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Miscellaneous - 135 ACADEMY ROAD 4/30/2018 (2)
135 ACADEMY ROAD ' 2101096.0-0039-0000.0 l J `l i i I I I I I I I i North Andover Board of Assessors Public Access Page 1 of 1 MORTM North Andover Board of Assessors i i^oma �r• siroperty Record Card Click Seal To Retum Parcel ID:210/096.0-0039-0000.0 FY:2013 Community :North Andover SKETCH PHOTO J Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales �� �- Y Summary r Residence ! t Detached Structure Condo 135 ACADEMY ROAD Commercial Location: 135 ACADEMY ROAD Owner Name: PICKUL,DAVID C KIMBERLY W PICKUL Owner Address: 135 ACADEMY ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 7-7 Land Area: 0.96 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2549 sgft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 777,800 733,500 Building Value: 543,900 508,500 Land Value: 233,900 225,000 Market Land Value: 233,900 Chapter Land Value: LATEST SALE Sale Price: 720,000 Sale Date: 08/02/1999 Arms Length Sale Code: Y-YES-VALID Grantor: GREGORY HOPKINS Cert Doc: DOC 70996 Book: 00103 Page: 0121 http://csc-ma.us/PROPAPP/display.do?linkld=2256022&town=NandoverPubAcc 3/19/2013 Residential Property Record Card PARCEL ID:210/096.0-0039-0000.0 MAP:096.0 BLOCK:0039 LOT:0000.0 PARCEL ADDRESS:135 ACADEMY ROAD FY:2013 PARCEL INFORMATION Use-Code:. 101, Sale Price: 720,000 W Book: 00103 Road Type: T -Inspect Date' 05/19/2011 Owner: Tax Class T Sale Date: 08/02/99 Page: 0121 Rd Condition P Meas Date: 05/19/_2011 PICKUL,DAVID C Tot Fin Area 2549 Sale Type: P Cert/Doc: 60C 70996-Traffic M Entrance X KIMBERLY W PICKUL Tot Land Area: 0.96 Sale Valid: Y Water' Collect Id. RRC'_ �_ - __. W. _.., _ Address: Grantor: GREGORY HOPKINS Sewer`- Inspect Reas: " C 135 ACADEMY ROAD Exempt-B/L% / Resid-B/L%,100/100 Comm-B/LP/o Indust-B/L% I Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CO Tot Rooms: 7 Main Fn Area: 2549 Attic: Y NBHD CODE: 7 NBHD CLASS 7 ZONE: R3 StoryHeight: ®1.00 Bedrooms 4 Up Fn Area: Bsm_ t Area: 1674 S'eg Type ",Cod_e Method_Sq-Ft Acres Influ Y%N'- Value Class _ — 1 P 101 S 41840 0.960 _ 233,948 Roof G Full Baths: 2-''Add Fn Asea:4 f Fn Bsmt Area: 1656 Ext Wall _' AFB Half Baths: 1 Unfinikea: S95 Bsmt Grade: A Masonry Trim 22 "-Ext Bath Fix: 0 Tot Fin Area: 2549 " DETACHED STRUCTURE INFORMATION Foundation:W CN Bath Qua[: T _ RCNLD:� 514821 S6'_Llhit Mir-1' Msr-2 E-YR-BlfGrade Cond%Good'P/F/E/R Cos4" —'Class 7 SE S 80 0.00 1988 �A A ///85_ 4,000 Ki4ch Qual:` `T' EffYr Built: 1993 '_Mkt`Adl•' PC S 800 0.00 1988 A A 50///50 25,100 . Heat Type: HW—ExtKitch: Year Built: 1947 -Sound Value: F661-Type: O. _ Grade: V _ Cost-Bldd 514;800 VALUATION INFORMATION Fireplace:_ 1'--' Bsmt Gar Cap_ Condition__ V_ AttStr Val1: _ ; Current Total: 777,800 Bldg: 543,900 Land: 233,900 MktLnd: 233,900 Central AC: Y Bsmt Gar SF. Pct Com tete. Att Str Val2: Prior Total: 733,500 Bldg: 508,500 Land: 225,000 MktLnd: 225,000 Att Gar " 378%Good P/F/E/R. /100/100/92 Porch Type Porch Area Porch Grade Factor T 450 SKETCH PHOTO 10150S i 10 FM 450 Sq 11`117 10 16 145f U^0.25/FM/B u724Sq.R `' t> 1656 Sq.Ft L till 26 ' k � j. .Ft y, } 7 6 378 Sq. B 71 135 ACADEMY ROAD -- Parcel ID:210/096.0-0039-0000.0 as of 3/19/13 Page 1 of 1 Date... �..`... �—�................. pORT�y TOWN OF NORTH ANDOVER PERMIT FOR WIRING 88AC►rt155 This certifies that ..........L/.. has permission to perform ......kin . C. / C................................... ✓i ,G�d./...............................I...... wiring m the buildin of.........//e�,1..Id�.........r,�'........................... at ..._... ................... GC�.'?'.t....... el/. ... _ North Andover Ma s. _ !P ®........., , Fee....�� .�............Lic.Na - .... ���- ........ .......yy�� .' .... ELECTRICALIRSPECTOR Check# �L�� _ 11699 a Commonwealth of Massachusetts Official Use Only ` Permit No. V(D q1 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code WC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: f Zpl3 City or Town oh NORTH ANDOVER To the lnspecto fWires: ' By this application the undersigned gives notice o his or er intention to perform the electrical work described below. Location(Street&Number) /3CA f1i / P Owner or Tenant U , t C, Telephone No. ly Owner's Address Is this permit in conjunction wi h a building permit? Yes ❑ No (Check Appropriate Box) 1 Purpose of Building �/ayyi 1 Iy 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: CA O A/ 1 < G Completion of the following table may be waived by the Ins or of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of To al Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o-._o_ mergency Lighting rnd. grnd. Battery Units A`o.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I Number Tons KW . No.of Self-Contained Totals: ...................... Detection/Alertin 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 KW 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: Z O U(2 ITL 5:6 W1 46 Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El ctrical Work: -� (When required by municipal policy.) Work to Start: ZJr Inspections to be requested-in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability i/surance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cover e is in force,and has exhibited proof o ame to permit issuing office. CHECK ONE: INSURANCE BOND ElOTHER El (Specify:) 6 Icertify,tinder thep_a ;and penaltfs of erjury,t1:�dt tTte in ormation on this application is true and complete FIRM NAME: " �l v 6A elu LIC.NO.: j Licensee:oTWW, '�ZTOhA Signature AM LIC.NO.: (If applicable,enter "e in l ceps ,number li . ,, 11 Bus.Tel.No.A IT Address: j� W►G�L`PfLl No Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department o 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. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the ► permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed V on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, § 32,an ✓ electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. `a Permits shallbelimited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: p g SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed M Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed❑' Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL IN CTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors SignaturA-1 Date: DEB WEINHOLD ...TOWN OF MERR MAC,MA. .......dweinhold@townofinerrimac.com i i The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ib OL l Name(Business/Organization/Individual): `�y/�J(I "t_/r-G( ►Ll "�-� Address: - City/State/Zip&o AN�dm_ Phone#: Are an employer?Check�he appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑ 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.t 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 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.[:]Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. I u Insurance Company Name:. Policy#or Self-ins.Lie.#: V,!�060 Expiration Date: 3 Job Site Address: i 3 City/State/Zip: /uc, Attach a copy of the workers'compensatio olicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well.as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 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 other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston}MA 02111 TeX,#617-727-4900 ext 406 or 1-877.7MA.SSAFI Revised 5-26-05 Fax#617-727-7749 w .m.as$,govfdia >w 4 FoK Tien Detach Abhp N P9e0oraepns ACOMMONWEALTH OF MASSACHUSETTS � BOARD <- ELECTRICIANS EL REGtSTlERED MASTER ELECTRICIAN: TSSUeS T$ABOVE'tCe4SE TU: TYPE STEPHEN M .W BA III —A 555 SALEM ST ?W - i- I�EOttTIi �ANDOI/ER. KA 01845-316 � 8557" 8 6 - t Di a � —•py ;� - F Feta That,Damah mwv N pmbmf. —i Date. .. . .. .. . NORTIy 04 0 TOWN OF NORTHAJN'�OVER 0 PERMIT FOR GAS INSTALLATION 6 S-4cmus This certifies that . ,..k-,,,. has permission for gas.-installation in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. No GAS INSPECTOR Check# F� 6610 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date Yl 19z�� Permit# Building Location 4�5— Owner's Name O%.. F Type of Occupancy ' New ❑ Renovation ❑ Replacement(Z Plans Submitted: Yes❑ No ❑ N N W N Y Z cc v, (A N U y N R O N = F W W cc O U m F _ .n J N W F a u Q ¢ o Z) o r Cr 4 cc O O t- a m ur r :u w 0 a ¢ W Q {- to > Q N cc N C7 V w = V1 Z Q ¢ O O W W W N W Z Q = fL Q W cc W I W F' Y C7 }- Z J F' Z }. W W C7 O LL !- W J Z Q W d L F r N m Z O Z a: O �t�yq x a W > W Z, < cC Q < 0 0 W OF� O O G7 S LL. a 3 G 0 J U C Q d SUB—BSMT. BASEMENT ISTFLOOR 2NDFLOOR I 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7THFLOOR STH FLOOR Installing Company Name Check one: certificate Address 41KI VZ&Q! 6X Z-oqAA;- ❑ Corporation - W AAAle6(le-X— ❑ Partnership Business Telephone �` Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability Insurapce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No If you have checked ye, ease indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of a General Laws. By T License: Plumber ' n re of Licensed Plumber or Ga Fitter Title Gasfitter Master License Number City/Town Journeyman APPROVED(OFFICE USE ONLY) ' I BELOW FOR OFFICE USE.ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING 1 I NAME S TYPE OF BUILDING + LOCATION OF BUILDING PLUMBER OR GASFITTER { LIC. NO. I I PERMIT GRANTED DATE 19 GAS INSPECTOR i 1 Date//X-e'q9 14ORTN TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING "S'4040 This certifies that . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of(-7Z�/ ��. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . .5. . . . . . . . . . . . . . . . . . ."/:. . . . . . .. North Andover, Mass. F3 Fee. . . . . . . . .Lic. No.. . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check 7918 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) �,�-✓/%ey1�0�/� 1ylass. DateAk/Z200�Permit# �Q ``a r Building Location ` tro Owner's Name /�fJ41 'Ple4z C.,Owner Tel# VZ� G � Type of Occupancy /&�Fs ' New ❑ Renovation ❑ Replacement Plan Submitted: Yes 11 No ❑ F TURES P 4 - z z d J w0 z z a w x 3 0 z x � ti 0 '- d ¢ A w Q ¢ a x °�� ¢ a 0 a ° .4 a a a a d 0 < F 3 x a w o A a 3 x t~ 'n w [7 O A d 3 x a O SUB-BSMT BASEMENT 1sT FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7r"FLOOR rx Installing Company Name-fes C�/f �JC Check one: Certificate Address 76 ❑ Corporation ❑Partnership Business Telephone# 2©lS3 � � 6irm/Co. Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S 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: `J �f Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapte 42 of the General Laws. By . Si4l; of Licensed Plumber Title Type of License:Master Journeyman El City/Town APRLzl APPROVED(OFFICE USE ONLY) License Number Date... ........ ...... NOR1p °t<��"„•�"° TOWN OF NORTH ANDOVER 1 ' PERMIT FOR WIRING SA HUS This,cbrtifies that ....:.......f.! ��lJ, �t� �rt•-�. ................................ ........... .......... has permission to perform ......-- ..................................................................... .... � d wiring in the building of.-,., ............................................... at North Andover,Mass. Fee ............... Lic.No.fN�? ................Pic�m-��LINSPECR)Mzll e.� j Check # 0473 Commonwealth of Massachusetts Official Use Department O ly t Department of Fire Services Permit No. ?L1 Occupancy and Fee Checked O , BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts.Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of hi or her intent' n to perform the electrical work described below. Location(Street&Number) , Q Owner or Tenant ,orm,,c/ yC Telephone No. 576 .171 Owner's Address Is this permit in conjunction with a buil rg 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: C a 4$7 Completion of the followinjZ table 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 ElIn- El o.o 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 o.of Detection and Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pum Number Tons o.o Self-Contained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW ecurity Systems: No.of Devices or Equivalent No.of Water KW No.of No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: r No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. ' Estimated Value of E ectri-al Work: (When required by municipal policy.) Work to Start: Z,41 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 cove age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE CBOND ❑ OTHER ❑ (Specify:) I certify,under the pains an penalties ofperjury that t information on this application is true and complete. FIRM NAME: P.v /k7. LIC.NO.:"�� Licensee: �� " Signature LIC.NO.: (Ifapplicable,enter " mpt"in the license number line.) s:Tel.No.:WI-771- Address: ..3� � cz/ .�,vd.✓ 615;5K Alt.Tel.No.:.V/-5''d W"' *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. � . T • r ' ,� r�. .. .rhe ±�U.. x N , ,x3� r;. ... .♦ .�'�� !"� .vv. I _ f 1 / 1 1 _ e - i x . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street I, " Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeQib} Name (Business/Organization/Individual): Address: &,-2 0," /,.-, City/State/Zip: Are you an employer?Check the appropriate box: I.VI fn a employer with 4. ❑ I am a general contractor and i Type of project(required): ployees(full and/or part-time).* have hired the sub-contractors6 ❑ New construction 2m a sole proprietor or partner- listed on the attached sheet 3 7• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp. insurance. o workers comp. insurance 5. 9• ❑ Building addition [1`l p. ❑ 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 l 1.❑ 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.] 1.3•[�ther o j 1e *Any applicant that checks box 41 must also fll ottt thesection below showing their workers'compensation policy information. +Homeowners who submit ibis af;idavi indicating uiey ate uoing j�ii wor:;a.t:l ihee hire outside eorirru:iurs musi submit a new atndavi t $Conmictors that check this box must attached an additional sheet showing the P•name of the sub-contractors and their workers'com policyindicating information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy#or Self-ins. Lid.#: Expiration Date: Job Site Address: City/State/Zip: Attach a Copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certlfyupdar the painsnd p n o perjury that the information provided above is tru and correct SiQrtature: Date: /� / .�11j Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: PermittLicense# 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# f Ili Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an enrloyee 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 o r Vocal licensing agency shall withhold the issuance or renewal of a license or permitao operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. if an LLC.or LLP does have _ employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions re din-the lava,or if you are required to obtain a workers' compensation policy,please call the Department at the nurnber 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 pen-nit/license number which will be used as a reference number, in addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The 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 Iavestioations 600 Washington Street Boston, MA 02111 Tel.# 617-727-4900 ex--t 406 or 1-877-MASSAFE Revised 5-26=05 Fax 4 617-727-7749 www.mass.mov/dia Date......r............................ NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4, 4MIq"MAW SAcmUS LST This certifies that ....... .. ..................................................... has permission to perform .. ............... UL wiring in the building of................... ....................................... at...... ................ .North Andover,Mass. Fee-�V. Lic.NoA2-1.7(.* ... ....... . ......... ELECTRICAL INspEcrdk V Check # 76'1 8 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS [Rev.1//0a7]ncy and Fee Checked 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' (/' — /m Q City or Town of: NORTH ANDOVER To the In pector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant DR. Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building_ Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps _ / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: gp'"tt Ef oo& mCL 11 h e-k-t-4 t rn ,y—;fc.he Completion of the ollowin table maE 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 Swimmingol Above In- o.o Emergency Lighting Pornd. ❑ End. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Tons No .of Alerting Devices No.of Waste Disposers Heat Pump Number Tons No.of Self-Contained Totals: ............................. .. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Connection Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eq uivalent No.of WaterNo.KW No.of No.of Data Wiring: Signs Ballasts . No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications firing: OTHER: No.of Devices or Eg uivaient t • 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 exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: ']Z+t_ 8t A-.)6 t 6-t--L&—cc tic, LIC.NO.: /U 71 Licensee: '17� 3"'.-C Signature_ jL_. LIC.NO.: (Ifapplicable, enter"exempt"in the license number line.) Bus.Tel.No.: �??'(y5-��T�' Address: P O l�ok ?7 r'.,��„� �!�} C7l � Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ S�t"� ISG /71 III r i i s. The Commonwealth of Massachusetts kt 1 Department of Industrial Accidents l. .� Office of Investigations l 600 Washington Street ,i Boston, MA 02111 j www.nxass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individuat);_ e/�, Address: Fo j3 53 7 CitylStste/Zip:_ D✓c O(g ZC- Phone#: . Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑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• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein 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.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself[No-workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' comp. insurance required..] 131-1 Other 'Any applicant that checks bort#I must also fill out the section below showing their workers'bompensation policy information, t Homeowners who submit this affidavit indicating they are doing all workand then hire outside contractors must submit anew 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. I am an employer that is providing:workers'compensation insurancefornw employees: Below is the policy and joh site information. Insurance Company Name:_ U r/c)— �c. Policy#or Self-ins. Lie.# Expiration Date: 0? Job Site Address: C a, It Citystate/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penaltiesOOof perjury that the information provided above is true and correct Sixrrature: /7 ��. ��� F Date• Ri 2 z/a 7 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract 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 contact for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not-the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the numberlisted 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #6I7-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia i Date......./...../........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING SAC u Thiscertifies that ...................................................................................... has permission to perform ... ....... ............................................................... wiring in the building of..........................................i........................................ at.../Js....... ........ I North Andover,Mass. Fee..:��... 7..... Lic.No. ........... . Check # 76 '10 l ammonwea o�/Y/a��ac�u�elh Official Use Only c� c7 (� Permit No. �<o/ elJeparlmenl o/..tire Services acf Occupancy and Fee Checked /15 . BOARD OF FIRE PREVENTION REGULATIONS [Rev: 1/071 Teave 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) Datee ipq City, or Town of: (`� ��t? tr-' To the Inspector of Wires: By this application the undersign de gives notice of his or her intention to perform the etectrical work described below. Location(Street&Number) 935 Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes [a No ❑ (Check Appropriate Box) Purpose of Building � „g, Utility Authorization No. Existing Service Z�Amps (2j/ 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:. Completion o the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above El In- Ela o Emergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets �° No.of Oil Burners FIRE ALARMS No.of Zm,es No.of Switches No.of Gas Burners No.of Detection and � Z.. Initiating Devices No.of Ranges ( No.of Air Cond. To No.of Alerting Devices ti eat um um er ons o.of el No..of Waste Disposers -Contained p Totals •-••�-•-� . •... ..... � —..__.._..__ Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other No.of D Heating Appliances KW Security Systems:* Dryers No.of Devices or Equivalent No.of Water KW' o.of No.of Data Wiring: Heaters Sims Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP elNomm eviceso r Wiring: No.of Devices or E uivalent ' OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (eat (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 exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ZL BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: T (,-,Qb LIC.NO.: -ZI-WI Z Licensee: SR{lx 4 Signature LIC.NO.: (Ifapplicable,enter"exempt"in the license number li e.) Bus.Tel.No.: ' kM-L Z 1.97 Address: . �o� ext. �Zs�x � M 15a� Alt.Tel.No.: q '91s 'T 5 *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. Signature Telephone No. PERMIT FEE: $ � I e r r �y NORTIy Town of And 0 : IL LAKE o . dover, IVi077 ass., COCHICHEWICK 7d A0"QA T E D P? C5 7 S V BOARD OF HEALTH Food/Kitchen -PERMIT D Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT.......... . ...�..d............ .....�.�... IwI..�. ...................................... ...... .... Foundation 0 1 has permission to erect................. . ................. ildings on ...�,�� 9 g i. �... Fou h to be occupied as !� �.. .... ... Chimney 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 N S ELECTRICAL INSPECTOR UNLESS CONSTRU ON TS Rough ....... Service .. ... ........ .... . . ... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Po 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. Location 13Y .Acoq -e in� j No. .5 4n Date ,.ORT TOWN OF NORTH ANDOVER ` ; ; Certificate of Occupancy $ s i ++,�s' E<�'• Building/Frame Permit Fee $ s�cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # -3?0 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Z44Z, BUILDING PERMIT NUMBER: b f[DATE ISSUED: ®© / SIGNATURE: Building Commissioner/I2EQEtor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 9 12 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property eat Dimensions: � 1 Zonin District Pr Lot Area Proposed Use s Frontse ft � 1.6 BUILDING SETBACKS ft i Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided Flood Z 1.7 Water Supply M.G.L.C.40. 54) 1.5. one information: 1.8 Sewerage� Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record �a,✓� � � �c�- lir��-� l�> �� _ Name(Print) Address for Service 7�����T f0-7 r i Signature Telephone Q 1 Q 2.2 Owner of Record: OyName Print Address for Service: �L Signature Telephone e, SECTION 3-CONSTRUCTION SERVICES 9 3.1 Licensed Construction SupervLr: Not Applicable ❑ Licensed C structton Supervisor: 06 0��� ® j L, �it�tr�tn p�� License Number Addres �fp 7a ~q9 Expirat on DAte 50ignature Telephone s i 3.2 Registered Home Improvement Contractor Not Applicable ❑ 9L-tf,ld Ax . Com any Name Registration Number r.. Address lbo /P e-�e_ 9��Z-g 177-101 -N' 40 Expir tion Mte F Si na u e Telephone i 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.......❑ No.......❑ SECTION 5 Description of Proposed Work check 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 IR, Completed by permit applicant 1. Building (a) Building Permit Fee 81 Dego Multiplier 2 Electrical (b) Estimated Total Cost of Pb Construction 3 Plumbing Building Permit fee(a)X (b) . 4 Mechanical HVAC 5 Fire Protection 6 Tota] 1+2+3+4+5 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 �l Tiw f W�i 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, h941 D,&61as 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 . 1, uve u Print Na kl7vw 2 �4 b Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 3Ku SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r r I � I V� VdI97/I9�i�iI7.G(/F2G(�2 �/(�(�ddd�1LLIAefA.O' � BOARD OF BUILDING REGULATIONS c License: CONSTRUCTION SUPERVISOR i I i r° Number:CS 068232 Birthdate:02/14/1962 Expires:02/14/2002 Tr.no: 17701 i Rest"ricted To: 00 STEPHEN:D HOWELL _ 15 MT VERNON RD BOXFORD, MA 01921 Administrator j �1.e Uro�wi�w�uaea��o�.��ao1,u� ;Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 123237 i Expiration: 01/10/2003 I ` Type: DBA HOWELL DESIGN 3 BUILD STEPHEN HOWELL 44 BEECHWOCD DRIVE N..ANDOVER,MA 01845 Administrator 00-35,000 cf enclosed space (MGL CA 12 S.60L) 1A-Masonry only 1 G-1&2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code ! is cause for revocation of this license. r DIG SAFE CALL CENTER: (888)344-7233 License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 I Not valid without sEgn...ure 05-25-2001 15:31 From-THE MCCARTHY COMPANIES +1-781-893-6679 T-328 P.002/002 F-697 UA l C Uww.—14 PID M'� ACRD_ CERTIFICATE OF LIAB:.I'L{YY !N.SURAN .. 8a> L-1 05/25/01 THIS CERTIFICATE IS ISSUED AS A M ITER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE wenton Tyler/Ralph Rubin 'ns- HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR rhe McCarthy Companies ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P.O.Box 540169 COMPANIES AFFORDING COVERAGE aalthgm DIA 02454-0169 COMPANY Edward J. MacDonald A Hartford Insurance Group Pt»roNo. 781- 9 -4808 Fax 781-8936679 COMPANY INSURED B Safety In Company COMPANY Stephen Howell dba G Howell Design S Buildr Inc. 15 Mt. Vernon Road MANY Boxford MA 01921 D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TD THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEb,NOTWITNSTANDINbAIVT REQU{REMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 4YTIH RESPECT TO WHICH THIS CERTIFICATE MAYBE TANPISSUED G MAY PERTAIN,THE INSURANCE AFI±ORDED By THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LIMITS 0 TYPE OF INSURANCE POLICY NUMBER DATE WOO" DATE(MM/DDNY) GENERAL AGGREGATE $2,000,000 GENERAL LIABILITY A X COMMERCIAI-GENERALLIABILRY OSSBAiGH1835 06/01/01 06/01/02 PROpUCTB-coMP/o1,000,00 PERSONAL&ADV INJUURYRY $8 1,OOO,000 CLAWS MADE []X OCCUR EgCM OCCURRENCE 61,00 .000 OWNER'S&CONTRACTOR'S PROT FIRE DAMAGE(Any one nm) $50 000 MED EXP(MY ane P°fs0n) $5 000 AUTOMOBILE LLaBILITY COMBINED SINGLE LIMIT 5 a ANY AUTO p4/1'1/01 44/17/02 BODILYIN.IURY *250000 X ALL OWNED AUTOS 1500162 (Pa P—M) R scHEOULEDAUT05 BODILY INJURY 1500000 X HIRED AUTOS (PareaddeM) X NON43WNED AUTOS PROPERTY DAMAGE 8 250000 AUTO ONLY•EAACCIDENT 8 GARAGE LIABILITY OTHER THAN AUTO ONLY: ANYAUTO EACH ACCIDENT 1 _. AGGREGATE b EACH OCCURRENCE 1 EXCESS LIABILITY AGGREGATE 1 UMBRELLA FORM UMBRELLA FORMX TO STS 0 R l WORKERsCOMPENSATION AND EL EACH ACCIDENT 1100 000 EMPLOYERS'LIABILITY A 06/01/01 06/01/02 EL DISEASE-POLICY LIMIT 1500,000 THEPROPRIEYOR1 INCL 08WECCD0247 pARTNERSIEXECUTIVE EL DISEASE-EA EMPLOYEE 8100,000 OFFICERS ARE: EXCL OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESfSPECIAL ITEMS /�' , / Wr_L� Carpentry - Dwelling CAuLLD ANY OF THEAsOVE CERTIFICATE HOI:DER. DESCRIBED POLICIES BE CANCELLED BEFORE THE REVRRLY EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO NJUL City of Beverly 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building Dept• PUT FAILURE 10 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1Il8 Cabot St OF ANY(OND UPON THE COMPANY.ITS AGENM OR r&PRESENTATNES. Beverly MA 01915 AUTHORIZED REPREBENTATNE ---�,I i ORATION 198F ACORD 2"(1195) I ACORD INSURANCE BINDER CSR RG DATE(MM/DD/YY) 06/28/01 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT,SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. PRODUCER — I aC,No,El: 781-893-4808 COMPANY BINDER# 6003 781-893-6679 Atlantic Charter Brenton Tyler/Ralph Rubin Ins. FF CIV ION The McCarthy Companies DATE TIME DATE TIME P.O.BOX 540169X AM X 12:01 AM Waltham MA 02454-0169 06/01/01 12:01 PM 06/01/02 NOON Robert L. Britt THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY CODE: SUB CODE: X PER EXPIRING POLICY#: BINDER CUSTOMER ID: HOWEL-1 DESCRIPTION OF OPERATIONS/VEHICLES/PROPERTY(Including Location) INSURED Design & Build House -Residential Howell Design & Build,Inc 44 Beechwood Dr. North Andover MA 01845 COVERAGES LIMITS TYPE OF INSURANCE COVERAGE/FORMS DEDUCTIBLE COINS% AMOUNT PROPERTY CAUSES OF LOSS BASIC F BROAD ❑SPEC GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ CLAIMS MADE ❑OCCUR PERSONAL&ADV INJURY $ OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ RETRO DATE FOR CLAIMS MADE: MED EXP(Any one Person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS MEDICAL PAYMENTS $ NON-OWNED AUTOS PERSONAL INJURY PROT $ UNINSURED MOTORIST $ $ AUTO PHYSICAL DAMAGE DEDUCTIBLE ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE COLLISION: STATED AMOUNT $ OTHER THAN COL: OTHER GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION $ STATUTORY LIMITS WORKER'S COMPENSATION EACH ACCIDENT $100000 AND EMPLOYER'S LIABILITY DISEASE-EACH EMPLOYEE $100000 DISEASE-POLICY LIMIT $5500000 SPECIAL FEES $ CONDITIONS/ OTHER TAXES $ COVERAGES ESTIMATED TOTAL PREMIUM $ 24602 NAME&ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN# AUTHORIZED REPRESENTATIVE F ACORD 75-S(1/97) NOTE:IMPORTANT STATE INFORMATI ACORD CORPORATION 1993 1-351�wv cood,<Y�eklj ac4v kz 4 9 9L -v vv 'wac\qQ"-M -o-I t 0( -n )lo -1 - -,3 Y 07/24/2001 11:10 978-352-7787 SCI �t9�t(�'"`S �� PAGE 01 C 0 E S U OTURAL T .._ N o July 24,2001 Mr. Steve Howell Howell Design and Build 44 Beechwood Drive Norah Andover, MA 01845 RE: Structural Evaluation of Existing Roof Truss Pickui Residence 135 Academy Road North Andover,Massachusetts Dear Steve: We have evaluated the existing roof truss for the dead, live, and snow loads in accordance with the Massachusetts State Building Code - Sixth Edition. We have also analyzed the truss for the proposed modifications as indicated on the sketch that you provided to us on July 23, 2001 a copy of which is attached. The proposed modifications include the removal of a vertical truss member and replacing it with a new sloped member of the same size as shown in the attached sketch. Based on our analysis,the modified truss can support the design loads provided the existing 4" x 6" truss gusset plate is not removed and the new sloped member is connected to the existing truss as shown in the attached Details 1 and 2. If you need additional information,please call. Sincerely, Structural Conaectioos,Inc. Fe N. Lucero Yako, P.E. President Structural Engineers 20 ANNA'B WAV po1(rona,MA 01 021 T¢L:978'352I7403 FAX:978 135217787 ' M'crMO(QM8N.C9M f N H Ci IL 4U: ! id Ln RIVA m \ j N iiL Lo cu 3 � �J oo 111A 411k m Q � -�� �. a�►� � + - ten ve2oc �� 3 a.. ' n CD N N v N .r N .0 � i 07/24/2001 11:10 978-352-7787 SCI PAGE 03 li w alt 8U lLD N Project: P j CXU L T)2��UL`s Subject: 1 STAU<TURA� o i�L.c�s _ t t0r,> � to Comp. BY: FNLY Date: Chkd.Bv: Date: p Sheet of Job Number: N 0 i `o AF a � + vEr N Cl�e�li:.., , `a� Nproit�ct: i C'h��l AL- (z2.-T � f r� '7-'Cl�. 4� 'GST.C ) S1RUC. TWRAL S—ect: U- �r► 1<x) 2 �.. ti. l--C E T Comp. By: FNLY Date: Chkd. B�: Date: N Sheet of Job Number: s IA �1 y t` 04 Z0 3Jdd IDS LOLL-ZSC-BLG EZ:ZZ I00ZIPZ/L9 NORTfy E Town 0dover No. s6 � o � �� tdower, Mass., ADRATE D p'Pa\,` C, S H � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �/ BIALDING INSPECTOR THIS CERTIFIES THAT.....0AWIZ.....�'.A� 01........AA.A040.1..................................................... Foundation A0has permission to erect....MP4 f uildings on.... ..... V Iy...... ............ Rough to be occupied as.............W.1.N..bo...w ...4.02.... .ef...--.....5..------....................................................... Chimney 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 Ins ection, Alteration and Construction of Buildings in the Town of North Andover. 16 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voidsahit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI TS 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 T No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burnet Street No. SEE REVERSE SIDE Smoke Det.