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Home My WebLink AboutMiscellaneous - 52 HEWITT AVENUE 4/30/2018 (2) 52 HEW;TT AVENUE 210/060.C-0039-0000.0 t ,I ORT11 F ® of Andover O ^=+ l A K E iO dover, Mass., �' •a'� -< COCHIC HEWICK �d ADRATED `SS BOARD OF HEALTH PERM IT T D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ..............�..................~........FAL60% ..................................... ... ................... ............... Foundation VON has permission to erect................................ .... buildings on ...................... ................................ ............A Rough to be occupied as........�.�... ...�. ......... ............. .......... �.1.�..�►�............................... ............... Chimney provided that the person accepting this permit shall in every respect conf to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final %30 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S TS Rough ...... ... .............................................. ................. ........ .... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERS E SIDE Smoke Det. Date... .1. P NOR71� ' 0 TOWN OF NORTH ANDOVER o PERMIT FOR WIRING •Oq�T�D��`1' ,SSACMUS� This certifies that ....... C)S(c A) C - .......................... ..... .................................... �,,o,-,Q0 � I a � has permission to perform .....t`�.`^..!'�.l.... ...................................................... wiring in the buildin of........ .... U ! °.. ................................................... at -5 ................. .N rth Andover,Mass. �eu l a W �. Coln ,�e,,� G�- Fee...j. U .... Lic.No. ?..... ............................. ....11/lM.(................. ELECTRICAL INSPECTOR + Check # 46 : 4 f Official Use Only Permit No. � q 9M COWWON",UW OT 9I1,WqCHVSETrS Department of rPu6Gc Safety Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number e cc/r—1 Owner or Tenant ! P L Owner's Address , Is this permit in conjunction with a building permit Yes 0 (Check Appropriate Box) Purpose of Buildin k\QJ Utility Authorization No. Existing Service Amps (s 2 3 VoitsCN Undgmd 0 No.of Meters New Service 20 Amps_1[,�oits Overttead } Undgmd 0 No.of Meters_ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of gghting LightingFixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets f. No.of Oil Burners Baftery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total w ,� No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices ` Heaf Total Total No,of Di sal / No. Pumps Ton KW No.of Sounding Devices No./of Self Contained No.of Dishwashers SpaWArea Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage s No.of Water Heaters KW Signs Bailases Wiring No.H ro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6,,,JJ,4 of Massachusetts General Laws I have a current Liability Insurance Policy including Cued Operations Coverage or its substantial equivalent YES C% NO 0 have submitteQ�lid proof of same to the Office YES O 0 9 fou have ch YES please indi a the typ�a�coyzPag�y e�clang the appropriate box INSURANCE )jf BOND 0 OTHER 0 (Please Specify) 6 AM - �i`,t, y/ [% e, Estimated Value of EI ctrl al W rk5 (Expi o Date �S ca Com✓ Work to Start t0 Inspection Date Resquested Rough Final Signed under nalfJes of rlury: — FIRM NAME L LIC.NO. Ti 6 Licensee Signatu �e•..�9�� p- LIC.NO. �---�� Bus.TeI No. Address k �d �(3 Gt/¢Zy.� + Alt Tel.No. OWNER'S INSURANCE WAIVER: i am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts y General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) /Cf Telephone No. PERMIT FEE $ ( [D �� (Signature of Owner or Agent) Location No. Date ,.ORTN TOWN OF NORTH ANDOVER 3? •. • O� 1 Certificate of Occupancy $ * ; Building/Frame Permit Fee $ Foundation Permit Fee $ P4 /Permit 7- $ Jut ' Sewe"r'sonnection Fee $ `� 19Qater Connection Fee $ �0•AndoVerGQ/ TOTAL $ 4 /�Cto - Building Inspector Div. Public Works PERMIT NO. 3 /i APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP KqO. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK iPAGE — ZONE SUB DIV. LOT NO. CATION j.,WURPOSE OF BUILDING CxPQ,S��? WNER'S NAME NO. OF STORIES F► SIZE NER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME 00ZE OF FLOOR TIMBERS IST 2ND 3RD irU'ILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING l/ DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x BUILDING ADDITION e3-, MATERIAL OF CHIMNEY Llid BUILDING ALTERATION er,,!; IS BUILDING ON SOLID OR FILLED LAND LL BUILDING CONFORM O REQUIREMENTS OF CODE 1/e� IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST �i OOb PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. 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 a PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FI ED 7 a BOARD OF HEALTH IGN URE OF OWNER OR AUTHOR IZv GENT OWNER TEL.# (� F E E O CONTR.TEL. sp, CONTR.LIC.# - PLANNING BOARD PERMIT GRANTED 2 - 12 19 BOARD OF SELECTMEN e BUILDING INSPECTOR �53 � � c � BUILDING -RE CORD 1 OCCUPANCY 12 SINGLE FAMILY " 1 sroRlEs THIS SECTION MUST SHOW EXACT DIMENSIONS'OFrLOT AND.DISTXNCE FROM " MULTI. FAMILY OFFICES' LOT LINES Al` EXACT DIMENSIONS OF'I3UILD7NGS, WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT.PLAN,. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE _ _ d 1 2 13 , CONCRETE BL K.• PINE BRICK OR STONE- HARDW D PIERS PLASTER DRY VJALL - UNFIN. 3 BASEMENT I' U✓ a+ AREA FULL FIN.-B M'T' AREA FIN. ATTIC AREA NO BM'T . FIRE,PLACES .HEAD ROOM MODERN KITCHEN .rl1C y 4 WALLS I"'9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH �_ - ` ASPHALT SIDING HARDVJ'D ! ASBESTOS SIDING COMMGN, VERT. SIDING ASPH. TILE STUCCO ON MASONRY ` STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. &,FLOOR BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME - -SUPERIOR I-I POOR ADEQUATE NONE Ss \\ _ 5 ROOF 10 PLUMBING I GABLE HIP BATH(3 FIX.) / , #5 l �tv GAMBREL MANSARD TOILET RM. (2 FIX.( „,V/ tt - FLAT SHEDWATER CLOSET ASPHALT SHINGLES LAV'.ATORY, __ V 1 WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING r l' TAR & GRAVEL STALL' SHOWER' ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO" 6 FRAMING i 1 1 HEATING - 0 WOOD JOIST PIPELESS FURNACE r C 1 FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS.- _ HOT WT'R OR VAPOR cr} WOOD RAFTERS AIR CONDITIONING "fir{ RADIANT H'T'G UNIT HEATERS � W0.)DR004p\ .•.•GAS J{ �/�" , 7OIL /7 j�/� �L',!B'M'TE 1stNOXMM\M m amp aaa•a+•aw � rim..r 4..,-e Q�! d_U V "_a N�tlj rIINALW o itAORTH • rc- ' 6 � own of L n over 0 RIVEWAY ENTRY PERMIT , � er, Mass., 7 " 1-? 199.E Aoa ?9- � q E ! A BOARD OF HEALTH PERMI LD THIS CERTIFIES THAT... 4o&.-Y/.. .. ...F40.04 Z• ,••••••••••••••••.•••••• BUILDING INSPECTOR has permission to erect ..... ••• ...• •• •••a•• � � Rough J.00?.. � .. Chimney tobe occupied as.... •••••••••••••••••••••••••••••••• Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough LJNLESS CONSTRUCTION STAR Service • � Final .. .......... . .. IN BNG INSPECTOR GAS INSPECTOR Qcupancy Permit Required to Occupy Building Rough Final Display in a '`Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner TREET WL No ., Vathing to Be Done Until Inspected and App'coved by - smoke Det. Building Inspector d I I I i , i ` j j ��►, �, ,� ti�� a�ys :fly �a xa � - -t I I ` I I j � � \ i I I I I I 1 V U i , if If \� f .d i dR 1 �f� 7 — 1 -v jr Town of North Andover r ' BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE dAq,- JOB LOCATION_ . 12LI /Number Street Address Section of town "HOMEOWNER" Name Home (Phone Work Phone PRESENT MAILING ADDRESS 4-,y/-/, /�1/l City/Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license , provided that the owner acts as supervisor. (State Building Code , Section 109 . 1 . 1) DEFINITION OF HOMEOWNER: Person(s ) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- ing , attached or detached structures accessory to such use acid/or farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit . to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the building permit . (Section 109 . 1 . 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and regulations . The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and ,requirements . HOMEOWNER' S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 ,000 cubic feet , or larger , will be required to comply with State Building Code Section 127 . 0 , Construction Control . FORM U - LOT RELEASE 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: Phone 42 /2 LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street ,jam e4i) 7� X Ile St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Health Agent Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date PER'ltrr NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. Iz 67/ LOT NO. 2 'RIEGORD OF OWNERSHIP DATE BOOK PAGE ZONE `/ I SUB DIV. LOT NO. 3I XS I JC9 if LOCATION SL EW i p,Y PURPOSE OF BUILDING��#IjnS �CLIfn� /2#% CG/i OWNER'S NAME d ` NO. OF STORIES 'iSIZE OWNER'S ADDRESS JrL awl jT AYL► BASEMENT OR SLAB �� ac11 / v (21M �C,GIi ARCHITECT'S NAME SIZE OF FLOOR TIMBERS QST�7�� !ND Z!x �' 3RD Z x G 1� BUILDER'S NAME � �D_` u G SPAN DISTANCE TO NEAREST BUILDING lv DIMENSIONS OF SILLS T DISTANCE FROM STREET r„gGG POSTS /��x 61� ep� 1t . Iwo DISTANCE FROM LOT LINES-SIDES R GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING 11 " SCII AA, IS BUILDING ADDITION MATERIAL OF CHIMNEY V IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST ft `yw®D O PAGE 1 FILL OUT SECTIONS 1 - 3 EBT. BLDG. COST PER 8Q. FT. 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 11 - 10 -9 2 /zz�� SUILDINO INGPECTOR 81GNATU F OWNE O AUTHORIZED AGENT 7- 113? j F E E Q OWNER TEL.#Ar �a o ` ��3a C I PERMIT GRANTED 3 » CONTR.TEL.# j 1 CONTR.LIC.# o.51?r Z Z�SO L G V H.I.C.# 10 9343 adAG � La BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ 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 I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 3 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D — PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'T' AREA _ '/. 1/1 �/� FIN. ATTIC AREA _ N_O 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 HARDVI D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MAS NRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR (J POOR ADEQUATE 1 NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBRELMANSARD TOILET RM. 12 FIX.) TL-AT1 A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING NORT Town of _ _ Andover No. S'I3 � /1/dv /3 199'iover, Mass., LCA KE A COCNICNEWICK �'�^• 'PP%y '4TEb A '� `G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 4 ._ BUILDING INSPECTOR THIS CERTIFIES THAT......... [` tVi...-".....�C.t.�.�K......�.-�..le... .............................................................................. "' ' Foundation 1 has permission to erect... . . .,.TJX.......... buildings on ........C!!. k.......WV..+ t.t.f......ck—!ot....................... Rough to be occupied as ` p S.l�n ��..... al1M.�..'. ...................(us.C.1'.t�.�!►.�.`. . ..............hc -%0'a.jt.0ary... ....�1.�.C.<< Chimney provided that the person acpting this permit sf�all in every respect conform to th8 terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough ...................... .. .... ........ . ..... ... Service ... .. ... . . .... ............ LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Q,e v pt Street No. Smoke Det. Gt* YS-7,6 r g0RTol ny i,all be filed o ` i:1 ) ;.'ays after the REGis.1'`F. �;IL. (:Z:0 ° :'; JOYCE cif; � ,t W cafe of ii:;lig of this Notice - TOWN GLIftK in the Office of the Town 'SS4 ustt NORTH ANDOVER CIerk. TOWN OF NORTH ANDOVER OCT 20 I 53 MASSACHUSETTS This is to certify that Mv*(20 days ATTEST; have elapsed from date of decision Mead v.ithout filing of an appeal. BOARD OF APPEALS A True Copy Date (��t1FMt pya.A.4442h - Joyce A.Bradshaw Town clerk NOTICE OF DECISION Tbwn Clerk 52 Hewitt Ave. NAME: Kevin & Kai Foley DATE: 10/15/97 ADDRESS: 52 Hewitt Ave. PETITION: 032-97 North Andover, MA 01845 HEARING: 10/14/97 The Board of Appeals held a regular meeting on Tuesday evening, October 14, 1997 upon the application of Kevin & Kai Foley, requesting a Variance from the requirements of Section 7, Paragraph 7.3 and Table 2, for a side setback, and for a Special Permit under Section.9, paragraph 9.2 for an addition to a non-conforming structure, of the Zoning Bylaws which is in R-3 District. The following members were present: William J. Sullivan, Walter F. Soule, Raymond Vivenzio, John Pallone, Ellen McIntyre. The hearing was advertised in the Lawrence Tribune on 9/30/97 and 10/6/97, and all abutters were notified by regular mail. Upon a motion made by Walter Soule, and seconded by John Pallone, the Board of Appeals unanimously voted to GRANT relief of front setback of 16.5 feet, side setback of 17.8 feet on Minute Ave. side, and area relief of 17,000 sq. feet. Relief of 45 feet on the front of Hewitt Ave. in accordance with the plan filed dated 9/17/97 requesting relief for a non-conforming structure. The proposed addition to non-conforming structure will not be more detrimental than presently existing. Voting in favor: William J. Sullivan, Walter F. Soule, Raymond Vivenzio, John Pallone, Ellen McIntyre. The petitioner has satisfied the provision of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Note: The granting of the Variance and/or Special Permit as requested by the applicant does not necessarily ensure the granting of a Building permit as the applicant must abide by all applicable local, state and federal and building cosies and regulations, prior to the issuance of a building permit as requested by the Building Commission. BOARD OF APPEALS William J. Sullivan, Chairman /DECOCT Registry of Deeds Northern District of Essex County Lawrence, MA 01940 11/10/97 KEVIN Fl:LEY DR # 1 Rec; Type DECN 14,(4 Postage 0.3-41, Total 14.32 # 2 Favnrent Check 10.,;2 THANK YotiTh(DmAs J. Burke {'c'3i._ter- of Deeds PLAN OF LAND NOTE: THE ZONING DIST. IS R-3 IN SEE ASSESSORS PLAN60'C' NORTH ANDOVER, MASS. PARCEL#39. SEE DEED BOOK#2860 OWMED BY PAGE#71. KEVIN P. and KAI FOLEY SEE L.C. PLAN#41949'A'. SEE PLAN AT END OF SCALE. I"=20' DATE9117197 BOOK#231RECORDED AT 0' 20' 40' 60' THE N.E.R.D. Scott L. Giles R.P.L.S. Frank S. Giles 50 Deer Meadow Road HEWET T Public A VE. North Andover, Mass. 80.00' PROP.5.5X 31' 16.3' ADDITION #52 Uj 32.7'+/_ EXIST. 1 1/2 STY. W.F. DWELL. Q) Q) Q 4' 122' j O o L O DECK 00 W PROP. 1OX 9' ENCLOSED ADDITION � I MAP 60'C'PARCEL #39 g 8000 S.F. OF EE] ... ' ., N I 0.13872 80.00' �k �+St1 E�� ~- I.P.FND. VINO 441- N/F COADY Exrsr.eLK. o z GARAGE o m o� THIS IS TO CERTIFY THAT I HAVE CONFORMED WITH THE RULES AND REGULATIONS OF THE NORTH ANDO VER REGISTERS OF DEEDS IN PREPARING THIS PLAN BOARD OF APPEALS DATE OF FILING' DATE OF HEARING- DATE OF APPROVAL• PERltlT NO. At I APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGZ i MAP X10. m �,y LOT NO. (2 0 2 RECORD OF OWNERSHIP JDATE (BOOK ;PAGE ZONE I SUB DIV. LOT NO. LOCATIONPURPOSE OF BUILDING L OWNER'S NAME ')-1-��L �� I=Q f ! NO. OF STORIES SIZE OWNER'S ADDRESS �\ � / - BASEMENT OR SLAW ARCHITECT'S NAME �p SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME rt SPAN — DISTANCE TO NEAREST BUILIbING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES —SIDES REAR - GIRDERS i AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW - - SIZE OF FOOTING X IS BUILDING ADDITION _ MATER:AL OF CHIMNEY IS BUILDING ALTERATION �. /rNyL �\ v� - IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIPEMENTi OF CODE) - IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE PROPERTY INFORMATION INSTRUCTIONS LAND COST SEE BOTH SIDES - EST. BLDG. COST . EST. BLDG. COST PER SO. FT. PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING A APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BUILDING IIiBPtCT'OR SZQTOWNER OR AUTH UR RI AGENT , SEE 0o OWNER TEL/ �,� - 71 / 1 •[RMr7 sluMto -- �ONTR TELT T40RT/y T0VM Of _ - Andover - L No. Vil 7 dover, Mass., � ICNE�94_coCHWICK 'q �A4 E D PP`y ,Cy S E BOARD OF HEALTH PERMIT.- T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT......#A:�. llis.. C .. ...... i .. ...� �17.......................................................... """ Foundation has permission to end......14"'tXX „•.......... buildings on .....��• .... t. .t.77.7.,°{r1�....................... Rough to be occupied as.............VIA1 e....%/.. W....a(J' ;.�NI I P......A .A!!J. �......................................... Chimney provided that the person accepfing this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTORUNLESS CONSTRUCTION TS Rough ........................ .... ...-......... ........... ................... Service ................................ BUILDING INSPECTOR Final Occupancy Permit-Required to Occupy Building GAS INSPECTOR Display.In a Conspicuous Place on the 'remises'-- Do Not ;Remove °' ' Final _ No Lathing .or :Dry Nall 'To BeDone FIRE DEPARTMENT - Until :inspected _and :Approvedy theuildmg inspector. .b ,4' " is a r DIPARTM&RT OP PDELIG sA�t ' n fi ' CORSPRU�fI�I.$DP$AYISOR L.F B �;,,rE�r�� i til ,P g `ted '�� 00 RAYMOIDP BBRU ' f �HDOVBR, NA 4�.� s I> V ^ tX { 4: t • The Commonwealth of Massachusetts ( Department of Industrial Accidents -_ � — Off/ceef/nresUgat/ens _ = 600 Washington Street A Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name 1 location: r�? city /V r A4.do,V e phone# 7�l r-1 I am a homeowner performing all work myself. a sole proprietorand have no orie'working in any capacity I am an employer providing workers' compensation for my employees working on this job. address. city: phone:# inst>ta co: ; polio: C] I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: cotnpany name. address,. X. ci c ; phone:# ffiso ante t o: comnanvname: atidtess. city: phone.# in air Failure to secure coverage as required under Section 25A of 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 civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 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/ nder the pains and penalties of perjury that the information provided above is true and correct Signature 1 / Date 5� Print name ( 12� e /` Phone# r, `' 7 � official use only do not write in this area to be completed by city or town official city or town: permit/license# I—(Building Department C]Liccnsing Board check if immediate response is required OSelectmen's Office pHealth Department contact person: phone#; nOthcr (revised 3195 P!A) � r Information and. Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not.because of such employment be deemed to bean employer. MGL chapter 152 section 25 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, 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. lill SON 1111 1, 11 VAMMRJ��:: Applicants Please fill in the workerscompensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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 Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns 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 evert 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. . '/ Off 4� ; The Department's address,til `ze73:. anc►_ F1AdT - .! taS Mce of Mestioatiolls 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 Location .�a �`"t" 7L/ /� y--' No. �' Date -, °��- y 3 HpRTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ 41 Building/Frame Permit Fee $ g cf,R/ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �p Check # Building Inspector TOWN OF NORTH ANDOVER • BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s �+ 11+ Use Q� BUILDING PERMIT NUMBER: c-5-6 3 DATE ISSUED: �j/ „• OZ QD3 SIGNATURE: /PICC Building Commissioner/InEeEtor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number �T 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 Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT rn 2.1 Owner of Record XL=-411,j P F"ocz--y Nam (Print) Address for Service Signa e Telephone 4� 2.2 Owner of Record: V Ko-At 1�., P f�I elr-Y Name Tint Address for Service: O Si nat1fe- Tele hone SECTI 3-CONSTRUCTION SE CES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construciton Supervisor: G 5 Z,t O License Number 4 5 Ql ti� �d,(l o- w1 Address r _ I ((, b v9 q�0 ,0 Expiration Date y ic Sign tore Telephone r 1 3.2 Registered Home Improvement Contractor Not Applicable ❑ v PA. 64V,, corn. � Company Namern 3 Z Registration Number P(3 -Pok , N, �r�ve�' r' Addressr Gt I Z4 _ Expiration Date` z Si natu Tele hone V fa 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 building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all livable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: f/2 t7�6 cyu5 p G . 4BrvNL) Assoc,►a M---> D I`t/a RY\r,Lf a Y-3 D e c'�rti SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be 0MCIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Q' Construction z/ b D 3 Plumbing Building Permit fee tel X (@) 4 Mechanical HVAC gD, 5 Fire Protection 6 Total 1+2+3+4+5 Q 0-&-w Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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 1, J (9�/`J �t�l ) 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 r a Si ature of Owner A t Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVMERS 1 2 3RD SPAN DIMENSIONS 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 1S BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of And 0 No. i * _ over, Mass., S-1 91aoo3 'i � COC RICH I V !� AD RA TED P'Pa�_\� S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..........�C V ..N F .1 ...� ..................... ........................................... Foundation I �� I has permission to erect..�..�2.... a y.... buildings on .. a ! W 1 V Rough iI.......................................... %Awlty to be occupied as.........................S A� �....oy......q.... ...3�....��.��................. r► Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 1%400 Final this office, and to the provisions of the Codes and By-11ws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 0 ` 3 ?D PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIONS ARTS ELECTRICAL INSPECTOR #A r. • Rough 40AService ....................................... ....................._............... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No LathingWall To Be Done or Dry Dry FIRE DEPARTMENT Until inspected and Approved by the Building Inspector. Burner Street No. LSEEE REVERSE SIDE Smoke Det. FORM U LOT RELEASE 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISIO�Nj_ LOT(S) ' STREET IQVLC—c� ST. NUMBER ************************************OFFICIAL USE RE MENDATION 9F TOWN AGENTS: `CONSERVATION ADMINIOR DATE APPROVED ST TI V DATE REJECTED COMMENTS �v,1�4` .� [�/ 01,i re" TOWN PLANNER DATE APPROVED DATE REJECTED_ COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS- SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT /� � ) jJ0, S tJ)j jyxg&-a RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm I' ^ ✓fie�amirnai �' A BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CB, 08281.6 �.. p Birthdate°06/16!1958 1r : �xp�res 06!16!2006 Tr.no: 82816 Restricted QO NIFi-01845 ` - ? JOHN R LEEMAN JR r 45 PINE RIDGE RD t y NORTH ANDOVER, Administrator IL —41 Board of Building Reguiations and Standardslug . HOME IMPROVEMENT CONTRACTOR e Registration '137552 t Expiration -1112612004 Type Pnvate Corporation 5 44 i y I NORTH ANDOVER BUILDING CORP. { JOHN LEEMAN =- 4-5 PINE RIDGE RD. --MA 0,1845 S. i,.trr arm Ac;uKu CERTIFICATE OF LIABILITY INSURANCE DAT M TM. MAY 103 PRODUCES THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MARSHALL LEINSON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE • SAMEL INSURANCE AGENCY,INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 15 CENTRAL STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ANDOVER MA 01810 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Aim Mutual Insurance Company NORTH ANDOVER BUILDING CORP INSURER B: P.O.BOX 132 NORTH ANDOVER MA 01845 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSF TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE MM/DD DATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE PREMES ER NT e e $ CLAIMS MADE IJ OCCUR MED.EXP(Any One Person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ POLICY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBERELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND AWC7010445012002 OCT 22 02 OCT 22 03 WOC STATU-S OTHER EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MeMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE K yes,describe under $ 100,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATION/VEHICLES/EXCLUSIONS ADDED ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: _ CANCELLATION Kevin Foley SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 52 Hewitt Ave. EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT North Andover MA 01845 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,IT'S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: ACORD 25(2001/08) Certificate# 5323 Marshall Leinson 37372 I PLAN OF LAND IN NORTH ANDOVER, MASS. NOTE: THE ZONING DIST. 1S R-3 SEE ASSESSORS MAP 60'C' OWNED BY PARCEL#39. KEVIN P. and KAI FOLEY PAGE#7o BOOK#2860 SCALE: I"=20' DATE:11/14/2002 SEE L.C. PLAN#41949'A'' 12/5/2002 SEE PLAN AT END OF 4/24/2003 BOOK#231 RECORDED AT 0' 20' 40' 60' THE N.E.R.D. THE PROPERTY LINES SHOWN ARE THE Scott L. Giles R.P.L.S. LINES DIVIDING EXISTING OWNERSHIPS,AND Frank S. Giles R.P.L.S. THE LINES OF STREETS AND WAYS SHOWN 50 Deer Meadow Road ARE THOSE OF PUBLIC OR PRIVATE STREETS North Andover, Mass. OR WAYS ALREADY ESTABLISHED,AND NO NEW LINES FOR DIVISION OF EXISTING OWNER IP OR NEW WAYS ARE SHOWN.. / l 1550 S.F. TOT. EXISTING LIVING SPACE. 942 S.F. TOT. NEWADDITION. 2492 S.F. TOT.PROP. LIVING SPACE. HEW/TT public AVE. 80.00' 16.3' ,9 IST.PORCH #52 s 20_2 W p v PROP. EXIST. 1112 STY. 6 E— ADD. W.F. DWELL. LU W Z UL 12.5' 4' 12.3' Z p 30' o Q OPROPOSED PROPOSED ADDITION a,x cTo O FRONT ELEVATION o DECK 10' 15.3' w o ' •i i NO SCALE '1 T -- 4. Lf I T v l ECf�,T/NG PROPOSED MAP 60'C' PARCEL #35 8000 .t". � _ .7 C\' + , FINISH GRADE_ SHED r 1 80.00' I.P.FND. oCi EXIST.NIF COADY GARAGE GARAGE O ro 0 vi THIS IS TO CERTIFY THAT I HAVE CONFORMED WITH THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS IN PREPARING THIS PLAN �,SH QF P G o• 13972 0� i `�'rsjo�O/STER c�4y'�� fL LANG ¢ i I • i p i A Date<F .Q. TOWN OF NORTH ANDOVER z °f ��'° �•1tio PERMIT FOR PLUMBING SSACMUS� < ! This certifies that V. 114.1^. . C! . . . I. .�. . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . .. . . . . . . . . . . . . . . . . . . . . . at . . . fly , .l.?. . . . . . . . . . . . . . . . ... . . North Andover, Mass. Fee. .10 Lic. No..l. .. . . . . . . . . . . . . . . . LU WING INSP Check # 5697 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMB (Type or print) NORTH ANDOVER,MASSACHUSETTS Date ' L)r,4 3 - Building Location wi, 4r Owners Name 11r ur� Permit# 57-6 4 7 Amount T e of Occu anc �m New Renovation Replacement ® Plans Submitted Yes No El FIXTURES rZ z H a arz w w w x w a as F1z d 21`D FLOOit 3DFLOOR 4IH FUM STfi FLOOR 6M FLOOR 7M FLOOR Sm FIOQ2 (Print,or type) Check one: Certificate Installing Company Name--- A ss Partner. Business Telephone — — Firm/Co. Name of Licensed Plu er: -i Insurance Coverage: Indicate the type of insu coverage by checking the appropriate box: Liability insurance policy 11 Other type of indemnity 11 Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the ab( three insurance Signature O er Agent I hereby certify that all of the details and in rmatio a submitted(o rite re abov cation are true and accurate to tl best of my knowledge and that all plumbing w and' stallations ed d r P ed for this application will be in compliance with all pertinent provisions of the Mas chus a mb' C e a ter 142 of the General Laws. By: Signature-olLicenseA Flum5er Type of Plumb' g Li cen Title City/Town License NumDer Master Journeyman APPROVED(OFFICE USE ONLY