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Building Permits, Electrical Permits, Plumbing Permits, Gas Permits - Septic Pumping Slip - 4/23/2019
Date... TOWN OF NORTH ANDOVER �a PERMIT<.. TA LLATION CHtJ��� This certifies that has permission for gas installation in the buildings of...., :::.. ,....... at North .ndover, Vass. Fee .�...,'.......:..... Lic. Check# ,,, iae°� �a ....... ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT PLAN REVIEW NOTES A The Commonwealth oflMTassachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UT www.mass.gov1dia Workers' Compensation Insurance Affidavit: :Builders/Contractors/Electriciansfplumbers Applicant Information Please Print Lcaibiy Name (Business/Organizationtfndividual): Address: � � CatylStat Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g. ❑Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its 10.❑ lectrical repairs or additions required.] officers have exercised their 3.El am,a homeowner doing all work right of exemption per MGL 11. Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs . insura€rcere required.] employees. [No workers' �. �.. 13.El other comp.insurance required.] 'Any applicant that checks box##1 must also fill out the section below showing their workers'compensation policy information. i"Homeowners who submit this affidavit indicating they go doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. 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.Lie.#: Expiration Date: Sob 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of crin in.al 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 of perjury that the information provided above is true and correct. Date: /C:� Phone#: Y. 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#: ljgl Location No. Gate f f' i s TOWN OF NORTH ANDOVER O T04 a Certificate of Occupancy IT" a4C101d���� Building/Frame Permit Fee Foundation Permit Fee r Other Permit Fee � TOTAL $ Check # 5,1, 40 Building Inspector i I t%ORTiq BUILDING^ PERMIT APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: _ _ IIVT .C�T�TA1To Applicant must complete all items on this page LOCATICD,N n rl r ✓ r/� /' r r rlt%� r r ri r a r /ri, r �r9 MAP 210_ PAREL: � Z ➢1IC DISTRICT Historic Distract yes no �. °Machuieshop 1/iIl gel yes no r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial repair, replacement Assessory Bldg Others: Demolition Other Septic; Well Floodplain Wbtlands Watershed t WtecdSeirve DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: fume: U J j�7 Phone974-60 ma 6 95- Address: " l-7 i _ _.__................._-_ CONT TOR brn'6 ,, 6: ry Addre r r Supenris6'es Cc n trurc it rt''I_icehse*, - xp.`date. L Horne 1rnpr6vemer t Licehse: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total ProjectCost: b w.. ®_ • FEE _ Check No.: Receipt No.: �` NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contracto AM FORTH iL -own ofAndover 6 pit 0 No. joP. ,20il 26 C, 64 LASK E ® f er, Mass., p,,,, LOLMiC MEWICK y�. .47 �0 rED P` ,� fg BOARD OF HEALTH Pt� Rml �lm �1 D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.............C. .......... ......,. ............................. ......... .......... ............................................. Foundation has permission to erect.................: . buildings on .... :.... �'..................t.......... e.......................... Rough #o be occupied as Chimney p ........................ ....... ............. . provided that the person accepting this permit shall in every respect conform to khe terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 10-^ - Final EXPIRESPERME � � � ELECTRICAL INSPECTOR UNLESS CONS ON S Rough ............. .............................................................................................. Service BUILDING INSPECTOR Final Occupancy ermit Required to Ocmpy Building GAS INSPECTOR Display in a Conspicuous Place on t Premises — Do of Remove Rough Final o Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. REVERSE SIDRE Smoke Det. ..__.. ace, oom 1 01, Boston,`Ildf/k U2p8 (617) 727-8598. ure wn construction: ted permits or s deal with their with unregistered ste ed contractors awil be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. EIN NO, .z _ . _ A. H.I.C. 108383 26-0462904 > CIS = Customer-Supplied S + I = Supply + Install ❑ See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: � f d - r� � _ } 1 r._.,�i _._� ,..�. �- J_._. d. y..... ff,._ .1� �_i__. 671E `<` ! 1 7 .. ...... _ I r , „ - �C q Construction related permits �... :. _...._.....__.,._....,,,..,._........................................_.._.._....._....... .,..,.,...........,............ WORK SCHEDULE Contractorwill rl?t begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about LL- i !.` (date). Barring de#ay caused by circumstances beyond Contractor's control,the work will be completed by✓I (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of ' following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contra tor,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmansNp.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications, for the sum of: _-. ay - ( (") I '[c..� d_ t r. �t d t:r' � { �j✓ _ r` 1 j r (�_� ��2 � �dollars Payment to be made as follows: KENNETH B. KEEN I ROBERT A. KEEN ($�r^. ) upon signing Contract; Name of Contractor I Designated Registrant ($ ) upon completion of 21 HEWITT AVE. Street Address % ($ ) upon completion of _ N. ANDOVER, MA 01845 Oily r State ($ wi ,. f. shad be made forthwith upon .p,_ �" :::':.., i (978) 691-6201 (978) 682-3231 completion of work under this contract. PhDfe Fax Notice: No agreement for home improvement contracting work shall require a _ _ >down payment (advance deposit)of more than one-third of the total contract price Name o!salesman f f or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials.and Autrioyre Pgnaiure equipment,whichever amount is greater. Note: This proposa€may be withdrawn by us if not accepted within days. Acceptance of Proposal -I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. ®® NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Date Signature Date 6/30/2010 11,02 AM FROM,: Gilbert Gilbert Insurance Agency Inc: TO, tl :.(97131 692-3231 PAGE: 001 OE 002 DATE(MM OIDN"... D,w CERTIFICATE OF LIABILITY IN.SURANC8 08/30/2010 PRODUCER- '(781)942-2225 FAX`. (781�).942-22:26 THIS CERTIFICATE IS ISSUED AS.AMATTER OFINFORMATION: `. Gilbert Insurance Agency; Inc. ONLY AND CONFERS NO BIGHTS UPON THE CERTIFICATE 137 Main:.Street HOLDER.THIS CERTIFICATEDOES NOTAMEND,F-XTEND OR ALTER":TIE COVERAGEAFFORDED BY THE:POLICIES,BEi OW. Reading, NA !01567-3922 INSURER$AFFQRDINC COVERAGE. NAIC# INSURED Kenneth Keen.'8i Robert Keen INsLOI Ra NORFOLIC & DEDHAN INSURANCE 23965 DBR: DB.A Keen. Construction Company ranl:te : 007Z a . on ' 21 Hewitt Ave. INsuRERc North Andover:, MA 0A45 INSURERD. INSURER E _ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE,INSURED'.NAMEU.APOVE FOR THE POLICY PERIOD"INDICATED.NOT1IVITHSTAIVDING ANY:RE TERM OR CONDITION OF ANY CONTRACT ok OTHER:DOCUMENT VVIT14 RESPECT TO V(IH1CH TH[:S CERTIFICATE'.MAII''BE'ISSUED OR' MAY PERTAIN,THE INSURANC£.AFFORDED BY.THE POLICIES DESCRIBED HEREIN IS SUBJECT-0ALL=THETERMS,E7(CLUSIONSAAIU:CONDITIONS OF SUCH' POLICIES_AGGREGATE LiMfTS SH01NN MAY,NAVE`9EEN:REDGCED BY PAID.CLAIMS:. INSR ADD' -.. PoucyEFFECTiVE PGLICY.'f`7(PIRAMON:- -LTR NSRL:: TYPE OF mu POLICY NUMBER ATE D LIMfTS::. - . :GENERAL LIABILITY ND-P 01007&/000 03/13/2010'• '03�13;�2011 EACNOCCURRENCE -$. 1,,000,000 - )( COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED: $ 50,00 'CLAMS MADE OCCUR MED'EXR(Any one peisnn) $. ,t).Q A PERSCNAL&ADV 1NURY $', 1. 000,,00 GENERAL A.GGREGA'fE .$ 2,.Q 00,OD GENL AGGREGATE LIIv1kTAAPLIES PER ,'. PRODUCTS-COMP/OP AGG $.: 2 000,00( POLICY jEC7 %LOC AUTOMOBILE L3ABILRY� - comw 1ED sINGLE LUX .$ ANY AUTO - - .. - i(>=8 accident) - - ALL OWNED AUTOS .BODILY 1N:fURY .'.a - SCHEDULEO AUT05 (Per patsori) HIRLD AUTOS BODILY INjjR.Y NON-OWNED AMOS ,(Pereccidenl) $. PROPERTY DAMAGE $ -.(Per accident) GARAGELIA$ILI3Y AUTO.CNLY-EAACCIDENi 14. ANY AUTO .:OTHER THAJV. EA ACC AUTO ONLY `.. AGG ExCESSlUMBRELLALIABILC1Y `.1=ACHOCCl1RRENCE' - OCCUt2 CLANQ MADE AGGREGATE..g $ DEDUCTIBLE $. RETENTION. WORKERS COMPENSATIONAND - WC006371378: 0$�03��2010- `O$�03�2011 :..� WCSTATu- OTH- - 0 L EMP4DYERS'LIABiZITY ORI IAIAL TO BE MAILED VIA: E.L.EACfiACCIDENi $., 100' 00 g ANY PROPRIETOWPMTNEFzmy iITfVE - - .. , OFFICERMIBER'EXCLU EMDED? MASS WORK'COMP .: AU ::7=L MSEASE-BA EMPLOYEE $::: ZOO,00 .. ... - BURE.. If.yes;:describeonder SP CfAL PROVISIONS below.: . tE-L.DISEASE-POLICY:LIMIT $::: ::500, 00. OTHER DESCRIPTION OF OPT .ATIGNSFLOCATIONS I VEHICLESI EXCLUSIONS AOOW BY ENDORSEMENTI SPECIAL PROVISIONS vi device".of Coverage. SHOULD ANY OF THE ABOVE DES' RIBED.POLiCIES BE CANCELLER BEFORE.THE: . - - - - .EJIPIRA770N iiATE tHEREOF,THE ISSUING INSURER WILL.":ENDEAVOR TO Mmf . . .. - .10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, . 9U7 FAILURE TO MAIL SUCH NOTICE SHALL iMPOSE NO.duLlGATION OR LUVBILITI" OF ANY KIND UPON THE MSURERl ITS AGENTS OR REPRESENTATIVES: Evidence Of Coverage AEITMORIZED REPRESENTATIVE : Nark Gilbert, CzC ACORD25(2001[08) OACORD CORPORATION 1989 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kv 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /p Please Print Le ibl Name(Business/Organizationandividual): 2£ (� �) N 5 Address:— �4 C W Tj A is e; __ _....... City/State/Zip: , y-Nd • „ ) 1,.3 yJ-- Phone#: - 6 v3 � B Are you an employer?Check the appropriate box: Type of project(required): 1.E9- am a employer with 4, ❑ I am a general contractor and 1 6 ❑New,construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached street. 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 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' �13 �tlter Ju�Wj®O,,LS comp.insurance required.] *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 their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: r) a q ou t✓' �� t} e: Policy#or Self ins. Lic.#: C p 6 G 3-7 13 ��..._ Expiration Date: Job Site Address: 1& t . City/Statc/Zip:_ `}•a 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p an penalties ofperjury that the information provided above is true and correct Signature: g Date: 4 6 Phone#: I 7 V- Cn q,( ' J� "Re t Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: OfOce ot`Oon�mer airsiness egu a to HOME IMPROVEMENT CONTRACTOR f Registration: ,,.108383 Type: Expiration: ;$..T1 /, 012 IDEA K CONSTRUOTION GQ Kenneth Keen 21 Hewitt Ave No,Andover, MA 01845 Undersecretary • -ILItitiLlltliE�Cttti - t)CiMI-Tnitnt Ot PLIbl11' y�Etetl Buurd of B€Iildinu Regulutiolls anLJ tit.Lnd.Lrtis Construction Supervisor License License: CS 58245 Restricted to: 00 KENNETH B KEEN 21 HEWITT AVE N ANDOVER, MA 01845 Expiration: 3/24/2012 T r;;:: 20523 ? NlaLssachusett.s - Di2pat-tmcnt ol' Pultli+ Sall'ct� Board of Builtlin!- Re!-ulation.s alnd Stitntlatrds Construction Supervisor License License: CS 76691 Restricted to: 00 ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2011 ( nuu,isiuner Tr#: 1690 LOcation '.....,. NODa te Towtv Von lad e� �a944@q `°'V a I A p is®®,,��yy ryyr }} �°� bq wPgi4 tG Bull/a, Fr Of ccupa cj� ar" P' tiOn P rrpit Pe rit Other b r it FeL L i .a I urldtng tnsp�or- NORTF{ BUILDING PERMIT TOWN OF NORTH ANDOVER F p APPLICATION FOR PLAN EXAMINATION * ,� t NO: 9 Permi Date Received 3yssacµu5��<y Date issued: IMPORTANT: Applicant must complete all items on this page 22 LAC!�T10I q■ r e ,..,.b r r_I}ki�w� �"u�, -^..'� ti�")� � `r , ,:'�`ytRyyk. r7�+ -., r < .mom TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑ Two or more family ❑ industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other x s v, rc✓ N' ,yF S-�, k: f 24 1.4 � y '� DESCRIPTION YOF WORK TO BE PREFORMED: Identification Please Type or Print Cl earl ) OWNER: Name: �"f i Phone. di�4,(i6A2 71 2- Address: M. NTITOI + 1 N > ry t Sr.�perv� �'� �n�tr�r�ti�n Lroer�se.� ° �� E�l� Otte ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. D do Total Project Cost- FEE- $ 19 O Check No.: Receipt No.: �? NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund Signature o Agerttwner: Signature cif coritracltor TA TH Town of Andover 0 No. 2 *7& 0 dover, Mass-V Ir - a LA CUCHICHEVVIC 11 01�'ATED BOARD OF HEALTH Food/Kitchen PERM IT T D Septic System THIS CERTIFIES THAT..... .......... 77.........................--..... BUILDING INSPECTOR ........... ...... ...... Foundation has permission to erect . .... . ....1-111......... buildin.gs on .A...r............'T. .6v!�A.......!Fl�.............. ......... Rough Chimney tobe occupied as.......... ...... ......-.1.1.......... ................... .................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPMES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS-fRIU ON Rough Service BUILDING TOR Final Occupancy Permit Required to Occ-upy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. KEEN CONSTRUCTION CO. °- 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Conte Funeral Home 17 Third St. N. Andover,MA 01845 (978) 686-2712 Contract# 1668;Appendix A Date:10/3/07 Rebuild front stairs: • Replace front landing and stairs(same size and style) Materials to be pressure treated framing,trimmed with white plastic boards and lattice, grey p.laste(composite) decking • Reinstall existing rail system.(re-welding of rails not included) - Total price:$4982.80(forty nine hundred eighty two dollars and 80/100) Price does not include cost of permits,removal or disposal of old stairs or landing, excavation of footings (four feet deep), or pouring concrete. Payment schedule:$1000.00 due upon signing contract $3000.00 due the first day of work $982.80 due upon completion of contracted work We L11 -Customer �% Ke n ph R. Keen Date Date e exC#utled from the Guarartty Fund Prouision of. MGL c.142A. PHONE DATE - REGISTRATION NO, F.ID.N D. MA. H.I.C. 108383 04- 125-8052 > C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: ... 6, r 1 1v .... ...... .......... .. ...... > Construction related permlts, .................................................._............,..............................,................_..__...-„_,,..,_....,..........................................,.... ....................,............................................ ............... WORK WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the slgnmg of this Agreement,unless specified here in writing- Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dales are approxlmate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY i The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of J VC C r� following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contract r,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work- We Propose hereby to furnish material and labor-complete in accordance with above specifications, for the sum of : c:� T �, 1,�. �f -.�.� c ti-t r..C .�.�__dollars ($ C 1 6,2 Payment to be m�as foltows: i % ($_ ) upon signing Contract; KENNETH B. KEEN i 1A Name of Contractor 1 Designated Registrant ($ ) upon compieit7(1 � _ 21 IiVVI T AVE. r �4 "i ;t Street Address U�o'Kf,Completion of : N. Af911]®t/fER, A 01845 City 1 State shall be made forthwith upon (978) 691-5201 (978) 682-3231 completion of work under this contract. Phone Fax Notice: No agreement for home improvement contracting work shall require a >down payment (advance deposit) of more than one-third of the total contract price Name n!sales an or the total amount of all deposits or payments which the contractor must make, in �1'A advance, to order and/or otherwise obtain delivery of special order materials and Awhoriz`e Signature equipment,whichever amount is greater. Note� r is proposal may 6e withdrawn by us ii°t accepted Within days Acceptance of Proposal -I have read both sides of this document and alf attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. �i®�T SI(aN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature T -/ 1� l Date Signature Date IMPORTANT INFORMATION ON BACK �'le -�o�nmuvrulea/f'L o�/!/�l',�aafcc�ucaeG�a � Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration; 108383 Exprref{sin :811 812008 T"Pe � # KEEN CONSTRI'CTI>7NGO Kenneth Keen r 21 Hewitt Ave I No.Andpv:er, MA fl1'845 ➢eputy Adwirnistrator t�rYirrrroncrl�a � � j B�ARi3 OF BIJI.LOIN 12I=GUI-ATIQNS: ieensg; CONSTRUCTION SiJPEFtUfSOR b timber 058245 :,F A irthdAtd 031241.943 d3�247�0d Jr.no. '734dtm Nat 6 t .At Dt�V F 1 A;opt-- C:o� t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/ludividuat): F 11 nj Address: _ ; City/State/Zip: VCIN ✓1r S491hone.#: 4 .......- 691 " S Z0_ Are you an employer? Check the appropriate box: general contractor and 1 Type of project(required): 1.K I am a employer with 2, �t. ❑ I am a g employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I-am_a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have &. ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp, insurance comp. insurance.t 9. ❑ Building addition required.] 5, ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I,[] Plumbing repairs or additions myself. [No workers' camp. right of exemption per MGL 12.❑ Roof repairs insurance required.] fi c. 152, §1(4), and we have no employees. [No workers' 13• Other �J_ comp. insurance required.] ems. fe4 *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. /a Insurance Company Name; (! 14 ti +k �' S CIO Policy#or Self-ins, Lic. #: 16 3 G (FIE 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 Iead to the imposition of criminal penalties of a fine tip to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance covera e verification. I do hereby certify under the pa' sand penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone#: 4 72 <A — .J Official use only. Do not write in this area, to be completed by city or fawn official City or Town: Permit/Liceuse# Issuing Authority(circle one 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: vvr ivr rvv, ay.+� ara�a v-sr .rry va uuuaza s .v�suzivu .�vvv ACORN CERTIFICATE OF LIABILITY INSURANCE osiiizoo' PROOUGER (781)942-2225 , FAX (781)9+42-2226 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,WFND OR 137 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW, Reading, MA 01867-3922 INSURERS AFFORDING COVERAGE NAIL# INSURED Kenneth 9. Keen & Rat'1:rt Keen IN5UREERA: NORFOLK & DED14AM INSURANCE 23965 a8A: Keen Construction Company INSURERs1 21 Hewitt Ave. INSURERC: North Andover, MA 018,45 INSURERO IN5URER E: 1=s THE POLICIES OF INSURANCE LISTED 3ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITH$TANDIIW ANY REQUIREMENT,TERM OR CONDII*N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORLIED BY THE 10OL-ICIES DESCRIBED HEREIN i5 SUgJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWrrMAY HAVE BEEN REDUCED BY PAID CLAIMS INSR DO' TYPE OF INSURANCE P(jCY NUM8ER POLICY E FECi1VE POLICY EXPIRATION LIMITS C.ENEFALUABILITY ND-P-010079/000 03/13/zo07 01/13/2008 EACHoCCURRENCE 3 1,QQO,Oo X COMMERCIAL GENERAL LIABILITY DAMAOETORENTED s � CLANS MADE [K OCCL R MEO EA'P(Any one perinni S A PERSONAL U,ADV INJURY S 1/00 GENERAL AGGREGATE: 5 2,00 GEN'L AGGREGATE LIMIT APPLIES F ER; PRODUCTS•CQMPIOP AGO S 2100)110.00 POLICY LIX: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIY ANY AUTO (Ea ac;Idan€) ALL OWNFO AUTOS BODILY INJURY b SCNEOLILED AUTOS (ae,paraonl HIREO AUTOS BODILY INJURY S NON-OWNED AUTQS IPer accidenk) . PROPERTY DAMAOE S (Peracc.draM) GARAGE LIABJUTY AUTO ONLY.SA ACCIDENT ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSlUMSRELLALIAR[LYTY EACHOGGURRCNCE S OCCUR CLAIMS MA?E AGGREGATE i DEOUGTIl;LE S RETENYION f 1 WC STATU OTH- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY E.L.E;AGN ACCIDENT S ANY PROPRIETOP/PARTNERIEXECUTIVE OFFICER)MEMSER EXCLUOEDI E.L.OMEA0C•CA EMPLOYEE S I" f Yes describe under SPECIAL PROVISIONS ibelOW E.L_DISEASE POLICY LIMIT 5 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS f VIiNICLES i EXCLUSIONS AIMED SY ENDORSEMENT I SPECIAL PRO%n5kON5 CERTIFICATE HOLQaR- CANCELLATION_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES LIE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1.0 DAYS WRrrTeN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover,' BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Osgood Street OF ANY XWO UPON THE INSURER S AGENTS OR REPRESENTATIV". North Andover, MA Olf:45 AUTHORIZED REPRESENTATVE Dawn Cram ACORN 25(2001108) FAX; (978'1682-3231 OACORD CORPORATION 1988 Vii/L9l LVVI 1.L.Vv rnn +ai vy r. LLLV Vx ,.Na+. + ++ ++�a�rxavx. �vvr 11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION _M ONLY AND CONFERS NO FIGHTS UPON THE CERTIFICATE Gilbert Insurance Agency Inc HOLDER_ THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 137 Main St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Reading, MA 01E67-3922 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Kenneth Keen&Robert Koen 21 Hewitt Ave North Andover, MA 0104"000 TTIIIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 'THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS liIUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T P$OFQiSURMCE POLL#: NUNDER POLICYEFF&C"19nATE POLICYEXI'MATIONOATE 2 oM TDN OD MPLOYERS'LIABILITY LIMITS OPRIETOR) ER&EIIECUTNE RS ARE- NCL n EXCL o 6360668 8/03/2007 B/03/2006 STATUTORY LIMITS THEE Ctwerep Applies IP MA Opwdma Only. ACCB1£NT 5 100.00 ISE44E POLICY LIMIT $ 500,00 ISIJ4 SEACN EMPLOYEE S 400,00 ESCIaF TION OF OPERATIGN,eIVEHICI. CIAL ITEMS :ROBERT KEEN IS COVERED ErY THE WORKERS COMPENSATION POLICY AND iQ=NI�EETH S KEEN IS NOT COVERED g1f THE -irRIKEP-11 COMPENSATION P_'�LICY. :CERTIFICATE HOLDER CANCELLATION JOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE THE E7PRATDN DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MdA.39 ,.'GD0 OSGOOD ST PAYS WRIITFN NOTICE TO THE CERTW14ATE HMPER NAMED TO THE LEFT,BUT `NORTH AN ROVER.MA 01 EAS FAILURE TO MAIL SUCH NOTICE SHALL WPOSE NO OBLIGATION OR L"ILITY OF ANY KIND UPON THE GOMPANY,,rrS AGENT'S OR REPRESENTATUES, AUTHORIZED REPRESENTATIVE E • I ' i as o uavw� TOWN OF NORTH AND ' 'VER 50 nqPERMIT FOR PLUI NG CHUB This certifies that has peraraissicara to perform . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of' �. . . . . . . at . . s' Fee. ] North Andover, Mas Lie. No.. s.. . . . . i ; Check # r 'PLUMBING (NSPtC" . . . MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ate Building Location Owners Name Permit# '2L� Amount � G " T e of occupancy 6V a2.-4- New ® Renovation ❑ Replacement 13- Plans Submitted Yes No FIXTURES Ur Wi a, E~Cn w STRUM lSF F[.�7Q2 2M f1fM 3M HDOR 4M f1fXR SM F10(R 6TH FIDCR 71H FLOOR 8M FLOCR (Print or type) / Check one: Certificate Installing Company Name�� ) / �''� �- /7 ❑ Corp. Address , 2 ` ` `J - '--- - - El Partner. Business Telephone f n 6 9 2- ~ Firm/Co. •YYwY q��Y�YI� , Name of Licensed Plumber: _ [,, �� �; v �' 1 ✓ Insurance Coverage: Indicate the type of insurance 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 Signature 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massac =- S Plumb' Code arlo Chapter 1-2 of the General Laws. BY t a ure teens er Type of Plumbing License Title ?, D 3 IW City/Yawn cense um er blaster a Journeyman ❑ APPROVED(OFFICE USE ONLY OV MORI. certilie .ash plu"n pan to �lP r III ELF�OP 177 • � Pe , Safi � �a o And %, 1r, a s s r MASSA�HUSETTS UNIFORM APPLICATION FOR PERMIT To w PLU IIING (Type or print) NORTH ANDOVER„MASS AC HUSF"f T tS Date i < . Building Location_.._. _ ' �' ?'. ._.__ Owners Name 0 e�,y Lf _ r � �°� __. Permit# .w_ , Amount T e of Occu a�nc New Renovation ® Replacement Plans Submitted Yes ® No El FIXTURES ua z W z W W C7 " E G7 U 5 M H(X)R 4M MOM FLOM 61H I+ 7III HIM (Print or type)yp e) Check one: Certificate Installing Company Name Corp. Address �` Li Partner. 1W, . Business Te ep one 11 T f y U Firm/Co. d Plumber: �.. �� ... Name of License ���� °°� 5 � ' � �n�"i^"4 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liab"Ay 'insurance policy El Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been inade aware that the licensee of this application does not have any one of the above three insurance signature OwnerEl Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stat Pumbing Code and Chapter 142 of the General Laws. By: Signature ol Mcensenurrr er Type of:Plumbing License Title City/Town tcense 19 um Der Master Journeyman APPROVE?D(OFFTC.,r USE ONLY Y� i AORTH r ;ry wnPERMIT FOR GAS INSTALLATION *PoQ �SSAC6d05�gti This certifies that . . . . . . . . . . . . . . . . . . . . . . his permission for ,gas installation . . . . . . . . . . . . . . . . . . lIn the buildings of . . . , a . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . D at . , �. .�' . � �.. � . . . . .. . . . . . . . . . . . . North Andover, Mass. i Fee Lic. No. . . . . . . . . . . . . . . CASINSPECTOR Check# AS ANUS EM tIl' MRM APPLICA"TON I�1O]C#P'EI7NHr TO DO GAS]FfMNG (Type or print) i� Date m °1 NORTH ANDOVEiz,MASSAC",HUSETTS Building Locations � r� — Permit Ik Amount$ "o 7 °;� — Owner's Name New LiRenovation Replacement El Plans Submitted El v� U W p UJ H ae G% O H E F` � 0 SUB -BASEM ENT B A SE M E N T 1ST . FLOOR 2 N D . F L O OR 3 R D . F L O O R qTH . FLOOR 4 T H . FLOOR 6TH . FLOOR '7T1I . FLOOR STH . FLOOR (Print or type) C eck one: Certificate Installing Company Name 2 '' � , Corp. Address El Partner, usrness a ep one ` " --- U Finn/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. 'Yes Na If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy 121 , 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 I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter By: Plumber Title Gas Fitter City/Town Icense urn er Master APPROVED(OFFICE USE ONLY) 12 Journeyrnan Date....... 14ORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING A This certifies that , has permission to perform .......... ............ wiring in the buildi,4g of... 7" at ........ ...... ........... .........—........ North-,"dover,Mass. Fee..... ...... Lie.No. ......, .............. INSPEcTOR Check # UtTICIal use C. Permit No. &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 CMf�12:GO 71 /9- 'X1, (Please Print in ink or type all information) Date '- L�, q ' To the Inspectdr of Zr—es: Town of North Andover The undersigned applies for a permit to perform the electrio/work described below. Location(Street&Nu Owner or T-..-. 0W lsl- �..".y Owner's Address Is this permit in conjunction with a building permit Yes EJ No /(Check Appropriate Box) Purpose of Building_ Utility Authorization No. Existing Service Amps_ -Voits Overhead 0 Undgmd n No.of Meters New Service Amps Voits Overhead 0 U dgmd 0 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above El In 0 No.of Lighting Fixtures Swimming Pool gmd 0 Rind 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of D pposal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained of Dishwashers Space/Area Heatin KW Detection/Sounding Devices 0 Municipal El Other No.ofD ��rs Heating Devices KW Local Connection No.of No.of Low Voltage Na of Water Heaters KW -Signs Bailases Wiring No, Hydro Massage Tuds No.of Motors Total HP OTFIER' 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 submi",,ed valid proof of same to the Office YES= NO = It you hqvp-7hpcked YES I sea m�ca e type Of coverage y, the appropriate box �,e INSURANCE = BOND = OTHER =.(Please Specify) Cold YZ— Estimated Value of Electrical Work$ (Expiration Date) Work to Start b ns tio Date Resquiested --Rough__—.Final Pa.the Penalties of pedury'. Signed unde FIRM NAME a LIC.NO. LIC�NO. Lkensee --Sig�ature .J Bus.Tel No. Address $14 )J-2 Aft Tel.No. 1�5 ,k wii,e kt`i Ali OWNER;S INSURANCE WAIVER: I arA aware that the Licenses doei�'not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITFEE $ (Signature of Owner or Agent) c a L°.YAI�{f .LfR!G fN-4C�.✓ i ---- -----� MO f -- � J{ NO iV {! t � Q44v - r r [ _, CE Thi wit p I #I? k of 33 5' 27' ='a i3 IS the O` _ wit zon of exc Not: M.appm Q Le I luba L I Lli rat Deed Reference: Bk./ Pg, /0 Scale Cert.No. -Il1 0 Date of Inspection � Plan Reference: PI.No. 5t6 tr Date of Plan 9 Location ;vo. h CbPBd '8' k 9 d �r .✓ � '.a ancy Floundab . t6 Other �� Penn't Fey n.t k: , ,�. .actAMe --` s Build 11dir`9 in or Div. u /i orbs PERMIT ��, �° APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER. MASS. PAGE I � d LOT NO. 2 RECORD OF OWNERSHIP IDATE 180OK ,PAGE Z�INE SUB DIV. LOT NO LoCA T IOC y. . ``_.. PURPOSE OF SUILDINGgo OWNER'S NAME �; _1-. _ � NO. OF STORIES SIZE _ �5 OWNER'S ADDRESS BASEMENT OR SLAB �- ARCHITECT'S NAME: SIZE OF FLOOR TI SERS IST �, �. 2rtD 3RD BUILDER'S NAME SPAIN DISTANCE TO NEAREST BUILDING DIMENSS ONS OF SILLS DISTANCE FROM STREET ,. .. POSTS DISTANCE FROM LOT LINES—SIDES REAR .. .• GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDAT ION THICKNESS 1S BUILL§ ' a'ES?+ _ t4 IS BUILDING ADDIT€ON MATERIAL OF CHININEY - IS BUILDING AL. ERA. ION `'� Is BUILDING ON SOLID OR FILLED LAND � WILL BUILDING CONFORIA TO REQUIREMENTS OF CODE .- .� IS BUILDING CON19ECTED TO TOWN WATER Ives - BOARD OF APPEALS ACTION, IF ANY r IS allILDiNG CONNECTED TO TOWN SEWER f I IS BUILDING CONNECTED F NATURAL GAS LINE BTL7Tt ( PROPERTY HNFORMATION (, LAND COST SEE BOTH S€DES ESA`. SLOG. COST EST. 8L . COST PER . Imo, PAGE `: FILL OUT SECTIONS e s � _ EST. bm G- COST PER ROOM -_.. PAGE 2 FILL OUT SECTIONS 8 32 SEPTIC PERMIT NO. ELECTRI€.. METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM. TO SATE FIRE REGULATIONS PLANS I UST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE [LE =' BOARD OF HEALTH SIGNATURE -'` _ � ld`i z� AGENT s F E E 0.° f - _ PLANNINGOA D PERMIT GRANTED BOARD 0- SELECTMEN s 4ORTH ot Andk"�Jver 0 No. 09 t.D i- ` dover, Mass., e i 1 19 fJ BOARD OF HEALTH PER -M IT i U Food/Kitchen Septic System AM BUILDING INSPECTOR THIS CERTIFIES THAT.... .................................................... Foundation has permission to so* �� ,&buildings on ... ... ........ ..�. ..e�. Rough ®. ................. to be occupied asito ..4f.40.4s.... A.. . .. ................. Chimney Ch' e provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-haws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. Am A A.M PLUMBING INSPECTOR AVAN* 09 P 45 % VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough Service BUILDING INS ECTOR Final Ocatpancy Rennit Required to Occupy Building GAS INSPECTOR la in a Conspicuous Place on the Premises -- Do Not Remove Rough Display Y � p Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL 4 107 3 CONSERVATION FINAL Street No. Smoke Det. SFWFR /WATFR FINAL� 1l DRIVEWAY ENTRY PERMIT Amwual ROBER°T ASSOCIATES, INC. Dupont Corian Fabricators & Installers Aegean Drive Unit 1 METHUEN, MASSACHUSETTS 01844 (617) 686-5951 April 19 , 1993 Dewhurst and Conte Funeral Home 17 Third Street North Andover, MA 01845 Left section of plan which includes lowering elevation of garage floor and lowering elevation of Parlor #2 to existing level of main structure . Estimated cost for this part of project $10,000 .00 WE PROPOSE to furnish labor and material — complete in accordance with above specifications, and subject to conditions found on both sides of this agreement, for the sure of: _ Ten thousand dollars dollars ($ 10,000 .00 ). Payment to be made as follows: To be arranged ACCEPTED. The above prices, specifications and conditions are satisfac- Respectfully submitted, tory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. (Read reverse side). R®4, RT A ®C:IAT , INC. Date of A�c5qeptance By By—, 13y ote:This proposal may be withdrawn by yes if not accepted within days. COMMONWEALTH cr'AH I ML"I Ur I'UbU%,7AfC I Y OF 1010 COMMONWEALTH AVE. I MASSACHUSETTS BOSTON,MASS.02215 I ENCLOSE CHECK OR MONEY ORDER LICENSE FOR REQUIRED FEE, EXPIRATION DATE CONSTR, SUPERVISOR EFFECTIVE DATE tICNO � MADE PAYABLE TO 06/30/1993 RESTRICTIONS "COMMISSIONER OF PUBLIC SAFETY" NONE ' 06/30/1991 022117 c ROBERT J SENNETT m (DO NOT SEND CASH). 20 AEGEAN DR UNIT 1 SS # 025-22-4410 1METHUEN MA 01844 P�EASti`NO1`E `'FEE'( iNCjR�ASE PgOT .S,. TMQ{7'hR-0NLvF. FEE: 00. 00 E FECTi1�E :F�SL 11� 1989:1 NOT-VALED UNTIL SIG E6 LICENSEE AND OFFICIALLY �' •�,• r* HEIGHT � STAMPED/QR N RE OF THE OMMI$$IONER II DQB. } ( ',', r l { .�S/©2/1933 � NO DETACH LIC'EHSE STUD THIS DOCUMENT MUST BE SIGN NAME IN FULL-ABOVE SIGNATURE LINE I,'C"RIEO ON THE PERSON OF ! SIGN TURE OF LICENSEE TH4 HOLDER WHEN ENGAG- .r•6T,F1• EO IN THIS OCCUPATnON. �� COMMISSIONER 204M-Z•E1�- aZ5' s �m ' . 3 Location Rio. Tows or n ' to of ccUP cy �� «moqa� riic $ a Permit eading Fee lFr rr4 $ it Fee Foundation Permit gather Permit. F � -- �— e er connection Fee $ me ter connection Fee $ "CU`TAt' "insp�ector �-- Luc �,' nrv. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS./ PAGE, I MAP 440. LOT NO. 2 1 RECORD OF OWNERSHIP !DATE BOOK PAGE ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE t, eAl OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF'SILLS DISTANCE FROM STREET 'A- POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE I HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY 15 BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 1$ 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 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 1 zy, PAGE I FILL OUT SECTIONS I - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS I - 12 SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED "D APPROVED BY BUILDING INSPECTOR DATE' FILED BOARD OF HEALTH SJGNATLM OF'OWNER OR AUTHORltgZ(AGENT F F E PLANNING BOARD PERMIT GRANTED_ 19 V BOARD OF SELECTMEN OWN-11 1, -4 t17 - 'CoNTR L.#4, 2—z j 13UILDIRG INSPECTOR CONTR, LIC 2 BUILDING RECORD 3 OCCUPANCY 52 SINGLE II SYOPIES I MULTI. FAMILY — THIS SECTION SU T O EXACT DIMENSIONS F LOT AND DISTANCE FROM ®IO.FICES 1 LOT LINES AND EXACT DIMENSIONS OF BUILDING .T PORCHES, � _ APARTMENTS - - -- RAGES, ETC, SUPERIMPOSED. THIS REPLACES PLOT PLAN, CONSTRUCTION FOUNDATION E ]. INTERIOR FINIS14 il ONCRETE CONCRETE BL;K. pIN_ RICK OR STt dE H4RD�,'D , I ERS ! :PI AA ER ryR7 WALL � I h;NFlr° _ BASEMENTi - AREA FULL FIN B MT AREA _ FIN ATTIC AREA F FIRE -ACE �— HEAD Room '0 -tviODE R'T €T ttEN -- 1 _ 4 WALLS FLOORS s Ci ti3OARDS B DROP SIDING - n E ' � I CONCRETE WOOD SHINGLES ASPHALT SIDING I HkRD"-'-D ' I ASBESTOS SIDING I COMFiN i _ - VERT. SIDINGASPH,TI E T— STUCCO ON MASONRY STUCCO ON FRAME BRICK GN MASONRY ATTIC SIRS. & FLOOR BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR POOR J (�-N- _ _. ADEQUATE NONE , � 5 ROOF j 90 PLUMBING � `u GABLE I HIP BATH 13 FIX.) _ GAMBRELI + MANSARD TOILET RM. ' - i2 FIX.} PLATSHED WATER CLOSET _ .' ASPHALT SHINGLES LAVATORY _ ___ ..®,. ..� _ �. WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROJvL Rfl FING I MODERN FIXTURES TILE FLOOR DAD TILE DADO FRAMING 1 HEATING WOOD JOIST 1 PIPELESS FURNACE FORCED HOT AIR FURN. - TIMBER BMS. & COLS. _� STEAM STEEL BMS. & COLS. HOT W T'R OR VAPOR � WOOD RAFTERS AIR CONDITIONING _ RADIANT H'TG UNIT HEATERS 7 NO. Of ROOMS GA B'M'T 2nd ELECTRIC Ist � 3rd _ NO HEATING .SEWERIWAT FINAL _ _.,. � NO R TR_ A go own naw V C10H O �- No 241 K ejr, Mass., _-ate ' N C F41 HE WICK o,q pR SS PERMIT T LD BOARD OF HEALTH THIS CERTIFIES THAT..................... .... t. ..... ....�...... .. ... .. BUILDING INSPECTOR has permission to e�et ... ........... buildings on .A7....�. :�. .... �..... Rough to be occupied as.J. I .. 1.jFAf .�...73JA44....4.0. �..►.1..�A........ Chimney Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTR S , Service Final . . .... .. . ...... ...... . .. ....... BU[LDENG INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by STRESmoU O. Building Inspector cation „ Jo. Date 4T TOWN OF NORTH ANDOVER t - Certificate of Occupancy $ - Building/Frame Permit Fee �cssu � Foundation Permit Fee Other er i 3.� sewer Conn , tl e � Water Connection Fee $ Y Building inspector 6 Div. Public Works PERMIT NO, ,� �=� APPLICATION FOR KERMIT TO BUILD NORF R, MASS. .3 , MAP +4 . LOT NO, 2 RECORD OF OWNERSHIP IRATE I BOOK ;PAGE -- -- I — ZONE SUB DIV. LOT NO. LOCATION � � PURPOSE OF 13UILDING A' OWNER'S NAME �s� � ,.� 3 � NO. OF STORIES SIZE OWNER'S ADDRESS .` CASEMENT CAR SLAG ARCHITECT'S NAME SIZE OF FLOOR TIMaERS IST a 2ND 3RD BUILDER'S NAME jA SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET .. ,. POSTS ----- -- DISTANCE FROM LOT LINES—SIDES REAR ,• GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING _X - IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BU3LD9NG ON SOLID 9R FILLED LAND WILL BUILDING CONFORM T9 REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTIN, IF AN: IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL.GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND CST SEE BOTH SIDES EST. BLDG. COST SAGE i FILL OUT SECTIONS I a 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTION 1 1 EST. I L.DG. I ER + SEPTIC PER IT NO. ELECTRIC DETERS MUST BE ON OUTSIDE OF BUILDING APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED ANI) APPROVED BY 13UILDING INSPECTOR DAT€ FILE BOARD OF LTK AF SIGN RE CS@NER€� €ITIIGRIZD AGENT F E: E \ PLANNING BOARD PERMIT GRANTED -` 19 } BOARD OF G&LECTMEN BUILDI * . A ` w 04" N 197 r ,E • {�i- or Andover, Mass., f(]C niE Ht wl4x Eggq \4 �-,- o ATE�° FFoodKi RD OF HEALTH n epym PEKMI BUILDING INSPECTOR Foundation THIS CERTIFIES THAT........ rowRough .t. .... . .. buildings on ... ... .... .... . ..�..................... . has permission to erect...$f .' ' Chimney ANA to be occupied as....... .ff ,•t ......... ...... - . ....:..............................•lication on file in Final Alteration and Construction of KING INSPECTOR provided that the person accepting this permit shall In everLaws relating to tect c hen Inspection, of t e application PLUMBING p _ P thisBuild ings yin the Town and to the ofNorth Andover. an By -Laws g Rough VIOLATION of the Zoning or Building Regulations Voids this Permit, Final �� � T 6 MONTHS ELECTRICAL INSPECTOR T P � j Rough . .................... .. Service " BUILDING INSPECTOR Final GAS INSPECTOR occupancy C'8 Tl't E.� �,cirC t� ��c�zR��� L�c��c�i�i� Rough in a Conspicuous Place on the Premises —� Do Not Remove Final Display P =No. o Lathing or Dry Wall To Be Done Until inspected and Approved by the Building Inspector. FINAL PLANNINGFINAL CONSERVATION ��nln�t=l� F1NAl. DRIVEWAY ENTRY PERMIT Location_._ No. Cute �oRr� � �$g44flb n � TOWN OF NORTH ANDOVER certificate of Occupancy _ Building/Frame Permit Fee $ �$�cmc.nw qr4� ACHS�� Foundation Permit Fee Other Permit Fee Sewer Connection Foe Water Connection Fee ---._--____ JAL -------- Building inspector Div. Public Works PEW MIT NO. APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS. I MAP 30. LOT NO. Z RECORD OF OWNERSHIP DATE BOOK iPAGE ZONE SUB DIV. LOT NO. ( j LOCATION 4 PURPDE OF BUILDING _= � OWNER'S NAME _ � NO. OF STORIES v SIZE.... -. OWNER'S ADDRESS -` �j BASEMENT OR SUPS - ARCHITECT'S NAME � � SIZE OF FLOOR TIMBERS IST $ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET ., ., POSTS ---- --- DISTANCE FROM LOT LINES—SIDES REAR „ GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING K IS BUILDING ADDITION MATERIAL OF CHIMNEY __.. IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND _. WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST L PAGE 4 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. WAGE 2 FILL.OUT SECTIONS i - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEP3 MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DAT ILED _ BOARD OF HEALTH S€SNATURE OF OWNER OR AUTHORIZED AGENT E J I F E E PLANNING BOARD PERMIT GRA @ BOARD OF SELECTMEN Z�' ' I [ � Ebi INQ Ilt PLANNi � FINAL4 T SEWE I � O��-� FIN L ONSE VATION own ndover 0 242 �'RIVEWAY ENTRY PERMIT IT A0 SCR BOARD OF HEALTH PERMIT L 0 THIS CERTIFIES THAT. .. ..... ....... .........7W.............................. BUILDING INSPECTOR has permission to erectay.. ...... buildings on ..... . .. ..� .. .... ................. Rough Chimney t�occupied as..........S.W.E.W.A140ft ......................................................... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids thisiwmh PERMIT PIPE I 6 )NTHS ELECTRICAL INSPECTOR Rough UNLESS N T DTI � T Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit required to Occupy Building Rough - Final Display in a Conspicuous Place on the Premises FIRE DEPT. F Do Not Remove Burner No Lathing to Be Done until Inspected and Approved by Smoke Det. Building Inspector 3 64 Den Wool . $� _ Of IAOVI Vio- ��GOei 'and � petet � fe MoAl A _ tet fee 0t' � .ctlollfee _ e F al t � PP 8�lam ,o \ v� Coll = \N OV\�s W e PER3flT NO APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE I MAP �-40. OT NO i2 RECORD OF OWNERSHIP DATE �BOOK PAGE 1-1N SUB DIV. LOT N . — LoCA ION _ p PURPOSE OF aUILD1t� OWNER— NAME ILL - = NO. OF STORIES SIZE O OWNER'S ADDRESS - _ BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS fST ZND 3€2D 1 BUILDER'S NAME SPAN DISTANCE T6 NEAREST BUILDING 67 � DIMENSIONS OF SILLS DISTANCE FROM STREET .. •, POSTS DISTANCE FROM LOST LINES SIDES REAR ,• ,• GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATER:AL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 15 BUILDING CONNECTED TO TOWN WATER -- BOARD OF APPEALS ACTION, IF ANY .. IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COOT a SEE BOTH SIDES � EST. BLDG. COS � PAGE f FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. PAGE 2FILL OUT SECTIONS i e 12 EST. LDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVER BY BUILDING INSPECTOR ,f - - _ BOARD OF NIZALTH SIGNATURE OF OWNS OR AUTHORIZED A ENT F E E OWE TEL PLANNINGBOARD PERMIT GRANTED - ....- N- 39 'I -IC. _ BOARD OF SE E B6€iLINGNspTQR I � _ I 3 `lam Town o Andover R <<, .No ndo�er, Mass., 199$�- BUILD BOARD OF HEALTH i Food/Kitchen f Septic System PERMIT To �� �� I),Il�,i BUILDING INSPECTOR THISCERTIFIES THAT....................... .. .......... .................................................�.................................................. Foundation .�—yL has permission to ereet,-�.. L � buildings on ® .....�/ �. � Et��� ~■�..,. Rough ,/........... to be occupied as..................... �[ 1 Ny�,...... . s ...s. ..... .!! ' �'g Chimney . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final :' _�. . �, : ` , I J..1 ELECTRICAL INSPECTOR Rough • Service ........... ............................... BUILDING INSPECTOR p g Final GAS INSPECTOR Display a Conspicuous Place on the Premises — Do Not Remove Rough P Y !in P Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Sumer PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT Notice: All home lmprovernent contractors and subcontrartorsengaged In home improvemenI contracIing;,nnles.S specifically exempt from registration by provisions of chapter 142aofthe general laws,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Dlreclor, home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02109. Designated Registrant's Name: _._...._..—...-_--- _-...-.. ........__ _ --- Registration Number: Salesperson's Name: This agreement is made on �f between (pA� {COh-FRACCOK) of (ADD 5) 0110NT NUMBER) hereinafter called"Contractor"and v — T cewnrx) of (AllnAI.SSp (III ONE NUMBIJO hereinafter called"Owner". 111.TAILED DESCRIPTION OF WORK TO BF PERFORMED Contractor agrees to perform in a good and workmanlike manner all work detailed bel)w. Such work consists of the following: DETAILED DESCRIPTION OF MATERIALS TO ItF,USED Materials to be used in performuig thh'abo%c d acriI d vv s k consist of tlic following- 11. PRICE m�v Contractor agrees to do all work described in.Section i for)he tnlal price of S �.�oa—.._._.___....__• 111. PAYNICNT Payment will be made as follows: [3a JDJ % (5 _. _ .—_.)upon signing Contract; up-on cmnpicliun of upon colnlilctio)I of _—, and the remaining -T,�4p,60a ulxm verifiralinn of the work by Owner and Contractor as having;been satisfactorily completed,which verification shall take place promptly after completion. Notice: No agreement for home Improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract price or the total amount of all deposits or pavruent_s which the contractor must make, In advance,to order and/or otherwise obtain delivery of special order materials and equipment,wh1s,ty r amount is grtal4C- IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin die work or order the lllalt:tiids beloic the died Clay following the sig;nuig tit Otis Agr"ment, unless 5pecif ied bete In writiilg. Contractor will begin the work on or about _Co Y (date). Barring;delay cloned by circumstances beyond Contractor's control,the work will be completed by ::�, S— (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violaiiom%of this Agiecrnent. cT are_... 3 'SANDO'VER_ --A NORTH i pF F IT FOR W11 S coo 'TfTis certifies that .... fi. permission to perfor has _ wiring in the building 0f. . .. � Iris. North Andover' P aGOLD... •.a ............. File ildincg Dept P1Tel�C:TfB�SUte� iieani CANARY: WiiITE:ApP I otfice Use only G �Gmmanwrzflt4 of Ifflasgar4mudis Permit No. ' 10evartmett of Jjuhtir ZRinfitu Occupancy A Fee Checked 3/90 (leave blank) 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 Electricat Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (%W or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street 8a Number r 7 Owner or Tenant "' 4,.{P t .d f ,.. >C .,� s Owner's Address e!2 l ` Is this permit in conjunction with a. building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service % Amps r volts Overhead 7, Undgrnd No. of Meters New Service Amps ._—/ Valts Overhead Undgrnd C No. of Meters Number of Feeders and Ampacity .. t Location and Nature of Proposed Electrical Work - t �,' f���..... ' � .� � �" r K Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Swimming Above In- No. of Lighting Fixtures g Pool grnd. — grnd. n Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Air Conc. Total r No. of Detection and No. of Ranges tons Initiating Devices No. of Disposals No of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Other No. of Dryers Heating Devices KW Local _' Connection i No. of No. of Low Voltage No. of Water Heaters KW ! Signs Bailasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massacnusens general Laws _ I have a current Liabidity Insurance Policy including Comoieted Operations Coverage or its substantial epuivaient. YES _ NO _ have suorri valid proof of same to the Office. YES - NO - if you have checked YES, please indicate the type of coverage by INSURANCE appropriate box. pp �" checking p P A aL.� gin°" ,f°r"a"",t"' �,"g rA&�u ".A ,/,.�" q' mu°�'","!f i,,l aw"" BOND - OTHER - (Please Specify) A, Date) Estimated Value of Electrical Work $ Work to Start Insoeciion Date Requested: Rough Final N e) y Signed under the Penalties of perjury: f a" ' FIRM NAME � w i �a"=�° N mm Signature _ ,���, r� ,,�.. �Ks. Tel.�Na "' c11 ":' O. O A to m aware that t Bu Address OWNER'S INSURANCE WAIVER: I a a that ice. h of n �af �:� e AIL Tel. No. the Licensee dais not have the insurance coverage or its substantial equivalent as re• quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Teleohone No. PERMIT FEE 3 _ --- (Signature of Owner or Agent) x•9ac� Location No Date r i � ,,�a :gi� * Certificate , Building/Frame . J "C"US^ rmit F'ee e u► ation Permit,,Fee ._. Other rr�m 9 �., Sewer Connect' on Water Connection 'Fee, ee TL 6709 � f3uf lding in spec sector Div. Public Works TRI1 T NO. g gAPPLICATION FOR PERMIT TO BUILD ® NORTH AND OVER, MASS. PAGE +40. LOT NO. I RECORD OF OWNERSHIP I AT� BOOK PAGE ZONE SUB DIV. LOT NO. LOCATION '� PURPOSE OF BUILDING 1 ' r 3 OWNER'S NAME NO, OF STORIES SIZE � OWNER'S ADDRESS - _-� s �,- � BASEMENT OR SEAS ARCHITECT'S NAME � SIZE OF FLOOR TIMBERS IST o 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST Ei3VILDING DIMENSIONS OF SILLS __-- DISTANCE FROM STREET .. .� POSTS DIS ANCE FROM LOT LINES SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS S IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY _.. IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEVER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS PROPERTY iNFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST ACE I FILL BUT SECTIONS i a 3 EST, BLDG. COST PER 90> FT EST, BLDG.G. C PER PAGE 2 FILL OUT SECTIONS 1 e 42 ROOM SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING � 4 APPROVED BY ATTACIMED GARAGES MUST CONFORM TO STATE FIRE REGULATION PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE `ILED BOARD OF HEALTm SIGNATURE OF OWNE OR AUTHORIZED Zi ENT FEE PLANNINGAlD PERT GRANTED >.._. - - _ - - Ao or BED N SUILDIING INS ¢� ORTvf I -own of 70 dover 0 Tin T , Q LANoq lover, Mass.,_jV6 � ® 19 BOARD OF HEALTH PERMIT T %j I LI) Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......,/ / I. ......... .� e.. ... ............................................................................. Foundation has permission to erect.. /.C/.. .... ............... buildings on .. . .. ..... �............, -..............I. Rough to be occupied as- .6.0,04TA1. .. ..4AN.4.... ........................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file In Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUcriON STARTS ELECTRICAL INSPECTOR Rough kla^ .................................... ................................... Service BUILDING INSPECTOR Final Occupancy Pernilt Require to c(-ul)y Buildbig GAS INSPECTOR Display in a Conspicuous Place on the Premises -- Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det, SEINER/WATER FINAL DRIVEWAY ENTRY PERMIT Location No. Date TOWN OF f NORTH ANDOVER , or fa ate of Occupancy at r aiding/Frame Permit Pee m Foundation Permit Fee Other Permit Fee ISe4W8onnection Fee Vier Connection Fee TOTAL Building Inspector Div. lalallc Works ( k. pry �tl. e, grateLo4ul�t�4/n,. No ✓ w--- `r m Certificate of (7cctp ana BuigdgnglFrame Permit Fee —d_---- Foundation Permit Fee r ^r _- C the Permit Fee Sewer connection Fee $ -----'__ ... t L nection FeeWu 14, --w-�----o-- j BuiNd6n9 r � iw.P ublic Works APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS. G I ado, LOT NO, � 2 RECORD OF OWNERSHIP ID ATE - iPAGE LOCATION �� � _ � I � SE F € UILDONr. �— � 1 i ` NEr'S NAME '` - O: OF STORIES t ' OWNER'S ADDRESS �. _ �, - .... � BASFMENT OR SLAB ARCH=CT7S 4AME ,._::z, I SIZE 6F ROOK TIMBERS VAT 2 D 3RD SWI-DER'S NAME SPAN ®®� DISTANCE TO NEAREs. BUILDING DIMENSIONS `F SILLS DISTA€CE FROPA, STREET .. POSTS ------ �i_- DISTANCE FROM LOOT LINES-9 SIDES REAR I GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION TH ICKNESS IS BUILDING ADDIT!Olq MATEP2AL OF CHIMNEY IS BUILDING NEW SIZE OF FOOTING x IS BWLIDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND `^1iLLBUNLOHNG CONFORM TO REQUIREMENT'S ' CODE IS BUILDING CONNECTED TO:AWN WATER —. BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO®O II' SEWER BUILDING CONNECTED TO NATURAL GAS LINE PROPERTY INFORMATION LAND COST -SEE BOTH SIDE PAGE I FILL BUT SECT IONS5 SST, aLOG. COST PER SQ. PAGE 2 FILL OUT SECTIONS 1 12 SST, BLDG. COST PER ROOM _ SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING APPROVED BY -. ATTACHED GARAGES MUST CONFORM T6 STATE FIRE REGULATIONS PLANS MUST BE FILED ANP APPROVED BY BUILDING INSPECTOR DATE FILE r BOARD OF HEALTH SIGN R OF OWNER OR AUTHORIZED AGENT T - N II T;71 ft PLANNING BOARD PERMIT GRANTED -. rnN �_ 9 � BOARD OF SELEC MIEN SUILDING ImarEcToft BUILDING RECORD OCCUPANCY j 1 SINGLELTI FAM,Lr. ®3 S_ORIES. _. __ _.. Lit HIS S `20N UST SHOW T DIMENSIONS F � AND DISTANCE FROG`' OFFICES 0£ LOTLINE— AND EXACTDIMENSIONS F B ILDI'N . WITH PORCHES. G - `'PARTMENTS - RAGES, ETC. SUPERIMPOSED, THIS =PLACE'S PLOT PLAN, . NS RUC— I N 2 FOLIMDAT€ON I�( INTERIOR FINISH CONCRETE CONCRETE 8L'K. PINE — BRICK OR STONE �jj HARDW D PIERS t PLAS ER - 66 r —I —f UNFIN. i I� a. BASEMENT AREA FULL FIN, a T AREA '4 xfx FIN_ ATTIC AREA NO 8 MT FIRE PLACES HEAD ROOM MODERN KITCHEN _. MS _ 17 9 FLOORS CLAPBOARDS B I I t 2 3 DROP SIDING CONCRETE WOOD SHINGLES + EARTH ASPHALT SIDING HARDIV D ASBESTOS SIDING COMt,ON �— VERT. SIDING III ASPH. TILE I G I STUCCO ON MASONRY STUCCO QN FRAME i — $RICK N MASONRY ATTIC STRS- FLOOR '. BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _.. �� SUPERIOR �� POOR e ADEQUATE NONE RGGF 1 13bLIM89FG GABLE � HIP BATH {3 FIX.! GAMBREL MANSARD TOILET RA . (2 FkX.? FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER —€ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO � i G I €1. HEATING WOOD JOIST PIPELESS FURNACE I .. .. FORCED HOT AIR TURN, TIMBER BMS. &COLS. STEAM STEEL EMS. & COLS. HOT lr`d'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G I UNIT HEATERS I € No. OF ROOMS GAS B M'T 2�d ELECTRIC t er 3,d —11 NO HEATING �AORTH "own of Andover Po- Abort dover, Klass. 19 97 Aof?ATED Is, ^H BOARD OF HEALTH Food/Kitchen An Ptt�IMIT T aw Septic System BUILDING INSPECTOR THISCERTIFIES THAT........................................ dfvoboft%�_V.......................................................................................................................� Foundation has permission to ms....... .......... buildings an ..... Rough Iwo"c�onfio�r�mm to be occupied as................ . ®. .. ....... .... . ........ e..... .... Chimney provided that the person accepting this permit shall in every resp o the terms of the applicatio on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIO ARVS ELECTRICAL INSPECTOR Rough . .....�.......... ................................................. Service BUILDING INSPECTOR Final Occ tpan.cy Kermit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises ® Do Not remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEINER/WATER FINAL DRIVEWAY ENTRY PERMIT