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HomeMy WebLinkAboutMiscellaneous - 16 RUSSELL STREET 4/30/2018 (3) 16 RUSSELL STREET 210/056.0-0026-0000.0 j ��a Date....... ....:................. Ir F NORTh TOWN OF NORTH ANDOVER 3 • - °c p PERMIT FOR WIRING gsgCMuS� This certifies that .....................!. ............"'...................^.5.:`..`.`............................................ has permission to perform ......&ja-y .,.................................................................................. wiring in the building of..................../ SSP at ......... ...................................................................................,�iorth Andover,Mass. Few .—�....�......�...............Lic.No!Y�........... ........� .......... . ELE'' ICAL INSPECTOR Check# 11319 0� - 13 ' f Commonwealth of Massachusetts Official Use Only a o Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS [ROccupancy 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 a (PLEASE PRINT IN NK OR TYPE ALL INFORMATIOA9 Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: C�v By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) (� PA5Sf71G 54 1 Owner or Tenantg r 74z t?,V� Telephone No. Owner's Address to e 1 l 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❑ UndgNo.of Meters Number of Feeders and Ampacity ``���C � e-e- rd,�-T Location and Nature of Proposed Electrical Work: Completion of the following 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 s No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting rnd. grnd. 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 and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump I Number I Tons IKW No.of Self-Contained Totals: I""'..... " ."'""'".."' Detection/Alerting Devices No.of Dishwashers ` Space/Area Heating KW Local❑ Municipal ❑ Other I 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 41 No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirin No.of Devices or Eq uiva ent OTHER: � Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Elpctrical Work: (When required by municipal policy.) Work to Start: Iris pe tions to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: Unless aived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liabiliollinsurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE IVI BOND ❑ OTHER ❑ (Specify:) I"certify,under thepains and penalties ofperjury,that the information on this application! rue and complete. FIRM NAME: . LIC.NO.: Licensee: l(�/ly Signature LIC.NO.: I t 10 y6 (If applicable,a ter "exet"i the license timber ' e.) Bus.Tel.No.. Q 79 Address: T Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,s&hrity work requires Departm nt of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage 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. $ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c. 143,§3L,the ` q permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed 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 Imo' 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. Permits shall.be limited 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 z 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: I Trench Inspection Pass 0 Failed EN Re-Inspection Required($.) ❑ Inspectors Comments: I Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: I Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSP ION: Pass ? QFai ? Re-Inspection Required($.) ❑ Inspectors Comments: / 3-1 _PV� Inspectors SignaturG Date: '- z-% /3 DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts. 0. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: A, �VV_ A / City/State/Zip: 6111 A(A �,�� Phone#: l �7 �) qq� r __5q/ /w Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and I � have hired the sub-contractors 6'. F1 New construction employees(fall and/or part-time). 2. I am a sole proprietor or partner- listed on the attached sheet. 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 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.[i 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 ate 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. 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.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). '�ailure 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 �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 Investigations of the DIA-for insurance coverage verification. I do hereby certi n the ' and penalties ofperjury that the information provided above is true and correct. Simature: /�✓ Date: Phone#: J 3 Offccial 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 a "...every nem to ee is defined as employee person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the , members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the ' applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture , (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The 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 6.00 Washington Street Boston,M.A.02111 Tel,#617-727_4900 exit 406 or 1-877rMASS.AFB Revised 5-26-05 Fax#617-727-7749 www.mass.govfdia Date... ............... NOwrM TOWN OF NORTH ANDOVE WIRING..................................... "", This certifies that 'sv ...... .......................... ...... ............ has permission to perform .........k*j........ ....... ........................ wiring in the building of...' .............................................................. at ...............I North Andover ass. 1 5 ........................ � ................ .. *W Fee... ......Lic.No.). 2.......M... ....... .........;.......1�5 ........ .................... CMUCAL INSPE OR Check Commonwealth of Massachusetts Official Use my Department of Fire Services Permit No. 1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 eave 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: 5—,-2— 3 'J, City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. 1n Location(Street&Number) / & /-2C1(5-56Z(- 5-7-- Owner .7 -Owner or Tenant /'I'J/a6(, Telephone No.";t78,3os Owner's Address 6 p,G[5y-cz - S,- N-A-k)(Awl X4# � Is this permit in conjunction with a building permit? Yes ©�No ❑ (Check Appropriate Box) u� Purpose of Building i n fle Ci!VV,;I" Utility Authorization No. k) Existing Service 10 y Amps _1U/ X101 o Volts Overhead� Undgrd❑ No.of Meters _L 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 ma be waived by the Inspector of Wires. No.of Recessed LuminairesNo.of Ceil:Susp.(Paddle)Fans No.o Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA 0 No.of LuminairesSwimming Pool Above El n- tJ o.o mergency Lighting tiprnd. rnd. Battery Units la No.of Receptacle Outlets ((o No.of Oil Burners (�j FIRE ALARMS No.of Zones 0 No.of Switches No.of Gas Burners No.of Detection and tv Initiating Devices 10 Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices � Disposers No.of Waste Dis Heat Pump Number Tons No.of Self-Contained p a Totals:I I Detection/Alerting Devices 10 No.of Dishwashers 1 Space/Area Heating KW Local❑ Munk hal E] Other CofinNo.of Dryers Heating Appliances KW Security Systems:* No.of Devices or E uivalent No.of Water IKms, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP el No.off Devices do r firing: Nes or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. % Estimated Value of Electrical Work: g a a (When required by municipal policy.) Work to Start: �j - ( - ( ?j 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 theinsI and pe allies of perjury,that the information on this application is true and complete. FIRM NAME: 0 h 0 YI LTC.NO.: Licensee: )OLA U O 0 klf� Signature LIC.NO.: 1 a L(,eA-13 (If applicable,enter"exempt"iry t tcense number line.) / Bus.Tel.No.:1n 17 �-o SSS Address: 0�{ y\/i ( li a" 5 �} 03 j(4,0 ✓YL6 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 a e t. Owner/Agent Signature Telephone No. PERMIT FEE: $ i r 1 I ��� �� - � 3 � � .� . - r. . , i i Iii w COMMONWEALTH OF MASagt,MUSE n S ._ BOARD. AS A REG JOURNEYMAN IAN ISSUES THE ABOVE UCENSE TO: • JOHN VOONG 64 WILLIAMS ST � t MALDEN MA 02148-184 , 12662 B 01/31/13 849364 77 �� f a 16 Russell Street North Andover, MA 01845 June 17, 2013 Peter Murphy Electrical Inspector Town of North Andover 1600 Osgood St. Bldg 20 Ste 2035 North Andover,MA 01845 Dear Mr. Murphy: I am terminating John Voong's electrical services immediately because he would not make himself available to work. Another licensed electrician will be pulling a new permit and performing the remaining work. Please contact me should you need anything further at 978-305-7222. Sincerely, Mark Fitzgerald 0960 f Date . . . . Ikll • TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ihis certifies that . /� . .! �.lr' ' ..? -. . . . . . . . . . . . . . . . \ / has permission to perform . �. �x --t. . . l �'plumbing in the buildings of. . . '' ?`1/c/ . . . . . . . . . . . . . . at . . . � . . .!P ,sSP 1 . S't � " �.e.: . . . . . . . . ,North Andover, Mass. ` j 7� �3��o4Fee . Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . j PLUMBING INSPECTOR i Check# //70- f 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK MA DATE PERMIT# JOBSITE ADDRESS J , OWNER'S NAME OWNER ADDRESS _ TEL o FAX _ P _ c _ TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: E-711 RENOVATION: REPLACEMENT: © PLANS SUBMITTED: YES Q NO FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM ( J ( _.._____. .._..._.- .� f ( __...___..( ! ..—_i -____.__I DEDICATED GASIOILISAND SYSTEM ' I -l .._._-._( _.. _ _ 1. _._.3 DEDICATED GREASE SYSTEM �J ..._--- _ l _......__! _.__.__1 __...._..l l ....._._.J .`__J _..._.___I ._..._.._._..4 __! _A= DEDICATED GRAY WATER SYSTEM _._.__( ____..l .___ .. I I __ ! _.__j _.__._i DEDICATED WATER RECYCLE SYSTEM DISHWASHER ._( ._. ._.� ___._( ..___..� .___..� _._.._.( ____f __._._-_ ---.....__� .---...__ ( .... _..1 _-- __1 .._ .._J _I ..._.._I "6 DRINKING FOUNTAIN —( ( _._..__ --..._--! � _ ( ( -..-_-_( 1 1 .---___a1 ..._ .!=3 .._...... FOOD DISPOSER FLOOR/AREA DRAIN INTEIRCEPTOR INTERIOR _ ( f ..---__.._-1 KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET U NAL7= AER HING MACHINE CONNECTI HEATER ALL TYPES _f ( I ......._.-f _ ( ._. 1 -..-- 1 -- _-_.l ._... _J ..___J WATER PIPING -- -_1 _ i _...__—( ....__.1 OTHER I -_.1 i I .771 .___.._1 i _ _I _.__......f _.._..._1 ..........1 —( _.._.__( _._._j ! _( d„ INSURANCE COVERAGE: c� have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Re'N0 E! IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 7r LIABILITY INSURANCE POLICY . i OTHER TYPE OF INDEMNITY i BOND ..l V / OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 01 AGENT SIGNATURE OF OWNER OR AGENT M I hereby certify that all of the details and information I have submitted or entered regarding this application are true and acc rate to the best of my knowledge .� and that all plumbing work and installations performed under the permit issued for this application will be in compl' ce all P in provision of the `\ Massachusetts State Plumbing Code and Chapter 142 of the General Laws. d!� PLUMBER'S NAME _- r� _ _ _ _ (LICENSE# b I SIGNATURE VIP 13K JP Ej CORPORATION .E# I PARTNERSHIP _l# !LLC _( 0 COMPANY NAME �,p l. y� y� ADDRESS - CITY .9 , -- ......_IISTATE _ _I ZIP ©/57�_ _II TEL llil2 CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No 1- -�� Ol e� 10 ti.✓ THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES ��e v r The Commonwealth of Massachusetts Department of Industrial Accidents Office Investigations .f.� o.f g 600 Washington Street Boston,MA 02111 U1. www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naffie(Business/Organization/Individual): S� g.,I"r Address: t, M /State/Zip: . M� dt b—U, Phone#: . n an employer?Check the appropriate box: Type of project(required): 7am a employer with 6 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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 mein 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 ❑ 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' 1311 Other comp.insurance required.] y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. )meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. itractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. n ian employer that is providing workers'compensation insurance for my employees. Below is the policy and job site wmation. _ trance Company Name: A's mri,PV_E, icy#or Self-ins.Lid.It: Expiration Date: Site Address: �(- `I` S S ` City/State/Zip: (Q. A �GUy4_ ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a 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 p to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ;stigations of the DIA for insurance coverage verification. herebycert acnrler e ' s a dpenalties ofperjairy that the information provided above is true and correct. tature: Date: csZc?9 19 ae 4: !frcial use only. Do not write in this area,to be completed by city or town official. i :ity or Town: Permit/License# ,suing Authority(circle one): Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other a Informafl®n 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 nbt 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 I 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 A the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. ?lease be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant hat must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current )olicy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or :own)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the Ipplicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each rear.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 bum leaves etc.)said person is NOT required to complete this affidavit. 'he Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, Tease do not hesitate to give us a call. he Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.A.co dents Office of Investigations 600 Washington Street Boston,MA 021.11 TP1 itC,17_777,Agn(l P.xt 4OlK nr 7„R77-MA.R.RAFF. COMMONWEALTH OF-MASSACHUSETTS�T PLUMBERS AND'GASFITTERS i LICENSED AS A.MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: STEVEN FAMOLARE v 662 SHAWSHEEN STI TEWKSBURY MA 01876-2335 13640 05/01/14 168404 r TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION t. This certifies that . . . ' t . . .�o� /... . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . in the buildings of. . 1. ���-��s . . . . . . . . . . . . . . . . . . . . d { at .III. ' . . . . . . . . . . . ,North Andov , Mass. � 1 Fee2Gf,. . . . Lic. No. . . . . . . . . . . . . . . . . . . . . 1 GAS INSPECT R- Check 8690 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 5/14/13 PERMIT# . ..yam JOBSITE ADDRESS 16 Russell Street OWNER'S NAME Mark Fitzgerald GOWNER ADDRESS same TEL 978-305-7222 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 7 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 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 3 ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I ' NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Kerry Martin LICENSE# 9320 SIGNATURE MP -, MGF JP JGF LPGI CORPORATION I # 2135 PARTNERSHIP # LLC # COMPANY NAME: K.Martin Plg&Htg.,Inc ADDRESS 124 Abbott St CITY Lawrence STATE Ma ZIP 01843 TEL 978-685-2521 FAX CELL 508-509-9898 EMAIL s. ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# /l PLAN REVIEW NOTES DEVAL L.PATRICK BARBARA ANTHONY GOVERNOR Commonwealth of Massachusetts UNDERSECRETARY OF OFFICE OF CONSUMER AFFAIRS AND GREGORY BIALECKI Division of Professional Licensure BUSINESS REGULATION SECRETARY OF OFFICE OF INVESTIGATIONS MARK R.KMETZ AND ECONOMIC DEVELOPMENT 1000 Washington Street• Boston • Massachusetts • OIRESSIONA LICENSURE U B IVI 02118 PROFESSIONAL LICENSURE July 9,2013 Mr. Richard Doherty Plumbing&Gas Inspector 1600 Osgood Street North Andover, MA 01845 Re: PL-14-007 Mark Fitzgerald (Complainant/Property Owner)vs. Brian O'Regan (Licensee) PL-14-008 Mark Fitzgerald (Complainant/Property Owner)vs.Tim Giard (Licensee) Dear Mr. Doherty: I have been assigned to investigate a formal complaints filed by Mark Fitzgerald who resides at property located at 16 Russell Street,North Andover, Massachusetts. The complaints filed are against Brian O'Regan and Tim Giard. In order to properly investigate this matter,please research your office records from January 2, 2013 to present and forward to this office, copies of any of the following associated with the aforementioned address: 1. Copies of plumbing and/or gas application(s)and permit(s). 2. Copies of written approval(s)or violation(s)found as a result of inspection(s) performed. 3. Copies of relevant correspondence, facsimile or reports associated with this complaint. 4. Any other information you feel is pertinent to this investigation. 5. Please use city/town stationary for personal correspondence. If you have any questions please call 617 727-6090_.Thank you in advance for your time and consideration in this matter. Respectfully, Richardris Compliance Officer Division of Professional Licensure Office of Investigation 1000 Washington St. Suite 710 Boston, MA 02118 -6100 Fax: 617-727-1944 is TELEPHONE: (617)727-3074 FAX: (617)727-2197 TTY/TDD: (617)727-2099 http://www.mass.gov/dpl DEVAL L.PATRICK BARBARA ANTHONY GOVERNOR Commonwealth of Massachusetts UNDERSECRETARY OF OFFICE OF CONSUMER AFFAIRS AND GREGORY BIALECKI Division of Professional Licensure BUSINESS REGULATION SECRETARY OF OFFICE OF INVESTIGATIONS MARK R.KMETZ AND ECONOMIC DEVELOPMENT DIRECTOR,DIVISION OF 1000 Washington Street• Boston • Massachusetts • 02118 PROFESSIONAL LICENSURE July 9,2013 Mr. Richard Doherty Plumbing&Gas Inspector 1600 Osgood Street North Andover, MA 01845 Re: PL-14-007 Mark Fitzgerald (Complainant/Property Owner)vs. Brian O'Regan (Licensee) PL-14-008 Mark Fitzgerald(Complain an Owner)vs.Tim Giard (Licensee) Dear Mr. Doherty: I have been assigned to investigate a formal complaints filed by Mark Fitzgerald who resides at property located at 16 Russell Street,North Andover, Massachusetts. The complaints filed are 4gainst Brian O'Regan and Tim Giard. " In order to properly investigate this matter, please research your office records from January 2, 2013 to present and forward to this office, copies of any of the following associated with the aforementioned address: 1. Copies of plumbing and/or gas application(s)and permit(s). 2. Copies of written approval(s) or violation(s)found as a result of inspection(s)performed. 3. Copies of relevant correspondence,facsimile or reports associated with this complaint. 4. Any other information you feel is pertinent to this investigation. 5. Please use city/town stationary for personal correspondence. If you-h-ave any questions please call 617 727-6090. Thank you in advance for your time and consideration in this matter. - ..-- --- -- and, Respectfully, Ric and G. Paris Compliance Officer Division of Professional Licensure Office of Investigation 1000 Washington St. Suite 710 Boston, MA 02118 -6100 Fax: 617-727-1944 to TELEPHONE: (617)727-3074 FAX: (617)727-2197 TTY/TDD: (617)727-2099 http://www.mass.gov/dpl /Vyl r DEVAL L.PATRICK BARBARA ANTHONY GOVERNOR Commonwealth of Massachusetts UNDERSECRETARY OF OFFICE OF CONSUMER AFFAIRS AND GREGORY BIALECKI Division of Professional Licensure BUSINESS REGULATION SECRETARY OF OFFICE OF INVESTIGATIONS MARK R.KMETZ AND ECONOMIC DEVELOPMENT 1000 Washington Street• Boston • Massachusetts • DIRECTOR,DIVISION 13 M 02118 PROFESSIONAL LICENSURE July 9, 2013 Mr. Richard Doherty Plumbing&Gas Inspector 1600 Osgood Street North Andover, MA 01845 Re: PL-14-007 Mark Fitzgerald (Complainant/Property Owner)vs. Brian O'Regan (Licensee) PL-14-008 Mark Fitzgerald (Complainant/Property Owner)vs.Tim Giard (Licensee) Dear Mr. Doherty: I have been assigned to investigate a formal complaints filed by Mark Fitzgerald who resides at property located at 16 Russell Street,North Andover, Massachusetts. The complaints filed are against Brian O'Regan and Tim Giard. In order to properly investigate this.matter, please research your office records from January 2, 2013 to present and forward to this office, copies of any of the following associated with the aforementioned address: 1. Copies of plumbing and/or gas application(s)and permit(s). 2. Copies of written approval(s)or violation(s) found as a result of inspection(s)performed. 3. Copies of relevant correspondence, facsimile or reports associated with this complaint. 4. Any other information you feel is pertinent to this investigation. 5. Please use city/town stationary for personal correspondence. If you have any questions please call 617 727-6090. Thank you in advance for your time and consideration in this matter. Respectfully, s Ric and G. Paris� -'!�- Compliance Officer Division of Professional Licensure Office of Investigation 1000 Washington St, Suite 710 Boston, MA 02118 - 6100 Fax: 617-727-1944 TELEPHONE: (617)727-3074 FAX: (617)727-2197 TTY/TDD: (617)727-2099 http://www.mass.gov/dpi -00000 � 00006000000000000 - 1c Cie-d. 'Tb ,S�te�c�-— i ) booe_b000000 '000000000000 uv PL f.)uA\ i Z 13 vl�' -AN 1 - t 1_ '' tlyl rk� - SG. l •• Y T 16 Russell Street j North Andover,MA 01845 May 8, 2013 i Richard Doherty Plumbing and Gas Inspector Town of North Andover 1600 Osgood St. Bldg 20 Ste 2035 North Andover, MA 01845 Re: Lack of inspection, improper vent and gas/water size of work performed by Tim Giard permit #6092 Lack of permit, inspections, and work not completed by Brian O'Regan Dear Richard, I spoke with state inspector Mr. Dennis Driscoll several days ago. He asks me to have the town inspect the gas and plumbing and assist me by documenting all violations. He also asked that I submit the town report with my complaint to the state. Since your department acts to protect the consumer, I assumed a report would be a normal matter of course and that this letter is just to confirm that I do want the report. The gas and plumbing are exactly as left by Brian O'Regan regarding all recent gas and plumbing work. So this work can be inspected right now. The prior work performed in 2007 by Tim Giard is also available. I have all the prior gas piping that was pulled out,the prior vent and many pictures taken prior to the rework performed by Brian O'Regan. I can provide these pictures for your investigation. I am asking that your office perform an investigation of work performed and notify me in writing of all issues found: - Tim Giard License#10301 in 2007, permit#6092 to install a gas tankless water heater -Brian O'Regan, license#24725, and Wai Ming Leong, license#19186 around April 2013 to install new gas lines and plumbing associated with a kitchen remodel (no permit pulled) I would also like to know what actions the town is taking in regard to these issues. I am diligently searching for another plumber to pull permits and have this work completed for your inspection asap. Please contact me should you need anything further at 978-305-7222. Thank you for your help. Sincerely, Mark Fitzgerald I i 1`6 Russell Street North Andover, MA 01845 May 7, 2013 Richard Doherty Plumbing and Gas Inspector Town of North Andover 1600 Osgood St. Bldg 20 Ste 2035 North Andover, MA 01845 Dear Richard, I am terminating Brian O Regans plumbing services immediately due to the many issues he has caused including: - Making threats - Demanding money payments for work not performed - Not pulling a permit to work on my plumbing - Leaving the plumbing unfinished I will be filing a complaint with the state plumbing board and also filing a civil action. His contact information: Brian O'Regan 61 Mesmur Road Malden, MA 02148 Cell: 781-588-5417 Please contact me should you need anything further at 978-305-7222. Sincerely, Mark Fitzgerald ,,Date . b. .(� . . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . . . . . .A-#-I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . -t-714Z- ,---,4 LCL— in the buildings of. . . . i�* * -� at . . . N*o*rth Andover, Mass'. Fee 27�)P-7. . Lic. No:��' F7'� . M6 . . . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check # 8661 No rr,st— 4PA\- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE(� II PERMIT# JOBSITE ADDRESS _ OWNER'S NAME OWNER ADDRESS _d .S - o>w _ M_ TEL[— TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL RESIDENTIAL.�J PRINT CLEARLY NEW:E3 RENOVATION: REPLACEMENT:© PLANS SUBMITTED: YESQ No 0i APPLIANCES 1 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 ( 1 ! FIREPLACE I' FRYOLATOR FURNACE - GFNERATOR I _. . . _f 1 _ -1 ! -- `T.) GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT ( J OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT 11~ST II . ! . J= = = UNIVHEATER UNVENTED ROOM HEATER • .f WATER HEATER OTHER F7 ........................ . _......._..... ........... ......... _. INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO []I 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY �_I OTHER TYPE INDEMNITY EA BOND I�]I OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER EI AGENT �II SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �,.� _ LICENSE#, � � SIGNATURE MPEj MGF(!,,,�_l JP - fJ JGF Q LPG]0 CORPORATION[j# ��PARTNERSHIP 0# LLCEk COMPANY NAME: ,q.1�`.-.-_ _.._y._i•,, .. ... !` ADDRESS . CITY STATE ZIP _ TEL FAX CELL EMAIL „_ _ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES i The Commonwealth of Massachusetts Department of Industrlg[Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name(Business/Organization/Individual): f b Address:) City/State/Zip: (M,Id,n 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. ❑New construction employees(full and/or part-time).* have hired the sub-contractors am a sole proprietor or partner- listed on the attached sheet.# 7• ❑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.El 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.]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. I 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. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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. Si ature: ) "� J,J ) Date: d 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 TeX.#617-727-4900 ext 406 or 1-877rMASS.AFB Revised 5-26-05 Fax#61.7-727-7749 www..mass.gov/dia a' MON LTH OF MASSACHUSETTS f'LUMFR.S ARI[ :GASFITTERS } L ICt JSCD At. A JO;IJANEYMAN FLIlly1 h�. ' , ISSUES THE ABOVEI CENSE TO } 9G1 4iEStWR RD �P11LrEN" 14A 0214.8 4730 a 247?_5 .05/01/14 7.551 LICENSE NO. EXPIRATION DATE SERIAL NO. .`tl "y Ma f i 1/ i C�- fro Date./ND . . . • 0""'.40TM 4 3? � �0� TOWN OF NOR 1 0 � F T r ' PERMIT FOR GAS INSTALLATION 1SSA HUS-' This certifies that . . . . . . . . . . .. . . . . . . . . . . . . . . . . . has permission for gas installation . . LA. .// . . . . . . . . . . . . . . . . . . in the buildings of . . . !. .! .t r to. . . . . . . . . . . . . . . . . . . . . . at . . . ... . . . . . . . . . . .. North Andover, Mass. Fee. ��V. '' Lic. No&U V. . . . . . . . . . . .1..,-C_. . . . . . . . GAS INSPECTOR Check# G 6092 MASSACHUSETTS UNIFORM APPUCATON FOR PERMrr TO DO GAS FITTING (Type or print) Date �-16a 7 NORTH ANDOVER,MASSACHUSETTS n Building Locations / Ouile // y`� p Permit# � ! L, Amount$ 3 v Owner's Name New D Renovation D Replacement Plans Submitted D w vl c�7 a w o m y x F >. W z G = C z F W vF z F z x w w w w u x a z w > a z d a Q d o °o w a o x x o x 3 12 u m > UB -BASEMENT A S E M E N T ST. FLOOR ND . FLOOR } 3RD . FLOOR 4T, . FLOOR 5TH . FLOOR " 6T . FLOOR 7T 13 . FLOOR 8TH . FLOOR (P not or ty Che k one: Certificate Installing Company Corp. Ad ress 4 Partner. A, ness a ep one 3 Firm/Co. A,S, Name of Licensed Plumber or Gas Fift INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes; No 13 If you have checked es please indicate the type coverage by checking the appropriate box. Liability insurance policy ,�' Other type of indemnity D Bond 13 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 A I hereby certify that all of the details and info mation 1 have submitte (or enter in above ppli t' are true and accurate to the best of my knowledge and that all plumbing w and installations rformed der r i Is ed this application will be in compliance with all pertinent provisions of the Massac S n hapte 2o e General Laws. By: Signature of 'censed Da4er Or Gas Fitter Title —Plumber 136 /11 City/Town [3Gas Fitter License Num5er ® Master APPROVED(OFFICE USE ONLY) Journeyman Date.eb. ... . . (40 NORTH TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION CH . . . . . . . . . . This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installatiod—'. . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . .ll� . ... . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . .I North Andover, Mass. ob Fee :7. . Lic. No..'.', ;-./ . . . . . . . . . . . . . GAS INSPg6'T0F( Check# 4. 162 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS Ffrr]NG (Type or print) Datec'— NORTH ANDOVER,M�ASSACHUS/ETTS( �. Building Locations / /Cy Permit# Amount$ Owner's Name �, o /moi` Tz C ✓�f3 L7 New❑ Renovation ❑ Replacement Plans Submitted 0 W a c � GO a � c� x w �a E°• a � C z a o c c ,C °w o SUB-BASEMENT BASEMENT Ji 1ST. FLOOR 2: D. FLOOR 3RD. FLOOR 4T,H. FLOOR 5TIH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH . FLOOR 1 1 1 1 11 11-H (Print or type) Cjjj&k one: Certificate Installing Company Name it/ 12i-c_ff7792 to --H, U Corp. Address2 '�5���-!� S%c ❑ Partner. Business Telephone ;2_7 29 ® Firm/Co. Name of Licensed Plumber or Gas Fitter Willl 1+N- C_c /2c`G(T _;?� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑' No❑ If you have checked M.please indicate the type coverage by checking the appropriate box- Liability oxLiability 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 ass.General Laws,and that my signature on this permit application waives this requirement. Check one: Si ature 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. By Signature o icensed Plumber Or Gas Fitter lumber Title � . ;2—O 2-1 1�! City/Town ❑ Gas Fitter License Nurnwr ❑ Master APPROVED(OFFICE USE ONLY) 0,Journeyman ocation No. Date Z/-of NORTH TOWN OF NORTH ANDOVER a Certificate of Occupancy $ L ; Building/Frame Permit Fee $ E<n Foundation Permit Fee $ sACNUs Other Perm it%eu2;� $ �6 v Sewer Connection Fee $ Water Connection Fee $ �— TOTAL $ 7! Uy �y Building Inspector 26.Ca PAIS J + 6751 Div. Public Works .PERM � NO. �G 0 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MAP KVO. _ I LOT NO. ��Q(i �7 2 RECORD OF OWNERSHIP (DATE BOOK PAGE ZONE SUB DIV. LOT NO. UPS �� LOCATION PURPOSE OF BUILDING OWNER'S NAME sz /\ >` ✓ / ` NO. OF STORIES SIZE x 1p OWNER'S ADDRESS Lfil i 4` / OL DCS/ BASEMENT OR SLAB ARCHITECT'S NAME L-I f- �v v SIZE OF FLOOR TIMBERS IST 0`7 v L/ 2ND 3RD BUILDER'S NAME -Il (3yy..�. dI�I P--ri SPAN --�✓-c 4 DISTANCE TO NEAREST BUILDING t DIMENSIONS OF SILLS -_ -- DISTANCE FROM STREET /� O % '� POSTS DISTANCE FROM LOT LINES-SIDES t ' REAR GIRDERS AREA OF LOT UQC s { FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW a r�tv/ll prL�'-�L ) `j SIZE OF FOOTING � X IS BUILDING ADDITION ! / MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY D IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION �� ��C LAND COST SEE BOTH SIDES �� L ) n` ^yL � EST. BLDG. COST 'Uj�4'U PAGE 1 FILL OUT SECTIONS 1 - 3 pe I A) ©� " EST. BLDG. COST PER SQ. FT. No PAGE 2 FILL OUT SECTIONS 1 - 12 / EST. BLDG. COST PER ROOM r �//©� SEPTIC PERMIT NO. l ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 5 r 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FIj.ED /< 33 fA BOARD OF HEALTH SIGNATURE OF OnWNER OR AUTHORIZED AGENT FEE d ` y C-) OWNER TEL.# -452 PLANNING BOARD PERMIT GRANTED CONTR.TEL.#- c2 9' 19 /9' CONTR.LIC.# BOARD OF SELECTMEN / fYiLDINO iNfPECTOR 7 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I ISFORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRU TION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARD-D PIERS PLASTER _ _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'T' AREA _ '/ 1/1 3/4 FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF W 10 PLUMBING GABLE HIP BATH (3 FIX.) < GAMBREL MANSARD TOILET RM. 12 FIX.) ' FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 1l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OI l B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING Q E R a � • Town of North Andover A' BUILDING DEPARTMENT Homeowner License Exemption II (Please print) J DATE 3 JOB LOCATION ��„ /�(,(S�jLL SJ Nufber Street Address Section of town "HOMEOWNER" o Z S-! S S� s & -5 Name Home Phone Wor-k/ Phone PRESENT MAILING ADDRESS F. LM S_)_9&T" A) 0()F_g__ I5CS 1 1910 City Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six 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 109 . 1 . 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 to six family dwell- ing , attached or detached structures accessory to such use acid/or farm structures . A person who constructs more than one home in a two-year period shall not be;. considered a homeowner . Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shal-1 be responsible for all such work. performed under the building permit . (Section 109 . 1 . 1) The undersigned "homeowner" assumes responsibility for compliance 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 . Ei0cIER ' S S IGNATURE " .e APPROVAL OF BUILDING OFFIC' Note : Three family dwellings 35 , 000 cubic feet , or larger , will be required to comply with State Building Code Section 127 . 0 , Construction Control . f � � I C i i � �/ .�►71 Q!`� Ods .r J CERnF/ED PLOT PLAN PREPARED FOR.' MA R A. F/TZGERALD AT /6 RUSSELL STREET NORTH ANDOVER, MA. NO. ESSEX REGISTRY OF DEEDS.'BK. 618 PG. 45/ PLAN.' 8K /82 PG. 600 ZONE.' R-4 ASSESSORS.' MAP 56, PARCEL 26 SCALE.' / 30 DATE.' SEPTEMBER /8, /993 RUSSELL STREET SB/OH (FWJ 1108' 2/.0' PORCH 20.2',0\ t EX/ST/NG DWELL/NG\ p O I � O , t 14.0' I LOT 77 ' /.OT 76 NOR'^N DISTRICT MSOi;X CZ3Tr.Y OF, D- F:D^ LAWPEIIC ; P 01 40 RECEIVED: C - FCR: eq S� r REGISTER OF DEEDS DANIEL LJNG Any appeal shall be filed 'b�•t TOWN CLERK " M""� ' !NORTH ANDOVER �'-, .� afte:� the .• i1"s •. within (^c0; -:'' s�: date cf fii ng of this i'otice �ic„o�� OCT �a 2 25 �� '93 in the Office of the Torn TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION Date . . .October. .14, . 19.9.3 . . . . . . . Petition No.. . .042-93. . . . . . . . . . . . . Date of Hearing. .Octobe.r .12,. 199.3 Petition of Scott Martin Premises affected . . .16. Rus.s,ell. Street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Special Permit under Referring to the above petition for a S e c t i on .9, . . . . . Paragraph. 9.3. o.f .the. Zoning. Bylaw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . so as to permit construction of . a garage.on. an .existing .non-conforming. foundation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . After a public hearing given on the above date, the Board of Appeals voted to . GRANT. . . . . the .Special Permit ,as requested . . . . and hereby authorize the Building Inspector to issue a permit to . . . . Scott :Martin... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . fi? ii8i+itia���Ie�,Y2� The Board finds that the petitioner has satisfied the provision of Section iu, Paragraph 10.31 of the Zoning Bylaw and the granting of this Special Permit in particular will not derogate from the intent and purpose of the Zoning Bylaw nor will it adversely affect the neighborhood. Signed r/ Frank Serio, Jr)!, C airman . . . . . . . . William Sullivan, Vice-chairman . . . . . . . . . . . . . . . Walter Soule, Clerk . . . . . . . . . . . . . . . . . Raymond Vivenzio . . . . . . . . . . . I . . . . Robert Ford . . . . . . . . . . . . . . . . . . . . . . . . . Board of Appeals Town of �� �r gAndover O 3� L to No. 5 S 0 ; . , ;�Jr i1�;��,;��� a , r: 0 v " r dover, Mass., • d 19 LAK EwICK 1- ��� COCHICHE �ADA'ATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT..........ro-furt..Illo..Al.relAxle^.1.0..... .... BUILDING INSPECTOR Foundation has permission to erect.A.f8�� ....... buildings on .�.�.../�!. .�I .t. �.�r...X. .. g ............... Rough 1 to be occupied as...:4.J�40.4.941�...1.0I...... .. ... `. � ....................................... Chimney provided that the.person accepting this permit shall in every respect conform to the terms o 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. $*)rj#a Ok O 4#J% m'X PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. d4e"6 ?'*s Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .. .. ....................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises o Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SFWFR/WATER FINAL DRIVEWAY ENTRY PERMIT Location No. Date GRT" TOWN OF NORTH ANDOVER G?O: "�ao 'a,�GGA „ Certificate of Occupancy $ Building/Frame Permit Fee $ SJ� Mus CH e� Foundation Permit Fee $ I ;other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ .SAL $ nnA Building Inspector Div. Public Works Location No. Date M0R7" TOWN OF NORTH ANDOVER .K Of ,•,ti00 ;, Certificate of Occupancy $ • � Building/Frame Permit Fee $ "'D'�th Foundation Permit Fee $ SSncMusE Other Permit Fee $ �h Se. r Connection Fee $ water Connection Fee $ ` TOTAL $ In Building Inspector 7 Div. Public Works PRII IT. NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40.S� I LOT NO. 2 RECORD OF OWNERSHIP DATE I BOOK 'PAGE ZONE SUB DIV. LOT NO. Ij LOCATION �/ � � PURPOSE OF BUILDING /' !► �J`Jl OWNER'S NAME NO. OF STORIES ' SIZE ;�-© 'Y' rl /�►\ OWNER'S ADDRESS �/�LLTl7 AG`�1,�`gt' � BASEMENT OR SLAB '6 L- ARCHITECT'S NAME [IJJJu(I' SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN ,DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET O POSTS DISTANCE FROM LOT LINES–SIDES2 ! CCA REAR �a© " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES � , EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 y-�cs EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR j /DATE FILED v BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED OWNER TEL.#— R w PLANNING BOARD CONTR.TEL.#&7 --���j7 / - 19 CONTR.LIC.# BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFICEs _- LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 I3 CONCRETE BL K. PINE BRICK OR STONE H A STER —_ —— PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'TAREA _ '/ 1/1 '/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD\!✓'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO ' 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. - - - TIMBER - "TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC tst 13rd JI NO HEATING AORTH 0Twn of � E ` Andover ..' "'�v No. 2 0A prt dover, Mass., �Vf 199,3 COC MSC \ ADRATED PPS\ LTJ BOARD-OF HEALTH PERMIT T D Food/Kitchen Septic System r� BUILDING INSPECTOR THIS CERTIFIES THAT............... w..I.*oAr ... ........ .aA. ....................... Foundation has permission to 11t.G....... buildings on ...IV....1%.SSCL. ......................... Rough t0 , � .... 'I� �... 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 PERMIT �Ib MONTHS Fina` JE JS C RUCTION T ELECTRICAL INSPECTOR Rough ..0............ ....... ...... ..................... Service 1 BUILDING INSPECTOR Final CCllpLrnLy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finalh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT OFFICES OF A TO ' n J26 main.Sireet' r� ■ _tNorth-An : 1 a .. - � iiover x�? : APPEALS :i Y? NORTH jUgD- VER_ .., M Chins 01846 BUILDING 1685.4775 �,�,.► DIVISION OF ' r (617y, CONSERVATION HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON,DIRECTOR Y In accordance with- the provisions of MGL c 40, S 54, a condition of Building Permit Number a,2'11-2— is that the debris resulting from this work shall be disposed bf in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: P-T tLk�)per,, A)O- (Location of.Facility) Signature of Permit Applicant 7/1 Iq _:�D' Date NOTE: Demolition permit from the Town of North Andover must be obtained for �� this project through the Office of the Building Inspector.