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HomeMy WebLinkAboutMiscellaneous - 40 FRENCH FARM ROAD 4/30/2018 40 FRENCH FARM ROAD 210/035.0-0072-0000.0 1 LCv-')e r e A vv - � ��ot �2Ce, en a"9H�5 Zoning Bylaw Review Form k. Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978-588-9545 Fax 978-688-9542 Street: Map/Lot: 0 6- 17 Applicant: e U .va �S Request: -7t-, In SAM,.. Y SL,/f-C Date: Please be advised that after review of your Application and Plans your Application is APPROVED/DENIED for the following Zoning Bylaw reasons: Zoning Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting 2 Frontage Complies 3 Lot Area Complies L?e-S 3 Preexisting frontage 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed `'(c' G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies y C 4 Special Permit Required Ll( S 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply Lie 5 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies �� S 3 Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information - 5 Rear Insufficient I Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies S D Watershed 3 Coverage Preexisting 1 Not in Watershed e 5 4 Insufficient Information 2 In Watershed j Sign 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District I( Parking 1 In District review required 1 More Parking Required 2 Not in district E'S 2 Parking Complies 3 1 Insufficient Information Remedy for the above is checked below. Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit Setback Variance Access other than Frontage Special Permit Parking Variance Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Independent Elderly HousinS ecial Permit Special Permits Zoning Board _..Special Permit Non-ConforminUse ZBA Large Estate Condo Special Permit Planned Develo ment District Special Permit Earth Removal S ecial Permit ZBA S ecial Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permit B' Cir S PEc_ a t P;n n,i Watershed Special Permit Su ply Additional Information review and or advice shall be based on verbal explanations by the applicant nor shall The above review and attached explanation of such is based on the plans,request for or information submitted. No definitive serve to provide definitive answers to the above reasons for this action. Any inaccuracie grounds for this es,misleading review in verbal explanations by the applicant subsequent or other be voided at the discretion i subsequent changes to the information submitted by the applicant shall b of the Building Department.The attached document titled"Plan Review Narrative"shall hi herein, refer, ce. he building/dattached hereto and incorporated epartment will retain all plans and documentation for the above file. ' �( t'LCW -80ding Department official Signature 11-3 0 -Z� Application Received Application Denied Denial Sent: If Faxed Phone Number/Date: Plan Review Narrative The following narrative is provided to further explain the reasons for the action on the property indicated on the reverse side: AR.1 Y gg f Q i , sL2 k i,ra �� + ' pt4 a i z 3444 t.l is t K �•Ri'RR:FF i�,.:"`.� srr J.:�t t+�r��fl, a�'� r1'�l'� Y�14M1£ �„�7'�"s�"y����Y`.. �+��#fie {� i°ll� s � i � � Q,c / L C./lel �• r./��� ,4 /S Referred To: Fire Health Police Zoning Board Conservation Department of Public Works Planning Historical Commission Other BUILDING DEPT ZoningEly lawDenia12000 1 Town of North Andover of 'AOR ,� RECEI�CF .� ;,, o JOYCE BR% f?4 %of the Zoning Board of Appeals - p TDevelopment and Services Division a"Ujf NOR William J. Scott, Division Director 2001 MAR 21 A 9: th 27 Charles Street SSS^cHus°� o D. Robert Nicetta Andover, Massachusetts 01845 Telephone(978) 688-9541 Building Commissioner Fax (978)688-9542 Any appeal shall be filed Notice of Decision within(20)days after the Year 2001 date of filing of this notice in the office of the Town Clerk. Property at: 40 French Farm Road NAME: Stephen & Donna Mastrocola DATE: 3/13/2001 ADDRESS: 40 French Farm Road PETITION: 002-2001 North Andover. MA 01845 HEARING: 3/13/2001 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday,March 13, 2001 at 7:30 PM upon the application of Stephen&Donna Mastrocola, 40 French Farm Road,North Andover,MA requesting a Special Permit from Section 4.121 Paragraph 17 of Table 2,in order to allow a family suite within an existing dwelling within the R-2 zoning district. The following members were present: Walter F. Soule,Raymond Vivenzio,John Pallone, Scott Karpinski, George Earley. Upon a motion made by George Earley and 2nd by Scott Karpinski the Board voted to GRANT a Special Permit to allow for a family suite to be occupied by Mrs.Mastrocola's parents and that the family suite not exceed 920 s.f. in accordance with the architect's floor plans by: Court Street Architects, Inc., 7 Court St., Arlington MA dated June 23, 2000, revisions October 16, 2000 and November 9, 2000.and per the Plan of Land by: Stephen E. Stapinski,RLS, #29876, Merrimack Engineering Services, 66 Park Street, Andover, MA dated: January 23, 2001. Voting in favor: WFS/RV/JP/SK/GE. The Board finds that the applicant has satisfied the provisions of Section 4.121 Paragraph 17 of the zoning bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one(1)year of the date of the grant, it shall lapse,and may be re-established only after notice,and a new hearing. Furthermore,if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two(2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced it shall lapse and may be re-established only after notice, and a new hearing. Town of North Andover Board of Appeals, Az Raymond Vivenzio, acting Chairman Ml/Decisions2001/6 Town of North Andover NORTH JOYCE BR ' of the Zoning Board of Appeals p � � Development and Services Division , . s :} William J. Scott, Division Director 2001 MAR 2� Aq: I 27 Charles Street 'SSAGHU D. Robert Nicetta Stt I�fJ� Andover, Massachusetts 01845 Telephone (978)688-9541 Building Commissioner Fax (978) 688-9542 This Is tO certify that twenty(39)days have elapsed from date of deoilion,Mild hihout flilnp of an aped, Any appeal shall be filed Notice of Decision 'D OU/ within(20)days after the Year 2001 Town t aria oue date of filing of this notice in the office of the Town Clerk. Property at: 40 French Farm Road NAME: Stephen & Donna Mastrocola DATE: 3/13/2001 ADDRESS: 40 French Farm Road PETITION: 002-2001 nn,,l North Andover, MA 018.15 HEARING: 3/13/2001 ( V The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, March 13. 2001 at 7:30 PM upon the application of Stephen & Donna Mastrocola, 40 French Farm Road, North Andover,MA requesting a Special Permit from Section 4.121 Paragraph 17 of Table 2, in order to allow a family suite within an existing dwelling within the R-2 zoning district. The following members were present: Walter F. Soule,Raymond Vivenzio, John Pallone, Scott Karpinski, George Earley. Upon a motion made by George Earley and 2 by Scott Karpinski the Board voted to GRANT a Special Permit to allow for a family suite to be occupied by Mrs. Mastrocola's parents and that the family suite not exceed 920 s.f. in accordance with the architect's floor plans by: Court Street Architects, Inc., 7 Court St., Arlington MA dated June 23, 2000, revisions October 16, 2000 and November 9, 2000.and per the Plan of Land by: Stephen E. Stapinski?RLS, #29876, Merrimack Engineering Services, 66 Park Street, Andover, MA dated: January 23, 2001. Voting in favor: WFS/RV/JP/SK/GE. The Board finds that the applicant has satisfied the provisions of Section 4.121 Paragraph 17 of the zoning bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one(1)year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two(2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced_ it shall lapse and may be re-established only after notice, and a new hearing. Aiq Town of North Andover Board of Appeals. Raymond Vivenzio, acting Chairman Ml/Decisions2001/6 ATTEST: A True Copy " #,.; Zak '�{:.:.,.• :1< . .„ TowrlZlerk Registry of Deeds Northern District"of ss x. County Lawrence, 01840 04/20/01 STEPHEN & DONNA MASTROCOLA AN. # 22 Rec. Type PLAN 45.00 7r,st: 11.351 Gies 2.2 # 23 Rec: Type DECSN 30.00 852. 77.25 y. Total 1 .00 # 24 Payseent Cash T,y.75 # 25 Chi arlrAe THAW YOU, Thomas T. $urke Register of Deeds ESSEX NORTH REGISTRY OF DEEDS t.,4VRENCW, MASS. -0- -�p I l 2-) �I A Il' M COPY: ATTsr: r REGISTER OF DEED r Legal Notice North Andover, Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at the Senior Center, 120R Main Street,North Andover,MA on Tuesday the 13th of March, 2001 at 7:30 PM to all parties interested in the appeal of Stephen&Donna Mastrocola, 40 French Farm Road,North Andover requesting a Special Permit from Section 4.121, Paragraph 17, within Table 2, in order to allow a(family suite)within an existing dwelling. Said premises affected is property with frontage on the North East side of French Farm Road within the R-2 zoning district. Plans are available for review at the office of the Building Department 27 Charles Street, North Andover, MA Monday through Thursday from the hours of 9:00 AM to 2:00 PM. By order of the Board of Appeals William I Sullivan, Chairman Published in the Eagle Tribune on February 27 &March 6, 2001. Reviewed: Legalnotice 2001/3 W cm••11L �NryYOa�O LL;ooUNmN ID 2]--L CI N rtN' 'tme°YNo3 1'--5 m`h�atoC>-LF«Nmay tNaaNL E -I_CM wWaQ(Ao•OrLL .- .` 0)0dc° 02°cZoOOonOWa>¢0 .Z�NCd2c' vLAN ao m (1) L eLUa'a = m y N o E >.M 'o oNm° _Cm EAj UsCNtN c co` m oo Z ZZLLL �NN �6.2-NodU me v UOoQ °� m= _ cmn yLL H Dm ° W¢ir0N'OIt - >t0lN -10 8.2Z o -6,, _vmZraw - o� T�N3i �oorv� o a>> oF NW ZW=NLc0 �mUQC� NaEoN-j Q� A ao I wco r ,o Legal Notice North Andover, Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at the Senior Center, 120R Main Street,North Andover,MA on Tuesday the 13th of March, 2001 at 7:30 PM to all parties interested in the appeal of Stephen&Donna Mastrocola, 40 French Farm Road, North Andover requesting a Special Permit from Section 4.121, Paragraph 17, within Table 2, in order to allow a(family suite) within an existing dwelling. Said premises affected is property with frontage on the North East side of French Farm Road within the R-2 zoning district. Plans are available for review at the office of the Building Department 27 Charles Street, North Andover, MA Monday through Thursday from the hours of 9:00 AM to 2:00 PM. By order of the Board of Appeals William I Sullivan, Chairman Published in the Eagle Tribune on February 27 & March 6, 2001. Reviewed: J� Legalnotice 2001/3 W . Gal��t Ate ' 0O�" 'N._aT NLN NthL>.m0 mal GL V N>mrnN�NOr� >armEc a- c¢ �--N vL� wN�N� �Q'oln.t,-o�acas0LLo_ I-�N OGNN No. oGEN o�>EN WWW aes.._Z�N'�N� vfCV SNm O-OCL,, cZo00 O FOanQ c a3 ~s'E a�oQ N c�3 c N m o dl¢tAL primo G -G��mc no•-oro Nom �ro�Em� >,n �o-iUN ZO QN oa, D0 o_ cc m:9 -2 Nrn L > mQ o i ZZ v' N m O:F m e N lit N+ .m o m Na a a -IaLLLcn0.UQlQ��yLN.,O'LL roNror �'c-O30 Nom: io m�aLu CO J =O vl 0 0_. g O m E 2 L-o:dY3O`WN� t� O= o� Noi § � m W� vwoarn � ca WO LL o-sO >mOQ•" OZR -�om�LN NGN3 W mZ = N NGo - N - — OO � 7 ` d> CO7� wN QLn Nnom E ( N>a zO �mU¢�LOaNocD TOWN OF NORTH ANDOVER Zoning Board ofi Ann�,7�; p 27 Charle North A� Town of North Andover, Zoning Board of Appeals APPLICANT'S PROPERTY: list by map, parcel, name and address (PLEASE PRINT CLEARLY, USE BLACK INK) MAP PARCEL NAME ADDRESS 3 7 L ST8°NBv 1�ONv,} /�lr riit0C.oLh yp fcEnrcH frAm A . ABUTTERS PROPERTY: list by map, parcel, name and address (PLEASE PRINT CLEARLY, USE BLACK INK) MAP PARCEL NAME ADDRESS Sq�c y Lvli,✓ 3f G S ice/ . L�NaA L.�iEitt�E�E q7 0z.. F4. ^,7 RA . 3f 70 A��iA t Jga,�E d ow,J 3,r oc.b 4A . 3f 7 / woI.J.-i.rx i f- eAT H Lt EYE! L.� 0 GiJ F,g2,yIZ 3 f 72 N�,cEw /l'I acou*C'E �� 3 ) 7y 14,01AJ XOJE Jb Ftc," tfb, 3 f l 4 A wt Eem f4l-A C H (,J F,CE.v c H F-,vt•+ 3 f 9 2 /1'1�ch�e / t L,N�y� %Na►K,�,r s.? �,rGy F�rc.� R .3 S CJ.3 r EIJ y INAXY eo wcAe l- �{Jl Fit EN cy Fit c y► �� 2 6v/LL/4M t Kh7HO(mig 3S Is' THIS INF RMATION WAS OBTAINED AT THE AS ESSOR'S OFFICE AND CERTIFIED BY THE ASSES R'S OFFICE: BY*NATURE, '7 DATE: 12 6� a ASS OR, TOWN OF NO ANDOVER Required list of parties of interest Page one of_� Received by Town Clerk: JOYCE RADSHAW NOOWN CRK RTH ANDOVER TOWN OF NORTH ANDOVER. MASSACHUSETTS BOARD OF APPEALS 1001 FEB -g A 11: 30 APPLICATION FOR RELIEF FROM THE ZONING ORDINANCE a Applicant �7E. /1eAj r 1)O~IA I& r-r4 o c o L A Address yc fA E^►c N Ftic.n *<et. Tel. No. 97t- d FI V.r7 1. Applicant is hereby made: oo a) For a variance from the requirements of Section ' Paragraph and Table of the Zoning Bylaws. b)) For a Special Permit under Section: /2/ Paragraph _~'— of Zoning Bylaws 'i C) As a Party Aggrieved, for review of a decision made by the Building Inspector or other authority. 2. a) Premises affected are land and building(s) numbered 40 --kA-n� Street. b) Premises affected area property with frontage on the North (6 South W East ( ) West ( ) side of .4L0 a2e-p--e6� Street. C) Premises affected are in Zoning District Fl - and the premises affected have an area of 4/5 /.la square feet and frontage of z p S ' feet. 3. Ownership: a) Name and address of owner (if joint ownership, give all names): /A-r740 COLA Date of Purchase 3-It- f V Previous Owner Rdkr'i KrNwf t%y b) 1. If applicant is not owner, check his/her interest in premises: Prospective Purchaser Lessee Other 2. Letter of authorization for Variance/Special Permit required 5 of 8 1 i 4. Site of proposed building: )0 / front; 36 feet deep; Height -2'/ stories; feet. a) Approximate date of erection ��a� i,rJ OcTahe-< 006 b) Occupancy or use of each floor: f QST C�aa2 �lsc°d ' �vt h A C) Type of construction C)ov d 5. Has there been a previous appeal, under zoning, on these premises? No When +►t�— 6. Description of relief sought on this petition ..r cc /ti Su r T& 7. Deed recorded in the Registry of Deeds in Book ,27° 1 No. Page Land Court Certificate No. Book Page The principal points upon which I base my application are as follows: (must be stated in detail) A ov eAe _ C.o..J .duiiA27_ TO 0 cc u`o,<d � itf—. 4^467 7c..r �o Illy (,(n,�lrr�, f�a Tis,,•� t ��c 1-� �E �4.�.r..rTs�&IC �,.r /j r •yam A '7b GUid,70 r/lko r•►�{ ryo c�i.e, ..� ova /e s iJElvc� iti Q/LiJ 70 u i uJk�cti t x L ei + %, ,.� LeG 'T�v�� 4)T MAX bo ►u / I agree to ay the filing fee, advertising in newspaper, and incidental expenses* Signature of Petitioner (s) 6 of 8 ' r WORK SHEET DESCRIPTION OF VARIANCE REQUESTED ZONING DISTRICT: 2- Required Setback Existing Setback Relief or Area or Area Requested Lot Dimension Area � 3 Street Frontage i Front Setback (s) Side Setback (s) Rear Setback(s) 3 d 5 / . N�� Special Permit Request: 14 4�7 7 of 8 TO: Members of the Zoning Board of Appeals - FROM: Michael McGuire, Local Building Inspector DATE: 2/26/01 RE: Petition of Stephen & Donna Mastrocola 40 French Farm Road For a Family Suite Dear Board Members, Please be advised that on the above noted petition on item# 6 the petitioner stated that "change of use for an inlaw suite"which actually should be a special permit for a family suite. The applicants had come in for and received a permit for the addition which was for a finished recreation room in basement, a study, family room, sewing room and bath/laundry on the 1" floor and a bedroom and bath on the second floor. The project as is now proposed is over the 25% of existing floor area but was originally for the single-family use and not a family suite. I hope that this memorandum clarifies any possible confusion on this petition. Cc petitioner file TO: Members of the Zoning Board of Appeals FROM: Michael McGuire, Local Building Inspector DATE: 2/26/01 RE: Petition of Stephen&Donna Mastrocola 40 French Farm Road For a Family Suite Dear Board Members, Please be advised that on the above noted petition on item# 6 the petitioner stated that "change of use for an inlaw suite"which actually should be a special permit for a family suite. The applicants had come in for and received a permit for the addition which was for a finished recreation room in basement, a study, family room, sewing room and bath/laundry on the 1'`floor and a bedroom and bath on the second floor. The project as is now proposed is over the 25% of existing floor area but was originally for the single-family use and not a family suite. I hope that this memorandum clarifies any possible confusion on this petition. Cc petitioner file JIOWN ON JOWII )l ! I A[ ID( , //ER ASSESSORS MAP #35 LOT #72. ).R.D. 130011, P 4 1-011 SITE DEED. > TRK-J I'-) R (PI ill NJ I lil -I i ICT 2) WHICH REQUIRES STRY OF DEEDS 11 , '11DF ANP 'I I Ifl 1 SETBACKS. ESSEX NORTH REGI LAWRENCE, MASS. A TRUE COPY: ATTEST: FOR REGI - I I -AO -FA s_ fs vv SUL- I J[ ! .11.1HY CERTIFY THAT THE PROPERT): LINES ,1 : A&IN -)N THIS PLAN ARE THE LINES DIVIDING X! ) ! IN( OWNERSHIPS, AND THE LINES OF THE : 11 1- 1 1`, AND WAYS SHOWN ARE THOSE OF PUBLIC 11VATE STREETS OR WAYS ALREADY AND THAT NO NEW LINES FOR J- )N OF EXISTING OWNERSHIP OR FOR NEW A -)E SHOWN AND THIS PLAN CONFORMS TO THE AND REGULATIONS OF THE REGISTRY OF DEEDS." JAPKSKI, R.L.S. DATE I )VI i ) BY THE TOWN OF NORTH ANDOVER fi OF APPEALS. 3 D � TE HEAR NG A , FILED Me ory �s$.ACFN7`�f'� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 62 0 Date y- o?Ol /THIS CERTIFIES THAT THE BUILDING LOCATED ON "�'D /�/'�';C/7 7—d R 127 1001 MAY BE OCCUPIED AS I/U�AWpp t ('�/ Rooms I B,�4�h ) pep213A/�PPiVG'A IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO :L)©VA-� •A 0,5 0,f p L. Q �C - Building Inspector 8Z 0711 ZZ00£0189Z00 £5:00:00 I£:80 l0-i(EW Was 10 NO LV98I988L68 orlso eiQ uogesnQ aunt oleo 5UL MEd lI uorlragiWR W80 ZO-IO-SEW iatdo3/xE3/Zajuud luumiod uodag 207 xE3 143311JO dH ® o r over �. No. r r Nord-;Andover, Mass., I O •� OO B f `�- BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT..... . O.N�� BUILDING INSPECTOR ................................................................... Foundation / � It� ,�p has permission to erect...Q�.�..�.�.............. buildings on 4 Q Fr� e�'1 �►r � - ...... ........ .............................................. Rough r, to be occupied as... A1a!!�t � ..rNh1'... .� �. .M �.*..;.'.0. .`�,...0. ...��i LI�... Chimtiey ~, provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M 3 S P r) PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ELECTRIC4 INSP CTO _ ou ............ ..�........................... , . ................................................ Service BUILDING INSPECTOR ina GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Qry -Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE, REVERSE SIDE Smoke Det. /� . 1 Date- .. . . . .. . .. . �pRTM 32 �` TOWN OF NORTH OVER . a PERMIT FO GA NSTALLAI ION h �9SSACMUSE�•C This certifies that . . . 1.+.�/../.-. !::r_ , , , c C. . . . . . . . . . . . has permission for gas installation . .1�4 [. . . . rf i!�. . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee. Lic. No. . . / GAS INSPECTOR Check# /?! 7 2 z� 'I r Y MASSACHUSETTS UNEFORM APPLICATON FOR PERMIT TO DO GAS FUTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS 40 Building Locations r1`C116-N M R w Permit# Amount$ .3U Owner's Name New❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ v v1 a m O vx G wZ x z z N a1 W d W p w O W F Gw W z < x x a W < W < .� F h O z O z U z O vw W o � D 3 0 ° x° > a ° o SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR - 8TH . FLOOR (Print or type) �I (� rr __ Check : Certificate Installing Company Name �1 leV''i 'C'L! rm G Corp. Address tctrro-zl f c h w- ElPartner. Business Telephone 7 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter o d h n INSURANCE COVERAGE Check on . I have a current liability Insuranc olicy or it's substantial equivalent. Yes No❑ If you have checked yes,please ndicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Oy G s Fitter Title ❑ Plumber �� , 1 O City/Town Gas Fitter Licensd Number E9 Master APPROVED(OFFICEUSEONLY) ❑ Journeyman The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations ,.600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeQ><bIy Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate bog; Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp. insurance 5. 9 ❑Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.ElElectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp, c. 152,§1(4),and we have no 12.❑Roof repairs insurance required] t employees_ [No workers' comp.insurance required.] 13.❑ Other ;.Any applicant that chec:W box#1 must also fel out the section below c _ Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submoit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sip-nature: Date: Phone#: [[6. Other l use only., Do not write in this area, to be completed by city or town officiaL r Town: Permit/License# g Authority(circle one): rd of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector t Person: Phone#: Information an d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25CM states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their 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 sore 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 worikers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future perxnits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Wuhington Street Boston,MA 0.2111 Tel. # 617-72.74900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-OS vww.mass_gov/dia FAX - TRANSMISSION T0: 77e- FAX Number: _ 7- 3 3o- FROM: Town of North,Andover Zoning Board-of Appeals FAX: 978-688-9542 PHONE: 978-688-9541- DATE: o? - / d oo/ r SUBJECT: Number of pages: REMARAKS: Attached is a fax containing your legal notice. As you are aware, the attached legal notice has to be placed with the legal notice department of the Lawrence Eagle-Tribune, and it is your responsibility to do so as-soon-as-possible in order to meet the required deadline. Failure to place the legal notice in the newspaper within the required deadline will mean that you will not be able to be placed on the ZBA agen0a for the upcoming meeting. The direct dial phone number for the legal notice department of the Eagle Tribune is 978-946-2412, 100 Turnpike Street, should you require any further assistance. Thank you. MI/fax-legal notice l \ �� i Office Use Only bepdPirlikAt of PiAlic Safety �� ✓/ Permit No. §0AR0 OE EIRE PktVENt10N RMULATIONS 527 CMR 12:00 Occupancy & Fee Checked 3/90 (leave blank) \\\ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All worts to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INk OR TYPE ALL INFORMAtION) Date City or town of To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Lbcallon (Street & Number)f !YO /r e-v c!r /Cit o• Owner or tenantlct- i Owner's Address QV 0- e- is this permit in conjunction with A building permit: Yes No (Check Appropriate Box) Purpose of Building /fDeSi'gle a/ Utility Authorization No. ExisliriR§&vitE Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of keeders and Ampacity Location and Nature of Proposed Electrical Work 4 a 74 17"nf ek 0-0/c/ 1iL,'O a/ TOTAL No.of Lighting Outlets No. of Not Tubs No. of Transformers KVA Abovein- No.of Lighting Fixtures Swimming Pool grnd. grnd. ❑ Generators KVA Bat er emergency ig ting No. of Receotacle Outlets No. of Oil Burners Batte Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No. of Zones lotal No. of Detection and No.of Ranges No.of Air Conditioners Tons Initiating Devices Heat Total T'laTNo. of Sounding Devices. No.of Disposals No. of Pumps Tons KW No. of Self Contained No. of Dishwashers Space/Area Heating KW Dr, :'ion/Sounding Devices r--; Municipal ((--�� No. of Dryers Heatingbevices kW Locall.._) Connection UOlher o. of No. Low Voltage No. of Water Heaters kW I Signs Ballasts Wiring No. Hydro Massage Tubs, No.of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusftes General Laws I have A current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent.YES J0 NO O t have submitted valid proof of flame to this office. YES K NO❑ If you have checked YES, please Indicate the type of coverage by checking the appropriate box. INSURANCEKA 11001 BONb ❑ OtNER❑ (Please Specify) p• e o (Expiration Date) Estimated Value of Electrical Work$a SO Work to Start 6Zz 1/p6 Inspection date Requested: Rough 6/y' Final Signed under the penalties of perjury: FIRM NAME L • � I S e L Al llc. No. �3 .Licensee Signature LIC. NO.IFZ 3 Eb Address L/ ea ,"e.^o e4y e , K; rW;e-X. � &- Bus. Tel. No.,56 '3S5/DS`"� Alt. Tel. No. .OWNER'S INSURANCE WAIVER:I am Aware that the Licensee dob3 hot hive the Insurance coverage or Its substantial equivalent as required by Massachusetts General Laws, and that my signature bh this permit application waives this teduirement,Owner Agent (Please check one) 4 telephone No. PERMIT FEES t U (Signature of Owner or Agent) C - '" Date. .. vcJ � . .j. NpRTN .1 TOWN OF NORTH ANDOVER pf „ao ,e 6 F PERMIT FOR QA�S'INSTALLATION .� D SACHUSEt This certifies that . . . .�� •. . :. . t. �. . . :: F.`-. . . . . . . . has permission fornstallation . $ot.t ?E �'! . . . . . . . . . . . in the buildings of . . . R S ?G c d���1 at . . . r,P!��>G . . .! � �1 . ./. , North Andover, Mass. Fee. .� '� . . . . . . . . . . . . . . . . . . . . . . . . . #, AA jPAID INSPECTOR WHITE:Applicant CANARY:wilding Dept. PINK:Treasurer GOLD:File