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HomeMy WebLinkAboutMiscellaneous - 1275 TURNPIKE STREET 4/30/20184 � North Andover ski area to get senior housing - Boston.com Page 1 of 2 ARTICiE COLLECTIONS bolsto-h Recol" Startrlgaf Iib Limit4ftme Sale r akour ned getaway tday.:.. CO -__D Vsounmssmw HOME TODAY'S GLOBE NEWS YOUR TOWN BUSINESS SPORTS LIFESTYLE A&E THINGS TO DO TRAVEL CARS JOBS REAL ESTATE Local National World Politics Business Education Health Science Green Obit4-Specialeports Traffic Weather Lottery HOME 1 COLLECTIONS Ads by Google Truth About Annuities... Try BostonGlobe.com today and get two weeks REE (already subscribe? log in). Don't Buy An Annuity Till You Learn All The Pros & Cons In This Video. SeniorAnnuityAlerf.com THIS STORY APPEARED IN t1 � 0I* North Andover ski area to get senior housing Senior Living Apartments Seniors, Live In Style! Check Out These Senior Apartments. seniorfacts.com Advertisement I MORE LIKE THIS Lennar 2Q profit falls but tops Wall St. forecast June 23, 2011 City asks nonprofits to pitch in more May 1, 2011 Aging boomers strain cities built for the young July 9, 2011 Advertisement March 22, 2012 1 By John Laidler Share E-mail Print A former ski area in North Andover that has sat largely idle for more than two decades will soon I see new life as a residence for seniors. A Maryland-based firm, the Shelter Group, is developing a 133 -unit senior living community —�--" at the base of the slopes at the old Boston Hill Ski Area at 1275 Turnpike St. Workers recently began clearing and grading A133 -and senior community isp&ned forthe old Boston the site. The one -building, 143,000 -square -foot Hal ski Area in... (Pro con) facility will include 65 independent living units, 41 assisted living units, and 27 units for patients with Alzheimer's disease. Construction is set to begin in June and take a year to complete. The Shelter Group will own and manage the all -rental, market -rate housing. Ads by Google Prices for Senior Housing Compare Pricing & Services on Top 5 Senior Living Communities by City. BestSeniorCareOnline.com Senior Citizen Housing Get Online info, prices, & options View pictures and floor plans today www.OurParentsPlace.com The project, which follows several unsuccessful efforts to develop the site over the last few years, is being warmly received in North Andover. "The town is definitely supportive of the project," said town planner Judith Tymon. "We have a specific special permit for continuing -care retirement centers, so that in itself indicates that we do support them." She said the project is also "probably the best outcome for that site" given the steepness of the slope of the hill. And she said that as a condition of its special permit, the developer placed a conservation restriction on the 25 acres of the site outside the project area. Of the eight acres within the project area, about five will be disturbed, according to the Shelter Group. Other benefits of the project are the permanent jobs it will generate - 61 full time and 78 part time once the facility opens - and the revenue it will provide for the town, Tymon said, noting that there will be no offsetting cost impact on the school system. http://articles.boston.com/2012-03-22/north/31218496 1 senior -housing -senior -communities -project 3/27/2012 4 � North Andover ski area to get senior housing - Boston.com Page 2 of 2 A condition of the permit provides that even if a nonprofit were to take ownership of the ti property in the future, it would be responsible for paying the taxes that would normally be assessed on the property. "For us to be able to guarantee there will be tax dollars going to help with the other areas of the community, the other services we provide, brings stability, which is important," said Town Manager Andrew Maylor. "There has been discussion of different projects over the years" at the former ski area, Maylor said. "It's certainly a positive that the project is moving forward, and from a community perspective, it will be an important asset and bring an important service to the region." Through its Brightview Senior Living division, the Shelter Group owns and manages 22 senior living communities in nine states, including four in Massachusetts - in Billerica, Danvers, Walpole, and Woburn. The company recently began permitting for development of a go -unit residence in Arlington. Ads by Google Aviv Centers for Living Woodbridge Assisted Living offers independence, support and activity. www.avivliving.org Assisted Living Heh) Sunrise Senior Living Official Site Find your loved ones care near you. www.SunriseSeniorLiving.com 1... 2 1'! . Next © 2012 NY Times Co. Index by Keyword I Index by Date I Contact Boston.com I Privacy Policy I Your Ad Choices ................... ........... _.......... ...................................................... ......................... ...................................... ..................:.............._......................... ...._.._..................... _.._............. _.._............................. .... ...................................................................... ......... _........... -.......................................................... ..._.......... htti):Harticles.boston.com/2012-03-22/north/31218496 1 senior -housing -senior -communities -project 3/27/2012 North Andover ski area to get senior housing - Page 2 - Boston.com Pagel of 2 ARTIOZ-LE COLLECTIONS � �T°� � .,.:. _ z WE bo'stonAlm Cool 0 A? RIO@ '$Deeds compa cl to 3 MbDs OSL> HOME TODAY'S GLOBE NEWS YOUR TOWN BUSINESS SPORTS LIFESTYLE A&E THINGS TO DO TRAVEL CARS JOBS REAL ESTATE Local National World Politics Business Education Health Science Green Obituaries Special reports Traffic Weather Lottery HOME I COLLECTIONS Ads by Google The New Porsche® 911 Try BostonGlobe.com today and -get two weeks FREE (already subscribe? login). The Most Important Moment In Sports Car History Has Arrived. Again. Porsche.Com THIS STORY APPEAREDIN t �+�i North Andover ski area to get senior housing Truth About Annuities... March 22, 2012 i By John Laidler Don't Buy An Annuity Till You Learn All The Pros & Cons In This Video. SeniorAnnuityAlert.com (Page 2 of 2) Pro Con, a firm based in Manchester, N.H., is designing and building the project for the Shelter Group. Advertisement "We are excited about it," said Dan Rexford, vice president of sales and marketing for the FUR Brightview division. With its existing senior communities in and around Boston, his company "has established a base here," Rexford said. "This is sort of a natural progression form that standpoint." The Boston Hill Ski Area opened in 1957, according to the website Lost Massachusetts Ski Areas, which said the area was one of the first in the nation to have snowmaking. Over the years, it also became a summer attraction, introducing an alpine slide in the 1970s, and in the 198os, "summer skiing" - skiing downhill on bristled mats, the website said. _- - Ads by GoogleCharter AARP Member Discounts Discount programs exclusively designed for AARP members. www.aarphealthcare.com Prices for Senior Housing Compare Pricing & Services on Top 5 Senior Living Communities by City. BestSeniorCareOnline.com The area closed in the late 198os. For a time in the 199os, an archery shop operated in the base lodge, according to the website. Several years ago, the then -owner of the property received town approval to demolish the old ski area buildings and construct a multifamily development at the site, according to Tymon. She said the ski buildings were torn down but the project never went forward. In 2010, the Planning Board issued a special permit for a development proposed by the Gralia Group, a Massachusetts firm, calling for a 125 -unit senior community, according to Tymon. But she said that project also never went forward. Last July, the Planning Board approved the Shelter Group's application to make use of the same special permit with some revisions, Tymon said. The board concluded that the changes - which included allowance for up to 10 additional units - were not substantial so a new special permit was not required. On Feb. 16, the Shelter Group closed on the purchase of the 33 -acre property, according to Rexford. The facility is scheduled to open in July 2013. http://articles.boston.com/2012-03-22/north/31218496 1 senior-housing-senior-communities-project/2 3/27/2012 I_ ? ' North Andover ski area to get senior housing - Boston.com Pagel of 2 TURNMICE STREE}.. REVISED EUV✓<TION .NORTH ANDOVER SENIOR HOUSING. SHELTER DEVELOPMENT GROUP 127S Tumptke Street North Atrdow, hl06"Ch"etts RATED PRO oWN INCOR -unit senior community is planned for the old Boston Hill Ski Area in North Andover. (Pro Con) httn:Harticles.boston.com/2012-03-22/north/31218496 1 senior-housinii-senior-communities-nroiect 3/27/2012 4 10595 Date ....t// .... TOWN OF NORTH ANDOVER I PERMIT FOR PLUMBING This certifies that has permission to perform ................ 0 ........................ plumbing in the buildings of ...... .............. 7 .............................. at,/(>) -75- ... ... .. .. .......................... ...... .. ................................ North Andover, Mass. Fee ..% ... Lic. No. P��, Z�/ -- L;6 ............................................................... ' PLUMBING INSPECTOR Checkjt 22' I <A g v MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK J / i �t CITY -41-0* �Ll d"W0JV�r MA 'DATE �o `�o zoite` PERMIT # �A rah ,Q� ovrEr JOBSITE ADDRESS %Z75' Tui-hF,'10E OWNER'S NAME POWNER ADDRESS<Z75" TI[G�lrt pt k 5%. TE(97$ Zoo Z67$ ZFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:F[] ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER 3A lvW 3 INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivaleittwhich meets he re uire ents of MGL Ch.142. YESNO ❑ eld- IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING.THE�APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNE ' NSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mas ach efts Gen r�ws, and at my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGEN� 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 com liance with all Pertinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE # SIGNATURE MP 0( JP ❑� CORPORATIONX# PARTNERSHIP E:1# LLC ❑ # ,�/ 0' /jlRell An'c'�jl L kV 0-1flKW1Q-042/ 2* COMPANY NAME ,( ADDRESS 7-1-3 - CITY ig l STATE Lt -/ ZIP 0&0,3 3 TE 3 -33.5-: FAX CEL&�96) 7Z6 --31(3 Z -EMAIL g v g�ARD ilE PLUMBERS AND G1SF ITTE;RS ISSUES THE FOLLOWING LICENSE LIC€NSEI� ,A'S A JOURNEYMAN PLUMB,:ER R I G;F#ARD P GIBBONS PO BOX 803y+ WABURY CT 06033-0803` 26003 05>0�/� 221174., y .'Please visit our web site at http;//www.mass.goO/dpi/boards/PL +4 GARY F WELCH HART PLB CO OF 'CT I.NC (PL) HART MECHANICAL, INC. 293 OAKWOOD DR GLASTONBURY CT 06033-5039 IMPORTANT NOTICE PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON -STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. Fold, Then Detach Along All Perforations tia OMAN OF M � �� A& USETT • • -. • "3PLUMBEIs�NGSf I�',>EVF ISSUES THE F0LLOW Iow"MARE N E lt�D AS PLgM9I N CO P.` ' �A Ali ( WELCH��: L. ,0 0-FV�'ET INC tii'. ,r'`,•'�; s HART ME` I'i41 CAL" .. s 293 OA.KWOOD DR:. A bNBUR � on"AT o6033-5013'5 24 �;: < 05/oV?y��.�V� �° 20704.7 Y_ +y The Commonwealth of Masssach.asefts Deparhnent of Indgsfiigl Aec1d&ts 0f flce of lnvestigadons 600 Washington Street Boston, .MA 02111 www.massgov/dia Workers' Compensation Lmurance Affidavit: Buildera/CoantractorAlectrxclansTlipinbers A. heant�oxmation PleaseMutLealbly Name (Businesslorgauizaiion/1nd dad): A4�� ��•�Yi� �� T -Zlc e .Address: Z r'3 Ojql,( sy�o � � .-• City/S �aie/2iti:���s but// L�� • Phone #:/") /,o 3-� - 3 3.5 3 Are ou an employer? Check the appropriate box: Type of project (required): 14.0 am a employer with / 4-P 4• ❑ X am a general contractor and I 6. New construction employees (full and/or part-time).* 2. El am a sole proprietor or partner have lured the sub -contractors listed on the attached sheet. 7• ❑ emodeling ship and'havena•employees These sub -contractors have 8. [] Demolition woxking forme in any capacity. workers' comp. insurance. 5. ❑ We area corporation and its 9. E] Building addition [No workers' comp. Insurance 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. [] Plumbingrepairs or additions myself. [No Workers' comp. c.152, §1(4), a-adwehave -no 12,M] Roofrepairs insurancerequired.) s employees. [No workers' 13.V Other. 5At-" (O -H1 comp. insurance required.] xAny applicant that checks box#I must also fill out the section bel6w showingtheir workers' compensationpolicy information. T'Homeowners who submitihis afddavitingoatingthey tie doing allwork and thenhire outside contractors must submit anew affidavitindicating siioh. tContractors that checktbis 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 li7orkers�ornpelisation insurance formy er,�ployees Be%w is the policy ancij0 site information. 'Tzi E /�f,► °�'—�/ T�rs�a-.q�u,� o . Insurance Company Policy # or S eXf ins. VG. #' D Z W �Q T 3 ` Expiration• Date: rob Site Address; 12 7 l:i �Yc P1 k jCaty/State/�ip:�1%1 s�-�/nyid V v Attach, a copy of the workers' comp ensation-policy declaration page (showing the policy number and expiration. date). Failure. to secure covexage•as requiredunder Section 25A ofMGL o.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 WORD ORDER and a fine of -up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of. investigations of the DIA for insurance coverage verification. X do hereby cep " under tlieiiai anrt pe/neral/ties o perjury that Me in ormation•provid'ed above is true and correct. - .CianafiTrw r I��/^`�—� Date: Z_ 6, 3 Oficial use only. Do not write in this area, to he completed by city or town official City or Town: Permit/License 0 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CiiylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - Contact Person: Phone • c. 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 iii. the service of another under any contract ofhire,- express or•impR4 oral orwritten." Au employes is defined as "an individual, partnership, association, corporation or, other legal entity, ar any two ormore of the foregoing engaged in a joint enterprise, and including the legal representatives of w deceased em . to ex ox 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 thm 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 p ermit to operate a business or to construct buildings iu 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapterhave beenpresentedta 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) alongwith their certiftcate(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,apoiicyismquired. B a advised that this affidavit maybe. 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 tail 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 andpxinted 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, iu addition, an applicant thatmust submitmultiple permit/Itcense applications in, any given year, need only submit once affidavit indicating curxeut Policy infon.ation (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or towiu)" A` copy of the affidavit that has been officially stamp ed 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. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license oxpermit not related to any business or commercial venture (i.e. a dog license orpermit to burn leaves eta.) 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 faxnumber: `rho CQon wealth o?aacl,ve Depa e l of.Zndu�fxial A.coldelit oface o; xRmaga-am 6b WW g(an ee Bogon,MA02111 TO.0 617n7 -2Z-49.00 oxt 4Q6 ox 1-877�M Devised 5-26-05 Wm4aagovIcha Linda Hmurciak Superintendent TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS BRUCE D. THIBODEAU, P.E. DIRECTOR WATER TREATMENT PLANT 420 GREAT POND ROAD, 0 1845 -2909 NORTH ANDOVER SENIOR LIVING 1275 TURNPIKE STREET NORTH ANDOVER, MA 01845 Telephone (978) 688-9574 Fax (978) 688-9575 05/27/14 Re: PROPOSED BACKFLOW PREVENTION DEVICE INSTALLATION At: BRIGHTVIEW NORTH ANDOVER 1275 TURNPIKE ST NO ANDOVER, MA 01845 Control Number: NEW LISTING Dear CHRIS RAND: The Town of North Andover Cross Connection Control Department has reviewed your application and plans for the proposed backflow prevention device mentioned above. The information submitted shows to install the following: DEVICE TYPE MANUFACTURER MODEL SIZE LOCATION RPBP WATTS 009QT 1:' WASHER FEED - COLD RPBP WATTS 009QT .75" WASHER FEE - HOT RPBP WATTS 009QT .50" DISHWASHER FEED In accordance with Chapter 111, Section 160A of the Massachusetts General Laws and 310 CMR 22.22 of the Massachusetts Drinking Water Regulations, the Town of North Andover hereby grants approval for the installation with the following provisions: 1. Drinking and domestic water lines, lines for safety showers and lines for eye wash units must be taken off (installed) the upstream side of the backflow preventer for devices installed as in - plant protection. , 2. The backflow preventer shall be located so as to permit easy access and provide adequate and convenient space for maintenance, inspection and testing. 3. Tightly closing valves must be installed at each end of the device. 4. The device must be protected from freezing, flooding and mechanical damage. 5.� . The owner or owner's agent must maintain a spare parts kit and any special tools required for removal and re -assembly of the device. 6. The owner or owner's agent must provide the necessary labor to assist the Cross Connection Control Inspector in the initial inspection and testing of the installed device. 7. For devices installed as in -plant protection, the reduced pressure backflow preventer shall be installed on the owner's side of the water meter on the potable water supply lines. 8. Before installing a reduced pressure backflow preventer, all pipelines shall be thoroughly flushed to remove foreign material. 9. The owner of the device shall be able to shut down water lines after reasonable notice during normal business hours to permit necessary testing and maintenance of the device. If it is not possible to meet this requirement, a by-pass line equipped with an approved type of reduced pressure backflow preventer shall be installed. 10. The reduced pressure backflow preventer and shut-off valves must be installed in a horizontal alignment between three (3) and four (4) feet from the floor and a minimum of twelve (12) inches from any wall. I 11. If the device is to be installed on a hot water line, a device approved for use at an elevated temperature must be used. 12. If a drain is to be provided for the relief port, there must be an approved air gap separation between the relief port and drain line. To be approved, the air gap must be twice the internal diameter of the discharge line. 13. All water lines shall be color coded according to the state plumbing code, except that water filtration plants, pumping stations, sewage treatment plants and sewage pumping stations shall label all water lines in lieu of color coding. APPROVAL FOR DOUBLE CHECK VALVE ASSEMBLIES 1. The double check valve assembly and shut off valves must be installed in a horizontal alignment with the floor. The top of the e check valves must be a minimum of thirty (30) inches and a maximum of fifty-four (54) inches from the floor, unless otherwise approved by the Town of North Andover. 2. There must be at least (12) inches clearance between the double check valve assembly and any wall. 3. The double check valve assembly must be provided with suitable connections and appurtenances for testing. In addition, the Town of North Andover Cross Connection Control Department requires that the installation be completed within thirty (30) days after receipt of this approval letter. Following the installation you must contact this office to make arrangements for the initial inspection and test. This approval is only for the installation of the backflow prevention device(s). All other permits and approvals must be obtained from the appropriate Town departments. As owner of this cross connection, you must be aware of the importance of maintaining these devices. Unprotected cross connections can and have resulted in the loss of water supply and public health damage. You are responsible for compliance with Massachusetts Drinking Water Regulations, 310 CMR 22.00. Failure to take any action deemed appropriate by the Department of Environmental Protection or its Designee, the Town of North Andover Cross Connection Control Department, or otherwise failure to remain in compliance in the future with the applicable requirements, could subject you to legal action including but not limited to, criminal prosecution, court imposed civil penalties or civil administrative penalties. A civil administration penalty may be assessed by the Department of Environmental Protection for each day you are in noncompliance with the requirement referred to above The Town of North Andover Cross Connection Control Department strongly recommends that you obtain a copy of 310 CMR 22.22 for information on legal responsibilities associated with the installation of these devices. You may obtain copies of these regulations by contacting the State House Bookstore at (617) 727- 2834. If you have any questions regarding this decision, please contact the Cross Connection Control Department at 978-688-9547. ti Sincerely, LINDA HMURCIAK SUPERINTENDENT OF pORTFH 9 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS BRUCE D. THIBODEAU, P.E. DIRECTOR �gAT[O SPP• ��J C""SES WATER TREATMENT PLANT 420 GREAT POND ROAD, 01845-2909 Linda Hmurciak Superintendent Dear Customer: Enclosed please find your approval for the installation of the appropriate backflow preventer(s) for your facility. Telephone (978) 688-9574 Fax (978) 688-9575 When the installation is complete please fill out this form and return to: TOWN OF NORTH ANDOVER CROSS CONNECTION CONTROL PROGRAM 420 GREAT POND ROAD NORTH ANDOVER, MA 01845 FACILITY NAME: ADDRESS: CITY/TOWN: CONTROL NUMBER: BACKFLOW DEVICE INFORMATION: DEVICE LOCATION:. DEVICE MAKE: DEVICE SIZE: SERIAL #: INSTALLATION PERFORMED BY: DATE COMPLETED: ZIP: MODEL: GATE TYPE: r p�'1�iy date f �rs ee A pp, / ltj / haSAe, s esthat FRMjrFORN Sl t '•' �V�� pR q� at I�1� the b °POT" �pfo IN, k# '. Lac N .r�•�� • .!��� ...�� �.'.' c 0Vr Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 17zhi Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: /t-6'7-4:5) City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical ork described below. Location (Street & Number) Is this permit in conjunction with a building permit? Yes I_ Purpose of BuildingDf�Ei ed 60 rt S iA %) F.Yictina Cervice Amns / Volts Overhead Ido / 0 `fl) VOIts . , _ . Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Utility Authorization No. l v Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Sus . le Fans p (Paddle) o Total TTrransformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- El rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. and No. of Switches No. of Gas Burners InDetection Initiatin Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons KW No. of el -Contained No. of Waste Dis sera po Totals: ............. Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ muni holn El Other No. of Dryers i'Y Heating Appliances KW ecSystems: NNoo. of Devices or E uivalent No. of Water KW No. of No. of Data Wiring: Heaters 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 desirec4 or as required by the Inspector of Wares. 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. 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 cover5e is in force nd has exhibited proof*se to the perrytiqW . CHECK ONE: INSURANCE OND VTHER ❑ (Specif): �' JJ f 3 I certify, under the pains and penalties ofRerjury, that the information on this application is true and complete. -, FIRM NAME:�QI I ,�I ory ` LIC. NO.:��C7v � Licensee: IA-pnn A0_//QhZ/-J'!D Signature n LIC. NO.: (If applicable, enter `exxee�mpt" in t icense number line.) J Bus. Tel. No.: �l Address: Alt. Tel. No.: wz:�� *Per M.G.L c. 147, s. 57-61, security wo requires D partment of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. �y my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ j %� Signature /° ` q�Telephone No. Itco mu_,� ff,"t e - r -3, � 40 V �t J a f' f. . .. t f ` F � � } � .�.. .. s � f f.. i i f. . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 I Print Form I ` www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: Y1 mof-e., ' City/State/Zip: Wf'w-L)M Q2hone #: 7 Are you an employer? Chick the appropriate box: 1.6 I am a employer with _ JD 4. E] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work ' myself. [No workers' comp. insurance required.] t These sub -contractors have employees and have workers' comp. insurance. 5. R We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' coma. insurance reQuired.l -/0 /D Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions I L E] Plumbing repairs or additions 12.❑ Roof repairs 13. EI-6therbn` w F� 6 i4 *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. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: _ Polipy # or Self -ins. Lic. #: l(/(1 a a 0q 0'Za v Expiration Date: z Z i Job -Site Address: Opt 7 Ul�e �f City/State/Zip: /V M&WAW /� 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 to the Office of Investigations of the DIA for insurance coverage verification. I do herebv cerdfv under tk painv d dpenalties of pedury that the information provided above is true and correct. a Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # �A- i,— 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 #: a 5 i tOEM Iu o 0 0 ••0 0 a • �� � 1 I ¢ I AN ,'SSUES':H FULi.OWi�l.lii A #! 1 ;TRAP FIC S iMAJAL I NTENA41 A60A1;,` j 3 ILI 1 'Y0if1{ k A 021 9 23t,� ;1 175s��tJq siYt t7 j y 41 N OGRE RE). WEYMOUTH MA. 02189 Tel: 7E 1-340-1045 Fax: 731�340.9835 F 143X To.- ., A14#&Ot-YQ-DsO1J— From Phor Pages: Fax= 0 ? Pate: zm :B LL-TRAFFIC :' SIGNAL,C. M IN ...... . .... . . .......... P=' ill-lassDu �/ YnukAm.ln MpAn....J1,wgr,r•U:r �I �npmNaparrigon PERNT ; NORTH ANDOVER Speed Feedback Signs Permit /t; 4-2013-0279 Subject to all the terms, Conditions, and restrIctions printed or written below, permission is here by' granted to JOR1Gl(T VIE, W NORTH A�OV.R to anter upoal tide State Highn ay known as 11;0UTr1 114 for the pargidse vi' installiaig a ;volar powered spent feedbacb sign. betty oett the sWeivalic and the v6rtheasterly (w.estbound) side of tlxe road1w iy at approxars,te station 133+32 and a Lard wired speed! feedback. sign bktween t11e sidew7�allr. and the southwesterly (easthouncl) side of the roadway at appro�imate stations 1:13+59 tis shown on the plan submitted and on File in the ]D6strict ]Cour Permant Office by N4sarclnionda & Associates, L.P. date:�d 7/15/13 wi,tlr a Registered Civil En rrofes do nal gi S The G m Roe shall notify Dig Sat' at 1.8883444.7233 at least '12 houtrs; prior to the start of i work i:or• the purpose of ldekti,fyiAg the location of underground`utilities. Dig -Ss fe 9 To be obtaixted prior to the commencement of work. The G ra atee shall utilize and pay for uniformed police officers with their official vehicles to be k a m rtte ndance at all times while work is being dome under ithias permit. The h rm ishing and erecting of all required si,gria asxd tratftac sanffe�► uReviees shall bay the respom sil yility of the Grantee. All sig as and devices shall conform to the 2069 edition of the, Manual on Uniform Traffic Contra of : Devices (1+,1 UTCD) with the Commonwealth of Massaachusetts Amendments. Cones arid noir-reflecting warning devices shall not he left in operating position on the highw, ay when tate dayth ne operations have cessed. If it becomes necessary for this Depar iataout to remove any construction warx"' g devices or their appurtenances from the projec t hie to negligence by the Grantee all costs for this work will be charged to the Grant we Flashi ag arrow boards will be used at all times when operations occupy the roadway and shall b e; mailable for use at RU times. All was ra ing devices shall be subject to removal, replacement and repositioning by the Grant .-e as often as deemed necessary by the Engineer. A sops F o Fthis permit must be on the job site sit all times for inspection. Failure to have this permi! available will result in suspension of fife rights gmnted by this permit until cutch permU b made available. The C Du►,pletioan of Work Fo nra shall be sent i10 tate Grantor as soon as possible after the comp'l al on of the physical work. All nd lit Y companies wlxose services are located within or adBancetnt to the proposed install at on areas shag be noted in writing of the proposer instalktion at leatst:48 hours prior in -the star' of any excavation in said aar+ess. This is independent of the required dig safe n0ttirication . Provis ion is shall be made for the safety and prot bctlon of Pedestdan Traffiie &uing the contra iclions period.Under no circumstances shall the operationa create a hazardous environment for the gf,sexal public. I It shal . b . the responsibility of the Grantee to provide access to the prope>.ty of residents and Fags 2 of 5 { husines s c owners during the progress of the proposed work. The Ga: W'.ee shall not engage in any utility work under benefit ofthisl Petaxaiit. Nothing in this Permit sh ill be construed as authorizing any installation or maintenance tla.ereof For all drivew, rya roadway applicatiotas requiring utilitie;3 (water, gas,. sewer etc.), a separate Permit most be applied for by the appropriate Udlity Company or Municipality. All wog k shall be in compliance with the 1988 Edition of the I%IwsachuseCts Highway Depaa; tt at of Standard Specifications for Highways and Bridges", and Supplemental Specif~t *ions Dated Tame 15, 2012. No equ ipt hent, trucks, workers, etc., shall occup:Y' any part of thy: traveled way except between the hor rs of 9:00 A.M. and 3:00 P.M. Monday tlwa Friday. Except for an emergency, in no case will op mfiions exceed the specified hours without the prior appnuvfal of the District Highway Directe r or an authorized Representative. This includes the placement of traffic control device: , i'chicles, equipment or anything that restricts the flow of traffic through the const ru d on zone. Dnergencaes must be unexpected situations or sudden occnurearnce;s of to serious aa:.d urgent mature that demand iiaaa.mv&te- attention. No wot k shall be dome Bander the terms of this pe.aw it on SaturAnys, Sundays or Holidays. Nowa k -will be performed on the day before or the day after a holiday or a long weekend which involve s , t holiday on as y highway, roadway or property under the control of the M=DOT I-lighw ay Division or in areas where the work would adversely impact the normal flow of traffic on the Sts le Highway Systema, without permission of the Dist dct Highway Director or an authori w 3 Representative. Signs r m st be installed so that the.visibility of any existing silts remains unobstructed. It is im pe ktrtive that construction operations are nmanaged so that motorists travel "delay„ is minimi zc d. At any time during the operation when a traffic delay of over twelve (12) mirnnaates occurs and the situation is worsening, the Granux—. will begin to suspend operations. Contin uo "sly increasing "delays" of over twelve (12) minutes are not to be permitted and may result 1 a t he suspension of the operation or termination of this Permit by the Department. Two,A ay traffic shall be maintained at all times, When : as L -he opinion of the Engineer, this operation constiitutes ,a hamrd to traffic in any area, the Gm mi ee may be regWred ro suspend opmxations during certain hours and to remove bis equipn ►Ea kt from the roadway. When ,ve r work is to be done within two hundred (200) feet of existing State Highway Traffic Signa, c, t he Distdct afflce must be notified by the Grantee at least 4S hours prior to the start of Page 3 or 5 work b V 4 tilling the District Traffic Office at 7911.641.9484. Care sl gall be exercised so as not to disturb any existing State Highway Traffic Loops. If said loops a re disturbed, they shall. be restored immediately after the end, of the work day to their origins I c ntadiflon..ca All expenses for restoring conditions shall be borne by the Grantee. Care sl lal l be exercised so as not to disturb any cmisting State Highway 'Traffic Duct Systeans or any un lei ground structures that exist. If said system is disturbed, it shall be restored irttmed iat ely to its original condition. Said damage shall be recotrded and include: baseline station lo.,.ation and offset, type of damage, method and extant of repair. Also any damaged! Traffic lis yes shall be restored to their original condition. All expenses for restoring conditions shall bpi : c harged to the Grantee. Ternporay video detection may. be required if traffic conges,lio n/delays become an issue. The Ga n tee will be responsible for any damage caused by this operation to curbing, stfuctures, ioadwey, etc. Ile Q au tee shall be responsible for any ponding, of water which may develop vrithin the State Highw ty Layout, caused by this worst. No wo. k shall be authorized daring snow, sleet, or ice storms and subsequent snow and ice operad Dns. No bite arm inous concrete shall be installed between Noveraber 15th and April 15th without prior approv at - 6rom the District Highway Director or jarn authorized Representative. The Sty tip Highway Layout shall be kept clean ok' debrits of any mature at all tiMcs and shall be thorou� ft y cleaned at the completion of this permit and all distuirbed areas shall be restored to a conditi on equal or similar- to that which existed prior to the workk Any gr as;; areas disturbed within the State Highway Layout shall be graded, loamed to a depth of 4" a id seeded. if the s idi malk area is disturbed, it shall be restored, full width, in kind a minimum of five feet beyoni a iy disturbed area. It shall bo the responsibility of the Grantee to replace all pavement inarldngs which have been disturt ed by this permit. These pavement merkiurgs shall be restored within ten (10) days abler this un Frk is performed or as deemed necessary b;i► the District blGglxway Director or an author zed Representative. Any ba gun id marked MHB shall not be removed or disturbed. If it becomes necessary to remove and m, et any highway bounds then the Grantee .shall hire aReg istered Professionat Land P295 4 of 5 Starvey or to perfon n this work. At shall be the responsibility of d is land surveyor to submit to this offia; a statement in writing and a plan, contaWng his Stamp ad signatim showing that said w4 art: has been peffarraed. I The Ga au tee assumes all risk associated with an, envirourmenta.E condition wdti& the subject prelim y; rnd shall be solely responsible for all costs associated with evaluating, assessing, and remedi ail ng, in accordance with all applicable lawns, any enviroanraental contamination (1) diseovorc d during G7 tutee's work or activities under this pennit to the extent such evaluation, assesst ae at or remediation is required for Grar x(Ws work, or (2) resultmag froom GravWs work or afth rites under this permit. Grantee shalt nolafy Grantor of kuay such. assessment and remedi A on activities. The Grantee is hereby heRd solely responsible for obtaining and mainta int ag any and all eatvirom mental compliance permits reclvrired by local, state and federal laws as td regulations when regular or emergency work is proposed within, or in close Proximity to, any w -.Hand area. TIds porn ut is issued with the stipulation that it niay be modified or revoked at any time at the discret iomk of the District Four I ighway Director or an authodZed Representative without render nE; said Department or the Commonweabb of Massachusetts liable in any way. The 0 ars tee shall indennnify and hold harmless the ConnmonvwrWth and its ]Highway Divisions against al l suits, claims or liability of every dame and nature ad sing at any time out of or iaA consequence of the acts of the Grantee in the performance ofthe work covered by this permit and or fu: lure to comply with ten ns and conditices of the pennit whether by themselves or their emplo;►eE,s or suboontrmctors. .APPU Ca 41 IS REPIML1TATIM Alan Sielgfrled TELE 'BONE NUMER: (410) 246-7475 The Pi mntit sball be void unless the work hOTRArr c0utemplstedl 0211 have been COMPleted before August28, 2014. Dated at Arlington this 28th day. of Aaganst, 2013. 1V1assl to T - highway )Divisi0n, By G� Paul I a. ; itedman ,El efful ;1L rhtrict Hirghnvay Di;rrecbr 1 jFhaj.r Page 6 of 5 12/27/2013 14:51 7813409835 BELL TRAFFIC SIGNAL PAGE 02/03 radairsi:.A n''TI 9 MAKING ROA )S SAFER WgLrrlin t, ods Inc., TC -500 Radar Speed Sign Specifications Mini -SD Mem,)r)- Card . System Storage Capacity: stores data on up to 5 million vehicles Weight TC -500A (AC); ;;2 1 )s. . TC -5008 (Setteiy): 56 lbs. (includes 2 batteries) TC -500S (Solar;: 511 lbs. (includes 2 batteries) Warranty , Two year warrs my on parts and labor, Including batteries , Exceptions: Dom not cover malicious abuse, theft, or damage due to unautho tzeI modification. Optional third y.,ar warranty extension available, Optional Feat arE:s StreetSmart; Ti affb; statistics software to report, organize and analyze speed and :raffic data, (Available for all models) > Ex Comm; Celli lar based remote sign management system with 15 month pro-pnrgnrmmable calendar. (Available for AC and solar models only) External Device Trigger Option; System that activates external devices from the radar speed sign based on time and/or speed, or temperature, (A% allo ble for AC and solar models only) T-'-500 on Radar on the Go trailer hitch Solar Power , Solar Panel Output: 40 watt Voltage at Pmax = 16.9V Current at Pmax = 2 34 Amps , Optional Upgrade; Solar Panel: 05 watt Voltage at Pmax m 17.4V Current at Pmax c 3.75 Amps Batteries: Two '12-vo11,18 amp/hour AGM batteries (UL recognized). Designed to slide into housing slots without any danger of movement. ► Battery Controller: Manages the flow of solar energy Input (up to 85w) from solar panel to battery. , Pole Mount: Side pole mount with 451 angle bracket for effective solar charging. o Software Control: SmartChargoO software prevents overcharging and intelligent shut- down when battery falls below acceptable voltage; auto restart when sufficiently recharged. . Battery Status; Via Bluetoothr", can check battery charge levels and solar amperage. TC -500 with School Zone Safety System TC -500 on Mobile Patrol Stand I 12/27/2013 14:51 7813409835 BELL TRAFFIC SIGNAL PAGE 03/03 radarsig nTM MAKING ROAD:; SAFER ,JJfflarlin Controls Inc. TC -500 Radar Speed Sign Specifications Power Optioni : . TC -5008 (Solar); Dl,al 12 -volt ,18 ampAnour AGM batteries with soli Ir p anel . TC -600A (AC): H and wire to 100V -240V power supply TC -500B (Batter r): )ual 12. -volt ,18 amp/hour AGM batteries; in 31u, les AC adapter/charger . Power Consuml tic r < 2.5 amps (24w) in active mode; Idle mode < 1 watt; Circuit Breaker Multi - circuit, 5 amp fus, m YOUR SPEED Fa:eplate • Full size 24"w x 21 "h YOUR SPEED faceplate with 3" lettering . MUTCD compiler t actors and reflectiveness • Oversized 24"w x 26'h faceplate optional with 4" lettering } Ideal for 10 MPH to 4.0 MPH speed limit roads Available in white flti crescent yellow or safety orange Standard IProgrannming YOUR SPEED YOUR SPEED M. . On/Off Timer Opt on::: 4 timers per day, also by day of week. Settings allow lov er apeod limits for school zones, . Oisplay On/Off: A lovas traffic data collection to continue even when display Is off. Display Brightneea Control: Auto adjusts to light conditions, up to 100 levels, . Setup Functions; Ealiy to follow menu- software managed, no mechanical sv, itches to operate, . Maximum Speed Cutoff; Prevents unwanted high speed displays, up to 99 mph; dis„ourages excessive speeds to lest sign. Choice of fleshlns ml itrlx, or LED display cutoff. . Date/Time Contrc I: Eattery backed real-time clock / calendar Speeding Merl 2 speeds of flashi rig -EDS to notify drivers that are exceeding the speed limit Operating Terr pe ratures . -40” F to +1380 F Sluetooth7N1 Cr►mmunication . Allows secure wir ale is operation of radar sign and data collection directly from lept(p fi om the comfort of a nearby vehicle. Housirig Dimensions: 15,6" 14 x 22.2"W x 5,25"0 . Thickness: 1875" to ,25" aircraft aluminum � ... with white powder coat finish Provides maximum protection from elements & vandalism V ::: ,�.,,�:::w•, .. . . NEMA 411 level eompllant ' r'el. Af'•. '— ... Non -sealed and ventilated . Humidity Maximum: 100% BASHPLATET11 with LED cones , Internal •375" aluminum shield to protect components from abuse or vandalism , Beveled design Flrotects LEDs and internal components by dissipating ry ,gr any force inflicted on the sign 318 "thl` ;,�/4i� . Conical holes for each LED focus and reflect light toward the road, providing the highest quality viewable display with minimum energy usage. LEDs 2 digits, 12" high super bright amber LEDs (life up to 100,000 hours) with directional beam technology . Automatic Intensity adjustment to ambient light conditions for maximum visibility . Provides directed viewing of display to oncoming traffic GE Lexann" Dfisplay Cover ..25" thick protective cover . Abrasion resistant . Graffiti resistant UV protection Shatter resistant Radar Type; K Band, single direction Doppler radar, FCC part 15 compliant , Sensor Range: Sensor range up to 1000' , Beam Width; 12 degrees, +/- 2 degrees . Operating Frequency: 24.125 GHz, +1- 50 MHz Accuracy: +/-1.5 mph . Speed Detection Range; 5 -127 mph 13v4 Date � �wgJLhb`7�6$x. y � TOWN OF NORTH ANDOVER � P � .� PERMIT FOR GAS INSTALLATION This certifies that . .0/Q 9 ,;..... . -- I has permission for gas installation���—� P.�,Vp .. - s ... . in the buildings of . �.�........................ at .... 71 5 r:,j p�. � . �. .......... North Andover, Mass. Fee 4� .5.� . Lie. No.��i ? (�Yl�..................... ... GASINSPECTOR Check # 8 517 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I NORTH ANDOVER MA DATE 12/21/12 PERMIT # JOBSITEADDRESSI 1275 TURNPIKE ST 71 OWNER'S NAME BRIGHTVIEW -PRO CON CONST GOWNER ADDRESS I SAME TE 603-234-6628 FAX Li TYPE OR OCCUPANCYTYPE COMMERCIALE] EDUCATIONAL® RESIDENTIAL® PRINT CLEARLY NEW: RENOVATION: ® REPLACEMENT: ® PLANS SUBMITTED: YES® NO APPLIANCES'l 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 _ TEMPORARY HEATER 1 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 COVERAGE BY 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. CHECK ONE ONLY: OWNER ® AGENT El 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 i ompliance with all P inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME FJOSEPH FALLONI LICENSE # 3010 SIGNATURE MP ® MGF ® JP ® JGF ® LPGI [D CORPORATION E]# PARTNERSHIP ®# LLC ®#� COMPANY NAME: FERRELLGAS ADDRESS 156 SOUTH MAIN ST CITY I MIDDLETON I STATE MA ZIP 01949 TEL800-244-6275 FAX 978-777-5295 CELL 978-790-6690 EMAIL 10%, . COMMONWEALTH OF MASSACHUSETTS Building Permit THE B MAY WITH TEMPORARY TE OF USE CERTIFICATE & OCCUPANCY TOWN OF NORTH ANDOVER ?24-12 on 4/12/2012 Date: April 1'1, 2013 THIS CERTIFIES THAT f' `ocatiph ! �' No. �7S 26 286 Fee: $50.00 Receipt: Z, Pn Z Check: 5`l (P 2 --,nike Street - Brightview IN ACCORDANCE S -'v.G CODE AND SUCH I y Cato /�( I7 �J 3 TO -Ie WN OF enficat oN FO e eA Th 4NO O 'Quin 90 gFaccUpaUndatmepIICYioPemitOher er�it ermiteeP ee SFR Build;n9 Spector 200 Date .. / f! . � �- ..... NORTH TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION A q _ • y`•`e n CSS f This certifies that ,.J�J or—A...... .. . ff.. ....... . has permission for mechanical installation.,. in the buildings of .�?'� `!`.�' :'�........................... at ...4 _� .. U 2 9 i ......... • • • , North Andover, Mass. Fee .3 %A.. Lic. No 3.� A.... NSD ....................... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer n Ir Commonwealth of Massachusetts Sheet Metal Permit Date: q l o ill �o Estimated Job Cost: $ 3.3 0, G 3� Plans Submitted: YES \// NO Business License # 9 ` 9 (0 at Business Information: Name: b c,�'t-a r\ ytz�- —`�qS t�C Street: City/Town: 03U7b Telephone: (o 0', ',3 Permit # 0-0 6 Permit Fee: $ M �g 11 Plans Reviewed: YES /NO Applicant License # 31 � � Property Owner /` JLob" Location Information: Name: —3,11 r _ r Street: City/Town: Uori� Wfyl-r Telephone: Photo I.D. required / Copy of Photo I.D. attached: YES V NO �. rr Staff Initial J-1 /9 -unrestricted license J-2 / M -2 -restricted to dwellings 3 -stories or less and commercial up to 10,000 sq. ft. / 2 -stories or less Residential: 1-2 family Multi -family Commercial: Office Retail Institutional / Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft..X Number of Stories: Sheet metal work to be completed: New Work: )� Renovation: Condo / Townhouses Other Industrial Educational HVAC Metal Watershed Roofing Kitchen Exhaust System id Metal Chimney / Vents Provide detailed description of work to be done: N P,w A ur Aw6 ((✓c , Air Balancing il INSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G:L. Ch. 112 Yes No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy I Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts Ggerat�t�'aws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxes, I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments By Title Cityrrown Permit # Fee $ Inspector Signature of Permit Approval Type Qf License: Master ❑ Master -Restricted ❑Journeyperson Signature of Licensee ❑Journeyperson-Restricted License Number: ❑ Check at www.mass.gov/dpl rca�m 1 W 0 S Dear Sir, Eastern Vent Systems, Inc. 4 Dick Tracy Drive Pelham, NIS 03076 Phone: (603)595-8559 Fax: (603)886-7317 Fax Cover Sheet Date: 9/28/12 Company: Building Dept. To: Gerald Brown From: Tim Angelosanto RE: Sheet Metal Permit - Brightview Attached please find the additional paperwork that was requested per Brian Leathe to go with our sheet metal permit for the Brightview project at 1275 Turnpike St.. He told me to send it to you as he was not going to be in next Monday or Tuesday. 1 gave him the sheet metal permit application this morning. Please contact me at the above phone number when the permit is ready. SPage(s) INCLUDING Cover Sheet Please call if you do not receive all of this transmission The Commonwealth of Massachusetts Department of Industrial Accidents qi 02 Office of Investigations 600 Washington Street It Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricia lease Print Le bI Applicant Information < Name (Business/Organization/Individual): S J _T_ C c Address: 4 D i rAL'LCa_ 1 cc%` City/State/Zipy- Yl rn .( F S a '7 (a— Phone #Le 3i - �� 19 Are you an employer? Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I _�� employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. $ 2. ❑ I am a sole proprietor or partner- These sub -contractors have . ship and have no employees working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL c. 152, §1(4), and we have no myself. [No workers' comp. insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. K New construction 7. ❑ Remodeling 8. ❑ Demolition 9. [] Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑ Other- --- *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit s 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. I am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and fob site information. 17 1 Insurance Company N Policy # or Self -ins. Lic. #:_ G �� �] Expiration Date I 2 Job Site Address: rai ✓� r= 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 to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under p ins and,,,Vnalties of perjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: AcoR& CERTIFICATE OF LIABILITY INSURANCE 8/27 12 i/ 0 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 pollcy(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 endorsemen s . PRODUCER Infantine Insurance P. O. Boa 5125 Manchester NH 03106 CONTACT Pauline Prouls . 603-669-0704 (ext2U Fnx 603-669-0831 f4wIrma pproulxQinfantine.con ARS -.Netherlands Insurance INSURED Eastern Vent Systems, Inc. 4 Dick Tracy Drive Pelham NH 03076 iNsuggag,pearless Ins-uran-ce 4198 INSURER Q; INSURER F INSURER F, ncft11E1d-ATc ui im= lo.9n7 7 17n7 2 MAATAT REVISIUN NUMMI-K` uvrclarlua.v.-. vim..... ..,�.,......----•---,.: 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 WTH 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,. EXC.L.USIgNS.AND CONDITIONS.OF SUCH POUC.I.E$. LIMITS $HOWN_MAY HAVE BEEN. REDUCED BY PAID CLAIMS.. InS CE DPL POLICY EFF Pi1Lx. �.... ARS GENERAL LIABILITY EACM OCWR§ENO $ 1,000,000 X COMMERCIAL GENERAL LIABILITY f y 100 ,000 A CLAIMS -MADE a OCCUR � P4798139 2/31/2011 . /31/2012 MED EXP An 15 000. PERSONAL 8 ADV INJURY 3 11000,000 GENERAL AGGREGATE 3 2 000,006 N -L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG 3 2 000; 000 POLICY P 5XI LO MBINED SINGLE L1MR AUTo!(OBILE uAswry dart,li000roall BODILY INJURY Per parson) 11 B X ANY AUTO -ALLOYWNEO-SCHEDULED ' 222572 2/31/2011.12/31/2012 BODILYINJURY(per eaidem) S AUTOS NON-0VIMED X :HIRED AUTOS X.. AUTOS ROPERTY. - GE 8 S. X UMBRELLA ILIAD X, OCCUR EACH OCCURRENCE S 3,000,000 AGGREGATE 1,000,000 EI EXCESS W►9 LA*As-RADE A NIA .2/31/2011 /31/2012 X -.RETENTION I10.,D0CUS223272 YWRKERSCOYPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRtETOR/PARTNERIEXECUTIVEa OFFICERMMEMBER EKCLUDED? (Mandatory in NH) A 8223072 /31/2011 2/31/2012 A X EL EACH ACCIDENT E.L. DISEASE - EA EMPLOYE 3 50a, E.L DISEASE - POLICY LIMB M Yea. �= « 6 llTi DESCRIPTION OF OPERATIONS / LOCATIONS M VEHICLES (Attach ACDRD 101, AddIdonal Remade Schedule, If more space Is reolmd) Various work throughout the policy term. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,. NOTICE WILL BE DELIVERED IN ACCORDANCE MTN THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Harvey/HEP ACORD 25 (2010/06) Tyaa-LV7V A6VKIJ GVKYVKl1IIV17. nn nyals rtilserrau. INS026 (20+005).01 The ACORD name and logo are registered marks of ACORD PRODUCT 51 140,-r"M dr wmwxdd"— ALIGN TYPE DIRECTLY ON TKISUNE WHEN*USING A TYPEWRITER SET TAS STORS'AS SHOWN ON THIS:SMB Fold at to fit 771 DUO-VUEI! Envelbpr .ALL. TEMP HN.A.C. CORP. =.Jr -L-i 9.11 UtWiai R-1,Unit-1 MA R, NH 03''10"9'-52'06 Showlik-Purchass Ofi:Wr Numbw -on all correspoodenop, invdges . . -10 2 0031.61. --S shippjng:paperqand packages - .1 � 997 FAX M03) 4Z,3-7062 ---------- t. P!ease 6&d -copies nl:yourinvoice. 2. Order J§ to be entered in act rdanee wfthpftme delivery Ondtpea'flca6brvs.shown above. 3. Notify us immediatefy-Wyouare..unable torsbip," apecitled. TOT& I- N Proposal if Eastern Vent Systems,Inc. 69 Floyd Rd. Derry, xH 09098 S PH: (609)595-8569 FAL (603)B86-7917 Company Name: 4H Temp V G Attention: Ta e - Date: 9a From: op &4-,. Job Name: N -1- Price Based On Mans and Specs Dated:_ Revisions: Supply/ Install Supply Does Not ITEMS Install Only Only Excludes Apply Remarks Duct Wok Duct Liner Duct Sealer RGD's Louvers Motorized Dampers Flues and/or Beaching Fans Fire Dampers Smoke Dampers Access Doors Seismic Restraints Sound Attenuators Aff if" S t&s ITEMS .i � er 1hlr�fe �ar� Acw Wt+ee,- '914owm Ok! _� Nn S k; ri-S ext q�tul cwt �j �% 1 Air g'r' 1&S / UNG J[�.ICeL S7'�l�itl�S�,To�( es� GalvaK� u� Includes, Exdudes ITEMS Includes Excludes Sales Tax Cutting/Patching Demolition Air Balancing Duct Wrap Overtime or / Coord. Drawings Night Work f/ Prev. Wage Permits 'tNtt Performance/Bid Bond 4./ Leak Testing Duct Cleaning Duct I.D. Labeling Smacna Cleanliness Standard (Basic/ Intermediate /Advanced ) We Propose hereby to furnish material and labor completeu? in accordance with he above specifications, forthe.sum of: $_ _dpi 3�r TERMS: 7 y1 All past due accounts will be subject to 2% interest per month, (27% per year). stomer is liable for all collection charges and reasonable attorney fees. Authorized Signatur . A4 F,Date: �It � 2, �� NOTE: Price subject to change a ay be withdrawn by us if not accepted within 15 days. = N CD (D Q 0 W CD O O N rn O u, W O cn N (D O -0 0 0 CL 0 O O 3 O _h 0 =r m, CD -a3 moo' (a f_n O� O O O +1=3 0 U) (n m O -p � h (DCD S (a n O OQ N. 0 NCD [fl Q. 3. cn n W o �- = 5 it < CD < fD O-� �CD (Q s p (D in �0 -u0 0 CD v? =, 3 (c O 3 ca o c 3 v CD o' m n3 N 5 ,{ o m zr -� m ow *-a :3 0 O 0 f,v z= O O �O D":3 Qm O CD O M N < CL v O CD -a :3 _0 � S > N m C v 3 0 0 =r Q° 0 a > 7- onOo (n -m 0 p p W CD CDD r- w _(Q °<o O CD CQ 6- 4 CD CC) ��,o (1) 4CD(1) (D (a oo O O h 0) C (D O O CD hh sS (Dcn W OD W. 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E H Q y Q W r Z.(yam O Q Q Q 0. iG Q fG Z a Cn y "? _ Q n (D I� (Q (Q v Q cn Q s N m Z (D z< yy Q �. OR O zO ` `2 m m 00 g3 vT N O A A QI = H Cm 01 W Z3 F A � 9 C - T N a M �� aok O$ - s-om g ---------------- Gfm t �OmaSow n _ - ... °26"5 3 n - T N m _ - z� C N i y> m �A+rn NO q 2255 ?n�7 T O p a 5z Az - n z e p O .m T _. o �_ o0 - a SSS vMM CS p C F J m to I > m Al Is m P > f z m i im > En z rl, ,> z o rl *0tRiEli o 21.75 00 m x x Iti> % V! z z > p 4� r;R P '10 c: m z.,z > - m A > OD iib zF > z uz m luz Im cc) I h 11 m z .0 00 ORPIE2 1+00 40 40 m )IWM3= ..Rug + KI >* "Mw p M , p M 1 971 2b' z 0 / > 0 Z 'U 0 u M Ll H- I 10-0� PEMIMCILjj �ACX�rISI .A . Ll H- I 10-0� PEMIMCILjj �ACX�rISI Town of North Andover Building Department 1600 Osgood Street Building 20 Suite 2-36 North Andover, MA 01845 February 7, 2012 Alan Seigfried Brightview North /Andover, LLC 218 North Charles Street, Suite 220 Baltimore, MD . RE: 1275 Turnpike Road North Andover, MA Alan: Your permit application, dated December 22, 2011, to erect a 133 unit Retirement Facility at the above referenced address shall be approved and issued with the following conditions: 1) The receipt of Building Permit fees in the amount of $ 220,200.00. 2) The receipt of Sprinkler and Fire Alarm design documents, by the North Andover Fire Department and their subsequent approval. 3) The receipt of approval from the North Andover Board of Health. 4) The receipt of Water and Sewer fees by the North Andover Water and Sewer Department of approximately $ 400,000.00 and their subsequent sign off. 5) Signoff of Planning Board conditions. 6) Signoff of Conservation Board conditions. 7) If fire alarm and sprinkler drawings have not yet been completed or reviewed, the Building Official will issue a permit for footings and foundations only. If you need any further information please contact me. Gerald Brown North Andover Inspector of Buildings CC: Pro Con, Inc.; PCIA a Location A; if No. '�-' 0 4 - 0 3 Date N0RT" 1TOWN OF NORTH ANDOVER O:t.•o ;•tiC • L A Certificate of Occupancy $ s'CMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee�L ,,,, $ TOTAL �J $ Ole Check # rr 20522_ 'Building Inspector f Y *** TO Oo lilt ^ _a • LI y a C *** TO Oo lilt ^ _a • LI �1 i' d tTf d 4• a CD oc c c O a. 0 SKI' V CD w t 4 wcr v o w Z "Y w_ r -y Cy n SCD O V] O O o�� e CD UQ �C,wC �• CD j y -a . O CD in. (D � C L7 aCD co CA w 0 ^{ i CDaq uoCL O • �• n w c r' CD CD CD CD FG _' CD O p m Q O COOQ o Vi � O N CSD CD ^ 0 w n °r �' a .- w (or, �. 0 y: •O CD a a 0 0 cD aQ�v 0MPO> �o g(M CD c CL H C 0 ON6 a cr 1 -wo u N CD O b 0 0 CD CLO CD CD w X Z o CD CCD i. O hi ve N zsN C7 0 a 0 CL W CD aQ�v 0MPO> �o g(M CD c CL H C 0 ON6 a cr 1 -wo u N CD O b 0 0 CD CLO CD CD w X Z o CD CCD i. O hi ve N zsN C7 I Prom: Kevin Al: Michals Insurance FaxID: 617-924-7420 To: Hazel Hopkins Date: 10!20.116 U1:41H'M Hage: t 01 z U, ACORD CERTIFICATE OF LIABILITY INSURANCE cPID, ADSA27-. D�.TE(MMIDDY(YY) 10/20/106 PRODUCER Susan A Michals Insurance Agency, Inc. 19 14ain Street THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LTR NSR 'l'PE OF INSURANCE POLICY NUMBER Watertown MA 02472 Phene:617-924-1100 rax:617-926-2162 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER P.: Arbella Mutual Insurance co, 17000 INSURER R _ 300000 Advanced Signing LLC 4 Industrial Park Road— Medway MA 02053 NSuRERc — INSURER N IJRER E: rrnrroeccc . THE P)LIGES OF INSLIRANICF L ISTFI 9FL, )VV HA','E BEFN ISSUED TO THE NSURE' NAMED A30VE =0R THE POLICY P=RIOT) INDIC.ATFD NOT,0TI-.- IDIN6 PN'eRE[],:IREMEN[, TERM CR cONCITION U= MIY (_ NrRA,1 OR 0 -HEP DOCUMENT VvfiH RESPECT TO WHICH THIS CEP,TIFICAfE f4A.,i BE :SU=G Cr: VA':. PERTAIN -HE 17SUPSNCE P.FFURDED D'i' TME POLICiES DESCRIBEC HEREIN I' SLIBJE C- TO ALL THE TERMS EXCL!u ONS AhD COf•IL'I-IONS JF c ,CH POLICIES. A33REGATE LIMITS SHONM NdAY HAVE SEEN RCCUCED BY PAID'CLAIM8. LTR NSR 'l'PE OF INSURANCE POLICY NUMBER DATE (&9hYDD1YY) DATE (MMIDD.nY) LIMITS V2000000 DATE THEREOF, THE ISSUING INSURER W!LL ENDEAVOR T: MAIL LO - DAYS VVR!TTEN GENERAL LIABILITY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL =P.Ct GCCLRR'_N<r 300000 A X=C'�dA+=RCIA_GcMER LLiPEILIT� 8500032124 10/15/06 10/15/07 _FEidI E&;Ea_cc:ra.cr 4UTHC IZED R SENTATIVE _o4 41 ZZ n rnoor�onTtr:w tio>zu :LAItI:,MAIE t?EGE>"r'(F-. :mq G`;c'r" 1y10000 - --' IEF63N L a a^,: I_+ -,1000000 i 3Er�F.F:a.L 06000000 I GEN" AG;.REOP.T_LIR!ITAi'FLIBSFEF: ��FC CTS_ ?"AF.'9=. '?i --�-------- i � �!C.Y i JEf'T i iAUTOMOBILE I A I LIABILITY AN,'Au-o 78999400002 10/15/06 10/15/U7 E�""'`'` _ ---- - 1 , 000 , 0 00 - .ALL ON -VIED rA_', 05 j 4'4.;! IF: S �:{ 13CHEUULEDP.UrOS :Harr:.:m; I.Paraic:dsnl X I NO r0'NIvEC AL?JS ---------'- I FCPF.RTY D°AIAC , ^s•:i•ici±..__�-a OARAGELIABU T1'T �- ! r --- ----- I— AIJ'r xi -o ;jTHEP Tr:LPI =LT•� Cit -- I EXCESSIUMBRELLALIABILm' nR7 ::'rCLRac!JCE S 5000000 --- A j cccuR :: AIVSMPbE 10/15/06 10/15/07 I � I F1 DEDUCTIBLE �4600032125 _ } RE-EI•.TONi X10000 I T -- v:. 7T71,---777! WORKERS COMPENSATION AJ,ID I'�F` V -.r _,..._, .-..._.._._._.._..--.._.. EMPLOYERS' LIABILITY A I A10 PROF'FIrI �2�F{ARTf4ERJEXFCIrC!'vE ( 0048881006 I 10/15/06 r_ .� L{� . 1000000 1G/15/U" �" -''' ''" r---- `-__-- -- - -- OFF 'CEP!MEMRcP.E3:CL! C%ED? i - "'•E�' : AE^_CJYE S 1000000 If ve _• dmrite urdm L L CEn E. F, A =T c, SPECIAL PROVTFIUNS lelov _` OTHER I i I — — DESCRIPTION OF OPER.ATIONa J LOCATIONS !'VEHICLES! EXCLUSIONS ADDED BY ENDORSERiFfT J SPECIAL PROVISIONS Re: Operations Performed by the named insured GERTIFIGATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA110ELLED BEFORE THE EXPIRATION HAARO O 1 DATE THEREOF, THE ISSUING INSURER W!LL ENDEAVOR T: MAIL LO - DAYS VVR!TTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL _ IMPOSE NO OBLIGATION OR LIAIILrrr OF AN'! K;Nb UPON THE Y iS'JRER, ITS AGFNTS OR REPRESENTATIVES, 4UTHC IZED R SENTATIVE _o4 41 ZZ n rnoor�onTtr:w tio>zu ACORG 25 (2001i08) • °r Location -r No. Date'' HORTPf TOWN OF NORTH ANDOVER p Certificate of Occupancy • Building/Frame Permit Fee $ y� s� MUS <'< Foundation Permit Fee $ �E rmlt Fee ' `' �� $ ,ewer C�ii dee $ Watt #o tion Fee $ NO. 4/718TAL ver C0,160tr Building Inspector Div. 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Z A m T T Z D T m;0A3 �ZD�� F) --i (ZjQO��j GAN / C3 �'N i`i D y� C N3 _ y 30m30DvDi Z� 2 D ^� IrI z7c m C A << D m O A "' Z m 0 (1 N r T y K r' '< A " ? O �c K z _ n i 0 LL I LLL I LL1 ISI D n NOppQ n ,l0 OAZZ mT ZpDDZ 0 C ON TO ,D D n ?�o S �2m z mm. pvD� Nom Z`m� n. Z A N AZO �ZD�� F) --i DAO 2 ., p �'N i`i _ y N D D m ,0 2 LI IrI O A Z D _LL O z i W to 7' EA 2: Lu ul MR H H E ba 0. 00 C iv H •�AA CL 0 V •C a m 1 f cc 0 =ac 0 � r � V oc W W H d d Z O W H W Z Z Lu Z Z V Z _ m m L C E J L :3 J L V u+ '� L � m Y o c 3 Q U ii a: U. U. Q co ii ¢ U. m 2: Lu ul MR H H E ba 0. 00 C iv H •�AA CL 0 V •C a m % r ! ' Location/,4'2-5 / tJi4 /��% ! S l / No. 5 5 —.S Date 9 Z- i TOWN OF NC*H ANDOVER Certificat% Occuu panc�/G�$ Building/Fr�ne PeK* Fee Foundation4—nit F4, $"9A Other Permit FAIR,.��� $ Sewer Connection $ Water Connection F;190� $ TOTAL j z 'illi /. Building Inspector Div. 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Materials: YCA;igSTi)CoAM. 7. How attached: (a) Against the wall aF 8V'1-b�AJr4 (b) Roof ( ) (c) Ground ( ) (d) Other ( ) 8. Illumination: (a) Not illuminated ( ) (b) Internally illuminated (wr (c) Illuminated from separate service ( ) 9. Proposed Colors: Background �iVtf9T�' Lettering C3pEEV Border. w0a0 10. Will sign overhang any public road or walkway: Yes ( ) No (vY 11. If Yes, Name of Agency who will provide liability insurance: 12. Attachments: 13. -;Photographs of building Material sample Color samples Site or Plot Plan .(Required for all free-standing signs) *Drawings of proposed sign Other, specify Is Board of Appeals decision required? Signatu e of.Applicant Yes ( ) No ( ) 0 00 0 1988 94e OUJZ4� . 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