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Miscellaneous - 55 BEAVER BROOK ROAD 4/30/2018
0 BEAVER BROOK ROAD 210/106 0000.0 \\\ 1 1 I I f I MetLife Auto&Home® Homeowner Operations Field Claim Office Attention:Claims P.O. Box 6040 Scranton,PA 18505 (800)854-6011 March 3, 2015 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: Robert A. and Kristin Skelley Claim Number: JDE93218 OG Date of Loss: February 19, 2015 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten (10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 55 Beaver Brook Rd,North Andover, MA Sincerely, Home Ops CAT Team Sarah Lackey Metropolitan Property and Casualty Insurance Company Claim Adjuster (800) 854-6011 Ext. 7440 Fax: (855) 411-6689 Email: MetLifeCatTeam@metlife.com MetLife Auto&Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates,Warwick,RI. MPL MA-REGDEPT Printed in U.S.A 0698 Dat8 e...�-.. .....Z........ �. ............. t OF NORTM,h TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 8$�CHUS� t (1 This certifies that ... �.......... ." --........... ......' ..'..................©..:.......................... has permission for gas installa� ...........................ion .............. ..Nz-�- � in the buildings-ca ................t-- ................. ...."^.. . .. ................................................... at............ ....................... . ? --, North Andover, Mass. Fee?..---'�.......—.... Lic. No.t -5 ..... ! .......................................................... �- GASINSPECTOR Check# 9166 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY �D�r� � I MA DATE 3 PERMIT# JOBSITE ADDRESS JS57 /Z7i� OWNER'S NAME GOWNER ADDRESS S- 13Man D TEL 0-92y 42-t7 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ] RESIDENTIAL PRINT CLEARLY NEW:F-1 RENOVATION: REPLACEMENT:L PLANS SUBMITTED: YES 0 NO APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATERY DRYER �T FIREPLACE FRYOLATOR �l _ FURNACE j _I GENERATOR GRILLE INFRARED HEATER _ LABORATORY COCKS MAKEUP AIR UNIT OVEN I POOL HEATER _ ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER _J UNVENTED ROOM HEATER I I WATER HEATER OTHER - _ I — - INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY L] 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 Q AGENT �[ SIGNATURE OF OWNER OR AGENT 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 compliance with all Pert' en rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-G SFITTER NAME 4E /?fie GN!F�«_ LICENSE# J3.rrYjj SIGNATURE (� MP MGF Ljl JP D JGF LPGI EJ] CORPORATION PARTNERSHIP©#=LLC 0#= COMPANY NAME: _/k Ai ADDRESS j_ CITY STATE /!?A ZIP O!9YF TEL !2 L'iF3cr 2 t FAX I - CELL_ EMAIL _ _ _ N I ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r II The Commonwealth of Massachusetts a Department of Industrial Accidents Office of Invesdgations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print LeLibly Name(Business/Organization/individual): / 0�1�(CU Ar•� 7 ,: Address: `� 1 !s 7 City/State/Zip: �,�,!� Phone#: r Are you an employer?Check the appropriate box: Type of project(required): 1.�am a employer with_3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El employees am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g ❑Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I-Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ` �✓�'Ali Insurance Company Name:. //(�Q Policy#or Self-ins.Lic.#: �s✓�1 g cJ®� �C� Expiration Date: 3 a 41 Job Site Address: 3-5— � 9 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. Y do hereby certify under the pains and penalties of perjury that flee information provided above is true and correct. Si ature: Date: 3 3- Phone#: �� Z �(% Official use only. Do not write in this area,to be completed by city or 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 y Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute an employee is defined as"...eve person' the service rvice of another under any contract of hrre, 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'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 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. 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(ifnecessary)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. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and shouldou have an questions, Y Y please do not hesitate to give us a call. The Department's address,telephone and fax number: The Gomy onwealthofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Sited Boston,MA,02111 Tel,#617-727-4900 ext 406 or 1-877.:"S.A.I{E Revised 5-26-05 Fax#617-727-7749 www.mass.govv/dia Division of Professional Licensure:License Search Page 1 of 1 The Official Website of the Office of ConsumerAffairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics ONLINE SERVICES Check License Locate a Licensed Professional Online Address Change Contact the Agency I More... REFERENCES&RELATED DTFO Disclaimer Regarding Website License f Searches I Enforcement Process Glossary Glossary of License Status Codes More... Home>Division of Professional Licensure> ....................................................................._................................................................................................................................................................................................_.............................. Check A Professional License By the Division of Professional Licensure I NEW SEARCH j LICENSING BOARD TYPE LIC. # LICENSEE'S NAME CITY/STATE STATUS Sheet Metal Workers Master/unrestricted 13848 I MARK B MAGNIFICO MIDDLETON, MA Current C Plumbers Ft Gasfitters Journeyman Plumber 25002 MARK B'MAGNIFICO MIDDLETON, MA Current Plumbers It Gasfitters Master Plumber 13559 MARK B MAGNIFICO MIDDLETON, MA Current Plumbers Et Gasfitters Plumbing Corporation 3266 MARK MAGNIFICO MIDDLETON, MA Current Plumbers Ft Gasfitters Apprentice Plumber 20301 MARK B MAGNIFICO MIDDLETON, MAS Expired i The page above has been generated by the Division of Professional Licensure web server on Thursday, September 12,2013 at 8:59:28 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us A , Date.... ....... OF NowrH,� TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ...... ......... ............................. has permission to performC4DVP' .................1................. ........ .................................. wiring in the building of......:. ............................................................. ........................... at .....6.�....... L............................North Andover,Mass. Fee ................Lic.No. ............. ......... EucmfcAL INSPECrOR Check# 36 7 Z-- 2 2 �. C mmonwea&o/Mamas lfi Official Use Only +i c� Permit No. /z-Z 2efari`ntent o/-7ire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK MAll work to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 CMR 12.00 M (PLEASE PRINT IN INK OR TYPE ALL IIVFORjWTIOII9 Date: City or Town of: To the nspector of Wires: By this application the undersigned gives no'ce of his or her intentiojn-to perform the electrical work described below. Location(Street&Number) 60ec'e - Owner•or Tenant ��PlP1�. Telephone No. n\ Owner's Address \U Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) �3 Purpose of Building Utility Authorization No. `oy� Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters r New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters � Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 7 Completion o theoflowin table EM be waivedby the Insector o fres. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o+of Total 2. Transformers KVA _ No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting d. d. Bette _Units y N No.of Receptacle Outlets No.of Oil Burners . FIRE ALARMS No.of Zones " . No.of Switches No,of Gas Burners o.of Detection an To Initiating Devices - No.of Ranges No.of Air Cond. Tons No.of Alerting Devices l No.of Waste Disposers eat Pump I Number ITons __ o,of Se f- ontained y� Totals: �' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ unicipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:*No.of Devices or E uivalent 3— No.of Water KW No.of No.of No. Wiring: .. Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: � Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: —J (When required by municipal policy.) �- Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. r INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless r the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The ---' undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND [3 OTHER ❑ (Specify:) I certify,under the pains and Ides ofpetjury,that the information on this application is true and complete FIRMNAME: Aries Electrical Service and Controls LLC LIC.NO15650a Licensee: Nor and Michaud SignaIC NO: 34594e (If applicable,enter"exempt"in the license number line.) __ Address: 290 Broadway suite 117 Methuen ma 01844 BTel.No.: A'PR hf37 0544 AIL .Tel.No.: *Per M.G.L.c. 147,s.57-61,security work 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 D owne•'s agent. Owner/Agent Signature Telephone No. P ERMIT FEE:$ .� 1� �, �� .sem, �� �� r' 77K Wfa'YfF nwade ofmanwi"WeaW .k1ul Office Of invadga&nS ,= 600 Wa0dn9titn Stied Bela,Man 02111 lawn an-gov/dia Workers' Compensation insurance Affidavit:Builders/CORftCtorSMIectricians/Plumbers Applicant Information Please Print Le My Name(Beammoypnizwonit dmdmt): •ARIgS.I. E SERVICE AND CONTROLS LLC Address 4.290 ixananwAv .qnTT 117 City/Stat9W,P: asp:tb,,,P,, Ma ni Ran Phone#:_ 97R R2 0544 Are YOU an employer?Check the spproprfide box: Type of project(required): 1.� i am an employerwith- .1 .4 0 I ani age coimactor andI 6.0 New constructionemployees(f dl and/or parttime* - hathired.the sub-contractors 2 ?1 'am a sole proprietor or partner listed on die attached sheet. 7.0 Remodeling 1*yip w4 havam e�rlcsyees bane 8.0 Demolition working ffor rite in any capaft. employees and have workers' [No workers'comp.insurance comp,insurance. 9 0 Building addition Te4dred] 5.0 We are a cw w&wn and its 10. 3.0 I am a homeownadit all work of5ieerS Imre their xxx �' or additions myself'[No worine cmu;L ofaxemption perm MGI. I L 0-Plumbmg repairs or additions ri ce t - e.M§l(4),and wehave no 12.0 Roofrepairs =rpioyNL[no workers' c0mF-insmancerequircd-) 13.13 Other *Any aPpBcaat OWbox al mastaho111 Wtft eswbn bei+dw esmpemnow pdity Wonutiea. $Homesxmerswhoso*two ittb�aitblavit 6nS T workBedtUmhireoak fe anearamdavit si& the=bctptsthat, tbisbs�mret�� nye a Md �,�a*zo�eeamteshmem,toyees u ffie�bave lam an a vrployerilratts prmridra MWfWTV awrenmam bnWOMWformy&WAVem Below is the po&y,andjob site inffflnzwon lnsuranm Company Mame_ . .Travelers;_Ins. - Policy#or Self-jus Int~ —5113 nom_ _ Expiration Davgf 2 X .lam Job Site Address. .> C�c tom_` � � —�.`. lSiai�p: �L Attach a copy of the workers'compenSittion policy declaration page(showing the Policy number and expiration(date). Failure to secure covmp as requbed,ander Section 25a ofMGy 152 can lead W the imposition of t ri minal penalties of a fine Up to$l, an&or oneyearImprisonment as well as diva Penalties in the fmrn of a STOP WORK ORDER and a fine of $250.00 a day against violator.Ali advised tht a copy oftis-st A meat maybe f W to the Office of Investigations of the DIA for coverage verification. 1 do herby eery mderikepakwaipamdGesofperjsry' ratite frfornWon provided above is true and cora L SnatuW Date PrwName:- Normand Kichand Phow-A. 938 687 0544 OJJieW use only Do not xrMe in this area to be complded by CI&or.town offlew City or Town: P�d`- Lssaing Authority(circle one): 6.i�of Heath 2. Department i City/Town Clerk 4.Elech3cal I r S.Plumbing Inspector Contact person: Phone � a a Date.................................. HORTM 94, .. TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �SS�cHUS This certifies that ....................................................... ........................... .,.... has permission to perform wirintg-in the building of................. `,E L C .�r'..................................: at ?.. �.. fj � .. ... �............,North Andover,Mass. Fee. . "" --Lic.No. g'�� C7 .. .-. .. ... ... ! ....................... S S Ce 06 Check # C,;p El RICAL NSPECTOR( / 8219 Cp, oicwaaLth o� aJsat a� Official Use Only w P � e7 Permit No. U . 4 a ar o ua arvlta� . Occupancy and Fee Checked BOARD,OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank) L APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the a sachusetts Elect.-ical Code(ttytEC)„52/vIR 1 .00 (PLEASE PRINT N INK OR TYPE ALL INFOPAL4TIO Date: City or Town of.- f J QtJ Doicrt- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. jLocation (Street& Number) Owner or Tenant ,� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Scrvice 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 EIectrical Work:. L•2r rrl �STPM ' Completion of the following table m be waived by the Ins ector Of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of ota Transformers KVA No.of Lu ninaire Outlets No.of Hot Tubs Gerierators KVA Swimmin-Pool Above n- o.o meroency ig.i rug• No.of Luminaires a ernd. ❑ grnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.ofZones No.of Switches No.of Gas Burners o.o electron an Ir'tiatina Devices No.of Ran es No.of Air Cond. Total No.of Alerting Devices g Tons eat ump rRumber lTons JKWNo.of Self-Contained No.of Waste Disposers Totals: __- Detection/Alerting Devices No.of Bishwashers Space/Area Heating KW Local❑ fv unicipal C] Other Connection No.of Dry:'.rs Heating Appliances Security ystems:* IQ No.of Devices or kcfuivalent - No.or Water °-° �0-°t Data Wiring: %I eaters KW Si nS Ballastc No.of Devices c-E uivaent No.of M°tors Total HP r elecommunications ming: No. Hydromassage Bathtubs No.of Devices'or Equivalent OTHER: 7- Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy:) Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVE GE: Unless waived by the owner,no permit foh the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation”coverage or its substantial equivalent The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) enalties o er'tt ,that the information on this application is true artd.eomplete- 1 eerttfy,under the pains and p fp J rJ' S3 3 e. FIRM NAME: ��T77 S�Gurt' Sc,rt1CCP5 LIC.NO.. Licensee: — � Signature' —� LIC.NO.: (lfapplicable,enter--e a pt"in the licens -num er line.) j�, Bus.Tel.No. $9l�GC Address: 't � C?L l NTm �_ ''" /(!S uH a` �p AIL Tel.No.: *Per M.G.L.c. 147.s.57-61,security work require Department of Public Safety"S"License: Lic.No. s CC G 9 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage no required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERtYIIT FEE. S YS Signature Te[ephoog No. 1 o Department of Public Safety _ One Ashburton Place, Ism 1301 Foston, Ma 02108-1618 License: CERTIFICATE OF CLEARANCE Number: SS CC 001975 Expires: 10/09/2009 Restricted To: 00 KENNY WONG 18 CLINTON DR HOLLIS, NH 03049 Tr.no: 439.0 Keep top for receipt and change of Et DPS-CAI A SOM-07ro7•PCB490 CO( fool'I'M ALTOF (��A55ACHUSEil15 ... .. �• L1•li 1: ! 1.7.11 :a ✓�c �novnsironncnl(� n!'✓�r�urr<«:��!!� • LEC 1A DEPARTMENT OF PUBLIC SAFETY REGISTERED SYSTEM TECH141CIAN UulCERTIFICATE OF CLEARANCE I5'-;U=_5)NIS LI.ENSE 10Number: SS CC 001975 Expires: 1010912009 Tr, no: 439.0 KENNY Q WONG S-License: ADT SECURITY 22 FIELDSTONE DRIVE I • n KENNY WONG BURLINGTON MA 01803-42-13 l' 18 CLINTON DR HOLLIS, NH 03049 "' LL CENTER: 888 344-7233 5966 D 07/51/10 28 4 07 2 DIG SAFE GA ( ) Commissioner z'. . L.- t•,•,7. 1.::1:1✓.• ;,;,;,; DRIVER'S LICENSE S$2919161SEX +' DATE Dr BIRTH CUSS RES �7� M 10-09.1969 D , Wo- 09 -2009 f VJONG r ' KENNY OIU �9 ONE DR 22 FIELDSTONE 1 1p�FiNl —___ - • BURLINGTON,MA 01803-4217 V r1q ` it .�.� L^j v`V J Location , No. Date 140RTPI TOWN OF NORTH ANDOVER opt.... ,•.'"o a Certificate of Occupancy $ Building/Frame Permit Fee $ ! * o st "" ,b �+Ss�CNUs t Foundation Permit Fee $ o Other Permit Fee $ I ' Sewer Connection Fee $ Water Connection Fee $ TOTAL 1 /Building Inspector "? 10909 Div. Public Works , AtIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I MAP KJ O. LOT NO. f 2 RECORD OF OWNERSHIP IDATEBOOK ;PAGE ZONE I SUB DIV. LOT NO. J Cf -I LOCATION �,© PURPOSE OF BUILDING �C$ /�, Je OWNER'S NAME - t� NO. OF STORIES J E %� OWNER'S ADDRESS BASEMENTgZ jiA�S6A.a„ ARCHITECT'S NAME _ SIZE OF FLOOR TIMBERS 1ST 2 k/V 2ND M j BUII,.DER'S NAME A% /^ 9� r SPAN J Jif% J� L/ V �i DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS -- DISTANCE FROM STREET POSTS I��IYcs, �• DISTANCE FROM LOT LINES--SIDES 9 j 7 EAR �/S%� « GIRDERS ( AREA OF LOT f7 A3 ,[(FCR,ONTAGE !/"1l HEIGHT OF FOUNDATION THICKNESS )® IS BUILDING NEW %i SIZE OF FOOTING h X 18 BUILDING ADDITI J^ �� MATERSAL OF CHIMNEY e 6 ✓if / IS BUILDING ALTERATION A�� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE f' IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY A-10' "A�O IS BUILDING CONNECTED TO TOWN SEWER `ICAloollo iIS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS s PROPER INFORMATION LAND COST SEE BOTH SIDES - V ((OO -'ST. BLDG. C08T FT.COST PER ER SQ. PAGE t FILL OUT SECTIONS 1 - 8 EST. 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 7 « OUILDIN41 INSPECTOR 'SIGNATURE OF OWNER-41h AUTHO ZED AGENT it OWNER TE ,F E E L.�I _ O•��� PERMIT GRANTED �y r CONTR.TELN N� �1 f � a mn CONTR.LIC.# Q 6 H.I.C.# MAY 1 5 1997 i BUILDING RECORD 1 OCCUP NCY 12 SINGLEFAMILY L., S FRIES: 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 RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ d I 2 I3 CONCRETE BL'K. PINE _ BRICK OR STONE HARDW'D PIERS PLASTER _ _ DRY WALL UNFIN. 3 BASEMENT AREA FULL I FIN. B'M'T' AREA op_ '/. 1/2 % FIN. ATTIC AREA NO B M'T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS L 9 FLOORS CLAPBOARDS V B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD%V'D ASBESTOS SIDING CO MCN _ VERT. SIDING . 111E S1UCC0 ON S NRY _ STUCCO ON �S QRVUtNRY ATTIC STRS. 3 FLOOR _ BRI " CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I J POOR 11 ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE I I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) / FIAT SHED ATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK $LATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING I I MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST I IPIPELESS FURNACE roip FORCED HOT AIR FURN. w,r{ " TIMBER BMS. &COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR �M WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G ZP7 11UNIT.HEATERS . J r: �Z 7 NO. OF ROOMS GAS OIL' B'M'T 2nd _ ELECTRIC ISI 13rd NO HEATING NORTri o Of4.�io e1'b0 i Town Of North Andover �_ °� oA Plan Building DepartmentReview , / 508-688-9545SSACHUS "CHUS `y � . 146 Main St. Town Hall Annex APPLICANT: 6S_JS54dSe M(0 d DATE: �g Zoning District : Use Code : Title of Plans and Documents: Request : Please be advised that after review of your building permit and or zoning review has been DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space Insufficient Lot Frontage Sign requires permits prior to Building Permit �Ot U not complete by other departments Not in conformance with Growth By-Law requires permits prior to BuildingPermit Other Remedy for the above is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign-offs Copyof Recorded Variance Information indicating Non-conforming status Copy of Recorded Special Permit Variance for Sin Other Plan RevleW The plans and documentation submitted have the following inadequacies 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, `4. Information is incorrect. 5.All of the above. # # of'ounlalion Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure 600 Construction Plans 127 Affidavit Mechanical Plans and or details I Plans Stamped by proper discipline Electrical Plans and or details Framing Plan Fire Sprinkler and Alarm Plan Roofing Footinq Plan Plans to scale Utilities Site Plan Water Supply Sewage Disposal Waste Disposal Other ADA and or AAB requirements Other Administration The documentation submitted has the following inadequacies : 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, 4. Information is incorrect. 5.All of the above. # # Water Fee State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other Other I The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice,by the Building Department,shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL.Any inaccuracies, misleading information,or other subsequent changes to the information submitted by the applicant shall bye rids for this review to be voided at the discretion of the B ' in epartment.The attached document titled"Plan Review rative" all be attached hereto and inc orated herein nce. The building departmen will rete' all plans and doc entatio or the above file.You must fi new uildi application form and or requ or plan view to receive a oval. Building nt cial Sig ure Inform ion Re eived Den' d If Faxed Denial Sent If you require assistance please call the above number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety.Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. I _ y Plan Review Narrative The following narrative is provided to further explain the reasons for denial for.jthe building permit and or request for plan review for the property indicated on the reverse side: 0,66 64 6:A fQa� ...�dl #iqM a„Fi Uk l'tot", Referral recommended : Fire Health Police Zoninq Board Conservation Department of Public Works Historic Commission Planning Other Other 'tAORT ovm of. op over No. � 0 —^ d dover, Mass. 19 9 rE $ BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...................................................... ........ ..S..S� ...., itJ�. :: Foundation has permission to erect...................�................... buildingg on �J. .ReA-0C.91?k-6 6 K-... Rough . ....... ......... ..... .... ........ .................... to bq occupied as S-1 Ata�.rL"............� 'I� ./... ... ...................................................... Chimney provided that the person accepting this permit shall In every respect conform to t terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspe tion, Alteration and Construction of 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 UNLESS CONSTRUCTION ELECTRICAL INSPECTOR --- Rough ....................... ... ........ .. .. ..... .....L..DiIN........IN.......PCTOR Service 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 Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. ,1 ' � RT Town, of 0 over In .No. 236 b dover, Mass., 19 9) �-COCMICME WICK0 E D 5 ` BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......................................................�!.....�..�.....C.�.�..x...�..........��....S,.S..��....�.....��..-�v�+ Foundation has permission to erect.................../................... buildingq on ......5_ .294.090 �..�+.,�.!L.�� ' .......... ...................... Rough to be occupied as.................................... ........... ................................. Chimney provided that the person accepting this permit shall in every respect conform to 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ATS ELECTRICAL INSPECTOR 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 _ k;7 Street No. Smoke Det. s Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Nam of Applicant on Building Permit(below) Address of Property for Permit(below) Map and Parcel : Purpose of Appligation (check below) Phy4ue Qf Applii t: __L-W9le Family —Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. 1 also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is An application for a building permit for the enlargement, restoration,or reconstruction of a dwelling in existence of the effective date of this by-law,provided that no additional residential unit is created. he lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Byaw. This application is for dwelling units for low and/or moderate income families or individuals,where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents,where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section"senior"shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density,(buildable lots), below the density,(buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply,whether done to my knowledge or not, is grounds for refusal by the Buil ' g Department to issue a Building Permit. Signati.Tre of Owner or,A >uthorized Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit. PAY 15 1997 FORM U - VERIFICATIOv 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. �C)o o�9 ****************Applicant fills out this section* * *** * **** APPLICANT: � �io,� ) kze Phone LOCATION: Assessor' s Map Number l/3Z2 Parcel ��►��`l r Subdivision -e-h /G-2 IS Lot(s) Street 5C' St. Numbers ************************Official Use Only************************ PC NDATIONS OF TOWN AGENTS: ` Date Approved Conservation Administrator Date Rejected omments l l JDate Approved ,i"Ik6-wn Pla"n-rief Date Rejected Comments Date Approved Foo4Ins ector-Health Date Rejected Date ApprovedpSpector-Health Date Rejected Comments Public Works - sewer/water connections / -T� /��T�� - driveway permit Fire Departmenj�24w w �a CA-u n W-. P_r �e-t2.s ✓�e�d l f I 1,7 Received by Building In4ector Date MAY 1 5 1997 OEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nuaber: Expires: Birthdate: CS 068988 10/14/2000 10/14/1958 Restricted To: 00 ALBERT C COUILLARO 85 CASABLANCA CT HAVERHILL, MA 01832 I 1' MAY 1 51997 0 EXIST.FND. T.O.F.=128.6' LOT 19 \ 1y 6+ EASEMENT j g+ _ RY STRUCTURE FOUNDATION LOCATION PLAN THE HoR/ZONTAL SETBACK REOUIREmENTS OFOWN 7HOCACONFORMS TO APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CER7IF7CA71ON DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS,WETLANDS,EASEMENTS. CLIENT: ��++ D.ECS M. ORDERS OF CONDMONS.ETC.) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY THIS CERTIFICATION /S MADE AND LIMITED PURPOSE OTHER THAN THAT OUTLINED ABOVE,EXCEPT WITH THE WRITTEN PERMISSION OF CHRISTTANSEN A• SERGI INC TO THE ABOVE CLIENT. FURTHERMORE THIS DRAWING is THE COPYRIGHM PROPERTY OF CHRISTZANSEN & SERGI INC. AND ANY UNAUTWIZED USE IS PROHIBIT£D.CHRISTIANSEN A• SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR- AIA770N CONTAINED HEREON. LOCATION:LOT 19 "EVERGREEN ESTATES" ` NORTH ANDOVERNA. VOF Mq�w' t SCALE. 1"=80' DA TE.7110197 ° MSC ' E No •U 's CHRI S TIA NSEN h SERGI PULANDFESS/ONAL SURVEYO SEERS �r,wo ver 160 SUMMER Sr. HAVERHILL,AIA. 01830 TEL 508-373-0310 ®1997 BY CHRISTIANSEN & SERGI INC. DWG.NO.: 94036076 40RTN Town Of North Andover Plan Building Department 4L,�a Review 508-688-9545 �'ssqcHuSE�ty 146 Main St.Town Hall Annex APPLICANT: 6 �`i7 yr#ezrd A DATE: �Z , Zoning District: Use Code : Title of Plans and Documents: Request : Please be advised that after review of your building permit and or zoning review has been DENIED for the following reasons: Zoning .Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space r Insufficient Lot Frontage Sign requires permits prior to Building Permit Form U not complete b other departments Not in conformance with Growth By-Law Use requires permits prior to BuildingPermit Other Other Remedy for the above is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign-offs Copy of Recorded Variance Information indicating Non-conforming status Copyof Recorded Special Permit Variance for Sin Other Plan RevlW The plans and documentation submitted have the following inadequacies 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, '4. Information is incorrect. 5.All of the above. # # oundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure Construction Plans 127 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details Framing Plan Fire Sprinkler and Alarm Plan Roofing Footing Plan Plans to scale Utilities Site Plan Water Supply Sewage Disposal Waste Disposal Other ADA and or AAB requirements Other Administration The documentation submitted has the following inadequacies : 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, 4. Information is incorrect. 5.All of the above. # # Water Fee State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other Other t The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice,by the Building Department,shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL.Any inaccuracies, misleading information,or other subsequent changes to the information submitted by the applicant shall be gr nds fort is review to be voided at the discretion of theVBnapartment.The attached document titled"Plan Review ative" all be attached hereto and inc ated herein . The building departmen will rete' all plans and doc tali or the u t fi new ildiation form and or u or plan 'ew to receive oval.above file.You m s r� Building pfa—AO@15`t-Qecia1 Sig ure Inform ion Refeived Den' d If Faxed Denial Sent IfYourequire assistance please call the above number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety.Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. y .Z.n ;., CERTIFICATE OF USE & ,OCCUPANCY ;. Town of North Andover V Building Permit Number 236 DatAJuly 29, 1998 THIS.CERTIFIES THAT THE BUILDING LOCATED ON 55 Beaverbrook Rd MAY BE:OCCUPIED AS Single Family Dwelling i IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY, CERTIFICATE ISSUED TO D.E.C.M. Essex Inc o ADDRESS'S' s 6 Rogers L wel s s �4-4`""S� Building Inspector i 1 FI 1 I ' 44 over TO". \ O `_✓j r 1 t •d No. * 7. _ lover, Mass., � 9A CO CN IC NEWICK ~ '�• - : . # '9S oqA E MIT ca BOARD OF HEALTH PER Food/Kitchen Septic System D DING INSPECTOR THIS CERTIFIES THAT C Foundation ;: buildings on . .... � has permission to erect.....::' """""' ""' /..... oug to be occupield as.............:...... ://�lC. � ..t..l ....... .............. .....:... :... the person accepting is-permit.shall:in every,t6spect conform to tf. terms of the applicatiori on file in provided that p pt g�11 ,. -Final this office, and to the provisions of the"Godes'andaBy=Laws rer' rng to the Inspection, Alteration and Construction of Buildings in the Town of North,Andover. t `! t �' PLUMBING INSPE R of the Zoning.or Building Regulations Voids thissPermit. VIOLATION 9 in 7 ` PEP;MIT EXPIRES IN :6 MONTHS ELECTRICAL INPE R _ UNLESS CONSTRUCTION STARTS/. -' Lugh ; f '.� ................ � Service /i DING INSPECTOR nam Occupancy Permit Required to Occupy Building GAS INSPECTOR" Rough • s Place on ;the Premises — Do Not Remove n g r Display in a Conspicuous No Lathing ,or Dry Wall To Be Done FIRE EPARTMENT Until Inspected ..and Approved -by the Building Inspector. Burner — /0 5 /c'� Street No. 4 ''I Smoke Det. IN, A • �e A v y. .ate MASSACHUSETTS-UNIFORM APPLICATION FOR .PERMIT TO'DO PLUMBI' �. (Print or T } Mass. Permit „, 60� Building ILocatlon _J0 7`f /t;l _ Ovrner•s Name L 12 4 ed. TYIe of Occupancy (( — _S1� i New a3--- Renovation O Replacement O Plans Submitted: Yes 0 N9 O FIXTURES z q z N = Y < h vlN O z h > W Y j N } V < � W N z N < ¢ < " �' N W X C! ¢ O W N' h W y ¢ S ¢. N X N d a ¢ 03 W ¢ < W ¢ � t W x < r o x s '' N W y y a a z o 0 y x x IW- o V xx 44'SUB-8S.MT. 13ASEIAENT IST FLOOR 2ND FLOOR , 3RD FLOOR 4TH FLOOR STH FLOOR eTHFLOOR TTH•FLOOR STH FLOOR Installing Company Name 10/.40+7i'� Check one: Gettlficate Address ®.Corporation , 0 Partnership Business Telepfhonp FiirrrtJCA. � Name of Licensed Plumber i4rr"l / I �- INSURANCE COVERAGE: ._. I have a current Rabjlity Insurance policy or its substantia} equivalent which meets the requirements of MGL Ch. 142. Yes Q' NO ❑ If you have checked yes. please Indicate the type coverage by checking the appropriate box. A habil t;y Insurance policy Gl--' Other type of Indemnity O Bonet O CWNER°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 -- Owner C1 Agent❑ 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 any knowledge and that ail plrinbing work and installations perfdrmed under theit issued for this application will be in compliance with ail pertinent provisions of the Massachusetts State Ptu ing Code and p r i6 of the oral Laws. BY._..__ g atuae of lace lumber Title- Qty/71 Gty/i own Type of License: Master( Journeyman Q ANP)Mv�,IEEt i US• oNL license Number 0 /D4 i_y ' Date4-- - . 12 36107 gORTM �'<.�•° .1�a TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SSACHO � This certifies that . �� �. �' . . . . .��°�. . . . . . . . . . . . . . . . . . . has permission to perform HP 4.--. < . . . . . . . . . . . . . . . plumbing in the buildings of .D f North Andover, Mass. Fee. .3? .Lic. No..l 04 D V, . PLUMBING INSPECTOR 02/09/98 09:12 337.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR'PERMIT TO CO GASFITTING (Print or Type) 1 Ar , Mass. Date ,,,p Building Location LO /9 Owner's Name D6-C/ll /—q- New �7E v-P,2.6YYip Type of Occupancy New � Renovation Q Replacement 0 Plans Submitted Yes 0 No 0 MIX Y Z a CO W M_ pq O _ j� O } Z 0 M _1 WW W w M O Z O w � 0 Z J Z < 2 M M W � W O WUj UJ Z � M Ill M N <, N M Z 6 Z w "'� I— W. o� x0axUUR :Z)M 50 Lu toQ SUB•®SMT. BASEMENT I IST FLOOR 2ND FLOOR 3AD FLOOR 4TH FLOOR STH FLOOR 8TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name f Address (JE.�^�—� Check one: Certificate I V,9- M O Corporation Business Tetephon0 Partnership dr dame of Licensed Plumber or Gas Fitter Firm/Co. TA M �"c .T: , INSURANCE COVERAGE: i have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes e''� No It you have checked es, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy. M°'r Other type of indemnity 0 Bond 0 i OWNERS INSURANCE WAIVER: 1 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 + i natur f wrt r r 'Check one: n r' % nt Owner C1 Agent 0 1 hereby certify that ail of the details and information I have submitted (or entered) In above the best-of my knowledge and that all plumbing work and installations performed under the permit issued f be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapteor 142 of the and accurate to or th.s application uvili By General Laws. Title T pe of License I mber O Gsfitter CIty1Town 8-roaster ature of is s d Plumber o as ltter AF'PAO r 0 Journeyman cense Number 1 Q r$'©© s Y� I r � Y � J 2 C � , � ) G � 1 �' Z � � 2 .V 3 2 Date. . ........ �� ca „pR7p TOWN OF NORTH ANDOVER a ,4, + PERMIT FOR GAS INSTALLATION F T i 7Qf�'r • SSACMUSEt This certifies that . . . ...... . . . . . . . . . . . . c. has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . ! . . . . .`. . . . . . �`. . :. . . . . . . . . . . . . . . . . . . at . .? . ' . . . ....,. . .. .�. . . . . . . . P�INPEcToh Andover, Mass. Fee. . ?. . . . Lic. No../. . .�!. . `. . . . . . . WHITE:Applicant CANARY: Building Dept. PINK:Treasurer