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HomeMy WebLinkAboutMiscellaneous - 86 OLD VILLAGE LANE 4/30/2018 (2)It NoarH ti �� • ' OOp t � t *;,sSACHU ��59 TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE Notice is hereby given that the Board of Appeals will give a hearing at the Senior Citizen's Center located at the rear of the Town Building, 120 Main Street, North Andover on Tuesday evening the 11th day of January 1994 at 7:30 o'clock, to all parties interested in the appeal of William G. Weiss requesting.a variation of Sec. 7, Paragraph 7.3 and Table 2 of the Zoning By Law so as to permit relief of 5.46 feet and 9.36 fbet on the Easterly side of the property on the premises, located at 86 Old Village Lane. By Order of the Board of Appeals Frank Serio, Jr., Chairman Pnhl i ah ; n t:he North Andover Citizen on December 22 and January 4.. 1994 LEGAL N0110E TOWN OF NORTH ANDOVER BOARD OF APPEALS NUIlGE Notice is hereby given that the Board of Appeals will give a hearing at the Senior Citizen's Center located at the rear of the Town Building, 120 Main Street, North Andover on Tuesday evening the 11th day of January 1994, at 7:30 o'clock, to all parties Interested In the appeal of Willem G Welty request - Ing a variation of Sec. 7, Paragraph 7.3 and Table 2 of the Zoning By Law so as to permit relief of 5.46 feet and 9.36 feet on the Easterly side of the property on the premises, located at 86 Old Village Lane. By Order of the Board of Appeals Franc Serlo, Jr., Chairman NAC: 12/22 a 12/29/1994 Date. .8/.z . �'.:-•;:rho TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. lrrf'.. ...... . l� /vSS t�JVIA& / ce., i has permission to perform .......... /... �"'�'.... plum in 'a.Ae uildings of .... ��c�olS4!%. . at .. U� N , rt Andover, Mass. Fee. Z> Lic. No. YcyG .... . �/ PLUMBING INSPECTOR Check �+ S/ mac°/ --SIP ceIrl WOL-i-- MASSACHUSETTS UNIFORM APPLICATION FO A PER TO PERFORM PLUMBING WORK CITY r I MA DATE % PERMIT # JOBSITE ADDRESS G• OWNER'S NAME o POWNER ADDRESS [ TEL FAX j TYPE OR OCCUPANCY TYPE COMMERCIAL Ol EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: ® REPLACEMENT: E! PLANS SUBMITTED: YES NOQ FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 BATHTUBCROSS *14 CONNECTION DEVICEDEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM L I__._ -__I I _____._1 ............ _! ___6 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _.-.._._I FOOD DISPOSER FLOOR /AREA DRAIN { 1 I f � I ___.._._. `s -1 . ____j INTERCEPTOR (INTERIOR) I 1-_.._._._I __-___._i _._.J .__._.____.i ...._._____1 __ ' 1 _... ...... I KITCHEN SINK I I 1 _._.� ! ! .._. 1 J I _...,_..__( ___—I 1=== LAVATORY _ _( L-11 -------- ._-----_1 ...........1 _____! -.--___.f __.__..I _ J _._____f .____J ._..__.-AE-7-11.__ _I 1 __.___i ROOF DRAIN SHOWER STALL (I J � 1 I 1 � f ...____I f ....____f f l __( SERVICE / MOP SINK TOILET I _I J ...._ l _ ,.i __-__.-1 URINAL.---------' WASHING MACHINE CONNECTION __f -__ _ .. . . WATER HEATER ALL TYPES _--. ( _f WATER PIPING OTHER._.._._. -._.1 __.___J _I _-1 ____I -_-_.___._1 ._____ I _ . __! .__.__( __I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES .._ f NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Y OTHER TYPE OF INDEMNITY © BOND M 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 Q 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 truqNd accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c is a with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME r1 ._.,_-__eI - I LICENSE # _ i SIGNATURE MP O JP CORPORATION II # PARTNERSHIP Q# LLC i ,OMPANY NAME�� Q ;ADDRESS i :ITY _ , _ fC� ]STATE L j ZIP .�C TEL _ ;I AX��E{tL 9 539 %I EMAIL--------_._...__..._._..____.._-----.._......_...._._-_._.._.__........__..__._.-_.....--.-..._....__...___._._....----_-_..._� F Z O F U W W o z � a r a o a W a w w w 0) p z a w� as � U J CL a x w LL W H O O H z o J a 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): e Address: % (9 City/State/Zip:&1 jW _ /4 t L 0/ %�O Phone #: ��� b � � U E2 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction ' gmployees (full and/or part-time).* 2. I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their �f nmbing 3. El am a homeowner doing all work right of exemption per MGL 11. Lt�J repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t 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. A Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. Iain an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company N Policy # or Self -ins. Lic. Expiration Date: Job Site Address: V/ l�4� / t'y AVe "1_e 4 1— 4 • 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 cert "e hepains andpenaltles ofperjury that the information provided above ins true and correct. Signature://Date:Y-Z � ll� - Phone #• #nE V 2 z Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone #: Information and Instructions - Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth. of Massachusetts Department of Industrial Accidents office ofInvestigations 600 Washington Street Boston., MA. 02111 Tei, 4 61.7-727-4900 ext 406 or 1-8.77:MASSAFB Revised 5-26-05 Fax # 617-727-7749 WWW-Mass,govldia 8953 ,✓ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... ................ has permission to perform 1f4 rkw.... . plumbing in the buildings of ..... .................... at ... S.�j ..... 0. ....0 / 4—w— North Andover Mass. F 5- E 6 0. L i c. No.,, ( . ..... We- A PLUMBING INSPECTOR Check# IN MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:-/j 417A () V (Or MA. Date: Permit# Building Locationi �'1� Owners Name: nC�t n C Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential I New: LIQ' Alteration: ❑ Renovation: ❑ Replacement: :— p ❑ Plans Submitted Yes❑ No FIXTURES DEDICATED LU Z SYSTEMS D 0 W Y > Z U y H a C Z F Y Q M Z = Q W Z H W Z FQ.. = of U p W N Z � in Qa' Z N W W N Ln H C Q m H = = F- Y C Q Y Z Z 0 J Q 0LA. Ln Q Vl ,/� C7 O a X W Z U a LL tQ/f Q = J F' Q Q 3Q LLI 0 W C. 0 F U Z Q O LL � 6. J X Z H LLU " W W 4� N Q co CO D D 0 2 Y p0[ = O N Q � Q Q Q F 3 3 3 o 0 w a< W Q a 3 SUB BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3" FLOOR 4T" FLOOR ST" FLOOR 6T" FLOOR 7T" FLOOR 8T" FLOOR Check One Only Certificate # Installing Company Name: � �q ( � f.� N 1� �' (�� T= El Corporation Address: Mrs d City/Town: s State: El Partnership Business Tel: %gi 8'fY o263? Fax: ❑Firm/Company { � Name of Licensed Plumber: 0261—: S4 LS IV INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2' 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner El Agent E] 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. By Type of License: Title ❑ Plumber Signat reof icensed Plumber City/Town APPROVED (OFFICE USE ONLY) ❑ jr Journourn eyman n License Number: J m __"o .0 CERTIFICATE OF LIABILITY INSURANCE OP ID BS FDA�IMNVDDM/YY--� nR/9S/in THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS v 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 IN R , the policy(les) must be endorsed. If SUBROGATIMWAIVED, su sect 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 NAME: PHONE F JAIC, No Ext): (AIC, No): McLaughlin Insurance Agency ADDRESS: 828 Lynn Fells Parkway Melrose MA 02176 $home?181-665-2775 FaX:781-665-0295 CUSTOMERID#: SALSM-1 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: Commerce Insurance Company 34754 George Salsman 6 St. James Rd INSURER B: INSURER C : Saugus MA 01906 INSURER D: COMMERCIAL GENERAL LIABILITY INSURER E: INSURER F: 06/08/10 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500000 PREMISES(Eaoccurrence) $ 100000 A COMMERCIAL GENERAL LIABILITY BCMQLL 06/08/10 06/08/11 CLAIMS -MADE F� OCCUR MED EXP (Any one person) $ 5000 PERSONAL BADV INJURY $ 500000 X Business Owners GENERAL AGGREGATE $1000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1000000 17 POLICY JEPROCT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (Per accident) NON -OWNED AUTOS $ $ UMBRELLA LIABOCCUR HDEDUCTIBLE EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? / A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ PROPERTY 5000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Plumber CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INFO — 01 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Information Only 0 ACORD 25 (2009/09) The ACORD name and logo are registered marks of AcvKo reserved. DateJ............................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... I ....... . . ............................... .............................. has permission to perform ... ......... AA- 41"7 --,X1 wiring in the builldal g of ............. A ........................................................ at ..... 4.). (.tq. ......... . ........ North A_qdover, Mass,. Fee ... Y ......... Lic. No .... . .... . . .......... ELECTRICALINSPECTOR Check # r' - Commonwealth wealth ®f massachusefts official use only _ Department of F`ii-e Services rperniNo._tBOARD OF FIRE PREVENTION REGULATIONS cupancyand Fee Checked_ 1/07] leave blank APPLICATION FOR PERMIT TO PERF O- RM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINTHINKOR 7TPEALL INFO City or Town of SON% Date: 5-10— l By this application the undersi ed gives no e of his or her intentionAr perform the electrical ctor of Wires: Location (Street �& Number)work described below. gip O i) AuAQ ksjL Owner or Tenant 1.1 z n , T�' Owner's Address Telephone No. Is this permit in conjunction with a building permit?u Purpose of Building iMYesC No ❑ BLDG PERMIT ff 400 Amps �, Utility Authorization No. Existing Service � Amps /ZQj/ Zrolts Overhead ❑ Undgrd / No. of Meters New Service Amps' _ / _Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Am act P t3' Location and Nature of Proposed EIectrical Work: A L K CkbM O F -->,`k S tK U lel QTS w� � � P--I✓-P�2� l�-t E J� T C�2s�-sT5 i D c Completion of the following table may be waived by the Ins ector of Wires. No. of Recessed Luminaires No, of Ceil: Sus . No. of p (Paddle) Fans Total No. of Luminaire OutIefs,.ransrormers No. of Hot Tubs KAVA No. of Luminaires Swimming Pool Above ❑ Tn_ Generators KVA o. o mergency ig tmg ElBatte No. of Receptacle Outletsnd' nd. No. of OR Burners Units No. of Switches FIRE ALARMS No. of Zones No. of Gas Burners No. of Detection and No. of RangesInitiatin No. of Air Cond. Total Devices No. of Waste Disposers Tons Heat Pump Number Tons KW No. of Alerting Devices Totals: ................................................ No. of Self -Contained No. of Dishwashers Space/Area Heating KW Detection/Alertin Devices Local ❑ Municipal No. of Dryers rY Heating Appliances KW Connection ❑Other Security Systems: No. of WaterNo. Heaters KW of No. of No. of Devices or E uivalent No. Hydromassage Bathtubs Si2s Ballasts No. of Motors Data Wiring: No. of Devices or E - alent OTHER: Total HP ' Telecommunications Wiring: No. of Devices or Equivalent Estimated Value of Electrical Work: 6v6 Attach additional detail if desired, or as required by the Inspector of Wires. W ork to Start: (When required by municipal policy.) _ J� — — (/ Inspections to be requested in accordance with AMC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE EJ BOND E]OTIiER E] (Specify.) . I cert, under the pains and penalties of perjury, that the information on this application is trace and eomplet� FIRM NAME: ��li � Licensee: �j _� I— � M 1 1�l LIC. NO.: a.�i✓�- (Ifapplicable, enter exempt" in the license numberline.) Signature LIC. NO.: S Address: t Bus. Tel. No.: *Per M.G.L. c.147, s. 57-61, security work requires Department of ublic Safety ` S" Licen Alt' Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability ins ane coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) [] owner Owner/Agent ❑ owner's agent. Signature Telephone No. P PERMIT FEE: $ (J ELECTRICAL PERMIT NO. INSPECTION REPORT: s ELECTRICAL INSPECTOR - DOUG SMALL 1. ROUGH INSPECTION: Passed — [ j Failed — [ j Re -inspection required ($50.00) - [ ] Inspectors' comments: 3. (Inspectors' Signature -no. initials) Date 2. FINAL INSP_XCTION. Passed — [ Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no iniiials) Date S �. 4. INSPECTION— SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - Inspectors' comments: -no Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. :_, The Commonwealth ofMassachusetts Department oflndustrial'.Accidents Office of Investigations 600 Washington, Street Boston, MA 02111 UV www.mas.. gov/dia Workers' Compensation Insurant-eAffidavit: ]3uidders/Couiiractoxs/JElectxicians/Plumbeirs APplicant Informailion. \ Please Print Legibly Name (Business/Organization/IndiviAnn all' 1! \� 0—A-1 I G• Aw.J InAF Lt. r C ;Z i M n A Address:,_ ` 44t> LF . City/State/Zip:K . 05, t La 1,1A • 6 �G Phone 366 -s31 i Are you an employer? Check the appropriate box: I . ❑ I am a employer with 4. [] I am a general contractor and I e oyees (full.aad/orpart time).* have hired the sub -contractors 2. am a sole proprietor or partner - listed on the attached sheet. s ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We area 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.] employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. C] Remodeling . 8. ❑ Demolition 9. [] Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other -nuy appicanr roar cnecxs box vi nmst also rot out the section below showing their workers' compensation policy information. i Homeoyrners who submitthis 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' camp. policy information. lam an employer that is providing workers' compensation insurance for my employees Below is the policy and joh site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Yob 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 tine 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 of the DIA for insurance coverage verification. I do hereby c ertiYy-lun der thepaws enaltles ofperjury that the informationprovidedabove is true andcorrect. sign ature: Date: Phone #• c FF,oficial use o�tiy. Do not write in this area, to be completed �Clty=own offzciaZ City or Town: Permit/License # Issuing Authority (circle one): I.13oard ofl3ealth 2.1luildingDepartment 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other ContactPerson: __ Phone #: 11 I COMMONWEALTH OF MASSACHUSETTS ° F OF IELECTRICIANS . SAS A.=REG JOURNEYMANaELECTRICIA ISSUES THE ABOVE,LICENSE TO:` x t. W ;GAM E_R0N 5 SHDRE= DRIVE iN-- aA :;READ-ING = ,MA 01864=123 07J,31113 .-B-15 33 CONTROL #f H O 0 61.2 1 IMPORTANT If this license is lost or destroyed, notify your Board at the: 4, Division of Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118-6100. Ll if your name or address shown is changed, notify your board of correct name or address to insure proper mailing of naxt r Renewal Application. Always refer to your license number. ; This license is subject to the provisions of the General Laws as amended. It is a personal privilege, and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. L—., -r- 14- \/Ae,t A AGE• o F- LSA fl iu SC.P,c�� ("age 12� Zo(43 p 4o Bo 120 l60 �� Ak. aI:D 2i,MA. " 0o_43-SoW VP L- e� -r 44 A U Qd V C-�- Et- 'EjOAm,fl off' Ar PPE:-Ak-,S DAT E— =, V= A P P ��Rv'• (, roc n E!:>>L 1043 I t 8 3 . Tt F Z.o ►1 r ► t st- t (z.- Z5 I ZS �-our-• �jo • ��OuT � 'T gGiC.C� 2�0' S r D� S+C.T8g0� T—l-k F -o S r o SE�-f L3A c Kms: S G�2T t -H FtT i- 4-1 o F" T1 -r E� TZE�G t ST�2�5 o t= C? -4 ZAD �i 3 DoT 1 � I Any appeal shall be filed within (20) days after the date of filing of this Notice in the Office of the Town :l-rk. , •3: APPILT" ;J0 t O• . '►.ssgciiu��', TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION RECEIVED DANIEL LONG *?'I TOCLtiiK NORTy.4N00VER JAN I Z 3 o9 PM X94 Date January. 12, . 1994. ... . Petition No..... 003-94........... Date of Hearing. January 11, 1994 Petition of . William. G... Weiss....... . ............................................... Premises affected .86. Ql,d ,Village ,Lane...... . Referring to the above petition for a variation from the requirements of .S.e c t ion. 7.,. Paragraph. 7...2 . and. Table. 2. of. .the. Zoning . Bylaw ...................................... .............. so as to permit relief, of .5.46. feet. and. .9...36 . feet. for. the. side. yard .setback. .o.n .... the .Easterly .side. of. the. pr.o.p.erty................................................... After a public hearing given on the above date, the Board of Appeals voted to .. GRANT .... the Variance. ..... .... and hereby authorize the Building Inspector to issue a Permit to William. G. Weiss. .. ............ .............. The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Signed Frank.Serio an Walter.Soule, Clerk .............. Robert.Fo.rd. John.Pall.one ...................... Board of Appeals ;ny appeal shall be filed vithin (20) days after the 4ate of filing of this Notice -i the Office of the Town Ark. REMY�C) oT�TOWN CLQ;?K NORTH ANGOVCH TOWN OF NORTH ANDOVER MASSACHUSETTS JAN 12 3 o9 ?V '94 BOARD OF APPEALS ****************************** * William G. Weiss * DECISION 86 Old Village Lane North Andover, MA 01845 * Petition #003-94 * ****************************** The Board of Appeals held a regular meeting on Tuesday evening, January 11, 1994 upon the application of William G. Weiss requesting a variation of Section 7, Paragraph 7.2 and Table 2 of the Zoning Bylaw so as to permit relief of 5.46 feet and 9.36 feet for the side yard setback on the Easterly side of the property located at 86 Old Village Lane. The following members were present and voting: Frank Serio, Jr., Chairman, Walter Soule, Clerk, Robert Ford and John Pallone. The hearing was advertised in December 22, 1993 and January notified by regular mail. the North Andover Citizen on 4, 1994 and all abutters were Upon a motion by Mr. Soule and second by Mr. Pallone, the Board voted unanimously to GRANT the variance as requested. The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Dated this 12th day of January 1994. BOARD OF APPEALS Frank Brio, J �� Chairman Received by Town Clerk: RE CF IyE I) TOWN CLE -11K NORTH A?,ItncivER TOWN OF NORTH ANDOVER, MASSACHUSET20 1TS 48 $ ,J BOARD OF APPEALS APPLICATION FOR RELIEF FROM THE ZONING ORDINANCE Applicant Address r, C',nc- n Tel. No. 1. Application is hereby made: a) For a variance from the requirements of Section 7 Paragraph 7.3 and Table 2 of the Zoning Bylaws. b) For a special Permit under Section Paragraph of the Zoning Bylaws. c) As a Party Aggrieved, for review of a decision made by the Building Inspector or other authority. 2. a)' Premises affected are land `� and buildings) V --'- numbered 9 GShe`"fit . b) Premises affected are property with frontage on the North ( ) South (l/) East ( ) West ( ) side of L/14 --Z-'44 --- ,ireet. Street, and known as No. a� Street. C) Premises affected are in Zoning District C-3 , and the premises affected have an area of square feet and frontage of feet. 3. Ownership: a) Name and address of owner (if joint ownership, give all names) : r ' 1 Date of Purchase ilz-z Previous Owner b) If applicant is not owner, check his/her interest in the premises: Prospective Purchaser Lessee Other 4. Size of proposed building: front; feet deep; Height stories; feet. a) Approximate date of erection: llz"l - Id s b) Occupancy or use of each floor:L tc��/ c) Type of construction: c:uca 6. Has there been a previous appeal, under zoning, on these premises? tia If so, when? I 7. Description of relief sought on,.this petition 8. Deed recorded in the Registry of Deeds in Book leg -3 Page Land Court Certificate No. Book Page The principal points upon which I base my application are as follows: (must be stated in detail) yi P')—i, X-),-1/' r,�i ^i! T I/, ) 10 /_/7 /0/_U ii 7 /'TF.i n. r—, J` 6' rT�i-�.i\//T?�! I agree to pay the filing fee,. --advertising in newspaper, and inc "dental exp s s* Signature of Petitioner(s) Every application for action by the Board shall be made on a form approved by the Board. These forms shall be furnished by the Clerk upon request. Any communication purporting to be an application shall be treated as mere notice of intention to seek relief until such time as it is made on the official application form. All information called for by the form shall be furnished by the applicant in the manner therein prescribed. Every application shall be submitted with a list of "Parties of Interest" which list shall include the petitioner, abutters, owners of land directly opposite on nay public or private street or way, and abutters to the abutters within three hundred feet (3001) of the property line of the petitioner as they appear on the most recent applicable tax list, notwithstanding that the land of any such owner is located in another city or town, the Planning Board of the city or town, and the Planning Board of every abutting city or town. *Every application shall be submitted with an application charge cost in the amount of $25.00. In addition, the petitioner shall be responsible for any and all costs involved in bringing the petition before the Board. Such costs shall include mailing and publication, but are not necessarily limited to these. Every application shall be submitted with a plan of land approved by the Board. No petition will be brought before the Board unless said plan has been submitted. Copies of the Board's requirements regarding plans are attached hereto or are available from the Board of Appeals upon request. r LIST OF PARTIES OF INTEREST SUBJECT PROPERTY MAP IPARCELI LOT NAME ADDRESS S !n S u9t 0'h A � c.C'F�f s Cox ; ABUTTERS MAP PARCEL LOT NAME ADDRESS sv , u 7 1-3 ,7 4 z. F. / 60 '7 Ile 1,-, i Q 4-16 /cc) a 1/1 15 ie -s LEGAL NOTICE TOWN OF NORTH ANDOVER BOARD OF APPEALS NOTICE Notice is hereby given that the Board of Appeals will give a hearing at the Senior Citizen's Center located at the rear of the Town Building, 120 Main Street, North Andover on Tuesday evening the 11th day of January 1994, at 7:30 o'clock, to all parties Interested in the appeal of Wiliam G. Weiss request- Ing a variation of Sea 7, Paragraph 7.3 and Table 2 of the Zoning By Law so as to permit relief of 5.46 feet and 9.36 feet on the Easterly side of the property on the premises, located at.86 Old Village Lane. By Order of the Board of Appeals Frank Serio, Jr., Chairman NAC:12/22 & 12/2911994 TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS William G. Weiss 86 Old Village Lane North Andover, MA 01845 Date:. December 27, 1993 Dear Applicant: En:losed is a copy of the legal notice for your application before the Board of Appeals. Kindly submit $ 11.60 for the following: Filing Fee $ Postage $ 11.60 Your check must be made payable to the Town of North Andover and may be sent to my attention at the Town Office Building, 120 t1ain Street, North Andover, Mass. 01845. Sincerely, BOARD OF APPEALS gte� 460b� Linda Dufresne, Clerk