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Miscellaneous - 68 RUSSELL STREET 4/30/2018
68 RUSSELL STREET 210/070.0-0048-0000.0 1 r i 0668 Date.....1z) HORTM TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS This certifies that ...... ... .................................. ......... has permission to perform ..... wiring in the building of....... .............................................. at....(-&, . ..QT............................... orth Andover,Mass. Fee..FO✓...... Lic.No9t........... ................... .. .. . ... CTRIC L INS E Check # ................................................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION CHU TVs certifies that has permission for gas installation . fval�r.............. in the buildings of....4 .......................... ........................ at.................................................................................................. North Andover, Mass. Fee ............ Lic. No. ./ X/...................I................... SINSPECTOR Check 9124 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY MA DATE3,_3_-,��PERMIT# JOBSITEADDRESS -.._..-.___ __-_ OWNER'S NAME (�;�z�!_5�..- OWNERADDRESS . ._ .a �,, �,t2 �1ec -___._.. _.._._._- - -_ - TE #FAX -- - TYPE OR OCCUPANCY TYPE COMMERCIALO EDUCATIONAL F-1 RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO E- --- APPLIANCES 7 FLOORS- BSM 1 2 3 1 4 5 1 6 7 8 9 10 11 12 13 14 BOILER -- - - - -- - E -- I--- -. _.•__. . - - - - -._ ...- .- - _ �-�i i._._ BOOSTER I- I._..1 _. CONVERSION BURNER --_ -. _ _ i _ ��E_ _ r---� �—�1 7771 COOK STOVE DIRECT VENT HEATER DRYER � EPLACE F _ 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS _ - - MAKEUP AIR UNIT OVEN ----- _..._. . - I.. .. POOL HEATER ROOMl.SPACE HEATER _ -_. .--,Y-i_-_.__ ROOF TOP UNIT TEST --- UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I_..._. OTHER _ ___ --_- --- ---- ------ -------I _ __.-.._ •.. -- -- _ I- -- -- -- - -- - -- - ___.. E-7-IF-71II_ E _ .. ... _ =E INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE INDEMNITYF-1 BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER FJ AGENT Ej 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 compliant with all Pe i ent pr ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r PLUMBER-GASFITTER NAME �}( (pAf LICENSE# t��NS �/ NATURE - - -- MP Q'MGF r--1 JP JGF F-I LPGI E] CORPORATION E]#� PARTNERSHIP F LLC � COMPANY NAME: cele �i(L T9_flZS-Se,w�ce5__. DDRESS CITY �i O C C6 (a STATE -ry)- ZIP _Da .p-)- TEL -6/7_-a87- loos, FAX CELL 5b8-74 EMAIL- ( 'r ROUGH GAS INSPECTION NO'T'ES THIS PAGE FOR INSPECTOR USE ONLY FINAL IN PECTIO ES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' y 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLribly Name(Business/Organizationllndividual):���e�4 LLC Address:_ City/State/Zip:( QA- A-) MA Phone.#: 6/-7--a<P7-1004/ Are you an employer?l� Check the appropriate'box: Type of project(required):. I, l an a employer with los- 4. E] I am a general contractor and I have hired the sub employe full an r art-time). contractors 6. ❑New construction 2.❑ I area s proprietor or partner-'. listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers'comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12.0 Roof repairs employees. [No workers' 13.0 Other CA,r 6jag K _ comp.insurance required.] t "Any applicant that checks box#1 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. �Contractocs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer'that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: r_5sD .9 Policy#or Self-ins. Lic.M A 0 t f 0c�, . Expiration Date: ©` 1)1 20<S�_ Job Site Address: 69-7Q S% City/State/Zip:/UO2T-r,.t /��,UQdo .' 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 eriminai penalties of a fine tip 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. Ido hereby certify and r the izs•a d enakfes of perjury that the information provided above is true and correct Si afore: f Date: --/ Phone 1#: Official use only. Do not write in this area,to be completed by.city or town officiaC City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/ToNvn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I 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 persotr_m 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,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-contiactor(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.-Anew affidavit must be filled ouf each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or perrnit 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: .e Comte awea.lth of MassachuseM. 1 opartment of ladustdal Accidents of j4m of Invest gadeaS.. 600 Washington Street Boston, IIIA 02111 TO. 617-727-4900 ext 406 of 1-977-MAS S.AFE Fax 9 617-727-774.9 Revised 11-22-06 wwvr.rr>ass_govfdi a FEENBRO-01 CLEDDUKE ACORO� CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 2/125/225/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such enddrsement(s). PRODUCER CONTACT NAME: April Skala Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c No Ext): AIc No):(877)816-2156 South Dennis,MA 02660 E-MAIL askala ro ers ra ADDRESS: 9 9 ycom INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Old Republic General Insurance Corp. INSURED INSURER B: Feeney Brothers Services LLC INSURER C 103 Clayton St PO Box 220801 INSURER D: Dorchester,MA 02122 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I TR TYPE OF INSURANCE JUM WVD SUER POLICY NUMBER POLICY EFF MMLDDrnrvv LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY A2CG07501400 02/01/2014 02/01/2015 PREMISES Ea occurrence $ 1,000,00 CLAIMS-MADE Fx_]OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO- LOC EBL AGGREGATE $ 2,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIM S ER A ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A A2CW07501400 02/01/2014 02/01/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD "Commonwealth of Massachusetts 7Fee ly Permit NDepartment of Fire ServicesBOARD OF FIRE PREVENTION REGULATIONS Occupan[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 ININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant / Telephone No. Owner's Address �/. Is this permit in conjunction with a building permit? Yes �, � ❑ No (Check Appropriate Box) Purpose of Building_ �/y jv1�yydySz� Utility Authorization No. �6 e Existing Service MO Amps 0/2 W Volts Overhead [je Und rd g ❑ No.of Meters Z New Service -ZQD�_ Amps /2c�Volts Overhead Und rd g ❑ No.of Meters Number of Feeders and Ampacity Z- 20 O Location and Nature of Proposed Electrical Work: T - BY"C, _��� -ADir Completion of the ollowin table ma be waived by the Ins ector 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 mergency Ig Ing rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. Total Initiatin Devices Tons No.of Alerting Devices No.of Waste Disposers Heat Pump R hm r. .Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KWLocal❑ Municipal Connection Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water , No.of Signs Ballasts No.of Devices or Equivalent Heaters as Data Wiring: l ts No.of Devices or Ecluivalent 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: 2d00. _ (When required by municipal policy.) Work to Start:– L _(p f! 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 prbvides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this ap ' tion is true and complete. FIRM NAME: LIC.NO.: Licensee:1�j�/�yL��k Signature (Ifapplicable, enter "exempt"in the license number line.) LIC.NO.: Q Address: ':e /1 S! j�,_� ) �,�3Bus.Tel.No.No.: Per M.G.L c. 147,s.57 61,security work requires Department of Public Safety"3��License: Alt.Lec.No OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nof have the liability in ance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ]owner El owner's agent. Owner/Agent "� � Signature (yvyrv,(' Telephone No.4'7$ -3p�;-,�yy� PERMIT FEE: $ �'jD�da ELECTRICAL PERMIT NO. � ELECTRICALINSPECTOR-DOUG.SINSPEC TION MALL PORT: Mt Y.ROUGH IN Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ I Inspectors'comments: (Inspectors'Signature-no initials) i Date �•FATAL INSPECTION; Passed— Failed—[ .] Re-inspection required($50.00)-[ ] Inspectors'c mments: (Inspectors'Signa re-no initials) Z ' Date 3•UNDERGROUND INSPECTION: Passed—[ I Failed—j I Re-inspection required($50.00) Inspectors'comments: (Inspectors'Signature-no initials) Date 4-INSPECTION—SERVICE: - DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-j Inspectors'comments: (inspectors'Signature-no initials) Date � 5.INSPECTION-OTHER: Passed—j ] Failed—j ] Re-inspection required($50.00)-j I Inspectors' comments: 'Signature-no initials) Date D OOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE 1F TRE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND ARE-INSPECTION OF$50.00 IS TORP.CHARGED. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UV. 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /tel jGiV/1/ ��� GJG1z� Address: ,¢/,U S%RZ'Tr i City/State/Zip: Y 0A/ , ZY1, ljZ j VZPhone #: __-�8 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 �mployees(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 shget. $ 7• ❑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 ate a corporation and its required.] officers have exercised their 10. ectrical repairs 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. 152, §1(4),and we have no 12.❑Roof repairs 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. 1 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: 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 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. .e-6pised that a copy of this statement may be forwarded to the Office of Investigations of the DIA foreinsuranceeverification. I do hereby cern r th ofperjury that the information provided above is true and correct. Si nature: p Date: l -' 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.City/Town Clerk 4.Electrical Inspector 5.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 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-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) °� p Y � (� ry)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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia Date...... ..j... /..'...:...................... CF yORTJI TOWN OF NORTH ANDOVER � � T J PERMIT FOR GAS INSTALLATION ,83�1CHU5�t This certifies that ........:�'.2,!f�,�:;�....�'-`1.�`sp............................................................. has% permission for gas installation .:/ - ............................................... Ni the buildings of 22' ........................................................................... at...........................................................................................n , North Andover, Mass. Fee,10.'�?J.... Lic. No./ .' ?.... ...... .............................. / GAS�INSPECTOR Check# 9125 " MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE - _. ....__.. PERMIT# JOBSITE ADDRESS ..7Q SSe_ S OWNER'S NAME OWNER ADDRESS .... _Co _v.. �/1 . ____-__.._ -..._......__ ..._ TEFAX E OR TPPRRIINT OCCUPANCY TYPE COMMERCIALQ EDUCATIONAL RESIDENTIAL ' CLEARLY NEW:Q RENOVATION:] REPLACEMENT: PLANS SUBMITTED: YES[I N0[Ej— APPLIANCES 7 FLOORS- BSM 1 2 1 3 4 5 6 7 8 9 10 11 12 13 14 BOILER -- - - - -- - + . -- ----- fel_-__. .i BOOSTER 7-1 CONVERSION BURNER COOK STOVE f 777i I_, DIRECT VENT HEATER I_._.... I__. �. .,_ DRYER I- {- 1..._-_. - -- FIREPLACEi- FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS —� 1,77771 MAKEUP AIR UNIT OVEN POOL HEATER ROOM SPACE HEATER --- - - -- -- - .- ._.. ... I---- ---- ROOF TOP UNIT TEST UNIT HEATERUNV ENTED ROOM HEATER WATER HEATER OTHER --- ---_- ------ ---___�... -- -- -- - I- - --- -- - - _ ._...... �... . I.. .. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES jt 'ISO r I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY(-. /' OTHER TYPE INDEMNITYF-71 BOND R 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 � AGENT 0 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAMEFI(�>'I�CQ LICENSE# SIGNATURE MP 0 MGF 0 JP 0 JGF[j LPGI Ej CORPORATION E]#� PARTNERSHIP # LLC[9 ® COMPANY NAME: I ADDRESS CITY 1Q6 �� ..... __.._ .. -__-- _. STATE - ZIP --- TEL K/ FAX CELLI. EMAIL A ��� ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY N F INSPE TION TESS 'Yes No �S } THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES FEENBRO-01 CLEDDUKE CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 2/25/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: April Skala Rogers 8r Gray Insurance Agency,Inc. AH/cONIJ Ext): A/c No : 877 816-2156 434 Rte 134 E-MAIL South Dennis,MA 02660 ADDRESS:askala@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:01d Republic General Insurance Corp. INSURED INSURER B: Feeney Brothers Services LLC INSURER C: 103 Clayton St PO Box 220801 INSURER D: Dorchester,MA 02122 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE UBR POLICY NUMBER MM/DDS MM/DD/YYri LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY A2CG07501400 02/01/2014 02/01/2015 PREMISES Ea occurrence $ 1,000,00 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/Op AGG $ 2,000,00 POLICY X PRO- LOC EBL AGGREGATE $ 2,000,00 AUTOMOBILE LIABILITY Ea COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS ( ) BODILY INJURY Per accident $ NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS (PER DENT $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED 1 $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE A2CW07501400 02/01/2014 02/01/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If yes,descr be under DESCRIPTION OF OPERATIONS below___T I E.L.DISEASE-POLICY LIMIT $ 1,000,00 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD vivo "TV .1•r, yrM60 ONnuioc.1 • Wm 0 roMmem WN-Usiff-11 MIR 10M,611111 mi� BOARD Of PLUMBtRS. ":A ND GASF.!IT-,T.E.0%.,' Ss.uEs__THE FOLLOW1 IdG LftENSr R.EG'I-STE RE 0 .AS-,lA-...-,,ip�.pMB ING COW" 19c DAVtD W GARFIELD a 4ul F E ENEY ..-BROTHERS SERVI L L C 21 WILLOW`ST w M -02 A 301 ;m :pi 21 fa Ve I or-,IN Wispl4w • 77— COAMONWEALTH OF MASSACHUSETTS rin%-j 0 a ,* 33EEM PLUMBLI--S AND GASFITTERS LICENSED CS A [RASTER PLUMBER ISSUES THE ABOVE LICENSE TO: DAVID W GARFIELD -21 WILLOW 31 Fn BROCKTON MA 02301-11451 15645 L5/01/14 166583 -.LICENSE NO. EXPIRATION DATE SERIAL NO._ COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASP 1172R- LICENSED AS A JOURNEYI IAN PLU BER ISSUES THE ABOVE LICENSE TO: DAVID W GARFIELD 21 WILLOW ST BROCKTON MA 02301-1451 • 23645 05/01/14 16tr394 l�, LICENSE NO. EXPIRATION DATE SERIAL NO. LocaTon 413-7b No. Date //—/o—i t Of NORTH, TOWN OF NORTH ANDOVER 6 3:0''t. c �C0L Certificate of Occupancy $ + i ; . Building/Frame Permit Fee $ ra2s �ss�cNusE< Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �-- f t Buildinig in P3 12227 11/11197 16oa3 PPID /�G� ` —Div. Public Works ,.;� MAP 440.�07r� OT NO. �O �' � 2 RECORD OF OWNERSHIP JDATE J!nK PAGE ZONE SUB DIV. LOT N PURPOSE OF BUILDING ."OWNER's NAME G v L I NO. OF STORIES I i12E -.6WNER'S ADDRESS 70 BASEMENT OR SUPS ARCHITECT'S NAME v SIZE OF FLOOR TIMERS IST !ND SRO �f ILD[R'i NAME , ' ^`�� SPAN DISTANCE TO NEAREST BUILOING l� DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES–SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW - SIZE OF FOOTING X . IS BUILDING ADDITION _ MATERIAL OF CHIMNEY 19 BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND ' WILL BUILDING CONFORM TO REQUIREMENTS OF CODE `IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE 3 PROPERTY INFORMATION INSTRUCTIONS LAND COST SEE SOTM SIDES too IT. BLDG. COST 4,1-0 Ll PAGE 1 FILL OUT SECTION! 1 2 EST. BLDG. COST M1064). FT. . EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PkANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR [•I/ a BUILDING INSID CTOR • 6NATURE OF6 +NER OR ALIT ORIZED AGENT po Owners Tel # FEE Contract Tel# 5Wg,, 1 2, ,TI02_ rERUIT GRANTEO \ _- Contra. Lic # VOY", in • HIC # tAORTjy Town of _ y _ over No. S7S _ m over, Mass., lV eys—i" 0 - LAKE '9=��CICNE OCNMCK '�• �•9S �q�E D► �G BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT N........ru..... .................................................................................. ati Found 'on has permission to wezl . .. ......... buildings on ........b.9.-7 ...... (L ....... .................; 7.?Z4e7�-�......... Rough to be occupied as.................$rx..P*...�'��- - E Zts.%, ?. '....JGJ �L L/�U( '......................... 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIO S, ELECTRICAL INSPECTOR Rough ..... ................................................ ................. 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner 7 Street No. Smoke Det. Town of North Andover pORTy ' OFFICE OF ?°� `'° '•��o° COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street M11"J.SCOTT North Andover,Massachusetts 01845 cNuset Director In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number -97-,5- is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by NiGL c 11 1, S 150A. The debris will be disposed of in: C01A +Gt /%A e i^ (Location of Facility) V Siinature of 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. 30ARD OF APPEALS 688.9341 BUILDING 688-9343 CONSERVATION 688-9530 HEALTH 688-9540 PLANNINO 688-9535 I W �.�� sus •. Town sof North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print ') �TE SOB LOCATION Number Street Address Section of town : MEOWNER". /'111/e�i`� 3cJ/ �q&I (7 60 y77 -S;rtkz,-L Name Home Phone Work Phone �SENT MA/ILING ADDRESS -70 City Town State Zip code The current exemption for "homE!owners" was extended to include owner occupied dwellings of - six units or less and 'to allow such homeowners to engage an individual for hire who does not possess a license , provided that the .owner acts as supervisor. (State Building Code, Section 109 . 1 . 1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- ing , attached or detached structures accessory :.to such use and/or farm structures . A person who constructs more than one home in a two-year pe-riod shall not be considered a i-i",iieowner . Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the building permit . (Section 109. 1 . 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and regulations . 'lie undersigned "homeowner" certifies that he/she understands the Town of 1,_ th Andover Building Department minimum inspection procedures and .requirements and that he/she will comply with said ,requirements . p y d procedures and 1 E0WNER' S SIGNATURE z `.PPROVAL OF BUILDING OFFICIAL .1ote : Three family dwellings 35 ,000 cubic feet , or larger , will be required to comply with State Building Code Section 127 .0, Construction Control . Location No. Date 10 13 9 �' N.RTIy � TOWN OF NORTH ANDOVER 0 0•tt�ao .• �A „ Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ "4CHU Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ art=' 2��Z . 10/16/95 14:49 40,&ildMabnspector 8884 Div. Public Works y PAGE 1 PERMIT NO. �QU APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. " MAP�KJO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE — ZONE I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING7j Cam QJry ld ea ' OWNER'S NAME �O NO. OF STORIES �/ SIZE OWNER'S ADDRESS-70 R,rC� 11 BASEMENT OR SLAB d� ARCHITECT'S NAME t! SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN -- DISTANCE TO NEAREST BUILDING `J DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT J o DO FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW 7/0 SIZE OF FOOTING X IS BUILDING ADDITION I♦/pl MATERIAL OF CHIMNEY �c IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER e BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER C S ZGla Z IS BUILDING CONNECTED TO NATURAL GAS LINE C. INSTRUCTIONS 3 PROPERTY INFORMATION L D COST SEE BOTH SIDES EST. BLDG. COST 61 am 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 FILED f a0i i27 �g BUILDING INSP[CTOR! SIGNATURE OF NER OR AU IZED AGENT F E E '{C� " OWNER TEL.# PERMIT GRANTED CONTR.TEL.>t L0 t 19 CONTR.LIC.N H.I.C.# -' 1998 4 l Z4/J J BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY 11 STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM+ ° MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS d 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 WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M AREA _ '/. 1/2 '/. FIN. ATTIC AREA _ NO 8 M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD\r✓'D ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY - ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� PCrOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. )2 FIX.) _ FLAT SHED WATER"CLOSET _ ASPHALT SHINGLES ♦ LAVATORY 1, WOOD SHINGES \ / KITCHEN,SINK'✓ SLATE -✓ NO PLUMBING r 1 TAR & GRAVEL STALL SHOWER f ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS L OI B'M'T 2nd _ ELECTRIC 1 lst 13rd I i NO HEATING 1 W �' 11 7 1 t`�✓� JW. 5�� NORTH *Town of 41.6 6 Andover 0 0 No. 5 0 G ' or dover, Mass., Me_ 1:� 19Rc 0 coc, „j%ViCm of?ATEI) BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.Y"!ti....7 ............................................................................................................. BUILDING INSPECTOR .. . ..... . ...... .. Foundation 'Pt3asexx. '&-V— has permission to ereCt,? ............. buildings on .,(o$.-7'10 ................'......."",... Rough to be occupied aamiLetio.)&....q'..X.-m.4...... Chimney .ftc*ex ....................................... . ................... .....�z x ............ provided that the persobccepting 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 I *Z944 PERMIT EXPIRES IN 6 MONTHSFinal UNLESS CONST UCN T ELECTRICAL INSPECTOR Rough q �zlq�- ................... Service 40 4 Fft BUILD INSPECTOR Final Occupancy Permit Required to Occupy Build ng GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION —FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT ee04 to FPAmE k2l, x451 cis -- 3(m TIO,'A kAekr.W-F MAX sPAcr.Jb l3 aLT @ 4-s k +0 mouse_ I _ -•--- --- -yet •-- _.___-___._�� tJ $'_�_— - -----aa(- --- _.. .---�,� ---�U� . 1C 9 0- y XG• Fi �St 14�0 C Q, Fbo r LP(9S p. r ILr • T[iliC+Sl: ttds is b~ ATrae copy ttilhow _ lot GL"rS,I.�R Rown Clark 1iQRSR At1 � ' ��a erad Town of North.Andover _ y f NORTH , TMM M* OFFICE OF COMMUNITY DEVELOPMENT ANDSERVICES 146 Main Street • ° .<:.ra_<. ,'+ KENNETH R.MAHONY North Andover, Massachusetts 01845 9SSACHUSE� Director (508) 688-9533 ANY APPEAL SHALL BE FILED WITHIN (2 0) DAYS AFTER THE BOARD OF APPEALS DATE OF FILING OF THIS NOTICE NOTICE OF DECISION IN THE OFFICE OF THE TOWN CLERK. Property: 70 Russell Street i Kevin& Julianne Julian Date: 9-20-95 70 Russell Street Petition# :045 -95 North Andover, MA 01845 Date of Hearing: 9-12-95 �V W The Board of Appeals held a regular meeting on Tuesday evening, September 12, 1995 tP upon the application of Kevin&Julianne Julian requesting Variances pursuant to Section CT 7, Paragraph 7.1, 7.2 & 7.3 and Table 2(Lot &Zoning Dimensions) of the Zoning Bylaw. The applicant is also requesting a special permit pursuant to Section 9, paragraph 9.2(1)(Non-conforming uses) of the Zoning Bylaw. This decision will Only reflect the request for a Special Permit. The request for the variances will be discussed and voted upon under advisement ata Special Hearing. It is o possible that the applicant will not need the variances. f`J The following members were present and voting: William Sullivan, Raymond Vivenzio, Walter Soule, Robert Ford and John Pallone. N The hearing was advertised in the North Andover Citizen on 8.23.95 and 8.30.95 and all abutters were notified by regular mail. ca Upon a motion by Raymond Vivenzio and seconded by Robert Ford, the Board voted unanimously to GRANT the Special Permit so as to rebuild and increase a 16'by7' deck to 20' by 9', onto a legal non-conforming structure. Voting in favor: William Sullivan, Raymond Vivenzio, Walter Soule, Robert Ford and John Pallone. The Board finds that the applicant has satisfied the provisions of Section 9, paragraph 9.1 of the Zoning Bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing non-conforming structure to the neighborhood. BOARDO ./ e. ✓i Vk Tv l I C, F APPEALS, William Sullivan, Chairman 0 Wu5.scllRaymond Vivenzio Walter Soule Af .Ado var-, k"4, 0 FL/- — John Pallone Robert Ford BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D.Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell r A PIAS, .�F 4039 IIS 1 N/F MACCANNELL PLAN OF LAND .�� 5 O. 00' -�, NO. AND MA I . 3 O' NORTH ANDOVER OWNED BY ' L OT89 EXIST/NG ZONING BOARD OFAPPEALS KEVIN JUL lA N _ GARAGE SCALE.' l"=20'DATE; 6127/95 51000 S. F. N/F 40 MCEVOY PROP.NEW PORCH SCOTT L. GIL ES, R.P. L.S_ 2O - 2/` NO. ANDOVER, MA. PORCH TO BE IS RT I IG EPORCH 6.5' D THIS IS TO CER TIF Y THA T I HAVE l9. 5' CONFORMED TO THE RULES AND DATE OF FILING REGULATIONS OF THE REGISTERS - DATE OF HEARING-lf�/ F DEEDS IN PREPARING THIS f� O BUIL DING Q E l NG Q DATE OFAVAL _ - S ZONING /S R-4 �` U/LGQ I,� MAP 70, PARCEL 48 Q O \ BOOK 2769,PA GE 262 O N/F # 68- "ROWN 70 i% 6.5' PORCH `°Y_ SEX NORTH tI / \ �, h jLAWnENOE, MAS 1\ 81 r,iU ";�, !+�-RIE COPY; ATTEse; i(/ 50. 00 6127195 RUSSEL L STREET it ON i _ . Town of North Andover BUILDING DEPARTMENT ' Homeowner License Exemmtion (P_ea=e r=ntj DA-17__ JC ._.ter,..:_ _�..., ` - / 0 �Urce_ 11 SV NL L:, Zr Scree= rlaaress Section of tow,-,, ��, -- �� �J �✓/ lGth (od to -37 � / �ctGy+2 Va-e t�,0ME Ph o n e Wort: ?!lone S� �y. AIdaVCr- C9 ys- - State Z-p ecce ^ - har.= e:.�.. �,c for " omeo•. rs" was extended to include ow,.e_ of six uni _-s or less and to allow such home c•.tiner- tz ind; c =al for hire who aces not possess a license . pro` -- - e o w ac __ as sucer•,7isc_ . (State Building Code Sec or -`=° • - • - ili_%.•1:..J,Y v;. o��-S a �arC. l O f la%d on which hels;.e res idtS or C is , or is in _ended to be , a one to six fug_ �. - a_ _Gc..Ed o_ QE_acaed struc ..ur_s accessory to suc:, use ac:cicr mar... - =s� A person who construes more than one home in a nc be_ considered a homeowner . Such "homeowner" s;,a '__ VEr �i.G1; _ 3u_'_c_. OL_ _c�a! , on a Lormi ac:eotable to the Bule_n= Ut _ _ Si1E S G__ bE resnons_ble for all such `.work- performEd-ui1C Vie-..,_ = . (`E'- __on as= ..:-e: reszons_C1-- o er a:'. -_ a..la CcQE _ ".lC 7neC'� .c= Cc- --- - -^atUP.CerS _a C. t... _ _ _ a7 :.Ec. S.. �___ rii_ii _a: ?rCCed - _= a:.- 7._- - - _ _ y _ - o r Lar e r TOWN of NORTH ANDOVER AFFIDAVIT Ham Taprvxmerit Cmtractm law a ploant bD lit tffUcaticn M�c. 142 A requires that de '1vccnstnrjdc n, altgim, rEnmmdcn, fir, I i wflicn, cmeadcn, nTmAma-it, rel, daDlitim, or cawt ncta t of an addi am bo any pn e- eastnng a wer-o xxped bmid- irg cantah*g at least ane hit riot mxe than far dwlliig unts...Cr m startrnres 4nich are adjaCEnt to s di residare or hd dW'be doe by registered cotracbxs, VAth certain acgAicns, alag wuth other Ents- --Type of Work: reOr Est. Cost 3, 000 - Tv�ck Address of Work LZ-70 _,-Owner Name: I�e v r`�, T✓ ► o, �. �- Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Qtly Work excluded by law Mph. Job under $1,000 Date Building not owner-occupied ,Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DFALING WITH UNREGISTERED OONIRACIORS._- FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. . Signed Mer pe-alties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: . Date Owner Name J111 - 1995 • .�. 1WIGA. . •• Town of N N0.15 0 North Andover, Mass., 19 BOARD OF HEALTH Food/Kitchen PERMIT TO BUILD Septic System I BUILDING INSPECTOR THIS CERTIFIES THAT.. :. ........^...A.'.k ............................... . .......................... ..... ....................... Foundatton has permission to erect.. . . ............. buildings on . . ....�:.a. .. . ° ..... ....................... Rough _ "� to be occupied as •..'h-.� . Chimne provided that the person accepting this permit shall in every respe conform to th to s of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Final V p y g p Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough �9 k _ 1'LKM11 LX_['11,_L5 IN 6 MONTHS Final d4-S --qS- UNLESS CONKRUC N T ELECTRICAL INSPECTOR q� 17gc m` Rough ....... . ...... .. .... ..... ... ........ Service . .......... O A BUILD INSPECTOR /U Final 'I Occupancy Permit Required to Occupy Build'ng GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT ' l NaR�kl Ahtl Town of North Andover �{ kORTH OFFICE OF L ` ? ,•< "• �o ° O COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street KENNETH R.MAHONY North Andover, Massachusetts 01845 9SSAUS�� Director (508) 688-9533 Any appeal shall be filed BOARD OF APPEALS within (20) days after the NOTICE OF DECISION date of filing of this Notice in the Office of the Town Clerk. Property: 70 Russell Street Kevin& Julianne Julian Date: 9-20-95 70 Russell Street Petition# :045 -95 North Andover, MA 01845 Date of Hearing: 9-12-95 The Board of Appeals held a regular meeting on Tuesday evening, September 12, 1995 upon the application of Kevin& Julianne Julian requesting Variances pursuant to Section 7, Paragraph 7.1, 7.2 & 7.3 and Table 2(Lot&Zoning Dimensions) of the Zoning Bylaw. The applicant is also requesting a special permit pursuant to Section 9, paragraph 9.2(1)(Non-conforming uses) of the Zoning Bylaw. This decision will Only reflect the request for a Special Permit. The request for the variances will be discussed and voted upon under advisement at a Special Hearing. It is possible that the applicant will not need the variances. The following members were present and voting: William Sullivan, Raymond Vivenzio, Walter Soule, Robert Ford and John Pallone. The hearing was advertised in the North Andover Citizen on 8.23.95 and 8.30.95 and all abutters were notified by regular mail. Upon a motion by Raymond Vivenzio and seconded by Robert Ford, the Board voted unanimously to GRANT the Special Permit so as to rebuild and increase a 16'by7' deck to 20' by 9', onto a legal non-conforming structure. Voting in favor: William Sullivan, Raymond Vivenzio, Walter Soule, Robert Ford and John Pallone. The Board finds that the applicant has satisfied the provisions of Section 9, paragraph 9.1 of the Zoning Bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing non-conforming structure to the neighborhood. BOARD OF APPEALS, William Sullivan, Chairman V Raymond Vivenzio Walter Soule John Pallone Robert Ford BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 6=9530 HEALTH 688-9540 PLANNING 688-9535 Julie Partin D.Robert Nioetta Mrchad Homed Sandra Starr Kathloen Bradley Tell Date.,,/.j ••••• pQTM TOWN OF NORTH ANDOVER pF�.ao ,^.1ti0 0 ' � pp PERMIT FOR GAS INSTALLATION SACHUSE� This certifies that G... . . . . . . . . . . . . . . . . . . has permission for gas installation . . . � . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . .7 0f.s•5.(. Z`. . . . . . . . ., North Andover, Mass. Fee. . Lic. No..°7. 3J?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PER`( 1T TO DO GASFITTING (Print or T ) v V` , /6/� Mass. Dat 199t Permit # 7 Building Location Owner's Name,MI-, AIG 1)/y �., 6 Type of Occupancy New p Renovation ❑ Replacement Plans Submitted: Yesp No p ccN N Z W N Y ¢ N N N V N ¢ N ¢ O O N = f W W ¢ O V m f" = Vf J N W ►� z O W Cr ¢ cc O ' O Z iW- ¢ m (A t- y W o a c N t7 W W = Z ~ O G > W CC W W 0) W = < S ¢ ¢ W ¢ W ~ W 0 F� Z -1 ;: Z ►. W W (a O > U. F- W J Y < W ¢ W < < O O W °' O W 1- ¢ 'i O WO S u. 3 G 0 J V > O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR I 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name "'Ae A iZ T Check one: Certificate Address 30 CiC C C H In f4ry G f1, ❑ Corporation 111 is 7 H U e rJ r 11 ra U 1 y ❑ Partnership Business Telephone - (7 7 f ©�rrm/Co. Name of Licensed Plumber or Gas Fitter -�r) E T A• 5 A W M f17A P � INSURANCE COVERAGE: I have a curre�nt pI' bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes C�' No ❑ If you have checked Ye, please Indicate the type coverage by checking the appropriate box A liability insurance policy dQ Other type of indemnity❑ Bond ❑ OWNiR'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 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 the per - i ued for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws. By T of License: L� Plumber n ure of cen u or Fitter Title fitter ter License Number City/Town Journeyman APPFKNE6T0—FF1—CTU9FZN17F— BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. - APPLICATION FOR PERMIT TO DO OASFITTING NAME A TYPE OF BUILDING LOCATION OF BUILDING - PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE - 19--- GASINSPECTOR