HomeMy WebLinkAboutMiscellaneous - 480 REA STREET 4/30/2018 (2) / 480 REA STREET
210!038.0-0062-0000.0
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Au:q►fcxrrc N�att�,iC4sUaarscs�
PO Box 1623
Winston-Salem,NC 27102
November 17, 2015
Town of North Andover
Building Inspector's Office
1600 Osgood Street
Building 20, Suite 2035
North Andover MA 01845
Claim Number, 1986198
Date of Loss: 11/14/2015
Insured: Richard F. and Jill P. Romano
Loss Location: 480 Rea Street
Underwriting Company: Integon National Insurance Company
Policy Number: 200325222500
Claim has been made involving loss, damage or destruction of the above-captioned
property, which may either exceed $1000 or cause Massachusetts General Laws, Chapter
143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter
139, Section 313 is appropriate, please direct it to the attention of this writer and include a
reference to the above-captioned insured, location,policy number, date of loss and claim
number.
On this date, I caused copies of this notice to be sent to the persons named above at the
address indicated above by first class mail.
Mcw1v Ch.av�e�v�.t't,�,v
Signature:
Mark Charnenti`r, Property Claim Specialist
314-813-2916
National General Insurance
PO Box 1623
Winston Salem,NC 27102-1623
LaMarche Associates
5 North Road, P.O. Box 250
Chelmsford, MA 01824
800-349-1525
Fax: 978-256-8590
April 3, 2015
Building Commissioner/Inspector of Buildings
NORTH ANDOVER, MA 01845
Board of Health/Board of Selectmen
NORTH ANDOVER, MA 01845
NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139 SECTION 3B
Claim has been made involving loss, damage or destruction of the property captioned below, which
may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be
applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to the attention of the writer and include a reference to the captioned insured,
location, policy number, date of loss, cause of loss and LA file number.
Insured: RICHARD &JILL P ROMANO
Loss Location: 480 REA ST
NORTH ANDOVER, MA 01845
Policy Number: PHD0056254N1301
Date of Loss: 02/15/2015
Cause of Loss: Ice and Snow
LA File Number: MA-2-28540
On this date, I caused copies of this notice to be sent to the persons named above at the addresses
indicated above by first class mail.
John Anderson
Adjuster
LaMarche Associates,Inc.-800-349-1525
Page 1 of 1
�avRvk
NORTH ANDOVER BUMDING DEPARTMENT
�'•$s RAteo , 5 .1600 Osgood Street .
sAcw�S
North Andover
Tel: 978-688-4545
Fax: 978-688-9542
.BUSINESS FOW.,UOR TOWN CLERK
DATE:
.Lll3tY1 : lI V 11 6L V1 V
ADDRESS: u�� .(/���� �). A.AJojexj, ,MA-- 0 I� '
ZONJ.NG DIBTF QCT:
rr e
TYPE OF$USINESS: ymlem S ��e. ( ?,( S �P c.
BUIL DING LAYOUT PROVIDED: YES NO
AVAMARL-R PARKING SPACES:
ZON NCT BY LAW USAGE: YES NO
I3UffiDING INSPECTOR SIGNA—ITHIE
BUSINESS FORM FOX TOWN CLERK
2.40 Horne Occupation(1989132)
An.accessory use conducted within a dwelling by a resident who resides in the, dwelling as his principal
address, which is clearly secondary to the use-of the-building for living piuposes. Home occupations shall
'include,"but not'limited to the following uses; personal services such as furnished by an artist or instructor,
but not occupation involved with motor vehicle repairs, beav4,parlors, animal kennels, or the conduct of
retail business,or the manufacturing o�goods,which impacts the residential nature of the neighborhood
d. For use of a dwelling in any residential district or multi-family district for a home occupation, the
following conditions shall apply.
a. Not more than a total of three (3) people may be employed in the home occupation, one of
whom shall be the:owner of thdhbmo occupation and residing in said diWIling;
b. The use is carried on strictly within.the principal building;
c. There shall be no exterior alterations, accessory buildings, or display which are not customary
with residential buildings; .
d. Not more than twenty-five (25) percent of the existing gross floor area of;the dwelling unit.
so used, not to exceed one thousand (1000) square feet; is devoted to'such use. In
connection with
such use,there is to be kept no stock in trade, commodities or products which occupy space
beyond these limits;
e. There will be no display of goods or wares visible from the street;
£ The building or premises occupied shall not be rendered objectionable or detrimental to the
residential character of the neighborhood due to the exterior appearance, emission of odor,
gas, smoke, dust, noise, disturbance, or in any other way become objectionable or
detrimental to any residential use within the neighborhood;
g. Any such building shall include no features of design not customary in buildings for residential
use.
Signature DatJ
}
The Commonwealth of Afassachusetts
Department o f rndustr ial Accidents
Office of,t'nvestigations
..600 Washington Street
Boston; MM 02111
www.mass-gov/dia
Workers' Compensation Insurance Affidavit. Builders/Contractors/Electricians/Plumbers
ApPlicant Information
Please Print Legibl
Name(Business/orgmizatioadndividual): (, N)
r
Address: � ,-le
el-
City/State/Zip:_ � � `
Phone#:_ C!7kr - 7�t1'..
FAyou an employer?Check the appropriate box:
I am a employer with 4. ❑ I am a F[]
ject(required):
employees(full and/or-part-time).* haVe�neral contractor and Iconstruction
the sub-contractors
2.❑ I am a sole proprietor or partner_ listed on the attached sheet 1 deling
ship and have no employees These subcontractors haveworking for me in any capacity. workers coin lition
[No workers'comp. P insurance.
p insurance 5. ❑ We are a corporation and its 9. ❑Building addition
required] officers have exercised their 10.7 Electrical repairs
I am a homeowner doing all work ri t of ex or additions
(� emption per MGL 11.
myself [No workers' comp. C. 152 I ❑Plumbing repairs or additions
(4),and we have no
insurance required.] t employees. [No workers' 17.0 Roof repairs
COMP.Insurance,required.] 13.11 Other
:=.ny a'Jlimut that.^.hecks box.#I.must 11so BE out the se,.^
'IIomeowu floe rse:ow s^ov^^b their worker's,comY rice.,,s: _
ers who submit this affidavit indicating they ars doing h work and thea hire outs ..ide contractors must submit a Dew affidavit indicating such.
tiom-
'Contractors that ch�k thiss box must attached an additional sheet showing the name of the sub-contractors and their.workers'comp,PoI'
I am an.employer that is providing workers'compensation insurance for my employees. Below is the oli����
information, p cy and job site
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
Failure to secure coverage as required under Section 25A of MGL c. 152 can to the imposition the poT[icy number
bof criminal expiration datea
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORD
penalties of a
of up to $250.00 a da against the violator. Be advised that a co ER and a fine
y g copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do her certifjr un er a pains a penalties ofp
erju?"
perjury th¢t the information provided abovee andcorrect
Stgnatur : _
Date:-��. .
Phone#: — ->C , ,L /.
Official use only. Do not write in this area, to be completed by city or town o ffciaL
City or Town•
1 ermitUcense#
Issumg,Authority(circle one):
1. Board of Health 2.Building,Department 3.Ci /Town p
6. Other t3' Clerk 4.Electrical Inspector 5.PIumbing Inspector
Contact 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 ox-other legal entity,employing employees. However the
owner of a dwelling house having not more than three apart[nL ents and who resides therein,or the occupant of the
dwelling house of another who employs persons to do mainte3nanee,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 colnipliance with the insurance coverage required."
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 unl1 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'comp=sation incirance. 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 stare to sign and date the affidavit. The affidavit should
be mt-arried to the city or town that the application for the pmi�t or frcenge is being requested,not the.Department.of
Industrial Accidents. Should you have any questions regardirLg 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 BE 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 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 burn 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 Cornmonwealth of Massachusetts
Departlnent of Industrial Accidents
Office of k est ipf ms
604 Washington Street
`^r
Boston,MA 02111
Tel. # 617-72.7-4900 east 406 or 1-9 77-MASSAFE
Revised 5-26-05 Fax 4- 617-727 7749
mrvrw.mass..gov/dia.
PE9-4IIT NO. �V
APPLICATION FOR PERMIT TO BUILD - NORTN' ANDOVER, MASS. PAGE 1
MAP 4d0. � I LOT NO. 2 RECORD OF OWNERSHIP I TE BOOK ;PAGE
ZONE 7 SUB DIV. LOT NO. �.� �—I
i
LOCATION PURPOSE OF BUILDING /�f L� K
OWNER'S NAME (7- NO. OF STORIES SIZE �/ Q
OWNER'S ADDRESS /�( `✓C^� BASEMENT OR SLAB !`.
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IIST4JG`•V„�i^2`ND 3RD
BUILDER'S NAME ) I !1 SPAN /
DISTANCE TO NEAREST BUILDING I /�9� DIMENSIONS OF SILLS/
DISTANCE FROM STREET ( POSTS &
DISTANCE FROM LOT LINES-SIDES REAR "' GIRDERS 'L 1
AREA OF LOT -✓g 1454 FRONTAGE HEIGHT OF FOUNDATION (,�.�/ THICKNESS 4 4
IS BUILDING NEW-✓ J�` SIZE OF FOOTING v/��/L!� X ;J, 4 Lam/
IS BUILDING ADDITION `.•J MATERIAL OF CHIMNEY (/,/J,v - �'V
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER ftp C/
BOARD OF APPEALS ACTION. IF ANY `fi
' n.1� IS BUILDING CONNECTED TO TOWN SEWER
/ ��/� IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES •� _ (jd O EST. BLDG. COST
T EST. BLDG. COST PER SQ. FT,
PAGE 1 FILL OUT SECTIONS 1 - 3 V o
PAGE 2 FILL OUT SECTIONS 1 - 12
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
ILDINO INSPECTOR
BIGNAT RE OF OVI&ER OR AUTHORIGENT
F E E OWNER TEL.0
PERMIT GRANTED
S CONTR.TEL.# 62
19 —_�
CONTR.LIC.#
H.I.C.N
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY Ir STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS IRAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE E l 2 13
CONCRETE BL'K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER
_ DRY WALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'TAREA _
'/, 1/2 FIN. ATTIC AREA
NO B M-T FIRE PLACES
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH
ASPHALT SIDING HARD\d'D _
ASBESTOS SIDING _ COMMON _
VERT. SIDING ASPH.TILE
STUCCO ON MASONRY _
STUCCO ON FRAME
BRIC ON MASONRY ATTIC STRS. 8 FLOOR _
BRICK ON FRAME
CONC. OR CINDER ELK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I J POOR _
ADEQUATE 1 NONE
5 ROOF 10 PLUMBING
GABLE HIP BATH (3 FIX.)
GAMBREL MANSARD TOILET RM. 12 FIX.)
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR E GRAVEL STALL SHOWER
ROLL ROOFING MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN. '--�
TIMBER BMS. 3 COLS. STEAM
STEEL BMS. a COLS. HOT W'T'R OR VAPOR /"1
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G5' ^r`�1
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
G
PVC I pcOPPRECAST CO,JC, Tj
W
IN FLO
VP1
.V \ C)
j-, ;;5 Tv,
E2" J, c tijl
000
...........
cop.
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FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: L .terms Phone �e 3�
LOCATION: Assessor' s Map Number J'? Parcel
S,/.
Subdivision -�,/. Lot s � .
Streeter St. Number --
********************* *Official Use Only************************
RECO1iB AT F/T AGENTS:
Date Approved
conservat7ionk. ministrator Date Rejected
Comments
WL0 Date Approved S-Is
Town Planner Date Rejected
Comments J,Q2d Q ('.,fCVM C /1..0-c4oriod Rw&n r- a&jatcs�
Date Approved
Food Inspector-Health Date Rejected
Date Approved
Sep Inspector-Health Date Rejected
Comments
Public Warks - sewer/water connections ( ,J Lt/ S - Z-2 7
- driveway permit 5 -2--97
Fire Department
Received by Building Inspector Date
Growth Management Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
Name of Applicant on Building Permit(below) Address of Property for Permit(below)
Map and Parcel WPurpose of Application (check below)
Phone N tuber lic t: X Single Family ^Two Family
V�V)
I the undersigned applicant for the above property attest that the attached building permit for which this
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party to this permit
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit is issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a building permit for the enlargement,restoration,or reconstruction of a dwelling in
existence as of the effective date of this by-law,provided that no additional residential unit is created.
VThe lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
ylaw.
This application is for dwelling units for low and/or moderate income families or individuals,where all of the
conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents,where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section"senior"shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40%permanent
reduction in density, (buildable lots), below the density, (buildable lots),permitted under zoning and feasible given the
environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently
designated as open space and/or farmland.The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism
approved by the Planning Board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and
commissions have been received and the project is in compliance with those permits),and the Development Schedule
does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per
Development until such time as the Development Schedule accommodates issuing building permits. Applicant must
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building permit is
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply,whether done to my
knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit.
a 7
ignature of Owner w6Authonzed Agent who signed the Attached Building Permit Dote
This form must be attached to the Building Permit upon application for such permit.
E
1 OR
NT�i/
F
Town of _ _ over`
14 _19?;
OC
�0 LAKE s dover, Mass.,
'Q'4_ ."ICME WICK L"r�•
E D" Pa`�
S E BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
' BUILDING INSPECTOR
THIS CERTIFIES THAT .�..�.(�.� ..... .•fif••••••.. . . .C.C.S...... Foundation
has permission to erect....................I................... buildings on ............BO........i\ .............3.. ............... Rough
to be occupied as........................ ..............................,r t l.,. ............le, .r�r... Chimney
provided that the person accepting this permit shall in every respect conform to the rms 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. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PES EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION ST T Rou L
i
.................................. .. ... Service
... .. .. . .. ....... ....... ... ...............
B DING PECTOR Final
! `
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises —- Do Not Remove
Rough
No Lathing or Dry Wall To Be Done FIRE
Until Inspected and Approved by the Building Inspector. DEPARTMENT
Burner
Street No. -
` Smoke Det.
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FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law
regulations or requirements. ,
****************Applicant fills out this section*****************
APPLICANT: yiCa� t � � c- JV Phone r�Z 37d
LOCATION: Assessor' s pMap Number �3 g Parcel _ !�
Subdivision / - �N'. Lot(s) s
Street St. Number
*********************/*�*Official Use Only************************
RECOMME ' AT FiT AGENTS:
Date A t
pproved
Conservation ministrator Date Rejected
Comments t� ?k`C.tlt,��
Date Approved
Town Planner Date Rejected
Comments M '_CC'_1 0 r-n �)EK-P lq
--�---��
Date Approved
Food Inspector-Health Date Rejected
—�•� X� �-� Date Approved
Septic Inspector-Health Date Rejected
Comments
Public Works - sewer/water connections
c lT
- driveway permit
7
Fire DepartmentkT;;—td,- 7
Cc l
Received by Building Inspector Date
05/15/2008 00:12 6273460 KELLY CONSTRUCTION PAGE 01/02
KELLYINCORPORATEDSINCE 197;
CONSTRUCTION CO.,INC. Tao EAST INDUSTRIAL.PARBORIVE
Construction Management•()eslpn/�ullq•General Conalruetton MANCHESTER,NH 0!100
Tbi(807)027420
3•Fax(001927•34/0
. www.kellyeonelructlon.eom
FAX COVER SHEET
Ta. r r C r row n rraml: IGS m
' but r
Fax: Pages: CR
'hone: Date: 5-15-D K
Re: Cc:
❑Utgent [j For. Review []please Comment []Please Reply ❑Please Recycle
Comments:
A5 re�,Lkks+� d ,.. .. -Dave `Deva1 '3 Up<r
CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number 382 Date December 12. 1997
i
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 480 Rea St
MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
���e
CERTIFICATE ISSUED TO wm R u
o�, - t� yes
: •. ' dp 1049 Turnpike St North Andover MA 01845
ADDRESS
• r
• i N
,Ss�CNUS� ilding Inspe o
c10RT
Town of tAndover
No. 3 ° - _ m
* _�_
Zdower, Mass., 19 9
0LAKE
COCNI CNE W�� ICK LY1• _�q�E
SS BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System ��2 /z� �7
BUILDING INSPECTOR
THIS CERTIFIES THAT............... ......%.......L..1..1..Q......................�.Q.�,.�....�.�............[+o.!1!1..e.s................. Foundation
has permission to erect...... ............I................... buildings on ......... ... . '
g -,l . ........... .a....... . ................................
// Rougl�_�
to be occupied as..................................................Sa..A.. -A ........... �...1.. .
. . .. . . Chimney
. . . . ...................................... .
provided that the person accepting 'his permit shall in very respect conform to the rms 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. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough h
7
PERMIT EXPIRES IN 6 MONTHS -
UNLESS CONSTRUCTIONST ELE IAL/INSPECO�
..... .. ......... .... .............................................
LDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
lja Q 7 `
No Lathing or Dry Wail To Be Done 0
Until Inspected and Approved by the Building Inspector. FIR DEPARTMENT
Burner
p �� ca+ ��s� d. Street No.
Smoke Det.
Use crommonwealib of o Permit No.ett Office Use _
2
flcpari int of Public: *aft;tq Occupancy A Fee Clucked-
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 10 peas 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 /,0//
q& or Town of-- NORTH ANDOVER To the Inspector of Wlnei 1.4.
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) yy0 jePG'
Owner or Tenant
Owner's Address
Is this permit in conjunction with a b1uildin permit: Yes f No ❑ (Check Appropriate Box)
Purpose of Building /1. 4� Or�PN T 7 a Utility Authorization No.
Existing Service Amps —Volts Overhead `I rnd Und r—�
g l�_-; No. of Motors
New Service Amps _! Volts Overnead Undgrna C No. of Meters
Number of Feeders ana Ampacity
Location and Nature of Proposed Electrical Work ��G
. yr.
No. of Lighting Outlets I No. of 4ot ',:cs I No. of Transformers Total
KVA
No. of Lighting Fixtures i Swimming Pcoi Above.— In- t— A
1
grn.a. _ grno. I Generators KVA !; •#';
No. of Emergency Lighting,
No. of Receptacle Outlets I No. of Oil Burners Battery Units
No. of Switch Outlets I No. or Gas S:uners FIRE ALARMS No. of Zones
No. of Ranges I No. ct Air Cznc,
Tota, No. of Detection and ;
:cns Initiating Devices
No. Of'Disppsals I No.of Heat :o:ai Total
Purnc;s :ons KVV No. of Sounding Devices
No. of Seif Contained
No. of Oishwasners I SoaceiArea r♦eatira KW pelectionlSounoing Devices
No. of Dryers I Heating Devices KW Local -7. Municipal ^Other �1
Connection
fl
No. of No. :)i Low Voltage
No. of Water Heaters KW ( Signs ?ail'as:s Wiring
No. Hydro Massage Tubs i I No. of Motcrs Totai HP c
OTHER: C
INSURANCE CCVERAGE: Pursuant to the reouirements at massacr users general Laws
I have a current Liability Insurance Policy incluoing Como:eiec Ccerations Coverage or its substantial equivalent. YES
have suomutea valid proof of same to the Office. YES If you nave checketl YES. Qlease indicate the type Of coverage Dy.�' `
checking the appropriate oox. ;
INSURANCE BOND = OTHER = (Please Scec:fvt
- (Excitation Dalai
Estimated Value of Electrical Work S O-C) '
/U rry
/� –
Work to Start � Insoec:ion Date Aacues:ec: Rough Final
Signeo under this Penal ies of perlury�:/ '
FIRM NAME -•S✓ vat, /7/1�// vat, �' f /fI,et - �Ys
UC. NO. jr
Licenaee � y /r////�i�t/O S g^a^ re 1••` UC. h10.ZZ2.2y?
�� / !/GrfX !/
Bus. Til. NAddress
Address —__ O�e Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Lxensee coes not nave the insurance coverage or its substantial equivalent as ro--
quirea by Massacnusetts General taws. and that my signature on :Ns «ermit aopiication waives this requirement. Owner Agent
(Please check oner
Teteonone No. PERMIT FEE S i
• •- (Signature at Owner or Agenn t
_ xdSia �
1216
4, TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
T D
This certifies that e�............................................
.. ........
has permission to perform .... ......................
wiring in the building--of......... ...... ...... .........
-A
at......44*0.... ...................... .North Andover,Mass.
Fee.: ............ Lic.No. .............................................................
ELECTRICAL INSPECTOR
# ,e,17V
10/20/97 12:29 35.00 PAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
(� ;(� Office Use Only r
U41 Cfammunwealth, of _gWriadmPm Permit No.
At.
$epmuirnt of Public *afrtq Occupancy A Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 1 3/90 M""e blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ' "
All work to be performed in accordance with the Massacnusetts Electrical Code, 527 C R 12.-00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 171 >`
or Town of NORTH ANDOVERTo the Inspector of Wiresf Yry
The udersigned applies for a permit t3 perform a electr cal work described below. ;
LJ �..
Location (Street & Number) "of
Owner or Tenant t3 1 V (L /l4cA_
Owner's Address
Is this permit in conjunction with a building pert Ye Yes 7- No C (Check Appropriate Box)
Purpose of Building r�6 L� iR/t1 tL 7( 4 L u ti� Utility Authorization No. 7/—
Existing Service Amps —J Volts Overhead 'l Undgrnd C1 No. of Meters
New Service i)(50 Amps ao/a/U Volts Overhead L_: Uncgrno - No. of Meters
Number of Feeders ana Ampacity ~'! "
Location and Nature of Proposed Electrical Work -&"-)`i 4-cc r"✓G
No. of Lighting Outlets I No. of Hot ':cs I No. of Transformers Total
KVA
No. of Lighting Fixturesi Swimming P^oi Abcve.— In-
Swimming _ grna. I Generators KVA
No. of Emergency Lil hong, ! .
No. of Receoiacie Outlets I No. of Oil Eurners I Battery Units
�..
No. at Switch Outlets No. of Gas Surr.ers FIRE ALARMS No. of Zones
No. of Ranges I No. cf Air Ccrc. 'ota' No. of Detection and ;
;chs Initiating Devices
Nd. of Disbos813 I No.of Heat To:ai Totai
Pur:cs :ons KW No. of Sounding Devices `
No. of Sett Contained
No. of Dishwashers I SoacerArea Heatirg K�b Detection/Sounding Devices
No. of Dryers I Heating Oevices KW Local i,� Muntcioai —Other
Connection � "
No. of - No )t Low Voltage
No. of Water Heaters KW I Signs ?a lass Wiring
No. Hydro Massage Tubs i I No. of Motcrs Total HP rl
OTHER:
INSURANCE COVERAGE. Pursuant to the reauirements of massacci-sers yenerai Laws
I have a current Liaoility Insurance Policy inducing Ccmc:eiec Ocerations Coverage or its substantial equivalent. YES .'=-NO
have suominso valid proof of same to the Office. YES v0 = if you nave checked YES, please inaicate the type of coverage oy.t'
checking the aoproonate oox.
INSURANCE 'L!-- BOND = OTHER = (Please Scec:�.,)
(Excitation oatel
Estimateo Value of E!ectncal Work S
Work to Start Inaoec;ion Date Aacues:ec: Rough Final .
Signed under the Penalties of perjury: _
FIRM NAME (�!GA UC. NO.
C� �7�--
r� t"
Signa
Licensee :ure UC. NO.
Address I t wf G f l I Ul f �� �( �G d ue V Bus. Tet. No.
s Alt. Tef. No. 2 11.
OWNER'S INSURANCE WAIVER: I am aware that the t_:censee Goes not nave the insurance coverage or its substantial equivalent as re•
auirso by Massacnusetts General Laws, ana that my signature an ;hta permit aopiication waitves this regWrement. Owner Agent
(Please chem onel-
,M
Teteonone No. PERMIT FEE S '}'
- (Signature of Owner or Agentl
_. iidS861' �i
.._ � .-...-._.- _ .� ..�-.......T3 ./,gypp
Date....4q.Al
19.99
f NOR7M 1
TOWN OF NORTH ANDOVER A
PERMIT FOR WIRING
,SSACMUS�
This certifies that .... .Wame1 ,�....V........ v. !e �....... .{e.r......
has permission to perform i 0
wiring in the building of...C QA 0.".$..0J......U.!. a ...........v !..............
0
at
..M..�o.......!(...fc: .... ....
..... ............................ .North Andover,Mass. o
Fie.3 �.� ... Lic.No.-Aw-—,r..............................................................
ELECTRICAL
INSPECTOR
c'Cct if t t �
WHITE:Applicant C31NARY: Building Dept. PINK:Treasurer
I
Commonwealth of Massachusetts
City/Town of NO. ANDOVER
System Pumping Record
Form 4
�M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
Important:
When filling out 1. System Location:
forms on the
computer,use 480 REA ST.
only the tab key Address
to move your NO. ANDOVER MA 01845
cursor-do not City/Town
use the return State Zip Code
key. 2 System Owner:
JILL ROMANO
Name
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping 12/21/07 1500
p g Date 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) �ptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes P/No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Benjamin Shute H79 406
Name Vehicle License Number
J's Septic& Drain
Company
7. Location where contents were disposed:
GL4ature
12/21/07
Hauler Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1