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HomeMy WebLinkAboutMiscellaneous - 66 CEDAR LANE 4/30/2018 (2) _ `� 6�. n (° O- i l i l i I i i l I �� �— _—_�— _ a �— _ i Town of North Andover 0� vkORTH YYLlD f6 Office of the Conservation Department o Community Development and Services Division 27 Charles Street �Ssackus�t North Andover,Massachusetts 01845 Alison McKay Telephone(978) 688-9530 Conservation Associate Fax (978) 688-9542 July 3, 2002 Thomas &Kathleen Hardwick 66 Ceder Lane North Andover,MA 01845 RE: VIOLATION of the Massachusetts Wetland Protection Act(M.G.L. C. 131§40) and The North Andover Wetland Bylaw(C. 178 of the Code of North Andover). 4 Dear Mr. &Mrs. Hardwick, On June 10,2002, staff from this Department visually observed at the above-mentioned property to the south east along the property line a violation of the Massachusetts Wetland Protection Act(M.G.L. C.131 § 40) and the North Andover Wetlands Bylaw(Chapter 178 of the Code of North Andover). The violation observed consists of the dumping of yard waste(leaves)in a protected resource area. This Department has the jurisdiction to require such materials to be removed from these protected resource areas as it is considered an "alteration". An "alteration"includes,but is not limited to,the placement of fill,excavation, or regrading(Section H. (b) of the North Andover Wetland Regulations). This notice also serves as an educational tool to inform you of the activities not permitted under the state and local wetland regulations. Wetlands and their buffer zones are not an appropriate location to deposit yard waste or any other material. If you are the responsible party for the placement of this yard waste,please remove all materials from the aforementioned location by hand no later than July 19,2002. Another site inspection will be performed subsequent to this date to confirm removal. i If you have any questions in this regard or would like to discuss the matter further,please feel free to contact me at the above number. Thank you for your anticipated cooperation. Sincerely, Alison McKay Conservation Associate a `Cc: Julie Parrino, Conservation Administrator NACC members BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ...... .. ..... DATE AND TIME OF CALL: 3 ' ,10 NAME: To m Har w,`c-K FIRWAGENCY: TELEPHONE #: PROJECT LOCATION: 0 6 Ce jtxr L",!, V,,o ll 41,0" SUBJECT: II tit'. ��aru9 c�( c--11& . re. -t 4,e �i0la�ioh nD�iGe S2nT on �cly 3o700Rr l y � 3,5 re--;e-V- fh Z. le � i e-r 4o � 7/�5��oZ/ Olt 2� 4o 0. V oL c Q O 1 14e . ��-�d+ fh�} �h e. re,M o v � 0..I X o Ne,AL J y us-f g o o a, i a-lSo �.�7orl<S e.�e-rr U)C,6 rale ted, r f f I / 66 CEDAR LANE l 210/106.A-0143-0000.0 Safety Insurance 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 NORTH ANDOVER, MA 001854- NORTH ANDOVER, MA 001854- i _ I RE: Insured: NICHOLAS J KLINE and MICHELLE'L MILJISE " Property Address: 66 CEDAR LN,NORTH ANDOVER, MA Policy Number: HMA 0393850 Claim Number: BOS00043954 Date of Loss: 7/4/2014 Company: Safety Indemnity Insurance Company i 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 3B 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. Lisa Monette Claim Examiner 7/8/2014 i i Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 I Phone: (857) 233-8618 Fax: (617) 535-5833 Email: LisaMonette@Safetylnsurance.com Date 9466 "0R'M TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that .. has permission to performu). to,��. �:cr-. . . . . . . r p t C. � L plumbing in the buildi gs of .1": O SC.s. . . . � .l at . . . . . . . . . . . . . , N h , Mass. .Fee.�. ..�OLic. No.c5dl I.�. . . . . . . . . . . . , PLUMBING 1 PE CTOR Check // i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i CITY F ai:0:V-V- 1- ( MA DATE PERMIT# JOBSITE ADDRESS L6,a Ce d a 1- OWNER'S NAME f�t1ol f _ ���E P - -- - OWNER ADDRESS / h n 4S K 1 i� ( TEL ��3 01 y a FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: EI RENOVATION: REPLACEMENT: M PLANS SUBMITTED: YES 0 NO 01 FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM ___I _._._._) I _.._.__,! .._.__._.J ..-____l I .__._._J _.._.._.I ...._.__1 .___� ._-.._....f ► f I DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM J _....__.._I i .__.____J ......_....J ___._._.J I .._--_-._...J _-___._.I __.._____J ______I _( _._._._.1 k . __4 DEDICATED GRAY WATER SYSTEM I ! I . { _.._I I ( _.._.._ i 1 —1 DEDICATED WATER RECYCLE SYSTEM I 1 I { J __..__.._.J f ___._....__I _...__J I ._._ I _._-..._f } �J DISHWASHER I ._...____J ( J ___._...._! ..__� f -._-__-! I J l 1 ( __...._...! DRINKING FOUNTAIN { { l ( � I F i J I ._......._J I= .__1 ........_J FOOD DISPOSER FLOOR/AREA DRAIN _I ..._._...___J INTERCEPTOR(INTERIOR) f I ! -----....__J i .._._.__1 J i I .._._..._._.l E _I ( I KITCHEN SINK LAVATORY ROOF DRAINR_-_-- SHOWER STALL SERVICE/MOP SINK TOILET URINAL ._........._I ___.._.. .__._.___` WASHING MACHINE CONNECTION _-7—D — 1 WATER HEATER ALL TYPES WATER PIPING OTHER ._...._....__�..___ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO �1 OF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY fj! OTHER TYPE OF INDEMNITY P BOND DI 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 Eli AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co liance with all Pertinen rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ov c� (LICENSE# S 4 1 ( SIGNATURE MPD JP �fi CORPORATION EI#L=PARTNERSHIP Di#=LLC[jff z4J COMPANY NAME „ 11 CITY AO'-COCA i STATE ZIP (� .W3 —� TEL FAX ^_ CELL _]EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No l 2- 3 THIS APPLICATION SERVES AS THE PEP�T� ❑ FEE: $ PERMIT# l/.eve l� ��' PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of IndustriqlAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leilibly Name(Business/Organizationgndividual):��j er'f' �crvi r,-,- SV1 f10-If Address: a. Tn-[U'n,,� o City/State/Zip: bgw 0(v_ MO 01M Phone#: 9 79- 6�3-,)T? 1 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.F1 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. 9. ❑Building addition [No workers'comp.insurance 5. ❑ 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 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t 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. 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. f rl i O n �n V!'�rn«- �C U Policy#or Self-ins.Lic.#: _ C PA 0 1 51 M - I G Expiration Date: Job Site Address:_. NOrk A1)aoV r 6,r- C-091 LA City/State/Zip: 1Jo 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 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 DTA for insurance coverage verification. Ido hereby certi nder the pains and penalties of perjury that the information provided above is true and correct. _F_Vv�� Si afore: // Date:Phone#: 9'7?' 6&'?- �•-7'71 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#: f l i 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 em to er is defined as"an individual a P y ,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in aJoint enterprise,and including the e le al representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents 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(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The 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 Departmnent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 `I'e1.#617-727_4900 ext 406 or 1-877-MASS.A.FB Revised 5-26-05 Fax#617-727-7749 wwwinass.gov/Xa