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%roperty Record Card
Parcel ID:210/060.A-0026-0000.0 FY:2013 Community: North Andover
Location: 30 HEATH ROAD
Owner Name: ARNDT, WALDEMAR
ULBIN, JACQUELINE
Owner Address: 30 HEATH ROAD
City: NORTH ANDOVER State: MA
Zip: 01845
Neighborhood: 7 - 7 Land Area:
0.70 acres
',Use Code: 101-SNGL-FAM-RES Total Finished Area:
2044 sqft
ASSESSMENTS CURRENTYEAR PREVIOUS YEAR
Total Value: 435,800 412,000
Building Value: 210,600 191,100
Land Value: 225,200 220,900
FMark—etLand Value: 225,200
IChapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkld=2254017&town=NandoverPubAcc 10/7/2013
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0312 Date..J,
.............................
0 q�
TOWN OF NORTH ANDOVER
0
4L PERMIT FOR WIRING
SAcHU
This certifies that ..... ........ lz--IA .......... 11.1 ........
h a' xform ...
s permission to pe ........ ............
wiring in the building of .......... /
... ... ... ...................................... ..............
....... ee y .............. North And/over
........ �'Masg
Fee..,T� ............ Lic. No7�!�V�4 .......
. . .... . �I�AL NSP
AEL71 R
Check #
04
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev- 11 /991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (ME9, 527 CIAR 12.00
(PLEA SE PRflVT INflVK OR TYPE ALL LUORMA TION) Date: Q / 9-a / / )
City or Town of- 0 A " ,- To the—Inspkjor of W�ir—es:
By this application the undersigned�Aives notice of 'his- or her intention to perform the electrical work described below.
Location (Street & Number) U
Owner or Tenant rA, a�lr
Owner's Address �-z -Pei
Telephone No.
Is this permit *in conju tion with a building permit? Yes No (Check Appropriate Box)
Purpose of Building A- Utility Authorization No.
Existing Service Amps Volts Overhead Undgrd No. of Meters
New Service Amps Volts Overhead UndgrdF� No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work -
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above o In-
Swimming Pool grud. grnd.
No. of Emergency Lighting
Bafte!y Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS I
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pu p
Totals:
NpM��rj
Tons
[ .................
KW
..............
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local o Municip�l (I Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance, including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such c7ove ge is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURAI BONDE] OTHER [] (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start:
I cerfify, under the
FIRM
Licensee: TCt.
(If applicable, enter
Address: Ll I
OWNER'S INS
required by law.
Owner/Agent
Signature
Inspections to be requested in accordance with MEC Rule 10, and upon completion.
andpenalties ofperjury, that the information on this application is true and conrlete.
:�� (-- I -t L A' % C-- /-) � - / a LIC. NO.: 5?4 T Jo k
IC4- k— Signature /Ze y LIC. NO.: ZVO �? 3 r -
"exempt" in the license number$e I Bus. Tel. No.: 6.6!� �23Y4
VZ".i , CA -C -Vv -"L :2N,�Z, �. a, N Aft.Tel.No.: "-�U? �011�r
JRANCE WA4VER: I am at the Licensee does not have the liability insurance coverige normally
By my signature below, I hereby waive this requirement. I am the (check one)E] owner 1:1 owner's agent.
Telephone No. PERMIT FEE. $
jo -lt�, . -� -� /-��
t
a
The Commonwealth ofMassachusells
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, AM 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): 0-i )h t1r V
i v\ Vcv S4,
Address:_"i
\J Jw 0
City/State/Zip:_ CL o x4 2 Aljq: 03%Ahie #:
Are you an employer? Check the appropriate box:
1. F1 I am a employer with 4. n I am a general contractor and I
wl$loyees (full and/or part-time).*
2. Zlel am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. E] I am a homeowner doing all work
myself [No workers' comp.
insurance required.] t
have hired the sub -contractors
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance.:
5. R We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. E] New construction
7. Remodeling
8. Demolition
9. Building addition
10.E] Electrical repairs or additions
I Ln Plumbing repairs or additions
12.n Roof repairs
13.n Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that isproviding workers' compensation insurancefor my employees. Below is thepolicy andjob site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:
Job Site Address:
Expiration Date:
City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
.fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
do hereby
ofperjury that the information provided aboke is t#ie and correct.
Phone #: I /J 03 (t 0--F f
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
NO
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
CHU
This certifies that . ... .. ....... .........
has permission to perform
plumbing in the buildings of 4�z/�/y
a t ........... North Andover, Mass.
. ............. ................
Lic. No..
Check # PLUMBING INSPECTOR
5,/,77
(Print or Type) Check one: Certificate
Installing- Company Name J4 OF'r-IYA01- -4 1C Corp.
Address 5-'� HOPit-YP X r'9 19 Partner.�-'(
P (U VC or (Z 1,14 "�S- E-] Firm/Co.
Business Telephone Y
Name of Licensed Plumber:, -Te- 5
A Insurance Cove Indicate the type- of insurance coverage by checking the
appropriate box:
Liability insurance policy F-71 Other type of indemnity 0 Bond
1A
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/�gent -of property Owner [D Agent J --J
. I hereby certify [fiat all of die details and information I k2ve subinittcd (or en(cgcd) in above application are liuc and accurate to Ute best of Iny
knowicdge and that all plumbing work and installations pctfornied under I'crittit i -sued for this application wiU be in coniptizincc with all peftinent pro-
visions of the Massachusetts State Plumbing Code and Cluptcr 142 of the Gcnciat Laws-
J�Ly
Title .
Cilty/Town:
APPROVED USE ONLY)
am
Signature of Licensed Plumber
Type of Plumbing License
License Number Ur Master 0 -journeyman
MASSACHUSETTS UNIFORM -APPLICATION'-IFOR,PERMIT.,-TO:"DO:
PLUMBING:,;.
(Type or Print)
NORTH ANDOV ER%
Mass.
Date.
Building Location*3 'p,
/;7.4 r:11 14 a
Permit
49
Owners
Name )kpL 0 It . FI -1 q/z .
WR4) 077
New Renovation
Replacement
Plant Submitted Ei
FIXTURES
(Print or Type) Check one: Certificate
Installing- Company Name J4 OF'r-IYA01- -4 1C Corp.
Address 5-'� HOPit-YP X r'9 19 Partner.�-'(
P (U VC or (Z 1,14 "�S- E-] Firm/Co.
Business Telephone Y
Name of Licensed Plumber:, -Te- 5
A Insurance Cove Indicate the type- of insurance coverage by checking the
appropriate box:
Liability insurance policy F-71 Other type of indemnity 0 Bond
1A
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/�gent -of property Owner [D Agent J --J
. I hereby certify [fiat all of die details and information I k2ve subinittcd (or en(cgcd) in above application are liuc and accurate to Ute best of Iny
knowicdge and that all plumbing work and installations pctfornied under I'crittit i -sued for this application wiU be in coniptizincc with all peftinent pro-
visions of the Massachusetts State Plumbing Code and Cluptcr 142 of the Gcnciat Laws-
J�Ly
Title .
Cilty/Town:
APPROVED USE ONLY)
am
Signature of Licensed Plumber
Type of Plumbing License
License Number Ur Master 0 -journeyman
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BASEMENT
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4TH FLOOR
STH FLOOR
6TH FLOOR
7TR FLOOR
8TR FLOOR
(Print or Type) Check one: Certificate
Installing- Company Name J4 OF'r-IYA01- -4 1C Corp.
Address 5-'� HOPit-YP X r'9 19 Partner.�-'(
P (U VC or (Z 1,14 "�S- E-] Firm/Co.
Business Telephone Y
Name of Licensed Plumber:, -Te- 5
A Insurance Cove Indicate the type- of insurance coverage by checking the
appropriate box:
Liability insurance policy F-71 Other type of indemnity 0 Bond
1A
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/�gent -of property Owner [D Agent J --J
. I hereby certify [fiat all of die details and information I k2ve subinittcd (or en(cgcd) in above application are liuc and accurate to Ute best of Iny
knowicdge and that all plumbing work and installations pctfornied under I'crittit i -sued for this application wiU be in coniptizincc with all peftinent pro-
visions of the Massachusetts State Plumbing Code and Cluptcr 142 of the Gcnciat Laws-
J�Ly
Title .
Cilty/Town:
APPROVED USE ONLY)
am
Signature of Licensed Plumber
Type of Plumbing License
License Number Ur Master 0 -journeyman
1%
This certifies that . —
has permission for
Date. .�IRO� .......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
... ... .........
..........
in the buildings of ......
at ... J� ...... North Andover, Mass.
.1 - IV. * , *h * , , * *
Fee.A. Lic. No -k Y .. ........... ..............
Check # GASINSPECTOR
4709
ELUMAI
MASSACHUSETTS UNIFORM APPLICATION FOR' PERMIT TO DO GASFITTI
(Print or Type) NG
06 PIV(26V'�,-e 'Mass.
Date? 20 0 Permit #
Building Location
owners Name
Tvve Of dicupancy 64' Ci-
Newo Renovation 0 (
Replacemen Plans Submitted: Yes Noo
Installing CCmP2nyName 9C19r1-141WJ-
Address. ��"? P- - /? v
1910 0.!� �V/— P, 19y -r
Business Telephone q'7-5- Y.,2k- -7VA��e
Name of Licensed Plumber orCaS Fitter J—"541"7P t,,.
Check one: Certificate,
o Corporation
/Partnership
0 Firm/Co.
INSURANCE COVERAGE�
I have a current liability Insurance Policy or its substantial equivalent which meets the requirements Of MCL Ch. 142.
Yes No
�f YOU have checked yes, please Indicate th e type of coverag e by checking the appropriate box.
A liability Insurance policy 'Er Other type of indemnIty 0 Bond 0
OWNER'S INSURNACE WAJVER: I am aware that the licensee do es not have the Insurance coverage required by Chapter
142 of the Mass. General Laws, and that my signature on is Permit application Walves this requirement
SignaEure Or 0 wner or.0wnSrs Agent
Check one:
Owner [] Agent 0
I hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of
my knovAedgS and that all Plumbing work and Installations performed under the permit Issued for this application YAII be In compliance with
all pertinent Provisions of the Massachusetts State Cas Code and Chapter 142 of the General Laws.
By Type of License:
;itic KPIumber 51grit(ture of LlCensed P umber or C2s Fitter
City/Town D C as fitter el 3 S—
,�(M as te r License Number—
APPROVED (OFFICE USE ONLY) 0 Joumeyman
MM
MM
M
M
MM
M
M
MM
MM
M
M
MM
VniN1191411
MMMMMMM�mm
M
Installing CCmP2nyName 9C19r1-141WJ-
Address. ��"? P- - /? v
1910 0.!� �V/— P, 19y -r
Business Telephone q'7-5- Y.,2k- -7VA��e
Name of Licensed Plumber orCaS Fitter J—"541"7P t,,.
Check one: Certificate,
o Corporation
/Partnership
0 Firm/Co.
INSURANCE COVERAGE�
I have a current liability Insurance Policy or its substantial equivalent which meets the requirements Of MCL Ch. 142.
Yes No
�f YOU have checked yes, please Indicate th e type of coverag e by checking the appropriate box.
A liability Insurance policy 'Er Other type of indemnIty 0 Bond 0
OWNER'S INSURNACE WAJVER: I am aware that the licensee do es not have the Insurance coverage required by Chapter
142 of the Mass. General Laws, and that my signature on is Permit application Walves this requirement
SignaEure Or 0 wner or.0wnSrs Agent
Check one:
Owner [] Agent 0
I hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of
my knovAedgS and that all Plumbing work and Installations performed under the permit Issued for this application YAII be In compliance with
all pertinent Provisions of the Massachusetts State Cas Code and Chapter 142 of the General Laws.
By Type of License:
;itic KPIumber 51grit(ture of LlCensed P umber or C2s Fitter
City/Town D C as fitter el 3 S—
,�(M as te r License Number—
APPROVED (OFFICE USE ONLY) 0 Joumeyman
No 4749 Date. 7 - -. -. .". .
T
14
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SACHUS
, /�'/ k - -
This certifies that ... 5�. "!� �? . '� !. �' . 'I ...........................
has permission to perform .... .......................
plumbing in the buildings of ............................
at. .................. , North Andover, Mass.
-c
Fee. Lic. No..'�� ......... ...........
PLUMBING INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
21
n��
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
I[)*; # I
Mass. Date ld;�;Wl Permit #
Building Location., --5") W,-,4 Owner's Namel-6 141111lem'.1j"r jrll�
Type of Occupanc
New Renovation 0 Replacemen 2' Plans Submitted: Yes No F1
FIXTURE-.�,���
IN
MONEMEMEMEMEMMIMMEMM MEMNON
EMEEMEMMEMMEMEEMEME MONIMEN
WW- M-- MNEMMnMMMOMMMMMMMMMM NEESE
MOM
Oslo
Installing Company Name 1'�OilEe,-r 0 - -SP (r M A T A e -0 Check one: Certificate
Address C0�40-�M4&) Pi Corporation
/r E T�4 0 f�l t4 E] Partnership
Business Telephone r1q 7 2-�—irm-/Co.
Name of Ucensed Plumber
INSURANCE COVERAGE:
I have a current jAbility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 3' No 0 1
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity 0 Bond El
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner [I Agent C3
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and in=n�.�ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts Sta ode and Cbapte�r7 of the eral Laws.
BY
re of Licen Plumber
Title
Type of License: Master Journeyman C]
City/Town
A P P R CIV E D— TOT Fl CC U-9 E —0 N—Lff License Nu�ber q-;3 1-77/=1
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