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Miscellaneous - 145 FOREST STREET 4/30/2018 (2)
145 FOREST STREET / 210/106.A-0178-0000.0 1 Date. . . . . . . .h.Z. 9569 TOWN OF NORTH ANDOVER C 9 PERMIT FOR PLUMBING � s ACMUSE� , This certifies that . .Lf. . . . !.. . . . . .. has permission to perform . . . . . . . . . . . . . . . . . . plumbing in the buildings of . ./. . . C..P•CS��✓ at . ...?.x�.1. . . .7.o!QPS . . .?MIBN o Andover, Mass. Fee,!,9.Lic. N�"4.`m. . . . . . . . . . . . . . . . . Jy`7 PLG INSPECTOR Check +� !� t MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING CitylTown• Imo, MA. Date: ��_ l'ermlt# t`` Building LocationOwners Name: 44!k( A 1Q Ili J Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional ❑ Residential [�- New: [� Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes E] No E] FIXTURES z z 0 Y n COLu LuU N n. W z ~ N (n Q cl) Q 0 Z o � < �. D a 1— z o o+ z w cn v a a Y = � 0 0 1�- _ Z a a a Y. a z w w uat W u F_ N in 1— z v O p p z d m m o 0 0 r °� tzn CO IQ-• 0 o SUB BSMT. BASEMENT 1 FLOOR 2 No FLOOR 3 Ku FLOOR 4TR FLOOR S FLOOR 6 FLOOR R 7 FLOOR 8 FLOOR �// / Check One Only Certificate# Installing Company Name: (3�T/N P Un[��I ��J�Gry E]/, Q � Corporation Address: �� QJ-g05 y OX41eJ CityrTown: (A/A,r°L/gr' State: Zig Code: ❑ Partnership Business Tei: CeLI: Fax: ❑ Firm/Company Name of Licensed Plumber: - INSURANCE COVERAGE: I havea,current liability-insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes❑ No If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A 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 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and Fnformation I have submitted(or entered)regarding this application are true and accurate to the best of Knowledge and that all plumbing work and installations performed under the permit Issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ❑Plumber Signature of Licensed Plumber Cityrrown ❑Master License.Number: �� APPROVED OFFICE USE ONLY) [ d'ourneyman t Flee Commonwealth of Massacillisetts 11epm teeaent gf'IndustrialAccidents ' Office of1"Vestagatiomy 1 Congress sh-eet,Smite 100 Boston,MA 02114=2017 min.in ss.govIdiie Workers' Compensation]Insurance Affidavit: Drdlders/Coungtracfor s/Electricians/Pll>t>tffik eirs Applicant 1pfo>rmation f Please lPriaa>t TLe, .�1 .. Name (Business/Drganization/Individuan: U n A�� f U� Address: City/Steel Zip,: j;.,./A r ktA_ 3.1 Aon1-e Are you an employer?Check the appropriate box: 'Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* . have hired the sub-contractors 6. ❑New construction 2. am a sole proprietor or partner- listed on the attached sheet 7. []Remodeling b-contractors have ship and have no employees These su8. ❑Demolition working for mein any capacity. employees and have workers' 9 ❑Buu1d naddition f Wo workers'comp.insurance comp.in ura„ce$ j ed. re 5. E] We are a corporation and its 10-[]Electrical repairs or additions � officers have exercised their.ElI am a homeowner doing all work 1 I.[Numbing repairs or additions myself [No workers' comp- right of exemption per MGL 12.0 Roof repairs insurance required.] c-152, §1(4), and we have no employees.[No workers' 13-❑ Other comp,insurance required.] Any applicant that check bax'�1 mnstnlso fiil out the section below showing theirworkers'compensation paucy information. 't Homeowners Soho snbmitthis affidavit indicating they are doing all worlc and then hire outside contractors must submit a new affidavit indicating such. TContractors that cbecic Ms box must attached an additional sheetshowing the name of the sub-contractors and state whether or not those entities have employees_If the sub-contractor have employees,they must provide their workers'camp.policy number. I miz alt elprp&ye-r ilrat is propidhlg iporlrers'conrpeelsai-on iltsrlrallce for•llry employees. Below is flee policy clad job site illforlltation- Insurance CompanyName: ���r e-7T ✓� U Policy#or Self-".Lie.#: Expiration Date: Job Site Address - City/State/Zip: 4,w Attach.2 copy of the workers' compensation policy declaration page(showing the policy number and expiration crate). Faz-lure to secure coverage as required under Section 25A ofMGI,c. 152 can lead to the imposition of cf minal penalties of a fine up to$1;500.04 and/or one-year imprisonment,as well as civilpenalties in the foam 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 may be forwarded to the Office of Investigations of the DIA for.insurance coverage verification. Y do Hereby certify ander the pains altd enalties of 'illy that the infonnation provided above fs trite and correct Si store• ----- ---- - - Date —_ Phone#: Official use only. Pg not iprite in this area,to be completed by city or town officiaL City°.or Towns: PermitfUcea>!se-9 Issning Authority(circle one): 1.Board of Elealth 2.Building Departanent 3. City/Town Clerk 4.Mlecttrkal Inspector 5.Plumbing Inspector 6.Othiir Contact Pelrsom phone#: • Date Z . . . •.�I�rti��� ra.. toTOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . ..Av:?.S ./ . . . . . . . . . . . .. . . . . . . . . . . . . . . has permission to perform . '-/!1-:L. . . .�. . . . . . . . . . wiring in the building of N . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . S . .f ��s .���•. . . . . . . . . . ,NoA Andover, Mass. Fee .0720. Lic. No. .6-j 9d T. . !Aid. . . . . ELECTRICAL INSPEC OR Check# l/ 11086 Commonwealth of Massachusetts Official Use Only Nw Department of Fire Services Permit No. 1/0 C76p Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I- k\ .- a 1 a 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 work described below. Location(Street&Number) Owner or Tenant _ k4 e� > , iv 1)��► SCl/ Telephone No. Owner's Address _ S� Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps J 2Q/ 20 Volts Overhead R Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ap ' Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ NO-50TEmergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: � ............... Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection No.of Dryers Heating Appliances Key Security Systems:* Y No.of Devices or Equivalent 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 E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: . 7 0 e-( �`/L 4�s�A LIC.NO.: Licensee: S10�1Li 5Y44 Vt?�E Signature IC.NO.: q L-19 c-5 C (If applicable,enter "exempt"in the license;umber line.) Bus.Tel.No.:97�_-Azz-q Address: 9 c;GcQ•,kaSs i�.v, 4ivA SS O( 9LI 5 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department 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. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. • 1 J 7 .-. • .�'+�J�7l..rAJ.�-L•'Vit'j(�'�jt�-(r�p-7J7.'V'.��''�l•-1j.�J.l�®7`�Y'p^yt�(+�'7/'�,(� �.�+.1��J:1'�1��..7 J-'a�✓...®J•'•�n ,- • . _ .VD f{.LJ.S.49.1� .!-�.RFSJ-.ILi'L.i,f.lJ'.C9."`�• .. .- � �^ r �' 3c'�sseu�-�[ �� �+'ailebi-•j � �e-xnspeetzou xequzxec�($�O.�D)�� � � h8pec#ors'cop=e;afs: VDVJI ectore sigo-ailwe-.to�R-lltjals) Pate 'asse � ciaile --� ate-has.Veetio)Z.3gl ixea(�;50.00) [ ` Yap ectaJrS'comm orfs: L (JC S&'etoxs', afire ointuals} Slate ' MDYIPI GROD"MUM TION. ?assecl--j � �+azIecl�j ) �te�ir►speetzo�xe[�ttiret�(��D.40)�[ � t�spectoz's'coJnxaerits: , [.Ln.spectors�uzgnature-.+ao in�f?a�s} - date - �, ' sse�---[ � �iaiieu-^j � �e-xnspectionxequiz'e�(�50AD)�� � i r,�ectbxs'eop�.�tte�t�s: (�xtspeetoxs',�zgn2tuz'e�3%ain.ifials) Jlate 'ed�-(' � :�'ailer�--•j }. 'ate�nsp ectio7a xe�uix'e�( 50.0 D)-'[ � - eetoxs'co�imenfs: _ . ' S .. �1,,�sp ecfo7c�'�zgxtature�xto initials} � Tiate . i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211.1 ,. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 101 am a employer with '2— 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ Remodeling slip and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its require10.❑Electrical repairs or additions 3.❑ d.] officers have exercised their 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �d(/�� Policy#or Self-ins.Lic.#: Expiration Date: `> Job Site Address:__ �f �r�$P 1 V City/State/Zip: 'y- y4 - 1z:,1k7 Lt � 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. F do hereby certify under the ietxaltiesperjury that the information provided above is true and correct. 3i nature: Date: / I Zc,�2, Phone#: zf/ 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: l Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials i Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-OS Av<viu mace onv/din Date.. MORTh OF o� TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION ACHUSEtt This certifies that . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . .. . . . . . . . . . . . . in the buildings of -''`. . . . . . . . . . . . . . . . . . . . . . . . . at . . .. .. ✓ . .y�. ` . . . . . . ..;-North Andover, Mass. Fee:-�: �.�. Lic. . . . . . . . . . . GAS INSPE�fO Check# 6724 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) u c Mass. Date a City, Town Permit # Building Owner's / °•`��r AT: Location_ f---� S--j Name & Type of Occu ancy: New ❑ Renovation El New Plans Submitted Yes ❑ No ❑ N WN Y Z x N la to cc y ¢ C N F- S F- td J N W H V m Z s �. a >- Z Z O 1- oc x Qom, m to t- W W O G c'. Q W F- C N 0 W Q Y Z l' to > Q 4J W W J Z Q W W CW9 W ~ W V = N J Q ~ N O > W 1. J f W Q OC W W O Z 6 Q a W > O O W O W F- m y SUB—BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check One: Certificate Installing Company Name TnSmcanrl Oil Co . .. Tnr ® Corp. Address 27 CherryStreet � ❑ Partnership Ilan r rG} A O 1 2 � ❑ Firm/Company Business Telephone 978-777-0701 Name of Licensed Plumber or Gasfitter 1pgp b Garry 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 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 1 have a current liability insurance policy to include completed operations coverage. ❑ By TYPE LICENSE: Title Plumber Signatur o icensed Plumber or Gasfitter City/Town ® Gasfitter APPROVED (OFFICE USE ONLY) ❑ Master ❑ Journeyman License Number �` ' Date. ..... .. f NORTH 1 O ti0 TOWN OF NORTH ANDDPVER O � F PERMIT FOR OAS INSTALLATION �,SSAG HUSE�2 This certifies that . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation .t!. . 13.14. . . . . . . . . . . . . . . . . in the buildings of . .�. .�.'.<�.G -I . . . . . . . . . . . . . . . . . . . . . . . . . at . . .` ?. . . . . . . . . . . .I North Andover, Mass. r' Fee.1.1. . . . . . Lic. No.. ) . . . . . . . . . . . . ... '. . . . . . . GAS INSPECTOR Check# >� �� Y 6094 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ,Mass. Date g- 20 ;7 Permit# Building Location V,26S7' Owner's Name Owner Telt Type of Occupancy New Renovation ❑ Replacement ❑ Plan Submitted: Yes ❑ No ❑ FIXTURES u tG , k w x a a 0j cn x 6r t7 w O Zr z z a x a m H w 0 o x o w o L� tr („1 W W co z ¢ x x w w of w H x � x a w Q J Q Z w t ¢ O n) W P .yr O Z O x a = G (C7 � 3 0< 1 ° a > a a° Fw- o w `� 1� SUB-BSMT BASEMENT 1sT FLOOR 2ND FLOOR t 3"D FLOOR 4T"FLOOR 5T"FLOOR t 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name Check one: Certificate Address . /30 V l c- ❑Corporation ❑Partnership Business Telephone# m/Co. Name of Licensed Plumber or Gas Fitter— INSURANCE COVERAGE: I have a cuilenj liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes'F No ❑ If you have checked Yes,please indicate the type coverage by checking the appropriate box. A 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: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true a crura the best of my knowledge and that all plumbing work and installations performed under the permit iss or this applicatiori w' a in cromplian with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the enera Laws. �( i(By Type License: C lumber. Signature of Licensed Plumb r or Gas Fi er Title ❑Gasofffter / &- aster License Number City/Town ❑Journeyman APPROVED(OFFICE USE ONLY) Departzzzerzt of Industrial Accidents r(� Office of lnvestigations o 600 iYashirzgtofz Street Boston, AIA 02111 www.mass., ov/dia 'workers' Compensation Insurance Affidavit: General Businesses A iicant Information ]Please Print Lezibly Y� v // Z 2 Business/Organization Name:�o15Izz_�`- Address: w y- l a °`p6 f 2 - City/State/Zip: ����/� >/ /` Phone #: f � Are you an employer? Check the appropriate box: Business Type (required): 1.(� I am a employer with ,3 employees(full and/ 5. [❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no T ❑ Office and/or Sales (incl. real estate, auto, etc.) employees worldng for me in any capacity. g ❑ Non-profit [No workers' comp. insurance required] 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4)7 and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]* 11.❑ Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other *Any applicant tbat cbecks box#1 must also fill out the section below showing their workers`compensation policy infonnation. **If the corporate officers have exempted themselves,but the corporation bas other employees,a workers'compensation policy is required and such an organization sbould check box 1t1. 1 am an employer that is providing woi-kers'compensation insurance for my entployees� Belolv is tine police it jormatiol. Insurance Company Name: 4_5 Insurer's Address: City/State/Zip: Policy #or Self-ins. Lic. # 5-00O29J FUS Expiration Date: Attach a copy of the workers' compensation policy declaration page (showing the policy number and eFpiration 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 er the pains peva. 1. ofpe7Jury that the Infermatior provided above is true and correct. Signature: Date: Phone#: 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. Licensing board 5. Selectmen's Oflice 6. Other Contact Person: Phone #: www.mass.gov/dig Location No. Date %ORT" TOWN OF NORTH ANDOVER Ota" O 14•G p Certificate of Occupancy $ ��• > �1' + +� Building/Fr me Permit Fee $ "Fo �sACMUSE undation Permit Fee $ Ote`,P4ermit Fee $ Sewer Connection Fee $ } Water.Connection Fee .. , . .TOTAL 4 Building Inspector Div. Public Works Location No. Date Q1 4- MCRTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ ' + Building/Frame Permit Fee $ Foundation Permit Fee $ / J swcMust Other Permit Fee $ Connection Fee $ ✓� Water40TIction Fee $ qn� p . r oke1'c0// Building Inspector e,01Qr Div. Public Works PERi%IIT Nd. 3�'� !APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PA E 1 MAP 4-40. /VG I,)LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK !PAGE / — ZONE SUB DIV. LOT NO. a6/9 F� y,�W,g 1 -JOS 7- LOCATION LOCATION 7 � ��rl�- T PURPOSE OF BUILD NG 5 pn� Q 1 OWNER'S NAME//it-Ijm � V�tTCy .N OF STORIES �1 SIZE 6�y ..�. ��,b��/�.•I. OWNER'S ADDRESS/f �{{VV o OF OR SLAB eY-G AIS e ARCHITECT'S NAME T w oQS G SIZE OF FLOOR TIMBERS IST •^l�(�V 2ND gxyo 3RD ply P' BUILDER'S NAME p � �{- C� 60�-15'Z SPAN 1'3 - d- /" O�/` (J DISTANCE TO NEAREST BUILDING 'tel DVS DIMENSIONS OF SILLS DISTANCE FROM STREET 3* •' POSTS DISTANCE FROM LOT LINES-SIDES W/��d-^� REAR GIRDERS AREA OF LOT ' 16 A L FRONTAGE �Sp• �-7 HEIGHT OF FOUNDATION [ THICKNESS lQ IS BUILDING NEW \ Q CJ' SIZE OF FOOTING !h"x X IS BUILDING ADDITION MATERIAL OF CHIMNEY V ,LLe4n4w4.e' 10,EepA,6 IS BUILDING ALTERATION IS BUILDING ON.SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Yes IS BUILDING CONNECTED TO TOWN WATER rJ 0 7 BOARD OF APPEALS ACTION. IF ANY n,/1 IS BUILDING CONNECTED TO TOWN SEWER �V ,V' IS BUILDING CONNECTED TO NATURAL GAS LINE �(J INSTRUCTIONS 3 PROPERTY INFORMATION RAW FOR FOUM� W LAND COST G'�� SEE BOTH SIDES REGULATED DI PAU 114 "��cW BA EST. BLDG. COST G PAGE I FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 D�iL /r/y�L �y�,PAID f�p � EST. BLDG. COST PER ROOM -FEE- AI SEPTIC PERMIT NO. 5 / ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR • DATE FILED V - ._ BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E gg b �—b- C D�(�, S70 am Pig/n0 PLANNING BOARD PERMIT GRANTED - �b PL M�� 7s �s BOARD OF SELECTMEN P "11T rPt- rnARor mi ti!_niNG sd DATE; 13 '►/ LL7^yD J BUILDING INSPECTOR 'S 3 g3 BuILO'NG RECORD sl' ' 1 'OCCUPANCY" 12 SINGLE FAMILY I STORIES THIS SECTION MU$TSHOW EXACT DIMENSION�SOFALOT AND DISTANCE FROM MULTI. FAMILY QFFiCES LOT. LINES AND•EXACT DIMEW$IONS`OF BUILDINGS."WITH 'PORCHES. GA- APARTMENTS - RAGES, ETC. SUPERIMPOSED. THIS'RERLACES PLOTPLAN..�: CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH ` t CONCRETE1 2a_ Y l t,I _ d -J CONCRETE BL'K. PINE w^"`. BRICK OR STONE HARDW D PIERS PLASTER '�,}'• I.. _ DRY WALL _ UNFIN. i 3 BASEMENT AREA FULL FIN. B M AREA , 1/1 '/Q '/. FIN. ATTIC AREA T NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN aor 4 WALLS I 9 FLOORS C CLAPBOARDS v' B 1 2 3 DROP SIDING CONCRETE __ .� �• WOOD SHINGLES _EARTH __ _ �„(� 'W,-- l ASPHALT SIDING HARDW'D .� ASBESTOS SIDING COMMON 31 VERT. SIDING ASPH. TILE y C _ um STUCCO ON MASONRY L - -� TIMMI _ STUCCO ON FRAME I— A� Oil AWAY{y�(UTA #;ra D BRICK ON MASONRY ATTIC STRS. & FLOOR dl/ * 7 1Q RI LI BRICK ON FRAME I CONC. OR CINDER BLK. •IW. STONE ON MASONRY WIRING TA "I 331 STONE ON FRAME ..,a.... ,�.. .`F�;j SUPERIOR I� POOR TA . ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH Q FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER 17 ROLL ROOFING MODERN FIXTURES TILE FLOOR - TILE DADO r 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H' Ln ""li`•""^ UNIT HEATERS ut„_,1,2,(y��w•�-.•++`�"'+Y+1ui 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC 1st '3rdI NO HEATING 1 FORti U TOWN OF NORTH ANDOVER LOT RELEASE FORM + SUBDIVISION ASSESSORS MAP /Q 1 -7 SUBDIVISION LOT(S) C24 6 ` PERMANENT ADDRESS ASSIGNED BY D.P.W. STREETr��s� APPLICANT �/7-2 lee PHONE 1� DATE OF APPLICATION �fjC�` (� /5 y z TOWN USE BELOW TES L1NE PLANNI G BOARD A AIT; DATE APPROVED TOW PLANIVE DATE REJECTED CONSE VATION COMMISSION DATE APPROVED o 7 ��Z— CON ERVATION ADMIN. DATE REJECTED BOARD OF HEALTH �J�ITA-LL DATE APPROVED HEALTH SANITARIAN DATA: REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS A:65pw ►—(�,�r~.C, ltl �S C� ��'Y FIRE DEPT. L RECEIVED BY BUILDING INSPECTION DATE :21Lli This form shall be signed by the agents of the Planning and Ilealtli llonrds, the Conservation Commission prior to the issuance of any building perml.ts for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. 1JLANW1NU ,__,.. FNA IL CONS E R VAT�P 0,D!, FINAL OR Tiq T awn o _____1 I I(V ndover f 16 , 0 I I, VIA 0 No.321 o ' er, Mass. ITU k"( 14, -1992 '1VEWAY ENTRY PERMIT Y_ _ 410;?/ ?40\1- el ? BOARD OF HEALTH PERMIT s` BOARD THIS CERTIFIES THAT..WjkL0%m "BAft BUILDING INSPECTOR r s r1rar ........................ has permission to erect buildings on Rough to be occupied asskhowrk. 44K..4ftAaC..(44-00C.... Chimney Final provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough PERMIT FOR FOUNDATION ONLY .Buildings in the Town of North Andover. REGULATE!)BY PARA. 114.8-3. B.C. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. ft. ELECTRICAL INSPECTOR PERM EXPIRES IN 6 MONIQW. FEE PAID$/Do Rough UNLESS CONSTRUCTION STARTS Service Final .............. .............. . ... ...... . BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke EET NF1 Det. Building inspector • A0RTfj ' . own of 0 No. A44 iC E over, Mass., 19. � A F BOARD OF HEALTH .PERMIT T LD THIS CERTIFIES THAT k4N t .1!'ftdM..1.`!-.1.7 - .. .11 ... !`l 1. ........... ...4.�i�!'4.a .. AA __-- '' � �©��� �• BUILDING INSPECTOR has permission to erect 4.0-44 ."�A.t... beildh gs on ..l. .... ....... ......... 1 Rough .^�.l.�N1 .. .�!h! !. . ..R�;✓r,� { r;!!! tiJ Chimney to be occupied as.... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration Construction Rough Buildings in the Town of North Andover. / Final VIOLATION of the Zoning or Building Regulations Voids this Permit. 1 PERMIT EXPIRES IN 6 MONTHS 0 ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTION STARTS Service PO, ........ .................�,., Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector rine 1 1'JG WGU i t 34 t Utu U K t tfiX NO, bUKl-)�U�b(1 P. 02 t REVISION: 8/29/92 PURCHASS ANQ SALE AGREEMENT - COMMERCIAL SUBSIDIARY Purchase and Sale Aar-ement made as of this 20th day of March , 1992 , by and between FiZgt parkwau Corporation with an address at 124 Grove Street, Franklin, Massachusetts 0203$-9104 (the "Seller") and Waverly Realty Trust with an address at 671 Waverly Road, North Andover, MA 01845 j (the "Purchaser") . 1. The Seller agrees to sell, and the Purchaser agrees to purchase, the land with the buildings and improvements thereon, if any, together with all rights, easements, and appurtenances thereto (the "Premises") , described as follows: Lot # `s 24A, 25A and 26A Forest Street, North Andover, MA The Premises are more particularly described on Exhibit A attached hereto and incorporated herein by reference. 2 . Included in the sale as a part of the Premises are the fixtures now thereon belonging to the Seiler and used in connection therewith. The Premises and all such fixtures shall be sold as is, and the Seller makes no representation or warranty as to the condition of the same. 3 . The Premises are to be conveyed by a good and sufficient quitclaim deed running to the Purchaser and said deed shall convey a good and clear record and marketable title thereto, free from encumbrances, except (a) Provisions of existing building and zoning laws; (b) Such taxes for the then current year as are not due and payable on the date of the delivery of the deed; (c) Any liens for municipal betterments assessed after the date of this Agreement; and (d) Easements, restrictions and reservations of record, if any, so long as the same do not prohibit or materially interfere with the current use of the Premises. 4 . The agreed purchase price for the Premises (the "Purchase Pricet,) is $ 169, 200 The Purchaser has paid a deposit (the "Deposit") of $ 5, 000. 00 with this Agreement. The balance of the Purchase Price is to be paid at the time of delivery of the deed by certified, cashier' s, or bank check payable directly to the Seller. T i 5 . The deed is to be delivered and the closing is to take place at 10 o'clock A.M. on the First day of May , 1992 (the "Closing Date") , at the offices of the Seller, or at such other location as shall be mutually agreeable to the parties. It is agreed that time is of the essence of this Agreement. 5 . Full possession of the Premises subject to existing tenancies is to be delivered on the Closing Date, the Premises to be then in the same condition as they now are, reasonable use and wear thereof excepted. 7 . If the Seller shall be unable to convey title or to deliver possession of the Premises, all as herein stipulated, or if at the time of delivery of the deed the Premises do not conform with the provisions hereof, then the Deposit shall be forthwith refunded and all other obligations of the parties hereto shall cease and this Agreement shall be void without recourse to the parties hereto, unless the Seller, at its sole option and in its sole discretion, elects to attempt to remove any defects in title or to deliver possession as provided harain or to make the Premises conform to the provisions hereof, as the case may be, in which event the Closing Date shall be extended for a period of thirty days. 8. If at the expiration of the extended time the Seller shall have failed so to remove any defects in title, deliver possession, or make the Premises conform, as the case may be, then the Deposit shall be forthwith refunded and all other obligations of the parties hereto shall cease and this Agreement shall be void without recourse to the parties hereto. The Purchaser shall have the election, at either the original or any extended time for performance, to accept such title as the Seller can deliver to the Premises in their then condition and to pay therefor the Purchase Price without deduction. 9 . The acceptance of a deed by the Purchaser shall be deemed to be a full performance and discharge of every agreement and obligation of the Seller herein contained or expressed. 10. To enable the Seller to make conveyance as herein provided, the Seller may, at the time of delivery of the deed, use the purchase money or any portion thereof to clear the title of any or all encumbrances or interests, provided that all instruments so procured are recorded simultaneously with the delivery of the deed. 2 --:--------------------------------------- ------ aED 17:26 FD 10 0 R E - F amX NO, 508520^2571 P. 04 11. Water and sewer use charges, utilities, rents (if any) and real estate taxes for the then current year shall be apportioned, and fuel value shall be adjustad, as of the closing Date and the net amount thereof shall be added to or deducted from, as the case may be, the Purchase Price. If the amount of said taxes is not known on the Closing Date, they shall be apportioned on the basis of the taxes assessed for the preceding year. 12 . The Deposit shall be held in escrow by the Seller subject to the terms of this Agreement and shall be duly accounted for on the Closing Date. Interest earned on the Deposit shall be retained by the Seller. 13 . If the Purchaser shall default under this Agreement, the Deposit shall be retained by the Seller. if the Seller shall default under this Agreement, the Deposit shall be refunded to the Purchaser as liquidated damages, and this shall be the Purchaser's sale remedy, at law and in equity, for any default by the Seller hereunder. 14 . The Purchaser acknowledges and confirms that it is not relying upon any representation, warranty, guarantee, promise, statement or inducement, oral or written, express or implied, which may have been made by the Seller or others acting or purporting to act on behalf or the Serer or any real estate broker or agent with respect to the past, present or future condition of the Premises, its actual or projected income and expenses, operation, value, uses, maintenance or any other aspect of this transaction or the Premises, and Purchaser agrees to accept the Premises in their present condition, AS IS, subject to normal wear and tear between the date hereof and the Closing Date. 15 . No assignment or transfer of any kind by the Purchaser of this Agreement shall be valid or enforceable against the Seller. Any such assignment, transfer or purported assignment or transfer of this Agreement shall be void and of no effect ab initio, and shall constitute a material default hereunder. 16 . All notices required hereunder shall be in writing, shall be effective upon receipt, and shall be delivered in person or mailed to the other party by certified mail, return receipt requested, to the addresses set forth at the beginning of this Agreement. 17 . This instrument, executed in multiple counterparts, is to be governed by the laws of the United States except wh3re there is no applicable federal law, in which case the laws of the state in which the Premises are located shall govern, is to take 3 MAR-11-92 WED 17:36 FDIC 0 R E FP,X N0, 5085202671 F, 05 effect as a sealed instrument, sets forth the entire contract and agreement between the parties, is binding upon and inures to the benefit of the parties hereto and their respective successors and assigns, and may be cancelled, modified or anended only by a written instrument executed by both the Seller and the Purchaser. If two or more persons or entities are named herein as Purchaser their obligations hereunder shall be joint and several . IN WITNESS WHUEOF, the Seller and the Purchaser have executed this Agreement as of the day and year first above written. SELLER: By: Its 4 MISIT "B" The Agreement is subject to tha Auyer obtaining all state; ltrc�il, and municipal permits required for three buildable lots by April 10, 1992 . If, at the time of delivery of the deed the Buyer has been unable to obtain such permits, then Buyer may elect to extend the closing for a period of thirty (30) days in order to obtain said permits. If, at the time for delivery of the deed the Buyer has obtained such permits but, the time for appealing the grant of any such permit has not expired, then buyer may extend said closing to a date and time not more than two business days following the expiration of such appeal period. If, 'at any time prior to delivery of the deed the appropriate state, local, or municipal authorities, boards, commissions, or inspectors, fail or refuse to issue such permits as are required for three buildable lots or, if after the issuance of such Permits, any appeal of such issuance is filed, then the Buyer may, at his sole option and in his sole discretion, elect to terminate this agreement, inwhich case the deposit shall be forthwith refunded and all other obligations of the parties hereto shall cease and this agreement shall void without recourse to the parties hereto. Purchaser Seller . ` . Purah - --- aser i • iED 17 :7 FDiO 0 R E-- - - -A N0. 50c-_ _- %l '--------- ---J6 EMUBIT A Legal Description of Property Lot# 's 24A 25 - � +�`'J A and 26A, as identified in Plan #10195 in the North Essex Registry of Deeds . 5 EXHIBIT C THE BUYER AGREES TO APPLY FOR A CONVENTIONAL MORTGAGE IN THE AMOUNT OF $84,600 .00 FROM AN INSTITUTIONAL LENDER AT CURRENT INTEREST RATES , POINTS , AND TERMS . IF THE BUYER, HAVING USED ALL DUE DILIGENCE, FAILS TO OBTAIN A FIRM COMMITMENT FOR SUCH A LOAN BY APRIL 15 , 1992 ALL PAYMENTS MADE HEREUNDER BY THE BUYER SHALL BE FORTHWITH REFUNDED AND ALL OTHER OBLIGATIONS OF THE PARTIES HERETO SHALL CEASE. THE BUYER SHALL BE DEEMED TO HAVE WAIVED HIS RIGHTS UNDER THIS PARAGRAPH IF THE SELLER AND BROKER HAVE NOT BEEN NOTIFIED IN WRITING BY APRIL 16 , 1992 OF THE BUYER ' S IN ABILITY TO OBTAIN SAID MORTGAGE COMMITMENT. J � t ASSET NUMBER: 741 365006 PROPERTY: Lot#s 24A, 25A and 26A Forest Street, North Andozer, MA , PURCHASER'S DISCLOSURE OF FDIC INTERESTS Purchaser hereby discloses any and all outstanding or pending claims, debts or legal proceedings involving Purchaser and FDIC. Purchaser further discloses any and all interests of FDIC employee(s) or their immediate family members in this transaction or any contemplated future transaction involving this property. NATURE OF INTEREST: (if none, so state) I hereby affirm that the foregoing is true and correct to the best of my knowledge and belief. Signed! - -------_"__- ` (Purchaser) Signed: (Witness) Date: i E HVWXO SIAL . .IJLANNINU FINAL FINAL NO R T'fy ,.�.®.®.d..--- own o � o T �� n over �GWEWAY ENTRY PERMIT � S��Y k 4. 1992 4h E ndo�er, Mass., G f r I BOARD OF HEALTH PERMIT Tc ' "' I LD THIS CERTIFIES THAT.. .I..k....... OARa �P:�A!Gr,"`� .� }yy .1..,...... 11--,,,,,�__ ' �. �..14�, • ---1 BUILDING INSPECTOR has permission to erect w! �.�. buildings on 4.t.��& 0i .jT............ Rough • /��, �,�1._ Chimney to.be occupied as S/.�.VR*.k4 . ��. .itiZM .... . .: 91 .. N.� !�.... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,AItgRMlT Fans FOUNDATION ONLY Rough Buildings in the Town of North Andover. REGULATED BY PARA. 114.8.5. B.C. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. n� 7� PERMIT -EXPIRES IN 6 M 0 N 1 MN 7 FEE PAID'f/o � ELECTRICAL INSPECTOR Rough INII ESS CONSTRUCTION STARTS service PERMIT FOR FRAME/BUILDING V Final �o ............... .. .............. ......... ......... DATE: " FEE PAID �� BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy, Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by Smoke T j'. Building Inspector CERTIFICATE OF USE OCCUPANCY Building Permit Number Dete�4 THIS CERTIFIES THAT THE BUILDING LOCATED ON �y�j Fa- —rf / �' r. G MAY BE OCCUPIED AS /� IN ACCORDANCE WITH THE PROVISIONS OF & MASSACHU w TTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. NORTH 32 CERTIFICATE ISSUED TO -1 ADDRESS D, /1�Q + r �9SSAC`NUSG9 _ Building Inspector \HWAL PLAN1411-w VP SEWE,9VWA'16"8_ A-10 — I b' :--jo -n T own of 0' .Andover NO-321 ' AVEWAY ENTRY PERMIT �v I IV,,, or, 99p- th-�Aa&ver Mass., Ab CHIC IIEWIC ?SS." BOARD OF HEALTH B,S I PERMIT TO LD 101,3619Z- -7 THIS CERTIFIES TH1T..W.j1LW%%A "BARitell"r BUILDING INSPECTOR has permission to erect buildings on kJ+,4r k� ................................. Rough Chimney All�to be occupied .... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in MUMM�INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of qjh PERMIT FOR FOUNDATION ONLY Buildings in the Town of North Andover. RMULATED BY PARA. 114.8-& B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. 7' 14' 1? IIERMIT .-EXI'IRES IN 6 MON-1041- FEE PAIDf/,Pl* ELECTRICAL INSPECTOR Rough llr,IIESS CONSTIlUCTION STARTS Service ?_7 PERMIT FOR FRAME/BUILDING Final 0 ........�iu ............... .. .... DATEA-416hFEE PAIDA-7% am" BUILDING INSPECTORGAS INSPECTOR O('cupanc ) 1'ernill Required to Occup), Budding Rough L966 Display in a Conspicuous Place on the Premises / FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by STREET NC-oj'� Smoke Det. Building Inspector N\F LOT 25A CERTIFIED PLOT PLAN 1 205.00' 37.15' N\F LOT 24A CLIENT: WILLIAM BARRETT THIS CERTIFICATION IS MADE AND LIMITED TO LOT 2 6 A THE ABOVE CLIENT. EX.FND w A=1.16 AC. w I CERTIFY THAT THE STRUCTURE SHOWN CONFORMS TO THE DIMENSIONAL REQUIREMENTS OF THE 49.58' ZONING BY-LAWS TOWN OF NO.ANDOVER,MA. WHEN CONSTRUCTED. 204.24' ! OFFSETS SHOWN ARE FOR ZONING DETERMINATION N\F LOT 27A ONLY AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR TO DETERMINE LOCATIONS rA OF FUTURE BUILDING ADDITIONS. iD TO THE BEST OF MY KNOWLEDGE AND BELIEF THE PRIMARY STRUCTURE SHOWN ON THIS PLAN IS NOT LOCATED WITHIN A FLOOD HAZARD ZONE AS SHOWN ON FEMA FLOOD INSURANCE RATE MAP COMMUNITY NO.: 2500980010B ATE: 6/15/83 ZONE (IF APPLICABLE) pLAti Of g MICHAEL cy� J. SERGI No. 33M Q 9f STER`� LANA SJ t MICHAEL J.SER .L.S. 1.49' 13.5�' TEMPORARY CONST.ESMT. C H R I S TI A N S E N & SERGI INC. 136.43' 160 SUMMER ST. HAVERHILL,MA. FOREST ST. SCALE: 1 '= 40 DATE: 8/92