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LLJ OO 00 c) CDcCa ULLJ J J CD LLJ ==C Z V' m zc) C U co r U ¢�v- E z O U w U Z O U m O LlO Z ai V) 0 Z U N � L C U p� N LU mcl D CD LU O w cn 2 C/) U Q U) Z O LU J W 0 W X W O N F- L� 193POHd I I WV31193POHd I I 1V3S I I S31ON I I SNOISIA3H I 131VO 3nSSI 1 1 31111 1 1 01133HS i ito rn N S \ V_ N 4) LOT AREA= 29,040 S.F. o EXISTING 6' VINYL c FENCE \� a� �.. 0 OL_ 0 L ` Q N Z 14" 4" EXISTING SLATE PATIO \ S7�*55'45"W 96.48' Approximate Sewer Service (SS) DEED REFERENCE: OWNER INFORMATION: BOOK: 13385 PAGE: 348 CARRIE BIANCHI ASSESSOR INFORMATION: TIMOTHY BUSICK MAP 97 PARCEL 13 100 SUTTON HILL RD NORTH ANDOVER, MA 3 BUFFER \ ROM NEARER TOWN WETLAGAS M Ap P [--,-..,EXISTING56.3' NORTH ANDOVER ZONING PERGOLA \ BOARD OF APPEALS 5 GG�GI illl/l llll/� DATE: ------- 4 `� N N O ,� li �CJ�°°�A oM NEARER SOW FR ND PE GIS MAP 24"� o -- 45.0'CIO / �� 0 — 38.1 0�o A /// ��'� �.o;• •poo l jll///` / oQ PO s, i zo 2� 0 - EXISTING 4' ALUM. 55.6' FENCE p s�1 32.5' ,p���� 2�c 30" N �h0 en N65 '00'00"E 99.38, UP# 35/9 46" 46" BIT BERM BIT BERM ZONING TABLE: S U T T O N H L L ZONING DISTRICT: R3 W/IN WATERSHED PROTECTION DISTRICT I CERTIFY THAT THIS PLAN PLAN PURPOSE: REQUIRED PROVIDED HAS BEEN PREPARED IN ACCORDANCE WITH THE RULES THE APPLICANT IS SEEKING MAX. HEIGHT 35 FEET < 35 FT AND REGULATIONS OF THE REGISTERS OF DEEDS. TO CONSTRUCT AN IN—LAW MIN. FRONT SETBACK 30 FT 32.5 FT ADDITION. MIN. SIDE SETBACK 20 FT 38.1 FT RESERVED FOR REGISTRY USE ONLY MIN. REAR SETBACK 30 FT 56.3 FT GRAPHIC SCALE SCALE.- 1 "=20' MIN. LOT FRONTAGE 125 FT 296.04 FT 20 0 10 20 MIN. LOT AREA 25,000 S.F. 29,040 S.F. PLOT PLAN OF LAND #100 SUTTON HILL RD. NO. ANDOVER, MA 01845 PREPARED BY: SULLIVAN ENGINEERING GROUP, LLC P.O. BOX 2004 WOBURN, MA 01888 (781) 854-8644 DA TE: 611116 SCALE: 1 "=20' Town of North Andover ZONING BOARD OF APPEALS Albert P. Manzi III, Esq. Chairman Ellen P. McIntyre, Vice -Chairman D. Paul Koch Jr. Esq. Clerk Douglas Ludgin Allan Cuscia Associate Members Deney Morganthal Nathan Weinreicb Alexandria a. Jacobs Esq. Any appeal shall be filed within (20) days after the date of filing of this notice in the office of the Town Clerk, Notice of Decision Year 2016 ; ;TT.,.. . 2016 JUL 12 AM 8.00 TOt', ev rS H4 AN!) !) This is to ;+ that twenty (20) days have elapsed Nom date of dedsim, filed tividuAtalinq,4an appeal. Date T .9a. o 2 0E& Joyce A, Bradshaw Town Clerk Property at: 100 Sutton Hill Road (Man 97- Pnreel 13) per Mass. Gen. L. ch. 40A, § 17 North Andover, MA 01845 r NAME: Carrie Bianchi & Tim Busick HEARING(S): June 28, 2016 ADDRESS: 100 Sutton Hill Road, PETITION: 2016-004 North Andover, Ma. 01845 Special Permit — Construct a Family Suite The North Andover Board of Appeals held a public hearing at The School Administration Building, at 566 Main Street, North Andover, MA on Tuesday, June 28, 2016 at 7:00 PM on the application of Carrie Bianchi & Tim Busick for property located at 100 Sutton Hill Road (Map 97, Parcel 13) North Andover, MA 01845. A Special Permit for the R-3 Zoning District is needed. The Petitioner is requesting a Special Permit to construct a Family Suite from 4.122.22 of the Zoning Bylaws in the R-3 Zoning District. Legal notices were sent to all the certified abutters provided by the Town of North Andover, Assessors Office, and were published in the Eagle -Tribune, a newspaper of general circulation in the Town of North Andover, June 14, 2016, and June 21, 2016. The following regular voting members were present: Albert P. Manzi III, Ellen P. McIntyre, D. Paul Koch Jr., Doug Ludgin and Allan Cuscia. The following Associate members present: Deney Morganthal, Alexandria Jacobs and Nathan Weinreich D. Paul Koch made a motion to GRANT the Special Permit from 4.121.17 of the Zoning Bylaw to allow for a Single Family Suite in the R-3 Zoning District at 100 Sutton Hill Road (Map 97, Parcel 13) North Andover, MA 01845. Douglas Ludgin second the motion to Grant the Special Permit. All those in favor to Grant the Special Permit: Al Manzi III, Ellen P. McIntyre, D. Paul Koch Jr, Doug Ludgin, and Allan Cuscia. All in Favor 5-0 The Board finds that this use, as developed by the building and site plans, will not adversely affect the neighborhood. There will be no nuisance or serious hazard to vehicles or pedestrians since there are provisions for the required off-street parking. Adequate and appropriate facilities are provided to the existing residential dwelling and will be provided for the proper operation of a -Family Suite. The Board finds that the Family Suite will not be substantially more detrimental than the existing single family dwelling to the neighborhood and that this use, to allow a Family Suite to the single family dwelling, is in harmony with the general purpose and intent of this Bylaw. 0vv- Page 1 of 2 Site: 100 Sutton Hill Road (Map 97, Parcel 13) North Andover, MA 01845 The Petitioner is requesting a Special Permit to construct a Family Suite from 4.122.22 of the Zoning Bylaws in the R-3 Zoning District. Special Permit: Section 4.121.17 of the Zoning Bylaw in order to grant a single Family Suite in the R-3 Zoning District. Plans(s) and titles 1) "Plot of the Land" containing one (1) sheet. Prepared by Sullivan Engineering Group, LLC , Dated June 1, 2016, P.O. Box 2004 Woburn, MA 01888 2) Demo First Floor (AD.1.1.0) containing one sheet, Demo Second Floor (AD. 1.2.0) containing one sheet, Demo Roof (AD. 1.3.0) containing one sheet, New First Floor Plan (Al. 1.0) containing one sheet, New Second Floor Plan (A1.2.0) containing one sheet, New Roof Plan (A1.3.0) Containing one sheet, Exterior Elevations, East Elevation, South Elevation (A2.1.0) containing one sheet, West Elevation, North Elevation (A2.2.0) Containing one sheet, Cover Sheet with Applicable Zoning Codes (A0.0.00) Containing one sheet, (dated May 27, 2013), Prepared by architect Michael Bianchi, 406 Redleaf Road, Wynnewood, PA. 19096. Voting in favor of the Albert Manzi III, Ellen P. McIntyre, D. Paul Koch Jr., Doug Ludgin and Allan Special Permit: Cuscia Voting in the Negative: 0 The Board finds that the applicant has satisfied the provisions of Section 4.121.17 of the Zoning Bylaw in order to allow for a Single Family Suite located at 100 Sutton Hill Road (Map 97, Parcel 13) North Andover, MA 01845 in the R-3 Zoning District. Notes: 1. This decision shall not be in effect until a copy of this decision is recorded at the Essex County Registry of Deeds, Northern District at the applicant's expense. 2. The granting of the Special Permit as requested by the applicant does not necessarily ensure the granting of a building permit as the applicant must abide by all applicable local, state, and federal building codes and regulations, prior to the issuance of a building permit as required by the Inspector of Buildings. 3. If the rights authorized by the Special Permit are not exercised within 2 years of the date of the grant, it shall lapse, and may be re- established only after notice, and a new hearing. WAR m9v W W-11, = Al Andover Zoninj Board of Appeals Bert P. Manzi III, Esq., Chairman Ellen P. McIntyre, Vice- Chairman D. Paul Koch Jr., Esq. Clerk Douglas Ludgin Allan Cuscia Deney Morganthal Nathan Weinreich Alexandria Jacobs, Esq. Decision 2016-004 Page 2 of 2 C ,a O p O�q �.9 ORATtD t'S.(% ss�c►+use 16000sgood Street Building 20, 2035 North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 COMPLAINT FOR INVESTIGATION DATE: �Q ` 2-0 L Tel #: FROM: ADDRESS: Complaint Against: ELECTRICAL: PLUMBING: GAS: BUILDING CONTRACTOR: PROPERTY OWNER: OTHER:�- r7� Signed:`' �J. 4yt. S - . TOWN OF NORTH ANDOVER i� Office of the Building Department — Community Development and Services — -- - — ---- -- — 1600_Osgoo�c tS reef -- -- - North Andover, Massachusetts 01845 Telephone (978) 688-9545 FAX (978) 688-9542 July 8, 2014 Lampros Realty Trust of C/O Carrie E, Bianchi 100 Sutton Hill Road North Andover Ma 01845 RE: 100 Sutton Hill Road. It has been brought to our attention that you have an in -ground swimming pool that does not have a proper barrier as required by The Massachusetts Building Code AG 105 Barrier Requirements. Enclosed is a copy of the code section you shall use as a reference to correct these code issues. Please feel free to contact the Building Department with any questions at 978-688-9545. OBrian Leathe Local Building Inspector. ar , — SWIMMING POOLS, SPAS AND HOT TUBS (The provisions contained in this appendix are not mandatory unless specifically referenced in the adopting ordinance.) SECTION AG101 GENERAL AG101.1 General. The provisions of this appendix shall con- trol the design and construction of swimming pools, spas and hot tubs installed in or on the lot of a one- or two-family dwell- ing. AG101.2 Pools in flood hazard areas. Pools that are located in flood hazard areas established by Table R301.2(1), includ- ing above -ground pools, on -ground pools and in -ground pools that involve placement of fill, shall comply with Sections AG101.2.1 or AG101.2.2. Exception: Pools located in riverine flood hazard areas which are outside of designated floodways. AG101.2.1 Pools located in designated floodways. Where pools are located in designated floodways, documentation shall be submitted to the building official, which demon- strates that the construction of the pool will not increase the design flood elevation at any point within the jurisdiction. AG101.2.2 Pools located where floodways have not been designated. Where pools are located where design flood elevations are specified but floodways have not been desig- nated, the applicant shall provide a floodway analysis that demonstrates that the proposed pool will not increase the . design flood elevation more than 1 foot (305 mm) at any point within the jurisdiction. SECTION AG102 DEFINITIONS AG102.1 General. For the purposes of these requirements, the terms used shall be defined as follows and as set forth in Chap- ter 2. ABOVE-GROUND/ON-GROUND POOL. See "Swim- ming pool." BARRIER. A fence, wall, building wall or combination thereof which completely surrounds the swimming pool and obstructs access to the swimming pool. HOT TUB. See "Swimming pool." IN -GROUND POOL. See "Swimming pool." RESIDENTIAL. That which is situated on the premises of a detached one- or two-family dwelling or a one -family town- house not more than three stories in height. SPA, NONPORTABLE. See "Swimming pool." SPA, PORTABLE. A nonpermanent structure intended for recreational bathing, in which all controls, water -heating and -- -----water=circulating equipment amanintegralpart-oftheproduct. - SWIMMING POOL. Any structure intended for swimming or recreational bathing that contains water over 24 inches (610 2009 INTERNATIONAL RESIDENTIAL CODE® mm) deep. This includes in -ground, above -ground and on -ground swimming pools, hot tubs and spas. SWIMMING POOL, INDOOR. A swimming pool which is totally contained within a structure and surrounded on all four sides by the walls of the enclosing structure. SWIMMING POOL, OUTDOOR. Any swimming pool which is not an indoor pool. SECTION AG103 SWIMMING POOLS AG103.1 In -ground pools. In -ground pools shall be designed and constructed in conformance with ANSI/NSPI-5 as listed in Section AG108. AG103.2 Above -ground and on -ground pools. Above- ground and on -ground pools shall be designed and constructed in conformance with ANSI/NSPI-4 as listed in Section AG108. AG103.3 Pools in flood hazard areas. In flood hazard areas established by Table R301.2(1), pools in coastal high hazard areas shall be designed and constructed in conformance with ASCE 24. SECTION AG104 SPAS AND HOT TUBS AG104.1 Permanently installed spas and hot tubs. Perma- nently installed spas and hot tubs shall be designed and con- structed in conformance with ANSI/NSPI-3 as listed in Section AG108. AG104.2 Portable spas and hot tubs. Portable spas and hot tubs shall be designed and constructed in conformance with ANSI/NSPI-6 as listed in Section AG108. (SECTION AG1051 BARRIER REQUIREMENTS AG105.1 Application. The provisions of this chapter shall control the design of barriers for residential swimming pools, spas and hot tubs. These design controls are intended to pro- vide protection against potential drownings and near - drownings by restricting access to swimming pools, spas and hot tubs. AG105.2 Outdoor swimming pool. An outdoor swimming pool, including an in -ground, above -ground or on -ground pool, hot tub or spa shall be surrounded by a barrier which shall comply with the following: _ 1,. The top of.the barrier-shall_be_at.least 48. inches mm) above grade measured on the side of the barrier which faces away from the swimming pool. The maxi- mum vertical clearance between grade and the bottom of 791 APPENDIX G the barrier shall be 2 inches (51- mm)-measured--on-the---- — --- - 8.2: The gate and barrier shall -have -no -opening -larger _ side of the barrier which faces away from the swimming than 1/2 inch (12.7 mm) within 18 inches (457 pool. Where the top of the pool structure is above grade, mm) of the release mechanism. such as an above -ground pool, the barrier may be at 9. Where a wall of a dwelling serves as part of the barrier, ground level, such as the pool structure, or mounted on one of the following conditions shall be met: top of the pool structure. Where the barrier is mounted on top of the pool structure, the maximum vertical clearance 9.1. The pool shall be equipped with a powered safety between the top of the pool structure and the bottom of cover in compliance with ASTM F 1346; or the barrier shall be 4 inches (102 mm). 9.2. Doors with direct access to the pool through that wall shall be equipped with an alarm which pro- duces an audible warning when the door and/or its screen, if present, are opened. The alarm shall be listed and labeled in accordance with UL 2017. The deactivation switch(es) shall be located at least 54 inches (1372 mm) above the threshold of the door; or 2. Openings in the barrier shall not allow passage of a 4 -inch -diameter (102 mm) sphere. 3. Solid barriers which do not have openings, such as a masonry or stone wall, shall not contain indentations or protrusions except for normal construction tolerances and tooled masonry joints. 4. Where the barrier is composed of horizontal and vertical members and the distance between the tops of the hori- zontal members is less than 45 inches (1143 mm), the horizontal members shall be located on the, swimming pool side of the fence. Spacing between vertical mem- bers shall not exceed 13/4 inches (44 mm) in width. Where there are decorative cutouts within vertical mem- bers, spacing within the cutouts shall not exceed 13/4 inches (44 mm) in width. 5. Where the barrier is composed of horizontal and vertical members and the distance between the tops of the hori- zontal members is 45 inches (1143 mm) or more, spacing between vertical members shall not exceed 4 inches (102 mm). Where there are decorative cutouts within vertical members, spacing within the cutouts shall not exceed 13/4 inches (44 mm) in width. 6. Maximum mesh size for chain link fences shall be a 21/4 -inch (57 mm) square unless the fence has slats fas- tened at the top or the bottom which reduce the openings to not more than 13/4 inches (44 mm). 7. Where the barrier is composed of diagonal members, such as a lattice fence, the maximum opening formed by the diagonal members shall not be more than 13/4 inches (44 mm). 8. Access gates shall comply with the requirements of Sec- tion AG105.2, Items 1 through 7, and shall be equipped to accommodate a locking device. Pedestrian access gates shall open outward away from the"pool and shall be self-closing and have a self -latching device. Gates other than pedestrian access gates shall have a self -latching device. Where the release mechanism of the self -latch- ing device is located less than 54 inches (1372 mm) from the bottom of the gate, the release mechanism and open- ings shall comply with the following: 8.1. The release mechanism shall be located on the pool side of the gate at least 3 inches (76 mm) below the top of the gate; and 792 9.3. Other means of protection, such as self-closing doors with self -latching devices, which are approved by the governing body, shall be accept- able as long as the degree of protection afforded is not less than the protection afforded by Item 9.1 or 9.2 described above. 10. Where an above -ground pool structure is used as a bar- rier or where the barrier is mounted on top of the pool structure, and the means of access is a ladder or steps: 10.1. The ladder or steps shall be capable of being secured, locked or removed to prevent access; 0 or 10.2. The ladder or steps shall be surrounded by a barrier which meets the requirements of Sec- tion AG105.2, Items 1 through 9. When the lad- der or steps are secured, locked or removed, any opening created shall not allow the passage of a 4 -inch -diameter (102 mm) sphere. AG105.3 Indoor swimming pool. Walls surrounding an indoor swimming pool shall comply with Section AG105.2, Item 9. AG105.4 Prohibited locations. Barriers shall be located to prohibit permanent structures, equipment or similar objects from being used to climb them. AG105.5 Barrier exceptions. Spas or hot tubs with a safety cover which complies with ASTM F 1346, as listed in Section AG107, shall be exempt from the provisions of this appendix. SECTION AG106 ENTRAPMENT PROTECTION FOR SWIMMING POOL AND SPA SUCTION OUTLETS AG106.1 General. Suction outlets shall be designed and I installed in accordance with ANSUAPSP-7. O 2009 INTERNATIONAL RESIDENTIAL CODE® 16000sgood Street Building 20, 2035 North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 COMPLAINT FOR INVESTIGATION DATE: ,J ,aQ� t�S, 2� l`i Tel #: FROM: 1l`3 ADDRESS: Complaint Against: ELECTRICAL: PLUMBING: GAS: BUILDING CONTRACTOR: PROPERTY OWNER: OTHER: Signed: �-� Q'$— Q -D . s TOWN OF NORTH ANDOVER " f Office of the Building Department Community Development and Services North Andover, Massachusetts 01845 XAV* `= Telephone (978) 688-9545 FAX (978) 688-9542 July 8, 2014 Lampros Realty Trust of C/O Carrie E, Bianchi 100 Sutton Hill Road North Andover Ma 01845 RE: 100 Sutton Hill Road. It has been brought to our attention that you have an in -ground swimming pool that does not have a proper barrier as required by The Massachusetts Building Code AG 105 Barrier Requirements. Enclosed is a copy of the code section you shall use as a reference to correct these code issues. Please feel free to contact the Building Department with any questions at 978-688-9545. Brian Leathe Local Building Inspector. ¢ro -- AP-P-E-N-DI=X G=---- - --- -_ -._-- SWIMMING POOLS, SPAS AND HOT TUBS (The provisions contained in this appendix are not mandatory unless specifically referenced in the adopting ordinance.) SECTION AG101 GENERAL AG101.1 General. The provisions of this appendix shall con- trol the design and construction of swimming pools, spas and hot tubs installed in or on the lot of a one- or two-family dwell- ing. AG101.2 Pools in flood hazard areas. Pools that are located in flood hazard areas established by Table R301.2(l), includ- ing above -ground pools, on -ground pools and in -ground pools that involve placement of fill, shall comply with Sections AG101.2.1 or AG101.2.2. Exception: Pools located in riverine flood hazard areas which are outside of designated floodways. AG101.2.1 Pools located in designated floodways. Where pools are located in designated floodways, documentation shall be submitted to the building official, which demon- strates that the construction of the pool will not increase the design flood elevation at any pointwithinthe jurisdiction. AG101.2.2 Pools located where floodways have not been designated. Where pools are located where design flood elevations are specified but floodways have not been desig- nated, the applicant shall provide a floodway analysis that demonstrates that the proposed pool will not increase the . design flood elevation more than 1 foot (305 mm) at any point within the jurisdiction. SECTION AG102 DEFINITIONS AG102.1 General. For the purposes of these requirements; the terms used shall be defined as follows and as set forth in Chap- ter 2. ABOVE-GROUND/ON-GROUND POOL. See "Swim- ming pool." BARRIER. A fence, wall, building wall or combination thereof which completely surrounds the swimming pool and obstructs access to the swimming pool. HOT TUB. See "Swimming pool." IN -GROUND POOL. See "Swimming pool." RESIDENTIAL. That which is situated on the premises of a detached one- or two-family dwelling or a one -family town- house not more than three stories in height. SPA, NONPORTABLE. See "Swimn-ling pool." mm) deep. This includes in -ground, above -ground and on -ground swimming pools, hot tubs and spas. SWIMMING POOL, INDOOR. A swimming pool which is totally contained within a structure and surrounded on all four sides by the walls of the enclosing structure. SWIMMING POOL, OUTDOOR. Any swimming pool which is not an indoor pool. SECTION AG103 SWIMMING POOLS AG103.1 In -ground pools. In -ground pools shall be designed and constructed in conformance with ANSI/NSPI-5 as listed in Section AG108. AG103.2 Above -ground and on -ground pools. Above- ground and on -ground pools shall be designed and constructed in conformance with ANSI/NSPI-4 as listed in Section AG108. AG103.3 Pools in flood hazard areas. In flood hazard areas established by Table R301.2(1), pools in coastal high hazard areas shall be designed and constructed in conformance with ASCE 24. SECTION AG104 SPAS AND HOT TUBS AG104.1 Permanently installed spas and hot tubs. Perma- nently installed spas and hot tubs shall be designed and con- structed in conformance with ANSI/NSPI-3 as listed in Section AG108. AG104.2 Portable spas and hot tubs. Portable spas and hot tubs shall be designed and constructed in conformance with ANSI/NSPI-6 as listed in Section AG108. [SECTION AG105J BARRIER REQUIREMENTS AG105.1 Application. The provisions of this chapter shall control the design of barriers for residential swimming pools, spas and hot tubs. These design controls are intended to pro- vide protection against potential drownings and near - drownings by restricting access to swimming pools, spas and hot tubs. AG105.2 Outdoor swimming pool. An outdoor swimming pool, including an in -ground, above -ground or on -ground pool, hot tub or spa shall be surrounded by a barrier which shall SPA, PORTABLE. A nonpermanent structure intended for comply with the following: recreational bathing, in which all controls, water -heating and 1. The top of.the barrier hall be at.least.48.inches_(1219--..-_—.__ ------watencirculating equipment are -an integral part of the product: - - - mm) above grade measured on the side of the barrier SWIMMING POOL. Any structure intended for swimming which faces away from the swimming pool. The maxi - or recreational bathing that contains water over 24 inches (610 mum vertical clearance between grade and the bottom of 2009 INTERNATIONAL RESIDENTIAL CODE° 791 This certifies that has permission to perform. d . lr� (2.. .... . plumbing in the build' gs of .. s�C)L- ................... . at .... . `'l.l!L )�`+�! 4�, North Andover Mass. Fee _ .... Lic. No. ` !�� ... . 0ty .................. ... PLUMBING INSPECTOR Check# �16q� P TYPE OR PRINT CLEARLY .-k MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY i2 _ _ UV-��1.. MA DATE-- 30 PERMIT # 1 JOBSITE ADDRESS Q 0 V o v1 �+ OWNER'S NAMEC OWNER ADDRESS TEL X1"1 I l -FAX OCCUPANCY TYPE COMMERCIAL 0I EDUCATIONAL El NEW: M RENOVATION: © REPLACEMENT:`® RESIDENTIAL D$ - PLANS SUBMITTED: YES 0 NO EO FIXTURES -1 • : 1 M. ����11�— 11�— F�— F�—f�T�IF�—fi�l��11�— 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 (INTEf KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER F -�__ _ INSURANCE COVERAGE: I havt;a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES P] NO (l1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY_ 'i OTHER TYPE OF INDEMNITY BOND .._I 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 _.i 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 and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in omplia a with UP 'Hent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER'S NAME t� I,{!1 s I LICENSE # U7 _ f �lvv) SIGNATURE MP ""� JP[I CORPORATION 0# _ ; PARTNERSHIP P# LLC [:!� E= I) COMPANY NAME{C Ove_ ! ADDRESS U ` v � )-SV CITY -- �'� 2° -- f STATE M --6L ._i ZIP TEL NI FAX 11CELL -) t43. EMAIL P H °z 0 H U a w o z El LU } p F � i� w O W a f z LLI 3 c a W N LU o w W U) p z a w I-- 0 J IL a a � LLi x w LJLH z � 0 H U a �7 a a °a ' The Commonwealth of Massachusetts Department of IndustrialAceWnts Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name (Business/Organization/Individual): i "i /T PU Y\. Address: A o, 6 C,Y �0;__-o City/State/Zip: S (M -E'f2Cs+n' Phoiie #: 1 �" '-7 �� 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 listed on the attached sheet. �• [J Remodeling 2.4 I am a sole proprietor or partner- ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. E]Building addition [No workers' comp. insurance 5. El we are a corporation and its 10. ❑Electrical repairs or additions required.] 3111 am a homeowner doing all work officers have exercised their 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 ] ired. re q u employees. [No workers' 13.[i Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they Aire doing all work and then hire outside contractors must submit anew 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' compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: Policy # or Self -ins. Lic. #:. 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 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. I do hereby cergy un dg the palm anoenalties of perjury that the information provided above is true and correct. Date: 7 3 U l Phone #: 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 N This certifies that ...4 ').. P. �(r,�n..�. has permission for gas installation .4f�k . ��+ ex, in the buildings of.... 2 M. CAL ............................ at ... CY C.", �-+j,�' A .J „ , , , , , .. , North Andover, Mass. Lic. No.�]... (.v.'� .................. .. . GASINSPECTOR Check # d 8675 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY C-/���r % ny r-/L, �( MA DATE _3� ` PERMIT # _ JOBSITE ADDRESS , _ ' , - o!�► " - OWNER'S NAME 6t ►2 kI GOWNER ADDRESS S t TE TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: 0 REPLACEMENT: ja PLANS SUBMITTED: YESE-11 NO R-- APPLIANCES APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER�- COOK STOVE DIRECT VENT HEATER.I DRYER 1 Tm-. _� FIREPLACE FRYOLATOR =:. I __j �— a 1 -� _4 FURNACE--� - -F GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN _ _ - l _ _ _ �._. . r�. l__� __ J _�_ I ...J tr POOL HEATER __ J ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER ,t _ . _ . . _t- INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ONO [� 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY- OTHER TYPE INDEMNITY I BOND—_I 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 E AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pert, ent rov,sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASATTER NAME �'v h v� cL 1ME LICENSE # SIGNATURE . - MP A MGF F-JI JP JGF LPG] CORPORATION # !I PARTNERSHIPEl#= LLC [—j# . COMPANY NAME: A- _ 0►'k11 ADDRESS D _ 0so CITY _ yl� _ STATE UZIP _JTEL 11663__ FAX �,:--� CELL I:V92 �7... MAIL ?�-.�'�--,:. . � --- — __---- r r r r_ o ❑ a z }Wo o ❑ w 0 °z U a a w ft f- < w 5 a O w uj > w a z a �y a U J H a M too:a S2 M: F-- iii w LL. W H z° z 0 H U W a C7 C7 °a J� The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): f /4 Pa Y\. Iry 0 00 Address: 0 0 V0 )_SCS City/State/Zip: Oil Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.4 I am a sole proprietor or partner- listed on the attached sheet. t ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. E] Remodeling 8. ❑ Demolition 9. ❑ Building addition 1011 Electrical repairs or additions ll.[] Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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 tire 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' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: 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. I do hereby certA& undg the paipq anrj,penalties of perjury that the information provided above is true and correct. Date: Z _ 3 U 117 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 9: 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 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 (ifnecessary) 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 Fay, # 617-727-7749 ww.znass,govfdJa. r" a t. r" t. `COMMONWEALTH OF MASSACHUSETTS + PLUMBSRS ANO GASFITTERS LICE SEI AS A BASTER PLUMBER E `{ "18SUES THE ABOVE LICENSE TO: i. JOHN R' SAL '.NES �. PO BOX 80250 02180- 000.3 STONEHAM FF }1 9074 05/01)'! 4 . 149409 l i' I/ i� �348 / Date. ..!..�.! �....... NORTH TOWN OF NORTH ANDOVER pyt i,,to ,e1tiOL �V 0; p PERMIT FOR GAS INSTALLATION \ ^a This certifies that ......... has permission for gas installation.'`. - :-�: `'%...P-. . in the buildings of ...Cr' r^ ,-''-? ......................... at ...... "f .:! % .... , North Andover, Mass. Fee . Lic. No �'W2.... XGAS'INSPE TOF WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS or print) tvvxl'11 ANDOVER, MASSACHUSETTS Date ,Z Building Locations 110 SU++ n intl� ]�QA• \ / Permit# 3 V Y I Amount S z;— Owner's Name 1--mr✓idcA_ Oro New ❑ Renovation ❑ Replacement Plans Submitted ❑ ('Print or type) Che one: Certificate Installing Company Name Andover Plbd. & Ht4. Co.. Inc. rz Corp. 9199 Address 20 Agean Dr. , Unit -10 ❑ Partner. Methuen. Ma. 01844 Business Telephone (978) 685-8383 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Ceorap LaROte INSURANCE COVERAGE Check one: . I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ 14 you have checked ves, please indicate the type coverage by checking the appropriate box. arability insurance policyOther type of indemnity ❑ Bond ❑ �?Wner'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. S12narure of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ i hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the N-lassachusetts State Gas Cand Chapter 142 -of the General Laws. By: Title C i tviTow n .4PPRO V ED (UF'i ici: USE ONLY) Pignature of Licensed Plumber Or Gas Fitter lumber 9983 ❑ Fitter 'cense i umoer (Vlasfer ❑ Journeyman - N C w W ~ Z ^ C n .n r k7 y F^Y r i \i :.t Z�z Z :'� ..c7 W— C CC cy*a SU SEM ENT BASE.M ENT IST. FLOG R 2ND. FLOUR 3RD. FLUOR 4T If FLOG R sTii. FLUOR 6T 11. FLOUR 7T 11 FLUOR ST If . FLOO R ('Print or type) Che one: Certificate Installing Company Name Andover Plbd. & Ht4. Co.. Inc. rz Corp. 9199 Address 20 Agean Dr. , Unit -10 ❑ Partner. Methuen. Ma. 01844 Business Telephone (978) 685-8383 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Ceorap LaROte INSURANCE COVERAGE Check one: . I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ 14 you have checked ves, please indicate the type coverage by checking the appropriate box. arability insurance policyOther type of indemnity ❑ Bond ❑ �?Wner'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. S12narure of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ i hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the N-lassachusetts State Gas Cand Chapter 142 -of the General Laws. By: Title C i tviTow n .4PPRO V ED (UF'i ici: USE ONLY) Pignature of Licensed Plumber Or Gas Fitter lumber 9983 ❑ Fitter 'cense i umoer (Vlasfer ❑ Journeyman