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Building Permit #0790-2017 - 97 MAPLE AVENUE 2/21/2017
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:d` � ���` Date Received Date Issued: BZ ti! IMPORTANT:Applicant must complete all items on this page '+�GY" a' �iLOs tx7 k r 4 r y 1C a`3 t t � * t ' `CATI �N ^� +dl' C��` i, .✓��' � i�J�� 3.refv--^qtr.>`R r�.•.wF..xsr..,w�— -•m... .yr,Zt FnfR_ROPERTY �1NNER,: ! .� � OO.Year O d Structure �` ' # ' PARCEL° ZONING DISTRICT .� Htstoric ®i`strict k K z'S} �,: r _, , �. 1MachineShopVillage i. .a...4 i.,"...t w.�,li�iar i't•:�;1r_... �i_v.t.�,�.+r..f "L�:.......3.. ...:«w+<tt« :4 w_..lE'a�a',:hM._,,S-....'a��ss..�4.._���-..�a:<.....w_,—a,..at...,t ,. ,...... TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 'fOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other El SepticglNell }� _ ❑�Flogdplairi .- �Wetlands� 1Natersfied Dlstnct , i...�. _1Nate_eiSew_ DSC IPTION OF WORK TO BE PERFORMED: Identificatio Please Type or Print C1earIy) OWNER: Name: t�i9 NdtWA r��iGak1l Phone: Address: AR PLS 4-V6 �JAte-Di 6 Ci(8�� 1C:ONTRACTOR Name3 __ s - -- - � , Rho s: Ir ; 'Address --/ ���. �.(�.,�_c ��L ��,`(��V� -�� �✓� /t1�.-+�-�=��"����� �'' �- "4��r—- �' --. ' .x" Y"~�,.."'�'V.F�+'•� � a... a♦ �,..-.. �� s "".:f.'®' .tit.�s'"'� r J ^4-'.t'x5+ �2. '1�,'. ��'j/,�':"'"'* ' .. � . Su ervisor s Construction`License ' a�flU��., Expo Date � r� Fti .pc.. — cc._,. .4: Horne Improvement Ltcense�4_ F ARCHITECT/ENGINEER Phone: r� Address: Reg. No. K FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ',Jn?S. •62 _FEE: $ Check No.: `T �_)g/ Receipt No.: f DOTE: Persons tr ca ting wi registered contractors do not have access to the guaranty fund Sign o Contractor=.. Signature Agernt/.. .,. ner: ,. .:: .:.::: _ - - -- Plans Sub' Plans Waived ertified Plot Plan ❑ Stamped Plans ❑ Building Department Tine following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 0: Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products (COTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o 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) a Engineering Affidavits for Engineered products 10TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan ❑ 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 o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cois�s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apn-al period is over. The applicant must then get this recorded at the registry of Deeds. One copy and proof of recording must bp- submAted with the building application Doc: Doc_Buhding Permit Revised 2012 r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped,Plans. ❑ ' TYPE-OF-SEWERAGE DISPOSAL Public Sewer ❑ TanningWassage/Body Art ❑_ .Swimming Pools ❑ 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 & DEVELOPME El F1COMMENTS CONSERVATION Reviewed on Signature COMMENTS i i HEALTH Review on Signature i COMMENTS Zoning Board of Appeals:Variance Petition No: pp Zoning Decision/receipt submitted yes Planning Board Decision: Co m s r . _`conservation Decision: o ent i Water & Seger Connection/Si nature Date DrivewaV Permit DPW ToyvL Engineer: Signature: Located 384 Osgood Street FIR --_:DEP ARTMENT - Temp Dumpster on site yes —no— Located at'124 Main'Street Fire Department signatureldate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions- Total imensions_Total land area, sq. ft.: ELECTRICAL: Movement of!Deter location, rust 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 i i B Notified for pickup - Date Doc.Building Permit Revised 2010 I i (/ew Locatio No. � �� "' Date D,' �r-/ + ` . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ _ t Check# J r# ` Buildingilnspector �/ NORTy Town of _ Andover O No. JiO oh ver, Mass, Z 2 COCN�C Ht.. . 1' �A�R�7ED 5 BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System THIS CERTIFIES THAT ... .. ..A. ./��. � ,. ��I BUILDING INSPECTOR has permission to erect .......... buildings on .. '�.,1 . ♦�'l/Q�Pl,�. ......... Foundation Rough to be occupied as �w!!�s<'ir�' ..... Q....'�...wt,R!".7' � �11i Chimney provided that the person accepting this ermI s�ev p p g p ery respect conform 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 CONST RU ION S S Rough Service ... .. ......... Final BUILDING I PECT GAS INSPECTOR Occupancy Permit Required to Occupy Ruildine 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. I INCIDENT REPORT Todays Date.62- + 00l� Address: 221�� LMap• Lot: Z 3 Date of Incident: Z- IZ- 2-01:7- Inspector'j-2-9z4— Description of Incident: ::F-1, fi-rG �►�G� ,' e� ��'G, � ,/reiTj ,�,j 5- %Ee- 6tn 7 5-zPf po- NO L/:vl Cn✓,,% L6 Ir l N-c7--,-Ok,--'t Departments Notified: i L I ServiceMaster Elite 12 Continental Blvd Merrimack NH 03054 Office: 800-338-5311 Fax: 800-443-1819 Dennis@elitesvm.com Tax ID#26-3242142 Insured: Hanna Lepicka Home: (978)857-8236 Property: 97 Maple Street N Andover,MA 01845 Claim Rep.: Bill Manchinton Business: (781)983-2742 E-mail: wjm@mccormackadjuster.com Estimator: Dennis Cushing Business: (800)338-5311. Reference: { Company: Commerce Contractor: Company: ServiceMaster Elite ' Business: 58Rear Pulaski Street Unit L2 Peabody,MA 01960 Claim Number: NCKP53 Policy Number: Type of Loss: Fire Date Contacted: 2/1.2/2017 2:44 PM Date of Loss: 2/12/2017 Date Received: 2/12/2017 2:44 PM Date Inspected: 2/1.3/2017 12:45 PM Date Entered: 2/13/2017 8:30 PM Price List: MAEM8X_FEB17 Restoration/Service/Remodel Estimate: LEPICKA HANNA-DEMO Source:Fire Deductible Collected Y/N:N Amount: $ CCAPS LLC, 1.2 Continental Blvd.Merrimack,NH 03054 TAX ID 26-3242142 i ServiceMaster Elite 12 Continental Blvd Merrimack NH 03054 Office: 800-338-5311 Fax: 800-443-1819 Dennis@elitesvm.com Tax ID#26-3242142 LEPICKA HANNA-DEMO 97 Maple Avenue Basement A,c11, y, 1 Source Room Height:8' I 1,117.65 SF Walls 1,069.49 SF Ceiling + Somme Room N rc2,187.14 SF Walls&Ceiling 1,069.49 SF Floor I � 118.83 SY Flooring 1.37.79 LF Floor Perimeter �t 1 L 149.29 LF Ceil.Perimeter 29'3" - 29'9"--� Door 216"X 61811 Opens into STORAGE-AREA Door 2'6"X 6'8" Opens into DEF_99_BASEM Missing Wall 311/211 X 8' Opens into STAIRS Door 2'6"X 6'8" Opens into DEF-97 BASEM Door 1'6"X 61811 Opens into BATHROOM Door 2' 6"X 6'8" Opens into Exterior DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 1.3. Contents-move out then reset- 1.00 EA 0.00 78.78 0.00 78.78 Large room Move content to mitigate from water damages and remove layer of cardboard and lauan from tile floor 14. Remove Batt insulation-6"-R19- 1,069.49 SF 0.25 0.00 0.00 267.37 paper faced Pull insulation due to odor 15. Water Extraction&Remediation 7.50 HR 0.00 70.33 0.00 527.48 Technician-after hours technicians to pick up debris and sort content-set content aside for adjuster evaluation-clean fallen insulation from content and floor-remove cardboard and lauan from floor-mop floor due to silt under cardboard-set aside loose brick and stone work-had to clean bathroom tub due to water discharge from multiple moppings of tile floor 16. Water Extraction&Remediation 3.00 HR 0.00 46.84 0.00 140.52 Technician-per hour technicians to pick up debris and sort content-set content aside for adjuster evaluation-clean fallen insulation from content and floor-remove cardboard and lauan from floor-mop floor due to silt under cardboard-set aside loose brick and stone work-had to clean bathroom tub due to water discharge from multiple moppings of tile floor 17. Clean with pressure/chemical 400.00 SF 0.00 0.41 0.25 164.25 spray-Heavy 18. Water extraction from hard surface 400.00 SF 0.00 0.21 0.00 84.00 floor 19. Water extraction from hard surface 180.00 SF 0.00 0.32 0.00 57.60 floor-after bus.hrs LEPICKA_HANNA-DEMO 2/16/2017 Page: 2 ServiceMaster Elite 12 Continental Blvd Merrimack NH 03054 Office: 800-338-5311 Fax: 800-443-1819 Derinis@elitesvm.com Tax ID#26-32421.42 CONTINUED-Source Room DESCRIPTION QTY REMOVE REPLACE TAX TOTAL Totals: Source Room 0.25 1,320.00 Total:Basement 0.25 1,320.00 Total:97 Maple Avenue 0.25 1,320.00 99 Maple Avenue Main Level Main Level DESCRIPTION QTY REMOVE REPLACE TAX TOTAL. 1. Single axle dump truck-per load- 1.00 EA 355.84 0.00 0.00 355.84 including dump fees Total: Main Level 0.00 355.84 15 1 -~ Master Bedroom lsr' Height: 8'2" � a � 474.50 SF Walls 1.91.63 SF Ceiling ci se (') 666.13 SF Walls&Ceiling 1.91.63 SF Floor q'4 Master BedroAPh r- .4' `r Toq ro athIT 21.29 SY Flooring 57.00 LF Floor Perimeter ° r 63.00 LF Ceil.Perimeter e1-9,7„� Door 2'6"X 6'81f Opens into KITCHEN Subroom: Clooset(1) Height: 8' 4"� j r 72.31 SF Walls 7.91 SF Ceiling a reset c 80.22 SF Walls&Ceiling 7.91 SF Floor 1 0.88 SY Flooring 8.46 LF Floor Perimeter r 2" 11.96 LF Ceil.Perimeter Bathroom Door 3'6"X 61811 Opens into MASTER_BEDRO DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 9. Contents-move out then reset- 1.00 EA 0.00 78.78 0.00 78.78 Large room 2. Tear out wet drywall,cleanup,bag, 1.6.33 LF 4.26 0.00 0.80 70.37 per LF-up to 4'tall LEPICKA_HANNA-DEMO 2/16/2017 Page: 3 ServiceMaster Elite 12 Continental Blvd Merrimack NH 03054 Office: 800-338-531.1 Fax: 800-443-1819 Dennis@elitesvm.com Tax ID#26-3242142 CONTINUED-Master Bedroom DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 3. Tear out wet drywall,cleanup,bag, 8.17 LF 2.93 0.00 0.20 24.14 per LF-up to 2'tall 4. Tear out and bag wet insulation 78.94 SF 0.65 0.00 0.35 51.66 5. Tear out wet non-salvageable 36.00 SF 0.49 0.00 0.16 17.80 carpet,cut&bag for disp. 6. Batt insulation-6"-R19-paper 78.94 SF 0.00 1.01 3.06 82.79 faced Temporary insulation for heat loss and sound insulation for next door unit 11. Cleaning-Remediation 2.00 PAR 0.00 46.84 0.00 93.68 Technician-per hour Pick up and bag debris from firemen and sort through content for tenant to dispose Totals: Master Bedroom 4.57 419.22 Total:Main Level 4.57 775.06 Total:99 Maple Avenue 4.57 775.06 Line Item Totals:LEPICKA_HANNA-DEMO 4.82 2,095.06 Grand Total Areas: 7,278.14 SF Walls 3,607.90 SF Ceiling 10,886.04 SF Walls and Ceiling 3,695.19 SF Floor 410.58 SY Flooring 888.58 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 960.57 LF Ceil.Perimeter 3,695.19 Floor Area 3,850.86 Total Area 6,312.23 Interior Wall Area 4,147.35 Exterior Wall Area 466.50 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length LEPICKA_HANNA-DEMO 2/16/2017 Page:4 ServiceMaster Elite 12 Continental Blvd Merrimack NH 03054 Office: 800-338-5311 Fax: 800-443-1819 Dennis@elitesvm.com Tax ID#26-32421.42 Summary for Dwelling Line Item Total 2,090.24 Material Sales Tax 4.82 Replacement Cost Value $2,095.06 Net Claim $2,095.06 Dennis Cushing c a LEPICKA_HANNA-DEMO 2/16/2017 Page: 5 ServiceMaster Elite 12 Continental Blvd Merrimack NH 03054 Office: 800-338-5311 Fax: 800-443-1819 Dennis@elitesvm.com Tax ID#26-3242142 Recap of Taxes Material Sales Tax(6.25%) Clothing Sales Tax(6.25%) Storage Tax(6.25%) Line Items 4.82 0.00 0.00 Total 4.82 0.00 0.00 LEPICKA_HANNA-DEMO 2/16/2017 Page: 6 ServiceMaster Elite 12 Continental Blvd Merrimack NH 03054 Office: 800-338-5311 Fax: 800-443-1819 Dennis@elitesvm.com Tax ID#26-3242142 Recap by Room Estimate:LEPICKA HANNA-DEMO Area: 97 Maple Avenue Area: Basement Source Room 1,319.75 63.14% Area Subtotal: Basement 1,319.75 63.14% I I Area Subtotal: 97 Maple Avenue 1,319.75 63.14% Area:99 Maple Avenue Area:Main Level 355.84 17.02% Master Bedroom 414.65 19.84% Area Subtotal: Main Level 770.49 36.86% Area Subtotal: 99 Maple Avenue 770.49 36.86% Subtotal of Areas 2,090.24 100.00% Total 2,090.24 100.00% I it I i i I I LEPICKA_HANNA-DEMO 2/16/2017 Page:7 ServiceMaster Elite 12 Continental Blvd Merrimack NH 03054 Office: 800-338-5311 Fax: 800-443-1819 Dennis@elitesvm.com Tax ID#26-3242142 Recap by Category Items Total % CLEANING 257.68 12.30% CONTENT MANIPULATION 157.56 7.52% GENERAL DEMOLITION 785.67 37.50% INSULATION 79.73 3.81% WATER EXTRACTION&REMEDIATION 809.60 38.64% Subtotal 2,090.24 99.77% Material Sales Tax 4.82 0.23% Total 2,095.06 100.00% LEPICKA_HANNA-DEMO 2/16/2017 Page: 8 99 Maple Avenue-Main Level 47' 11" 170411 13' 8" 151711 411-1 T 2' I ose�F1 1`t - ;�, = Living Room _ Master Bedroom °�° Kitchen 41411-i 61411 Bathroom 11' 1" 31311 N to s M - i 8' lift JU 3, T L 2 -91711 ~3 :--� �3' 10" 10' 7., 1 17' 7" Main Level LEPICKA_HANNA-DEMO 2/16/2017 Page: 9 97 Maple Avenue-Basement 56'8" 12'10" 13'3" 29-3" Storage Area/Room z 13'7" 99 Basement 265" 13'8" Source Room 8' 97 Basement 4'9" 8'3 9" 6'3 2' 8'3" 6'3" C seP— Bathroom -- 1 CV 15'5"— [L-8'4" -4 Basement LEPICKA—HANNA-DEMO 2/16/2017 Page: 10 jhe Commonwealth of Hassachuseds Department of Industrial-Accide-ars - -� 'ate 100 1 C`ong:�ess,S`t�eet,,S`u d Boston,MA 02114.2017 www mass.gov/dia M 5y+v9�cance A ffida-dt:BuRders/Contr.actorsWectrlcians/Plumbers. �qa?>kers Compensation BE FILED WrM TEE PERIVIlT 1 O ApTg012I1'1'. Please Print L ToI A '-licantn ormatt'on tinnNam ( usinesslOzga7aodividua�: /�C; 1 ✓1 G U�LJ 1J a i Address: 3 City/State/Zip: xR Ateyon an employer?f heckthe appropriatebox: 'Type o�pro7ect(reclaixed) �J 7. [Nevi consiav'ciion I. I am a employer with 1____employees(fall and/or parE time).' g, EI Remodeling 2.0 1am a s ole proprietor or partnership and have eq employees yrorlang forme in emolitiort rkers'comp.insurance 9.] 9. D any capacity.[Novo [� 3.3.0lam ahomeownez doing allworkmysel£[Noworksur ers'comp,inancerequired.]i 10 Building addition will be hiring contractors to conduct all work on my property- I will 11.[]L^,le,tdcal Tepaixs or additigns 4.0 I am ahomeowner and , MnrGthat aII contractors githerhave workers'compensation insurance or are sole 12[]Plumbing repairs or additions proprietors with.no employees. ontractor and Ihave bicedtho sub-contractors listed ontbe attached sheet 1g.0Rbofzepdrs 5.❑I am a general c Thesesub-contractors have employees and have workers'comp.insin'ancet 14.p Other 6.❑-We area corporation.and its,officers have exereisedtheir right of exemption ed-] c. 152,§1(4),andv'e ha?e no employees-[No workers'comp.ms�ance required] *�nyapplicanithat checks boat#1 must also fill outihe sectionbelow showindthe:r ire outside co mpensat,,g=st s brnnmation affidavit' i Homeowners who submzttbis affidavit indicating they are doing all workanname of the snbd contractors and state whethero not fihome� have dicating h }Contractors that clreckthis boXriiusf attached'an addittonal sh r de their workers_'comp.policy nronbeL • employees. Ifthe sub-conisactors have employees,they mus P eYn ro ee.S. •Below is tTie policy rxrzd job site X ane an employer that isproviding�vor"7�ers'compensation insurancefor my p Y informadon. N5 � Insurance Company Name: �L��C L 5 5 C - �,(�9 q b� 1 ExpirationDatez Policy#oz Self-ins. �� 1 C ►V C f A 1+ � /7.0 /� A AVE —CithepolZip: Too Site Address:_,-- e shownag the policy number and exprx atxon date). Attach a copy of the workers' coanpensatxon p olzcy declaraiaon pag e as re uu under MGL o.152,§25A is a crvminal violation pumshabl and a fm ofd to $250.0 0 a Tailureto secure coverag and/or one-year imprisonment as well as civil penalti be fozwarded to the offios in the form of aSTOP e o juve tions of the DTA.for insurance day against the violator.A copy ofthis statement may coverage verification. proynde d above s true e and cortect- X do Iieryceprthe ainsndpenaltesofperjurythattlzernforman • 17-17 _. Date: Si-nature: e#: , 3 II Phon Official zsse only. Do not-write in its ea,to be corr�pleted by city or to7vn offzczal permit/License# City or Town: • fssuingA.ntho�rity(circle one): ector 5.plumb9ngXnspector 1.Board of Health 2.BuildingDepartm:ent 3.City/Town Clerk d.Electrical Insp 6.Other Phone#: Contact Berson: CCAPLLC-02 AMORSE ACOR/p" CERTIFICATE OF LIABILITY INSURANCE DATE 02/201201 YY) 02120/2017 . THIS CERTIFICATE 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 have ADDITIONAL INSURED provisions or 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). PRODUCER License#AGR8160 gRAJACT Ann Morse,CIC Clark InsurancePHONE FAX One Sundial Ave Suite 302N (AIC,No,EN:(603)716-2367 (AIC,No):(603)622-2854 Manchester,NH 03103ESS: EMAIL amorse clarkinsurance.com ADDR INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance 24198 INSURED INSURER B:Netherlands 24171 CCAPS,LLC dba ServiceMaster Elite INSURER C:Crum&Forster SpecialF Insurance Co 44520 MAJE,LLC dba Elite Construction 12 Continental Blvd INSURER D: Merrimack,NH 03054 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDSUBR PO LTR DL POLICY NUMBER POLICY EFF POLICY EXP DY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [X OCCUR CBP8869089 08/2912016 08129/2017 DREMISES R(Ea NTEDoccurrence) $ 100,000 MED EXP(6in one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,000 POLICY XX PEe E]LOC PRODUCTS-CO PLOP $ 2,000,000 J T PRODUCTS-COMP/OPAGG $ OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea ac c dent $ __ X ANY AUTO BA8867299 08/29/2016 0812912017 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY BODILY INJURY Per accident) $ X AUTOS ONLY X AUTOS ONLY ParOacaGent�AMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE CU8862891 08/29/2016 0812912017 AGGREGATE $ 10,000,000 DED I X I RETENTION$ 10,000 A WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE WC6994621 08/29/2016 08/2912017 1,000,000 MFICER/M MBER EXCLUDED? Y� NIA E.L.EACH ACCIDENT $ 1,000,666 andatory In NH) E.L.DISEASE-EA EMPLOYEE $ _ If yes,describe under DESCRIPTION OF OPERATIONS below 1,000,000 E.L.DISEASE-POLICY LIMIT $ C Contractor Pollution PKC104371 08/29/2016 08/2912017 Each Occurrence 2,000,000 C Liability PKC104371 08/29/2016 08/29/2017 Includes Mold DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Alan DeGeorge&Matt Troyer are excluded from Workers Compensation coverage. Workers Compensation States covered in 3A: NH/MA/ME/VT/NY Cyber Liability: BCS Insurance Company: Policy#RPS-P-0302360M: 11/23/16 to 11/23/17: Limit: $1,000,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE _ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r / '1 Office of Consumer Affairs nd Business Regu atl n 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement,Contractor Registration Registration: 165712 Type: Supplement Card Expiration: 3/22/2018 MAJE LLC./dba Elite Construction ALAN DEGEORGE --_ � 12 CONTINENTAL BLVD - -- --- - — MERRIMACK, NH 03054 Update Address and return card.Mark reason for change. ❑ SCA I e: 20M-05/11 Address ❑ Renewal 7 Employment Lost Card ---� —• � r�/+C ((,'079t77101rlr'C17hJ7 CI C�/�(UciJar'�rrJr�lr' @trice of Consumer Affairs&Business Regulation License or registration valid for individual use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 'S 1 Office of Consumer Affairs and Business Regulation � r Registration 1ti5712, Type: 10 Park Plaza-Suite 5170 Expirati'on 3%22/2018 Supplement Card Boston,MA 02116 MAJE LLC./dba EIIWCon$truction- •' ELITE CONSTRUCTION-.l ALAN DEGEORGE ''` •.` "` 12 CONTINENTAL BLVD MERRIMACK,NH 03054 Undersecretary Not valid without sigiralture I Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-106109 f Construction Supervisor s ALAN DEGEORGE s ; ` 12 CONTINENTAL BLVD MERRIMACK NH 03054 CA— Expiration: Commissioner 03/16/2018 Construction Supervisor Restricted'to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS Location Of O AA Pie No. :34 -3 Date Z d „oR,M TOWN OF NORTH ANDOVER 9 i Y Certificate of Occupancy $ Building/Frame Permit Fee $ s�CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ _�--- { Check # v 17834 A A( Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 4..H BUILDING PERMIT NUMBER: 3 DATE ISSUED: Lc;2 L/ 10,54 X SIGNATURE: — Buildin Commission er/Inspector of Buildings Date SECTION 1-SITE INFORMATION z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Aa p)e 5f Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: W Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide —Required Provided R 'red Provided 1.5. Flood Zone Information: 1.8 1.7 Water Simply M.G.L.C.40. 54) Sewerage Disposal System: Public ❑ Private ❑ ZOIIe Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic istrict: Yes No rn 2.1 Owner ARecord ', L ;L k ;/f 31 �a���� 5,�� S,ZaWYP mce Or�ti3 n� Name(Print) Address for Service: 4 Signature Telephone 2.2 Owner of Record: _e N%1ne Print Address for Service: ��q ~s 1�1 Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: License Number Address Expiration Date F Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r Address r Expiration Date 1^ Signature Telephone Y♦ r s r f SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: P Po ou -�doov I' 6���j ;h�o at4 iii door 6rc4 L5 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIO US) ,ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 0 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTTIORtZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT we 1 L as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf all matte s relalive tow authorized by this building permit application. Si ature of Owner % Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property r Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Own /A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvMERS 1 2ND 3RD SPAN DI vIENSIONS OF SILLS DIMENSIONS OF POSTS r DIMENSIONS OF GIRDERS r HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i pORTq TOWN OF NORTH ANDOVER � BUILDING DEPARTMENT sAC1q)g 400 OSGOOD STREET NORTH ANDOVER MA 01845 D. Robert Nicetta, Building Commissioner 978-688-9545 978-688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print f1 DATE D y JOB LOCATION / / 01t Number Street Address Map/Lot HOMEOWNER Pitve( g7�--6'97- q353 D Name Home Phone Work Phone PRESENT MAILING ADDRESS S s t City/Town State Zip Code 1 The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1.) DEFINITION OF HOMEOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be,one or two family dwelling,attached or detached structures attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEWOWNER S SIGNATURE' APROVAL OF BUILDING OFFICIAL i I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision 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 c11, S150A. The debris will be disposed of in: (Location of Facili Signature of Permit Applicant 6c Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I a . NORTH Town of . 4 over 0 .:w No.3 /'� dover, Mass., / S/ Q COC MI'CC CQ wIC � ORATED v'P .(5 S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ���I ! ,C k0a 6 BUILDING INSPECTOR THIS CERTIFIES THAT ................................................... ............. ............ S � � ...... ........................ � Foundation has permission to erect.. .........0...................... buildings on I IS ug ... ........ Rough ........ ...WW . ... ... ..... to be occupied as O � r P* ..IP�,�4 S �j�� f y .. .../ ..... ............................ ,.......................................................s... himne provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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. O rooj";/y Mdi PW 14 361A 3 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough M..... Service .. . .. .. .. .... . .. .. . ... B DING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry.Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner i Street No. SEE REVERSE SIDE Smoke Det. r GAR A CSE d �G f.' �.-- 20 0� o FTI a3 rn qg q7 9 8' MAPLE AVENUE 1 CERTIFY THAT THIS LOT IS NOT IN THE F.I.A. FLOOD ZONE. Tula CER11FICATION IS BASED Ci4 Ttic SURVEY MARKEkS OF CEK IFIEV PLOT PLAN OTHERS AND IS NOT A PROPERTY SURVEY, FOR MORTGAGE OF LAND AT PURPOSES ONLY. I CERTIFY THAT THE BUILDINGS ARE LOCATED AS SHOWN AND, THAT THEY CONFORMED TO THE ZONING BY-LAWS OF THE 9 MAC L CITY/TOWN OF Nn R'r H AN DO UG tZ M A _ WHEN CONSTRUCTED. mnK m,,i SCALE: 1" _ �-OJOf AS DRAWN FOR: DEED BOOK �� PAGE Io 5 T zG q _ �, NoRTH�As r AREA 1� 77I t P Ris H -(�()M ll'Y PLAN fC►STERE��,��lc� ASSESSOR MAP ,� 8 BLOCK 2- 0o R.A.M. ENGINEERING LOT IL tso 11"c"],ltvfiww8 lrxl eeUts01836 71OL:(998)9724449 FAX(978)372-9189 -7� 2- Date........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING �---mrqr- This certifies that ... /-C....... .............................. has permission to perform ......e;,*.47ZUrG ....................../ wiring in the building ............................ ..... ........... .North Andover,Mass. Fee.. Lic.No.ErI6.7.?........... ELECTRICAL INSPECTOR Check # Cy ..., p� jam.77777 �{� boffice lizee'only. r� fir �I[ Co +Y!�Jnwealth of 11�ja+S.Sac use W Nn U Depurrment of Public SafetyX�1l2� �t t7.o ca.cuaa __[.11� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 gryO 0-'aNmk) APPLICATION FOR PERMIT TO PERFORM E=LECTRICAL WORK All Work to be pedomcd In aeeorerance wish the Massaehusetu Electrical Cede. S21 CMR 12:00 (PLEASE PRINT IN INR OR TYPE ALL ItTFORMATION) Date_ al i L®� City or Town of AZ4:)&gU A&Y--nyea- To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Humber) !�l I -gel er r Tenart 99{,1.,IPA, ,���P _ Owner's Address - sPhoomlt Is this permit in conjunction with a building permit: Yes !._.! No � Wieck Appropriate Box) Purpose of Building Utility Authorization NO. -3y.I7 3�0 Existing Service f 1p aAmps EZAD / 2,4,Ovolts Overhead Undgrd[3 No. of !eters New Service02 Raps d .V / Yo'sts Overhead Undgrd❑ No. of Meters�� Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work .rid m,�t Zoo � No. of Lighting Outlets No. of Hot Tubs No. of Transformers oral KVA No. of Lighting Fixtures Swimming Pool Above In' grad. Q grnd. 0 Generators KVA I No. of Receptacle Outlets No. of Oil Burners No. of Emergency LightingBattery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges Total No. of Detection and g No. of Air Cond. tons Initiating Devices No. of Disposals No. of Heat Total Total po s No. of Sound MMA KW �8 Devices No. of Dishwashers Space/Area Heating XW No. of Self Contained Detection/Shrouding Devices No. of Dryers Heating Devices KW Local®Mun£c£pal E]Other Connection 10 No. of Water Heaters KW Sig of Ballasts �inolta$e No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Lairs I have a current Liabilit Insurance Policy including Completed Operations Coverage or its substantial • equivalent. YES[ NO I have submitted valid proof of same to this office. YES❑ NO0 If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE Q BOND 0 OTIMER n (Please Specify) I,I (Expiration to Estimated Value of Electrical Work S e Work to Start - f P Signed under the penalties of perjury: FIRM 211!18 LIC. NO. w License. /N JC � �,ff� _._SignatuteLIC• NO' 13- Addrrtsa 0 Afis. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I an aware that the Licensee does not have the insurance coverage os is su -t stantial equivalent as required by Massachusetts Central T+s;'and Bat my signature on this pertuft applicatu waives this requirement. Owner Agent (Please check one) {{,, Telephone No. 1/ = FEE S ` to orAgent) MASSAt;t-lUst 1 Ib UNIFURM APPLICATION FOR PERMIT TO DO GASFITTING (Pont or Type) _ /Ud �7 . Mass. Date_ 14.C � 1g� 2_ Permit # 2,2 C-7 Building Location�9 �, Owner's Name coq, o v ti ,` �o d�r�lDa7iv� Type of Occupanc J1,0 E,yf-z� New ❑ Renovation `® Replacement ❑ Plans Submitted: Yes❑ No w -- N � W N N H VZ a N H a a }- O N (W7 J N W O >- = Z a m N N y ar p o O 0W W a " n. a W art a W = V W = y Z d a O. > W O w wcc < N a W 0 > u. }W. v H ' z 0 x CW y� TW O O yax d w J V F- o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name. BAY STATE GAS 1 COMPANY Address 55 MARSTON STREET Check one: Certificate # " LAWRENCE,- MA 01840 Corporation 1862 Business Telephone 508-68.7-:1105 ❑ Partnership Name of Licensed Plumber or Gas Fitter Francis X. Corker ❑ Firm/Co INSURANCE COVERAGE: 1 have a curren liability insurance policy or its substantial uival Yes No O �I ent which meets the requirements of MGL Ch. 142. If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy $( Other type of indemnity O Bond O 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/lgent Owner❑ Agent❑ hereby certify that all of the details and information I have submitted(or entered)in abo plication knowledge and that all plumbing work and Installations performed under the permk iss f r thisapp are tare and accur to to the best of my Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene ���ceh0n SIU n mpliance with all � T of license: True Plumber Signature o cen Plum r or Gas Gasfitter W___ wn Master license Number 8697 IIPP O C p Journeyman BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION i FEE NO. APPLICATION FOR PERMIT TO bO GASFITTING NAME A TYPE OF BUILDING ~ LOCATION OF BUILDING PLUMBER OR GASFITTER ' s LIG NO. I PERMIT GRANTED DATE 19 GASINSPECTOR 2763Date. ././../c .... ... , .. .,r: 1 MOH7M TOWN OF NORTH ANDOVER \\' Of PERMIT FOR GAS INSTALLATION o � M 9 �+O+..ev•'� qh �9SSACHUSES J This certifies that . �fl' �/�. �. . . . . . . . •�u 1 has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . � in the buildings of . �. . . . . . . . . . . . . . . . . . . . . . . . . . at . .�.?, . /7<.h.T !� • • • • • . ., North Andover, Mass. Fee. . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING � (Print or Type) G1.�3 .�V C ` NORTH ANDOVER Mass. Date 7 rr... i Permit # / /� s`t/ � _ building Location �� �' r 4t Owners Name1 / GZ��c • New ^ Renovation D Replacement [Z]---,Plans Submitted j] FIXTUP=c Y W N to aI v a 4 df Q O t) m t S N _ t= a r x z o t- CC 0t7 w Z m N N W u�i OG1 a a W 4 y to � W Z U W ` 07 uJ 4 Q � O W W W t77 Q : a a: a a W W r = 10 CL O i✓ 2 ;- z W O ? LL Z d W G LC 4 4 G 4 C1 ' O Z W O N = d ,u y C W d O O W rt O W F� t= O cs u. a ca .1 v y c a f- O SUR-8S TWIT. t BASEMENT IST FLOOR 214D FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check one: Certificate Installing Company Name Q Corp. Address r - -.�j^ Partner. Firm/Co. Business Telephone: t 0 zz. f Name of Licensed Plumber or Gas Fitter =c'i Insurance Coverage: In the type of in urance coverage b checking the appropriate box: Liability insurance policy Q Other type of indemnity Q Bond 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 coverages. Signature of owner/agent of property Owner 17 Agent El I heteby certify that all of the detail:and information 1 have submitted (or entered)in above application are true and accurate to the best of mY knowledge and that all plumbing work and Installations petformed under Permit issued for this application wW be in Wmplianoa with all P=tlnent provisions of tho Massachusetts State Cas Cude and Qupter 142 of tho Genual Laws. By TYPE LICENSE: Plumber Title Gasfitter Signature of Lice ed Master Plumber or Gasfitter City/Town: Journeyman APPROVED (OFFICE USE ONLY) License Number Date.. . . . . .. ...... '... 4. 5 NORTIy TOWN OF NORTH ANDOVER 0 � pp PERMIT FOR GAS INSTALLATION s i i �9SSACHUSEt This certifies that . . . . . ... . r. . ,. , t �`�.. . . . . . . . . . . . . . . . . . . has permission for gas installation .,. :�. :.': . .�. a. . . in the buildings of . . . ?.( �. . ° ... . . . . . . . . . . . . . . . . . . at . .r .,'. . . . . .. . . . . . . . .. . . . . . . . . . . North Andover, Mass. Fee./.-!. Lic. No../ -?�..�. . . . . . . . . . . . . . . . . . . . . . . . . . . '.).GAS INSPECTOR t WHITE:Applicant CANARY:.BuOding Dept. PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PE11MIT TO 00 GASFITTING (print or Type) NORTH ANDOVER Mas Date - r- " Ihui ding Location G19 Permit # 2Z�S Owners Name ,, L,A6 &4Z New All, Renovation �-Replacement 0 Plans Submitted D FIYTUP=c to � W N z z rr tri Q as CC a to a Cz o v m N to �_ w d 03 H W O O O 4 t cr W a W W 1- to a W Ncc W Z U W ` pf W 4 cc t— G > tu Y W w W to W ¢ = a tt o a W W v t:� W r a e a a. m c -s: z a ,u > ¢ w o zd o o W Cr o W 2 O t7 tL O A c7 .t U 0 ¢ > a a f— O SU1�-3S7,1T. BASEMENT I ST FLOOR 2ND FLOOR I 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check one: Certificate Installing Company Name �p��,�✓-,�1� �, y�OQ� Q Corp. Address_ Partner. Z4 R141 �l �G Firm Co. Business Telephone: 3 2 36 i� ?j Name of Licensed Plumber or Gas Fitter Insurance Coverage_: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E?�]�Other type of indemnity Q Bond 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 coverages. Signature of owner/agent of property Owner 7 Agent El I hetcby 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 aU plumbing Work and installations perforated under Permit iuued for this application will be in eomp)ianeo with all pertinent provisions of tho Massachusetts State Gas code and Chapter 142 of the General Laws. By TYPE LICENSE: Plumber Title Gasfitter s-igZature of Licensed Master Plumber or Gasfitter City/Town: Journeyman APPROVED (OFFICE USE ONLY) License dumber 't HOR7M TOWN OF NORTH ANDOVER 0 0, PERMIT FOR PLUMBING r This certifies that . . . . . .` "?. . . . . . . . . .��, . . . .'.. `'. :...-y . has permission to perform . . . . .-,: .: r.1 { ' . . . . . . . . . . . . . . . f �. plumbing in the buildings of . . - . !E . . . . . . `; y' !. . . . . . . . . . . . . at. . . . . `. . . ..�. E'. . {+. . . . !� . . . . . . North A ,dVlass CU Fee. !.. . .�- " c. ANO..! .-r. .d.,./ r'. . . . . . . PL BING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File k i. p10RYh < re 9 a ti < . O tl F I tg- ' CERTIFICATE OF USE 4 0CCUPANCY TOWN OF NORTH ANDOVER Building91 Permit Number O �a 6 ` Date THIS CERTIFIES THAT p� c THE BUILDING LOCATED ON 7 1;f 4�lG MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ��A �-P✓ ( �ly- !e /Cl i e�� C • Building Inspector j i • I �®RT1y T0VVn of 0 No. 0 col - `A. dower, Mass., coCHICMEWICK ��� �A0RAre p '9s BOARD OF HEALTH PERMIT T rt Food/Kitchen Septic System P44 "o* I X* P, C eI mBUILDING INSPECTOR THISCERTIFIESTHAT.... ......................................................................................................................... Foundation has permission to ewct. .....r ..t�..... buildings on ... ... ...... �.. � .....,j ...�.,�, Rough c to be occupied as......1...�.......MARI,&...1#5 .... .'�!... V ... ...... � . .. ... Chimney provided that the person acceptingr this permit shell in every respect conform to the terms of the application on fi a in Final 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. 3 0 -op dR3 PLUMBING INSP� VIOLATION of the Zoning or BIdIng, Regulations Voids this Perm, & t L�i–� 7—G�PERMU EXPIRES IN 6 MONTHS UNLESS CONSTRUC�qgN ELECTRICAL INSPECTO S TS o _�y�s .........................................�,. Service BUILDING INSPECTOR ' a Occupancy Permit required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place~ons the Premises — Do. Not' Remove Final 4 No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner Street No. T` SEE REVERSE SIDE j Smoke Det. l NORTN ori.<� °„•,��,o� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 49 1SSACNUSE� This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . R c !I o.k-.u?.Y/w t . . . . . . . . . . . . . plumbing in the buildings of !. . . . . . . . . . . . . . . . . . . . at . . /4. .�-�. . . . �?. . . . . . . . . . . . , North Andover, Mass. P o Fee/ � Lic. No. �.L. . . . . . . . �. . .[_! . !. . . . . . . . . PLUMBING INSP CTOR Check # 6415 `� 1 MASSACHUSETTS UNIFORM AP LICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, Building Location �wners me tT (,U 11" J I C �t# Amount /0-7 'T e o Orr anc New Renovation Replace t Plans Submitted Yes ❑ No FIXTURES Cr Ea ^✓ r r j� BASEU M)MOOR _ .s ZD 1TJOCR �M HIOM 4)H1HI" $1H M" 6)H HA" 71)H L" 9M HDM (Print or type) 1 Check one: Certificate Installing Company Name . , K(,�.l�s Corp. Address NO Akw Idow P ElPartner. h Business Te ep one 1Y 2 0 49 Firm/Co. Name of Licensed Plumber: .[G1 (St(A(la Kt& Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ❑ Other type of indemnity Bond 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 ❑ Agent ❑f f i 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 for this application will be in compliance with all pertinent provisions of the Massachusf is tSt to Plumbing ode//and Chapter 142 of the General Laws. By: �CC�,,/ if Signature of Licensee rtum er _ Title Type of Plumbing License ` � G lCity/Town icense INUMDer Master Journeyman APPROVED(OFFICE US ONLY y LTJ Date,?'°.."./4):7.45. ^� NORTM "� TOWN OF NORTH AND�VEiR p PERMIT FOR WIRING r ,SSACNUS� , (�j This certifies that .....!..�.).q..../.. .....�:.. >!�........................................ has permission to perform ........ �... .. 6.......................................... wiring in the building of.....6.....4,4-1 ek-.!........................................ �/� at..........�5......M#PZE.............. .........?�.U.�.............. ,North Andover,Mass. B G Fee. 3J..:&i.^ " Lic.No„LJr�1.6� ........... — f'��G4+�!. ?_�: . ELECTRICALINSPECTOR� 7 Check # efl� J// 5628 Office use itl The Commonwealth o/An7 usetts > N, Deportment of Pubo� ya�cte�a _1 BOARD OF FIRE PREVENTION RECMR 1200 3/90 0e"`a� I APPLICATION FOR PE MITFORM ELECTRICAL WORK All work to be performed In act rAencusetu Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE I2iDate 3-� --CJ s City or Town of <` R' To the Inspector of Wires: The undersigned applies for a permit tor�tapoa_— the electrical work described below. Lc4ation (Street & Nummb�beer) e- - Ouner r Tenar c "I-� Owner's Address �� l" -C3` i 3 i �.A�-�--� �+ _ r,�W ��i�--Awnds Phase•��Z� ��� � �3�3 Is this permit in conjunction with a building permit: YesX No ❑ (Gteck Appropriate Box) Purpose of Building O(JE✓v�n_�UC � Utility Authorization NO. Existing Service -4L(- 2 Imps IZJ 1240 Volts Overhead Undgrd❑ No. of Meters 2 New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters 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 In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units I No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices at No. of Disposals No. of Pummps Total Total No. of Sounding Devices T s KW g No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑Municipal ❑Other Connection No. of Water Heaters KW Si, sf Ballasts LowWirVoltage . ng Hydro Massage Tubs No. of Motors Total HP v 4. • 4 INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO iff I have submitted valid proof of same to this office. YES❑ NO� j If you have checked YES please indicate the type of coverage by checking the appropriate bale. INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify) (Expiration-M-t-eT Estimated Value of Electrical Work S Work to Start Signed under the penalties of perjury: FIRM 214ME LIC. NO. LicenseeN AA U, - ll jAf Signatute LIC. NO. Address_e n M1 eke )'o :Sr.• !�-seP1(VCFIeL Q Hi� s. Tel. No. Alt. Iel. No. '1'3 `�--?� OWNER'S INSURANCE WAIVER: I an aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts Coneral .&ws, and that my signature on this permit app tyi�on waives this;requirelpent. Owner Agent (Please cheek one) 46 �f Telephone No.Cq/'9l) �i$ - 3 S3 PERMIT FEE S /.35, 00 Signature of Owner or Agent ELECTRICIAN MUST CALL FOR INSPECTION: 8:15-10:00 A.M. & 1:00-2:00 P.M. ❑ Office Use Only The Commonwealth of Massachusetts Dep�rrment of Public Safety O mpomqapw ChwhW BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12.00 1/90 (k a'°bl'ek) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AN work to be perio ned In aeeorlence With the Msssaehusetu Electrical Code. $27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFOPMATION) Date City or Town of MoeA-14 ftmpa.e a To the Inspector of Hit s: l The undersigned applies for a permit to perforce the electrical work described below. Location (Street 6 Humber) (S�or Tenarc g -r----- Ormer's Address Is this permit in conjunction with a building permit: Yes ❑ ho (Cieck Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service J,Qp _Amps !Z� Q Volts Overhead ® Undgrd o No. of Meters �se�� ____Amps Volts Overhead ❑ Undgrd❑ No. of !eters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work AJ e-4_ A�C4, n"'3 ti- � No. of Lighting Outlets No. of Not Tubs No. of Transformers T�� Mo. of Lighting Fixtures Swimming Pool Above In- rnd. ❑ rad. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of mergtsncy Lighting tterNo. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of RangesT tat No. of Detection and No. of Air Cond. Initiating Devices No. of Disposals No. of Neat Total Total a No. of Sounding Devices No. of Dishwashers Space/Area Heating KH No. of Sel( Containunding ed Detecevices No. of Dryers Heating Devices iW Local❑Connect�ion❑0ther No. of Hater Heaters sis o No. of Ballasts �inoltage No. Hydro Massage Tuba No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabioit Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO I have submitted valid proof of same to this office. YES❑ HO Ea If you have checked YES, please indicate the type of coverage by checking the appropriate boa INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify) Estimated Value of c91e trical Rork S (Exprat on to Work to Start 2 Signed under the nalties of perjury: FIRM PQM _ LIC. No. Licensee x acct'' � !i )� Signatute _fir LIC. No. % l Addtross—ao dk,c'1�—XiOA) _ 5;1& .�'rG/roles �� us. Tel. No, __ Alt. Tel. No. q - D O OWNER'S INSURANCE WAIVER: I am aware that the LYcensee does not have the insurance cvverftw or Its su stantial equivalent as required by Massachusetts Conaral J.vm,andtwat my sigmture on this permit vaives this requiremeat. Owner Agent (Please check one) Psit kTelephone No. PERMIT FEE S Signa re o r T'd �- �•�J�w��-A 7`¢Lk Tb office use only The Commonwealth of Massachusetts N„nk No. Depurrment of Public Safety O"upmyARisCWcbtd ` BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 am"W'OW ^ r)PLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK i All work to be performed In accordance with the Massachusetu Electrical Code. 527 CMR 12:00 1 FRSE PRINT IN INR OR TYPE ALL INFORMATION) Date S-' i City or Town .of Q1:, :TVA AiU%- 2 To ttie Inspector of Wires: ,u undersigned applies for a permit to perform the electrical work described below. ation (Street b Number) / Pt-e.— 8t\ i cYZE?-N2_ 1-i A , er r Tenarr er's Address __ 13 i �'arra-Q S+ _ U is(L �1,:�i�....o ccs Phone/ ��7 ) > -�'`3;3 i s this permit in conjunction with a building permit: YesX No ❑ wreck Appropriate Box). Purpose of Building b2eV�L�GK�X Utility Authorization N0. ting Service _[',c.1 Amps !ZJ /2.,�10 Volts Overhead (31 Undgrd❑ No. o_ Meters 1 rJO:2 E Service Amps / Volts Overhead❑ Undgrd❑ No. of Meters er of Feeders and Ampacity tion and Nature. of. Proposed Electrical Work �.� j`" Fi-C of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lf Above In- 8 8 Swimming Pool grnd. ❑grnd. ❑ Generators Lighting Fixtures KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Batter Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones tal No. of Ranges No. of Air Cond. Ttons No. of Detection and Initiating Devices Heat Total Total No. of Disposals No. ofpum s T s 167 No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑Municipal ❑Other Connection No. of Water Heaters KW No, of No. of Low Voltage Signs Ballasts Wirin Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabilit Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO I have submitted valid proof of same to this office. YES❑ NO JU If you have checked YES please indicate the type of coverage by checking the appropriate bo! INSURANCE ❑ BOND ❑ orm❑ (Please Specify) p rat on tr Estimated Value of Electrical Work $ Work to Start " J Signed under the penalties of perjury: FIRM Y*11 LIC. NO. LicenseeLJ _ i state LIC. NO. t� - 1 e1L. i 24 4� S8n Vs. Tel. No. AddressFiY.�.n �lr�- --� ® Alt. Tel. No. r Nf7NER S INSURANCE WAIVE: . I as aware that the Licensee aces not have the insurance cOverAge or lts su - stantial equivalent as.required by Massachusetts C*ntral I-1ws, and that my signature on this permit app stion vaives this.1 requirewent. Owner Agent (Please check one) 91.35- 00 G2 CM, Telephone No.( ) G -�}3_S 3 _ PERMIT FEE S Signature of Rorer or gent ELECTRICIAN MUST CALL FOR INSPECTION: 8:15-10:00 A.M. & 1:00-2:00 P.M. �`_� V 5 �� Location 4-Pte i � —,4N0. Date ,.ORT1y TOWN OF NORTH ANDOVER O? ` • Gw #4A Certificate of Occupancy $ Building/Frame Permit Fee $ s�cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # C C D 18 6 9 / eBuiltling Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING ` ;k m BUILDING PERMIT NUMBER. r�--Q DATE ISSUED. J 62 , c — SIGNATURE: Buildin Co - sioner/In for of Buildings Date SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BURDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record /11, ca /,,0 --game P Address for Service Signature Telephone 2.2.Owner of Record: 0 me Print Address for Service: z M Signature Telephone �w SECTION 3-CONSTRUCTION SERVICES R� 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address > Expiration Date is Signature Telephone f" 3.2 Reg,—lered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number rM r Address Expiration Date Signature Telephone G) SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check aII A cable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Des c 'p 'on of Propose Work: r lloa1)�l SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL,USE ONLY Completed by permit applicant 1. Building ,a,. O Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbingBuilding Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZ TION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIE OR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on M behalf,in all matters relative to work authorized Y nz d by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject ro ert P P Y Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date I NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I' 2' 3 RD SPAN DIMENSIONS OF SULS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t �>C North Andover Building Department IIS Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with t provision rovision 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 c11, S150A. The debris will be disposed of in: Tilc . Sc.[ (Location of Facility) , (24 Signature of 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 a HoaTH TOWN OF NORTH ANDOVER OFFICE OF ` o _ p BUILDING DEPARTMENT 4 " 400 Osgood Street. „.�"'`,gx North Andover, Massachusetts 01845 1Ss^CH�15t� D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: J•f L•CAT • y It Number Street Address Map/Lot HOMEOWNER ��w� �e �(i 7 8"-6 9 7 -g 3 3 Name Home Phone Work Phone PRESENT MAILING ADDRESS l �a3�°►� 7� City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE ea ,I�/I, APPROVAL OF BUILDING OFFICIAL BOARD OF APPEALS 698-9541 CONSERV\PION 688-9530 HI{A 11 699-9540 PLANNING 698-9535 - I . 9 L i I � i i I � -41 cf 00 U-' I I r I - I ' i I - i � k 1 � i i I ` - e ISI II 1� NpRTH Tovm- Of 4 over 0 "1 10j No. _ A dover, Mass.,L . 3 S COCMICHEWICK V 7�S RATED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System � � BUILDING INSPECTOR WW 1'* P� � �,THIS CERTIFIES THAT.. RPA....................... ..........................................................................��.......................�....... Foundation 4f has permission to eject .....r ..... ..... .......... buildings on Q� Rough ....,[.....�. .....,,'4............�' . ..... ..... . to be occupied as..` '.......1�I . ' .... � V� � p'r�' ......� .. Chimney Opp V .............. ... ..... .......................... .... .. . . . provided that the person accepting this permit shall in every respect conform to the terms of the application on fi a in Final 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. 3 0 ,op dRPLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU S TS Rough ELECTRICAL INSPECTOR ............................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det.