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HomeMy WebLinkAboutMiscellaneous - 69 SALEM STREET 4/30/2018 (2) 69 SALEM STREET 210/096.0-005000.0 JOHNSON& Mark B.Johnson(MA,NH,DC) BORENSTEIN, LLC Donald F.Borenstein(MA,ME,NH) ATTORNEYS AT LAW Kristine M. Sheehy(MA) Denise A.Brogna(MA,CA,NH) 12 Chestnut Street Kathryn M. Morin(MA,NH,ME) Andover,MA 01810-3706 Lorri S.Gill(MA) Tel: 978-475-4488 Michael A.Klass(MA,NH) Fax: 978-475-6703 www.jbllclaw.com of Counsel kathryn@jbllclaw.com Robert W. Lavoie(MA,NH) Paralegals Karen L.Bussell Danielle R. Corey Lianne Patenaude Ellen M.Melvin February 28, 2013 Gerald Brown, Building Inspector Town of North Andover 1600 Osgood Street North Andover, MA 01845 Re: Lot 69, Salem Street, North Andover Lot 70, Salem Street, North Andover Dear Mr. Brown: This office represents Jeffco, Inc. relative to its application for building permits on the captioned parcels. In connection with such representation, we have caused to be examined the title to both Lot 69 as shown on plan recorded with the Essex North District Registry of Deeds as Plan No. 16230 and Lot 70 as shown on plan recorded with the Essex North District Registry of Deeds as Plan No. 16231. Based on our analysis of the title abstract and without intending to opine as to encumbrances of record, we hereby certify that Lot 70 as shown on Plan 16231, excepting the parcel depicted thereon and designated as "Parcel Described in BK 11015 PG. 209" has not been held in common ownership with Lot 69 as shown on Plan 16230 since 1941. Based on information contained in the Zoning Bylaw for the Town of North Andover, the Zoning Bylaws were adopted at the Annual Town Meeting on March 13, 1943, were approved by the Attorney General on April 13, 1943 and were posted on May 1, 1943. Therefore, Lot 70 exclusive of the ten foot strip and Lot 69 have not been held in common ownership since the date of adoption of the Zoning Bylaw. I Gerald Brown, Building Inspector February 28, 2013 Page 2 In point of clarification, the parcel described in Book 11015, Page 209 and depicted as a portion of Lot 70 on Plan 16231 is not vested in the same owner as the remainder of Lot 70. Lot 70 exclusive of the parcel referenced above and Lot 69 can potentially be deemed to be held in common ownership based on Parcel 70 being held in a realty trust. The beneficiaries of the trust are not a matter of record at the Registry of Deeds. Notwithstanding non-disclosure of beneficial interest of that trust, it is noted that the trustee of that trust has full power and authority to act without direction or authorization from any of the beneficiaries. It is further noted that while there is a Release Deed regarding the parcel described at Book 11015, Page 209 into the chain of title to the 1049 Salem Street Realty Trust, the parcel is actually owned by one James W. Rice or his heir successors and/or assigns. Title to the parcels was severed in 1941 when the 10 foot parcel that is the parcel described in Book 11015, Page 209 was deeded to Rice. At that time, Rice was the owner of the remainder of Lot 70. However, Rice was the then owner of Lot 69 and the parcels including the parcel described at Book 11015, Page 209 have not since been held in common ownership. Please call me if you have any questions regarding this matter. Very truly yours, JOW& B RENSTEIN, LLC Ka o 'n KMM/mbf Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies thattJ!,�! C{fi. ^! j has permission for gas installation . . . . . . . . . . . . . . . . . . . . . in the buildings of. . . u.;�?Q--- at . . . . ,N rth An over, Mass. Fee . . . Lic. No. ���j��. . . . ✓. '". . . GASINSPECT0*1 Check# (p T 8392 •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE f � PERMIT# JOBSITE ADDRESS r /� ^ S OWNER'S NAME GOWNER ADDRESS i TEL[ TAX TYPE OR OCCUPANCY TYPE COMMERCIAL( EDUCATIONAL i RESIDENTIAL PRINT CLEARLY NEW:E1 RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YESE-11 NO APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE ... T �1 t_T (_ _�.l� _ [i_,.:�,. FRYOLATOR — FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS (. ( MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT T! _.. ! _. ,_T---- TEST UNIT HEATER '. UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE _ have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES _ NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY M— OTHER TYPE INDEMNITY 0 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: OWNER 0 AGENT El SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true aA 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 comp46c6 with all/Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r C _UMBER-GASFITTER NAME tG.L_ _ c - _ _h__ LICENSE#[L65 SIGNATURE [B-'MG­F IG TURE MGF JP n JGF ,__ LPGI _[ CORPORATION�' c, ' __.._PARTNERSHIP LLC[ (]# °ANY NAME: ]ADDRESS ,1_/ rf _Cry STATE ZIP c� TEL -�: -'o_� o � ._____ `/_`f3�-mad ELL IEMAIL �. ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ �� FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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):/7/ey �7 l�L,.. ��U6,,.3 ir, .��/ •. �S Address: 1.3 O c5r_7 4n.% S, City/State/Zip: 57-& „"Iq- Ga t i'b Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. [11-aim a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.ElI am a sole proprietor or partner- listed on the attached sheet. $ ORemodeling 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.El Electrical repairs or additions 3.❑ 1 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.] 13T] Other *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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name: 7e C /1�s 165 Sc.�c n r �° e G n•/-'4- g Policy#or Self-ins.Lic.#: Expiration Date: r'/—% e. .16 Job Site Address:_ e S .S c f'�:�. S City/State/Zip: 0,;2 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 af 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. F do hereby cern der the pains and penalties of perjury that the information provided above is tree and correct. 3i nature: Date: ?hone#: 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"...ever •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)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: I 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 � y dll/EALTH OF MASSAEfSETTS ,. - = Mu M 'NM ...,-AIN 10 GASrtt # C ASA MASTER P ISSUES THE ABbVIPE SE IJ{��ID P HL�Gt1TE7t� T - TJ H{•1 ....... 1fl9_ 05%61/1417 t_qo. 9'N01E S28537258 = y' 3 as-a 963 j: 1lpNE ism M 4VM(fHRppST o ST%tEMAM.MA ff118@m9 OD Rw 07-1s20" i Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION J 4 �� This certifies that . yj C�(. . . has permission for gas in tallation . . . . �'—r. P in the buildings of. . . . . . NP .. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . .(P v. . . . . . . . . ,N h And ver Mass. Fee -3b . Lic. No. .t�391. . . �. . . GASINSPECTOR Check AL 8391 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY v /. _� u rP__ MA DATE PERMIT# JOBSITE ADDRESS eo — � OWNER'S NAME POWNER ADDRESS _( TEL _ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: ! RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM _f _._.__. ( _A_..._._. DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN --I ...._-- __.__._J _._.._._} .___._.._J _ { _.._..__( -........ _f FOOD DISPOSER FLOOR/AREA DRAIN _-.__J INTERCEPTOR(INTERIOR f f ..._..___f ___-__.J ._-- I .--..- J KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL _}M---i ._._-_j ..--._--kSERVICE/MOP SINK ( f I i f f } f s ! l ......._JTOILETURINALWASHING MACHINE CONNECTION ____-.i ___. ._ ___J .-.-__J __ i -__-_ .__._. ( ___._f _.__ . ___ ! .___-_I —.-Of WATER HEATER ALL TYPES WATER PIPING OTHER f --------_( i INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES+Eq-NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY�� OTHER TYPE OF INDEMNITY D BOND Ell 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 0 AGENT IDA SIGNATURE OF OWNER OR AGENT C 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 c liance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME . l�� X, ,,_. LICENSE# /� l �r SIGNATURE MPz'JPD CORPORATION ' ;PARTNERSHIPD#LLCM COMPANY NAME /1! �.,c - ADDRESS5- CITY —STATE m A { ZIP Got I8v —� TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR-OFFICE USE ONLY FINAL INSPECTION NOTES 10--Zr-t, Z Yes No 2r G- THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �s • The Commonwealth oflMlassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationPlease Print Le0bly Name (Business/Organization/Individual):/7//Ou 4 74-,. �fC•l,�.�ir, ��e /y^C Address: /3 6 i 5-1- Pty/State/Zip: �City/State/Zip: n 0-119b Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I m 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.[:] I am a sole proprietor or partner- listed on the attached sheet. # 01Zemodeling 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.[:1 Electrical repairs or additions 3.E3 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' 131-1 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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: e C1126 Policy#or Self-ins.Lic.#: T C✓ 302 5'tt``t'rJu Expiration Date: !–/ C :.(3/2 Job Site Address: e S S<.. /P:s. S City/State/Zip: G,-2 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 DIA for insurance coverage verification. r do hereby cerrq der the pains and penalties of perjury.that the information provided above is true and correct. Signature: /� // v'n / `- Date: /C1/Xa u 1� ?hone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License it 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#: lip G�11iiNEALTH OF MASSL JTVTBERS AN GA AESETTS =i��-. AS A MASTER PLE�R §§UES THE ABOVELICENSE U -T, H 9IJGHTf3t� 4 WINIDP: 53 `_ _MA 0215 -2 � WMI ��";✓�4:.x.4_u�'I s.��:__,_`�;'± "•t P+�a M 44 3 S28537258 ism0644 63 x.:. Y " ��/i/c(Vj ps,�-1610 RN PT-1SZp�9 JAN-21-2009 02 :54 PM LARRY OGDEN 978 352 2858 P. 01 LAWRENCE H.OGREN,P.E. 198 EAST MAIN STREET GEORGETOWN,MA 01833 978.352-8318 fax 978-352-2858 cell:978-502-5921 Januwy 21,2009 Mr.Kevin Murphy 169 Boxford Street North Andover MA. 01845 RL: Payn�ey idcnc0,69 Salem Street,North Andover,MA, 01845 Dear Mr.Murphy - As you requested I visited the project 1/21/09 to review the LVL members used in the framing of the addition to the above residence. 'These are shown on sketches Dated 1/8/09 prepared and teed by me. I also reviewed the 2-1.75-* 11,875"LVLs used as window headers in the front addition. Based on these site visits I can certify that to the best of my knowledge the LVL members utilized in the above structure are acceptable and meet the loading conditions required by the 7'b Edition of the Massachusetts State Building Code. Should you have any questions please do not hesitate to call. Yours truly, Lawrence R Ogden,P.E. Structural 27765 Hkr"LU U QGUEAi �t..�, 1, 27765<Q P�Sfi Gcr`���t�,��/4�' i N2 2207 Date....J i ...... 40RT#1 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that .. ..... ...... .. ..... ........................... ... has permission to perform ...... ...... W`...................... wiring in the building of....... ......... ......e�yyl.. G..Z 591f��....5-7- ... ........ .... ............ ..... North Ando-ii, �0 Lic.No../2 1.. .......... . ... ..-Z..... . .......... ........ .... lr� - / ELECMICAL'i** ECTOR 7 -7 () 01/12/99 14:48 35-00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only � E C�ammuuurettltl� Df �Itttsl�tttllu�>:#t Permit No. Elepartutent of Public i5ufctg occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 52VRR 3/so peeve blank) APPLICATION FOR PERMIT TO PM ELECTRICAL WORK All work to be performed in accordance with the Mas Electrical Code, 527 CMR 1 :00 (PLEASE PRINT IN INK TYPE L INFORMATION) Date City or Town ofyCJ n To the Insp ctor of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) L - J Owner or Tenant L �`ti'- AJ ✓d 6 !S✓G 1 � Owner's Address Is this permit in conjunction with ac building permit: Yes ❑ No ,tTSl (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps^J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work b No. of Lighting Outlets No. of Hot Tubs No.of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above in- grnd. ❑ grnd. ❑ Generators KVA No.of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No.of Zones No. of RangesNo. of Air Cond. Total No.of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No.of Sounding Devices No.of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices 1Municip No, of Dryers Heating Devices KW ocal al Other ❑`connection No.of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring (� /L No. Hydro Massage Tt:bs 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 1= NO ❑ I " have submitted valid proof of same to the Office.YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE C BOND. G OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of EIctric I7L��.�/�j Work to Start Inspection Date Requested: Rough Final Signed undor the Penaltles of perjury: FIRM NAME LIC. NO. 171117 Llcensee nnnald A- Brooks Signature _ UC. NO. 19410 4400 Address 111 Morse Street, Norwood, MA All. Tel. No. (781) 737-1111 All. T01. No. (7�A.1�7�a1.1..3.1 OWNER'S INSURANCE WAIVER: I am aware that the Liconseo does not have the Insuranco coverage or Its substantial equivalent as re- qulred by Massechusolts Genoral Laws. and that my signature on this permit application waives this requirement. Owner Agent (Please chock ono) (J Telophone No. _.._ PERMIT FEE $ 1 G (Signature of Ownor or Agont) x•OS/i5 ` Date... 3r° o°rM "°oma TOWN OF NORTH ANDOVER y PERMIT FOR WIRING • +� ,SSAC14US� This certifies that C ...............................................` ................ . has permission to per(/form .... .... .. �..�. .. ..! . > L ,/1 wiring in the building of�..�-:��r�..:�:r.,.:....��..................................... ................ at... .A,.. ;, !fl �.. .... ........................North Andover,Mass. Fee.. r. Lic.Nom-. � .....e .. � �ELECTRICAL INSPECTOR Check # _ 5 5 t4 �s Otce Use iiUOnly ^ : Y The Commonwealth of Massachusetts rerelt b: Department of Public Safety Occupancy b Fee Checked C BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1ZW 3/90 (teaee blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed In accordance With the Massachusetts Electrical Code, 527 MR 2:00 (PLEASE PRINT IN INK OR E I ORHATION) Date c� J City or Town of , 7 To the Inspector of Wires: The undersigned applies for a permit to perform the elect ical work des5xLbed below, c Loation (Street & Number) Owner or Tenant 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 Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and A:pacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting FixturesAbove In— Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No, of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges Total No. of Detection and g No. of Air Cond. tons Initiating Devices No. of DisposalsINo. of Heaos t PumTotal Total Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal 1:1 ❑Other Connection No. of Water Heaters ISiensf Ballasts No. of Wirinoltage No. Hydro Massage Tubs No. of Motors Total HP OTHER: i 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. YESK NO 0 I have submitted valid proof of same to this office. YES Qg NO Ifou have checked YES,, please indicate the type of crage by ecking the appropriate box. INSURANCE � BOND ❑ OTHERI� (Please Specify) �� Expir, tion Date! Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Fina Signed under the enalties of perjury: FIRM LIC. NO.�3 3 Licensee S f"//% `/ele 4 s�& Signature tore $ 8 LIC. N0. 9:3.3 Address 16 Z 0/f# Tel. No.(5'Obr CO y 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 S Signature of Owner or Agent 2 45)5 Date................... ....... ,40RTN "6 —.'. 0 TOWN OF NORTH ANDOVER ". PERMIT m 0 FOR WIRING imm ,SSACHUSEt ........... This certifies that ... ........... ........ ........................................... has permission to perform ......... ......................................................... wiring in the building of...... ............................ ...................................... at....:.....1.....:./!./J .North Andover,Mass. FeeJ.................. Lic.No. ..........n... .................i........ ................................... I-le .4 LECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File r uric+r IILC UllI c' Permit Nil So�O q,1...1 g17n rfr,4r.ni �,e _`JervrC •------_. •r" i, BOARO OF FIRE F'RI;VFNTIONiFlt AH-AT(ONS (Rey an,l Fee Che:4ed � 1 I/99J ttc„•,:bla„t,� APPLICATION FOR PE' MIT U PERFORM ELE'C'TRIC;AL WORK r►!!c,•urk to he rcrlo(mcd,n ar.corcla,cc\-, he �l.,x• •I��I;clts ( ! etrifll Ct�cle I,�lC('},S1,)CAIR 11 00 1 L I:vl-1. Rll !1!()1V 1)atc:�� J� City or Towll of: fh �� //�� �`---p fly IIlls applic-Ilion the ultdcrsi•,lwd t,tvC5 ttI)OCC!v c 1 EC141'of i6'ir t?s, her unc;,ti;c,,l Ill pt rlGint the elcc0leal work descnbe,i bctow. f.oc'kIiu,s (Strt±ct & Ncssstbcs') , Q►v �'elc' Moll e \'a. Owner'sAddre.ts Is this permit in conjurtcliasu ,vitl, a t•„rildinQ I'm lulSe of lscrnul:' ycg 1 IVa E) wiled, AI)wnpriatc Bax) l.luilJirrn� rq - � �t Ulslily AI)0 ,>6716uis ,Nu. F'kislilf b Set vite Amps _ , 'Ills QICItIC:tll U unj,url) ��~~•�� l-J No. of Alatars , rVecr�i�c Assslrs Uk trtl Number of Feeders anJ Anrlaacity _ ,`tn of,)feters � Loeotiu,s 'kill INahsr ur Pro jos t) Electrical n,Rybr �Ir 'N'o, of fteccssccl Fixtures - - t ----� 4sr ccrar frau _...___ N'n.of CCII.-.,c usls.(I ad�tic) Fans a.of --ow I,i Iain01100s �rraiss(or)il( V No. of r� Cesrerafors © ryo_ of )lul 'f'ui:s -- - KVA, �'No, of lt.,igl)ting k'ixtttrt's _ .St►in,n,ill Foul AI'a` . . Ali= ��Iellll ilergeticc .,tgT,tilig _ ,Bils No.of Receptacle nutic'ts N f Oil Burners 11F21G Al /�A11)s (��01 .,m, . N4�o(s'vitcl'es net,�r ere` +�o �UeiecIipsa aril) _._....,"......._.._._._.._...—... lrsitialin�Uavices .�...— rNo. of Ranges No. of Air Coud. ---'�`0tal Tong N9,a crllog evict ..._------- f ftll Devices \'o. of Waste Dis nsess fKC-110'usslp iVun,ber Ions ) 1V q-^ - --- _ _..._-.....'totals. ._ .__ �)cic�tiosrJ.�,)erfir►p :No.of f?islt►sasltr.rs -- — ___'. �___^ _ �,Aevices SpaiCPJAIPI },ruling 100 L.vca1 ❑ llltetpal n ntfser __.� .. Cotsucclioll — 1`:v. of f)rycrs )Icalinf, ,�pplilrsccs ccurttV yslctsts:�� ►leer ,,\o of� \Nil o. a!' __ o o(lac.►icrsarl� laivaltr)!f ' lic:stcrs I<11 No. ,Hydrotm-mage f3atls(ubs _ No. of Motors � ��-�nsrstiaisfC�fian TOW Jill S�`il' 11 : ___.__..__ No.of f)a"ices ori uiv�tlenl O T H E f t; __ —._ _—_ .--..._ -•--q_._. _....___..__•-_-_...,...._._._________...�____.._..__._-_---.__..--lr?n�!, nll!(iti�ann!demi ,/' ...._ he livens` c r CON't roof of U,afcy wlivcd by the owner, no permit for the per formas ce of e)ectricolb�orrl: nilly issue unless the tic•r.nsca provielcS proof of liability iusurls,ce includ:Itc; 'con,pleled ofseralign"c4vcta�e or its suhstanlial equiti'salettl. TIIC undersign(A c.erl+ries Thal such cover a is in force,all(] (,as eslribate(] prnef cf lanae to lite permit issui+ss� offset. C�f-lr_GK 0�g. li\'s R-/\ (1 Nr.� c�)ill a - . k6A 0C. Cstiut;aied able of Electrical Ivotk: tEtprration O:nc) { hen requited by mimic pal pooh) ) \Vorl: to Sink r{� t,+spec!„ h.s lu be rrduecicd in u ,1cc��Tj. ,cc %k ill, ti•IEC Rule anJ r�i•>prt cur'tplrtion. .._ _ the llnir„ nn,f/r(',rnitr<.c a ,(!)r1r], rl,,,r;? r ;n!r+„rrr lin++ (7.-1 flus nl,l,rirrtriu„ +s!r rr a,+rl calnplrrc'. I�tlt,1) N:lttlt�:-- � �,� t irt•„trr. .. — .. J -7 \Jlresx flus. Tel.twv s\a.;•p�' A�rI a��:,uare IIt:,I Ilse 1.irrnsr'c d s not/.n.` > �All,Tttl cNo.crate . � �./2�1 rec)uifrJ by 11.v 1.3r Illy' slskla n,e belt v.. I l,c;c, +r:+i,” i nam ally _ O,►iter/,I�cn( ! s rr`l +'r+'' s i 1 Jns rlie (,lscrk rnsc} o Ilei []o„iter':itirnl. Ssgrsaturr ------- _ A"/?JIIT rr” 1 1: S 'qb - N2 2904 Date... ..... NOR711 3 0 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUS� This certifies that ........ ..........� .. 6a..`Q......................... has permission to perform ....... ...... .................. wiring inthe building of....J.C(..<�I?... ......................................................... tt C at.......... ..G(......,.�Gt...� ' ....S...... North Andover,Mass. 24.'$ Fee..... Lic.No. .U.. ELECTRICAL I SPEC Check # ---�� WHITE:Applicant CANARY: Building Dept. PINK:Treasurer l TBFC0W0AW1f'.4L7H0FMi`) &4CHU ' Office Use only I DEPARTMF.I�ITOFPUBLICSAFETY Permit NoI . (J BOARD OFFIREPREYE MONRWULATIOAN527CMR 12:00 u,p- Occupancy&Fees Checked PPLICATIONFOR PERAff TO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. ,,r� Location(Street&Number) / ALCM 1j T NdR'nA AtJ ooVac Owner r Tenant M IC N A E L PA`p O E Owner's Address _ "O RT R R N OOV ER S Awe C Is this permit in conjunction with a building permit: Yes F71 No r—J (Check Appropriate Box) Purpose of Building i=AMM 1Q00 ®1`l ■_�_ Utility Authorization No. Existing Service100_ Amps f) /220 Volts Overhead = ' Underground F-1 No.of Meters f New Service Amps— / ` Volts Overhead [:3 Underground No.of Meters +•J��--•• Number of Feeders and Ampacity 3 fveu 9 Cacu(Ts 1 S A C' CH Location and Nature of Proposed Electrical Work A D 0 3 AJ Cw C12C0 k'TS S 1 aE &MILY WOIM E No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.oiLighting Fixtures Swimming Pool Above Below Generators KVA ground ound No.'If Receptacle Outlets 10 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals _ No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices _ No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other, 4 a Connections No.of Water Heaters KW _ No.of No.of Signs Bailasis l No.Hydro Massage Tubs _ No.of Motors Total HP OTHER Irmranoe Ptasuaittothe scbCoxriLaws IhaNeaamet ' h>✓traioe CtwdgeoritsakswUecgmalat YES NO Ltabrldy P1HryattdUdrtgt..at�te lhawsubrru admWproofafsamellotheOffloe.YES M NO ffjwha%edI9 WYES,pleaseirdc*thetypecfmwaWb5'dcdortgthe awcpnale WSURAI� a BOND OTHER ftmSpoffy) c FSd Value�ial WX 500 &n e WcrkbSiart 2— 0 k hspecdonD*Requesd Rough 4 C'1 Fstal 60 0 Sigiredtaxla�iePF��ofpajtay: FIRM NAME Lioa�seNa Li=9W Signer Lit�erseNo BtsirMTdNa AIL Tel.Na OWNER'SNRA ANCEWAVER;IamawaretblftI ioasedmnotavei theirstm=ooaeagetxi akslar1Wet asr *zWbyMa%adxs&Gaxr.4Laws andiatnTYS 1&n(nthepml*eppficaiortwainthisre4sie ent (Please check one) Owner � Agent Telephone No. CP SS -2609 PERMIT FEE 0. 0 0 Location No. ��� Date 2,191-. x MORTM 1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ sACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14103 / �Building InspIdaor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING 70 BUILDING PERMIT NUMBER /, / DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION I O1.1 Property Address: 1.2 Assessors Map and Parcel Number: Sot. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 73 D Zoning District Proposed Use '' Lot Areas Frontage ft 1.6 BUnDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Sypply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone Municipal On Site Disposal Syste J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record ` ^ L 1 ` t and(Pri Address for Service: e� �-32 r Signature 61fTelephone 2.2 Owner of Record: Name Print Address for Service: O Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number mn t_. AdAress WC �, ) D nL v V J Expiration Dae ic Signature Telephone r1• 3.2 Registered Home Improvement Con ct Not Applicable ❑ Company Name Registration Number r rMU dress � r 7% Expiration Date /) Sin ure Telephone Y/ r SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and sukmitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the kuilding permit. Signed affidavit Attached Yes......Yk No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ` ❑ Other ❑ Specify Brief Description of Proposed Work: 1 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ©FFIGIAL USE(?NLY � 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 -- a C—� 5 Fire Protection 6 Total 1+2+3+4+5 DI Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property ereby authorize I�Q, .�(„ to act on lf� halin 11 ma r Pie, work authorized by th bu g permit application. �,.�_ f L 2l L Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION / I, ! L L 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 n 13Finit me V Si att f Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 SPAN DINIENSIONS OF SILLS DM ENSIONS OF POSTS z '' DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING Ix MATERIAL OF CIINNEY IS BUILDING ON SOLID OR FILLED LAND S �.i✓J IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations , Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: Gam. -CIC Le It,,, City �)c L ��-.� t I"� Phone F7am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: 4 �- Address City Phone#• � Insurance Co. ���R '� c, Policy# Company name: Address City: Phone# I .Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I anderstan a copy of th' statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cert' un he pain and penaftie of perjury th a information provided above is true and correct. Signature Date Print name Phone Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION I ! I � I I L T t T I t T + r 1 I I i i f I i I IL-3 + Z,x.>t.{ �I ��I' U.�.1. � I I } I � � i i � � ( I = � �.�"�,w..e�.f. � 1� - �'�i►..,i� FLt31 I i I I i i I I r I ; I , I FORM - U - LOT RELEASE FORM y INSTRUCTIONS: This form is used to verify°that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. monsoon.......i'............................■................................ Il APPLICANT �C �i V1-.) ry ��/ PHONE 5''3 5 ASSESSORS MAP NUMBER LOT NUMBER UbSA SUBDIVISION A d0� LOT NUMBER 6 1 STREET Veli S` ' STREET NUMBER OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED coNiNrErrls ( � DATE APPROVED TOWN PLANNER DATE REJECTED DATE APPROVED FOOD I,NS/P TQ -HEALTH DATE REJECTED "-" DATE APPROVED L.�) �$FPTIC PECTOR-HEALTH i ' DATE REJECTED CONSENTS i PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTA4ENT DATE-REJECTED CON VIENTS RECEIVED BY BUILDING INSPECTOR DATE i ' i 30 27 LOT 7 ' 39, 3/O. Scr > i� STY Who . I I I h //S./7 15ALE/`/ 57-12EEE7- S .vOMSY' ele-C71TO TyE T/Te---1A1X6-,-OC wo PL O T o4.41(;l 17V Tf/E,64Me T.f�g7'T,VEO�rELL/.Kt/S LOCATED O.V r//E LOT A.3'.Sift9lrV ANO TiG4T?OG+E3' COA1A:2ePf /N JYI711 T,(/E 70-,N OF MO. A1Y4ZVeZ 2ON/N6 eE6vG.4iWAI' ,15-Alf 1,44 serf40lrf sr peers!4vTL..vE.S. NOR TH S F!/.e!if/Ge GE.eT/Ffl�Tif�.1aT T OiY'crLL/N6 /SNOT J_ LOCATED/H T•YE ,4�L; O//AZ.OeO APER. O,PA�iV f�iP r/e CAFF/2 CY t�P P19YNE �TC-7ehEN .e L S, DATE „ �'• � 'X00 J��Y 149 s � J�/S PLAN FO,P �1O,rT�gGE Pv,C�SES-�:✓OT FD.P Bovvo,Py GL"TE.P�ficiAriov Boa�O.o.PY if/Fo.P�tf- �E•P.P/�ff.9Gf'E.liGis/EE.P�.li6 SE.Pf�/lES ,4rov rA.e-E.y F,COM Exisrivc .ee-eo,Pos, 66 �q,P,{� ,ST,rEET ii_y e}G A.t/ODYE,�; �J,4SS.4L',f�vSETTS O/B/O P� n'�I�� �j � fi,�vd i�f�a/ /�Id /�- ! ��i�- NORTH Town of over. 0 No. �� ~ _ D - L o dover, Mass., COCHICMEWICK AORATED OPCl S H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT...AII.C.Ail.•..1... ...M.V 1%%?V 41)....... NNOL......... ............................ BUILDING INSPECTOR Foundation has permission to erect.. .... ...Q......... buildings on .....40..I........b*.14.Iw.........% • ... ................... Rough to be occupied as.....F/►rn.1 ly.....R.00"...... .......4 t v 0 Y**tor.................. 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. M of to P64? $ 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 Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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.