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HomeMy WebLinkAboutBuilding Permit #404-13 - 481 REA STREET 11/15/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: �� ` Date Received Date Issued: / IM ORTANT: Applicant must complete all items on this page LOCATION Rec, n� t Pri PROPERTY OWNER Print 100 Year Old Structure yes MAP NO: 05? PARCEL.W.5"I ZONING DISTRICT: Qa Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition EI-Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District- 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: I entificatio Please Type or Print Clearly) OWNER: Name: 'e,� NVA �` Phone +q,-( -3(.a Address: 0 l 8 CONTRACTOR Name: &SC, n .r�n�sa Phone:SUF.• a!>U> Address: Vks Q �Oorv, Supervisor's Construction License: S3 Exp. Date: Home Improvement License: I 1-67 1� Exp. Date: 3- 3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ /Sro1. Check No.: (9-4b y 3 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund =Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ A i I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ i Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS i I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 Towp. 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 crop 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 El Notified for pickup - Date l S Doc.Building Permit Revised 2010 Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application o Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application u Certified Surveyed Plot Plan o Workers Comp Affidavit u . Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (if Applicable) E3 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) u Building Permit Application o Certified Proposed Plot Plan L3 Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract L3 Mass check Energy Compliance Report o 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 Doc: Doc.Building Permit Revised 2012 Location No. L -- Date i + • TOWN OF NORTH ANDOVER u Certificate of Occupancy $ Building/Frame Permit Fee $Y/ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# V7 7� A i 25954 Buie g idspector � NORTf{ Town of No. I * 7�4-W-0 h ver, Mass, ///// W-0 WICK s V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System ' BUILDING INSPECTOR THIS CERTIFIES THAT ..........Y2........ ??.'Yz.�c:.t/ ........................................................................ �� ��`� foundation has permission to erect .......................... buildings on ........ .�`�.e. ........ .......................................... Rough to be occupied as ...................��. .(r ......c ...( ... ��.Gt ,S.................................................... 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 UNLESS CONSTRUCTIO STARTS Rough Service .......1 ..a r r..................................... Final Y 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. SEE REVERSE SIDE Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor I License: CS-095707 .n BRIAN D DENNISON 7 LAMBS POND CIRC:$1� f r, s Charlton MA 01507 Expiration 1 Commissioner 09/08/2014 Office of Consumer Affairs&Bdsiuess Regulation TWAI HOME IMPROVEMENT CONTRACTOR Registration: < 170810 Type: Expiration: .'•12/23/ 2013 Corporation BY ANDERSEN-CORPORATION S'. BRIAN DENNISON 104 OTIS ST. NORTHBOROUGH,MA 01532 Undersecretary I r 9 i 1 RenewalMA Home Improvement Contractor bYAndersen. •• License#170810(Expires 12/23/2013) Federal Tax ID#41-1918413 WINDOW REPLACEMENT an Andersen Company Renewal by Andersen Corporation - 104 Otis St.,Northborough,MA 01532 (508)351-2200•Fax:(651)351-4810 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s) ame Date of Agreement M-1 b �, Cori(Vo Buyer(s)Street Address,City,State,and Zip Code 1�i &Ca A 4' VR-,— E-Mail Address // Hope Telephone Number Work Telephone Number Co Ah{I(`1t10ML/�COMCU-S7,�C /y—� Buyer(s)hereby jointly and severally agrees to purchase th6roducts and/or services of Renewal by Andersen Corporation ("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively,this"Agreement").Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. � E ated Starting Dgte: Method of Payment: Total Job Amount:_' � 1J— Amount Financed �. iY ❑Check ❑Cash Deposit Received(33%): 0 -/1 &Z ❑Visa/MC ❑Discover nanced ❑AMEX / Balance at Start of Job(33%): NLe� D Estimated Completion/Date: 7k (/ s credit card is selected,please Balance on Substantial see Credit Card Payment Form. Completion of Job(33%): � Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alteration to or deviation from this Agreement will be valid without the signed,written consent of both Buyer(s) and Contractor.Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and as orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ANY ACES. Renewal And e o r tion Buyer(s) Buyer(s) By: 9=C,-, S' ature of Pro t M nuger Signature Signature not Name of Product Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT — — — — — — — — — — — — — — —91<- — — — — — - --- — — — — — — -X— — — — — — — — — — — — — — —x NOTICE 9F CANCELLATION X NOTICE OF CANCELLATION Date of Transaction u-ja- . You may cancel I Date of Transaction You may cancel this transaction,without any penalty or obligation,within I this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any I three business days from the above date If you cancel,any property traded in,any payments made by you under the property traded in,any payments made by you under the Contract of Sale,and any negotiable instrument executed Contract of Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt I by you will be returned within 10 days following receipt by the Contractor ("Seller") of your cancellation notice, I by the Contractor ("Seller") of your cancellation notice, and any security interest arising out of the transaction will and any security interest arising out of the transaction will be canceled.If you cancel,you must make available to the be canceled.if you cancel,you must make available to the Seller at your residence,in substantially as good condition I Seller at your residence,in substantially as good condition as when received, any goods delivered to you under I as when received,any goods delivered to you under this this Contract or Sale; or You may, if you wish, comply I Contract or Sale;or you may,if You wish,comp!y with the with the instructions of the Seller regarding the retum instructions of the Seller regarding the return shipment of shipment of the goods at the Seller's expense and risk. I the goods at the Seller's expense and risk.if you do make Ifyou do make the goods available to the Seller and the I the goods available to the Seller and the Seller does not Seller does not pick them up within 20 days of the date I pick them up within 20 days of the date of your Notice ofyour Notice of Cancellation,you may retain or dispose I of Cancellation,you may retain or dispose of the goods of the goods without any further obligation.If you fail to without any further obligation. If you fail to make the make a goods available to the Seller, or if ou agree I goods available to the Seller,or if you agree to return the to return the goods to the Seller and fail to do so,then I goods to the Seller and fail to do so,then you remain liable you remain liable for performance of all obligations under performance of all obligations under the Contract. the Contract.To cancel this transaction,mai or deliver a To cancel this transaction, mail or deliver a signed and signed and dated copy of this cancellation notice or any I dated copy of this cancellation notice or any other written other written notice,or send a telegram to Contractor: I notice,or send a telegram to Contractor: Renewal by Andersen Corporation, 104 Otis I Renewal by Andersen Corporation, 104 Otis Street, Street, Northborough, MA 01532, BY NOT LATER THAN Northb rough MA 01532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF 11'(lr-tom .(Date) OF�t"t .(Date) 1 HEREBY CANCEL THIS TRANSACTION. i I HEREBY CANCEL THIS TRANSACTION. I Buyer's Signature Print Name Data I Buyer's Signature Print Name Date RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink QJBLLP2009.RBA-Ph.MANH Renewal .. renewal by Andersen Corporat. L MA Home Improvement Contractor byAndersen. , 104 Otis St.,Northborough,MA 01532 License#170810(Expires 12/23/2013) WINDOW REPLACEMENT an Andersen Company (508)351-2200•Fax:(651)351-4810 Federal Tax ID#41-1918413 WINDOW SPECIFICATION SHEET Buyer(s)Name Date of Agreement ThelBuyeks5 listed above hereby jointly and se erally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of=windows in Owner's home,using the following individual quantities: Double Hung(DB)�Equal sash_Cottage sash(1/3 top,2/3 bottom)_Oriel sash(2/3 top.1/3 bottom)_Flat sill awa a of class of s) Casement(CS)_Hinge right_Hinge left(as viewed from exterior) Double Casement(CD) /) i ` t�-U 2 Lite Gliding Window(GW) Casement/Picture/Casement(CT)_1:1:1 or_1:2:1 I Glider/Picture/Glider(GYM_1:1:1 or_1:2:1 1 4�}- Picture Windo ( C6 v Y \ Bay or Bow Awning Window _#Lights Soffit/Roof Shingle/Copper Specialty Windo Patio Doors(see separate door spec sheet) Seat to be Primed/Oak/Pine L11 1 2_1_Qty of Windows to be Custom Fit Replacement: 3.1_Qty of Windows to be Custom Fit FuII frame(INCLUDES NEW INTERIOR&EXTERIOR CASINGS) Exterior casings:—Pine_Maintenance-free material_Factory applied 908 Fibrex brickmold 4.Glazing to be:5 HP Low-E-4 TM _Tempered _Other If other,please specify: 5.Exterior color to be: White_Sand Canvas_Terratone_Cocoa Bean_Dark Bronze_Forest Green_Black G.Interior colo be: White=Sand_Canvas_Pine_Maple_Oak_Same as Exterior Note:Wood interiors need to finished by Owner. 7.Hardware: White_Stone Canvas_Estate Hardware: Style: 8. Install Lifts with Double Hung Windows 9. Screens:windows to have.I Half or_Full screens Screens to be.Fiberglass_Aluminum_TruScene GRILLE DETAILS 10. Windows have grilles Grille Between Glass(GBG)_Removable Interior Wood(INTW)_Full Divided Light(FDL) Owner approved(initials) f" J Draw grille patterns below `Use additional sheet if needed ty:�_ Qty: Qty: ° QtyQty: Qty: Qty: dEEEEI I'l 11 [:1 ADDITIONAL WORK DEFAHS 11. Qty of Sills_Sill noses to be replaced by Contractor 12. Contractor will remove metal frames of windows. 13. Contractor will install new_paint-ready or_stain-ready_Interior d Exterior casings in_Pine_Maintenance-free material J4., 0 Contractor will install new_paint-ready or_stain-ready_Interior_Exterior stops in_Pine_Maintenance-free material Piy/( )Inds Owner is aware that Contractor does not do any painting. 1 Contractor will wrap exterior casings with coil stock of color. Note:Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing. 17._3 Contractor will insulate,caulk and seal windows with 3-Point system to prevent water and air infiltration. Removal and disposal of all job related debris,windows,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall he issued. 18. Yes El No Building Permit--Contractor will secure any and all necessary permits.The fee for the permit(s)is not 0included in the Contract Price and a separate check is required at the time of sale for this fee. Ck# $ 19.6iLYes❑No All discounts vekeen pplied to this iagree ent price. 2 .Additional job details: (b ` /� bw L„ L✓o V-0 -, 21.t§4kj❑No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s). It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,constitutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms.This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and C tractor.Buyer(s)hereby acknowledge that Buyer(s)has read this Specification Sheet. Rene al y d rsen Corporafi It Buyer(s) Buyer(s) By: .(' Aignatu roduct Manager Signature Signature Print NamekfddctManager Print Name I `��IN Print Name 2U Comrn mma h of Maa'sad!ixi;eM ff' ' Depara�iceht.of Iredas�rial�4ccidetcb' ' kipOff= of&vi*ations 600 Street 'Boston;MA 172111 iw►�►ra.rr�grrvldia . . Workers' Compensation lsmmee Affidavit" $mlders)ContractOr&Meetriciam/Phmlbers A�gjicant l�afal�natian Please Print-LeeibIy Name(aes;necs�org�iot�naividaetl: �'t'l�P l� �. u Rr�e(�Ce n mss: 1 a L4 '�s �-t- GitplStata/Zig: �1QD3 Phone# �d'�' - S 51-,92 0 ' Are pot an amployer.9 Check the apprapriah'b= Type of prejeet(requh-ep, L-E,I M a emplopea with — 4, ❑ I em a gm=ul oomhactar axid I fi, ❑New camstivcfioa • employees(fall aadlorpart-�1,« have]mt;d the snb-co�ecbss 2.❑ I am a sole pivpaietnr aspertna- listed cm fix atthAd sheet Z 7. � aeSing W*and have M effipinyees Those cis have s, ❑Demolition 4..1.i:..� n v wmidmg fir mL m WCl3='CAIIIp.IDsurancx 9, yu++waab [No yam' �, uIMMBnCC S. ❑ We are a oorpmRfi m and its 10.❑ iepeas Cr arldiiiaus offrceas have aurcised tiuea . -• 3.❑ I am a h�eownea doing an wciri6&of exemptkn pea MGL 11.❑nmdbiag sapan or additions myself [No wod='-comp, c. 152, ¢1(4},and'we hirm no 12.❑hoof xepeas t employees. [No (� msaz�co �, Camp.insuianee ing red) j I13. Ofhet sA�epgafieadt that�baa#1 ams ileo fM amt the scatim below 6vwimg their w�' PDB* t He�mwnr�wbo eai>mic thio aSdn*iodiadiag they am daunt all*ukmd thm hoe anode ao t am&=bmdt.►new aMdavh ind;aat3ng aneh. 3C_ooft==-that rheet thk box amts attached as ad"MI died dwwimt the=cm of f='rab-M*3ft=and thea wdmr'aammp Ply m oa f am an MVIVYff aigr it provk67T worlaaa'compenamfan va wtce for my MPkW= Below ra&e PO&7 Md jnb s' Insatamce CGmpamy 21ame;_ . Policy*or set€mss.Lir. # 1� ' 1 � ` .?� - Fspir Dat: Job bite Aid&esa; Li I \ moi. �� t�y'/StatrJTsp N�r-�� �t�&Jet. Kip, .Atm a copy of the warl='eompeusstiion policy dedarafien pale(shDwhq the pA q number and expiration dxt84, Potline'tn secure eo#erage'as iegmmd tinder Section 25A ofMQ.c, 152-can lead to the*Ositiom.of tial penalties of a fisc-Up to&1,500.00 and/or ome yrar*sisammeat,as well as civil penalfiex in the fon of a MP WORK ORDER and a fine of up to 5250.00 a day aphiht the viola6L Be advised•that a copy 0- is stsirmed may-be fxVm'ded,to the Ofoe of kvzwftptiaw of tit:DIA foo•lassoes:mvem o vrfficahm .,Ido herby.cert�j+-r�.�e - Pte'of,P�7't�t3,e ircjmieealion prvvidad-above is tree svtd coi�ct : i�afirre Doty O,flciid=e meiy. Do not writ!in Aunts, m-be complatcd�by rosy or WM,offidd City ar Toga Peen-,t/ta # ' �rctaiag ��-ones; • .L Board of Seal& z.Bi�Dgartma& 1 Oty/T.00rn Clark 4;$ietdxacal Iarpedar S.Plmm59ag h spedw 6.•err- - .. • Coabr�t pry-ens: thane#: - . CERTIFICATE OF LIABILITY INSURANCE � /m 09/25/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THII CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIEI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIM REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject if: the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to thl certificate holder in lieu of such endorsement(s). PRODUCER 1-612-333-3323 CONTACTJonelle 8a Says Cotmanies NAME: rgrove or Eric Johnson P ML . 612-333-3323 FAX 612-373-7270 80 South 8th Street L No Suite 700 PRODUCEADR Irinneapolis, HN 55402 1086 NiSURED INS S AFFORDING COVERAGE NMC S Renewal By Andersen Corporation INSURER A: OLD REPUBLIC INS CO 24147 INSURERS: NATIONAL UNION FIRE INS CO OF PITTS 19445 104 Otis Street INSURER C: Northborough, NA 01532 INSURER D.- INSURER :INSURER E: INSURER F! COVERAGES CERTIFICATE NUMBER: 29229436 REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE DL UBR POLICY EFF POLICYFXp POLICY NUMBER MIDD MM1DD LIMITS GENERAL LIABILITY WwnNIiZY 59828 10/01/1 10/01/13 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO ED PREMISES Es occurrence $ 500,000 CLAIMS MADE Z OCCUR MED EXP(Anyone Person)' $ 10,000 PERSONAL 6 ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: S POLICY PRO LOC PRODUCTS-Comp/Op AGG $ 3,000,000 A AUTOMOBILE LIABILITY1rNT8 21700 10/02/14110/01/13 COMBINED SINGLE UMIT $ 3,000,000 X ANY AUTO (Ea aoddent) ALL OWNED AUTOS BODILY INJURY(Per person) S SCHEDULED AUTOS BODILY INJURY(Per aodd.M) S Z HIRED AUTOS PROPERTY DAMAGE $(Per accident) Z NON-OWNED AUTOS $ t B X UMBRELAALIAB R OCCUR 13273355 10/01/1 10/01/13 EACH OCCURRENCE $ 25,000,000 EXCESS LJAB CLAIMS-MADE 5,000,000DEDUCTIBLE AGGREGATE j2 X RETENTION 25,000 S A WORKERS ANDEMPLOVER 'UABRfN MKC 117948 00 WCSTATU OTH S AND ROPRIEERS'LU TNER YIN 10/Ol/1 10/01/13 X ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? FNI N/A E.L.EACH ACCIDENT $ 1,000,000 (MendNory N NH) K s,desaibe under E.L.DISEASE-EA EMPLO S 1,000,000 DESCRIPTION UO OPERATIONS below E.L.DISEASE-POLICY UMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Add oral Remarks Schedule,H more span b requbed) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION Evidence of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE erica neme Adel„ m«.oto Rs�u►e�Qrr �a,lnd,an►t�.e, 1 "�°aMo ENERGY PERI`ORt CE PATMGR U-FacMi(U.s)A-P Solar Heat Qain Coefficient 2 9 19 . PXDITIMU PERFOR CE RATINGS Visible Tmnsmitkgce 42 , «......w..♦.rA..l......+pwrna,,�,.,,¢MhIC,,,,,.w,O,���� - ��r.MODariaraioMr�1�/ArcirNa+tN�rtl�wa ' 05"Not M~w1camongw�.w.�jw/�s �w soft aw.roe.p 1* q ip •w•..awr •a :;• wcwnosou �• awaral.ariaW RT �• ;��� .wne4 asr �� � . DE�KaN PAd`SUAE(PSF) ax - fib Slopes i. . •�MYAIilrMNIpM�1111�ap�i a� . M�NrRwewbM.ErC,CIrC.&Eye"Ak1�RNc���MtMO1111WrIc OnYWIa�G. . ' .••. -, : .. _ - � � ' ' .. •- : A •~ � dc6o1� Save iahe�forfi�huerc'fe►�nr�.' •` • "Dn nal remave ung feral nmde insp Cs ihan•DFa 4 4,- I k tv TmtAOY =GueldnldlAdnylssihh /�+^ Wn1�OW pETLY- p,�ybm111Cv, ' �; V`my1M►aad Camper►��eriel n • 5a}�sr Dual Argon 'Low�4 Smarf ' Pichi{e • � -� Product Type, ' sNERI PEKFDRMMcE W1.TIN� " U-Fartrtr . . . . Sour}-ai U�aln Caemcle�t •0 .27 1 .53 a . 22 ; loNAl AM PUIFoFcMANCE WINGS . Malble Ttansmif�ce ... .mAaapnc �^�a�Enw���`►�I°°ce°ucbr�di9v"i°�pc°°"c , . c,m.ileac Nhror m o �'t t"d1 aam eurtmmm.mu��icn�o¢'�� �c�. ' µ9tCamYnsrrr�nnvamac'P�p01Q'^tlaoncn:w,o.neukr�0 �e2 . �n�nusA�maurt�lorcmcpmnn?Podmmm�*>�°�`' ' - • - _MwrhhcmP ' BrSan ar�R RhA FMC WIr7dDw MILL ,Kr r ntr�MlrwwA+u�tmu�raao-as DP•psf F� C �n SLIM . - �y• pweml�ctul9Y' . ' .. :� .MidrntY hlsy%mecq . . �.In niefiiot>�nm � mm�(P►ct<.Dhu..nr ' .�'C m�lnt•. QQG-ODj . � .. I,�p�earmcl+•E�•.cFC,t-lE.c�.,ltr•In�oQaoontr�mrmm�lvotk.Nannu� +�r°0� . ~ _ " `' - I ♦ �� - rte• 7 6 V � Date. i ...... .... NORTH o� TOWN OF NORTH ANDOVER F ... 9 PERMIT FOR GAS INSTALLATION SSACHUSE 2 This certifies that . �4.4f� S!�`.1. . . . .�� . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . at . . L�. /. . . .P.c e. . .F:t. . . . _ . . . . . North Andover, Mass. Fee. 3�. . . . . Lic. No./(.?v.'�. . . T.I. _:.. :_.... . . . . . . GAS INSPECTOR Check# Z y 99U4 Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACHUS This certifies that ....................... thas permission to perform .....i ,.. .... .......................... wiring in the building of.....III/Z(- u-.....C Y. ................ at...... ......-IF7 ..................... North Andover,Mass. Fee.... .......... Lic.No..Z�?.01.4............ LE I'CAL INSPECTO Check it l.osnnwnwealtli o� aaaachu�al Official Use Only c� Peimit No. `!�4 " aLJeparfin®►af o j.}ira�ewice� � Occupancyand Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C),527 CMR 12,00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: a I d h I City or Town of: 1V I V\ AnAQyt2 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) - Owner or Tenant AI"Le- Cb nf 11,J Telephone No. 972— 71y--36,?7 Owner's Address Is this permit in conjunction with a building permit? Yes 9 No ❑ (Check Appropriate Box) Purpose of Building S�`nwl� �d hr�� Utility Authorization No. Existing Service Amps I `' Volts Overheads❑ Undgrd 0 No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,- 9 4 'mal+ yfty Conn,t_ lLISo Sun Amm 60�1411M Completion o the ollowin table nsav be waived by the Inspector of fires. No.of Recessed Luminaires No.of Ceil.-Susp. (Paddle)Fans No. of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of LuminairesSwimming Pool Above ❑ In- E] No.u Emergency Lighting rnd. rnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ._. ...........­­I­........... Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local[:] Municipal Connection ❑ Other SecuritySym stes: No.of Dryers Heating Appliances KW Na f Devices or Equivalent No.of Water KW u.of o•of Data Wiring: Heaters Signs Ballasts No,of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: e No.of Devices or Equivalent OTHER: Attach additional detail if desirerj or as required by the Inspector of fires. Estimated Value of Electrical Work,3,0CP0 (When required by municipal policy.) Work to Start: It Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation'coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ©BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penakies ofperjury,that the information on this application is trite and complete. FIRM NAME: ZrV4a LIC.NO.: /0017 Licensee: " u l,( Signature LIC.NO.: olOY 39 (If applicable,enterxenspt"in the cense number line.) Bus.Tel.No.• 97t- 7(07-07g A Address: 2� S,'�ut ad-oo k " Sa��rr N H 010 Alt.Tel.No.:22f- 767-a-7 *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safe "S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does _ o s not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner El owner's a Owner/Agent Signature Telephone No. PERMIT FEE: ��` '� r 1 �, s MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CitylTown: T�p�.(�( n PV-(6-0V ([M-A Date: 3 l 0 - l Permitil Building Location (i er say Owners Name: CK.-3AAC- Type of Occupancy: Commercial ❑ Educational❑ Industrial ❑ Institutional❑ Residential New: ❑ Alteration: ❑ Renovation: % Replacement: ❑ Plans Submitted: Yes ❑ No❑ FIXTURES W W UJII Y = W Z D W W jX O Z H Q O J >. W Z W O W W W to W m O �" W 00 Q H H 0 XWX v w W X O Q W to O W W o = W W Z O J I- F O Z J O W H ui = W �- W W UO o ur O 0 X X O a o' W !- > > > 3 O V SUB BSMT. BASEMENT 1 FLOOR F 2 FLOOR 3 FLOOR 4 FLOOR I t 5 FLOOR 6 FLOOR VH FLOOR 8 FLOOR Installing Company Name: GALA A:5& PLth+AQtkk, NCATioG Check One Only Certificate# [Corporation Address: P•O. 'DO)( 001 City/Town: 14AQ LI*t LL State: M-4 . Business Tel: q7g-- q- 174 ❑Partnership 3 Fax: q�8� SSI-�13t ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: STEP N t J. . C. 6Ai iJ�KH INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes O No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy I?,- 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 installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: 7 By Qfilumber C � Title ❑ Gas Fitter Signature of L ensed Plumber/Gas Fitter [+Master City/Town ❑Joumeyman License Number: 0 iq% APPROVED OFFICE USE ONLY ❑ LP Installer i I FINAL INCPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE; $ PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAMLF&TYPE OF BUILDING i LOCATION OF BUI .DIN SKETCH i ELUMBEIL.QASEITTER,LE INSTALLER r LICENSE NUMBER: PERMIT GRANTED F-] 'DATE; I 1 GAS FITTING INSPECTIOR