HomeMy WebLinkAboutMiscellaneous - 273 MAIN STREET 4/30/2018CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 159 (9.3.2004) Date: November 1, 2005
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 273 Main Street
MAY BE OCCUPIED AS Complete Renovation - Sinale Family Dwellina IN
ACCORDANCE WITH THE PR VISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Map 11, Parcel 60
Cerfificate Issued tO: Frank & Rose Ann DiNuccio
273 Main Street
North Andover MA 0 1845
'�e tor
Bu ildiiTihis crz,4�
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 159 (9.3.2004) Date: November 1, 2005
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 273 Main Street
MAY BE OCCUPIED AS Complete Renovation - Sinde Family Dwelline IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Map 11, Parcel 60
Cerfificate IssuedtO: Frank & Rose Ann DiNuccio
273 Main Street
North Andover MA 0 1845
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Town of North Andover
Building Departinent
460 Osgood Street
North Andover MA 01845
978-688-9645 Fax 978-688-9542
o047
APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
ADDRESS/LOCATION OF PROPERTY: a73 m4mi �-r,
N A-�_[ 06 oc-4,
DATE REQUESTED FILED/READY FOR INSPECTION
CLOSING DATE ON PROPERTY:
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A
RE -INSPECTION FEE OF TWENTY DOLLARD $20.00) WILL BE CHARGED IF THE
STRUCTURE DOES NOT MEET ALL APPLICABLE CODES.
Signature
OFFICIAL USE ONLY
ROUTING
D.P.W. — WATER METER DATE
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
THE INSPECTION REQUEST DATE.
SIGNATURE/DPW AUTHORIZATION
APPLICATION CERTIRCATO OF OCCUPANCY MVMW 11 .15.2004
C,
BOARD OF FIRE PREVENTION REGULAT
(ALL WORK TO BE PERFORNM WrM
PLEASE PRINT IN INK OR TYP9-ALL INFORMATION
City or Town of: Al, - ANDOVER
By this application the undersigned gives -notice
Location: (Street &
Owner or
Owner's
(Rev. 11/99) For Office Use Only
Pennit Numlber:�_ %, 9 �F,
Occupancy & Fee— . --i i /M
ELEMUCAL CODE 527 CMR 12:00)
Date: 47�
F/ U/ I r 1 To the Inspector of Wires:
or Jer Iniention to perform the electrical work described below.
Is this permit in conjunction with a Building Permit? Yes li��No 0 (qheck Appropriate Box) .
Purpose of Bulldlng:,&61Z/
Utility Authorization #:
Existing Service: Amps Volts Overhead 11 Underground. 13 # of Meters
New Service: Amps
4&a. . /-;; a / ;.- olts
Number of Feeders and Ampaclty-
7
Location and Nature of Proposed Electrical
Overhead 0 Undergrc
of Meters:-
-1:2t P, V. -3
e r�;�
No. of Recessed Fixtures
No. of Call.-Susp. (Paddle) Fans
No. of Transformers Total KVA
No. Of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool: Above ground E3 In Ground m
# of Emergency Lighting Battery Units
No. of Receptacle Outlets
No. of Oil Burners
Fire Alarms
of Zones
# of Detection & Initiating Devices
# Of Sounding Devices:
No. of Switches rr-,� 671
No. of Gas Burners
# of Self Contained
Detection/ Sounding Devices
No. of Ranges
No. of Air Conditioners TOTAL TONS:
Local 13 Municipal Conne ction C) Other o
No. of Waste Disposals
Heat Pump Totals:
.
Security Systems:
Number. TONS: Kw:
No. of Devices or Equivalent
No. of Dishwashers
Space /Area Heating:_ KW
Data Wiring, No. of Devices or Equivalent:
Telecommunications Wiring: No of Devices or
No. of Dryers
Heating Appliances KW
Equivalent:
No. of Water Heaters KW
No. of Signs*._# of Ballasts:
OTHER; 4,9 Jh
L#of Hydro Massage Tubs
No. of Motors Total HP
I
la -Deaf.
—'— � vr-r%^uc; uniess walvea 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 01�-' BOND a OTHER c Please specify:
Estimated Value of Ele I ctdcal Work $ (When required by municipal policy)
Work to Start: & —
Inspections to be requested In accordance with MEC Rule 10, and upon completion.
ce under the pains and penalties of perjury, that the Information on this application is true and complete.
-D'. 6-2 1
Firm Name: --- 1!�� 12 Z --Z e6 'Z-2 9
V IL-- LIC.
Licensee: �u
(if applicable, enter **exempt- in the license number /IW.)
q-� n -
Address: Bus. Tel. # Ali. Tel. #
,""I Z2 A2 14 -)9"1
wyMCK-4 INCAUKANCE WAIVER: I fim 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 0 OR Agent a
Signature of Owner/Agent: Telephone #
PERIMT FEE: S
"I Office Use Only
Depa-Hment of Ppiublic 'ty
f
BOARD OF FIRE PREVENTION R VGATION S 527 CMR 12:00 Permit No.
Occupancy & Fee Checke
3190 (leave blank)
APPLICATION E
'r�MIT TO PERFORM ELECTRICAL WORK
All yz-rdance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL I N. N) Da e
Gitr-w Town of Z'/Iz
The undersigned applies for a per orm the electrical work described below. To the inspector of Wires:
--V
Location (Street �, Nu4ber)
Owner or fenant p
Imer's Address 4,
iis permit in conjunction with a building permit: Yes 1�41 No (Check Appropriate Box)
:)ose of Building 0/�� D."f /////� � Utility Authorization No. -1-3 4- 19
;ting Service - Amps �7 /— Volts Overhead Undgrd No. of Meters
Service —!!2 4 n Amps ( :;j 0 / ;2 s-/ 0 volts Overhead Undgrd No. of Meters
iber of Feeders and Ampacity
ttion and Nature. of Proposed Electrical Work A'Jw'� ip, waq),4 61kll-
10
lof Lighting Outlets
No. of Hot Tubs
TOTAL
No. of Transformers KVA
of Lighting Fixtures
A
Swimming Pool
Generators KVA
i
1 of Receptacle Outlets
No. of Oil Burners
No. of Emergency Li ting
Battery Units
:)f Switch Outlets
No. of Gas Bumers.
FIRE ALARMS No. of Zones
Total
Df Ranges
No. of Air Conditioners Tons
No. of Detection and
Initiating Devices
Heat Total Tot7a—
�f Disposals
No. or Pumps Tons KW
No. of Sounding Devices,
No. of Self Contained
f Dishwashers
Space/Area Heating KW
Detection/Sounding Devices.
Municipa I r-7
"Other
If Dryers
Heat �ing Devices KW
Lo call], Connection
No. , No. of
-
Low Voltage
f Water Heaters KW
Signs Ballasts
Wiring
ydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws
I have a current Liability I nsurance Policy including Completed Operations Coverage or its substantial equivalent. YES TAO 0 ! have submitted valid proof
of same to this office. YES [D�O 0
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE F—Y'-ROND D OTHERD (Please Specify)
Estimated Value of Electrical Work $
Work to Start /.2 - 2 - 0 �v Inspection Date Requested: Rough 2 Final
Signed under the penalties of perjury:
(Expiration Date)
FIRM NAME Iq ;00 LIC. NO. Z-7 J; 9 2 2'
Licensee -/'7P Signature
Address --/Z.. AOX-, A — LIC. NO.
,4em, Bus. Tel. No. C�
9
Alt. Tel. No.
OWNER'S INSURANCE WAIVER- I ;im;iwirp thatthp I icpnrpp dneq not have thp in�.Iirine-pr�v�,nap nr itc ciikct�nfiAl Pnfli-1—t— rpnisi-4 h%i
Date..!��7:,.�k.0.0 . . .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
...................
q ...........................
�has permission to perform. ....... I .... ele.-..��4.:L-,i., .... ...... ...................
wiring in the building of
......... ...................... . North Mdover, Mass.
Fee ....... Lic. No.��-M ............. 6/
E�EcrRICAL IMPEcrOR
Check # 9,f �2?
57-1 3,
1%
11M Lluivilyluiv VVrAWAJ7 Ur iV1t1a0V11-"L1JL�A I J
DE%fflMM0FPUBLrSAPM' Permit No.
REVEMO
BOAMOFFMP N Occupancy & Fees Ch . ecked
'0
APPUCATIONFORPERAff ELECMCAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE THEMASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 0 0-57
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover dl—�
The undersigned applies for a perrait to perform the
Location (Street & Number)
Owner or Tenant
owner's Address
described below.
S+ �
0
To the Inspector of Wires:
Is this permit in conjunction with a building permit: Yes F] No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead Underground 1:3 No. of Meters
New Service Amps_/ Volts Overhead =1 Underground=3 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Abov
[:3
Below
M
Generators
KVA
grouned
ground
No. of Receptacle Outlets
No. of OU Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local M-1 Municipal
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No.of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
C-1
Ja==C0vWW PW&WID the W4XMnff& Cf N1%Sad1l9M Cmaal Laws
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clrckirglhe*pERE��D
INSLRANCE F";�71 BOND r7 011AR M
q ErVakrdBmbjcalWuk$
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sgrledundAr
FIRMNANIE A14"?, Ik=No.
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BusiressTel.NoL q7F-T75---5'-9c/0
AIL Td No.
,swsURANCEWAIVER; fich
anddaffW§g)ancn&pmnkq4'kad*mwa'rAsdisMim�
(Please check one) Owner Agent
lelephone No. rrUtivul Mr,
signature of Owner Of Agent
A
wd
Date. C2
...............
110-N, TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that../R'... ..............
has permission for gas installation ..........
. . ...... ..
in the buildings of ......................
at
............. North Andover, Mass.
...........
FeA� Lic. No.?Z479.4.. -4,
�-' GAS 14W�TOR
Check #
5-b 3, 8
10
11/
MASSACHUSETIS UNNORM APPLICATON FOR PERNff TO DO GAS FTrrING
(Type or print)92-3 Date /0,2 10L
NORTH ANDOVER, MASSACHUSETTS I
Building Locations Permit # 025
Amount $ 7,
Owner's Name va nyj VC I N Q r -CA
Newd Renovation Replacement 1:1 Plans Submitted E]
(Print or typeb Check one: Certificate Installing Company
Name \Koa�x -ri om��P—kL 'A oo�--�- 14 M�-\— — 1:1 Corp.
0 Partner.
E] Finn/Co.
Name of Licensed Plumber or Gas Fitter 2(lyJAUN
INSURANCE COVERAGE Che4zkK oAe:
I have a current liability Insurance policy or it's substantial equivalent. YesLESL_, No[]
If you have checked yes, pleasAindicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 13 Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 0 Agent 0
I hereby certify that all of the details and intormation i nave SUMMElea
best of my knowledge and that all plumbing work and installations PeT
compliance with all pertinent provisions of the Massachusetts St)Xe"Ga
A
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
IN
IN
0
I III dlyk)Vr, dPF11tdL1V11 MU LJUV anu al,�utaL�, LU tll�,
-r Permit Issued for this application will be in
Chapter 142 of the General Laws.
Signature of Licensed Plumber Or C��itter
Plumber
Gas Fitter License Number
Master
Joumeyman
�SUB-BASEMENT
l'BASEM ENT
!IST. FLOOR
HZIMSI
4TH. FLOOR
5TH. FLOOR
'5-TH. FLOOR
1�
;8TH. FLOOR
(Print or typeb Check one: Certificate Installing Company
Name \Koa�x -ri om��P—kL 'A oo�--�- 14 M�-\— — 1:1 Corp.
0 Partner.
E] Finn/Co.
Name of Licensed Plumber or Gas Fitter 2(lyJAUN
INSURANCE COVERAGE Che4zkK oAe:
I have a current liability Insurance policy or it's substantial equivalent. YesLESL_, No[]
If you have checked yes, pleasAindicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 13 Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 0 Agent 0
I hereby certify that all of the details and intormation i nave SUMMElea
best of my knowledge and that all plumbing work and installations PeT
compliance with all pertinent provisions of the Massachusetts St)Xe"Ga
A
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
IN
IN
0
I III dlyk)Vr, dPF11tdL1V11 MU LJUV anu al,�utaL�, LU tll�,
-r Permit Issued for this application will be in
Chapter 142 of the General Laws.
Signature of Licensed Plumber Or C��itter
Plumber
Gas Fitter License Number
Master
Joumeyman
a
Date.. A0 q
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
P4 ... f7
This certifies that ........ ...............................
has permission to perform .. qltar ..... 14ATPI("A 44!�4? ...... ma(4015
wiring in the building of ..... /. /?,,,I h). K ...... 1. P ........................
at ......... 40 AK�g ..... :5.7 . ........................... . North Andover, Mass.
Feell..��... Lic. No. A
.10
Check # 44;,50* . ..
5452
(gattimanwraft4 of Maosar#usats
Deriartraent of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only
Permit No.
LOccupan:cy:& Fee CheckeR�& Ir
3190' bla2nk)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
1114 0-7 -
C+tr-w Town of
The undersigned applie-s
Location (Street & Number)
a pprgn4 to perform the
work clescribed below.
21 06 t
Owner or Tenant
- 69 1 C)
Owner's Address
To the Inspector of Wires:
Is this permit in conjunction with a building permit: Yes LLI' No Ll (Check Appropriate Box)
Purpose of Building 0 i'll 11141� .� —Utility Authorization No. -,:5 6� 0 S
Existing Service Amps Volts Overhead El Unclgrd No- of Meters
New Service
__2_dL0__Amps /:;�Q 0 Volts Overhead Undgrd LO No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work -,;;Lw 0
16
- P
No. of Lighting Outlets
No. of Hot Tubs
TOTAL
No. of Transformers KVA
t4o. of Lighting Fixtures
In-
Swimming Pool -nd . F]
Generators KVA
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Light5ng
Units
-Battery
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
Totar-
No. of Ranges
No. of Air Conditioners Tons
No. of Detection and
Initiating Devices
Heat Total I otal
No. of Disposals
No. of Pumps Tons KW
No. of Sounding Devices.
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices.
Municipal
DOther
No. of Dryers
Heating Devices KXIV
Local[:] Connection
No. of Water Heaters KW
No. of — —No.- _o7
Signs
Low Voltage
Ballasts
No. Hydro Massage Tubs
No. of Motors Total HP
-Wiring
OTHER
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES VNO 0 ! have submitted valid proof
of same to this office. YES WInO 0
If you have checked YES, please indicate the type of coverage by checking the appropr'iate box.
INSURANCE TeBOND El OTHERO (Please Specify)
Estimated Value of Electrical Work $ (Expiration Date)
Work to Start .. Z 2 - 21 - O!V
Signed under the penalties of perjury:
FIRM NAME __D; .rl 0
Inspection Date Requested:
tl,� V
Rough / V - ^2 - '0 !t Final
LIC. NO. -1-7Z929v
.Licensee , X 7-_� Z-) Jr., C2 Signature .. I 4.> LIC. NO.
Address 1Z Bu,. Tel. No.
Alt. Tel. No.
OWNER'S INSURANCE WAIVFR- I arnawarp. thitthp 1-irpn,;Pp does not have thp inqiirnnrP rnvPrn.. nr itihctnntiiI pnijix/al-t ac ranitirad 1- MnCC-kiocatt,
IDate ..... ...... . ....... .......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
14, -X--
.. .......
This certifies that ................... ............ ....................... .....
has,permission to perform ....... .............. �e .............
/I/u C C
wiring in the building of ....... . 0.17 . . ........................................................
I I
at ........... � 7
.;d5. .............................. I�orth Aildovpi4Mags.
Fee.,5T ............ Lic. No A�A0..� .............. .......
Check # >E E MiCAL�'I�SPECTQR
5318
BOARD OF FIRE PREVENTION REGULATIO
NS
APPLICAnOMN FOR MR -MIT TO PEI
(ALL WORK TO BE PERFORNM WrrH nM MASSACHUSE
PLEASE PRINT IN INK OR TYPE ALL INFORMATION
City or Townof: -
By this application
Location: (Street &
undersigned gives
(Rev. 11/99) For Office Use Only
permit Number____,Cf;.L rrr
Occupancy & Fee____13 �./&
CODE 527 CMR 12:00)
Date: /9 1,4
I-
I To the Inspectorof Wires:
of his or her Intention to perform the electrical work described below.
- , 14 f - — ;
Owner or T ' enant: -14L 7e, 1 10 L7 A; -
Owner's Address:
Is this'permit in conjunction with a BuIldin Permit? Yes ell"No (Check Appropriate Box)
Purpose of Building:
Atility Aut
horization #:
Existing Service: _Amps ---Volts Overhead D Underground.O. # of Meters
New Service: Amps__�_Volts Overhead 13 Underground.13 #,of Meters:
-.11 - -ol - — �
NuMber of Feeders and Ampacity:
Location and Nature of Propos'. ad Electrical Work:
No. of Recessed Fixtures
No. of Call.-Susp. (Paddle) Fans
No. of Transfo M Total KVA
No. Of Lighting Outlets'
No. of Hot Tubs
Ge�
Generators KVA
No. of Lighting Fixtures
Swimming Pool: Above ground n In Ground D
# of Emergency Lighting Battery Units
No. of Receptacle Outlets
No. of Oli Burners
Fire Alarms
of Zones
# of Detection & Initiating Devices
No. of Switches
No. of Gas Burners
#of Sounding Devices:
* of Self Contained
Detection/Sounding Devices
No. of Ranges
No. of Air Conditioners TOTAL TONS:
Lncai c Municipal Connection 0 Other o
No. of Waste Disposals
Heat Pump Totals:
Security systems:
Number TONS: KW.-
No. of Devices or Equivalent
No. of Dishwashers
Space /Area Heating: —KW
Data Wiring, No. of Devices or Equivalent
No. of Dryers
-Heating Appliances KW
Telecommunications Wiring: No of Devices or
Equivalent
No. of Water Heaters KW
No. of Signs.,_# of Ballasts:
OTHER;
# of Hydro Massage Tubs
No. of Motors Total HID
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 equi rd. The undersigned cartifies that such coverage is In force, and has exhibited proof Of same to the permit
issuing office. 'CHECK ONE: . INSURANCE nP*80ND 0 OTHER a Please specify:.
Estimated Value of Ele . ctrical Work $ (When required by municipal policy)
Work to
Firm
-0
Inspections to be requested in accordance with MEC Rule 10, and upon completion.
rJury, twhafth information On this application is true and . complete. - .7—
LAI
ature:
#
enter "ixempt'7ju the license number line)
Bus. Tel. #
Ali. Tel.#
OWNER'S INSURANCE WA—IVER: I am aware that the Licensee does not hava thA li;khllftV innilmn-i ........
Date.. Y7 e— 6L�—
........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... ......... ......................
...... .... ........... ... . ....... ................
has permission to perform ........ kew..Se:7 ........
I -
wiring in the building of ... 77.��7� .......... ..........
at ........... r ..... 0 ............ ...... ................. . North Andover, Mass.
Fee 40—.. Lic. Noll5je. 2.1 ........... 4196x�� ....... �..
Check # ELEcrRICAL INSPEC"TOR.
BOARD OF FIRE PREVENTION REGULAT
(ALL WORK TO BE PWORM
PLEASE PRINT IN INK OR TYPE ALL INFORMATION
City or Town of: . IV, - ANDOVER
By this application the undersigned gives notice of hii1or
Location: (Street & N.umber)_ ;2
Owner or Tenant
Owner's Ad dress:
For Office Use Only
(Rev. 11/99)
Permit Number: 1Z, �, 52,
Occupancy &
ELEMUCAL CODE 527 CMR 12:00)
Date:_�
I To the. Inspectorof Wires:
tion to perform the electrical work described below.
Is this permit in conjunction with a Building Permit? Yes ii��No C3 Pheck Appropriate Box)
Purpose of Building:-,�., �-41;717�VO Utility Authorization
Existing Service: —Amps —Volts Overhead Q Underground.0. # of Meters
New Service: A00 Amps/ Vol
;P J7 1 -2 4e a ts
Number of Feeders and Ampacity:
Location and Nature of Proposed Electrical
Overhead El Underground. #of Meters:—
g(p, V. F, 3 - 0 44
C T -le. � A I A- , fL,:r-�21,zi-
WG e-..,
No. of Recessed Fixtures
No. of Cell.-Susp. (Paddle) Fans
No. of Transformers Total KVA
No. Of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool: Above ground o In Ground o
# of Emergency Lighting Battery UnIts
No. of Receptacle Outlets
2 coo
No. of Oil Burners
Fire Alarms of Zones
# of Detection & Initiating Devices
# of Sounding Devices:
# of Self Contained
Detection/Sounding Devices
Local c Municipal Connection in Other o
No. of Switches
No. of Gas Burners.
No. of Ranges
No. ofAirCondItIoners TOTAL TONS:
No. of Waste Disposals
Heat Pump Totals:
Number: TONS: KW:—
Security Systems:
No. of Devices or Equivalent
No. of Dishwashers
Space /Area Heating:_ KW
Date Wiring, No. of Devices or Equivalent:
No. of Dryers
Hsating Appliances KW
Tsiecommunications Wiring: No of Devices or
Equivalent:
No. of Water Hee�ters KW
No. of Signs: of Ballasts:
THER;
L# of Hydro Massage Tubs
No. of Motors— Total HP
-D e a
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue I 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 d--' BOND 0 OTHER o Please specify:
Estimated Value of Electrical Work $ (When required by municipal policy)
Work to Start---4� Inspections to be requested In accordance With MEC Rule 10, and upon completion.
Fir . m Name: 7z); 1 certflj4 under the pains and penalties ofperjury, that the information on this application is true and . complete.
LIC. # 9
Licensee: (-Ae,12-10 Q LIC. #
Address:-YZ-2!F� ek (if applicable, enter "exempt" in the license number line)
Bus. Tel. # Aft. Tel. #
UVVNhK',5 INSURANCE WAIVER: I Sm 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 r3 OR Agent o
Signature of Owner/Agent: Telephone #
PFRNUT FEE: S
3L)) Date. ----------
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATIONN.
CU
This certifies that
.............
has permission for gas installation ...................
CU
Zdz ....................
in the buildings of ..(., " '. .
at .1 ......... h Andover, Mass.
Fee. .... Lic. No.'A spEcTJR.� ........
G PIN
WHITE: Applicant CANARY: Buildin opt. PINK: Treasurer
MASSACHUSETTS UNIFORM APP . UCATION FOR PERM -IT TO DO GASFITTING 0)
(Print or Type)
4�,l 1-0 J 2-� -. Mass. DateA/dl) 9 2-19 Permit # -3 0A I
Building LocaRo-ILNj
ja�-
�� s + (da a14 "A Az A W-0
_Owner's Name
/\J, A11J-0,1Qv1- MA _Type of Occupancy--RE5i -i--')Clv 7-,, iq L --
New [] Renovation 0 Replacement Plans Submitted: Yes[] No [3
Installing Company Name T �Im AIA TI') �0 Check one: Certificate
Address 30 0DA(H/y%,,At1J i -N[. 0 Corporation
E. 7 H Ue rQ ol t-1 01?j�j 0 Partnership
Business Telephone 2- - '7 (7 -7 1 2-Firm/Co.
Name of Ucensed Plumber or Gas Fitter -'RoAF-P-'F A f)AmmdzAec-�
INSURANCE COVERAGE:
I have a currentjabillty Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes b,?' No El
If you have checked Yes, please Indicate the type coverage by checking the appropriate box
liability insurance policy 01", Other type of Indemnity 0 Bond F-1
OWNER'S INSURANCE WAIVER: I am aware that the licensee ' does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner[] Agent 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 all plumbing work and installations performed under the pe i2ed for this application . be in compliance with all
f tl?
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 o Laws
By of L cense:
f U
T%
Plumber 1,WhAture of Licensed Plurnmr-or Gas Fitter
Title 1, tter
er Ucense Number
City/Town Journeyman
APPROVED (OFFICE USE ONLY)
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0
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0
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03
LocationA(09 MwIp') Srr�-
No. Date
TOWN OF NORTH ANDOVER
+��gz Certificate of Occupancy $
04)
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee s
TOTAL s
Check # / c, A
btlexte i LC kj A, d -H
6/0,ok 4. Tkusll do.,
i 7 6 u 5
I�i)
"Building'inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUMDING PERMIT NUMBER: DATE ISSUED -
SIGNATURE: or
Alo -A
Building Commissioner/I of Buildings Dafe
SECTION I- SITE INFORMATAON
1. 1 Property Address: 11
1.2 Assessors &-�ap and Parcel Number:
01
�j AW
Map Number Pared Number
1.3 Zoning Information:
f— �
1.4 Property Dimensions:
Zoning DisbAct Proposed Use
Lot Area (sf) Frontage (ft)
1.6 BUnDING SETBACKS (ft) I .
Front YaTd Side Yard Rear Yard
Required Provide Required _+ Provided Reqtfired Provided
Z.,� 1.5. Flood Zone Information:
_ 7, m �S� 1.9
�7: 54) Sewersp Dispossl System
0 zone Outside Flood Zone M"I -�X On Site D*md System 0
SEC11OR,,2.- P�QfERTY OWNERSY11PIAUTHORIZED AGENT,
2.1 Owner of Record
C e- It ac m W/// sr
.60W'LA
Name (Print) s for Service:
Telephone
2.2 Owner of Record:
Name Print Address for Se vice:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVI
3.1 Licensed Construction Supervisor:
Not Applicable
J-064
Licensed Construction Supervisor:.
License Number
Add
Expiration Ilate
Si natu Telephone
3.2 Registered Home Improvement Contractor
Not Applicable
(; fi W -fro
Company Name
r'7�
Registration Number
;�ddre'
q7 f(;
ExpiratiodDate
Si na Telephow
01
41
.10
MEN
n
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2
rl
W;
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r
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rss'
r's'
010000
z
G)
SECTION 4 - WORKERS COMPENSATION (XG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will
in the denial of the issuance of the buiWing permit
Signed affidavit Attached Yes .... :�.. L N o ....... 0
SECTION 5 Description o Pr6pose-WVork (Cheeck oppOcable)
New Construction 0 Existing Building P" Repair(s) 0 Alterations(s) gr Addition
Y. I — . . I
Accessory Bldg. 0 Demolition 0 Other 0 Specif�
Brief Description of Proposed Work:
C 04 XTA V-7- RN H Z7 0 N Jb- 14"7-1�4 h 0 LUC
I StRrTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
Completed y permit applicant
OMCL4J, USE ONLY
I .
Building
(a) Building Permit Fee
Multiplier
2
Electrical
'a'd
(b) Estimated Total Cost of
Construction
3
Plumbing
4CX
Building Permit fee (a) x (b)
C-4 0
1
4 Mechamcal (HVAC)
5 Fire Protection Nec~.
Ob 0 6 Total (1+2+3+4+5) 1 t3l q-' & (3 () % AM771 CheckNurnber /fair 01+95to
SECTION 7a OWNE )RIZATION TO BE COMPLETED WHEN XA.%J9r�*L(. /, jUrif
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT lbowK d
A
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relati�,e to work authorized by this building permit application.
Signature of Owner Date
QW.VTinN 7h 0WNVR/A1TTH0R17Xn AGRNT nFrIARATION
1, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Si ature of Owner/Agent Date
NO. OF STORIES 42 SIZE 4VO 6
BASENENT OR SLAB i0AS-eWmr- ND
SIZE OF FLOOR TNMERS INI 2 31u)
SPAN
DDAENSIONS OF SILLS
DRAENSIONS OF POSTS
DM4ENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHD&4EY
IS BUILDIN ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NAUJRAL GAS LINE
A
SITE PLAN
401 SOUTH BROADWAY LAWRENCE, MA 01843-3522 TEL:(978) 837-3335 FAX:(978) 837-3336
RICHARDSON LANE
20.06-' -
110.00
9 8'
co 9Q-
lp�OPOSED I STORY
WOOD ADDITION
',/—'/77-7�7777
1111,2 STY WOO
2691
4Lk [PROPOSED
ADDITION
icy)
i -Q
jc� ic)
i i lz�
i
130.90'
MAIN STREET
01-'*5—tlwR OF
�*71CA
I A Rjl�V,
CY A';�
PREPARED FOR: FRANCIS L. DINUCCIO PLAN REF: #28137A
269 MAIN STREET CT. #4644 BK 31, PC 377
NORTH ANDOVER, MA SCALE: I"=40'
DATE: SEPT. 1, 2004
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 or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
/1_71 411
APPLICANT OINJUCC—irJ '1PHONE979-699-0079-
LOCATION: Assessor's Map Number t0 a& 6 PARCEL 00 00
SUBDIVISION LOT (S)
I/ STREET—miq IN(Smee ST. NUMBER_016f
I'"OFFICIAL USE ONLY**********************
I RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
V/
DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
5( -PUBLIC WORKS - SEWERIWATER CONNECTIONS
X DRIVEWAY PERMIT A/
FIRE DEPARTMENT 2ZI 1,161 �&kALL
f
RECEIVED BY BUILDING INSPECTOR V1=1
f,r-PATE
Revised 9197 jm VC 0 2 -TO -04
BUILDING DEPT,
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111 -
Workers'Compensation Insurance Affidavit
FN—ame Please Print
Name:
Location:
am a libmie-owh4r-p-erficirming all v�o�k in yself.
F-1 I am a sole proprietor and have no one working in any capacity
r-171 I am an employer providing workers' compensation for my employees working on this job.
L.( -\-i
Company name: CZ &J
I U f- 0 1A.An,
Address
4A) P1 W25�' -TT
Cily: A)Q, A- 0 J FJZ 0 Phone #:
I
Insurance Co. Policv #
Compan name: Cr
Address
Ci1y: Phone #:
Insurance Co. Policv # &.,C- 78a ff 0 0
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00
and/or one years' imprisonment -as -well-as -civil.penalties in -the Iffmofa.STOP.W.ORK..ORDJER,.an.d..a.fined ($1 0-0.00.)-aday against -me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify un4er7h'apains and penalties of peilury that the information provided above is true and correct.
Print
Cifficial use only do not write in this area to be completed by city or town official' N
City or Town Permit/Licensing
Building Dept
[]Check if immediate response is required 11 Licensing Board
Selectman's Office
Contact person: Phone A, F-1 Health Department
o Other
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 022988
Birthdate: 10/31/1943
EXPIrss: 10/3112005 Tr.no: 6077
Restricted: 00
JOHN GRASSO
865 TURNPIKE ST
NOANDOVER, MA 01845
Administrator
11
Board Of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 113130
EXPIration: 5/18/2005
Type: Private COrPoration
GRASSO CONSTRUCTION Co., I
ZHN GRASSO
865 TURNPIKE ST
N. ANDOVER, MA 01845
0
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number I !" is that the debris resulting from this work shall be
disposed of in a l5roperly licensed solid. waste disposal facility as defined by MGL
c 11, S 150 A.
The debris will be disposed of in: t 0 M P,5-16 K
o9A 9 14 A / PJ —0, --r— /Uo
(Location of Facility)
.—qg na—�A
nature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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Location A4,;
d No. C:) 0 -X -,
Date -:Ti-, (3/
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
A C, Building/Frame Permit Fee $
Foundation Permit Fee $
7 -
Other Permit Fee -,)e�o s ; 2-->
TOTAL s 3n�,
Check # 3 g
17 4,-)- 4
VWidind-ITfs'pector
A
TOWN OF NORTH ANDOVER
I BUILDING DEPARTMENT I
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
4,
MIR" ftr
BUILDING PERMIT 07BE'R: -i)a44..
I DATE ISSUED:
Tu
SIGNATURE: 46, - I& a "!n6u.
Building Commissio=42EeEtor of Buildings Date
SECTION I- SITE INFORMATION I
I Property Address:
1.2 Ass;essors Map and Parcel Number:
(9c
03/ 0
Map-'Ku-mber Parcel Number
P* I V)
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
I Lot At- (sf) Fromage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Required
Provided
1.7 Water SuW�ppl�yM.G.L.C.40. 54)
Public 0 Prrvate 0 Zone
1.5. Flood Zone Information:
Outside Flood Zone 0
1.8 Sewerage Disposal System:
mut�cipal 0 On Site Dispo:s!l Syszem
, 0 1
SECTION 2 - PROPERTY OWNERSHW/AUTHORIZED AGENT !Ci,
2.1 Owner of Record
Name (Print Address for Service
SL 0-7
SigAture Telephone
2.2 Owner of Record:
Name Print
Address for Service:
�3jv,�- A 1%fll X - A X%U%, A X%X11 1
3.1 Licensed Construction Supervisor: Not Applicable 0
- -j -0 a?) . a R $a
Licensed Construction Supervisor: �22 9 Rtq
icense NumKeF
A)-
Addren 011-
/ 0 /0 I -IS
(OL Expiration Da#
Signaitire 978-4bc)-OW
Telephone
3.2 Register HotTM Improvement Contractor
(�;a)4559c, Ca -1
Company 14ame
Bar
Add
7��L
Not Applicable 0
Registration Number
- - <- / o -�-
Expiration Date(
f 0 - .'
SECTION 4 - WORKERS COMPENSATION (KG.L C 152 § 2!
Workers Compensation Insurance affidavit must be completed and submitted
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... 0 No ... ... 0
SECTION 5 Description of Proposed Work (check all applicable)
New Construction 0 1 Existing Building 0 1 Repair(s) 0
with this application. Failure to provide this affidavit will result
Alterations(s) 0 1 Addition 0
Accessory Bldg. 0 Demolition Other 11 Specify -
Brief Description of Proposed Work:
R-Ieptt 0-c- Iq LL SI -e C7-- J?6 CA - MJqffVW 4 UV /52r>0 ffj_
C-�LL
41V
S.RCTION 6 - FRTIMATM VnN-�T-Q1TCT1nN MQTQ
Item
Estimated Cost (Dollar) to be
Completed y permit applicant
OFFICIAL USE ONLY
I Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
7o
4 Mechanical (HVAC)
5 Fire Protection
.6 Total (1+2+3+4+5)
CheckNumber I ,
ar,%-JLJL%J1'4 /H UWALK AU InumtZA]LIUM 1U BE UUMPLEYND WHEN
OWNERS AGENT OR QQNTRACTOR APPLIES FOR BUILDING PERMIT
as Owc,/Aulho'rized Agent of subject property
Hereby authorize to act on
all rn c ive to work authorized by this building permit application.
Si6aturi"of Owner Date
r SECTION 7b OWNERJAUTHORIZED AGENT DECLARATION
1, 71—'o 14 Yq as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
0
Print Name,
Date
NO. OF STORIES SIZE
BASENIENT OR SLAB
SIZE OF FLOORTINMERS I ST 2 ND 3Fw
SPAN
DDAENSIONS OF SILLS
DII,�IENSIONS OF POSTS
D12VENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHRANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
a
k
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
f7ame Please Print
Name: f� 14 2 -
Location:
Citv N Phone # 7 91 -7 2;1� -'?A,�
F-1 I am a homeowner performing all work myself.
CK-� I am a sole proprietor and have no one working in any capacity
F1I am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
Cily: Phone #:
Insurance Co. Policv #
Companyname:
41 Address
illo A1011 k6p—
Cily: Ne, H-1\1 vme< Phone#:
STh--17�r /pt/,g Co policv# LA.) C ? g,�p Y YaO
Failure to secure coverage as required under Section 25A or IVIGL 152 can lead to the imposition of criminal penalties af,a fine up to $1,500.00
and/or one years' imprisonment -as -wefl-as-civil..penaltiesin _ffie fffm -of -a.-STOP -W-ORK.ORDER..and..a.fine.of..(.$100..00.)-a Aay against -me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and
I J
Signature
P r i n t n a V 6
1?19z.
of peijury !#at the information provided above is true and correct.
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
E]Check if immediate response is required
Contact person:
o 7 9 1 -7
LJ
Building Dept
0
Licensing Board
r-1
Selectman's Office
F�
Health Department
F-1
Other
A.CORDTMCERTIFICATE OF LIABILITY INSURANCE
DATE (MMDDYY)
1 06/29/04
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INSR1
LTR
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ribeiro-DeSousa Insurance Agency
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1092 Cambridge Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
A
Cambridge, MA 02139
INSURERS AFFORDING COVERAGE
INSURED
INSURER A,Penn-America
Jose Braz
FIRE DAMAGE (Any one fire) 50,000
DBA Demolition Joe
INSURER B'
102 Bowman Street
INSURER C*
M ED EXP (Any one person) 5,000
Malden, MA 02148
INSURER D'
INSURER E,
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT TERM OR CONDITION OF ANY CONTACT 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR1
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
DATE IMMIDDNY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
PAC6367224
03/05/04
03/05105
EACH OCCURRENCE 1,000,000
FIRE DAMAGE (Any one fire) 50,000
CLAIMS MADE 7 OCCUR
M ED EXP (Any one person) 5,000
PERSONAL & ADV INJURY 1,ob 000
GENERAL AGGREGATE 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG 1,000,000
PJRE06T
F1P0LICYF_1 F-1 LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) $
BODILY INJURY
(Per person) $
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident) $
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESS LIABILITY
EACH OCCURRENCE $
AGGREGATE $
OCCUR CLAIMS MADE
S
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TWC STATU- T H -
CRY LIM TS DER
E.L. EACH ACCIDENT $
E.L DISEASE - EA EMPLOYEE $
E.L. DISEASE- POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
-1. 11 1- " . AUDI I IONAL INSURFU: INSURER LETTER: 1LANLr_LL,1k I IUN
Town of Andover, MA
Ar'non �= C `7107%
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERT�IF� H BI �TR NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATI Y OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVE R`�= :;:) 4 4,
AUTHORIZED REPRE*fNTAjVt X // //�,ff
��"rum� I lulm I WOO
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 022988
A Birthdate: 10/31/1943
Expires: 1013112005 Tr.no: 6077
Restricted: 00
JOHN GRASSO
865 TURNPIKE ST Z�— —e4all
NOANDOVER, MA 01845 Administrator
Board Of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
u,p Registration: 113130
=xpirailon: 5/18/2005
Type: Private Corporation
GRASSO CONSTRUCTION CO., I
!)UHN GRASSO
865 TURNPIKE ST
N. ANDOVER, MA 01845
Administrator
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number 6)&
is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
The debris will be disposed of in:
/Oc��eo-t 7'�qmr,)lKe �WCW A114 6/90eC
(Location of Facility)
L",
Sionature bf Permit Applicant
7 - 1-6
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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Location
No. Date
jORTh TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 33 - 00
Foundation Permit Fee $
MU
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee
TOTAL
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