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HomeMy WebLinkAboutMiscellaneous - 201 CARLTON LANE 4/30/2018 (2)N° 1 /2i ,( Date.!.,.......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ................ f l.. :... .'.... �....................... has permission to perform .....Z....:. _ ./` ............................................ wiring in the building of ......... Z 2. •01 /).-,r�........:�................................. c: / < l / l.�...... 1.^... J" ........... , North Andover, Mass. Fee... /v...'...... Lic. No., -`.2 ....~...'.'2......................................................... ELECTRICAL INSPECTOR 06/23/99 14:02 40.40 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer W-CDM10AWE4LTH0FM4SSACHUS= Office Use only MAP DEPPARDffi7 TOFPUBLICS4 Ty Permit No. -�� BOFF7REPREYE7V77ONREGUL4TIONN527CMR 12:00 --t-- Occupancy & Fees Checked r PARCEL —Ul— I DD FJ PERMIT TO PERFORM ELECTRIC U WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date G ` t O r C� —) 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) © 1A t ,vl� Owner or Tenant Owner's Address 1 Is this permit in conjunction with a building permit: Yes � No (Check Appropriate Box) Purpose ofBuilding� p Utility Authorization No. Existing Service Amps / Volts Overhead ® Underground M No. of Meters New Service AmpsVolts Overhead Underground No. of Meters Number of Feeders and Ampacity A L.ocalon and Nature of Proposed Electrical Work \ T-9— 0 G --� (� No. QfLighting Outlets No. of Hot Tubs -14 No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA and eround 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 Cord. 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 Seif Contained Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of _ Siens Bailasis lJo. Hydro Massage Tubs No. of Motors Total HP OTHE a WctkioS= FIRM NAME �z e c-\ c- OWNER'S I1�IJRANCEWAIVER;IamalA=thatdrel dmnct# audthzirrrvsigt*a�seClltlaspeQtts apccrtwaivestiM# UTZI (Please check one) Owner Agent xprzocri Liam 1 E tm Valuec#naliml Wok S 1%4 1 .40 - . t Telephone No. PERMIT FEES �� Location r,�20 t. P1 r c No. -,,237 Date L ° / NORTq TOWN OF NORTH ANDOVER } n Certificate of Occupancy $ J-3 Building/Frame Permit Fee $ / -3 SACNUS! Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ! U Building Inspector I J i u v 06/15/99 14:39 130.00 PAID Div. Public Works Q O UE � CIO W G r,� _ C N c g ( [ z U O 0 z O Q z , z w z F- ..l a a C � O z i F z czl . } a i C O O p O C 0` C -x -K [y v L L G a C U U c Z O • z© w -J L z w c`n] -s F C z L r w O O Z U z w in in F OU vo-. m w C zzi w 5 rn w w O � a w t m a c (,^+ - to G F� O z o � U Z ^� • a a w w u z Z C a cn w a w F w C Z O F z F [ z Q C4 � � z w Z C c kz. C � w U G c c � c-. V z v w z w Z w z O z z z G to U) w m tl CA tl �A W O UE G r,� u u g ( [ 4 0 z O Q z w z ..l a a C � z i F czl w } a i C O O p O C 0` C Q FF� [y v L L G a C U U c Z O O z© -J W W w -s U V � z W � � a v, F a C 3L w F F z z z `= UE G r,� g ( [ 4 � � a v, F a C 3L w F F z z z ' r Town of North Andover NORTH 1 10 OFFICE OF 3� o `' y°0 COMMUNITY DEVELOPMENT AND SERVICES - x, r 27 Charles Street o North Andover, Massachusetts 01845 '' 4°q,•<° "` c5 WILLIAM J. SCOTT 9SSACHUS�t Director (978)688-9531 Fax(978)688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: tw (Location of Fa lity) " �tgffatiure of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-95.10 PLANNING 688-9535 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone _# I am a homeowner performing all work myself. 0 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. I Company name: Address City: Phone #: Insurance Co Policy # 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 civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under theyfains andVL-0,4s of perjury that the information provided above is true and correct. Signature 67 I&AFF Print namewit U iii. • - # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑Check if immediate response is required Contact person: Phone #. ❑ Building Dept ❑ Licensing Board ❑ Selectman's Office ❑ Health Department ❑ Other OCT -4-29-1998 1c7,: 7-,.9 ............................... . •Jia.....; }.. 4n >r' Ax: i` . X'n: 'd.'r. PRODUCER DAVID S WATERS INS AGENCY 36 MAIN ST - BOX 377 TOPSFIELD MA 01983 INSURED ALAN SIVIALLMAN 2 HAYMEADOW RD BOXT+ORD MA 01921 F .y RT;` rr r,• •r i DATE wo n tM I .1 :'ii'i• S' 29/ 8 08 THIS CERTIFICATE 1S ISSUED S A MATTER OF INFORMATION ONLY AND CONFERS NO GHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE OES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFO DED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A _ NATIONAL GRANGE MUTUAL INS CO COMPANY j COMPANY C COMPANY — -- D j THIS IS TO CERTIFY TKAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA AED ABOVE FOR TME 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 POUCIES DESCRIBED HEF EIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CO TYPEOF INSURANCE POLICY NUM8EA POLICY EFFECTIVR POLICY EXPIRATION OMITS LTR DATE (MM/ODPrY) DATE (MWDDIYY) GENERAL UABafYY MPP 2 9 9 2 6 1610-1798 10/01/99 GEN RAL AGGREGATE *2 000,000 PRO UCTS - COMP/OP AGG a 2 , 0 0 o , ('�IC�OMMERCIAL GENERAL LUIBILTTY _ 000 '..: J CLAIMS MADE � OCCUR PER ONAL & ADV INJURY a 1 , 0 a 0 , 000 OWNER'S E CONTRACTOR'S PROT EAC I OCCURRENCE ' S 1, 0 0.0 a-0 0 FIRE DAMAGE (Any one ere) IS 5 0 0 0 0 0 Mw, EXP (Any City psrw.,) 1-s--101,000 AUVOMODaff LULBUJTY CON DINED SINGLE LIMITa ANY AUTO ALL OWNED AUT08 I 80 LY INJURY SCHEDULED AUTOS (Per y i s �----�- { HIRED AUTOS 80LY INJURY �7',NON.OWNED AUTOS I lPor�etxl0entl a pARAGE LIABIMY l ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS'UABIUTY THE PROPRIHTOR/ INCL j PARTNER$IEXECUTIVE OFFICERS ARE; EXCL OTHER i I DESCRIPTION OF OPERATIONSR,OCAT1,0MM NAME ADDRESS PRIPFATY DAMAGE AUT D ONLY • EA ACCIDENT 0 R THAN AUTO ONLY: EACH ACCIDENT AGGREGATE a SHOULD ANY OF THE ABOVE DES ZED POUCMS BE CANCELLED BEFORE THE EXPIRAMN DATE TWALOF, THEUM COMPANY WILL ENDEAVOR TO MAL DAYS WRITTEN NOTICE TO CERTIFLCATTi HOWER HAMID TO THE LIFT, OUT FAILURE TO HAL SUCH NOTT SHALL IMPOSE NO OBUURATION OR ABILJTY rnr AMY KIND–A)IMIN TMM AN E COY. TTS AGENTS OR REPRE$TNTATNES, a S. Xaters _C«'�'r ,.-7• rl�t',y.^. T....E Oct -29-98 02:48P Mathias Insurance 978 687 7460 P.01 "LIABILITY INSUR ANCE DATE (MWoolyy) ACORD. CERTIFICATE,'Of . I . . ........ PRODUCER. ............. . . ... . .............................. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MATHW INSURANCE AGENCYt INC. I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 200 Sutton Street, Suite loo ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Iforth Mdmw, MA 01U5 COMPANIES AFFORDING COVERAGE . . . FbM (978) 688-6531 FAZ (978) 687-74W COMPANY i INSURED A Granite Stato Insurance(omp4jny 0UMPANY Alan Smallman 0 2 HRYMPMOW Road COMPANY MX f(7) rki HA 01921 C COMPANY COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE I.I$TEU ULLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THL POLICY PERICO INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 08 MAY PERTAIN, THE INSURANCF AFI.-ORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI TI IE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LTA TYPE OF INSURANCE POLICY NUMBER DATE (MMIDONY) DATE (MMlODlYY) LIMITS GENERAL LIABILITY """"—'""'-- BODILY INJURY 0(X,; CClIAPREIIEN!iIV6 FORM BODILY INJURY AGU PRFMISES/()FLHAI IONS UNDCAlliPlOOND PROPEM I Y DAMAGE OCC. EXPLOSION & COLLAPSE HAZARD PHL)rEnTY DAMAOlF A(,(, S PRODUCTS/COMPLCTCO OPER CONTRACTUAL 51 & F0 C0M8IW;t) oQC $ DI A Pr) COMBINED AGG INDEPENDENT CON1 HA(, [()HS PPRSONAL INjunY AGG g. GROAU FORM Fm0pLHTy DAMAGE l`I:HSQNAL INJURY AUTOMOBILE LIABILITY BODILY )Nji.jHy ANY AUTO (Pcr pnmon) ALL OWNED AUTOS (Piivair. P.i!-,r,) ALL OWNED At.11 08 UQDILY INJURY (Olner than Private re6swigul) (For accident) HlHtL) AUlTQ5 NON-OWNCO AUTOS PROPFRTY UAMAQE GARAGE LIABILITY 00011 Y INJURY PROPERTY OAMAG F ....... COMHINEC) EXCESS LIABILITY DESCRIPTION OF OPFAAYION$ILOcATIONWEHICLESMPECIAL ITEMS ... ........ ... ... ..... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CATS THEREOF, THE ISSUING COMPANY WILL ENOEAVOA TO MAIL ZQ-, DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ,BUT FAILURE TO MAIL SUCH NOTICE $HALL IMPOSE NO OBLIGATION OR LIAVILITY OF ANY KIND UPON THE COMPANY, 4k�ITS AGENTS OR REPRESENTATIVES. CRI_ _10 AMEIIIENTATIVE EACH OCCURRENOF I.ImHHtLLA FORM ACGFICGATG 01HtH THAN UMBRELLA FORM WORKERS COMPENSATION AND A 'WC —isTvp OTH-* EMPLOYERS' LIABILITY WC 351-57-61, 9/01/98 9/01/99 TOR LIMITS I:H Tl IC PROPRIETOR/ EL EACI I AcwmhN i $ i0o1000 PARTNEIISICXCCUTIVC INCL CL DISFA$e - POLICY LIMIT $ 5()01003 U FICERS ARC.—_ FXCI OTHER .. .. ...... FL UISEASE •- CA F.MPI OYEE 1.004ao DESCRIPTION OF OPFAAYION$ILOcATIONWEHICLESMPECIAL ITEMS ... ........ ... ... ..... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CATS THEREOF, THE ISSUING COMPANY WILL ENOEAVOA TO MAIL ZQ-, DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ,BUT FAILURE TO MAIL SUCH NOTICE $HALL IMPOSE NO OBLIGATION OR LIAVILITY OF ANY KIND UPON THE COMPANY, 4k�ITS AGENTS OR REPRESENTATIVES. CRI_ _10 AMEIIIENTATIVE tgjf v PUBLIC ;SAFETY `. 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