HomeMy WebLinkAboutMiscellaneous - Exception (106)r
1199)
(Rev. t Hunbe
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rmitktur:
Occupancy & fee
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
(ALS WoaxTO U MFORM111 V= TIM MASSACHt1WM ELECTRICAL CODE 527 CMR i20(I)
PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: /,7
— City or Town of: To the Inspector of Wires:
By this application the undersigned gives notice of his orfier intention to perform the electrical work described below.
Location: (Street & Number) y� /v i2/,-✓ C/( Ste/
Owner or Tenant
Owner's Address:'- �—
Is this permit in conjunction with a Building Permit? Yes No a (Check Appropriate Box) .
Purpose of Building: c 4Utility Authorization
Existing Service: ,2 c- Amps �N / 2-40: Volts Overhead D� Underground.0 m of Meters
New Service: Amps ! Volts Overhead ❑ Underground.❑ #of Meters:
Number of Feeders and Ampacity:
Location and Nature of Proposed Electrical Work
No. of Recessed Fixtures
No. of Cell: Susp. (Paddle) Fans
No. of Transformers . Total KVA
No. Of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fbcprres
Swimming Pool: Above ground a In Ground o
# of Emergency Lighting Battery Units
No. of Receptacle Outlets
No. of OR Burners
Fire Alarms # of Zones
# of Detsulbn & Initiating Devices
# of Sounding Devices'
# of Self Contained
Detection/Sounding Devices
Local o Munk ioal Connection o Qtner
No. of Switches
No, of Gas Burners
No. of Ranges
No. of Air Conditioners TOTAL. TONS:
No. of Waste Disposals
Heat Pump Totals:
Number. TONS: KW:
Security Systems -
No_ of Devices or Equivalent
Pio. of Dishwashers
Space !Area Heating KW
Data Wktng. No. of Devices at Equivalent
No. of Dryers
}seating Appliances KW
Takicamr nanicabons Wiring: No of Devices or
Equivalent
No. of Water Heaters KW
Na, of signs: # of Ballasts:
OTHER
# of Hydro Massage Tubs
No. Of Motors Total HP
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of elegy wank may Issue unless the licensee provides proof of Natillity irsi ar
including 'completed operation' coverage or Its substantial equivalent. BOND
undersigned uirtlfies that such coverage is in force, and has exte'bited prof of same to the r
issuing office. CHECK ONE: INSURANCE 0} BOND a OTHER ❑ Please spedty:
Estimated Vatue of Electric/al Work 5 (When required by municipal policy)
Work to Start / inspections to be requested on accordance with MEC Rule 10. and upon cDm*1
1 cartlfy, under the pains and ponaities of perjury, that the information on this application is bare and complete.
tic.# -1"733
uc. # /,51- 973-a
41 Alt. Tei. #
AWNSR'S INSURANCE WAIVER; I am aware that the Licensee does not have the IWAty insutance coverage normally required by law. By my signature betaw, i nE
woem this roeulr moral, i am the (chock @he) Ovmgr a OR Agent. B
LM
Location --0>
No. 41 9D Date e t 6,,,-
LM
f
Check # ,/,
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $��
1 x923
�. Building Inspsetor
TONM OF NORTH ANDOVER
BUILDING DEPARTMENT
T
APPLICATION TO CONSTRUCT !UA RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/InWtor of Buildings Date
I ���, a avis r- J>1l✓ llvr VKti'lA 11UPI 1
1.1 Property Address:
a S'i 0 -t 9- c-
S+tee eT
1.2 Assessors Map and Parcel
Map Number
Number:
/1:5
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
Signature Telephone
1.4 Property Dimensions:
I at Areas
Frontage fl
1.6 BUILDING SETBACKS fit
Name Print Address for Service:
Signature Telephone
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Required
Provided
Licensed Constructio Supervisor:
1.7 Water Supply M.G.L.C.40. 54)
Public ❑ Private ❑
1.3. Flood Zone Inforoution:
Zone Outside Flood Zone ❑
1.8Sewerage
Municipal
Disposal System:
❑ On Site Disposal System ❑
a�a iivi. - rxvrt~K1 Y UWfNEKbtHF/AUTtfUK1GED AGENT
Historic District: Yes _ No _
2.1 Owner of Record
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
dua,11�14?
Not Applicable ❑
UV ItZNil
Licensed Constructio Supervisor:
License Number
Address
Signature Telephone
I a -a`7 - o-7
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Wynd
i ('89
Company Name
Registration Number
0 L wry t (' P
Address
�I
1950 -33,96
Si nature Telephone
Expiration Date
I
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SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify
Brief Description of Proposed Work:
K, +(J, n h S tZ� O f r"2Q l g c Q—
S
1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be'
Completed by permit applicant
-OFFICIAL USE ONLY...
1. Building
(a) Building Permit Fee
Multi lier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee te) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
d 2, (p
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, S ( Ae CO r 11 -t-r-Q- LT— 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, W,to- ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/Agent— Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS iST 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS 77
S17 -E OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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NATIONAL GRANGE MUTUAL
INSURED
�` INSURANCE COMPANY
55 West Street, Keene, NH 03431
Telephone: 1-888-646-7736
CONTRACTORS POLICY DECLARATIO
Named Insured and Mailing Address
EDWARD E VIEL DBA
VILLAGE KITCHEN & APPLIANCE
200 SUTTON ST REAR BLDG
NORTH ANDOVER, MA 01845
Agent: CHAS F HARTSHORNE & SON INC
781 245 4300
POLICYHOLDER INFORMATION
Policy Number: MP I66885
Account Number: CAC I66885
Producer Code: 20 0 16 7
Named Insureds Business: CARPENTRY INTERIOR
Entity: INDIVIDUAL
Policy Term: 12
Effective: 09/20/05 (12:01 A.M. Standard Time at the address
Expiration: 09/20/06 of the Named Insured stated above)
In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide
the insurance as stated in this policy. See the attached schedules for Description of Premises, Property Coverage,
Optional Coverages, Forms and Endorsements applying to this policy and Mortgagee Schedule if applicable.
BUSINESSOWNERS LIABILITY COVERAGE
LIMITS OF INSURANCE
Liability & Medical Expenses - each occurrence
S 1 1000,000
Personal and Advertising Injury Limit
S 11000,000
Products -Completed Operations Aggregate Limit
$ 2,000,000
General Aggregate Limit
$ 2, 0 0 0, 0 0 0
Fire Legal Liability - any one fire or explosion
S 500,000
Medical Expense Limit - per person
5 10,000
Business Liability and Medical Expense: Except for Fire Legal Liability,
each paid claim for the above cover-
ages reduces the amount of insurance we provide during the applicable
annual period. Please refer to
section DA. of the Businessowners Liability Coverage Form.
For policies subject to premium audit: Annual Audit Applies.
Countersigned:
64-5470 (9/00)
Estimated Annual Premium: S 1,368
TOTAL PREMIUM AND CHARGES $ 1,368
09/08/05 RENEWAL MC
By:
TIONAL GRANGE MUTUAL INS. CO.
WARD E VIEL DBA
LLAGE KITCHEN & APPLIANCE
CHAS F HARTSHORNE & SON INC
Policy Number: MPI66885
Account Number: CACI66885
Effective Date: 0 9/ 2 0/ 0 5
Producer Code: 2 0 016 7
CONTRACTORS DECLARATIONS - COVERAGES APPLYING TO THIS LOCATION
D SCRIPTION OF PREMISES - ADDRESSES
P ems. Bldg.
o. No. Address
D SCRIPTION OF PREMISES - OCCUPANCY AND CONSTRUCTION
P ems. Bldg.
o. No. Occupancy Construction
C VERAGES PROVIDED
P ems. Bldg.
o. No. Coverage
Limit of
Insurance
OPTIONAL COVERAGES
Pi -ems. Bldg.
o. No. Coverage
Ak L ALL MECHANICAL ELEC & PRESSURE SYS BREAKDOWN
GL AGGREGATE LIMITS APPLY PER JOB
4188-19/00 09/08/05 RENEWAL MC
Limits
INCLUDED
SEE BP0702
Protectior
Ded
NATIONAL GRANGE MUTUAL INS. CO.
EDWARD E VIEL DBA
VILLAGE KITCHEN & APPLIANCE
Agent: CHAS F HARTSHORNE & SON INC
Policy Number: MPI66885
Account Number: CACI66885
Effective Date: 0 9/ 2 0/ 0 5
Producer Code: 2 0 0 16 7
CONTRACTORS POLICY DECLARATIONS - LIABILITY SCHEDULE
LIABILITY COVERAGES PROVIDED
%T
Code Premium Advance Premiun
Classification No. Basis Rate Prems/Op & Product
STATE - MASSACHUSETTS
CARPENTRY -INTERIOR 74231 41725 32.227 1345
* PD DEDUCTIBLE = NONE PAYROLL
ADDITIONAL INSURED
BP0402 MANAGERS OR LESSORS OF
2
# INSD
Total Estimated Liability Premium 1345
* LIABILITY PROPERTY DAMAGE DEDUCTIBLE PER CLAIM
64-N188-2 9100 09/08/05 RENEWAL MC
INCL
N1
.10NAL GRANGE MUTUAL INS. CO.
EpWARD E VIEL DBA
VILLAGE KITCHEN & APPLIANCE
CHAS F HARTSHORNE & SON INC
Policy Number: MPI66885
Account Number: CAC I66885
Effective Date: 0 9/ 2 0/ 0 5
Producer Code: 2 0 016 7
CONTRACTORS DECLARATIONS - COVERAGES APPLYING TO THIS LOCATION
ESCRIPTION OF PREMISES - ADDRESSES
rems. Bldg.
No.
No.
Address
2
1
9 OSGOOD ST
LAWRENCE, MA 01840
ESSEX
ESCRIPTION
OF PREMISES - OCCUPANCY
AND CONSTRUCTION
rems.
Bldg.
No.
No.
Occupancy
Construction
2
1
CARPENTRY -INTERIOR
FRAME
OVERAGES PROVIDED
rems.
Bldg.
Limit of
No.
No.
Coverage
Insurance
2
1
CONTENTS -SPECIAL
11000
PTIONAL COVERAGES
rems. Bldg.
No. No. Coverage
88-19/00 09/08/05 RENEWAL MC
Limits
Protection
3
Ded
250
JOE & SUE NOWELL
45 EAST WATER STREET
NORTH ANDOVER MASS 01845
978-688-2662
uescnptions
Job Total
GC fees
Management fees
Permit fees
TEAR OUT
$ 200.00
$ 1,000.00
DUMPSTER FEES
$ 1,000.00
ELECTRICAL & LABOR
$ 1,500.00
PLUMBING LABOR
$ 500.00'
CABINETS
$ 4,519.90
0
INSTALL
$ 1,600.00
GRANITE COUNTER TOPS
$ 2,072.00
=�
SINK & FAUCET
$ 695.84
TILE FLOOR & INSTALL
$ 1,614.00 _
CARPENTRY LABOR
$ 720.00
MATERIALS
$ 200.00
SHEET ROCK
$ 800.00
CABINET HARDWARE
$ 200.00
(.
6 FOOT SLIDER
$ 900.00
"
Job Total
GC fees
Management fees
Permit fees
$ 16,521.74
$ 3,304.35
$ 1,000.00
$ 200.00
Grand Total $ 21,026.,09
RY LABOR RATES ARE $45.00 PER MAN HOUR
NOWELL 2.xis
11/23/2005
--j
ESTIMATE
AL
X
X
X
3
00-- 35,000 cf enclosed space
(MGL C.112 S.60L)
1A-- Masonry only
1 G -I & 2 Family Homes
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revocation of this license.
DIG SAFE CALL CENTER: (888) 344-7233
GENERAL CONTRACTING SERVICES
VILLAGE KITCHEN & BATH
200 Sutton St.
North Andover, MA 01845
1-978-618-0003
CONTRACT
This Agreement is made between, Joe & Sue Nowell hereinafter called Customer, of 45 East
Water Street North Andover MA 01.845, in the town of No. Andover, in the state of
Massachusetts and General Contracting Services this 28th day of October in the year 2005.
Description: See Estimate and scope of work as attached documents
Job Total: S 2-1102.6.09
Deposit: S 4,5 ig , 90
Payment: As needed
Balance Based on allowances
It is understood by Customer and by General Contracting Services, that the above Job
Total includes material and labor as per attached estimate only. Any additional, costs to
the above Job Total, whether by necessity or by the request of Customer will be considered
an extra charge and therefore governed by paragraph (`d). It is also understood by
Customer and by General Contracting Services that the management and general
contracting fee included in this contract is subject to change in accordance to extra time
and management involved in extra work carried out.
1. All jobs accepted by General Contracting Services are subject, however, to strikes,
accidents, or details occasioned beyond the control of General Contracting Services.
Il. All sketches furnished by General Contracting Services shall remain the property of
General Contracting Services and no use of same shall be made, nor any idea obtained
therefrom be used, except upon compensation to be determined by General Contracting Services.
Ill. By signing the acceptance, the customer (or his/her representative) agrees to all terms and
conditions as outlined, and binds him/herself to accept the contract in its entirety.
IV. The customer also promises to pay any and all attorneys fees and/or cost(s) associated
with the collection of the amount stated herein this contract.
V. All materials are guaranteed to be as specified. All work to be completed in a workman
like manner according to standard practices. Any alteration or deviation from specifications
involving extra cost will be executed only upon written orders, and will become an extra charge
over and above the original contract price.
VI. All fixtures and hardware, excluding cabinet order, purchased for this job must be paid
for, in full when picked up/delivered.
VII. The terms of the contract are not to be varied, except in writing, signed by a duly
authorized officer or agent of General Contracting Services.
VIII. This contract covers all of the agreements between the two parties hereto, and is
governed by the uniform Commercial Code and other applicable state laws.
IX. Any request for a delay of said delivery of goods, merchandise, and site labor by the
customer which exceeds a ten (10) day period shall cause customer to be liable to General
Contracting Services for any damages caused by such delay, including but not limited to,
storage charges on goods or merchandise, and General Contracting Services shall have the
option to invoice customer and receive payment within ten (10) days.
X. General Contracting Services guarantees its products for a period of one (1) year from
the date of delivery against defects in workmanship or materials.
XI. General Contracting Services cannot be held responsible for damage to work after
delivery to the delivery site.
XII. In any event, General Contracting Services' liability is limited to the repair
or replacement at the option of General Contracting Services of such work that is defective in
either workmanship or material.
XIII. Once an order for cabinets has been placed there will be no returns or cancellation of
product. If a cabinet arrives damaged it will be replaced by General Contracting Services.
General Contracting Services
-:49 By: P, C(n,�.e- Date: �O —
Edward E. Viel, Jr.
Todd P. Crane
Customer
IN
1 /
Date: /0O�
Cusmer
Soct/11 Secu 'ty No.
2
ATTACHMENT "A"
PROPOSAL & AGREEMENT
FOR PROFESSIONAL INTERIOR DESIGN SERVICES
To: _)cre_4—SL)J �J0WJ_L_ —
Re: 2 -hour Complimentary Interior Design Service
THIS PROPOSAL/AGREEMENT IS FOR INTERIOR DESIGN PLANNING FOR A NEWLY
PURCHASED KITCHEN THROUGH VILLAGE KITCHEN AND APPLIANCE.
1. A two-hour complimentary design service will be provided by Village Kitchen and
Appliance to each customer who purchases a kitchen (valued at $10,000.00 or more) and will
generally include the following:
a) Review of existing space
b) Review of space with requirements for new kitchen
c) Review of final kitchen planning layout
d) Specifications for types of materials that would be required in implementing final design
phase (counter top, tile, lighting, hardware, etc.)
2. If the customer requires further design services a fee of $65.00 per hour be will charged.
Continued design services may included the following:
a) Final color concept for walls (paint, faux, wallpaper)
b) Window treatments
c) Furniture (tables, chairs, barstools, etc.)
d) Accessories. (tableware, pictures, etc.)
e) Shopping for, or with, the customer
f) Consulting with additional special advisors needed for the project
g) Preparing specifications as need and preliminary estimates
h) Phones calls and follow up calls as needed throughout the design phases
i) Additional rooms
Fee Agreement
The customer hereby agrees to pay a fee of $65.00 per hour for services rendered over and in
addition to the 2 -hour complimentary consultation outlined in paragraph 1.
Print Name:
P C'
Date
6 3
/- IF- 06)
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...........P........Al........ ...................................................
has permission to perform ........ f.Ate,
.............................................
wiring in the building of ................. 041f ....................................
at.�, � .... 4E ... / eq.TeX ...... 5: - 7 . ................. . North Andover, Mass.
Fee.31.�7'0 ....... Lic. No.4.473-43 ................... 41 Z 2—�,t -< - " P.
ELECTRICAL INSPECTOR
Check # 11 L/ (0 7
"'' —� fronvxan wsalUs o f I /%aas3arJtttlsl�l For Office Use Only
(Rev. t
�—C.JtPar� �Jtt+ Jsrvittl Permftl�FutHui nber.
Ocarpancy & Fee
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
(Au. WORKTO as »amu M vena ME M&S&&CM sans st seln CAL cans sir csa ural
PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date:
City or Town of: /Z/- —/' < � To the inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location: (Street & Number)
Owner or Tenant: CTI! C — %1/fi w C-
Owner's Address: J,�-
Is this permit in conjunction with a Building Permit? Yes 4;1 - No ❑ (Check Appropriate Box)
Purpose of Building: 411 Utility Authorization tr
Existing Service:Amps L` I L�f Voits Overhead Underground.❑ T of Meters
New Service: Amps f Volts Overhead ❑ Underground.❑ # of Meters:
Number of Feeders and Ampacity:,
Location and Mature of Proposed Electrical Work: S
No. of Recessed Fixtures
No. of Cell: Susp. (Paddle) Fans
No. of Transformers Total KVA
No. Of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of lighting Fixbrras
Swimming Pool: Above ground a In Ground o
# of Emergency Lighting Battery Unfts
No. of Receptade Outlets Z
No. of OA Burners
Fire Alarms I # of zones
# of Detection & Initiating Devices
# of Sounding Devices:
# of Self Contained
DetedioNSoundmg Devices
Local o Municipal Connection C Otner
No. of Switches
No, of Gas Burners
No. of Ranges
No. of Air Co,tdturer
itis TOTAL TONS:
No. of Waste Disposals
Heat Pump Totals:
Number. TONS: KW
Security Systems:
No. of Devices or Equivalent
No. of Dishwashers
Space /Area Heating KW
Data Wiring, No. of Devices or Equivalent
No. of Dryers _ _
Heating Appliances KW
Taiecarrunu mitations Wiring: No of Devices or
Equivalent
No. of Water Heaters KW
No. of Signs: # of Ballasts
OTHER;
# of Hydro Massage Tubs
M. of Motors Taal HP
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of elect icai work may issue unless the licensee provides proof of liability itwu:ar
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 t
issuing office. CHECK ONE INSURANCE g/ BOND O OTHER n Please specify:
Estimated Vatue of Electrical Work 5 (When required by municipal policy)
Work to Stay: d ell inspections to be requested in accordance with MEC Rule 10, and upon coma!
1 car t fy, ander the pales and penalties of perjury, fhat the Information on this appllcatiun is true and complete.
Llc. #
LIC. #, 9 3 3
1 All. Tel.*
OWNSR'S INSURANCE WAIVER: I am aware that f►te Licensee dues not have the liability insurance coverage normally required by law. By my signature betpw, I nE
waive thts moulfilmo ik I am the (chock one) Owner 0 OR Agent o
ft
ri NORTH
r s
Date.... — ..'. (4_
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies tat L
//
has permission to perform ..�[ �j�/ ��...... .°�............ .
plumbing in -the buildings
of . /.(/�/K- -f.'.<.. ................
at. `,!�. � i� .. . ............... . North Andover, Mass.
Fee .,:� �.. Lic. No....lam
PLUMBING INSPECTOR
Check # S"5
5:79
a
G
MASSACHUSETTS UNIFORM
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location 'q5
ra
r
k'ATION FOR PERMIT TO DO PLUMBING
N-6
Date
NO N-6 Ltr Permit #
Amount
New 1:1 Renovation ® Replacement ❑ Lv Plans Submitted Yes ❑ No
FIXTURES
(Print or type) Check one: Certificate
Installing Company Name �A % D / %i�Y-{'./ %% L 1-i°�/i�/% 11 Corp.
Partner.
Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 10 Other type of indemnity ❑ Bond a
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
iIgnature IOwner 11 Agent 1-1
I herepy 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/rider Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plum bin ode and Chapter 142 of the General Laws.
X11
By:
Title.
Citylrown
APPROVED (OFFICE USE ONLY "
VI�l141U1 \. VL L11.V11JVU 1 1 111 GI /( -- - -
/ 2 pe f�Plumbing nse U
Icense Flumner Master ® Journeyman ❑
•
a
!
•
/
/
/
W
_
(Print or type) Check one: Certificate
Installing Company Name �A % D / %i�Y-{'./ %% L 1-i°�/i�/% 11 Corp.
Partner.
Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 10 Other type of indemnity ❑ Bond a
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
iIgnature IOwner 11 Agent 1-1
I herepy 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/rider Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plum bin ode and Chapter 142 of the General Laws.
X11
By:
Title.
Citylrown
APPROVED (OFFICE USE ONLY "
VI�l141U1 \. VL L11.V11JVU 1 1 111 GI /( -- - -
/ 2 pe f�Plumbing nse U
Icense Flumner Master ® Journeyman ❑
Location
L -14 57—
5%'No.
No.�'
Date
�.P 40*Th
TOWN OF NORTH ANDOVER
„
Certificate of Occupancy $
s s ;
Building/Frame Permit Fee $
'Ss�CHUSE`
Foundation Permit Fee $
Other Permit Fee $ 1-S rw
Sewer Connection Fee $
,_,.r
(Nater Connection Fee $
TOTAL $
2
� 195 ����
• ;
; ��,1!/,
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P+ Div. Public Works
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No. Date �� ;�/C>
Ot
T".
TOWN OF NORTH ANDOVER
.mow
p Certificate of Occupancy $
Building/Frame Permit Fee
$
IFCMUseFoundat'on Permit Fee
$
-,, - Other Permit Fee
$
r Connection Fee
$
�Q WatSewer Connection Fee
$
TOTAL,
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Location --
No.�) Date'
NORTq TOWN OF NORTH ANDOVER
F w
9
Certificate of Occupancy $
cMust<�' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#l���
17G80
/ Building Inspector
13
I SECTION 1- SITE INFORMATION I /
1.1 Property Address:
Te 1Z
`� 1 •
1.2 Assessors Map and Parcel
9
Map Number
Number:
"—�D,C s'
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas
Frontage tt
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
R red Provided
R
red
Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5.
Public ❑ Private ❑ Zone
Flood Zone information;
Outside Flood Zone 0
1.8
Municipal
Sewerage Disposal System:
0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.11 Owner of Record
, v S ay b J p �i� l'�y LJC�-�—_ L 5 L S T -(.CJs l IL S
Na a (Print) Address for Service
)e -1v ti 15'
Sign — Telephone
2.2 Owner of Record:
Nathe Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
J) e AU Ai, 5 � IZee S� �
Licensed Construction Supervisor: o? CY v� 7
License Number
Address ^ ] �/;
l q �p FL / V I S /'
- /D %�w ea ! (y t'7Expiration Date U
�igtlur� Telephone
j1t6--X- '::-r ? - 6. & 6 6
3.2 Registered Home Improvement Contractor Not Applicable ❑
+ ! -/1 S
Company Name
/ �1 Registration Number
Address
Expiration Date
Si na ure Telephone
ou
M
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z
O
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 permit.
Signed affidavit Attached Yes ........❑ No ....... ❑
SECTION 5 Description of Proposed Work check au applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ TAddition 0
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
l/ �ewtr� e 4 LL P >r15TN,r FULL 4e �
I/2 b e..1" C1 I N s `(` ,- CSL lu c w
I SECTION 6 - F.STTMATED CONSTRITCTInN MRTC I
Item
Estimated Cost (Dollar) to be
Completed bV permit applicant
OFFICIAL USE ONLY r ."
1. Building
g s�
(a) Building Permit Fee
Multiplier
2 Electrical
'A1 0
(b) Estimated Total Cost of
Construction
3 Plumbina
Building Permit fee (a) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
O O
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
'2 5Gq as Owner/Authorized Agent of subject property
Hereby authorize to act on
M�behalf, in �;tlrs rely at�iv`�to work �(� d b building permit application. ��� /
r �'
Signature of Owner Dat r
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR Tl vIBERS 19F2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIlvINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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To: Dennis From; Yvonne C, Baker 2-23-04 12107pm p, 2 of 2
I,i..� .. •,:,:11 I -.I;I I... j: _I ,I � ;+ ,
t ,�i{■ ■■ ��,I +■■■■
CO
IlAI
II ,^^•j �r• !ISI ,II!■��1
1,:11111 :: 'I •; 11 1 I I .il;! ; , ,....:.1 I I I ! I L., I :.ii!1'I � 1 11 .. L.j; I I 1 ; I:Iq� I;I,1;�, L,f, II
PRODUCER
, I -:I , I I,L' I;, I II 'i' I , I ,I I' 1 ! I IIII,
1 lI 1I 1I I
`I
ill.; ! i.;. .•: :. 'I �'•I'' L:; 11. ,tl;�. 1 � I L!.,
•_,.., •. :: ..,: :: :.
I, DATE IMM/DDnr)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Feingold & Feingold
Insurance Agency, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
22 Elm Street
COMPANIESAFFORDIIIMG COVERAGE
Worcester, MA 01608
YCB
ooMPANYTravelers Indemnity Company
A
INSURED
coMPANYNORGUARD Insurance Co.
D.R. Frasca Co., Inc.
B
26 Flint Street
North Reading, MA 01864
COMPANY
C
COMPANY
D
�'fu l; 91:1' I j � II .. ;I i 1 ' •-• 1 I ; 4 `..I'Y111, �I,, ; 1 '�''1_ , 1.1. Y. •i 1 1 ,1".: '� i � I I , , �. I �I y 1 t �_.' � III I'..I.1. , , 1111'1 I I , I !LI 1 II .',jl';Iji;l 1 I L1.1.,1; i; I , i � ; I , I"..
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 1S SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Co TR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
(MMIDDIYY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL
IJABIUTY
GENERAL AGGREGATE s2,000, 000
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX-1
I680978D5786INDBOP
7/24/03
7/24/04
PRODUCTS • COMPIOP AGO 02, 000,000
PERSONALPERSONAL & ADV INJURY $1,000,000
EACH OCCURRENCE 0,1 0 0 Q 000
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Any one }Irel 0 300, 000
MED EXP {Any one Pereon) 0 5 000
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT 01,000,
000 000
BODrpers n)
{Pe"YJN 0
A
X
ALL OWNED ALTOS
SCHEDULED AUTOS
I810435H2661INDCAU
10/26/03
10/26/04
X
X
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY 0
(Per accident)
PROPERTY DAMAGE 5
GARAGE LLABILITY
AUTO CMX - EA ACCkM%T 6
ANY AUTO_:'.
OTHER THAN AUTO ONLY:
EACH ACCIDENT 0
AGGREGATE 0
EXCESS LIABILITY
EACH OCCURRENCE $
AGGREGATE 0
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
0
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
DRWC4 0 7 7 2 5 WC
3/08/03
3/08/04
WG RY STALIMITTU• DTS ER
TO
EL EACH ACCIDENT 4 100,000
THE PROPRIETOR/ INCL
PARTNERS)EXECUTIVE
EL DISEASE • POLICY LIMIT 0 500,000
EL DISEASE • EA EMPLOYEE 0 10 0 0 0 0
OFFICERS ARE: EXCL
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHR:LE9/SPECIAL ITEMS
RE: Mr. & Mrs. Joseph Nowell, 45 E. Water St. No. Andover, MA
I�
tiM',� 4FAj��1,�.,I N:.'I lil I 1 .i,I I I -III, �,.; 1 ,'I�I1! ,,, , it ' 1..I_. pYpi; , I -!.i-', , ..1j• 1,•Ij1 II. i 1 1 11..1Iji, I ,�.. : 1 I --(.hr ��
:iGl I Iw,�;1•"�lr'7,ER11!� 1�-..I;Y•-1!M a,, 1 1 I i ,l, ,I , 1i,: ,II-- i1•�1�{l 1 ', 11 I,,.,. �I-h 1 1 I '� , ! 111, '..�
!.111
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Town of No. Andover
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAR.
Attn : Bui ldingn�rDept .
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
No. Andover, MA
BUT FAILURE TO MAR SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
;I,, . .. I:I I I 1 ,•:,:'i 1 ,Ill I I I 1 , .'I I :I I;, ! , 1- .,
..I!• :.� .. 1 .jja 1 I i-Il.!,I'\ 1 1, 1'11 III l I I III LI'i,1 '' 1! :'I. Ill 'll :II ,III II 1 II III
1'�ii 'llI, IVyVRk$LI�I1�RP�i1y�Cyt�1yyyl �ry0
k1 II(,
BOARD OF BUILDINGEGU.
IONS
icense: CONSTRUCTION SUPERVISOR
' Number: CS 029274
Birthdate: 03/04/1949
�Pirgs: 03/04/2004 Tr. no: 17866
Restricted: 00 Y
DENNIS R FRASCA
26 FLINT ST
N READING, MA 01864
Administrator
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR !
Registration: 117458
Expiration: 10/10/2004
Type: Private Corporation
D.R. FRASCA CO INC. a
DENNIS FRASCA
2E FLINT ST
NO READING. MA 01864 --------
Y '
Date.—
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thit certifies that .... ......... . ......
haspermission to perform ..... tl-� lcl.........k"............le�9.a4l z
wiring in the building of .....
...............
.......... ...................................
at.... V5 R ................. North Andover, Mass.
Fee ..'3� .......... Lic. N
Check #
SU87
e&i?L'nZo7m5s?w dg xi
D040MMI! 4 700.541#
BOARD OF FIRE PREVENTION REGULA
APPLICATION FOR PERMIT [rO
All work to be performed in accordance wit the
(Please Print in ink or type all information)
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number `7 �� S % (NI,4 )/ f' O- SZ -
Owner
or Tenant Svc `I- � o c / (,/0 ty(f✓L
Owner's Address
Official Use Only
Permit No...
r.00
f;40
527 CMR 12:00 Occupancy & Fee Check
ELECTRICAL WORK
Electrical Code 527 CMR 12:000 �
Date .3 //�;/()�/
To the inspector of .141r es:
Is this permit in conjunction with a building permit Yes II,,/ No 0 (Check Appropriate Box)
Purpose of Building Res /G G � Utility Authorization No.
Existing Service Amps Voits
New Strvice Amps Voits
Num►^:r of Feeders and Ampacity
Locan4.)nand
� Nature of Proposed Electrical jWork
R f IV;A/0-`l e— a S T 1;-2 q
Overhead a
Overhead 0
�fiT/f��DD tylS
Undgmd 0
Undgmd 0
No. of Meters
No. of Meters
OTHER:
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 va id proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE e✓ BOND - OTHER - (Please Specify)
(Expiration Date)
Estimated Value of. Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury: v
FIRM NAME
Cd
LIC. NO.-�CI621,
NO.
�7 %� %� Bus. Tel No. `jam %/ !� 9 17 l 91 S�
Address 3 J / / Dy� �l elm��, /%% AIt Tel. No. 4 'i E �/ ;35-2
OWNER'S INSURANCE WAIVER: 1 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) d�
Telephone No. PERMIT FEE
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above 0
In 0
No. of Lighting Fbdures
Swimming Pool gmd 0
grnd 0
Generators INA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
v
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No_ of Zone
No. of Detection and
Total
No. of Rai
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diposal
No. Pumps
Trois
KW
No. of Sounding Devices
NoJ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
DetectioNSounding Devices
0 Municipal a Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. Of
Low voltage
No. of Water Heaters
KW
Signs
Bailases
Wiling
No. Hydro Massage Tuft
No. of Motors
Total HP
OTHER:
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 va id proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE e✓ BOND - OTHER - (Please Specify)
(Expiration Date)
Estimated Value of. Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury: v
FIRM NAME
Cd
LIC. NO.-�CI621,
NO.
�7 %� %� Bus. Tel No. `jam %/ !� 9 17 l 91 S�
Address 3 J / / Dy� �l elm��, /%% AIt Tel. No. 4 'i E �/ ;35-2
OWNER'S INSURANCE WAIVER: 1 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) d�
Telephone No. PERMIT FEE
(Signature of Owner or Agent)