HomeMy WebLinkAboutMiscellaneous - 3 IRONWOOD ROAD 4/30/2018Date .....
.... ...... .. ...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............. e",
..... ........ .... 4 .. ........................................
has permission to perform ...... . ..... .......... . ..... .....
wiring in the building of ........ ..........................
.............................................
at ................ .................. orthh Andovtl�, Mm
Fee Lic. No..��Dl ......... . ............. ... ... . . ......... ..
LECMCAL INSPEC��i
Check #
10607
131
Commonwealth of Massachusetts OffigialUse Only
Department of Fire Services Permit No. 07 b 07
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [[gev.1/o7] oeaveblank) —
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be..prerformed in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00
(PLEASE PREVT 17V INK 0-R� TYPEALL XFORAL4 TION) Date: TAnJ .2,-3- 2-D/ Z -
City or Town of. NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her inte t* n to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
P Telephone No.
Is this permit in conjunction with a building permit? Yes No n (Check Appropriate Box)
Purpose of Building CLZ-�6clllve Utility Authorization No.
Existing Service2<�:�OAmps /?-04!KJVolts Overhead [J Undgrd D ----No. of Meters
New Service — Amps Volts OverheadF1 - UndgrdF] No. of Meters
Number of Feeders and AmpacitY
Location and Nature of Proposed Electrical Work:
4>A-1 ) 5 ----
Comvletionnfthe fn1lowing table mav be waived hv the In ctor -f Wires
No. of Recessed Luminaires 20
No. of Cefl.-Susp. (Paddle) Fans
No. of Total
Transformers K -VA
No. of Luminaire Outlets 3
No. of Hot Tubs
Generators K -VA
No. of Luminaires
Above o In- E]
Swimming Pool grnd. grnd.
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches 3 0
No. of Gas Burners
No. ol"Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
..... ......
J.K.W ...........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Areia Heating KW
Municipal El other
Local M Connection
No. of Dryers
Heating Appliances 'I KW
Security Systems:*
No. of Devices or Eauivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total UP
Telecommunications Wirinj:
No. of Devices or Eq i ent
OTHER: I
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start:/—/ 1,AZ!0:J` 2— Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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 El BONDE] OTHER [I (Specify:)
I certify, under thgains andpenalfleF ofperjury, that the in ormation on this appli *on is true and cornpieie.
FIRM NAME: 1,1k1filC 9J,067, �T )(14 P r - 7 11 LIC NO: A/41q3
Licensee: ( --NA&LI a
(Ifapplicable enter in the licensi
Address: G -7 'go Lki
*Per M.G.L c. 147, s. 57-61, security m
OWNER'S INSURANCE WAIVER:
required by law. By my signature belo,
Owner/Agent
Signature
Signature LIC. NO.: r2 2— C;l
number hnl.) Bus. Tel. No.
3-" Alt. Tel. No. Z/ 7
ruires Department of Public Safety "S" License: Lic. No.
I I in aware that the Licensee does not have the liability insurance coverage normally
ml
,he'r,eby waive this requirement, I amthe (check one) El owner Elowner'sagent.
Telephone No. I PERMIT FEE. $ _J
FfFCTWdAL13FRWTX0.- INSPECTIONREPORT:
EUCTMCALINSPECTOR
I- ROUGAINSM-CTION;
�ass�d-:u ., Yailed—[ I Re-iuspectionrequirecT($50.00)-f
laspectors, comments:
A
Cfu�pectox-sySignature-noiultials) Date
F2. —.v)wAy, iNspricnoN.,
rassed FaUed Re4uspection required ($50.00) -
Ingpecto' C ments:
K'�X . 'A
4
Osl�egtorsl WgWature--46 initials) Date,
3. UMER GRODND INgPECTION
Passed — f I Falled—f I Re -inspection required ($50.00) - f
Inspectors, comments:
(Inspectors" Signatare, - no Htlals) Date
DOOR TAGS An TO BE MMED AND LEFT ON SHE IF TBE APXA TO BE INSPE CTED 18 NOT
ACCESSIBLE AND A RE-WSPECTION OF �50.00 19 TO BE CMRGED.
a
i;
I
Ll
,7n
The Commonwealth of Massachusetts
D7 Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
k1V www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual):
City/State/Zip:
�' 7Y- 6,F, 2 ;� PC -,
Are you an employer? Check the appropriate box:
1. [�am a employer with —
4. El I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2.0 1 am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El 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.] f
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. F-1 New construction
7. E] Remodeling
8. E] Demolition
9. E] Building addition
10.El Electrical repairs or additions
1 l.F] Plumbing repairs or additions
12.F1 Roof repairs t
13.0 Other
*Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing al I work and then hire outside contractors must submit a new 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 is providing workers'compensation insurancefor my employees. Below is thepolicy andiob site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:
(t
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 required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a dayAgamst the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of t D for insurance coverage verifie-4ion.
I do hereby certiWder the pains
IN
Official use onl�. Do not write in this area, to he completed by city or town officiaL
City or Town:
Permit/]License #
is true and correct.
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
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 of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint 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 local 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 carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be 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 line.
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.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need 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 future permits or licenses. A new 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 Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 6.17-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
0
CIOL
CUSTARD
INSURANCE ADJUSTERS
4/16/2015
Gerald Brown
Inspector of Buildings
1600 Osgood Street
Building 20, Suite 2035
North Andover, MA 0 1845
Claim Number:
Policy Number:
Company Name:
Date of Loss:
Insured:
Property Location:
033577246
17452400003
Atbella Mutual Insurance Company
2/13/2015
David Gruber
3 Ironwood Rd
North Andover, MA 01845
To Whom It May Concern:
Claim has been made involving loss, damage, or destruction of the above captioned property,
which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6,
to be applicable.
If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please
direct it to the attention of the writer. Kindly include a reference to the captioned insured,
location, date of loss and claim number.
Very truly yours,
Arbella Mutual Insurance Company
PO Box 699225
Qumicy, MA 02269
CC: City/Town Fire Dept, City/Town Health Dept
b
I;
Date,/ . .......................
TOWN OF NORTH ANDOVER
PERMITPOR WIRING
r
This certifies that ....... # ... .... .............................
has permission to perform .... /4-* ........ .......
wiringin the building of ........................... . ..................................................
a .......
at .............. .7a. � "n "'(
........................................ North Andover, N*s.
Fee..63 .. .... Lic. No....�(/V/
. .........................
EICAL INSPECTOR
Check #
10405
Commonwealth of Massachusetts Official Use Only
Permit No.
Department.of Fire Services.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 Ocaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Cog(MEC), 527 CMR 12.00
(PLEASEPRNTIATIATK OR YYPE ALL XFORMA TION) Date:(VJP7 215 - 20��Z—
City or Town of. NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perfofm the electrical work described below.
Location (Street & Number) . 3 --L? CA.) 6, eJ 0 Q A
Owner or Tenant
Owner's Address
Telephone No.
Is this permit in conjunction with a building perxnit? Yes �No 0 (Check Appropriate Box)
Purpose of Building c cf-,-�v Utility Authorization No. // 5,5ZIFE�
EidsfingService/60 Amps 12o /A;e-(;)_VoIts Overhead � UndgrdE] No. of . Meters tl
New Service 2-66)Amps 120 /2YOVolts OveyheadF-1 Undgrd No. of Meters
Number of Feeders and.Ampacity
Location and Nature of Proposed
31?A soff"lee U --
V Ciomnletion of the follolWne table mav he waived bv the Inspector of Wires.
No. of Recessed Luminaires
No. off Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above El
grnd. grnd.
IN 0. of Emergency Lighting
Battery Units
�Zpnes
No. of Receptacle Outlets
No. of Oil Burners
FlPtE.A.L.ARMS
—of
7Nr- 7f
No. of Switches
No. of Gas Burners
No. Detection and
initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
I Number
I
I Tons --TKW
No. of Self -Contained
Detection/Alerting Devices
No.'of Dishwashers
Space/Area Heating KW
Local EJ Mqnic'p�l El Other
Connection
No. of Dryers
Heating Appliances KW
9ecurity Systems:*
No. of Devices or Equival t
No. of Water KW
Heaters
No..of No. of
Signs Ballasts.
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
JOTHER:
C Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical. Wo-rf (When required by municipal policy.)
Work to Start: /0 -2 5-- / ( spections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: -Un ess 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 cover s . force, and has.exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND [I OTHEREI OR=
I ceiW p fi�"4
fy, under the ains andpenalatiesof. erjury, that the in ation on this app icapap is true and conip ete.
LIC. NO.:
FIRM NAME ;Z I A r- 0)k;1le-61- e lv�) 11 ; 47
Licensee: ( Sign tare LIC. NO.: e Z �
(Ifapplicable, enter in the icense num er line Bus.Tel.No.-227' G9276f G
Address: -& — . .. Alt. Tel. No.: Of 7 E q 7 2/13 5
*Per M.G.L c. 147, s. 57-61, security o requires Department of Public S "9"License: Lic. No.
OWNER'S INSURANCE W 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) [I owner ' F1 owner's agent.
Owner/Agent FEE.
Telenbone No. FPERmrT s 55---t—
-e
The Commonwelzith of)jlassachusefis
Department of Industrkd Accidents
Office of Investigations
Milt 600 Washington Street -3
Boston, MA 02111
WWW.hzays.gov1dia
"
ra
Workers' Compensation Iasi, nee Affidavit: Builders/Co etors lectnic'ian"j
A�ylicant aformation s1plumbers
se Print Leggibly
Narr;e (Business/organization'/Individual):_
Address:
City/State/Zip: Phone #:.
Are you an employer? Cheek.the appropriate -box:
I. El I, Eim - a employer with
4. R I am a general contractor and I
emp loyces (full and/or part-time).*
2.0 1 arn.a.sole proprietor. or
have hired the sub -contractors
listed I
partner-
ship and have no employees
on the attached sheet
These sub -contractors have
working fior mein any capacity,
[No workers' comp. insurance
workers' comp. insurance.
5. 0 We are a corporation and its
required.]
3. El I din a homeowner doing all work
officers have exercised th'e*ir
right of 'exemption per MOL
Myself. [No-worke'rs'comp.
c. 1.52, § 1(4),* and we have no
insurance -required.) t
employees. [No workers'
comp. insurance required-]
'Any applicant that checks bo)!� I must also fill out the
section "j� u
Type Of Pr9ject (required):
6. New construction
7 Remodelm-g
8. Demolition
9. ED Building addition
10. [] -Electrical repairs or additions
I I.n. Plumbing repairs or additions
12.0 Roof re'pairs
13.n.Other
w s ow ng their wonce ompensation policy information,
HGmeowm6q Who submit this affi'daVit indicating they are doing all work and then hire outside connctors must submit a n4waffidavit indicating such.
�Contmctors th'at che4c this box must aftncbc*d an additional shcotshowfing Vile name of the sub-contmctors and th ; *
r -!* "6013' ccrrp. Policy infbinmtion.
ara an empkYer that is,
.Prc?vidii-ig:worlwps,COPAPCilSadOigifISUr,7iZCefOPiftyeiVloyeeS. BeloWiStIlepoliCy.
MformatiolL apidjob site
Insurance Company
Policy � or Self -ins. Lie.
Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the worke.rs','compens�tion policy declaration P2,ae (Showing the Policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a -
fine UP tO,$1,500-00 and/or one-year imprisonmentj as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of thl-s tement may be forwarded t the 0-ffice of
Investigations of the DIA for insurance coverage verification. sta
I do hereby certify under the pains andpenalfies ofperjury that the information provided above is Irtie and correct
&L,zaturei Date:
Phone
Fiat use only. Do not write Lai f -his area, to be compifeted by cky or town officiaL
City or Town:
Permit/License #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town -Clerk 4. Electrical inspector 5. Plumbing Inspector
6. Oth6r a,
Contact Person: Phone #:
TLH CONSULTING
STRUCTURAL ENGINEERING SERVICES
505 Middlesex TPK
Unit 14
Billerica, MA 01821
Phone — (978) 362-1804
Mobile � (978) 406-5726
January 26. 2011
Mr. Gerald Browil
inspector of.BUIldiligs
1600 Os-ood Street
North Andover, MA 0 1845
P11- (978) 688�9545
Fax: (978) 688�9542
Re,,arding: Structural Framin,,for New Addition
31 Ironwood Road
North Andover. MA
AFFIDAVIT
Mr. Browrt..
Consulting visited the above referenced site on January 24. 1-0 12. The purpose of
the visit was to observe the as constructed framing for the new addition. The framing
appeared to meet the design intent of the projject contract documents and meet the
parameters ofthe Massachusetts State -Building Code for One and Two Family
Dwellmos. . 8"' edition.
t) 780 CMR,
if you have any questions or require additional. information feel free to contact TLH
consulting at (978) '362-1804 or (978) 406-5726.
Sincerely,
Todd LT, Hedly. P.E.
C.c.: File
TLH CONSULTING
STRUCTURAL ENGINEERING SERVICES
505 Middlesex TPK
Unit 14
Billerica, MA 01821
Phone — (978) 362-1804
Mobile — (978) 406-5726
January 26, 2011
Mr. Gerald Brown
Inspector of Buildings
1600 Osgood Street
North Andover, MA 0 184 5
Ph: (978) 688-9545
Fax: (978) 688-9542
Regarding: Structural Framing for New Addition
3 Ironwood Road
North Andover, MA
A UUM A 171rlr
Mr. Brown,
TLH Consulting.visited the above referenced site on January 24, 2012. The purpose of
the visit was to observe the as constructed framing for the new addition. The framing
appeared to meet the design intent of the project contract documents and meet the
parameters of the Massachusetts State Building Code for One and Two Family
Dwellings, 780 CMR, 8 1h edition.
If you have any questions or require additional information feel free to contact TLH
Consulting at (978) 362-1804 or (978) 406-5726.
Sincerely,
Todd LT. Hedly'�.T.
C.c.: File
me
6-1 . '2
12-6 Date. ..........
.1
'40RTN -1 TOWN OF NORTH ANDOVER
4,
6 6
PERMIT FOR MECHANICAL INSTALLATION
CH �pj
This certifies that .......................
has permission for mechanical installation .........
. . . . . . . . . .
in the buildings of 0
.....................................
at ................................... I North Andover, Mass.
7
Fee. . . Lic. No ........... ..........................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. . PINK: Treasurer
JOWN OF NORTH ANDOVER
1600 OSGOOD STREET
Building 20 Suite 2-36
NORTH ANDOVER MA 01845
FURNACES, BOILERS, ROOF TOP UNITS, AIR CONDITIONERS,
EMERGENCY GENEREATORS
Date:
The undersigned applies for a permit to install the following at:
Location 3 IRONWOOD ROAD
Owner of premises MR. & MRS. DAVID GRUBER AddressSAME
PETER MONGAN
Name of mechanic
Address 23 FORGE VILLAGE RD WESTFORD, MA
Building occupied for SINGLE FAMILY RESIDENCE Material of buildingWOOD
Kind of fueIGAS
.Chimney_No. Of flues Size
Chimney Thickness I Lining
If steel stack location Diameter Height.
DESCRIPTION OF HEATING APPARATUS
Kind of heater GAS FURNACE how manyONE makeCARRIER
BTU Input60,000 BTU
Location in buildinciBASEMENT
Protected against fire as required How protected
See the State Code (Pertaining to Chimneys, Smokestacks and Heating Apparatus)
Make
Dimension Length
ROOF TOP UNITS OR EMERGENCY GENERATORS
Weight
Width Height
Location of building how supported
Size of roof timbers Material of roof timbers
Span of roof timbers Distance on center
Protected against fire as required How protected
AIR CONDITIONS
Kind of apparatus make
HVAC FORM REVISED 11.04
Client#: 72692
I M-11P.T61-y-A.H.14
ACORD. CERTIFICAT-E OF LIABILITY INSURANCE 1
DATE (MMIDDNWY)
1/09/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
HUB Int'l New England (WILSB)
299 Ballardvale St
Wilmington, MA 01887
CONTACT
NAME: Robert Britt
PHIONE0, 978-661-6897 FAX, No): 866-460-8786
(AIC, N Ext): (AIC
E-MAIL
ADDRESS: bob.britt@hubintemational.com
CUSTOMERID#:
INSURER(S) AFFORDING COVERAGE NAIC #
01/22/2012
INSURED
INSURERA: Ohio Casualty Insurance Company
Nashoba Sheet Metal Inc
INSURER B: Peerless Insurance Co
Attn: Harriet Leva
GENERAL AGGREGATE s2,000,000
P.O. Box 1143
INSURER C:
$
Westford, MA 01886
INSURER 0:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
DL
N R
SUBR
NVID
POLICY NUMBER
POLI
(MMISYDAY)
POLICY EXP
LMM/DD1YYYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F__';1
OCCUR
BHO1153437668
0112212011
01/22/2012
EACH OCCURRENCE $11000000
DAMAGE TO RENTED
PREMISES (Ea occurrence) $100,000
MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
7 —1 RO
POLICYF JPEC� LOC
PRODUCTS - COMP/OP AGG s2,000,000
$
A
AUTOMOBILE
—
—
—
X
X
X
1-1
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON-OWNEDAUTOS
BAWI 153437668
1
01/2212011
01/22/2012
COMBINED SINGLE LIMIT $
(Ea accident) 1,000,000
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(Per accident)
$
1 $
A
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
US01153437668
01/22/2011
01122/2012
EACH OCCURRENCE $1,000,000
AGGREGATE $1,000,000
X
DEDUCTIBLE
RETENTION $ 0
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNEPJEXECUTIVEF-NI
OFFICER/MEMBER EXCLUDE(
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WC8622699
04116/2011
04/16/2012
TW CRS TLA CRTH-
0 Y IZS I JE
L. EACH ACCIDENT s500,OOO
_E
E.L. DISEASE - EA EMPLOYEE s500,OOO
E.L. DISEASE - POLICY LIMIT $500,000
111
I
1 -7
-
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
I =1; Lei III a] =I V
Town of North Andover
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1600 Osgood Street, Bldg 20,
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Suite 2-36
North Andover, MA 01845
AUTHORIZED REPRESENTATIVE
fXV4461 .9 C40^ -V-
0 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S641257/M524254 LB005
NASHOBA SHEET METAL, INC.
P.O. BOX 1143
WESTFORD, MA 01886
PHONE/FAX (978) 692-7056
www.nashobasheetmetalinc.com
December 30, 2011
REVISED
BUSHNELL CONSTRUCTION ADDITION / GRUBER RESIDENCE
89 MEADOWBROOK ROAD 3 IRONWOOD ROAD
CHELMSFORD, MA 01824 NORTH ANDOVER
JOB ESTIMATE
1.) PRICE TO SUPPLY AND INSTALL A NEW GAS FURNACE, DUCT SYSTEM AND
AIR CONDITIONING UNIT TO HEAT AND COOL ADDITION ON TWO ZONES.
THE MASTER SUITE WILL BE ZONE ONE AND THE FIRST FLOOR WILL BE
ZONE TWO. THE FURNACE WILL BE LOCATED IN THE BASEMENT, FIRST
FLOOR DUCT SYSTEM FROM BASEMENT, SECOND FLOOR (MASTER SUITE)
DUCT WILL RUN THROUGH DUCT CHASE TO ATTIC TO FEED FROM ABOVE.
A.) 90%+ FURNACE WITH (13) SEER AIR CONDTIONER.
$7,685.00
B.) 96% FURNACE WITH ECM MOTOR AND (16) SEER AIR CONDITIONER.
$8,900.00
C.) 98%FURNACE WITH ECM VARIABLE SPEED MOTOR WITH MODULATING
I
0
)GAS URNER AND A (21) SEER AIR CONDIT --1
$10,800.007
$1
(:::o 0
0
2.) PRICE TO ADD RETURN TO SECOND FL OR, RUN A NEW 14X8 DUCT TO THE
ATTIC AND INSTALL RETURNS IN EACH BEDROOM. ALSO INSTALL A
DAMPER OR RELOCATE FIRST FLOOR SUPPLY THAT IS BLOWING TOO
MUCH AIR.
$1,895.00 RETURN ONLY
$3,595.00 SUPPLY AND RETURN
OPTIONS
AIR BEAR AIR FILTERS
$400.00
E.W.C. S2020 STEAM HUMIDIFIER $1,400.00 (wiring not included)
APRILAIRE #600 HUMIDIFIER $600.00
OPTION #2 WILL REQUIRE OPENING UP AND POSSIBLY EXPANDING
EXISTING DUCT CHASE TO EXISTING SECOND FLOOR. PRICE DOES NOT
INCLUDE CARPENTRY, SHEETROCK, PAINT ETC TO REPAIR WALLS
CEILINGS.
** PRICES DO NOT INCLUDE GAS PIPING OR WIRING.
13
Date. . ........
A
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLAT[ON
This certifies that ............
has permission for gas installation .............
in the buildings of v4?41-7 ......................
at .......... Nort�h
�dover, ass.
Lic. No.
Fee. AF
GASINSPECTOR
Check # Z'SZO
7957
NIASSACHUSEM UNUMM APPUCAMN FDR PERNIrr TO DO GAS Ff MNG
(Type or print)
NORTH ANDOVER, MASSACHUSETTS Date
Building Locations #0%0
Permit #
Owner's Narne Amount $
N I W M/ Renovation Replacement Plans Submitted
laj M Q 13
(.Print or type
Address 3
C-7/, Z�r
7 9— Fl -f 67 7/'o
Misiness Telephone
Name of Liccnsed Plumber or Gas Fitter J—imm
VW1
one: Certificate Installing Company
Corp.
U Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked Yes, please indicate the type coverage by checking the appropriate box M
Liability insurance policy LA Other type of indemnity Bond
7- 1 1:1 13
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of tile
I
Mass. General Laws. and that mysiernature on this p
ermit application waives this requirement.
Check one:
Signature ofOwner or Owner's Agent Owner 13 A2ent 13
1 hereby certify that all of the dctails and information I have Submitted , 'or entered) in above application are true and accurate to the,
hest ofnv� knowledge and that �jjj plumbing work and installations 1XI I' f0 I'll IL'(1 lindcr PL-rrnit fssued for this , I
applic� tion will he if)
compliance with all pertinclit pl-()visi()Ils 01 the Massachusetts State G, (IC 311d Chapk(Q42 of the �� Laws.
By: ",/ 1,?f - 04 24,
Title I
C i tyj;To �� n
�PPROVED (OFFICE USE ONLY)
Signat
rVI 0 L!��)f Licensed PlUmbur Or Gas Fittcr
Plumber 15-310 3ir
Gas Fitter C Aumber
rM Master
dJOUrnewnan
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SUB-BASEM ENT
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(.Print or type
Address 3
C-7/, Z�r
7 9— Fl -f 67 7/'o
Misiness Telephone
Name of Liccnsed Plumber or Gas Fitter J—imm
VW1
one: Certificate Installing Company
Corp.
U Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked Yes, please indicate the type coverage by checking the appropriate box M
Liability insurance policy LA Other type of indemnity Bond
7- 1 1:1 13
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of tile
I
Mass. General Laws. and that mysiernature on this p
ermit application waives this requirement.
Check one:
Signature ofOwner or Owner's Agent Owner 13 A2ent 13
1 hereby certify that all of the dctails and information I have Submitted , 'or entered) in above application are true and accurate to the,
hest ofnv� knowledge and that �jjj plumbing work and installations 1XI I' f0 I'll IL'(1 lindcr PL-rrnit fssued for this , I
applic� tion will he if)
compliance with all pertinclit pl-()visi()Ils 01 the Massachusetts State G, (IC 311d Chapk(Q42 of the �� Laws.
By: ",/ 1,?f - 04 24,
Title I
C i tyj;To �� n
�PPROVED (OFFICE USE ONLY)
Signat
rVI 0 L!��)f Licensed PlUmbur Or Gas Fittcr
Plumber 15-310 3ir
Gas Fitter C Aumber
rM Master
dJOUrnewnan
The Commonwealth ofMassachusetts
Department ofIndustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledbly
Name (Business/Organization/individual).
Address:
Ll
City/Statelip: Iv. Ph'one #: 91 2 6� -2
Are you an employer? Check the appropriate box:
1. El I am a employer with 4. El I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2 -Er, am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance
required.]
3. El I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
workers' comp. insurance.
5. [1 We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required
Type of project (required):
6. M New construction
7. Remodeling
8. Demolition
9. Building addition
10.0 Electrical repairs or additions
I.E] Plumbing repairs or additions
12.FJ Roof repairs
13.R Other
*Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
�Contractors 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 is providing workers' compensation insurancefor my employees. Below is the policy andjob site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:
Job Site Address:
Expiration Date:
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 required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert�& under the pain,,�ndp�a�perjury that the information provided above is true and correct.
Sign ure: Date:
Phone #: " 9 7 r' — — -2 f_7 Z ff'
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Realth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
9229 . Date. /� -
,40R'r#q
TOWN OF NORTH ANDOVER
0 0
PERMIT FOR PLUMBING
S C14US
This certifies that
4, k-
..................
has permission to perform ... oL4 ....
plumbing in the buildings of . ...............
at ... gzlq�?,��4�?�Aco ......... North Andov;pr, Mass.
Fee., �W�Pl-ic. No..,�rJ<,3.Xe ....... . ... .....
PLUMBING INSPECTOR
Check# - 7-3 2L-
�-SUB BSMT.
B�=AS�EMENT
11T _�E
FLOOR
-;Z D �-- - -�
FLOOR
3 RD FLOOR
-��F—LOOR
?W—FLOOR
?WFLOOR
Fff—FLOOR
F FLO—OR
MASSACHUSET17S UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
C aty/Town:
it ITown. 11111',"It5ii L MA. Date: ZR -,f- Permit#
Building Location: 3
— !!T79,VV Owners Nam'
e:. DA,,C beu6e,-�
Type of OccupancY: CommercialEl Educational lndustriaIE] InstitutionalEl Residential
New: rk] Alteration: El Renovation: 0 Replacement: Plans Submitted: Yes F1 Non
FIXTURES
Address:3 syr;n, 54
City/Town: lto.o� Cie 1/1, A� State: 0714
B usin ess Tel: 7 8— Fax: 5� 7e-- ?-f-/ '27 1P
Name! of LUCensed Plumber: Tir),;ig
Che,3!-, 0ne ond".
El Corporation
U Partnership
El Firm/Company
DEDICATED
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City/Town: lto.o� Cie 1/1, A� State: 0714
B usin ess Tel: 7 8— Fax: 5� 7e-- ?-f-/ '27 1P
Name! of LUCensed Plumber: Tir),;ig
Che,3!-, 0ne ond".
El Corporation
U Partnership
El Firm/Company
DEDICATED
C &; - � ; f ; ,- -,� I j,-, jT-
INSURA "ut: UUVERAGE:
I have a current Hai insurance policy or its substantial equivalent which meets the' requirements of MGL. Ch. 142 Yes;JrNo El
If You have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy -9 , Other tvne of inripmnif- M
OWNER'S INSURANCE WAIVER: I am aware that tie licensee does not h the insurance coverage required by Chapter 142 of the
b Flo[ �
Massachusetts General Laws, and that my signature on this pe!�rmitnave
application waives this requirement.
Check One Only
Slypature of qwner or Ownees Agent Owner El Agent
1 hereby CeTLIIY MaX all 0! the details and info—l—LIU11 I nave Submitted (or enter I
Knowledge r I 1 11, 113 1� IN
Pertinent pro I I I : I ; -- 8
and that 211 Plumbing work and I Stallatlons Performed under the pie! r1mit issued for this - 11111"111:i1l''11 ::''!�Iac—ratetoth bestofinly
vision of the Massachusetts State PluZing Code and Chapter 142 application will be in compliance with all
— —n- Chaptei-142ofthe General Laws.,-�� .. �C..
_iy �ype Of �Llcense-
tle
Plumber -�i!gMure of Licensed Fil-u—mber
r
Master '
PPROKE—D-0—F—F—IC— -Eliourneyman License Number:
E USE ONLy) _3
a
I
D
j3
Cl
<
LU 6
U
J)
Ln
LU
C &; - � ; f ; ,- -,� I j,-, jT-
INSURA "ut: UUVERAGE:
I have a current Hai insurance policy or its substantial equivalent which meets the' requirements of MGL. Ch. 142 Yes;JrNo El
If You have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy -9 , Other tvne of inripmnif- M
OWNER'S INSURANCE WAIVER: I am aware that tie licensee does not h the insurance coverage required by Chapter 142 of the
b Flo[ �
Massachusetts General Laws, and that my signature on this pe!�rmitnave
application waives this requirement.
Check One Only
Slypature of qwner or Ownees Agent Owner El Agent
1 hereby CeTLIIY MaX all 0! the details and info—l—LIU11 I nave Submitted (or enter I
Knowledge r I 1 11, 113 1� IN
Pertinent pro I I I : I ; -- 8
and that 211 Plumbing work and I Stallatlons Performed under the pie! r1mit issued for this - 11111"111:i1l''11 ::''!�Iac—ratetoth bestofinly
vision of the Massachusetts State PluZing Code and Chapter 142 application will be in compliance with all
— —n- Chaptei-142ofthe General Laws.,-�� .. �C..
_iy �ype Of �Llcense-
tle
Plumber -�i!gMure of Licensed Fil-u—mber
r
Master '
PPROKE—D-0—F—F—IC— -Eliourneyman License Number:
E USE ONLy) _3
a
I
�A
The Commonweauh ofmassachusetts
-DePartment oflndustrialAccide�ts
Office of Investigations
600 Washington Street
Boston, PM 02111
Workers I Compensation Ins-urane www-masx.govldia
)DECant Y"fnrrna+;mm e Affidavit: Builders/Contractors[Electricians[Plumbers
Name (Business/Organization/Individual).-___�f 5 PIVMif;
Address: -3 5-e
City/State/Zip-_,I,�. C�e
M 4 11 Phone #'
Are you an employer? Check the appropriate box:
LEI I am a employer with
_mt-time).
4. El I am a general c ontractor and I
CMP I oye e s (ful I an d1or p
2. 1 am a sole Proprietor or
have hired the sub -contractors
listed
pattner-
on the attached shget. t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers, comp. insurance
5. El We aie a corporation and its
required.]
I am a homeowner doing
officers have exercised their
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'
COMD, insurance re in -A 1
Type of project (required):
6. El New construction
7. El Remodeling
8. 0 liemblition
9. El Building addition
10 -El Electrical repairs or additions
I I - 0 Plumbingiepairs or additions
12.E] Roofrepairs
13 -El other
,I- L
!Any applicant that checks box #1 must also fill out the section below showing their workers, compensation policy infornuition.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
�Contractors 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 emp loy er M at is pro Viding w orkers' Comp ensa flon ins u ra n c efor my emp toy ees. B elo w is t7l e p 0 licy
information. andjob site
Insurance Company Name:
P0liCY # Or Self -ins. Lic. #:
Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers, compensation Policy declaration page (showing the policy number and expiratio'n date).
Failure to secure coverage as required uhder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
r do hereby certify under thepains and OfPeriury th at th e information pro vided above is true and correct
F' - ;-/j— - -) 7/0
WIcIall'se only. Do not writein t7lis area, toke completed by -
&Y Or town official
City or Town:
PermittLiccuse #
suing uthority (circle one):
1.13o ard of Health 2. Building Department 3. City/ToWn Clerk
6. Other
.2 — / /
4- Electrical Inspector 5. Plumbing Inspector
ContactPerson: Phone
Information and Instructions
Massachusetts General Laws chapter 1.52 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an ein
,ployee is defined as "...every person in the service of another under any contract of hire,
express or implied, ora� or written."
An employer is 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 apardnents and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenan . cc, 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 local 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 jnsuranci6 coverage required."
Additionally, MGL chapter 152, §25C(7) s '
enter into any c tates "Neither the commonwealth nor any of its political subdivisions shall
ontract for the Performance ofpublic 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) naine(s), address(es) and phone number(s) along with their certificate(s) of -
insurance. Limited Liatility Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of '
Accidents for confirmation of " Industrial
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 q�estions rega�ding the law or if you are required to obtain a workers,
compensation policy;please call the Depaitment at the number listed below. Self-insurcd companies should enter their
,self-insurance license. number on the appropriate line.
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 Inves�tigations has to contact you regarding the applicant.'
Please be sure to fill in the pernait/license -number which will be used as a referencdnumber. In addition, an applicant
that must submit multiple permit/licerise applications in any given year, need only submit one affidavit indicqing 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 new affidavit mustb'e filled out each
year. Where a home Owner or citizen is obtaining a license Or Permit not related ta 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 Commol-rwc-an o,NjasSachLjSetts
Department Of Industrial Accidents
Office of Investigations
600 Wasbington Street
Boston;MA-02111
Tol. 4 617-727-4900 ext 406 Or 1477-MASSAFE
Revised 5 -26 -*05 Fax # 617-727-7749
Www-mass.im/dia
-3 - 1-'5-- 0 Cn-
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............. 4FP ..... A.4JT#,,�
.......... ..... ........ e ..........
has permission to perform ........ ......... I ... ........... ........ 7 . ........
wiring in the building of ..:P ......... . ......................................
at ....... 3 ..... T� ............................. , North Andover, Mass.
F.ee4?'-'� ...'o . .... Lic. N:(� .............. 1.0 e .....
ELECTRICAL INSPECTOR'
Ch�ck #
6507
t
01,11cial li"'e 0111N
Commonwealth of Massachusetts
Permit No. 6�� 7
Department of Fire Services
OCCLIpanc� and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.9.051 fleavellialik)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
,\I] %�ork to lie perfornied in accordance �Nith the Massachusetts I'lectrical Code (\It'C). 52 ' 1 7 (AIR 12.00
(I'LLISE PRINTININK OR TYPELCL LYFORHITION) Date: S -/,,?, - 0 6
Citv or Town of- A)01� �-14 tl 97Z_ To 117e h7S1vL,1or oflVire.y:
By this application tile Undersionedgives notice ot'his or her intention to perform tile electrical work described below.
Location (Street & Number)'�',3 -�7:-(n 1v weioq
OwnerorTenant -b461,1,o (f-,- C z"',6 Telephone No.
Owner's Address SA o-) z -
Is this permit in conjunction with a building permit? Yes [g" No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service_ Amps Volts Overhead El UndgrdE1 No. of Meters
New Service 'Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: W Ile/ 4) Yt/ " Sh
Completion (?/ IllefiXo1i ing ohle inta, he waived 1?y the Inspector ql'Wire.�
No. of Recessed Luminaires
No. of Ceill.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool , %bove o In-
nd. grnd.
-,N—o.of Emergency Lighting
Battery_Uilits
No. of Receptacle Outlets d)o
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches go
No. of Gas Burners
No. of Detection and
Initiatiniz Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
I Number
IT9.n.s..,
.,KW.
lNo. of Self -Contained
Totals:
Detection/A IeKqM Devices
No. of Dishwashers
Space/Area Heating KW
Mul * , I
LocaIE] . llclp� 0 Other
Connection
No. of Dryers
Heating Appliances KW
Security S stems:*
�`evices
No. of or Equivalent
No. of Water
KW
No. of No. of
Data Wiring:
Heaters
signs Ballasts
No. of Devices or Equivalent
No. "ydromassage Bathtubs
No. of Motors Total HP
Teleconimunications Wiring:
No. of Devices or Equivalent
OTHER:
if,desirc(L (was rciplirecib.v the hi.spccior )/ Wiie:;
Estimated Value of Electrical Work: (Alien required by municipal policy.)
�Vork to Start: Inspections to be requested in accordance �0!i MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by tile o�vncr. no permit for the perrorniance of electrical work inay issue 1.1111CSS
file licensee rro� ides proof of liability insurance including "conipleted operation" coverage or its Substantial CqUivalent. -111C
undcrsigned certifies that 'AlCh Co�, n- W,,c is in lorce, and has cXhibited proof ofsanic to th- -nlit issuilw office.
e Pei
(Spccily:)
(1-111-:CKONE: INS(-'R.\N(.F- In BOND 0 (-)Fll[:R I
I cert�ljy, wider th e pains if nd penalties ofperju ty, 1h tit th e infi)".01fation wfib is application is trite etit d emuplefe.
)� / fj� . . .
FIRM NAME: C;r- (Z- LIC. INO.A30---
Licensee: L-:%�- Signaturt LIC. No.el-'79dpl�-
�-Iitvl, L, I P1 1H MC liL( lf,';L' 11111)1/7 ( I- 107e.) Bus
n !�P . Tel. No.,
Ad�res Slq L E> /V. Alt. Tel. No.:
*Security Systein Contractor License required For this work; if applicable, enter the license number here:
OWNER'S INSURANCE WAIVER: I arn aw;�tre that tile Licensee doc�y nol have the liability inS1,111111CC COVcr',we llornlall�
required b� law. By nlysignature below, I her�:by waive this requircincrit. I ;un tile (check one) E] owner [] owncr'�; ;i,rent.
Owner/Agent
3ignature Tcltphone No. PFRMIT FFF,.- i
/� t 4 /-,(, p k
0
It
Location
C
N o. 5- 0 Date
,40RT
TOWN OF NORTH ANDOVER
jaiwalMilk I Certificate of Occupancy $
Building/Frame Permit Fee $
A s
CH S Foundation PermitFee $
RECEIVED PAYMegher Permit Fee v $
NOMAN30\ERCOLLECiewer Connection Fee $
Water Connection Fee
qgFTAL
Building Inspector
Div. Public Works
Location
��rr-7
No. Date
,&ORT
1�60 TOWN OF NORTH ANDOVER
0
Owicate of Occupancy. $
otl�;
,oRg/Frame Permit Fee $
CIM4U Foundation Permit Fee $
Other Permit Fee $
4 "Connection Fee. $
'Water Connection Fee
TOTAL
Building Inspecior
Div. Public Works f7
klocation
No. 6 Date
A�9
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ 5'0, c-� 0
Building/Frame Permit Fee $
Foundation Permit Fee
Other,Pgrmit Fee
Sewer Connection Fee
Watdonnection Fee
%X3'1 f'OTAL
Building inspector
Div. Public Works
J,
Location w
N& Date
,&ORT TOWN,
Of
,, NORTHAN60VER
0
Certificate of Occupancy $
. . . . . . . . Building/Frame Permit Fee.. $
3S Foundation,Peemit F6e $
r
Other Permit Fee
e nnection Fee
—/2, -Water Con'nectioh Fee
),go
A�Buhdlng Inspector
qq
Div."Public Woiks
PERmIT 140. APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASsf1A4)'5'3j L/ I PAGE I
0
MAP 4-40. /0 r
I LOT NO. aroNLVoo C[ RE)
2 RECORD OF OWNERSHIP IDATE
OOK
;PAGE
ZONE
SUB DIV. LOT NO.
LOCATION aroAl Wo6d
PURP6SE OF BUILDING
OWNER'S NAME 4:KZ O -e tlze/ z:o
NO. OF STORIES Slik 42
OWNER'S ADORES
�pgz
BASEMENT OR SLAB
e",7,)4
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS I ST 3RD
_,/,&) I N I
BUILDER'S NAME gp
g �gl
SPAN
12
DISTANCE TO NEAREST BUILDING p
DIMENSIONS OF SILLS 2
POSTS
DISTANCE FROM STREET
DISTANCE FROM LOT LINES SIDES 3,5q- '5�0 REAR /0
GIRDERS
FRONTAGE
AREA OF LOT p4,
HEIGHT OF FOUNDATION THICKNESS
17 -=l
IS BUILDING NEW
SIZE OF FOOTING x
-- z L-f��
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 'y /'o
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIC1,4S
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 3 Fm rowmmT -'c
PAGE 2 FILL OUT SECTIONS 1 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
9 DATE I �1.
3 PROPERTY INFORMATION
LAND COST 47"!nl
EST. BLDG. COST
EST. BLDG. COST PER SQ. Fir.
EST. BLDG. COST PER ROOM
.SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SKILECTNIEN
.Ull DING INGPEC-TOR
SIGN)MURUF OWNER OR AUTHORIZED AG . ENTO'
F E E
OWNER TEL,
PERMIT GRANTED CONTR. TEL.
CONTR. LIC. # -7--"-'�
Or 2 8 1992
'72
BUILDING RECORD
Occ.110ANCY 12
:§INGLE FAMILY
MULTI. FAMILY
�OF F , C E S
APARTMENTS
CONSTRUCTION
"t'2 FOUNDAT , ION
CONCRETE
CONCRETE EIL K.
BRICK OR STONE
PIERS
8 INTERIOR
a
PINE
-;TARDW D
PLASTER
DRY WALL
-UN FIN Loll
FINISH
2 3
3 BASEMENT
AREA FULL
L
. B M'T AREA
1/1 1/2 1/1
-FI_
FIN. ATTIC AREA
�!O 8 M -T
FIRE PLACES
T
7:
L
HEAD ROOM
MODERN KITCHEN
4 WALLS
9, FLOORS
CLAPBOARDS!
B
z
1
2
3
DROP SiDINGJ
CONCRETE
Wo D 1�!ING',ll
EARTH
ZS P 12A L 113191f�
S
ASBESTOS SIDING
VERT. SIDING
STUCCO ON MASONRY
STUCCO ON FRAME
HARDV,/ D
COMMCN
ASPH. TILE
'AAA?
BRICK OW--M7ZONRY
BRICK ON FRAME
ATTIC STRS. & FLOOR
CONIC. OR CINDER BLK.
WIRING
I
STONE ON MASONRY-,
STONE ON FRAME
ERIOR I Ao"I POOR
ADE 1 NONE
QUATE I LH
10 PLUMBING
5 ROOF
GABLE
I
BATH 13 FIX.)
TOILET RM. (2 FIX.)
--
GAMBREL1
I _tIP
MANSARD
FL—ATJ
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
DERN FIXTURES
TILE FLOOR
TILE DADO
6 F ING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL EMS. & COLS.
HOT W T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H*T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
I
B'M*T en I 2nd
l2t �— I 3rd
E ECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT.AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS'OF BUILDINGS. WITH. POR634ES. GA-
.. ---'S. ETC. SUPERIMPOSED. THIS REPLACES.PLOT PLAN.
NK
X
J, 3- IFT
-10/-28/92 13:149" 617 776 '35 166
DEPARTMENT OF PUBUG SM
COMMONWEALTH
1010 COMMONWEALTH AVE,
OF,
-MASSACHUSETTS BOSTON, MASS. 02215
NCLOSE CHECK OR MONEY OADEP
LICENSE
EXPIRAkTION DATE CONSTR. SUPERVISOR FOR REQUIRED FEE,
06/30/1993 MADE PAYABLE TO
RESTRICTIONS EFFECTIVE DATE LIC -NO,
NONE 6/3011991 019862 OMMISSIONER OF PUBLIC SAFETY"
RTHUR R GIANGRANDE
7 PLEASANT (DO NO �tj TF3SH).
SS N, 025-124-986Z READING-.1MA 0 1 864;k! -NOTE FEE INCREASE
PWOT NLY� FEE: -
100.00 TIVE6FEB. , 1 1989
HEIGHT: NOT VALID UNTIL S�GNEV BY LICENSEE AND OFFICIALLY
TAMP 09 S.. NATURE OF THE COMMISSIONER
DOB:
05/28/1933
T DETACH LICENSE ST
lcIA3A DMUMINT MV upe BiGN NAME IN FULL -A
RIE. N THE IERIO. oq' SIGNA OF LICENSEE j BOVE SIGNATURE UNE
0 TH HOLD WHIN IEINA)TAII
T EDE IN Yl�'Rls O�U -q COMMISSIONER
DSS 1, 1 NC.
i
i
10/28/92 13:48 1& 617 776 3350 106 DSSI,INC.
G & Z DEVELOPMENT CORP.
265 Medford Street, Suits 3e3
Somerville,'MA 02143
FAX NUMBER (617) 776-3350 Ext. 106
VOICE NUMBERi (617) 776-3350
DATE SENT:
SENDER'S NAMEs
NUMBER OF PAGES: THIS COVER AND
DELIVER TO:
COMPANY KAMEi ZL),*-) 0L ALY711
DEPARTMENT: L) 7-�
INDIVIDUAL: k �: TO C t<
FAX NUMBER: 6-
COMMENTS
0i
0 Z
FORM U
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
SUBDIVISION
ASSESSORS MAP /0 A/ — ;C -
SUBDIVISION LOT(S)
PERWENT ADDRESS (ASSIGNED BY D.P.W.)
STREET V ) C)�� -S L40 -
APPLICANT C- -Z oeevj
DATE OF APPLICATION, 9
TOWN USE BELOW THIS LINE
CONSERVATION COKMISSION
CONSERVATION ADMI'N.
BOARD OF HEALTH
HEALTH SANITARIAN'
DEPARTMENT OF PUBLIC WORKS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE, APPROVEA) / A -2 -
DATE REJECTED r
DRIVEWAY PERMIT a.4, - - A--- - J- - - - --'# -1 AP 45te-c- 112 Z � 421
SEWER/WATER CONNECTIONS P-�f 0�'v
FIRE DEPT. C AW % I pity/
ily, i2?—kS
RECEIVED BY BUILDING INSPECT10N
DATE
This form shall be signed by the agents of the Planning and Health Boards,
the Conservation Commission prior to the Issuance of any building permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
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(:.*()NSI: I WATION
Town of,
�jl
NORTAl ANDOVE
111 VVill IN 111
I'l,ANNING' & (,()Alr%lL!Nl'l"Y
KAH.FNI 11.1'. NI:I.S( V. D11 tl:(:*l ( n t
CHIMNEY APPLICA11014 ANO VERAll f
10; 5
11; 1 7) 1 iiii-, -17 7!;
)ATE. P E R N I'l,
. # � I �
OCATION at L4 i
71-2-3r�
WNER'S NAME:. Lit V1 1) tT
-7 4
UILVERIS NAME: ' ' '6"
ASONIS NAME: TCF e e- -?19q
ASONIS ADDRESS: �: c>
�SON'S TELEPHONE:— 9
WERIAL OF CHIMNEY:
VTERIOR CHIMNEY: WERIOR CHIMAY:
JM BER AND SIZE OF FLUES:
/4,' el
HICKNESS OF HEARTH:
,�U clv�nney oa (jiup-Cace con()aAm to 4ILe. imimil(elliell-05
egutat-iow been %eceZved:_
,ddz—
kT.E: �0-
IGNATURE OF WSON:
oO the code and have "ttice.6 and
-EE
':RMIT GRANTED: F
)BERT NICETTA
jILVING INSPECTOR
4SPECTEV:
-MARKS:
ft
SOLID BLOCK R [�(J� I It E 1)
THIS PERMIT 1,11ISF GE VISPLAYLL) 014 111E PUMISES
March 21, 1993
Mr. Walter Cahill
N. Andover Building Inspector
N. Andover, MA
Dear Mr.Cahill:
This letter regards property at 3 Ironwood Road that you are going to inspect for all
occupancy permit.
Due to weather conditions, G & Z Development Corp. could not complete certain exterior
work (driveway, landscaping, exterior painting, side porch steps, rear deck, etc.). This
.7 t�'
letter is to confirill that we will not hold the Town of North Andover or any of its employees
liable for any injuries that may occur due to the state of these uncompleted items.
If you wish to contact us we can be reached at (508) 851 -0720. Thank you for your
assistance in this matter.
CWL
Christopher J. Cool W: (603) 886-1230
Susan L. Brodeur W: (508) 475-9214
75 Apache Way
Tewksbury, MA 01876
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06/08/2005 10:49 19786888058 SMOLAK FARMS PAGE 02
June 8, 2005
Re., Ironwood Bog & Beavers
Dear Neighbor,
I am sure you are all aware of the beavers that are living next to you in the bog. Until
now, they have not impacted us In a negative way. However, we are now seeing more
and more damage. I know there has been some impact on your properties as well. I won't
get into the problems that have occurred on our property as I am interested in finding
solutions not getting into investigative work. There is a fairly simple and effective way to
remedy the problem and I would like to discuss It with you. I believe the company is called
Beaver Solutions which is the company that the town uses. I spoke with the owner, Mike
Callahan, and asked what the solution would be, I have enclosed sorne literature about it. it
is a device that is installed that keeps the water from rising above a certain level and the
beavers cannot compromise the device.
. I have spoken with Susan Sawyer from the Board of Health and Allison McKay from
The Conservation Commisslon. They are in favor of applying for an emergency permit
which is issued for a period of 10 days.
lam getting estimates from the DPW as to what they have paid and was wondering
if we,�uuld split the cost of the installation. The cost should be in the $9W to $1200 range
and I guess it is installed rather quickly. I think that this is a proactive solution that will benefit
all of us,
What I would like to do is meet sometime next week briefly and get this in motion
with the cooperation of the Board of Health and the Conservation Committee. Please
contact me at (978) 688-8058 and leave me a message. I will work to get more information
in the meantime.
Thank you,
H. Michael Srnolak Jr.
cc. The North Andover Board of Health - Susan Sawyer
The North Andover Conservation Commission - Allison McKay
06/08/2005 10:49 19786888058 SMOLAK FARMS
. Beaver Solutions - Beaver Management) Education and Consulting
B[AYIR
S 0 L 0 110 N S
PAGE 03
Vage 1 01 1
P,
I Beaver SolutionsTm: Consulting and
I is 'Beaver Management Services
\'Ooli Aincricil Solving Beaver/Human contlicts, since. 1998.
1111NIC'Itiolls A leading expert in resolving human/beaver conflicts. Since 1998 we have applied
I csl 1 moll mIs innovative technologies to solve hundreds of beaver problems in the northeastern United
1\ States, our highly successful devices provide cost-effective� long-lasting, and
environmentally friendly solutions to beaver -related flooding problems, We also offer
Pcrl)llttill�11, IK'aic" licensed beaver trapping,
Available for consultations and trainings throughout the U.S.-
Our comprehensive beaver managernent plans are particularly
valuable for towns, or groups with large property management
responsibilities, We also offer customized training workshops for
individuals or groups,
C-�i I U I*C C We are proud of the reputation we have eamed with highway
departments, public utilities, major railroads, state and federal
agencies, private businesses, and property management,
conservation and humane groups, We provide our clients with -the
most comprehensive beaver management services available.
Beaver Solutions
98 Bay Road
Hadley, Massachusetts 01035
Phone: (413) 585-9145 Fax: (413) 587-9788
S - u
,iLe M;W I ie n5.Pfljqe I PriYAcY-PQ1J-OY-
l3eaver repairing
a breached
beaver dam. -
All content and images in this web site am property of 13eaver Solutions. The use of anY images and informati,
on this web site, without the expressed consent of Beaver Solutions, is prohibited. Beaver Solutions Copyrigh
2005. All Rights Reserved.
At�omt,Bf�gv!!t solgtion - s - AbOt—BIZAKETIS - RMavl�0-3iQlggy - 5 L M - anagernev
L-AQrlb Ameri - Howjq.Lrajn�o - Beayg�r
AdOitionaL9P5Q-1!rce$ 09ELV9KCOM!in9 �9AO 1-9-4 -1
Lf dqK _MkCqrkq1L1,tk& - oqqNTr.Manggenqn;�.Educa.t..i..o-n.
Nvcation.aO Qpnsulti,ng -)-3pqKerJvWag-qm;V -- ?Ltion
It pM�pc
5,,- NQKtjigast V tive Fm�Lps - QuAY9 yTo�ection&WKqrQear Svstem�
And Consulfiog.5PTYice- 5 - QW qVt
t T: n Velma - TEWPing
Nyersio panj§ - Ed ional.P -0 Le
y _Devices gg
"n Flexible. P
ubli - Testimonials - C Us - Beaver
.:q�at Q.
EAQ - F91-51
Sqtptiopss
http://beaversolutiOns.cOnV 6/8/2(
06/08/2005 10:49 19786888058
Beaver Solutions - flexible Pond Levelers
V-1
Noifli Amer. 1c:1
"\J1t)t1t
ISSLICS
( olit �Ict
1"A Q
'About I Is
,..%dd10o11;.11
JZk:S( )LIrk:c"
BEIYIR
S 0 10 110 N S
SMOLAK FARMS
PAGE 04
Fage ( ot
F Flexible Pond Levelers T.M
'Where flooding ftom a free-standing beaveT dam threatens
human property, health or safety, a Flexible Pond Leveler TM
'pipe system can be an extremely effective solution. If properly
designed and built, a Flexible Pond Leveler TM will create a
permanent leak through the beaver dam that the beavers cannot
stop. Our Flexible Pond Leveler TM devices are so effective We
,*guarantee them. They eliminate the need for repeated trapping
despite the presence of beavers.
A Flexible Pond Leveler
being installed, ..
In order for these pipe systems to work, they must be designed so that a beaver cannot
detect the flow of water into the pipe. The Flexible Pond Leveler TM works by
surrounding the submerged intake of the pipe with a large cylinder of fencing to prevent
the beavers ftom getting close enough to the intake to detect water movement, As a result
the beavers do not try to clog the pipe, and maintenance is rarely needed. Usually a pond
depth of at least three feet is required for the Flexible Pond Leveler TM to function
properly,
The height of the pipe in the dam determines the pond level (see diagram). Water will
flow through the pipe unless the pond level drops below the peak of the pipe. The pipe 1$
set in the dam at the desired pond level, and can be adjusted up or down if desired.
Flexible Pond Leveler TM Diagram
Flexible Pond Leveler TM pipes do not need to be sized like culverts to handle
catastrophic stom events because heavy storm runoff will simply flow over the top of d
dam. Following the storm the pipe will return the pond to the normal level. Some mild
pond fluctuations, are possible following very wet periods, but since the dam height is
controlled by the pipe the pond size remains controlled at a safe level.
When installing a pipe system it is very important to lower a p6nd only enough to prote4
human interests. The more a pond is lowered the more likely itis beavers will build a nc
dam downstream to render the pipe ineffective. Lowering a beaver pond by up to one
vertical foot is generally not a problem.
Whenever a pond must be lowered by more than a foot a single round of trapping may'
http;//beavemolutions.com/flexible pond levelers.asp 6/8/2(
06/08/2005 10:49 19786888058 SMOLAK FARMS
* Beaver Solutions - Flexible Pond Levelers
PAGE 05
r dr24; 4 tj L d.,
necessary prior to the flow device installation. When new beavers wit"I't the memory of
the higher water level relocate to this area they are more likely to tolerate the smaller pond
so repeat trapping will not be needed. Most flexible Pond Leveler TM failures are due to
new downstream damming in response to a dramatic lowering of the water level.
Begver SolutiO08
99 Bay Road
jjadley, N4assachusetts 0 103 5
Phone: (413) 585-9145 Fax: (413) 587-9788
Site..M.Ap I le-M-PUDIK I P--TiY-O'qy-P-QIL'cY
,ontent and images in this web site are property of Beaver Solutiojis. The use of hnY images and informatio,
Ail r consent of Beaver Solutions7 is prohibited. Beaver Solutions Copyright
on this web site, without the expressed 2005. All Rights Reserved,
v!u Whi - f1p JAIQU - -
Abvtle- fiorLs - Ab-OAt Bg�avpt* -ayq-Di -gQment,
11ing
C WILItilIg
AdtitionAll ROMP` ggattQp and —.0. BeaKer Man@gqn -,I�Auqati.gp
Cu verC pig. $ystem� -
Ed�!Qafion and QPnWlt 119
-'�je ices
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Diversion uam§ - 54q—atiQ!%I.FXgSgRt-4( m - T.MI-irRQIWE!Is, - Q0144c-t- V5-- pgayer
r -s - Trqt.�r .
13.gait f A -Q - FQr-Mi ting Is$ -u -P§ t�c-2"'Q
hdp://beaversolutions,com/flexible. pond levelers.asp 6/8/2(
778
,koRTH
0
Date ...... �-.ZU
TOWN OF NORTH 'ANDOVER
PERMIT FOR WIRING
S US
-,6
This certifiesthat .......... .... .............. ................ .............
.........................
has permission to perform ..... .. ... ....
.............. .
wiring in the building of .... ..................
at .............. ........ .............................. . North Andover, Mass.
.. ........
Fee. ............. Lic. ................ E . C . TR . ICA . L INSP . ECTOR .................
41 -
CM
WHITE: Applicant CANARY: Building Dept. PINK: Treasu rer
000 ne Commonwealth Of Massachusetts Off jet Use only
NJ Deparment of Public Safcry * 1`0#44t No.. -_ - �
BOARD OF FIRE PREVEN71ON REGULAnONs 527 CMR 1= Occuilancv 4 rat owcmd_/J
# 3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All *vrk to be PaiOrnild 1A OCC*fd&nCg Wilh jhC M&4"ChUSena F
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j#Clr,C&I Code. 527 C1,R7,
(PLF.ASE PRINT IN nM OR E Alm INFORMAXION) 5�
3 -7
Date 7
City or Town o A>,) y —
v
To the Inspector of Wires:
1he undersigned applies for a permit to perform the electrical work described below.
Location (Streat Number� 3
Owner or Tenant
Owner's Address
Is this permit in conjunctior..wL h a bU441ng
;S�t 4 - permit: Yes C1 No eck Appropr a Box)
Purpose Of Building tl�3m(
Luiting Service —.Utility Author zat n NO..
New Volts Overhead El Undgrd 0. f Haters
—u—mri—ce - - ps- Jolts Overhead C3 Undgrd C3 NO- of Meters
N=b4r Of Feeders and Ampscity
Location and Nature of Proposed El . ectrical Work
161d 161mia
No. of Lighting Outlets No. of HotlTubs
No. of Lighting Fixtures Lmming Pool Above No. of Transformorm
n. -------
No, of Receptacle Outlets rnd Generators KVA'
No. of Oil Burners No, —Li 'gh _rl n _g
Bal
Recep tacl c 3
s No. of T�n4
Above.
'r.d_
Out e No' Of Oil Burne rS "'j
Ou
NO- Of Switch 0itlets No. Of Cas Burners
P FIR4 ALV14S No. of Zones
NO. of Ranges No. of Air Cond. local No. '10f Detection and
tons
Lspos of Hett Total jo� 1 Initiating Devices
No. of Disposals Heat Total I tal
No. of Pu_%,s
No. of Dishwashers Pu=%)s Tons KW No. Of Sounding Devices
Space/Area Heating KW No. Of Self Contained
De tec t Lon /Sounding Devices
No. of Dryers Heating Devices
KW Local 0 Municipal 00ther
a oc,
No. Of Water Heaters KW 00. ot Connection
Sizns Ballasts Low Voltage
Wiri
ti===±1 ng
No. Hydro Massage Tubs No. of Motors Total HP
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current LiabilL_LY Insurance Policy including Completed Operati6pi, Coverag;Eor_�ts substantial
equival e n t. YES U NO [] I have submitted valid proof of same to this
If you have checked YES, Please indicate the t office. SE] NO
ype of cover by che ki the appropriate box.
INSURANCE t BOND'13 OT1HER(P Qlease Specify)_ &7; Y.
Estimated Value of Electrical Work S
Work to St . art p I ation ace
i Inspection Date Requestedi Rough ---- Flnsl.�_
Signed under the enalties 01i �erju*
ry;
'y
FIRM NA.J
HE C, d 7 &
LTC. NO.
Licensee Signature
t� V—
Address 41&(. LICi NO.
�����us. Tel. —No.- 775-- -3
:. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have th insurance coverage or its sub-
stantial equivalent as required by Massachusetts Genera l_t;ws7,_3'nd_j�&c may )signature on this permit
application waives this requirement. Owner Agent (Please che c k one
( gnature of Telephone No.. PERMIT FEE S
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