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Miscellaneous - 338 ABBOTT STREET 4/30/2018
L I North Andover Board of Assessors Public Access ,. It NORTl� 0. O ,SSwc►wS� Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 (forth Andover Board of Assessors rnTPrfV Rarnrrl ('aril Location: 338 ABBOTT STREET Owner Name: LEARY, MARY E C/O 338 ABBOTT STREET REALTY TRUST Owner Address: 338 ABBOTT STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6 - 6 Land Area: 1.16 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1682 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 369,900 353,200 Building Value: 160,100 145,100 Land Value: 209,800 208,100 Market Land Value: 209,800 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2252239&town=NandoverPubAcc 3/18/2013 r r� N N� r °r° U C- M ooX2U (3) m D Id a> Q U CU U) U' to N c,O N Q 5 2;W U S O M r ' o �a� N G E U- N O, o W oU" W m C)F- N cn — O m o m O � Q co 0 00 M MU' m U)E �U) 00)� E U of m CL >- U 20 Q `J O G U ON Q O o Q o'a Q .CD w.i d d N a''O � J @ O U L c O LL0 > O a)0 0)Ni y cn cn (n (n 0 Q� O J N O N r O r O r F'C� r O t Y .. cu o O o N. m J a NQa CO o m c c a UUti- cu -j E co � F@-iW Cl) 0 W Q � H o Z O O CD C? Q w N CD c O W LL Z W . M W OW ui � I CD U �O Ni N Qm �I a �¢ O. 00 , W I � m U) ao 2c Q 3JC��M; D O a m O O N € ' t16 00 — to ��, r 0 00 NN pW tNO00p O r JJ le (0 CIO 05— N �W > N r `�' Q�LL 00 r' Z 00Z CN 04 y W LLI co m Ix J J N �0=�ocoo OC EO` `.VO UQQ00 LL. ONrQ�o H �o6 . LL Z V L t t0 °� O s 'LLO Z N m13 : a cino JJ' coo J CD 0) epee V 0 W > CO CO F- UIWrnrn C. ;�(nQ Z 0 NOO m goo 6c a o O O Cl) C0 lD r W r V W N OGo 8 O •. M .+ O O ... M U f-wW p p cn U) a ~O m 4) Lww �a = z cnrN 0cncn U a e_ o M O. N N. t- •. ur) LO o (6 ; a) 4) O N O i D) f6 (6 CD p Q �U dam»r m v NLL Um ZQ��fn O c):. `1 O O QmlLm w-..2cn(UQ',Q� d R cn y 3 O W Qmt Z�� N :CO LO o rnrn _. - O co Osti r r.rQQ o v co COLI uLL 0 m ami N LL O LL GQ CQ G 7 3 pia m 0 LL co Z C LL G ll :�. 'OO C �U O 'm (-; W CL cp o�,c�o w>- C-) I$ �(A N N n m W tO rOHx}-'. N M,r a k� m G .X co LL i W W ii iri ILL '' '' U'U L: E ELS 3'::�t (6 f�6(n L co a00 o o co m NCJ.U. (D (D ofpm 'a ,�mt'tYU O N��7+.N SJC @.� X co 0 HmIt2WCOY W mmQ N Vr1 Q L) 0rZ 4) ID 6 CL CL r = o..' �� � 7 N N:C s 2 F- Y - N «A. Oho 't9 � o',%' o , a� _ a� 0�4 0 o cn cn-n =wwU awl m PO Box 55098 Boston, MA 02205-5098 617-951-0600 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139 Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N ANDOVER, MA 01845 N ANDOVER, MA 01845 RE: insured: MARY E LEARY-IPPOLI T O Property Address: 338 ABBOTT ST, N ANDOVER, MA Policy Number: HMA 0146607 Claim Number: BOS00052070 Date of Loss: 2/13/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Bryan Savosik Claim Examiner 2/26/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 2070 Fax: (617) 535-5841 Email: BryanSavosik@Safetylnsurance.com Location �� D 7�1 y No. 3 -/ y Check # Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $/L"' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ `B611din6 Inspector of TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION'...—3s fit°,. . r/�Eea— PROPERTY OWNER 33S - _ - D. `. . _ _V •PP.n _ _ _ Y2 Print 100 ear O d Structure MAP NO:& -J PARCEL: O(J ZONING DISTRICT: Histndc District TT. Machine Shop Villa yes yes 0r n n TYPE OF IMPROVEMENT, PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Eby k f f Laey e'/!7 e v f /`,c) ic.� 110d+�'<✓ 'cli-/ia, Identification Please Type or Print learly) OWNER: Name: – Phone: 7 �'` �,�-�/5 Address: 33,f Ahe f t CONTRACTOR Name: _ _ Phone: _ _ Address: _ Supervisor's Construction License: Exp. Date: Home Improvement License: _Exp:, Date: ARCHITECT/ENGINEER Phone: V Address: Reg. No. FEE SCHEDULE: BULDING PERMIT.• $12.00 PE. $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $;C�® Check No.:���f Receipt No.: Q-.� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ,la, s Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ a�ep�aan��ufis���aw}ar�daa_aa�y:- .. ou sari 6.is uo jajsdwna ducal IN 32!13 1aaJ1q poo sn tRp paleom :9.1n;BU21S :aaaulMua :!Aio, L Aa([ Ilwaad ennanlaa olua ig aanjeu is/uoiloeuuoo jaAAeS'p j%eM sluewwoo :uolsloaQ uollenaasuoD sluawwoo :uolsloaQ paeo8 6uluueld sant pall!wgns Idlaoai/uolsloaQ 6uluoZ :ON uollllad 'aouelaen :sleaddyjo paeo8 6uluoZ S1N3WW0O aan}eu is uo parv►aina�j H1Td3H S1N3WW0O aanleu . is uo pannainaZ:j N0IIVh 13SN00 S1N3MOO ❑ ❑ 1N3Wd0l3n3a. T ONINNVId (BAG2IddV iVU x313 --:IN 131VG - Wm03 n -4=10 NOIS -IVIN3W1MVd3(IN31NI A-INO 3sn 301330 -MOA SNO1103S ONIM0170d 3Hl sueld pedwelS Ueld fold palplia— panieN - sueld :E]..p@jj!wqng.suejd ajis_uo zajsdmnC[ juaueuugd- ❑ ❑. soleS/iuiftioudpood. solsg000egoL ❑ a II t1c1 slood 2uluw-lgms ❑ Pv spowo2lessLj uiva'?L F1 zannaS oiland . - 'I�'SOdSIQdtJF�2i�tY1�S.30�d1�.L` sueld pedwelS Ueld fold palplia— panieN - sueld :E]..p@jj!wqng.suejd 3 0 H LU LL c c O m O t0 E N T N fl. N cr_ G a z z 0 '1 mJ C N 7 LL 7 tw O OC ' 41 E_ L V f0 O Il o Wa Z z co d j O f0 I.i o H Z v t; J W 7 O OJ v N f0 C iLL ocz O LU °- ? a O OC f0 O LL LU Q W 0 LU oC LL � O O CL1 O z N a+ N a N O 41 O E N CO i Z C CD Z W X LLJ F- W CL O a V) z 0 In //^� V, N O Z cn O cn J w w W E O O Z N tm O <(D •(D W C 0� Vca O � a. �- � Q t J .2M O = Z � O U tQ N o cc o � CL 0 cc d¢ c = c 0 CA 0 r L N • V w O: E ai L = V i N V O' J � y i m a E. N 0 • L •a_ _ �\\ _chO NO o-0 > Eoo 0 o N > 3 _ :�2CLcts� U) a, f- o c c _ ' Q L L c O 0 N N V O cc m W li = •� -0-- O O O N = EL . �. O z W Er O V = O . O N H U -M oO O U = � a. > CO i Z C CD Z W X LLJ F- W CL O a V) z 0 In //^� V, N O Z cn O cn J w w W E O O Z N tm O <(D •(D W C 0� Vca O � a. �- � Q t J .2M O = Z � O U tQ N TO" OF NORM ANDOVER OFFICE OF BUILDING DEP.ARTMENI .:1600 Osgood Street13uilding20,-Suite 24*36 ' North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 TnspectorofBuildings Fax (978) 688-9542 HOMEMNER•LICENSE P-M&TION BUtDING PERMIT APPLICATION pleasenririt • DATE: - JOB LOCATION: � 3� . IJA� ' �-,�f� � � - � �✓��� �3�® � �a 9� Number tt Street Address Map/L_ of oiviEoWNER%--7 P Name. Home Phone Work Phone PRESENT MAILING ADDRESS .� M / teA� ('%tv Tod fir. The current exemption for "homeowners" was exten to allow su�ded to include owner-occtip 'ed dwellings to two units o� less and i� ho�neo ;;vers to engabe an i sczyidual.for hue dvho does uilnot possess a license, provided that the owner acts as supervisor). State DO' (Code Section 108.3.5.1) DEFINITION OFHOMEOWNER Persons) Who awns a parcel of land on which he/she resides or intends to reside, an which there is, oris intended to be, a one or two family structures. A person who constructs more that one Home in a tyro-yearperlod shall not be considered a homeowner. The undersigned "homedwner" assumes responsibility for compliances with the State B Applicable codes, by-laws, rules andregulations, uilding Code and other 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 nrnePA,trPs n-4 requirements. ROMECMITERS SIGNATWU APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CO)1TSERVATTON 688-9530r r. HEALTH 688-9540 PLANNING 688-953 i -.Di ienslori Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area; sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of ..Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes N® MGL -.Chapter -•166 section 21A --F and G min.$10041000:fiine NOTES and DATA — (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department - � g p The folowing'is'a=list of -the required -forms to be filled out for:the appropriate. permit to .be obtained. Roofivg, Siding, Interior Rehabilitation Permits Building Permit Application 0 Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/0'r-C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster..permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp th`e decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Bui)ding permit Revised 2012 TOWN OF NORTH ANDOVER OFFICE OF TOWN MANAGER 120 MAIN STREET NORTH ANDOVER, MASSACHUSETTS 01845 Mark H. Rees Town Manager June 11, 2009 Mr. Thomas Ippolito 338 Abbott Street North Andover, MA 01845 Dear Tom: OF jORTF1 q 3? et.v .,,•° OL O — p �A1i°o I•'�y'(y �9SSACHUSEt Telephone (978) 688-9510 FAX (978) 688-9556 On behalf of the Board of Selectmen, I am granting permission to display banners advertising the Lions Club sponsored Circus performing on July 1 and July 2, 2009. These banners will be placed at the Messina's Shopping Plaza and on the Middle School Field from Sunday June 14, through July 2, 2009. I understand that you received permission from the Messina family to place a banner of their property. Sincelly. ark H. Rees Town Manage /aj j cc: Board of Selectmen Gerald Brown, Building Inspector LocationNo. S Date Check # 1 20 5 3 4 lz§�--- Building Inspector TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Hus°<A Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 20 5 3 4 lz§�--- Building Inspector BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 1 57Z-- Date Received Date Issued: ' 2-"' o I6''YO\ 6 OL � i f TYPE OF IMPROVEMENT PROPOSED USE Reside 'al Non- Residential ❑ New Building ne family ❑ Add'' n ❑ Two or more family ❑ Industrial 2-9 teration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other wXa.. DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: /6& /ti /V'5 .� eA/2 z / ��� �� Phone: lv 7 � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERf12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 1��� FEE: $ z Check No.: ` Receipt No.: 6 NOTE: Persons c.91vac 'n with unregistered contractors do not have access to a guaranty fund Signature of Agent/Owner Signature of contractor r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ i b Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Located at 384 Osqood Street Driveway Permit �I Z id x a� � xco o w v v cn a z o w o rz v U wG oo� U w a o u: c w' O w a w w o u: cn iz. x O F' o w co w w A w CO z V)U) r d Q � w3 Y= 0 W x Q 4Q * M' u cm NJ m O: C C, C m ay cc EN CD L CD 0 dV i / N Z m -o �a O` •"` a 2 s iii �fA O vmZ CD CL Q i i m C = m d m y. O m a p H O F- 0 N W�=...'O LLJLL m C j� .y at W C Oa" �_ U= .&- eca 'o _o ca • o SCC C z Nam x CO) = - = C'CL m I.- s S o. � m m a N S r�+ N �O O N C 0 o s cmCD C: m L 0 cm C �C N Bo t 0 ZCD 0 F. W 26 • r.a a (a CD .E CL C cc O CL CIO O V .y C O C-3 O O V CDCL CO) C CO CM C CD O m m ev �' O L CL CL. cma C cc O Z CD 0. CA C •• c o " m C " C V O ` yy C h O J�Ep O m C o L N EQ CO C v Q a C N : ES m a N S r�+ N �O O N C 0 o s cmCD C: m L 0 cm C �C N Bo t 0 ZCD 0 F. W 26 • r.a a (a CD .E CL C cc O CL CIO O V .y C O C-3 O O V CDCL CO) C CO CM C CD O m m ev �' O L CL CL. cma C cc O Z CD 0. CA C CS # 022680 HIC#103358 =,Vropagal � A. J. Walsh & Sons 55 Pleasant Street North Andover, MA 01845 # of 978-688-6737 or 1-866-AJWALSH Proposal Submitted To: Job Name Job # —Ahi' Address � � � � Job Location Date tf/,V /O Date of Plans Phone # Fax # Architect '415 Wa harahu mihmit cnarifiratinnc nnrf actimntac fnr- We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of: $ �S l!o� Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate. All agreements contingent upon strikes, accidents, or delays / beyond our control. Note — this proposal may be withdrawn by us if not accepted within days. 21ueptanct of jkopoga[ I �? The above prices, specifications and conditions are satisfactory and are Signature �'� d ! - a� hereby accepted. You are authorized to do the work as specified. J (/ Payments will be made as'outlined above.(/ Date of Acceptance / y Signature ]tie (.-ommonweaun of LvlasJuenuseu� Department of Industrial Accidents ' Office of Investigations . 600 Washington Street Boston, MM 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elects icians/Plum hers Applicant Information Please Print Legibly Name (Business/Organ ization/Individual): Address: __:5_5— City/State/Zip: " hllyboye� ,42*Phone #: 9'. 1� � � —61Z3 7 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity. workers' comp- insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have, exercised their 3- ❑ 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.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F-1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. El Roof repairs 13.[:]Other //��� *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 are 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 ofthe sub -contractors and their workers' comp. policy information. I an: an employer that is providing workers' contpensation insurance for my employees. Below is the.policy and job site information. Insurance Company Name: /`f `�"/ / "� /� y rG%'4, ` (� �V Policy # or Self -ins- Lic. it: %01411 C4 D —7 Expiration Date: i l Job Site Address: c � � C S City/State/Zig: Nd /T oe C_� 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 cf 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insuzance coverag .verificarion. I do hereby cer�l under the pains and penalties of peijury that the information provided above is true and correct Signature: Date: �% ' Official use only. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: CERTIFICATE OF INSURANCE ISSUEDATE(MM/DD/YY) � 11108/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Samuel J Durso Insurance CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Agency Inc POLICIES BELOW. 198 Mass Ave Suite 101B COMPANIES AFFORDING COVERAGE North Andover, MA 01845 r INSURED Arthur Walsh dba A. J. Walsh & Sons COMPANY A.I.M. Mutual Insurance Co LETTER A 55 Pleasant Street North Andover, MA 01845 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY POLICY NUMBER EFFECTIVE DATE(MM/DD/YY) POLICY EXPIRATION DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ LAIMS MADEE::1DCCUR PERSONAL & ADV. INJURY $ OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE S FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) S HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE E EXCESS LIABILITY EACH OCCURRENCE $ MBRELLA FORM AGGREGATE S THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY X WC ITU- OTH- TTA ORY LIMITS $ A THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: RX EXCL 7014648012006 11/14/2006 11/14/2007 EL DISEASE--POLICY LIMIT $ 500'000 EL DISEASE--EA EMPLOYEE S 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of North Andover EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO,MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Roard Of Building Rdjtrlations and $t+etdarda HOME IMPf PVEMENT CONTRACTOR fRegisxr�,._ rD3358 e'f CorPoration A. J. WALSH i ArtngrjSJr,�� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of , Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — For department use I E I I ❑ Notified for pickup - Date Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Form 81 P - 1 `(1963) North Andover Planning Board SUBMISSION TO PLANNING BOARD OF PLAN BELIEVED NOT TO REQUIRE APPROVAL UNDER THE SUBDIVISION CONTROL LAW Name and Address of Applicant: .Albert Ray Doyle R, D. #2 Salisbury, Vermont North Andover Planning Board Town Office Building North Andover, Massachusetts Gentlemen: Date of Submission of Plan: January 8, 1970 Pursuant to the provisions of G.L. c. 41, s. 81 P, the original of the plan described below, together with two copies thereof, is herewith submitted to you for a determination that your approval of the same is not required by the subdivision control law. EXACT TITLE OF PLAN, with date and name of Surveyor: Plan of Land in North .Andover, Mass.. Surveyed for Albert Ray Doyle Stowers Associates.'Reg. Land Surveyors,' Sale 1" = 501, December 1969 Description of land "sufficient for identification": Northeasterly by Abbott Street 137. 18 feet; Easterly still by said Abbott Street; 92. 21 feet; Southeasterly by land now or formerly of Calzetta, 480 feet; and Northwesterly by land now or formerly of Milo J. and Edith H. Owen; 417. 82 feet. Containing 49;660 •,tgtire feet; more or less. Title reference: North Essex Deeds, Book 963, page 46 1 . Attorney for Applicant: James H. Eaton III; Esquire It is believed that such a determination should be made for the reasons given upon the reverse hereof. Iq APPLICANT'S REASONS FOR'BELIEVING THAT APPROVAL OF THE PLAN SUBMITTED HEREWITH IS NOT REQUIRED BY THE SUBDIVISION CONTROL LAW: The plan shows an isolated lot on Abbott Street owned by the Petitioner, the frontage and area of which conform to the existing zoning requirements. Very truly yours, Attorney for Albert Ray Doyle N.B. The subdivision control law requires the Planning Board to make the re- quested determination "unless such plan shows a subdivision." G.L. c. 41, s. 81 P. Accordingly, the foregoing statement of "reasons" must clearly indicate that the subject plan does not "show a subdivision", which is defined by G.L. c. 41, s. 81 L (as amended by St-. 1963, c. 58o), -as follows: "Subdivision" shall mean the division of a tract of land into two or more lots and shall include resubdivision, and, when appropriate to the context, shall relate to the process of subdivision or the land or territory subdivided; pro- vided, however, that the division of,a tract of,land into two or more,.lots shall not be deemed to constitute a subdivision within the meaning of the subdivision control law, if, at the time when it is made,, every lot within the tract so divi- ded has frontage on (a).a public way, or.a way which the clerk'of the city or town certifies is maintained and used as a public way, or (b) a way shown on a plan theretofore approved in accordance with the subdivision control law, or (c) a way in existence when the subdivision control-'Iaw be effective in the city or town in which the land lies, having, in the opinion of the planning board, sufficient width, suitable grades and adequate construction to provide for the needs of vehicular traffic in relation to the proposed use of the land abutting thereon or served thereby, andfor the installation of municipal ser- vices to serve such land and the buildings erected or to be erected thereon. Such frontage shall be of at least such distance as is then required by zoning or other ordinance or by-law, if any, of said city or town for erection of a building on such lot, and if no distance is so required, such frontage shall be of at least twenty feet. Conveyances or other instruments adding to, taking away from, or changing the size and shape of, lots in such a manner as not to leave any lot so affected without the frontage above set forth, or the division of a tract of land on which two or more buildings were standing when the subdivision control law went into effect in the city or town in which the land lies into separate lots on each of which one of such buildings remains standing, shall not constitute a subdivision. 4 P 0 W 0 w e 0 o- 0 o Raq Q 4 0 9Q•Z w a a' Lk ° R tia r Q � as Q C N • ,�n4Ti4 R N s UA - Z3 � A-Bzf� AE T S C � L •• .5 TO WE.e.S A,5 SCG//9 T.E S �^ � r L-- �`SQ, SEG, Lh'NC7 tSu.2VEYO�S �Y',>v;���t.v /D69 ME?HUEN� M,9 S S. Q Q 0 HBBOTT varies gym. t5- Ul tcl12 41 ka a c4 q MA Of M. M RA J Location 3 3 £ ' �.� d io fr S ' No. c s Date N TOWN OF NORTH ANDOVER a ` Certificate of Occupancy $ �— o ^�# Building/Frame Permit Fee $ f �7��+' .e'�t.('� Fnunrtatinn Parmit Faa Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ _ TOTAL $ S U r^,,`r ( U Building inspector 25.00 PAID -�- Div. Public Works PER111T NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4J0. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE I SUB DIV. LOT NO. LOCATION 60 PURPOSE OF BUILDING 1 OWNER'S NAMENO. OWNER'S ADDRESS OF STORIES SIZE BASEMENT OR SLAB ARCHITECT'S NAME BUILDER'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD SPAN DIMENSIONS OF SILLS --- DISTANCE TO NEAREST BUILDI ,� DISTANCE FROM STREET 66A POSTS ? 0+ REAR DISTANCE FROM LOT LINES - SIDES '310+ J V " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW �J /I ,�J � �'/ SIZE OF FOOTING X IS BUILDING ADDITION A F 11- / V MATER:AL OF CHIMNEY IS BUILDING ALTERATION cr- IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CO� 16 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 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS P6ANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE PERMIT GRANTED Ci /dig 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 BUILDING INSPRCT011 OWNER TEL. k 6 " & ` g CONTR. TEL. # CONTR. LIC. # H.I.C. N 0 EME4 ml F O o w a cn � � w z s u. ? yU U iz. � u w z to ti a O z P W z > cn w O W z c¢7 O a: m G a. w w A a G cn d v cin o o cn IQ T 73 G� i c r- o o E CO c COLU�_- o CD � z o. c ` O N Cl - 0 c 0 C., v CO tm o w G3 o 'a cr- Co m m R R m c > CD L- o w ~_ L G o m N O i E � CE R o Q m EL �1 as COD C_ o c N O� C +� R �C 0 c J V J 'p 0 CO Z .CL CA Cco Z :oo v c :mom . a. E p1 •� CL = H L N ` c_ O J N \ W W m O L y C C N 'SZi. E CD \co CD� O -C- i N m m m = iz cm Os O c %A dCL � O co R � Z OD cm m \f a N R c c fV CD CL 401 03 co L LLI R c N aL �+ O Z CD LU cm V3 _C43 L H o F" L CD aL... m i IQ T 73 G� i J a z o E U- COLU�_- o � z o. Cl - 0 c CO tm o w G3 o 'a cr- Co m m LU N z > CD L- o w ~_ o O i O o _ L R o Q EL o� Q COD C_ O� C +� R �C J V J 'p Z .CL CA Cco Z J z v c •� CL = LU n G z Z \ W W Date...'' a� „aR,,, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that...... ............. � . has permission to per ..�.... ........... . form- plumbing in the buildings of ....... ........... ....... ` ... , North Andover, Mass. yy � f Few./..'.... Lic. No.......... ! :.. ....... / v PLUG INSPECTOR Check # `� 61C. 4.'58 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) �Q uey -, Mass. Date O) Permit # vv ` Building Location 33A AL b6 ILL S-1-- Owner's Name. 70MT m �J n Type of Occupancy Residential New ❑ 0 r Renovation ❑ Replacement IN Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg . &Plg . Co. Inc. Check one: Certificate Address 35 Pleasant Street IX Corporation 714 Stoneham, Ma 02180' ❑ Partnership Business Telephone 781 -43 3 8-7776_ n Firm/Co. _ Name of Licensed Plumber Gordon Switzer r INSURANCE COVF-GAGE; . I have a Current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9) No ❑ If you have Checked Vis, 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 1142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 1 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 � nowledga and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent piovisionS of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By inn 12 A -) Signa ure o i s d rU—M er Title -- Type of License: Master M Journeyman E] City/Town $ 3 2 2 APPROVEMO FjEi S—e-6JC�l—j - License Number.__ W Y .a Ji N .< O Z 4- `� h U W O lJ W In OJ Z vi d N 2 . ? O Z Z (n a 111 1r 114 x` U= (n W CC W co N 3: Q ~ 4 W N Y a a rn 0 Q G a 3 rd (U C[: W 0 7 2 d W vi ¢ l a w N o z¢ o C a U.14 x x F h W = d o X = 3 J Y 0 OJ O- OU. h a _2 Y _Z W F- Q O U rl 1"'r O Q d S a O Q -F� i-' +� �-,+ = F- N LL u n a o a 3 SUB—BS MT, BASEMENT 1ST FLOOR 2ND FLOO)t 311111 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH rr,OOn Installing Company Name Heritage Htg . &Plg . Co. Inc. Check one: Certificate Address 35 Pleasant Street IX Corporation 714 Stoneham, Ma 02180' ❑ Partnership Business Telephone 781 -43 3 8-7776_ n Firm/Co. _ Name of Licensed Plumber Gordon Switzer r INSURANCE COVF-GAGE; . I have a Current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9) No ❑ If you have Checked Vis, 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 1142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 1 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 � nowledga and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent piovisionS of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By inn 12 A -) Signa ure o i s d rU—M er Title -- Type of License: Master M Journeyman E] City/Town $ 3 2 2 APPROVEMO FjEi S—e-6JC�l—j - License Number.__ Location g 3,e 4 No. 1 O J Date r'll"� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20174v Building Inspector �-5 BUILDING PERMIT Permit No#� Date Issued: LOCATION S_`_ PROPERTY OWNER MAP PARCEL TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION / Date Received RTANT: Applicant must complete all items on this page NORTF� O��Ttieo �b qh ' 963,x. .,:+p •6 u,4 c� Print r _ Hini—ell 100 Year Structure yes 0 ZONING ISTRICT: Historic District yes n Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential _ p New Building_ _ ftne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ,Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 11 Water/Sewer__ 9, OWNER: Name: or4rrroce- 0 tit Nttct-uruvitu: - Please Typepryrint Clearly �rap�l� To Phone: 1 Contractor Name:�� Email: Address: Supervisor's Construction License: Home Improvement License: / �l Phone: SG Exp. Date: Exp. Date: __H_67_017 ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ r" 7M FEE: $ / Check No.: ��� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acedies, to the gua anty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS • Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: ';F IREDEPAR�TrMENT Ternp Durr "stet m s� _ p�_ _ onsife 1Y�e ono LocatedOsgood Street iiMRc i6 chat ,12`_4hMaintStFP6f . - -----� -1- -~�-� - -- - -- Am/ ature/_ 3 0 H LU LU LL OZ CC Do O Lte O O a+ ?O � fl_ N VI Z G m O Y LL Ci T C U LL 0 H z m J �' L � cc m LL Cie 0 CL y ? Q �—�, W W L v D U i N _ Fa LL cc OU a0 CA Z H Q L D 2' _ m LL H zW °c W O W LL i m z (j +: Y O V7 H ca 4 '(, ,r 0i 0 = O Q N '� Cl) W = O O LL y NU) C CL O W 0 V V O m cn CL . N y t M O . 0.oQ O W LU O S_: G � V J O Z � O cnd z F-- 1.1W .�mm py ; O p CL � c t� LUO c V > Oo XZ �+ LO CL CL �� yc a 0.' w c a- Z O d Z d O CL v U cn O ctt � c N P� v 0 Page No. / of / Pages xaas�xC Supervisor CS 068461 ^ i j's�' • Fully Licensed &Insured Home Construction Reg. # 146722 O'Keefe ) 0 ` ass -c-, B m Roof* ��� � B8 m North Reading, MA - 978 -276-3043 A 978-276-3043 Gly colLecrlo CertainTeedG PROPOSAL SUBM17ED TO � PHONE DATE �-� STREET 33c t -;. DaNAME " CITY, STATE AND ZIP CODE i JOS LOLATION We hereby submit specifications and estimates for: Recommended Optional (Included in price) (Not included in price) Rip & Remove all shingle debris from roof & job site: SIrl layer %d2 layers ❑ 3layers or more Repair/or Replace any roof decking; not to exceed 50sq. ft. Install 8" aluminum drip-edge/and rake -edge along entire perimeter. Choice of mill whit or brown Install ICE &WATER underlayment along horizontal eaves, valleys, sidewalk and sky -lights &chimneys •;% Install premium base sheet underlayment between roof deck and roofing shingles 415 Ib. telt ❑ 30 #. felt • Install 25yr CertainTeed/GAF/IKO traditional 3 -tab roof shingles 0 30 year Install CertainTeed/GAF/IKO architectural gLiietime roof shingles — — GAI ' See manufacturer warranty policy for more details ry% Install new aluminum vent -pipe flange (s) •t% Chimney (s) -counter-flash and re -step existing flashing Cut & Install new lead flashing •✓ Ridge-vent/exhaust vent with low profile design, hidden by shingle caps ❑ Soffit -ventilation ❑ Roof louver -vents • Seamless style aluminum gutters - custom fabricated at job site ❑ downspouts •✓ Other / - - i O'Keefe roofers will properly dispose of ali roof debris in our own dump truck. `Please Note: All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear -off Price includes all items above that are checked only / others may be priced separately upon request. I Pe Propose hereby to furnish material and labor - complete in accordance with above specifications, in a sum of: Total price not including options. dollars is Payment to 5e made as follows: 30% deposit required upon delivery of materials. Balance due in full upon day of completion. Please make all payments out to Michael O'Keefe, 21 Francis St., No. Reading, MA 01864 Late charges of $50 per week for all outstanding bills due upon day of Authorized completion. Signature l - Accepting proposal means agreeing to the terms of the enclosed binder Note: This proposal may e contract. mrithri—m by H, if not a —fled within ri— comp. uisurance iequued Inv %lpphcanl That nc:rks box N 1 nnat also IIII oul the ;cellon below snowing thea workers' cornjwn saoon policy uiforinallon 1 I ltlrne,rlwut"u: who ;uhnul this afildavu m(llcallnl,, They are, doing, all work and then hire nuiside., contractors 11)11;1 suhrull a new alta lavit Intlic:,hn,, 111,1, nnrl:Icull,'• that rilcck to bnr muss anached an additional sheet showing the nan' of We soh mi-incm, and stale whether w ma 0", cull ti have wnployr:c:: II ihr soh"conrncinls have employees• & must provide the" workers' comp pobcy number I owl art employer that is providing workers' compensation insurance for illy employees. Below is the policy and job .cite err formation. ire;llr;uli:r. C'olllparry Name;: t� 1yl'+GGjGIL�_"---- -- 1'�:llcy1lnr'r1f in'. I.It it Gam. loh S59 lixplt al Ion L)ale: b 'l 5--16 (:1,ylSl,itci7nc�}• /�ur AMach a coley crf Ihe woe kers' compensalion policy declaralion page (showing the policy nunihet and "piral m dmQ- Fal]In e to secuI c coverage as iequired under Section 2M of EACH. c- 1.52 can lead to the impos(tion of ci irrunal penalUe of li Me up to 11JOR00 an(Un one yton n;lptisonment, as well as civil penalties Ili the foie of a STOP WORE ORDER moo tole elf up Io V51100 a day against the violator Be advised that a copy of this statement may he forwmdcd in It ()fIice d lliviatlf,ations of the WA for iiisuraiu_e coverage vetificahoii t 110 herrehy certify anderthe paint' and penabi'e of pezjtrry that Me inforniation provided above Anne and ewru Official rare onll'. Do art write it, this (!tcu, to be completed by city or town officiaL (.,it)' of "1'ovvri: Yert7lit(Liccrr;r N ISeuilllr Authority ((If (Ac c"1nc) 1- R and of 1600 2.Buildinq Dclawme:nt 3. (My/Tows Cicrk 4. Ekctricai Inspector" 5 i'll�ulbl�i�, II 11�r!or Ca he r Ct.lntarl f t I tion: Plaonr i; o1711-110,Z)vewlth of /ti'il1S`'flC/111\1'ttS ; r-, _"-I, x />r•partrrzclzt of Jwdzr.etrial ,'t ccicic_rltc I - Officc oj*lnv(`sti•r;atioll.s 6t,-= (ton {'1'rrshirlton .�'trrrr Rnsurrr, 1Y1.,1 02 11 - wwl"v.nlass.,�ov/rlin Workers' (:oI)I ieIts ation I ris u i ,I j i c. e Atfid3viL Builders/('ontractors/l'Aecolda»s/Phinhers _ i liCBnt"iill(IriilnfifitV 7X Erie:l.se Pl-ilii l.("Il (lily. (I"111'.1111"�,'�tr)I4'�illl/:IIIC,�I'.tl Ctrl i`J IIIU:III /_� Xn-�, J96 ( I l y / � l ii l c / /. i i l jd"//a " �-�%f.�-O'•'��'Y.�- . P f l rl n c� if " � l ,err yon an employer ('heck Ihe aippi riale box: Tyl,t' of 171 c.ilcrl (r rrlull If I am t etiililoyci w111, 1 I ,jm;i genera{ con0acioi mill I crrlployre.s (fill and/cu pmt I111Ic) ' have hired the Soh conhactrM i, � � 1`-1e:.'.v cunstiucin,n FI I nim m Sale I:"opticiur (II llalinc.t- lusted on the attached Sheet 7 Ll keanl,r_lduil � ,illi) JII(I 11, yr Ilu r'IIIIIIUyrr,, lhese sub-corinaCiw hal V('. I I n l `Lia lli l{1111 ill '•:V(il kinf_; 1111 III1' In ,Inv rai11:11 lilt c: crnpinyes and havt workcl''; I 1 Irl w,;1 1- r. , ''I 1)1-1 li r.lii:l Tli i' cnillp ull roianl.r I I � I li:lin-11)".1111111„il 10 �_] F.Icctnr.al lt(juucd.1 5 We are a corpotnlio l and it'l Il p�,u:. ul arIllllunr. 1 U I am a hnmcownet doing all work officeis have exercised then 1 LEl }'huDbIK rcpans lir addl imv; niy:;elf” [No wolkcis' comp right of exemption per MGL 1' Roof repair insru"ancc lequtred"1 I u 152, §"41 and we have no -\ employees No workers' i 3.[,_] nor, comp. uisurance iequued Inv %lpphcanl That nc:rks box N 1 nnat also IIII oul the ;cellon below snowing thea workers' cornjwn saoon policy uiforinallon 1 I ltlrne,rlwut"u: who ;uhnul this afildavu m(llcallnl,, They are, doing, all work and then hire nuiside., contractors 11)11;1 suhrull a new alta lavit Intlic:,hn,, 111,1, nnrl:Icull,'• that rilcck to bnr muss anached an additional sheet showing the nan' of We soh mi-incm, and stale whether w ma 0", cull ti have wnployr:c:: II ihr soh"conrncinls have employees• & must provide the" workers' comp pobcy number I owl art employer that is providing workers' compensation insurance for illy employees. Below is the policy and job .cite err formation. ire;llr;uli:r. C'olllparry Name;: t� 1yl'+GGjGIL�_"---- -- 1'�:llcy1lnr'r1f in'. I.It it Gam. loh S59 lixplt al Ion L)ale: b 'l 5--16 (:1,ylSl,itci7nc�}• /�ur AMach a coley crf Ihe woe kers' compensalion policy declaralion page (showing the policy nunihet and "piral m dmQ- Fal]In e to secuI c coverage as iequired under Section 2M of EACH. c- 1.52 can lead to the impos(tion of ci irrunal penalUe of li Me up to 11JOR00 an(Un one yton n;lptisonment, as well as civil penalties Ili the foie of a STOP WORE ORDER moo tole elf up Io V51100 a day against the violator Be advised that a copy of this statement may he forwmdcd in It ()fIice d lliviatlf,ations of the WA for iiisuraiu_e coverage vetificahoii t 110 herrehy certify anderthe paint' and penabi'e of pezjtrry that Me inforniation provided above Anne and ewru Official rare onll'. Do art write it, this (!tcu, to be completed by city or town officiaL (.,it)' of "1'ovvri: Yert7lit(Liccrr;r N ISeuilllr Authority ((If (Ac c"1nc) 1- R and of 1600 2.Buildinq Dclawme:nt 3. (My/Tows Cicrk 4. Ekctricai Inspector" 5 i'll�ulbl�i�, II 11�r!or Ca he r Ct.lntarl f t I tion: Plaonr i; UN/18/2015/THU 10:13 AM A&K FOWLER INSURANCE FAX No.9786642209 F. 001/001 CARD CERTIFICATE OF LIABILITY INSURANCE 6/18/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be 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 endorsement(s). PRODUCER CONTACT NAME: No Ext : (978) 664-0366 AAC Na : (978) 669-2209 A & K Fowler InsurancePHC 200 Park 5t E-MAIL INSURER(S) AFFORDING COVERAGE NAIC # North Reading MA 01864 INSURERA:Penn America Insurance Co. INSURED INSURER B INSURER O'Keefe Roofing LLC 21 Francis St. INSURER D INSURER E 9/8/2015 INSURER F North Reading MA 01864 COVERAGES CERTIFICATE NUMBER-CL1491907021 RFVISI(AM NIIMRFP- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDDYYYY POLICY EXP MM DD YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR NPP1388425 9/8/2014 9/8/2015 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 1,000,000 X POLICY jE� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION VbC STATU- OTH- AND EMPLOYERS' LIABILITY Y A N ANY PRO PR I ETORIPARTNER/EXECUTI VE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under N/A VTorkers Compensation cert to follow from AIM Mutual TORY LIMITS ER E.L. EACH ACCIDENT If E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Insurance verification - Please refer to actual policy for all other terms, conditions and exclusions. Icm (978)688-9542 Town of North Andover 120 Main St. North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Orlanzo/NMO AL.VKLJ ZO (ZU1UIUo) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD 0 }?2 \§ \ 0 0 C) 0 r- I IMO 0 3 sa) . v' A 0 v) . \ 'too CL C) m CL (n t� x PJ S 4! Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-si000 fine Doc.Building Permit Revised 2014 r-- Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4, Building Permit Application �. Workers Comp Affidavit rr Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan :,. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract 4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan �. Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 1