Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 1849 GREAT POND ROAD 4/30/2018
�O ,M1!�T !!�,�. {�M. -fc:-:,:..meq; -:T:.'i. ,8s�, f... - }.M-. ;y.,�.yr.et� n Date .Oy ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ��'l�..�....``..... ......... ..... ... . ........................ has permission to perform ........ .................................................................................................. wiring in the building of.... <s.......44.:.... . ............... orth Andover, Mass. .......... ........ .... .... . .......... Fee ... 76 .. 5 .......... .... Lic. No. .................. ....... ......... . . .......................... . . . ....... ... ELE cL. INspEcrOR Check #c2?(o4,P, 12392 % �_�f,�,,,/7� Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS 01 (Please add zip codes & electri ft1$ cell #; contract # & bid permit # if applicable.) On Permit No. Occupancy and Fee Checked :ev. 1/07] (leave blank) ��- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PL,PASE PRINT IN INK OR TYPE ALL. INF RMATION) Date: `j .2a /L�/ Ci or Town of: /C p f City � �iVe O��P To the Inspector of Wires: By this application the undersigned gives notice of his or her intention o perf the ectrical work described below. Location. (Street & Number) Owner or Tenant Telephone No.17 3e 2-S�D Owner's Address U fl --21-/ Is this permit in,conjunction with a building permit? Yes ® No ❑ (C eck Appropriate Box) Purpose of Building _ e s Utility Authorization No. /6R0%gyp Existing Service Ams / Volts Overhead Amps ❑ Undgrd ❑ No, of Meters New Service UD Amps o)qol "Volts Overhead ❑ Undgrd No. of Meters Number of Feeders and Ampacity Vocation and Nature of Proposed. Electrical Work: Attach additional detail i -desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: -I� Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAG : 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 certio, under the pains and enalties o erju'�°; that the i formation n this application is true and complete. FIRM NAME: LIC. NO. Licensee: L Signature LIC. NOAW,�?C) (Ifapplicable, e�{er "e e t e tic a tuber ine.) Bus. Tel. N �9 7 Address: �,(� . /�O X /� �G��i�G ^ ' Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: _T 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 a ent. Owner/Agent Signature Telephone No. [�___OWT FEE: $ S� Completion of the following table may be waived by the Ins ector of Wires , No. of Recessed Luminaires Generators KVA . No. of Ceil.-Susp. (Paddle) Fans o. o Total No. of Receptacle Outlets Attach additional detail i -desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: -I� Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAG : 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 certio, under the pains and enalties o erju'�°; that the i formation n this application is true and complete. FIRM NAME: LIC. NO. Licensee: L Signature LIC. NOAW,�?C) (Ifapplicable, e�{er "e e t e tic a tuber ine.) Bus. Tel. N �9 7 Address: �,(� . /�O X /� �G��i�G ^ ' Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: _T 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 a ent. Owner/Agent Signature Telephone No. [�___OWT FEE: $ S� Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA . No. of Luminaires Swimming Pool ove ❑ n- ❑ rnd. grnd. o. o Emergency LFg9ing Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas .Burners ' - o. of Detection an Initiating Devices No. of Ranges. No, of Air Cond. otar Tons No. of Alerting Devices g No. of Waste Disposers eat Pump Totals: .,,:,um,,:er " ' " ons """...... """ """""""""""' o. o e - ontaine Detection/Alerting Devices No. of Dishwashers. Space/Area Heating KW Local ❑ unicipa ❑ Omer Connection No.. of Dryers Heating Appliances KW ecurity ystems: No. of Devices or Equivalent No: of Water KW Heaters o. of o. o Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunica ions Wirmg: No. of Devices or E uivalent OTHER: Attach additional detail i -desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: -I� Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAG : 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 certio, under the pains and enalties o erju'�°; that the i formation n this application is true and complete. FIRM NAME: LIC. NO. Licensee: L Signature LIC. NOAW,�?C) (Ifapplicable, e�{er "e e t e tic a tuber ine.) Bus. Tel. N �9 7 Address: �,(� . /�O X /� �G��i�G ^ ' Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: _T 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 a ent. Owner/Agent Signature Telephone No. [�___OWT FEE: $ S� The Commonwealth ofMassachusetts - Department of Industrud Accidents Office of Investigations 600 Washington Street Boston, MA 02111 - www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibly Name (Business/Organization#Individual):_ Rice & B o d 1 1 and Electri c, Tnr• Address: 37 Stevens Street City/State/Zip:_ Haverhill, MA 01830 Phone#: (978) 372-8734 Are you an employer? Check the appropriate bog: Type of project (required): . L ®I am a employer with 4. ❑ I am a general contractor and I 6. $6 New construction ' employees (full and/or pari -time).* 2. F1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. x 7. E] Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions • required.] officers have exercised their 3. ❑ 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.QRoofrepairs• insurance required.) t employees. [No workers' 13.❑ Other comp. insurance required.] -Any applicant that checks box#1 must also fill out the section below showingtheir workers' compensation policy information. T Homeowners who submit this affidavit indicating they Ric doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. f'-) S. M Policy # or Self -ins, Lie. #: E QC (oaf - LAW -N ' S -Qt j � 9A.- Expiration Date: 7o1'Site Address:�`��-Q�p�,� City/State/Zip:_ Qp .f)0(jt Attach 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 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 ofup to $250.00 a day against the violator. De advised that a copy ofthis statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert under the pains and penaltles ofperjury Aat the information provided above is true and correct. Suture: �_:� . 0 Date• -a�-1y Phone Official use only. Do not write in this area, to he 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. PIumbing Inspector 6. Other - - Contact Person: Phone #: �1* 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-com -complete and rintecl le ibI . ThdD - aitiiieiit'IfCs- r6vided a s ace at the bottom P p g y p p- p --- 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 (ifnecessary) 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. Anew affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum 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: Tho ComJ4031wealthofM-assachwetN Dop.artment offadustdal .Accidents O fRoe of IaVestigat iona 60G Wmbigtm Street Boston} MA, 021 Z X TO, # 617-72.7_4900 at 406 ox 1-877,MASSAFE Revised 5-26-05 Fax # 617-727-7749 .f .p: Date.. ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has -permission to perform .................. N--, -A u--1 i`��1 -P, ........... P ................................. wiring in the building Of .... . .......................................................... ............................ atAndover, Mass. kJ Fee.............................. Lic. No. ................. ............. ELECTRICAL L CAL INSPECTOR Check# 219-- 1 27 19 _ 127 3 � Commonwealth of Massachusetts Department of Fire Services BOARD OF FERE PREVENTION REGULATIONS (Please add zip codes & electrician's cell #- contract # & bld permit # if applicable.) Official Use Only Permit No. 12111 Occupancy and Fee Checked :ev. 1/07] (leave blank) T— APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: L/ —,9 — /V City or Town of: IVO'? 7/ A vel To the Inspector of Wires: By this application the undersigned gives notice of his or her intention t perfoym the el ctrical work described below. Location (Street &.Number) y9 ti Owner or Tenant V //0 Telephone No41?g?2 'SDOU Owner's Address Is this permit in conjunction with a building permit? Yes JZ No ❑ (Check Ap -iate Box) Purpose of Building P/VP S'fROle f Utility Authorization No. /,&-7-h003 / Existing Service Amps aWo / A ,) Volts New Service -/DU Amps /. Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Al Overhead 0 Undgrd ❑ No. of deters Overhead ❑ Undgrd ❑ No. of Meters No. of Recessed Luminaires ,,...,.X No. of Ceil.-Susp. (Paddle) Fans uuec ,,,u ue wutveu o the inspector o nares.., No. ofTota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑No.—OTEmergency Ligliling rnd. rnd. Battery,Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o etect�on an Initiatin Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pump .Number .. Tons K No. of elf -Contained Totals: Detection/Alertin Devices No. of Dishwashers.Space/Area Heating KW Local unicipal ❑ Connection ❑ Other No. of Dryers Heating Appliances KW Security S stems: No. Devices No. of WHeaters KW o. of No. of of or Equivalent Data Wiring: Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total ITelecommunications Wiring: No. of Devices or Equivalent OTHER: Ailacn aaatnonai detail ii desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work; (When required by municipal policy.) Work to Start: V Q--1�1 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, uW7insanddies q verjrry; t the information on is application is true and complete. FIRM NA0/((* JLIC. NO. Licensee:Signatur LIC. NOep% O(If applicabnse number line.Address:G ��� Bus. Tel. N . Alt. Tel. No.: k *Security ystem Contractor License required for this work; if applicable, enter the license number here; 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 [I owner's agent. _ Owner/Agent Signature Telephone No. I PERMIT FEE: $,5 F 0 a`r`k The Commonwealth of Massachusetts Department of Industrigl Accid&ts Office of Investigations 600 Washington. Street Boston, MA 02111 www.massgov/clia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElecWcians/Pliunbers Applicant Information Please Print Legibly Name (Business/Organization/Individual)."' e I Address: City/Stat,"\,A Phone #: Are an employer? Check the appropriate box: Type of project (required): ,you 1. M4 am a employer with ��-- _ 4• ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. �• ❑Remodeling ship and1ave no employees These sub -contractors have 8. ❑ Demolition working forme in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its 9. El Building addition [No workers' comp. insurance required.] officers exercised their 10.f -Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c.152, §1(4), and we have no 12.❑ Roofrepairs insurance required . ] employees. [No workers' 13.0 Other comp. insurance required.] ,Any applicantthat checks box#1 must also fill outthe section below showing their workers' compensation policy information. 7 -Homeowners who submit this affidavit indicating they Aire doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer• that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name% \CYN Policy # or Self -ins. Lic. 9: �-A O CDS S Expiration Date: I i —1 t 1A Joob Site Address: \SSA •s ''� P�`(�a -Pity/State/Zip:_ 0. PVV\, "Ae- .(\NS_ Attach a copy of the workers' compewation-policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL 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 maybe forwarded to the Office of Investigations of the DIA. for insurance coverage verification. I do hereby cert& under the pains and penalties ofperjury that the information provided above is true and correct, Sianature•��-�---- Date: Phone Official use only. Do not write in this area, to be completed by city or town official. City or Town: PermMicense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6 Other - - - Contact Person: Phone #: .•a Information and Instructi®ns 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(I) states "Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the performance of public work until' cceptable 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 certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cant' workers' compensation insurance. If an LLC orLLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain, a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate he. 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. lu 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 "a11 locations in (city or towh). " 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: Tho CoaoWeaihof iassa.,huetfs Department o ndustdal Accidents OfMe OfloVeStigatIM,% 600 Washii on. Strut Boston} MA 4.2111 TW # 617-727-4900 @9 406 or 1-877- A4ASSAY Revised 5-26-05 Fax # 617"727'7749 �W W..l>�aS�,g4vfdia. P- , 10563 Date... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that. ... 0.,A.4j ..... ..... .... ...... ... ................ .... .... ...... ... has permission to perform .......... )"� 9-0 �A JVN� .... I ... V .......................... ................................. J plumbing in the buildings of ..... at .............1.i . ... ....... gra-� .... plvnj .... North Andover, Mass. ..... . ........................ ............ ..... .... .... FeeLic. No. �.VA.5 ... ... M.............................................................. P PLUMBING INSPECTOR Check# N77 ;4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE-�A PERMIT# 1� JOBSITE ADDRESS OWNER'S NAME nZz ell POWNER ADDRESS i TEL FAX TYPE OR YE COMMERCIAL DI EDUCATIONAL © RESIDENTIAL OCCU7RENOVATION: PRINT CLEARLY NEW: REPLACEMENT: Q PLANS SUBMITTED: YES ® N0� I FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM I _._M ,.___._) _-_ J-___.,_ ( f . _ __1 __JI DEDICATED GREASE SYSTEM _._� _ _._ ; I { If DEDICATED GRAY WATER SYSTEM f .. ( DEDICATED WATER RECYCLE SYSTEM DISHWASHER f _f DRINKING FOUNTAIN FOOD DISPOSER _.__..I ._.._--.1 __._.__.I K___1 ------- -__--_FLOOR/AREA FLOOR/ AREADRAIN I 1 ..___ __.._._I _..__ I I � 1 _ I _.._.. .._ _.__. __...--) . f ___--__I INTERCEPTOR (INTERIOR) __J ___ _ _I __.._._..__i ____J _^` ___.._._$ ...... KITCHEN SINK LAVATORYf J__--I -- - f-- ROOF DRAIN .__...___ E ___ __4 SHOWER STALL f -_ _i _ ___f _____.-f .._.._f _-_.._I _______I __I ___t .____.� __.-...-_t I f SERVICE / MOP SINK _-) f _._ ____f __J __j __..__._f �_.� __f __._j __._._j ._—_ ..-__-- ._._____f __._^1 f TOILET t URINAL WASHING MACHINE CONNECTION _ _t I __.. _ f WATER HEATER ALL TYPES WATER PIPING _ I _ ` f .___-.. _ _.__._. _.t _- t f _.E_.I __A __ _j I ..-_.__f --I I f INSURANCE COVERAGE: have a liability insurance its current policy or substantial equivalent which meets the requirements of MGL Ch. 142. YES O'NO Q IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY'4 J OTHER TYPE OF INDEMNITY 0 BOND M OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT IEII SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true an curate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli an provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME P I LICENSE # D I SIGNATURE MP Er JP 0 CORPORATION F] PARTNERSHIP D# ; LLC Qt#i COMPANY NAME t�' _ ADDRESS G,..-,,, C, CITY( �/!/�® I� !1 �_ j STATE ®ZIP C?3�S ,- it TEL FAX III CELL —� EMAIL Ij OX� Z�� H U W ��4 a w � o r] z tn O L W a z u LU 3 U) W CL Co 3 Co O z a a w a U J IL a Cl) z w f- a F O z O H U a a a � V The Commonwealth of Massachusetts Department oflndustriglAccidents Office of Investigations 600 Washington Street Boston, MA 02111 UT www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):� Address: �� ^,N K lk / r 1ve City/State/Zip: i(/,! Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. El am a general contractor and I 6. ❑New construction ' yees (full and/or part-time). � have hired the sub -contractors ❑Remodeling 2. I am a sole proprietor or partner- listed on the attached sheet. t ship and' have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its g, ❑ Building addition [No workers' comp. insurance required.] officers have exercised their 10.❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.[i Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they Ace doing all work and then.hire outside contractors must submit anew 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self ins. Lic. #: Expiration Date:. Job Site Address: ,City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to $250.00 a day against the v lator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for inso4ce coverage verification. I do hereby certify under Phone #: that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Y Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Pers 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 of hire, - express or implied, oral or. written." An employeiis 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 producedacceptable 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 numbers) along with their certificates) 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 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 bum 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 Massa hmetts Department of Jrxdustda.1,A.ccidents Office ofInvestigations 600 Washington Street Boston, MA. 02111 TO. # 617-727-4900 ext 406 or 1-877,7MASSAFB Revised 5-26-05 Fax # 617-727-7749 wwwanass,govldia J Date... ...................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Thiscertifies that ................................................................................................... has permission for gas installation ... inthe buildings of .......................... ........ 14 . .................................................................... I at ......................... ........ . M .............. ...................... ............... I North Andover, Mass. . .... ... Fee ....60 . .... Lic. No. M . ....... . .... .............................................................. GAS INSPECTOR Check# t'�M 9336 vy) INFRARED HEATER . . . . . . . . . . . LABORATORY COCKS MAKEUP AIR UNIT OVEN ...... ...... POOL HEATER ROOM / SPACE HEATER" L—A' ROOF TOP UNIT TEST __j J UNIT HEATER L LINVENTED ROOM HEATER WATER HEATER --6T—HERF .... ....... - .. . .............. . ..... . ...... .. .... ........ . ... ... . ..... INSURANCE COVERAGE hava current liabili!y insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES d'NO I I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF CO�HECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY [j BOND F-1 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER F-] AGENT Ell SIGNATURE OF OWNER OR AGENT 4r I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurawl , _!5Ke best of Ty knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with al I vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAMEq est . . . . . . = LICENSE #�p� _ —SIGNATURE MP Ud'*MGF E] JP D JGF Q LPGI CORPORATION Ej# PARTNERSHIP E]#= LLC []# COMPANY NAMEQ�e, ]ADDRESS CITY I Ale STATE ZIP TEL V FAX CELL EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY OCL. MA DATE I Lj,,L1-LJjPERMIT #. JOBSITE ADDRESSNER'S OWNER'S NAME G OWNER ADDRESS TEL® TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: ZRENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES NOE] APPLIANCES I FLOORS- I3SM' 1 2 3 4 5 6 7 8 9 10111 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE LU DIRECT VENT HEATER . . . . . . DRYER- - - - - - FIREPLACE FRYOLATOR FURNACE . . . . . . GENERATOR r=l I P INFRARED HEATER . . . . . . . . . . . LABORATORY COCKS MAKEUP AIR UNIT OVEN ...... ...... POOL HEATER ROOM / SPACE HEATER" L—A' ROOF TOP UNIT TEST __j J UNIT HEATER L LINVENTED ROOM HEATER WATER HEATER --6T—HERF .... ....... - .. . .............. . ..... . ...... .. .... ........ . ... ... . ..... INSURANCE COVERAGE hava current liabili!y insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES d'NO I I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF CO�HECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY [j BOND F-1 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER F-] AGENT Ell SIGNATURE OF OWNER OR AGENT 4r I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurawl , _!5Ke best of Ty knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with al I vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAMEq est . . . . . . = LICENSE #�p� _ —SIGNATURE MP Ud'*MGF E] JP D JGF Q LPGI CORPORATION Ej# PARTNERSHIP E]#= LLC []# COMPANY NAMEQ�e, ]ADDRESS CITY I Ale STATE ZIP TEL V FAX CELL EMAIL O z 0 H U W a � w • o El z O Fl W } f- W O w p LU W z a w a LU O > w � w U) Cw,7 z a o a a icy U �[ J a IL a � � w = w H LL w H zz z H w a O U Commonwealth of Division of Registr. Board of PluMbILIQ JAMES 1A 3 BREN NEWTON, Master Plu PL16085-M 05/01/2016 License No. Expiration Date. 005323 Serial No. MAY/28/2014/WED 11:34 AM FAX No, P,002/003 Sl. CERTIFICATE ON LIABILITY 7 UR6"R C,S+m 1'M{S CE{iIFICME fS E - !M- A3 A NA 3' 33 ..6.0 WOR{f ATKA ONLY AND CC�Pif -3i� �d 3 3?3Gi3!.S :PON 7'f t� iFfi3'!3 fait f �. F'O� CEfi. TW'S GERT?PtCAT* iDO 3�EU:f 1,3-Fi333>.+flc:Tfb7'3.Y OR NTGA` WELY �t3tiE??r+; z"<T3 ?dEl op. m �"F%2 S ?F COVERAGE- AFF tlRriEa �l' 'F' 3 3�C1E fC{iC. 3? Cit+tl. YMS CE{�7ifdi�l IE OF if�{WR,C{VLE 3�OE5 NOT :cONS'1i10F. A CONTRACT E3E3V,?FiZts Tiff. t�i.':t{3K IN.LSU ERf2 +j, AUT:40RIZED 33�Evfi£Ss Pd3 ,T3+i f;�i PROUI 3C ER. AND73 ii -t CMTEF;i! iA F 3�t3:_ `EfY, ---=-- - - =- R,---.. _ 3PL3't1nl.NF: tfi: i to �;c>iiFl��aft h?7dsr t r AtiD11'10�ut i- it�Ei3RE S3. the Tsai y.(!6R). �tt5' .k:: C.n•.:'(ime 1, 3f St.3MMi.Tl, N 5 1fuAPVEi', su,jzCt IS) ?s a :vm;c and 4; r,ti t3ass:af tf+e.�nf;ry; e�rtairt Ela < f�:: cfssy rtgtiis ar. arT�nr�farne�2 A s{9.ement ion fts, asr{:ficaleceS Zmt-;;^nfQr'i W' t:, sig ;:crfSi.af.� 3ToI��r fry 3ia;; .�::�);r•;1.4ndu)sptrlt;fsrtsj. ; ;�soqL'L-£a Kin r11:s::cii. Zsiwi.srizn Anpancy .'Kis-sgs tors .S N�i:Y�fr:2t:lli2 V • 4rT fM'Zj --'---����• __ ________ L�i�. �.��l. ..... ' d:.-s::a:: C;k::ncstazi�s�e.�:�ro -- - -- --------- - ii+iStjRF_r:_; ) A6F»f!L'!NGi:JY�i2.`.'GE :NA1C' a IN3ZiRcR,A MG 131.48 115 2 _14', ,NS> JRER c : --- ----------- F--FSCNAi.2 Ail f4Jl[i'ii - - - - ---- . 1NSWLFik r.; fioi), rtn0 -------------- FR ;c':C�'s= C�tde+r3? �3c; - --- _Z:, . ':, Sst?t>, f1CQ t>ri.siEE76LGES. r;E3cf3fft;�f3 .fFiiRit333:`1x.�4?EOr74? (m rulA $ TC ERT! -y TkAT TPF .P L!c.; ; , ;NS ;R;�•'::.> [ LHS-FED4- -�-..! i qc -c -- =' = �...--- 3.'-.JLi IJ ,IE CI! Io�l D F� flit i..lti�tU:dhf4iFC.48C't�E FCR 7Tfc �JL;GY Pcy{afi :N_ CA.TED NOPPATf °Ti N'u1�Ii3 A.NY KEQU!RFMENT, TF RQ rR CCttp;TECf+1 OF Nein (,!XVfRA T C? r'T1t .: L.���=ll�A('RY VV:.?i SPEC Tf. t�;r:;CH THiS i;EF i I.QATE MAA" BE SSfic.(J t;R MAY PEP"AIN Ti'_ INSUIRM .F. ?.F��1 1)C== 3T TffE ?C'�f'^t=S .L'ESC K1Fl 7'r_.El2EIN i6 Si1%.f C '?C' AL. <k ERSviS. Xr�U .GW A,IV7 COND: ONS.( SUCH r C::: `1c.` -;. MAY HAVF 0,c*EN REDUCR FY %=Ai C; -A;',',$. L�f21•fl'pE:;cah154nlidC£ i •W' i.rhT ?% CfAWt I>PO LG_Nf•nL'.e„L;r:-?vsnitr R ----- _:: ,REP9iS_SfEzG:.^aifc'.'�GU• -- I F--FSCNAi.2 Ail f4Jl[i'ii - - - - ---- . DERE "M. AG G,.r ,ATF fioi), rtn0 .^,F`': At .f a�Gh = Lanrc �.:•r . cs.f•> a.. FR ;c':C�'s= C�tde+r3? �3c; - --- _Z:, . ':, Sst?t>, f1CQ - A!F(UYICtF7ti.�r .. .. �-------------- ria;: _ .fv ------ . .- ' S1b tw=:� - �i•1 : I �. - ... i.._ PJTgS. AL'TC+ct.... WtUn AUTO: . : ?fill FRt`' vAf C,4(Gt CU C+tiE?i^r I '� t t R�C:E�3t_:.43 �.•=.r�!,+,t?iu1E:L�c: ; ,i.1X --=--...------------------ GY,C'FVfdiC�:.^_v't7lFSiCS'k`finN _ -- .. AII^ �NS�LV� l•�.S' :.v4 S 1'ft' 4N'!.�<J�RIETOfflf•:,h':,ftt'Lti�cv.:TlVc � :J=rt^i•f!IUF:+d'c�u'cY.rLULEv% --------•.- --^i--"-^=^"--•----`�... : ; ° S PJ:'- T i H .-. �-'- -------'--..-__ L-.:_'cn^H:.SL:Ci�'cNT —.�;N:7i: _ _+ yes, ti:-isi.: r:��amr,�• C.!_ f�13E!�^,-c - F_�. �is;�i..iY'r"F -- i ncS(`T;'?'SOh''i7F6iP•2i.T!�i�yh:'ir.• — -'--------- -' C'i8ck°r' F^i tt;v LC:4T $ . ; J; 'Ac5Ca.-tPYfi,NC:^i)dF.'?'?yjC;•i:.UCitT14F15;�JSEStCLCf,yA.Ba:hAOCU:C'.:D'1.X121[ivratF`irinwtis$e7tvi}i[r: �7roafes z:,eisLs_ -.._... i •. . - -•---. .-_ .—., �E�iIT•T:i3 �iCZti:�,S LP.�� „CORD 25 ; S9aht$f :i!!tY•iS.Z We � �F i'ii% 6. 0k't..6Ek ;'CRIN;�f) POWCMS SC'.ANCa;UXO UErfIt2. THC CXPRANCPubn.4'',c. THwFRr-7QF, NQTiCk WW_ gE. ;R;RJt_ZCD Y\. 4::f ORDAti,C VV;T 4 ME t C < 5,1' 9�tf3+l�tiff iS. r�r!sr n:raYr, -----.-... 11 ThPAPORP.nanw i�id. fugo 21m x�l i rSP�U.i� iif:acXs �3 �►GfJnE3 ;f2Ll'ffi.?f�i. A33ri�3�es;x�aKttf• Y/28/2014/WED 11;34 AM FAX No, P,001/003 From: ATTN ffiX TRRnSMISSIOR 5/28/2014 11:32:35 AM Brittney Flaherty Kingston Insurance Agency TOWN OF NORTH ANDOVER REGARDING JIM BAHRAKIS- CERTIFICATE OF INSURANCE !/j Date .... . .. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that J ...........................cit ................ .... . .................................. has permission for gas installation . ........ ele�; in the buildings of ....4):e.... . . ... ........................................................................... atat ............ 2 .......... j(&.4.f.7 . ... . . ..... .. I .. %orth Andover, Mass. Fee ... Lic. No. A.57 .......... ................................................ GASINSPECTOR Check# /095--V 9430 G TYPE OR PRINT CLEARLY APPLIANCES 7 BOILER BOOSTER MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY .SSU MA DATE — - PERMIT # C] .JOBSITEADDRESSOWNER'S NAME TEL! (ern FAX OWNER ADDRESS (® 5� r,,.� 5 OCCUPANCY TYPE COMMERCIAL EDUCATIONAL I RESIDENTIAl i t': NEW: RENOVATION: [I REPLACEMENT: 0 FLOORS- BSM 1 1 1 2 1 3 1 4 CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER _ROOF TOP UNIT TEST 21 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER PLANS SUBMITTED: YES[J— NO[] WWI. ,l l'l!Im INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES iD NO IIF YOU CHECKED'YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY: OTHER TYPE INDEMNITY BOND 0? OWNER'S INSURANCE WAIVER: I am aware that the Ii c "see does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E—J: AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and.E and that all plumbing work and installations performed under the permit issued for this application will be in complia. e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME, O�C�nh vT..wy " LICENSE #LL MP ® MGF ® JP [] JGF LPGI CORPORATION jam# _ PART SHIP.,?# COMPANY NAMEI To Lj.n �, n 1 ADDRESST CITY I Gay rr� STATEZIP,TEL' FAX j CELL�l �EMAIL rate to the best of my knowledge a!I Pe nen. pro v ion of the LLC # xx i .41 i The Commonwealth of Massachusetts Demff Iaus6rial Accidents nt o Uf Zce of Investigations 60 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aug aM t la&rffiltion. Please. Paint Legibly Name (Business/Organization/Individual): Townsend 0.3.1 Company, Inc. Address: 27 Cheery Street PO Box 9.0 Are you an eemp%yer? Check the apps 1. ® I am a employer with 6.0 employees:.(full and/or part=tune):* 2. ❑ I ain a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required:] 3. ❑ I am a homeown T.doing all work myself. [No workers' comp. insurance. required.] t Phone #: 978-777 4. [] I -am a-geaeml contractor and I have,hired the sub -contractors listed on. the:attached sheet. These sub -contractors have employees:and have workers' comp. insurance.'* 5. We a corporation and its officers have exercised their right.of exemption per MGL c. 152, §1(4), and we have no eniployaes. [No workers' *Any applieant thatchecks box # 1 must also fill qu#:the s t Homeowners xdro snhrrnt this afiidavit'iridreatingYhey s tConUactors that chock ihts boli utust at&6h6d an -ii ifioi employees, if ia. tocs Neve emptayees . eY i I am air empMyerlharls providi ig-wworlaers' information. Type of project (required): 6. New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roafrepairs 13. ❑ Other workers' compensation.goticy information. Hire outside contractors must submit a new affidavit indicating such. ofthellsiibmconftaddrslrfd state whether or northose entities have wo -Ims' comp.:polky number. rnstrr formy employees Below hi thepottcy "9)4sete Insurance Company Name: h er^ tel _._. Policy # or SelMns. Lic. #: ? w C o �� Expiration Date:_, _ ��f Job Site Address: L � 4 On �' City/StatelZip: C,A e_ Attach a copy of_the workers' co *4 r n page (showing,the polity. number aced expiration date). Failure to secure Coverage as req t€ urger Seetaen 25A of MCI. c. W can lead to the imposition of crimuial penalties of a fine up to $1,SQ0.00 and/or one-year egiigriso0mit, as woil as civil penalties. in the form of a STOP WORK QRtiBlt and ti fine of up to $250A a day agaertst Hite. viola -Ow a copy of this statement may be forwarded to the Office of lavestigations of. the DIA for insuraht a covers�t; Yo Modtion. I& in orrhatianFrOM04aboveis true and correct. use only. Do not write in this aril to Ae et� by city or town ofieial City or Town: PermittLieense ## Issuing Authority (circle one): 1. Board of Health 2. BuildingDepart mt 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Phone #: Toy, wa. 6c� 1 , j - �ua-k.c Propant TanK 978-372-8898 p.2 N/F SOPHIE PAPHEY \ ` i - >>1 LOT I 121,534 S.F,* 18(47) GREAT POND RD Lu r vy MAP 35 LOT 4 8K 1042 PG 465 14, 93 P ge RE r..- .162x3 App-lue f z6l� 0 .157 •147X4 PROP. ROOF `PROP. —155 RUNOFF INFILT. EE U 1�k CHAMBERS '-,..*.UMIT OF WORK JA 14 xq PROP. ........... ' PROP. ()I e412 10' ()F.& S 22' i,WALL . _ 4X5 wo 0. !A7 PROP. S.F. N 0<rl AB r 4-5 BEDRO SILL -144.5' 24" 9 42' !A8 H av T. P. #1 ts I jA5 Al t 1 *7 upx3 1 .NO -DIS PROP- I.r-C'- STMED HAMUS AND SILT FENCE wf Ula F OF WORK A2 AQAd 145 137 FND LINE: BVFF'D j25x8 --- AM- -91 DX TW, AEAT gmp= IG. OND " 'EX. ShIH -123X1.EDGED 37cE OF PAW 'I 17,31a PKA!"ic123xl 7— 909?ffl61q- 65! WIDE ) .................... MCK I!— JAM B ro 5 STREET S9 sa6 r - --h 202 -YZCE CF RDw. PROP. T.EC. C. 9.3 STAKED HAYEIALES 92 LA" C("WHEWICK AND SILT FENCE 0 CA 1, t : r i V1.1 I (�v, -e- lta,-V 11W-429 100' 13.14W. BUFFER. av PROP. CONS' SE ENTRANCE SHEET BVFF'D j25x8 --- AM- -91 DX TW, AEAT gmp= IG. OND " 'EX. ShIH -123X1.EDGED 37cE OF PAW 'I 17,31a PKA!"ic123xl 7— 909?ffl61q- 65! WIDE ) .................... MCK I!— JAM B ro 5 STREET S9 sa6 r - --h 202 -YZCE CF RDw. PROP. T.EC. C. 9.3 STAKED HAYEIALES 92 LA" C("WHEWICK AND SILT FENCE 0 CA 1, t : r i V1.1 I (�v, -e- lta,-V air �t�r , �,r ;�►�1, Date .2 14 2 Checl<45/jO. 27387 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector it t Of �10RTM '9 Pte# BUILDING PERMIT �� b,4``�°0 " TOWN OF NORTH ANDOVER ° r APPLICATION FOR PLAN EXAMINAT+ Permit NO: Date Received ON I ��1 �9Ss� Date Issued: (i cHus I ORTANT: Applicant must complete all items on this page LOCATI No N t i t Print PROPERTY OWNER ' SIL y IF D MILI L L. L) PrintA MAP NO: PARCEL: q?b ZONING DISTRICT: Historic District 'yes go Machine Shop Villaae ves �N TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building J40ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Others: ❑ Repair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Other ❑ Septic ❑ Well .Water/Sewer ❑ Floodplain. p Wetlands ,Watershed District 1Lti n OA Ft Jn vs �= df x `-( 2 3 6' ,-LL r- A :a Ak .. _CIO jL� Gi f l,n l s �j FcS�r•� N A4I, � -e- Identification Please Type or Print Clearly) OWNER: Name: fl�P ✓L= ' ) -14-u CL O Phone:9 7 Q) 3 D o Address: CONTRACTOR Name: 7 Phone:8_00 Address: , r�". rX rv� ► -� ; rte %j e, 11 Supervisor's Construction License: Exp. Dater OS'97o3 C1 Iq I Home Improvement Licenser - Exp. Date r I ARCHITECT/ENGINEER La $ A/C= J 0,1Y CS Phone: '%$ -t? Z Address: /0 (<oe -:5-Y G/631 'lue"IALIAu Reg. No. ! < < FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. ! O Total Project Cost: $—y�`EE: $ -i Check No.: Receipt No.: ` NOTE: Persons contracting with u registered contractors do not have acc ss toffe anry fund PlansSubmitted>❑ .-Plans Waived -0 "_Certified Plot Plan ❑ Stamped Plans ❑ TYPE—:OP SEWERAGE D Comments Public Sewer Tanning/Massage/Body Art El Swimming P001s El ll Tobacco -Sales El •Food Packaging/Sales ❑ -P--ri�ate:(septic tank etc,*.❑ Permanent Diimpster on Site ❑ ! i =THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM 4T, PLAN r�IING & DEVELOPMENT` COMMENTS N -: DATE REJECTED DATE:APPR.OVED q.Grjer oie,i7S .CONSERVATION Reviewed on 3�\ COMMENTS C7- �- — �Q ®O ,� �k HEALTH COMMENTS iture - cZ1n -5 Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments ater Sewer Con nectionisi nature & Date , Driveway Permit ` ;..DPW 'g'o`o Engineer: Signature: Al 7 Located 384 Os ood Street FIRE DEPARTMIr N =Temp Dumpste"r on side no Located at124Mair`Str'eet 1 �� r.< .:yes r' r Fire De"partme►�t t »� ♦ C011fM.ENTS- - t •. r t. -Dimension _. Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land -area, sq. ft.: -ELECTRICAL: Movement of. Meter, location, mast or service drop requires approval of ..:Electrical inspector Yes No ®ANGER ZONE LITERATURE: =Yes No MGL -Chapter 166. Section 21A=F and G min.$10041000:fin.e NOTES and DATA — (For department use I ■ Building Department The fo6wing is a list of the required.forms to be filled out for the appropriate. permit to .be obtained. Roofivg, Siding, Interior Rehabilitation Permits u:' 13,Uilding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or G.S.L Licenses ❑ Copy of Contract ❑ Floor Plan.Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster..permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apo•ial period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buil ing PI -Mit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED f -PLANNING & DEVELOPMENT COMENTS CONSERVATION ❑ ❑ COMMENTS DATE APPROVED ❑ V DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments i Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street Ii a Energy Code: Location: Construction Type: Glazing Area Percentage: Heating Degree Days: Climate Zone: Construction Site: Great Pond Rd North Andover, MA REScheck Software Version 4.4.3 Compliance Certificate 2009 IECC North Andover, Massachusetts Single Family 16% 6322 5 Owner/Agent: Designer/Contractor: Steve Dehullu Dehullu Homes Groveland, MA Groveland, MA Compliance: 10.2% Better Than Code Maximum UA: 481 Your UA: 432 The % Better or Worse Than Code index reflects how close to compliance the house is based on code tradeoff rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum -code home. Gross Cavity Cont. Glazing UA Assembly Area or R - Value R -Value or Door Perimeter U -Factor Ceiling 1: Flat Ceiling or Scissor Truss 1172 38.0 0.0 35 Ceiling 2: Cathedral Ceiling 936 38.0 0.0 25 Wall 1: Wood Frame, 16" o.c. 2178 21.0 0.0 96 Window 1: Wood Frame:Double Pane with Low -E 377 0.280 106 Door 1: Solid 70 0.300 21 Door 2: Glass 42 0.300 13 Wall 2: Wood Frame, 16" o.c. 1218 21.0 0.0 58 Window 2: Wood Frame:Double Pane with Low -E 201 0.280 56 Wall 3: Wood Frame, 16" o.c. 384 21.0 0.0 22 Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2009 IECC requirements in RESchesAc Vers' 4.4.3 and to comply /with the mandator quirements listed in the REScheck Inspection Checklist. ` a F s J I 3r/ a e- Ti a Signature Date Project Title: Report date: 03/06/14 Data filename: C:\Users\kmonaco\Documents\REScheck\dehullu - great pond rd n andover.rck Page 1 of 4 REScheck Software Version 4.4.3 Inspection Checklist Energy Code: 2009 IECC Location: North Andover, Massachusetts Construction Type: Single Family Glazing Area Percentage: 16% Heating Degree Days: 6322 Climate Zone: $ Ceilings: ❑ Ceiling 1: Flat Ceiling or Scissor Truss, R-38.0 cavity insulation Comments: ❑ Ceiling 2: Cathedral Ceiling, R-38.0 cavity insulation Comments: Above -Grade Walls: ❑ Wall 1: Wood Frame, 16" o.c., R-21.0 cavity insulation Comments: ❑ Wall 2: Wood Frame, 16" o.c., R-21.0 cavity insulation Comments: ❑ Wall 3: Wood Frame, 16" o.c., R-21.0 cavity insulation Comments: Windows: ❑ Window 1: Wood Frame:Double Pane with Low -E, U -factor: 0.280 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 2: Wood Frame:Double Pane with low -E, U -factor: 0.280 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1: Solid, U -factor: 0.300 Comments: ❑ Door 2: Glass, U -factor: 0.300 Comments: Air Leakage: ❑ Joints (including rim joist junctions), attic access openings, penetrations, and all other such openings in the building envelope that are sources of air leakage are sealed with caulk, gasketed, weatherstripped or otherwise sealed with an air barrier material, suitable film or solid material. ❑ Air barrier and sealing exists on common walls between dwelling units, on exterior walls behind tubs/showers, and in openings between window/door jambs and framing. ❑ Recessed lights in the building thermal envelope are 1) type IC rated and ASTM E283 labeled and 2) sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. ❑ Access doors separating conditioned from unconditioned space are weather-stripped and insulated (without insulation compression or damage) to at least the level of insulation on the surrounding surfaces. Where loose fill insulation exists, a baffle or retainer is installed to maintain insulation application. Wood -burning fireplaces have gasketed doors and outdoor combustion air. Project Title: Report date: 03/06/14 Data filename: C:\Users\kmonaco\Documents\REScheck\dehullu - great pond rd n andover.rck Page 2 of 4 �❑ Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. Air Sealing and Insulation: Ll Building envelope air tightness and insulation installation complies by either 1) a post rough -in blower door test result of less than 7 ACH at 50 pascals OR 2) the following items have been satisfied: (a) Air barriers and thermal barrier: Installed on outside of air -permeable insulation and breaks or joints in the air barrier are filled or repaired. (b) Ceiling/attic: Air barrier in any dropped ceiling/soffit is substantially aligned with insulation and any gaps are sealed. (c) Above -grade wails: Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier. (d) Floors: Air barrier is installed at any exposed edge of insulation. (e) Plumbing and wiring: Insulation is placed between outside and pipes. Batt insulation is cut to fit around wiring and plumbing, or sprayediblown insulation extends behind piping and wiring. M Comers, headers, narrow framing cavities, and rim joists are insulated. (9) Shower/tub on exterior wall: Insulation exists between showers/tubs and exterior wall. Sunrooms: Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U -factor of 0.50 and the maximum skylight U -factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Materials Identification and Installation: LI Materials and equipment are installed in accordance with the manufacturer's installation instructions. LI Materials and equipment are identified so that compliance can be determined. L) Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. 0 Insulation R -values and glazing 1.1 -factors are clearly marked on the building plans or specifications. Duct Insulation: LI Supply ducts in attics are insulated to a minimum of R-8. All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R-6. Duct Construction and Testing: Building framing cavities are not used as supply ducts. All joints and seams of air ducts, air handlers, filter boxes, and building cavities used as return ducts are substantially airtight by means of tapes, mastics, liquid sealants, gasketing or other approved closure systems. Tapes, mastics, and fasteners are rated UL 181A or UL 181 B and are labeled according to the duct construction. Metal duct connections with equipment and/or fittings are mechanically fastened. Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three equally spaced sheet -metal screws. Exceptions: Joint and seams covered with spray polyurethane foam. Where a partially inaccessible duct connection exists, mechanical fasteners can be equally spaced on the exposed portion of the joint so as to prevent a hinge effect. Continuously welded and locking -type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). Duct tightness test has been performed and meets one of the following test criteria: (1) Postconstruction leakage to outdoors test: Less than or equal to 208.1 cfm (8 cfm per 100 ft2 of conditioned floor area). (2) Postconstruction total leakage test (including air handler enclosure): Less than or equal to 312.1 cim (12 cfm per 100 ft2 of conditioned floor area). (3) Rough -in total leakage test with air handler installed: Less than or equal to 156.1 cfm (6 cfm per 100 ft2 of conditioned floor area). (4) Rough -in total leakage test without air handler installed: Less than or equal to 104.0 cfm (4 cfm per 100 ft2 of conditioned floor area). Temperature Controls: Where the primary heating system is a forced air -furnace, at least one programmable thermostat is installed to control the primary heating system and has set -points initialized at 70 degree F for the heating cycle and 78 degree F for the cooling cycle. L1 Heat pumps having supplementary electric -resistance heat have controls that prevent supplemental heat operation when the compressor can meet the heating load. Heating and Cooling Equipment Sizing: Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial Building Mechanical and/or Service Water Heating (Sections 503 and 504). Project Title: Report date: 03/06/14 Data filename: C:\Users\kmonaco\Documents\REScheck\dehullu - great pond rd n andover.rck Page 3 of 4 ,- Circulating Service Hot Water Systems: Circulating service hot water pipes are insulated to R-2. Circulating service hot water systems include an automatic or accessible manual switch to tum off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: Lj HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3. Swimming Pools: LI Heated swimming pools have an on/off heater switch. Lj Pool heaters operating on natural gas or LPG have an electronic pilot light. O Timer switches on pool heaters and pumps are present. Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar- and/or waste -heat -recovery systems. Heated swimming pools have a cover on or at the water surface. For pools heated over 90 degrees F (32 degrees C) the cover has a minimum insulation value of R-12. Exceptions: Covers are not required when 60% of the heating energy is from site -recovered energy or solar energy source. Lighting Requirements: A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following: (a) Compact fluorescent (b) T-8 or smaller diameter linear fluorescent (c) 40 lumens per watt for lamp wattage <= 15 (d) 50 lumens per watt for lamp wattage > 15 and <= 40 (e) 60 lumens per watt for lamp wattage > 40 Other Requirements: 0 Snow- and ice -melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting off the system when a) the pavement temperature is above 50 degrees F, b) no precipitation is falling, and c) the outdoor temperature is above 40 degrees F (a manual shutoff control is also permitted to satisfy requirement V). Certificate: LI A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R -values; window U -factors; type and efficiency of space -conditioning and water heating equipment. The certificate does not cover or obstruct the visibility of the circuit directory label, service disconnect label or other required labels. NOTES TO FIELD: (Building Department Use Only) Project Title: Report date: 03/06/14 Data filename: C:\Users\kmonaco\Documents\REScheck\dehullu - great pond rd n andover.rck Page 4 of 4 C4 -;- 2000 IECC [energy j( [efficiency Certificate Ceiling / Roof 38.00 Wall 21.00 Floor / Foundation 0.00 Ductwork (unconditioned spaces): POMOWM7=0 Wamw -- am Window 0.28 0.26 Door �? 0�.30,�, 0.26 Heating System: Cooling System: Water Heater: Name: Date: Comments: 01 NORIN . 1 02 n•';r. •• �. i o� 4� SACH�'6 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 662-14 on 3/27/2014 Date: March 18, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1849 Great Pond Road MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Steve Dehullu 32 Benjamin Street Groveland, MA 01834 Building Inspector Fee: PrePaid $100.00. Receipt:273 87 Check :5169 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost G $ 60310,'O0.00) m $ - $ 7,236.00 Plumbing Fee $ 904.50 Gas Fee 100 comm. $; 10,010,0) Electrical Fee $ 904.50 Total fees collected $ 9,145.00 1849 Great Pond Road 662-14 on 3/27/2014 New Home No DIM of, . N 'fi r�O4r.. rr�419 �SS�[INSt CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 662-14 on 3/27/2014 Date: March 18, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1849 Great Pond Road MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Steve Dehullu 32 Benjamin Street Groveland, MA 01834 Building Inspector Fee: Prepaid $100.00 Receipt:273 87 Check :5169 T' i' Z E9—' r O lC O � as �a W. w-, 5 -'� E Q s � � L O iIi c c 0 - MOW: y.J i � d a. ) >_ L N o �: c <n — o -0 > S U rn a -a t s O -•E c • - `y O z CL a► T C O O O = � w�+ .y a1 > O = CL (D O ) y"'O.. m V r+ C L O ._0) . V O C= Q i o O f a = O Q fn � O O O m t LUuq o 'a - O p LLti . d -;5 O O I- .y m t tO z •� O W U m O a LT. N r= �> O J O O_ O C.) O W .a z _ o CO J_ m 2 0Cl) CO Z U W CL Cl) w0 cn cnW CL Z 1: 0 S.: O CLw C 00 0 CL CL �a J 0 Z CL U) i �l Al O 0 u \\ ui z v O `9 wLL CLW 6 m N j u T m 00 d W J W V, L��L \ U y4 Nto O aa) -O C O O t O L O O u c L O C y N cu 0 ` t ; LL N LL OC U LL LL d' N LL d' N N r O lC O � as �a W. w-, 5 -'� E Q s � � L O iIi c c 0 - MOW: y.J i � d a. ) >_ L N o �: c <n — o -0 > S U rn a -a t s O -•E c • - `y O z CL a► T C O O O = � w�+ .y a1 > O = CL (D O ) y"'O.. m V r+ C L O ._0) . V O C= Q i o O f a = O Q fn � O O O m t LUuq o 'a - O p LLti . d -;5 O O I- .y m t tO z •� O W U m O a LT. N r= �> O J O O_ O C.) O W .a z _ o CO J_ m 2 0Cl) CO Z U W CL Cl) w0 cn cnW CL Z 1: 0 S.: O CLw C 00 0 CL CL �a J 0 Z CL U) i w 5t 111 Au J U tu 0 to 151 0- 0 uj (3. 10 LL zi In W. -0 ku -ri ul u 0 - to 0 In Vu , -q,4 1 "1-, -0 i w OE CL o -.0 -L"-j c -pu ii 0 0 o ul tU co lu LU -i Ill 03 tu ID Ll CI, tU , ol -tn- lu tU C J 07 IL iU tnul ku In U) LL A APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION A """°' BUILDING PERMIT # SACMUSE Q ADDRESS/LOCATION OF PROPERTY: 0 Gre-0+ And l\ Q U 0 d J qMap 21 Parcel Lot'Number ,I SUBDIVISION: DATE REQUESTED FILED/READY FOR INSPECTION: I 19- I CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLICANT SIGNATURE Permit Issued to: s� �en_� Address:,° (1 iO4 �,m IV) ROUTING CONSERVATION PLANNING�lj-30—I� DPW -WATER METER1 SEWER CONNECTION 6� DPW MUST INDICATE THAT TH WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST SIGNATURE File: Application for OC form revised Jan 2007 c• PERFORMANCE AIR LEAK TESTING, LLC 100 MCINTOSH LANE HAMPSTEAD, NH, 03841 978-852-7207 Duct Leakage Test Form Client Information Name: S A PN EC—i� 0J1 0 Address: - .'� m> RQ. , City/State/Zip: N �WN Phone: Email: System #1 Location: Type of Test. Total / O to Outside Approx. Floor Area Served: CFM Leakage at 25pa: (� Approx. Leakage for Single System*: System #3 Location: Type of Test: O Total / O to Outside Approx. Floor Area Served: CFM Leakage at 25pa: Approx. Leakage for Single System*: Building Information Address: 1 • +' CAOoq D RD City/State/Zip: N Test Date: Test Time: 30 A/77 Point of Construction: O Rough"N Final System #2 Location: Type of Test Total / O to Outside Approx. Floor Area Served: CFM Leakage at 25pa: Approx. Leakage for Single System*: Combined Results Total Conditioned Floor Area: �oo sq. ft. Leakage Limit: O 6% 08% N 12% Leakage Limit: S�Bq� cfm@25 Combined Leakage**: cfm@25 2009 IECC Compliance: SD�PssO Fail * Approximations for single systems are for diagnostic use only. ** Total combined duct leakage is required for 2009 IECC Compliance. that this test was preformed in compliance with applicable standards. PERFORMANCE AIR LEAK TESTING, LLC 100 MCINTOSH LANE HAMPSTEAD, NH, 03841 �qo 978-852-7207 Building Air -Tightness Test Form Customer Information: p� `� ,> Q1 Name: ��`F� IJ rl L) LL v Address: i 6 � Gta VC *%D Rkp City: N c* Y L Q, State/Zip: j Phone: Email: Billing Address: (if different from above) Street: Src1� City/State: Building & Test Conditions: Date: Time: 1/.,,/o 'Am Floor Area (W): q � Comments: '` �� '\,t\ 4 1 P_W 0 6 {lov S 4 Test #1 Depress:y Press: PrP.-tASt RasPlina PYPSRI IYA' - 34 9 113a1 Bldg Press. (Pa) Flow Ring Installed Fan Press (Pa) Flow (cfm) Post-test Baseline Pressure: Fan Model/SN: Results: CFM50: ACH50: (Pa) Post-test Baseline Pressure: - (Pa) Fan Model/SN: !'�e-Q 'c- c'-_7 1000 Results: C CFM50: ACH50: FA �-. 113 PcN Test #2 Depress: Press: Pre-test Baseline Pressure: Pa Bldg Press. Flow Ring Fan Press (Pa) Installed (Pa) Flow (cfm) Post-test Baseline Pressure: Fan Model/SN: Results: CFM50: ACH50: (Pa) x W LL. O O m N \ O Ll N > N U Q Lry d ? Z 0 m C O to j LLL O M 41 L U _ C LL U d Z Z m D d b0 p or _ C LL 0 y0 Z u W W d0 7 p w G1 > LL v Ln m C LL oc LLJ a0 CA Q O K p LL z CWC C Q p W Uw L i 7 m O z v N y Ln N 41 p E Ln Eq-* rA rA cl O LU U) CD z_ D m i O Cf) to Z V W r CL Z/\ XUJ 0 H V G (n wJ ,oma r+oo r r -W L .O The Commonwealth of Massachusetts F" /&r4JI-o", 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 Name (Business/Organization/Individual): ;�c Address: �' 2-y"ln, Q.m i n !- N City/State/Zip6'goVeJAiJ, WISE- 13 [S -3c Phone #: q. � 9 3; � ZS -000 Are you an employer? Check the appropriate box: general contractor and I Type of project (required): 1.;Z I am a employer with 4. ❑ I am a g employees .(full and/or part-time). * have hired the sub -contractors 6. New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have g, ❑ Demolition working for me in any capacity. employees and have workers9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their 3. ❑ �'�am a homeowner doing all work o 11. EJ Plumbing repairs or additions ;myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] If c. 152, § 1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities'have. employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name ep-�'L► Policy # or Self -ins. Lie. #: / / l/O i� Cq '°f 47 Expiration Date: to &7-k o3 J l�fK Addr ss:t ,1 61_7 po_"1. �' � 7 City/State/Zi : /1/ ,eA ACZ viz. 61'x' r.. p O /,r y Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce^fy under the pains and p5-nalties pfpe5(ug that the information provided above is true and correct. Phone #: % --2 7 2,,S 0 o 0 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): L. Board of.Ilealth 2. Building Department 3. City/Town,Clerk, 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: .1 Rightfax C3-1 11/7/2013 5:52:55 AM PAGE 2/002 Fax Server Ae f" i CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) TMS,GERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER.D THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement A statement on this certificate does not canter rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX SAMUEL J. DURSO INS AGCY 198 MASSACHUSETTS AVENUE (AIC, No, Ext): (A/C, No): E-MAIL NORTH ANDOVER, MA 018 45 ADDRESS: 77L41 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: HARTFORD UNDERWRITERS INSURANCE COMPANY DEHULLU HOMES LLC INSURER B: INSURER C: INSURER D: 32 BENJAMIN STREET INSURER E: GROVELAND, MA 01834 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ItJWREDNAMED FORTHE POLICY PERIODWDICATEQ N07WTHSTANDW ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DWAWW WITH RMPECTTO WFICH THS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE NSUIW CE AFFORDED BY TME POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERNS, EXCLUSONS Ado OOPWTn M CF SUCH POLICIES, LMTS SHAWN MAY HAVE BEFN REDUCED BY PAIDCLAIMS NSR ADD SUB POUCY EFFDATE POLICY DXP DATE LTR TYPE OF1VSURANCE L R POLICYNUMBER (WDD,YYYY) (MIADMYYYY) LIMTS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE � OCCUR. DAMAGE TO RENTED REMISES (Ea occurrence) $ ED EXP (Anyone person) $ ERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 1-1 PROJECT ID LOC ENERAL AGGREGATE $ RODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANY AUTO LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) BODILY INJURY (Per accident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ A WORKER'S COMPENSATION ANDWC EMPLOYER'S LIABILITY YM UB -9956M844-13 10/25/2013 10@5/2014 STATUTORY X UMTS i OT1 ER I ANY PROPEFVTOWPARTNEWEXECLMVE OFFICEPRVEMBER EXCLUDED? ya WA E. L. EACH ACCIDENT $ 100,000 E.L. DISEASE- EA EMPLOYEE — $ 100,000 (M-ftoryin NH) If yes, describe irder DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEMCLES/RESTMCTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 420 MAIN STREET BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVIS10ty8 NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE AGQRD 25 (20i 0ruo) The ACORD name and Ingo are registered marks of ACORD 1988-2010 ACORD CORPM#iCN.--• i4 ffidfits reserved. '4� E® CERTIFICATE OF LIABILITY INSURANCE lli6i2o1�) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Laurel Tousignant NAME: PHONE (978)897-7773 FAAIC No: (978)897-1553 The Getchell Companies ADDR1ESS:laurel@ getchellcompanies.com 183 Great Road, Unit 15 INSURER(S) AFFORDING COVERAGE NAIC # PO BOX 844 INSURERAAcadia Insurance 31325 Stow MA 01775 INSURED INSURER B INSURER C: STEPHEN DEHULLU DBA Dehullu Homes, 76 North INSURER D: Street Realty Trust & SAT Realty Trust INSURER E: 32 Benjamin Street INSURER F : GROVELAND MA 01834 COVERAGES CERTIFICATE NUMBER:2013-2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTYPE LTR OF'�INSURANCE ADDL SUB POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR PA0166034-18 0/28/2013 0/28/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 250,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC 7 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS Ea BINEDtSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB H OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- I 0TH - TORY LIMITS E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Town of North Andover Attn: Building Division North Andover, MA 01845 J. ....—f INS025 /9mnn.m m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Laurel Tousignant/LJT 1:: 4xe{ 2.c._ 1 W 71Joo-ZU'IU ACUKU CORPORATION. All rights reserved. Tho Armon name nnA Innn Ora ranieforarl mnArc of Annon Office of Consumer Affairs & Business Regulation UX'VeME IMPROVEMENT CONTRACTOR pistration: `118273 Type: iration F 21112(15a Ltd Liability Corpd DEHULLU HOMESLLGx , STEPHEN DEHULLU'' 32 BENJAMIN STREET GROVELAND, MA 01834" - Undersecretary r Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Su:penisor I & 2,Famii}� License: CSFA-059703 STEPHEN M DEIfOL �' s 32 BENJAMIN ST GROVELAND WA 0� " {}1 Expiration Commissioner 09/14/2014 3 w odb Q ra CX a I * , 0 LY.L) Z> � qp 2-2 S0.p7.1 c tz m ^ d CL o ® i N tf1 WOL m f S N o -.�,.: = D QJ �V ^^b Ix Q O yj e b V ur4 4bV-4 U% -t—. od0 2 8 to :t am N a f r� w 4 a * , 0 LY.L) Z> � qp 2-2 S0.p7.1 c tz m ^ d as 2 a RCAF o��a mw b: Qcpr7 C -.�,.: = D C 3 N ^^b ,jJ Q O yj e b V .(ato, 3 q) O 0 O S ti C� O U a f r� w 4 a * , 0 LY.L) Z> � qp 2-2 S0.p7.1 c tz m ^ d as 2 a RCAF o��a mw b: Qcpr7 C -.�,.: = D C 3 N ^^b ,jJ a f r� w 4 J O �P P ox ZZ� W a C) 0 EEo ., H F z VpOV� Far. E W'Wa� 12OUO cc adAo~�� 3oa wj � a Quo �aQW� A��••aa C!1 O �Wz3 w p� v a za�.EA0cc o t' — L 4 0 0 ME � k q� Cb C a T a * , 0 LY.L) Z> � t0 S0.p7.1 c tz m ^ d as 2 a RCAF o��a mw b: Qcpr7 C -.�,.: = D C 3 N ^^b J O �P P ox ZZ� W a C) 0 EEo ., H F z VpOV� Far. E W'Wa� 12OUO cc adAo~�� 3oa wj � a Quo �aQW� A��••aa C!1 O �Wz3 w p� v a za�.EA0cc o t' — L 4 0 0 ME � k q� Cb C a T C O 0 LY.L) Z> � t0 S0.p7.1 c tz m ^ d as 2 a RCAF o��a mw b: Qcpr7 C J D C 3 N ^^b ,jJ Q O yj e V .(ato, UD J O �P P ox ZZ� W a C) 0 EEo ., H F z VpOV� Far. E W'Wa� 12OUO cc adAo~�� 3oa wj � a Quo �aQW� A��••aa C!1 O �Wz3 w p� v a za�.EA0cc o t' — L 4 0 0 ME � k q� Cb C a T r C O 0 oi Z> � t0 S0.p7.1 Q' I a RCAF o��a � a a lb r C O Q � t0 O.O o��a how lb 7.6 L A O Fti" zz- O UD q) O 0 O S ti C� O U F-xf*d jo veju,u We g7u"nobar IQ I IQ 14' Pi r` i. a e � z� ,;'r ter-;' �, !��'•'— '_�� � �� �� •. � � 8�. 43$ii i i � s n 31 1� 14 0 1 t 11 � o d pt veju,u We g7u"nobar IQ I IQ 14' Pi r` i. a e � z� ,;'r ter-;' �, !��'•'— '_�� � �� �� •. � � 8�. 43$ii i i � s n 31 1� 14 0 1 t 11 pt „ s UL �xt-ftJ _d v ar--eZl c -- veju,u We g7u"nobar IQ I IQ 14' Pi r` i. a e � z� ,;'r ter-;' �, !��'•'— '_�� � �� �� •. � � 8�. 43$ii i i � s n 31 1� 14 0 1 t 11 dWW aU �zF Q� o3w a0w�W F�aw�� aQC� V z ��a 0 @wa `"Aon z owz z0�o� t� co w8do��w C~N (i-0> AU0 N A �Uz C'n Z F a�AW 3U3zr� pgOzao W�3 awzUxU < .,.A va dFAW wdF W °� x o woZ E✓ d p� � FQ O ,.a O �G A' W OV zw o pp0� Boz zFa wF. �Uz ow od�Q�Wno 0 Z w�C U0 F �aA�� woFo 5 d WAFrA N N fV N w a w "4 OwoN o z 3 O waw, �a�oM f �wo5 W M le ,a J �1 I V �( I - o o . } to N �► z w 3 Q F ., °4 � • -o � F vu, � � �$z ol J Jzw WWim., far, � E.4 O�02�c i o ¢o 0 3 rn .a A U c z a w Z O 00 guAO� �3 d 2 z 0 F"„ ��mw4� ot U�c�o ¢ AO Q M z 00W0 � rn o QW °� ¢z a oE-Y F"zaaw z0 v� wpO� 0 V wcU�t`n z w v�� AQArx Qxw w 'tna Ov°"iC�p � j o zU 0 ¢ od¢E.,A rj 0 -4�8 rwn 0 >Ap w ~�A `i' � O C7 a ?z oa x w x 0 0UF 3 �¢rAAwwa �00 La¢ E -O waa� QOH O H 000 A g w� o ¢ a ¢O��Z0 ox a ¢ cliiwAo� wd `o QO �?w aZvj�O O @ "4[ mzOE-z�Vw oOz U OU O �4F oa60dW W oG WOMF- zZQzwp E' W A o �.a,Nd O a a worn a� w TUU O O F.A �O ccW — . rr� Ow .a oNZ¢t:.Q q�:DW. < A ¢Ew,,,�O a t�;WA ¢W u �d �A owl 03 � WoF�o o w wv�A oow ¢ w w0: in A 0 n d U22reU3uoo Baa '�oAoaoQ a H 0v� rn m�A0 � �A A Zvi ��O U w 00 FU � U � ESA 0 � H F� Ems- ¢z a o�x zw� W O WO0w�O° OF aG�� wQOr OUd U�A4Fi�.a ¢ �n� Ud F W wa Gs,QQw ..E OAC aU r w zw� GgUUO�F,.,z�30 v,d >s � �'d o m��Z�tz �d F �a x zA��'9 ¢ w H ,,.� ,- Co F +� W �,-��¢ �E.w rao..,a A ��H Hat,r� rn O w�..a¢z�3,dQ d �i 00.1 3U� v� dW0. O' dzwrnma �j'e U� WvFia¢Ex+ Q O �'G7o: Uopaw ��} �w. �� p E0.o p�7,� p OZPO, t?v R8W v� �iv'c� wOz` z0 z r� �+ F p�O wfr; U 0°WAA grWnw8ai o Awa o c4 ?wWW� v, OF aq W aaazv�►a -a� O OZ ..ww Z��¢r:' ww rs,a, Az WadtOF wv�Wv-�CGFU ¢HR xzQp4�q� a'"tSwW Av>�wA ooa� O O mQ�aad�wn^w w O wrnA E" U W tixAO FzF UOx Z O O o� HoH a N a Z a .� A� .� N Q <z 0 2 a A wed cq U a a�o�F <Fo"'�.��� osoz �x dao aa� Notaw� ate a�ooa�UO oQo �W�Mooa F- w�a= wHW3�w=zZ 90-,w¢ �z"$'- 9 m Z �w a fir; ww��� �wo A m .W0¢r a �F po W),ew 3wE"a�Z9>'?d ow w A a AQwa° 3w o�� o oz �F�o`�o°o°¢ L4 wO� �rx� v,v FO w va o®p�U��wH* AaZFA'-a� mx°0¢� >z> 00� t7 �e O� a��j wWOG W �04.�•: Zp3 Z $ � O p � SFO .3farw IX -2 Q d� m."as>o�rQraO�v"'"�"a¢vwa00�rU�waNa �.+ E-3�A��'r�rx�'�A D �fs,daCmt�a.AG9Q��r��zAHaWin CD Go Zm �QS'y�4 6�U°A,00w� , • t+ en � M N W c o Q� Sz3W U V@coo ZFWo`�o dp0w00 ! r, W O� 0 �. o Nz z w A4 A a pM p w0 ODoz VIM A00� pzwW `� EypC (�U o+ria �inU3aA, Z U x W� O d z�0 U'A °o 46 O �'Pw �owN� F Uo w��Uv OO a p� a�w� p3 O�Ha z oa a U�. ��• a� � U���U ��a�zU 6z � o w0� A wr�0 a as �OlwFU A;Tq W AOZU Q� Mp o cWW ra w u j LL. A � cz 0. n Q o� o a 0 A a®ce o - J dE- d a v Q N w LIJ a O Nd .1 01. o J CW It sal O � COJ tu a ' 4 ° V vo-£ U'i N 4) as maw � F� a �UF J S U'i N 4) as v ---------� f , -- „ CL