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HomeMy WebLinkAboutMiscellaneous - 25 RIDGE WAY 4/30/20180 0 � N CT 0 o v 0 23 m O O y O O Cunningham Lindsey U.S., Inc. P.O. Box 703689 Dallas, TX 75370-3689 Telephone (888) 738-8714 CLCAT@CL-NA.COM Facsimile (214) 488-6766 ********************'**AUTO**3-DIGIT 018 805 T3 P1 95000058995 Building Commissioner or Inspector of Buildings 120 MAIN STREET { North Andover, MA 01845 Cunnin ham Va Lindsey Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B 3050717 3050717 01 MERRIMACK MUTUAL FIRE INS ICE DAM 2/28/2015 Larry Tecce 25 Ridge Way Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 36. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Claim Number: Policy Number: co Company Name: 0) a) Cause of Loss: OD to S Date of Loss: Insured: C) Property Location: Cunnin ham Va Lindsey Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B 3050717 3050717 01 MERRIMACK MUTUAL FIRE INS ICE DAM 2/28/2015 Larry Tecce 25 Ridge Way Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 36. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 Date ..:.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING r This certifies that ... .. `................... has perrrussion to perform .................:. ......... ................... f:::.:.::i.:::............................,it...... wiring in the building of..........:.....:.........::::r............................................................................... r ' at ........ r �..................... . North Andover, Mass. .............. 4 Fee ........... ........ Lic. % .. ........ .......:.:............ " - ELECTRLCALINSPECEOR Check # f J ami 4 v aoi o N aC c�c w .0 m w ° 3 civ �3 948 w Q p a L- c0 0 a. •a b � ,[ b 4, � 0 o �n � �o +�+ LTA " p. N O cys! o' N ti p N .moi ami y � o 0 '22 8 �•o .o v � o� o 'O"g 'cp y t1, C ';'1 c�0 'Opq 4 ,y y 0 O U W p '� p 0 GL y cy N N O cNC p GL a � d b � °� IS N y A,,o a� GLC 'E[ w w •� C 30 T O u p U N C W -82 N-� c��,, •w o O ••-•� a a 0 In O 0 O y 0 0 'O M N O tH W 3 d W d o o 00 40 0 C> 0 Al x.o ma avb'aCi E 00Ptv2772" a•�a�5 Qi ,p„ „a+y N N44 N O b o 00 O y o S Lr Ci N W..L H M T GL .54 o °Za o o w a a"i w p 17 N• c O ami '" aN., O pp iV .ti p 4Z Wyaoi � .moi � N O , � •,^, iC +'� y FN. Vi N Wo o a N p N ti N N 4 d N N " o 0 C Pte. Hwa:... �� o ffild i! - 0 A PPLUIC TION FOR PERA-fi'MTO PERFORM ELECTRICAL WOR M work to ba performad in accordance Zvi h the lSassacfiusetts Electrical Code (NII -C), 327 C -AM 12.00 (1' d,q.P.I'� VTMIWKORT.YZ'P&L�f1R�1�- T10�7 a,a �. City or Tory i of.,.� � � � To flae bis, pector° oT Mires. es. By flus applieatioa the undersigned C VVk notice of his or`j, r mfentioa to perform the eJecirical work- described bele �:oeafiozr (Street c�i N''umber) `�� � � — Q Ov�neror$exianfT l —Si� �' C Telephone 11� Cci 6 ® � O- ner's Address t3perrcuitincoxtjuhctiortnit}zabuildingperm[f? Yes ❑. q (Check Appropriate Box) Purpose of Binding Utility Autho rizatloxt Not MdszflrrgService 'maps I Volts Overhead undgrdEl 1`v''o,-of meters l�ley e do 'gimps l Volts 43vahead El ilndgrd ❑ No. of defers SgMberofRedersand A.a+ pacify Locatioxi and Nature of �,.roposed ElecfricaiTjrork: Compef?ortoftlaefoZloHir,�ta�lzmaybe�J�aiyeldb�ytl�e�upectorof Pyres I�To. of Recessed I,umivaires No -of Ce&susp. (Pa.ddle)) ams J�T° of ,Y Total I\To of Lmuzualre Outlets Commonwealth of Massachusetts Official Use Only -_epar�telt f , of Fire ,etvs`ces BOARD OF 24 No. of -t ecep cele f3utlefsND. FIRi= PREVENTION REGULATIONS _ of Zones No. of Snitches (Tease atldzip codas & electriclarrs cellveblank} Fee. Checked Iwo; of Ranges contr'acf # & blcl permif # ifapplicabfe 1 F jNo, ofAleriing Devices PPLUIC TION FOR PERA-fi'MTO PERFORM ELECTRICAL WOR M work to ba performad in accordance Zvi h the lSassacfiusetts Electrical Code (NII -C), 327 C -AM 12.00 (1' d,q.P.I'� VTMIWKORT.YZ'P&L�f1R�1�- T10�7 a,a �. City or Tory i of.,.� � � � To flae bis, pector° oT Mires. es. By flus applieatioa the undersigned C VVk notice of his or`j, r mfentioa to perform the eJecirical work- described bele �:oeafiozr (Street c�i N''umber) `�� � � — Q Ov�neror$exianfT l —Si� �' C Telephone 11� Cci 6 ® � O- ner's Address t3perrcuitincoxtjuhctiortnit}zabuildingperm[f? Yes ❑. q (Check Appropriate Box) Purpose of Binding Utility Autho rizatloxt Not MdszflrrgService 'maps I Volts Overhead undgrdEl 1`v''o,-of meters l�ley e do 'gimps l Volts 43vahead El ilndgrd ❑ No. of defers SgMberofRedersand A.a+ pacify Locatioxi and Nature of �,.roposed ElecfricaiTjrork: Compef?ortoftlaefoZloHir,�ta�lzmaybe�J�aiyeldb�ytl�e�upectorof Pyres I�To. of Recessed I,umivaires No -of Ce&susp. (Pa.ddle)) ams J�T° of ,Y Total I\To of Lmuzualre Outlets INO. of vot Tabs ' � Generators " N0.OfLuminaires S�rimmin.gpool Above ❑la- Qrxcd. ad, El - o. o -mersency zg ting clattery knits No. of -t ecep cele f3utlefsND. of 0i1 Burners _ of Zones No. of Snitches INTO: of Gas EItruers INo. of DetectioiE and 7nitMbaba r Devices Iwo; of Ranges No. ofrklr Cozad Tow ow F jNo, ofAleriing Devices -No. of Waste Disposers Heat Primp NumberTons xW Totals: Vo. of Self-cmatained Detectiou/Mertin Devices No. of Dishwashers — S ace/Area ?3eathiv KW - I p � l IM -1M, ,pa.l I%cal( lrnnt�a V,, El cuter No. of Dryers HeatingApplianeeS JCVSecttritpsysterns:- NO. S M. ox Fater l=featers Et' NO. of 1Vo. of of DeNlmg or 3gquiyalent pata'F}ixing: Biu g I�iallaStS No, of Re' x* es orE ttxvalent :NioulTydronlassagelRathtubs 1aa°ofl4 ofors offal ET��elecoxauzixiicatioxrs s izingg: ,- !4To" of;l�e-�ices oz� E nivwaIex�t ©I'HER— tuiach adahYb m1 de,ai1 f desire4 or aS reguircdhy t7se lrzrpecfoY of is ices F.,stimated Value of Electrical �%ork: f L 0lhen required by mnnicipal policy.) Tork to Start; N Ste_ lasperdom fo be requested to accordance w th MEC Rule 10, and upon completion. UN-SIJkMCE COWRAG'k. Uhless wali, ed by the OvWncr; no perni t for the performance of electrical -work may issue unless the licensee provides proof of liability insurance including "completed.operatio0 coverage or its substantial equivalent.. %e undersigned certJi os that such coveraga is iu force, and has exhibited proof of same to the permit issuing office: MCK 010: 71\TS0aAhTCE 0 BOIL ❑ OTMk X (Speolt,.-) Self-insured -- t certify, under the paints a7zd pezzaliia of perjuq, that the infbr}naf otx on this applienfion is fru e rcnd eomplete FI1-M NAME, ADT MC DBA ADT SeGwny —� I�Ii`'. NO.: C-172 ) icensee: Thomas 3: Lae MC. 1`70,: G-172 (Ij appikahle, etster ` ar mpi"iti arse Tcens-a ruanber lznz) _ l3tts. TO., No., Address: \`& �\�n���- �c���5���� Q���! mtTel.No. `Security Systam Con�'License requizea dor this -work; if applicable, enter the license number here; 001779 OWNEW S )NMi`Rf' NCE WAWER: I am aware that the licensee does not have the liability insurance coverage normally 7 required by Iav� . By my si`guaisre below, I hereby vnive this requirement I am, tJte (check one} Q ov emer�Q owner's agent Owner/Agent Skgaatuxe TelephomNo. Fpm,PH,�'. �'e s S! 5 7 _�_.-__.___ ._.max: z--..::w _...__•'��__��___:--_ - :(ilk_�-•`�:��C��IUJ_�C���u:�=:�r>>�1 r � � _ • �;fi�>P.,l`�'[;5=1'C�I���p:_5Y`5�i<E�M: �h t ,! 1 I IV j Tl'-f ;-TY 1•••'r :u'NYMIOIU�VI�^Z�I:II:FF�L:e....•�,,4-�lYl•1• Commonwealth of MassachuseUs Depattment of Public Safety • SecurityS�•stems-5-l.icensr �`-�=- ^ License: SL-001779 r = k 1 ,•R�.rs `l �yl'1 G 9des FOGdM 0299 Expiration: CDITMISSIDn L �f9tif�0�6 ' i c j �5 l ACCERTIFICATE OF LIABILITY INSURANCE 1ir� DATE /2014 m(YY) 10/08/2014 _1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh USA Inc. 1560 Sawgrass Corporate Pkwy, Suite 300 CONTACT NAME: FAX M. No Ex A/C No): Sunrise, FL 33323 Attn: FtLauderdale.Certs@marsh.com E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Company 16535 048953-ADT-GAW-14-15 INSURED ADT LLC INSURER B: American Zurich Insurance Company 40142 INSURER C : 18 Clinton Drive Hollis, NH 03049 INSURER D: INSURER E: INSURER F: MED EXP (Any one person) $ 10,000 COVERAGES CERTIFICATE NUMBER: ATL -003303542-01 REVISION NtIMRFR:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY GLO 5095899 02 10/01/2014 10/01/2015 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX1 OCCUR DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 X POLICY PRO LOC $ B AUTOMOBILE LIABILITY BAP 5095900 02 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? � (Mandatory in NH) NIA WC 5095897 02 (AOS) WC 5095898 02 (MA, WI) 10/01/2014 10/01/2014 10/01/2015 10/01/2015 X I WC STATU- OTH- L I R E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEd $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below 2,000,000 E.L. DISEASE - POLICY LIMIT. 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Town of North Andover is included as additional insured (except workers' compensation) where required by written contract. CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: Electrical Inspector THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 124 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �Cav�not . @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD - - ----- - - -- _---_ -- -- ---- - - - -- - - -- - - - _- ------ - -_--—_ -----.- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street t Boston, MA 02111 www,mcass-gov/diva Wo>r1rcerrs' Compensation Rnsuranee Affidavit: Buillders/Cointraeto>rs 4lectrieians/Plain ileus ApiLflncant Information flease Print Le6>�ll� Name (Business/Organization/Ind yidua1)�_ r Address: \'g C ty p: Ci /State/Zi V,)<;�, Phone #:.`' L l Are you an employer? Check the appropriate box: 1. FAbI am a employer with _\O0ct_r 4. ❑ I am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors 2. ❑ Iam a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ 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): 6. ❑ New construction. 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions I L ❑ Plumbing repairs or additions 12.❑ Roof repairs 1IF] Other N- qvj 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infomlation. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I arta an employer that is providing workers' compensation insurance for nay employees. Below is the policy cared job site information. n Insurance Company Name:.. Policy # or Self -ins. Lic. #: ` a =` al, `_f }' 0 9 /State/Zi Cit : Job Site Address: Y p 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 sme up to $1,500.00 acid/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 veru -ation. Ido hereby certify-`arnder tlae pairaslan&veii.affiea. eijury that the information provided above is true and correct Signature," - r:n­— Date'-\�`Z-� L`� f Phone #: Official use only. Do not write in this area, to be completed Icy ci6; or town official.. City or Tower: -- Permit/License # Issuing Authority (circle one). 1. Board. of Health 2. Building Department 3. City/Town Clerk 4. Electric,al suspect®r 5. Plumbing Inspector 6. Other Contact Person: — -- Phone #: Location r. t c)��u�qY No. Date TOWN OF NORTH ANDOVER p #q Certificate of Occupancy $ i Building/Frame Permit Fee $11. �(oo oy � cNus < s� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ (00 6- Building Inspector 07/21 /95 12:35 1 , 4fi0-'� ID �? 4 8 6 4 9 Div. Public Works Location 2� �zoe No. ��_ Date i TOWN OF NORTH ANDOVER b Certificate of Occupancy $ Building/Frame Permit Fee $ MU ACM�SEt " Foundation Permit Fee - $ Other Permit Fee $ '?,D7 Sewer Connection Fee $ �1�0• J 4--d Water Connection Fee $ //43.0 TOTAL ' llC �Zoga,4 06/e7fi?�:51 t 1.000.00 dD $ Z 3,aZa Build! ,Inspector I Pp Div. bli Works Location 1 (Y. No. 7 COD Date t NORTH, TOWN OF NORTH ANDOVER C F pp Certificate of Occupancy $ S"D Building/Frame Permit Fee $ '' MM Foundation Permit Fee $ too Other Permit Fee $ S Sewer Connection Fee $ Water Connection Fee $ TOTAL $ f , Building Inspector 8648 Div. Public Works ZZ1*3,a� Q m Z 30 n p X c LU O� z < D � Z \ • O I� Z W > Z 3 FO IJ , CL Z 0 r p Z 0 Z H F > K Q 0 M 0 m j F Q O Z n W' p Z U. 0 W z C w m F J w 0 Q F Z C �a J -� ►= F p\ a 0 z 0= F W J 0 F F W m 0 (A0 I 0 LL Z FO U 0 J J V f LL O K O O — m V W J O LL 0 i C Z m W WW J t = W o 0 O �` 0 F 0 z a a x 0 K I IL 7 0 W < Z N < W F N N W V- 7 m N d Z m IL N N O I F Q m Z 30 n p X c LU O� z < D � Z \ • O I� Z V 0 m FO IJ , CL Z 0 r p Z 0 N H F > K M 0 2 K J W F z Z n Z < 0 Z p 0 a W z a U z w F IN 0 60 ' w Q F Z �a O ";I OZ :vl ° J m NKA L• "nU e A C z 0 n 0 g Z d � ci m w W W Z 0 IL 0 u0 v a a 0 0 0 0 d U m m m U z 1- 1= !- cv J m Z 0 N OR p 0. 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C.O N� =0 y CO CD S- CO) O CD Z O O o CD C CD O 5 Im O 04 f C O MA O Z O O O _ m O C_ c. _ U2 CD m c 0 t 0 a H N CD w?"o0I_ M O CT CA dO�m CA 3 m n m C7 CD CL 3 m Cos CD =r go CO3 �1 O O O =r CD1/V CD= co, CD -" or0% z ` CC' O `1'11► N A D = _ Cc*.m ' Z C �► rt o O CD N � C. CD3 90 COD a. m til c r= r IE C cc � y imp N H � _ m m A ED o C ^' Tp �V s CD < .QCF„F; a Co =r zZ=m: .� aa= A Qn n pp Zoff c • o; A to oqV' z, VL =m: v r o n ►-+ \O 10 n 1 0=3 0 0 c C/ n!0 71i ni 0 'm n g O '17 O A M w w C �y C OQ m T C G L7 cp > ;t 9 d c4 �Z z d W x z c� n ►-+ \O 10 n 1 0=3 0 0 c FORM U - LOT RELEASE FORM 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: LOCATION: Assessor's Map Number Parcel Subdivision Noary kN4"e_1?_ aa_&Wdlz�i Street lel D611 144+Z Lots) .ti St. Number QS^ ************************Official Use Only************************ ,RECOMMENDATIONS OFTO A NTS: /t! C— / Date Approved Conservation Administrator Date Rejected Comments g Date Approved -q-Cq]� Town Planner . Date Rejected Comments Food Inspector -Health , 0 _ A , c-rp ant-_, Comments r -Health Date Approved Date Rejected Date Approved G� Date Rejected Public Works - sewer/water connections -r-'TO 5-!�v - ?5 - driveway permit, 5 --30,- t5 Fire Department ��� ,moi °Received by Building Ir A - 81995 Spector Date 7 N, NOrL: Aa V",UTY LC-^-A'MQtJZ ARE TO DE FIELD V"lFtED W- 1HE c() R tll' v -J 1,31 u, LAND PLANNING; INGUMMG Jk 9URVZY IL67MARTF 'RD &Vlm-M XnAVGHAJI- ba Mote (0*6) M-4130 PAX- (&W) 06-5(*4 G&4DING / SIU PLAN Loom= M. LOT o, o ( i 8)� FORM NYU MATE:$ NOVM MA purmw me 'OU BROTHERS, INC. bwTcff FAM Dim W&MRO, bu olml h4 r N- -4 7 N, NOrL: Aa V",UTY LC-^-A'MQtJZ ARE TO DE FIELD V"lFtED W- 1HE c() R tll' v -J 1,31 u, LAND PLANNING; INGUMMG Jk 9URVZY IL67MARTF 'RD &Vlm-M XnAVGHAJI- ba Mote (0*6) M-4130 PAX- (&W) 06-5(*4 G&4DING / SIU PLAN Loom= M. 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Z o I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED ON THE LOT AS SHOWN ON THIS PLAN AND THE LOCATION DOES CONFORM WITH THE FRONT, SIDE, AND REAR SETBACK REQUIREMENTS SET FORTH IN THE TOWN'S ZONING BYLAWS AT THE TIME OF CONSTRUCTION. I FURTHER CERTIFY THAT THE STRUCTURE IS NOT LOCATED IN THE SPECIAL 100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT TO BE USED FOR THE ESTABLISHMENT OF PROPERTY ONES, ERECTION OF FENCES, OR CONSTRUCTION OF ADDITIONAL STRUCTURES ON THE LOT. MAP NO.000ic COM N0.25oo" DATE: G -2-93 FOUMATION AS --BUILT t At LOT 60/ is NORTH ANDOVER ESTATES NORTH ANDOVER, KA wWAM r= TOLIWO V= PAM ikU INC wzszso>wo, w► 01591 LAND PLANNING ` mmagmx R R sulm wr WAROM sped FM (IN) ""AK W o0 7-rs-95 T77 40' INAE Go 9 S-- ZG7 7 DRA I N pA5aMEN't��� ; N b FIE N r� _342.4v /d. L.0'- 'eo, S E"r8AGK5 . F 2 S - O. Z o I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED ON THE LOT AS SHOWN ON THIS PLAN AND THE LOCATION DOES CONFORM WITH THE FRONT, SIDE, AND REAR SETBACK REQUIREMENTS SET FORTH IN THE TOWN'S ZONING BYLAWS AT THE TIME OF CONSTRUCTION. I FURTHER CERTIFY THAT THE STRUCTURE IS NOT LOCATED IN THE SPECIAL 100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT TO BE USED FOR THE ESTABLISHMENT OF PROPERTY ONES, ERECTION OF FENCES, OR CONSTRUCTION OF ADDITIONAL STRUCTURES ON THE LOT. MAP NO.000ic COM N0.25oo" DATE: G -2-93 FOUMATION AS --BUILT t At LOT 60/ is NORTH ANDOVER ESTATES NORTH ANDOVER, KA wWAM r= TOLIWO V= PAM ikU INC wzszso>wo, w► 01591 LAND PLANNING ` mmagmx R R sulm wr WAROM sped FM (IN) ""AK W o0 7-rs-95 T77 40' INAE Go 9 S-- ZG7 7 Cl) m -0 D _ J] r n Q C m � z z ray I'D cam\ I'r v �� •� 1� z .� / / � •^i � ^ V z CO) D � \ N .Ot Cl) CD D J'� y T r- CD O 'v z r CL r- CM C7 O � C� �• CO) v CD CD o cr I Cfl C) CD O CD o M C/) CD �CD Dm < tZ v m � O' Z O CO CO) McD D T �• D w 1 � N!' 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