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Home My WebLink AboutMiscellaneous - 27 ANDREW CIRCLE 4/30/20189 9D C) C) North Andover Board of AS'sessorA Public Access Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial 0 Page I of I MWL �4broperty Record Card Parcel ID:210/047.0-0128-0000.0 FY:2013 Community: North Andover SKETCH Click on Sketch to Enlarge F] PHOTO Click on Photo to Enlarge Location: 27 ANDREW CIRCLE Owner Name: HASTINGS, IAN Y HASTINGS, CYNTHIA Owner Address: 27 ANDREW CIRCLE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5 - 5 Land Area: 0.07 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1152 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 208,300 213,000 Building Value: 74,900 76,000 Land Value: 133,400 137,000 Market Land Value: 133,400 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2253455&town=NandoverPubAcc 3/26/2013 to to 40 CD 0 cz !�,!Z! 0-0 0-0 0 CD X M (1) 76 *a)* <D 076 bj:2 m t 00-- 5 c (-), L) a) E2 T U) 0. - cl 0) a) C -a U) w IL CD 0, LL a) -4-- LU C: 0 L::u L) O'D m U) L) w Z cm 0, OD IT 0) 0 _0 U) 4i 0 U) 0 V) -� W 0 m a) W co a- L) 0 -20 w Oc < z Of -i p Lr) D LLJ CD CD r - L) C:� w Of to a CD LU 2 < > > -0 a) a) a) 0 0 C . cn cc DD mffi mffi -ffi -ffi 2 a) �� U) cf) U) U) (D 0 CO Ln 04 CD co L) 2 0 < j -a < 0 cu C'/) CID -1 8-01 - I 8-0 —i in - 091 E E 0 0 CD CD CD — I R Z CD CD 0 CD 9 '4Zt C> LO co C14 11 Go CD 0 LL W E C, - w z W C D T >. - L) 0 C14 a W z w z i6 z L) L-: U) CO) U) < < 2? 1.- 0 CD X C4 Z a_ —0 r I 0 CD 0) ca Q- co (D CD C> R co 0 C) 0 0 '4Zt C> U) Cfi r17 Cl) Cl) CD 5�20 m CD 0 0 C) It C) I iz cli 1-: z Z......... ...... 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L) CO -�u C�r V) D cu U) 0 0 15 Ca C)O— (D 0- IL (D cc Oc LA - 0 — of "0 CO ca CO �e (D -0 co ,6 -= !t: 0' 5 m 'S� co,u_ m w co w ca m 20 > z M C4 0 CO 0 MOOZ E C) P) F- 0 (3) 0) bi < a), 1p CL CL L) > 1: co - 0 (.) w (13 a) a) C: Z, 2 0 1 (u 0 (1) m i= (L) (/) C/) of w 2i LL Z: LL LL a 0 (L 3: U) 0 CD 0) ca Q- co (D CD C> R co , Location(V No. Date 40RT" TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ MU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # BuilTing Inspector TOWN OF NORTH ANDOVER 4 14ORTN APPLICATION FOR PLAN EXAMINATION 0 0 Permit NO: L-) Date Received Date ISSUed4- 1 0 �SACHU IMPORTANT: Applicant must complete all items on this page LOCATION s27 Cvs\r-:� —7 Print PROPERTY OWNER Lc_e� N,IAP NO.: PARCEL: TVPV ANn ITRF OF RITITBING ING DIsTRICT: 141STORIC DISTRICT VFS F1 OF IMPROVEMENT PROPOSED USE -TYPE Residential Non- Residential 7j New Building Addition C Alteration k? One fain i ly _1 Two or more family No. of units: F Industrial L2�epair, replacement Demolition 2 Assessory Bldg D Commercial 1� Moving (relocation) E Other :j Others: r- Foundation only I I DESCRIPTION OF WORK TO BE PREFORMED —J CH -A A) 6—<F 0, qe 0 (C, .ep, 1) e c, �,t n T rLeX T) EZ t:::' Q0_(,0 SPI 4,621 On 1C, - Identification Please Type or Print Clearly) OWNER: Namj \x =z _-�" / C_'*,J,-��V.,N� �"S��- NX,��"r,,,-Phone: 'I CQ�"7 Address: <=27 CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Home Improvement License: Exp. Date: Exp. Date: ARCHITECT, ENGINEER Name: Phone: Address: Reg. No FEESCHEDULE: BULDING PERMIT. $10.00 PER S1200.00 OF THE TOTAL ESTIMATED COSTBASED ONS125.00 PER S.F. lotal Pro.ject Cost:$ x12.00:=FEE:$ Check No.: Lz Rece i pt No.: llagt I of 4 TYPE OF SEWERAGE DISPOSAL 7 Tanning/MassageiBody Art j — Swimming Pools Public Sewer Well Tobacco Sales Food Packaging/Sales Li Permanent Durnpster on Site Private (septic tank, etc. 1 Electric IN/leter location to prQject NOTE: Pervons contracting4ith i1gregistered -ontractors do not have access to the guarantyfinid .vte (I o j Signature of Agent/Ownej/!� C� Signature of contractor L Plans Submitted El Plans W�#ed Certified Plot Plan Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoninu Decision� receipt Submitted ves I'lannin- Board Decision: I Conservation Decision: DATE REJECTED El E]Water Shed Special Permit Site Plan Special Permit Other DATE APPROVED DATE REJECTED DATE APPROVED FI 11 DATE REJECTED D Comments coninle F] DATE APPROVED Water cvz Sewer connection/Signature & Date Driveway Permit Fire Department signature,,date Ternp Dumpster on site yes_n 0 / D tx- %AORTH A TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-64 North Andover, Massachusetts 0 1845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: HOMEOWNER Street Address d I // Name t Home Phone PRESENT MAILING ADDRESS City Town i L.- State Map/Lot Work Phone Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two 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 108.3.5. 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 or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she unders minimum inspection procedures and requirement and that requirements. / z HOMEOWNERS SIGNATU APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption of North Andover Building Department iply with said procedures and BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEAUM 688-9540 9535 PLANNING 688- 0 "Cl vw-t i LIP 0 0 0 0 cl, 0 0 EMO LLJ 0 CL z 9 0 ZW cc Cl C� C3 C2 u —cl x CL'o to g2 cz �2 CA C, to —M 0 Cf) o C/) 0 EMO LLJ 0 CL z 0 \0 4 cf) P-4 Cf) z rl C/) z 0 u C/) C/) "D 4� u 0 0 4-j N CD E (D z Q ca CD M E CD co Q cc M W 0 Q CL CO3 CO) C2 ts CD CL Cos E CD CM 0 CD cc CX3 0 ID CL 0 CL cm< 0 2c Q co CL Cie LLI w cn 19 LLI LU I% LU LU co CO cc Cl C3 CL'o CLC cc cc 10 0 Cc CD CD M 0 CL ca S s CD, cm mi I=.— E ca %- ma cc CA cc W. Go -wo CD cm CLC.3 *OWE* 0 cm 410 C3 mv C3 0 cm CD L- 0 g 4D 4CDL CO3 AD 1; 'm CL= s M u lei* C3 Lo C.2 4D C3.45 0 0 CO2 C36 CD cm 0 \0 4 cf) P-4 Cf) z rl C/) z 0 u C/) C/) "D 4� u 0 0 4-j N CD E (D z Q ca CD M E CD co Q cc M W 0 Q CL CO3 CO) C2 ts CD CL Cos E CD CM 0 CD cc CX3 0 ID CL 0 CL cm< 0 2c Q co CL Cie LLI w cn 19 LLI LU I% LU LU co Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Provided —Required Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. NO I 11-S and DA I A — (For department use) lkc] I H)"NA1. SERVICLS DH'AR FMLN I BPWIV,105 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits • Building Permit Application • Workers Comp Affidavit • Photo Copy Of H.I.C. And/Or C.S.L. Licenses • Copy of Contract • Floor Plan Or Proposed Interior Work Addition Or Decks • Building Permit Application • Surveyed Plot Plan Lj Workers Comp Affidavit • Photo Copy of H.I.C. And C.S.L. Licenses • Copy Of Contract • Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) • Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) • Building Permit Application • Certified Proposed Plot Plan • Photo of H.I.C. And C.S.L. Licenses zi Workers Comp Affidavit :i Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) • Copy of Contract • Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECHONAL SER% WES DEPARTNIEN'r:1111FORN105 Date ... /n .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............... 4 ............................................................................ .has permission to perform ......... .............................................. "wiring in the building of ................................................................. at ........ :�:!��A ................. . North Andover, Mass. Fee.............. Lic. No. . ....... ...................... Check # %�� -7' T (/// 'tLEcriucAL INspEcrOR 4 7 I" Commonwealth of Massachusetts Department of Fire Services /ri,Official Use Only Permit No. -2 1 Occupancy and Fee Checked , :?K-Ze- BOARD OF FIRE PREVENTION REGULATIONS . [Rev. 11 /991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonned in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR 7TPE ALL INFORMATION) Date: J /) — '— (J '3 City or Town of: &AXW— d,1&Ve117 To the Mspector of Wires: By this application the undersign�d gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant J I Telephone No. Owner� Address (Check Appropriate Box) Is this permit in conjunction with a building permit? Yes No F Purpose of Building Utility Authorization No. Existing Service I 40�—Ii Amps /,; V --)l J��olts OverheadE:1 UndgrdE1 No. of Meters New Service Amps Volts Overhead UndgrdF� No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: le A5;� z, ��— iqe 4--- 4F - Completion of the.followin table may be waived by the In ector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above Ei In- grnd. grnd. 0 No. ot Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Totol Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number I' Tons TWW-- I I No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local EJ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional dt ail ifdesired, or as required by the Inspector qf'Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the perf6imance 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: INSURANCEQ�OND El OTHER [_1 (Specify) 1/),-) 4L I - (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under thepains andpenalties ofperjury, that the in o ation on this application is true and complete. FIRM NAMF: LIC. NO.: Licensee: /11U& 4�1 Signature 4;;;,, LIC. NO.: (If applicablir entj-r "exempt "in the license number line) Bus. Tel. No.: 9!? Address: Alt. Tel. No.: Ae OWNERS INSURANCE WAIVER: I am aware' -hat the Licensee does not have the liability insurance coveiage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) El owner E] owner� agent. Owner/Agent Signature Telephone No. PERMITFEE: $J�S b Location -9 7 A),),,,,- /,(� - /C *9 / 0 No. Date /I/,/" - I I TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check # /I $ Z/O. 06) 6 7 6 J r I /� , � -, 0 r), v Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT ��EAI RENOVAT!� OR DEMOLISH A ONE OR TWO FAMILY DWELLING (Ift "'�Vo _000 541wr ?7– BUILDING PERMIT NUMBER: DATE ISSUED: 1:/1—C>)- -c;2 d5 SIGNATURE: X Building CommissionaLn-SLX—d—or of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Map Number Number: R Parcel Number 1.3 Zoning Information: Zoning Diaiict Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage (ft) 1.6 BUIELDING SETBACKS (ft) Front Yard Side Yard Rear Yard RaItfired Provide Required Provi&d Required Provided 4- 1.7 Water Supply M.G.L.C.40. 54) Public 0 Private 0 Zone 1.5. Flood Zone Information: Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: D On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSI]EIP/AUTHORIZED AGENT Historic District: Yes _No I I Owner of Record �O jLAVI (�, Lee ame (Print) Address for Service: Signature Telephone 2.2 Owner of Record: S. ) tA Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone T M z 0 �j 0 z M 90 0 M z G) I SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) I 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 ....... 0 No ....... 0 SECTION 5 Description o Proposed Work (chemyck applica New Construction 0 Existing Building 11 Repair(s) 0 Altc;�iions(s) Addition 0 Accessory Bldg. 0 Demolition 11 Other 11 Specify Brief Description of Proposed Work: Make A_ AFI)l rVOv�-N SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pennit applicant OF'FICIAL.VSE, I Building (a) Building Perinit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction -3 Plumbing Building P it fee (a) x (b) -4 Mechanical (HVAC) 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 T 1, as Owner/Authorized Agent of subject property Hereby authorize to act on Myb h If 1 11 atters r e �Iative to work autkorized by this building permit application k -7 , L_ S . - 2 Z Z47ignature of Owner Date SECTION 7b QWNER/AUTHORIZED AGENT DECLARATION JLA Y) L e— 42-- as Owner/Authori7ed Agent of subject property Hereby declare that the statements and inforination on the foregoing application are true and accurate, to the best of my knowledge and belief J LA vi S' Print2Nne Signature of Owner/A ent Date i NO. OF STORIES SIZE BASENENT OR SLAB ST 11D RD SIZE OF FLOOR TINMERS 2 3 -SPAN _DRVIENSIONS OF SILLS -DUvIENSIONS OF POSTS -DRvIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS -SIZE OF FOOTING X -MATERIAL OF CHDANEY -IS BUILDING ON SOLID OR FILLED LAND -IS BUILDING CONNECTED TO NATURAL GAS LINE Design for basement legend = 30 pixels equals 1 foot .......... .......... - .. .... .... ........... .......... ........ ... X g�i .......... . .. .......... . . . .......... ................. ........... ................. .......... .... ...... . . .... ....... . . ..... .......... .......... .......... .......... ......... ....... .......... ........... . ...... ................ ....... . ........... :X, ............... ........... ........ 1�:i� 0 -:N -N Ki .......... ... .......... ..... ....... 00 ............ . . . . . . . . . . . . door! closet style ................... .............. .......... ............ .......... �g g ........... ............. . .. . .... :iggni:E: . . . . ....... closet style door: :MM:$� . .. ........ windows bulkhead—] Layout for basement (current) legend = 30 pixels equals 1 foot .......... .......... .......... .......... .................. ............ .......... . ..................... ........... .. .... . .. ... ............... ................ ......... .... ............. .......... .... Rie ......... . ........ ......... . .... ..... ................... .............. . .W tM., .......... ......... . ............. .... ......... .......... .......... ................ ....... .. .... : --------------- ................ ........ . .......... .......... ........ .... .................... ........... ............... . :.kk% ........... .......... ...... . ..... ............ ......... . . . . . . . . . ................................ *****" - MO xx ....... .. .......... N. -I. window bulkhead basement specs ........... ..... . . ......... .. ... .. . . ... .............. ................ ... 7 ...... . . .................. .......... ........ . . . . . . ................. .............. .......... ... ............... ............... ................ ............................... ...... ..... ............ ............... .......... ................ .............. . ........... ... ...................................... . ......... ......................................... . ... ........... ..... ... ............ . . ....... ....... f ............ pole 8f3l' from right wall 8'10" from left wall ceiling 88-1 floor to ceiling 7911 floor to beam bulkhead 71 height 3' width 4 0 =Nod i5 ui z 0 cc x 0 x Cd 0 —Cd ZW ca cn 0 cn ui z C/) z 0 r-4 0 u 0 10. 4.4 E CO3 CD CA E CL C.3 cc ME CO2 A2 CL Zift cc "a CA) C2 ts co CO2 CM C) 0 CD 03 CD L.. C:L CD CK cm< cc 0 CD CD CL C#* c w 0 U) w U) cr w w ir w w C/) cc 0 LZ C.3 Cj: CL. co cc 4D CE cc C.) ei MEsL-:R C* cc CID C3 :mD =o M a CLC�) MY. cm 0 S:E cm cp t7 cm 4c 1 cc co -on 12 'COL LLI C. CD Me CL.= CM C3 ID CL 'M :2 CD s C, cm CL.- C=o C/) z 0 r-4 0 u 0 10. 4.4 E CO3 CD CA E CL C.3 cc ME CO2 A2 CL Zift cc "a CA) C2 ts co CO2 CM C) 0 CD 03 CD L.. C:L CD CK cm< cc 0 CD CD CL C#* c w 0 U) w U) cr w w ir w w C/) Date. ./-. .� .-. 1-. .1. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . 6 L" e (" )').), 14 . . . .......................... has permission to perform ... ........................ plumbing in the buildings of ... D. ... ................... .......... North Andover, Mass. Fee. Lic. No.. c!75.). -1 . ........ ............ . ........ V PLUMBING INSPECTOR Check # 2- 5087 01 .......... ... TO DO MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT 7- Y- 0(�'? (Type or print) NORTH ANDOVER, MASSACHUSETn Z.Date P rrr Building Owners Name5ezA Zc,111�u Permit Amount Type of Occupancy Replacement Plans Submitted;,Yes No New Renovation IWTYTTTIQpq (Print or type) - Check pae: Certificate Installing Company Name Andover P1bQ Htq.- CO., Inc. Corp. 2122 Address 2 0 Apapan nr- 11nit-10 0. Partner. Methuen, MA 01844 -- Business Telephone -(978) 685-8383 Firm/Co. Name of Licensed Plumber- nonrnn I qOnqp Insurance Coverage: Indicate thekpi of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 0 Bond El InsArance Waiver. I, the undersigned, have been made aware that the licensee of this application does not haVe any one of the above threeinsurance Signature Owner Agent 0 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 a1l plumbing work and installations perfo edunder Permit Issued fDr this application will be in gj compliance with all pertinent provisions of the Massachusetts. State:PluZing Code_and P�ppt of the General Laws. By: bignature of Licensea riywDer Type of,Plumbing License Title �Number Master eyma City/Town =Qeapnse �Journ _n El APPROVED (OFFICE USE ONLY Date. . /.-. . . ?.-. . �'. . . . . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... /i/Al. ................... has permission for gas installation .................. -P X in the buildings of .... el! ............................... at C I'/ ............ North Andover, Mass. Fee..) ....... Lic. No ........... ............. ...... GASINSPECTOR Check # � , 2 '�" 31-79 MAS!§ACHUSETTS UNIFORM APPLICATIO14 FOR PERMIT TO DO GASFITTIN'G (Print or Type) NORTH ANDOVER Mass. Date tullding Location *Z-1 13VI CiTe-LA21 Cjr-c-le- I Permit # —Owners Name New -7 Renovation 13 Replacement la' Plans Submitted E3 F XTURES (Print or Type) Check one: Certificate Installing Company Name Ar,80-m-, 1?1�'. "'Lq- C":,., T". [Z- Corp. 2122 - Address j Q 0 AeA e ovl,, -pr. LV, Partner. V IYL.- (")j?,,4A4 Firm/Co. Business Telephone: tqm) Name of Licensed Plumber or Gas Fitter Ge,.'e. L0'_R"S'e_ '.j Insurancr- Coverag Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 5K Other type of indemnity = Bond Ej Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent M I hcscby certify that all of the details and WosMaLlon I haYe submitted (or entered) in above application are true and accusate to the bocst. of MY knowledge and that aU plumbing work and WtALlations pctformc�d under'Permit WLed fo.- this application wiLl-bc in compliance with all pertinent provisions of the Massachusetts State Gas Code and CIAptet 142 of Lho General LAwa. By YPE LICENSE: Plumber Signatu're of Licensed Title - sfitter- Master Plumber or Gasfitter City/Town: c qq%3 Journeyman APPROVED (OFFICE USE ONLY) License Number ul 0 0 0 us cc UA 02 (a W W W 0 ;; 0. cc z W fr- A W 0 W a ZU (j OC uj W -K 0: 0 > U, LU z j vvj Z W Lu a C 0 > W W 4 = I- >.. 0 0 = 0 5 0 (a ra > W CC < (a < 0 0 W 0 W Q -9 > a C6 0- SUIA—BS&IT. BASEMEHT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STHFLOOR 6TH FLOOR 7TK FLOOR EST� FLOOR (Print or Type) Check one: Certificate Installing Company Name Ar,80-m-, 1?1�'. "'Lq- C":,., T". [Z- Corp. 2122 - Address j Q 0 AeA e ovl,, -pr. LV, Partner. V IYL.- (")j?,,4A4 Firm/Co. Business Telephone: tqm) Name of Licensed Plumber or Gas Fitter Ge,.'e. L0'_R"S'e_ '.j Insurancr- Coverag Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 5K Other type of indemnity = Bond Ej Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent M I hcscby certify that all of the details and WosMaLlon I haYe submitted (or entered) in above application are true and accusate to the bocst. of MY knowledge and that aU plumbing work and WtALlations pctformc�d under'Permit WLed fo.- this application wiLl-bc in compliance with all pertinent provisions of the Massachusetts State Gas Code and CIAptet 142 of Lho General LAwa. By YPE LICENSE: Plumber Signatu're of Licensed Title - sfitter- Master Plumber or Gasfitter City/Town: c qq%3 Journeyman APPROVED (OFFICE USE ONLY) License Number 3.--03 Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ...... X, ....... hazWrmission to perform ....... ......... .................. wirilig in the building of ........ ...... ...... North Andov"erass. Fee ... Lic. ...... 17 LECrRICAL iNSPECrOR Check # -- The Commonwealth of masachusetts Ott . Lce Use IRnly Department of Public Safety 90 occuparicy 4; NO Checked 130ARD OF FIRE PRMNTION, REGULA71ONS 527 CMR IZ= - 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM I ELECTRICAL WORK AJI "(k to 6e performed In accordance with 'he M&L"chusens EJectrical Code. 527 CMR 12:00 (PLEASE PRXHT Lq XM OR TYPE ALL INFoRMATION) Date CitY or Town of TO the Ulpeallor at witool MAWILS"44 applies for a permit to perform the electrical work described below. Location (Street Number)_49? /41V&Ze,_� C,r__rj- 45 - Owner or Te Owner's Address L16 Is this Permit in conjunction with a building Permit: Yes El H04 (Check Appropriate Box) Purpose of Building Existing Service Utility Authorization No. I Overhead El undgrd 0 New Set -rice NO- Of h4ters I — Amps Volts Overhead 0 Undgrdo No. -of heters--� Numbei Of. Feeders and Ampacity Location and Nature of 'Proposed Electrical Work V -ho No. of Lighting Outlets No Of Hot Tubs EJ No. of Transformers Total No- of Trans No. of Lighting Fixtures ti iE xtu ------ Swimming Pool Abndve In XvA No. Of Receptacle Outlets gr ............. grnd. NO- Of Oil Burners Generators No -.__of Einergen—cy—Lighting No. of Switch Outlets No. of Gas Burners Battery Units No FIRE ALARMS No. of Zones _. of nges 10 t7i-� No, of ALr 06fids "n" Nlon-iof Detection and No. of DIspossis - No. _g Heat lotal Total— tiating Devices V& Pumps KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Co . ntained i No. of Dryers Heating - Devices 1CW Detection/Sounding Devices Local E] Municipal _10the;- ConnectionE No. of Water Beaters KW No f no. Ot Signs Ballasts Low Voltare i No. Hydro Massage Tubs — NO. Of Motors Total HP I OTHER: lNiURANCE COVERAGE: Pursuant-tO the requirements of Massachusetts General Laws I have a currenk�iability Insurance Policy including Completed Operations Covera YE�rbits substahtial equivalent. YESZ:1 NO 0 1 have submitted valid proof of same to this office &e No If you have che4ked YES, please indicate the type of coverage by . checking the &;propriate box INSURANCE 4.-BOMD n OTHER E] (Please Specify) Estimated Value of Electrical Work S 5W. co —TUPTr —art MO _n Ta ZeT Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME �11C* No Islethsti (oeA-t— Pign;ture Address LIC. No� BUS. Tel. -Alt. Tel. 140.9-;� 6!9:? -?q10 OWNER'S -INSuRANcE WAIVER: I am aware that the Licensee does not -have the ins ce-Foverage or its sub- st a ntial equivalent as � required by Massachusetts General Laws, -and that my signature on this permit 3PP,licaticn waives this requirement. Owner Agent (Please check one) Date.. ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation .... P.,,-? n. � ................. in the buildings of ..... P X; �� e.�. % 7: ....................... at ... d13. � i ,.. r ........... North Andover, Mass, Fee. Lic. No..'--�,,) .... ..... ,IiA;INSPEC*TOR Check # ? ) 2 "' 4 2 6 3' MASSACHUSETIS UNIFORM APPUCATON FOR PERNUr TO DO GAS WrING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations 2-1 ayieLre-L,0-5 Permit # Amount $ Owner's Name New Renovation Replacement [2f Plans Submitted (Print or type) Q�h e k one: Certificate Installing Company Name Aggggc�gar '? it>$ Co., -Ine, Corp. :Z 12-2- 1i %J VI Address 7-0 AeAg&yl Zr. 0 n; lc�, Partner. �0 0 t044q M'sinessTelephone Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check I have a current liability Insurance policy or it's substantial equivalent. Yes ff No If you have checked yes, I ase . ndicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity [3 Bond 0 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. I Check one: Signature of Owner or Owner's Agent Owner 13 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 CA Code and lg�ppx-442 of the General Laws. By: Title City/Town 1APPROVED (OFFICE USE ONLY) rv�Signature of i Plumber [3/Gas Fitter IZI Master E] Journeyman sed Plumber Or Gas Fitter OR 15 1-�s License Number U z 0 z z 9 W ;z) C) Z G 9 Z U <� 0 E-4 z - U W= 0 0 z 0 W> a 3 U g FW* 0 SUB -BASEMENT BASEMENT IST. F L 0 0 R 2ND. F L 0 0 R 3RD. F L 0 0 R 4 T H F L 0 0 R 5 T H F L 0 0 R 6 T H F L 0 0 R 7 T H F L 0 0 R 8 T H F L 0 0 R (Print or type) Q�h e k one: Certificate Installing Company Name Aggggc�gar '? it>$ Co., -Ine, Corp. :Z 12-2- 1i %J VI Address 7-0 AeAg&yl Zr. 0 n; lc�, Partner. �0 0 t044q M'sinessTelephone Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check I have a current liability Insurance policy or it's substantial equivalent. Yes ff No If you have checked yes, I ase . ndicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity [3 Bond 0 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. I Check one: Signature of Owner or Owner's Agent Owner 13 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 CA Code and lg�ppx-442 of the General Laws. By: Title City/Town 1APPROVED (OFFICE USE ONLY) rv�Signature of i Plumber [3/Gas Fitter IZI Master E] Journeyman sed Plumber Or Gas Fitter OR 15 1-�s License Number Location ; I &,-&, No. 171t/1 -A, Date A - TOWN OF NORTH ANDOVER 'A Certificate of Occupancy $ P Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check# &9� 17 G 2 6 '--Buildinig lnspel�r I . A 11 VPAR-T-NffNf' TO-CoNgmucr ikkoUgH AQMQRTVXbFAM[Ly�DWELUWC — - - ----------- Bun DIKG Puma mwm-, 19SUED r A L7 SIGNATM- DaW I -SM DIFORMATION z .$EMON 1.1 ftqmdyAddmm .2 Asscom Map md Pared Number. 7, mber 7 —u 13, Zoninglaf-mation: 1.�. pfopaty Zoning Distrid Proposed Use 1�:lA Ara (st)- - L6 WADING SIETRACEN (ft), Front Yard SWYard "..:..Rear Yard - RoMfilled —Iltelllalimd LlWstc- SUA*MnJ-Q4flLl-S4) pdffic 6 Wift boallsom . . ........ . Zone a on 46 Di4osd syslaut a SEMON 2 - PROPERTY AGA". 2.1 Owner 6f Record r 0 Name Addrm for.Service: TolephM. 2.24mnpvfilbm .3 L1.5 NomjA Address for LA -,l b 4. M 16 I�Crt to SECTION 3 - CONSTRUCTION SERVICES �7" s �up a `�7. NotAppficable um 0 . Address'. vx0ration Tdcphouc 3.2 R40tered, Home II coultz Not-A4)pfic" 13 ... ... CompanyNamc, Address: z L r Expirafi=Dva w 4 SWflON4�WORICFR$E!IW.RNS�7O�,(!LC.L:C�IS2 J 2k6). C, ompensation Insmance affidevit mu#06 cm*W,W submitted with tWs ikoica" this affidavit will rwult in the denial ofthe isffluume of dw building liormktv Siped affidsvit Attached Yes ....... 0 No ... 1: U MMON 5 -Ancriptim Proosed Wd7rk(Cdh*&k' aiine" PtW S, r3 Cons!rlictiol7n., 0 0 A=ssoryB1dj Demolition 0:.: 011teir. 0 Specify Brief id VJbrk- Descriptiomof Propose CA SECTION 6 - FNTMUTED item EdWisted Cost (Dollar) to be. Comleted 1�'r p�ficairt I Building (a) Building Permit Fee (0 006 2 Electrical Estimated Total Cost of construction 3 Plurabing Permitfee, -x-(b) 4 MedumicEd aWAC), 5 Tirr.Protwion 6 Total (1+2+3+4+5), axeck Number SECTION 7x-OVVNER AUTHORIZU10N TO BE -COBU%ETIED WEIRN OWNERSAGMT. O.R.CONTRAC'M APPLES YOR BUHDING PIKR?Aff - - as 0.wncr/Authonzcdkgent of subject property Hereby auffiorize to ad on My beW in all man relative to work wthorized by tbas building permit awlicatim S4uature of Owner Date SECTION 7b,+ OWNMAUTHORIZED AGENT DECLAFATION As Owner/Audwrized Agen t Of subject Property Hereby declare that the statements and information on the foregoing applicatton are true and accurate, to the best of my knowledge and belief S, of Nyper/AR&I NO. OF STORIES SIZE FASEMENT OR KAB SIM OF FLOOR TIMBERS P. ND 2 spm .... .. DDAENSIONS OF SILLS DRAENSIONS OF POSTS DEVMiSIONS OF GIRDERS HEIGHT OffOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND. IS BUILDING CONNECTED TO NATURAL GAS IRE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: --Su v.., S. Le. t� 4 bl - 2,-7 0 E-1 am a homeowner performing all work myseff. E-] I am a sole proprietor and have no one working in any capacity E�<am an employer providing workers' compensation for my employees working on this job. Company name: 440YTNE, DkDV+ 0) ft-4- 96cl66q Company name: Address Cily: Phone #: Insurance Co. - Policy # Failure to secure coverage as req i ed ndejS tion 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 a il penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of thjCV4tement ma be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the Apinslani$penalti* of pkury that the information provided above is true and correct. Print vv�-- Official use only do not write in this area to be completed by city or town official' []Check if immediate response is required Building Dept Contact person: Phone FORM WORKMAN'S COMPENSA77ON -S 6 466k E] Building Dept 0 Licensing Board E] Selectman's Office E] Health Department 11 Other I I 01� C -Y- * ro 0 0 tA. o�) Branch Name: II(XV r:Xi Llgl/ Date: 12 0 Sold, Furnished & Installed by U The Home Depot Installed Sales Branch Number: Job#: (656�; 345A Greenwood Street, Worcester, MA 0 1607 Toll Free (800) 657-5182; (508) 756-6686; Fax: 508-756-2859 Federal ID# 75-2698460 ME Lic # C 02439 RI Cont. Lic# 16427 CT Lic# 565522 /I MA Honig, Imppvement Contractor Reg. #126893 Installation Address: e- / 1-7 i1W J'6r;ZQ t _( 4 u V_V III, ?-I City I State QQlk- rl,ivpr�tlf.ir ff&F.yn_nntP! WnrkPhnne: Home Phone: Home Address: (if different from Installation Address) City State Zip V�_ 7C Y Proiect Informati�n UWe ("Purchaser"), the owners of the property located at the above installation address, offer to contract with The Home Depot ("Home Depot") to furnish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet# I Z -7 (0 �: , incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it cannot perform its obligations due to a structural problem with the home or because work required to complete the job not inrlodpd in thp contract. ow CONTRACT A�OUNT *LESS DEPOSIT $ BALANCE DUE ON COMPLETION $-q *25 % of Contract Amount due upon execution of this contract. One-third (1/3") of Contract Amount is required for MASSACHUSETTS RESIDENTS ONLY. Indicate Payment Method For BALANCE DUE ON COMPLETION L - - I- ( , [�. , ( " a I . I DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval.) 1 . Check, Cashiers Check or US Postal Service Money Order (made payable to The Home Depot). 2. Credit Card* and/or other payment options - Circle One Below Visa Mastercard Discover American Express Home Improvement Loan Available Credit: $ (HIL & HDCC ONLY) -'-3q 19' '5 -�Z�.(Dale:_ Name as it appears on card: ; � 14 14 ba 0_�� -By my/our signature below, VWe agree to allow The Home Depot to charge the above f ced ed t card for the depost di d , 2=, i V1 Cardholders Signature Date If this is a finance transaction, the agreement for financing is containeo in a separate occurrent, wnicn is mcorporateu nerein oy Reference, and made a part hereof. At -Home Services Credit/Loan Application Ref. # Purchaser agrees that, immediately upon satisfactory completion of the work, Purchaser will execute a Completion Certificate and pay any balance due (unless the job is financed, in which case, upon submission of the executed Completion Certificate, Home Depot will be paid in full by the lender). Purchaser also agrees to be jointly and severally obligated and liable hereunder. For Mass. Residents Only: Contractor, at owners expense, shall procure all permits required by law as follows: Owners who secure their own permits will be excluded from the guaranty fund provisions of MSL Chapter 142A. Unless otherwise noted within this document, this contract shall not imply that any lien or other security interest has been placed on the residence. Entire Agreement -. This agreement and its attachments, including any financing agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 25% of the contract amount if the job is cancelled by Purchaser AFTER the third business day. BY MY/OUR SIGNATURE BELOW, IIWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. LIWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW, VWE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND VWE AUTHORIZE HOME DEPOT AND RMA HOME SERVICES, INC., A HOME DEPOT AUTHORIZED CONTRACTOR, TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. r— 7 - 0 .� SUBMITTED BY: 1W, /Z— - -4LZ Date: SidesConsultant ACCEPTEDBY: Date: 1 l/lIZ-3 11-14-03POI :52 RCVD Homeowner Date: Homeowner NOTICE: ADDITIONAL TERMS, CONDITIONS AND WARRANTIES ARE STATED ON TRE REVERSE SIDE AND ARE PART OF THIS CONTRACT White — Bmnch File Yellow — Customer Pink — Sales Consultant r 9-18-02 C -SC Loki M. W Home Address: (if different from Installation Address) City State Zip V�_ 7C Y Proiect Informati�n UWe ("Purchaser"), the owners of the property located at the above installation address, offer to contract with The Home Depot ("Home Depot") to furnish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet# I Z -7 (0 �: , incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it cannot perform its obligations due to a structural problem with the home or because work required to complete the job not inrlodpd in thp contract. ow CONTRACT A�OUNT *LESS DEPOSIT $ BALANCE DUE ON COMPLETION $-q *25 % of Contract Amount due upon execution of this contract. One-third (1/3") of Contract Amount is required for MASSACHUSETTS RESIDENTS ONLY. Indicate Payment Method For BALANCE DUE ON COMPLETION L - - I- ( , [�. , ( " a I . I DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval.) 1 . Check, Cashiers Check or US Postal Service Money Order (made payable to The Home Depot). 2. Credit Card* and/or other payment options - Circle One Below Visa Mastercard Discover American Express Home Improvement Loan Available Credit: $ (HIL & HDCC ONLY) -'-3q 19' '5 -�Z�.(Dale:_ Name as it appears on card: ; � 14 14 ba 0_�� -By my/our signature below, VWe agree to allow The Home Depot to charge the above f ced ed t card for the depost di d , 2=, i V1 Cardholders Signature Date If this is a finance transaction, the agreement for financing is containeo in a separate occurrent, wnicn is mcorporateu nerein oy Reference, and made a part hereof. At -Home Services Credit/Loan Application Ref. # Purchaser agrees that, immediately upon satisfactory completion of the work, Purchaser will execute a Completion Certificate and pay any balance due (unless the job is financed, in which case, upon submission of the executed Completion Certificate, Home Depot will be paid in full by the lender). Purchaser also agrees to be jointly and severally obligated and liable hereunder. For Mass. Residents Only: Contractor, at owners expense, shall procure all permits required by law as follows: Owners who secure their own permits will be excluded from the guaranty fund provisions of MSL Chapter 142A. Unless otherwise noted within this document, this contract shall not imply that any lien or other security interest has been placed on the residence. Entire Agreement -. This agreement and its attachments, including any financing agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 25% of the contract amount if the job is cancelled by Purchaser AFTER the third business day. BY MY/OUR SIGNATURE BELOW, IIWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. LIWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW, VWE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND VWE AUTHORIZE HOME DEPOT AND RMA HOME SERVICES, INC., A HOME DEPOT AUTHORIZED CONTRACTOR, TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. r— 7 - 0 .� SUBMITTED BY: 1W, /Z— - -4LZ Date: SidesConsultant ACCEPTEDBY: Date: 1 l/lIZ-3 11-14-03POI :52 RCVD Homeowner Date: Homeowner NOTICE: ADDITIONAL TERMS, CONDITIONS AND WARRANTIES ARE STATED ON TRE REVERSE SIDE AND ARE PART OF THIS CONTRACT White — Bmnch File Yellow — Customer Pink — Sales Consultant r 9-18-02 C -SC Ok 4- 0 4) 4) (U = a cf) 75 0 w (L) w U) z 0 w CL U) 0 a, --- z C W S 0 U) CL !2 x 0 ca c 0 U) 0 u C: CD .0 LL Co LL E .F .2 "a cu CC 0 Lu > UJ z �d a 0 L) x = .x 2 Z 0 LU F - cc 0 < < Lu 0 0 �: cn UQ) - 10 0 0 L) x 0) E— U) r- o 0 0 z = cn L) M cu V) C: r 0� 6 -E ; 0 r 0 41 0 0 0 (Oj 0 0 E m a 0 0 CD cn .0 LL CID ca c 0 Im 0 0 m cn z z 00mmmmmmmmmmmm cc w 0 Fn 0 z 0? 0 3; L) C? U LLJ CL E CL V) 0 U) .0 0 0 :"o 0 M! :6 L) 01 CL 0 L> cz a .0 co a) -E 2 76 CL '0 c ca 76 16 s 'E U, .2 C', 2 E MR.".111MCNIN 'Lill _0 2.T 75 E 0 C .2; .2 LL 0 00 cc LD CL !2 x 0 ca c 0 U) 0 u C: CD .0 LL Co LL E .F .2 "a cu CC 0 Lu > UJ z �d a 0 L) x = .x 2 Z 0 LU F - cc 0 < < Lu 0 0 �: cn UQ) - 10 0 0 L) x 0) E— U) r- o 0 0 z = cn L) M cu V) C: r 0� 6 -E ; 0 r 0 41 0 0 0 (Oj 0 0 E m a 0 0 CD cn .0 LL CID ca c 0 Im 0 0 m cn z (n z cc w 0 Fn 0 z 0? 0 3; L) C? U LLJ CL E CL V) 0 U) .0 (n z cc w 0 Fn 0 z 0? 0 3; L) C? LLJ CL V) E �w THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE SSUED OR 'ED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF sucm SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS. Wait �909MIERAL TYPE OFINSURAMCE POLICY NUMBER F��,CYVFECTIVE PKXICYEXPIPtATION LIwrS L"LITY EACH OCCuRFIEWa 11000,000 0,000 A COMMERCIAL GENERAL LIABILITY A03AG16362 3110/03 3/10/04 FIRE DAMAGE (My cine 109) 3 50,000 CLAIMS MADE OCCUR f K MED W (Any wo 411 pwwn s EXCLUOED PERSONAL&ADVINJURY a 1,000,000 GENERAL AGGREGATE 8 2,000,000 GwI.AocREGATE LIMIT APPLIES PER. PRODUCTS - COUPPOP AGG 3 1 1000,000 RO- POLICY 0 JPECT 0 Loc . ...... -1 AUTOOMIL.9 UAftffY COMBINED INGLEUMIT ANYAUTO ALLOWNEDALITOS. BOOLY INJURY SCHIEDULIEDAUTOS (Pw pww") HMO AUTOS NON-OWNIED AVYOS (PW--$@" PROPERTY DAMAGE (Per scadem) GARAGE LUMIILITY AUTO CiNLY. EA AmOf .mr S O.Mr AMY AUTO OTHERTHAN EA ACC 6 AUTO ONLY: - AGO S EXCIESS LIABILITY [goAtmoccumENCE 8 OCCUR CLAIMS MACE AGOREGATE s 3 DEDUCTIBLE RETIENTION 5 WORKIRB COMPENSATION AND WC9696691 07/01/03 07101/04 X I Two'cR y A I im S IMPLOYIERrUABILMY R E.L. EACH ACCIDENT 11000,000 E.L. DISEASE - LA EMPLOYEEr-.4 I 3 1,000,000 S 1,027 OTHER usimmi-pupi or ongAnoNWLOCATIC)N&'4KtCLI&tXCLUSIONSADOFO BY ENDORSFUENTISPECIAL PROVISIONS 110N SHOULD ANY OF THE ABOVE O"CRIBEDPOUCIES BE CAMCILLEDOEFCRIITH& UpIRATiON DATE THEREOF, THE IS3UlNG INSURER Mt 8WEAVOR TO UAL —2L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, SUTFAILUIllr000 $0 SMALL IMPOSE NO OSILIGATtON OR UlA5lLtfY OF ANY NINO UPON TK 'Nswigilt rrS ACENTS Opt (7197) SOB,# Ol pg"ne Rog oad 4w�rft mom own0vatONT CONTMATOR RepouDon., i2lM KSPVWM: &f3tm T"W: suppw"MM CAVO Mw"O Oew AA -MMS evvions PAUL. VENTRE 32W GM GA"X#bA PKWY WA ALTANTA. GA 30339 ......... .......... .... 4r Lkftu or rewnwee VON lor NW*Vktvl ww only berm the "pirgt6ft dw" It aned rwgisrs 6w Board of &Wldbl ItIPISO$U Wd SUwd&r* 039 Aebburftn PIW RIM 1301 Bob". Ms. $2100 Not we 0 lc$ 0 0, rA fA PQ 0 LE Cf) u 0. Cf) 0 F-4 u w r-4 PQ og C Lro. r2 u x ow co C2 U) —cd —Cj E-4 ZW CE U) 4.; 0 C/) !a LLI ui C.) COIJ cm CA m E CL Cos ca 0 CD C2 ca CL cc cts CO 0 go C3 &- co ca = E4CC C2 :2= ca co CL C* CD 0 cm CS lift cc Cc W3 C, C* E 'COD ma CID.. cm"— CA Ice S CD cj C3 me cc C:, 3: CL cc CCJD ca C2 AD % cm 0 CD , LA CL= COD co CD cm cc 0 CO E 0 C) F. U) 0 C/) cl) Cf) z 0 u Cf) C/) 40. LW 2 I�j 4:). 0 E 0 co CL 0 CO) G3 cm 0 CO3 Ca -0 co — m w = E ca cc G3 C2 co L- I... = CL — *.a CD Co 0 > C:j CD I.. C.3 CL C3 CL Co 0 ca CD co) ts CD 0 CL C.3 CO) cc CA Y� LLI LLI LLI I%- LLI LLI U) NORTH ANDOVER BUILDING DEPARTMENT 400 Osgood Street Tel: 978-688-9545 Fax: 978-688-9542 -7 /167 /0 DATE: 'Z NANE: ADDRESS: 2- ZONING DISTRICT: B USEVESS FORM FOR TOWN CLERK ,iJv-e w 4. 10 f er el e - TYPE OF BUSINESS. BUILDING LAYOUT PROVIDED: e,, Aid,,oQe+-- AVAILABLE PARKING SPACES: 0 vc�r �— ZONING BY LAW USAGE: L�S NO tAA le - 0 A� L BUILDING INSPECTOR SIGNATURE Revi3ed 11.5.04 BUSNESS FORM FOR TOWN CLERK