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Miscellaneous - 383 ABBOTT STREET 4/30/2018 (2)
North Andover Board of Assessors Public Access Ot NORTH 41 � T �sSwClp1=ES Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of . A- 4 Property Record Card arcel TD :210/038.0-0050-0000.0 FY:2013 Community: North Andover PHOTO ll�rI i Available 4=, Location: 383 ABBOTT STREET Owner Name: THE AVERKA REALTY TRUST C/O ATTORNEY ARMAND M. HYATT Owner Address: 8 JACKSON COURT City: LAWRENCE State: MA Zip: 01840 Neighborhood: 6 - 6 Land Area: 1.00 acres Use Code: 130 -RES -DEV -LAND Total Finished Area: 0 sgft ASSESSMENTS Total Value: Building Value: Land Value: Market and Value: Chapter Land Value: CURRENT YEAR 214,900 6,300 208,600 PREVIOUS YEAR 212,700 5,800 LATEST SALE Price: 1 Sale Date: 05/12/2004 Length Sale A -NO -FAMILY Grantor: AVERKA, FAYE Doc: Book: 8779 Page: 246 http://csc-ma.us/PROPAPP/display.do?linkld=2252198&town=NandoverPubAcc 3/18/2013 O O N � m U �X..,m f � o N to J f0 a) m a a 6fa) C C, ca, m 0) a) a �2'wU5 O f Cl) CD H a. (� N i c. LL O o w�-. CV:..9�,� w �L)U= 3 ::30 v f6 a) -o ch m CO Q r 04 M O N co u,6 a... .. m M to(] E W °o m w o Of ma.Q } U o pQ LL p J O `1 O v U w' o 0 a) Of .-caQQ o OO U.�iT=@"� m o a`oF > o a o () a): m a) i m O u) cn lCo in (7 O �. J r CM ) 'G Y ca O ai' vi Q a0 J o rn Q -o m 0 mc c a UULL-i E 00 � H'H „� ; { W Cl) O LL Q Z CD O } CI Q y= O = 7� H o O}� e z co ? -J O J Lu W pe o V w N tY Z V c IL a Wf ys >� Yu w aQ iitl� ..w NQS Q 3:F— V co a. 0 a @ y o 0 N CO CT y �U () O 0 N N ~O a C C SAD 10 M t i CO J J Y Y O 3 N W LU 0 rn � I} � a o0 Z NN O W� O o Lf)LL' H Off'p 6 -6 Q W f,.N. Zoe LLI J coin jok _ �Orp. oO �;t.i¢ OOO ON 'ar LL H,d L) Zoo Cl) (A t7 Q Zoe ZN cM Q to fA v tom Q � JJ W�000 _j DID) V L U W > m m 04 0 00 Z Via) wN O ALO O r N pC) N N co U LliN L o CL co V i~CL c �t O p �U c o m iyr a) 'C oa 0 = Z !tA r to C7 UCL ) C J J = U F - C ,J Y U) 0 m LL PA P 0 m 0 0 0 O 0 Lo 0 0 w Cl) 0 N 0 U a Date.............. .. ..... ........................ NORTI{ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies thaIJ 11c v ............... I -C . ............ . has permission for gas installation I )�I I ...... 51 .... PAI�A (.0.4 ... 119 ... in the buildings of C :ins. ... s�— ............................... Andover, Mass. at ...... ....... �*� .:.......................:North Fee kYY? Li c. No. Ok� ................................................... GASINSPECTOR Check # e n4 G1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK n CITY N. Andover MA DATE 7/31/2014 ,PERMIT # v( JOBSITE ADDRESS 383 Abbott St OWNER'S NAME GOWNER ADDRESS Same TE�— FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ❑ RESIDENTIALEI PRINT CLEARLY NEW:❑ RENOVATION: Q REPLACEMENT: ® PLANS SUBMITTED: YES® NOQ APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 M1213 14 BOILER ___j g BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER 1 DRYER FIREPLACE I FRYOLATOR FURNACES GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS i MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST I I UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER Re lace 1 Gas Meters x� a d Associated Piping! i 'I INSURANCE COVERAGE !have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY FTI OTHER TYPE INDEMNITY F-1 BOND E] 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 co liance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Joseph Marino LICENSE # 8736 SIGNATURE MP Q MGF F-1JP [jJGF ® LPGI Q CORPORATION Q# 3285C PARTNERSHIP®#LLC ®# COMPANY NAME:j RH White Construction Co ADDRESS 41 Central St CITY Auburn STATE MA ZIP 01501 e TEL 508 832 3295 FAX 508926 ......................... -4347 CELL 508-832-4614 EMAILJMarino@RHWhite.com ROUGH GAS INSPECTION NOTES I THIS PAGE FOR INSPECTOR USE ONLY Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES FINAL INSPECTION NOTES •'.. 'r�,'Yj •L hf'•: r '.'a ;: :gip''] `Co :;�'� gv • �{.,I ;jF' :I[�:r,�.:,p` it j. '�f',Ji '. � ::�� '1,�?n F:,if: ul U) •'t , Q U19tt Ln �y am \ 47v]''. rt "6= d"tl uz LU UJ tOwl, ..ra, �: . `'G'fAf;� 1;.. ; :. 'r :•'l::•J;'� ij_.tf'' ti)'` • .0 ,t't i::.�aw'rli��=.il`ls �:.g }".'' •is v1 : P `• � f;�i}y .:n;,rf';jFyl�'i'�,`� �'iiUj_.'f+;),ri:�:ii��iii:�•/;'�liil.l:q; i '1'�n;........l:ui=..,.i.:.'.+f:,rr.L(.7:.,:•r:-�..'.'1'.;Fiei.%f„' U,,`'a,t%'!JJi . ,r l /1CC7�O® -- , CERTIFICATE OF LIABILITY INSURANCE Paye 1 of 1FATE29/20 3' THJ "UERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE; AFFORDED BY THE POLICIES 9EL.OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)muat be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate dogs not confer rights to the certificate holder in lieu of such endorsement(s). willi4 of Massacbueatte, Inc. C/o 26 CQntusy Blvd. P. 0. sox 305191 XRObviller TN 37230-5191 R. X. Whiee Constrnotion Company, Inc. 41 Cmntral Street P. O. Boz 257 Auburn, MA 01501 -23 nvaun=m1o) Arrvnu [N� G V VtKAGt NAIL 1r INBURERA:The CLart9a Oak Finn Tneuranoq Company 25615-001 INSURER 9:TraYu19XB Property Casualty CorWany of Am 25674-003 INSURER C:NntiOMA.1 Union Fir9 Insuranca Company of 7,9445-001 INSURERD:Travelers Indamnity Company 25659-DO1 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 COND17ION 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 - A GENERAL LIABILITY X COMMERCIAL GENERALLIA9II.IT( CLAIMS -MADE OCCUR PER: B �tx AUTOMOSILELIABILITY ANYAUTO AAILLOBWNED FI gUTO8ULED HIREDAUTo9 X NON -OWNED AUTOS ed X Coll nea UMBRELLA LIAR %� OCCUR BXCES& LIA13 CLAIMS -MADE 3L X XD DED F. RETENTIONZ =0,00( VTC2000 977X940-13 9/7./2013 1'9/1/2014 LLACN 9771i955A-13 0/1/2013 19/1/2014 RE8766140 X9/1/2013 19/1/2014 EXP BODILY INJURY(Perperson) 3 BODILY INJURY(Peraccident) 6 AGGREGATE 2,000,000 D WORKERS COMPENSATION ii'j,'RXUB 920SA105-13 9/1/2013 9/1/207,4 X U - AND EMPLOYERS' LIABILITY YIN 7DIZY LI 0 ANY PROPMETOWPARTNERIFXECUTIVEI ; l NIA VTC2RuB 9203A71A-13 9/7,/2013 9/1/2014 E.L. EACH ACCIDENT !6 1,000,000 OFFICERMIEMBEREXCLUDED7 LLJJ (tMLt1d!(ONNInNH) E.L.DI2EAGE-EAEMPLQYEE $ 1,000 000 iT�ee, daac7bo undar U tSlan•IIUNUI-UPHRATiONSBaIew E,L,DISEASE. POLICY LIMIT S 1,0001000 OF Evidence of Inaurance Remarke SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NDTICE WILL BE DELIVERED IN ACCORDANCE WITH THE; POLICY PROVISIONS, AUTNORInD REPRESENTATIVE COAII4197604 Tp7,o1694012 Cest:20267680 ©1988-2010ACORD CORPORATION. All rights CORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 3'a -L Location (� a P-,, 1 ( 57 2 tZ'� No. 2d c4 -(T, uA-, Date U U 3 Mme,. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame g/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee 0 �U $ 0 TOTAL $ e-2 L2 Check# T-- I 16848 _rte Boilding-In- pector W TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING DATE ISSUED 3 BUILDING PERMIT NUMBER: -50 Co SIGNATURE: , i Building Commissioner/IREQEtor of Buildings Datd SECTION 1- SITE INFORMATION 1.1 Property Address- 33���T� s� ].2 Assessors Map and Parcel Number: S-0 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: I Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided ReqWred Provided ystem' 1.7;z Supply M.G.L.C.Q.. 54)1.5. Flood Zone Information: 1.8 Sewerage 1 System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No ✓` 2.1 Owner ofRecord � l / SF p J F/4,rE '/ s/ 6 ! L ame (]Print) Address for Service 0 (Aignatu6tr Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone 00 rn M Z O 0 rn 09k O z M 90 F11 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 6 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 .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check a0 applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: Z D ------------- SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be�`��� Completed by permit applicant 1. Building Ali+fN. ` s (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 BUILDING PERMIT 7 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 Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR THYMERS 1 sr2 ND 3 RD SPAN DIMENSIONS OF SU -LS DIMENSIONS OF POSTS DMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS OCT 2 SIZE OF FOOTING X MATERIAL OF CHRvlNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL. GAS LINE I In f VA Town of North Andover NORTH 0 Building Department 0 27 Charles Street 0 I. - North Andover, Massachusetts 01845 70 3 (978) 688-9545 Fax (978) 688-9542 iL Buildine Demolition Affidavit '13AC HU DATE -5?ez� OWNERS NAME & ADDRESS T T, 14 PROPERTY LOCATION -3 _V5 �?M�T VT (5- C&C N RPTIO ti CONTRACTORS NAME & ADDRESS DUMPSTER- ON/ OFF STREET ✓DIG SAFE NUMBER -06'2 .. 2 oe) .5 7?) b)(? 4 lac-, BLDG- INSPECTOR DATE REUD, MAI --HIRE PEST GOIATROL 51=1 � 7 31 12 � ' Mf Y[[• [M 1 iDNA L ACjQ(.II.TI�jIJ D.O. 6OX 5005, BRADFORD STATION HAVERHILL, MA 01835 October 24, 2003 Wm. A, d MITEyfiCfONTAQtiscs r /— \J Mlbur Hyatt, Esquire 8 Jacks on Court Lcavrence, AM 01840 RE: Rodent Control,Prior to ,Demolition Dear Attorney Hyatt: Please be advised that ort October 214, 2003 our personnel carried out a prograrrt of rodent control prior to demolition at #,383 Abbott Street, North Andover; Afassachusetts. The procedures used were in conformity with local, state, rind federal regulations. Please do not hesitate to contact us if there tare any questions tivith regard to this matter- Cordially. J C A / a Laurie A. Gobhi 0 ce Manager LAG. -in gin HAVERHILL LAWRENCE (978) 3747061 (978) 681-0390 10-24-03 11:31 TO:HYATT&HYATT EXETER, NH NEWBURYPORT (603) 772-3311 (978) 462-9282 FROM:5083731122 P_ 0= T 6UGS YOU? ROSCOE N. KIDDER, PRESIDENT August 26, 2003 BUILDING & WRECKING, INC. Joseph Averka 383 Abbott Street North Andover, MA 01850 RE: Demolition of House 383 Abbott Street North Andover, MA Dear Mr. Averka or Whom it May Concern: LICENSED, INSURED & BONDED Please be advised that Kidder Building & Wrecking, Inc. was contracted by Joseph Averka to demolish the residential structure at the above referenced location. Upon receiving copy of the fully executed demolition permit from the Town of North Andover and/or Mr. Averka, Kidder will schedule the demolition within 5 days of receipt of said permit. Anticipated schedule if conditions are met is the week of September 22, 2003. If you have any questions, please feel free to call me at 603-382-1422. Sincerely, - - Geootj Mello General Manager 247 MAIN STREET ® ROUTE 121 A ® PLAISTOW, NH 03665 ® (603) 362-1422 ® FAX (603) 362-3697 AN EQUAL OPPORTUNITY EMPLOYER Oct 27 03 01:25p NORTH ANDOVER 9786889542 p.1 t 1D=9786898977 P02/02 10'27-03 11:58 HYAT"CaHYA7T FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvalstpermits fror Boards and Departments having jurisdiction have been obtained. This does not rellevE. the applicant and/or landowner from compliance with any applicable or requirements. .t.,.,,„�...,w�******"** ,.=APPLICANT FILLS OUT THIS SECTION'*"***&*`*�'•�"*�,•�,+�� To 5 rz PH T. -�- F Y L. APPLICANT PHONE — LOCATION: Assessors Map Number � � � PARCEL SUBDIVISION LOT (S) Q STREET 7—r ST.— ST. MUM' -REQ IF 3373 �-• -��FFICFAL USE ONL +�+� RECQMIN �kTl N$ gob" AGEWS: 12. colo RAII�NI sTRATi�R DATE APPRovw 207-2 DATE REJECTED TOWN PLANNER COMMENTS DATE APPREI DATE REJEGTfD FOOD INSPECTOR-jE IEALTH DATE APPROVED --- DATE RLJFJDTED �-�-��`� SEPTIC INSPECTOWItEALTH COMMENTS DATE APPFKNED. D/L"fE AEJECiEb PUBLIC WORKS- SEWERM/ATER CONNECTIONS DRIVEWAY PERMJtIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR _ DATE n ?' 02 Revised 4197 j- 16-27-03 12:20 TO:HYATT&HYATT FROM:9786889542 P61 COMPLETE DEMOLITION OF ABOVE NAMED STRUCTURES_ PRICE INCLUDES REMOVAL OF SLABS, FOUNDATIONS AND FOOTINGS, SLOPING AND ROUGH GRADING OF AREA WITH EXISTING MATERIAL. REMOVAL OF ALL RELATED DEBRIS TO AN APPROVED DISPOSAL SITE. NOTE: OWNER TO MOVE ITEMS OUT OF WORK AREA AS DISCUSSED DURING SITE VISIT. L-$Wr? O' PRICE DOES NOT INCLUDE ANY SITE PREP. ADDITIONAL FILL MATERIAL, COMPACTION OF FILL OR ASPHALT PAVING REMOVAL. NOTIFICATION BY KBW. PERMIT BY OWNER. CUTTING AND CAPPING OF UTILITIES BY OWNER. FIRE AND POLICE DETAILS BY OWNER IF REQUIRED. PRICE IS BASED ON SALVAGE. KIDDER NOT RESPONSIBLE FOR TESTING, REMOVAL OR DISPOSAL OF ANY HAZARDOUS WASTE OR OIL TANKS. SSeevven Tho ss nNine b IundredmFiftyn andlabor r00% 1(�0 Dollarsnce with the above specifications, for the sum of: 7,950.00 dollars ($ ). Payment to be made as follows: PAYMENT DUE UPON COMPLETION. IF PROPOSAL IS ACCEPTED, PLEASE SIGN AND RETURN COPY. THANK YOU. All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications Authorized involving extra costs will be executed. only upon written orders, and will become an extra Signature charge over and above the estimate_ All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Our Note: This proposal e qq workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepte within d ys. ACCEPTANCE E OF PROPOSAL —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are Signature authorized to do the work as specified. Payment will be made as outlined above. A f r fi� Signature Date of Acceptance: / NESS To Reorder. 800-225-6380 or nebs.com PRODUCT 131287 FOLD AT (c) TO FIT COMPANION 771 DU-O-VUE ENVELOPE. PAINTED IN USA, A a - Fite Commonwealth of AIassacliuseas Department of Industrial Accidents affegMINY9991gl%0 600 Washington Street Boston, Mass 02111 Workers' Compensation insurance Affidavit name, iatiQn: tC iY Q I am a homeowner perforating all work myself. [}� am a )ole proprietor and have no one working in any cavacity am esti employer providi4 workers' compensation for my employees working on this address: Ma -v) city PI �A I .s'� t�v� , ►.S b3, S (, Rhone q Q 1 am a $ole proprietor, general contractor, or homeowner (circle one) and have hired d. contractors listed below who have the following workers' compensation polices: eonteanv n4me• ' phone No �Y' ehene !t• aflare to sec#re coverage as -V wader oader Sct'tioa 2SA of MCL 13Z ao icad to the imposition of cria+iie7 �teotlies ora Rnc np to St_SitQ.00 anJ/or ,it yOrs' imOrisanmeni as Well as civil penalties in the form of a STOP WORK ORDER and a rine of SINA11 a day agaiost me. r understand that a ;ry it this statement may be rorwsrded to the oince or Investigations of the DIA for coverage verification. da hereby certify under Lite points and penalties of perjury that the Information provided above is trod and correct gnatatrr_��—r�-�. �� faate — (�P-02 rint r- tise',only • do not write In this tires to be coiispleted 6' City or town oRclat 0 (0 0 3- 3 Ca - NeA- a- sUr or town: prttalttTicense 0 -- —Building Deportment ®LIcensing Board O check if®mmediate response Is required 0St)trtmto°s O>7irr ,..,...;�,. : • ®lleatlfi Sleparlmea4 contact Person: "'"' phone d;• �.__ r�Othrr SA4 PAM North Andover Building Department Tei: 978-688_9545 DEBRIS DISPOSAL FORM In accordanc with the provision of MGL c 40.S 54, a condition of Building Permit Number is-that..the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S.150 A.. The debris will be i--acaity) Signature of Permit Applicant Date MOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector DE N. KIDDER, PRESIDENT July 16, 2003 KI®®ER BUILDING & WRECKING, INC. Town of North Andover Attention: Bob Nicetta North Andover, MA RE: Disposal Sites 383 Abott Street North Andover, MA LICENSED, INSURED & BONDED The following is the disposal site that Kidder will be utilizing during the above referenced job. 1. Demolition Debris will go to LL & S Wastewood Processing, Salem, NH 2. Metal Debris will go to Prolerizor New England, Everett, MA 3. Masonry Debris will go to Miles River Sand and Gravel, Paradise Road, Ipswich, MA If you have any questions, please call me at 603-382-1422. Sincerely, ebra L. D Permit Coordinator MAIN STREET a ROUTE 121A ® PLAISTOW, NH 03865 ® (603) 382-1422 ® FAX (603) 382-3597 AN EQUAL OFFORTUNITY EMPLOYER 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS provisions. of .780 .CMR in case _,of,.any. false. statement or. misrepresentation .of fact in .the application or.,on the plans on which the permitor approval was based. 1111;"'Approval n part: The building official may issue a permit for the construction of foundations or any other part of a building or structure before the construction documents for the whole building or structure have been submitted, provided that .adequate,information and detailed statements have been filed complying with all of the pertinent requirements of 780 CMR., Work shall be limited to that work approved by the partial approval and further work shall proceed only when the building permit is amended in accordance with 780 CMR 110.13. The holder of such permit for the foundation or other parts of a building or structure shall proceed at the holder's own risk with the= building operation and. without assurance that a`' permit for the entire building or structure will be" granted. 111.14 Posting of permit: A true copy of the building permit shall be kept on the site of operations, open to public inspection during the entire time of prosecution of the work and until the completion of the same. 111.15 Notice of start: At least 24-hour notice of start of work under a building permit shall be given to the building official. 780 CMR 112.0 DEMOLPIION OF STRUCTURES 112.1 Service connections: Beforc a building or structure is demolished or removed, the owner or agent shall notify all utilities having service connections within the structure such as water, electric, gas, sewer and other connections. A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating .that their respective service connections and appurtenant equipment, such as meters and regulators, have been removed or sealed and plugged in a safe manner. All debris shall be disposed of in accordance with 780 CMR 11.1.5. 112.2 Notice to adjoining owners: Only when written notice has been given by the applicant to the owners of adjoining lots and to the owners of wired or other facilities, of which the temporary removal is necessitated by the proposed work, shall a permit be granted for the removal of a building or structure. 112-3 Lot regulation: Whenever a building or structure is demolished or removed, the premises shall be maintained free from all unsafe or hazardous conditions by the proper regulation of the lot, restoration of established grades and the erection of ADNMI41STRATION the necessary retaining walls and fences in accordance with the provisions of 780 CMR 33. 780 CMR 113.0 CONDITIONS OF PERMIT 113.1 Payment of fees: A permit shall not be issued until the fees prescribed in 780 CMR 114.0 have been paid. 13.2 Compliance with. code: The permit shall be a r license to proceed with the work .and shall not be ,construed as authority to violate, cancel onset aside 'any of the provisions of 780 CMR or any other law or regulation, except as specifically stipulated by modification or legally granted variation as described in the application. 113.3 Compliance with permit; All work shall conform to the approved application and' the approved construction documents for which the permit has been issued and any approved i amendments to the approved application or the A approved construction documents. 113.4 Compliance with site plan: All new work shall be located strictly in accordance with the approved site plan. 780 CMR 114.0 FEES 114.1 General: A permit to begin work for new construction, alteration, removal, demolition or other building operation shall not be issued until the fees prescribed in 780 CMR 114.0 shall have been paid to the department of building inspection or other authorized agency of the jurisdiction, nor shall an amendment to a permit necessitating an additional fee be approved until the additional fee has been paid. 114.2 Special fees: The payment of the fee for the construction, alteration, removal or demolition for all work done in connection with or concurrently With the work contemplated by a building permit shall not relieve the applicant or holder of the permit from the payment of other fees that are prescribed by law or ordinance for water taps, sewer connections, electrical permits, erection of signs and display structures, marquees or other appurtenant structures, or fees of inspections, certificates of occupancy or other privileges or requirements, both Within and without the jurisdiction of the department of building inspection. 114.3 New construction and alterations: The fees for plan examination, building permit and inspections shall be as prescribed in 780 CMR 114.3.1 and the building official is authorized to establish by approved rules a schedule of unit rates for buildings and structures of all use groups and types of construction as classified and defined in 780 CMR I, 3 and 6. 2/7/97 (Effective 2/28/97) 780 CMR -Sixth Edition 23 U) m o CA Q CD a 2 CO) CZ) O '0 06 r FS, CL 5 CO) 3:NU2 -V O 10 *0 CD CD Q. C:r =r CD CD 0 CCD gm 9. CD co) CD CO2 CD S7 CO) 2! O CD :q C3 mc CD cn rn 0 z cn cp Pd CO2 W rL rA ft zi CA W M O ir 0 c CD -I- Town of North Andover Building Department 27 Charles Street North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. � NORTy q o •tt lEQ °• �O � o r 9SSACHU`-SEK DATE OZq ` a O O JOB LOCATION Number Street Address Section of Tc "HOMEOWNER S 2 v" `- Number Number PRESENT MAILING ADDRESS ocg p�W Aj\) A,9v e a_ City Town Home Phone State Work Phoi (D 18 ( 5 Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of 1 or 2 units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section (108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which of two there is, or is intended to be, a one family dwelling, attached or detached structures accessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requlements. HOMEOWNER'S SIGNATUR APPROVAL OF BUILDING OFFIC 4b/ a Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. Revised 4.30.03 Home owner Exemptions Form v '3 �oµvH apoo opo` P9 1 th Andoa tment slp° "•`� pY aY SeTVeoeWv °e eaXth DhduSetts V Ces VY Th7n 81�`9e�$)5 6 �82 8 -95 40 O ft �ert an eeP9ne 6s&9 lOvineSacet°1x45 Fax loeve0,0 / arAty ? e1,l�aa8 � GO ��eh Ardov a O AVLV O �u AN�O��� SOUL SER j,@ Chaptex 11,Minim O� Code, more ons of the 05tCN1R 410 00 S?ncPrell uncle tH xpnx x abitation, l extY 1'peat. iot' r1 ' itlless f oxtxeet g45 IyPd fah Ute 20 2003 3g3 Abbott st ex MA 01 /'mate j xa eco: Noxth A vvrex of R Attoxne To e h Avexka ixsfoxnsed demobs Faye andott peer A p1g45 Ith v` as v to take incloa d neat 'condi{ cc. 38g Ab Andover, oaxd °f Ide e deoded s voeb s eCV, iss Abl 1�Oxtls ovex6 oUlav novationaddxtxonal p28,2003 A,-, of -6e eNoxth A Se of acti y e egU'xed p3 to isoandFeb 'uve olloN'im ht ort St aJt of th coUx of th 20 20p3 If t11e the -(I �h�h yh rr ��h gtaff att that the . ' place onS"T"19, waxy 25, xopexty reserves d ,,7elly �2abetv A,c°`Prp 1'�I� Wilbur klytin& d`� elhn�d meed Yg datedFea d subject a of �TealConde'nn the h chi `re e eXis ched-Ne Lette nexs e 130, t to 9ttor La �h�I re Oe of the their s 0xdex ow d, tl` xigh follow le fey wev, Forth voted at ed to the ed proper me allott and also tl'e actiois if the P any c d on e tie s 'o bY`e afoxens enn t xne ri k OxdexS 1�R� vo{ed to table ion` t 8 43 dikiojo theot 8410 ously exm"t A Ia �s con enfOxce 105 CM th unan'm olition px an)uly oI faccyoxdance Bo rd of zeal elved a dens bs no la tb ent. cox`di s ale met ov nets mo d n °' h tt ed t etY eE1ea thpel'axdby nota evvY ent subxn omplete 1' IBu Y �� �pevi-fl sn usthavethe dem Oh lo". n c 0 e pzQ eYty ovanex aT�oN eas 95'� lksP011 bsa gs 2• 17 200 co�ysuv. t: ��Q,ySNG �g�_95R5 a� Eby jS B°�OV J 2 F] Town of North Andover of Ko RTF{ Office of the Health Department oa °wood Community Development and Services Division * 27 Charles Street - ti North Andover, Massachusetts 01845 �4SsACMUS Sandra Starr Telephone (978) 688-9540 Public Health Director Fax 978 ) 688-9542 NORTH ANDOVER BOARD OF HEALTH ORDER LETTER-ADDEMDUM Issued under the provisions of the State Sanitary Code, Chapter II, Minimum Standards of Fitness for Human Habitation, 105 CMR 410.000. Date: June 20, 2003 To Owner of Record: Faye and Joseph Averka 383 Abbott Street North Andover, MA 01845 Property Location: 383 Abbott Street North Andover, MA 01845 Staff of the North Andover Board of Health was verbally informed by Attorney Wilbur Hyatt that the course of action you have decided to take includes the demolition of the existing dwelling in place of the required renovations. The Board unanimously voted at their scheduled meeting on June 19, 2003, to issue additional special conditions to be added to the Order Letters dated February 25, 2003 and February 28, 2003 issued to the aforementioned property owners and subject property. If the following conditions are not met in the time allotted, the Board of Health reserves the right to fully enforce the original Order Letters and also the right to condemn the dwelling in accordance with 105 CMR 410.831(E). The Board of Health unanimously voted to table any action if the following conditions are met. 1. The property owners must have a received a demolition permit from the Building Department to demolish the dwelling by no later than July 4, 2003. A copy of this permit must be submitted to the Health Department. 2. The property owners must have the demolition completed by no later than July 17,2000'. BOARD OF APPEALS 685=3541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 0 If you have any questions, comments or concerns, please feel free to call me at the aforementioned number between the hours of 8:30-4:30, Monday through Friday. Sincerely' �gr�iiian'jj. LaGrasse Health Inspector CC: Board of Health Sandra Starr, Public Health Director North Andover Fire Department Michael, McGuire, North Andover Building Department Elizabeth Englehart, Merrimack Valley Elder Services, 360 Merrimack Street Building #5 Lawrence, MA 01843 Attorney Wilbur Hyatt, 8 Jackson Court, Lawrence, MA 01840 File Town of North Andover NORTk Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 �SSACHl1s�S Sandra Starr Public Health Director Telephone (978) 688-9540 Fax (978) 688-9542 NORTH ANDOVER BOARD OF HEALTH ORDER LETTER Issued under the provisions of the State Sanitary Code, Chapter II, Minimum Standards of Fitness for Human Habitation, 105 CMR 410.000. Date: February 25, 2003 To Owner of Record: Faye and Joseph Averka 383 Abbott Street North Andover, MA 01845 Property Location: 383 Abbott Street North Andover, MA 01845 An authorized inspection was made of your property at the above referenced address by North Andover Health Department personnel on February 24, 2003 in response to a request by The North Andover Police Department regarding potential housing code violations and the presence of conditions deemed to endanger and impair the health and/or safety of any occupants. The inspection revealed violations of the State Sanitary Code, Chapter II, as listed on the attached Violation Form. You are hereby ORDERED to correct the violations within the time allotted on the enclosed form. Failure to comply within the specified time period may result in further action by the North Andover Board of Health. Several of the violations documented are conditions deemed to endanger or impair the health and/or safety of the occupants and emergency personnel. The conditions documented on the Inspection Report including the excessive filth, unsanitary conditions and the failed subsurface disposal system are severe enough for the Health Department to deem the dwelling unfit for human habitation until the violations are rectified. In accordance with 105 CMR 410.831(D) the Board of Health will hold an immediate public hearing regarding the conditions of the property located at 383 BOARD OF APPEALS 688-9541 BUILDING 688-9545 COiNSERVATION 688-9530 HEALTH 688 9540 PLANNING 688-9535 r VIOLATIONS TO BE ADDRESSED WITHIN FIVE (5) DAYS 5. The sinks in the bathroom and kitchen and the pipes in the basement leak. The pipes in the basement are leaking from the base of the bathroom fixtures and may contain gray water and/or coliform bacteria. There is an excessive build up of mold, mildew and fungus in the basement. "The owner shall install in accordance with accepted plumbing, gasfitting and electrical wiring standards, and shall maintain free from leaks, obstructions or other defects, the following: (A) all facilities, and equipment which the owner is or may be required to provide including, but not limited to all sinks, washbasins, bathtubs, showers, toilets, waterheating facilities, gas pipes, heating equipment, water pipes, owner installed stoves and ovens, catch basins... " (105 CMR 410.351(A)). Please repair all water leaks. The water leaks have caused a severe chronic dampness problem around the sinks.and in the basement. "Every owner shall maintain the foundation, floors, walls, doors, windows, ceilings, roof, staircases, porches, chimneys, and other structural elements of his dwelling so that the dwelling excludes wind, rain and snow, and is rodent proof, watertight and free from chronic dampness, weathertight, in good repair and in everyway fit for the use intended. Further, he shall maintain every structural element free from holes cracks, loose plaster, or other defect where suchholes, cracks, loose plaster or defect renders the area difficult to keep clean or constitutes an accident hazard or an insect or rodent harborage." (105 CMR 410.500). Please alleviate the chronic dampness and clean all mildew, mold and fungi. VIOLATION CORRECTED: DATE: 6. The Health Department sent correspondence dated October 5, 2001 (copy attached) mandating that the dwelling be connected to the municipal sewer system after staff confirmed that there was septic effluent ponding in the rear yard from a failed septic system and total coliform bacteria was confirmed through water testing. This is in violation of the Massachusetts Housing Code, Title 5 Regulations and The North Andover Septic Regulations 105 CMR 410.300, 105CMR 410.750(F), 310 CMR 15.303(1)(a)(2), 310 CMR 15.305(l),310 CMR15.024 (5) and 6.03 of the N. Andover Septic Regs. Please connect to municipal sewer immediately or submit a letter/or written contract stating when the house will be connected. VIOLATION CORRECTED: DATE: 6 105 CMR 410.910 PENALTY FOR FAILURE TO COMPLY WITH ORDER 7. "Please be aware that any person who shall fail to comply with any order issued pursuant to the provisions of 105 CMR 410.000 shall upon conviction be fined not less than $10.00 nor more than $500.00. Each day's failure to comply with an order shall constitute a separate violation. See also 105 CMR 410.854(B)." The Board of Health shall levy a fine in accordance with 105 CMR 410.910 for each day or portion thereof in which a violation exists after its associated deadline. 105 CMR 410.831 DWELLINGS UNFIT FOR HUMAN HABITATION: HEARING: CONDEMNATION: ORDER TO VACATE: DEMOLITION 8. "If an inspection pursuant to 105 CMR 400.100 or 105 CMR 410.820 reveals that a dwelling or portion thereof is unfit for human habitation, the Board of Health may (after complying with 105 CMR 410.831(B), (C), or (D), if the dwelling is occupied) issue a written finding that the dwelling or portion thereof is unfit for human habitation. The finding shall include a statement of the material facts and conditions upon which the finding is based". (105 CMR 410.831(A)) "Exception to notification and hearing requirements. If at anytime the Board of Health determines in writing that the danger to life or health of the occupant(s) is so immediate that no delay may be permitted, then the Board of Health may immediately issue a finding that an occupied dwelling or portion thereof is unfit for human habitation without providing the notification or hearing specified in 105 CMR 410.831(B) and (C). A copy of the determination of immediate danger, and a copy of the finding of unfitness for human habitation shall be sent to each affected occupant, and to the owner". (105 CMR 410.831(D)) Upon inspection of the subject dwelling and conditions therein, it is the opinion of the Health Department that an emergency exists and that this letter and violation form serve as a determination in writing that the danger to life or health of the occupant(s) is immediate enough to relinquish the 5 day public hearing notification. It should be noted that one of the occupants is a senior citizen and included in the Highly Susceptible Population (HSP) and should be cared for accordingly. 7 A Re -inspection will be performed by the North Andover Health Department subsequent to the deadlines stated above. If the conditions are corrected prior to the required time limit, please call the North Andover Health Department at 978-688-9540 for an inspection. If you have any questions, comments or concerns, please feel free to call me at the aforementioned number between the hours of 8:30-4:30, Monday through Friday. Sincerely, Zj -" Bpran J. LaGrasse Health Inspector CC: Board of Health Sandra Starr, Public Health Director Officer Jay Staude, North Andover Police Department Criminal Investigations Inspector Daniel Cronin, North Andover Police Department North Andover Fire Department ,Michael, McGuire, North Andover Building Department Elizabeth Englehart, Merrimack Valley Elder Services, 360 Merrimack Street Building #5 Lawrence, MA 01843 File OWNE ADDR DATE �LC�,�c�,.r�S � ��eS � ©� ;(J�� nn t5 �� rJtr e �I't-z 5�..,..e d� �. j��•� � NORTH ANDOVER HEALTH DEPARTMENT 120 Main Street • North Andover, MA 01845 Telephone (508) 682-6483, Ext. 32 Complaint Investigation/Inspection Report irk %-ek nj 1 � wj .1 >i �r►r;�� y'+�?�y �3!� 3� 4 $ l�iA t�f C`J'�i1c' �. ��' �ti-•t�-��1dJ 'ry vrc' Lf- 1+ vfu � v. t�L(�;! �• C a�+r 2 � � `-;1%1 "� •tC J� �I i t% -s ~ �Xc.eS3�� l��s'+� l�,rrr1 Tr^5� �s1� �;J��ti�ti,� %trlt+-c�.2�9 -- 1 �-e- --!�dN� G'lt)�a� �•+'h9V� �-!c_ c11s+JA [oScm — LAID. i4s-1 ! off' C �� Klt�• �c� l�� `-- — %kzS't.,syrtt nl to ri- C, Or.&t Lf c.t" `5 rVOw.�/� l �����'� lVw+� �v� �17V�t�\,�li. \5 i���i+�c� j /+5 i�°�q�i ly� �1UtV��.� 1ItiN��s��tt>�� iGlVt�. �^+'� '}+✓t \�Jk, li 1t?t\�i irk %-ek nj 1 � wj .1 >i �r►r;�� y'+�?�y �3!� 3� 4 $ l�iA t�f C`J'�i1c' �. ��' �ti-•t�-��1dJ 'ry vrc' Lf- 1+ vfu � v. t�L(�;! �• C a�+r 2 � � `-;1%1 "� •tC J� �I i t% -s .ix 1 ri i5 �i4 SIC ~n- rf'-�%e ;�r��d�� kms" int `Qf =a s�� 5 O Sandra Starr Health Director Town of North Andover Office of the Conservation Department Community Development and Services Division October 5, 2001 Faye and Joseph Averka 383 Abbott Street North Andover, MA 01845 RE: Sewer Tie -In Dear Resident: Health Department 27 Charles Street North Andover, Massachusetts 01845 ORDER LETTER Telephone (978) 688-95, Fax (978) 688-9542 Our records indicate that your property is currently in non-compliance with the North Andover Board of Health Regulation regarding sewer tie-in. It appears the sewer tie-in fee has been paid to the North Andover Department of Public Works but the actual tie- in has not taken place. Your subsurface disposal system is in violation of 310 CMR 15.303(1)(a)(2) " there is discharge of effluent directly or indirectly to the surface of the ground through ponding, surface breakout or damp soils above the disposal area..." Since the current system is failing to protect public health, safety and the environment, you are hereby ORDERED to immediately connect to the municipal sewer system. The connection must be completed before December 24, 2001. Failure to connect by the aforementioned date will result in legal action that may result in the condemnation of the dwelling. You have the right to request a hearing before the Board of Health if you feel this order should be modified or withdrawn. A request for said hearing must be made in writing and received by the Health Department within seven (7) days from the receipt of this order. At said hearing you will be given an opportunity to be heard and to present witnesses and documentary evidence as to why this order should be modified or withdrawn. All affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all "records concerning the matter to be heard. You may be represented by an attorney. You also have the right to inspect and obtain copies of all relevant records concerning the matter to be heard. BOARD OF APPEALS 688-9541 BUILDING 688-954.5 CONSERVATION 685-9530 HEALTH 688-9540 PLANNING 688-9535 If you have. any questions, please feel free to call the Health Department Monday - Friday between 8:30 and 4:30 at 978-688-9540. Sincerely, Sandra Starr Health Director cc: Board of Health Brian LaGrasse, Health Inspector Department of Public Works File Town of North Andover Office of the Conservation Department Community Development and Services Division (3Health Department 27 Charles Street Sandra Starr North Andover, Massachusetts 01845 Health Director ORDER LETTER October 5, 2001 Faye and Joseph Averka 383 Abbott Street North Andover, MA 01845 RE: Sewer Tie -In Dear Resident: Telephone (978) 688-9540 Fax (978) 688-9542 Our records indicate that your property is currently in non-compliance with the North Andover Board of Health Regulation regarding sewer tie-in. It appears the sewer tie-in fee has been paid to the North Andover Department of Public Works but the actual tie- in has not taken place. Your subsurface disposal system is in violation of 310 CMR 15.303(1)(a)(2) " there is discharge of effluent directly or indirectly to the surface of the ground through ponding, surface breakout or damp soils above the disposal area..." Since the current system is failing to protect public health, safety and the environment, you are hereby ORDERED to immediately connect to the municipal sewer system. The connection must be completed before December 24, 2001. Failure to connect by the aforementioned date will result in legal action that may result in the condemnation of the dwelling. You have the right to request a hearing before the Board of Health if you feel this order should be modified or withdrawn. A request for said hearing must be made in writing and received by the Health Department within seven (7) days from the receipt of this order. At said hearing you will be given an opportunity to be heard and to present witnesses and documentary evidence as to why this order should be modified or withdrawn. All affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. You may be represented by an attorney. You also have the right to inspect and obtain copies of all relevant records concerning the matter to be heard. BOARD OF APPEALS 688-9541 BUILDIN/i88-9545 CONSERVATION 688-9530 HEALTH 688-9.540 PLANNING 688-9535 If you have any questions, please feel free to call the Health Department Monday - Friday between 8:30 and 4:30 at 978-688-9540. Sincerely, Sandra Starr Health Director cc: Board of Health Brian LaGrasse, Health Inspector Department of Public Works File No 2 G 1 5 ' Of NORTH '�h ti p ,SSACMU.. Date ...1... ;A.x177. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................... . ��:....... �<� ! � t/ r / ................................................. has permission to perform ...................! �...f f vc?..'. �............ wiring in the building of .:� �' ......................................................................... at r�r�:...........r r.................,.North Ando er,-Mass. c �! rJ r' Fee ..................... Ltc. No.,...:....../...... ...... ... ...:.?..l-.:..:.-: %ELECTRICAL INSPECTOR �-_ WHITE: Applicant CANARY: Building Dept. PINK: Treasurer J Office Use Only / _1<<y UiP Cromintin ralt4 of fflca55cathu5Ytf5 Permit No - i, . -,� iDrpn'imrnt of IJublir _afrtg Occupancy &Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT 1N INK OR TYPE ALL It��Iy,�ORMATION) Date %/ - 2 City or Town of ✓1 - &,. « To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. a Location (Street & Number) % R_ Owner or Tenant .%/ -t-ile/" i -,- Owner's Owner's Address J 4k_1__T 'L_ Is this permit in conjunction with a building permit: Yes ElNo !_�f'� (Check Appropriate Box) Purpose of Building .• �Utilit�y Authorization No Existing Service Amps / -2Yv Volts Overhead t_'T Undgrnd ❑ New Service Amps _J Volts Overhead ❑ Undgrnd ❑ • Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical )�119rkt`/^yr No. of Lighting OutletsI No. of Hot Tubs I No. of Transformers Total K VA No. of Lighting Fixtures _, Swimming Pool Above In- grnd. ❑ grnd. ❑ I Generators KVA No. of Receptacle Outlets No_ of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local❑ Municipal ❑Other Connection No. of Ranges I No. of Air Gond. Total tons No. of Disposals I No -of Heat Total Total , Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers I Heating Devices KW n1n nr Uri•... --- - - y„s banasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the recuirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Completed O erasions Coverage or its substantial equivalent. YES �rc0'� I have submitted valid proof of same to the Office. YES G If you have checked YES, please indicate the type of coverage by checking the ap�prop�na�e box. INSURANCE Cf—BOND ❑ OTHER ❑ (Please Specify) fit f% Estimated Value of Electrical Work S (Expiration Date) Work to Start �� Y:7 Inspection Date Requested: Rough Final Signed under the Penalties of erjury. / FIRM NAME LIC.: NO. -- — Licensee ZIPOSignature,_ LIC. NO Address Bus. Tel. No, Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature o1 Owner or Agent) a-fi5E5 k t f - i Uw 16 r.r i •' ASS' .+���- , A � -. f� �?� '•Ate y _ IME alk A. V F A � i� r' 1 / � �'�� �'� ;�,;, •, ,, , �.` �' � 'Cy`+�'a =�;a � p ^�. i. o � "� '�, y �, S"'ir � � i. t r.,. '. ��1 .... , � '4 ' � r '� > 1 �` . r- ";� � p.. - Oww 1�� �`- r� ,� �9 ���� � .� ��'�; �.,� �• q � `�..::i � - _ ...- , �,�' �- ' '� ./ . \� �_ _ _ _ > . � �: - - _ `� ` 4. ,�> ,' �� �'`� � ` '/ F,;O� :.: �: � `r -� ," '� _ _ ,,: � 4, � I• � ; • a�� �+� �. . "0 -� F=� J i ;;1��,.,.; �� �" +. "�'�' `:,` � ,, .'y �. •, ;i:� ', '1 is 0 4. k. L 4B kh A _ f ., ..� �. . I if t 1