HomeMy WebLinkAboutMiscellaneous - 219 BERRY STREET 4/30/2018 (2)M
Date. ...........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that ........................ �t ......................................................................
has permission to perform ...... ......... ..............................................
. 11 -
wiring in the building of.. .....................................................................
J, at ..... NorthAindover, Mass.
FeeY.�/..."-t... Lic. No-.7"Z.2.Y,�44 ..............
&9LECTRICAL iN'*S*P'*E*
Check #
8 9 �) i
j;.
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Occupancy
(leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
W r Y O R K
(PLEASE PMT EV OR TYPE ALL INFORMATION) Date:
City or Town of: NORTH ANDOVER —i— —�-6 i Oq
By this application the undersigned To the Inspector of Wires:
gn gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) ��t;'�P,e y S
Owner or Tenant 1" A 11)
Owner's Address 4:—' %D—AA,
Telephone No.
Is this permit in conjunction with a building permit?
Purpose of Building Yes NO ❑ (Check Appropriate
�Box)
g�C Utility Authorization No.—��
Existing Service Amps / Volts
Overhead ❑ Undgrd ❑ No, of Meters
New Service 20-0
Amps 4U/ ;LU Volts 1 Overhead Undgrd ❑ No, of Meters
Number of Feeders and Ampacity 4
.200 ►�w�,pS
Location and Nature of Proposed Electrical Work.
f-t014A 6
Uom "tion of the foliowin table may be waived b the Ins ector of Wires.
No. of Recessed Luminaires �1 No. of Ceil.-Sus No. of
p. (Paddle) Fans 3 Transformers Total
No, of Luminaire Outlets No. of Hot Tubs KVA
Generators KVA
No. of Luminaires Above _Swimming Pool 111111115, "1d. y ig g
No. of Receptacle Outlets JCS No. of Oil Burners tIId' Battery Units
FIRE ALARMS No. °Bones
No. of Switches 2
C5 No. of Gas Burners No..of Detection and
No. of Ranges' TInitiatin Devices
No. of Air Cond. otal
Tons eat No. of Alerting Devices
Pum
No. of Waste Disposers p Number Tons KW
Totals: _ o, of Self -Contained
--•`�•'w'"' _���'.` �". Deteetion/Alertin Devices
No. of Dishwashers Space/Area Heating KW
Local ❑ Municipal
+ No. of Dryers ' HeatingA Connection ❑ Other
Appliances KW Security Systems: *
No. of Water KW No. of o. of No. of Devices or E uivalent
Heaters S Si s Ballasts . Data Wiring:
No. Hydromassage Bathtubs No. of Devices or E uivalent
No. of Motors Total HP TelecommunicationsWiring:
OTHER: No. of Devices or E uivalent
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work:0C3
Work to Stark (When required by municipal policy.)
t G Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE C GE: 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 69- BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury,
FIRM NAME: U that the information on this application is true and complete_
' � ., � "G /Z l C
Licensee: J �� LIC. NO.- 7`f 3C
-- U� + Signature
(If applicable, enter exempt " to thhee license number
ber line.) �g�LIC. NO..:
Address: p4 p Q7 3 j-����t wt H 6 a�G �� Bus. TeL No.:.�%_�aG�_ 7
*Per M.G. c 147, s 57 b1, secunty work requires Dty Alt. Tel. No.: 60i 87n CY yq�
OWNER'S INSURANCE WAIVER: I am aware that the Department
a doses not have the liability " anc No.
required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner coverage normally
Owner/Agent ❑ owner's agent
Signature g
Telephone No. PERMIT FEE: $
9
r.
e
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 *-�ashington Street
Boston, MA 02111
{ : www_nzass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricians/plombers
M11
t ant Information
Name (Business/orgenization/individual): `J
Address:. 0 .pX 37 3
City/,State/Zip:
VIP
.�T✓ c U C
3 Phone t-60 3 (5 75 G�
Are you an employer? Check -the appropriate box:
I. ❑ I aro a employer with —._
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2.E3 I am a:sole proprietor or
have bred the sub -contractors
listed
partner-
ship and have no employees
on the attached sheet t
These sub -contractors have
working for mein any capacity.
[No workers' comp. insurance
workers' comp. insurance.
5. ❑ We are a corporation and its
required.]
3. ❑ I am a homeowner doing
officershave exercised their
all work
right of exemption per MGL
myself [No -workers' comp,
a 152, § 1(4), and we have no
insurance required.] t
.employees. [No workers'
comp. insurance required_)
Type of Project (required):
6. 0 New cotis ction
7. ❑ Remodeling
8. [] Demoiition
9. ❑ Building addition
10. [1 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.❑ Roof repairs
I3.❑ Other
'Ally 8PPiicent fiat checks bo)r# l must also fill out the section below ahowia their workers' co
t
Homeowners who submit this affidavit indicating they am doing all work and then hire outside con�usctom policy a new a fridavit indicating such.
�Contractons that check this box mustatnsched an additional sheet showing the name of the su
b-comractors and their xorkrs' amp. Policy infamnstion.
1 ant an employer that is providing: workers' compensation insurance or e
information, f m3' mPtOy Below is the policy and joh site
Insurance Company Name:
C
M P 11.0,e
Policy # or Self -ins. Lic. #:_ tv �� . � � � "�
Expiration Date: 30 ( p
Sob Site Address; AI f�;`-� S`�' ��(� �n1 rho �Ctt);/3tate/Zi � N
r
Attach a copy of the workers' com P - BOJ't�
pettsatioa Policy declaration page (showing the policy umber and expiration daie�
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the irnpontan nuof mber
penalties of a
fine up to $1,500.00 and/or one-year imprisonment; as welltan c
iof up nvestigations
ivil penalties in the form of a STOP WORK ORDER and a fine
to 0 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
nof the DIA for insurance coverage verification.
em
I dhereybertif and the and
0fPer% that the information provided above is true and carred
Si tore.
{{ ,h, Date: O G ! O el
Phone #: poll C> -7 Q ) q t
Oficial ase only. Do not write in this area, to he completed by city or town ofciaL
City or Town:
Permit/License #
i Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
Information a end Instructions "
Massachusetts General Laws chapter 152 requires all emp 3 oyers 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, assadiation, corporation or other legal entity, or any two or more
of the'foregoing engaged in a joint enterprise, and includirig the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, associatioin 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 *o construct buildings in the commonwealth for any
applicant who has not produced acceptable evidenmof 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 cointracting 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), addresses) aind 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' m-rnpensation 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'iicense number on the'appropriateline.
City or Town Officiais
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 permitflicense number which vvilI 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 valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The Commonwealth of Massachusetts
Uepartrnent of Industrial Accidents
Office of investibstions
600 Washington Street
Boston, hA 02111 i
Tel. 9 617-727-4900 ext 406 or 1-8.77-MASSAFE
Revised 5-26-05 Fax 4 617-727-7741
www.rrtass.gov/dia
M�tN
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i
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 53(7/20/091 --Date: December 18, 2009
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 219 Bm Street .
MAY BE OCCUPIED AS Single -Family Dwelling IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: Nathan Brooks
219 Berry Street
North Andover, MA 01845
Building Inspector
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APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION
��T� .To ••'its BUILDING PERMIT #
iCiiUSE
ADDRESS/LOCATION OF PROPERTY: C�
Mapj O�Parcel Lot Number
SUBDIVISION:
DATE REQUESTED FILED/READY FOR INSPECTION:
CLOSING DATE ON PROPERTY:
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A
REINSPECTION FEE OF TWENTY DOLLARS ($20.00)WII,L BE CHARGED IF THE STRUCTURE
DOES NOT MEET ALL APPLICABLE CODES. ,A ,11
Permit Issued tom /lJ� �/1 ►l K
Address:�� /.� PX✓V
CONSERVATION
PLANNING
DPW—WATER METER
SEWER CONNECTION
ROUTING
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST
DPW
SIGNATURE
File: Application for OC form revised Jan 2007
of ,40RTH a TOWN OF NORTH ANDOVER
dr't`" "•,"aoL OFFICE OF
- A BUILDING DEPARTMENT
C
1600 Osgood St Ste 2-36
North Andover, Massachusetts 01845
Gerald A. Brown
Inspector of Buildings
TO: Brian Tierney
FAX: 1-603-666-7913
DATE: January 7, 2010
FROM: Building Department, Jeannine McEvoy
TEL: 978-688-9545
Tel: (978) 688-9545
Fax: (978) 688-9542
I am sending you (8) requested documents regarding property @ 219 Berry St ( Lot 5). If you have any
questions, Please let me know.
The document from Merrimack Engineering is the only dereference to Christian Sylvestri name.
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 14EALTH 688-9540 PLANNING 688-
9535
N/F
BARNES
BERRY (PRIVATE -VARIABLE WIDTH)
rn I "I HEREBY CERTIFY THAT THE FOUNDATION IS LOCATED
� ON THE LOT AS SHOWN."
r
7131109
DATE
10.25
sl vol
PLAN OF LAND
IN
NORTH ANDOVER, MASSACHUSETTS
LOT 5 BERRY STREET
DRAWN FOR
NATHAN BROOKS
19'/2 BOURQUE STREET
LAWRENCE, MA 01843
SCALE: 1"=30' DATE: JULY 31, 2009
0 15 30 60 90
TOWN MAP #106D TOWN LOT #52
MERRIMACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
Date.....................
TOWN OF NORTH ANDOVER
/ -PERMfT FOR GAS INSTALLATION
This certifies that . ell, J P. - /' "4 �-'- A." -
. �,% ........................
has permission for gas installation ....... ...........
in the buildings
,,of
dl
at ................. ............ North Andover, Mass.
Fee�<*'.'. .... Lic. No.�:-
........... .............
'E 7 '
Check # GAS INSP CTOR
6 U(' ',-,7
Af
MASSACHUSETTS UNIFORM APPLICATON FOR PERNIlT TO DO GAS FITTING
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations �'�% G'ii�,> Permit #
/ Amount $
s /I�iJaT Owner's Name
New Renovation 1:1 Replacement Plans Submitted
i me or type)��jG�/QL� Check one: Certificate Installing Company
N
�/--J/ Corp.
—S ��
Address ✓I� Partner.
Business Je ep one �G3 5'/ G y Finn/Co.
s
Name of Licensed Plumber or Gas Fittery
s
INSURANCE COVERAGE Check one:
I have a current liability Insurance pol' or it's substantial equivalent. Yes No
If you have checked yes, please in ' ate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 13 Bond El
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent
I nereoy certtry tnat an of the oetails and mtormation 1 have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts_$tate Qa Code and Chapter 142 of the General Laws.
(OFFICE USE ONLY)
ignature of Licensed Plumber Or Gas Fitter
Plumber 3c91 Y�-
Gas Fitter License.Number
OA- Journeyman
•
•
•
6TH. FLOOR
i me or type)��jG�/QL� Check one: Certificate Installing Company
N
�/--J/ Corp.
—S ��
Address ✓I� Partner.
Business Je ep one �G3 5'/ G y Finn/Co.
s
Name of Licensed Plumber or Gas Fittery
s
INSURANCE COVERAGE Check one:
I have a current liability Insurance pol' or it's substantial equivalent. Yes No
If you have checked yes, please in ' ate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 13 Bond El
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent
I nereoy certtry tnat an of the oetails and mtormation 1 have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts_$tate Qa Code and Chapter 142 of the General Laws.
(OFFICE USE ONLY)
ignature of Licensed Plumber Or Gas Fitter
Plumber 3c91 Y�-
Gas Fitter License.Number
OA- Journeyman
N
•• c .vir�rrtplZWL'QLfli of Mmachtae#s
.�' X f
D ►artmerztOfInductrialAcd&to
i Qice of Ike igations :
VS1 I "1 600 r=fiingtan Street
i
��� Boston, MA 02111
nsation ins'
www-nurss g
Workers' Camnv/dia ,
A 'cant lnft►r�ation ecranee Af�Eris 8ui ars/ContractorsMecfriciRRG/Plambers
Please Print
N�(Bttsin�ss/orgeai�sfion/fnaiviauat�' . /3�P�� %�
Phone 4- 5? --3
FEM
employer?Cbeok.theaPProPT'i2te.bD=a employer with 4. [] I am 8 w Typeof
Y(full andlor�r 1d the .contractor ad I sole.. )-tuna have 6. Now constructionPmpr'etor ar partrrer.Iisted orf the attached 9zeet t 7.nd have no employees Q Rt modei6,ng forme in �` suL�COntraators have
orictrrs' �' capacity. workers' comp. insurance, DemmolttionmP mance ..VJe are a. corporation and its9• Q Building additionmqmm�] Offic= have exercised their homeowner doing alt work ri Q . Electrical repairs or additions
ght of exemoon per MOL 1 I.[] Plumb
myseI£ [No •w.ork�s' comp. .c I �2, § I ,¢ • mS TeP� or additions
insurance. ] t (4L and -we have no
ted'• =Pjayertr [Noworkrug' 12.[] Roof
7 l sPPt tr timr t#rrelcs hog t j mort ttiso fin outrhn WMP• irmMunce required.] I3,C ai=
KOm�wtreta who submit this egdevh ' t E+an blow ahowiag thdrworkad' 'aomprmcat Pot y in
_ =Cmmacmrr filar 6=k ahed ling ttrey srz Going an work .end rhes hire oumidn mno anon mast s 1t a rely affidavit
ind•
fFiia bvx awutat�eh� ad
d tiaas} Awrshovvi M- the neuro oftmr iw nmiins roach
I arrr.arr en scoyer iant isp�tiiai►rg:wor�...;., � Md.
�
�+?�arrnraiar_ Ott i++srrrattaeformy exp*g . gel. f�.;S
Insurance Company Name:
Policy # or Sw_ins Lie,2xpir#:
Sob 5iis Address- rOT1 Du e:
Attach a copy of the workers;'
�n C��rP
Peasation Policy dxFa.rafioo page (showing the policy number and e
Failure to seem�e coverage as requimd under Section 25A of xpitation dafej. .
fine up to SI,590 Qo and/or one-year im 1v1CiL c. I M can 1=6 to the imposition of craminal
Of up to 1'250.00 a y 0 w .17 $s civil penaliics in the form of a plea of a
�3 against the violator. Be advised that a copy of this statement STOP WORK ORDER and a fine
investigations of the DIA -for insurance coverage verifirshion, may be forwarded to the Office of
I do hereby certify under the pains and penaWas a e
lP y that fkc
Sr nrm�ina Prnvrded above is tragi and aorrr4
•. '
Phone #: �3 Sly Date•
ficial ase a)*. Do not, write in this arra, lab be mntplete� j y � or town ofjrtia[
City or Town:
Fssuin g Perwit/License #
m Authority (circle ones:
1. Board of Fieatth Z Bniltiing Daparr�ent 3. City/To
6. Other wn a=* 4. Electric( Inspector 5• Plumhiauo Ias
Factor
Contact Person:
Phone #:
intormatlon & red Instructions, .�
Massachusetts General Laws chapter 152 requires all cap 3oyars to provide workers' =npertm6on fur Choir employees. '
Pursuant to this statute, an employee is defined as "..:ave -y person in the service of another under any cDntmet ofhira,
e;mz or implied, oral or written." ` I`
Am employer is defined as "an individual part nanhip, amcxciation, corporation or other legal entity, or any two ar more
ofthe'famping engaged in a joint enterprise,s-t
and includig the 1:0 represerutaf.vex of a deceased amployer, orfht
receiver ort mstr~-of as individual, partn=T.hip, assocfatici n are other legal •a City, employing employers. 'Aowemthe
owner of a dwelling house having not more than three apartments and who resides thcrcK or the occupmrd of the
dwelling house of another who ,employs persons to do me-Imtmarice, consovction orrepair w6A as such dweiEnghotme
or on the grounds or building appurtcnaac therein 'shall nal b=at= of suer employment be deemed to be an amployer."
MGL chapter I 5 §?5C(6) aim states that "every state otic kwal 6eensing agency sW withhold the issaanwor
renewal of a licann or permit to operate a business or Ito construct h u d'iugs is the commonwealth for any
applicant: who has not produced mumptsble with the.insuranee 6overaaoe required."
Additionally, MOL chapter 152, §25C(7) states `° c6cr tiie carmzonw=Hfi nor any of its poli€icsl subdivisions shat}
ante into V eontraet far the pm farms = of public wm ie oath'} •acecptzble evidence of compiieac c with
!0= insuaarucc
rzq==cmtis .of this cimpter have been prod ta.ti= eo�r&ar ting j,,*
Applic nts
Please fill out Elia workers' .compensation• affidavit complmtely, by chocking the boxes that apply tn, your sitvat an and, if
necessary, supply sub-co�s) name(sj, addrzss(es): mLiud phone number(s) along with their cottificate(s) of
insurance. Limited,Liabiiity Companies (LLC) or Limitma Liability. Partnerships (LLP) with no-employeas others am the
members arparb=%, are notrequa•ed1to easy workeas' cxni.rmpens;ziim irstan, = }fan LLC or -LLP does have
employees, a policy is required. Be advised that this afncia*h nuW be submitted to the Depw mm t of industrial
Accidz nts for crmfamatian of insuaanct Coverage- Also sure to sign and date the affidavit The effidavit should
be returned m the city or town that the zppiicsdion for the pciink or license is being mquwted, not-cht Dcpmrtznant of
industrial Accidents. Should you have arty questions regarburg the law or if you are required to obtain a workers`
oMpensation policy, plcase-call the Department atthe -narmber listed below. Self insured om!;=im sh_uld antstheir
self-iFrsr nuc HCenac Dumb= on the appropriate lire.
City or Tower Officials
Please be sure Cleat the afvdavit is complctz and printed 6fbiy. Phe D;pa tm= t hes provided a spate at the botmm
of the affidavit for you to fill out in. the event tim Offire of investigations has to comsat you r tgarding fisc applimn .
?I: M' be sure to fill in the pea rnMiccnso number which Will be meed as a r eferrncc number. in addition, an appikant
that must submit multipie Permit/iica= applications in any given year, need only submit onaaffidavit indicating current
policy isuformotion (if necessary) and under "Job Site Addr-ess" the nppiicant should write "all locatim s in (city or
town) " A oopy of tic affidavit that has beer .offieiaily stamped or marked by Bre city ort own may be provided to the
appiiczat as proof fbat a valid affidavit is on Me for futvrm permits or licenses. A new affidavit must be Med out each
year. When a horns owner or citizen is obtainhrg a li=me-_ or permit not related to any business or commercial vmhac
(i.e. a dog license or permit tp burn leaves este.) said pms&n is NOT.mquircd to -complete this afndaviL
The Ofirco of Invesiigpiions would Bice to thank you in ati<rsnCe for your coup on and shoWd you have any 4vestiorzs,
please do not. hesitate to give us a call.
71= Dcpartmeat's address, telephone anti fax number..
The Commonwealth Qf Masse huse=
Iepartineg of Lv usbial AccidenrtS
(1%ce of Invedig$tions "
600 'Washing -tan Strut
Basica, MA Q2111
Tel. # 617-727-4900 cx-t 406 or I -11.77 -WI SSAFF-
R_-vised 5-26-05 Fax 9 61 7-727-7741
wrvw.m ass.govidia R
Aw
A Z� - 'A �
Date.. X
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ............. .....................
has permission to perform .......... .................
plumbing in the build
g .......
North Andover, Mass.
at.
Fee ... Lic. No.__;�...
............
PLUMBING/INSPECTOR
Check #
8202
4
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location ;Lv%w '4""' S�`• Owners Name
of
Date O
Permit #—AP—_
Amount 4,(9
New El Renovation 13 Replacement 1:1 Plans Submitted Yes 11 No ❑
(Print orCompany
o)P y 0�� ��//moo f�'l�i��
Check one: Certificate
InstallingCom an Name 4 Corp.
Address
Partner.
3 /a
Business Telephone +�� 3 y-� y Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the t e of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond -.❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature IOwner ® Agent n
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachuse s Stat lumbin ode and Chapter 142 of the General Laws.
By: ignature a lumoe
Type of Plumbing License
Title 3 O q/ �
City/Town icense NumSer Master ❑ Journeyman
APPROVED (OFFICE USE ONLY
Llgq.,,0�!'
i
MOM
ME
Ms"FINIMEMNIM
IMEMMM
�������������
MIN
"WERFUNIMMIMEMIME
I
M����������
,.
IMEM
ON
EMMM
(Print orCompany
o)P y 0�� ��//moo f�'l�i��
Check one: Certificate
InstallingCom an Name 4 Corp.
Address
Partner.
3 /a
Business Telephone +�� 3 y-� y Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the t e of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond -.❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature IOwner ® Agent n
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachuse s Stat lumbin ode and Chapter 142 of the General Laws.
By: ignature a lumoe
Type of Plumbing License
Title 3 O q/ �
City/Town icense NumSer Master ❑ Journeyman
APPROVED (OFFICE USE ONLY
Llgq.,,0�!'
Job Site Address:
Attach a copy of the workers' con City/statezIp.
Failure to secure coverage
pensafion policy declarat%oo Page (showing the policy number and expiration date).
as required. under Section 25A of MGL C. 152 can lead to the imposition of criminal
fine UP to $1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK QR_ Dp ER fin
and a
Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the e
Investigations of the DIA for insurance coverage Verification. Office of
I do hereby certify under th airs and peria/ties of perjsuy 1`hat the in ormatioRro '
.f p untied above is [rue ane' coned
OjTxgal ase only. Do not write in this area, m be comietiad by cio, or town official
9-C
City or Town
Permit/License #
Issuintg Aafhority (circle one):
I. Board of Health 2 - Building Department 3. City/Town Cierk 4. Electri
6. Other cal Inspector
e'
Contact Person-
Phone #:
The
Comman►sealth of Massachusetts
i or
'
Department of -Industrial Accidents
affcce Inver
t'
of gatdons
a
itis /
600 kTrashdngton Street
\ ,to �
�
Boston, MA 02111
c www mas�gov/din •
Workers' Compensation Insurance Affidavit. t InformatioBuilders/Contractors/Eleatriciaas/Plambers
A ' 1i n
Please Print LeQib
aIIme (Business/ izatiordindividual):
/�✓
Address: %, --r
—
s�,�,
L
City/state/Zip:1W c3—_`
� Phone #:. 62-5�3 Sim-_
employer? C'hwk the aPProP�t box:
Type
employer with
of reject (required):
4. ❑ I am a general coriisactar and I
yees (foil and/orpari-time).*
sole proprietor or
have bred the sub-contracots 6 Now construction
listed
F2.pn
partner-
d ire4e no em io ees
P Y
on the attached sheet 3LRemodeiarg
These subcontractors have
g for me in any capacity,
orkers.' comp, insurance
Demolition
workers' comp. insunince.
5. ❑ .We are a corporation and its Building addition
d.]
.rahomeowner doing all work
myself.
officers have exercised their Eiectricairtpmm Mpairs
right Of exemption per MOL °r additions
Plumbing repairs
(No•workers' co
required ] t
or additionsmp. I52, § I(4), and we have no Roof repairsinsurance
employees [No workors'comp.
insurancemquired-] Other
bozo a I mutt also ou
`f+nY Pin that ehmi affidavit iuiic$=
Iiomeownera who sabmtt this t the section below showing their warlcers' oompencati- poi icy information.
t ting Choy ars itoin an
iCoatractnrs tFtat g WO* and than his outside
check this box must contractors mus -submit a new affidavit indi
etmahed an additiaasl sheet show cotnractots their mit a n cow. it i . caiiag such.
ing the trema of Bre mb.
i po•f^ sr<fmrnstioa.
ar art emloper thm GSyr,;r?:w�;s� VOPil=!
Mforrnadom
compensation insurance for MY employees: Below is the po[acy m+d job site .
Insurance Company Name:
Policy # or Self -ins. Lie. #:
Expiration Date:
Job Site Address:
Attach a copy of the workers' con City/statezIp.
Failure to secure coverage
pensafion policy declarat%oo Page (showing the policy number and expiration date).
as required. under Section 25A of MGL C. 152 can lead to the imposition of criminal
fine UP to $1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK QR_ Dp ER fin
and a
Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the e
Investigations of the DIA for insurance coverage Verification. Office of
I do hereby certify under th airs and peria/ties of perjsuy 1`hat the in ormatioRro '
.f p untied above is [rue ane' coned
OjTxgal ase only. Do not write in this area, m be comietiad by cio, or town official
9-C
City or Town
Permit/License #
Issuintg Aafhority (circle one):
I. Board of Health 2 - Building Department 3. City/Town Cierk 4. Electri
6. Other cal Inspector
e'
Contact Person-
Phone #:
4,
rY
Information a nd Instructions �.
Massachusetts General Laws chapter 152 requires all emp I oyers 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." `' 1
An employer is defined as "an individual, partnership, mc:)ciiation, corporation or other legal entity, or any two ormore
of the'foregoing engaged in a joint enterprise, and includirsg the ]eget representatives of a deceased employer, or the .
receiver ortnrstm--of an individual, partnership, associatioin or other legal entity, employing employees. 'Noweverthe
owner.of a dwelling house having not more than three apar 1:men s and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work an such dwelling house
or on the grounds or building appurtenant thereto shall nit bec a= of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state oar- local licensing agency shall withhold the issuance or
renewal of license or permit to operate a business or *a construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence -of compliance with the insurance coverage required."
Additionally, MGL chapter I52, §25C(7) states `Neither t1he commonwealth nor any of its political subdivisions shall
enter into any contract for the pmfornnnce of public work- rmta'l acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the carni acting 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) mind phone numbers) along with their =%:ificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other 6ian the
members or partners, arc not rcquired1to carry workers' cavrnpensafion insurance. ]fan 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.. Ain lose sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the peimit or license is being requested, not'the Department of
Industrial Accidents, Should you have any questions regarding the law or if you arc required to obtain a workers'
compensation policy, please -cd the Department at the mo-nberlisted below, Self imsured oomp.nim Should art+ -the
self insumne'e-license number on the'appropriste lyse.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department hiss 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 permittlicrose number which %%-ill be used as a reference number. In addition, an applicant
that must submit rn iltiple permittlicense applications in any given year, need only submit one affidavit indicating•current
policy information (if necessary) and under "Job Site Address" the applicant should write; "all locations in (city or
town)." A copy ofthe affidavit that has been officially starnped or marked by the city or town may be provided to the
applicant as proof that a valid afEsduvit is on file for fidmm permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen i obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit'to bum leaves etc.) said persorz is NOT.required to complete this affidavit
The Office of Investigbations would Ifim to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Depamnont's address, telephone and fax number.
The Commonwealth of Massachusetts
Dzpattmont of lmdustrial Accidents
Mee of Enveatkations
600 Washington Street
Boston, MA 02111
TeL # 617-727-4900 ext 406 or 1-9.77-MASSAFE
it..vised 5-26-05 Fax # 617-727-7744
www.mass.gov/dia _,_
Ki
0
N /F
BARNES
REED
BERRY (PRIVATE -VARIABLE WIDTH) ��
"I HEREBY CERTIFY THAT THE FOUNDATION IS LOCATED
ON THE LOT AS SHOWN."
I
PLAN OF LAND
IN
NORTH ANDOVER, MASSACHUSETTS
LOT 5 BERRY STREET
DRAWN FOR
NATHAN BROOKS
19'/2 BOURQUE STREET
LAWRENCE, MA 01843
SCALE: 1"=30' DATE: JULY 31, 2009
0 15 30 60 90
TOWN MAP #106D TOWN LOT #52
MERRIMACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
,---) :) 6,
Date. . /. ........... -.
40RTH
0 TOWN OF NORTH AN/DOVER
X PERMIT FOR GAS NSTALLATION
This certifies that
has permission for gas installation'��
in the buildings of
......................................
'v. /'�� . . , North Andover, Mass.
at,
Fee�A-�-c"!.. Lic. o.:--.�. ..........
GASINSPECTOR
Check# z1 �J'
6 9 0'1
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Mass. Date C 20 / Permit #
J`r^r Building Location Zl JOwner's Name
j���5
Telephone 9-79 ' j�®'� �3 Type of Occupancy
New Renovation Replacement Plans Submitted: Yes 1:1 NoEl
G
Installing Company Name EnergyUSA Propane, Inc. . Check one: Certificate
Address 100 Myles Standish Blvd., Suite 101 X❑ Corporation 132 C
Taunton, MA 02780 El Partnership
Business Telephone (800) 822-1300 X8055 Mike Smith Cell (508) 922-7891 0 Firm/Co.
Name of Licensed Plumber or Gasfitter William Kent Corson (800) 822-1300 X8051 Cell (508) 294-6660
INSURANCE COVERAGE: EnergyUSA Propane, Inc.
has a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes X❑ No
If ybu have checked ves, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy X❑ Other type of indemnity ❑ Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner El Agent
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and
accurate to the best of my knowledge and that all plumbing work and installations performed under the permit
issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Code
and Chapter 142 of the General Laws.
Type of License:
By ElPlumber
Title X❑ Gasfitter
City/Town X❑ Master
APPROVED (OFFICE USE ONLY) Journeyman
Signature of Licensed Plumber or Gasfitter
License Number 3707
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SUMMARY OF DIMENSIONAL REQUIREMENTS
IRON
REQUIRED
PROVIDED
LOT AREA
43,560 S.F.
19,413 S.F.
HEIGHT (MAX.)
35'
35'
STREET FRONTAGE
85'
100'
FRONT SETBACK
25'
26.70'
SIDE SETBACK
15'
15.17'
REAR SETBACK
30'
136.81'
FLOOR AREA
N/A
N/A
LOT COVERAGE
N/A
N/A
DENSITY MAX/ACRE
1/ACRE
N/A
OPEN SPACE
a
IPF
89.
BARRY
LEGEND
OIRF
IRON
ROD FOUND
OIPF
IRON
PIN FOUND
PROP.
PROPOSED
W.F.D.
WOOD
FRAME DWELLING
N/F
NOW
OR FORMERLY
EDGE
OF WETLAND
ENVfRVWENTAL SERVICES,
AUGV,'!, 2008
Ile
NEW 39
N/F
BARNES
100.00'
1
r
:9
AREA=19,413 S.F.
=0.4457 AC.
PROP.
DECK
12"
0
8
PROP•
I N 2 STORY
�? W.F.O.
12gx5 PORCH 4 '
N Z
i N
�A
N IRF
—S28'39'53"E
(PRIVATE—VARIABLE WIDTH)
NO TES
0 I. ZONE DISTRICT IS VILLAGE RESIDENTIAL DISTRICT
WHICH REQUIRES 25' FRONT, 15' SIDE AND 30' REAR
YARD SETBACKS.
2. WETLAND SHOWN FROM NORSE ENVIRONMENTAL
3 SERVICES, INC.
v
0 3. SEE TOWN MAP #106D LOT #52 FOR THE SITE.
(o
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�r
"''`V it'" 4113109
STEPHE E. API` SKI, R. L. S. DATE
N
841'26' 43
E
SCREE
PLAN OF LAND
.11
IN
NORTH ANDOVER, MASSACHUSETTS
LOT 5 BERRY STREET
DRAWN FOR
NATHAN BROOKS
19'/2 BOURQUE STREET
LAWRENCE, MA 01843
SCALE: 1"=30' DATE: APRIL 13, 2009
0 15 30 60 90
TOWN MAP #106D TOWN LOT 152
1MERRIMACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLA MINATION
Permit NO: Date Received
Date Issued: ` ole6
IM R ANT: Applicant must complete all items on this page
bt• 11 v M p 0�
� p4
TYPE OF IMPROVEMENT
PROPOSED USE
Resi tial
Non- Residential
One famil
Addition
o or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic: W -e11 `
Floodplain1Netlarads-
Eaters# ed District
Water/Sewer
` ..
UES KIPTIUN OF WORK TO BE PREFORM D•
.�s ?/� //`chi
Identification Please Type or Print Clearly)
OWNER: Name: /VC: � 6,-.,. %,J Phone:
Address:
64 v
CONTRACTORName
1r�/�- 0/r�J
ARCHITECT/ENGINEER NO— Phone: &3 � -� -, �r�6
Address: Reg. No.�%
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S. F.
Total Project Cost: $ ®-O� FEE: $ 7' 9
2 �>
Check No.: 0-;a % Receipt No.: �S✓?�
NOTE: Persons contracting with un r stered contractors do not have access to theuaran
g tJ'fffl•
Sjgnatu-of A en- w -er Signature of contras 10
re
F E6!4ing Inspector
M
Location
_
f�
Al2
No. Date
-7 611,-,/
NaRTM TOWN OF NORTH
0.��•o 1ti0
ANDOVER
,•
-__ • O
d
1?�.
- 3
�
9
`�"}
Certificate of Occupancy
$
Building/Frame Permit Fee
$'
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
f
t_
Check #
F E6!4ing Inspector
M
Licensee Details Page 1 of 1
The Official Website of the Executive Office of Public Safety and Security (EOPS)
Mass.Gov Home
Public Safety
Department of Public Safety Licensee Complaints
License Type
Construction Supervisor
License #
72262
Restriction
00
Name
Philip G Cummings
City, State, Zip
Epsom, NH, 03234
Expiration Date
7/21/2010
Status
Current
No complaints found for this
Licensee.
Back To Search
http://db.state.ma.us/dps/liedetails.asp?txtSearchLN=CSL72262 1/7/2010
Mar 19 09 12:22p TCM BUILDING
16036248844 p.2
A4-. p CERTIFICATE OF LIABILITY INSURANCE DATE(MMID
D3/os/zoos009
;
PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
AIIStBta Insurance Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Gregg J. Jodoln, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
163 Manchester Street; Suite: #2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Concord, NH 03301 INSURERS AFFORDING COVERAGE NAIL N
INSURED N3URER A' 'GM Insurance Company 58997
M3 blunagemen:, LLC INSURER B:
125 Erskine Avenue INSURER C:
Manchester, NH 03104 MURER a
Y16URER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED MED ABOVE FOR THE POLICY PERIOD INViCATED, NO'nMTHSTANCING
ANY REQUIREMENT, TCRM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND GOIDITIONS OF SUCH
POLICIFR AC[%RFAaYrg I furft C6hP1tmm LeAV LJA%ic ammki btni inen ov nn m n, A1—
I R'AOD' POLICY NUMBER
LTRiNSR TYPEOFINSURAAICE
POLICY EFFECTIVE
DAIVfM"DJYYj
POLICY LXPM710NII
12Altl0A=WYVj
LIMITS
GENERAL LIABILM M3MAN-2
11/2112003
11/21/2009
EACP OCCLIRRENCE S 1=,Duo
X COMMERCIAL GENERA LIABILITYPREMISES
E uErwnc� e s 500,000
CLAIMS MADE - ' OCCUR
'
MED EXP (Any Cne peraonl S 10,000
PERSONAL$ADV INJURY $ 1,00,000
I GENERAL AGGREGATE a 2,900,000
GEN'LAGGREGATE LIMIT APPLIES PER
PRODUCTS-COMPMPAGG y 2,000,000
POLICY X i JECY LOC
6
AUTOMOBILE LIABILITY
COMBINED SINGLE I" $
ANY AUTO
(Es amidanr)
ALL ONNED AUTOS
b`CHF1?UI.EDALIYOS
BODILY INJURY S
(Per parasol
MIRED AUTOS
I
BODILY INJURY
NOMd7NNEDAUTOS
(Par ,@"de„U S
PROPER'IYOANIAGE
(Per wds"Q
ow" um&rY
AVTOONLY-FAACCIDENT S
1_�
Ar%Y AUTO
OT)IERTHAN FA ACC S
AUTO DNLYr AGG S
EXCE3=M3REILA LIABILITY
EACJ! OGCURREHCE s
OCCUR CLAIMS MADE
AGGREGATE S
IS
DEDUCTOLE
3
RETENTION g
s
4MORK9tS GOWIPEN$AriOH wNp I
EMPLOYERS" LWaIUTY 70 LIMRb ER
_
ANY MOPRIEr0MPARTNERIEXECUTIVE FL. EACHACCCENT 5
OFRCEArMGMBEREXCLl1=?
It yas, dozabo unser E.4 DISEASE - I P,ENPLCY S
9 PECIAL PROVISIONS balD* EJ_ DISEASE -POLICY Lurr 3
OTHER
DESCRIPTION IDP OPpRAT1ONS 1 LOCAM46I V9MCLES J EXCLUS ONS ADDED 8Y ENDORSEMENT I SPECIAL PRO VI&ONS
CERTIFIGF HAI nFsr .....�.... �_--
SHOVLDANY CF THE ABOVE DESCRIBEO POt1CIp,S ee CANCELLED BEFORE THE EXPIRATIQN
DAYS THEREOF, THE 13SUINO INSURER WILL EMMAVOR YO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NALED TO THE LE}'T, ISM FAILURE TO DO SO SHALL
'MP4MNOOBLI0ATION01WWSIU!"YOPANYKINDUPOMT IlY6URER,ITSAGENTSOR
REFRESENTATNES.
AUTHORIZED REPRESENTATNE oz
A r
N
70 7n" -j
Mar 19 09 12:22p TCM BUILDING
16036248844 p.1
The Commonwealth of Massachusetts
� ! Department of Industrial Accidents
At t
q O t
- ffee ofInvestigaiinns
600 Washington Street
Boston, MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
3nlicant fnfarma+;nn
Name (131
Address:
City/Stat
Are you an employer? Check the appropriate box:
1-7
I . 1 am a employer with _ 4. ❑ I am a general contractor and t
ern ogees (full andior part-time).*
2 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3111 am a homeowner doing all work
myself [No workers' comp.
insurance required.] t
have hired the sub -contractors
listed on. the attached sheet. t
These sub -contractors have
workers' comp. insurance.
❑ We are a corporation and its
officers have exercised their
Tight of exemption per MGL
c. 152, § 1(4), and we have no
.employees. [No workers'
comp. insurance required.]
Type ofpr ect (required):
6• : ew construction
7. [] Remodeling
S. []Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
I 1-0 Plumbing repairs or additions
12.[I Roof repairs
13. [1 Other
*Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information,
Homeowner; who submit this affidavit indicating they are doing an work and then hire outside contractors must submit a new affidavit indicating such.
tConfraclors that check this box mustattached an additional sheetshowing the raarne of the sub -contractors and their workers' comp. policy information
I am an employer thin is providing workers' compensation insurance for rrry employees Mow is the policy and job site
information.
Insurance Company
Policy 4 or Self -ins. Lic. it:
Expiration Date:
Job Site Address: city/state-/Zip.-
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DCA for insurance coverage verification.
do hereby c �; ander the pains and penaWes of perjury that the information provided above is true and correct
1! i t7
Official use only. Do not write in this area, to he completed by city or town uffciaL
City or Town:
_ Permit/Lice"
Issuing; Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTowa Clerk 4. Electrical Inspector S. Plumbing Inspector
6.Other
3
Contact Person: Phone 4-
Fax sent bg : 1978794962
Manzi
MMBM—LAW-OFFICES
v/y/MZ44 Z avleolll A
VINCENT C. MANZI, JR
EUGENE, PATRICK MCCANN
STEVEN A. BADDOUR
CHARLES SCOTT NIERMAN,
Massachusetts & Florida
LEGAL ASSISTANT
Barbara M. Day
Robert H. Minasian, Esquire
Minasian & Aziz
127 South Broadway
P.O. Box 346
Lawrence, Massachusetts 01843
Dear Attorney Minasian:
E'Y# AT
06-26-09 15:58
& Nierman
Pg: 2/5
OF COUNSEL
Patrick F. McCann
Texas Only
Angela Dehonte
Michaelene O'Neill McCann
REAL ESTATE DIVISION
Maria Trovato
Jennifer M. Boylan
June 26, 2009
RE: Proposed Construction
Lot 5 Berry Street, North Andover
Please be advised that I represent Mr. and Mrs. Brooks with respect to the
construction of their home at Lot 5 Berry Street in North Andover. I am in receipt of your
letter dated June 14, 2009.
Mr. and Mrs. Brooks have retained Merrimack Engineering Services, Inc. of
Andover, Massachusetts to review the plans and survey work done at Lot 5 Berry
Street. I enclose for your review correspondence dated June 23, 2009 from Mr.
Stapinski of Merrimack Engineering Services indicating that, in fact, the Brook's lot is
100 feet wide, 200 feet deep and is an existing grandfathered lot which would allow the
construction of the home as designed. Mr. Stapinski has advised me that he met with
James Curran who was hired by the abutters. After that meeting Mr. Curran represented
to Mr. Stapinski that he would be advising Mr. Russo that the lot was a buildable lot and
Merrimack Engineering Services, Inc.'s survey work was accurate.
59 Jackson Street —Lawrence-- Massachusetts 0I840
Telephone (978) 686-5664 Fax (978) 794-9628
07/20/2009 09.18 9786877288 MINASIAN LAW OFFICE PAGE 03/03
page 2 of 2
to following the curvatures of the road, If one measures the curvatures, the bounds are all changed.
I would suggest that the status quo be held until we recertify all, of our figure -S. By the way,
Mr. Stapinske has never set the bounds along the common walk line between Brooks and Russo.
Mr. Curran feels that this was done due to the obvious fact that he was not sure of the bounds.
RHM/ki
Very truly yours,
Robert H. Minasian, Esquire
dictated but not read by Robert H. Minasian in can ef%brt to expedite this communication
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS
66 PARK STREET • ANDOVER, MA 01810 • (978) 475-3555, 373-5721 • FAX (978) 475-1448 • E-MAIL info@merdmackengineedng.com
August 4, 2009
Mr. Gerald Brown, Inspector of Buildings
Town of North Andover
1600 Osgood Street
North Andover, MA 01845
RE: Perimeter/Foundation Drain
Nathan Brooks
Lot 5 - #52 Berry Street
North Andover, MA
Dear Mr. Brown:
Relative to the subject please be advised that the site plan prepared for the Conservation
Commission permit depicted a cellar floor elevation of 124.0, making the bottom of floor
elevation 123.50. The elevation of the ground at the 25' no disturb zone on the lot averages
125.0, so that a perimeter drain leading from the outside of the foundation, at the elevation of the
top of floor or below cannot be installed such that it is free draining by gravity to the wetlands at
the no disturb zone, since the ground at the 25' setback from the wetland is higher than the cellar
floor.
In lieu of an exterior drain installation, we have recommended to Mr. Brooks that he install a
perimeter foundation drain along the outside perimeter of the foundation, on the inside wall of
the face, with cross connecting laterals between the front and rear, and with everything sloped to
a sump pump pit that would be installed in the corner of his foundation, in the cellar. The sump
pump would then pump the groundwater in the basement through the foundation to an outlet
where that water will then flow overland to the wetlands in the rear of the site.
Given the above please do not hesitate to contact me should you have questions or comments.
OF I'4SS c
9
Very truly yours,
o vLADIMIR L yG
NEMCHENOK c
MERRIMACK ENGINEERING SERVICES
C)
to
CIVIL
No. 39840
y
V44,nI�lf/rC /li(W,,166 1, fir'
-/STER�`�
ass/ONALENG,
Vladimir Nemchenok, P.E.
Project Engineer
cd
cc: Mr. Nathan Brooks
Mr. Christian Sylvestri