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HomeMy WebLinkAboutMiscellaneous - 75 BRIDLE PATH 4/30/2018North Andover Board of Assessors Public Access a „oR►►, F b R >r �9�sA[IM1 6� Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales Page 1 of 1 Property Record Card Parcel ID: 210/104.C-0092-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge 75 BRIDLE PATH Location: 75 BRIDLE PATH Owner Name: BURKE, MARY E Owner Address: 75 BRIDLE PATH City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 8 - 8 Land Area: 1.01 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 3235 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 746,800 778,800 Building Value: 519,800 540,000 Land Value: 227,000 238,800 Market Land Value: 227,000 Chapter Land Value: LATEST SALE Sale Price: 1 Sale Date: 12/30/1993 Arms Length Sale Code: F -NO- Grantor: BURKE FAMILY CONVNIENT REALTY Cert Doc: Book: 03949 Page: 0027 ` Y http://csc-ma.us/NandoverPubAcc/J*sp/Homejsp?Page=3&Linkld=l 180502 3/18/2008 The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P. O. Box 1025 State Road, Stow, N4A 01775 PERMIT Date: North Andover Permit No ( Cityof Town) (If Applicable) Dig Safe Num er In accordance with the provisions of NL G.L,14 8 Chapter__LIL as provided in section R 34 /n'/ /j Start Date This permit is granted to: u-('!. %F�y/�,?/ 64 c /7 Full name of person, Firm or Corporation Penwssionto locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be. 25` from structure if unable to place with required Restrictions: clearance dumpster must be covered witlj plywood or tarp end of work day at (Give location by street and no., rd crib such ' er as to provied adequate entiEcation of location) FeePaids 50.00. Fire Chief This Permit evil! expire Q ( tgnature of o al granting permit) Officai nting pemut ( Title ) Date ... ../% f� Z- ..... . NORTH pF „ao °.6 0 0 °� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SACMUSEt that This certifies � ............ ....... . has permission for gas installation ... .......!!x . ...... . in the buildings of1p °`�e��Q .................. . at fQl......... over; ass. Fee.*�_�� . Lic. No..B�� .. ........ GAS INSPECTOR Check # 19411 8112 I- JP hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � PLUMBER/GASFITTER NAME:SIGNATURE'!6 � LQ J� E•1'• LICENSE # � ,3 7 �-- COMPANY NAME: n V� SNIFF MEET Mat CITY: an ci Fuc—i STATE: FR -61 ZIP: FAX: q I -1 TEL: CELL: IEMAIL: )(I IfirA am MASTERO'JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION #30 -9 PARTNERSHIP ❑ #0 LLC ❑ #�� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK GOWNER TYPE OR PRINT CLEARLY MA. DATE PERMIT # CITY lwrih! An nLL�1Ll�`1� U JOBSITE ADDRESS OWNER'S NAME VjIfU ADDRESS: r0aij TEL: FAX: OCCUPANCY TYPE:: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXUTRES Z FLOOR- Bsmt 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 FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT e OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YE SL NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the Ii ensee does -no - ot 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 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � PLUMBER/GASFITTER NAME:SIGNATURE'!6 � LQ J� E•1'• LICENSE # � ,3 7 �-- COMPANY NAME: n V� SNIFF MEET Mat CITY: an ci Fuc—i STATE: FR -61 ZIP: FAX: q I -1 TEL: CELL: IEMAIL: )(I IfirA am MASTERO'JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION #30 -9 PARTNERSHIP ❑ #0 LLC ❑ #�� 0� C; 2 4 0 ive(jzv RICHARD A. SMITH PE 1012 Main Strcet READING, MA 01867 (781)944-4151 email: RASmkbPE@verizon.net July 23, 2010 Mr. Walter Casavecchia C' 75 Bridal Path North Andover, MA Subject: Casavecchia Residence Remodel Dear Mr. Casavecchia; Based on my field observations, and calculations, all recently installed LvL beams and all new wood framing of this residence have been designed and constructed to properly support the applied maximum loads as required by the 7th Edition of the Massachusetts One and Two Family Building Code. The joist and beam shear stresses, bending stresses, live ,load deflections and connector capacities and column compressive stresses are all within allowable limits for the materials used. The existing walls have been constructed and attached to the foundation as to properly resist both the anticipated vertical and lateral loads. Sincerely, M Ric ARNO p STRUCTURAL H ENGI URAL 4 Richard A. Smith PE �>tt� 7394 Date.. ...... Of .NORTH a? �` TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SSACMUSES This certifies that ... ?`'? .a �` `�'� has permission for gas installation in the buildings of. . [ c �...................... at ... (. !.kt.... P� .. ....., North Andover, ass Fh�� .4X.. Lic. No.. .3.0 (4.. ...... j/JILIZAAa/. ! . .. . . GASINSPECTOR Check # U S MASSACHUSEI'IS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITrLNG (Type or print) Date 1g192 1/6 NORTH ANDOVER, MASSACHUSETTS Building Locations 1, ri Nfe, Put Permit # e Amount $ Owner's Name y�'�-r l ( . New Renovation ❑ Replacement Plans Submitted (Print Name Addre Chec one: Certificate Installing Company Corp. Partner. Business Telephone i� 53l def Lj Firm/Co. Name of Licensed Plumber or Gas Fitter Ste-L)e\) kI (..Ya0r INSURANCE COVERAGE Check one- El I have a current liability Insurance policy or it's substantial equivalent. Yes � No If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy P Other type of indemnity ❑ Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 13 I hereby certify that all of the details and information I have submitted (or entered) ig'above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and ChaAter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter yGumber �© 19 as Fitter License Number Master Journeyman x O W a W O F 2 zo w c z O o O z ra F Gz m U F4 z 0 z oK Z a ow aQ xH O x rw� aQ A C9 aF U c° 5- A O SUB -BASEMENT B A S E M ENT 1ST, FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print Name Addre Chec one: Certificate Installing Company Corp. Partner. Business Telephone i� 53l def Lj Firm/Co. Name of Licensed Plumber or Gas Fitter Ste-L)e\) kI (..Ya0r INSURANCE COVERAGE Check one- El I have a current liability Insurance policy or it's substantial equivalent. Yes � No If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy P Other type of indemnity ❑ Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 13 I hereby certify that all of the details and information I have submitted (or entered) ig'above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and ChaAter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter yGumber �© 19 as Fitter License Number Master Journeyman ii;ainel"eF." t keektho alae b►w 1 ant a e14i�with 4 ❑ I am a.vneral-ce ttractor azid I Type �rf,proJot (re uredj: _ anplees AW aniitor pad-AWe). Qy : have liire�i e.sub� cdr�acfiors 6 1 G vv o itt? : 2. ❑ .I ain a adile prophetar or pw t wr ltsted:nn �e hedsheet: # 7 Remodel' ❑ andhave'no emp1q es Thee 617b ,;PIn adwtyt litioll w0da . g bane in *TY, a ty. [ITo w€ r> x comp„utsttratr �s!orl ers' coli inoi poo.. '5• ❑ Wo area clorpor4ot and•its; 9, Buil additaon. ❑ e officers have exercised their til ❑ Elactncal repairs or addr*s ❑ .I am a hoznEowner;tloum,a11 irk rtgfit o exemption per MqL, 11 [] I?it tbrt r pari or :asldrttaris tttyseIf, (fid evo kers :clamp§1(,4 and 7 we have_to 1.2.1] 1 d£t paiis ir=aixoe i eyd j t: empYoyee& o roi si:s' 13. El C)flter Ins ur:iiice.�egttied.,] I awareTiD . rthatis: r ' J'e P rrwding�vvrkers :co#{ aeatton:: rtsuranee rmY, err�ln�+e s < elatarsilre ay poU,anij she informad on. Insttrar pobompaoy wt n a, I I t) if-rS-pnlp_ In, q CI) l h1r, v i t2njnrc ►s -,CA”, Policy # .or Self -ins Lic: ' . -i 3 O l� c3 llxpiratit ,mate: rob'Site Address city, taLef ip ; A Ob e (*howkrg tete policy ntMiabRr attd apiration dame): Failure tb.. ure Covera e:ssre lied vender eetton 2 A tsf 1vtGL c..1 s:an lead -Oihe . pastti=f crtttriital,penalEtes of a fine up ttr 1 s5t3(3:T30 artclf®r torte -year uuptisonrtteat Swell as CaY ;pcttgiti�s art the ��; cr£ a �T.OI' � � ORD1rRaiYg`a fine. Of.q. to Sb 04 a -da y the vt©later._, Be advised thata OY p£f1w" Mtemclitrttay 6':fpz*arded to.;theC3ffiee:;�f Ihvrs49t ons:�f the ]iii £or ulsutanee uz�Yarage YerLf cation 1+do.:hereby ca J1'at er:t?t patsand n+gltiaaoft�eriuv&ajtkenf4Orntada nxm�i�ariai,v�'FIV, ,n ��»eA. E t #al usevn#... Donot vo*e t;nlhis.area, to. be -c©mp eted � pity or, imn offieic Ci; a , Tb*' ' .Pe.. -I J`Lice s Issuirjr�:,�tttlnorily;�cirQle nne}s' 1� Bttot`d of $ aitk Z. tlr> g.l tea n Ott: :Cil Tpwp lot` t �,11ectY iealllaspectar 5 P1tlap ng I spejCf 4t GontactPe=On: Phone_#; M 4 r COMIiA(?NINEAI:1 ti OF AC KPLUMBERS AND r%ASFI LICENp TTERS ,�p p L ER"" - _S STA :40 ,STEVEN A Rlb'H'ARD I -NOBLE LN f._R EAboby MA 01960-317 sm 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time ofongoing construction activity, and may be.deemed.by.the lnspector_of_Wires abandoned-and.invalid.iflme—_.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying p 'od beginning on August 15, 2008 and extending -through August 15, 2012. ' le 8 — Permit[Date Closed: :/ Note: Reapply for new perm] `' ❑ Permit Extension Act — Permit/]Date Closed: \\ 9640 Date ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 7— ............................................................ ................................ has permission to perform .... kl-rc-wav - -2- 13,07A-lf ...................................................................... wiring in the building of ........ VC7'::Z .. ..4f. 6 ......................... ............ North Andover, Mass. i �; (�-4 �i- 12A 12" -irRICAL NSPE Fee... 7�1-77!77 Lic. No . ............. ..q ........... Check# S-6 (I I ,ti k Department of Fire Services Permit No. 7& 10 Occupancy and Fee Checked ,w BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEA SE PRINT IN INK ORTYPE A LL INFORMA TION) Date: &0, City or Town of: NORTH ANDOVER To the Inspec or' of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Qa ` 1,P r wo Telephone No. Owner's Address Zo 1k Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building ke-hosb Utility Authorization No. Existing Service 2-00 Amps Zv L Volts Overhead ❑ Undgrd LJ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,Z' jam, _���f, t 2— X0ar Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires ! No. of Ceil: Sus . addle Fans p ) % No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- Elo. rnd. rnd. 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 1 No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Dis Disposers p % Heat Pump Totals: Number Tons KW ........... ........ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers 1 S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW SecuriNotof System Devic: or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs 1 No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Vleclical Work: (When required by municipal policy.) Work to Start: 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VE GE: 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 cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the p 'ns andpena! 'es of per'ury, that tike information on this application is true and complete.„ FIRM NAMES IVO G by-/CiLIC. NO.: Licensee: 1 JrdJ Signature IC. NO.:CZ y' (If applicable, enter "exem t" i the license number line Bus. Tel. No.: Address: ✓7` I '�', Alt. Tel. No.: oaj *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety " 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 Owner/Agent PERMIT FEE. $ SignatureturaTelephone No. M� O'er— �?— Z,U- /") A t"— 4 b f I a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street' Boston, MA 02111 s�• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,00, C� Address:_J � /)n/,,/ 5�� Sv,,5�� CitylState/Zip:+ lflDJ✓���� Phone #: Are u an employer? Check the appropriate box: 1.4/� 1 am a employer with �_ 4• ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ ship 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.,p 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.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11. F1 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box h 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: ZAAI Policy # or Self -ins. Lic. #: VO �{ g © 10 % Cr) 0 . Expiration Date: lL11 �jjj f Job Site Address: % s /✓I") � � �/Gu '9 . &J�wo lty/State/Zip: ���� Q � ��� Attich 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 cer under the pains�an/df penalties of pe ry that the information provided aboo e is true and correct. "a' Phone #: C3� 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 #: Date... This certifies that , .''.:�::'. ...::':...................... . has permission to perform......`. ........... ............ plumbing in the -buildings of .... ...... . at ... . .... .... .. ............ .North Andover, Mass. Fee/ .... Lic. No. 7% . :1. ��, J. .......... . PLUMBING INSPECTOR r � r Check # 8569 NORTH f 1 °,<� •'„.,"o°� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 'TS' us This certifies that , .''.:�::'. ...::':...................... . has permission to perform......`. ........... ............ plumbing in the -buildings of .... ...... . at ... . .... .... .. ............ .North Andover, Mass. Fee/ .... Lic. No. 7% . :1. ��, J. .......... . PLUMBING INSPECTOR r � r Check # 8569 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or Print) NORTH ANDOVER, MASSACHUSETTS Building W=01, New ❑ Renovation Replacement FTXTTTD Q Plans Submitted Yes Date / /D Permit # AmountCJ_ !� No 13 i (Print or type)_ � Check one: Certificate Installing Company Name CG yZ cam/ / �if'T 6T �� Corp. t Address Partner. I Business Telephone ❑ Firm/Co. Name of Licensed Plumber: 1 f r ` J , l j yCl ;• Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ❑ Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner. ❑ Agent rl I hereby certify that all of the details and information I submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and '� . perfornied under��'ermit Issued for this application will be in compliance with all pertinent provisions of the Mas tts State Plumbing C=d Chapter 142 of the General Laws. By ti� .V_a.-.__...,, Title _- Type of Plumbing License ., `/ _ City/Town icense um mr Master� Journeyman APPROVED wncE USE ONLY`13 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ky www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lecibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: 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). * 2. ❑ I have hired the sub -contractors am a sole proprietor or partner- listed on the attached sheet x ship 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.] 3. ❑ I am a homeowner doing all work officers have exercised their 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 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other ...., — r—mow+- —1 �L= U-:: �-- muJL a:sa ru; Out :ne section eio" shO� inb +heir work�8' compensation policy info: ation. t Homeou Hers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of hp 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. Signature: Date 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. Piumbine, 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 retuned to the city or town that the application for the pem-lit 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 mumber. In addition, an applicant that must submit multiple permitflicense 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 bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: 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 Fax # 617-72.7-7749 Revised 5-26-05 wmrw.mass.govfdia DateZ.74.7.,/.(> ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 6crm ......... ..... 64%---'-........ has permission to perform .... . ................. wiring in the building of ... l'rC........... ... ......... . .................................... at .... :Z3 ...... 6. . ........ ............. .North Andover, Mass. 44 Fee .. SD..V ........ Lic. No............ ................ ELECTRICAL INSPE Check # 1 X31 9381 Commonwealth of Massachusetts Official Use Only n Department of Fire Services Permit No. `'� 3SI Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed ai accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersignedgives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 71 yr I, Owner or Tenant (�gG�-�- lrocil ;le - Owner's Address 73 13rlelIe PU-(.t Telephone No. 2141;S'/s- /7%g Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps /oi3O /.L}t0 . Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd �J No. of Meters Overhead ❑ Undgrd ❑ No. of Meters �?oc�s o?d0 sZe e R Completion o the./b/lowing table In be waived bi, the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o. o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In Swimming Pool rod. ❑ rnd. ❑ TTO—.OTEmergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No, of Switches No. of Gas Burners o. o and D Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers p Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local [:1 Municipal Connection 1:1 Other No. of Dryers Heating AppliancesK'V Security Systems: No. of Devices or Equivalent No. o atero. I o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: No. of Devices or E uivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of E ctric Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. �,, FIRMNAME: /'i�L LLG- LIC. NO.:.�;CL� Licensee: Ark J 1 q��� Signature LIC. NO.: C 5 (If applicable, eater "exe/mp�t" in the license number line.) ,/ Bus. Tel. No.:�7Tg'6'//�i Address: �[%14Gc.Rri/G/i �� �P�, /0y /S�lJ7i' Alt. Tel. No.:�G3- SS=97Z+jJ *Per MGL c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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. m r . r r The Commonwealth of Ajassachusetts Department o f h2dust-ial Accidents Office ofInvesk ations 600 Y1"ashin;ton Street Bostorz, MA 02111 ,b dia Workers' Compensation Insurance Affidavit: Btuilders/Contract scant Information ors/Electricians/Plumbers Name (Business/Organiza6on/Individua1): Address: t�l VV I r- r l City/State/Zip:� i�✓1 �N CT c�s�t 1 n E67 Phone #: 77 YOU an employer? Check the appropriate box: �Aree '1 am a employer with 4. ❑ I am a general contractor 2 -4employees (full and/or part-time).* 'I am a sole and I have hired the sub -contractors proprietor or partner_ ship and have no employees listed on the attached sheet, x These subcontractors have working for me in any eapazity. [No workers' comp, insurance workers' comp. insuran. 5. ❑ We am a c orporabon its re aired. ] 3 • [] I am a homeowner doing andce officers have exercised their all work myself. [No workers' comp. right of exemption per MGL c. 152, § I (4), and we have insurance required.] t no employees. [No workers' Pomp, ins -,,n Type of project (required): 6. ❑ Nev, construction 7. ❑ Remodeling g• ❑ Demolifion 9. ❑ Building addition 10. El Electrical repairs or additions 11.11 Plumbing repairs or additions 12.❑ Roof repairs ce required.] I I3.❑ Other I `=n1' plicant tis r�i�- U� box iul mus! aso uu out the senor btsow shoe g :h ' Homeown= who submit this affidavit indicating they are doing all work b � worre:s' comp=�we� ..,,s...,. _r ___ e and thea hireOutside contractors mulct submit anew affidavit indi=iing such. +Contractors that checl this box must attached an additional sheet showing the name of the subcontractors and their workers' comp. pohcy information. I am an employer that is providing workers' compensation information insurance for my employees Below is the policy and job site Insurance Company Name: Policy # or Self -ins. Lic. #: mow► -.- sv Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration age(showingCity/State/Zip: the Policy Failure to secure coverage as required under Section 25A of MGL c.. 152canlad to the impostronbof er and � u� on date). fine up to $1,500.00 and/or one-year imprisonment, as well as civil Penalties in the form of a STOP WORK ORpenalties ER and of fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office a Investigations of the DIA for insurance coverage verification I do hereby certt✓l/ under the pis y�ties of�periury that the information J%d pe /j"�_ / I .f motion provided ab3ve is true and correct Official use only. Do not ►write in this area, to be completed by city or town offciaL WAMIMV® City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town . Clerk 4. Electrical Inspector SPIumbin 6. Other bQ Inspector Contact Person: Phone #: Information an- d 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 pe=rson 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 umstee of an individual, partnership, association ox- other legal entity, employing employees. However the owner of a dwelling house having not more than three aparbrk-eats and who resides therein, or the occupant of the dwelling house of another who employs persons to do mainte3narice, 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 coxUpiiance 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. United Liability Companies (LLC) or Limited Liability, partnerships (LLP) with no employees other than the members or partners,. are not required to carry workers' compr—wation insurance. If an LLC or LLP does have employees, a policy is requirecL 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 pert or license is being requested, not the .Department of Industrial Accidents. Should you have any questions regardigg 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 ofInvestigations would Bice to drank 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 Commonweal& of Massachusetts Department of bndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 021.11 Tel. # 617-72.7-4900 ext 406 or 1-677-MASSAFE Revised 5-26-05 Fax 4 617-72.7-7749 umrw,.mass.-Gov/dia. It NORTH a?� V. OL O p s ��•'a ,SSACMUSE� Date ..... (— c� D .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ".mss 42�.................................................................... has permission to perform ...........R- f L L !" .... �.' : l/.-Gc.. .i i2 ' .......................... wiring in the building of ..........Q... at ..........(..`.() .......... , North Andover, Mass. Fee...2 5..'. Lic. No.l,7...... ......... /� ELECTRICAL INSPECTOR Check # SI6 6 n()9 C ommonurealth o� /I/assacif� Official Use Only cc�� c7 Permit No. a1JeParimerit o� dire �eruices Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 IN INK OR TYPE ALL INFOUION) Date: City or Town of: /U a r t0i j� 11 6 d • To the Inspector of Wires: By this application the undersigned gives notice of his or her intentionp perform the electrical work described below. be Location (Street & Number) Z 1 1t Owner or Tenant Cal S, V ec. Owner's Address S G, Imuc Telephone No. Is this permit in conjunction with ab lding permit? Yes F-1No ❑ (Check Appropriate Box) Purpose of Building 12c s 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 Location and Nature of Proposed Electrical Work: A _ . _1_. ,n 1 Completion of the following; table may be waived by the Inspector or Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. s Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ElIn- ❑ rnd. rad. Igo—.07 Emergency Lighting Battery Units No. of Receptacle Outlets o. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices Heat Pump umber Tons KW No. of Self -Contained No. of Waste Dis Deers p Totals: ........... Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Municipal El other Local ❑ Connection No. of Dryers 1'Y Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o aterK`,1, No. o No. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP el No. of Devic sons or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: CO 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 cov rage is in force, and has exhibited proof of same to the ermit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Z t1l, C 1 cerdt, under the pains and a 'es o!fpejJ'ury, that the infornur o on this application is true and complete: FIRM NAME: C_ 4"000' /'A LIC. NO.: Licensee: Signature LIC. NO.: A3pl97 (If applicable, enter "exempt" in the license number line),Bus. Tel. No.: s Address: E9,? i ® `e-1 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security woA 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: $ Signature Telephone No. 1) NORTH s � A Date. .. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS � /, �, . This certifies that -T�* ..................... has permission tom .............. plumbing in the buildings -of. �' ............. at. ....... North Andover, Mass. Fee�a r-13 \ 1 ..�... Lic. No. 4..<. .... . P M� INSPEC ;;Ott Check# r O� 8229 v�%' L MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) J / ass. Date_{ / X O—L Permit # P� _ Building Location -1, e y^I J le � Zowner's Name G Qs a V e c rh l Ci Residential � � % � Type of Occupancy New ❑ Renovation ❑ Replacement 29 Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg . &Plg . Co. Inc. Check one: Certificate Address_ 35 Pleasant Street LX Corporation 714 Stoneham, Ma 02180 ❑ Partnership Business Telephone 781 -438-7776 i-1 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9 No ❑ If you have checked, please indicate the type coverage by checking the appropriate box. A liability insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass_ General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Title Si a u e of Licensed Plumbg- 6 City/Town Type of License: Master [X Journeyman ❑ APPROVED (OFFICE USE ONLY) License Number 8322 %" Watts 9D KI) on water line to water boiler— ?n I = (n - " Ntn o Z > o w b ~ t W n � Y J x iN W of m ca z t¢ O y a n _ a a aj cn x x }¢ w H r- W a N c ¢ z o¢ o x rx�1 O> . o x o i �� ~ a~ r �' a n vxi 2 Da a N z w ~ o u a) N � a a x a d 0 o a J J a ¢¢ M a C a 4J 4-) 4-) H' Y ..! !a N O J x C7 N 3 UI SUB—BSMT, i BASEMENT 1ST FLOOR FF 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR r STH FLOOR Installing Company Name Heritage Htg . &Plg . Co. Inc. Check one: Certificate Address_ 35 Pleasant Street LX Corporation 714 Stoneham, Ma 02180 ❑ Partnership Business Telephone 781 -438-7776 i-1 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9 No ❑ If you have checked, please indicate the type coverage by checking the appropriate box. A liability insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass_ General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 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