Loading...
HomeMy WebLinkAboutMiscellaneous - 22 CLEVELAND STREET 4/30/2018e �¢Rry •� ' bM�i6CD 46,Ya O F p NORTH . OVER BM-DING DEP". TWNT .jp CeoticptwKw y7• �• °R�rE° F 5 1600 Osgood Street North Andover Tel: 978-698•-9545 - Fax: 978688••9542 .BUSN.F'SS FO" FOR TO WNCLERK DATP- Nom: Des 13 ADDMSS: 7 � � • � GMSTR �.�. TYn OF)BUSMES :0 BUILDINGLAYOUT PROVIDED: YES NO �..V.AIlLAffLRP RKING 8llACtN- ZON]NG BY LAW USAAGE: • ES NO �f BUILDING INSPECTOR SWNATUPW .BUSINESS FORM FOR TOWN CLERIC v 2.40 Rome Occupation (1989132) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary io the use. of the building for liAng pluposes. Home occupations shalt -iiicll de,'bu't not limited to the following uses; personal services such as 1 riushed by an artist or instructor, but not occupation involved with motor vehicle repairs, beaply pallors, animal fennels, or the conduct of retail business, or the manufacturi6g c�goods, which impacts ilio residential nature of the neighborhood,, d. For use of a dwelling in any residential district or multi-&niiy district for a home occupation, the following conditions shall apply: a. Not more thana total o£ three (3) people may be ems loyec��in the kmo occupation, one of whom shall be the-aw�ier of the Norrie occupation and residing in said dwelling; b. The, use is carried on strictly withinthe principal building; c. There shall be no ex -t for alterations, accessory buildings, or display which are not customw with residential buildings; -. d. Not more fhan twenty- five (25) parcmt of the oxisting gross floor area of the dwelling unit. so used, not to exceed one thousand (1000) square feet, is devoted to -such use. fn connection with. such use, there is to be. Dept no stock in trade, commodities or products which occupy space beyond these Jimits; e. There will be no display ofgoods or wares visible from the street; f The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the extedor appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimentalto any residential use, within the neighborhood; g. Any such building shall include no features of design not cust6maxy in buildings for residential Use. 3 W r North Andover MIMAP May 8, 2015 23 SAUNDERS ST z x z z z z z z z z z 040: C 16000sgood Street Building 20, 2035 North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 COMPLAINT FOR INVESTIGATION DATE: -1I?All4 FROM: Ntj� Tel #: qj� ADDRESS: 2A be ,j e. A, -J S4--�- 1 Complaint Against: ELECTRICAL: PLUMBING: GAS: BUILDING CONTRACTOR: PROPERTY OWNER: (� OTH E e -�,I� Signed: -1 y44 � C4 2012 Massachusetts Electrical Code Amendments 527 CAM 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 pursuanttom. aL c. 166, § 32, an electrical pen -nit 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 ofongoing construction activity, and may be-deemed-bythe-Inspector-of-Wires abandoned-and-invalid-iflie— 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 23 8 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 farthers 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. Permit[Date Closed: 1!:�� Note: Reapply for new permit 0 Permit Extension Act — Permit/Date Closed: 9651 �- F- /4!�� Date... ............................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING I This certifies that .......................... ........... . ............................. has permission to perform ....... ...... wiring in the building of ........................ S.,42 ............................................ .... .... ...... at ......... ..... 5."� V5-7`70 .................. �,North Andover, Mass. Fee ..................... Lic. No.'/S-< //T�.n ....... / ............ ....... ELECrRICAL Check# 3-2! 9, -V- l.ommonwealg of Maddachudet9 Official Use Only ryC�� Permit No. 1JeParInwnf op'." SerViced 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 IN INK OR TYPE ALL INFORMATION) Date: 9 -/—/e) City or Town of: My ✓" %iA)�I elvel - 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) oLoZ C LQVe Sf, Owner or Tenant 1? -7 Q r -le n c SQ—t% Telephone No. Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps i 'volts New Service Amps / Volts Yes ❑ No tg] (Check Appropriate Box) Utility Authorization No, Overhead U Undgrd U Overhead ❑ Undgrd ❑ No. of irieters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA _ No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above ;1n - SwimmingPool rnd. rn❑te o. o Emergency Lighting Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection andInitiating Devices No. of Ranges Tota No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers P Heat Pum Totals Number I - - - Tons " - -- KW �- - No. of elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other ection _ No. of Dryers Heating Appliances Key S euro. o S evices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent „� . Telecommunications Wiring: IN.r— i;;y«rornassage Bathtubs INo. of 1%4oturs Ito' ,.., H No. of Devices or Equivaient j OTHER: 1 9 % -2 pS�jrJ' 1 Attach additional detail if desired, or required by the Inspector of Wires. Estimated Value of Electrical Work: Q (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 [jg.= BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that th, 'nformation on this application is true and complete. FIRM NAME: _ ��T Se�Cs^� 3 r t LIC. NO.:� Licensee: f't-) a r Y, Ct iI Signatu LTC. NO.: (If applicable, enter "exe t " in the license number' 1 Bus. Tel. No.: Address: ti - --t n 7o1'i 1..!r. —to 1k,5 030 Alf. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 00 953 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. "I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Sigr, :tune _� Telephone No. Fold, Than Detach Along All Perforations CHUSETTS --COMMONWEALTH OF MASSA fa A_.REGISTERED SYSTEM CON�T.RACT.OR�._. ISSUES THE ABOVE LICENSE TO: A D T S E- C U R I T -Y , SERVICES, rt..MARKA. BROPHY SR fm G.-*: U N, VERSITY.-'AVE ESTWQOD MA�:02.090-2311 f 44 45 C 07/31/13 F 'Fold. -Man 0alach Along All Psdaradons T. IDEPARTIMENT OF PUBLIC SAFETY Number: SS CO 00,J�53 Expires: C, 2:0 7.-"-1 0 Tr. no: 1117.0 Z3 S -License: ADT SECURITY SERVICE MARK A BROPHY SR 111 %-I0R1c;_= ST ?,IORIr1)000. NIA 020;:-2 _Z 0 Commissioner A Zo Z3 0 C-71 Date. 000` .......... TOWN OF NORTH ANDOVER 0� PERMIT FOR GAS INSTALLATION This certifies that ..... /'� X .�/. . . . . / has permission for gas installation .�7. � . . ,� ......... in the buildings of ... ......................... at ............... I North Andover, Mass. L) Fee.. Lic. No.. ... ..... GASINSPECTO� ....... Check# 3&6(( 1 6 6 64 M MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFMING (Print or Type) ti OKM AVODy,--Ccs `. Mass. Date J- Permit # Building Location Aa -a7 C<.EU6LAAt0 ST Owner's Name &VO&C 51A / �)ORTH X k)Dd VE!< MA Type of Occupancy , r': Ai' l _ v r� u New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01841-2312- Business 1841-23 2 Business Telephone q 7 8 - 6 8,7 -110 5 Exr *306 Check one: certificate # X1 Corporation 1862 ❑ Partnership ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery �. INSURANCE COVERAGE: I have a current liability ins ace policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No If you have checked Yes, please indicate the type 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: Signature of Owner or Owner's agent • Owner[] Agent El 1 hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and aocu�Ate to the best of my knowledge and that all plumbing work and installations performed under the permit iss i r this application will n mplianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. (/ By T e of License: Plumber Signature of License Plumber or Gas Title Gasfitter Master License Number 374.5 City/Town Journeyman APPFiOVt D (OFFICE USS O�JCYf Y • Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01841-2312- Business 1841-23 2 Business Telephone q 7 8 - 6 8,7 -110 5 Exr *306 Check one: certificate # X1 Corporation 1862 ❑ Partnership ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery �. INSURANCE COVERAGE: I have a current liability ins ace policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No If you have checked Yes, please indicate the type 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: Signature of Owner or Owner's agent • Owner[] Agent El 1 hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and aocu�Ate to the best of my knowledge and that all plumbing work and installations performed under the permit iss i r this application will n mplianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. (/ By T e of License: Plumber Signature of License Plumber or Gas Title Gasfitter Master License Number 374.5 City/Town Journeyman APPFiOVt D (OFFICE USS O�JCYf Z - O W CL N _z N N w n O LC m n z_• F- H IL N J n I 2 0 . O w � t1 � cr LL O w n z 0 z p, a � LL LL o a ° o w t' w a w C13 v a J � a a ula LL N) ww X: 0� Y N P 1- V w N z .v m o X OJ 0. J Date. . .1 11 TOWN OF NORTH ANDOVER 0 Siam PERMIT FOR PLUMBING �401 29 z -7� 44 - SA US This certifies that ............................. A L't " has permission to perform ............. plumbing in the buildings of ......................... at ....... ............................. rth Andover, Mass. Fee. ...... Lic. No../. . ....... 7 PLUMBING INSPECTOR Check#)) - 7849 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building I �Owners Name Date .� G Permit # Amount Type of Occupancy 1 -F j t Newz" Renovation Replacement ' FIXTURES Plans Submitted Yes❑ No ❑ (Print or type) ^ Check one: Certificate Installing Company ame (�� ,�7®Corp Address t��*-- - ❑Partner. . r— usmess elephone y— Firm/Co. Name of Licensed Plumber!—i-77} Insurance Coverage: Indicate the a of ins ance 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 I hereby certify that all of the detailstb information I have s bmitt or en ed in b e plication are true and accurate to the best of my knowledge and that all plungwork and instal tions . - o d der sued for this application will be in compliance with all pertinent provisions o e assachu Sta lura mq Cuod d pter 142 of the General Laws. (APPROVED (OFFICE USE ONLY Type of Plumbing Li se 6 z icense IN umber'- Master Journeyman 11 I* Date .... �n Z�4.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................................... E/Z- ........... ............................. has permission to perform .......... ....................................... wiring in the building of .............. Z7 .............................................. at ....... 12/ - 6�/— - ..... . North Andover, Mass. Fee).7 Lic. No.. .. ............... Check # ELEc rRicAL I&sPEC7 rR 8 3 L.'. 8 a VI Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. FS gy 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 IN INK OR TYPE ALL INFORMATION) Date: 9/� - d E City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned es notice ofhis or her intention to perform electrical work described below. Location (Street & Number) C C 4e j j h" _C -- G Owner or Tenant Telephone No.qiL Owner's Address L Is this permit in conjunction with a building permit? Yes C No ❑ (Check Appropriate Box) Purpose of Building 1,2YwCUtih uthorization No. Existing Service �l�l) Amps ' a V / ��J Volts Overhead ` t 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 Comnletion nftha C An,..in— tabl.. --,. 1... .....a._J i_. .L_ r____ _ No. of Recessed Luminaires i .���•.�•.... No. of Ceil: Susp. (Paddle) Fans . '—Y ac wulveUU [dei ecIOY of Wires. No. of Total Transformers KVA No. of Luminaire Outlets.] No. of Hot Tubs Generators K -VA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. In d. o. o Emergency Lighting Battery Units No. of Receptacle Outlets q No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches �j No. of Gas Burners No. of Detection and Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers! / Heat Pump Totals: Number Tons ....... ..KW...... .............. No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers No. of Water W Heaters K Heating Appliances KW No. of No. of Signs Ballasts Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Dvices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail tf desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: _ , (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: (� Licensee: A 1.1 LIA A vVlte'lSignature LIC. NO.: (If applicable, enter `exempt" in the Ice number line.)Vf L�A/li� l� A Bus. Tel. No. C Address: 1� �� i?� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires DeparterrTent 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. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. FPERM1T FEE: $ V r The Commonwealth of Massachusetts Department of Industrial Accidents .. Office of Investigations 'a 600 Washington Street 4,; Boston, MA 02111 r : www.»:ass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �� Please Print Legibly ISL. Z - Name (Business/Organization/Individual);-Q. L te j'( (! U Address: rl. LA/u e- City/State/Zip;_ --L v1TTA„LjA 0.361 f Phone Are you an employer? Check the appropriate box: Type of project (required): 1. ©° I am a employer with 4. ❑ 1 am a general contractor and 1 6. Q New construction employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any Capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its q, Q Building addition required.] officers have exercised their 10. F-1 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.Q Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required_] •Any applicant that checks bo>; # 1 must also fill out the section below showing their workers' compensation policy information. 1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 4contractors that check this box must attached an addition-) sheetshowirg the name of the sub-contntcto s and their worke camp. 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: __,,_A& e,. k) . Policy # or Self -ins. Lic. #: VI3' — o-36 j Expiration Date: 3©-10 Job Site Address:_ �IeLl/'Cal City/State/Zip: / %1'1&1 e., -- Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c�r i� u erg he p and penalties of perjury that the information provided above is true and correct Si %'r\ afore: Date: q-16 — lS 7— 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 d 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 tiq 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 ,1 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, nofthe 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 nuraiber listed below. Self-insured companies should enter their self-insurance license number on the appropriate tine. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 42111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7744 www.mass.gov/dia Ilk Date.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... .......... e. 9,0'�'Z�41L has permission to perform ..... plumbing in the buildings of ... .......... ...... at ... ........... , North Andover, Mass. Fehw-z)�� Lic. No..10.,�n/ . ....... - " 'PLUMBING INSPECTOR Check # '-�w 7830 1* MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MA SACHUSETTS / c r (� Building Location Date 'Flit° CY Owners Name G� i Permit # Amount Type of Occupancy New rl Renovation Replacement - Pians Submitted YesNo ❑ . T'i 7V7'T TD TC, (Print or type) Check one: Certificate InstallingCompanyName f I A [ f'� d r, ' / Z' '�* !i' 6 � corp. ddress Partner. usmesselephone — Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 2i Other type of indemnity ❑ Bond F1 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 _ I hereby certify that all of the details and in rmation I have best of my knowledge and that all plumbing ork and insta compliance with all pertinent provisions of the sets State nAgent ted (ornt red) in abov Title / � � �� � Type of Plumbing Lic rise City/Town Tcense UMDer Master APPROVED (OFFICE USE ONLY .on are true and accurate to the r this application will be in of the General Laws. Journeyman ❑ N mmmmm I ---M.----�-.�--.-.-.-.--� 1 •. • i/ MMM-M.-----�------------ I ..' O--O--M-----N ----�- ..' MMMMMOMM����e���o������W� • I ..MM MMMMM���� I .. ' �MMMMMOM EMMMW-5-05me-IMMMOMMOMMI ���������� BMW --No (Print or type) Check one: Certificate InstallingCompanyName f I A [ f'� d r, ' / Z' '�* !i' 6 � corp. ddress Partner. usmesselephone — Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 2i Other type of indemnity ❑ Bond F1 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 _ I hereby certify that all of the details and in rmation I have best of my knowledge and that all plumbing ork and insta compliance with all pertinent provisions of the sets State nAgent ted (ornt red) in abov Title / � � �� � Type of Plumbing Lic rise City/Town Tcense UMDer Master APPROVED (OFFICE USE ONLY .on are true and accurate to the r this application will be in of the General Laws. Journeyman ❑ Ar Date ... A,� ..... ,AORTH 4% TOWN OF NORTH DOVER 0 41 PERMIT FOR A INSTALLATION CH This certifies that.. ........... has permission for gas installation .......... .. in the buildings of ...... e at e�<rA�" .............. .... North, Andover 'NWs Fee. Lic. No.. GAS INSPECTOO Check# "? so,)(, 6524 MASSACHUSETTS UNIFORM APPUCATON FOR PERMI I' TO DO GAS FrFMG (Type or print) Date f /® /if NORTH ANDOVER, MASSACHUSETTS Q Building Locations G e 1,4. Permit # Is/Amount $Owner's Name �/New Renovation Replacement D PSubmitted SU B-BASEM ENT BASEMENT IST. FLOOR 2ND. 3RD. 4TH. FLOOR FLOOR FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. 8TH. FLOOR FLOOR (Print or Name= c Name of Licensed Plumber'or Gas Fitter /lit, U Check one: Certificate Installing Company ElCorp. 11 Partner. Firm/Co. INSURANCE COVERAGE Check one: 1 have a current liability insurance, policy or it's substantial equivalent. Yes 13 If you have checked Les, please indicate the type coverage by checking the appropriate box. No� Liability insurance policy A Other type of indemnity ID 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: Signature of Owner or Owner's Agent ner I hereby certify that all of the details and inf rmation 1 have sub 'tted (or eyed) in best of my knowledge and that all plumbing 1w1ork and installations pe d unde compliance with all pertinent provisions of the se ode an By: Title City/Town, APPROVED (OFFICE USE ONLY) ature of Plumber Gas Fitte aster Journeyman pucation are true and accurate to the ied for this application will be in of the General Laws. icensed P lmber Or Gas Fitter Ir / Ll 3 0 (cense Number U o ° s x Z c F F m ww W Q w O z OC w F a v V w s W F t OF F d C s a A x W s > o Q x C Ei " F 3 0 M Z o O � > o c Name of Licensed Plumber'or Gas Fitter /lit, U Check one: Certificate Installing Company ElCorp. 11 Partner. Firm/Co. INSURANCE COVERAGE Check one: 1 have a current liability insurance, policy or it's substantial equivalent. Yes 13 If you have checked Les, please indicate the type coverage by checking the appropriate box. No� Liability insurance policy A Other type of indemnity ID 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: Signature of Owner or Owner's Agent ner I hereby certify that all of the details and inf rmation 1 have sub 'tted (or eyed) in best of my knowledge and that all plumbing 1w1ork and installations pe d unde compliance with all pertinent provisions of the se ode an By: Title City/Town, APPROVED (OFFICE USE ONLY) ature of Plumber Gas Fitte aster Journeyman pucation are true and accurate to the ied for this application will be in of the General Laws. icensed P lmber Or Gas Fitter Ir / Ll 3 0 (cense Number 4 Location oNo. Date TOWN OF NORTH ANDOVER Check # A- — i ka BUildling Inspect6il v Certificate of Occupancy $ 'r -I CHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # A- — i ka BUildling Inspect6il v PT T OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .:.� �. i:': t Y.� ,.� x. �'R�„r�i�v� `! �..... >xJ��i�a i�t1Y� �i{Y>�:t.V �- .i� '.^,¢i ,�� kk k '-• k Y'� i. %�. BUILDING PERMIT NUMBER: _IJ DATE ISSUED: SIGNATURE: Building Connnissioner/12TEtor of Buildings Date 1 ZIM-11O1N 1- NILE IINVOKMA110N f 1.1 Property Address: -X22-2� C1rvELA\,,1 S:_\�c��r�; 1.2 Assessors Map and Parcel Map Number 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 fid' Required Provide RegWred Provided R aired Provided 1.7 Water Supply M.G.L.C.40. 34) Public ❑ Private p 1.5. Flood Zone Information: 1 Zone Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 I SECTION 2 - PROPERTY OWNERSI3IP/AUTHORIZED AGENT I 2.1 Owner of Record M vt 0 0 C", Name (Print) OR 7 Telephone 2.2 Owner of Record: Name Print T SECTION 3 - CONSTRUCTION SERVICES 22-L) of NF_i_ k -JD SZC6t� �Jo�\rt f�N6>u.�G� Address for Service : 16 Address for Service: 3.1 Licensed Construction Supervisor: Licensed Const cationupervisor: �y Address S WaWre Telephone 3.2 Registered Home Improvement Contractor Company Name Address Not Applicable ❑ — License Number -- % — Expiration Date Not Applicable ❑ Registration Number Expiration Date SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) 7-1 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Si red affidavit Attached Yes .......0 No ....... 0 SECTION 5 Desch tion of Proposed Work check ail a licable New Construction ❑ Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ I Demolition ❑ ! Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beN s; QFF`ICIAIJ"USE Com leted b rmit a licant x ..� �...s 1. Building (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L as Owner/Authorized Agent of subject property Hereby authorize— to act on My beha Y --'Pi all inatters elative work authorized by this building permit application. Al /lc2 Signature o wrier Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 214y K a A 2 -"_C� —,property as Owner/Authorized Agent of subject Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print of -�,-A-�.c D/ Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS IST 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH VIINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: �-- Location - 1A Dhnna It F -1 I am work myself. �+I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City- Phone #: Insurance Co., Policy # Company name: Address City Phone #i: Failure to secure coverage as required under section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500 and/or one years' imprisonment -as _welLas.civilpenaltiesin-the.f mofa_SIoP_W-ORK_ORDFR,and..afine _oft.$1-00.00)-adayagainst.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penaities of perjury that the information provided above is true and correct. official use only do not write in this area to be completed by city or town official' # City or Town Permit/Licensing Building Dept ❑Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person: phone #: ❑ Health Department 0 Other 4 m m m CO 0 m CA go S7 M Co! Cl) 10 0 CD c, Z CD CL o �, r c � � c C. y O C* v CD CD o CLQ CD CD o CD vw 2. G CD y CD CL O CO2 CC CCD a v y O 'o Z CD a O • CD C CD cn cn n 0 cn O cn C O 0 0 CD O O C m CO ccd 0 CA N C 0 c N m C ? % O y d N �. C Q d m d n m C2 N y rt 0 ndr O� CL •+a o 0 o m r" O m m • O p O COQ! _ �' O O d o) O N n • ?0C: N a �. o =r E: O NCD ' d N 1 O. d W— �< X m : N W 0) C42 0 'O O O O Ci ...r O C, O N ...r = 0 CD CCD: o CO3 CDd C2 CD m d CL 0! 25 m COD n m T m y Cd o d ac z ac ou r" oa zOTJ z n. O d z 0 H 0 9 Proposal Page No. of / Pages Tua'p-'Temm Co. — General Contractor — Lawrence, Massachusetts i4L SUBMITTED TO CITY ARCHITECT Tel. 975-2726 I I PHONE I DATE JOB TE OF PLANS ' I IJOB PHONE Ile 11r>appst hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: r "'dollars (E �dd0 Payment to be made as follows: All material guaranteed to be as specified. All work to be completed in a workmanlike r manner according to standard practices. Any alteration or deviation from above spetifica• from Authorized tions involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be withdrawn by us if not accepted within days. ,Arrr rirr It PrI111 $d —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature I a I BOARD OF BUILDING REGULATIONS i Ucense: CONSTRUCTION SUPERVISOR Number: -CS 047600 Birthdate:.'01/01J1954 Expires 01101/2002 Tr. no: 14126 Restricted To:. W. WADIH E RAMEY 53 HILLCRESTAVE"d`'.:�' METHUEN, MA 01844 Administrator