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Home My WebLink AboutMiscellaneous - 392 MASSACHUSETTS AVENUE 4/30/2018................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING T is ce i es h' rt*fi that..... ........... .. ...................... I? ., C Lfl. pern-fission to perfol 2- rrn - ............. wiring in the buildin& Or.. ...... OANg .. ............................ at .......... �j ... . ....... ........................... . North Andover, Mass. Fee �3 . ...... Lic. No. ELECTRICAL INSPECTOR Check # ��i�� _� �� x�. =1a - Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 17-�l �-I Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL RWORMATIOA9 Date: i 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) 5 .Z- /14,t� S S ,4✓e Owner or Tenant 1% Gam_ 0 M1 Telephone Not -1,970 g ys'-G VSI Owner's Address Is this permit in conjunction with a building permit? Yes Purpose of Building /Q,, M Al - Existing Service -200 Amps /ZV / 2460Volts New Service Amps / volts Number of Feeders and Ampacity No ❑ (Check Appropriate Box) Utility Authorization No. Overhead Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters f No. of Meters Location and Nature of Proposed Electrical Work: �� H A Z $4 4 f l 1i/ h c Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans TransTotal Trsformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires 10 Swimming Pool Above ❑ In- El rnd. rnd. 0. o mergency ig ting Batter Units No. of Receptacle Outlets 12 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches (p No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number * ' "* Tons I"""."'...."'..."" KW """""""' "'' No. of Self -Contained Detection/Alerting Devices No. of DishwashersMunicipal Space/Area Heating KW Local ❑ Connection [:1 Other No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs 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 Wires. Estimated' Value of Electrical Work: L/1-00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSUIRA-NCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, sander the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME`:. �,, ` . ' �� , /� G1 r fh S < <✓ �f�r/• 2 ,,I,IC. NO.: So el't-10 ,� Licensee: �1 �' r , %��4 c/ h/ Signature LTC. NO.:22-12 .� (If applicable, e ter exempt" in the license number line.) Bus. Tel. No.•e`Y ?) PZL- o6G5' Address: F r� �"f S7- L,4wel/ Alt. Tel. No.: *Per M.G.L c. 147, < 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent Owner/Agent PEhMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the + permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed R �� on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an 1� electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the U notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending'through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass R Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass F?] Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INFECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPEC N: Pass IN XX Failed Re- Inspection Required ($.) ❑ Inspectors Comments: 4 44 Inspectors Signature: Date: — 24 DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com a b The Commonwealth of Massachusetts F Department ofIndustrial Accidents I Congress Sheet, Suite 100 _ Boston, MA 02114-2017 Y�r www mass.gov/dia ODM 591 Wa kers' Compensation insurance Affidavit: Builders/Conixactoxs/Electricians/Plumbers. TO BE FILED WITH THE PF-MTTING A171'HOI2IT'Y. Name (Business/Orgauzation/lndividual): Address: Y,9 �i City/State/Zip: LQ well es'I � o l k S'Z Phone #: � 9� �1 c�/ S" —G p G s' } Type of<project (�•ecluired): Are you an employer? Check the ap_—]I 1� propriate box: ees full and/or part-time).' 7. [1NeVV d6nstr66t1On 1.® I am a employer with_-_ __ em P to y 2.E]I am a sole proprietor or partnership and have no employees working for me in $. Remo deling any capacity. [No workers' comp. insurance required.] 9. ❑ Demolition 3.❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t 10E] Building addition 4.[] I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑ Electrical repairs or additions ensure that all contractors either have workers' compensation insurance or are sole , . r:. 12TEj.plumb ng repairs or additions proprietors with no employees. 5.❑ I am a general contractor and 1 have hired the sub -contractors listed ur the attached sheet 13. [] Roof repairs These sub -contractors have employees and have workers' comp. insurance? 14.0 Other 6, ❑ We are a corporation and its, officers have exercised their right of exemption per MGL c. empl 152, § 1(4), andw. have no oyees. [No workers' comp. insurance required.] *tiny applicant that checks box #i must also fill out the section below showing their workers' compensation policy information. Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such 1?t: tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not (hose: entities• have tractors have employees, they must provide their workers' comp. policy number. employees. If the sub-con X am an employer that is providing workers' compensation insurance for my employees. P.elow is the policy and job site information. f Insurance Company Name: Wi Expiration Date: policy # or Self -ins. Lie. #: � �,,� ` t city/State/Zip:, fob Site Address: .N Attach a copy of the workers, compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under ill enalties?inthe form of criminal25A is a TOPiolation WORK ORDERIand a fine of up to $250.00 a and/or one-year imprisonment, as w p day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certify under andpenaltie erjury tliat the information provided above is true and correct. Phone #: ( %%, Official use only. Do not write in Mis area, to be completed by city or town official. City or Town: Permit/License ## Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their errI 10 -gees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hife, express or implied, oral or written." An employer is' defined as "an individual; partnership, association, corporation or other legal entity, or any two or more Of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver'or trustee of an individual, partnership, association or other legal entity, employing employees. • However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage req'W"red. " Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for theperformance ofpublic 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 Accidents for confirmationof insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial -Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be oiled 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASS.AFE Fax # 61.7-727-7749 Revised 02-23-15 www.mass.gov/dia 1 1111 A. � 0" Date ....... ...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 2-6 60 4+ 0 �'This certifies that ...................................... ... ........ ................................ has permission to perform .......... C .4 ......... L ........... plumbing in the buildings of ............. ; ........ ......... ................................................ at .... aci 2- M�� ..... A/e- ............................... ............................................. North Andover, Mass. 1:y-* ws -11 Fe e 31.1 ....... Lic. No . ..................... ................................................................................. PLUMBING INSPECTOR Check t� G 20� 6-n lj)�JK � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK v _ CITY MA DATE(PERMIT# 14101 JOBSITE ADDRESS 3 2 ► � J2.� OWNER'S NAME _ _��__ S 41 POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: Ei—REPLACEMENT: Q PLANS SUBMITTED: YES Q NO© FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM �I-_.._._l ( -_-- i _.___1 _.__.i DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM _._._.. f ___ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER -,.,.-JF 7 ! DRINKING FOUNTAIN FOOD DISPOSER _ I .. _....(......___.( ___j ...._ _. j ..._ ___1 ( ._,_J g FLOOR/AREA DRAIN _i ___._1 ___._ ► ___. _.__ i _{ __..__-�---__.1 _. _....i _---_(._-_- _ ._.--.-.-_( .___i _ ! __.._-_-[ INTERCEPTOR (INTERIOR] (J ( __...,__.r...__._ ( _( _..._._.I . ± ..____._.l ..._. 1 ..._.i i . KITCHEN SINK 11 ------ -I .-_._-- ___....J ! _-._J LAVATORY _I -j" -11 l _.. i _._._-_1 --_J _---__1 ROOF DRAIN I J ( -_—! -_- (__..I SHOWER STALL (._ _i I ._- _____J _. __.( _._ __.I _._.I ____ _ .! ____.( ___.J �( SERVICE / MOP SINK __.I __. _( ( I __ _ I ._( �.__J __---.� _ J ._.. _ _f _ _ { ._.__1 ._ . -_i _ -__J f TOILET __._-_J URINAL } i -_--- [ ! WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATE PIPING OTHF\R _..__ _ _.� i —( -.._._.l .__ _. _..I _ ! -i .__ _ ._._( _... __._! ....__._ l . __.._ f f I I [__-_i f __..__j _ _-_._-I ._.__,.-f ._...._«.( _(. . .__._. t f _-( INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES _., .( NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE OF INDEMNITY F] BOND D 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: OWNERE-11 AGENT IEI SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _�cI _ a v ` IILICENSE # _ B _ I SIGNATURE MP 0I JP Q CORPORATION �# 80 f PARTNERSHIP# ; LLC r�- COMPANY NAME (✓tsS�� - CL- �l _ (�C df S ADDRESS f CITY_ _— —STATE ZIP L8( FAX L .-' - ; CELL EMAIL LIM o rl z LU M iw w Ll- L Date ....... S ................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 41 This certifies that ............ 6,0-+ ko 0 ............................ has I ertnission for gas insiallation ................ 10 ..................... ( ...................................... in the buildings of .............. ....... I ..................................... ..................... at ........ ::��J.:Zz .......... ................. C ............... . North Andover, Mass. Fee .... 100 .. . ..... Lic. No. I " ............ ..................................................................... GASINSPECTOR Check # 19 2-Z5 2 -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK low CITY rn d"�r _� MA DATE�S PER # JOBSITE ADDRESSr;�i?iAW �- � _ OWNER'S NAME r� �zf�s- ;mos GOWNER ADDRESS _ 1 TEL- =FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL �]J EDUCATIONAL� RESIDENTIAL CLEARLY NEW: El RENOVATION: [a REPLACEMENT: PLANS SUBMITTED: YES 0 NO APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE L r- . m DIRECT VENT HEATER DRYER FIREPLACE _ FRYOLATOR FURNACE GENERATOR__j _. _. I- __..._. ._-y� _ _ _I J GRILLE-t..-.-_- INFRARED HEATER�- LABORATORY COCKS MAKEUP AIR UNIT OVEN _ J T _._ . - - - I R POOL HEATER ROOM/ SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES NO 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [� OTHER TYPE INDEMNITY ® BOND 0 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 Q AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME c -rrf e06.6/'o _ LICENSE # q SIGNATURE i MP f MGFEJI JP [ JGF 0 LPGI 0 CORPORATION Rj# o� PARTNERSHIP Ell #= LLC D#(_.__ COMPANY NAME a,�S,—_� /1C a!S ADDRESS CITY --,9 STATE ZIP (TEL FAX CELL ' 7 !�'J6EMAIL ^r!'o " ' �C 1ASS bC cnt H O z U W a t on O on W } Con � ~ W ULU Z LU 4* �- pW., iz- � W w 5 COco O LU w u w CO a oEn a a U J E., a a r C w x w H LL N O z 0 H U W a �7 °The Commonwealth of Massachusetts i . F Department ofindustrial Accidents 1 Congress Street. Suite 100 021142017 _ Boston, MA www.mass.gov/dia ODM 5V'yl VVaI kers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/l'lum ers. TO BE FILED WITH THE PERMITTING AIITHORTI Y. Name (Business/Oiganization/Individual): Address: City/State/Zip: I Are you an employer? the appropriate box: "'5 d— Jit��` �y (;ter► fi�ncra f S Phone 943 -5 ef3 1•E'l am a employer with employees (full and/or part-time). 2.❑ I am a sole proprietor or partnership and have no employees v✓orking for me in any capacity. INoworkers' comp. insurance required.] 3. ❑ lam a homeowner doing all work myself f No workers' comp. insurance required.] t 4. ❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contracto , and I have hired the sub -contractors listed on the attached sheet- 51-11 heet. rs have employees and have workers' comp. insurance.$ These sub-contract� 6. Q We are a corporation and its, officers have exercised their right of exemption per MGL C. 152 § 1(4) and bye have no employees. fNo workers' comp_ insurance required.] Type of project (xequired); 7. ❑ N6*'c0`nstr6tion 8. [] Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. [dumbing repairs or additions 110 Roof repairs 14.[] Other *Any applicantthat check's box #1 wrist also fill out the section below showing their workers' compensationpolicytnformation: Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not thosa entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. X am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: _ AS baa Y/ a 3 Expiration Date: l I D l Policy # or Self -ins. Lie. #: r 1 / / ( '� /'y�4-gS "P , City/State/Zip:/V �,i Deje ` lob Site Address: Attach a copy of the workers, compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fnie 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. X do hereby certi and li a a na 'es of perjury that the information provided above is th}ruue and correct. Phone#: 6/! "6 � �36�7 Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 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 hir'e, s express or implied, oral or written." �. An employer is' defined as "an individual; partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver•or trustee 6f 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 occupani 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 b6 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 r'equized. " Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractor(s) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia — - -----�--. a COMMD�WEAL , �H OF MgS,gACHUSETTS --- gOARU OF 1. PLUMBERS AND GASFITTERS ISSU.E:S; THE FOLLOWfi�l�ICENSEi� L I s;ENSEO AS A JOURN.EYMAN!F.1 UMBE r ��.'`-i�. .•�c7 ROGER G T: ROBE I 0 33 HARRIS MALDEN MA 02148-5322 1GAW • r� i r, i i i r �r i i r r — - -----�--. a COMMD�WEAL , �H OF MgS,gACHUSETTS --- gOARU OF 1. PLUMBERS AND GASFITTERS ISSU.E:S; THE FOLLOWfi�l�ICENSEi� L I s;ENSEO AS A JOURN.EYMAN!F.1 UMBE r ��.'`-i�. .•�c7 ROGER G T: ROBE I 0 33 HARRIS MALDEN MA 02148-5322 1GAW • TOWN OF NORTH ANDOVER Office of the Building Department NORTH of LED , qti Community Development and Services st „"=6 0 4 - Z. 1600 Osgood Street, Bldg. 20, Suite 2035 North Andover, MA 01845 ATE ACHUS�� Gerald Brown, Inspector of Buildings August 10, 2015 To: David Seymour—City Light Homes From: Gerald Brown Re: 392 Massachusetts Avenue Dear Mr. Seymour, Based on the inspection on the above address on July 6, 2015, the following violations were observed. The in ground pool located in the back yard is a safety hazard and is not secure. Please refer to the 2009 International Residential Code, Appendix G swimming pools, Barrier requirements, Section AG 105. The HVAC system is no longer functional and needs to be repaired/replaced. This call out pertains to 780 CMR, Section 102.8, Maintenance of Existing Buildings and Structures, states "All Buildings and structures and all parts thereof, both existing and new, and all systems and equipment therein which are regulated by this code shall be maintained in a safe, operable and sanitary condition." The room between the main house and garage is failing structurally due to undersized framing. Please refer to 780 CMR, Section 116.2, Standards for Making Buildings Safe or Secure. Please contact our office at 978-688-9545 with questions or concerns. Sincerely, Gerald Brown Inspector of Buildings Cc: Eric Kfoury Abigail Fee 98A Billerica Ave Billerica, MA 01862 (978)5024325 k9diesel@comcast.net ESTIMATE ADDRESS City Light Homes 392 Mass Ave North Andover, Ma 01845 A6Y . ESTIMATE # 1306 DATE 07/08/2015 ACTIVITY _ QTY RATE AMOUNT 05 Permits 1 1,895.00 1,895.00 Obtain permits from Town of North Andover to update existing home and bring up to current code and make it habitable saftey fence 1 1,289.00 1,289.00 supply 100 feet of saftey fence to secure inground pool that is not fenced in and is a hazard and danger to the neighborhood clean out work area 1 2,875.00 2,875.00 The property is full of contents and debris garage is full and basement in unpassable all contents will be put into dumpsters and removed labor 11 Dumpster and Removal 8 720.00 5,760.00 Fee for dumpster and removal of all waste produced on job site ACTIVITY Y 13 Demolition f he room between the kitchen and garage is a hazard it was built obviously with out permitting and is sub standard the joists span is over 14 feet and are 2x6s and are two feet on center the joists are shimmed up in the middle with cement blocks this area is not only safe but will be a major issue by a buyer and home inspection and will prevent selling the home the floor needs to be removed and disposed of the walls in this room will be required to be opened up there is a brick fireplace in the corner that is cracked and pulling away due to a insufficient footing entire room will be cleared and all debris will be put into dumpsters to be removed kitchen cabinets are damaged and hanging on left side all will be removed the pergo style kitchen floor is damaged and will need to be removed once cabinets are removed the second floor bathroom in the tub area appear to have been leaking and floor is all spongy and appears mold its appears the water pipes may have frozen in out side wall side bathroom will need to be gutted down to studs to eliminate these issues the venting of drains will need to be brought up to current plumbing code all areas labor and material oil tank removal there currently is a oil tank in the basement that is rusted and to be removed permit to remove and dispose off labor and material QTY / RATE 1 17 AMOUNT 17,765.00 1,375.00 ACTIVITY 18 Roofing The main roof appears to be in good enough condition to save, but does need a ridge vent to allow proper ventilation and prevent ice damns There are three sections of the house that have rubber roofs the front of the house flat roof is failing there is a large rotted area that has allowed a large water area to form this roof will need to be removed down to roof boards, once down boards will be assessed and repaired as needed. the rooted railings on the roof will also be removed and disposed of new insulation boards will be installed new drip edge and rubber roof will be installed with a slight pitch to prevent puddling that has been there previously The second flat roof area is in between the kitchen and garage that was not built correctly this entire area will be taken down to the rafters and have rafters sistered up to guarantee it is built properly and and will handle new roof correctity all new insulation, drip edge and rubber roof installed the last flat area is above the garage will be addressed the roof will be taken out and disposed of the joists will be sistered and secured properly new insulation, drip edge and rubber will be installed labor and material for all work required 30 Windows The front of the house has several windows that were vandalized and will need replacement the bedroom windows appear they can be saved and reused a total of 22 windows will be needed windows will be Simonton replacement and meet Massachusetts energy star rating labor and material 29 Doors The front door is boarded over and kicked in new front door with side lights will be needed to install the driveway side door is also damaged with side lights both doors will need new lock sets doors properly installed with new exterior trim fire door is required from garage into living room labor and material QTY TE AMOUNT 1 3;875.00 23,875.00 22 398.00 8,756.00 0 4,210.00 4,210.00 0 ACTIVITY QTY RAT AMOUNT 26 HVAC:26.1 HVAC- Subcontractors 1 17,899.00 17,899.00 the has a forced hot air and ac for climate control the unit is in the basement and has water lines on it approximately 11 inches off the floor from when the cellar was flooded the basement has been flooded numerous times in the four years the home has been abandoned. The existing sump pump has not functioned during this time . the basement would in effect flood and then slowly drain off overtime This water damage has in effect ruined the water heater and furnace the unit will have to be replaced new unit will be installed and hooked up The duct work is all corroded and numerous flex ducts are all over and not up to code the ducts will need to be replaced and brought up to current code , which only allows 8 feet of flex ducts labor and material for entire new hvac system sized properly 24 Electrical 1 18,995.00 18,995.00 The house has a 200 amp service coming into the house that appears acceptable the problem is the panel is completley oxidized which is caused by all the moisture in the basement from all the moisture. The panel will be removed and updated and will require all new breakers and arc vault breakers due to new codes the hvac unit will need new wiring the kitchen will need updating to current codes with ground faults and arc volt breakers the bathrooms will also need updating and per code exhaust fans installed and vented the outside doors will require porch lights per code the garage needs wiring per code the basement needs lights and plugs labor and material 28 Plumbing 1 17,544.00 17,544.00 the bathrooms will require all new water piping and drains new tub shower unit and valve new toilets new vanities the kitchen will need new water piping and drains the dishwasher, sink, faucet new gas water heater that will be power vented labor and material ACTIVITY basement water dry system The basement is extremely wet due to high water table the basement will need to have the perimeter saw cut on the floor and a trench dug in around leading to sump pump container the trench will be lined and have a four inch pipe leading to container that will then pump it outside once trench is complete cement will be poured into trench and floor even a pump will be installed and wired to automatically come on labor and material 31 Insulation The attic requires additional insulation for code all walls opened up will require foam to bring up to code the cellar currently has no insulation and will need to be brought up to code the garage currently has no insulation labor and material 23 Exterior Work The exterior of the house has several issues first and foremost the inground pool is collapsed and full of debris and is a hazard the pool needs to be dug out, all debris will trucked away and disposed of the pool area will be filled in and leveled off all over grown brush will be removed several trees are over grown and need to be cut down for saftey around the house are over twenty overgrown bushes that need to be removed on the back side of the house is all over grown and will need to be removed there are cement pads in the back yard that will need to be removed and disposed of new loam will be spread and seed planted new shrubs and bushes will be installed all new landscaping will be complete labor and material 32 Blue Board & Plaster all walls and ceiling that were opened will need new half inch blue board installed and finished with a smooth glass like finish kitchen, bathrooms, room between garage and kitchen front entry that has water damage bedroom ceiling garage will need 5/8 " sheetrock on wall in between garage and living room labor and material QTY 1 1 1 1 RATE 13,865.00 5,877.00 26,689.00 9,310.00 AMOUNT 13,865.00 5,877.00 26,689.00 9,310.00 ACTIVITY _ QTY RATE AMOUNT garage doors 1 1,775.00 1,775.00 current garage door is damaged and needs updating all new tracks and garage door is needed with opener labor and material 35 Kitchen 1 18,237.00 18,237.00 new kitchen cabinets to be installed per design of original kitchen counter tops included appliances to be included, stove, mimcrowave, refridgerator cabinets will be installed handles will be installed labor and material 39 Finished Interior Work 1 14,788.00 14,788.00 windows will need new trim that were installed new trim baseboard, window trim, doors in bathrooms living room will need all new baseboard, window and door trim front mudroom will need all new baseboard and trim labor and material 41 Painting 1 8,934.00 8,934.00 entire interior of house will need to be painted all rooms will be primed ceilings will have two coats all walls two coats all trim two coats all paint will be california labor and material flooring 1 13,422.00 13,422.00 all hardwoods in house will need to be sanded and refinished kitchen will need new hardwood installed to match rest of house once pergo is removed living room will need new hardwood once floor is rebuilt stairs will need to be sanded and finished the bathrooms will need the installed the front mudroom will need broken tile removed new sub floor installed and new tile installed the garage floor has many cracks in cement and opening up this will have to be jack hammered and removed and new cement floor poured labor and material ACTIVITY 19 Siding The current siding has many areas that are broken and pulling out it is a low grade white vinyl and is in need of repair all siding will be removed and disposed off new 3/8" styrofoam will be installed on exterior of home to increase Rvalue new siding installed and all trim will have white aluminum installed labor and material QTY RATE AMOUNT 1 16,889.00 16,889.00 TOTAL $252,024.00 Accepted By Accepted Date To Whom it may concern July 8, 2015 On Monday July 6, 2016, 1 met David Seymour from City Light Homes and General Contractor Todd Donaldson at the property of 392 Mass Ave in North Andover, Massachusetts, Mr Seymour is the receiver of this property that has been abandoned for several years. This property has been a safety hazard and nuisance in the neighborhood as the building commisioner in North Andover, I am well aware of what a problem it has been. Mr Seymour informed me that all the debris in the home, garage and outside were loaded in three dumpsters and disposed off. I then walked through the property with them and there are numerous areas of concern with this property. First and foremost is the inground pool that is overgrown In the back yard is a safety hazardan�� not secure. It should be noted a security fence was Inst tied on 718/15 ao the pool is now safe to �nelghbarh d. �o A, I. �` �.�' p �-*��t j��p�i;��f '� �:/:�sV' G.11 6 V"5-4 �6 1. the cellar appears to have been flooded several times. The oil tf k heeds to be removed before there is a hazardous waste spill. 2. the hvac system appears to have a consistent water line about one foot off the floor and is ruined R 3. the room between the main house and garage is sub par construction. It has 14' 2x6 {. `mow - span and are two feet on center. The framing of this room needs to be addressed 4. there Is no insulation in the basement �Ik P -2s 5. inside the house there are numerous Issues, windows damaged, doors boarded over, frozen water pipes, kitchen cabinets in disrepair, bathrooms needs updating with proper ventilation and wiring, cleaning and painting, floors etc. 6. three rubber roofs need to be completely removed and new installed This are issues that need to be addressed as well as others to bring this house habitable under building codes and help the neighborhood. Respectfu y Geral Brawn Inspector of Buildings North Andover, Massachusetts 978-688-9545 APPENDIX G SWIMMING POOLS, SPAS AND HOT TUBS (The provisions contained in this appendix are not mandatory unless specifically referenced in the adopting ordinance.) SECTION AG101 GENERAL AG101.1 General. The provisions of this appendix shall con- trol the design and construction of swimming pools, spas and hot tubs installed in or on the lot of a one- or two-family dwell- ing. AG101.2 Pools in flood hazard areas. Pools that are located in flood hazard areas established by Table R301.2(1), includ- ing above -ground pools, on -ground pools and in -ground pools that involve placement of fill, shall comply with Sections AG101.2.1 or AG101.2.2. Exception: Pools located in riverine flood hazard areas which are outside of designated floodways. AG101.2.1 Pools located in designated floodways. Where pools are located in designated floodways, documentation shall be submitted to the building official, which demon- strates that the construction of the pool will not increase the design flood elevation at any point within the jurisdiction. AG101.2.2 Pools located where floodways have not been designated. Where pools are located where design flood elevations are specified but floodways have not been desig- nated, the applicant shall provide a floodway analysis that demonstrates that the proposed pool will not increase the design flood elevation more than 1 foot (305 mm) at any point within the jurisdiction. SECTION AG102 DEFINITIONS AG102.1 General. For the purposes of these requirements, the terms used shall be defined as follows and as set forth in Chap- ter 2. ABOVE-GROUND/ON-GROUND POOL. See "Swim- ming pool." BARRIER. A fence, wall, building wall or combination thereof which completely surrounds the swimming pool and obstructs access to the swimming pool. HOT TUB. See "Swimming pool." IN -GROUND POOL. See "Swimming pool." RESIDENTIAL. That which is situated on the premises of a detached one- or two-family dwelling or a one -family town- house not more than three stories in height. SPA, NONPORTABLE. See "Swimming pool." SPA, PORTABLE. A nonpermanent structure intended for recreational bathing, in which all controls, water -heating and water -circulating equipment are an integral part of the product. SWIMMING POOL. Any structure intended for swimming or recreational bathing that contains water over 24 inches (6 10 2009 INTERNATIONAL RESIDENTIAL CODE® mm) deep. This includes in -ground, above -ground and on -ground swimming pools, hot tubs and spas. SWIMMING POOL, INDOOR. A swimming pool which is totally contained within a structure and surrounded on all four sides by the walls of the enclosing structure. SWIMMING POOL, OUTDOOR. Any swimming pool which is not an indoor pool. SECTION AG103 SWIMMING POOLS AG103.1 In -ground pools. In -ground pools shall be designed and constructed in conformance with ANSI/NSPI-5 as listed in Section AG108. AG103.2 Above -ground and on -ground pools. Above- ground and on -ground pools shall be designed and constructed in conformance with ANSI/NSPI-4 as listed in Section AG108. AG103.3 Pools in flood hazard areas. In flood hazard areas established by Table R301.2(1), pools in coastal high hazard areas shall be designed and constructed in conformance with ASCE 24. SECTION AG104 SPAS AND HOT TUBS AG104.1 Permanently installed spas and hot tubs. Perma- nently installed spas and hot tubs shall be designed and con- structed in conformance with ANSI/NSPI-3 as listed in Section AG108. AG104.2 Portable spas and hot tubs. Portable spas and hot tubs shall be designed and constructed in conformance with ANSI/NSPI-6 as listed in Section AG108. SECTION AG105 BARRIER REQUIREMENTS AG105.1 Application. The provisions of this chapter shall control the design of barriers for residential swimming pools, spas and hot tubs. These design controls are intended to pro- vide protection against potential drownings and near - drownings by restricting access to swimming pools, spas and hot tubs. AG105.2 Outdoor swimming pool. An outdoor swimming pool, including an in -ground, above -ground or on -ground pool, hot tub or spa shall be surrounded by a barrier which shall comply with the following: 1. The top of the barrier shall be at least 48 inches (1219 mm) above grade measured on the side of the barrier which faces away from the swimming pool. The maxi- mum vertical clearance between grade and the bottom of 791 APPENDIX G the barrier shall be 2 inches (51 mm) measured on the side of the barrier which faces away from the swimming pool. Where the top of the pool structure is above grade, such as an above -ground pool, the barrier may be at ground level, such as the pool structure, or mounted on top of the pool structure. Where the barrier is mounted on top of the pool structure, the maximum vertical clearance between the top of the pool structure and the bottom of the barrier shall be 4 inches (102 mm). 2. Openings in the barrier shall not allow passage of a 4 -inch -diameter (102 mm) sphere. 3. Solid barriers which do not have openings, such as a masonry or stone wall, shall not contain indentations or protrusions except for normal construction tolerances and tooled masonry joints. 4. Where the barrier is composed of horizontal and vertical members and the distance between the tops of the hori- zontal members is less than 45 inches (1143 mm), the horizontal members shall be located on the swimming pool side of the fence. Spacing between vertical mem- bers shall not exceed 13/4 inches (44 mm) in width. Where there are decorative cutouts within vertical mem- bers, spacing within the cutouts shall not exceed 13/4 inches (44 mm) in width. 5. Where the barrier is composed of horizontal and vertical members and the distance between the tops of the hori- zontal members is 45 inches (1143 mm) or more, spacing between vertical members shall not exceed 4 inches (102 mm). Where there are decorative cutouts within vertical members, spacing within the cutouts shall not exceed 13/4 inches (44 mm) in width. 6. Maximum mesh size for chain link fences shall be a 21/4 -inch (57 mm) square unless the fence has slats fas- tened at the top or the bottom which reduce the openings to not more than 13/4 inches (44 mm). 7. Where the barrier is composed of diagonal members, such as a lattice fence, the maximum opening formed by the diagonal members shall not be more than 13/4 inches (44 mm). 8. Access gates shall comply with the requirements of Sec- tion AG105.2, Items 1 through 7, and shall be equipped to accommodate a locking device. Pedestrian access gates shall open outward away from the pool and shall be self-closing and have a self -latching device. Gates other than pedestrian access gates shall have a self -latching device. Where the release mechanism of the self -latch- ing device is located less than 54 inches (1372 mm) from the bottom of the gate, the release mechanism and open- ings shall comply with the following: 8.1. The release mechanism shall be located on the pool side of the gate at least 3 inches (76 mm) below the top of the gate; and 8.2. The gate and barrier shall have no opening larger than '/z inch (12.7 mm) within 18 inches (457 mm) of the release mechanism. 9. Where a wall of a dwelling serves as part of the barrier, one of the following conditions shall be met: 9.1. The pool shall be equipped with a powered safety cover in compliance with ASTM F 1346; or 9.2. Doors with direct access to the pool through that wall shall be equipped with an alarm which pro- duces an audible warning when the door and/or its screen, if present, are opened. The alarm shall be listed and labeled in accordance with UL 2017. The deactivation switch(es) shall be located at least 54 inches (1372 mm) above the threshold of the door; or 9.3. Other means of protection, such as self-closing doors with self -latching devices, which are approved by the governing body, shall be accept- able as long as the degree of protection afforded is not less than the protection afforded by Item 9.1 or 9.2 described above. 10. Where an above -ground pool structure is used as a bar- rier or where the barrier is mounted on top of the pool structure, and the means of access is a ladder or steps: 10.1. The ladder or steps shall be capable of being secured, locked or removed to prevent access; or 10.2. The ladder or steps shall be surrounded by a barrier which meets the requirements of Sec- tion AG105.2, Items 1 through 9. When the lad- der or steps are secured, locked or removed, any opening created shall not allow the passage of a 4 -inch -diameter (102 mm) sphere. AG105.3 Indoor swimming pool. Walls surrounding an indoor swimming pool shall comply with Section AG105.2, Item 9. AG105.4 Prohibited locations. Barriers shall be located to prohibit permanent structures, equipment or similar objects from being used to climb them. AG105.5 Barrier exceptions. Spas or hot tubs with a safety cover which complies with ASTM F 1346, as listed in Section AG 107, shall be exempt from the provisions of this appendix. SECTION AG106 ENTRAPMENT PROTECTION FOR SWIMMING POOL AND SPA SUCTION OUTLETS AG106.1 General. Suction outlets shall be designed and I installed in accordance with ANSUAPSP-7. d 792 2009 INTERNATIONAL RESIDENTIAL CODE® 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS 1.00: continued 102.4 Referenced Codes and Standards. The codes and standards referenced in this code shall be considered part of the requirements of this code to the prescribed extent of each such reference. Where differences occur between provisions of this code and referenced codes and standards, the provisions of this code shall apply. 102.5 Partial Invalidity. In the event that any part or provision of this code is held to be illegal or void, this shall not have the effect of making void or illegal any of the other parts or provisions. 102.6 Existing Structures. The legal occupancy of any structure existing on the date of adoption of this code shall be permitted to continue without change, except as is specifically covered in this code or as deemed necessary by the building official f6r the general safety and welfare of the public. 102.6.1 Laws in Effect. Unless specifically provided otherwise in this code, and narrow to the provisions of this code, any existing building or structure shall meet and shall be presumed to meet the provisions of the applicable laws, codes, rules or regulations, bylaws or ordinances in effect at the time such building or structure was constructed or altered and shall be allowed to continue to be occupied pursuant to its use and occupancy, provided that the building or structure shall be maintained by the owner in accordance with this code. 102.6.2 Laws Not in Use. In cases where applicable codes, rules or regulations, bylaws or ordinances were not in use at the time of such construction or alteration, the building or stiucture shall be maintained by the owner in accordance with this code. 102.6.3 Less Stringent. In cases where the provisions of this code are less stringent than the applicable codes, rules or regulations, bylaws or ordinances at the time of such constriction or substantial alteration, the applicable provisions of this code shall apply, providing such application can be reasonably demonstrated to not result in danger'to the public, as determined by the building official. 102.6.4 Existing Means of Egress, Lighting and Ventilation. The building official may cite the following condition in writing as a violation and order the abatement within a time frame deemed necessary by the building official to make the building environment safe, healthy or otherwise comply with this code. a. Inadequate number of means of egress. b. Egress components with insufficient width or so arranged to be inadequate, including signage and lighting. c. Inadequate lighting and ventilation. Where full compliance for means of egress, lighting and ventilation are not practical, the building official may accept compliance alternatives, engineering, or other evaluations that adequately address the deficiency. 102.7 Moved Structures. Buildings or strictures moved into or within the jurisdiction shall comply with the provisions of Chapter 34: Existing Structures provided that any new system shall comply as far as practicable with the requirements for new structures and provided fiuther that the siting and fire separation distance comply with the requirements for new structures. 102.8 Maintenance of Existing Buildings and Structures. All buildings and structures and all parts thereof, both existing and new, and all systems and equipment therein which are regulated by this code shall be maintained in a safe, operable and sanitary condition. All servicer equipment, means of egress, devices and safeguards which arerequired in a building or structure, or which were required by a previous statute in a building or structure, when erected, altered or repaired, shall be maintained in good working order. 102.8.1 Owner Responsibility. The owner, as defined in Chapter 2: Definitions, shall be responsible for compliance with the provisions of this code. 4/11/14 780 CMR - Ei hth Ed'ti The text of the regulations published in the electronic version of the Massachusetts Register is unofficial and for i ormati nal pu poses only. The official version is the printed copy which is available from the State Bookstore at http:/Mnvw.sec.state.ma.us/sprlsprcat/catidx.htm. 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS 1.00: continued 114.2 Notice of Violation. The building official is authorized to serve a notice of violation or order on the person responsible for the erection, construction, alteration, extension, repair, moving, removal, demolition or occupancy of a building or structure in violation of the provisions of this code, or in violation of a permit or certificate issued under the provisions of this code. Such order shall direct the discontinuance of the illegal action or condition and the abatement of the violation. 114.2.1 Notice Service and Content. Every notice or order authorized pursuant to 114.2 shall be in writing and shall be served on the person responsible: 1. Personally, by any person authorized by the building official; or 2. By any person authorized to serve civil process by lea" i'mg a copy of the order or notice at the responsible party's last and usual place of business or abode; or 3. By sending the party responsible or their agent authorized to accept service ofprocess in the Massachusetts a copy of the order by registered or.certifred mail return receipt requested, if he is within the Massachusetts; or 4. If the responsible party's last and usual place of business or abode is unknown, by posting a copy of this order or notice in a conspicuous place on or about the premises in violation and by publishing it for at least three out of five consecutive days in one or more newspapers of general circulation wherein the building or premises affected is situated. 114.3 Enforcement. Violations to this code shall be enforced in accordance with the applicable provisions of M.G.L. c. 143, M.G.L. c. 148, and M.G.L. c. 148A. 114.4 Violation Penalties. Any person who violates a provision of this code or fails to comply with any of the requirements thereof or who erects, constructs, alters or repairs a building or structure, or makes a change of use in violation of the approved construction documents or directive of the building official, or of a pennit or certificate issued under the provisions of this code, shall be subject to penalties as prescribed by M.G.L. c. 143, § 94a. _ SECTION 115 STOP WORK ORDER 115.1 Authority. Whenever the building official finds any work regulated by this code being performed in a manner either contrary to the provisions of this code or dangerous or unsafe, the building official is authorized to issue a stop work order. 115.2 Issuance. The initial stop work order may be verbal, but shall be in writing within 48 hours and shall cite the time and date of the verbal order and be given to the owner of the property involved, or to the owner's agent, or to the person doing the work. Upon issuance of a stop work order, the cited work shall immediately cease. The stop work order shall state the r reason for the order, and the conditions under which the cited work will be permitted to resume. 115.3 Unlawful Continuance. Any person who shall continue any work after having been served with a stop work order, except such work as that person is directed to perform to remove a violation or unsafe condition, shall be subject to penalties as prescribed by M.G.L. C. 143, § 94a. Each day during which a violation exists shall constitute a separate offense. 'SECTION 116 UNSAFE STRUCTURES AND EQUIPMENT 116.1 General. The provisions of this section are established by and work in conjunction with the requirements of M.G.L. c. 143, §§ 6 through 12. 116.2 Standards for Making Buildings Safe or Secure. Any owner of a building who has been notified that said building shall be made safe or secure under section 116, shall: 1. Remove all materials determined by the head of the fire department or building official to be dangerous in case of fire. 2. Secure all floors accessible fiom grade utilizing one of the following methods so long as such method is approved by the head of the fire department and building official in writing: a. Secure all window and door openings in accordance with the U.S. Fire Administration, National Arson Prevention Initiative Board Up Procedures found here: www.usfa.dhs.gov/downloads/Pdf/Publications/napi4.pd continuously until such time as the building is reoccupied; or b. Provide 24 hour watchman services, continuously until such time as the building is reoccupied; or 4/11/14 780 CMR - 26.2 The text of the regulations published in the electronic version of the Massachusetts Register is unofficial and for informational purposes only. The official version is the printed copy which is available from the State Bookstore at http://vwaw.sec.state.ma.us/spr/sprcat/catidx.htm. To Whom it may concern July 8, 2015 On Monday July 6, 2015, 1 met David Seymour from City l-Ight Homes and General Contractor Todd Donaldson at the property of 392 Mass Ave in North Andover, Massachusetts. Mr Seymour is the receiver of this property that has been abandoned for several years. This property has been a safety hazard and nuisance in the neighborhood as the building commisioner in North Andover, I am well aware of what a problem it has been. Mr Seymour informed me that all the debris in the home, garage and outside were loaded in three dumpsters and disposed off. I then walked through the property with them and there are numerous areas of concern with this property. First and foremost is the inground pool that is overgrown in the back yard is a safety hazard and not secure. It should be noted a security fence was installed on 7/8/15 and the pool is now safe to neighborhood. 1. the cellar appears to have been flooded several times. The oil tank needs to be removed before there is a hazardous waste spill. 2. the hvac system appears to have a consistent water line about one foot off the floor and is ruined 3. the room between the main house and garage is sub par construction. It has 14' 2x6 span and are two feet on center. The framing of this room needs to be addressed 4. there is no insulation in the basement 5. inside the house there are numerous issues, windows damaged, doors boarded over, frozen water pipes, kitchen cabinets in disrepair, bathrooms needs updating with proper ventilation and wiring, cleaning and painting, floors etc. 6. three rubber roofs need to be completely removed and new installed This are issues that need to be addressed as well as others to bring this house habitable under building codes and help the neighborhood. Respectfu y Geral Brown Inspector of Buildings North Andover, Massachusetts 978-688-9545 To Whom it may concern July 8, 2015 On Monday July 6, 2015, 1 met David Seymour from City Llght Homes and General Contractor Todd Donaldson at the property of 392 Mass Ave in North Andover, Massachusetts. Mr Seymour is the receiver of this property that has been abandoned for several years. This property has been a safety hazard and nuisance in the neighborhood as the building commisioner in North Andover, I am well aware of what a problem it has been. Mr Seymour informed me that all the debris in the home, garage and outside were loaded in three dumpsters and disposed off. I then walked through the property with them and there are numerous areas of concern with this property. First and foremost is the inground pool that is overgrown in the back yard is a safety hazard and not secure. It should be noted a security fence was installed on 7/8/15 and the pool is now safe to neighborhood. 1. the cellar appears to have been flooded several times. The oil tank needs to be removed before there is a hazardous waste spill. 2. the hvac system appears to have a consistent water line about one foot off the floor and is ruined 3. the room between the main house and garage is sub par construction. It has 14'2x6 span and are two feet on center. The framing of this room needs to be addressed 4. there is no insulation in the basement 5. inside the house there are numerous issues, windows damaged, doors boarded over, frozen water pipes, kitchen cabinets in disrepair, bathrooms needs updating with proper ventilation and wiring, cleaning and painting, floors etc. 6. three rubber roofs need to be completely removed and new installed This are issues that need to be addressed as well as others to bring this house habitable under building codes and help the neighborhood. Respectfully Gerald Brown Inspector of Buildings North Andover, Massachusetts 978-688-9545 r •, C/I North Andover Health Department Community Development Division 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: October 20, 2014 To Owner of Record: Mr. William Matthews 46 Harvard Street Medford, MA 02155-6208 Dear Mr. Matthews, Property Location: 392 Massachusetts Avenue North Andover, MA 01845 According to our records, you are the owner of property located at the above address. This property has been abandoned for an extended period of time. Several complaints regarding the condition of the property have been submitted to the Health and Building Departments over the past year (s). On September 24, 2014 a letter of conditions observed, was submitted to the Community Development Director. Town officials reported that the interior of the property was unable to be observed, although graffiti was observed on the inside of the windows. Doors were locked and secured and most windows were covered. The yard had been grown for years, but recently mowed. It appears that the property is vacant, although a pile of debris was observed in the driveway. You are hereby notified that you are requested to contact the N. Andover Health Department within Forty Eight hours (48) of receipt of this notice and to provide information or submit proof of the engagement of a licensed contractor; who can provide details on your intention to address the issues at the property. Failure to do so may result in legal action by the Town. Thank you for your cooperation in this matter. Sincep6ly, S.�isan Y. S,a�Y`e�r� r HS/RS Public Health , 'rector Cc: Curt Bellavance, Community Dev. Director Gerald Brown, Inspector of Buildings 1600 Osgood Street, Bldg 20 Unit 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com North Andover Health Department Community Development Division 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: October 20, 2014 To Owner of Record: Kody & Company Mike Dulong 60 Ashland Street North Andover, MA 01845 Dear Mr. Dulong Property Location: 213 Berry Street North Andover, MA 01845 According to our records, you are the owner of property located at the above address. This property has been abandoned for some time. Town building and health officials reported that the general condition of the property is poor and the foundation is on cement blocks and piers. Rot and deterioration were observed in multiple locations. Two chimneys are poorly built. There is no driveway and the septic system looks as if to be under the entire front yard, due to the raised soil. The rear property appears to be wetland and not suitable for building and a 500 gallon propane tank was observed in the wetland area. The inside lower level is dated 1960's and a complete update is needed. The second floor was not observed since entry was not obtained. The interior code violations are unknown. On September 28, 2014 a finding by the Building Inspector was provided to the Director of Community Development indicating the conditions above. You are hereby notified to contact the N. Andover Health Department within Forty Eight hours (48) of receipt of this notice and to provide information or submit proof of the engagement of a licensed contractor; who can provide details on your intention to address the issues at the property. Failure to do so may result in legal action by the Town. Cc: Curt Bellavance, Community Dev. Director Gerald Brown, Inspector of Buildings 1600 Osgood Street, Bldg 20 Unit 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.lowoofnorthondover.com IV North Andover Health Department Community Development Division 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: October 20, 2014 To Owner of Record: Mr. William Matthews 46 Harvard Street Medford, MA 02155-6208 Dear Mr. Matthews, Property Location: 392 Massachusetts Avenue North Andover, MA 01845 According to our records, you are the owner of property located at the above address. This property has been abandoned for an extended period of time. Several complaints regarding the condition of the property have been submitted to the Health and Building Departments over the past year (s). On September 24, 2014 a letter of conditions observed, was submitted to the Community Development Director. Town officials reported that the interior of the property was unable to be observed, although graffiti was observed on the inside of the windows. Doors were locked and secured and most windows were covered. The yard had been grown for years, but recently mowed. It appears that the property is vacant, although a pile of debris was observed in the driveway. You are hereby notified that you are requested to contact the N. Andover Health Department within Forty Eight hours (48) of receipt of this notice and to provide information or submit proof of the engagement of a licensed contractor; who can provide details on your intention to address the issues at the property. Failure to do so may result in legal action by the Town. Thank you for your cooperation in this matter. Sincepely, 1 Susan Y. Sawyer,,;- HS/RS Public Hei th l/'rectcr Cc: Curt Bellavance, Community Dev. Director Gerald Brown, Inspector of Buildings 1600 Osgood Street, Bldg 20 Unit 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER Office of the Building Department Community Development and Services 400 Osgood Street North Andover, Massachusetts 01845 To Curt Bellavance Director of Community Development RE: 392 Massachusetts Avenue Notice of ownership unknown. Telephone (978) 688-9545 FAX (978) 688-9542 September 24, 2014 Issues observed at requested inspection and all photos were taken from the exterior of the structure. General exterior appearance appears to be in good condition. The interior was not observed although graffiti was observed on the inside of the windows. Doors were locked and secured and most windows were covered. The yard had been over grown for years but recently mowed. It appears the property is vacant although a pile of debris was observed in driveway. Sincerely Yours, Brian Leathe Local Inspector i; p! 1 1! 4j- 4' 1 - W \ \ \Ai ,x ate,. �o.. �•� � �`��; \ t � �_ = i a, f �`.� ,. •�""�> `;yak',,::`::. '' kyr"} ';� � • �..zi, ., •:i••' rr;�ti�•"!j : `t �;; liar';;, ' %J�:-,, - R t\� 14al r i ,tai _ ,1E.c-, i � �, i :•b:)d� .�"7�4'.'4rx�li .-. Lel .� • ! �•..&`r -i`��'i; / - `. rpr4•�; 111,,, IF. W7 5�r Dai, TOWN OF NORTH ANDOVER NORTH Office of the Building Department 3=o4,t�E0 ;,1�c Community Development and Services . 400 Osgood Street r North Andover, Massachusetts 01845y,,e�:��'_��% Telephone (978) 688-9545 FAX (978) 688-9542 September 24, 2014 To Curt Bellavance Director of Community Development RE: 392 Massachusetts Avenue Notice of ownership unknown. Issues observed at requested inspection and all photos were taken from the exterior of the structure. General exterior appearance appears to be in good condition. The interior was not observed although graffiti was observed on the inside of the windows. Doors were locked and secured and most windows were covered. The yard had been over grown for years but recently mowed. It appears the property is vacant although a pile of debris was observed in driveway. Sincerely Yours, Brian Leathe Local Inspector Iti a tip !74 {'�,• .. T�1 ail i'!i' �1 ��. '� . zl_: I IT I? , , . , , pip, At A M., t�tns 417 North Andover Board of Assessors Public Access Q :NO RTF# ,�.l■ 161N0 FO 00 ' .. X70 gow�y S� ** SSACMUSE Click Seal To Retum Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 North Andover Board of Assessors EEz�roperty Record Card Parcel ID :210/045.A-0016-0000.0 FY:2013 Community: North Andover SKETCH Click on Sketch to Enlarge PHOTO Click on Photo to Enlarge 392 MASSACHUSETTS AVENUE I Ltion: 392 MASSACHUSETTS AVENUE ierName: MATTHEWS, WILLIAM ier Address: 392 MASSACHUSETTS AVENUE City: NORTH ANDOVER State: MA Zip: 01845 ;hborhood: 5 - 5 Land Area: 0.48 acres Code: 101-SNGL-FAM-RES Total Finished Area: 1575 saft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 361,700 349,100 Building Value: 183,400 163,100 Land Value: 178,300. 186,000 Market Land Value: 178,300 Chapter Land Value: 4ZI(Ithttp://csc-ma.us/PROPAPP/display.do?linkld=2252844&town=NandoverPubAcc 7/22/2013 TOWN OF NORTH .ANDOVER a a Building Department 0 ~ 1600 Osgood Street Building 2- Suite 2-36 Building Dept�qs°RAT.D �•SRCHUS North Andover MA 01845 Tel: (978) 688-9545 Fax (978) 688-9542 COMPLAINT FOR INVESTIGATION DATE: TEL #: �7p NAME OF COMPLAINTANT:u ADDRESS.;:.,. /U 11-'11A5'5 Alz_ COMPLAINT TYPE: F,4 !l,,✓ dc V /1i fo 7%Ls Electrical: Plumbing: Gas: Building: Property Owner: �f �� mews Address: ,� �a %n,9Ss 4 Other: 1Q64W/is e_16,10 el See.741 Z4 Signed: a- 4hz Complaint Form - Revised 6.2007 (PHONEVALL) A -M '114 FOR OATE TIME P. M. Z-; s 4 M A 0,4s 5. PHONED 141c RETURNEQ PHONE- -YOUR CALL AREA CODE NUMBER EXTENSION LEASE CALL MESSAGE 'VOL, WILL CALL AGAIN 71 -77-444-, 7--6 CAME TO SEE YOU y4) (d i_ > �W ANTS TO SEE YOU j k,SIGNEO gj =iversar 48003 -r6WN OF NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street, Suite 2-36, North Andover Ma 01845 NOTICE OF VIOLATION Date: 14 -0 ArIrirP--,-,- Zq-L OAM<< lgje 0* tAORTH 1E 0 0 rill Building P\ Zoning Bylaw Stop Work Order 0 Certificate of Inspections 13 Electrical _O Plumbing rE3 Gas Violation observed: oW -poot, Ala( tAt 6 Failure on your part to comply with this notice within 10 days may subject you to penalties prescribed by Massachusetts Law 780CMR--!Yorth A%IdOler's Zoning By law. Please contact the Building Department for further information at 978-688-9545 I ris ,rct(5—r Home Owner Contractor TOWN OF NORTH ANDOVER Building Department 1600 Osgood Street Building 2- Suite 2-36 Building Dept North Andover MA 01845 Tel: (978) 688-9545 Fax (978) 688-9542 moo. COMPLAINT FOR INVESTIGATION DATE: /-21171��016 TEL #: �7p F P,7' /5"',57 NAME OF COMPLAINTANT: S:��u ADDRESS. X COMPLAINT TYPE: J FrWP�✓ d c ,xl l� fol-- Electrical: Plumbing: ] h Gas:- k1i wilding: L Property Owner: All 12 f#M aJ-S Address: Other: g v dyl-rl 41S A/ se_ , _42�..� 6�t/E Signed: Complaint Form - Revised 6.2007 6133 -t2--Z'S Date ..... (P . ..................... 1 0 '� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... ...... ........................... has permission to perform 5".//1.;.4: ... AP'41C-4,1.7 -, 7,-Ce.J5� wiring in the building of . /&�. ..... ............................. 'at ....... 3.1.Z ..... MAS.v ..... o9�VX�.r .................... . North Andover, Mass. �Fee./!A.4*-... Lic.No,�W�.24 .............. i 4-;� Z �i�; Check # w0Rk DE9 B1 2ff0,FKUffixSAF= �_ �'�� mu Dnnv Z=17 ZWVVZ%nWWROGI1lAT1g111SS17(1KR12'W %-fZt 9gZ- Permit No. /n occupancy & Fees Checked APPUCATIONFOR PERMUTO PERFORM ELECTRICAL WORK AU. woRK TO BE PEMRMBD IN ACCORDANCB WrrH THE MASSACHUSSTS M.ECMXAL CODE, 527 CMtt 12:00 / (PLEASE PRINT IN INK OR TYPE ALL 2MRMATION) De Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street &Number) -3q Z IN SSAGH u5Sx-7- 7r!< A✓C-FJ-iv� Owner or Tenant 2OQ Q c-) NN Owner's Address ?Y C MA.N NALta rr s is this permit in conjunction with a building permit: Yes Purpose of Building p W (E -L L Existing Service AmpsIZo��Volts New Service Amps 2a I Z.', <) Volts Number of Feeders and Ampacity 00E - Location and Nature of Proposed Electrical Work rNo Overhead Overhead .0 (Check Appropriate Box) Utility Authorization No. Underground No. of Meters Underground No. of Meters No. of Ughdng Oudas Na of Hot Tube No. of Trnaftrrroon Total KVA No. of Ughting Rama Swimming Pool' Above Around Below 01 Oerterattrn KVA No. of Receptacle ouch" No. of OU Burma No. of Emegeocr Ughdng Battery Wig No. of switch Oudeu . No. of On Bamers FIRE ALARMS No. of Taros No. of Rangy Na of Air Cond. Toul Tom No. of Debctioo ad No, of D(sposda Na of Hast Tau! Told Pangs Toga Kw loidedog Devices Na of Sounding Davion No. of Dishwasher Space Area Homing Kw No. of Self Coouhwd DasoctionoSoundlog oovkn LoadMmic4W Other No. of Dryer Hoeft Devices Kw Connections No. of Won Heater KW No. of Na of situ BdW6 No. Hydro Massage Tabs No. of Minors Told HP OTHER- IJ E>u� T-�ft.Y t�g pw D5 i c�V � Z zo �c� � C- u y 'r-<-) R C kK==CVAVP Pinntbfetagiisirtnr�aflbloedssel�C>QtealLaws Ihateaa=tLW*iU=zePbftir><idrgClotr aribstdoile4iyia YI39 M IhneshA6dvMpaxrfo(saae1DiteCtz YDS F)CuheYEKpl=h*IegVo(c)yagbtay Sr Bmo mm o rm** rp• a�� '�� t F dyak teaf 3- N ` O 6 WakbSINt r — I�-c� DePimmad R Sgndu�ft,ftofpajnq►. FRtMNAME UWUNoo �C [icaeeNo 34 l Z rI C Bui telsUNn Loa 8R> -44.72. ,am qE RE110ET-4 Rc>AN I SANi�bi.�IAJ A _W • ��i� 7? AkTdN4 lgOZ �Vrl(��$)NSURAl��An%Q�IalnaWllli>�IlllJost��ltBil�071Q�Of>B 3tBMl�tX}lv8bga! arddiettrrysi@lmizonthbpeatitappicsdta thilteQrrRtlele ss}ssidbyMea�dsnetbGsniiLavrs (Please c ASM Telephone No. DR r FEE 1 C B04MO: FZRE RDGUL4?X"537C2WRUM Pemdt Na e ! ` ✓� It (., 'J .L OCCuPnncy & Fees Checked �•..`�. APPLICAnoN FOR PERMIT TO PERFORM ELEcnucA L WORK ALL WORT; To BE PERFORMED IN ACCORDANCE WTM TIM MASSACHUSSTS M.ECMXAL CODE, 527 CMB 12:00 (PLEASE PRW IN RK OR TYPE ALL MRMATION) Da 161-— Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Sum &Number) 39 Z 1e)A5�nc k ,5N, T, A; r> Owner or Tensi t L` Owner's Address 1s this permit in c, Purpose of Building Z> t,v QZ (-.I ,U ISI Existing Service j Q Q__ Amps 1 "�? p_Volts Overhead New ' (_� - Amp 2 Q Volta ovediead C Number of Feeders and Ampacity �� G2�_:-p C ---S1 Location and Nature of Proposed Electrical Work A3Yh1v ; j, (Check Appmprh to Box) Utility Authorization No. Underground 11 Underground C3 No. of Meters j No. of Meters Na of Uandn= 00" Nm of Her Tobe M. of Tmslbnean TOW Na of UahtinE Fli mu swlrnodna Pod' Above! In BelowKVA ri (I KVA ZROM good No. of Emergency Uahtina Battery Units No. of Receptacle Ou" No. of 00 Human Na of Switch Outlet Na of Ou Bum= FIRE ALARMS Na of Taros No. of Rsnaea Na of Air Cond. Total Toot Na of DoNctim and No. of Dlspoub Na of Heat Tota Total PUMP Toot KW baidathig Davices Na of Souodlq Dsdenn No. of Dishwuhms Space Ares Haft KW Na of self C nidned °�0°�i El mumew Comecdom a �. a hw No. of Dryer Hestina Devices KWLeeai No. of Water Heston KW Na d No. of Man Bdimb No. Hydro Maeaae Tabs Na of Moon Total H► T c, D c ! , r, ,`; "A, -,-t- snarnetlmwV RUMID11e11�iele�cfHlasclas;�(3Qasllavt� hwaam tLAft etsaaeitiryzickx*VCm#a Qibate�sidti}iNO ysitt y� t'haesubrr�dvaidpioddstsaebfret�n Y$9 tmddrgtbe ifyouhtredniedYB4�PhWhk*tt WofwmVby MRANCI BCrO rm** r!1 ,'v„: -•,c,n laces; t 4 ' t�f C:.+ Y # JW VAR � _ 4� z- r r WadcbStat �S .� ispectiortDoeRet}te�d Rani -' wil d r P dpe* tial HRMNAM [iomeZNo. Artirer '�} S 1{ h�.� BdsTdNn -2 Lf,7 ALTdNaOWI�WSIIUAIWANRIamwaQalel U ardthatrrrysgtasueonthbpaQr>i<appic i_12Ltifequieaas _�� O� nR4�b9h'ks®dardsCBndlsws (PleAMC Agept 13 ` O/�,/ Telephone No, ERM FEB i Date 'AOR TOWN OF NORTH ANDOVER W �PERIMVIT FOR PLUMBING This certifies that has permission to perform .................. plumbing in the buildings of t7'� ....................... at . '71�—? � . I- �-e .-f � J-. /-/. ............ I North Andover, Mass. Fee. Lic. No..?.(-. YA J �P-L*U'M'BING INSPECTOR Check # 6641 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS F-� Date Building Location 3 Y SAkI,,; Owners Name l `- UMWdAtQ Permit # q/ Amount ,��- SL Type of Occupancy New Renovation Replacement �� Plans Submitted Yes No E] FIXTURES (Print or type) _ Installing Company Name �� .� • 2 k�(5 p Check one: Certificate Corp. 11 Partner. �irm/CO. Name of Licensed Plumber. (Z -Tc &A Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy � Other type of indemnity 11 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installatipqs performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuseta Plu a Chapter 142 of the General Laws. BylgnaltlreoI LIcensea Type of Plumbing License Title Z4 k �.�?— City/Town is n e Master ❑ Journeyman0. ®.. APPROVED to�tct uss ora..Y Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts Asbestos Notification Form ANF -001 A. Asbestos Abatement Description ■ i100� 023851 Decal Number 1. a. is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied rpsiripncp of fnur units nr Ipcc? 17 Ypc 711 Nn b. Provide blanket decal number if applicable 2. Facility Location: Bob Buthman a. Name of Facility [North Andover MA c. City/Town d. State INSTRUCTIONS 3. 1. All sections of -this form must be completed in order to comply with 4. DEP notification requirements of 310 CMR 7.15 5. and the Division of Occupational Safety (DOS) notification requirements of 453 CMR 6.12 6. 7. 8. 9. Blanket Decal Number 392 Massachusetts ave b. Street Address 101845 (978) 420-2010 e. Zip Code f. Telephone Number Worksite Location: basement a. Building Name/Building Location b. Building # c. V11ing d. Floor e. Room Is the facility occupied? ✓❑ Yes ❑ No Asbestos Contractor JAIR QUALITY EXPERTS INC a. Name SALEM 103079 c. City/Town d. Zip Code AC000167 f. DOS License Number (GERMAN POSADA ZINIGA a. Name of On -Site Supervisor/Foreman richard salvatelli AM030636 n/a a. Name of As 10/21/2005 a. Proiect Sta C. 10. a. What type of project is this? ❑ Demolition ✓❑ Renovation ❑ Repair ❑ Other, please specify: 11. a. Check abatement procedures: in Glove bag ❑ Enclosure ® Cleanup ❑✓ Full containment ❑ Encapsulation ❑ Disposal only 1❑ Other, specify: 40 LOWELL RD UNIT 1 b. Address 603-894-6465 -7 e. Telephone Number g. Contract Type: ❑ Written ❑ Verbal i. Contact Person's Title AS032579 b. Supervisor/Foreman DOS Certification Number n/a 10/21/2005 b. Describe b. Describe 12. Is the job being conducted: ✓❑ Indoors? [] Outdoors? bio To Top 0 anf001 ap.doc - 10/02 Asbestos Notification Form • Page 1 of 3 0 Commonwealth of Massachusetts Asbestos Notification Form ANF -001 Ll A. Asbestos Abatement Description (cont.) ■ 100023851 ^� Decal Number 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encapsulated: F116 10 a. Total pipes or ducts (linear ft) `b. Total other surfaces square ft c. Boiler, breaching, duct, tank 1= C surface coatings Lin. ft. Sq. e. Corrugated or layered paper 1110 C pipe insulation Lin.ft. Sq. F_g. Spray -on fireproofing —� Lin. ft. Sq. o Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes ✓Q No i. Cloths, woven fabrics Lin Facility Description k. Thermal, solid core pipe j insulation Lin. ft. Sq. 14. Describe the decontamination system(s) to .be used: 3 chamber decon l d. Insulating cement Lin. ft. Sql ft � a. Name of DEP Official b. Title f. Trowel/Sprayer coatings — Lin. ft. Sq. ft. c. Date (mm/dd/yyyy) of Authorization d. DEP Waiver # h. Transite board, wall board Lin. ft. Sq. ft. j. Other, please specify: Lin. ft. So. ft. I. Specify 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (a): 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a. Name of DEP Official b. Title c. Date (mm/dd/yyyy) of Authorization d. DEP Waiver # I e. Name of DOS Official f. DOS Official Title �N g. Date (mmldd/yyyy) of Authorization h. DOS Waiver # o 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes ✓Q No _° B. Facility Description �N —� 0 1. Current or prior use of facility: (residence —o 2. Is the facility owner -occupied residential with 4 units or less? ✓0 Yes ❑ No 3' same as location a. Facility Owner Name b. Address o c. City/Town d. Zip Code e. Telephone Number (area code and extension) u_ 4. a. Name of Facility Owner's On -Site Manager b. On -Site Manager Address Q c. City/Town d. Zip Code e. Telephone Number (area code and extension) ■ anf001ap.doc • 10/02 Asbestos Notification Form • Pa a 2 of 3 [4I Commonwealth of Massachusetts Asbestos Notification Form ANF -001 B. Facility Description (cont.) a. Name of General Contractor 1 _ 7 ( 1 c. Ci /Town _ d. Zi Code ode f. Contractor's Worker's Comp. Insurer 6. What is the size of this facility? /100023851 Decal Number b. Address e. Telephone Number area code extension) g. Policy Number h. Exp. Date (mm/dd/yyr a. Square Feet b. Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): 0 0 0 0 -- o Q e. State u. toerEITication 144432 f. Zip Code The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts regulations - for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. E anf001ap.doc • 10/02 b. Address e. Telephone Number from removal/temporary site to final disposal site jpo box 2132 b. Address (877) 999-9559 e. Telephone Number b. Address e. Telephone Number b. Final Disposal Site Location Owner's Name LISBON _d_ City/Town g. Telephone Number ( hristopher thompson a. Name _ air quality experts president � Note: Transfer a. Name of Transporter -- Stations must Li f. Representing comply with the c. City/Town d. Zip Code Solid Waste Isalem __J 03079 Division 2. Transporter of asbestos -containing waste material Regulations 310 CMR 19.000. service transport group a. Name of Transporter Bristol 19007 c. Ci /Town d. Zip Code 3. a. Refuse Transfer Station and Owner c. City/Town d. Zip Code 4. JA & L SALVAGE INC a. Final Disposal Site Location Name 11225 STATE ROUTE 45 0 0 0 0 -- o Q e. State u. toerEITication 144432 f. Zip Code The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts regulations - for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. E anf001ap.doc • 10/02 b. Address e. Telephone Number from removal/temporary site to final disposal site jpo box 2132 b. Address (877) 999-9559 e. Telephone Number b. Address e. Telephone Number b. Final Disposal Site Location Owner's Name LISBON _d_ City/Town g. Telephone Number ( hristopher thompson a. Name _ b. Authorized Signature president � c. Position/Title 1(603) 894-6465 d. Date mm/dd/ y air quality experts, inc e. Telephone Number f. Representing 40 lowell rd unit 1 g. Address Isalem __J 03079 h. City/Town i. Zip Code Asbestos Notification Form • Page 3 of 3 0 Air Quality Experts, Inc. (603) 894-6465 Asbestos Removal (800) 621-1189 40 Lowell Road, Unit 1 Residential -Commercial -Industrial (603) 894-7044 FAX Salem, NH 03079 AirQualityExperts@AQENH.com October 5, 2005 North Andover Health Department 146 Main St North Andover, MA 01845 Dear Sir: OCT 1 1 Z005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Enclosed please find a copy of notification sent to the state for an Asbestos Abatement Project. The job will take place on 10/21/05. Project: 392 Massachusetts Ave Any questions concerning this matter should be directed to my attention. Sincerely, mftv---- Christopher Thompson President Location&),c,�, No. Date Th TOWN OF NORTH ANDOVER Certificate Occupancy $ of 0, ss HU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19�' I 1,8551 guilding Insp r 1 ISECTION 3 - CONSTRUCTION SERVICES I .J j l Licensed Construction Supervisor: � -5 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE FAMILY DWELLING yOR/yTWO BUILDING PERMIT NUMBER:/ DATE ISSUED: / �9 SIGNATURE: A .." Building Commissioner/I or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: ff 1.2 Assessors Map and Parcel Number: / Map Number Parcel umber Expim ' n Da 1.3 Zoning Information: Zonin Distrid Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft 3.2 Registered Home Improvement Contract Front Yard Side Yard Rear Yard Required Provide red Provided red Provided Registration Number 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2- PROPERTY OW NERSHIP/AUTHORIZED AGENT r i S O f i C I S CIC : Yes _No 2.1 Owner of Record Name (Print) J/► Address for Service: v atu Telephone 2.2 Owner of Record: Name Print Address for Service: 5i ature Telephone 1 ISECTION 3 - CONSTRUCTION SERVICES I .J j l Licensed Construction Supervisor: � -5 Not Applicable ❑ -D Licensed Construction Supervisor:, 0 License Number Addre �7-11e Expim ' n Da rgnatur . Telephone 3.2 Registered Home Improvement Contract Not Applicable ❑ m y N-amiep1� Registration Number Addres /y �J Expiration ate i Telephone SECTION 4 - WORKERS COMPENSATION (KG.L C 152 Workers Compensation Insurance affidavit must be completed d,.subn in the denial of the issuance of the building permit. fj^ Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check A applicable New Construction ❑ 1 Existing Building ❑ 1 Repair(s) this application. Failure to provide this affidavitw* result Y Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ Other ❑ Specify I W.rTIn1N / - RIMIMATIM irnrjvTDTr/-,iry wr ! AL TL Item Estimated Cost (Dollar) to be OMC AI, USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (1) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number CF.rTmiv 7a nWN-V1D ATT rUnDr7 A grTr%wT aJL a L' L ♦111L' 1� I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 OWNERIAUTHORIZED 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 of NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST SPAN DIMENSIONS OF SII,LS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I [EIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL. OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND 1S BUILDING CONNECTED '170 NATURAL GAS LINE Date SIZE 2 THICKNESS X Q� O` z W W to E b - IE MAt ca c 0 vs cm mac+ W m 0 n C c s m t w .0 - cm O I Ccm O•— CA 0 CD .Me y O O 'g m m CL ~ Z O.� �3 O O G O cc O a d. QmQ co c cc coozCL� C.) h O C C cc CL c �+ O ` C h O C w_v x w v V)w o w A G oG a U G w a w w a a G [i a w a w o rx u w �' c:G c t�. w a rA cn o cn E b - IE MAt ca c 0 vs cm mac+ W m 0 n C c s m t w .0 - cm O I Ccm O•— CA 0 CD .Me y O O 'g m m CL ~ Z O.� �3 O O G O cc O a d. QmQ co c cc coozCL� C.) h O C C cc CL c �+ O ` C h O C w_v CLC ev R m c o E Ea CF o� o o. to E� c . CO2 o •ate o 0 • : Z'CD 3 m� • c � � _ m o w� y w y m mo nS Le O O Q •c y iC moo W ;Z :o`er CL _ • n _" 00 W 0 CID +- � • J2 06SO C O.� m y 0 W E tOi- V ca n 0 N2 4D c z $ nim E b - IE MAt ca c 0 vs cm mac+ W m 0 n C c s m t w .0 - cm O I Ccm O•— CA 0 CD .Me y O O 'g m m CL ~ Z O.� �3 O O G O cc O a d. QmQ co c cc coozCL� C.) h O C C cc CL Department of InduaWd Accidents Qffiee of Investigations 600 Washington Street Boston, MA 02111 www.massgov/die Workers' Compensation Insurance AMdavit: Builders/Contractors/Electridjim?lumbers Name (Business/orpnization/mvidw): Address: #:_ a ?7 �1�d x-01&4 Are you an employer? Check the- appropriate box: 1. ❑ I am a employer with 4. ❑ I am it general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.K I am a sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. (No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work Tight of exemption per MGL myself. [No workers' comp. c. 152, 1 1(41 and we have no insurance required.] t employees. [No workers' cMm4- insurance required.] Type of project (required): 6. ❑ New construction 7. g1temodeiing S. ❑ Demolition 9. ❑ Building addition 10.11 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other rv.Y FF.w..n. s...wy. wn n a — .yq ala VYl SOT. -- -t - MOW j9 �� W0*M, commmidon p0� M HomwWnen vow submit this stiidavit iodicatiea they we doiaa all Work and then bun outride Mutfattm must submit a mw dtidavit bacatiaa such tContreca n that check this box must athched as additiotnt sheet sbOwiq the nom of da subo�s and ter WO&M, oort4• policy ' mf ormtaRion. I an an em plops 11W is providlwa workers' comptr edon bUw wnce for my eMp/oJ'ees. Below Is d w policy owd job �t informadaL Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State2ip: - Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiref 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 t, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 v4rification. I do hereby certify lire ns a d gems" a�ofPeyw7' tw the lnfwmadon prov/ded b mrd correct. Si OS. Phone #: 00ci8/ Use only. Do 0101 wrhe In this arca, to be convieted by c4 or tow01 offlcw City or Town: Issuing Authority (circle one): I. Board of Health 2. Building Department 6. Other Permit/I.icense N 3. Cky/Town Clerk 4. Electrical inspector S. Plumbing Inspector Contact Person: Phone #: 1111V1 111"Miu1, Aiiwa ilaDva a,avWav Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employes. 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 employe' is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,125C(6) also states that "every state or local licensing agency shall withhold the Issuance or renewal of a license or permK to operate a business or to construct buildings in the commonwealth for any applicant who hu not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, MGL chapter 152,125C() states "Neither the commonwealth nor any of its political subdivisions shall enter ins 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." Applicant Please fill out the workers' compensation affidavit completely, by checking the boxes that apply lo your situation and, if necessary, supply sub -contractors) nan*s), addresses) and phone nmnber(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be an to sip 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, aot the Department of Industrial Accident. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their Self-insurance license number an the appropriate line. City or Town Officiab 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 111e Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permiVUcemc 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 � been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid a is on file for future permits or licenses. A new affidavit most 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 burn leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would bice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us s cad. 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 Revised 5-26.05 Fax # 617-727-7749 www.mass.gov/dia 'BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Numbed. CS 028557 Bi,Adate: 07101./1952 Expired'. 07/0172007 Tr. no: 14598 Restricted:' 00 .1 { ROBERT P BUTHMANN..:.;�' PO BOX 653 NEWBURYPORT, MA' 0195 Commissioner �iie �anvnzanaea�,i a�✓�aaatrciiu6ei�b Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR. Registration: 132151 Expiraf w 11/28/2006 Type:.Private Corporation R.P.B. INVESTMENT REALTY. DE �FDMVgUTHMAN �i 19 MAIN ST. #193 SEABROOK; NH 03874 Administr'tor The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P. 0. Box 1025 State Road, Stow, MA 01775 APPLICATION FOR PERMIT N. Andover Permit No ( City or Town ) (I£Applicable ) In accordance with the provisions of M.G.L. Chapter 10 as provided in Section 527 CMR 34 applica *on is hereby made by Ir 7144�z Date: r; ASS. u�.,Mrc:rarc: Dig Safe Number Start Date �( Full name of person, Firm or Corp n) ' State clearly Address purpose for (Street or P.O. Box City or Town) which permit For permission to locate dumpster for construction/renovnti on/ripmnl i ti nn is requested of building Comments: dumpster must be 25' from structure or covered when not in tt-ge at ( Give location by street and no., or describe in such manner as. to provied adequate identification of location ) Name of competent operator Cert No. --- ble ) Issu -�ted �� .S� BY r ( Signature of Applicant ) Date of expiration 1,13 Q 1 Fee s 50.00 Paid Due The Commonwealth of Massachusetts glow Department of Fire Services Office of the State Fire Marshal R O. Box 1025 State Road, Stow, MA 01775 PERMIT Date: North Andover Permit No ( City of Town ) ( If Applicable) Dig Safe Number In accordance with the provisions of M. G.L.14 8 Chapter_JQ as provided in section 5 2 7 CMR 34 Start Date This Permit is granted to: Full name of person, Firm or Corporation Permissionto locate dumpster for construction/renovation/demolition of building Comments: dumpster must be 25' from structure if unable to place with required Restrictions: clearance dumpster must be covered with plywood or tarp end of work day at ( Give location by street and no., or describe in such ma er as to provied adequate identification of location ) FeePaids 50.00 �tv�n� Fire Chief This Permit will expire / d S ( Signature of offical granting permit) Offical granting permit ( Title ) �� TWIC 01=RMIT MI ICT RP ('_r)NCP1r'1 Irll ICI Y Pr1CTi=n I IPr1N TNI` PPFMICFC ♦� NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the proviion of MGL c 40 S 54, a condition of Building Permit at: 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. 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 of Facility) Signature of Permit Applicant Date 1 + -+ r __ Y,. .�_ -+ ..--,-. +-/-+•' I t fill � a 1 i i I ! I I ' , 1 1 '" -F' - --* -- -�•- - '+'- r - - + + - +-- } - - } —�- -+ — + " i / / .JET/`/ - -t + —'+ - -+ -�- -+ � � . � — +. i• - -- -i-- '� - + - - ell i I I I I 1 I , ' I I - l � I 1 ' , I 1 i I 1 I ' i— 4- + - 1 Office Use Only 01 4t LD1IU nuitalth of ff t5s Eff Ll Permit No. 1tFMt nrW of Public *afctq Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 W90 pea" blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date %* or Town of-- NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) MA /- (�% ` Owner or Tenant li 5/�_r� 6 9 sl-,/� Owner's Address ,T A -f I Z5-,� Is this permit in conjunction with a building permit: Yes _ No (Check Appropriate Box) Purpose of Building Existing Service Amps _l Volts New Service Amps _J Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Utility Authorization No. Overhead `! Undgrnd 0 No. of Meters Overnead _ Undgrno No. of Meters No. of Lignting OutletsI No. of :-lot ', cs I No. of Transformers Total KVA No. of Lighting Fixtures i Swimming Pcot Above.— In. r" Generators KVA Grn.o. _ grno. I No. 01 Receotacia Outlets No. of Oil corners No. of Emergency Lighting. Battery Units No. of Switch Outlets I No. or Gas 3urr.ers FIRE ALARMS No. of zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Sell Contained Detection/Sounoing Devices Local '_ Municdai --Other .- Connection No. of Ranges I No. ct Air C:.rc. 'otai 'tete No: O(Disoosais I No.of Heat .oral 'eta' Purncs :ons KW No. of Dishwasners SoacerArea Heating KVv No. of Dryers I Heating Cev ces KW No. of Water Heaters KW No. of vo. of I Signs 9a las;s Low Voltage Wiring No. Hydro Massage Tubs I No. of Molars Total HP OTHER: ��/� _ i11-�D`Z.��f _ '�i' � .ti,�✓f �.1/YI.F'0 /, iro il.F' INSURANCE COVERAGE. Pursuant ;o the requirements or %Iassac-users ;enerat Laws I have a current Liability Insurance Policy incluaing C;,mc:etec Ccerations Coverage or its substantial equivalent. YES = NO = I have submitted valid proof of same to the Office. YES = NO = It you have checked YES. please Indicate the type of coverage Gy checking the aaprobriate box. INSURANCE BOND = OTHER = (Please Scec:��l (� Estimated Value of E!ectncal work S (Exoiration Oatel Work to Stan 8 -!fp 7 Insoecaon pate Aacoes:ec: Rough Final Signed under Me Penalties of pe ury: FIRM NAME NO. 20 Licensee c(iGra:oreNo/ �'J� A f C. . - S^ - - Address � L J�v�eitxf,f�c.e�iri til -4–a ��/??/ eus. Til. No. OWNER'S INSURANCE WAIVER: I am aware that the L• nsee toes not nave in* insurance coverage or its suosianital equivalent as re- quireo by Massacnusetts General Laws. ana it my naiure on :nu cermet aopimation waives this requirement. Owner Agent (Please check onel- steonone No. PERMIT FEE S . ... (Signature of fawner or Agann 1217 A j Date.A—/'o e;v .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ............. i ........................................ has permission to pei ...... ........................ :z- )- ...... --- — ---- .. . ........................ wiring in the building of ................. .... .......... at ... �7 .... .. ................................................................. . North Andover, Mass. Fee.:�4-� ............. Lic. No . ............ ............................................................. ELECTRICAL INSPECTOR '1� /Z '4 '�' WHITE: Applicant CANARY: Building D,�9!20/97 AlAreasurer 15. 00 PAID