Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 35 ABBY LANE 4/30/2018
w 9 North Andover Board of Assessors Public Access NO RTM Of �a �� stip ♦ e ; M ,SSACNU`+Et Click Seal To Retum Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Aorth Andover Page 1 of 1 L46roperty Record Card Location: 35 ABBY LANE Owner Name: TILTON, BRIAN K. TILTOM, MARIA N. Owner Address: 35 ABBY LANE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 10 - 10 Land Area: 0.50 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 4582 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 989,200 978,300 Building Value: 740,900 692,600 Land Value: 248,300 285,700 Market Land Value: 248,300 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2254804&town=NandoverPubAcc / i 3/18/2013 CD NN; V, �B _� € C9 ' ooXV)a � � O a)0 W Na) c CgWUC 0 t i (L } o°Lim'G) m LL tOUmm� > a W ckX,F g ` m N m O co a � 00 � L70 U �' m �'U > U .o 0 4 p 00 Z aa) Q O a of LCD JLI o o ? c na) F- o � c; 0 0 oQ �0[LI Z o 10- CL E ••' o OMd.N "O J O p p. U7 (OD U)m'.m U) (D X0 O J � co coo o LQ .3 NO Y � U O d ui l a) m 0.0.0 C, CL L U U,ii E O N (XOO OX LO :5 F- F- F- W O d cQ C o Z O O O O c a I* N co O Q 0 R LL _Z O J Y Z W CD V z W% Qw z N of a m2 JQ } c_IJ 2L o Q 3F F CMZ a O Q m 0 0 0 0 0 ao CIDN O 0 LO to 0 O N 0 N o_ 00 M h y`. W OD N CO J J #7'OD 81.. ;.N x _ .e•J c; O O. a M r 00 LO N Z C'4 C4 Z Lr OW II a v a .. Q Q�� C c J J ��.. 2 N cc l oC) O z s O ao 66 Z Z o (V au O Wi m ` �. �y.�N = Q QNQ •7 -2:2a W o ;_ > m m �::: �►\ g I�.co Z O 0 N MMOO m co P- d �'s O'er m m o o col VF;� FF - O c 0 O Z d m[OE Oi.O a ! N coo C7 � � E�aj. 3 a1 ..N, Q o ' v1 61•. m ` Q Ia.+ E O comL V N � i0 m U ECO.E ZIaO y�l�� LL CIO Ci,N UY O+O=IV'� QmkLLm of2InU Q, ZZ d H kc Z O/CD ! co 00W f L - N O i N N Vim' N N i W ilii. O N Qf asp w n LA in rr O m((�< af)i :: ¢¢a1 LL .30. fi W CQIQ E�Q °iE� LL C Q C I m_d'=�0-0 OI C C LL LL •i OL w— a7 . M C ,...,..Ur Vf r 0 N v � � Q � .I- fL. 0;Q_ Z 0 � Q Q� OE&L U) U- '•� C mkc � 0 q C) 0 o;m'd.mC7Uwa U�'m d".0 -r IvY� �w Ur 2 W Oco m ti M R UJ CO a J O '. UtVO(Dm ooU LLL. C7Mi''. ! d { O) F- 0'• M,Qj'..�U d I ia) ? CL Q, dIQ Xf..'' � jC+-03 F- Q 2 45 v- O F- >,o;o,X � of ('� �Ia) ( U)10_ W 2 LL S LL LL V o > CL L7 Y m 0 0 0 0 0 ao CIDN O 0 LO to 0 O N 0 N o_ 9 1 ,4ORTM O A te.... ........ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SS�cNusf� This certifies that".'.... ........................ has permission to perform ,... plumbing in the buildings, of ' ................................. at y�f ... .... r ;...... , North Andover, Mass. Fee.yl' Lid`No.�.�� ,=I�NSPE ..........: j F CTOR Check # ��'7' ?223 ' r MASSACHUSETTS UNIFORM APPLICATION?EOR;PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date 2 - 20 .a- Building Location _'� Owners Name L Permit # " a,3 Amount je4tj44 -- Type of Occupancy . New [2] Renovation 0 Replacement Plans Submitted Yes C] No FIXTURES (Print or type) Check one: Certificate 1 Installing Company Name C0\'\P0a-T 'rLC4-- =-rte Q Corp. 17 Address �lR GF-- 3 �;� y � Partner. Business Telephone G'I f _ CISH - `7rW E] Firm/Co. Name of Licensed Plumber. Insurance Covera¢e: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity E] Bond insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 1:1 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts�tqPPlumbing Code d Chapter 142 of the General Laws. By: Signature 61.0censea rlumuer� Type of Plumbing License Title f (3�S" City/Town icense um Master © Journeyman Y APPROVED (OFFICE USE ONLY Date .. / % .... . HORTM OF ,M TOWN O TH ANDOVER O .3141559 PERMIT FOR GAS INSTALLATION �y 3 SACMUSEt This certifies that .......... ..... .... . has permission for gas installation,-.,X.,...71 . `.... .............. in the buildings of ".� Pte........................... . at .-.�..L�� / yy .� ,North Andover, Mass. Fee �. � .. Lic. N�o.!!..,�'..... ........... �4�GAS INSPEI�TOR Check # _ ? /,�6 r 5851 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations 3,5 xy:;04 LN...- -c-, Date I D- • Z) 0 - Owner's Name QA ,t-,wl 1 (jz� New D Renovation 1:1 Replacement D Plans Submitted Permit # Amount $ Aer, ei (Print or type) I� Check one: Certificate Installing Company Name 1:1 Corp. Address 1°�Gl`��¢ S� • �-` 33'3 Partner. Business I a ep one pt15 ,Q`---7_-1�� � Firm/Co. Name of Licensed Plumber or Gas Fitter fXA 1'(L,—AA idA LA - INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D Noo If you have checked ,yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy © Other type of indemnity 13 Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 13 I nereoy ceruty tnat au of the aetaus and information l 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. N .L, A I — (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber 11353' Gas Fitter License Number © Master Journeyman x z a C4 O a a W O F U x C4 °m F W a > c c o w F w Q > z W p > z O � wz > d C ¢ Q O O w m x o m 3 q t5 w a > a a0 H o SUB-BASEM ENT B A S E M E N T 1ST. FLOOR 1 2ND. FLOOR I 3RD. FLOOR I 4 T H. F L O O R 5TH F L O O R 6THFLOOR LOO R . HF R (Print or type) I� Check one: Certificate Installing Company Name 1:1 Corp. Address 1°�Gl`��¢ S� • �-` 33'3 Partner. Business I a ep one pt15 ,Q`---7_-1�� � Firm/Co. Name of Licensed Plumber or Gas Fitter fXA 1'(L,—AA idA LA - INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D Noo If you have checked ,yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy © Other type of indemnity 13 Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 13 I nereoy ceruty tnat au of the aetaus and information l 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. N .L, A I — (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber 11353' Gas Fitter License Number © Master Journeyman Date .........:.. 1...`p HOR711 O� TOWN OF NORTH ANDOVER n PERMIT FOR WIRING ACHUS This certifies that ........................................................ ............................. has permission to perform .......... . n OL .........� . �.......................... wiring in the building of I.; P ................... v................................. at ..... . �T .. S 44 t/ Lam/ ................................... , North Andover, Mass. Fee .: ;� °:.'�.4n.. Lic. Not 3?n..........(E At" -'e- .... ELECTRICAL INSPECTO,Tt Check # ^� r 6 ! i;'I Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. �i 77/ Occupancy and Fee Checked [Rev. 9/05] (leave blatnk) 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 INK OR TYPE ALL INFORMATION) Date: 7-11-0,6 City or Town of: �/ //&t— To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 2o7 .'— 4Mel 44R -/o - Owner or Tenant !; ��� p (j�j,/.fr�h c! Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. 911�11 9dG Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service UO Amps /20 16-D36 Volts Overhead ❑ Undgrd EAI- No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:Completion of the ollowing mble may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above—❑ In- ❑ o. o Emergency Lighting rnd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Number Tons KW No. o Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal [_1 Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. o No. of Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP elecommunications firing: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify�iisapplic, I certify, under the pays and penalties of perjury, that the information on is true and complete. FIRM NAME: /% C�iLla AZ LIC. N0.:OD305i '- Licensee: i �`L% Signature LIC. NO.P23 (lf applicable, enter "exempt" in the license number line) �� Bus. Tel. No.. Address: 0A06 %WOW l� � Alt. Tel. No.: *Security System Contractor License required for this work; if a plicable, enter the license number here: OWNER'S INSURANCE WAIVER: 1 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. 1 am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE. $ SignatureturaTelephone No. "pRTq pf ,Mp TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....t . �. ? �! ..... ! ................ has permission to perform ... ............... plumbing in the buildings of ...�""14. Ae?'..f ................... at.I s G i............... North And over'Miss. Fee.16.G,. Lic. No../.?. �.'.1. ........ r O PLUMBING INSPECTOR Check H « . " MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location `J Owners Name N1 I'Yb' Permit # Amount ---Type of Occupancy /� Ie S New d Renovation Replacement Plans Submitted Yes ❑ No ❑ (Print or type)4Check one: Certificate Installing Company Name/'m',/' ❑ Corp. Address Partner. T-6 C, Busme s Telephone -42 Firm/Co. Name of Licensed Plumber: )'f fil-'AA s / 'o, & Insurance Coverage: Indicate the pe of insurance coverage by checking the appropriate box: Liability insurance policyIq Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ 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 Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusettsS Plumb' g Codeendue the General Laws. By: rgna ure o icenseo riumDer t Type of Plumbing License Title ,*--41- ,._/` 7 City/Town 1INEMDer Master Journeyman ❑ APPROVED (OFFICE USE ONLY i • -,': V DL/ D\I mk-lmoco-o,.Mnmnmmnnmmmmmmmmmmmmmm mmonnnnnmnnmmmnnnmmmnmmmnnn W-5 T' MnnMnMMMMnMnnnnnnnnnnnnn�■ ofmmmmMMMMMMMMMMMMMMMMMMMM� • 411 nnnnnnnnrnsaMHMaM�nn , „' MMMMMMMMMMMMMMMMMmmmmmmm �;,MMMMMminimmiiiiiiiiiimiiii (Print or type)4Check one: Certificate Installing Company Name/'m',/' ❑ Corp. Address Partner. T-6 C, Busme s Telephone -42 Firm/Co. Name of Licensed Plumber: )'f fil-'AA s / 'o, & Insurance Coverage: Indicate the pe of insurance coverage by checking the appropriate box: Liability insurance policyIq Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ 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 Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusettsS Plumb' g Codeendue the General Laws. By: rgna ure o icenseo riumDer t Type of Plumbing License Title ,*--41- ,._/` 7 City/Town 1INEMDer Master Journeyman ❑ APPROVED (OFFICE USE ONLY Insurance Company Name: Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/state/Lip. Attach a copy of the workers' compensation policy de'ciar ation page (showing the policy number and expiration dat?4 Failure to secure coverage as required. under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is tree and correct Si ttrre: Date: Officio! use onfy. Do not write in this area, m he completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Towu Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Coniact Person: Phone # The Commonwealth of Massachusetts k; 1i 1 Department of Industrial Accidents Office ©, f Investigations 411 fUU ,: �'fi 600 Wliuhington Street Boston, MA 02111 WWW massgov%dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pinmbers Applicant Information Please Print Legibly Name (Business/Organiza6on/indlvidual): Address: City/State/Zig: Phone #: . Are you an employer? Check.the appropriate box: t. [] I am a employer with 4. Type of Project (required): ❑ I am a general contractor and I employees (full and/or part-time).* 2•❑ I am.a-sole proprietor or have hired the sub -contractors 6• ❑ New construction . listed partner_ ship and have no employees on the attached sheet, S 7• ❑ Remodeling These sub -contractors have 8• Q Demolition working for mei' an capacity, Y tY [No workers' comp. insurance workers' comp. insurance• 9. Building 5. ❑ We are a corporation and its Q addition 3. ❑required.] I am a homeowner doing officers have exercised their 10.Q Electrical repairs or additions all work myself. [ND -workers' comp. right of exemption per MGL I I .Q Plumbing repairs or additions c, 152, § t (4), and we have no § 1( insurance required.] t 112-[] Roof repairs e m to P Y [No workers' comp. iinsurancc required..] 13 Q Othtr- •Airy applicant checks bo> !/ I must also fill out the section below showing their workers' oompensefion policy information, homeownewhoho t rs submit this affidavit indicating they are.daing 1111 work and then hire outside contractors ;Carrdactors roust submit a new affidavit indicating such that check this box tnustattaclred an additions) sheet shawire ; ke nine of the sub -contractors and their workers' comp• pclic; i ;fortnetion. I enc an employer that iss.ptotriding:workera' comp information. ensa&an uzcrsrance fOr AV e/nploye= Below is the policy and. job site . Insurance Company Name: Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/state/Lip. Attach a copy of the workers' compensation policy de'ciar ation page (showing the policy number and expiration dat?4 Failure to secure coverage as required. under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is tree and correct Si ttrre: Date: Officio! use onfy. Do not write in this area, m he completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Towu Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Coniact Person: Phone # Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract 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 inciudirig the legal representatives of a deceased employer, or the receiver ortrusb_— of an individual, partnership, association or other legal entity, employing employees. •Howeverthe 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 requn-ements 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).arid phone number(s) along with their certificates) 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 tate 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 num. berlisted 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 hes 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 mill 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 policyinformation (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 starnped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for firtum permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Depamnent's address, telephone and fax number. The Commonwealth of Massachusetts Department of Iandustriai Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL # 617-727-4900 Ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.ma&s.gov/dia INA 1a 1/ an o i Date ............... c..... Of .NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION i .This certifies that ... 6. ....../.. .f/� .............. has permission for gas installation .... &.' .UC ... in the buildings of ......... .............. . of ... 3. ? ................ Noroi Andover, Mass. Fee.. ?p �. Lic. No..�.a�� ���.a.. i ? ... . G r�AS�INSPECTOR Check # Ll 6797 MASSACHUSETTS UNW ORM APPLICA,"YON FOR PERMIT TO DO GAS I'1TnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations _ '406 % -�'►l Owner's Name New _ Renovation Replacement ❑ Date Plans Submitted ❑ Permit # Amount------------- $ -- mess ti Name of.Licensed Plumber'or Gas Fitter R '-heckone: Certificate Installing Company n Corp Partner. 0 Firm/Co. INSURANCE COVERAGE I have a current liability insurance, policy or it's substantial equivalent. Check one: If you have checked ves, please in 'cate the type coverage by checking the appropriate box.Yes No Liability insurance policy 2 Other type of indemnity D BondEl Owner's Insurance Waiver: f am aware that the licensee does not_h� the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: i hereby certify that all of the details and information 1 have submitted or entered) Owner in D application a and accurate best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State to the Code d Chapt 142 of the en ws. �. Title Signature of Licensed Plumber Or Gas Fitter City/7'own, � Plumber1:1 4 Fitter License um er Master 4PPROVED (OFFICE USE ONLY) n Journeyman U Z G Z m W O UO p � p z F H Z z Q x a v' �' Z W dF vy2� C p C C Q zW y o F W W z w r1 W z F o i F yW. W SU B-BASEM ENT z _z $ C ; CG o _BASEMENT i IST. FLOOR 2ND. FLOOR 3.R D. FLOOR ATH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH, .FLOOR 8TH. FLOOR mess ti Name of.Licensed Plumber'or Gas Fitter R '-heckone: Certificate Installing Company n Corp Partner. 0 Firm/Co. INSURANCE COVERAGE I have a current liability insurance, policy or it's substantial equivalent. Check one: If you have checked ves, please in 'cate the type coverage by checking the appropriate box.Yes No Liability insurance policy 2 Other type of indemnity D BondEl Owner's Insurance Waiver: f am aware that the licensee does not_h� the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: i hereby certify that all of the details and information 1 have submitted or entered) Owner in D application a and accurate best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State to the Code d Chapt 142 of the en ws. �. Title Signature of Licensed Plumber Or Gas Fitter City/7'own, � Plumber1:1 4 Fitter License um er Master 4PPROVED (OFFICE USE ONLY) n Journeyman WHYKI_ mass.; ovl a Workers, Compensation Insurance.A.Eidavit, Diicant Information guijtiers/Contractors/Electriccans/plumbers of_ — . .- Name (Bus iness/Drganization/Individual): Address: City/Slate/Zip: Are you an empioyer? Check the appropriate box: ❑ I an a employer with 4. ❑ I 2. ❑ 3. ❑ employees (full and/or part-time).* i am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] I am a homeowner doing all work myself. [No workers' comp. insurance required.] t LE `Any applicant that checks box M .must slso'fill out the section below showin + ` g their work rinmaowners who submii •iwt aiudavit indicating Stev are doiti� = . Cvc: r �' compensation ofi L- IC ilial eheci; this box.musi attached an additienal sheet showing p L mrormahoa. "'u Erten lilt✓ outsiae eonvac lura moil xuhmii a new amunvii indicating s cit. the —me of the sub carp -tors and their workers' comp. policy information. I am an. errtployer that is providing, workers' contpencatiorz i�urarice for rrg� e 1 e� . information mp oJ' -s Below is the policy and job site Insurance Company Name: Policy 4 or Self .ins. Lit. #: Expiration Date: Job Site Address: Attach a copy of the workers' compeCity/state/Zip: nsatiolin pocy deciaration page (showin; the policy number and expiration �y Failure to secure coverage as required tinder Section 25A of MGL C. 152 c P bate}. fine up to 511500.00 and/or one-year imprisonment, as well as civil penalties in theforme of a STOP WOR�mposition of rpRDER�and a fin of up to .5250.00 a day against the violator. Be advised that a Copy Investigations of the DIA for insurance cov,,age verification. of thisstatement may be forwarded to the Office of e I do hereby certify under the pains and penalties ofperjury that the in or f motion provided above is true and correct Sign atvre: Dat>; Phone #: Official use on1p. Do not write in this area, to be completed by cit), or town nciaL City or Town: Issuing Authority (circle one): Permit/License # 1. Board of Health 2. Building Department 3. City/Town Gierk 4. Electrical inspector 5. Piumbin- 6. Other d Inspector Contact Person: Phone Phone #: aM a general contractor and I have hired the sub -contactors Iisted ozi the attached sheet t These srrb-contractors have workers' comp. insurance. We are a corporation and its offir- s have exercise d.theit right of exemption per MGL c. 152, § h (4), and we have no employees. [No workers' COMP- insurance required.] Type of Project (required): 6•. ❑ New construction 7• ❑ Remodeling . 8• ❑ Demolition 9. ❑ Building addition 10:❑ Electrical repairs or additions 1' 1.0 Plumbing repairs or additions 12:0 Roof repairs 1.3.❑ Other The Commgn wealth of Manachusettr ' 146 Department o Ind 1 ustrial Accidents IK I l±i 1 IbH..7fI ' :; �-,L, . Dffiee of Investia ; ?I 'n, batlolLS 600 Washin,,,,ton Street tl" L'nsto WHYKI_ mass.; ovl a Workers, Compensation Insurance.A.Eidavit, Diicant Information guijtiers/Contractors/Electriccans/plumbers of_ — . .- Name (Bus iness/Drganization/Individual): Address: City/Slate/Zip: Are you an empioyer? Check the appropriate box: ❑ I an a employer with 4. ❑ I 2. ❑ 3. ❑ employees (full and/or part-time).* i am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] I am a homeowner doing all work myself. [No workers' comp. insurance required.] t LE `Any applicant that checks box M .must slso'fill out the section below showin + ` g their work rinmaowners who submii •iwt aiudavit indicating Stev are doiti� = . Cvc: r �' compensation ofi L- IC ilial eheci; this box.musi attached an additienal sheet showing p L mrormahoa. "'u Erten lilt✓ outsiae eonvac lura moil xuhmii a new amunvii indicating s cit. the —me of the sub carp -tors and their workers' comp. policy information. I am an. errtployer that is providing, workers' contpencatiorz i�urarice for rrg� e 1 e� . information mp oJ' -s Below is the policy and job site Insurance Company Name: Policy 4 or Self .ins. Lit. #: Expiration Date: Job Site Address: Attach a copy of the workers' compeCity/state/Zip: nsatiolin pocy deciaration page (showin; the policy number and expiration �y Failure to secure coverage as required tinder Section 25A of MGL C. 152 c P bate}. fine up to 511500.00 and/or one-year imprisonment, as well as civil penalties in theforme of a STOP WOR�mposition of rpRDER�and a fin of up to .5250.00 a day against the violator. Be advised that a Copy Investigations of the DIA for insurance cov,,age verification. of thisstatement may be forwarded to the Office of e I do hereby certify under the pains and penalties ofperjury that the in or f motion provided above is true and correct Sign atvre: Dat>; Phone #: Official use on1p. Do not write in this area, to be completed by cit), or town nciaL City or Town: Issuing Authority (circle one): Permit/License # 1. Board of Health 2. Building Department 3. City/Town Gierk 4. Electrical inspector 5. Piumbin- 6. Other d Inspector Contact Person: Phone Phone #: aM a general contractor and I have hired the sub -contactors Iisted ozi the attached sheet t These srrb-contractors have workers' comp. insurance. We are a corporation and its offir- s have exercise d.theit right of exemption per MGL c. 152, § h (4), and we have no employees. [No workers' COMP- insurance required.] Type of Project (required): 6•. ❑ New construction 7• ❑ Remodeling . 8• ❑ Demolition 9. ❑ Building addition 10:❑ Electrical repairs or additions 1' 1.0 Plumbing repairs or additions 12:0 Roof repairs 1.3.❑ Other Information and Instructions Massachusetts General. Laws chapter 152 requires all employers to provide workers' compensation for their employees. y Pursuant to this statute, an employee is defined. as ".. every Iperson 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 inclurii-n.athe legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, associati on 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 o r local licensing agency shall withhold the issuance or renewal of a license or permitto operate a business or to construct buildings in the commonwealth for -any applicant who has not produced acceptable evidence mT 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 compi-etely, 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 certificates) 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 L1.0 or LLP does have . employees, a policy is required_ Be advised. that this affid-a.vit may .be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Aiso 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 re a- ding the law or if you are required to obtain a workers' compensation policy; please call the Deparnnent at the nuanb ,listed below. Sslfinsured 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 pe:rmitAicense number which will be used as a reference number. In addition, an applicant that must submit multiple permi0icense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicantshould 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 Iicens-- or permit not related to any business or commercial venture (i.e. a. dog license or permit to burnleaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like tothank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fay, number: The Commonwealth of Massachusetts I2epartment Of lmdus tial Accidents Office of Lavestigations 600 WashLirigtQn Street Boston; MA (12111 Tel. # 617-727-4900 e�_t 4.06 or 1-9 7/7 -MASSA -FE Revised 5-26=05 Fay, # 61 7-727-7749 VAvvur.Mass.gov/dia Location �� No. 6v i�z Date ' ,. TOWN OF NORTH ANDOVER Check # 192t;3 1 Building Inspector Certificate of Occupancy $ sACbM4 Building/Frame Permit Fee $ G Foundation Permit Fee $ Other Permit Fee $ �� TOTAL $ V Check # 192t;3 1 Building Inspector Permit NO: f� Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page LOCATION !� � L -a we LOT s ,,`` __ n nn Print PROPERTY OWNER �\`jd,4x` 4,.,AO'4e Z Kea[4-� 6f _ Print '615 ;-� MAP NO.: 4S cJ PARCEL: cZ S8 ZONING DISTRICT: urcmnurr "I[QT1211"T VTC n I rrr, 1-111111 Vow Vl TYPE OF IMPROVEMENT - PROPOSED USE Residential Non- Residential )(New Building O(One family El Addition ❑ Two or more family El Industrial ❑ Alteration No. of units: C Assessory Bldg ❑ Repair, replacement ❑ Commercial ❑ Demolition [I Moving (relocation) 11 Other ❑Others: ❑ Foundation only DE CRIPTION OF WORK 1'U 13 Yx1✓r uxMr li DE 51 rv, le o l 1 . ,111"� ";,A -rO f 4 i---)&xe Fbo!�2y L4 S60 Identification Please Type or Print Clearly) OWNER: Name: �rt� �ralpt %094V Coro • Phone: �8 77-077-7(o Address:_ i r Ye! �+�� 1) M. Q (9 3 Q CONTRACTOR Name: Vlk e C V &ir61 f &!4 Address:07 Supervisor's Construction License: CS 00.5323 Exp. Date: 7 Home Improvement License: Exp. Date: ARCHITEC3 3 qq q Name: Phone: J-49 y 40 3 Address: 57qa' * Nortk >=.Q aLgd -p%-Reg. No. 3 qq FEE SCHEDULE: BULDING PER 1 : , 12.00 ER $V 0.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ � ©© x12.00=FEE:$ VSb (� 5U 0100 oc �l 1 J 0',� n Check No.: �ow Receipt No.: Page Iof4 L 'T` TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer x Well Tobacco Sales ❑ Food Packaging/Sales [I❑ ❑ Permanent Dumpster on Site ❑ Private (septic tank, etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund- Signature of Agent/Owner s V �� Signature of contracto cawn 0n 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 ❑ ❑Water Shed Special Permit ❑Site Plan Special Permit "�/ ❑ Other COMMENTS �/v �, S Ciz► s i DATE REJECTED D TE APPROVED CONSERVATION El4e.S i COMMENTS jV bhp5�9ts�i oha� 1. HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition N Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: DATE REJECTED DATE APPROVED Comments ComnWnts � - / Water & Sewer connection/Signature & Date Driveway Permit Temp Dumpster on site yes., no_ Fire Department signature/date 17,70; �� Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Re uired Provides Required - Provided 3� v Dimension Number of Stories: ` 2 Total square feet of floor area, based on Exterior dimensions.�� Total.land=area, sq. ft.: 0 710 Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC. Jan.2006 - " J T 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 ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Pane 4 of 4 W O ry ti N W��QU O c WW M °i Po o 00 II II mOQ�O ill= � 1� o H2 �U IIV%IYQ3WtQ> a V o (7 4� QZO W y� h�WN� 2 i 2 2 h Zt 3N� J W HOZ O O :zz J N W N Q � Vp � W / I / C / / I �• / I eJ \ I c N / 11 n• �gY ti a r y ZN ac o g a W W C<Q cl� ab O a z ...�!v•. , _ii in w•ai _ •,7cl:a, _ l•'fV. VV IVV JIV GG1iYlc S 5 ac arai Nineerirlq LLC Phone 978-465.6436 Daniel L. Gelinu, P.E. Fax Line: 978.465.5160 579A North End Blvd, Salisbury, MA 01952-1738 email danigelinas@,idelphia.net December 27, 2006 Carroll Construction Jim Carroll cell 978.479.2776 163 Highland Road fax 978.475.0942 ALdover, MA 01810 phone 978,623.3386 SUBJECT: Lot 5, #35 Abby Lane, ;north Andover, MA Dear Mr. Carroll: As per site observations on Thursday December 21, 2006, The Framing was observed per the GraiNings and conforms to Ma.sachusetts Building Code 6th Edition Chapter 36. Please call all with any questions. Very truly yours; Daniel T . Gelinas, P.E. K letter report Lot 5 at 35 N)bv i,n N Anduver 12.27.06.doc jjklVi�l.:.• GE -ON a' No.33B9a �r�r, V 11 efREScheck Software Version 3.7.3 Compliance Certificate Project Title: PLAN NO 9421 Report Date: 07/18/06 Data filename: C:\Program Files\CheddREScheddPL29421.rck Energy Code: 20001ECC Location: North Andover, Massachusetts Construction Type: Single Family Glazing Area Percentage: 16% Heating Degree Days: 6322 Construction Site: Permit Date: 5-30-00 Owner/Agent: Designer/Contractor: Permit # Permit Date Compliance: Passes Maximum UA::455, Your Home UA. 361 > 20.7% Better Than Code (UA) Ceiling 1: Flat Ceiling or Scissor Truss: 1680 30.0 30.0 29 Wall 1: Wood Frame, 16" o.c.: 2512 13.0 13.0 101 Window 1: Vinyl Frame:Triple Pane with Low -E: 360 0.330 119 Door 1: Glass: 39 0.330 13 Basement Wall 1: Solid Concrete or Masonry: 1680 19.0 19.0 99 Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 IECC requirements in REScheck Version 3.7.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Builder/Designer Company Name Date Project Notes: Previously saved project information: COLONIAL HOUSE BRUNO ASSOC. 28 BERKELEY ROAD N. ANDOVER, MA 01845 PLAN NO 9421 Page 1 of 4 REScheck Software Version 3.7.3 Inspection Checklist Date: 07/18/06 Ceilings: ❑ Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity + R-30.0 continuous insulation Comments: Above -Grade Walls: ❑ Wall 1: Wood Frame, 16" o.c., R-13.0 cavity + R-13.0 continuous insulation Comments: Basement Walls: ❑ Basement Wall 1: Solid Concrete or Masonry, 8.0' ht/7.0' bg/4.0' insul, R-19.0 cavity + R-19.0 continuous insulation Comments: Exterior insulation must have a rigid, opaque, weather -resistant protective covering that covers the exposed (above -grade) insulation and extends at least 6 in. below grade. Windows: ❑ Window 1: Vinyl Frame:Triple Pane with Low -E, 1.1 -factor 0.330 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1: Glass, U -factor: 0.330 Comments: Air Leakage: ❑ Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. ❑ Recessed lights must be 1) Type IC rated, or 2) installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials. If non -IC rated, the fixture must be installed with a 3" clearance from insulation. Vapor Retarder: ❑ Required on the warm4n-winter side of all non -vented framed ceilings, walls, and floors. Materials Identification: ❑ Materials and equipment must be installed in accordance with the manufacturer's installation instructions. ❑ Materials and equipment must be identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. ❑ Insulation R -values and glazing U -factors must be clearly marked on the building plans or specifications. Duct Insulation: ❑ Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-6.5. Duct Construction: ❑ Al joints, seams, and connections must be securely fastened with welds, gaskets, mastics (adhesives), mastic -plus -embedded -fabric, or tapes. Tapes and mastics must be rated UL 181A or UL 181 B. Exception: Continuously welded and locking -type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). ❑ The HVAC system must provide a means for balancing air and water systems. PLAN NO 9421 Page 2 of 4 Temperature Controls: ❑ Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Service Water Heating: ❑ Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. ❑ Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: ❑ Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: ❑ All heated swimming pools must have an onloff heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: ❑ HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F must be insulated to the levels in Table 2. PLAN NO 9421 Page 3 of 4 Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes Table 2. Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Piping System Types Range("F) Insulation Thickness in Inches by Pipe Sizes 2.5" to 4" Low Pressureffemperature Non -Circulating Runouts Circulating Mains and Runouts Heated Water Steam Condensate (for feed water) Any Cooling Systems 2.0 Temperature ("F) Up to 1" Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-169 0.5 0.5 1.0 1.5 100-139 0.5 0.5 0.5 1.0 Table 2. Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Piping System Types Range("F) Heating Systems 2.5" to 4" Low Pressureffemperature 201-250 Low Temperature 120-200 Steam Condensate (for feed water) Any Cooling Systems 2.0 Chilled Water, Refrigerant and 40-55 Brine Below 40 NOTES TO FIELD: (Building Department Use Only) Insulation Thickness in Inches by Pipe Sizes 2" Runouts 1" and Less 1.25" to 2.0" 2.5" to 4" 1.0 1.5 1.5 2.0 0.5 1.0 1.0 1.5 1.0 1.0 1.5 2.0 0.5 0.5 0.75 1.0 1.0 1.0 1.5 1.5 PLAN NO 9421 Page 4 of 4 �jr IF,7-ClOG Pl ru o/qu yfvit'ciry yyr, CERTIFICATE OF LIABILITY INSURANCE 2 L� - THIS CERTIFICATE IS I$SUED AS A MATTER OF iNF"AATION .1 M-P-ROBERTS INSURANCE AG*z.wcy INC, j ONLY AND COWERS NO RIGHTS UPON THE CERTIFICATE 111$0 THIS CERTIFICATE DOES NOT AMEND, LIXTEND OR 1060 OSGOOD STREET ALTER THE COVERAGE AFFORDED EY THE POLMIES UEI-OVV. NORTH ANDOVF.R MA ()1$45 INSURERS AFFORDING COVERAGE su E1' NAIC4 U15R1�ri A�50VER REALLY CORP. REM A: JIM COLL 459 ILAST SROADWT-�y WSUPCP C: f1hVERRiLL, Mh 01030 INSURER Q. XXTRIC" '.,WMIM ASSURANCE INSURER E COVERAGES `71-iE F711LIC E -S OF NaURANCE 1.157ED BELOW HAVE BEEN IS64JED FO THE IN5.JREr) NAMED ABOVE ZOR 'THE O(Tucl� PIP710L. ANY REQUIREWNT. TkMi OR CONDInCN (�F A.NY CGNTktCT OR OTHER DOCUMENT RES' TO WHICH THIS (;kRT,;ZPTE WY SI! fl,-,UED OR MAY PERTAIN, THE INISMANCE AFFORDeO BY TlHE POLICIES DESCRIBED HEREIN;8 S6RJr-GT TO A '. -AF .ALL TERMS, EXCLUSIONS ANQ CONDITIONSCONDITIONSOF SjCFj POLIMPS AGGREC T---: LIMITS SHOWNWY HAVE MEN REDUCEDBY FWOCLA!W, Vo- -pvT—FDF EcTIvF FTLO-7 211F r� IL GCNLRAi- LIABILMV MERCIAL GENCPAi. LABILITY pc'!.v:v 00 Al.-(CMOGILELIANLITY ANY,'U-0 'L, OWNED A00,A /\UTOi HFZEDAUTOS EACH -7,,---' 7 Q-71,711—,M�CF r.u;N6kAlAGGRI3A7r. UAPIOT-Y 1 f, -*A0 iNtEl t- lV17 k0r.10 NXRY 730r) LY)NJURY PR0flER71(,D-AMAGF E XCCSVULOR".!.1-A LlAskiryEACH UAPIOT-Y 1 1 $ EA ;�CC OTHM THAN AVTOONLY; E XCCSVULOR".!.1-A LlAskiryEACH OrCURRENCi C,jtl CLAIMSMADE �1,02F LA:E. DMUGTILLF p Tr 189504821113820306 03/13/06 03/13/071,L. RACHP-1:00r N $001000 A,4y FFP I E.L. EA 7MzLOYE4! .500 C) 07�,FR ML.ICY )E SCRPNO N OF V'''c / LOCATIOWS fVCF ICLE,' ' F 1—CLUMNk ADDED EY njX;Rf,FAF4'I T IVE CEN. FAX: 97 ,'ER71FICATE HOLDER CANCELLATION TOPM OF NORTH ANDOVER 400 OSGOOD STMET NORTH A"01171R, 111A 01945 SHOUL0,1,W OL YF-r.AUOVE DESCRIOCE) P0LI:,';1I=.S Hf. C;ANCELLF0 BECORE 11:1 l.:KP!HA f ChkTF TI-I-TR;oF, THP. ISSUING msunr timt. DIOCAVOR 10 OA:; 1G_ GAYS wo,ricr- 10 THE Ct:4TIFIGATR HQl 5CR NAWUl TQ THE LFFT, SVT FAI:_IJRE TO U( D!.''\.L ImPOIZ wO 08LICIA71014 GR LADLrrY OF A -NY UflIoN THE INSUIRLP !T T /\,7R 4 "i REPRESWATIVES AIJTIHORW9.� ArPRES"MtATIVE 77 iCORD25(.200"i08) I . MACOFkD coRpoWION 1988 XIN The Commonwealth of Alassacltttsetts Department of Industrial, lecidents Office of Investigations ti Ell 600 Washington Street tin, Boston, AM 02111 www.1nass.;ov1dia Workers' Compensation Insurance ,affidavit: Builders/Contractors/Electricians/Plumbers applicant Information Please Print Legibly Name lllusincss;lhganitationllnJividuull: �64 ` "ev- ''SOU (fore ;\ddress: c4,) el City.'State,iZip: t -W er k ))f O 0193 Phone #• 478 S56 qR 3 �j Ire an employer? Check the appropriate box: ' I . I am a employer with ` . El am a general contractor and I employees (full and/or pa time).* have hired the sub -contractors 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. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §I(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. [New construction 7. ❑ Remodeling 3. ❑ Demolition 9. ❑ Building addition 10. F-1 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other _ `.\ny applicant shat checks box 41 must also lilt out the section below showing their workers' compensation policy information. y I lomeowncrs 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 Iheir workers' comp. policy information. 1 am tin employer that is providing workers' compensation insurance fir my emph{veec. Below is the policy and job site inf urination. Insurance Company Name: 4MQrtt4%4 A4qnle ---- --- Policy :l or Self -ins. Lic...=1: 'R9 5O L/,9 a©I Ig PC)3� Expiration Date:_ ( 3 -07 —_ Job Site AcJdress:, Any cape City%State/zip: i��oi:l1. 09 �__._ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required antler Section 25A of 1061- c. 152 can lead to the imposition of criminal penalties of a Fine up to S 1,500.00 and%or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a tine 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 DLA for insurance coverage verification. I do herehy cerfyJ under the pains and penalties oJ'perjwy that the in%ormation provided above is true and correct. Ci,, t`Ylicial ase only. no nut write in this urea, to be coiapletcd b4• city or town u� ficial. City or Town: ?&!rmit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk d. Electrical Inspector 3. Plumbing Inspector 6. Other Cootact Ptr-mn: Phone #: ZW D = m O y. �.t m=om Z D yOX � W r- o�p m w rr ,`�: a; Cal) 3 N W Q co 0 �} a m' : D Oo o o 00 o Co Z p Ct) T o�W ;o C C of cn rn 3 � o ZGl !� w C m l T G 7 me <� 0 N 00 y i yin y�_ h CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Permit 0 046 Dote: June 5.2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 35 Abby Lane MAY BE OCCUPIED AS Single. Family Dwelling - ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Realty Corp 459 East Broadway Haverhill Ma 01830 Building Inspector E o s � o Q W : C N O '�c O q : n0 �C ;Z O cc �m ♦; E a m t r.+ V :Q :cam :o V �. cm m C 2 o a 1 m 3 — C G L '= C N O 2 00 ate, y m O ��. IM C c Q Q N d C L a m O C.) 44 �Z co a Q m y O C .!2 mZ 30 = F- o o nOH W co •N CD ., c O C cc �E ns •N ca v w mcm CODCobN = cts L � N O �= aim cn cn E o s � o Q W : C N O '�c O 9 1 H H0 � uml Z CL z 0 E � N Cf) L ,. N O N C r*, O F�1 A m C: cm C m 0 co C 'c N m 'L 0 n C/) Z O cm I 0.— CD .—C _ •s m m CLCD 0 CD F-♦_-+ CD CD i to O Q CL C c c ev �•o •C C2 CD Zts CD V H c C C C c CO) 0 t lu W W W CA o � o : C N O C o vv q : n0 �C ;Z O cc �m ♦; E a m t r.+ V :Q :cam :o V �. cm m C 2 o 1 m 3 — C L '= C N O 2 00 ate, y m O ��. IM C c Q Q N d C L a m O C.) �Z co a Q m y O C .!2 mZ 30 = F- o o nOH W co •N CD ., c O C cc �E ns •N ca v W mcm CODCobN = cts L � N O �= aim z 0 E � N Cf) L ,. N O N C r*, O F�1 A m C: cm C m 0 co C 'c N m 'L 0 n C/) Z O cm I 0.— CD .—C _ •s m m CLCD 0 CD F-♦_-+ CD CD i to O Q CL C c c ev �•o •C C2 CD Zts CD V H c C C C c CO) 0 t lu W W W CA APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # C) 16— ADDRESS/LOCATION OF PROPERTY: 35 A66y LAoe- i Map Parcel ) 88 Lot Number SUBDIVISION w -FV m A Cleo, S e DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: MV C4, DAAQ\kz �e4u-y Address U5� S*S i 6rg4Qtwo-Lj E VhVerkjj . lm,q, Df -b3 SIGNED ROU IN CONSERVATION 7 PLANNING DPW - WATER METER SEWERIWATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OC UPANCY/IN PECTION REQUEST DPW .-- 5,-r-07 File: Application for OC form revised Jan 2007 I 05/28/2009 08:22 9783723960 CHRISTIANSEN & SERGI PAGE 01/02 r CHRISTIANSEN & SERGI0 .INC. PROFESSIONAL ENOnYEM AND LAND SURVEYORS 160 SUAMER 61NEET faVERMM1I. MIS 01696:9 L97BI 373.=0 FAft OM 372.3960 FACSIMILE TRANSMITTAL SHEET PROM: TO: Judy Tryma Dan O'Connell COMWa4y: 5/28/2009 North Andover T0vN1 plwner Ib7AL NO. OF PAGES INCLVDLNG COVER: FAX NUMBER: 2 97&688-9542 c.c.: Tim Carroll: 978475-0942 n8: #35 Abby Lane Lot 5 Auwmn Chase Subdivision O URGENT l' FOR REVIEW ❑ PLEASE COMMENT ❑ ?LZASE REPLY ❑ PER YOUR REQUEST NOTES/COMMENTS: Judy, attached for your records is the engineering certification for the completed house construction at #35 Abby Lane. Condition #12.a. of the Special Permit issued by the Planning Board for the Planned Residential Development. requires the certification letter prior to the Team's issuance of a Certificate of Occupancy. Call me if you have any questions. Dan 05/28/2009 08:22 9783723960 CHRISTIANbLN a =Kul k C14RISTIANSEN & SERGI, INC. PROFESSI l ENGINE RS AND LAND i URVEYORS (978)3730310 :(978)372-39W 160 SUMMER STREET. HAYERHILL, MA 01830-6318 May 28, 2009 Ms. Judy Tyman, Town Planner Town of North Andover Planning Department 1600 Osgood Street North Andover, MA, 01845 Re: #35 Abby Lane (Lot s "Autumn Chase") Dear Ms. Tyman, In accordance with Condition #12a of the PRD Special Permit Approval issued by the Planning Board, I hereby certify that the building and site layout on Lot 5 substantially comply with the plans approved by the Planning Board. Very truly yours, Christiansey&S gi, inc. *Pb.iHpn+.s . C.C. James Canoll, North Andover Realty TWO