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HomeMy WebLinkAboutMiscellaneous - 200 CHICKERING ROAD 4/30/2018 (4)® The Commerce Insurance CompanySm MAPFRE Citation Insurance Company5m INSURANCE ® 11 Gore Road, Webster, Massachusetts 01570 508.949.1500 1www.mapfreinsurance.com January 27, 2016 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our- Insured: CHRISTOPI-IER-CIFRA-/ DI.ONF,SIA:.CIFRA _ _- Property Address: 200 CHICKERING RD 102B Policy#: YZ8612 Date of Loss: 07/25/2014 File#: MAAJ31-JTCKA6 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. REBECCA MCGOVERN THERRIEN Telephone: (508)949-1500 Ext: 15189 Sr Claim Representative, Property Toll Free: 1-800-221-1605, Ext: 15189 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. January 27, 2016 CIC 254 (Rev. 4/95) MAIL M33 is<r Date..... a��,t.�............................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...:..........:... Irk .l 1r..............................................:...................... has permission for gas installation t" ;.... ka......................................... in the buildings of /� ...................� ......... ................ ................................ at ... 1PP... l r?4: &N ................ -..., Nof th Andover, Mass. ................. Fee. Z'.'.. Lic. No... ... .......'0 ... `:."..........:......... .............................. GAS INSPECTOR Check # . ov" 10388 `I Date ..... /-v h: C TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION a. I This certifies that . -Q/ . ... . .............. .I ...................................................... has permission for gas installation......... -.1 ........................................ in the buildiggs of ................. ...................... . ........... .......................... orth/Andover, Mass. Fee Lie. No., ....................... -GWNG-ECT0R Check 033 7 ca\- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ - P of T! CITY ANDOVER _ ( MA DATE PERMIT # JOBSITE ADDRESS 200 CHICKERING RD OWNER'S NAME KITTREDGE CROSSING C GOWNER �_ ADDRESS I TEL I FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL ! j EDUCATIONAL _ j RESIDENTIAL J CLEARLY NEW:_J RENOVATION: _J REPLACEMENT: PLANS SUBMITTED: YES _J NO _.:LJ APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ _j J _j BOOSTER _� J _ _.j CONVERSION BURNER __.1 j J _ _J �J J —J �� COOK STOVE DIRECT VENT HEATER _ ° I ' DRYER _ 1 _j _? _ 1 __j FIREPLACE ---- - .T-1 - ___j ___ __j ____..I FRYOLATOR FURNACE j __J _A ___J GENERATOR -__1 --_r-1._ _ _.: ___._.J GRILLE INFRARED HEATER ____j .� LABORATORY COCKS MAKEUP AIR UNIT OVEN _____-,j POOL HEATER ]ROOM / SPACE HEATER R OF TOP UNIT ___j _.__.._f TEST UNIT HEATER � J i __J —J _..P_I UNVENTED ROOM HEATER (� _-_1 WATER HEATER a_ R .__ _1 _ _! OTHER 1 —� _ �.( —!� _J . - -j I 4 € INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES . j NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY j OTHER TYPE INDEMNITY _,j BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ._J AGENT _J 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 d urate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp an ' h all Pertinent provision of the Massachusetts. State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JEFF HUTNICK j LICENSE # 15212 SI URE MP %J MGF _,J JP _j JGF _J LPGI .I CORPORATION +1# 3532 PARTNERSHIP -J#_ LLC j# COMPANY NAME: CALLAHAN AC AND HTG �T� ADDRESS 91 BELMONT ST R CITY NORTH ANDOVER ( STATE MA I ZIP 01845 TEL 978-689-9233 FAX j CELL 978-423-6305 1EMAIL PLUMBING@CALLAHANAC.COM ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ANDOVER MA DATE i�- j% I i PERMIT# JOBSITE ADDRESS 1801CHICKERING RD 1 OWNER'S AME KITTREDGE CROSSING GOWNER ADDRESS I TEL z FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL _�j EDUCATIONAL RESIDENTIAL _J CLEARLY NEW:_j RENOVATION: ! REPLACEMENT:.] PLANS SUBMITTED: YES I NO APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ _j __j._.-._. ! ___J .J BOOSTER CONVERSION BURNER COOK STOVE i ! __J I ___._J DIRECT VENT HEATER DRYER _! __-_:d FIREPLACE _j ___j ._ _1 ____j FRYOLATOR.__! �i ,_a_...._ _ I FURNACE _ .1 __j __A GENERATOR_! GRILLE ._.. j I —__1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT _ �l j m_m J __. ! -r_ _.._! .—.—! _ —.) .._.._.. OVEN _j ._,a 1 _1 POOL HEATER _J __J _ — _j __ . I ROOM / SPACE HEATER ROOF TOP UNIT _ _i _ ! _1 .. I .T^i TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER _ _J -.1 _ 1. _a. _ , ._.1 .,.,_.j _! _ 1. ! J _J. _ ! _,JA I INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES IZj NO �! I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY !.J OTHER TYPE INDEMNITY _j BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER _j AGENT .-j SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in cc m li wit all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JEFF HUTNICK _ _ _P� 1 LICENSE # 15212jJ ANATURE MP + j MGF .j JP JGF _J LPGI _j CORPORATION !j# 3532 PARTNERSHIP _ 1# LLC .._j# COMPANY NAME: CALLAHAN AC AND HTG _ _� ADDRESS 91_BELMONT ST CITY NORTH ANDOVER STATE MA ; ZIP 01845 TEL 978-689-9233 FAX __W4_ CELL 978423-6305 1EMAIL PLUMBING@CALLAHANAC.COM RM :;3d9 LSM e Cii.4. iiv:, 43 �Jic 3 tat Gil *� fir, 1 f _►i. osa c $ ` r } LI :;3d9 LSM ul The Commonwealth of Massachusetts Department of IndustrialAccidents (= d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAffr NG AUTHORITY. Applicant information Please Print Legibly Name (Business/Organization/Individual): Callahan A/C 8r Heating Services, Inc Address: 91 Belmont Street City/State/Zip: North Andover, MA 01845 Phone #:978-689-9233 Are you an employer? Check the appropriate box: 1.❑✓ I am a employer with 25 employees (full and/or part-time).' 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.[J I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.❑ I am ahomeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees - 5.E] I am a general contractor and I have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance) 6.❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. n New construction 8. E] Remodeling 9. [1 Demolition 10 Q Building addition I LM Electrical repairs or additions 12.E] Plumbing repairs or additions 13.[:]Roofrepairs 14. [:] Other '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 ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AmGUARD Ins Co Policy # or Self -ins. Lic. #: CAWC604073 Expiration Date: 9/25/16 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 MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: �/�` Date: Phone #: 978-689-9233 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 #• OP ID: PS A� �� CERTIFICATE OF LIABILITY INSURANCE oA111161201 Yj TYPE OF INSURANCE 11!1612015 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. IMPORTANTE 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). PRODUCERCO Foster Sullivan insurance 163 Main St. North Andover, MA 01845 Stephen Sullivan CT Pete Sullivan PHONNAME: AIC, No E4:978 -656-2266 (A/C, No): 978-686-6410 E-MAIL ADDRESS: psullivan fostersullivangroup.com PK(JUUE;F=K CALLA -1 CUSTOMERIDt7: INSURER(S) AFFORDING COVERAGE NAIC INSURED Callahan A C and Heating Services, Inc. Kate Callahan INSURERA:LIBERTY MUTUAL INS CO 23043 INSURER S:GUARD INSURANCE COMPANY INSURERC.: 91 `Belmont Street INSURER D : North Andover, MA 01845 INSURER E : 09/25/2016 INSURER F MED EXP (Any one person) $ 5,00 COVERAGES CERTIFICATE NUMBER: 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 MAYHAVE'BEEN REDUCED BY PAID CLAIMS. I SR LTR TYPE OF INSURANCE FkUUL IN r= POLICYNUMBER POLICYEFF PMIDD P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1;000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_] OCCUR X CBP4016154 09/2512015 09/25/2016 PREMISES Ea occurrence) $ 100,00 MED EXP (Any one person) $ 5,00 CONTRACTUAL LIAB PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'LAGGREGATELIMITAPPLIES PER : PRODUCTS-COMP/OPAGG $ 2,000,00 POLICY- X PCT LOC $ A AUTOMOBILE LIABILITY. ANY AUTO X BA4544035 09/25/2015 09125/2016 COMBINED SINGLE LIMIT $ 1,000,00 .(Ea accident) BODILY INJURY (Per person) $ X ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE (PER ACCIDENT) $ X HiREDAUTOS X NON -OWNED AUTOS $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS -MADE X CU8809334 09/25/2015 09/25/2016 AGGREGATE $ 5,000,00 DEDUCTIBLE $ $ RETENTION_ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER,EXCLUDED? �N NIA CAWC604073 09/25/2015 09/25/2016 WC STATU- X TH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE- EA EMPLOYEE $ 500,00 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 5000000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS? VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it mores ace iire °} ** EVIDENCE ** ° s required) aX # 978 688-9542 TOWN.OF NORTH ANDOVER 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 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 W 1V5t5=[UUV AGUKL) cUKPORATION. All rights reserved.. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD t t t-�- Date .....I...... ... 4 ............ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION :This certifies that ...... A 4.1 .. .. ....... ............. ................................................................ s perraission for gas installation ............................................................................ :in t the:buildings of ............. ✓ ............................... at ... ... ......... ............ �North Andover, Mass. ,Fee,:. ........ Lic. No. AL.......... k ..... ..................................................................... GASINSPECTOR -UJ 2 8'a CJ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 11/10115 PERMIT # JOBSITE ADDRESS 200 Chi k_e6ng Road Unit 303 OWNER'S NAME Nancy Ordman GOWNER ADDRESS 200 Chickenn Road, Unit 303 TEL 978 420-6451 FAX 1 - TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIALEj CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES D NO'S APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERI ...__. 1_3 _- -I ____j ___j __j __j BOOSTER _ J ..._ :__'�J CONVERSION BURNER ! _ ' j T _ j ._[ _ j ___.jLLD ...�._.,.j�i - __j ____j __j COOK STOVE_ I I _ m l ':.� �.� j `_ -J '_ f _� '__ __ ___j ___J[ _ DIRECT VENT HEATER DRYER.. �'_j' j'j % P _ �i .� -j FIREPLACE _!' i, I I I E t.__�� �' -- ►. T,. a� I _ _(_ FRYOLATOR FURNACE____j j I._ ._ __..j',T-.j ._.j A ..,...� . Lj __J GENERATOR __J'___j_j._.-._,_.j __j ..__,.-_f GRILLE f _ _ 1' _ I _j '___j __-_.j =,_..._.-.1=j •__,.j _. J i._....._..( :__ j '_ INFRARED HEATER =. LLJ __j __,,_.1 ___Ti __j ,�j ;= LABORATORY COCKS {____j ,._, .._.._.._..1...,..._ __j'_ J _ _ j �......._j MAKEUP AIR. UNIT i _ OVEN - POOL HEATER,,._._�.s_j ._..1 __... _ ] ROOM / SPACE HEATER — it . _,--.. `_ _. I'_.I , .j __I ROOF TOP UNIT f ._. ..1j'I Fi _ __j TEST ____.j ? ( .__..._1 __j f UNIT HEATER --- - UNVENTED-ROOM HEATER _ w(` I WAT R HEATER _ _ _ _. _1 .__. —� j ! _ (,s—1 _�__._j I__.__j _.e_.€ ._.J ._...f '_.____.1. _ 1 OTHER I New Gas Service_..�_J � - _j ._�___J ;�..__�. rt j'^� --- - INSURANCE COVERAGE I`have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 o the Massachusetts General Laws, and that my signature on this permit application waives this re remen . CHECK ONE ON Y: GENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this appl ation are ea a ur a to th b t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will in comp -P it a rov sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME i Timothy A Giard LICENSE #110 0 GNATURE MP-0,MGF JR0. JGF (� LPGI CORPORATION[ 3443 PARTNERSHIP I # LLC # COMPANY NAME' Timothy A. Glard Plumbing &Heating Inc ADDRESS P.0 Box 782 CITY [NorthAndover STATE ,Ma ZIPS 01 1845 TEL 9 8 89 8336 A _ FAX 978 689 8300 CELL 978 490 7108EMAIL tglardplb@yahoo.com �, _ Cd ozEl o �El ui CL u uj 4t cn U) LU LU U) z0 CL IL w LL rA O rA rye O Cd 11501 Datel/���5 ..... r TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......... ............................................................... has permission to perform!...... ................. �+ plumbing in the buildings of ....:............................................ at(:%jPP604&4e�. . .... 4Y. .. 4�&4st).a .. . . .......... .. ort Andover, Mass, Fee ?��. ...... Lic. No ./�>.iRO..(..... ....................................................... -LUMBING IN PECTOR Check #� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY MA DATE _ ( PERMIT # JOBSITE ADDRESS 20c� �,., 3 OWN R'S NAME POWNER ADDRESS H TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES ® NO Ell FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM i f DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN ( ( -__-- f I (.___..__i FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK __' _-__—.f __-- 1 LAVATORY _ I __._—f ____.-A --j, __-!---.___-! ____..f __�! __. _f ..__.._J .___..._f ..---. � f ► __-_—( f DRAIN ROq SHOWER STALL SERVICE /MOP SINK I TU1'ET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING j OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ,_ .( NO ._ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW E;�� LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY D BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this require ent. CHECK ONEO".r — NT J® SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this a plication ar true a rate t t es of y knowledge and that all plumbing work and installations performed under the permit issued for this applicatio will be in mplia hall e ' e sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NA 1 .4 d LICENSE # 03G I._ I _ SIGNATURE VIP 0f JP [3I CORPORATION_�_]1 #©PARTNERSHIP Ti s LLC COMPANY NA -_Z� ; ADDRESS + L CITY ( STATE �� ZIP (�'tE—� TEL FAX CELL EMAIL— MAIL `� C", o rl z iii w U - t�` WN The Commonwealth of Massachusetts _ .Department of IndustrialAccidents " r 1 Congress Sheet, Suite 100 d Boston, MA. 02114-2017 www mass.gov/dia Wa kers' Compensation InsuranceAffidavit: Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organizationgndividual): Address: City/State/Zip:_ Are you an employer? c the appropriate box: Phone 4: 1. 0 I am a employer with employees (full and/or part-time).* 2.] I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. Q I am a homeowner doing all work myself [No workers' comp. insurance required.] T 4. ❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no erriployees. 5. ❑ I am a general confraoto 8 and I have hired the sub -contractors listed on the attached sheet. rs have employees and have workers' comp. insurance.T These sub-contracto 6. Q We are a corporation and its. officers have exercised their right of exemption per MGL c. 152 §1(4) andweHave no ' employees' [No workers' comp. insurance required.] �-b61-Y_� Type of project (required); 7. ❑ New'constriic-tion 8. 01temodel hg 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical rppaixs or additions 12. [] Plumbing repairs or additions 11 Roof repairs 14.[] Other *Any applicant that check§ bbk #i_ must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affiavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this Uox dmust 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. ensation insurance for my employees. ,below is tlae policy and job site X am an employer that is providing workers' comp information. Insurance Company Name:. Policy # or Self -ins. Lic. #:, Expiration Date:_ City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. X do hereby certify under thepains andpenalties of perjury that the information provided above is true and correct. Date: Sinature: 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): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their eriiploy+ees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hvee, express or implied, oral or written." An employer is deified as "an individual', partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enierpri'se, and including the legal representatives of a deceased employer, or the receiver'oir 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 commonvs;ealth for any applicatt•who has not produced -acceptable evidence of compliance with the insurance coverage requiired." Additionally, MGL chapter 152, §25C('1) 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' 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. Anew 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 requited to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia j� 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -w. ith the provisions of M.G.L. c. 143, §, 3L, the i \ permit application form to provide notice of installation of wiring shall be uniform throughoutthe Commonwealth, and applications shall be filed- " on the prescribed form. After a permit application has been accepted by an Inspector of Wiresappointed pursuant to M. GI 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 maybe deemed_bythe.Inspector_of_Wires abandoned.and.invalid,ifhe—.. 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 job4rowth 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 concerning the use or development of real property. With limited exceptions, the Act automatically dxtends, 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 extending1hrough August 15, 2012. ule 8 — Permit/Date Closed Note: Reapply for new permi ❑Permit Extension Act —Permit/Date Closed: �J Date.. /�:7. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......a, ................ has permission to perform ..... v%� . ........ wiring in the building of . . at. ...... ... h Andover, Mass. /7 ... Lic. No... ELECTRICAL INSPECTOR Check 4 737 :1132-,0 —'\'` (ommonwea& of Maieackuaelfs 2eloariownt of Jme Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. %P 5 2— 0 Occupancy and Fee Checked tev. 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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:VtV� 12 City or Town of. t OVNI" Nr, k aY q--4— To the Inspector of Wires: By this application the undersigned gives notice of his or'her intention to perform the electrical work described below. Location (Street & Number) 'Z p � Cn \ C -,o \ yl s, a 3 oy Owner or Tenant SA) kA _ Telephone No.��'��� Owner's Address t-.Mq- Is this permit in conjunction with a building permit? Yes ❑ No © (Check Appropriate Box) Purpose of Building \+Q -S Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthefollowing table may be waived At, the Ins c0 t r W' No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans :r o. of Total 0 es. Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- E] rnd. grnd. No. of Emergency ling Batt= 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 and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number Tons No. oSelf-Contain el -Contained Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers No. o Water KW Heaters Heating Appliances KW o. o No. o Signs Ballasts Securityystems: No. f Devices or Equivalent Data Wiring: No. of Devices or E uivalent No. Hydromassage BathtubsNo. of Motors Total HP Tel ecommunic�tsons Irang: No. of Devices or E uivalent OTHER: Attach additional detail ij desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation", coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND [I OTHER F1 (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NA ME: �zr t N1 Q\ � t r t LIC. NO.: Signature CLIC. NO.: /A 116 1 ;f (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.:' Jnl 413 ��e$ Address: \ kd Ltvckn Qt QZ:%rfta4 Alt. Tel. No.:4-gi ii 3S 4's -4t *Per M.G.L. c. 147, s. 57Z1, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.- S y/ '/ �/ , �9��/z _ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with theprovisions of M.G.L. c.143, §.3L, the 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 MG.L. c. 143, § 3L. Penruts shall be limited as to the time of ongoing construction. activity, and maybe deemed_bytheJnspector_of_Wires abandoned_and.invalidaf he—. 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 certain7permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwis a applicable expiration date, any permit or approval that was "in effect or existence' during the qualifying period beginning on August 15, 2008_and extending1hrough August 15, 2012. Rule—Permit/Date Closed: e /� Note: Reapply for new per4iT — \` ,,.� 1 ❑Permit Extension Act — Permit/Date Closed; Date./— z yJ�� f This certifies that ..... . ............................ . has permission to perform G wiring in the building of at. ,North Andover, Mass,. Fee . Z � .. Lica No. A.-/% k ?%.... � I fc/ CTRICAL INSPECTOR 5,94 Check # C�onwnonwea� o� i�a�acl�u�etta Official Use Only 4 Ue artnzent o .tire Jerv�ce� Permit No. Z/ / O j -- E i lug, N p BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: r4'N \1'7112 City or Town of: `n or 4tln Nn ko y or To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 'Z pa Ch 1 C\�,tr 11n v. (k C �%ln tJ� 3 O 5 Z6 Owner or Tenant C, \ \ s 1A0,Ck Telephone No")74'3C.4 j N 2 S Owner's Address So^ 4, Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Bog) Purpose of Building ` IP.S Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overbead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: \-gRko e.Q. \1 Z �A No. of Meters No. of Meters Comnletinn of tha fnllnwina tnhlo mm, ho wniv d h„ tho 1 —o..t— „f w;, No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. o _ Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No.;'of Luminaires Swimming Pool Above ❑In- grnd. d. o ]Emergency Lighting I'VEl Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. o Detection and Devices No. of Ranges No. of Air Cond. Total Tons -Initiating No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: umber _..... ........ ons ........................ ........................ o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local El Municipal ConnE3 Other ection No. of Dryers Heating Appliances KW Security Systems:* a Nof Devices or Equivalent No. o Water KW Heaters o. o o: o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uiva.ent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of,Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: G r Q� Aran 6% n S2 r o t C e s - LIC. NO.: Licensee: &g^ v. s: \_rA,m o yr QU,X . Signature LIC. NO* 1 G G'2-% (If applicable, enter "exempt "in the license number line.) Address: Bus. Tel. No.•yo \ `l 1 z z��q 1 W Q,\\ hg or (��\ j _�.,-; o\ r (�'� O Z$ S Alt. Tel. No.•S01 GZ° 4%'41 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVES: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signs.- , be13::; I hereby -waive this requirement. I am the (check one Q� owner El owner's a-ent. Owner/Agent �r .... PRRM7T FF'F'• .1f ma_��_�_ wt_ - 9413 Date. . TOWN OF NORTH ANDOVER PERMIT .FOR PLUMBING This certifies that has permission to perform .r plumbing in the uildings of . . f/ p�':"!�rl ................. at . `" Uh� ,Aofth And ver, Mass. Fee .�r�.� .. Lic. No. .�`. Z-?�� . � ..... .......... PLUMBINGIN PECTOR Check #-&e19 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY Q MA DATE I A�Q- _ I PERMIT # JOBSITE ADDRESS j�_���.�_t.o OWNERS NAMEC�=2�S POWNER ADDRESS Mel 12 TEL -M FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL] PRINT CLEARLY NEW: 0 RENOVATION: Ej REPLACEMENT: [ PLANS SUBMITTED: YES ❑ NOX FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM. DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY I - ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES i WATER PIPING OTHER f INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets 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 N7 OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I arr7aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate o the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 1 J LICENSE # SIGNA RE MP ipt3l, CORPORATION ❑ #PARTNERSHIP❑ #�� LLC ❑# COMPANY NAME C- ADDRESS CITY STATE [ :KR] ZIP I�a�� TEL FAX II CELL I EMAIL .+ ,. , ... a .. .. � # i .,. ` e - The Commonwealth of Massachusetts Print Form = Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 ti Boston, MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: Phone M Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. [] I am a general contractor and I 6. ❑New construction employees (full and/or part-time).' 2. U I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. ❑ Remodeling ve no employees These sub -contractors have g, (] Demolition working for me in any capacity. employees and have workers' comp. insurance.# 9• Building addition [No workers' comp. insurance required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.[] Other employees. [No workers' comm. 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. tContractors 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:,_ Policy # or Self -ins. Lie. #: _,_____T__ Expiration Date: nyl�/ Job Site Address: Of RG/UAfi��&ity/State/Zip:. Attach a copy of the workers' compensation po 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 Itereby certify under thedprain�s and�tenalties ofperjury that the i Jbrmadon provided above is trite and correct Lhone #: Official use only. Do not write in this area, to be completed by dry 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 S. Plumbing Inspector 6. Other Contact Person: Phone #: Date. � � j ...... , TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission foras installation . �QT g ............................ in the buildings of... at. c. ............ , No h Andover, Mass. �.� Fee �.3 .�.. Lic. No. fl�o.4. GASINSPEC R Check #4257- 8445 42` 7-8445 MASSACHUSETTS UNIFORM APPLICATION! FOR A PERMIT TO PERFORM GAS FITTING WORK _ CITY mr• MA DATE / r 2s 2 PERMIT # J0l3S1TE ADDRESS Zab �.lY!!C�(P �. %I63 OWNER's NAME 0WHERADDRESS F I., ,,... . TYPE OR PRINT OCCUPANCY TYPE COMWERCIAL f _j EDUCATIONAL RESIDENTIAL101 CLEARLY NEW-i'l-I RENOVATION: 0 REPLACEMENT PLANS SUBMITTED: YES I N® [ APPLIANCES Z FLOORS B Vt t 2 s a s s 1 1 61 g 10 it f2 13 14 901LER- BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR .GRILLE INFRARED HEATER LABORATORY:000KS MAKEUP AIR UNIT OVEN — ..._... . POOL HEATER .. ROOM /SPACE HEATER ROOF TOP'UNIT J 1 k m i. TEST I UNIT HEATER ( I UNVENTED ROOM HEATER _WATER HEATER OTHER I Li w� LLJ 4 INSURANCE COVERAGE. t have a current.liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES No I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY (� BUND OWNER'S INSURANCE' WAIVER: I am aware that the Pcensee does not have the insurance coverage required by Chapter 142 of the :Massachusetts General Lams, and that my signature on this permit application waivesthis requirement. CHE K ONE ONLY: OWNER 1'L". �.1 AGEN9B, SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application re true and accu to of my ktt and that all plumbing %-mrh and installations performed under the permit issued for this appfrcalion vAl be In iarmce ori I Pe ' en sign o Massachusetts State Plumbing Code.and Chapter 142 of the General Latins - PLUMBER-GASFiTTER NAMtM b �LiI LICENSE # l63 G(! GNAT MP MGFI� JP JGF LPGI CORPORATION #�PARTNERSHIPLLCtd4 COMPANY NA O �../ i !� t)� � /.�-►-�1 PI� DQRESS fj p6)C., 7�'0� Cffy1 STATE�J� ZIP ®/ S TELf}Y� QJ J __32 FAX..., .,67/6 E� h wool k vow, O Z C a. F U W Z Z o� z 2 W F a uImu � t= z 3 o. < �LU w W o � tm a 0 0 w t1� 0 U r A. CL Q to H LU 8 W f� z w a C z c� P G o� � the C19nullorlipealth of mi7sslceltrtsefls � ;_- 1Jeda�lrieerearfoflierdrrsfi'dclf�cc�ftdi'tts ®ffdcoafit l�estigafdon; tfll0 li�asltlfglt711 SIiY'@ Boston, lily 02111 � talV1te111ass,�tttOldia N1101 (ors" C01111iG1saflo11 IE1slt ftllt CAfi[tlttt'(h. 11 t�CD`S'%'011�rac(oi'sliICCtriciallsjpltimbti-s A 1 ilie IllfIlf l' 1181 �®1DPleastp►'hit UAW N81110 (Busimento 11$tationlindividaa Address: _.... . , n fit'/SitrtefZ • . � V ' (�_*� r l latent:. —d 33 G Able you an etnlilextO Cttecit /lilt appropriate hox: t. ane a entpioycr %viiia �(' 4. ❑ 1 am a general contactor tntd 1 T}�te ofpD'Qject (regEliicli): . citiplol'c i@ 611aietVorintt-11111e10 havotdmiltltosub•conirnctors 6. �] Non constra0ioa ?. [� loin a solopreprictor or(iattuei listed oil the attached sheet.': 7. Remodeling Ship and haveno.crupioyees ' l►txc stab=caalmdoes 113%10 8. Mutation wtttt.it% fortneinany capacity. [iso tvorkiFe Conti►. lusitrattco UVikcrecoinp.Insurance. S. ® We are a corporateon and.l(s. 9. ❑ilnitdingaddetion netjtliR'dj ofticersWeexercised their to.[3meclricalrepairs 0,ramitiotn 3111 tint a Itoii eotriter doing all cork 1lglet of exemplion ink MOI. 11.Q I'hnnbing Dti imirs or additions myself. [No Workera comp. c. i 52, §t(d); and tmv have Ito i2:Q hoof rcl>ti11rs Insurance required.) t empioyces. (No trork-cie 13.[10 comp, tusuntuce required.] °As�pcpn$icautd�t<traAsGo�[�tt�custatsoCdEoiattt<sscteicn.slot.alw��fagds$ntvit�cis'C m motion [*MY 1ar0I"mIal tl�na:ruizrs��Fasat�attfissuff ►rittndieati:sgtiugr dJ3arootturtt rrddatn�trrwns$dzcadlAttmImlitsilt-nit ftwireffid3vitGtditA13iiKte.. rt\,t( a646i ltlttfttttl:tGiS t'R*\t�litit.'i`13�,tk1�02tt+ttt'MFlltfGtai ftklU$[i4 ti[t11]:ll2 Rfti1F 94i�6•(Y�dEtflSCItV{nU/t dia'16 i{t*1�%Ctf•(1�{Fitt, rtSt$f} tAfttSlnaltL�1_ 1 errea dee ¢rrr�rlvy�rtlrrrtlst,�atdr/r`ng �=ar��rc' eTvlri�mtesotlntr/rrsr�rrrrte�forrt�+ettr�lfv�=e�a< Iletutr it lhe�aotdcr atreOJabslte� lr{I"otnrrrtloet. Insucancc Conyiotborr 1110:. Policy It or Self -itis, Me f{: i'sxpiration bate .lobSitelle[ctress our 1N V �-J. Cit}JStaielZip: Attach it copy of (he.writers' cornirensatioil polley dectarti toir page (spotting the pulley nutuber-autt espir'atlon Dlnte). Failure to secure coverageas required underSection 25A of MOI. C 152 can lead to the iniposftion mfcrimhtal penalties efit farce etp t lNt dfior onc-year itnprisosnneut, as as Citi it penalties In the form era S�'OMMORK OE DAR and a fittc of a Io S25t1.t60 tt day tsi tho c'i tor. Be advi d d t n copy of this statcalent, utay be foa�Muled to the Office of hive bopsof iite DIA fa nsur co ref n. IIto zfera Cl'f E rCi r .. J4' pa [air it rrrflle rrrj Urtrllilefr{/ortltrrtFoiatitotlrlertfaba: fs?®rr ruirtcirroeri: aignattir 11atn� //� Z 6 2u/ Z ti iteit: 4 01�-& 3 c� o, fletal rice 0116.: Do lie/w.-Ifc lit 1111v rreer, (vile eo► umild by efl}=or feint official City or ioCsit:. I'ernrltl4tccltsetd Issuing Auittority (circle L.Roard of ilcalth 2. Clniirting Taepartruent 3.Oilyirotrri Cleric 4. Blechical inspector S Plntnbing Itrspecto ' 6.611mcr:.... I in' -form ROM and Instructions Mtchusetts Genecttl %ttvs ci<<opter #SZ regttaEs`atl etiipioyers, to proviite tvorl,eis* r�®tttpettsation for their et Io Pursuant to this stattit% an employee is defied As K;.,e lemon in t1te serviCP ofatioticeiunder any contrad'ofhire, a'tlrrss� oritttpied,ointgrivritten" _ Att e4163ter is defined os "ani irtitividctairpartnerstiip;association, of the faregoat corpDration or other legal entity,-orany (cy6 birriiore tg eng l in a Joint enterprise, and, .ft i.ng the legal representatives of a deceased eniglayer, or -ilia reoei��erortttFsteeofanindividual,patiitersltip,assoelet[onorotherlegalentity,empldy igemployiees.1{otvcverthe welolvnl of a dtveil ng huyse ltavittg spot mote than three apaib rte its and lvho amides (hereiiy or the occupant of rho dtveltirt. hoose of another-tvlto etoploys persons to, to nianFtcnance; Coilstrcictian oraepair ivorR on sttcii it► ii tg Biotic or oft thegrottnds or buiidi`ttg appurtenantthereto.shall not bw�ueasofsttch a tiptoynient be deemed to o an employer.'" MGL chapter 752, §2SC(6) Rkso states that."every►stntc or local Ilceiisiitg age,aey s6n11 irv[thhold the fs-seaino• renewal of a license or pet niit to operate n Gusiitess or to constrtrct ce btilldltigs itt fhe coniinonivealtlt for p iT` appilcaw tuba has not pretincto 6eceptnble evi(tettee of coritpliartce tivith'tlte insuriinoe co�'erage required" Additional' MGL chapter 732, prep) stRtes "Neither file commonwealth any contract fon fitter ior anS= of its political su3ulivisions shalt rnto r flit perfonnauce of public work unlit acceptable evidence of coriTliance with cite insttratice ecptireteients of (ilk chapter have acceptable to the contracting authority:" i'lease flit[ out tlt workers' ixr Vensation-aftidavit completely, 4y cheekitig tlee boxes Ebur apply fo your siicFatiiin turd, if necessary, sEtppiy sttG contmctor(s) ttatne(s), addr�ess(es) and phone ituFn6er(s) alauig �vitit their cerde`}icste(s) of insurance._ Limited Liability trotnpaiDles (LLe) orLitnlfedDibili[y Partnerships (LLP) with n®_ ent' o ees Doter than the rttentbeas or partners, are not required to carry workers' compensation irisurante. Iran LLC or L does have . Ac6id ntsf ttpo ar is required. Be advised that this aftidakit ivay be submitted to the. Department of Industrial Accitu n e for the cinna(ion of it)Sttt'a RC6 coverage.- Also he sure to sigh aced date the affidavit. The allidavi(should. tie returned to the city or t®tun that lite apitlie.ltian for the pannit or license is iteing requested, not the Jyeltarintcrtt of Industrial Accidents. Should you hate any questions regarding life lulu orifyott me required to obtain a work=ers' cotupensation policy, please cal[ the Deparinrent nt the number listed below, Self inner t conapenies sktould enter titch self utsur®atce license number o_t_t tits ti prat riate line. Cify or Tow, ®ffe[als Please be sure that the affidavit ts.complete And printed legibly. The Depatwient has a'davit lot you to fritDlin the eventh?provided a space at the iottoeiietoIvesigations has to ooutactyou regarding thea lieattt. Please be sutra to fill is the perutit/licettse nttittlrer which tvlll be used ars a teferetrt:e tittntbt r. in addition as applicant tlilicyi tsttbmttntuitiplegertnit/licensea ticationsinarty.givenYear, .needoniyst¢bmitoneafiidavitindicatingtxttrenf policy int'oamation (ifnecessa PP7 , torn ". A cit )and under Jab Site Address' the appiicaut . . d write°'al[ locations hi .,_.(city of the affidavit fhatltas been ofrictal[y;stantped ormarl eEl by lite city or town n be (city or applicah as proof that a valid affidavit is ori file for future tai" provided to the Year. tt�tiere a hoit must fic filled me bit7ter or citizen is obtainntg a license or pal rater not related to any businaffildavess or eotne 1 but C.e a cling license orniture permit to burn leaves eta) said person"is NOT required to complete this affidavit: y ' Tl asb'd ce Of hositafigations tvetrld liEci: to.tttatticyoniii adv�nce for yottrcooperafdari € nd sl dukl ouhaveanS uestiotts please do not hesitate to give t.a call. The Degarttnent's address,..felcpltone andfam tuitnber. Thd CommoutvealthofllIassaciaitsett§ Depatltuent Of-Mattstrlal Accidents = Office of ftiyestig€atiorts 600'iVas1lingtoti $tij t Bostoah MA 02111 Tei. # 617-727-4 -W406414 © 77 -MA SSAI•'E Revised S-26-05 'Oak W-727-7749 ' ��►�v�v.fti�ss.gov/dig h y. �r it 1 r i --� . mft • a o z {y„ t.c�' �� 0 m ri D; m b m M ►cn D� m A 1 (n_ �cn D i H M, o j t" I C7 < DD 3 , m, O 7i CD, z m cn M 1 cn o (1� ' W�1� „�a,y ? :a /• � :. � S wf��. `171- t� t Srgna' a r Date -11V�.. . < ti TOWN OF NORTH ANDOVER .o 9 ' PERMIT FOR PLUMBING This certifies that has permission to perform ... RL plumbing in the buildings of ..f '.���.�.��...� h �.�.�<. ?...... . at. . ..(J ` ..�...... G.'...... /. ? ..... . , North Andover, Mass. Fee. ;:%U.... Lic. No../, .74'�'c!c cF ....... •LUMBING INSPECTOR Check # 8 4.9 2 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location loo -�)00 -d .10 - / �,q ��I �G / �'� %� Date P-10- 1)0 �i Permit #--4j-_� t Owner Amount e,, New ❑ Renovation ❑ Replacement ® Plans Submitted Yes ❑ No FIXTITRF.fi (Print or type) j� Check one: Certificate Installing Company Name /,F S, 2'1 ❑ Corp. Address ❑Partner. Business Telephone 2— ❑ Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type urance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance .Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance ignature I Owner ❑ Agent I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By:WgnatUre 01 LicenseaviumW Title �a Type of Plumbing License City/Townr�cense Numbm Master Journeyman APPROVED (OFFICE USE ONLY ❑ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):- � Address: T f/')q_X -i o City/State/Zip: Phone #:Df'> - ox:L❑Are you an employer? Check the appropriate box.- LEII am a'employer with 4. ❑ I am a general contractor and I (full and/or part-time).* have hired the sub -contractors 2.Vmployees Iam a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their 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 ) sa3 5,938' Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other ---- -- ----•••, ••............o: casv iva mut cuc SCcaCr1 oetow snowing :heir wcrk=r compensation policy :nfbrm_, 6Cn. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site 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 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 certify under the pains andpenalties ofperjury that the information provided above is true and correct Si ature: Date.: Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3- City/Town Clerk 6. Other Contact Person: 4. Electrical Inspector 5. PIumbing Inspector 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 employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be retu.-ned to the city or town that the application for the perruit 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 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 4.06 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 w—v w.mass.gov/dia BUILDING 3(8) 200 Chickering Road 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cl 0 0 0 Cl 0 Cl 0 0 0 y o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 U O w CT N O ^ N [� G1 Q\ N ! n O� CT CT G1 CT (w l� O\ O� C\ - V C , vl O\ aT �!1 a% U CT v1 C- (71 Cil CTC, O\ CT C\ C, C1 01 a, a• kr) V M Vl �O Vl 00 'IT 00 wl C— d N N N N N Cq N N N N m ,,qI6qI61I61I6,:jI69I6SIGol�IGSI619IGo-C)IIqI61IGO) I61)I69IV�IEnI6"JIEnIfAIGSI�nIeog M M Kt d' Ce) Co m M M V M m M M M M M M -t d' M M M 4 0 0 0 0 0 0 0 0 0000000000000000 Y 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 m N N N N N N N N N N N N N N N N N N N N N N N N � (D N CO (C) In T U-) T O 11'5 tf) It 'Y CO r CC7 CO r 00 ti N NN N d T r r _ N N N N N N N\ N N T N T N N N N� � !n r T N r N N T T T TT T T T T T T T T T T T O r r r r T T T T r T r T T r r r U M M M M M M M M M M M M M M M M M M M M M M M M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 U N N N N N N N N N N N N N N N N N N NQ NQ NQ '�- O 00 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O N N N N N N N N N N N N N N N N N N N N N N N N M T r T T T r T T T T T T T r T T T r T T T T T T T T T T T T T T T T T r T T T r T r T r T T T T Q N N T N T r N NININI,—INI.—ITININININITININITININ M MMM M m o M MIM I Co M M CMIMIMIr7InlC'MIMIC'MIMICMIM Z M r N 1'�) �t CO h CONN M Cn CD C- O (n p 0 0 0 0 0 0 0 00 0 0 0 0 0 0 (n N = T T T r T T r TN N NNNN N �ow,V C it L� l it it it L�� U CC Y Y Y_ Y Y Y_ Y Y Y Y_ Y Y CL W •C C C C C C C C C C C C C C C C LL C] Z ui -o -0 '0 v '0 -o '0 -a _0 -a 'a _0 'a 'D '0 io m Ca M m M m M m M m m M M M m M Y? o OO m O O al q QI al Cy O m a a1 o c C C C C c C C C C C C C C C C tlullt * Y Y_ Y Y Y Y C •C C C C C C mmmm ��� AW m ,zae Y �C Y -C Y 1 Y -,z Y Y Y �C Y -le � UUU_ U U_ U U U_ U _U U U_ U_ U U_ U_ U U_ U_ U C L L L L L L L L L L L L L L L L L L L U U U U U U U U U U U U U U U U U U U U U U U U O O O O O O O O O O O O O O O O O O O O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Co 0 0 0 0 0 0 N N N N N N N N N N N N N N N N N N N N N N N N m Y U � U C o a m aTi O c i O U N C7 Ca LL C Y CO M N O_ YO m m m } a) Ca a Co U a) L E Ca .L — L � U J U Co m U) L U)C Q) Q U 5 Z U N -0 m C� 'a °� N M LL N Cu m > a> 'a C N 7 O 07 C p ) O U` U C7 C U U T M O Ca Co=` C-0 a) O N U) J L U O U �.Cc: O M U N E M M i ai E -01 Z a) N �O Q (6 C O 7 CC M O M g E c O E a a) U M a) L s- m'C J L aLa U -J O`MOu1 H•�mm HL U O O[ TU �Q m a) C a) W`Yc O¢ Y J cY C Z' ME U p a,) ac)M j CO O lu Y-i f-2� JUmZ-i00CD� Of µORT a 94 } Y Oy�SSACHOSpt . CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: M 2 0 2W3 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen":"Building MAYBE OCCUPIED AS Unit #101 - TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC" 231 SUTTON STREE, NORTH ANDOVER Building Inspector Of ,,ORT), 1ti • O O � L :r o •'"Ph �9SSACHUSES CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOY 2 0 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- Shawsheen" Buildin MAY BE OCCUPIED AS Unit #102 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 2 1 SUTTON S``TREE, NttO HANDOVER 01845 Building Inspector C Cf pORTN i h � A tss���t O CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: MY 2 ® 20D3 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road - "Shawsheer' Building MAY BE OCCUPIED AS UNIT 103 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AN)) SUCH OTHER REGULATIONS AS MAY APPLY. EO CERTIFICATE ISSUED TO: TERRA PROPPRTIES, LLC 231 SUTTON STREET NORTH ANDOVER 0184 Building Inspector M� s�11 ti F t YSSR[1P7� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: Nov 2 ® 203 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT 104 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH ANDOVER 01845 ® U Of OORTH a �9 rS4 CMu5ft� O CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOY 2 0- 20 THIS CERTIFIES THAT THE BUILDINGr ON 200 Chirkerin2 ;..fl .- .. MAY BE OCCUPIED AS UNIT #105 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC `31 SUTT N STRE)T, NORTH ANDOVER Building Inspector Uf ,poNT ry �� 9SSA�IJSp1 CERTIFICATE O F USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 2h(� ,-13-n)Date: NOV 2 0 .2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #106 -- ONE BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON ST EET, N�ANDOVER 01845 �r Building Inspector EO Ee O� ,tOFTq ^N a t r �9SSACHUSEt4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: ted. THE BUILDING LOCATED ON THIS CERTIFIES THAT 200 Chickering Road -- "Shawsheen Building MAY BE OCCUPIED AS UNIT #107 -- TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH ANDOVER 0184 Building Inspector L91 O` NOfl TM �� 2 . O t K S ��STACHUSE44`� CERTIFICATE OF USE & OCCUPANCY O TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: . NOW 2 0 2D3 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAYBE OCCUPIED AS UNIT #108 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. c 101 NO CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH ANDOVER, MA 01845 B ding Inspector Up pORTH qN O O 9 ♦ s, : f K ' Y �9SSAC NIISF'S % C) CERTIFICATE& O USE OCCUPANCY PANCY U TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: V 3 0 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road "Shawsheen":'Building MAY BE OCCUPIED AS UNIR #201 ...-- TWO BEDROOM UNITIN ACCORDANCE wrrH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STRE NOR•TH-.ANDOVER 0182 `J� Building Inspector M f NOR7M O ��O 4S"CHUSES CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: ' THIS CERTIFIES THAT NOV . 0 2DO THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #202 -- TWO BEDROOM UNIT ACCORDANCE WITH THE MASSACHUSETTS OF THE ASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. h EO CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 23 �tU EETN R� AND 01845 Building Inspector OF "ORT sAN O R ��SSACHUSE� 3 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: N®V 2 0 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #203 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH ANDOVER 0181 duig spector Of NORTH ^N • O � r• A K �9s3q`Hus�t CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOV 2 0 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Buildi MAYBE OCCUPIED AS UNIT #204 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 23L SUTTON STREET, NC TH ANDOVER, MA 01845 Building Inspector Of ,kORTM ,y s r s � r �,SSACM156�ii O UERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER NOV 2 0 2003 Building Pert -nit Number 26(11-13-02)Date: THIS CERTIFIES THAT THE BUILDING LOCATED ON200 Chickering Road -- "Shawsheen"200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #205 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. U CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 1;_'8UTTON STREE NOR'1'�ANDO�VER 0184 l , Building Inspector NORTH .i? °'•+y` do � R •; r 44 SA[NU �y CERTIFICATE OF USE & OCCUPANCY O TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOV 0 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAYBE OCCUPIED AS UNIT #206 -- ONE BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGU_A,LTIONS AS MAY APPLY. �CERTEFICATE ISSUED TO: TERRA PROPERTIES, LLC ,31 SUTTON STREET RTH ANDOVER, MA 01845 Building Inspector 0 Gf µORTq 1y h � P ,SSACHU66t4y O CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOV 2: 0 2093 THIS CERTIFIES THAT THE BUILDING LOCA'T'ED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #207 -- TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUER TO: TERRA PROPERTIES, LLC 231 S TTON STFEST,, NORT OVER 018, Building Inspector 101 NortrH ti A IE CERTIFICATE OF USE & OCCUPANCY O TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOV Q 0 20D THIS CERTIFIES TfLkT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #208 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. NO EO CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTO STREE ,--NORTH* ANDOVER, MA 01845 Building Inspector OE MON7M 4y h ' p asACNU56S CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267.(11-13-02) Date: NOV �,� 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #301 -- TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTI , LLC. `j1 TON ST Building Inspector U HORr„ f� 9 R - Ri '� SSACNU4� CERTIFICATE ■ E OF USE & OCCUPANCY O TOWN OF NORTH ANDOVER Building Permit Dumber 267 (11-13-02) Date: NOV 220 003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAYBE OCCUPIED AS UNIT #302 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH. ANDOVER, MA 01845 *�' b —: � � Building Inspector E* 0 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Dumber 267 (11-13-02) NOV 2 0 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Buil 1vf'lY RE OCCUPIED AS UNIT #303 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER. REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 4�)T�TON N. MA 1 Building Inspector EO � Noterk � f R k ti CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: mod 2 nD3 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road - "Siawsheen" Building MAYBE OCCUPIED AS UNIT #304 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. 101 CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH.ANDOVER, MA 01845 `J� Building Inspector Ot PORT .�y h ti- P tSSACNUst� O CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building. Permit Number 267 (11-13-02) THE BUILDING LOCATED ON THIS CERTIFIES THAT Date: NOV 2 wj' 2003 200 Chickering Road "Shawsheen" Building MAY RE OCCUPIED AS UNIT #305 -- TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULA'T'IONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 7231 SUTTON STREET, N. -ANDOVER, MA �, 1 84 6A Building Inspector µOR7l� O � P �SS�cNuse� CERTIFICATE OF USE & OCCUPANCY O TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOV 2 0 2M THIS CERTIFIES THAT THE BUILDING LOCATED ON 200_ Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #306 -- ONE BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231SUTTONSTREET, N. ANDOVER, MA 01845 Building Inspector C Of NOFiH HN h 9 0 �4SSAC14U54S � CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH COVER Building Permit Number 267 (11-13-02 THIS CERTIFIES THAT Date:, mV 3 a no3 THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #307 -- TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC �23N7 N STRE T, N. AKDLIIi A 0184 Building Inspector O` NONTp 7ti i . s i r r K CERTIFICATE O F USE & OCCUPANCY TOWN OF NORTH ANDOVER � 2 � �p03 Building Permit Number 267 (11-13-02) Date. N®_ THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road "Shawsheen" Building MAYBE OCCUPIED AS UNIT #308 -- Two BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTO STREET� RTH"ANDOVER, MA 01845 Building Inspector E0 39Vd 1NIOdHldON 0099LZE8L6 r , 6E=9I E00Z/8Z/E0 • 1 0 a o M 6 u .. w lz z „ c c9; w aG U x a w rs: JS w a t r cn rq • 8 4 h y W SE w ci y 2 r C3 Z0 39Cd 1NIOdHINON 0099LZE8L6 CL C9 Z a� C L3 C4it) CJ CL In 6E:9T E00Z/8Z/E0 W 55 LLJW W W to 0 `` Z d CL O- 0 32 men m O O m r m � m ca Q d. CL CA C •s CL C9 Z a� C L3 C4it) CJ CL In 6E:9T E00Z/8Z/E0 W 55 LLJW W W to 0 Date. P :.�..G........... TOWN OF NORTH ANDOVER e.� O 9 PERMIT FOR GAS INSTALLATION 09 This certifies that .. �! !! h," .................. has permission for gas installation %'1 �.�.... !�� :.�. �...... . in the buildings of .. /.s.'. at ... . ............. . North Andover, Mass. Fee .j Lic. No./.,"/.-') .'... ...... �1 .... . GAS INSPECTOR Check # 2 C' G y 4543 .� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) h �,� Mass. Date Iflo v 'pagj�L Permit # Y Building Location o�$ �JC�IC•t/�-� f /Z�• AOwner's Name/J /�%s�• �L 6aa_," A f Type of Occupancy.,,/, ��01 R New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Business Telephone /oCU-6 9 2 - re 9d Q Name of Licensed Plumber or Gas Fitter Check one: 5--60rporation ❑ . Partnership ❑ Firm/Co. Certificate QcQ M C INSURANCE COVERAGE: I have a current Ibilih' insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 15' No ❑ If you have checked yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application wi in comp noe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General La BY TyDe QLkicense: umber Signature of Liceru- *Kmber or Gas Fitter Title er License Number%S %�1��0�( City/Town umeyman 1 NL THE FIRE DEPT. MUST APPROVE THE PERMIT FOR LPG STORAGE BEFORE REQUESTING INSPECTION BY THE PLUMBING/GAS INSPECTOR. Y V • STH FLOOR■t����tt�t����t�<t���■ MO■ .. ■tv����������s��t�st�■ MEN Installing Company Business Telephone /oCU-6 9 2 - re 9d Q Name of Licensed Plumber or Gas Fitter Check one: 5--60rporation ❑ . Partnership ❑ Firm/Co. Certificate QcQ M C INSURANCE COVERAGE: I have a current Ibilih' insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 15' No ❑ If you have checked yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application wi in comp noe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General La BY TyDe QLkicense: umber Signature of Liceru- *Kmber or Gas Fitter Title er License Number%S %�1��0�( City/Town umeyman 1 NL THE FIRE DEPT. MUST APPROVE THE PERMIT FOR LPG STORAGE BEFORE REQUESTING INSPECTION BY THE PLUMBING/GAS INSPECTOR. z 0 P V W a N 2 N N W ¢ 0 O a W W W r O Z .a W M Z J W m i C Z J V W IL N _Z co Q A Date./..- 3.:G.?. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. l :.� !'. S `. `".. l .`.... • • .. • ........ . has permission to perform .... /.-- ................. LL .l plumbing in the buildings of ..1�.. fit' .'. ?.�..................... -t� at . ).61.0..G�'. ('A. ! !'. 1'. hh �....... North Andover, Mass. Fee (��.lr �.O, L,c. No.. /� PLUMBING INSPECTOR Check # )& 'J- 5822 z MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) mm /�/ F a iZ fi�/�'it o��ei" ,Mass. Date S 1� ov Permit # Sy t Building Locatio114:20(o C. h (C e<" -t ^ s 2 , - Owner's Name `y New R I Type of Occupancy / UIIZII k Replacement ❑ FIXTURES Plans Submitted: Yes ❑ No ❑ Installing Company Business Telephone Name of Licensed Plumber 9 Check one: Certificate C3 -Corporation o;22? - 0 Partnership O Fnn/Co. INSURANCE COVERAGE: I have a current Iinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checkedrtes, please indicate the type coverage by checking the appropriate box A liability insurance policy O Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner O Agent ❑ 1 hereby certify that all of the details and 'information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the rrnit ' for this plication will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Cod 1 o General BY St nature of Ucen umber Title Type of License: Master [�-�'� Journeyman City/Town O I ONL License Number/1%/d7S-72S ---P d9e • V • • • • ... �/19�►1'i���1iR'iQ'1�iiii�ii�ii�����I) . ... �'t��F.��►�a*r1i�l�tii�i��isii���it� ..-it��iiiii�iiiii�ii�������■ .. - ■���iiiii�iii��tii�ii■®tt�� Installing Company Business Telephone Name of Licensed Plumber 9 Check one: Certificate C3 -Corporation o;22? - 0 Partnership O Fnn/Co. INSURANCE COVERAGE: I have a current Iinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checkedrtes, please indicate the type coverage by checking the appropriate box A liability insurance policy O Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner O Agent ❑ 1 hereby certify that all of the details and 'information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the rrnit ' for this plication will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Cod 1 o General BY St nature of Ucen umber Title Type of License: Master [�-�'� Journeyman City/Town O I ONL License Number/1%/d7S-72S ---P d9e D 'el � m v z m IN r A c � Z '� to z Z D � 2 o �+ � z 0 � n z o � � D 'el � m v m IN r A z � o �+ z 0 � z z o � � � O C N O C � Z r . crc m z 0 41'76 "It Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... M. �. i q L— ( -r , f 0 ( ......................................... has permission to perform...... 7' !°.-e " ........................................... wiring in the building of ..... ......... .............. ,it .... ............................. . oy. r, �rth An Fee.J. P�? Lic. No. 4 . ......... .................. . ....... 17 .................. 7 2�CTRIIC;A�L INSPECTOR Check # THECOMMONWEA,LTHOFMASS4CHUSEM Office Useo- DEPARTM1AT0FPUX1CS4FETY 1.11-7W BOAROOFFIREPREVE ONREGMHONS527CM12..•OO Permit No. Occupancy & Fees Checked APPUCATIONFOR PERMIT TO PERFORMELECI'RICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location (Street & Number) 00 Cin 1 C 1J t \ _ Owner or Tenant <racrA VrorJ>;f' ,Pr,. Owner's Address -tom % SQ44-i'm -- Is Is this permit in conjunction with a building permit: Purpose of Building O (fn, o e"k—r AA' Yes EM No [D (Check Appropriate Box) Existing Service Amps / Volts New Service RX) Amps lawamj Voltsle(yle Number of Feeders and Ampacity Location nd Nature of Proposed Electrical Work No. of 1— X ting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals No. of ishwashers No. of Oryers No. of Hot Tubs Swimming Pool Above _ ground No. of Oil Burners No. of Gas Burners No. of Air Cond No. of Heat Total Pum s Tons Space Area Heating Heating Devices Utility Authorization No. ma g a 3 Overhead D Underground No. of Meters Overhead M Underground No. of Meters �Ve2 MD 7777-77 No. of Transformers Total Below KVA Generators KVA round No. of Emergency Lighting Battery Units Total No. of Water Heaters KW No. of No. of No. Hydro Massage No. of Motors . Total HP FIRE ALARMS Total No. of Detection and KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW LocalMunicipal El Connections No. of Zones 7stiranceCovwage Rrmit othc,-w4manerits awb%ad>tlm( =;g Lam :have ao Liabllityh>s�poky>nclt> CMP CovUaWorZsub legt� y� E havesubnmledvalidproofofsametfltheOffim YESNO hx1drigthe apP� box ffynuhavedledmdYESpleawindc*lhetypeofcovtrageby VSUZ[IRANM 1BOND OtIHQt Y) /4 Jaktostart 16It>SIDRegttes�d Evram D& '30 E5ima d VakrofEbct al Work $ Final Other LmwNo. _ n C - - - 01rauac Litho 3S$ BasolessTel No. -� MN1R'SINSURANCEWAMT,Iamawatethatthe Licmsedt> mthave the iriauuecovaa�oeorilsst> antial valetas AhTUNo. Idiatmysgrtattueonthisperrrvtappli �eurm 1 �bY t>s�1sGaleralLaws lease check one) Owner Agent p � Signature ot Crwncr or gen Telephone No. PERMIT FEE (� ` C% M 2 f Date..... ..... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SS� • This certifies that �' �-*y :-'� '%�:' �/� '' has permission to perform :. !. ...:. �~�.............. . plumbing in the buildings of ...: !- ! ! .�......... .-' ` ....... . at . c ...` ....... `. `.:�. ` .' .. '....... , North Andover, Mass. Fee�.f ..f..Lic. No!t/44.,.� ...::•..f ��.�-.......... PLUMBING�NSPECTOR Check # r�L 5483 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. DateJ4r7 a 11A,JMj Permit # �,J_ r Building Location go,76O C4tcf&crs•P& /2A4 Owner's Name /Cresr4 d►e or ies G DPt a c ` O-Axo ` -Ce 4, ` Type of Occupancy ""Cso" eg -v .Q/e New p' Renovation ❑ Replacement ❑ Plaru Submitted: Yes ❑ No A FIXTURES Z Z N Q N H ¢ O Z CC Z N < tL < to Y J a]¢ _ ¢. N W 7- 0 N W N p~j = 1" V W 0 Y< Nd 3 x V Q in N W 30. < r- N= p 4 tlf ¢ a ¢ o W ¢ W 0 d N ¢< W W Q 'J W=< S 3 3 O z, _ Y 0.Q a Y W o y t- o= `� ' H z o o W=_ .W o o s < ►�- <. to < < 0 < -j�, < ¢ ¢ W o sue—SSMT. BASEMENT 1ST FLOOR 2ND FLOOR i 3RD FLOOR 4TH FLOOR STH FLOOR STH FLOOR 7TH FLOOR STH FLOOR Check one: 0-6x pgration ❑ . Partnership Business Telephone 6Q3`(oV.1-_(oS/S'OO Frm/Co. Name of Licensed Plumber &s c 44e / T x. .4 Certificate,_ Aid 73 - INSURANCE COVERAGE: 4 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes CR--' No ❑ i.Vyou have checkedrimes. please indicate the type coverage by checking the appropriate box A liability insurance policy ❑ Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General taws. and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of General ws. By gnature of uoenseVdmt>er Title Type of License: Master Cr— Journeyman Et— City/Town APPROVED (OFFICE USE ONLY) license Number/y/o23'7 T/P4"4 y .f Date ....../�/ " TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...............,......q / �^ %G �( has permission to perform 1.... P.. x� . -'� ` .......... ........ .............................. wiring i1the building of ........... /..T i. �'�..... ... ...�l��... !!�.. .............. `,.� � C r G%'`7r1� orth And . at........5.:......................................................... �' ` CJC� .............. _. /S.7 Fee... ............... Lic. No ...... r.!........................... % �ELECTRICALINSPECTOR Check # r ///// 4377 THE COMMONWEALTH OF MASSACHUSETTS DRY'AR7AAM'0FPUK1CS4MY BOARD OFFIREPRFVE MONREGULAMNS527CAMINO Office Use only � '7 Permit No. / Occupancy & Fees Checked APPLICA,HONF'Q PERNLIT TO pERF'Ql��►,I ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street Owner or Tenant Owner's Address Is this permit in cc Purpose of Building Existing Service Amps�/Volts Overhead " Underground New Service CZL Am . p sAW1Af,0Volts Overhead EmUnderground Number of Feeders and Ampacity 1-12 ,9m,4ruaC Location and Nature of Proposed Electrical Work iw. vi . Jgiuing wuca I No. of Lighting Fixtures No. of Recep 3cle Outlets No. of Switch Outlets No. of Ranges Vo. of Disposals do_ of Dishwashers `o. of Dryers o. of Water Heaters �- Hydro Massa N Tubs t Y EIER No. of Hot Tubs Swimming Pool Above ound No. of Oil Burners Space Area Heating Heating Devices KW No: of No. of Motors No. of Bailasis Total HP Utility Authorization No. 131r z9�� No. of Meters No. of Meters No. of Transformers Below Generators >round _ No. of Emergency Lighting Battery Units FIRE ALARMS Total No. of Detection and KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Municipal Connections Total KVA KVA No. of Zones M Other s :ur.�.wvu[�G. rw.xauaelu,c,U�mt1713ffi orlvJa�1�S<;ala-dllaws / :aamartLiab>7ityhm>ta�lcePblicy>ncT��gCorr Cor�'age�stl�ar�aleg2ivaierg YES t�txrntmrlva}klproofofsametotheO�ce YES p If}rluhawcha WYE Pia9eirr1i &dletypeofcovgag,-by lngthefflxq RANG BOI�ID OrIHQ2A103 >ValueofF7ectticalWoik$ - - lnStart h>specfionDa1eRoWestd Rout �(//�- L' ✓ILf, Firlai LvIc,E- 6ofZ (_ 1�"&0fpU CDP" �.4t4 Siwe BltarmTel No. Alt Tet No. R'S IN%RANCE WAIVER; I am aware that the License does nothaye the insurance coverage orits subtantbl apvalent as raltrired by Massac>rttsetts (',metal) ws my sign&m on this pemt applicah® this regtmzrr>ent check one) Owner Agent ® �. Telephone No. PERMIT FEE rgnature o caner or gent No. of Gas Burners No. of Air Cond. Total Tons No. of Heat Total Pumps Tons Space Area Heating Heating Devices KW No: of No. of Motors No. of Bailasis Total HP Utility Authorization No. 131r z9�� No. of Meters No. of Meters No. of Transformers Below Generators >round _ No. of Emergency Lighting Battery Units FIRE ALARMS Total No. of Detection and KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Municipal Connections Total KVA KVA No. of Zones M Other s :ur.�.wvu[�G. rw.xauaelu,c,U�mt1713ffi orlvJa�1�S<;ala-dllaws / :aamartLiab>7ityhm>ta�lcePblicy>ncT��gCorr Cor�'age�stl�ar�aleg2ivaierg YES t�txrntmrlva}klproofofsametotheO�ce YES p If}rluhawcha WYE Pia9eirr1i &dletypeofcovgag,-by lngthefflxq RANG BOI�ID OrIHQ2A103 >ValueofF7ectticalWoik$ - - lnStart h>specfionDa1eRoWestd Rout �(//�- L' ✓ILf, Firlai LvIc,E- 6ofZ (_ 1�"&0fpU CDP" �.4t4 Siwe BltarmTel No. Alt Tet No. R'S IN%RANCE WAIVER; I am aware that the License does nothaye the insurance coverage orits subtantbl apvalent as raltrired by Massac>rttsetts (',metal) ws my sign&m on this pemt applicah® this regtmzrr>ent check one) Owner Agent ® �. Telephone No. PERMIT FEE rgnature o caner or gent The Commonwealth of Massachusetts 1 Department of lndustrial'Accidents / ©Ice of Investigations Boston; Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for rry employees working on this job. Company name: Address City Phone # Insurance. Co.' Policy # Company name: , Address City: Phone #7 Failure to secure coverage as required under Section 25A or MGL. 152 can lead4o the imposition of a**W penalties of.a fine up to $1,5W.0C and/or one years' imprisorxnent_as_well_as_ciN penaltiesin belmn-daSTOP:wDRK 0MBUW afm-d ($1jDOM)-aAay igai .mom I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i / do herebyeertffy under the pains and penalties ofpa jury that the information provvaded above is true and correct. Signature Date Print name per.# Official use only do not write in this area to be completed by city or town officiar City or Town' " Permil/i.icensi El Building Dept E]Check.if immediate response is reghredEl t1t:Si/ig'BOard ❑ Selectman's Office Contact person: Phone #: E Health Department Other Date...... l. -J. -.C)3 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... .t.�j Q. �. ...... P C ............................................ has permission to perform...................................................... ................................................... wiring in the building of ° -, r { ............................................................................ �PD C h' 'P ? , North Andover, Mass. FeehK ... Lic. No. � �. ........ :. Cnl a ...! _ ELECTRICALNSPECMR Check N ` 5 4440 THE COMMONWFALTHOFMASSACHUSETTS Office Use o ►ly 6 DEPARTAIUNTOFPUBIICSAFVY Permit No. BOARDOFFMPREVE MONREGULIHIONS527CMRl2W Occupancy & Fees Checked APPLICATTONFOR PERMIT TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / 'd Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & "Number) 1�00 olm'ao?41%l6- a b • 'R it Owner or TenantW—RES LC,<-' Owner's Address r 114,47N ST N.MT Is this permit in conjunction with a building permit: Yes 1zNo a (Check Appropriate Box) Purpose of Building IVCD CD/V%,0jM1;V1'M Utility Authorization No. LS -00 Existing Service Amps _Volts Overhead Underground No. of Meters New Service 000 Amps / Agvolts Overhead Underground E9 No. of Meters I�As- Number of Feeders and Ampacity 3 IOX4AP5 Location and Nature of Proposed Electrical Work 4� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ound round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal r ---j Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs ` No. of Motors Total HP OTHER• IrlaltarwCoveraga PtmanttotheWzmuzofMassxbiseMGa alLaws IbavoaamentLmbl7dylnst==RbficyiwkxklgComple�bomCovaageoritsaistmtialequiv&I YES NO ED Ibavest>brnatedvandpVofsametothe011ioe. YES c/ j Ifyoulowdrd®dYES,plea9 n dcaethetArofoovaageby g 1_.J / P4SURANCE� T,," BOND M MIER r7 ( SPAY) ��-3 � r._ •� rte_` WolktoSM Af- 9 ` �3 kq ectmD&Requesw SignedunderTr, ofpajuT.�- FIRMNAME Licmsee Signature r Esfim&dValwofE6ctricalWak $ v Rottgll Ui/C,1— �. t.C, Final wtc- d t.L „�• _�� LioawNo. /377/67) / v V Lioms,-No BmirmTetNo. 603- 03,0 0 --,0AltTUNo. 3"" ® A OWNER'SINSURANCEWAIVER;IamawarethattheLwwdoesnothavetheinst>tamoovetageoritsatbstaMepvakmaswgimedbyNb%ad m3GaiedLaws and thatmysigilawonthispermitapplicationwaives thistegtmer ML (Please check one) Owner M Agent Telephone No. PERMIT FEE signature o caner or gen Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am,a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address Cifir Phone # Insurance. Co. Policv # Company name: Address CW.. Phone #- Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition d aiminat penalties of.a fine up to $1,500.00 and/or one years' imprisonment_welLas-iW penaltiesjnihelnrm-da-S?OP VAKM ORDMI-and a fine.aF_($1-00.0o)-aidwagsinstMe, 1 understand that a copy of this statement may b; forwarded to the Office of investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature pie Print name Phone .# Official use only do not write in this area to be completed by city or town offidar 1 City or Town -- - Permit/Licensin-g J El Building Dept Check if immediate response is required .0 Licensing Board E] Selectman's Office Contact person: Phone #. E] Health Department Ei Other 1* 4132 Date.................................. /�', i 2� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... . ............................. .. ............ has permission to perform ............................................ I .. .. ..... wiring in the building of . . ......................... .............. (-7 V - , r ............. at .. . ......... I North Andover, Mass. Fee.. Lic. No1396f}' .z ...................... ELECTRICAL INSPECTOR Check # THEC0MM0NWE4LTH0FM4SS4CHUSEnS Office Use only DEP4R7711W0FPUBIICW,67Y / vl— BOARDOFF7R[E EPREVHONREGUL4HONS527CM12� Permit No. _ O ccupancyy & Fees Checked APPLICA77ONFoR PERMIT TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) - 9 POO � Date �f� Town of North Andover -- The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location (Street & Number) 2-00 Ch ' Owner or Tenant )( I I 1,k V Y. J .r. 10 ri v ii7vm .5S0C/ 7//ai Owner's Address Is this permit in conjunction with a building permit: YesNo ® (Check Appropriate Box) Purpose of Building Utility Authorization No. La Existing Service �� Amp =Volts Overhead M Underground g No. of Meters .� New Service ©6 Amps / Zo / 2,0 Volts Overhead Under ' ound to No. of Meters f Number of Feeders and Ampacity — Location and Nature of Proposed Electrical Work l ns z// temp- 77,yi( /onn,o No. of Lighting Outlets No. of Hot Tubs No. of Transformers No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters Key No. I;iiydro Massage Tubs Swimming Pool Above Psi Below No. of Oil Burners No. of Gas Burners No. of Air Cond. Total Tons No. of Heat Total Pumps Tons Space Area Heating Heating Devices No. of No. of Signs Bailasis No. of Motors Total HP venerators —--vJ9e11cy i,igntmg battery Units FIRE ALARMS Total I No. of Detection and KW Initiating Devices ;KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices LocalMunicipal M Connections Total KVA KVA No. of Zones Other rmuanceCbmrgr- PlIIa =6D thew4mal>eas dwbmdustSCim"al am 'haNcaumailiabklmnanoepo y>rxkIdTQMPCo oritsst legwvalalf m y� hart;subm�dyalidproofofsametothe Offie M ® NO If}utmdekedYES,leaerdetpofcvrheUigthe box ageby VSRANCE� BONA � (Specify) OTHQZ �btklaStart /0%/�o � E0naledVahleof lWoti�$ ignedunderthiePumlties pajuty Rough Final iRMNAME G ' So/j lYor�{iw� �cr� A,/Ve- -5a�m N/1 LiwwNo. l3 s j0 It �9ae �su< c'7uG /7�S�ve iii- Si�hlte I.icerwNo i<fiPcc / BusblessTel.No. &)3 �t ,9r�-O Z, j NMR SINSURANCEWANEIZ IamawatethattheLu edoesnothaveti�inAuar>�covaageorifsst>l antial AI-TUNo /a � 23 /—/.SCT - -da-,— Jdmtmysignatint;onthispwnitapphcahonwalmesthisiequhm-ot �I �bY Laws lease check one) Owner M Agent p Telephone No. I Igna ure or Owner or Agent PERMIT FEE Date.2 :.//-?. -. . ..... r� Of°1ti0 TOWN OF NORTH ANDOVER PERMIT FOR CAS INSTALLATION 'This certifies that .. hI/.�-.5.l. ...44c- //..c........ . has permission for gas installation ...... , . in the buildings of. !� �? !? l: �..../.'!. c:/ ? ....j �.(� ...0 ..... �-. . at ....7. (::�,: f ... t ...... North Andover, Mass. Fee.J.& ( .. Lic. No.M 7)..'... a .� .:... . GAS INSPECTOR Check # 3 3 CJ 4319 MASSACHUSETTS UNIFORM APPUCATON FOR PERAMMU TO t-& TING (Type or print) D?/Q 3 NORTH ANDOVER, MASSACHUSETTS Building Locations /GIkle ri i Owner's Name New Renovation ❑ Replacement ❑ 6.0,7 jg # Permit # W) 19 Amount $ •� p G Plans Submitted ❑ (Print or type) / Chec one: Certificate Installing Company Name /`�//J9�S/On A44g0/e4l C•L-9-corp. A223—c Address [ i2� 2te /// ❑ Partner. Business Welephone (�03_ ` Firm/Co. Name of Licensed Plumber or Gas Fitter 9— 1l 4i/9 er/y,'I INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy ®r 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 ❑ 11VI VUy LA -,1 My ulal au vi me uetalls aria mrormarton 1 nave summinea (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State GasyCode andj;hapter 142pf the General Laws. (OFFICE USE ONLY) 13"Plgnature of ] umber Gas Fitter H[R�- I ter ourneyman ;ed Plumber Or Gas Fitter License Nurnuer OR Date //.?-. G. 3 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............. has permission to perform ... ........ plumbing in the buildings of ........ at. . ....... North Andover, Mass. Fee. Lic. No, .. ..... ......... / PLUMBING INSPECTOR Check# 5546 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date sz � Building Location p�00 �[ c.��er �i►ey / Owners Name 7er/'k /"ra,o«T/t J Permit # Amount �, �D o '00 dr7 /i i I / �I4 fl Type of Occupancy .4 New vRenovation ❑ Replacement ® Plans Submitted Yes E] No FIXT'.0RES (Print`or type)/ Check one: Certificate Installing Company Name //�QSf i� �tChaale l � G . a Corp. 207,3-5- Partner. 073-GPartner. ® Firm/Co. Name of Licensed Plumber: /VliGii4L1 f S4 --n 0lo f Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy B�_ Other type of indemnity 11 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner 1:1 Agent rl I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State �lumt�rrg de and Chapter 142 of the General Laws. ,D (OFFICE USE ONLY Type of Plumbing License zi: % X5_6 z License um er Master Journeyman El-- (Print`or type)/ Check one: Certificate Installing Company Name //�QSf i� �tChaale l � G . a Corp. 207,3-5- Partner. 073-GPartner. ® Firm/Co. Name of Licensed Plumber: /VliGii4L1 f S4 --n 0lo f Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy B�_ Other type of indemnity 11 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner 1:1 Agent rl I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State �lumt�rrg de and Chapter 142 of the General Laws. ,D (OFFICE USE ONLY Type of Plumbing License zi: % X5_6 z License um er Master Journeyman El-- .4 Date ...IA.. 7/K, 3 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies ............................................................. has permission to perform ..... ....... ............. ':ring in the building of ........... ...... ................................ ..................... ! , k ,a,, zo c) ................. ....... ....... North Andover., Mass-. C)U ....... . .. Fee..../.5 .......... Lic. No.C/.,.... . ............. ........ ...... o.. /l/ ELECTRICAL INSPECTOR Check # 7 ??C0 4922 Commonwealth of Massachusetts Official Use only Permit No. Department of Fire Services �; O'ccupancy,and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Re',v. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12JOO (PLEASE PRINT IN INK OR TT LL FO ATION) Date: % a City or Town of: To the Inspecto of Wires: By this application the undersigned aives notic .o i1 or er intention to perform the electrical work described below. Location (Street & Nu r) Owner or Tenant Telephone No. 1 Owner's Address Is this permit in conjunction with a building permit? :. Yes.. ❑ No IFTqV (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts . Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity , Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the following table may be waived by the In.cnertnr of Wirec No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool. Above rnd ❑ In- rnd_ 1:1o. omergency ig►ng 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 g No. of Waste Disposers . 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 Equi valent No. o Water KW Heaters No. o No. o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. No, Hydromassage Bathtubs No. of Motors Total. HD Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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:) (Expiration Date) Estimated Value of EI pct Work: , (When required by municipal policy.) Work to..Start: Inspections to be requested in accordance with MEC Rule_ 10, and upon completion. Icertify, under the pains "nd penalties ofperjury. , that the information on this application is true and complete. FIRM NAME:Soci-city LIC. NO.: J g31c Licensee: John S. Bassett Signature W. LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line.) Bus Tel No • ri0. 594 5928 OWNER'S IM required by law Owner/Agent Signature _ Alt. Tel. No.• URANCE WAIVER: I am aware that the Lid9hsee does not have the liability insurance coverage normally By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Telephone No. PERMIT FEE: $ , 202 Date: Z.7.: (".;�...... NO"T" TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION This certifies that !? ��.�� ...� 2r.i?... A r....... .. . has permission for mechanical installation ............. in•the buildings of ....f ... /.'.�?.�' ../.:'! �,�'.................... at .. ? -. ..�:. '.�. !' '!:: %� � 1... North Andover, Mass. :. r_ Fee. f`. ? .�:.. Lic. No........... ...rte... ! ......:.:, .... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TOWN OF North Andover 27 CHARLES STREET NORTH ANDOVER MA 01845 FURNACES, BOILERS, COMrnv&)T(y Cc-i't°T{-12 ROOF TOP"'UNITS, AIR CONDITIONERS, EMERGENCY, GENEREATORS�;'. FEZ, IO 19 The undersigned applies for a permit to install the following at: Location Owner of premises 1 A'a 'C .r C' /1 e Pr/ 4 , Address Name of mechanic r��@ 4A0_1_"C Address % PDU� l�fi2/% S� /"#AX If_6� TF1Z f Nff & iS Material of building Building occupied for Kind of fuel LF Chimney No. Of flues oZ Size '/"" Chimney Thickness Lining If steel stack location Diameter Height DESCRIPTION OF HEATING APPARATUS Kind of heater �O�t f'0 how many �Z? make 2 i2.1 f` 2 —�1 145,1L BTU Input 100 UCoo Location in building RT Protected against fire as required How protected See the State Code (Pertaining to Chimneys, Smokestacks and Heating Apparatus) ROOF TOP UNITS OR EMERGENCY GENERATORS Make Weight Dimension Length Width Height Location of building how supported Size of roof timbers Material of roof timbers Span of roof timbers Distance on center, Protected against fire as required How protected AIR CONDITIONS Kind of apparatus make 203 ....... &ORTN TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION This certifies that ...... 4xl� .. .............. has permission for mechanical installation ...N11."1. !c; ............ in the buildings of ... Ar. ........ at ......... North Andover, Mass. Fee —Lic. No........... ....... GAS7 INSPECTOR WHITE: Applicant CANARY: Building Dept. V PINK: Treasurer TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MA 01845 HVAC PERMIT FOR THE INSTALLATION OF AIR CONDITIONERS, BOILERS, EMERGENCY GENERATORS, FURNACES OR ROOF TOP UNITS. The undersigned applies for a permit to install the following at: LOCATION(, ,� r ad S c /14 DATE OWNER OF PREMISES ADDRESS CONTRACTOR NAME. PREMISES NAME _ TYPE OF FUEL CHIMNEY THICKNESS DIAMETER ADDRESS MATERIAL OF BUILDING CHIlVINEY NO.OF FLUES LINING SIZE IF STEEL STACK LOCATION DESCRIPTION OF HEATING APPARATUS TYPE OF HEATERNUEL Gam- R3 'f HOW MANY 42 V_ MAKE 3 A �,NA A— BTU INPUT PROTECTION AGAINST FIRE AS REQUIRED HOW PROTECTED LOCATION IN BUILDING ROOF TOP UNITS OR EMERGENCY GENERATORS (See the State Code pertaining to chimneys, smokestacks and heating apparatus.) DIMENSIONS: LENGTH LOCATION ON BUILDING SIZE OF ROOF RAFTERS SPAN OF ROOF TIMBERS PROTECTION AGAINST FIRE AS REQUIRED HOW PROTECTED BTU INPUT / OUTPUT WEIGHT WIDTH HIEGHT HOW SUPPORTED MATERIAL DISTANCE ON CENTER FUEL TYPE APPLICANTS SIGNA DATE _ j d TOWN OF North Andover 27 CHARLES STREET NORTH ANDOVER MA 01845 FURNACES, BOILERS, ROOF TOP UNITS, AIR CONDITIONERS, EMERGENCY, GENEREATORS The undersigned applies for a permit to install the following at: Location I,C T� 1� 5N� Owner of premises Address / / Name of mechanic Y `'� �-Ca- ('f ✓ 6� L Pa:5e- l ,� /Z Address % 7y '50 UC jl,7 /Z Building occupied for Material of building Kind of fuel tl'C"5 Chimney No. Of flues Size—& Chimney Thickness Lining If steel stack location Diameter Height DESCRIPTION OF HEATING APPARATUS Kind of heater how many make Rft 5 %4 0"-)</ BTU Input Location in building Protected against fire as required How protected See the State Code (Pertaining to Chimneys, Smokestacks and Heating Apparatus) ROOF TOP UNITS OR EMERGENCY GENERATORS Weight Dimension Length Width Height Location of building how supported Size of roof timbers Material of roof timbers Span of roof timbers Distance on center. Protected against fire as required How protected AIR CONDITIONS Kind of apparatus make s TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that .....1 c1.1v�'1u�tt ' ` �y has permission to perform ..........CC).......:%..........i.�..................... wiring in the building of......... �'t ° fir? SSS r i7 //�" ...... ............... .. U .. � � � � ? 0 !Y) ... .... brth Ando r, Mks Fee . .7.5 V rfi Lic. No.l'f. `b fU ........ �. ...' .....� LECTRICALINSPECTO Check # Oni � 4371 THECOMMONWE4LTHOFMASS4CHUSE77S Office Use DEPA[d1fflYT OFPUXJCSAFETY Permit No. BOARD OFFMPREVEM0NREE'ULATIONSR7CMR12.E Occupancy & Fees Checked AI'PLICATTONFOR PEI,M�'T FO P_F'RFCaRMELECl'RICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date >d Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 6- 'LA LN&J- Owner or Tenant /I/047W �/ �`�� !.� Owner's Address 7roC / " ® ` 7W jMhi/* Sr. 40AW 0L1eP _ MA I)I P tl c— Is this permit in conjunction with a building permit: Purpose of Building G Existing Service New Service Amps / Volts Amps Ido 014fovolts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. ofLighting Outlets No. of Lighting Fixtures No. of Ritceptacle Outlets Yes ® No r7 (Check Appropriate Box) Utility Authorization No. S® Overhead F-1 Underground No. of Meters Overhead M Underground r7l No. of Meters No. of Hot Tubs No. of Transformers Total KVA Swimming Pool Above Below Generators KVA ground round No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets el) In , No. of Gas Burners No. of Ranges / No. of Air Cond.Total FIRE ALARMS Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW No. of Sounding Devices / No. of Self Contained Detection/Soundin9 No. of Dryers Heating Devices KW Local unicipal No. of Water Heaters / KW No. of No. of Connection III Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP tTHER No. of Zones ami 8 J Other stuarroeCovaage, Rusr�tY�dieregtritamrgsofMassada�tlsGa�-alLaws raw aamatll"tyknrdncePbkynrhxbgCmpkiD omrdhcwCmnagccrltsatstanWeqmvakzt YES r NO awahnwEdvandpmdofsametotheOffioe YES ® F)ouhaNedmkodYES, Pime"kd *thetypeofODMMa pby Cdr..--- x SURANCE BOND OIIHER r, Dai � ' �� Es�dvaluedBamica Wok $ xktoShatt /hq)"onD�Re sled Rough fit/ Lf— DedunderTrIftviltiesofpejtny Fir�l f.(//LL- CEJ ':MNAME x Cl ,rlvc" iic=No. 13 5Y of 2f ISO-,�i�T �wK / Signahm I.icerwNo 13,5 A %ES%L 1� D3O� BusinessTel No. � i�D 3 1J� A� Tel lam. �NM'SNSURANCEWAM3? Iamawa�ethattlteLio�sedoesrtothavetheirlstuar>cecovt'tageoritssulxtariUequivalaxasragmedbyMassachumCtneralLam that my signature on tins permit application waives this regturzrrrm /. ase check one) Owner ®' Agent Telephone No. PERMIT FEE L ignature of Uwner or Agent ..... L Name The Commonwealth of Massachusetts Department of Industrial'Accidents Office of Investigations Boston; Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone #- I am a homeowner performing all work myself. I am a sole proprietor and have no one working in. any capacity ExI am an employer providing workers' compensation for my employees working on this job. Company name: 1%/g ` ��:e�%1 Address JVD IV WMAIE5 f �� 6411 City: N 4�fJ%l Phone# W3"` ureuice, Policy# In_ICA 1,5-611V5-16 Company name: i Address City: Phone# - Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as_well_as-civilpenattiesin-thelmn-da-ST_OP:VU9RK_ORDERand_a.fine-cf.($7110.OD)-aAay.agains .me: I understated that a copy of this statement may be forwarded to the Office of Investigations of the DtA for coverage verification. l do hereby certify under Me pains A / Signature Print penalties ofperjury 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 Peimit/Li,—si El Building Dept El Check if immediate response is required Licensing Board El Selectman's Office Contact person: Phone #: Hearth Department F, Other Date. .3 o'<" �':��o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING hhnnc ` This certifies that .1.... Ph l I.. 0 ........................... . IRRIf�q`i•iV•� ' has permission to perform ....�r.� �. i .1'.� q`�?.. Pr ,j-.. • • 7•� fP!"� �'. plumbing in the buildings of b << k ............ , North Andover, Mass. Fee. .4.0 Lic. No �`.I'L3.8.. PLUMBING INSPECTOR Check # 5662 MASSACHUSETTS UNIIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Typeor print) NORTH ANDOVER, MASSACHUSETTS Building Location Owners Name Date 7—A-03 - Permit # Amount Type of Occupancy New M Renovation ® Replacement ® Plans Submitted Yes ® No uyvlrTTDT'i C (Print, or type) Check one: Installing Company Name Corp. 1 Partner ® Firm/Co. Name of Licensed Plumber: z „�, Vri !y Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy � Other type of indemnity Bond Certificate Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will. be in compliance with all pertinent provisions of the M sachusetts State P Code and Chapter 142 of the General Laws. BY of Licenseaum r e of Plumbing License Title r,` � Lt License 3$ City/Town ise um r Master ® Journeyman APPROVED (OFFICE USE ONLY T Date................. TOWN OF NORTH ANDOVER ;. PERMIT FOR GAS INSTALLATION I ^'th This certifies that .jam Y�`:�..... �``... has permission for gas ins llation in the building of :j� cs=a .......... at ''a - ``.. ```�.. !....°. , North Andover, Mass. .,:.5 .. �d� • r Fee �'°.... Lic. No. G.. �� V GAS INSPECT Check # 4361 i MASSACHUSETTS UNIFORM APPLICATON FOR PERMTr TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations e-)100 Owner's Name New r Renovation ❑ Replacement ❑ 19 Permit It _4/2 Amount $'Z7o °y Plans Submitted ❑ (Print or Q type Che& one: Certificate Installing Company Name Al"'n Ia � i'1< a/ �C• B -Corp. Address ❑ Partner. Business Te ephone l0 6 6 Finn/Co. Name of Licensed Plumber or Gas Fitter AG'.1w'.--r .,.� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes � No❑ Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy [ / Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General, Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I ucicuy Ucruiy uiaL ail ul uiC uCiaus anu unormanon t nave suornmea (or enterea) m above appiwahon 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 MassachusStag Ga d an Chapter j42 ofthe General Laws. I (City/"I'own I (OFFICE USE ONLY) Signature 6f umber ❑ Gas Fitter 0 -171W -ter 1-a Jt�eyman censed Plumber Or Gas Fitter License Number • (Print or Q type Che& one: Certificate Installing Company Name Al"'n Ia � i'1< a/ �C• B -Corp. Address ❑ Partner. Business Te ephone l0 6 6 Finn/Co. Name of Licensed Plumber or Gas Fitter AG'.1w'.--r .,.� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes � No❑ Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy [ / Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General, Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I ucicuy Ucruiy uiaL ail ul uiC uCiaus anu unormanon t nave suornmea (or enterea) m above appiwahon 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 MassachusStag Ga d an Chapter j42 ofthe General Laws. I (City/"I'own I (OFFICE USE ONLY) Signature 6f umber ❑ Gas Fitter 0 -171W -ter 1-a Jt�eyman censed Plumber Or Gas Fitter License Number TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ........ has permission to perform plumbing in the buildings o Mass. at ....... ....... North Andover, Lic Nor��L?. ; :-4 Fee'1.... ....... /"--PLU�,"i INSPECTOR Check # 5602 a .4 ,4 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ,m (Type or print) NORTH ANDOVER, MASSACHUSETTS / // n Date 4 lc,„20(D3 Building Location Q[) (' keron\ 5 12d- Owners Name T/lz Permit Amount &0-C::,. # 3 TypeofOccupancy (�njp'( New Er RenovationE] Replacement ® Plans Submitted Yes ® No FIXTURES (Printor type) Check one: Certificate Installing Company Name n 11 C c ` Corp. %3 t; Address / X Te �� ❑ Partner. ,����� Business Tdrephone _��� 9;:Z bps o ® Firm/Co. Name of Licensed Plumber: �%!Gh �i ✓� ��+ i , y ^ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0-� Other type of indemnity 0 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner El Agent F 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 Massachuefts tat lu C and Ch 142 of the General Laws. no Ar By Igna o Licenseum r Type of Plumbing License Title �1��1�.7 City/ I own ccense Numoer Master �oumeyman (/ APPROVED (OFFICE USE ONLY �J Date....-`�..:�� . �� ....... TOWN OF NORTH ANDOVER P PERMIT FOR WIRING This certifies that c-:::::�..:-�-_� .............................. has permission to perform ..... ,`..:..../ - -, .�G..,.fj.�... V wiring in the building of ............ % ; G - -ycc z �. Y ....... , North Andover, Mass. t` R. Fee . r. r ' '....... Lic. NoI2,5 ............... . ... .................. f' IECfRIGALINSPECTOR Check # 4513 THECOMMONWEALTHOFAWSACHUSETTS Office Use only DEPARTMENTOFPUBIICSAFETY Permit No. �s73 BOAMOFFREPREVEVHONREGULAHONS527CM12M Occupancy & Fees Checked APPUCATTONFOR PERAlff TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) � Q �i C C I Cr Amt (%ui 3 Owner or Tenant a / Owner's Address N04Vi /N Skr livCW Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Cow& loul'044I Utility Authorization No. Existing Service ��,,p� Amps /Volts Overhead Underground No. of Meters New Service " 000 Amps/VV / $'Volts Overhead Underground P No. of Meters Number of Feeders and Ampacity 3 /000. Location and Nature of Proposed Electrical Work R4'a/VV6— Af-3 P S S0 4Mi MI No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool . Above Below Generators KVA round around No. of Receptacle Outlets No. of Oil Bumers No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total i Tons No. of Detection and No. of Disposals No. of Heat Total Total Pum sTons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained' Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW M Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total, HP OTHER• Ihh�aartoeCovvage Ptasl�rrttattleragimana�cfMassad>veettsGeneralLaws �� � ^,1( NO -*w h>tsttrmoePokyirr u&CC 4iele Cov*�ageorilsst>I U IhawstlbuiWd'vafdproofofsmwiDtheOffm YES U 7 ..Fyxhaw dledDdYES, irdca edrVA eofcomtageby, c' igthe X.�/ �� II SURANCE BOND �,. OUIER F&aseSpo*) r T worktoShatt 5_;-19c-03 OWNER'SINSURANCEWAIVER;lain awarethattheLio mdoesnothavethei and thatmysignatuteon thispetrrtitapphcatim waiNesthisrequimnfftt. islg-mm -all�_ oil iii -%: � � r � • � . '�' - t1 �. ��. (Please check one) Owner L__J Agent o-� Telephone No. PERMIT FEE $ (6c'e'2'/ � Signature ot Uwner or Agent Names The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigationsi Boston, Mass. 02111 r' Workers' Compensation Insurance Affidavit Please Print Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address Cibc Phone # Insurance. Co. Policy # Company name: , Address City: Phone # Insurance Co. Policy # Failure to secure coverage as required. under Section 2M or MGL 152 can lead too imposition of criminal penalties of.afine up to $1, 5w.00 and/or one years' irnprisonmentsasvrdLas_civil:penakiess-m2heimm-f-a-STOPYdDWDPJ)BRand_afinejt_($11.1 M)atlay�gainstme_ I understand that a copy. of this statement may be forwarded to the Office d bons of the DIA for coverage verification. I do hereby caertify under the pains and penalties of perjury that the i mWmaborr provided above is true and correct_ Signature pate Print name Pbone.# Official use only do not write in this area to be completed by city or town officiar c e City or Town eerrrdt/tact� i _ Check Y immediate response is required El Building DeptEl Licensing Board El Selectman's Office Contact person: Phone # E] Health Department Ei Other Date..:/.�.".G.�. 40 R7 :��o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This -'certifies that ... . ! j.1/ ::.... `,�%7�" . �............ . has permission to perform ....4/. . C... ............... . plumbing in the buildings of ..... .1-........... at.cif Jt >.. C/r r /: e .:,....1. �......... North Andover, Mass. Fee 4� G!? U- : Lic. No.. lQ .?.>... c .. . �LumBING INSPECTOR Check # /K 73 5619 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS / / Date �e 3 %� a oa Building Location o206 c c -lee- 2 l:» lew Owners Name �r//at 1o,0�2T/G.S Permit # 6 Amount Type of Occupancy New 61-� Renovation ® Replacement ❑ Plans Submitted Yes ® No El FIXTURES (Print'or type)f/ / Check one: Certificate Installing Company Name n /i' ,4dar1�%%�l ha// c� / Corp. d� 7 3 —C Address / ❑ Partner. Business Teleph6ne Go3 S/a — (9 l��d Firm/Co. Name of Licensed Plumber. CJS 4G/ �4 e � 04 Insurance Coverage: Indicate the type "insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent. I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under,permit Issued for this application will be in compliance with all pertinent provisions of the Massachu efts S e P g C and Ch 142 of the General Laws. By: 7gilauire of l'IcepagirriumBer Type of Plu&6ing License Title Ci /Town ty icense Numoer Master Journeyman APPROVED (OFFICE USE ONLY Date. Ca: 12::<J ?...... 3� TOWN OF NORTH ANDOVER ! O T p PERMIT FOR GAS INSTALLATION This certifies that .. ... r. ............ . has permission for gas installation .... "'.j ' -.'/...... . in the buildings of ..4.h /°. P. �a./.�.................. . at c?C�4..��c �t lz �i�.�.� ; . /�.�.. ./....' North Andover, Mass. Fee ....>. U o'... Lic. No.16 2)-.. 2 .. ..... .....1. ✓_ c � :... . G. S INSPECTOR Check # / 7 (V 4375 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITI]TG (Type or print) j Date g(�o,, Id ?003 NORTH ANDOVER, MASSACHUSETTS �/ Building Locations r)60 /Cl�tdZ /i�g �a sz ( ii! q .2 Permit # 413 7j'" Amount $ Owner's Name t New Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type)//�� C e heck e: Certificate Installing Company Name /S �n� 7o n / /t G h at n i c cLT orp. as i.3 e Address Aug )?ai 27 L t�� ❑ Partner. !� o Business Tele hone 6a3 45e ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes Q'—1 No❑ Ifyou have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all"plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts SSatSGas.CodAd Chapt9;42 ofthe General Laws. (OFFICE USE ONLY) S ahire of Licensed Plumber Or Gas Fitter Plumber AXI 7S'7 — J1-f50f( ❑ Gas Fitter License Number �PGlaster journeyman 3RD. FLOOR 8-TH.- FLOOR (Print or type)//�� C e heck e: Certificate Installing Company Name /S �n� 7o n / /t G h at n i c cLT orp. as i.3 e Address Aug )?ai 27 L t�� ❑ Partner. !� o Business Tele hone 6a3 45e ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes Q'—1 No❑ Ifyou have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all"plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts SSatSGas.CodAd Chapt9;42 ofthe General Laws. (OFFICE USE ONLY) S ahire of Licensed Plumber Or Gas Fitter Plumber AXI 7S'7 — J1-f50f( ❑ Gas Fitter License Number �PGlaster journeyman Date.. ". !..�' ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........... has permission for gas installation J in the buildingszo�.. �� ! ...... ... .:���....... . at ............................. ... , North Andover, Mass. Few'.... Lic. No.1!?.. �,/' q ........... (/ GAS OR Check # /f-/(2- 4384 f/C 4384 Z-00* CXrCGleklh MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAFITTING (Type or print) Date 1 b NORTH ANDOVER, MASSACHUSETTS R� U Building Locations % rV � / V� ' ��� Permit # xf l/� C� S VAmount $ C/ Owner's Name New ❑ Renovation ❑ Replacement Plans Submitted ❑ (Print or type) G Ch one: Ce�m��te I�agt�llyg Company Name 'v`p p Wil` Address _./;' �� �e, ❑ Partner. Business Telephone 7 _ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter t�j��,�/�✓ �/� INSURANCE COVERAGE Check e: I have a current liability Insurance policy or it's substantial equivalent. Yes [Z No[:] Ifyou have checked yes, please indicate the type coverage by checking the appropriate box Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i nereoy cermy mat an or the aetans ana mrormatnon t nave submittea (or enterea) in above application are true and accurate to the best of my knowledge and that all plumbing work and instal at performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus Ga5.Co e w-4Q)Apter�2 of the General Laws. 'AYYKV V hl) (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 0 616Z ❑ Gas Fitter License Number ElMaster ❑ Journeyman • IST. FLOOR (Print or type) G Ch one: Ce�m��te I�agt�llyg Company Name 'v`p p Wil` Address _./;' �� �e, ❑ Partner. Business Telephone 7 _ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter t�j��,�/�✓ �/� INSURANCE COVERAGE Check e: I have a current liability Insurance policy or it's substantial equivalent. Yes [Z No[:] Ifyou have checked yes, please indicate the type coverage by checking the appropriate box Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i nereoy cermy mat an or the aetans ana mrormatnon t nave submittea (or enterea) in above application are true and accurate to the best of my knowledge and that all plumbing work and instal at performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus Ga5.Co e w-4Q)Apter�2 of the General Laws. 'AYYKV V hl) (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 0 616Z ❑ Gas Fitter License Number ElMaster ❑ Journeyman BUILDING 3(B) 200 Chickering Road 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 d o 0 0 0 0 0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 Cl 0 0 0 0 0 Cl 0 0 0 0 0 0 0 0 0 0 0 0 U O\ O� N Os Ow N [� O^ G� Q^ N Qn cl Cl O� C^ an O� C ^ C O� O\ C� L �' a1 vl O\ d\ Vl � O\. O� 71 ul r O\ ON O\ 01 C\ O\ (� O\ Q\ d Vl V M •-� M d M d' M [` V vl �O �/1 00 d' d' 00 V) rl n. N N r. N N N N N ^' ^' N N N N N --^••^� ^' N N ,,,I's 69 U}t 69 6R 69 of I Es I 69 69 69 6R U" 6R 69 69 6R 69 69 6A 69 69 I 69 M '.M d MMM M co d co co co co co co co co 'i' M co CO r+ O O O O O O O O O O O O O O O O O O O O O O O O 0 r l0 T O m 1p V d' (O LO(D CA d' N (O (O N CO to T to (O T d0 h y r T T N N N N N N N N N N\ N N\ N T N N— N N N N N N T T T T T TT T T T T T r T T T T O r r T r T T T T T r T T T T T T U M M M M M M M M CO Cl) (•J C7 C<j V� c', c•, — — - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O O O O O O O O O O O O O O O O O O O O O O O N N N N N N N N N N N N N N N N N N N N N N N N 6666 0 666 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N N N N N N N N N N N N N N N N N N N N N N N N T T r T T T T T T T T r TT r T T T T T T T T T r T T r T T T r T r T T T T T T T T r T T T T T ,,,iN icq nTM IN T IN r r N N NINITININITICNIN M MMM CO MMM Icol M IC01MIMIMIMIMICrMIMIMIMICMIMIcMIM ,It m �o Z M T N M d CO f� CA T N M CO O T N M (n '01,001 O f� CC) p 0 0 0 0 0 0 0 00000000000 0 0 0 000 U p T T T T r T T T N N N N N N N N M M M M M M M M N � 'E •+ aJ +_ 'E a+ w LL C C C C C C C C C C C C C C C C C C C C C C C C D D � � Z) Z) Z W� -o-0-oio'o-o-o'a-0-0 o 0 ov ov-a'o'oioio o � co m m m m ca m m (a m m cv m m (a m N N m (a m m m m k� O:O O O o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Y Z y m'm m O m O m m m O O O m m O m m m m O O m m N C C C C C C C C C C C C C C C C C C C C C C C C .L .` .L .` •` •` •` .L .L .` .` .` '` .` .L •L •L O N O N O fU N O N N N N O O (U CU N d,z N O CU O 4) N Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y U U U U U U U U U U U U U U U U_ U ._ ._ ._ ._ ._ ._ t L t L L L L L L L .0 vUUUUUUUUUUUUUUUUUUUUUUU 000 O O O O O O O O O O O O O' 0 0 0 0 0 0tos 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0N N N NN N N N N N N N N N N N N N N N N ciO L N •C C 7 N C N Y C (6 -0 O O L cl >: } (0 a — U 41 E E Mn (9 O J N U c4 (0 L (V m S- U M Z L U N p co co U N i N C Q 7 lL O N 2�C cu > N N O N Co c6 t N N > 3 m o O U v j m U R 0 0 m V- @ rn O O C C L CU 0-3 cn o O= J U � C 1- 0 YO C O N in O t c' N E c E f° o N N voi E Z (V L .0 U C 0 L co Q (6 O 7 a E 2> cU O E O O N J -O L O Q U cm a) > U (1 O c l O 0 a -� (6 W Y N cor -a N U C >, a 0 LL1 v, Q H O C L a) C O in Mo ._ o` N O LL1 O v O (0 Y C c O W N L V E C O L N O N� O L U (6 Cu L a) m 'r N Cu 'm (6 -oi�00002Ja- L L Q O o O xo:� �UY -)Z H2-1 -�,- nnao �y y�sSACHU`�tS CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: M 2 ® M IMS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS Unit #101 - TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC'' 231 SUTTON STREE, NORTH ANDOVER Building Inspector Ot pORT/1ti O o n s • ' s 9SSgCHU`'Ei CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER . Building Permit Number 267 (11-13-02) Date: NOY 2 0 200 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- Shawsheen" Building MAY BE OCCUPIED AS Unit #102 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 2 1 SUTTON STREE, NO HANDOVER 01845 Building Inspector 0 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: DW 9. 9 213 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road - "ShawsheeA' Build MAY BE OCCUPIED AS UNIT 103 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE ANP SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET NORTH ANDOVER 0184 Building Inspector x r xi gv SswcNu CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: Nov 2 0 M THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT 104 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH ANDOVER 01845 m Of NORTH AN ��SSAC NUSE�� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-0-02) Date: NON 2 ®- 2DO3 THIS CERTIFIES THAT THE, BUILDING LOCATED MAY BE OCCUPIED AS UNIT #105 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC t311 SUTT N STRE5!T; ORTH ANDOVER Building Inspector O` "ORT{ 1N t n�• 71 .� n n wF••4ri 9SSA`HJSp� CERTIFICATE O F USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (II -13-o2) Date: NOV 2 0,21D3 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAYBE OCCUPIED AS UNIT #106 -- ONE BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231SUTTON ST EET, N ANDOVER 01845 `J Building Inspector O� "ORT" Ah t I 1 � 7 SACHUSEtt CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen Building MAYBE OCCUPIED AS UNIT #107 -- TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH ANDOVER 0184 Building Inspector Of ,ORT :1H 9SSACHJSEt� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 261 (11-13-02) Date: NOY 2 - THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAYBE OCCUPIED AS UNIT #108 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTMCATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH ANDOVER, MA 01845 B ding Inspector OF "ORT1, qM O a a . r • r � 4 �9'SSACHUSE� 5 CERTIFICATE OF USE & OCCUPANCY 'NOWT OF N0RTH ANDOVER Building Permit Number 267 (11-13-02) Date: V U ZD03 C 1 Y1DRUM THE BUILDING LOCATED ON 20U Chickering Road -- "Shawsheen"' Building MAY BE OCCUPIED AS UNIR #201 , -- TWO BEDROOM UNITIN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET,,,NORrTH ,ANDOVER 0182 Building Inspector f NORTH o �M M off-• r.0 ", « �/q ••r.e .A�4h SSACNUSES CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOVA- 0 2M3 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #202 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 23�UT EET, N R AND 01845 `J' j� Building Inspector Of pORTN qN ♦ y� K t"S �9SSACNUSE4 9 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH COVER Building Permit Number 267 ( 11-13-02) Date: t40V 2 0 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Buildin MAY BE OCCUPIED AS UNIT #203 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH ANDOVER 0182 6 ���g ppect®r OF ,µORT j R �SSMH�g� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: THIS CERTIFIES THAT NOV 2 0 2003 THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAYBE OCCUPIED AS UNIT #204 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 23L SUTTON STREET, NQgTH ANDOVER, MA 01845 Building Inspector Of ,koR TM 3= �'�_ n t•�° Oft h sy A • i F r M �br+„ Armor �tSSACN�S�� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Pen -nit Number 267 11-13-02t NOV 0 2003 Date: THIS CERTIFIES THAT THE BUILDING LOCATED ON200200 Chickering -- "Shawsheen" Building-- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #205 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTMCATE SUED TO: TERRA PROPERTIES, LLC �2312SUTTON STREE NORTH ANDOVER 0184 Building Inspector RORTry Of < •� �p e A t r • o r 49Ss1cNus•� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date. NOV _� 0 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAYBE OCCUPIED AS UNIT #206 -- ONE BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGU_ALTIONS AS MAY APPLY. -,CERTMCATE ISSUED TO: TERRA PROPERTIES, LLC 31 SUTTON STREET RTH ANDOVER, MA 01845 l , Building Inspector Of "ORTk 7ti F � A t i . Ci�iiL_ f r taSACNU4E� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOV 20 200 .. THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #207 -- TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 S TTON STPEFq, NOR DOVER 018, 'J Building Inspector NORrk os f. ,aiyo eo. e R x - Y x f w Y �.lCH's 5e�h CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: Nov 2- ® 2M THIS CERTIFIES TILAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #208 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LEC 231 SUTTO STREE ORTH•ANDOVER, MA 01845 `J Building Inspector r Gf h°R7 : iy f A 1S.sA+Cn�s6<4� CERTiFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267. (11-13-02) THIS CERTIFIES THAT Date: NOV 2110 2003 THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #301 -- TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTI , LLQ �TONST NMA Building Inspector O, NOR7ry A A k T Fi 4� ,SSACNU�� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) Date: NOV 220 003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAYBE OCCUPIED AS UNIT #302 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH. ANDOVER, MA 01845 Building Inspector of Ko�xrM �y F P i• �b ya•'� i, i its=ACNUSEt� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 11-13-02 mate: NOV 2 0 2003 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Buildin iYi.AY BE OCCUPIED AS UNIT #303 -- ONE BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER. REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC �\ 1 TTON S �-��MA Building Inspector. ,10RTM D i3•eb. M.� h 9r �SsAcRusQ� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit dumber 267 (11-13-02) Date:My 2 P nD3 THE BUILDING LOCA'T'ED ON THIS CERTIFIES THAT 200 Chickering Road - "Shawsheen" Building MAY BE OCCUPIED AS UNIT #304 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH O'T'HER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTON STREET, NORTH.ANDOVER, MA 01845 `J - Building Inspector Pf NORi{� q4 a.n. ✓��1h tSSACWSE� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11-13-02) THE BUILDING LOCATED ON THIS CERTIFIES THAT Date: NOV 2 r 2DD3 200 Chickering Road "Shawsheen" Building MAY RE OCCUPIED AS UNIT #305 -- TWO BEDROOM UNIT IN ACCORDANCE R -TM THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUT``TON-- STREET N.• ANDOVER, MA Building Inspector O � R SAC CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 267 (11 -13-02) Date: NOV 2 0 ZDD3 THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" B i 1 di ng MAY BE OCCUPIED AS UNIT #306 -- ONE BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231SUTTONSTREET, N. ANDOVER, MA 01845 `J Building Inspector of NORTN qH • r �4SSACNus, CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER v 2 a no Building Permit Number 267 (11-13-02) Date: - THIS CERTIE"IES THAT THE BUILDING LOCATED ON 200 Chickering Road -- "Shawsheen" Building MAY BE OCCUPIED AS UNIT #307 -- TWO BEDROOM UNIT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC \23 N STRE T, NN STRE T, N. A�A 0184 Building Inspector ,iOATry • r �9S54CHt15 S� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER .� ® 003 Building Permit Number 267 (11-13-02) Date. NOY THIS CERTIFIES THAT THE BUILDING LOCATED ON 200 Chickering Road "Shawsheen" Building MAY BE OCCUPIED AS UNIT #308 -- TWO BEDROOM UNIT ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGUALTIONS AS MAY APPLY. CERTIFICATE ISSUED TO: TERRA PROPERTIES, LLC 231 SUTTO�ZSTREET ^NQRTH-ANDOVER, MA 01845 Building Inspector