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Home My WebLink AboutMiscellaneous - 132 CRICKET LANE 4/30/2018 (2) b. e ter. r /� THENORFOLDC DIED -f1AMGROUN February 24, 2015 i FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1587685 Insured: STEVE CHANNEN AMY CHANNEN Address: 132 CRICKET LANE, NORTH ANDOVER, MA Policy No.: F0102043 Loss Date: 02/16/2015 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, Ima'aA 'N- 7?' ,�� Michelle M. Roust Senior Property Claims Examiner 1-800-688-1825 x1171 NORFOLK&DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Z Telephone:(800)688-1825 FITCHBURG MUTUAL INSURANCE CO. C@ Fax:(781)329-1818 Date.. ... .... - H°RTM TOWN OF NORTH ANDOVER • `` PERMIT FOR GAS INSTALLATION •" h SSAC HUSEt�( This certifies that . ti6'v�. .`L�! �?/��'. . . . . . . has permission for gas installation X.hlm-il in the buildings of . . . . . . . . at . �3 . .�� !? meqq . „S,1 . . . . .., North/�ndover�Maass. Fee. Zq�.�. Lic. No.f. v . . . ll.*4r�!. .l�'n t.!?9. . GASINSPECTOR Check# 07 7862 :VIASSACHUSEMUNIFORM APFUCATONFOR PERNI ff TO DO GAS HUNG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS -- Building Locations Permit# Amount$ Owner's Name CMi/e / 4,411AA New❑ Renovation ❑ Replacement Plans Submitted ' rO U F : O ` F W z O F q rn E-4 O O �;) O E+ OCn A { F 0 a w o w w 0.7 O 5 A U p0, O� tW, SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH . FLOOR 6TH. FLOOR 7TH. FLOOR , 8TH . FLOOR (Print or type) iL &2�y Ch�ec cone: Certificate Installing Company Name ja 0FA�/d�MOA i o6P jg_ZGr_7r �'Corp. Co . Address P Partner.. ,EG • D Business Te ep one — 3 Firm/Co: :Mame of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check o I have a current liability Insurance policy or it's substantial equivalent. Yes No 0 If you have checked yes,please jqAcate the type coverage by checking the appropriate.box. Liability insurance policy Other type of indemnity Bond13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the :Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 1:3 Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the- best of mt knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with.all pertinent provisions of the Massachusetts tate Gas Code and Cha r of the General Laws. By; bnaturr of Licensed Plumber Or Gas Fitter Title Plumber CityiTown [3 Gas Fittertc�'ense i um er Master .1PPROVED(OFFICE USE ONLY) H Journeyman . � �' ' i t i Tire Cour"nWedtJk oft assgcltuseus, �.. Depar7tiibit ofZirlrisirwAec dents Office gfLiva#gR#ons: U 600 Washr'pgton Street. n Boston,MA 02111 ` rptvrknrasi�gov/dla Woricerss Compensitioii-Ilnsurancc Affidavit:.BMderdid6ii racfoisMect ridans%Plumtiers_ Applicant Information'. . Please Print Leeibiv Nance(Budness1Ogpn'rzatimvbdividunQ:_AVj / /��f/�/!T ff �• Address:--a& AWJ�60A/ � :City/statelZip: Are ypu an employer?Check the appropriate,bo=-.. Type of-proiect.(required). 1. I am a employer with. 4 O.l*ua general coptracw.aad 1 employees(bill and/or pa"me).* 9.1m hired the 6: []New tmnstivction 2.❑ I am a sole proprietor or patfiter- •fisted on the aMw*d.sbeex . :.7•- Wieling shipand have no 1 _ Pse sub-contractors have $.. Demolition emp oyees._. . _.. [ .. working for me in any capacity. r.mployees and haveViorkers'-. 9. 0 Building addition (No workex_s'.con .insurance cow•ice•$ required.] 3: Q Wa are s corpora6oti-and its 10.0 lectricai iopairs or additions 3.0 I am a homeowner doing all work afters-haves exeiciseid't�s .1.1: .(-Plumbing repaus or additions• . myself,[No workers'camp. right of exemption perMCIL• 12.0 Roof Vairs . insurance required]t c. 152,§1(4) and we have no . . employees:lNo wo ' i3.136016r - . . -coutp� instirencerewim�i-] - ;"'�Y aPPlicam that box#t must also lin outdo sign beloir dowing theirworftas'ea' .— ou Policy talon radon. Hoy who submit this affidavit iod1cming they ore doing ail work and ion hire outside comm tba must submit anew affdavit'md'iea6ng such. =Coauactois tbot cbedc this 6wi must attadted atf�otml shxts) g tbe"aome,ot'•tbe�ors cad smte• ar not those esuitus have eaployees. If the sub-�rs bavc catpbyces,.dW nate Povide thea•Wokae camp.polky munber I am an employer drat is pro lift workers'compensadon hi wnuce for my employees. Bala>v is diepolicy andJob she information. Insurance Company Name: /01' Policy#or Self-ins.Lit:.#: Expiration Date: Job Site Address: City/Stafie/Zip: ��i� % ./�l�'Gl✓�f Attach a copy of the workers'compensation"poUcy dcelriratitin gage(showbig he polley=mber-and expiration date). Failure to secure coverage as required under Section 25A.of MO L c't52 caa lead to the imposition of criminal,penalties of a fine up to S1,500.00 and/or one-year iiaprisorirnenL es well as civI.penelties in the form of a'�"1'OP WORK ORDER and a fine of up to X50.00 a day aglinit the violatac. Be advised that a copy of this statiemelit-may be-foiwarded to the Office of Investigations of the DIA for insurarum.coverageyeMokdon. : 1 do hereby car.*, lite hr and penalties ofperfurq that fire infgrmation provldad alcove Is true and coarct.- . . . ...: . :,. :: ... .._� - Sign—sty Phone Oficial use only. Be not rt Me In this area,to he ceinPhNed by city or town offtdai City or Town: PermidLlcense# Issuing Authority(eirde one): . ` 1.Board of Health 2.Building Departm-ent 3.City/Town Clerk 4.Electrical Inspector S-Plumbing Inspector 6.Other i Contact Person: Phone#: .'f. . a : . _1�Pf�LU 'S A`11iD-GA`SFCT�ERS` REGISTERED ASA.PLUMBING CORP °: GEORGE R LAROSE ANDOVER PLUMBING 8 HEATING C . ' -20 'AEGEAN DR ° . :_=:UNIT 10 =:- METHUEN MA 01.844-1580.' 2122 05%01/12 '- .- ,784263:, LICENSED IADS A J URN UM , f�L- INfBEft'AND tiIT 'BRS LICENSED AS A MASTER PLUMBER RGE .R LAROSE GEORGE R LAROSE ---_.-:44ODILE .ST = 44 :WILE STREET \- - �D :METHUENMA: :0`1844-4233; METHUEN MA 01844-4233. 18725 05/01/12 784282 • 4983 05/Ql/12' 78428 _' - -- JE*� CERTIFICATE OF LIABILITY INSURANCE OP ID RM DATE(MMIDDIYYM 10/25/11 ,THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cats holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. ,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights.to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Macdonald & Panglone Insurance PHONE kX P.O. Box 428 - No Ext: — M.NO):_ 104 Main Street ADDRESS: North Andover MA 01845 PKUDMEK CUSTOMER1De: ANDOV-7 Phone:978-688-6921 Fax:978-688-5350 INSURER(S)AFFORDING COVERAGE Noce INSURED INSURERA: Utica Mutual .Insurance Co Andover Plumbing & Heating Co INSURER B: Trawlers casualty c surety PL 31194 PO Box 262 -. Andover MA INSURER C: _ INSURER D: _ INSURER E: -- INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PENTAML THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. SK LTR TYPE OF INSURANCE MR POUCYNUMBBt (MM M LIMITS GENERAL LIABILITY EACH OCCURRENCE $1 000 000 A X COMMERCIAL GENERAL LIABILITY TBD !10/26/11 10/26/12 1Pu=lSES(Ea oeasrence) $100TORENTED 000 CUUAAS MADE rjgi OCCUR t MED EXP(Any one persm) $5,000 { PERSONAL&ADV INJURY $1,000,000_ GENERAL AGGREGATE s2,000,000 _ GEM AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPlOPAGG s2,000,000 X POLICY JEC LOC S AUTOMORMUABIUTY COMBINED LIMIT aS1,000,000 ANY AUTO II ) BODILY INJURY(Per pwson) i A SCHOWNED EDULEOA OOS BA-7A965705 10/26/11 10/26/12 BODILY TYDA (Pereccidmn) $ HIRED AUTOS PR r acckl DAMAGE 5 (Per accident) NON-OWNEDAUTOS S i A X UMBRELLA LIAB ][ OCCUR TSD 10/26/11 10/26/12 EACH OCCURRENCE S1,000,000 EXCESS LIAB CLAIMS•MAOE AGGREGATE 51 000,000 DEDUCTIBLE ! i RETENTION $ -- A W13 UIERS AND EMPLOVERS'LIABILITY YIN TBD 10/26/11 10/26/12 i –TORY LIMITS VVGSTATU- X ER ANY PROPRMTORIPARTNERIEXECUTIVED EL EACH ACCIDENT 1$500,00O OFFICERIMEMBEREXCLUDED? MIA _ (MamlatorykNH) E.LDISEASE-EAEMPLOYEE s500,000 DESCR OF'OPERATIONSbeiow EL DISEASE-POLICYLMIT Is50O 000 J. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101.Additional Remarks Schedule.H mons space is required) Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EMRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Plumbing & Gas Inspector Building Dept AUTHOREED REPRESENTATIVE 1600 Osgood St Bldg 20 #2-36 North Andover MA 01845 g ®1988-2009 ACORD CORPORATION. All Nights reserved. ACORD 25(2WWO9) The ACORD Tame and logo are registered marks of ACORD 9 , 60 Date TOWN OF NORTH ANDOVER • PERMIT FOR PLUMBING ,SSACHUS� 'f _� / This certifies that . /7/�? �!l!�?!�. �7d`�? ..�. . . . . . has permission to perform plumbing in the buildings of �/. !l. . . . . . . . � at. . .67,e TZ�'e . . ,�North Andover, Mass. Fee. O,.Ov .Lic. No.. �FC� !d��.✓4/!. . ter. �. . . . . PLUMBING INSPECTOR Check # `� ING MASSACHUSETTS UNIFORM"PLICATION FOR PERMIT TO D O PL1D'M 3 (T)?pe or print) NOF,MANDO'VER,MA.SSACHUSETIS Date D BuildingLocafion �� / � Owners Name cs �/.� /V/1/.E� Amount _ Type of Occnpancy • l..Jl New II Renovation � Replacement � Plans Submitted Yes NO - FDKTURES 12 crrn rf a C S�-RSlY� R44i1V�1Vi' - . •�ECO[R ._ 41EBLD0:2 , SISIISJCR 6ISROM 7TSM OM SiSFtlOQt � Check e- Certificate Watortype) ��/// E �f il/ .�i�' . Corp. Installing CompanyName .� Address ElPartner. ,E D Firm/Co. BusnessTelephone_ Name oflacensed Plumber. Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate bo�cBond Liability insurance policy Other type of indemnity. :insurance Waiver: L the undersigned,have been made aware that the licensee ofthis application does not hale any one ofthe above threeinsuzance _ i azure Owner F Agent gu II T hereby certify that all ofthe details and information I have submitted(or entered)in above application are.trae and accurate to the , best of myknowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts a Phmabin a 142 ofthe General Laws. By; -Signimne o ce um er Type ofPlumbing License 'Iitla City/Town �e um�� Master Journeyman .APPROVED(omm USE ONLY ��/��.� R -- x 11 t h Date.. ...............�.:." NORT1{ °�,"`°:•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,sSACMUSEt This certifies that ........... .-, ............ . ............................. {has permission to perform .....:�''�:�*-�- - ��'........�'"�-+ -- ...... wiring in the building of .f ................-�.. f at/.--' / �'� X ................ .North Andover,Mass. Fee-:'<t'............... Lic.No.... ......... �.�-c°� ELECTRICALINSPECTOR Chett��c}}k # Of 4P Tommnur<upalO of Massar4uspus Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �SZ� = ri (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: J2 City or Town of: OR*rll 14- p HOZ To the Inspector of Wires: By this application of the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) )3 2 C a 16!b<-E /_ /V Owner or Tenant 7-/7-V E A G 1-1,4 A/A,/EV Telephone Nol�c X 4�� i Owner's Address .SA/Li F Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building _S I N6rLE A1141 )" 6�2tif1=- 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: W 11Zl7Y Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.o3 Lighting Fixtures Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets /9 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detectionand F Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pum I Tons I No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.of 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. INSURANCE COVERAGE:Unless waived by the owne•. io permit for the performance of electrical work may be issued unless the licensee pro- vides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such cov- erage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE lX BOND❑ OTHER❑(Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) xpi a io ate) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: CONTINO ELECTRIC ' LIC.NO.: 19 o , A 1�8� Licensee: LOUIS CONT I NO Signature --PIP LIC.NO.: E 2 8 7 8 8 (if applicable, enter'exempt"in the license number line.) Bus.Tel.No.: 978-363-5420 Address: 1 T)nNClNr n N T)R T��F W F 4T tUFr URY 019 8 5Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law.By my signature below, I hereby waive this requirement.I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: FORM F.P.11 HOBBS&WARREN-BOSTON (REV.11/991 Location No. OO A Date v 115 3 AO TN TOWN OF NORTH ANDOVER Certificate of Occupancy $ �'�b'•'°''�t�' Building/Frame Permit Fee $ sswCMU Foundation Permit Fee $ Other Permit Fee $ ..v TOTAL $ �� Check #1-� i665 " 1 Building Inspeto, J TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING VC Tis for Ffici3ld Use Un1 BUILDING PERMIT NUMBER: 3 DATE ISSUED. , _ a C � SIGNATURE: A .� Building Commissioner/inspector of Buildings Date C? c/ 'U Z SECTION 1-SITE INFORMATION O LI Property Address: 1.2 Assessors Map and Parcel Number: 1.3Q ei-�'C�� X rl, 037,0 03a g Bo D JMap Number Parcel Number da-117 /�,o��v�ly�, _f 1.3 Zoning Information: 1.4 Property Dimensions: / (� Zoning Disti ict Proposed Use pLot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 30 3 p 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public K Private 0 Zone Outside Flood Zone Municipal ❑ On Site Disposal System SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service: Qj1 Signature Telephone +� 2.2 Owner of Record: Name Pri Address for Service: O Z M Signature Tele hone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: C S 7,2 y,�;7 O License Number /2 &/�c.�r'o Sr ,vim, /�,r�DovG�-� vl�!. Address li ' Expifation Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r Address r z Expiration Date Signature Telephone Q 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......V No.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ,I Specify Tf�s4netrt /s";„;SN Brief Description of Proposed Work: �-4.,�Jr9�z y" t�/��Gj , IfLC'Gf.�.i t jf,.lt� He^df} y✓f'✓�?a SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee �O dod. Multiplier 2 Electrical (b) Estimated Total Cost of / r Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 // Check Nuunber SECTION 7a OWNER AUTHOR ZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,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 1, 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 Siature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1SIF2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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 S7r-✓CA*1 64-01 PHONE LOCATION: Assessor's Map Number /��o� C��'C�cf�n/. PARCELO 0 ,OD3aS Odd �� SUBDIVISION LVQJ c-1Gv�'jyeLOTS) STREET ST.NUMBER /c3� ************************************OFFICIAL USE ONLY************ ******** ***** * ** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED n rn� LC DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED C Z b ( it DATE REJECTED n COMMENTS N U IQ�rr W- -C U t� PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT i RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm et,D115064r �Atf � 3 2 GarGKES L� 'S o /too w 1G , x �oopS l . � ...•• u '� ,J� U/IN77/I7tO'ItII/CCLUiG �.� �LII.dG'(.L6 ,F.Ja.s•.o I° BOARD OF BUILDING REGULATIONS_ ;x._. License: CONSTRUCTION SUPERVISOR Number: CS 072.487 Birthdate: 03/22/1960 Expires: 03/22/2004 Ta no: 19067 Restricted: 00 ` MATTHEWF DESMOND �/ 31 UPLAND ST (. «� N ANDOVER; MA 01845 z Administrator w The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers'Compensation Insurance Affidavit 07M Sy 9. Name Please Print Name: leigrf �dfs.rfa,✓� Location: /9 ` &,fxg 1 f City Al d, . 4ke0vrl,,4 Phone # 97� 1,gV-2 9.s l am a homeowner performing all work myself. 1 am a sole proprietor and have no one werking in any capacity 1 am an employer providing workers'compensation for my employees working on this job. Company name. Address City Phone#- Insurance Co. Policy ComRM name: Address. . Cl ii` Phong* Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGI.152 can lead to"imposition of c rkdnal petaltim of afine up to 51;50 and/or one Years'knprisonment-as vmI.as l p as s�ol6eSarm a�]QP fiae�f lOA ppj�dagF tee. understand that a copy of this statement may beforwarded to the Orrice of Imestigatkm of the DIA for coueFa9e verification. /do hereby cr y undsr the pam and penalties of perjury that the V3bJ7WdW provided above is bye and connect Signature Date Print name pine Official use only do not write in this area to be completed by city or town officiar City or Town Prru�lisi Building Dept ElCheck d immediate response is required Ecensirtgr Beal SeleCh7rd S O Contact person: Phone# Health Departf Ei Other NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-954 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: i .i6 (Location of Facility) 7signature of Permit Applicant f°a� 3 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTH Town oover f 0 No. 3oa L COCHdover, Mass., IC I 0'%ATED H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System P---* V.V Y ! U 4. N 4 A bf C' A s)AO PJ W BUILDING INSPECTOR THISCERTIFIES THAT...... .....................................................Y.....................I............I....................................................... Foundation * - e,&4 1A AS IL ...... Rough has permission to mW .......... buildings on ....../a Can a Je AD Chimney tobe occupied as..........RCC 9;......k...pp�m............ ........................................................................................... 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. 34643678 4 /4;so dow PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ouService ................ ...............I.......... 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. Burner Street NO. SEE REVERSE SIDE Smoke Det. 1 � MASSA I APP CATON FOR PFR UT TO DO GAS FITTING Type or print) _PARCEL _ Date 19p0J NORTH ANDO ^ // j Building Locations � / — 62,--C(1c.; `�-•� Permit# Amount S Owner's Name LZ rt New Renovation ❑ ReplacementElPlans Submitted ❑ n LU t5 IL n :C N �w F WW n W Z .W-. V Z 'C W -.1. .� �L. . ^ n ^ Z C Z '� C SU8-8ASE ,M ENT BASE .M ENT Is,r. FLOGR ZN0 . FLOOR it D . FLOG R 1'r ll . FLOG R ST ll . FLOGR 6'r ll . EF1O O R 7'r ll . OG R s T I1 . FL O G R (Print or typ Check one: Certificate Installing Company Name v( o ❑ Corp. Address / ❑ Partner. Business T4ephone (/ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �-eAj#J(S L/ ,/– INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes' No❑ If you have checked ves,please indicate the type coverage by checking the appropriate bor. Liability insurance policv Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ agent ❑ I hereby certify that all of the details and information I have submitted(or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Ivlassachu State Gas Z� Cod d Cha r�the General Laws. .,.i Bv: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber f c� CitviTuwn ❑ Gas Fitter License Numoer Master APPROVED(oFF(c(.(jsE ONLY) rz umeyrnan 3 U� 7 Date.. � ". .4-...... NORTH TOWN OF NORTH ANDOVER pf"I.° I... O 3? ' p PERMIT FOR GAS INSTALLATION T 41 f A s ,'rSACHUSEt This certifies that . . . . . . 1. . � . . . . . . . . . . . has permission for gas installation • in the buildings of `G':• at . . . .! . :" ./ . . . ./. . . . .t :. . . . . . . . ., North Andover, Mass. Fee. . Lic. No.. . :. . .... . . . . . . . ... . . .r.-- .. . . . GASINSPECTOR V WHITE:Applicant CANARY:Building Dept. PINK:Treasurer Date. N° 1.. 65 HO 01 ..' h0 TOWN OF NORTH ANDOVER �,. o�.1 3: OL $ p PERMIT FOR PLUMBING ,$SACHUS� / 1 This certifies that S.�.�. . �1.�:./. r-. l-• . . . . .�. • . . .. . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . plumbing in the buildings of .. , . . . ./ P. at ./,. . .-1 Z. . . . .�. .C. .! - . .'.-1'?�. .1.4. . , North Andover, Mass. c Fee Lic. No..� L . . . . . . . . . . . . . 1- .�:t �. . . . . . . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PE MfT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS P�(;/06 Date Building Location F�. (� bwners Name Ptermit# � ZG� Amount Type of Occupancy New Renovation Replacement El Plans Submitted Yes ® No FIXTURES z w x z w H w H a z x w a w a a a Q+ r� H d H a SLRBgVE RksE M lS}r ROQt 211 ROQt �- 'M FIDQ2 M FIOCR 5M RDM 6IH ROM 71H ROM 91H RDQ2 (Print or type) Check one: Certificate Installing Company Name S U s a/ C �Le Corp. Address El Partner. Business Telephone cj�,� F--�7 j—� // / Firm/Co. Name of Licensed Plumber: PUN f tJ Insurance Coverage: Indicate type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent El I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work 9dinstallations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the sa usetts S e Plumb' Code Chapter 142 of the General Laws. By: SiViatureol CenSea Number Type of Plumbing License Title City/Townrcense (u—m�Se� Master Journeyman APPROVED(OFFICE USE ONLY �ORTFi �� D own of over 4Q � o dover, Mass.j/ l� l 1 VTL , C OC HI E � AORATED S 5� 7 BOARD OF HEALTH Food/KitchenPERMIT T /� Septic System ,"�Z'4—T C._.. T THIS CERTIFIES THAT...l�t�A 0 7'„ � !j............Aw As�� Cw BUILDING INSPECTOR .. ' Foundation has permission to erect.......... .......................... buildings ;Fi ... ... .... ..�. r ... �' Dgh �•52�''oP D� PSg NW, to be occupied as... � a �� .'I....V. ..... +� � imney 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. P99L IN rj/7 VIOLATION of the Zoning or Building Regulations Voids this Permit. 3 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONTRtJCTIOT� TS / ELECTRICAI�llVSICTGj R�� is C ervic � BUILDING INSPECTOR �J Fi Occupancy Permit Required to Occupy Building GAS INSP CTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. ` Smoke De SEE REVERSE SIDE