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Miscellaneous - 1094 SALEM STREET 4/30/2018
1094 SALEM STREET 21.0/106.A-0057-0000.0 I i Date....�Q. 23� OF AORT/q TOWN OF NORTH ANDOVER '? s PERMIT FOR WIRING 4j+•� ��rdotgg li s`SACHUSf� 1 'x This certifies that ................................�..:.. UiL,................................................................ . Sit, has permission to perform . `t� ..............................................�`........ .:..���� �-G� f. wiring in the building of........... �.. .P..../c' ..................................................... .. at ....:.. . . . :....... .... f..... North Andover; ass. z: Fee......,.RR. S.."....Lic.No. ��...1.: .......................................................................�! ........ ELECTRICAL INSPECTOR f Check# f '� 2 -(}--/ Dot:uS,gn Envelope ID:OE9324AE-4OF6-435E-BC66-03AEDB40122CC 4 �O?ltdYt0/1tt+ +r 7/Irl se � Official Use unly � �/� Permit No. ��� V 1 .L3alamr�»xanl t�.tiiw Ices Y--- I, Occupancy and fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1107) (leave blank) 9J - APPLICATION FOR PERMIT TO PERFORM! ELECTRICAL WORK All wort:to be performed in accordance with the Massachusetts Electrical Tical Code(MEC),527 CMR 12;00 (PLEASE PRINT IN'INK OR TYPE ALL II+lFO12.&UT101V) Date: City of crwn o#c '1,7Arc>o C To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical wort:described below. Location(Street&Number) \Oa Ll Soy\ems Owner or Tenant Qlte_y,c.e-c7 �,�vn Mt\\tr- Telephone No.G17$'�0$(�"�-1C` Owner's Address Is this permit in conjunction With a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building z ax Utility,Authorization No. r Existing Service Amps 1 "Volts Overhead❑ Undgrd❑ No.of Meters !'clew Service Amps 1 Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature ofP sed Electrical Work: 4,- t, `�(� ' '�j j� a complerion44thefolibawingtable maybe waived by the ins ctor Of.Wires. TOW No.of Recessed Luminaires No.of Ceil.,Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of floc Tubs Generators KVA No.of Luminaires Swimming' A ve ❑ ►�- ❑ x o•a Units cy Lighting is d. end. Baste Knits No.of Receptacle Outlets No.of Oil Burners FILL ALARMS No..of Zones No.of Switches No.of Gas Burners No.of ItaDetection e • �Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices iied No.of Waste Disposers eat um umber ons o.o to stirs Po Totals _ Detection/Alerting Devices MuniciNo.of Dishwashers Space/Area-H acing KW Local❑Connection C3 Other Security s Appliances . \o.of Dryers Heating pp K� No of twvices oruivalent No.of Water No.of ="o•o Data Whin Heaters KW Signs Ballasts No of Devices or uivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecomfDe ca r c n No,of Devices or u'avtint OTHER: 4aach additional detail if desired,or as required by the Inspector of!fires. Estimated Value of Electrical''etiork,!�\N 000 ('Cohen required by municipal policy.) Work to Start: 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. C14ECK ONE. INSURANCE & BOND ❑ OTHER ❑ (Specify:) I certify,under thepairn and penalties of-peowy,that the informut# n on this application is true and conVieta FIR11M NAM.i✓: i LNC.NO.:21', �' .Licensee: )( ki/ Signature LIC NO.:��a�� !If applicable,enter"exempt"in the license n ber line. Bus.Tel.Bio.!J 1`&2,6 -t1 L Address: Alt.Tel.leo.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S''License: Lie.No. OWNER'S INSURANCE'4 RIVER: l am aware that the Lice`nsee does nol have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one} owner owner's agent. OwnerlAgent P IT .$ l Z 5 Signature Telephone No, I F 1 v w ' 42 t„/ fib/ q �� r i 00 IM m X X c()w z z m m L- M m m Cl In x 70 nn 3 -0 -9 --4D CP -A z M m 3 0 N -T - -T> D �' _Z o 0 �fll= rpr w n E70 3M- r O - o I-J w O 3 ui Xan 5. 5„ 71 a a -u Ew N 13'-2" O I_ >wE O r N 13 M C C-- Cf) > W =Z-� �m70 In °r-0 cn - O L=i -n CLIENT INFORMATION SOLAR SYSTEi �, n� 7.150 kW DC Home BILLER RESIDENCE � i S"';-AR INVERTERS TOM FETERSEN ROOF DIAGNOSTICS 10° T4 SALEM STREET, 26 -250-60-2LL-522 ARCHITECT.LLC SOLAR AND ELECTRIC LLC 6 COUNTY LANE PANELS HOWELL,NJ 01-131 DATE: 4.18.Is NORTHANDOVER, IA 01845 26 MODULES e 215W PER MODULE THOMAS r.FETERSEN DWG NO.: 4s'3 NY ARCH.LIC.035290 732.730.1763 BY: cz PROJECT DESCRIPTION: SHEET INDEX PROJECT SITE ung PV-1 SITE PIAN &VICINITY MAP Home PV-2 ROOF PLAN & PAPANELS 26X275W ROOF MOUNTED PV-3 ROOF ATTACHMENT DETAILS SOLAR PHOTOVOLTAIC MODULES _ 4 SOLAR PV-4A ELECTRIC LINE DIAGRAM&SIDE ELEVATION DETAIL y � �p:,0 SYSTEM SIZE: 7.150 kW DC STC PV-5 LABELING i' a�Eo Aep, PV-6 SPECIFICATION DETAILS ARRAY AREA: PV-7 SPECIFICATION DETAILS _ o-r R-1: 231.25 ft' 5t �Ne.Jt6zta PV-8 SPECIFICATION DETAILS N ' HOWELL, R-2: 231.25 ft x PV-9 SPECIFICATION DETAILS �. ,ter NJ PV-10 SPECIFICATION DETAILS 4 PV-11 SPECIFICATION DETAILS ,' pr e•� PV-12 SPECIFICATION DETAILS • 'i PV-13 SPECIFICATION �DETAILS Ttl443atemSt cn()# _U w F <W / O J (E) UTILITY METER / 1, 2 VICINITY MAP / PV-1 SCALE: NTS PROJECT SITE z Ln ui \ / R• / Nai< � ploDL w W l\ / w � W F U Q Q 13 PV MODULES / r to z �cr Q. O •a J: DRIVEWAY / '; W O F ,.. W Oz v• 13 PV MODULES Drg. No.: --- Drg.B9.: TMG r Rev.BU: --- Date: 22-SEP-15 PLAN P1ORTH TITLE SHEET: SITE PLAN t 1 SITE PLAN WITH ROOF PLAN VICINITY MAP PV-1 SCALE: 1/32'= 1'-0' 3 HOUSE PHOTO PV-1 SCALE: NTS P V— ARRAY & ROOF AREA CALC'S � nrg. ROOF R-1 Home ARRAY AREA 231.25 ft' ROOF FACE AREA : 317.97 ft' SOLAR 231.25/317.97 = 72.73% ROOF FACE AREA COVERED BY ARRAY D AR,j ROOF -2 xc�oa`�F°eT�sm No.31521 r ARRAY AREA 231.25 ft' NOWE�4 ROOF FACE AREA 652.09 ft' °'w, NJ 231.25/652.09 = 35.46% ROOF FACE AREA COVERED BY ARRAY �U U� N U 5 Z w Uw Q ROOF DESCRIPTION R-1:COMP. SHINLGESLL 6 a AZIMUTH 159' ..' o i O Q J PITCH 27 SHADING 92% v o� o Q[N R-2:COMP. SHINLGES g AZIMUTH 249' PITCH 23' SHADING 80% \t l" Z Ln T r= Q LEGEND ENPHASE MICRO-INVERTERS L M250-60-2LL-S22 N W Q v ROOF ATTACHMENT 13 PV MODULES y- CHIMNEY RAFTER (N) PV LOAD CENTER UNIRAC SOLAR MOUNT RAIL L-GATE 12C0 CELLULAR '' ~ T�o N METE ... �.- w p cn OC O PIPE VENT SKYLIGHT (,PRODUDISCONNECTR 37 ATTACHMENT® 48"O.0 MAX w W W C-1 AIR VENT n�AACC a 6 w =W O (E) UTILITY METER rU Q p --- CONDUIT 1" PVC/EMT CONDUIT SATELLITE lY c7 z Z Q ELECTRICAL EQUIPMENT ANTENNA t 8 ENPHASE MICROINVERTERS 1, W O� ® M250-60-2LL-S22 WHIRLYBIRD O :R `• .• J- VENT t ` MODULE SPEC'S 13 PV MODULES � Z —" ,�.-�' —� 27 ATTACHMENT® 48'O.0 MAX 3'-3' O. � �........, .,' �..- Drg. No.: --- L Ll: �t Drg. By.: TMG l - Rev. By: --- Date: 22-SEP-15 PIAN NORTH TITLE SHEET: ROOF PLAN ROOF PLAN WITH PANELS PANELS LG275S1C-B3 PANELS-275W ;�6' PV-2 SCALE: 1/8'= 1'-I1' LG PANELS j i ne Home SOLAR t�(tED ARChJ i S r No.JSaYi a g� NO NJ U U� O FFc Z U Ow Q 0 UNIRAC SOLARMOUNT GROUND WEEB & Q RAIL WITH ECOFASTEN MODULE CLAMP !L L—FOOT O Q PV MODULE O p COMPOSITE ASPHALT N SHINGLES Ln GREENFASTEN FLASHING: z ECO—GFI—BLK-812 WITH Q ao ECO—CP—SQ COMPRESSION cn F- p BRACKET 111 NulQ 5/16"X4" S.S LAG BOLT WITH 2.5" I r- MINIMUM PENETRATION SEALED WITH F APPROVED SEALANT m Q C)tf)IV W w =WO F UQ� mac _ W O f- J � z Drg. No.: --- Drg. By.: TMG Rev. By: --- Date: 22-SEP-15 1 ATTACHMENT DETAIL TITLE SHEET: ROOF ATTACHMENT PV-3 SCALE: NTS DETAILS Pv-3 nrg:K` Home SOLAR 1FytED aq�h QW of F'Pu, c r qo.31611 i (E) DOWNSPOUT xowxju, �U .. .. . O F- ......... _.._. .. ..__ -__.___..._ z U Lu UJ <W �Zn LL� cD oQ (Y w Z O 0 U _ .. .. . ._._. . .. _.... .... ...... .. .. Ln FROM PV ARRAYw FROM UTILITY PROVIDER `r co w Z N __._ ........... ....._ ..... ........ __ _.._.(OVERHEAD) En cD o�`nw Qw> � F UJl7 N Q w f— Z Org.No.: --- (N) JUNCTION (E) UTILITY METER Drg.By.: TMG BOX FOR ENVOY (EXTERIOR WALL) Rev. Bq: - -- Date: 22-SEP-15 CENTER (EXTERIOR WALL) (N) t00APV LOAD (E) TO MAIN SERVICE PANEL TITLE SHEET: ELECTRICAL 1 (INTERIOR WALL) (N) UTILITY AC DISCONNECT 1 ELECTRICAL&SIDE ELEVATION DETAIL SIDE ELEVATION (N) L—GATE 120 CELLULAR DETAIL PRODUCTION METER (EXTERIOR WALL) (EXTERIOR WALL) SCALE: NTS [TV-3A SERVICE INFO INVERTER SPECS MODULE SPECS nU'e UTILITY COMPANY NGRID ENPHASE QUANTITY 26 Horne MAIN SERVICE VOLATGE 240V INVERTER TYPE ENPHASE MODULES TYPE LG275SiC—B3 SOLAR MAIN PANEL BRAND -- QTY 26 WATTAGE 275W MAIN SERVICE PANEL 200 A WATTAGE 210-30OW NOCT WATTAGE 202W ABED A4,H MAIN CIRCUIT BREAKER RATING: 200 A SERVICE VOLTAGE: 240V FRAME THICKNESS 35MM MAIN SERVICE LOCATION SOUTH—WEST WALL CEC EFFICIENCY 96.5% FRAME COLOR BLACK Ho.St6it z SERVICE FEED TYPE OVERHEAD Voc 38.70V HOWELL, p NJ MAIN SERVICE PANEL GROUND EXISTING GROUND ROD VpmaX 312760AV s9.26A Imp 8.68A TO Unun U U� 1 - JUNCTION BOX (E)MAIN SERVICE PANEL 200A RATED BUS BAR L-GATE 120 PV 1GOA SDIµONLY SOLAR ARRAY (7.150 kWstc) N 604 AC PRDOUCIION LOAD CENTER JUNCTION BOX O 1 - L-GATE 120 PRODUCTION METER (E)201Y1/2P MP OIscONNECT METER 3 3 3 C 2 A 1 BRANCH 1 BRANCH/1 O t— D B 2DV2f At4 3 NODULES IN PARALLEL CONNECTED IN BRANCH Z U 1 - 100A SOLAR ONLY LOAD CENTER °o° _ LLI C❑ 2 - 20A/2P SOLAR BREAKER O°e x i u MODULES LG LG275SiC-B3 L I 000 tRCUIT 1 - 20A/2P ENVOY BREAKER (E)UDLIIY __p J ______ _______L____ __ r___________ ___________ _ ❑ METER f Ecc __J Q D 1 - 6OA AC DISCONNECTLL Q 4az� MP 1 - 35A SOLAR BREAKER 2 1 BRANCH #2 BRANCH 2P C� 1J NODULES IN PARALLEL CONNECTED IN BRANCH ECCJL'EC_ O O r - -J 1 aRcurt [k N (N)3s4/2P 120% RULE x 13 MODULES Lc LG275s1c-B3 = 1 ---------- --- BUSBAR RATING: 200A 1 bWIII WRN cbubYl6 L----------fiC-, MAIN BREAKER RATING: 20QA i xLT.�µ0 D1NMSL (200 X 1.2)-200 40A MAX BACKFEED: 40A 2a/1r A Ln I PROPOSED SYSTEM: 35A ' © Z 'q- 35A<40A i 1(E)GROUND ROD 2-/12 THWN-2O 1 -/12 THWN-2 EGC/GEC MONTLET '1' IN 3/4'EMT CONDUIT OUTLET N ul Q I- Q(n� W W W =J1 uQQ WEATHER STATION F to Z INFORMATION Q LAWRENCE MUM ASHRAE 2R AVG. 1 32'C 13-90 MN ABOVE W O_ F- NOTES: ROOF SURFACE TEMP c J Q[ 1. ALL MODULES WILL BE GROUNDED IN ACCORDANCE WITH Q CODE AND THE MANUFACTURER'S INSTALLATION 3 2 1 Z INSTRUCTIONS. 2. ALL PV EQUIPMENT SHALL LISTED BY A RECOGNIZED 3-18 THWN-2 3-08 THWN-2 CONDUCTORS ARE ENGAGE CABLE R TESTING LAB. 1 - /6 THWN-2 EGC/GEC 1- /6 THWN-2 EGC/GEC SUPPORTED ON PV 06AWG BARE COPPER 3. NOTIFY SERVING UTILITY BEFORE ACTIVATION OF PV GND M FREE MR SYSTEM. IN 1'EMT CONDUrt IN I'EMT CONDUIT RACKING SYSTEM NOT vNOOC:N FREE Drg. NO.: --- 4. WHEN A BACKFED BREAKER IS THE METHOD OF UTILITY VOC:240VAC VDC:24DVAC EXPOSED TO DIRECT INTERCONNECTION, BREAKER SHALL NOT READ LINE AND LSC: 26.0AOC LSC: t3.OMC SUNLIGHT13.nMC Drg. By.: TMG LOAD. 5. WHEN A BACKFED BREAKER IS THE METHOD of UTILITY ENPHASE INVERTER TOTAL SYSTEM CALC'S JUNCTION BOX TO LOAD CENTER CALC'S ENPHASE INVERTER BRANCH 1&2 CALC'S Rev. By: --- INTERCONNECTION,THE BREAKER SHALL BE INSTALLED AT THE OPPOSITE END OF THE BUS BAR OF THE MAIN QTY:26 MAX AC:32.50A QTY:13 MAX AC:16.25A QTY:13 MAX AC:16.25A D6te: 22-SEP-15 BREAKER 6. WORK CLEARANCES AROUND ELECTRICAL EQUIPMENT WILL NOC:1 (Ott.NDC).1.25 NOC:1 (GTY.NDC).1.25 NOC:1 (QTY.NDC).1.25 TITLE SHEET: BE MAINTAINED PER NED 110.26(A) (1), 110.26(A) (2) WIRE GAUGE: 8 WIRE OCP:47.00A WIRE GAUGE: 8 WIRE OCP:33.50A WIRE GAUGE:#12 WIRE OCP:23.50A ELECTRIC & 110.269A) (3) 7. ALL EXTERIOR CONDUITS, FITTINGS AND BOXES SHALL BE TEMP RATING:75'C AMP RATING.TEMP DE-RATE TEMP RATING:75'C AMP RATING.TEMP DE-RATE TEMP RATING:75C AMP RATING.TEMP DE-RATE LINE DIAGRAM RAIN TIGHT AND APPROVED FOR USED IN WET LOCATIONS PER NEC 314.15 AMP RATING:50 A MAX Ac TO BE LESS OR EOUAL AMP RATING:50A M AC TO BE LESS OR EQUAL AMP RATING:25A MAX Ac TO BE LESS OR ED- 8. ALL METALLIC RACEWAYS AND EQUIPMENTS SHALL BE TO WIRE OCP FOR WIRE TO BE TO WIRE OCP FOR WIRE 70 BE TO WIRE OCP FOR WIRE TO BE BONDED AND ELECTRICALLY CONTINUOUS. TEMP DE-RATE:0.94 APPROIED BY 2011 NEC TEMP DE-RATE:0.67 APPROVED BY 2011 NEc TEMP DE-RATE: 0.94 APPROVED By 2011 NEC PV-.4 4 DocuSign Envelope ID:7239A81C-709E-4CA5-8E9D-OFDC975083D8 The Commonwealth of Massachusetts Department of IndustrialAccidents .1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov1dia AVorkers'Compensation Insurance Affidavit:Builders/Contractors/LiectriciansTlumbers. TO BE FILED WIT11 THE PE&MITMG AUTHORITY, Applicant Information Please Print Legibly Name (Susi-iess/Orgenizati6mlndiviaiial): EA A-6 A Address: ,..., )' City/State/Zip:m'��-�-�' " 'kNv�- a�Phone SV' Are you an employer?Check the appropriate box: Type of project(required): I am a employer with [� employees(full and/or part-time),* I am a sole proprietor or parmer ship and have no.em, loyees working fort in 7. New construction 2J p 8. Remodeling any capacity,Nlo workers'comp ir-surance required] 9, ❑Demolition 3,F-1 I am a homeowrer doing 4 work myself.No worikers,comp,iMurance required.] 4J7 1 am a homeowner and will be hiring contractors to conduct 10 Building addition ,all work on my property.. I will ensure that all contractors either have woexe,s'compensation insutarce or are sole 11. Electrical repairs or additions proprietors with noemployees, 12.❑Plumbing repairs or additions 5,17 1 am a general contractor and I have hiredtffie sub-contractors listed an the attach-ed sheet, 13•F�Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 14� Otherj2qA,_,XAjX;� 6.M we'are a corporation and its o,-kars have exercised their right of exemption per IVIGL c, 152,§1(4),and we have no employees,fNo workers'comp.insurance required.] Any applicant That c ecks box I must also.fill out the section below s ... ......... t showing their workers'compensation policy infortmation, .1 Homeowners who submit this atfidavit hidicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, *`Contractors that check this box must attached an additional sheet show-Lrm the name o`the sub-contractors and state whether or not'those entities have employees. If the sub-contractors have employees,they must provide their workers'co=.policy nurnber. I am an employer that isproviding;workers'compensation insurance for my employees. Below iSthe policy and job site information. Insurance Company Name: 1(. Policy#or Self-ins,Lic.#: 0 di—\.M Expiration Date:, 0Q Job Site Address-, I _A.UC�W\ ��� CityfState/zip:'tA_ je�v v- ffvph 0%'17 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure Coverage as required under TYICYL c. 152,§25A is a criminal violation punishable by a fine up to S 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.A copy of this statement maybe forwarded to the Office of Investigations of the DIA forinsurance coverage verification. z" Ido hereby cerdfy under rhe pains and penalties of perjury that the information provided above is true and correct.. UocuSigned by: sia-mature: Efnaaws Date.-, LPhone 4: 02 2t��A .._.' Official use only. Do not write in this area,to be completed by city or rDwn official City or Town: Permit/License 4 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone 4: .4C�oma® CERTIFICATE OF LIABILITY INSURANCE DATE(MMID/YYYY) 7/15/2015 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 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 CONTACT Darlene Mulcahy y Malcolm & Parsons Insurance AgencyPHC No Ext: (781)344-3200 AIC NO:(781)344-1425 713 Washington Street E-MAADDRESS: P.O. Box 527 INSURERS AFFORDING COVERAGE NAIC# Stoughton MA 02072 INSURER A Northland Insurance Company INSURED INSURERB:Sentinel Insurance Company Ltd 39098 Certified Safe Electric, Inc. INSURER C Nautilus Insurance Company 50 Tower Avenue INSURERD:CNA Surety INSURER E; Marshfield MA 02050-5131 INSURER F: COVERAGES CERTIFICATE NUMBER:CL157602635 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 ADDLSUBRPTYPE OF INSURANCE IVSD WVD POLICY NUMBER MMIDDY/YYYY MEFF M LICY EXP LTR IDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE �OCCUR -PREMISES (E.occu ence $ 100,000 x ISO Form CG0001 TBI 7/15/2015 7/15/2016 MED EXP(Any one person) $ 5,000 X Contractual Liab PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1 PRO JECT F—] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: General Aggregate $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED OBUECZJ8251 3/7/2015 3/7/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident x ISO CA0001 PIP-Basic $ 8,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 C X EXCESS LIAB X CLAIMS-MADE AGGREGATE $ 2,000,000 Ff DED I I RETENTION$ TBI 7/15/2015 7/15/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ D FIDELITY- EE DISHONESTY 62447764 7/1/2015 7/1/2016 $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION certifiedsafeoffice@gmail. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Amne Parsons/DARL °'""' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r?n14nn VF 2"u tl; bra .merit.crt czw r,5 r ,z Boom,of�u «,k a u4srt rin*�rat3 �Yt .�tUS B /-^ DAVIS ggV^y � 50 TOWER AVFKUY 744 7;2— C NS mp glod xv e% rte. «.L E2T'£'y iA AyS s REGISTF, ED MASTER FLECTIR lCiAN S. w '€*Hs' ? A 0 A r 3 j , 0 W E P, A V r 206,09 A ..wry // /y, aw,z,;.,,CI,mowE',,AM— Office at'Conmmtr Affairs,eye T,uotie�.s£tr uiation License or registrarmn valid for tndivid"I''mr,only �l E IMPROVEMENT CON AC70R ibc3c�m the explrat+arrr date. If found ret rrrn to'. Otlisc of '� Is atian p�, C sfnsurner Affairs-and Business Reg ul2ti€trt tx;piratsan: 5'2x'6 �=readx ,,;orpwafi r, 1113' fIt l'lr� -'+uit� €I'il Boston,MA 02116 E'LEC 1 FtiC,L%C. r L 601 TUOIER AV �:� � _... •��� a r MARSHFlE,_D,MA 02050, i-r,tferses;csary Not valid without sfgrsaturr. . Location No. Date 0 . TOWN OF NORTH ANDOVER O � "CTT:Tib 76 S$. 4c, • ;. Certificate of Occupancy $ Building/Frame Permit Fee $�— i, Foundation Permit Fee $ Other Permit Fee $ tnn.S` � TOTAL $ Check*AJ 29504 Building Inspector Location y s�" No. �S- _A Date v 7 �. TOWN OF NORTH ANDOVER S VED" ;e a Certificate of Occupancy $ Building/Frame Permit Fee $� -Foundation Permit Fee $ rcv Other Permit Fee $ TOTAL $ t Check Building Inspector Location No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $1 Foundation Permit Fee $ � Other Permit Fee TOTAL $ Check Ill Building Inspector F NORTH t own of 2 7ndover O - No. � t = - y i o h ver, Mass, t O coc.ac«ew.ca �•9 ASR^rEo �Pa��S S U BOARD OF HEALTH Food/Kitchen PERMIT e.'cSy�em THIS CERTIFIES THAT ........64C,"4.......�I� il. .' ! g ILDING INSPECTOR has permission to erect buildings on 1.QQ. i Foundation .......................... ..... .....Si. . ............. Ro to be occupied as Q(......�..v.......S..J. -x4'!�..►............................... provided that the person accepting this permit shall in every respect conform to they er s of the applic ion final on file in this office, and to the provisions of the Codes and By-Laws relating to the n ction, Alteration and Construction of Buildings in the Town of North Andover. f�PLUM ING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough a Fin PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T TS Rough Service ..................... . ...................................................... 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. Date.-T11 ..4. ... . .. . TH 41 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 9 . 9 �,SSACHUSEtS This certifies that . . . i ! .i. . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . .1-1.13. . . . . . . . . . . . . . . . . . in the buildings of (.-t i. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . //2.q.'/. . . .5W.L:-: . . . . . . . . .. North Andover, Mass. Fee.34?. . . . . Lic. No.l? ).. .7.1. _. ... . . . . . 91GAS INI E;CT Check# 2 7 7200 Vol MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date 5167 l NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# r t Ck X, Amount$ � /, ( l / Owner's Name New Renovation Replacement Plans Submitted rA w w U zz rA cz O C F C x Z z F W O O O z F 44 x a a w a o w z� w Q z w w O > w F U 1y F Z O v w CC O O x O 3 0 tj U C > y SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLO O R 4TH . FLO O R 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 18-T H . FLOOR Name or tYP t U A� �}- ( � Check one: Certificate Installing Company Corp. A,ddmss P CAL r Partner. D-l Ax A,, Business I a ep one 75 1— — [3-F Co. Name of Licensed Plumber or Gas Fitter Af Cl7A-e l—, INSURANCE COVERAGE . Check one: I have a current liability Insurance polic r it's substantial equivalent. Yes13 No13 If you have checked yes,please in ' to the type coverage by checking the appropriate box. Liability insurance policy LZOther type of indemnity 0 Bond 0 Owner's Insurance Waiver: I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 1 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 perfo ed andof rtFiis application will be in compliance with all pertinent provisions of the Massachus to ha 1 2 of the eneral Laws. By. Signature of Licensed Plumber Or Fitter Title Plumber City/Town Fitter License-Number Master APPROVED(OFFICE USE ONLY) 0 Journeyman The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual)��CAQ101-) Hf , 7 �c n 5: Address: v f?,v1f City/State/Zip: EA®f /Y� Q I t�6�'Phone#: 7 g �fc{ G Are you an employer? Check the appropriate boa; Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I �Jama oyees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2. sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling y ship and have no employees These sub=contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. t o workers' comp. insurance 5. 9 ❑Building addition � p. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[� Iumbing repairs or additions myself. [No workers' comp, c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' compr.insurance required.] 13.❑Other ;Any applicant that checks box#1 must also FWD out fire section below sbow__thei w^:4=1 compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hie outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information, //�� Insurance Company Name: f> ADI ec�v16 Policy#or Self-ins.Lic.#: 1p o u "' 7567 /1156 716- Expiration Date: 2 2 3 fr C ( _j� �� Job Site Address: /Oci q S�6-e 51�T City/State/Zip: C�/L Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the impositionof 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 Investigations of the DIA for insurance coverage verification. I do hereby certify and r th ains a penal ' of perjury that the information provided above is true and correct Si attire: r�7 p Date.: C/G Phone ff: I tl� �C(— �G D Official al use only. Do not write in this area, to be completed b c or town n officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Elect::r::::6. Other Contact Person: Phone# Information as d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartmrzents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall notbecause of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coxnpliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither,the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contca,eting authority." Applicants r Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if j necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or tcmn that the application for the per=it or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the numbmr listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,.need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. . The Office of Investigations would like to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 5-26-05 vvwur.mass._aov/din Date. G. . fi TOWN OF NORTH ANDOVER 0 c? PERMIT FOR PLUMBING'' ,SSACMUSE� This certifies that . . r.,09. Pa. . . . t . . . . . . . . . . . . . . . . . has permission to perform . . . . . /. . . . . . . . . . . . . . ... . . . . . . . . . . plumbing in the buildings of . .Al. l<l�` . . . . . . . . . . . . . . . . . . . . . at . . . .�U. .�.Y. . . . S �.t.---. . . . .e�'`.'- . ., North Andover, Mass. Fee. ,34Z Li c. No. . . . . . . . . -�y�r�. . . . . . . . 'PLUMBING INSPECTOR Check # 12 7 8591 N 7 , MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /� ' �� / �� / Building Location 7` / s� `� 7' PeDate l Permit Owner !C t l -P Amount 73/) New Renovation E] Replacement ® Plans Submitted Yes No FIXTURES Ur 1 SIBEM I1ppl��i��J.�/�/\te�l)� 2M ELOCR 3M ELOM 3ii5 V gm 17DM (Print or type) Check one: Certificate Installing Company Name. /-l/ �/—a- ' ❑.Corp Address lbu � Partner. e -w O t� r El Business Telephone -7�( ry�C/cF —�� Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the of nsurance 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 Age El I hereby certify that all of the details and information I have submitted(or entered) ' ove a -c on are true and accurate to the best of my knowledge and that all plumbing work and installations perf P Issued for this application will be in compliance with all pertinent provisions of the Mass P o d Chapter 142 of the General Laws. By Signauire or MOOG rium= Type of Plumbing License Title City/Town 1,1censulNumouT Master I Cil' Joumeyman APPROVED(OFFICE USE Orrin t� r ` The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 N'aslzington Street Boston, MA 02111 www nzass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly a Name (Business/Organization/Individual): Address: 6b ou City/State/Zip -e i�v( � I� 0 l 6 l Phone#: Fyc( Are you an employer?Check the appropriate boa: Type of project(required): 1.❑XIamployer ewith 4. ❑ I am a general contractor and I yees(full and/or part-time).* have hired the sub-contractors 6' New construction y 2. I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition worlds for in g any capacity, workers comp.insurance. [No workers' comp. insurance 5• El We are a corporation and its 9' Building addition required.] officers have exercised their 10.0ctrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11. Plumbing repairs or additions myself, [No workers' comp. C. 152,§1(4),and we have no required.]I12.E]Roof repairs r insurance re t to q ] employees.Yees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that eheck s.box#1 must a?so fill out the section beior. sh p rrrelr wCrke r''c3::tt.a:SEt1:7n ppt2C)'2nIDrraat1QII. t Homeo�vIIers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 4Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below,is the policy and job site information. Insurance Company Name:_ vicl,4r�f 5- Policy#or Self-ins. Lie.#:_L ® 0 —73-0 y'/�,� 3 fo Expiration Date: Z 3111 Job Site Address: �� � .S/y'/t°�f S City/State/Zip: (J2j � �Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).4ze 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 Investigations of the DIA for insurance coverage verification. I do hereby cern 7 un r pains enol ' s oerg that the information provided above ' true a d correct Si ature: Phone Official use only. Do not write in this area, to be completed by city or town off ciaL 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#: v Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." ' Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date-the affidavit. The affidavit should be returned to the city or town that the application for the permitor license is being requested,not the --partment of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investibatons .600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSA-FE Fax#617-727-7749 Revised 5-26-05 vrwu,.mass_gov/dia Location t No. ',3 G/ Date -a� �O�TM TOWN OF NORTH ANDOVER Certificate of Occupancy $ NUBuilding/Frame Permit Fee $ sACSE Foundation Permit Fee $ e Other Permit Fee $ TOTAL $ Check # 1 7 8 2 9 �,...- ~wilding Inspector`/ 'T TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING "ran wrn BUILDING PERMIT NUMBER. 0 DATE ISSUED._ X Alt,SIGNATURE: Building Commissioner/layector of Buildings Date / SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use_ Lot Areas Frontage ft 1.6 WELDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40.° f_4) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private t—, �"'� ` Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY 6WIfRSHIP/AUTHORIZEDAGENT Historic is riot: Yes No M 2..lOwner Record 4too T. /1,/0, Name Ill, t) Address for Service: 7 Signature Telbphone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 640000, Licensed Construction Supervisor: License Number M" Address _ Expiration Date Signature Telephone rM 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r Address z Expiration Date G) Signature Telephone I SECTION 4-WORKERS COMPENSATION(KG.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 ❑ ti Existing Building ❑ Repair(s) ❑ Alterations(s) `{❑ Iddition ❑ �. Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: V G/( T,n�D� /QF/� &aT /1T/41G f sa SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be k' z OV ICI I.USE O ,y Completed by pern a licant a 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit feb 181 X (b) 4 Mechanical HVAC 30, 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZA ION TO BE COMPLETED WHEN _T_ OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT a as Owner/Authorized Agent of subject property Hereby authorizeMAI ' t to act on My bill`,in all�na�s relati rk authorized by this building permit application. lignature of Owner Date S CTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property 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 Owner/A ent Date aWWI mom NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS 1 ST 2 No 3 RD SPAN DIMENSIONS OF SILLS DIIV ENSIONS OF POSTS DIlvIENSIONS 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 I $ NOIRM 10- P TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER MA 01845 D. Robert Nicetta, Building Commissioner 978-688-9545 978-688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE N3 0 t/, d�o`i- 44T U q JOB LOCATION SCLLcv-t S4 - W19 jopr-7 , Number Street Address Ma /Lot n HOMEOWNER 1�C1kcL y-A%SLA- _ j q q 01,2 Name Home Phone Work Phone PRESENT MAILING ADDRESS l Le Rcrc)S 5 City/Town State Zip Code 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 helshe 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 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 �i of 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. They debris will be disposed)of in- C_ Ci�lrl l.� l 1 I��yY�D ✓�. (Location of Facility) 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 NORTH Town of Andover 0 VA �3G No. LA E over, Mass., ff co HICHEWICK 7�S RATED BOARD OF HEALTH Food/Kitchen 'PER IT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.... ............................................................................... Foundation has permission to erect........................................ buildings on 6./ W ................................................................ Rough tobe Occupied aLe... .. . ... .. . 64.............. ................................................................................. Chimney provided that the person accepting this permit-shaii-*- every..respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and B -Laws relating to the Inspection,-Alteration and Construction of f 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 CONSTRUCTION STW Rough ................................................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy, Building GAS INSPECTOR R Display in a Conspicuous Place on the Premises —. Do Not Remove Finalough No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SlDt_j Smoke Det. 'i r i Date. . .C... . . . . . . °T� Oq �"o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 . � ,SSA CNus�This certifies that . .. has permission to perform . �. : 1�"' . . . . . . . . . w plumbing in the buildings of ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. 16.e<-1Y ... . . . . . . ., North Andover, Mass. FeeA . . . . .Lie. .� ,' PLUI�A�ft1G INSPECTOR Check # 6169 MASSACHUSETTS UNIFORM APPLI TION FOR PERMIT TO DO PLUMBIl' (Type or print) NORTH ANDOVER,MASSACHUSETTS / Date Building Location Owners Name Permit# i!i, Amount _>; Type of Occupincyl New Renovation Replacement09 Plans Submitted Yes 0 No FIXTURES u V. ,fes Si.KHM HdSEW+If IST FLOCK 3SD FLOCK 4D•I FLOCK 5M FLOCR 6M FLOCR 7M FIDCR gm FUXR 4 i (Print or type) Check one: Certificate Installing Company Name S Corp. Address 1U RPartner. Business Telephone - [ErFmi/Co. Name of Licensed Plumber: /'-Q (7-41--In a k Insurance Coverage: Indicate th of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 0 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 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 pert ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa c t Stat bi r 42 of the General Laws. By: Signature of Licenseaum e Type of Plumbing Lic se Title 06 G City/Town tcense INUMDer Master Journeyman (� APPROVED(OFFICE USE ONLY LJ Date.... le NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING -SSACMUS This certifies that J has permission to perform . . ......... - . -- wiring in the building o .....'.....T:. " . r.....+. '::�............................................ r, at.%� .7.:, t,:t ....�.. � ... - C... ........... ,North Andover,Mass. l_1 f4? /. Fee... .......-......� Lic.No. .�. .... ................E... . .......NSP.....E.C.....R.................. � LECTRICAL.... .. ITO Check # 5440 Commonwealth of Massachu etts Official Use Only _e/ Permit No. `T Department of Fire Serv' es Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/991 leave blank APPLICATION FOR PERMIT O PERFORM ELECTRICAL WORK All work to be performed in accordan!e wit the Massachusetts Electrical Code(MEC),527 CMR I .00 (PLEASE PRINT IN INK OR TYPE ALL INFO A ION) Date: kZ31 d City or Town of: �1l�teZh? /QN tTV K To the Inspec r of Wires: By this application the undersigned gives notice of his dr her intention to perform the electrical work described below. Location(Street&Number) /09 tS� �M f t2P ` Owner or Tenant p esph t? yjOrk — Telephone No. Owner's Address d 4 A/9 t" S OP ,N yL Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building pried,,,, Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of ProposedElectricalWork: IV/122 cSFW A � �/P GhOK- a m tom' cAn / alarM 10An Completion of the folloiiing table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA NAbove ❑ In- ❑ o.o Emergency Lighting No.of Lighting Fixtures Swimming Pool rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.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. I I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal F-1 Other Connection No. of Dryers Heating Appliances Kms, Security Systems: No.of Devices or Equivalent No.of Water No.of o.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: /�- No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 e permit issuing office. CHECK ONE: INSURANCE � BOND ❑ OTHER ❑ (Specify:) A /1e (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the ains andpenalties o petfur;that the information on this application is true and complete FIRM NAME: !/'GIM! LIC.NO.: t!p Iq Licensee: Signature 1^1 LIC.NO.: (If applicable, enter "exempt"in the license number line) Bus.Tel.No.- Address: Alt.Tel. t OWNER'S INSURANCE WAIVER: I am aware that the Licensee does 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 ❑ owner's agent. L, i Owner/Agent SignatureTelephone No. PERMIT FEE: $ 1 Location Jx _ No. � Date N°RTM TOWN OF NORTH ANDOVER 3. # y # Certificate of Occupancy $ ^ tt� Building/Frame Permit Fee $ wcMus Foundation Permit Fee $ Other Permit Fee $ .y } TOTAL $ Check # /—) Y 18676 Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERNUT NUMBER: DATE ISSUED: SIGNATURE: JLJI&,*.10' Building C W2i er t" of Build.ings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dist c—t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 - On Site Disposal System ❑ �! SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT IStOI IC District: Yes (VO 2.1 Owner of Record Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Duval Roofing, LLC PO Box 637 (� Name nt No. ReadMaesMA MifM4 ISI I ture Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 0 Licen Num r Mn Address Expiration D to Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Duval Roofing. LLC Registration Number r Address P— PO Box 637 No. Reading, MA 01864 'Expiratio ate A 4ti ure Tele hone G) y. C) �� 1 , SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) w Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will resin6 in the denial of the issuance of the building it. Signed affidavit Attached Yes....... .......[I SECTION 5 Description of Pro osed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg,' • ❑' Demolition ❑ Other pecify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be >� OFJC SSE QTI,y 9 Completed by permit a licant 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 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> ( , �0o�� /�l as Owner/Authorized Agent of subject.property Hereby authorize to act on My. ehalf,in all matters relative to work authorized by this building permit application. lo -Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and bel' f Prinl- a �I Si ature of`Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS OT 2ND 3RD SPAN DIMENSIONS OF SILLS 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 Department of Industrial Accidents JQffiee of Investigations 600 Washington Street Boston,MA 02111 www-mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Applicant Information MyM RonfinaLLC C Please Print Leidbly No Name (Bushmsiorpnization/Individual): NPO Box 637 -�-.�-Readi nc, RAA Q 1864 Address: City/State/Zip: Phone#• ��/�.. jC`� A,r,e.,yo an employer?Check the-appropriate box: Type of project(required):1.L� I am a employer with_ 4. ❑ I am a general contractor and I 6. El New construction employees(full and/or part-tine).• have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' eomp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a Corporation and its - required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.(No workersconte. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required-]t employees. [No workers' comp. insurance required] 13•❑ Other •Any applicaet that cbedm box#1 must also fill out the action below diowirg their worker'corttpenaation policy infotrttstie�a t Homeowner wbo=limit this sdB vit indicating they are dmM all work and then bin outd&eonhacton must submit a new affidavit indicating such tConb ectora that dwck this box nod attached an additional sheet abowing dw risme of do sub-coniactora and their workers'corny policy iufbrrnation- I am an employer that Is provkOna workers'compensation insurance for my employees, Below Is the polky andjJob siaAa information. Insurance Company Name: 777 Gr) Policy#or Self-ins.Lic.#: j t'Cay Expiration Date: Job Site Address:_ City/Statemp: Attach a copy of the workers' compensation policy declaration page(Showing the policy number and expiration date). Failure to secure coverage as requiref 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 t,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 Investigations of the DIA for insurance aace Coverage verification. I do hereby ce der the pains and penahies of perjury that the Information provided above Is true and correct Si / fel Phone#: Offlcial use only. Do not write In thb arca,to be compkted by city or town 00cid City or Town: Permit/License 6 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4-Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 0: lniormation anu xnau ua,tullma Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. s is defined as"...every person in the service of another under any contract of hire, Pursuant a this statue, an employ express or implied,oral or written" ' An employer is defined as ,an individual,Partnership,association,corporation or other legal entity,or any two or snore of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,Parmersb*association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an earployer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of auies or Limited Liability Partnerships LP with no employees other than the insurance. Limited Liability Comp (LLC) i7ity (LLP) not required to c workers' compensation insurance. If an LLC or LLP does have members or partners,are req airy employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the ' to line. city or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for You to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that waist submit multiple permit/license applications in any given year,need only submit one affidavit indicating current and under"Job Site Address"the applicant should write"all locations in (city or PO licy information(if necessary) town)."A copy of the affidavit has been officially stamped or marked by the city or town may be provided to the ry applicant as proof that a valid a is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax mimber: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 wwwmm.gov/cha P age No. of Pages Builders License # 58443 Home Construction Reg. # 109288 U,n,L 0 (981) 944-1994 (998) 664-2559 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 r PRO ALSUBMI TO f ` A NE iit2S C) � DATE R /Cl '7 q f�/�f JOB NAME ! CITY,STATE AND ZIP CODE JOB LOCATION i'./.: ��,.•Cit d�t We hereby submit specifications and estimates for: Recommended Optional o T / (Included in price) (Not included in price) L7 +f Rip& Remove all shingle debris from roof&job site: 1 layer ®12 layers ❑3 layers or more •` Repair/or Replace any roof decking; not to exceed 50sq.ft. P/ Install 8"aluminum drip-edge/and along entire perimeter. Choice of mill;white r brown s -ede/and rake-edltiiC _ ✓ Install ICE&WATER underlayment along horizontal eaves,valleys,sidewalls and sky-lights&chimneys sl Install premium base sheet underlayment between roof deck and roofing shingles •� Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year . • Install 30yr CertainTeed/GAF/Tamko or Owens&Corning architectural roof shin ❑40 year lfseo ❑50 year ❑ Lifetime "See manufacturer warranty policy for more details r . Install new aluminum vent-pipe flange (s) *� Chimney(s)-counter-flash and re-step existing flashing 0 Cut& Install new lead flashing Ridge-vent/exhaust vent with low profile design,,tiidden by shingle caps ❑Soffit-ventilation ❑Roof louver-vents • Seamless style aluminum gutters-custom fabricated at job site r f 7o ❑downspouts / +! Other11✓1::f/' il: `!? /P �tdt' l.1y C�ttl7N 4.jr'Ls1 ''! 1 'Please Note:All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: Total price not including options. dollars($ ). Pay ent to be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized r� t} ft , completion. Signature -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract. Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted within days r s NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of NIGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by NIGL t1, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section l OA. The debris will be disposed of in: Location of Fac' ty) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date NORTH over Town Of _ No. LA over, Mass., O COCMICMEWICK RATEDCl '9S E BOARD OF HEALTH Food/Kitchen PERMIT T Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT.....T;W ................................................... Foundation ............................... .................................... has permission to erect........................................ buildings on .. ...... Rough Chimney to be occupied as -::....... ...... ...... ......................................................................................................................................... provided that th rson acce g this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisio 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 CONSTRUCTION STARTS Rough " ............................................. Service A WING 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. Smoke Det. SEE REVERSE SIDE i NORTH Town of .. � Andover L A = dover, Mass., �4- O a COCHICHEWICK V` 7�A0RATE O PPS\ KC7 '9S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT........ .. ..................:................ .........................::.............. .............. " ................................................... Foundation .... buildings ............... ............. Rough has permission to erect..................... 9s on ..A'�s�........... .... to be occupied as.. Jacc�epp .. .. ......................................................................................................................................... Chimney provided that thesg this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisio 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 t� ,tT T Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service LDING 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.