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Home My WebLink AboutMiscellaneous - 42 ROYAL CREST DRIVE 4/30/2018 (4) i I I i I LO .a RTI{ ao #6 q~O ? y+ 6 p L y Town of North Andover D.B.A. —Zoning Compliance Form °? .-AA2 s 978-688-9545 �SSACHUS�� This form must be reviewed with the Inspector of Buildings. Office Hours are Monday-Friday 8-10 am,and 1-2 pm Monday-Thursday. Applicant Name: �l'l � f l� Name of Business: Aa lav S Address of Business: U04 Zoning District Map 2� Lot X13-53 $ L ` Phone' �`-� � Email 0., Nature of Business: �6, Do you own this property? Yes No If no, written permission is required from your landlord. Will you have clients coming to this property? Yes No _ Will you have any employees? Yes No Will you have anymajor deliveries? Yes No Description of Business Activity(Must be Completed) 'jam � &M t S�rvi�,. LA)Of k O- If w� 3 Co l Signature of Applicant __aM For Signage Refer to North Andover Zoning Bylaw Section 6 The proposed u e is an all wed use in this zoning district.' Date �� /00'17 Issued By k,OYAL CkE'ST Amy Petit Manley Petit 42 Royal Crest Drive Apt 3 North Andover, MA 01845 RE; Event and Wedding Planning Business To Whom It May Concern, Please accept this letter as verification that the above mentioned residents who reside here at Royal Crest do have permission to run a home based business from their apartment. This business does not require the residents to have extra traffic enter our premises, client visits or to have product stored in her home. If you require additional information please do not hesitate to contact me direct at 978.682.7200. Res�� -4-� Milissa Titus-Fox Community Manager 42 ROYAL CREST DRIVE-Apartment#3 Complaint Detail Report Printed On:Tue Jan 14,2014 Complaint#: CT-2014-000033 Status: Closed GIS#: Violator: Royal Crest Estates so, Address: 42 ROYAL CREST DRIVE-Apartment 93 Map: Address: 50 Royal Crest Drive `�` `F<• Date Recvd.: Dec-16-2013 Time Recyd.: 02:20 PM Block: NORTH ANDOVER,MA 018 Category: Housing Lot: Type: Commercial GeoTMS Module: 113oard of Health District: Trade: food Recorded B jLisa Blackburn Zoning: Structure: Description Complaint: Kristen Burnes 978.995.5925 called regarding a complaint of mold and chipping ceiling paint.She is at Bldg 42 Apt.3 Royal Crest.Michele Grant will do an inspection on 12/17/13 at 10:30. Comments: Inspector Assigned to Complaint: Contacts Contact Type Date Time Name Phone Best Time To Reach Recorded By Response Tenant Dec-16-2013 2:20 PM Kristen Burnes (978)995-5925 Q Lisa Blackburn Forwarded to Health Inspector Actions Taken GeoTMS Module Status Date Time Response Type Action Taken Comments Board of Health REFERRAL Jan-14-2014 3:08 PM Follow-Up by Re-inspection done.All Michele Grant violations were fixed. Certificate of compliance was issued.Case closed. Dec-20-2013 8:44 AM Follow-Up by Inspection was done on Michele Grant 12/20 and an order letter was written to Royal Crest management.The tenant requested that the work be postponed until after the Christmas holiday.Work will begin on 12/30 and be completed by 1/2/1.4.Royal Crest will notify the Health Dept.when work is completed.Case closed. GeoTMS®2014 Des Lauriers Municipal Solutions, Inc. Page 1 oft 42 ROYAL CREST DRIVE-Apartment#3 Complaint Detail Report Printed On:Tue Jan 14,2014 Dec-17-2013 10:30 AM Follow-Up by Michele Grant did an Michele Grant inspection of the apartment. An order letter will be written and sent out to Royal Crest Management,AIMCO and the tenant. GeoTMS®2014 Des Lauriers Municipal Solutions, Inc. Page 2 of i s T"MEW1 • Letter of Compliance DATE: January 14,2014 TO OWNER OF RECORD PROPERTY LOCATION Royal Crest Estates Kristen Burnes 50 Royal Crest Drive 42 Royal Crest Drive,Apt:3 North Andover,MA 01845 North Andover,MA. 01845 A Health Department ORDER LETTER dated December 17,2013 was issued to you as owner of record of the property listed above citing violations of the State Sanitary Code,105 CMR 410.000,Minimum Standards of Fitness for Human Habitation. A re-inspection of the property has found that all of the violations noted on the Order Letter have been corrected. The Health Department would like to thank you for your cooperation. lgrely, ichele E. Grant Public Health Inspector Xc: File Cc: Tenant-Kristin Burnes BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 S TMID, ■ Letter of Compliance DATE: January 14,2014 TO OWNER OF RECORD PROPERTY LOCATION Royal Crest Estates Kristen Burnes 50 Royal Crest Drive 42 Royal Crest Drive,Apt:3 North Andover,MA 01845 North Andover,MA. 01845 A Health Department ORDER LETTER dated December 17,2013 was issued to you as owner of record of the property listed above citing violations of the State Sanitary Code,105 CMR 410.000,Minimum Standards of Fitness for Human Habitation. A re-inspection of the property has found that all of the violations noted on the Order Letter have been corrected. The Health Department would like to thank you for your cooperation. t c rely, Ghele 1EGrant Public Health Inspector Xc: File Cc: Tenant-Kristin Burnes BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 f+ • Town of North Andover CORRECTION O R D E R for HOUSING INSPECTION Issued under the provisions of The State Sanitary Code, Chapter H,Minimum Standards of Fitness for Human Habitation 105 CMR 410.00 Date: December 17, 2013 To: Owner/Agent of Record: Property Location: Royal Crest Estates Kristin Burnes 50 Royal Crest Drive 42 Royal Crest Drive Apt 3 North Andover, MA. 01845 North Andover, MA. 01845 An authorized inspection was made of your property at the above address on December 17, 2013. This inspection revealed violations of the State Sanitary code, Chapter II, as listed below. Owner must repair within seven days or contact a contractor for work. Proof of contract to be completed within 30 days must be submitted. Failure to act will result in further action. 105 CMR 410.... Bedrooms, Regulation Description ✓if conditions Time limit for # may endanger or impair health, compliance safety or well- being 410.353 Master Bedroom ceiling has many areas that are chipping and have broken away YES '?"0) from the ceiling. Asbestos is friable and of a dust material Every owner shall maintain all asbestos material in good repair, and free from any defects including ,but not limited to, holes, cracks, tears and or looseness which may allow the release of asbestos dust, or any powered, crumbled or pulverized asbestos material. Every owner shall correct any violation of 105 CMR 410.353 in accordance with the regulations of the Department of Environmental Protection appearing at 310 CMR 7.00 and in accordance with the regulations of the Department of Labor and Workforce Development appearing at 453 CMR 6.00. � '•is � S�{tGEnY� Remediate, Hire a licensed company to remediate entire master and second bedroom ceiling. Submit all paperwork. You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations,may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you,in writing,and filed within seven days after the day this order was served. If you request a hearing,all affected parties will be informed of the date,time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary language by greater than I%of the community's population, include"This is an important legal document. It may affect your rights. You should have it trgnslated.11 4L � M1heleant Cc:AIMCO-Corp Kristin Burnes Susan Sawyer,Director File I • S�.TStiEDl� . Town of North Andover CORRECTION O R D E R for HOUSING INSPECTION Issued under the provisions of The State Sanitary Code,Chapter H,Minimum Standards of Fitness for Human Habitation 105 CMR 410.00 Date: December 17, 2013 To: Owner/Agent of Record: Property Location: Royal Crest Estates Kristin Burnes 50 Royal Crest Drive 42 Royal Crest Drive Apt 3 North Andover,MA. 01845 North Andover, MA. 01845 An authorized inspection was made of your property at the above address on December 17, 2013. This inspection revealed violations of the State Sanitary code, Chapter II, as listed below. Owner must repair within seven days or contact a contractor for work. Proof of contract to be completed within 30 days must be submitted. Failure to act will result in further action. 105 CMR 410.... Bedrooms, RegulationDescription if conditions Time limit for may endanger or # impair health, compliance safety or well- being 410.353 Master Bedroom ceiling has many areas that are chipping and have broken away YES from the ceiling. Asbestos is friable and of a dust material Every owner shall maintain all asbestos material in good repair, and free from any defects including ,but not limited to, holes, cracks, tears and or looseness which may allow the release of asbestos dust, or any powered, crumbled or pulverized asbestos material. Every owner shall correct any violation of 105 CMR 410.353 in accordance with the regulations of the Department of Environmental Protection appearing at 310 CMR 7.00 and in accordance with the regulations of the Department of Labor and Workforce Development appearing at 453 CMR 6.00. • S�StED"tea • .7 Remediate, Hire a licensed company to remediate entire master and second bedroom ceiling. Submit all paperwork. You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations,may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing,and filed within seven days after the day this order was served. If you request a hearing,all affected parties will be informed of the date,time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary language by greater than 1%of the community's population,include"This is an important legal document. It may affect your rights. You should have it tr slated." tr slate ."M1 bele Grant Cc:AIMCO-Corp Kristin Burnes Susan Sawyer,Director File C�yA� CREST ,r January 3,2014 RECEIVED i Michele GrantLU v�y Public Health Inspector T,QN& fffIA v� Town of North Andover Ham_,,,.;,WRTMENT • Office of the health Department 1600 Osgood Street 10 North Andover, MA 01845 00 Iq RE: Order dated December 17th 2013 regarding Unit 42 Royal Crest Drive#3. Dear M:icttele, This letter is to inform you that the work related to your order referenced above has been completed by .o our vendors and is ready for inspection by the Town of North Andover Health Department. - .. 01 • Concern Description: o Master Bedroom ceiling has many areas that are chipping and have broken away from the ceiling. Asbestos is friable and of a dust material. LO co • o Work Regueste(t;�_^� o Remediate.Hire a licensed company to.-remediate entire-masterand second LU edroom ceiling. Submit all paperwork..' • -- --. _ -e__�___ _ _ Action 'Taken: •:� Resident was moved into on site guest suite on Sunday, December 29th. ❖ On Monday, December 30th, a licensed remediation contractor(Golden Gate.Se_--ices.Inc..of 4d' Warren St, 3rd Fl, Charlestown,_MA 02129)removed all ceiling texture from both bedrooms. LU •.� On`TEesday, December 31St, Golden-Gate-Services-applied new ceiling-texture_and paint to Cbotli bedroom ceilirigs� ❖ On-Thursday;-January2°`- Royal Crest Maintenance completed additional work related to the replacement of a uathrooin iiglit iix-Lare, baf oom repainting, &Z-Wallpatch rt7pA—.s-,<T �ste.. by the resident._/- -� ❖ On Thursday, January 2nd work requested in order referenced above was inspected by the Community Manager Bryan Nicholas and Service Manager Tony Russo. • We kindly request you re-inspect the apartment to verify the above referenced work has been LU • completed. Golden_Gate Services intends to forward all applicable documentation needed by the City and State early next week for your records. Please contact me if you have any additional concerns or questions. LU i - Best Tegards, LU LU af [fr Nicholas mmunity Manager 978-682-7200 • Q Purchase Order Dispatch via Print 042391 Royal Crest Estates (North And Purchase 2A 0000024795 12te 7 2013 Revision Page Payment Terms Freight Terms Currency Ship Via Due Immed Destination USD COMMON Buyer Phone Fax Vendor: 0000406111 ANTHONY RUSSO 978-682-7200 978-682-9064 GOLDEN GATE SERVICE INC Email 74 SPRINGVALE AVE#8 ANTHONY.RUSSO@aimco.com CHELSEA MA 02150 Ship To: 042391 Royal Crest Estates(North And 50 Royal Crest Drive North Andover MA 01845 Requisition Name 42-003 GOLDEN GATE DELAM Bill To: AIMCO PO Box 981725 EI Paso TX 79998-1725 Line-3ch Item/Description GL Account Mfg ID Quantity UOM PO Price Extended Amt Due Date 1- 1 42-003 GOLDEN GATE 101320 1.00EA 4,200.00 4,200.00 12/16/2013 ACM REMEDIATION 300 SQFT Schedule Total 4,200.00 Item Total 4,200.00 2- 1 42-003 GOLDEN GATE 101320 1.00EA 1,250.00 1,250.00 12/16/2013 POPCORN PUT BACK 300 SQFT Schedule Total 1,250.00 Item Total 1,250.00 Total PO Amount 5,45 Comments: Purchase Order 12A-0000824795 All invoices related to this Purchase Order must include the PO number,and line items must match in terms of unit price and quantity.Failure to provide required information on invoices or invoices that do not match the PO will delay payment. Vendor shall supply the Products/Services to Buyer in accordance with the terms of this Purchase Order,including the Terms and Conditions accompanying this Purchase Order(or,if not accompanying this Purchase Order,found at www.aimco.com/vendorterms).The Terms and Conditions are part of this Purchase Order. In addition to the covenants,representations and warranties of Vendor under the Terms and Conditions to this Purchase Order,by acceptance of this Purchase Order Vendor agrees that(a)it shall not assign or subcontract any of its rights or obligations under this Purchase Order,including,without limitation,its right to receive payment from Buyer,and (b)it shall indemnify and hold harmless Buyer and its parents,subsidiaries and affiliates(including,but not limited to,AIMCO)from and against any and all claims,liabilities,damages,losses,costs and expenses(including,but not limited to,reasonable attorneys'fees)arising out of its violation of part(a)of this sentence. i 4M � 14„x. : :._ ►��R�I�r�' aSs I1VEC� 40 Warren st 3rd floor Charlestown MA 02129 Fax 781-605-1017 Cell 781-962-99801 Sidnei Eleoterio December 09,2013 Attention: Tony Rusoo Royal Crest Esates North Andover Ma 01845 ACM Proposal *De-lam Bolth bedroom texture ceiling about 300sf $4,200,00 *Put back Prime and retexture $1,250,00 Total $5,450,00 Thank you for letting us present this proposal to you. If you have any questions,please Let me know Sincerely, Sidnei Eleoterio CELL#781-962-9801 FAX# 781-605-1017 Golden Gates Services Inc. • uj - CIkEST ROYAL 0 RECEIVED Monday, December 23, 2013 DEC 3 C 2013 TOWN OF NORTH ANDOVER • Michele Grant HEALTH DEPARTMENT North Andover Board of Health 1600 Osgood Street; Suite 2035 North Andover, MA 01845 00 .: Good Morning, ° I received your Correction Order on December 20th, 2013 regarding required repairs needed,to #42-003 Royal Crest Drive, North Andover, Ma. 01845. 00 Iq The contractor was prepared to complete the work by Saturday, December co C>I 21 st, 2013. The resident requested postponement of work until after the Christmas Holiday. We have rescheduled with the contractor for Monday, December 30th to begin the Abatement work to both Bedroom ceilings. The •O work is scheduled to be completed by Thursday, January 2nd, 2014. All paper work submitted by the contractor will be forwarded to you as soon as the work is completed. LU• Should you have any further questions, please feel free to contact myself or Bryan Nicholas, Community Manager @ (978) 682-7200. LU Sincerely, LU • .Anthony C. Russo • Service Manager Royal Crest Estates LULAJ LU LU • 9 Q I I j Town of North Andover CORRECTION O R D E R for HOUSING INSPECTION Issued under the provisions of j The State Sanitary Code,Chapter H,Minimum Standards of Fitness for Human Habitation 105 CMR 410.00 Date: December 17, 2013 To: Owner/Agent of Record: Property Location: Royal Crest Estates Kristin Burnes 50 Royal Crest Drive 42 Royal Crest Drive Apt 3 North Andover,MA. 01845 North Andover,MA. 01845 j An authorized inspection was made of your property at the above address on December 17, 2013. This inspection revealed violations of the State Sanitary code,Chapter II, as listed below. f Owner must repair within seven days or contact a contractor for work. Proof of contract to be completed within 30 days must be submitted.Failure to act will result in further action. 105 CMR 410.... Bedrooms Regulation Description ✓if conditions Time limit for may endanger or # impair health, compliance safety or well- being 410.353 Master Bedroom ceiling has many areas that are chipping and have broken away YES from the ceiling. Asbestos is friable and of a dust material i i Every owner shall maintain all asbestos material in good repair, and free from any defects including ,but not limited to,holes, cracks, tears and or looseness which may allow the release of asbestos dust, or any powered, crumbled or pulverized asbestos material. Every owner shall correct any violation of 105 CMR 410.353 in accordance with the regulations of the Department of Environmental Protection appearing at 310 CMR 7.00 and in accordance with the regulations of the Department of Labor and Workforce Development appearing at 453 CMR 6.00. j I s P . a' I 1 I I tS Remediate, Hire a licensed company to F remediate entire master and second bedroom ceiling. Submit all paperwork. i i i You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations,may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you,in writing,and filed within seven days after the day this order was served. If you request a hearing,all affected parties will be informed of the date,time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary language by greater than I%of the community's population,include"This is an important legal document. It may affect your rights. You should have it translated." i I 4Mi41hiele4Grant Cc:AIMCO-Corp Kristin Burnes Susan Sawyer,Director File 'i i 42 ROYAL CREST DRIVE-Apartment#3 Complaint Detail Report Printed On:Mon Dec 16,2013 Complaint#:- CT-2014-000033 Status: In discovery GIS#: Violator: Royal Crest Estates Address: 42 ROYAL CREST DRIVE-Apartment#3 Map: Address: 50 Royal Crest Drive Date Recvd.: Dec-16-2013 Time Recvd.: 02:20 PM Block: NORTH ANDOVER,MA 018 Category: Housing Lot: Type: Commercial GeoTMS Module: Board of Health District: Trade: food Recorded By: Lisa Blackburn Zoning:. Structure: Description. Complaint: Kristen Burnes 978.995.5925 called regarding a complaint of mold and chipping ceiling paint.She is at Bldg 42 Apt.3 Royal Crest.Michele Grant will do an inspection on 12/17/13 at 10:30. ' Comments: Inspector Assigned to Complaint:11 Contacts Contact Type Date Time Name Phone Best Time To Reach Recorded By Response Tenant Dec-16-2013 .2:20 PM Kristen Burnes (978)995-5925 0 Lisa Blackburn Forwarded to Health Inspector Actions Taken GeoTMS Module Status Date Time Response Type Action Taken Comments Board of Health REFERRAL GeoTMSG 2013 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 1� NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report OWNER ADDRESS DATE I r\ A iA 4-t 9 �=�- ,n s a.Laa,-, i-kto Va A )"a-- Rev.6/04 I NSPE 41 WOAL CREST DRIVE-Apartment#3 Complaint Detail Report Printed On:Tue Dec 31,2013 Complaint#: CT-2014-000033 Status: IClosed GIS#: Violator: Royal Crest Estates 4wrrr�nrs Address: 42 ROYAL CREST DRIVE-Apartment#3 Map: Address: 50 Royal Crest Drive . t• Date Recvd.: Dec-16-2013 Time Recvd.: 02:20 PM Block: NORTH ANDOVER,MA 018 Category: Housing Lot: Type: Commercial GeoTMS Module: Board of Health District:I Trade: food Recorded By: Lisa Blackburn Zoning: I Structure: Description Complaint: Kristen Burnes 978.995.5925 called regarding a complaint of mold and chipping ceiling paint.She is at Bldg 42 Apt.3 Royal Crest.Michele Grant will do an inspection_on 12/17/13 at 10:30. Comments: Inspector Assigned to Complaint: Contacts Contact Type Date Time Name Phone Best Time To Reach Recorded By Response Tenant Dec-16-2013 2:20 PM Kristen Bumes (978)995-5925 Q Lisa Blackburn Forwarded to Health Inspector Actions Taken GeoTMS Module Status Date Time Response Type Action Taken Comments Board of Health REFERRAL Dec-20-2013 8:44 AM Follow-Up by Inspection was done on Michele Grant 12/20 and an order letter was written to Royal Crest management.The tenant requested that the work be postponed until after the Christmas holiday.Work will begin on 12/30 and be completed by 1/2/14.Royal Crest will notify the Health Dept.when work is completed.Case closed. Dec-17-2013 10:30 AM Follow-Up by Michele Grant did an Michele Grant inspection of the apartment. An order letter will be written and sent out to Royal Crest Management,AIMCO and the tenant. GeoTMSO 2013 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 • ESQ`C LU ROYA N-I� rREICEIVED Monday, December 23, 2013 3 r4 2013 LU i.O,Wil OF nIC e i 1 ANDOVER Michele Grant HEALTH=EP"�RT'�''Fv r North Andover Board of Health 1600 Osgood Street; Suite 2035 10 North Andover, MA 01845 co co Good Morning, • I received your Correction Order on December 20th, 2013 regarding required repairs needed to #42-003 Royal Crest Drive, North Andover, Ma. 01845. The contractor was prepared to complete the work by Saturday, December co 21St, 2013. The resident requested postponement of work until after the • Christmas Holiday. We have rescheduled with the contractor for Monday, LO December 30th to begin the Abatement work to both Bedroom ceilings. The •o work is scheduled to be completed by Thursday, January 2nd, 2014. All paper work submitted by the contractor will be forwarded to you as soon as the work is completed. Uj Should you have any further questions, please feel free to contact myself or Bryan Nicholas, Community Manager @ (978) 682-7200. N • LU Sincerely, f Anthony C. Russo LO Service Manager Y Royal Crest Estates LU • LU LU LU • • Date. �r� 14, TOWN OF NORTH ANDOVER 3? ��.� -'•..'. of ° PERMIT FOR PLUMBING SSACMUS� h �4 Tfris certifies thatt. . . .. -«- rte -✓. . . . .C. . . . has permission to perform . . �.j. . . . . . . . . . . /C�ZV plumbing in the buildings of. ./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . �.�. . . . , . . .'. . . . . , North Andover, Mass. Fee. . . L4c. No��. . . .�. . . .,.-./. . . . . �) —P L M8k INSPECTOR Check # V 1J 5733 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) r NORTH ANDOVER,MASSACHUSETTS Date Building Location wners Name Permit#_ 6-n:j / Amount G3,5`y 7�,�1 �ST �a&.1 A cj �s' Type of Occupancy e e r eX c� i u.i'� �{�-—0? New Renovation Replacement Plans Submitted Yes No FIXTURES zrA � a H W a a. H F ox w a A 0-4 a a x SLRH?YE B4S94M ]S)C)F IM zr Rfm 3Mffimt 4MIOCR 5MFUM sffl H,oQt 7M>ZfM siH>Fioat (Print,or type) `/ ,�i Check one: Certificate Installing Company Name.4k� 4a,'cat 7)A: ct c ❑ Corp. Address Partner. AJJ4 Q ' Business Te ephone V14irm/Co. f T� Name of Licensed Plumber: Insurance Coverage: Indi t type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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 s la 'tted ered)in above application are true and accurate to the best of my knowledge and that all plumbing work and i 1 p rmed un r t Issued for this application will be in compliance with all pertinent provisions of Mass us to od an Chapter 142 of the General Laws. By: gnature-w Licensea Plumber, Type of Plumbing License Title d City/Townkcem er Master Joumeym APPROVED(OFFICE USE ONLY Date. �`� '� NORT1� s °ttr``°:•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSE� This certifies that f .G ...... .,. ....................... ................. has permission to perform -'��-�^^-� "� .........,. .................. .. r wiring in the building of....... � .�..... :� ................................. at ya... 3........ .................... .North Andover,Mass. Fee. !............. LIc.No !(Jsd-' C / _, .......................... ._ELECTRICAL INSPECTOR Check # 4739 THECOMMONWEALTHOFMASS4CHUSE77S Office Use only DEPART1lfVTOFPUBUCS9FElY APermit No. z1 7c3/ BOARDOFFMPREVEMONRWULUTONS527CMR12M Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of WireE The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 5�0 Y)-Y\, L)e Owner or Tenant _ �,*7 C. Owner's Address Y\ Is this permit in conjunction with a building permit: Yes No E3 (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service AmpsVolts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No.of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work W177 fi 7 170 U 7770-7 C7 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• s kardnceCovrrage.R=aflttOdICOWkMentSOfMaMdUSeUSCtmalLam IhavuaamentLialn7ityltnaunoePolicyinchxlTCompletewegrialt YES NO na1:3 Iha,&subrnbAvandptuofofsametoft0ffim YES rT EyouhawdrdodYFS pic?&rldcatethetypeofcowrageby cl>ec3dT diebox INSURANCn BOND MIER F1 Specify) EvirAmDale Estimated Value ofElec1ncal Wolk$ 2 Q U, d WodctoStatt C1 " 22, >iTectio1D&RW,*d Ru# Feral Signed undArF'bnalties I �� a \ C YOF3'2—5- FIRMNAME IioerlseNo. Iica�see C a Signalm OX` �'t r"l Cft 5 LiwwNo 4 7 Z s� BusinmTel.No. C,0r3^2 3Y^Zq/</ Arkhtcc AltTUNo. 43^L�75 OWNII SINSURANCEWAIVFP Iamawale theIio wdoesnothavethemarmxcovwageoritssub mtolequivalentast2rntredbyMa%achuseasGerlaralLaws an dArnysignahneonlhispelrmtapplicalion thistegtlilerrt�lt (Please check one) Owner Agent Telephone No. PERMIT FEE$ signature o - wner or Agent w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 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 I am an employer providing workers'compensation for my employees working on this job. Company name: Address Cid Phone#. Insurance.Co. Policv# Company name: S Address City Phone#: r Insurance Co. Policv# 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 well_as.ch4l.penaltiesinlhelnmo-fa-STOP WORK ORDERAnd_afore-&.($1D0-00)a-day.against ms. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pains and penalties of pedury that the information provided above is true and correct Signature Date Print name Phone.# ' Official use only do not write in this area to be completed by city or town official' .1 City or Town Permit/Licensinci El Building Dept []Check if immediate response is required - .0 Licensing Boafd F1 Selectman's Offcs Contact person: Phone A ❑ Health Departmen Other