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HomeMy WebLinkAboutMiscellaneous - 104 MILK STREET 4/30/2018N O O D � o o o m o '' b 11036 /-t f This certifies that.�— A .... Vj . , .. \ . \ .. \ V.N-r�.As .............. . ...... .......... .. .. . .. ....... ........ has permission to perform ........ ....... . ......... ......................... plumbing in the buildings of ......... HSC.I.Piq:... . . ...................................... 0 at ........ ......................... North Andover, Mass. Fee.. ... Lic. No. ......... ......... & .................... PLUMBING INSPECTOR Check# 1 1A W1 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 3 �9 Date 3// ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......................................... ........................... ..... ... ... Adr Lj has permission to perform e�w .... -e ............................. US.Z�A?le .......................... wiring in the buildingr of ........ ............................................................ at ...... "1.11L............ 1�5 ... ............. . .......... orth Andover, Mass. .................. Fee .... ............ Lic. No��]Nl . .............................. .. .. . ................... ... ELE PiR�ICAL�IfNSPFCTOR Check # /� 1'5 Commonwealth of Massachusetts Official Use Only 1 Department of Fire Services Permit No. z--04 Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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 IN INK OR TYPE ALL INFORMATION) Date: 4bv/ IS . 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) 10 4 M H S4 r ee-A . Owner or Tenant enh: S Telephone No. Owner's Address rnzA /V.,AhJ0Vt1 rv1A Is this permit in conjunction with a building permit? Yes g No ❑ (Check Appropriate Bog) Purpose of Building bpal tck,J rte` ole- Utility Authorization No. Existing Service Z4V Amps Q/ 2 OVolts Overhead 'IV 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: t/ e klAevl e— Completion of'the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ - Elo. d. d. oEmergency ig g BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat um Totals: um er ..................................... ons o. o e - ontame Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection El other No. of Dryers Heating Appliances IW Security ystems: No. of Devices or Equivalent No. o atero. Imo' o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications ung: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Qj00 , ©U (When required by municipal policy.) Work to Start: y aKI/ I S 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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: OpLyi J Ro,- q roft,,t cZ Gln1l �' l LIC. NO.: 373�,•I E Licensee: pcv.() p±t.lc'JqyCC-Z. X SignatureV , LIC. NO.: (If applicable, enter "exempt" in he license number line.) Bus. Tel. No.,• (pQ - y 1(b 931 Address: Cj? l,1 cl NrF MCJt /�} �,�Sw >1i�1 Ole Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE ER: I am aware that the Licensee does not have the liability insurance coverage normally required by la . By s' a below, I hereby waive this requirement_ I am the (check one El owner El owner's agent. Owner/Agen Signature Telephone No. PERMIT FEE. $ COMMONWEXLTH OF MASS�bHr �SE?', � 0 0 o ••o o ,i W 'Of aSSUESJHE FOLLOW AS , Iii OURNEYMpN :ELECTRICIAN JDgt� 1" BAJGROW i C� : ` iI TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY A < �r1 �� MA DATE J3:::����<' PERMIT # JOBSITE ADDRESS % 4Z �/i s a'"; OWNER'S NAME OWNER ADDRESS /r ` t� /� 6 TEL FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION: ❑ REPLACEMENTS PIANS SUBMITTED: YES C1 NO FIXTURES Z 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'GASIOIUSAND SYSTEM , DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: 1 have a current liabilityinsurance" policy or its•substantial equivalent which meets the requirements of MGL Ch. 192. YES NO ❑ IF YOU CHECKED YES, PLEASE INDICATETH YPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information 1 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 appticalion will be in compli all Pe 'nest pro ` of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. LICENSE # SIGNATURE PLUMBER'S NAME ��%Z/ MP. JP ❑ CORPORATION El# PARTNERSHIP ❑ # LLC ❑ # 50 J COMPANY NAME�lr'0vv' / 4t ADDRESSr CITY r /JSTATE/-,PVZIP TEL FAX CELL EMAIL vy) yl Workers' C Name (BusinessIOrganization/Individual):. Address: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www. mass.gov/dia Insurance Affidavit: Bal�.Iders/Contractors/Electricians/Piumbe>rs city/state/zip: dthone #: �v� / Are ey an employer? Check the appr�riate b e ?Pype of project (required): a employer with G ' 4. I am ❑ a general contractor and I 6. ❑ New construction employees (full and/or part-time). * have hired the sub -contractors 2. Y -I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' compo insurance required.]. 3. ❑ I am a homeowner doing all work myself.. [No workers' compo insurance required.] or I have hired the contractor listed on the attached sheet listed on the attached sheet. These sub -contractors have employees and have workers' compo insurance. t ElWe are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' compo insurance required.l 7)*�=Wemodelmg 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs 13.❑Other * Any applicant that checks box #1 must also fill out the section below showing their workers' compensation.policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' compo policy number. 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: Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure covers as required under Section 25A of MGL e, 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 violas Be advised. that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifv cion. I do n -,-eby certifY under the pains and penalties of perjury that the information provided above is true and correct. Signat��re: Date: Phone: — �9 '5> ��- I? — t�- Division of Professional Licensure: License Search r - The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) 1 Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name: GLENN B. WILLIAMS WEST NEWBURY, MA NEW SEARCH **This Licensee has additional Licenses, click here to view them.** Licensing Board: PLUMBERS Et GASFITTERS License Type: MASTER PLUMBER License Number: 11144 Status: CURRENT Expiration Date: 5/1/2016 Issue Date: 10/11/1989 Exam Date: 9/9/1989 School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Friday, March 06, 2015 at 9:18:42 AM. ® 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Glossary of License Status Codes More... Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicenseQ.asp?board code=PL&typeclass=_M&lic... 3/6/2015 Date .4.o. 11.5 ............. ...... . ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thajA % 4 ) A e ,-,i I C Z— ............................... ............ has permission to perform bob �-C- ........... .. ............................................................................... f 0 � ( wiringin the buildin 0 ..................... .......... I . ......................................................... `-1 `fit at orth Andover, M S. .......................... Fee ........... .. ....... Lic. No . ................. .......... ...... ALECTRICAL IN . SPECT ......... Check # 13 1 A 9 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS O)�I LH Use Only Permit No. Occupancy and Fee Checked (Rev. 1/071 (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 IN INK OR TYPE ALL INFORMATION) Date: 3/ 9, S, City or Town of: NORTH ANDOVER To the Inspector of Wares: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 10 H rn' I h S4r eeA Owner or Tenant -> - NaynC4 P\, C I eqt 4 Telephone No. (o )7 - I R' 7SSS Owner's Address S4 Mc As A bovt Is this permit in conjunction with a building permit? Yes Z No ❑ (Check Appropriate Box) Purpose of Building +lrpot, I?2ilovc41or\ Utility uthorization No. Existing Service 10 Amps ��&olts Overhead 'Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: T)3 + 1 �,-ll 6r,4rppK )re-noV0,4,or, r�S•}�11 llew-���k-��vcs @.. 2k�s-���g IU��i•�ohs Comoletion ofthe followine table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n-❑ d. gmd. o. o Emergency Lightmg Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 14 No. of Gas Burners No. of Detection an dTotal Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat ump ._. nm_. er ons _........._....----• -.---......._..--•.-.- o. oSelf-Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating AppliancesKW ecurity ystems: No. of Devices or Equivalent No. of Water KW o. o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommumcations irmg: No. of Devices or E uivalent OTHER: S Z, W Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: S O O (When required by municipal policy.) Work to Start: '3/91 S 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 cov rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Da v, ro w1 c Z LIC. NO.: % 1- Licensee:y; �� fty 1� Z Signature �� LIC. 3 � (If applicable, enter `exempt" inn tf:e license number line Bus. Tel. Nc� 4 d Address: (D---7 k.1 et J W ev 12.E , A-V Vt h kK fU 4 03811 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 Signature Telephone No. PERMIT FEE. $ 4 �� v / \/ ^l 4^x_1\. I • � S l 1 C\ The Commonwealth of Massachusetts Department of Industrial Accidents tvl 1 Congress Street, Suite 100 Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual).' 4 Address: (, `7 LJ c j W e,- Q J City/State/Zip: j . k nSt�\ N'' 0'521( Phone #: Co 17 ' 3 b ^ 3 T1 Are you an employer? Check the appropriate box: 1.0 I am a employer with employees (full and/or part-time).* 2V I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4, D I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. (] Remodeling 9. ❑ Demolition 10 [] Building addition I Q4 Electrical repairs or additions 12. E] Plumbing repairs or additions 13. E] Roof repairs 14. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infonnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer tl:at is providi::g ivorkers' compep:salon insurance for n:y employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. Expiration Date: Job Site Address: 164 (1'i 14 SA City/State/Zip: N Ahr&yc' . Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. I do and penalties of perjury that the information provided abov]Q!is trio and correct 3 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 Date ..4'-3A— .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 4,07— k Z, ................................................. y ................................................ has permission to perform .......................... / . ........ 7 wiring in the building of .... . .................................. 4ca_ at........ ......................................................................................... . No Andover, Mass. Fee...'6� . . . .......... Lic. No.01-13--.11-74 . ............. .. .......... . .... .... .. . ........ ....... r1l ..... ...... .... ................. ...... .......... J� .r ELEC [CAL INSPECTOR Checkio?��7 i it 1311P s"l i o����`'--"�/77i�a:�dac�ic%�etid J a.JefrarEmenf o1 ire Serviced BOARD OF FIRE PREVENTION REGULATIONS F[Rev, UO No.anc}, and Fee Checked 7] (leave blank) APPLICATION FOR PERMIT TO PERF=ORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (lv1EC), 527 CMR 12.00 (PLE,4SE PRINT IN -WE OR TYPE ALL LVFORMATIO.A9 'Date: City or Town of: N� � a To the Inspector of Fflires; By this application the undersigned give notice of his or her intention to perform the electrical Work described below. Location (Street & Number) c Owner or Tenant ,� _., ` C u—'. - ( \ y Ids- r1\ Owner's Address Telephone No 1 Is this permit in conjunction with a building permit? Yes❑ No ® (Check Appropriate"' Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overlie -ad ❑ Und rd g ❑ No, of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �S 1 Completion of the Poll T !able ma , be waived by the Inspector• of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No, of Total Transformers gVA • No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool above ❑In- o. o emergency ighang ❑ Und grnd, Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons INo. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons ]CANo. of Self -Contained Totals: _.__.....___.._ __._._....._....___...___. Detection/Alertin ry Devices No. of Dishwashers Space/Area HeatingICV4' Local Municipal ❑ Oihrr Connection No. of Dryers Heating Appliances KW Security Systems:' No. of Water No. of No. of) evices or E uivalent � \ 1� No. Heaters ICW of Data Wiring: Signs Ballasts No. of Devices or Eauivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or' Equivalent OTHER: 1111ach additional detail if desired, or as required by the Inspector of llrires. Estimated Value of Electrical Work: rJS� (When required by municipal policy,) Work to Start: G 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 ' ssu unless the Iicensee provides proof of liability insurance including "completed operation" coverage or its substantial equivale to The ? undersigned dertifres that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECI( ONE: INSURANCE ❑ BOND ❑ OTHER (specify:) S tN I certify, --under thepains andpen alties ofperjury, that the information on this application is true and. complete. FIRMNAME: ADT LLC DBA ADT Security LIC. NO.: C-172 Licensee: Thomas j. Lee Sign�uUe / �. �� / �'— LIC. NO.: 0-172 (If applicable, enter "exempt" 'n the license num er lilac.) "' 'C "-' c" Bus. Tel. No. Address: \ � �� o c��CI(t �� �a `��$.�r� O. "'Per M.G.L. c. 147, S. 57-61, security woric requires bq&*%ent ofpublic Safety "S" License: Alt cl No. SS 00 1779 -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/Agent ) ❑ ❑ owner's agent, Signature Telephone No, PERMIT FEE: �� s ' t - _�^"""17'vP'rTsT .r.R -�_� ___. _w�->vr-'r {.-; ■ :st�sF�?�/iiVl�Ue��I�Cr®�,�41i�a�l _at r�3 , € i (gyps° .. ..\• ..f. }..:�:k:Y•'� 's .•,' 1:51 1 S *Sft* G.ONTRAC T;[} _ �• i • 3'" ��^? ...".�� •::2.prgU= 3'x:1' .rx zo 6.1 � � •'•�,�-..ta��l'y? - •ta`,Jrs�.!\�J �_. _ u • o 'VI? ifi' l4;!i."4 • • ! ." .• _ _ ... -. . • ' ' .. ,. c•" .. 4 Gommonv'iealth of Massachusetts Department of Public Safety Serurit}• S�vstetns- S- r.irente License: SS-001779 ``tea• , , Thomas J Lee = �• ` _ 41.OUniversityAverT,�� Westwood MA. :0205 '1� 1 < � -Or— Expiration: t Commissioner 0511612016 °s • 1 The Commonwealth of Massachusetts Department of Industrial Accidents w Office oflnvestigations 600 Washington Street Boston,, MA 02111 �M SY9v`6 www.rnassgo Y/dia Wormers' Compensation insurance Affidavit. builder s/cContractors/,+ sect ricians/Planmb errs Augicant Information Mease l�uin'� ILe i ll Name (Business/Organization/Ind-iyidugll�_ i Address: City/State/Zip: -K0 N'S, i,,� k 'hone#: Are you an employer? Check the appropriate box: 1. ^� I am a employer with \C34o s' 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. 2. ❑ I am a sole proprietor or partner- These sub -contractors have ship and have no employees 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. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.®_Other �An}-applicant that checks box #1 must also fill out the section below showing their workers' compensation policy mtormauon. f Homeo«mers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I arca all employer that as providing workers' corllpensation insurance for rry enTloyees. Below is the policy and job sate information. i p � C3�af,,,.t .a �-E �..F "�ia�pv�F. +.e7 :!'� "fie i}"'r'�w _t`x b�F"�s^,..» � "c3 r�t'NCE� y t•i Insurance Company Name: Policy # or Self -ins. Lic. #: ° " �° - �I3 MUG k_ ` S � i � � 1-5 0 � � \ � City/State/Zip: \�� �� Job Site Address: . Attach a copy of the worriers' 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 alid/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 DTA for insurance coverage verif­ation. I do hereby certify -under the �q Phone # theft the information provided above is trice and correct. 2\V3 I \5 Official use only. Do not sprite 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 #: A� �® CERTIFICATE OF LIABILITY INSURANCE DATEIYYYY) 10/08/2014 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh USA Inc. 1560 Sawgrass Corporate Pkwy, Suite 300 Sunrise, FL 33323 Attn: FtLauderdale.Certs@marsh.com CONTACT NAME: A/CONNo Ext): A/C No): ADDRESS: GENERAL LIABILITY INSURERS AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Company 16535 048953-ADT-GAW-14-15 INSURED ADT LLC INSURER 6: American Zurich Insurance Company 40142 INSURER C: 18 Clinton Drive Hollis, NH 03049 INSURER D: INSURER E: INSURER F DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence S COVERAGES CERTIFICATE NUMBER: ATL -003303542-01 REVISION NUMBER -2 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY GLO 5095899 02 10/01/2014 10/01/2015 EACH OCCURRENCE s 2,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence S MED EXP (Any one person) S 10,000 PERSONAL &ADV INJURY $ 2,000,000 GENERAL AGGREGATE S 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY n PROiEc- LOC PRODUCTS - COMP/OP AGG S 4,000,000 S B AUTOMOBILE LIABILITY BAP 5095900 02 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT 1,000,000 Ea accident) S BODILY INJURY (Per person) S X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) ( ) S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAR CLAIMS -MADE DED I I RETENTIONS S B WORKERS COMPENSATION WC 5095897 02 (AOS) 10/01/2014 10/01/2015 X WC STATU-OTH- A AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICERIMEMBER EXCLUDED' N] (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below _ N / A WC 509589802 (MA,W) 10/01/2014 10/01/2015 TORY LIMITS ER E. L. EACH ACCIDENT S 2'000`000 E.L. DISEASE - EA EMPLOYEE S 2,000,000 -- E.L. DISEASE - POLICY LIMIT $ 2,000,000 r DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Town of North Andover is included as additional insured (except workers' compensation) where required by written contract. N L,r—K I It-lk A I L r1ULUtK GANGLLLA I IUN Town of North Andover ATTN: Electrical Inspector 124 Main St. North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee-•_N4,,t1e..1� @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Claim # AD1585 Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139; Sec. 3B To: Building Commissioner Board of Health or Inspector of Buildings Board of Selectmen Town Hall Town Hall North Andover, MA 01845 North Andover, MA Re: Insured: Dennis J. McCleary Property address: 104 Milk St. North Andover, MA 01845 Policy #: 2532473 Loss of: 2014/12/11 File or Claim No. AD 1585 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. _Gen._Laws,_Chapter_143,_Section_6 to be applicable. If any notice under Mass_Gen_Laws,_Ch._139_Sec._3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by first class mail. 12-17-14 ignature and date P 0 q> "n p > w A > M M n 1 N 0 ♦ C c o n i ^oo O n p Z r r M I i ■ > .a 0 0 O z r ej n n h ws(� o z : 0 ", � J C -+ I` z • z z p I 0 w u > 0 0 .. 7 z Z z , 0 w �0 0 G > 0 w A • o n j Z C ., • -1 o , r Z v a 0 n z 0 c C a r I s • 0 I� w 'I L 1_ � I I I I I � I� �• w y A A 0 3 W R R r H z n n 0 y q O n o z141, < p al C4 a • z ,N C1° 8 0 • ; °° ° c 0 r • • • ^ a Iz r i r C C C> 4 X i n 0• x r r r 0 n z n n 7 0 IR C o 0 0 w w w w > F o a o 4 s i 0 t o r O n i i z_ > n^ o f r w>^ r0 Z ■ 00 4 n n o > 0 z r^ 4 �+ O j Z c Z r 0 z c w s 0 z 0 Iw 0 w z ■ 0 Z I 0 , • > Z o� ^= RZ = w w 7 4 X ' x c = z s w > j M .w M 0172 o� O C � 0 d s d p �. m CO) �• p .00 HA . C2aA T •�' a► _ '•* d o T W C roomy ,0 y m: CD m o m =cl,a0 m = o A 0,o=Y n� o z :s 002 0 o H• A CD CD C2 Z v, r.., H -• CSD O 'C. 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C �o m0H' 10 C. ? ca dam , Q ? 0 0 a '� a C p oti m �. e_a ! ^ ••� X m : y a� �• l/J y v� o Q m m 0 m W C41: ='o 1 to \ CD o CD O O p Aca w :fin CD CO) 1 appy ,_.� Z m o, CD o m 'pZ o4 �.� CD o, d; CD Ab CD CL's CCD ro , tai ; c o m z 0 omi 0 g. 0 c Z d tri as 7- p a w :j GC y g 7d O 9r a O O z 0 omi 0 g. 0 c CE96199 D IINNYIJ 0106889 Hd.'IV3H 0£56-889 NOLLVA113SNOD 0196'889 Ofd(rMS 1*56'889 Slt iddd0CMVOE e �olaadsuI &uiplmg aql jo ao!pp ayl gSnonll loa[oid still ioj pautulgo aq asnw Janopud glJoN,lo Umo j aql woij miad uoililowaa :3' ION alu4 1 I- iuuoilddV l[wJad 3o amluAS (4111 oud.lo uofluooq) :111_10 pasodsip aq II!M siagap atl,L 'SOS l S 'I I I o -IDIN Aq pauilap su Xlilioej lusodsip alsum phos pasuaoil Apodoid P ui jo pasodsip aq Ilutls liom siva wo.ij sulilnsai sugap ayl luyl sl aagwnN liwJad Suippngjo uoil[puoo u `bS S Oh o 'IJIN,Io suoisiAo.id ;)yl thin aouup.i000u uI " &Snm s ,ss 12OOS f moa . a Y�Ivrm �`� Sb8l0 sumgoesseN `ianoPud gVON y • � A WAS UMN 9bi APPOWo SH3IAH3S aNv iLNa aori A3G A.LINfl%1 NOD ���oNX0 aanopuV gl.joN jo uboZ Location t No. -� i Date %/A A/ f NORTH TOWN OF NORTH ANDOVER Of"•O •.�h0 Q OL C� p Certificate of Occupancy $ Building/Frame Permit Fee $` cMu '•�s',•°''<� Foundation Permit Fee $ s�sE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector J Div. Public Works The Commonwealth of Massachusetts Department of hiblic Sofcty - r... It s.. 's.roa.c•.i $LATI DARD OF.FiRE QREVENn6N REGUONS Sn CMR'11W 3/91)o:..r...r a APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All vori to `t performed In •ecord.nce Mth the ♦tav-achusttu EJecrrlul Gods. SZ) CHR 12.00 (PLFASI: YRltti I22 120; OR ?YPE WL INFORMATION) Date City or Torn of i}:",/c, To the Inspector of Wires: The unt•rslZned applies for a permit to perforce the electrical work described below. Location ('trect 6 Ntraber) 0.rer or Tenant_ a+ncr's Addres 2s this permit in conjunction with a building permit:� Yes �--' "° l� i/ 2 e- � (Check Appropriate Box) Purpose of Building_ • �.,�� �. //rte.. Utility Authorization NO. ixisting Ser. ice Raps / Volts Overhead ❑ undgrd❑ No. of :<t.ts__ LV Service Amps / Volts Overbead ❑ Und d gr ❑ No. of2ieters Number of Feeders and llapacity Location and Nature of proposed Electrical Work li✓ Z. No, of Lighting Outlets No. of hot Tubs 'w. of Lighting Fixtures y Svi=ing pool Above ❑ l Send. No. of Receptacle Outlets L/ No. of Oil Burners No. of Switch Outlets No. of Fangos tic of Disposain :fo. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro liassage *Tubs R: Z, No. of Cas Burners No. of Air Cond. Total tons No. of al eat Total Iot s Int Space/Arca heating 13t Heating Devices p.+ No, of o. o SS s Ballasts No. of Motors Total HP No, of Transformers ❑ Generators VVA "A Battery Units FIRE ALMS No. of Zones No, of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ t#:nlcipal DpLbcr Connection Low.Voltage IKSURAI.CE MTRAct: Pursuant to the requirements of tiassacbuaetts Gcntral Laws 2 have a current L_ billt _Insurance Policy including Cocpleted Operations Coverage or its substantial equivalent. YES �I have submitted valid proof of aaae to this office. YES Q..SIB 0 Ii you have checked YES; please indicate the type of eoverap by checking the appropriate box. INSURANCE (please Specify)�� _— Estiruttd Value of Electrical Work S(Expiration ate Work to Start,//- 2j — InRequested: tough sptction Date Rd . i1� fJEinal Signed under the penalties of perjury: rim KA�z IC.. 31-32, Licensee 4 s f . G fgnatur L'' C. /.ddrtss s Sir ro o`t Bus. Tel. No.er 8'7 CWhlZ'S INSURANCE WAIVER: I an aware that the Licensee does rot have the�i eural. ntce coverage or is su_- stantial equivalent a! required by liassschusetts Cenral vs�ve t e aignaturt on this or Its it application waives this requirement. Owner Agent (Please check one) Telephone No, PLRHIT !TY'v� Sl nature of Amer or Agent da � ° S D 4 Date............/...7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING _ Q This certifies that ........ ................ C' E c c ........� ...� �.. ............................ .. has permission to perform ..... ......r...::.1....... .c ::.::. 4.. j ................... u wiring in the building of 11.1. G " at ... /.(.)..X ....kA!.... .................................. . North Andover, Mass. Fee ... S.: � v..... Lic. No � 1 / ............... .......... ........................... ELECTRICAL I splac lk �t [4 �, - M WHITE: Applicant CANARY: Building Dept. PINK: Treasurer � � rt d ; A z. Q > ; n o•> r r c (D rim R s s rN Ar O c Sty Q O � po Z -�nZZ Z G1 i n n • � ZI w r O o a 0 0 w _ n e n n ^ I 1 A i n n N.� 0 z M r p n A 3 Z I z 2 t tl z D > G M Z A n � rt p rt (p Q H n n n o•> r r H (D rim R Oj Q 3 rN Ar O w Sty Q r � z Z -�nZZ Z G1 o0 n n ZI 0 w > r O o a 0 0 o 0 w r -4 n e ,. T x 0 M v a < i > n p n ^ s N r O w w x x r rr. w 0 o -cfR 4 - w n � _4 '1 0 0 M w w N z in M C n -4 0 z N I w 0 I� z 0 0 z f�fl r�! I E F a:;> ac Q 8 o� w>w>„> c o•> r 0 0 rim R 0n-i 3 Ar O w rr r o z Z -�nZZ Z 1A n n ZI 0 w > r O o a 0 0 o 0 w r -4 n e n n n n 0 A i n n N.� 0 z M r p n A 3 A 3 z 2 t tl z 0 s > G M Z A / r 0 w X > a = n w n > -4 w 2no >i 0 0 z f_ M -f r .40 z = .. ^ " co C 4(0 --^ C C x 0 33 a c Z 00 0 n `v Cl C 0 O® w n 0 N_ ^ ; 0 n �. r0i Z c .. c c I" w z n a O M•• 1 Z^ > n Z 0 1 C s p 0 0 0 0> 0 _ i , M Z „ 0 w z o w M z o z n z o Z O r w g 0 w w p z w "Z4 r0 8 o -04M w w n 0 0 Z 0 z 0 Z„ Z z Z o C o r n A .' a 0 N C F X O 0 Z n z n Z III? 0 o a > 4 i 0 G 0 O O 4 O A o Z A w w Z 4 O -1 0 4 0 d 0 -1 0 e r G ;I Nj Pi vAi c Z Z i�l _ v > r 0 w E 4 z o � _w N > ^ n n _ r z n x i� z fn n iN I _n M ( 0 Ow $A o N S o - f�fl r�! I so Z 8 r rn 1A 1A so I ; Lo --r- l=o'R. McRTGAG4E PUP-PcSES—p5A11WV, OSE ON4.�< (bAsep Upon PubUC RECORDs ARD EVf DejICE! 09 -r4F-GP00WQ> AV D P.e S'S L- V -- MORTGAGOR, 11 OTC) Ld fyj F4 5 L A,:5 Z FS D) I J -- Y \ .. -. -5T Ac�co,,, Syv-E E-1 COE j i • ; ; .. , . ' . .'A'C'E : bS �31,(8� OWNER (3) (�-,ro P, D6 M CERTIFICATE REGISTRY: E4 5sv- N02_i44 I CERTIFY that the Lot shown hereon DEEM: Bj{.. I l 7Co P. 2-4g that the --Dvf at 4-1 ocr ahown PLAN PR I 8t?. Zoningb-Y-- LAVJ _present CERT. OF TITLE: NOTE: LOT Nay kcEot,-''p&-�d of the of Amu�oC)Fkz P-Ecof?-p 'K.)KN The prevuse3 do Ecu not lie within a designated Jj,�S, I I Flood Hazard '" ALE 4Pf" 'Lone ROBERT G. GOODWIN* R.L.S. , . . Z., I -�- COC", 82 ciN!Rn',L &SUREET 1.1 "71' ANDOVER,, HASS. .2 Nicholas T. Mitranof Account Representatite Fred C. Church, Inc. One Merrimack Naza, P.O. Bax 1865, Lowell, MA 01853-1865 Telephone (978) 458-1865 INSURANCE SINCE 1865 Fax (978) 454-1865 Fry— name: y. name• PQV T. CM CL ocation: 3 9 ( M*WI-tKo�4 P–b cit�(�f_ t/i1 G °tE phone # 4,� I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. oanvname. I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. Signature (� Date �i 7 Print name. t rj "i. ". "T 1 3; ....._ .._ _....._._.. Phone official use only "do not write in this area to be completed by city or town official city or town: permit/license # oBuilding Department CjLicensingBoard -� 0 check if immediate response is required ❑Selectmen's Office 0Health Department contact person: phone #; 00ther (revised 3/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any o contract ire, 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 section 25 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, neither the commonwealth nor any of its political subdivisions shall enter into any contract forthe performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. 7371 EN FOR Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address, and phone numbers as- all affidavits 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.. q 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. a� s .afvstf City �or 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 permiUlicense number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's -aid- dress, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 9 Y O i a r17e-Vomarizanurea� o�✓��voaT�u.:ell�a . DEPARTMENT OF PUBLIC F. SAFETY CONSTRUCTION SUPERVISOR LICF,MSE Nusber: Expires: Birthdate:' CS 065046 06/25/1998 06/25/1968 Restricted To: 00 •�x r, PAUL T GOAD - 381 MAMMOTH RD PELRAM, -NH iOiole J t HOME IMPROVEMENT CONTRACTOR t Registration 123826 t Type - INDIVIDUAL _o Expiration . 0414/99 1 Paul T. Goad 381 Mammoth Rd Apt 2A 14, Ge'lham NH 03076 1(� Q ADMINISTRATOR O .� MORTGA&Mt LDCA TrM CITY. STAT' DA TE MORTGAGE INSPECTION PLOT PLAN NORTHERN ASSOCIATES, INC. 630 TURNPIKE STREET NOR'.i-1 ANDOVER MA (508)975-7117 DENNrS J. C /NANCY 0- 104 MILK S1 NORTH ANOOt 11 /5/9i MCCL FARY [EEO REF_ 2468 / 467 CERTIFIED TGt MAIN STREET MORTGAGE NOTE: This mortgage inspection was prepared specifically for mortgage purposes and is not to be relied upon as a survey. Northem Associates, Inc. accepts no responsibility for damages resulting from said reliance by anyone other than the said mortgagee and its assigns in connection with its proposed mortgage financing to said mortgagor. it mis mortgage inspection was prepared in actordari:g with the Technical Standards for Mortgage 1,15an li(J. ATOLI No. 30780 I FURTHER STATE THAT IN MY PROFESSIONAL OPINION the principle structire/s and accessory outbuildings, CONFORM with the setback requirements of the local zoning ordinances, and that there are no ncruachments of major improvements either way acros roperty lines except as shown. PANEL E- ALSODATE-.- * 1. Property is not in a Flood Hazard Area. 0 2. Property is in a Flood Hazard Area. 0 3. Information is insufficient to determine Fk;od Hazard. I rloo, 'c mor h�;Z&c '?'ro e a28 Ns• � / F r�or,0�)er b ar to ���A�*�*?* �** *►. * l*a*d*s�* * *ArAep�j 'l•fr?eh �sai 2 . Us�p�rc02s ojoplj.s ect o'o � EFor�ee�oe.sr0 - geAar �M S r°N• 1 °dry a'�r re11e,�a Esse (� t f111 aAA1 jc�,e � Via` lI street 1°� ss°r,s s 014t ale j aAA �9 ee8e **** Na A ( thl s Deal Zc� o it 4c, 04 04, IP, ***** e�a-tl� of o �� arcel � � 00> CIO 1 1to b ppro ** eecte� 9d Od i- \ Oea to �e Aro \ Jecte� Oa \ to Od to Re Arov ecl Dc, A ,ected to R ppro e,ec eo Town Of North Andover Building Department 146 Main St. Town Hall Annex 508-688-9545 APPLICANT: TSL `r'• QrvAb Project: . t'Qc s1" DATE: % . :17� /517 RE: 3 L %L' INA- I�t72u. t' f��G o�y I X oZ dF 6-10r72AFkC Title of Plans and Documents: Pb . fO, d 1' 2X o*u s C-. V r Yb R L4- #-X CPO �'i 3saC Please be advised that after review of your Building Permit Application and Plans that your Application is DENIED for the following reasons: Zoninq Use not allowed In District Not in conformance with Phased Development . Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation of Building Coverage ' Insufficient Open Space Use requires permits prior to Building Permit Si n're uires permits prior to Buildin Permit Form U not complete b other department Not in conformance with Growth B -Law Other Remedy for the above is checked below. Dimensional Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Other Other Plan Review The plans and documentation submitted have the following inadequacies: 1. Information Is not provided, 2. Requires additional infomnation, 3. Information requires more ciarification_ 4_ Infomnation is incorrect 5_ All of the above # # Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure 3 Construction Plans 127 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details Z Framing Plan ! Fire Sprinkler and Alarm Plan Roofing Footing Plan 1 Plans to scale Utilities Site Plan Water Supply Sewage Disposal Waste Dis osalOther 'lam A Ns Do ru j &;rr—I r ADA and or ABBA requirement—s:: Plelo Q,t' Ir -^11 Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information reauires more clarification. 4. Information is incorrect. 5. All of the above # # Water Fee V j I 1 State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form t Other 't)dl%b AeFj4 ,a j -j Etui iT Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative' shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building. permit application form and begin the permitting process. Building Department Official Signature 9--14 Denial Sent Referral recommended: 9 - 0?3-,`7 Application Received If Faxed : Application Denied Fire Health Police Zoning Board Conservation Department of Public Works Planning Historical Commission Other cc: William Scoff R Plan Review Narrative The following narrative is provided to further explain the reasons for denial for the building permit for the property indicated on the reverse side: Ox„ C �.�Y�3 fi I 13� a: � �, 9 k] y �T^ i t If� �I��F !��•'_thk �Ih� 4 li k �y_{J! `f' I i .1 1 i .i Town Of North Andover Project: Building Department 1 NORTH 146 Main St. Town Hall Annex 0�o`tD A DENNIS MCCLEARY 508-688-9545 t 104 MILK ST • a �.. NO. ANDOVER MA 01845 APPLICANT: PAUL T. GOAD "ssqjjjjSEt' RE: BUILDING PERMIT FOR 28' X 24' GARAGE DATE: SEPTEMBER 27,1997 Title of Plans and Documents: BUILDING PERMIT APPLICATION 8r PLANS BY G. J. BRUNO ASSOC. Please be advised that after review of your Building Permit Application and Plans that your Application is DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Si n exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation of Building Coverage Insufficient Open Space se requires permits Prior to Building Perm FitSin requires to Building Permit complete departments in conformance with Growth By -Law fRther!���� Remedy for the above is checked below Dimensional Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Other Other Plan Review The plans and documentation submitted have the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification 4 Infnrm=tinn is in—r—f G eu ,.s IL Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information reouires more claririratinn 4 Infnrmnfinn.ic inrnr # c All -----------. .. .. .... _....,....... ..... ....... wl. nn Ul lnc UUVvQ. M Foundation Plan Sewer Fee X 1 Plumbing Plans Subsurface investigation X 3 Construction Plans Homeowners Improvement Registration Certified Plot Plan with proposed structure 116 Affidavit Mechanical Plans and or details Electrical Plans and or details X Plans Stamped by proper discipline 2 Framing Plan Fire Sprinkler and Alarm Plan Roofing Footinq Plan X 1 Plans to scale Utilities X 1 Site Plan Water Supply Sewage Disposal Waste Disposal I X 4 Other PLANS DO NOT MATCH APPLICATION ADA and or ABBA requirements Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information reouires more claririratinn 4 Infnrmnfinn.ic inrnr # c All -----------. .. .. .... _....,....... ..... ....... wl. nn Ul lnc UUVvQ. Water Fee X%01 State Builders License Sewer Fee X 1 Workman's Compensation Bpilding Permit Fee Homeowners Improvement Registration ilding Permit Application Homeowners Exemption Form X 1Other DEMO APPLICATION & PERMIT Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. Building Department Official Signature _9/29/97 If Faxed Denial Sent Referral recommended: _9/23/97 9/27/97 Application Received Application Denied Fire Health Police Zoning Board OVER Conservation - Department of Public Works Planning Historical Commission Other X BUILDING DEPT w. vvnndnr Jcv[t C COO 00 CD CM)Z � O d O.= o p a� Q CCD O CD CL O to CD F CA CSD 0 Cos CD CD a, y CD 0 ii 0 CD cc c=gip = S O = o Q H d o < �p m ,p y mj p m O 0 ycl d . 0 T Z O o•s N -4 m =r 0t CO) CD �OaH p p .0 -1 O p• m m > > m co, �)0 o z o m o �. � 3 1oa p eA mo c a y A r e1 oCL m: s `r'^' t0 O 'V'^/ m m eA VJ efl o m ^ ( ) m m OO y d eT ez cn m H n cn • N N p co o op: z=r o m CDm , C/) =W � HCD pCD:: d • d 0: CL= o=' i pea cn c(f)- o In w T C� 'T1 w �0°-r 'JC1 G tom n ro 70 Irl w �7 C °a- "t7 r y ?J m � fD 9 �' G n � r O b C 0 °�" n r) br- O M M No omi 0 0 c I i !t. ;L Ilii�ll!� p p Z 0 c n j 2 N • F w: H O O o �I ■ • ■ S v 0 (7 C1 (p n n n 0 , c a c>>>> >° L F p= z ,� 2 n H Z C H N �• ro N m n n n n n+ x n n N i oP � n �• n 4 x o 'a 0 2 1 0 10 i Z Q n >O 0 � -1 0 m f I � i i A i a N n 9 G tfi M Vi A o ps p p Z 0 c n j 2 N Y 0 Z 0 X J z • F w: Z > o �I ■ • ■ S v 0 i Z Z r R n n < 0 , c a c>>>> >° L F p= z ,� 2 n Z 0 wn o o o m n n n n n+ x n n N i Y 0 Z 0 X J z • F w: w> n o �I o p• > n o o r R N 0) a F•• r c c a c>>>> >° F p= z ,� 2 n Z 0 wn o o o m n n n n n+ x n n N i z n n n 4 x o 'a 0 2 1 0 10 i Z Q n >O 0 � -1 0 m f I � i i A i a N n 9 G M o 2 A o ps n 0 w i Z Z r 1!1 c f z 0 a\ o N r 0 R1 a n A L � � I M^ M • i•= ^ p Z r• " Z 7 p C_ r c_ r c_ r n o o Z p 2 p 2 Q>2 2 r 0 w g 0 0 w r i -+ x o n 0 0 0 0 0 e 0 0 z n 1 2 w 0 c r w G 8 a 0 s M M w c_ r� Z Z Z Z Z•= 2 0 i 0 z > L1 a w r ;• r p O m n -4 m m n - o z z m e& r z a 0 0 0 0z a .A, n f 2 0 0 0 w ' A > -1 F F r c A z 2 r w N j Z M_ > w N A N a N PI O n n � z ` a gY o � Town of North Andoverf AORT4 1 OFFICE OF 3? o COMMUNITY DEVELOPMENT AND SERVICES 10. 146 Main Street North Andover Massachusetts 01845 Wu ll" J. SCOTT Director In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in. gL16�&E— Ro&,5 ..74 Wewvll (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Once of the Building Inspector. 1-V CO o BOARD OF APPEALS 688-9341 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Cb c �- c H d CA CD C � d 'v O az y CD O CL y CM) O v CDCL c O cr. ? CD cc CD C O W CL: v y _• O co C F v CA O CD 'o Z o CD C O c?�c O �• N C ca r ac < o y =amn o Cl) 0 H n d � STI Z CD c Mr, H =r m d?g _ CL WO CD POOH p N o ;; o a 7 �-00 co 0 O C y" c) C13 CD S. ? C4 C'1 ] fo oa =rS CD m a - n H3 O rrl H �1) n H adscr C c CL ►�1 FTy y 17.1 1, ,•► my • ? H :Ci c -� CA _ {� m m r(° m d io o t T O co a o n tr: H � O CD �. od o� �• tzCD �. .00 CL =s: c o = co Cl) O �O cobo ~ ?l w G ?f w Poo G ^r1 phi G z W n � F In w rt 'd `� r.� 0 c z�PERMIT NO.�.34 t APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP NO. I LOT NO. 12 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE SUB DIV. LOT NO. I_ LOCATION YeS /11zlk ST PURPOSE OF BUILDING OWNER'S NAME VS Q / - NO. OF STORIES SIZE 16 r OWNER'S ADDRESS ' f ' ` f". Y /• w BASEMENT OR SLAB /� d&2C�/` r (,IST1'� =l�cl ARCHITECT'S NAME SIZE OF FLOOR TIMBERS X G 2N �6 ♦/O C.^ 3RD Q BUILDER'S NAME _f. ,/ \j v SPAN _ DISTANCE TO NEAREST BUILDING f / e e_j DIMENSIONS OF SILLS �j/jl, r� 6 v DISTANCE FROM STREET ItIQK�-+�iO_ _, POSTS '7 �/�� DISTANCE FROM LOT LINES — SIDES REAR !6-V " GIRDERS " X AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION �� �, 2 THICKNESS ! �� IS BUILDING NEW SIZE OF FOOTING IG X /G C/ IS BUILDING ADDITION / MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �j�_ •�v IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE i FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED /AND ,APPROVED BY BUILDING INSPECTOR /( 7� DATE FIL /J/.s yaa _ ,., SIG ATU OF OWNER OR AUTHORIZED AGENT FE E PERMIT GRANTED %/ y.s I s 3 PROPERTY INFORMATION LAND COST G EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN /C��C.OfJ�GJ•C. ' V BUILDING INSPECTOR 'NV'ld lO-ld S30V-Id3H SIHl 'a350dW12i3df1S '013 'S30VH -V9 'S3H:)NOd H11M 'S`JN1a-ims d0 SNOISN3W1a 10VX3 aNV S3N11 10-1 0 WOUA 3NV1S1a aNV 107 JOSNO1SN3WO 1a lVX3 AAOHS1.Sf1W N01103S SIHl ys lI z l I AON Vd (1000 l 0V0J3a JNiaiina `JNIIV3H'�ON Pic JIM319 _I PUL 1. 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