HomeMy WebLinkAboutMiscellaneous - 90 OLD FARM ROAD 4/30/2018NEW ENGLAND CLAIMS SERVICES INC.
❑ Incorporated 1985
Reply To Reply To
Mansfield, MA 02048 4,;., V" 131 Dodge Street, Suite 6
P.O. Box 345 ASSOW,'� Beverly, MA 01915
TEL. {508} 337-8058 '" Ns; Rs TEL. {978} 927-3000
FAX {508} 339-5835 Fa6nnz6FAX {978} 927-3002
wrandall@newenglandclaims.com
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec 3B
To: Building Commissioner or
Inspector of Buildings
City Hall
N. Andover, MA
RE: Insured:
Property Address:
Cause of Loss/Date:
File or Claim No:
Joshua & Jennifer Stacey
90 Old Farm Rd, N. Andover, MA
Collapse/2-18-15
BOS054228
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.
Section 3B. No insurer shall pay any claims (1) covering the loss, damage, or destruction to a
building or other structure, amounting to one thousand dollars or more, or (2) covering any loss,
damage or destruction of any amount, which causes the condition of a building or other structure
to render section six of chapter one hundred and forty-three applicable, without having at least
ten days previously given written notice to the building commissioner or inspector of buildings
appointed pursuant to the state building code, to the fire department or arson squad of the city or
town and to the board of health or board of selectmen of the city or town in which the same is
located. If at any time prior to payment the said city or town notifies the insurer by certified mail
- _%
of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to
section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B
of chapter one hundred and eleven, the said payment shall not be made while the said
proceedings are pending; provided, however, that said proceedings are initiated within thirty
days of receipt of such notification.
Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and
forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall
extend to and may be enforced by the city or town against any casualty insurance policy or
policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect
the lien were initiated.
No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other
interested party for amounts disbursed to a city or town under the provisions of this section, or
for amounts not disbursed to a city or town under the provisions of this section.
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.
Very Truly Yours,
Bruce Stanley
Adjuster `
978-430-0486 cell
87yG
Date V� // G. .
TOWN OF NORTH ANDOVER -
PERMIT FOR PLUMBING
� a ,
SSACMUS�
This certifies that ... .. .... ..}................. .
has permission to perform ..... Ljj :.4 .........................
plumbing in the buildings of ... h..v ..........................
at ... ��C.r" ...�.. f?� <<.'.. ..... ,c -North Andover, Mass.
Fee. 3 Lic. No.. .? .I... ............l J,- Gam .........
PLUMBING INSPE OR
Check # 2 L
ok
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
-\ (Print or Type)
Leh gt Mass. Date
_ Permit #
Building Location_`() a�QI m ,� / �e �o
Owner's Name�p,-1. j LU
Type of Occupancy Residential
New ❑ Renovation ❑ Replacement 09 Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Heritage Htg. &Plg. Co. Inc.
Address , 1 as an S resat
Stonehamy'Ma 02180
Business Telephone 781 —43g—.7276
Name of Licensed Plumber Gordon Switzer
Check one: Certificate
EX Corporation 714
❑ Partnership
171 Firm/Co.
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy IN Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter 14 of the General Laws.
Title 51wlatupu ol ucensedPlumber
City/Town Type of License: Master [g Journeyman p
APPROVE 0 1 9EZffUT-- License Number 8322
p
!f
: Jr, .moi ..
Y L 4) ii
W
,sok4f',
}cr J 4 f t <
t >;
9
j
cc
� e � � # { • t t i
-
�
e} t
� y � 4
x
rr`
5..
{ t:wl.
4v'
e
.. � ' �`� (' t Y R�
Y t � 4!� H �, + q /
..
Y� Y1 � 5 7 f
l r i � �, .,
3 � t •sn. Yf
3 c f+f,'k a �x.r '( q#r Lr
�
'.1 � � ��. `�o`rt.
yt t t
ft .. '{ ., L.. j �i f, ° {
,,.i7�.
z �,
�
d qq
.4 a
il..:i f
� � •
�
{{ 4
Ic
z
CL
i
#
.-
a
LL
O •' CC
A
a
cc
z
O
u,
¢
p
3
o
� , LL"
W
1
Y
a
to
ac
UJ 0.
Ju
r
;r
1�—
ql
�
.. t •� tYiCt �". ��t: #rf'J t,+4. t'jf �� rw:"'
^a.
r. '
..t'
' � �
,". ,,,w .. }:. ...i. }+..:•i tet. M1'r•=..�,,.t.. ...... ........ •,,.
i .h.
a'1'
�� �"i � FIY .'i� y 5. L•�7i 7 ..
...`
{�
lr F F�•Z T, Lf "IrhQ l! 3J,!+{ .Fh � � 45''•
.l'�3
.`}
.;
r
F
Location
C�o a/cOARAf J"fid
No.y () -8 Date Y -13-0a
e�
,SJACNUSES
I
I
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # /C) S(
n 0
16010 /U ( r -.A- -
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
er ,' , z.AM W 01 s.: s f, e (t `,r's. (l., x>°a� 21 x' s ti . c�':`, `' Fwy^ .�;s� '
u"
xr 1`.. i�,i,:
BUILDING PERMIT NUMBER: DATE ISSUED:
.2. 7 V t f
SIGNATURE:
Building Commissioner/I ctor of Buildings Date
[�T /1TTA1T l',iTT
uI.+V L1V1� 1-ul AL` J Ix VA%.Lv %L 1V1q
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Ah /� A M V�
Map Number
Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
RNuired
Provided
1.7 Water Supply M.G.L.C.40. 54)
Public ❑ Private ❑, ,. `• Zone
1.5. Flood Zone Information:
Outside Flood Zone ❑
1.8 Sewerage Disposal S tem:
erag Disp ys
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
AIN
qo b I,
PF"gy n D , A).141VP6V
Name (Print)
Address for Service
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 ❑
DAV I R CJ4STR J ctA
/
1E
Licensed Construction Supervisor:
OD s 1,�TTa A) - ' T:
A
�►J'y, ,�� o U1 j2)
License Number
ss
r
Signature
Telephone
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
.,,4 1
(j
Company Name
a
ry 6 b u ��b J ST
r , fl 6 ��� � r' � Or ��
Registration Number
j
A s
1 `f / C)
Expiration Date
Signature Telephone
OU
M
X
z
m
O
z
M
90
O
Z
Q
C-1
SECTION 4 - WORKERS COMPENSATION (MG.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 .......0 No ....... 0
SECTION 5 Description of Proposed Work check ap licable
New Construction ❑ Existing Building V
Repair(s)
❑
Alt�tion )
Addition ❑
Accessory Bldg. ❑ 'Demolitiori ❑ "Other,
Brief Description of Proposed Work:
P
Specfy
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
�beItem Estimated Cost (Dollar) to
C leted b ermit a li
1b` ,
s
1. Building
6
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee ta) X (b)
70'
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
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, DAV 1-2 C h -. X 11 Ch AI F as Owner uthorized Agen 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 195
Print e
Si nature of Owner/Agent
NO. OF STORIES
Date
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1
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:
0-, P �A-Q-- V?- a -(2P 0,,cg-
(Location of Facility)
(I ;7�
ignature 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
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 104569
Expiration; 7/14/2004
Type: Private Corporation
DAVID CASTRICONE ROOFING, S
ENO Nstricone
7 Hillside Road
Boxford, MA 01921
Administrator
ACQWL CERTIFICATE
3/20 2'
OF LIABILITY INSURANCE ZION
PRODUCERTHIS
INTRRNRT IDTsf<CRA1r1C! A=NcY
CERTIFICATC IS ISSUED A$ A MATTER OF
ONLY AND CONFER3 NO RIGHTS UPON THE CERTIFICATE
HOLDER. TH13 CERTIFICATE DOES NOT AMEND, EXTEND OR
522 CBICIMRZXQ ROAD
ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NORTH AiIDOVLR, Nh 01865
INOuREo
DAVID CASTRIcalm
INSURER A: AREtI+I.LA
INSURER B: AMLLA PROTIICTION
-
ROOFIIiG AND SIDIdTG INC.
INSURER C. ROYAL SUN ALLIANCE
200 WJTTON &TRUST, STSTTZ 226
IN8URERD.
]!SORTS AXDMR UK 01865—
INSURER E
06/06/2002
rnvcQAcca
FINEDAMAGE(Anyorafir� B 50,000
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY MAY PERTAINMTHE INSURANCE AFFORDED BY THE POLICENT, TERM OR CONDITION OF ANY ES DESCRIBED HEREIN S SUBJ CTCTOR OTHER DOCUMENT WITH ` O AALLL THE TS CERTIFICATE MA F
Y 8 ISSUED OR
ETO IRM ECH I%CLU510 SAND CONDITIONS Of SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
TTPEOPINBU !
POLICY NUMBER
Pali OYEkPIRATICN
GGNERALLIANUITY
LIMIT8
EACHOGGURRENCE s l 000 000
A
COMM@RCUILGEWRALLIABILITY
CLAUS NUDE fc-1 OCCUR
8500012710
06/06/2002
06/06/2003
FINEDAMAGE(Anyorafir� B 50,000
. MED EXP (Any on..acn) iS 5,000
PERSONAL& ADV INJURY 4 1,000,000
GENERALACOREGATS s 1 000, 000
GEWLAGGREGAT PUMITAPPLIESPER:
Lol POLICY LOC
' PRODUCTS -COMPIOPAGG 0 11000,000
AUT0110M1B
LIABILITY
ANY AUTO
COMBWEDSINGLE LMIT =
TFj Aawtm
B
®
SCHEDULE AUTO
SCHEDULED AUTOS
44506400001
08/01/2002
00/01/2003
BODILY INJURY
(perp) 7 230,000
HIRED AUTOS
N044MGOAUTOS
pP�Y IN1 Y t $00,000
--
PROPERTY DAMAGE
(PrzeiMrl!) i 100,000
IBAKW9 UA UTY
ANY AUTO
AUTO ONLY • EA ACCIDENT i
OTHER THAN EA ACC B
AUTO ONLY: AGC f
EXCESS LM"ITT
OGCUR CLAIMS MADE
EACH OCCURRENGS
AGGREGATE B
s
❑ DEDUCTI6LE
AtTlNTION
B
WQRKlJRS COMPENSATION AND
EMPLOYOW UABWTY
T _
E.L. EACH ACCIDENT s 100 600
C
791X978101
09/23/2002
09/23/2003
E.L. MC U-F,AEMPLOYE 3 B00,000
EL. DISEASE - POLICYUum s 100,000
OTHER
DR601 ION OF OPERATION>ifLDCJ1TWNiryE}IlpLlyE><G UBIONB ADDED PY iNDORUMI NNOAMAL PROVISIONS
CERTIFICATE MAI 119D
BHOULP ANY OF THE ABOVE DESORHIED pOL101E8 BE OANCILLED BEFORE THE EXPIRATION
CATS THEREOF, THE IBBUIND OIBURER WILL BNOKAVORTO MAIL 03-0 pAYG W N ITR14
NOTICE TO THE GB ITIFICATE HOLDER NAMED TO TNS LEFT, BUT FAILURE TO DO SO SHALL
IMPORE NO OBU12AIM OR LIIBWTY OF ANY KIND UKM THE IN"ItEk ITS AGENTS OR
AUTHORISED
m
M
m
.w
y
co
CD O
o. r
Co 03
O
Odc
CD
p
CL
Q
CD O
.. :
I&
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
NORTH ANDOVER Mass. Date 3/3 19 97 Permit # „�Z 6 U
S Building Location 90 Old Farm Rd. Owner's Name Lu
Type of Occupancy Residential
New ❑ Renovation ❑ Replacement N Plans Submitted: Yes ❑ No ❑
FIXTURES
t '
Installing Company Name Heritage Htg. &P1g. Co. Inc.
Address 35 Pleasant Street
_ Stoneham, Ma 02180
Business Telephone 617-438-7776
Name of Licensed Plumber Gordon Switzer
Check one: Certificate
EX Corporation 714
D Partnership
F] Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N No ❑
If you have checked ,yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy (3 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
^ _ Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 o the General Laws.
By .�
A^ Signature of Licensed Plumber
Title____
City/Town�_T Type of License: Master (X Journeyman ❑
APPROVED (OFFICE USE ONLY) License Number -8322
N
V)
'�
N
o
z
Q
�_'
:
y
ri r -I
0 W
'd
F-
W
0
Y
J to
Q
V
F
N
Z
7
O �
a
Uj
¢
�
�I
O
W
H W_¢
N
zX
F{
++
Z
ca
N
W
?
O
0.
Q
N
C:
a•,
O
7
W
2
+:
Q
W
Z
C O LL
LL
X
x x x
jl
Q
S
z
=
Y d
0
~
Z
x
`i
W W Y
W
�4
F-
Q
U
H �'
F-
S
O y
d
N
]
y
H
Z O
O
N
__
W
I"
z
�+
3
Y J
I CO
to O
O
J
3
=
N N
LL
O
7
0
Q
3 O—i
m
O
ra rd b
33 33�n
fd
SUB—BSMT.
BASEMENT
1
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
Business Telephone 617-438-7776
Name of Licensed Plumber Gordon Switzer
Check one: Certificate
EX Corporation 714
D Partnership
F] Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N No ❑
If you have checked ,yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy (3 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
^ _ Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 o the General Laws.
By .�
A^ Signature of Licensed Plumber
Title____
City/Town�_T Type of License: Master (X Journeyman ❑
APPROVED (OFFICE USE ONLY) License Number -8322
J
z
O
W
N
W
V
LL
LL
O
¢
O
LL
3
O
J
W
w
N
z.
Oi
N
U
W
M
N
z
N
N
W
2
0
O
a
N
W
U
F-
W
Y
N
W
w
LL
O
z
co
z
m
J
a
O
Q
O
F'
H
�_
O
¢
O
w
J
z
a
�
o
O
LL
LL
Q
m
z
w
LL
O
a
O
z
Q
O
W
U
Fc
07
W
OA
QZ
CL
Oi
.-
Location Qu d (A 'FA r M 2 CQ
No. Date
TOWN OF NORTH ANDOVER
5 6 Li J Building Inspector
+ (�
Certificate Occupancy
of
$
swCHus
Building/Frame Permit Fee
$ 3
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$ 3
3 'l q
Check #
5 6 Li J Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED: Q a
SIGNATURE: ZO�/M LCA
Building Commissioner/I for of Buildings Date
SECTION 1- SITE INFORMATION
LI Property Address:
o OLD FARM
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
V / f� , C
J
1.3 Zoning Information:/v
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
L LA
ame (Print) Address for Service
Signature "1 Telephone
/ 1J0
2.2 Owner6f Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed C± struction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
00
M
X
ic
Z
O
W
I -
N1 I
I
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Faili
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) ❑ Alterations(s) • ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
F(A) 1514 F4rilLV A
to provide this affidavit will result
Addition ❑
CC--/ Lrov c Z_� 614 7s & crl'(ct4 X
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building
DC�C7
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, G( &i�l" (S;)
weer/Au orized Agent of subject property
Hereby authorize c' to act on
My behalf, inV!6�
e to ork orized by this building permit application.
6 X27^ tZ
Si nariue of i4 4 Date �
SECTION O R/ VTHORIZED 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
/
l
Signature of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 s 2 ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
llM ENSIONS 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
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 0184.5
�•':.
d
D. Robert Nicetta .
Building Commissioner
(978) 688-9545
(978) 688-9542 Fax
HOMEOWNER LICENSE EXEMPTION
Please print
DATE
JOB LOCATION O�. FA ` ni
"HOMEOWN
)er
(EFF,ez
OU CC[ HOQre55
Name Home Phone
PRESENT MAILING ADDRESS]
City Town State
3 �Y4
Map / lot
50,i&
Work Phone
0 / Fys- '
Zip Code
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 ads as supervisor. (State Budding Code Section 108.3.5.1)
DEFINITION OF HOMEWOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one or two family dwelling, attached or detached structures ac-
cessory 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 horneowner
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned "homeowner" certifies that he/she understands the Town of No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedures and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICI
If
I ,r _ t '� »{.: t, . . A _ ar 3 i e t J` ,, ,x ..'`! - #`g % v i' 4 4r :� y r.'
i L. S h' +{J pjox 1 f
:. x a 4 a.. S *3
9 .. ,_x ,.V: 'F. r �, t tea, v - W .6:x e ��s',. •b e . ''.t a .'t _--.i,
, :4
).:' C i _ r .� # G xJ Y f ..:s� a 'x�y. a 1 y� Jp d r t ''.
'• > . r i r W.'Fa! 5 ♦ t x ° , . > K:r ` � s A ". r L.r it 1 R ' « i t [ { E"':
Y, :k. `.,1:-I'-,1,.-, t 1.4 r,� a L S -x.. � 3. " a .ak ..V +
,a2.� S 1 d<t• r`'< L r i.., .~ •RiT s �^= -v [ 'r )` �:.i + 3 p yy~,;� .3 v r
1.1. -,.... ). d ..Z J -'tTR. l :'J. J F ,.�._ .app < 3 ,� 1
jj
S H
v. r .. K f; w << W .r a i, e t _ p �' z <, a .i i ni- i X i -•.
a S X +'" '11-z. ) t t �, e }..� . + c *° .4; 1x 'x ( s = - } ;ep 1, :.W rai yY s h �
{'t R 1. i4 `'h 1a Y 1;Y ,.� .t .'rr:,,,st ;M kie �tr.tc 1 '4 j: r -..Y't .3-•'/' s a t �"<c �,. p R c q'� ,
11 I1 '' Y i j: i h AF '<t I„4t W c. 'F y r + r a, - �.v t% ti r Y, s-
'� ' N.
y .tea ,#,. c .tv +� , 1.54L..Y + } ' ` L r r r't
h fid.' g s _ _ E y 1! f- '` ie t• "Y - C v'1 Z " v "I y, ?.
t �„ } v i €, -4, y""4 of r a - t+ •' - r �` e x ts.. t a < .
r 3 & ti� F .}�`,> :I:,- f y- s - h ..'. S r�,_ ! ! x -',r t
4 , � � e s ; s tom) xx, - ,i p, a si
10,
'jp
S': , d ' z.`t. J F `Y:. Y*yA�10" ',, ,, Y.ij„Ei � �1 > {
_ f. _�, ) ;'t Z s : `?' aL S✓T .Txy .at 7 y n .
L fi Y i, b r t K -`` '
a
:'» r s. r c`:' 1 ., a .s ." as Efjj" r t' 't i c •, e ..,t
TZ, F .:
F 1' y .-i< t r 1500-453f, .d } i, a+,ar S W. Sj -t r,.
n WASAX
g. t t t -.r�, a .. q -. _ y w -+`P 't?' `'ri' `t a Y
I-
- : xa Y til. n�'3 t y, <,x ...l. z -' } .: h �t 4 5 c
#i 4Y' i i}F a Y16� t# .+''i+1 ex ..-V}J� Y t �ti, t. i.'A. ".r 4 t
... '...'r av y < ' �� 't 1
S s�. � 5 t R` `~` of .i..°; f •... f i s f- # e` { t : t k 3 r i.�V,., ,V * lt "-{
�� t" .. L *" ,.J 4 xa '`, .�f'� rte' j c r t :'rr r < ✓ .. }s. � .A ''
11
z.. _v 11 r r ..... fir. ,� -. ,, 1 sf+ v g i H. y
` ! .y !
_vr
.` 2 1. + '�'_ k :. ,tj: e'a' .y's' c c 4 }� ♦ i S 'sz } t;. r rR f`
✓ �� F' fi,£ y.
. A tS i . r tt.� r0 to -
.X
tz�
1 12
Jt s fi.- S �., ,t K x �..,i x'r' .. f �. �, 'r . Y i } a f ••�I
/1 5 y 'k 'k� "- r . ifi � 1 1 �. " +"t1 e •� i,� r 'Z .�... t 3 . t` s -rs. , yb
:.. a r- SL a* _ • t L " i .r :'.M { � .1 4 tL �# # 't i! Y
1-1- '_ f i ;A ,t I. ` i? {i¢` t �i �A a 4lh t ,, b > 5 INA r r
u F s+ ., at'•y * f �,. : 'r v .r '„ .,tr,.,.- 0.? ^' 3 •/�. � vS y R r ,�
't ar' .rt $ St }
A t• of �1,1` r r'
. i}t t �c.j � � * -': .e.. r m =, ft.,, t.' ''t Y r �` #f .--W. f rr a 3i �> ti "s
ATONT
T" ^ ..
1 F ! q - 'xe tj_ t 3 '�? . Fi r.+ S 11 ; , o- .2 i v
i. r ''U ,— `4` €"a*RY t cr .. s. . < S t `. 4.. e,i x --- Y .} t, 'i L
I,, , "'� F �' ay's` ` . ` S S.. "". .: : s ao-.. t ryAd t ) r t * y
4 r f> .: ) ♦ X1.11 1 = -% 3'. s ti + ^r tax r i .,. r, ,< . 4 .zY .
t t s} 'Fi \ Y "4 s i° .w at i t y 3 ,Y f�'ti ':t "sY.. n # J t t
.�i� t f rx n i:;,s r4 i� c t e, } .1
� rrf `r,c r
-" gy. 31 ..! - v, ��_.�-j .- "QW, 1"�� ,
Q_ i k 1.4 f41
A y. fi .ka i }�? t #, �� I ., } l r '�i t /. r ti .
g
r 'r :,G i S. , ^ 1.. - X `'/ f r ,� ° ^�` i `y. .vy ''i{ y; .
. ...¢s. i . -"x Z y.. -
,i YiY'st 4x 'YS { F tti i+.n r;'x ., � to .4 —qj.�, a%i; t r Z [ s Vit.
Mnw!
I A,
' Z Ff 4t `SA f x a .t •v i- r+" bi',:..- r.,�. r .t-tf J:. #'. c ?,..!•' # " A",
r. 1i�. , i. ^ t n M.{ t £' !' 4 ' �.•. 4 S Y 111 -. ? f `,..!
9 F a +.
Biu 'fi A.?G,; ,+'4e ;r; -
t .t+ t 'i-`a•'01vz, sR \ w>„u t e r ,+ ..} -i `5
s ar 1 - s s k. FF - r.` 'rt a., '� " a 1' .: F }r,3'z y,v
` :j4. .f ? 4 ' ''F4'n \ 4 t S 2 �. au.. ax ✓_
F .1 5 .%- - .�.
_ _ -''- a..... :. n .:ti ,.... ......a a... E _....a.��__ , ., ....,<.f.._G;:<� :__....,..,_»...»..._ ..,�. ._ ...,' :......t ,c_' ,+' . 3 «''..:r .+...Fti.-- .A�. �-aa:a. � -.. _ . . _ _.,. » _,.: 4,t,,; r, x Y. .... s.•�..,......
32 jr^ r
,
Date.
-TOWN OF NORTH ANDOVER
ry
PERMIT FOR PLUMBING
This certifies that . ...... ...........
has permission to perform .................... ........
ro
umbing inthebqx1din
gd of ... ...............
North And^r,Masl.
leeLic. Io..2. Z- .........
PL � �Bl G INSPECTOR
WHITE: Applicant, CANARY: Building Dept. PINK: Treasurer
a
m
m
m
C/)
0
m
C)
CA Cl)
10 0
CD
n Z CO)
CL o
? C
CZ =' y
aCO
�o
oom
CDCL
o
Cr
CD
CD O CD
WWF
CD �
r
a O CD
CO)
O -• CO) O Q H
»S m v y
a.o m n
o H 5 a� 3 m
Z CD �-0 H '_•I
m c -n
o n � d = m
m —1 O m H O —i
O =r m m
-0 C',
:` Cm9 •��
co �• p =
O G y n
00 ' m
b I
r� � y = /� 1
Cil a n O = `0
A r"' a = U2 0O
C=Dr
Cn
,.. CD
d m c»
c m '%
n Ham:
Od:Z
H y
CL
c
^� o r C12ra
►ay N �i C to
CA CDCA :0
Q O
VJ y -1, ai
CD
O O mo` 0:
z �1 CD o Z
� O
� z co
� O
Ah
. pm,
OC41:
� 177: • o, 0..
1�CO
_
_�
n:
O ..,
CA
c o
O_
0 : m
:Ow = .
o
m �
�q
Cn
0
9
Cn
Z
07
r��ry
?7
x*7
z
J
rb
x
�"'
�
rA
m
'j7
"C
r
C
',.r,1
n
:j
(D
G
�7
x
^rf
p..
n
M
Ccn
p•1
�
0
Cn
y
fr9
In
?�
r)
.n7_
rD
9
PI
v
W)
v
1
y
0
9
0
c
3914
Date ;71:�l....
f NorrrM 1
�3:°.;�`°.;•.."o,L TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that ..... ?.. �...1.
/`'�
... J.(.. ...........................
kas permission to perform ................... ..l'.C:�...1..
wiring in the building of .....................� G!.lt.�..f............................................
4 17 011-1 ���.� L
at........./...................................................... Z'/ ..— ,. North Andover, Mass—
Fee ... �!.......... �.`) Lic. No. ,` lam'
ELECTR'CAL INSPECTOR
Check # / `
utnciai use unniy
PermitNo. !/ ..
Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date
To the Inspector of W' es:
Town of North Andover
The undersigned applies for a permit to
Location (Street & Number
Owner or Tenant �l
Owner's Address
the electrical work described below.
is this permit in conjunctionwitha building ptermiit/t�� ���� Yes 9Y ` r No ❑ (Check Appropriate Box)
Purpose of Building �Ci�7/dA) %9J"bM , f Utility Authorization No.
Existing Service n` Amp -1 � /f7 Voits Overhead ❑ Undgmd ❑ No. of Meters
New Service Amps Voits
Nunlber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
Overhead ❑ Undgmd ❑ No. of Meters
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER =.(Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury:
FIRM NAME LIC. NO.
OWNER'S INSURANCE WAIVER: I am aware that the
General Laws. And that my signgtuge on this permit
(Signature of
Bus. Tel No.
Alt Tel. No.
.s does not have the insurance coverage or its substantial equivalent as required by Massachusetts
on waives this requirement. Owner Agent (Please Check one)
Pl
Telephone No. vim+ � 9v PERMITfEE v
Total
No. of Light nOutlets
No. of Hot fuse
No. of Transformers KVA
Above ❑ In ❑
No. of Lighting Fixtures
Swimming Pool
grnd ❑ grnd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
1
No. of Switch Outlets
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 Di sal
No.
Pumps Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of ishwashers
Space/Area Heating
KW
DetectiorkSounding Devices
❑ Municipal ❑ Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wiring
No.. Hydro Massage Tuds
No. of Motors
Total HP
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER =.(Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury:
FIRM NAME LIC. NO.
OWNER'S INSURANCE WAIVER: I am aware that the
General Laws. And that my signgtuge on this permit
(Signature of
Bus. Tel No.
Alt Tel. No.
.s does not have the insurance coverage or its substantial equivalent as required by Massachusetts
on waives this requirement. Owner Agent (Please Check one)
Pl
Telephone No. vim+ � 9v PERMITfEE v