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HomeMy WebLinkAboutBuilding Permit #113-15 - 25 FARRWOOD AVENUE 7/30/2014 t%OR BUILDING PERMIT lu" ' O�4t,.EC �6�•rO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 7e A0Aw7ED 1SSACHUSfc Date Issued: 11 I PO TANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER O�Print 100 Year Structure yes nan MAP ARCE�> Z ING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alte ation No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer D C / ON OF WgOgK TPOE PERF MED: �' dent' cat' - Please. or Print Clearlyr/ Name: �r Phone.L?IV U r1 11 OWNER. Na Address: D Contractor Name:/7 Phone: Address. Supervisor's Construction License: Exp. Date: Home Improvement License: l Exp. Date: / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS�! ED ON$125.00 PER S.F. Total Project Cost: $ 'a :, 0 FEE: $ r Check No.: Lo I'D Receipt No.: t� U NOTE: Persons contracting w' u ed contractors do not have access to the guaranty fund Signature of Agent/Owne VMSignature of contractor Location No. .. � Date 3v �� • - TOWN OF NORTH ANDOVER s � . . Certificate of Occupancy Building/Frame Permit Fee _ $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinnning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ � Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Lj Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe:Building Permit Revised 2014 NORTFt Town of EAndover No. h0 t" ver, Mass, JJU coc..IGNl WIC.f �1. ��S RATED S U BOARD OF HEALTH -PERMIT T LD Food/Kitchen _-- -- 11 Septic System THIS CERTIFIES THAT ........ X` . ........ '' ........... BUILDING INSPECTOR Foundation , has permission to erect .......................... buildings on .©` .. :t.rv�? .....�...............2.. 1 .................................................. Rough to be occupied as ......... �...... �t..'y.v...... 0.�?.:2-..... � Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Lq - UNLESS CONSTRUCTIO Rough Service ........................ .......................tc-- ,.......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. G11 to r CT lhtstalec T C��TRA mnished� Services,b'es �pRptiE�A.�15 gold�ND At_4 A�:�ome'efl�5�5 gOME PVE�'S� 'lhe K°rr'e D��ewwsbury'�� � d(b�a tke knit t Tont e nt lie# � g43 BOO,,,�Um� lame: �?rlctOeve°CyeOnZto tROe{� CP-- Vic - � � 1a�t #152 �11nP South FedCA� "�K ZIP hostou1. State e: Branch cher.31 end 33 �� �Z e. Cell Yhp° $ranch� (IN � City �o�e phou ZorkPt►one' q allation�'�d�ess: C '_lr�t��y`� � "[ ` .� Z1P 1"St LR 1 v state purchex�s}: City tion address, UatiO ct b3chis Depot 131 'tthe abo4e ti ea 5tal?c° , °s'kc t1ed`rely, X d dome je DeP aced at o e tot ted fides s s omThe on e roPertyxeT od'ars e j41cotPanY Cbange Addt�samrr'uacatlp°s of th P. deli' which �,d once Addres��nSCallation ect G em cis tsh of GtctO aunt K di{terent fc to receive p�o y ketin omen,.) the o a� s to ftlot s), alT ed b rzt' gree Sheen attach pro`ecti Am �E.raail ►�� wish to t Undersigne If1 e Kotne�eQf; n went�,ummarY ` c Sheets , Q lDO Ittf°�t�e SetvtGethe beli'v`' state 5L1PPleme S e 2--� pro ect �t-K°p k °n liable itrid 1 Nt descry any apP ann ! $ all Ina along wtth products: Insula ce, .,Avl °ws retGren " $ ,Contract)' ilnteYnal getccencel Q�°oflnt Coed Ent� d°\y4 V\nsnlg[lon ob S 3 s�dinQEno;,Pyoots� �S.itaini� Covers QCt'ttcts gidiV'% DO()v n �n'rY �sulatio mount ectifu ate RooSin secs d°mss tract 1Gtron er this C°' }vin 0 1 Coo Cotap and QC°tie15 I cot►tTat�. 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Siding D°°rs fitomer QR°°tlne QEi:tr7 �udon airs .�ai11 e' ble, ea I CQ`,ers aunt torzle 5 apPlica ct An' Cus etu-at QC,utters t duz vP°nd of t antra ,1t lroduct, dire, inclntled hei ct Amop7 £tIu for balance odnct(c) to a stTttGt�ir tie Gr r11 than an e w ark �. any uai C'r s due beau` vid gatiori� s or �;c�t.lxl tcrf dePm a letit�n of th ef) rind pa; sndi obbg v error. epv� mai n� diately 000 c am�dual Spec ��ebereuCtder' this Coll of,0 4etlo.colleeins P'"cin e toktll trr+►n' rchasers th tt e ed by an in bPLIed and r terminate nes that it other safety Sets forth th gees s deftn d Se ob ge prdes o d4ternv d p11nt, a� vzally rovidestos or lea Comirac, sko c�PtOdt'ct a 'Cl Chan` tope ea to be x0111 l} isfiue a Service old-as of tis t the ri ht to ole, d m included as P ) grecs u D of or ltr auth act. hcable ' to atd- , Cots S� I op Cerocate 1o4uct Contact a� LMerves S�,tich ache� 1 ` product(las apP once Depot rim cP anent h`v' eluded in 1e� or that Che rico of in b is y Come k Ch` t1o+� rf e.en` ob was n Q a.,Tv of rG llom e v dtmal F © iER ots)before rya its disc ed`O Complet,th Summ TU CLl5I �tit1, ar, boT,e'`�eos term e d Posits a bine trUaaSv�'Sh eT prob s Ie�ul edfot th' e of materials,la us n5 °�T5 utr e P'ay ke th dt 1 �` IS oil:req vmn'aT' sent �Contract aeftnedb5 the costs teTnvnan°�LI1 Al�,�gpl)T of the ,rex as gePot date of WIT�N E W p rIV 'act.. Pay COP}listed pT e e Contract` e1y filled-i each a,; lheg°hrouIr t� I�It� � 1L2�� tomer �ecl to a O�ertifrcate loT eT a°Tee. to it Prordd£r a4 ,� F[t P p TS' between C s �itl�ec fou are en�r 4 ornPletro t Crrstom ed Sem Iar� T v O� C1 �,M oreenlent ureement� sued A YhgE T pP e Ohre aW. ns atld W' the'vrthe ere is on of this CoI)ePot�QT �der aPClsi1 FN C0V ER ,eat is th.or discussi e cePt by a i1Y aG``t'tti th cotnPlete. nation e game allo"ved E A0 F4V,RE Peen s�!po trnended ds,volt`vv is nt of ter d b� Th nieut°r v 1 Tg DIE`' that this tiupersede ed ort of In the ekes PT0`r n this ~p Teeple F R RF IE underttal�d rvlces andnot be assrha ted°and d ser forth � 2E T'5� s and tion^teeli eat CanCustoncer an otints Set TKti g 14E i*00 met agree d lnstalla i am . TO gp� Gusto tdu-is an , yhl,;Pic agees that UI � TIN T C p with©Y'itate d to dte d InsraUnc°ledges and L. ' and with oducts er ark nr+�Aok .,. Acte nj lceome D e n(= Tg (". �esLldi "o=tL2.3u.'.L.w'J�doJe�'..�3 11kG^�u�MbJ�rJS^L� �7 � 7 Medol3 V Off,eo p f Tn vestip aa?ons 600 Washington Street Boston,MA 02111 wwwwxzass-gov/dia Workers' Compensation Insurance Afdavit: Builders/ContractorsClease Print mbLegr A llcant Inrarmation ly Name(BusinesslOrganization/Ind ividual):, Address: City/State/Zip: lav�Y- 94. X033 Phone#: Are you an employer? Check the appropriates: Type of project(required): 1. I am a employer with 4• 1 am a general contractor and I 6 New construction have hired the sub-contractors employees(full and/or part-time).* listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have g. Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. ❑ Building addition comp.insurance.$ [No workers' comp. insurance 10.❑ Electrical repairs or additions required.] 5. � We are a corporation and its 3.F-1 I a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions _ myself. [No workers' comp. _ right of exemption per MGL 12.E]Roof repairs c. 152, §1(4), and we have no 13.❑ Other insurance required.]t employees.[No workers' 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 anew affidavit indicating such. SContra ctors 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. ation insurance for my employees. Below is the policy and job site I am an employer that is providing workers'compens information. Insurance Company Name: C 1 wam2di/-e, yNY �o , � � /(� � g r2 Expiration Date: -� � �5' Policy#or Self-ins.Lic.#: W 0 L1,�a j � N dIVU i UU Job Site Address: City/State/Zip: (showing tion a e showin the policy.number and expiration date). w Attach a copy of the orkers compensation policy deelara p g 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investi ations of the for urs ce covers a verification. I do hereby certi u der 1 e pa' s allies perjury that the information provided above is trues and�rre Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Permit Services 401 2462868 P.1 MassaGl', - setts - Depart. ei:k , .3417 R.j s.<.t;: ,ee— Boa.rd 0f -.-11I'd 1 '7q Regula oos aind Stand aro-s C e f .s e- CS-088756 SCOTT A MACM .I.AN _ 10 PARK AVE SALEM NH 030' 03/2912016 I 1 nrfryiinyrrnr•Cr III, n. !-? n:f.frir•X.rr:fr//1 � MCC of Consumer Affairs& Business Regulation { License or registration valid for i"dividul use nnly _ - OME IMPROVEMENT CONTRACTOR ! before the expiration date. 1f found return to: t. Registration: 126893 . Office of Consumer Affairs and Business Regulation =% Tvnr 10 Park Plaza-Suite 5170 Expiration: 8%3/2014 Supplement ,z rd Boston, MA 02116 The Home Depot At-Home Services j RICHARD TROIA 2690 CUMBERLAND PARKWAY S 4�- AYU�M, GA 30339 (lndersccrctary i Not valid without signature X. i / A 1 enelgysial n�an—Inca n.gc.ca �- �� • Ak • :;� Cvalllled Remove label,atter Clnal inspection; SAVE for future reference Weather Shield CPDd 050-A-172 NFRC Model 8108 Double Hung Operating % Alum clad Thermal Frame I$dt Fes':" 314 inch Glazing _ E .022 Low—E Argon Fill Grille in Air Space ENERGY PERFORMANCE RAT1tGSllpc�► Sql o.1 • u—finer . 0.30 1 .70 • SJI—P f(KlricI51 • ADDITIONAL. FERFORMAKEDRIAT-INGS toad Ylslble 1rsn:rttl►leoa Q 0.40 ben to ePpncabl,HF RC proccdurca br YreulrcYriai>iPule mdacllanirgT Pcrb�cL HFIIgsxC raenge NFRC docs lottrrec�rrn�'d dalermlelnq.hde P dlane end WA trod+el dTss ec7sc usa. ►scd c>l of aedrvnmLnw con rpdocl for."7 ( &nT prodocl end'doet All ra rant Int WI Iqq o e�InlarMAIM. lyasull menulattanl't Auniun 101 Mel FMdu'Ilper 1bnfun wwV Meas ur esceedt M.".. C.E.C.,end I.E-C.C. All In1111r 20n R�QtLsr2 f7n1 leeed1,jxsV&AuMww G (DP) • ,(PSO H—LC7e4"" lesre/la uY LtA/WDAXIA �o,n UTA"a•—os UH—LCIS II1"ZZ"(""M une Y..Iti 9gtbr�i�d�'u�•F.r LS1Y E]C olein 1101SCO2U"M • ' � eoelgyslal•��can-rncan.gc.ca r Remove label•BRer final Inspectich; SAVE Iar tulure reference Weather Shield CPDI 050 -A-172 Hung ppe�ting r NFRC Model 6109 Double Alum clad Thermal Frame 3!4 Inch Glaring I-�h.rd F ZO—E .022 Low—E . Argon Fill Grille in Air Space ENERGY PERFORMANCEoIRAT1GSljgenl 70 0.3 ) • • 0.1� . . 0.30 1 I S JI—P I{KIricISI • ADDITIONAL PERFORMANCE RA Ace R'IeNIG5 Condmsztlo Visible lrmsmh1loce 0 f 0.40 hrtn to ppn,&bjs NFRC prec.durce br Ilraulecuur TIPulsl>s hit mei.reings cent`HFKC Henle ert d.lermined for. l eni perbrmm NFRC don an[rtmn- e d •hde rodsc rqr rodrel dres s. P c u . d.lenrd t%II dllon$end dd Pu r�docl br.n7 spedec tz.d cel of.nrlranroinW ten c.Inbmueon. •r+1 product end'does nil•hurt be ml loa e r�p Coasull menul.cluni s Min un lot othwr,l w.111m..0 C.E.C.,end I.E.C.C. Air Inllllrei)on Ra ulr.menls Meir or es:ceeds S7•EG.• ItAJMvrWp1 tvLs.2—!7 1 ecled to f:KSYu' (DP) • .(PSS —jl]Si<Le9 I CS7.d Is uu►!W DU L/C el join 511ANo'—os -- H—LCIS lljex7volux9m ` rz� a uni Y..1.9rlttsrJ F.r.r�.ur.I.r 1514 ESC o . 61�65CO21�11NSiD rrr1F.�d7 LI;—1-1 —_. DATE(MMIDDNYYY) ACCN?® . CERTIFICATE OF LIABILITY INSURANCE 02119/2014 THITIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND;EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.' THIS CERTIFICATE-OF INSURANCE DOES NOT.CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement'on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CON ACT PRODUCER NAME: MARSH USA,INC. PMONE FAX TWO ALLIANCE CENTER AIC No 3560 LENOX ROAD,SUITE 2400 E-MAIL ADDRESS: ATLANTA,GA 30326 INSURER(S)AFFORDING COVERAGE NAIC I 100492-HomeD-GAW14-15 INSURER A Steadfast Insurance Company 26387 INSURED INSURER a Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. ..". New Hampshire Ins Co 23841 DEN THE HOME DEPOT AT-HOME SERVICES INsuRER c 2455 PACES FERRY ROAD INSURER D:Illinols Nallonal Insurance Company 23817 ATLANTA,,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003242685-01 REVISION NUMBER:3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN.ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR AODL IUB POLICY EEF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER- MMIDDIYYYY MMIDDIYYYY 8,000,000 A GENERAL LIABILITY GL04887714-04 - 0310112014 0310112015 EACH OCCUUAmAUETORRENCE $ PREMISES Ea occurrence) $ 1,000,000 X COMMERCIAL GENERAL LIABILITY EXCLUDED CLAIMS-MADE OCCUR LIMITS OF POLICY XS MED EXP(Any one person) S OF SIR:$1M PER OCC PERSONAL 6 ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9,000,000 PRODUCTS.COMP/OP AGG $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO X = S. POLICY LOC I COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY 8AP 293BB63-11 0310112014 0310112015 Ea accident BODILY INJURY(Per person) $ X ANY AUTOBOIL S D Y INJURY Per accident) ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED P r a cldanl HIRED AUTOS' AUTOS S UMBRELLA LIAR. OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S S DED, RETErRIONS WCSTATU- OTH- C WORKERS COMPENSATION WCD49101882(AOS) 031012014 03101!2015 AND EMPLOYERS'LIABILITY WC049101884(AK,AZ,VA) 03/012014 0310112015 ,000,000 C ANY PROPRIETOR/PARTNERIEXECUTIVE YIN N E.L.EEACH ACCIDENT S . OFFICERIMEMBER EXCLUDED? NIA WCD49101883(FL) 0310112014 0310112015 E.L.DISEASE-EA EMPLOYE S 1,000,000 D (Mandatory In NH) 1,000,000 If es,describe under E.L DISEASE.POLICY LIMIT S DESCRIPTION OF OPERATIONS below 1,000,000 C WORKERS COMPENSATION WC049101885(KY,NC,NH,VTI 03/012014 0310112015 (EL)LIMIT C WC049101886(NJ) 031012014 031012015 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addloonal Remarks Schedule,If mors space Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhedee ©1988-2010 ACORD CORPORATION. All rights reserved. G umbra Gasc of Massachusetts A NiSource Company 995 Belmont Street April 9, 2013 Brockton, MA 02301 The New Heritage Realty 25 Fairwood Avenue North Andover, MA 01845 Dear Customer: During a recent visit, our service technician detected a safety problem with your gas heating system at 25 Fairwood Ave.,North Andover,MA 01845—boiler needs to be serviced by a licensed plumber. Accordingly,we have issued a Warning Tag because of this situation. Under the circumstances,we strongly urge you to correct the code violation. In addition, the Massachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737,Acts of 1960, requires that the condition be remedied. If you have any questions, please call our Service Department at 1-800-677-5052 and ask to speak with the Service Supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Customer Service Department Columbia Gas of Massachusetts