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Miscellaneous - 34 SAUNDERS STREET 4/30/2018 (3)
N O w O � , N y � C Q Z o� o � 9° `� o �, o � � m o -� August 31, 2016 Mr. Donald Belanger Building Inspector Town of North Andover 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 Dear Mr. Belanger: This letter will serve as notice that we will not install a kitchen on the third floor of our home at 35 Saunders Street, North Andover, Massachusetts. If you have any questions, please do not hesitate to contact me. Since e , I n ifuentes Hom owner 35-37 Saunders Street North Andover, MA 01845 978-208-7893 State of Massachusetts County of Middlesex, ss. On this 31 st day of August, 2016, before me personally appeared Ingrid Cifuentes, to me known to be the person described in and who executed the foregoing instrument, and acknowledged that she executed the same as her free act and deed. Notary Public My commission expires: GAYLE DANFORTH OTIS Notary Public fin+ of MAS rre my coed E*m wmb.>ts► M3 August 4, 2016 Town of North Andover 1600 Osgood Street Suite 2035 North Andover, M A 01845 Re: 35-37 Saunders Street Please be advised that I have terminated the contract with Juan Duran Tejada (electrician) and Edward Phelan (plumber). I need to terminate the permits for the above reference address. I'll be hiring a new plumber and electrician to finish the job at my residence. Please let me know if you need anything else. Sincerely, Ingridi ntes Date. ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifi ..... TP '/i do, yhat ...... \—/ :j . ..................... ......... 0-- ..... *"*"**"***"** ...... **'* (�c rm has permission to ................................................................................................... rev e( wiring in the building of ..... c .... ... . .................................................................. at ..&5.." .. I ....... ............ 1. N, North Andover, Mass. ...... ... ...... ......... . ..... .... ........ . .. ............ Fee . ..... Lic. No. '.0. 6.V ................... **'* - "A' L* ... EC0 ** **T --R ECT - Check #'0 vA 2 12L4 it Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 131 11 Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN HK OR TYPE ALL INFORMATIOA9 Date: 0,9 C City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice ofhg's or her iptention to pe;form the electrical work described below. Location (Street & Number) 3'- �3 % J,! wQ /' Owner or Tenant .�'yt / /G+f Cl .tea ei' Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service -/00 Amps .2J //,gQ Volts Overhead DJ Undgrd ❑ New Service .�06 Amps 440 / 120 Volts Overhead ® Undgrd ❑ Number of Feeders and Ampacity Loc-atJon and Nature f PP oposed Electrical%Work: 7 k+e&yk/ uc- �f ���T ` J y A /B1�J c�J =::7 /z/Cal/ ;//c+�!/i�/��Lu/rC I aNG� N��v SeR�✓/C� ��� No. of Meters _4 No. of Meters 3 cf� d'7;- 24,0 T24,0 :7 Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires 6 No. of Cell: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires / SwimmingPool Above ❑ In- El rnd. rnd. 0- o in rgency ig ting Batte Units No. of Receptacle Outlets p7 No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. of Gas Burgers No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons ................. KW ...""..""... "" No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of DryersHeating Zi Appliances KW Security Systems:'' No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs 7--INo. —Signs of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: _ 4,y Attach additional detail if desired, or as required by the Inspector of Wtres. pections Estimated Value of Electrical Wor U�• (When required by municipal policy.) I Work to Start: to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: 1NSURANCE ❑ BOND ❑ OTHER ❑ (Spe • ) I certify, under the ,mac'* and penalties of perp', th the infor tion n this application is true and complete. FIRM NAME: ZINC? <aG�"� / LIC. NO.: d 7 Licensee: V1/491,1 T4o741c4 _ LTC. NO.: (If applicable enter ex t" in tly�i'cense mamberl e.) / / Bus. Tel. No.•57f'3� al• ° Address: .� t�Do! Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security rk 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 M WIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: 0 Trench Inspection Pass R1 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: 16 Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: ji A tvg,4 Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com Name The Commonwealth of Massa chusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Address: ,2,,20 ti /'4�4 0-7 � City/State/Zip: ,./(//C. Are you an employer? Check the appropriate box: r/J. /o, aW:�' 6111f 41 Phone #:_":9 -21 - 31, - -D '-/7`7 1. F1 I am a employer with employees (full and/or part-time).* 2, I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4-❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 6. ❑ 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): 7. ❑ New construction 8. (Remodeling 9. ❑ Demolition 10 ❑ Building addition 11. ❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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 mustattached 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 tTiat is pFoviding workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: IF' VIC ` /� �,,�/ Job Site Address: % VJ �L� 14 ���' S City/State/Zip: 4 "-/ 4i4� a /p/� I U�1 i7 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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 yielatpr. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verjzicanonj I do hereb certifyAhder the i sa ' s of erju that the information provided above is true and correct. 71 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 Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract 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-'contractor(s) 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 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia JW c t, -7e Zvi �L55 NA+s s t5- � J� r .2 L 4-2 �k- L& a_4,ae_ 44 n ' I:"'7RaCiAN<5;.><: ISSUES. THE FOI'1 9 W1CEN5 AS A `RSG JOURNE:ELECTRI'CI .f.::TEJAQA k fF y;_ 7.1 WESTEHE5rER DFi.. J'.�; �� 14v'R"ENC—E '"A 01843—jp3� 4047;:>> 07/a:::/:.�6 >>9061 U2/25/2Uib 12:51 y18b8/y8bl NAMECH PAGE 02/03 . klomm WAA'6' Tu 8/4/2016 Town of North Andover Mail - Re: Termination of Plumbing and Electrical Permits NORT1 ANDOVER Maura Deems <mdeems@northandoverma.gov> Massa hu -�--- Re: Termination of Plumbing and Electrical Permits Ingrid Cifuentes <inelicifuentes@gmail.com> Thu, Aug 4, 2016 at 10:47 AM To: Allan Paduchowski<apaduchowski@townofnorthandover.com>, Jim Hurley <jhudey@townofnorthandover.com> Cc: Maura Deems <mdeems@northandoverma.gov> Good Morning All, Attached is the signed letter requesting to terminate the plumbing and electrical permits at 35-37 Saunders Street. Thank you, Ingrid On Wed, Aug 3, 2016 at 9:58 AM, Ingrid Cifuentes <inelicifuentes@gmail.com> wrote: Good Morning Allan and Jim, I need to terminate the permits for 35-37 Saunders Street that Juan Tejada (electrical) and Edward Phelan (plumber) pulled at the Town of North Andover to perform work at my residence. I'll be hiring new plumber and electrican to finish the job. Please let me know if you need anything else from me. i i Sincerely, Ingrid Cifuentes 978-208-7893 sn Town of North Andover.pdf 124K https://m ai l.google.com/mai I/ca/u/0/?ui=2&i k=aeO2b3b5c4&view=pt&search=i nbox&m sg=15656063dOaac3d3&sim l=15656063dOaae3d3 1/1 POWNER TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY ! y O , Int AA 6 04-A— MA DATE q k t Y PERMIT # j JOBSITE ADDRESS ')6 '3 .'U U Yl �QQcS S7r OWNER'S NAME ri 6!6 6/ ADDRESS _26 S7 �� TEL % $ / "�J-xS 10 FAXI 10 TO OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION: REPLACEMENT- ❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES 1 FLOORS 13SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liabil' insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCYN OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:1 am \aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signatLre 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 I have submitted or entered regarding this application are true and accurate to the 4W of my knowledge and that all plumbing work and installations performed under the pennit issued for this application unll be in co nce with P envision of the Massachusetts State Plumbing Code(( and Chapter 142 of the General Laws_ PLUMBER'SNAME�ps,_L LICENSE#a,5�`I SIGNATOR MP ,(P� j CORPO TIO # PARE r ❑ # LLC El# COMPANY M Cts I Mbl Q ADDRESS T` V. C` r CITY vI'o�A- STATE ZIP O A TEL 97R 15 /0 5 - FAX CELL EMAIL M The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Les _I Name Addre; City/& Are you an employer? Check the appropriate bog: L K I am a employer with 1 4. ❑ I am a general contractor and I _ employees (full and/or part-time).* have hiredthe? 2. ❑ I 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. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required] t employees. [No workers' comp, insurance required,] Type of project (re4uired): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0iElectrical repairs or additions 11. MPlwnbing repairs or additions 12. ❑ 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 Tien 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 workems' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. _e ; Insurance Company Name: r�� Policy # or Self -ins. Lic. M tt� l � � Expiration Date: Job Site Address:: -►n GU-�- z!) i City/State/Zip: /VO Alfl (7a-01- 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 eri ninal penalties of a fine up to $1,500.00 and/or one-year imprisonment. as weLl as pena?ti-- in 1he forma of a STOP WORK ORIYEEAL 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 certify under the p ' d penalties of perjury that the information provided above is true and correct Sicnature: Zletir All (4 - Official use only. Do not write in this area, to be completed by city or town of Wal City or Town: Permit/ficense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone August 4, 2016 Town of North Andover 1600 Osgood Street Suite 2035 North Andover, M A 01845 Re: 35-37 Saunders Street Please be advised that I have terminated the contract with Juan Duran Tejada (electrician) and Edward Phelan (plumber). I need to terminate the permits for the above reference address. I'll be hiring a new plumber and electrician to finish the job at my residence. Please let me know if you need anything else. Sincerely, Ingrid ► ntes 8/4/2016 Town of North Andover Mail - Re: Termination of Plumbing and Electrical Permits NORTAi, DOVIR Maura Deems < m deem s@northandoverm a.gov> Massachusetts Re: Termination of Plumbing and Electrical Permits Ingrid Cifuentes <inelicifuentes@gmail.com> Thu, Aug 4, 2016 at 10:47 AM To: Allan Paduchowski<apaduchowski@townofnorthandover.com>, Jim Hurley <jhudey@townofnorthandover.com> Cc: Maura Deems <mdeems@northandoverma.gov> Good Morning All, Attached is the signed letter requesting to terminate the plumbing and electrical permits at 35-37 Saunders Street. Thank you, Ingrid On Wed, Aug 3, 2016 at 9:58 AM, Ingrid Cifuentes <inelicifuentes@gmail.com> wrote: I Good Morning Allan and Jim, I need to terminate the permits for 35-37 Saunders Street that Juan Tejada (electrical) and Edward Phelan (plumber) pulled at the Town of North Andover to perform work at my residence. I'll be hiring new plumber and electrican to finish the job. Please let me know if you need anything else from me. Sincerely, Ingrid Cifuentes 978-208-7893 on Town of North Andover.pdf 124K https://m ai l.google.com/mai I/ca/u/0/?ui=2&i k=ae02b3b5c4&view=pt&search=i nbox&msg=15656063d0aac3d3&si m l=15656063d0aac3d3 1/1 Q,) V�, �A- a,. JA, --5 �. jo�l C F 6me) Perri#21320-1 X c https•/,n� verma.viewpoinbclmd.com/#/�erord1121320 C C Q' Q P.) d .. _........ - .. _...... ........ r Appsrw mW ardaverma.gwboolaoerks rargNdc—,plame wtbahriarYs nne w the bo*rwks bar. Impart boolanarks row... ._. _-.------------------- ------- ------- ____- _-- -- - Town of North Andover, MA Q sealrch•.. 0' j 21320 -Plumbing Permit - In Conjunction with a Building Permit (Commercial or Residential) TIMEUNE Submission received Sep 8, 2016 ac t t:Diam Thursday, Sep 08, 2016 11:10 AM Your request is in progress We'll let you know of any updates via email. Feel free to check the status at any time by coming back to this page. F.U. Sent toNWMDE\_-A1WH Cqv ESC P.Bcir;on st 41 Heav'nty Donuts0 s "s App!kanc Loca:- Jose L Marquez 35 SAUNDERS STREET, NORTH ANDOVER, MA c,<ma. VAKILL EHTERAM S .................. Attachments 11:10 AM Plumbing Permit Re*w In Progress 0 Per),$itfee t OPermit issuance Thursday, Sep 08, 2016 11:10 AM Your request is in progress We'll let you know of any updates via email. Feel free to check the status at any time by coming back to this page. F.U. Sent toNWMDE\_-A1WH Cqv ESC P.Bcir;on st 41 Heav'nty Donuts0 s "s App!kanc Loca:- Jose L Marquez 35 SAUNDERS STREET, NORTH ANDOVER, MA c,<ma. VAKILL EHTERAM S .................. Attachments 11:10 AM Date .`t.t'-11". TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that................................................................................... has permission to perform ... ..0� ..................................... . plumbing in the buildings of.H..��.A.....`.!......!..�:�-. c at ........,-..NR�-Q..... ...:........................ North Andover, Mass. Fee .3.o.......... Lic. No.ZA.�.:� A6................................................................... PLUMBING INSPECTOR Check #1 �� 1z '\ �E _ POWNER TYPE OR PRINT CLEARLY ner►vvnvs v vnu V1\111I r l I 161%oe%I rv11 I vN% n 1 1-9un11 1 v 1 3-1%9 1 wma,ruw •w1%1% CITY NORTH ANDOVERMA DATE PERMIT # o'"t JOBSITE ADDRESS 3 7 ,S,4oxlo L� $ Sr OWNER'S NAME1/4&/�/f /a 1*1-1,fiVA1, 40 ADDRESS SAME TEL FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL RESIDENTIAL NEW: RENOVATION: [2i REPLACEMENT:, PLANS SUBMITTED: YES[] NO ✓j FIXTURES 1 FLOOR— BSM 1 2 3 4 5 1 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK VATORY ROOF DRAIN SHOWER STALL 'SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING OTHER INSURANCE COVERAGE: I have a current liabilily nsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES7,/— NO 1—' 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 I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertirn�eenj 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 E# PARTNERSHIP} j# 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 tomhalloran@comcast.net w) 4111--114 12 -cu 61 t uil ti DatA. 1 ..1. ��....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that 1.....�'�`� -� ... (..A `'0/Z � .......................................................................................................... has permission for gas ins lation. ........................................................ 1 in the buildin "n ................. ....................^..�....`...........-.—.... ................................................ at .............. ........................ 2.5....5 ................, North Andover, Mass. Fee .... Z'b.. ... Lic. NoZ.-�4i.?5..... M.�............................................. GASINSPECTOR Check # +-M GOWNER TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTH ANDOVER MA DATE el-,�-'l L/ PERMIT # Z J013SITE ADDRESS 3 % S4vvz; e:��tS .S'OWNER'S NAME ADDRESS SAME TEL FAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL NEW:[ RENOVATION:❑ REPLACEMENT:✓ PLANS SUBMITTED: YES] NO, APPLIANCES Z 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 / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER INSURANCE COVERAGE I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY �E, OTHER TYPE INDEMNITY 0 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 D 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 compliance with all Pertinent pr vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �1w PLUMBER-GASFITTER NAME THOMAS HALLORAN LICENSE # 24833 SIGNATURE MPE MGF7 JP',/] JGF[—' LPG17 CORPORATION�i# PARTNERSHIP-4 LLCE# 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 978-685-9504 EMAIL tomhalloran@comcast.net The Commonwealth ofllMassachusetts Department of Industrial Accidents • A Office of Investigations a 600 Washington Street Boston, MA 02111 N www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers ADDlicant Information Please Print Legibly Name_(Business/Organization/Individual): 71 fid✓ �''� Address: -Va 6.>� 4 �•�� ��� City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: I. ' i; 4. F1 I am a general contractor and I El I am a employer with employees (full and/or part tame):* have hired the sub -contractors 2.M Tam a 'sole proprietor or partner- listed on the -attached sheet. ship and have no employees working for me in any capacity. [No workers' comp, insurance required.] - 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have employees and have workers' comp. insurance.t - 5. n 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 reQliired.l Type of project (requir 6. [❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. n Building addition 10.0 -Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. F1 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. #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 ain 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. Lic. #:' 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 coveratre verification. I do hereby certify under the pains •and penalties of perjury that the information provided above is true and correct. Signature: `�`�r Date: �? _ Phone #: 29 77 City or Town: area, to be completed by city or town official Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact.Person: Phone #: Q. 0 Q < LU D 03 LilIj =I- U) LEJ 0 P -q Ln fn to, La co 0 z Z221 Lid U, I -q rz wl! Q. 0 Q < LU D 03 —1 U) LEJ 0 P -q Ln fn to, r Date .. 3/!! /-'� ....... . of -I TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION 9 •4 SSCNUSEt •�� ('</ This certifies that. �� ... fj................... ......... . has permission for gas installation ... //9 ................... in the buildings of ...!!! �! ........................... . at ...�. s .............. . North Andover, Mass. Fee. ..... Lic. No./.? ?./?... ..... ........ GkS INSPECTOR Check # 1) P/) / MASSACHUSETTS UNIFORM APPLICATION F PERMIT TO DO GASFITTING _^ 2_ Jy- Mass. Date � �()1/�(L , 200 Permit # l) Building Location s SAUL b ejCr S Owner's Name IZA& i (_ f - 4 Type of Occupancy A es I Renovation n Replacement rte! Plans Submitted: Yes n Installing Coniparny Name Check one: ©"Corporation ❑ Partnership ❑ Finn/Co. No ❑ Certificate y� 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 have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance pohcy ❑,'"''�.:. Other tv p e of' enuuty ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the MGL, and that my signature on this permit application waives this requirement. Si r natme of Owner of U«ner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information t have submitted (or entered) in above 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 provisions of assaehpetts State Gas Code and Chapter 142 of the General Laws. i4f By Type of License: Title umberi aster Si a r. of Licensed lumber/Gasf tter City/Town ❑ Gasfitter ❑ Journeyman License Number APPROVED OFFICE USE ONLY) U OU all C� E Q H�0 nQ z H z W w a G Q x W fx lWW� W 44 W U f� Oc�7r� 35c�7Q0� OHQlO SIJB-BASEMENT BASEMENT / FIRST (1 ST) FLOOR SECOND (.2ND) FLUOR THIRD (,RD) FLOOR FOURTH (414) FLOOR FIFTH (STH) FLUOR SIXTH (6TH) FLOOR SEVENTH (TTH) FLOOR FI(THTH (8TH) FLOOR Installing Coniparny Name Check one: ©"Corporation ❑ Partnership ❑ Finn/Co. No ❑ Certificate y� 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 have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance pohcy ❑,'"''�.:. Other tv p e of' enuuty ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the MGL, and that my signature on this permit application waives this requirement. Si r natme of Owner of U«ner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information t have submitted (or entered) in above 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 provisions of assaehpetts State Gas Code and Chapter 142 of the General Laws. i4f By Type of License: Title umberi aster Si a r. of Licensed lumber/Gasf tter City/Town ❑ Gasfitter ❑ Journeyman License Number APPROVED OFFICE USE ONLY) r,1 TOWN OF NORTH ANDOVER Office of the Building Department Community Development and Services 1600 Osgood Street North Andover, Massachusetts 01845 Gerald Brown Inspector of Buildings February 5, 2008 Ehteram Vakili 37 Saunders Street North Andover MA 01845 Dear Mr. Vakili Telephone (978) 688-9545 FAX (978) 688-9542 Please be advised that upon an inspection, requested by the Police Department, of the rear garage structure on February 5`h 2008 it has been deemed that the structure is in an unsafe condition which may result in injury to abutters or abutters property, local children or anybody utilizing the structure for its intended use. Please accept this letter as a official notice under the Mass State Building Code (780 CMR) section 121 Unsafe Structure which states in part "The building official immediately upon being informed by report or otherwise that a building or other structure or anything attached thereto or connected therewith is dangerous to life or limb or that any budding in that city or town is unused, uninhabited or abandoned, and open to the weather, shall inspect the same; and he shall forthwith in writing notify the owner to remove it or make it safe if it appears to him to be dangerous, or to make it secure if it is unused, uninhabited or abandoned and open to the weather. Please contact me so that we may begin the process to remedy this in a timely fashion, i may be reached between the hours of 8:30 —10:00 AM at 978-688-9545. The State code also has serious penalties for failure to make a structure safe section 118 states in part " Whoever violates any provision of 780 CMR, except any specialized code referenced herein, shall be punishable by a fine of not more than $1000. or by imprisonment for not more than one year, or both for each violation. Each day that a violation exists shall constitute a separate offense. Respectfully, Gerald Brown Inspector of Buildings R Page 1 of 1 Brown, Gerald From: Brown, Gerald Sent: Tuesday, February 05, 20081:55 PM To: Leathe, Brian Subject: FW: Structurally unsound buildings Brian please check this out and take pictures and do order letter thanks Jerry -----Original Message ----- From: Thomas E. Donovan [mailto:tdonovan@napd.us] Sent: Tuesday, February 05, 2008 1:42 PM To: Brown, Gerald Cc: Paul J. Gallagher Subject: Structurally unsound buildings Mr. Brown, I'm a detective at North Andover police department. Can you check two garages which appear to be unsafe and are either falling down or appear to be structurally unsound. The first being a garage behind the old Bradford st school. The roof is caved in and the building is falling down. The second second being a garage behind 94 Main St. which appears to be leaning to one side. Chief Stanley requested that I notify you and ask if something could be done. Please let me know of your findings. Detective Thomas E. Donovan North Andover Police Department (978)683-3168 2/29/2008 Page 1 of 2 Brown, Gerald From: Brown, Gerald Sent: Friday, February 29, 2008 2:58 PM To: Bellavance, Curt Cc: 'rstanley@napd.us; 'tdonovan@napd.us' Subject: RE: structurally unsound buildings I am attaching the February 5, 2008 order letter and accompanying photos, mailed the same day as the complaint from Officer Donovan. The second garage, berhind 94 Main Street, did not appear to be in dangerous condition to Brian Leathe, so no order letter was sent to the owner. Mr. Vakili's garage does seem an immediate danger, and he was notified. He has phoned the office, and he is taking steps to correct the situation. -----Original Message ----- From: Bellavance, Curt Sent: Friday, February 29, 2008 12:49 PM To: Richard M. Stanley; Brown, Gerald Subject: RE: structurally unsound buildings Importance: High Jerry: Can you please check this out and let the Chief and me know what the story is with the two garages. Thanks. Curt. -----Original Message ----- From: Richard M. Stanley [mailto:rstanley@napd.us] Sent: Friday, February 29, 2008 12:36 PM To: Bellavance, Curt Subject: FW: structurally unsound buildings Curt -many attempts and no help. PIs get involved. Thanks-rms From: Thomas E. Donovan Sent: Thursday, February 28, 2008 5:33 PM To: Richard M. Stanley Subject: RE: structurally unsound buildings That's a negative. Let me know what you want me to do next. TED From: Richard M. Stanley Sent: Thursday, February 28, 2008 12:00 PM To: Thomas E. Donovan Subject: RE: structurally unsound buildings Tom -Did you get anything back from him????? 2/29/2008 rage L or L From: Thomas E. Donovan Sent: Monday, February 25, 2008 1:41 PM To:'cbelevant@townofnorthandover.com' Cc: Richard M. Stanley; Paul 1. Gallagher Subject: structurally unsound buildings Sir, I'm a detective at North Andover police department. I had asked Mr. Brown if he could check two garages which appear to be unsafe and are either falling down or appear to be structurally unsound. The first being a garage behind the old Bradford St. school. The roof is caved in and the building is falling down. The second being a garage behind 94 Main St. which appears to be leaning to one side. Chief Stanley had requested that I contact Mr. Brown. After two E-mails, I failed to hear from Mr. Brown and had to notify the Chief of this, to which he was not happy. The Chief stated that he was informed that Mr. Brown was on vacation and asked me notify you in his stead. Please let me know of your findings and if there is anything I could do to assist. Thank you for your time and attention to this matter. Detective Thomas E. Donovan North Andover Police Department (978)683-3168 2/29/2008 Date . /! ................ . o? h` TOWN OF NORTH ANDOVER F F • PERMIT FOR GAS INSTALLATION �9SSACHU5Et This certifies that .............. ~... ........................... . has permission for gas installation ... -4 .................... in the buildings of..1....................................... at ..... ? ............................ . North Andover, Mass. Fee......... Lic. No. ...... ........................... GASINSPECTOR Check # ' , MASSACHUSETTS UNIFORM APPLICATION FOR ERMIT TO DO GASFITTING av , (Print or Type) r = /V 4"V Mass. Date ! d L Permit # 32,23 G Building Location M __; 419uy 4 &c& j /iJ Owner's Name 6tDR6,Z 6Zc , Type of Occupancy, New p Renovation ❑ Replacement ES � '' Plans Submitted: Yes❑ No p 4 Installing Company Name12.4i:/ / LSEih /c Check one: Certificate . Address 6d-/ OL d Y.�..r/frl.;2� IK -0 O Corporation A114m6P Vo r n-7,,4 Q/ g -.LL Q • Partnership Business Telephone 9 i; i .2.2 9' M::�-Firm/Co. Name of licensed Plumber or. Gas Fitter 0/— INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes R. No 0 - If -If you have.checked yes. please indicate the type coverage by checking the appropriate box A liability insurance policy IR 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: Owner[3 Agent ❑ Signature of Owner or Owner's Agent 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 installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen Laws. By. Tyae of License: umber Sign lure of Licensed Piu ror Gas lFitter Title Gasfitter gMaster License Number CityJTown Journeyman I1PPFidVED I NL . Y .. - ■�tt�t��t���t�e��l��i�il��t�� Installing Company Name12.4i:/ / LSEih /c Check one: Certificate . Address 6d-/ OL d Y.�..r/frl.;2� IK -0 O Corporation A114m6P Vo r n-7,,4 Q/ g -.LL Q • Partnership Business Telephone 9 i; i .2.2 9' M::�-Firm/Co. Name of licensed Plumber or. Gas Fitter 0/— INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes R. No 0 - If -If you have.checked yes. please indicate the type coverage by checking the appropriate box A liability insurance policy IR 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: Owner[3 Agent ❑ Signature of Owner or Owner's Agent 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 installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen Laws. By. Tyae of License: umber Sign lure of Licensed Piu ror Gas lFitter Title Gasfitter gMaster License Number CityJTown Journeyman I1PPFidVED I NL . 0 D J m LL z O - Q 0 J w W U. C9 O w J CL J N/ z N O. W a N 0 V LL O 0 O Z U.H O w w ma LL. 69. CA W r U F- W Y c z O H U W a z J Q z LLI 0 D J m LL z O - Q 0 J w W U. C9 O w J CL N/ / N a 0 Date. -'!..'.! . (. 7 . . NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING •no SACHUS� This certifies that!.f ................... . has permission to perform .......... ...................... . plumbing in the buildings of ... /`.<..t. (........................... at ...3. ?`� !�....� c .. ................. .North Andover, Mass. Fee..2 & .... Lic. No.. .. .........-.. rl..> .......... . PLUMBING INSPECTOR Check # 16 1 5)S4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING - (Print or Type) Dw L Mass. Date r? Permit # Building Location .3 % -Si4yV17gae l � !O/wner's Name, Type of, cupancy &L< 1 New ❑ Renovation ❑ Replacement OF Plans Submitted: Yes ❑ No ❑ . Installing Company Name �� ��Sfir�/G� �,! ' Check one:. Certificate Address / `� 6L d Y.�. /► F_ ef l ❑ Corporation oirf ?7— ❑ Partnership Business Telephone U1 firm/Co. Name of Licensed Plumber 10/51-U INSURANCE COVERAGE: 1 have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Cg-*— No ❑ If you have checkedrtes, please indicate the type coverage by checking the appropriate box A liability insurance policy 1,5L 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: 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with. all pertinent provisions of the Massachusetts State Plumbing a and Chapt 2 of the Ge ws. By /1 Sign re of Licensed Plumber / Title - Type of License: Master Journeyman ❑ j City/Town APPF%OVEp (O FICUS ONL _ License Number /2 �f FIXTURES . z z an Y • WZ I- ars J OO !. 0 X < Z W W <r y O D ¢ j N W p W W W ¢ r V < W a Y< __ ¢ 0 IL W o Z < O. < "3 x V Z 0 9 ¢ W fA <. W r CJ p 4 ¢ of J Z¢ Q a¢ p Q 16 ¢ W=<= W W 3 3 0 2 S Y d 0 r < Y < = W {6 Y W ~ < V a a- O S d W yr 0 a 0 O. y Z ¢ Z .W 1- < O U 1' < < S < < < .j 1 < .¢ ¢ O < F- SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR. 4TH FLOOR STH FLOOR GTH FLOOR 7TH FLOOR STH FLOOR Installing Company Name �� ��Sfir�/G� �,! ' Check one:. Certificate Address / `� 6L d Y.�. /► F_ ef l ❑ Corporation oirf ?7— ❑ Partnership Business Telephone U1 firm/Co. Name of Licensed Plumber 10/51-U INSURANCE COVERAGE: 1 have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Cg-*— No ❑ If you have checkedrtes, please indicate the type coverage by checking the appropriate box A liability insurance policy 1,5L 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: 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with. all pertinent provisions of the Massachusetts State Plumbing a and Chapt 2 of the Ge ws. By /1 Sign re of Licensed Plumber / Title - Type of License: Master Journeyman ❑ j City/Town APPF%OVEp (O FICUS ONL _ License Number /2 �f w w V Cni cn Z 0 W CL Cl) Z ziFL Z 0 uj (1) LLI 0 LL 0 U) 0 LL 0 i w ui ui LLI co IL LujL w w V Cni cn Z 0 W CL Cl) Z ziFL LU U) O LU LU D Location —3y --?12 SA S�— No. Date HORT1� TOWN OF NORTH ANDOVER F ' Certificate of Occupancy $ s':^�„ t<Building/Frame Permit Fee $ Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ Check # -796)-3 j PIP Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 7777 BUILDING PERMIT NUMBER: DATE ISSUED:Z�J SIGNATURE: � " G ,>/j% C Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION �j 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ap Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RegWred Provided RecMired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �d �iw�? r? /,►o� (/i� �� ��/ � � ��y�lip��'l/� �/f h/G �yr�dUzrYC �'/A Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: r i nature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 3 Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name 7 ����� - n��G f j�� //f 1/ fi" . Address Registration Number Expiration D99 Si nature Telephone bi u 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 ....... El No ....... ❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: vo' SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant-;,`-,": OMCIAL. SE ONLY 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 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH.DING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Prin Zr Si ature of Owner/A ent Da NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVMERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t 1. BUILDE iG DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properiy licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Signature of Permit Applicant y i ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Y � 92. Voorurnana�eall�i o� �,a�taciuueCla �\ HONE IMPROVEMENT CONTRACTOR Registration: 120131 = Expiration: 10/22/01 Type: Individual ROBERT R. BELANGER 1278R8RIOGEAStER ADMINISTRATOR ORACUT NA 01826 i !PRODUCER INSURED 11� CERTIFICATE OF INSURANCE //DATE(M/WDD/YY) THIS CERTIFICATE IS ISSUED AS A MATTER O INF8RMAT O ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JEAN D. LECLERC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR INSURANCE AGENCY INC ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1006 WESTFORD ST - - .---------.-. COMPANIES AF_F.ORDI_NG_CO.VERAGE. LOWELL,MA 01851 COMPANY A FIRST FINANCIAL INS CO COMPANY ROBERT BELANGER B 1278 BRIDGE ST COMPANY DRACUT, MA 01826 C AUTOMOBILE LIABILITY BODILY INJURY (Per person) ANY AUTO $ ALL OWNED AUTOS (Private Pass) BODILY INJURY $ I ALL OWNED AUTOS (Per accident) (Other than Private Passenger) HIRED AUTOS PROPERTY DAMAGE $ NON -OWNED AUTOS GARAGE LIABILITY BODILY INJURY & - PROPERTY DAMAGE $ COMBINED _EXCESS LIABILITY �— EACH OCCURRENCE $ _ _l UMBRELLA FORM AGGREGATE $ _ l OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND I STATUTORY LIMITS EMPLOYERS' LIABILITY - -- EACH ACCIDENT $ THE PROPRIETOR/ INCL DISEASE • POLICY LIMIT $ PARTNERSIEXECUTIVE ------------- --------- ------ OFFICERS ARE: EXCL !P DISEASE _EACH EMPLOYEE (OTHER POMMERCIAL GENERA, IABILITY COVERAG F0131G414178 0/27/1999 6/27/200 _ $500,000 - DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS FOR: PLEASANT ST NO ANDOVER, MA 'CERTIFICATE HOLDER CANCELLATION I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MOHAMMAD VAKILI I EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I 3219 PALM AIRE I Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ROCHESTER HILL, MICHIGAN 48309 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF_ ANY _ KIN_D_ UPON THE COMPANY, ITS AG E OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE i ACORD 25-N (3/93) © ACORD CORPORATION 1993 COMPANY D 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 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___ _____ _- COI LTR TYPE OF INSURANCE � POLICY NUMBER POLICY EFFECTIVE DATE (MDD/YY) W POLICY EXPIRATION DATE (MIAIDD/YY) LIMBS GENERAL LIABILITY BODILY INJURY OCC _ I COMPREHENSIVE FORM BODILY INJURY AGG $ ' PREMISES/OPERATIONS I ( PROPERTY DAMAGE OCC_l $ !UNDERGROUND EXPLOSION &COLLAPSE HAZARD PROPERTY DAMAGE AGG $ -- -_-- PRODUCTS/COMPLETED OPER _ BI & PO COMBINED OCC _ $ CONTRACTUAL BI & PD COMBINED AGG _� INDEPENDENT CONTRACTORS PERSONAL INJURY AGG $ BROAD FORM PROPERTY DAMAGE - AUTOMOBILE LIABILITY BODILY INJURY (Per person) ANY AUTO $ ALL OWNED AUTOS (Private Pass) BODILY INJURY $ I ALL OWNED AUTOS (Per accident) (Other than Private Passenger) HIRED AUTOS PROPERTY DAMAGE $ NON -OWNED AUTOS GARAGE LIABILITY BODILY INJURY & - PROPERTY DAMAGE $ COMBINED _EXCESS LIABILITY �— EACH OCCURRENCE $ _ _l UMBRELLA FORM AGGREGATE $ _ l OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND I STATUTORY LIMITS EMPLOYERS' LIABILITY - -- EACH ACCIDENT $ THE PROPRIETOR/ INCL DISEASE • POLICY LIMIT $ PARTNERSIEXECUTIVE ------------- --------- ------ OFFICERS ARE: EXCL !P DISEASE _EACH EMPLOYEE (OTHER POMMERCIAL GENERA, IABILITY COVERAG F0131G414178 0/27/1999 6/27/200 _ $500,000 - DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS FOR: PLEASANT ST NO ANDOVER, MA 'CERTIFICATE HOLDER CANCELLATION I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MOHAMMAD VAKILI I EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I 3219 PALM AIRE I Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ROCHESTER HILL, MICHIGAN 48309 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF_ ANY _ KIN_D_ UPON THE COMPANY, ITS AG E OR REPRESENTATIVES. 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