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Home My WebLink AboutMiscellaneous - 11 COMMONWEALTH AVENUE 4/30/2018 . \ f - - - -- - - . _ ;� j 11 COMMONWEALTH AVENUE 1 / 210/002.0-0012-0000.0 77-Z 'L/-4 4 Date.................................. 40RTN TOWN OF NORTH ANDOVER 0 'A PERMIT FOR WIRING ,ss/1CMUSEt This certifies that7-75,)iAo.!&&e 447t-z has permission to perform ...... wiring in the building of........114 .......... ..................................... 3 at........ 74 N-? 'P . ... North Andover,Mass. Fee...?V Ar........ Lic.No-11. 7I.V21 f .. .............. ...ei.-'..................... .......... . ELECTRICAL NspEcTMR Check # 68 *16 Date....�1/.a�� NORTh,h .TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION P� .. This certifies that ��4llil!�t! ll.!........................................................................................ has permission for gas installation .- ... ? .................................... inthe buildings of................................................................................................................... at.././:./.A... ,C�?�t.<..!f..c�l1.!✓. 1. '`' ........ ...,gNo, h ndover, Mass. Fee.. .,Q).... Lic. No. IDP t.�'6...... .... .. .. ................................ AE OR Check#!74(0 r r :w Date.....9�1�1..!........... ".Op7"�ti TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING _� gB�cMus� E This certifies that...XI ..f" '"" '.................................................. Q ' r has permission to erforrn;� T / P P /! ` .i ..�..? ri d .................:.. plumbingin the buildings of............................................................................................. t at hl .3.......I ..�?��.<�� -....�.. �....., NortthAndover, Mass. Fee ....Lic. No, ................ ►!.. ................................. /PLb BING IPECTOR Check# L/'/ i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK !1 tb CITY (J_� / Ldp MA DATE I 9� PERMIT# JOBSITE ADDRESS �G/� '/� OWNER'S NAME j ��— }�jj`j AVW"µJ tl POWNER ADDRESS . _ w. s_ _..._A TEL17..?6Lp4 _jFAXM, _..._ TYPE OR OCCUPANCY TYPE COMMERCIAL,,['_',-] _ EDUCATIONAL . . RESIDENTIALV� PRINT _ CLEARLY NEW:€_j RENOVATION:JREPLACEMENT: _� PLANS SUBMITTED: YES N0 'µ,. FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM j DEDICATED GAS/OIL/SAND SYSTEM el DEDICATED GREASE SYSTEM i�W _. _ _ IL DEDICATED GRAY WATER SYSTEM + DEDICATED WATER RECYCLE SYSTEM F . I i ; DISHWASHER __.. ._.... - ., ., DRINKING FOUNTAIN I, i ,,. ' L .. 3 .... II FOOD DISPOSER �_._ ,fe-� _ _-. l..- _ i ..... ---- ..,.._ FLOOR/AREA DRAIN i s 3" ., r, ;1 .; , ¢7 .. ,.. INTERCEPTOR(INTERIOR) KITCHEN SINK -- _. -.-_.-._ __. LAVATORY ............ ROOF DRAIN . . t SHOWER STALL SERVICE I MOP SINK e ( I � TOILET URINAL _ II WASHING MACHINE CONNECTION (_ WATER HEATER ALL TYPES _...._:.. ..__..( _ WATER PIPING I =HER ' _._ l ! 1 € t- I _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[-"J" NO _..:I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY l ] OTHER TYPE OF INDEMNITY % BOND �_ 3 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ['y� AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ith a ertne t provision of the Massachusetts State Plumbing Coe and Chapter 142 of the General Laws. PLUMBER'S NAME1� / /�!� LICENSE# U GNATURE MP�,w JP;_, CORPORATIONS I# PARTNERSHIPI#I I _..I COMPANY NAMElf�ff�i�j ADDRESS' .s CITYUd7� STATE_ /.�/�--€ ZIPO� TEL Q��Q .......... . FAX ( CELL t EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` GCITY '. __ .. .�.._m.,. ., . PERMIT# l�VB/l. MA DATE �a JOBSITE ADDRESS ;OWNER'S NAME GOWNER ADDRESS r TEL ?� �ft FAX TYPE OR OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:; REPLACEMENT.'V PLANS SUBMITTED: YES, NO' APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER ... .,:.:.... FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS _.__ __.. ..... MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. C SIGNATURE OF OWNER OR AGENT HECK ONE ONLY: OWNER AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliarQke—�with II e ii ent ovision of the Massachusetts State Plumbing Code and Chapter 142 of he General Laws. PLU%GF ASFITTER NAME �� !4`j�l{q►'l LICENSE#M& :! SIGNATURE MP JP JGF LPG[, i CORPORATION✓# PARTNERSHIP, # LLC # __. ,. COMPANY NAME: r--7 I�. I./ �Q�( � ADDRESS CITY ZIP {- J STATE/tel . 01t`L(�^ TEL tt FAX CELL EMAIL 77ECOMIIOIVVE4LTHOFIII4S-l�4CR SETM Office Use only DEPARaL VTOFPIIBLIC,"FEIY Permit No. � I6 BOARD OF FIREPREVENI70NRECU 4770AS'527CV1RI2.�00 Occupancy&Fees Checked J(q PPUCATIONFOR PERMIT TO PERFORMELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wire: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) (I CLTMO'OL11�C1 1'tf` ).Q Owner or Tenant Ml k2 SUI l Iyc,4 Owner's Address )I r op( Moq W-e_c ft e Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose ofBuildingC-kCt'CIt al S�tyl CQ Wl('Z tnq Q tVW�� Utility Authorization No.1W6903 Existing Service , 10D Amps 0 / ZgNolts Overhead Underground No.of Meters Z New Service 200 Amps /ZD Volts Overhead Underground No.of Meters 3 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work reo I M No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total • KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and round No.of Receptacle Outlets No.of Oil Burners. r No.of Emergency Lighting Battery Units No.of Switch Outlets i No.of Gas Burners i No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW J Local Municipal Other' No.of Water Heaters KW No.of No.of Connections signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP v 0 R n�>J I La I n ba czL a 2 bo,6,rS , Ptd Ir` Ir>SI�oeGae-age P►asl�ellotheraglmar,a��a,se�sGalaalLaws IimeaasretLiabtldyhmm=Pthcymduffigca74i a CnmaWcrds gkjm * YES NO Iha%esubmibdvafidprmfof ID#xOMne YES M NO IfjwimecfxdWYES,pimen**thetAxofwmn_zbydmk gthe aysvwArrc�E BOND OTI>r+x Q (Pl�espe EViafimD* ESVahrec#F�7achral Wodc$ workIDSlat ht�IetttnDaleRegtrt�d RL h Fatal Si�tad undaTie Pahl I�MNAMB <<6 �� -r<<u I S�v�c L�oaiseNo _i(- .._ (o Sign �^N Io�,� ,,�` Gelb 413 4—� BushSsTel.No. Aclrhesc 1 � I t�„ I"'t� Ak.TeLNa. OWNER'S INSLT2ANCEWAIVFR;larttheasm4oWbylvlassadtfrm CorralIaws �dt�tnrysigrahaernitaspamitappfic-Itratihisrac;tmerrlart. (Please check one) Owner MAgent a Telephone No. PERMIT FEE$ Date'Sj(Q/0�. .. .... 11 NORTH TOWN OF NORTH XAVER 4PERMIT FOR GAS INION ♦ a �,SSACNUSE�� This certifies that . cC .f S. .h. . . !. t . . . . . . . . has permission for gas installation .oP-. WO�'h . �� • in the buildings of JL•rot�7m /?w t,a.` ' . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . , North Andover, Mass. Lic. No..( 7f��" . . . . . . . . . . . . . . . . . . . . .16 . GAS INSPECTOR Check# 10r2-- 5676 oke5675 NtA%A0WSEITS UNIFORM APMCATON FOR PERM TO DO GAS FITTING (Type or print) Date /—/ NORTH ANDOVER,MASSACHUSETTS Building Locations (tea.ytyl/1,j,j) 1/Pt L/1 Permit# Amount$ o Owner's Name New❑ Renovation Replacement Plans Submitted A o p; Cy V dd z a > Q CW7 F z (�+ z t W 0.� CW7 F� W U Cz d 6z1 Wd CG .. F } n z C z F c4 O x A a 0 a W A a F C SUB -BA SEMEN T BASEM ENT 1ST. FLOOR r 2N D . F L O G R 3 R D . F L O O R 4T H . FLOOR 5TH . F L O O R 6TH . FLOOR 7TH . FLOOR 8 T H . F L O O R (Print or type) Check one: Certificate Installing Company Name11 J mac' ��STcivt l /"yLf� �i� Corp. Address C t, Partner. 3 J6 Business e ep one cj) _ y� _ /vr3S?• Firm/Co. Name of Licensed Plumber or Gas Fitter r� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No 13 If you have checked Les,plA ndicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 0 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 13 I hereby certify that all of the details and information I have submitted(or entered)in above application aree 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 Massachusetts State Gas Code and-Chapter 142 of the General Laws. s By: Signatu of Licensed Plumber Or Gas Fitter Title Plumber c9 0 7 City/Town Gas Fitter License Nurnoer Master APPROVED(OFFICE use ONLY) 0 Journeyman Date.4 �(�� . TOWN OF NORTH AN VER p PERMIT FOR P MBING SA US This certifies that .y. . S. . • . . .\"�'. . . . has permission to perform� . t !! . . ` . .AIf,-/�� plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . --North Andover, Mass. Fee Lic. No.� . . PLUMBING INSPECTOR Check d L)14 u 7n57 t6o MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location )& G/2�Owners Name Date Permit Jt O J^7 Amount /�U Type of Occupancy i New Renovation Replacements Plans Submitted Yes No FIXTURES H z > w ' r SUMWIE w z r a A 1Sr FUM M FUM 4M M" 5M FL" ! 6TH FLOOR i M FLOOR SiH FLOOR (Print or type) Check one: Installing Company Name �`$-�Gt,f) �C� Certificate Corp. Address La" D63 Partner. 4 iisineisTelephone 97 _ S""F - FirMCo. :Mame of Licensed Plumber: Z— zC'�4cq Insurance Coverage: Indicate the type ofLihsurance coverage by checking theappropriate box: Liability insurance policy \P Other type of indemnity ❑ Bond El 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;ill of the details and inlcrmation 1 have submitted(or entered) in above;application:arc true and riccuratc to the hest„f my knowledge and that Al plumbing work and installations performed under Permit Issued for this application will he in compliance with all pertinent provisions of the1Li;;sac "setts""ate' P!um� de and C Napier I.12 of the General Laws. .By: Title Type Of Plumbing License City,Town z;u icense, urn er Master Journe man ,F-USE ONLY �kPPROVED iCFFit i I I Date... �QtO NORTH °ft"`°:•�"° TOWN OF NORTH ANDOVER ° p PERMIT FOR WIRING ,SSACMUSE� �j This certifies that .......!d!".(...... ...................... has permission to perform ....... ...........Je.e .�.� .................. .... ..... .... wiring in the building of..............�. >C. /.lee.................................... at........ rf�� J�'7J✓Ulf.'E; .!! ......... 29 A rth Andover,Mass. Fee...�!� �:.. Lic.No.��3.)�.6.................. �(-��. .,e .4.r ........ .. �Y , /� �/ �! ELECTRICAL INSPECTOR VC9 (I Check # ��0�� .....aUtnar,WiUrrUMAL IMA17 Permit No. 9QAIPDOFFL7�A�LVFIVI]�QIVRI�UlA1110i�S3Z11�12� OCCUPWICY R Fen Checked QFIUCA HON FOR PERIVU T O PERFORM ELE=Ca WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WTrH TM MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL IriFORMATION) Da Z8B(o Town of North Andover K To the Inspector of Wires: The undersigned applies for a permit to perform the electrical worts described below. Location(Street&Number) tj CPAOAWea[lA Owner or Tenant iG ¢ IV&- 17 Owner's Address �-�- is this permit in conjunction with a building permit: Yeses No M�; (Check Appropriate Dofe)� Purpose of Building &jv.n if Utility Authorization No. Ll�: Existing Service Amps f Volta Overhead Underground C3 No.of Meters New Service Amps Volts Overhead E] Underground C3 No.of Mateo _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Na of Lighting Outlets Na of Hat Tubs No.of Tmwbm s @ Told Na of baiting Fiataras Swhz udna Pod' Above Below ratan KVA � � KVA Na of Receptscla Out1W Na of On Bnrma No.of Ernwpocy Uahtina Hanery UOiti 1 Na of Switch Oudsb . No.Of dr HarMn Na of Rwwa Na of Air Cond. Totd FIRE ALARMS No.of Zones Tons Na of Dispasds Na of Hest TOW ToW Na of Detaotioa std pulugs TOM Kw Iaidadoa Davits No.of Dishwsshan Spsce Area Hestina Kql Na of Sounding Davies Na of Self C=Wnad Na of Dry= Hestina Devices KW DewcdarJ3oaadna Device LOcal � Maairdpai � Other No.of water Hestan Kw Na Of No.of Conn"do w 311105 Bsiasis No.Hydro Mmap Tuba Na Of Mown Told HP 3 1 oTHIEt' heuanaeCavwo Ptltswtb6e01it0=1 G'ermlLawt � N fp!rormtwww6tidya the,estt�rriibrlveldproddsenebhft YM rwtihned�edtedYES . piaadcalehtypedaoveVby IIVS<fRANCB B(NDLZAWAI 0 rgm*+» R E�ioitoriDale t om , > dValsrdlbcftWakS wcticbsmti AW 1000.Gly under ) MMNAI� liars eNa► ,>ddm�, � ►yer�t � 0 it TdNa 0WT,WSIIVS1MAl,awAM-I=awne#9ftl�d, =,w1 tcirs�ce � ft rddwfrp*"cnfptnr;t viIhstitewwmt co`° °f�s�htr8oil°q"valrn`ae'eq�i"°dbyil+ c cene�illawns (Please check one) owner C3 AgM Telephone No, PERMrr FEE I ( Location No. Date ,.ORTq TOWN OF NORTH ANDOVER Certificate of Occupancy $ t i � e SA�NUS t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r" Check #8379 Building Inspec4o 1 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: X SIGNATURE: 114U Buildln Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: OQ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft 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: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No PPI 2.1 Owner of Record 4tiF,>RCJ Suc_c_k,/Ad fytM0AlwEAL�-(,k AV„E Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ � !3 Licensed Construction Su S d? o Supervisor: O XU;—:�- A-1, 1 _ License Number Address / �'f 7 37/-/ cf" 2 Z V Expiration Date ic Sig 11attTelephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name m Registration Number r Address r s z Expiration Date /1 Signature Telephone Y� t4ORTH Town of over No. over, Mass., 0 'A E COCHICHEWICK 7,9 ol?A'rED P�? BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System -PA 0 BUILDING INSPECTOR THISCERTIFIES THAT................ad, ...... ........ ........ ............................................................... Foundation has permission to erect........................................ buildings on' ./)........dw��- - ...... Rough .... . ........ to be occupied a rp�iio�.i��i ng t� Chimney I this provided that the person ac ng Is 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION S S ELECTRICAL INSPECTOR PI Rough y2z Service ............... .......................................................AN��............................ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. j�/��R� ;r Q �j r d. i t K� tt ii ��11(/-r�� jA CORD, RTIFI ATE 0 L[�4B� .[TY � Y Al w 74/ DATE(MM/DD/YY) 02/22/05 1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BOYLE INS AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 445 MAIN STREET COMPANIES AFFORDING COVERAGE WOBURN MA 01801 COMPANY A NAUTILIUS INSURANCE CO INSURED COMPANY LAMBERT ROOFING CO B COMMERCE INSURANCE COMPANY T G L R C INC D/B/A COMPANY 37 STEVENS ST C HAVERHILL MA 01830 COMPANY D C011ERAGES.; ;:..::... ,..:...:";::::;:::>>:.•.:::>:;:. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY NC3 7 4 9 5 7 10/12/04 10/12/05 GENERAL AGGREGATE s2 , 000 , 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $1, 000, 000 CLAIMS MADE a OCCUR PERSONAL&ADV INJURY $1, 000, 000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1, 000, 000 FIRE DAMAGE(Any one fire) $1, 000 , 000 MED EXP(Any one person) $ 5, 000 AUTOMOBILE LIABILITY Z T 6 915 7/16/04 7/16/05 `r ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ 500 , 006 X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $1, 000, 000 rlPROPERTY DAMAGE $ 500, 000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND N STATU- TH- EMPLOYERS'LIABILITY TORY LIMITS ER THE PROPRIETOR/ EL EACH ACCIDENT $PARTNERS/EXECUTIVE INCL EL DISEASE-POLICY LIMIT $ OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS WC CERT WILL BE SENT DIRECT FROM A. I .M MUTUAL TO YOU PER WC BUREAU RULES CERTIIA'f <HOi.plwR':::: »»:.. CA i.�.A fl NC0IV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUC OTIC SHA IMPOSE NO BUGATION OR LIABILITY OF ANY KIND UPON COM ANY, rjO A OR REPRESENTATIVES. AUTHORIZED REPRESENTAT / i.................. I Gerard F B J FF A ACORp �5 S {1/95) . ORP >::: •i ^.:,r.' d' p :CO:F�A?ION> 1958 CERTIFICATE OF INSURANCE ISSUE DATE(MM/DD/YY) 01/27/2005 I PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Boyle Insurance Agency Inc DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P O Box 606 POLICIES BELOW. Woburn, MA 01801 COMPANIES AFFORDING COVERAGE INSURED T G L R C Inc COMPANY dba Lambert Roofing Co. LETTER A A.I.M. Mutual Insurance Co 37 Stevens Street Haverhill, MA 01830 COVERAGES 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 RESPECTTO 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. Co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. S ::::]CLAIMS MADEE:::]DCCUR PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one tire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS ' BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ MBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM W ST WORKER'S COMPENSATION AND C ITS^T T R X THER EMPLOYERS'LIABILITY LIM EL EACH ACCIDENT Y SOO,000 6009966012004 08/28/2004 08/28/2005 A HE PROPRIETOR/ X INCL EL DISFASE--POLICY LIMIT S ARTNERS/EXECUTIVE 500 000 FFICERS ARE: EXCL EL DISEASE--EACH EMPLOYEE I $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEIUCLES/SPECIAL ITEMS WORKERS' COMPENSATION COVERAGE APPLIES TO MASSACHUSETTS EMPLOYEES ONLY. CERTIFICATE HOLDER CANCELLATION It SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR I REPRESENTATIVES. ! AUTHORIZED REPRESENTATIVE •.4D a viisnavitrvCKt<!/! VJ inassacnitsetts Department of Industrial Accidents LV 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 Lezibly Name (Business/Organization/Individual): qm J6k t Zor- 10-ic Address: S7y i'E V(&V s c�'—(- City/State/Zip: /�AL/ER cd, 0/1L 10/Z30 Phone#: Are you an employer?Check the appropriate bo Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employee's(full and/or part-time).* have hired the sub-contractors 6. ❑ Newponstruction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. 02-Memodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. o workers' co 9• El Building addition [N 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 workers' comp. C. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. (No workers' comp. insurance required.] 13.[:] Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors 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: &-/Ce Policy#or Self-ins. Lic. #: Cabo�j`t Go o y Expiration Date:_ Job Site Address:—1( Al/ , City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year"imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded In the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: S� Phone#: Oficial use only. Do not write in this area,to be completed by city or town ofcial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector [.Other Contact Person: Phone#: Ein`#"S1--M3313 T. S�E0.N 414S MA Reg.Hic#121981 MA Lic,#UCS 078130 5`y RI. ll✓ ' BBB Single-ply Li #1711 ambo g -V y i.✓�c-.� c I 932 �- 265 Winter Street,Haverhill,MA 01830 MEMBER We are: ✓ Licensed ✓ Insured ✓ Factory Trained ✓ Factory Certified Installers Date: .2- 2(--('.sJ Estimate for:_1� i Telephone 1: 'i 72- 7 f e' (, Telephone 2• (-->1 y' Address:_ r fit,) Il Jt' City/Town: State:_ /4.f Job Location: City/Town: State: L.R.C.agrees to commence described work on/or about and described work will be completed in about working days.L.R.C.shall not be held liable for delays due to circumstances beyond our control.L.R.C.shall not be liable for any damage to landscape,attics and/or fixtures due to circumstances beyond our control.L.R.C.can not and will not be held liable for any damage to the surface that the disposal container is placed on.L.R.C.shall not be held liable for pre-existing conditions including but not limited to mold and/or wood rot,defective,faulty,rotted or worn building counterparts such as but not limited to siding,gutters,masonry,plumbing,and windows that jeopardize the watertight integrity of the building and are not covered under the roofing warranty. The following work includes all labor and materials needed to complete your job in a professional workmanship like manner. Steep slope Quick-quote proposal to furnish and install the following: Approximate roof area WK] ew Roof ❑ Re-roof ❑ Gutter ❑ Repair ❑ Ventilation ❑ Re-sheathing of roof deck using plywood. UY Prepare for re-roofing by ensuring all safety measures are taken in accordance to OSHA standard regulations and landscape is properly protected. 2' Remove existing layers of roof material down to roof deck and inspect wood.If upon inspection we discover any rotted wood replacement will be performed at $ 5"-" per SF.If wood is sound we will re-nail any loose wood to rafters,sweep deck and prepare for installation. U/Install 8"Drip edge LI Install 5"Drip Edge LJ Install Hug edge(Re-roofs only) Color UYApply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and or B'Apply 3�) #felt paper(UNDERLAYMENT)to the balance of the exposed wood deck. C}r'*'Reflash all stack pipes,tie-ins,chimneys and/or any roof penetrations as required and dictated by good roof practice to ensure water tightness. ❑ Re-seal chimney base using cement&fabric. ❑ Re-Lead&point chimney ❑ Re-build chimney $ WInstall a new ?x") Year ❑ Traditional architectural style shingle roof system Color ft''`;`Q 'r Manf. t ❑ Furnish and Install a new shingle over style ridge vent system ❑ Soffit vent system $ / Q"AII debris generated by Lambert Roofing Co.,Inc.will be cleaned up and disposed of from the job site in a legal fashion.Under no circumstances will the watertight integrity of the building be compromised. L 7-' Special Notes:T FE-5 7/1c P C Cr 1 �< ,c v�Y G r7, fIN R o 5 rn i tacd r- r 7�f' I!S 'Lr LI,.,411 r I— C 6" L'C. r ` f C d0 L r2 701 1FLA_7 74W,i u_i,i r '7'r r',7-1Tr --feIC C, [ f� -,?, -*,Yk Warranty options: ❑ Standard LRC ❑ Manufacturers Upgrade UPON COMPLETION AND PAYMENT IN FULL,ROOF SHALL HAVE A WORKMANSHIP GUARANTEE FOR A PERIOD OF TEN YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND YEARS HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. This document can serve as a contract,however if a more elaborate contract is desired we will issue it at the owners request. Please sign and return one copy upon acceptance.NOTE:if this contract is not accepted in_days it may be withdrawn by LRC. NOTE: We accept major credit cards* &financing is available! *Due to merchant related costs there will be a 2.3%service charge. *A finance charge of 1.5%per month(18%per year)will be charged on past due accounts over 30 days. Total Estimate Price: $ �7 '!C�}. Date of Acceptance Payment to be made as follows: �'�' i f'' Home/Business owner),.. Signature 6^109 P L f"..r. 0CI C- I l r"r �:. 1�i (LRC) 7— Signature Haverhill MA 978 374-9224 • Lawrence MA 978-687-7339 • Atkinson NH 603-362-9500 • 1-888-SOS-ROOF(767-7663) • Fax:978 521-5791 "Our Proof is on Your Roof www.lumbertroofina.net • 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 at: //�a�r.> ,Q wF,�< his 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit ,7-e-0s Date iq�trmsncan Environmental Contractors, Inc. Date: June 5, 2006 North Andover do er Health Department North Andover, MA 01845 To Whom It May Concern: This letter is to serve as notification of an asbestos abatement project to be performed in North Andover the future Sullivan residence located at 11 Commonwealth Ave. The job will commence on the June 12, 2006 Enclosed is a copy of Commonwealth of Massachusetts Asbestos Notification Form 001 for your reference Res ectfully, Tom DiBlasi Project Manager Enc: #0602-09 /sdl File:#North Andover Health Dept 72A Concord Street, North Reading MA 01864 • Tel:(978) 276-1211 • Fax:(978)664-5433 "let us handle all your environmental needs" Ll Commonwealth.of_Massachusetts_ 100033407 A sbestos Notification Form ANF-001 1Decal Number Important: when-fining out. p- A. Asbestos Abatement Description .. formsmp to the 1 a. Is this facility fee exempt city,town,district, municipal housing authority,owner-occupied computer,use tY P - ❑ P 9 tY� only the tab key residence of four units or less? ✓ Yes ❑No to move your cursor-do not b. Provide blanket decal number if applicable: Blanket Decal Nu ber use the return key' 2. Facility Locatt Validation process Is n1 g SULLIVAN RESIDENCE 111 COMMONWEALTH AVE. a.Name of Facility _ 'Street-Address NORTH ANDOVER MA �"' c.Cityrrown d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. Worksite Location: 1.All sections of this SAME I IBASEMENT form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed In order to comply with 4. Is the facility occupied? ❑Yes Q No DEP notification requirements of 310 CMR 7-A5. . . 5. Asbestos-Contractor -.-_ and the Division of Occupational INATIONAL CLEANING 132 R NEWBURY STREET Safety(DOS) - a.Name b.Address notification requirements of 453 PEABODY 1 01960 1 1978-405-3280 CMR 6.12 c.Ci (town d.Zip Code e.Telephone Number AC000511 .DO License umber g.Contract Type: ❑✓ Written F-1Verbal as i ntact Person t.Contact Person's Title 6 JIMMY MAO NET OWNER AS000339 a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number 7 MIKE MCCAFFREY I JAM033696 a.Name of Project Monitor b.Project Monitor DOS Certification Number SCILAB AA000162 8° a.Name of Asbestos Analytical Lab b.Asbestos Analytical Lab DOS Certification Number =0 9 06/12/2006 06/23/2006 _ a.Project Start Date mm/d b.End Date mm/dd/ 0 7:30AM-4PM INIA �N c.Work hours Mon-Fri. d.Work hours Sat-Sun. =o 10. a.What type of project is this? _o ❑ Demolition ❑Renovation IBASEMENT FLOOD ❑ Repair ❑✓ Other,please specify: b.Describe 11. a.Check abatement procedures: o ❑ Glove bag ❑ Encapsulation -o ❑ Enclosure ❑Disposal only _LL 0 Cleanup ❑Other,specify: Q Full containment b.Describe --z =Q 12. Is the job being conducted: ✓❑ Indoors? ❑Outdoors? anf001ap.doc.10/02 Asbestos Notification Form-Page 1 of 3 L1 Commonwealth of Massachusetts ■ 100033407 Asbestos Notification Form ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed,or encapsulated: 250 1 13275 a.Total pipes or ducts near otal other surfaces square c.Boiler,breaching,duct,tank 75 d surface coatings Lin.ft. S .ft. .Insulating cement Lin.ft. S ft. e.Corrugated or layered paper 250 rq� L f.Trowel/Sprayer coatings pipe Insulation Lin.ft. Sq.ft. Lin.ft. Sq.ft. g.Spray-on fireproofing Lin. Sh.Transite board,wall board Lin I.Cloths,woven fabrics J.Other,please specify: L1 3200 Lin.ft. Sq.ft. Lln.ft. S .ft k.Thermal,solid core pipe IFLOODBASEMENt insulation Lin.ft. Sq.ft. I.Specify 14. Describe the decontamination system(s)to be used: THREE STAGE DECON 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) g): KEEP WET/BAGGED/DOUBLE BAGGED/SEALED/LABELED/TRANSPORTED IN COVERED T 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver# e.Name of DOS Official t.UQ5 OfficialTitle N g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# —° 17. Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this project?❑Yes❑✓ No -° B. Facility Description =o 1. Current or prior use of facility: RESIDENCE �o 2. Is the facility owner-occupied residential with 4 units or less? ❑✓ Yes ❑No ANDREW SULLIVAN 11 COMMONWEALTH AVE. 3' a.Facility Owner Name _ b.Address NORTH ANDOVER 01845 o c.Ci /Town d.Zip Code e.Telephone Number area code and extension u. 4. a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address �Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) ■ anf001ap.doc•10/02 Asbestos Notification Form•Pa a 2q of 3■— F Commonwealth of Massachusetts ~; 100033407 - Asbestos--Notification--Form ANF-00-1- - Decal Number B. Facility Description (cont.) 5' a.Name of General Contractor b.Address c.Ci /Town._.... d.Zip Code____ e.Telephone-Number-larea code.and extension ._..... f.Contractor's Worker's Comp.Insurer g.Policy Number h.Exp.Date mm/dd/ 6. What is the size of this facility? 2500 13 a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): JOB ROLLOFF P.O. BOX 6037 Note:Transfer a.Name of Transporter b.Address Stations must ICHELSEA, MA 02150 (617)387-1495 comply with the c.City/Town d.Zip Code e.Telephone Number Solid Waste DivisionI Regulations 310 2• Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: CMR 19.000 SAME I a.Name of Transporter b.Address c.Ci /Town d.Zip Code e.Telephone Number 3. aa..Refuse Transfer Station and Owner b.Address f c.CI /Town d.Zip Code e.Telephone Number 4. IWASTE SYSTEMS INCORPORATED a.Final Disposal-Site Location Name b.Final Disposal-Site Location Owners Name 90 ROCHESTER NECK I IROCHESTER c.Final Dis osal Site Address d.CI /Town N H ---- —� 603 330-2134- - Cf) e.State f.Zip Code g.Telephone Number D. Certification The undersigned hereby states,under the JIM NET �O penalties of perjury,that he/she has read the a.Name b.Authorized Signature �O Commonwealth of Massachusetts regulations DOWNER �- for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and c.Position/Title d.Date mm/dd/ 310 CMR 7.15,and that the information (978)405-3280 INATIONAL CLEANING contained in this notification is true and correct e.Telephone Number f.Re resentin 0 ° to the best of his/her knowledge and belief. 1132R NEWBURY STREET o .Address _ PEABODY, MA —� 01960 —� -Z h.City/Town 1.Zip Code N anf001ap.doc^10/02 Asbestos Notification Form-Page 3 of 3