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Miscellaneous - 77 ELM STREET 4/30/2018
10841 Date.,.0 �`.\A....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 4,V tV t This certifies that .. " (?.!�'...h....�-- ............................................................................. has permission to perform .......M1! �..Tt ��.. . P,,,If r?��......................................... plumbing m the buildings of .......... ................ at .......... ..... .. ........................ North Andover, Mass. 1`1 Fee CS Lic. No. 1 PLUMBING INSPECTOR Check4t 2 --7 2, to jw� WMIHNG MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTh`ER F INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES .-_ NO IF YOU CHECKED YES, PLEASE INDICATE THE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 7 OTHER TYPE OF INDEMNITY © BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachus tts G eral Laws, nd t at my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT 10i SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ( _� t 'i _ 2i r I LICENSE # SIGNATURE IMP JP0 CORPORATION FJ#PARTNERSHIP®#LLC Ek E COMPANY NAME r � ; ADDRESS ,' 6 /L Z Z CITY r;L ; •M c�-�� _� STATE ZIP t _( TEL E FAX ]CELL EMAIL O'er __L V MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1, CITY I MA DATE ! ERMIT #� JOBSITE ADDRESS ~7 "� I OWNER'S NAME POWNER ADDRESS TEL FAX _ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: Q PLANS SUBMITTED: YES DeNO 01 FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM I _- - _ --JI ___j --_-_ ► -.-1 -__ --JI.--- I ---I1I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR( INTERIOR) _ ! 1 _ _ _ I (I _._J �._i KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK _ J _ _ l f _..._ j _.__.I TOILET URINAL WMIHNG MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTh`ER F INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES .-_ NO IF YOU CHECKED YES, PLEASE INDICATE THE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 7 OTHER TYPE OF INDEMNITY © BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachus tts G eral Laws, nd t at my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT 10i SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ( _� t 'i _ 2i r I LICENSE # SIGNATURE IMP JP0 CORPORATION FJ#PARTNERSHIP®#LLC Ek E COMPANY NAME r � ; ADDRESS ,' 6 /L Z Z CITY r;L ; •M c�-�� _� STATE ZIP t _( TEL E FAX ]CELL EMAIL O'er __L V o El z N ❑ W CL W LIL The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):�C2 Address: Ao , �J e)7-- City/State/Zip: )`-- City/StatelZip: IM Q P.SZ /1 A -c �L �, Phone #: � ©3 — ?� 5 C Are you an employer? Check the appropriate bog: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction ployees (full and/or part-time).* have hired the sub -contractors 7. kRemodeling 2. M I am a sole proprietor or partner- listed on the attached sheet. t ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition [No workers' comp. insurance required.] officers have exercised their 1011 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152 § 1(4), and we have no � 12.E] Roof repairs insurance required.] employees. [No workers' 13. ❑ Other comp. insurance required.] *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. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. X am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Y do hereby cerfifyjun deg the pains #d pe1ialties of perjury that the information provided above is true and correct. Phone #: Ia C) 3 3 G 5 — I$ -3 r Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # 10-31-I 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 r 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 -contractors) name(s), address(es) and phone numbers) 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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 Mossachuse-tts Department offadustirial Accidents Office of Investigations- 600 nvestigations6,00 Washington Sheet Boston} MA. 02111 Tel # 617-727-4900 ext 406 or 1-877 MASSAFE Revised 5-26-05 Fax # 617-727;7749 Www.zuass,gov ata 4 0 Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING .0 This certifies that --I- AJ .................................... I ........................................... has permission to perform ...................................................... wiring in the building of ........ I............................... ....... . ... I ........... atNorth Andover, ........................... .............................................................. Mass L 9 .... .. Fee .... n; .... ic. No ...... le ................. ELECT ICALINSPECTOR Check # 73 - �L\ Commonwealth of Massachusetts Official Use Only Permit No.— ("2—'KUt> Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev- 1/071 (leaveblank 'M APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(j(jVIFC), 527 CMR 12.00 (PLEASEPRINT.ININKORTYPEALLINFORMATION) Date: Il/✓���[// 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) 77 Elm 54 - Owner or Tenant tl' L Felyl oO 5 `� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes L Purpose of Building 4 IN 0.41 O� �"fi(el144 al��f �t, 3 R �t� 1— Overhead ❑ Overhead ❑ - Existing Service New Service Amps / Volts Amps / Volts No ❑ (Check Appropriate Box) 1v Authorization No. Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W, �e 4oye rylarkA A4 V4b Ae ae4,w.11o/zri Cmmnlotinn nftha fnllnwinu tahle may he waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans V s Total Trsformers KVA Tran No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above [IIn-❑ rnd. grnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. oSwitches f rn No. of Gas Buers No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers P Heat Pump Totals: Number I Tons KW No. of Self-contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security o Device s 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 Te1No. of Devicor EquivWirinalent OTHER: Attach additional detail V desired, or as regzrtrea by the lnspecror of rvrres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: /%/3 / 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 cove ge ism force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) X certify, tinder the pains and penalties ofperjury, that the information on this application is true and complete. d FIRM NAME: ^ \ LIC. NO.: oP 1767 ( t Licensee: �', +"�' Signature LIC. NO.: 5/303 L (If applicable, enterS�xempt" in the lice a number line.) Bus. Tel. No.:%C�"sd Address: ©?Y/ L�.r1.49Q � 1y1Pvt�jvi2h- i✓l�}- o/y6 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: $ Signature Telephone No. 0 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 of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he 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 purpose 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 period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Ins ection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re -Inspection Required ($.) ❑ Inspectors Commen YI(NInspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Co ents: Inspectors Signa ure: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com The Commonwealth: of Massachusetts - Departmentof'IndostriolAce .. is Office oflnvesiigations 600 Washington Street Boston, MA. 02111 www.rnassgov/cira Workers' Compensation Insurance davit: SuiZders/Cont°actors/Electricians/Plumbers .A.. heant Information Please Prim Le ibX r . Name (Businessiorganizaiion&dividuat): Address: City/State/Zip: �np�5 �l�-' e�� , OI y%— Phone #: r8 ' SD `ji T S . Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I mployees (fall and/or part-time).* have hired the sub -contractors listed on the attached sheet. 2. I am a sole proprietor or partner ship and1ave no. employees. These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporajion and its [No workers' comp. insurance required.] officers have exercised.their r 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c.152, §I(4), and we have no insurancerequired.] i employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ Now construction f 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions II.❑ Plumbingrepairs or additions 12.❑ Roofrepairs 13.[] Other xAny applicantthat checks box#I must also fill out the section below showingtheir workers' compensation policy information. Homeowners who submit this affidavit indicating they go doing all work and then hire outside contractors must submit anew affidavit indicating such. rContractors that check: this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. _T am an employer that is providing workers' compe1asation insurance for rely employees Below is the policy and job site information. Insurance Company Policy 4 or Self ins. Lic. ff: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensatioWpolley declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL 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 ORDFR and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of- Investigations fInvestigations of the DIA for insurance coverage verification. X do hereby cerin unci ae pains ^nd penalties of,�erjury that the information provided above is true and correct. Date: Phone#: 9 79- 50-53 Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitMeense 0 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 Y Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an eraployee is defined as "...every person in the service of another under any contract ofhire,- express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, ax anyiwo or more Of the foregoiug engaged in a joint enterprise, and including the legal representatives of a• deceased employg,_ or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. l Iowever the owner of a dwelling house having notmore than three apartments and who resides therein, or the occupant ofthe 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 bean employes." MGL chapter 152, §25C(6) also states that "every state or local lie -easing 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 -contractors) name(s), address(es) and phone number(s) along with their certificates) 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,apolicyisxequired. De advised that this affidavit maybe submitted to the Department of Industrial Accidents for confrmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retmued to the city or town that the application for the permit or license is being requested, not the Dop' niment of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a yvorkers' 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 thatmust submitmultiple peimit/Rcense applications in any given year, need only submit one affidavit indicating current PORGY information (if necessary) and under "lob 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 Hermits or licenses. A new affidavit must be filled out each year. More a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e. a dog license orpermit 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 hesita%to give us a call. The Department's address, telephone and fax number: The Coon�roai oMassar,.hvsoiis Pepar eut offudwrial ,A;ccidanta Office ofTuvestigaMxts. 600 Wash. agwn Stoat Bos�on� : 0�X X x TO. # 617-72,7_4900 oyd 406 or. x•-877-SSAF`.F, Revised 5-26-05 Fay, # 617"727-7749 WWW.Massgvfc`a Commonwealth ofl✓!as usetts Division of Registrati Board of Electrical TIMOTH m W 241 LEA m r > a 0 LUNENB Master Elec ' 'a 21767-A 07/31/201 s e v009045 License No. Expiration Date. Serial No. r, Lire tual. October 17, 2014 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Re: Property Address: 77 Elm St, North Andover, Ma 01845 Policy Number: H3221229309412 Underwriting Company: Liberty Mutual Fire Insurance Company Claim Number: 030543552-0001 Date of Loss: 9/6/2014 Attn: Town/City Official Pursuant to M.G.L. c. 139, � 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable.' You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, 599, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws, Ch. 111, 5 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 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 of ongoing construction activity, and may be_deemed.by the 7nspector_of _Wires abandoned.and.invalidaf_he—__ .. _ 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 period beginning on August 15, 2008 and extending through August 15, 2012. f Rule 8 — Permit/Date Closed: 23 4 * Note: Reapply for new perm.i� ❑ Permit Extension Act — Permit/Date Closed: IL Date...... . 2— ........................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... .. ... ....... ( P-4 P&-a'ow r'k has permission to perform ...... ... . ........................... wiring in the building of ........... ........... at ...... ...... ............................. North Andover, Mass. North Fee ... Lic. No. /676 7Z ........ ............. ............ ........ . .......... /ELEc ICAL INS croR Check # 10764 t� Conwwnwea& o f Aamachu db l? I 2epal&ent o/-?iro semiw �?r BOARD OF FIRE PREVENTION REGULATIONS Official UseOnly Permit No. Occupancy and Fee Checked [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performec: in accordance with the Ivlassacinrsetis Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT BY INK OR TYPE.4IA iL INTO TIOM Date: j--/-- City or Town of ,' j1/To the Inspector of Wires: By ,; application the us undersigned givenonce of his or Viii, Iinii nflon to perform the elcetricai work described below. Location (Street & Number) /�/) %m S16-eP-iL Owner or Tenant �L I• Z is f a n e 5S K Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Ek (Check Appropriate Bos) Purpose of Building Utility Authorization No. Existing Service Amps I Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampaeity Location and Nature of Proposed EIectrical Work: No. of Recessed Luminaires No. of Cei1.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luaninaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above [I In- ❑ rnd. ad. o. at E mergency Lighting Batte , Units No of Receptacle Outlets No. of Oil Burners FIRE ALARMS, No. of Zones No. of Switches No. of Gas Burners No. of Detection and InitiatingDevices No. of Ranges No. of Air Cond. -Tons No. of Alerting Devices No, of Waste Disposers Heat Pump Totals:: I Number I Tons K No. of Self -Contained Detection/Alertina Devices I I No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KIV Security Systems: - No. of Devices or E uivalent No. of 17*ater Heaters KW No. of Bal as g -a Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications WTIn No. of Devices or E uivaTent OTHER: Attach addflionai detail y-desit-ed, oras required by the Inspector of Rlires. Estimated Value of Electrical 1volk: (When required by municipal policy.) Work to Start: 1 - q^--1 toy-- Inspe--tions to be requested in accordance with IviEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless c hived 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 ge is in force, and has exhibited proof of 19 the p_. .it issuing office. C1irCK ONr: INSURANCE UVD [I OTHER [I (Specify:) /f1 1 cert; tender the pains and penalties : fperjrtry, that the inform ono I�i7p�Fon is true and completes 1 �7 FIRM NAME: � .� �(t- l�Pcf/'rC 11���1i��� Y►o LIC. NO.: l [0 Licensee:- Ua tom% G_, (4d j,(.a14 J-- Signature (Ifappficab/e curter "exempt" in the license;nanber line.) - Address: _1_LL6o)Mf 5 s e-1- ,t�4�L� ��P�^-RA LIC. NO.: 13u_s. Te] No a)$ - Alt. Tel. Per M.G.L. c.1'17, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER 'am aware that the Licensee does not have the liability insurance coverage nonnally required by law. By my signature below, I hereby waive this requirement. I am the (check one ❑ owner ❑ owner's a em Owner/Agent Signature Telephone No.. b M R`el q S PERMIT FEE: $ S� 9364 Date. . 0-11 - -- -- .. - TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......... �p�eov . XX ...................... has permission to perform plumbing in the buildings of .... ............... at .... %Z. . Sr ................ N9 ,rth Andovet Mass. Fee. Lic. No. Z% 4...�. ...... PLUMBING INSPECTOR Check # —?04 Latr3-#�?'.:' X At ar-r�;M !• C{T�f J, ;h 114,1-.I �y_=_� f ERIA T ;;i JOBS{ s E ADD#?ES3 L* - L /ff'IG'�r1fvERS I`IAhrIE . OWNER; 3DDFtESS . _ .._ UCCU{aANC'#` TYPEEDUCATIONAL ELIICtT{ {gyp; RESIDEN IAL,, !4'EIN' RtFLAC ILiLIt! f :..- I FIXTURES ?- FLOOR , BPa7;-ITUS CROSS CONNECTION* _IEVICE DE #C�;# EC SFE�IHL ihtj4 .ci try DE!�iCA! Cr`tSic^,IL rg IdD SYSTESVi T!:u t.3rttN� iEr 6YS T ENI .�1(=,'�iIlll�i•�Ti Arlt. V(t•.=i��:;7'Yi? ff''.t+:7Ei ?�✓ICAiE_'Jjl:1tIEnRE CLEv{sfEiii UIJI-ivA$I i=R DRINKING FQUNI T AIN F JOG t7ISFJSER rlfFjorI t tR t tea I,:t U?: f 0RY R (J0 Nr tdr? sEi:'�if � : r"NIQF s#isx I`'If ET URINAL NASliff-4Gi:a�C Iif�;ECCri:P�E �iERicl�#�FC?AL1 pES -- t ra Stltlli { f I c YES: plQ t 13 ! i iii^t,..:;f.'!z'.`'-I�e#f �� i.�:�£�tt+a' Lr.M�iG.�`�• .__ �No li?ai staw aY't.ii'�. �� i. E Y> i:l 4� tur'�t_ •i -:E Til ��qq E: tt (� - � t >: ar_f RAY L. f Zi F i'a`'.i1V:'fil�4 ' 50" 0 i2.E..Lf.€1 Lit .3i IT` 1NISUP 3ifCE PODGY I OT"'=R PrPEOF i DEPANMYSac i`f r E , a 3i4£rct' du ait t r _:rF sei.ra#"L tiiia. ui� -I s8�'?=i?_ iii tl3is $le a7Ga• c?sS,r , f_ E a ...f P, v ; s i 4` ` s; �:.x _al�c 3tiy. ul itc'i 'sFG on al€;s f Annie appil:-UtI0il tns remirenual. iE€' i s LtT $�l2 OF Cl+NIER OR I.no:cug'L�r(grflli ata -_.•. ..__ :Z��:.I . af(e; file i_,_!ts Aral iiiomaflon f have submitted or enf=red r�uarding L' is zgpfication E '+ f =: d Ihat all elc,z biro ::uric ar !ns#a[taflons pariorma urdar fha Pezif !sse+ed for f�is a ante zrd aceuraie io the nest oP m Icno: �adgz i:fassac#iusefis Slafe Flumbinc` dodo a -d Chapter i42 of ft;e G. m is -tion � rilI be in t€o�r. � General , F•iarrc--Leith #1 ertjnerf .rovisic iih2 °LUf4k eR `I {. E �Sie `lEil G ---I r i _ _ -. _< ._. �__ L{ E i''ISE 7 3 5 ��--� ..'� I n Milp COR-QnATIQi'i0:1,F5-51 ,RT€5 ERSNIF - ---7 C'"I iPiT iPAM ;' I�IAk4E,�'farc� iEr GoiG Cfi i r ..y ��L.�_` � LLC �� { _. rbc aii,n U, TV - _ e /;IlDRESS 13 €Gcl t STATE( 7 c 61_08 --- i EL. FAX (�OB7?dl _�...€ CEL — EMAILAIL #ranIUX m J-5— j 1 � f i 1 f 1 1Jiiiilu CIO � CO 1 f+ 2 f ;t o !!! I 4 31 S2 L'S -LL LILI,i 1 I i 1 I � 1 75 ol � 1 i Albert P. Manzi III, Esq CU man Ellen P. McIntyre, Kx-Chdnwa Richard J. Byers, Esq. Clerk Joseph D. LaGrasse Richard M. Vaillancourt Town of North Andover ZONING BOARD OF APPEALS FINDINGS AND DECISION RE: Appeal of Lizetta M. Fennessy 77 Elm Street, North Andover, MA Date: September 17, 2009 PROCEDURAL HISTORY REM1VED *TOWN CLEWS OFFICE '7009 SEP 17 AM I 1; 55 TOWN OF NORTH ANDOVER MASSA"6o Thomas D. Ippolito Daniel S. Braese, Esq. Michael P. Liporto ZomnngEn Wffew macer Gerald A. Brown 1. On or about May 28, 2009, Lizetta M. Fennessy (hereinafter, the Appellant), of 77 Elm Street, North Andover, appear the decision of the Building Commissioner to issue a building permit (#628) granted to MetroPCS Massachusetts, LLC to erect a wireless communication facility on property owned by the Trinitarian Congregational Church, 70 Elm Street, North Andover, Massachusetts per M.G.L. ch. 40 § 7, 8, and 15 as North Andover Zoning By -Law Section 8.9.3(cxv)(1). 2. The Zoning Board of Appeals (ZBA) held a public hearing on the matter at a Special Meeting on June 18, 2009, and continued the hearing until August 11, 2009. The documents listed and identified herein within Appendix "A" are hereby incorporated by reference attached hereto and made part hereof, as identified by exhibit numbers one (1) through twenty (20) and exhibits A and B respectively as marked by the Chairman at the Public Hearing and constitute documents received as to the record. The ZBA Public Hearing contained oral testimony as set forth in the Board's written and recorded record. 3. The ZBA deliberated the matter at its meeting on June 18, 2009, August 11, 2009, and September 3, 2009. Public Hearing closed on August 11, 2009. 4. On September 3, 2009, a motion was made to uphold the appeal of the Appellant. The vote of the ZBA was two (2) in favor and three (3) opposed as noted herein within the Chairman Certification of Record Vote. 5. Pursuant to M.G.L. ch. 40A, § 15, the appeal was denied. FINDINGS 6. In a decision of the Planning Board of North Andover filed with the Town Clerk on March 5, 2009, MetroPCS, LLC and the Trinitarian Congregational Church obtained a special permit to erect a wireless communications facility in the steeple and basement of the Church located at 70 Elm Street, North Page 1 of 3 Andover per M.G.L. ch. 40 § 7, 8, and 15 as North Andover Zoning By -Law Section 8.93(c)(vXl). 7. The Appellant, and others, appealed the Planning Board's decision in Fournier, et al v. Simons, et al, C.A. No.: 2009-559-C (Essex Superior Court). S. The Building Commissioner granted a building permit (#628) to MetroPCS, LLC and the Trinitarian Congregational Church on or about May 18, 2009. 9. The Appellant filed her appeal with the ZBA on May 28, 2009. She alleged that the Building Commissioner wrongfully issued building permit #628 because the proposed wireless communications facility is located within 600 feet of her residential premises, in violation of Section 8.9.3(cxv)(1) of the Zoning By -Law. 10. The Appellant is a "party in interest" as defined by M.G.L. ch. 40A, § 11. The ZBA finds that Ms. Fennessy is an aggrieved person for the purposes of this appeal. 11. The ZBA finds that the Building Commissioner properly issued the building permit. The building permit was, in effect, authorized by the special permit granted by the Planning Board to MetroPCS, LLC and the Trinitarian Congregational Church, filed with the Town Clerk on March 5, 2009. The Building Commissioner's decision to grant the building permit was therefore a ministerial step taken in reliance upon said special permit. RECORD OF VOTE The Board took the following action: Upon a Motion made by Ms. Mcintyre, seconded by Mr. Braese, to support the Appeal of Ms. Fennessy and overturn the Budding Inspectors findings as set forth within the filed petition, The following members of the Zoning Board of Appeals voted to SUPPORT the appeal of Ms. Fennessy: Albert P. Manzi III, Esq. and Ellen P. McIntyre The following members of the Zoning Board of Appeals voted NOT TO SUPPORT the appeal of Ms. Fennessy: Richard M. Vaillancourt, Thomas D. Ippolito and Daniel S. Braese, Esq. The Chairman declared Ms. Fennessy's petition denied as it failed to obtain four votes in support thereof as required. - a," 4 �44 .4 Ch ' Filled with the Town Clerk on September 17, 2009 Page 2 of 3 APPENDIX A Exhibit #1 Letter from former Telecommunications Subcommittee (dated 1/26/09) Exhibit #2 Materials list submitted by Lizetta Fermessy (12 items) Exhibit #3 Letter from Walter Soule to John Simons/Planning Board (dated 1/23/09) Exhibit #4 Email from B Fink to Liz Fennessy (dated 1/26/09) Exhibit #5 Letter from Attorney Joseph Fitzgibbons to Ms. Karen Carroll (dated 1/15/08) Exhibit #6 Letter from Attorney Edward J. Collins to Ms. Thea Fournier (dated 1/26/09) Exhibit #7 Letter from D. Robert Nicetta to Rev. Andrew M. Gilman (dated 10/24/00) Exhibit #8 Letter (Page 1) from Janet R. Stearns to Mr. Robert Nicetta (dated 7/27/01) Exhibit #9 Letter (Page 2) from Janet R. Stearns to Mr. Robert Nicetta (dated 7/27/01) Exhibit #10 Letter from Michael McGuire to Janet R Stearns (dated 8/1/01) Exhibit #11 Letter from D. Robert Nicetta to Mr. Paul Gascoigne (dated 5/25/02) Exhibit #12 Letter from Gerald Brown to Gin Vilante (dated 4/12/06) Exhibit #13 Letter from Gerald A. Brown to North Andover Planning Board (dated 12/3/08) Exhibit #14 Affidavit of Lizetta M. Fennessy(dated 6/18/09) Exhibit #15a DVD of North Andover Annual Town Meeting night one Disc 1 (dated 5/12/09) Exhibit #15b DVD of North Andover Annual Town Meeting night one Disc 2 (dated 5/12/09) Exhibit #16 Letter from Lizetta M. Fennessy to Gerald Brown (dated 5/15/09) Exhibit #17 Letter from Gerald Brown to Lizetta M. Fennessy (dated 5/19/09) Exhibit #18 Peter Morin Letter dated June 10, 2009; including attachments Tab A thru F Exhibit #19 North Andover Town Charter Exhibit #20 North Andover Zoning By-law Submitted on August 11, 2009: Exhibit A Essex Superior Court Complaint, Civil Action No. 2009-559-C Exhibit B Letter from Attorney Peter Morin to Albert P. Manzi, III, Esquire (Zoning Board of Appeals) (dated 7/27/09) M.G.L. ch. 39, § 23D Participation Form(s) rA Page 3 of 3 May 15, 2009 77 Elm Street North Andover, MA 01845 Gerald Brown Zoning Enforcement Officer 1600 Osgood Street Building 20 Suite 2-36 North Andover, MA 01845 Attention: Zoning Enforcement Officer RECEIVED MAY 15 2009 NOR 1 N ANDOVER PLANNING DEPARTMENT This letter is written with respect to the case of the MetroPCS proposal to install wireless antennae in the steeple of the Trinitarian Congregational Church located at 72 Elm Street. In accordance with Chapter 40A, Section 7 of the Massachusetts General Laws, I hereby request that you enforce the Town of North Andover Zoning Bylaw with regard to wireless facilities, Section 8.9 3) c) v) (1), which states: v) Setbacks All wireless service facilities and their equipment shelters shall comply with the building setback provisions of the zoning district in which the facility is located. In addition, the following setbacks shall be observed. (1) In order to ensure public safety, the minimum distance from the base of any ground -mounted wireless service facility to any property line, shall be 2x the height of the facility/mount, including any antennas or other appurtenances. This set back is considered the "fall zone". A minimum setback of 600 feet shall be required for all wireless devices, antenna and their mounting structures, whether attached to a new or existing structure, as measured from the adjacent property line of properties which are either zoned .for, or contain, residential and or educational uses of any types. On March 3, 2009, the Town of North Andover Planning Board issued a special permit for this proposed installation, in violation of Section 8.9 3) c) v) (1) of the town's bylaw. In accordance with Chapter 40A, a building permit cannot be issued for projects that violate the zoning bylaw, without a variance from the ZBA. Therefore, in this case you are required to enforce the bylaw and deny a building permit. I look forward to your notification, in writing, of any action or refusal to act, and the reasons therefor, within 14 days of your receipt of this request, as required by Chapter 40A, Section 7. Thank you for your prompt attention to this matter. Sinc ely, <-a Lizeitta M. Fennessy C: Zoning Board of Appeals; Attn: Chairman Alfred Manzi III Location % 7 ' "' IM— No. 7 Date 12- "dl aj' 10RTh TOWN OF NORTH ANDOVER ?0;� ,6o ,4'�.ya F,jiswiKs " + i , Certificate of Occupancy $ '��s'••� Eta' JACHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $� Check # 02),;; 18889 Building Inspector 80 rn X Z O v rn TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT IPA RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ).•..L.-,� �., DATE ISSUED: SIGNATURE: O)Alding Commissioner r of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 7 411n �1.2��Map and Parcel Number:7 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronto ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 water Supply M.G.L.C.40. 34) Public 0 Private 0 1.5. Flood Zone iafomratiion: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record L-/ 2 Fen', Ps -5-j Name (Print) 7 7 ��ir� 5`� �✓d u -rte JJ // Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Sistnature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 ,Licensed Construction Supervisor: Licensed Construction Su 'sor: A � D M 6---V/ Signature �� ! ��� Telephone Not Applicable ❑ License Number `0 Expiration Date 3.2 Registered Home Improvement Con r Not Applicable ❑ /a Company Name fa P' P 11,\ Registration Number 0 Add ss 01,1- 7 Expiration Date Si afore V Telephone 80 rn X Z O v rn SECTION 4 - WORKERS COMPENSATION (M G.L. C 152 § 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Building Estimated Cost(Dollar) to be ( )OFICA. Completed by permit a licant IAL (a) Building Permit Fee Multiplier USE ON)<.Y 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 $ yd G Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, `-may ,J as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief j�G /int ®J Q LFA Print Nam 12 Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 ST 2 ND 3 SPAN DM ENSIONS OF SILLS DMIENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE VL r }� w O I h 1 W s� A o a W rq C � :oma U w W a a°' ii F U w�"yIy' w W a�' c9i w W v� �� rr,, V a�' m w w A w G rig z cn o cn c c C z N c W :oma N � me m O ts a r0+ N E c cc �Z :cam' O COi r C CLS S lo— mS • O L o CA cm ; O a O� C CID Go I=_ C z E L N Z N O N a CD cm c m L O Co c �C N m z e Z 0 5 CD zip rz v C 4 2 2 0 O � L O v Z °D CL O H Q C CD cm I � C a — .CO2 O O g m m 0 CD CD y-- 3 CD O Q i Cc O d CL CM< co O cc v 'C i. CD CL V ^y c C - C R Q CO) 0 N LLI Y/ 19 W W it W U) N c W Em � m 0 y O ; y... '00 COQ cz cc �Z aC O to CD CLS S lo— mS •� O '_ = C �E w oca , a O� C D Go I=_ cc E L N Z N O N a CD cm c m L O Co c �C N m z e Z 0 5 CD zip rz v C 4 2 2 0 O � L O v Z °D CL O H Q C CD cm I � C a — .CO2 O O g m m 0 CD CD y-- 3 CD O Q i Cc O d CL CM< co O cc v 'C i. CD CL V ^y c C - C R Q CO) 0 N LLI Y/ 19 W W it W U) 'Ift ropogar page of IP Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 (978) 691-1355 THOMIPSON'SIR"OOFING Shingles - Slate - Rubber Roof Single Ply - Copper Work PROPOSAL SUBMITTED TO PHONE DATE Liz Fennessy — _ STREET JOB NAME 77 Elm Street CITY, STATE AND ZIP CODE JOB LOCATION North Andover MA 01845 ARCHITECT DATE OF PLANS jJOBPHONE j We hereby submit specifications and estimates for: 11 Strip off all roof shingles on house c tee✓ bours— Install aluminum drip edge around roof line Apply ice and water shield 6 ft. up all along edges and in valleys Apply 151b. felt paper on rest of roof area Reshingle with a 30 year Architect shingle Install new flanges around soil pipe Waterproof chimney flashing t� Cut in 2 roof vents? � Install a rubber roof on top section only ,fig Remove all work related debris 30year warranty on material s"tl� 5 year guarantee on labor j .construction lic. #060112 ;improvement #128612 RIC Vr0POOe hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: Ei ht thousand four hunLlged dollars ($ 2 40 g0 ). Payment to be made as follows: $3,000.00 start of lob All material is guaranteed to be as spaitiied. Ail work to be oompww in a workmanlike manner according to standard practow Mfr shnittion or deviation from show sped inttiionssinvolviN Age extra wi to oxmium only q= vwm orders, end win b000rm an fta ova above the estimate. All agrewwb vondnpent upon strikes, woklerts or delays bepW our control, Owner to carryrnado fore, toand other necessary kcs riume. Our workers we fully Note: This proposal meY be covered by Workmen's Conn a stlon hmromk witMirawn by tim H M* it #-i -ithin Bio- 21ueptance Of propwaY — The above prices, specifications and - conditions are satisfactory and are hereby accepted. You are authorized to do the Signature work as specified. Payment will be made as outlined above. 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 at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c119S150A. Also, note Permits are required under Fire Prevention laws:;Chapter 148 Section I 0A. The debris will be disposed of in: � � S x Ir (Location of Facility) SignatuV of Permit Applicant Fire Department Sign Dumpster Permit C2 ZIRJ ©S Date A090 CERTIFICATE OF LIABILITY INSURANCE DATE 0 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ?elham Insurance Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ?.0. Box 960 L22 Bridge Street 03076 INSURERS AFFORDING COVERAGE NAIC # ?elham NH INSURER A Nautilus NSURED INSURER B: Associated Industries Phomas Doyle dba rhompson's Construction & INSURER C: B West St INSURER D: Q=lcm NH 03079 INSURER F. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _IrY FaEac2mE. Bni,IrY Fr.plRAnoN ;NSR ADD'L -- ----- _ ---- _ ___ _ LIMITS _ LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYY) DATE (MM/DD/YY) 04/15/2005 04/15/2006 EACHOCCURRENCE $ 1,000,000 A GENERAL LIABILITY NC 330578 DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence)$ MED EXP (Any one person) 1,000 CLAIMS MADE a OCCUR 1,000,000PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 oonnurrc-rnMP1nP`AGG $ -210001000 GEN'L AGGREGATE LIMIT APPLIES PER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY I ANY AUTO EXCESSIUMBRELLA LIABILITY CCCUr F7 ri N,.6 ,c DEDUCTIBLE B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER AWC7012214012005 04/21/2005104/21/2006 DESCRIPTION OF OPERATIONSILOCATIONSAIEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Job: Various roofing and construction TE COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AWC7012214012005 04/21/2005104/21/2006 DESCRIPTION OF OPERATIONSILOCATIONSAIEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Job: Various roofing and construction TE $ E.L. EACH ACCIDENT E. L. DISEASE - EAENIPLOYEE $ P i MCFASF - POLICY LIMIT $ 100,000 100,000 500,000 vERTIF= i G nt7� UCK -" CANCELLATION WynWOOd ASSOClateS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. 19 BaSSwOOd Lane MA 01810 AUTHORIZE REPRESENTATIVE � • �� ?,ndover © ACORD CORPORATION 19BE ACORD 25 (2001108) Page t of: • r, crronnur f GSFR Fr1RMS INC. - (800)327-0545 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,11A 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly ✓1 .. Narne Illusincss/Organiraliun/Individual): Address: L) -Pte A S A/O City/State/'Zip: 1 -e /11)'<-- /P/-�;S Phone #: 6 %/ " 135-5- A ass ore you an employer? Check the appropriate box: ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees ( full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no 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 I I .❑ Plumbing repairs or additions 12� Roof repairs 13.❑ Other :'Any applicant that checks box # I must also till out the section below showing their workers' compensation policy information. y Homeowners who submit this at)idavit 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 intimnation. 1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy ,4 or Self -ins. Lic. It: WC % 6 I d oZ/ `/D/ 9 D D S Expiration Date: D b Job Site Address: Ci /State/Zi d1 do J e� 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 tine 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 4ienature: Y©W - / -\ Date: 102 /a fM s Q11ieial use only. Do not write in this area, to be completed bp city or town ollic•ial. 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 4 6. Other Contact Person: Phone #: Date ..41.`.�1. %4........ . p`4.ao ,wee OL TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that � ................ "' ... . has permission for gas installation in the buildings /of ... z5'1. .1111 ,FXY ........................ at ..... 77 ell,?.. X1.............. . North Andover, Mass. Fee. Z.-0. Lic. No. GAS INSPECTOR Check # ?xo- o 8147 dam-\ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) I IO N ��Q�yE , Mass. Date--051109)2,Q)j Permit # Building Location F -4t Sr, Owner's Name LI ZE= PE A t4gr Y Kk Type of Occupancy SI WGUE FAKILl New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name_COLUMBIA G&S Off MASSACHUSETTS Check one: Certificate #` Addr6ss 55 MARSTON STREET D3 Corporation 1862 LAWRENCE, MA 018 41 - 2312 ❑ Partnership Business Telephone 9 7 8- 691- 6406 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have alcusrrenntt liability insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy K 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 El I hereby certify that all of the details and information I have submitted (or entered) in abo pplication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issuve f r this application will n Ompliance with all pertinent provisions of the Massachusetts State Gas Cove and Chapter 142 of the Gene S. (/ T e of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 374-5 City/Town Journeyman APPROVED 0 FICE SE ONLY - 1 Muni ■����������������o�tt���son mass • • M ■ENNEENNENNEEN NEEMON■ Installing Company Name_COLUMBIA G&S Off MASSACHUSETTS Check one: Certificate #` Addr6ss 55 MARSTON STREET D3 Corporation 1862 LAWRENCE, MA 018 41 - 2312 ❑ Partnership Business Telephone 9 7 8- 691- 6406 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have alcusrrenntt liability insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy K 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 El I hereby certify that all of the details and information I have submitted (or entered) in abo pplication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issuve f r this application will n Ompliance with all pertinent provisions of the Massachusetts State Gas Cove and Chapter 142 of the Gene S. (/ T e of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 374-5 City/Town Journeyman APPROVED 0 FICE SE ONLY 0 • N iN x m • ICA m m m D m 9 s v 0 r c� • m " N 0 z � N o o s � m m s o m � z A •m � c � N O . O O 2 p r � N •z p m s 0 c� • m " N cn N ° o _ z Location—7 / 1 No. Date / TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee Other Permit Fee TOTAL Check # �Z - 17791 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 77 ,M y x BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1-7 Property Address: cl 1.2 Assessors Map and Parcel Number: Map Number Parcel Number i /U /1/�► a Vim. / ! �J �J S, 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Fronto ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 34) 1.3. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal Syatein 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT ' ,> :or is >r i striCt: ye 2.1 Owner of Record < Liya c 4* iw,r� 0✓�f s s _ ? 7 '6:0/^J A I Name (Print) Address for Service Signature Telephone 2.2 Owner ecord: Name Print Address for Service: Signature Tele one SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not. Applicable :Er - Company Name Registration Number Address Expiration Date Sinature Telephone Mg M z O 5M 4 z M 90 0 aaa� rn r z G) SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 6 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check ao applicable New Construction E7 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: - SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant licant1. O VICIAL USE ONLY 1. Building - ff C� UDO (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction(� / O 61C)_____ 3 Plumbing Building Permit fee (a) x (b) a IL 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7bOWNER/AUTHORIZED AGENT DECLARATION S' as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/&t Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS i s 2 3FD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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: (Location of Facility) /z se . 10A Signature of Permi Applicant Date J NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Afdavit Name Please Print Name: ro M -',- 9 C Ss li Location: %�'i 251,2A �7 City Ai 4NdpV eA , 17,?4 4 s Phone # Z1&' 57 8'Y 3d ` 3 30 ® I am a homeowner perfdrming all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address City: Phone # Insurance Co. Policy # Company name: Address City: Phone # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment.as welLas_civil.penalties.inthefwnda..STOP WORK.ORDER..and.a fine .of (.$100.00).aJ* 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Date > > V Print Official use only do not write in this area to be completed by city or town official' # f 79,Y3a.3?u8 City or Town Permitll.icensina ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A ❑ Health Department ❑ Other D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax ppA Ti1� ORL!° Town of North Andover Building Department y 27 Charles Street North Andover, MA. 01845 1ss{ChUSE< HOMEOWNER LICENSE EXEMPTION Please print. C> DATE JOB LOCATION 7,2/0/ S ' &/ 3 Number Street Address Map /lot "HOMEOWNER G v Name Home Phone PRESENT MAILING ADDRESS .77 5;f 60 Work Phone City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC Aec,L imm a v t U C4 Jv,-y 13---,0, F .q d t, T4 0 I rA W ~ c o 0= ' �w .a.o a C :L o oCD Ea m� m CD s :L oa N CD hyo m .Q'mm � m L O N AECD 0S a CJ m c N HO ::5LO Of �� C •: C5Q e W : CL C Q co n a C=3 .0 m =m3 _ :nw•o •CA CL= W C Z v .y CO LU COD a mL o� Q O awl Fm i� 0 a z 0 U CO 0 "t CD E z co E 0 CD CD cc Cal0 CL COO m i CL. CA C r"� W 0 W C4 19 W ce ft d a 9 � �?. cii as w° a°G U w o ~ c o 0= ' �w .a.o a C :L o oCD Ea m� m CD s :L oa N CD hyo m .Q'mm � m L O N AECD 0S a CJ m c N HO ::5LO Of �� C •: C5Q e W : CL C Q co n a C=3 .0 m =m3 _ :nw•o •CA CL= W C Z v .y CO LU COD a mL o� Q O awl Fm i� 0 a z 0 U CO 0 "t CD E z co E 0 CD CD cc Cal0 CL COO m i CL. CA C r"� W 0 W C4 19 W ce ft d MORTGAGE INSPECTION PLAN FILE No�s3oo UNREGISTERED LANDS-. ADDRESS: 77 ELM STREET, NORTH ANDOVER, MA DEED BOOK:5381 1 ATTORNEY: LAW OFFICE OF DANIEL LADD 22237 PLAN BOOK: PAGE: LOT(S): LENDER: - PLAN NUMBER: OF r OWNER: RUMACK FAMILY REALTY TRUST REGISTERED LAND APPLICANT: LIZETTA & JAMES FENNESSY DATE: 08/07/2002 SCALE: 1"=40' REGISTRATION BOOK: PAGE: CERTIFICATE OF TITLE: PLAN NUMBER: LOT(S): FLOOD HAZARD INFORMATION FLOOD MAP COMMUNITY NO.: 250098 ZONE: X ASSESSORS MAP MORTGAGE INSPECTION PLAN FILE No�s3oo UNREGISTERED LANDS-. ADDRESS: 77 ELM STREET, NORTH ANDOVER, MA DEED BOOK:5381 PAGE: 325 ATTORNEY: LAW OFFICE OF DANIEL LADD 22237 PLAN BOOK: PAGE: LOT(S): LENDER: - PLAN NUMBER: OF r OWNER: RUMACK FAMILY REALTY TRUST REGISTERED LAND APPLICANT: LIZETTA & JAMES FENNESSY DATE: 08/07/2002 SCALE: 1"=40' REGISTRATION BOOK: PAGE: CERTIFICATE OF TITLE: PLAN NUMBER: LOT(S): FLOOD HAZARD INFORMATION FLOOD MAP COMMUNITY NO.: 250098 ZONE: X ASSESSORS MAP PANEL: 0003C DATED: 06/02/1993 MAP: 55 BLOCK: PARCEL: 8 N/F DAVIS & FURBER MACHINE CO. 53.76' SHED THIS IS THE RESULT OF TAPE MEASUREMENT, NOT THE RESULT. OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO. THE TITLEDES Rks�,,JDF INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER. �C A:CCOCT A'I'7S'c 40 KENWOOD CIRCLE,. SUITE 8, .FRANKLIN, MA. ,02038 THERE ARE NO DEEDED EASEMENTS 'IN THE ABOVE REFERENCEDTEL.: (800)2$7-8800 FAX.: (608)5'14011, .DEED OR ENCROACHMENTS WITH RESPECT TO BUILDINGS SITUATED ON THIS LOT EXCEPT AS SHOWN. 144 OF THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN oma' ROBERT G A SPECIAL FLOOD HAZARD ZONE. EDWARD ; BISSONNETT Zn THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER NO. 31300' WAS IN COMPLIANCE WITH THE LOCAL ZONING BY-LAWS IN° FFG/STER��.o EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL ���NAI LANDS` SETBACK REQUIREMENTS ONLY), OR IS EXEMPT FROM .VIOLATION . ENFORCEMENT ACTION UNDER MASS. G.L. TITLE VII CHAPTER 40A, SECTION 7. GENERAL NOTES: (1) The declarations made above are on the basis of my knowledge, information, and beh f as the result e ins of a mortgagpection tape survey mad to the normal standard of. care of registered land surveyors practicing in Massachusetts. (2) Declarations are mode to the; above nary cllerit only as; of this .date (3) This plan .was not made for recording purposes, for uae in preparing deed descq Ions or for constructlon (:4:) Verikdtlons of property line tlimensiona bullding offsets; fences, or lot configuration may be accomplished by an accurate,instrument survey. (5). No responsibnity l§r assumed herein 3o the<(artid owner' it occupanttr; Date. /,?. - . -. '. ?. -:aha TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... f ?- G .................. has permission to perform .....��/. .......................... plumbing in the buildings of ... l `..`...`.` . f at ........` ....`.'.... .................. . North Andover, Mass. . Fee.. � 3 .... Lic. No..�?.1 �.? .. . .. ...... f . . .. ?;�-` ...... . PLUMBING INSPECTOR Check # 5445 n\ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date 4 (% 20o_2 _ Permit *—IWW Building Locati n l� Owners NameA; z ~. A,6 Type of Occupancy_t S i 1D E ikJ TI ,n L_ JJ 19 New ❑ Renovation ❑ Replacement 2 Plans Submitted: —Yes ❑ No ❑ FIXTURES Installing. Company Name ""AOMLE Q • SAerMA T A?_ -0 Check one: Certificate Address ;t-) COACNmt4tj s:pj ❑ Corporation 1Y) E TN -, #1 A 01tF(1L/ ❑ Partnership Business Telephone 7 A 9-virm/Co. Name of Licensed Plumber Z.67-ftl SA.�t�ry1�9 regOf-% INSURANCE COVERAGE: I have ayes ent jabiiity insurance opolicy or its substantial equivalent which meets the requirements of MGL Ch. 142. p' If you have checked Les, please x. indicate the type coverage by checking the appropriate bo fid A liability insurance policy "/ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations Wormed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g Oode andr?l and?of the ONerall Laws. By. 7iL 1" Title re of Licensed Plum er Type of License: Master % Journeymah ❑ City/Town - APPRONED OFFICE USE ONLI� License Number 233; Y • Installing. Company Name ""AOMLE Q • SAerMA T A?_ -0 Check one: Certificate Address ;t-) COACNmt4tj s:pj ❑ Corporation 1Y) E TN -, #1 A 01tF(1L/ ❑ Partnership Business Telephone 7 A 9-virm/Co. Name of Licensed Plumber Z.67-ftl SA.�t�ry1�9 regOf-% INSURANCE COVERAGE: I have ayes ent jabiiity insurance opolicy or its substantial equivalent which meets the requirements of MGL Ch. 142. p' If you have checked Les, please x. indicate the type coverage by checking the appropriate bo fid A liability insurance policy "/ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations Wormed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g Oode andr?l and?of the ONerall Laws. By. 7iL 1" Title re of Licensed Plum er Type of License: Master % Journeymah ❑ City/Town - APPRONED OFFICE USE ONLI� License Number 233; D m A O Z • N N x • A _ -D•-I m O O 0 O m � m C O = O_ 40 m A r c a Z o :� A z -I m m Cc z v v m Q O O 2 M m m ; A v I . O m N ' N Z N T m A -1 O Z N 3 4 2, 3 Date..,/:. ,%.. �.�! ...... NORTH TOWN OF NORTH ANDOVER pb`4co ,e1tiOL p PERMIT FOR GAS INSTALLATION This certifies that ....1.`.: J:.. 5f? ................. has permission for gas installation ... . /It,... .............. . in the buildings of ... 4? ......................... . at .... ........ , North Andover, Mass. Fee. //i �... Lic. No.. / ...`.... .....`. ..(.� '.:G. .. ....... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer jA SSACHUSETM UNIFORM APPLICATON FOR PERK ITTO DO GAS FITTING .- or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations ! A/ Permit Amount S WL Owner's Name R k New Renovation ❑ Replacement Plans Submitted ❑ (Print or type Name Address U Business Telephone .1. 5 T G A TZ Check one: Certificate Installing Company ❑ Corp. ❑ Parmer. []'(`i rmi Co. Name of Licensed Plumber or Gas Fitter 13 y 6`�- INSURANCE COVERAGE Check one: 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 Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: [ am aware that the licensee does not have the Insurance coverage required by Chapter 1421 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ i hereby certifv that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pertormed under Permit Issued For this application will be in compliance with all pertinent provisions ufthe Massachusetts St G/Cude and pter I h the Gen aws. By: Title Ciry/Town .�PPE�0'v-ED (()rric;- usF -)Ni. Y) Signature of L1censeePlumber Or Gas Fitter ❑- Plumber Z� 3 ❑ Gas Fitter icense wum er 1❑� Joumeyman Pf (Print or type Name Address U Business Telephone .1. 5 T G A TZ Check one: Certificate Installing Company ❑ Corp. ❑ Parmer. []'(`i rmi Co. Name of Licensed Plumber or Gas Fitter 13 y 6`�- INSURANCE COVERAGE Check one: 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 Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: [ am aware that the licensee does not have the Insurance coverage required by Chapter 1421 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ i hereby certifv that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pertormed under Permit Issued For this application will be in compliance with all pertinent provisions ufthe Massachusetts St G/Cude and pter I h the Gen aws. By: Title Ciry/Town .�PPE�0'v-ED (()rric;- usF -)Ni. Y) Signature of L1censeePlumber Or Gas Fitter ❑- Plumber Z� 3 ❑ Gas Fitter icense wum er 1❑� Joumeyman Location C Im S No. I3 Date —3 %cJ MaRTh TOWN OF NORTH ANDOVER , • 0 4 F n 41 Certificate of Occupancy $ Building/Frame Permit Fee $ 1.�� s++cHusE Foundation Permit Fee $ �— Other Permit Permit Fee $ 1 Sewer Connection Fee $ Water Connection Fee $ TOTAL t/ -- Building Inspector J V U O 05/m/99 dl:34 58. il(i Darn Div. Public Works �� N I w L. Z w Illb C Z Z M (>:t � M 00 vl — H W _ W A V Z ;u w V Z m N V77f V. h v 7N7 v X L Z LZG Z W - V Q ,71i- :C L L < C V cl L. Z Vf Illb C I� M (>:t � u Z 1 W A V Z ;u w V Z m OQ V. h v ri w v - \ll LU z � � C Q � W 3 LL C V InLU = n h O z V w z < { W c • .. n L'J Y U :J U Q C C cl L. Z C I� M (>:t � Z } W Z Z m v ri w \ll LU z � a C Q � W 3 LL C r L. 4 I� M (>:t W Z Z m \ll w � W 3 7 k -� FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT fiLLS OUT THIS SECTION*********************** APPLICANT RA,2e,� -A ib aLv ,E'V W,4C e PHONE LOCATION: Assessor's Map Number UX.4- PARCEL SUBDIVISION LOT (S) 0008 STREET f72 �511M ST. NUMBER 97 *******************************OFFICIAL USE ONLY********************************* RECOMMNDATIONS OF TOWN AGENTS: / — - r n CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECT40R DATE Revised 9197 jm i °T� ���to,t�alr� `7 •��iaa,ac%uaerla HOME. IMPROVEMENT CONTRACTOR F` } Registration 101846 TYPe - INDIVIDUAL t`€. Expiration 06/29/00 e I STEPHEN M. KEISLING 68 Glenncrest or �O ef,WAndover MA 01845, ADMINISTRATOR ��t6 "CJai»rrnancueacLft• o� ,'G'CaJilacfauJe%/J DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number .x Expires: Birthdate: 14 1 1 CS'021489" 07/161999 01/16/1953 Restricted To:. 00 ! e a c-ItEPHEN.M 'KEISLING 68 GLENCREST OR N ANDOVER, MA 01845 i °T� ���to,t�alr� `7 •��iaa,ac%uaerla HOME. IMPROVEMENT CONTRACTOR F` } Registration 101846 TYPe - INDIVIDUAL t`€. Expiration 06/29/00 e I STEPHEN M. KEISLING 68 Glenncrest or �O ef,WAndover MA 01845, ADMINISTRATOR M0RT8A6E INSPECTION. PLAN CitylTovn JVo_2�-,c/ �•vovvc�e State Date: ✓uvG 2a �990 Scale: --------------------- Owner: ItJM'A(r�_�_--- Buyer:------/ti//--------.9 ------- Deed Ref. %/9,5 7Z4N�A------- Plan No. Drawn per City/Town o1Vo. ANDovC,�-Tax Assessors Map, r OJNFQ CQ �( �o h gZ � JAAos �t E ,�' Al o o, V-� s k 'lea �{ °o - •j �j� dGe. ��' .. .• n�i � I bereby certify• that the above Mortgage Inspection Plan was prepared for use in connection intended or represented to be a property line or land survey. It cannot be used for establishing fence hedge lines. No responsibility is extended herein to the land owner or occupant. The loca with a new Mortgage and is not g walls or building herein was in compliremeiance with the local applicable zoning bylaws pa effect when constructed, with res dimensional requirements, or is exespt from violation enforcement actiin on andion Of the original building(s) as shown otherwise shown herein. Subject building(s) m violn a flood zone designated Zone: � Pett Sec. horizontal Consunity-Panel # z5©d 3eq _ o,�� ,K_ �, Zone: Nass G.L.6Title VII, Chap, §pA� $eC, 7� unless Andersen- Windowalls' COMMERCIAL - RESIDENTIAL DATE Brockway -Smith Company Brosco Architectural Group Serving Greater Northeast Architects since 1890 Office and Exhibit Area: 146 DASCOMB ROAD (Route 93 - Exit 42) 800-225-7912 ANDOVER, MA 01810 FAX (24 hours) 800-242-4533 JOB . i� � a ' if r t. a1 It —. ,. ��i.,_._.�,_._...._.®- �....._....{_,._.. -�?-__•_.-t----t---•,-�'-•-�--+---}m,�.._,- --+--- �f --••i M v- -.-, -fir �...-�ir � .— .-_.-�'. r + _ ¢— _ {....__p,_.. «.....�_.. f e._;_.fit p.L— _ } J d. t i" I O �• P� < [ tt d _ —;5701 ifa6fe fo_.s.er_ueyou.0 will _ J3a' d J rices,_ irio�o''rr� D failn9 .a I cf-csp.ec. ) ifinq__.;_._. f i l I I ENTRY DOOR SYSTEM Andersen "Rain Sensitized" I I I Wood and Steel Automatic Closing Hinged French Patio Doors ROOF -WINDOWS Andersen- Windowalls" IF' , COMMERCIAL - RESIDENTIAL DATE Office and Exhibit Area: 146 DASCOMB ROAD (Route 93 - Exit 42) ANDOVER, MA 01810 JOB Brockway -Smith Company Brosco Architectural Group Serving Greater Northeast Architects since 1890 800-225-7912 FAX (24 hours) 800-242-4533 _----_...f._... ------------- ! f I i _.- f ! » !� f ! 10 3I y 44 ..�_.—a—_.� —.._.1.._�-«—........,,{,..�_.}"____'.�_.p.....�,....r._,._,.,�-._.„._..`.___..__.._...p._.__..�.e.---+--„�------Y._. _,.; _ 111 .••--9`�. f � I ! 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