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HomeMy WebLinkAboutBuilding File - Miscellaneous - 45 THISTLE ROAD 1/29/2026 NORTHTOWN OF ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING nig � BUILDING PERNIIT NUMBER / DATE ISSUED: SIGNATURE: 'Al G Buildin Commissioner/Inspector of Buildin s Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: —` 1.4 Property Dimensions: Zoning District. Pr osed Use Lot Areas Frontage f 1.6 BUIrLDING SETBACKS fY Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40.§54) 1.5. Flood Zone Information: _/ 1.8 Sewerage Disposal System: Public V Private ❑ Zone Outside Flood Zone Municipal W/ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHW/AUTHORIZED AGENT 11 Owner of Record P Name(Print) Address for Service: Signature 4011 Telephone 2.2 Owner of Record: Name Print Address for Service: Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ P LV i N .J, M A L L E T - C� I � 5 1 I Licensed Construction Supervisor: t , S C 0 ,T T K License Number Address J� Expiration Date ra Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(NLG.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 it. -Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction [Y Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify _ Brief Descriptionof Proposed Work: `cam 1/►r C L, tcf e L L I A/q IJ t i 1.4 /9-1(�'t- SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit a licant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3O - 3 PlumbirlS Building Permit fee(a)x (b) _ 4 Mechanical(HVAC) a 0 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTIIORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,U l IV 4-- L C as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to.work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I L-V I (Y -J-' /Yl 4-- I L_L E✓T 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 P(I-V I/V J, /n T Print Name Si ature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB -p 11:_�M 6 N -- SIZE OF FLOOR TIMBERS 1 ST o-x 16 2 .11,4- t d 3 3 x (D SPAN 114 DRvIENSIONS OF SILLS a X( 'P DR 4ENSIONS OF POSTS I- PLLqs DiMNSIONS OF GIRDERS HEIGHT OF FOUNDATION g J THICKNESS f O " SIZE OF FOOTING o r i N u 0 c s i U) X MATERIAL OF CHIMNEY vt 6 S o N A I_� IS BUILDING ON SOLID OR FILLED LAND SO 1) IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ,F-;w----***********************APPLICANT FILLS OUT THIS SECTION*********************** PHONE LOCATION: Assessor's Map Number PARCEL,- SUBDIVISION 0 Lo I LOT (S) V STREET ST. NUMBER USE REC0MA,4,*I?AT 0NS s='OWN AGrN-1133- P, CONSE47(t4df4 ADMIMS1-RATOR DATE APPROVED DATE REJECTED COMMENTS---- ----------------- ........... T W L - 01 N, DATE APPROVED 3 DATE REJECTED = COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED_________.-.-._ SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS_PUBLIC WORKS - SEWERIWATER CONNECTIONS——/ o DRIVEWAY PERMIT FIRE DEPARTMENT ­12 3 RECEIVED BY BUILDING INSPECTOR.---_..._._...._._.._......._._....__...__.__.._..............._.____._..._._._..._...._......_..__..._DATE____.... ___._.__._ Revised 9\97 Jim 1793 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in rR " l> Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. � C Street or subdivision lot no. Owner Address Contractor Address s rA- IkIpli ant's nature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at � �� / �cl . Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By ,?3 Inspected by Date See back for rules and regulations 1156 APPLICATION FOR WATER SERVICE:CONNECTION North Andover, Mass. - Application b the undersigned is hereby made to connect with the town , �' Y 6 Y e awn water mom in Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. C ` Street or subdivision lot no. A!s'2— A��Zlllel"' 47 j Owner Address Contractor Address v A icant's;Signature �C .e2vot 0172 PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at f -Ile ��-�l� Street subject to the rules and regulations of the Division of Public Works. Board of Public Works By inspected by Date See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J-WILLIAM HMURCIAK, P.E. Telephone(978)685-09 DIRECTOR Fax(978)68"573 � NORrH 320f,tLED s9�0 D 41 9g1F0'Pp,, 5 9SSA[µUSEt� DRIVEWAY PERMIT DATE ` ` 23 260 2 ' LOCATION BUILDER phone OWNER CSC`e hone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET . CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. X A�11 A L ca N i stGNAY v�� MAScheck COMPLIANCE REPORT Massachusetts Energy -Code Permit MAS c iec SQ£tware_ itP ram;on .2-_01 .Release. 3. Che_ck-ed- by/tea TITLE: 1-198 CITY: North Andover STATE: ssachuse.tts HDD: 6322 CONSTRUCTION TYPE, 1 or 2 Family, - Detached x ' SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 5-24-2002 PROJECT IDIEQRMATIQN A.J. Mailet 3 westcQtt- Rd- Andover, MA COMPANY NFORMAT-DON; J & J heating and -Air conditioning 17 Arl icgta st. Dracut, MA 01826 COMPLI. NCE: Passes Maximum VA Your Home_. 666 Area or. Cavity - Cont . Glazing/-Do Perimeter R-Value R-Value U-Value ------------------------------------------------------------------------ CEILINGS- 2GG6 3G.-G GdQ WALLS : Wood Frame, _16" O.C. 3542 _1.3_D GLAZING. phi ndaw-s or- Dao 465- O_36.Q GLAZING:, Window-s or _Doors 42 D-3AD MOBS- 5-7 0.4_6-0Z FLOORS : Over Unconditioned Space 2066 19.D 0-0 HVAC EQUIPMENT: Furnace, 92 .0 AFUE ------------------------------------------------------------------------ COMPLIANCE STATEMENT: The -proposed -building .design desc -ibed _here _is consist6nt- taxi th the bui l d ng p1 ans speiflaa-tiDng, and- der- a i o submitted with the -permit application. The proposes- building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load .fear- this building, and the cooling 1-oad if appr9pr; at-P, has beep det prm;ned using the aT2 I?r-a_hl-P �randar_d D-es.i_gxl_ Conditions_ four_. in the Code. The HVAC equipment selected to heat-or -cool the building shall be- ao- great-Pr than 12r,*-.. of the-dessi an_ load as specified in Sections 780CMR 1310 and J4 .4 . TITLE: 1-198 MAStheck INS2EC''T _0N -CHECKI_TST_- Massachusetts Energy Code MAScheck So­ftw:are..uerzicn, 2 . 01 Release 3 DATE: 5-24-2002 Bldg. Dept ., Use CEILINGS: [ j 1. R-30 Comments/Location WALL,q [ ] '1- Wood Frame-,- 1-6"- 0_ C_, g-11_ Comments/Location W-INI.2t2WS.- AN-D. GLASS DOORS [ ] 1. U-value: 0-.36 For-windows without labeled- U-values, describe features: * Panes Frame Type. Thermal Break? [ ] Yes [ Comments/Location [ ] 2 . U-value. 0-.34 For windows- without labeled -U-values, describe- features: # -Panes Frame Type Thermal-&re-ak?- [ ) 'des- [. } Comments-/Locat ion DOORS:- 1 . U-value: f}.46 Comments/Location FLOORS : [ j 1. Over Unconditioned Space, R719 , Comments/-Location - - ffVAC QUiPMENT: [ ] -1. Furnace, 92-0 AFUE -or higher Make and Model -Number [ ] 2:.- Air Conditioner, 10 . 0 SEER - AIR LEAKAGE_: [ ] faints penetrations, anal_ all other- such. openings- in the bu i 3 din envelope that are sources of air leakage must be sealed. When- installed in the. building envelop-e-, recessed lighting fixtures shall meet one of the. following requirements: 1. Type IC rated,, manufactured with no penetrations between the inside of the- -recessed fixture and ceiling cavity and sealed gas-ke-ted to prevent air leakage- into the- unconditioned space- 2. Type IC rated, in accordance with 'Standard ASTM E 283,, with more than 2. 0 c-fm- (0 . "4 L/s-Y air movement €rom the the conditioned space to the ceiling cavity. The lighting fixtu shall have been tested at 75 -PA or 1 .57 lbs/ft2 -pressure difference and shall -be labeled. VAPOR RETARDER: [ ] Required- on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ } Materials and equipment must be_ identified so than compliance ca be determined._ Manuf- cturer manuals for all installed heating and- cooling ng equipment- and_ service_ water heating, equipment must b_ _ provided_ Insulation_R-values.,- glazing U-va al.lues, _anheating _. equipment efficiency must-be clearly marked on the building plan- - or -specifications . DUCT INSULATION-- [ ] Ducts shall be- insulated._per Tabrl e-- J4-.4 .7 . 1 . DUCT CONSTRUCTION: [ ] All acceseibFle- joints, seams, and connections. of supply and retu ductwork located outside conditioned space, including stud.bays joist cavities/spaees used toy transport air, shall be -sealed - using mastic and fibrous back-ing- tape installed according to the manufacturerrs- installation instructions Mesh tape may be, omitted where gaps are less than 1/8 inch. Duct tape is not permitted. Tire "HAC" system must provide a means- for bafanuing air and water systems . TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manna or automatic means to partially restrict or shut off the heating and/or ,cooiing input to each zone or floor shall 'be provided. HVAC EQUIPMENT_ SIZING [ ] Rat-ed output -capacity of 'the heating/cooling system is_not greater than 12.5 o£ the- design load as specified in Sections 780CMR 1310 and J4 .4 . SWIMMING POOLS: [ ] All heated swimming pools -must. have- an on/aff- heater switch and require- a cover- unless over 2.0 of. the- heating energy is from, non-"depletable- sourcea.- Pool- pumps- -require a- time clock. H-VA-C PIPING INSULATION: E } HVAC piping conveying fluids= above-120 F or chilled fluids below 55 F~ must b-e insulated to the following levels- (.in-) PIP SIZES (in, ) HEATSNG-_SYSTEMS": TEMP- (Fly 2--w RUNOU'I'S -0"-1 m `1 .25-2 rr 2. Low pressure/temp. 201-250 1 . 0 1 .5 1 .5 2 -Low temperature 120-200 0 .5 1 .0 1A 1 Steam condensate_ any 1 .0 1 . 0 1.5 2 COOLING SYSTEKS: Chilled -water or 40-55 0 .5 0 .5 0. 75 1 -ref rige-rant. below 40 1 . 0 1 . 0 1 .5 1 _CIRCULATING HOT WATER SYSTEMS: [ ] Insulate circulating hot water pipes t-o the. following -levels (in PIPE SIZES NOR-CIRCULATING CIRCULATING MAINS & UN HEAT" 'WA= TEMP (F) BUNOUT$ -0-1" QQ-1.25" 70-1$Q 0.5 - l•.Q l.5 a 0-1-60 0.5 0'.5 1 . 0 1 140=130 0 .5 0 .5 0 .5 1 ---NOTES TO FIELD (Building Department Use Only) ----------------------- ORT►y Town 0 Andover No. � ? / o . .! J CO ~ - X, z �o `A K E o ndover, Mass., 'p COC H IC ME WICK ADRATED a`P���.(1 9Is,SAC HUS�� P IT FOR EXCAVATION AND FOUNDATION yyyy�� f THISCERTIFIES THAT . .:. .:......(�1. L.// .....i�� 5.....'..................................................................... has permission to excavate and pour foundation at ..�a,d . .. �.!.S�`........... ............ ..............`................. for the purpose of... ..P040 .. 1� .. ..(Si J f f...17'�.........................4 e ��•U�, � JL_r�5/alie V C ei The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. 381,333 � 1 S0 VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. BLDG. PERM ) �F- t.-a O LESS FDA FL -- -- DUE FRAM �'t���`;v�f i � 1 � � BUILDING fNSPECTOR NORTH 0VM Of E f. Aindove r �0 3 adoa °� � � dover, Mass., iA ADRATE D -`Cl S H � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT...... `�... .... A..../..//'� ...,.. UNCS BUILDING INSPECTOR """"' Foundation 1 ! �............1-���4' Rou h has permission to erect... .......... buildings on .,�ql...�.... ...... ... ...5....../'�... gl�oo rai - 3 8 A47 h -43 (S4a) c-,to be occupied as.. ................... � i¢.........r.. .... t�Jc..�'�... �5/ 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-La relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 3 8/ 3 33 (� l 8 96- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .. ....................... C-..................`.......................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. Commonwealth of Massachusetts official use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS v —�[Re . 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 27 CMR 12.00 n r ( City or Town of k � AI,,L, MATION) Date: the Inspector " PLEASE PRINT IN I R YPE INFOR Y pp d gives no,tic a �� P for oj'Wares: Y B this application the un �,rst e` lira or her intent�i �r E{�perform the electrical world described below, Location Street&Numberi ? Owner or Tenant �i� %' 1 �A r' �,, ` � Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No p j I,p ❑ ❑�' (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service_ Amps / Volts Overhead❑ Undgrd❑ No,of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Completion o'the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No. of "Total Transformers KVA No.of Lighting Outlets No. of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- o.o EmergencyLighting rnd, grind. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No,of Zones No, of Switches No. of Gas Burners o.of etectian and Initiating Devices No.of Ranges No.of Air Cond. Tonal No. of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals; Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ElConnecci Munipaltion ❑ Other No. of Dryers Heating Appliances KW Security Systems: `1Z Y No.of Devices or E uivalent i", No.of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP F No.of Devices or Equivalent OTHER; Attach additional detail iitdesired,or as required by the Inspector o/Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ FOND ❑ OTHER ❑ (Specify:) �- (Expiration Date) Estimated Value ofEleetrical Work I �"' ' (When required by municipal policy.) Work to Start: - ( s,) Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the ains a nd penalties of perjury, that the information on this application is true and complete. FIRM NAME: Ser_�Xices , LIC.NO.: Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line.,) Bus.Tel.No.: 603 594 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER; I am aware that the Lic see does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. Cunningham Lindsey U.S.,Inc. 02► P.O.Box 703689 `(►'a� Dallas,TX 75370-3689 Lindsey Telephone(888)738-8714 Facsimile(214)488-6766 CLCAT@CL-NA.COM Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B Building Commissioner or Inspector of Buildings Address: 1600 Osgood Street Building 20, Suite 2035 North Andover,MA 01845 Claim Number: 2332107 Policy Number: 2332107 11 Company Name: MERRIMACK MUTUAL FIRE INSURANCE CO Date of Loss: 03/02/2015 Insured: BRIAN WHIPPLE Property Location: 45 THISTLE RD, NORTH ANDOVER, MA 01845 Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3B. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 I d Date a � �� �N. 9 7 %, . ®. .. i NpRT/y f 1 F p TOWN OF NORTH ANDOVER i PERMIT FOR CAS INSTALLATION '. �,SSACHUSEt ,I I This certifies that . . �.�.� has permission for gas installation . . . . � �. . r . . . , . . . in the buildings of . . . .. . . . . . . . . . . . . at . . U . . . �: . . North Andover Mass. Fee ° '.` C?0 Lic. No.�d:�. . . . . A GAS INSPECTOR Check# L H 7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING Cityrrown 40 Permit# MA. Date- Building Location: Owners Name;,�/.Ii'lz 1W Type of Occupt'ficy: ❑Commercial Educational F] ❑Industrial Institutional F] Residential El New:'EjAlteration: F-1 Renovation: F-1 Replacement: E] Plans Submitted: Yes El No FIXTURES co W co Z LU LU W < 0 =3 ul 3: ca 0 LU Lu U U) 0 W Lu F- 0 -j W — 0) 0 2 Lu W z z 5 Lu z W W 0 p 0z gmo M ujaogl- W Lu X ujzwwol-- < 0- 1-- LuW a Lu W 1: UJ LLJI-- wzg . wwo W W X Z W W ZLLJ 10 -ji-- Poz -jowl�- F- > uj W I.- W W Cn z 0 W 0 z 0 > > 0 g 0 Z Z 0 > 0 SUB BSMT. BASEMENT 1'5' FLOOR 2"uFLOOR 3"u FLOOR 4T'FLOOR 61H FLOOR 6'" FLOOR -T'—FLOOR —FLOOR Plumb Perfect Construction Check giv Only Certificate# ""I Installing Company Nam Plumb Company,Inc. El C o I r I poration Address: P 0 BOX 241 250 Pleasant St. ite: DUnstable, MA 01827 n Partnership Business Tel: 0(978) 649-8989 cell (978)S69-4498 n Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes El No El If you have checked Yes,please indicate thertype of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity F-1 Bond R 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 F-1 Agent n Signature of Owner or Owner's Agent By checking this box E];I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installatjon�sjerformed under the Wmit issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbin nd Chap�i42 6?eneral Laws. Typa-of'Llcense: By FT Plumber Fl Signature of Llce�iSecl Plum0er/Gas Fitter Title Er"Master City/Town Fliourneyman el APPROVED(OFFICE USE ONLY El LP Installer License Number:— �2'0( — The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibl Name (Business/Organizatio�ndivi Ile? qual):Zz� e,�;7 Xle, Address: Cit /State/Zi p _�, one 4: Are pa~fin employer?Checkle appropriate box: Type 4"projeet'(reqa1red): 1.0 1 am a employer with, 4. D I am a general contractor and 1. 6. [E'14ew construction employees (full and/or part-time)." have hired the sub-contractors 7. ®Remodeling 1❑ 1 am a sole proprietor or partner- listed on the attached sh%et. I ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. workers' comp.insurance. 9. R Building addition [No workers' comp.insurance 5. F1 We ate a corporation and its 10.❑El Electrical repairs or additions required.] of have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.n Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.E]Roof repairs insurance required.]t employees, [No workers' 13.n Other comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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'compensgtion insurance for nty employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. Kee"I A, Expiration Date: City/State/Z.Job Site Address: �Ve,51b 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 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$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 cept! the p * A''hirp)-offai uly that the inforniatioiiprovided�abo7v ,Is tr ie and correct Sianature: Date: 7 Pbonw#: 7 f�fflcitl1Ilse 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#: f g�P�py ��RI/ItJt�@pJMp�yW�9l/ L &//U.11, i1'➢�IDY�w+JEl�L71�(G�1� ,1/��/r/�I/�1� �lFS� 1�.0.iLr"l�.!p�G1/✓{lL���i/��� IN PLUMBERS AND GASFITTERS LICE P �I � �9 ' 'LunnuEl BRIAN J FLYNN c 250 PLEASANT ST BOX 241 DUNSTABLE MA 01827-170 (,W V`IFlrI N, `r G 2 57 H thiS kef),:U, is lo,,;f or ifuafiayrdl nOWy N)dtlF@mcm der" �,JD',1 r,sr"r i if yCxd t f1t ric, C}f i ➢l.lr �,IE; is of a,«rrecl narn,, or n dr �, i,o, Ftr.,remd ApN,,,Oic k on, Nvv iy,, (<,rk '!, This, license i, subIeci as,-arnoi dad. It is, or ns,,Jwwd k,) ',ri, u br�rErrari or prr,.fr { r, r�(ji.ii'�,�� Date.... ............ v ,aOFTI♦ "° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUS A 6 � gem �r �i This certifies that .........,......... ............................... .... a has permission to perform ...... ....... .................... ............................... wiring in the building of... Via. .... � .. ........................... at..,,��...... ...��.........................��:�.�.................... ,North Andover fass. Fee... ��� ....... Lic.No �� �� ........... f LECTRICAL INSPECT Check # I l,oncmonwealik o/fi'laeeac4adette Official Use Only cc� Permit No. L ' 2epartrnent of3 ire Serviced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: —f e City or Town of: ��� To the Inspector of Wires: By this application the undersignedgives notice of his or her intention to perform the electrical work described below. Location(Street&Number) � Z j`7 Owner or Tenant 2-1 l,: itf Telephone No. Owner's Address "s* Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Servicem2,�, ) Amps j lei /,,Z 2 j9 Volts Overhead ❑ Undgrd No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: tag. r°sry�� a ,✓ o"�`'.�.J 1'"c'�d� Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans TransTotal Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KlV No.of Self-Contained Totals: iDetection/Alerting Devices No.of Dishwashers Space/Area Heating K El Local Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water I No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent rt No.Hydromassage Bathtubs No.of Motors r: -- Total HP -7 Telecommunications Wiring:No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Tod ` 42 (When required by municipal policy.) Work to Start: `•"` Inspections to be requested in accordance with NEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0- BOND ❑ OTHER ❑ (Specify:) d � L`, �, ` -- 1�6"' I certify,under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:," � %'r ;' I e' ,i LIC.NO.: Licensee: . /7 Signature -t, a ^ „� -_� ,LIC.NO �,i j ` (Ifapplicable enter "exempt"m the ense lic number line.) -- — ��-- .� � Bus.Tel.No. Address: J t- / a ' �r�x � No.: w y y F '� Alt.Tel. *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ , Signature Telephone No. �� . � r ���� �� � l ACC>0 CERTIFICATE OF LIABILITY INSURANCE °��'"�'°°�'"Y' 10/19/10 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 policy(ies) 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 lieu of such endorsement(s). PRODUCER NAME: T Me an MaCBe Anawan Insurance Agency, Inc. PHONE (617) 325-9431 1 T N,; (617) 327-9033 4 Anawan Avenue AoiwESs: mmacbey@anawaninsurance.com West Roxbury, MA 02132 PRODUCER 4277 INSURE S AFFORDING COVERAGE NAIC# INSURED INSURER A:Norfolk & Dedham Robert Aquino INSURER B:Commerce DBA Aquino Electric INSURERC: 763 Webster St. INSURERD: Needham, MA 02492 1NSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER M/DD/Y MM/DD1YYYY LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY R801559 11/4/10 11/4/11 DAMAGE TO RENTED I E Ea occurrence) $ 50 000 CLAIMS-MADE F_x1 OCCUR ME EXP(Arryone person) $ 5,000 PERSO UAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APP LIES PER PRODUCTS-COMP/OPAGG $ 2000000 POLICY� JE LOC $ AUTOMOBILE LIABILITY COMB INED SINGLE LIMIT B ANYAUTO Y38351 7/16/10 7/16/11 (Ea accident) $ ALL OWNED AUTOS BODILY INJURY(Per person) $ 500,000 x SCHEDULED AUTOS BODILY INJURY(Per accident) $ 500,000 PROPERTY DAMAGE $ 100'000 HIRED AUTOS (P er accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WEND0595 8/13/10 8/13/11 wcsTATu- oTH- ANDEMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACGDENT $ 500,000 OFFICERMIEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPT 120 MAIN ST AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 Megan MacBey ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD i Location � � ® L � No. Date 6-2 0 MORty TOWN OF NORTH ANDOVER # ; : Certificate of Occupancy $ c►auSEs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # G Building Inspector ...........Date. .�..... .'. .. � °i a aoRTN, oa°'�`•':•�"�a� TOWN OF NORTH ANDOVE a 6 PERMIT FOR WIRING � rt a i -� nff CHUSEt w � i •' This certifies that .:,Z r .: y has permission to perform 4....x.....�....... .. ..., �,r..�.. ...s.... j wiring in the building of.. ,.... ........: .:....,.. ................ r at.... = _ _ .... ....t.'... : ................ .North Andover,Mass. Lic.No. yi .. ................ ELECTRICAL INSPECTOR Check # N i E-Jj ` �' Jr. Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99) ticave bunk) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pc.flormcd in a6cotdaiicc with the Massadiuscus Electrical Code(MEQ,527 CNIR 1100 (PLE"ASE PRIjVTIiV INK OR TYPL",SILL INF012.,V1,3T10N)/' c) City orl'own of: & -- To the Inspector of Wires: By this application the undersigned gives notice of his or her.ititention to perform the electrical work described below. Location (Street& Nuiiibcr.)--'-A,` Owner or Tenant ......2D, Telephone No. Owner's Address Is this permit in conjunction with n buildin,perinit? Yes No F-1 (Check Appropriate Box) Purpose or Building Utility Authorisation No. Existint, Service Amps Volts Overhead El Und-rd M No.or i-,Ictcrs New Service Anips i Volts Overhead Und-rd ❑ No.of Meters. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthe following table may be waived by the hzs')ccror of 111ircs. No.of Recessed Fixtures No.of Ceii.-Susp.(Paddle)Fans t No.of Total 'rransformers KVA a No. of Lighting Outlets No.of Hot Tubs Generators XVA Above In- No--.of Emergency Eig Ming No.of Lighting, Fixtures Swillirning Pool arnd. ❑ grIld- Batteg Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARINIS INo.of Zones No.o election and No.or switches No.of Gas Burners Initiating Devices T No.of Ranges No.or Air Cond. Toonstal No.of Alerting Devices catPuznP 74—o- of Self-Contained No. or Waste Disposers Totals* Detection/Alerting Devices ,No. of Disli)'vasliers Space/Area Heating MY Local n ttilOther Connection No.of Dryers KW 'g—ec7ty Systems: i fleatingAppl-Appliances No.of Devices or Equivalent No. of Water KW No.of INO,of Data Wiring: Heaters Sit,Its Ballasts No.of Devices or EquivnIelit feleconiniunications wir�-Jig: �,No.Hydroniassage Bathtubs No.ofAlotors Total 11P No.of Devices orEqUIV21elit OTHER: Attach additional detail i(desired, or as required by the Inspector of Wires. 1,N*SUR--k,NCE COVERLAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such co crage is in force,and has exhibited proof of some to the permit issuing office. CHECK ONE: INSURANCE BONDE] UrNER 0 (SPccifY*) (Expiration Date) Estimated Value of Electrical Work: fLi, (When required by municipal policy.) Work to Start:\A0 t Inspections to be requested in accordance with MEC Rule 10,and upon completion. I eerdfj,, vfperjttr)-,that the inforination on Ilds application is trite and complete. rX FMAI NAME: -cN-•--i- ', C :�� C, Ll C.N 0.-.7377�A Licensee: gltatur c,77--ac.NO.: (If applicable. cuter "r-%,cnijal in the license number tine.) Bus.Tel.No.t (00*'S-S95--- t06&b ' Address: OWNER'S INSU RANCE WAIVEW. i a"'awe that the Licensee does not have the liability insurance coy crage normally required by lavv. By my signaturc below, I hereby waive this requircment. I am the(check one)[—j owner L-j Ownes ak$elit, ONvuer/Aryent mi T r�E.i-,: $ Si-nature Telephone No. Town o E oe v �o 3 -l ._ _ - 0 - - 9 �ao6z D� „<< ,Q dover, Mass., , ADRATED 7 S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 5 THIS CERTIFIES THAT....... ............... .. /�/ A�`�� �vN C� BUILDING INSPECTOR /4.`.................................. .........7 ...................!.. ............... .... Foundation a ` has permission to erect........................................ buildings on. o...................... ......... ..... Rouh to be occupied as.. .. DOS.� 3.. .[.!�.� ...�� �t��.... .#�G� r ....sJ l!� ��e- �'SS9�p Cc. Chimney-/�.r ct�f-- c�........... 'U — - 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-La s relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 0133 8 9 PLUMBING INSPECT VIOLATION of the Zoning or Building Regulations Voids this Permit. o h 4e; z PERMIT EXPIRES IN 6 MONTHS 1411 l- Z UNLESS CONSTRUCTION STARTS ELECTRICAL 7ECT .. ....................... .° '...........:. ................ Service , BUILDING INSPECTOR ina aAt� Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove14 ��� No Lathing or Dry Wall To Be Done lJ FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner e)�- Street No. (''1f, SEE REVERSE SIDE Smoke Dett ,/�,� aMQ row,* Oro sSRCNa3`-'E CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number c3 Date THIS CERTIFIES THAT THE BUILDING LOCATED ON ,COBS© 06�6_ '/X/3 R411 MAY BE OCCUPIED AS 51.,VqI a m JCS S 1 W le we le— IN ACCORDANCE WITH THE PR SIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. q' /Ped0 h?S — 3 B-4" .3,S // v.va9- ^ CERTIFICATE ISSUED TO elo" s 7 - wes-t M- ,/` PCj,e7cxe-/L- ,,0 e,-�A Building Inspector Town of North Andover NORTH Building Department y, y , ».*� o 27 Charles Street o : North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 by . ^QA Ce[rryLHwcn V � SSdICNl1����� APPLICATION FOR. CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS LOT NUMBER SUBDIVISI DATE REQUEST FILED DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVATION ° .. DATE r . i PLANNING effq DATE m D.P.W. —WATER METER DATE ' D.P.W. MUST INDICATE THAT THE WATER METER.HAS BEEN INSTALLED o TO THE INSPECTION R QLEST DATE. PRI 46GNITURE,./..DI?W A . ��Q..�RIZATION µORTM G4ttea Ids~Q 5S14C#ius CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number /IV I c3 ( Date THIS CERTIFIES THAT/ THE BUILDING LOCATED ON ,COBS© 0' _ �� MAY BE OCCUPIED AS 61 ilke- IN ACCORDANCE WITH THE PR SIGNS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. S - T AA ft CERTIFICATE ISSUED TO t72•' I��4.l l!�•7� t V 151. Building Inspector tIOR TH Town of E Andover 0 TO I 0 -�oC HIC LA � dover, Mass., - 7,9�RATED P'PG,��� H 4 BOARD OF HEALTH Food/Kitchen PEHIVIIT T D Septic System 5 __� ( I BUILDING INSPECTOR THIS CERTIFIES THAT........- .:....../.�/t9../..11'---...........r6)ty S ........................................ Foundation /rvat has permission to erect........................................ buildings on .,�.o...................... ..... .............. . Roughs. ��:(r�.--- � _. �-�-�_ // .. .................................... to be occupied as..� Room -.3..�� !� -�...��dll... �i4G{l r.�....�t��c..�'�... �r��l'p�C'c. Chimneys ce- ---�--- provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final s tic --j 2— this office, and to the provisions of the Codes and By- s relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 307,333 !8 96; PLUMBING INSPECT VIOLATION of the Zoning or Building Regulations Voids this Permit. ° h ;--L PERMIT EXPIRES IN 6 MONTHSl � L UNLESS CONSTRUCTION STARTS ELECTRRICAL INN§PECT 60 Ro .. ....................... !...........:....................................... Service BUILDING INSPECTOR final ��f �rj Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove , y No Lathing or Dry 'Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. �"'�(— Smoke Det. SEE REVERSE SIDE r r_ ✓_,- F 'atldn - 1 No. Date 0OR714 TOWN OF NORTH ANDOVER a Certificate of Occupancy $ wus Building/Frame/Frame Permit Fee $ swct 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # ` - Building Inspector �f.. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NU ER. � DATE ISSUED: 0 ic SIGNATURE: � Building Commissioner/Inspector of Buildings Date SECTION I-SITE INFORMATION omm 1.1 Prn Address: 1.2 Assessors Map and Parcel Number: 3 P 333 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lort Aref 3 S Frontage ft 1.6 BU111DING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Re Fred 4Provided Reaed Provided 1.7 Water S ly M,G.L.C.40, 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ( Private ❑ Zone Outside Flood Zone ❑ Municipal A On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHINAUTHORIZED AGENT Histolic l i'ii" 2.1 Owner of Record ic -� ,1. Name(Print) Address for Service: Y J Signatare Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone 90 SECTION 3-CONSTRUCTION SERVICES 3.11 se-d Construction Supervisor: Not Applicable ❑ �� ym�`1 ,�(J ff LicenseAd Construction Supervisor: ( q- ;Z 4 ` Z L� p G (q � ` �"�, (��/ l ,/L1 a?L License Number Address Expiration Date S t re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ C mpany Name 13 T 9 7 7 1 �a G> .J&& �4l J r/�-~ 2,(�� {� �+!11 � �(t�E Registration Number Address 1 t`'.V �" FJ �/ ® t'9 a L3� �" Expiration Date Si nat a 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 build' rmit. —Signed affidavit Attached Yes......kr No.......❑ SECTION 5 Description of Proposed Work check aIl applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ T�aons(s) ❑ 1 Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �3 se✓�J ON CkV�t (*� "?®T C- ( _l Ll Yl4 �/ a.y ��1�Irks l�?�fL,7e4 "f'' �Gt'd'c lr v.✓ � �fJ }Cl� ! !3/l Grp��c`�. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be pFP ICIAL USE{INg ky Com leted b ermit a licant 1. Building (a) Building Permit Fee ,2 b O o Multiplier 2 Electrical (b) Estimated Total Cost of �'d U Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 3 5 Fire Protection 6 Total 1+2+3+4+5 12 D rJ Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHO'`RIIZED AGENT DECLARATION 1, J d c e� 1�'l!Jworo E -ir-'r c-?'— as k0ma#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 of C � MA'1Z �d Print N e (� S f /A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TI MERS IST 2 3RD SPAN DIMENSIONS OF SILLS DMT-NSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Sri0n C-Y aAz- FORM — U — LOTRELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. w a w IN 0 0 0 0 0 0 a a 0 0 n 0 0 N a a a W 0 a 0 a a a 0 w 0 a 0 a 0 0 a a a a a APPLICANT d? I Gu k,t W-e PHONE 0 ASSESSORS MAP NUMBER 39 LOT NUMBER 33 3 SUBDIVISION L9 LOT NUMB R - STREET STREET NUMBER S .............. 0"IMLL USE ONLY monsoon son now 0 RE MWENDATIONS OF TOWN AGENTS $mew wwwwwwo!9wo I�ww 771 DATE APPROVED COMSERVATION ADMINIS TOR DATE REJECTED COMM NIS kv) 11( DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS, DATE APPROVED FOOD INSPECTOR-f1EALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-11EAUM DATE REJECTED COMMENTS PUBLIC WORKS-SEWER WATER CONNECTIONS DRIVEWAY PERMIT DAITAPPROVED DFi-,ARTmi--mr DATE R17JECTED COMMENTS RECEIVED BY BUILDING INSPECTOR r)cC .0 _ 02 09 = 14 aaM E MC SURVEY9784697046 P. Al Ii I i I E K SURVEY INC 1 I 0 NAWERHILL.AAA M Phone 075 105♦Fare 9 I i M041ITGAGOR r� 111d &W mllt OEED REF PG AO ESS OF RINCIPL BUILDING KAN REF M � DATE OF INSPECTION SCALE V _Iwo I i � I I / t f ' I t 4r�Q 7 j toY ZK ° 4 rrr- Il9 ' I i � i w� ( it UDI 1. CIE ATIFICATipty TO No. 1ab6a ♦ The IocabOn 7"the fu,ne"ple Situct,,re/m. This aonpapc Ploi P4,war prepared oplctlically earl r E' _ 'r�erlfpge pv s only eno,a,s not. ar represented °.►r rrrilf�� Wdh The►oval tohlt'�bylaws in effect wlier const u[Icd Ig be a e or land survey Thi plan is rwol lay be used �dyN i,adt►1 and/os is at"(from violation snow«trnnena establah any tTwr peopemy utter lot�anyy purpose No action under Mass 0 L Title VII,Chap qQA.Sec I kaMty b iAc to the I"�"1` ar eeeypwr,l • S ► np n not In a hard Hazard Area T*M Mauat"is basao on ttw 1aesAMf*w of WaVyyr mawlaer O ISubject butTdinp is an a Flood Hazard Area. 04 cows Flood Hazard daNem'aned from the FIRM mao_ Elated_ ( f ! I y AUTHORIZATION TO OBTAIN BUILDING PERMIT /"Y" UA, as owner of the subject property, hereby authorize Gage Hill Remodeling Inc. (dba Blue Sky Patio Rooms)to act on my behalf in all matters relative to work authorized by this building pen-nit application. (Address of job) : Z' & Signature of Owner: Date: Gage Hill Remodeling,Inc. 603 890.3552 (ph( 169 Old Gage Hill Rd.N. MA HIC# 13 (_ J Pelham, NH 03076 Federal 1D#: 02-0_. U � SKY "ALL SEAsoN PATio Rooms" RESIDENTIAL CONTRACTING AGREEMENT DATE: Building our repirtnli0H,our room at a tirnr Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. This agreeme rs made betweeiGarTe Hill Remodel'n 7.[nc. db—a Blue S1<y Patio Roc'>ms, hereafter called"Company" and (Owner)6//Y/1,' -I- —_ located at Address --City �1 Phone number G � hereafter called "Owner". Owner hereby accepts contractors'proposal to furnish all labor and material necessary to perform the following work on the premises at the above address. THE WORK TO CONSIST OF One Unheated Patio Room: Color: White I I Sand Style. !_ St dio ;"A" Frame Porch Enclosure FJ�O�thaer Size to be a roximately._ --x _ x em J - A Wall: pered Door(s)& Screen(s) " mpered Window(sl & Screen(s) Transoms: ... ewa :e _ l8" '�J Other__- � .?Solid Mass B Wall: �I T p d Door(s)& Screen(s) empered Window(s) & Screen(s) Transoms: r_1 _ (with -�Ti Solid XG 1 isos on A & C C Wall- Kneewpered Door(s) & Sclreen(s) i crrpered W ndow(s) & Screen(s) Transoms: 6" fill block) m, Kneewall: 18" Other _ 1 Solid r Glass Roof: C_ oarn Gut er System Thermal `"H" Color: - Whitc/White '_I SandlSand I Other _ Room Glass (, 'ngle Pane Insulated � tller�on Room Doors-be built ondm CL Storm Door nl Other : K�olllp Room gers g deck if it is up to code* any to add subfloor , 1 }� ��.�� *NOTE: Additional deck reinforcement may be required by local building department to bring deck up to code. Any additional costs will he the responsibility of the customer. Company does not warranty customer's existing deck. Deck built by Company (includes subfloor) I 1 Steps to grade off wall(s) Additional Deck/A dttiit�nal Work(dormers,patio door description,etc). IV New Open Deck Construction: Approximate size. _. x f t _ o"�i All deck sub-structure to be pressure treated lumber. Top decking material to be: _e3 - CJ41y1-/ _ Description _ _ IY% d i L7(I ice`' - n.=nP �crv,ne;hle In rlisoose of all construction debris � 'ompany to remove all construction debris at additional cost$ �� :0w ner is rcspo I I s I h1c I o(I ofa I I cow,I I I Ic I I o n „ AN ACCEPTABLE AND UP TO DATE PLOT PLAN IS REQUIRED BY .ALL TOWNS To PULL A. PERMIT. IF YOU CAN NOT PROVIDE US WITIA ONE WITI-IIN 5 DAYS Oh THIS CONTRACT DATE, COMPANY WILL ORDER ONE XF CUSTOMER'S EXPENSETOTALING $500.00. If permit fee exceeds , 200 ny, additional costs will be the of the customer. If there is Any work to be done that is not - included in the contract, customer and com , ny, represeqLative must complet a "change of contract iVerrienC.jfsubs�tantial design changes occur,a new contract may he required. ONE-YEAR GUAR ANI't L. Contract guarantees the installation of the work for a period of one(I)yeal.Isom the(late ofinstallation. Contractor will provide,tree of,charge,all service labor necessary to repair the installation during the guarantee period," This guaran(ec is in addition to the manufacturer's s warranty ofiriatcrials and workmanship. This guarantee does not include damage to the work resulting from accident,misuse, improper operation or UnatI1110riZCd repair,alteration or actsol-God. YOU may obtain service by calling or writing to Contractor at the address and I)hOoe number listed ahocc. Such Service shall he perl'ornied only on%vcek(hiys between 8:00 arm and 4:00 pun. OWNER'S DEFAULT. if Owner refuses to permit the Contractor to proceed\n ith the work or attempts to rescind this contract(except as provided in the Notice ofCancellation attached),Owner agrees to pay to contractor the profit that Contractor would have earned on the the completion of ihe work arid reimburse Contractor For all out-of-pocket CL)SIS and expenses inCLITNLI by Contractor, including labor, materials and corornissiows. ['he Contractor's lost profit shall be limited to 2Wi)of the contract price. All patio room and clerking material remains the property of the company until final payment by custorner. ENTIRE AGREEMENT. This,contract is the entire agreement between Contl*,MOV and OWnCV. Owner agrees to be bound by the terms of this Contract as written. 1-here are ne other understandings between the Contractor and Owner,either orally or in writing. SCHEIDULIX(�_01KiLej licreby acknowledges and agrees thin the scheduling (late," arc applkwinalc and that Such delays that are not avoidable by the contractor shall not be 'in this A� red violation of The contractor sliall not be deemed responsible for delays in(lie work described co e,I a s a v t rre.�iDcnt. grecincrit caused by regulatory,permit grantinj inspectional agencies,authorities or 'duals. �OWNERS RIGHT TO CANCEL: YOU IMAY CANCH.THIS AGRITMENT A`l_ANY TIME PRIOR 1-0 MIDNIGHT OF 1-11F.THIRD BUSINESS DAY AFTER 1-1 It-,DATI F THIS AGREEMENT PROVlD1,,D__j14A-l`'111F OWNER NOTIFIES THE COMPANY IN WRITING /VI' HIS PLACE OF RIJSINVSS (NOTED ZVI'TOP OFFAGF1 (3) � NARY MAIL S7t�3t4 CRAM SENT OR BY DELIVERY. 'Fill-'COMPANY HAS AN EQUAL RIGHT TO CANCEL. CONTRACT PRICE' ACCEPTANCE BY OWNER: The above prices, specifications an, 1. Contract Price ---------�_11 conditions are satisfactory d arc, her, accepted. YOU are authorize Ile A. Down payment: to do t115"W�rk ass CC P, Yn ill be made as outlined. B. Material Order Installment: C. Balance Due Upon Installation '/o) Owner Signature By— fgllg`natAre of Designer Owifer Signature ............ r i m f i r 4 (F.r i°FiDyi l,tir r � r ' i F r i �r`vr� r�Dl�1�✓�t r i i I � �fu D✓��r��r;rd ��,'�k� �,r„ � F r1 i is 9�✓err, ?' s F � r � U,�� lid�� r If ��������f� I �✓ � ��� r' P/�r r, 1 r Oli lYi UYl ,�. �i /(i,/rrJ/j`iN�b/r���lli (✓��lr� � rl � / ,i,r„ D� , i� Ifi�✓g i�i�f�iDi��D�{zA "la�r�y k °� , � � i � �II ��,; �r r,,,4Fi,/Fvo l✓r,�7�� f� , M 4y a p"i i 95 rljr'1�/ r � �iry N �r 9 � r Gvly �r� I�Y✓Y rrr!r 1 ill �i, Fff r l� r r i it .w�u �w' ✓Gi,r , Q ..v w low ivy1�1r, �fu Gage Hill Remodeling, Inc (dba) Blue Sky Patio Rooms 169 Old Gage Hill Road Pelham,NH 03076 603 890.3552 Date: 2/9/04 Residence of: Brian&Julie Whipple Address: 45 Thistle Rd Phone# 978 685 7805 PROPOSED PLAN FOR UNHEATED PORCH Sunroom deck construction : We will be replacing the existing deck beam and posts and replacing it with a triple 2x8 PT beam on new 6x6pt post, using the existing footings. Footings: 12 inch diameter sonotube, Proposed unheated Porch 48 inches deep with anchors. 14' X 16' shed style 3 1/4"EPS roof system 2X10 PT frame @ 16" O.C. 40# live roof load Ledger Bolted with double 1/2X6 lag bolts 32" O/C. Electric wire raceway to NEC standard Joist Hangers at ledger and outer band Double side joists Triple 2X8 PT beam 1/2 T&G plywood sub floor 6x6 PT posts with galvanized base plates and anchors Stairs and Rails: 58"wide stair 36"High Rail 4"baluster space I I"tread 7"rise Open Deck 10'X14" 2x10 PT Joist 16" OC Trex composite top decking Triple 2x8 PT beam on 6x6 PT post 12" sontobue footings 48" deep Gage Hill emodeli g;irc' #? IM 03076C � I '; ev � ff` 1 € � z i A jr 51 F fir£ g , j �`' P �. � `R.�.,„.:..5.^-��"•',.���"� �,W »�.,.s-:�.,��.�.`..kn,,*M»,,.,,ae.d r,.�, ,:. _ m4s„� _.. ,�.. "'u�p '"°r-""�+ "�� 41 rac 3.1aill Hilo / U`C � .` Th-, lvla,ssachusetts, Stato building,Code (780 Mfi) i7lols`ades pro�lslons to casrr;6 tha.6.hoiase� wid hog=.se additiclris meet energy standards_ 1115 suppl-6rrten'al CON9UMER 1NF0PMATj0.N FORM is to be Flltd as nast of thy:: building permit application when a build:r/contrac:tor° or horrie&wmer, eras` rckin Jinn lain a }rouse a.ddi.tirarl will; very lrar•r-oerceiim,ad eaf, l'i s to opaque wall,-seeks to utilize a k;:1 cragy Ci ax::SrvatloiT C:'x,enl fltIC rl 011 Lt Dll fai "Slll'iFo,orn" addition !c an hous: (p G0 C�4 , Appendix I, Section 11.1.23J). This FORM is not untended to prevent a hornewrmcr from s�-,Iectin9 a e iw4T r[7oC1„ of any size, C rlfiguration, orietltad n, l01 or construction or perceaCt glazin bLCra%ller i5 only ira!!nde-;d to asx<sls;t horller, wiers in b,; orniiig aware of sane of the important en-trgy conservation and Y-�ar round considty a ions invoh,e,d in sniefting,and utilizing a "sunraocn" addition, lle r CJr eCt,lCki1 3l 'IXSiWifoCr}t"rkry" structures to residential buildings alb Create comfort and erdery consumption issues due to uncontrc fled solar gain or uncontrolled radiation cooling or tdae main house. In tim-- selection and "su%roo?;? ",, Included below is a. 13OU_i`e`quir t d,,op--n-crided list of product and desic7 a considerrstiohs that a horneown r may lsh to consldoz' before actually cons-tiu cticia/:r:st lling a ""sunrr am". It is,recunimend:rd that co,-rsumers'car-efull revise these optior:s � ith Ehezr designer, builder, or contractor, ila order to' trririitnizd pot ritial ener co'"surription a.rzd/or bousc discomfort issues. In addition, the quali5c tions and re utation ofthe conrdariy or individuals to 5e hired are impox-t t.consider .'tiolxs_ a Solar Orientation and Platar-d Sivi ding Type of Glizing InSIalatilI v rilrrc oTnr beat gain Irr°rtcrar artrlteui.tts GCzlarizav to frame scaling and gas eticlg r1.l.aterials/seal durability and/or wentber filth mess of:he,suaroorn .rdegtxate ventala.tiob - Operable windowfanad Sea Applied Sha,diag'S;ystexn,s insulation level in, boss,rwx4s, and ceilings Possible Sunroram-sraInGcare rrom the iniin house via a wa31 andfor door rar slicder f L r , "a.d_d . aLai,tC�" _=__ % .'__tr o are:.m ea ,17rxy.. "a �>0_t . kTAcss 4 U "`.atazar �vrr e r' clr ra ti�l Ord�rra c ra t , .T ht 1" assacliusetts SiateBuilding Code, Section J1.1.2.11" requires that the actual property o rr r..( of 6e orvraer'sa eritorrepresentative) ao; sl:�Nle(Igtracei tofthis CONSUMERINTO �"I"ZCdNTFORMpriorto zssuanc! of a BAdiner Permit for a 1;rnj ct that incic;dcs "sunroorn " additions to an existinS residential bull in.g. In accordance N-vith this ro.quire„aclit, the undersigned hereby acknowledges es that sht/bc- has read the i�r50—ilcatiOT 11$ i:llis" td}`l.C?.rMe i C011CeT'n 1i17 511i17001`12 CCiifor and .".ntr CC�F S�t��tlCr�l. Si naGsrCof,Actlaal BAWing -,,,/ncr ;date he .Print 4 amc ,address cfPerzn,`ntwd project 0vn,,.erAddrt:3s (ifdiffuent 0mra prgjjvct lo-:atilon) 0-miner's telephorrr nurnbe,, _..._. PRE-CUT ;HEET DATE. 01123104 1 PREPARED Y- PHIS @ EXT 231 _ALFR NA Mk: GAGE HILL REMODELING 0 ALER DOCUMENTATION REQUIREMENTS&NOTES �a'3.s 3iv i`S:.i°4-: gs:G.�C�"'.�.�^1t -'..,`F:ii;�,tc:L'i�R i??#` €�E.S'TAS f.U AVOVN S(AROVf--:.) (€(S9TL1i€2 fib �jFLFVAFK-JN€DRf MiG, P-E STATIC]ST[E TIA-f IN A1,1d ING IAREA: INN =%Mk-€ECKDf- dLDRAVIWG5 PE.LOAD vALCULA flO7 Z YVCR jrZTALL.: _ � ELTTgER ROOF OPTMNS ggg G EQ.D SNGW,'V Mf LOAD: L__ 83.E €Of. Y?Ef3TFi: 4 €E.E3LA G § €�vL�PAWL L Lck`. TH Sa O�ii R'OF PAWL!EWIH .00FFROFCIif7il: €5. 6 S2X1T FSt;ti3Ps�PU�Ed?kSC � ".u5 RE£EStA..TINC,€Tt2CE-Y,[St- JRG( €=ARFI r4-r. 3 3 j4 TKERNAL su€.fNl(ROOF PRO1 � -46 iRFSU I ING ROOF Vd10 fH(TNCL.REAlstj � e 3UX {�Ti„f_5H_ t`"LE_AKE i f-I'�a'GLFABb„ PAW & C-SSTe.s sfiuG f�-€f=�CS.w�s`s". i�LT-;�• t t€� S g "'^t!i �=�GI;TT��i (3tA P,TC£# 2BTC AY'taE: € €14 ILL DEGREES JROOF PAWL COtOR: Ll:v FE .Of% EXTRUSFON COLO.Z: iwfuTE WOOF 74CUhF;WC,TO: iE5€I G8LDG 9C,lFF'9E TYRE: 3EXTRUDED FAH K-At?MaY L3OWRZ_FL EC. p0 £CHATN­-5KA!G4T: Ii MaN§4YLI __ €ST FRID,1 Fi-A T?CUT If�C: LOOSE Room OPTIONS €_z�Oc 'COLOP H D� �r AJ: ' ITE HM_ .ALL:ALL s-E sLuoms NOTE;USE 0.0 HE E m € -E €�LJ IONS. f �RLASS TRANSOM KE€G-ET .X;E A g W€ TYPE JDOOR ?Y;TYPE: '1 72 P qO Od3i'bR IDOOR MIN ;?:s`n ILA' ;:1.,f5}�tR. Y§av' Rz sm-T T Hf" /SY M-, Am/A zQTY/_ i± iNGE r svdlNG- W"A Q 1 y f TYPE. B� FmoR HINGEr`SYlr_ fA GL ASS TV F/GRIDS: €IG f LOWE � F �WALL€a IGURATION TYPE DESCRIPTION IPLEASE RaFIEW',4 H f E-CUT.ORDER 0 4RRMATTTO$SHEET AND COMPA dYING ta-=i ViAl I-!t K E ass TRAP I GLASS eta DRAWINGS&`ORKSH E S FOR ACCLRACY AND COMPLETENESS,INDICATE ANY REVISIONS 0. ,KH H 4 dd LL CCAN IG.: E GLASS TRAP f GLASS Cif OR CHANGES Ae`T THIS "F)E, r T Y1L C < sa fT `S ¢ � RS c _ s � �ELEJ C "REVISED ORDER€ + , ` a��-- , AC>7 VWALL CO_wjc: �€:. CONFIRMATION l'HA T ILL REQUIRE YOUR SIG ATIJRE BE,--RE YOUR ORDER WILL 6E ISTIKK EGOS rS: 0 _ _ F`LACE€D INTO PRODtr- [ON. ri.00R-YN,: EXISTING DECK N TE: BY SIGNING AN, 'RETURNING THIS PRE-CUT ORDER CO?gFI}ZMA iTON SHEET,YOU AREI T—DU.-DLa-SYSTEPT,' E- NG MIA TRE'Li L -PHE ORDE$. DIRECTLY INTO PRODUCTION, PI Fit MAKE SURE A'I �i�0�r�,a of-18`PA x LENG' : MIA PERM HA'v�E 6E€N C TAINE}PRIOR TO SIGNING AND R--R-RNING HE F�r4� CHANGES r_CIF-N'PAN-i_S N LENGIH, ;`A CANNOT BE MADE TO' -ic ORDER ONCE RELEASED INTO PRODLCRON. �1ALL TZO cT€eat 62 1.12 PLEASE NOTE;DUE I R REVISIONS MADE FROM THE ORIGINAL ORDER OFIRMATION Y I RECEWED,YOUR RDER IS INOT CURRENTLY IN r$r x�ALL€xzo r�"sc a1,pRoDucrrom, PLEA E IMMEDIATELY SIGN AND RETURN AND WE WILL PROCEED s�TT VdAt3_€E T a& u ORDER, 2C�'r V4ALL VJiD w -- € - FOR.SOY' USE ONLY `=B XVT WALL?_FKIHl: 'as� FF'' p ",-F P, T'.�Fi elf=CALkK(DOLOR 24 WHITE 0 dil"!23IN R_ PELE.� ED r P S '?'C~rUCFFi, P,0.#}di'C3LC:t p-, _=f ,_ .00J PER C LEP RE' fj__.- DEALER APPROVAL. TE< Q.0 (1 j C d/'d�•1GE ',,10CEL FROTH LSD 25:)Cl T 0",0 PER C E'1LER RECI ZEST. 71 >i'? FASCIP r;'A'iL-/ ,'oUPLLR �' vl_PLE ni M1.. IA y� O m 'y r" cL. � I I 6� I 2 �/4 4IMDov{ �'v�'+rJou;; P 7a r/4- Po �n o P i e i PP 3 � I GE .L) tF p f �m o a5 BER(EA,04 023M�� c)EALF�' GAGE --- L S ;3000 VINYL,PRE-CUT ROOM WALL SECTIONS si�cE'.— r� cusTo44�i��h�.4� Ja.Ara4�oti��z KI +LLrRFE(600)e�tll79m CALF 112 -9'-C — DHECKEDB � u�/�`C�o4 PS _ S_E JAl- u,-)HN FAX�( ) L,12 LEORDC ! 1OC,CGo9 - -- REV DATE BY 01 — -- ,y rm TOLL EPEE:(P)b)d24�79Fl� �A1'iN Bl: PSL C � — )IJ ��I af�0�E n we ) AlC, 9 +1.5,04 � ',OF , m 1� i I, I I : I I e ri ° 0 _ -Ali f Jx' !/l.^,F 6 4 I e',, t i nl G,,F i=61 (r-. J i� 1125 BE F1���7u 4�h��� GAGE HILL BEREA Oh L VINYL Ie PRE-CUT ROOM ELEVATION Y: cp fl 440)2 9 1812 UtdAP N 0YC7 ��OC406G9 ur` LTV RI J l)'1/E'_ ,'N Oi NvENT ® L E iSCALE: 9 0 DAIE OV29i'04 'OF m� F v, L LJ ,jAi ROOF ANEL J, "t P 0N, F 1 3/16' FILL a� C)-W kCl A NCO OTH NA BAD RWF O.H. i12 ac NIOPK Y DEALERNMfIE: GAGE HILL LSR 3000 VINYL PRE-CUT ROOM FLOOR PLAN - &STOFIERNAN . NO, ANDWER PR N -l--6�----1,,----- l----c—.--l-----,--------, M No 1 1 c ForN112MAU Ao"CEGRDERV: 16,040069 REV Dm� A- 1 7AL MEE f8 DRAMN BY PSL I F D,i 824-7,�88 t 03 KAU: 3 VOL! a Board of Building Regul bons and Standards ' One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 134945 Type: Private Corporation Expiration: 2/15/2006 GAGE HILL REMODELING INC. JOSEPH MARALDO 169 OLD GAGE HILL R D. N PELHAM, NH 03076 Update Address and return card.Mark reason for chang Address I-] Renewal [__] Employment LostCard f<: oo.�tr,ifeayr{u�,rrll� o ,. �z;�:saT�uaeCld Board of Building Regulations and Standards License or registration valid for individul use only i HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 1 ;( Board of Building Regulations and Standards Registration: 134945 Expiration: 2/15/2006 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: Private Corporation GAGE HILL REMODELING INC. JOSEPH MARALDO 169 OLD GAGE HILL RD.N PELHAM,NH 03076 Administrator Not valid without signature Cbwmmv9wwa1W;4, Board of Building Regulations aDd Stand-Ards One Ashburton Place - Room 1301 Boston. Massaic-busetts 02108 Home Improvernent Contractor Rmistration A"iWaftor. 134945 Two: PrIvate Coton bn ExphoWn: 2175104 AGE HILL REMODEUNG INC. OSEPH MARALDO 69 OLD GAGE ALL RD. N JELHAM, NH 03076 Updair Addrvys nd rdern ew'L Mark MGM for cbnar- Lost Card Address i- kenewell '—! EMPIeTn"t 55 34W Board of BOHM Reputations I Ace, rn 1301 One Aviburton BosTlon, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate, 07/1511949 Number GS 082646 Exp1m.0711�,12(X)5 Restricted To- 00 JOSEPH F WARALDO 169 OLD GAGE I JILL RD PELHAM, NH 03076 Tr,no- 82W Keep top for nmelpt wW change of address noweavan. The Commonwealth of.'Massachusetts 1 'Aj y s!h Department of Industrial Accidents MCA'illllM511W#A7S r` 600 Washington Street Boston Mass. 02111 Workers' Com ensation Insurance Affidavit: BuildinPlumbin /Electrical Contractors /'/ ter, :'Mr � r�J/i//////r / r //'//%' /,/ //O //r r naatr address city state: zip: phone# work site imation(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ❑ I ram a sole proprietorand have rnorone working in an capacity./ / ElBuildiing Addition �i�/ i,Y//��i//iriiriiii%✓✓/i,�����/i i���/�/��i/v/��i����/f✓%r////�// ////������///��%/�i///���/������/��/Hii%���i��%��/,,,��ii,/ii/����/�������/���/, I am an employer providing workers' compensation for my employees working on this job. compatry name- Q A SC �A 4 ®�ge1i 1** uddress• ! I 01 '7 A Q—xv 1:LL city:/ F11 is At YW 0.Y0-P4 Phone 03 f ® ? 7 insurance co/7 m e o V a) olicv# C / ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices. company name: address: city- phone#: insurance co. oliev# Company name: address- MI.: phone #• insurance co. PiAicy# Failure to secure coverage as required under Section 25A of NMGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'unprboument as well as civil penalties In the form of a STOP WORK ORDER and a fine of 5100.00 a day agauut me. 1 understand that a copy of this statement may be forwarded to the Office of lnvestigatiowt of the DLA for coverage verification. I do hereby certijy,under the pains and penalties of perjury that the information provided above is trite and correct. B Signature �,_- fir✓ � Date — r� --r==Print name y r I�� Phone# 60 3 �i�p S75-F.� £. official are only do not write in this area to he completed by city or town official "S P, city or town: permit/liceme# ❑Building Department ❑Licensing Board ❑check if immediate respotuc ut required ❑Sclectmeu's Office ❑Health Department ti contact person: phone#; ❑Other ;f - (rc�ocd'ictn.;.tXul it: AMERICAN HOME ASSURANCE COMPANY 69194-0000 WC 560-72-59 13781 013-82-0403-00 wrw Ynpk GAGE HILL REMODEL i NG i NC 169 OLD GAGE HILL RD NORTH PELHAM, NH 03075-0000 SEE NAML AND ADDRESS SCHEDULE - WC990610 i i.D# ---PR nraE:SnmalE-:;rnlL-ING A-7ar:r ITAP INSURANCE AGENCY, INC. WORKERS COMPENSATION AND EMPLOYERS 10 NEW ENGLAND BUSINESS CENTER LIABILITY POLICY INFORMATION PAGE I ANDOVER, MA 01810-0000 INSURED IS PREVIOUS POLICY NUMBER rnR.PnRpTInN I NEW -OTHER iiV nl(PLACES NOT Sift'sWN ABOVE:'SE-E NAME AND ADDRESS SCHEDULE - WC 9- 0610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address ! 1.,L r ! /,,, ,,,, FROM CJ�F/ L/V} TO V4 LL/V4 ITEM 31 A- Wnrkare Cmmnancatinn Incuranr-P7 Part nna of tha nnlir-v annliac to tha Wnrkars rmminancratinn Law of the ctatac lictarf here- I I MA NH B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: 8"T 1i !=air_v n_t asmr a",x®nt I3nr$iv Inhiry hV Disease $ Son-non pe!icti limit Bodily injury by Disease $ 100.000 each employee IC. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AL' CO CT DC DE FL GA Hi IA ID 1L IN KS KY LA MD ME Mi MN MO MS MT NC NE Ni NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI 1 ITEM 4 The premium for this policy vigil be-determined bV our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verilieation and change by audit. Esfimated Total Rate Per Estimated Remuneration Premium Classifications Code Number $100 OF Re- L Annual 3 Year muneration ( �X Annual 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 I I I I TAXESjASSESSMENTS/SURCHARGES ) $7 I I I I I FXPFNSF Cr)NSTANT/FXCFPT WHFRF APPI.ICARI F RV STATFI C 1(,n NI-i I I I I MINIMUM PREMIUM $750 NH TOTAL ESTIMATED PREMIUM $10,413 If indicated below, interim adjustments of premium shall be made: ElSemi-Annually II Quarterly tJ Monthly DEPOSIT PREMIUM -.a v.e_.— in x r 04/30/03 PARSIPPANY 82 ;&.Site Date IDJU�iIy V�:iI:G FNl:IIVI%ECU neiAI CJG(Ila 11YC WL Llu Uu UI 3N67 INSURED' COPY ORTH 01" Of Andover 0 No.<, wap'4rwep APO"t, af -0 dover, Mass., COC. HEWICK 0'-?A-rEED) P'? U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 0 BUILDING INSPECTOR THIS CERTIFIES THAT..........ki.700 47W Lt .* ............it .....A�.P.P/e ......................................... .... .............. .............................. Foundation has permission to erect... 0Y.............. buildings on ......AA .......eo4 ........................................................ Rough to be occupied as....0 090,0 $c....*r *3 SO JP,%VAJ *A# AIV19 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 Insp ction, Alteration and Construction of Buildings in the Town of North Andover. 43 8/313.3 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS _UNLESS CONSTRUCTION STAR­jS ELECTRICAL INSPECTOR Rough . ............................................................................... Service BUILDING INSPECTOR Final Occupancy Permit 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumer Street No. SEE REVERSE SIDE Smoke Smoke Det. l i &: ,, 4p a cfl _ C 198 \ PROPOSED DWELLING, SILL ELEV 205.00 GF ELEV 197.00 — PROPOSED �RAGE \20 GDRIVEWAY FLOOr\ <v G W ELEV 2 2.00 s 37'-5'= S \ L 1� \ 2o2 Andover Conservation Commission Site Inspection et Dep File # does not have permit with Conservation Commission ®ate: o f 0 C)() q Address: Ue' AgentlRepres tative/O ner present: Findings: l�►� 5 �—�—°�` c A S rc s ca 6u), ink l r'r s*-s b PL-r age W U rK W I t 0'1,t-If s i-V s � e �s 'l 68 Location No. Date Z,- NORTHTOWN OF NORTH ANDOVER 0 0 Certificate of Occupancy $ cb4us Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check # -Building Inspe qtr 4 0 511 Date. TOWN OF NORTH ANDOVER PERMIT FOR WIRING S CHUS This certifies that .... ......... ..................... has permission to perform ......... .................................. wiring in the building of....... ... .............................................. at...... A........ ..... ............. ............................. .North Andover,Mass-. Fee..".-;', ... ... ........ ....................... ....... ......1;......... ELEcnucAL INSPECMR Check # Official Use Only Permit No. ��J Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Owner or Tenant J Owner's Address 6'o Is this permit in conjunction with a building permit Yes�/ No 0 (Check Appropriate Box) Purpose�of Buildinci AJ Utility Authorization No. Existi%Services Amps_ Voits Overhead 0 Undgmd 0 No.of Meters New ServiceAmps Voits Overhead 0 Undgmd"01 No. of Meters Number of Feeders and Ampacit "T Location and Nature of Proposed Electrical Work ('5 7 Total No,of Lighting Outlets No.of Hot fuse No.of Transformers _KVA Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 0 gmd 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.ofZone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di oral No. Pumps Tons KW_ No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSU RANCE'COVE RAGE. Pursuant to the require—,Teo6ts of Massachusetts General Laws I hgv6"At9rreht Liability Insurance Policy inducting Completed Operations Coverage or its substantial equivalent YES,-- NO have submitted valid proof of same to the Offi; th�typo of coverage by checking the appropriate box, re YES NO = If you have checked YES please indicate /INSURANCE = BOND = OTHER ease Specify) (Expiration Date) Estimated Value of,EIe(;trI(;al Work$ Work to Start �1 c e-, Inspection Date Resquested Rough, —Final Signed under the Penalties of pedury FIRM NAME r ("�'1 LIC.NO. A�Y r-, 0, Signature Lkensee- LIC.NO. Bus.Tel No.— 'r Aft OWNER'S INSURANCE WAIVER: I am aware that the Lice nse s d oes not have the insurance coverage or its substantial fg uivalent zl Tel.No eq 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) — Date. RT ".O TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING •'SS "US� This certifies that . . .� . . . . € . . . . . . . . . . . . . has permission to perform . . . . . . . ": . °e. :. . . . . . . . . . . . . . plumbing in the buildings of . . . . .� :. . . . . . . . . . . . . . at. . . . ..F. . F. . ,`. e�.:.. . . . . . . . . . . . . . . . North Andover, Mass. Fee. . .'Lic. No.. . . . . . . . . .... . . . . . PLUMBING INSPECT;6H Check # i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS e, Date Building Location Owners Name//0' 15"rrv" Pen-nit# Amount Type of Occupancy. New Renovation Replacement Plans Submitted Yes Na ri FIXTURES Z Z 4 z 00 p ZG. z RASEVM isr Him z"Mm �n" 4M H-CM 5M HACM 6M FL" 7M K" gm H-(XR (Print or type) ✓ Check one: Certificate Installing Company Name cl rl Corp. Addrrs 72 Partner. Business Telephone 7 1` Finn/Co.13- 7 r Name of Licensed Plumber: insurance Coverage: Indicate the type of insurance coverage by the the appropriate box: Liability insurance policy M Other type of indemnity rl 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 El 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 Mas�achusett§St 'e Plumbing Code and I Chapter 142 of the General Laws. By: Signature 01 Licensed FlumDer Type of Plumbing License Title City/Town License 19urnrier Master F1, Journeyman F1 APPROVED(of�rICE USE ONLY Date. . .. . . . . . ... . NORTH 03� TOWN OF NORTH Y ER 0 PERMIT FOR GAS INSTALLATION ,SSACHUSEI i This certifies that . . . has permission for gas installation . . . f . . j :. . . . . . . . . . in the buildings of . . .la-m4i . . . . . . . . . . . . . . . . . . . . . . . _f � �� at . . . . . . . . s. . . . . . �::. . . . . . ., North Andover, Mass. Fee. ,7?�. . . Lic. No.. . . .� GAS INSPECTOR Check# 1L 1 r i ` r / ` r r ♦ ♦ i ' r r r ! • • • i i e IM Rate IM WOM MmmMMMMMMMMMMMMM����� ! / PI / 1L"LUG" / Title / • ,war +�1 � 1 1 % / + / / / %w / :1 1 I M c... r.% r /% w: / /' MII11111�11�1 / / / , . , APPROVED . • f f 0 . Date.... �aOWTfi TOWN OF NORTH ANDOVER PERMIT FOR WIRING ... �,SSACMU EIS L This certifies that .............J.............. .. ...1........ .......................... has permission to perform Wiriny,in the buildin of . ..`.. .. �.�� .......................... .at- u..� . .�.. ... ..... .. ti6;%.4, ..... orth Andover Fee. ..... ......... Lic.N ............ ........ .. ......� FLECMICAL INSPECTOR Check # � y� Official Use Only Permit No. ?e+azw�z a� �uBlie Sa�et�y Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS,527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 A (Please Print In ink or type all information) Date f ate; To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes l] No ❑ (Check Appropriate Box) Purpose of Building '�'r , •.` �' /err"m" Utility Authorization No, Existing Service _ Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacit > Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units 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.oil Di osal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of rishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of D rs —Heating Devices KW Local Connection _ No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER; F k r' ;.y ' INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO have submitted valid proof of same to the Office YES k'�NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) Work to Start / R $ on D (Expiration Date) Penal eo i Work i, .. � l" Inspection ��esquested G� � Rough � Final r Estimated Value f Electl� FIRM NAMEigned erth a/ f&J " tr ate LIC.NO. ') ns ea � ��� " k p � ';��° ��'���c-" � ature "� �� k 0 .a l Siy � 9� �7 r, �'` LIC.NO. w• „�, d,� F 0 Licensee „ ,ti " u % Bus.Tel No. Address.��^ rl°a � . ,������ ^°°" _ Alt Tel.No, OWNER'S INSURANCE WAIVER: I am aware that the Licenses does 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) TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 'Q- �e IMPORTANT:A licant must complete all items on this page LOCATION 4S ` uy TLE L—xi Print PROPERTY OWNER Q tk!M Lc►CAF-Pi Print MAP NO: - PARCEL:-- ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Cj-One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ ommercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other Septic 0 Well D Floodplam 0 Wetlands ❑ Watershed pistridt r]Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ft A e (identification Please Type or Print Clearly) OWNER: Name: `-�- afbU , V, Phone:q96 t,(YS AS60 Address: fAIS ITL6, CONTRACTOR Name: f �ma—z-,Zwx I Lao Phone: Address: s tp i�, `Z� �l�l`L�•� Supervisor's Construction License: Sa77:S!J` Exp. Date: S 141 b 12 Home Improvement License: [ Exp. Date: 2-n 2 1 2 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 Project Cost: $ " I FEE: Check No.: 9 Sri-I— Receipt No.: - NOTE: Persons contracting with unregistered contractors do not have access to the guars ty fund f Signature of Agent/Owne.r Signature of contractor Location No. 's Date I i pORTiy TOWN OF NORTH ANDOVER °� ,•'°,•.'moo i Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 1 i TOTAL $ Check # 2L4' � v Building Inspector i I i ORTH 01" Of Andover -. 0 NO. �y LAKE =' !Over, Mass., ._ .1— D C OC RICHE WICK � DRgrE® P'P���� BOARD OF HEALTH . Food/Kitchen E11MIT I D Septic System BUILDING INSPECTOR THISCERTIFIES THAT....... .... ....... .. .. .. ......................................................................... Foundation has permission to erect...........:............................ buildings on ....... fs .... ...... .......... �®........ .' .... .:...................... Rough w A to be occupied as v ........ . .... .... '.................................................... 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 PERMIT EXPIRES IN 6 MONTHS � ELECTRICAL INSPECTOR UNLESS 1� U Rough ........... ............................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. IL—SEE REVERSE SIDE Smoke Det. liassarhusCtts- Department of Pnl)IiC Saretl ti 8��artl of 13toildin�t a� > Re�ulatirnts and 4tandartls Cons n cdon Su0ai-viscr !cense License: CS 57754 Restricted to: 00 WILLIAM D HOPE 57 CHASE ST t, _ METHUEN, MA 01844 Expiration: 3/4/2012 t nnnti>.i ncr Tr--: 18748 �. g ✓t/ a�xorr urea iQ mel * License or registration valid for individul use only Office o onsumer airs ss egu a ton HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: -`bnRe istration: 101730 Type: Office of Consumer Affairs and Business Regulation 9 10 Park Plaza-Suite 5170 Expiration: ,6/29/2012 Private Corporation 4,1a --------- Boston,MA 02116 HfONSTRUCTION.INC William Hope 57 CHASE STREET METHUEN,MA 01844s Undersecretary Not valid without signat e r 6 CO"'IrNITRACTOR WORK ORDER �+ Conservation Services Group Printed: 6/16/2011 Contractor Information Customer/Site Details Dave Hope BRENDA KRAFFT Phone(eve): (978)655-4560 HRH 45 TURTLE LN Phone(day): (617) 721-9939 57 Chase St Site ID: S10000672192 NORTH ANDOVER MA 01845 4922 Methuen, MA 01844 () Appointment Details Completion Deadline: Location Description Quantity Unit$ Total;$ Notes/Revisions Work Order: HRH 2O110616 AFL Attic Floor 9" Fiberglass Batting 66 1.70 112.20 AFL Densepack Cellulose-6" 248 1.91 473.68 AFL Open Attic 9"Cellulose 740 1.38 1021.20 OVERALL Propavent 2'or 4' 10 3.44 34.40 6mm PolyVB crawlspce Sponsored 442 0.80 353.60 OVERALL Air Sealing-Hours 8 75.25 602.00 HALLWAY Therma-Dome w carpentry sponsored 1 209.63 209.63 Whole House Fan Box Sponsored 1 45.00 45.00 Total for Work Order HRH_20110616 : $2,851.71 Grand Total: $2,851.71 Road Blocks Moisture Existing Minor Concerns/Conditions SAND CRAWL SPACE/NEEDS VAPOR BARRIER, Conservation Services Group-40 Washington Street-Westborough, MA 01581 -800-480-7472 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 s< www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): fl l 1 sT 7 17--n u Utc_ Address: be [_ OCQ City/State/Zip: kZj - _64S Phone #:_q1t &q Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with _ 4. ❑ I am a general co VI and I 6 ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.El 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. 9. ❑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 I L❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.nPof repairs insurance required.]t employees. [No workers' 13. Other )fJS _ kVj_ aJ 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 thepolicy and job site information. _ Insurance Company Name: E&fpeKo {•, 111 Policy#or Self-ins.Lie.#: ; -S\l'_t 6- bZ4 Expiration Date: i 2- Uq - =t Job Site Address: R j Llr L.A,1 City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and t and penalties of perjury that the information provided above is true and correct. . SigLiature: Date: ,,V 6--- Phone#: 4 . 2-6 ®fffcial 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#: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: -' IMPORTANT:Applicant must complete all items on this page LOCATION 1 L.-E.. f Print PROPERTY OWNER 1 C.4H Print MAP NO:— i�_PARCEL:335 ZONING DISTRICT: _ Historic District yes no Machine Shop Village yes no 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 XOther ®to ❑Septic :Dwell P Floodpla ri We ands " ❑ Watershed District Rater/Sewer DESCRIPTION OF WORK TO BE PERFO ED: -lub 2® '. �4®� Q S5 . (Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: `arm 14° _Y1nIA CONTRACTOR Name: tS Phone:t� •212 -9(,� r Address:46?E- V��� , ® \���.-�c�, Supervisor's Construction License: Z-) `9y Exp. Date: ',y \A • \2 Home Improvement License: \\ li-n-z , Exp. Date: 1 , ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.'M00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Q®b ��"' FEE: $ Check No.: J Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund , nature of Agent/Owner "j�'-Signat.qre of contras �{.zs-�t -�-25 • il Plans Submitted Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE A PROVED z. LANNING & DEVELOPMENT ❑ COMMENTS GYC j �2 i CONSERVATION Reviewed on S /r� Si nature = r l T J i � 1 COMMENTS 2 -AE t HEALTH Reviewed on Signature COMMENTS Zc:ning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature:_ Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Location No. R n Q Date � ,.oRTr, TOWN OF NORTH ANDOVER 4 i Certificate of Occupancy $ r ,'4 J,ItNUSE4� Building/Frame Permit Fee $ � k Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f Check # r + � �Building Inspector TOVM Uf 6 Andover 0 >,,.. w- W, o. ®/ A K- v . dower, Mass., t '1� coc MIC HEWICK E" LPG �D"?ATED U BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......f6f.14.1t.......... ................... .................. ...................................... Foundation has permission to erect........................................ buildings onIT t. t... Rough to be occupied.as............ � ......... ....�. .................. ... Chimney . . . .. . .. . . provided that`the person7e4�tthis permit shall every respect conform to the terms of the application on file 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 EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR SS S U S�Ts Rough ..... Service BUILDING INSPECTOR Final Occupancy Perrait Required to Ocatpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final o 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. I m :r: tra a tt w D p to trttt nt oil IFulrRaa Saki% Board d of Ruildino Rt1,ul tions and t rrarfaard% Ltr:r:rmse: CS Z7999 Restricted Ux 00 RODNEY P ANDRE - 1647 LOWELL RC CONCORD, MA 0 742 IExpirante:w 3114/2012 t snmuim�nl ^�irMw�ro° "tr : 19942 ( °i s . � t n Office oCansuincrhfars Maarcseaata License or registration valid for individul use only , HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer affairs and Business Regulation Registration: 113772 10 Expiration: 7/15/2011 Tr 237951 Plaza-SuiteSl7(l Rostton,on,MA 02116 Type: Private Corporation ANDREWS GUNITE CO.,INC. RODNEY ANDREWS 6 REPUBLIC RD �. ,� ..,.._ N BILLERICA,iVIA 01862 Undersecretary No lid a t out signature TE *� 0CERTIFICATE OF LIABILITY INSURANCE D 31 7/D/ 0112011) 0 PRODUCER 800-572-4538 FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 1129 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northboro, Ma 01532 INSURERS AFFORDING COVERAGE NAIC# INSURED Andrews Gunite Co. Inc INSURER A: Acadia Insurance Company D/B/A Pools by Andrews INSURERB: Continental Western Insurance 6 Republic Road INSURER C: North Billerica, MA 01862 INSURERD: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MM/DD/YY DATE MM/DD LIMA GENERAL LIABILITY CPA0136208 03/01/2011 03/01/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES AMAGE TO RENTED $ 300,000 CLAIMS MADE ❑X OCCUR MED EXP(Any one person) $ 15,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC JECT AUTOMOBILE LIABILITY MAA0136210 03/01/2011 03/01/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ A X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CUA0136211 03/01/2011 03/01/2012 EACH OCCURRENCE $ 1,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 1,000,000 A $ DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION WCA0136213 03/01/2011 03/01/2012 X IWCS AT - TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE[:] E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? — (MandatorylnNH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. "For Informational Purposes AUTHORIZED REPRESENTATIVE On y" Francis Kittredge EO ACORD 25(2009/01) 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Depar°tinent of Industrial Accidents W Office of Investigations 600 Washington Street Boston,111A 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ' Aj2plicant Information Please Print Le ibl r Name(Business/Organization/Individual): Address: .{ , City/State/Zip (7- NVL Phone.#: re you an employer? Check the appropriate box: Type of project(required): j I am a er w y emp to ith 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition ! workingfor me in an capacity. employees and have workers' Y P h• 9. ❑Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other 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 new affidavit indicating such. lContractors 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. ^� Q Insurance Company Name: 3-.�1 vY• V T+ Policy#or Self-ins. Lic.#: %'2 t 7 " Expiration Date: Job Site Address: t ®5 R»'R i'l�1`��® Yal1® City/State/Zip: ®N -Z) 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certi a the it and enalties of perjury that the information provided above is true and cot-reef. Signature: Date: Phone# •2--V2 ®'1CN��o Official use only. Do not write in this area, to be completed by city or town official. City or Town: Perrnit/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#: Date'—.-............................ ,toRTH TOWN OF NORTH ANDOVER S PERMIT FOR WIRING & Emu TI,ds certifies that .............. ........................................................... j has permission to perform .............................. .. ......................................... wiring in the building of.......-.­";-�- ....... ....................................................... North Andover,Mass. ..... ....... ....................... ...at........ . .......... ................ Fee...................... Lic. .... ....... ...................................................... ELECTRICAL INspwm Check # Q, LJ