Loading...
HomeMy WebLinkAboutMiscellaneous - 48 Wild Rose Drive 46 WILD ROSE DRIVE 210/098.B-0026-0000.0 C/ tiy �- i Location %No. Date � � o 3 0.x«•0 t10RTly TOWN OF NORTH ANDOVER ,•1tip Certificate of Occupancy $ A W-)2-qq ' Building/Frame Permit Fee $� �U roe Foundation Permit Fee s�CHuse Other Permit Fee $ {` �rl 7) Sewer Connection Fee $ 26 F, Water Connection Fee $ TOTAL $ Z 65 i'v Building Inspector clof Ja!1� it � 6700 Div. Public Works a-7 Locationc-rrc-- No. 7,)- Date A) PORT" TOWN OF NORTH ANDOVER 3?0�,...° ti0 . ' p Certificate of Occupancy $ - fO•a U ° �$uilding/Frame Permit Fee $ Foundation Permit Fee $ /��''�� y SACMUSE Other Permit Fee $ Connection Fee $ S �# ,Water Connection Fee $ TOTAL $ JVD O Zl/ GGfir/�f� cc Building Inspector 6 6 3 4 Div. Public Works ,,,,,,,.Location - Flo. Date 53 j ' NCRTM TOWN OF NORTH ANDOVER ?.r `% Certificate of Occupancy $ * Building/Frame Permit Fee $ Foundation Permit Fee $ sACMUS t Other Permit Fee $ �V 7 Sewer Connection Fee $ Water Connection Fee TOTAL $ je,4)b 41 t0 T1 Building Inspector• . 22 .1993 ` Div. Public Works PERS IT NO 7 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER,�MASS. AGE 1 AP KJO. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE 9Q FJ _ _ ZONE SUB DIV. LOT NO. —I LOCATION ` ' , PURPOSE OF BUILDING Tri OWNER'S NAME`] NO. OF STORIES " ^� e SIZE OWNER'S ADDRESS. 0 `� 'ice ASEMENT OR SLAB 3-1177 ARCHITECT'S NAME /� n w� 8� SIZE OF FLOOR TIMBERS IST �f V!��1� 2ND 7 y'rO 3RD BUILDER'S NAME 1� © SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS ;Lw(a DISTANCE FROM STREET POSTS �C- 4a DISTANCE FROM LOT LINES -SIDES REAR 514 '� GIRDERS AREA OF LOT '%_ 1 L FRONTAGE c60 HEIGHT OF FOUNDATION `'� I�_ THICKNESS IS BUILDING NEW his✓ilG� L SIZE OF FOOTING uyT��G1 X IS Bf . i BUILDING ADDITION MATERIAL OF CHIMNEY !` Vcko;z IS BUILDING ALTERATION t� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY `"� ` `7 IS BUILDING CONNECTED TO TOWN SEWER 1LI cl,-s •V IS BUILDING CONNECTED TO NATURAL GAS LINE C -S INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST len, 0 c SEE BOTH SIDES ,, /' ��. �] / EST. BLDG. COST . O PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER&Q. FT. 1-0—FUM tn�KRMIT$,e" , �y � c� EST. BLDG. COST PER ROOM - AGE 2 FILL OUT SECTIONS 1 - 12 j/� j�+ ��(- J SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED `O `Z qa BOARD OF HEALTH SIG A RE OW R O _AUT ORIZED AGENT \As% FEE PERMIT GRANTED p, � d OWNER TEL. PLANNING BOARD CONTR.TEL.#�8 Z� 19 CONTR.LIC.# BOARD OF SELECTMEN t OCT 14 f993 r �3L Vs /n J BUI iNG INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY sroRlEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA— APARTMENTS i RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K.. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL IN. B M'T AREA _ V. 1/1 1/. FIN. ATTIC AREA ool_ N_O B M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR ->.-»,.+-.+-< �•:' "'�''� �' _ BRICK ON FRAME I :' kf CONC. OR CINDER BLK. ... _-...,...,_...<.,�.•ar.+e•>-+- t M A mi STONE ON MASONRY WIRING ' STONE ON FRAME -•-• ^•- -`•"�' { SUPERIOR I�POOR ADEQUATENONE 5 ROOF 10 PLUMBING GABLE f HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.( FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 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 \ NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC Isl 3rd I-CD NO HEATING FORM U _ LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************'�**Applican fills out this section***************** APPLICANT: 1 c� Tmft Phonk LOCATION: Assessor's Map Number Parcel Subdivision /Vc2� rt�►`1 � �Z ��S Lot(s) Street T �lV i ��) ` ���Q\�14 St. Number 1A(0 J ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planne Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit ��11 F're Department . b � 0 7 � �'�f 797 X77-/ ecei ed by Building Inspector Date OCT 141993 I? T r v `off - Town of . ...-,.,,Andover No. y'7i. 7: k• !(p k - � �.� ` ' -North .Andover Mass. 19 BUILD BOARD OF HEALTH Food/Kitchen -PERMIT TO Septic System 40 pow BUILDING INSPECTOR THIS CERTIFIES THAT......./.... . �'..... �.I..ji.... r*-S.... ... u """""""""'�'•""" Foundation .has permission to erect.0000001ftP � buildings on ... .�... �4 j ,> �• � Rough to be occupied as. .I �. .`Is �.`!/..• Af ••• A Chimney NO provided that the person accepting this permit shall in every respect conform to the terrffs of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the InspectR$'RrNi)efVjpqrvgA& j"WftrVof Buildings in the Town of North Andover. REGULATED BY PARA. 114.$-S. B.C. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. _ Rough DATE/d L _1!5� FEE PAID�L C�'0 C Final PE.RTAIT 11\4 6 Nth� TH ' ELECTRICAL INSPECTOR PERMIT FOR FRAME/BUILDING . Rough d-V ... .... .... Service GATE: �a FEE PAID• BUILDING INSPECTOR Final OCatp,aTicy j"Ci-mit Rctnt!1led tt) O,C(`I pN' Bull(11)-1P GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT 7 t CERTIFICATE OF USE & OCCUPANCY Tommin of North Andover Building Permit Number 472 (1993) Date MAY 5, 1994 THIS CERTIFIES THAT THE BUILDING LOCATED ON 46 WTLD ROSE DRIVE ( Lot #4) - Type C MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAGE IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 01N°p'M .4 CERTIFICATE ISSUED TO Toll Bros, Inc. 3 •._� 3103 Philmount Ave. ADDRESS Huntingdon, PA 3ACHU5 Buil ming Inspector . If t �4QRTH ovm of �o�ti over U; -lot, p -J t L A�Tor over, Mass., &I: / COCHICHEWICK, VA0 ATED PPS\ "♦� f BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ENWOR UIL THIS CERTIFIES THAT.......I.... .<<..... .��.I..j�.... iR....(...T Yr ... ........................... B �ICA4 "�j%� . . Foundation y has permission to erect J0.##jVAj#i� buildings on ... A...JW.IjAV05f A41ftRough o/� to be occupied as . .I.. �. .f� �. r ... � Chimney provided that the person accepting this permit shall in every respect conform to the ternfs of the application on file in Finall(��. this office, and to the provisions of the Codes and By-Laws relating to the InspectRMNN eFV0iF®gA tWftrVof Buildings in the Town of North Andover. REGULATED BY PARA. 114.8-S. B.C. PLUMBING INSPkCTOR, VIOLATION of the Zoning or Building Regulations Voids this Permit. pl/l��'�- PERMIT EXPIRES IN 6 MON/� �� PSD rg o ITT 1--SS CONSTRUCTION STARTS ELECTRICAL SPECTOR PERMIT FOR FRAME/Will) 1G . Rough(0 �p %rr.��`!� ... .... ... Service DATE: FEE PAID• BUILDING INSPECTOR Final r—) v ' Oca4pancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough y No Lathing or Dry Wall To Be Done Frj FIRE DE ARTMENT Until Inspected and Approved by the Building Inspector. Burner J PLANNIN �-y0\4`I CONSERVATION ,1� ,., FINA Street No. ..�. . .^... ... ../���Fi� \ J � Smoke Det. x111/►-111/AV rn 1-rr)V D ^"4IT 11 � 75b7,j Date.. l. NORT1, /TOWN OF NORTH ANDOVER O 3 9 --PERMIT FOR GAS INSTALLATION �,SSAC14USEt This certifies that �r�1 .. . . . .e C, . . . . . . . . . . . . . . . . . . has permission for gas installation . . . 6-AS . . �-Dq. ... . . . . . . . . in the buildings of . . .(k).Q.$S Q r . 4. . . . . . . at . . . .401 A11?QY4 . . ..1 /! . . . . Nort A ver, Mass. Fee. . . . . Lic. No.. .4a rY3 J. . . . . . . GAS INSPECTOR Check#�D 3 i� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: MA. Date: Permit# Building Location: 46 O i XPt6e_ Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No(- FIXTURES U) m LU LU Cd I.- W `� o 'W' m = O w w v U) 1-- O = w w +� i Ce o z QQ z o w M w °� o a o LU N w m 0 Q a o O w x N > W z ~ W Q W ZLL W Q W W w z N = w Wz W tL' z W W z J H ~ O z J U' U. N = W W W I Z W0 W >- W U) Q Q m w O z 0 ~ z H SUB BSMT. BASEMENT -i'FLOOR 2 FLOOR 3 FLOOR 4 TH FLOOR 5 FLOOR -i'—FLOOR 7 FLOOR -Y'FLOOR Check One Only Certificate# Installing Company Name: �\ ❑Corporation Address: n 'Tr b,,c`1Ji+%t City/Town: Ami&t,J State: ❑Partnership Business Tel: 6b3FZ !'73_s Fax: Ge-j 3921-S"74L) ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: vt' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 54 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 ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and i tions Performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State umbin C;/Ir, o and Chapter of the General Laws. Type of License: By [N Plumber 011 Title ❑Gas Fitter Wigg-'aRtureof Lice&ed Plumber/Gas Fitter ❑Master City/Town EgJourneyman License Number: 2� APPROVED OFFICE USE ONLY ❑ LP Installer NThe Commonwealth of Massachusetts r_ Department of Industrial Accidents r '" Office of Investigations °� :;t►U _: 600 Washington Street ;`w" Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): .��SC ?� °`^ ��c��in s Address: �-i , .� ►-`v� �� City/State/Zip: Phone#: to 3 3R 2 5733 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2,9 I am a sole proprietor or partner- listed on the attached sheet. # E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5. [:1 We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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 acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 maybe forwarded to the Office of Investigations of the DIA for insurance.coverage verification. I do h eilbry certify 41ndirlthe pains dpenalties ofpeijuiy that the information provided above is true and correct.' Si nature: Date: Phone# a 3 Z 73 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or-on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 cavy workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confinnation 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 pen-nit 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 pen-nit/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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit 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 mnaaM%.nuci io uniruilm Art'LIUA11UM il-un rmnmi1 1u uv r-a.ums-el—+ (Print or TWO) V NORTH ANDOVER, , Mass. Data//' _10 Building lb �K�J� yi`e PetmN # a�5 (�V Cir Location Owner's Name New Renovation ❑ Replacement p Plana Submitted: Yea❑ No FIXTURE8 a 02 U / ~ t< R • Ids~e J M s V 0 t! MO �v M Y M t = i M 1r ~ L a i Las I< N M F' , *1 M O S y» ~ L a.i U y o f Y a s o $ ea s �' 0 u �e s i�- i s o 401 i 0 eua—��kiT. �AetM�HT 16T I-LOOP !NO FLOOR ,9-Fn IND FLOOR 4TH FLOOR ITH FLOOR OTHFLOOR. ITHFLOOa aTH FLOOp - Check one: Certificate Installing Company Name �- Z�r ❑Cor p• Address Wportnetship l`N O Firm/Co. Business Telephone �� .Name of Licensed Plumber INSURANCE COVERAGE: ec one I have a current liability insurance policy or No substantial equivalent. Yea No ❑ It you have checked jM, please Indicate the type coverage by checking the appropriate box A liability Insurance policy Other type of Indemnity ❑ Bond O OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 112 of the Mass. General Laws, and that my signature an this permit application waives this requirement., Check one: gri-natufs of Ownu or Cwnu!Aceni Owner O Agent p I heteby cartity that sl of the details and Information I have submitted tot entered)In above appkatlon are true and&osmate to the best of my knowled a and that al pplIumbing work and Installations performed under the parmill Issued for this application wil be in compliance with an pertinent provisions of tM M isachusetts State Phrrnbing Code and Chapter 112 0l the r law*. care of Lkensed Plumber TNN Ucense Numbs City/Town l� Type of Plumbing License: Mader APPROVED(OFFICE USE ONLY) Jowneyman ❑ ' Date. . . . . . . . . . . . . i ' "oRr:, o TOWN OF NORTH ANDOVER 3� .��. ...... oc PERMIT FOR PLUMBING s i , x - " • SSAMus� This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . : . , . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . ... . . . . . . . ... . . . . .. North Andover, Mass. Fee. `Lic. No.. . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File 4` MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (� (Print or Type) . NORTH ANDOVER Mass. Date � �3uilding Location f� r���/�1i P d/G�d`C�Q Permit # i3�� -�N Owners Name 20l • New Renovation D Replacement Plans Submitted D FIXTUR'"S W N Q N a .O N S F W W Q d z o W d O H +' Q GC p- O O x t- 0 Q .6 W w F, N a cc y LU4 to W z V tu Of uJ a CC f. O t- x W tytth 1 Q x a OL O Q W W V t7 tL o Ir x J P z h- H YW- to 0 ? O 2 W O N = Z < W < cc .. QJ Q m > C W 2 < eC Q d tL X O t7 x u. A O .3 U = } Ct M 1— O SUE(—BSP.1T. BASEMENT I ST FLOOR 2N0 FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check, one: Certificate Installing Company Name ���� ��(�it-t�/iv f- i Q Corp. Address - ��jiy,� Partner. Ql Firm/Co. Business Telephone: )- ME Name of Licensed Plum er or Gas Fitter1 �� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M Other type of indemnity Q Bond E1 Insurance Waiver: 1 , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent F7 I hereby certify that all of the details and information 1 hate submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pctformcd under Permit issued fo: this application will_be in compliance with all pertinent provisions of the Massachusetts State Car Code and Chapter 141 of the Genual Laws, By TYPE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town: Master Plumber or Gasfitter ��367 Journeyman APPROVED (OFFICE USE ONLY) License Number Date.. . .... . . . ... ...... .. NORTry TOWN OF NORTH ANDOVER pf ��ao ,s1ryp 3? '� O PERMIT FOR GAS INSTALLATION F 'rl �0+...0••��qy 7 1SSAGNUSEt This certifies that . . . . . . . . . . . .... . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . ... . . . . . . . . . . . . . . . . in the buildings of.. . . .` . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . ...'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. J � Fee. . .. .. . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . .AG [?.; i_ ��.0 C;A$DNSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer Date. NpRTry Of ,No TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING lo . „p�{,• ,DI�T�D•A'`1' ,SSACMUSE� (� This certifies that .. . . . . . . . . . . . . . . . has permission to perform . . . . .lit. . r{. . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . r �.'.` . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . 11., North Andover, Mass. Fee. /(?,. .: . .Lic. No..� 1 r� . . . . . . . . . . Vim... r.I . .. . . . . . PLUMBING INSPECTOR Check # ” 5156 51,3 6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location ��0 wr1Q 1" e DO V� D�h C� � � Date 013-05-61z- Permit 3—0 5'd Z 0 S Owners Name �Q(� permit#_ Type of Occupancy Amount New rl Renovation M Replacement Plans Submitted Yes ❑ No 0 FIXTURES 1v1' ' ]SL)HLOQIZ } a1II.)HIDQR 3M)FI" 4II3)HI�OOR smHfm 6M 1HL" 7M H" gm FWM (Print or type) Check one: Installing Company Name (W A �f e, )2,Q c,1L � Certificate o�%� 10 Partner. /�o©9 C Address ac) X 72 0 r h R / do e ^ �Q' O!g¢S 0 Partner. Business Te ephone 7 ¢ Finn/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Q Other type of indemnity ❑ Bond n 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 ri Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above applica ' n are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued this al2plication will be in compliance with all pertinent provisions of the:aXsusetState bing od and Chapter 1 of en ral Laws. [City/Town y. 1gnure o icense um er Type of Plumbing License tle B�icense um erMaster Journeyman ❑ PPROVED�or�rcE USE ONLY Date.. ...... ?....... Of TORT"e, ti0 o? °� TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION s ♦ I �,SSACMUSE� t This certifies that . . X . . . . `. . :. .�"�. . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . .t .�:� . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . , .t :{.. . ... . . . . . . . . . . . . .. North Andover, Mass. Fee. . . ?. .-. . Lic. No.. .`. . `. . . . . . . . . . . . . . t .. . . . . . . . GASINSPECTOR Check# MASSACHUSEIIS UNN ORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date 03-O -O 2- NORTH NORTH ANDOVER,MASSACHUSETTS Building Locations V11 121 did 5 e !7 r t I/-e Permit# Amount$ f J^ No, r4 n do Lj er . 1-f<I _Owner's Name `)Ad 1e le-k Qf1t--v1 New❑ Renovation ❑ Replacement M Plans Submitted ❑ U Cw7 aa 0 U O W a z o w W d 0 0 a N tw-G z o a w H o c x OA G�7 a > A a Ew+ O SUB-BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) l C one: Certificate Installing Company Name WA i{'-- t�G aG`L ! 5/7/ LJ Corp. Address (6oK 7 Z 8 ❑ Partner. &10- ,qndoyer , t4a 01645 Business Telephone q 7 q 7 .5 4-Z 9, q ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter 'L>p{>e l-+ e l d fl C h e4-0- INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No[] If you have checked�,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. Check one: Signature of Owner or Owner's Agent Owner ❑ 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 Permit Issued this application will be in compliance with all pertinent provisions of the Massachus State Te and Cha er 142 o e General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber g-5 Q7 City/Town ❑ Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman 4 �� � , Insurance Adjustment Service, Inc. 936 Roosevelt Trail Unit 5 Windham, Maine 04062 207-892-0522 Fax 207-892-0526 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B Date: March 11, 2011 TO: Board of Health/Building Inspector RE: Insured: Wassim Matraji Property Address: 46 Wild Rose Dr. No. Andover, MA REC Date of Loss: 2/4/2011 MAR 11 ?011 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Policy Number: Type of Loss: File or Claim Number: 69414 Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6,to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 38 is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, locations,policy number, date of loss and claim or file number. Thank you for your cooperation. Very Truly yours, Matt Martin Adjuster Ext. 109 r' Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: Ll WPA Form 8B — Certificate of Compliance 242-1204 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. Project Information Important: When filling out 1. This Certificate of Compliance is issued to: forms on the Wasim Matragi computer, use Name only the tab 46 Wildrose Drive key to move your cursor- Mailing Address do not use the North Andover MA. 01845 return key. City/Town State Zip Code 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: Wasim Matragi Name June 26, 2003 242-1204 Dated DEP File Number 3. The project site is located at: 46 Wildrose Drive North Andover Street Address City/Town Map 98B Parcel 26 Assessors Map/Plat Number Parcel/Lot Number the final Order of Condition was recorded at the Registry of Deeds for: Property Owner(if different) Essex North Document#45024 County Book Page N/A Certificate 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: 11/12/04 Date B. Certification Check all that apply: ® Complete Certification: It is hereby certified that the work regulated by the above-referenced Order of Conditions has been satisfactorily completed. ❑ Partial Certification: It is hereby certified that only the following portions of work regulated by the above-referenced Order of Conditions have been satisfactorily completed.The project areas or work subject to this partial certification that have been completed and are released from this Order are: wpaform 8b.doc•rev.12/15/00 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1204 Massachusetts Wetlands Protection Act M.G.L. c: 131, §40 Provided by DEP B. Certification (cont.) ❑ Invalid Order of Conditions: It is hereby certified that the work regulated by the above- referenced Order of Conditions never commenced. The Order of Conditions has lapsed and is therefore no longer valid. No future work subject to regulation under the Wetlands Protection Act may commence without filing a new Notice of Intent and receiving a new Order of Conditions. ® Ongoing Conditions: The following conditions of the Order shall continue: (Include any conditions contained in the Final Order, such as maintenance or monitoring, that should continue for a longer period). Condition Numbers: 67 C. Authorization Issued by: North Andover Conservation Commission Date of ssu nce This Certificate must be signed by a majority of the Conservation Commission and ent to the applicant and appropriate DEP Regional Office(See Appendix A). Signatures: /� a C - C On 17�h Of �pvenl o2p0� Day Month and Year before me personally appeared Sco-ff K to me known to be the person described in and who executed the foregoing instrument and acknowled ed that he/she executed the same as his/her free act and deed. Af Gtr N tary Pubic My co DONNA M.WEDGE WTARY K" MrCam EV=AM.7,2009 wpaform 8b.doc-rev.12/15/00 Page 2 of 3 .l + LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1204 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP D. Recording Confirmation The applicant is responsible for ensuring that this Certificate of Compliance is recorded in the Registry of Deeds or the Land Court for the district in which the land is located. Detach on dotted line and submit to the Conservation Commission. To: North Andover Conservation Commission Please be advised that the Certificate of Compliance for the project at: 242-1204 Project Location DEP File Number Has been recorded at the Registry of Deeds of: County for: Property Owner and has been noted in the chain of title of the affected property on: Date Book Page If recorded land, the instrument number which identifies this transaction is: If registered land, the document number which identifies this transaction is: Document Number Signature of Applicant wpaform 8b.doc•rev.12/15/00 Page 3 of 3 l c LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Appendix A - DEP Regional Addresses Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments,payable to: Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 02211 DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham Dwight Street Agawam Conway Hancock Montague Plainfield Wales 436 Dwi 9 Alford Cummington Hatfield Monterey Richmond Ware Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick Springfield,MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone:413 784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Westfield Belchertown East Longmeadow Holland New Ashford Savoy Fax:413-784-1149 Bemardston Egremont Holyoke New Marlborough Sheffield Westhampton Blandford Erving Huntington New Salem Shelburne West Springfield Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Buckland Gill Lee Northampton Southampton Whately Charlemont Goshen Lenox Northfield South Hadley Wilbraham Cheshire Granby Leverett Orange Southwick Williamsburg Chester Granville Leyden Otis Springfield Williamstown Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor Chicopee Greenfield Ludlow Pelham Sunderland Worthington Clarksburg Hadley Middlefield Peru Tolland DEP Central Region Acton Charlton Hopkinton Millbury Rutland Uxbridge 627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren Ashby Douglas Hudson New Braintree Shrewsbury Webster Worcester,MA 01605 Athol Dudley Holliston Northborough Southborough Westborough Phone:508-792-7650 Auburn Dunstable Lancater Northbridge Southbridge West Boylston Fax:508 792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield Barre Fitchburg Leominster Oakham Sterling Westford TDD:508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster Berlin Grafton Lunenburg Paxton Sturbridge Winchendon Blackstone Groton Marlborough Pepperell Sutton Worcester Bolton Harvard Maynard Petersham Templeton Boxborough Hardwick Medway Phillipston Townsend Boylston Holden Mendon Princeton Tyngsborough Brookfield Hopedale Milford Royalslon Upton DEP Southeast Region Abington Dartmouth Freetown Mattapoisett Provincetown Tisbury Acushnet Dennis Gay Head Middleborough Raynham Truro 20 Riverside Drive Attleboro Dighton Gosnold Nantucket Rehoboth Wareham Lakeville,MA 02347 Avon Duxbury Halifax NewBedford Rochester Wellfleet Phone:508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater Fax:508 947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport Bourne Easton Harwich Norwell Scituate West Tisbury TDD:508-946-2795 Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham Brockton Fall River Mansfield Pembroke Somerset Yarmouth Caner Falmouth Marion Plainville Stoughton Chatham Foxborough Marshfield Plymouth Swansea Chilmark Franklin Mashpee Plymplon Taunton DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield 205 Lowell Street Andover Chelsea Holbrook Methuen Randolph Walpole Arlington Cohasset Hull Middleton Reading Waltham Wilmington,MA 01887 Ashland Concord Ipswich Millis Revere Watertown 61-7600 Bedford Danvers Lawrence Milton Rockport Wayland Phone:978-661-7600 Belmont Dedham Lexington Nahant Rowley Wellesley Fax: 978-661-761561-76 Beverly Dover Lincoln Natick Salem Wenham TDD:978-661-7679 Billerica Dracut Lowell Needham Salisbury West Newbury Boston Essex Lynn Newbury Saugus Weston Boxford Everett Lynnfield Newburyport Sherbom Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester-By-The-Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Wnthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield wpaform8b.doc•Appendix A•rev.11/16104 Page 1 of 1