HomeMy WebLinkAboutMiscellaneous - 83 ELM STREET 4/30/20182012 Mqssachusetts 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 oforigoing construction activity, and may be.deemed by the Jnspector-of-W-ires abandoned-and.invalid-ifte—
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.
El The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 20 10 and extended by Sections 74 and 75 of Chapter 23 8 of
tl�e Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use oi 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'4 during the qualifying period beginning on August 15, 2008 and extending'through August 15, 2012.
'Rule 8 — PermitMate Closed:. ***Note: Reapply for new perm!!�-
Permit Extension Act — Permit[Date Closed:
0240
Date .... 2?
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........... :] .......... e ........ ...........................
...... ..... ..... ....................
has permission to perform ... U.L4�e . .............................
wiring in the building of ............ .....................
at ....... (5-3 ... ... . ..... ........ North Udover, Mass.
Fee..�5 .. 1 ............ Lic. No—: . ........... ...... .. ........
�ri � �j
P�LE; RICAL INSPEj R
Check#
Conzwnweahli of Official Use Only
QPEOUM0c7 Permit No. 1Q
Aparfi wd o�}ire Seruieej
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code ( ), 52 "CMR 12.00
(PLEASE PRINT ININK O T 'PE L INFORMATION) Date: ( t<
City or Town of• d , J r' To the Inspector of Wires:
By this application the unders' a PEAL
of his or her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant Yi«/'( ih 11 f Ya Telephone No.
Owner's Address SAM �e
Is this permit in conjunction with a b ildin ermit9 Yes ❑ No a (Check Appropriate Box
Purpose of Building S (� t� t I Utili uthorization No. �� q 9 2—
Existing Service W Amps 2-U/ '1 (,Volts Overhead Undgrd ❑ No. of Meters
New Service Z00 Amps i W / 2 VVolts Overhead Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: V!Q 51? Se(wtc-e -zoJ
Comnletinn nfthe fnl/rnvinc inhlp min) ho Auniuotl by flip himprfnr of ti i—
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
o. of Tota
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
rnd. grud.
o. ol Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No, of Switches
No. of Gas Burners
o. o etection an
InitiatingDevices
No. of Ranges
No. of Air Coud. Tota Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
umber
ons
K
o. oSelf-Contained
Devices
_Detection/Alertin
No. of Dishwashers
Space/Area Beating ICW
Local ❑ un'c'pa ❑ Other
Cyonnection
No. of Dryers
Beating Appliances I(W
SecNo of Devices or Equivalent
No. of Water KW
Heaters _
o. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
TelecommunicationsofDeicer Wiring
No. of Devices or Equivalent
OTHER:
Estimated Value of Electrical Work:
Attach additional detail if desired, or as required by the Inspector of n1tres
(When required by municipal policy.)
Work to Start: inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
-the licensee provides proof of liability ins ce including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cover is in force, and has exhibited proof of s e to the ermit issuing o ce.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)C?l
C�
I certify, under the pa�ais and penalties of perjury, that the information on d is application is true and contple �j
FIRM NAME: j " L r zle( —P 1 C LIC. NO.: 71
Licensee:5 1,0h-- 1'► '�i] � bA Signature r , LIC. NO.:
(fapplicable, enter ' exetn tat the 1'c nse number line n Bus. Tel No.-
1
Address: .� - E o� f L li' 1 • _Alt. Tel. No.: -�
*Pe M G L c 147 s 57-61 security wor a uires Department of Public Safety "S" License: Lic. No.
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 die (check one) ❑ owner_ 0 owner's agent.
Owner/Agent IPERMIT FEE: $
Signature Telephone No.
t
I
7 4 55'
Date. ......
TOWN OF NOR/T'ANDOVER
6 0
ST L
PERMIT FOR4A INSTALLATION
This certifies that. .................
has permission for gas installation . .
in the buildings of ..........................................
at ...... //4-'-"' ................. North Andover, Mass.
Fee. .?.�� .... Lic. No./?.
k.--- ..............
S INSPECTOR
Check#
FIXTURES
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town:�J�v�rt� MA. Date: % % Permit#
y L./
Building Location: ��� ( S Owners Name: � E- �/_ 11L 1Z
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential 9 --
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: 2-' Plans Submitted: Yes ❑ No ❑
FIXTURES
INSURANCE COVERAGE:
I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes' -1 No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy [2- 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box n: I herebv certifv that all of the details and information I have submitted (or entered) reaardina this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Type of License:
By Q'Plumber
Title ❑ Gas Fitter Signature ! ens d Plumber/Gas Fitter
2 -Master
City/Town ❑Journeyman License Number: t
APPROVED OFFICE USE ONLY El LP Installer
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Check One Only Certificate #
Installing Company Name:
[[t5orporation
Address:�l 2
City/Town: /V f' PNLC,,L�
State:
❑ Partnership
Business Tel: GIS �f
Fax:
❑ Firm/Company
Name of Licensed Plumber/Gas Fitter:
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INSURANCE COVERAGE:
I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes' -1 No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy [2- 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box n: I herebv certifv that all of the details and information I have submitted (or entered) reaardina this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Type of License:
By Q'Plumber
Title ❑ Gas Fitter Signature ! ens d Plumber/Gas Fitter
2 -Master
City/Town ❑Journeyman License Number: t
APPROVED OFFICE USE ONLY El LP Installer
8750
Date. 1//) � —/ / C�
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that . ....................
has permission to perform ... ...................
plu mbing in the buildings of . ............
at ............. North Andover, Mass.
Fee .3K L i c. N o. .. ...... ......
C ?0
Um NSPEC OR
Check # 3 �6
FIXTURES
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: l" -1�1V(�OUZ , MA. Date: Permit#
Building Location: 93 i / S-1- Owners Name: z --I / aglz
'SG1
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Q"— Plans Submitted: Yes ❑ No ❑
FIXTURES
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes,B—No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
re of Owner or Owner's Agent
by certify that all of the details and
regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 ey t
By Type of License:
Title B?Iumber
City/Town 2111aster
APPROVED (OFFICE USE ONLY) F71Journeyman
S
for this application will be in compliance with all
gyral Laws.
umber
License Number: ! 5���-
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3RD FLOOR
4T" FLOOR
5T" FLOOR
6' FLOOR
7T" FLOOR
8T" FLOOR
Check One Only Certificate #
Installing Company Name:
/ Corporation
Address.T/ /� '-' City/Town: � 1.(, State:
[I Partnership
,(�
Business Tel: �-�S b 7 —/�� Fax:
❑ Firm/Company
Name of Licensed Plumber:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes,B—No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
re of Owner or Owner's Agent
by certify that all of the details and
regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 ey t
By Type of License:
Title B?Iumber
City/Town 2111aster
APPROVED (OFFICE USE ONLY) F71Journeyman
S
for this application will be in compliance with all
gyral Laws.
umber
License Number: ! 5���-
11
E? -,-, E I M C-,
Location
No 3,cD �3 Date 11-12- 0-�
Ahz
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ L/ 0
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
4 t17
Check #
16 b 7 7 — /�w , Cx--
,-� Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
`aizSE' rc: �F
.'S.,x ,'
BUILDING PERMIT NUMBER: Lr,� DATE ISSUED: / ! _ tz
SIGNATURE: AA /v` < b—'
Building CoKmissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
y `) ax-"�_
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
etoO
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide R red Provided
R red Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public 0 Private ❑ Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
/�qIQ se,h N�l,�ilyG-�R �� L1�'l �� lyo hl7UyCrp,
Nam Print) Address for Service
Q—z� WIWI (D8�-731
Signature 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:
Address -
-473
Signature Telephone
Not Applicable ❑
0,2a 4�96
License Number
d
Expiration Date
3.2 Registered: iAome Improvement Contractor
(9 4 Gvail a &?o
Com N
Not Applicable ❑
l®.�. f'
Registration Number
/
Address/ j / —7
�7 4 loo dG�'tO 7, /
Expiration Date
Signature Telephone
00
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SECTION 4 - WORKERS COMPENSATION (XG.L. C 152 § 2506)
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 ....... 11 No ....... ❑
SECTION 5 Description of Proposed Work check all
applicable)
New Construction ❑
Existing Building ❑
Repair(s)
❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
(3FFICIAI. USE ONLY. n 3
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (e) X (@)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number 67
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH DING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to w&I authorized by ffis building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, As Owner/Authorized Agent of subject
property
Hereby declare that the statements and informatur ion on the foregoing application are true and accurate, to the best of my knowledge
and belief
Pri
Signature of Owner/A ent
140104,
NO. OF STORIES
3
Date
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 s
2 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS j
SIZE OF FOOTING
X
MATERIAL OF CH EY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
I
T,� �:-- L
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Afdavit
SC
Print
eu-/tl c-e,iZ,
City No. A iN 00'
V f— %9 Phone f 7i- i�/� 7
am a homeowner performing all work myself.
DI am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
campany name: GULLS ff
Address ��' J'19-S1i-,�/7— S i
City.: /YO Phone737
5-0
Comwanv name:
Address
city: Phone #
Ins-urance Co.
Failure to secure coverage as required under aecfion 25A or MGL 152 can lead to the imposition of criminal penalbes.of a fine up to $1.500.00
and/or one years' imprisonment as well as dvd penalties in the form of a STOP WORK ORDER and a fine of ($100:00) a day against me. I
understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification.
the pains and penalties of perjury that the i donnation provided above is true and correct
Date
Phone # /�� o�� 77 7
Official use only do not write in this area to be completed by city or town official'
ElGheck if immediate response is regqulred Building Dept
Contact person:
VORKMA.M'S COMPENSATION
❑
Building Dept
El
Licensing Board
E3
Selectman's Dfce
n
Wealth Department
0
Ofher
f
Location
No.
3
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL
Check #
'17873
Inspector
' TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
WELDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE: �—
Building Commissioneffl for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
OJ6
Map Number Parcel Num ber
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
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) 1.3. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System ❑
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
,i:�:c;l,:; listrirt: Y^^ P!n
,,
2.1 Owner of Record r
,�C,b
N*.me (Print) Adgress for Service:
t-
Sigdature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
x
Licensed Construction Supervisor:
_4
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improve ent Contrao +
Not Applicable ❑
Company
Inl )9w
1-k v t
Registration Number
U ,�"
/0--r
Expiration D e
Add ss
�'L L tt� l� l ��� ` '/✓` (A�
Si nature 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 the building permit.
Signed affidavit Attached Yes .......❑ No ....... 0
SECTION 5 Description of Proposed Work check all applicable
New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑
Accessory Bldg. ❑I Demolition ❑ I Other [ISpecify r
Brief Description of Proposed Work:
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building
(a) Building Permit Fee
Multi tier
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
G
Check Number
JLl.11VA /a vw14LK Au 1nuX",A11VP1 1v BL UUMPLEI-ED WHE1N
OWNERS AGENT OR CONT }R .APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, it matters relative to work authorized by this building permit application.
Si ure of 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 trt:e and accurate, to the best of my knowledge
and belief
Print Name
of Owner/Agent Date
I
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TII013ERS 1' 2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING _ X
MATERIAL OF CHIMNEY r ---
1S .BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
Name: ,-
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
Comoarnt name:
Address
City Phone t
and/or one years' impriaorxnent-ee rNall_as_dhiN,RenaRtesln he famo de SIOP VNDW_ORDER.and.a.fkw d.(ia40.OD)� r agai_me. i
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
L
I do hereby cw* under the pains and penaltles of perjury that the information provided above Is true and correct
Print
Iql-ti0
Date
r1?_ FY
Official use only do not write in this area to be completed by city or town Adel*
City or Town Permit/Licensing
Building Dept
[]Check d immediate response is reguked UceiWn9 Board
C] Selectman's Office
Contact person: Phone # C] Health Department
Other
(hard Schehellinger
0 kim st.
No. Andover, MA
November 20, 2004
SEAMLESS GUTTERS
RESIDENTIAL - COMMERCIAL
Strip- complete roof house and porches
supply and install 6ft. ice and water shield
supply and install shingle mate
supply and installr. architept shingle-Chateau"Driftwood"
su�nd install ita aluminum drip edge
supply and install proper ventilation
supply and install high density fiberboard flat porch
supply and install permanently adhered 060 rubber w/perimeter metal
remove all working debris
total labor and materials
Deposit
balance due upon completion
Thank You We apprecitate your business
$12,700.00
-$41700.00
$8,000.00
Don Connolly Homeowner
SHINGLES - MEMBRANE - METAL
ATIQNAL �1GE MUTUA
' NS Ust St E COMPANY L 55 INSURED
etepn�e-8�-6�7X3431
36
CTORS POLICY DEC
LARgT10NS
SOW
-IN
Nam" Insured
and Mailing Address
PATRICK
AS
2 BAILEY
CONNOLLY DBA
HOME IMPROVEMENT
PLA SOLI,
DR
NH 03865
A'
Policy Number: MPS43772
Account Number: CACS43772
A SURANCE GROUP (SALEM)
SONE 603 898 6320 Producer Code: 280
130
POLICYHOLDER IIVFORMAT)ON
Nutnied Insureds Business; CARPENTRY RESIDE
-= nay
NTIAL/SIDING INST
.�INDIVIDUAL
IM� Policy Term; 12
Effective' 10/10/04
(72:01 A.M. Standard Time at the address
F-rcPn'ation: 10/10/05
In return for the of the Named Insured stated above)
Payment of the premium and subject to all the terms of this
the insurance as stated in this poli _ ^ A`
Optional Coverages, Forms See the attached schedules for Descript,policy.
nrp 'prem,sree P '
g rms and Endorsements an'.yo.. provide
pplying to this policy and Mortgagee Scheduleplicableerage,
BUSINESSow -- ---
Liab
nY &Medical Expenses - each occurrence LIMITS OF INSURANCE
Personal and Advertising injury Limit
Lagesreduces
$ 500, 000
ompleted Operations Aggregate Limit
$ 50}0, 000
Aggregate Limit - $ 1, 0 0.� , 000
Liability -any one fire or explosion
pense Limit - $ 1, 0 0 0,000
Per person $ 500,000
abil' $itY and Medical Expense: Exct ofept for Fire Legal Liability 10,000
of the Bus nnessowners Liabilitinsurance we y during the applicable annual claim for the above cover-
s
Coverage Form. Period- Please refer to
For policies subject to premium audit: Annual Audit Applies.
Commercial Inland Marine Coverage Part
S
Estimated Annual Premium:
TOTAL PREMIUM AND CHARGES %
Countersigned
64-5470 (9/00) 08/04/04 RENEWAL
J6
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:
(Location of Facility)
Signature of Permit Apoicant
, e)
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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mass. l.l(;J NSI # 022680
55 11casalli S(rcc(
Nurlh Andover, MA 01345
A1ass. RIaiIS'I'IZATI0N h I0.3.3.58
RESIDENTIAL CONTRACTING AGREEMENT
Read this agreement and make sure you understand it before signing it.
This agreement has legal force and effect and binds those who sign it.
Notice: All home Improvement contractors and subcontractors engaged In homeimprovementcontracting,unless specifically
exempt from registration by provislons of Chapter 142& of the general laws, must be registered,.vrlth the Commonwealth
of Massachusetts. Inquiries about registration and status should be made to the Dlrect6r, Home Improvement
Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108.
Designated Registrant's Name:
Registration Number:
Salesperson's Name:
This agreement is made on jL —p 6," 0 _--3
hereinafter called "Owner".
NUMBER)
DETAILED DESCRIPTION OF WORK TO BE PERFORMED
Contractor grees to perform in a o d workmanlike tanner all work detailc(i I)elo . Such work co vias of the
2.P.Gti
4-0
DETAILED DESCRIPTION OF MATERIALS BE USED
Materials to be usedin p�rforfr tin the absve described wor1�onist of the Following:
ll. PRICE 9:21�
Contractor agrees to do all work described in Section I for the total price of S
I.I.I. PAYMENT It
Payment will be made as follows:
0=o (S DDOu) pon signing Contract;
-
%(S )'upon completion of ,
upon completion of
-- — —
and the remainin2&0 % (S M-0---,5--Upon verification of the work by -:Owner
and Contractor as having been satisfactorily completed, which verification shall take
place promptly after completion.
Notice: i�o.agreement for home Improvement contracting work shall require a down payment (advance deposit) of more than
one-third or the total contract price or the total amount of, all deposltc or payments which the contractor must make,
in advance, to order and/or otherwise obtaindelivery of special order materials and equipment, whichever amount is
ereater.
IV. COMMENCEMENT AND COMPLETION OF WORT:
Contractor will not begin the work or order the materialsthe third day following the signing of this Agreement, unless specified here in writing.
Contractor will begin work on p:pA t Z*M `'r_+ - ate). Barring delay caused by circumstances beyond Contractor's control, the work
will be completed bya-'`t4-:-) (date). The Owner hereby acknowledges and agrees that the.scheduling dates arc approximate and that such
49delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement.
V. NO ACCELERATION OF PAYMENTS IICT LSCROWING ALLOWED
The Contractor may not retluirc.pAymenu to be male tit A& &Ih.e of•tire ernes slxxificd in Set tion I I (Payment 1 above for the rearm that he dooms himself
or the payments to be insecure. If, however. he (imms hinisclf to tx- Insecure, he may require, as a prerequisite in continuing the work described herein,
out din balance of the paymenti. under t1iis contra( t thou ;or tit Ihr riautol of the Owner, shall Ix- placed in a joint escrow account that requires the signature
of both the Contramnriand the Owner for withdrawal.
VI. INSURANCE
Contractor will be responsible to Owner or any third party for any property damage or ixxfily Injury caused by himself, his emple aces or his subcontractors
in the performance of, or as a result of, the work under this Ageement. Contractor agrees to cant' insurance to cover such damage or injury.
VU. SUBCONTRACTING
Contractor agrees that, notwithstanduig any ahreement for material~ and/or labor between Contractor and a third party, Contractor is responsible to Owner
for completion of all work described in a um..cly and workmanlike manner.
VIII. CONSTRUCTION•RE,LATED PERMITS
The following cons ort-relanedjermits�l 1w nbi:Spary in order to complete the scope of work included in this Agreement:
The Contractor tinder provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction -related permits. The Contractor
shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies,
authorities or individuIlls.
Notice: If the homeowner obtains his own constructhm-relaled permit% for the work described under this agreement, the
homeowner is hereby ad'vise'd that in the event of a dispute, Judgment and nonpayment of the contractor, the
homeowner will not be entitled to make a claim to or collect from the guarantytund established by Chapter 142A,
M.G.L.
IX. MODIFICATION
'Mis Agreement• including the provisions relating to price (Sectit n1l) and payment schedule (Section 111) cannot be changed except by a written statement
signed by both Contractor and Owner. However; cancellation by Owner is allowed in accordance with the Notice of Cancellation (annexed).
X. WARRANTIES
The Contractor warrants that the work ltit rtishedlie reunder shall be II cc fium defects tit m:dct labs and workniartship for a period of following
completion and shall comply with the requirements of this Agreement. in the event any defect in workmanship or materials, or damage caused by the
Contractor, his subcontractors, employees or agents. is dtsu)vered within one year a(tq,,cA?mpletion of any job, including cleanup, die Contractor shall,
at his own eipcnse. MAIiu+ith remedy, repair, correct. rvplacc, lir c:ursc to he remecdiut, red, or rcplacc"lt , suc image or seg h defect in materials or
workmarishi . 'flie iorecoin Wanam= shall siirvtvr. anv ins vction �•rformr:l `-.�, r
p f p In Clirnr(•Itnn WIlr1 Uig' A�rn!•.:('"u;x:T work.
All warranties for equipment supplied by the Contractor under this Agreement shall br thoseigiven by the manufacturers of such equipment, which shaU
be turd otc hcichy ptisscil through directly to 1hv ( )wort. t Micro --w It nuund,tcoucrs' wilt ❑uuir•:, di Owner may Ile required io register or mail in a warranty
card or other evidencelof ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail inarregister such
documentation, wluch Ifailurc voids the manufacturer's wananty, shrill not create any responsibility for the Contractor to warranty such equipment.
i
This warranty gives the owner specific legal rights, and owner may also have other rights which vary from sL-tLc to state. Under Massachusetts law, sales
of goods carry an implied warranty, of mcrchania'bility and fitness for a particular purpose.
XI. COMPLETENESS OF AGREEMENT FOR EXECUTION
The Owner is hereby advised that he should not sign this Agreement unless and unul all blank sections have been filled in or marked as void, deleted or
riot applicable, And until all exhibits and related or referenc•r•d documents that are incoilxira ied herein arc attached hereto.
XII. COPT OF AGRP.EMENT TO BE GIVEN TO OWNER
Tliis Agreement is govcmed by die Laws of Massachusetts. It must be executed in duplicate, and an original signed copy hereof given to die Owner at
dir time of execution. No work under the Agreement shall begin prior tri the signing of the Agreement and transmittal to the owner of a copy Utereof.
RIGHTS TO CANCEI,
'['lie owner may cancel this abreentet►t if it hais'been signed by the owner at a place other
than an address of the contractor which may be his main office or branch thereof,
provided that the owner notifies the contractor in writing at his main office or branch
by ordinary mall posted, by telegram sent or by delivery, not later than midnight of the
third business day following the lignin' 1of this agreement. See attached Notice of
Cancellation.
HOMEOWNER:
DO NOT SIGN TI[IS CONTRACT IF TIIERE A
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Location Fz, /9��
No. 174 Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
log Building/Frame Permit Fee $
CHU
Foundation Permit Fee $
Other Permit Fee $
TOTAL s
Check #
16 7 u 3
—building Inspectou
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
DATE ISSUED:
BUILDING PERMIT NUMBER: 174
SIGNATURE: AAJ
Bull n ommisslone for of Buildings Date - �►
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
05�s-i d
Map Number Parcel Number
FI��V �(� S�
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
,,2-Q 3jL-
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide R 'redProvided
ReqWred Provided
1.7 Water Supply M.G.L.C.40. 54) 1.3. Flood Zone Information:
Public 43, Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
Historic District: Yes NO
2.1 Owner of Record
4r- 3 U,
Name (Print) Address/ for Service
1
�gnature 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:
Address
Signature Telephone
Not Applicable Cl'
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable H'
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 25c161
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 check applicable)
New Construction ❑
Existing Building
Repair(s)
Alterations(s) ❑,
SAddition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
S 1 (Q i01, ok
c� / l
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed b permit a licant
1. Building
v
OICIAL USE
x `r
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumb±E
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
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 permit application.
Signature of Owner Date
SECT!QbLJb OW R/ UTHORIZED AGENT DECLARATION
I, 1 ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and info ation on the foregoing application are true and accurate, to the best of my knowledge
and belief
Sc (I G t4,tar
Print Nam i
Signature o wner/A ent
,
NO. OF STORIES
11°3
Date
r f
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 RT
2 3
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
Tel: 978-688=9545
Please print.
DATE
JOB LOCATION% 3
Number
"HOMEOWNER
Number
PRESENT MAILING ADDRESS
City
Town of North Andover
Building Department
27 Charles Street
North Andover MA 01845
HOMEOWNER LICENSE EXEMPTION
_2F_L- 7—
Street Address
971 ( Y -S_ -g712 -
Home Phone
vu
00'a ,
State
E10RTif
OFSt�eD ,6'9
� nD
ORATED ♦T~`y
�Ssac►+usE�
Section
Work
a
Zip C(
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of six units or less and to allow such homeowners to engage an individual for hire who does
not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1)
DEFINITION OF HOMEWOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one to six family dwelling, attached or detached structures ac-
cessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned "homeowner" certifies that he/she understands the Town of No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedures and requirementsp.
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING OFFIC
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
0
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-954
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 properly
licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. , -
The debris will be disposed of in:
+-t-w!C&C Gck (,-, 11L C,rJls ci4"8vkt&'.,
a�-E0u,.6c ASiet
(L6 tion of Facility)
Sn nvtct
Signature l f 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
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Location
N o. Date 5r3
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
-,Pijilding/Frame Permit Fee $
-j r
00 $
,ermit Fee
Othe�� F
ee $
Sewer Connection Fee $
'60ater-Connection Fee $
TIM $ j s, fj. 0
Building Inspector
Div. Public Works
I j
PERMIT Nd. ly �
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP 4-40.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK IPAGE
ZONE
SUB DIV. LOT NO.
�I
LOCATION
PURPOSE OF BUILDING A
OWNER'S NAME
NO. OF STORIES SIZE
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME i./
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES — SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS I - 3
PAGE 2 FILL OUT SECTIONS I - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FLL^ED
SIGNATURE OF OWNER OR AUTHOR
FEE lf /.<d 6)
PERMIT GRANTED
19
/
i
r'
OWNER TEL. #-��`5'
CONTR. TEL. #0-
CONTR. LIC. #�_ Z_
19i}ss / o 3
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST `
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
Wwgu gnv InarM.NWIR
BUILDING RECORD
1 OCCUPANCY 12 '
♦ t
SINGLE FAMILY
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.
s
t
�? 1
SiOkIES
MULTI. FAMILY
OFFICES
APARTMENTS
_
CONSTRUCTION
2 FOUNDATION—I
8 INTERIOR
FINISH
CONCRETE
PINE
3
1
2 13
CONCRETE BL K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B M TAREA
_
Y. 1/2 '/.
FIN. ATTIC AREA
NO B M'T
FIRE PLACES
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4 WALLS I 9 FLOORS
CLAPBOARDS
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WIRING
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