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Miscellaneous - 50 JAY ROAD 4/30/2018
50JAYROAD - 210/098.A-0059-0000.0 North Andover Board of Assessors Public Access {, r Page 1 of 1 NOR*a North Andover Board of Assessors of •�ao,.�•yo F � 9 'SSwC Ll - roperty Record Card Click Seal To Return Parcel ID :210/098.A-0059-0000.0 FY:2012 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales Summary Residence Detached Structures. y: ' Condo 50 JAY ROAD Commercial Location: 50 JAY ROAD Owner Name: MARCUS,ALLAN M. MARCUS,LORI Owner Address: 50 JAY ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:6-6 Land Area: 1.12 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1878 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 383,900 383,900 Building Value: 176,100 176,100 Land Value: 207,800 207,800 Market Land Value: 207,800 Chapter Land Value: LATEST SALE Sale Price: 1 Sale 02/21/2002 Date: Arms Length Sale F-NO-CONVNIENT Grantor: ALLAN M. Code: MARCUS Cert Doc: Book: 06681 Page: 0119 http://csc-ma.us/PROPAPP/display.do?linkld=1893797&town=NandoverPubAcc 7/16/2012 Residential Property Record Card PARCEL ID:210/098.A-0059-0000.0 MAP:098.A BLOCK:0059 LOT:0000.0 PARCEL ADDRESS:50 JAY ROAD FY:2012 PARCEL INFORMATION Use-Code: 101- Sale Price: 1 Book. 06681 m Road Type: TY m Inspect'Date: 04/30/2008 Tax Class: T Sale Date: 02/21/02 Page: 0119 Rd Condition: P Meas Date: 04/30/2008 Owner: — _ --_ MARCUS,ALLAN M. Tot Fin Area: - 1878 sai6 Type P '- Cert/Doc 'Traf i M Entrance X ' _�.: _F_ MARCUS,LORI Tot Land Area: 1 12 Sale Valid F------- - � � Water � � �'�Collect ld � RRC____ - - - - _ !'�` Grantor ALLAN M MARCUS Sewer. `Ins ect`Reas Address: _ p 50 JAY ROAD Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/° Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CP Tot Rooms: 6 Main Fn Area:_ 1157 Attic: a NBHD CODE: 6 NBHD CLASS: 6 ZONE: R3 Story Height: 1.75 Bedrooms: 3 Up Fn Area: 721 Bsmt Area 962 Segs Type Code .Meth_o_d Sq-Ft Acres I M -YM LL Value Class Roofm` G' FuII-Baths: 2 Add Fn Area: Fn Bsmt Area: 481 1 P 101 S� 43560 1 000 206,910 _ 2 R 101 A 0 0.120 912 ExtWall: 'FB Half Baths: � ._, Urifin Area: _6smt Grade:v Masonry Trim _ Ext'Bath Fix. ---0 Tot Fin Area `1878 -— ,. .-' Foundation: CN Bath Qua1 T RCNLD 169927 DETACHED STRUCTURE INFORMATION -y..� , 6 u _.�,,._. _ _-. _ Str Unit Msr 1 Msr 2 E-YR-Blt Grade Cond%Good P/F/E/R Cost Class Kitch'Qual: T�``Eff Yr Built: 1975"�Mkt Adj:; ��� �..f,_,-. m. a _ SEi"S_160 _0.00 ..2002 _._G...- _///96 . ..._.� 3,500 M_.. Heat Type HW ExtKitch. Year Built: 1971 " Sound Value: 1 PA S 24 0.00 2002 A A ///96 500 -__ Fuel Type: - G -' Grade. A _Cost Bldg 1.69',900't DW S 112 0.00 2002 A A ///96 2,200 Fireplace: � 1"' Bsmt Gar Cap: Condition: —�A � Atf Str Val1: Central AC N Bsmt G6FSSr:' Pct Complete: Att Str Val2: VALUATION INFORMATION Aft Gar'SF:_ -572%Good�P/F/E/W'__ /100/100/78'__ Current Total: 383,900 Bldg: 176,100 Land: 207,800 MktLnd: 207,800 Porch Type Porch Area Porch Grade Factor Prior Total: 383,900 Bldg: 176,100 Land: 207,800 MktLnd: 207,800 P 60 - - S 160 T 224 W 384 1 Parcel ID:210/098.A-0059-0000.0 as of 7/16/12 Page 1 of 2 "Nr Date......f .... OF,,AORT#1 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CHU This certifies that ....... +..tom ......................... has permission to perform ....... ........ ................................................... wiring in the building of............ .................................................................................................. at ...................�j........... . .....I North/findover,Mass. Fee.... .............Lic. ................ ........... ELECTRICAL INSPECTOR Check# 13017-/ Commonwealth of Massachusetts Official Use Only YJ Department of Fire Services Permit No. OccupBOARD OF FIRE PREVENTION REGULATIONS [Rev.O] (leand eeve bllankank)Checked (lea APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(IvIEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL) FORMATION) Date: /�� City or Town of: NORTH ANDOVER To the Iepec r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) s-© j-�f Y A/.1 Owner or Tenant �ni� �tiGtrS Telephone No. Owner's Address $,0,-Z4 car Is this permit in conjunction with a building permit? Yes �No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 4 :p t Completion of thefollowing table may be waived by the Inspector of Wires. i No.of Recessed Luminaires No.of Ceil.-Sus addle Fans No.of Total P ) Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 51 Swimming Pool Above ❑ In- F1 o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets 7No.of Oil Burners FIRE ALARMS I No. of Zones No.of SwitchesNo.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons "KW No.of Self-Contained Totals: ""' """"'"" """....'"'"' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:'' No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eq uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of 97res. Estimated Value of Electrical Work: YO-A e0 (When required by municipal policy.) Work to Start: 61 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCEOCO - GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The p undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. Q CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I"certify, under the pains and penalties ofperjury,that the information on this application is true anti complete. FIRM NAME: " i'/���D aJ �clGj`/Lt'ji ti�i C.NO.: X3 mei Licensee: f,A,,7-1,jy /,I Signature MC.NO.: (Ifdadpplicable,enter "exempt"in the license number line.) Bus.Tel.No.z63 Address: &0 , i)! Z3 2. %C�i�Sa� /vim I3tl Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security worR requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent AWMIT FEE: $ SignatureturaTelephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed }" P PP� P g � PP� on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ]FINAL INS CTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: 4A-:L,, Date: 7 /6 DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth ofMassachusetts Department of IndustrialAccidents I Congress Street,Suite 100 A -2017 02114-2017 0 . Boston,MA tee, www.mass.gov/dig �M 5V'wP -Porkers'Compensation Insurance Affidavit:Buil dexs/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. „Please Print Le iN A licant Information G�GTi�G L Name(Business/Oiganization&dividual): /YTi�isvi —T— Address: 4/,?,) Z j Phone#: City/State/Zip: �_. Are y u an employer?Check the appropriate box: Type of project(required): �i employees(fiill and/or part time).* 7. ❑N6Vd6nstriiation 1. I am a employer with--- 2.❑1 am a sole proprietor or partnership and have no employees working forme in n �n._nli l�iig any capacity.[No workers'comp.insurance required.] 9, Demolition 3•0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t JOE]Building addition 4•❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will JI.E]Electrical repairs or additions ensure that all contractoks either have workers'compensation insurance or are sole 12L—�,plbiag repairs or additions proprietors with no employees. 5.❑1 am a general contracEo;and 1 have hired the sub-contractors listed on the attached sheet. 11[]Rbof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.0 Other 6.Q We are a corporation and its,offices have exercised workers' rcishcompeir ight of exemption per ]MGL c. ed 152,§1(4),and We Nava no empldydes:[N *An applicant that check's boi W1 must also fill out the section below showing then hire outside contractors must submi'rtmaanow affidavit indicating such y pp �affidavit indicating they are doing all work an 1 Homeowners who submit•this, Contractors that check this box must attache additional sheet showing the name of the sub-contractors and state whether or not those entities, ave employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ••,. • I am an employer that is pr�ovidingworker�s'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: T&Go Expiration Date: Policy#or Self-ins.Lic.#: Job Site Address: 15'10 J1W An City/State/ZipA 04°?!1711'V �l?� y/yJ Attach a copy of the workers' coxnipensation policy declaration page(showing the policy number and expiration date). by a filib Up to 0-00 Failure to secure coverage as required under iil enalties?in the form of criminal WORK ORDER and a fine f up to $250.00 a and/or one-year imprisonment,as well as iv p be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A copy of this statement may coverage verification. I do hereby certify der the OU, andPena s of perj that the information provided above is ti e and tett. Date: Si ature: Phone#: cSG'-3 Official use only. Do not-write in this area,to be completed by city or town official. Permit/License# City or Town: Issuing A.uthoirity(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person' . L Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is'd'efiued 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'ortrustee of au 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-whd has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C('1)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 Pleasb fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub'contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial-Accidenis. Should you have any questions regarding the law or if you are req*ed to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant 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 af#ldavit 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Tndustrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MA.SSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia �---.._. ' OMMO "' ---�- t e NwEALTHOF o o AhAs$ BC}�!I"tfi'C�� ti (E SUES n+ SUFE, THE AS FOL L041 NC : n ,p AN'T Y I +: J I UEI,E:... �f J p $a 2-- R rte.. N5 0f1 O3OF MASS P11 Lr © Of I s . V ISS ELECT IES THE. _ RICIANS REGIS. FOLLOWING LICFhSt . EREO MASTED ELECI � . ANTKOMY ,1 IUELE '0 BOX 232 '''t I i<sON 6 MR -o NH l 03811-0232 �`'' 8 i 1 nn `kY z qAlfs T Of r P. i� 232 1VH 0381 00 ON 1116 0` � SIR Date..... 11579 CF,40RT#4 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 4L • This certifies th a ...... has permission to perform.......... a. ..................................................... plumbing in the build'vl s Of....................................................................................!........ ...... .................................................. Andover, Mass. 0 Fee.!iil............ ic. No. .lf ..................................... SPECTOR 9LUG41N Chec kI# {j MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CIN ®✓ IMA DATE /' _ ! ( PERMIT# JOBSITE ADDRESS �D ��/ OWNER'S NAME POWNER ADDRESS TEL[ IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: Df RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES® NOD FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _I _ I _._ I ! f ___ ! . I -___.J _f f CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM f _ ..'. 1 .___# ._.__..1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I I ► __ __� f f __.J _ __ I __�_! I _. I DEDICATED WATER RECYCLE SYSTEM __._.-J ._..._f DISHWASHER DRINKING FOUNTAIN I .----._f _.._.__ ..-----_-d FOOD DISPOSER ^i _.___'1 C __-._._ .__-.__1 I ______I .__..__! ._._..__.._ .._____J FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) I _._.gid _.___f _ ..___._I !. __.._ E ____I T__I __.__f __.____..[ ___._J ! I __.._..... KITCHEN SINK _J LAVATORY J _v_f __.____J __.— .____f __.___I _._.___I _-._-- _—__J ..:_.__.__f ____1 J ROOF DRAIN J __-__! I •—_--_S SHOWER STALL f _ :_J SERVICE/MOP SINK _—.J TOILET URINAL WASHING MACHINE CONNECTION d f _.____ ------.)= WATER HEATER ALL TYPES _! i d __ I _ ! d — f __ _____J WATER PIPING I _'' __---E ; I _--_--- ......... -___f ---I OTHER _1 _.._._f INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[ '! NO _I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER L] AGENT 10 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian with a! ert' nt provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME L .Tia- I LICENSE# 15-q 9' Y'll SIGNA RAE---� MP EK JP 0 CORPORATION®# Z 4_ Cif PARTNERSHIP 0# LLC L - COMPANY NAME �v r�, Svc ADDRESS 3/ l✓�5+-cis`i l v�,l}- E CITYcL,` g n i 1 STATE ZIP Q 3 y S'- TEL p FAX ! Y9 CELL s t.X jj EMAIL' m r. a�-. sr��J - - - .-. ' cue-�•-.. --...------- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY AL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES i i l The Commonwealth of Massachusetts z. Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 021142017 ,.t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. , Applicant Information Please Print Legibly Name(Business/Organizationdndividual): y °'Y �p�/ f'Sa/' Address: �� City/State/Zip: �!��`�' —vc v /V If 9W hone#: (o L9 6 Z 97010 Are you an employer?Check the appropriate box: Type of project(required): LAI am.a.employer with .� employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp,insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[4 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ ' 14.❑Other 6.❑We area corporation and its officers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees,they must provide their workers'comp.policy number. employees. If the sub-contractors have 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify un er the pains and penalties of perjury that the information provided above is true and correct. Si nature: O Date: l Phone#: Official use only. Do not write in this area,to be completed by city of town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract oi'liire, 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,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub'contractor'(s)name(s),address(es)and phone number(s)along with their 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 foi confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensatiori'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 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia fh e , 9 ' 50 Jay Road, North Andover, MA 01845 978-685-5955 allan-painting.com February 10, 2010 Brian Leathe Local Building Inspector Town of North Andover 1600 Osgood Street, Bldg 20 Suite 2-36 North Andover, MA 01845 Brian, This is a note to state that I, Allan Michael Marcus of Allan Painting, work out of 50 Jay Road in North Andover, MA for the purpose of office business only; phone calls, bookkeeping, scheduling ect. This address is not used by any employee for any reason. Allan Michael Marcus f NORT" .i'r b!.'d '•• UL O 9 NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street SSS^GNUS North Andover Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: l NAME: ADDRESS: G J //✓� -117 (� ZONING DISTRICT: r TYPE OF BUSINESS: 60— an ' . BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING.SPACES: I`� ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE BUSINESS FORM FOR TOWN CLERK 2.40 Home Occupation(1989/32) 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 purposes. Home occupations shall include,but not limited to the following uses; personal services such as famished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business,or the manufacturing of goods,which impacts the residential nature of the neighborhood. 4. 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 the home occupation and residing in said dwelling; 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; f. 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. d11 j"/) /� 'J Si e LI Date I Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING •'SSACMUS� This certifies that . .1. /.``.�..`. . . . . . . . . . . . . . . . . has permission to perform . . . . (I y. . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .rl, s'. 1` h `` at. . . . °:7. . . . , North Andover, Mass. Fee. .3.3. . . .Lic. No.. .�. 7. �.? . . . . . . . . PLUMBING INSP CTOF Check # >� 8484 MASSACHUSETTS-UNIFORM APPLICATION t=OR_PERMIT TO DO PLUMBING / (Print or Type) ,1 �3 ✓ Mass. Date V 20Permit �--` Owers me lu"Idication �9 el Ell" Type of Occupancy New 0 Renovation 0 Replacement i'Tr3'� Plans Submitted. Yes❑ No D FIXTURES URES B.P.4 ER# SEPTIC tIl t�r LO U) Z Z u i tlf tg W 4� O Z tl f ill M o in z to 0 Z d - abj '-` U U i Y 0 LL 1:2 Q ~ ZU z QQ Zz Lu 0 OQ ' Yv -> a0W � ZQ) wa ¢ o o Qo 0 tl1=o Cl ttm o SUB-BSMT BASEMENT IF) 1ST FLOOR 2ND FLOOR 3RD FLOOR 14TH FLOOR STH FLOOR 6TH FLOOR L-� 7TH FLOOR _ ` I I-4-4- STH FLOOR 1 istaliing Company Nance ,1-j 61iv1V_ Check onq' Certificate ddress M ye— CI Corporation vy1?1 CPartnership lephoneusiness Te y� rcn/Co. ame of Licensed Plumber or Gas Fitter ( �a Q - L INSURANCE COVERAGE: i have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes NO..0 If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy Other type o indemnity 0' Bond 0 OWNER'S INSURNACE WAIVEIv- I am aware that the:licensee does not have the insurance coverage required by Chapter j 142 of the Mass_General Laws, and that my signature on this permit application waives this requirement. Check bne. Signature of Owner or Owner's Agent Owner 0 Agent 0 hereby certify that all of the details and-inforrmatton l I-eave submi€tedentered)In above-application are true and accurate to the best of .y knowledge and that all plumbing work and instailatioas performe nd r the permit iss for this application will be in compliance with .1 pertinent provisions of the Massachusetts State Plum Ging Code a t 142 of the era!Laws. By Si na ure of Licensed lumber Title � Cirylf'ovcn Type of License: bKQter OJourneyman APPROVED(OFFICE USE ONLY) License Number i 50 jay north andover ma- Google Maps Page 1 of 1 r Address 50 Jay Rd North Andover, MA 01845 maps 85, 4 2% 4-4 All" A-W x _ r % 5 rt i 2 n- u } yg� J XA.- N N N # key: 4 � � �x'�.`•.__ L ,y mow. `''F. ,.� ". ... km e e fl..r.. r- f•.-+ 4 - http://maps.google.com/ 4/11/2008 Residential Property Record Card PARCEL ID:210/098.A-0059-0000.0 MAP:098.A BLOCK:0059 LOT:0000.0 PARCEL ADDRESS:50 JAY ROAD FY:2008 PARCEL INFORMATION Use-Code 101 ' TM- Sale Price: 1' Book` 06681 ` a Road Type _ T^ Inspect Date: 10/29/2002 Tax Class T - Sale Date: 02/20/02 Page: 0119 _ Rd Condition. P Meas Date: 10/2.7/2002 Owner: m_._ ALLAN M.8�LORI MARCUS TtSt Fin Area. � '1878`���'Sale�Type: R CertiDoc: To Land Area. 1.12 Sale Valid F Water: _ Collect Id 1 RRC Address: y, _�.� 50 JAY ROAD Grantor ALLAN M.MARCUSSewe� Inspect Reas: -C , NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 1001100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION Style: CP Tot Rooms: 6 Main Fn Area. 1157 Attic: NBHD CODE 6 NBHD CLASS 6 ZONE: R3 StoryHeight: 1.75 Bedrooms 3 Up Fn Area: 721 Bsmt Area -�962 Seg Type` . Code Method Sqm; cres lnflu Y/N Value Class"- �.. , . Roof:- G ~ Full Baths -XW2 Add Fri Area: Fn Bsmt'A�ea:-'481-- k 1 P 101 S 43560 1.000 208,652 _._ .,. 2 R 101 A 0 0.120 912 Ext Wall:- FB Half Baths: � HUnfin Area: - ._.. Bsmt Grade: MasonryTrim: Ext Bath Fix:'w0 Tot Fm Area 1878 { DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual T m RCNLD £191362 --- -m- -. . Str Unit Msir-4' Msr-2V E-YR-81t'Gradi d d°/aGoodP/F/E/R` Cost n Class,; kitch Qual T Eff Yr Built:" 1975 Mkt Adl _. _. - - SSEErc` S' w240 0.00 2002 G G ///98 3,100 Heat Type: HW Ext Kitch Year Built 1971 Sound Value 0.00 2002 A A ///97 500 Fuel Type: G Grade A Cost Bldg 191,400 DW S 112 0.00 2002 A A ///97 2,200 Fireplace: 1 Bsmt Gar Cap: Condition: A. A Att,Str Val 1. Cent'r`al AC: N I smt Gar SF: -77 'Pct`Complete"-� _ A t f Sty Va12 � VALUATION INFORMATION Aft Gar SF: 572%Good P/F/E/R: y/100/100/79 Current Total: 406,800 Bldg: 197,200 Land: 209,600 MktLnd: 209,600 Prior Total: 436,400 Bldg: 204,600 Land: 231,800 MktLnd: 231,800 Porch Tvpe Porch Area Porch Grade Factor P 60 T 224 W 384 SKETCH PHOTO . ; 2245 Vit: W 10 y 384 Sq. 16 F ` " 48 .Ft 6 :' .. 962 S457 Sq Ft 13 572 Sq. Q6 26 r, agg Int 9 2.2go. ". . t 50 JAY ROAD Parcel ID:210/098.A-0059-0000.0 as of 4/11/08 Page 1 of 1 _ Location -0 J�7 � No. Date 40*T" TOWN OF NORTH ANDOVER Certificate of Occupancy $ �',s'^••'•'��' Building/Frame Permit Fee $ < sACMUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ —�—�— Check # ul ///v/ 15342 Building Inspector I TOWN OF NORTH ANDOVER .BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH YA-ONE ORTWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: ' i ' SIGNATURE: Building Commi.491oner/Inspectoi of uildin Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1:2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning l Information: 1.4 Property Dimensions: Zonin District• Use >Lot Area Fronts It 1.6 BUILDING SETBACKS ft Front Yard - Side Yard Rear Yard.. .. Required Provide Regifired Provided Required Provided c: 1.7 Wates SupplyNEGI-C.40. 54) 1.5." Flood Zovc Infoiuiation l.s S-verage D4osal;Syste- Public ❑ Private 0 Zone Outside Flood Zone 0 M—kipal._ P On•$itaDrsposal:System ❑ SECTION 2 ,PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record _ Z no, Name(Print) Address for Servi Sign re 4 Telephone ' 2. wner of Record: Name Print Address for Service' Si ature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Not Applicable ❑ Licensed Construction Supervisor: License Number Addrps:: k Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone ' 1 N Ms I I SECTION 4-WORKERS COMPENSATION(NLG..L. C 152 § 25c(6) 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. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable New Construction El Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition . 0 Other 0 Specify Brief Description of Proposed Work: -641 SECTION 6-ESTIMATED CONSTRUCTIONCOSTS Item Estimated Cost(Dollar)to be Completed by pit applicant 1. Building (a) Building Permit Fee s. Multiplier 2 Electiical (b) Estimated Total Cost of Constructiioir 1,3 Plumbing Building Permit_fee•(a)x(b) 4 A4gchanical AC 5 Fire Protection 6 Total.., 1+2+3+4+5. ,.., ., •. .Check.Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing-application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB 1 . SIZE OF FLOOR TINMERS 1 sr 2 NO 3RD SPAN DEVIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town . of No. a T �O - L A o - �` dover, Mass., COCHICKEWICK 7,9 RATED Py .S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System r BUILDING INSPEC'T'OR THIS CERTIFIES THAT........ .. .iJ�/1/............ .. .. ............................................................................. Foundation has permission to erect....�:.l.�.S►.... ........... b ildings on.. �.....T Y........I...i..0/.,...................... Rough to be occupied as ..........Q X..W0.V WA. Chimney ......SV04-011 ......................... ....................... .. . 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 tly Inspection, Atterati n and Construction of Buildings in the Town of North Andover. � s PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. C fj Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIONS ELECTRICAL INSPECTOR Rough .................................................: Service BUILDING INSPECTOR Final Occupancy Permit Required to Omcu Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. 1511.)�D Q 4rX-- W NF EI�NLP-V�a/L2A�U�-`(CAF 'tGl DOUPAJOIL mW. TO \qb"A,17015-TAT17 edtP 8 x din . 1.4EAEZ AW14 I , Pt ►N-o� - �hr_ � ! C,C. ,, I ,=,'-�,,, PLAH aT F S45#\ j, . CL.4, f..�. ..a;; COT EDOT Aolq''m HW,, I r XVsxcl%2"_ 2:pEfaS..p i.NN i I � W. 9o1h IT At%4 ccv-. I I j Ta.IlV�Tl4 `rP{Ct N / NENRYGo` QFC, I E i I AT 2 ��� / • 4, No.25 N. I I =��RF.,lI�l3�:-LX1 ►1� � � Ntt7 os o I .g r n O F t!i PSS 5�1.?� �f 0a� Fdt•1r.0 NG-�Y t�EAln �G�I4.../� R R C H I T E C T U R R L ENERGIES 200 Sutton Street No.Andover.MA 01845 Tel (508) 681-0055 Fax (508)68t-tta� CHRRLES GOLDSTEIN RIR 3346Date. �D : d7'. ...... TOWN OF NORTH ANDOVER F? ' `p PERMIT FOR GAS INSTALLATION t 1SSACHUSEt . This certifies that . . . . . . . . . . . . . . . . . . . . . /.. . ` has permission for gas installation✓ �'• �`'• x-� • !^�'r, in the buildings of .77c u ate. . . . . . . . . . . . . . . . . . . . . . • • • at jl 'J,.- . . . . . . . . North Andover, Mass. /�e1d . . Fee �� . . . . . Lic. No.. �. . . . . . . . . . . . � • /.L.�•A'GAS C SP CTOR ' WHITE:Applicant CANARY: Building Dept. PINK:Treasurer I w 59 1 MASSACHUSETTS nNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING f ype or print) Date NORTH ANDOVER, MASSACHU'SE�T'TS Building Locations 1.? U �'" Permit# `� 1� A& __ Amount S �� Owner's Name ��/C�X�'r�- /VaIL4AClj2.. N'w Renovation ❑ Replacement ❑ Plans Submitte ❑ ,n .r Gnz1 — L J) Z "f ^ Z C Z zCn R C z c SUB -BASE ,NI ENT BASE .M E NT j Is'r. FLOG R 2ND . FLOUR JR D . F L O O R -4"r ll . FLOOR ST If FLOOR 6T 11 FLOOR 7"r II . FLOOR 8T I1 . FLOOR (Print or type) Check one: Certificate Installing Company Name r �L. ('7 ❑ Corp. Add1 s /�-� ❑ Partner. Business Telephone 0 6 211 ` ❑ Firm/Co. Nam`--of Licensed Plumber or Gas Fitter &aL INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes,please in rate the type coverage by checking the appropriate box. Liabilin 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 i hereby certify that all of the details and information I have submitted(or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ins atl s per-formed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac setts ate GA Cnd C ter the General Laws. By: nature of Licensed Plumber Or Gas Fitter Title Plumber % O Citv/Town ❑ Gas Fitter License I umoer I taster APPROVED(OFFICE USE ONLY) ❑ Journeyman Date.!�.��• • N°- 46 r 0 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSACMUS� I- I This certifies that...,. . . . . . . . %�j'� -c• has permission to perform I plumbing in the buildings of • • • • • • • at . A'� .�. . �,'�" - �'. . . . . . . . . . • . . . . . . ., North Andover, Mass. Feel . . .Lic. No./ � � L.... . . . . . . . . . PCUMBING�NSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS 00 Date Wr A/7 Building Location s'C Owners Name Permit# � Type of Occupancy Amount New Renovation Replacement ri Plans Submitted Yes No FIXTURES CC Z w x x a 00 W W � H a Cf)x Cr a dCnx aCn a a W a d H E~ E CC Cn z w o d = " �. d )4 d a d H .4 d Pa SiB&FF;MI: BASE"M M HDCR ZD HOCK 21M FL" 4M FLOCR 5M FIOCR 6M FLOCK 7IFI Mcm 9M HDCR (Print or type) Check one: Certificate Installing Company Name2 40 Z I Corp. Add-- �" El Partner. Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the tv=of insurance coverage by checking the appropriate box: Liability insurance policy FI 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 F] I hereby certify that all of the details and information I have sub ed(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and' stallati perfo ed der Permit Issued fo is application will be in compliance with all pertinent provisions of the Massacinus tate P lodna=pGeneral Laws. By: i ot Licenseum er Type of Plumbing License Title /A 3 City/Town License Num er Master Journeyman ❑ APPROVED(OFFICE USE ONLY Location -/ Pa w No. d?/� Date NORTIy TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ �� �'�s'•• t<� Building/Frame Permit Fee $ AC NUS Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ Check # i 17444Building Inspector Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED. f7 / SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Ad 1.2 Assessors Map and Parcel Number: Map Number . Parcel Number Q 1.3 Zoning Information: 1.4 Property Dimensions: ~ Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Reg" Provided 1.7 Water Supply M.G.L.CAO.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1-jistult District: res NO 1 Owner of Record 'Mcwt-u s �L �-TAy - o al in A in J ov-cq PA Name(Print) Address for Servicb 2 12 33 141, Signature Telephone 2,#2 Owner of Record: O Name Print Address for Service: Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: �t1Val RoofingLicense Number Mn Address 1 z/ > 0I864 Expiration Date — gnature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ i �Roofing � m Company Name �r P.O.Box 637 Registration Nu r r Address 1864r ate � Signature Tel Expiration D ^^ Telephone Y/ SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) 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 buildi rmit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Descrition of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL.USE ONLY- Completed by permit a licant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on M be it 11 elative to work aul%oriz6i by this building permit application. b , SfKat6e of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Duval Roofing P.O.Box 637 Print a Q1864 7 Si a e of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3 SPAN MIENSIONS OF SILLS DIN ENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS ,+ SIZE OF FOOTING X MATERIAL OF CHI1VWEY 'r IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE er Pages P6ge No: of jrjapas a Builders License # 58443 � Home Construction Reg. # 109288 CertainTeed/Certification # 1911 y I GAF Certified.Master Elite R G OOfi COFLECRCDFITIO (781 ,944.1994 (978i 664.4537 "The Areas'O CertainTeed LIldest Roofing Company" P.O. Box.637, North Reading, MA 01864 PROP AL 1 D TO qO / NE / ; ATE ST EETo B NAE i7 ,,,) Tex - CITY,STATE ZIP CODEAJOB LOCATION . � . nc�ovPt We hereby submit specifications and estimates for: Recommended Optional En 4 f t Q (Included in price) (Not included in price) ✓ Rip& Remove all shingle debris from roof&job site: ® 1 layer U 2 layers ❑3 layers or more ✓ Repair/or Replace any roof decking; not to exceed 50sq.ft. ✓ Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill, white or brown ✓ Install ICE &WATER underlayment along horizontal eaves, valleys, sidew,alls and sky-lights&chimneys ✓ Install 30#felt underlayment between roof deck and roofing shingles • Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year Install 30yr CertainTeed/GAFITamko or Owens&Corning architectural roof shingles ❑40 year O 50 year O 60 year ❑ Lifetime See manufacturer warranty policy for more details ✓ Install new aluminum vent-pipe flange (s) ✓ Chimney(s) -counter-flash and re-step existing flashing ❑Cut& Install new lead flashing toRidge-vent/exhaust vent with low profile design, hidden by shingle caps ❑Soffit-ventilation ❑ Roof louver-vents mless style aluminum gutters custom fabricated at job site ❑downspouts ❑aluminum leaf guards ✓ Otherr Wl'u�Q �P j Io /ecP Am. Afl)I//1Z Of da ` d JIdP vl t o K7 �..,a"�" .,;#• "w x. -p"M"C ''=:S —w w«4a� t •s "�S 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: ` (Location of Fa lity) L Si nature of Permit Applicant "7 /4/ 14 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 o�O�M SJO�, Workers'Compensation Insurance Affidavit Name Please Print Name: Location: Cily Phone # m a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity aI am an employer providi, rs' corn ensation for my employees working on this job. Company name: C1� Addres2 d —2g� (S CWN Phone#: �� Insurance.Co. LZ2 Polic # P- U, 30 Company name: Address City: Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties af,a fine up to$1,500.00 and/or one years'imprisonment-as_well_as_civil,penakies in-the farm nfa_STOP WORK_ORDER..and_a fine of.($1-00.D0)_a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify ddr a pains and penalties of perjury that the information provided above is true and correct. Sign Ur Date 7 Print name ��evc%" - 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 d immediate response is required Licensing Board p Selectman's Office Contact person: Phone#: I] Health Department I] Other Terms and Conditions 1. Contractor is amply protected with workman's compensation,public liability and property damage insurance in connection with all work performed by it on the Purchaser's premise. 2. Contractor shall not be responsible for any damage or delay resulting from acts of God, civil commotion or disorders, strikes, fire, accidents, storms, delays or default,by carriers or suppliers, inherent defects in subject premises, or any other causes beyond its reasonable control. 3. Homeowner acknowledges code requirements of roofing nails penetrating through roof decking and will be visible on underside of some surfaces. 4. If the contract price is not paid when due,Purchases agrees to pay all costs of collection and reasonable attorney's fees. 5. Purchaser agrees to hold no retainage for work performed under this agreement. 6. All items not on the accompanying proposal ordered by the Purchaser will be added to the amount due. 7. All oral, or written agreements, statements or presentations made by or on behalf of this company are expressed or superceded by this proposal. This contract contains in writing and print the entire contract between the parties thereto. No warranties or guarantees,expressed or implied, are made by the seller except those set forth in this contract. 8. If as a.result of the proposal, work is performed without a properly signed copy to Contractor, the purchaser automatically agrees to all applicable terms and conditions. f 9. Contractor warrants to perform aworkman-like job using materials consistent with contract requirements, however,because of material shortages substitutions may be made at the Contractor's option, provided i equivalent materials are used. y 4 10. The terms of this contract shall be governed by laws of the State of Commonwealth of application. s 11. The person who signs the contract,or who accepts by verbal implications,corporate,personal,or otherwise, accepts full legal responsibility for payment of all monies due under the terms of the contract. Without offset the signer waives demand, protest; notice of presentment, notice of protest and notice on non-payment and dishonor hereof and also agrees to pay attorney's fees under the terms of the contract. 12. Contractor agrees to take every precaution to protect landscape but due to the delicate nature of some vegetation some minor damage can be expected. Contractor does not except responsibility for repair costs to any plant life that will grow back in the following year. 13. If Homeowner cancels after materials have been order,any monies paid as a deposit will not be returned to you unless we are able to cancel the materials ordered specifically for your job. 14. To cancel this transaction, mail a signed and dated copy of this cancellation notice or any other written notice, no later than midnight of three business days after the contract date. Signed Date (� Shingle Color and Style Deposit Amount i.. r•: ,t. BOARD OF BUILDINGG REGUI,4TION3 + License: CONSTRUCTION SUPERVISOR ; i Number: CS 058443 10 Birth": 12/:10/1966 i" Expired: 12(10/2005 Tr.no: 10052 i Restr;*i 00 KENNETH P DUVAL PO BOX 190/12 NORTH ST -7��c N READING, MA 01864 Adminlitrator ( . 71. {,oanvneo�uuealf/ o�Aaaa¢c/.,k$ ! Board of Building Regulat'sons and Standards HOME IMPROVEMENT CONTRACTOR ==Reflistration: 109288 Expiration: 9/9!2004 Type: DBA DU`:/AL RGCFING Kenneth Uue•a! PO BOX 190/72 NORTH ST i!_.: Grr� NORTH Town of No. CN fl doves Mass.,,— / O T O -- LAKE ' COCMICMEWICK 7�S RA T E D P'P�,`�� V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �0� ' I�IA..leCa.5 BUILDING INSPECTOR THIS CERTIFIES THAT................ .... . ........................................... . ............. ............. """ oun ation has permission to erect.... ............... buildings on ...... D..... .Y.......R ............... Rough R Ip ................. to be occupied as.. ... r + t ���a ...... 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 B��7 relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 940 S 9 %500006� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION Sj�kRT Rough AtagCft. 000 I ........................ Service BUILDING INSPECTOR ! Final t i 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 and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.