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Home My WebLink AboutMiscellaneous - 291 MIDDLESEX STREET 4/30/20180 0 — 0 0 r— gm I C/) cp M X C, --j ;o m 0 m L Location No. -c2,58. Date It T 41 TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ cx2 Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 3'187 06/15/99 14:37 25.00 PAID Div. Public Works 0 o"I C) GO 101 -IN > Cfj EA Z; r7 Co rl, L51 rl. C� I:z CP 2 -r �11 cr 0 0 m cn rn cn "I (n r, > n 0 n 0 'n 0 0 2 T n z 2 7 Z z C4 = z w V) rn n M n Cll w cn cn lo Ul 0 o"I C) GO 101 -IN 0 Town of North Andover CIMCE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 0 1845 WILLIAM J. SCOTT Director (978) 688-9531 tkoRTN 11 1� 6 0 0 0 cl Fax (978) 688-9542 In accordance with the provisions of IVIGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by IVIGL c 11, S 150 A. The debris will be disposed of in: lelqLs � Pt 11 (Location of Facility) Signatu 3, 9� Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project throug-h the Office of the Building Inspector BOARD OF APPEALS 688-9541 BULDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PL.4-NINING 688-9535 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Pen - U, 1;Uli ( CijY J'-JG--�T Phone F1I am a homeowner performing all work myself. 71 1 am a sole proprietor and have no one working in any capacity F/7 I am an employer providing workers' compensation for my employees working on thisjob. Company name: -� e a A -I - M041,lu Co k)V�-Vdlo t/ Address ql(' ST Cily: AM Odd bl ee— Ac, S- Phone #: c/o 7 insurance Co. Poligy # Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to. $1,500.00 and/or one years' imprisonment as well.as.civil.penaltiesin the form -of a STOP WORK ORDER.and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify underAq pains and penalties of Print -2 that the intbn�ation provided above is true and correct. I � a Date Phone 40 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing F�Check if immediate response is required Contact person: Phone Building Dept Licensing Board El Selectman's Office E] Health Department F1 Other UBLIC SAFETY DEPARKHT Of P CONSTRUCTION SUPERVISOR LICENSE Expires: Birthdate: CS 12/11/1950 Restricted To: 00 JEAN N KORIN 4$t,,tA55 FOREST ST . No ANDOVER, �hA 01845. ROME IMPROVEMENT CbflTRACTOR Registration 115194 X Type - INDIVIDUAL Expiration 01/03/00 MORIN CONSTRUCTION CORP JEAN N. MORIN FOREST ST NORTH ANDOVER MA 01845 Jun -10-99 03:02P A&K FOWLER INS. AGENCY ACOMD- PRODUCER A & K FOWLER INSURANCE AGENCY 200 PARK ST. NORTH READING, MA 01864 (508) 664-0366 FAX: 664-2209 JEAN MORIN JEAN MORIN CONSTRUCTION 895 FORREST ST NORTH ANDOVER, MA 01845 978 664 2209 P.01 DATE (MMIDOfM 6/10/99 T1415 CEFrriFICATE IS ISSUED AS AMATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY'THE POLICIES BELOW. COMPANIESAF—F—;�RDL NO COVERAGE COMPANY A ZURICH INSURAIqCE COMPANY COMPANY 8 SAVERS PROPERTY-&- CASUALTY -- COMPANY c COMPANY D p: THIS IS To CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. CO LTA TYPE OF INSURANCE POLICYNUMBER POUCVEFFECTIVE POLM VEXPIRATI07N DATE (MMIDONY) DATE (MMeDolyy) LIMITS LI GENERALLIABILITY L�ENERAL AGGREGATE s 2 0 0 0 , 0 0 0 X COMMERCIAL GENERAL LIABILITY PRODUCTS - C,70MPIOPAG-G s2 0 0 0, 0 0 0 CLAIMS IVADE I X I OCCJR PERSONAL & AOV INJURY $1 000,00 -- — — i - 0 OWNER'S& CONTRACTOR'S PROT SCP34180415 12/2/98 12/2/99 EACH OCCURRENCE $1, 000 000 —H owl 'ESCRIPTION OF OPEMT]ONSILOCArIONS/vEmICLES/SpECL4L ITEMS INSURANCE VERIFICATION TOWN OF NORTH ANDOVER FAX 978-989-9925 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I.Q— DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE $HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TH COMPANY, ITS AGENTS OR REPRnEkTAMUM. FIR�MMi�3E (Any one fim) s MED EXP (Any one AUTOMO ILE LIABILITY persor.) 3 ANY AUTO OMBJNEDSINGLE LIMIT $ ALL OWNED AU70S SCHEDULED AUTOS 13OUILY INJURY $ HIRED AUTOS NON -OWNEDAUTOS BODILY NJUR (Per acoident) Y $ PROPERTY DAMAGE RAGE LIAGILM ANY AUTO AUTO ONLY - EA ACCIDENT $ -OTHER THAN AUTO ON�� EACH ACCIDENT S EXCESS UABILITY AGGREGATE 5 UMBRELLA FORM EACH OCCURRENCE AGGREGATE OTHER THAN UMBRELLA FORM I WORKERS COMPENSATION AND AND I-WCSTArU I -TOTH-i T Limi 1 EMPLOYERS' UABILI TY B THE PROPRIETOR/ F—I,NCL PARTNERS11EXECUP'VE AR0000509 12/14/98 12/14/99 EL EACH A CiDENT $100,000 �EL OFFICERS ARE- EXCL, DISEASE - POLICY LIMIT $500,000 -.--± _ 5- --73t—"ER— r R MlZrAap- "EMPLOYEE 1 $10 0 00 0 'ESCRIPTION OF OPEMT]ONSILOCArIONS/vEmICLES/SpECL4L ITEMS INSURANCE VERIFICATION TOWN OF NORTH ANDOVER FAX 978-989-9925 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I.Q— DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE $HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TH COMPANY, ITS AGENTS OR REPRnEkTAMUM. el"! s 01 rA rb Aa. cc M6 :2 CL. CLC m m CD CO CE CD.e CL E E cm (D.c C9 ca CA cc 04N.Ak.0 CLL3 mo D C>D �:s = S A CD . C., z M> 0 t5 CL 2 cc) 0 a) = 0 CL� CO) 4- 4, .2 .0 =CD MD Go ui E ca .0 o w L- Q w !E cm LD CD Q -0 CO) CL C.S C, CL 0 -4 U u u u z w w w COD CD CIO CD CL E co CD CL M r CIO co 0 cc ZL m CO) C/) Q CIO cm Cia cc h- C2 U6 01 cm C%3 IS z cd ZI cz cz Z) cz 0 u x 0 E cf) V) Aa. cc M6 :2 CL. CLC m m CD CO CE CD.e CL E E cm (D.c C9 ca CA cc 04N.Ak.0 CLL3 mo D C>D �:s = S A CD . C., z M> 0 t5 CL 2 cc) 0 a) = 0 CL� CO) 4- 4, .2 .0 =CD MD Go ui E ca .0 o w L- Q w !E cm LD CD Q -0 CO) CL C.S C, CL La CD C3 ,-.. 2 :10 40� L 0 4-0 C.) CD CL CO) (D co 0 CD co CL 0 CL Cc OCO CD CL CO) m A w 0 CO w U) m w w Ir w w U) 0 -4 U to z COD CD CIO CD CL E co CD CL M r CIO co 0 cc ZL m CO) C/) Q CIO cm Cia cc h- C2 U6 01 cm C%3 La CD C3 ,-.. 2 :10 40� L 0 4-0 C.) CD CL CO) (D co 0 CD co CL 0 CL Cc OCO CD CL CO) m A w 0 CO w U) m w w Ir w w U) k a 1 4 Date ... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................... ;': ............................................................ has permission to perform---, ............................................................................... wiring in the building of Z ....... .. .................................................. .- Z at ..... t/ // , ........................................ .... 7 ...... I ..................... . North Andover, Mass. Fee ..................... Lic. No. ............ Check # INSP ECTOR k ! V 01 Department of Vublic �$afetU Office Use Oni Permit No. Occupancy & Fee Checked 4 0 1 15 3/96 (leave blank) Ward BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Area 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 7J y3J,,2_003 I City or Town of Ael du ytr To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. A'f ri C() -v Location (Street & Numbe leter S*Tol- Floor rq Owner or Tenant 80 Te 1. N o. A,/ Owner's Address Is this permit in conjunction with a building permit: Yes El No 9 (Check Appropriate Box) 011. '1 v,6 weth' Utility Authorization No. Purpose of Building j2!� rml 119 Existing Service /0 0 Amps Z2_0J 2 )(0 Volts Overhead Undgrnd New Service 7410 Amps /—?P--/ Z -V03 Volts Overhead ER U.ndgrnd El Number of Feeders and Ampacity /Wo Location and Nature ofProposed Electrical Work Q /t2v, /Ylvt e"I -/�,S - No. of Meters Z-,' No. of Meters 17 " d a Le C, a V1 No. of Lighting Outlets No. of Hot Tubs Total No. of Transformers KVA No. of Lighting Fixtures -L 0 Swimming Pool Above grnd. 0 In gr'nd. El Generators KVA No. of Emergency Lighting No. of Receptacle Outlets &0 No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges C_" No. of Air Cond, Total tons Initiating Devices No. of Disposals No. of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained /(L? If-roko C�e,) No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices 12 - Local I . Municipal F .9 Connection DOther No. of Dryers 0- Glew Heating Devices KW 7— N N 0. Low Voltage No. of Water Heaters Siognof Ballaosts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy includ- ing Completed Operations Coverage or its substantial equivalent. YES X NO 0 1 have submitted valid proof of same to the Office. YES E) NO If you have checkod YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND 0 OTHER 0 (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ Work to Start. Inspection Date Requested: Rough Caiaqw Final AV/611// Signed under the Penalties of Perjury: ' III C L I C. N 0. 10 FIRM NAME &9 e c/n (a Licensee hm T—rovo vbo Signatur LIC. NOA/(r/,9 A V V Address '9X C-4-) e, J c9l 50 7, Bus. Te i. No, (n!�e si Alt. Te . No. XE& V1 OWNER'S INSURANCE WAIVER: I arn awa�re that the Lic'ensee does not have the Insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit I application waives this requireme nt. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Ovmc�r or Agent) Notify Inspector lor rough and/or linal inspeciion, Permit must be obtained before commencing any, and all work in compliance with G.L.C. 141 & all applica- ble laws & ordinances is required and undofsicod. X-6796 _kA COMMONWEALTH OF SSACHUSETT OF ELECTRICIANS AS A REG JOURNEYMAN ELECTRICI ISSUES THIS LICENSE TO JOHN J GAROFALO 10 MID IRON,DRI-VE NO READI,.Ng MA 01864-3401 1 22436 E 07/31/04 349570 C ETTS COMMONWEALTH OF MASSA H DIVISION OF PROFESWNAIL LICENSURE OF ELECTRICIANS �REGISTERED MASTER ELECTRICIAN ISSUES THIS LICENSE TO COLANTUNO ELECTRICAL CO INC 1� JN— JOHN J GAROFALO 32 ERIE ST LYNN MA 019027196 16861 A 07/31/04 38ZB32 (781) 595-2600 Fax (781) 595-'3970, JJG@colantunoclec'coinc.com Colantuno Electrical Co., Inc. Electrical Contractors John Q�rofaio 32 Erie Street Ly�nn, MA 01902 President Date. A-.11-7.' aj - - TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ............ This certifies that ..... ....... has permission to plumbing in the buildings of ..... 7 .......... at. ...... N h Andover, Mass. FeeX-)O. Lic. No .......... ?-�--�P �/ING I*NS*P*E'C'T'O'R' Check # 5625 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS 6-5--o3 Date Building Location c2ql MI,0165CY51— OwnersName zgo� r- C -TQ 10 Permit # Type of Occupancy - o2 Amount 40� New Renovation Replacement Plans Submitted Yes No FT 17 (Print'or type) Check one: Installing Company Name 90A 140017 AllutnXln4 4- j0d-11;9 El Corp. Address - i �j 'uckx) &L� - FiPartner Certificate I ol 9 1 S- 3usiness Telephone, 910 IL9,-2 0 Firm/Co. 3 Name of Licensed Plumber: kol e, rl Xo Insurance Coverage: Indicate the �ype of 'insurance coverage by checking the appropriate box: Liability insurance policy Er Other type of indemnity Bond Insurance Waiver. 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner M 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 ibis application will be in compliance with all pertinent provisions of the Mas ode and Chapter 142 ofthe General Laws. By: Tignature oT -Licensea FlumBer Type of Plumbing License Title City/Town LH Master El Journeyman ET" APPROVED (OFFICE USE ONLY OMMMMI WWWWOMOMMMMOMMMOMMOMMUMMMI Mail MOMMOMMOMMMOMMOMMMIMMM Is U 16:9Z E��WWWMWMWWMNMWWMMN 0000MMMM (Print'or type) Check one: Installing Company Name 90A 140017 AllutnXln4 4- j0d-11;9 El Corp. Address - i �j 'uckx) &L� - FiPartner Certificate I ol 9 1 S- 3usiness Telephone, 910 IL9,-2 0 Firm/Co. 3 Name of Licensed Plumber: kol e, rl Xo Insurance Coverage: Indicate the �ype of 'insurance coverage by checking the appropriate box: Liability insurance policy Er Other type of indemnity Bond Insurance Waiver. 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner M 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 ibis application will be in compliance with all pertinent provisions of the Mas ode and Chapter 142 ofthe General Laws. By: Tignature oT -Licensea FlumBer Type of Plumbing License Title City/Town LH Master El Journeyman ET" APPROVED (OFFICE USE ONLY ACORD C ERTIFICATE OF LIABILITY INSURANCE IV ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR A-(MMfDDfYYYY) T6373 0 �0 POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION C.E.DESJARDINS INS. AGCY., INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE POLICY EXPIRATION HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 20 NEW DERBY STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. SALEM, MA 01970 DATE IMMIDONY) LIMITS INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: HOLYOKE MUTUAL INS CO 2/7/04 BOB MORIN PLUMBING & HEATING INSURER B: PREMISES (Ea occureace) 142 NEW BALCH STREET INSURERC: BEVERLY, MA 01915 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. [I= AWL POLICY EFFECTIVE POLICY EXPIRATION LTR INIM TYPE OF INSURANCE POLICY NUMBER DATE (MMMWM DATE IMMIDONY) LIMITS GENERAL LIABILITY BO -1717713 2/7/03 2/7/04 EACH OCCURRENCE s300,OOO PREMISES (Ea occureace) $50,000 COMMERCIAL GENERAL LIABILITY CLAIMS MADE I F�vl A I OCCUR MED EXP (Any one person) s 5,000 PERSONAL & ADV INJURY s INCL X BUSINESS OWNERS GENERAL AGGREGATE s600,OOO GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 600,000 —1 POLICY [—� PRO- F-] LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY ALL OWNED AUTOS (Per person) $ SCHEDULED AUTOS BODILY INUURY HIRED AUTOS (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ CgM OTH- W WORKERS COMPENSATION AND T—TORY LIMIT. ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETORfPARTNERtEXECUrIVE E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER -7 DESCRIPTION OF OPERATIONS I LOCATIONS I VENICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS PLUMBING & HEATING CERTIFICATE HOLDER CANCELLATIUN CITY OF NORTH ANDOVER NORTH ANDOVER, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL EM)EAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SK41L IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR e/1- / /- Date ............ !�� ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... (Y�y A�. .Thas permission for gas . . . . . . . . . . . . . . . . . . . ,in the buildings of .... .. at ....... North Andover, Mass. �X�� ........... Fee., .... Lic. No.. x��y ... Q --,GAS IIWK OR' Check 4 Ags-0 4t 7 7 I MASSACHUSETTS UNIFORM APPUCATON FOR-PERNUr TO DO GAS FfrrING (Type or print) � " z Date �,-6--63 INNJJMJLII 1Vjt1aaAV-11UaKx I a Building Locations C�9/ /17, 0101e,5ew 5T permit # Amount $ ov Owner's Name &16 ls()e-Z,91�aso New Renovation Replacement 1:1 Plans Submitted 1:1 (Print or type) fr,�k 4�- H 0 � Qh-e-c* one: Certificate Installing Comp any Name mo(-Iy\ PL,-) Corp. 1 0 Address 7s -r. n Partner. (nn. CD vi ks- Ile Business Telephone 9 7L — 9 (ol agq Name of Licensed Plumber or Gas Fitter —I mc) f t'n INSURANCE COVERAGE Check one - I have a current liability Insurance policy or it's substantial equivalent. Yes ff� NoE] Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy 01�, Other t3W of indemnity 1:1 Bond �Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the ,Alass. General Laws, and that my signature on this permit application waives this requirement. Check one: Agent Signature of Owner or Owner's Agent � , Owner f herehv ceftifv that all of the detail-, and information I havesubmitted (or entered) in ahnivennnfientinn nri- tn1P �ind nryni�*� f- th- 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 Massachu �Pte Gas Code and Chapter 142 of the General Laws. S74 i /') - - - ITitle VED(OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber � �C)-7L/ 0 Gas Fitter =17ense Nurnt)er Master Journeyman 4 S T. F L 0 0 R i7TH. FL--00R--_N==================== STH FLOOR (Print or type) fr,�k 4�- H 0 � Qh-e-c* one: Certificate Installing Comp any Name mo(-Iy\ PL,-) Corp. 1 0 Address 7s -r. n Partner. (nn. CD vi ks- Ile Business Telephone 9 7L — 9 (ol agq Name of Licensed Plumber or Gas Fitter —I mc) f t'n INSURANCE COVERAGE Check one - I have a current liability Insurance policy or it's substantial equivalent. Yes ff� NoE] Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy 01�, Other t3W of indemnity 1:1 Bond �Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the ,Alass. General Laws, and that my signature on this permit application waives this requirement. Check one: Agent Signature of Owner or Owner's Agent � , Owner f herehv ceftifv that all of the detail-, and information I havesubmitted (or entered) in ahnivennnfientinn nri- tn1P �ind nryni�*� f- th- 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 Massachu �Pte Gas Code and Chapter 142 of the General Laws. S74 i /') - - - ITitle VED(OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber � �C)-7L/ 0 Gas Fitter =17ense Nurnt)er Master Journeyman Date.&.-. ........ TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION SACH S This certifies that ................ has permission for gas installation ... f3 in the buildings of ...................... at ... �). �s y ..... North Andover, Mass. 7 Fee.'.�� ..... Lic. No ........... -i'; -INSPECTOR Check# 'If 3 z 127 4415 MASSACHUSEM UNIFORM APPUCATON FOR PERNUToTO DO GAS FTrIING (Type or print) Date 4-e) j NORTH ANDOVER, MASSACHUSETTS V Building Locations ��291 "15T Permit# Rper-�arC) Owner's Name Amount $ — A/0, New 1:1 Renovation 21-, Replacement n Plans Submitted E] /("/j (P--fint or type", 'ho2k one: Certificate instalfing Company Name_ P'S- 4 Corp. E] Partner. 0-1;�Vco. 1 1&3 Name of Licensed Plumber or Gas Fitter &4 lyorll') INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes � Noo Ifyou have checked M, please indicate the type coverage by checking the appropriate box - Liability insurance policy ff Other type of indemnity 0 - 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 r-3 Agent r-1 I hereby certity that all of the details and intbrination 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 Massachuse"tp' je 6,6s CpOe S4 Chapter 142 of the General Laws. City/Town (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber /261175/ Gas Fitter License Number Master n-�Iourneyman 2ND. FLO-OR_--___ (P--fint or type", 'ho2k one: Certificate instalfing Company Name_ P'S- 4 Corp. E] Partner. 0-1;�Vco. 1 1&3 Name of Licensed Plumber or Gas Fitter &4 lyorll') INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes � Noo Ifyou have checked M, please indicate the type coverage by checking the appropriate box - Liability insurance policy ff Other type of indemnity 0 - 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 r-3 Agent r-1 I hereby certity that all of the details and intbrination 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 Massachuse"tp' je 6,6s CpOe S4 Chapter 142 of the General Laws. City/Town (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber /261175/ Gas Fitter License Number Master n-�Iourneyman Office Use Only Permit No. cupancy & Fee Checked 42- 1 3/960,:* (leave blank) Department of Pubilt ihfetu %Al� -4 L,,q t_ t :U7D / tkp S 0 F --Pt 01 0 M Location 2-7 No. o / Date 6- - /"-) <3 I *ORTIJ Of TOWN OF NORTH ANDOVER Certificate of Occupancy s Building/Frame Permit Fee $ b4u Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # P-3 6451 Building lnspe�& TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING . . . . . . . . . . . . . . BUELDING PEPMT NUMBER: DATE ISSUED: 9- I - SIGNATURE: C- 6�-- �- Building Commissionen(Inst)ector of Buildings Date SECTION I- SITE INFORMATION 7 1. 1 Property Address: 1.2 Assessors Map and Parcel Number: X(ap Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Mai ict Proposed Use Lot Area Frontage (ft) 1.6 BURDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: .8 Sewerage Disposal System: tic 0 Private 0- Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHW/AUTHORIZED AGENT 2.1 Owner of Record -�R"ezz g 4- ame (P�r-init) Address for Service -*4/v Sighature 0 Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele h SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 -0 loP � 6 1�? Licc`nsed_Conitnicti6n Supervisor: , - e ��"K &wd- t11 License Number -f Address Z, 0740elj Expiration Date gign�tur-e' Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 11�5e'IeMl-,v rewjT- r,,� 1117 Company Nade 175- )FiJet -.fT- Registration Number AAdress 112171 Expiration Date *Telephone Signature 09 M X z 0 I F'. 0 SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) J 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 of Proposed Work (check A applicable) New Construction 0 1 Existing Building 0 1 RepaWs) 0 Alterations(s) 0 Addition 0 Accessory Bldg. 0 1 Demolition 0 Other 0 Specify Brief Description of Proposed Work: 4 SE&TON F.qTTMATF.n rnNqTR1TVT1n14 Vnl.T-. I V Item Estimated Cost (Dollar) to be Completed by permit applicant OFftCIAL.`USE ONLY I Building '900, 06) 416, (a) Building Permit Fee Multiplier 2 Electrical 6, 0,0 (b) Estimated Total Cost of Construction 3 Plumbina 6 - 00 Building Permit fee (a) x (b) 3 —4 Mechanical (HVAC) 5 Fire Protection 7, C76) 6 Total (1+2+3+4+5) a02.0 e) 0 Check Number bEUILILUA'/aUWAJEKAUI'HUMZA'I'IUN TO HE COMPLETED WHIEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHOPJZED AGENT DECLARATION 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 of t�4�Z / � 3 Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2 ND 3 RD SPAN DIMENSIONS OF SELLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHUVINEY IS BUILDING ON SOLD) OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: city Phone # F-1 I am a homeowner performing all work myself F-1 I am a sole proprietor and have no one working in any capacity Fx__1 I am an employer providing workers' compensation for nrry employees working on this job. Compagy name: Pergola Construction Co Inc. Address 175 Essex Street CiPL. Swamp�cott -Phone #- (781) 599-4895 Insurance. Go. The Hartford Policv 08WEKH8044 Comony name - Address Phone #7 Insurance Co. Po1icV # Failure to secure coverage as required under Section 25A or MGL 152 can lead to -the imposition of crimina penalties Of.: fine up to $1,5-OD.00 andlor one years'imprisorwnent.as-YMLas-cbApenakiesin-tboic)rmda-STjDPYOOMDRDFjt-md_afm _dA$jj00_0D)_ajftyAgainstDx-_ I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Official use only do not write in this area to be completed by city or town otrmial- ;0 U� City or Town Permkfijcensin-q Building Dept E]Check ff immediate response is required 0 blGer?Sinq Board Contact person: Phone A E] Selectman's Office E] Health Department Ei Other From: 781-246-2601 To: Pergola Construction Co. Inc. Page- 2J2 Cate: 612/03 11:01:16 AM AACOAD., CERTIFICATE OF LIABILITY INSURANCE OP ID C PERGO-1 � DATE (MWDOINYN) 05/31/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INUK LTR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thomas Gregory Associates Inc, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 601 Edgewater Drive S235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Wakefield MA 01880 Phone: 181-914-1000 Tax:781-246-2601 I INSURERS AFFORDING COVERAGE NAIC # INSURED NSURER A: Hartford Insurance Company 22357 INSURER 8. Pergola Construction Co., Inc. Mic ael Pergola I\JSURER C 175 Essex Street Swampscott M& 01907 INSURER D INSURER E. 08 ULTS 135709 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIR41TS SHOWNIMAY HAVE BEEN REDUCED BY PAID CLAIMS. INUK LTR -kULJ'L NSIRD TYPE OF INSURANCE POLICY NUMBER EFFECTIVE 'DATE0Y(IAWDD/YY) PDOALTICY(MMIDRYI) LINUTS GENERAL LIABILITY EACH OCCURRENCE �$l 1 0 00,000 • X71 CCP4ERCIAL GENERAL LIABILITY CLAIMS MADE [�] OCCUR. 08 ULTS 135709 06/28/02 06/28/03 �MoAut lu _�t'j tu (-a occurence) 1$250,000 _L�RENIISES MED EXP (Arry on3 oerson) $5,000 P�R'SCNAL & ADV INJURY $ 1,000,000 GENERA- AGGREGATE ls2,000,000 GENIL AGGRECATE LIMIT APPLIES FIER PRODUCTS - CON4P/OP AGG $2,000,000 PC)LIICYF—] R�E"Co�, 7 LOC Emp Ben. 1,000,000 A AUTOMOBILE LIABILITY ANY Aj-0 08 MCP 700114 06/28/02 06/28/03 S I, 'LE LIMIT COMBINED, (Ea accidentl 1 $1,000,000 X ALLDVV'�ED AUTDS SCI-iEDUL�DAIJTCS $ BODILI INJOGY (Per person) X HIREDPUTOS BDDILI 1114JLIFY X N NON-CWKED AJ -QS' (Per acddenj P �OPERTY DAMAGE (Per accidem) $ GARAGE LIABIL AJ -0 ONLY - EA ACCIDENT $ ANY AJ -C, OTHER THaJJ EIA ACC $ $ AJ -O ONLY: AGG EXCESS/UMBRELLA LIAEILITY EACH OCCURRENCE $5,000,000 • X oCCUR 17 CLAIM- RACE 08 XHTJ IB5307 06/28/02 06/28/03 A�,CREGATE $5,000,000 DEDiCTIBLE $ X RETENT ON $10,000 $ • WCRIKERS COMPENSATION AND EMPLCYERS'LIABILn ANY PPCP� ETORIPARTNER,EXECUT VE 108 WE KH8044 06/28/02 06/28/03 X ITCIRLY T_L,77-, 71_11(�IEI hP_ E.L.EACHACCIDEN1 $100,000 OFFICER/MENSER EXCLUDEC? 1, �es, de3cribt Lnder SPECIAL PR -)VISIONS below E.L. D13EASE - EA EMPLO�EE $100,000 E.L. DISEASE - -OLICY LIMIT $500,000 OTHER A_ Equipment Floater 08 UUN 135709 06/28/02 06/28/03 DESCRIPTION OF OPERATIONS I LOCATIONS j VEHICLES � EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CTOB SITE: Bob Spezzafero 291 Middlesex Street — North Andover, MA CERTIFICATE HOLDER CANCELLATION NORTH -3 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION North Andover Building DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS wRiTTEN Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL Attn: Michael McGuire IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. This tax was sent with GFI's FAXmaker FAX Server - For more information-, visit: hftp:/AtAm.gfi.com North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit Number is-that.the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by IVIGL c 11, S.1 50 A.. The debris will be disposed of in: /;7 (Location of Facility) S Signature of P �it A�pppplicant ignature of Date, NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector Al 0/ 1 B -d of Building Regulations and Standards ow HOME IMPROVEMENT CONTRACTOR Registration: 111779 Expiration: 1/27/2005 Type: Private Corporation PERGOLA CONSTRUCTION INC MICHAEL PERGOLA 175 ESSEX ST. SWAMPSCOTT, MA 01907 Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid withou�siigg�nae 0 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 026679 Birthdate: 07126/1944 Expires: 07/26/2003 Tr. no: 12540 Restricted To: 00 MICHAEL P PERGOLA 40 BUENA VISTA AVE SALEM, MA 01970 Administrator Of Page 1 of 2 CO eCONSTFRUCTION CO., INC. rwoc 97 Harwood Street, Lynn, Massachusetts 01902 781-599-4895 / 978-745-7445 - 781-581-9603 fax Proposal Submitted To Bob Spezzafero Phone 7D 781-983-5475 -ate 06/03/03 Street 35 Mansfield Street Job Name Renovation City, State, Zip Code Somerville, MA 02143 Job Location 291 Middlesex Street, No. Andover t .=ate of plans Job Phone We hereby submit specifications and estimates for: Scope of work: Renovation to existing two family dwelling Terno existing bathroom on 1 st and 2nd floor to sub floor Terno existing kitchen on 1 st and 2nd floor to sub floor *Remove paneling on all wall areas *Demo 2'x4'acoustical ceiling in dining room * Remove existing rugs on 1 st and 2nd floors *All existing interior walls to remain *Blue board ceings and skim coat in dining areas *Blue board walls that had paneling New Bathroom on 1st and 2nd floor: *Blue board and skim coat plaster walls and ceilings *Fixture allowance $3,000.00 ( toilets, tubs vanities, base cabinet with bowl and faucets) *Plumbing and electric Taint all new work P)r f�Jropo5c hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: Payment to be made asTo-lTows-:- dollars ($ All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifi- Authori "d cations involving extra costs will be executed only upon written orders, and will become Signature an extra charge over and above the estimate. All agreements contingent upon strikes, La cidents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be i ii c� nsurance. Our workers are fully covered by Workmen's Compensation insurance. withdrawn by us if not accepted within 30 days 'ACCePtallitC Of j0r0P05Z11 - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified Payment will be made as outlined above. Date of Acceptance: 00 Signature.�,�, Signature Propozat Page 2 of 2 —'111,11 q-CUPt11l1CC Of 101*01305011 - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Signature'-�6 Payment will be made as outlined above. Date of Acceptance: Signature CO eCONSTFRUCTION CO., INC. rwoc 97 Harwood Street, Lynn, Massachusetts 01902 781-599-4895 / 978-745-7445 - 781-581-9603 fax Proposal Submitted To Phone Date Bob Spezzafero 781-983-5475 06/03/03 Street J7b- Name 35 Mansfield Street Renovation City, State, Zip Code Job Location ornerville, MA 02143 --7 291 Middlesex Street, No. Andover Architect f plans i We hereby submit specifications and estimates for: Kitchen Renovations on 1 st and 2nd floor: *Cabinet allowance $8,000.00 *Formica Counter tops with back splash *Kitchen sink with faucet allowance $500.00 *Blue board and skim coat walls *New NAFCO Luxury Vinyl Flooring *Paint all new work *Plumbing and electric (26) Replacement Windows: *Remove and replace with Harvey Vinyl replacements *Painting of unit included. in price *Rernoval of all debris Total Cost $62,500.00 1))r VVOP05c hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: Sixty Two Thousand Five Hundred dollars and 00/100 ------------------------ dollars ($ 62,500.00 Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifi- Authoriz-e _0 cations involving extra costs will be executed only upon written orders, and will become Signature an extra charge over and above the estimate. All agreements contingent upon strikes, dents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be L' incsc,rance. Our workers are fully covered by Workmen's Compensation insurance. withdrawn by us if not accepted within 30 days Ail q-CUPt11l1CC Of 101*01305011 - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Signature'-�6 Payment will be made as outlined above. 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