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Forth Andover Board of Assessors
—Qproperty Record Card
Parcel ID :210/047.0-0119-0000.0 FY:2013 Community: North Andover
SKETCH
Click on Sketch to Enlarge
PHOTO
Location: 18 ANDREW CIRCLE
Owner Name: DESMOND, DENISE A
Owner Address: 18 ANDREW CIRCLE
City: NORTH ANDOVER State: MA Zip: 01.845
Neighborhood: 5 - 5 Land Area: 0.08 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area: 1152 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 205,600 209,800
Building Value: 72,200 72,800
Land Value: 133,400 137,000
Market Land Value: 133,400
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkld=2253446&town=NandoverPubAce 3/26/2013
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No. / -� d /3 Date t 3 13 r
Check #33Z9 7-
26352 26352
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ ?O•
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
AV
,s
Permit N0:
Date Issued: !� 1 i
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
p
LOCATION
int
PROPERTY OWNERi�//rG'--
Print 100 Year Old Structure yesno
MAP NOOPARCEIa ZONING DISTRICT: Historic District yes no
Machine Shop Villaqe yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
JOne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed: District'
0 Water/Sewer
Identification
OWNER: Name:
Address:
CONTRACTOR Name:
Address:
Supervisor's Construction Licen
Home Improvement License:
ease Type or Print Pearly)
N Pt
Phone:
Exp. Date:
Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F
Total Project Cost: FEE: $�'
Check No.: '�ZY 9 -2- Receipt No.: 3: 5-12,
NOTE: Persons contracting ith unre istelred contractors do not have access to the guarantyfund
Signature of Ac
ent/OWne Signature of contractor.
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
f
ti
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE -OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑ ..
Swimming Pools D.
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENT
CONSERVATION
COMMENTS
HEALTH
I COMMENTS
tl
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer ConneCtion/Signature & Date Driveway Permit
DPW Tow ]Engineer: Signature:
Located 364 Usgood Street
FIRE DEPARTMEN'T' Temp Dumpster on site yes no
Located at 124 Mair Street
Fire DepartFnent signature/date
COMMENTS
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The Commonwealth of Massachusetts
Department of IndustrialAccWnts
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:
City/State/Zip;
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).*
2. ❑ I am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet. #
El Remodeling
ship and'have no employees
These sub -contractors have
8. ❑ Demolition
working for me in any capacity.
workers' comp. insurance.
5. ❑ We are a corporation and its
g. 0 Building addition
[No workers' comp. insurance
required.]
officers have exercised their
10.0 Electrical repairs or additions
3.A I am a homeowner doing all work
right of exemption per MGL
I L ❑ Plumbing repairs or additions
myself. [No workers' comp.
c. 152, § 1(4), and we have no
12.E]. Roof repairs
insurance required.] t
q �
employees. [No workers'
13.0 other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site
information.
Insurance Company
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 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 /'andpenalties ofperjury that the information provided above is true and correct.
.
c;n,,�fi,ra• /I Im t A 1,�..N/1'1Vk9X-- nate. <"I3/Jv13
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTown Clerk 4. 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 maybe submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and 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 (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit 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 ofladustrial Accidents
Office of Investigatitolls
600 Washington Street
Boston, MA 02111
Tel, # 617-727-4900 ext 406 or 1-877:MASSAFE
Revised 5-26-05 Fax # 617"727;7749
_WWW-mass,govfdia.
TOMW OF NORTH ANDOVER
o= b>0 °L OFFICE OF
Yd
ELUDING DEPARTMENT
o� py 1600 (Osgood Street Building 20, Suite 2-36 +
North Andover Massachusetts 01845
Gerald A. Brown Telephone (97$) 688-9545
InspectorofBuildings - Fax (978) 688-9542
HOMEOWNER -LICENSE EXEMPTION
BUIDZNO PERMIT .APPLICATION
r
lease rint •
DATE:
J013 LOCATION:
Number Street Address
WMEOWNER PeA-/se
Name
PRESENT h ATLING.ADDRESS
Cltd To,,,r,
Home Phone
Map/Lot
WorkPhone
-=wrw • Zip Code .
The current exemption for "homeowners" was extended to include owner -occupied dwellings tot4vo units -Or less and
allow subb homeotiirers to engage an individual.for hire who does not'possess a license, provided that the owner
acts as supervisor). Sate Building (Code Section 108.3.5.1)
DEFINITION OFHOAMOWNER
Person(s) who awns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to
be, a one or two family structures. A person who constructs more that -one home in a two-year period shalt not be
considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules andregulations,
The undersigned "homeowner" certifies that he/she understands the Town of I�orth Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with,said procedures and
requirements,
HOMBOWNI;RS SIGNATUREY2 AA24kx6yu
kk
APPROVAL. OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
.
BOARD OF APPEALS 688-9541
CONSERVATION 688-9530
HEALTH 688-9540
PUNNING 688-9535
N0RTH ANDOVER BUILDING DEPARTMENT
1600 Osgood Street
North Andover
Tel: 975-688-9545
Fax: 978-688-9542
BUMNESS FO" FOR TOWN CLEW
NAME: eAll
ADDRESS;
ZONINGDISTRICT:
TYPE OF BUSINESS:
BUILDING LAYOUT PROVIDED: YES L
AVAILABLE PARKING SPAM:
ZONING BY LAW USAGE:. YES
BUSINESS FORM FORTOWN CLERK
2.40 Home Occupation (1989132)
An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal
address, which is clearly secondary to the use- of the •building; for living purposes. Home occupations shall
include, "but riot 'limited to the following uses; personal services such as famished by an artist or instructor,
but not occupation involved with motor vehicle repairs, beauty, parlors, animal kennels, or the conduct of
retail business, or the manufacturing of goods, which impacts the residential nature of the neighborhood.
.4. For use of a dwelling in any residential district or multi family district for a home occupation, the
following conditions shall apply:
a. Not more than a total of three (3) people may be, employed in the home occupation, one of
whom shall be the olwier of the hbme occupation and residing in said dwelling,
b. The use is carried on strictly within the principal building;
c. There shall be no exterior alterations, accessory buildings, or display which are not customary
with residential buildings;
d. Not more than twenty five (25) percent of the existing gross floor area of the dwelling unit .
so used, not to exceed one thousand (1000) square feet, is devoted to* such use. In
connection with
such use, there is to be kept no stock in trade, commodities or products which occupy space
beyond these limits;
e. There will be no display of goods or wares visible from the street;
f. The building or premises occupied shall not be rendered objectionable or detrimental to.the
residential character of the neighborhood due to the exterior appearance, emission of odor,
gas, smoke, dust, noise, disturbance, or in any other way become objectionable or
detrimental to any residential use within the neighborhood,
g. Any such building shall include no features of design not customary in buildings for _residential
use.
Signature Date
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No,
MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine
NOTES and DATA — (For department use
® Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
Li Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
o Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the app: al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: Doc.Building Permit Revised 2012
MW
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 "
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 5
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-bythe . Inspector_of_Wires abandoned-and_invalid.ifhe—.. _
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: 1 *** Note. Reapply for new permit
❑ Permit Extension Act—Permit/Date Cosed:
Q�
Date .... /A ..G�.........
. .i
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
O�'�/ , F � ...............................................
This certifies that .......<. ............................. T..Y/
has permission to perform...........................//..................................................
wiring in the building of ....... AIF IIVI ..'.......C. Y /.....................
A. /'lug ..
at............................................................................... orth Andover, Mass.
Fee ... ......... Lic. No....,�1. ............
EL RICALINSPECTO
Check # 2 y
7957
4
r
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. ?I }�
Occupancy and Fee Checked
[Rev. 1/07] leave blank
r
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 /1/-/
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
City or Town of: NORTH ANDOVER
By this application the undersigned gives notice of his or her inti
Location (Street & Number) /"?
Owner or Tenant
Owner's Address
Is this permit in conjunction with a wilding permit? Yes C
Purpose of Building
Date: %,f/ -
To the Inspector of Wires bL
perform the electrical work described below.
Telephone No.
r
ay -
01
No ❑ (Check Appropriate Box)
Utility Authorization No.
Existing Service 19D Amps J- / C)-Vp Volts Overhead ❑ Undgrd R No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
i'.omnletion of the { 11.,,..;.,.. fable — . G,....,.:-._,� — -- '-----
No. of Recessed Luminaires g
__... __..... ., ••••, •
No. of Ceil: Susp. (Paddle) Fans
LNO. Of y Uc waived u otic UspectTotarui rrires.
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
rnd. grnd.
o. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection anT-
Initiating and-
InitiatingDevices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
Heat Pump
Totals:
I Number
Tons.......
No. of self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
No. of Dryers
No. of Water
Heaters KW
Heating Appliances Kms/
No. of No. of
Signs Ballasts .
Security Systems:*
No. of Devices or E uivalent
Data Wiring:
No. of Dvices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 1-11-0? 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 covVage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ff BOND ❑ OTHER ❑ (Specify:)
I certify, under the ins andpenalties, ofperjurry�, that the information on this application is true and complete.
ME:
FIRM NA1 �4-A iC ( A LIC. NO.:
Licensee:
LIC. NO.:
(If applicable, enter "exempt,, ,, in the license number -Line.) Bus. Tel. No.: i 7'� �(S`�i,-
Address: �ci3"� bSAlt. Tel. No.:—q;?.I-,S� /, -31.)�
*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: $
f
The Commonwealth of Massachusetts
Department of Industrial Accidents
.c Office of Investigations
rI 600 Washington Street
Boston, MA 02111
www.nxass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le-vibly
Name (Business/Organization/individual): !j i�.Ql -P /'A-1 r�-61 ) �
Address:? �l n �-•�
City/State/Zip: /j/1 Phone #• )�' �f - C� C� i
Are �+6u an employer? Check the appropriate box:
1. I am a employer with �_
4. ❑ I am a general contractor and I
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
ship and have no employees
These sub -contractors have
working for mein any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing a1i work
right of exemption per MGL
myself, [No -workers' comp,
c. 1.52, § 1(4), and we have no
insurance required.] t
employees. [No workers'
'
comp. insurance required.]
Type of project (required):
6. [ New construction
7. ❑ Remodeling
8. Q Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
1 I.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
"Any applicant that checks bott # 1 must also fill out the section below showing their workers' compensation policy information,
r Homeowners who submit this affidavit indicating they ars doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheetshowing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employeep Below is the policy and job site
information. .01
t
r� `'l re
. O-98
Insurance Company
Policy # or Self -ins. Lie.
Job Site Address:
-X3
'/t Expiration D2
v-
_ 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
t• 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 un ai penalties of perjury that the information provided above is true and correct.
Signature: Date: C-0
Phone #: —(2`D
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 individuals, 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 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 cavy 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 permittlicense 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 42111
Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/di:a
NORTH ANDOVER BUILDING DEPARTMENT
400 Osgood Street
Tel: 978-688-9545
Fax: 978-688-9542
BUSINESS FORM FOR TOWN CLERK
DATE: /-J-
c Lal- /), ��✓
ADDRESS: / �1 ���/c`i' �`Gr/ Gi/Z l 15-,
ZONING DISTRICT:
TYPE OF BUSINESS: C;X.I:C 'X'd �
BUILDING LAYOUT PROVIDED: YES NO
AVAILABLE PARKING SPACES:
ZONING BY LAW USAGE: YES NO
BUILDING INSPECTOR SIGNATURE
dcl2¢- �� u..4
Revised 11.5.04
BUSMSS FORM FOR TOWN CIFRK
Date.'/�% •. o
TOWN OF NORTH ANDOVER
cV, c�
PERMIT FOR PLUMING
,SSACMUS�
This certifies that .. ...G. t err. 6-1 . ?.. !.'. " • ' . ......... n
has permission to perform ................. .
plumbing in the buildings of pfgono ..n�...... .
at ..%l,F.. J CI4-4 .' .... , North Andover, Mass.
Fee.4/7- .. Lic. No. 1
PLUMBING INSPECTOR
Check !/ 11-72,
7603
'M
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date l-? -✓�/ o
Building Location IFS IIVAJ W G //2 Ce�c Owners Name'OE/IJ I S .�/oiU b Permit # Go )
n S y�
Type of Occupancy / Amount
New Renovation Replacement Plans Submitted Yes NoEl
Do K
o
'4
r
M1119
MM
W 1 •0 '
----..-------------------
.,1 0 0.'
--.---.-------M-----.--
1 .. '
---M-----
---------------
1 00:'
MMOMMOMM-MMMMM-MMMMOMM
1 •.:'
------------------------
1 •.'
MMMMMMOMM
MW
MWOMMOMMMM�
(Print or type) p ' � Check one: Certificate
Installing Company Name �}-S / LUIjA-111y 1f C///l�yG ❑ Corp.
Address/65 ��G� S 7 /� P /`7 rl Partner.
(-d w�: Ij— f -r
Business Telephone y,)5 yq s )'30.q Firm/Co,.
Name of Licensed Plumber: OR -6-C- 5H4
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy a` Other type of indemnity ❑ Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature IOwner 1:3 Agent M
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 Plumbing Code and Chapter 142 of the General Laws.
BY lgna ure o icBafse(l rlumoer
Type of Plumbing License
Title / S-7 F
City/Town (cense 1,4umDer Master❑ Journeyman
APPROVED (OFFICE USE ONLY
COMMONWEALTH OF MASSACHUSETTS
IN P1* UMBERS AND GASFITTERS
LICEK1 kD AS A JOUR -N,
EYM?N PI,t!!►flBER
ISSUES THIS LICENSE TO
1:05 F�171K�:2 ST
LbWEL mA 018-82-50 a3
21578 05/01/08
Ing
CONTROL # E 19 7 7 8 4
IMPORTANT
If this license is lost or destroyed, notify your Board at the:
Division of Professional Licensure; 239 Causeway St.,
5th Floor, Boston, MA 02114.
If your name or address shown is changed, notify your board
of correct name or address to insure proper mailing of next .
Renewal Application. Always refer to your license number.
This license is subject to the provisions of the General Laws
as amended. It is a personal privilege, and must not be loaned
or assigned to_any other person. Keep this license on your
i - suo!1moPad py 6uolv.4oela -
O ua41
'Plod
Location i l`� 1`►�(%��P� �l
No. 159 % Date 6 03
I.
TOWN OF NORTH ANDOVER
,.-. 0
o ; ; Certificate of Occupancy $
1 <w�i�:�• 4 i
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
I Check # ! 6 / 6 O /02&1
c
'i 6 4 7
1
_S v
M /V I;r-,
Building Inspector
' TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
oil
BUILDING PERMIT NUMBER: 16 ----nl DATE ISSUED.
C�SIGNATURE:
Building Commissioner/I for 6ituildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
r -nck
1.2 Assessors Map and Parcel Number:
ap Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide RaTfired Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public 0 Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name ( nnt) Address for eerrvice
gnature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Si nature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.3�_icensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
t
Registration Number
Address
0
Expiration Date
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (1VLG.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 ....... El No ....... ❑
SECTION 5 Description of Proposed Work(check all applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work: /
—� i�lC YIYDr S�iP�� CSC �� 5 Zti �/
l//l/ , /sa Cry
d SZ� OI "4 tu/L—A/o A(P
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed bypenrdtapplicant
.OMCIAL,USE ONLY -
1. Building
(a) Building Permit Fee
Multi Tier
2 Electrical
(b) Estimated Total Cost of
Construction
�Q�d
3 Plumbing
Building Permit fee (a) X (b)
5O
4 Mechanical (HVAC)
5 Fire Protection
6 Total 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 Ze" to act on
My beha - in allam tters relative to wok authorized by this building permit application.
Si ature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS is 2ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
IIEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Town of North Andover * i
Building Department
27 Charles Street
�GHu5E��5
North Andover MA 01845
Tel: 978-688-9545
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE LFA 3;'—O 7
JOB LOCATION �Q �lifiCGt/ �s�r�,P
Number Street Address Section of Town
"HOMEOWNER
Number
, _ X75 —
Phone
PRESENT MAILING ADDRESS z&�i/`/�2i/L�ic� i
d
>�-_ oyjs
Work Phone
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 HOMEWOWNER:
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 dwelling, attached or detached structures ac-
cessory to such use and and/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,
a form acceptable to the Building Official, that he/she shall 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 No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedures and requirements.
HOMEOWNER'S SIGNATURE.%
APPROVAL OF BUILDING OF
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A..
The debris will be disposed of in:
-ere
(Location of Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through. the Office of the Building Inspector
Although there may indeed be certain benefits to the condominium form of ownership
under Chapter 183A, the process of attempting to submit Town House Homes to the statute
would be substantial. For instance, at the very least, the Master Declaration, the By -Laws, and
the Articles of Incorporation, and all the deeds to the individual townhouses would have to be
amended, in order to comply with the specific provisions of the statute. All of the amendments
would require 100% approval of all the townhouse owners, along with 100% approval of all the
holders of mortgages on the townhouses. In sum, meeting these requirements would be difficult
and a very time consuming task.
2. Decks
A. Whether the homeowners at Town House Homes own their decks.
To begin with, it appears that the homeowners at Town House Homes own their
individual decks, but that their ownership is subject to the terms and conditions contained in the
Master Declaration. From a review of the Development Plans and the Quitclaim Deed to the one
townhouse you provided, it appears that each individual homeowner at Town House Homes
owns a portion of the building containing his or her townhouse, along with the land directly in
front and behind his or her townhouse. The plans do show a deck on the back of each portion of
the buildings contained in the various lots, and the deed to Lot 5B-1 specifically grants the land
with the buildings thereon contained in Lot 5B-1. Therefore, it appears that the decks at Town
House Homes are owned by the individual homeowners.
Although the individual homeowners own their decks, they own them subject to the terms
and conditions of the Master Declaration. The deeds to the individual lots (based on the review
of the deed to Lot 5B-1 only) state that the granting of the lots are subject to the terms of the
Master Declaration, and by accepting a deed to a townhouse, each owner thereby agreed to be
bound the restrictions. Therefore, an individual homeowner's ownership of his or her entire lot,
including the deck attached to his or her portion of the building, is subject to the covenants,
conditions, easements and restrictions contained in the Master Declaration.
B.. Whether the Homeowner Association is responsible for making repairs to the
decks.
According to Section 3.02 of the Master Declaration, each townhouse owner has an 18
foot by 18 foot easement area behind his or her townhouse. According to Section 3.03 of the
Master Declaration, each townhouse owner shall be entitled to use his respective 18 foot by 18
foot easement areas for landscaping purposes, and to build a deck or patio. As diagramed in the.
Development Plans, all 24 townhouses at Town House Homes appear to have decks, and all of
the decks appear to be located in the 18 foot by 18 foot easement areas behind each townhouse.
If the decks behind each townhouse are in fact located in the 18 foot by 18 foot easement areas,
then it would appear to be the responsibility of each individual townhouse owner to make repairs
to his or her deck.
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