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HomeMy WebLinkAboutMiscellaneous - 177 MASSACHUSETTS AVENUE 4/30/2018I/ This certifies .. < ............... .............. has permission to perform ... 4c,-4.�� .........., plumbing in the buildings of. . ....................... at ...... .... H.A North Andover, Mass. Fee Lic. No. PLUMBING INSPECTOR Check # 5% 1 TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING VVORK CITY �+ �7`/L vvtot MA DATE �� 7 _ PERMIT# I/ JOBSITE ADDRESS./ 7 % !/V�-� b��_ OWNER'S NAME OWNER ADDRESS TEL a 7t- 6-a ` V46(fAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ NEW: RENOVATION: ❑ REPLACEMENT: ❑ FIXTURES 7 FLOOR BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER RESIDENTIAL 5�— PLANS SUBMITTED: YES ❑ NO ❑ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 y I have a current liability insurance policy or its substantial equivalent which meets s the requirements of MGL Ch. 142. YES ❑ NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 Massa use eral Laws, and7th signature on this permit appf ationwafives this requirement. SIGNATURE OF OWNER OR AGENT 1 / ry —CHECK ONE ONLY: OWNER ❑ AGENT ❑ I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the and that all plumbing work and installations performed under the permit issued for this application will be in compli ith all P Hent pro ' ' knowledge of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE # �ClS1 SIGNATURE MP ❑ JP Lam' CORPORATION ❑ # PARTNERSHIP ❑ # LLC f 3 COMPANY NAME J Rte, �'-'�' 1 ADDRESS CITY STATE Gy✓' ZIP TEL+7 FAX CELL EMAIL 6-�N N 0-c- 4 \ VV--C-AZA- 4) 7 w. This certifies that v has permission for g.as installation ..... . . . . . . . . .... . in the buildings of ......,, �.cr,, ; .................. . at ... ill ..... r iS�,, , - P, . , , , , ... , North Andover, Mass. Fee Lic. No,'-4511, .. � . i . . . . . . . . . . . . . . . . ... GASINSPECTOR Check # 8692 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY JIV r MA. DATE _ — PERMIT JOBSITE ADDRESS % r /�✓+C_ OWNER'S NAME OWNER ADDRESS: v✓ _ TEL:rl — 6� � 6 �( FAX: TYPE OR PRINT OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL' CLEARLY NEW: [RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXUTRES Z FLOOR Bsmt 1 2 3 4 5 6 7 8 BOILER 9 10 11 12 13 14 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets therequirements of MGL. Ch. 142 YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massac tts General Law�ad�Mygnature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENTS CHECK ONE ONLY: OWNER ❑ AGENT ❑ hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application w' in compliance wi rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: j Su LICENSE # SIGNATURE `COMPANY NAME: e ADDRESS: 't w� � STATE: IW4 ZIP: G FAX: r� 77CELL: EMAIL: ,`] JOURNEYMAN LJ LP INSTALLE�E] CORPORATION ❑ # PART NERSHIP❑ #= LLC 2 a 14 6 � � ` ` , � � ~ ~ 8 ' ! ' � ` ` , � � ~ Date ....7....." ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that...............P. �, h% has permission to perform .... J� /Zl/� .... 4,/'.¢ilQ �/ � �I .C.T wiring in the building of.............„„� SS / /// /�,...................................................................................... 7 7 / r' 4 //ff ,North Andover, Mass. at........................................:5...........!1....v..=....... 6 Fee... --"" Lic. No.....�.................. ...........<1 ................. ELECTRICAL INSPECTOR Check # ? �?i Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL .INFORMATION) Date: � f 6, X 13 City or Town of: NORTH ANDOVER To the Inspector ofMires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 17-7 A14 -'s' /} ChVJJer Owner or Tenant )5&7 A& * Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No[2'/(Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service & Amps a / o7 o Volts Overhead Rf Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters rAhlaA sce/'i l&l t'%kil MOP/ New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,&IT- U1, 7)91PAhd1-e/01 t' 7',4,4rN Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans V No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- Elo. rnd. rnd. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number ­ Tons '���*-- " ' KW " "' "' "''' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:' 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 Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated' Value of le trical Work: (When required by municipal policy.) Work to Start: NOY 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 c!07age. is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE LO BOND ❑ OTHER ❑ (Specify:) X certify, tinder the pains and pen hies ofperjury, that the information on this application is true and complete. FIRM NAME: Pd9ov T ST-:ji lir/ ,Cfea�ll e LIC. NO.: ''o? /d Licensee: /?,4A0 J1-1, JT-, J -el V Signature LIC. NO.: ewl" (If applicable enter " exempt " in the license number line.) � Bus. Tel. No.: Address: 1(/r/ f' ff,d Alt. Tel. No.: l *Per M.G.L C. 147, s. 57-61, security work requires Department of Public Safety "S" License: Mc. 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 PERMITTEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 §Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the Y/ permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed ' on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he i or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: * * * Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass EN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: I Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations .�4F 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print UAW Name (Business/Organization/Individual): b/a `G' 5 71 Address:a?-a �l of, City/State/Zip:. 4 J/PT Phone #: _V Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* or have hired the sub -contractors listed on the attached sheet. t 2. I am a sole proprietor partner- ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. E] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company N Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 'ZAttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a frie 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. Ido hereby certify under the`p'ains and penalties of pt. erjury that the information provided above is true and correct .vCI -� - 1 /i3O,t . �` . Date: 4611 1 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 #: 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 ofhire,- express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the 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 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 tl 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 Massachwetts Department of Industrial Accidents Trice of Investigations Goo Washington Street Boston., MA. 02111 Tel, # 617-727-_4900 at 406 or 1-877,7MASSAFB Revised 5-26-05 Fax # 617-727-7749 wwwauass.gov/dia TOWN OF NORTH ANDOVER Building Department 1600 Osgood Street Building 2- Suite 2-36 Building Dept North Andover MA 01845 Tel: (978) 688-9545 Fax (978) 688-9542 ttORTH ,• ITL.IED 1, �2 6t1 11•- "h� Te 0 O M F A COMPLAINT FOR INVESTIGATION DATE: / o . "Z.0 ll TEL #I �� �f j� r 6a NAME OF COMPLAINTANT: ADDRESS.,:_../ ��C�/���,••�/�Q�� ,'� l %'/%=1:� Jai COMPLAINT TYPE: Electrical: Plumbing: Gas: - , Building: rV SS 9YZ 9 i _ /� 1 Property Owner: ,/�/ c� %DSV J ,9� Address: %/�©�i'I�l �✓`� Ci/'��.� ,r, I%Cl,��,�/, J� B�j��j Other: �w gda Signed: Complaint Form - Revised 6.2007 =fid 9/A%/ TOWN OF NORTH' ANDOVER BUILDING DEPARTMENT APPGiCATtON TO CONSMUCTULA5 ItItNOVA OR DEMOUSH .A ONE OR TWO TAMMY DVMLLING BUILDING PMOM NUNMER DA'C'E ISSUED: I SIGNATURE: Building Commissioner of Buildings Date .SECTION i- SITE INFORMATION 1.1 Prapey Addrtm i o/ 1.2 Aastesots Map and-Parod Number / () )0.0-00lIO -T- M 'Number ap Number 1.3 Toning h* matioa: Zonin District fto5ed Use 1.4 Propcay Dimensions: Lot Arta Fmnu ft 1.6 BUEMING SETBACKS ft Front Yard Side Yard Rear Yard Provide Provided Required Provided 1.7WataSappipMt31.Ci0. 34) 11 Flood Zonetaromatioa: IA SewawDispMfSystem powk a Private a Zone . OacieW Flood Zoo 0 MueWp i a oa Site Disposal Syamm U SECTION 2 -PROPERTY OWINEItSM)AUTHORMED AGENT 2.1 Owner of Record RIU-a . LD^ b _ r ��.1 �� MGAISs Awe., We (Print) Address for Sorvioe : Signature Telephone 22 Owner of R Name Print Address for Service: Si tura Ta! bone S`RMON 3 - CONSTRUCTION SERVICES 3.1 Canstruahon Son r � r _ ✓l Licensed Construction Supervisor. (` 2J- ✓ kt 7 �I Address r� Si elephaae J i- J Not Applicable 0 /� V 2 k i 3 License Number C .6 . n e 3/1 _ 3.2 Registered Fiume Improvement Contractor Not Applicable 0 Registration NNutnbo° t D / �j Company Name n / / c�Jp / Expira ' n Da Si a T orsa 69 M Z 0 0 z M 0 r r r z 0 Workers Com in rho denial 11 1. nation Insurar� avit affidmust be.00mplited and submitted with.this application. Failure to provide this affidavit will result the issuance of the building mit. Si nedaWitAuachcd Yca..,..,.0 No....:..0 SECTIONS Description of Proposed Work chetkell &able New CoA on_o Existing Building Repairs) 0 Alterations(s) 0 Addition 0 Accessory BI . 0 Dernolitiion 0 Outer 0 Specify Nief Descril tion of Proposes Work: SECTION • ESTIMATED CONSTRUCTION COSTS Item Estimated Cost Mollar) to bevCont leted b t a lit7uttYM' 1. Build' C7C9 (D (a) Building Permit Fee Multiplier 2 Electri (b) Estimated Total Cost of Construction 3 Pltmtb' R Building Permit fee x. (b) 4 Mechm. cal NAC 5 Fire Pr tection 6 Total(,+2+344+5).Check Number SECTION's OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT P" Z a.,zt 1.G1.✓Pi , as Ow=lAuthorized.Ageatt of subject property Herebyau "-tiL k— GJ ) et to act on mvhwlt all matters relative to work authorized by this building pyrmit application, Q S e o Owner / ' SECTION Tb OWNERIAUTHORIZED AGENT DECIARATION Vn �C�C___,u Owner/Authorized Agent of subject property Hereby dee, are that the statements and information on the foregoing application ate true and accurate, to the best. of my knowledge and belief Print Name Si o Date 140. OF STORIES SIZE BASEMM OR SLAB SIZE OFF 0OR TIMBERS fir 2NV 3 SPAN DIMENSIONS OF�SRIZ D10 OF POSTS DTMENSI . S OF GIRDERS . HEIGHT 0 FOUNDATION THICKNESS SIZE OFF TII+IG X MLng40FCKWEY IS BUILD G ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department DEBRIS DISPOSAL FORM Tel: 978-688-9545 In accordance with the provision of MGL c 40 S 54, a condition of Builc ing 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 c11,S150A. The debris will be disposed of in: AVC V -6/t& &d0VQ1- o (Location of Fad) Sigy(a&re oaf Perr iit/Apolikant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 03128/2014-00:30 fAX Ein # 51.CS033313 MA Reg. Hit #1219111 IIIA lit. # UCS amity Single -ply LiL # 1711 tool/001 oo f�el.1022 R 265 Winter Simel, Haverhill, MA 01630 We are ✓ licensed ✓ insured ✓ Factory Trained ✓ Factory Certified Installers . Dater OI1S' EVInwrefor: 't'19r-�ir�n�.lL�" E c>&:S ! Telephone 1 Telephone 2:. IAX � v �9-9 - y ';? Address: p L7. (��fi� Ciry/roma ,Jp/ r/7- 6yP./'State;,�Zip: i Cil ro+m r�D✓P,� Slale;, ji/�� Iip: .r Job Locotloa JY�I�.LT L.R.C. agrees to comereQce deudbeda I or about Ov and desalted work will be completed M;bout _ L,..^„wwkinp dayL LR.C. shill not he field Rabb lar delays due to dreunatontas our control, L K shell not be liable for any domage to londmape, atria, interior woUs or ceilings and/at fMura due to dream- storas beyond our control. L.R.L cod will not be hoid liable for any damage to the surface that the disposal tontainer is piamd on. l R.0 shot) not be held liable for pre• aeistiag comliiions irtladifill tut not li mold and/or wood rat, deknive, foalry, tuned or worn building counterparts such os but not limited to siding, guseers, mosongy plumb. Ing, and windows dot fespordize theght fatal tt of the building and are nor covered ender the rooting wormntylite raftavdrg work Indedet:an t er and etftMals naetkd to tArephn Year p► In . pretxdeeel er.rbenuilP as Ae®er. Sae t�ttie9e.te ( 1t► sh ad IWaN dro fepeveteg: Approximate roof alga We N Roof Q Re'roof ❑ Gutter © Repair aHlorlon C3e lar re -roofing by emuring f safety measures oro token in accordance fo OSHA 0andard regulations and landscape is properly protected. p�fCemore existing layers of roof maim cal dome to roof "and inspect wood. If upon inspeototr we dboaver any rotted woad, replacementwill be performad at S—_3- per LF. • ll su fanlial deck rot i3 distovered. re -sheathing of root deck can be performed of S 2 per Sf. ' 0 wood is sound we will eep did prepare for ittslollaliaa. ro - II any loose wood to ratters, s ck an ' n 16" Drip ad" ❑ loon so Drip Edge o Install Hug edge (Re -roots only) *11 11(1 � t £4VI S Color L•r la Irj!i"- - r�r its B want shield (UNDERLA M as per manufoduren' spedfle dont and or 0"'Apply felt paper (Uthe expand mood dark. D4Afiash all stack pipes, tie-ins, chfnt and/or any roof penetrations as requited and ditmed by good roof practice to ensure water doom ass. C) I shimmy base using cement fabric D Re- Q Rs-pointd6imney ❑ Re -build tbimney '�}., tastall a new,,, --P— Taor Troditianal Cf Archneaural style shingle roof system Color ,y�/P� Marl � d "Mbh and lesson a now shingle ov style ridge tram system ❑ Sofit vent system S /'1 Zff "I debris generated 6y Lambert o ,Jrisad. ng Co., Inc. will be dimmed up and disposed al from the job site in o logo( fashion. Under no tirctmsrontas will the watertight it filthy of the building be comp Soedd fb»r r C / C O Warranty options: Ci4mdard l Qg(l�_ Monufacwan Upgrade Detrafie addidoind msec abowdot 4d ass maNd price. UPON COMPLETION AND PAYWW IN ROOFING COMPANY AND This dw inenf I'f#= sign and n NOTE: We accept major credit ( ' A boom charge of U% per i Total Estitowe Prn: S —,6-�,,,-� Paywas N to nude as folfavrrr Naysr6311 MA 975 374-9x24 L T - Cl ROOF SMALL HAVE A iWORKM NSHiP GUARANTEE FOR A PERIOD OF TEN YEARS HONORED AND ISSUED BY THE LAMBERT HONORED AND ISSUED BY THE SHINGLE MANUFACTUREIL m serve ar a cantrad, howsver if a mare elaborate canhad is desk d we wX +ewe ft of the aimers n"W. rat elle mpy upari meplenre. NOM if this twm d is not vaViod in _ dap, it maybe m7hdrorm by LRC " & financing is available! ,*Dile to mwhmft rebl (18% par year) will be chargd oat post due aaeums over 38 don M - Date of Ameploom (HomeAusiness (LRC) costs !here will be a 7-3%sorWm MA 97B-6117-7339 - Aeldnm NN 603462-9500 • 1 -MI -505 -ROOF (767.7663) • Fast: 9713 521.5791 "Our Proof is on ]tour Aloof" writ+. hM&&rdwn/i".eee ,m;{}.{v.+f....v;;.hv{..{.nwn v.v xrw:xr.., .,:.:.:w:{4v}•.v :x : :;r.\:v{:.• vf: ��. r• >. }•. ; r{.: ... S,o}: •.'���•', • "''r. ti! . ,'','y;4,;., }$y{'o'°s�,•��,�.�{�ff^ DATE (MM1DD/YY) •r::. `:: I��C!LZl.�.0 ���:: ?;,•:IY�•,••: •'... :. f::�:• :: %t2tyi :. r. : •.}t 1;'v '•: {;:;::5;?SY{:: •i}:: :•,:f} :}f{•}} "4: y,f:+,h'''�'•t•FA,�:Cff?4�}i 0/12/05 },. t}ri>}..; ..: ••:{{'v: •. . ?: }ifi+},{4{\.vf:r,:: f::v!i'r?\:: }: �:+f fir.+4'Y,{.r ::G•Yf?r{•q`}.•':}'•:f:•:. }:v,{..•.,. {:4{:.: v.?{'?Ai:%i}:}}}:;ti },;;.y r. xw, IODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOYLE INS AGENCY INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 445 MAIN STREET COMPANIES AFFORDING COVERAGE WOBURN MA 01801 COMPANY A NAUTI'LIUS INSURANCE CO SURED COMPANY LAMBERT ROOFING CO B COMMERCE INSURANCE COMPANY T G L R C INC D/B/A COMPANY 265 WINTER ST C HAVERH I LL MA 01830 COMPANY D ..::::: •::.w: n... n..... v:::..:...... \... .:... r. Marv: •:: •: 4•.v?•:f•v;fr;.}•}:ti{4:ti:?i{•X•}:{•Y•. n..�.. fi ..... 4. rc } k,... L•fNrn / rN ..4 v r }r .v }}}Y :; •: ..:.1..... r.. • •%'' / •. : �..• {•F• i•>...,?;4:;f,% . {{.:: X 4;, 4:..;y:•}i?:�}:;:;i i}.0}}:n.. f {}fn .}}: n4; }: n}.; ,.; fh, '�:vv: .i:T vrrr.•i^�.."'{U•�v1 v :{?:. , r . l . xx:::.............r.v}vv::;::•}::::::}}::v:v;};4:.r.::?v:,vv::}}.:r:..n}}Y.:.}v:•}'•}}}fi4;•v,4:w.Y / ..?v. .J'i{ ri!.: v:.'vW.. .���( ,Q�.�6� t :: ?S{>:::rfv.:},:..} r }}� •. Yv {v.. • }.4 r�,S+�y �};vr}}:',{•}:•}r v. .:r}::.. ..,.,}{;..:,:.r:f.:.,,:. ,• .�. • ..f::•:}fi::?::: ..:fir ,r ..4 hvfn�f:•:{'\�i+�f}Sl'•'.^fu{xw n\.::•rk:vf:.. firinx. r}r�'fr.•/?� �4ffr��f��<SSS{ii:K�{i{i�•7'x4G4:4'�vrfiF:4f}{�%YF•}';iit�lfi'rrf:'%f.<iQtr{YivfC{?ii?�v:�:�%x{�v^.'f.•irfiYffnirffk: .:,n4::{4}}h'r�x'i:v"n•.V-0'$:Sf::�i'v'}}..v..,. .. .::fif}:^vi:•r.:. xr}. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE'LISYED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INUICATED, NOTWITHSTANDINC3 ANY -REQUIRE iMtttT--TekM BR-CONE1MON-OF ANY-OONTRAGT(-OR-OTHER=.DOCUMENT WW.RESEECT TO- WHICH. THIS.. . CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY. EXPIRATION LVAITS DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY ) C3 7 4 9 5 7 10/12 /05 10/12/06 GENERAL AGGREGATE s2,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $11000, 000 CWMS MADE OCCUR PERSONAL A ADV INJURY $1 000 000 OWNER'S A CONTRACTOR'S PROT EACH OCCURRENCE $1 0 0 0 0-00 FIRE DAMAGE (Ary gm Iln) $1,000,000 MED EXP (Ary Orr Wmm) i 5,000 AUTOMOBILE LIABILITY Z T 6 915 7/19-/05 ANY AUTO " COMBINED SINGLE: LIMIT; $ ALL OWNED AUTOS X BODILY INJURY $ SCHEDULED AUTOS (Por Ponos) 5.0 0 do 0 X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Por wold") Ili 0 0 0 0 0.0 PROPERTY DAMAGE $ 500,000 GARAGE LIABRftY AUTO ONLY - EA ACCIDENT i OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ _ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND RY LI'TA R ER - :'•: EMPLOYERS' LIABILITY EL EACH ACCIDENT THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL DISEASE -POLICY LIMIT EL DISEASE -EA EMPLOYEE III OFFICERS ARE: EXCL OTHER ;CR"ON OF OPERATroNSfLOCATIONSNEHICLE1/SPECULL ITEMS WORK COMP CERTIFICATE WILL BESENTFROM A.I.M: MUTUAL INS PER WC BUREAU 4}. .. ;...5{}:'S'::is�:4�y':'•:i{•'}4\:Sf\\}Y:`i::::W,{i}'i:'F,.h.\,•fi:{?::.1:{S:}i:::tij':i:':.}vS: .v: r...y: .:::::.. .: . n.: r ::: SY}.r k}}f+ . .,. . ;, ,.•.. . . . .. :: .. ..i.�. ,..{,...;4..:.}i}::.;,Y.,yy .....v ... ..,:. .$}i r ..{....... \r ...rr.::.........i.%. } : %}S.. ..3 .:* :.A.vM . 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St•::. }..,.. :.....:: /.'s 'hv.......... ..,,,: ..�.Y, :•:, .+,: {{}.,.:;{.9. •:r rr r..•r ., :.:,::,::. r. .. ,..:. ........ ...,. ..}?. .. ... ..... .. .:.. .r r.. .... ....FM7iM�xFr.? .^,.,. :. ; . : , a •:: {..{f,. +Yui?$2{.}}..,+Y r.�;,• •r.4?•::4• •.: M..{....x.%v.{....:..: \.xC,.sy.::.: f{•::.v::::.1Y•..v.:v.Kw:}}:::::vm{v{{w::::tvX•,v,.},::.:.:{.r.::4.,::::w:::v:}::::}::}.:.4f}vk}}.,x4.,K•}}:ti4:?i {4If.•}} ?4'ff::i/f.;.',.ffr.,:Try}iu:}v.•i:•}}}}}if�f�n1::: v::i}W�.�',�n�?:i}y:,{+i: v'ii.Y,v:rx:},riser:x}nw•�:sv:.vh:v%4:::tvv�nr4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTI T CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MA�IL%$UCH OTIC IMP ENO OBLIGATION OR LIABSIIY' OF ANY KIND. U. 0 NIS OR REPRESENTATIVES. AORDfD REPR A H Gerard/ FF A •: r.,r?Y'£ rr:+rq.cx•}+::.t4.:ff:Y<}:ffc:4::Ntr:fff.'•9,fa:r:.s}"::nf{{{f,h:::};:,r,.{{{{:4:{{{,Y{..{{{{a{{{{?:»r,.,:•:{.v ;rf,.a:.Y {N, :%{{t:{{rtr k :.v...........:.v . v}rr,.i.:.•; :. rft. ^4.. $: • vi(ifi'•• "• { ?4' x{rrvxrrr .v r: :.:::::: Y4:: ..r:?..:.. {•i.....}} ..;r:.. rrr..:>;••lit{f:... , r.•}r}r:+.;i.:v :. .i•.f• X• ,ff. 4. # ?.. Y f:{...{r. ;rr •.;:: r:..: , r::.}:;.•.,.. .••.• •• a S? ��iti':}:?fi �.�j,��yyy �y �y �y� '�''r: �... .+�. .��•.•�.:. .i}`.i>isn?+ix'4"v'•:i}r`.'v'r{:Yti}v''i}:vL:''iiL:f:ti{v'ii:ii:f:i::i4:{'{>.>':f f v: :...... h........n, ......:.........nh ...... .. ..... }...:.; ........ 1':iiYiff: f}..r :}:.v�.•%vr.:v: f: }: r}: ::: }r ... ....... .. ::};'�,:R�A1Ii'I.ia„N,.;L}?NR�#:i�ifii�V{► .CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Boyle Insurance Agency Inc DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE P O Box 606 Woburn, 06 01801 INSURED T G L R C Inc dba Lambert Roofing Co. COMPANY A.I.M. Mutual Insurance Co LE'TT'ER A 37 Stevens Street Haverhill, MA 01830 COVERAGES: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER1viS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIl&TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/)DNY) POLICY EXPIRATIOT, DATE(MM/DDNY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE S PRODUCTS-COMP/01` AGO. $ COMMERCIAL GENERAL LIABILITY 'JAIMS MADE�CCUR PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ OWNER'S & CONTRACTOR'S PROT. j] FIRE DAMAGE (Any one Bre) $ MED. EXPENSE (Any one person) S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S BODILY INJURY person)S ALL OWNED AUTOS EDULED AUTOS BODILY INJURY Per °refer) S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ MBRELLA FORM HER THAN UMBRELLA FORM WORKER'S CONDENSATION AND Ltmrrs MSTATUTORY X 7.:_, A LNIPLOYERS'LIABILITY rKE PROPRIETOR/ X MCL PARTNERS/EXECUTIVE FFICERS ARE: EXCL 6009966012005 08/28/2005. 08/28/2006 EL EACH ACCIDENT $ 500,000 EL DISEASE—POLICY LIMIT $ 500,000 EL DISEASE—EACH EMPLOYEE $ 500,000 . OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VMUCLES/SPECIAL ITEMS CERTIFICATE HOLDER KCANC�LLATION+ / SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE - -t. EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE T N 0 c H �h WD s.� ,. W w o x CO u z o C2 U u. U G X U U w W C2 v c1 w w a x O a C w A a w v CO z V) v v 0 U) i E Ma t_ CO) y m C> c m 0 a c �G N CD t r.+ O Z O 5 f !01 CO CM I c� co p� h O � 'E m m CD CD ID �3 CD CD p O O d CL cmQ ca c ev CL cl CD C Z tsO 0 CL V y O C C C c H p uj 0 uj U) W LLI ce W U) Q o m W_ � mlA W �E C.3 m C#* a y i E Ma t_ CO) y m C> c m 0 a c �G N CD t r.+ O Z O 5 f !01 CO CM I c� co p� h O � 'E m m CD CD ID �3 CD CD p O O d CL cmQ ca c ev CL cl CD C Z tsO 0 CL V y O C C C c H p uj 0 uj U) W LLI ce W U) Location No. C� �� S� Date 1 O 1 a I O'( NORTot TOWN OF NORTH ANDOVER Oi.c D Certificate of Occupancy $ Building/Frame Permit Fee $ `3 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 O Check # ZMb 17 0 I f Building Inspector r + TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �1>!E S for Otis Use 0if BUILDING PERMIT NUMBER: 02� DATE ISSUED: C9 SIGNATURE: C6-,C,— Building Commissioner/InseEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: I %�l On 1.2 Assessors Map and Parcel Number: qg Map Num Parcel Number /�� �!/C 09/0 AzA b9— -Ne- 1.3 Zoning Information: 1.3 Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ,Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2- PROPERTY OWNERSIiIP/AUTHORIZEDAGENT Ui`triCt: 2.1 Owner of Record Z6 me (Pri Address for Service iI,?-_ 19 tgnature Telephone 2;2 Owner of Record: E AName Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed.Construction Supervisor: Licensed Construction Supervisor: Address _ Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company ame ' Registration Number Adhress a Expiration Date Signature Telephone 00 M ic z O r SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2! Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... ❑ SECTION 5 Description of Proposed Work check all a cable New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ this application. Failure to provide this affidavit will result Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ . I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - F.STIMATRD VnNCTR1T('T11nN f'ncTQ i Item Estimated Cost (Dollar) to be Com leted by permit applicant OFFICIAL USE ONLY 1. Building 0Ro0 0 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x iblf 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number "'".aivi� is'L,TV" nnvinViu��►iiVt� 1V IfE l V1YlYLElEll Wli11V I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Herebv authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION .1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name of Date NO. OF STORIES SIZE BASENIENT OR SLAB SIZE OF FLOOR TINIBERS 1' 2' 3 SPAN DIN ENSIONS OF SILLS DINIENSIONS OF POSTS DINIENSIONS OF GIRDERS _ HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 1 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: _odvation of Facility) i Signature o Permit Applicant Yate' NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Town of North Andover • Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax Please print. DATE /")/",4-0 JOB LOCATION "HOMEOWNER Number PRESENT MAILING Zowt Name HOMEOWNER LICENSE EXEMPTION City Town Address W--779 Home Phone State Map / lot -5-344 Wry Work Phone D` The current exemption for "home6wners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF 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 or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that 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 APPROVAL OF BUILDING OFFICIAL ro Zip Code I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town Perm!UUcensin ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office,Contact person: Phone #: ❑ Health Department ❑ Other E ;`r%, � c o cmc AO O C � gl o C3 CS n c :_ 0 ' o � : •r 0. �Ec C VO .. .. ts n m c%o,, E m m� o • . L`Nal _ O y 16: � 3 .. C_ O y co � C 7 J = C CO y c ho 'Eo m o c nL1 O .00 cm '~ C C cO!ha 32 8 2 7 acz n mor m �: C3yo : f: �Z o 1: ` o n Q � �CL c cooc .o = O CL o N ~ $ Ca O .0.. f m h C co t m w LiJ O � �' C_„ •� ocIra ca E C = Z y O y n • O .0 _ 0 O n,- co :110 M flil w 0 0 ev ts CL y C Co CM C 0 � m m 3� di O L L c. O d cma t+ cc Z m CLCA o a a w A a N G H � a w C w° cit a ca l U w �° w w°' w a4 rw rA o z cn i o cn ;`r%, � c o cmc AO O C � gl o C3 CS n c :_ 0 ' o � : •r 0. �Ec C VO .. .. ts n m c%o,, E m m� o • . L`Nal _ O y 16: � 3 .. C_ O y co � C 7 J = C CO y c ho 'Eo m o c nL1 O .00 cm '~ C C cO!ha 32 8 2 7 acz n mor m �: C3yo : f: �Z o 1: ` o n Q � �CL c cooc .o = O CL o N ~ $ Ca O .0.. f m h C co t m w LiJ O � �' C_„ •� ocIra ca E C = Z y O y n • O .0 _ 0 O n,- co :110 M flil w 0 0 ev ts CL y C Co CM C 0 � m m 3� di O L L c. O d cma t+ cc Z m CLCA a v wvilI'IIM rIamac Tel: 978-688-9545 Fax: 978-688-9542 COMPLAINT FOR INVESTIGATION DATE: �;�/2�,� FROM: Rs, 41v.,v v,N ADDRESS: / 7:3 lvll -sslq c h u s el—1-s A v />'a : iii✓d �v.�,�'; r��• c i�'y�_' Complaint Against: ELECTRICAL: PLUMBING: GAS: BUILDING CONTRACTOR: Tel #: ei ---") 6, i% BUILDING CONTRACTOR: j_ ROPERTY OWNER: owes A OTHER: / 77 f11r-1--sS�^ r� u --is �5/ Signed:. Complaint form 4.03 RECEIVED NOV 2 4 2004 DI M mutt n or I As 6 ( C) -8 c9 ___AqA- - /r1 VO WEEKLY TIME SHEET (Exempt Emplc eguii�rbuT[5 37.5 Regular Sick Vacation Hours Hours Hours Sunday Monday 7.50 Tuesday 7.00 0.50 Wednesday 7.50 Thursday 7.50 Friday 7.50 Saturday Totals 37.00 0.50 0.00 �Atltlif�©!�#�� �OUtS'V�'GIC@t Sunday Note: Monday Tuesday. . ,J . Page 1 of 1 McGuire, Mike From: lou rossi [eddyl2@comcast.net] Sent: Wednesday, December 08, 2004 9:35 PM To: mmcguire@townofnorthandover.com Subject: copy Mr. McGuire, I would like to request a copy of the complaint form filed for 177 Mass. Ave. Also, could you please provide me with the name of the attomey representing my neighbor. Thank you, Lou Rossi Fax -978-779-2859 12/10/04 d Is MORTM o� ,�.o ,•1�0 ee o a SSACMUS Date. !G :-?� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING � r This certifies that ..�.�... �.... x%'...... . has permission to perform plumbing in the buildings of.//�r'�--d- ..................... . at .I.. . "�?:......'.. , North Andover, Mass. ...... Lic. No.. / I PLUMBINJ SPECTOR Check # I7 (" 5702 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO -DO PLUMBING �1 (Type print) NORTH ANDOVER, MASSACHUSETTS /' �e Date Building Location / `z? i� A -S S /� Owners Name I"�!WIC 1 W -i f, Permit # Amount cd Type of Occupancy BnjAk New rl Renovation ! Replacement ID/ Plans Submitted Yes No FIXTURES (Print, or type)/� /� Check one: Certificate Installing Company Name D, g, IL" i4w � Corp. Address ` Partner. Business Telephone 7$1 — 9 7S _ (, ? Firm/Co. Name of Licensed Plumber: , Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: - Liability insurance policy Other type of indemnity ❑ Bond ❑ ro 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 11 Agent F1 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 MassacyfolState Plumbing a and Chapter 142 of the General Laws. �s�' ' BySignature ot Licenseaum er Type of Plumbing License Title 2-g City/Town icense TNurnoer Master u Journeyman 0 - APPROVED (OFFICE USE ONLY I (Print, or type)/� /� Check one: Certificate Installing Company Name D, g, IL" i4w � Corp. Address ` Partner. Business Telephone 7$1 — 9 7S _ (, ? Firm/Co. Name of Licensed Plumber: , Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: - Liability insurance policy Other type of indemnity ❑ Bond ❑ ro 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 11 Agent F1 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 MassacyfolState Plumbing a and Chapter 142 of the General Laws. �s�' ' BySignature ot Licenseaum er Type of Plumbing License Title 2-g City/Town icense TNurnoer Master u Journeyman 0 - APPROVED (OFFICE USE ONLY Date... "2...).F. �.� .... TOWN OF NORTH ANDOVER -� PERMIT FOR GAS INSTALLATION s o • ,ih This certifies that .................: has permission for gas installation . ��............ . b in the buildings of ...: . = ............................. at ......... ..� , North Andover, Mass. Fee:.( ..... Lic. No.."" 'GAS INSP6C OR Check # . /y 44-)6 MASSACHUSETTS UNIFORM APPLICATON FOR PERAW TO DO GAS FfynNG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations -7 -7 1141+-sS Ay- k �,, r Permit # Amount $ Owner's Name 7P f �� New ❑ Renovation Replacement Plans Submitted ❑ (Print or type) Name of Licensed Plumber or Gas Fitter pZ1111/y).7 one: Certificate Installing Company CD Corp. ❑ Partner. ❑ Finn/Co. INSURANCE COVERAGE Check one. I have a current liability Insurance policy or it's substantial equivalent. Yes Er No❑ Ifyou have checked yes, please indicate the type coverage by checking the appropriate box Liability insurance policy 1�y 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 ❑ --j w, uaj --"- alt — l.t., t,.. Ia a„U AIMM,,auani i „aVF buu„uucu kvr en[CreQ) In anove 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 Massachusps tate Gas Code aS&gh9pter 142 ofthe General Laws. OVER (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber I aY 2-8 ❑ Gas Fitter License Num5er �1vlaster ❑ Journeyman