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HomeMy WebLinkAboutMiscellaneous - 807 TURNPIKE STREET 4/30/2018O 'oun Am ovFR BM.Di G DFP-ARTAENT 1600 Osgood i�.Feet ���SActus �y .. North Andover - . Tel: 97.9-698-9545 Fax: 978-688-9542 B USMSS FORM FOR TO WN DATE � NMM: ,SSA .DDRES,9: y77 T�,� moi` . , s MU,DITG I,AYOT. T PROWED: YES NO AVAILARLEPARKM SPAM; ZONMGBYL USAGE: Mo BT MD)WO JE SPECTC Off. SIGNATURE BUSINESS FORM FOR MVM CLERX 2.49 Howe Occupatian (1939132) An accessory use conducted wiffi a dwelling by a xresu e4t wha resides in the dwelling as his principal address, which is dlearly secondaEy •to the use, of the -b-OdIg for 1144 ptuposes. Home occupations shall 'iiicli de, "bu'.t iiot'limited to the following uses; personal services such as funushed by an artist or instructor, but not occupation involved with motor vehicle repairs, beau4T parlors, animal kennels, or -the conduct of retail business, or then ufacEuxing agoods, which impacts the residential nature of the neighborhood; 4. For use of a dwelling in any residential district or xnuld-£atnily district for a hoarse cccupaiip, fihe following conditions shall apply. a. Not more than a total of three,y (3) people may be, gffip oyeq,,�4.thejkMo occupation, one of whom shall belbe aw1zer oiitie home ocoupatioiz and residingitz atd d suing; b. The use is carried on strictly withinthe, principal building; -. c. There shall be no cKforior alterations, accessory buildings, or display which arc mot customw with residential buildings; - d. Not more than iwen�r rive (25) percent of the existing gross floor area of Vii dwelling ITR. so used, not to exceed one thousand (1000) square feet- is devoted to 'such use. In connectaonwiih such use, there is to be kept no stock in trade, continodifie� or products which. occupy space beyondthese trouts; e. Therewill be no display ofgoods or wares visible from the street; f The building or premises occupied shall not be rendered objectionable or detrimental to the xesideniial character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or .m any ather way become objectionable or ' detrimental to any residential use within. the neighborhood; g. .ivy Bach building shall include no features of design not; cu&mq m buildings for resident+al I NR.'T)FI -NDO +R. BEING JIB P -ARTA lam` 1600 Osgood Street : l: 978-6$8-9545 Fax: 978-688-9542 DAM NAW MF, € F)3USIMM. BUMDINGLA.YOUTPROVIDED: YES 0 ZONINGBYLAWUSAGE: f) NO 13TMDTNG INSPECTOR SIGN.ATM .HUSINE SS FORM POR TOWN CLSRT� 2.4f) Home Occupation (1989132) An accessoxsr use conducted within a dwelling by a reszdepj wha resides in the dwelling as his principal "address, which is clearly secondary la tho use• of the -building for living piuposes. Home occupations shall 'iiidV de, "but noflimited to the following uses, personal services such as wished by an artist or instructor, but not occupation involved with motor vehiole xepairs, bealafy parlors, animal kenads, or the conduct of retail business, or the xxzavufaoiuring agoods, which impacts the residential nature of the neighborhood; 4. For use of a dwelling in any residential district or multi -fancily distdot for a hoarse occupation, tho following conditions shall apply. a. Not more than a total of three (3) people may be,eml?Ioyed-in.f0i�ome occupation, one of whom.shallinhaidNelling; b. The use is carried on strictly withinthe principal building; o. There shall be no oxtexlor alterations, accessory buildings, or display which are not customary with xesidential buildings; - d. Not more than -twenty- five (25) percent of the existrng gross floor arca of ;the dwelling unit. so used, not to exceed one thousand (100D) square feet, is devoted to'such use. I. connectionwith such use, there is to be kept no dock in trade, commodities or products which occupy space beyond these Ximits; e. Thue, will be no displayofgoods or waxes visible from the street; f The building or premises occupied shall not be rendered objectionable or detrimental to the xesidential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disttuhance, or in any other way berme objectionable or detrimental to any residential use within the neighborhood; g. Any such- building shalt include no features of design. not customary in bulli ngs for residential Signature - >/ _ /I Dale ML �*�keA •e. NORTH ANDOVER BUMDING DEPARTMENT 1600 Osgood Street North Andover Tel: 978-688-9545 Fax: 978688-9542 .BUSINESS FORM .FOR TOWN CLERK DATE: . Aa/L z//y NAME: /?� k�r� , /V / Z -4 Pf.92 ADDRESS: U d r oxo p It k" STn i' "''y��2 -202- No0-21- 4,Vt10 v9j ZON NGDISTRICT: TYPE OF BUSINESS: BUILDING LAYOUT PROVIDED: YES NO A7 Au` ABLE PARKING ,SPAM:_ ZONI NG BY LAW USAGE: YES NO BUILDING INSPECTOR. SIGNA.TUPIE BUSINESS FORM FORMWN CLERK or' 2.40 Home Occupation (1989132) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use. of the -building. for living ptuposes. Nome occupations shall 'include,"but not 'limited to the following uses; personal services such as funiished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturing o£goods, which impacts the residential nature of the neighborhood. 4. For use of a dwelling in any residential district or multi family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the owner of thd home occupation and residing in said dwelling, b. The use is carried on strictly within the principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings; - d. Not more than twenty, five (25) percent of the existing gross floor area of the dwelling unit so used, not to exceed one thousand (1000) square feet, is devoted to 'such use. Tn connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f. The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design_ not cust6mary in buildings for residential use. )2 z/1 Z( Signature Date V North Andover MIMAP October 22, 2014 038 r� : >" C� #214 09811D- D1046': 1 r ter'`, 098X-0045 _ •:,i,.••.. +s.... #790098.B-0 048 098.D-0049 !u: I#7 y � CYD�2 �'�r. #790 #210 C#199 098.D-0044 #193 #790 #790 .et #202 :.. .... #187 098.B-0051 #790 #790 98X-0043 #194 #177 #151 / 098.D-0069 #790 0:98'004_2 #186 #733 #733 733 :.-:.::'Jtr •.r;.. ;r. ,i, •:_:.::.:_. #165 098.8-0041 733-= #800 #178 0 8.8-0040 #800 #800 098'B ®065 ' #170 #164 %ri$ 194 'fl98J) 0008 #800 098.8-0039 #800 140 098. 045 :•• ,I•-:•"`' ..,.�. .. _ :_::: -:- �' #820 #757 •�x . . 98.D-0009 :. #820 098.8 0095 R: #75 Mk #820 #70.0 �\ #820A 098_B-0009 98-8-0010 #120 098.D-0053#789-793 #820a #710 #20 / #795 �0 #795 � 098.B-0008 098.D-0044 'k � }Rosa #815 #799 `� 098 80006 #100 #815 #799 �� \ #25 098M-0054 ` , 098J)-0050 \ #811, ' #860 #809 / . 114 107.0-0111 ff #807 098 D-0042 #865 #871 0.25.0-0027 #60 0O #863 I1 a: #861 #869 ::. #30 G #30 erg #867 098.D-0018 d ►a 4 #859 #873 •...:-:_-- .:, ... I .. 107.0-0074 �� #857 107.0-0072 #855 107.0 0004 #33 -•025A 0 79_;'9 •''.' _ J. -- �L 107.0-0075 _:_- , •••• • 107.0-0076 107.c-0071 #65 #30 `t #815 1b7.0-0113 107.0-0021 - #815 #85 s 107.0-0022 '—".J0 0083':''.;:'._i ,. 107.C-0023 107.0-0023 , ;_ •. ':= - 107.0-0079 Rail Line -;r Wetlands Zoning Interstates Q Exempt Lands _ I • ' Busine s 1 District O Busine s 2 District Horizontal Datum: MA Sateplane Coordinate System, Datum NAD83, — SR O Busine s 3 District Busine s 4 District tA011i Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of Roads C r Easements Genera Business District f r q p +,t o ! �. D Planne Commercial Devi + �o ,1 North Andover. Additional data provided by the Executive Office of Environmental AffairslMassGIS. The information depicted on this is MVPC Boundary et � C Corrido Development Dist 3 L map for planning only. It may not be adequate for legal undary C3 Municipal Boundary Zoning Overlay ® Corrido Development Dist Q 10 G Corrido Development Dist N -^ A Industd I 1 District ♦ defiition or egrulatory interpretation. THE TOWN OF NORTses HAND VER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY 8 Adult Entertainment Q Downtown Overlay District C: Induslri 2 District w ,r �. i IndusM 13 District i o �� i 0 Industri S District •moo r�...- OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF © Historic District ® Water Protection Reside ce 1 District X1,9 '��f{p ��t.(oJ Residei ce 2 District S$ACNUS� THIS INFORMATION O Parcels IM Reside ce 3 District n Hydrographic Featuresde1c: 4 District Streams 1" = 281 ft de -1District rdeeB District e aesidential District 1G750 Date ........ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that le -4 Mae .......... has permission to perform ............ ................... plumbing in the buildings of .............................. e ............................................................ at ..;,Ml.rvoyWP i.. Le.. A.,Cue..k- 11 ........ ... North Andover, Mass. Fee�a�� ... I L'ic. No. 9,1,c -3 ..... .......:1... .. . ....................................................... ................ _-..x 1�/ PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE j PERMIT # JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS_ TEL8M' t FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL O RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION: Q REPLACEMENT: Id PLANS SUBMITTED: YES Q NO© FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM I �I _ (�1 --J! DEDICATED GREASE SYSTEM �f DEDICATED GRAY WATER SYSTEM { ...._...__I I ____I __._.I _I I I ► __J f I _1 �1 f DEDICATED WATER RECYCLE SYSTEM I _....-__.w ___----._I DISHWASHER DRINKING FOUNTAIN.... -- FOOD DISPOSER I FLOOR (AREA DRAIN INTERCEPTOR INTERIOR i -..._._f KITCHEN SINK LAVATORY I - ...? .. l --� - --I-..__...r� _._._.( _.__.. -------1 ._._._-; _:._- ---..J ROOF DRAIN ( _._._.-� _...__! I f J I ._-.-_. I _ i _I ..__.....! J I __..-_I SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION ^� f WATER HEATER ALL TYPES ; I WATER PIPING OTHER ------------r , - INSURANCE COVERAGE: I have a current liabIIIjy nsurance its 'NO policy or substantial equivalent which meets the requirements of MGL Ch.142. YES [OM IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d OTHER TYPE OF INDEMNITY —f BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [2 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true nd 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 co ance with all Massachusetts State Plumbing Code and Chapter 142 of the General Laws. M;�W= PLUMBER'S NAME - . -G-.__ __. i LICENSE#_• SIGNATUREMPd JP CORPORATION.4#_ N PARTNERSHIP0#OLLCDO COMPANY NAME �/ �•q/ _ e — - DRESS STATE , � ZIP TEL CITY .�' v-- - -I FAX �',$ ELL - - EMAIL FIN LU 0- W W LL rA W H O z w z a Yoe Conitnonwealth of ldassachuseits Department of lizdudriva[Accidents Office of Invesilgations 600 Washington Street Boston, MA 02111 www.m as&govldia Workers' Compensation Insurance Affidavit: Buffders/Contractors/Eiectriiciam/Plumbers A®piicant Information Please € rpt Ledbl Name (Business/Or amzabonitndividnal): City/State/Tip: //gp /W- Phone #- n 8 _ Are7ou an employer? Check the appropriate box: 1. [Z -I am a employer with. S 4. j� I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub-coniractom 6. E] New construction 2.. Q I am a sole proprietor or partner- listed on t3 -se attached sheet t 7- Remodeling ship and have uo employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. 10 auorlorrs' comp insrnan workers' comp. insurance. 5• Qe a -a vorpoFati� and i� 9, Building addition required.] officers have exercised their 1Q. Electrical Q repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. 61umbing repairs or additions myself [No workers' comp. c.152, § 1(4), and we have no 12TI Roof repairs insurance required.] t employees. [No workers' 13.[] Other comp. insuran0e required.] 3• 3PP^IqI- a— s . >� y_ y Muse--s-so ry c is �� n� �� �n �•i^� TM - e• r^ s' ^-mss moa rfl�a� io:.Wic T Homeowners who submit ills aiadavit i adieating they are dow-u all wort; and -&ea hire outside contractors must submit a new ain-davit indicatine suds. tContmctors ilial chi this box must attached an adariionaT sheet showing the name ofthe snb-contractor; andtheir worlers� comp. pogo, info ma- , ram art errtplayer that is providing workers' compensation ftrsaerauce for xzy employees. Below is thepolicy acrd job sire information. Insurdnce Company Ivame: Policy t or Sett ins. Lic. TG �J� ��O Expiration Date: Job Site Address --27 25 City/State/Zip: Aftaeh a copy of the workers' compensation policy declara€ion 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 S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of rip 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 th,. DL4 for insurancs coverage velcanon. I do Aereby certify the pains mtd penalties of l that the informal7on provided ¢b qe is mce and correct Signature: Date: D Phone, diw—&['use oniy. 17o not write in this area, to he eorrzpleted by city or town offxia% City or Town: PermiVUcense Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. .�Iumbing Inspector 6. Other Contact Person: Phone , Information and Instructions Massachusetts General Laws chapter 152 requires all emp10y1errs to provide workers' compensation for their employees. pursuant to this statute, an employee is defined. as "...every person -in fie service of another under any comract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, assoc�on, corporation or ather legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal represeniafives of a deceased employer, or fLe receives- or tcnstee of an individual, pminership, association ex- other legal entity, employing employees. However the 'owner of a dwelling house having not more than free apahtno_ents and who resides therein, ortheoccupant of the dwelling house of another who employs persons to do maintemance, construction or repair work on such dwelling house or on the grounds or hmldin or appur6enant thereto shall not because of such employment be deemed to be an employer-" MGL chapter -152,• MC(6) also states that "every state or local ncpensingagency shall wifhhold the issuance'or renewal. of a license or permit to operate a busbms or to a onstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coanpliance with the insurance coverage required_" Additionally, MGL chapter 152, §25CC7) states "Neither the commonwealth nor guy of its political subdivisions shall enter into any contract for the perf mance of public work imp acceptable evidence of compliance with the insurance requirdments of this chapter -have beenpresented to the contra? cting authority." - Please fill out tee workers' compensation affidavit completel5r, by checkinjo; 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 Lmb&y Companies (LLC) or Li 2ftd LiabrZity Partnerships (LLP) wiikno employees -other flm the members or partuers,.are, not required to carry werkemg' compensation insurance. If an LLC -or LLP does have employees, a policy is required. Be. advised that this affidavit may be submitted to fate Department of inastrial • Accidents for conformation of insurance coverage. Also be save to sigh and date the affidavit. The affidavit should '� rued fr< the cu3 or awn � the applwatusn f;}r � p-�ifior li: ewe :s b.-i�:�.,qu.-std, not �e De3zm�.�: of Industrial Accidents. -Mould youhave my moons regamdimg to law or if you are required to obtain a workers' compensationpoUcy, please call the Department at the numbox listed below Self-insured compames should enter their self-insurance license number on the anprap'am line. City or Town Officials Please be sore that the affidavit is complete and printed legbly. The Department has provided a• space at the both of the affidavit for you to MI out in the event the Ounce of Investigatiow has to contact you regarding the applicant Please be sure to, fill in the pnsp*+se member which will be used as a reference member. In addition; an applicant that must submit multiple permidlicense applications m any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "orf locations in (city or t)wn.)." A copy of the affidavit fiat has been officially stamped or marked by the city or town may be provided io fie applicant as proof that a valid affidavit is on file for fatmEepernits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or peumit not related to any business. or commercial venture (Le. a dog license or permit to burn leaves etc_) said person is NOT required to complete this affiddvit. _ The Office of Investigations would like tc fihank you in advance far your cooperation and should you have any questions, please do not hesitate to give us a tali. The Deparimeafs address, t-,Iephone and fax number glint VEX tr i 1Hl .3i 3 7 S H 0 3 Y TeL fit' 617 -727 -4900 -ext 406 or 1-877 MASSAFE Pax IV617-727-7749 Revised 5-26-05 virwwmacc govfdia OP ID: CHCR A� RCP CERTIFICATE OF LIABILITY INSURANCE DATE(M 10!222!12/1YYY) 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 978-688-6921 Macdonald & Pangione Insurance P.O. Box 428 Fax: 978-688-5350 104 Main Street North Andover, MA 01845 Craig S Childs CONTACT ac°NN Era): ac No): E nnAIL ADDRESS: CPRODUCER ANDOV-7 USTOMER ID #: INSURER(S) AFFORDING COVERAGE �NAIC # INSURED Andover Plumbing &Heating Co PO Box 262 Andover, MA 'r INSURERA:Utica Mutual Insurance Co INSURER B: Quincy Mutual Fire Ins Co 15067 INSURER C : INSURER D • X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR INSURER E INSURER F 10/26113 THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBRPOLICY POLICY NUMBER EFF MMfD POLICY EXP MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 1325 10/26113 10126/14 r PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5100 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECPRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB (Ea acddent) $ 1,000,00 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ B SCHEDULED AUTOS AFV206229 10/26/13 10/26/14 PROPERTY DAMAGE (Per accident) $ HIRED AUTOS NON -OWNED AUTOS $ $ X UMBRELLA LIARX OCCUR EACH OCCURRENCE $ 1,000,00 ACULP EXCESSLIAB CLAIMS -MADE 448141 10126113 10/26114 AGGREGATE $ 1,000,00 DEDUCTIBLE $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA 4481326 10/26113 10/26/14 WC STATU- OTH- TOR LIMIT X R E.L. EACH ACCIDENT $ 500,00 E_L DISEASE - EA EMPLOYE $ 500,00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Plumbing and Heating contractor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Plumbing & Gas Inspector ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept AUTHORIZED REPRESENTATIVE 1600 Osgood St Bldg 20 #2-36 North Andover, MA 01845 �f1� I W Tyuu-zous ACURD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD P'L U M B r3 -ASF I .S- I E N - E0' , AS A MA ... ....... LAROSE OD I HUEN MA ol844-423-----3V"'- 223429 Date ... ... �.—? TOWN OF NORTH ANDOVER PERMIT FOR WIRING `%GI k -r7 -,S 0 G1 0 U it ,J This certifies that ............................................... .� ...............G has permission to perform wiring in the building of.....T11— ./P£',ta/✓�ct—�f'd"�r." Jfl c�l� ......................................................................... a t .......... �...7......... .r!t Q.N :. ,.. T .... orth Andover, Ma s. I� J Lic. No.1 EL nucAL IN$PEcrm Check # �5�5 11413 Commonwealth of Massachusetts Official�Ufse Only Department of Fire Services Permit No. �� 7 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN HK OR TYPE ALL INFORMATIOA9 Date: .9 ' 19, l.3 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives u`otice of his or her intention to perform the electrical work described below. Location (Street & Number) ?o? rL v-xvPx )C N 3-7. Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building CC) ti rM 21 OFF -mg - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone No. No V (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: PEpLg C E fieAT Ptlri P -f-- if1,2 A,4A,6ie,1,> Completion of the following table maybe waived by the Inspector of Wires. t No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above In- rnd. ❑ rnd. E]Batter o. o mergency Lighting Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burgers No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat PumpNumber Totals: " Tons "'*""" ""I-" KW ** No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water I KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or 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: 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 co erage is . force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) f certify, under the ains and penalties of perjury, that the in orntation on this application is true and complete. FIRM NAME: til ES 4�i u 7Oc) /I CeC ),-A--j c-;rq aj LIC. NO.: ,f— f/6 f `� ^n e"5' Sign LIC. NO.: (If applicable, enter "exempt" in the license numer line.) Bus. Tel. No. -2 12ZO J d ib2. Address: (�` 'otveG<— / - — A69l-7wq ?%A • O / 9 lr 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. ❑ 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 Inspection Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: " SERVICE INSPECTION: Pass IN Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: r Date: ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL IN CTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts 07 Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Uf www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaffily Dame (Business/Organization/Individual): \JAh EJ �6 0—/a LJ /4-1 -Z 9N Address: 6 5` c/_ o w E-i_I- - City/State/Zip: N , 21 /? m IJG ��`f • O/N 9 Phone 0 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors Tam a sole proprietor or partner- listed on the attached sheet. t / 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. ❑ 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.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10ectrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they ace 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. 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 requiredunder 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. Ido hereby certto under the �s.and penalties of perjury that the information provided above is true and correct. r'v 1 1L_____ Date: a .) / 1) 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 North Andover Board of Assessors Public Access `4 V Page 1 of 1 http://csc-ma.us/PROPAPP/newSearch.do?town=NandoverPubAcc&from=NewSearch 2/14/2013 North Andover Beard.. of Assessors �►ORTh OE tt�ao 4'�qp ,SS< MATCHING PARCELS Click on a column title to sort data by that column Click Seeatal TToo Return 6 items found, disWayin2 all items.1 Fiscal Year Parcel ID St.No. I Street Owner Name 2013 210/098.D-0028-0014.0 807U- TURNPIKE 807 TURNPIKE REALTY TRUST, ROBERT STREET FORD,TRUSTEE Search for Parcels 2013 210/098.D-0028-0015. 807U- URNPIKE 202 TREET SANBORN, ANDREA, MARK H SANBORN Search for Sales 2013 210/098.D-0028-0016.0 U- TURNPIKE 204 STREET SANBORN, ANDREA, MARK H SANBORN 2013 210/098.D-0028-0009.0 807U TURNPIKE MCINNIS, JAMES & CAROL TR., C/O 101 STREET KIERAN CROSBY REALTY TRUST 2013 210/098.D-0028-0011.0 807U- ITURNPIKE MCINNIS, JAMES & CAROL TR, C/0 102 ISTREET KIERAN CROSBY REALTY TRUST 2013 210/098.D-0028-0013.0 807U- ITURNPIKE 807 TURNPIKE REALTY TRUST, ROBERT 201 ISTREET FORD, TRUSTEE 6 items found, displaying all items.l http://csc-ma.us/PROPAPP/newSearch.do?town=NandoverPubAcc&from=NewSearch 2/14/2013 Date ..... /....!� '3i ;• a ppL TOWN OF NORTH ANDOVER PERMIT FOR WIRING s • s This certifies that .....1..%..``.........t,! s.....z::................................................ has permission to perform ........ _ $ / ..........:......................... wiring in the building of�. C 6-1 ............................................................................ '01at ........ .... ...... ..!:?. �........:S.r............. . N h Andover, Mads Fee..f....... Lic. No. 'i /�................ . �CECTRICAL INSPECTOR Check # � . 45� U coni 1/0//Illleam Of bssac usefts Deparbuent of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Uae Only V / Permit No. J Oocupanty and Fee Checked Ck APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfomied in accordance with the Massachusetts Electrical Code (MEC), 52,7,CMR P.00 (PLEASE PRINT IN INK OR TYPE ALL INFO TION Date: 3 City or Town of:. /,)0, ,�%�� To the inspector o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described low. Location (Street & Number) farts 4 Gl q, Owner or Tenant 77, !J' © C e r Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building utility, Existing Service Amps I Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (Check Appropriate Box) ,uthorization No. Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters Gxw"an ofdw feflondw fable may he wdmd byAe &wedorofwig. No. of Recessed Findares No. of Cel-Sroµ (Paddle) Fags No. of Dual ram%rmers KVA No. of Lighting Ondets No. of Hot Tubs Generators KVA Na of Lightieg Fixtures Swims Pool Above In- ❑ ❑ o` Dmfs No. of Receptacle Outlets No. of Oil Burners FME ALARMS No. of Zones No. of Swite6es No. of Gas Bor vers NKUDetection mul Iniffathm Devices No. of Ranges Na of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers MkmtTem - omber ITan I KW No.of Sie Devices Na of Dishwashers Space/Ana Heating KW Loeal❑ M°°1e ❑ Other Conner' No. of Dryers HatingKW Na or FAwlyalest No. of Water KW Heaters No. of No.� to !yuf g: No. of Devices or t No. �e Bathtubs o. Nof Motors Total T � Na of Devices or OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 c�o�vCmW is in face, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ND OTHER ❑ (Specify.)2&c din His �;1.r. a a `� Estimated value of w /� 00 ( by policy.) Work to Start: Q Inspections to be requested in accordance with MEC Rule 10, and upon completion. I , fie' Aepdwadgfped ,y,wtheWA IM campieft FIRM NAME: a lac LIC. NO.: Licensee: —TQ f QL 1-14 LIC NO.: Q- Y (IfapplitaaW e� "in fihw- Bos. Tel. Na:6G3 rYA'3 �ljy Address: % li�%�t i �8. Q // KC • l %.1 o /i%!l 0.41ag AIL Tel. No.: OWNERS INSURANCE WAIVER: I am aware that the L floes not now the liability insurance coverage normally required by law By my sigaadue below, l hereby waive this reqWremem I am the (check one) ❑ owner ❑ owner's agent OwnedAgent Signature Telephone No. PERMIT FEE. $, fid, 0 � Division of Registration ���'�'j Board of State Examiners of Electricians Paul E-Obin Hooksett. MAST �,1A LICENSE N SERIAL NO A18154 112W4 880908 Commonwealth of JUL-21-2005 1028 Jun 10 08 01s15p w r- C Mei h CT CORPORATION MPLS NORTH RNDOVER 612 904 7314 P.03 9786889542 p.1 NORTH ANDOVER BUMDING DEPARTMENT 400 Osgood Street Te1: 978-688-9545 Fax: 976.688-9542 DATE, --June 10, 2005 NAME• J"dy Carryt•vounp ADDRESS: 807 Turnplka St, Unit 202, North Andover, MA 01845-8131 ,ZONING DIS7'1't.tCT: Essex county oNar Anancial products and services to help clients ldenUfy and than meet their unique finerKlal TYPE OF BUSWSS: cancers and obiectives. BUILDING LAYOUT PROVMRD_ AVAILABLE PARKING SPACES I , �e_r 1Pt T e-0 an ZONINO BYLAW USAGE: BUILDING MAEC1-0R SI NATURE enid n S,Or MSDOSPamp teMNC.WX TOTAL P.03 t NORTH TOWN OF NORTH ANDOVER OFFICE OF �;~ A BUILDING DEPARTMENT t ~~ 400 Osgood St North Andover, Massachusetts 01845 Michael McGuire Building Inspector TO: Lisa Uttech FAX: 612-333-2524 DATE: July 26, 2005 FROM: North Andover Building Department TEL: 978-688-9545 FAX 978-688-9542 Tel: (978) 688-95454 Fax: (978).688-9542 Pursuant to your request, I am sending you the signed Business Certificate for property at 807 Turnpike Street North Andover MA. Jeannine BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 HP Fay K 1220xi Last Transaction Ii= Tie Jul 26 11:32am Fax Sent Identification 816123332524 Log for NORTH ANDOVER 9786889542 Jul 26 2005 11:33am Duration Pages Result 0:20 1 OK JUU-41-CYJgJ 1C!•c0 .., .,,.moi., v,.,.,.... ... �.. --- -_ __ Jun 10 DS 03:15p NORTH RNDOVER 9786889542 M� M N 1 ;s -? NORTH ANDOVER BUMDING DEPARTMENT • 400 Osgood Street Tel: 978-688-9545 Fax: 976.688-9542 DATE; lune 10, 2005 NAME: Judy Caryl-Young ADDRESS: 807 Turnplko St, Unit 202, North Andover, MA 01845-8131 ZAWO DISTRICT: Essex Cotwy offer Menial products and services to help dleft Identify and then meet then unlque finenclal TYPE OF BUSINESS: cane erne and obiectHea. BUMDfNG LAYOUT PROVMRn- p.1 AVAILABLE PARKING SPACES• 1 00 Cj ¢Pr 1 CosyoNa ZONM BY LAW USAGE: tl No RUILDINO ra.w n�a erYwlss s� torr toww�r csasc SIONATE�g TOTAL P.03 JUL-21-2005 1028 CT CORPORATION MPLS 612 904 7314 P.02 CT CORPORATION Via ,Regular Mail June 28, 2005 Attn: Building Inspector North Andover Building Department 400 Osgood Street North Andover, MA 01845 Re' Business Certificate Dear Sir or Madam: Please find enclosed the Business Form for Town Clerk. I am submitting this form in order to obtain a Business Certificate from the Town Clerk. Please return the signed form to my attention in the enclosed self-addressed envelope. If you have any questions regarding this form, please contact me at (800) 626-1773 ext. 3014. Thank you. Sincpgly, rN Fulfillment Specialist CT Corporation System Inc. Enclosures 401 Second Avenue South, Suite 454 Minneapolis, MN 55401 Tal. 612 333 4315 Fox 612 333 2524 A WoltersKluwer Company JUL-21-2005 10:28 CT CORPORATION MPLS 612 904 7314 P.01 CT Corporation System 401 Second Avenue South, Suite 454 Minneapolis, MN 55401 To: North Andover Building Inspector Re: Business form for Town Clerk Fax phone: 978-688-9542 From: Lisa Uttech Fulfillment Specialist Phone: 1.612.333.4315 ext. 3014 Fax hone: 1.612.904.7314 REMARKS: ❑ Urgent H For your review ❑ Reply ASAP ❑ please continent Please find attached the Business Form submitted by mail on June 28, 2005. Please mail the signed form back to My attention at 401 2 Ave S, Suite 454, Minneapolis, MN 55401. Thank you, Lisa Uttech CT Corporation