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Home My WebLink AboutMiscellaneous - 40 Kingston Street 40 KINGSTON STREET �I 210/023.0-0006-0040.R s 1 a, GolmlAa Gas- of Massachusetts A NiSource Company i i 55 Marston Street P.O. Box 869 September 28, 2012 Lawrence, MA 01841-2312 978.687.1105 Fax:978.688.1875 Brenda Fredericks Account Number: 40 Kingston St North Andover MA 01845 Dear Brenda Fredericks: During a recent visit, our service technician detected a safety problem with your gas range located at 40 Kingston St., North Andover, MA. Accordingly, we have issued a Warning Tag because of this situation. Range needs to be serviced or replaced. Under the circumstances, we strongly urge you to correct the code violation. In addition, the Massachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737,Acts of 1960,requires that the condition be remedied. If you have any questions, please call our Service Department at 1-800-698-0940 and ask to speak with the Service Supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Customer Service Department Columbia Gas of Massachusetts CRR: CRR#, C:\cisupdatedletters\110 09/28/12 Date. "O°T:��a TOWN OF NORTH ANDOVER at"O' p PERMIT FOR PLUMBING SA us I This certifies that . . .Q !!/`� .� . . . .,fel;hr. 77 - . . . . . . . . . . . has permission to perform . . .1 H !-!. . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . at . . .//.(;. . . . . . . . , North Andover, Mass. Fee.3 O2 . . . . .Lic. No../. P. . . . . . . . . . �. . . . PLUMBING INS COR Check # trl cl �l 8371 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO.DO PLUMBING (Print or Type) An Mass. Date 20 10 Permit# / ' ;c] Building Location Owner's Name —,T ' e Z j qu eh \ Type of Occupancy New ❑ Renovation ❑ Replacement LR9 Plans Submitted Yes ❑ No ❑ FEATURES lN" z cn Cn 1W-- J Z z W W Y } Q U a- O z w cn vi W r� U w ¢ c� u- z Z z a J _ � Q w rn Y o= d Q a R 3 X v z 0 w Q W > Q W z o Q -j Z o[ a m 0 iZ W = Q = = a z Y a O z z Q W LL Y W U M O � z 0 0 w � 0 U = Y � m w o o Q 02 � W LL cal 0 O Q cr m 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOG Installing Company Name - SCheck o e: Certificate � r r Address U orporation (/ J ❑ Partnership Business Telephone a ❑ Firm/Co. Name of Licensed Plumber INSURANCE COVERAGE: I have a currenj,1iability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy �� Other type of indemnity ❑ Bond ❑ OWNERS 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: Owner ❑ Agent ❑ Si nature of Owner or Owner's Acient 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 o and installations performed under the permit issued for this application will be in compliance with all pertinent provisions the assachuse is St a PI bing Code and Chapter 142 of the General Laws. By igna u of Licensedum e Title Type of License: Master Jouurpeyman ElJo City/Town License Number �� APPROVED OFFICE USE ONLY) L TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR (DEMOLISH ANY BUILIDING OTHER THAN A ONE OR TWO FAMILY (DWELLING -fi Q"r�for Q1�OfficialOfficial31�7 BUILDING PERINUT NUMBER: /^ DATE ISSUED: SIGNATURE: Buildin Cdhmissioller/Ins or of Buildin Date -rl 9 G 1.1 E Property Address: 1.2 Assessors Map and Parcel Number: v c?� 3 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning District Proposed Use Lot Areas Frontsge(ft) rn 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 11 private 11Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ Q t a�, t:''.:f, .e s.<u ,x r:' .:... .� �n�'•.. .-rzY,e. -F:,. .h�..,s,. ..,.V:-.., ,,, .„. ,n...,..n i 2.1 Owner of Record r V1/ �/t L (J r t/.c. Clj v 0 u f' �y0 /ti/ f 41 t!"l (J V Z'A h 04 -j Vil 2 Name(Print) Address for Service q7 F- - X32 ' ?00 /7f Signature Telephone iv t 2.2 Authorized Agent / / ) /f Zi//si W s4"( �/t//GTrs✓� ">0 2Bv �,y (.r��/ . '+ g9,7t 26 :2 Name Print Address for Service: Z / 7k � S�i�gr ture Telephone M 90 3.1 Licensed Construction Supervisor' Not Applicable ❑ 41192-2 Address j/ License Number O { -n I Licensed Construction Supervisor: Expiration Bate r [.nature �G Telephone 3.2 Registered home Improvement Contractor Not Applicable ❑ Company Name.. Registration Number Address Expiration Date ! G Signature Telephone J f I Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Si ned affidavit Attached Yea....... No.......❑ 9FCTI( S,-P1 �111 I®IN, ,IDlDfiW JR, :7 y, 3� .3gY$¢17A��r 5.1 Registered Architect: Name: { Address Signature Telephone 1R�sBerecl<�feg�'Snat� �` Areaof Responsibility Name: itNu Address: Registration Signature Total Expiration Date Not applicable ❑ i Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility r Address. Registration Number 1 Signature Telephone Expiration Date Name Area of Responsibility I Address Registration Number Signature Telephone Expiration Date 1 � ail :'• �,� .� Not Applicable ❑ 1 Company Name: :r4,7 w J//C'h Responsible in Charge of Construction L aU app 'le ' New Construction ❑ Existing Building 0 Repair(s) iiY Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / A,, z— �!/I�.� � �� wY/ QLo,r otir, v.�� a/` lNd14 /L r WET t✓ ✓ 7� rly( /1 Z�tvz/ �Js�� />� /� A �v USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 0 ]A ❑ A4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A 0 C Educational ❑ 213 0 F Factory ❑ F-] 0 F-2 0 2C 0 H High Hazard 0 3A ❑ IInstitutional 0 1-1 0 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA ❑ S Stora e _ g ❑ S-1 0 S 2 ❑ SB ❑ U Utility ❑ Specify: M Mixed Use 0 Specify: S Special Use ❑ Specify: COMPLETE TRIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area r Floor s Total Area s Total Hei t ft Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization- TO DE CO16'IPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property Hereby authorize to act on My behalf in all natters relative two work authorized by this building permit application Signature of Owner Date - `4� • 5. - I, Vv f Id ex- was Owner/Authorized AEnt— Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury T,4n of W , e Print Nam ture of Owner/Agent Date Item Estimated Cost(Dollars)to be Completed by permit applicant . 1. Building �D (a) Building Permit Fee G, Multiplier 2 Electrical (b) Estimated Total Cost of --�' Construction from(6) � 3 Plumbing Building Permit fee (a)X (t) D _ 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Lr3-00. Check Number y� st r 4 4 vt v'�vtz y t..,f •� - 'r tj z r3 s S! i sstz Fr 4/ t /� N kS X+i7 t$ i J7` •(C� b x s, �'.:s3i i" •t 3 t ?r!# „_C ,7::. w,. _ a,_ :,i_ `..,:a, _hy..»,.. ��.t t:. ,•'a f< NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1 sr 2ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f i I� -777 7ely ✓tie C� uuea�l/ � aaaactuaet�a s BOARD OF BUILDING REGULATIONS License CONSTRUCTION SUPERVISOR j. Number. CS 019129 F Birthdate. 10%15/1951 i± v Expues 10/15/2005 Tr.no: 5181 ti Restricted 00 JAMES W SHEA l 45 DEARBORN ST L. ,.,p y—e J SALEM, 'MA 01970 Administrator 4 4�. Z a The Commonwealth of Massachusetts u r Department of Industrial Accidents Office of investigations wF Boston, Mass. 02111 Spey'' Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 " I am an employer providing workers' compensation for my employees working on this job. Company name: �/U�t/✓-l6r-y/ (/C o''/�G y G.d.v0 1A, t, Address Av -2 ,12-- City' IA Ir•, , 174 <r Phone#: Insurance.Co. ku. U1,11 Policv# Company name: Address City_ Phone#: Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of"a fine up to$1,500.00 and/or one years'imprisonment-as-w-eflas_civil.penattiesin ttie-fnrm ofa..STOP WORK.ORDER..and_a.fine_cf.(.$100.OD)_ailay against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby certify and he pains and penalties of perjury that the information provided above is true and correct. / Signature Date Pr' name A r., Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required ❑ Licensing Board Selectman's Office Contact person: Phone#: Health Department Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste. disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: /�O<7✓ ✓��LY G Art7/"� �ivY�/Or(J r � .J2//"`ls / � ��i/' (Location of Facility) ��/`G�j"" rG✓l dl� v Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ACORD CERTIFICATE OF LIABILITY INSURANCE °"'E`"�"°°/ 9PR�OF02B 05 10 04 04 PRODUCER THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE John J Walsh Ins Agency, .Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P O Son 4407 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Salem RIA 01970-6407 ' Phone:978-745-3300 88x:978-745-9557 INSURERS AFFORDING COVEkAGE NAIL# INSURED INSURCRA: National Fire & marine INSURER W. A. rican 2ur1cL Inanranro Co. Professional Roofing Contractors Inc. MSURBRC7 P. O. Hoz 262 INSURER a. Salem NA 01970 INSURER E: COVERAGES THE POLfC(ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANYREOUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRMED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICI6WAGQREGAYE L(MIT3 3HOYTN MAY HAVE BEETI REDUCED BY PAID CLAMS. LTR INSW TYPE OF INSURANCE POLICY NUMBER PATE pAT9 MWW LOM GENERAL LLABLITY EACH OCCURRENCE $1000000 A 8 COMMERCIAL GENERAL LIABILITY IN ISSTM 05/01/04 05/01/05 =S(E9OscC'N10e) $100000 CuueIS;MUADE ®oc" ME13E7IP91hYa pokso) $5000 PERSONAL BADV INJURY $1000000 GENERAL AGGREGATE S2000000 GENIAGGREGATE LIMIT APPLES PER PRooucTs-cawmrAOQ 52000000 POLICY n LOC AUTOMOBILE EDIBILITY COMBINED SINGLE LIMIT ANY AU (En AUTO - $ TO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS ' O er Pelson) HIRED AUTOS BOOKY RULIRY (Pp Rmdd-i) NONOWNEDAUTOS PROPOI!TY 0 AGE S . (Per aezidai) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANYAUTO O'rWR THAN EA ACC S AUTO ONLY: AGG S IXG9S6NIPRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENMN $ s WORxER3 COMPENSATION AND - TORY UMI1S ER B EMPLOVEOVLAeam NCAR456712 05/01/04 05/01/05 E_L.EACHACCIDENT $500000 ANY PROPRIETORIPATRTeERIFJ�GGTTIAtE OFFICEWMENIBER DLCLUDEO7 E.L.DISEASE•EA Ee,PLOYE S 500000 II yos.desu^be=eer SPECIAL PROVISIONS below E L.DISEASE•POLICY LIMIT S 5 00 0 0 0 OTNER DESCRIPTION OF OPERATIONS I LOCATIONS I YEHrLES I E=LUIRoN3 ADDED BY ENDORSEMENT I SPECIAL PROVOO"s CERTIFICATE HOLDER CANCELLATION 0001003 SHOULD MY OF:THE ABOVE DESCRIBED POLIES BE CANCELLED 89RM Tea EIWIRATIOH DATE TTIEREOF,THE IBMPK INSURER WILL CWEAIIGR TO MNL 10 DAYS WRITTEN Town of Worth Andover NOTICETO THE CBRTIRCATE HOLDER AMID TO THE LEFT,BUT FAILURE To DD 50 SHALL Michael Maguire IMPo3ENOOBLIGATe�N Ae �lJ TNEasURER,tTSP40asOR 27 Charles St TTN4Ztti N Andover MA REPRIEWNTA i"t „ A. AUTHORIZED REP John J Wa In Ent Inc. ACORD 25(ZMB M @ACORD CORPORAMM IV86 ZO 'd ££:£t 0002 01 AeN 1SS6SVL8L6:xe3 30NVUSNI HSIVA NNOP IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon. , ACORD 25(2001108{ £0'd ££:£t VOOZ OI Aew LSS6GVL816:Xe3 30NYUnSNI HS1VA Nor MAY-10-2004 1650 CROWN I NSH I ELD MANAGEMENT 9785326023 P.01 ra oft Wff VdA ■ ■ immistsion CROWNINSHIELD MANAGEMENT CORPORATION 18 Crowninshield Street Peabody, MA 01960 Phone: (978) 532-4800 Fax: (978) 532-6023 Al Date: Fax: q � p — �0 -- �'S ;Z, Pias: From: (Including Cover shoot) -C-:K-X�- (-Y-- An Subject: V,� ,GJ COMMENTS: ab IF YOU DO NOT RECEIVE ALL OF THE PAGES OF THIS FACSIMILE TRANSMISSION, PLEASE CALL US MAY-10-2004 16:51 CROWNINSHIELD MANAGEMENT 9785326023 P.02 Village Green West Condominium Ob CM*Whshield Management Corporation 18 Crownlnshie/d Street Peabody,AIA 01960 Tel978-532-4800 Fax 978 ,32-6023 May 10, 2004 Town of North Andover Building Department Attn: Michael McGuire 27 Charles Street North Andover,MA RE: Village Green West—Roof To Whom It May Concern: The Village Green West Board of Trustees authorizes Professional Roofing Compan the roof of 40 Kingston Street,North Andover. y to repair If you should have any questions please call Gaynor Dickenson, 978-532-4800,ext. 214. Th you, Gaynor Dickenson As Agent for Village Green West Condominium Trust TOTAL P.02 FROM :JAMES FAX N0. :9767446814 May. 10 2004 03:46PM P2 Village Green West Condo ' ' m�niums April 5, 2004 Professional Roofing Contractors Inc. P.O. Box 262 45Dearborn Street Salem Massachusetts 01970 Attn: James W.Shea Re: Village Green Condominiums North Andover Mass. Unit#40 Dear James, On behalf of the trustees'I am please to award Professional Roofing Contractors Inc. The work scope as detailed in your proposal dated March 12,2004 pertaining to the above referenced location. Please forward an insurance,certificate of liability and workman compensation in the amount of no less than 1,000,000,000.00 naming Village Green certificate holder to my office and the date you plan to start the work. Thank you, avid Hamel Crownins icid management Corp. As managing agent For Village Green Condominiums NpRTfy 6 Town _ Andover �O _�= 0% LAKE dover, Mass, •S�� 'ay�y COC MICMEWICK ORATE RATED U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT V II..l A.rk,6.........�'�..'.�ereo �O-!4-40........�S.SOC ""' Foundation has permission to erect... ...ir!"p............. buildings on ........YAP.......A4***I.. /04) SAA.. Rough to be occupied as �' r r�� ...:Vif�I �IV.L Y y .............. ...................................... ..... . . . . . .. . . . . . ... ...................................................... Chimney 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 I spection, Alteration and Construction of Buildings in the Town of North Andover. °��le OMP PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ALTS • ........................�......... Rough ......................... C Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises ® Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT • Until Inspected andApproved by the Building Inspector. Burner 41 Street No. SEE REVERSE SIDE Smoke Det. Location AM 0%540 No. _6 7 Date ,*c aT: TOWN OF NORTH ANDOVER i Certificate of Occupancy $ ♦ i �''�s'••° Eta' Building/Frame Permit Fee $ — s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17276 Building Inspector