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Miscellaneous - 72 LINDEN AVENUE 4/30/2018
az 6 m o z oZ C: m �� 'i 4 f t i 0 V 1J o w o Z o Zui o a N zo w Q z J lA r N 1 ' LEE4L WMV,E TOWN OF NORTH ANDOVER BOARD OF APPEALS NOTICE Match 28, 1991 Notice is hereby given that the Board of Appeals will give a hearing at the Town Building. North Andover, on Tuesday evening the 14th day of May 1991, at 7:30 o'clock, 10 all parties Interested In the appeal of Kenneth & Egen Dobson requesting a variation of Sec. 7, Para. 7.3 E Table 2 of the Zoning By Law so as to permit cons',740lon of a two -stall garage to close to the lot line on the premises, located at 72 Linden Avenue. Frank Serlo, Jr., Chairman NAC: 4/3, 4110/91 LEGAL NOTICE TOWN OF NORTH ANDOVER BOARD OF APPEALS r NOTICE March 28, 1991 Notice is hereby given that the Board of Appeals will give a hearing at the Town Building, North Andover, on Tuesday evening the 14th day of May 1891, at 7:30 o'clock, to all parties Interested in the appeal of Kenneth 8 Ellen Dobson requesting a variation of Sec. 7, Para. 7.3 8 Table 2 of the Zoning By Law so as to permit construction of a two -stall garage to close to the lot line on the premises, located at 72 Linden Avenue. Frank Serio, Jr., Chairman NAC: 4/3, 4/10/91 dinator for the Road to Recovery Program. Volunteers will be trained to assist with trans- portation of patients to and from outpatient treatment appointments. For more informa- tion call American Cancer Society, 372-1960 or Hoe Health Haverhill Visiting Nurse, 373-1141. ..................................... ............... r By ie of Fran Serio, Jr., Chairman Publish in N.A. Citizen on April 3 & April 10, 1991 ': Bill to Kenneth Dobson, 72 Linden Ave., N. Andover, MA 01845 {f hearing at the Town Building, North Andover, on. Tuesday , ' evening.......... the 14th. day of ..May 19.91 , at. ... 9'clock, to all parties interested in the appeal of A. M Kenneth.&. Ellen .Dobson .............................. Fi MwALY" i law requesting a variation of Sec.TaBlea5ag - 7.3 & of the Zoning I TOWN OF NORTH ANDOVER t MASSACHUSETTS s BOARD OF APPEALS ................................... NOTICE i .... March.28. ...19.91 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on the premises, located at..... 72 -Linden -Avenue . ..................................... ............... r By ie of Fran Serio, Jr., Chairman Publish in N.A. Citizen on April 3 & April 10, 1991 ': Bill to Kenneth Dobson, 72 Linden Ave., N. Andover, MA 01845 Notice is hereby given that the Board of Appeals will give a hearing at the Town Building, North Andover, on. Tuesday , ' evening.......... the 14th. day of ..May 19.91 , at. ... 9'clock, to all parties interested in the appeal of Kenneth.&. Ellen .Dobson .............................. requesting a variation of Sec.TaBlea5ag - 7.3 & of the Zoning By Law so as to permit ........................ . construction of a two -stall garage to close to the .'% 10' t line ............................................. ................................... .. �. ..... ........ .......I ............................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on the premises, located at..... 72 -Linden -Avenue . ..................................... ............... r By ie of Fran Serio, Jr., Chairman Publish in N.A. Citizen on April 3 & April 10, 1991 ': Bill to Kenneth Dobson, 72 Linden Ave., N. Andover, MA 01845 Date . �. . . . . . — / Z- . . . . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.... S7.—,Ot�..P. has permission to perform ..... �.e.;oeZ2,0. ............. wiring in the building ofkz-4..,Da&.5P!Q .............. I ... at.,,.. .... North Andover, Mass. F66 Lic. No. ....... ELECTRICAL INSPECTOR Check # 10995 00 ❑ o Ob N CD kh N a Co M � r'oSl�ooM CD `� cD " p c1 y 'a y CD '8' N = A! K rn o w �. N O o CD GQ FP mFj rn o o a m co w ti CD rn kJ ° cao CCCD CCD Q 90 co ° b ' ° w GL �'. o N O po�ovw`o, (84 y P cC, c' M y o_ v �. �, p CC '�7' � ° o w O O F' p OVi o 0 '7 y o fD 4� o cco�D t°•y cr co 0�� `Cb N bo rn < wob �+ N. tro p rn Pte' o r o o em 0 o tl a a 'b ti Cw_' W .'r 'C CD N a OCl rn > r-' o o w ° go; �' 11 N N wo— O y ° • A. CD (� w y p N o N CD 0 O w b 0° w o o. a, CD H W a cr w WinW. o' rn 0. G M b •+ "� p CD O CD CD '��"• CD PPP C ' (Dfiq CD n• V� C C ° baq '�G on,CD y O•b p �. (� CD �C n G � .�'�.at°.A ISGCD dQ N O H � O � p• � N N �G � � o .A N w "nS' o P. ° ro w• Ory ti ottA N ban o P- 'CO, p o ° o o 0 �+ rn ~° o w I w w ia w o. CSD r `� Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. (j q3 -- occupancy _ Occupancy and Fee Checked [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 W INK OR TYPE ALL INFORMATION) Date: S -Q —/ oQ 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) '702 Owner or Tenant KMv/1 Telephone No,"-`t?I Yy3f 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 /43) Amps 1,901 PYO Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ No. of Meters Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans v No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Batter Units Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices Heat Pump Number Tons No. of Self -Contained No. of Waste Dis osers p Totals: J----- .... F I.KW Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local.❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW SecNo. of Deices 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 No. of Devices or E u valent OTHER: lsnK�6/- Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: adr-,�- (When required by municipal policy.) Work to Start: $" to 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 ams andpenalties of erjury, that the information on this application is true and complete. FIRM N �-f OHS LIC. NO.: Licensee: Signature LIC. NO.• ya (If applicable, a ter " pt" in the license number line Bus. Tel. No.: Address: a4f Alt. Tel. No.: *Per M.G.L c. 147, S. -61, security work requires Department of Public Safe "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner. ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. o3 116 46 r �"ns,�ectoxs' �oznxnepts:.. . (]f-asneetore szffnatao »xo butials) Slate 3'asset --[ +aiTe[i--j Re-hnspectiob.required ($60.00)—[ � . �a5�ecto�rs' comm.exrts: - (Ibs�ectors' gzgn.atare.-azo Wilds) Slate i, TMDA3R GROTT.[VD WSTACT`XON' 'asset--� j �'azletl--j � ate-Sins�eetZo�,xet�uzre�(��O.UO)�[ � . aspectoxs' coznm.ents: , (1ns�eetoxs'rgnaiure�aoifasj pate k ± E CAU'l- r -u N"A a +OWMC-3, 1: NA : seri--[) �+`aileri--j � �e�7nspectionxec�uiretl (50.00) � j � ' i�38Ct0A'�'9 f'4XJIXTI.0�7,�3: (Xuspectors' ftu.ature - io Wtials) Date redRe-Ins ectloA rpqvkea ($50.00) - - ectoxe co)tmerifs: - S eeio& 81gnature -oto initials) Pate . a n':), rO A C.V AD . rP r►'RV IPfCY.." nl7r ° Aw'6l firwe nv.Q-frpTtr. w qT ` App, d 'F' *R* i,, I'i37ORCTED Tq ffnT 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 Uulicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: /V1 Oji{ Phone #: (ap 3 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2QJ am a sole proprietor or partner- listed on the attached sheet. t M ip and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3.0 I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.RElectrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ 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. 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 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. 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) 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 homeowner 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-NIASSAFE Revised 5-26-05 Fax # 617-727-7749 www,mass,gov/dia NORTH 0 o AT2D ,SgACHUS —,'7 .....-* —A .....7 ...... Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............................................. has permission to perform ........................... wiring in the building of ...... ....................................... at../ ........ North Andover, Mass. ............ ....... ........ . do ' 11*1 *1 *1** -1 - Fee'.... ... ...... Lic. ELECTRICAL INSPECTOR Check # '&/ ?2 53 Date.. 4AA ...... . TOWN OF NORTH ANDOVER ,z PERMIT FOR GAS INSTALLATION N This certifies that .... /?.. 2e., 47?? e ............ has permission for gas installation r'" .......... in the buildings► of ......a.f?..�4- ! ......................... at .......ham .1����.........., N h d er,,Mas > Fee.,52J-4>. Imo.. Lic. No. IZ. �G��.. � .. .:. . GASINSPECTOA Check # -C\- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATEPERMIT # JOBSITE ADDRESS %oZ _. OWNER'S NAME GOWNER ADDRESS TEC2 zV - [/L/6 , _; FAC;,.. TYPE OR OCCUPANCYTYPE COMMERCIAL❑ EDUCATIONAL 1--� RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION:[; REPLACEMENT: ❑ PLANS SUBMITTED: YES O NO APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 1 11 12 13 14 BOILER ' E BOOSTER - CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE j 1 FRYOLATOR FURNACE` GENERATOR i r--- GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HFATPP OTHER INSURANCE COVERAGE I have a current liabilinj insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES Z0 EJ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d OTHER TYPE INDEMNITY F-� 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 [.:] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru d accurate to the bes m nowt ge and that all plumbing work and installations performed under the permit issued for this application will be in compli a withall fen rovi ' n of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �� �.. u N - LICENSE # %-LZ OYI SIGNATURE MP EI MGF 0 .JP Q JGF [II LPGIQ CORPORATION - i# JQ, $, L!C#PARTNERSHI COMPANY NAME: ,fJ % j -. �l ADDRESS 16 5y 7— CITY CITY ax�a. � _ ..._ ... STATE r� ZIPS 1LZ� L CELL �' �r_ C� EMAILa -/- / W /- 711, 7 // ?- - P� � a W IL ai ul W LL wo M �w z '0 11 ,TOWN OF NORTH ANDOVER BUILDING DEPARTMENT CAT ON TOCONSTRWr W VA OR DBMOUM AONB TWO FAMM . >� 13i WING PERIvIi'I' NUMBER: "' DA'Z'E ISSUED: /'� �•••• SIGNATURE: Bw!ft Connnissirnnes r of Md&ng Date SBCTION I- SITE INFORMATION i.i v_Addr_nss: 1.2 Assemas � �d'Psrad Nnmba: a Location 1.3 z0o. ;': No. �. Date --. aain Disuia _ La>�v>�n F , �°�T►, TOWN OF NORTH ANDOVER °?°•`"'° _,,�o` A t.7W&MM S v 4L"°, # Certificate of Occupancy Pancy $ f SECTION ' S�CHUSE< Building/Frame Permit Fee $ Foundation Permit Fee $ Name '' _ tf Other Permit Fe Fee $-�-- TOTAL Signanm : $ =_ 2.2 Check # Names` _J ('� ry SLOT 3.1 Ltoa�soa�i wa.. r ,S., Building Insp for Licensed Construction Supervisor LicennsaNumber AddreaExpira . tion Batu Signature Telephone 3.2Home rA9-'-'1U2 Improvement Contsetpr N Com ItegistratioeNuFaber�T iacpuation DAB atuie Telephone wo M �w z '0 11 Workas C4mpwstion hmmm affidavit must in the denial oft isomw ofdw buy di Sived ed affidavit Arlachod Ya ...... No.. SECTIONS Dbobtfort of Pftbsed Wo New Construction I a I I Eldstift Baih Ao"or, B14 - 11 Demolition 1 4- . - cicw�e) henthentEstimated Cost (Dollar) to be Com fetedbY t t"W"21M , 1. Building (a) Building Permit Fee 2 Electrical (b) Estimated Total Cost of -Construction 3 Pl!!Mbjg& Building Permit fee (a) x. (b) co 4 Mecba"QffACJ 5 Fine Protection - 6 Total (1+2+3+4+51 awck Number North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: f 3 3 I (�p z;� —(Location of Facility) MP- 004 Signature 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 CD m m m m y m y m v y POO d —• CA C) az y CL �• d C D. COD aCc 0 d 0 CD CD o CL CD CD C CD CO) �. C a: C2 ytt �• O UM CD v CO) O CD z O � • CD O C CD r� C 0 c 610 390 So CL -' a CT m c?a ,,r • m O ?m 'oo _ O 0 0 � o_m o^' ma 1 dm C3 m N ?: CLO IE h i 33 910m ao OR 3B: 'fl o 0 0 'o. y 0 0 gym: m o+ ate: nC0 �o moo: c o �o CD IN mz y on m C2 M go T CO2 O � a Q C a m ti 0 I Mi Cf) o cn W Cil y b 0 Z ro a x 0 c phone # 0 I am a homeowner performing all work myself. n La h a sole proprietor and have no one working in any capacity 0 I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: ddre Company name: a d h #• i Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of fine up to 51,500.011 anmor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 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. 1 do hereby ce ' nder the pains and penaltie )fperjury that the information provided above is true and correct. Date—0 Signature 7� Print name /�l �L l ` Phone # official do not write in this area to be completed by city or town official city -or 0 check if immediate response is required contact person: (revved 7/95 P!A) permidlicense # -Building Department C)Licensing Board ciSelectmen's Office pllealth Department phone #; -Other _ Information and Instructions 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. MGL chapter 152 section 25 also states that every state or local licensing agency shall withho)d the -issuance or- ' renewal of a Iicense or permit to operaf" busines"r to uogstruct.'buixging 3n. the, commpnw@alth for any applicant who has knot produced accep{#ab a el.'idend6 of coi4liante�vith'tb�ii�surad�e coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shah, !jnter�go any contract for the performance of public w rk u �it table evidence of compliance with the insurancprequirements of this chapter have been presented to thT&6)rctirl����rity. Appucants Please fill in the workers' compensation affidavit completely, by.checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial,Accidents for onfirmation 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 bepartment of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please the De artment b mail or FAX unless other arrangements ill_be used as a reference number. T.he, affidavits may, a returned to be sure to -fill to theyermitflicense numberwhich w P Y gements have been made. 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. The Comma{:nv.1C;1111tii -0'A 1' asscel-A.i:l.�:i.. Departmegt of Indusi "al Ace_,yien ;; Office of Inaes1110200 rs 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 arae& 7031 12haft"SC M WOroe Or' MA 0 W4 50-79Z-81 • E 9-1GIT•T'.74 rH CONTR.4F made 11" _. [6t�.� P IME OWNER c:I R%n Drum eras•:: An usw In thk cardraaL tiro w01 a fro, US or cur refer to New England each, Inc, ww =,nn wards you and your refer to It* watrxpBat, WO *brae to fuNf!aft all rafter an, material wrwary to Imeatl that foliowino doxtibed 11AntlEf1A al; • � � S1V V� �_ SIO ; ,UA eN AA. mArynall!r lar mrtd9oea w malroaPraID pa}'I au ernycl Baudre cadAnvcNA IIadMP Total _. or date b prsetl�Ptp rarollefe GIA Nf4lI %Www.v A *A"'An el W"VA. Total Unita: 0H i CS Exterhtr FINsh: I SlOrm 000tn: Alum i W.'CDra %-W:— $11oling C4aas Doors, ' CDlor:•="^ I �� ! e81dRC6 D118 Cn0O1nd: Ya N� -� ,.'� GI�J, its yf On Delivery: E kQ VpMA) 7."P-5, sv'oe-gp . )J,9 1, Z'qc*w'-- s OgPOSIT Y ITH ORD R AICASH 0 CHECK N ____•___ BALANCE DUE f-7 CAW ArFINAKE You acme to M OWN OVIW V t NIA tw1rA Al~- dwA at. I "1.10 0.0hM Ia ARImOW, W elan n nolo p-Aitid 6y w to ow—A of Aho w"Um iaa. Ya+ ode aww to sign a 6"WIon vantlFjaw wan wml+m. 1 d trig wurx P you tW to meter paymArret whin By, MA ffIIA, tixt," may li"M dlA" Prep M*. Wo maty choow to no was wetk =IV u>A VM Am oueaU WO N pOWWO As I Lei feol mxUm h oWablra em maW ft paywmAa. P"III pay suipimp olein r eIn it. Pie pre w ty, Walt cbky Old at w4eea1y wswtd Hw date a AaealAnliel c"Olp9 r. .. P+yr..lmla &. *rld w Moo umarr INS eamamwM Mm2 twx Wamnt rmin 1hw AmA py"'t 1,41 0 ft 0l 11 MN A 19% a, of rho maAtmam laps: rale, wfarae~ b Id . It ft wnd ffUd - I—nA+A a Aepeit M ht c ftft j 01121 AVIROM app slid URPPJC YU1 Anptt pay M& eF1Atl AAA 4'AI14AA0yy tr4"Irg mi Out atwrnay'O fan rn offMA YOU Urft=f d :hat by Wiria to Day ACoold!ng ta 0, AN!uA !arMR f e+l?or may hayo a ate" e0o vt las yAaeh may as aniaIt" M aaaaManaa y1111 dta aPA'6alble Nann late. 1*a we"tlon writ mein an a Will I ".MY4�-:s V-0 a1S be cutmbrRWIV amMbmd an at ,maul �, 5 , N la 100*ee6 h- 1Mat !ha lafowhP MKF4goia0,410 raaw w-*Wi* chow Mo ®amI d OwTbaon data Atatw amen, nKtsAxre h4A.ry ra able or vnON xr f'"'&rIrt', mara<mm rmaaAa AfAkAn O•!+Har rLlFiar dNRtolbn; IVA-11UPa1ARAY Of WNFAN RIO at ad. A. ApmAAm mel W! CMIy Abrkarl .emaLmam en nno FNDNp LWAlY tIVI"Mn S tits AMOK O'a1Ln,feO t GJG,DOD. AL, REEIDFNTIAL COfMACT71 AND al;9CO4"r Ta AFF Re4UIREC TSJ HF•, r'[ -(ti _rjW 1101?hI TM- 6M95AC1U3e773 GOAFO OF W OING RROtILAT10hR ANG ?ANDARDE. L•PLE88 WFOR: ILLY EXEMPT SROM R6(i14TRATIOY. INGUIRIFE CONCFRA;NJC IIMMTWION SHOULD Be alv=TED Ton 01RarTOR, HOW INPR0V1JM9W 0*qr ROTOR R 31STRA7I0N, ONE A6NWIRTCN "M ROOM, 1001, rAOT3T 9 (e,71 TU -8171$, CJMRACTOR pp 'Y7oCONYAr.: OR at7aL166G TO OBTAIN IME! LCWIidG 00 M41 �y D E8 k-tf/-f , IF WC DO NOT CST'Aw THebe MATS, Ann YOV OM1`, N T1EM, OR IA MARE NGT REGIBTERFD IWrH THE DCARD OF 6UWNG "WILATIO Na, U MBLLNOT EF f nrLPLI TO OFTAIN ANY KNER17S FROM THE OLA1: p}yEc RVND P_RTaP1.t�tiGO UMOEd MA87M.i.USGTYB OEAlfaRAt LAHrS, CHAI'min T4Ah, ANY OW951 i IiE Mr4-'O UMJEI THI3;iGRUV. ENT TO BE PAIC IN ADVk Wr (FATE• IIIMENL"F]`$M OF WORK 94ALL NOT FYCRI 5 THE ARPATCP OF 011a•T4Pb Or• T?4 T ->L cOfTMcT PRtci QA TNF AG%AL COST OP ANY MATERAL OR EOUIPMPNI t "Cli MST() BE BP1rtAL 0ROaMbV LIR GUSTW MAOC, WHLH ATLLRT oa OROt;INLC IN ADVAKC Op 11 =? CONAMENGEMENr Op TNF war•TN, IN ORDEP TC AWFURE il-e PROJECT WILL PROCT.FD OV frHLDLILE• NO PINNAL PAYMWr MAY BE 019iAM40ED UNTIL INE AOM A7ENT IS CCMPLE?= tO THE SATIRPACTIOW OF ROTH or US YOV MAY CANCEL THIS AGF tbxNT !P IT HAS 13"N S1GMD AY A PARTY TwrnvO AT A ?LACE OTHER Ti1AN AN ADOArGS 9P TLM SS,LIER, WHR;H MAY FP, W? MAIN OF 10C OR BRANCHTHOW0e, rmuvrvED YOU NOTIr•Y TN's. SELLER IN WRIT1NGAT HIS MAf-I OMOF OR BAAWCR 9Y ORDINARY MAIL POSTED, W 'TtI.Ei WAM SEW OR BY 06UVRky,, NOT LATER THAN MIDNIGHT OF THE THIMD $1JOAf468 DAY FOLLOWING Tt% $10MM7l1 OF THIS AGREEME, I. DY SKiNING 19EI,OW, YOU At KNOWLEDGE THAT YOU OWN THE ABOVE PROPERTY ANO TWAT YOU ACME TO ALL OF TWE Tutus OF TWIS ,^.GNTHACT. YOU ALSO ACK DWLIK"C CHAT YOU HAVE RECEIVED A PVWY COWL= COPY OF Th63 CONTRACT AND TWC COMPLETED COPIES OF THE NOTICE_ OF ANCELLATION AND THAT YOU HAVE BEEN ORALLY 1NPc4wS) OF YOUR RIGHT TO CANC€L. 1)0 NOT SION TN* CONTRACT W TMIFIX AMC ANY k6" $PASTES, IN'rATNE38 WNF..RF F, P'ro hays fTNlWrtb rtllpwll "'AllndaYlOO tMp /tit d M r'__� e._ In fate yoer ef i teat E , , .. MW d C O rev OMER A2cepta0! ,JAW PAgLrM Saa1, ua, i By DILYIed AUItltamaT.:KaITA1LtIe; TrRe � .. _ awrA;R- —_ rnt ncE OF CANCFJ.f.ATfON ✓ 1, DATE (TODAY'S YOU MAY CANCEI.THS THAI i.Au rm, W NHW T ANY FETJALTY OR 08610ATION, WITHIN TWREE 9U@INESS DAYS FROM TFL$ APv," mt. iF YOU CANC61„ ANY PROI 57Tfy TRADED 14, ANY PAYW,LNTB MADE BY YOU UNDER THE CONTRACT OR GALE, tIM ANY NEGOTIABLE INSTRUMENT EXECUTED 11 YOU WILL aE RETURNED IAATWIN 40 8:141 NESS GAYS PML*WING RECEIPT BY THP, SELr„ER CR YOUR C^MLLF!KON NOTICE, AN: CNY OBOUAED !NTEMT ARISING OUT OF THE TRANSACT10N IMLL 89 CANCGLEO, TO CANCEL THIS TRANSAl nON, MAIL OR OBUVER A a^IGNUD AND CAM OOPY •OF TWO CANOELLATION NOTICE OR ANY OTHCq WRIT?EN N(Yrl(:'E, ON SENO 47FLEQlRAM „b; NEW ENGLAND 64P,11,gNG- 1831 GRAFTON 57TEEr. W0140r$ tA, MA U1dDt :N0T LATO THAN MI1:N01-ITOG. / / o,A1a, QLM': ya A MtlLlaur:. nat.UpED7 I Hamv CANCEL 71115 TRA BACT1Dq, eUf['i1'A alatuwrlO "'--'—.-•"'" a;,yr, '� WPRE-DRI I"xed" MLOA-CA}aYOA wp Copy I'M -OaRCE 00" MA"Mw-Cvffm#h O cwr Peg®: 002-004 CO CERTIFICATE Of LIABILITY INSURANCE ANY REOPIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMPNT WITH RE8PECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR OQUM 'FIC Knox & Cornpimy, Inc. One• Goodwin Square :Hertford, ff 08104SW 960524-7800 THIS CERTIFICATE IS ISSUED ASA MATPER OF INFORMATION I ONLY AND CONFERS NO FdQHT'S UPON THE CERTIFICATE I HOLDER. THIS CERTIFICATE DOES NOT !TEND, EXTEND OR ALTER THE COVERAGIE AFFOR ED BY THE POLICIES BELOW. INSURERS AFFORDING COVERACIE MAIC # INEUPIED National Energy Syetemo, Inc. 1391 Grafton Stmet Worcester, MA 01604 INSURER a One Beacon Insurataoe CA s INSUAFA : iNBURER C' INSURER Or INSUN-R E: CCIVERAon N THE POLICIES OF INSURAMCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTIMMMSTANDING ANY REOPIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMPNT WITH RE8PECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TH E POLICIES DESCRIDED HEEREIN IS SUDJ ECT TC ALL THE TERMS, DCLUSIONS AND CONORIONS OF SUCH POLICIES, AG ORSMAT,S LIMITS SHOWN MAY HAVEPM RSIXICED BY PAID CLAIMS. TYPE OF IN"ANCE POLICY NUMBER LIMITS A ORNERAL UABnm RUS121 10/11/04 10/11106. EACH OCCQAftNCE Ci'OMMEAOAL GENERAL. L1ASIUTY CLAIMS MADE 12 OCCUR �. sum IMPwarnam.Y PER AL A AOV iN )RY GENERAL AWMOATE N'L Al OW,9ATIE UM11 APPUES PER. MECTO - COMP • AGO 6 Q00 POUCYACT LOC AUTOMOBILE UJ O LITY ANYAUTO COMIMNED ONMI! UMIT (E6WaIdON) E 80D 0INJURY ALL OWNED AUTOS SCHEOUL.ED AUTOS OODILY I"RY QUIT Qodder4} S HIREO AUTOS NCN{NVNEDAUTCS PRa EM DAMAGE 6 (pK eodd�nt} CARAOM UASIUT/ 'Y FQE�Y�ACIQOLNT ALp ONLµyFA AOC 6 AOC ANY AUTOS ca6soAlMBnELA�urr EACk+ ACJ:v ;4ENc,E Ir A a OCC7Aa a CLAIM® MADE i• 0F0U sLE O FRETUMZ, S WOPXXFS GOMPENMATION AND ,- EMPL.OYVW LIABILITY NT,� ANY PROPRETORPARTNERCMCUTIVE SAIM 9FFICERMEMOER EXCLUDED9 It anctirmundw '' It S OTHfiR DESC RPTION OF OMATIONe I LOCATIONS / VfsFNCL,TCS / 9XC UJIIONR ADDED BY GNDORUMENT I $PaCIAL PRBVIBICNR - Supplemental Name 01' First Supplemental Marne applies to all policlee PoIky# 14926121 - Name Printed on DEC base: National Energy Systerne, Inc., stal Insured Multiple Names: National Energy Systems Owens Corning, Ino Insured Multiple Names; New England Sash, Inc (Be* Attached Deeorlptlone) EI•io= ANY OP TMa AAOVE DIESCAMO POLIOIaa Ba CANCIL"o SBJ<ORt THE EXPIMAYI ON DAYa TH"190r, THE MOAN* INWMM vnLLENOTAVOA TO MAIL .,,,30„ DAYE WRITTEN NOTICE TO THE CEATIACATE HOLDER NAMED TO THE LEFT, BUT FAILURE To DO SO SHALL IMPOW NO OBLIGATION OR LN1e1UTY cf ANY IVND UPON THa INSURER, IT$ ACIEANTS On MPASE AMIS. N.;WnD REPAIINNTAIWE DATff(MIL�IDDMNYI iCERTIFICAT C)F LIABILITY INSURANCE PRODUCER. (701)i73-3200 F 12/13/2004 I(791)273-0600 R INF Tonacors.0 Insurance Agency E 3 Cambridge Street P.O. Bon 1302 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE.' HOLDER. THIS CERTIFICATE GOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Burlington, MA 01803 INSURERS AFFORDING COVERAGE MAIC # , IN R Nese England Sash Inc && National Energy Systems INSURERA: American Home Assurance Compan 1331 Grafton Street INSURER : Worcester, MA 01604 INSURER C: I INSURER O; INSURER E! ISE-PREMK +tv S THE POLICIES OF INSURANCE LISTED BELLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDIN 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 ANIr, CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INS LTR NS TYPE OF INSURANCE POLICY NUMBER DA MMfD DA E fMMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE 13 OCCUR ISE-PREMK +tv S MED EXP (any we porton) � S d PERSONAL It ADV INJURY, S mr� GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: � PRODUCT$ • COMPIOP AGO $ POLICY PROLOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ . (Ee 11Celdenty..... _ .. ALL OWNED AUTOS SCHEDULED AUTOS HIREO AUTOS NON•OWNED AUTOS 1 "� BODILY INJURY $ (Per pe"o+) BOON.Y INJURY $ (Per aw�iderlt) PROPERTY DAMAGE S . (Pet ecaldent) GARAGE LIABILITY AUTM ONLY • EA ACCIDENT S ANY AUTO OTHER THAN FA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY OCCUR ® CLAIMS MADE EACH OCCURRENCE 8 AGGREGATE $ s DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC 76$4732 04/29/2004 04/29/2005 TORYUM€T&ER ,. G.L. EACH ACCIDENT $� $00,000 A ANY PROPRIETOR/PARTNERIEXECUTIVE CFF ,,d$3r by and EXCLUDED? S C dsserlbe under SPECIAL PROVISIONS below w�M E.L.DISEASE • EA EMPLOYE $ 5 0 0 0 0 0 E.L. DISEASE • POLICY L{M17 $ 500.000 DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLIcB ADDED BY ENDORSEMENT I SPECIAL PRO BIONS 1 AM^11 aMw.. LsANUr.LLAI IUN ' SHOULD ANY OF THE ABOVE DESCR16+ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL -ENDEAVOR TO MAIL .,•1,0,_„• DAYS WRMEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THI?,LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRE NTATIVES. AUTHORIZED REPRESEN Maria NixonAI/ ACORD 25 (2001/08) TA ,$r CORPORATION 1988 ., � ... .. k .. ....._...�.,.... ,��.n_w, u. 4�rr O�tBtnhue-CltBYOMEaptY}PV it �����yy ��_ 'l ... ...: ... .f ' _ .i .- e�- �. , w., .. . Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. /�S 3 Occupancy and Fee Checked [Rev. 1/071 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 IN INK OR TYPE ALL INFORMATION) Date: -3' IQ ( 0'7 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) '7 3 C + N �e-x iN U� Owner or Tenant J A». --S S ovb V-, Telephone No. q?�--2g5/_t07 Owner's Address SAo,.e 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 Ampacity % t<e1 c x_ Ze ,%,, PS- l Z© t,o l- Locaatti�on and Nature of Proposed Electrical Work: � '1.rS�,A �\�� v_A G-,, c -7 P/a �,-c -<- 6 Rccte C•SRCc.+ k,.,,4,41 Gr-cx F•vccle stwa�%c�+ Completion of the followine table may be waived by the Inspector of Wire- rte No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans V No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number Tons KW No. of Self -Contained 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 Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Estimated Value of Electrical Work: #?-Co'06 Attach additional detail if desired, or as required by the hispector of Wires. (When required by municipal policy.) Work to Start: 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 [9 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: V ® @10 � LIC. NO.: ZZ 5A Licensee: ,A-C't { Signature �� LIC. NO. `� (4S-9 L-� (If applicable, enter "exempt" in th icense number line.) Iv Bus. Tel. No.: 978`3(,0 3is$'L 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. Owner/Agent PERMIT FEE: $ SignatureturaTelephone No. rIL-t 311 r 9271 Date. �l.?�� // , . ��:��•°,;:��oot TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that /" �. �� ...... ! . has permission to performs plumbing in the buildings of ..A!? .�?-Sorb at .104 ........ . , rt Andover, Mass. Fee 30.: U . Lic. No... ,/©l`�'7..� . /....r�.. .. ............ PLUMBING SPECTOR Check # �� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITYMA. DATE I PERMIT # JOBSITE ADDRESS DoZ��r'�y OWNER'S NAME Ill QXl �I `�51� POWNER ADDRESS TYPE OR OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:) PLANS SUBMITTED: YES ❑ NO [� FIXTURES 1 FLOOR- BSMT 1 2 3 4 5 6 78 9 10 11 BATHTUB 12 13 14 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE C1 1 have a current Ilahility insurance policy or its substantial equivalent which, mets the requirements of MGL Ch.142. Yes 59'No ❑ IF YOU CHECKED YES,. PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY woo^ OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the license _does_ not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application_ a es this requirement. Signature of Owner or Owner's Agent CHECK ONE BOX ONLY: OWNER ❑ AGENT ❑ 1 hereby certify that all of the details and information I have submitted (or entered) regar ng this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Co a and Ch er 142 of the Gene I Laws. PLUMBERNAME Daniel HLntrecg SIGNATURE l LIC # 10977 MP EX JP ❑ CORPORATION ® #_23A9 PARTNERSHIP ,❑ # LLC []#_ COMPANYNAMVUrotoco of MA d/b/a Roto ADDRESS: 175 Maple" Street CITY StouahtonRooter •' STATE MA ZIPS_ EMAIL dan.huntressrarrsc.com TEL 7S1-2a7 794� 2021 0 CELL _781 -60,1-s41 2 FAX 781- 41-881 7 71�/ 0 A ❑z 0 m iii lcn m m 121 C CA m > Mft W m n ft 0 m 0 1-3 X W PI ic ❑z 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UIVY- 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):Numtc)cc) of MA d b a Roto -Rooter Services Address: 175 Maple Street City/State/Zip: Stoughton MA, 02072 Phone #: 781-297-7049 Are you an employer? Check the- appropriate box: 1. lam a employer with �_ 4. ❑ I am a general contractor and I employees {full and/or part-time). * have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet # ship and have no employees These sub -contractors have working forme in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] officers have exercised their 3. El am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.® Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other -troy appncani mai cnecxs oox 01 must also till 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 tcontractors that check this box must attached an additional sheet showing the nese of the sub -contractors and their workers' comp: policy information. I am an employer that is providing workers' compensation insurance for my employee& Below is the policy and job site information. Insurance Company Name: Ma r ah USA Policy # or Self -ins. Lie. M we - 9379366-07 Expiration Date: 4 - 1 - 2 012 Job Site Address:_ ca b ri dsn uqL City/State/Zip:n0>J4 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-io.$3,5.00;,00 and/or; one-year imprisonmem, as wed as civ" penalties in the form of a STOP WORK ORDER and a -Elbe 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Phone #: - - apt? 1 `4_a Official use only. Do not write in this area, to be completed by city or town offuiat 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 #: Location % �iti��t�✓ NUC No. -71 Date 6147 41 I-/ NN OF NORTH ANDOVER cate of Occupancy $ av ig/Frame Permit Fee $ jjU �— ation Permit Fee Permit Fee Connection Fee Connection Fee $ Building Inspector Div. Public Works APER?=7T NO. 1 (17% APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS V '11I PAGE 1 LAA 12 dl 0. — LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE SUB DIV. LOT NO. F—— � LOCATION PURPOSE OF BUILDING ,S OWNER'S NAME ,(�) oW3Sa / f v NO. OF STORIES / SIZE �i/S ,(_7/� pK/ OWNER'S ADDRESS7c;2 / /`�f ooej�GpJ/� jj0006 !P"' I� /7 BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS ST//Owe�ND 3RD BUILDER'S NAM U.,k)40ftgarAR l 'I SPAN &D DIMENSIONS OF SILLSy �7-, POSTS DISTANCE TO NEAREST BUILDING *?Q� DISTANCE FROM STREET/� `/. // ] / DISTANCE FROM LOT LINES! - SIDES /2 REAR 1 GIRDERS AREA OF LOT / D' ��� FRONTAGE�O 00 HEIGHT OF FOUNDATION Q / THICKNESS 8 V IS BUILDING NEW SIZE OF FOOTING / X �yv/J x IS BUILDING ADDITION p� MATER:AL OF CHIMNEYQ IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND eS WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER ya BOARD OF APPEALS ACTION. IF ANY \ /ey ]' / Q % IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE , - INSTRUCTIONS (0// SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OWNER OR AUTHORIZED v ° A 3 PROPERTY INFORMATION ® LAND COST Owner Tel # C17-4(- Contr. 1%4Contr. Tel/#'$oa';Zy x i65"o Contr. Lic # £ .)LDG: P ERMIT FES n LESS FDA --� -'= AME PERMIT PERMIT GRANTED! t �q �41� � �L/ EBT. BLDG. COST //% Q _ y / EBT. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 'A19 630ND 80 'JNOD 1 _I 3WVbA NO ADM 60014 R '3613 :)I11V AHNOSVW N lag _ 3WVa4 NO O:)JniS G h _ A6NOSVW NO oxin1S \1 3111 'HdSV ONIOIS 'la3A Q 6+ 17 r V ne a� v 'NM'la 101d S3:)V'ld3L1,;S_IH1,;03SOdWill3dns '013 'S3VVM 'V'J 'S3H02lOd H1IAA 'S9N1a11f18 AO"SNOISN3WIa 10VX3 aNV S3N11 10'1 WO2ld 30NV1S1a aNV 101 d0 SNOISN3PtIIQMl0VX3,MOHS 15f1W N01103S SIHI Zl OV033a JNId11f19 NOYlWO� ONIOIS 1O1S39SV O MGM `ONI01S 11VHdSV _ H1aV3 " S31`0NIHS DOOM E 1 9 313y0N0� 2NIGSOaV109dV10 Saoold 6 S11dM v H 11A Na300W W008 OV3H _ S3:)Vld 3811 1.W 9 ON V3" JI11V 'Nil /e /1 /i V38V ,1.W.9 'NII 11nd V38V N3W35V9 £ NI3Nn 11VlA AM a31SVld I� S631d 3NId HSINIA 101>f31N1 9 `11O11rGh N0110f1211SN00 C. HI 1 V, Z ;\ y�+�` ��� 1► C't `,N'4:• �� v 1'?•, •, , yf�IUN . �- \ j�l O p I t_ n L��I��.I. �„ �`,• V p ' pi + 1 1 1 a VNIIV3H ON _I PIC PUC l.W•9 L Wool d0 'ONsvo Sa314Va DOOM 510 4 'SW9 1331S — 'S10:) R 'SW9 639WI1 I 1^>IOf OOOM ONIWMd 9 ON14008 1106 13AW0 R aVl 31V1S S30NIHS DOOM D180313 110 Sa31V3H 11Nn jqO ONINO1110N00 6IV 8OdVA 60 b.1,M lOH WV31S Nand aIV lOH 037604 3:1VNan4 ,3313414 ONII�AH ll 00V0 3111 60014 3111 _ S3anixu Na300W 63MOHS 11V1S _ 0N19Wn1d ON ANIS N3H:)11A A6O1VAV1 S310NIHS 11VHdSV 13SO1J a31v 03HS 1V14 08VSNVW 13a9WV'J dIH 319VC dooa 9 'xu ZI 'W6 131101 'XH C H1V9 ONI9Wn1d OL 3NON31VnO30tl a00d �I 80I83dn5 3WVa! NO 3NO1S AbNOSVW NO 3NO1S / �b ONIIIIM 'A19 630ND 80 'JNOD 1 _I 3WVbA NO ADM 60014 R '3613 :)I11V AHNOSVW N lag _ 3WVa4 NO O:)JniS G h _ A6NOSVW NO oxin1S \1 3111 'HdSV ONIOIS 'la3A Q 6+ 17 r V ne a� v 'NM'la 101d S3:)V'ld3L1,;S_IH1,;03SOdWill3dns '013 'S3VVM 'V'J 'S3H02lOd H1IAA 'S9N1a11f18 AO"SNOISN3WIa 10VX3 aNV S3N11 10'1 WO2ld 30NV1S1a aNV 101 d0 SNOISN3PtIIQMl0VX3,MOHS 15f1W N01103S SIHI Zl OV033a JNId11f19 NOYlWO� ONIOIS 1O1S39SV O MGM `ONI01S 11VHdSV _ H1aV3 " S31`0NIHS DOOM E 1 9 313y0N0� 2NIGSOaV109dV10 Saoold 6 S11dM v H 11A Na300W W008 OV3H _ S3:)Vld 3811 1.W 9 ON V3" JI11V 'Nil /e /1 /i V38V ,1.W.9 'NII 11nd V38V N3W35V9 £ NI3Nn 11VlA AM a31SVld I� S631d 3NId HSINIA 101>f31N1 9 `11O11rGh N0110f1211SN00 S1N3W18VdV 3371430 AlIWV4 I11nW S3160!S A11WV4 319NIS AON Vd f1000 l r CD 0 CD v N 0 9 En cD cl- ct O OD 4- 0 ALL STRESS TRUSS SYSTEMS Designed By: "CANTILEVERED" for the extra -strength and ,easier on site finish. 22=o" OR 24-oo Spacing: 2'-0" O.C. C,AbI.E TRUSS n i n c o r p o r a t e d New England's Premier &gilder Since 1962 2�,$n L TC?P. 411 I Z. "WOODMASTER "WOODMASTER with the All Stress Truss System has located the webbing members for the most uniform distribution of stresses and forces. This provides the greatest strength with no bearing walls. No interior post needed.(clear span) ------------------------------------ APPROVALS CERTIFICATION ----------------- CONNECTOR' PLATES 7 y2". TYPICAL OVERHANG DESIGN LOADS: 45 PSF T.C.L.L. 10 PSF T.C.D.L. 0 PSF B.C.L.L. 10 PSF B.C.D.L. 65 PSF TOTAL @ 15% INCR. ----------------- Of Ot•�:�::;;fC •.,OXE.RfEa �•y�,•.•• ' �y` S`a •,...... ••- (�F~� ,oHEq! J/C 2 rp•� �, IIIEION E, . s i _ MILTON •�Ir ��, . MI ETON • _� �P'i S.2' f�f •: a AEEOEA RE_OER �� REE:ER • �' H' 9 N0.3726 c Ne ]lbt ; W = ..: -`"•'' Or 1, O •• W a %0.29157 I No. 4413 _ S Xo.ItGli 7 'a••.• :car,?` V�C'C/STEQE;'V QFC/EtcO / •:40,rF'••.....•••G\+, ... •ES1 '� ._ \ylEa ••',9pf 9.. 1�• C�, r4TEP' p ��t'�:��Ey • n- �Fstrono yi �G `` Fss/ONAI E���\ r,,,,,•',• '.,•u,.,• , - �'••F'SS/O SAL E.a`'+• (PLATE RATINGS) 20 GA. PT (222 PSI GRS) 16 GA. H (183 PSI NET) TRUSS COMMONLY USED (Not Recommended) WOODMASTER has chosen a connector plate made of 20 gauge prime quality galvanized steel. Its sharp, short tooth design with 8 teeth per square inch, produces superior holding power hydraulically pressed at right angles, to carry the load forces deep into the lumber, eliminating the chance of wood failure. 400 (KINGPOST TRUSS) The 400 truss is used primarily for support of garage roofs, or short spans on residential construction. "NOT' certified for clear spans over 20'. P.O. Bo: 295 (603) 669-1650 J -Ll r1 AL _ DA LP J=i FASCIA j,� B S O Tr F17 Ix3 F�:FLt .1 jo I RAW 4110 i n c o r p o r a t e d � X q Aq a c, SrP ".t; Tcwir • ' ' !�x tL �c„crc�t-�cefin� O O 0 O V) N E D V/ � n w o m 0 r� T l/ O o CL_. 5. m �• � O C P`mo C m Ma < rr eD PI► o � � i� aq POOL o 7 eD n ^ > eD o 3 (A H '7 O cin v z O T fl. O 0 O V) N E D V/ W -n m -nVl m �m T l/ 5. m m < rr d U3 o n ^ o (A W v z O T z • T Z > ^ C '' v v o T m Z Z Z T � 4 M M O _ i F MORtH 0 ..o • 1ti0 - , O D ;s1ACHUSt TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Date: �% 0Y Dear Applicant: Enclosed is a copy of the legal notice for your applic3tioir hefore the Board of Appeals. Kindly submit $ � for the following: • Filing Fee 7 Postage $ �J "t Your check must be made payable to the 'Town of North Andover a-n(I. may be sent to my attention at the Town Office Buil-ding, 12O 1lai'rr; Street, North Andover, Mass. 01845. Sincerely, BOARD OF APPEALS Audrey e ' W. Taylor, Cle.r.l: .