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HomeMy WebLinkAboutMiscellaneous - 90 BOSTON STREET 4/30/2018 (2)r Date ...... 7 .4..J.S....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........�� ... �...'...... �%-'".......................................................... has permission to perform .....AbQ✓.....GG. •....... j��}....................... ............... l wiring in the building of.!.Q,+�,,,,,,,,,,.��j.��, at ..............J .�./... ...... T' North Andover, Mass. Fee...... Lic. No.Tff-,r,< .......... X!�.v- ��-1.... !^✓ ""'."-:. ELECTRICAL INSPECTOR Check # a I - N .. Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 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 (ME ), 527 MR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: -71 City or Town of. NORTH ANDOVER To the Inspec oro Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street 4 Owner or Tenant Owner's Address Is this permit in c Purpose of - Existing Service 2-U' Amps ZV"/ a(A) Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Overhead ❑ Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Ilf (e LS &dVV 0 IW4 /2a,4,VD P ac) L Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- Elo. o mergency Lighting rnd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches L, No. of Gas Brners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: Number Tons KW ....................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal [I Other Connection No. of Dryers Heating Appliances KW Systems:* SecuritNo. o evi es or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total IIP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of E1e trica Work: IS -6-0_ (When required by municipal policy.) Work to Start: A Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERA E: 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 �Q BOND ❑ OTHER ❑ (Specify:) Icertify, under thepa' sand enalties ofperjury, thatthe 'nformation on this applica 'on is true and complete. FIRM NAME: _ Srte, LIC. NO.: (9S11 TR Licensee: Eyew w 3 ov1 t e - —Signature 4 LIC. NO.: (If applicable, enter "exempt" in he license number line.) Bus. Tel. No.- R9�957 Address: I W 4LU&9 S" lie ty Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires epartment of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. 7 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the.provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the Y notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Ins ectio Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: 4 4a Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signatur Date: FINAL INS TION: Pass 0 k1 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: — —,IJ-' DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department oflndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. Name (Business/Organization/Individual): Address: `2 S'7- City/State/Zip: S µ" N Are you an employer? Check the appropriate box: Phone #: 4�ro6l�? 8-gV l!2 ��7 11-11 am a employer with employees (full and/or part-time).* 2. I a sole proprietor or partnership and have no employees working for me in Thy capacity. [No workers' comp. insurance required.] 3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.Electrical repairs or additions 12. Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other edlr 61&11-6 ht®t— *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name; Policy # or Self -ins. Lia #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif` under the ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone # Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cityor town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1 -877 -MASSA -FE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia :7�-5 a /C- 1-7 4f E w 1' I I _ i\❑ _ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with the provisions of M.G.L. c. 143, §, 3L, the y i `amu\ permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be fded (f f on the prescribed form. After a permit application has been accepted by an Inspector of Wiresappointed pursuant to M. G.L c, 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall_be limited as to the time of ongoing constmction.activity, and maybe,deemed_by-the Inspector_of_Wires abandoned.and_invalid,iflme _ 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 thq permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job,growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certairrpermits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, anypermit or approval that was "in effector existence" during the qualifying period beginning on August 15, 2008.and extending'through August 15,1 20 " /Rule 8—Permit/Date Closed: �� x ` ***Note: Reapply for new permit 0 Permit Extension Act — Permit/Date Closed: ;❑ _ 2012 Massachusetts Electrical Code Amendments 527 CMR 12,00 § Rule S: Tin accordance -with theprovisions 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 Wiresappointed pursuant to M. G.L c, 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction. activity, and maybe deemed_bythe,Inspector_-of-Wires abandoned_and.inYalid-,ifhe.—. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the, permit application. ❑ The Permit Extension Act was created by Section 173 of Chanter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certaiwpermits -and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008.and extending'through August 15, 2012. ❑ Rule 8—Permit(Date Closed: ***Note: Reapply for new permit ❑ 0 Permit Extension Act — Permit/Date Closed: f f NvRrry, 3 0:°•;�``-° {' :"°oma TOWN OF NORTH ANDOVER PERMIT FOR WIRING f ,S$ACHUSE� �e' f^t n This certifies that ...................:1.1. v.7 '....T......................... has permission to perform ............;7 /ctocc !L his ............ wiring in the building of ! ` at ........1. IAX'9457;�� ............ .T...- ............ .. . North Andover, Mass. Fee..`�.s....-� Lic. No. 5 �� *:. .... ............. . ................ . . . . . . .......... � ECTRICAL INS�E R Check # 10737 8 Commonwealth -of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 1. 7— ` Occupancy and Fee Checked [Rev. 1107] ' (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ME. ), 527 qMR 12.00 (PLEASE PBBVT•ININK OR TYPE ALL INFORMATIOA9 Date: i City or Town of. NORTH ANDOVER To the Inspector of ices: By this n (Street the undersigned gives notice of his o�� ]Ter intention to�perfoim the electrical work described below. Location (Street &Number)_ Q% /� I�uj c>� Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a buildigg permit? Yes ❑ No EJ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service —Amps fi / Vo 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: —7 !/, f. j, _ _ , _ _ No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires 7No.of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers o. of Dishwashers jNo. of Dryers No. of Water Heaters No. of Ceil: Susp. (Paddle) Pans No. of Hot Tubs Swimming Pool jnd e ❑ In No. of Oil Burners No. of Gas Burners No. of Air Cond. Total Space/Area Heating KW Heating Appliances KW XW No. of No. of Signs Ballasts. o. Hydromassage Bathtubs OTHER: of Motors Total HP win table may be waived by the Ins ecta No. of Total Transformers KVA Generators KVAr o. o mergency ig ng Bat!2U Units F IRM F.LAR IS Ido. cf hones No..of Detection and o. of Alerting Devices 11 lvlunicipal ❑ Connerfinn ❑ Other No. of Devices or Equivalent Ea Wiring: No. of Devices or Equivalent ecommunications Wiring: No. of Devices or Eouivalent — attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of El ct ' al Work: " (When required by municipal poIicy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO GE: 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 o ,�e,t%tthe permit 'ssu' g office. CHECK ONE; INSURANCE BOND ❑ OTHER ❑ (Specify:)!/CGt`-r `�`�O Xcertify, under the pat s d enalties ofperjury, th the it mation on this a lication fru and co FIl2M NAME: !-J L)ba Q le PP mp- Licensee:� ��� Si LIC. NO..: gnature + LIC. NO.: (If applicable, e�r exe�in th license num r line, / Bus. Tel. No.: ` Address: G *Per M.G.L c. 147, s. 57-61, security w k requu es Department of Public Safety "S" License: Alt. Tel. No.: Lic. No. - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ _ The Commonwealth of Massachuvefts - ki - Department oflndustr°Accidents Office of Investigations 600 Nrashing ton Street till.l Boston, MA 02111 www hzass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambers rinliicant infn.•....:s;,... _ � aca�c 1 i'!(tri LeQibl Name (Business/Organizadon/individual): Address: City/State/Zip: Phone #: . Fo* re you nn employer? Check -the appropriate bole: ' I°am a employer with 4, ❑ I am a general contractor jd� Type of prgject (required): employees (full and/or part-time),have hired the sub-contra6 ❑New construction I am.a.sole proprietor or partner- listed on the attached she7. ❑ Remodeling ship and have no employees These suit -contractors hav8. ❑ Demolitionworking for me.in any capacity. workers' comp. insurance[No workers' comp, insurance 5. ❑ We are a corporation and 9• ❑Building addition required.] officers have exercised th10.❑ •Electrical repairs or additions 3.❑ 1 tiro a homeowner doing ail work right of exemption per MGl l.❑ Plumbing repairs or additions myself, [No•workers' comp. .c. 152, § 1(4),'and we have no 12.[] Roof repairs insurance-required.)'t employees. [No workers' camp, insurance required_] 13•❑.Other 'Any applicant that checks bob# l .must also fill out the section below showing their workers' bompensation•policy information, t homeowners who submit this a rf 'idavit Indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box mustattached an additional sheet showing flee name of the sub -contractors and their wQr?rers' Camp, poli ; ; ,;,g,;ari. I ant an etrtvloyer that is prquiding:workers' compensation insurance for nzy information. employees. Below is thepolicy and job site ' Insurance Company Name: ' Policy # or Self -ins. Lic, 4: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers"compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against -the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Sienature: Date: Phone #: F iff riot use only' Do not write in this area, to he completed by city or town. official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/TownClerk 4. Electrical Inspector. 5 6.Other . Plumbing Inspector Contact Person: Phone*: Location t No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 7 ~ �� Building Inspevcrr r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR. RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: t 9 DATE ISSUED: / I` �i a D1 SIGNATURE: / / l '/t'L C�'`�`" I of I SECTION 1- SITE INFORMATION I Date 1.1 Property Address:��� o _,R05147a 1.2 Assessors Map and Parcel Map Number Number: eD Parcel Number LA)d V)6,— %� Q �ll / �� 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide ReqWred Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private 0 Zone 1.5. Flood Zone Information: Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record /l " 92 dos �� SIl Name (Print) Address for Service: i h na Le DA Signature Telephone C178 2.2 Owner of Record: Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 'I r!c AyrrC y Li snce d Cons�n Supervi . 01'A r/l 2n) 2 6 y -Cgla y elephone — / * 3.2 RegistereMome Improvement Contractor vrr�y �OraQ 1�+ionsvePm¢�.f L tc. Is Company Na a S /1 `t, lTo�fl� 7G I/ S-�°Y Not Applicable ❑ 0 771-1"/% License Number ,,)1dla©-3 Expiration Date Not Applicable ❑ 1,27y/s RegistrationsNumb d/�G aoo.�- Expiration Date SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) P-'- Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify Brief Description of Proposed Work: �/Y 6Gr/%1 res/r/e G✓y/�1 / � %N �'r QG/ik,^' G2//h.it�n /`i,�'1 qty CW Ps' Co c � on bFy v0daLa Ct 10 i1 P, A/ TieCK r'ePA(Y' SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pennit 4 OFFICIAL I . Building _applicant (a) Building Permit Fee Multiplier 2 Electrical aConstruction (b) Estimated Total Cost of / 0 3 Plumbing Building Permit fee (a) X M 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, c f1 eU// as Owner/Authorized Agent of subject property Hereby authorize !it to act on My b dlf, in all n relative towo authorized by this building permit applicatio . 1 d Signature of O er Date SECTION 7b R/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS iST2ND 3RD SPAN DINIENSIONS OF SILLS DMIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 8 r OF BUILDING REGULATIONS r BOARD 1 License:, CONSTRUCTION SUPERVISOR =t Number: CS E40'"iP7 077319 Birthdate. 10/2011973 Expires: 10/20/2.003 Tr. no: : 77319 Restricted To: 00 ERIC J MURRAY 5 NORMAN ROAD. Administrator .� R BILLERICA, �. 018MA 62 ta" ...-s..•.n^.'r' ""�. �'^"' ....tea. _ ""' �\ NOME IMPROVEMENT CONiRACiOR Registrations 12141 r Expiration 10/26/2002 Type: Tndiui�iiai ERIC MURRAY ERIC MUM Rq ADMINISTRATOR BILLERTCA MA 01862 01/23/2001 11:06 19782500488 "JAY" COLANGELO INS PAGE 01 AMOCO* Cvmmm � "p'°�'. uteelMiMl MA O1824 8■eliC� MA Olen i Y INSUG iP'v:i.iPDATE NMIDDIM THIS CFRTIFICATC IQ lSSUen Ac A IAT" ^r f-jF0R. A` -� ...... cn yr u�Funlrw�iUll ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE IHOLDER. i ►iia CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE CiMPAAC-E ARIURDED nv Tue � cu.s - - - - � - .+ v. �. �� r VICJ OGL IY. INSURERS AFFORDING COVERAGE INSURER A meimm hfe INSUAER B: COMM11e01 IN CO INSURER C MBUREA D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIC MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICJES DESCRKD HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS POLICIES. AGGREGATE LIMITS SHOMI N MAY HAVE $EEN REDUCED 8Y PAID CLAIM$, TYPE OF MSURANCE POLICY NUISBER I 8 GENERAL LIA8ILITY MJ4467 JJJ 07/27/00 071277/01 X COMMERCIAL GENERAL LIABILm 1 MANS MAOE ❑ OCCUR It OENt. AGGREGATE LIMIT APPUES PER: I POLICY nil& Fl= AUn0MMU U&SUfY ANY AUTO AL QW0 ALITOS SCISepULiD AUTOS HRED AUTOS NON NMID, AV' .03 GARAGE Lt4BILITY ANY AUTO EXCESS LUBILITY OCCUR CLAIMS MADE I OEOuCTISLE I RETENTIDN f WORIOS COMPENSATION AND A EVYLOYERS,LASUry 6KUB•447X788-6-00 08/20/00 08/20/01 Town of NoM Air 27 at NOM A+dow ADDITIONAL !. RUPED; U'tMER MA mas JICATED. NOTWITHSTANDING lTE MAY BE ISSUED OR AND CONDITIONS OF SUCH LIMITS EACH OCCLIRRENOE s 300,000 FIRE DAMAGE Wry arra IN) 3 50,000 AIED W (Airy oro PWI 3 51000 PERSONAL A ADV INJURY 3 300,000 GENERAL AGGREGATE s 600,000 PRO OJ 3 - COMPIOP AGG s 600 ,CCC uW =wu roLE LIMIT s 1 EMILY ILY s )CRY Few S PROPERTY DAMAOF s IPer AUM ONLY - EA ACADENt f OTHER THAN EA ACC s AUTO ONLY. AGG s EACH OCCURRENCE $ AGGREGATE s 6 S s L.L. MGIC A,=DEkl 3 100,000 EL DISEASE - [A EAVIDVFE ; 500.000 E.L. 01.% Sr. - PC' rY LMIT Is —700 , 000 COLLO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FXPIRATION DA7 T'CrOf. THE liSi)IYG 11"REA WRL ENDEAVCMi To MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLLER NAincn u TO TKE LENS, M FAILURE TO DO 80 $HALL IMPOSE NO OBLIGATION OR LIABILITY OF AMY ICCID Ute: TW IrUREF. ITS AGENrS OR PROPOSAL August 29, 2000 MURRAY HOME IMPROVEMENT 5 HORMAN RD. NORTH BILLERICA, MA 01862 TEL. (978)663-7839 C.S.L. 77319 H.I.C. 127415 CONTRACT SUBMITTED TO: NAME: BILL & JENNY PICKET STREET: 90 BOSTON ST. CITY: NORTH ANDOVER STATE/ZIPCODE: MA. 01845 TEL. 978-685-4648 WORK TO BE PERFORMED AT: NAME: BILL & JENNY PICKET STREET: 90 BOSTON ST. CITY: NORTH ANDOVER STATE/ZIPCODE: MA. 01845 TEL. 978-685-4648 WE HEREBY PROPOSE TO FURNISH THE MATERIALS AND PERFORM THE LABOR NECESSARY FOR THE COMPLETION OF: • BOW WINDOW: HARVEY SIGNATURE SERIES 5 LITE BOW WINDOW WILL BE INSTALLED AT FRONT OF HOUSE. WINDOW WILL BE INSULATED AROUND AND NEW INTERIOR TRIM WILL BE INSTALLED. ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED, AND THE ABOVE WORK TO BE PERFORMED IN ACCORDANCE WITH THE SPECIFICATIONS SUBMITTED FOR ABOVE WORK AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER FOR THE SUM OF: $2,425.00 WITH PAYMENTS TO BE MADE AS FOLLOWS: $2,425.00 LUMP SUM 5 YEAR WORKMANSHIP GUARANTEE ALL PRODUCTS INSTALLED BY OUR AUTHORIZED TECHNICIANS ARE FULLY GUARANTEED AGAINST FAULTY WORKMANSHIP FOR FIVE YEARS FROM THE ORIGINAL DATE OF INSTALLATION. THERE WILL BE NO CHARGE TO THE CUSTOMER FOR LABOR OR MATERIAL ON ANY REPAIR DUE TO FAULTY WORKMANSHIP DURING THAT FIVE (5) YEAR PERIOD. AUTHORIZATION TO DO THE ABOVE.. HOMEOWNER WORK AS OUTLINED ABOVE. PAYMENT WILL BE MADE AS OUTLINED X ERIC MURRAY Murray Home Improvement 5 Horman. Rd Billerica, MA 01862 Name / Address Bill & Jenny Picket 90 Boston St. North Andover Ma 01845 Proposal Date Estimate # 8/29/2000 3 3 YEAR WORKMANSHIP GUARANTEE All products installed by our authorized technicians are fully guaranteed against faulty wottmanship for three years from the original date of insfalladon. Thera w0l be m charge to die customer for labor of material on any Signature repair due to faulty workmai Wp during that three (3) year period. PROPOSAL August 29, 2000 MURRAY HOME IMPROVEMENT 5 HORMAN RD, NORTH BILLERICA, MA. 01862 TEL. (978)663-7839 C.S.L. 77319 H.I.C. 127415 CONTRACT SUBMITTED TO: NAME: BILL & JENNY PICKET STREET: 90 BOSTON ST. CITY: NORTH ANDOVER STATE/ZIPCODE: MA. 01845 TEL. 978-685-4648 WORK TO BE PERFORMED AT. NAME: BILL & JENNY PICKET STREET: 90 BOSTON ST. CITY: NORTH ANDOVER STATE/ZIPCODE: MA. 01845 TEL. 978-685-4648 WE HEREBY PROPOSE TO FURNISH THE MATERIALS AND PERFORM THE LABOR NECESSARY FOR THE COMPLETION OF: • SIDING: STRIP EXISTING SIDING AND INSTALL CERTAINTEED MONOGRAM (&TD-COrM) TO ENTIRE EXTERIOR OF HOUSE USING 3/8" POLYSTYRENE INSULATION AS A BACKER. FOUNDATION WALL AT REAR OF HOUSE 53'X8' WILL BE STRAPPED AND SIDED, • TRIM: ALLUVIINUM COIL STOCK .019 (WHITE) WILL BE USED TO COVER TRIM ALONG ROOFLINE. • WINDOWS&DOORS: WINDOWS & DOORS WILL TRIMMED IN FULL. • CORNERBOARDS: 3 '/z" CORNERS WILL BE USED (WHITE) • LIGHTS: LIGHTS WILL BE REMOVED&REPLACED ON VINLY BLOCKS • SOFFIT: PERFORATED SOFFIT (WHITE) WILL BE INSTALLED AT ALL EVE LOCATIONS FOR VENTILATION. • VENTS: DRYER& GABLE VENTS WILL BE INSTALLED AS NECESSARY. • GUTTERS: GUTTERS WILL BE INSTALLED AT FRONT & REAR OF HOUSE WITH DOWNSPOUTS. • SHUTTERS: 3 PAIR OF SHUTTERS WILL BE INSTALLED AT FRONT OF HOUSE. • COPPER ROOF: CUSTOM BEND & INSTALL 16 OZ. COPPER TO BAY ROOF AT DRIVEWAY. ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED, AND THE ABOVE WORK TO BE PERFORMED IN ACCORDANCE WITH THE SPECIFICATIONS SUBMITTED FOR ABOVE WORK AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER FOR THE SUM OF: $9,300.00 WITH PAYMENTS TO BE MADE AS FOLLOWS: $3,000.00 DOWN, $3,000.00 HALF WAY, 3,300.00 UPON COMPLETION 5 YEAR WORKMANSHIP GUARANTEE ALL PRODUCTS INSTALLED BY OUR AUTHORIZED TECHNICIANS ARE FULLY GUARANTEED AGAINST FAULTY WORKMANSHIP FOR FIVE YEARS FROM THE ORIGINAL DATE OF INSTALLATION. THERE WILL BE NO CHARGE TO THE CUSTOMER FOR LABOR OR MATERIAL ON ANY REPAIR DUE TO FAULTY WORKMANSHIP DURING THAT FIVE (5) YEAR PERIOD. AUTHORIZATION TO DO THE WORK AS OUTLINED ABOVE. PAYMENT WILL BE MADE AS OUTLINED ABOVE. HOMEOWNER ERIC HURRAY Murray Home Improvement 5 Horn;<an Rd Billerica, MA 01862 Name / Address Bill & Jenny Picket 90 Boston St. North Andover Ma 01845 SCOPE OF WORK Proposal Date Estimate # 8/29/2000 2 Project siding Siding: Remove & replace existing siding. Install Certainteed Monogram to entire exterior using 3/8 insulation as a backer. Foundation area at back of house 53x9 will be strapped & sided. Trim: Aluminum coilstock .019 (white) will be used to trim along roofline. Windows & Doors: windows & doors will be trimmed in full with coilstock. Corner Boards: 3 1/2" corners will be used. Lights: lights will be removed & replaced on vinyl blocks. Soffit: perforated soffit will be installed at eves for ventilation. Vents: gable & dryer vents will be removed & replaced with vinyl fixtures. Gutters: gutters will be installed at all fascia Shutters 3 pair shutters will be installed at front of house. Copper Roof custom bend & install 16 oz copper roof on bay at right side of house. Please sign & remit to above address. Total $9,300.00 3 YEAR WORKMANSHQ' GUARANTEE All products installed by our authorized technicians are frilly guars deed against faulty workmanship for three years from the original date of installation. There will he no charge to the customer for labor of material on any Signature repay due 10 faulty worktnaoship during that three (3) year period. Jan. 24 2001 9:38RM MURRAY HOME IMPROVEMENT 9784581717 P.1 Murray Home Improvement Proposal 51, !Tom= Rd — �, - Bi ierica, IMA 01862 Ioste EsHnu�e AW I sn��2ooa s Name I Address Bill & Jenny Picket 90 Boston k Nor&,. Andover IAa 01945 COPE OF WORK I P R&Awd Deck: Deck at rear of hoose will be rebuilt. All rotted & warped wood will be replaced. Triple 2x10 beam will be installed using 4x4 for suppart Decking will be removed and replaced with lx4 Fir. Railings will be removed & replaced with coda. Cedar will consist of 4x4 posts connected with 2x4 cedar. 2x2 coder balusters will be screwed to outside of 2x4. Rail cap will be 514 x 6 cedar countersunk, screwed, pluggaa, and sanded smooth. Plse sip & remit to above z dz — Total !Y " 4K)RfafRdS" QUARAM'66 All pmftl wAWWbyanau&wkW1p�aCi�n!e[OfOlypLft.�s9d@SabgfiWywo vfattwft ymMethsalpAd=ofm on. 'tbmwfflbemd ploft=WowCorrberofaomma, 54n Buie -V-Pakduetobaby "msmgrft- (3)yWWSD& $5,598.00 Jan. 24 2001 9:38RM MURRAY NOME IMPROVEMENT 9784581717 p.3 zs Jan. 24 2001 9:38AM MURRAY HOME IMPROVEMENT 9784581717 p.2 M 0 z rA 4" GQ w U)v a cn o w oG c U w x a p. 0 o C2 �, q w U w W o rs: v u cn A w 0 w Cn q w w c as o z v) D o cn an 46 o O y O Y v: a� Q• C R R - = O Ea C CCOL8 m : 0 Co S'Co u � � y.v E y w CO O +' •R m �' C R cm O O c y O m A _�,,, �O Q1 r.+ C M C = •� r%- o m 'z�'-Z o .,:dos c o c CL •C �' $ ymo� m LU Lij •y AD = gZ = r+y=mC.2 CD o�1E= CLM COD C m O'O = 4�y•8 C = sa�m €O U Q FA vx. z O U C+ CD Q Z O 0 y .E i Z c 0 CD cc h CD CL y C 0 ev a - C ev O. CO3 L CD V CD CO2 C H = 3 .� ?• co 0 Q Lm CD CL. cmcC C cc c Z ts CDCL COD C 0 U) U) w w w U) No 4.5r 2 Date ............ r' TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......... ` `............................. . has permission to perform ............... ......:............... plumbing in the buildings of .� .�/...... �. �' . f:'::.I .......... . at .% .....!; North Andover, Mass. Fee,. . ` ... Lic. N/Z�J `.'........ -f. PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICA ION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date fy GY 1 Building Location 4-Wwners Name j 1 ► Permit # 1/3 Z y Amount 5i Type of Occupancy_ 9 ( la'1 C P New 0 Renovation Replacement Plans Submitted Yes El No ►' i '7 (Print or type)L Check one: Certificate Installing Company -Name J 1 a h Corp. Address J `/ Partner. El Business Telepho a ®�um/Co. Name of Licensed Plumber. I—rXo Qg S � 1 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boac Liability insurance policy Other type of indemnity Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does nothave 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 applicationl are true and accurate to the best of my knowledge and that all plumbing work and installation�=b P ued s application will be in compliance with all pertinent provisions of the Massa ch e C 2 f the General Laws. By:rgna or Licenseaum e Type of Plumbing License Title %cs Vo City/Town rcense um er MasterJourneyman APPROVED (OFFICE USE ONLY Location %o No. e>3L Date NORTN TOWN OF NORTH ANDOVER s Certificate of Occupancy $ s�CNUsE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ U� Check # ami 6Z4P 1S0v9 - BGQing Inspector 1.1 Property Address: ^� 1.2 Assessors Map and Parcel X0'7 3 Map Number Number: Parcel Number 1.3 Zoning Information: F Zoning.��r District osed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 SEUHUN 2 - PHUPERIY UWNEKSMPJAUTHORIZEll AGENT ' 2.1 Owner of Record �, ) a e (Print) Address for Service: 2.2 Owner of Record: Name Print Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Li ensed Construction Supervisor: 3.2 Tele e� 03 i Telephone Address for Service: Not Applicable ❑ OR/ 61- &90 11 License Number 85/c/` Expiration Date Applicable ❑ %j J) Registrationy Number yW ou rn M aas z Q i rn 0 rn 90 O ic v rn r z G) SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buil4ing permit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Description of Proposed Work check aIl 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 - - - QFl[CIA XEOi+1L.Y'` ` 1. Building O� -a / (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) rn c� 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 ou a 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 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Own er/A ent Date Emma NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR ITABERS 1 ST 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ln6 HOME IMPROVEMENT#CQNpACTOR TYPe Expiration 04/20/01 FRANK VALENTE BLDG & REMODELI "FRANCIS VALENTE noMiwslRnToaACHARY CROSSING SALEM NH 03079 13 J !r' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance .Affidavit dame %ZW1��1,/T%Z Fiease Frint I I am a homeowner perTcrming an worx myselr. I am a sole proprietor and have no one working in any capacity CI am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address Citi: Phone #: Insurance Co. Policv # l Comoanv name: Address Citv: Phone #" Insurance Co. Polio Failure to secure coverace as recuirac under Sec:icn 25A or MGL 152 can lead to the imposition of criminal penalties or a rine up to 51,500.00 and/or one years' impnscrrnent as -Neil as cavil penalties in the f.crm d a STCP WCRK ORCER and a fine cf (5100.00) a day against me. I understand that a copy of this stmement may be forwarded to the Office cf Investigations of the CIA `or coverage verification. 1 do hereby certiry u ? the pains and enaltie bf pe. a that the information provided accve is true and correct. Sicnature Print nam Fhone # � Official use only do not write in this area to be completed by city cr town ciriciai' '\ C`ty or Town PermitlUcensinc Building Dept ❑Check i immediate response is required [I Licensing Board .Selectman's Office Contact person: Phone T. ❑ Health Department Other p4p 0 d z rA x w o GQ.' d v $ w N a cn I:d w z 0 A w e .0 a w to a a: �. E :c U cz c w cd w pzq � o a: c w a o w U � w o 0x v cn c w a o U c., cc d o o 0� c w z w Q w x as o cn v cu o � LU z O U 0 z O U C/) CD c� o O a3 c o tsts O v CD Z Q. C H O D y � i.+ O o: co cm Cyi C3 W Im :2 OM CA CL) O CL M tv •9 m m C 0=1 LU !� O co F— ate... O L Cf) co �m m w E a O G C LU co 0 , ::5 ca LU� O A M OCL Qi Q : 0 a W W 'O y C U) O � c Ccoo co .. 0 V cm ti COD CD CDm a V y CO C CO m y 1C A:ycc O _ E m v cm cooC C coot/ m C7 y O i �oo fOA m C _cm �C 2 :m=., p N COD W C R = m C w _,,, O COD w �E O `� m 'y co W V m ca'0 o Cm V m CO2 :10 H �O = W z O U 0 z O U C/) CD O O v CD Z Q. O D y � co cm W Im :2 CA CL) O •9 m m LU CD a O co F— ate... Cf) co �m w O G C LU co LU� O A M OCL Qi Q W W 'O U) O � c Ccoo V COD CD V y CO CO .. y o .n PERI liT NO. i APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE, 1 MAP NO. LOT NO. 12 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE I SUB DIV. LOT NO. LOCATION a PURPOSE OF BUILDING �! S• •� OWNER'S NAME - A NO. OF STORIES 4iZE OWNER'S ADDRESS G BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME •�/U"�>`�`... SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET G ' POSTS DISTANCE FROM LOT LINES - SIDES -30 / 'f REAR •/ GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS v IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION Of 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 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATEFILED- O / `/h /� SIGNATURE OF OVHCER OR AUTHORIZED AGENT F E E � cr-0 PERMIT GRANTED ee_�11_-- S 19 3 PROPERTY INFORMATION LAND COST _ tip 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 BUILDING INSPECTOR 'NV -Id 101d S30b'1d3N SIH1 'a3SOdWIN3dnS '013 'S3E)vu -`d°J 'S3H0N0d H11M 'S9NIO11n9 d0 SNOISN3WIa 10VX3 aNV S3N11 101 WONd 30NV1SIa aNV 101dOSN0ISN3Wla 10VX3 MOHS1SnW N01103S SIHl 1s 1 _ I DIN1D313 pal I 1.W.9 110 SWOON 40 'ON L SVO S631V3H 11Nn 0.1.1-1 1NVI4V6 _ ONINOI114NOD NIV Sd313Vd 400M NOdVA NO 8,1.M lOH 'S10D '8 'SW9 1331S WV31S 'SIO: '8 'SW9 N39W11 NNf13 NIV lOH 437NOd 3JVNdnj SS313dld 1SIOf (lOOM DNIIV3H L L II DNIWVNd 9 OOVG 3111 60013 3111 _ S3dnikl3 NN300W ONId00N 11ON 63MOHS 11VIS 13AVNO'S NVl ON19Wflld ON 31V1S NNIS N3HDlDI S30NIHS QOOM ANO1VAVl S3l)NIHS 11VHdSV 13S01D 631VM 43HS 1V13 ('X13 6) WN 1311014NVSNVW 136MV0 'X13 E) H1V9 dIH 319VO ON19WIlld OL floodLNoN 5 NOOd I 3N0 1713d S 3WVN3 NO 3NO1S ONIHIM AdNOSVW NO 3NO1S )119 N34NID NO 'JNOJ _I 3WV83 NO XDIN9 60013 '8 'SdiS JI11V kNNOSVW NO NDIN9 —� — 3WV NO S ANNOSVW o:)Dni NO O��f11S 3111 'HdSV `ONI41S '1N3A NOWWOD ONMIS SO1S395V 0,M(1dVH ONMIS 11VHd SV H16V3 S310NIHS 400M E � l 9 313NDN0D ISQ6V09dVID SNOOK 6560011 6 I�S11VM bb N3HDlDI.NN340W WOON CIV3H S33Vld 3613 1.W.9 ON V36V 7111V 'NId %c °/i '/i V36V .1.W.9 'N13 1183 V3NV 1N3W3SV9 £ N13Nn 11VM ANO _ 631SV1d S631d Q.M(16VH 3NO1S NO )IJI69 3NId '>I.19 313dDNOJ Z ¢ 313nNO5 HSINId HOIN31N1 8 NOIIVONnoA Z N0110nN1SN00 _I S1N3W16VdV S3J1330 AlIWV3 'I1lf1W 53160!5 �-AIIWV3 3l°JNIS zL ADNedn000 L 0110:)3a JNlaiinv JNIIV3H` ON PIC zL ADNedn000 L 0110:)3a JNlaiinv 4- 0 a) 0) (13 CL d' LL 4- 0 (1) 4-J 11 a Qb V) Cn W i -d 76 (V Ln 0 U Ja) H�- a� ro 0 o a1 LL 2 4 ro 0 8 = fe a _ a� E c'y 0 w 0 m H O L L Q = 42 U v 0 i C O E C 0 = ,0 f}'G O 'G OGQ a� I 1= _o a 0 U O O C o � � a o � NORTH ANDOVER BUILDING DEPARTMENT °Arm 400 Osgood Street �Ss.-1sit Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: /0 ( , k_)_� NAME: --leaUi A, ADDRESS: __. 61_0 ZONING DISTRICT: TYPE OF BUSINESS: BUILDING LAYOUT PROVIDED: 1q, AVAILABLE PARKING SPACES: ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE Revised 11.5 04 BUSNESS FORM FOR TOWN CLERK