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Miscellaneous - 980 FOREST STREET 4/30/2018 (2)
Commerce INSURANCE' June 17, 2015 The Commerce Insurance Companyw Citation Insurance Companyw 11 Gore Road, Webster, Massachusetts 01570 508.949.15001 www.commerceinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL NORTH ANDOVER MA 01845 Board of Health or Board of Selectmen Town/City Hall RE: Our Insured: DIDIER THIBAUD / SABINE M THIBAUD Property Address: 980 FOREST ST Policy#: BCMQJD Date of Loss: 06/15/2015 File#: KKVT00-HYKCJ4 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. ELIZABETH BOTTIERI Telephone: (508)949-1500 Ext: 15284 Sr Claim Representative, Property Toll Free: 1-800-221-1605, Ext: 15284 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. June 17, 2015 CIC 254 (Rev. 4/95) MAIL M39 1 .0 ... � 1 This certifies that ..1�.1 .... t .7 �' ��. �, _}��� ':� S has permission to perform. r��: .- .................... wiring in the building of ..... .................. at .......9 ....... NjMh Andover, Mass. Fe._9t..... ��o !�!-'J ......... . ELECTRICAL INSPECTOR Check # 11215 u 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. 01 c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time ofongoing construction activity, and maybe -deemed -by the . Inspector-of_Wires abandoned.and_invalid-ifhe 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 instal '09 entity stated on the permit application. i 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 i5 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. [We 8 — PerxnWDate Closed: Note: Reapply for new permit. ❑ Permit Extension Act — Permit/Date Closed: ( r Commonwealth of Massachusetts Official Use Only a Department of Fire Services Permit No. l d BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �lv.1/071 eave 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 NK OR TYPE ALL )NFORMATION) Date:1 -/J Q City or Town oh NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives n tice of his or her ' tention to per the electrical work described below. Location (Street & Number) �� �— Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building - Existing Serviced Amps ,&10 /.Z41G Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No.,1y ocg-03p(� Ys ❑ No 0 (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Completion of the followin table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. grnd. ❑ o. o mergency Lighting Battery 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 Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: Number Tons . KW ..................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security f System : or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or E u valent OTHER: Attach additional detail if desired, or as regi red by the Inspector of Wires. Estimated Value of Electrical Work: 80U. (JV (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties o�%perjury, that the information on this application is true and complete. FIRM NAME:. �a/ S LIC. NO.: Licensee: j Signatur LIC. NO.: 01 S (If applicable, enterer"exempt" in the li nse n ber 11ne.) , `� Bus. Tel. No.: �-7/& - 60t % Address: 3f31 `�4oiy� / r /- 3�o T Alt. Tel. No.: *Per M.G.L c. 147, s. 7-61, 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 tl e 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 11 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: r Pass M Failed 0 Re- Inspection Required ($.) ❑ ' Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass R Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: ` Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): City/State/Zip: Phone #: (2P3 — %/6p --&Q / 7 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 2am a sole proprietor or partner- 11�hip listed on the attached sheet. # 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.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other i'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I 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. i am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: fob Site Expiration Date: City/State/Zip: kttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). i ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a .me up to $1,500.00 and/or one-year imprisonment, as well as civil penal "s the form of a STOP WORK ORDER and a fine if up to $250.00 a day against the violator. Be advised that a cop this statement may be forwarded to the Office of nvestigations of the PIA- for insurarw*-9overage verificatio do hereby pe"tify jMder 4WpaKs and penalties perjury that the information provided above is true and correct. 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 #: a 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Date . .� J.) Z' . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION C This certifies that ............ . ff has permission for gas installation ......0Jv% LIG .................. in the buildings of ..... �: ',.b Cky c� at .... �V.. rP s4l ee �� orth Andover, Mass. �l Fee . � Lic. No..`I � �.� �! .. GASINSPECTOR Check #_ iii}Jj MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY . V . _ dV 6�MA DATE / S _ / Z PERMIT # -- JOBSITE ADDRESS _ _ � B / - OWNER'S NAME p 10 /C1 GOWNER ADDRESS _ TEL =FAX TYPE OR PRINT OCCUPANCYTYPE COMMERCIALQ EDUCATIONAL) RESIDENTIAL CLEARLY NEW: .- RENOVATION: REPLACEMENT: 0 PLANS SUBMITTED: YES Z NOR APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 S 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE _ �' _.. ._I I _.__.J DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACEr� I—, --I-- - GENERATOR GRILLE INFRARED HEATER _--1 — ._ -- -�. C�-I_ __a._._ I_T _•_ - ----1. _ _ _1 . __ LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT - TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER r _j INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch.142 YES - NO .Ell IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY( OTHER TYPE INDEMNITY Q BOND Ej 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 0 AGENT �I SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co liance wit all Pert' t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 1/(r1ik1, � _� VC LICENSE # �i ,. � SIGNATURE MP N.I, MGF �J JP D JGF LPGI E] CORPORATION []#� PARTNERSHIP []( #= LLC COMPANY NAME: i4U(ri�= �/ ✓t: �fi/ j ADDRESS yS%---'f�'--- --- G//�C,cl ___.__ _.. __ _.--------. _..._. _._._� CITY (//ilG.v . -.__.. _.u_. _--- .. _. _._.._I STATE ...ZIP FAX CELL EMAIL -_ c °z � 0 U a w r zo O y❑ w �- I_ W FO CL Z U w ft w � � a w Oco w � w N a o a a a U J E, a IL a c w x w F- LL H zz z 0 0.0 H U W P-4 4 C�7 c�7 °a id 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): U U � L*J L5 !>✓��� Address: ;1--Y C l /z C r City/State/Zip: 14(1p;(11-' y,. / Phone #: L ---- - Are you an employer? Check,t'(ie appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 2.6 employees (full and/or part-time).* have hired the sub -contractors I am a sole proprietor or partner- listed on the attached sheet. I hip and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t 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 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. I 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. 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. #: Job Site Address: Expiration Date: 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. l do Hereby cer#A under t fe pains and penalties of perjury that the information provided above is ;rue and correct. rL Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Q Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1.877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia :COMMONWEALTH "OF-MASSACHUSETts PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: DOUGLAS E DUCHES14E 38 8 EAYERS POND RD HUDSON NH 03051-5343 11744 05/01/14 203307 t 7 J � v f; f� r r` r` r' ! j CONTROL #H412382 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118-6100. i If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next . Renewal Application. Always refer to your license number. i 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. GENERATOR DATE: I L Iy1�v LOCATION: IUO OWNERS NAME:I � �� botk0.- GENERATOR kw APPLICATION NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: 06"ICkcZ '% PHONE NUMBER: ELECTRICAL "ESIDENL GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *CONSERVATION APPROVAL Town of North Andover Page 1 of 1 `� uue4te5ausr Deco kgotmNga� fie Vie e t +�+ tuxdme.�rronn wnsa.amw,unw, http : //mimap.mvpc. org/NorthAndovermimapNiewer. aspx Selection 11 Legend Location M F' Select (show all) rOwnerProp ID A THIBAUD DIDIER,105P--0079-0.0.00.0.19 1 selected To Mailing Labels To Spre, Pla Owners THIBAUD, DIDIER Owner2 THIBAUD, SABINE Address 980 FOREST STREET PropertyM 105.D-0079-0000.0 Lot Size 2.41 A Fiscal Year 2013 Land Use 101 Code Last Sale 05/28/2009 Date Book/Page 11612 Total $548000 Valuation Building CL Type Year Built 1996 11/5/2012 Town of North Andover Page 1 of 1 0 Sizes[([] Help Scale 1" = 127 ft I YV, 1 �Ir W W i IEcSDCd�i ,tc . +`14: v_4� _ '� < v U - �Ja• `�NL m0.B71t , 1 7 1kLII1. -- 16SDt0lf J 1 yi J 0951 p . YL 1 - yl -.1 i.. :._ G (1800 109$7 Q We t 111&6201 gk, 1RG1Y0071 a. ==._ 1Q6IIim _. � lift - • � 91! _. -]1�(C i : a4. -. 1 r �v_Iv ��• �. ,., via. _ _ `- ,iaometry imag co Mrr/m v32.0 http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx Save Map as Imag ,election (! Legend (( Location (. M ;Select.. (show all) OwnerProp_ID _A THIBAUD DIDIER lOS.D-00791-0000.0 9 1 selected To Mailing Labels To Spre• Pla Ownerl THIBAUD, DIDIER Owner2 THIBAUD, SABINE Address 980 FOREST STREET Propertym 105.D-0079-0000.0 Lot Size 2.41 A Fiscal Year 2013 Land Use 101 Code Last Sale 05/28/2009 Date Book/Page 11612 Total $548000 Valuation Bolding CL Type Year BuBt 1996 11/5/2012 . -.1 i.. :._ G (1800 109$7 111&6201 gk, ,iaometry imag co Mrr/m v32.0 http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx Save Map as Imag ,election (! Legend (( Location (. M ;Select.. (show all) OwnerProp_ID _A THIBAUD DIDIER lOS.D-00791-0000.0 9 1 selected To Mailing Labels To Spre• Pla Ownerl THIBAUD, DIDIER Owner2 THIBAUD, SABINE Address 980 FOREST STREET Propertym 105.D-0079-0000.0 Lot Size 2.41 A Fiscal Year 2013 Land Use 101 Code Last Sale 05/28/2009 Date Book/Page 11612 Total $548000 Valuation Bolding CL Type Year BuBt 1996 11/5/2012 GENERATOR APPLICATION DATE: I I 17 117, -- LOCATION: OWNERS NAME: I h I GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: �6 ELECTRICAL 0 GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *CONSERVATION APPROVALlu Date .... . /.)...... ..1.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...(1, ......................... (1,............6 ........................................ has permission to perform. t '......" -"...l..................................L... . wiring in the building of 19--7 ' at .... /.... ..-.''� T� �% ... h Andover, Mass. ............................................... r ,�-/,� Sys' Fee. S J .............. Lic. No.............. ................ ............. ..:... ......... LECTRICAL INSPE Check # I J I p . The Commonwealth of Massachusetts pW" W Department of Public Safety comma „a BOARD OF IM PREVENTION RMULAMONS W7 CMA 1WO 3M Wn VW4 APPUCATION FOR PERMIT TO PERFORM ELECTRICAL. WORK M *16* In be Oerlo nW in apcW ntoe *0 the Mmnowuao Beoor" Caffr, JM7 CMMI I 9 (PI.g M "off IN WX OR TYPE Ala. swo MA mm) 000 jj&L // c` to OW or Town of , AV! -,-2t? TO ft WgXOW of Who 111f unlientpitpd �9ptiois br a anNt b Pd�l'17 Me atacirlc;al work dMOrilswd beioa►. Laceim (8irrral Nurrlba►� 'S— ra _ Owner orTwm*, O~Is Aftm Is Itde ptt I* In t�attt O pe WM a bUN& ffft We 0 No (Ch@M ftp Wr1sW ftx) at ma" d owwi_� 1-6 110„w ,c. Uft/luihorinsm Na ExlN W gWvW ,m An" Zoo ,I/",- Wft owrfwa L'~ C] W- d Maa..,..Ll_..1,..__ mmir tea u � An" oWWW 0 ~0 Iia d Mai mm Nurnbar CO Rgft* and Ampeoipt iaicetfart and Nabuad Aapoead t=iecbloal Vrorlt 'i1_ i_l 1= �' UP6�,y�� t,JL1;N �r//l7,� N06 of uon" otafaie Nay of Hat Tube Na dTranMomtere Na d t tpit�Mto ft""tAi�ittartiro Aaol 'x'01' ❑ , Q W Na d Aeo"We Outlet Na atop Burners HD of erns: No. of SW#oh ouwh 0% d o.e bumwt FIRE ALARMS Na d No,Do rI and Na d $Wndtnp p Nia d slsil avwss LOW Q 00W No, d RVOW No. tat A r Coed. Togtl Na. d DW001" TOW Mad HowTate KW I Na of SPWWAM Kvv , Wov of Drom hNMlnp KW No. d HeMere KW 9 wrMe Low Nov Hydro--.- VOWN Na of MMWS TOM HP �/ Z 1NWRANCE COVERAeL, PuteuertttofherequitWrwttbd MAsuedhtw%Q* wW Laws I hew a ourmm llebiibt in ummos Pbffoy h oklcitp Compfele CJpsrrUwr C&M*pe ar iM subetonlie► *QuWd" YES No 1 have Wb"" proof or sena b oft cam N yvu Tar. �Iw.yr,�dyt' M IN a+e qo. a ourv+ro�e a► a+eaaro >� raaoo++w e>oz N o O rmm O 5Ntttta1 1 %WW of l WkW Work i ,/ O- iE�Ivka110f1 Ovid Ylbtk v sMtt 2&4CG e4 ce--i Mfined wd r Vo pMpI;ee of ps*W,. FOW NAME Addtdee �/t/ /G"�.il aKT /%Jfj �J/c; %G 9LL TN. No .,.......... At Tet Na OYNrER't3 OId AVia E voivv lam awMD iM tioewee eta dN lrietraltpe oarerape or b tubMarktet ipt It ae uaqutrod by Mssetahttstdle Ciwtetr iat►a, tittd Utat my on tMtte pttntttt appY�oallon rret+ae tate npupelrtettL ownw © Aam D vvn aheatc on.) RMWIN uroof owmr ar Aawid -- 0"e NR PEAR Pais, The Commonwealth of Massachusetts Departni�nt of,'Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pplicant Information Please Print Leaibl' Name (Business/Organization/Individual): Address: City/State/Zip: CO � 'R7CP' �__— q 3 � ? Are yK an employer? Check the appropriate box: 1. 1 am a employer with _�� 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] f 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 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other So *Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information. t Flomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. /► Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: Q �; C'� 4; r -V S /U. City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sig -nature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Date .........'...�,f� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......Ac fir. �?' C !-� �� rf................. e......... .......ra........ r........ has permission to perform .......�'?1t ` .. ............. Irl, wiring in the building of .....:.............................�:.........I....................... at ...... �w.......... �........:rth Andover M -Fee ..... ,e. ..r:...:.- F..... _.......�. �� �i L ECTRICAL INSPER Check # J �0 M// SEP -28-04 04:50 PM HARDACRE ELECT 6033625910 P.01 TW COW WFALTH OF eprw" w@fA&kcs BOARD OF FIRE PREVENTION F APPLICATION FOR PERMIT TO M woAt to be Pofa d In o000td2 0B mfl #N (Ple se PM M IM► at Type &H H wwadon) Town of TAe wde oWW won fore perfte 10 perform 1Ns eWo*st wak ditoVW blow. tecow (ohm a Ntmber &xAd f� Ort w w Termtt �rift, allotwD f omchi No. rT5 Pettit 527 CMR 12:00 pa,penov a Fes I' IRM ELECTRICAL WORK welt Godit0 Coes 12A oe�.. 2, TO tlas Ms Is eft pen* In *W*Xx qon with s bus ft Pon" Yes • r No • (Check AW Wffi* tlwoc) ow d Bi um G=2024-6 Utlltr A44wftsflM No uoV ft ft C12100 ,*0 0 Vob Ovrheod U *rw • No. of Meters NewlBel>its __ �_hulpe WtNe Owrlteed • LI►tdQRd - No. of m*m Nwraor of Food m end MtpecMy Lecetlon"Netodpmpow EAed" 1AMc OTHER: COVERAL#E. tArsnettlbtfst dMeweMtetdalOa+wrlsw I Irrs s ourtsnl IJMrtdlr tn�tltsnos Pttwoy inehsfrt(a CartplMed t wof o> a Ota tattOslnrhl saafrslrxR>� NO h" NAMMed vswd pmd d wft 10 eM omw Imo to . N drdrd YES000 trldule eM type drelrnp Mte appw{MtMe 946URANCE ■ 00010 . OTMR 1. wat to t�Ps�tt� DsM i01M N11 flwLYt-i.-+/•r� •oqLIC. N0,•��L�� asgolr CtIMlICO w 1 am ewtlrs leattl r Llosnws d0s� i iat Irns TMwnnes oann� w Rti sa�sfarntW ograhal�w sd 4 U t w'" LM& Aud ad av 4 prrn em to om an oafto bnwMs 09 neetitwrnnt: &~ AeNe vw» CMck a" /7 /� � 'rewww wb. PH : '/ v p ign amci arAgNO TOW d Ouws No. of Hd lista Na d Twoko" ra KVA Mat Liphlinp Flkirsa Ata'° 1n Bwlnvlti Pod (�mwdm KVA Na wo" Loq No. d DOror+ptsdo odws Na d Oi Damm un" -- -.— �. — No. d Swikh Oubb No of Gee Rumen FUM ALARMS NO. d 2aN No. dDsiedlon see Tdd No. d R ' d Tar UYwserq DoA= — No. d Soundloo ODA= Oro! of Sdf c4mo ed No. d a dd Na PWW Torr KW waft _ Kw DamewNsourAng Dwom Muriwpst • OUM Nw. of 09" -- — Hooku Dr4aft 9w Lam GaaNdoe No. of WAN Hewn Kw No. d d nta . eralars Low vdupw Widmg_ _ No,"Y"MaNNOT06 No. d MOM TON W OTHER: COVERAL#E. tArsnettlbtfst dMeweMtetdalOa+wrlsw I Irrs s ourtsnl IJMrtdlr tn�tltsnos Pttwoy inehsfrt(a CartplMed t wof o> a Ota tattOslnrhl saafrslrxR>� NO h" NAMMed vswd pmd d wft 10 eM omw Imo to . N drdrd YES000 trldule eM type drelrnp Mte appw{MtMe 946URANCE ■ 00010 . OTMR 1. wat to t�Ps�tt� DsM i01M N11 flwLYt-i.-+/•r� •oqLIC. N0,•��L�� asgolr CtIMlICO w 1 am ewtlrs leattl r Llosnws d0s� i iat Irns TMwnnes oann� w Rti sa�sfarntW ograhal�w sd 4 U t w'" LM& Aud ad av 4 prrn em to om an oafto bnwMs 09 neetitwrnnt: &~ AeNe vw» CMck a" /7 /� � 'rewww wb. PH : '/ v p ign amci arAgNO HARUACRE ELECTRIC 25 Maple Ave. Atkinson, NH 03811 Office 603-362-5901 Fax 603-362-5910 EMail Hardacrelectric@Netscape.Net BILL TO Derrick Davies 980 Forrest Street North Andover, MA 01845 P.O. NO. DESCRIPTION Permit Fee Invoice DATE INVOICE # 9/20/2004 442 WORK PERFORMED AT Derrick Davies 980 Forrest Street North Andover, MA 01845 TERMS QTY X18 DUE DATE 9/20/2004 RATE START DATE 9/20/2004 SERVICED - -'•`}---if'�M � � _ _ itcxs _ - i�.a/` Get c„�� -- - r /AAJIL— j Cof L f �J PROJECT AMOUNT 70.00 1 $70.00 HARDACRE ELECTRIC 25 Maple Ave. Invoice Atkmson, NH 03811 DATE INVOICE # Office 603-362-5901 Fax 603-362-5910 EMail Hardacrelectric@Netscape.Net 9/20/2004 442 BILL TO WORK PERFORMED AT Derrick Davies Derrick Davies 980 Forrest Street 980 Forrest Street North Andover, MA 01845 North Andover, MA 01845 P.O. NO. TERMS DUE DATE START DATE PROJECT 9/20/2004 9/20/2004 DESCRIPTION QTY RATE SERVICED AMOUNT Permit Fee 70.00 70.00 Total $70.00 SERVING THE MERRIMACK VALLEY SINCE 1984 NH Lic.#8157 MA. Lic.#12192 HARDACRE ELECTRIC John Hardacre ATKINSON, NEW HAMPSHIRE Office 603-362-5901 • Fax 603-362-5910 • Cell 978-697-2878 e-mail. hardacrelectric@netscape.net A oAr rST r Location 3 p No. & o> Y Date f -//g M0R7M TOWN OF NORTH ANDOVER ' L Certificate of Occupancy $ yes ESQ' Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ a Other Permit Fee $ TOTAL $ O Check # d Building Inspector 1.1 Property Address: Historic District: Yes No 1.2 Assessors ((��Map and Parcel I SJR `✓ Map Number Number: cr Parcel Number ctQ to 1.6,/ V � SCS Pa -u D v 1.3 Zoning Information: Zoning District Proposed Use 9455 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft 7 8 6 83 96'96 Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 3 Signature Tele hone 1.7 Water Supply M.G.L.C.40. 54) 1.5. Public ❑ Private ❑ Zone Flood Zone Information: Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record Pa -u D v 9455 *a le (Print) Address for Service Signature -- Telephone 7 8 6 83 96'96 2.2 Owner of Record: J Name Print Address for Service: 3 Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone I 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone MA z M 90 0 Wn ic e r M r r Z G) SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 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 .......❑ No ....... 0 SECTION 5 Description of Proposed Work check all applicable New Construction 0 Existing Building ❑ Repair(s) ❑ [Alterations(s) 0 JAddition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �' GoNS 2cI�c l N 24-- I-< Z0-7 A4AC � I SECTION 6 - F.ST1rMATF.D CONSTRITCTION CORTR l Item Estimated Cost (Dollar) to be Completed bypermit applicant licant1. OFFICIAL USE ONLY 1. Building - 20 ©QO (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) �- �1 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SEC HUN 72 UWNEK AU THOKIZATION TU BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on y behalf in all matters relative to work authorized by this building permit application. oo -"�---- IQf_,'� X03 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 Print Name Sianature of Owner/Aizent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1sr2 ND 3RD SPAN DEvIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHI1vINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A„ N :�--i "Amur FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessaryapprovals/permits l fron Boards and Departments having jurisdiction have been obtained. This does not relievF the applicant and/or landowner from compliance with any applicable or requirements. ---"°"APPLICANT FILLS OUT THIS SECTION******-** ** * ** APPLICANT_ --D p, D� V f S PHONE LOCATION: Assessor's Map Number PARCEL I SUBDIVISION j� STREET I 0 AGENTS: LOT (S) ST. NUMBER. 713 0 USE QNLY ** R CONSERVATION ADMIN! ATOR DATE APPROVED DATE REJECTED - COMMENTS r , i e - rya - ►a�� TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH 9 PTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED _ 1 DATE APPROVED I DATE -REJECTED oe- 'UBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT IRE DEPARTMENT ECEIVED BY BUILDING INSPECTOR wised 9197 jm b DATE 0 Town of North Andover * _ � ,y Building Department•-•- �AAiD 27 Charles Street SACHUSEt North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE /0/lfO3 JOB LOCATION P Ca/�ES Number Street Address �*` Section of Tc "HOMEOWNER © 1C K Pku L SV '7 D[es 7g 69—s &!�8-6 Number Home Phone Work Phot PRESENT MAILING ADDRESS_ As rA eO V (-- Gity Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of 1 or 2 units 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 of two there is, or is intended to be, a one family dwelling, attached or detached structures accessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) 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 SIGNATOR ��� APPROVAL OF BUILDING OFFICIA Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. Revised 4.30.03 Home owner Exemptions Form m m m X CO) CO) F) CO) .0 CD a Z CD O ar CO C n� '00 o v CD a� Q CD O CO) 'O CD 0 CO! d d O COD 10 C!. 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to y m 'on e�mlq sesrlJ lsri}i>N .>nl ,moIg2UJA8A 01 2nnlq s2sd1 to slot sri} Yd 6sbnsf+s w noiz2imisq J-11-> Juorl}iw vow Yno ni bs>ubolgsl ni>1>61 b>di l>e>b sla}>u11e sril pnibliud ni >zusmiJ sM lonozl>q eirl loi �szori nuq sri) slo bno a>Joi Ioi>sgz lot Ylilop >2u >Igillum N b>12>lsJni zlsrilo b— ,z qof> b ,el>bhu8 .>lipn; Of b9pO u0 pnill>w0 Yl;moi owT bro -0 08AJ -?j pni2u bsgcl>vsb bro b—pi2>b ns>d >vnri 2rolq sz>riT >ime>ke fol roilo>ilibom sliupsi vom enoito>ol >irigolpo>p -1 10 .o00 ]2swriJlon n shod --1-9 5HT .tnsmso�olns >bo> 11bm�l ,e oi >iJoib ,znoiJoi lov line ,yli v'�ho b— ,,oil>ul}zno> Pnim;psd slolsd eJ"gg pnibliud lo>ol>moii s>ivhmo It'll 0} 6seivbo Ylpr�ollz Ionoizzslol9 to J»JilinA b>l>f21P>l p Yd bsmlollsq >d lzum znoi)o>ilibom bslips7 vno -i-mib IID Ylil>v .2Pnlumlb 52>ril 91D>e Jon OQ .>2n>g x9 on2192ANi>lUq >rtJ Jo 1>>niPn3 lol z>i>nogsvzsb Yro io .l ,a'olg2UJA8A Ylilon bro noihu�l2no> pninnip>d >loi>� b>mloliso 2' >6ow vro >lol>d no'lulozs m� 1 ' 1 4, w r� Ile Location— No. ocation y �J y tel✓ � �/✓ ,i� ��r - No. Date NORTH TOWN OF NORTH ANDOVER 3?Of 1,y 't•••o ,•• OG p Certificate of Occupancy $_ } • . Fee $ Building/Frame Permit Foundation Permit Fee $ swcMust, Other Permit Fee $_ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works mm©l d VI W N U_ Q Z -x ° ta u h o ? -x Z -xw w 1c z 3 I�r l =0 0 0 rl = '�w = z n C z G U U z z Z U Ci U U F•. zP6LLI J z z z z z z uZ tzsl L:J W p¢, L L W �_ N a z c7 9i n G G G rn `" ' 2 O Q[ dLU u Z1LeiLU c iA �/ O M do LU �- (� z LU a- d U m _ LU z o cu NZ Z Z 3 d z W E.4 p a O z a Z Z Q J7 lJ.I JJ LU O Z Z Z J C C LL, ct u u u F F ¢ M t r_11•. � C z � .� x �' J Z L LU z' C- u u u 9 m G J LU LU m a F-: tom, v'. 4 ,c=. '24 . . . . . . . . . . . j ads:- FORM U - LOT IWASk'-PORM i1PR 7 'INSTRUCTIONS; This #orgi is used to verify 0WO)l tiece"afy a ovals/permits from Hoards an epartrMils haviffg j fiction bane been *taink� -This does nck rOieve the applic nt fpr 16ndowner fdr*compliance with an a licabte or re uireme tQ'; Y ISP q *****APPLICANT FILLS OUT TH It SECTibN****** v APPLICAi6 � C� ± �Dc PHONY 4 ',L vATlft A§Wsss Map Number -s PARCEL � $�IBE1tVISfON� LO)T (S) RECOMMEN13ATIONS OF TgIWN A �x: I bj& " ki 0 C SEf2VATIQN ADMIMSTRATO t QA APPROV DAT& PAACTED CC MENTS PLAKNft APPROVED DEJECTED ` i FOOD I LTH DAA APPROVED c OXTE R11JkTW E C IN RECTOR HEALN A APPROV U I' DATi* REJECTFD COMME �—I/, s> -o''` PUBLIC WORKS - *VVE'UWATEI2 CONNECTIONS IIVEVI(AY PERMIT E DEPT) TMLrNT -'2ECEIVE1313! BUtLDING INVWOR ►�'E • • Page No. of Pages COBY CONSTRUCTION, INC. 8 Ellen Road STONEHAM, MA 02180 (617) 665-4133 PROPOSAL SUBMITTED TO PHONE DATE STREET nd 980 FoR F JOB NAME CITY, STATE aZIP CODE 71 JOB LOCATION ARCHITECT — — """ DATE OF PLANS IJOB PHONE We hereby submit specifications and estimates for: SCOPE Or' THIS JOB BUILD A OUTSIDE DECK IN THE DIMENSIONS OF 38' X 1 V ALONG THE BACK OF THIS DECK WILL ALSO STEP D CK DOOR7S--A-ND--TFAVE- TWO SETS OF STAIRS TO EXIT FROM ON EITHER SIDE. SPECIFICATIONS OF THE DECK A) ALL PRESSURE TREATED WOOD FRAME MADE UP OF 2 X 10 X 14' ON HANGERS B) ALL RAILINGS TREATED WOOD 36" HIGH MADE OF 2 X 4'S RANCH STYLE. C) TREATED WOOD 4 X 4" POST D) DECKING IS A 5/4" X 6" TIGHT KNOT RED CEDAR NAILED TO THE FRAME. E) STAIRS AND LANDING DECKING WILL MATCH THE DECKING STOCK, RAILINGS RANCH STYLE " HEIGHT * F) THERE ARE 7 EACH CEMENT FOOTINGS 10" X 4' DEEP AND ONE 36" X 20" LANDING ALL LA UAL JOB. rHTS HOMEOWNERS INSURANCE FUND 057785 / 109663 1 ORIVEM�AI` & tJTLIIiY �I f4 EASEMENT � I FOUNDAWilk TION LOCATION PLANoc ,",A' �SOWN ,� oars _ WNUK COLONIAL yn,�,AG� Day CURD• � Nar .c wta it r� w"Ir► komy CLIENt: r'as OdtAA rw�a IMA► ou►v " l tNls CERTIFICATION f5 yApE' AND UMITEO r sim or ANy��'u""°Mt`°� a =„�w- np THE ABOVE CLIENT.pp,wrrta�aw� WE+a or no FM wt1oM OOM► N" �,�nger suoN+ WAL40 Dat War + E FEW IS M A IOI� X AS iNOWN LOCATION; LOT1A FOREST ST.,NO•ANDOVERNA' � , DOW to A� N��r SCALE:1=100' DAM.'412-1/95 f�£V.9/1/95 IANSEN &SERGI "'°�� CHRISuawmu T MA. o,so Ia t xc �• pW� t M ow N p,:94003017 TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units ... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: ��� Est. Cost 3 2 - Address Address of Work /9Sd ('—'e 7- S Owner Name: Date of Permit Application: 7 9 I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner -occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date caner Name Cl .7 CO) Cl) MZ y d O 0• O C. �• y o p CD CDCL o v�_ CD CCD O CCD C CD y o. v v �• o CC C � v CO) O CD Z O � • CD O CCD f`} z r cn V J n O V J C n m Cn 2 N PO PO C C ? m S y O Cr N dO CL O O y N O. C-) T Z - �-C N' -4 =r d .-* O. O C O m CO) C y -� S' mm; m n > > N m CO O cl O N' CC.) o c � co) N O. C2 t0 C3 CD O N co CS CD O N � O d N' CO) d CS O .W d CL N ICD '� H CO) 9 CD: gCO) CD JR 2 o h ?� �o m.41 o CO) CD VimCD: CD m m d CL ,%: C -) C -) o: o- :W 0.. R Z a rfl 0) pC: ro w W y G C C b 7C a 0 A+ 0 W H 0 0 c .Location - No. Date ,40RT1t TOWN OF NORTH ANDOVER •.. '• OL - p Certificate of Occupancy $ Building/Frame Permit Fee $ l o ...:�. . '"'aa' E��' sAcMus Foundation Permit Fee �� Other Permit Fee Q Sewer Connection FPS Water Connectio'�,v a '$ TOTAY W $ Building Inspector Div. Public Works PRR311T N0. //? APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d40. /O LOT NO. 7 q 2 RECORD OF OWNERSHIP IDATE (BOOK 'PAGE ZONE SUB DIV. LOT NO. LOCATION 0 o PURPOSE OF BUILDING Accef3�i9 lR.J� OWNER'S NAME 4 Q1 - NO. OF STORIES SIZE ' OWNER'S ADDRESS 990 ' �R BASEMENT OR SLAB ARCHITECT'S NAMEO� Q. C SIZE OF FLOOR TIMBERS IST 2ND 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING e OF SILLS DISTANCE FROM STREET !OO / �DIMENSIONS / /'1� POSTS DISTANCE FROM LOT LINES - SIDES REAR 7a,/ .. GIRDERS AREA OF LOT '2 --f/ QC FRONTAGE /75-/ HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW &-LA9 SIZE OF FOOTING foo M X _T IS BUILDING ADDITION c x MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND PCL WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /` ar) IS BUILDING CONNECTED TO TOWN WATER Ai p BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 4 p IS BUILDING CONNECTED TO NATURAL GAS LINE /jf3 INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 • ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED -jLlZ 7 81GNATURE O OWNER OR AUTHORIZED A FEE PERMIT GRANTED19 3 PROPERTY INFORMATION LAND COST c� 4 ?" 0 (DOD EST. BLDG. COST ^ ;E006 EST. BLDG. COST PER SQ. FT. EST. BLDG. COBT PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY SUILDING INSPECTOR OWNER TEL. # 0/"p`- CONTR. TEL. # CONTR. LIC. # H.I.C. # BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S'OHIES _ MULTI. FAMILY OFFICES APARTMENTS AN24401 _ __ CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE IN 3 1 2 13 CONCRETE 8L K. BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT lz AREA FULL FIN. B M AREA _ 1/1 1/1 '/ FIN. ATTIC AREA NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 �_ 3 _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDIIJ D COMLICN ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK N MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR I�POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBQEL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR d GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR LLE DADO l� 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd t.r O 13rd Oi ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. o d ^' o wo O O o n � o re r -• N QN = W 10 O o G7 n a O H CD an CD Cl) m p � 00 GO O� C CD O a 2! Z CD fu N CA -� WCL -4. o m C o 0 o N c o -o f =° `: m C = n coCD CD o c y CO) n f 1 Co CD y.6N CD �j' ► -y -•v" n CA a COAD 0 CZ r C' S. co 0 W W H: m cCD CL d y m � oCr d CA ad c O -t C) CD O .� O a CD v CO)J, oICN `CA z CD C) '_ ►n CZ C#12 NO !D W 1 1 CD im CA CD . . ='G = N ' .•�� t'7 CD O CD W c CD y -. �. O. CD CO) r� i--/ N m ON Op Cm' �O CD I r_ o W . OCO) Z CD m o CD �• i r :CD C, Q Off+ p 07 O CD �, CL o o 0 0 C �� CD y cn o d ^' o wo o n � o re o o Cay' < o G7 COD 0 y10M � 00 GO O� O a F-+ �O "110 y 0 0 c 0 �ll Any appeal shall be filed within (20) days after the date of tiling of this Notice in the Office of the Town Cleric. BK moi+. REi;.iACSfiA�Y . f•. Baas . `(CE ds� �;T�;.•....•�,�� �@T©WN CLERK. ►.....•. N AN _ ER 4 '62'1 PG 1�1 TOWN OF NORTH ANDA EZ MASSACHUSETTS JUH L' c_ N C�..3 oft ATTEST: R=ter a public hearinq given on the above date, the BOARD QF APPEALS ATrue Copy voted to GRANT ti,e ppnj a 1 pprmi t and herebv �n �uaG.1a�.c- to issue a permit to: NOTICE OF DECISION Town Ckrk z to certify that twenty (20) days Colonial Village Development Corn w ,, as elapsed from data of dodeion MW above work, based upon the fol* - `9 z x :.:_:out filing of Date June 21 1 99.5 Date �+ , Joyce A.BridMum The applicant must adhere Petition No. 033-95 in-law suite as outlined in the Zoning Bylaw. Tcwn Cferk M.0 Date of Hearing June 13,_1995 Petition of iColonial Village Development Corporation Ul Premises =_ffected 980 Forest Street C!' Referring to the above petition for a variation from the reauireme:=s of Section 4.2.1, para. 17 of the Zoning Bylaw sous to permit an in-law suite for a proposed house. c_ N C�..3 oft 0 CD CD Board If, eals, William Sul i an, hairman Walter Soule Joseph Faris Robert Ford John Pallone w v R=ter a public hearinq given on the above date, the Board of voted to GRANT ti,e ppnj a 1 pprmi t and herebv �n authorize the Building Inspector to issue a permit to: cr M Colonial Village Development Corn w for the construction of the above work, based upon the fol* - `9 z x c � conditions: �+ The applicant must adhere to the requirements associated with an 0 in-law suite as outlined in the Zoning Bylaw. M.0 0 CD CD Board If, eals, William Sul i an, hairman Walter Soule Joseph Faris Robert Ford John Pallone T r- N, � z o a r �. C 1p ti )::NCO ..o . o p CD C -n N O ..' Q) Din Z O y T r- N, .--r O CD 'O D a r �. C ti )::NCO ..o . o p CD C CD O ..' CD �L7 O O O CD CZ m O CD - CnnCD < O Cn D Z z O CO CD I C3 -< y O m CD Z CD 'z LC-rrL��: O CD C7 2141, ,-4 r r 003 5-0 o a .. N <. Q m N o CL CD CS, Q1D —a 3 y CD ..n tn+ --•• M a O A f "► G , CD moy ra•-« m m y Q.CD m o n ` o Z` % CA � o N' c -j mCD CD CA a C -)CD , � � o raa N N d � Cr C � W F a a N m CD � N o C CD m n ..i CD N ,- ^� n A 0 0 rn �QQ o CP m o • „ ;W N o CD 00 Z a — �� O o C-) ll Ci9 : 1 1 n 0 0 0• p C4 m T m CO w F -W :ta z O cry. �r •� 47 •� i 40iCZ t. F. h / - NORTH aricovl:R Town of Forth Andover OFFICE OF COMMUNITY DEVELOPMENT AND kRVICES + 146 Main Street . MAHONY North Andover, Massachusetts 01845 ector (508) 688-9533 Colonial Village Development Corp. * Decision 701 Salem Street * Petition #033-95 North Andover, MA 01845 PG 1 A:.4 The Board of Appeals held a regular meeting on Tuesday evening June 13, 1995 upon the application of Colonial Village Development Corporation requesting a Special Permit under Section 4.121, para. 17 of the Zoning Bylaw so as to permit an in-law suite for a proposed house located at 980 Forest Street, Zoning District R-2. Note: The applicant was given the incorrect house number by the Town therefore the legal notice advertised the property as 970 Forest Street. The correct address is 980 Forest Street. The following members were present and voting: Walter Soule, William Sullivan, John Pallone, Joseph Faris and Robert Ford. The hearing was advertised in the North Andover Citizen on 5.24.95 & 5.31.95 and all abutters were notified by regular mail. Upon a motion by John Pallone and seconded by Walter Soule, the Board unanimously voted to GRANT the Special Permit with the conditions that the dwelling unit not be occupied by anyone except brothers, sisters, maternal and paternal parents and grandparents, or children of the residing owners of the dwelling unit and also that the premises be inspected annually by the Building Inspector for conformance to this section of the Bylaw. Dated this 21 st ,day of June, 1995 i BOARD OF APPEALS 688-9341 BtJILDING 688-9545 Julie Parrirto I D. Robert Nicatta Board of Appe s, William Sullivan, Chairman Walter Soule Joseph Faris Robert Ford John Pallone CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-953` Michael Howard Sapdra Starr Kathleen Bradlcy Colwr APR. -12' 96 (FRI ) 14:4' STONEHAM SAV I NGS - TEL:61'4389400 r - L P. 002 APR,-12'96(FRl) 14:4' STONEHAM SAVINGS- TEL:61114389400 04-12-1996 13:51 6174385914 STONEHAM SAVINGS ' " L, S' B-29-1935 5:SaPI1 FROM COLONIAL VILLAGE 508 682 2337 14V, Jvl - - tr soest:aaee 4 v M w K /� SOS r oWrrwur unurr +P' CASCACrr �t,eb ,�S ar FOUNDATION LOCATION PLAN ' ci; ,, Aft= a WENT: CIOLORW i UJAOJF DRV. CARP. a� M5 AMW AND UWreg ra rxt AWK d� 1� . M4f�41� LOCanow: LOTIA AWST srr,X0.AMD0VCR.MA. Pr.9LD1=1dVP DA M-8125195 CHR/STIANSEN &SERGt--~m v^aiiimmiglooM. aw-ml-wis GtL Gi[YCN/ P. 001 P.01 P, 2 � P0/ ' � r m r�1WP17rgGW10ANr iw -- [ a► .' � Im Aoranvr p t� Aw AYI &W t M WIM AM F d;Op!a I ��. OWY.. Na: �oaJO r 7