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HomeMy WebLinkAboutMiscellaneous - 119 HIGH STREET 4/30/2018 119 HIGH STREET 210/067.0-0073-0000.0 BUILUINb FILE Date..t..Z:4.. �1'..... `gip?35 40nrry, TOWN OF NORTH ANDOVER 9 PERMIT FOR PLUMBING ,�sgCMUg�t This certifies that :. ..... .... .........(1 ,.......... ........................................................... -:has permission to perform..... ... Ay �..........LA/. j......i. � ......... .......................... plumbing in the buildings of. .4 ���U .. ......... ........................................................ at...... .. . ...`. `'X ` ...........:...'�...-. .....................I North Andover, Mass. '�Lic. No. Dth'` Fee...1��t...... ...........�L.. ................................................................................. PLUMBING INSPECTOR Check#2(�) 2.04citP4 792Ll�i h e-L y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK M CITY �(/� L __ MA DATE PERMIT PERMIT# "/ JOBSITE ADDRESS / 'T OWNER'S NAME POWNER ADDRESS __ TEL (p/�- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:® REPLACEMENT: 0 PLANS SUBMITTED: YES 0 NOQ 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 SYSTEMI DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM _ _ ....f t _._._ ___..I � ! ...__ L DEDICATED GRAY WATER SYSTEM. I E __-- DEDICATED WATER RECYCLE SYSTEM-- -.___( .___.__( DISHWASHER ----J __.__( DRINKING FOUNTAIN _.-_- FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR ( .__._( .___._._.L __._. i ....__► ( ____( __._._.L .�___. __._._,. __.....__{ ..__.__ ( .____.._� KITCHEN SINK LAVATORY I .___J -- _.—_( ___ ( __.___.L .___...L __.__ f __.____( _..__.... ..,.- ._ _._-_._1 . ( ► __.__..! ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ._. ._i WATER PIPING OTHER — ( ( ..._.-..._-� ---.___-( : .----._._f ___.__t . __ 1 -_� ( D J; INSURANCE COVERAGE: 4 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO ; IF'JOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _ __.,OTHER TYPE OF INDEMNITY BOND �Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachuset eneral Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER M AGENT GNATURE OF OWNER OR AGENT I hereby certify t t all of the details and information I have submitted or entered regarding this application are true ccur to to the best of my owledge and that all plu. ing work and installations performed under the permit issued for this application will be in co ianc i II Perti t pr visi of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME \ - T �- (LICENSE# SIGNATURE MP - JP CORPORATION n#PARTNERSHIP _(#LLLC j COMPANY NAME I � r��� it ADDRESS _ CITYSTATE ZIP dlc'' a �� TEL FAX CELL g EMAIL -Com _ I AVA �. ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES �sr ffklu ® _ Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES t a The Commonwealth of Massachusetts - - Department of IndustriqlAccMiks Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.govldia Workers' Compensation Insurance,Affidavit:Builders/rContractors/EIectricitans/.Plumbers Applicant Information > Please Print Legibly Name(Business/Organization/tndividual): Address: Ci /State/Zi tY p: -Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. [J New construction employees(full and/or part-time)" have Hired the sub-contractors �„ 2 I am a sole proprietor or partner- listed on the attached sheet.x 7• emodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L ]Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs j insurance required.]t employees.[No workers'. comp.insurance required 1311 other a *Any applicant that checks box#1 must also fill out the section bel6w showingtheir workers'compensation policy information. I Homeowners who submit this affidavit indicatingthey d're doing all work and then hire outside contractors must submit anew affidavit indicating such. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. i I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy anti job site information. Insurance Company Name:. Policy#or S elf-ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a.copy of the workers'compensation-policy ileclaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Hereby ce un the p ins and alties ofperjury that the information provided above is true and correct. Si ature �2 Date: - "1- Phone#: I 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 Iffealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: 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 j oint 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 ofits 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),addresses)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 LL C or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' . compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that-the affidavit is-complete-aadprinted legibly: The Departm erit has pzovided a space at the boffom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in . (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit ie on file for future permits or licenses. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial'venture (i.e.a dog license or permit to burn leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho Gompouwe'alt� o:fM-assachmotts Dopa ant ofladustdal Aceldonts OfApe ofha estigat ims. 600 Washi gtanWeot Boston,MA021.X1 Tel,#617-727-4900 at 406 ox 1:-577:MASSAFE Revised 5-26-05 Faze#617-727-7749 .t 1 I .. I l7iJlC3ERS ANU �/ S'�ITFLI2S 1 �fCFNSE© AS"A A- YMATV Pl`UF P� f)uRri,w .. LICENSE TQ'- DAN na v 1�w��wi 1 sro w � tiG,c , 1 �,vl� !rt c:ilsF�C CSTS�' �I;?1I1 Rrr.VI LL\` �a� rta�`UL8s&2 11�; X-5 T •' ,�,3 '= �.S�wrn '» ..iY'tx:'x y xry�>i:f Al- + kms' • k A • •Y, � a I 1. • I I...b1 OF NORTH�.`, TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION g3'�CMUS�t This certifies that .. ... . ......�.twa ..... ..... :..... has permission for gas installation . .��. ....................... ......................... in the buildings of.. :. � ....... .................................................... at..........................................�---�..>� ` ................ North Andover, Mass. . . Fee.l�..t�..... " . Lic. No. 11??..... ..H1�,,.�....................................................... ^ GASINSPECTOR Check# 2cs�\ 8943. (Z2rAq 64312,4 66 �i dee MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY Lb 1 �J�ClJC'� - .__�I MA DATE PERMIT# _���W: JOBSITE ADDRESS 1,1t •` S. '��`� OWNER'S NAME GOWNER ADDRESS TE f =1 — 7 FAX TPYPPIErOTR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL44 CLEARLY NEW:[ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO APPLIANCES'l FLOORS BSM 1 2 3 4 5 6 . 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACES FRYOLATORF_ 1 I FURNACE _I = 11 - FE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN - - .� - POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TESTI UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER kAId- ._ ........ . _ III = HI I �. INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE INDEMNITY E] BOND]_( OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts eneral aws a my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNE - AGENT MI IGNATURE OF OWNER OR AGENT hereby certify at all of the details and information I have submitted or entered regarding this application are true a - curate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn nce t I Pe ' ent provis' of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. -- � ` j6.3) PLUM BER-GASFITTER NAME U/ Gy�L _ _ _ �� �a1 LICENSE# / IGNATURE MPMGF JP 91 JGF LPGI CORPORATION�#=PARTNERSHIP El#�� L6' #= COMPANY NAME: v l�1 _ ADDRESS CITY STATE ZIP / , d ]TEL OCSv' _ . FAX CELL cxaa' EMAIL _ � -- - --- - ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No ®�G R—47 /-/3 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES A • _ The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractorsf Electricians/Plumbers Applicant Information Please Print Legibip Name(Business/Organizationgndividual): G Address: (` C� ��� � - City/State/Zip:- Alycer-Al-ll Phone#: 5? S `' --ow Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New oonstruc#ion employees(full and/or part-time),* have lured the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.t 7• emodeling hip and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]i employees.[No workers'. 13.❑Other comp.insurance requiredJ *Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. T Homeowners who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and f ob site information. Insurance Company Name:. i Policy#or S el£-ins.Lie.M Expiration Date: Job Site Address. City/State/Zip: Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Itereby c n the pans andp ltles ofperjury that the information pro vide Cd ab Ove is true and correct Si ature 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.CitylTown Clerk 4.EIectrical 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"...eve person in the service o •"...every p f another under any contract ofhixe 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 ofits political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence P p vi nce 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 anLT C or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be,returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' . compensation policy,please call the!Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials -Please be sure that-the affidavit is-complete and riotedleg Y. TheD ePartmexit Iis-provided a sa—e—of he b6-t om- 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 toivn)."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. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho GAxnmonwealt�ofMassarl?v.:sotts - Dopartment offadmtdal Accxdonts Office of fimstigatiom 600 Washingtw Street Boston?MA 02111 Tel,#61.7-727-4900 ort 406 or 1-577MASSAFF, Revised 5-26-05 Fax#617-727-7749 Date..... ............ 40Rrh 4 TOWN OF NORTH ANDOVER PERMIT FOR WIRING rbc This certifies that ................................... .......................................................... has permission to perform ... /r,4- g 0 f Al.�. .../.............:..................... wiring in the building ................. . at ....... ................ Ma Cll Iee.. L ............................Lic.No./ ......3......................... — North Andover, . ....... LEC-MICAL NSPECM Check# Ze5l 11966 — -- � r -- Official Usc � a�/ I I _ .omn'2onwealt�i o��r�rd9acr!c9ntt9 •'' c� c�77 lJerartment o�}ire Service9 i'crmi( No. Occupancy and i CC-Checked o BOARD OF FIRE PREVENTION REGULATIONS [Rev. liC?] (1Ga 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: \0 I 2H City or Towle of: X1A_aave.4_ 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) 1,I I lR in S _\r rt4A_ Owner or Tenant JDh 30-f' bTelephone No. Owner's Address Is this permit in conjunction with a building permit? Yes [Y No ❑ (Check Appropriate Box) Purpose of Building (Zey\ovo..\c,k ov1 Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Q New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters 9- Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: a �d NAM MAX Tce o\acc 6e->j tdzS Com lesion o .the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o mergency Lighting rnd, rnd. Battery Units No.of Receptacle Outlets S D No.of Oil Burners FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners o.of Detection and \ . InitiatingDevices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g � Heat Pump um er Tons o.oSelf-Contained No.of Waste Disposers Totals: """ "' '"' "' '' DetectioinjAllerting Devices No.of Dishwashers Space/Area Heating KW Local❑ unictpal ❑ Other Connection No.of Dryers Heating Appliances K`,1, Security Systems-* � No.of Devices or Equivalent �-- No.of Water No.of No.of Heaters KW No. Wiring: Si \.(1 ns Ballasts No.of Devices or Equivalent uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eq uivalent 1 OTHER: �1 Attach additional detail if desired.or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 exhibitedroof of same t th p o e permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I r I certify,under the paing and penalties of perjury,that the information on this application is true and complete. FIRM NAME: av x k_1 \ CO A V0, tI LIC.NO.: Licensee: 04yjD �6„g/'a. Signature LIC.NO.: 6 � (If applicable,enter "exempt"in the license number line.) 3 $� Bus.Tel.No.:j7 -6C2_—C24 x Address: 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 WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally -�— required by law. By my signature below,1 hereby waive this requirement. 1 am the(check one)❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ � I � �:- I°v�'� �� � � �z� ., � . 4, ,. ., . , . .� .. QU 'Ize Gimmonwealth of 1Yfassachusds Print:Forr�i I GASShM4Sake 10 Bostox MA OU14 2017 ww .Maxgov1&ff WerkmT Compensation Iasarattce A#fieiaWt;BaiidsfComhurtorsffleefridaiis/Ph mhers pfie�nt I�ori�atioa Pie•ase Prat LErgwav Name(8usiness/0tgnirati0n4nd chat): DAVID ELECTRICAL CONTRACTING LLC Address: 87 BELMONT ST f4OR1 H AISMVEP,UA-01845Phone 97"82-8262 A—yns as employ"-C.�iheappruptiat�e be= I-QIamaompkaawM 7 � []jam a�erdwandi T�ofProms(req �diaudfh�• ej� have hiredthe � 6- �New cowknction 12-Q Iamasole�or oathe 3 QRmadelmg S*andbave moemployees These have Demomou vvbdg fihrnh-,,in ay capacity_ cmployees and nave lHocomp-i comp- 9 0$uddingaddifim recLJ 5-0 We areaoor nand its 10 0 0ecrrscairepairs oraddi£ions 3.0][am ah0meowncrdni0gaU wort` aft6emhaveemmmised1heir II-©Phunbing napairs or addiiaAs MYsd£[No waalcere comp- 'W 0f mon per MGL -Q .] r-15Z$1(4),and we have no 1? Roof Foye-JNo workwe I3-[]thirst CMWL inseuance required.] aPPlkmtdmt box-A mLztabo filtoatthe L poti�v un5ormax�ar who tinsWNdavei tb ra�dos ail andti�,hiraauaide s 'CowmcossubmR 4that 8vsiwsmist �8dci 2 g8� ►cnflhe a aff�avitm g�cr� emgtoy Iftite� ffiF�o9 Y P�idethei wD&ws oruot ea0t share ---_ �F-po}isy mimber t inn a..�®n�toyer�ispr�vvi���:� � f�,��j�� BeFmv zs t7re ne�or�on pr►ticymad�oh�te 7nsuisni�e Company Name; THE HARTF©RG Policy#or Self ins.Lic_#: 08 WEC 018293 ExpiMARCH 9 / ration Date. ,209 Job Site Acldresj,- j7— Attach a of the wa cflFT rkers'coin tion Rai to secure geusa Policy declaration page(showing# Poky number and eapiraition date). fine caveMV as under Section SA ofMGL c.152 can lead to the imposition of cry penalties fa $I,SE}OA©andlor one-year mVris=nent,as well as civ]Pau&es in the fpm of a STOP WORK ORDER and a fine Of uP to$250300 a clay aga�stthe violator. Be advisedSud a ma "Els0 s ofthe DIA For i verification. Y be forded.to the Office of dabawstrsaegad corms Ptnnne& ase party_ Da in dig areU6 iobes�r byagy OrAmaa ojpckL ChyorTown: e� bsg&gAnSuedy(ch vie one)-- Ir GrIffeaft 2.Bmlftg Depwftent X�tyt#-om clerk IilestrieaThvecter PIgtar 'Perso>c Ph���: Date.).b.. ... ............... NORT/� TOWN OF NORTH ANDOVER ���• �� • OCL 9 PERMIT FOR WIRING HU tt 1 This certifies that ti..to`--�.. tel..... ........................... ......... .... hasermssion toefom . .......... ............... .. . � a"j— .1 wiring in the building of..........` Ai? c�4 .. .. . . ............................................................. at ............. ! `1 �--r ......., orth Andover,Mass. Fee........... ............Lic.No. .... l.. .. .. .!� .. .. . .. ELE'TRICAL INSPECTOR f Check# 11973 �at. � a acs Ojcia UseOnly • epartrnent seMz d 6ccupancy and Fee Checked BOARD OF FIRE PREVENTION REGU -IONS ev.1/07] eave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work wbe performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PL_8.4SE PRINT PV INK OR TYPE ALL INFORM4TTPA9 Date: y 1 City or Town of: !J rclAeye 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) 1 16 r f 4 �1 V Owner or TenantCt d �a\ —�-g Telephone No. Owner's Address , Is this permit in conjunction with a building permit? Yea No'❑r (Check Appropriate Box) _ Purpose of Building ?_e s X8 can Utility"Authorization No. r Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:: czsnn i�y� amu.J c ('�= S 1 c 1✓ice Completion o the ollawin table may be waived by the Inspector of Wires No.of Recessed Luminaires No.of Ceil.-Snsp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tabs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency g d. d: Butte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No`ofGasBurners No.of Detection and Initis Devices No.of Ranges No.of Air Gond. : Total of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of/Self-Contained Totals: I I Detection/Alerting Devices No.of Dishwashers SpacelAres Heating KW I t Q Municipal ❑ mer Connection No.of Dryers Heating Appliances �K'W Security' ems:$ Na of vices or Equivalent No.of Water -KW No.of -Nm of Data Wiring. Heaters S- Ballasts ' No:of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications inrmngg ' No.of Devices or uivalent OTHER Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 10 ' 11 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 rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEBOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenahiec ofperjury,that the information on this appheadon is true and complete FIRM NAME:_i` a V 19 I'IE"Rl CAL cw4nzA4c-'w to ae, LIC.NO.: IA Licensee: DAVID 4A64A P, Signature LIG NO.: 1 Li 9(a 3 R � (If applicable,enter`exempt"in the License rttmtber line.) I Address- �Z BEtri+t�Ft'r s-r t�Otz'tt� �/�BVEQ � Ulggs Bus.Tei.No.:97�8-b81-b��e2- Alt.Tei.No.:4't8.3T5 513`�� *Per M.G.L.c.14.7,s.57-6i,security work requiresDeparhnent of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance wverage normally required by Law. By my signature below,l hereby waive this requirement. I am the(check ane owner owner's ,nt. OwnerlAgent Signature Telephone No. FEE: $ �- The Commonwealthoof�M�o� ac�h�u�seyft Pant Form Dep �&e]i# �uJLlL[/LAeddent I Co rm Street,Suite IN -= BostOX MA 02II4-20I7 xmm.nmS&gavta7a Workers'CompensationUsurance Affidavit Builders/Contractors/FieetrimasMh mbers A�pulicant Informa#ion Please Print Legibly Name{gusiness anfiad,,; }: DAVID ELECTRICAL CONTRACTING LLC AddreSS: 87 BELMONT ST CiLy/S1a JGg. NORTH ANDOVER,Ma 01845Phone� 97"82-6M Are you atz emgioyer.Check theappropriate box: T of in I-Q 1 am aemployervyM 7 4- L]lams a�mal r and I S P 1 E 4ffi 1 emplo!"M(£ullmworpart-time).; have 1 the moots ti. []Now construction 213 1antasole !mrorparuw_ fisted onthe anached she& 7- [1Remodermg ship and have no employees These have $_ []Demolition wdd;fmg formes in any cagaciiy- employees and have worla re [Nowoxkwe comp camp.iosmancei 9 []Bw1 mgadd#ion re4uire1-I 3-0 'Q�e are a corpmation,and its 10-0 Electrical rcpairs or additions 3 am aIt out eawner d6m- g a n wort officem have exercised the I I.D Plying vepairs or ad&Cw ns MYSdE tKo widnue camp rW of exemption per MGL hmnanve requhe&]r c 152,§1(4),and we have no ;-- Roaf employees-[No wcukae 13.E]Ott= A°YaPPtiemtthatd=ksboxi9lmastalwfin out the section g,awmgtheaworloe&com�s�tivn Hot�COL'VIlC3 who aftutthisaff7davt o,{,�� po� 7 are sh a*t svotk a=theft bllzoubade conuachm musts t tta new affidavit"ahcamw suckL khrnmrion- 'its lha2etteekt�sba�xmustaUa�aoadditioealshuwmgtite>tt�ofthea�sta�whetherorrwt�a�ceeot�hate �►P�Slees IfBtesteboo�acGu►slmveanptoyee�tiny ua�tPtovidetheff�va> s'camP .mw*w 1 mti'an emwtayar that is pnoviamwworkers'rompe pn f� , P . Below is the information. P�eF andjuh site Insurance Company Name: THE HARWORD Policy#or Self-ins_Lia#: 08 WEG 018293 Expiration Date: MARCH 1,20.1q Job Site Address: CttyMate/Zip: Attach a copy of the workers'110mPensation policy declaration Page(showing the L Failure to secure eov as Policy number and expiration date}. stage required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a f neap to$1,500.00 and/or one-Year imprisonment,as wall as cva pena}ties in the form of a STOP WORK ORDER and a fie Of up to$250.00 a day against the violator. Be advised that a of this statement Investigations of caP3` Y forwarded to the Office of the DIA for insurance coverage verification. Idake rrbpt�arBJs'underibe ---tbtatthe p abwestrueWdcaorea S, -- --- ------ Phone#: �8�2-6L62 FL ul}L Do aatwr&'In this arer� to be completed by czEy ortorm o ,ceiQL : Permil&iceuse# oray(crrcle one} eap 2.Bengt3 Ctyl#'ownClerk4L]ULsPct. Phone ft DateAMLE �9 • TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that -CT . . . . . . _ . . . . . has permission to perform . . ., wiring in the building of . . (,/ -T,fgt , r , . , , , . . . . _ . . at . . .�.(�. . l . . , i. , , . . . , , , . .North Andover, Mass. Fee .3 .� . Lic. No. �.6 41 7 7� . . � ELECTRICAL INSPECTO Check# 6 Coe r` 11071 Commonwealth of Massachusetts ori ialUse•�Only � 4 Department of Fire Services Permit No. Occupancy and Fee Checked 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 CodeC), 27MR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: S„ 1 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives noti e of his or her intention to perform the electrical work described below.hi Location(Street&Number) 9 Hi Si Owner or Tenant �� AA— Qdc 'C S Telephone No.I06�" 9q toc o 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 Location and Nature of Proposed Electrical Work: y j}�►6W►� j,,, Siat►^e-✓iT' y L,^�L�;� • Completion of the ollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total{ Transformers KVA j No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above oN—O.—Or Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection andInitiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local E] Municipal El Other P g Connection No.of Dryers Heating Appliances KW Security Systems:Y Y No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: P{ 1� 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 anti complete. FIRM NAME: .COGt.�^�-LS�G�b e G�2R-io S LIC.NO.: All Licensee: r-- - t/ Signature LIC.NO.: (If applicable,e er "ex pt"in the licensenumber line.) Bus.Tel.No.: ���q I Address: X D � 7J SiU1$'---) VACA Alt.Tel.No.: c2- > o S- *Per M.G.L c. 147, s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. P r J . • 7 - _ � Yrry�y/f��•—��•�y�./y� -��{y-�•��/�� i1��•7r — yp,•��y may-� y� •�- .+.••�-hn' � . ... �J-NL•(YJ.�..�i.�.`V-�tF�/('-*'-�ft/�^(i�yJ'J�.'��.'I�i'J-LJj�'��.`�®p'�'�{'pyt �(t •�-� •'+•{F.J�,4lV��.,.\.1l'Ci1�liJ•wJ.� , .�1It-LL!1L.!!.q•i.�,f�,1Lf J-l'91�3..�i�J.®.�9.".• -• r � •.'� r ON, �• •• �oss14 : 'ailefl [ ] e-xuspeet�on xequixecY{$�d.QO)~[ �ns,�ectozs'�a�oaxne�ts: - @Cagectoxeizgnatuxe-w Wtials) Slate 3'assed--[ ailed--j ) te3usectiozz�ersixed($ 0.00)- [ �ns�ectoz•�'c ts: (�iisiectazs"i9ign a no' aTs) Pate 3,MOTDPIR GROTJM$3Q7U11+CTfox. . Passed—[ �eetiou,xequixea($60.00)-[ � Cnspetozs"comments. , Cwspecfozs'Rrgnatuz'e•-no Initials) Pate 3ssed—[ ) failed- [ e-5nsrectionxequixetl 050.00) [ . spectbxs'eo)mmeifs; (Xttspectoxs",�ignatuxe�t�ouftzals) Date ' �ectaxs'cobam.erifsa S � , � s�,ectoxs" zgnatuxe uo xnitiaTs} date Old�'A .AF 7('O JZ Ela Q'—UTAM Y RFT MITEW TIM.APXA TO BE INSP CTED IS NOT The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,AM 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ) Please Print Legibly Name(Business/OrganizatiorAndividual): Address: City/State/Zip: ?Phone#: 0 9ir Ar you an employer?Check the appropriate box: Type of project(required): 1.)I am a employer with 4. ❑ I am a general contractor and I 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition t working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:. Policy#or Self-ins.Lii ic.#: Expiration Date: l Job Site Address: ) IJ 1 ��l" S 1 City/State/Zip:N �v'�-O6SZ'"_ Ma�, QLrl Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a i fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certi and nalties ofperjury that the information proviQded abov is true and correct. Signature: Date: ( S 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#: r 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 tooperate 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CommoziwealthopMassachusetts Department o:f ladustrial,Accidents Office of Investigations 600 Wasbington Street Boston,SIA.02111 TOL#617-7274900 at 406 or 1-877:MASS.Ak'B Fax#617-727-7749 Revised 5-26-05 www.mass.govfdia $: Date... i TOWN OF NORTH ANDOVER o ' PERMIT FOR WIRING ? �,SSACMU`�ES r � /J This certifies that . ....... .... .. .... ..................._ ............................. 40v.. .... ........ / / / has permission to perform .... .... :._.:. 1.1..%: �. ............................... wiring in the building of ...(.....� at.... ./.1......��. ..... -,,,,N rth Andover,Ma,s. ELECTRICAL INSPECTOR Check .4 4 V I b V JIM UU1MVU[v rrriftUn Ur tnn aalrtiU"V U;#A AJ •w � DEPAJUME 70FPUBL1rCSAFM Permit No. •��� BOARDOFF=PREVffM0NREOULAT70NSS27aR12-M Occupancy&Fees Checked APPLICA77ONFOR PERMUTO PW2FMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical w de ribed below. Location(Street&Number) w; Owner or Tenant Owner's Address ` Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of BuildingUtility Authorization No. Existing Service --V 00 Ampsze7/ 2govolts Overhead Underground No.of Meters 1 New Service Amps I Volts Overhead Im Underground 1:3 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Trensfortners Total KVA No.of Lighting Fixtures / Swimming Pool Aborta Below Generator KVA grou ground No.of Receptacle Outlets _/� G No.of OU Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burner No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Dispossh No.of Heat Total Total No.of Detection and Pumps . Tons KW Initiating Devices No.of Dishwasher Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryer Heating Devices KW Local Municipal Other Connections No.of Water Heater KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motor Total HP 41-0 OTHER r ..IttsttratoeOnaage Plmm�mltbllletec}nBila�IsdMa®d7�tlsGa1®lLaw9 iItmeaaaaiLidAtylrmato Pokidu&gCmv e mcmetaxoribs q*ai t YES NO Iharestkmikdvafidp a faf=nebtte00ke.YM lrycuW ectrdWYE%pk=irrlratelhetypeofeNwVby d=kiq;u–=-q--4—augwbox INSLRANCE J/<1 BaD rl allM � (Please�e�Y) `�,�r F�avatreofF]eiwodc$ ,��G 0 wodcbstac �–S�/ rtspac�atDaleRec}rs�a Ita> L Fvd Sigrdi I`enaki%of ' FIRMNAME 1 �c' "� LicaeeNa /zSo3a o _ i ioat4ae sT-�°�li� .ye'�z�_ Sigrm�e -� LioereeNo �SG..s� Busk=TdNa AltTUNa OWNEICSMURANCE AVER;IalnawaethettheLaereedoomthareft mmn w,,Vorib, egPWataswgx dbyMhnftmGanwLm andthatmysig rizcnItispentappkabmwaivesdicelo#mnat (Tease check one) Owner Agent Telephone No. PERS FEE S aigniture of Owner i .. .�-'��� �� � j. ,. r" ' Date... ................ L NOR7F, Ot t.�ao ,e1�40 3a ,.� •- .'e o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SS CH S� This certifies that ... .. .................... ................................... has permission to perform .,�/41(be— . /� . ........ wiring in the buildingof..al.. ... ?�:�f:�.... < 1 ........ at.// �' . ............. ,North Andover,Mass. Fee.'�......�.�..... Li c I�o.'k!�(.!��.. � I.GG'LY ELECTRICAL INSPECTOR - %1 5679 11M UU1VVV1V1V rrrVi"111 t!L'�rltsa,aru,riv.usi i ��7��� DEPARMENTOFPUBIICSAFM Permit No. / B0ARD0FFYEPREVEW0NRB9AA7T0NS527C.tYM12W i Occupancy&Fees Checked APPLICATION FOR PEI Aff TO PEIZFO LECTRELE��WORK ALL WORK TO BE PER (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 5 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electricill work described below. Location(Street&Number) / s Owner or Tenant ' Owner's Address Is this permit in conjunction with a building permit: Y s No (Check Appropriate Box) Purpose of Building Ad�/f —_ Utility Authorization No. Existing Service . //�70 - Amps */ Olts Overhead Underground El No.of Meters New Service Amps/? Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps . Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER r hrsivanoeCowrage.Purstrartovdretegttirerna�.sofM��tlsGalaalLaws Ita�eaamaYLiab>7�ylnuaataelblicyirrtrarlgCorrlplere Co�ageailssu69arialagtuvala* NO Ihavesu6mWdVMproof0fs8rne10lh5Offi=YES IfycuhawdrdlodYES,pkmeindc*dietMxofw aWby drddngft*Pc_E0_*b0X INSURANCE J BOND a (Plea9espe�y) EstirrlatedValreof&dotal Wade$ WOdckqpec6mD* Rao F %rWurt&r&Pamkiesof FiRMNAME LNa o- Licame ,Nene,_- I%al'�r" Signa. BcsinessTdNd if t�'�A1tTdNa 9 '!!� '{l S e1� OWNER'S INSURANCEWANII2 IamawmthatdleLionisedoesnothatethemrmwamagzoriNsubstantialegzah tasmgxWbyMmdusMCtnffWlaws ardthatmysignaMeonthispenritapplica imwaivesdam*zMn t (Please check one) Owner Agent Telephone No. PERMIT FEE$ signature of Owner or Agent . � ,� t LE16 L 1XIOTICE Date Article , Section the Zoning Ordinance WHEREAS, VIOLATIONS OF Article , Sectio of the Building Code have been fount Article , Sectio of the Code these premises, IT I HEREBY RDERED in acco ance with the abme Code that all per s cease, sit fr m, a v �'� S P Aw Mk AN M To W" R at once pertaining to construction, ale ti ns or re on these premises known as 1 Q11 persons acting contrary to this order or removing or mutilating this notice abl arr st unless such action is authorized by the Department. CODE OFFICIAL • North Andover Health Department fommunity Development Division Letter Of Compliance DATE: December 10,2012 TO OWNER OF RECORD PROPERTY LOCATION Charles Camirand 119 High Street Sudha Camirand North Andover,MA. 01845 101 Shiloh Street Branson,MO. 65616-7716 A Health Department ORDER LETTER dated October 25,2011 was issued to you as owner of record of the property listed above citing violations of the State Sanitary Code,105 CMR 410.000,Minimum Standards of Fitness for Human Habitation. A re-inspection of the property has found that all of the violations noted on the Order Letter have been corrected. The illegal apartment has been gutted and reduced to the studs and 4 walls.The Health Department would like to thank you for your cooperation. S- r ly, Mi ele E. Grant North Andover Health Inspector Xc: File Susan Sawyer,Public Health Inspector Gerald Brown,Inspector of Buildings Richard Morway,Avatar Properties Lt. Fred McCarthy,Fire Department 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.town0northandover.rom i AORTil q O �t�eo �6• ~O r 3,r bt '•_ OL 70 Town of North Andover 4 ea 1600 Osgood Street / "•-"• * Bldg.20,Suite 2-36 4Arso 0' �gSSACHUsNorth Andover,MA 01845 Phone: 978-688-9545 Fax: 978-688-9542 Gerald Brown,Inspector of Buildings October 28,2011 j i I Charles E. Camirand II 101 Shiloh Street Branson,MO 65616-7724 Reg: 119 High Street,North Andover,MA 01845 Dear Mr. Camirand, Please be advised,a recent visit to your property revealed that a Building Permit was never issued for the illegal basement dwelling unit and that renovations are being done to the interior of your home. The Massachusetts Building Code 780 CMR 105.1 Permit Applications: (It shall be unlawful to construct, reconstruct, alter,repair, change use occupancy;which is regulated by 780CMR without first filing a written application with a building official and obtaining the required building permit and all other required permits therefore). Occupying a structure without a Certificate of Occupancy is a violation of the Massachusetts Building code 780CMR,and the Town of North Andover Zoning Bylaw. You must discontinue this illegal use and Occupancy and remove the illegal apartment immediately and obtain a building permit for renovations. Thank you for your attention to this matter. If you have any questions,please call the office of the Building Department at 978-688-9545. Very truly yours, Geraid Brown, Inspector of Buildings Building Department cc: Curt Bellavance/Comm.Development Susan Sawyer/Health Dept. mi/Desktop/Gerry pORTy O �tL'eo *6,gti0 2 6 O 6 f" G Y yre 70 Town of North Andover O e�* 1600 Osgood Street f q �• -'- • ^' Bldg.20,Suite 2-36 �9SS'4 U`-+'�� North Andover,MA 01845 Phone: 978-688-9545 Fax: 978-688-9542 Gerald Brown,Inspector of Buildings October 28,2011 Charles E.Camirand II 101 Shiloh Street Branson,MO 65616-7724 Reg: 119 High Street,North Andover,MA 01845 Dear Mr. Camirand Please be advised,a recent visit to your property revealed that a Building Permit was never issued for the illegal basement dwelling unit and that renovations are being done to the interior of your home. The Massachusetts Building Code 780 CMR 105.1 Permit Applications: (It shall be unlawful to construct, reconstruct, alter,repair, change use occupancy;which is regulated by 780CMR without first filing a written application with a building official and obtaining the required building permit and all other required permits therefore). Occupying a structure without a Certificate of Occupancy is a violation of the Massachusetts Building code 780CMR,and the Town of North Andover Zoning Bylaw. You must discontinue this illegal use and Occupancy grid remove the illegal apartment immediately and obtain a building permit for renovations. Thank you for your attention to this matter. If you have any questions,please call the office of the Building Department at 978-688-9545. I Very truly yours, Gerald Brown,Inspector of Buildings Building Department cc: Curt Bellavance/Comm.Development Susan Sawyer/Health Dept. mi/Desktop/Gerry ti Ippolito, Mary CnT : Ippolito, Mary Thursday, November 03, 2011 11:57 AM . 'ccamirand@msn.com' Cc: Grant, Michele Subject: Charles E. Camirand Il.doc Attachments: Charles E. Camirand Il.doc Dear Mr.Camirand; Please see the attachment sent from Gerald Brown, Building Inspector for the Town of North Andover. Thank you. Mary Ippolito, Building Department Town of North Andover 1600 Osgood Street Bldg. 20,Suite 2-36 North Andover, MA 01845 phone: 978-688-9545 fax: 978-688-9542 mippolito@townofnorthandover.com O 1 Date. V /Z- 9568 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i oma- .` �• ,SSACHUS� i This certifies that has permission to perform plumbing in the buildings of . . . . . . . . . . at. . . ��. l. . . . . . ! ?� . . . . . . . . . . . . . . o ndover, Mass. q�[ PLUMBING INSPECTOR Check x 2vhl T of MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 'v CITY n , n _ _ IMA DATE PERMIT# JOBSITE ADDRESS _ OWNER'S NAME POWNER ADDRESS !j TEL FAX �Y TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL PRINT �y�/ CLEARLY NEW: 0 RENOVATION:L r REPLACEMENT:Q PLANS SUBMITTED: YESDJ NOD FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 ._w1!I!ct!(_-._-_._-.-.-.....__._.-,_�-____...__.___._.____._.._..___......,.J{I(!(I!_._____.__..._.._.-..-._�._-._F.�E__ii{lI,-__..r.__-____.__-__..._.__-________._-._...._________-_.__-___.'EfJI!!4._._.,-.___._.__.____..__,..._-_.___-..-___..-._..____._-_.--___.___:.(J!I!(i!____._..._.._..______.___,.__..__.._.__.__._.....__.__.....11I!(IIi__-_..._�-_____....___...___-•`-1II!___,-._...,-,_._-.____-_._.._-..____._.__..l.._,(J(I .____..._._._..._..._...__..__...._____..__._._.._.__...1_JJ1I._.___..__._.._._-____...___.-...J.___.t(IiIf--.____.-__-__._-..__.__..___.._.__.__:J.!I1Ii{...._._._.._._.._._..____..-......_..._.J.__._._.--_._._J.!(fffI. �._.._-______.-�_______-.#.J_IfI!(I___.'.—_1.-.3_�- _.__.....-.-1...__.4 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISANDSYSTEM DEDICATED GREASE SYSTEM I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ..........-11 E771 . __ DISHWASHER -1 __ __ F-7-1_ ! _ .! __ ._........ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN -___.-.._i _ 1 _ . __ _ _ _ _ ._ i INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN ....-.,__.E ....-..____3 ___.......I _..._.___( ( �..._...._.I SHOWER STALL ___! .._._..__J _._._-__I SERVICE I MOP SINK TOILET ► ..._.._:_I ..... ..__.I _._.___I ._,__._t _._ ..� ----..__! ._.-- _-__._E _.._t _.__-__( .... ___ -._I ..____.__- _..._..._i URINAL ( --.-.__-__! __..-..__.J __.__--( WASHING MACHINE CONNECTION $ _' __.� } _ _J _ .^ I.-_ .__i ..•._ ,! _, _J ,_.. . ; _. j _ WATER HEATER ALL TYPES __W( _^) f(� I �I[_ C_d�_ i Ct�._ [ M_ .i __€ _ _! ..._-._i _ WATER PIPING OTHER I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES . rklo 01 I1F YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ,� OTHER TYPE OF INDEMNITY Ej BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance cove rage required b Chapter 142 of the q Y p Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER - AGENT �0 SIGNATURE OF OWNER OR AGENT R 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 complia inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NA e C .-_.._ ,._®__._ �_ ..._ �N.. _.-LICENSE# _ I SIGNATURE MP ET", JP O,_( CORPORATION[I#� � _ I PARTNERSHIP __i# _ I LLC D� - �}_ COMPANY NAME _ ®c t ]ADDRESS O ©X CITY t 'STATE ZIP LP,310 7 TEL FAX _ ______€ CELL o3S- (Q EMAIL I ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes Ao. THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 0Washingtoneet 6 D Str Boston,AM 02111 UT. www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �® (11,14 �5::F� * fft%e::�: Address: / ` 0 Y d V City/State/Zip: e 3-0 29 Phone#: (a 03- T- FY�Y Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.$ E]Remodeling ship and have no employees These sub-contractors have 8. [Demolition working for me in any capacity. workers' comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' comp.insurance required.] 13F]Other `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site reformation. nsurance Company Name: �'�� 2Nt 'olicy#or Self-ins.Lic.M Expiration Date: ob Site Address: �� J i�fi h �5 /• e City/State/Zip: A10 Utach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 ,f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certify c s and penalties of perjury that the information provided above is true and correct. i ature: Date: hone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees s 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M.A.02111 Tel.#617-727-4900 ext 406 or. 1-877-MASSAFE evised 5-26-05 Fax#617-727-7749 www,mass.gov/dia October 28, 2011 Charles E. Camirand II 101 Shiloh Street Branson,MO 65616-7724 Reg: I I9_High Street,North,Andover,MA 01845 Dear Mr. Camirand, Please be advised,a recent visit to your property revealed that a Building Permit was never issued for the illegal basement dwelling unit and that renovations are being done to the interior of your home. The Massachusetts Building Code 780 CMR 105.1 Permit Applications: (It shall be unlawful to construct, reconstruct, alter,repair, change use occupancy;which is regulated by 780CMR without first filing a written application with a building official and obtaining the required building permit and all other required permits therefore). Occupying a structure without a Certificate of Occupancy is a violation of the Massachusetts Building code 780CMR, and the Town of North Andover Zoning Bylaw. You must discontinue this illegal use and Occupancy and remove the illegal apartment immediately and obtain a building permit for renovations. Thank you for your attention to this matter. If you have any questions,please call the office of the Building Department at 978-688-9545. Very truly yours, Gerald Brown,Inspector of Buildings Building Department cc: Curt Bellavance/Comm.Development Susan Sawyer/Health Dept. mi/Desktop/Gerry pORTH q O '6� .�.0 1O ti _ Town of North Andover 1600 Osgood Street Bldg.20 Suite 2-36 �9SSACHUSNorth Andover,MA 01845 Phone: 978-688-9545 Fax: 978-688-9542 Gerald Brown,Inspector of Buildings October 28,2011 Charles E. Camirand I1 101 Shiloh Street Branson,MO 65616-7724 Reg: 119 High Street,North Andover, MA 01845 Dear Mr. Camirand, Please be advised, a recent visit to your property revealed that a Building Permit was never issued for the illegal basement dwelling unit and that renovations are being done to the interior of your home. The Massachusetts Building Code 780 CMR 105.1 Permit Applications: (It shall be unlawful to construct, reconstruct, alter,repair, change use occupancy; which is regulated by 780CMR without first filing a written application with a building official and obtaining the required building permit and all other required permits therefore). Occupying a structure without a Certificate of Occupancy is a violation of the Massachusetts Building code 7E0CM>Z, and the Town of North Andover Zoning Bylaw. You must discontinue this illegal use and Occupancy and remove the illegal apartment immediately and obtain a building permit for renovations. Thank you for your attention to this matter. If you have any questions,please call the office of the Building Department at 978-688-9545. Very truly yours, Gera d Brown, Inspector of Buildings Building Department cc: Curt Bellavance/Comm. Development Susan Sawyer/Health Dept. mi/Desktop/Gerry Residential Property Record Card PARCEL ID:210/067.0-0073-0000.0 MAP:067.0 BLOCK:0073 LOT:0000.0 PARCEL ADDRESS:119 HIGH STREET FY:2011 PARCEL INFORMATION Use=Code: -10.1 Sale'Pnce 1 Book 10475 RRoad Type:�r TInspect Date: 05/1'4/2003' _.. Tax ClassT_ Sale Date 11/03/06Page 248 Rd Condition: P Meas Date 05%14/2003 Owner. - CAMIRAND,SUDHA Tot Fin Area 2075.Sale Type_�P Cert/Doc. "` Traffic M Entrance = C"�' _ CAMIRAND,CHARLES Tot Land Area 0 17 Sale Valid:_-A -` " Water Collect Id RRC 4 _ Grantor -CAMIRAND SUDHA _-_ _ Sewer: Inspect Reas:_ C___ Address: ®-_. .4 a. ee- -.. __ _ . a�.w-.:. 4 - - - - - Q 119 HIGH STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CO Tot Rooms: 8 Main°Fn Area: 1475 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R4 u., �.8--M inT Sto _Hei ht. 2.00 Bedrooms: 4 U Fn Area: 600.-._Bsmt Area: 875 V Seg i�Type: Code .Method Sq-Ft Acres Influ-Y/N Value Class . -" _�" ' 1 P 101 S 75470.170 _ " 156,033 - Roof:` G Full Batfis: 2 Add Fn Area: Fri Bsmt:Aea: Ext Wall:_ AV Half Baths: Unfin Area Bsmf Grade. DETACHED STRUCTURE INFORMATION Fo'_sonry Tnm: Ezt`Bath Fix:_ 0 Tot Fin Asea: 2075 5tr Unit Msr 1 Msr 2 E-YR-Blt Grade Cond%Good_-P/F/tA—Cost '—Class Ma undation: _CN Bath Qual - T s �RCNLD: 139805 - _-� - -� - - - .ua. �----- �-- -�-- PA S 177 0.00 1999 A A /50//47 1,700 1 Ketch:Qual T Eff Yr Built . 1962 =PMkt Adj: .r_ �.-. Heat Type: HW_ Ext Kitc' K Year Built -1950 Sound Value h VALUATION INFORMATION FuelType:` -G Grade: A 'Cost'Bldg � 139,800 Current Total: 297,500 Bldg: 141,500 Land: 156,000 MktLnd: 156,000 _ . .. Fireplace: 0 Bsmt Gar Cap�$Condition A Att Str Val1: Prior Total: 299,500 Bldg: 143,500 Land: 156,000 MktLnd: 156,000 _ -- y., _ Central Ac:- N Bsmt Gar SF 455 Pct Complete: Att Str Val2� _- __.x �.- `%Good P/F%E/R: /100/100/72 Porch Type Porch Area Porch Grade Factor W 254 SKETCH PHOTO _w s 2 ------ 24S gFt Fu 600 Sq . Ft - _.. 2:4. Z4 W., = ._ FM - 34 1475 SgFt I♦�� s _ 49a _ . �f j B X30 �h:4ss Sq 420 Sq� _ 2'S 119 HIGH STREET 13 Parcel ID:210/067.0-0073-0000.0 as of 10/25/11 Page 1 of 1 Date.,3:"�$.:� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i � a This certifies that C bCqu-,Ae )>,r— has permission to perform . . P . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . rnan?r ray S at. . .1 I q . �� h. . . . . . . . . . . . . . . . .. No -h Andover, Mass. f -41. 6 Lb �'• 7rozZ i �........_. Fee.� ./.•. Lic. No.��. . . . . . . ! . . . PLUMBIN. INSPECTOR Check # 6406 MASSACHUSETTS UNIFORM AP LIGATION FOR PERMIT TO DO PLUMBING �J Print of Type) AnM>t�s 0ate3°a$-0S 11l►'bov Pcmtitt lx lJ Building Locatlon 11G H 134 AST. Owners Name I ` W- 4nc� r' m A c71 y; Type of Occupeutcy &St r P A New O Renovation Replacement O Plans Submitted: Yes O No O FIXTURES = 01 < _ Z a tl tl tl O Z = > W tl .� W tl Z tl K a < ~ ^Id z O 2 tl 6 Wtl a2V = a o a O W C < ~ tl Z O i tl = 6 O. C O a W �. W tl O Ir .J tl C F Y O C O k a t V > �Z„ = 6 ; a t Z O p tl Z Z W T O V S < K' < Z tl tl. i < O < d K e a 6 < O < F is SUB-8SMT. BASEMENT IST FLOOR . 2ND FLOOR. ORD FLOOR 4TH FLOOR STN FLOOR eTH FLOOR 7TH FLOOR • STH FLOOR TI ` Installing Company Name C. Cheek one:. Certificate Address 11- Q. ST(bAVJ1ZQk\-k t1-, 1.1)E (L1,, OCorporat)on -- _ MC L6)A%x,,, • N 1 k . U 3 0 G n -0 Partnership R* Business Telephone 01 O hrrn/Co. 1 Name of Licensed Plumber A} (LC`nyA n !'.Vt INSURANCE COVERAGE- y I have a current liability Insurarp�policy or b substantial equivalent which meets the requirements of MGL CIL 142. Yes 13 No Q It you have checked yo.please Indieate the type coverage by checking the appropriate boat A liability tnsuance policy ❑ Other type of Indemnity O Bond O OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by [MChantarlofheMass.,,Geneal Laws.and that my signature on this pemtlt application waives this requlremertL Cick one:Owner (9Agent Ow s I hereby oerNfy that an of Ute details and information I have submttled(or entered)in above appriiatim we true and soarrate to the best of my know dpe arta that 91 Plumbup work and installations PetWMW raider tM permit k uW for this aWkstion will be In oompl'utna with all pertirtertt provislans of the Massachusetts Statepvde an Cod 01apter 142 of the General Lays. 8y ,/ a?il'34Git '�Irr..�� n lure of LMW Mumber rtUe Type of I.ioense:Master❑ .burrisyrttart tixnse Number 5 i Mwnt D NOV0 ANDOVER ENT IN WITNESS THEREOF, the parties hereto execute this Agreement as of tha Public Clinic: Signature i Print-Now ,. Print Title: UMMS: Signature: Marc Thibodeau Director, Center for Health Care Financing Commonwealth Medicine l i 1 I i' 4 i Residential Property Record Card PARCEL ID:210/067.0-0073-0000.0 MAP:067.0 BLOCK:0073 LOT:0000.0 PARCEL ADDRESS:119 HIGH STREET FY:2011 PARCEL INFORMATION Use-Code: 101 Sale Price: 1 ^ Book: 10475 Road Type: T Inspect Date: 05/14/2003 Tax Class: ' T Sale Date: 11_/03/06 Page: 248 Rd Condition: P Meas Date: 05/14/2003 Owner: Tot Fin Area: 2075 Sale Type: P Cert/Doc: Traffic: M Entrance: C CAMIRAND,SUDHA Tot Land Area: 0.17 Sale Valid: A Water: Collect Id: RRC CAMIRAND,CHARLES Grantor: CAMIRAND,SUDHA Sewer: Inspect Reas: C Address: 119 HIGH STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CO Tot Rooms: 8 Main Fn Area: 1475 Attic: i NBHD CODE: 5 NBHD CLASS: 5 ZONE: R4 Story Height: 2.00 Bedrooms: 4 Up Fn Area: 600 Bsmt Area: 875 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 7547 0.170 156,033 Ext Wall: AV Half Baths: Unfin Area: Bsmt'Grade: DETACHED STRUCTURE INFORMATION Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 2075 Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond%Good P/F/E/R Cost Class Foundation: CN Bath Qual: T RCNLD: 139805 PA S 177 0.00 1999 A A /50//47 1,700 1 Kitch Qual: T Eff Yr Built: 1962 Mkt Adj: Heat Type: HW Ext Kitch: Year Built: 1950 Sound Value: VALUATION INFORMATION Fuel Type: G Grade: A Cost Bldg: 139,800 Current Total: 297,500 Bldg: 141,500 Land: 156,000 MktLnd: 156,000 Fireplace: 0 Bsmt Gar Cap: Condition: A Att Str Val 1: Prior Total: 299,500 Bldg:, 143,500 Land: 156,000 MktLnd: 156,000 Central AC: N Bsmt Gar SF: 455 Pct Complete: Att Str Va12: Att Gar SF: %oGood P/F/E/R: /100/100/72 Porch Type Porch Area Porch Grade Factor W 254 SKETCH PHOTO s 224 SgFt 25 FU —T 600 SgFt — 24. 24 FM 34 1475 SgFt ■■� 19 25 12 49 , - e �o ggFt 45s Sg 42o Sg ' a rw - 35 35 35 25 119 HIGH STREET $h -Parcel ID:210/067.0-0073-0000.0 as of 10/6/11 Page 1 of 1 Location I t t _ No. .� 3 Date NORTFTOWN OF NORTH ANDOVER AL Certificate of Occupancy $ cNust CHU I Building/Frame Permit Fee $ s�► Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � s 18 (- 60 ✓ 'Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMj�OLIISH w�A�ONE OR TWO FAMILY DWELLING . KaN 1111a ,iBE VltR.1�E[ xr - 5 _.s BUILDING PERMIT NUMBER: J-f— DATE ISSUED: SIGNATURE: Building Commissieder/Inspector of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: \ vel 1 Map Number Parcel Number 1.3 Zoning Information: V 1.4 Property Dimensions: Zoning Diiiic_t Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record r , W _ _ I Na a(Print) Address for Service F/�l Signature�� 2.2 Owner of Record: I •Name Print Address for Service: r Si ,lure Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: 0. License Number Address >s Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ t t Company Name M Registration Number r Address r . Expiration Date e�'1 Signature Telephone Y� t SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No......bCi SECTION 5 Description of Proposed Work check as applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 / v Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I• as Owner/Authorized Agent of subject property Hereby authorize_ to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ' I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 S7 2 No 3 RD SPAN DIMENSIONS OF SII,LS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X - i} MATERIAL OF CHI34NEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE • NpRTM TOWN OF NORTH ANDOVER OFFICE OF " A BUILDING DEPARTMENT 400 Osgood Street ,;, North Andover, Massachusetts 01845 ,SJACFWS�� D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE:- JOB LOCATION: Num6r Street Address `p Map/Lot HOMEOWNER Namb Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE __;4 APPROVAL OF BUILDING OFFICIAL I no.01.)OF.AITEALS6X80541 IIF„AI;f1IOX-9540 PIANN'1\6(iRS 9535 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT�uCl�0. Corn�Raat> PHONE LOCATION: Assessor's Map Number (o PARCEL c'UO'? SUBDIVISION �` LOT(S) STREET l��e& ST. NUMBER I l� OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED ' DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revl"d 9187 Jm VIM The Commonwealth of Massachusetts > Department of Industrial Accidents Of s of Investigations Boston, Mass. 02111 Workers CorrrPensaUW Insurance Affidn* Nares Please Print Name: A 0,\nc.-r\t�5 Cc"M\Ro"n►D L C� r, c U4LfZ C. C t84 Phone- 918 '68a_0L3 I am a homeowner perloffnirfg all work myself. C,e.11 603 -6-70 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. Company name: Address City: Phone Insurance.Co. Pokkv! Company name: Address C ft Phone# PoYcv f Felkwe to semre coverage m requlrod under Seudion 25A or MGL 152 can lead to"kiwaitton d crhnind arrdror one years'imp hcNin ent_n.wd.as.chiN.RaoeNnJn ftf=dA STOP WDRK ORL1ER.nd a.fln d.(;pa1�d.a Ane up to$1,5W.00 �-ady►agalost.ma I understand that a copy of this stdammt may be forwarded to the Offlos of Inveadgadons of the DIA for coverage verHicadon. I do hereby corny under nue patine and pemOn or per/ury Mar Me lnlbnrradon provldbd above is drug and career. Signaturs."r Date Print name �o.r+�� Pune# 41B AWL 1 31 Offidol use only do not wrRe in this area to be completed by city or town dfidaf City or Town ai ❑ ❑Check Mlmmedlele uespouus<b regwirod Building Dept ❑ Lkenft Board ❑ Selectmen's Offke conracr person: Phone tr ❑ Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision 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 a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: C-11�-ezlra (—LocatiorObf Facility) X Signature of Permit Applicant . x Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTIy Town of 4Andover _ /00 LA dover, Mass., 3 COCKICKEWICK y�. 7d A0 ATED 7`s BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D �.� C "a Mw �� BUILDING INSPECTOR THISCERTIFIES THATI 61 V...... .. .................. . .................................................................. ............................ Foundation 1 has permission to erect....rl. !. �.. Nf �......... buildin son... � pe ........ ....... $ ..�. .................�. . ...................................... Rough to be occupied as p la�. r•O..M!!...... .� I. 7%. ..... Chimney ... ........ i * provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws rel Ing to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ` � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI S '1' ELECTRICAL INSPECTOR Rough . Service . .. . ... ......... ......... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burnet Street No. SEE REVERSE SIDE Smoke Det. Location 1 - - No. Date 4 0. NOR, TOWN OF NORTH ANDOVER F a Certificate of Occupancy $ Building/Frame Permit Fee $ �'�s''••°•''�� Foundation Permit Fee $ s�CNusE rPermit Fee $ Sewer Connection Fee $ Water Connection Fee $ • TOTAL $ Building Inspector 12664 Div. Public Works Location No. � �� '� ,( Date Ant' l f GRT" TOWN OF NORTH ANDOVER ? •. • LA Certificate of Occupancy $ Building/Frame Permit Fee $ y�s'••a°''<� Foundation Permit Fee $ s�cHusE - -Other Permit Fee $ G Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector • ` " Div. Public Works PERM IT NO. APPLICATION FOR PERMIT TO BUILD********NORTII ANDOVER, MA NI%P NO. ©1Q / O LOT.NO. 1J©®a O 2. RECORD OF OWNERSIIIP DATE BOOK PAGE ZONE �[JSUB DIS'. LOT NO. 1 , LQ LOCAIION ��� PURP()S1=()FBI)IIDING -` OWNER'S NAME L ,QlC NO.OF ST(CIES U SIZE- i AVNF.R'S ADDRESS l H VSH ST Mir BASEMEN(OR SLAB Nr) RD ARCI 111 EC1'S NAME SIZE OF FLOOR TIMBERS I 2 3 00/7 [3111LDER'S NAME SPAN DISI ANCE TONEAREST BUILDING DII IENSI(N1S Of SILLS DIS I'ANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDESCC) REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE IIEIGIrr Of FOUNDATION T1IICKNESS IS BUILDING NEW SIZE OF I(XYIING X IS BUILDING ADDITION MATERIAL.(Y CI IIJANE Y IS BIJILDING ALTERATION IS BUILDING ON SO.IDO2 FILLED LAND L WILL BUILDING CONFORM TO RE"JIREMENTS OF CODE IS BUILDING CONNECIED'1 O TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDINGCONNECTEDTOTOWNSEWER IS BUILDING CONNECT ED TO NATURAL.GAS LINE INSIAW'FIONS 3. PROPF1111'1NFOR111A110N LAND COSI cc^^ ESI. BLDG.COS r3�3/Jt� "� PCO I_ y7J.00 INSTALLAIRWO PA.E I FILL OUT SECTIONS 1-3 ESI'. BL.DG.COST PER SQ. FT. ES 1'. BLDG. COST PER ROOM ELECTRIC METERS MUST BE ON OtTI'SIDE OF BUILDING SEVIIC PERMIT NO. A1'1ACHED GARAGES MUST CONFORM'fOSTATEFIRE REGULATIONS $. APPROVED BY: low PLANS MUST BE FILED AND APPROVED BY BUILDING INSPE(7ToR BU11. )ING INSPECTOR )A I E FILED �1 OWNERS TEL# �C.J �� ! � � �✓ CONTR.I-IC# SIGNATURE OF O -R 1111 Atli T IORIZED AGENT " FEE S / L� �� ' PERMIT GRANTED 7/ f /UN 2 is 19 { vIJ,Y FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ***************************i**APPL�I�CANT FILLS OUT THIS SECTION************* W ********** APPLICANT ' ALP `� V ILDC— PHONE 00122 LOCATION: Assessor's Map Number PARCEL SUBDIVISION J' LOT (S) STREET_ l7 AST. NUMBER *************OFFICIAL USE ONLY***************�********* ZEENDATIONS OF TOWN AGENTS: TION ADMINI BATOR * DATE APPROVED ' DATE,REJECTED COMMENTS 1 TOWN PLANNER DATE APPROVED j� DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT ` FIRE DEPARTMENT 1 RECEIVED BY BUILDING INSPECTOR DATE i ' L 20` [\6-up� Town of North Andover 40RTH OFFICE OF a 01"'90 I e 100 3 , c COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street • _ r . o North Andover, Massachusetts 01845 ''.,,, WU LIAM J. SCOTT 9SSACHUS�t Director SWIMMING POOL REGULATIONS NOTE: PERMIT CARD SHALL BE POSTED IN A VISIBLE AND ACCESSIBLE LOCATION FOR OBTAINING THE VARIOUS INSPECTORS ' SIGNATIIRES. ALL SWIMMING POOLS IN EXCESS OF 2 FEET IN DEPTH ARE REQUIRED TO HAVE A BUILDING PERMIT AND CONFORM TO THE FOLLOWING REGULATIONS: 1. ELECTRIC: An electrical permit must be obtained prior to an application for a Building Permit to install a pool . 2 . ZONING: Pools shall be located to the rear of the front building line of the house and no closer than 10 feet to the side or rear lot line. 3 . HEALTH: a. Location from subsurface disposal system must be approved by the Board of Health. b. Semi-public and public pools must have plans approved by the Board of Health prior to construction and must also have an annual operating permit from the Board of Health. 4 . SAFETY: Pools must be enclosed by a suitable wall and fence, at least 4 feet in height with self-closing and latching gate that meets the approval of the Building Inspector. * No water allowed in pool until fence is erected. Pool cannot be used until inspected and approved by the Electrical Inspector and Building Inspector. I *Fencing on corner lots must be erected 20 ft. inside lot line. FEES: ELECTRICAL PERMIT - $35. 00 BUILDING PERMIT - 6.50 per thousand on estimated cost; 35. 00 minimum permit fee D. Robert Nicetta, Building Inspector I BOARD OF APPEALS 688-9541 BUMDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 x t'. T0w7N of NORTH ANDOVER �u AFFIDAVIT Catactrz Ian KL c. 142 E0. rad cries that the Itracartmizticri, alb, stn, fir, mQ3esrn�, mrx,gl � � cn, or ccrb-tortim of an a�L'im to any pte- eaos=$ L= , keg =tad rg at least are"but wt mze ti-�n far Uig ��� .cr to states finch ate kr h .'nidi rffi� Ct h: lthrg�' be da-p- by _.,g;ste e•1 � �n�1�1 C�I1 @ 1fI5� a11T� . Est: cosi Type of Work: 1 U` lt\) � 1 N �� E ' ' ,Address `6f Work I IQ HIGH ST J�1,/�Noov�2 , MIA alS�lS Owber Name: \` L�1-1 (/� s � I7a'te 'of. Permit Application: 3r I;hereby certify that: r Registration is not required for the following reason(s): car J. � ,. Work excluded by lav K , Date Job under $1,000 gulng not owner-occupied pi =Owner pulling own permit ` Other (specify) b - :No tice7 is hereby 'given that: 1 CARS pUII.a1G 'I>3ETR O4+'N PERNM OR DEALING WIZH IINREGLS'I�RED " FOR APPLICABLE EiCNE , GkRR DO tCr HAVE ACCESS TO THE ARBIIRA- i.t .' TION P ZGRAM OR QJARANIY:,SIP FM DNDr�R ( L c_ 142A_ y ' -- sigled Lrl�e_r pa-21 perjury: hereby apply for a' permi t as the agent or the owner �N Contractor Mame egistration `to. At Da to y ra .OR I hereby pp Ly for a permit as the ¢ Notwithstanding the above notice , owner of the above property 6-26 -fig #' Date :, ': wn e Name NORT/y Town of `_ - _ over 0 No. dover,r Mass., ( _19 / 0 s. LAKE CO CMI CNE WICK '9 AoR'� E� S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT....................................... ... .e............. . ./laig.................................................................... Foundation ............ o g2 buildings on !..�........ �. rG` �.... .�................ Rough has permission to erect. ..'�. ..............` g •••••••�• • ��• 1 .......` ...d ./`i �.........P AD..... ........................................................ Chimney to be occupied as....... .....:.�....�••�•••••.. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST S Rough ................................ .. ... . . .... ... ......... ......... . ........ Service BUILD INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector.' Burner Street No. Smoke Det. MORTGAGE INSPECTION PLAN 930402 NORTHERN ASSOCIATES, INC. 630 TURNPIKE STREET N.ANDOVER MA TEL . (508) 975-7117 FAX. (508) 688-6060 • �E MORTGAGOR t2ALPE 4 Lel I LDE DEED REF ADDRESS OF PRINCIPLE BUILDING PLAN REF. i9 j:�1&E-1 dw%zeis"T DATE OF INSPECTION:-J (,_ ��t��4 cam' zo N 1F Fi >u � oc�-�lotzo moo' k c-, is Y f I� t t Nlr-- t A rLVI 31, 144- .......... � µ x'1 .9 4 Certification to: This mortgage inspection was prepared in accordance with the Technical standards for Mortgage Loan Inspections as adopted by the Massachusetts Board of NOTE: This mortgage inspection was prepared Registration of Professional Engineers and Land specifically for mortgage purposes only and �0�� OF 414 Surveyors Surveyors 250 CMR 605. is not to be relied upon as a land or property �` �� I further state that in m � C �., y professional opinion that line survey. Building location and offsets i the structures shown conform with JAMES J.o v shown are specifically for zoning determination •` :r,� the local zoning horizontal dimensional setback only and not to be used to establish property1. C; A RELY requirements at the time of construction or are lines. The land shown hereon is based on L& 20 �' D exempt under provisions of H.G.L. CH. 40-A Sec. 7. referenced information noted end may be subject to further takings and easements. Northern ,�� l.Property/House is not in a Flood Hazard. Associates, Inc. accepts no responsibility for 2-Property/House is in a Flood Hazard Area. damages resulting from said reliance by anyone + `. ].Infornation is insufficient to determine other than the said mortgagee and its assigns i 'f:;% ;t!,:,`: `" Flood Hazard. connection with its proposed mortgage financing �'� ;.�, Flood Hazard determined f on 1 est Fed rnl flood to said mortgagor. Insurance Rate Mep Panel _ ate i No C ' Date.L!�.- ../ - 1 � . L NORY1{ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACH i This certifies that '-` /� -:�::' �' ''� ......1........... ...................................................... has permission to perform .................................................. wiring in the building of ",.0? .......................................... at....:�/. ........ 4...... ....:.. ......................... .North Andover,Mass. Fee.R.�'`'..!�..�.......... L.ic.No..9. ........��............................................................... ELECTRICAL INSPECTOR 06/12/9813:39 35.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 0"_ Office Use Only Permit No_ ?>��et7�1a!O�ifr�.r'TT<dl�SSri?e>�Sfi??S f Sammy FRz Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:09 (Please Print in ink or type all information) Date To the Inspectof of Wires: Town of North Andover The undersigned applies for a permit to perforin th electrical work de5cnbed h eIlow. Location(Street&Number Owner or Tenant Owner's Address _ Is this permit in conjunction with a building permit Yes/�/ No ❑ (Check Appropriate Box)) Purpose of Building /� Utility Authorization No. E)dsting Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity 'Location and Nature of Proposed Electrical Work Total No.of Light8ng Outlets No.of Hot fuse No.of Transformers KVA AboveIn ❑ No.of Lighting Fixtures SwimmingPool and and ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Bumers Battery Units h'tu.of Switch Outlets No of Gas Bumers FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices F Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Soace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heatinq Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Si ns Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts — sachusetts General Laws I have a current Liab ' 'Insurance Policy including Com ted Operations Coverage or its substantial equivalent YES " O = have submi id proof of same to the Office YES— NO If you have checked YES please indicate the type of covyLage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) / e Estimated Value of Electrical Work$ S-460 — (Expva n ate)— work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME 09 LIC.NO. Licensee G Signature t� LIC.NO. �f `' /T) Bus.Tel No. �03AIM Address• I��1 4 .L/'P�C��ZY Alt Tel.No. OWNER'S INSURANCE WAIVER:.l am aw that the Licenses s not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) COMMONWEALTH OF'MASSACHUS8T.Tr-;' . 11,4. OF EL-.E..C-.,R-I'CIANS AS A RE €fi ;CTRI ALTON W FiITCK=_= k r' ' P. 0 B 0 X 2dig: DERRY ttNH' 03038=-028,- . al