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North Andover Board -2f Assessors Public Access
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North Andover Board of Assessors
.4property Record Card
Location: 288 GREENE STREET
Owner Name: HARVEY FAMILY REALTY TRUST
URSULA CEBULA LT
Owner Address: 288 GREENE STREET
City: NORTH ANDOVER State: MA
Zip: 01845
Neighborhood: 6 - 6 Land Area:
0.24 acres
,Use Code: 101-SNGL-FAM-RES Total Finished Area:
1110sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 305,300 295,900
Building Value: 132,200 122,400
Land Value: 173,100 173,500
Market Land Value: 173,100
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkld=2250745&town--NandoverPubAcc 10/22/2013
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10630
Date27/z0"*/***`-y .......
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that..3 ....................... ....... P/1-1.: ..................................................
has permission to perform ......... / . ....... ............. 6
..............................................................
plumbing in the buildings of.
..........
at .... P?c.e ................................................................................ North Andover, Mass.
.........................................................
Feez....0 .. . ...... Lic. No .................... ......... . ............
PLUMBING INSPECTOR
J 7-71
Check 0
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY MA DATE PERMIT#,
JOBSITE ADDRESS OWNER'S NAME
POWNER
ADDRESS TEL FAX
TYPE OR
OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY
N E W: Fil RENOVATION: Ell REPLACEMENT: PLANS SUBMITTED: YES DI NO
FIXTURES1 FLOOR- BSM 1
2 3 4
5
6 7 8 9 10
11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
Eli
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OILISAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREADRAIN
INTERCEPTOR (INTERIOR) ------ -A=
KITCHEN SINK -D IF
LAVATORY E -7-D .. . ......
ROOF DRAIN --.j -J
SHOWER STALL
SERVICE/ MOP SINK
TOILET I j
URINAL L-3
WA§�,,ING MACHINE CONNECTION
WATER HEATER ALL TYPES
-,T.E�RPIPIN
WA7� - -- ------
OTHER j ---.-Jl
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGIL Ch. 14-2. YES NO
IF V -;U CHECKED YES, PLEASE INDICATE THE TYPE OF COV'ERAGE BY CHECKING THE APPROPRIATE BOX BELOW
1-1 LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D BOND D
OWNER'S INSURANCE WAIVER: I am aware ihat the licensee does not have the insurance cove . rage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER E-11 AGENT IMI
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME [Aj4tt-,j r, A-( V
�&e --11LICENSE # SIGNATURE
MPr i P CORPORATION n] # PARTNERSHIP Eb LLC
COMPANY NAME IIADDRESSLf-I &�Ktfrz�
CITY jISTATE ZIP TEL 17 Z fiv
.. 7 sr- *V
T
F7AX L CELL EMAIL
�m
LLI
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LLI
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id
The Commonwealth ofMassachusetis
Department ofIndustriqlAccidints
Office of Investigations
600 Washington Street
Boston., MA 02111
www'.mass.govIdla
Workers' Compensation Insurance Affidavit: BuildersfContractors/FIelctriciansfPlumbers
Applicant Information A Please Print Legib
Name
Address:
City/,State/Zip:
to V-14
0 it PY1Z
,-/ N�,4— o 5 k& I" phone#: 4-17 S-- 'iiey 17 7 6
Ar ou n employer? Check the appropriate box: -
Typp of project (required):
I am a employer with L.-
4. F1 I am a general contractor and 1
6. E]New construction
employees (ffl and/or part-time).*
2.[] 1 am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet *
7. F1 Remodeling
ship and'have no employees
These sub -contractors have
workers' comp. insurance.
8. E] Demolition
I
9. El Building addition
working for me in any capacity.
[No workers' comp. insurance
5. 0 We are a corporation and its
10.0 Electrical repairs or additions
required.]
3. El I am a homeowner -doing all -work
officers have exercised their
right of exemption per MGL
I lip Plumbing repairs or additions
myself. [No workers' comp.
c. 152, § 1 (4), and we have no
12.Q Roofrepairs
insurance required.] t
employees. [No workers'
13.[:] Other
comp. insurancerequired.]
'Any applicant that checks box fil must also fill out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they ire doing all work and then hire outside contractors must submit a now 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.
lam an employer that isproviding workers' compensation insuranceformy employees. Below &Yhepollcy andjob site
information.
Insurance Company
Policy # or S elf -ins. Lic. #: ExpirationDate:
Job Site Address: I City/State/Zip:
Attach a copy of the workers' compensation p olicy declaration page (showing the p o . licy number and expiration date).
Failure to secure coverage as requiredunder Section 25A ofMGL 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 maybe forwarded to the Office of
'Investigations of the DIA for insurance coverage verification.
1 do h'erihy certIfy under th epains an dpen affles ofperjury th at M e information pro vided ah ove is true and correct
Simature: Date:
Official use only. Do not write in this area, to be completed by chy or town official
City or Town: Permit/License 9
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 Instruction's
Massachusetts General Laws chapter 152 requires all employers to provide workers, compensation for their enaployees.
Pursuant to this statute, an employee is defined as "....every person in the service of another under any contract ofhire,
express or implied, oral or written."
An eMployeiis defined as "an individual, partnership, association, corporation or other legal entity, or any two or more,
Of the foregoing engaged in ajoint 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 thhu. three'apartirients 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 subdivi'sions 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
riecessary� supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If anLLC orLLP does have
employees, a policy is required. Be advised that this affidavit may I be, submitted to.the Department of Industrial
Accidents for confirmationof insurance coverage. Also be sure to sign and date the affidavit. ihe affidavit should
be returned to the city or town that thie application for the permit or�liceinso 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
Lselaf-insurance Ilicense number or, the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printedlegibI.Y. The Department has provided a space at the bottom
of the affidavit for you to 1111 out in the event the Office of Investigations has to contact you regarding the applicant.
Pleas * e be sure to fill in & permit/license number wbichwM be used as a reference number. In. addition, an applicant
that must submit multiple pennit/licenso applications **in any given year, need only. submit one, affidavit indicating current
policy information (ifnecessary) and under "Job Site Address" . the a I pplicant should write "all locations ia_(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 fRe for future permits or licenses. Anew 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 ofInvestigations would like to thank you in advance -for your cooperation and should y . ou have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The ComyA
onwealth of M
Department ofindusWal Accidents
Office ofinvestiptim's
600 Wasbingtoa Street
BostpMA02111
Teel, # 617-72.7-4900 oyd 406 or 1-877,�MASS
. AF.F,
Revised 5-26-05 Fay,# 617-727-7749
r7
:vt)
C�
26'
DEVAL L. PATRICK
GOVERNOR Commonwealth of Massachusetts
GREGORY BIALECKI Division of Professional Licensure
SECRETARY OF HOUSING
AND ECONOMIC DEVELOPMENT 1000 Washington Street e Boston 9 Massachusetts e 02118
DecemberT 2014
Inspector of Wires
Peter Murphy
1600 Osgood Street, Suite 2035
North Andover, MA 0 1845
Re: In the Matter ofMichael V Mammola, Sr., Docket No. EL -1 4-129
Board ofState Examiners of Electricians
Dear Inspector Murphy:
BARBARA ANTHONY
UNDERSECRETARY OF OFFICE
OF CONSUMER AFFAIRS AND
BUSINESS REGULATION
MARK R. KMETZ
DIRECTOR, DIVISION OF
PROFESSIONAL LICENSURE
The Board of State Examiners of Electricians (hereinafter "Board") has placed a six
hundred dollar ($600) civil administrative penalty (fine) upon Mr. Michael V. Mammola by way
of Consent Agreement in docket no. EL -14-129. .
. Please note that this matter will be closed shortly in our Agency's database. Please feel
free to contact me at (617) 727-6530 with any further questions.
Sincerely,
Fayede Mon -g
Prosecuting Counsel
Office of Prosecutions
Division of Professional Licensure
1000 Washington Street, Suite 710
Boston, MA 02118
617.727.6530
TELEPHONE: (617) 727-3074 FAX: (617) 727-2197 TTYITDD: (617) 727-2099 http://www.mass.gov/dpi
ELECTRICAL CONTRACTORS, INC.
724 EAST INDUSTRIAL PARK DR. UNIT #11
MANCHESTER, NH 03109
(603) 627-6270 - FAX (603) 627-6210
March 31, 2014
Construction Services of NH
333 Pleasant Street
Epping, NH 03642
Re: 288 Greene Street in North Andover, MA — Buco Residence
Dear Denis:
jt,
"I P
-41
14
C/i tv L;
3).
We are pleased to quote the following prices for additional electrical work at the above
referenced property.
Kitchen = $585.00
Previous electrician installed (13) recessed -lights on existing circuit. The circuit
is now overloaded with thirty-foR items.
Furnish and Install:
I - New 15 Amp 120 volt circuit for (13) recessed lights
Basement Bathroom = $625.00
- There is a junction box above the shower feeding the washing machine and
bathroom receptacles which needs to be removed. Sheotrock will need to but
cut/patched by others.
Furnish and Install:
I - New 20 Amp 120 volt circuit for clothes washer
I - New -20 Amp 120 volt GFI-protected circuit for bath receptacle
Thank you for the opportunity to be of service. Should you have any questions
this proposal please don't hesitate to call.
Sincerely,
Ael
Daniel J Levasseur, President
Proposal Accepted By:
The above signed agrees that any balance remaining unpaid for more than 30 da�y
collection/legal costs for delinquent payments or non-paymen
10
ISO.
C0
Pox
0
'0
i
1
Date
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
T-1 -
This certifies that ..... (/yV..IK.0 ....
has permission to perform ..... ...... I .......
.. ................................ .
.......... . .......
Wiring in the building of ................ ...........................................................
at-21�.�8 ...... .... IS .... ....... Andover, Mass.
...... .. ......... ....
Acndover, Mas
....... Lic. No-�.))
E mlc
CTRICAL SPECTO
Check #
124AI
Commonwealth of MalYcletts Official Use Only
PermitNo.
Department of Fire Services
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 Massachusefts Electrical Code rC), 527 CMR 12.00
(PLEASE PRIWT17VIYK OR YTPE ALLMFORMATIOA9 Date: 18- 1 Ifn 1 144.
City or Town of. NORTH ANDOVER TO the lnspe�tor qjvires:
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 )��.AJkCjey I Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes -E] No (Check Appropriate Box)
Purpose of Building Utility Authorization NO.
Existing Service — Amps volts OverheadE] UndgrdE] No. of Meters
New Service Amps Volts OverheadEl Undgrd n No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: C-0(A,LCCZ:XJi24 ) !OA
C -1 --LL CA,4 u as, i X2 "D i -)! �� t-:;
Completion ofthe following table ma -v be waived bv 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
Swimming Pool Above Ei In-
grnd. grnd.
No—. -oTEmergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE AL
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
No. of Waste Disposers
Heat Pump
Totals:
J.NMyjh.!�K]J�A�
J.M ...........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local El Mun'elpPl El Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:' ;
No. of Devicesor Equivalent
No. of Water KW
No. of No. of
"
Data Wiring:
Heaters
Signs Ballasts ,
.11 � No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Eguivalent
OTHER:
r
4tiach additional detail ifdesired, or as required by the Inspector of Mres.
Estimated Value of Electric Work: (When required by municipal policy.)
�rork to Start:- lns5AFo�s Too be requested in accordance with NIEC 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 operatioif 'coverage or its substantial equivalent. The
-undersigned certifies that such cover5gf.4s in force, and has exhibited proof of same to the permit issuing office.
CBECK ONE: INSLT-kA-NCE N"-BONDE1 OTBEREI (Specify:)
I certify, under the pains andpenalties oJ erjury, that the information on this application is true and com
plefe.
LIC.N04*A?�,st 6
LIC. NO.: C -
Tel. No. -LQ �S
Tel. No.:
FIRM NAME: r,�ru . J 1- 11
Licensee: �,� 'Zyignature
-, qtU41��-? AA OX0, (AA -4 Q, -J
(Ifapplicable entar "exem t" 'n the license num-ber line) Bus.
Address: 7 LA)AZ) M A Alt.
*Per M.G.L c. 147 s. 57--61 securitv work reauires Dmartment of Public S'afe "S" License:
Lic. No.
5 2
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) [I owner E] owner's agent.
Owner/Agent
Signature Telephone No. 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.
El 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 0
• Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass F?1
Faileg
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass M
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass F?1
Failed
Re- Inspection Required El
Inspectors Comments:
1 V&T C&
7-
41-14
Inspectors Signature: '41<�
Date:
ROUGH INSPECTION:
Pass
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
FINAL INSPECTION:
Pass
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
DEB WEINHOLD ... TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com
The Commonwealth ofMassachusefts
DI Department of industrialAccWhts
Office of Investigations
600 Washington Street
Boston, MA 02111
U1V www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders[Contractors/Electricians/Plumbers
Applicant Information Please Print UPON
NaMe (Business/Organization/Individual):
Address:
City/State/Zip: L2ACI;�,-b L,44 C/ ?2 0 &A Z__
jA=:� Phone #:
A�nn employer? Check the appropriate box:
I . a employer with �)
4. El I am a general contractor and I
. employees (full and/or pari -time.).*
have hired the sub -contractors
2.0 1 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. El We are a corporation and its
required.]
officers have exercised their
3.01 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 con.struction,
7. Remodeling
8. E] Demolition
9. E] Building addition
l0Q-Efe'_ctrical repairs or additions
ILEI Plumbing repairs or additions
12.E] Roofrepairs
13.1-i Other
*Any applicant that checks box 01 must also fill out the section below showing their workers' compensation poliry information.
Ti Homeowners who submit this affidavit indicating they aie 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 isproviding workers'compensation insuranceformy employees. Below is thepolicy andjoh site
information.
Insurance Company Name:. �A 4..&) o) C��& 4. �, )!5:-,
Policy # or Self -ins. Lic. 9: Expiration Date:
JobSiteAddress: Z,='C^Ff5_ PRY/State/ZiP: A)01 A2��,
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
oPap to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
.1 do h ereby certOWnder the pains andpen alties ofperjury that fil e information provided above is true and correct.
Official use only. Do not write in this area, to be completed by city or town of
ficial
Ci ty or Town:
Permit/License 0
IL
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 4:
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 ofhirel
express or implied, oral or written."
An employerls defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint 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 ii�lot 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' employen"
MGL c , hapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who,has not produced -acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ 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 confirm�atiori 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 hue.
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.
Pleas ' e 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, reed only submit one affidavit indicating current
policy information (ifnecessary) and under "Job Site Address"' the applicant should write "all locations in _(city or
town)." A copy of the affidavit that has been officially stamp led 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 ol 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 M-assachwettq
Department of Jadustrial Accidents
Office of Investigatious,
600 Washiugtoa Street
Boston, MA 02111
TO, 9 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
_wwwmass,gov1dia
Date ..... i ............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
. ..................................................................... .... S
has permission to perform ....
. .......... ........ ..............................
wmngin the building of ......... &.
...........................................................................................
at �./-,Vorth Andover, Mass.
...................................................................................................
9*VeeP ........... Lic. No. ..4(4 . . ........................... .....
CAL INSP*EC*'*T*O'**R*"*"***
(4
7P 11*11
heck#
1 2258
1�
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
W!cial Use Only
Permit No.
Occupancy and Fee Checked
[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 PRflVTININK OR TYPE ALL INFORM4TION) 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) 9"Ta G-reene- 5vec�L
Owner or Tenant 5kk(-L> Telephone No.
Owner's Address 5 0-rV-,-Q—
Is this permit in conjunction with a building permit? Yes E] No [:1 (Check Appropriate Box)
Purpose of Building
Existing Service
New Service
Utility Authorization No.
Amps Volts Overhead Undgrd [:]
Amps Volts Overhead UndgrdEJ
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
No. of Meters
No. of Meters
Completion of the followiniz table mav be waived bv 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 K -VA
No. oL4.*AAu4iGa Vi�qer 90OV-1w
Above E:i In-
Swimming Pool und. grnd. F-1
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. 0W*Aw*%w Arfi-4t&&� q
No- of Detection and
Initiating Devices
No. qfigfto, C�Ap, Xl 3
No. of Air Cond. Total
Ton
No. of Alerting Devices
No. 3
Heat Pump
Totals:
I Numk�LKJX!!!!�
*,
J---
1KW
............ .
No. of Self -Contained
Detection/Alerting Devices
No. of VA%%%Vm&%fts (fa4r
Space/Area Heating KW
Local [I MunicipPl [I Other
Connection
No. of Dryers
Heating Appliances KW
Security S stems:*
No. of Mvices or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:,
No. of Devices or Eouivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
TeTe—communications Wirig:
Nn- of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value o� Elecirical Work: $q 000e (When required by municipal policy.)
WorktoStart: 3JX7/)q Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVEkAGE: 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[] BONDE] OTHER F] (Specify:)
I certify, under thepains andpenaldes ofperjury, that the information on this application is true and complete.
FIRM NAME: Lq-va.6,!,e\xr T-- t e-c4.yj Co k1tr&dcV r-, - Cb r-�, 5 1�)"r a -S LIC. NO.: 1 .9 0 M
,T
I
-S
'.0
Nr -
Licensee: PEfZ--1:3 Signature 6d LIC6 NO.:
,&,AZ - L11
t &AD G P2
(If applicable, enter "exempt" in the license number &He.) I -
Bus. Tel. No. tPaI7 Lo ID
Address: n(\cL,&, u�t, nvk o Alt- Tel. No.: -
*Per M.G.L c. 147, s. 57-6 1, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law- By my signature below, I hereby waive this requirement. I am the (chec one) [I owner E] owner's a t
Owner/Agent �ent
Signature Telephone No._ PERMIT FEE: $
". o�< /-/- --IVA
JOB# 14166
Construction Services of NH
333 Pleasant St
Epping, NH 03042
Re: 288 Greene Street in North Andover, MA — Buco Residence
Laundry Room in Basement — Fire Damage
Furnish and Install (devices and covers to replace existing):
2- Single pole switches and (1) 2 -gang switch cover
2- 6" Recessed lights
1- 15 Amp 120 volt receptacle and plate
I- 2 -gang plate for dryer
I- GFCI receptacle
Check existing wires with Megger or re -run circuit:
- (1) 14-3 Romex smoke detector circuit
- (1) 12-2 Romex washing machine circuit
- (1) 14-3 Romex lighting circuit
- (1) 10-3 Romex wire from panel to dryer
Basement (per code)
- Check splice boxes
- Staple all wires correctly
- Rewire (7) existing 6" recessed lights and clip/jack chain in
drop ceiling)
Furnish and Install:
1- 15 Amp 120 volt receptacle for in-line dryer vent,booster
(vent booster and.venting furnished/installed by others)
I - Bracket and box for CO/Smoke detector
3- KO Seals in boxes
I- Splice, box -in, and properly ground wire above ceiling
4- Are Fault breakers for receptacles, lighting, smoke,
and co/smoke detectors
Basement Mechanical Ar * ea (per code)
- Tighten loose BX wire connection
- Add GFI protection for (2) receptacles
- Re -run wire hanging on heat pipe
- Check (4) splice boxes
Basement Family Room (per code)
Remove devices and check/tighten connections. If any issues are found, wiring
inspector will want sheetrock cut out or removed to replace wiring and/or devices
(patching/painting by others). Devices to be removed and reinstalled are as
follows:
10- 15 Amp 120 volt receptacles
2- Single pole switches-
2- 3 -Way switches
Basement Bathroom (per code)
- Check wiring and connections
- Check wiring for recessed shower light
- Check wiring for (2) single pole switches
- Properly secure exhaust fan/light in drop ceiling
Furnish and Install:
I - Dedicated circuit to GFCI receptacle
I - Dedicated circuit to 1500 Watt wall -mount fan heater
Smoke and Carbon Monoxide/Smoke Detectors
Replace Existing:
3- Smoke detectors in bedrooms
2- CO/Smoke detectors in basement
I - CO/Smoke detector on Is' floor
I't Floor Kitchen and Living Area (per code)
- Check (12)'6" recessed lights for proper splices and staple
wires in attic
- Secure splice box to joist
Furnish and Install:
I - Arc fault breaker (replace standard breaker)
I- Octagon box
Provide electrical permit and inspections
Because the wiring is presently not visible, any issues found while wiring is being
checked will be identified and a cost for repair will be estimated at that.time.
Standard White: Duplex receptacles, single pole, 3 -way and 4 -way switches.
ORYER BOOSTER FANS/METAL
ITECH'S INTELLIGENT'
F:JYER E300S Fp
T
DBFULT "Intelligent" Dryer Booster
.rhe . newest dryer booster fen from Fantech is the most
i�vanced In the industry. The unit can be used to effectively
:��6st dryer exhaust In duct runs up to 130 feet. Fan features
: anized steel housing and Integrated airflow sensing switch.
)81
.UdZional components --include: mounting bracket, quick-
;o�nectldlsconnect duct collar, 51/2 foot power cord with plug
�Idls�'wall-mount indicator panel. LED light on wall panel lets
eowners know fan Is working properly,
UP
2'
-1.1;— NOTE: If OBF4XLT is IMAVAthin 15 lln�NI138t of
FIVE
YEAR the dryera DBLT4 Lint Trap $kid be added *jaen
00 the dryer and the fan.
WARRANTY ISee back cover for description.1
G -iiiat Fan Performance
il'
T4fX . .60, Max Max CFM CFM CFM CFM CfM CFM Duct
rWWdel Wall$ Amps 0, ps r ps Cps .61 ps rPs Url's Dla.
MXLT.1 83 0.73 170 150 134 119 103 86 4
—n.
4 Certified Ratings Program, charted airflovi performance has bean derated by a factor
a�toal test results and the certified rate at.2 inches WG -
am
DBF4XL Metal Dryer Booster Da,, L_eVA se4AII
Tap into the power of this dryer booster fen which can be used 771 -W6 0
on duct runs up to 130 feet. Includes fan with galvanized steel
housing, automatic pressure sensing switch, mounting bracket,
hardwa�"1619TJ2-1@ot power cord with plug. Pressure switch'
act! en drgVr comes on. Backward Inclined Impeller
nil"'A'VwItt", %)Ils thro4ah the fan.
1* 1/ 1- —71-1*
FIVE
YEAR
C GO -U S WARRANTY
EKhaust Fan Performance
Fan Max Max CFM CFM CFM CFM CFM CFM Duct
Model Watts Amps 0, ps X p$ .4, ps .6,ps Irps IrPs Dip.
DBF4XL 83 033 170 150 134 e
Per N's CeOed Ratings program, cha rted aifflo,.v perforinance has been derated by a factor
based on actual test results and the certified rate at 2 Inches WG.
Division of Professional Licensure: License Search Page I of I
The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR)
Division of Professional Licensure
Mass.Gov
Mass.Gov Home State Agencies A -Z Topics
Home Division of Professional Licensure
ONLINESERVICES
. .................. -- .......................... . ............ - ................ .............. ...................................... . ............... .................. ....... . .......... . ........ . .................
Check a License
Check A Professional License
I Locate a Licensed
Professional
By the Division of Professional Licensure
Online Address Change
Contact the Agency
More...
LICENSEE
Name, BERT SAUNDERS
REFERENCES &
DUN R 'ON, NH
RELATFDINFO
Disclaimer Regarding
i Website License Searches
Licensing Board: ELECTRICIANS
Glossary of License Status
Codes
License Type: JOURNEYMAN ELECTRICIAN
TYPE CLASS: E
More...
License Number: 20682
Statuv CURRENT
Expiration Date: 7131/2016
Issue Date:
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, April 01, 2014 at 3:44:26 PM.
@ 2007-2011 Commonwealth of Massachusetts Site Policies Contact Us
http://license.reg.state.ma.uslpubliclpubLitenseQ.asp?board—code=EL&type—class=—E&Iicense—number=O... 4/1/2014
..... . . . ......
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03-27-'14 1b:0b HiUM-
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a
CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIIJDIYYYY)
1/24/2014
F�=
T'31% CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOI-DER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) most he endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsernent(s),
PRODUCER
Aspen insurance Agency
CONITACT Allison Gould
(6 3) 647-0800 PAX
_ jAjc_ NS)!_(603) 647-0330
t -MIL a goui Loa—spen- Ins. coin
P 0 Box 510
2FqM.&F-FORDING COWRAOF NAIC 0
INSURCRAMica insurance
Manchester NH 03105
INSURED
gu3�Sjjc4t cpMa 39454
Lavasseur Slactriclkl COntraCtOrs Inc.
INSURPRC:Star IIIISUrarkCO COMPany 524126
IN5URER D:
724 East Industrial Park Drive
unit 11
=RE-'
F!
Manchester NH 03109
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION Or ANY CONTRACT OR OTH�R
DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, YHIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
HEREIN 16 SUBJECT TO
ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
— — ADDL SUBR IF
INSR
LTR TYPE OF INSURANCE POLICY pqq YVII
I MPER jym_
GENFRAL LIA191U1Y
EACH OCCURRENCE
qO 0 10 0 0
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100,000
X COMMERCIAL GENI��k. LIAtIlLITY
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wo FxF, (Any ono penion)
5,000
PW80N�!'_& A(5V IN.JUAY
$ 1,000,0()0
GENERAL A43GREGATE
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OEN'L AOGREGATE LIMIT APPLIES PER.
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7 rmloy Fx_� 'I FRQ'T ED LOO
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AUTOMORILE LIAOILITY
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9/.1/2013
9/1/2014
ALITOS AurO8
X X NON -OWNED
HIRIED ALAbS AUTOS
PROPERTYDAMAGE
$
Endorsement
I_
S
X
UM8RF;U.A LIAB
EACHOCCURRENCE
$ 1,000,000
A(WAF
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$
A
EXCESS LIAB
WXOLCCUR
CLAIMS -MADE
C A
ULP4692829
9/1/2013
9/1/2014
DED I X I RrTrNTION$ 10, OIDC
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WORKERS COMPENaAnON
%(VCSIAIU. "O[H-
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OFFICERIMEMBER
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9/1/2013
9�/1/2014
E.L. DISEASE - EA EMPLOYEE
$ .500,000
E.L. DISEASE - POLICY LIMIT
-0-
if
,ve deacribe under
,RIP rJON OF QPFRATIONS NIO%Y
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AtiachACORDIOI.AddlilonllRam;lrk5 SGhedule. Ifenore%pate 6 required)
TOWN OF NORTH ANDOVER
1600 OSGOOD STREET
NORTH ANDOVER, MA 01846
ACORD25
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFLLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ligon GoUld/ALLI 0_10_��
0 1008-2010 ACORD CORPORATION. All rights reserved.
INS025 MIMS% 1111 The- A1'fNPh narnp nnA Inn^ nrp rAnI,.fPrPr4 ms%rka nf Arnpn
ELECTRICAL CONTRACTORS, INC.
724 EAST INDUSTRIAL PARK DR. UNIT # 11
MANCHESTER, NH 03109
(603) 627-6270 * FAX (603) 627-6210
March 26, 2014
Town of North Andover
1600 Osgood Street
North Andover, MA 01845
Please allow Robert Saunders to pull an electrical pennit for Levasseur Electric, under MA Electrician's
license #780MR, for electrical work at 288 Greene Street. If you have any questions, please contact our
office.
YSincere
C ris
hris urns', VP
-1 --- �� V�l S S E U R
ELECTRICAL CONTRACTORS, INC.
724 EAST INDUSTRIAL PARK DR. UNIT#11
MANCHESTER, NH 03109
(603) 627-6270 - FAX (603) 627-6210 "7 LZ_
r
March 31, 2014
Construction Services of NH
333 Pleasant Street
Epping, NH 03042
Re: 288 Greene Street in North Andover, MA — Buco Residme e
Dear Denis:
We are pleased to quote the following prices for add itional electrical -work at the above
referenced property.
Kitchen = $585-00
Previous electrician installed (13) recessed -lights on existing circuit. The circuit
is now overloaded with thirty4M items.
Furnish and Install:
I - New 15 Amp 12 0 volt circuit for (13) recessed lights
Basement Bathroom � $625.00
- There is ajunction box above the shower feeding the washing machine and
bathroom receptacles which needs to be removed. Shearock will need to but
cut/patched by others.
Furnish and Install:
I- New 20 Amp 120 volt circuit for clothes washer
I - New .20 Amp 120 volt GFI-protected circuit for bath receptacle
Thank you for the opportunity to be of service.
this proposal please don't hesitate to call.
Sincerely,
Daniel J Levasseur, President
Proposal Accepted By:
The above signed agrees that any balance remaining unpaid for more than 30
collectionAegal costs for delinquent payments or non -pa
Should you have any questions
ca $
01. 0
zs
cj
"3�1 00
ELECTRICAL CONTRACTORS, INC.
724 bST INDUSTRIAL PARK DR UNIT #11
MANCHESTER, NH 03109
(603) 627-6270 # FAX (603) 627-6210
July 15, 2014
Town -of North Andover
Building Department
1600 Osgood Street
North Andover, MA 0 1845
Attn: Peter Murphy
Re: Permit 4 12258
288 Greene Street
Dear Peter:
Our company has completed our portion of the electrical work for repair of fire damage
at the above referenced property. Please release permit # 12258 dated 3/27/14.
Levasseur Electric will no longer be performing work at this property.
Thank ou,
Chris Bums, VP
ELECTRICAL CONTRACTORS, INC.
724 EAST INDQSTRIAL PARK DR. UNIT #11
MANCHESTER, NH 03109
(603) 627-6270 . FA)((603) 627-6210
March 31, 2014
Construction Services of NH
333 Pleasant Street
Epping, NR 03042
"7 f
Re: 28 8 Greene Street in North A e
ndover, MA — Buco Residenc
J
5
eel r
JC-41 &J,
Dear Denis:
We are pleased to quote the following prices for additional electrical -work at the above
referenced property.
kitch * en � $585.00 led (13) recessed -lights on existing circuit The circuit
- Previous electrician instal
is now overloaded with t1drtY4M' items.
.7
Furnish and Install: i W)
I - New 15 Amp 120 volt circuit for (13) recessed lights
Basement Bathroom � $625.00 'machine and
There is a junction box above the shower feeding the washing
bathroom receptacles which needs to be removed. Sheetrock will need to but
cut/patched by others -
Furnish and Install
1 - New 20 Amp 120 volt circuit for clothes washer
I - New 20 Arnp 120 volt. GFI-protected circuit for bath receptacle
Thank you for the opportunity to be of service. Should you have any questio . ns rp,'
this proposal please don't hesitate to call.
Sincerely,
. ........
Al-,
Daniel J Levasseur, President
Proposal Accepted By:
,Me aboNfe sipied agrees tbat any balance remainmg unpaid for more than 30 d6y,
collection,legal costs for delinquent payments or non-paymen�,,,,,
ell
0
0�'
N
C,
'C� Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Wicial Use Only
Permit No.
Occupancy and Fee Checked
[Rev. 1/071 (leave blak)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00
(PLE,4SE PR1WT1JV1JVK OR TYPEALL IATORMATIOIV) Date: 5-c2-+-J1A
City or Town of. NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned jives notice of his or her intention -to pei�orni the electrical work described below.
Location (Street& Numb4r)- 5ve-c"L
Owner or Tenant 5w_,Z;, Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes El No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Yolts Overhead [] Undgrd [:] No. of Meters
New Service Amps Volts Overhead [:J UndgrdE] No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work---,
No. of Recessed Luminaires
[No. of Luminaire QvItteb;_
41' * ,
Completion of the.following table may be waived
INO. of
No. of Ceill Susp. (Paddle) Fans,
Transformers
Generators
0 12
Date .... .......
KVA
FIRE ALARMS No. of Zones
L
No. of Detection and
InitiatinIZ Devices
ig Devices
)ntained
�rting Devices
Acipal M Other
nection
�ms:*
7ices or Eauivalent
I
ired by the Inspector of Wires.
d upon completion.
rical work may issue unless
bstantial equivalent- Ile
suing office.
and complete.
LIC. NO.: I �9 C) M
IT
LIC. NO.: &dO G P2_
Tel. No. nu`�) 1-02-4 - U12TO
Address: "F-- :Cyav6iyJoS -Vk VY*kV 1111M&JU�ct NA 0_5i09 Alt. Tel. No.:-
*PerM.G.Lc. 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. By my signature below, I hereby waive this requirement. I am the (check one) [] owner 0 -owner's a t-
Owner/Agent
Signature Telephone No. FPER;�T FEE: $
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. 1112��
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS I [Rev- 1/07] (levblak)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00
(PLEASE PRflVTININK OR TYPE ALL INFORAIATION) Date: -14
City or Town of- NORTH ANDOVER To the Inspector of Wires:
By this application the undersigi�edves notice of his or her intention to perform the electrical work described below.
Location (Street& Number) d,'-3�3 G-ree-ne- 5Ve_6_
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes No [:] (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts
New Service Amps Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Overhead Undgrd F]
Overhead Undgrd F]
No. of Meters
No. of Meters
Completion of thefiollowing table may be waived by the Lns
,Xector 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. oL4AkftftahWs 9-r 96.0-'Aw
R,
swimming Pool Above In-
grnd. L -J grnd.
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No.~&avh~ k(,64 6"
No. of Detection and
Initiating Devices
No. OaWoo& 3
TOM
No. of Air Cond. Tons
No. of Alerting Devices
No. 3
Heat Pum
Totalsp:
KW
No. of Self -Contained
Detection/Alerting Devices
No. of DIOWWrAfts
Space/Area Heating KW
Municippi
Local F1 Connection [I Other
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telccommuni�ations W, ,
HiMR:
No. of Devices or Equivalent
I
11v
OTHER: I N
Attach additional detail if desired, or as required by the Inspector of Wires.
EstimatedValueo Eec; calWorkAme (When required by municipal policy.)
Work to Start: 3 a117 I q Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE CbVERAGE: 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 operation7 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: INSURANCEE] BONDE] OTHEREI (Specify:)
IceyWfy, under thepains andpenalties ofperjury, thatthe information on this application is true and complete.
FIRMNAME: LeW�_55evr T—t4�7ficc0\ 7�,-nc_ -CV1r,15, 6t3kro_'S LIC.NO.: 4-3c)mg-
Licensee: pEjz_,��- Signatur9 LIC. NO.: &AO C, P2_
(1fapplicable, enter "exempt" in the license numbe. -_1 Bus. Tel. No.JkCu�?) ty,_14 __�OR-41D
Address: -4 D\A 7-- :EyakSir� a 'V L 'D�-# ti, f1'\0,n&j U�ci_ R\A 0 09 Alt. Tel. No.: -
*Per M.G.L c. 147, s. 57-6 1, 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
requiredbylaw. By my signature below, I hereby waive this requirement. lamthe(cheekone)EI owner Downer's agent.
Owner/Agent �7T --'A — I
Signature Telephone No. FPE� FEE. $ 0")
JOB# 14166
Construction Services of NH
333 Pleasant St
Epping, NH 03042
Re: 288 Greene Street in North Andover, MA — Buco Residence
Laundry Room in Basement — Fire Damage
Famish and Install (devices and covers to replace existing):
2- Single pole switches and (1) 2 -gang switch cover
2- 6" Recessed lights
1- 15 Amp 120 volt receptacle and plate
1- 2 -gang plate for dryer
I- GFCI receptacle
Check existing wires with Megger or re -run circuit:
- (1) 14-3 Romex smoke detector circuit
- (1) 12-2 Romex washing machine circuit
- (1) 14-3 Romex lighting circuit
- (1) 10-3 Romex wire from panel to dryer
Basement (per code)
- Check splice boxes
- Staple all wires correctly
- Rewire (7) existing 6" recessed lights and clip/jack chain in
drop ceiling)
Furnish and Install:
1- 15 Amp 120 volt receptacle for in-line dryer vent,booster
(vent booster and.venting famished/installed by others)
I - Bracket and box for CO/Smok6 detector
3- KO Seals in boxes
I - Splice, box -in, and properly ground wire above ceiling
4- Are Fault breakers for receptacles, lighting, smoke,
and co/smoke detectors
Basement Mechanical Area (per code)
- Tighten loose BX wire connection
- Add GFI protection for (2) receptacles
- Re -run wire hanging on heat pipe
- Check (4) splice boxes
Basement Family Room (per code)
- Remove devices and check/tighten connections. If any issues are found, wiring
inspector will want sheetrock cut out or removed to replace wiring and/or devices
(patching/painting by others). Devices to be removed and reinstalled are as
follows:
10- 15 Amp 120 volt receptacles
2- Single pole switches,
2- 3 -Way switches
Basement Bathroom (per code)
Check wiring and connections
Check wiring for recessed shower light
Check wiring for (2) single pole switches
Properly secure exhaust fan/light in drop ceiling
Furnish and Install:
1 - Dedicated circuit to GFCI receptacle
I - Dedicated circuit to 15 00 Watt wall -mount fan heater
Smoke and Carbon Monoxide/Smoke Detectors
Replace Existing:
3- Smoke detectors in bedrooms
2- CO/Smoke detectors in basement
I - CO/Smoke detector on I't floor
Is' Floor Kitchen and Living Area (per code)
- Check (12) 6" recessed lights for proper splices and staple
wires in attic
- Secure splice box to joist
Furnish and Install:
I - Arc fault breaker (replace standard breaker)
I - Octagon box
Provide electrical permit and inspections
Because the wiring is presently not visible, any issues found while wiring is being
checked will be identified and a cost for repair will be estimated at that time.
Standard White: Duplex receptacles, single pole, 3 -way and 4 -way switches.
DRYER BOOSTER FANS/METAL
ITECH'S 91INTELLIGENTS
RYER -E300S FR
T ,
,"7-`--"'!`iiiF4XLT "Intelligent" Dryer Booster
newest dryer booster fan from Fantech is the most
In the Industry. The unit can be used to effectively
dryer exhaust In duct runs up to 130 feet. Fan features
viiiivanized steel housing and Integrated airflow sensing switch.
dclitional components --include: mounting bracket, quick-
-.i�onnect/disconnect duct collar, 6112 foot power cord with plug
wall -mount indicator panel. LED light on wall panel lets
know fan Is working properly,
I-V
61
I .-? 2'
FIVE NOTE: If DBF4xLT is locafe�,vli'hi" 'I
YEAR the dryar, a CKT4 Unt Trap, 101.1
WARRANyy the dryer and the fan.
ISee back cmr for desc6pHon-)
DBFUL Metal Dryer Booster
T-ap into the power of this dryer booster fan which can be used
on duct runs up to 130 feet. Includes fan with galvanized steel
housing, automatic pressure sensing switch, mounting bracket,
hardwara,8rra5_1/-2'fo,ot power cord with plug. Pressure switch'
ctivat4rfem-w,hen dr"r comes on, Backward Inclined Impeller
:11 s4ln\to pa%s thro4h the fan.
2 -
FIVE
YEAR
C @0 -us WARRANTY
Fan Performance Ellifialld Fan Performance
Max Max CFM CFM CFM cFM CFM' CFM Duct Fan Max Max CFM CFM CFM CFM CFM CFM Duct
Watts Amps (712 X Ps ? ps r ps .1rFs I.TFs DIa. Model Watts Amps V Ps rPs XP9 -VPs rps jrP3 Dis,
83 0.73 170 150 134 119 103 . 86 4' DBF4XL 83 0.73 170 150 134 119 .. 103 86 4! -
tified Ratings program, charted airflow performance has been derated by a factor per "Is certifled Hatins program, charted airflue, perfornlarn has been derated by a factor
jai test results and the certified rate at .2 inches WG. based on actual test results and the certified rate at 2 inches WG; .
I
Division of Professional Licensure: License Search
rr� 11
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
............... ............................ .... . .............. I ....................... . ...... ....... .
Cbtedr, A Professional License
By the Division of Professional Licensure
LICENSEE
�B 'ER SAUNDERS
T
TON , NH
Name:,, -R BERT SAUNDERS
DUN VARTON, NH
Licensing Board:
ELECTRICIANS
JOURNEYMAN ELECTRICIAN
License Type:
TYPE CLASS: E
License Number:
20682
Status:
CURRENT
Expiration Date:
7/31/2016
Issue Date:
Exam Date:
School:
This web site displays disciplinary actions dating back to M3.
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, April 01, 2014 at 3:44:26 PM.
Q 2007-2011 Commonwealth of Massachusetts
Page I of I
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http-.Hlicense.reg.state.ma.uslpubliclpubLitenseQ.asp?board—code=EL&type—class=—E&Iicense—number=O... 4/1/2014
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CERTIFICATE OF LIABILITY INSURANCE
DATE(MMJ0DrfYYY)
=DAI1D1rY4
TE'"
1/24/2014
24/2
T"AIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND cow -ERS NO RIGHTS UPON THE CERTIFICATE Hol -DER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWSEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER,
IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, tile Pollti�(Iewrwiist be endorsed- if SUBROGATION IS WAIVED. subject to
the terms and conditions of the policy, certain policies may require an endorsement. A atatement on this r-ertiflicate does not confer rights to the
certificate holder In lieu of such endorsernent(s).
PRODUCER
0�1 M11 on Gould
Aspen InSUrance Alyency
PHONE (603)647-0800 ,AX -D330
VC:, .1:(4503) 647
1411-
U2
@aspen-lns.com
P 0 Box 510
X COMMERCIAL C.�.
IN0URERA,.TJt:IC&
Mancbester NH 03105
INSURED
ItMqR R -S �ty_ 39454
re
Levasseur n1actrical Contractors Inc.
1NsUFtGRc:Star Insurance Compamy �24126_
UAS R -Star
.JReR D,
724 East Industrial Park Drive
Unit 21
Li
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1 IN..5V.RFR Fl
,Manchester NH 03109
UILIV12-KAUM 1�%wfA I IF I%,P% I%. n -----------
LISTED BELOW HAVE BEEN ISSUEDTO THE! INSURED NAMED ABOVE FOR THE POLICY PERIOD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
INDICATED. NOTWITHSTANDING ANY REQUIREMENT.
MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
CERTIFICATE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIE$, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TRLW ALYDL SUBRI C P LIMITS
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RC0428629
E.L. DISEASE - EA EMPLOYEE
500,000
E.L. DISEASE -POUCYL Ii.
ifyoo doscripetinder
Dr,S6RIPI)ON OF OFERATION8 below
DESCRIPTION OF OFERATION3 I LOCATIONS I VEHICLES (Attach ACORD 401, Addlilansil Rern;trk-s SGhedule, If more%pAGe 1% required)
TOWN OF NORTH ANDOVER
1600 OSGOOD STREET
NORTH ANDOVER, MA 01846
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVIERED IN
ACCORDANCE WITH THE POLIGY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ison Gould/ALLI 0_e�� I
25 (2010/06) (0 1988-2010 ACORD CORPORATION, All rights
INA025 MIAMI Al Tkft AI'I)Pn n5amp sqnrl Inrin Pirp rpj1jqrPrPr11 ms%r(d-x nT at-UIWI I
L E V �1 S—S E U R
ELECTRICAL CONTRACTORS, INC.
724 EAST INDUSTRIAL PARK DR. UNIT #11
MANCHESTER, NH 03109
(603) 627-6270 a FAX (603) 627-6210
March 26, 2014
Town of North Andover
1600 Osgood Street
North Andover, MA 01845
Please allow Robert Saunders to pull an electrical permit for Levasseur Electric, under MA Electrician's
license #780MR, for electrical work at 288 Greene Street. If you have any questions, please contact our
office.
Sinc/ere,
(-C'�ris
hris urns, VP
ELECTRICAL CONTRACTORS, INC.
724 EASTINDUSTRIAL PARKDR. UNIT#11
MANCHESTER, NH 03109
(603) 627-6270 - FAX(603) 627-6210
March 31, 2014
Construction Services of NH
333 Pleasant Street
Epping, NH 03042
Re: 288 Greene Street in North Andover, MA - Buco Residence
Dear Denis:
t--, - -
J
Ale.
We are pleased to quote the following prices for additional electrical work at the above
referenced property.
Kitchen = $585-00
Previous electrician installed (13) recessed -lights on existing circuit. The circuit
is now overloaded with thirty -&—w items.
Furnish and Install: T -,Vo
I - New 15 Amp 120 volt circuit for (13) recessed lights
Basement Bathroom = $625.00
- There is a junction box above the shower feeding the washing machine and
bathroom receptacles which needs to be removed. She6trock will need to but
cut/patched by others.
Furnish and Install: -
I - New 20 Amp 120 volt circuit for clothes washer
I- New 20 Amp 120 volt GFI-protected circuit for bath receptacle
Thank you for the opportunity to be of service. Should you have any questions rr'
this proposal please don't hesitate to call.
Sincerely,
Daniel J Levasseur, President
Proposal Accepted By:
The above signed agrees that any balance remaining unpaid for more than 30
collection/legal costs for delinquent payments or non -pa
\0
C,11 AW
0`1
#5
N48
ELECTRICAL CONTRACTORS, INC.
724 &ST INDUSTRIAL PARK DR. UNIT # 11
MANCHESTER, NH 03109
(603) 627-6270 s FAX (603) 627-6210
July 15, 2014
Town of North Andover
Building Department
1600 Osgood Street
North Andover, MA 0 1845
Attn: Peter Murphy
Re: Permit# 12258
288 Greene Street
Dear Peter:
Our company has completed our portion of the electrical work for repair of fire damage
at the above referenced property. Please release permit # 12258 dated 3/27/14.
Levasseur Electric will no longer be performing work at this property.
Thank ou,
hfis Bums., VP
WORKERS OMPENSATION
FIRE, XN I LINES
CAUALTY & AUTO
PRODUCTS LIABILITY
POLLUTION
Flynn, Riedel & Young, Inc.
Insurance Adjusters
Building Department
Town of North Andover
1600 Osgood Street, Bldg. 20, Ste. 2035
North Andover MA 0 1845
RE: Our File: 14-0056-04
Co. File:
1124237
Insured:
Andrew P. Buco
D/L:
02/08/14
Loss:
Fire
Gentlemen:
February 17, 2014
Bedford Place - Unit 36
40 South River Road
Bedford, NH 03110
(603) 641-6984
FAX -(603) 641-9961
Toll Free (855)-660-4823
Email: fry-inc-l@att.net
RECE-OVLD
FE116 �6 Z014
TOWN Of- NORTH ANDOVER
HEALTH DEPARTMENT
The purpose of this letter is to notify you that the Concord Group/Concord General .
Mutual Insurance Company of Concord, NH is in the process of completing an adjustment for a
claim for dwelling and personal property damages to a dwelling owned by Andrew P. Buco and
Christopher Buco of 288 Greene Street, North Andover, MA. The dwelling and personal
property sustained damage as a result of a fire which occurred on 02/08/14.
A claim has been made involving the loss, damage or destruction of the above captioned
property will which exceed $1,000.00 or cause, the Massachusetts General Law, Chapter 143'
Section 6 to be applicable. If notice under Massachusetts General Law, Chapter 139, Section 3B
is appropriate, please direct it to the attention of this writer and include a reference to the above
captioned insured, location, policy, date of loss, and claim number.
On this date, I have sent copies of this notice to the persons outlined below by first class
mail. If there are any outstanding liens or issues, please inform.
Very truly yours,
Daniel T. Flynn
Adjuster
DTF/ft
cc: Craig F. Curley, Claim Department
Andrew P. Buco
�x
Tol"'M A of North Andover, Building Department
Concord Group Insurance Company
cc: Andrew P. Buco
288 Greene Street
NorthAndoverMA 01845
cc: Perry Insurance Agency, LLC
522 Chickering Road
North Andover MA 01845
cc: H T
Eailftff DepiAn &�Q
Town of North Andover
Town Hall
124 Main Street
North Andover MA 0 1845
Page 2 of 2
February 17, 2014
Electrical Insnectors Basic Notes:
Called to respond: North Andover Fire scene @ 288 Greene Street on 2-8-14 about 9:50am
Dryer Wiring:
The 30 amp_ 240/120volt dryer outlet was Wired Incorrectly by Mammola Electric. The neutral wire
(white), 120 volt ungrounded ((black or red)(per photo ..... with voltage readings)) wire transposed (or crossed) creating a
short circuit and a fire resulted in the basement finished wall of the dwelling at 288 Greene Street. The circuit
did not have a ground return path from the dryer outlet connection which was not noticed by the installer but
if tested he would have found the defects in the wiring job immediately. An existing 30 amp (Rornex) 10/3 NIVI
type cable four wire used for the dryer connection had a grounding wire but was cut at the circuit breaker
panel to the first splice box (photo, cut not used). Thecable continued to a second splice box, at this location the
grounding wire was exposed (not cut) andMr.MamolIa ran about 20feet of new 10/3 fourwire NM cable
(orange) for the dryer outlet connection. (Per photo) ..... with voltage reading)
Dryer unit:
Note: NEC Violation Four wire - Neutral (white) bonded to dryer frame (green) NEC 250-114 HNEC 250-140
Mr. Mamolla stated, "The four wire cable (pick -tail) connection installed on the dryer was delivered from a
vender to the dwelling connected to the clothes dryer appliance."
Wall mount Fan Heater:
Basement - Bathroom fan type 1000w/240volt heater with 15 amp (Rornex) 14/2 NIVI (white) cable was
connected to the 30amp 240volt dryer circuit at the second splice box above suspended ceiling creating a
Mkg_r NEC code violation. (As per photos)
Mr. Mammola stated, "I wired the wall heater Temporarily for heat in the basement and forgot to remove it
from the circuit."
Inspector: I found this statement to be a lame excuse at best. MkE NEC Violation
Additional, NEC code violations or electrical issues may be found above the drop ceiling upon tile
removal and inspection of the basement area.
Electrical Permit: Town of North Andover #11916 Issued:10-09-13 Inspected: 12-20-13 (enclosed)
The extent of the basement wiring was unknown to me at the time of my December 20, 2013
inspection. Permitting and rough inspections for the basement work was never requested before concealing
the basement walls. (527 CMR Rule #10) The extent of the work in the basement area was not stated completed
on the permit application.
Mr. Mamolla stated on 12-20-13: "Basement area was done previously by someone else and they (Mammola)
only painted, installed lighting fixtures, smoke detectors and new suspended ceiling tiles." Ifoundthis
statement to be Grossly or Blatantly Untrue while interviewing Mr. Mammola at the town office on Monday
2-10-14.
Ultimately at that meeting, Mr. Mammola has taken full responsibility for doing the basement work in
question that created the life safety issues at the dwelling.
-'WORKiRS COMPENSATION
FIRE & ALLIED LINES
CASUALTY & AUTO
PRODUCTS LIABILITY
POLLUTION
Flynn, Riedel & Young, Inc.
Insurance Adjusters
Building Department
Town of North Andover
1600 Osgood Street, Bldg. 20, Ste. 2035
NorthAndoverMA 01845
RE: Our File: 14-0056-04
Co. File:
1124237
Insured:
Andrew P. Buco
D/L:
02/08/14
Loss:
Fire
Gentlemen:
February 17, 2014
Bedford Place - Unit 36
40 South River Road
Bedford, NH 03110
(603) 641-6984
FAX (603) 641-9961
Toll Free (855)-660-4823
Email: fry-inc-l@att.net
The purpose of this letter is to notify you that the Concord Group/Concord General
Mutual Insurance Company of Concord, NH is in the process of completing an adjustment for a
claim for dwelling and personal property damages to a dwelling owned by Andrew P. Buco and
Christopher Buco of 288 Greene Street, North Andover, NLA'. The dwelling and personal
property sustained damage as a result of a fire which occurred on 02/08/14.
A claim has been made involving the loss, damage or destruction of the above captioned
property will which exceed $1,000.00 or cause the Massachusetts General Law, Chapter 143,
Section 6 to be applicable. If notice under Massachusetts General Law, Chapter 139, Section 3B
is appropriate, please direct it to the attention of this writer and include a reference to the above
captioned insured, location, policy, date of loss, and claim number.
On this date, I have sent copies of this notice to the persons outlined below by first class
mail. If there are any outstanding liens or issues, please inform.
Very truly yours,
Daniel T. Flynn
Adjuster
DTF/ft
cc: Craig F. Curley, Claim Department
A�idrew P. Buco Page 2 of 2
Town of North Andover, Building Department February 17, 2014
Concord Group Insurance Company
cc: Andrew P. Buco
288 Greene Street
NorthAndoverMA 01845
cc: Perry Insurance Agency, LLC
522 Chickering Road
NorthAndoverMA 01845
cc: Health Department
Town of North Andover
Town Hall
124 Main Street
North Andover MA 0 1845
.360 YRS.
Of -q 9
F%,
NORTH ANDOVER FIRE DEPARTMENT
CENTRAL FIRE HEADQUARTERS
124 Main Street
North Andover, Mass. 01845
ANDREW V. MELNIKAS
Fire Chief
Subject: Structure fire at 288 Greene Street North Andover, MA 01845.
Incident: #2014-484
Date of report: 2/25/14
Date of incident: 2/8/14
Time: 09:27 AM
Chief (978) 688-9593
Business (978) 688-9590
Fax (978) 688-9594
Owner: Andrew Buco — 1/22/86 - 288 Greene Street N. Andover, MA 01845 — (978)771-1383
Christopher Buco — 3/14/90 — 465 Chestnut Street N. Andover, MA 01845 — (978)273-
7303
Tenant:N/A
Insurance: The Concord Group Policy # 1188015 Claim. #1124236
Craig Curley 1-800-888-6050 ext. 6125
Notification & Response: At approximately 09:27 AM on 2/8/14 North Andover
Communications received a 911 call from Andrew Buco for a dryer fire with smoke in the
basement at 288 Greene Street. Engine 1, Engine 2, Ladder 1, Ambulance 1, Ambulance 2 were
dispatched and responded. Engine I arrived on scene to find a one story wood frame ranch
with nothing showing from the outside. Lt. Nussbaum was met in the driveway by Mr. Buco and
Anthony Sideri (5/18/82 — 55 moody Street N. Andover, AM 01845 — (978)208-9869). They
stated that they had seen smoke and some fire in the walls and ceiling behind the dryer in the
basement. They stated that they had tried to put it out with glasses of water and an ABC
extinguisher.
SERVING PROUDLY SINCE 1921
Discovery: The fire was discovered by Anthony Sideri and Pamela Buco (9/28/51 — 465 Chestnut
Street N. Andover, MA 01845 — (978)273-7424) while in the basement trying to use the clothes
dryer for the first time.
Suppression: "DISPATCHED FOR A POSSIBLE FIRE IN THE WALLS BEHIND A DRYER. MET
OCCUPANTS AT FRONT DOOR WHO STATED THEY TURNED THE DRYER ON, HEARD A POP AND
SMELLED SOMETHING BURNING. THEY LOOKED ABOVE CEILING TILES AND SAW FLAMES AND
CALLED 911. THEY USED A SMALL ABC EXTINGUISHER ON WHAT THEY COULD SEE. WE HAD A
LIGHT SMOKE CONDITION IN BASEMENT. WE REMOVED THE DRYER AND CEILING TILES. USED
THE THERMAL IMAGER AND FOUND HOT SPOTS BEHIND THE WALL. WE HAD A WATER CAN IN
PLACE AND BROUGHT DOWN AN ATTACK LINE. OPENED THE WALLS AND FOUND A SMALL
POCKET OF FIRE WHICH WE EXTINGUISHED WITH THE WATER CAN, WE CHECKED FOR
EXTENSION AND OPENED UP ANOTHER SECTION OF WALL BUT FOUND NONE. VENTILATED THE
BASEMENT WITH ELECTRIC PPV. CALLED FOR PHOTGRAPHER AND ELECTRICAL INSPECTOR. FF
CROSBY ON SCENE WILL DO THE INVESTIGATION. LEFT SCENE WITH FF CROSBY IN CHARGE." Lt.
C. Scott Nussbaum
Building Description: One story wood frame ranch structure with asphalt shingled roof and oil
forced hot water heat. The structure has a total finished area of 1110 square feet and was
bought by Mr. Buco on 2/7/14 for $345,000 from David Minicucci (7/22/50 — 508 Main Street
N. Andover, MA 01845 — (978)688-4400). Mr. Buco had the home inspected by ABC Home
Inspection (21 Wingate Street Haverhill, MA 01830) which is owned by Andrew Consoli (978-,
373-2859).
Fire Scene Examination: After I assisted in the extinguishment of the fire, I went outside and
didn't observe any fire damage to the outside of the structure. The first floor had no fire
damage, but did smell of smoke. I walked back to the basement and went down the basement
stairs. At the basement stair landing, the wall directly in front of me, the sheet rock wall was
breeched by NAFD pe.rsonnel looking for fire extension. A fair amount of wall debris was on the
landing due to the breech. The fiberglass insulation in this section of the wall was undamaged
by the fire. As I continued to the basement the same wall previously described was opened up
by N. Andover Electrical Inspector Peter Murphy during the investigation in order to trace one
of the wires that were in the area of origin. The hole that was made was to the left of the
basement stairs light switch. The smoke detector at the bottom of the basement stairs was not
connected and was later found on top of the furnace. The detector had been taken down
during overhaul operations by NAFD personnel, was tested and worked on battery only due to
the hard wired line being shut off at the panel. The drop ceiling was mostly intact in the main
room; a few tiles had been removed during suppression to look for extension and the dryer
vent ducting. The drop ceiling did have what appeared to be 6" recessed can lights. The
basement walls in the main room were sheet rocked and painted. The floor was carpeted and
had baseboard heat. In the middle of the main room was the white Amana electric dryer
(Model #NED4600YQ1 — Serial # M33043117 —Type DWJR-ELE-2406026-FM54) purchased new
from A & M Appliance (44 Main Street North Andover, MA 01845 (978)682-3875). It was noted
by electrical inspector that the white jumper wire was connected to the ground on the back of
the unit.
The utility room of the basement along the "D" side wall had exposed fiberglass insulation in
the ceiling covered with plastic, no fire damage, and smelled of smoke. A smoke detector was
on the ceiling with a pink plastic cover over it. To my left was a door leading outside to the "C"
side of the structure, no fire damage to this door was observed. The interior walls of this room
were partially sheet rocked, the concrete foundation walls were still exposed, and the floor was
poured concrete. To the right of the door previously described was the oil tank, which looked
somewhat new and was not leaking. In the center of the room was the furnace. In the "AD" -.
corner of this room, the 200 AMP electrical circuit breaker panel was located. The only breaker
that was tripped was the 30AMP dryer. All other breakers were intact and in the "on" position.
I then walked into the basement bathroom through the laundry room. The bathroom had no
fire damage, only a strong smoke smell. The drop ceiling was the same as the -rest of the
basement, a vent in the ceiling was observed, sheetrock walls, shower, an electric heater in the
bath room/laundry room wall, and a tile floor. I observed an approximately 15' section of silver
flexible ducting on the bathroom floor, 2'— 3' section moderately burned, other burn marks
along the ducting over about 4, and it was clean of lint.
I walked into the laundry room, about half of the ceiling tiles were taken down during
suppression, the walls were sheetrock, tile floor, four glasses were on the floor to my left, a
white plastic slop sink was in the left corner, the washer was to the right of the sink, numerous
pieces of fiberglass insulation were on the floor and had charring on the pink and paper side. To
the right of the washer was the black dryer 220V outlet. The outside of the outlet was intact
and no heat or fire damage was observed. The outlet was photographed by NAFD in place and
then unscrewed from the bracket to look at the backside by Peter Murphy. Mr. Murphy noted
that the red power lead and the white neutral were reversed resulting in an improperly wired
outlet. Photos were taken of this outlet showing the various meter readings that were obtained
by Mr. Murphy of the various leads. No heat or fire damage was observed on the back of this.
outlet or the plastic box it was secured to. The wall to the right of this outlet had been opened
up by me during suppression. The two right most wall studs had charring about three quarters
of the way up continuing to the first floor, floor joists. The same damage was observed in the
bay to its left, but the charring was more severe. The plastic vapor barrier that was between the
foundation and the insulation had melted behind the dryer. Two 110v white wires were free
floating in the wall between the melted vapor barrier and the insulation. One wire had two
damage points; one in the area of the dryer vent clucting and the other about 1.5 feet to its
right. The second wire only had one damage point which lined up with the first point on the
first wire. A "V" pattern was observed on the foundation starting behind the first wire's initial
damage point expanding up the foundation. The aluminum dryer vent clucting had charring in
various spots along the first six feet coming out of the dryer. The paper side of the insulation
that this was up against had been burned away and is the area of origin.
Note: Please refer to Electrical Inspector's report for any further info relating to the electrical
components, processes, and code violations of this investigation. His report also breaks down
and describes all violations found in the entire 220v dryer circuit.
Heat sources in the area of origin:
- Two 110v wires; one going to the basement lights switch at the base of the
basement stairs & the other going to the basement smoke detectors.
- Aluminum dryer vent clucting
Witness interviews:
"I turned on the dryer and it made a very loud noise. I shut it off and checked inside to see what
was wrong. Then I tried again to turn the dryer on and the fuse had tripped. My son-in-law
noticed smoke and realized there were flames coming from the ceiling above the dryer."
Pamela Buco 218114
I interviewed Mr. Sided and he stated that he was in the basement while Mrs. Buco was using
the dryer. After the dryer made the loud noise and popped its breaker, Mr. Sideri tried to
resent the dryer breaker and it immediately tripped again. He walked back to the laundry room
and noticed smoke and flames coming from the ceiling above the dryer. Mr. Sideri and Richard
Sheehan (4/26/85 — 146 Farnum Street N. Andover, MA 01845 — (978)509-3697) tried to
extinguish the flames with numerous glasses of water and then used an ABC extinguisher from
his vehicle. He stated that the extinguisher did put most of the fire out, but there was still
smoke coming from the ceiling area. At that time Mr. Buco called 911.
I interviewed Andrew Buco, he stated that he had closed on the home on 2/7/14 and bought it
from David Minicucci. Mr. Buco stated that he had started to move in his bedroom furniture
around 8:30AM on the day of the fire. His mother had called Mr. Sided to the basement to help
her plug in the clothes dryer. A short time later he heard his mom, Mr. Sided, and Richard
Sheehan yelling fire and tying to put it out. Mr. Sided had come up from the basement and
went outside to his truck to get a fire extinguisher, that's when Mr. Buco called 911 reporting
the fire.
"Was called by seller David Minicucci on Saturday and was told he wanted to help in any way he
could. At this point was unaware of my situation and told him I would let him know. I received a
call Sunday from Service Master informing me Mike Mamolla had been at the house and stated
he would be returning between 11 and 11:30. 1 immediately contacted David (seller) and told
him I was not ready to have anyone come in yet because my insurance company had not yet
looked at it. I received a call Monday morning in which he stated he was with David (seller) and
Mike Mamolla (electrician) and they stated they had spoken to electrical inspector and he
wanted Mike to go in and fix situation. I again declined because once again it hadn't been
looked at by insurance company. On Tuesday I went in house and realized that burnt insulation
had been removed according to Service Master this was done by Mike Marnolla (electrician)."
Andrew Buco 2111114
I interviewed David Minicucci who sold the home to Mr. Buco. Mr. Minicucci stated that he had
bought the house in June or July of 2013 from a reality trust, possibly Harvey Family Reality
Trust. He stated that the house was in disrepair and he had renovated it. All work was done on
the house under the proper permits according to Mr. Minicucci. He stated that the basement
was partially finished when he bought it. The basement walls had some paneling and sheet
rock, a drop ceiling, and tile floor. During his renovations all the basement walls were sheet
rocked, can lighting was put in the drop ceiling, carpet was put down on the basement floor and
all the outlets were replaced. The electrician that performed the work in the home was
Mammola Electric (483 Chickering Road N. Andover, MA 01845 - Mike Mammola — (978)423-
9638).
I interviewed Mike Mammola on 2/11/14 at the North Andover Fire Dept Station 1. He stated
that he had been contracted by his step father David Minicucci to install ceiling can lights in the
first floor & basement, replace/ update all 1.10v electrical outlets, replace wall switches, install
new hardwired smoke detectors, replace some drop ceiling tiles & frame, and install a new
220v outlet in the laundry room for the dryer. Mr. Mammola stated that when he first started
working in the home, the drop ceiling was already present. I asked Mr. Mammola if he had
wired the dryer plug into the dryer and he stated "No". During the interview Mr. Mammola
stated that he did not wire the 220v dryer outlet correctly and it was an oversight on his part. I
asked Mr. Mammola about the wiring for the basement bathroom wall heater; he stated that
he had wired it temporarily due to tile work being performed in the bathroom. One of his
employees was supposed to return to the home and put in a permanent wire for that heater,
the employee never returned to complete this task. When asked about the size of the wire he
used to temporarily power the heater, Mr. Mammola stated that the wire was 220v wire. I
asked Mr. Mammola about the existing 220v circuit and junction box dedicated for the dryer
outlet; he stated that it was his opinion that it was sufficient to remain and that's why he
tapped into it and extended it into the laundry room. I asked Mr. Mammola why a new junction
box in the attic that had wires powering the new can lights on the first floor was attached to a
free floating 2' piece of 2x4; he stated that per NEC code it didn't have to be attached to a
beam and it could be free floating like it was found. When asked about why he was in the home
twice after the fire without the owner's permission; Mr. Mammola stated that he had went into
the home the night of the fire to assess the damage and see what he would need for repairs.
Mr. Mammola stated that he went back into the home the following Monday to begin repairs.
David Minicucci had given Mr. Mammola the Service Master lock -box code in order to gain
entry into the home. Mr. Mammola stated that while he was in the laundry room he took out
the pile of charred insulation from in front of the washing machine and put it into his truck. Mr.
Mammola stated that he took this because it "stunk" and he wanted to get the smell out of the
house. Mr. Mammola also stated that he had the dryer vent clucting in his hands and was about
to remove that from the basement, when he was stopped by a Service Master employee who
told him he couldn't go in there and to put it back, which he did. Mr. Mammola stated he took
the charred insulation and other.non related trash to the dumpster in front of 19 Fernview Ave
in North Andover to dispose of it. Mr. Mammola uses this on a regular basis to get rid of
construction debris. Mr. Mammola stated he wasn't aware that he couldn't go into the home
after the fire. He received a text from Andrew Buco's insurance agent the Monday after the fire
telling him not to go into the house, by then he had already left with the insulation.
Origin & Cause
Origin of Fire: The fire originated in the laundry room wall behind the clothes dryer; extended
up to the ceiling in between the first floor, floor joists, and the basement drop ceiling.
Cause: Accidental cause due to the dryer vent clucting being energized when the dryer was
plugged into the improperly wired 220v outlet. The most likely scenario that occurred was that
the vent ducting was energized, which allowed the electricity to travel up the vent clucting,
heating it up, transferring the heat to the wall insulation paper & vent clucting material, causing
the fire. The plastic vapor barrier in the wall contributed to fire spread and size. The
homeowner's insurance company electrical engineer (Matthew Elliot — GAI Engineers —
(781)297-3500) found that the vent clucting had arched out against a water pipe/ drop ceiling
frame in the laundry room ceiling.
Follow up Investigation: On Tuesday February 11, 2014 1 met with Laurence Brandoli from
Tetra Fire & Explosion and Daniel Flynn from Flynn, Riedel & Young Insurance Adjusters. Mr.
Brandoli was conducting an origin & cause investigation for The Concord Group at 288 Greene
Street. I assisted him in answering questions in regards to my investigation and my findings.
After my interview with Mr. Mammola on Tuesday February 11, 2014, he took me to the
clumpster in front of 19 Fernview Ave North Andover, MA to recover the burned insulation he
had taken out of 288 Greene Street North Andover, MA after the fire. The clumpster & its
contents were photographed by me; Mr. Mammola pointed out the burned insulation in it and
pulled it out. I placed the insulation in a clear plastic bag, tagged it with an evidence tag, and it
was transported to the North Andover Fire Dept's fire investigation office.
On Wednesday February 19, 2014, Tetra Fire & Explosion Investigations (representing The
Concord Group), Matt Elliot, and Peter Murphy went back to the scene for a further
examination. It was discovered that some time after the fire, the dryer outlet had been rewired
correctly to code specifications, most likely by Mike Mammola. Official NAFD photos show that
the dryer outlet was wired incorrectly on the day of the fire, but correctly on February 12, 2014.
Evidence: Photos taken by Fire Photographer J. Loisou.
Unresolved Issues: None
Respectfully Submitted,
Li 12,1
Jeffrey B. Crosby
Fire Investigator
North Andover FD
Electrical Insvectors Basic Notes:
Calldd to respond: North Andover Fire scene @ 288 Greene Street on 2-8-14 about 9:50am
Dryer Wiring
The 30 amp_ 240/120volt dryer outlet was Wired Incorre ft by Mammola Electric. The neutral wire
(white), 120 volt ungrounded ((black or red)(per photo ..... with voltage readings)) wire transposed (or crossed) creating a
short circuit and a fire resulted in the basement finished wall of the dwelling at 288 Greene Street. The circuit
did not have a ground return path from the dryer outlet connection which was not noticed by the installer but
if tested he would have found the defects in the wiring job immediately. An existing 30 amp (Romex) 10/3 NM
type cable four wire used for the dryer connection had a grounding wire but was cut at the circuit breaker
panel to thefirst splice box (photo, cut not used). The cable continued to a second splice box, at this location the
grounding wire was exposed (not cut) and Mr. Mamolla ran about 20 feet of new 10/3 four wire NM cable
(orange) for the dryer outlet connection. (Per photo) ..... with voltage reading)
DrVer unit.,
Note: NEC Violation Four wire -Neutral (white) bonded to dryer frame (green) NEC 250-114HNEC250-140
Mr. Mamolla stated, "The four wire cable (pick -tail) connection installed on the dryer was delivered from a
vender to the dwelling connected to the clothes dryer appliance."
Wag mount Fan Heater.,
Basement - Bathroom fan type 1000w/240volt heater with 15 amp (Romex) 14/2 NM (white) cable was
connected to the 30amp 240volt dryer circuit at the second splice box above suspended ceiling creating a
Djggjr NEC code violation. (As per photos)
Mr. Mammola stated, I wired the wall heater Ternporaril for heat in the basement and forgot to remove it
from the circuit."
Inspector: I found this statement to be a fame excuse at best. MILqr NECViolation
Additional, NEC code violations or electrical issues may be found above the drop ceiling upon tile
removal and inspection of the basement area.
Electrical Permit: Town of North Andover #11916 Issued:10-09-13 Inspected: 12-20-13 (enclosed)
The extent of the basement wiring was unknown to me at the time of my December 20, 2013
inspection. Permitting and rough inspections for the basement work was never requested before concealing
the basement walls. (527 CMR Rule #10) The extent of the work in the basement area was not stated completed
on the permit application.
Mr. Mamolla stated on 12-20-13: "Basement area was done previously by someone else and they (Marnmola)
only painted, installed lighting fixtures, smoke detectors and new suspended ceiling tiles." Ifoundthis
statement to be Grossly or Blatantly Untrue while interviewing Mr. Mammola at the town office on Monday
2-10-14.
Ultimately at that meeting, Mr. Mammola has taken full responsibility for doing the basement work in
question that created the life safety issues at the dwelling.
00 YPS.
f t&ORT
0
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Vol C?
ANDREW V. MELNIKAS
Fire Chief
NORTH ANDOVER FIRE DEPARTMENT
CENTRAL FIRE HEADQUARTERS
124 Main Street
North Andover, Mass. 01845
Subject: Structure fire at 288 Greene Street North Andover, MA 01845.
Incident: #2014-484
Date of report: 2/25/14
Date of incident: 2/8/14
Time: 09:27 AM
Chief (978) 688-9593
Business (978) 688-9590
Fax (978) 688-9594
Owner: Andrew Buco — 1/22/86 - 288 Greene Street N. Andover, MA 01845 — (978)771-1383
Christopher Buco — 3/14/90 — 465 Chestnut Street N. Andover, MA 01845 — (978)273-
7303
Tenant:N/A
Insurance: The Concord Group Policy # 1188015 Claim, #1124236
Craig Curley 1-800-888-6050 ext. 6125
Notification & Response: At approximately 09:27 AM on 2/8/14 North Andover
Communications received a 911 call from Andrew Buco for a dryer fire with smoke in the
basement at 288 Greene Street. Engine 1, Engine 2, Ladder 1, Ambulance 1, Ambulance 2 were
dispatched and responded. Engine I arrived on scene to find a one story wood frame ranch
with nothing showing from the outside. Lt. Nussbaum was met in the driveway by Mr. Buco and
Anthony Sideri (5/18/82 — 55 Moody Street N. Andover, AM 01845 — (978)208-9869). They
stated that they had seen smoke and some fire in the walls and ceiling behind the dryer in the
basement. They stated that they had tried to out it out with glasses of water and an ABC
extinguisher.
SERVING PROUDLY SINCE 1921
Discovery: The fire was discovered by Anthony Sideri and Pamela Buco (9/28/51 — 465 Chestnut
Street N. Andover, MA 01845 — (978)273-7424) while in the basement trying to use the clothes
dryer for the first time.
Suppression: "DISPATCHED FOR A POSSIBLE FIRE IN THE WALLS BEHIND A DRYER. MET
OCCUPANTS AT FRONT DOOR WHO STATED THEY TURNED THE DRYER ON, HEARD A POP AND
SMELLED SOMETHING BURNING. THEY LOOKED ABOVE CEILING TILES AND SAW FLAMES AND
CALLED 911. THEY USED A SMALL ABC EXTINGUISHER ON WHAT THEY COULD SEE. WE HAD A
LIGHT SMOKE CONDITION IN BASEMENT. WE REMOVED THE DRYER AND CEILING TILES. USED
THE THERMAL IMAGER AND FOUND HOT SPOTS BEHIND THE WALL. WE HAD A WATER CAN IN
PLACE AND BROUGHT DOWN AN ATTACK LINE. OPENED THE WALLS AND FOUND A SMALL
POCKET OF FIRE WHICH WE EXTINGUISHED WITH THE WATER CAN, WE CHECKED FOR
EXTENSION AND OPENED UP ANOTHER SECTION OF WALL BUT FOUND NONE. VENTILATED THE
BASEMENT WITH ELECTRIC PPV. CALLED FOR PHOTGRAPHER AND ELECTRICAL INSPECTOR. FF
CROSBY ON SCEN E WILL DO THE INVESTIGATION. LEFT SCENE WITH FF CROSBY IN CHARGE." Lt.
C. Scott Nussbaum
Building Description: One story wood frame ranch structure with asphalt shingled roof and oil
forced hot water heat. The structure has a total finished area of 1110 square feet and was
bought by Mr. Buco on 2/7/14 for $345,000 from David Minicucci (7/22/50 — 508 Main Street
N. Andover, MA 01845 — (978)688-4400). Mr. Buco had the home inspected by ABC Home
Inspection (21 Wingate Street Haverhill, MA 01830) which is owned by Andrew Consoli (978-:
373-2859).
Fire Scene Examination: After I assisted in the extinguishment of the fire, I went outside and
didn't observe any fire damage to the outside of the structure. The first floor had no fire
damage, but did smell of smoke. I walked back to the basement and went down the basement
stairs. At the basement stair landing, the wall directly in front of me, the sheet rock wall was
breeched by NAFD personnel looking for fire extension. A fair amount of wall debris was on the
landing due to the breech. The fiberglass insulation in this section of the wall was undamaged
by the fire. As I continued to the basement the same wall previously described was opened up
by N. Andover Electrical Inspector Peter Murphy during the investigation in order to trace one
of the wires that were in the area of origin. The hole that was made was to the left of the
basement stairs light switch. The smoke detector at the bottom of the basement stairs was not
connected and was later found on top of the furnace. The detector had been taken down
during overhaul operations by NAFD personnel, was tested and worked on battery only due to
the hard wired line being shut off at the panel. The drop ceiling was mostly intact in the main
room; a few tiles had been removed during suppression to look for extension and the dryer
vent ducting. The drop ceiling did have what appeared to be 6" recessed can lights. The
basement walls in the main room were sheet rocked and painted. The floor was carpeted and
had baseboard heat. In the middle of the main room was the white Amana electric dryer
(Model #NED4600YQI — Serial # M33043117 — Type DWJR-ELE-2406026-FM54) purchased new
from A & M Appliance (44 Main Street North Andover, MA 01845 (978)682-3875). It was noted
by electrical inspector that the white jumper wire was connected to the ground on the back of
the unit.
The utility room of the basement along the "D" side wall had exposed fiberglass insulation in
the ceiling covered with plastic, no fire damage, and smelled of smoke. A smoke detector was
on the ceiling with a pink plastic cover over it. To my left was a door leading outside to the "C"
side of the structure, no fire damage to this door was observed. The interior walls of this room
were partially sheet rocked, the concrete foundation walls were still exposed, and the floor was
poured concrete. To the right of the door previously described was the oil tank, which looked
somewhat new and was not leaking. In the center of the room was the furnace. in the "AD" r
corner of this room, the 200 AMP electrical circuit breaker panel was located. The only breaker
that was tripped was the 30AMP dryer. All other breakers were intact and in the "on" position.
I then walked into the basement bathroom through the laundry room. The bathroom had no
fire damage, only a strong smoke smell. The drop ceiling was the same as the rest of the
basement, a vent in the ceiling was observed, sheetrock walls, shower, an electric heater in the
bath room/laundry room wall, and a tile floor. I observed an approximately 15' section of silver
flexible ducting on the bathroom floor, 2' — 3' section moderately burned, other burn marks
along the clucting over about 4', and it was clean of lint.
I walked into the laundry room, about half of the ceiling tiles were taken down during
suppression, the walls were sheetrock, tile floor, four glasses were on the floor to my left, a
white plastic slop sink was in the left corner, the washer was to the right of the sink, numerous
pieces of fiberglass insulation were on the floor and had charring on the pink and paper side. To
the right of the washer was the black dryer 220V outlet. The outside of the outlet was intact
and no heat or fire damage was observed. The outlet was photographed by NAFD in place and
then unscrewed from the bracket to look at the backside by Peter Murphy. Mr. Murphy noted
that the red power lead and the white neutral were reversed resulting in an improperly wired
outlet. Photos were taken of this outlet showing the various meter readings that were obtained
by Mr. Murphy of the various leads. No heat or fire damage was observed on the back of this.
outlet or the plastic box it was secured to. The wall to the right of this outlet had been opened
up by me during suppression. The two right most wall studs had charring about three quarters
of the way up continuing to the first floor, floor joists. The same damage was observed in the
bay to its left, but the charring was more severe. The plastic vapor barrier that was between the
foundation and the insulation had melted behind the dryer. Two 110v white wires were free
floating in the wall between the melted vapor barrier and the insulation. One wire had two
damage points; one in the area of the dryer vent clucting and the other about 1.5 feet to its
right. The second wire only had one damage point which lined up with the first point on the
first wire. A "V" pattern was observed on the foundation starting behind the first wire's initial
damage point expanding up the foundation. The aluminum dryer vent clucting had charring in
various spots along the first six feet coming out of the dryer. The paper side of the insulation
that this was up against had been burned away and is the area of origin.
Note: Please refer to Electrical Inspector's report for any further info relating to the electrical
components, processes, and code violations of this investigation. His report also breaks down
and describes all violations found in the entire 220v dryer circuit.
Heat sources in the area of origin:
- Two 110v wires; one going to the basement lights switch at the base of the
basement stairs & the other going to the basement smoke detectors.
- Aluminum dryer vent clucting
Witness interviews:
"I turned on the dryer and it made a very loud noise. I shut it off and checked inside to see what
was wrong. Then I tried again to turn the dryer on and the fuse had tripped. My son-in-law
noticed smoke and realized there were flames coming from the ceiling above the dryer."
Pamela Buco 218114
I interviewed Mr. Sideri and he stated that he was in the basement while Mrs. Buco was using
the dryer. After the dryer made the loud noise and popped its breaker, Mr. Sideri tried to
resent the dryer breaker and it immediately tripped again. He walked back to the laundry room
and noticed smoke and flames coming from the ceiling above the dryer. Mr. Sideri and Richard
Sheehan (4/26/85 — 146 Farnum Street N. Andover, MA 01845 — (978)509-3697) tried to
extinguish the flames with numerous glasses of water and then used an ABC extinguisher from
his vehicle. He stated that the extinguisher did put most of the fire out, but there was still
smoke coming from the ceiling area. At that time Mr. Buco called 911.
I interviewed Andrew Buco, he stated that he had closed on the home on 2/7/14 and bought it
from David Minicucci. Mr. Buco stated that he had started to move in his bedroom furniture
around 8:30AM on the day of the fire. His mother had called Mr. Sideri to the basement to help
her plug in the clothes dryer. A short time later he heard his mom, Mr. Sideri, and Richard
Sheehan yelling fire and tying to put it out. Mr. Sideri had come up from the basement and
went outside to his truck to get a fire extinguisher, that's when Mr. Buco called 911 reporting
the fire.
I
"Was called by seller David Minicucci on Saturday and was told he wanted to help in any way he
could. At this point was unaware of my situation and told him I would let him know. I received a
call Sunday from Service Master informing me Mike Mamolla had been at the house and stated
he would be returning between 11 and 11:30. 1 immediately contacted David (seller) and told
him I was not ready to have anyone come in yet because my insurance company had not yet
looked at it. I received a call Monday morning in which he stated he was with David (seller) and
Mike Mamolla (electrician) and they stated they had spoken to electrical inspector and he
wanted Mike to go in and fix situation. I again declined because once again it hadn't been
looked at by insurance company. On Tuesday I went in house and realized that burnt insulation
had been removed according to Service Master this was done by Mike Mamolla (electrician)."
Andrew Buco 2111114
I interviewed David Minicucci who sold the home to Mr. Buco. Mr. Minicucci stated that he had
bought the house in June or July of 2013 from a reality trust, possibly Harvey Family Reality
Trust. He stated that the house was in disrepair and he had renovated it. All work was done on
the house under the proper permits according to Mr. Minicucci. He stated that the basement
was partially finished when he bought it. The basement walls had some paneling and sheet
rock, a drop ceiling, and tile floor. During his renovations all the basement walls were sheet
rocked, can lighting was put in the drop ceiling, carpet was put down on the basement floor and
all the outlets were replaced. The electrician that performed the work in the home was
Mammola Electric (483 Chickering Road N. Andover, MA 01845 - Mike Mammola — (978)423-
9638).
I interviewed Mike Mammola on 2/11/14 at the North Andover Fire Dept Station 1. He stated
that he had been contracted by his step father David Minicucci to install ceiling can lights in the
first floor & basement, replace/ update all 110v electrical outlets, replace wall switches, install
new hardwired smoke detectors, replace some drop ceiling tiles & frame, and install a new
220v outlet in the laundry room for the dryer. Mr. Mammola stated that when he first started
working in the home, the drop ceiling was already present. I asked Mr. Mammola if he had
wired the dryer plug into the dryer and he stated "No". During the interview Mr. Mammola
stated that he did not wire the 220v dryer outlet correctly and it was an oversight on his part. I
asked Mr. Mammola about the wiring for the basement bathroom wall heater; he stated that
he had wired it temporarily due to tile work being performed in the bathroom. One of his
employees was supposed to return to the home and put in a permanent wire for that heater,
the employee never returned to complete this task. When asked about the size of the wire he
used to temporarily power the heater, Mr. Mammola stated that the wire was 220v wire. I
asked Mr. Mammola about the existing 220v circuit and junction box dedicated for the dryer
outlet; he stated that it was his opinion that it was sufficient to remain and that's why he
tapped into it and extended it into the laundry room. I asked Mr. Mammola why a new junction
4.
box in the attic that had wires powering the new can lights on the first floor was attached to a
free floating 2' piece of 2x4; he stated that per NEC code it didn't have to be attached to a
beam and it could be free floating like it was found. When asked about why he was in the home
twice after the fire without the owner's permission; Mr. Mammola stated that he had went into
the home the night of the fire to assess the damage and see what he would need for repairs.
Mr. Mammola stated that he went back into the home the following Monday to begin repairs.
David Minicucci had given Mr. Mammola the Service Master lock -box code in order to gain
entry into the home. Mr. Mammola stated that while he was in the laundry room he took out
the pile of charred insulation from in front of the washing machine and put it into his truck. Mr.
Mammola stated that he took this because it "stunk" and he wanted to get the smell out of the
house. Mr. Mammola also stated that he had the dryer vent clucting in his hands and was about
to remove that from the basement, when he was stopped by a Service Master employee who
told him he couldn't go in there and to put it back, which he did. Mr. Mammola stated he took
the charred insulation and other,non related trash to the clumpster in front of 19 Fernview Ave
in North Andover to dispose of it. Mr. Mammola uses this on a regular basis to get rid of
construction debris. Mr. Mammola stated he wasn't aware that he couldn't go into the home
after the fire. He received a text from Andrew Buco's insurance agent the Monday after the fire
telling him not to go into the house, by then he had already left with the insulation.
Origin & Cause
Origin of Fire: The fire originated in the laundry room wall behind the clothes dryer; extended
up to the ceiling in between the first floor, floor joists, and the basement drop ceiling.
Cause: Accidental cause due to the dryer vent clucting being energized when the dryer was
plugged into the improperly wired 220v outlet. The most likely scenario that occurred was that
the vent ducting was energized, which allowed the electricity to travel up the vent clucting,
heating it up, transferring the heat to the wall insulation paper & vent clucting material, causing
the fire. The plastic vapor barrier in the wall contributed to fire spread and size. The
homeowner's insurance company electrical engineer (Matthew Elliot — GAI Engineers —
(781)297-3500) found that the vent ducting had arched out against a water pipe/ drop ceiling
frame in the laundry room ceiling.
Follow up Investigation: On Tuesday February 11, 2014 1 met with Laurence Brandoli from
Tetra Fire & Explosion and Daniel Flynn from Flynn, Riedel & Young Insurance Adjusters. Mr.
Brandoli was conducting an origin & cause investigation for The Concord Group at 288 Greene
Street. I assisted him in answering questions in regards to my investigation and my findings.
After my interview with Mr. Mammola on Tuesday February 11, 2014, he took me to the
dumpster in front of 19 Fernview Ave North Andover, MA to recover the burned insulation he
had taken out of 288 Greene Street North Andover, MA after the fire. The dumpster & its
contents were photographed by me; Mr. Mammola pointed out the burned insulation in it and
pulled it out. I placed the insulation in a clear plastic bag, tagged it with an evidence tag, and it
was transported to the North Andover Fire Dept's fire investigation office.
On Wednesday February 19, 2014, Tetra Fire & Explosion Investigations (representing The
Concord Group), Matt Elliot, and Peter Murphy went back to the scene for a further
examination. It was discovered that some time after the fire, the dryer outlet had been rewired
correctly to code specifications, most likely by Mike Mammola. Official NAFD photos show that
the dryer outlet was wired incorrectly on the day of the fire, but correctly on February 12, 2014.
Evidence: Photos taken by Fire Photographer J. Loisou.
Unresolved Issues: None
Respectfully Submitted,
J
L1,12,11q
Jeffrey B. Crosby
Fire Investigator
North Andover FD
'SSO yps.
'�X
CHUS
ANDREW V. MELNIKAS
Fire Chief
NORTH ANDOVER FIRE DEPARTMENT
CENTRAL FIRE HEADQUARTERS
124 Main Street
North Andover, Mass. 01845
Subject: Structure fire at 288 Greene Street North Andover, MA 01845.
Incident: #2014-484
Date of report: 2/25/14
Date of incident: 2/8/14
Time: 09:27 AM
Chief (978) 688-9593
Business (978) 688-9590
Fax (978) 688-9594
Owner: Andrew Buco — 1/22/86 - 288 Greene Street N. Andover, MA 01845 — (978)771-1383
Christopher Buco — 3/14/90 — 465 Chestnut Street N. Andover, MA 01845 — (978)273-
7303
Tenant:N/A
Insurance: The Concord Group Policy # 1188015 Claim, #1124236
Craig Curley 1-800-888-6050 ext. 6125
Notification & Response: At approximately 09:27 AM on 2/8/14 North Andover
Communications received a 911 call from Andrew Buco for a dryer fire with smoke in the
basement at 288 Greene Street. Engine 1, Engine 2, Ladder 1, Ambulance 1, Ambulance 2 were
dispatched and responded. Engine 1 arrived on scene to find a one story wood frame ranch
with nothing showing from the outside. Lt. Nussbaum was met in the driveway by Mr. Buco and
Anthony Sideri (5/18/82 — 55 Moody Street N. Andover, AM 01845 — (978)208-9869). They
stated that they had seen smoke and some fire in the walls and ceiling behind the dryer in the
basement. They stated that they had tried to put it out with glasses of water and an ABC
extinguisher.
SERVING PROUDLY SINCE 1921
Discovery: The fire was discovered by Anthony Sideri and Pamela Buco (9/28/51 — 465 Chestnut
Street N. Andover, MA 01845 — (978)273-7424) while in the basement trying to use the clothes
dryer for the first time.
Suppression: "DISPATCHED FOR A POSSIBLE FIRE IN THE WALLS BEHIND A DRYER. MET
OCCUPANTS AT FRONT DOOR WHO STATED THEY TURNED THE DRYER ON, HEARD A POP AND
SMELLED SOMETHING BURNING. THEY LOOKED ABOVE CEILING TILES AND SAW FLAMES AND
CALLED 911. THEY USED A SMALL ABC EXTINGUISHER ON WHAT THEY COULD SEE. WE HAD A
LIGHT SMOKE CONDITION IN BASEMENT. WE REMOVED THE DRYER AND CEILING TILES. USED
THE THERMAL IMAGER AND FOUND HOT SPOTS BEHIND THE WALL. WE HAD A WATER CAN IN
PLACE AND BROUGHT DOWN AN ATTACK LINE. OPENED THE WALLS AND FOUND A SMALL
POCKET OF FIRE WHICH WE EXTINGUISHED WITH THE WATER CAN, WE CHECKED FOR
EXTENSION AND OPENED UP ANOTHER SECTION OF WALL BUT FOUND NONE. VENTILATED THE
BASEMENT WITH ELECTRIC PPV. CALLED FOR PHOTGRAPHER AND ELECTRICAL INSPECTOR. FF
CROSBY ON SCENE WILL DO THE INVESTIGATION. LEFT SCENE WITH FF CROSBY IN CHARGE." Lt.
C. Scott Nussbaum
Building Description: One story wood frame ranch structure with asphalt shingled roof and oil
forced hot water heat. The structure has a total finished area of 1110 square feet and was
bought by Mr. Buco on 2/7/14 for $345,000 from David Minicucci (7/22/50 — 508 Main Street
N. Andover, MA 01845 — (978)688-4400). Mr. Buco had the home inspected by ABC Home
Inspection (21 Wingate Street Haverhill, MA 01830) which is owned by Andrew Consoli (978-,
373-2859).
Fire Scene Examination: After I assisted in the extinguishment of the fire, I went outside and
didn't observe any fire damage to the outside of the structure. The first floor had no fire
damage, but did smell of smoke. I walked back to the basement and went down the basement
stairs. At the basement stair landing, the wall directly in front of me, the sheet rock wall was
breeched by NAFD personnel looking for fire extension. A fair amount of wall debris was on the
landing due to the breech. The fiberglass insulation in this section of the wall was undamaged
by the fire. As I continued to the basement the same wall previously described was opened up
by N. Andover Electrical Inspector Peter Murphy during the investigation in order to trace one
of the wires that were in the area of origin. The hole that was made was to the left of the
basement stairs light switch. The smoke detector at the bottom of the basement stairs was not
connected and was later found on top of the furnace. The detector had been taken down
during overhaul operations by NAFD personnel, was tested and worked on battery only due to
the hard wired line being shut off at the panel. The drop ceiling was mostly intact in the main
room; a few tiles had been removed during suppression to look for extension and the dryer
vent ducting. The drop ceiling did have what appeared to be 6" recessed can lights. The
basement walls in the main room were sheet rocked and painted. The floor was carpeted and
had baseboard heat. In the middle of the main room was the white Amana electric dryer
(Model #NED4600YQ1 — Serial # M33043117 —Type DWJR-ELE-2406026-FM54) purchased new
from A & M Appliance (44 Main Street North Andover, MA 01845 (978)682-3875). it was noted
by electrical inspector that the white jumper wire was connected to the ground on the back of
the unit.
The utility room of the basement along the "D" side wall had exposed fiberglass insulation in
the ceiling covered with plastic, no fire damage, and smelled of smoke. A smoke detector was
on the ceiling with a pink plastic cover over it. To my left was a door leading outside to the "C"
side of the structure, no fire damage to this door was observed. The interior walls of this room
were partially sheet rocked, the concrete foundation walls were still exposed, and the floor was
poured concrete. To the right of the door previously described was the oil tank, which looked
somewhat new and was not leaking. In the center of the room was the furnace. In the "AD" .
corner of this room, the 200 AMP electrical circuit breaker panel was located. The only breaker
that was tripped was the 30AMP dryer. All other breakers were intact and in the "on" position.
I then walked into the basement bathroom through the laundry room. The bathroom had no
fire damage, only a strong smoke smell. The drop ceiling was the same as the -rest of the
basement, a vent in the ceiling was observed, sheetrock walls, shower, an electric heater in the
bath room/laund ry room wall, and a tile floor. I observed an approximately 15' section of silver
flexible ducting on the bathroom floor, 2'— 3' section moderately burned, other burn marks
along the ducting over about 4, and it was clean of lint.
I walked into the laundry room, about half of the ceiling tiles were taken down during
suppression, the walls were sheetrock, tile floor, four glasses were on the floor to my left, a
white plastic slop sink was in the left corner, the washer was to the right of the sink, numerous
pieces of fiberglass insulation were on the floor and had charring on the pink and paper side. To
the right of the washer was the black dryer 220V outlet. The outside of the outlet was intact
and no heat or fire damage was observed. The outlet was photographed by NAFD in place and
then unscrewed from the bracket to look at the backside by Peter Murphy. Mr. Murphy noted
that the red power lead and the white neutral were reversed resulting in an improperly wired
outlet. Photos were taken of this outlet showing the various meter readings that were obtained
by Mr. Murphy of the various leads. No heat or fire damage was observed on the back of this.
outlet or the plastic box it was secured to. The wall to the right of this outlet had been opened
up by me during suppression. The two right most wall studs had charring about three quarters
of the way up continuing to the first floor, floor joists. The same damage was observed in the
bay to its left, but the charring was more severe. The plastic vapor barrier that was between the
foundation and the insulation had melted behind the dryer. Two 110v white wires were free
floating in the wall between the melted vapor barrier and the insulation. One wire had two
damage points; one in the area of the dryer vent ducting and the other about 1.5 feet to its
right. The second wire only had one damage point which lined up with the first point on the
first wire. A "V" pattern was observed on the foundation starting behind the first wire's initial
damage point expanding up the foundation. The aluminum dryer vent clucting had charring in
various spots along the first six feet coming out of the dryer. The paper side of the insulation
that this was up against had been burned away and is the area of origin.
Note: Please refer to Electrical Inspector's report for any further info relating to the electrical
components, processes, and code violations of this investigation. His report also breaks down
and describes all violations found in the entire 220v dryer circuit.
Heat sources in the area of origin:
- Two 110v wires; one going to the basement lights switch at the base of the
basement stairs & the other going to the basement smoke detectors.
- Aluminum dryer vent ducting
Witness interviews:
"I turned on the dryer and it made a very loud noise. I shut it off and checked inside to see what
was wrong. Then I tried again to turn the dryer on and the fuse had tripped. My son-in-law
noticed smoke and realized there were flames coming from the ceiling above the dryer."
Pamela Buco 218114
I interviewed Mr. Sided and he stated that he was in the basement while Mrs. Buco was using
the dryer. After the dryer made the loud noise and popped its breaker, Mr. Sideri tried to
resent the dryer breaker and it immediately tripped again. He walked back to the laundry room
and noticed smoke and flames coming from the ceiling above the dryer. Mr. Sided and Richard
Sheehan (4/26/85 — 146 Farnum Street N. Andover, MA 01845 — (978)509-3697) tried to
extinguish the flames with numerous glasses of water and then used an ABC extinguisher from
his vehicle. He stated that the extinguisher did put most of the fire out, but there was still
smoke coming from the ceiling area. At that time Mr. Buco called 911.
I interviewed Andrew Buco, he stated that he had closed on the home on 2/7/14 and bought it
from David Minicucci. Mr. Buco stated that he had started to move in his bedroom furniture
around 8:30AM on the day of the fire. His mother had called Mr. Sideri to the basement to help
her plug in the clothes dryer. A short time later he heard his mom, Mr. Sided, and Richard
Sheehan yelling fire and tying to put it out. Mr. Sideri had come up from the basement and
went outside to his truck to get a fire extinguisher, that's when Mr. Buco called 911 reporting
the fire.
13
"Was called by seller David Minicucci on Saturday and was told he wanted to help in any way he
could. At this Point was unaware Of MY situation and told him I would let him know. I received a
call Sunday from Service Master informing me Mike Mamolla had been at the house and stated
he would be returning between 11 and 11:30. 1 -
Immediately contacted David (seller) and told
him I was not ready to have anyone come in yet because My insurance company had not yet .
looked at it. I received a call Monday morning in which he stated he was with David (seller) and
Mike Mamolla (electrician) and they stated they had spoken to electrical inspector and he
wanted Mike to go in and fix situation. 1 again declined because once again it hadn't been
looked at by insurance company. On Tuesday I went in house and realized that burnt insulation
had been removed according to Service Master this was done by Mike Mamolla (electrician).'
Andrew Buco 2111114
1 interviewed David Minicucci who sold the home to Mr. Buco. Mr. Minicucci stated that he had
bought the house in June or July of 2013 from a reality trust, Possibly Harvey Family Reality
Trust. He stated that the house was in disrepair and he had renovated it. All work was d
was partially finished when one on
the house under the proper permits according to Mr. Minicucci. He stated that the basement
he bought it. The basement walls had some paneling and sheet
rock, a drop ceiling, and tile floor. During his renovations all the basement walls were sheet
rocked, can lighting was Put in the drop ceiling, carpet was Put down on the basement oor and
all the outlets were replaced. The electrician that performed the work in the home was fl
Mammola Electric (483 Chickering Road N
9638). - Andover, MA 01845 - Mike Mammola — (978)423-
1 interviewed Mike Mammola on 2/11/14 at the North Andover Fire Dept Station 1. He stated
that he had been contracted by his step father David Minicucci
first floor & basement, replace/ update all 110v electrical outlets, replace wall switches, install
to install ceiling can lights in the
new hardwired smoke detectors, replace some drop ceiling tiles & frame, and install a new
220v outlet in the laundry room for the dryer. Mr. Mammola stated that when he first started
working in the home, the drop ceiling was already present. I asked Mr. Mammola if he had
wired the dryer plug into the dryer and he stated "No'. During the interview Mr. mammola
Mammola about the wiring for the basement bathroom wall heater; he stated that
he had wired it temporarily due to tile work being performed in the bathroom. One of his
stated that he did not wire the 220v dryer outlet correctly and it was an oversight on his part i
asked Mr.
employees Was supposed to return to the home and Put in a permanent wire for that heater
the employee never returned to complete this task. When asked about the size of the wire he
used to temporarily Power the heater, Mr. Mammola stated that the wire was 220v wire. I
asked Mr. Mammola about the existing 220v circuit and junction box dedicated for the dryer
outlet; he stated that it was his opinion that it was sufficient to remain and that's why he
tapped into it and extended it into the laundry room. I asked Mr. Mammola why a new junction
box in the attic that had wires powering the new can lights on the first floor was attached to a
free floating 2' piece of 2x4; he stated that per NEC code it didn't have to be attached to a
beam and it could be free floating like it was found. When asked about why he was in the home
twice after the fire without the owner's permission; Mr. Mammola stated that he had went into
the home the night of the fire to assess the damage and see what he would need for repairs.
Mr. Mammola stated that he went back into the home the following Monday to begin repairs.
David Minicucci had given Mr. Mammola the Service Master lock -box code in order to gain
entry into the home. Mr. Mammola stated that while he was in the laundry room he took out
the pile of charred insulation from in front of the washing machine and put it into his truck. Mr.
Mammola stated that he took this because it "stunk" and he wanted to get the smell out of the
house. Mr. Mammola also stated that he had the dryer vent clucting in his hands and was about
to remove that from the basement, when he was stopped by a Service Master employee who
told him he couldn't go in there and to put it back, which he did. Mr. Mammola stated he took
the charred insulation and other.non related trash to the clumpster in front of 19 Fernview Ave
in North Andover to dispose of it. Mr. Mammola uses this on a regular basis to get rid of
construction debris. Mr. Mammola stated he wasn't aware that he couldn't go into the home
after the fire. He received a text from Andrew Buco's insurance agent the Monday after the fire
telling him not to go into the house, by then he had already left with the insulation.
Origin & Cause
Origin of Fire: The fire originated in the laundry room wall behind the clothes dryer; extended
up to the ceiling in between the first floor, floor joists, and the basement drop ceiling.
Cause: Accidental cause due to the dryer vent ducting being energized when the dryer was
plugged into the improperly wired 220v outlet. The most likely scenario that occurred was that
the vent ducting was energized, which allowed the electricity to travel up the vent clucting,
heating it up, transferring the heat to the wall insulation paper & vent ducting material, causing
the fire. The plastic vapor barrier in the wall contributed to fire spread and size. The
homeowner's insurance company electrical engineer (Matthew Elliot — GAI Engineers —
(781)297-3500) found that the vent ducting had arched out against a water pipe/ drop ceiling
frame in the laundry room ceiling.
Follow up Investigation: On Tuesday February 11, 2014 1 met with Laurence Brandoli from
Tetra Fire & Explosion and Daniel Flynn from Flynn, Riedel & Young insurance Adjusters. Mr.
Brandoli was conducting an origin & cause investigation for The Concord Group at 288 Greene
Street. I assisted him in answering questions in regards to my investigation and my findings.
0
After my interview with Mr. Marnmola on Tuesday February 11, 2014, he took me to the
dumPster in front Of 19 Fernview Ave North Andover, MA to recover the burned insulation he
had taken Out of 288 Greene Street North Andover, MA after the fire. The clumPster & its
contents were photographed by me; Mr, Mammola Pointed Out the burned insulation in it and
Pulled it out. I Placed the insulation in a clear Plastic bag, tagged it with an evidence tag, and it
was transported to the North Andover Fire Dept's fire investigation Office.
On Wednesday February 19, 2014, Tetra Fire & Explosion Investigations (representing The
Concord Group), Matt Elliot, and Peter Murphy went back to the scene for a further
examination. it was discovered that some time after the firel the dryer Outlet had been rewired
correctly to code specifications, most likely by mike Mammola. Official NAFD photos show that
the dryer outlet was wired incorrectly on the da y of the fire, but correctly on February 12, 2014.
Evidence: Photos taken by Fire Photographer J. Loisou.
Unresolved Issues: None
Respectfully Submitted,
leffrey 13. Crosby
Fire Investigator
North Andover FD
Electrical Inspectors Basic Notes:
Calred to respond: North Andover Fire scene @ 288 Greene Street on 2-8-14 about 9:50am
Dryer Wiring
The 30 amp_ 240/120volt dryer outlet was Wired Incorrectly by Mammola Electric. The neutral wire
(white), 120 volt ungrounded ((black or red)(per photo ..... with voltage readings)) wire transposed (or crossed) creating a
short circuit and a fire resulted in the basement finished wall of the dwelling at 288 Greene Street. The circuit
did not have a ground return path from the dryer outlet connection which was not noticed by the installer but
if tested he would have found the defects in the wiring job immediately. An existing 30 amp (Rornex) 10/3 NM
type cable four wire used for the dryer connection had a grounding wire but was cut at the circuit breaker
panel to thefirst splice box (photo, cut not used). The cable continued to a second splice box, at this location the
grounding wire was exposed (not cut) andMr.Mamolla ran about 20 feet of new 10/3 fourwire NM cable
(orange) for the dryer outlet connection. (Per photo) ..... with voltage reading)
Dryer unit
Note: NEC Violation Four wire - Neutral (white) bonded to dryer frame (green) NEC 250-114HNEC 250-140
Mr. Mamolla stated, "The four wire cable (pick -tail) connection installed on the dryer was delivered from a
vender to the dwelling connected to the clothes dryer appliance."
WaY mount Fan Heater.
Basement - Bathroom fan type 1000w/240volt heater with 15 amp (Rornex) 14/2 NM (white) cable was
connected to the 30amp 240volt dryer circuit at the second splice box above suspended ceiling creating a
fljk�jr NEC code violation. (As per photos)
Mr. Mammola stated, "I wired the wall heater Temporarily for heat in the basement and forgot to remove it
from the circuit."
Inspector. I found this statement to be a lame excuse at best. MqLq[ NECViolation
Additional, NEC code violations or electrical issues may be found above the drop ceiling upon tile
removal and inspection of the basement area.
Electrical Permit: Town of North Andover #11916 Issued:10-09-13 Inspected: 12-20-13 (enclosed)
The extent of the basement wiring was unknown to me at the time of my December 20, 2013
inspection. Permitting and rough inspections for the basement work was never requested before concealing
the basement walls. (527 CMR Rule #10) The extent of the work in the basement area was not stated completed
on the permit application.
Mr. Mamolla stated on 12-20-13: "Basement area was done previously by someone else and they (Marnmola)
only painted, installed lighting fixtures, smoke detectors and new suspended ceiling tiles." Ifoundthis
statement to be Grossly or Blatantly Untrue while interviewing Mr. Mammola at the town office on Monday
2-10-14.
Ultimately at that meeting, Mr. Mammola has taken full responsibility for doing the basement work in
question that created the life safety issues at the dwelling.
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Oct 14 13 09:41 a
MOVE OR
REMOVE
EXIST. SHED
David Minicucci R. E, 9786827998 P.1
ZDArING DrS7)ZIC2% R-3 RESMENCE 3
MIN. LOT APSA: 26,000 S.F.
MIN. FRONFA0. 125'
FRONT YARD SETBACK. 30'
SME YARD SETBACK.- 20'
REAR YARD SETBACK. 80'
GREENE STREET
10111113
f, R.L. S. DA TE
7,f -,7 ?d - 5-0,5 4,-,'
Ii
0
3�
PLOT PLAN
IN I ORTH ANDOVER, MA
SHOMNG PROPOSED DECK
DRAWN FOR
DAVID L 11INICUCCI
FRANCIS MURPHY
SCALE: 1"=20' DATE: OCTOBER 11, 2013
MERRLWACK ENGNEE)UNG SERV7CF.5
66 PARK STRM
f 10285 IIANDOVER, HASSACBVSEM 01810
311 Date.. tt�'l I P./ /—]�; .....
tLORTH TOWN OF NORTH ANDOVER
PERMIT FOR MECHANICAL INSTALLATION
4SACHU
�Vk 10 VM r- C- '4
This certifies that - Do qtA .... 1�kA I i-1 I t J�/ Z-
.............. ...........
A-."
has permission for mechanical installation ................
in the buildings of .... . .............
at .... North Andover, Mass.
F e e . L i c. N o.
.. ............
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
f
Commonwealth of Massachusetts
Sheet Metal Permit
Date: Permit
[.0
Estimated Job CostJ �50 -0 Permit Fee:
Plans Submitted: YES NO Plans Reviewed: YIES NO
,,4A A C, o6 q o Appli,
Business License 4 �,,t License 4
Business Information:
Name: pAT M f c -Vi 4n 4" 0 A I
Street: �q S-4-
City/Town: M-e--jrhsen MA -
Telephone: 9-7Z5 -36-oqg5-)
Property Owner / Job Location Information:
4
Name: AA'Y0"CQCC"
Street:
City/Town: 411�eNR,-`
Telephone: 57%' I -SE 3,2,9-�
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Building Type: -2 family / Multi -family Condo / Townhouses
Residential: 1
Commercial: Office Retail Industrial Educational Institutional.
7
Building Cubic Footage: under 35,000 cu. ft. over 3�5,000 cu. ft.
Sheet metal work -to be completed: New Work: ��z Renovation:
HVAC Metal Roofing _ Kitchen -Exhaust System Chimney / Vents
Provide brief description of work to be done:
%, I �c
!,�) GA -41 N
k .
INSURANCE COVERAGE:
I have a c urrent liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No F1
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy n Other type of indemnity El Bond El
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner E] Agent F1
Signature of Owner or Owner's Agent
By checking this boxEl, I hereby certify that all -of the details and information I have submitted (or entered) regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Date
I Date
Promss Inspections
Comments
Final Inspection
Inspector Signature of Permit Approval
Comments
Signature of Licensee
License Number:
Check at www.mass.gov/dpi
Type of License:
By
El Master
Title
El Master -Restricted
CityfTown
Eliourneyperson
Permit #
E]Journeyperson-Restricted
Fee $
EJ
Inspector Signature of Permit Approval
Comments
Signature of Licensee
License Number:
Check at www.mass.gov/dpi
Sheet Metal Commercial Guidelines I Life Safety / Critical Systems
Inspection Checklist
Yes No N/A
Set of stamped engineering documents and detailed description of
mechanical system to be installed has been provided
All workers performing sheet metal work onsite has valid Massachusetts sheet metal
license
All sheet metal work being performed with proper journeyperson-to-apprentice ratios
Fire dampers with access door properly installed and chocked for operation
Smoke and combination fire / smoke dampers with access doors properly installed -
actuator checked for proper operation (May also be verified by fire department during
fire alarm testing)
Duct smoke detectors with access doors properly located
(May also be verified by fire department during fire alarm testing)
Smoke / atrium exhaust systems installed and operation verified
(May also be verified by fire department during fire alarm testing)
Stair pressurization systems installed (where required) and operation verified (May also
be verified by fire department during fire alarm testing)
Grease / kitchen hood exhaust system installed with all scams and connections welded
airtight with properly located cleanouts. Proper cldianoes, fire rated enclosures and
pressure testing requiTed...
-F "';.-aii --,V) te n and &J,,%ori,
e..o ecluibment
�C. "IR; ire, nib instalte.d i6id quir d
Duct penetrations in and flo"ors* seal6d'
Metal roofffig systems installed watertightusing proper materials and fasteners
Flexible duct runs installed 6'-0" maximum length
Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle
iron
Ductwork / plenum connections scaled substantially airtight
Ductwork insulated by means of external covering or internal lining
Volume dampers installed for each supply air branch duct
New/clean - properly sized filters installed (final inspection)
Testing and Balancing report complete (final sign -oft)
Sheet Metal Residential Guidelines / Inspection Checklist
Yes No N/A
I
Detailed description and sketch of sheet metal system to be installed has
been provided
All workers performing sheet metal work onsite has valid Massachusetts
sheet metal license I
All sheet metalwork being performed with proper joumeyperson-to-
apprentice ratios
Equipment sized per heating / cooling load calculations
I
Duct work sized per manual "D" calculations
Bath / shower rooms contain mechanical exhaust fan vented outdoors
Electric dryer exhaust properly installed maximum total run 35'-0",
maximum flexible run 8'-0"
Flexible duct runs installedl 4'-0" maximum length
i
Volume dampers installed for each supply air branch duct
Ductwork installed using proper gauges and hangers
Ductwork / plenum connections scaled substantially airtight
Ductwork insulated by means of external covering or internal lining
New/clean -properly sized filter installed (final inspection)
Testing and Balancing report complete (final sign-ofo
I
-~---___�'-_'---- .
----' ET��
3.
1�
, I cf
m
911,
ZI
Q4
rl
BRIGHT
STAR
Heating Supply CO., Inc.
978-815-9452
Duct Leakage Test Form
Customer Information: Test Conditions
Name:
Address:
City:
State/Zip
Phone:
c �,N
4 -1
C211 r? IC &I Ic S- r7
Building Address
Street: '-.T
City/State
\ \,
Date:
Floor area:
Location of
supply duct work:
Location of
return ductwork:
System location:
Total allowable
duct leakage:
2009 International Energy conservation code
t 6 La S-113
1 o r2 S
(-'A 7 k C -
:L C�-�,A
Testing Option Used
Maximum CFM per 100 square ft CM25 Pascals
At rough -in, air handier not installed
4
At rough -in, air handier installed
6
Post construction, leakage to outdoors
8
Post construction, total leakage'
12
Total Leakage Test
Test Pressure: 25 Pa
Test no. Duct Pressure. (Pa)
Flow Ring Installed
Duct Leakage (cfm)
15- S7
C
Results:
Total Leakage: 3 :5- cq w\
Total leakage as %
of floor area:
Tester Signature:
Bright Star Heating
P.O. Box 607
North Reading, Ma. 01864
�nvdce
BILL TO
MPM Mechanical
89 Currier St
Methuen, MA 01844
Please detach top portion and return with your payment.
---c
ACTIVITY
Duct Pressure test
288 Green St.
No. Andover
978-815-9452
b�ahtstarheatina@verizon.net
http://www brightstarheating corn
AMOUNTDUE
$250.00
QUANTITY RATE
1 250.00
INVOICE NO
1004
TERMS
Due on rec,
DATE
10/24/2013
DUE DATE
10/24/2013
ENCLOSED
AMOUNT
250.00
TOTAL 0%
z�250.00
Cust—omer Inform
ation.
Name:
Address:
City:
State/Zip:
Phone:
BRIGIffT
STAR
Heating supply CO.; Inc.
978-815-9452
Duct Leakage Test Form
Test 'donditions
Date: 6 S-- [-3
Floor area: 0 r7
Location of
supply duct work:
Location of In—
return ductwork: 7,k C_
System location:
Street:
-,T Total allowable
City/State duct leakage:
2009 International Energy conservation code
------------
Maxim UM CFM per 100 square ft g25 phscals
At rough -in, air hand— -led 4
At rou h -in, air handier installed 6
Post construction, leakage to outdoors 8
Post construction, total leak— * 12
'Test Pressure: 25 Pa
22-_IDuct Pressure.
Results:
Total Leakage:
Total leakage as %
of floor area:
Tester Signature:
Flow Ring Installed D ct Lea2l
_[�u�
C __� 3 -
3 45
a
10332
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... (Q(
...... ....................... ..................... .............
has permission to perforrn.k�.16-1.x ..... Y3-44. ..............
plumbingin the buildings of., ..........................................................................................
........................................ ...... /North Andover, Mass.
Fee.!�U .... Lic. No. 4f .......... . .... ..................................
'PLUMBING IIISPECTOR
Check
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY MA DATE PERMIT#
JOBSITE ADDRESS 41e OWNER'S NAME
POWNER
ADDRESS TEL ---_—JIFAX
TYPE OR
OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY
NEW: Ell RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NOQr
FIXTURES FLOOR- BSM
1 2 3 4 5 6 7 8 9 10
11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM 1 —3 1 J1 IIE-2-j
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR / AREA DRAIN —J.—A ---i
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY 11 -j-j
ROOF DRAIN
SHOWER STALL ---j __j ---if _J
SERVICE / MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION _____j --j
WATER HEATER ALL TYPES
WATER PIPING
-6THER --------
L.--J
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D BOND 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance cove rage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER [I AGENT E-11
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application Will be in compliancygith all Pertinent provision ofthe
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
O!q
e 0 V
PLUMBER'S NAME Lhinc6r—e --L�� LICENSE # SIGNATURE
Mpg JP[3 CORPORATION FJ # PARTNERSHIP P-1 #�� LLCP&
COMPANY NAME ADDRESS
CITY STATE ZIP SI—A TEL
FAx CELL [17'�- tr-OYI EMAIL
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A% The Commonwealth ofMassachusefts
Department ofIndustrh!lAccidints
Office of Investigations
600 Washington Street
Boston, MA 02111
kvi www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectxiciansIPlumbers
Applicant Information Please Print Legib
Name (Business/Organization/Individual): a C�ey L/C,
Address:
City/Stat ef,!�,s fzv A 03k��_ pho_Ue #: 5=0� /72-(-
ArUou an employer? Check the appropriate box:
F1
Type of project (required):
1B I am a employer with !Z�
L'
4. I am a general contractor and 1
6. E] New construction
employees (fall and/or part-time).*
2. 1 am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet. :
7. E] Remodeling
ship and'have no employees
These sub -contractors have
8. Demolition
working for me in any capacity.
workers' comp. insurance.
9. Building addition
[No workers' comp. insurance
5. n We are a corporation and its
10. Electrical repairs or additions
required.]
3. 1 am a homeowner doing all work
officers have exercised their
right of exemption per MGL
I LpOltirnbing repairs or additions
myself. [No workers' comp.
c. 152, § 1(4), and we have no
12.E] Roofrepairs
insurance required.] t
employees. [No workers'
13.n'Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they aie 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.
lam an employer that isproviding workers'conpensation insuranceformy employees. Below isthepolicy andjoh site
information.
Insurance Company Name:.
Policy # or Self -ins. Lic. 9: Expiration Date:
Job Site
.City/state/Ziv
Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one�year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cero under thepains andpenalties ofperjury that the infonnation provided above is true and correct.
Signature: Date:
Phone#:
Ofjlclal use only. Do not write in this area, to he completed hy city or town official
City or Town:
PermittLicense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "....every person in the service of another under any contract ofhire,.
express or implied, oral or written."
An employeiis defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint 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 As political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability 'Companies (LLQ 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 thi's 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. 'fhe 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.
Pleas ' e 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 now 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 Eke 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 Commonwalth of Massachusetts
Department of Industrial Accidents
Office of lavestigations
600 Washington Street
Boston, MA 02111
Tel # 617-727-4900 oxt 406 or 1-877,7MASSAFE
Fax # 617-727-7749
Revised 5-26-05
_www-massgov1dia
ZL/I A2
Date .... !Jz� ... �Iq .......
I
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that.. h--f--CVej
................................................................................
rm ... Ab ..................... ) ...............
has permission to perfo
plumbing in the buildings of ...... ...... .... JA�� ..........
at .... 2:;�ZQ�2 -e
........................................... ...... .... ........... North Andover, Mass.
.......................................................
FAIJb ..... Lic. No. .. .... ... mj� . .....
PLUMBING INSPECTOR
.Check# 71-
1,4—
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
I
CITY MA DATE 21 PERMIT V
JOBSITE ADDRESS flic OWNER'S NAME
OWNER ADDRESS TELE _JIFAXL_l
TYPE OR
OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
F
PRINT
CLEARLY
'—"I
NEW: RENOVATION: REPLACEMENT: IF PLANSSUBMITTED: YES01 NQ/kj
'SM
FIXTURES -1 FLOOR- BSM 1 2 3 4 5 6
7
8 9
10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOIL/SAND SYSTEM 1, _JI __j
DEDICATED GREASE SYSTEM L: -j
DEDICATED GRAY WATER SYSTEM =1 E_ 7-J _j __j
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN I
FOOD DISPOSER I
FLOOR / AREA DRAIN
INTERCEPTOR (INTERIOR
KITCHEN SINK —I =
LAVATORY
ROOF DRAIN I _A
SHOWER STALL
_j
SERVICE / MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION —J==
WATER HEATER ALL TYPES
WATER PIPING
OTHER
IF
11 1 1
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Ra' NO
AA
T
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
A --
LIABILITY INSURANCE POLICYr OTHER TYPE OF INDEMNITY D1 BOND DA
OWNER'S INSURANCE V aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER 0 AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complianc�wlth all Pertinent provision ofthe
AAassachusefts State Plumbing Code and Chapter 142 of the General Laws.
'f
PLUMBER'S NAME J? LICENSE# / Z(.-- NATURE
—1i [T�=
M ip CORPORATION FJ # PARTNERSHIPD-I# LLC
Pp
COMPANY NAME e'l f,�j ADDRESS ItYL
i A/ t0i I
CITY jISTATE rRV___1j ZIP TEL NJ\ A N
I
FAX CELLI cllla-Sv�177� EMAIL
If
INA
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Mi.
The Commonwealth ofMassachusetts
D7 Department oflndustriqlAccidiiks
Office of Investigations
600 Washington Street
Boston, MA 02111
WWW.MaseigovIdia
Workers' Compensation Insurance Affidavit. iuilders/Contractors/ElectriciansfPlumbers
Applicant Information Please Print Le0b
Name (Business/Organization/Individual) U 6-100e4Z1A,1
p6 j2A(t
Address:
U 17 Z(,
City/State/Zip: Ph,,e
Are you an employer? Check the appropriate box:
1. 1 am a employer with J—
4. El I am a general contractor and I
employees (fall and/or part-time).*
have hired the sub -contractors
2.0 1 am a sole proprietor or partner-
listed on the attached sheet. I
- ship and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. F1 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. E] New con.struction
7. 0 Remodeling
8. E] Demolition
9. El Building addition
10. 0 Electrical repairs or additions
11. MIumbing repairs.or additions
12.F] Roof repairs
13. FJ Other
!Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information.
I Homeowners who submit this affidavit indicating they 6e doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached anadditional sheet showing the name of the sub -contractors and their workers' comp. policy fiformation.
I am an employer that isproviding workers'compensation insuranceformy employees. Below is thepolicy andjoh site
information.
Insurance Company Name;
Policy # or Self -ins. Lie. 9;
Expiration Date:
Job Site Address: C tate/Zip:
r ity/S
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 oner-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 h ereby cert& under th e pains an dpen alties ofperjury th at th e information pro vided above is true and correct.
Signature: Date:
Official use only. Do not write in this area, to he completed by cUy 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 Instrnetions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursua ut to this statute, an employee is defined as "....every person in the service of another under any contract ofhire,
express or implied, oral or written."
An employer'is defined as "an individual, partnership, a8s o'ciation, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint 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 subdivi '. sions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers, compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s,) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ 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 thi's affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. !he 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.
Pleas ' e 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 ffie 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 firture 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 p* ermit 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: i
The Commojawalth of Mossachusetts
Department of Industrial Accidents
Office of hivestigations.
600 Washin&n Strec,�t
Boston, MA 02111
TO, # 617-727-4900 oxt 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
__www-mass,gov1dia
PLUMElERS AND',dAq1u'TTER
LICENSED A8,A.MASTER PLUM
-:`!��'Is§UMTHE ABOVE 'Ll ENSE 1U
A N D R iROBERGEL
Ar --
4 L
0
P BOX '11 2
PLAISTOW 2
.1'1'18 9
05/ 40
Date ..... / Z, .. . ... 7.-..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ................. my4mMottl
........................................................................................................
has pe r . ......... . ..........
mission to perfo . ....................
wmng in the building of .......... M . I . V .. .. L) ................................... .......................
...... . . ... . .... .... . .... ...
at. Z --FO
. .................................................................................................. q., North Andover, Mass.
Lic. No. taw
.. ... ... ........... ..
............ ............ ........ .... .. V, ... k�
�-M C
4 fLEC NSPE
C c
he k # 3017
119-16
!I JZ
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. 1 1 q /, 6
Occupancy and Fee Checked
[Rev- 11071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 QMR 12.00
(PLE,4SE PNNT 1NNK OR TYPE ALL INFORMA TIOA9 Date:
City or Town of: NORTH ANDOVER To the Inspector of Wif es:
By this application the undersigned gives notice of his or her int . to perform the electrical work described below.
Location (Street & Number) ?_F8 6rt_,,_4e_ sr
Owner or Tenant —7-,)A V 'k CA; C.C.4 Telephone No. 'I 13 CICIX)
-t_ k,f
Owner's Address r", 0 U4., 5,�
Is this permit in'conjunction w, ha iii. ingpermit? Yes No F1 (Check Appropriate Box)
Purpose of Building 4 r" f I V — Utility Authorization No.
Existing Service Overhead Undgrd No. of Meters t
_Zoo Amps /?,e IZ'to Volts
New Servic Amps Volts OverheadF] Undgrd n No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
N
a ' Completion ofthe followinQ table mav be waived by the Inspector of Wires.
No. of Recessed Luminaires / _3
No. of Cell.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminalre Outlets 1,6
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above Ei In-
grnd. Lrnd. El
TEmergency Lig
No. o liting
Battery Units
,No. of Receptacle Outlets lk)–
No. of Oil Burners
FIRE ALARMS
I No. of Zo
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
No. of Waste Disposers
Heat Pump
Totals:
I Number
* ................
I Tons
I
IKW
..........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local [:] Municippl E] other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
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
I
Telecommunications Wiring:
No. of Devices or E4uivalent
FOTiiER-
Attach additional detail ifdesired, or as required by the Inspector of Wires -
e -c ical Work: :? (
Estimated Value of El - tr* -)600 (When required by municipal policy.)
Work to Start: jt) / 9 _ Inspections to be requested in accordance with NIEC Rule 10, and upon completion.
INSURANCIf—COVWAGE: 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 operation7 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.
CBECK ONE: INSURANCE F1 BoNDEI OTBEREI (Specify:)
I certify, under th e pains (in dpen alfies ofp erjury, th at th e inforin ation on th ation is true and com
I is apRYc plete,
FIRM NAME:. 11114gy'a2_6 &4 LIC. NO.:X QU
4 'ek
Licensee: A, — Signatu&_/Z_7_W LIC. NO.: f7f YZ 3
(If applicable, enter "e IR ber if
;, Xjnpt" in, the licen Bus. Tel. No.:
Address: _2 2sr 9, L L4A el y.?
Z X A21.1 -K . . . .."tei /t/ Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Dep,, ;Rf 01 "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (che one) D owner E] owner's agent.
Owner/Agent
-Signature Telephone No. ERWTFEE.- $
I P
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 sball.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.
El 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 0
• Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass F?]
Failed IN
Re- Inspection Required El
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass
Failed.M
Re- Inspection Required El
Inspectors Comments:
V,
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass n?
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass fM
Failed IN
Re- Inspection Required El
Inspectors Comments:
Inspectors Signature:
Date:
FINAL INSPECTIQN,;
Pass
Failed
Re- Inspection Required 0
Inspectors Comments:
-/3
Inspectors Signatule:
(T- 'LIA
Date:
V
DEB WEINHOLD ... TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com
I
/7 -
The Commonwealth ofMassachusefis
Department ofIndustrialAccidents
Office Of investigations
600 Washington Street
Boston., MA 02111
www-mass-govldla
Workers' Compensation Insurance Affidavit: Builders/Contractor�/Ele,etriciansfrIumbers
Applicant Information— Please Print Legibly
Name (Business/Organization/Indilvidual):�
r
Address:
City/Stat Phone Z,
A)Krou an employer? Check the appropriate box: .
I am a employer with
4. El I am a general contractor and I
employees (fiffi and/or part-time).*
have hired the sub -contractors
2.0 1 am a sole proprietor or partner-
listed on the attached sheet.
ship and'have no employees
These sub -contractors have
working for mein any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. [1 We are a corporation and its
required.]
officers have exercised their
3.0 1 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.]
Typo of project (required):
6. []New con * straction
7. E] Remodeling
8. E] Demolition
9. n Building addition
1011 Electrical repairs or additions
11. F] Plumbing repairs or additions
12.E] Roofrepairs
13.[i Other
1%ny applicant that checks box4l must also fill out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they ire doing all work and then hire outside contractors must submit anew 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.
lam an employer that 1sproviding workers'com
pensation insurancefor my employees. Below is thepollcy andjoh site
information. /
lusftrance Company
P
olicy # or S elf -ins. Lie. JUe67 U ExpirationDate:
9M City/State/Zip:
Job Site Address:— 1 1 � - - Al. 4np a
t'tach a copy of the workers' compensation -p olley declaration page (showing the policy numb er and expiration date).
affure to'secure coverage as requiredunder Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a
0 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
pf up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
I.rivestigations of the DIA for insurance coverage veriflcation,,_�_
hereby
6'that the information provided above is and correct.
Date:
�;F
Official use only. Do not write in this area, to he 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
ContactPerson: 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 ofhire,
express or implied, oral or written."
An em
wloyeiis defined as "an individual, partnership, association, corporation or other legal entity� or any two or more
of the foregoing engaged in ajoint 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, const�uction 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 licensmg 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 requ.1red."
Additionally, MGL chapter 15�, §25C(7) states "Neither the commonwealth nor any of its political subdivi , sions shall
I
enter into any contract for the performance ofpublic; workuntil 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
nocossary� supply sub-contractor(s) name(s), address(es) and phone number(s) along with their cortificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
mombers.or partners, are not required to carry workers' compensation insurance. IfanLT—CorLLPdooshave
employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confirmationof insurance coverage. Also besureto sign and date . theaffidavit. iho affidavit should
be returned to the, city or town that thic 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'
COMPansationpolicy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate Eno. I -
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.
Ploas.e be sure to fill in the permit/licenso number which will be used as a reference number. In addition, an applicant
that intist submit multiple pormit(license applications in any given year, need onlysubmit ono, afffdavit indicating current
policy information (ifnecessaty) and under "Job Site Address"' the applicant should write ,all locations in (citV or
town)." A copy of the affidavit that has been offf cially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit ii on file for firture 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 aild fax number:
Tho Commonmalth of massach-Use"tts
Dopaftent of Iadustrial Accidenta
Office of westigations
600 wasbington stroa
BostQnMA012111
Teel, 0 617-727-4900 Q:Kt 406 or- 1-877�,MASSAFE
Revised 5-26-05 Fax# 617-727-7749
Division of Professional Licensure: License Search
The Official Wb.ite of the Office of Consumer Affairs and Business Regulation (OCABR)
Division of Professional Licensure
Mass.Gov
Mass.GovHome StateAgencies A-ZTopics
Home Division of Professional Licensure
.............. ............... ................................................................ .......... .................... ..................... ........... ..................... ...................................... ...............
Check A Professional License
By the Division of Professional Licensure
Licensing Board: ELECTRICIANS
License Type: MASTER ELECTRICIAN
TYPE CLASS: A
License Number: 18012
V. Status: CURRENT
Expiration Date: 7/31/2016
Issue Date: 5/7/2001
Exam Date: 5/4/2001
School: PETERSON SCHOOL
This web site disptays 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 Monday, February 10, 2014 at 3:23:24 PM.
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http://license.reg.state.ma.us/public/pubLicenseQ.asp?board—code=EL&type—class=—A&li... 2/10/2014
3471
0
Date.1
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
has permission to perform ....... ...... �A .. AR. ........................
wiring in the building of ..... ... I ... C( ..................................................
at ............. ....... . ........ 9. .................... . North Andover Mas,,r,
U, j
Fee ... Lic.No./.-A..)..9( ........... ... . .......
LECrRICAL INSPECrOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
, J
official Use Only
Commonwealth of Massachusetts
- ------- 71
Permit NO.
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS
pay, 111991 (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be patfictmed in accordance with the Masuchusem E3ectrical Code (Nmp� 5;7 CMR 12.00
(PLZ4SE PREYT EV EYW OR TYPE ALL EYTORW770N) D a t e: /// 31p, ot, I
City or Town of: I lVvv-7'� 414�v yf-/ -7 ;p_7e6tor of Wires:
To the n7
By this application the undersigned grves notice of his or her urtention to perform tL- electrical work described below.
Location (Street & N -umber) 29.f 6-,�Z&l
4
0i
OwnerorTenant arStj
Owner'sAddress . etyl,,e_
Telephone No. 4 fil
is this permit in conjunction a building permit? Yes El No (Check Appropriate Box)
Purpose of Building L!� �711V Utility Authorization No.
Existing Service Amps volts Overhead Undgrd No. of Meters
New Service Amos volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
Location. and Nature of Proposed Electrical Work:
e)"
Comnletion ofthe folInwino, tahle mav he waived bv the Imnertor of Wires�
No. of Recessed Fixtures
No. . of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Gener-atom KVA
No. of Lighting Fixtures
swimming Pool Above In- 0
2md. 0 emd.
M. ot Linergency Ligliting
Batten, Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
170-57 Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Beat Pump
Totals:
Number
I.
Tons
I
l(W
I
No.. 7oSelf-Contained
Detection/Alertin% Devices
No. of Dishwashers
Space/Area Heating XW
Local E] Municipal
Connection El Other
140. 01 Uryen
--r. fLW
No: of - Device - s or Equivalent
No. of Water XW
Heaters
No. of No. of
Signs Ballasts
Data Winn
NO. of j� ices or Equivalent
1.0u. "Juromas.3aga
14U. IJA IfLUCUiS A Uiai ap
Telecnrnmunications Wiring:
No. of Devices or Equivilent
IOTHER:
Attach additional derail ifdesired. or as required by the Inspector OfWi—
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 substaritial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE KI -BOND [I OTHER 0 (Specify:)
Estimated Value of . Electrical Wor1c - (When required by municipal policy.) (F-xpiration Date)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I cerdfy, under th e pains and penalties ofperjury, that th e information on this app n is true and complete.
FIRM.NAME: American Alarm & Comimmications, Inje? LIC. NO.: 1212C
Licensee: Richard L. Samt)son Signature K" LIC. NO.:
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.- 781-641-2000
Address: 7 Central Street, Arliugton, HA 02476 Alt Tel. No.: -
OWNER'S INSURANCE.WAJIVER: 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) M owner C3 owner's agent
Owner/Agent
Signature Telephone No. PERVHT FEE: $
'Location
,�No. Date 941/
kORTh TOWN OF NORTH ANDOVER
0 Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee , $
ooPther Permit Fee
Sewer Connection Fee $
tZ Water Connection Fee $
$
je�T A L
Pal (e4w
Building Inspector
Div. Public Works
PERA "I N,
4
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
I
,/PAGE I
MAP 440.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK 'PAGE
ZONE
SUB DIV. LOT NO.
SEPTIC PERMIT NO.
4 APPROVED BY
LOCATION
cn–zav— 05-�-
PURPOSE
OWNER'S NAME
r,kA^4!::fl
BOARD OF HEALTH
PLANNING BOARD
NO. OF Sl
OWNER'S ADDRE"
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAAST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES SIDES
REAR
GIRDERS
AREA OF LOT
FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
.IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE t000l
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
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 3
PAGE 2 FILL OUT SECTIONS I t2
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
if
ENT
F E E leol 4TI-S &'tl
PERMIT GRANTE
19
SEP � 2
VoC- r, E R� F�' t v t
;,3s'-,, G 7 ---N ` k
OWNER TN If
CONTR.. TEL. # — fAl 0—
CONTR. LIC- #
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
.BUILDI-NG RECORD
I OCCUPANCY 1'2
�.INGLE FAMILY S-ORIES
S THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
_r0F`FICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS.'WITH PORCHES. GA -
APARTMENTS RAGES. ETC. SUPERIMPOSED�THIS REPLACES PLOT PLAN.
MULTI. FAMILY
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
CONCRETE
a
1
2
13
CONCRETE BL K.
INE
BRICK OR STONE
HARDW D
—i
PIERS
PLASTER
FRY WALL
UNFIN.
3 BASEMENT
AREA FULL
V, 1/2 1/1
FIN� B M T AREA
FIN. ATTIC REA
NO B M*T
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
CONCRETE
EAPTH
HARD\!,/'D
COMMCN
ASPH. TILE
B
1
2 3
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING_
ASBESTOS SIDING
VERT. SIDING
STUCCO ON MASONRY
STUCCO ON FRAME, %
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. & FLOOR
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
Po
00
SUPERIOR OR
ADEILIATE _j -NO "N!E
5 ROOF
10 PLUMBING
GABLE
I HIP
BATH (3 FIX.)
GGAMBRE]L
-FOANSARD
I
TOILET RM. (2 FIX.)
FLAT
FLAT
SHED
R CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
L)tKrJ FIXTURES
TILE FLOOR
TILE DADO
6 F MING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER EMS. & COLS.
STEAM
—
STEEL BMS. & COLS.
HOT W T'R OR VAPER
WOOD RAFTERS
AIR CONDITIONING
—
�A—DIANT H T G
UNIT HEATERS
7 NO. OF ROOMS
I AS
Oil
B'M'T
lst I 3rd
ELECTRIC
11 NO HEATING
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OFFICF-S OF:. Town of
APPEALS
NORTH ANDOVER
BUILDING
CONSE I IVA-1-ION DIVISION OF
HEALI'H
PLANNING PLANNING & COMMUNITY DEVELOPMENT
KAREN FI.P. NELSON, DIIIEC-1-011
12() Main Street
North Alidover.
Mi1S-';;1Cht1SCt1S 0 1845
(6 17) 68f-)-4775
In accordance with the PfOvisi0n.s of MGL c 40, S 54, a condition of Building Permit
Number . 43-c;, is that the dcbris resulting from this work shall be
disposed of in a properly liccased solid waste disposal facility as defined by MGL c ill, S
150A.
T'he debris will be disposed of in:
(Location of Facility)
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.