' :3 C- Z z 0 0 3 3 0 0, tn: 10 . :c 10 10 0 0 E :: Ev 0 0 0 rp) C., re): 0 O :0 W:P, 0: :< <: . . ............. . s. :ct: 0 0 0 a O 0 0 :m. 0: .......... o 0,0 :0 0:0 re) orp) 0:NOTA 0 w O o 00 00 > of C, C! Date ......!.1. ...... �.�........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 44�e-cm4ami, Thiscertifiescertifies that ................................. ........................................... , ........ 0 4 has permission for gas installation A ........ ....... ................... I ....... in the buildings of .... . ............................................................... ....... ........... .......... at ............ M -P c,-&,) ,J .......... North Andover, Mass. Fee.((,) ..... 7 ...... . Lic. No. H?.kr ....................................................... 9640 GASINSPECTOR Check # 9266 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I North Andover MA DATE4/1512014 ERMIT L JOBSITE ADDRESS 81 Meadow Lane OWNER'S NAME _ G OWNER ADDRESS Same I TE IFAX, — TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL[] PRINT CLEARLY NEW: ® RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES® N0[3 APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Replace 1 Gas Mete x and Pi in as Needed INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [:] NO 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application a 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 co pliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Joseph Marino LICENSE # 8736 SIGNATURE MP Q MGF ® JP ® JGF ® LPGI ® CORPORATIONE]# 3285C PAR SHIP # LLC ®# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St -•--.._......__......-•-•-- CITY I Auburn STATE MA ZIPJ 01501 TEL (508) 832-3295 FAXI 508-926-4347 CELL 508-8324614 ]EMAIL JMarino@RHWhite.com �A LW L O z z 0 H U W A, CA d z w C ❑ a z z O y❑w r w O w O z F a :u LU z w j N a w x w a a U w N a c7 o a Q a a c U F a a a � � w x w LL F O z o H � U W � �- N x 0 a L -, 0 sLL rd .a:, U) <Z (JR -;3 LL o ..w CR > 0. zd -mo U) MU) UJ< w LD REU -'ipf 0 U'-,/ U.!/ LUlY Lt. UY JUUUJLU ( Jl I\I I WI Il I L VUI I-) I 1\U1' I I "UL UL/ UL 1--044 AC ® BTE "1DD/yyrY01Y) A --, CERTIFICATE OF LIABILITY INSURANCE Page 1 of z aa129/23 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED, the policy(ies)mu5t be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does notconferrights to the certificate holder in lieu of such endorsement(s), willi4 09 Maesachusette, Inc. c/o 26 cQntury Blvd. P. 0. Box 305191 Nftghville, TN 37230-5191 R. H. White Consematiou Company, Inc. 41 Central Street P. 0. Box 257 Auburn, MA 01501 ,NOaF`-Cr1_ a_If -y-AO.--/3"/6 I in/r. nlrn. 8RR-497-9.R7A I uv3UnGn1C1 HrrU1rUINLi4VVERAGE NA100 INSURERA:The Chartor Oak Tire Ineurancg Company 25615-001 INSURERS:TrRval*rs Property Casualty Cogpany or Am 25674-003 INSURERC:Nationdl Union Piro) Insuranca Company of 19445-001 INSURER 0; Travelers Indmnu',zty Company 25658-DO1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I$SUSD TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IT17 NSR TYPEQFIN3VRANCE DO' SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS jL GENERAL LIABILITY VTC2OCO 977RD948-13 9/7./.2013 '9/1/2014 JEACHOCCURRENCE F 2.200.00( IMF.RCIAL GENERAL LIABI I.ITY CLAIMS^MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER; DED I X (RETENTIONS =0,00( D I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY D ANY PROPRIETORIPARTNERIFXECUTIVE Y NIA OFFICERIMEMBER EXCLUDED? below OF Evidonce of Inmurance 977K955A-13 19/1/2013 19/l/2014 BE8766140 19/1/2013 19/3./2014 VTRXUB 8205AI05-13 19/1/207.3 19/1/2014 9/1/207.4 VTC2xUB 92o3.A71A-13 9/7,/2013 Acord more epees one 2,000,00a BODILY INJURY(Perpemon) I$ I BODILY INJURY(Peraccldont) $ 4� AGGREGATE E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE -EAEMPI_pYEE S 1,000,000 E.L. DISEASE•POUCYLIMIT $ 1,000,000 SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCQ.I.ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE c:OA1:4197694 Wp1:1694012 Cert:20287680 ©1988-2010ACORD CORPORATION. Ali rights ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AUTOMOBILE LIABILITY x ANY AUTO AUTO$ NED AUTOSULED X HIREDAUTOS X NON -OWNED AUTOS X Co Ped X Coll Ded CUMBRELLA LIAR OCCUR X EXCESS LIAa CLAIMS -MADE N DED I X (RETENTIONS =0,00( D I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY D ANY PROPRIETORIPARTNERIFXECUTIVE Y NIA OFFICERIMEMBER EXCLUDED? below OF Evidonce of Inmurance 977K955A-13 19/1/2013 19/l/2014 BE8766140 19/1/2013 19/3./2014 VTRXUB 8205AI05-13 19/1/207.3 19/1/2014 9/1/207.4 VTC2xUB 92o3.A71A-13 9/7,/2013 Acord more epees one 2,000,00a BODILY INJURY(Perpemon) I$ I BODILY INJURY(Peraccldont) $ 4� AGGREGATE E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE -EAEMPI_pYEE S 1,000,000 E.L. DISEASE•POUCYLIMIT $ 1,000,000 SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCQ.I.ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE c:OA1:4197694 Wp1:1694012 Cert:20287680 ©1988-2010ACORD CORPORATION. Ali rights ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Location Date {►ORTM TOWN OF NORTH ANDOVER 3? • 0 c ; : Certificate of Occupancy $ ,SSACNUS�S'�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ J TOTAL $=� Check # 15 653�'""Bliu ding Inspgeto TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING :w'� BUILDING PERMIT NUMBER: c DATE ISSUED: SIGNATURE: Building Commissioner/InEeEtor of Buildings Date I SECTION 1- SITE INFORMATION 1.1 Property Address: �k McAAaw VVoo� -Z�nve- 1.2 Assessors Map and Parcel ain 103S.0 Map Numb& Number: 0-0/013 Parcel Number Neo . �� S V't 61��5 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS(ft Front Yard Side Yard Rear Yard Required Provide ReIqUired Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Public 0 Private ❑ Zone Flood Zone Iufomution: Outside Flood Zone ❑ 1.8 Municipal S e Disposal System: On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSI[IP/AUTHORIZED AGENT 2.1 Owner of Record ev�v� QV Name(Print) Address for Service (vo,"j. Signa a Telephone 2.2 Owner of Record: Dame Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 90.Q \ 7z:) e_S)()�,z Licensed Construction Supervisor: License Number Address �y 9��Q Expiration Date Signa re letephone 3.2 Registered Home Improvement Contractor La 0, � Not Applicable ❑ S),4-04/ �riilJa Company Name Registration Number Address --� ��e� o �, •��, o ti Expiration Date Si na Tele hone C� SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance atttdavlt 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 ....... 0 SECTION 5 Description of Proposed Work check au applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition ❑ Other V Specify Brief Description of Proposed Work: r SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beUSE b1 . Completed VIM by permit applicant .. .. .xL � xF.^ nkY 3nc xek S Z* 9 Y .sfk� -.�l 1. Building (a) Building Permit Fee 1%000% Multi lier 2 Electrical (b) Estimated Total Cost of Construction��� 3 Plumbing Building Permit fee (e) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number — - SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize C°L. to act on My b lt; all wattiters or . ' e to work u orized by this building permit application. Signature Owner Date SECTION"7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,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 Print Name Signature of Owner/Agent Date MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT-Q!/t"IFjfe,�), LOCATION: Assessor's Map Number �00 SUBDIVISI STREET 5 2VQJO V W Prr PHONE2 d 0 PARCEL —010 —0000,0 LOT (S) ST. NUMBER 6*****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS QPTOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED Ix DATE REJECTED I UWN PLANNER COMMENTS FOOD rtt; I U14-11LAL 1 H r I It; INSrtc I UH -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTM RECEIVED BY BUILDING INSPECTOR Revised 9\97 jm TE Q 00 VCJ O L G .ry O N O DC GO O �-- _'� V M OO W n } P n W O 4 N'f N QC 4 L&jW �• v L. J • .-� G.) .. .�1 Q 00 VCJ L G 'a � Y ✓!ee U� omvnurn.�uea�i a�. iivaeild ,� , ' . BOARD OF BUILDING REGULATIONS .I License: CONSTRUCTION SUPERVISOR) Fer. t. 9 :I Number: CS 027154 Birthdate: 01/08/1,942 Expires: 01/08/2002 Tr. no: 20427 Restricted To: 00 PAUL W DEBOW _ 682 LAWRENCE ST LOWELL, MA 01852 Administrator' f (^ 00 - 35,000 cf enclosed space~ (MGL C.112 S.BOL) rt ' 1A - Masonry only f 1 G -1 & 2 Family Homes + ' It { Failure to possess a current edition of the 'Massachusetts State Building Code is cause for revocation of this license. 1� DIG SAFE CALL CENTER: (888) 344-7233 ""�".DATE ACORDp CERTIFICATE OF LIABILITY INSURANC��oM_1 (MMIDD/YY) 08/21/01 PRODUCER R. C. Lafond Insurance Agency 396 Andover Street North Andover MA 01845 Phone:978-686-3826 Fax:978-682-0713 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED E. B. Homes, Inc. Brian Emmons 12 Henderson Avenue Andover MA 01810 INSURERA: Western World Ins. Co., Inc. INSURER B: ASSOCIATED INDUSTRIES OF MA INSURER C: INSURER O: INSURER E: I.VYGKAVC0 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR A TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX] OCCUR POLICY NUMBER NPP 728288 POLI Y EFFECTIVE DATE MM/DD/YY 09/29/00 POLI Y EXPIRATION DATE MM/DD/YY 09/29/01 LIMITS EACH OCCURRENCE $1000000 FIRE DAMAGE (Any one fire) $100000 MED EXP (Any one person) 5 5 0 0 0 PERSONAL & ADV INJURY $1000000 GENERAL AGGREGATE 5 2 0 0 0 0 0 0 - COMP/OP AGG $1000000 GEN L AGGREGATE LIMIT APPLIES PER:PRODUCTS X I POLICY JEC LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE S s S DEDUCTIBLE s RETENTION $ B WQRKERS COMPENSATION AND EMPLOYERS' LIABILITY AWC 7006139012001 08/15/01 08/15/02 X TORY LIMITSI ER E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYE $500000 E.L. DISEASE - POLICY LIMIT $100000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CEKTII-IGAItMVL:JCK I r I AND111VPIALIRJVnousuw.-�•----•---- RUS SE -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL E DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. 25-S TION 1988 M M�� 30'6 10' 11 9'4 10'3 46 65 13'10 16'8 LIVI N o,6AREA 821 sq ft 00 ih r M N E.-B. Homes, Inc. AN AFFILIATED OFFICE OF EXIT GRUUP�GNF REAL ESTATE AND BROKER- ONE MORTGAGE COMPAN, 'Yo .sa` ON rydo- Additions • Roofing • Remodeling - Bate "Ns Windows & Doors structural Restoration Q 28 Andover Street, Andover MA 01810 0 Qp flify il's on the house! Name / Address Kevin Bligh 81 Meadow Wood Drive North Andover, MA 01845 Est Start Date I Est. Completion Date I Terms w/o 9/25/01 1 10/25/01 1 See below Estimate Date Estimate # 9/23/2001 42 Description of Work Total Replace the existing deck boards, stairs and hand railings with TREX or Fiberon or equivalent decking 1,650.00 material and paint the trim. Wash, sand (as necessary) and paint exterior trim on the garage and front porch. Supply the necessary material and construct a finished basement in the house as per the attached drawing. 15,000.00 Frame and insulate to code and cover new walls with blue board and a 1/8" skim coat of plaster. Install new electrical outlets to code . Install three telephone jacks, additional electrical outlets and Cable TV outlets and recessed lighting as per plan. Install a 2' by T dropped panel suspended ceiling. Supply and install a carpet of homeowners choosing with up to a $25.00 per square yard allowance. Allowance includes a pad, carpet and installation. Supply and install two 6 panel masonite hollow core doors as per plan. Supply and install 7 1/4" speed base paint grade molding to the new area. Prime and paint all new surfaces using one coat of primer and one finish coat using Benjamin Moore product. PAYMENT TERMS: 1/3rd upon commencing the project. 1/3 upon completion of rough framing, rough electrical completion of installation of blue board. Balance upon completion Total I $16,650.00 E.B. HOMES, INC. Signature mFa�z� Any alteration or deviation from above specifications involving extra costs will be executed only upon written order and will become an extra charge over and above the estimate. All agreements contigent upon strikes, accident or delays beyond our control. APPROVAL OF WORK ORDER The above prices, specifications and conditions are satisfactory are hereby APPROVED. You are authoriz to do the work specified. Payments will be made as outline abo e. Signat North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance w�01 h the provision of MGL c 40 S 54, a condition of Building Permit Number isthat the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: ornpkvw, Owv\ei LwLA:�CuL,K - C "kov°tie�Ao J-�s L 43aaew06 (Location of Facility) �,kG'm 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 x 0 p G \ a ° v z z o o m 0 O G a 0 u w a�a U W W o c40 chi w" x 0 U U) ? cG if. z w w p m v) o cn M LAM co LLJ z Q: c o •'t m r- 0 0 0 c H o c I «. O fl a� oev ea 3�ca E=:*V9► o -CE - �C) o CL E C : o m :+c Co., o :, ..?;.. ; CD CD E CCD L cc* 0 o m3� Mo N a' cm _mo �a 'r � � y C c ta • � N �+ m ocm c.c., CD m 9 o cm c_ • ' '0 C C O Q � N `N C m cI •L Z o ea o w cm i o to C' m N m c �c = O CM0 G N �' r M d5 c Z ac E E� W N Qo w CL m 0:5 Q 2 �oy•c O arm a N y co .y CDL CL GD 0 CD Q m CO) 0 .v CO) C O V 0 Cn Cc W CcW IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25S (7/971 Ldication jai No. Date MORTh TOWN OF NORTH ANDOVER 0 •. • 09 " Certificate of Occupancy $ 9 cMBuilding/Frame /Frame Permit Fee $ s�usE Foundation Permit Fee $ � 4 Other Permit Fee $ &9 TOTAL $ Check # %/0 ' t' 15024 r,' —,—Building Inspector f. r i TOWN OF NORTH ANDOVER DUIL.DING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING � � V' C `X??�.... �h �4Y4�.. :- ..x.„, n, .... .°k' re... `. ., .,. .,:. � Z:��'?�1.,`M�++T�..., .. .. ate: d�, Y "1 �`:n�,&,L`.% ,++'� y� �•A,xg,^,� ��X � �C BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building CommissionerAnspector of Buildings to SECTION 1- SITE INFORMATION . 1.1 Property Address: 1.2 Assessors Map and Parcel Number: S f �M"/v "V/ y� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 water" Supply M.G.L.C.40. 34) 1.5. Flood Zone information: 1.8 Sewerage Disposal System: Public ❑ Private❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ' l eri 7- /rAcy F l�iii%7r%ly 11 %tGK /fir �l/✓I%/_% Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: NanLe Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ^ V L T— " l� Z4 /4� Licensed Construction Supervisor: 0 Oc? g ;t -b? License Number 25 3 / Al yw ?K1191 � k4 ---f 1� / 0 C -Gam/ �� A dress oy��-oma Expiration Date ignature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ /Name ir 2 y� 7 Company/ // 4 1,r/(2 l L ' .T WJ[ — Registration Number Add ess 2 / p 4 �� QPg Expiration onDat2 Signature Telephone SECTION 4 - WORKERS COMPENSATION (NLG.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 ....... fr No ....... 0 - SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ 1 iDemolition ti ❑ Other ❑ Specify Ifff Brief Description of Proposed Work �4 � c� � �ii,�-�i�� /,�,�-J1�r.� � i=/�L l r�°��✓X./r A/yD 3 J-44? A-SAi 7- 51.11 eLlIC I SFCTTON 6 - FSTTMATFD CONSTRUCTION COgTC I Itern Estimated Cost (Dollar) to be Completed by permit applicant �3 .• ir% kwx5`..,x •.er�r�..rv. ,i.,c^i � USEONI✓1' i '1£y4 : F « v'N.b.�...r :: Y yrs 1. Building G add — (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) x (b) d 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 0,16 --- Check Number SEC 11UN 7a UWiNEK AU,iHoR1GA"TION TO BE COMPLETED WHEN OWNERS AGENT OR.CONTRACTOR APPLIES FOR BUILDING PERMIT 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 Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, V A L J L IlrA1-?_41 &1Z_.i dr,, 0k;/A4yas Owne Authorized Age '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 VA -L ,i Z A k1 -2_A Print N of 9-i'? --a-1 Date NO. OF STORIES / SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 RD SPAN DU\, ENSIONS OF SILLS DINIENSIONS OF POSTS MIENSIONS 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 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: 00 t 4W 2 A_ %its 1,v ZAW I5 City Py, &IYalii'Z/2 Phone %- 3 1-5"7 0 am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity E -TTI -a -m an employer providing workers' compensation for my employees working on this job. Company name: 'Y /.,W &AtYCa�,Q (f ,fi S 7—,J>-7, aff,,('1 "J Address ll . 6 L614/s�lz S % Company name: Address City: Phone #: Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) 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. I do herby certify and r the pains and penalties of perjury that the information provided above is true and correct. l� i f e 'In S 0l'AW01 Print name V /fir+' ✓ � T&,&/ .-%� Phone # r d'9 d% Official use only do not write in this area to be completed by city or town official' n Building Dept ❑Check if immediate response is required Building Dept p Licensing Board E] Selectman's Office Contact person: Phone #: Health Department Other FORM WORKMAN'S COMPENSATION 2 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: T41/" nivel Y# lest �ev,K � y l'� �/Z J � �✓ �iY1GLL nos r� fr,-� , (Location of Facility) SigrOure o P it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector � �` ✓fie -�o�r�>u�,cz� o�✓`�a�Ja:c��e�d ;o )Y d. o-1 One Fa:JflDu t,of:I f' I :-iC:ta ;;'II I :3( 01 I1(mle 1.1-1.1p v c:!Vt:,lllc'.IIL. III:I I i I;•: ::!l :l.i �1..•. I::_1...1 gal, l ..''ll- I O .;a 1.. L_ I I .i C. 11 O: , . " r. . I Y('i: � F'1' .I �i l I i::>l l a,,i .�I I i <71'I '��_` �:•;. r.„,.,,.,,., .,/i/, ,i'. //,..,,,i.. (VIEW ENGI...i11',11D C;UST )1°1 1)1 .c7 (:I\I ., ai\1i•:.. V a 1. L_ cl n Z;.1 W:fL.-MINGTON IVIA 111,1111 1 11PPVI III NICON (RAC IOR —i fli h'egl:(r,tliol' 102461 1' int . f�plraliofl: 01/02/2002 Iype: private Corporalio MW 111618N0 Cusloh 01516N, Val lata 67 226 lOOfll SI. ADMINISTRATOR k' I I h IIiG 10N I MA 011131 71. BOARDriomv�narzurea a� ae�zuaelia BOARD OF BUILDING REGULATIONS is License: ;;CONSTRUCTION SUPERVISOR Number; CS 008828 Birthdate:, 04/20'/A 951 Expires:,04/20/2002 Tr. no: 1.9514 Restricted To: 00' VAL J LANZA 34 BIXBY STS �i J REVERE, MA 02151 Administrator an I W W �¢ o a� u p "i a cn U o co w w°' v U is w w w�' is u. a o a w W a�' cn m w a � czC w z a w 0 z " V) v Q i C/) H :co m� o o � C - C O v C.3 •CZ � C• C O Cc r o o Ea C= V ~ h W V m o W C.) C/2 H :co m� o o � C - C O v C.3 •CZ � C• C O Cc r o o Ea a� O CD ■ L O o � Z °D CL. O y C C ICD Ccm O•— CCD p� CO) C ■9 m m CD G3 CL co �3 O p O O a CL cmQ O coma CO2 C ZCL � V y R C C C C. CO2 is 0 CO U) w w Irw vJ C= m o o c Z E� `o m 0 o O L2 Cf .=-0. m C f:.. o m3 � (n h m y 'C C • m O ' 42C • h O C � r�1 W E m mo c aCa I.:m O Hcm CL v .y O co � C�•�Z O: s+ C O d C •� m y m C ® . N Cr a.. c W - O . • C Z E 5 L cwm ® c .- Q C. O ®'a y'= cc 0 b- a� O CD ■ L O o � Z °D CL. O y C C ICD Ccm O•— CCD p� CO) C ■9 m m CD G3 CL co �3 O p O O a CL cmQ O coma CO2 C ZCL � V y R C C C C. CO2 is 0 CO U) w w Irw vJ N2 454.8 Date. . rJS o r� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �/ This certifies that ... �'�`- ............ has permission to perform ... �-.... . ...................... . plumbing in the buildings of�/�c.....-'. . ................ . at ... ... North Andover, Mass. L �-PLUMS44G Fee %... Lic. No � 3..............CTOR Check # ��✓ �Z WHITE: Applicant CANARY: Building Dept. PINK: Treasurer M\ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) /0' 152& tl'&Y"' Mass. Date 1 Permit # it ,;,_b Building LocationOwner's Namg4 //Jr Type of Occupancy t I DE."j f A(— MASSACHUSETTS (— New ❑ Renovation ❑ Replacement ud" Plans S itted: Yes ❑ No ❑ FIXTURES Installing Company Name 2o,,)Ee7 jg - '� cj,,4(rmA TAe-n Check one: Certificate Address _ �� o C0 4C 4 mAn) PJ ❑ Corporation " M E T w o F_ n 1-, fi l A 0 l b/L/ ❑ Partnership Business Telephone-/7�Z-i971 2-Arm/Co. Name of Licensed Plumber •�f)r% F? -T- fry �A�y►rylr4 rr.4er"% INSURANCE COVERAGE: I have ayes current flability insura 13ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checkedrtes, please indicate the type coverage by checking the appropriate box A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: 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 narformed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and apter 11 of the eral laws. Title re of Uoensed Plum r Type of License: Master �/ Journeymah ❑ Oty/Town APPROVED OFFIC US ONL License Number 133 5 V • NONNI ■ Installing Company Name 2o,,)Ee7 jg - '� cj,,4(rmA TAe-n Check one: Certificate Address _ �� o C0 4C 4 mAn) PJ ❑ Corporation " M E T w o F_ n 1-, fi l A 0 l b/L/ ❑ Partnership Business Telephone-/7�Z-i971 2-Arm/Co. Name of Licensed Plumber •�f)r% F? -T- fry �A�y►rylr4 rr.4er"% INSURANCE COVERAGE: I have ayes current flability insura 13ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checkedrtes, please indicate the type coverage by checking the appropriate box A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: 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 narformed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and apter 11 of the eral laws. Title re of Uoensed Plum r Type of License: Master �/ Journeymah ❑ Oty/Town APPROVED OFFIC US ONL License Number 133 5 z Q 2 N v m A -4 O m r O A s O z 0 c 0 z Q :1 6 Date... NORT"TOWN OF NORTH ANDOVER 4. TOWN p PERMIT FOR GAS INSTALLATION This certifies that-: ............................ has permission for gas installation ................... in the buildings of ..-�-'!�^-�/� ............................. at ..�. w- .�l` ` '�-:..:.. . , North ,Andover, Mass. Fee? ...... Lic. Noir' GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date' [d -DD __ Permitil 1t5 Building Location d'/ /%ii-�dn� Z,�N� Owner's Name Type of Occupancy ' Neuf ❑ _. .. ' }..� dnL}T .1 , I.,k Renovatiori' J '� Replacement -C ; ; Plans Submitted Yes ❑ No (B— C0 Ic U) x w 0 U) 0) V Z ¢ j W ¢ U)¢ O _ ¢ C7 J (n w 0 U m 2 U)Z CL ►- >- Z 2 ¢ LLg m rn F- w ¢ O p z F- W Cz rn 0 U w= Z FO 2 p¢> w W Z Z W ir F- im' ILLt- Q U w a D 2 Q� 'Q m 2 0 2 W 0(n_ X X O O i w D 3 o 0 5 UO ¢> E O fw- O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR ''! .............. EE Installing Company Kj.__ /11 ---••�-••, ..o,.,o . _a -.� i t-v`C�/U�IT_f/T f'LU/%7,a� -- -- Check one: Certificate AGrs Z r ©� _... I J Corporation /yS d� � c/ -7__ ___ - I I Partnership Business Telephone — ,S — Qtol© (D Name of Licensed Plumber or Gas FilterJLr INSURANCE COVERAGE: - I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes 21 No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy Lam' Other type of indemnity f_7 Bond 1-1 OWNERS INSURANCE WAIVER: I am aware that the licensed'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: Slanature of n r or ner's A ent --- -- Owner CI 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 pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By T e of License Title umber �-- U Gaslltter Signature of Eluentnssesed Plumber or Zees Fitter CIW�yTown &'Master APPROV DFF I-� Journeyman Zff ) License 4*. Date ...,! .` J "rte. ...... TOWN OF NORTH ANDOVER p -.z PERMIT FOR GAS INSTALLATION N This certifies that ...�.%. .. .. �...�� ........... has permission for gas installation .... ................ . in the buildings of.......................... . at 4. .... ... kAlN�SPECTOR North Andover, Mass. Fee. � Q..... Lic. No.. �.}/. �.�.. 4 c? -,!z ..... Check # ? / ) 5 MASSACHUSETTS UNIFORM APPLICATION FOWPERW TO 00 GASFnMNG (Print a Type) ///�/Y�i/Pr . Mass. Date Gd 2qa_ Permit �t Bwdit1ocatioo- ZAJ Owner's Nance LZOVOS _Typed 0=". New p Renovation ❑ Rpm Submitted: Yesp No p Business Name at Licensed Plumber or Gas FlNter ❑ Cofporation. .. ❑ Partr>ership . A FImVCo. INSURANCE COVERAGE.* I have aYc4rm liability irw o ce•poI4 or Its sal egnivalent�which ireets the requicemerf. dMGL- Cts: -142.- es If you have-checWgM" m*Wiosbe*w ype=vemge-by dwd ft the appeopdae boot. A liability insumnoe:polky X Othec:.type W indemnity Q Bond ❑ OWNER'S INSURANCE WAIVER: I am-awwo Vot the llcensee4oesMUM - the kwaunce -coverage requivd by Chapter 142 of the.Mass. General Laws. and ahs! my signature on Vft permit -application waives aha requirement. Check one: Owner❑ Agent.❑ Signature of Ownrrot.:OwrNrs Apant.. I hereby co* that an of the detafs and information l have subn ttW for enter d) in above application are true and accurate to.the best of my knowledge and that all plumbing waft and Maliatim performed under the pwW aswd this will be in with d Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the B T of licensor: T Plumber SignatLn of WohMd- Plunter or Gas Fdw Title gjot= rt eyman Limne Number 31 OCD. City/Town A EE= NOW Name at Licensed Plumber or Gas FlNter ❑ Cofporation. .. ❑ Partr>ership . A FImVCo. INSURANCE COVERAGE.* I have aYc4rm liability irw o ce•poI4 or Its sal egnivalent�which ireets the requicemerf. dMGL- Cts: -142.- es If you have-checWgM" m*Wiosbe*w ype=vemge-by dwd ft the appeopdae boot. A liability insumnoe:polky X Othec:.type W indemnity Q Bond ❑ OWNER'S INSURANCE WAIVER: I am-awwo Vot the llcensee4oesMUM - the kwaunce -coverage requivd by Chapter 142 of the.Mass. General Laws. and ahs! my signature on Vft permit -application waives aha requirement. Check one: Owner❑ Agent.❑ Signature of Ownrrot.:OwrNrs Apant.. I hereby co* that an of the detafs and information l have subn ttW for enter d) in above application are true and accurate to.the best of my knowledge and that all plumbing waft and Maliatim performed under the pwW aswd this will be in with d Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the B T of licensor: T Plumber SignatLn of WohMd- Plunter or Gas Fdw Title gjot= rt eyman Limne Number 31 OCD. City/Town A a W S V F w Y a Z w F a � w J O Z O O 0 W O y. _N Q O O Z d ' C C O O Z O O W O � V J 6 d W W a W S V F w Y a