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HomeMy WebLinkAboutMiscellaneous - 108 MOODY STREET 4/30/2018 (2) 108 MOODY STREET °U TNS (L 210/080.0-0015-0000.0 P S TFC 7- 41 - e i a \' l Legal Notice TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS January 8, 1987 eT Mu'TM Notice is hereby given that - �r. *na•e the Board of Appeals will give a hearing at the Town i v Building, North Andover, on •�i:`e.: ,x'f« Tuesday evening the 10 day a�+• � of February 1987, at 7:30 o'clock, to all parties in- terested in the appeal of James D. &Diane M. Guthrie requesting a variation of Sec. 4.122, Para 19 and Table 2 ofthe2oning By Law so as to permit relief from 20'rear setback requirement to shed too close to lot line on the premises,located at 108 Moody Street. + By Order of the Board of Appeals Frank Serio,Jr., Chairman Publish in North Andover Citizen on January 15 and 22, 1987 175 Legal Notice TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS January 8, 1987 NepTN Notice is hereby given that the Board of Appeals will give 3' hearing at the Town ' Building, North Andover, on Tuesday evening the 10 day of FeLnjary 1987, at 7:30 •a�c�ais o'clock, to all parties in- terested in the appeal of James D. & Diane M. Guthrie requesting a variation of Sec. 4.122, Para 19 and Table 2 of the Zoning By Law so as to permit relief from 20'rear setback requirement .to shed too close to lot line on the premises, located at 108 Moody Street. t� By Order of the Board of Appeals Frank Serio,Jr., Chairman Publish in North Andover Citizen on January 15 and 22, 1987 175 • b .v. i . a. ' *&ORT/ 32• rP AMILM :.V CHt1g�� TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE -. .January. 8. . . . .19 8.7 Notice is hereby given that the Board of Appeals will give a hearing at the Town Building,North Andover,on.Tue s day. evening . . . . the . .1.0 day of .February. . . . . . . . . . . 19. 8 7, at7 ;30'clock, to all parties interested in the appeal of , . . . James - D, - & -Diane- -M-. Guthrie . . . . . . . . . requesting a variation of Sec..4 : 12 2-,-Para 19 of the Zoning By Law so as to permit. . . and Table. .2 . . . . . . . . . . . . . . . . relief €rom .20 '- rear- s:etback .requirement. .for shed to close . to lot line . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on the premises,located at. . . . .108 -Moody. -Street . . . . . . ... . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . By Order of the Board of Appeals Frank Serio, Jr. , Chairman Publish in N. A. Citizen January 15 and 22 , 1987 r /}/ ./.� Date.....11.9 ............... r►ORTh TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0 o., CHU Thiscertifies that .................................. ...... ................................................. JJS has permission to perform A 7..................... . . .......................................................... wiring in the building of......... ....... ................................................. at ...... ....................r. ....I No?Andover,Mass. Fee .......... IAI..".........Lic.No. ELECTRICAL INSPECTOR Check# V$ - - Commonwealth of Massachusetts office U o Permit No. I ) IVDepartment of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank) APPLICATION FOR PERMIT TO PERFORM .ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: G - 1- t S` 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) /p s fn ba r1y s hre t I- Owner or Tenant /' L !2 Lt. L Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters _ New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity ,f Location and Nature of Proposed Electrical Work: Completion ofthefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires .20 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators ISA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.0-rumergency Lighting -\ rnd. rnd. Battery Units No.of Receptacle Outlets I No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches f O No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices C� No.of Waste Disposers { Heat Pump Number Tons KW No.of Self-Contained Totals: ""' ""'"" ........................ Detection/Alerting Devices No.of Dishwashers ( Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers , Heating Appliances , Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent Heaters ICS' Data Wiring: Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1000 (When required by municipal policy.) Work to Start: 6- 4- J 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 1)9 BOND ❑ OTHER ❑ (Specify:) 4i t SJ if f V I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: v '� tit k ,. LIC.NO.: y Licensee: AW pi". Rki ,40 Signature LIC.NO.: (Ifapplicable,enter"exeml t"in the lic se number line.) Bus.Tel.No.•—IT-11-3781 9- 9$ 7 �L Address: r .c S q vi u.s M,* !3 f G Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires De artment 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)E]owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.S YMECTR M rEWMT INTO. ,)NSPECTIONREPORT: ELECTMCAL INSPECTOR- 1.ROUGA.MS TION_ Passed=L Sailed--[ ] Re-inspection regnzrecr($50.00)-[ j Inspectors'comweAts: - (fug ectors'Signature-no'initials) d Z,r✓L . pate 2j z 2.I+'INAL MTSP TION, . Passed L[ Failed—[ ] Rt-Inspection required($50.00)-•[ j Inspectors'comments: (Ixis&ctors'Signature•-no initials) IdDate Z,, o -,/3- 3.UMER GROUM lNgPECTION: passed--[ I Sailed--[ ) Re-inspection required($50.00)�[ ] s Inspectors'comments; (Inspectors}Signature-no initials) Date PINSPEECION—CR1XC�:CAY MSTONALG1 N1M•DI Faled—[ ) Re-inspectionrequired($50.00)-[ Insl owen:fs: ] (Iuspectors'Signature•-no initials) bate • f � 5.MSPECTION-OTHER:" passed—[ ) Tailed--[ ]_ Re-inspection required($50.00)-•[ ) Inspectors'colnm.ents: +` (&spectors,slinature no iiutialls) Date DOOR.TAGS.ARE TOM FLGLED OIIT AND LEFT ON SITE IF THE APXA TO DE INSPECTED IS NOT ACCESSIBLE AND.A AE 7ITSPECTION OF$50.00 IS TO DE CHARGED. s w rJ The Commonwealth of Massachusetts F Department of Industrial Accidents d 1 Congress Street,Suite 100 Boston,MA 021142017 v` www.mass.gov/ilia I� SV•V Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/piumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le>=ib1v Name(Business/Organization/Individual): Address: 6fv• t City/State/Zip: SOV V-v l�'!` G106 Phone#: S �' `� T O X Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).` 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.Q Other, 6.0 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.] gggggig that checks box#1 must also fill out the section below showing their workers'compensation policy information. who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. at check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have he sub-contractors have employees,they must provide their workers'comp.policy number. loyer that is providing workers'compensation insurance for my employees. Below is the policy and job 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 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 4_ Date: Signature: Phone#: '791 5441- q s 17 )_1 E only. Do not write in this area,to be completed by city or town official. n: Permit/License#hority(circle one):Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts , Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia i Fold,Then Detach Along All Perforations <;.COMMONWEALTH OF MASSACHUSE:TTS:,:'= . � 4OARb OF E1»ECTRICIANS � ISSUES THE FOLLOWING LI<CENSE l AS .A.- :R:EG JI.-URNEYMAN E.LECT,RI.CI:AN ANTH.DNY RUGGIERO . 16 BLUERI:DGE AVE SAUGIJS MA- ::::01906-1302 38634 E . a7/31l16 70089 . r Date......4h .J.1......................... r►ORT/y OF ...o ..�ti TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 1 c• �or.�.tag sSACHUS� This certifies that . N� ,� / rf4 . ..........................................r...... has permission forgas installation�.:'�.f �... 4 ........ 1 inthe buildings of................................:................................................................................. at...10 '.... ..... ......................................... North ndover, Mass. Fee. D�.....t?(7 Li No. .f A I PECTO Check# laL) � . Date... .l.lt..� .......... 12th TOWN OF NORTH ANDOVER Off?•, ``r•• O� PERMIT FOR PLUMBING S.gC�S This certifies that.............N..U�I'', has permission to perform o;&4k...t. r7 !-........................................ plumbingin the buildings of............................................................................................. at.1 Q., ... a l.... ............................. ......... North Andover, Mass. Fee.fl/t, )....Lic. No. . ........r.` .. �2BIJINSPECTOR....................................... Check# fl� V MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY - e h over MA DATE t I PERMIT# I�INI JOBSITE ADDRESS �a�� —� OWNER'S NAME L —�qv POWNER ADDRESS TEL `7R']- X10'b GO FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:O( PLANS SUBMITTED: YES® NO© FIXTURES Z FLOOR--> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTIONs DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ( 6 �_. _ I ._.. - _ I DEDICATED WATER RECYCLE SYSTEM _._I __-_ .. DISHWASHER DRINKING FOUNTAIN __...__I __j _..___._I FOOD DISPOSER _I ._..__1 __....J ___-__( __ . I ( .—.. ; ---_ __l .___._f 1 _.__I ---- -. _1 ( 1 FLOOR/AREA DRAIN _i INTERCEPTOR(INTERIOR) KITCHEN SINK .J LAVATORY EE _-_._._l _._. _ ( -_-___l _._ _J —__( _.___► ..__._._.1 ___ ._._.J i ( _ I ROOF DRAIN __._._,J SHOWER STALL __ _.__.i SERVICE/MOP SINK __—_..( TOILET d __ _____I ____d URINAL -___I ____I _._.- ---.� .__1 ..____.€ ..__..._J __._. ___-___I _ __ . J' :..._.__d __.___I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _.I WATER PIPING _ . I __I OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES .I NO �I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND Dj 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 10 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME L=YXXM•�cs�,� LICENSE# SIGNATURE MP® JP Q CORPORATIONJJ# PARTNERSHIPP# LLC COMPANY NAME S � �y �,�c, — ADDRESS CITY L( nr STATE ZIP TEL FAX _ _.. CELL .-- --_---------� EMAIL � --------------------------------..._...__.._.___....._--------._...__------._.....__--------__ -__� OUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INS?ECTI OTES [ oZ f J Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES d v The Commonwealth of Massachusetts r Department of IndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 yV:yt www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organization/Individual): �, b)n Address: 'lb Rd City/State/Zip: L,.irO MR 11 01 Phone#: `�1-9-49' 1640 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.F]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 0 Building addition 4.❑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 11.E]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.F1I am a general contractor aniud I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insance.t 6.Q We are a corporation and its office rs.have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,'they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: f 0�e Moo,),1 oo,)H S City/State/Zip: Attach a copy of the workers' compel sation 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 hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Sijnature: Date: 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not 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'contractor(s)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(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext.7406 or 1-877-NIASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Ir° I CITY Vel MA DATEER�MIT# JOBSITEADDRESS"I`_ oacl S OWNER'S NAME GOWNER ADDRESS _ TE 1-9 t 0-(o°)(0jFAX TYPE OR OCCUPANCY TYPE COMMERCIAL Ej EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:F-1 RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES 0 NOD APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ . BOOSTER L--_ _�-� �----- _ _ CONVERSION BURNER COOK STOVE DIRECT VENT HEATER + DRYER FIREPLACE FRYOLATOR [. - FURNACE GENERATOR _I GRILLE - - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I I OTHER ......................... . -.......................... �. (L 1 -� INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES J[HNO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Na� OTHER TYPE INDEMNITY 0 BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0I AGENT Q 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Mc,iS _ LICENSE SIGNATURE MP® MGF Ej JP ® JGF Q LPGI® CORPORATION Q#=PARTNERSHIP®# LLC®# COMPANY NAME: Ta, TA u ADDRESS 1S G p CITY r\n _--_Il STATE E _ — TEL FAX CELL EMAIL _ _ ROUGH GAS INSPECTIO NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPE!Q41ON NOTES G.fs 2- /d- Yes No dM� THIS APPLICATION SERVES AS THE PERMIT El E] iv FEE: $ PERMIT# PLAN REVIEW NOTES 4 V it The Commonwealth of Massachusetts M Department of IndustrialAccidents :;:.y =--•;d I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.[J I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.FJ We are a corporation aoffice and its ocers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no.employees.[No workers'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 submif this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-co*fi6ct6rs have employees,they,must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. 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 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 hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: 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): l..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fillout the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)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(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia r r %tORTy Of Stt[G»6'�O O A '!f,' �w4r�o rr�t49 SSACHUS 16000sgood Street Building 20, 2035 North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 COMPLAINT FOR INVESTIGATION DATE: &136/201 S� Tel #: 9 7 0 P7 7-0 35^r o - �S�- FROM: ADDRESS: Complaint Against: ELECTRICAL: PLUMBING: GAS: BUILDI (CQn RACTOR: OPERTY OWNER: f �' OTHER: 6 d Signed: � �^'�� i i TOWN OF NORTH ANDOVER F OORTH 'i BUILDING DEPARTMENT ° �o 1600 Osgood Street, Suite 2-36, North Andover Ma 01845 o 6 0� f" p NOTICE OF VIOLATIONArco " 1,* CDate: Address: l)(T - �)')0d� �T Building 0 Zoning Bylaw Stop Work Order Certificate of inspections Electrical 0 Plumbing Gas Violation Observed: s i 41 rIG, ' r f tJ Failure M your.01t to comply with this notice within 10 days may subject you to penalties prescribed by Massachusetts Law 780CIVR or P5h Andover's Zoning By law. Please contact the Building Department for further information at 978-688-9545 Home owner ' OFractor North Andover Board of Assessors Public Access Page 1 of 1 �e NORTH North Ando v e! Board of Assessors OF1«�o y7tio I _. Property Record Card Click Seal To Return Parcel ID :210/080.0-0015-0000.0 FY:2015 Community : North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge k Search for Parcels Search for Sales Summary .�,mom,• Residence Detached Structure . Condo 102 MOODY STREET Commercial Location: 108 MOODY STREET Owner Name: SCIONE JR,WILLIAM J VALERIE M SCIONE Owner Address: 108 MOODY STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:5-5 Land Area: 0.27 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2173 sgft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 358,100 346,900 Building Value: 189,700 182,200 Land Value: 168,400 164,700 Market Land Value: 168,400 Chapter Land Value: LATEST SALE Sale Price: 168,000 Sale Date: 05/30/1994 Arms Length Sale Code: Y-YES-VALID Grantor: GUTHRIE,DONALD Cert Doc: Book: 04055 Page: 0011 http://csc-ma.us/PROPAPP/display.do?linkld=2620110&town=NandoverPubAcc 6/30/2015 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING' (Print or Type) �✓ ✓Z�2 Mass. Date _ 19 l Building Location — OD y Permit# Owner's Name New ❑ Renovation ❑ Replacement V/ Plans Submitted: Yes ❑ No ❑ U) 0) vi Y OC m cnLu Cr Cr Cr 0 z H _ Cr (7 Cr LU U) W O� U ] Z = W ¢ F- Q } m cr mW W W00 (0 L W a (A m toW U) LU O U W =1: cr m W Q pLu cr C7 F- Z J F- Z W W C� W O W U J U W 0 > W Z W > � W Cr Z Q X Q m 0 0 W 0 W F- Er = 0a XLL 53oc� g00W > 0M 0 SUB-BSMT. BASEMENT 1ST FLOOR J 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Check one: Certificate Installing Company Name -� r '4 ` ❑Corp. Address 9 ? 21 Uc 4- ❑ Partnership "roaVeC /9- ❑ Firm/Co. Business Telephone �� fro Z S`2 (e Name of Licensed Plumber INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURA WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. neral Law ,and that my signature on this permit application waives this requirement. Check On Owner Agent ❑ Signature of O ner or Owner's 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 the permit issued for this application will be in ompl• nce with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of t ene Laws. By Type of License: Title ❑ Plumber Signature of Licensed Plumber ❑ Gasfitter License Number City/Town ErM-aster APPROVED(OFFICE USE ONLY) 0 Journeyman Date..................... ' r , J ,.ORTq TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION s i, • '1 may.♦.O•�•y� � l �MACHUSEt This certifies that . . .1. :. . . . . . .. . . . . '. . has permission for gas installation,.'.,.-,..... . . . . . . . . . . . . . . . . ... . :. in the buildings of . . . . �l. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . ' at . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . ., North Andover, Mass. Fee.... . . . . . . Lic. No.. ... . . . . . . . . . kS INSPECTOR WHITE:Applicant `CANARY: Building Dept. PINK:Treasurer GOLD:File Date �Via. .. .... NORTH Of o� °� LTN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION AcHUSEtS This certifies that /!. . . .f. . . . . . . . . . . . . has permission for gas installation . . .1?�, . )�?. . . . . . . . . . . . . . . . . . . in the buildings of k n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at /1::.-...rl . . . C ..... . . . . . . , North Andover, Mass. Fee.7�:' . . Lic. No..?7 ! : : . . . r . .�.�� . -�.. . . . . . . . . GAS INSPECYOR Check# 5 � G � F� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 7� ` k 1Q Tfl A 006 l l E RL . Mass. Date--LQI65 Permit #-5L CG Building Location Owner's Named/L L 1,4n SC i 0 N c A ADOLL }A Type of Occupancy eC S/Q G�J—j/ New ❑ Renovation ❑ Replacements Plans Submitted: Yes❑ No ❑ N N = . X W � N N V Z [L N U) N = 0 = F m s n W J a N O F- U = LU o W ~ a >- Z Z a 1.- W Q m o W m w a '� W O a H t- N O W N fl: W Z V W N w Q a 0 c W W 0 J Q = = a 0 Cr W W H = Z, Q W �! a C 2 H yW„ N O Z 0U. z W 0 W m z o z o = 'S O O cc Y a n 3 C tl J U Y a a F- O 1 1 SUB—BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR d' 4TH FLOOR STH FLOOR • 6TH FLOOR E7TH FLOOR 8TH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET HCl Corporation 1862 LAWRENCE, MA 018 4 0 ❑ Partnership Business Telephone q 7 IB-6 8.7--L 110 5 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked res. please Indicate the type coverage by checking the appropriate box. A liability insurance policy J( Other type of Indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner'sAgent Owner❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitted(or entered)in above pplication are true and aocurto to the best of my knowledge and that all plumbing work and Installations performed under the permit Issupe fir this application will n mpliance with all Gene pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GeS. (j Tvoe of License: Plumber Signature of cense Plum er or Gas Title Gasfitter Master License Number 374 City/Town 4Joumeyman APPte3W (OFFICE U _O BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TODO GASFITTING NAME E TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. _. PERMIT GRANTED DATE GASINSPECTOR Town of OI E-1(sES OF: 03 a 12()Nl ain Street ��h"I>I ALs NORTH ANDOVER :'.h'' t North Anlirn'l°r, 131.111_I)INC; ;,'°•i:;e. �� M�1SS�)Chus( tis O 18.4�> 3B 01 (•, '�•• CONSERVATION `" s DIVISION OF �1,j;� ; �'((317)G85-4775 HEALTH Pl_,;1NNING PLANNING & COMMUNITY DEVUf.),'PT' KAREN H.P. NELSON, DIRECTOR February 11 ; 1987 �. U1 111 �.- Petition #41-87 c1l`0 James D & Diane M. Guthrie tc� k. 108 Moody Street Mr. Daniel Long,. Town Clerk .120 Main Street North Andover,' MA 01845 Dear Mr. Long: The Board of Appeals held a public hearing on February 10 , 1987 upon the application of James D & Diane M. Guthrie requesting a variance from the requirements of Section 4. 122 , Paragraph 19 and Table 2 of the Zoning Bylaws so as to permit relief from 20 ' rear setback require- ments for shed, allowing shed to remain on lot. The following members were present and voting: Frank Serio, Jr. ; Chairman, Alfred Frizelle , Vice-chairman, Augustine Nickerson, Clerk, Walter Soule and Raymond Vivenzio. The hearing was advertised in the North Andover Citizen on January 15 and January 22 , 1987 and all abutters were notified by regular mail . Upbn a motion made by Mr. Frizelle and seconded by Mr. Vivenzio, the Board voted to GRANT the variance as requested. The vote was unanimous . The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10 . 4 of the Zoning Bylaws and the granting of this variance will not derogate from the intent and purposes of the Zoning ByLaws nor adversely affect the neighborhood. Sincerely, NORTH ANDOVER BOARD OF APPEALS /•J `cam Frank" Serio Jr. , Chairman /awt ortr ✓�N...N ��'G�`iii AC 135 VVV'wqq '9 AFRILT" No ro'jTOWN OF NORTH ANDOVER I ( r MASSACHUSETTS in 'I` BOARD OF APPEALS NOTICE OF DECISION James D. & Diane M. Guthrie 108 Moody S t. Date . . F.ebr.uary. : North Andover, MA 01845 Petition No.. . .4 17$.7. . . . . . . . . . . . . Date of Hearing. February. 10,. .19 8 7 Petition of . . James D. & Diane M. Guthrie . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Premises affected . . . . . . . . . .108. Moody Street Referring to the above petition for a variation from the requirements of f4 ^Seotion• 4,122 , .Paragraph .19. ,and. Table 2 of . the Zoning By-Laws . . . . . . . . . . . . . . . . . . . . . . so as to permit relief from 20 ' . rear setback, requirement. for shed, all.owi.ng. .shed. to, remain. •on ,lot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . After a public hearing given on the above date, the Board of Appeals voted to GRANT. . . • , the variance. . . . . . . . . . . . . . . . . .X X� 0I 4ttq X*R? 'TWRr?:K±,x - as • requested... ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signed . . . . . . . .Frank. •Serio.,. . r. ,^ -Chairman. • . . • ^ ^ .Al^fred .F^rizelle , • Vice-chairman Augustine -Nickerson •Clerk . ' • . . .Walter 'Soule . . . . . . • . • . . . . . . . 'Raymond"Vivenz-io. . . . . . . . . . . Board of Appeals TOWN OF NORTH ANDOVER, MASSACHUSETTS BOARD OF APPEALS APPLI� ON FOR RELIEF FROM THE REQUIREMENTS OF THE ZONING ORDINANCE Applicant vA'CiO5 y ! E =- �Q(� Address 68 1. Application is hereby made: Q a) For a variance from the requirements of Section'lUU, Paragraph and Table of the Zoning By Laws. b) For a Special Permit under Section Paragraph of the Zoning By Laws . -- c) As a Party Aggrieved, for review of a decision made by the Building Inspector or other authority. 2. a) Premises affected are land and uildin numbered YX 6 DI �(. Stree , b) Premises affected are property with frontage on the North ( ) ; y South ( ) East ( ) West ( ) side of J Street, and known as No. Street . ,i C) Premises affected are in Zoning District, and the premises of ected have an area of���square feet and frontage of rl�--feet. 3. Ownership a) Name and address of owner (if joint ownership, give all names): P-A -4vnaii, Date of Purchase 3 14 8(c� Previous Owner vpyooJ _ 1.i11 CLA•� rsYPi h h(*tt N's��...,a........"Y�;'.X4''"'1rO_',raw:+a:�ypf�y^Y"ye+•sx'na.-.?.ar.r.«.a..7e:kr�. «— .... .. ss.-�-.-sx+t .as•. .-. .. . b) If. applicant is not ow er, check his/her interest in the premises: =: Prospective Purchaser Lesee Other (explain) �.� Size of proposed building: front; feet deep; P Height stories; feet. a) Approximate date of erection: b) Occupancy or use of each floor: -i c) Type of construction: S. Size of existing building. 10 ,5•feet front; g, 3 feet deep; Height_stories; I feet . a) Approximate date of erection: (/(/ b) Occupancy or use of each floor: C) Type of construction: 6. Has there been a previous appeal, under zoning, on these premises? _ If so, when? / . Qt),escripti.on of relict sought on this petition � t I�� -��•`� 8 . Deed recorded in the Registry of Deeds in Book jPage_ � Z Land Court Certificate No. Book Page The principal points upon which I base my application are as follows: (must be stated in detail ) A&LI OWL � �l�o ►tom 5 t�� �� ;�t.�i�5 ���.__�_��—� �- ����G�_����c'r - �b�L� I agree to ay the filin fee, advertising in newspaper , and incidental expenses* 60 Sign ture of Petitioner sy � Every applation for action by the Board shall be made on a form approved by the Boa These forms shall be furnished by the Clerk upon request. Any communication purporting to be an application shall be treated as mere notice of intention to seek relief until such time as it is made on the official application form. All information called for by the form shall be furnished by the applicant in the manner therein prescribed. Every application shall be submitted with a list of "Parties In Interest" which list shall include the petitioner , abutters , owners of land directly opposite on any public or private street or way, and abutters to the abutters within three hundred feet (300' ) of the property line of the petitioner as they appear on the most recent applicable tax list, notwithstanding that the land of any such owner is located in another city or town, the Planning Board of the city or town, and the Planning Board- of every abutting city or town. *Every application shall be submitted with an application charge cost .in the amount of $25.00. In addition, the petitioner shall , be responsible for any and all costs involved in bringing the petition before the Board. Such costs shall include mailing and publication, but are not necessarily limited to these. Every application shall be submitted with a plan of land approved by the ` Board. No petition will be brought before the Board unless said plan has been submitted. Copies of the Board' s requirements regarding plans are attached hereto or are available from the Board of Appeals upon request. LIST OF PARTIES IN INTEREST Name Address �vN C�f iZ ion' M00b f 57. �u✓�-' KLP,� T. (ZN4 S5 J P�OSi r`i �7. C4v_4' -, °� G t'IZICMA IZp ,(?A 1-4 C �-( �)0AJALp 4, �2GO�KtCK iJ ARf-I (I PHELAr( 'fig i�2oSP�Cr St . 'IA. U ALLAM, LCONA A . Hct_r---9-56 . f Nt TM 1 SA us ' TOWN OF '10PT 4 ANDOVER MASSACHUSETTS BOARD OF APPEALS Date: 1- -16 - S-7 Dear Applicant: Enclosed is ,a copy of the legal notice for your application before the Board of Appeals . Kindly submit $ 3 . for the following: • Filing Fee $ . Postage r Your check must be made payable to .the' Town of 'North Andover and may be sent to my attention at the Town Office Building, 120 Main Street , North Andover , Mass .. 01845. Sincerely, BOARD OF APPEALS �12�— Audrey W. Taylor, , Clerk ��6 47 4��