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Miscellaneous - 9 PERIWINKLE WAY 4/30/2018
North Andover Board of Assessors Public Access : .' f NORTI� � �SSACIIU�+� Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Parcel ID :210/038.0-0278-0000.0 FY:2012 SKETCH. Click on Sketch to Enlarge s Page 1 of 1 ]roperty Record Card Community: North Andover PHOTO Click on Photo to Enlarge a Ll Location: 9 PERIWINKLE WAY Owner Name: POLONSKY NOMINEE TRUST POLONSKY, MICHAEL A Owner Address: 9 PERIWINKLE WAY City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 10 - 10 Land Area: 0.64 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3808 sgft �—] ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 761,900 761,900 Building Value: 468,200 468,200 Land Value: 293,700 293,700 Market Land Value: 293,700 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=1889943&town=NandoverPubAcc 5/17/2012 } w J Y Z w a C/O � V/ U W 20 0 Q CDUJ �U 0.0 d O O � O 0 O ti N O Y U O m O 00 M O CL 75 0 (0 IL Oo 00 - y; W 0) 0) N N -0-0 S (0 O SIN ... 00 00 Z M M j 0')0) N N �; a aZ cu c 2N X00 O V (O O iQ 0 Z O O F..- N N Z� a Z OO ; Z coag Q -2-a F Ol G > °o °o m (n o o h Y Z . g (3) CF) p Z jTd! V r r ro m LV a. Q{ F /w F- H O a c0 � m [ O; € € N i c of 'O M N iN -00 co 00 - Z3, 04 (aO) (Oa(0 ATa��F r clF > O i :> O N}� _.0 v m QsJP'.aim .�..'.�..� U E'm' E CZ) cm !LL jco j n Z 0040 r 00 �'rp 1 i 'y ch in ice c N (V r M- N � , 0 `N ..0 n .. s . t a) w N�g� N: O LL ¢,m°� (o=fit Efld ¢gym°¢ - C: e C 3 7 O LL �¢ - , 0 &00 m ?L[ CLL. I>- o` I co n Lu CO,a- �O(c10 '01 FO -U �C9,U€a,o n r� N -m LU r� iN,� cl t cn + ; '0.— -- N w i/iLL €(6(0 0 ICF7IO'�( mm n w= YEE.0 —� U'..ti o -co mwmYw; m:m:¢ JiOR `m _, Z� N'C9 LL U LL'C9`N a Q O ,Q _ > CL w O O .•(�k0p a) Is 0'c r.-.POrx O O� a) Is ��N_ Y (n,(nj0_' wf� LL° 2 LL,LL;U' Cl) 0 (0 IL 4 MAPFRE INSURANCE® August 22, 2016 The Commerce Insurance Company1m Citation Insurance Companysm 11 Gore Road, Webster, Massachusetts 01570 508.949.1500 1 www.mapfreinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL NORTH ANDOVER MA 01845 Board of Health or Board of Selectmen Town/City Hall RE: Our Insured: ANDREA POLONSKY / MICHAEL POLONSKY Property Address: 9 PERIWINKLE WAY Policyk BCZNCY Date of Loss: 08/21/2016 Filek MRRP21-KKHRV4 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, 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 my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. RACHEL CHRISTIAN CLAIM REP I, PROPERTY Telephone: (508)949-1500 Ext: 15392 Toll Free: 1-800-221-1605, Ext: 15392 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. August 22, 2016 CIC 254 (Rev. 4/95) MAIL Y51 Form of Notice of Casualty Loss to Building Under MASS. GEN. 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: Michael & Andrea Polonsky 9 Periwinkle Way BCZNCY 12/23/2013, Water/Toilet Leak a-11<:�'ID 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. Mike Peterson On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Permit No. dU3 ?P5 i7q °6;aa6�a Sam Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK0 . All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 1200 (Please Print in ink or type all infonT ation) Town of Date - If- a -6 To the Inspector of Wires: i— e— The undersigned applies for a permit to perform the electrical work described below. Location (Street & Owner or Owner's Address T Is this permit in conjunction with a building permit Purpose of /c d Yes 4/ No a (Check Appropriate Box) EAsting Service Amps / 2'L' _z yC/ Volts New Service Amps Voits Overhead U Authorization No. Undgmd No. of Meters Overhead 0 Undgmd I No. of Meters Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work A110" >"? OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability 1 nee Policy including Completed Operations Coverage or its substantial equivalent YES - NO have submitted val' sof same to th&Olrrce YES - NO - tf you have chocked YES please indicate the the a INSURANCE BOND OTHER - (Please Specify) .._ a on appropriate box. Estimated Value of.Eledrfcal Workt (Expiration Date) Work to Start S inspection Date Resquested _/-Rough Rnai Signed under the Pena es of FIRM NAME fZ. C UC. NO. Licensee `✓r �i s �. Siyi .e �' Signatur . G- UC. NO.��9 3 Tel No. lr7d�l7 — /Ci A'°ddress Misr /oi t S %- %vim �TcY .rpt Tel. No. "9VER'S INSURANCE WAIVER: 1 am aware that the Ucenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts J neral laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) O0 Telephone No. PERMIT FEES 33 I Total No. of Ughting LightingOutlets No. of Hot fuse No. of Transformers KVA Above f In 1 No. of Lighting Fbdures Swimming Pool grryd f gmd 0 Generators KVA 2 3 No. of Emergency Lighting No. of R es Outlets No. of Oil Burners Units No. of Switch Outlets Z No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers S Arca Heating KW DetectionlSounding Devices No. of Dryers Heating Devices KW Municipal Local oboB Other ns_ No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases I ylifiring No. HVdro Massage Tuds I No. of Motors TOW HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability 1 nee Policy including Completed Operations Coverage or its substantial equivalent YES - NO have submitted val' sof same to th&Olrrce YES - NO - tf you have chocked YES please indicate the the a INSURANCE BOND OTHER - (Please Specify) .._ a on appropriate box. Estimated Value of.Eledrfcal Workt (Expiration Date) Work to Start S inspection Date Resquested _/-Rough Rnai Signed under the Pena es of FIRM NAME fZ. C UC. NO. Licensee `✓r �i s �. Siyi .e �' Signatur . G- UC. NO.��9 3 Tel No. lr7d�l7 — /Ci A'°ddress Misr /oi t S %- %vim �TcY .rpt Tel. No. "9VER'S INSURANCE WAIVER: 1 am aware that the Ucenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts J neral laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) O0 Telephone No. PERMIT FEES 33 I ,i. Date . .-p :'tio TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSA�MUS� ��_� ✓ This certifies that :.. ' ..................... has permission to perform_, ................. plumbing,,in..the buildings of ............ at .. ?. North Andover, Mass. Fee . Ow... Lic. No/��5V... J PLUM KG INSPECTOR Check # `L 6560 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type print) ^ _ NORTH ANDD ASS,�CHUSETTS Date �,,-�/p Building Location Owners Name Permit #-� i Amount Type of Occupancy I New 12 Renovation 11 Replacement 11 Plans Submitted Yes n No n (Print or type) Check one: Certificate Installing Company Name iLt /_vna zZA^, 1:1Corp. Partner. 10 Firm/Co. Name of Licensed Plumber. 114 ( L_Lte9,o_ / A4 Co 4 l,,�,-o k Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [a Other type of indemnity D 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Sta lumbing CVe and "r 142 of the General Laws. 1By: City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License it�n�l� er '� Master0-*' Journeyman ❑ _ration No. Date MaR'r TOWN OF NORTH ANDOVER Ov 's ,•,ti 3? ' • ►0. s a • Certificate of Occupancy $ s ; , �'+ s••••°•E��' ACMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18456 1 / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Cvy .'b _� x x a BUILDING PERMIT NUMBER: ( DATE ISSUED:* C1� SIGNATURE: Building Commissionerh for of IfIldings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 9 Periwinkle Way North Andover, MA 01845 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R-3 27,700 sf 125' Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Provided 30' 30' 20' 20' + —Required 30' ' 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone n A Outside Flood Zone 1k Municipal k On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic (Strict: Yes No 2.1.( caner of Record f ,,.Mr. -and Mrs. Michael Polonsky 9 Periwinkle Way, North Andover, MA 01845 Nama (Print) Address for Service 978-258-1110 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Nuf •� V' Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 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 & 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 .......❑ 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: Build out of recreation room and bath in basement area. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant ,C) FICIAL r USE t?N;Y - I . Building $ 10, 000.00 (a) Building Permit Fee Multiplier 2 Electrical 2,000.00 (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) l 8 6 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. Si ature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 10 I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information onde foregoing application are true and accurate, to the best of my knowledge and belief Mi r -;P1 Polnnsk3z Print n July 16, 2005 Si ature of Owner/Agent Date s a s: �> NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRABERS 1 2 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 NORT1j Ot,,,ao ra 4 3? oa ;. ,..a. •. OOL TOWN OF NORTH ANDOVER s ^•'� ss,K�dc BUILDING DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER MA 01845 978-688-9545 978-688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE July 16, 2005 JOB LOCATION 9 Periwinkle Way Number Street Address 38/ 278 Map/Lot HOMEOWNER Michael Polonsky 978-258-1110 617-572-4342 Name Home Phone Work Phone PRESENT MAILING ADDRESS 9 Periwinkle Way, XpxkkxAKdj&uuxgx xQJ:dAR North Andvoe City/Town State zip -C e The current exemption for "homeowners" was extended to include owner -occupied dwellings of two 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 108.3.5.1.) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is or is intended to be, one or two family dwelling, attached or detached structures attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said. procedures and requirements. HOMEWOWNEWS SIGNATURE APROVAL OF BUILDING OFFICIAL 0 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 at: 9 Periwinkle way 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: off site dumpster owned by Crecio Trucking, Inc. located at Lot 43 Thistle Lane. Fire Department Sign off: Dumpster Permit (Location of Facility) Signature of Permit Applicant Date y m m iii C m m m y d � O CA CM) 5ZzCD y r� C! C3. p � to O.� y n a�O � -4 0 id 00 C=CD 'm Cn C= d CD n CD O CD � � O p CD CO) �. p �C CD — 0 10CD CD oq o � d CD n� Ir C 0 CZ � P - O 0 m _Go G Ic �OdO m BCD O O t7 mwC 3 =r'O N o asm V 0 IEO D � 0=: Z:l n • ?CI: D z %tb CL 0 0 � 1 0 CL, CD B M am fA >.: cr dd : C w d 5i CO m N Cos m, m C= 0 CD a 33 CO) o �m Wim: •: .i N d 'm a*: nC2 O moo: � m z 0 4 1 — IV 1 Omq 0 c z "X X a � M �r PO � 'r 1 GO Gi ,Y 'rJ O� a n ro x z 0 4 1 — IV 1 Omq 0 c Location No. ���' Date 21)- 02, NORTH TOWN OF NORTH ANDOVER .. 9 Certificate of Occupancy $ ��s'•°°'<� Buildin /Frame Permit Fee $ fir, CM 9 Foundation Permit Fee $ Other Permit Fee $ �i TOTAL $ Check # 15289 / Building Inspec R APPLdCATYON TO CONSTRUCT REPAII BUILDING PERMIT NUMBER: SIGNATURE: Building Commissiol SECTION. i- SITE INFORMATION VER BUILDING DEPARTMENT A ONE OR TWO FAMILY t/ I DATE ISSUED: ' : A- A ... rIupeny yaaress: k ,\ Uj �rXAQ �jj D.�l r 0VzX- , M 01 Qay S 1.3 Zoning Information: Date 1.2 Assessors Map and Parcel Number: 47 34P Map Number Parcel Number 1.4 Property Dimensions: c.omng 1Jtstnct Proposed Use Lot Area (sf) Frontage (ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Required Provide Required Provided —Required 1.7 Water Supply M.G.L.C.4o. 54) 1.5. Flood Zone Infomution: 1.8 Sewerage Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT /.I owner oI Record A`«. a, W�or-,sK . Name (Print) or 258- M0 Signature Telephone Rear Yard Provided System: On Site Disposal System ❑ Address for Service � lY 2.2 N -39-5 Qxce� rwo A � V41 Print 3 \ Address for Service: \eft Signature Telephone 3 - CONSTRUCTION SERVICES .3:1 Ltcensea uonstructton Supervisor: Licensed Construction Supervisor: Address Signature Telephone 3.2 Registered Home Improvement Contractor ---� Company Name tl_ Not Applicable ❑ License Number Expiration Date Not Applicable ❑ -fit `z-6ga3 Registration Number 12) .. 3 (?Z Expiration Date L w r SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. in the denial of the issuance of the buildin rmit. Signed affidavit Attached Yes ....... No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑VExi -ting Building, ❑ Repair(s) ❑ Alterations(s) w Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / 1 1\ I J0�AD0W-PP t tN to provide this affidavit will result -Addition ❑ ri � SECTION 6 - r;NI A1LLY l Itern v1V.7dilut livi.. �.�:., Estimated Cost (Dollar) to be Completed by pennit applicant (a) Building Permit Fee Multiplier yr 1. Building Z �jC`7 (� , 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)_(�(7 Check Number SECTIOIN7aUWiNJEHAUJLnUKtLaIJLiJi'I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner/Authorized Agent of subject property r,? Hereby authorize to act on o, My behalf, in all matters relative to work authorized by this building permit application. f Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ,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 belie Print N Simiature of Owner/Agent _ Date now llw�,r NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 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 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: C..,A�-1 S ' (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector • �T, s P 'ct ire , , t rs own me my A bm v 2? Ff*9? 33r'. 2 ' �;� ) iy "•±'*ZBi. , .` � .pat �._ .._ { MAN N'oQawi;, tirlr �, �.. 5;.... ,a �xeaaa:,saa ! aQC 31gmO:S IRA RmiR 70si QQ .mlep 7 vuoM r rn#mq ati si �+- W s ..3n&S3 i nviP3iirr6A0� s geFsae,� -10 �aik�a, rr �'^ as r�n,zgxaF�-, ,-)t -:VTa• ,..3 .. rias 0 e SES CONTRACT Branch Name: t�� �• / f( Date: // -�' -)/ Sold, Furnished & Installed by The Home Depot Installed Sales Branch Number: r Job il: z ' 345 Greenwood Street, Unit I Worcester, MA 01607 508-756-6686 (800)657-5182 Fax: 508-756-2859 Federal IDN 75.2698460 RI Cont. Lich 16427 CT Lich 565522 MA Home improvement Contractor Reg. #126893 Installation Address: G r ✓-!1��� 7 zn1 `L City State Zip �i/�L�✓- 7' ' Home Address: (if different from Installation Address) License: Work City State Zip Proiect Information UWe/You ("Purchaser"), the owners of the property located at the above installation address, offer to contract with The Home Depot ("Home 1 V L• Depot") to furnish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet N incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it cannot perform its obligations pursuant to the contract specifications. SALE AMOUNT J" CONTRACT AMOUNT pc DEPOSIT �u S �W 25% of Cuatract Amount due upon execution of this contract (UNLESS project is financed through Chevy Chase, in which ease no deposit is required). BALANCE DUE ON ;( , COMPLETION S DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval.) I. Check, Cashiers Check or US Postal Service Money Order (made payable to The Home Depot). Credit Card- - Circle One Below Visa Mastercard Discover America:, Express Exp. Date: Name as it appears on -By m/or signature low, a agree to allow The Home Depot to cha/ge �ta'jvc tint inoldDate If this is a finance transaction, the agreement for financing is contained in a separate document, which is Incorporated herein by Reference and made a part hereof. At Home Services Credit Application reference # Purchaser .gr:es that, immediately upon satisfactory completion of the work, Purchaser will execute a Completion Certificate and pay an, balance dw. (unless the Job is financed, in which case, upon submission of the executed Completion Certificate, Home Depot will be paid in full by the in.der). Purchaser also agrees to be jointly and severally obligated and liable hereunder. For Mauachaseus Residents Only Contractor, at ,wncrs expense, shall procure all permits required by law as follows: Owners who secure their own permits will be excluded from the guaran! fund provision. of MSL Chapter 142A. Unless otherwise noted within this document, this contract shall not imply that any lien or other security interest ha, been placed on u.r residence. Entire Aereement This agreement and its attachments, including any financing agreement, contain the complete agreement between the partit. and can not bL� .emended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read It. You are entitled to a completely filled-in copy of the contract at the time you sign. Keel, it to protect your rights. Do not sign any Completion CertiScate or agreement stating that you are satisfied with the entire project ractors from requesting or accepting s Completion Certificate signed before this project is complete. Law prohibits home repair cont by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 25% of the contract amount if the job is cancelled bl Purchaser AFTER the third business day. BY THE TERMS OF THIS RECEIPT OF,, COPY OF T / HS CONTRACT AND TWO COMPLEWE AGREE TO BE TED COP ES OF THE NOTICE OF CRAA CELLATIONKNOWLEDGE BY MYiOUR : fGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTO:'.Y .AND I/WE AUTHORIZE HOME DEPOT AND R_MA HOME SERVICES, INC., A HOME DEPOT AUTHORIZED CONTRACTOR, f0 VERIFY AND REVIEW MYlOUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RI t_t:99SE THEM FROM ALI., LIABILITY INCURRED FROM INAD ERTEN OMISSIONS OR ERRORS. SUBMIT i'EDi3Y _ Date: — t,�-)3-OtPas-I:15 f;C'a'G Safes consul - % r Date; l / ✓� `� I J' ACCF,PTL D B'r - ,�.• omeownec.-' / 17-03-01 P03:30 CFMC Date: __— Homrown-r NOTI• E. ei)uITIONAL TERMS, CONDITIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT White - aranchFile Yellow -Customer Pink - Sales Consultant 05/09101 SA -SC V r l.U4 MLI a r I URA N L ta++lin�i9 Balls 11FICATr: IS ISSM AS A MATTEJIINF ItMA I SHCP,iRD dI SCOTT COJtP. ON1.1► ANO CONFERS NO MONT$ 4) T10 YK£ CERrlF16AT '352 SC:VENTH AVENUE - SUITE $05 HMI*PL YNIS C€RTIROATIE DOES BOOT. O, "TEND 0 NEW YCRK, NEW YORK 10001 ALMINSCOVERAGE 7- AFFQRdEO BY THE oOtlC1 x GLOM + INSURERS AFFMANG COVE.RACM RMA ti�?N!C SI:RV'C�S, .NL : "-,- IIA ADMlA i1 INrDAAfXE Ca0ANv R i� 32LS: C,)W GALLFR!A P;i X�4AY !� 1 � RAVELM INOEM_ N1TY 0% IL.UNOI5 - -- j A%ASTA. GEORGIA 3QU9 ±+1e11ILJlc. CONTlNEFI�i�+l C ^t1r^Ll'r iN ftAirG C0 - - a+o; AMERICAN ArE AT104AL GFitxJf' roc P00(l1ES or N1SLf{AHfX IsSTCU BELOWHAVE DE9N ISSUED TA ThE jm6vRLtA 14W£a Ax*A iGM T11E PdItCY l�il1QA fNOfCAT>rQ• HCiiWlTMS1M'fyfNQ A,.Y (tlrCi�(t�jlMfh'T, "AM Cft C)WM:0N Oh' ANY WNTMCT ON OTHER GOCi1M6TfTtlNTH R':SMCT TQ WtIC11 TH15 CC.RT'FCATE MAY 8E +S5C11�1 OR W.'+ ►Ei T111�, ?HE 1�+5tJRANCE 1► i C1t1F0 BY 711E ►+p;JCK3 pEgCR{I1� MERIOM IS SUQ If Cf 10 All T1kE 75AMQ, tJfCXUSY>r1y A[d0 CONDITIONS OF S�� PIA IC+ES AGGREGATE LIMI "S y;riMt MAi kAVF BEEN REOVZD By PAILS CLAW. 00 � ,- •-+mit4;iAYr6— �E -- 1 lCr NU�tiOt M� _ .1 .._ _ _ .. S _ `a'°.�11u` uAar. ( I p I i! RC�1111atr -.. 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V my 1 IMN14m'" AOe,,,s on �rro :a•s ta�vrl .1 s I Board of Building Regulations and Standards 140ME IMPROVEMENT CONTRACTOR Reglabadon: 126893 Expirsdon: 0&o03/2002 Type: Supplement Card Home Depot At -Home Servlws PAUL VENTRE 3200 COBS GALLERIA PKWY #26 ALTANTA, GA 30339 Administrator ®river's License� 12-046 12.".01 M 6,00. D S90460"5— DO* of ft1h 1114*66 am "MGM am" NU wilow VENTRE PAUL A 81 WEAKE ST E WSTON. MA 02124 I�o w O Y s: is aG w U) ox U A ro r. w oo a U w w � 00 Cr bot C2 W. w r� �'i ca 5 i=. o z )O t)O w w z A W m z cn Q o E cn �I ti COO W LL Ir- 1•- W C.2 ti FE c o c O � c` O N VO V CL c lV O m C := O O 12 N m Ea 20 o a N E E :w= o� co all m Nl �c :gym o m3N co O C13 N �p N m o CLC.7 y O m :CMoQ N d c 0 y Z c O` O m d h Oc a o •O. N mr~ C � � C � O m •H CL=A c V �p O 'r mv N E m CL O� O cms Wa � ti$ � z 8 c.m CLO - E N Z N O N cl �o a O cc Of m v cm c 'c N O t 0 Z O Q :U :W tea+ Lrl CO o C/) p � U rn Cf) 0 Oil R; i7 2 6 L Q Z °D d O h Q C e I G C Q•— C Q C CD:— y Q Q 'E m m co CDCL CD CD R � �3 G Q CD Q L m Q OL. 2L a OQ .6-0 G co L) �� c Z CD CL V y m G c oaH Q 0 V! w w w ^ '' vJ O' MORIN ,� 3 O Town of �`'==Mcwus�t�• NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT NO.: PROJECT: �?r 1eSO4&00tww DATE: C; - PERMIT UNIT NO.: FLOOR: WING: BUIL DING NO.: /1.,, r7 �Q��GtiL�V REMARKS: E-km-� a60 9 D -- 7:::� ---- z loom- 0r�6A-,f�' 3 A1tL-1 O C Excavation - depth and soil conditions Framing - Other: Date: J-3-01 Date: 6- Date: Inspector ,/%/�� Inspector� Inspector Footings and foundations and drains - Insulation - Other: Date: ©� Date: _ Date: Inspector Inspector iW Inspector Electrical - rough - Plumbing and/or gas - rough - Other: Date: S-31-01 Date: 6 -./ - C° Date: Inspector _ Inspector lif, Inspector Electrical - final Plumbing and/or gas - final Other: �j Date: 6 �v Date: 30 ' 0/ Date: Inspector Inspector L Inspector. moire Dept - ,il burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy ` Date: Date: C of 0# Inspector /�`', Inspector /1 Inspecto Form #995 Action Press, 885-7000 jr . "' - d =R� rolmm 11 '-�, coo �O Oo >0 y �y A d k> o� O CG A �x x WA �t ► a Cf) m m C/) 0 m _v, y CD C � � O C2 Z y CLO CMM • C C d� Co 0 C.) CD o p C O CD O Q "Cd CD CD o CD C CD y. c. v y —• O t0 C=D a y v O Z .cl G CD w aq ozjo- G m ` 0 C O C?�CD m S O -•0OQ H d O m, C 10 m C) mcol cC.� m Z O d 01 - C M o A •n rt =r C CL 0 T O a O O y C y N CD S > >� O Ocl) o z5.� C O H 0. W ^='O"c . )ZIO C ?yam rr d = O m IC C..: m ..r W m CA • :O C co O m:�: C. CCA Oj H O `w _ C. CL ca Cir:E 0 : CA �yQ c � mCA i m C) Sa C,ma ?m: z 0 !!r TO CD03 h '� .••.5 � s s CD d d CL nC2 .� p o ^; .CC-'.. ' 7 C/) C/) d CD �\ \` G w aq ozjo- G m ` 0 aJ cl R� ` O r O C CD Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 I I ADDRESS Of ;NORTH\ 414ao ,6'q�y O ... [OL�1iM WK• T10 P, �9SSgCHUS� LOT NUMBER % SUBDIVISION 1) b b OtV- U i I I Ct, DATE REQUEST FILED / 3 010 1 DATE READY FOR INSPECTION At ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN tHIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLIC LE CODES. i SIGNATURE ROUTING CONSERVATION DATE PLANNING DATE UI i D.P.W. - WATER TER (.fit DATE _,J ;7 -AZ I �� 7- D.P.W. D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE IN ECTION REQUEST DATE. SIGNA / ORIZATION N2 3C.95 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... ......... J-111ul.aq ............ has permission to perform ..... .1q&. I ........ ............................ .. + wiring in the building of .... ..... 9-. k x1a. 4re ................... 4 at .... CYl i .North Andover, M-assr .... �� 10/?.. (.. W..!L .' A P ........................ No Fee..Ao.... Lic. No..�U.lc ......... .. ELECTRICAL i N—S* PACTOR Check # ./ -•......... I WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1171:W1Y1[YLVLYYIl fi4lll UrIVJ/A ►."LJ1U►]CIIJ voice Use otuy DEPARMENTOFPUBLIMFMt Pemtit No. BOARD 0FFIREPREVENI70NRXULATI0AN5r01R12:00 ' Occupancy & Fees Checked APPUCATTONFOR PERW TO PEWORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL. INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 9 /2F r i w Owner or Tenant r✓i frd-- Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building "e{ f i We., f / Utility Authorization No. Existing Service Amps Volts Overhead Underground No. of Meters New Service ��- AmpsY/ Volts Overhead Underground Q No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work t. - Z ." No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of LAghting Fixtures Swimming Pool Above Below Generators KVA ground 0 ground No. of receptacle Outlets No. of Oil Burners No. of Emergency Lighting -Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No: of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal 17 Other No. of Dryers - Heating Devices KW Connections a No. of Water Heaters KW No. of No. of _ Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP 1 OTHER- IrRlra eCaU� %SW1t101he=pm%s1sdMasmAB&GamWLaws IhawaamentLiabtlRyfimm ePblicya>dudirgCaq*be COArdWCrtS& St"dqrivalat YES 1 NO Iha%est$:m#kdvatidptootofsa w1othe06= YES M NO r ff}cuhmcdxdWYES pl=m&*# NxcfwmaEpbYc nktrgthe INSURANCE U 13010 M OTf&IZ (Pf�eSpeafy) EvirAm Dale Esfnbsratt G ' %-G dvakxdE1xfiicW W«k $ Wotk9 0 a hgxc6mD*,RgjasWd Rough Final Signed unierm paw. FIRM NAME ?" !l l VA ,.-ld 4 AW. /A Lioensre -/(?C" j._0. f✓/ /l t✓A.-- sigma 14,ki �.C! �vy— Liar>seNo -..2 Y % BusuressuNa97B- ( 82- G Y`7 AkTdNa OWNER'S 1NSURANMWAP✓FR;Igrinawarelbatthel-kawtheitnlramet a -t IecgmiatastaclwWbyNbsmdms&C Lam aod�atmyrnihispeh�appfic�aiwai�trsdristt�msnai. � (Please check one) Owner a Agent Telephone No. PERMIT FEE Location iA P�,eelwPVK No. NORThl TOWN OF NORTH ANDOVER L • Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ s+CHust 9 Foundation Permit Fee $ Other Permit Fee TOTAL Check # CV r 4556 Buildi g Inspector Ta-1.4611-77G.5o' �r 7 10 4 li /7 9' WfIvAl e- tap�p�p0l uS at) I h7maY CUIVY r0 m iso , voww- gLtd WAF MN I"prN, is LOCIM ON MI LOr AS SHOW AND nur 1r Doss compo" MTN RaW"nom RBG1RMC RRMCM FROM A`rRaars &LWSs.' • r ruRram CIlRr71�T r rXIS F r mor LOCAl7rD Ix FLOOD HAZARD ARBA AS S80Ax Ox PANRL -7Op q 6 ooh bate �.lulazi -rl .r r ��),Vi r BAN mar pa BOUNWY'lJt (lIQ�Ti� ►, BOUMMY BWOR1 MON TAM FROM" RccojtDs. l9 7 10,�9 PLOT PLAN IN DIUWX FOR Ll r L -W AH b GT-( �- E5 ll' +ol Ht,�H 61Znp1 MRRAWCIr NMOIMRRN.VG SCRUMS 66 PARK STRSRr AND MA 1lASSACXUSRrrS 01810 N° 3 Date.� ��...! ..... ° t"`° '• '"° TOWN OF NORTH ANDOVER ,..., ° PERMIT FOR WIRING This certifies that ............ ......................... has permission to perform.i�r �yZ i1 wiring in the building of .............' l/. at .............../...,�!....��� lt1r.?f/� ...... ....... �, North Andover, Mas Fee...`'` .. Lic. No.B3t........e,'t���i� .. ELECTRICAL IN6PECTOR !/ Check # ( �d WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use `05L Permit No.�c� Occupancy and Fee Checked [Rev. 11/991 (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 NFORMA TION) Date: —05-61 City or Town of: 0 • To the Inspector of Wires: By this application the undersi gi notice of his or her intention to perform the electrical work described below. Location (Street & Number) r l (. 11 Owner or Tenant Telephone No. 6 - Owner'sAddress _ 4bea Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Boz) Purpose of Building 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: L -,O a imm�totinn nrtho rnit—;— No. of Recessed Fixtures ---- ------. _ ..._ ........... No. of Ceil.-Susp. (Paddle) Fans ....................... ...........� ..0 c...v. .. a w. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ n- ❑ rnd. grnd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I 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 g No. of Waste Disposers Heat Pump Totals: Number — Tons KW No. of elf- ontained Detection/Alerting Devices _"" _ "�` No. of Dishwashers Space/Area Heating KW Local ❑ Municipal C1 Other Connection No. of Dryers Heating Appliances KW SecuritySystems: No. of Devices or E uivalent No. o ater KW Heaters o. o o. o 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: Attach additional detail if desired, or as required 1:1, the Inspector of )Vires. 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 ❑ BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: -4 16 (When required by municipal policy.) (Expiration Date) Work to Start: 5 `dl Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: ADT Security Services 111 Morse Street, No voo , MA 02062 LIC. NO.: 1533C Licensee: John S. Bassett Signature LIC. NO.: 1533C (Ifapplicable, enter "exempt"in the licensenuniberune.) Bus. Tel. No.: 781-278-1169 Address: Alt. Tel. NO.: 781-278-I 1 1 JRANCE WAIVER: I am aware that the LicYnsee does not have the liability insurance coverage normally By my signature below, I hereby waive this requirement. I am the (clieck one) 11owner [Iowner's anent. Telephone No. PERMIT FEE: $35.00 required by law Owner/Agent Signature _ I k% Date.. ... ....... No 3 L 9 0 ..... ....... .o ,so ', TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ........ 14.�h ....... A41?1/...../ .If C 2!. has permission to perform ..............1.......i... ....................... wiring in the building of .......... Z' ....... h/n/17/f; ................. at ... ............ North Andoy-er. Masr15�7 F4�*,.("Lic. No. ". K ............ ...................... ...................... Check # ELECTRICAL INSOECTIOR JI WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TW OOMMONWEALTHOFARMCHUSEM Office Use only DEPAR7317 TOFPUBLICSAFM Permit No. BOARD OFFREPREVEMONREGMTIOAS527MR 12:00 VAA Occupancy &Fees Checked PPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, $27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL. INFORMATION) Dat G Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to Location (Street & Number) Owner or Tenant perform the electrical ork described below. vJ.5L # 97 tiZ,-t � 7 'se iU),,�,�t Owner's Address It) q 91 Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building -5( 1 L rid; 0 / L ��(� W- G (- t A, Utility Authorization No. Existing Service Amps Volts Overhead Q Underground No. of Meters New Service ( Amps/ olts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work' (. c.y7%�_i z i �i NC Fy d ; 5 . n/ c 4 - I,L No. of Lighti:.lg Outlets No. of Hot Tubs IhaveaaztrtLi bkyhtx==PbbcymdudrtgC e�` nC &aWcr9sslkstmMecpu Jat No. of Transformers Total U NO � WymImedWWYES,pimeirdica6eth NxcfineaWbydakirgtkte MxqINSURANCE BOND SII ER KVA No. of Lightiog Fixtures Swimming Pool Above Below Wcik $ Generators Rough KVA ground ground FIRM NAME " ,1� ✓�l � D ? �' /G U= 60% «, No. of Rec p cle Outlets No. of Oil Burners D` /4 Lioa�ee Sigtlarine No. of Emergency Lighting Battery Units No. of Switch Outlets BuklessTdNa Arl&u ' L I /1 / i<. r V1/ 1 �J /1 ,4/ .�� A1tTdNh No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW s Connections a No. of Water Heaters KW No. of No. of Signs Bailasis _ NotHydro Massage Tubs No. of Motors Total HP OTHER histaanoeCo►aage: Putsual�bthetequbanatis�G�Laws IhaveaaztrtLi bkyhtx==PbbcymdudrtgC e�` nC &aWcr9sslkstmMecpu Jat YES NO Iha,,eabntwdvibdproofofsamlotheOffioe YES U NO � WymImedWWYES,pimeirdica6eth NxcfineaWbydakirgtkte MxqINSURANCE BOND SII ER EWmWedVahxdHechA Wcik $ WotktDSlatt hq)mfimD*ReWeshed Rough FmW Sighed utda�te Pl��es ofpajtay. FIRM NAME " ,1� ✓�l � D ? �' /G U= 60% «, D` /4 Lioa�ee Sigtlarine I;oa>seNo BuklessTdNa Arl&u ' L I /1 / i<. r V1/ 1 �J /1 ,4/ .�� A1tTdNh OWNER'SMJRAN EWANFR;I.amawatethatdxlk redo etheiruuanoec mrVoritsakkvidec &icttasmgmWby s&CardLaws andfatmy seont2tispem*Wpbcabatv"*Asftm*M rtetrt. (Please check one) Owner Q Agent 1:1 Telephone No. PERMIT FEE w Location )0r r ! [9`Pt/Gy/A) 6r WM No. Sf Date o1 c,7f -Q TOWN OF NORTH ANDOVER Certificate of Occupancy $ 0 Building/Frame Permit Fee $ Foundation Permit Fee $�� Other Permit Fee $ TOTAL $ X50 r� Check # `xbO8 14531 Building Inspector I/ =° TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Q" Building Commissioner/Ingwor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ® 1 4* - Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: _ _S1 nQ e� �aM 1 ,i. 167 x:5.5:3 ZoningDistrict Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required I Provided Required I Provided 30 too t ab e4�u t+ 130 1 (en � 1.7 Water S° M.G.L.C.40. � 54) 1.5. Flood Zone Information: / 1.8 Sew a Disposal System: Public 13 Private ❑ Z°ne Outside Flood Zone Ci/ Municipal f On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name71W1 Signature 2.2 Owner of Record: Name Print Telephone Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: 1-1 1 Fores`l- S1-. iN®, nn c�ovrr Addres Signature Telephone 3.2 Registered Home Improvement Contractor Company Name Address W449 `rL)V n,o► k e 5-f- MO Address for Service -/og.IL-Q3&0 Address for Service: Not Applicable ❑ 0,5 SL a 4 License Number to Expiration Date Not Applicable ❑ Registration Number IN u' FEB 8 Expiration Date SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 6 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 check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Gor-\SA-r0CA-�*aVN) 0 `� cam. smgIe' FamOv ouiell�ny ,1 4- 1\ ©, 3 CcAr Ga�� aC16 � SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Com eted by permit applicant QF>F'ICt, L USE'ONLY 1. Building 3000 (a) Building Permit Fee Multiplier U 2 Electrical / 6100 (b) Estimated Total Cost of Construction n _ 3 Plumbing O0 Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Q O 5 Fire Protection P, 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE MPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FO - 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 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, tij1 j i a ra garteff Pf C Si cl en' }"4bba4 bbOev Coro ,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 (.c,s\��ct✓r" rret�— Pri v/q3 Lo i 1 t o r ent Date NO. OF STORIES SIZE BASEMENT OR SLAB 5 eA-r SIZE OF FLOOR TIlvIBERS X Io 161 btX 10 2 ND 3 SPAN ) ' DINIENSIONS OF SILLS y k DINIENSIONS OF POSTS 14.VG DIMENSIONS OF GIRDERS — 2)elQ HEIGHT OF FOUNDATION g ' THICKNESS 0 " I S14E OF FOOWG i b `k Si 4 X MATERIAL, OF CHRMMYI & r C k IS BUILDING ON S lD OP FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �( e FORM - U - LOT RELEASE FORM 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. kj'/J�� ��11zz....../APPLICANT Z Qr UGC T PHONE 0 7 2 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISIONlDb �� 1 LOT NUMBER STREET (l" �Yl4)��1 - W 1 ■ ........................... ■ . O RECOM ENDWONS OF TO VATION ADMINISTRATOR STREET NUMBER ONLY .................................. .................................... DATE APPROVED t.) 0 V DTE Gt C7` _6 -�/ CON N ENTS �j. DATE APPROVED DATE REJECTED DATE APPROVED FOOD INSPEC HEAL DATE REJECTED f� DATE APPROVED -5 3EI=Iii SP,jiefOR - HEALTH l-" DATE REJECTED COMMENTS e-71 _ 5 e-,-- PUBLIC WORKS -SEWER / WAT` t CO C NS 0� jo DRIVEWAY > > T � —- �� �C�(' V / 2d G' � q DATE APPROVED ® d FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 i CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 HEATING SYSTEM TYPE: Other DATE: 1-24-2001 i i DATE OF PLANS: 1-23-01 TITLE: 9 Periwinkle Way PROJECT INFORMATION: Abbott Village Lot # 7 COMPANY INFORMATION: William Barrett Homes COMPLIANCE: PASSES Required UA = 724 Your Home = 634 family,'detached (Non -Electric Resistance) , Permit # , , Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA '------------------------------------------------------------------------------- CEILINGS j 2318 30.0 0.0 82 WALLS: Wood Frame, 16" O.C. 3427 13.0 3.0 244 iGLAZING: Windows or Doors 513 0.350 180 DOORS 43 0.350 15 'FLOORS: Over Unconditioned Space 1810 19.0 86 BSMT: 8.0' ht/6.0' bg%2.0' insul. 174 10.0 27 HVAC EFFICIENCY: Furnace, 86.0 AFUE ----------------------------------=-------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitteid with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building Ishall be no greater than 125% of the design load as specified in sections 780CMR 1310 !and J4.4. Builder/Designer !r�-d'� Date a30� Q pL ¢ of IJ STLAWP I6 wr4. �A. AMY i►�tf 1. Mope F I ap -vrre- _ate�Lj 7P�ai"1rV+use JJ - II, ZL-.,CgI WAY pttx. -• GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDE% DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. A bbd Deo. CL�o? G Pefiwinkle LJdy -38197? Permit Applicant fProperty address Map / Parcel (-0gID, -C).3a-a ✓' Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 ofthe Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more ofthe following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as ofthe effective date of this bylaw, provided that no additional residential unit is created. V The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all ofthe conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land. For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ter buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKIN9OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS JOWVQR REFW G DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION Town of North -Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM F t►oRT q 0 ? 4r1'. bye O O J In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: Sorren+tV)o 10i506SX Co -1: Facility location Signature of XpP icant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 11 4 REQUIREMENTS FOR BULDING PERMIT SIGNOFFS BY BOARD OF HEALTH To be filled out by the annlicant nnri c„hm;ttAA ,.,;tt, application 1. What. is the proposed project? Deck pool addition CEED other 2. 3. 4. 5. 6. 7. Are plans attached? (For additions and new houses on septic systems, cgmplete floor plans of proposed construction and arty existing house must be submitted. For pools and decks, a site plan with location of pool or deck is required. Dimensions of deck are needed.) Is municipal sewer available at this location? If sewer is available and a house already exists, is it tied in to the sewer? I Is the ;location served by private well? If this project is an addition and the house is served by a septic system, has there been a Title 5 inspection done recently on the septic system? If, yes, is the inspection report on file at the BOH? GDNo Ye No Yes No Yes No N4 Yes No ,/vA. Yes No The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone aam a homeowner performing all work myself. F -1I am a sole proprietor and have no one working in any capacity 5a, am an employer providing workers' compensation for my employees working on this job. Company name: --CC lors,,aA U'►Il(sqr' Deo- C—^rn 013,E l� h l� tr l7N ofl� T Address I O ti 4 -7'u rn City: Aa') din ✓n, Phone SS )L Insurance Co. (�rerx."t" eif! I"C.Q ) Policy # p IA C1 Comoany name: Address City: Phone # Insurance Co. Policy # 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. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do Sig Print Official use only do not write in this area to be completed by city or town official' ❑Check d immediate response is required Building Dept Contact person: Phone #. FORM WORKMAN'S COMPENSATION F] Building Dept p Licensing Board C] Selectman's Office C] Health Department 0 Other 13 4. �_ .---- BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 052241 Birthdate: 10/10/1952 Expires: 10/10/2001 Tr. no: 7876 Restricted To: 00 WILLIAM K BARRETT. 1049 TURNPIKE ST N ANDOVER, MA 01845 Administrator 4. WILLIAM J. SCOTT Director (978)688-95;1 DATE LOCATION Town of North Andover cf 40RTN , OFFICE OF 4.4"40 ? 4' " " 10 MMUNITY DEVELOPMENT AND SERVICES to 27 Charles Street North Andover, Massachusetts 01845 9. .,-Too .••'s15 OWNER'S NAME (-) Fax(978)688-9542 CHIMNEY APPLICATION AND PERMIT PERMIT �D / BUI LDER' S NAME_ j 1, 11 j CL 8 Q, ( r C �t , I MASON'S N MASON'S ADDRESS LIR [�(} -s r A., MASON'S TELEPHONE_ c? y y MATERIAL OF CHIMNEY INTERIOR EXTERIOR CHIMNEY V/ NUMBER AND SIZE OF FLUES THICKNESS OF HEARTH t Will chimney; or fireplace conform to requirements of the code and have rules and regulations been received:g e S DATE I � SIGNATURE OF MASON .r CONTR. LIC. # (,�`5,� a LA I EST. CONSTRUCTION COST/CON CT PRICE_ 4��lj�t') PERMIT GRANTED FEE I ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS I I SOLID BRICK REQUIRED - i THIS PERMIT MUST BE DISPLAYED ON THE PREMISES Y a I J.WILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT Telephone (978) 685-0950 Fax (978) 688-9573 DATE nc> ,;) LOCATION BUILDER phone OWNER �,�� (I Gce.��� %���� hone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. N® 980 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. i-1 Application by the undersigned is hereby made to connect with the town water main in er t I _ subject to the rules and regulations of the Division of Public Works. The premises are known as No. or subdivision lot no. Owner Contractor CJ '�E� I, re, treet ,� r �82�2320 Address Address -0i pplicant s Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at eft subject to the rules and regulations of the Division of Public Works. Inspected by Date rP� Street B/oa'rdr of Public Works By See back for rules and regulations 1525 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in ' 4 Street; subject to the rules and regulations of the Division of Public Works. The premises are known as No. I t VL �l e wCL Street n or subdivision lot no. Owner The Division of Public Address k ss Applicants Signature PERMIT TO CONNECT WITH ) SEWER %MAIN hereby grants permission to ti / `1 \4 1-k to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date I' Lo'cmc � 1 1 4 /-111 e. C-1 Street Division of Public Works By ' GAt See back for rules and regulations 4 . . . . i . , N2!.� 1 � - 3854 .1 Date ........... 0 TOWN OF NORTH ANDOVER 0 RECEIPT �SgCHU ........... This certifies that ...............Ll .............C4.. has paid J ............. 0 o . ' i—* ... * ............ ;t ........................................................... for ...... ....... Received 6y ..................... < Department .................. It ... . .. .. .......... Sl.'!�.. ......... CANARY: Department PINK: Treasurer i i (Building Value Calculation - for Property at..... Room Length Width Sq.Ft. Cost per Sq. Ft. Total Cost Kitchen 25 16 400.00 65 $ 26,000.00 Living Room 19 12 228.00 65 $ 14,820.00 Dining Room 15 12 180.00 65 $ 11,700.00 Family Room 21 18 378.00 65 $ 24,570.00 Study 12 12 144.00 65 $ 9,360.00 Laundry 14 10 140.00 65 $ 9,100.00 Garage 24 30 720.00 35 $ 25,200.00 Entry 17 12 204.00 65 $ 13,260.00 Basement Finished - 65 $ - Deck - 10 $ - Screened Porch - 35 $ - Breakfast Nook 14 10 140.00 65 $ 9,100.00 Bedroom 1 30 24 720.00 65 $ 46,800.00 Bedroom 2 17 12 204.00 65 $ 13,260.00 Bedroom 3 17 12 204.00 65 $ 13,260.00 Bedroom 4 17 12 204.00 65 $ 13,260.00 Bedroom 5 - 65 $ - Bathroom 1 12 6 72.00 65 $ 4,680.00 Bathroom 2 17 12 204.00 65 $ 13,260.00 Bathroom 3 17 12 204.00 65 $ 13,260.00 Bathroom 4 - 65 $ - 5 65 a�Bathroom 10rmu2.5 Mat! -k so, 3 Stall attached � `$ .' aj� < m o 5 n mO m -,Z o ? O :r M CL �' � N' � 0 �� —0 6. O f9 0 fD ' y m :3MfD O 0-0O M C• C. 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OF FINS NOMAS 1, ii f io° WILLIAM 13Ap1�� 1'�i' orT vi���� gar of DUILb�p OF FINS HOM�5 L ff f �L�VA11ON 111AMIIY: ' �i 1 • [a i w i � ppo��cT ren : A�r�Orr VILLAGE _ Lor � i i WI L L I AN1 I3Ap�� 1'1' i � ppo��cT ren : A�r�Orr VILLAGE _ Lor i I I i I i � �; I 1 I�11�- i�8 -i T O� �IN� NOMAS 5l �T111L�: �Ip51' coop\ PLAN -oi8ioi nim aY .--6 rn VM 6 ,R) 6 I I Ii IT O 5c& PM &' 11 WILLIAM L3AP--P--F,-r-r CONP F�00r\ r�AN Wo-Eff flt�: ml�M VILL 2/8/01 DULP�pl, Or rM HOMO�5 5H��T T (Y: Wl'-,-,Illl\M I ppOJ�CT i11L�: 5CU: PATS: SN�ET: WILL IAM I3AI�I��1'1' MPOrf VULA6� gar - 1/8 -i -o" 218101 PULbEfP,, OF FINE HOMES S cT„n�: FIp5f F1,001; FEAMIN6