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HomeMy WebLinkAboutMiscellaneous - 32 FURBER AVENUE 4/30/2018 32 FURBER AVENUE 210/067.0-0021-0000.0 r� 4 .1 North Andover Board c,f Assessors Public Access Page 1 of 1 Orth Andover Board of Assessors fq MEN Y 6 l,.�roperty Record Card Click Sem To Rcmn Parcel ID :210/067.0-0021-0000.0 FY:2014 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels "` 4 . Search for Sales , ill x Summary Residence Detached Structure Condo 32 FURBERAWEE 9 1 Commercial Location: 32 FURBER AVENUE Owner Name: LONG,KATHLEEN E. Owner Address: 32 FURBER AVENUE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:5-5 Land Area: 0.20 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1348 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 283,900 284,500 Building Value: 1.27,200 127,800 Land Value: 156,700 156,700 Market Land Value: 1.56,700 Chapter Land Value: LATEST SALE Sale Price: 290,000 Sale Date: 04/27/2005 Arms Length Sale Code: A-NO-FAMILY Grantor: GROBER,MAUREEN Cert Doc: Book: 9481 Page: 195 http://csc-ma.us/PROPAPP/display.do?linkld=2436654&amp;town=NandoverPubAcc 5/14/2014 Residential Property Record Card PARCEL ID:210/067.0-0021-0000.0 MAP:067.0 BLOCK:0021 LOT:0000.0 PARCEL ADDRESS:32 FURBER AVENUE FY:2014 PARCEL INFORMATION Use-Code: 101 Sale Price: 290,000 Book:-- 9481 Road Type: T Inspect Date: 06/15/2006 Tax Class: T Sale Date: 04/27/05 Page: 195 Rd Condition: P Meas Date: 06/15/2006_ Owner: Tot Fin Area." 1348 Sale'Type: P Cert/Doc. Traffic M Entrance: X LONG, KATHLEEN E. - Tot Land Area: 0.20 Sale Valid: A - Water Collect Id RB - Address: - 32 FURBER AVENUE _.,_ Grantor: "'GROBER, MAUREEN + " - _. Sewer. - -"Inspecf Reas: S» NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/° Indust-B/L% / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION Style: CO Tot Rooms: 7 Main Fn Area: 724 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R4 Story 9 p - Se T .rva Code -,Method" Sw Ft. _ .fu . . Sto Height: 2.00 Bedrooms 3 � U Fn Area: 624 ��NBsmt Area: 592 9 YP, __ q- _ Acres Influ-Y/N 'Value ""��Class f��� �� . "_ i r Roof: G n� Full Baths. 1 Add'Fn Area. - µFnRBsm4 Area: 1 F' 101 S p 8548 0.200 156,650 Ext Wall __._.WS Half Baths: Unfin Area: Bsmt Grade: DETACHED STRUCTURE INFORMATION -3 - . _ . ason Trim:.,_ Ext Bath Fix: 0 Tot'Fin Area 1348 ._. , _ _ F. _,. rY ._ _ .u_,.. - Str Unit Msr-1 Msr-2 E-YR-BIt Grade Cond%Good P/F/E/R Cosh n Class Foundation ST Bath Qual: T � _ RCNLD: � 123018 _ - SE S 72 0.00 1990r v n a - _.,. --- _ ..r ._..._ �< PA' w.S 452 0.00 1988 F F. ,w ../58443'.__. 3,200. 1 Kitcn Qual T Eff Yr Built: 1970-" "'1Vlkt Heat Type: HW Ext Kitch: Year Built: 1940 Sound Value: 1,000 Fuel Type G­__71 Grade A —Cost Bldg 123,000 VALUATION INFORMATION Fireplace 0 mBsmt Gar Cap. Condition: A - Aft Str Val 1: Current Total: 283,900 Bldg: 127,200 Land: 156,700 MktLnd: 156,700 Central AC: N Bsmt Gar SF: Pct Com Tete. Att Str Val2 Prior Total: 284,500 Bldg: 127,800 Land: 156,700 MktLnd: 156,700 Aft Gar SF: /°Good P/F/E/R /100/100/75 Porch Type Porch Area Porch Grade Factor E 308 W 264 SKETCH PHOTO I d 506 S ,F , ` Y R2 264$ p� FM 11132 Sq,F- % 12 l 4 2SF1 X02 Sq,Ft q� PIFii Ai/ IV Parcel ID:210/067.0-0021-0000.0 as of 5/14/14 Page 1 of 1 Date V-1m.4........ 10653 a? ".0pT",�tiaoL TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING w 88ACHu This certifies that SMG1'^ : ...........:........................................................................................................... has permission to perform.... .��.-.... ............................................... .. . .......................................... plumbing in the buildings of...`-- ?, � at_... '��2.�t-1�� ...... :t................................. North Andover, Mass. Fee...� .Lic. No. ` a ?'?... PLUMBING INSPECTOR Check# °�' , „� ,� IiU'IVVAVttVVL Iv VI71t WIWI At ! L.tVT1t 1Vt•I W1%0%1 121%I9111 1v 1 1-1%1 VI%M t LVlnu/tw VW%01%1% CITY NORTH ANDOVER MA DATE 7-21 1,� PERMIT# ' 6.� JOBSITE ADDRESS 32 FUR 43 4 IZ /41/C OWNER'S NAMEA�r,'YZCeti Z0-"-6 TMOWNER ADDRESS SAME TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL:--,', EDUCATIONAL ' RESIDENTIAL PRINT - CLEARLY NEW:'.. _ RENOVATION:'. }' REPLACEMENT: ✓ PLANS SUBMITTED: YES. NO 1l- FIXTURES Z 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET ,URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING OTHER INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ,0,. NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY .® OTHER TYPE OF INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER �:. AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information 1 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 THOMAS HALLORAN LICENSE# 24833 SIGNATURE MP' _ JP'✓ CORPORATION_y _# PARTNERSHIP: # LLC # COMPANY NAME T.HALLORAN PLUMBING ADDRESS 826 DALE ST CITY NORTH ANDOVER STATE MA ZIP 01845 TEL 978-685-9504 FAX 978-208-0840 CELL EMAIL tomhalioran@comcast.net +� � A 'Y i l i• f QN MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTH ANDOVER MA DATE ;?—,2/-/Y PERMIT# OH JOBSITE ADDRESS ,.,a2 F"URG CfZ 41JC OWNER'S NAME/r-,-7-/1,1eeN ZO/VG IIX OWNER ADDRESS SAME TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIALZ PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESO NOZ APPLIANCES-1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT , Date . $.. .� .................... 40Rrh TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ants of MGL.Ch.142 YES ✓ NO * ' BOX BELOW s`QACHug� BOND tNh G-S -'�- ........... age required by Chapter 142 of the Thiscertifies that ......................................................................... ...................:......... ment. has permission for gas installation �...:��.. ....—..... •............................ ii K ONE ONLY: OWNER AGENT in the buildings of................4t . .. . . R _ , .....................North Andover,Mass. re true and accurate to the best of my knowledge at..,,,,� ....... •• compliance with all Pertinentp vision of the Fee.. -Q......... Lic. Noy-°- $ M ''................................................... i GAS INSPecTOR SIGNATURE Check# t5 RSHIP # LLC[J# 9424 TEL 978-685-9504 FAX 978-208-0840 CELL 978-685-9504 EMAIL tomhalloran@cDmcast.net �. _� `"� r� �� �1 F \\�,Z� The Commonwealth of Massachusetts Department of Industrial.Accidents 4f f ce of Investigations 1 600 Washington Street Boston,AM 02111 4 www.mass govt a Workers' Conipen' sation Insurance Affidavit: ]Builders/ContractorsXlectriefans/Plunmbers Applicant Information Please Print Legibly Name.(Business/Organizadon/Individual): 7*_ Vf .4 -Address: 0!y V.;— City/State/Zip: . } OMMONW 60 M1 j P�.uMBER ASFITTERS ISSUES TNS ..fOLLOWkNE* SE JOURNEY N �( U TH0MAS :14 HALLORA�€ 6 DALE DOVER P�lA 01845 1,422 < TFk,.AN 0101/16 223446 ; 24 r h 10020 Date`. . O�l TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING .. / A.,� . . This certifies that . . . . . . . . . . .� . . . . .,.. :}�:,� ` . , , , . , has permission to perform . . : 1 S:" � " 'XA �.ti,-tatitJ I. . plumb' gin the build'ngs of. b.�. . . . . . . . . . . . . . . . . . . . at . 5z "c 2 e ' North Andover, Mass. Fee . . . . . . . . . Lic. No. . . . . . . . . . . . PLUMBING INSPECTOR 32 Check# < MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE ! ----i PERMIT# hit JOBSITE ADDRESS L3 a � b n ve it OWNER'S NAME OWNER ADDRESS TEL -- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL EJ PRINT CLEARLY NEW: Q RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES NO© FIXTURES'l FLOOR- BSM 1 2 3 ---4—F5 6 7 8 9 10 11 12 13 14 BATHTUB ! _ k J k k ( _ _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM �J DISHWASHER _.._._.J ` ! DRINKING FOUNTAIN FOOD DISPOSER I ..___--__l _..-.___J .-- f I I _.___...i FLOOR/AREA DRAIN 9 ,_.__._1 .._..._ -_._ I ._.__1 I _.1 1 _ kJ .__...._.) _....._..( ....____1 I INTERCEPTOR(INTERIOR) _-----_I KITCHEN SINK '..._J LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK ([77-1 TOILET 11_____._I ----i __ _J _._. J --_ _. I I .._._.....__.1 � .--__...J _..__. _.._..__J _.-___J _....____ UR;�JAL �( J .._...._.-.J ._..........._I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING _ -_( ( _._.J I .' OTHER _i _.-_._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 Cf LIABILITY INSURANCE POLICY i OTHER TYPE OF INDEMNITY P J, BOND �I OWNER'S INSURANCE WAIVER:I am 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 [ik 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 com fiance with all Pertinent provision of the h4assachusetts State Plumbing Code and Chapter 142 of the General Laws. :3?dnyAft � PLUMBER'S NAME 01a �n � g LICENSE# —3� o _. G SI TURE MP .k JP xI CORPORATION n# PARTNERSHIPD# LLC EkN COMPANY NAME ,rayt .&14G n14*\ n41 ADDRESS l6 _ fLdl_ CITY E_y vim, STATE tMa4 ZIP _e�t '1�_ _ II TEL 104, EMAIL FAX CELL L� i 1f , ROUGH PLUMBING INSPECTION NOTES 113ELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES f f r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please (Print Legibly Name(Business/Organization/Individual): &V\'61'\ iLA06r\`(aV\ '�t,yhb^�c l 'l�t'r11 Address: 1y City/State/Zip: Sb c_\ �M J,. o tfil f Phone#: q 7g_1?4.qqS Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.Nr I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling \ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g,, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.[i 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 aire doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. -Policy#"or Self-ins:Lit:#: --Expiration Date:- - Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certtfy under the pains and penalties of perjury that the information provided above is true and correct. c Si azure: Date: G`1'3 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Informati®n 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 employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is co_mplete and printed legibly._The Department has provided a space at the bottom of the affidavit for you to fll out in the evenf the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth,of Massachusetts Department of l dustriaX Accidents Office o£Investigatlons 604 Washington Street Boston,MA.02111 TO.#617-7274900 ext 406 or 1-877,7MASSAFE Revised 5-26-05 Fax#617-727-7749 www.Mass,govldia f. COMMONWEALTH OF MASSACHUSETTS .. PLUMAJ ERS AND GASFITTERS L,I.'CENSEa ASA JOURNEYMAN PLUMBS . UES THE ABOVE'LICENSE TOc BA-4 AN `.W... M'AGNAN 10 WORDEN RD TYNGS.BUR0 MA 01879 202'6 27Z 05/01/14 176"615 , Date...� v ............ OF 00RI, TOWN OF NORTH ANDOVER PERMIT FOR WIRING IM4%j This certifies that ........... ...C.0.......6............40......................... ... has permission to perform .................... ...... ................ wiring in the building of........ ...t . ................................................................. �,r........-52 North Andover, ss. ...........................p.................................................................... ... ....... ...... Fee-:.. ..........Lic.No. ............ MD........ I* CAL' "!;E Check# L4 1-5 116,91 vo, (,Pj Q j Commonwealth health of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked i0^M BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: C ^/ City or Town of: NORTH ANDOVER To the Inspector of Wires: B this application the undersigned gives notice of his or her intention to perform the electrical work described below. Y pP g Location(Street&Number) 3 A wr 6,,, Owner or Tenant rr46-e- Haile-✓ Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes o (Check Appropriate Box) Purpose of Building AL i¢(Ac^ Utility Authorization No. - Existing Service Amps //-o / tgo Volts Overhead❑---'ffndgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cel Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin2 Devices No.of Ranges No.of Air Cond. TonTots No .of Alerting Devices Disposers Heat Pump Number Tons . KW No.of Self-Contained No. of Waste Dis p f Totals: Detection/Alerting Devices No.of Dishwashers I S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection No.of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: ± Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or E uivalent OTHER: .:7 r1 ST 4 il. Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: J /Ca W (When required by municipal policy.) Work to Start: 6,d b-,/j Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance includi "completed operation"coverage or its substantial equivaleni. The undersigned certifies that such coverage force,and has exhibited proof of same to the permit,issuing office. CBECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,sander the pains and penalties of perjury,that the information on this application is true and complete. FIRMNAME: Cf1`�CGh tt�—r�`� LIC.NO.: �O 44 Licensee: u/w R A L� Signature la LIC.NO.: (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.•, `l?&7 81 Address: c31. k h M t4ao U t2 a C-Ae t o s-4 ,,•d M,+ 018.),/ Alt.Tel.No.: *Per M.G.L c. 147,s.57-6,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(check one)[]owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. 1- Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants _ Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current t policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or .a 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. 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 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 Massa ft—tts Department oflndustrial Accidents Office of Investigations 6.00 WasWngton StreEt Boston,M.A.02111 Tel,#617-727-4900 oxt 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 www.mass,govfdia 1 ` REGISTER ED M STEP E� � RfCl,q F ISSUES TH q pvE jCENS -to:. N JOSEPH1 -At TiTo Y t� ADOW Ra CHEZ M:SFOR°p"� * r `- M<a �' 0182., q 720.42.6. q a G,..:• , 20.49 1= 840 r. • • 1 x,13 • s• a • e. t Fry r 6 Date./ ��! .�. . .. .. NORTIy o? TOWN OF NORTH ANDOVER ti p . � • PERMIT FOR GAS INSTAI'�LATION _S / SACHU This certifies that . . .All.>I-. .S a'" �/�`._ . . .(.�-f- "� . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . in the buildings of . �?.C/. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . U.R. . Y.1.1. . .A v�. . . North Andover, Mass. Fee. .3�. Lic. No..:3:?Y. . . . . . . . . . .. . . . GAS INSPECTOR Check# 6154 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) WORUH AMDOV(St . Mass. Date 0112-hi� Permit # .. Building Location32 FUK112. AUG Owner's Name kA7kfflJ LOM& •�� _ 00 kTH �N-0 6R-_ A Type of Occupancy USI DC-krl A L New ❑ Renovation ❑ Replacements Plans Submitted: Yes[] No p N N � Y W � dl N V X s OC F- Oc a N = O F- w w a 0 0 m FN- _ c� X O W ~ a 0 0 0 �' w 0 .4 z H a: m w d '° W F.0 N a c a < N a N C7 O W x O W a a O. O W W W N W z Q = M a s Cc W ~ W _0 -j H a X 4 W J < ~ E yW vl m X 0 Z WO x aac o 0 1 a �'3 c d 0� y A a 1- O SUB-8SMT. BASEMENT I 1ST FLOOR 2ND FLOOR 3RD FLOOR r 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone q 7 b-6 8,7-110 5 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ . If you have checked ye, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certiy that all of the details and information 1 have submitted(or entered)in abo plication are true and accuWe to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (/ % BY T e of License: Plumber Signature of cense Plumber or Gas Title Gasfitter Cit /Town Master License Number_374"5 Journeyman APPROVED O FIC SE ON BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PER TO DO GASFITTING NAME TYPE OF BUILDING LOCATION OF BUILDING t.; PLUMBER OR GASFITTER_ LIC. NO. PERMIT GRANTED DATE �.19 GAS INSPECTOR Location No. 5/// Date NORTq TOWN OF NORTH ANDOVER 0 � 9 + ; , Certificate of Occupancy $ �'�s''•"°Eta Building/Frame Permit Fee $ JACNUS Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ f Check # 17! 18816 v,' `Building Inspectdr 3 r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT WA VAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. M SIGNATURE: Building CommissiE2ft ector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Ave �o G Ile y�`/4 Map Number Parcel Number 1.3 Zoning Information: /V 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred I Provide ReqWred Provided ReqWred Provided 4-- 1.7 Water Supply M.GI.C.40.§54) 1.5. Flood Zone Infomution: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record J �Al �aa 3,2- u .4e- me(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: License Number 'rte Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone �S s, G SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) *' Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: al 41 �000. a o SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ?FFICIAL USE ONLY Completed b permit a licant __vF ,, y 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 OOCI,O 0 Check Number SECTION 7a OWNER AumowzAIION TO BE COMPLETED WHEN OWNERS AGENT-OR CONTRACTOR APPLIES FOR BUILDING PERMIT / as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf all matter el ti work authorized by this building permit application. Signature of Owner QY Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date ►� NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVMERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT - 400 Osgood Street ` North Andover, Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION:_ Number Street Address Map/Lot HOMEOWNERS%f7 J�e ei l �oV �?_& 9 9 9 Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE CI APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption V40RTH ® of . ....... ..Co E dover, Mass., Sr COCHICHEWICK ^ ADRATED 7 S BOARD OF HEALTH PERMIT . D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............. ... . ............... '_ . Foundation has permission to erect........................................ buildings ................ Rough to be occupied a ..... ..... Chimney . ............. ...................................................... provided that the person cepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the p isions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TAR Rough Q� .............................. Service .. .. .......... ............ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous "Place on the Premises — Do Not Remove Final No Lathing or Dry Mall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner {` Street No. SEE REVERSE S1®E Smoke Det. Loc tib on a� No. '3(aG Date S1 2-;h'3 N°"7" TOWN OF NORTH ANDOVER pt � o ,'ti'0 p Certificate of Occupancy $ Building/Frame Permit Fee $ ,SSACMUSEt Foundati n Permit Fee $ Other Pei'rtiy;F£ee `_ $ ewer Conn iot1 Fee $ X/Oer Connect g"e'61 $ \TOTAa� \ ��9 � �9c9 ` Building ihspecfor C: _ s 32 6372 Div. Public Works Location rc. No. �L Date �'; . /•:. NORTH TOWN OF NORTH ANDOVER F , p Certificate of Occupancy $ • e 1 &Iding/Frame Permit Fee $ cMusE�� 47t)undatiori Permit Fee $ r%ther Permit;Fee / $ r G,r Sewer Connection Fee $ Water Connection Fee $ TOTALd . $ Building Inspector 6 7?, Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. I LOT NO. 2 RECORD OF OWNERSHIP jDATE (BOOK ;PAGE ZONE SUB DIV. LOT NO. �- LOCATION PURPOSE O FXu4TgtvriiaiI , r' ,OWNER'S NAM g C�� NO. OF STORIES SIZE WNER'S ADDRESS BASEMENT OR SLAB bt�yt ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD UILDER'S NAME SPAN -- DISTANCE TO NEAREST BUILDIfJG DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR ' GIRDERS - AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESSII IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 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 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST GAGyG PAGE i FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS i - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ✓DATE FILE �. ` BOARD OF HEALTH SIG AT E OF OWAER WA6THORIZE AGENT FEE PERMIT GRANTED OWNER TEL.# d w PLANNING BOARD CONTR.TEL.# fq'- t9 93 CONTR.LIC.# St7F=- BOARD OF SELECTMEN � --Cp 3�2 BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY. sroRlEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d t 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDSTER VJ D — PIERS PLA _ DRY—WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/1 1/2 FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 —FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HAIA __ ASBESTOS SIDING _ COPMHGN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I I POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER a ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO I 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS ' GAS OIL B'M'T 2nd _ ELECTRIC 1st 15d NO HEATING' . _ NORTH Town oAiridover No. 366 yy � Q -� = dover, Mass. %4 19TS T - E 1 1 GOC MICC KE WICK � 7 �AQRA TE D PPS\ �C2 '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR .......... . THIS CERTIFIES THAT....................... .. ...... """""" Foundation A Oft 32W .�... �� Rou h has permission to �Ett........................................ build s o .......� . g to be occupied as.ftno ...�. �/ ....... ...... .. I..�1.............. Chimney ' e provided that the person accepting this permit shall in eves respect conform to a terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUC � T ELECTRICAL INSPECTOR Rough ........ ................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT aS7s -