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HomeMy WebLinkAboutMiscellaneous - 62 SUTTON HILL ROAD 4/30/2018 62 SUTTON HILL ROAD 210/097.0-0034-0000.0 I 9800 Fredericksburg Road 101&.11 San Antonio,TX 78288 USAA® 04664. 27162. JSS1187241672. 01 . 01 . 9608 ESSEX TO N HALL January 26, 2016 30 MAR ST 2ND FL ESSEX A 0 29-1235 Reference: MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B I Attention Building Commissioner, I I am writing regarding the claim referenced below. Policyholder: Jennifer C Schutzbank Reference #: 009146999-17 Date of loss: January 13, 2016 Loss location: North Andover, Massachusetts Location Address: 62 Sutton Hill Rd. 01845-4617 A claim has been made involving loss, damage or destruction of the property referenced above, which may either exceed $1000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to my attention and include the reference #. You may submit correspondence or questions to me using one of the following options: 009146999 - DM-04664 - 17 - 3760 - 26 54577-1215 Page 1 of 2 Address: P.O. BOX 659468 am SAN ANTONIO, TEXAS 78265 Fax: 1-800-531-8669 Phone: 1-800-531-8722 Sincerely, ul Jesus D Soto Property - CVA Unit 87 Garrison Property and Casualty Insurance Company PO Box 659460 San Antonio, TX 78265 Phone: 1-800-531-8722 Fax: 1-800-531-8669 REM/IDS Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance Company, is authorized to use the USAA logo, a registered trademark of United Services Automobile Association. 009146999 - DM-04664 17 - 3760 - 26 54577-1215 Page 2 of 2 S.027162.009 608.0001.0001.1.000000.Z. North Andover Pictometry Viewer Page 1 of 1 Town of North Andover, Massachusetts MIMAP Pictometry Viewer View from F the South Fri,Nov 23, 2007 ` = 1:59 PM View from the west '• w_ =l-. 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V i http://maps.mvpc.org/GPVPictoNorthAndover/viewer.aspx?lon=-71.1103 504&lat=42.67... 10/12/2011 r V NORTh A F � ]1 csACH CERTIFICATE OF USE & OCC, tJ'PANCY TOWN OF NORTH ANDOVER Building Permit.Number Date-62 S CER THAT THE BUILDING LOCATED ON (� 7c�.y 4 A0 .)(� MAY BE OCCUPIED AS T- IN.ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Z/ �N Building Inspector NORTay ® ® over Zo �AK a over, Mass., 3 22 Q COC MICKEWICK ^• �A \V ORATE O P'P `I S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT ........ 1I�!l!�...... I1`� ....... .................................................. ....... .............. ..... ... ... Foundation has permission to erect. A.! ....... buildings on ..................... .�... .. ........�. �. .. CeAl- to be occupied as... /... .�............ .� n. .20.dD• Chiy� � provided that the person accepting this permit shall in every respect col;fort.,P!q.rAd o tterms of thea lication on file in C this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final �/& ��_'2 7�v� Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS Z z�-�y ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS Z S Rough _1 =- ..... .................................... ... d Service . .. ... ................... ........... BUILDING INSPECTO al Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the premises — Do Not Remove RR a No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. 0 SEE REVERSE SIDE Smoke Det. Date.....�3, .//� •' . NORTN `'3rpe`���D•�'+eMOpt TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSEt This certifies that has permission to perform ..... °.w.�;I.!!! CAI- ....................... wiring in the building of.... ...PT' .l.1Nv........ .................................. c. 1... l.../.(.l1. � .. ,North Andove ass. at. a....,? 1`GN . v 3 �� Fee �.......... Lic.NoA/� ............ .. ... ,-f.� �rc:..�!... ................... ELECTRICALINSPECTOR Check # 5084 Official Use Only /y Permit No. _,��' �,' , DO-0--a 4 POO&Sapry Occupancy&Fee CFt�ecked BOARD OF FIRE PREVENTION REGULATIO S 527 CMR 12:00 APPLICATION FOR PERMIT TO P FORM ELECTRICAL WORK All work to be performed in accordance with the M chusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 3 T�o-i-... „�,-.�<< f err-_ �v u�c inaNca.avr v •Lii`�a: Town of North Andover The undersigned applies for a permit to perform the electrical work describe below. Location(Street&Number Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes 9 No 9 (Check Appropriate Box) C Purpose of Building .�/�� � , w-t l..-- Utility Authorization No. Existing Service Amps Voits Overhead 0 Undgmd 0 No.of Meters R2/ l New Service Q-,U U Amps YyVoits Overhead/ Undgmd 0 No.of Meters Number of Feeders and Ampacity 06 �✓r.- z d!� /��vc Locdtion and Nature of Proposed Electrical Work C Total No.of Lighting Outlets Pr_ No.of Hot fuse No.of Transformers KVA Above 0 in 0 No.of Lighting Fbdures 3 Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets 7- No.of Oil Burners Battery Units. No.of Switch Outlets CJ No of Gas Bumers FIRE ALARMS No.of Zone q Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No_of Sounding Devices t Nol of Self Contained No.of Dishwashers / S ce/Area Heating KW Sounding Devices. 0 Municipal 0 Other No.of Dryers / Heating Devices KW Local Connection. No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO - hav ub i alid proof of same to the Office YES= NO If you have checked YES please indicate the of e b checking the X31 type y g appropriate box. INSURANCE NO - OTHER (Please Specify) f -Gcov�e (Expiration Date) Estimated Value of.Electrical Work$ Work to Start 3 —O Inspection Date Resquested N�/ r,!! G Rough Final Signed under theenalties of perjury: a FIRM NAME } ` LIC.NOIA_f I`` 3 Licenseea�PCi Signatur L LIC.NO,190-y.57 .3 3 _ Bus.Tel No. ,�7� 7 — Z/�✓ Address 5 —�o- Alt Tel.No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does no have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) �G/ Telephone No. PERMIT FEE $ (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. F1I am a sole proprietor and have no one working in any capacity �Iam an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: `'./�7 Insurance Co. Policy# Company name: Address City: Phone#- Insurance Co. Policy Failure o-secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fined($100.00)a day against me: 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of ' ry that the inf9rmation provided above is true and correct. Signature Date 3 Print name &-, S. a Gj/ Phone# 31, Official use only do not write in this area to be completed by city or town official' ❑ Building Dept F1 Check if immediate response is required Building Dept easing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION G Date....................... ....... t N°RTq °�,«'°:•�"o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING s o�•o • This certifies that '! .. has permission to perform-,.-4-4.-.1.'z d ..............:..:..................................... .. .. .-. .. wiring in the building of ..............c ' / .......... .. ........................... c at.6......a..;�......... ` North-Andover,Mass............. . . . ....... ...... .�.Zr Fee.4/0!.. ..... Lic. ..... ..................................... a j y/ ELECTRICAL NSPECTOR Check P # . � p 7278 Commonwealth of Massachusetts Official Use Only Permit No. '7 --78 Department of Fire Services Occupancy and Fee Checked /y0 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR P C ON O PERMIT T 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: 3 190/o J City or Town of: NORTH ANDOVER , To theI pector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Ct2 Owner or Tenant �i%c, Telephone No. WM0 Oyo7 7 Owner's Address Is this permit in conjunction with a building permit? Yes 2—. No ❑ (Check Appropriate Box) Purpose of Buildingl,,mck Utility Authorization No..Z2 S'y;7p/ Existing Service /60 Amps .2 yo /l2p Volts Overhead Q" Undgrd❑ No.of Meters New Service 740 Amps &0 Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followingtable 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 9,5 KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets Y6 No.of Oil Burners FIRE ALARMS No.of Zones No.of SwitchesNo.of Gas Burners o.of Detection and © Initiating Devices ' No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g « Heat Pump Number Tons No.of e -Contatne No.of Waste Disposers .. . . ._... .......................................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ unicipal F1Other Connection Security Systems: No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of No.of' Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: I, No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: '7x00 (When required by municipal policy.) Work to Start: 1/70/4?7 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE D—BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NA bs LIC.NO.: /.Q&2?14 Licensee: i cc, 't o 17yAJ Signature LIC.NO.: WF02,7 (If applicable,enter �e. empt"in the license nu r line.) l Bus.Tel.No.:S7?.p r rril' Address: 9�2 '�,ual.�4 -^c.. / t/1Gn«a,14ayl d'Z i Alt.Tel.No.:97y!!y �?� *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: $ /y0 I I � i r ti I i Date.. x.10.. .... ... . . t HORTM i€ o TOWN OF NORT ANDOVER • PERMIT FOR GAS INSTALLATION '�f9SSAC MUSES j This certifies that . .. . . . . . . . . . . . . . . . . . . has permission for gas installation . .� in the buildings of . S'�/c-. .�.1:��-. ./�. . . . . . . . . . . . . . . . . at . . . {.�. .!. . . . ., North Andover, Mass. Fee. 30.. . . . Lic. No..4=J6.?. . . . . . . . . .: �.... . . . t GAS INSPECTOR Check# 3 7 3 5956 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date LIA10� NORTH ANDOVER,MASSACHUSETTS Building Locations O` SLT TCJY� Fly 1d 1 Rd Permit# 1 ff Owner's Name Amount$ �'riL -s4 sGt'1 c 1 fZ�a� New® Renovation Replacement1-3 Plans Submitted � a w vaj' � a o � � w c � o° z F m v w Q x w F v, a a > a w w = � . x a a w � w � w N x a w > a > m z o z W o a a x o x 3 a a Q a > E a H Fo SUB-BASEMENT BASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR Y 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or type)�11 pi ] o Che k Certificate Installing Company Name FibrA a>J f / Pr1bi 4 /y>°S�i nt� NL Corp � �Address S-O `fQnn er S�` one: Partner. 11b"—e-11 PY1SS5 pl�,J"'D El usines—s e=epnone 37 hl e%sy 5 5 Firm/Co. Name of Licensed Plumber or Gas Fitter 54eveN _S INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. YesIffNo� If you have checked yes,please indicate the type coverage by checking the appropriate box Liability insurance policy U Other type of indemnity D . Bond 13 Owner's 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. Check one: Signature of Owner or Owner's Agent Owner 13 Agent hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the 13 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 Massachusetts Stat Code and Chapter 142 of the General Laws. iQ By: Signature of Licensed Plumber Or Gas Fitter Title Plumber niPl- )�Lj �. City/Town 13 Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) 1:3 Journeyman Location 6A Sy �0,4-) 1� I) e" No. 35& Date 11-do-03 x �ORTh TOWN OF NORTH ANDOVER f 9 • Certificate of Occupancy $ ��s"••°•Eta Building/Frame Permit Fee $ ACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3U Check # 10 3�' r 169 '10 Building Inspector ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION T6 CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING �y M Or BUILDING PERMIT NUMBER. r- DATE ISSUED. M SIGNATURE: ✓ - - Birilding Commissimjn4ector of Buildings, Date z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: �. �. Ict?wygeL Zoning District Proposed Use LotAea Frontage(fl) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide Required Provided Re(Fuired Provided 1.7 Water Supply M.G.L.C.40. 54)' 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public a"' Private 0 Zone Outside Flood Zone 8-- Municipal ❑C) C, Si e Dis 1 System LAY r SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M 2.1 Owner of Record Name(Print) Address for Service o '-wt -- Signa 0 Telephone 2.2 Owner of Record: Name Print Address for Service: O ti Z Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 'W 0�,"+1, ry Licensed Construction Supervisor: - -- License Number mn Address r Expiration Date Sig Telephone P �j 3.2 .egistered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address 0 Expiration Date ^� Signature Telephone tl• i SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildigg permit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Description of Proposed Work check altapplicable) New Construction ❑ Existing Building Repair(s) Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: l e 00 �` vt Cs— �� S Q� it VI-14.©d 0,6( Ike,.l T.L e SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be " l ) e ;k ra ..Fll[CIA� E iC3NI.Y xp �k Completed by permit a licant 1. Building (a) BuildingPermitFee �S Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing & I Building Permit fee(a)X(b) 4 Mechanical HVAC �3 5 Fire Protection o 0 6 Total 1+2+3+4+5 i500 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject � property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief ►l1_\gli C- Pri e Si at of wner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TI HERS 1 2 RD 3 SPAN DIMENSIONS OF SILLS r+.- DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS r SIZE OF FOOTING X MATERIAL OF CHWINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Buildin9 Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) �p C -3�0kiOS4e Signature U Permit Applicant Il � 2b �o� Date NOTE: Demolition permit from the Town of North Andover must be obtained for I this project through the Office of the Building Inspector The Commonwealth of9Kassachusetts Ot, �� (Department of Industridgaidents Office ofInvestigations 600 Washington Street Boston, W 02111 Workers'Compensation Insurance Affidavit APPLICANT INFORMATION Please PRINT Legibly Name:_ Key—Lime, Inc. Location: 62 Sutton Hill Road, North Andover, MA City: North Andover,MA Telephone#: 978-683-3163 111 I am a homeowner performing all work myself. ❑ am sole proprietor and have no one working in my capacity I am an employer providing workers compensation for my employees working on this job Company Name: Key—Lime, INc. Address:r0 RoorbuTnnd nriiTP City: North Andover, MA 01845 Telephone#: 978-683-3163 Insurance Company: AIM Policy#: AWC 7013446012003 O I am(circle one) sole h t ener proprietor,gal contractor or homeowner and have hired the contractors listed below who h I� . . have the following I workers' compensation pohctes: i Company Name: Address: City: Telephone#: Insurance Company: Policy#: Company Name: Address: F City: Telephone#: Insurance Company: Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information above is true and correct. Signature: Date: 11/20/03 Print Name: RPnjamin C. Osgood, Treas. Phone# 978-683-3163 Key—Lime, INc. Official Use ONLY-Do not write in this area ❑Building Department City or Town: Permit/License#: o Licensing Board Selectmen's Office ❑Check if Immediate response is required ❑Health Department o Other INFORMATION & INSTRUCTIONS Massachusetts General Laws chapter 152 section 25 requires all employers toprovide workers compensation for their employees. As quoted from the "law" an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for 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 Fax# (617) 727-7749 Telephone# (617) 727-4900 ext. 406, 409, or 375 F a' M 'E � I I I II R BOARD OF BUILDING REGULATIONS [[ t ,4 License: CONSTRUCTION SUPERVISOR > a Number S\ 075302 ;Birthdate!'1-2 04%1941 E�ic �res 12/0472004 Tr.no: 4972 - -- �� Restricted 00 BENJAMIN C OSGOOD 69 OLD VILLAGE LANE d NO ANDOVER, MA 01`845' Administrator j o i T O t�-� LAKE "V lover, Mass., . COCMICMEWICK S V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... ..".......�..... .. ........... /..................0................ .... ........ Foun anon . ........... R. has permission to erect..... * '�..'., buildings on ...�i.+o� S..v... ' Rough J . ..... ....... ............................................... to be occupied as...: ..�`�... � �...,/I/o W Q&Pei.....v p ,� ../ 6,� 'fit. Chimney .. .. .............. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Ins pec ion, Alteration and Construction of Buildings in the Town of North Andover. #7 143 V PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PER MIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION LO�JCTI®N !1L\ Rough r(.�'..... .................>.. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. LV PAGE 1 �= MAPTKJO. Cj 7LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE I SUB DIV. LOTN. -I LOCATION PURPOSE OF BUILDING _ l?es L JQ� OWNER'S NAME �u�/r j- ���-y/ �jti,/1 NO. OF STORIES SIZE �— OWNER'S ADDRESS .a S+c3�'I'oAt ,ljG4 RO40 BASEMENT OR SLAB _v#jffAow',ll- ARCHITECT'S NAME _TUga,% �►`�W�1l�bRJ�ILEr ?,A/ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME e-W4 Q/yVt&z&yf 1ptr4L 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 X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION umcwzpw 2-;wjn IS BUILDING ON SOLID OR FILLED LAND r +jo ^ WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER WW LU4Tw` BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 501041 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 S BUILDING INSPECTOR SIG ATU E O ORIZED AGENT t•tswtr� 3�.•0� FEE OWNER TEL.# PERMIT GRANTED CONTR.TEL.# z,Av? 19 CONTR.LIC.# H.I.C.# FE-w25Pro 97 ' 2 1 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 11STORIES 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 _ 3 1 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL IN. B'M'TAREA _ '/. 1/1 FIN. ATTIC AREA _ N_O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDVJ D _ ASBESTOS SIDING COMIACN _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRI K N MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONIC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR 1-1 222R _ ADEQUATE NONE 5 ROOF 11 10 PLUMBING GABLEHIP BATH )3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) f FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS L OI B'M'T 2nd ELECTRIC 1st 13rd NO HEATING 2 f% Y Gerald E.McCarthy,. l� Technical Supervisor 24 HOUR SPILL RESPONSE it COIL POLLUTION CONTROL INNY,fREMQVAL d,INSTALLATION E0 V I R 0 0 m E 0 i 0 l HAZARDOUS WASTE DISPOSAL SERVICES TANK CLEANING-SEPARATOR CLEANING USED OIL RECYCLING 1-800-622.6365 outside Mass. 1-800.242-5818 in Mass. 900 EAST FIRST STREET TEL. 617-464-6370 FIRST FLOOR FAX 617-464-6382 SOUTH BOSTON,MA 02127 t►O R 7- Town of4Andover 10 No. o84 dover, Mass., 2 Z 19 LAKE '9A_COCMICNE W ICK 0 -4 `rS BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT................................................... 1E %! ... 1QA,L.I ....................................""" . ' Foundation has permission to eecL.... . ....... .. ................... buildings on ....... Z..........T-4 .7�0... ...�/..//..... . Rough to be occupied as..................................................:l�I!�.4...��'.�'1. ........tauM. .D..A4. ..�.til................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ....................................... .. .. ... . . ........................................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. p� ✓,ie '�amniorzc�ea��i a�✓� tac�ivaeGt I - �\ Restricted To: 00 DEPARTMENT OF PUBLIC SAFETY 283:1 1 CONSTRUCTION SUPERVISOR LICENSE 00 -.None Number: Expires: Birthdate::, 1A - Masonry only ` CS 054525 1011111991 10/11/1954 1G - 1 & 2 Family Homes Restricted To: 00 Failure to possess a current edition of the Massachusetts.State 9�iilding Code ANDRE J BISSONNETTE is cause for revoc 'o of this.4c se. 100 BROOKSIDE DRIVE BRIDGEWATER, MA 02324 FEB 2 5 1997 SEE PLAT NO 7 Z M4 yf. M1s. f M1G 1tG,.E .yG. C' 14 s O ' d 51 Z (Oz , ••t Z �4 0 i.1r7 Ar. yG Z � � Ge St. t�}t .. 1.61,A, I tie, '.•' ,0/ 14, I oilbb LJ , }t. u M1 yf. t M1 1C L^' t• �JI 1 M �� 0 ,9 #A. 4�N 4• 1 STREET '70 45.9"&,w ego . Sgrrr •' �°°° 27 5 inr•� 1 100,768 s.F, ��` � 67 lap GLV 39477 s.F 3 t�r�+ •t Z 3o.670 S.F. • 1 •, �` ,` 1 I i ecs::y, SE , y Y b e a' e.6►t k• 6.161 46 r43.69C , 1rA b yid r �� ♦7 t3 ' 1 "n e.0.4. I %,Gov 4 1 I NCH ROAD SO. , I SEEP AT N0. 8 4- 1 —1i cwj FEB 2 5 1997 FORM U - VERIFICATION FORM. INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLI CANT: ( .YAl �✓0� hone 617-34 I- 976e LOCATION: Assessor' s Map Number 91'7 Parcel -i Subdivision _�•, _. Lot(s) Street (aA -e--L"7rVQ "A+ 9040 St. Number _ ************************Official Use Only************************ RECPMMNDATIONS OF TOWN AGENTS: Date Approved a� Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector Health Date Rejected Comments Public Works - sewer water connections ions - driveway permit I Fire Department Received by Building Inspector Date FEB 2 5 1997 Date,3- .R- TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING SACHUS This certifies that AK. .. . . . . ... . . . 4 . . . . . . . . . . . . has permission to perform,;-%, . . . . . . . . . . . . . . . . plumbing in the buildings . . . . . . . . . . . . . . . . . a t , North Andover, Mass. Fe�':;�W. '. .7 Lic. NoA .. . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check '#'13-J-3 7308 rb MASSACHUSETTS UNIFORM APPLICATIO FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date ✓ _ Building Location 62- Sc44an Owners �r C S�; �6x Permit# ,p Amount Type of Occupancy F-ec- New ® Renovation Replacement [:] Plans Submitted Yes No MLaj FIXTURES A SZBEM 1ST FLODi fru FLOM M FUM 4M K" 5MFUM 6MHfM 7MROM s[H Hnm (Print or type) t Check one: Certificate Installing Company Name /-/4 ntpSn tJ PID";i Cg� 14ea�i n NG Corp. ;LO-511 F �� Address Sb �Q✓t n tr- St Partner. Lome[/ t.4-o-5 p11?S"/ Business Telephone S7 y YSY / 9 96 92? 76/ ,fg A y ee/l Firm/Co. Name of Licensed Plumber. ,5f eut:N 5 14ewrAsyi Insurance Coverage: Indicate the type of insurance coverag by checking the appropriate box: e Liability insurance policy ® Other type of indemnity ElOther insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent 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 Massachusetts State Plumbing ap Code and Chapter 142 of the General Laws. 701+----- By: Signature or Licenseaum er Type of Plumbing License Title 02P I— osw City/Town icL"e�MOW' Master IZI Journeyman APPROVED(OFFICE USE ONLY h STATE OF NEW HAMPSHIRE - Lu NMI I;ICENSING s BO"i CERTT S"THAT - N1ME } , STEVEN SYP HAMPSON c 10ENVID AS A°M�iSTER PLUMBER i'ER RSA 329 t ExPIREs i�r�or�o is THIS GAItD A40ST BE PRESEi�T1F.D�'OANINSPECTOR N �IJEST "AL- IN _ IN P-LUMBERS -AND GASFITTERS - LICENSED AS A MASTER PLUMBER . . ISSUES THIS LiGaISE TO STEVEN S HAMPSON , 149 PARKER ST LOWL.L MA .01851-4019 125085101%08 255431' no l -z IIS M Official Use Only r may. Permit No. Sy 7S y Dr�iarlwaxt q(pad!!e Sa�ryt BOARD OF FIRE PREVENTION REGULATIO S 527 CMR 12:00 Occupancy&Fee Chked O APPLICATION FOR PERMIT TOP FORM ELECTRICAL WORK All work to be performed in accordance with the M chusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 3 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work descriv' below. Location(Street&Number � v %�• i� �i� • Owner or Tenant A Owner's Address ZG 4" J rmit in conjunction with a building permit Yes L/ No 0 (Check Appropriate Box) l 2aJ ' & of Buildi � � wt-` r Utility Authorization No. .p ? Service Amps Volts Overhead 0 Undgmd 0 No.of Meters erviceU U Amps 1 Y4,Volts Overhead �� Undgmd 0 No.of Meters r of Feeders and Ampacity. n and Nature of Proposed Electrical Work Total Lighting Outlets '`r No.of Hot fuse No.of Transformers KVA U Above 0 In 0 O r Lighting FrAures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Receptacles Outlets .� No.of Oil Burners Battery Units Emergency � of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and kofD Ran No of Air Cond Tons ,3 Initiating Devices Heat Total Total iI No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained of Dishwashers S Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other of Dryers / Heating Devices, KW Local Connection No.of No.of Low Vow o.of Water Heaters KW Signs Bailases Wiring o.Hydro Nbssaqe Tuds No.of Motors Total HP THER: INSURANCE COVERAGE. Pursuant to the requirement of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES=NO ha�W"lid proof of same to the Office YES= NO - If you have checked YES please indicate the type of a by checking the a INSURANCE ND - OTHER - (Please Specify) y -,= PProPriate box. c Estimated Value of.Electrkal Works (Expiration Date) Work to Start —G Inspection Date Resquested N `/ (41-1-4 •Rough Final Signed under the enattles of jury: FIRM NAME } / I LIC.NO/�-,I S .3 Licens G G g -t 6 Signatur G� Z-i`��4' _LIC.NO.10'y-�;7 3 3 Bus.Tel No. _ 7� - i�V / - .Z%G .• 1 Cdress 'v/c f f •- Alt Tel.No. VNER'S INSURANCE WAIVER: I am aware that the Licenses does no have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ /� (Signature of Owner or Agent) U �1 Date.e pf "ORT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �,SSACHUSE� p This certifies that . .����` !'�6?s.`°. . . . . • ���• •�• • . . . . . • • • • • • • has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . .1. . . . f.. .T. . . . . . . . . . . . . . . . . . at . . . . North Andover, Mass. Fee. .�:. Lic. No.. . . ?.�. .? . . . . . . . .I. . . . . . . . �-c�-y. . . . . . PLUMBING INSPECTOR Check # > f l f 5269 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date Permit # J 6 Building Location Owner's Name_/�/%`� - _ Te o occupancy Residential New L I Renovation CJ Replacement LnJ Plans Submitted: Yes ❑ No ❑ FIXTURES UU to 0 O Y r z z O � W b w x -j W i �� � o M 3-r 3 t N V) z �� 4 Cr. ~- O 2 N a N N ^�4 x O — W f- W N V^ U �' N a fn tL Y � ,u( � n _ yr to z rc ; w U) Y z a c� a ° a 3 R1 N b 1 2 m (r W 0O W N J UI a J p O x �i ►�+ r 1 u, z a z 3 3 o x x x 0. 0 .t w w r. pl U. I- u r- o z a z I- z o o to z w IL O o ri z �' N a a O a -J _j < cr CC a s 0 a 11 � 4J S4 3 x as ur o o w x r- LO w a D a a 3 L_ co 3 3 3 3 r SUQ-13sMT. - — — — -- — — — BASEMENT IST FI-0011 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TIi FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg. &Plg. Co. ..Inc. Check one: Certificate Address 3 . na t Street CX Corporation 714 Stoneham, Ma 02180 ❑ Partnership Business Telephone_._ 8l —438=11-76 FI Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes V--J No 0 If you have checked,des, please indicate the type coverage by checking the appropriate box. A liability insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details arid 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws. Si atwe of Gcenso< lumb y�"� Title City/Town Type of Liconse: Master[.X Journeyman[] APPROVE)FoFrCE t1SE ONLY) License tJumbor__8322 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 1g PLUMBING INSPECTOR r