HomeMy WebLinkAboutMiscellaneous - 99 PHEASANT BROOK ROAD 4/30/2018THE COMMONWEALTH OF MASSACHUSETTS
fJSCAL YEAR
OFFICE OF COLLECTOR OF TAXES
N 1998
TOWN OF NORTH ANDOVER
YOUR PRELIMINARY TAX FOR THE FISCAL YEAR
BEGINNING JULY 1, 1997 AND ENDING JUNE 30, 1998
ON THE
PARGELOF REAL ESTATE DESCRIBED BELOW IS AS
FOLLOWS:
'N
MAIL TO P.O. BOX 124
Map 106B
NO. ANDOVER, MA 01845
Block 0228
OFFICE HOURS:(120 MAIN ST.)
Lot 00000
TUES TO FRI 8:30AM-4:30PM
MONDAYS 8:30AM-7:30PM
ASSESSOR'S OFFICE= 688-9566
TREAS-COLL OFFICE= 688-9550
PRIOR YR TAX BAL. NOT INCLUDED
Page: 1209 Line: 2
Location: PHEASANT BROOK ROAD
THIS FORM IS APPROVED BY THE COMMISSIONER OF REVENUE
SEE REVERSE SIDE FOR IMPORTANT INFORMATION
Taxpa�7er' s Copy
COLLECTOR OF TAXES
KEVIN F. MAHONEY
VERGADOS, NICHOLAS
CONNIE VERGADOS
8 DOUGLAS ROAD
CHELMSFORD MA 01824
115
PRELIMINARY REAL ESTATE
TAX BILL
2nd Quarter BILL NUMBER 9396
Preliminary Tax: 643.08
1st Pymt Due: 8/01/97 321.54
2nd Pymt Due:11/03/97 321.54
Credits Appl'd -321.54
Past Due:
Balance Due: 321.54
Amount Now Due: 321.54
INTEREST RATE OF 14% PER ANNUM WILL ACCRUE ON OVERDUE
PAYMENTS FROM THE DUE DATE UNTIL PAYMENT IS MADE.
98 09396000 3 0000032154 9
i
SCAL YEAR 1998 98 PRIEr�'I INA tY TAX..: This bill snows the amount of preliminary tax you owe for fiscal year 1998 (,July 1, 1997 -June 3Q, 1998),
PREL,t'INARY TAX APviC3',`NT; As a general rule; your oreli€�inary tax will not exceed 50% of your adJuslqr? fiscal year i 99'7'tax (including any betterments;
special assessrer t.� and other c^arges ached to the tax). Adjustments are made for any abatement or exemption granted for fiscal year 1397, and any tax
increases allowed under 6' R)pos f=on 21 _ in fiscal year 1998. Under certain circumstances, your preliminary tax may exceed 50% of the adjusted arrIount.
PAY -MEN t C'. E DAFE.S... INTEREST CHARGES:: If preliminary bills were mailed on or before August 1. 1997, your preliminary tax is payable in, t.Wo equal
iristailM nis.Your fist payr„€ ns is due August 1, 1997, or 30 days after iho bills were mailed, whichever is laler.Yot,r second payment is due Novombor 1;
1997. Hov^,ever, if preliminary bills were mailed after August 1, 1997, your preliminary tax is payable in fulfil on November 1, 1997, or 30 days after the bilis
were rnailed, whichever is later. li your payments are not made by their due dates, interest at the rate tiwili be charged on the amount of the payment
that is i=='1pji d and overdue. If ;are liminary bills were mailed on or before August 1; 1997, interest will be compL.ted on overdue first payments from August 1,
1997, or the payment, due date, vvihiche:ver Is hater, and on overdue second payments frorn November 1, 1997, to the date payment is made. If preliminary
bilis were aiailed after August 1, 1997, interest will be computed on overdue payments from November 1; 1897; or the payment due date, whichever is later,
to the (late payrrieW is made. You will also be required to pay charges and fees incurred for collection if oaymemts are not: made when due. Pavaienis are
considered made v,,he . receivea..by thie Collector, To obtain a receipted bill, enclose a self-addressed stamped envelope and both copies of the bill with your
payrner it.
f=1SCAL YEAR 1998 ACTUAL l �L,,"1AX BILLS: will receive your actual tax bill for fiscal year 1998 after your community sets its tax rate. Any preliminary tax
payrnen s (rode will! )e crodited t , vard roayment of your fiscal yea,r1998 tax. Your actual tax bill will provide you with more detailed inforrnation on payment
die dates,
ABATEMENTrEYEEMPTiON APPLICATIONS: Your right to seek an abatement of or exomption from your fiscal year 1998 'tax is not prejudiced by the
issuance of preliminai,y tar. bills. Once the actual tax bills are issued, you will be able to apply for an abatement or exemption. The deadline for fling your
abatement or exerrrp ion applicaVon will be (measured from the date the actual tax bills are mailed, not the date preliminary tax bills were rnailed. Your actual
tax bill wi l provide you :asitia more d :=taled information on application procedures and deadlines.
INQUIRIES: S: If voi,r have cuesVons on hair your preliminary tax was determined, you should contact the Board of Assessors. If you have questions on
pnymeats, yo i should contact the Collector's Office.
T T
;F 1 z�N DOVE M. A5 A
R K S
E 1VIS�(_X-J OF PUBLIC 'VV'
GEORGE PERNA
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DRIVEWAY PERMIT
Date:
LOCATION:
BUILDER: phone:
Telephone (508) 685-0950
Fax (508) 688-9573
OWNER: phone: 7oe:> 9
The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the
grade and set -back from street established in any driveway entry onto any street or way maintained by
the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval
of such entry.
FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT.
Remarks:
Approval:
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'*-NI` 3939
ftNORT: , TOWN OF NORTH ANDOVER
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PERMIT FOR PLUMBING
SSACNus� '
This certifies that .'�'--' '�. ...............
has permission to perform . 61 ..................
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plumbing in the. -buildings of ... ......... ...............
at ...i . /..... ? `.. ; North Apdoyer, Mass.
PLUMBING INSPECTOR
02/16/99 12:10. 300.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PER IT TO DO PLUMBING
(Print of Typo)
,�,7—, Mass. Date ✓ 19� Permit # 3 �'.
Binding Location � .,,t ,. 1 . � wner's Name
Type of Occupancy
New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name �/'���/��R Check one: Certificate
Address Z� r�C�jiR-7,r lr�e�oLra. l�,! ,[� 3G3 i2(Corporation
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Business Telephone G 63 -3 eb 3 ❑ Firm/Co.
Name of Ucensed Plumber L L4
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yea k No ❑
If you have checked yn, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy K- Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my
knowiedge and that all plumbing work and installations parlorunder Ne permit is- u for this application will be in compliance with all
pertinent provisions of the Massachusetts State, Plumbing e, Chapter of lha rat Laws
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INSURANCE COVERAGE:
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If you have checked yn, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy K- Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my
knowiedge and that all plumbing work and installations parlorunder Ne permit is- u for this application will be in compliance with all
pertinent provisions of the Massachusetts State, Plumbing e, Chapter of lha rat Laws
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TOWN OF NORTH ANDOVER g
PERMIT FOR GAS INSTALLATION
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GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS, UNIFORM APPLICATION FOR PERMIT TO DO GA FITTING
(Print or ype) P 9J
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` Building Location % % ;0hC4�r'�L
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INSURANCE COVERAGE:
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Yes 9, No ❑
If you have checked yes, please ,Indicate the type coverage by checking the appropriate box.
A liability insurance policy K'
Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above 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 provisions of the Massachusetts State Gas Code and Chapter 142 of the ra laws. n
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Yes 9, No ❑
If you have checked yes, please ,Indicate the type coverage by checking the appropriate box.
A liability insurance policy K'
Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above 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 provisions of the Massachusetts State Gas Code and Chapter 142 of the ra laws. n
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.4 ". 11 -;� Date.... .
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that.... i(C4.04A .... Co. 12.�..................
has permission to perform .... -4V
wiring in the building of .... ................................................
A ...............................
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.. . ...... fif .... !fN�rth Andover. M�Ss.8
at ..... ...........................
Fee.35...'().O.. Lic. No.1177C.
ELECTRICAINSPECTOR
C�
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
ThECUWONWF•4LTHOFAL4yS4CHL7SE77'S' Office Use only
7A8.
DEPART712FJYTOFPiIBLICS4FElY Permit No.
BOARD 0FFIREPREVLV70NRWUT4TI0A S527G�M 12:00 --�'
Occupancy & Fees Checked
116-UVPPLICATIONFOR PEST TO PE PERFORM ELE=CAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MAssACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date !/� —
�g
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below. /�
Location (Street & Number) _ 22 �� oL/� ± (aL z2
Owner or Tenant
Owner's Address
'A
Is this permit in conjunction with a building permit: Yes No :0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ® Underground ® No. of Meters
New Service Amps / Volts Overhead ® Underground ® No. of Meters e�
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
and
round
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
A
Si s
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
hstrwxC wrage. Ptrsuar>t�lhere�atlarisofMassadasdlsC�ataalLam
Iha,,eaaxmlLihltyhnra=PobyuaLdgCanpk!e Covet-agecritssttslargiale#alat YES NO
I tow stibxrtiuedvatidxdafsanetDtheOffioe YES F1 NO ® Ifj uhmduicedYES pleaseirdc*thetypeofwo wr bydi-dmrgthe
WSURANCEBOND ® 01I-iER ® (P1taseSpeu(y) _
Ex a6w Dae
EMnaled VahredEl &Aml Work $
WodctoStart e _ ��� � hspection *R d Rough Final
FIRM NAME 1 — (/Yl Ct7 n
n LicaseNa �/�j� � C..
Lroasee r� i,�Lll®_
'64 Sign. r L seNO , Jg V
BiTa Na 47 1?s 2 -NSA'
C j Alt Tel Na
OWNER'SNSL�WANER;lama%Nmbldr dmm ethe irsuraaxe oritsshr>bal e4ovallatasz*urdby C,kneniLmNs
and 8rtmyWmftnrn$aspmnit tv4aiymt)zM4 X*aT
(Please check one) Owner Agent ED
Telephone No. PERMIT FEE
OEfice Use only
7 The Commonwealth of Massachusetts
D , Permit �o /,3�(
apartment of Publlc.Safety
„an Occupancy & Fee Checked "
BOARD OF FIRE PREVENTION REGULATIONS 527.CMR 1200 .3/90
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ,ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527: CMR 12:00
(PLEASE PRINT INh INK OR TYPE ALL INFORMATION)ry ie14 17if
City or Town of PSL=A e of =11"-- To the Inspector ol Wires:
The undersigned applies for A permit to perform the electrical work described -below.
Location
Owner or
(Street & Number) 1 �h•��( Irl ✓Tf Gryo �o+-
�' j
TenantAhch
o ias- 5
Owner's Address
Is this permit in conjunction with a building; permit:
Yes, ❑
Purpose of Building Utility
No ❑
(Check Appropriate Box) �-
'>
Authorization NO. h
Existing Service Amps / Volts Overhead ❑ .Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and'Ampacity 03 -770
Location and Nature of Proposed Electrical Work : e" kA.e0eA Q,U S g_ a Lx Cie (an 4.
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
g g
Above In-
Swimming Pool, grnd. ❑ grnd. ❑
Generators':. KVA
No. of Receptacle Outlets
No. of Oil Burners
No sof Emergency Lighting
Batter• Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local 0Municipal ❑Other
Connection
No. of Ranges
Total
No. of Air Cond. tons
No. of Disposals
No. of Heat Total Total Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
Nosf Ballasts No. of
Low Voltage
ng
No. Hydro Massage Tubs
No. of Motors Total HP.
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts GeneralLaws /
I have a current Li ilit Insurance. Policy including Completed Operations Coverage or ids Substantial
equivalent. YES NO I have submitted valid proof of same .to this..office. ,..YES,_ NO ❑
If you have ch ked YES; please indicate the type of coverage by checking'the'appiopriate box.
INSURANCE BOND ❑ OTHER ❑ (Please Specify)
Expiration Date
Estimated Value of Electrical Work $
Work to Start Inspection Date,Required: Rough Final
Signed un
FIRM NAME
Licensee
—�j 'Yaai�
Address '� P �i D�� a / S 6��'`/�... � r. Z� Dye�_�
Alt., Tel. No� .�S� SS
0 SS
OWNER'S INSURANCE.WAIVER- I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General •Laws,.and that my :signature on this permit
application waives this r uirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE
Sienature of er or Aeent
I#
Mr 15 41 Date....
4
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies th6............... ... ...................................
has permission to perform -.0 ..... . .................................
- , 42'—'A:� : ........................
wiring in the building of .....
.........................
at
.......... North Andover, Mass.
.... Lic. No�./ . ..............................................................
ELECTRICAL INSPECTOR
04/22/98 15:08 3.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
December 21, 1998
Mr. Michael McGuire
Building Inspector
Town of North Andover
27 Charles Street, 2 d Floor
North Andover, Massachusetts 01843
Re: 99 Pheasant Brook Road Structural Review
Dear Mr. McGuire:
Per your request, H.H. Morant & Company, Inc. performed a visual structural inspection at the
above referenced residence on December 12, 1998. The inspection was performed to determine
the structural condition of the Trus Joist MacMillan, Micollam LVL beams, Parallam columns,
TH joists and CDX exterior sheathing.
During our inspection we noted the following structural information:
1. The "Trus Joist MacMillan" TH joists showed no structural signs of moisture and/or
delamination of the product. The Til joists at the exterior sills of first, second and ceiling
joist framing which would show the greatest amount of weathering all appear to be
structurally adequate.
2. LVL beams and Parallam columns show no structural deficiencies due to moisture damage
and/or water penetration. Connections at all joining points of members also appear to be
unaffected by their limited exposure to the weather.
3. Exterior CDX wall sheathing although showing signs of discoloring does not display any
structural and/or material failure. Although it would be advised that prior to installation of
house wrap, plywood should have at least 3 days exposed to dry weather, to remove any
top moisture on sheathing.
In conclusion, it is our opinion, following completion of the above noted recommendations, that
the residence is structurally sound. If you need additional information, please advise.
SWL/99pbrl
K. H. Morant 0 Co., Inc.
P.O. Box 4485
(Salem, M&BsachusettcS 01970
978.744.5354 Fax 978.740.9161 Email: hhm@Uac.net
UTown Of North AndoverProject: 99 Pheasant Brook RD
Building Department
146 Main St. Town Hail Annex
508-688-9545 DATE: September 20, 1997
APPLICANT: Nicholas Vergados
RE:_ 99 Pheasant Brook Rd.
Title of Plans and Documents: Building Permit Application & Drawings by Wm. Balkus
Associates
Please be advised that after review of your Building Permit Application and Plans that your
Application is DENIED for the following reasons:
P
inUse not allowed in DistrictViolation of Hei ht Limitations
Violation of Setback Front Side Rear
Not in conformance with Phased Developmer
Sign exceeds r uirements
Insufficient Lot Area
Violation of Building Coverage
Insufficient O en 5 ace Use r uires perm rior to Buildin Permit
Si n r uires ermits rior to Buildin Permit Form U not complete b other de artmen
Not in conformance with Growth B -Law Other
Remed for the above is checked below. gSecial Permit for Watershed Review
Dimensional Variance .S ecial Permit for Site Plan Review... Permit for si n
Com lete Form U si n -offs Recorded VarianceInformation indicatin Non-conformin status f Recorded Special Permit
OtheOther
Plan Review The plans and documentation submitted have the following inadequacies:
1. Information Is not provided, 2. Requires additional information,
._. _�_._......,.., .o in,n rP!'t 5. All of the above. -
Administration
The documentation submitted has the following inadequacies:
1. Information Is not provided. 2. Requires additional �informic 4ionr t. 5. All of the above.
The above review and attached explanation of such is based on the plans and information submitted. No definitive review and
or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to
provide definitive answers to the above reasons or DENIAL. �Any be nds inaccfor uracies,
reviewmisleading
sle to bevadedinformation, or
ot ration er subsequent
t Bent
changes to the information submitted by the app
licant Building Department. The attached document titled "Plan Review Narrative' shall be attached hereto and incorporated herein
by reference. The building department will retain all plans and documentation for the above file. You must file a new building
pit application form and begin the permitting process.
9/16/97 9/20197
t ulidi g epartmen �idialignature Application Received Application Denied
If Faxed
9122/97
Denial Sent
9;:
lmmended : Health
Zoning Board _
De artment of Public Works
Historical Commission
cc: William Scott
�Chcx� I S+_ 1
FORM U
- LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify
approvals/permits from Boards and Departments that all necessary
have been obtained. This does not relie the havin
landowner from compliance with an a 9 jurisdiction ,
regulations or re Y applicable local t ate la
requirements. state law,
****************Applicant fills out this se t• **
APPLICANT: � n � ion ***************
0
� Phone
LOCATION: Assessor's Map Number 5(' - 9-,035
Parcel
Subdivision ;
Street Lot (s) I D
** St- Number
Official Use Only************
RECO TIONS 0 TOWN AGENTS:
c:
Conservation AdminisApproved
trator Date A D
Date Rejected c
Comments ,
is � `(�,�� _ �S.
R7,
, I
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Comments
Food In pect r -Health
Septic Inspector -Health
Comments
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P lic World -o0 -34
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d
connections
riveway permit
e Department _
Received by Building� ���
Inspector
Date Approved-' "� [ (� I
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date
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Date
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CAJ Deparmumt of JndUTxrx;j.-jCCidentS
600 Washingron Strew
Boston, .Vain 0:111
Workers' COmPtnsadon Insurance Affidavit
1 2m a homeowner ;erfor.-ninpil wont =vse:-,7
I am a sole 'brocriemr and have no one wc6g :-- 3mv
ata 1 soil -roor.etcr, general coatr3c:or. -,,- aome-3vme:-
-)nej ana nave nir= :."L* I.onL--C' OrS bc;ow who
the -.'011owing workers* compensation poi c=
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2ddress-
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nhane,J-
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2ddzesit
city!
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Failure 'a jec, re coverage is required under Secnoo ,!.aJf.NLGL L--:- =MCI -CMQ -0 Me IMIDOSIGOIN O(cnaziom penuries of Ila* up to Sjj00.d0-3RQ-jjF,,
:Re .tears' imprisonment as well as civil penalties in tae ror-.* Of a STOP WORX ORDER and a line O(SI00-00 S JSV 3t2idSt Me. I understand that
OPY Of :his statement M2i be forwarded to the OMcc of lavesti-2ciams of ne :)LA or coverage wenfication.
Idhereby c9rdfi. under the gains and penalties 0f,7C7w7 :AXt :he ZRfor-naxton,7ravided above is .7ut snd corrm
Sip
03LC
P
Print name t-� r) r) Phone*
Amcial rise OGIV danot Write i0thin arca tDbteoapieigdbmcin *r=_ *jMCW
eity or town:
peraio'Ucease 'e "Saitdlns. Department
C:
contact
ifinernediate response is required CUee"ag Mard
I CS*Iect an's 01171ce
persoo.. phoee 0. CHalth Department ---Z-Otber�
WIIllAM J. SCOTT
Director
Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
North Andover, Massachusetts 01845
In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be disposed of in a
properly licensed solid waste disposal facility as defined by MGL c 111, S 150A.
The debris will be disposed of in:
(Location of Facility)
Signature o Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
` a3 J000 GLS We- h 1 r -P a- / n vn,f "u'n��
r
BOARD OF APPEALS 68&9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Growth Management Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
Name of Applicant on Building Permit (below) Address of Property for Permit (below)
-1-5 q 9 (t hews -M k rJ2
o � ppliati
Map and Parcel :1O(C6 Purposecon (check below)
Phone Number of Applicant: - )�_ Single Family _Two Family
I the undersigned applicant for the above property attest that the attached building permit for which this
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party to this permit
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit iq issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a building permit for the enlargement. restoration, or reconstruction of a dwelling in
existence as of the effective date of this by-law, provided that no additional residential unit is created.
VThe lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
Bylaw.
This application is for dwelling units for low and/or moderate income families or individuals, where all of the
conditions of 8.7.6."re met and/or represents Dwelling units for senior residents, where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section "senior' shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40% permanent
reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the
environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently
designated as open space and/or farmland. The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism
approved by the Planning Board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and
commissions have been received and the project is in compliance with those permits), and the Development Schedule
does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per
Development until such time as the Development Schedule accommodates issuing building permits. Applicant must
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination'
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building permit
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply, whether done to my
knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit.
ature of Owner or Authorized Plbent who signed the Attached Building Permit Date
form must be attached to thb Building Permit upon application for such permit.
• �J 11C 009I7//noJz�nCn��'/ (/Z
Restricted To: 00'
-I1 DEPARTMENT OF PUBLIC SAFETY
i CONSTRUCTION SUPERVISOR LICENSE 00 - None J -'-
- � Number: Expires: Birthdate: lA - Masonry only
•^ _-rte
CS 036610 04/04/1998 04/04/1935 1G - 1 & 2 Family Homes
Restricted To: 00 Failure to possess a current edition of the
Massachusetts State Buiilding Code
"'"�` �,r✓ GEORGE PAPAGEORGIOU is cause for revocation of this license.
60 FOURTH AV
LOWELL, MA 01854
location: /�h{a 51r.YTf li .If��i� l� /C (J` �U� I� �✓�i�%-0��1 S
- .........
_ .._
...................................
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.......................................... .
................... ........................ .
....................................... .
.......................................
jhgne: #,
one), and have hired the contractors listed below who have
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature �i —DateU�'
Print name W {� Yl l� V(� 5 Phone # ��1_ 5�)— 5-f_�2
official use only do not write in this area to be completed by city or town official
city or town: permit/license #
check if immediate response is required
contact person: phone #;
-ised 3/95 PJA)
C]Building Department
pLicensing Board
OSelectmen's Office
C]Health Department
mother
Information-, Instructions
Massachusetts General Laws chapter 152 sectiow25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another under any
contract of hire, express or implied, oral or wtitten:"
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 orbuilding-appurtenant thereto�shall_not:because. of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a Iicense 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, 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.
�b„6 /„i /rvz✓i.,��i'i�.,G,.ta„n..�.�„e.'�uoa�or/rw!,r�,:�.Cl�tli, v��r/< ,<.v.<zrw°'u„d *,.�2hY.�e n �<k',Y5_ :"r. R... .,.1'r,:,�.. .t :;:; u.�i„.xaur,..
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits 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.
✓ .� l y /fd - zzip 3.' x/ �r r YY �.y:.,a ,<y33 < �.. z z s 4` .� ,t`..
MI.
Mn.
City or Towns
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 m 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. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
�Szh"�'y%1/.1s4%/i� /. i,fix,%va`k .'`.�scl k"'�°w✓y`rY >s 7 IV
ari p'
✓fifes
Department'sne
The
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
,N0 767
APPLICATION FOR WATER SERVICE CONNECTION
S
North Andover, Mass. 5e%J 19 �e
Application by the undersigned is hereby made to connect with the town water main in 1 v1`��u �l StfeeY
subject to the rules and regulations of the Division of Public/Works.
n
The premises are known as No. 7 tGam-/ Street
or subdivision lot no. 1/12 4s — 706>0
Owner Address
Contractor
if ydel
Address
Applicant's Signature
oZ .0'�7
PERMIT TO CONNECT WITH WATER MAIN
The Board of Public Works hereby grants permission to
to make a connection with the water main at r— `/i
subject to the rules and regulations of the Division of Public Works.
Inspected by _
Date
f
Street
BVarfP lic Works
B `
Y c
See back for rules and regulations
RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES
1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town
of North Andover without a valid permit from the Division of Public Works.
2. All water services shall be installed a minimum of five feet below the finish grade.
3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964.
4. Service connections shall be 1" type k copper tubing.
5. All fittings shall be brass flange type Mueller or equal
H 15202 Corporations
H 15212 Curb stops
H 15402 Three part unions
H 8185 stop and waste valves
6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 41/2 foot rod and brass plug
type cover.
4
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TF1 S CERT[6kIS iS - TTER DF MFORMA'TION
S U 1: 0, A S 10 A
UpoN THE CERTIFIC,WrE
OKY AND CONFEFS NC? 'R GH,r S
04SURANCE AUINCY -$ NOT AMEND, EXTEND OR
HOLD* P., THIS CERT!FIGATE 00E-
P.O. Brj; sia/ I 4 ALTE r TME COVERAGE AFFOPDED BY THE POLICIES BELOW
I , A GE
e a COVER
R' ;oMp,.NIEs AFFOR
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GEORGE PAt-AGEORC—TOU I-! AIR "I' TJ A N D
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60 FOURTH ;M
LOWELL, M�. 0 18:-54
D
THIS I$ TO C5PTIFY TPA -i THE POU(JIES OF INS-L)RAKE U87E[l BELCW4 HAVE SEEN ISSUE[) TO ``-1E r,AIAED ABOVE THE PCI.ICY PEP'OC
INDICATED, NQTNITHSTkj,�iNG ANY REQUIREMEN-l', TEW, OR, ONDITION OF AiNlY CQI&4-TRA;-1 '-F�� D7FQ'Ql DOICJ"EN- W!"H TO IPJ�-!CH -wl�-;
;S =i..!3 --T TCj ALI- THE TEW,15
eE ISSIjE,,E) rjR tAA`' �EfAT,'IN, THE 14SURAKE AFFORDED r,,Y THE PPL, C!SS
CER' �FICAT� I I - L4!Vw'.
-!H i10L JMITIS SHOWN MAY HA` BEEN RED(JCEE, BY PA! D r
EXCLU�IONS AND OF; -3
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TOWN OF NORTH ANDOVER
NORTH ANDOVER, MIA
POLJC�'V - rNt-nVE f�OLICY EXNRATIO�'
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&F0JL.D ANY OF THASOVE DtSCAUD POLICIES BE CANCELLED SEFOAV ThE
EXWIATICIN DATE 7HEF-!!Ot. THE i53IJlmQ C0101PANY WILL ENDCAVOR TO MAI:
10 ;JAYS WPrrTI--m. NOTICE 1.-0 THF CERTIFICATE HOLOEA NAMED Ta THE LEFT,
BUY PAILUAR YO WUL SUCH NOTICE SHALL IMPOSE NO 08LICATICLki (7'R I-JAEfLirf
W ANY *N10 UPUN THE COMPANY, 175 AGENTS OR REPHESENYAIWES.
7
jwTnat PIRPRE— TATIVE ,-
0 ACC RD &,014P6 ATION 1988
CERTIFICATE OF USE &OCCUPANCY
Town of North Andover
Building Permit Number 50 7 � Date
THnI�S CERTIFIES THAT `�
THE BUILDING LOCATED ON `7 C1 le a �� ` ) S A �^ n k ` J ,
MAY BE OCCUPIED AS S I S ) C A W(11 (A)q IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
9 ROOM s) 3 both%; 3 S all wodv fry,
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ADDRESS 9 P
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TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
11/8/00
This is to certify that
the individual subsurface disposal system
.constructed (X ) or repaired ( )
by
Dave Maynard
at
99 (Lot 10) Pheasant Brook
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
v
The g} bottom of bed; ( ) septic system located at
I ZOT f� �iy/�S�it,TUf'OD� , has been inspected and
approved on ���d ��/� by Board of Health personnel, and
the Health Department has no objection to a construction permit being issued
for this lot.
Inspector
Date
MAR � 3 999
�hi� lefi�ei- is �v corr�i�+ "May/�v�
-
_.ra.�ls w �'�l b� Ola ced o � y5be4
t .4
a.
; �s
�5 �{
The ottom of bed; ( ) septic system located at
ZD �iy�/�5latiT 0,C604 been inspected and
r
,has
approved on/Z�%
by Board of Health personnel, and
the Health Department has no objection to a construction permit being issued
for this lot.
01,k
Inspector Date
fi
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H
0.