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Home My WebLink AboutMiscellaneous - 39 FARRWOOD AVENUE 4/30/2018 (2)'� CD A D 01 .Tl V Tl 90 0 C') D o�m i z C: b m c Date...' . / /.:....,r� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ,G' �/ U Z- t G��T7"' L ............................................................................................. has permission to perform ............. .... .... wiring in the building ofs ' 1 :.... (/'} C.... 5 c� r ..... .... ............................. at -t7.:=.....62 �:.................. . North Andover, Andover, Mass. Fee, -'7-0 l... Lic. No.. � t : / l 7 ........./. fir! k !e!� : -�-�-C ELEcmR AL INSPECTOR Check # %Z n C tJ commonwealth of Massachusetts Official Use Only Department Of Fire Services Permit No. — ? 14 3 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /! / City or Town of: NORTH ANDOVER - I r� /�/—�CI By this application the undersigned gives notice of his or her intention to perform the elp electrical wector ork Woes described below. Location (Street &Number) ;3 – � � n Owner or Tenant /-0- Owner's -0- Owner's Address Telephone No. Is this permit in conjunction with a building permit? Purpose of Building _ Yes ❑ NO 15–(Check Appropriate Box) — k w Utility Authorization No. Existing Service Amps _ / _Volts Overhead A ❑ Undgrd No. of Meters New Service Amp' _ / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: U No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers Completion of the Of CeiL.-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool Abd e ❑ No. of Oil Burners No. of Gas Burners No. of Air Cond. T� Space/Area Heating KW No. of Dryers Heating Appliances KW No. of Water, No. of No. of Heaters Signs Ballasts No. Hydromassage Bathtubs No. of Motors Total HP win table ma be waived b the Ins ector of Wires. J.Batter of Total — nsformers KVA eators KVA o + mergency ig g E Units FIRE ALARINI-S No. of Zones No. of Detection and Initiating Devices No. of Alerting Devices No, of Self -Contained �� Deteetion/Aler[in Devices Local [I1Vlanicipal Cnnneot,n., ❑ Other No. of bei Data Wiring: No. of Dei or or OTHER: No. of Devices or Euivalent p / A ` G / Gh � Estimated Value of Electrical Work: b ff?�' h .gttac additional detail if desired, or as required by the Inspector f Wires. �_p_ � a o (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 per issuing office. CHECK ONE: INSURANCE [G,– BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Licensee: ��y �_ l LIC. NO.: j 0 J G�2 Signature L ss 3 5r (If applicable, enter 'exempt " in the license number line)LIC. NO.: Address: / „v�,/l� 7r– /r Bus. Tel. No.:(,/ 2– 7 F5_ 4 � *Per M.G. c 147, s 57-6 , security work requires D t of ty Alt Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that � Licensee doles not have the liability Lic. No. verage nonnally required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner wn insurance owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ �r ! i iiiJJJ777j to IUD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www nzassgov/dia . Workers' Compensation Insitrance Affidavit: Builders!Contractors/Eiectricians/Plumbers p�licant Infortrtatinn Nanle (Business/organization/Individual):_ jl% [/ z - Address:_ l v Al I) rr= 4' - — City/,State/Zip:v �>^ eft- IV— Ss/ tune #• (�/ f1�- 7�/9 (� Are Type of Project (required): 6. ❑ New construction 7. F7Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.7 Roof repairs 11M Other omeownets who submit this affidavit indicating they are doing all work and then hie outside c ntracton Ymust submit new affidavit indicating such. ;Contractors drat check this box mustattaebed an additional sheet showing the name of the sub -contractors and their workers' comp. Wit; y inro I am an employer that is.providing: workers' compensation insurance for my employees; information. Below is the policy and job site . Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date:___� p1 p Job Site Address: :wry w aD �5, City/State/Zi : , p Attach a copy of the workers' con p 4V )-y— C� r/Y compensation policy declaration page (showing the policy number and expiration date), Failure to secure coverage as required. under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above // is !rue and correct - 0 iMMAzAM� Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/license # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 6. Other S. Plumbing inspector Contact Person: Phone #; YOU an employer? Check the appropriate box: t.❑ I am a employer with 4. ❑ 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 listed partner- on the attached sheet. _ ship and have no employees These sub -contractors have working for me .in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.) 3. ❑ 1 am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No -workers' comp. c. 1.52, § 1(4),'and we have no insurance required.] t employees. [No workers' COMP, insurance required..] *Any Aapplicant that checks botf # 1 must also fill out the section below showing their workers' 600 sat' H Type of Project (required): 6. ❑ New construction 7. F7Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.7 Roof repairs 11M Other omeownets who submit this affidavit indicating they are doing all work and then hie outside c ntracton Ymust submit new affidavit indicating such. ;Contractors drat check this box mustattaebed an additional sheet showing the name of the sub -contractors and their workers' comp. Wit; y inro I am an employer that is.providing: workers' compensation insurance for my employees; information. Below is the policy and job site . Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date:___� p1 p Job Site Address: :wry w aD �5, City/State/Zi : , p Attach a copy of the workers' con p 4V )-y— C� r/Y compensation policy declaration page (showing the policy number and expiration date), Failure to secure coverage as required. under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above // is !rue and correct - 0 iMMAzAM� Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/license # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 6. Other S. Plumbing inspector Contact 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 including the legal representatives of a deceased employer, or the receiver or trmstee of an individual, partnership, association or other legal entity, employing employees. 'However the owner•of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance 'coverage required." Additionally, MOL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation, affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their 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 Accidenas for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the numberlisted below. Self-insured companies should enter their self insurance license number on the*appropriate'line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. in addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (.if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy ofthe 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 future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industdal Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.govIdle a Date......�D 2..0.'.... .. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that J co % l I'.,� ..... . ............................... r��R has permission to perform .. � .:....... � . %� ....../.�f,Fe .... r'. . ............ wiring in the building of ►"�'' { 1 �7�5 =�( �/��:z 6 --q at ...... (.... ,.. ,� .:. �. �. �.....�-.�..-- .................. .North Andover, Mass. f Jnr. Fee.... ............ �Y ELECTRICAL INSPECTOR Check # � Z_u P Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Z/.- ;�-62& City or Town of: NORTH ANDOVER 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) 6 /'!'(,�-7.0d6t' ll%U Owner or Tenant /Pr.,, Y2q eCZf--1 Al j Telephone No. Owner's Address lel sedan I Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 6une vAl.-rte XgAl, *74? Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:�A:;; f `t >qh/ toi` /�sw✓!d' A �,d,'/` L.'F% 2xA4,.s j A � Completion of the following table ntav be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. o Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 2 No. of Gas Burners No. o Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat ump Totals: NumberTons .. K o. o - el ontained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ unic'pal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Sim Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of N"ires. Estimated Value of Electrical Work: SK -op, pp (When required by municipal policy.) Work to Start: //.,? p(� 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 Z BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: 1�-o/'% �P �f/G-yli Signature c� LIC. NO.: VOW,5D (If applicable, enter "exempt" in the license number line.) Bus. Tel. Address: ri% % S % ,&14 EZ ryf4 Alt. Tel. No.:9.V -.?AL /lofi� *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ Town of North Andover Office of the Conservation Department Community Development and Services Division 27 Charles Street Julie Parruio North Andover, Massachusetts 01845 Conservation Adni_inistrator December 30, 2003 Heritage Green Condominium Trust C/O Karen Sorkin 39 Farrwood Street North Andover, MA 01845 RE: Replacement Decks, #90 Fanwood Street Telephone (978) 688-9530 Fax(978)688-9542 Violation Notice: Violation of the Massachusetts Wetland Protection Act, MGL Ch. 131, Section 40 and the North Andover Wetland Protection Bylaw. Dear Ms. Sorkin: As you are aware the North Andover Conservation Department issued a Violation Notice for unpermitted deck reconstruction activities located in the buffer zone to wetland resource areas. A filing with the Conservation Department was required to be submitted no later than January 16, 2003. The Violation Notice issued on December 3, 2003 required the immediate installation of erosion controls (consisting of haybales and silt fence) along the limit of work. The site was inspected on December 29, 2003 and erosion controls were not properly installed. In some areas the haybales were not staked and no silt fence was installed. Large piles of soil exist behind the erosion control line. The erosion controls must be installed properly by an experienced contractor and should be installed behind all disturbed areas. Failure to properly install the erosion controls by Tuesday, January 5, 2004 will result in the issuance of a $300 per day fine until properly installed. The Conservation Department must be contacted to conduct a site in inspection. Thank you for your ;' J amino, � nservation Administrator (.— NACC Heidi Griffin, Community Development Director Building Department Neve -Morin Group BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover a� NORTH Office of the Conservation Department F A Community Development and Services Division 27 Charles Street SS�cHu�� North Andover, Massachusetts 01845 Alison E. McKay Telephone (978) 688-9530 Interim Conservation Administrator Fax (978) 688-9542 April 3, 2004 Heritage Green Condominium Trust C/o Karen Sorkin 39 Farwood Avenue, #1 North Andover, MA 01845 RE: ENFORCEMENT ORDER: Property at #88 and #90 Farwood Avenue Violation to the Massachusetts Wetland Protection Act (MGL C.131 S.40) and the North Andover Wetland Protection ByLaw (C.178 of the Code of North Andover). Dear Ms. Sorkin: On 3/17/04 the Conservation Department issued an Order of Conditions, DEP file #242-1234, to allow work activities to proceed on the reconstruction of the decks and stairways at the above referenced property. The approval was granted in conjunction with specific conditions so as to adequately protect the wetland resource area on site. Furthermore, several conditions were required to be met immediately upon the receipt of the Order and have not been executed. This department received the signed certified mail receipt from yourself some time ago indicating that the Order of Conditions had been received. However, to this date, no action has been executed to indicate compliance with the Order. A recent site inspection of the property also indicates non- compliance with the Order. Full compliance with the Order of Conditions must be executed immediately, specifically to conditions 38, 39, 42, 44 (proper installation of erosion controls as specified), 45, 46, 47, 48, 51, 52, 58, and 69. Aside from the violations pertaining to the Order of Conditions referenced above, additional work activities were observed to have occurred adjacent to building #50. An excavated open trench of 2-4 feet in depth and of approximately 50 feet in length was observed along the side of the building. Excavation was noted to have occurred within the 25' no -disturbance zone protected under the local Bylaw. This work was conducted within 100' of a wetland resource area without a permit from the Conservation Department and is in further violation of the Wetlands Protection Act and the local Wetlands Protection Bylaw. All activities pertaining to this site work must cease and desist immediately until a proper filing has been submitted and approved for the work. ORDER: Acting as an Agent of the Commission under MGL C.40, S.21D and the Act (310 CMR 10.08(3)), enclosed please find an Enforcement Order mandating immediate compliance with the Order of BOARD OF APPE_-LS 688-9541 BUILDENG 688-9545 CONSERV \TION 688-9530 HE-1LTH 688-9540 PLANNENG- 688-9535 Conditions under DEP file # 242-1234 and the submission of a permit filing for work activities adjacent to building #50 by no later than April 16, 2004. The violations as documented herein are subject to a $100 per day per violation penalty' until such time as the impacted resource areas have been mitigated. Each day or portion thereof during which this violation continues shall constitute a separate offense. At this time the Conservation Department has elected to levy a fine in the amount of $1,200. However, we reserve the right to take additional action in the future should this Enforcement Order not be complied with retroactive from the date we were first made aware of the violations. Failure to comply with this Order and the deadlines referenced herein will result in the issuance of additional penalties. MGL C. 131 S.40 and the North Andover Wetland Bylaw, C.178 authorizes the Conservation Commission to seek injunctive relief and civil penalties per day of violation. In addition, a violation of the Massachusetts Wetland Protection Act and the North Andover Wetland Bylaw constitutes a criminal act, which is subject to prosecution and the imposition of criminal fines, also per day. This Enforcement Order shall become effective upon receipt. Please feel free to contact me if you have any further questions or concerns in this regard. Your anticipated cooperation is appreciated. Sinc rely, �� Alison McKay Interim Conservation Administrator Encl. CC NA CC Ms. Heidi Griffin, Community Development Director Robert Nicetta, Building Commissioner Michael McGuire, Building Inspector DEP-Northeast Region file 1 In accordance with the provisions of MGL c.40 s.21D and Section 178.10 of the North Andover Wetland Protection ByLaw (REV May 1993/REV October 1998) Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands WPA Form 9A - Enforcement Order Massachusetts Wetlands Protection Act M.G. L. c. 131, §40 Provided by DEP B. Findings The Issuing Authority has determined that the activity described above is in violation of the Wetlands Protection Act (M.G.L. c. 131, § 40) and its Regulations (310 CMR 10.00), because: ® the activity has been/is being conducted without a valid Order of Conditions. ® the activity has been/is being conducted in violation of the Order of Conditions issued to: Karen Sorkin 3/17/04 Name Dated 242-1234 38,39,42,44,45,46,47,48,51,52,58, & 69. File Number Condition number(s) wpaform9a.doc - rev. 12/15/00 Page 1 of 3 A. Violation Information Important: When filling out This Enforcement Order is issued by: forms on the North Andover 4-3-04 computer, use only the tab Conservation Commission (Issuing Authority) Date key to move To: your cursor - do not use the Heritage Green Condominium Trust c/o Karen Sorkin return key. Name of violator 39 Farrwood Avenue, North Andover, MA 01845 °b Address 1. Location of Violation: SAME Property Owner (if different) 88-90 Farrwood Avenue and 50 Farwood Avenue Street Address North Andover 01845 City/Town Zip Code Map 36 83 Assessors Map/Plat Number Parcel/Lot Number 2. Extent and Type of Activity: Failure to comply with the Order of Conditions and additional site activities on the land adjacent to #50 Farwood without an Order of Conditions. New activities are within 100' of a wetland resource area. B. Findings The Issuing Authority has determined that the activity described above is in violation of the Wetlands Protection Act (M.G.L. c. 131, § 40) and its Regulations (310 CMR 10.00), because: ® the activity has been/is being conducted without a valid Order of Conditions. ® the activity has been/is being conducted in violation of the Order of Conditions issued to: Karen Sorkin 3/17/04 Name Dated 242-1234 38,39,42,44,45,46,47,48,51,52,58, & 69. File Number Condition number(s) wpaform9a.doc - rev. 12/15/00 Page 1 of 3 Massachusetts Department of Environmental Protection DEP File Number: L7� I Bureau of Resource Protection - Wetlands WPA Form 9A - Enforcement Order Massachusetts Wetlands Protection Act M.G. L. c. 131, §40 Provided by DEP B. Findings (cont.) ® Other (specify): See attached EnforcementNiolation Letter C. Order The issuing authority hereby orders the following (check all that apply): ® The property owner, his agents, permittees, and all others shall immediately cease and desist from the further activity affecting the Buffer Zone and/or wetland resource areas on this property. ® Wetland alterations resulting from said activity should be corrected and the site returned to its original condition. ® Complete the attached Notice of Intent. The completed application and plans for all proposed work as required by the Act and Regulations shall be filed with the Issuing Authority on or before 16, 2004 Date No further work shall be performed until a public hearing has been held and an Order of Conditions has been issued to regulate said work. ® The property owner shall take the following action to prevent further violations of the Act: See Attached Cover Letter Failure to comply with this Order may constitute grounds for additional legal action. Massachusetts General Laws Chapter 131, Section 40 provides: "Whoever violates any provision of this section (a) shall be punished by a fine of not more than twenty-five thousand dollars or by imprisonment for not more than two years, or both, such fine and imprisonment; or (b) shall be subject to a civil penalty not to exceed twenty-five thousand dollars for each violation". Each day or portion thereof of continuing violation shall constitute a separate offense. wpaformga.doc . rev. 12/15/00 Page 2 of 3 zwp Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands WPA Form 9A - Enforcement Order Massachusetts Wetlands Protection Act M.G. L. c. 131, §40 Provided by DEP D. Appeals/Signatures An Enforcement Order issued by a Conservation Commission cannot be appealed to the Department of Environmental Protection, but may be filed in Superior Court. Questions regarding this Enforcement Order should be directed to: Alison McKay, Interim Conservation Administrator Name 978-688-9530 Phone Number 8:30 AM to 4:30 PM, Monday - Friday Hours/Days Available Issued by: North Andover Conservation Commission In a situation regarding immediate action, an Enforcement Order may be signed by a single member or agent of the Commission and ratified by majority of the members at the next scheduled meeting of the Commission. Signatur s: A r1l" op 3 /©/C) 000) DM 73 h) Signature of delivery person or certified mail number wpaform9a.doc - rev. 12115/00 Page 3 of 3 TOWN OF NORTH ANDOVER NOTICE OF VIOLATION OF WETLAND BYLAW 0190 1 nATF nl Tu .1-1 ii ys II �L t0 64I'l '1,i `� "titer `f Cs,; �iaJtlt�l`vr711 �UGfKt�CTlJfri2i itll�{�� ^S. t,A,JCCJ"4' TIME AND DATE OF VIOLATION J (A.M.) (P.M.) ON AC T 20,f)y LOCATION OF VIOLATION ATjj J 76? F�iarC'0 �U'�t^rtrr f 3�© fi ll.tC�r1 it I nCr1C6T /AUr NUVVLEUtiE HE OF THE FOREGOING CITATION l,�able to obtain signature of offender. Date Mailed [o%Citation mailed to offender J f THE FINE FOR THIS NON -CRIMINAL OFFENSE IS $ p F D YOU HAVE THE FOLLOWING ALTERNATIVES WITH RE ARD TO DISPOSITION OF THIS MATTER. (1) You may elect to pay the above fine, either by appearing in person between 8:30 A.M. and 4:30 P.M., Monday through Friday, legal holidays excepted, before: The Conservation Office. 27 Charles Street, North Andover, MA 01845 OR by mailing a check, money order or postal note to the Conservation Office WITHIN TWENTY-ONE (21) DAYS OF THE DATE OF THIS NOTICE. This will operate as a final disposition of the matter, with no resulting criminal record. (2) If you desire to contest this matter in a non -criminal proceeding, you may do so by making a written request, and enclosing a copy of this citation WITHIN TWENTY-ONE (21) DAYS OF THE DATE OF THIS NOTICE TO: The Clerk -Magistrate, Lawrence District Court 380 Common St., Lawrence, MA 01840 ATTN: 21D non -criminal (3) If you fail to pay the above fine or to appear as specified, a criminal complaint may be issued against you. ❑ A. I HEREBY ELECT the first option above, confess to the offense charged, and enclose payment in the amount of $ ❑ B. I HEREBY REQUEST a non -criminal hearing on this matter. Signature WHITE: OFFENDER'S COPY YELL%W: CONSERVATION COPY PINK: POLICE COPY GOLD: COURT COPY Town of North Andover Office of the Conservation Department �r ° Community Development and Services Division , 27 Charles Street 'Ssgpµ�sEt North Andover, Massachusetts 01845 Alison E. McKay Telephone (978) 688-9530 Interum Conservation Administrator Fax (978) 688-9542 March 1, 2004 Heritage Green Condominium Trust C/o Karen Sorkin 39 Farwood Avenue, #1 North Andover, MA 01845 RE: ENFORCEMENT ORDER: Property at and adjacent to #88 and #90 Farwood Avenue Violation, to the Massachusetts Wetland Protection Act (MGL C.131 S.40) and the North Andover Wetland Protection ByLaw (C.178 of the Code of North Andover). Dear Ms. Sorkin: Upon site review of the Notice of Intent application for the reconstruction of the decks associated with the above referenced property under DEP file #242-1234, the North Andover Conservation Department observed a very large landscaping debris stockpile area within the 25 -foot no -disturbance zone of a protected wetland resource area. The North Andover Wetlands Bylaw (Section 3.4) strictly prohibits land -altering activities, including but not limited to, grading, landscaping, vegetation clearing, filling, excavating, and yard waste disposal within 25 feet of a wetland resource area. The landscaping debris pile is located behind the existing fence line just beyond an existing weldand flag (WF100A) associated with the deck replacement project to the north west of the subject property. A portion of the debris pile appears to extend off property onto portions of Wood Lane, a paper street. This enforcement Order is being issued for the removal/clean-up and mitigation associated with. the subject debris pile, which shall occur according to the methods and procedures described below. Specific wetland resource areas affected by the activities include the following: • 25 -foot No -Disturbance Zone (NACC Bylaw Section 3.4) • 100 -foot Buffer Zone (NACC Bylaw Section 1.3) ORDER: Acting as an Agent of the Commission under MGL C.40, S.21D and the Act (310 CMR 10.08(3)), enclosed please find an Enforcement Order mandating the removal of any unauthorized materials located within the 25 -Foot No -Disturbance Zone and restoration activities. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 2 The Heritage Green Condominium Trust shall immediately take the following actions: 1. Removal of Landscaping Debris Pile • A minimum of 15 hay bales and sufficient stakes for staking these bales (or an equivalent amount of silt fence) shall be on site prior to removal. The Conservation Department shall determine at any time if said erosion controls need to be installed. • Prior to removal efforts, the contracted landscaper and a designated environmental professional shall meet on site to discuss removal procedures. • The debris pile shall be immediately removed from the 25' no -disturbance zone and be properly disposed of in a manner that has no further negative impact to the resource area. • Removal efforts shall occur and be completed within 1 day and shallbe monitored by the designated environmental professional during the coarse of the day. • Upon completion of removal activities, the Conservation Department shall be contacted for a final inspection. • During the final inspection, Conservation staff shall have the authority to require additional conditions for resource area protection 2. Buffer Zone Restoration Report/Plan Upon completion of removal activities, a report shall be provided by a professional wetland scientist to the NACC in narrative form that includes a detailed description of existing conditions, the size of disturbed area, and the proposed 25 -foot no -disturbance restoration methods, including the sequence of work, plantings strategy, anticipated fixture landscaping activities, current and future sedimentation/erosion control measures and site stabilization measures. The report shall address all impacts to the resource areas protected by the Act and Bylaw as well as the proposed mitigation measures in detail. This report shall be submitted for review and approval prior to implementation. Removal of said debris with the conditions referenced herein shall be completed by no later than March 12, 2004 and The Restoration Report/Plan must be filed with the Conservation Department by no later than March 19, 2004. The violations as documented herein are subject to a $300 per day penalty' until such time as the impacted resource areas have been mitigated. Each day or portion thereof during which this violation continues shall constitute a separate offense. At this time the Conservation Department has elected not to levy a fine. However, we reserve the right to take additional action in the fixture should this Enforcement Order not be complied with retroactive from the date we were first made aware of the violations. Failure to comply with this Order and the deadlines referenced herein will result in the issuance of additional penalties. MGL C.131 S.40 and the North Andover Wetland Bylaw, C.178 authorizes the Conservation Commission to seek injunctive relief and civil penalties per day of violation. In addition, a violation of the Massachusetts Wetland Protection Act and the North Andover Wetland Bylaw 1 In accordance with the provisions of MGL c.40 s.21D and Section 178.10 of the North Andover Wetland Protection ByLaw (REV May 1993/REV October 1998) constitutes a criminal act, which is subject to prosecution and the imposition of criminal fines, also per day. This Enforcement Order shall become effective upon receipt. Please feel free to contact me if you have any further questions or concerns in this regard. Your anticipated cooperation is appreciated. S' erely, 111OW-1- - ;' Alison McKay Interim Conservati n /Administrator Encl. CC NACC Ms. Heidi Griffin, Community Development Director Robert Nicetta, Building Commissioner Michael McGuire, Building Inspector John Morin, Neve Morin Group GregHochmuth, Neve Morin Group DEP Northeast Region file LAIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 9A - Enforcement Order Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 DEP File Number: Provided by DEP A. Violation Information Important: When filling out This Enforcement Order is issued by: forms on the North Andover 3-1-04 computer, use Conservation Commission (Issuing Authority) Date only the tab key to move To: your cursor - do not use the Heritage Green Condominium Trust c/o Karen Sorkin return key. Name of Violator 39 Farrwood Street, North Andover, MA 01845 Address 1. Location of Violation: SAME Property Owner (if different) 88-90 Farrwood Street Street Address North Andover 01845 Cityrrown Zip Code Map 36 83 Assessors Map/Plat Number Parcel/Lot Number 2. Extent and Type of Activity: Existence of a very large landscaping debris stockpile area within the 25' no -disturbance zone protected under the North Andover Wetlands Bylaw. B. Findings The Issuing Authority has determined that the activity described above is in violation of the Wetlands Protection Act (M.G.L. c. 131, § 40) and its Regulations (310 CMR 10.00), because: ® the activity has been/is being conducted without a valid Order of Conditions. ❑ the activity has been/is being conducted in violation of the Order of Conditions issued to: Name Dated File Number Condition number(s) wpaform9a.doc • rev. 12/15/00 Page 1 of 3 Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands WPA Form 9A - Enforcement Order Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Findings (cont.) ® Other (specify): See attached Enforcement/Violation Letter C. Order The issuing authority hereby orders the following (check all that apply): ❑ The property owner, his agents, permittees, and all others shall immediately cease and desist from the further activity affecting the Buffer Zone and/or wetland resource areas on this property. ® Wetland alterations resulting from said activity should be corrected and the site returned to its original condition. ❑ Complete the attached Notice of Intent. The completed application and plans for all proposed work as required by the Act and Regulations shall be filed with the Issuing Authority on or before Date No further work shall be performed until a public hearing has been held and an Order of Conditions has been issued to regulate said work. ® The property owner shall take the following action to prevent further violations of the Act: See Attached Cover Letter Failure to comply with this Order may constitute grounds for additional legal action. Massachusetts General Laws Chapter 131, Section 40 provides: "Whoever violates any provision of this section (a) shall be punished by a fine of not more than twenty-five thousand dollars or by imprisonment for not more than two years, or both, such fine and imprisonment; or (b) shall be subject to a civil penalty not to exceed twenty-five thousand dollars for each violation". Each day or portion thereof of continuing violation shall constitute a separate offense. wpaform9a.doc • rev. 12/15/00 Page 2 of 3 Massachusetts Department of Environmental Protection LIBureau of Resource Protection - Wetlands WPA Form 9A - Enforcement Order Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals/Signatures DEP File Number. Provided by DEP An Enforcement Order issued by a Conservation Commission cannot be appealed to the Department of Environmental Protection, but may be filed in Superior Court. Questions regarding this Enforcement Order should be directed to: Alison McKay, Interim Conservation Administrator Name 978-688-9530 Phone Number 8:30 AM to 4:30 PM, Monday - Friday Hours/Days Available Issued by: North Andover Conservation Commission In a situation regarding immediate action, an Enforcement Order may be signed by a single member or agent of the Commission and ratified by majority of the members at the next scheduled meeting of the Commission. Signature Signature of delivery person or certified mail number wpaform9a.doc - rev. 12/15/00 Page 3 of 3 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING r OTHER THAN A ONE OR TWO FAMILY DWELLING '.;s:K.� s Section for Official Use Onl 3 ?"`ti a#_ a�' p-`5-r:'�s '`�'s BUILDING PERMIT NUMBER: 02 6DATE ISSUED: SIGNATURE: /vl A `-&` I 1.1 Property Address: ?> I - q k jr,«vr09A i�. A+6jeC M4 19S Date 1.2 Assessors Map and Parcel Number: % 3g _ q I Map Number Parcel Number 1.3 Zoning Information: - -- 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard R red Provide Required Provided RNWred Provided 1 1.7 Water Supply M.GI-C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal On Site Disposal System ❑ 2.1 Owner of `iRecord �ec'-tMgQ- Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Signature Telephone ""R 3.1 Licensed Construction Supervisor ` Not Appli ble ❑ Nihnber Z Expiration Date Address iLicense A- Licensed Construction tsor. 791631 -33T, Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 6xc;'A 1, as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed u„ der the pal s an pe hies of�erjury PrintName 1,019/0 —t� Si of Owner/Agent Date POO Item Estimated Cost (Dollars) to be ,' r Completed by permit applicant 3 1. Building (a) Building Permit Fee 1q.006. Multiplier 2 Electrical (b) Estimated Total Cost of Construction from 6) 3 Plumbing Building Permit fee (a) x (e) 0 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number > !� ' �yS e(�ii � �F s� �:xl '�`t. .�, �•i � T'fi"d-w £L N � g ,�' ..'. -dS2+' <ELf ,i � � t i .E '1a�. "� rf ;' �t W �� i "" i , Y.. 2,1 3" I t.(4 ✓ �- F y,y iF h : v::y � - .'i }.:.. ✓',i+:. L.+. ..•!3 .iy..' ^R t4j._jy M�.'{y. v.. 1?'iyt`` } 4 �ylty SV'"4{ t5fjv6.i VJxYgk '.S'e%}`j71h fiad'£t�gl}v{S/t N; �.t SSL ��i' (Af NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 sr 2 ND 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND 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. Si ned affidavit Attached Yea ...... JK No ....... ❑ SECTION s >�� zal .> > s � M � 1� � rmi sr s l T� a� . n +til+ 1 sa 5.1 Registered Architect: ! Name: Address Signature Telephone Name: Address: Signature Total Area of Responsibility Registration Number Expiration Date Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date i Name Area of Responsibility Address Registration Number Ntgnature Company Dame: Responsible in Charge of Construction Telephone Expiration Date Not Applicable ❑ !EIbr0 E ali,appircab� New Construction ❑ Existing Building . ........ . Repairs) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: A Assembly ❑ A-1 ❑ A4 ❑ sk'IeJ?s IA 113 Owner of the subject property Hereby authorize My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on 5 USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 ❑ A-3 ❑ A-5 ❑ IA 113 0 0 B Business 0 2A 213 2C 0 0 0 C Educational 0 F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard 0 3A 313 0- 0 I InsUtutional IInstitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 0 R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 513 0 0 S Storage 0 S-1 ❑ S-2 ❑ U utility ❑ M Mixed Use ❑ S Special Use ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft -'- Independent Structural En ' eerie Structural Peer Review Required Yes ❑ No 0 SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Hereby authorize My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on Location C/" No. a 3 Date A TOWN OF NORTH ANDOVER .. 9 ' Certificate of Occupancy $ y's'••... 11 Building/Frame Permit Fee $ �U RCMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ c �� Check # / rl i u _ .i X11 /G l ` (.,✓. , Building Inspector 01/11/1994 06:28 0000000000 MS. KAREN SORKIN, PROPERTY MANAGER DIVERSII~M FUNDING CORP. HERITAGE GREEN CONDOMINIUM 39 FARRWOOD AVENUE NORTH ANDOVER, MA 01845 DIVERSIFIED PAGE 01 Contract 2q 57 m Vr= N T Z Roofing Service, Inc. 82 $a"derson Avenue, Lynn, MA 01902.1937 Phone 781 593-9300 Fax 781 593-9399 ///23/2003 Max Sontz Itoafing Services, be. proposes to furnish all labor, .materials, equipment and supervision to remove existing roofing system and install new "GAF" (30) Thirty Year three tab shingle roofing system complete with all tlashJugs over building #'s 45-47 (2 bed); 68-70 (2 bed); 88-90 (2 bed); 99-101 (3 bed) Edgelown; 39-41 Farwood (2 bed) and 70-72 (3 bed) Feraview, all as per the following specifications. 1. Furnish owner with TEN (10) year Max Sontz Roofing Semites, Inc. guarantee upon completion. 2. Furnish owner with (30) Thirty Year manufacturers guarantee forms upon completion.. 3. Protect all surrounding bushes, trees, shrubs and flower gardens prior to commencement of work. 4. Strip existing shingles, nails, fasteners and felt down to structural roof deck on ENTIRE rear roof areas. S. Remove existing aluminum air vents and cover with plywood. 6. Broom all existing loose debris and remove from roof and premises and dispose in proper EPA landfill site. 7. Install new 8" "WHITE" finish aluminum drip edge flashing on all leading edge sides roof areas as needed. S. Install proper base flashing around all roof projections (i.e. plumbing vents pipes, chimney areas, etc.) as per manufacturers recommendations. 9. Install new bituthane Ice and Water Shield to first (3) three feet of roofs edge and around all roof projections as per mans bdures recommendations. 10. Apply new XS# nonperforated felt over remainder of exposed roof deck area. 11. Furnish and install new (25) Twenty Flye Year three tab roofing shingles. Color to be: SILVER LIFTING. Initial.. Should this aoteam meet with your approval, please sign, date and return to above adWm%$. TOTAL BASE PRICE Massachusetts $pW Tax Metwevo Al!'+alr+ial it ro 8P as tprtliied. All wor/i b br rofWrrrd in a wonbxanlib nrannrr an ording fo industun• tometirrs. Am• alteration or drriadan jrorn the abmr Jyrri,4ratiars iavoh inA rtrrra roars wilt hr r.ranurd rnrp uppn xdtpn orsdsrs, asd r!!1 bL(rJrnt an Pa'oV fAAsge p yr and ebpjY dU agrPP+npnr, ,1/1 agrprMPms rpntAtgPxe upon vgkeJ. nCC)dHr[r or 4e 14,4Y ✓1 rwlnd ouy eonnp) Qarle� , c v P^oSfar+' 0 C�+1e Ryr. ramooa and uh r n , uaumwrr. Ary wdtAPPo A!Y fid(y rOrryrd by Worbnrn } Conprnmtron /nsuranrr. Udmr oth—ise oullinrd aborr. wr assume na liab96; for Asbsk s wyrr ownrr.M aquirr all pr+muJ anJ /hrrmr+i!i ri nrr fo Ar moos ;n V.1pgvnrrnrr.7krahaveprkrs,tpef(leaf vandrondldoncarrw1ftjarrorraro/a+rArrrhvarrrprrd,Nut.Som. Rooft.1wr1rt.Inr.1.iArrrbtduftri_sdroprrjnrnrtoe abrtr.ria*,sJspogth-fIt!sagreeddatati dtspur v ar}tbag our OjMlepnopatbRnruns�r ,VIII W motive by o lMnt,xrgr aJ•pirrvrar and bryhrr d(Jion Httl APP"al. MAX SONTZ ROOFING SERIV7CE5. INC. CUSTOMER ACCFPTANCJ~ ._� - i(1 Z --- DATE: !7 Page 1 - — - -11 1 . 4-U UUtJeJ✓ UUrJUU DIVERSIFIED PAGE 02 MS. KAREN SORKIN, PROPERTY MANAGER DWERSIFEM FUNDING CORP. HERITAGE GREEN CONDOMIN JM 39 FARRW'OOD AVENUE NORTH ANDOVER, MA 01845 Contract 6/23/2003 12. Install new lineal "ridge" ventilation syste ver top of all gable areas. 13. Clean aN existing gutters and Paaesac all support brackets and downspouts. NO new gutters or downspouts will be installed and all existing will remain. 14. Rem#)ve all roofing debris from grounds daily, clean around premises at completion of job. TOTAL BASE COST: NINETY FIVE THOUSAND FIVE HUNDRED DOLLARS. $98,500.00 PAYMENT TERMS: $32".00 epaa acceptance of contract, 2 -•progress payments of $25,000.00, balance of $15,700.00 due upon completion of roofing work. A.ItiMIONAL'WORD: A. Remove and replace any rotted roof deekia.g as necessary and/or re -secure existing decking for proper inst21181100 of shingles @ $5.75/ft Initial—LI– B. Re -lead existing chimney areas as necessary. S525.00/ea. Initial p� �3ayoo.I- 1J( ^� 5 ba '�l9lNSt�. r 2 hes - ly�gco. Should this contract fleet vnith your approval, ,please sign, date and return to above adds. TOTAL BASE PRICE $98,500.00 M�s"Chusaffs Sales Tax Induded ,ft/nhVer}"O n d! 6f ipkr(bfd. RK renk4 be a?F'r 9ver pl a bVve dW h aam"rm"t. a llog of a ltld!iSMrypAielkra. Artr rllrration or dot-iefim from Ap 46cat veelfraliov In+nh ins cora r»va Hifi he exe.•uree0e1: + t•►tKit OnllYd. Oaf »iYbrcarx as rttry chor=e awrandabnve t/d! agreement. d fl aprrrmrvU tOnnl�ea! uPdt+;!ri4et. we ldrr:a or drlays hniord our rompl. QHdrr b ev!V11.w tnr!tada and o!hi•r e+rrrttan' +^jugs•�>7F►ria+Yll+liYr�odbyWorknen'sCotr�pivat!dnfray, Unlersarhernrarou!!im!dabat'F.iwaumnrnplU.cl�ityjcr,lsbsloawuJlr.ounrrtnage,'rrollvPrmn.F�rA(.nFmMlfr/rrrfo'rt�.cnadrirt 1/3 P*..vmm&. Ae ahow prim, 9K'13t "Otu and cQW410u a" aahafarbry and an htrvby emPred. nta+' Rmfz Roofing Sen im.: Mr. .1 horehy awhomed !o perfdnn t/ r abo r Rork rtr rtrrrr�rd f! l t agreed Ma: ;.e diapula a WAS ar! 01 *# PWWdlkonb+nt.itl he n%ohyd 0 a third Parry Rn ftlor and hWhrr daion hill 0Jird. MAX SONCZ ROOFING SElzvICkS, INC. CUSTOMER ACCEPTANCE_ p� QL �, DATE; Page 2 BOARD OF BUILDING REGULATIONS Ucense: CONSTRUCTION SUPERVISOR Number: CS 0752% Birthdate: 12114/1965 t Expires: 12/14/2004 Tr. no: 5852 i E restricted: 00 i BRADLEY J SONTZ 7 McKINLEY RD, MARBLEHEAD. MA 01945 Administrator Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents . Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 1 am an employer providing woke compensation for my employees working on this job. 9n C Com name. Addressy L- �,/JO-050, AJ•Q tcl 0Z Insurance: Co. C M -A Policv # W C 1? i 1 S62rq 1 Company name: Addre's. Farre to segue coverage as required under Section 2SA of MGL tat can lead to the imposition of criminal p'enafthm er ormo up to sy.; and/or one years' imprisorunenLas_welLas_cndl,�enaltles�nSheSarm � lS?P a:fne�i understand that a copy of this statement may beforwarded to the office of Investigations of the DIA for coverage verification. Official use only do not write in this area to be completed by city or town dWar City or Town 13 BtdIc ntg Mi []Check if immediate response is required .❑ Lkensing BG ❑ Selectman's Contact person: Phone A ❑ . Health Depa. ❑ Other NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-6f DEBRIS DISPOSAL FORM In accordance 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 prof licensed solid waste disposal facility as defined by MGL Chapter 111, S. 150 A. The debris will be disposed of in: (Location of Facility) AA j Jk, S' of Pftr4t Applicant to Date NOTE: Demolition permit from the Town of North Andover must be obtained for this p through the Office of the Building Inspector O EMM4 a O 0 a 0 l O i� w w A O v O U9 ; C v cn p 1-4 u w 2 z A o ca p w O w -C U G w" O w p rs: CO w a a C U w w p w2 Cf)w G a O w z C7 O w G w z w w w G 7 o z u Cf) Q o cn E o 3 =o D C O O o 0 me E m o y O • : � y C40ab CfG, M y m a 01 c y O O_ y .40 O7 ac. in tcm t 01p c S IAQ ' V m or m v y o v•�Z o c o cn o_ c h m c c COOL 3 N � o. o 8 y m$~r W = c `o •v = �: ;; MDUujH Co.) dttvc Z W .E � CD 0 m 0 �C o C** o. IDCL o � _CA .0 OMS C E- r $ arm W CD O E Z O D I CO2 H 03 Q. O f+ O O C.2 _O CL CO) O v .CL CO) C O O C CO d CO2 r�-1 0 w co CL y O CD gm O 32 CD m m LLI 0 C) U) crW W W Lli U) Location ` r No. Date N°RTM '�� TOWN OF NORTH ANDOVER 9 4 s Certificate of Occupancy $ sACMus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �' `� Building Inspe or Location JgP ale-' No. dT Date 5 TOWN OF NORTH ANDOVER ° Certificate of Occupancy $ '�b'•'°�<� Building/Frame /Frame Permit Fee $ 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 9% 14131' ilding Insp or '1611994 02:08 0000000000 DIVERSIFIED PAGE 03 ,Date 1 OU TORNOFN01R.MA-"OVER 27 CHARLES ST APPLICA TIONPDX C£Nlif7CATE-of I °ltSPEC'Tf4N Fee Ri!quired (Amount) `��d , « Q () No Fee Required Accordance with the provisions of the Massachusetts State Building code, Section 108,15,1 hereby apply foi Certificate of Inspectlan for the below-nawd prem s Awated -rt the following addrAes F: Street and Number Name of Premises Purpose for which UsedMjjAq Licenses (s)'Or pod uz Z9 71 -(s) &UPired for the 1'xePuses by Dlber kC auemmntal Agencies: Cenifscate to.bfr #tuGd to �._•_ ... Address r '= TT111AO 4/1 Telephone Owner of'Reqd of Bu* n Address 1 ,,� Norrie of Present HoW of Certificate Alame of Agenc)4 if any__ iV �JLd SIGNATURE OF PERSONS TO WHOM CEA IS 9SUED OR I At THOIRIZED AGENT INSTRU�,"lT�h�• 1) Mahe cheekpayable to, Town of North Andover 2) Return this application with your check to.- figgft 27 Charles Street, North Andover MA 01845 PLEASE NOTE: Application form with accompanying_1 F must be .submitted for each building or structure or part thereof to be cert 3) Application and feeAnust.be recgixwdhefozethe cerh��cate �uill.be issued_ 4) The bugft officials shall be notified within ten (IY2 d s qLany Chan a in the above in ormation_ CERTIFICATE # EXPIRATIOND, 47F: Fo�sacc-3-�� >ti�r ti Location � � /`N L.�Jdy � !/R C /%�v/ mo I, g } No. Date / l D S� TOWN OF NORTH ANDOVER Certificate of Occupancy $ i� °'•"°''t�' 9 Buildin /Frame Permit Fee $� P Check # 7 a Foundation Permit Fee $ Other Permit Fee $ C 11,, U TOTAL $ f ,r / Building Inspector e TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT ELM& RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 101 seed" fow BUILDING PERMIT NUMBER: j� DATE ISSUED: SIGNATURE: C6" Buildin "- Buildin Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: �p \ 1.2 Assessors Map and Parcel Number: 3 Fel r r U-) o P1 V C- Map Number Parcel Number w J h d o v e w' 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District I r Use Lot Area Frontage R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Reauired I Provide Required I Provided Required Provided a a e (_-nV qeA Undo fYl� �� i 2.2 Owner of R rd: osGwn i"y �a Print , Si ature 7 Tel one rmrnnr z _ rn11iC i!'TiA11T CF.RVr!'F.0 /% ��ow_ Address for Service: 3.1 Licensed Construction Supervisor: 1.3. Flood Zone Information: Not Applicable 0 1.8 Sewarar Disposal System: 1.7 Water Supply M.G.L.C.40. 34) Public ❑ Private ❑ ZOOe Outside Flood Zane ❑ e License Number Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHWIAUTHORIZED AGENT - S off'- 5 X 2.1 Owner of Record Signature Telephone �ee''�gge �,eeerl 7�sf f ��/,C�LCt�Ood �ve / /(�fE��e la --J-6p 3 (.o�o�o�rt,i�,u� \3 Registration Number Name (Print) V Address for Service c a a e (_-nV qeA Undo fYl� �� i 2.2 Owner of R rd: osGwn i"y �a Print , Si ature 7 Tel one rmrnnr z _ rn11iC i!'TiA11T CF.RVr!'F.0 /% ��ow_ Address for Service: 3.1 Licensed Construction Supervisor: Not Applicable 0 Ro bfr-v C9'' L-y_—/)4S Licensed Construction Supervisor: q % & e License Number e ` Q + ► e it l C � � �4' c. Address t o.�tiu . 9 7 �`- �ocv �- - S off'- 5 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ C la --J-6p 3 Company Name Registration Number k6— iz tieC a t l �� tC �t o l p�- Address c f7'f-_Tr7P ExpirationDate Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 Workers Compensation Insurance affidavit must be completed and sub[ in the denial of the issuance of the buildig permit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTIONS Descri tion of Proposed Work check spokubk New Construction 0 Existing Building ❑ Repair(s) with this application. Failure to provide this Alterations(s) E' I Addition ❑ s will result Accessory Bldg. ❑ Demolition 0 Other Specify r ns aV 5 ro c:V Brief Description of Proposed Work: �5 it'y"C CI ec-k . Icut\kS C{r _Ic"u i �k V% r S � �n!�� 44 lla -L ,n L, 6 Q cit coos i ec 14- nc� rg i -,,L i4 -+ P Y (,n5 St{ sot, CF.C.TION 6 - FATIMATFn V0N1.qTR11TVTinN VAQQTc Item Estimated Cost (Dollar) to be Completed b unit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 A ra14 - / �5o Check Number 13Ma-1AWLI rA vTVLIMAZ%1Uaravluc,t111v11 1V Djr, I.UMrLAI]&IN W"N:jr OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner u orized A e t f subject property Hereby authorize�0/I-f,Q�ICj (' �i� e to act on My,byhalf, in all ►tters,re tive to work authorized by tfiis Wilding permit application. 'l/�/oc�! S k iature of er — Wke,eWq '-fwo'w< Date SECTION 7b OWNER/AUTIfORIZED AGENT DECLARATION k property ,as Own u onzed TAgen of subject ` prope yy Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIABERS 1 2 -Nu 3 RD SPAN DIMENSIONS OF SELLS DMIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHPVNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATU1tAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT 111662geM17 a106 1,9 14' 1 7��C PHONE F7,F6F6 `(IX40 97 LOCATION: Assessor's Map Number PARCEL SUBDIVISION �! STREET �3 9f f'��Woo_/ N ,,/ LOT (S) .��/�-'�l� ST. NUMBER ,3% ��i 4 # I OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS DATE APPROVED DATE REJECTED TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT DUMPSTER PERMIT RECEIVED BY BUILDING INSPECTOR DATE FORM U - Revised 6.05 JMC NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: u° 6, me� is that the debris resulting from this work shall be disposed 61 in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: Fire Department Sign off: Dumpster Permit -'?60 66" (Location of Facility) x 164 Signature of Permit Applicant Date Town of N. Andover Massachusetts DEPARTMENT OF INSPECTION SERVICES CONSTRUCTION CONTROL AFFIDAVIT As Per 780 CMR - Sixth Edition BUILDING PERMIT # PROJECT/OCCUPANT Heritage Green Apartments PROJECT LOCATION/ADDRESS: North Andover, MA PROPOSED WORK: Pool House Balcony Repair. IN ACCORDANCE WITH SECTION 116.0 OF THE MASS. STATE BUILDING CODE, I_STEPHEN J WESSLING TELEPHONE NO. 617-773-8150 REGISTRATION NO. 4191 BEING A REGISTERED PROFESSIONAL ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL_ X _ STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL OTHER (specify) FOR THE ABOVE-NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASS. STATE BUILDING CODE AND OTHER, ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AS OUTLINED IN SECTION 116.2.2 OF C.M.R. CODE AND BE PRESENT AT INTERVALS APPROPRIATE TO THE STAGE OF CONSTRUCTION TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT. I, OR MY REPRESENTATIVE, FURTHERMORE AGREE TO SUBMIT PERIODICALLY, AN INSPECTION REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NOR' ANDOVER BUILDING COMMISSIONER NOT LESS THAN SEMI-MONTHLY. UPO gLpED 4 COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE ��U J. W� SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. % N No. 4191 In Y, & TPP (NO FACSIM1ETF Town of N. Andover Massachusetts DEPARTMENT OF INSPECTION SERVICES CONSTRUCTION CONTROL AFFIDAVIT As Per 780 CMR - Sixth Edition BUILDING PERMIT # PROJECT/OCCUPANT Heritage Green Apartments PROJECT LOCATION/ADDRESS: North Andover. MA PROPOSED WORK: Pool House Balconv Repair. IN ACCORDANCE WITH SECTION 116.0 OF THE MASS. STATE BUILDING CODE, I_STEPHEN J WESSLING TELEPHONE NO. 617-773-8150 REGISTRATION NO. 4191 BEING A REGISTERED PROFESSIONAL ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL_ X _ STRUCTURAL, MECHANICAL FIRE PROTECTION ELECTRICAL OTHER (specify) FOR THE ABOVE-NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASS. STATE BUILDING CODE AND OTHER, ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AS OUTLINED IN SECTION 116.2.2 OF C.M.R. CODE AND BE PRESENT AT INTERVALS APPROPRIATE TO THE STAGE OF CONSTRUCTION TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT. I, OR MY REPRESENTATIVE, FURTHERMORE AGREE TO SUBMIT PERIODICA ` eO .:R AN INSPECTION REPORT TOGETHER WITH PERTINENT COMMENTS TO THP.,� H WF�'rF ANDOVER BUILDING COMMISSIONER NOT LESS THAN SEMI-MONTHLY. 0 ' COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO T& No 4191 G) SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR ` QUINCY, MA OCCUPANCY. AMP (NO FACSIMILE) Town of N. Andover fMassachusetts DEPARTMENT OF INSPECTION SERVICES CONSTRUCTION CONTROL AFFIDAVIT As Per 780 CMR - Sixth Edition BUILDING PERMIT # PROJECT/OCCUPANT Heritage Green Apartments PROJECT LOCATION/ADDRESS: North Andover, MA PROPOSED WORK: Pool House Balcony Repair. IN ACCORDANCE WITH SECTION 116.0 OF THE MASS. STATE BUILDING CODE, I_STEPHEN J WESSLING TELEPHONE NO. 617-773-8150 REGISTRATION NO. 4191 BEING A REGISTERED PROFESSIONAL ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL_ X _ STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL OTHER (specify) FOR THE ABOVE-NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASS. STATE BUILDING CODE AND OTHER, ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AS OUTLINED IN SECTION 116.2.2 OF C.M.R. CODE AND BE PRESENT AT INTERVALS APPROPRIATE TO THE STAGE OF CONSTRUCTION TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT. I, OR MY REPRESENTATIVE, FURTHERMORE AGREE TO SUBMIT PERIODICALLY,,,_ o AN INSPECTION REPORT TOGETHER WITH PERTINENT COMMENTS TO THE N - R� ANDOVER BUILDING COMMISSIONER NOT LESS THAN SEMI-MONTHLY. UP A'.- COMPLETION '�COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR o CONCY. OCCUPANCY. ATUPX& STMP (NO FACSIMILE) Town of N. Andover Massachusetts DEPARTMENT OF INSPECTION SERVICES CONSTRUCTION CONTROL AFFIDAVIT As Per 780 CMR - Sixth Edition BUILDING PERMIT # PROJECT/OCCUPANT Heritage Green Apartments PROJECT LOCATION/ADDRESS: North Andover, MA PROPOSED WORK: Pool House Balconv Repair. IN ACCORDANCE WITH SECTION 116.0 OF THE MASS. STATE BUILDING CODE, I_ STEPHEN F. ONDRICK JR TELEPHONE NO. 617-472-1800 REGISTRATION NO. 39029 BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL_ _ STRUCTURAL_X_ MECHANICAL FIRE PROTECTION ELECTRICAL OTHER (specify) FOR THE ABOVE-NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASS. STATE BUILDING CODE AND OTHER, ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AS OUTLINED IN SECTION 116.2.2 OF C.M.R. CODE AND BE PRESENT AT INTERVALS APPROPRIATE TO THE STAGE OF CONSTRUCTION TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT. I, OR MY REPRESENTATIVE, FURTHERMORE AGREE TO SUBMIT PERIODICALLY, AN INSPECTION REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING COMMISSIONER NOT LESS THAN SEMI-MONTHLY. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. AJ'AAj4 �R OF AT6 STEPHEN FryG ONDRIC3K, JR. #" ATURE & STAMP (NO FACSIMILE) STRUCT U AL 10NAI. Town of N. Andover Massachusetts DEPARTMENT OF INSPECTION SERVICES CONSTRUCTION CONTROL AFFIDAVIT As Per 780 CMR - Sixth Edition BUILDING PERMIT # PROJECT/OCCUPANT Heritage Green Apartments PROJECT LOCATION/ADDRESS: North Andover, MA PROPOSED WORK: Pool House Balconv Repair. IN ACCORDANCE WITH SECTION 116.0 OF THE MASS. STATE BUILDING CODE, I_ STEPHEN F. ONDRICK JR TELEPHONE NO. 617-472-1800 REGISTRATION NO. 39029 BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL_ _ STRUCTURAL_X_ MECHANICAL FIRE PROTECTION ELECTRICAL OTHER (specify) FOR THE ABOVE-NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASS. STATE BUILDING CODE AND OTHER, ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AS OUTLINED IN SECTION 116.2.2 OF C.M.R. CODE AND BE PRESENT AT INTERVALS APPROPRIATE TO THE STAGE OF CONSTRUCTION TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT. I, OR MY REPRESENTATIVE, FURTHERMORE AGREE TO SUBMIT PERIODICALLY, AN INSPECTION REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING COMMISSIONER NOT LESS THAN SEMI-MONTHLY. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. �� 'i �a ._>' OF MS rT, STEPHEN F. ONDRIGK, #390'ka > NATURE & STAMP (NO FACSIMILE) STRUCTUhAL Town of N. Andover Massachusetts DEPARTMENT OF INSPECTION SERVICES CONSTRUCTION CONTROL AFFIDAVIT As Per 780 CMR - Sixth Edition BUILDING PERMIT # PROJECT/OCCUPANT Heritage Green Apartments PROJECT LOCATION/ADDRESS: North Andover, MA PROPOSED WORK: Pool House Balcony Repair. IN ACCORDANCE WITH SECTION 116.0 OF THE MASS. STATE BUILDING CODE, I_ STEPHEN F. ONDRICK JR TELEPHONE NO. 617-472-1800 REGISTRATION NO. 39029 BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT. MECHANICAL _ OTHER (specify) ARCHITECTURAL_ _ STRUCTURAL_X_ FIRE PROTECTION ELECTRICAL FOR THE ABOVE-NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASS. STATE BUILDING CODE AND OTHER, ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AS OUTLINED IN SECTION 116.2.2 OF C.M.R. CODE AND BE PRESENT AT INTERVALS APPROPRIATE TO THE STAGE OF CONSTRUCTION TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT. I, OR MY REPRESENTATIVE, FURTHERMORE AGREE TO SUBMIT PERIODICALLY, AN INSPECTION REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING COMMISSIONER NOT LESS THAN SEMI-MONTHLY. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. OF STEPHEN �` #sso2s / s +NATURE & STAMP (NO FAeSIMILE) STRUCTURAL BOARD OF BUILDING REGULATIONS 9- t License: CONSTRUCTION SUPERVISOR Number: CS 072629 Birthdate: 05/03/1954 Expires: 05/03/2006 Tr. no: 22998 Restricted: 00 ROBERT G INGS 85 RIVEREDGE RD N BILLERICA, MA 01862 Acting 48-mil Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR jRegistration: 127563 Expiration: 11/16/2006 i t Type: Private Corporation t J & C CONTRACTORS INC 1 ROBERT INGS 85 RIVEREDGE RD BILLERICA, MA 01862 `� , Administrator ..a: a,vsss"sursrVVUJ8n UJ inassacnusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADDlicant Information Name (Business/organization/Individual): ,S - � �,- r t,{� Address: P; )Io �-P A /0 _J - City/State/Zip: 1 I � E -3 Lk �, Q_ Phone #: `Y 77 e /.4-1 Are you an employer? Check the appropriate boa: 1.Rr I am a employer with �_ 4. ❑ I am a general contractor and I employee's (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp, insurance. 5• ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ N construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. [:1 Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ oof repairs 13.[Other nI ha e lzo d� - -- — -- .... —. -• r -••11- • t HM�L,V.J on,ow snowing then workers' compensation policy informatiinformation:omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors xContractors that check this box must attached an additional sheet showing the name of the submust submit a new affidavit indicating such contractors and their workers' comp. policy inforrmtion. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: CO12=i;! E xpiration Date:y-- rtCY'l.� Job Site Address:3 y 1�a rr t4 , 8 {�y Ci /State/Z' tY ip: /�/ • A n �l,,t Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year'lmprisonment, 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 certifyn e/ the pains and penalfies of perjury that the information provided above is true and correct 3J"?8 ` U«: -e ,9- YJ/ Oficial use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers n in theto service of another under any cone workers' compensafion for tract o p f hir6, Pursuant to this statute, an employee is defined as "...every express or implied, oral or written." er r any two An employer is defined as ,an individual, pian hin ludsmg the legalrporation dr representativesrepresentativets of legal eceased oemployer, or the of the foregoing engaged in a joint enterprise, to employees. However the receiver or trustee of ab individual, partnership, association or other legal entity, employing owner of a dwelling house having not more thanm IIantr e, cconstructionnd who eorherein, or the repa r wok on suchant of the dwelling house dwelling house of another who employs persons or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." y 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 lic work until acceptable evidence of compliance with the insurance enter into any contract for the performance of pub requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely, andphonenumchecking althe ong with txes thatheir certificate(s) f situationapply to your and, if necessary, supply sub -contractors) name(s), address(es) p 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 coverthisage. affidavitsbe ure to sign anof d damitted te the atTdathe �vit. tThe affidaviitlshould Accidents for confirmation of insurance 8 be returned to the city or town that the application the dm�g the law or if you ae is re requested, to obtains Department t of Industrial Accidents. Should you have y compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the app er which will be used as a reference number. In addition, an applicant Please be sure to fill in the permit/license numb that must submit multiple permittlicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 wwwmass.gov/dia JUL-01-2005 10:30 64MALCOLM AND PARSONS 7813441425 PHuuucFrt (781)344 3200 FAX (.781) 344 1425 null Y AND CONFCRS NO RIGHTS UNUN TSF CEIRTIFICATEIQN i Mal Co Irtl w Parcnn� Ills. Agcy. Inc, HOLDER. THIS CERTIFICATE n(]F,)' NOT AMEND, EXTEND OR IiFrcellJan $t. ALTER THE ((JVFRAGE AFF912DED SY TF1C POLICIES BE6Qw_ p,0, Sox 577 INOUPXRf, AFFORDING COVI_h.a(;F NAIC N SroaU}Iton, MA 02072_ _ W�11nEo Ji�r- �nnrrdc tl}I-s, Znc. - Ih:aJREa ✓•: Associated k1'J>p10yi-rs In Sur'S�nce �.. — 85 Riveredga Road IuAI IRRR H' tsii1pricd, MA 01862— IN;J rrg3URCR': COVERAGES THE POLI YRF1OF INS ERN .F I IS OI EL)T:ON� ANY rrN ONTEZA WED OTHER pOCUMCN WTOTHE � H RESPECOT TO WHIrIq I HIS UERTIFIC;ATE MK(B[ IG ELI OR D1P C MAv PERTAIN, TML' IIdCUR/%NCE AFFnRD�I I HY 1'HE PWCIE3 DGCC1113ED HERO ;S $1J4a IFC I 10 ALL THE T"RMS, EXE LUDIO�t. AND G;�NDIT'CNW LIF ti. ICFt F OL101t:£. AGC:pEGA7F 1 Rd:'f 5 SHUWIV MAI' HAVE L)CC"J R$.DUCeL) BY PAI1 11:. AIMS. LIL`V NtIM0.FR prv.IrV FFFEc_�r'ly"...LLL• 1-UucY ez�,1tAT OH LIMIT.i ... (NSH UUW TYPE OF INSUKANt,, r+0 M�+vv+ l DA IL IM6'IWL'Q. .R Vtirfl] � GI.CI!Cr'r'; IG'Ri 1•:f:H ' G=NERrwL LI,181UTv DA1'Nc •r' Ti aL•, I =7 � �. C �)MfAiln d.9L G_wFRAL LIAMUTYi,:.� 'I'u"Y" ' CLn�u� N6D� � I :Xx.;UK I _. _. �J �H:i!IVHL LI nI �r i�611.Ki . CCCIEwA At.:'.P-1::AT- S .�—.•• ( "". It .VRCC:IK�:=.Gl�psl•,urnu:, _ -- .GI -N L AGI;HlU'A I t 14�'T AipLICO I`: R: r�RT I nr. AUTOM00.1' I- I IARILIT Y AV'i 6-J.C.Al l DYlNFU AAWWLt nc:rICCl11 :'.o A! ITta; wW r, A:irtki tv )1q.0 1'tli I; AUTCEi OARAC'c uAQIL:'Y Ani AUTO FXCES*[tjMt2KCLLA LIA61LIT3' 71 Lx•:uw O 1'.I AIMS MAUc f11i'I aDUr_-I pt r xrTEhJTF.iN 5 Z:C11'AT COMPENSATION DWrl MPI&V LIABILIi Y A vR PTORA-AFtTNERlUtCCUTIV f. riWtwnv AL'fNR M. OTHEq IUN Ur UPERATIOn�1 J HOLDER Cneln hFD GIDIt,:1_:' l MIT KinLf IN (P., ..r ,�t n) g11•�ri TI IhV CM hU.CJ •.7 ,.'i• ar.F. f rAC.H CXAAJ:, <-r.i.- 4 WCC500361501ZVV4 10 0;/7.004 10/03/2005 IwySrlru .n G.L. -a CH A177111 -NI j Soo t,0( e I CASt A:iF • r -h CMI`l OVC F SOO , OI r •CI:=A�'H • PC% ICY' IMI I 5OO OI LG41 EYf':I IIAIONS ADULU of t,Noonse r`14T I GPCOIAL FIflOVISIONS Heritage Green Condmil; isms 39 Farrwvod AVp- North Andover, MA 01E65 ACORDR�(2001108) FAX! (978)685-05 cANccLLnTIorJ StIGULJ Ar'fi OC TIIc ACO+IE pcf:CP.IBEi Fr'1 If:IFA AF. CANCELL;•U Ut:hVlYk I tiL 'nkPIRATInN DATF THFHL'JY. I M�- 133UINo 1:1tfURCR WIUL C14DEAVOR YO MAII, DAN WRITTCN NoYICE TO TqG CCRTIcrroTr HDI CF.R NAME TU I HL'_& L. oUY FAILIJR�- TO MAII SUCH NOTE.- SMALL WUSC Iq0 OnL10ATION ort LIADILITV _ OF ANY KIWO UPON THL INSURER. Ir' � T4 nR 1F//PRE5' A_TI+/ES- AUY'1I0RIZED KL-lll=yENTATIYE t. P. 01/02 OACORD CORPORATION 1999 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers I §u. w ce Company Burlington, Massachusetts NCCI NO 40959 (800) 876-2765 ITEM 1. The Insured J & C Contractors Inc Mailing Address: 85 Riveredge Road (No. Street ❑ Individual ❑ Partnership ® Corporation ❑ Other Other workplaces not shown above POLICY NO. WCC 5003615012004 PRIOR NO. WCC 5003615012003 Billerica MA 01862 Town or City County State Zip Code FEIN 04-3014138 2. The policy period isf,0,10/03/2004 to 10/03/2005 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500, 000 each accident Bodily Injury byDisease $ 500,000 policylimit Bodily Injury byDisease $ 500,000 eachemployee C. Other States Insurance: See Endorsement WC 20 03 06 A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates GOV CLASS 10042 Estimated Per $100 Estimated Code Total Annual of Annual No. Remuneration Remuneration Premium INTRA 254745 SEE EXT NSION OF INFORI IIATION PAGE Minimum premium $ 486.00 Total Estimated Annual Premium $ 951.00 As indicated, interim adjustments of premium shall be made: Deposit Premium $ 984.00 ® Annually ❑ Semi Annually ❑ Quarterly ❑ Monthly MA Assessment Chg. $676.00 x 4.9000% $33.00 This policy, including all endorsements, is hereby countersigned by 08/17/2004 AV Authorized Signature Date GOV STATE GOV CLASS 10042 KIND AUDIT PLACING OFFICE CLAIM OFFICE NAME CHECK SAFETY GROUP MA 7 1505 WC 00 00 01 A (11-88) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. Malcolm & Parsons Insurance Agency Inc 6 Freeman Street - P O Box 527 Stoughton, MA 02072 L'i �I O O E L CO z a O CO) � c � CD c CO) o� CD y O O ff m m co 0 CD H_ CL _ t,. 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ZCDO� �3 -o O G O L L- CD K cma H c C .1-0 c O Q 'p C. o co CA Z 5 C.3 CO) R c C. 0 LU U) W W 19 W U) Location No. Date 4r- ij TOWN OF NORTH ANDOVER , Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fe, ��;�� $ Sewer Connection Fee $ Water Connection Fee $ T TOTAL $ % `y Building Inspector Div. 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" N "X m -1Q- c mm DD ll� Nps = o Z p T p I —LL�L� _ _L_L_l i IIIIIIIW i� I III 1� Ilill"-11 1111 H 111 11 I IIII >Ox ��tll yrN zm im yA NZZ �C sXi 3ntn 010 ave mim mx -Iza IN_!1 InOZ _ �o mW3 [oZ ymN M 0 NCz m F rOO ANO z�z xv 0 nz x0 mm N ,q m 61 00 3 m m A O v L4 O� 11 O A p w° a U) O U z O z m co w° C U w O z z �. 4 ; C a rs cz 0 a U W 7> cn m w a d °D m ii W w � w Ca w w C y m' z an o o cn mCIA O m � N ~ O cm CD zoo co H O O t1: S-5 m - v: y O ' r t o cm c oa O Q m acz c o V N O O cc CM C O C O D. CL. CJ ti t O W G :: �C � .r. LL +c O ast°c z C O (Wj m o c m CLCL. 'a O = cc s 09 �j o o Z ti N � J Q z o U- Q Z O o a •� m C cCOD cw w O z v1 w .. CZ O O LU O i j r o 0 CD CD v o G 0 o cc oo' 7 cc ev :mom CO.) s S C cc o c {� C D H C '' Z C.) J z U - CS a �a V L.7 C* O c vQ cc = W co) CD : w o O z z Go `N � l O O •w z mCIA O m � N ~ O cm CD zoo co H O O t1: S-5 m - v: y O ' r t o cm c oa O Q m acz c o V N O O cc CM C O C O D. CL. CJ ti t O W G :: �C � .r. LL +c O ast°c z C O (Wj m o c m CLCL. 'a O = cc s 09 �j o o Z ti N � J Q z o U- Q Z a o a •� 0 cCOD cw z v1 O p 'a .. LU O i .CD o 0 CD CD v o G 0 o cc oo' CO.) Cl C cc Q D C" c C '' Z C.) J z U - CS a V L.7 C* O c cc = W co) CD G z z l z w w 0- u) Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ RECEIVE� pAyME),;er Connection Fee $ _ NOV2Water Connection Fee $ _ 1991 TOTAL $ No. Andover Collector Building Inspector Div. 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INw 8 0 Z 't UNI QZF- WIW 3oN a. NUI HX NWW ] �Z] ZaN ONS U WZ - U) W NF,U F0lx I MIIIII IIII MIIIIIII I I Illillll T I TITF- u. W Z oc O -I I - Z o z 2 O a Z T c� Z m _ LL W Z LL 4 O a ¢ > 2 I I I m I p rol O LL � ~ Z Z Q� ¢ tx. w ed 3 I cV YC�� z z 3 X� uai _ 26 z �O��n 0�! W w- d x 0 0 z Z 3wy Z i Q a Z� `�" �01= vii O� MF W p-3��O W o �0Zi ¢ s U OO U ] "a=aoZ N m U? p S U w O 2 ¢ QQ�p<0 S a U n. 3 FO'Q7QJt0 V¢ 2 a - ZZLL0 O¢2VQ w Q vIiQ0m 3�YZ nit a nx¢o �(�OwZ i TTIT I 1 TTl I 1 TT 111 i� z 1 0 N U Y 0 O O Z Q 2 z y oc O y m� O¢ W LLz� W Z J O °e O j H Z Y m Z W ¢ ; Z z 0 Z e p� Z ¢ K LL C ¢¢ Z¢ V LL O °� 0 Z w 0 z Z W ed W Z N M ¢¢Z O W www N m -' N Z Z LL x wx Q O ��¢ „ LL wt O F„O Oxv��no00ZZoeZZ < j, �' �Oapp 000 00 � (70 O �m W � N uuY,,, u�.= w �� mo 0 m 0¢ W �uu U U Y Y U Zz w m °0�� 0�-� lo w eEoc O mw02�y ¢ OO&uL UU ma o� ¢= o`t Z x a �opc>p1�mi- u O> ¢¢% DUVz00 N N m m O N N Iii 0 (.� LL 00< J N�� D O 3 i�++0NI 1— w� m � 3 00 FW4 I w • h Cd E z` I .. C E71 sz V) z O V) W J v v O O N(�u L H L ^w i 40 0 V R A. H 0 3 .v a 0 U `1 0 0 *r*+ 0 C z 0 c 0 C 0 0 CL w .� i E 1402 0 z a c w c 0ad C9cc 0 0 oc Q W W W 0 C6 CA. 96 LL N Z Z Z W W W0 Q Z 16U o z z u oc m m L C J L j t V L Y CP E 96 �' LU a '� � E o o t S o S o m o s :3 E. ¢ U ii [C U. Q to Q U- m (at E z` I .. C E71 sz V) z O V) W J v v O O N(�u L H L ^w i 40 0 V R A. H 0 3 .v a 0 U `1 0 0 *r*+ 0 C z 0 c 0 C 0 0 CL w .� i E 1402 0 z a c w c Date .. ? l. /? .�V. l ....... YIN TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION .1� f f � This certifies that ....�:Y..C, r. ,........................ . has permission for gas installation .... f f. l' ................... in the buildings of .... ........................ at ....1. ?...y. ! ../.. r! r.;. L : .:......... . North Andover, Mass. r Fee. .1-.4 :... Lic. No. ... �.....4� GAS INSPECTOR t Check # 14 � I C. MASSACHUSETTS LT iooRMAPPucATON FOR PERMIT TO DO GAS bi nm (Type or print) NORTH ANDOVER, MASSACHUSETTS Date A 1 o Building Locations Uj n. J Pernmit # - � Z- Z- Owner's Name �� / '�7 jam, e. i 1y 4� ti New U Renovation Replacement Plans Submitted ❑ � � o 0 w a � 4 a E� p ra cW C O a p z F W W h C7 V < W CL ` W <FF O q < W i" z W W C9 C W Ci C9 �' O m > z W O W w SUB-BASEM ENT a a > a o r o BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. F L 0 O R H. FLOOR H. FLOOR H. FLOOR L7T H. FLOOR H. FLOOR (Print or type) eck one: Certificate Installing Company Name.- I ' ) i� tF t i 't' l G 1� /`i (� Corp. Address '+� O V, (6 s— � Partner. usmess Telephone ,gam 9 _ y y� aTirm/co Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: • I have a current liability Insurance policy or it's substantial equivalent. Yes �r No� If you have checked �, please indicate the type coverage by checking the appropriate box. Liability insurance policy 13 Other type of indemnity Bond 13 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 13 Agent a I hereby certify that all of the details and information I have submitted (or entered) in above appliatiqn are true and accurate to the best of my knowledge and that all plumbing work and in e�ons performed under Permit %6dfor is application will be in compliance with all pertinent provisions of the MassacIfiettsptate Ga6d"d Cher1f tV General Laws. City/Town APPROVED (OFFICE USE ONLY) Signature of Plumber 0 Gas Fitter. Master 0 Journeyman sed Plumber Or Gas Fitter rcense Number '— Date.S..J.AC, . . TOWN OF NORTH ANDOVER _ PERMIT FOR PLUMBING. This certifies that ... �� .. r. has permission to perform .... T...................... plumbing in the buildings of1.�... !... r ................ . at.. c?...Y. �.. , C ��! �' L`' °.` ........ , North Andover, Mass. Fee. 7.`�..... Lic. No......?.s........ '�}. �V r::-1----\ ......... t PLUMBING INSPECTOR r Check # (' ) 7 L) I t: I MASSACHUSETTS UNIFORM APPLICATION FOR PERMrr TO DO PLUMBING (Type or Pte) NORTH ANDOVER, MASSACHUSETTS Building Location _ 3 9— r '2:7 P Q New 13, . Renovation 0 woo j, Date .S-- `.> --i D Permit k i� Amount _ 1 Replacement LJ Plans Submitted -Yes No 0 \+ ►+uL Vl Lypu) kswlinSName ,A. 1'i D / �c%' Check one: Certificate Address1� C; (� m m 0 �� Partner. Business Telephone �—O •� 6 1 69 T7 79 B—Fitm/Co. Name of Licensed Plumber Ait ,A r jc j Insarsnce Co me. Indicate the type of inscaance coverage by appropriate Liability insunraace policy IJ '— bor Other type of indemnity ❑ Bond three Insurance insuranWaivecer. L the undersigned, have been, made aware that the hoensee of this application does not have any one of the above Owner Age ❑ I hereby certify that all of the details and information I have submitted or best of my knowledge and that all a, entered) in aall ation are true and accurate to the compliance with all �� tiO� Peet provisions of the Mas �State� Pthis application will be in Bw 8 d of the General Laws. Type of Plumbing LicLem own 41 (' E1OVED (OFFICE USE ONLY Jicense uim Master ff, JOurneYmmm ❑