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HomeMy WebLinkAboutBuilding Permit #455-15 - 2 BONNY LANE 10/11/2014 NORTH BUILDING PERMIToFst,Eo 6 ,, TOWN OF NORTH ANDOVER 0� ry _ °� APPLICATION FOR PLAN EXAMINATION F h w Permit No#: Date Received �qSS Ar..0 .`1y CHU Date Issued: IL i4�140 TANT: Applicant must complete all items on this page LOCATION 0)N -76) )/) Print PROPERTY OWNER / 6 b/LII� C�4�8 Print 100 Year Structure yesno' MAP PARCEL: ZONING DISTRICT: HistoricMachine Shop Village yes istrict ye no no TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑AI ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 96my:( 1zY IP dit 0,64 /sT %G4� USIA-)� awtmu,- c..IV'f✓�9-15 L,� �fitJt w/rr/� SYS. Sf �ru�s� 0,0.16 y, ME /3'`7; Identific tion- Please Type or Print Clearly _ OWNER: Name: P/) Phone: Address: 2 &Nvy Contractor Name:� �PL,�19" Phone Address: u3- &14 JJ &k Supervisor's Construction License: � Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ JD � FEE: $ ? r Check No.: Receipt No.: d 9 NOTE: Persons contracting with unregistered contractors do not have access th guaranty fund Signature of Agent/Owner Signature_of contractor r Location No. — Date . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee _ •� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS V 1 d Zoning 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 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 30,5522.00 m $ - $ 366.26 Plumbing Fee $ 45.78 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 45.78 Total fees collected $ 557.83 2 Bonny Lane 455-15 on 10/11/2014 Remodel Family Room McCabe,Todd&Lisa 2 Bonny Lane N Andover,MA 01845 978-423-5921 508-294-0960 CONTRACT Customer Name Tac<o202 Customer Signature SKETCH Contract Datev� z� 2r��L1 Sales Representative Signature ATTACHMENT Customer Phone a')a L6-i--. Contract Price :30saa 1 2 3 4 5 6 7 6 9 10 1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 39 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 65 56 57 58 59 80 I I I -- -- --- LAA,1 7 10 _ --r 1 10 1s 17 1 a9 F-+ 21 L. __ -- — -- — zz 23 - 25 I _ 26 I- - - — - -- - -- 27 28 - 29 �- - — - - — — -- -- — `S — — e- _ - _ 1 1- 33 - 34 1 35- -1- - �- -�- 1 I � I NOTES: y w,arc:Alk �trr k�'oru �.,oe+ %P';w+�_C<�\P�a ck ,e �7IM OO WS 'Each box equals one foot unless otherwise noted.This sketch is a good faith representation of the work to be done,it is understood that all dimensions derived from this sketch are approximate,and that all locations of outlets,light N w S fixtures,plugs,jacks and/or switches are subject to change if necessary. r 1 - NORTH W* .. of �. Andover q661145 ONo. * t T&N _ h ver, Mass, 1 l I I c.ac ne w�c.c 1• � AOR-ATE O p.P�`��,�5 S V BOARD OF HEALTH Food/Kitchen PERMIT Septic System THIS CERTIFIES THAT ..... ...pla........I` . /� BU ILDING INSPECTOR� ............... ......................................................... Foundation has permission to erect .......................... buildings on . ..... ?..i7!J�k. ......� � . ................................... 2 Rough tobe occupied as ...............�........ 4.... . ....... �!:'. ....... �^... ...-........................... Chimney provided that the person accepting this permit shall in LUe re �_I s ect conform to the'l�th�s of thea application p p p g p � p pp Final on file in 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 3(v� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION SRRTS Rough Service ............... . .......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dr Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. McCabe,Todd&Lisa 2]Bonny Lane N Andover,MA 01845 978-423-5921 508-294-0960 CONTRACT Customer Name TIC-Gabes Customer Signature SKETCH Contract Date- !�b±yt-k'3^ Mot y Sales Representative Signature ATTACHMENT Customer PhonL6-rs 6%P)i Contract Price :30,5aa 1 2 3 4 5 6 7 B B 10 11 12 1314 15 16 17 18 19 20 21 22 23 24 25 26 27 28 20 30 31 32 33 34 35 36 37 39 39 40 41 42 43 N 45 46 47 48 49 60 51 52 53 54 65 56 57 59 59 60 I f I _ _ H `-'�'---I---�- I 7 _ --f---�-i - ++ 10 - 1- 13 1. — , 1 17 18 20 22 24 I - t _ 25 26 27 29 I I I I 31 _ _— - - "ve 32 33_ — 34 .Lt±L . --+---- J- 4-1--t+-77 NOTES' S« Anr� wNW N �Nab LOS 'Each box equals one foot unless otherwise noted.This sketch is a good faith U representation of the work to be done,it is understood that all dimensions •N derivedfrom this sketch are approximate,and that all locations of outlets,light 2 N W S i F fixtures,plugs,jacks and/or switches are subject to change if necessary. The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciansfplulmbers Applicant Information Please Print Lewbly Naive (Business/Organization/Andividual): Address: 60o Saw Mu G� " City/State/Zip: �/� t!20h011e#: 7k? 8 2( U� y Are yogi an employer?Check tbr appropriate box: Type of project(required): 1. I am a employer with -1-- 4. El am a general contractor and I 6. E]Ne onstruction F employees(full and/or part-time).* have Hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7 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 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.] employees.[No workers' 13.❑Other comp,insurance required.] 'Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information. T-Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit anew affidavit indicating such. TContractors that checktbis 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 thepolley and job site information. c _ Insurance Company Name:. S SGlAP91/� Policy#or Self-ins.Lic.#: 6,,r, Q YZ q/M_ Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can 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. Ido Hereby cer fy and th ai and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: P71 D O Official use only. Do not write in this area,to be completer)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.PIumbing Inspector 6.Other - - - Contact Person: Phone#: L Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,- express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any ciuestions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho Commonwealth of.Massaehusetts Department ofladusidal.A,coidents Office of javestigati 0mg 600 Washington.Street Boston}MA 02111 Tel#617-727-4900 at 406 ox 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.znass,go��c�.a • 16.�. I Ra CERTIFICATE OF LIABILITY INSURANCE DAM MMD°'YYYY' 9/11/2014 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Andrew G. Gordon, Inc. NAME' PHONE pA7( 306 Washington Street Alc No 7R1-r,5<)-?26? A/C No: Norwell MA 02061 E-MAIL — — ADDRESS: info@aqordon.com FrKOUUGFR Cus ER ID 4440 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A:Peerless Insurance 24198 Lux Renovations, LLC INSURERS:Pil rim Insurance Owens Corning of New England 60 Shawmut Road INSURERC:Star Insurance Company18023 Canton MA 02021 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:639296000 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MWDD MM/DD LIMITS A GENERAL LIABILITY CBP8512851 9/5/2014 9/5/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY 100,000 PREMISES Ea oowrrence $ CLAIMS-MADE a OCCUR MED EXP(An one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 X POLICY PRO LOC $ B AUTOMOBILE LIABILITY PGC10007161409 1/17/2014 1/17/2015 COMBINED SINGLE LIMIT $1,000,000 X ALL OWNED AUTOS ANY AUTO (Ea accident) BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ A X I UMBRELLA LIAB X OCCUR CU811953 9/5/2014 9/5/2015 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000 IXDEDUCTIBLE 10,000 $ RETENTION $ $ C WORKERS COMPENSATION WC0428715 5/24/2014 5/24/2015 XWCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,desaibe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Sehedule,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 ACCORDANCE WITH THE POLICY PROVISIONS. Lux Renovations, LLC 60 Shawmut Rd Canton MA 02021 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD � ?/1�ZQ� l2 O� - -- nsume�r Airs Business e ulation _ Office of Co g 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement"Contractor Registration _ Registration: 137943 Type: Supplement Card _ = Expiration: 1/29/2015 OWENS CORNING BASEMENT FINIS.HI'NG,_`: ='--` DANIEL WALSH 60 SHAWMUT RD - - CANTON, MA 02021 - Update Address and return card.Mark reason for change. - 7 Address Ej Renewal E] Employment ❑ Lost Card SCA 1 % 2OM-0511 t C��e tpa��vr�waz�aeall�a�C�%%���a�ac%uaeG� —_ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only er ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistration:_:_137943 Type- 10 Park Plaza-Suite 5170 Expiration; Il2g/2015 Supplement ::ard Boston,MA 02116 OWENS CORNING BASEMENT_;FINISHING SYS DANIEL WALSH = 60 SHAWMUT RD - -- CANTON,MA 02021 Undersecretary Not valid without signature IVW Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-079893 DANIEL F WALS a 488 KENDALL RDs TEWKSBURY WA01! Expiration Commissioner 10/0512015 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits La Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses L, Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Li Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 r10RTF� TOWN OF NORTH ANDOVER * PERMIT FOR WIRING 88,��gE This certifies that .....GT....' ........... ...... ..0 4.. .. .. ............................................... has permission to perform � ...!r ........................C� 4g ivr yz�q�n wiring in the building of........... :`.. '. .................................................................. Fatee.....�:.� �:.1......"}':.. M l�'f........................... N .. ........... ..... ............................. ...... ,Andover,�Mass. U.....Lic.No.�,.QA� ICALELE � INSPECTOR / Check# c- Commonwealth of Massachusetts Official`Use.Only o Department of Fire services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancyv. ml and Fee Checked w � j leave blank 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 INMK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER 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) 66jjyjV Owner or Tenant Telephone No. Owner's Address _ vh L Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 1 juyte 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: h:1,At-\cvt r2W10 1� Completion of thefollowing table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets 10 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. Tons TotNo.of Alerting Devices No. of Waste Disposers ( Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices Py No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs - Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eq uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated'Value of E ectr'cal Work: p U (When required by municipal policy.) ` Work to Start: 3115115 Inspections to be requested in accordance with MEC 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: INSURANCErena, BOND ❑ OTHER ❑ (Specify:) t`') I certify,under the gins ndlties o per'ury,that the information on this application is true and complete. ZN FIRM NAME: . ( LIC.NO.: '�)(l o y 3,4 Licensee: j" f-F C(� (LA-1 Signature C.NO.. Y (If applicable,ent r `exempt"in the license number line. f r n i ,�/I us.Tel.No.• 5j 9,V ys9 l Address: 1VC- Alt.Tel.No.: *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 agent. Owner/Agent PERMIT FEE.$ Signature Telephone No. i' ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166,§ 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass IN Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: + Inspectors Signature: Date: ROUG INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors ents: 1 i Inspectors Signature: Date: FINAL SP TION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Co m ts: �1 Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA.02111 UV www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): P i" \_ , b Address: V Aur UK , d �� City/State/Zip: 4mZA2:,�6U(`Y/Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2N] I am a sole proprietor or partner- listed on the attached sheet.# �• ❑Remodeling ll 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 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. A Policy#or Self-ins.Lic.#: Expiration Date: JoViSite Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of 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. Ido hereby cert! uncle pis and penalties ofperjury that the information provided a ove is rue and correct. Signature: Q / C q� Date: Phone#: ! L7 � J / Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom G of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877,MASSAFB Revised 5-26-05 Fax##617-,727-7749 vvww.mass.govfdia 4 _ tACat OFII�IASSAbRUg M -- r� �..�.�._ --ter...,.. - 4. • • • . CONTROL'#* 'H058282 ELEC7 RICIAN,S f IMPORTANT A5 A RSG JOUR'NEYMAN`ELECTfIIt (AN, ISSUES THE LICENSE TO hrs license is dost-:oe,destroyed, notify your Board;at the: :. .. vision of.Profess'ional Licensure,,1000 Washington St., �k MA02118-6100.. ; E.TH T �iCCOLLUM uiteF/10;Boston,., your name or address shown is changed, notify your board .6f correct name or address to insure proper mailing of next 1 E3 f�p pf N A V l T Renewal Application..Always refer to your license number. 11 N I T. 2.-65 ti. pro of the General Laws .t A P1 E This license is subject to the p S B U R Y as amended.It is a personal privilege,and must not e.oaned , M A 0 1 9 13 1 12 0` or assigned to any other person. Keep,this license onygLJ r „. i person or posted as required by law. y `.. C MO E H NUSI:T�...,�.� OM NW ALT 01= MASSAC F CONTROL#' H058283 ' ' ' ELECTRICIANS R:EGISTERED.-MASTER •ELLECTt?1[' AN IMPORTANT ISSUES THE.l�BOVE`'ICENSE TO r� c. t If this license is lost or destroyed, notify your Board at the Y , �)ivision of Professional Licensure, 1000 Washington St.,`+ 1 .'rite 710,Boston,MA 02118-6100. r-,.,:..-..-_S-ET.H T Pt 0 0 0 L L U M ' f your name or address shown is changed,'notify df come g fy your board. 1 :E R 0.WN, AVE #' ct name or address to insure proper mailing of next tJ NJ b 5 r Le lication. Always refer to your license number:. /a t1 E S B U RY MA 0 19 7 subject to the provisions of the General LawsIt Is a personal privilege,and must not be loaned3 0 /31/13o any other person. Keep this license on yourted as required by law. r- ' '' • '' '` ' ' • F • l'fi 'All t i J 1.f l I 09821 Date 212 1� . . . URh�G45� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . -►!�C,�C�1 has permission to perform . . ' '.`""`'� plumbing in the buildings of. -02.0'` e . . . . . . at . . . l- , , , , , . , . , North Andover, Mass. Fee .1.(03.0. Lic. No. ) . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check 4 Z-2.)15 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY1 /UP/LT/I /VQr�✓, MA DATE 2 /dr Zoi 3 PERMIT# JOBSITE ADDRESS OWNER'S NAME 040 POWNER ADDRESS _ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:ED RENOVATION:9 REPLACEMENT:Ej PLANS SUBMITTED: YES NO® FIXTURES 7 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET _ URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE OF INDEMNITYF- BONDE] 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 Q AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true nd acc to the best of my cnowledge and that all plumbing work and installations performed under the permit issued for this application Will be i m e e ent of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Richard N.Hackett LICENSE# 13246 SIGNATURE MPQ JPQ CORPORATION Q# 2483 PARTNERSHIPD#O LLCQ#� 4� COMPANY NAME Hackett Brothers Inc. ADDRESS 1145 Summit Street Unit#2 CITY Fpeabody STATE MA ZIP 101960 TEL 978-538-0088 FAX 1,9785380542 CELL 781-589-7420 EMAIL I Rick @hackettbrothersinc.com z j404 0-6 nn a'A J, 21 Z1 I►4 e Ke ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES '41r Division of Professional Licensure: Licenob Seatth Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov, Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ........................................................................................................................................................................................................................................................................................ Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency More... LICENSEE Name:RICHARD N. HACKETT SR. REFERENCES& PEABODY,MA RELATED INFO t i1 yt � AB Kf{ Disclaimer Regarding **This Licensee has additional Licenses,click here to view them.** Website License Searches Enforcement Process Glossary Licensing Board: PLUMBERS Et GASFITTERS Glossary of License Status License Type: MASTER PLUMBER Codes License Number: 13246 1 More... Status: CURRENT Expiration Date: 5/1/2014 Issue Date: 10/15/2001 Exam Date: 9/8/2001 i School: i i This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. ( I The page above has been generated by the Division of Professional Licensure web server on Monday,February 25,2013 at 4:10:40 PM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/pubLic/pubLicenseQ.asp?board code=PL&type class= M&1... 2/25/2013 i Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 1099018.00 m $ - $ 1,308.22 Plumbing Fee $ 163.53 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 163.53 Total fees collected $ 1,735.27 2 Bonny Lane 731-12 on 3/29/2012 Kitchen Remodel r)2, 2 w �XZ�71 -off Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 109,018.00 m $ - $ 1,308.22 Plumbing Fee $ 163.53 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 163.53 Total fees collected $ 1,735.27 2 Bonny Lane 731-12 on 3/29/2012 Kitchen Remodel fpJ Pj" 1 it Date z�z�,. `�-,z,. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . .�.C...►!!c}^c . . . . . . , , . , , has permission for gas installation . . . . in the buildings of. . 0.0-6.p . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . , . . .t• ..... . . . . . . . . . . . North Andover, Mass. Fee, 1 P.Q^. . Lic. No. . 374.(/6. . .H.kb. . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# € 606 (s r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATEI / ,?4)37 PERMIT# JOBSITE ADDRESS c7 NN tiF OWNER'S NAME GOWNER ADDRESS TE FAX PRINTT � TYPE OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL,EJ CLEARLY NEW:® RENOVATION:9L REPLACEMENT:[j PLANS SUBMITTED: YESKI N00 APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 67 8 9 10 11 12 13 14 BOILER _ BOOSTER - CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE - � FRYOLATOR FURNACE GENERATOR GRILLE - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER - -- s - --- UNVENTED ROOM HEATER WATER HEATER OTHER ill 11 IL L� INSURANCE COVERAGE I have a current liabilit insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E]NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE INDEMNITY 0 BOND 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_] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are t e an acc rate to th best of nowledge and that all plumbing work and installations performed under the permit issued for this application will be in li Pe ent n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. • PLUMBER-GASFITTER NAME I Richard N.Hackett LICENSE# 1324 SIGNATURE MP 0 MGF 0 JP© JGF© LPGI[D CORPORATION E]# 2483 PARTNERSHIP®#0 LLC[]#� COMPANY NAME: Hackett Brothers Inc. ADDRESS 1145 Summit Street Unit#2 CITY I Peabody STATE MA ZIP 01960 TEL 978-538-0088 FAX 978-538-0542 CELL 781-589-7420 EMAIL rick@hackettbrothersinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES a • NL Division of Professional LiCensflre`: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ............ .................._..........................................._...._....................................................._.......................-........................_.................................._..... Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency More... LICENSEE Name:RICHARD N. HACKETT SR. REFERENCES& PEABODY,MA RELATED INFO ti Disclaimer Regarding **This Licensee has additional Licenses,click here to view them.** Website License Searches --- — ' — -- — — Enforcement Process Glossary Licensing Board: PLUMBERS 8 GASFITTERS Glossary of License Status License Type: MASTER PLUMBER Codes License Number: 13246 More... Status: CURRENT Expiration Date: 5/1/2014 Issue Date: 10/15/2001 Exam Date: 9/8/2001 School: i This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. i The page above has been generated by the Division of Professional Licensure web server on Monday,February 25,2013 at 4:10:40 PM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/pubLic/pubLicenseQ.asp?board—code=PL&type—class=—M&1... 2/25/2013 ¢ � (Printt oor MH.7.7Fint t urvrlrvrtiM f+rru�:A I IVIV t-Uti 1't1iM11 IV LJU UASFI1TINa-" r Type) e) Date .Mass.' _ *4161 3a 19•7� Permit Building Locationn��J/�/L rte` , '' Owners Name Type of Occupancy, �.� New Renovation p Replacdmefit Q Plans Submitted: Yes[] No • to z ac. �. `. .vr03 - �.: iz la I r OC :td •+( lu.OA ':1 _ �l.._•,\r `.9!• ;K.•.'.:.:.' .�� � .I".• •IGS .�. •�• .1ra .1 ;;•_ ;.�. ''�'' ;mow r .�/.? ' s ;�: .!'j. _�. •'a: :� .r. ��: .i-:" :•�;•:�•;O •fit' :Q `iy' ;:,r• ;C1`' �1- %s.: �'�j' � ��: iiWi 'li''•�': .. • ��: ::•t:•i::, ._..;., � � ti. '4. •;a• ;1*►.'. :i�Q :�' r�` 'iii �;' •.i ::y: Sue—asMT, BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X❑ Corporation 1862 LAWRENCE, MA 01840 Partnership Business Telephone 508-68.7—'1105 El Partnership Fir❑ Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked • please Indicate the type coverage by checking the appropriate box. A liability insurance policy , � Other type of Indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ ' Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in abo knowledge and that all plumbing work and Installations performed under the plication are true and accu�te the best of my permit iss t this application will n mpliiiance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene U ; Title Plumber Signature of cen Plumber or Gas Gasfitter City/Town Master License Number 8697 APPROVED OFFICE SF ONLY) Journeyman 2Date... / � •t• k i HORTh TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION SACHUSES This certifies that . J .` . . . . . . . • • . has permission for gas installation tl tt e -I��/�. . , . . . , , , , ,cc r X) f in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a 1 •Q at ..w�`��.. �.JU G.t `- !`�: . . . • • •, North Andover, Mass. Fee.�,�L':P. Lie. No.. .1.V(c 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . C F# /5 GAS INSPECTOR tt WHITE:A plicant CANARY:Building Dept. PINK:Treasurer CANMNE CARE & CONSULTING Specialized care for Canines f Helen Uusitalo ' 978-794-1166 978-457-2679 t ,&ORTH O�tI�..;°qq•0 NORTH ANDOVER BUILDING DEPARTMENT °AATfD 27 CHARLES STREET �SswcwUS Tel: 978-688-9545 Fax: 978-688-9542 DATE: NAME ADDRESS l/ �Cl ZONING DISTRICT: TYPE OF BUSINESS: /l S C 0 e `c BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE t4Llit/I CJS ! .S Ca lg joc( � C � �1��Q d S � I ti c@ 1--lit A F ��� i� ,� 1. 'x-41 , l n C (c o r Ll C C d J•}t n.q / fa't' �q`�1'u q 1 Po/J•prwt7a�C 7 IA.' �.�oA ,c ow `' -e CN NY�i -eaQ rt,v m �� S� � " N �_ �- SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. �- ❑Agent 11 Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of elivery ■ Attach thif.card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No 3. FSice Type �, /� ertified Mail ❑ Express Mail 7vegistered 13 Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) ?002 0 510 0000 0894 3117 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-0835 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No. G-10 I, `�? • Sender: Please print your name, address, and ZIP+4 in this boxy C.. North Andover Building L, Department f' 27 Charles Street North Andover MA IY' f 4�. t' TOWN OF NORTH ANDOVER NORTly ` Office of the Building Department 3:°eti t` Community Development :Ind Services o 27 Charles Street * c North Andover, Massachusetts 01845Offl ��SS^GHUStiS4y D. Robert Nieetta, TelcThone(978)688-9545 7 uffifing Commissioner FAX(919)688-9542 September 20,2004 Helen Uusitalo 2 Bonny Lane North Andover,MA 01845 Dear Ms.Uusitalo: Please be aware that atter a complaint from the Animal Control officer for the Town of North Andover it was brought to this departments attention that a dog training school has been started at your home.As you are aware from our conversation of 9/8104 I had told you that this type of business is not allowed in a residential area,at which time you told me that it was carried on off site at the customers home.At that time I told you that it was still not a allowed use as it may well start off site but end up on site and that was why I was not allowing it according to the Zoning Bylaw. It has been brought to the department's attention through the animal control officer that fliers are being put up at various locations around town a copy of which is included in this correspondence. Please be aware that this activity is not allowed and that this letter is an ORDER TO CEASE AND . DESIST IMMEDIATELY THE CANINE CARE BUSINESS. Failure to do so will result in court action and enforcement of Section 10(10.13)which states"Whoever continues to violate the provisions of this bylaw after written notice from the Building Inspector demanding an abatement of a zoning violation within a reasonable tim shall be subject to a fine of three hundred dollars($300) Each day that such violation conrimmes shall be considered a separate offense.(1986/15) Respectfully, Michael McGuire Local Building Inspector CER'I'IH'!ED MAIL.: 7002 05100000 0894 3117 Cc: Heidi Griffin,Division Director D.Robert Nicetta,Building Commissioner t Joyce Bradshaw,Town Clerk `V Susan Northam,NAPD Linda Hmurci.*Water Treatment Plant Postal Service (DomesticCERTIFIED MAIL RECEIPT . Coverage • . N a ra M 0^ Postage $ r-3 Certified Fee 0 V- 3Postmark 0 Return Receipt Fee Here C3 (Endorsement Required) O 0 Restricted Delivery Fee Endorsement Required) C3 r-1 To=al Postage&Pees Lr) O S t o ru St ee,dpi+No.; - a---� � 'f or PO Box No� 0 -----------=---- - - -- --------- t� City,State,0P5 4 :�� �. Y Certified Mail Provides: 0 A mailing receipt 0 A unique identifier for your mailpiece O A signature upon delivery 0 A record of delivery kept by the Postal Service for two years Important Reminders: 0 Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. 0 Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. 10 0 For an additional fee,a Return Receipt may be requested to provide proos of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece to Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail reciKt is required. 0 For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the. endorsement"Restricted Delivery". 0 If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. . PS Form 3800,January 2001 (Reverse) 102595-02-M-0452 SNE CARE & CONSULTING Specialized care for Canines TER BUILDING DEPARTMENT CHARLES STREET Helen Uusitalo 978-794-1166 978-457-2679 Fax: 978-688-9542 DATE: O NAME j 1�c �1 ADDRESS 6el" Z 4 el ZONING DISTRICT: TYPE OF BUSINESS: Z11 0 ,1 BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE (i l R wt �S- v-���-2 ,.,L A s 610q. C. kc LOA f 7 tiAf `F'��Q t-4 bv'kwrrr C2.^� rJr �-.Q n� , �S•o."1' s 1'a '° �e ��-,��c� F� is-S �' i't� G,'�r'-- �a rit X-1- Y-" — L n c tt o� r L7 kj lN�O' 14 „P. pp�J.erLvCGk,K h`a! 9 Th.t �Lrev N ra r.p Sl��N�ra l ✓'✓or N'ly 6l CIf•'LGO Oj a 1 v 4. ! .rte " f .4/ d-w / c m ntom✓., l . 717 4 AORTH F : ' 9 � 4 �1ssAC14 S S� THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BOARD OF ASSESSORS BUSINESS CERTIFICATE SUPPLEMENT (y'NEW BUSINESS( )CHANGE OF NAME AND/OR ADDRESS ( )DISSOLVING BUSINESS 36 CERTIFICATE NUMBER �L,) DATE FILED: er D NAME OF BUSINEESS: h LOCATION: BUSINESS MAILING ADDRESS: (IF DIFFERENT FROM LOCATION TYPE OF BUSINESS: af IS BUSINESS A REGISTERED MASSACHUSETTS CORPORATION: YES ( ) NO � FULL NAME AND RESIDENTIAL ADDRESS OF PERSON OR PERSONS IN CHARGE CERTIFICATE NUMBER THE COMMONWEALTH OF MASSACHUSETTS Of NORTI,, O Op t r r s�C"Wu TOWN OF NORTH ANDOVER- TOWN CLERK BUSINESS CERTIFICATE IN CONFORMITY WITH THE PROVISIONS OF CHAPTER ONE HUNDRED AND TEN, SECTION FIVE OF THE`dkNERAL LAWS, AS AMENDED, THE UNDERSIGNED HEREBY DECLARE(S)THAT A BUSINESS UNDER THE TITLE OF: _��4 i'A P A7/1 , IS CONDUCTED AT: IN THE TOWN OF NORTH ANDOVER,MASSACHUSETTS. BY THE FOLLOWING NAMED PERSONS: NAME RESIDENC l � SIGNED• SIGNAnTP.E SIGNATURE SIGNATURE SIGNATURE ESSEX COUNTY // //DATE PERSONALLY APPEARED BEFORE ME THE ABOVE NAMED: _ xC/,�/�/1 /�f da-54/ AND MADE OATH THAT THE FOREGOING STATEMENT IS TRUE. CERTIFICATE EXPIRES: Xa 0�. po Joyce A.Bradshaw,Town Clerk WNW.- $4152Q7-51 PAP OFQIRTH. CLAD R"T. HIVONT W 11�05�1;955 s F . E1(P.IREB 11.05.2007 UUSITAIA I1ELEy M 2.6ANNYIN N.UDAYR,MA 01845.1223/-n S ts�cr..1 ao r J Ti J I Y. ock . ka 4�n ev ek I 'j; a"e-el. 1441, 6*-. . CANINE CARE Providing specialized care for dogs including daily walks, exercise, and training reinforcement. Skilled in special needs care and animal communication. Excellent references. Bonded and insured. Helen Uusitalo 978-794-1166 978-457-2679 'may 1 Town of North Andover DRINKING WATER TREATMENT PLANT 420 Great Pond Road North Andover, Massachusetts 01845 Dennis L. Bedrosian Telephone(978)688-9574 Superintendent Fax(978)688-9575 KOItT. O BUILDING FILE September 29, 2004 _ •7 ���A) Helen Uusitalo RC1 2 Bonny Lane North Andover, MA 01845 Dear Ms. Uusitalo: It has come to the attention of the North Andover Water Department that a Canine Care business has been initiated at your place of residence at 2 Bonny Lane. Even though we do not restrict family pets in the watershed area of the lake we certainly do restrict the activities in the watershed and in the lake. Based on the information that you are distributing flyers around town stating that you have "lake access for hiking and swimming for the dogs", and due to the fact that Lake Cochichewick is the "sole source of drinking water" for the Town of North Andover, I am informing you that you are in violation of the State of Massachusetts' Drinking Water Regulations, 310 CMR, 22.20B, Section (4) stating, "No stabling, hitching, standing, feeding or grazing of livestock or other domestic animals shall be located, constructed, or maintained within 100 feet of the bank of a surface water source or tributary thereto." . and Section (6), "No person shaU swim, wade, or bathe in any public surface water source, and no person shall, .... cause or allow an animal to go into, or upon, any surface water source or tributary thereto." Thus, we are informing you that any continued animal activity that violates these, or any other, drinking water regulations will be met with enforcement, fines and/or court action. Formally, , Linda Hmurciak Assistant Superintendent North Andover Drinking Water Treatment Plant cc: Heidi Griffin, Dir. Community Development Susan Sawyer, Dir., Health Dept. D. Robert Nicetta, Building Commissioner Michael Mc4uire, Building Inspector Joyce Bradshaw, Town Clerk Susan Northam,NAPD