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Miscellaneous - 208 HIGH STREET 4/30/2018
/"'," 11�c 15ckf5L,� C4,,�te4 LtA-1 C� Hie. 2sma.it, ru.�ee.,s a lot 1�/ 46� 7389 zli3lis (Vol — �vI -;� Ik'5 .,fo,), sf � ci f- Q. gJ - Z-0 K e.14be rod JN-L-- r�m d4 4v�� 66 6"A L�' &wj-- Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... has permission to perform -4LECj7l a... ............... wiring in the building of ...A .....�ZlolnlfF . . ................................... . ............................... ...............%................................. Nqj0 And, Mass. Fee. ......................... Lic. No. A . ..... .. ... ........ ....... ... LEC-T-t'CAL INSPECTOR Check # a Commonwealth of Massachusetts Official Use Only " = Department of Fire Services Permit No. C! 0 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: 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. Location (Street & Number) Owner or Tenant Ow v I Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 0--- No ❑ (Check Appropriate Box) Purpose of Building I va t 7TH Utility Authorization No. Existing Service o D Amps / Volts Overhead Q----Uhdgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity 2 (;p 14 Location and Nature of Proposed Electrical Work: I Completion of the following table may be waived by the Ins ector of Wires No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans P No, of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting 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 Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: "' Number I " Tons .......""""""'""....."""""_....._.. KW No. of Self -Contained Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent i o. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent L LATHER: Attach additional detail if desired, or as required by the Inspector of WYres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC 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:) Icertify, under thepains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME:. LIC. NO.: Licensee: V t ;,, p� Si, gnature LIC. NO.: L g ?n (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: Address: 2D S7— /V 4.1 CfA-V P � �� ` 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. B y signature I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No, q/b; yoj73,f 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 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 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 request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass R1 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass n Failed IN Re- Inspection Required ($.) ❑ t Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass n Failed M Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Dto DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents 07 Office of Investigations 600 Washington Street Boston, MA 02111 U9. www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLibly 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. El am a sole proprietor or partner- have hired the sub -contractors 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. 5. El We are a corporation and its 9. E] Building addition [No workers' comp. insurance required.] officers have exercised their 10. ❑ Electrical repairs or additions 3. ❑ 1 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' 13.0 Other comp. insurance required.] (*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: 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). ON Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a firepp 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 uk 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 cero under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #: 1 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial .Accidents Office of Intvestigations 600 Washington Street Boston, MA 02111 Tel, # 617-727_4900 oxt 406 or 1-877rMASSAFB Revised 5-26-05 Fay, # 617-727-7749 wwwanass,govfdia TOWN OF NORTH ANDOVER Office of the Building Department 0* %AORTy q neo , ti Community Development and Services 032 1600 Osgood Street, Bldg. 20, Suite 2035 '' 70 North Andover, MA 01845 �9SSgc►+us���y Peter Murphy, Electrical Inspector August 13, 2013 To: David A. DeSimone Fr: Peter Murphy Re: 206- 208 High Street Dear Mr. DeSimone, This is a letter to follow up on outstanding electrical permits that have been issued for your address. At this point in time there are two outstanding electrical permits #11247 issued on 11/27/2012 and #11423 issued on 2/26/2013. Permit #11247 was issued for a service change, a rough inspection was done on 11/30/2013 for the wall portion and the rough inspection passed but there there were safety issues that needed to be addressed on the same permit and those issues need to be reinpsected to ensure that they have been corrected. Permit # 11423 for repairs on electric heat in bedrooms, no electrical inspections have been conducted on that permit. In order to be compliant with the Massachusetts electrical code an inspection on both permits must be performed by September 13, 2013. Please call the office at 978-688-9545 to schedule the inspections. Sincerely, Peter Murphy Electrical Inspector Date..//— d:7- �Z, This certifies that ......� /9U/0 ..... DE. .S/ .0ell�( wn'LIZ ) has permission to perform.. 2-.. S.. v< <-= ihr y wiring in the building of Pz at. cio6 - 20?� /� . 57*- . . ©o Fee ..... Lie. No.� ��.��.� 0 djeck # 11247 ........ North Andover, Mass. LECTRICAL INSP�CTR .p �L\ Commonwealth of Massachusetts Official Use Only ' Permit No. i � LZ7 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] peaveblank 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 ININK OR TYPE ALL INFORMATIOA9 Date: // - 2, 7 — 2— City 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. Location (Street & Number)_ ?- n � -.2, O �- ///(� 4 Owner or Tenant _ Telephone No. qi 6- yo o) 3 & C/ Owner's Address A o g- Is this permit in conjunction with a building permit? Yes ❑ No ©-- (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service e,/9 C> Amps 20 f% Volts Overhead Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above o In Swimming Pool rnd. rnd. E]Batter o. o Emergency Lighting Units No. of Receptacle Outlets Z No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches Z No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I.NyMler I I Tons I *" "*I I KW *' "'"" No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems. No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: L+� c� rYre 2 3o cA e 7` `�! 4 0 o &�- Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, cinder the ains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. y de S2h o n LIC. NO.: Licensee: 6,2 / 917 O Signature LTC. NO.: E,z l 17,70 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.• Address: () 8` 1-1/6 lj 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. y signature be , ereby waive this requirement. I am the (check one ❑ owner ❑owner's agent. Owner/Agen PERMIT Signature Telephone No. FEE: $ �'/asyaez ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the y permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed r on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an +' electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the ' notification of completion of the work as required in M.G.L. c. 143, § 3L. 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 request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass IN Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass IN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: `-S =10 � Inspectors Signature: Date: ROUGH INSPECTION: PassK 0 1� Failed Re- Inspection Required ($.) ❑ Inspectors Comments: \k) ,41-,�, d --7b6 -- 2, Inspectors Signature: Date: FINAL INSPECTION: Pass / Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com d V , , The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ,www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/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: 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. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. jNo workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ i`am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 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. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 1111 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other r-kny applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. isurance Company N olicy # orASelf--ins. Lic. #: Expiration Date: )b Site Address: City/State/Zip: t .ttach a cdpy 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 ne 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 up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Nestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. .gnature: Date: 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 w 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 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE evised 5-26-05 Fax # 617-7277749 www,mass.gov/dia Murphy, Peter Flfom: Leathe, Brian Sent: Friday, November 30, 2012 11:55 AM To: Sawyer, Susan; Grant, Michele; Brown, Gerald; Murphy, Peter Cc: Bellavance, Curt Subject: 206 High Street Health Dept. The Building and Electrical department did an inspection on a duplex residence @ 206 High Street. Many Electrical, mechanical, building violations were observed such as poor wiring, fire wall issues, Illegally installed pellet stoves(main source of heat), egress violations, the cook stove is in the basement not in the kitchen and there is NO heat on the main living floors (space heater observed in the bedroom). It seems many unrelated people live in the dwelling and the general condition of the living space is poor. Please investigate and advise. Brian Leathe Local Building Inspector Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2-36 Phone 978.688.9545 Fax 978.688.9542 Email bleathe@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. BUILDING DEPARTMENT [ommunity Development Division November 13, 2012 To: Dave Desimone Fr: Peter Murphy — Electrical Inspector Re: 206 High Street Dear Mr. Desimone, Our office has received two phone calls regarding electrical work being done at the above address. Our records show that no recent electrical permit has been pulled to conduct electrical work at above address. That being said if electrical work is being performed a permit needs to be pulled and then the work needs to be properly inspected. Attempts to reach you at 978-408-7389 as well as visits to the address have been unsuccessful. Please call us at your earliest convenience so that we can discuss the matter further and come to some resolution. Sincerely, Peter Murphy Electrical Inspector Town of North Andover 1600 Osgood Street, Suite 2-36 North Andover, Massachusetts 01845 Phone 978.688.9545 Fax 978.688.9542 Web www.townofnorthandover.com Division of Professional Licensure: License Search Q The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > .1-1 ................. .. .. I - 11- --l-1-1.1-1 ........................... __..........._._._....... Check A Professional License By the Division of Professional Licensure I LICENSEE j Name: DAVID A. DESIMONE I N ANDOVER, MA i NEW SEARCH i Licensing Board: ELECTRICIANS I i License Type: JOURNEYMAN ELECTRICIAN TYPE CLASS: E e License Number: 21970 Status: CURRENT Expiration Date: 7/31/2013 j Issue Date: 5/20/1996 i Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Tuesday, October 23, 2012 at 8:48:45 AM. © 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATEDINFO Disclaimer Regarding Website License Searches Enforcement Process Glossary Glossary of License Status Codes More Site Policies Contact Us http://license.reg.state.ma.us/publiclpubLicenseQ.asp?board_code=EL&type_Class=_E&1... 10/23/2012 O 0 O o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 0 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 O O 0 0 O o 0 0 0 0 00000 0 0 0 0 o 0 0 O o ----- 0 0 0 0 0 0 0000 0 0 00000 0 0 0 0 0 0 n mmm .r-1,20 M m m N O M M N n 0 0 n M m O m M r m m r O m n O m m M m O N m O m O O r r M m n m N M N O m n M m O r M m Ip m m m r n a m m r m m n m mar N n M n m n m a m O m N m O r r O m m m M n m N m r r Oma N m m 0 O r r n r N m M m r O m M m N n a m m M O n m m m N r m m m n m n M N m m m O m m n m M m r M m 0 m N m m N O N r n a r r a m a a a a a a a a m a m a a a m n m N m m m n r m m W M N M N ti N M N M N N N N N M N N r M N N N N N N r M a M M a 0 o 0 0 O O 0 0 o o 0 0 o 0 0 0 o o 0 0 0 0 0 0 0 0 0 0 0 0 0 o O 0 0 o 0 0 0 o o 0 0 0 o 0 0 o o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 no 0 0 0 0 0 0 0000000 0 0 0 0 0 00 O O o 0 M m N r m m m O m n n m N a M m m r M m c m � m m m O m O m m m m O r m O a M r O m m m n m � O m m M m m m O1 a m m M M m N M M m m O m O N m O a m O Cl) r n M N 0 m o 0 0 m N m M N M r a O O 0 o r m a o n r m r m m r r m m r r o o N N m o r N 0 o N N m m r r m r r m m r r M M N N M M N N M Cl) N N a r N r N '� N n m m r r n n r r n n r r n r m r M N m r m n r r m r n r m a r r M m m a r r r N m n r r r O N m M r m m O 0 a O O 0 0 a O O 0 0 M NO O O 0 0 m OO 000 0 0 m N OOOO 0 0 m a 0 0 O m 0 no 0 0 m m O O '00 0 m O 0 M O 0 0 O O m 0 O N 0 0 cocoa n or-, m m 0 0 m 0 0 m N 0 0 0 m O M O O 0 0 m m O 0 0 N O O o 0 0 N M 0 0 0 0 N 0 0 0 0 N m 0 ... 0 0 m N 00 0 0 M m 0 0 0 'a m 0 0 000 0 0 m 0 0 0 Manna M m 0 0 a m 0 0 m 0 M m O N m m a m O M m m m N m N n O O N 0 m m n m N m m m m m n a O M N N a m ��}} N a M O N M N m C) m O M O m 0 O m m t° a m n m N N m � O LO a a m n m m m m m N M o M O r u7 N N M m 0 m -00 N M M N N N M N N N N N N N M N M N N N m m m m n m M m r r N N N M m NIT N r r N r r r M N r r N a In aaaaaaaaaaaaaaaaaaaa+aanaaaaaaaaaaaas`�aaaaaaaoaaaaaaaaaaaaa mmmmmmmmmmaommmmmmaomm�mm m LO h m m m m m m m N m m m m m m m � m M m m n m m mm m m m m m m mmmmmmmmmm m m m m m m m m M m m mmmmmn m m m r m m m.0 m m Ow mmmmmmmNm m m m m m m o r m O O O O O O O O O O O O O O O O O O O O ma N O 0 0 O N 0 0 0 0 0 0 0 0 0 0 0 0 0 N 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N aaaaaaa¢aQaaaaaaaaaaaaa❑aaa¢aaaaaaaaaaaaaaaaaaaaaaaa¢aaaaaa N xxmxxxmxwWWWWWWWWWWW wwwwwwwwwwwwwwwwwwww mx ww wwwwwwwwwwwwww WWWWWWWWWWWWWW mmxxm wwwww mxmxmmWWWWWW wwwwwwwwwwww x w >>>>>>>>>>>>>>>>>>>> O ❑ O O ❑ ❑ O O ❑ ❑ O O ❑ ❑ O O ❑ ❑ O O O O o 0 ❑ ❑ 0 0 ❑ ❑ 0 0 0 0 0 Z > > 0 0 >>>>>>>>>>W 00000000008 } > > 0 0 > 0-j > >>>> 0 0 0 0 0❑ >>>>>>>>>>>> 0 0 0 0 0 0 0 0 0 0 0 0 > z 2 0 zzzzzzzzzzzzzzzzzzzz a a a ¢ Q Q Q Q Q Q Q Q Q Q Q O ❑ Q Q O ❑ Q Q ❑ p Q� O ❑ zzm Q Q ❑ zzzzzzzzZZZzzZ>zzzzzgzzzzzzzzzzzzwz ❑ O ❑ ❑ ❑ O O O ❑ O ❑ O ❑ - 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LL E E :L � 3� u mv) aN 0 0 00�mmCiC'J� U_U_ca LL Z HQ Q �-m m cY 'a v E E(D Wg p w o0�mxtax tom• HMLLMwm2w mm1 J w > LUo p N C) p 'o a �0:c U LL a9 z w a z xa� 0x d ~ aQa)Q 2 CN a = m c� H~ LU) (n A LL 2 (D L) to t ai o c a: H O p -ON Z O p•� M 0 f6 N C i W 0 ¢ v)toww2LL zLLLLU a�: co V N N 0 0 cu O 6 O O Ct 0 0 0 N LO 0 C) North Andover Board of Assessors Public Access 1� E �►ORT1/ 'p ,sS�1CHUSEt Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 North Andover Board of Assessors I� property Record Card Parcel ID :210/052.0-0041-0000.0 FY:2012 Community: North Andover SKETCH Click on Sketch to Enlarge PHOTO Click on Photo to - L --,� 206 HIGH STREET Location: 206 HIGH STREET Owner Name: DESIMONE, DAVID A Owner Address: 206-208 HIGH STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5 - 5 Land Area: 0.28 acres Use Code: 104 -TWO -FAM -RES Total Finished Area: 1500 sqft ASSESSMENTS :al Value: (ding Value: id Value: rket Land Value: tpter Land Value: Sale Price: Arms Length Sale Code: Cert Doc: CURRENT YEAR 313,200 144,100 169,100 169,100 PREVIOUS YEAR 309,200 140,100 169,100 LATEST SALE 1 Sale 12/30/1997 Date: F-NO-CONVNIENT Grantor: DAVID DESIMONE Book: 04927 Page: 0349 http://csc-ma.us/PROPAPP/display.do?linkld=1891090&town=NandoverPubAcc 10/22/2012 VA J Nfbwc� � Ile�a�l��_ 2�n�e�� 2ic) b -41 St \�J 20e3 cl o c) i Zilp-1 9n za6 9-66-1-- --- -�i✓ c� — �+?*�edo�-tel c'-- NORTH ANDOVER BRANCH NORTH ANDOVER, Massachusetts 018459998 2445930845-0097 11/14/2012 (800)275-8777 03:02:30 PM ------------- Sales Receipt Product Sale Unit Final Description Qty Price Price NORTH ANDOVER MA $0.45 01845 Zone -0 First -Class Letter 0,50 oz. Expected Delivery: Thu 11/15/12 Return Rcpt (Green $2.35 Card) Certified $2.95 Label #: 7012101006011 i, 0554446 Issue PVI: $5.75 Total: $5.75 Paid by: Cash $5.75 Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps.com/clicknship to print shipping labels with postage. For other information call 1 -800 -ASK -USPS. Get your mail when and where you want it with a secure Post Office Box, Sign up for a box online at usps.com/poboxes, Bill#:1000301456041 Clerk:08 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER Go to: https://postalexperience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE Peer FLete-el �s— U5 Nosta��ervice�rM CERT�LFIED;MgILTM.RECEiPT : A {Domestic Mail tiOnly, No Insurance�,Coverage Provided) � Fob delivery5information visito—fj ebsite at www•uapsxom6u- 4845 Postmark Here i i I 11!14! �01� i rlt [ant To ,V& nl ra ------------------------reet, Apt.No.; Z�y � S�OBox No. ------------------------------------------------- ity. State, ZIP+4 h11 I/T_ � ✓t�'�- 'j 'A' i�DftTH AN- .. R MR o]$45 Ln Q Postage $ $0.45 Certified Fee $2.95 ra C7 C3 Return Receipt Fee (Endorsement Required) $" 35 M Restricted Delivery Fee (Endorsement Required) •�Q r3 '�$5.75 CO Total Postage & Fees 4845 Postmark Here i i I 11!14! �01� i rlt [ant To ,V& nl ra ------------------------reet, Apt.No.; Z�y � S�OBox No. ------------------------------------------------- ity. State, ZIP+4 h11 I/T_ � ✓t�'�- 'j 'A' N/ Blackburn, Lisa Frdm: Sawyer, Susan Sent: Monday, December 03, 2012 8:38 AM To: Blackburn, Lisa Cc: Bellavance, Curt; Grant, Michele; Leathe, Brian; Brown, Gerald Subject: RE: 206 High Street visa, please let us know if/when you receive any tenant complaints on this address. A'Iso, keep a copy of this email in the address file for reference. Thanks, Susan From: Leathe, Brian Sent: Friday, November 30, 2012 11:55 AM To: Sawyer, Susan; Grant, Michele; Brown, Gerald; Murphy, Peter Cc: Bellavance, Curt Subject: 206 High Street Health Dept. The Building and Electrical department did an inspection on a duplex residence @ 206 High Street. Many Electrical, mechanical, building violations were observed such as poor wiring, fire wall issues, Illegally installed pellet stoves(main source of heat), egress violations, the cook stove is in the basement not in the kitchen and there is NO heat on the main living floors (space heater observed in the bedroom).' It seems many unrelated people live in the dwelling and the general condition of the living space is poor. Please investigate and advise. Brian Leathe Local Building Inspector Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2-36 Phone 978.688.9545 Fax 978.688.9542 Email bleathe(@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: hftp://wvvw.sec.state.ma.us/pre/13reidx.htm. Please consider the environment before printing this email. TOWN OF NORTH ANDOVER Office of the Building Department Of NORTF/ Community Development and Services yo�t. .•.,6 y6 O - p 1600 Osgood Street, Bldg. 20, Suite 2035 North Andover, MA 01845 SAC 14Us���y Peter Murphy, Electrical Inspector August 13, 2013 To: David A. DeSimone Fr: Peter Murphy Re: 206- 208 High Street Dear Mr. DeSimone, This is a letter to follow up on outstanding electrical permits that have been issued for your address. At this point in time there are two outstanding electrical permits #11247 issued on 11/27/2012 and #11423 issued on 2/26/2013. Permit #11247 was issued for a service change, a rough inspection was done on 11/30/2013 for the wall portion and the rough inspection passed but there there were safety issues that needed to be addressed on the same permit and those issues need to be reinpsected to ensure that they have been corrected. Permit # 11423 for repairs on electric heat in bedrooms, no electrical inspections have been conducted on that permit. In order to be compliant with the Massachusetts electrical code an inspection on both permits must be performed by September 13, 2013. Please call the office at 978-688-9545 to schedule the inspections. Sincerely, Peter Murphy Electrical Inspector ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: s n tGre / �- i ❑Agent X ❑ Addressee v' B. Received by (Printed Name) C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Peg/ice Type Certified Mail 0 Express Mail Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Numl 7 012 1010 0001 1056 7408 (Transfer fronaerne.,...q PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540,, UNITED STATES POSTAL SERVICE First -Class Mail Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • T P' David Desimone 206 High Street North Andover, MA 01845 Re: 206 High Street TOWN OF NORTH ANDOVER Office of the Building Department Community Development and Services 400 Osgood Street North Andover, Massachusetts 01845 K1'. � l z'' 1 z Telephone (978) 688-9545 FAX (978) 688-9542 February 13, 2013 Due to a complaint submitted to the Building Department and a walk through on November 30, 2012, to date no building permits have been issued to correct the following violations. Violations Observed: 1. Fire wall between units has been compromised 2. No heat in individual sleeping rooms 3. Two illegal pellet stove installations 4. Numerous wiring violations. 5. Very poorly installed Deck and Stair Egress. 6. Basement cook stove. CMR Section R113 VIOLATIONS 780: It is unlawful to construct, reconstruct, alter, repair, a building or structure; or to change the use or occupancy without written application. Violations: Section 10 Administration, North Andover Zoning Bylaw amended October 15, 2012 10.13 Penalty for Violation: Whoever continues to violate the provisions of this Bylaw after written notice from the Building Inspector demanding an abatement of a zoning violation within a reasonable time, shall be subject to a fine of three hundred dollars ($300). Each day that such violation continues shall be considered a separate offense. (1986/15) Ample time has been given to address the issues stated. To date, no formal action has been by taken by you to correct these violations. Please contact Brian Leathe, Local Building Inspector, at 978-688-9545 about these issues and violations. Sincerely Yours, 7 Gerald Brown Inspector of Buildings Cc: File Copy ;z 06 - Zna 14 Ape .: ..v &�I I I(2I IU)- #C Medicare HMO Blue (Blue Cross Blue Shield of MA) # Medicare PPO Blue (Blue Cross Blue Shield of MA) # NaviCare (Fallon Community Health Plan) #E Senior Whole Health , # Tufts Health Plan Medicare Preferred (Tufts Health Plan) # Medicare Card Number # I give permission to bill my insurance coml (Signature of person to receive vaccine or that person's F-4 For Clinic/Offic Vaccine name: Injection site: to V S given: — Vaccine manufacturer: s l VE Name and title of vaccinAHAN, R.N. Clinic/office addresNORTH ANDOVER HEALTH DEPT Seasonal Influenza Forms - MAHFt6@G d8 f* program Building 20, Suite 2-36 North Andover, MA 01845 1ackburn, Lisa From: Sawyer, Susan Sent: Monday, December 03, 2012 8:38 AM To: Blackburn, Lisa Cc: Bellavance, Curt; Grant, Michele; Leathe, Brian; Brown, Gerald Subject: RE: 206 High Street 1.1sa, please let us know if/when you receive any tenant complaints on this address A'Iso, keep a copy of this email in the address file for reference. Thanks, Susan From: Leathe, Brian Sent: Friday, November 30, 2012 11:55 AM To: Sawyer, Susan; Grant, Michele; Brown, Gerald; Murphy, Peter Cc: Bellavance, Curt Subject: 206 High Street Health Dept. The Building and Electrical department did an inspection on a duplex residence @ 206 High Street. Many Electrical, mechanical, building violations were observed such as poor wiring, fire wall issues, Illegally installed pellet stoves(main source of heat), egress violations, the cook stove is in the basement not in the kitchen and there is NO heat on the main living floors (space heater observed in the bedroom).' It seems many unrelated people live in the dwelling and the general condition of the living space is poor. Please investigate and advise. Brian Leathe Local Building Inspector Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2-36 V Phone 978.688.9545 Fax, 978.688.9542 Email bleathe(@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: httP://www.sec.state.ma.us/pre/preldx.htm. Please consider the environment before printing this email. 1 v . � Commonwealth of Massachusetts Department of Fire Services t/ BOARD OF FIRE PREVENTION REGULATIONS N Official Use Only Permit No. (I 2.17 Occupancy and Fee Checked tev.1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL )NFORMATION) Date: // 2, 7 — /,?-- 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. Location (Street & Number) J_ n � _ � O � 7 1116 Owner or Tenant .-7 01 Y Telephone No. 7/6- yo E) J& V Owner's Address _� 0 g- l 4j Is this permit in conjunction with a building permit? Yes ❑ No ©� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ;,,,) 19 AmpsV Volts Overhead 9---' Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Date ../- o? 7` rZ- TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......1�! ............. • • •�'t has permission to perform .. z' . • -� "�'v� [_ ,%r y� wiring in the t7 buil of of . � *w. at. c?O,6 •- 2020?/W. ST.... . Fee . Lic. No.c-,2. 17. W.-�_ . C ick # 1 1.247 ` ......PLEECTRICAL North Andover/,, Mass. INSPL�CT R No. of Meters No. of Meters kvriivnluquucuuySnunimpalp y Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may tissue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial -equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the gins and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. r c fr, „ LTC. NO.: Licensee: 6,2 ! j O Signature LTC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No., Address: r' 0 e 11/61] Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. y signature be ereby waive this requirement. I am the (check one) ❑owner El owner's agent. Owner/Agen j, PERMIT FEE: $ Signature Telephone No.��5' E, ay be waived by the Inspector of Wires. f Total sformers KVA rators KVA mergency Lighting r Units ALARMS No. of Zones Detection and itiatin Devices Alerting Devices Self -Contained tion/Alertin Devices ❑ Municipal ❑ Other Connection ity Systems:* of Devices or E uivalent riring: of Devices or Equivalent mmunications Wiring: . of Devices or E uivalent as reapdred by the Inspector of Wires. o c .) kvriivnluquucuuySnunimpalp y Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may tissue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial -equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the gins and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. r c fr, „ LTC. NO.: Licensee: 6,2 ! j O Signature LTC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No., Address: r' 0 e 11/61] Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. y signature be ereby waive this requirement. I am the (check one) ❑owner El owner's agent. Owner/Agen j, PERMIT FEE: $ Signature Telephone No.��5' E, ru Sent To rq �.... ---------- C3 Z 1 ��cn�.x,t Street Apt N., ` or PO Box No. IA � City, State, ZIP+4 � � ��� ¢tel �� ------------------------ ------------ ---- -- Vk PS Form :r0 August 2006 See Reverse for Instructi , ons (DomesticOnly; 1171- „ AA --01845 0 b O Postage $ $0.46 0845 Jr -91 $3.10 Certified Fee Oq O Return Receipt FeeX2.55 P ere (Endorsement Required) O HO Restricted Delivery Fee $0.00 O (Endorsement Required) ra$6.11 O Total Postage &Fees 02/15/2013 irq ru Sent To rq �.... ---------- C3 Z 1 ��cn�.x,t Street Apt N., ` or PO Box No. IA � City, State, ZIP+4 � � ��� ¢tel �� ------------------------ ------------ ---- -- Vk PS Form :r0 August 2006 See Reverse for Instructi , ons s i Certified Ma0rovides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: is Certified Mail may ONLY be combined with First -Class Mail® or Priority Maile. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please cpnsider Insured or Registered Mail. ■ For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPSe postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. PS Form 3800, August 2006 (Reverse) PSN 7530-02-000-9047 AdoO jawolsn0 S1Nf100 ,NOINIdO df10A 30N3Id3dX3 1d30d IN3338 df10A inogv sn 1131 sod/woo'aouaLaadxatp;sod//:sd;;y :o; 09 831139 nOA 3A83S S(1 d13H ssaulsnq jnoA jol noA �upyl Aluo saolAAs paa;upjen6 job spun�a8 ase;sod pup sdweIs uo leuL�.sales lltl 60:�A[3 9ZOZl9l0£0001:#llt9 ,saxogod/woo,sdsn ;p aulluo xoq a job do uslS 'x09 90t��0 }sod ainoas p y}tM ;i ;upM noA ajagm pup uagm l�pw anoA ;ag 'Sdsn-Nsv-009-1 lleo UOLINJo�ui J8yj0 and a6e;sod y;tM slagpl BulddGys ;uljd o; diysu�otlo/woo'sdsn o; og 'tZdwplS-009-1.ttp3 Jo days/woo'sdsn }e sdWPIS Japi0 '1181-ZZZ-009-1 RPO ao woo'Sdsn o; 05 saiaLnbui Jo OUL4�#--J-Od PP . 90#100 4;tdla0a8 9t9otZ£06£Z 9£Z :# not;opsueJI 9601b1 :# tenojddy £890XXXXXXXXXXXX # ;un000y ZZ'Zl$ `PjpO ;6ga0 :Aq pled ZZ'Zl$ :lplol lt'9$ :IAd anssl Z6£L990110000101Z1OL :# tagpl 01'£$ p84llja0 09 (PieO 99'Z$ uaajg) ;dod uan}ad £l/9l/ZO ;US :AJaAtlaO pe;oadx3 'zo 09'0 0-auoZ 96810 9ti'0$ VW 83AOONd H18ON 11'9$ :lAd anssl BW9901100001.01Z1OL :# lagpl Ol'£$ pati;J80 go (P�eO 99'Z$ uaajg) ;dod ujn;ad £l/9t/ZO ;US :AJaAtlaO pe;oedx3 'Zo 09'0 jallal ssp10-;sJld 0-auoZ 9ti910 9ti'0$ VW 83AOONd H18ON aolJd aolJd 40 uolIdljosa0 leuld ILun ales ;onpoJd ;dl8098 saleS ry -Wd �1:61:90 LLL8-9LZ(008) £lOZ/91/ZO L600 -9b90£6 W , `. 86669tr810 sj}asnyopsspW `83AOONV H18ON HON19 83AOONV HAON Blackburn, Lisa From: Sawyer, Susan Sent: Monday, December 03, 2012 8:38 AM To: Blackburn, Lisa Cc: Bellavance, Curt; Grant, Michele; Leathe, Brian; Brown, Gerald Subject: RE: 206 High Street Lisa, please let us know if/when you receive any tenant complaints on this address. Ao, keep a copy of this email in the address file for reference. Thanks, Susan From: Leathe, Brian Sent: Friday, November 30, 2012 11:55 AM To: Sawyer, Susan; Grant, Michele; Brown, Gerald; Murphy, Peter Cc: Bellavance, Curt Subject: 206 High Street Health Dept. The Building and Electrical department did an inspection on a duplex residence @ 206 High Street. Many Electrical, mechanical, building violations were observed such as poor wiring, fire wall issues, Illegally installed pellet stoves(main source of heat), egress violations, the cook stove is in the basement not in the kitchen and there is NO heat on the main living floors (space heater observed in the bedroom).' It seems many unrelated people live in the dwelling and the general condition of the living space is poor. Please investigate and advise. Brian Leathe Local Building Inspector Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2-36 Phone 978.688.9545 Fax 978.688.9542 Email bleathe(@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: hftp://www.sec.state.ma.us/pre/preidx.htm, Please consider the environment before printing this email. NORTy O16Ati0 BUILDING DEPARTMENT Community Development Division November 13, 2012 To: Dave Desimone Fr: Peter Murphy — Electrical Inspector Re: 206 High Street Dear Mr. Desimone, Our office has received two phone calls regarding electrical work being done at the above address. Our records show that no recent electrical permit has been pulled to conduct electrical work at above address. That being said if electrical work is being performed a permit needs to be pulled and then the work needs to be properly inspected. Attempts to reach you at 978-408-7389 as well as visits to the address have been unsuccessful. Please call us at your earliest convenience so that we can discuss the matter further and come to some resolution. Sincerely, Peter Murphy Electrical Inspector Town of North Andover 1600 Osgood Street, Suite 2-36 North Andover, Massachusetts 01845 Phone 918.688.9545 Fax 918.688.9542 Web www.townofnorthandover.com NORTH ANDOVER BRANCH NORTH ANDOVER, Massachusetts 018459998 2445930845-0097 11/14/2012 (800)275-8777 03;02;30 PM -------------------------------------- Sales Receipt Product Sale Unit Final Description Qty Price Price NORTH ANDOVER MA $0.45 01845 Zone -0 First -Class Letter 0.50 oz. Expected Delivery: Thu 11/15/12 Return Rcpt (Green $2.35 Card) Certified $2.95 Label #; 70121010000110554446 Issue PVI; $5.75 Total: $5.75 Paid by: Cash $5.75 Order stamps at usps.com/shop or call 1-800-Stamp24.. Go to usps.com/clicknship to print shipping labels with postage. For other information call 1 -800 -ASK -USPS. Get your mail when and where you want it with a secure Post Office Box. Sign up for a box online at usps.com/poboxes. Bill#:1000301456041 C1erk:08 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER Go to; https://Postalexperience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS Customer Copy Ln Ln O r-1 NO* ", � 4a Postage I $ $4.45 1 4$45 Certified Fee $22.R5 48 r:1 0 Return Receipt Fee Postmark Here O (Endorsement Required) $2.35 O Restricted Delivery Fee (Endorsement Required) $4.44 2 0 r� M Total Postage & Fees $ $5.75 11/14/2412 r9 X u Sent To m -N n� sr�o�F ra Street, Apt. No.; or PO Box No. Z p /� r y h ST ----------- ------ City, State, ZIP+4 PS Form :ir August 2006 See Reverse for Instructions IL ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. A Si aturd ❑ Agent ■ Print your name and address on the reverse ❑ Addressee g, ceived by (P ' d e) r C. Date of Delivery so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. a 2c D. Is delivery address different from item 1? �❑ Yes If YES, enter delivery address ❑ No 1. Article Addressed to: �I116 2011 3. Service Type � Ol Mail ❑N M❑Certified �ilwvl r h ❑ Registered ❑ Return Reed r Merchandise (}l �� E) Insured Mail 13C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number !` ,17�12_1•Z_0�1,0 10001 4105St4'4'461 (Transfer from service IabeQ ({ ; ; . ;_ � !' , � PS Form 3811, February 2004 Domestic Return Receipt f 102595-02-M-1540 ; Division of Professional Licensure: License Search The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Page 1 of 1 Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > f ONLINE SERVICES Check A Professional License i Check a License j Locate a Licensed i Professional By the Division of Professional Licensure Online Address Change ..:......:..........:............_....... I Contact the Agency LICENSEE More... Name: DAVID A. DESIMONE ! REFERENCES & N ANDOVER, MA I i RELATED INFO NEW SEARCH !...... Disclaimer Regarding ._........... .... ---.._.___......_..._._...__----...._..._._...._._....__.................. .... ....._--.-------.------.--.._--..__..----...__.._.._......._..__.-...._._...._.._._� Website License Searches Licensing Board: ELECTRICIANS j Enforcement Process Glossary License Type: JOURNEYMAN ELECTRICIAN TYPE CLASS: E i I Glossary of License Status f License Number: 21970 i Codes 1 Status: CURRENT ! i More... Expiration Date: 7/31/2013 Issue Date: 5/20/1996 Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Tuesday, October 23, 2012 at 8:48:45 ANI. © 2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg. state.ma.us/publiclpubLicenseQ.asp?board_code=EL&type class=_E&1... 10/23/2012 Fk 00 0 hMN 0 0 0 0 0 0 0 O)NN 0 0 0 0 hmGmrNNNOrrNNnM[I) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 000000 0 0 NrhNNNhhmNNM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 M 0 0 0 0 NC11 0 0 0 0 N m 0 0 0 0 0 0 0 0 0 0 00000 0 0 0 0 0 0 0 0000 0 0 0 0 0 0 0 0 0 O 0 0 O O m h0N V N m N sf O M OMh tT er O O Mr e} N M N '7 'V O O) h O 'a N M N O N N O Or M N h rO M N m N O r M m N m 1* N N r h m N[Fr M h CA N O cn O r N M hO)ON�ONmNMM r r m O r h r MN r O NN h 7 NNN MONrO)nwoMQINNNr h N N m W M N 0Nhm N N r M M0 N m NOrr h 'cT sf N V V V' m h m N m M h r N N N M N M N M N M N M N N N N N M N N r M N N N N N N r M �1' M M 'd' 000000 0 0 0 0 0 O 0 0 O O 0 0 O .... 0 0 O O 0 0 O 0 0 0 0 0 0 0 0 0 0 0 0 00000 0 0 0 0 0 o 0 0 00 0 0 0 0 0 0 0 0 00 0 0 0 O O O O O O O O 00 O O 0 0 0 0 0 0 0 0000 NNN NON—wNN CF Mo fm0 th[)fND OtN0 CNO 0000 OOmi Otho iq m4)'m7MMM M W)00 NOv C, Ot'm)M NfooOOO 0 0 0 �MMN 0 0 0 0 Oo-oN 0 0 0 0 Q) r O) CN r r N m r r O o N N ... r N O N N CI) [A r r m r r Q) O) r r M M N N MMM N N M N N V r N r C-4W)N N F r r h n r r n h r r h r N r Cl) N N r N h r r N r h r N V r r N aT r r rN N h r r m N r Cl) 01 r r 0 0 MO 0 0 0 0 -e 0 0 0 0 04 0 0 0 0 bhNOnnONI�OtN00N) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O 0 0 O o 0 0 NIMtI001�MO�Nara O 0 -0- 00 0 0 0 0 0 O t- 0 0 0 0 0 0 0 0 0 O o 0 0 0 o 0 o o 0 0 0 0 00 0 0 NNW 0 0 0 000'a 0 0 Nom 0 0 O O 0 0 O O 0 0 O O 0 0 O O 0 o O O O o O O 0 0 W N m N M N 0 M N N N N N N r N N N n O N M O N N CO 0 N h r N N try N N N N N N h N T M m NONtNOMo r r N 0m9�0I N N M m NhnaNO N N N N N r O N t} N r N nNthO m m r vmFOMhNeM-MfVAnMM N M O r N r N O r M r N N r N N r N a N N N N N N I D f l) N 10 1 tl N t C) N! 7 1 g N) C) 10 t p 00 N N h N NvvaavaavvaavaaaavaaaovaaavvaavavVI? 10 10 10 1 t) I C) N N N 10 NNN I p M N 1 i l 10 N N r N N N N N N N N N N N N T" N mmmm 0 0 0 m 0 0 m m 0 O 0 0 m O O 0 0 0 p O O m m O O m m O O m m O O co m m O O m O a N O m m W 0 0 N m N 0 m m 0 0 C 0 m 0 0 m m 0 0 m mmmm 0 0 0 0 m 0 0 m 0 0 m m 0 0 m N 0 0 m h 0 0 m m 0 0 0 0 m :2199:2 m m 0 0 m m m m m m N m N aaaaaaa¢aaaaaaaaaaaaaaa❑aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa N wwwwwwwwwwwwwwwwwWww »»»»»»»»»» Ww Wwwwwwwwwwwwww WwWWW Wwwwwwwwwwww W O ❑ ❑ ❑ ❑ ❑ ❑ ❑ >> >-Oo000000000000000000z00 00000000000000�000000000000000000z0 »»»»»»»w»»> »»»»»» > Z aQQ¢¢QQQasQ¢aQaQQ¢QQ�QQNQQQQaQaQQQaQQQKQa¢QQg¢QQQQQ¢QQQaQJQ z Z Z Z Z Z ❑ z Z ❑ ❑ Z Z ❑ ❑ Z Z ❑ O Z Z O O Z Z ❑ ❑ Z Z O p Z ❑ O Z Z ❑ m Z ❑ O Z Z O ❑ Z Z ❑ ❑ Z z ❑ ❑ Z Z ❑ ❑ Z z ❑ O Z Z ❑ - Z> ❑ ❑ Z Z O O Z Z ❑ Z Z ❑ O Z Z ❑ ❑ Z Z ❑ O Z Z ❑ ❑ Z Z ❑ ❑ Z Z ❑ ❑ Z Z ¢ ❑ W z x 2 x S x x S 2 x x F-FF-FF-F-F-F-F-F-FFFF-FFFF-F-F-Z KKKKKKKKKKKKKKKKKKKK S 2 x x x 2 2 x 2 2 W x 2 F -F- J 2 F -HF S S -F x x -f -F x 2 -F -F 2 S -F -F x x -FF 2 S -1 -F 2 -FF 2 S -F 2 2 -f -F- 2 U x S F-Ff-1--F-F-FF-F-F- 2 S 2 S 2 S 2 2 x x U S 0000000000009000000a KK 00 KKKKKKKKKKR'�0_a'OxLL'xLL'x¢KIYa'�RKaLL'xKaa' 00000000000001'00000 000000000 00 x z zzzzzzzzzzz zzzzz zzzzzzzzzzzz zo ❑❑❑o❑❑❑❑❑❑❑❑❑❑ aaaaaaaaaaaaaaw°aa o c w w O000000000000Owo0i-F K K K K K K K K K K K K K K K K K K F �F- K Q F- K K W F- Z W ❑ ¢F- W wF W F F W FF FHF F -F ~ w~ F' F H W7 FzMF F F -F F FF -F -F F❑ F J J J J J J J w W J J J J J J F- J_ J_ K >>°>> O O K O O W g K p W K K~ W K W K W W W K K W W W W K K W W W W W W W W W W W K W w W W www W W a W -� W ~ W W W w W W W W W W W W W W W W W W W W W W W w w S W U 2 }}}}}}} KKK SSS22 SOx2x22x❑Sx000 K }}}}}}O w O Z III w W U w F UUKF?F-NF-F-FFF-F-FF-F-F-FF-F W W❑ N a Z NxUNNUyUNyyU g Z S W x 2 x K K S x K K 2 x K 0mm 2 KKK Urny 2 2 J JWF-F-�FF s xM K Nrn K w K K rnrnUUNtn���N K K F -F -F- K K K K 000o000J00000000000Oz❑❑wa K K K K w m K K K K K O}} 00 w R axC7YU(7f7C9(7C7L7C7OJO(7_U(9f9¢SC7f7 x x 2 F_ m S 2::c °------xxw x S (7 (7 2 x C7 f9 x S C7 C7 S 2 (7 (7 m x (7 Y 2 Y Y Y Y Y Y ci K Y Y Y Y Y c. 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'�! t�. c.; _ .:_ '�� ' +R.. �Jproperty Record Card Parcel ID :210/052.0-0041-0000.0 FY:2012 Community: North Andover SKETCH Click on Sketch to Enlarge PHOTO ition: 206 HIGH STREET ier Name: DESIMONE, DAVID A ier Address: 206-205 HIGH STREET City: NORTH ANDOVER State: HIAA Zip: 01845 ;hborhood: 5 - 5 Land Area: 0.25 acres Code: 104 -TWO -FAM -RES Total Finished Area: 1500 sgft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR — Total Value: 313,200 309,200 Building Value: 144,100 140,100 Land Value: 169,100 169,100 Market Land Value: 169,100 Chapter Land Value: Sale Price: Arms Length Sale Code: Cert Doc: LATEST SALE 1 Sale 12/30/1997 Date. F-NO-CONVNIENT Grantor: DAVID DESIMONE Book: 04927 Page: 0349 http://csc-ma.us/PROPAPP/display.do?linkld=1891090&town=NandoverPubAcc 10/22/2012 a )- Mk -LAJAA 2- J� P - I. -M q1t qo�- iz)., -N ( � Z-6 (Z,2�pH ---------- - ri N2 2931 Date ........ 2A.//*/—`** TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ .............. .................................................................. —,;// q C c = , /, i / , - , 1 T � j., z �(. I.. has permission to perform ............................................................ .. wiring in the building of .............. zq O..l.....d ........ -) Y-- o at ..... 0 G .................... ................. Z1. fqdrth Andover M S;' -7:� N .......... .......... ; ...... ............. Fee -2A.-. Lic. Check # 1,-77() / LECrRICAL INSPE&R WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ecoo , fie` �r(1:..<'.i'�JJ' C_...�i�. TO DATE TIME A TIME PAM M P PM Pi FROM j��� PHO E (Q/�"? 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DESIMONE N ANDOVER, MA NEW SEARCH Licensing Board: ELECTRICIANS License Type: JOURNEYMAN ELECTRICIAN TYPE CLASS: E License Number: 21970 Status: CURRENT Expiration Date: 7/31/2013 Issue Date: 5/20/1996 Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Tuesday, October 23, 2012 at 8:48:45 AM. O 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Enforcement Process Glossary Glossary of License Status Codes More.. Site Policies Contact Us http://license.reg.state.ma.us/publiclpubLicenseQ.asp?board_code=EL&type class=_E&1... 10/23/2012 00 0000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000 0 0 O' 00 ' 0 0 000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 0 0 0 0 0 0 000000 0 0 0 0 0 0 0 n Cl) M b LO m m. 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U.(n' v LL O O MOO dN0EELE � �m O',atc6i�7_ p`Om'dw(Dt�a LL m,� m t,v.Ya Ee Z Q ws Ota). m;x m;--"5< °n.cn. m m f'-,;mLL 2'W Y w m mQ N Fm jj CL z FE 0 00 = 19 C), m�N UmQ��CL 0 °'w ' w N Z c, O i aa, O Xm,0 >> O n (n O_W;2 L-1 IT (Yn v N N O O N 0 0 0 0 0 V 0 0 0 N C) O o_ N 0 m m Cl- North Andover Board of Assessors Public Access E NO oT.i '1 3.T e�gr. .:,w, • �G i _ y • i F .sSACMtlgit Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 3 roperty Record Card Parcel ID :210/052.0-0041-0000.0 FY:2012 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e -r, t 1 206 HIGH STREET Location: 206 HIGH STREET Owner Name: DESIMONE, DAVID A Owner Address: 206-208 HIGH STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5 - 5 Land Area: 0.28 acres Use Code: 104 -TWO -FAM -RES Total Finished Area: 1.500 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 313,200 309,200 Building Value: 144,100 140,100 Land Value: 169,100 169,100 Market Land Value: 169,100 Chapter Land Value: LATEST SALE Sale Price: 1 Sale 12/30/1997 Date: Arms Length Sale Code: F-NO-CONVNIENT Grantor: DAVID DESIMONE Cert Doc: Book: 04927 Page: 0349 http://csc-ma.us/PROPAPP/display.do?linkld=1891090&town=NandoverPubAcc 10/22/2012 Town of North Andover Office of the Health Department Community Development and Services Division William J. Scott Division Director 27 Charles Street Sandra Starr North Andover, Massachusetts 01845 Health Director DATE: January 4, 2001 L TO OWNER OF RECORD To Owner of Record: David DeSimone 206 High Street North Andover, MA 01845 LETTER OF COMPLIANCE Telephone (978) 688-9540 Fax(978)688-9542 PROPERTY LOCATION Property Location: 208 High Street No. Andover, MA 01845 A Health Department ORDER LETTER dated December 7, 2000 was issued to you as owner of record of the property listed above citing violations of the State Sanitary Code, 105 CMR 410.000, Minimum Standards of Fitness for Human Habitation. A re -inspection of the property has found that all of the violations noted on the Order Letter have been corrected. A copy of fnis letter is being sent to the persons) who .made the complaint. a the complainant has any questions or comments concerning this determination of compliance, the Board of Health must be contacted within ten (10) days of the receipt of this letter. Sincerel , r S San Y. Ford, R. S. Health Inspector CC: Mike McGuire, Building Inspector Renter, Mostafa Elbasher file BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 0 06 lak ma.Jou,�t U }� „ Zo 6� ; � m 6,j .. 'fit 0 ,� �✓✓� � �-`� . . �� � 2-03 3 5 - -• 'ea^ kf iJ 1., THEC0MMONWEALTHOFMAMCffU.'SE77S DEPARTMFW OFPUBLICSAFETY BOARD OFFZREPREVEVTIONREGUL4TIOAN5270MR 12.00 O o ce Use No. �� V / racy & Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ( •r ,_� Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street &Nu er) �DGk6 Owner or Tenant ,L -31 Owner's Address 1-610 A A A • Is this pen -nit in conjunction with a buidng permit: Yes � No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service .DIDAmps / 1 8 Overhead Underground a No. of Meters New Service kolts Overhead Underground No. of Meters 4 At 1A Number of Feeders andAmpactty Location and Nature of Proposed Electrical Wor No. of Lighting Outlets No. of Hot Tubs No. of Transformers MIA Total KVA No. of Lighting Fixtures Swimming Pool Above and ow d Generators KVA No. of Receptacle Outlets I) No. of Oil Burners No. of Emergency Lighting nits - No. of Switch Outlets ' No. of Gas Burners FIRE ALARMS No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices oc M Municipal Connections No. of Zones a Other No. of Ranges w / 'r No. of Air Cond. a No. of Disposals AN No. of Heat Tota Total Pumps To KW No. of Dishwashers A KW Space Area Heating#1A No. of Dryers Heating DevicesIVIV4 KW No. of Water Heaters WA No. of Signs No. Hydro Massage Tubs No. of Motors a OTHER- ' -r :,.� Ras; :,3iof1>rreca�gr c `?vsass� MCeIr I Tws ^ IimeaomtLiab dyhmr�a=PblicyaidudingCt a 1s 1 Co&agecrissksbntde4iv&VA Y„-6 NO t�,.s� lha%esubmtl>jdNWidprod'of=x1olheOfftoeYES rj Fyuha%cdWWYES,plmmdc*the4Wofw&aWby�tgthe agrp INSURANCE a BOND� O� 1 y) WotkiDswt 2' t - D 1 htspeWonD*RoWested Sigted u JXTV %Xtit0 cfpafiey. FIRMNAME EVirAm Date Es&raadVakxcfEkoftioll Wcdc $ Rough L - .2 Sr' 0 [ Feral LioaWNa ucalselb &&xssTd.Na • 33S Adams g' %� y, sr /-/. 9a ds ►•gr A)tTVh OWNER'S MSURANMWANER;I.ammmtuhn eLimmdo r dreitrstrdnoec orEss> le�ivaiartasrecpmad:byMa tdxse�Ga>aalLaws and that my sigt�aeoaflris petrt� appfimtiar umi� this tagtiiisna>!. (Please check one) Owner Agent Telephone No. PERMIT FEE $ I Blackburn, Lisa From: Sawyer, Susan Sent: Monday, December 03, 2012 8:38 AM To: Blackburn, Lisa Cc: Bellavance, Curt; Grant, Michele; Leathe, Brian; Brown, Gerald Subject: RE: 206 High Street Lisa, please let us know if/when you receive any tenant complaints on this address. Also, keep a copy of this email in the address file for reference. Thanks, Susan From: Leathe, Brian Sent: Friday, November 30, 2012 11:55 AM To: Sawyer, Susan; Grant, Michele; Brown, Gerald; Murphy, Peter Cc: Bellavance, Curt Subject: 206 High Street Health Dept. The Building and Electrical department did an inspection on a duplex residence @ 206 High Street. Many Electrical, mechanical, building violations were observed such as poor wiring, fire wall issues, Illegally installed pellet stoves(main source of heat), egress violations, the cook stove is in the basement not in the kitchen and there is NO heat on the main living floors (space heater observed in the bedroom). It seems many unrelated people live in the dwelling and the general condition of the living space is poor. Please investigate and advise. Brian Leathe Local Building Inspector Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2-36 Phone 978.688.9545 Fax 978.688.9542 Email bleathePtownofnorthandover.com Web www.TownofNorthAndover.com ease note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: htto://www.sec.state ma us/ore/preidx htm. Please consider the environment before printing this email. Leathe, Brian To: Sawyer, Susan; Grant, Michele Subject: 206 High Street Health Dept. The Building and Electrical department did an inspection on a duplex residence@ 206 High Street. Many Electrical, mechanical, building violations were observed such as poor wiring, fire wall issues, Illegally installed pellet stoves(main source of heat), egress violations, the cook stove is in the basement not in the kitchen and there is NO heat on the main living floors (space heater observed in the bedroom). It seems many unrelated people live in the dwelling and the general.condition of the living space is poor. Please investigate and advise. Brian Leathe Local Building Inspector Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2-36 Phone 978.688.9545 Fax 978.688.9542 Email bleathe@townofnorthandover.com Web www.TownofNorthAndover.com Town of North Andover Office of the Health Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director December 22, 2000 Mostafa Elbasher 208 High Street North Andover, MA 01845 Dear Mr. Elbasher, Telephone (978) 688-9540 Fax(978)688-9542 This letter is in regards to your complaint to the Health Department about a problem with nighttime heat in your apartment. In a conversation with the building inspector, Mike McGuire and myself you stated the following: 1) From approximately 1-5AM the temperature in the apartment falls and it is very cold. The exact temperature is not known. The thermostat is near the wood stove and doesn't allow the heat to turn on until it gets very cold, however, you can go down stairs and turn it up manually. 2) You keep the door to your bedroom closed, so the heat from the wood stove in the basement does not warm your room adequately. We had the following comments: 1) By choosing to be in your unique living situation, in which you feel it necessary to keep your bedroom door closed and locked, you block the heat from entering your own room. Also, you have access to turn up the heat manually within your apartment. Although you feel that it is inconvenient, this is not a violation. If however, there is no heat to maintain the required temperatures than it may be a violation. There must be official documentation of the temperature reading by this office or the Police Department. For your information the code requirements are as follows: 105 CMR 410.201— "The owner shall provide heat in every habitable room and every room containing a toilet, shower, or bathtub to at least 68'F between 7:00 A.M. and 11:00 P.M. and at least 64'x' petweC!p 11:91 P.M. and 6:59 A.M. every day other than during the period from June 15th to So�tember 15th". As per our previous conversation, I spoke to Officer Thomas Driscoll of the Police. Department. You may recall that he was the responding officer to your home last week. He stated that you complained about the heat that day, but he found that you did BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 .7 have sufficient heat. According to Officer Driscoll, he also spoke with your roommates regarding this problem. They told him that they had no complaints concerning the apartment. As they have done previously, the Police Department will respond to any heating complaint that you have off regular business hours. Please contact the Health Department if you have a heat problem during business hours (8:30 — 4:30P.M.). It would also be helpful if you had a thermometer available so that you can verify the temperature violation before you lodge a complaint. If you disagree with any part of the above-mentioned facts or determinations you have the right to submit your concerns in writing and request a modification. Thank you. Z�sa�nfiord, R.S. Health Inspector n,.. moi,. 1 Town of forth Andover f Office of the Health Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01.845 Sandra Starr Health Director December 22, 2000 Mostafa Elbasher 208 High Street North Andover, MA 01845 Dear Mr. Elbasher, Telephone (978) 688-9540 Fax(978)688-9542 This letter is in regards to your complaint to the Health Department about a problem with nighttime heat in your apartment. In a conversation with the building inspector, Mike McGuire and myself you stated the following: 1) From approximately 1-5AM the temperature in the apartment falls and it is very cold. The exact temperature is not known. The thermostat is near the wood stove and doesn't allow the heat to turn on until it gets very cold, however, you can go down stairs and turn it up manually. 2) You keep the door to your bedroom closed, so the heat from the wood stove in the basement does not warm your room adequately. We had the following comments: 1) By choosing to be in your unique living situation, in which you feel it necessary to keep your bedroom door closed and locked, you block the heat from entering your own room. Also, you have access to turn up the heat manually within your apartment. Although you feel that it is inconvenient, this is not a violation. If however, there is no heat to maintain the required temperatures than it may be a violation. There must be official documentation of the temperature reading by this office or the Police Department. For your information the code requirements are as follows: 105 CMR 410.201— "The owner shall provide heat in every habitable room and every room containing a toilet, shower, pr bathtubto at least 68'F between 7:00 A.M. and 11:00 P.M. and at least 64'� petweep 11:01 P.M. and 6:59 A.M. every day other than during the period from June 15th to Seftember 15th". As per our previous conversation, I spoke to Officer Thomas Driscoll of the Police Department. You may recall that he was the responding officer to your home last week. He stated that you complained about the heat that day, but he found that you did BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 have sufficient heat. According to Officer Driscoll, he also spoke with your roommates regarding this problem. They told him that they had no complaints concerning the apartment. As they have done previously, the Police Department will respond to any heating complaint that you have off regular business hours. Please contact the Health Department if you have a heat problem during business hours (8:30 — 4:30P.M.). It would also be helpful if you had a thermometer available so that you can verify the temperature violation before you lodge a complaint. If you disagree with any part of the above-mentioned facts or determinations you have the right to submit your concerns in writing and request a modification. Thank you. Znord, R.S..S. Health Inspector Cc: file Building Inspector Loc tion C2,(%74 No. Date n TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee ChWAkI $ C>-2,S— TOTAL $ Check # &(9 03 14373 Building Inspector c;' R TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING i � u ?`, 1 k�1r � �•-x � L����- +ziT i`".i.""R �_Y''� ,. _v .err .� t.5:'.�. .�"�?'k.. ,...e� m�,r' ,^,.'. ,. -_ w ... .f�� �'T�w �, �� BUILDING PERMIT NUMBER: DATE ISSUED: and Parcel Number: Parcel Number SIGNATURE: 1.3 Zoning Information: Zoning District Proposed Use Building Commissioner/Ir for of Buildings Date SI C' 1014 I- SITE I-NYORMATION 1.1 Property Address: 1.2 Assessors Map Map Number and Parcel Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) P+blic 0 Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Pri Address for gervice : ll J^ Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature. Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licei sed Construction Supervisor: LicensediConstruction Supervisor: Address Signature %J f f elephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement,Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone X L i WILLIAM J. SCOTT Director (978)688-9531 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 CHIMNEY APPLICATION AND PERMIT DATE / j - 0 C2 LOCATION OWNER'S NAME �,�y t ,C = /� s' o •� BUILDER'S NAME S14 /n �. MASON'S NAME MASON'S ADDRESS MASON'S TELEPHONE Fax(978)688-9542 PERMIT # Cl/ 13 rw� MATERIAL OF CHIMNEY 17Zp GK -� %L CU INTERIOR CHIMNEY EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES THICKNESS OF HEARTH Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE SIGNATURE OF MASON EST. CONSTRUCTION COST/CONTRACT PRICE PERMIT GRANTED ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS CONTR. LIC. # FEE SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER UCENSE EXEMPTION Please print DATE r'l — "24? — 0 D Joe LOCATION Number Street Address Map /lot "HOMEOWNER Name PRESENT MAILING ADDRESS S/�/i City Town Home Phone State Work Phone Zip Code The current exemption for "homeowners" was extended to include owner-0ccupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF 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 or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. 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 SIGNATUR APPROVAL OF BUILDING OFFICIAL a as x 0 w C/) z .o w° w°' G U CO w w w" a a � w w c9i Cd w" w as w ZW0 w a'a z cn Q o cn ui z 0 w w w z 0 z 0 U Cf) Ew O v CC4 O Q � v Z CD C. O CO) p C I Ccm O•— � p� .— h O O 'E m m in- ~ y=•+ O O p O O O d a. cm< ca co ca Z� V h O C C _c C. V3 C C � C . C V O ` O H V V .n C• C O t0 m C ;= O Cc CD Ea � c o c. y C _ �•�, c$ 0 O .gym 0 ; C� ma�a ... m- E a►: :mm a ✓i ed Z e :AI--�s • � IwoCD �V O CLO C.3 CD 3N O 0 -1 20 C. cm Q � c St �O V Z. p dO C Q o c m c o = m c"t'o N C LUC=. W t m � C y.. .y rZ.., AD w- W .E dt V •� Z O C.3 m Vt m d • 'O O t NC) = A 9 z 0 w w w z 0 z 0 U Cf) Ew O v CC4 O Q � v Z CD C. O CO) p C I Ccm O•— � p� .— h O O 'E m m in- ~ y=•+ O O p O O O d a. cm< ca co ca Z� V h O C C _c C. V3 Location ' iyi F S79&Z7 }r 'NoF�h'3 Date TOWN OF NORTH ANDOVER pCRTg4 k p Certificate of Occupancy $ 41 Building/Frame Permit Fee $ •tio '� 'Ss�cHusEt Foundation Permit Fee $ o va R Other Permit Fee U"r'1lc� $ %� Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 1 i6 6 _ o raiding �,,,� �{ �y iding inspector Div. Public Works PERMIT NO. 48�F APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. 0 PAGE 1 MAP KJO. ` v LOT NO. I O 0 /-T lA 1 ' 2 RECORD OF OWNERSHIP DATE BOOK PAGE ZONE SUB DIV. LOT NO. �I LOCATION PURPOSE OF BUILDING L�VLt� ON OWNER'S NAME V) v n NO. OF STORIES SIZE OWNER'S ADDRESS y ✓ BASEMENT OR SLAB ARCHITECT'S NAME •i SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 07J7'C btAl SPAN DISTANCE TO NEAREST BUILDING 01 u DIMENSIONS OF SILLS DISTANCE FROM STREET f noC1 POSTS DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT 000 0D Is /-- FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW /O SIZE OF FOOTING X IS BUILDING ADDITION ,1 � 4,110 MATERIAL OF CHIMNEY IS BUILDING ALTERATION /V ^ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Ye S 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 �-7 / h /Tb� 6 SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 s ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING (ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR PATE FI % �l ^ L ✓ ��� G%R�� rte/ SIGNATURE OF FEE /S ^ PERMIT GRANTED d ICS( 3 19 y' F AGENT 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST '7s� OHO EST. BLDG. COST PER SQ. 1'T. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL.# i6o (5-(o CONTR. TEL. # CONTR. LIC. # A s OFFICES OF:� '~rN ��-_ Gown of _-:_.. _ , _ i 20 twain Strees" • - -- - - - �- North Andover. APPEALSNORTH ANDOVER BUILDING t ,e MgssaCtluSetts o 1845 CONSERVATION DMISiON OF HE.-kLTH _ - F't�.�XItiG PLANNING & COMMUNITY DEVELOPMENT KARE_` H.P_ tiELSO\, DIRECTOR In ac:^rdance withhe ';� r �'�tc =s - • ••«::. S a cor.dit:cn of Buildinr Number s^ :: Date /d )WN OF NORTH ANDOVER ificate of Occupancy $ ding/Frame Permit Fee $ ass<' . Foundation Permit Fee $ ACMU r . 7-7 Other Permit Fee F: ,. Sewer Connection Fee $ Water Connection Fee $ TOTAL $ & Building Inspector rta Div. Public Works iM No? Date G f z. NORT01 TOWN OF NORTH ANDOVER f ,,y a.; F Certificate of Occupancy $ C - 4L .� �, « Building/Frame Permit Fee $ -rev �<� Foundation Permit Fee $ c►�st x r Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ -TOTAL $! B(qildi s eEtor -06/10/97 16:15 .25.00 P Div. Public Wo r s 7:111T. NO,_ APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. I LOT NO. 0 0 Y� 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE SUB DIV. LOT NO. - LOCATION () ri / /�� G J C PURPOSE OF BUILDING (-fJ OWNER'S NAME )+V I d 04 S//71 NO. OF STORIES SIZE OWNER'S OWNER'S ADDRESS J BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �� SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES`% REAR GIRDERS AREA OF LOT / ) �' ®O � S FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW yl V / (5 SIZE OF FOOTING x IS BUILDING ADDITION V D MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ` 'e (' �i IS BUILDING CONNECTED TO TOWN WATER BOARD OF IF ANY #r • IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE v INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 `PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 0— ;SIGNATURE ;SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. Pt. V (/ EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. # CONTR. TEL. # CONTR. LIC. # H.I.C. # 4�0�? S \,z OrL a 4"'I q izgc �� O-e c L Z- L �6, 6-(2 r h/ c6 - o v C CTO i s 7- c e. fi l=oo o l- c-7-o/ r —Z71-2 $' �4 62/2 a W-11 e V 11 Owl �4, F 'i :y_ k "� _��``�8,,�•r rXY" YOM ot e §Y loaaec Btp�f2't�XlB►tA�y r r W W Ica 0 C.3 'ate 06 co cc LD =C - Mo ca O r= L CD &a cm E. WE E Cc 0 COL Go cm 6p co CA • 0 Cc -0 = = col O 0 I'D -0 7S 0 CD CD 'D 07 cm cm -a CC" S 0 coo CD CD tioc 'c 4D CRD CO3 0 '0.6, U- 'ra .92 w OLD S Z ui C3 -.0 CW3 4D CO2. CL F CD C3 E , L- -2 = CLO. III 41.1 4.4 �tpl O da 0 co QjW U x od r. Fir. ua U) 0 V) Ica 0 C.3 'ate 06 co cc LD =C - Mo ca O r= L CD &a cm E. WE E Cc 0 COL Go cm 6p co CA • 0 Cc -0 = = col O 0 I'D -0 7S 0 CD CD 'D 07 cm cm -a CC" S 0 coo CD CD tioc 'c 4D CRD CO3 0 '0.6, U- 'ra .92 w OLD S Z ui C3 -.0 CW3 4D CO2. CL F CD C3 E , L- -2 = CLO. III 41.1 4.4 �tpl 1 i 00 417 Yaw E Q CL Q o ,, o E Zcoco co C. 0 IC 409 <, = O low W2 o C 'fl A o v •�COcc 0 LM F`j LCL x dv co C moo oC C/)O = O c C 'aCos Zv Cc r m Q+ C O sit ca v� O ti. v•�Z OCD o a o c O O C Q y m C t 3 IS C O'tv- er, S7 Olw- +_•+ ' CM f y O; Os Q = W e �_' CLQ,. m 1 Location` No = Date ' 40 Th, r TOWN OF NORTH ANDOVER 3? ..t�ao 1oOL r. . p Certificate of Occupancy $ Building/Frame Permit Fee $ sw,b',^°'�t�' Foundation Permit Fee $ _ SSAtMUg� Permit Fee $ co Sewer Connection Fee $ 4` Water Connection Fee $ TOTAL $ J Building Inspector 9 574 Dig Public Works ,^ �. W CL Y 0 m > ; 0 0 Z m I mz W 0 0 O = I m W m m W 0 m o z 0 u 0: m J �- O �. 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LU LU O ti < Z ¢ < 0 O m W ¢ 2 i z 3 0 U 0 0 4 r- 0 0 V = 3 W m F J r 0 u W d I m I z lzO L7 z m m Wu I > i m < O p W ' W N > ¢ ¢ 0 L F <rs. 0 O ti < Z ¢ < 0 O m J z k 0 W m 4 r- 0 m pW 3 W m F J F H m < Z tZ J < L ho r �� ti 4- Y N 0 z c c tw � r N CD c � O Vi O vy fl C a = a .� O w 8 v cn O U 0 Q p w o r_G v Eri C U C i. O V p u: C w �i O w U �~ w p cL U co a d p �L v 1-4 W w A w w 61 ~ PQ z a.+ Iv ° 4- Y N 0 z cm CSCc= .mm c c tw as c N CD c � O Vi O vy fl C a = :CM :m= :t c m o CD Nom' :Ea : D� °m �L v CD N z C N co, cm CSCc= .mm co CL H O N C R CS) CD C: m O Cf C N CD L 0 Z O 0 tw N N CD �p m J O Vi cc _O fl C CO) R N m m o CD CL8 . H m m O L rtL+ � O Q z N acL m o� _ o 0 coZ : V e O c�•�Z cc C c O d Q � : y m = = m m = p O.CM* O O H Cf co LU u w "o E O � N CJ C2 m CD O== C CL= w = 0.5 O5 o A C) H � i0 CD co CL H O N C R CS) CD C: m O Cf C N CD L 0 Z O 0 tw O CD z o _ o 0 coZ O COD CD cm Cf ca u Ln ° •E m m o i0 CD = 3� CD Cc O o �. CO) C C1) 'r"'' CD W � V .Q o co COD 0 z U ° y C m C c CO) 0 rt in I ce LL CL d a c � O c E mm 3 .o ®�0 Cc Lm O a fi O!Q o=cc C� a 0 O Z 0± y � C . , r CL v w a q w aG U a � w is. � U oG w � a w A ao cn rn u 5 O .01 ail :9 com CL C CD .z g ciD E� om "Zya O C d O Is m' bf 0Cijm 3 ID N ' C m LC-) m o JOB :mat ID IS -lee C d0 ' o c H C W a ZSZt CL uj tic- .2 S C.3 a !�Fco H oz �o E � Z N z am 0 w U cp CO C m a� 0 co C �QC N J 0 'a � c � O c E mm 3 .o ®�0 Cc Lm O a fi O!Q o=cc C� EL C 0 O Z 0± y C . , r CL 0J 4e LfnmmnnWr# IIf �4fittnstt#nettn +9tvartmtnt of Public *afttu BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 office Use Only g OSS Permit No. Occupancy & Fee Checked /1 U 3/90 (leave blank) U APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 q (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Aro / (%1i or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address C2 0 �, A//'e; 4 Is this permit in conjunction with a building permit: Yes ❑ No U71� (Check Appropriate Box Purpose of Building Existing Service ?C) D Amps l20o2O 'Volts New Service Amps —J Volts - Utility Authorization N Overhead Undgrnd ❑ No. of Meters Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws J I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO _ I have submitted valid proof of same to the Office. YES = NO �_ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE " BOND OTHER � (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Signed under the Penalties of periury: FIRM NAME �v/�� Zh0N —� Licensee eg�� Vi d d e v,-, -rc Signature _ Final LIC. NO. A w LIC. NO. td % Gl J /p. 4�, Bus. Tel. No. Address l �I n � / _Alt. Tel. No. OWNER'S INSURANCEAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws and thA my signature on this permit application waives this requirement. Owner Agent (Please the ne) . �2�F0 5�_ / C_ / — D Telephone No. 41 PERMIT FEE 5 G � � (Signature of Owner or Agent) X-6565 Total No of Lighting Outlets No. of Hot Tubs FNo. of Transformers KVA No. of Lighting Fixtures SwimmingAbove In - Pool grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of es Ran9 I No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals Heat Total Total No.of Pumps Tons KW No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Local 111MunConnection [I Other No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws J I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO _ I have submitted valid proof of same to the Office. YES = NO �_ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE " BOND OTHER � (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Signed under the Penalties of periury: FIRM NAME �v/�� Zh0N —� Licensee eg�� Vi d d e v,-, -rc Signature _ Final LIC. NO. A w LIC. NO. td % Gl J /p. 4�, Bus. Tel. No. Address l �I n � / _Alt. Tel. No. OWNER'S INSURANCEAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws and thA my signature on this permit application waives this requirement. Owner Agent (Please the ne) . �2�F0 5�_ / C_ / — D Telephone No. 41 PERMIT FEE 5 G � � (Signature of Owner or Agent) X-6565 2625 Date L S 'ORT" TOWN OF.NORTI 3� y ° PERMIT FOR 09� ' CH This certifies that (t�. . �CTIZ lC/�t�_ has permission fordo installation�`�n in the buildings of .. .g. Sa 41 �. at Fee.. (�� CXR Lic. No. 'IN $ WHITE- Applicant CANARY Building Dept a'PINK. T NORTH ANDOVER HEALTH DEPARTMENT 120 Main Street • North Andover, MA 01845 Telephone (508) 682-6483, Ext. 32 Housing Inspection Report COMPLAINT #_ COMPLAINANT ADDRESS OF PREMISES e b46 —" OCCUPANT t -8T. OWNER _ 1 / .� OWNER'S ADDRESS -DACE 4� Z57,0 �o DATE OF INSPECTION &ZV lf%46 HOUR %e° ROOMS/VIOLATION: Form MR -1 Actlon Press 685.7000 INSPECTOR Office use on / 01 v:Qmmunwratth of Permit No. EC1 artmt2It of Ilublic *ffYtg Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:000 peave Manx) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT 1N INK OR TYPE ALL INFORMATION) Date ` f� (XV or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electric/al work described below. Location (Street & Number) ��o ��f h `� Owner or Tenant Z �M,/_/z Owner's Address S/Aot-lie Is this permit in conjunction with a building permit: Yes _ No C (Check Appropriate B(o�x.)p�f Puroose of Buildino Utility Authorization No. Existing Service Amos Volts Overhead LJ Undgrnd r No. of Meters New Service Amps _J Voits Overhead r Uncgrna r No. of Meters Number of Feeders and Ampacity Location and Nature of Prcoosed Electricai WcrU !� Totai No. of Lignting Ouuets i No. o', Hot -.:bs I No. of ransformers KVA No. of Lighting Fixtures Swimming Pool ACove— In- KVA g 9 grre. — crnd. _ Generators No. of Emergency Lighting No. of Recectacie Outlets I No. of Oil Burners I Sanery Units No. of Switch Outlets I No. of Gas Burners I FiRE ALARMS No. of Zones Total No. of Detection and No. of Ranges I No. of Air Core. tons Initiating Devices No.of Heat Total Total No. of Disposals Pur cs Tons KW No. of Sounding Devices iVo. of Sart Contained No. of Dishwashers SoaceiArea Heating KW DetecadniSouneing Devices Municioai No. of Dryers Heating Devices KW Local Connec*:on _Other No. of No. of Low Vottage No. of Water Heaters KW I Signs Sailasts Wirinc No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the reduirements of Massacnusetts general Laws I have a current Liaetiity Insurance Police inclucing Como:etee Ccerations Coverage or its sucstantial equivaient. YES = NO = 1 have suomittee vaiid proof of same to the Office. YES C = If you nave checxeo YES, please indicate the type of coverage cy checxing the aoprooriate Dox. INSURANCE — 30NO — OTHER = (Please Scec:fy) �t (Expiration Oatei Estimated Value of E'.ectncal Work 5 t' {_:" Work to Start � '� � Insoecaon Date Recuestec: Rough - Finai A —f ys Signed under the Penalties of perjury: FIRM NAME L - r CIc - Licensee ^Lr%tKr^�t /a w Signature Address L cp,�_-6 Ott 5.� �� /4-t OWNER'S INSURANCE WAIVER:.1 am aware that the Licensee does ni cuireo by Massachusetts General Laws. and that my signature on :his i LIC. NO.1 Z i % ! LIC/..��NO. Sus. :el. No. yy7,ly 7 71 Alt. Tel. No. the insurance coverage or its suostannal ecuivalent as re- aooiication waives this requirement. OAgent w4 I 0 (Rease cnecx one) �) 'ft'" PERMIT.FEE S �` v i.v, , Teiegnone No. _ iSignature of Owner or .agents f"` Y 6555 V r (41\Of}Ic8 USe Only V: - T uh>' ��mm>1n>uEi >�aruEi Permit No. J r~ Occu anc & Fee Checked - �P}IIIil'IIIPRL tlf �II�IIC �°e3fPttj p � , 1 3190 (leave blank) 1. BOARD OF FIRE PREVENTION REGULATIONS 527 CAR 12:fla APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (X� or Town of NORTH ANDOVER Ta the Inspector of Wires: The udersigned applies for a permit to perform.the electrical Nark described below. Location (Street 3 Owner or Tenant Owner's Address RV o �fr / Is this permit in conjunction with a building permit: Yes !G No (Check ;�pproori-' a �� Utilit Authorization No. Purpose of 5uildina � Existing Service 20 UU Amps. L.22J 202 Vc'•ts Overhead _ Unagmt3 No. of Meters Ne�.v Service Amos Vdits (Overhead UncSmd l_. No. of .Meters Numcer of Feeders and Amcacity % /D U r Location and Nature of Preoesed Electr.cai .'lcrx li�— No. of Lignnng Outlets "Jo. o...ct ' �s To tai i No. ct—ransformers KVA No. of Lichttng =fixtures i--.. Aaover-- i Sw mmtng ?cci grne _ ;n- -- Enc. '_ I Generators KVA No. of Emergency Lighting ^ No. f cectacie Cutlets qe No. of Cil Eumers 3aaery Units / I No. Gas Eurners I =IRE ALARMS No. of =ones No. of Switcn Outlets ! > I cr Total Na of Detection and No. of Ranges No. cf Air Cana. tans initiating Oavtces _ No. of Diseosais I No.ai Peat ^s atns KWt No. of Scunaing Devices y No. of Self Containec SoaceiArea Heauna K1N Oetect;ontSounaing Oev:ces No. of Cishwasners / I KW Muntcioa, Other Local No. of Cr/ers t•leatina Devices _ Connection _ No. of No. of I Law Vcitage No. of '.Vater Heaters KVJ i Sicns 9ailasts W nric No. Hyaro massage Tuds No. of Mctcrs Talai F;P OTHE=. INSURANCE COVERAGE: Pursuant :o the recuirements at Massac-usars general Laws — NO I have a current Liaotiity Insurance Paticy inciuccnc C�rnc:etea Ceeraucns Caveraae or ;ts sucstantial ecuivalent. YES . nave suomirea valid preof et same to the Office. YES If you nave cttecxea YES. Tease indicate ;he (yoe at coverage Cy cnecxing the aoproenate cox. INSURANCE = 3CNO _ OTHER — tP'ease Scec:ty) IExciration Oatei Esumatec Value of Electrical Work 5 Worx :o Start Inscec::on (Date nacuesteC: Rougn F nal Signea unaer the Penalties of perjury =tRNA NANAE P UC. NO. Signature LcenseaV/ ti �— �O L� Sus. Tet. No. Aacress /Tr v) � U'/ P V Alt. Tet. No. INSURANCE `NAtVEa: I am aware that ;ne L:censee aoes not nave the nsurance coverage or is suoscanttw eautvatent as re- OWNER'Sauirea oy Massacnusetts General Laws. ano :hat my signature on :n:s permit aoplicattan waives this requirement. Own�er/ Agent (Please cnecx one( /� - 0 :etecncne No. PERMIT FEE S Yr— Signature at Cwner or agent( "'=�' Date... /..�!• ./../ �!�.. 494 NORTH . ".!6 - 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING o *Aroo SA MUS This certifies that .... .................... ...6 0 ........................................... has permission to perform ...... ........ C4 wiring in the building of ....... ............................................... at ....y.�...... ............................. . , North Andover, M Fee.(z-Q ....... ... Lic. No. ............... .. ............ ..... W LECTRICAL INSPECTOR 60. PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer r� J Th DRTIy TOWN LOI7 o' t 1tiO Y _ P. PERMIT: EO i 1H i :III 5 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:5)2— %J Date Received Date Iss - )(-3 IMPORTANT: Applicant must complete all items on this page LOCATION. 62./ PROPERTY OWNER P I,/e-,1 `/77 69 Print 100 Year Old Structu MAP NO: J,2—PARCEL L/ J ZONING DISTRICT: Historic District Machine Shop Vil yes no yes no e ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One 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 11 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: t Please Type OWNER: Name: Address: ,-2 C2 S' /-/, r e, rnone: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: ARCHITECT/ENGINEER Date: Phone: Address: Reg. No. FEE SCHEDULE: BULD/NG PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATE�OST BASED ON $925.00 PER S.F. Total Project Cost: $_ > SAD FEE: $ f o? Check No.: �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund gnature of Agent/Owner' Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ 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 ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW Towp ]Engineer: Signature: Located 384 Osgood Street FIRE bEPARTMFNT - Temp Dumpster on site yes no Located at'124 Main "Street Fire Departifient-signature/date COMMENTS 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 Doe.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 o 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 a Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ 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) Li Building Permit Application o 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 ❑ Mass check Energy Compliance Report o 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 appy al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:4ted with the building application Doc: Doc.Building permit Revised 2012 Location r%b No. Date l Check 4;* 26170 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $U Foundation Permit Fee " $ Other Permit Fee $ TOTAL ' $ Building Inspector TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT • ....1600 Osgood Street Building 20, -Suite 2-36 North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 inspector of Buildings Fax (978) 688-9542 �f HOMEOWNER•LTCENSE EXEMPTION 13UIDING PERMIT APPLICATION lease rint DATE: -/ 3 • :JOB LOCATION: � �o '•. y ,�/ � .S' j /')/ � v ,� e2_ Number Street Address Map/Lot 11UMEOWNER L9 09 Name Homophone WorkPhone PRESENT MAILING ,ADDRES S p l C"_.f� Tot*m S+„ +te - - (--/ Zip Code The current exemption for `homeowners" was extended to iiZclude owner -occupied dwellings to two units -or less and 'io aIlow sub homeov"ners to engage an individual -for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOAMOWNER 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 far mly structures. A person who constructs more that one home in a two-year shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules andregulations, The undersigned "homeowner" cert fies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with,said procedures and requirements, HOMEOWNERS SIGNATURE 2 APPROVAL OF BUlI.,DING OFFICIAL Revised 9.2009 Form Homeowners Exemption BOARD OF APPEALS 688.9541 CONSERVATION 688-9530 • HEALTH 688-9540 PLANNING 688-9531 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UV- www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Alpplicant Information Please Print Legibly Name (Business/Organization/Individual): Address:_ � o Zc z- // G S7— City/State/Zip: TCity/State/Zip: Phone #: —T. kre you an employer? Check the appropriate box: ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its r wired.] officers have exercised their I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. F1 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other ry applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. w an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site grmation. urance Company Name: icy # or Self -ins. Lid. Expiration Date: Site Address: City/State/Zip: ach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). lure 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 LP to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. Itereby cert' under the pains an ena ' s of perjury that the information provided above is trite and correct. iature: Date_ ?fftcial use only. Do not write in this area, to be completed by city or town official. ;ity or Town: Permit/License # ssuing Authority (circle one): . Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Other '.nntari PPrenn• Phnna if! Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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, Tease do not hesitate to give us a call. he Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fav #U All -777-774A David Desimone 206 High Street North Andover, MA,01845 Re: 206 High Street TOWN OF NORTH ANDOVER Office of the Building Department Community Development and Services 400 Osgood Street North Andover, Massachusetts 01845 Telephone(978)688-9545 FAX (978) 688-9542 February 13, 2013 Due to a complaint submitted to the Building Department and a walk through on November 30, 2012, to date no building permits have been issued to correct the following violations. Violations Observed: 1. Fire wall between units has been compromised 2. No heat in individual sleeping rooms 3. Two illegal pellet stove installations 4. Numerous wiring violations. 5: Very poorly installed Deck and Stair Egress. 6. Basement cook stove. CMR Section R113 VIOLATIONS 780: It is unlawful to construct, reconstruct, alter, repair, a building or structure; or to change the use or occupancy without written application. Violations: Section 10 Administration, North Andover Zoning Bylaw amended October 15, 2012 10.13 Penalty for Violation: Whoever continues to violate the provisions of this Bylaw after written notice from the Building Inspector demanding an abatement of a zoning violation within a reasonable time, shall be subject to a fine of three hundred dollars ($300). Each day that such violation continues shall be considered a separate offense. (1986/15) Ample time has been given to address the issues stated. To date, no formal action has been by taken by you to correct these violations. Please contact Brian Leathe, Local Building Inspector, at 978-688-9545 about these issues and violations. Sincerely Yours, Gerald Brown x J = o O m> u +� \ O LL E v N to u O. .N 0 U Z Z m C O a 7 L.LL L 7 � T cu _ <0 LL O � W Z Z _ > d L d' t6 rL O 0O~ W Z _� W W t tio :3 0 N (6 LL Q a z t j 0 f0 LL W a W LLI� Y. (U i O Z + N ` v O Ln Ln L: O .A wQ o0 N V E d • L N �0s Ecn O= Cc U L � J N � L ` m >+ c > r Cc CD L C d O O O O CO) 'a N(ODQ 0 • ." D O N '.. N = O •�'. O o0 Qom. a) L 0 w.. _ •cc 0U)tm F- r+ O = V Q LL L C _ a .- 1— p (Aco O v m LU= 'a +'�-� O O L_L d N C N •= .a t O . E LUL V c> O -WN 4) CLOCK J z G CD Z W w CL W H G W CL O V W IL z C9 z 0 J m LF E O O Z H 0 o .a Nom �E m m ,O �+ d v a L- m m 0 Q a CL ca V J � �CL O; ,r O V U) Q.