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Miscellaneous - 240 GRAY STREET 4/30/2018
Date... ✓...1. ..6).......... TOWN OF NORTH ANDOVER PERMIT FOR WIRI —34V6,� This certifies that43�' ' "_ � L.. �i.................. .................................................................... has permission to perform,..!:....!...A"........5...........`.0.:....!.��. ................... fviring in the building of........., ry ..�� ............................................................................. at ................TV.........1..Vl'. . S ' .............................................. , North -Andover, Mass. Fee .,..�......,Lic. N..... .E.L..E..C..T..R..LPECR Check # k —\ CotnmoauweaA of Maddachud M Official Use Only 1�epartmeni o��ira �erviced Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS fRev. 1/07] 0caveblank) 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: 3/12/2015 City or Town of: North Andover 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) 240 Gray Street Owner or Tenant Amy Provost Telephone No. 617-803-7903 Owner's Address same Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of a 10.75 kw (43 panels) rooftop solar array Can lesion of the followinz table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- 1:1o. rnd. rnd. o Emergency Lighting iBattery Units No. of Receptacle Outlets No. of Oil Burners IFIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number ............................ ons I KW ......... ..' ""."' o. o elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal❑Other Connection No. of Dryers Heating Appliances KW Security Sstems:* No. of Devices or Equivalent No. o Ater KW Heaters No. of No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $22,625 (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 ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: The Boston Solar Company N LIC. NO.: 12689A Licensee: William T. Foglietta Signature /\.� LIC. NO.: (Ifapplicable, enter "exempt" in the license number line.) `' Bus. Tel. No.,• 781-462-8702 Address: 10 Churchill Place, Lynn MA 01902 Alt. Tel, No.: 978-836-6220 *Per M.G.L. c. 147, s. 57-61, 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 PERMIT FEE. Signature Telephone No. Mailing address: 55 Sixth Road, Woburn, MA 0 180 1, Attn: permits email address: permits@bostonsolar.us I, 0 •t o:. COMMONWEALTH OF MASSACHUSETTS BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A � REGISTERED MASTER ELECTRICIAN (� THE BOSTON SOLAR COMPANY LLC WILLIAM T FUGLIETTA III 10 CHURCHILL PLACE d W LYNN''LLpp MA 01902-2719 mafaWiiB-rA 1IM SRC CONTROL # J 2 8 418 8 IMPORTANT If your license Is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass.gov/dpi for Instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electiicians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): The Boston Solar Company Address: 10 Churchill Place :Lynn, MA 01902 Phone #: 617-858-1645 Are you an employer? Check the appropriate box: 1. M I am a employer with 20 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 3. ❑ 1 am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' coma. insurance recuired.l 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.❑ Roof repairs 13.X Other solar "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. lam an employer that isproviding workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: HDI -Gerling America Insurance Company Policy # or Self -ins. Lic. #: EWGCC000153815 Expiration Date: 1/14/2016 Job Site Address: 240 Gray Street City/State/Zip: North Andnver, MA 01845 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 0"ains and penalties of perjury that the information provided above is true and correct. Phone #: 6178581645 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 #: NI:... 44 4fl44A0 Rnccn ACORD�. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1/13/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER People's United Ins. Agency CT CONTACT CT Peggy J. Merati P,ti"�"N , 860 524-7624 RIC No): 844 702-8075 AA�DIDRREss: peggy.merati@peoples.com One Goodwin Square INSURER(S) AFFORDING COVERAGE NAIC # Hartford, CT 06103 INSURER A: HDI -Gerling America Insurance C 41343 860 524-7600 INSURED The Boston Solar Company, LLC 55 Sixth Road, Suite 1 Woburn, MA 01801 INSURER B: Merchants Mutual Insurance Co 23329 INSURERC. INSURER D• E: -INSURER INSURER F: PREMisFES ERaEu soca $100,000 CnVFRAAFS CERTIFICATE NUMBER_ KFV1510N NUMUEK: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSRL UBR WVD POLICY NUMBER MMffDDDY EFF MMIDCY EXP LIMIT'S A GENERAL LIABILITY EGGCC000153814 0/03/2014 0110112016 -EACH OCCURRENCE $_1,000 000 X COMMERCIAL GENERAL LIABILITY PREMisFES ERaEu soca $100,000 CLAIMS -MADE ER OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGG $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- JECT El LOC POLICY I ^I $ A AUTOMOBILE LIABILITY EAGCC000153814 0/0312014 01/01/201 �MBa�IN iSINGLELIMIT 1,000,000 AX ANY AUTO EAGCC000153914 0/03/2014 01/01/201 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS ED X IR DAMAGE $ HIRED AUTOS AUTOS (PROPERTY accident) $ B X UMBRELLA LIAB X OCCUR CUP0001367 0/03/2014 01/0112016 EACH OCCURRENCE $5,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE s5.000.000 DED I X RETENTION $10.000 $ A WORKERS COMPENSATION EWGCC000153815 1/14/2015 X STATU- I I OTH- 01114/201 WCER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE 7 N E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N f A E.L. DISEASE - EA EMPLOYEE $1,000,000 li yes describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $1-000-000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) RE: Permit Work Certificate Holder is included as Additional Insured per the terns, conditions and exclusions of the referenced general liability and umbrella policies, if required by written contract or agreement. Town of North Andover 1600 Osgood Street North Andover, MA 01845 ACORD 25 (2010/05) 1 of 1 #S565647/M565467 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 T'wAo ti l A01c 01988-2010 ACORD CORPORATION. All rights reserved. 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Ja m w� ui LuO0 � Z_ gzWO O c7}U) � Lu Ud WLLzi U W w� gm Wim U Jaw Z �Q'4 U5 :3 ma apa a� o aim www C7 wQ ez- OOW 0 mow Z)wx omr g Commonwealth of /t amacAweth Official Use Only cc�� Permit No. 2-partment oire Servicee Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11.071 (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: 3/12/2015 City or Town of: North Andover 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) 240 Gray Street Owner or Tenant Amy Provost Telephone No. 617-803-7903 Owner's Address same Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps ! Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of a 10.75 kw (43 panels) rooftop solar array Date ... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING l This certifies that /`rte (_,,�d� ...................................................................... . .................... has permission to perform445 ' # -� ............ vtiring in the building of....,.U` ....................................................................................... .....................................................".............................................. , Nort ndover, Mass. Fee... ........, Lic. N ....... /AL (nC E.. INSPECTOR sv Check # .tors KVA .mergency Lighling Units �LARMS No. of Zones )etection and tinting Devices Uerting Devices ,elf -Contained un/Alerting Devices Municipal Connection El Other oSystems:* f Devices or Equivalent firing: 'of Devices or Equivalent nmunications Wiring: of Devices or Eauivalent as required by the Inspector of 1Vires. ' •) 10, and upon completion. if electrical work may issue unless r its substantial equivalent. The rmit issuing office. is true and complete. LIC. NO.: 12689A Licensee: William T. Foglietta Signature (A LIC. NO.: (If applicable, enter "exempt" in the license number linea Bus. Tel. No.: 781-462-8702 Address: 10 Churchill Place, Lynn MA 01902 Alt. Tel. No.: 978-836-6220 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie: 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 PERMIT FEE: $ Signature Telephone No. Mailing address: 55 Sixth Road, Woburn, MA 01801, Attn: permits email address: permits@bostonsolar.us Massachusetts Electric Company & Nantucket Electric Company (d/b/a National Grid) M.D.P.U. 1219 Certificate of Completion for Simplified Process Interconnections Installation Information: ❑ Check if owner -installed Interconnecting Customer: Amy Provost Contact Person: Sandra Reisman Mailing Address: 240 Gray Street City: North Andover State: MA Telephone (Daytime): Facsimile Number: Address of Facility (if different from above): Zip Code: 01845 (Evening): E -Mail Address: Electrical Contractor Contact Information (if appropriate): Name: Sandra Reisman E-mail Address: sreisman@,sungevity.com Mailing Address: 66 Franklin Street, Ste 310 Telephone: 510-496-5677 City: Oakland State: CA Zip Code: 94607 License number: 168430 Date of approval to install Facility granted by National Grid: Application ID number: Inspection• The system has been installed and inspected in compliance with the local Building/Electrical Code of (City/County): Signed (Local Elec.tr�cal Wiring Inspector, or attach signed electrical inspection): Name (printed) License #: AU 77 Date: '�—_ 2e-_ r� As a condition of interconnection you are required to send/e-mail a copy of this form along with a copy of the signed electrical permit to National Grid: National Grid Attn: Distributed Generation 40 Sylvan Rd Waltham, MA 02451 E-mail: distributed.generation(cr�,nationalgrid.com Massachusetts: http://www.nationalgridus.com/masselectric/home/energyeff/distributed generation asp Nantucket: hqp://www.nationalgridus.com/nantucket/home/energyeff/distributed generation asp Page 1 of 1 i Location No. 1-333 Date 1e) n TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit e $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17800 Building InspecL,,r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, ORDEMOLISHA ONE OR TWO FAMILY DWELLING Q BUILDING PERMIT NUMBER: DATE ISSUED: SIGNA of I SF.CTION I - SITE INFORMATION I Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: / G i"lJC l/ T /O7 /D Map Number Parcel Number 1.3 Zoning Information: 1.4 -Property Dimensions: 493A_c6:5-f Zoning Dia;ic-t Proposed Use Lot Asea s Frans ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zona Outside Flood Zone ❑ Municipal ❑ 1On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT „A,l ;t; ! :isTncT: 2.n Owner of Record �...�� rd _ Cid �a��'or•- /�>� �,1 ���� ��' .. Name (Print) Address for Service: �'F 6 43 -6 ao Signature Telephone 2.2 Owner of Record: ; Name Print SECTION 3 - CONSTRUCTION SERVICES i 3.1 Licensed Construction Supervisor: �Q � �r� j^ • .1yr. V1.r .f Licensed Construction Supervisor: Address _ 9i7 660 -6x®9- ignature Telephone 3.2 Registered Home Improvement Contractor Company Name Address Address for Service: Not Applicable ❑ 06-8 0 3 q License Number Expirat n Date Not Applicable ❑ Registration Number Expiration Date --6c- SECTION 4 - WORKERS COMPENSATION (M.G.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 building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all a ucable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / �DDl4'l5, a '/07- s, v� �S�ZI% VIVO a �e r- 3 [ ` ! �f 1,G" 14 Ci7i-466- /4P-ee - ,a � �s Zi�PCIC ►�� �� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b rmit applicant OFFICIAL USE ONLY 1. Building ©©. o ®o (a) Building Permit Fee Multiplier I a J`rr vc j, 6 P 2 Electrical !.x BB a (b) Estimated Total Cost of Construction y g q a s 3 Plumbing /" Building Permit fee (a) x (b) 4 Mechanical HVAC .qep 5 Fire Protection 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 Herebv authorize to act on My beh lf, in all matters relative to work authorized by this building permit application. -Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIESSIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS is ,� p� )6• 2' 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION .711 _ THICKNESS SIZE OF FOOTING `x 2'' X MATERIAL OF CHIMNEY MQ, Q, 1S BUILDING ON SOLID OR FILLED LAND _T'6 IS BUILDING CONNECTED TO NATURAL GAS LINE _4 - FORM U -LOT RELEASE FARM � ®l INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. +t* APPLICANT FILLS Our THIS SECTION*********************** APPLICANT_ - LOCATION: Asseswes Map Number LO .b SUBDIVISION STREET_ PHONE 27t-C93-.Coa6' PARCEL. '10 LOT (S) _U__ ST. NUMBER -24 d • VCSERt iiV • TWN(A0 DATE REJECTED. f��l I / I1 A. PC I �7 - . 7�I� by— ► �� _int �N1i_ i FOODINSPECTOR- TH DATE APPROVED ,e DATE REJI-'CTED 3E IC INSP CT -H LTH DATE APPIROVED r a DATE REJECTED_ COMMENTS s �s Q/:n � - � _--- PUBLIC WORKS - SEWER/WATER FIRE DEPARTMENT, RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm 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. I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. 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 v elLas_civil..penattiesinthefmn ofA..STOP WORIf ORDER..and..a fine.of.($1Do..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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensin Building Dept []Check if immediate response is required p Licensing Board p Selectman's Office Contact person: Phone #: 0 Health Department o Other Oct -19-04 03:55pm From—AIG; 973-316-6903 T-081 PZ2/002 F-071 u INSfm A- PRODUCER THIS CERTIFICATE is ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Tony Kasinskas Ins Agency HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR 7 Bridge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Box 5177 Billerica, MA 01822 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED R L I Corp 475 Boston Rd Billerica, MA 01821-0000 THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWI\ MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TWE OF INSURANCE POLICY NUMBER POUCYEFFECTIVE DATE POLICY EXPIRATION DATE A vvQRKPPS COMPENSATION AND EMPLOYERS LIABILITY LIMITS THE PROPRIETOR/ PARTNERS MOUTIVE OFFICERSARE: INCL 0 EXCL 0 4315962 5106/2004 5106/2005 "TATuTORyumnsti;Fl - , PTHER overage Applies toMAOperations Only. EACHACCIDENT $ 100,000 :HSEASE POLICY LIMIT $ C.00,000 21.SEASE-EACH EMPLOYEE 5 100.000 DESCRIPTION OF OPERATIONSIVEHICLES/SPECM rVEMS CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANYOF THE ABOVE DESCRIBED POLICIES Be CANCELLED igEroRE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAUL jq 27 CHARLES STREET DAYS WRMEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT NORTH ANDOVER, MA 01845 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABILrryOF ANY I(IND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE a North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. 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W c O CA .� p i� t a �a CD �Q L � pr � tl u 3 O� 2-C tl L.D,C—�1o�oa �.. ��� V� u i�uoo nio's y� °oa Xo unO LL u U U �" u La- 4 2� t u m= U O W (9pn1$ „9/li Z6) a (4pn}s 1199) el (9pnis ..9/9 Z6) (5 (9pni9 „99) a ,Z/1 k,9 = (-)„t'/E L Ti N Q ,L ,8 = (+)„s/L L & iJ til w n w l x e w „y/I }9tor JOoIA 9)(Z 9:� =u O > 1 SIDI c v C ill X N U Jr."- m � � .� v •- �o Rl � u p EO u� O•omO I-pRp� M m _u O m ro a.3•o m cn Jl ut..liSe ° o • a.. . • — _ O _ a Q E m IF ul- emu=ogo gypO' o o —" .�92' �o � >.r '''' Yom ` 09 2� �� V tl tl 6 uin 'o 9U a p •off _ C Q� ° S .' �N ° p U x a ��p tl �ocNn o tL V ra ��+' 3 �? p Cal 45 W� o tl ���s� d 'n� �g5 �- �"i q q �S tp1 n aK�i U y tl `- F �p o O G 'o O 0 Q Si o '.0 o Q U �. .— b� o° o SP _ o p _ � zop 4 tl b— Z, y tl o S u 3 Q o ILlh= 1! �i .� w n d O O tlj �i E f-1 n �+ G L N UspN 4 L N O S 1i In In r4 2 tl • ` m .n if L �p '° ? W c O CA .� p i� t a �a CD �Q L � pr � tl u 3 O� 2-C tl L.D,C—�1o�oa �.. ��� V� u i�uoo nio's y� °oa Xo unO LL u U U �" u La- 4 2� t u m= U O W (9pn1$ „9/li Z6) a (4pn}s 1199) el (9pnis ..9/9 Z6) (5 (9pni9 „99) a ,Z/1 k,9 = (-)„t'/E L Ti N Q ,L ,8 = (+)„s/L L & iJ til w n w l x e w „y/I }9tor JOoIA 9)(Z E o O E M � O ill m � � .� v •- �o Rl � m O•omO I-pRp� M m m ro a.3•o m m E cc CO O A a1 m p O r, _ •O N . > U -Lu $? S a �. > at t �- a-0, �- is rt O V N 4I in W 101 3 •. '� E � m � s � > � m iii m � O • �— o � rn -c 43 4 v 4) Q3 -;E .-r_. a) a -O_ s m ms �� m� "0 x�o > `UEm�o�,�Ql€3 mlU—�cvO c u E a O go 1] (88" stud) �1 VV44" II I 0 Ni;3 ► O W W N X X ... N C X 1 _Q Ep QD = N "Ti m i► r— m p a` � ii' N tC a• O tp ' �1 yIT ul 0 X tv O _ T� soma 13L CL mQO N J (1► � '� N N lit ° ?5 Qpn� OLX cn a b o cr I � � tp ° � s � -u lb A) t� 11 ce �� a� o o`mo � Q � th R 4MW p a, r O % n O c w '' 1 Date.................................. E NORTH '1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that............................................................................................. 'has permission to perform............................................................................... wiring in the building of................................................................................... at.....:......................................................................... . North Andover, Mass. N Fee ..................... Lic. No.............. ............... ...........:....:............:............... ELECTRICALINS.PEC.TOR Check # Jim t,v MVIV[v vvra% to yr a va�,ntv.usl u --•••w -�- •� DEFAMBIENTOMBUMFElY Permit No. B0ARD0FFIREPREVEW0NRDGUTA770M 0112120 Occupancy & Fees Checked APPUCATTONFOR PERhff TO PERF RMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC STS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date _ G� Town of North Andover The undersigned applies for a permit to perform the Location (Street & Number) Owner or Tenant Owner's Address 1116 work 0scribed below. To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes M No [:3 (Check Appropriate Box) Purpose of Building �� G/� ���% Utility Authorization No ?Q� X6, Existing Service AmpsVolts Overhead [:] Underground No. of Meters New Service Amps / olts Overhead Im Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /"F /Lily No. of Lighting OutletsL /0 No. of Hot Tubs No. of Transformer al {o Kot of Lighting Fixtures/ Swimming Pool Aborta Below Generators KVA grou No. of Receptacle Outlets No. of Oil Burner No. of Emergency Lighting Battery Units No. of Switch Outlets G No. of Gas Burners FIRE ALARMS 1 No. of Zones No. of Ranges No. of Air Cond. Total / Tons No. of Detection and No. of Disposals No. of Nest Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwasher Space Arca Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW Connections No. of Water Heater KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motor Total HP OTHER• k &==CovH't AxvuttiDdlerecltnarembcfNbmKbnmCtrimdLan tmeaatuetLiabtTtyliuvmt=PcLYmditCMO—* ar st�Aatielegtivalat YES M NO Ihnesubrrv&dv*lpwdcfsarnebdeOlfKZ YES ffycuhmdrd®dYFSplea9eatdraledtetypeofamWby NSGRANCE I. BOND O'IfIDt espacdy) DwimdonDale wodclostat /G� ]isp"mDateRegt�d �1a r.�,q� Estirr�dvaiteotT]eLmcal Wade $ Find sgtedundarFumki sofpejli<y. F�tMNAME LicawNa BusimTd.Na P7e- Cle2bl AltTeL f- OWNER'SMRANCEWAIVER;IxnmmedutdzLwwdotsmthmedlem unEeaNaVcrils&&Mdq valentasmgmWbyMassad>< mCanWLaws andthatmysignaturecndtislwnk ffkobmwaivesdism4amnaR (Please check one) Owner 1:3 Agent Telephone No. PERWr FEES . Signalu or Owner 1I= L'u1 yltlly VVr.AL.Ln yr �r�rs k t ntv.usl l u �••••~ .. •� DEP14RT11 WOFPUB KSAFEIY Permit No. BOARDOFFMPREVffv7 NREGUTA770MSl%C MlZ--W r%t` �✓ Occupancy & Fees Checked ■ ---� APPUCATTONFOR PERNIlTTO PERFORMELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 C�.- 0— (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ;15 Town of North Andover To the Inspector of -,Wires: f , , The undersigned applies for a permit to perform the electrical work described below. j Location (Street & Number) Owner or Tenant Al /— 11, '/ Owner's Address S� �"'` ✓2� �" �� Is this permit in conjunction with a building permit:. Yes,] No (Check Appropriate Box) Purpose of Building ' U 11�- 617- Authorization Nt Existing Service Amp%/Volts Overhead Underground No.'of Meters New Service -.Z Amps..�. V olts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work : 1-e utlets1 /0 No. of Lighting Outlets/—/0 No. of Hot Tubs No. of Transformers To A l of No. Lighting Fixtures / Swimming Pool Above Below Generators KVA and and No. of Receptacle Outlets No. of Oil Buroera No. of Emergency Lighting Battery Units No. of Switch Outlets li No. of Gas Burner FIRE ALARMS No. of Zones No. of Ranges No. of Air Cord. Total Toru No. of Detection and No. of Disposals No. of Haat Total Total Furnpa Tons KW Initiating Devices No. of Sounding Devices No. of Dishwasher Space Area Heating KW / No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Neaten KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motor Total HP OTHER• -- irxr =GoraW P=miDdiewg&anmacfN e®adslsetiaGwadLam Ihwxaamait1AAly1M0xeFbicyitriftGMp1ei orilssufff"alt YES rl NO Ihamsknikdva1dploafaf9=lDdWOffi t: YF{SM IMMMMIN rMVryouhavedgedBdYMpl= fttypeefo:Nwgeby WbikoStat �G%�� kapectionDateRegtme�d Ra* ��"-�.��' EsturattedVaizofDacmcaiWotic$ Find Stgtlodurld3 1?riml�stfptxjlay. /, i%I r�/rC %f C rMIAATALAQ N n -4F Ltoe wNa y� BlisinmTd Na r' -7,r- 2Ks' OWNER'SIIVSURANMWAIVMIamawmdudrLilaeedmmtharedlemmzoew,w*cri sak* ridgmvalatasmec} byMas cWMGalaall m arcatttetmy*madrtecn dispanitappicadmwaivesdlisto#MMI (Please check one) Owner ED Agent Telephone No. PERMIT FEES Signature #3 -Te e�k ` (* A16F 6 ei I 0 1 0 Date.6� . `.�. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...... ^'""'� has permission to perform_ .. ................... . plumbing in the buildings of . . at W / ./-- ... North Andover, Mass. r '} Fee .rl.4�(.X!.. . Lic. No. 2. ?d.:: * .............. . ,1 U ING INSPECTOR Check 6475 MASSACHUSETTS UNUMM APPUCATON FOR PERMIT TO DO GAS FTI'TING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations 0 New tr✓' Renovation Date & — 3 Permit # Amount $ �*i :r's Name 11 Plans Submitted (Print or type) < f tt - - Chec ne: Certificate Installing Company Namet ^I ,.a1.9 -A^ 1�� t Corp. ��� � , Name. of Licensed Plumber or Gas Fitter > e� i C�c„ V-, 11 Partner. ElFirm/Co. INSURANCE COVERAGE Checkone: I have a current liability Insurance policy or it's substantial equivalent. Yes �� No O If you have checked yes, please in ' to the type coverage by checking the appropriate box. Liability insurance policy10 Other type of indemnity 13 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 1 hereby certify that all of the details and intormation 1 nave sunnuttea kor enterea) in aoove apprrcauon are rruc anu accuiaLc w u,c 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 Massachytts7State Gas Codnwr�hapte of the General Laws. By: Title City/Town APPROVED (oFFicE USE ONLY) Si ature of] ' Plumber Gas Fitter aster Journeyman Plumber Or Gas Fitter /3oc)C-;, tcense Num0er U OU CA W W v� LY. O E+ cc F O W z W C a ] z FF x1 m a' a a GE� H Ua Ez ' x a � a H oU 1 SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type) < f tt - - Chec ne: Certificate Installing Company Namet ^I ,.a1.9 -A^ 1�� t Corp. ��� � , Name. of Licensed Plumber or Gas Fitter > e� i C�c„ V-, 11 Partner. ElFirm/Co. INSURANCE COVERAGE Checkone: I have a current liability Insurance policy or it's substantial equivalent. Yes �� No O If you have checked yes, please in ' to the type coverage by checking the appropriate box. Liability insurance policy10 Other type of indemnity 13 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 1 hereby certify that all of the details and intormation 1 nave sunnuttea kor enterea) in aoove apprrcauon are rruc anu accuiaLc w u,c 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 Massachytts7State Gas Codnwr�hapte of the General Laws. By: Title City/Town APPROVED (oFFicE USE ONLY) Si ature of] ' Plumber Gas Fitter aster Journeyman Plumber Or Gas Fitter /3oc)C-;, tcense Num0er 10 Date ....e :�3 no 4 . . -a " i W, �. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . . . . . . . . . . . . . . . . has permission for gas installation .................. ,in the buildings of . ..................... at=?.-/ . —4; �.t, ............ North Andover, Mass, Fee .5 M ... Lic............... Check # WA ""N, =PECTOR 5133 10 MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location ,') yd V S Ow Type of a New d Renovation 0 FIXTURES TION FOR PERMIT TO DO PLUMBING Date I' -3- r 5 Permit # XTZSA3 Amount 2S^Pi Plans Submitted Yes 0 No (Print or type)c ����,1- Check one: Certificate �� Installing Company NameC3J� �� cSy `-+ otY\ \T`i`t � c 5® rp• 0 Partner. Finn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 3-1�-7— Other type of indemnity a 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 El 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 Plu mg a and Chapter 142 of the General Laws. By: Signature of ERTHWOum er Type of Plumbing License Title % 30t::P0 City/Town r7icense NumDer Masterjourneyman 1:1APPROVED (OFFICE USE ONLY 0 '0 0 1 Y "' ui C� CD :so �: C O i y cc, C CO% C d W m C i.+ Ea f: O a a Gq -Cc: : V O rr • i Q m c E C -Z: a� � � w vi w w U w w O c 2 � =ate w w rA cn Vo) "' ui C� z. z O U T 96 M CD 0 CD L O c Z Q. O y G C I c� o•— v) p -o co h O O m m 03 �� y.+ CD 3.0 O p `O' CL 0 CL CMQ C occ � C CD CD CL C..2 h cc C C CO)cc p LLI cl Y/ LLI U) W W 19 LLIW CD :so �: C O i y cc, C CO% C d W m C i.+ Ea f: O a c : V O rr • i Q m c E C -Z: cc Vs-: CCU O c 2 � =ate co y O ; OCf `C ya m ®.off O V Ncc Z O • C ` � Q! Q ` 4D � 'c H o CL C:, Z •y O C OE E O , m y v Z Q y a CD g = C42CD !— t .- CL 4- m. > z. z O U T 96 M CD 0 CD L O c Z Q. O y G C I c� o•— v) p -o co h O O m m 03 �� y.+ CD 3.0 O p `O' CL 0 CL CMQ C occ � C CD CD CL C..2 h cc C C CO)cc p LLI cl Y/ LLI U) W W 19 LLIW Date .........-..... '.. HORTM Of o? TOWN OFORT DOVER PERMIT FOR GAS INSTALLATION • o� - _ a ,y This certifies that .. ....... 4 has permission for gas installation......... !-. �•! in the buildings of ./ .. C-... .................... at !. .......�.....! VNorth Andover, Mass. Feez-. Lic. No.Li�'�...,.,�^�C! ........ . 7 GAS INS ECTOR Check # 7 .�.`! j 5165 MASSACHUSETTS UNIFORM APPIXATON FOR PERMIT TO DO GAS FMING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date _ �ji �'?j o Building Locations _ V `'r C) l 9 rc 1ST. FLOOR 2ND. FLOOR 3RD. Permit # 'J iaS� FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. 8TH. FLOOR FLOOR Amount S Owner's Name R nn /� C n av P New Renovation Replacement Plans Submitted ❑ CIO� W 012 x W UO a to rA t z a� o w [-+ w z ada0. O 2 o ,z w `� F Cc07 Wm W a a O E"WO > WxWF�• SV�' a 4C7 W Q -W 7 - O z SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. 8TH. FLOOR FLOOR (Print or Type) Eastern Propane Gas Ch one: Certificate Installing Company Name El Corp. Address 131 Water S t . � 0 Partner. ?fan rarer NTA m 2p;, Business Telephone;,RQO pp _ �)Cg / /�:1 Finn/Co. �, Name of Licensed Plumber or Gas Fitter / l/� �/ "�/ I C.1 L� cy INSURANCE COVERAGE Check I have a current liability Insurance policy or it's substantial equivalent. Yes No Ifyou have checked Yes, pleEF dicate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity 13 Bond iOwner'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 Q 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 Massachusetts State Gas Code and ChapterGenerar ICityffown OV -ED (OFFICE USE ONLY) Signature of Licensed Plumber Plumber Gas Fitter 71 FM777u Master Journeyman Fitter • LocationS- F No. 33-3 Date J SO • r P Check # t76 & { TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ q 9,00 — b 1 8 1 2 "` Building Inspector v�. c- M y , ml'o-f -N L6 LA N cp K 'FRAWCUN H No. 37045 c CrSSEQca� .0 �0 tp kr,,gl LAAO THIS DRAWING IS THE RESULT OF A LIMITED 1y, FIELD SURVEY BASED UPON THE FOLLOWING: DEED REFERENCE: BOOK 9183, PAGE 113. ESSEX NORTH REGISTRY OF DEEDS. PLAN REFERENCE: PLAN 14712, ESSEX NORTH REGISTRY OF DEEDS. THIS PLAN IS FOR THE USE OF THE BUILDING INSPECTOR OF THE TOWN OF NORTH ANDOVER FOR THE DETERMINATION OF ZONING COMPLIANCE. THIS PLAN SHOULD NOT BE USED FOR CONVEYANCE. NO. BEARING DISTANCE L1 N31'52'10"E 19.29' L2 N40'02'00"E 22.97' L3 N 54' 57'30"E 19.15' L4 N61'26'40"E 18.83' L5 N7527'20"E 55.13' L6 N78'14'30"E 14.62' 50' 0 50' 100' 15 LOT 4 43,558 SQ. FT. - FOUNDATION AS BUILT PLAN LOT 4 GRAY STREET NORTH ANDOVER, MA PREPARED FOR R.L.I. CORP. 375 BOSTON ROAD BIL LERICA, MA 01821 SCALE: 1" = 50' MARCH 25, 2005 NEW ENGLAND ENGINEERING SERVICES, INC. 60 BEECHWOOD DRIVE NORTH ANDOVER, MASSACHUSETTS lk 978 686-1768 DRAWN S.G.B. BY; J.E.F. . & B.C.O. Jr. FILE 976FAB-3-25-05 � �cJ.E.F. & B.C.O. Jr. Town of North Andover Building Department 400 Osgood Street North Andover MA 01845 978-688-9545 Fax 978-688-9542 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY: 2 AI o (r.z. , S -r r a* 14 DATE REQUESTED FILED/READY FOR INSPECTION.. CLOSING DATE ON PROPERTY:®s— FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY DOLLARD $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Signature���,,,,,,, OFFICIAL USE ONLY ROUTING D.P.W. — WATER METER DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. f<L'k_�k ( V �_. SIGNATURE/DPW AUTHORIZATION APPLICATION CERTIFICATO OF OCCUPANCY revised 11.15.2004