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Miscellaneous - 59-61 PARK STREET 4/30/2018
U� i �V v v PO Box 55098 Boston,MA 02205-5098 617-951-0600 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N ANDOVER, MA 01845 N ANDOVER, MA 01845 RE: Insured: PAUL LAURIN and SUSAN LAURIN Property Address: 60 PARK ST,N ANDOVER, MA Policy Number: HMA 0293531 Claim Number: BOS00048448 Date of Loss: 2/11/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any.notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number,date of loss and claim number. Marc Chizauskas Claim Examiner 2/17/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3526 Fax: (800) 297-5212 Email: MarcChizauskas@Safetylnsurance.com P Date..... -../..`. ... r NORTI� 3:0;• ``°-••'."°0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ssAC14US� This certifies that ..... ................. A..Z1.. . ......... �T'....... has permission to perform ....!. !. A� ... G/T�K!a.........s�� "o....� " wiring in the building f...........SL./:�, � ......................................... at..�./..:'.!�..`.�/Z/ ,.. �................... North Andover, j Fee..`.��.. ....... Lic.No.67 1 �..........(2�'Ea ��ig . ' ' Check it 8 6 u 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 3 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 . W 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. . 1 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. EWRule —Permit/Date Closed: **Note:Reapply for new permit rmitExtension Act—Permit/Date Closed: .40 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked b BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: e c) City or Town of. NORTH ANDOVER To the Inspec of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ,-.6 / d4 ti/ Owner or Tenant ,t, Telephone No. Owner's Address j e LC i,_ 14 Is this permit in conjunctio ith a building permit? Yes © No ❑ (Check Appropriate Box) Purpose of Building 1,, "t i Utili Authorization No. Existing Service !l� Amps > �,D / Yaolts 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: ��� f-�_74- Completion c.,Com letion of thefolloudng table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp. (Paddle)Fans �No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency ig g d. nd. Baq=Units -- No.of Receptacle Outlets No.of Oil Burners FIRE.ALARMS No.of?psnes No.of Switches No.of Gas Burners No.of Detection and InitiatingDevices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump I Number ._,ons 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 WaterNo.of No.of Heaters KW Signs Ballasts . Data of Devices or Equivalent 0 No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent -,, OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: /Q e C7 U(When required by municipal policy.) Work to Stal LSD Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: 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 undersigned certifies that such cov ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 9 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: i4tA,/t LIC.NO.: 9 20 Licensee: I ---Q/41 ,t 2 ,,V Signature/7� /A4 . O, LIC.NO.:��� 22 (If applicable, enter"exempt"intense number line.)-�� Bus.Tel.No.: Address: /d/ kA= , r�" �jl,�./ Alt.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 ❑ owner's agent. Owner/Agent ere Signature Telephone No. PERMIT FEE: $ �j , ti- ��� t� t 1 r e ' The Commonwealth of Massachusetts ki ! Department of Industrial Accidents a # Office of Investigations "�'" 600 Washington Street VM Boston, MA 02111 . www.mass.gov1dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name(Business/Organization/individual): ✓y�/Z. /9 e16 G Address:_ / 7n City/State/Zip- r e, Phone#: . 90 Z q Are you an employer?Check.the appropriate box: LEI❑ I am a employer with 1- 4. 11I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑� New construction / 2.❑ I am a:sole proprietor or partner- listed on the attached sheet.t 7. f Remodeling J` ship and have no employees These su&contractors have 8. ❑ Demolition / working for me.in any capacity. workers' comp.insurance. 9, ❑ Building addition [No workers'comp, insurance S. ❑ We are a corporation and its aired 10.❑Electrical required.] officers have exercised their repair;or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No-workers'comp. c, 1.52, §1(4),and we have no 12. Roof insurance required.] employees. ❑ repairs u1 � [No workers' i comp. insurance required-) 13.(]Other •Any applicant that checks bo)t#l must also fill out the section below showing their workers'compensation policy information. t 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•polio,infomu don. 1 ant an employer than is.provi&ng:workers'compensation insurance for mY employees: B information. elow is the policy and job site Insurance Company Name: O i✓ /L Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: tS� �'� /"� `ti City/State/Zip:_ rl�� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a- f 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. I do hereby certify under th pains andpenalties ofperjury that the information provided above is true and correct. Si tore: D �---- D Phone#: [Contact l use only. Do not write in this area,to be completed by city or town official r Town: Permit/License# g Authority(circle one): rd of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector er Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. c 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." , r 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 cavy 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 ,. Accideri s 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 numberlisted 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 hes 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 permitnicense 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. When 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-7274900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7744 Revised 5-26-05 www.mass.gov(dia 59 ELM STREET 055.0-0018 Complaint Detail Report Printed On:Fri Oct 09,2015 Complaint#: CT-2016-000015 Status: Closed GIS#: 2985 Violator: SLATTERY, SHAWN M 4Yur Address: 59" Map: 055.0 Address: 55 EQUESTRIAN DRIVE • Date Recvd.: Oct-09-2015 ITiIne Recvd.: 08:14 AM Block: 0018 NORTH ANDOVER,MA 018 Category: Trash and Debris Lot: Type: Residential GeoTMS Module: Board of Health District: Trade: Recorded By: ILisa Blackburn Zoning: I Structure: Description Complaint: Anonymous call received from neighbor of 59-61 Park St.Excessive amount of trash and debris in the back yard.Caller is concerned about mice/rodents.Landlord is Shawn Slattery,55 Equestrian Drive. Comments: Inspector Assigned to Complaint:iMichele Grant Contacts Contact Type Date Time Name Phone Best Time To Reach Recorded By Response Caller Oct-09-2015 8:14 AM Anonymous Lisa Blackburn Follow-Up by Michele Grant Actions Taken GeoTMS Module Status Date Time Response Type Action Taken Comments Board of Health REFERRAL Oct-09-2015 10:17 AM Follow-up by Public Deb Rillahan went out to Health Nurse property.Did not see any trash/debris.Could not see into back yard due to mature trees and a fenced in yard. No public health hazard noted.Case closed for now. GeoTMS®2015 Des Lauriers Municipal Solutions, Inc. Pagel of 1 Date...../.nLe;,.�f.... J NORT1� o?°;��``°;•.�"°off TOWN OF NORTH ANDOVER ` PERMIT FOR WIRING ss�CHUS -}� r7 This certifies that .....�!!l?........-�✓.�.....��..�.�Z�.�.....................,.............. has permission to perform ,,n U n .../. ..13 5/n ak—rlcd . ........... ...... SLS�i^7i C�c�%C►���rt.� wiring in the building/!of.......... .,..........f...l.......... ............. ........................... k. .� ... ./ ......,........... ...... ....................Pra North Andover,Mass. Fee. "o...... Lic.No.� 7� 6.......... LINSPECIQR Check # f � 88r 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 §Rule S: In accordance-with the provisions of M.G.L.c. 143,§3L,the r� permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed "IJ( 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 G electrical permit shall be issued to the person, firm or corporation stated on the permit a2plication. 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 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. . 7 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. [,1! . ule 8—Permit/Date Closed: 2 /f **1oTote:Iaeapply for new pePermit Extension Act—Permit/Date Closed: \\ Commonwealth of Massachusetts Official Use Only f Department of Fire Services Permit No. 9K-2 Z Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of 's or h r intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No. Owner's Address ti pf n.�?,v In" 69 Is this permit in conjunction with a building permit? Yes FIA No ❑ (Check Appropriate Box) Purpose of Building 6VL2 ,,y,t U ' 'ty Authorization No. Existing Service J 0 O Amps /-2,U olts Overhead Undgrd❑ No.of Meters z5?, New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters .A Number of Feeders andmpacity Location and Nature of Proposed Electrical Work: / ly .v t) �c. A.v i60-ic G leh'on o the followin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total . Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA 1 No.of Luminaires Swimming Pool Above ❑ In- o.o Emergency Lighting r d• nd. E] Battery Units — No.of Receptacle Outlets lS No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burnerso..of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump __umber. Tons KW _ No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingMunicipal KW Local❑ Connection ❑ Other No.of Dryers Heating Appliances Kw Security Systems:* No.of WaterNo.of Devices or Equivalent Heaters KW No.of No.of Signs Ballasts Data W f Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �„ od LJ, 04V (When required by municipal policy.) i Work to Start-/ 0 �j Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: 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 undersigned certifies that such cov9rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. _ FIRM NAME: l�/itlG��✓� �i F-i�.,i �P LIC.NO.- Licensee: ��i,JP G✓� �� Signature LIC.NOcf> e-oZ (If applicable, enter"ere t"in the license number line.) Bus.Tel.No.: Address: A�9 n1 , G Alt.Tel.No.)0? 1Z,,i *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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 1 ' The Commonwealth of Massachusetts kj ! Department of Industrial Accidents t . c Office of Investigations 600 Washington Street r lair v. ! Boston, MA 02111 t�3 www.mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician/Pinmbers Applicant Information Please Print Legibly Natne (Business/organizafion/Individual):_46AJ/ Address: l /)--?' �/' ,, ✓��,, /' City/State/Zip:Z14 �-cJ ifs Phone Are you an employer?Cheek.the appropriate box: 1.❑ I am a employer with 4, ❑ I am a general contractor and I Type of project(required): employees (full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2. am a.sole proprietor or partner- listed ort.the attached sheet t 7" E'Remodeling ]]]]]] ship and have no employees These sub-contractors have 8. [J Demolition working for me.in any capacity, workers' comp.insurance. g, ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No•worke'rs'comp. c. 1.52, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp. insurance required..] 13.70ther Any aPPtican that checks bo)t#I must also fits out the section below showing their workers' nonP�sation of icy information. t Homeowner¢who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. 4Contnactors that check this box must attached an additional sheet showing the mune of the sub-contractors and their workers'comp.policy.information. I ant an employer that is.providing workerscompensation insurance for my employees; information. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie.#: 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 Section 25A of MGL e. 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct y Signature., IDate. d Phone#: 9, � �� r—,S y�. 8 F only. Do not write in this area,to be completed by city or town ofcialn: Permit/License# ority(circle one): ealth 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: '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 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, MOL 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 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,notthe 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 numberlisted 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-8.77-MASSAFE Fax 4617-727-77 49' Revised 5-26-05 www.mass.gov/dia Nicetta, Robert From: Nicetta, Robert Sent: Friday, October 04, 2002 3:13 PM To: Dolan, Chief William Cc: Melnikas, Lt. Andrew, Morgan, Deputy Ed; D'Agata, Donna Mae; Griffin, Heidi Subject: RE: 59-61 Park St. Chief--Pursuant to the Planning Board SPECIAL PERMIT decision of September 29, 1992 the following is stated under Paragraph 4 of the Special Conditions: "The existing 59-61 Park Street building may be used only for employee meetings and storage of non-medical supplies or as the designated residential use. No patient services are to be provided in this building. The building will not be permitted for use as a general office or for administrative purposes". Hope this helps, Bob -----Original Message----- From: Dolan,Chief William Sent: Thursday,October 03,2002 2:13 PM To: Nioetta,Robert Cc: Melnikas,Lt.Andrew;Morgan,Deputy Ed Subject: 59-61 Park St. Bob, 59-61 Park St. is the two family next to the Greenery. I know that when the Greenery added on a few years ago some stipulations were applied to this building and they could not use it. They are now using it as storage and i have gone through with the Deputy and Lt. Melnikas and they are going to clean it up. I have a meeting with the management in a week or so to discuss this property and its future use. What are the conditions or restrictions on the use of this building? I knew at one time but cannot remember now. I think they wanted to put offices in there and were precluded from doing that. I would like to work with the management and neighbors to get this used(it is still in good shape)or if need be taken down before the building becomes a real hazard. So what can you tell me about 59-61 Park St.l Tracking: Recipient Read Dolan,Chief William Melnikas,Lt.Andrew Morgan,Deputy Ed D'Agata,Donna Mae Read:10/4102 5:11 PM Griffin,Heidi Date.� . . . . . . . . ♦ HORTN �'.� •° .'�o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,'SSACMUS� This certifies that .�.,!� . .�. . . . . . `'. .� . . . . . . . . . . . . has permission to perform . . . .f . . . . . . . .. . . . . .I. . . . . . . . . . . . . . ' plumbing in the buildings of . . . : .-:-- . . . .1. . . .. ...!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. North Andover, Mass. Fee Lic. No;.' 1./. ./. /0-..��!r� .;y . . . . . . . . PLUMBING INSPECTOR C ' Check # / T r�C� tJ 1 2 1 � J MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS I`/ Date Building Location '5-y` 6 / AG1� J7r Owners Name Sz4 �'�y Permit# Amount Type of Occupancy New Renovation Replacement v� Plans Submitted Yes ❑ No ❑ FIXTURES Fy �• O E~ � W o Ln un W � w x A U a O H F x x a z A w A x x U x �7 Cq A A ►� x F a C�7 A � � W SLIMM BASEUM MR" 21\II FI�2 3M FLOOR 4M ILOCR SII3 H M 6M)FLUOR - 7II3)FLocXt SIH FLOOR (Print or type) -7� Check one: Certificate Installing Company Name /J���� Z, Z PL(j 4 I-Ie44,v�� ❑ Co Address -/ / v"' '`' 44e Partner. Business Teleph one Name of Licensed Plumber: z(y`j,¢/L "47— 'Z/-z- y Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massae et Sta Plumbing Code and Chapter 142 of the General Laws. By: 01g„aLuie 01 i censea Ylultroer Title Type of Plumbing License � a'L / S'9 City/Town lcense um er Master ❑ Journeyman APPROVED(OFFICE USE ONLY •� `` \ The Commonwealth of Massachusetts k� t� Department of Industrial Accidents Office of Investigations ii tLtrr 600 Waskingion Street ,Ja \ rf Boston, MA O2111 c www-mas..gov/tits . Workers' Compensation Insurance Affidavit: Builders!Contractors/Electricians/pfumbers APPlicant Infnrn;ation Please Print Up- -Maine (Business/organization/individual): In \•77 yy-� Address: City/State/Zip: /v/ � ✓��. (�ld�y L-- Phone Are you an employer?Check.the appropriate box: 1.❑ I am a employer with 4. ❑ I am a general c7sheet F[] ject(required):' employees(full and/or part-time).* have hired the stNewconstruction 2. I am.a:sole proprietor or partner. listed on the attadeling ship and have no employees These su&contractors have . working for me.in an lition y capacity. workers;' comp.insurance.[No workers'comp, insurance 5. ❑ We arc a corporation and its ng addition requ1am sed.] officers have exercised their ical repairs oradditions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c, 152, §1(4),and we have no insurance required.]t employees. [No workers' 12.7 Roof repairs comp• insurance required_] I3.0.0ther "Any applicant that checks ba#l must also fill out the section below showing their workers'compensation policy information, T Homeowner;who submit this affidavit indicating they are doing all work and then hkC outside connactots 4Contractorn that check this box must attaeh�sn add•'tiauai sheet showing Ehe name of the sub-cp tst submit a new affidavit indicating such. ntmetm and their workers'cera.cod - • I am an employer that is provWtng,:workers'cum enation srformahor. information. ! P �nsurarue f or nt1'emP�Yees: Below is the Policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date Failure to secure coverage as required.under Section 25A of MGL e. 152 can lead to the impost#ion 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 fi 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 ne Investigations of the DIA for insurance coverage verification. I do hereby cerci nder the p and pen of perjurY that the information Provided arbove is true�Uct Si ture: Date: Phone 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.CitYfrown Clerk 4.Electrical Inspector S. 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 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 mom of the'foregoing engaged in a joint enberprise,and including the legal representatives of a deceased employer,or the receiver orbustee 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 compietely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)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 requited to obtain a workers' compensation policy,please call the Department at the numberlisted below. Self-mn red comnanie-S Should-.nt--their self insurance'liceme 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL# 617-727-4900 ext 406 or 1-8.77-MASSAF'fi Fax#617-727-7744 Revised 5-26-05 www.mass.govldia ".O TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING 40 ,SS4CMUSf This certifies that .j . . � lt .l, U . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . 1- L. . . . . . . . . . . . . . . . . . . . . at . . .(.p. . .O/.4/?./. . . f.r`' . . . . . . . . . , North Andover, Mass. Fee. Lic. No..12/y.4 . . . . . . ..`1: �.. . . .� �y,� . . . . . . . G -t PLUMBING INSPECTOR Check # - 6731 'Inspection of Plumbing MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print of Typo) Mass. 3 Permit # 8ullding Location /� Owner's Name-y V l r4al vl --- Type of Occupancy �)V1New ❑ Renovation ❑ Type Plans Submitted: Yes O No O FIXTURES z .V) Z' . r' N 0 O Z ti W Z 41 < < v h. v) > j �y W O H = e: y Z — = N 4 ¢ ►. c a 0 d 2 J _ �+ r_ b i 3 Y J O- IA p < < W. 0 V z c -+ 3. x ►- yr q a ; ° m o SUF170SMT, BASEM x FNT IST FLOOR 2N0_;FLOOA 3RO..:FL0,6A 4TH FLOOR STH FLOOR 6TH FLOG-R 7TH FLOOR OTH FLOOR Installing Company Name . Address L–CACheck one: Certificate �O�rnun 4 IQ� 4 Y-N Corporation _ Business Telephone__78\ (C) ❑ Partnership Name of Licensed Plumber Q Flrm/Co. INSURANCE COVERAGE: I have a Ye curr-nt liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. elf you haves checked No � 2 Yk,9, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee Insurance coverage required by does not hav the I Chapter 142 of the Mass. General Laws, and that my signature on this permit a thePPlIion waives this requirement. nature O net Or nei's A ant Check one: Owner ❑ Agent❑ 1 hereby certify that all of the details and information I have submitted( tared)i b e applicaC are true and accurate 10 the bast of m knowledge and that all plumbing work and installations performed u , or a parr s for(hi Pertinent provisions of the Mhssachusetts.State P)umDing Code a a plication will be in compliance with all y Pter I By Title Signature o scense um or Cit /TownType of License Master Journeyman❑ License Number 0(r- NELOW FOR OFFICE UEE ONLY ' tN 4INEPE t1.0�1! 'OKE� TCHEE FEE 'ROQq ItS.IN ptCt1CN8 NO. APPLICATION-FOR PERMIT TO DO PLUMilN6' J UNDERGROUND ROUGH COMPLETE ROUGN FlN L IN8PQCTiCN 4' PERMIT G��NED DATE PLUIRSING TRIFiFfo" Location �aq_ 61 J No. S70 Date A Q a ,.ORTIy TOWN OF NORTH ANDOVER A Certificate of Occupancy $ Permit/Frame Buildin P g e Fee $ °' n a ' n Permit Fee $ S�cMust • °� ermit Fee $ 0 Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspe or i Div. Public Works PER111T N(5,7 y APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. v PAGE 1 �.- MXp -No. T NO. �� 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE SUB DIV. LOT NO. �) LOCATION RPOSE OF BUILDING OWNER'S NAMEJe�� NO. OF STORIES SIZE OWNER'S ADDRESS ..[�Q / / /Jj1/>�] / BASEMENT OR SLAB - ARCHITECT'S NAME JJ 77 C f�1C�/l.� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME `' D�S U�/ �y1 SPAN DISTANCE TO NEAREST BUILDING 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 % IS BUILDING ADDITION MATERIAL OF CHIMNEY j X15'-BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND v 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 - BLDG. COST 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 PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FIL I Ii-- BUILDING INSPECTOR SIGNATU F NER OR HORIZED AGENT F E E O �' OWNERTEL.k y �' �� �7Z PERMIT GRANTED R.TEL. 19 ONTR.LIC.# H.I.C.# �� � t , BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYSTORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LY MULTI. FAMIOFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY VIALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'T' AREA _ 114 1/7 '/, FIN. ATTIC AREA _ N_O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDY✓'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME 01 BRICK ON MASONRY ATTIC STRS. 6 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I_ 1 POOR ADEQUATE 1 NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13BATH FIXE_ GAMBREL I MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 6 GRAVEL STALL SHOWER _ ROLL ROOFING I I 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 11 7 NO. OF ROOMS 0 S OI l B'M'T 2nd ELECTRIC 1st 13rd NO HEATING �e 10anvi�taruuealC` 0/-14�11/1 w", Restricted To: 00 �? DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE �� 00 - None f NUAber:: Expires: Birthdatei 1A - Masonry only CS' 052921 ', 05/19/1997 05/19/1964r 16 - 1 8 2 Fasily Hones Restricted To: " 00 JOSEPH H ORALINSKI 107 BRADFORD ST EVERETT, HA 02149 i Town of North AndoverNORTH f � + OFFICE OF �a o`,"`o -0 0 COMMUNITY DEVELOPMENT AND SERVICES p . - 146 Main Street ;rO ; + North Andover,Massachusetts 01845 `0�.'Io- y WILLIAM 1.SCOTT SSACHUS� Director In accordance with the provisions 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 c 111, S 150A. The debris will be disposed of in: (Location of Facility) J � ignat e f Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of over L No. s . over, Mass., 19ff LAKE 9A_COCNICMEWICK 11•" �J%4 E o PP`y 'Cy S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • �� w BUILDING INSPECTOR THIS CERTIFIES THAT........ .. ..... ...... ... .. ..........10 ...... .. ......................... ou • F ndation has permission to west...... . . . .. ............. buildings on ..... ......... ... ....... ........... Rough to be accupled as • ,.................................... Chimney providyJ than the person acc ting this permit shall in every r ect cc'nform 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 tine Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI N STARTS ELECTRICAL INSPECTOR Rough ........ . .. ........ . .. .. .... ..............................................................r Service BUILDING 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 Until Inspected and Approved by the Building Inspector. DEPARTMENT Burner Street No. Smoke Det. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN' G t (Print or Type) ,t NORTH ANDOVER Mass. Date 71 {wilding Location �(' ypk(; - Permit . Y wners Name ? New 77 Renovation Replacement 13"*�' Plans Submitted II 9 Fly—Llo-� as ,. _ iL of aC t!f Z .O Z to Z l— w m ° c� m 01 d Oi Ow o L us wwa v es 0a Z w u, a ? W U -4 cw , c `z o tas W % a v i y c a 1- o SUR—BStdT. BASEMEt1T 1ST FLOOR { 21,iD FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR TTK FLOOR 8TH FLOOR 4 t (Print or Type) ffkk Check one: Certificate Installing Company Name I I XQCkN k C (R� �,(yC Corp. Address ; j 41(a2,r— Partner. Ly, Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter kroy-y/ n2NJ - f Insurance Coverage: Indicate t:^e t•.,pe of insurance coverage by checking the appropriate box: Liability insurance policy = Other type of indemnity Q Bond Insurance Waiver: 1, the undersicned, have been made aware that the licensee of this a h•catton does 4ot have anv one of the above three insurance coverages. Sign ure of owner/agent of property Owner u Agent I hcteby certify that all of the dc(ails and information i hare tubmitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and Instadatio= —wafa ated under Fermut i=cd fo: this sppUcation wiLl be in contplianca With all pertinent Provisions of the Massachusetts State Car Qdc and 0Aptes 14�of tSe General Law&. -_ By _PE LICENSE: Z, Plumber Title I Gasfitter Signature/ of Licensed City/Town- I Master Plumber or Gasfitter Journeyman o?! S3 e2 APPROVED (OFFICE USE ONLY) License Number 4 •r Y b; I' A?a 1997 Date.�L�> �". ......... 1 ~ Q . �pR*� TOWN OF NORTH ANDOVER EE 0 PERMIT FOR GAS INSTALLATI N LO SSACHUSE This certifies that . ...?.:. t., . . . . . . . . . . . . . . has permission for gas installation . . .b--. P. . . . ..... . . . . .o in the buildings of . . .��{�� 1. 1. . . . . . . . . . . . . . . .CU at . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. .5 P '. . . Lic. No.. !?3 L. . . . . . . . . . . . . . . . . . . . . . . . . . . . t GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File K Location No. Date HORTM TOWN OF NORTH ANDOVER . p Certificate of Occupancy $ * = • Building/Frame Permit Fee $ �sJACMUSE� Foundation Permit Fee PAID BY CHE(Mer Permit Fee $ NORTH ANDOVER COLLESTW Connection Fee $ Water Connection Fee $ $I,, , _ _ TOTAL $ rDLC� ,i� 1992 Building Inspector Div. Public Works ,�► I'I:,�I.; �: :: )� N(1IV1 II AN1)0NTEIt l, „ .I. lillll.l)IN(� �' '' `••= tl�l�:��IIIII'.c•II'.�11F( I WATION " I11VI.+I1IN1W Ilii 71 itt!)-I i 7 I II:i\1:I'I I�i.��NNINc� l'l,ANN1NG & (;t)!11[tll!N1'1'1' Ul;�'l:l,t)1't111 N'1' I::\I.1 i l.l'. NI:LSO )N. 1 41(1:(J OI CHIMNEY APPLICATION ANO IT1,3111' 'ATE. . /�Aq 2— PE mn'. # /cvG. vcArlvN S+�e 6u ' u 2FAPVIjL :LINER'S NAME: JILDER'S NAME: " T) lP�� U ©Aj n1 SON'S NAME: 1 N U A )e Lo © rr /?.tJ6� O ) C 1 v 4SON'S ADDRESS: kSON'S TELEPHONE: 17 UERIAL OF CHIMNEY: 4TERIOR CHIMNEY: )� _ W ERIOR CHIMNEY: .!f'WER AND SIZE OF FLUES: Alone 1I7— "A 12" BRIcic (2) _-----__-_-- 1I CKNESS OF HEARTH: ,,U chbiney an• OiAenCace con(janul to .tile I(e.(iublentell.ts u( •thc code and have -cuLn curd ,guta,tiom been neee.sved: JE: 2 f IGNATURE OF MASON: RMIT GRANTED: FEE )BERT NICETTA 1ILDING INSPECTOR — 1SPECTEU: — — _4IARKS: - ' qo SOLID BLOCK HE'QUIRED THIS PERMIT 1,11ISF GE UISPLAYEU 014 IHE I'RI:MAS