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Home My WebLink AboutMiscellaneous - 27 MEADOW LANE 4/30/2018rtj 1 RI ig 0i TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Thiscertifies that .......................................................................... .......... F�� has permission for gaspnstallation � ...... C� Y, . ....... e.-Iz . ....... inthe buildings of ....... .. j . ................................................................................... at ... Z-1 ........ NA ...... U .......................... . North Andover, Mass. ........... T� ...... M.4r Fee Lic. No.@ .... . ....................................................... GASINSPECTOR Check # (OqoK -1 r- - r% L .- .'� J O -W PLO �4 El u) 0 a. u LU LLI a. ui > LU U) z 0 Aw ca U - cc w 31\ H LL> - LL .0 -COQ Ln C3 LU MU) Uj< w U4/IJJ/2_U14 14:U4 bU813:32b tbl KH WHiIE UUNSIKUUI HAUL IJ2/ IJ2 ACC?RD DATE (MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCEP... I of 1 08/29/2013 11�� THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND 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: It the certiflcata holder Is an ADDITIONAL INSURED, the policy(jes)must be endorsed. If SU13ROGATION is WAIVED, subJect to the terMS and conditions of the policy, certain POliCies may require an endorsement. A statement on this Certificate does notconferrights to the certificate holder in HOU Of such endorsoment(s), willia of masamchunotts, Inc. c/o 26 CoAltury Blvd. P� 0. Box $05191 Naghville, TH 37230-5101 R. K- White COnffltr=tion Company, Znc. 41 Central 9treet P. 0. Box 297 Auburn, MA 0150,1 � V.�� INBURERA! The Chartar Oak Firo Insuranoo Company 25619-001 -INSURERS: TraVa:tArs Property Ca3ualty Ccm�Tpany of Am 25674-001 INSURER C: 1Tftti0nA1 Ilion Piro Insuranca Company oE 3.9445-001 INSURERD, Travelers Indamnity Company ZSGSO-Dal INSURERF; VoUYLIKAGES CERTIFICATE NUMBER: 20287680 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVS 13EEN ISSUED TO THE [NSUR INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER I CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,NS R I TyPrOPINSURANG A MERAL LIAMLITY I I I VTC2000 977X9949-13 19/3./2023 1-9/l/203.4 GENERAL UAWLITY CLAIMS-MADET OCCUR GEN'L AGGREGATE LIMIT APPLIES PER; POLICY IreT 7 LOG _Mf B AUTOMOBILE LIABILITY ANY AUTO ALI CHEDULED AU "W"E" 17ASUTOS �Oe X HIREDAUTOS WON -OWNED AUTOS X Com Ng Dad Coll Ded Hior-00 L UMBRELLA IIAS OCCUR RXCESS LIAB F CLAIM$-MAOE DED I X IRETENTIONS 10,C00 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y�N 3) ANY PROPRIETORPARTNERIEXEOUTIVE N NIA OFFICER/MEMSER EXOLUDI!D? fMandstoalnNH) Irs.deollba LInElar U eg KfI' UNUI,-OFURATIONSbaloW VTaCAP 977K95SA-13 P/l/2013 19/l/2014 BE0766140 P/l/2013 19/l/2014 VTRXUB 820SAI05-13 19/l/2013 1.9/1/203,4 VTC2XUB 820,AA71A-13 9/3,/2DI3 19/1/2014 epilea CERTIFICATE HOLDER CANCELLATION LVidonce of insurance NUMBER; 'D NAME ;D ABOVE FOR THE POLICY PERIOD )OCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE 1$ 2,000, 0 QCL 3 0 0 Aqo_ IVIED FXP (Any one person). . _000 1p, PERSONAL &ADV INJURY 000 _GGNERAI AGGREGATE 4-, 000, 000 PRODUCTS - COMPIOP AGO L__3, 0 0 0, 0 0 a M8TED SINGI.F. LIMIT U �G Cent) $ 2,000,000 BODILY INJURY(Pervemon) s 130DILY INJURY(Peraccident) ACH OCCURRENCF. $ 51 000� 000 GOREGATE $ 5 0 0'0 ,000,000 WG T TORMWLj L. �ACH ACCIDENT E .L. E Aor ID 3.1 000 COO 1,000 _r E.L. DISMA6E EA E _z S MPI'OYr EA EMPI.OYRr 2 S 1,000 , 00 1,000,000 El, DISPASE- P0410Y LIMIT S 11000,000 SHOULD ANY OF THP ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED AePRESENTATrw U9AA3qA!J7bUS WPI:1694012 Cert:20267680 @ 1988-2010 ACORD CORPORATION. All rights reserved. NCORD25 (2010105) The ACORD name and logo are registered marks of ACORD r 7 ') i. I,,' U , Date... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..... zj�o�� ....... .. ......... 2 ..... �� ............................................. has permission to perform ........ ....... I ....... plumbing in thebuildin ,gs of../ A '7 ................................................................. j at ........ LL) ............ I E—..o ........................... ... . North Andover, Mass. i:� Fee��:..'�b.. Lic. No. ... ........... ............................................................. PLUMBING INSPECTOR Check # 11M7 @ i��FM-FM-FM-Fm-lm-KFM-FM-F=-FNNFM-Fm-Fm-Fm-[=-I FNNWFIW� WATER PIPING --dT—HER J INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES R -'NO Ell IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 01 BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance cove rage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E-11 AGENT 10 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli nce wvith all P ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 11LICENSE 4 SIGNATURE MP 01 ip a-' CORPORATION F11# PARTNERSH I P # LLC COMPANY NAME ADDRESS 7— J CITY STATE zip TEL FAX CELL EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK P TYPE OR PRINT CLEARLY CITY MA DATE __-,IIPERMIT#- 74Y JOBSITE ADDRESS OWNER'S NAME OWNER ADDRESS TEL a -aAX j OCCUPANCYTYPE COMMERCIAL EDUCATIONAL El RESIDENTIAL 11", NEW: F-1 RENOVATION: Ell REPLACEMENT: [F PLANS SUBMITTED: YES NO 01 FIXTURES -1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM A --j= DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I DISHWASHER L�J J i DRINKING FOUNTAIN FOOD DISPOSER ---Jl J --j FLOORIAREADRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL 11M7 @ i��FM-FM-FM-Fm-lm-KFM-FM-F=-FNNFM-Fm-Fm-Fm-[=-I FNNWFIW� WATER PIPING --dT—HER J INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES R -'NO Ell IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 01 BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance cove rage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E-11 AGENT 10 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli nce wvith all P ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 11LICENSE 4 SIGNATURE MP 01 ip a-' CORPORATION F11# PARTNERSH I P # LLC COMPANY NAME ADDRESS 7— J CITY STATE zip TEL FAX CELL EMAIL LLI CL Lij LLJ Lt - N The Commonwealth ofMassachusefts Department oflndustriqlAccW�ts Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):'— rkeD,2� S / � � 12 f- 0 �`,' X, L Addr6ss: clt'6 37- City/State/Zip: cJ U Hl' . Phone #: t, 6,J1 - 3V ��670 W Are you an employer? Check the appropriate box: 1. 1 am a employer with 4. El I am a general contractor and I eig*,oyees (falt and/or part-time).* have hired the sub -contractors 2. � am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their 3.0 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. F1 New con * struction 7. E] Remodeling 8. F1 Demolition 9. Building addition 10. Electrical repairs or additions 11.0 Plumbing repairs or additions 12.n Roof repairs 13FJ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they aire 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 am an employer that isproviding workers' compensation insurancefor my employees. Below is thepolicy andjoh site information. Insurance Company Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fmc up to $1,500.00 and/or one�year imprisomnent, 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 h ereby certo un*r tl�e paln�,=3pen aftles ofperjury th at th e infounation provided above is true and correct Phone#: Official use only. Do not write in this area, to he 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 M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire express or implied, oral or written." An empluerIs defined as "an individual, partnership, association, corporation or other legal entity� or any two or more of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or lo'cal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who,has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cany workers' compensation insurance. If anLLC orLLP does have employees, a policy is. required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. the affidavit should be returned to the city or town that the' application for the, permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed. below. Self-insured companies should enter their self-insurance license number on the appropriate Eric. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas ' e be sure to fill in the permit/license number which will be used as a reference number. Inadditionanapplicant that must submit multiple permit/license applications in any given year, riced only submit one, affidavit indicating current policy information (if necessary) and under "Job Site Address"' the applicant should write "all locations in _(city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is'on file for fature permits or licenses. A now affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Jndustdal Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel, # 617-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fay, # 617-727-7749 __www-mass,gov1dia Al C? 9 6 Date .. . . .. �; 7 z TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies C . ..... ......... has permission to perform ..... ... ........... ............. !ee� ................. e'O /-7 ...... .... -7 > ... ................................ I ............ wiring in the building of... at A�7 ... North And v r ass. 2 Fee.�..v .. . . ...... Lic. No.../ .... ...... . .......... ........ ......... ELECIRICAL INSPE OR .4 I C h e c k # 04,)-� 1 0 , 4c�x (fl-monweaIg ol Ma-44achuietti Apartment -/ gire Servicei BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Pennit No. Occupancy and Fee Checked [Rev. 1/07] (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 ININK OR TYPE ALL INFORMATION) Date: Jr -2 -l' -lo CityorTownof- N04IN A140V4QL 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) 027 Me4Z)O&J /-Jv. Owner or Tenant e/94/7-Q,-Z)A/ Telephone No. Owner's Address S)tATC— Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Undgrd No.. 4 Meters New Service Amps Volts Overhead UndgrdF] No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cnmnlofi— Ifth, Mhlp —,; A- L- L - No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of w Tdtal Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators k -VA No..of Luminaires swimming Pool Above grnd. No. of Emergeq�y Lighting Battery'Units No. of Receptacle Outlets' No. of Oil Burners FIRE Ai�-ARMS No. of Zones No. of Switches i� No. of Gas Burners No. of Det ion and I Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: J.N!!!!��r. . Tons .............. .. JXW-- ........................ No- of Self -Contained Detection/Alertin2 Devices No. of Dishwashers Space/Area Heating KW Local 0 Municipal Other Connection No. of Dryers Heating Appliances KW Securi Systems:*, No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts J Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs i No. of Motors Total HP - Telecommunications Wiring: - - . I No. of Devices or Equivalent OTHER: "02,/ Attach additional detail i(desired or as, required by the Ir(spector of Wires. Estimated Value of Electrical Work: "/Ooo, (When required by municipal policy.) Work to Start: k—ZLJ—J6 Inspections to be requested in accordance with MEC Rule 10, and upon corn letion. p 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 [Q BONDE] OTHER n (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: 0 e�� / A/C_ _ 40 -W&4 &A4,1X6 It SL --7"4 64--1 LIC. NO.: i 2/ Licensee: A&CAeljje-L, Qrly� Signature LIC. NO.: (If applicahle, enter "exe t in the license number line.) Bus. Tel. No.: 617 r, Address: -,Oeo 94f�- �96.2 AW,��-6 AA It. Tel. No.: *Per M.G.L. c. 147, s. 57-6 1, 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)Elowner El owner's t Owner/Agent Signature Telephone No. EE.- $ 10 29 The Cowwainvc-alth. aflilfressu-chuseas De ,parfunent ofludustrial A ccidents 0-4j'ice of lavesti-ations 600 Yflashingion Street Boston, PP, 02 -ill Wt O"r Crannpensa6-Ti-k Insurai-ace Affidavit: Appj,jicarai Inforiva-Gon Pleise P-ninut Le2itl- Address: PO vy/'--acc/ZlP: AZn,01-eV6, X. - L Pheneft: (el77V?Z"1 Are ym,-,i an ennp?".u--Yer'� Check t;i-� I arn a crinployer widl arn a uencral coritractoT- and I L --J -vc h C�-Alployecs (ftill andior pan -lime" U2, �iTed the sub-coi 1 arn a S.--dic propnetor OF padnci- Hs'Led, cn& aaached.. sheet, Ship and, have no unployces thxse sub-conuacturs have vvork-lng for rne in any capacity. wockcTs' collip, 111surailce 3 -EJ- I am a komeow-ne.- dlD'ir,,- all -,7,FoT-k Myse�F- IrNcl %,Vod�ers� Comp'. insurailce employees a -ad have workers, 5. We are a corporatilor, officus bave exer6sed 'mic-ir right of' , exeniption -,,cF YMGL 152, § 1 (4)7 aad we have no cmpioyccs, [IN9 woFkcrs' cornp. insurance i-equilFeek] 1, pe Of projiect 6 IF—1 j'4CV,1 Col-:tjUC�: Ll — IG-� 7�^ R e nr i -, d, c �i; Bu-'UnE add"' Electnica! ��pa:-,s o -i add i� ,3-0 Oth.-er 'Aiw Ia ip p!:. ciin i �hwl chcdks box :a! -)-,Ug aiso i-�D eui 03C b--Ic;,- showitig �Rcit woyk,�Fs' HQjllcmvncrS -vvjlc 5ublT.,2-" this af-lid-a-vill Oicy aie duirg DU v-rQFk aiid thu, h4c euLsidc cwwv--C�OTS Tllus� -�Ulniii a af,'-.duv�t thua clicck �his boN rnusz aaached an addilionu�� sheci Showing Ole nume of �Ilc sub-coiltvac2ors or nol 'hosc- ci,iployccs- 1 if dit: sub-coi-i-Ir-acioFs Inavc Cniployct-IS, Ilicy musi uTo-wildt 'OheilF. woFicers" comp. policy Fui-,bcc. 1 (un an efil),glove.- "hat is pww"iding niv fzfnployees� SetuFu Ts "he avuf fosujra�-,ce Company Nanne:_?anu—S Policy �E O�-L Self-In's. J'L�C� �'E: W C 9(P 3 7 7 2 7 Expninno n D,-,, -'e: 2- S - 2-01 ( job S:Aic Addres--: 62 `7 ME ci �,(/S ta �F I" z F2: MOOL.) L -AJ 7�, Al, 1-k-vdasK - Fal: 11 u-ic SCCU Te c o -v cil-age as req ul Fed., u nider S ecti on 25 A o FJ\4GL c� 3 52 lead to the 6c, n o c ri —a i pcnal 6 c _� �z; F fl ne Ui3 to S 1 -500.0.3 a q d/OT as vrcl 1 - S c iv, Pena �. 6 es 'ro o -ie foci—, , c a ST OP -',71 ORCK 0 B, EIR a� 6 a j5zt up to S250.00 a day against flic violatv-. Be aovised a cripy oF ihis staiei-nent nnav be �orvvc-,,7 cd to Office oF lllvcsti!.�atiens of th-e D.LA- for insurance covccaac vcrification- i do heref;v cer 6,je if,FuIcP- -�u' wk�- vi,,iehrd C.;b/,7T7,L' 15 v-Tr(z �, V u 6r, ff, 171 p ture: r—J, Q� cird ofu�,,;. Dg wi-4�: ;,-I- ichis aven, 1,'q br-, c(wl,,,.17,� ted by ck ty or i'o-iwn vfjUcird. City -.,i- Tu-�-r-,: -R 115SU'lig Authcrity (zircle ucile)- 1 . B o a rd. rA'i- f I ea 1 �L 2) B rLi i i d 9 sa g D e p. q R- mui e T, �C- lu�y -,Y, r�. C c R- I EE e c tr c E, 7..,, 5 7 c t u 5 P UL Fp-" 9 g 5 j-; z 7 - 6. 0 corlac" Person: a e Apr 09 08 12:58p 978-688-4098 p.2 i PATEINWw"m CERTIFICATE OF LIABILITY INSURANCE I 01/171mg AD=. - THIS CEgTjj-IcATE IS ISSUED AS A MATTER OF INFORMATION m0UCFX—(978)37Z-z790 FAx jLwrgj31 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Sullivan insurance Agency. 3MC- HOLDER. THIS CERTUICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAW AFFORDED BY lEpOLUMBELOW. 467 Groveland Street iiaverbi-01, M OigiO ImsuRERS AFFORDING cOVERAG E NA IC 0 wisuRERk Essex Insurance C=Veny 39020 's. Inc. INSURER & Trravelers Insurance t le FIE T ve r .4 IS3 Maple Street Methuen, MA OU44 INSURER f.� INSURER E: IN URANCE I BELOW HAVE BEEN ISSUED To THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NCTWITHSTANDING RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR CT OR OTHER DOCUMENT WITH ANY EQUIREMENT. TERM OR GONOMON OF ANY COMM IN IS SUBJECT TO ALL THE TERMS. EXCLUSIOW AND CONDITIONS OF SUCH THE INSURANCE AFFORDED By THE POUCiFS DESCRIBED HERE PERTAIN. POLICIES. AGGREGATE UfATS SHOWN MAY HAVE BEEN REDUCED Ely PAID CLAIMS - PO PMO EVIRAIM %9V jyPEOFMISURAFACE PIDUCYRUNISM no, IN 3CMW219 1AS/Z003 01/16/200 EAW OCCURRIMICE S GENIERAILLNUmily DAMAGE TO REMEQ $ SIDIN X C0mmERctALGeNERALLLA0LFTy FX -1 OCCU.R MEU EXP (Arvi on Pwma) 8 CLAIMS MADE PERSONAL&ADV"Ry 1.000.0( A GENERALAGGREGWE S __Z�Looc q[ PRODUCTS - COM PW AGG 11 11000.01 GEN' ATE UMIT kPPUES PER' X POLICY f --j Toy LOC COMSUM SINGLE I.Wrr AUT0100INUE LIASLffy ANYAUTO e0my INAAy S ALL OWKED AUTOS Iper perwn) SCHEDULED AUTOS somy1manty HIRFDAUrOS (p4pr neddeml WOR -OWNED AUTOS PROPERW DAMAOE $ (PeraxAmAI -EAACC1IQENT S CARA" L19ANJIV OTWER THAN EAAOC 5 ANY AUTO AUTO ONM AGO S EAcH OCCLNWNCE 5 EKCW=VWLLAUA8Lny F-1 CLARA KADE Aamwe S OCCUR S DEDUCME REmNrcm 8 VOOMMpS CORIPEPrATION AM 8111101010MIUMBL"y $my pROPMETOWAWTHER&I(JECUTNE OFFICIERMEIMER EXCLUDEW ON contractors excluded from Workers ConensatiOn Steeplechase Builders ACORD 251200111011) I � �-+- me aow 7 E.L SACH AC ClOt Ex. DISEASE - ZA E.L.OtSEASE-PO IMOULDAWCWTMAWn UMXMm POUCIIE9 BECANCELMBEFOARTM IMMA7M 0AjrEy"MWy.jW=WNG R=FIER WILL 11001EAVORTOPAUL _R_DAVSWNTfM RDnCIETq THECOMF"TENCLuM MWWTO THE LWf. gUT FAILURE '10 MAIL MKK 0110TICASHALL NPOK"OOSUGATMORUA131LITY OFANy MI) upcwTHE mumt ITS AGENTSORREPRIEIIIIENITATNES- THORMO REPRIMMATIMME I r 7::�- r--- VACORD CORPORATION 1111188 - '-I glow Date ...... 91. 0. ..... ........ ... .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. v ... ...................................... .... ...... has permission to perform ................ ;-:� ...... ...... ..... ............................. wiring in the building of ... ........................................ at . 7 . ............. . North Andover, Mass. .................. Fee -36 .. ......... Lic. No. ............... i� ..................... ............... Check # EcrRICAL INSPE (- . / 6 9 4 3 -0 Commonwealth of Massachusetts Official Use Only Pennit No. 3 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev- 11/991 (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: 17-0-1-061 City or Town of: AY'04-7W 4/v0V,'&'yL 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) 2-7 Owner or Tenant tw /t lc�q A-1 7-z- e-0 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes E] No [:] (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead El UndgrdE] New Service Amps Volts Overhead Undgrd Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: daq-� le* -172 49,0 No. of Meters No. of Meters Completion ofthefollowing table may be waived by the Inspector 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 M In- grnd. L -J rnd. No. of Emergency Lighting BatteEy Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I .......... J.K.W ........... ..... ...... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local Ei 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. Hydromassa2e Bathtubs s Total No. of Motor HP elecommunications Wiring: T No. of Devices or Equivalent OTHER: Attach additional detail ifdesired, or as required by the Inspector of Wires. 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 RI BOND El OTHER El (Specify:) (Expiration Date) Estimated Value of Electrical Work: 7(9 0,. 0 o - (When required by municipal policy.) WorktoStart: 9-71-06, Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties !f rJury, 0 that the information on this appliTtion is true and complete 4,6 FIRM NAME: 04�rY 1111'C- 1&2 7 -Vt1Z-7ZZ -/ A;�7ZV146T LIC. NO.: , 4L Licensee: 1L4ii<--&- Signatureom/i,:;?� LIC. NO.:.-?- 9973 t�'- (If applicable, enter "exempt " in the license number line) Bus. Tel. No.: Address: /40 _4X a7 IW2 �1'7 �� Alt. Tel. No.: 4 - " aL� Me) 0 2 - 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 Signature Telephone No. FPERMIT FEE: $ PqA,�,A Avk-4 This certifies that ��Q ...... ............... has permission to perform ........ plumbing in the buildings of".,.,) �� .. ........................ 7 a 7 .......... ......... North Andover, Mass. F e e L i c. N o,/-? e7 - 'e .............. '�'L'm BING INSPECTOR Check # 71 '15 Date. TOWN OF ATH ANDOVER PERF�IT,70R PLUMBING This certifies that ��Q ...... ............... has permission to perform ........ plumbing in the buildings of".,.,) �� .. ........................ 7 a 7 .......... ......... North Andover, Mass. F e e L i c. N o,/-? e7 - 'e .............. '�'L'm BING INSPECTOR Check # 71 '15 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETI-S Building Location Date Owners Name P\k) � �uo K) Permit Tyve of OccuDancv 1��v i i , . ( � �'i\ v-& � t . Amount New 1:3 Renovation Replacement SA Plans Submitted Yes No 0i (Print or type) Check one: Certificate Installing Company Name --M Q\Kko Corp. Address (7�1�y("'FNkj !�AA El Partner. Business I elephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicateth type of insurance coverage by checgn—g the appropriate box: Liability insurance policy 0 Other type of indemnity 11 Bond 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 Signature I Owner 11 Agent 1:1 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 �Ne Plumbing Code and Chapter 142 of the General Laws. By: - SE 4- SignalUre or Licenseci PlunTer Title Type of Plumbing License City/Town I -z- I j( -j APPROVED (OFFICE USE ONLY Mcense Murnrer Master Journeyman 10 OFA e 0 //,-1 �z Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING ....... ... This certifies that ..41111;k / ........................ ... has permission to perform ... ............................. wiring in the building of ................. ................. at i0j, J9. /I ...... . North Andover, Mass. Fee... ..... ............................................................... Check # ELECTRICAL INSPECTOR 5423 111C GommonwecZU12 01 Massachusetts NrIbic So. Department of Public Safety U,*c.1cV A. F.e Check.47��6 BOARD OF FIRE PREVENTION REGULATI NSS27CMR1= 3/90 tleave blank) APPLICATION FOR PERMIT TO�PERFORM ELECTRICAL WORK All vmrk to be performed In accordance with the'AaAachusens Electrical Code. 527 CMR 12:00 � i (PLEASE PRM IN INK OR TYPE ALL INFORHATi0k) Date City or Town of 1i,1),A11_- 414_c(d,1x--- V To the Inspector of Wires: - W. L The undersigned applies for a z --w j the electrical work described below. Location (Street & Number) , �) me-c(O-A) Owner or Tenant v--V\w Owner's Address C Is this permit in conjunction with a building permit: Yes 11 N3 (Check Appropriate Box) Purpose of Building Utilit� Authorization No. Existing Service AMP, 210, Volts Overhead Undgrd L7 No. o! MAters New Service Amps 2-0 Volts Overhead UndgrrdO No. of Meters Number of Feeders and Location and Nature of Proposed Electrical Work V &6 -.0 No. of Lighting Outlet1v No. of Hot Tubs No. of ransformers Total KVA No. of Lighting Fixtures Above In- Swimming Pool grnd. El grnd. 'Generators lCiA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Municipal Local 11 Connection1:10ther No. of Ranges Total lNo. of Air Cond. tons No. of Disposals Total Heat Total No. of Pumos Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers lHeating Devices KW No. of Water Heaters '(W No, of No. of Nizns Ballasts Low Voltage Wiring No. Hydro Massage Tubs I No. of Motors Total HP 1NSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws 1 bave a current 1;4_ibility Insurance ?olicy including Completed Opparati6rs Coverage or its substantial equivalent. YES g NO C] I have submitted valid proof of same to this office. YES Q No C] If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE Cg BOND [] OTHER 7 (Please Specify) Estimated Value of �lectrical Work S (Expiration Date) Work to Start S/xh(� Inspection Date Requested: Final I -itdv,,�, pena of perjury: Signed un the T 7 1161 /7/" -3?C( ItYIao Signature FIRM NA.. A LIC. NO. Licensee LIC. NO. Address I o Bus. Tel. No. el -Alt. Tel. No. OWNER I S INSURANCE WAIVER: 1 am a.re that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent)