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HomeMy WebLinkAboutMiscellaneous - 69 PROSPECT STREET 4/30/2018 69 PROSPECT STREET 210/080.0-0007-0000.0 Date. 9 0 b IL r •• p',".��r:��o TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING I t. SA HUS I I / C. This certifies that . . . 1� �!!. l�l� l.t.P� . . . . . . . . . . . . . . F_ has permission to perform . . . .(!t! . . .i t.P.1!1. . . . . . . . . . . . . . . plumbing in the buildings of . . . 1I . 0+ at . . . . . . . f,0: . ` . . . . . . . ., North And ov r, Mass. Fee Lic._ # PLUMBING INSPECTOR € Check MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town; / —17EIOd VC ,MA. Date:_ '°/ Permit# 4„ Building Location:-149 �,�j � 57 Owners Name: d005 I Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential 0-1 New: Alteration:❑ Renovation:❑ Replacement: ®. Plans Submitted: Yes❑ No[� FIXTURES DEDICATED LU Z SYSTEMS W Y 0 fA Z H 0 d C Z Y Q Ln U(A LnF W Z W C' _Z N Z Q H tnLL _Z Q Q C O LU m y „�, p H �- C to Y 4n O ° x Q �' �- Q li. r- ?�. � tr �Q W O W Z W Z U d U. S J Q ? W U F- y d rte- U = ; 0 d z Z V) H F- -W Uj oZS 0 H FLU - a m en —e o LL °x Y g 3 °o � rQ- 3 3 3 0 W a < •SUB BSMT. a 3 BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name:1�&"j rrT kurv,,6 mo Check One Only Certificate# Address•54--3 YY 441 fV ❑Corporation City/Town:W �L->N�-e,vJQ State:_ (�i�� � q ❑Partnership Business Tel: { ?e Tq� ©5j�04 Fax: m/company Name of Licensed Plumber: �l S Jr-y—f INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YeNo❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ 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 un permit issu d for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and C apter 42 oft e Gneral Law r [ByType of License:e -plumber ignature of Licensed Plumber /Town Master APPROVED OFFICE USE ONLY Journeyman License Number: ` Date.... ...."... ..-........... Of 3ro���.o'ia1tippc TOWN OF NORTH ANDOVER PERMIT FOR WIRING a ,SSAC01US This certifies that ......4*v has permission to perform ..... !&.� ..... ./. . wiring in the building of A/... . y-- ....... . ,North Andover,Mass. Fee... . LiL.No. ............... .. ELECTRICAL INSPECTOR V!f l+ Check # r 10442 f Commonwealth ®f Massachusetts Official Use Only j Permit No. Department of Fore Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] geaveblank 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 INFOR1VfA OA9 Date: City or Town of: NORTH ANDOVER To the Inspegtor of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 41 S1.101r Owner or Tenant — P 1 h Telephone No. Owner's Address & �. Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building 3 Utility Authorization No. Existing Service/vy AMPS /a c.,Volts Overhead �Undgrd❑ No.of Meters 3 New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and.Ampacity Location and Natpre of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. Recessed Luminaires m f C '1 c . � )r No.of Total No,of__ _�ss __,_ .._re No.o� eu:cusp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ ❑ IN o.of Emergency Lighting nd. grnd. Battery Units --• No.of Receptacle Outleis No.of Oi BijYners FIRE ALARMS No. of Zones ' No.of Switches No.of Gas Burners No.-of Detection and Initiating Devices ?� No.of Ranges No.of Air Cond. Total No.of Alerting Devices ' Tons No.of Waste Disposers Heat Pump I�1.ixmber Tons KW No.of Self-Contained Totals: - - Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of 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: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: //- Z // 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC. Licensee: �vva frl S,�F /Z Signature / LTC.NO.: (If applicable"exempt"in the number line.) Bus.Tel.No.• Address: Alt.Tel.No.: *Per M.G.L c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Own Pr/A urnt - The Commonwealth ofMassachusetts ( Department of Industrial Accidents • Y i _ Office oflnvestigatimu 600 Washington Street Boston, MA 02111 { j www.hurssgov/dia . Workers' Compensation Inshra.nee Affidavit: Builders/Colntractors&iectricians/plu AmbePs pe icant Information Please Pri Le�bly Name (Business/Organization/individual); Address: City/State/Zip: Phone [Are you an employer?Check.the appropriate•box; - ❑ I-J.m•a employer with 4. ❑ I am agenera)contractor and I Type of prgject{required):employees{full and/orpart-time). have hired the sub-contractors 6 ❑Newooristruction.❑ I am.a.sole proprietor.or partner- listed on the attached sheet 1 7• ❑Remodeling ship and.have no employees These sub-contractors have S. ❑Demolition. working for me in any capacity, workers' comp.insurance. [No workers'comp.insurance 5. 9• ❑Building addition p ❑ We are a corporation and its required] officers have exercised their 1 d•❑-Electrical repairs or additions 3.❑ I dm a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions Myself•[No•workers'comp, c, 152, §l(4),'and we have no insurance-required.]t 12.❑Roof repairs .employees, [No workers' 13.[].Other comp. insurance required_] ------------ 'Any applicant that checks bo)'#1 trust also 1111 out the section below showing their workers'bompensation policy information, t homeowners who submit this alrrdavit Indicating they am doing all work and then hire outside contractors must submit a new'. davit indicating such. $Compactors that check this fox rtrustt trached an€ddition_al shyer sltowing the name of the sub-contractor and their sver.Uars'comp,pclicj infa,;,at oa. I Scr%t employer that Is,pY�aa6i8r7aP:FY®FIteP.�s t'6IdA1' efisrado a 1f'BsUFa?Ice Or inform ationa. %` 3'errtpinyees: del®e�is tlse policy-and job site ,r Insurance Company Name: ' Policy#or Self-ins.Lie,#: Expiration Date: Job Site Address: • City/State/Zip: Attach a copy of the workers'compensmtion policy 4eclaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penaalties of per,jury that the inf ormationz provided above is true and correct Signature:• Date: Phone#: L only. Do not wrNef►i tits area,t`o be Cornplgtedby MY or tawri official n: Permit/License thority(circle one): Health 2.BuildingDepartment 3.City/Town•Clerk 4.Electrical Inspector 5.Plumbing Inspectorson; Phone#: .�_,R ...... -.r,+.li.' r<%�. 1 -,{.: z..a.-�,.,.�<:ti�ra-+...++.•..y� fix :y,_ ve-.e ; y Location 69 No. Date c;? 7 r NORTH TOWN OF NORTH ANDOVER F r } Certificate of Occupancy yes'•••°'''��' Building/Frame Permit Fee $ s►CHU Foundation Permit Fee $ 4. l Other Permit Fee $ TOTAL $ ii Check # / 19998 Building 61pector ' Date. NORTH ` TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 �SS�cHUSEt This certifies that . . ��. . .��.t . . . . . . . . . . . . . . . . . . . . . . . . . . . . .i has permission to perform . .tI .1 . . . . . . . . . . . . . ... . . . . . . . . . . ;1; plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . at. . P11 G.kA . . . . . . . . . . . . . , North Andover, Mass. *' Fee. Lic. No..� PLUMBING INSPECTOR ?/ y Check # � 6739 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) No R;1H D o✓ 2 D _ ate ®'L ' Permit* Building Location __� /'. f Pfl.> f7 Owner's Name_ Type of Occupancy- New O Renovation O Replacement M,- Plans Submitted: Yes O No Ld' FIXTURES = m z y Z x < in O Z + W Y J N V < y C W M'. C t y < ft < Z y W F W 4 .Z 6 m O = d O (I/ Z .,.. � O W y Y < m W � Q Q d � � m < c 3 x W 0 O c y W a ~ y Z o < m 0 n < 0 < a Q W W S W iD p . i p G p r fY O = 6- V S � O < W tt 1G W Z O y Y = W < < < S < < O O .. .W. O p =J < < m J J d ¢ tL Y 0 • Slr6—BSMT. . BASEMENT . 1ST FLOOR 2ND FLOOR Il, I SRA FLOOR - i 4TH FLOOR i STH FLOOR 6TH FLOOR 7TH FLOOR I , aTHFLOOR r ti Installing Company Name Address Check one:. Certificate ��1�Q�('a 1/� �r � o . _ Business Telephone q��1 .. \, O Partnership Name of Ucensed Plumber INSURANCE COVERAGE: I have a current,ftilltyns O ce Policy or Its substantial equivalent which meets the requirements of MGL Ch: 162: Yes �Lqq If you have checkedes Please Y PI indicate the type coverage by checking the appropriate box , A liability,insurance policy Other type of Indemnity, O Bork O 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 pemdt application waives this requirement Check one: Signature of Owner or.Owner's Cogent Owner O Agent O I hereby certify that all of the details and information 1 have submitted knowledge and that all plumbing work and installations performed undw®rater ) above application are true and accurate to the best of my pertinent provisions of the de MassachusOM State Plumbing Coand f for this aPP"=ion will be in compliance with all Title Signature o umber City/Town Type of license:baster(Lv Journeyman O x BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS #KETCHES PROGRESS INSPECTIONS FEE d NO, i APPUCATION FOR PERMIT TO DO PLUMBING s NAME i TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE._1S PLUMBING INSPECTOR Location? Datewy NORT" TOWN OF NORTH ANDOVER o�;...° ° Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s+cMuse 9 Foundation Permit Fee $ } Other Permit Fee $ TOTAL $ 1 t Check #1d6 Building Inspector/ TOWN OF NORTH ANDOVER f BUILDING DEPARTMENT APPLICATION TO CONSTRUCT MEN&RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Ah seefift AfSC . M BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/1for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address:. 1.2 Assessors Map and Parcel Number: . Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use I Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R •red Provide ReqWred . Provided R •red Provided v 1.5. Flood Zone Information: 1.8 Sew e 1 System: 1.7 Water Supply M.G.L.C.40. 54) ora8 > ys Public ❑ private ❑ Zone Outside Flood Zona 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I"' i l e•5 110 rn 2.1 Owner of Record a �l c Nam(r(Priin'tf Ad rd ess for Service: Signature Telephone 272 Owner of Record: zzl,690 OZ4" — ame Pnn AddOress for Service: Z i' rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ oei Lice 'ed onstruction u lvisor: n 3' ;.�t�.�, /y—� �7�— License Number Address ' Q2 Expim n Daj ic ig re Telephon �. 3.2 Registered Home Imrprovement Contractor Not Applicable ❑ v mpany Name Registration Number r.. i Address �� Z Expiration to ^ t ure Tele hone V I e • 1 SECTION 4-WORKERS COMPENSATION(NLG.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 building it. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Descri tion of Proposed Work(check all applicable) New Construction. ❑ Existing Building ❑ Repair(s) ❑ Alterations�s ❑ Addition ❑ •sv w +?� o Accessory Bldg. 13, .; o ition ❑ Other ❑ Specify t i% k t\ Brief Description of Proposed Work: ~J SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUII.DING PERMIT I, as Owner/Authorized Agent of subject property >r 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 I arae Si ure of wn r/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of Andover 0 Noio233 C, r, Mass., 0 LA dove r, 0'0'?ATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System .......... BUILDING.INSPECTOR THISCERTIFIES THAT ...................................................................................................................... Foundation has permission to erect................ .................4_ buildings on ...1.9P...........10......... ................... Rough tobe occupied as..ft�,,,... ...........I..........................................;................................................................... Chimney provided that the person acce g 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 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. SEE REVERSE SIDE Smoke Det. Castricone Roofing & Siding REPAIRS FREE ESTIMATES Telephone (978) 682-4266 MARIO CASTRICONE 31 Court Street,North Andover,Mass.01845 I/we,the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials, labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: P Owner's Name..................... . .. ..... '1.............................................................................................. ................................................................ ✓la) Xk---�*, .......................Ci i...... /�'� �1' jSte....:..../,/Job Address........:....... ........ y.... .. ... ry. /� ............. SPECIFICATIONS 6 , / ..... ......... .. ...: ........... ..A-1.2..................................... .............. ... ............ . ............ ................ .... .............. .... ........... ............. .... . - -..: . . ...�.......�... o ) ....... .. ....... . ... . . .. . .. ..... . .;ti. ..W. ... :.., .� ....`. ....................................................................................................... ................................................ .............................................................................................................................................................................................................................................................. .............................................................................................................................................................. ..................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................... . .................................................................................................................................................................................................................................... . ......................................................................................................................................... ........................._ ................................................................................. Materials and labor to cost$.......Ll..0.d •.••••••••••••••••••••••••• Payable ...:. ren ................................and balance in............ monthly installments of$.........................................each, payable on ........................................day of each and every month thereafter until paid in full(..............%charge per year is to be added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation and a completion as requested by the contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid,that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor;and also that the obligations hereof shall bind and apply to their heirs,successors or estates of the parties. The undersigned warrant(s)that he is(they are)the owner(s)of the above mentioned premises and that legal title thereto stands of record in his(their)name(s). I PROVISO:This contract shall be void and of no effort if credit approved of owner(s)is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Cover attic storage cleaning not included. Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement hot herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in ope tion. IN WITNESS WHEREOF,the parties have hereunto signed their names this ...., ,(, �..........day of... ,1�..........., 31J`1� � • Accepted: ,/' � l� Signed..:r i, .............................. I Owner (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Signed...................................................................................... 1 Owner Per. .... � ............. ........... Signed...................................................................................... Representative i r Yom,- ;� The Commonwealth of Massachusetts Department of Industrial Accidents -� Office oflnuestigations 600 Washington Street, 7' Floor Boston Mass. 02111 Workers'Compensation Insurance Affidavit Building/Plumbing/Electrical Contractors Please PRINT le tbl 'A licant information:' ; name: address: /cz city�'/o state: ///��b zip: phone# work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition ❑ I am an employer providing workers' compensation for my employees working on this job. company name: address: � I/` .� city: eL41 1= phone# � Al insurance co policy# / � f N:�.,',.._.» .�.. `' .,; .,.,, ❑ 1 am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: Companyname: address:. City: phone'#• insurance co. uolicy.# company name: address city: phone#- insurance co. policy# Failure to secure coverage as required under Section 25A of 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 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 id pei Ines of perj4fry that the information provided above is true and correct. Signature —Date gn ° Print name ? Phone# �/0 1 at (� W official use only do not write in this area to be completed by city or town official � V;;3 ' city or town: permit/license# Ng P ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office I ' ❑Health Department contact person: phone#• ❑Other ii (revised Sept 2003) Information and Instructions I i Massachusetts General Laws chapter 152 section 25 requires all employers to provide 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. t r local shall withhold the issuance or MGL chapter 152 section 25 also states that eve state licensing a o g enc g y p every 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. I', Applicants I Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,address and phone numbers along with a certificate of insurance 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. .a � �: sk�•�`-"Yi�`a5z'* 'v-'-' `7 t: �-y� � z ,�....r,..,. .� e �� "`a*�'�` �r� .a � 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. j The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. d xr M< The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7`h Floor Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 r FILE 2 � I.991 a BOARD OF APPA , January 31, 1997 j CERTIFIED - RETURN RECEIPT REQUESTED AND FIRST CLASS MAIL I 1 Robert Nicetta, Building Inspector Community Development & Services i 146 Main Street No. Andover, MA 01845 I Re: Illegal Conversion of Two Family Dwelling into a Three Family Dwelling and Construction of a Third Driveway Premises: 69 Prospect Street Owner: Ralph Bevin R i Dear Mr. Nicetta: We the undersigned abutters to the above referenced premises would like to bring to your attention the work performed within the past year, as well as currently being performed without i proper permits from your Department, the Department of Public Works, and the Board of Appeals. At the. outset, we would like to point out that the above referenced premises are located in a predominantly single family neighborhood both on Prospect Street and Moody Street. However, the area is zoned R-4 which also allows two family homes. The structure at 69 Prospect Street was a two family home prior to the work done within the past year. i The two family structure had a colonial style house on the Prospect Street side and an attached ranch style house on the Moody Street side. Within the past year, the owner has performed the following: installed an additional street level door and entry stairs to the colonial j style house and a makeshift fire escape and stairs from the second floor of the colonial to the ground level. He has accomplished this by converting an approximately three foot window to a three foot door.. He has also commenced the construction of a third driveway on the Moody Street side by removing loom and putting down a crush stone base. This would make a total of three driveways, one on Prospect Street and two on Moody Street to service these structures. We have been advised that an R-4 zone allows one or two family dwellings and further states that a Special Permit is required from the Zoning Board of Appeals to convert any existing dwelling to accomodate not more than five (5) family dwellings. We have not received notice of a hearing for a Special Permit from the Zoning Board of Appeals. 'll I i i The- items listed herein are what we have noticed without seeing. the interior of the structure. We have also noticed that there is a relatively new tenant living in the colonial style structure-who parks in the driveway on the Prospect Street side. We are aware that the ranch style structure has-been rented to a young couple who have lived there about one and a half years, who park their vehicles on the Moody Street driveway. We have also noticed that Mr. Bevin is parking'his vehicle overnight in the new driveway he has started to construct on the Moody Street side. His vehicle is being parked overnight indicating he is sleeping in the newly created third family dwelling in the colonial style structure. Curiously, the installation of the third driveway coincided with the winter on-street parking ban. It is evident that there are three families living at 69 Prospect Street in violation of the Zoning By-Laws. We request that you investigate this matter and take the appropriate action to bring the structure in compliance with the Zoning By-haws. Kindly respond to the ` undersigned abutters upon completion of your investigation. cc: David Bailey, Department of Public Works Y M 7CIF Board of'Appeals Nameb/f C% rte A,-o v G N Name �z f r/c l-�?-. Ll Address ` Address Name 6�ixlraanna / Name y ry .,tY Address Address I i i Name / fes- _,e y i;eb ,'Z L 4afiieC he r la{ P Address Address Page 2 .t tt' Name W .� i ra m S c e e_ Name to `c3 Moo ti �L Address Address �Jo CA Name Name Name Address Address Name Name Address Address ;s rr i i 'h Page 3 Office Use Only The Commonwealth of Massachusetts Peal= No. o Occupancy & tee Checked J V Department of Public Safety 3/90 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR __ E-��ALL INFORHATION) Date `1�-6 Ar City or Town of Ca3�f�ly / tea ,, To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) �L Owner or Tenant A PJAI v d q o— Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service Amps / Volts Oyerhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters_ Number of Feeders and Ampacity ; Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool gbrnde ❑ grnd. 11Generators ovIn- E. KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting z Battery Units 3 No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones 1 e m Total No. of Detection and c No. of Ranges No. of Air Cond. tons Initiating Devices = Heat Total Total W No. of Disposals No. of Pumps Tons KW No. of Sounding Devices W D No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local 11 Municipal ❑Other Connection a No. of Water Heaters KW No, of No. o Low Voltage Signs Ballasts lWirin f o No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES p NO E] I have submitted valid proof of same to this office. YES❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Expiration Date Estimated Value of Electzical Work $ Work to Start Inspection Date Requested: Rough Final Signed under the penalties f perjury: FIRM NAME LIC. ti'l. G Licensee X22��° _Signature LIC. NO. us. Tel. No. ,3'�pJ� Address(/ - Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial 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 SCk (�' V Signature of Owner or Agent le-C) .�j..y.r ,4. :R . ♦ .r ii.-.•.:1 a*- x:sY'4`'S�=..rYx.,:..'r �.:'�--:$:tom} '.>a"Y -.. .d,T�"�4. sl..:.%y:` Date... ' r ;} NORT" °14, TOWN OF NORTH ANDOVER PERMIT FOR WIRING, ; tom. ,'MACOW This certifies that .....':)o,Ito ...... ..f'{..'....`..'. .. . !r .1�.... a ........ }�Y� has permission to perform A— h/P : ....... .... .................. ........................................ wrong in the building of.... ....; t,..........................!:...........I............. at.... . ' ' . ....`....................... .North Andover,Mass. f:. t "`.. Fee... Lic. ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File *; i v � Atjjcav C2 ) WRs S O l R 16 I Fe6 �57199S KK®$�'N A cv i OV R i a R 'N G- N S pec`�otZ, Sst" 'eci, House- mem{ P SOC Pl?ospi sT -. ) a t:Lo-2 . ��S �ot�s� '�-0 4 ele�4�o►vc� C�� � ev-sQ.`}-1`UNS, T am reques -Hrv� oL Hasc uhne.�e r 1 I C- se en N) (oc, r rooMs ►(� e. �'� r��- �' � ©G� w< <1 re �a � nr cam Sinal, ci (�a 'me►.)�' c �a mass �a(,.) require--s7 --kaf -4-e v is kow e 'tine i k, ow r,3 meie—r�- --Th r your APPr-avaL py -7� ;I AIP- I 1 p 1 t� FEB I 7 112nS i I i