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HomeMy WebLinkAboutMiscellaneous - 92 PRESCOTT STREET 4/30/2018N Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 14,700.00 m $ - $ 176.40 Plumbing Fee $ 22.05 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 22.05 Total fees collected $ 320.50 92 Prescott Street 419-2016 on 10-5-15 Reno 3/4 bath Date... 1$5 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..........................................................:........ has permission for gas instal ati n ..... -V......... inthe buildi s of...................L'.......................................................... at .....q.71 ..... i A......................................... 1...., North Andover, Mass. Fee!�P...�7.......... Lic. No... � .. ... .................................................... GASINSPECTOR Check ?1 ! 09902 G TYPE OR PRINT CX,EA,RLY BOILER BOOSTER MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY fJoRz Nola �aDa ,. - _j.:MA `DATE; PE•tI�iT JOBSITE ADDRESS Sr OWNER'S NAME a OWNER ADDRESS TEL.— —_FAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL NEW: Q RENOVATION: ----- 7 FLOORS.; -► f3f17T�:7 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GRILLE _ INFRARED HEATER - LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT UNIT HEATER UNVE NTED ROOM HEATER WATER HEATER REPLACEMENT: 13' INSURANCE COVERAGE PLANS SUBMITTED: YES El NO[ - 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 I have a current liability nsurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES [gfO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY �! OTHER TYPE INDEMNITY ® BOND �l OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY:. OWNER ® AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate a best of no ge and that all plumbing work and installations performed under the permit issued for this application will be in compliance II anent no Massachusetts State Plumbing Code and Chapter 142 of the General Laws. f PLUMBER-GASFITTER NAME r g&ri£ LICENSE# 1S6k SIGNAT MP �MGF 0 JP ® JGF [- LPGI ® CORPORATION ..3f�( PART RSHIP ®# LLC E# COMPANY NAME: eerSec-e•,S ADDRESS o2v — CITY STATE' !►t A ZIP 2 t Z 2- TEL FAX CELL �EMAIL w �r w -6/56 Aft. NQ-1�006.. -S-If 44 N 3,31 3-7 1 Ald I S - 'Old'81 fl3,hJbV9 M d'i "A' St! atu, .... .. . . . . - g, 3SN13-11SS - "i'3 3 w n I'd Al 7367WV3Ai �NOWKO O -t pp ZIMIHC _7 rt 31, g S if W' APq ,Hl r 513111 3S E led S, FEENBRO.01 SMORAN 'AC-l"RIED I- -- —----CERi1FtCldiE OF LIABILITYINSURANCE �'� FDATE(MLVDDNYYY)-- 1130/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In ileu of such endorsement(s). PRODUCER Rogers & Gray Insurance Agency, Inc. 4344 Rte 134 South Dennis, MA 02660 CONTACT PHONE (F 877 816-2156 (AIC,No Ext : Arc NII: IF-MAILDDRESS: INSURER(S) AFFORDING COVERAGE NAIC A2CG07501501 -' INsuRERA:OId Republic General Insurance Corp. 24139 02/0112016 INSURED INSURER B INSURERC• Feeney Brothers Services LLC 103 Clayton St PO BOX 220601 INSURER D: INSURER E. Dorchester, MA 02122 INSURER F: $ CrTVFRAr.FR CFRTIF"IRATR Bn IRARPR• 0MVICIAAI AIFIAAQCC. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I�7R TYPE OF INSURANCE DD SBR POLICY NUMBER IMVDCDIYYYY POLIC XP LIMITS A X COMMERCIAL GENERAL LIABILITY CIAMIS-MADE a OCCUR A2CG07501501 -' 02101/2015 02/0112016 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrencel_ 308,00 MED EXP (Any one Person) $ 10,00 PERSONAL &ADVINJURY $ 1,000,00 GEN 'LAGGREGATELIMIT APPLIES PER: PODCY� jE�T LOC OTHER: GENERALAGGREGATE S 2,000,00 PRODUCTS -COMPIOPAGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALLO"AUTOS N£D AUTOS LEO HIREDALITOS q�OSS�9VE0 - COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per Person) $ BODILYINJURY(Peraccident) $� PeracdcllentlERTY AGE $ g UMBRELIALIAB EXCESS LIAR OCCUR ClAi6JS l.44DE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN A14YPROPRIETORIPARTNER/EXECUTNE OFFICER11.I0.I8EREXCLUDED? (Mandatory In PIN) Ivyes, descnbe under DESCRIPTIONOFOPERATIONS b0aN NIA A2CW07601501 02/01/2015 02101/2016 X PER O7H- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EA EMPLOYEE S 1,000,00 E.L. DISEASE - POLICY LIMIT S 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North 1600 Osgood And ACCORDANCE WITH THE POLICY PROVISIONS, North Andover, MA 01845 AUTHORIZED REPRESENTATIVE '1 .�1 iS a ©1988-2014 ACORD CORPORATION. All rights reserved. N ACRD 25 (2014101) The ACORD name and logo ate regibtered marks of ACORD. Date ..(�J.�. J . ....... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........ . has permission for gas installation .. �. . .............. in the buildings of .. �... �J�`'%k t ! ' ..................... . at .......... North Andover, Mass. Fee. Lic. No. / / .� .. ..... dAS INSPECTOR Check # 6021 J G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 40 /Y- Ayj„c,,/ , Mass. Date / 0-1�2 2007 Permit # C/-niJ 2 / Building Location9� �j^� cb1 Owner's Name Owner's Tep %' Type of Occupency j New ❑ Renovation M Replacement 0 Plan Submitted: Yes F-1 No Installing Company Name Addario's Plumbing & Heating LLC. Check one : Certificate Address 20 Cooper StreetX Corporation 2720 Lynn, MA. 01905 Partnership Business Telephone 339-440-8100 Firm/Co. Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr. Insurance Coverage : I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑x No F1 If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑x Other type of indemnity 1:1 Bond El 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 1:1 Agent Signature of Owner or Owner's Agent I hearby certify that all of the details and information 1 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 Gas Code and Chapter 142 of the General Laws. By Type of License: Title X Plumber ' City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter Approved (OFFICE USE ONLY) X Master Journeyman License Number 13106 Owl Installing Company Name Addario's Plumbing & Heating LLC. Check one : Certificate Address 20 Cooper StreetX Corporation 2720 Lynn, MA. 01905 Partnership Business Telephone 339-440-8100 Firm/Co. Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr. Insurance Coverage : I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑x No F1 If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑x Other type of indemnity 1:1 Bond El 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 1:1 Agent Signature of Owner or Owner's Agent I hearby certify that all of the details and information 1 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 Gas Code and Chapter 142 of the General Laws. By Type of License: Title X Plumber ' City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter Approved (OFFICE USE ONLY) X Master Journeyman License Number 13106 r- 0 n D O z O m W c F v z 0 m m m z O m z D r z on a m co O z con CD X m -i n a m on X O O 70 A cn cn z m n O z P Date . �/? ... /G . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 4 ,SSACMUSES This certifies that!q..`..........r..... .... . has permission to perform .... ........ . ` ...... ...... . plumbing in the buildings of .................. Pn, . r ` C�� ........... <North Andover, Mass. Fee. �3..... Lic. No...�`>. 3 3. ... .......... � /�......... . /PLUMBING IN PECTOR Check +f ii Ulf * MASSACHUSETTS UNIFORM APPLtCAT10N FOR PERMIT TO DO PLUMBING 3 CitylTown- MA. Da_ermiY# Owners Name. G Building location: f ore' dial ❑ Educational ❑ Industrial Institutional ❑ Residential Type o occupancy: P cy: Com New: C] Alteration: ❑ R novation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ FIXTURES z z 0 Z CD 1 = t— W fn ix CO) 0.. L>= Z i tX fn ? a a O z eQ� t– w Q QQ, ; o o w in ¢ w w ttu U.l =� Q�Q w U 0 ID m F BSMT.MENTOOR 2 FLOOR 3 FLOOR - 4 FLOOR 5 FLOOR 6 FLOOR I Vn FLOOR 8 FLOOR Check One Only Certificate # installing Company Name: ❑ Corporation Address: /Town �e ❑ Partnership Business Tei: �4��. ax* — _ trmlCompany i Name of Licensed Plumber. INSURANCE COVERAGE: 1 have a current liabilityinsurance-policy or its s siantial equivalent which meets the requirements of MGL. -Ch. 142 Yes No ❑ if you have checked Yes. please indicate the type` f coverage by checking the appropriate box below. A liability Insurance policy" Of, r type of indemnity ❑ 'Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that a licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signat.re on this permit application waives thisCheck One Only Owner ❑ Agent ❑ �1�_naneratureof or Owner's A entby certiat all of the details and inforntation 1 have submitted (or enteredj regarding this application are true --and accurate to the best of my at. Pertinent Provision ofithe Masi ach work a State Installation.. performed de and C der the 142 of the General Lawsrmit issued for this Ppt(cation will be in compliance with all gy Type of license: aiure of Licensed um er Tide ❑ PIPI bef , _ F2' Caster `' License Number: 4?v3 Gtylrown ❑Journey an APPROVED OFFICE USE ONLY).- Date. ./e XIIW'�l ........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that0 . ..................... has permission for gas installation in the buildings of .... eqrol . V114e.�................. ... at .... Y,?.A4.X4P........ North Andover, Mass. ....... Fee. sA<�V Lic. No../6 91-:1 .. I GAS INSPECTOR Check# lv'7� 7897 MASSACHUSETTSLTAMRMAPPLICATONFDR PERNIlT TD DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Pre S Co -ti s -f CCc ro tI , 151'1 -e U Owner's Name Date 11 -to -11 New ❑ Renovation ❑ Replacement Ef Plans Submitted ❑ Permit # Amount $ 30. OQ (Print or type Address Name of Licensed Plumber or Gas Fitter! Checone: Certificate Installing Company Corp. 1-7 a0 ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked yes, please i icate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: 1 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 ❑ I hereby certity that all of the details and intormation 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 Statee�e a Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of 1 ❑ Plumber ❑ Gas Fitter Master ❑ Journeyman Plumber Or Gas Fitter 1©aS-& (cense Numoer z a z a w z a a o c F x U F z F z F C7 0 > w Fw w W z a w e a F d �- w z o z o x a w > w z a d d o o w a o w F x x o x w 3 a v a> a w F o SUB -BA SEMEN T BA SEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4 T H. F L O O R 5 T H. F L O O R 6TH. FLOOR 7 T H. F L O O R STH . FLOOR (Print or type Address Name of Licensed Plumber or Gas Fitter! Checone: Certificate Installing Company Corp. 1-7 a0 ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked yes, please i icate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: 1 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 ❑ I hereby certity that all of the details and intormation 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 Statee�e a Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of 1 ❑ Plumber ❑ Gas Fitter Master ❑ Journeyman Plumber Or Gas Fitter 1©aS-& (cense Numoer MASSACHUSETTS UNIFORM APPLICAT[Ot4 1-011 PERMIT TV DO GASPfTZ-1111( � (Print or Type) NORTH ANDOVERMass. Date l .�! j� Q uilding Location 1J Permit # 30 '�. Owners Lame New Renovation Replacement n Plans Submitted (Print or Type) ' Check one: Certificate Installing CompanK Name ,� (� Corp. _ Address Partner. �%9��lLf✓ �� rill Co. Business Telephone: Name of Licensed Plumber or Gas Fitter (vPGG Insurance Coverage: Indicate the type of i nsurance coverage by checking the appropriate box: Liability insurance policy] Other type of indemnity Bond ,''Insurance Waiver: 1, the undersigned, have been made aware that the licensee of .;; , '!this application does not have any one of the above three insurance coverages. i ,Signature of owner/agent of property Owner Ageiit f 1 l -hereby certify that all of the details and information I have submitted (or entered) in above application are true an c knowledge and that aMtl plumbing work and Installations performed under Permit issued for this application wW be P provisions of that Massachusetts Slate Gas Code and thaptet 141 of the Central laws. By Titae .City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plutrtber Gasfitter Master Journeyman ate to the best of my too with all peatinent Sig'nafio6re of Licensed PlumprNeftliG—c Gasfitter . LICe11r N V W x N CC m N Q at a o to = z t- ' a m to tw- W w o ul =- 0. W r a a. LU V7W .. t~ a �, a A y 4 w W W W W x H Q x tTr W cr o a W w �' trr t• x h Cr t� Z I- Q z- W 1.4 z CC t•. -+ w }- y a W y ._ W p t- = w ..t O N x d w >• a w o z d x< d o o W W i - a x v z >• t– o sUa—I3S..tT. BASEMERT 1ST FLOOR 2ND FLOOR 3RD FLOOR— — — — 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 13TH FLOOR (Print or Type) ' Check one: Certificate Installing CompanK Name ,� (� Corp. _ Address Partner. �%9��lLf✓ �� rill Co. Business Telephone: Name of Licensed Plumber or Gas Fitter (vPGG Insurance Coverage: Indicate the type of i nsurance coverage by checking the appropriate box: Liability insurance policy] Other type of indemnity Bond ,''Insurance Waiver: 1, the undersigned, have been made aware that the licensee of .;; , '!this application does not have any one of the above three insurance coverages. i ,Signature of owner/agent of property Owner Ageiit f 1 l -hereby certify that all of the details and information I have submitted (or entered) in above application are true an c knowledge and that aMtl plumbing work and Installations performed under Permit issued for this application wW be P provisions of that Massachusetts Slate Gas Code and thaptet 141 of the Central laws. By Titae .City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plutrtber Gasfitter Master Journeyman ate to the best of my too with all peatinent Sig'nafio6re of Licensed PlumprNeftliG—c Gasfitter . LICe11r Date.. Y .�.�.:/.... t „ORTH TOW ORTH ANDOVER Frog 'v,tio A C p PERMIT FOR GA ' 11ALLATION SACHU This certifies that ...- :.,t. %r-►. . ! 1..... . as permission for gas installation �, �. ?..� •:1.rf. � t. he buildings of ..`1�! �`{. . ��ft.��r�'.... . KI ��?f ✓!�: . 3 .. , North Andover, Mass. Lic. No.��...��`i�- GAS INSPECTOR ;1 Applicant /r/,1 CANARY: Building Dept. PINK: Treasurer GOLD: File Location�J No. Date aoRTM TOWN OF NORTH ANDOVER n Certificate of Occupancy $ �ACMus CM Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $-}' Check # 7aq 15596 Building Inspec r A 41l TOWN OF NORTH ANDOVER `4-7 BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING im a' BUILDING PERMIT NUMBER: �^� DATE ISSUED: SIGNATURE: Buildi ommissionerfl for pm—of Buildin Date SECTION 1- SITE INFORMATION 1.1 Property Address: �l Pf?EEZ cpm n '� V DOy�� 601 1 �1-"/ l s77 1.2 Assessors Map and Parcel Number: Map Number Parcel umber 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Address for Service: Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided Name Print Address for Service: Signature Telephone 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private 0 1.3. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHWfAUTHORIZED AGENT 2.1 Owner of Record Al Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1L LL/icensed Construction Supervisor: Not Applicable ❑ % / jqy)-V CASTA I CD4E RFG, / � SP& , Licensed Construction Supervisor: License Number �4 S �?TP� S7: Alto. "Po Vibe IV.J Ad J Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ STSG+ Ll t Compgany Name Registrition T—mber �^ n p aT7-0 Al S / � i /V � �� U E4 A s _ !} �C 9% g / g3 -" ,S L .2 -® L1.2- h l 0 Expiration Date Signature Telephone k - u 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. Si red affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check applicable) New Construction ❑ 1 Existing Building Repair(s) 0 Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: S 7 - RIP I SECTION 6 - FSTTMATUM rnNCTRTTr TT(1N IYICTC Item Estimated Cost (Dollar) to be ;t.......... FF CIpq US1?. ( g Y x ��,i'° `� �� Completed b permit applicant 3J _- , ' 1. Building A� r^-'..... «.. .ti „"..iF L g � (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 3 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 r. �mt�wt n Check Number OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, V AV U. CAS TR OAZF 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 Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS S17_E OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Cf) m M C/) 0 m C H CD .0 C � d � O O Z CO) CLCor c CZ M. H C2 v CD cil. O Q %< CD CD 0 CD c O V) CZ C2 y O CO C=D S v CO) O .0 Z CD O CD O CCD C 0 O 2 o. UP O 0 _ m O c _ m CO m C s N O d N H m cc c S� O go x d ti do H y ® n m C) Cl CL C -j =r -O N m a - go rn �o mort y -1 =r CD mCD x e d O N c .�. O m a N = « _ �m CL ? W O H � CL CDN toCL y C to d _ m m : N y Q : O �a = m m N �m co .. r CD p A W O : a� P-., ? : I CD � o .� N CD SCD: dd: a'n Cl) Co col Q i_ a=' =m cn cn ;n ;Z �7 cn qZ 'rf ;a 0 21 „ 0 b �'. a0v z'��y z p' °� tb 0 7 w 0 p = 0 000 :7 C 0 G. G b R. n cp 0 G1, 9 W 0 V r z 0 H 0 O C Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM 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 c11, sl 50a. The debris will be disposed of in /at: s -r9-TEZ-i11 E C W TiV E& Facility locatio Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. ��'- b Board of Building Regulations and Standards { " HOME IMPROVEMENT CONTRACTOR p ' Registration: 104569 Expiration: 7/14/02 Type: PRIVATE CORPORATION DAVID CASTRICONE ROOFING, S RN&- O;astricone 7 Hillside Road Boxford, SAA 0192'. Admin;strator u Licence or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and StP ndards One Ashburton Place Rm 1301 Boston, Ma. 02105 Not valid without signature 6449 /P/1� (( Building Inspector r q) ` Location No. Date G" fd, 03 MORT1y TOWN OF NORTH ANDOVER 1 w s Certificate of Occupancy $ s',uM�s.t' Building/Frame Permit Fee $ Y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a 0 Check # 1 6449 /P/1� (( Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: 2 SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Cit � 002 l - Map Number Parcel Nultriber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUR DING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 11 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record - M C d�iFAI l Rets q 2 AUS 6'� ST Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 LicensedQ Construction Supervisor: Not Applicable ❑ A iC�t ( LL. I 1,4M �= Licensed Construction Supervisor: i / A(3- n — 5;A4 D_ . License Number _..- 4 �0 Address _ Expiration Date Signature Telephone 3.2 RegisteredHomeImprovement Contractor Not Applicable ❑ ��l (zu_(SIQ 1 �"� j 0 Company Name O. Registration Number / Address !9' 6 2-9 6.oT. Expirati— i Date �— Si nature f Telephone 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 ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) -f AIterations(s) [I Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be1+IGAhUSE Completed bv permit applicant ONLY 1. Building �� Sb (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 69 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf; in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ld b ffay r 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 1JILLI&M�t04 Print Name Si attue o Owner/Agid Da e ZZ - 703 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 191 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 1>EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: 9 2 PV- &s C ml— � T City Nf - KU 0 0VVA Z Phone # 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job Comoanv name: Address City: Phone Insurance, Co. Policv # Company 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 $1,5oo.00 and/or one years' imprisonment.as_weU_as_civil.penattiesinsheinun-f-aSTOPWORKORDERand..afine.4.(,$1110.00)srlayagainst.o. e 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pa/nsApd penalties of perjury that the information provided above is true and correct. V A Print name IAC- Rel Pbone.# C138 214- '26 9 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Ucensinq Building Dept r-lCheck if immediate response is required 0 L%censin_q Board E] Selectman's Office Contact person: Phone k E] Health Department E] Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that. the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A.. The debris will be disposed of in: (Location of Facility) Signature of ermit Applicant 124 2 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector 70 wz "10w O w T v cn O w° OO w w C U w. c 0 U w � O c4 w" O w c � � U O a4 chi c w O U a 00 z to O n4 C w w � A CO cn cn uj am 0 U) LL) cr LLJ LUW U) c c as c ;off O N O V V p, C rmc 0 as EQ c �: _• O ` d N .:E� Q: E:5 O O V r V cm4 � me E Coo O � N N .� r tm N C m O C ': E m o Y cm CD m v O 0 cm Q C D CL mc c c = m m. C N � N N m isS m w W C : G r ',� � r C r •N O � �. �ca O.t C r m N E Z O W C3 0��0, 0 O o c g y d O 'O O A M N •O = O.L-. m i 0 U) LL) cr LLJ LUW U)