HomeMy WebLinkAboutMiscellaneous - 99 EDGELAWN AVENUE 4/30/201810623
Check # 3
Date -1.1 jl................
ITH ANDOVER
I PLUMBING
C,A� eTe e- �
...........................
lorth Andover, Mass. •-
.............................
PLUMBING INSPECTOR
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I
CITY I N 00. A roc V e Q _ MA DATE Q 1 PERMIT #
JOBSITE ADDRESS ' 99 Ed c,1P►ww 114v4. R y OWNER'S NAME! R u 0.'t0.a5-' A VIZANc � y
OWNER ADDRESS€TEL $0$ 3?�0-"►.1.5"1�FAX {
TYPE OR
OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL '
PRINT
CLEARLY
_
NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES:f NO
FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10
11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE '.. !. (.........
___.. rT ;.._. T..i:_ ...:...._ ..
DEDICATED SPECIAL WASTE SYSTEM {
DEDICATED GASIOIUSAND SYSTEM L
E ,
DEDICATED GREASE SYSTEM ? -
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
:
DISHWASHER _
£
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR / AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL,_
SERVICE I MOP SINK
TOILET _._ . ; ...__ __._ .. , .� I ..._ . _.,, _._ , .� �
URINAL
WASHING MACHINE -CONNECTION n_.£
WATER HEATER ALL TYPES
WATER PIPING
OTHER _
.....» ...E F-. ,
INSURANCE COVERAGE:
I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES [D NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY [» BOND
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNE `j AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and acc a of best of my knowledge
i and that ail plumbing work and installations performed under the permit issued for this application will be in compliance all & hent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. j
PLUMBER'S NAME_ Philliurfee �. y LICENSE # x.13774 /SIGNATURE
z LLC
MPI101 JPD CORPORATION #� (PARTNERSHIP'- #( #' 3152
.,�., , ..:, »..... �
COMPANY NAME i Durfee Plumbinn &Heating LLC ADDRESS; 2A Huntington Ave
CITY South Yarmouth 1 STATE MA ZIP 1-026'-64 TEL 508-610,3078
FAX 508 258-0592 CELL 508801-8.004 EMAIL phil�durfeeplumbin .com
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Name {Businessi'Organizationilndividual):
Address:
Phone #:
Are you an employer? -Check the appropriate box:
1. dl am a employer with ] () _ 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ I 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. employees and have workers'
[No workers' comp, insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its
3. ❑ 1 am a homeowner doing all work officers have exercised their
myself. [No workers' comp. right of exemption per MGL
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers'
Como. insurance reauired.l
Type of project (required):
6. ❑ New consu-ttction
7. Q Remodeling
8. Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
I .I.2"Plurnbing repairs or additions
12.0 Roof repairs
13.❑ Other
"Any applicant that checks box #1 must also fill out the section below showing thcirworkers' compensation policy information.
}iomeowners who submit +this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatin, such.
Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
,=p)oyees. if the sub -contractors have employees, they must provide their workers' comp, policy number.
1 unit an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. r
Insurance Company Name: � fl*irr, T�/ .
l -r-� - i
Polic-F y # or Self -ins. Lic. / J W �i
Expiration Date:
Job
Job Site Address:191* /ya aw., City,'Statc/Zip: / wav
Attach a copy of the workers' compensation policy declaration 1>age (slhowang the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. I52 can lead to the imposition of criminal penalties of a
fine ftp to S1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and. a fire
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
Investi ,ations of the DIA for insurance coverage verification.
I do hereby (-Z �d�r the paints and penalties o perjury that the information provided shove is true said correct:
Phone #: P`56 `t/ ' t!J M ' 30 7 —
Official use only.. Do not write in this area, to be completed by city or town official
City or Torun:
Permit/License #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
The Commonwealth of Massachusetts'
m E;
-''
Department of Industrial Accidents
Office of Investigations
'
1 Congress Street Suite 100
Bostot; MA 021.14-2017
www -mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name {Businessi'Organizationilndividual):
Address:
Phone #:
Are you an employer? -Check the appropriate box:
1. dl am a employer with ] () _ 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ I 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. employees and have workers'
[No workers' comp, insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its
3. ❑ 1 am a homeowner doing all work officers have exercised their
myself. [No workers' comp. right of exemption per MGL
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers'
Como. insurance reauired.l
Type of project (required):
6. ❑ New consu-ttction
7. Q Remodeling
8. Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
I .I.2"Plurnbing repairs or additions
12.0 Roof repairs
13.❑ Other
"Any applicant that checks box #1 must also fill out the section below showing thcirworkers' compensation policy information.
}iomeowners who submit +this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatin, such.
Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
,=p)oyees. if the sub -contractors have employees, they must provide their workers' comp, policy number.
1 unit an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. r
Insurance Company Name: � fl*irr, T�/ .
l -r-� - i
Polic-F y # or Self -ins. Lic. / J W �i
Expiration Date:
Job
Job Site Address:191* /ya aw., City,'Statc/Zip: / wav
Attach a copy of the workers' compensation policy declaration 1>age (slhowang the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. I52 can lead to the imposition of criminal penalties of a
fine ftp to S1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and. a fire
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
Investi ,ations of the DIA for insurance coverage verification.
I do hereby (-Z �d�r the paints and penalties o perjury that the information provided shove is true said correct:
Phone #: P`56 `t/ ' t!J M ' 30 7 —
Official use only.. Do not write in this area, to be completed by city or town official
City or Torun:
Permit/License #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
�:�: ,��a�nr�Ma�nanxacRa -�u
Town of North Andover
Your permit has been sent back to you for the following reasons:
1) Check amount incorrect
2) No copy of current license
3) Insurance Binder not on file or expired
4) No Workers' Compensation Insurance Affadavit Form
Please call with any questions 978-688-9545.
Workers' Compensation Form and Schedule of Fees can be found on the Town of North Andover
Website under Building Department.
Date .6.bf l i......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......:...:.....!.`.l��.. �' ,C"�.... 1.� 1 kt��S......
has permission to perform .....� ......C�<<?4.v� r��j14/...................
wiring in the building of..,,..�,�C-i }
at ........1... J �C t w J2..........:.........."INSPECTOR
.................Fee .........: Lic.Not°�g2 ... ...........ELE
Check #
At�, C� 0#64 Official use04
,
Permit No.—
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS ev.1/07] eave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachuseds Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
Dater 1 `
CityorTownofQoA+� At "veZ _ To the Inspec or
of Wires:
By tris application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) qQ 010k W
Owner or Tenant Telephone Na508 •�b'7-'1:.b' 7
Owner's Address Same as above
Is this permit in conjunction with a building permit? Yes ❑ No Q (Check Appropriate Bos)
Purpose of Bmldmg Dwelling Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Vohs . Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: k,—p6,c d.b�w ae�� fZ ► ►� t•Z. �,
n_�_I...:.....,s'.L., 4.11-6- snl.lo —m 1W weiWd 11V the InSDeClOr Of tires.
Estimated Value of Ele ical Work: $660.00 (When required by municipal policy.)
Work to Stan: 1 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE CO E: 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 0,at such coverage is in force, and has exhibited proof of same to the permit issuing office.
CMM 0NE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) true n is and c:o fete.
7 certify, u�.the pains and penalties of perjury; that the informadon on this appkcatio mp
FIRM NAME: Northeast Electrical Services INC. LIC. NO.: 20782A
Licensee: Daniel B. Kobus Signature C. NO.:
(Ifapplieabk, eater "exempt" in the license comber line) Bus. TeL No.. 5W966-7467
Address: 40 N. Main Street, P.O Box 361, Bellingham, MA 02019 Alt TeL Na:
*Per IvI.G.L. c.147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S .INSURANCE WAIVER:. I am aware that the Licensee does not have the liability insurance coverage normally
required by law.. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owder/Agent Telephone Na PERMIT FEE: S.
Sfig�natim f
. 1
No. of o
No. of Recessed Luminaires
Na of CeiL-Susp. (Paddle) Fans
Transformers KVA
Na of Luminaire Outlets
Na of Hot Tabs
Generators KVA
Na of Luminaires
Swimming Pool �Odve ❑ d. ❑
a o me
Butte Units
Na of Receptacle Outlets
Na of Oil Burners
FIRE ALARMS Na of Zones
a o on and
No. of Switches
No. of Gas Burners a
Initiating Devices.
Na of Ranges.
Na of Air Cond. Total
Tons
Na of Alerting Devices
No. of Waste Disposers
eat p umber Tons
Totals•
o. of t ontained
Detedion/Ale Devices
'
Na of Dishwashers 1
Space/Area Heating KW
ani Other
Local ❑Connection ❑
Na. of Dryers
tiA
Heating Appliances KW.
s'
Na of ices or Equivalent
Na of star'
$�
"
a of a of
g- Ballasts
Data Wiring.
Na of Devices or aivalent
lqo. Hydromassage Bathtubs
No. of Motors Total HP
Telel trmg�
Na of Devices or E nivalent
OTHER: the Irz manr Of Mires.
Estimated Value of Ele ical Work: $660.00 (When required by municipal policy.)
Work to Stan: 1 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE CO E: 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 0,at such coverage is in force, and has exhibited proof of same to the permit issuing office.
CMM 0NE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) true n is and c:o fete.
7 certify, u�.the pains and penalties of perjury; that the informadon on this appkcatio mp
FIRM NAME: Northeast Electrical Services INC. LIC. NO.: 20782A
Licensee: Daniel B. Kobus Signature C. NO.:
(Ifapplieabk, eater "exempt" in the license comber line) Bus. TeL No.. 5W966-7467
Address: 40 N. Main Street, P.O Box 361, Bellingham, MA 02019 Alt TeL Na:
*Per IvI.G.L. c.147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S .INSURANCE WAIVER:. I am aware that the Licensee does not have the liability insurance coverage normally
required by law.. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owder/Agent Telephone Na PERMIT FEE: S.
Sfig�natim f
. 1
r-C4-t� <f 9�
/ 0 " 14 -/��
��1?�r�n#�L}#
The Commonwealth of Massachusetts `` k
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers bl
A liont Information Please Print Leg v
Name (Business/Organization/Individual):
Northeast Electrical Services
Address:40 N. Main Street, P.0 Box 361
Belli ham, MA 02019 Phone #:508-966-7467 x307
City/State/Zip: 9
Are you an employer? Check the appropriate box: Type of project (required):
I .✓❑I am a employer with 24 4. E]I am a general contractor and 1 6 E] New construction
have hired the sub -contractors
employees (full and/or part-time).* listed on the attached sheet. ❑ 7. ,/ Remodeling
2. LJI am a sole proprietor or partner-
ship and have no employees
working for mein any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself [No workers' comp.
insurance required.] t
These sub -contractors have
employees and 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'
come. insurance required.]
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 #1 must also fill out the section below showing their workers' compensation policy information.
r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
'Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Automatic Data Processing Insurance Agency, Inc.
NOW428117 Expiration Date:7/29/14
Policy # or Self -ins. Lic. #:
Job Site Address: AV -e City/State/Zip: KV) PsVf , �n VN5
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
invP-tioations of the DIA for insurance coverage verification.
I do hereby certi under the ains and enalties of erjur that the information provided above is true and correct
A,YI,f it /' _ _ Date
Si ature
Phone #:508-966-7467 x 307
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 #:
1
DateJ .4 /-//. & ........
'R
TOWN OF NORTH ANDOVER
'2'0N
• PERMIT FOR GAS INSTALLA ION
This certifies that .... ................
has permission for, gas installation n ....................
in the buildings of ... .....................
at �5.'A .......... North Andover, Mass.
Fee... .--Lic. No..
As INSPEC��
Check# 6,
72+6
L�r, ��� �M
MASSACHUSETTS UN IF ORMAPPUCATON FOR PER W TO DO GAS FITTING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date
Building Locations Y -/y/ 1d )41 ✓A ( �
�Permmit # 47
ount $
6601101Owner's Name
New Renovation a ReplacementBOO' Plans Submitted ❑
(Print or
Name_
Name of Licensed Plumber or Gas Fitter T n r , . K 1 1^: rr tj
Check one: Certificate Installing Company
.0 Corp.
Partner.
9-Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes M/ No[3
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity Bond
Owner's Insurance Waiver. I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement
Signature of Owner or Owner's Agent Check one:
Owner 13. Agent
I hereby certify that all of the details and information I have submitted (or entered) in above appli n are true and accurate to the
best of my knowledge and that all plumbing work and in ons perfo ed under Permit Is for is application will be in
compliance with all pertinent provisions of the Massac ,�etts tate Gasj(od"d Chh 14 f General Laws.
(OFFICE USE ONLY)
Signature of.
Plumber
Gas Fitter
Master
Journeyman
Sed Plumber Or Gas Fitter
icense Number
Q
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2ND. FLOOR
i
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
S.T.H. FLOOR
(Print or
Name_
Name of Licensed Plumber or Gas Fitter T n r , . K 1 1^: rr tj
Check one: Certificate Installing Company
.0 Corp.
Partner.
9-Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes M/ No[3
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity Bond
Owner's Insurance Waiver. I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement
Signature of Owner or Owner's Agent Check one:
Owner 13. Agent
I hereby certify that all of the details and information I have submitted (or entered) in above appli n are true and accurate to the
best of my knowledge and that all plumbing work and in ons perfo ed under Permit Is for is application will be in
compliance with all pertinent provisions of the Massac ,�etts tate Gasj(od"d Chh 14 f General Laws.
(OFFICE USE ONLY)
Signature of.
Plumber
Gas Fitter
Master
Journeyman
Sed Plumber Or Gas Fitter
icense Number
o
'Lee,
Date. 0 .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .... V . L... �. `� J........ .
has permission to perform .... .................... .
plumbing in the buildings of ... F!c.1H �.;��v
at.. .%-/Gl... North,AAndover, Mass.
Fee.)-.�..r.. Lic. No..�J .9. 5. �! ............. D... .
PLUMBING INSPECTOR
Check # f i w
u
owner 0 Agent ❑
best reby cer* ,that all of the details and infrumation I have submitted {or entered) m a pp artion are true and:w7!b_-
to the
my edge and that all plumbing work tions P ,
eompIiance with all pertinent pmvisions of the Mas State this appli:: in
derma 1 of the General
Type of Plumbing Lice
own l-icense �
[LOVED tommus8 omy Master Journeyman 0
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owner 0 Agent ❑
best reby cer* ,that all of the details and infrumation I have submitted {or entered) m a pp artion are true and:w7!b_-
to the
my edge and that all plumbing work tions P ,
eompIiance with all pertinent pmvisions of the Mas State this appli:: in
derma 1 of the General
Type of Plumbing Lice
own l-icense �
[LOVED tommus8 omy Master Journeyman 0
Date /. ///h- ell. .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING.
This certifies that ... II , "f -. -. . A.q C. /. ( .(. t ...................
has permission to perform .... )� .... 5-11 . %--,1 /-4- / � . ........
plumbing in the buildings of . ................
at ... North Andover, Mass.
Lic. No../ W5. Z :) . ..........
PLUMBING _ �IN-SpecT IR
Fee. .6
Check#
7208
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
ll T Ji. 0-orfi , A f�_ Blass. Cate inyv,- H , r:.�D Permit -c>_
-iG 1
B iilding Location Q F_ � ��� Owner's Name
v ---
``'r _ Type of Occupancy ^
Renovation - Replacement Plans Submitted: Yes 'J No
11
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y
FIXTURES
Installing Company Name Nnrni-n-Cn OF MA n/R/A Roi-o-Roo Check one: Certificate
.4ddress175 Maple Sheet Corporation 259-C
Stoughton MA, 02072 r Partnership
Business Telephone -781- 97-7049 ❑ Firm/Co.
Name of Licensed Plumber naniQl u„ntrP�s
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of YGL Ch. 142.
Yes No
if you have checked ves, please indicate the type coverage by checking the appropriate box.
A. liability insurance policy Other type of indemnity ❑ gond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Clhaiter 142 of tie i'Aass. General Lave s, and that my slgnatura on this permit application waives tills requlr.'_men...
Check one:
Or✓ner Agent
7
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Installing Company Name Nnrni-n-Cn OF MA n/R/A Roi-o-Roo Check one: Certificate
.4ddress175 Maple Sheet Corporation 259-C
Stoughton MA, 02072 r Partnership
Business Telephone -781- 97-7049 ❑ Firm/Co.
Name of Licensed Plumber naniQl u„ntrP�s
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of YGL Ch. 142.
Yes No
if you have checked ves, please indicate the type coverage by checking the appropriate box.
A. liability insurance policy Other type of indemnity ❑ gond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Clhaiter 142 of tie i'Aass. General Lave s, and that my slgnatura on this permit application waives tills requlr.'_men...
Check one:
Or✓ner Agent
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Date . y:d.. ,!� 3 .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
'...
This certifies that ........../J... .
has permission to perform ..13. ,y ........................ .
plumbing in a buildings of... _�!.......-............
at ./ ........................ North Andover, Mass.
Feel?fP�9--� .. Lic. No.. 95� -/ ........WPS
:......... .
` J PWMCTOR
Check # 6 S l
61
5703
A
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS l
_ � Date q�
Building Location IT `i � A � t� � ? C-) -n Owners Name � Q ✓�'�` Permit #��
Amount 9t/62)
� Type of Occupancy
New 1:1 Renovation
Replacement ® Plans Submitted Yes ❑ No
It
(Print, or type)
Installing Company Name Q S
AAAI ec I ', d L rl,^ v,) �I
CaCorp.
ne:
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Partner.
® Firm/Co
Name of Licensed Plumber:
Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity 11 Bond ❑
Certificate
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 11 Agent
I hereby certify that all of the details and infon
best of my knowledge and that all plumbing w
compliance with all pertinent provisions of the
By:
Title
City/Town
APPROVED (OFFICE USE ONLY
have submitted (o entered) in above application are true and accurate to the
stallations perf rmunder Permit Issued for this application will be in
kt
e Plu g Code and Chapter 142 of the General Laws.
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Type of Plumbing License
Lj
tense TNumDer Master Joumeyman 0 -
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(Print, or type)
Installing Company Name Q S
AAAI ec I ', d L rl,^ v,) �I
CaCorp.
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Partner.
® Firm/Co
Name of Licensed Plumber:
Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity 11 Bond ❑
Certificate
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 11 Agent
I hereby certify that all of the details and infon
best of my knowledge and that all plumbing w
compliance with all pertinent provisions of the
By:
Title
City/Town
APPROVED (OFFICE USE ONLY
have submitted (o entered) in above application are true and accurate to the
stallations perf rmunder Permit Issued for this application will be in
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&
Type of Plumbing License
Lj
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,SSACHUS�
This certifies that
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
Z0. � ....5fvm. � .:.P .
has permission to perform .....(1 �S�n1; �Sp.j2^ ..............
plumbing in the buildings of ....�.....................
at .... .. e ... vv� ... AV�. , North Andover, Mass.
Fee 30 .w. Lic. No.
1 PLUMBING INSPECTOR
Check
FIXTURES
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: MA. Date: Per it#
,
Building Location. ' _ Owners Name-
T
Type of Occupancy: Commercial ❑ EducationalE] Industrial ❑ Institutional ❑ Residential[' J
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: V Plans Submitted: Yes ❑ No
FIXTURES
INSURANCE COVERAGE:
I have a current Ilabilft insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes (Y16' ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Sionature of Owner or Owner's Aaent
1 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 Lavj%
By Type of License:
Tale ❑ Plumber VSatu"re of Licensed FTumber
Cityf .o`"n "aster .
npaRnvFn rnpRrx i inp n�ui v► []journeyman Number:
journeyman 9
DEDICAUD
SYSUMS—
,
Check • - • nly
Certificate #
[4.rporation
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mpany
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11
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INSURANCE COVERAGE:
I have a current Ilabilft insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes (Y16' ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Sionature of Owner or Owner's Aaent
1 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 Lavj%
By Type of License:
Tale ❑ Plumber VSatu"re of Licensed FTumber
Cityf .o`"n "aster .
npaRnvFn rnpRrx i inp n�ui v► []journeyman Number:
journeyman 9
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BOARD OFHEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
Mr/Ms Marchetta
99 Edgelawn Ave.
Unit #2
North Andover, Mass. 01845
TEL: 682-6483
Ext 32 or 33
July 20, 1990
it has recently been reported to this office that you are
harboring 13 cats in your condominium. To keep so many animals in
limited space not designed for the purpose can be very unhealthy
for both you and the rats. In additions your neighbors are
concerned about the smell Of urine and feces emanating from your
home.
The complaint has been forwardzd to the M.S.p.C.A., who will be
contacting you. We hope that this matter can be promptly resolved
to the satisfaction of all concerned.
Sincerely,
Stephanie J.C.Foley
Hpalth Agent
Dear ���_l\ c?► t�"��` �rY\Ca 1jt;j,*!\
As you know, I have talked with you about the report of suspected
child abuse and/or neglect in your family which was received by the Department
of Social Services.
After visiting with you and your child(ren) and talking to other people who
know your family, the Department has found no reasonable cause to support the
allegation(s) that your child(ren) has been abused or neglected.
If the report about your child(ren) came from a person who is required by
state law to make this type of report (this could be a doctor, nurse, teacher or
other professional) I will be sending them a copy of this letter.
If you would like to know more about any services which DSS can offer you
or if you would like to apply for services, please contact:
If you have any questions about this letter or want to talk to me, please
call me or come to my office.
Sincerely,
s
CY
r
cc: Mandated Reporter
• ENTRY LETTER -4 NOTICE TO PARENTS OF INVESTIGATION OUTCOME: REPORT UNSUPPORTED
t, OAS 116 ON A FAMILY NOT CURRENTLY RECEIVING SERVICES (Rev. 12/88)
July 20, 1990
Mr/Ms Marchotta
99 Edgulawn Avc.
Unit #2
North Andover, Mass. 01845
It has recently been reported to this office that you are
harboring 13 cats in your condominium. To keep so many animals in
limited space not designed for the purpose can be very unhealthy
for both you and the cats. In addition, your neighbors are
concerned about the smell of urine and feces emanating from your
home.
The complaint has beer• forwarded to the M.S.P.C.A., who will be
contacting you. We hope that this matter can be promptly resolved
to the satisfaction of all concerned.
Sincerely,
Stephanie J.L.Foley
Hoolth Agent
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P 257 054 669
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
sent to Marchetta RE: CATS
Street and No. 99 Edgelawn Ave
P.O., State and ZIP Code # 2
H•f�2iTA GE.--• Green -Gendes
PostageN . ANDOVER
Certified Fee
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Return Receipt showing
to whom and Date Delivered
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Date, and Address of Delivery
TOTAL Postage and Fees
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BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
Mr/Ms Marchetta
99 Edgelawn Ave.
Unit #k2
North Andover, Mass. 01845
TEL: 682-6483
Ext. 32 or 33
July 20, 1990
It has recently been reported to this office that you are
harboring 13 cats in your condominium. To keep so many animals in
limited space not designed for the purpose can be very unhealthy
for both you and the cats. In addition, your neighbors are
concerned about the smell of urine and feces emanating from your
home.
The complaint has been forwarded to the M, S. P. C. A. , who will be
contacting you. We hope that this matter can be promptly resolved
to the satisfaction of all concerned.
Sincerely,
Stephanie J. L. Foley
Health Agent
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
Mr/Ms Marchetta
99 Edgelawn Ava.
Unit #2
North Andover, Mass. 01845
TEL: 682-6483
Ext 3Ior33
July 20; 1990
It has recently been reported to this office that you are
harboring 13 cats in your condominium. To keep so many animals in
limited space not designed for the purpose can be very unhealthy
for both you and the cats. In addition, your neighbors are
concerned about the smell of urine and feces emanating from your
home~
The complaint has been forwardEd to the M=S.P°C.A.v who will be
contacting you. We hope that this matter can be promptly resolved
to the satisfaction of all concerned.
Sincerely,
'
Steph�nie J.L:.Foley ~
Hpalth Agent
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® UNDER: Complete Items 1, 2, 3, and 4.
Add your gess In the "RETURN TO"
space on reverse.
(CONSULT POSTMASTER FOR FEES)
1. The following service Is rested (check one).
SWj to whom and date delivered ............... s
Show to whom, date, and address of delivery- 1
2. ❑ RESTRICTED DELIVERY ...........................
(rhe Msht W Jai M hDe tt charged !e r ddt
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TOTAL
3. ARTICLE. ADDRESSED TO:
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4. TYPE OF SERVICE: ARTICLE NUMBER
13 REGISTERED ❑INSURED �f
❑CERTIFIED 13COD
❑ EXPRESS MAIL
(Akup atttatn elgmture of addressee or apcat)
I have the article described above.
SMAT RE 0Addressee/—,0Auftrized Mm
S' DA OF 6ELIYERY �'i LPOSTMARK
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BOARD OF HEALTH
►` 120 MAIN STREET
NORTH ANDOVER, MASS. 01845
Mail return receipt requested
TEL.:682-6400
2/12/87
Marlene Leatherbee
220 Boylston St.
Boston, Ma. 02116. re=99 Edgelawn Ave.
North Andover,Mass.
Dear Ms. Leatherbee,The toilet in your condominium. at this addres
lea' -s This is a violation of Massachusetts regulation 410-351
which clearly establishes the owners responsibility to maintain
plumbing fictures. A copy of the Lregulations is enclosed.
You are hereby ordered to correct this violation
within two weeks of receipt of this letter. Violations of the State
Housing Code are subject to a fine of up to $500.00 dollars,and
each days failure past the date of the order to correct the problem
constitutes a separate and additional violation. The conditions
which exist may permit the occupant of the dwelling to exercise
one of the several legal remidies which are allowed. A copy of these
remidies is also enclosed.
If you feel'that maintaining your propertyis an
unreasonable request you may request a public hearing on front of
the Board of Health by filing a written petition with us within
seven days of the reciept of this,letter.
cc J.Shea 99 Edgelawn Ave.,
hevcr 907 reTC&O rte, pi
t�vr kIT segz lcr)b-d sgid 5lied
W.��1(0 69PIgtr Tl�ov.'
Sincerely
Board of Health INspe or
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
COMPLAINT FORt•1
Made by �Uh T
DATE FEB
TEL. 682-6400
Address A Ai/ ! Te 1
tri !1
Nature of complaint v,, C C.
f _ I
La Qtau L,- . L
Location � � �I\Q Occupant J "tA d L" ova
Owner or Agent r UjAx- LR -e - be --e- Address 2-Z,0 f j (.I4vz J j'
Y23" Coto 63os��, AAA brit
W Nf)T WRTTF RFT.01AT TNTq T.TNF t
Referred to Date of Investigation
Result of investigation
U(o`c4T,eyi qio. 5 Zcwrlerid wdhl'r bac tkyhTil 16-s?
Recommendations
Action taken
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P-586 441 213
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR IXTERNA"ONAI MAIL
(See Reverse)
Sent to VC
Street and No
a. D7-
P.O..
P.O.. State nrd ZIP Code 021
Postage
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Certified Fee
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to whom.and Date Delivered
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TELEPHON!
:uUrasa (. 4`06E WIV
�.y r1JJr Apailmerli No. No OccupantsNo or Haoilaole Rooms -.. No Siaeomg Rooms - _ No aweding or rooming units .... -._-_ . _ No Stones ...—. f
Name and auuress of owner M...r� j,3%_ZLl9
r YARD Out Slags.: Fences:
Garoa a and RuoOlsn:
Containers: +
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps, Stairs, Porches:
Dual Earess: and Obst'n.:
O 8 ❑ F ❑ M Doors. windows:
Root. _.
Gutters. Drains:
Walls: -
BASEMENT. I Gen Sanita
namnni477
Ti1>�
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICM
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF TME
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE COOS OR THE
AUTHORIZED INSPECTOR. (See Over)
INSPECTOR MIK�G.0F. _— TITLE.. -
//7 A. M.
DATE - - TIME ! V P.A.
A $i
THE NEXT.SCHEDULED REINSPECTION .._ _ __ ..__.. _.. P M. Vp
s
,i -
Stairs:
Liantin :
STRUCTURE INT.
Hail, Stairway:
Obst'n.:
Hall, Floor. Wall. Ceiling:
Hao Lignnng:
Hall Windows:
HEA TINGChimneys:
Ceni.ral O Y O N
TYP+3:
— —?`--
Eauio. Reoair
Slacks. Flues. Vents:
PLUMBING:
7 MS O ST O P
I Supoly Line:
waste Lina:
H W Tanxisl Saletv and Vent(s) j
ELECTRICAL
0110 0 220
AMP:
Panels. Meters. Cir.: �g!
Fusina, Grnd.:
Gan. Cond. Distnb. Box:
I Uen. Basement Wiring:
Kitchen
DWELLING UNIT i t
Venni. I L to . Outlets walls Cads. Wind. Doors I Floors locks .
bathroom
Pantry
-
pen
Living Room
bedroom 1)
Bedroom (2)
bedroom (3)
_
6edroom (4)
Hot Water Faeil._
Suo Ten.
Stacks. Flues Vents Safeties:
Kitchen Facilities
--I
Sink 1 _
-
Stove
Bathing, Tollet Faeil.
Vent. Pluinti. S inirn.: i
Wash Basin, Shower or Tub:
Inforotlllfoh
ais, Ml e, RoachN or Olner. -
Egress
Dual and t bst'n,.
General
Building Posted:
Locke on door*:
Ti1>�
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICM
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF TME
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE COOS OR THE
AUTHORIZED INSPECTOR. (See Over)
INSPECTOR MIK�G.0F. _— TITLE.. -
//7 A. M.
DATE - - TIME ! V P.A.
A $i
THE NEXT.SCHEDULED REINSPECTION .._ _ __ ..__.. _.. P M. Vp
s
,i -