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Miscellaneous - 13 HARWOOD STREET 4/30/2018
13 HARWOOD STREET 210/006.0-0030-0000.0 I tsu APIC I i I v I i Liberty Mutual. Liberty Mutual Insurance Liberty New England Region Central Property Unit INSURANCE 75 Sylvan Street Danvers,M(1 01923 Tel: (800)566-0323 January 24,2014 Town of North Andover Attn:Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address: 13 Harwood St,North Andover,Ma 01845 Policy Number: H3S21814837340 Underwriting Company: LM General Insurance Company Claim Number: 028812138-0001 Date of Loss: 1/4/2014 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, � 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien Pursuant to Mass. General Laws, Ch. 139, � 3A & B, or Mass. General Laws, Ch. 143, § 9, or Mass. General Laws,Ch. 111, § 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 i 1 Date...�'.7..!�... ,aORT►, °�,�`'°;•'"° TOWN OF NORTH ANDOVER 3: �,� ... ._• of p PERMIT FOR WIRING "SACHUSEt This certifies that x-. ............. has permission to perform .......... ........:....................................................... wiring in the building of`' .Uj......................................................... at.... .1.... . ................ .North Andover,Mass. Fee..................... Lic.No.0,1ryF �,.�:;:�................. ..1�..�.�............. tj j " ELECTRICAL INSA Check # � - 5b, E9 THE COMMONWEALTH OF MASSACHUSETTS -Permit No. V�� Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy&'Fee Checked � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordancewith the Massachusetts Electrical Code 527 CMR 1(2;:00 (Please Print in ink or type all information) Date 0(0 -a-1-05' To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform � the electrical J �e work described below. LoWion(Street&Number 15' 416-rL�i C!) .-f n/1 Owner or Tenant 1 f o F l am f JQ Owner's Address /,5, 1jar lrhI cT rAe, Is this permit in conjunctionwitha building permit f Yes No (Check Appropriate Box) Purpose of Building otsid9nh U Utility Authorization No. Existing Service (�)n Amps oils Undgmd No.of Meters New Service Amps Voits Overhead Undgmd • No.of Meters Number of Feeders and Ampacty Location and Nature of Proposed Electrical Work (,V)fe ne1 A bo✓2 Cr )ad Cl o/mm Ina Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA 6i) In No.of Lighting Fbdures Swimmin Pool and Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di al No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices r Municipal • Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW signs Sailases I Winn No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremenOts of Massachusetts General Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantialequivalen(�j� NO = thavesubmitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. IN$ll = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start u)&eK O F -414/QS Inspection Date Resques6ed Rough t Q 1 I I C0_1( Final W f I C Out Signed under the Penalties of perjury, �1 FIRM NAME i-rrYY i C=j � y)rfr(I EUofficcd Coy) GLC�{U✓J InC. LIC.NO. EIM2-A Licensee _I=C f r)orri I I Wgnaturez yi -�lil/1.[ 1 LIC.NO. 1- n ,.0 I,I n Bus.Tel No. q Address I'LI,� fl(,'l. er h i I l i'1(X / NI�Q 5 b"/ "A Aft Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the Insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE b (Signature of Owner or Agent) Date. -2 .a . . . ..... WORTH ,tiO of TOWN OF NORTH ANDOVER Ip • - PERMIT FOR GAS INSTALLATION i gs,SSAC'HUSE,�I(h This certifies that . . . . . . . . . . . . . .,. . . . . . . . . . . . has permission for gas installation �. .� l. . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . at . .47 . .� .�?/�. . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee.? Lic. No..*). . . . . . . . GAS INSPECTOR Check# 55G9 THE COMMONWEALTH OF MASSACHUSETTS Permit No. ' Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy&Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (. All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 1p2:00 ',--,'(Please Print in ink or type all information) Date Q(9 -C -`-05 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform L the electrical work described below. Dation(Street&Number 15 '1 6-rLt)I (-1) (0+ n�1 Owner or Tenant 1 1 l Q F 1 0- ire 1 10 Owner's Address /,5' lj o-'rW i r ) Is this permit in conjunctionwitha building permit ` Yes • No • (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service a n Amps oils `Overtie� Undgmd • No.of Meters New Service Amps Volts Overhead • Undgmd • No.of Meters Number of Feeders and Ampacity Dation and Nature of Proposed Electrical Work )(P Q,Q 1-k-) A bo Ile GIL(-),o( c5WIMMin &Z Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above In Vo.of Lighting Fixtures Swimming Pool gmd Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area H ting KW Detection/Sounding Devices • Municipal • Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW I Signs Bailases I Wring No.Hydro Massage Tuds No.of Motors Total HP OTHER-- INSURANCE THER:INSURANCE COVERAGE. Pursuant to the requirementits of Massachusetts General Laws 1 have a current Liability insurance Policy including Completed Operations Coverage or its substantial aquivale<llF6 NO = hama-sigbmitted valid proof of same to the Ofte YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. IN$lJ = BOND = OTHER = (Please Specify) i:l CL-hl I jno p/o(.a / (Expiration Date) Estimated Value of Electrical Work$ Work to Start wt E'K O( V-MI/OS Inspection Date Resquested Rough I D i 11 CCL I( Final l�lr u C CLU Signed under the Penalties of perjury: FIRM NAME r r.r 1 /Cr( � r, ')Q r f i(I Ut C it i C0.. COY) } - (lC LIC.NO. 1-7 -A Llcensee,FSCL I C� 1 l Mr0(TI ISigaaZweC-! �l_� //1/Lf LIC.-NO. �1 1 Address i'� fl Ol U P r h l j� 1'�(X.tl l / N I�.�s b(.1��/ UL- AftBus.Tel No. q�a �tX�'l �G O- Tel.No. OWNER'S INSURANCE WAVER: I am aware that the Licenses does not have the Insurance coverage or its substantial equivalent as required by Massachusetts general Laws.And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No. PERMIT FEE $ _ (Signature of Owner or Agent) o �i MASSACHUSETTS UNifORivi APPLICATION FOR PERMiT TO DO G,4SFITl`.iN1 (r'rinl or Tyipe.} Mass., Date ,: T Perm#! # Cj '• Building Lgcatiori ©�� S Own�r'sName f� LA S�L U �. TYpe of Occupancy New [. '�; flenovallon [p Rep(acetsien# 0 Plans:Submitted: Yes p : tJo ❑ N LL' ' _ in x s vi C6 cc yr cc o °C in .020 d r o N is Lr 4 W t = FW ta ' rei UUWj UJ _ O. d u > cc m <a .z. a :=c o o W a o r� sue—asMT�. 13 As 1ST FLP- 0 Q 0Q 9 RUMFLOOR 5TH FLOOR a T H FLOOR 7 Tfl F.000rt '.'8T}i FaOOR - Instaliing Company'Name`; 1 L/�- t1 Check ane: Ceri(ilcale Addre �arporallon. L -/�- ❑ Partnership ruthless Telephone �a �, �} 0 Fir %Co. ' Name.01 Licensed:.-lumber or Gas INSURANCE COVERAGE 1 have a, current Ilalllity insurance policy or its substantial'equivalent which meets the_requirements'of MGL Ch: 142. Yes �"'_. ` No ❑.;._:. - .r it ou have.checked Y, .::please-lndfcate the type cover4ge'by checking the,approprlate box. A liability insurance-policy C- - Olhef type of"inderrinliy Bond O OWNERS NSUAANCE'YVA1VE:fi: I am.aware that the licensee does not have the insurance.coverage required by ' Chaplet 142.0! !he_Mass.<:General Laws: and:that rrij+signature on this permit spp(#cation walves this regtlremen#. Check one, OWnero Agent Or Signature of Ov!inet or Owner's Agent. I hereby cerifty that alto![he detarfs aFld Iniotrrralron!have submitted for enteredt in above appticaibn are lrue:'snti aceurate to the bes of my knowiedge and that sli;mpfumbing work and instal�ations:_pedormed under the ppermit Issued for this application will be In<compllance with all pertlneist provisions ol.the Massachusetts State.`Gas Co- e.and.Chapter 1d2 of the Gene,ai'Law3: T e of Ucense: Title Plumber Sig ,tu e o c nse Plumber or.Gas itler asGttar asterUcense Number,, City/Town Journeyman - uIn wro. o e o - T Date. . . f...... . NORTH o p TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION ,SSACMUSES This certifies that . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . .All /. . . . . . . . . . . . . . . in the buildings of . . .S!. .>. . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . .. North Andover, Mass. Fee. .3v'. Lic. No.. .I.:. {t! GAS INSPECTOR Check# ? (f G 3 55 ,19 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) f�rJ�/� Mass. date ,L. Permit # Building Location f�ttJyoi) 'J , Owner's Name_ Type of Occupancy New Renovation p Replacement ❑ Plans:Submftted: Yes[ No p W N � CC N N tr N n O fA 7a1 W cc. t] U in t--.- t!f n J _tai :;.. c9 F .c r- z �' .o r re z O La =4 c C � (d �• O w tt tut 4 t. to4 N st. W Z tJ O p > W CC W U w J C } t y O LL t- W .i W s y cr m z. < m z o x n o to r x _ •s o u u .a c� ry v > c a ] o SU8--8SMT. BASEMENT ISTFLOoR 2Nt)-FLOOR 3RD FLOOR 47tt FLOOR 5Tit FLOOR r 6TH FLOOR T.TH FLooA B�`H=FLOOR.. Inst ailing Company:Na/m�e �J�L�,� v � Check one: Certlflcate # Addressorporalion ❑ Partnership Business 'telephone�� p FIr /Co. Name,o# Licensed Plumber'or Gas: Fitter J04 C--z INSURANCE COVERAGE: t have a curret .l} biltty insurance.policy or its substantial equivalent which meets the requirements of MGI.Ch, 142. Yes 0 No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance.policy Other type of lndemntty❑:r Bond O L. OWNER'S INSURANCE WAIVER: i am aware that the iict:nset;does not have the Insurancecoverage required by Chapter 342 of the Mass. General.Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ 5,gnalure.of Owner or Owners Agent hereby certify that all of the details and Information I have submitted(or entered)in above application are true and acxurate to the best of my knowledge and,{hat all plumbing work and Installations perlormed under lite permit Issued for this application wail be in compliance with all pertinent provisions of the MaSsachuSeltS State°Gas Code and Chapter 142 of the Gane a1 taws. . pa of UCehSe`' Title Plumber Sr !u e o c. nse urber or Gas titer a;fii(ar -,//4/Z),�f aster License Number �„_`'/`� City/Tow70E--M�- � Journeyman APf'fKr/f I'EIZMIT NO. o2a APPLICATION FOR PERMIT TO BUILD*****/* NORTII ANDOVER, MA NI\I'NO. ( IAT NO. q-7-_ Q, 2. RECORD OF O\\•NERSIIII' PATE BOOK MAGE ZONE: SUB DIV. LOT NO. v \ 1(WAT'ION �/ I de uo L-� T— PURPOSE:OF UUR.U1:Nc ��P�/� ���C.?Gt i.'106N"T CN%MAAf�,: Q. OWNEWS NAME: LL/C-7 /J,-/+ NO.OF STORIES SIZE e-�v���U t��! s i _O\\NFR'SADDRESS 1_ 57- / BASENIENTORSLAII e;1 6 utc'urrE'("r's NAn1E: e � gZ a�5ih X1213 SIZE OF FLOOR TIMBERS 1 r 2ND Sen III111.1)FIt'S NANIE: EU� Dk Clui SPAN �a DIS VANCE'1'0NEARFSTBIIII.DING K�LA, DIMENSIONSOFSILTS DIS T\N('E:FRONI STREET 9_it. � DIMENSIONS OF POSTS 911 i �p I11S I'.\N('I:FRONI I.01'LINES-SIDFS t44 REAR N n DIMENSIONS OF GIRDERS fS A \ItI:A OF LOT �C C� 4 FRONTAGE �I IIEIGIITOF FOUNDATION 4��)t THICKNESS is BUILDING NE\\' SIZE OF FOOTING x IS1111ILDINGADDIFION MATERIAL OFCIIININEY IS III 1111)ING AI.TERA'I ION IS BUILDING ON 501.11)OR FILLED LAND LA \\'11 1.111;ILDING CONFORNI TO REQIIIREMENTS OF CODE "Y IS BUILDING CONNECTED TO TOWN WATER 1 \(G- ` l\ 110%HD oI .11'I'EAI.S ACTION, IF ANN' t 7 IS BUILDING CONNE:CT'ED TO TOWN SEWER fGe2 IS BUILDING CONNECTED TO NATURAL GAS LINE 'YES INS'I I1c'r1ONS 3. PROPEAVIA'INFORNIA-ZION LAND COST L EST. III.DG.COST VVA: I FII.I.01;FSECTIONS 1-3 I`�C `� ES"r.B1.nG.COS'rPEItSQ. ET. NLA EST. BLUG.Corr 1'E:R ROOM t A 1'I 1'.c"TRIC�IE'I'hltS NIUS'1'1)I?ON OU'T'SIDE OG BUILDING SEPTIC PERMIT NO. N A E \I EUTII'I:GARAGES NIUSTCONFORNI TO ST'AT'E:1:I111:RFGIILAT'IONS 4. :1P1'RON'1':D IiY: e� I'L.ANS NIUS"r III:I II.FD:\ND A'1'ROYEII BY BIIII.DING INSPECTOR BUILDING INSPFC-FOR DAII:FILED OWNERS TELH CONTR.TEI.# S� I1'I(E: (11' O\1'NER Olt:\11"ITIOItIZE:D AGENT /j ( Aze -1 CONTRAAC# IJA I'1.1. b 1 ILLC.# 7� I'llt,\III GI(\N I'LD / Rcl iscll 5/5/99 .IPI -- ------ --- - ----- — FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ***************APPLIC;NT FELLS OUT THIS SECTION"y, ` *S57 8i6s- wo2K APPLICANT ELv l NO nP s(Lu r—I RA PHONE ' I8 &T6 6-724 LOCATION: Assessor's Map Number PARCELS SUBDIVISION Ks* LOT (S) STREET (41+12 wyU1 'ST ST. NUMBER 13 USE O N LY ,* ,t k*****,�,***•,.***t k, ** **** j-,,e(F I A c,e A_ RECOMMENDATIONS OF TOWN AGENTS: Iz�pI�C>° voo /— CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS i TOW NNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED 4" DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm J J J Dater ........ .. ...... .. N RTM TOWN OF NORTH ANDOVER o= ° . op PERMIT FOR GAS INSTALLATION 5 SACHUSEtt This certifies that . . . . .:: . .::4. :... . . . . . . .`. . . . .r: . . . . . . . . . . . . has permission for gas installation .-: . . := �''?. . . . . . . . . . . . . . . . in the buildings of . . . .* ... . . . . . . . `. . . . . . . . . . . . . . . . . . . at Z. . . ..... . . . . . . . . . :. . . . . . . . . . . . . . North Andover, Mass. /(_� Fee! . . . . . . Lic. No..-:!:-./l. . . r. . ... .,. :. . . ,..'. . . . . . . . GAS INSPECTOR /� WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MAP t S W PARCEL � d MASSACHUSETTS UNIFORM APPLICATON 777Date DO GAS FPIT NG (Type or print) ► NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# Amount$ / Owner's Name � t�In� � New® Renovation ❑ Replacement ❑ Plans Submitted Uw fx r� CG fx � x O U z� z z �a w O c c a C G zw w v w a w �" o x > w d x p> w w n w SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH . FLOOR 6TH . FLOOR 7T 11 . FLOOR ST1$,. FLOOR (Priv,or type) 1-1 one: Certificate Installing Company Name_ � / � 'l///' "2 Corp. Address /? �� ❑ Partner. Business Telephone 7�/ — -� 3�7y ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter 11X2 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [2 No❑ If you have checked M,please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations ormed under Pe"sued sued for this application will be in compliance with all pertinent provisions ofthe Massachus Gas a and C r 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber C� f Cityaown ❑ Gas Fitter Lieens-e Nurn er ❑ Master APPROVED(OFFICE USE ONLY) �' Journeyman Daterr- Ir j . . . . . . . . . N° NpRTp TOWN OF NORTH ANDOVER 3: '4` 0 PERMIT FOR PLUMBING ,SSAC144 This certifies that . . . . '.` . . . . . ... . . . . . . . . . . . . . . . . . . . . . has permission to perform . . : .. . . ... . ...'. . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of .-. . . . :. . . . . ..� . North Andover, Mass. Fee .... . r. r.Lic. No-���C:. . . / ��-�'. . .!. . . . . . . . . . . . . . . /^ / PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer .MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS //__ ) �, � ,Date Building Location /3 /XlO�P/2.C1X� Owners Name/ ///t o A l UCp/A Permit#� Amount �� Type of Occupancy New Renovation Replacement 1:1 Plans Submitted Yes No FIXTURES a w ww d W ax CC CnCna Frn CnH Gn G A sup3m BASMI YT M E OCR 1 1 ZOFLOOR s 3MFLOCIR 4M1LaR 6MBLM 7MROM 91HFLOCR (Print or type) Check one: Certificate Installing Company Name,-/-,a,//.S Corp. Address y�iP� �l/a'd li4/J �!/C's Partner. Business Telephone��j—9.� � �'��� Firm/Co. Name of Licensed Plumber Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box Liability insurance policy E3 Other type of indemnity Bond ❑ Insurance Waiver I,the undersigned,have been made aware that the licensee of this application does not.have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass setts SPhimb' a and Chapter 142 of the General Laws. By: Signature of Licenseaum er Type of Plumbing License Title City/Town License Nuuiocr Master Journeyman APPROVED(OFFICE USE ONLY /�, � No 2 t. 1 Date................. ............ pORTM TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMU`'� This certifies that ................................ , •.0 has permission to perfo m 0, `:.......................................................... r 'wiring in the building of...:................... ....................:............................... . /r' o " at-2..:..........................................`.......:.................. .North Andover,Mass. Fee.....:............... Lic.No. ............. ....:........................................................... ELECTRICAL INSPECTOR Check # � L WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 771ECOMWARE4L (FAIASYAC HU,S'E77S Office Use only 1?F.F19VTOFPlJI3IlCSAFE7Y Permit No. BOARD TTONS 5270M 12-00 Occupancy&Fees Checked i APPLICATTONFORPERAIET TOPERFORMELE=(R 'AL 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 Wires: The undersigned applies for a permit to perform the electrical work described below. WAP PARCEL Location(Street&Number) 4�1,/DO Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes E: No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /r •r/ �� tiL--� No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground and No.of Receptacle Outlets No.of Oil Bum ers No.of Emergency Lighting Battery Units No.of switch Outlets No.of Gas Burners 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.c¢'Dtyers Heating Devices KW Local a Municipal Other Connections No.if Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER- htstarmoeCo�Rasl�tottletac}manaisoflvla�aseltsGala-allaws IbaNeaQmu1liabtlityhtstu=PbigyirU1JTgYES Er NO Iha%est>brrl»dvihdprocfdfsametotheOfce YES l.JNO a Yyottharedged®dYES,pkaso metre peofowaaEpbydrekirgthe >rr cE �Bor>o Q ORER Q ?=mSpady) EstirnAdVahiedfllxbcal Wbrk$ Walktosurt hpxtimDMRegtlestcd Rough Final SigpedtmdmTiepamkl sof F[RMNAME Limme Sigr'ahae Lidet�eNo ��/�oTs C' BtstrxssTeLN,b fdg-3�0-5�3d 9 Atkirss lr D t� /g/ Alt Tel Na OWNER'SINSTJRANCEWANI~R;IamawatethattheLiotmsedoesmt lheirn�aatreotn�rgecrilsstlb�at>balegt>ivalartasrec}medtryM�dnseitsGrY�aalLaws andd�mysigc>aht>remthispc��applira>ialwai�es dnsr�.rital�art. (Please check one) Owner r7 Agent l Telephone No. PERMIT FEE$ Signature of Uwner or Agent Town of North AndoverNORTN OFFICE OF o'`•�•� °'�°oma COMMUNITY DEVELOPMENT AND SERVICES ° 27 Charles Street North Andover, Massachusetts 01845 sACNug�t<y WILLIAM J. SCOTT Director (978)688-9531 Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION ouccv �' Number Street Address Section of Town „HOMEOWNER 6 -bbl'6 - x-1'24 9 I --:99 -81&! Number Home Phone Work Phone PRESENT MAILING ADDRESS 3 RA'P—U!C0 Q 51 N o2 i A kDajaz NI A - City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one to six family dwelling,attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner'shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner'assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner'certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE �� Z/4� APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. BOARD OF APPEALS 688-9541 BLTILDrNG 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANT NTNG 688-953= Town of North Andover ct wOPT., ' OFFICE OF _ ° o L COMMUNITY DEVELOPMENT AND SERVICES ° 27 Charles Street i North .Andover, Massachusetts 1840 ;5 �c • '' �`' �Et WT—LIAM J. SCOTT ACHU- Director (978) 688-9531 Fax (97S) 68S-95112 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: NA[� ,tiR4W► J)t�PSL- Co 4-t7e PAVAZ- I PIA- i"1 36i (Location of Facility) Signature of Permit Applicant /099 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project throucb the Office of the Building Inspector BOrIRD OF APPL,kLS 6SS-9541 BT.7=TNG 6SS-95.15 CONSERV ATION 688-9530 HEALTH 638-95.10 PLANNING 6SS-9535 Phe Commonwealth of.,vassacnuserts Department of Industrial.�c�idents 9MC,*ol/ayev(921loos ' 600 Washington Street Boston, Mass. 0'111 Workers' Compensation Insurance Affidavit �9 •rtnt ry I&I am a homeowner^er Jr:fir.? all wori` .;.yseif. I a soie procrie:or ants nave no one woricin, in any caeaciry I an, an ernoiover prcviding workers' compensation for my emcloveLs wor::ng cr. this ioo. cornDanv ,5 T2• ad dr--- C'rv` in-nrnnr. rp nniic. s I am a sole precriemr, utmerai cont.actor, or homeowner(circle one) anti :ave !fired the conc- oriisred beiow wQo t.ve the following workers' ccmpersacion polices: rontnznv Rsm.., �)lA addr--�- Cit—, nh ,nr d in=ranr nnlic�� CoMn3nv addr- C•.v- nhnn inrnr-nr ro _�.• Mad r:atlure to secure coverage as rcau:rcc unuer Secnon -5A ul NIGL 155 can lead to the tmoostnon of criminal penalnc of a fine up to 51400.0 and/or one yean' imprisonment as well a.c;v;l nenalties in the form of a STOP WORK ORDER and a Fine of 51100.00 a day against me- I undersand:bat a copy of this statement may be for.•arocd to the Office of lnvcSUg3tlLn7 of the DIA for coverage vcnficanon. I do hereby cern✓: under,he petrrs and pe.aatlies of perjury that the iniormarion provided above s:r-ae and corre aI_ J1 o'nt;aZe �yll,)V UA SiL�l�-I(ZA ay ESh -6••724 one -Mc!al use only do not wr;tc in tots area to be comole:cd by c:tv or town ulTicial LcIrYor permiUliccnse 4 —Building Department — Licensing Board mmediate response:s r,:;u;r1 ^Seiecrmen's OfTicc^Health Department on: phone x: —Other ;rrnsm;.95?!Ai F NORT1y Town of 0 dover o� , q�rE dower, Mass., roe go ORATED P`?9'\V C) S 56 BOARD OF HEALTH PERMIT T Food/Kitchen Septic System /IV'/6 v / BUILDING INSPECTOR THIS CERTIFIES THAT........ D..�........... .�..f.. .. ......�./4......... ............... ............. Foundation / 3.. ........•o w n S� has permission to erect.......... . r......... buildings on ........... Rough .N� r� •1 S�� �r �I �� �p�� ��004 Chimney to be occupied as....'C provided that the person accepting this permit shall in everyrespect 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 3, UNLESS CONSTRUC N XT ELECTRICAL INSPECTOR Rough O&O ..... ......... ........... ................ Service DING INSPECTOR Final Occupancy Permit .Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location 13 11,4 ewc)o d s�— No. Q Date �, /3 w MOAT" TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ _ ` Building/Frame Permit Fee $ C.2�� q i , ITs" ° tFoundation Permit Fee $ wcNust Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ a Building Inspector ! J ;064199 11:30 25.00 PAID Div. Public Works ORTtj Town o �� �: Andover No. 3AIIA1W o ndover, Mass., T O C lCKE , COC NICHE WICK y"� /y/��J/� DRATED PPtt ClJ �f J44 7 4`` L SACHUS - IT FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT .�!�'..^.U1' 0.. . d.....J J. . ....................................................................... M. 6/. has permission to excavate and pour foundation at . ^ 0 ...45 ........A.&....�..9 7- purpose 1.... xly... . �K.l�� y.. a. ).���....A5 � ....f`1�'�-......... , 9 for the ur ose of... . �. � � The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. F99, S jga'r FA W I L y 0%,46 VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. IL.......................c BUILDING INSPECTOR Y\1`1 �v— �� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) /des Mass. Date '/ - > 19 q5 City, Town Permit # Building Owner's '� � � � - �r AT: Location 1 � � �` Name 'pli n-0 Type of Occupancy: GNew❑ Renovation❑ Replacement❑ FIXTURES Plans Submitted Yes El No F1 co (n W vi W to U C W CC Lu Cr o [ O W Cr OW I— v m 2 = U) Z O W Q (rM Z D O Z W C0 U H W W O O 0- O W ~ M W Q 2 z _ W O oC > WW W Cn W Z_ Q = , W ~ W _Z J H Z � W O > W F- W J W Z Q W — Q � — } Z O Z 2 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Installing Company Name v2�— �, �t� _Ln)C� _ Check One: Certificate Address ❑ Corp. ❑ Partnership ❑ Firm/Company Business Telephone Name of Licensed Plumber or Gasfitter I hereby certify that all of the detail and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent NOV 20 I R_a current liabilityInsuranc oli to 'nclude completed operations coverage. ❑ ❑ Aaster ❑Journeyman ❑Gasfitter Signature of Licen d Plumb4r or Gasfitter License Number BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME do TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR 1985 Date.l�,e%?!,f 9.� :....... h i ef,No pT;1ti TOWN OF NORTH ANDOVER o p PERMIT FOR GAS INSTALLATION ,SSACMUSES This certifies that .f . // . . . . . . . . . . I �.R.a�1°?�o. . .Q.�. l . .1./t f has permission for gas installation . ./`?f . . �. . .!-L !?'. . . . . . . . . . in the buildings of . DA. .: 'i �, u c-r(?p• • , • j •� 1 at . . . . . . , Nj r: ) Andover, MasU Fee. /i!U . . . Lic. No./G�a/. . . . `�,,,r..r�Q .�—. . . . . 1 GAS INSPECTOR WHITE:Applicant CANARY: Buildinq Dept. PINK:Treasurer GOLD: File Location 13 I-lar W 0o`'/ S No. .3 o Date 3 h MaRTM TOWN OF NORTH ANDOVER o� Certificate of Occupancy $ # ; ; Building/Frame Permit Fee $ �'�b''•°''<� Foundation Permit Fee $ Ss�cMust Other Permit Fee $ ._ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �' Building Inspector 08/04/99 11:58 487.00 PAID Div. Public Works PFRMIT'6NO, t,370�, APPLICATION FOR PERMIT TO BUILD********NORTII ANDOVER, MA f nl U'NO. LOT NO. ` �? 2. RECORD OF OWNERSIIIP DATE BOOK PAGE /()NE SDR DIV. LOT'NO. 6 - 2 _3� 27 f l u :\1TUN 1f� c clowT PDItPosE of Run.o►:Nc C �l�nl F � CN?IZF3iy� �'Q'r>�•- OWNEWS NAME ELI/lfl CJ 5/LL�� NO.OF STORIES SIZ.E241_�X,�,�.} 01%NlAt'S:IDDRISS — f, / �.- II.ASEAIENTORSLAII Mfr �� /� �G/ �E f`�>✓/ y��`\ Altl'111'1F.CT'SNAME C11kR k-5 4�L04REW AA-"IZZ V SIZE OF FLOOR TIMBERS 1SFG�y,L2ND J3RD WA 111111.1)EWS NA'M F. 6UiL �A !71LxJ0� SPAN ��%tl 1115IANCE1()NI:.\ItI:S'I11111 .l)IM.' F3C3jt 1)IMt:NS1ONSOFSILLS 12_2)go %aK/y DEC AJ zolv7°l6.yPa� 1,1,1-\NCL IIMnISIItFE1 30'211 1)In1ENS IONS OFPOSI'S edky AIV DISI\NUL FROM LOT LINES-SIDES ` 1 REAR j;�a* DIMENSIONS OF GIRDERS Q 11t1'1l)FLOT (0)CC47 5FRONTAGE JW( IIEIGll'1'OFFOUNDATION Inti �rG THICKNESS �cl Is BUILDING NEW No SIZE OFFOOTING Ix/�" X IS III IILDI.NGADDIFION VD MATERIAL OFCIIIAINEY �IQ IS 11UILDING ALTERATION 'YEZ7 IS RIIILDING ON SOLID OR FILLED LAND %%11 I.111;ILDING CONFORM'FO REQUIREMENTS OF CODE D IS DOWDING CONNECTED TO TOWN WATER IM 11iD OFAPPEALS 5 ACTION, IF ANV IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTEDTO NATURAL GAS LINE �ES INN'1'l1("1 IONS 3. I'll 0PFR'F1' INFORAI.A11ON LAND COST _- -- EST. BLDG.COST 17 cw• ,' ow a9,t/. :20m t--� 3&Q�C���iJti1 f P\GI: I I'll 1.OU F SECTIONS 1-3 EST.RI.DG.COST'PER SQ. FT. EST. BLDG.COST PG:R ROOM CDI�1i�; t��4W C: ° Wqa-)-DqTD IyIS qAj?-J,- I'l I'CTRIC\I FT'FItS Al1IST IIE ON OUTSIDE OF IIIIILDINC. SEPTIC PERMIT NO. #31A \'I I W111D G.%RAGFS MUST CONFORM TO STAT:FIRE REGULATIONS •I. APPROVED BY I'1.\NS nIUST III:1 11 FD AND APPROVED R1'111111DING INSPECTOR BUILDING INSPECTOR W%I I:FI LE I) OWNERS TEI.# SIGN.\T'I RF. OF-OWN Ell Olt AUTHORIZEDCONTFt.1.IC#AGENT �fC .. �.� I'I It\IFfGIt\\TLD J:-3 19 1? 7/y v , Rcvisrll SSS/99 .Illl - — ---- - --- - --- -- --- 4 . FORM U - LOT RELEASE EORt'il!, INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****APPLICANT FILLS OUT THIS SECTION**************"*****"* APPLICANT E1-V1Q0 hA SILUi✓1QA PHONE X18 &T'6,,-6724 LOCATION: Assessor's Map Number lD PARCEL 30 SUBDIVISION KAh, LOT (S) --I STREET (4/}2woo1 ST ST. NUMBER 13 ********* ****** *************** *OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: C NSERVATION ADMINISTRATOR DATE APPROVED ZB �/ J v DATE REJECTED [V COMMENTS y '�L�^"' TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm Town of North Andover „ORT" OFFICE OF of " ° 0- COMMUNITY DEVELOPMENT AND SERVICES A 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT SAC HUSE Director (978) 688-9531 Fax (978) 688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) �, Signature of Permit Applicant /.4v 9 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the-Building Inspector 0 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 68S-9535 , The Commonwealth of,,Vassacnuserts ,( Department of Industrial. aents Mi—ii — OlTica vl/QyesUgaUvns 600 Washin;ton Street K� Boston Mass. 02111 Workers' Compensation Insurance Affidavit _ r'v nth nes__ C�UIr'.T� L* %lL\lq RA hone- I L-n a homeowner pe. crmtng all work rnyself. r I a:-n a seie proorie:or and have no one workinc in anv capacity I am an employer p�r)oviding workers' compensation for my emplovees working or, this job. comnary n.:Te: address- nhnne =- n.urance rn noii v I aW a sole proorie:or, oener-al contractor, or homeowner(c.rcte one) and nave hired uie cont^c:om listed below wbo bave L`le following workers(' compe^sation polices: ma nme com - , • qA addre cit-: rah*n r d- i a=ri n s—, -ia=rincc co. somoanv name:�Jrl addresa- _ C nhnnc insar^nr res _�•�`.,.. Failure to secure coverage as required unucr SCC:Ion 25A of SIGL 15: can lend to the imposition of criminal penalna of a tine up to S1=,OO.W and/or one years' imprisonment as well as civil Penalties in the form of a STOP WORK ORDER and a fine o[5100.00 a day against me- I undc"Land that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage vcrtticndon. do hereby cerirfy under the pains andDpertaities u(-periury that the inlormation provided above is true and corre Sipa—Ri' �..��f(GGf'!//rrFFJJIIov�_4�it3�'�l,/�L D a[t: c Pant nay e � )VJD OA SILK R(ZA phone official use only do not write in this arca to be completed by city or town official city or town: permiUlicense r ^Building Department L Licensing Board check if immediate response is required [Selectmen's Office LHcalth Department contact person: phone 4: "Other (re•ueu 3:95 PIA) Town of North Andover o t 40RTH 1 OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street North Andover, Massachusetts 01845 9 WILLIAM J. SCOTT SSACHUSE Director (978)688-9531 Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION 3 WW al) T Number Street Address Section of Town "HOMEOWNER q 16 40 6 - �1`Z4 9 i g --:g'l -8165 Number ��,���������� Home Phone Work Phone PRESENT MAILING ADDRESS 3 R"W"� -5 City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one to six family dwelling,attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws,rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE__t4 zla/ ,a APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NORTH TO" Of dover No. 3q ;k i _ 0 1.7 C 0CH I C,L A dower, Mass., ORATED H BOARD OF HEALTH Food/Kitchen PERMIT T Septic System �/9.......r5lve ; ra BUILDING INSPECTOR THISCERTIFIES THAT ............ ..I.............................................................................................. Foundation has permission to erect....Z07 X 1 if..A".. buildings on ......13...... rwoo�...... ......1146........... ,,6, Rough to be occupied as. Cv!# . .1. Chimney provided that the person accepting this permit shata..... K k�-Sdsftmp...Ab....**'*" 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. For Sovels )r*1ft I"& &#JJ' V PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. V- AIEW POUT EV7*"Y Rough (a PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIO T TS ELECTRICAL INSPECTOR (� o+l 7 $ • Rough Rec.#- ....... .. .................0-0-0....#.................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Dec. ORTI, 4 `s Town o ndover 0 No. rya - - o yy dover, Mass., 3 T o - LAKE T COCMICKEWICK y1. 7 SADA? TED P" �SSAC HUS�� FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT . a....•,�..a.....lrrl.� �. .�� ....................................................................... has permission to excavate and pour foundation at + ^� � �� A f 98 ....... ....... .............................. ................................................ for the purpose of.. x�y . � �.�.!1.1....G...a Pel ! ... L .z ... .A!1- Boom Ado(c� T(le:person-accepting this permit must-return to the office of the Building Inspectora`certifiecrfot pran-sfiovw� of building thereon before Foundation will be inspected. For S tft4 6 FA W I 051%4' VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. c . .. .. .. ... .. .. . . ...................................................................... BUILDING INSPECTOR 5987 Date........ ...e\.-5...... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SS Thiscertifies that ................ .................................................... has permission to perform ......... . .. .. .. ... ................................................. wiring in the building of='z., ................................ at... /-.3..... ..i............................. .......................... North Andover,Mass. Fee.. ! ...... Lic. . ...........I...... ELECTRICAL INSPECTOR Check # ThE V1YMOl r �Ol'li� "CRUS�S Office Use only DEPARTMEVTOFPUBLICSA= t No. BOARD OFFIREPRLTEV 70NRWM770NS527CyR12.00 occupancy&Fees Checked UAPPLICATIONFOR PERMIT TO PERFORM ELECTRICAL 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 Wires The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) /3 11XR&&V1) 67- Owner or Tenant je cVl tld le GgCe11L7* Owner's Address ,-- Ts this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Q Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets _ No.of Gas Burners No.of Ranges No.of Air on Total FIItE 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 Local Municipala Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP + OTHER 1 Ir>,stnanwCmaaW-RnsmtlothemWmnuitdNbm&usettsGffxzaiLmNs IfineaamertLmbldyhsr==Pbbyirru&gCorrgAde ComageoritsaksWnfa(oWivalaix YES NO IhawsttbmJ edvaliddpM0fofSane1DthCOTM YES U NO F-1 W3cuharedteclodYES,pleaseirr5c:tethetypeofwm gebydiedtgthe INSCJRANCE El� BOND MHR F-1 ftweSpadfy) E mDeft E ValtredBecrrdWak$ `600' WcrktoStart hq)ectionElA,-R Ratgh Feral ' Shredux xTvRndhmofpajtay. FIRMNAME L mseNa t tioa> signalrne LiteNo a6 FIE BIwessTdNa AILTdNa OWNER'S INSURANCEWAIVER;lam awarealartheLusedxsnothavetheirtstaasre orrissubstari alergm3latasre#adbylvfamfm9ellsCoallaws anddrtmysagiaftncnftpwnftrwa'fk,eS sreW'Mlklt (Please check one) Owner M Agent Q d-i Telephone No. PERMIT FEE$ 170 y WAR-14-05 09:48AM FROMyam Brothers Insurance 197898TOT45 T-882 P.001/902 F485 CERTIFICATE OF LIABILITY INSURANLC morcK 2l 03114/05 PRODUCERTRIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS No R1014TS UPON THE CERTIFICATE $Y Bros-Mahoney Insurance HOLDER.THIS CERTIFICATE DOSS NOT AMEND.EXTEND OR 191', B ros-Mat neyBlvALTER THI=COVERAGE AFFORDED BY THE POLICIES BELOW. LowE,11 MA 01854 INSURERS AFFORDING COVERAGE NAIG 0 Phone, 978-454-2926 Fax:978 -937-0746 INSURED INSURER A: ME3Y'Chant$ =nsu�4n0Q Co- Taylor C- Ta for INsuhCR 8; 1N9UR@R 4rc�3go�y �- 71 9tIff 9 e° 1576 1,%5u" D. — - — jowk3bury MA INSURERL COVBRAt31:S THE PQLICIcS OF IN5URAUCe LISTED BELOW HAVE EEEN ISSUED TO THE INSURED NAMGD ApCVr-FOR THE POLICY PERIOD INDICATED.NOTWITh15TANDWG ANY REQUIREMENT,TOM MR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RF9PECT TO WMGM THIS CERTIFICATE MAY 9E ISSUED OR I:fiY PERTAIN,THE IG FiCU AFFORDED BY THE POLICIES DESCRIBED HERFJN IS SUBJECT TO ALL THE TERMS,EICLUSIONS ANP CONDITIONS OF SUCH POLICIES.AGGREGATE LfArfs SHOWN NAYWAVE BERN REDUCED SY PALO CLAIMS. I I I�p- PRBMpSFs(Sanecwcrw_eLIMITS 14 - pOuevlluM6RR flATF NMIDN TYPEOFINSURAKWOCCURENCS GENERAL LIA89T 5110000000004 Ai X COMM9jkCIALGt-NERALLIA3LITY CCP6005900 03/20/ 06 4 {LAMAS MADE OCCUR MFR (Any�°Pereenl 5400 - PERSONAL LAW INJURY $1000000 GENERALAGGRFGAYE g2000000. �GENII.AGGr+EOATELIMITAPPLdGPSR i I PRODUCT&-COMPtoPAGG s200a000 POLICY n PRS LOC �AYTQMDE6.0 LIAMI.ITY I COMBINED BII'JGt-E LIMIT j y (Se e:elawG) i ANYAUYO ALL ODUNEO AUTQS ROD�f mw ply g I sCHEOULGO AUTOS gomy INJURY HIRED AUTOS I (Per 8egQUM) S NONOWNEDAUTOS PROPERTY DAMAGE 5 (Par amdeft) Il AUTQ 0`LY'•EA ACCIDENT S GARAGE LIABILITY �- i OTHER THAN inS4___ C4- i AYYAUTO i AUTO ONLY; AGO'S EXCE9!VUMBLLA LIABILIEACH OCQURRENCE RETY 5 AGGRE13ATE 5 pOCCUR Lrs CLAIMS MADE I I DFoucnBLE � 1 � rdL•TENTtON S i _ `-(r WORKERS COMPENSATION AND , TDR 3 ER EMPI.OYER6':LOBILfrY EL.GACHACCIDENT _ S � ANY PRGPRIETORIPARTNERIViCUTIVE j E.L.DISPOSE.EA EMPLOYeeI s OFFICERIMEMBRR ExCLUDGO? i 1{ �- I!Xaq,sescrWm under E.L.DISEASE-POLICY LIMIT 9 SPECIAL PROVISIONS 0610w OTHEAi � I DESCRIPTION OPOVCRAMONsILOOATION64VEHICLUIMCCLUSIONSADDED NOORSEAEENT1SPFCIALPRCVMONS E%X# 978-256-6620 E:ERTIFlC ATE HOLDER CANCELLATION i- ENVIR01 SHOULD ANY OF THE A®OVE DESCRIBED POLICIES BE CANCELLED p0FOR£THE GXPMATIONi' DATE THEREOF. ,�TH�EI$6WU}WGMISUAGRWIW-ENDEAVORT`O"L �0 DAYSWR9TTEN Fj;VIR0bUaNT4%p L.�P��OqOLS No-not To TiLj 1'1iY17�� E HOLOFJ;NASO,TD`7hE,{SFT.[>lU�rf��fta%D*GO SHALL ATTN: TOE GtJ1�TA O wf,05F N0.9BLIGA1I0N OR LIABILITY OF ANY KIND UE0,14 THE INSURFR,rrs AGENTS OR 1848 R1VERNECK PJ= REPRESENTA"nuEl- r CKELA3SFOR:) NA 01824 AUTNORREC RCPRCSFNTATIV s' 8.res ©=31110 CORPORATION 1988 ACORD 26(2001108) i i' r 7 F Fill AS AG, f � t�A L CTRICIAN S,�i.Tt'ft. GREGORY A, TAYL:oR: , 71 PIKE s'" AEt.`T TEWKSBuRY 4� 8545 ; 4 11 fnl;l.hien L';vtt�ch�L,ng?i!t'ertc.•r��llnns �, 1 THECOMMOAWE LTHOFAL4SSACHUSErIS Office Use only DEPARTME NTOFPUBLICS4FE7Y Permit No. s�S'S'�'7 BOARD OFFIREPREVEN ONREGUL4TIOAS527CIfR12:00 VA Occupancy&Fees CheckedPPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACI USSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires 'The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) /3 W WWC0v 67- Owner TOwner or Tenant /AIo fe Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Q Underground ED No.of Meters New Service Amps / Volts Overhead r--J Underground Q No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed gpct ical Work 1Q5, t 1/.Q,?l)=/iSIS,r&I 6;el ll GD No.of Lighting Outlet No.of Hot Tubs No.ofTransforrhers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 1:1round No.of Receptacle Outlets No.of Oil Bumers No.ofEmergency Lighting Battery Units No.of Switch Outlets _ No.of Gas Burners l 1 No.of Ranges No.of Ait Cond. Total FIRE ALARMS No.of Zones l�J 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 TNo.of Dryers Heating Devices KW Local a Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER l sur&=Cmwgm A>rs Miotheta# nazc GanWLaws Iha,.eaamtxtLiabtldylm==Poryarh&gCompl�� CmvaraWcrilssiEbdaleWivA rt YES NO limes ubm&dvaWpoofofsaneiothe0)floe YES U NO r If}cuharedodmdYES,plemirr5c*theNnof=crWby&adcingthe INStJRANCE 6 BOND OMM F-1 (Pleasespe* N/4ffC /y�S S7a/-L13/D!a . F cnD* End VakrdEfied xdl Wo&$ 1,00a' waktaSta+t h ;pmdicnD*Roque*d Ralg}t FM Signed un dxTr A=fta ofpajW FIRMNAME Li MWNa Lio�sae �,2��' f�,_'�,41/L J, Signahue P LioalseNo 3 a 6�� BuskwTeJNo. / Pry o AkTd?,h OWNER'S PgSURANCE WANFR;IammmthattheIxmedm noth,netheinsurmmammWotss>tsit>tWequivala>tasIagmedbyNlmmdaseltsGmrAlaws "dttmy xeonftpet *g#cabnwai,stmm memai (Please check one) Owner M Agent Q Telephone No. PERMIT FEE$ � � PP l 1� Rex 02/20/2013 23:09 #2510 P. W,, Feb 21 2013 10: 19RM LFS/COMPASS CRPITRL CORP. 9786864120 p MASSACHUsLrffS DEPARTMYi;NT OF PUKJC IMALTH SUMWETERING OF WATER AND SEWER CERTIFICATION FORM In accoaianco with M.O.L.0. 186.122$tut 105 CMR 410A00:MiSIMuta ftn&u*of Fitness for liuman itlsbita Lien (State Sanitary Code Chepaor pD,rite fallowi tg dwallbg unit b efigible for the imposition on the tenents of a ctat p fbr watern Vcw sewer service. 1''ROPBRTY 1NF0>ntMAT10N ' Address: Unit d 0 #Of units t'�n lend . MM. � U�2- .MA. I BQUIRI NT IrIBTALi•ATION 1NF RMA'i'.1ON d 105 CMR 410.000 requires the iustatlAthm ofwater aviccs prior to a dwelling unit lsecx:ming eligible for the impositioa� ofe aJNs��vrat+sr sarree.71wde�'ioaa oa+sattl�a�iisorltsg apeu� Showotbeeds with rs.wmam flow rates not to exceed 2 ti$anions per mfitute(2.5 gpm) lrauft"W"M84Mutnwow me n"to eueeeii' 2r°'t 'gdfibns per iaiiuraa C�2'gpm)' Ultra low flush water olosets(too")not to exceed 16i20 gallons per flush(1.6 gpt) Tits submeterfal equipment used to messure the quoift ofwatar used fbr each dwelling unit and emnmon area must meat dte"dw&*race;Moy and testing of rho Autetica WOW' 011(s AM01016"of similar sxredibd asaociatim. dll0tna nwst'ra�►1!tba vatat.ck�setis.aadsal+e�aaoedaSegteiptpeort.. au�sber Subme taring ec}uipumat l dbMatia : d Lloeaeal Plemieer't�tifleatioo Print Name of' lumber License d Data I mt*that(check all that apply): [3i have hastalbod die st bnteterfn8 aptipinent'#imttabove in'l daactr -samptedpfitnbing staidw ; 1 have installed one or more water closets not exceeding 1.6 gallons per flush. Deowmiaa!that extating water closets do not Mooed 1.k,phone,per flash. Tho plumbing permit isod by the cityRm ,if required,is attached. MDwal ttg unit is ootwectm!dlreot�y to a motor' td'a we spa rtttd. ilyrc ane th M.G.L.a 166.12201 does not re pdire the laetal ofa ou ter, Sig;ted�uadert6erp>Rips araFFat>slti�af:perjtty�,. St aPL sed Plumber Property Owuer CarliAcn l sorters tit;(4) gists dNreEi etnihle a biC 4�+rtise itrtftee�itiewION 0 P -cinaeg�a 0Mrweter anVbr scwc, trtftv is ae0 Wane with the water subnteferift low(M13L o. 184 FM)-,(2)All d* arhesds,fltu eta,and wabsr closets in this dwelling aoit arc water coraorvetion devices that roost ft sla UhWs MW above;{3)The wager submeter meaeuting the use of water In the dwoUing ualtvM lnstallod by a licortead plumber and Is in coropllanee a►ith the standards specifled above,or the wader nbeter measuring the use of water in this dualling unit was installed by s"worst company" as defined In M.O.L.a. 186,122; (4)The water meter or submeter mcmuras the water usage excltall"to this twit;(5)1 will provide to the tet aam of this dwelling troft,print to occupoaogr,a written reptal agroetaent tbat clowly provides fur tate separate chargh*of water.and/or ower eervitto.and a=M of flus cat ieatton faint(6)That alt lntfomsetion Included on this certifieaflotl ia.ttue qpd wguMe 10 ffis best.ofMy knave SiVied under tits pains and penoWes of per urs, two Y Print Name of Owner f3' of tllvaar 9oardof Nealth/tiealth rtment Received B MDl'bi1CSP Submtefita COrdfl tloa Pam,R"'eed 1CA06h M Location Q No. .3 Date 40RTil TOWN OF NORTH ANDOVER 3? 0 _ SOL f s ` Certificate of Occupancy $ °•t.1 Building/Frame Permit Fee $ sAC" Foundation Permit Fee $ Other Permit Fee $ y TOTAL $ yya Check # ;� Building InspectdL TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH.A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: Q DATE ISSUED: B O SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 13 f-r!f1RJ57, ./ OO�o p ® C7 Map Number Parcel Number (W� lJV 1.3 Zoning Information: 1.4 Property Dimensions: ,nock 66)r /OD Zoning District Pr osed Use Lot Areas Frontage(R) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1 66 41 IQ f3 s D ' 1.7 WaterJSi�pply M.G.L.C.40. 34) 1.3. Flood Zone Information: 1.8 Sew a Disposal System: Public t�Private 0 Zone Outside Flood Zone 0 Municipal On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Q 2.1 Owner of Record Q Nae P Address for Service ass-oaVC $'ignaI elephone 2.2 Owner of Record: r Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed do-ristrilctYon Supervisor: License Number A,Tress /-Z, C• ^d Expiration Date T Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �i 1VLe,6NM�V�_T�L� - /,0 7 d `d �ompany Name jr MW Registration Number d dres 97 �—QofG+V Expiration Date ianature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the builging permit. Signed affidavit Attached Yes.....*..V No.......0 SECTION 5 Descriion of Proposed Work check all applicable) New Construction 9 Existing Building 0 Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. 0 Demolition ❑ Other Specify tea dL Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTSgr �y Item Estimated Cost(Dollar)to besr x € Rs Completed b permit a ltcant , , I ON 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC �. 5 Fire Protection 6 Total (1+2+3+4+5) VZ1,anO Check Number SECTION 7a OWNER AUTHORIZATION 10 BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of su 'ect property Hereby authorize My beha -all ma r relativ ork thorized by this building permit application. ll i na a of O ier Date SECT ON 7b OWNER/AUTHORIZED AGENT DECLARATION 1 as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 2Prnt ame Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS I ST 2ND 3 SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFENINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATTIRAL,GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT Pg nWV//2Dtil/>?-Pfy7rG1,C� L TA C, PHONE x4'I� a?.56-0QW ASSESSORS MAP NUMBER LOT NUMBER 9 7 SUBDIVISION LOT NUMBER STREET h'Ag W Dd STREET NUMBER 13 OFFICIAL USE ONLY nommusnuffise .. 0... .. ATM, F TOWN NTS ....................... ........... DATE APPROVED CO S VA N OR DATE REJECTED CONnvIENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER!WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE 91te Board of Building Reu actions ,. One Ashburton P ace, m 1801 Boston, Ma 02108-1618 Y License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 12/24/1948 i E Numbor: CS 013965 Expires: 12/24/2005 Restticted To: 00 i STEVE A KALAITZIDIS 7 POWERS LANDING#203 -- NE:RRIM_ACK. NH 03054 i I Tr.no: 12346 Keep top for receipt and.change of address notification. _ ,yam_ ✓fry cnur�wrPr�e2�z ✓ �credz.c�e b ' A BOARD OF BUILDING REGULATIONS a � x License: CONSTRUCTION SUPERVISOR Number: CS 013965 Birthdate: 12/24/1,948 r Expires: 12/24/2005 Tr.no: 12346 �RAST x Restricted: 00 STEVE A KALAITZI{71S 7 POWERS LANDING4203 MERRIMACK, NH 0305471�OIiSAlGfali'2k € Administrator 149EP.ItlIg14C}€Nf�ttk � `_ � �- i , Y f C EE pp 9 �. ✓�ie Uammiom�uaa� �/l�LllQdl�Cl2CC6P,�6 Board of Building Regulations and Standards 1 License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. Ufound return to: a _- Registration: 107083 Board of Building Regulations and Standards Q. Expiration: 7/29/2006 One Ashburton Place Rut1301 I Type: Private Corporation Boston,Ma.02108 i r.. I ENVIRONMENTAL POOLS INC. Andrew Everieigh 184R Riverneck Road Chelmsford,MA 01824 Administrator Not valid without signature i ACn CERTIFICATE OF LIABILITY INSURANCE 05/16/200S PgOxc.GR. 4508)675-2191 FAX (56073-2186 THIS CERTIFICATIt ES 16SUED AS il NFORMATION welsattr Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i?,%8!' A Webster Insurance HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR I COVERAGEALIER THE AFFORDED BY T14E POLIMES BELOW, P.O.I30'x 907 I SWANSEA, MA C2777 INSURERS AFFORDING COVERAGE MAIC R �rrSURLD virommenta P—m s INSIMERA: ,(1RCH INSURANCE COINP Y j 184 R R uPrneck Road .Nsummo; EK ISIS. NCE COMPMTES CSelmsfOrd, MA 018124-2821 INSLIRERC; iNSUREtl E L� COVERAGES THE POUCIES OF F.ro9URANCE USTEO B@t_OW MAVE BEEN ISSUED TO TME INSURED NAMEO ABOVE POR THE POLICY PERIOD INOICATaD.NQTM,FTHSTANNN j .A Y REQUIREMENT,TERM OR CONDITION OR ANY CONTRACTES OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CSRtIFICATE MA.Y BE 135:'1)OR aaw PES?TARI,THE INSURANCE AFFORDED BY T146 POUC RS CCRBED HEREIN 18 SUBJECT Tt7 au HE TERMS,EXCLIASIO^i&AND t:ONOPT1QhL 4R SUCH j w)i.,C1'-3.AGGIREGA?'E?.im!T5,SHOWN MAY KAVE SEEN REfii.10ED BY PAID C(AIMS. 3W4"F LAR8LICYMmoplit1.TTEDFIN5lJcCE Y eENEAluAioLR 2AGLI59007900. a 4128 5 05/14;200f aAcrlo=ffdwes : 11000, 000 X mraMP.qcLaL„ENERAL LfAB4iTY ammmloolvI711115 lul E 100,0001 ci.&&S MADE .-- ,OCGUR kEO EYP(Any ono wmq $ S.No A P %NAL 8 Mb rriJURr b 1,000,I) I 0°JfERALAQQREOAft : 2.000 00 i ffNLAGGRAGATE UUrr AFPLW PHti! PRODUCTS-OOMPAOP AGG tI 1.000.0 I I'OLICv j l.00 r !AuTCaOWLE UAWL11Y PENDING 05/14/2"S 05/14/2006 Comwp4D$IwA6 wmkT ANYAU'J {Eo aaldwo ,S I A,LOVYNEDAUTOS I -__ I i Move INJURY f ( sc+r•vuLCD..JtgS i j(Per versant 1.000,000! B x HIRED AUTOS i BOOLYIHJURY NO!A-OW NM AU"DS {P!*iOddBnl) PROPERTY DAMAGE S (Pa asddae) 1 000 !SARAOStiAEtLIT j AUT60ULY EAACf:®EIIT E t I ! EAAC. S ANY 'vTr, C'rHS TW AUTO ONLY: AOG $ 6rGEIUMBRELLA LIABILTTT' _ y��-- EACH OCCURiSNCF I r� ! I j --jCC"R OL '"MADE 1 AQWG47E S oECVCrBI.E ! f OZTW-ON 1 S 9110RY.F.SPGCIhL RB COMPENSAT4N AMC - A all s EA7PLOYfRsLJABlLJTY ZAIIIC19014700 05/14/ZOOS OS/14120M EL&cmALciowt s 1,000 �,!+r vgePreETGwPniT4��euin� I rl 7=PIrnMEMB6�T E�LflJEDi E.L.DL%OZE-EA EtAP O 3 110001 ° C Yes,dewloe L!M.-r 1, _ E.LINA8F-FDLIDYLLWT i Z 000 � PRtY51S7N'a bObM OTHER 1 s s ! t I f t ThSC il�TrWN OF>?PEPA.'T9M3�LDCATIOIs9�'YE►eCI.E9±EXCLYSIDNB AGOEA OY lIIDQRICMF.1Jt r XPEG.AL FT;IOYiSI0H5 I4 31 a ti i CERTIFICATE ! S.'+OULO ANY OC THE aBU4tE OF�CRI9FIS PQLI•.".!R_S BB CANCEi.LEO 900112-TWE EXPIRATION DATE TMEWF,T11E MURG GISUREN HULL EXUFAYOR TO MAIL 1 2.0 DAY$WRRTEN NOTIO@ TO Til&CM0 CATE HOLDER MWOTOTHA LlM, EMiSRONA9E'1+1 fAL POOLS INC BUT FAILURE?n MAIL SUCH LIDTTCE SHALL1MPM MID 0>11lGIA 1CW ON LULWTV 4 3-44R R111ERMECK ROAD 09 ANY KAD UPON"Ii ASIARER,:TS AGMTS OR R£PRESWATMOL } CFIEI_MSFORD, MEA 01824 A10'HOMD RFPRESMA'r Ve aokvmo 25(2001108) @ACORO CORPORATION 1998 The Commonwealth ofMassachusetts Ail— M —= Department of Industrial Accidents Off1C6 vflnuestfgativns r — _ 600 Washington Street, 7'''Floor Boston,Mass. 02111 L Workers' ComSensation Insurance Affidavit: Building/Plumbing/Electrical Contractors L. x, 'i'pR'•" .i� 'a1.a. �:?;•6+:h��' "''Yii�fi y;r,•y:Vr':r.c'=:k,*rSFW. ;:� 1•T{ } .,Y.;yf iii :k �«:USda x.; f041;, a•��.,:ee�'�.:4.�:"k.�tr.3�.: ..� i...�C=��.�v. ,dENd6"0. 11�'''2=kQ]'�'i.#�;'k:•�;,_sC'rr�..�r.'.'F.9��1,r- �4.�«3�tb,,.,.un5��1.5:���?"M/ss:�'��r Ap'nhcl�b'� nl'a`�ion .s t,,..0 �-,A�' h1P t l� � � �, t.-• w �. name: address: city ,/ stater ��// zip: phone# work site location(full address): %i f1AF�l&a5 sT Ale• 4AIbQ)/,C::R. { E] I am a homeowner performing all work myself. Project Type: [�New Construction❑Remodel ❑ I am a sole proprietor and have no one working in any ca acityv BuildingAddition 3 - ;^ i.r.nc>x..•zr, t1 .....�:� 4. ,. ....:'(`:ALS...,.�li:}?azx•4+rt'. ,.__ .. 3;....r.31.�_, �rvi.:_5...1y,:•.:x .�._r.,.rS£:,t., _..�J:,:�99z '3.;14'1'. .>_. .L�i`':ir. ,a�.,..ri _r.,, I am an employer providing workers' compensationformy employees working on this job. company name: ie .-- address: 1 19141 {moiyp c <—fs• ' ` cit1�.�—►�c—�l [ufLj_f ciF 7. insurance.co. -µt 4•t� q .w... t_ ' { �� '. P`r uLi � dfli"1'Cl'U��^i ❑ 1 am a sole proprietor, general contractor,or homeowner(circle one)and havehiredthe contractors listed below who have the following workers' compensation polices: companv.name: ' address: :: city: insurance,co. company name: ' address: city: phone#: .. insurance.co. g -otic. # Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the AIA for coverage verification. 7 do hereby cerci in th pai nalties 0 u that the information provided above is tnze and correct. Signature . Date �� Print name C.A illat=w A--- 44E Oq Phone# �7h9-454 — 4wao tea. :•L',�{,a'Evi:l;'%i�'X.�i�'a�'l�A'�{,;i���'i�7�1e'`.tS:�YXu-'}�71't��`�•siiti7L°kui'�u�K��'1�4 tt�r�'4"coev>6 ns�T i."�s:��J• a,t�ufi�'(:4�--'�w�Y.' i'�aF.�dY':sl'��i�d'£'tw�Ji�'8L fiU if official use only do not write in this area to be completed by city or town official city or town: permit/license# []Building Department F Licensing Board ❑check if immediate response is required ClSelectmen's Office D13ealth Department ,� contact person: phone#; ❑Other `� (revised Sept.2007) �y; e Information and Instructions X Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire, express or implied,oral or written. hnemployer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. y iv yp :� �•r:• __,_. S. �` '.��v°°,•^�i5'eL`=.a'T;r€'_ "v'FA' i'�cu}r ✓ �.�.kt�-_r T�N'"!,��cy'L�Y `.$`�'{ 'K�4 4t`{T;4`s'' •yr,ss_s`ka�, tMileyt° 'ryj +51 1 .ryi, . h.�E,-jr�1 'Fti 2' 3FYit�rY'F3 J� s�'SI� �5'�id 4+t�v�.�S rss{aY^� F tYE�x�rT"�$ � ,r,n Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. �l,.+rk3f nw�t,'`Irt�r t � ,a�",S�F,i�'" c :"� .. sj lYrr "r�. ,,+ r.�"�ar�` w '0`� �fi'+' 1Fi5k�� '�rs fif •ar 0� 1`,� rgak� a� �„ 5`°'i"e'.... sF� 4 n tk R City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7t6 Floor Boston,Ma_ 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 NORTH Town of : t _ 4 over0 . No. 1 8. _ J dow 00 slow yQ LEdover, Mass., C $ 8 T COC MICC KE WICK V 4A0/*. E D "? �y S. BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System r BUILDING INSPECTOR THIS CERTIFIES THAT.....L..'�. .......... �...��.�tl..�.t...�..�................................. ............... ... Foundation has permission to erect.... ... . ' .3,...... buildings on.......�.. ...... A ..w e o �g Rough t0 be Occupied 8S V aof .�NI ......1 � ' N r` � Chimney ...... ........... .................... ...................................................... .. .................. . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 0C /3 O — - PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS ARS Rough / ...............................W'••••'•••... Service BUILDING INSPECTOR Final Occupancy Permit Required to Oca iPy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. IF—s47E REVERSE SIDE Smoke Det. A" salt .ft M[tfMA1.l>AOE D.tAvfit AWI,or F.evil M04 �.! ! ' S• C. , ?Z' •S• �►3 OARS /M JOAO 9WAAW L/GArr rvrcwrc • .�srEUFrEo v L=zEvo 0 TOrOIrQONO 3f�iM rrxsrT— AS MIN. wArfd pwar rl' J• A' 6: (f( /'1.4X V&-CC WiOL( _ wAsirm `•'ynn A ELEY2'O• NAIVAR 7R9NS/r/CN PO//YT It. Ad 84AS m troc907 DIVING B&qjtwvXA?T .s.+fcrrcca4El •c co.•rr► I L:Rouiva ELEY • — O _ 30 --- _ — curoFF wcr 5vAANrC, anRc s _ ELEY! O • 1W3 aARs - CUr Cf4F AS NOTED ELEY S'D• - S'RAO/!/S P!A/fV O�C�i/N S'X ft ELEY 4:0, OCGrsavECT DI�?fCT TO LUMP ifE{'fi'YALYE — — RESIDENTML CO/anexcift ` `~• . 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