HomeMy WebLinkAboutMiscellaneous - 230 FARNUM STREET 4/30/2018 (2) 230 FARNUM STREET
210/107.A-0101-0000.0
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TOWN OF NORTH ANDOVER
low PERMIT FOR PLUMBING
,S$AGNUSE� ,��- I
This certifies that . .t,. �� . . . . /v � . . . �?V,t �. .-.L/?C-
has permission to perform . . �? {. . . .t,41 � . . �L. . . . . . . .
plumbing in the buildings of q? .9. ! . . . .
at . .c� .YJ . . . . . .4-!? S f. . . . ., North,Andover„Mass.
Fee.?ULic. No.. �07. . .
! PLUMBING INSPECTOR
Check tt f
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
CitylTown: t1 szok Q.r ,MA. Date:-S\1 %1 Permit# 1
�' r c @,\1 C! 1
Building Location-. � 01 AN1h1 S 1 C+wnersN ame�� �a1 ���► W �.�
Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residentiai g]
New: ❑ Alteration:❑ Renovation:❑ Replacement: (R Plans Submitted: Yes❑ No[K
C�� '•or�• " 1� `O� 3$6�' FIXTURES
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SUB BSMT.
BASEMENT
1 FLOOR
2 FLOOR
3mu FLOOR
--- -4._-FLOOR. -
6T"-FLOOR
6 FLOOR
7 FLOOR
8 FLOOR
Check One Only Certificate#
Installing Company Name:�s-�.���j�u►�+c►���� �.ry�L�S \he
®Corporation Z �1a1
Address. c�'�aca Q C CIty/Town:�,c"t"\�n State•
0 Partnership
BusinessTei:%AQ\ £t3'01 6 '�s4\ Fax:
❑Firm/Company
Name of Licensed Plumber: �r 9.a cv.%C- ax�ntom
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 Yes Z) No❑
If you have checked Yes.please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy IQ 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
Massachusetts General Laws,and that my signature on this permit application waives this requirement
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owners Agent
I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and Installation performed under the permit issued for this application will be In compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
Title ❑Plumber Signature of Licensed Plumber
City/Town ❑Master Q (' ^�
APPROVED OFFICE USE ONLY) ❑Journeyman License Number: t`O G,
FINAL INSPF�I:I()N III L-dW'i;Ow()FFICE USE ONLY.,,. RIiSS INSI'I(:'�1( N.LSt
t FlF.:'S 1'C.RMIT#
APPLICATION FOR PERMIT 1.0 DO I'LUMI.�IN'(ti:;
I.00ATjC)N of nun.r�iNr
SKETCH
P!.uMnEli
LICENSE NUMBER
PERMIT GRANTED j7ATii`
.. r•
PLUMBING INSPE,CTIOR
6L-,J Date..
:y
V 'ACRTh
TOWN OF NORTH ANDOVER
p 9
- PERMIT FOR GAS INSTALLATION
�1SSACHUSES
This certifies that . . . . J . . . . .f�/��cy�jr✓aG . . .
has permission for gas installation . . .G
in the buildings of . . . CoAe /.'.0 . . . . . . . .
at .J.3o. . . . . . . .. North Andover, lMass.
FeJt 3t.).(.)e-.>. Lic. No..56 d�. . . . . . ./.
GAS INSPECTOR
Check#
91
MASSACHUSETTS UNIFORM APPUCATION FOR PERIM17 TO CO GAS FITTING
� ll`` 11
CitytTowr��ftyk % J\h 4 csV P.4" .MA. Date: Per.nit;t
Eulldirg Lacation:23Q T AV1 y*%k W% Si Cwners Name 1 C6 ,0,l Ck1A V W IC�
Ty;e of Cccuparcf: Ccmrne tial❑ Educational Q . Irdust:�al Q Irstituticral Q Res:derffai
New:Q Alteration:❑ Rencvatfcn:Q Repiacernent: 21 Plans Submitted: Yes Q No
C� •@�oti� FIXTURES
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SUB BSMT.
BASEMENT
141 FLOOR I
2' FLOOR i
3 FLOOR {
4 FLOOR
5' FLOOR { f { I
7 FLOOR I I I I I I II f
8 FLOOR {
y Check Cne Cniy Cerificate 4
Installing.Ccmpany Name--( r
ttc -9'iCor-oration z�`
Address\\Z"-\� ��,c,'T.�, F.� Cfi/kart-, z:1\n State:lt�,—)�-
�. Partnership
Business Tai:,�--,< <c3S �cS�i Fax
Q FirniCcmpany
Name of Licansed Plurnber,'Gas Fifer 7- r 2� r c C,
INSURANCE COVERAGE:
I have a cur. liatilihr insurance policy or its substantial equivalent Nhich meets the raruiremerts of NGL.Ch.142 Yes No❑
ii you ha re c e.xzd Y3g•please Indica`.e e ty;,e of ccvsra,e 57 check:rg the arcrcpr ate tscx 6eicw.
A liahilit:j insurance policy Ct.`:er type of indernitj ❑ Band ❑
OWNER'S INSURANCE WAP/=R:i am rNwa that"te licensee does nct hav4;he insurance coverage recuirzd by Chapter 142 of the
Massachusetts General Lays,and that my Signature on this per nit application wiiv4s this requirement
Check One Only
C Neer ❑ Agent ❑
Si ratLrs ct 0-wrer cr CWrees Agent
ay checking this bcz K;I hereby camtj that all of the details and inrcr,naticn i have submitted for anteraa)regarding this application are true and
accurate to t**best of my Knawtedge and that all plumbing work and Installations per!crmed under the permit issued to this application will he in
compliance wrh all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General taws.
Type of License:
BY CR Plumber
rife
C] Gas Fitter Signature of Licensad PSumber:Gas Fitter
Master
Cie/rcwn []Journeyman License Number: �.
APPROVS:)ICF?ICE USE CNLY C]L?Installer
Mir1l.INSPECTION BELOW FOR OFFICE USE ONLY ('RO(iRGSS INSrGC'(tONIS} l
FB['.: $ PLR.Ally N
APPLICATION FOR PERMIT TO DO OAS Fill IMG
s T A *A TYPE Piz BUIL11ING
U&AT ION Or j1LI LLL Iii {.
SKETCIi '
vy'
_ PLUAIBEI
`.- LICGNSE NUMBER: '
w PERK41T GRANTED❑ �1�1�: '
z
- 6a
' •� GAS TITTMG lKSPEC110K
E'
Location
No. �1 C-3 Date
NORT" TOWN OF NORTH ANDOVER
Ott*`1O ' ,t�0
„ Certificate of Occupancy $
Building/Frame Permit Fee $
�cMus
SS Foundation Permit Fee $
� sE�c
Other Permit Fee cw
' a ^- Sewer Connection Fee $
Water Connection Fee $
� 1 4 1(,'UiTOTAL $
Buildinb•lnspector
Div. Public Works
PERMIT NO '�L-S� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. v PAGE 1
MAP INO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE
ZONE I SUB DIV. LOT NO. �I
✓LOCATION O /� ��,) ,/ �i �T PURPOSE OF BUILDING 4/`�Epx 2i'0 4goV6/��/JO aoL
OWNER'S NAME zf I4
j Av'�"L G �D 1�A/'/1/ NO. OF STORIES SIZE 7" /-I Y
✓OWNER'S ADDRESS C5Z 3V�!'I '!rJ �AA Crflv�Y�-+\ BASEMENT OR SLAB
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME -::�Ame A,$ 4,�o l/ SPAN
DISTANCE TO NEAREST BUILDING r/ DIMENSIONS OF SILLS
DISTANCE FROM STREET „ POSTS
DISTANCE FROM LOT LINES-SIDES 50leo REAR �C�/�'y�.� „ GIRDERS
AREA OF LOT /FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
vll9-,LL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
W -DOARD OF APPEALS ACTION. IF ANY �NL IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES 0/ EST. BLDG. COST
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
T 1L D Iq
BOARD OF HEALTH
'1131 ATURE F OWNER OR AUTHORIZED AGENT
F E E S CONTR.TEL.q
CONTR.LIC.9 PLANNING BOARD
PERMIT GRANTED
J4- >Is -
BOARD OF SELECTMEN
BUILDING INSPECTOR
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY 11 STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE _ B 1 2 13
CONCRETE BL K. PINE
BRICK OR STONE HA DW D
PIERS PLASTER _
_ DRY WALL
UNFIN.
3 BASEMENT I h
AREA F FIN. B TAREA _
'/. FIN. ATTIC AREA _
NO 8M' FIRE PLACES _
HEAD RO M MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDW D _
ASBESTOS SIDING COMMON
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIORI ' POOR _
ADEQUATE NONE
rj ROOF 10 PLUMBING
GABLE I HIP BATH (3 FIX.)
GAMBRELMANSARD TOILET RM. (2 FIX.) _
FLAT A SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING I i l HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. & COLS. HOT W'T'R OR VAPOR
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS _
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
CONSERVATION _ FINAL` ®PLAI114II�C � FINAL tEVV R/ ATER_ _ _�I� AL
F N
Town 6 OL Over
No. 253
9TVEWAY ENTRY PERMIT -----�-
cr M`EW� er, Mass., J&'eoje / 19y/
A ,�
OR P fi
SS
BOARD OF HEALTH
T 0
•
Z
THIS CERTIFIES THAT.........PERMIT
. .... .. .................
BUILDING INSPECTOR
has permission to erect ....................... s on ? P Rough
.. ....... .. ....... ... ...
f .'.'. .....� �. ......... ...../�.,. j Chimney
to be occupied as.. ....
Final
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in
PLUMBING INSPECTOR
this office,and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough
Buildings in the Town of North Andover. Final
VIOLATION of the Zoning or Building Regulations Voids this Permit.
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
Rough
UNLESS CONSTRU ST Service
Final
.............. ................t . ... .
BUILDING INSPECTOR GAS INSPECTOR
Occupancy Permit .Required to Occupy Building Rough
Final
Display in a Conspicuous Place on the Premises
FIRE DEPT.
Do Not Remove T►B�'�48No.
No Lathing to Be Done Until Inspected and Approved by Smoke Det.
Building Insolector
Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE 114 Al
JOB LOCATION o�3C� SCJ �J
Number Street` Address Section of town
"HOMEOWNER" �f• ��l j�l t�ti� tc�rG,� �3 3��� /7 144-EL 0
Name Home Phone Work Phone
PRESENT MAILING ADDRESS30
6Lfal,--4 42VD0v4!52_
City Town State Zip code
The current exemption for "homeowners" was extended to include owner
, -occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does not possess a license , provided
,that the owner acts as supervisor. (State Building Code, Section 109 . 1 . 1)
DEFINITION OF HOMEOWNER:
' Person(s ) who owns a parcel of land on which he/she resides or intends to
reside , on which there is , or is intended to be, a one to six family dwell-
ing, attached or detached structures accessory to such use and/or farm
structures . A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
. to the Building Official , on a form acceptable to the Bulding Official ,
that he/she shall be responsible for all such work performed under the
`'building permit . (Section 109 . 1 . 1)
The undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes , by-laws , rules and
'regulations .
The undersigned "homeowner" certifies that he/she understands the Town of
.., North Andover Building Department minimum inspection procedures and
requirements and that he "s e will comply with said proce ures and
requirements .
-HOMEOWNER' S SIGNATURE
( Az,6&6
APPROVAL OF BUILDING 0 IC AL
'Note : Three family dwellings 35 ,000 cubic feet , or larger , will be
required to comply with State Building Code Section 127 . 0, Construction
Control .
x
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4,2AO ok 4 � yq-`"'°
foo
4-2
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nfzNil //�
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Location a�b
No.-ff o Date ?p <
NORTIy TOWN OF NORTH ANDOVER
' Certificate of Occupancy $
• i , i
Building/Frame/Frame Permit Fee $
s�cMust 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
r
18799 _
/duilding Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCTREP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING
77
BUILDING PERMIT NUMBER DATE ISSUED.
rn
SIGNATURE:
Building Commissioner/I r of B 'ldin Date
-SECTION 1-SITE INFORMATION I
O1.1 Property Address: 1.2 Assessors Map and Parcel Number:
a 30ruff
/40 U iAlto.
/u. D�� ` Map Number Parcel Number
ti
J 1.3 Zoning Information:
r VlJ 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Fronto ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Regaired Provide ReqWred Provided RegWred Provided
1.7 water Supply MG.1-C.40.11 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Pablic 0 Private 0 Zone outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 J
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No rn
2.1 Owner of Record
l�/I 1P� G 1��1G1f a36
Name(Print) Address for Service
Signature Telephone
2.2 Owner of Record:
j`"`V<., O
Name Print Address for Service: z
rn
Signg2re Telephone
SE ON 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construgtion Supervisor. i�S O
l�7 License Number on
Address / 7
JC�' 1��/�� �j
.iri
Expiration Date
S a Telephone r
Registered Home Improvement Contractor Not Applicable ❑ v
iC4rl r,q� j?e,,,j�7
- -6�3
Company Name (� rn
IU(4))/� Registration Number
Ad ress
0,64 7 Expiration Date
(/V
Si Tel hone
a
SECTION 4-WORKERS COMPENSATION(bLG.L.C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the b loing permit.loin
Signed affidavit Attached Yes......Ar No.......❑
SECTION 5 Description of Proposed Work cher all a liable
New Construction ❑ Existing Building Pf Repair(s) ❑ Alterations(s) Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
r-vi
411 ��15 r ����� �a�� -� 7-0
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be UFZ'ICIAti USE f?NLY
Completed by permit aDDlicat �
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost ofo J
Construction 7 •ld s-
3 Plumbing Building Permit fee(a)X(b)
4 Mechanical HVAC
5 Fire Protection �-7.2,
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize 1iPi >r 'moi Y 444-'jib to act on
My behalf,in all matters relative to work authorized by this building permit application.
it&uk
Signature of Owner Date�
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Print Name
Signature of Owner/Agent Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIIvBERS Isr2ND 3Ru
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHININEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
' Liberty Mutual Group
Liberty PO Box 7202
Mutual„. Portsmouth,NH 03802-7202
Telephone(800)653-7893
Fax(603)431-5693
July 13,2004-
RE:
3,2001RE: Certificate of Workers Compensation Insurance
Insured: JEFF MARKLIS DBA AMERICAN EAGLE
47 MAIN ST
NORTH ANDOVER,MA 01845
Policy Number: WC5-31S-351431-014 Effective: 4/26/2004 Expiration: 4/26/2006
Coverage afforded under Workers Compensation Law of the following state(s): MA
Employers Liability:
r
Bodily Injury By Accident: $ 100,000 Each Accident
Bodily-Injury by Disease: $ 100,000 Each Person
Bodin Injury by Disease: $ 500,000 Policy Limits
As of this date,the above-referenced policyholder is insured by LM Insurance Corporation under the policy
listed above.
The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions,and is not
altered by any requirement,term or condition of any or other documents with respect to which this certificate
may be issued.
This certificate is issued as a matter of information only and confers no right upon you,the certificate holder.
This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by the
policy listed above.
If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of such
cancellation.
AUTHORIZED REPRESENTATIVE
LIBERTY MUTUAL INSURANCE GROUP
Ibis Certificate is cucuted by LIBERTY.N1171rU LL NSUI ANCE GROUP as mpeets such insurnce as is W onied by those companies.
cc: Insured: Producer of Record:
JEFF MARKLIS DBA AMERICAN EAGLE GULDECOOK INSURANCE
47 MAIN ST 173 CAMBRIDGE STREET
NORTH ANDOVER, MA 01845 BURLINGTON,MA 0130 3
71 _'dpi
ACORD,. CERTIFICATE OF- LIABILITY INSURANCE °04130/200° 4
PRopucEP781-270-6824 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
I AL MARA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
GULDE-COOK INSURANCE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
173 CAMBRIDGE ST
BURLINGTON,MA 01803 I INSURERS AFFORDING COVERAGE
INSUREDINsuRER A: PENN AMERICA INSURANCE COMPANY
JEFF MARKLIS
45-47 MAIN ST INSURER B:
NORTH ANDOVER,MA 01845 INSURER C:
INSURER D:
INSURER E:
COVERAGES
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
j POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
{INSR TYPE OF INSURANCE I POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
,TRLIMITS
1 GENERALLMU?UM EACH OCCURRENCE $ $1,000,000
i COMMERCIAL GENERAL LIABILITY TBD 041+26/04 04/26/06: FIRE DAMAGE(Any one fire) S $100,000
X I CLAIMS MADE OCCUR MED EXP(Arty one person) $ $5,000
PERSONAL&ADV INJURY $ $1,000,000
GENERAL AGGREGATE $ $1,000,000
I
GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP)OPAGG Is $1,000,000
POLICY LOC
AUTOMOBILE L'tABIUTY COMBINED SINGLE LIMB $
ANY AUTO (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
'SCHEDULED AUTOS i (Per person)
I r_�
y HIRED AUTOS BODILY INJURY '$
I NON-OWNED AUTOS (Peracciderd)
PROPERTY DAMAGE
I (Perarddent) $
I(GARAGE
LIABILITY I AUTO ONLY-EA ACCIDENT
S
I LANY AUTO OTHER THAN ° $
{ I AUTO ONLY: AGG S
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR FICLAIMS MADE I AGGREGATE $
S
DEDUCTIBLE 1 I I —�i$
RETENTION S I I S
WORKERS COMPENSATION AND TORY LIMITS ER
j EMPLOYERS'LIABILITY I E.L.EACH ACCIDENT I S
E.L.DISEASE-EA EMPLOYEE $
I I E.L DISEASE-POLICY LIMIT $
i OTHER }
I � ,
j 1 i
DESCRIPTION OF OPERATIONSA.00ATIONSIVEMCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIRL PROVISIONS
RESIDENTIAL ROOFING
I
� I
I
i
CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITtEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORED REPRESENTATIVE
ACORD 25-S(7/97) O ACORD CORPORATION 1988
135 6 �3
* �, Cit}Aff ? BUltC�i1� t3UN5
, ' � License',;CC7NSTRUCTIgM��pi*RVISQr�''
Birthdate; 03128/1978 p„
��,kr �. P 26/2447 Tr iao� $�r9'14'
Restrieted, 00 `
JE FR '
47 naArnt 9TRE `�'
NO ANC�OV�R MA 49845 x
' Adrrsinistraft�r
EAGIE ROOFING
R O. Box 444
North Andover, SIA 01845
(978) 258-7866
::I
PROPOSALSUBMITTEDTU PHONE _ DATE
't TIN
STREET JOB NAME
s;
CITY,STATE AND ZIP CODE JOB LOCATION
ARCHITECT :fLDATEOFPLANS JOB PHONE
We hereby submit specificaWm and estirnates for.
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WPI0iD9e hereby to furnisp material and labor- complete in accordance with above specifications, for the sum of:
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Payment o be made as follows: �G d dollars ($1�� A: )
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Alf material is guaranteed to be as specified.All work to be completed in workmanlike manner Authorized
according to standard practices.Any afleration or deviation from above speciation involving Signature 4/1 fVV g I A a r
extra Costswill be executed only upon written orders,and will become an extra change over and
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above the estimate.All agreements Contingent upon strikes,accidents or delays beyond our e: i roposal may be
control.Owner to Carry fire,tornado and other necessary insurance.Our workers are fully cov- withdrawn if n t accepted within { days.
erect by workmen's Compensation Insurance. +f
Zttmptance of jkopgd The above prices,specifications and con- 4
ditions are satisfactory and are hereby accepted.You are authorized to do
the work as specified.Payment will be made as outlined above.
Signature '-
Date of acceptance:
This contract is not transferable
NORTH
TOMM Of RAndover
No. .3 AOAA 00P
_ �— _ e ►
dover, Mass.,
T O LA
_ COCHICHEWICK y
7,p RATED
7`S BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........... V. ..... .t�i►. .. non
.... . �► a
o
has permission to erect........................................ buildings on
......jr.
....... .0:..... ...
ugh
0 0 Chimneyto be occupied as.... . isProthat the e Zxx permit all in ev rspect conform' erms pplic ion file in
Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Constr ion of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTTOTS Rough
.... ..... . . ... ...... ...........
Service
low
BUIL ING INS
.
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.