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Home My WebLink AboutMiscellaneous - 325 Abbott Street 15 BUILDING Fit, r i r i f Date....... ....... OF NOR7H,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSMC U This certifies that ...................................................... has permission to perform ........................ .................................... wiring in the building of....... 4-5/ at ..........................................................North Andover,Mass. Fee... ..-'........Lic. No/ . .. ................................................................................... ELECTRICAL INSPECTOR Check# 2 9V 64, YVL Commonwealth of Massachusetts OfficAUse ' '� Department of Fire Services Permit No. 11,717Aonly Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NBC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: g t'2 V;6 16 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) f 3 2" j h t- �+, Owner or Tenant 161h I c>t G S ( Telephone No. 479'-'M-3 s3 Z Owner's Address .125 bd>4-1- ` Is this permit in conju ction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Bu- Utili Authorization No. - Existing Service Amps '�1/0/00 Volts Overhead Undgrd❑ No.of Meters t New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and pN,a,�ture of Proyp�osed Electrical Work: 1 � � � tQ q Se Completion of r,_,r_rs__...__.�ip+-. x L�-:.� �*_+ti=+�r--.,___:__. rlr�•--_ No.of Recessed Luminaires 13 No.of Ceil:Susp.(Paddle)R' No.of Luminaire Outlets No.of Hot Tubs No.of Luminaires Swimmin Pool Above ❑ g rnd. I. V• No.of Receptacle Outlets No.of Oil Burners �( No.of Switches ® No.of Gas Burners No.of Ranges No.of Air Cond. Tot Toi No.of Waste Disposers Heat Pump Number .Tons Totals: No.of Dishwashers Space/Area Heating KW No.of Dryers Heating Appliances I j No.of Water No.of No.of Heaters KW Si ns Ballas No.Hydromassage Bathtubs No.of Motors Total OTHER: Atfach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 50,D d (When required by municipal policy.) Work to Start: 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 tthe licensee provides proof of liabili ' urance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify) I certify, under the pains and penalties ofperjuty_that the information on this application is true and complete. FIRM NAME: .?C WP' i°n Q C+%11C I"q LIC.NO.: Licensee:j a 4 1 i Y!S Signature LIC.NO.:^ cA 3 (If applicable,enter "exempt"in the license Timberline.) Bus.Tel.No.- Address: 10 6! i-flSOtj 0 / �T)=I Alt.Tel.No.: -171-761' *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent / Signature — Telephone No. PE$MIT FEE:$ Commonwealth of Massachusetts OfficA UseOnly Permit No. 1-71 //"I' Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASEPRINTflVMK OR TYPEALL INFORMATION) Date: g /a aZ 6 1 (o City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ` 32,5)- AUott ` f, Owner or Tenant 16lh ya s(4 S r Telephone No. 47F'-73)-3,573)- Owner's 17573)-3s3)- Owner's Address . Is this permit in conjuction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Z951-A ei7-i- j t10". Uti1i Authorization No. - Existing Service Amps PO Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: y5e 1 ►11 FSGfm -13 r�C�Sse� � ; h+�'rl OtAi-ler �� , b w ' rye. 1-0 Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 13 No.of Ceil:Susp.(Paddle)bans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above E] In- [:Io.o mergency ig tmg rnd. grnd. Battery Units No.of Receptacle Outlets 6 No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and ® Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Dis posers Heat Pump Number Tons KW No.of Self-Contained p Totals: ............................................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of WYres. Estimated Value of Electrical Work: 0 O (When required by municipal policy.) Work to Start: 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 liabili ' urance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury_that the information on this application is true and complete. FIRM NAME: .?c3 N t ✓L e C��1 C t�4 LIC.NO.: Licensee: 7iCAn Cf 1 E i »S Signature LTC.No.: 13 5 -19 (Ifapplicable,enter "exempt"in the license ,mber ine.) q Bus.Tel.No.• Address: 10 69 b��1.S O m S < �1 t (�� L q , .M A- 0 $ _ Alt.Tel.No.: '171-761- (� ,Z 'Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent / Signature — Telephone No. PENMIT FEE:$ ' The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. , Applicant Information y Please Print Le ibl Nalne(Business/Organization/Individual): —)6 Address: 16 6 G r r i's Oh 5 Q City/State/Zip: la 1 0 4 AA O) $tel I Phone#: Are you an employer?Check ttie appropriate box: Type ofrolect(required): 1.N/1 I a employer with employees(full and/or part-time).* 7. ew construction 2. am a sole proprietor or partnership and have no employees working£or me in S. Fj Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.F]I am a homeowner doing all work myself[No workers'comp,insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. • 12.❑Plumbing repairs or additions 5. I ama.general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ g- 13.❑Roof repairs • These sub-contractors have employees and have workers'comp.insurance.# 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *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 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 state whether or not those entities have employees. If the sub-contractors have employees,'they must provide their workers'comp.policy number. Iain an employer that is providing workerscompensation insurance for my employees.•Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: � a s 08 � S+ _ City/State/Zip: N, endo ll d, G' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby 2eer�Ir,� p ' sand penalties ofperjury that the information provided above is true andcorrect. Si nature: Date: "-) Phone#: q 2 o_ ?6 1- d Official use only. Do not write in this area,to be completed by city or town official.. I City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: COMMONWEALTH OF MASSACHUSETTS,>. Bf3AR pF ELECTRICIANS ` ' 1 LIC ISSUES T11 FOLLpIENE E�ECTRICSAN•; I AS A ► EG JE3URN£YM ` .JOHN H: HIGGINS 111 9 CROSS ST APT $ _�- ,* .VAo1$63-111.4 4 � LMSFORD CHE 1 � B 0 1 - i 6 Locations "i No. /.r !� D a t e:,—:z l ��-1I • - TOWN OF NORTH ANDOVER • yr Certificate of Occupancy $ Building/Frame Permit Fee l tl - - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# i� 0 Building Inspector xw�ly . TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: -�/ Date Received At Permit �hh* �9SSAcHu`+�� Date Issued: t4OORTANT: Applicant must complete all items on this page LOCATION 32 S A-�I TT , kwr, Arboyixt... AW Print PROPERTY OWNER rv-M 014,0 45l Print MAPNO:&39 PARCEL: UP_ZONING DISTRICT: Historic District yesnn Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building V One family ❑Addition ❑Two or more family ❑ Industrial IOAlteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑Septic 0 Well D Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer �,u/4,-, r��✓YI�'N1 �q•c�U ��t/LTi7/oc� _ �Cli�%�Z.9�1� �� C4 fm. Flo 41f&-p Identification Please Type or Print Clearly) OWNER: Name: (0AA l�a[2ASl Phone: 17e- 116 -2577 Address: CONTRACTOR. Name: NICK 36rI1rFF4 Phone: 7- 7Tq- 7SZ� Address: 440 670 74 a Supervisor's Construction License: Exp. Date: CS IQS SZq 2�zr�;� Home Improvement License: S� S3 Exp. Date: ZS 7 Z ARCHITECT/ENGINEER N �i4 Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 21. 7S6 FEE: $ 2C 1. Qo Check No.: 2W. 2Q2-- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acce to the guaranty fund Signature of Agent/OwnerC N Signature of contractor l Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan �❑ Starnped Plans ❑ 1 TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. Permanent Dumpster on Site ❑ 1 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM )O PLANNING & DEVELOPMENT Reviewed On Signature_ V _ COMMENTS kNSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on R o Si natu 4:p�-4 COMMENTS M - l -bwdS r�5 c > � Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes s' Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Siqnature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARaTMEifVT , .� TempiDumpsterton.s�teo �L ted at 124 Main1Street, �� '"'� " t�- +' �'^ + �+ , r rip(j• ` s _{�y7 fir. r r, ,.,s- a�^r ` .. ia.i'tl FireDepartmentsignature/date�•� -�°j'�G.��•+.i{.��'�j'.�1��1„*�'i al'� t�` �eYtt 3c�r�.�.pp j f r`' t�'/ `!,�',4�G F t r `�r j� ,.� ti S f�. '�._- i �i r "• s'+ �,' '..•,n h'Sr# .. / .• i.a :w7 ,a"{. 4 ,.� f w�" y + t "' 4 N' ;� as i+i n .�.+ 4;f a f� t M` ,, r "r •a s�� „'w s.�y u)"'� t c 'sr:.l..ry . �:s�.N" COMME.NTS:`.., :.xr.`'t ., t, .•t+-'9't` Y.:'i'a��rl�p T' Yjf wM„~2 �< I•s. .�'_`a_ aT '�.+r.�' Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 21 ,750.00 m $ - $ 261.00 Plumbing Fee $ 32.63 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 32.63 Total fees collected $ 426.25 325 Abbott Road 892-2016 on 2/17/2016 Basement Remodel � NORT1y Town of A No. _ h , ver, Mass, 141t, COCNICNIWICM 1 x.95 RA'rE D U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .... Q�!/�•... ..V s 1 , ...., .. BUILDING INSPECTOR . ................................................................................ LL has permission to erect.......................... buildings on .5.z5......fthzT :.917_0............ Foundation T Rough tobe occupied as ....... ^ ►........ .................................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. Y40 ��i �o PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final a PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TARTS Rough Service ............... ..... ... .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. C©►'Y U L [D E This agreement made on the 12 of January 2015 by and between Tom Vorrasi herein after called the "Owner", and NS Builders hereinafter called the"Contractor" that the Owner and the Contractor, for the consideration herein under named, agree as follows: Article 1= Scope of Work: Permitting Building permit fees and inspections Framing Install interior watts per discussion onsite j Walls shall be attached at floor with mechanical fasteners Alt lumber in direct contact with concrete shall be pressure treated Alt lumber not in direct contact with concrete shalt be typical KD Framing shall be 16'on-center Ceilings shalt be installed to the maximum height as possible Duct work shall be wrapped tight to allow for the smallest soffits passi to �N37'A// /uS u/srt?LU r'►�A/.�-�70-��= ',c(ilI/orJ /,cl�+�/" Wallboard ✓ Install 1/2" blue board and veneer type plaster Smooth finish wails and ceilings Paint Prime walls and ceilings throughout Ceilings: single coat white, flat Watts: two coats, eggshell, color TBD Trim: two coats, semi-gloss, white Trim, Doors and Finish Install (2)interior doors Mechanical space Under stair closet Instatl casing: (1)french door (2)windows (2)interior doors Install baseboard throughout space Instatl shelf at foundation where required (Moulding profile shalt match existing home) Custom built wine closet as discussed Allowance based on discussion Refrigerator not included, homeowner to provide Design drawings to follow 7C (617)799-75211 nick Onsbuildersma.com I mmnsbuildersmacom Post Office Box 47 Mansfield,MA 02048 1 Crf 4 �Y i Article 2. Time of Com letion: The contractor shalt complete the work described above in a professional and timely manner. Contractor is not responsible for delays associated with weather, local jurisdiction and responsibilities of the Owner that may hinder the Contractors performance. Such as but not limited to, owner supplied materials and labor. Article 3. Contract Sum: The Owner shall pay the Contractor, in current funds, for the performance of the Work, subject to additions and deductions by Change Order, of the Contract Sum of: Twenty-one thousand seven hundred and fifty Dollars $21,750 Contract Sum in Words Contract Sum in Numbers Article 4. The Contract Documents: The contract documents, together with this Agreement, form the Contract and are as fully a part of the contract. N/A Article S.Alternates: The following Alternates have been accepted and their costs are included in the Contract Sum stated in Article 3 of this Agreement: 1.) Flooring option excluded and shalt be discussed and determined at a later time Article 6. Permits: The Owner shall obtain all necessary building permits and licenses required by the local municipal/county government to do the work;the cost thereof shalt be excluded as part of the contract sum. Should the Contract require additional permitting the Owner shaft agree to allow the Contractor to act upon his/her behalf. 1 -, , as owner of the subject property here by authorize All �S c— t �7_e _ to act on my behalf, in all matters relative to work authorized by this contract, including but not limited to permitting. /1/3/x`6 Sigliature of Owner Date (Signed under the pains and penalties of perjury) Article 7. Workmanship:The contractor shalt provide the Services in a workmanlike manner, and in compliance with all applicable federal, state and local laws and regulations,including but not limited to all provisions of the Fair Labor Standards Act, the Americans with Disabilities Act, and the Federal Family and Medical Leave Act. Article 8. Payment: Payments shall be made to NS Builders, PO Box 47 Mansfield,MA 42048, in the amounts as described below: X (617)799.7521 t nick(Onsbuikiersma.com I www.nsbuildersma.com Post Office Box 47 Mansfield,MA 02048 2 of 4 �7 Payment Schedule Deposit due upon accepting contract $1,750 Due upon completion of framing $4,000 Due upon completion of blue board and plaster $8,000 Due upon completion of interior trim $3,000 Due upon completion of paint $2,000 Due upon acceptance of drawings for custom cabinet $1,000 Due upon completion and installation of custom cabinet $2,000 If any invoice is not paid when due, interest will be added to and payable on all over due amounts at 2 percent per month, or the maximum percentage allowed under applicable laws. Owner shall pay all costs of collection, including without limitation, reasonable attorney fees. In addition to any other right or remedy provided by law,if Owner fails to pay for services when due, NS Builders has the option to treat such failure to pay as a material breach of this Contract, and may cancel this Contract and/or seek legal remedies. Article 9hange Ord r• Owner, or any allowed person, e.g. tender, public body, or inspector, may make changes to the scope of work from time to time during the term of this Contract. However, any such change or modification shalt only be made in a written "Change Order"which is signed and dated by both parties. Such Change Orders shalt become part of this contract. Owner agrees to pay any increase in the cost of the Construction work as a result of any written, dated and signed Change Order. In the event the cost of a Change Order is not known at the time a Change Order is executed, NS Builders shalt estimate the cost thereof and Owner shalt pay the actual cost whether or not this cost is in excess of the estimated costs. Article 10. Warranty j The Contractor shalt provide its services and meet its obligations under this Contract in a timely and workmanlike manner, using knowledge and recommendations for performing the services which meet generally accepted standards in Owners community and region, and wilt provide a standard care equal to, or superior to, care used by service providers on similar projects.The Contractor shalt construct a structure in conformance with the plans, specifications, and any breakdown and binder receipt signed by Contractor and Owner. Article 11 Free Access to Worksite• Owner wilt allow free access to the work area for workers and vehicles and wilt allow areas for storage of materials and debris. Driveways wilt be kept clear for movement of vehicles during work hours. Contractor wilt make responsible efforts to protect driveways, lawns, shrubs and other vegetation. Contractor also agrees to keep the Worksite clean and orderly and to remove at(debris as needed during the hours of work in order to maintain work conditions which do not cause health or safety hazards. Contractor reserves the right to photograph work performed and the Owner understands that these photos may be used for marketing or advertising purposes. Article 12. utilities• Owner shalt provide and maintain water and electrical service for duration of construction. X (617)799-7521 I nick@nsbuHdersma.com i www.nsbuildemma.com Post Office Box 47 Mansfield.MA 02048 3 of 4 ACCEPTANCE Ot=CONTttA[�, CONTRACTOR OWNER NS Builders Tom Vorrasi contractors Name Owners Name Post Office Box 47 325 Abbott Street Street Street Mansfield, MA 02048 North Andover, MAO 1854 City State Zip City State Zip Sig tura Signature Please initial the bottom right corner of every page X (617)799-75211 nick@nsbulldersma.com I www.asbuildersma.com Post Office Box 47 Mansfield,MA 02048 4 of 4 I Y E �� The Commonwealth of Massachusetts Department of Industrial Accidents b 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Lesibly Name (Business/Organization/Individual): Nei Sumv%_-Y-5, L�.�. Address: PC 12o x 1-(7 City/State/Zip: Mktzsf-uL P MA- =LI6 Phone#: `7'1'1- -757-t Are you an employer?Check the appropriate box: Type of project(required): 1.®I am a employer with t employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.❑I am a homeowner doing all work myself.[Ido workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions j proprietors with no employees. 12.[J Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13. Roof repairs These sub-contractors have employees and have workers'wrap.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *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 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees., Below is lire policy and job site Information. Insurance Company Name: MCK-St.� �tJ�tl�C/4t�-►C(: A(,e-),Jof P(- Policy#or Self-ins.Lic.#: 1�1Ur!-,0(ar t 35 G..S 1 k S Expiration Date: 7 1 1G Job Site Address: '027 S kaPxsr-t '51 ;:rr City/State(Zip: r-c-vG-4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pain and penalties of petjury that lite information provided above is true and correct. Si nature: Date: 1 i a Phone k �o 17 7 S 7521 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 Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/10/2016 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 CONTACT Margaret Viera NAME: g Morse Insurance Agency, Inc. PHONE (508)748-9577 AIC No:(508)748-9579 354 Front Street E-MAIL ADDRESS:magg ieviera@morseins.com Suite 4 INSURERS AFFORDING COVERAGE NAIC# Marion MA 02738 INSURERA:Selective Insurance Company of 19259 INSURED INSURERB:Selective Insurance Company of the 39926 NICHOLAS SCHIFFER D/B/A NS BUILDERS INSURERC: PO BOX 47 1 INSURER D: INSURER E: MANSFIELD MA 02048-0047 INSURER F: COVERAGES CERTIFICATE NUMBER?015 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE TO PREMISES(Ea occu RENTED ) $ 100,000 S 2110633 2/12/2015 2/12/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY PRO- JECT Fx—1 LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accident $ 1,000,000 Ea B ANY AUTO BODILY INJURY(Per person) $ ALLOWNEDX SCHEDULED A 9099157 2/12/2015 2/12/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ Auto Elite Pac $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION To be sent by carrier PERDTH- AND EMPLOYERS'LIABILITY YIN STATUTE _ ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Job: Tom Vorrasi-335 Abbott Street, North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE I � Margaret Viera/MMV v116...�-... 4 t/&A-.4L^� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02519M4n1) 1 ® -DATE(MM/D.Nyyy ATE(MM/DD/YYYY) .4CORv CERTIFICATE OF LIABILITY INSURANCE 1 02/10/2016 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 CONTACT NAME: Sandy Marchant MORSE INSURANCE AGENCY INC P"�"o : (508)238-0056 a No): ADDRESS: sandymarchant@morseins.com 285 WASHINGTON ST. INSURERS AFFORDING COVERAGE NAIC# NORTH EASTON MA 02356 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: NS BUILDERS LLC DBA NS BUILDERS INSURER C: INSURER D: PO BOX 47 INSURER E: MANSFIELD MA 02048 INSURER F: COVERAGES CERTIFICATE NUMBER: 29906 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F1 OCCUR DAMAGES(RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I SPER TATUTE OER" AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 7PJUBOG13563115 07/01/2015 07/01/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street AUTHORIZED REPRESENTATIVE North Andover MA 01845 L Daniel M.C4y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD �J Massachusetts-Department of public Safety' Board of Building Regulations and Standards Construction Supervisor _ License:CS-1058.24 -. NICHOLAS RSCFFER`_ 148 Burt Street ' Norton MA 0276& �r141'' Expiration Commissioner 02/21/2016 U/te Tpa�xmz�+�uaecr�f�a��ldac�'ude� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR egistration: .-':,175653 Type: Expiration5128/209=7 Individual NICHOLAS SCHIFFERjfoa NICHOLAS SCHIFFER ? 148 BURT ST -- NORTON,MA 02766 Undersecretary i i I a �avRvy . Q4' gyCD(6,�f� �'�.hp'�lt . b�rta Qfi • 71 W¢� �� NORTIIANDOV R.BUIL-DI G DEPARTMENT agAYea F � 5 .1600 Osgood►Street .. . North "do*er Tel: 978-688-045 Fax: 978-688-9542 B USMSS FO"FOR T,OWN CLEW DATP-: NAIVIE: C, ADDRESS: ,0NMGDISTIUCT: TYPE OF)BUSHES :, r--P5 L� c is BUI LDING LAYOUT PROVIDED: YES NO A'VA1LA�3irEPAUS,MG SPAMS: ZOWNGBYEAS"MAGE: YES NO RLTVDING INSPECTOR.SIGNATUPW BUSINESS FORM POR TOWN CLERK 2.40 Howe Occupation(3.989132) An accessory uw conducted witbin a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use-of the building for living�piuposes. Home occupations shall Ecliide,-bit notlimited to the following uses; personal services such as fimilshed by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty pallors, animal kennels, or the conduct of retail business,or the manufactcuing o£goods,which.impacts the residential nature of the neighborhood;' 4. For use of a dwelling in any residential district or multi-family district for a hoarse occupation,the following conditions shalt apple: a. Not more than a total of•three(3) people may be et1ie�Tioine occupation, on" of whom shall be thaowaier of the home ciccupatioix and residing is said'dwelling; b. The use is carried on strictly witbin-the principal building; e. There shalt be no exteaxor alterations, accessory buildings, or display which are not customary with residential buildings; - d. Not more thaa twenty-five(25)percent of the existing gross Moor area of<the dwelling unit. so used, not to exceed one thousand (1.000) square feet, is devoted to'such use. 7n connectionwith such use,there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display ofgoods or waxes visible from the strut, f The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neigfilorhood due to tine exrtenor appearance, emission of odor, gas, smoke, dust, noise, &sturbauce, or in any ocher way become objectionable or detrimental to any xesidential use vin lsin the neighborhood; g. Aj.Y such building shaft include no features of desigh.not cust6mai7 in buildings for residential r ignatu're Date North Andover Board of Assessors Public Access Page 1 of 1 NORTh North Andover Board of Assessors Ip- 9 �'Ss Mss QiProperty Record Card Click Seal To Return Parcel ID :210/038.0-0020-0000.0 FY:2015 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales ' s, Summary f ,•' Residence Detached Structure :: i I Condo ' 325 L,3 ABBOTT STREET Commercial Location: 325L-3 ABBOTT STREET Owner Name: BOBERIN LLC Owner Address: 9 WHITNEY ROAD City: BOXFORD State: MA Zip: 01921 Neighborhood:6-6 Land Area: 1.61 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2451 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 596,1.00 21.1,900 Building Value: 382,800 0 Land Value: 213,300 21.1,900 Market Land Value: 213,300 Chapter Land Value: LATESTSALE Sale Price: 182,000 Sale Date: 11/24/2013 Arms Length Sale H-NO-COURT-ORD Grantor: MANZI/ESTATE Code: OF REG Cert Doc: Book: 13712 Page: 0012 http://csc-ma.us/PROPAPP/display.do?linkld=2617028&town=NandoverPubAcc 8/7/2015 • North Andover Board of Assessors Public Access Page 1 of 1 .M If NORTH North,.. Andover Board of Assessors �SSwcwusE� I roperty Record Card Click Seal To Retum Map/Block/Lot: 210/038.0-0020- Parcel Address :325L-3 ABBOTT 0000.0 STREET RESIDENCE DATA Style : COLONIAL Total Rooms : 8 Search for Parcels Story Height: 2 Bedrooms: 4 Ext-Wall : FRAME-CLAPBD Full Bath : 2 Search for Sales Foundation: CONCRETE Half Bath: l Year Built: 2014 Heat Type: FORCED-AIR Overall Grade : VERY-GOOD Heat Fuel: GAS Overall Condition: AVERAGE Central Air: Y Summary Living Area: 2451 sqft. Fireplace : l Residence Basement Area: 1086 sqft. Detached Structure Finished Basement: Basement Garage : Capacity :2 Square Foot Condo Attached Garage: Capacity: Square Foot: Commercial Carport Trailer: Width: Length http://csc-ma.us/PROPAPP/particulardetails.do?subAction=Residence&town=NandoverPub... 8/7/2015 North Andover MIMAP August 7,2015 a y" f- 4.. N w psi �,5y �f 4� •�t 1r� Ja` -�;,xh R•� 1..v yam,.b,.a . ,✓"Av -. • I y�yw r x e i1Yu% 1 d, x - p. n t "s G n _ • :art 0 MVPC Bo Interstates Horizontal Datum:MA Staleplane Coordinate System,Datum NAD83, Meters Data Sources:The data for this map was produced by Merrimack —SR {iORTM Valley Planning Commission(MVPC)using data provided by the Town of Roads Of ttao r�,�O North Andover.Additional data provided by the Executive Office of Cs Easements 2.'o O Environmental Affairs/MessGIS.The information depicted on this map is DParcals 3' C for planning purposes only.It may not be adequate for legal boundary definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING t THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY •i ^f OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION SiOCHU`��t 1"=157ft �° North Andover MIMAP August 7, 2015 0-009, ••--• ,atu. lx 038;0 0302 G •.:c #,344 - #338s 038`.0',=0052f •�Ur �;�� ': 038 d:=0301', 1T #:1115,+ 03&O 0049 ..__.-.••' : (#120' �p . h. 9 \SSL Q38 0 0304 038'0 0305a O 038 O 03p0; .. o• ;#los3 038.0''-0012? ••,�. . :038'0 x0306. .�• #388 -.."�!�• :.'..:,alu..�:.:: Valu ..�Ci.•.`.':"::••'.;i..;. 038 0:=,0,051'. ; •• :.: :..c: __:.??�!� '-'•...'::.:_-`:_:• :.038.0-029., •- 038 0-0307 038:0 03`18, == :;.-:.._. .:::r 038 0,-029; .. #353? 03.850=0319': .. y�,•:::.:c:_. :', ... I, :. 038'0`03085 #84 #345 03,8:.0-0089: _ uJ,� ._..•_...::::� 038 0-024 _ Jtt•::::::a)ltt :i... 11l.: .::: al 038 O 0309 #3391 ::..... ._.. ._._. -.._..._ •._..• :_i=_ cry ••_jur•.i..-�llt.:`.':.,J.. _::r•?4.. s]l(i " 2i) Q- / �. - _--:._.'•,Slit •`.=%..-. ``_ �ltc•,.: 03810 00119 -ulfltr #f7Q? ... ... <'sj `� 038:0'0312 _ .... 038.;;0 0311 03,8�Or0093: \eDj � •- 11038 O Q3;1:Oi �\ O._38':�0,-,0020:, \ _._._�__:-�31,�r.. _..... -• tft n.••'yam::'_..,._ 4? : .i,... Jtr.. ••:: lu...i,..: : ...... •- aL 038:0`�;0255� • 03.800T. 0313' lD 038:y0-0336' #34;: 038:0=02561 #300' �'� 03:8 O 03;144 03810-0007 038:0 0026 #301} -• 038:0=0329: .b S31dr'•:a.: ai MVPC Bo ='.Wetlands Zoning Busine s 1 District [!Municipal Boundary O Exempt Lends a Busines 2 District Horimntal Datum:MA Stateplane Coordinate System,Datum l— Rail Line C Busine s 3 District Meters Data Sources:The data for this map was produced by Mernmack Interstates Busine s 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Town of _ OGener Business District Or so q North Andover.Additional data provided by the Executive Office of —SR O Plam Commercial Dev : ,, rhe O Environmental Affairs/MassGIS.The information depicted on th,c map is C Cori Development Dist 3 _ L for planning purposes only.It may not be adequate for legal boundary Roads O Corrido Development Dist O - Is definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER t Easements 0 Coni Development Dist F 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ❑Parcels Industd 1 District 41 THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY d Indusl6 2 Di not rF } at OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Zoning Overlay O Indusln 3 District >F°o 7� i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Adult Entertainment IN Induslri S District :� THIS INFORMATION 0 Downtown Overlay District Reside ce 1 Distinct �1 o��r,n�� B Historic District Reside ce 2 District ,S$wCNU`��t 0 Water Protect— G Reside ce 3 Dislricl O Hydrographic Features J, de ce 4 District --Streams 1"=157 ft "K T'de ce5oistrict Y de ce6Disnct .e a esidential District E Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of I Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) J'� �j , s. 0 Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan F❑ Stamped Plans ❑ • 6 � i TYPE OF SEWERAGE DISPOSAL. Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunmmg Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM .�TPLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS kNSERVATION Reviewed on Signature ,_V COMMENTS r HEALTH Reviewed on Si natu COMMENTSa4= 6 l rI oy-1 bzm f2 k �� ez Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street � F R§DERAR-11MEN Ternp�Dumpster 4L7ocateat 124 Main'Street � � .» t•} +� t, rYi�€ 0re DeppartmentFsigria3ture/date,,, _..4r .li,_5s_ a °"ly""F}$�'r'Ysi•�t�<c' ?,• �` «y, i`5`;} tiv�t 'ty` rs+yyr �LS` �� /,;.`.{�4�C`►##t(�'�it�"�ri(-'{�"t- �!"� «�1....� +�--^� . .;,4� I ` i'.7 e'.I• i�r1 '.uY:'' i�Er Ta•z 3 �f's ! ';5� � I�3, .'ty r.., .r '� � l c .i' ;' ?+l. •..:•1"ar'�riL.Lr : .y} `e• xs^ ti r. h 3 i'3 .,L a�f' v ,, it o.� ��(i. 10 .. . �.( ,t '� r "lr„f .+• . Fta � COMMENTS ."s Building Department artment The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4. Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products `; OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses 4. Workers Comp Affidavit 4. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location �°� �J � S r No. SLI -/-41 Date e - TOWN OF NORTH ANDOVER X31 ' .. � F Certificate of Occupancy $ /00 i Building/Frame Permit Fee $* . Foundation Permit Fee Other Permit Fee $ TOTAL $-,01 — Check# 2I G6 :� Building Inspector L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: L - Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �� 4 �? b f: S - Print PROPERTY OWNER_ �a� ��t ✓t✓ Ll G ISo� Print 100 Year Old Structure yes AnoMAP NO: . �- PARCEL:Z® ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Buildingne family ❑Addition ❑Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Lt-CF 11n6 Go2Gv2 t/ Mauw&a Phone: �17�S��z. 370 . Address: CONTRACTOR Name: Q ,ocoPhone: - l 3 F Address: �/ ti/ I f 41r- , 7-Ce 4 J ZJ& C) /52- Supervisor's Construction License:- O b o P Exp. Date: /�/ Home Improvement License: � 3_. Exp. Dater 7 t'y ARCHITECT/ENGINEER C 2r .� 7�alzei ver Phone: 727- '7,2 -7 Address: y914 /19t"Irc�re 6,U7,6—Reg. No. T_�o_5-n �— y FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. -� 7/ 62 / Sq Total Project Cost: $ FEE: $ �� - � Check No.: �+� �/�i' Receipt No.: �72 � NOTE: .Persons contracting with unregistered contractors do not have access to the guarantyfund nature of AgentJOwner - � - Signature.of contractor Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF:SEWERAGE.DiS'P_OSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc.. permanent Dumpster on Site ❑ THE.FOLLOWING SECTIONS FOR-OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE.iAPPROVED PLANNING&DEVELOPMENT= ❑ "'4 ba OQ COMMENTS I .CONSERVATION Reviewed on � G 3 Signature COMMENTS—�; � HEALTH Reviewed on Signature COMMENTS ca ; LX Ul� t - i =, L I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decisio 1-elv�comments DJ's 3 j Conservation Decision: -�-- i lo. lC7 . Comments \-P, Mater & Sewer Connection/Signature& Date 'DivewaPermit N/ vl-c-e' ", � 4-DPW To` ; Engineer: Signature J/- (3 Loci ed 3 O ood street FIREDfPARTN L-AT- Temp Dump si e yes no Located"at 124 Mair Street Zl- Fire'DepartmeFif-S�ignature/date ~ '• COMMENTS_ ' RTH r 3g �t M ^h s �a �SS.ICHSft CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 547-14 on 1/14/2014 Date: November 12, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 325 Abbott Street MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Boberin LLC 9 Whitney Road Boxford,MA 01921 Building Inspector Fee: PrePaid$100.00 Receipt: 27233 Check : 3644 i r .r' I p _ii7H CJ''C, •E P Ma q�O H? 46 ,r •,6 Lp APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION 4AR.rev'PP�5* BUILDING PERMIT#_ ' 7 9SSHClOW`�� ADDRESS/LOCATION OF PROPERTY: ��J� b Map �' Parcel 01- Lot Number SUBDIVISION: I A DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: /\(G-F V K/W w A) FIVE(5)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLICANT SIGNATURE Permit Issued to: b��t N �'�•�- Address: wki f —� /V1/1 4 G- ROUTING TOWN ENGINEER; SITE PLAN—D E-WAY REVIEW Y 6 r �� CONSERVATION w PLANNING t DPW-WATER METER SEWER CONNECTION DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW SIGNATURE File:Application for oc form revised San 2007/2011 NORTH Town of 2 sAndover O - No. — * - ,� CO,o h ver, Mass, r 4, COC .1CHRW/CN ArEo P.? U BOARD OF HEALTH PERMIT T L"..D Food/Kitchen Seec Syste f �� ILDING THIS CERTIFIES THAT ...... SO2. e'�Y ... INSPECTOR...................................................................... ................. buildings on S � ...5 ............................... o has permission to erect......... g ..1 ..�...r. f to be occupied as f�.t l.,C:7.`�'�: ....z J l(.� �'s i/...f,�.0 ?. .............................. chimney __,_ �l , (4,"L, provided that the person accepting this permit shall in every respect conform to the terms of the application . Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and r Construction of Buildings in the Town of North Andover. PLUI�BrG�NSPE OR //a''/'� VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS .ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS '� � %' �'�/ f� Service .... . ..................................... BUILDING INSPECTOR Final `j/r GA INSPEC Occupancy Permit Required to Occupy Buildin Rough 01"1 Display in a Conspicuous Place on the Premises — Do Not Remove � f�� No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. 14 SEE REVERSE SIDE Smoke Det. Cv,/ i Y 'sSACHISE CERTIFICATE OF USE & OCCUPANCY 1 TOWN OF NORTH ANDOVER Building Permit Number 547-14 on 1/14/2014 Date:November 12, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 325 Abbott Street MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Boberin LLC 9 Whitney Road Boxford, MA 01921 Building Inspector Fee: PrePaid$100.00 Receipt: 27233 Check : 3644 NORTH own of ndover O - 0% No. 0 LAKE - h ver, Mass, r NIC HI WICK 7�ADR�TED PP��,(y S U BOARD OF HEALTH PERMIT T L" D Food/Kitchen tic SLyste �� THIS CERTIFIES THAT / ( � LDIN�INSPECTOR oundatio V —� has permission to erect buildings on .. 5� �d �' .S' ................ ............ .......r.. ................................................ o `741// � � to be occupied as ............ ................................... chimney � y __T_V4 provided that the person accepting this permit shall in every respect conform to the terms of the application oFinal on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING NSPE oR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS .ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS 6pgrrl 7 .......,.. Service .......... .... ! .........:...... . . . ... .......... Final i)� fr6 BUILDING INSPECTOR GA INSPEC Occupancy Permit Required to OccupV Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove )E_ No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE _ / Q,NORTH�H M'S 1CIIUSE4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 547-14 on 1/14/2014 Date:November 12, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 325 Abbott Street MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Boberin LLC 9 Whitney Road Boxford, MA 01921 Building Inspector Fee: Prepaid $100.00 Receipt: 27233 Check : 3644 NORTil Town of ndover O - ..�: h , 0% ver, Mass, r cocNchewrcw yq' S U BOARD OFKHEALTH Food/Kitchen PERMIT T L"..DSLic Syste ! ` THIS CERTIFIES THAT ..../Ic ILDING INSPECTOR oundatio has permission to erect ................... buildings on .. 1s :.. 6�° . \ 17 Aa�,i to be occupied as ............/ .. 1 irM.4.................................... Chimney X-7 provided that the person accepting this permit shall in every respect conform to the terms of the application Final r on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMB G JNSPE oR � ®�V VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CON STRUCTI STARTS t � Se �1�� Service ........ ........................... Final KA If-6-1/l BUILDING INSPECTOR 7 GA INSPEC Occupancy Permit Required to Occupy Buildinz Rough P4'fll Display in a Conspicuous Place on the Premises — Do Not Remove ,� fi� No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. I7p SEE REVERSE SIDE Smoke Det. NORTH Town of �. � Andover O ~" �► No. h h ver, Mass, / 4 LAKS �4 COC MIC HlWICK\y1' �.95 RATED Pl, U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......90. :....h.... .� BUILDING INSPECTOR ...................................................................... has permission to erect buildings ony �d ° -S Foundation Rough to be occupied as ............ b�.r,�.CJ..� (%f...5'... �.::�!,�1.�.�. �!�a!l./yet...f, .0. ??.5:................................... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 1 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough .. Service ................ . ............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE n1gnI;1&x TVG-1 lllulGV1J ! :'! : OJ API PAUL L/VVG riix i7uL-VUZ- CERTIFICATE OF LIABILITY INSURANCE ErMM190111 YY) DAT AM4ERTIFICATE 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 ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER E CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the ems and conditions of the policy,certain policies may require and endorsement A staternent on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: MCLAUHGLTN WS AGENCY PHONE FAX 828 LYNN FELLS PARKWAY (A1C,No,EXt): (AIC,No): E-MAIL MELROSE,MA 02176 ADDRESS: 2STG14 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA BOBERIN LLC INSURER B: INSURER C: INSURER D: 9 WHITNEY RD INSURER E: BOXFORD,MA 01921 INSURER F.- COVERAGES :COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: RODNDICATED. NOrNITFISw7m /NYRSMAMAE Vr,IUM OR C01 3710N CF ANYCONTRACTOR OTHER 0001NF r V/TH FOWE CTTOV1t4M MMS CO F1(ATE MAY BE ISSUM OR MAY PERTAnL THE NSURANCE A:MRDEDBYIMPOLIdESDFSMBEDH9MNISgMECTTOALL7MTFfMD(CLUSIOMPM00PDIr10NSOFSLIWPOLK3ES. LMTSSWMMAYHAVEBEEN REO)CEDBY PAIDCLAtMS NSR ADD SUB POUGYEFFDATE POLILYE)FOATE LTR 7YPEOFINSURANCE L R POLICYfARWR (M&MYYYY) WDMYYYY) LIMITS GENERAL UABIUTY CH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE 0 OCCUR DREMISES(Ea occurrence) D EXP(Anyone person) $ ERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY [—]PROJECT O LOC RODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIREDAUTOS BODILY INJURY $ (Per accident) NON-OWNEDAIJTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE_ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WCSTATurcRy OTHER EMPLOYERS UABIUTY YIN UB4787P930.13 08/052013 08105F2014 UMTS ANYPROPERIOWARfNEFYE)SCUTIVE a N!A E.L EACH ACCIDENT $ 500,000 OFFICE RIAS BER EXCLUDED? (Mad—V In NJ E.L.DISEASE-EA EMPLOYEE $ 500,000 nyesesaibePnON F er O E.L.DISEASE-POLICY LIMIT $ 500,000 OESC�IIPi1GN OF OPEiRAT101�15 Wow DESCRIPTION OF OPERATIONSILOCATIONStVEMCLESIRESTRICTIONS/SPECIALfTEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION 'DOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 120 MAW ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT -(VE NORTH ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. A(1 rights reserved. BOBER-1 OP ID:BS ACORD° DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/04/13 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: H 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 endomemen s. CONTACT PRODUCER Phone:781-665-2775 NAME: McLaughlin Insurance AgencyFax:781$65-0295 PNONE FAX 828 Lynn Fells Parkway LAIC No AIC No Melrose,MA 02176 £-MAIL William B.Markhard,CPCU ADDRESS` INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER A:Travelers Prop.Cas.Co.of Am INSURED Boberin LLC INSURER B:Western World Insurance Co. Attn:Bob Corcoran 9 Whitney Road INsuRERc:Associated International Insur 27189 Boxford,NIA 01921 INSURER D: INSURER E: INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTIi RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER 4:w?.�D,^h;M :39Uff,.. Ltrs ETS ai;e'7rERAL LLAoiL.iT'Y i��, ^I i --RRENCE !$ i C:g^.IC.C, qnMMERCIAL GENERAL LIABILITY i i NPP1349890 x-104,353 I IJ6104114 I--A"' y 50,00- CLAIMS-MADE 0DoreCLAIMS-MADE ()�OCCUR I MED EXP(Any ane Person) $ 5,nPd iI 1 1 PERSONAL&ADV INJURY $ i OG0,00Vp GENET AL_AGGREU'ATE _9r��,Q rGEN'LAGGREGATE LIMIT APPLIES PER- I I I PRODUCTS-COMP/OP AGG I$ 1,000,00cl PROE ;�c7LICY T 711 LCk, j '$ iAUTOMOBit.E LIABILITY COMBINED SINGLE UMii i# ( I !tEWQent) g i 1 nriy AUTO 1 I 1 RODILW INJURY(Per Person; 1$ ) All OWNED SCHE'JULED RODILY INJURY(Per acrident) $ AUTOS AUTOS HIREDAUTOSNON-0WNED I PROPERTY DAMAGE $ AUTOS Per accident $ X UMBRELLA LIABOCCUR EACH OCCURRENCE $ 1,000,00 C EXCESS LIAB HCLAIMS-MADE CUBW4546413 06/04113 06/W14 AGGREGATE $ I I DED I X I RETENTION$ 10,000 $ WORIfERS COMPENSATION X WC SL M S T AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVEYIN NIA TO BE ISSUED BY CARRIER 08/05/13 08/06114 F.L.EACH ACCIDENT $ 100,00 OF.,CERIMEM3ER EXCLUDED? - `' (Man tory.c NH) i E._.DIISLSE-LA E&A.PLOYE'i$ 1-30,ICU€ If yeE,desDII,-Under 1 I e n t i DESCRIPTION OF OPERATIONS b--krH E.L.DISEASE-POLICY LIMIT $ 50o'00131 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional insured(s) are as allows i£ required by written contract with Iname I..a,,.� insured: Tc:�L of P3crttL Fu,dc.er, .'-`.fi i i f f CERTIFICATE MOLDER CANCELLATION HANDO-1 1 I v:.uL'LD.4•IY�•�T T i .�..PCVE OZ-SC 121�-0 -L'CIES BEL.A!CELLED3E ORE Town of North Andover THE EXPIRA F rON DATE THEREOF, NOTICE VALL BE DELIVERED IN 160 plain St ACCORDANCE WITH THE POLICY PROVISIONS. � l North Andover,,IRA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD JEW Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuperN icor License: CS-065208 . I•S ROBERT S. C.4 CORAN 9 WHITNEYAD. Boxford MA-,'01921 O J. .N j4;'six Expiration Commissioner 02/1512014 ��ie a�r�u��,o�s�runa; z 5a Office of Consumer Affairs& Business Regulation ME IMPROVEMENT CONTRACTOR gistration: 171633 Type: xpiration: -.4/312014 -:, LLC BOBERIN LLC. f ROBERT CORCORAN 9 WHITNEY RD > BOXFORD, MA 01921 �— Undersecretary !J 4 ASSESSOR/NFORMATION ASSEA'OR 6ARC0.�9 2ro/ RO�A-OW].D ___ t_ ' OWNER OF eoeLRrN c BOAFDRD.AM 019TI m'E PO- GN d' �. zTi NM l O'MRL r ` (0[Y5 INE PROPWry R LOGFED wtlNlN ME RE90ENCE J i - /JS9 ABBVR B fXIJ A�LI,(or J ZLWING OIBMR'T ACLMOJm ro M£�U fV of AUIPM g ANWVER ZpYING IVP'PRINTED AqK n,POIJ. �- c ME SUeIEtt PFOPEPry TS NDT SVR/ELT ro ANY 20.NINC B$N°� ovLwAr psmlcrs INOIGTm oN Mf'iDNN o£NORM N Ba / \ 5\. ANDOVER ZONNG MIP"PRINTED CN MRtt Tf.T0r] / ME SYIBJEDT PROPERTY 5 NOT LOGTm w'TIMN ANY // \ ' sT � R6VRNm£q NUN�ATJ009COT] E°�TFEC // \ �'� GIE Di,2LY J,2011. / \ NO r. M£PURFDSE OF MIS PUN 9 ro PROVIDE ME '°100m1 FFiRDRmiairw°Gi A a:'I�'°NEiworA'Wno°N £`�cNc A4i/ A5 \ Z—.;&=—.M RENnO PIAN 1.E MIfMER rp \\ \ o^ N REFFR_F,N!`FG slrsFr ME axnFrm FWNGRDII As-Runs aErnAREMrxr / A6 A7 \ v nnRnF EssIX rouNrr TFFcvsmr o£DFms vmicLmam mM rnrmRucnorF oT ME PBolrosm OwfillN'C ANp SEPTIC SYSIAI. \ - \ All CE HAP OJ0.0�OC'A'wIP w DEm �12.PA12!/Jw ABB01r tl/FEET.LOT J) T. 9WNOARY AND mPLCRAPNM INFDRNAnCN SHOWN \ ..- -..~ 1. UPON AN —1 B6 A8 n REF£FENL1S HEREON lS BASm EON-MEUNO q�E1D SURh]' A3 \ D ,wo°i i r% nv A LE>�Trn S E7 ms mrx n Irav'T° \ B _ A n\ nroRDG An�rm a uroN PUN rs!/]w A—mrEEr,ms r.z e J) PUN 5 NOT m BES 5 Ax r S° z AITAttio=.71e e cR�FmmuxD sEm+cLs pv H'• \ a\�, L o£wrrN B81 LEG£dll APRIL 9.ZOIf. -- . LY J MAPPRm w oNmE umrnEs Is uNlrm ro GMWINC uP A2 \ B4 _.By.,. i� u"IGRLO1F TaEi F EvrIXNCE OF ==TAY Unl/IIES HELD IB96 ' �'�"" �Y)) Ar-E w SVRIEY ONLY, ME LOCATION 0'ANY �\ B i O \ \ ,vv.. p/ • MEABURm IMOmNERCRWNp SroRAGFm NMS,IF ATpNY,ARE r WN \ A® A ME E C0.NTTUC4 TO YgBrr M-1 LZE AND E,c,MnDN A 1 % _ SIoxE wA(L OF ALL UN/iiES PRIOR ro COMNENCING ANY 5�XDFM. \ \ pl S LOG[OF ASPFVLT C WnAM 0/OSAl Bi I Ai!£AC(Tz NouRs vmaR ro 'B2 ANY IXGVAImN.OEMCLI/pN 0.P L1)NS1RUCnIXI. sL s. soME srMBOLs MIr BE ENLAPCm ma aGGannr. �>-!^'"' B? B3M'Aa S. BIFnER aINRM.IIIWI 4 9,VWN HEAEUN PER ME mWN T"A CP ��ANDOVER ASSESSOR MWS FDR LLLUSMAnVf xAiJN)99.w \ CP -.—__— IE W n BVFTEA IPNE . n \ N \', t' <osazJ°0'»O5 rou LorLor FRLwrACE B. WERAND RESOURCE AREAS DE'P2'Im HEREON ARE 5-0.pPB �, _ �)(xflp) BISm 0.V FlElD LOCITI0N5 O£MGS AS DEUNGRD BY � \ ai S/�` .l BNI E AMNUEt1 OF W£iIANOS AND IANO AN F°E�T�w°/°R � \ � \ \ � VERIFICInON�M£roWN OF NORM ANOOVW \ �, CONEEPVA11pV LOIIMI951oN ANO/PRDTmME YASGCM/SEPS OEPMMLM pF LNWTt0.NMExTAL NA PO.RTIN of TFK BURER ION£Ar THE EASTERLY �pT•J• B 1.'J DRIKW 0.T ME PREMISES 5 SNg4TF A^gm1MAFELY PER .(sET s/rJ/PDrJI +`�' I FOUR Fuss SEI BY pLL MWUEll OF WEMNoS Avp UND 31Vs RMA-APPRwIAITE oFFsxr wsTANLF ro .\ \ \ OFFSITE WERANO FESVURCE AREAS. �. RDMNDm m RTE xGALST BDu,WE mDT 0.4 � „f,'"'1eT�,j r 614 y\ TEN MW5INOM pF AN ACRE !NEAR DIMENSmNS ARE $ \. RouRDm�mSME�EARESf muFORmM of A Fool '\ LOT J BTS _ '� GRAPHIC SCALE Fourew ENsmvs ARE Rol/nvLD m D/E AREA=70,313 SF3 \ o rD 20 to eD NEAREST 1FNnI OF A FDOi. /\\\ (1.6)42 ALRES3) \ 9. A IT1 LORRUG11m qP£CONvEYS SI0.4NWA1ER FROM \\ 46.118 513(CBA) /r SLYmpL Pw6TEWFty SAS IE�L ENT Ef£MfM \\\ B 1 E \ �' I rNtTiN�T FEET PRWEPII'. RESFM'CH p0 NOT RLYF L RELORO OF ANI' T �� ' OPAMACE GSEAI�AFFELRNC ME SI,riImT PROPmIY. '�� \\ � ANWYW gl5lR.'11AFlf5 CEPAFIMENr M£fX6RTIt£LF IINE�CROSS�CLLNV£RT�Cf sYSIEv"� �S \ � B 17\ 818 Io. cur LN AODr7LATm wTnF unurr PoIE xEr Nr rsrs '^ \ A6 B20 Noi REvuL a�of AN urirLnr F° AsniExis. 1 � \' P.gvnc \ ,rc srsmr rs sxpxN PER Pux MW arao BLocr ozss lsec�i0�r l \ F SYSTEM OE52'N-sllE PUN•PaLPAam TUNN of J&AM.b1ER \ \ \ B 19 BY DG—RIICME TNG HIED QlOBER 2—MM A 2 L SARfkTFT£L£NENlA.RY SLMYmL UIFST RLY1E]ON MIE OF NOVflIBW Tr.Z01J. %CD Rea n V 70N/NG REOUIRFMEN75 \ \ �r AREA 2sr wiAw o— m n,x—r% IX/S77NC wniMUM F Fr AV. IRNBaBr ,svYA�.m PDn ia7on \ CONCRETE // \ P Jt Low rDOiBJ'iii�32 uAMMJM --I u nT \ > FOUNOA7701V // �, EPRFEIL Bp IBsO wnrrmlGME rwvDAnw ax. nn n r / „1 W R,- �'�' pwsrRDDrm AT Ms,Aa y ,/\ / FOUNDA77ON AS—BUILT PLAN mm 'm ..0, s 512B+a \ A /795 ABBOR S7..LOT J.NORM ANDOVER.M4 01845 aLERFIFr Mar ME FwNOnrwF rs LOGMn o� DN)' \ // // pN gip) PREPARED FOR: +ME cmuNo Ar sHowN,Arm NMPUES nYT1� r / / / \ (N)IN BOBER/N,LLC W/IN Mf OIMEN9'pflL ZONING REDUIRMO- \ of ME—DF NORM A / / OWN£0 BY.., NOTA CERnFi A d-ME TnE£0.P / // awNDrsEF o< / \ � , - BOBERIN, LLC BOXFORO,MA 0191 r NEIeI�9B // � AM a Art JG(E i•_PO' p N� 1' / , \ \ �mJ�J oaANFF Br. ,IPAF prtLTr BY - / / L07.� 1 DRAxrNa vP.owG urour Fav�e_Lor_] /•/Ae+Y AREA=z;02Z SF \\ ( 1 SHEET. I OF r PRwEDr. TOIJ-17IJ EY P.AIO,RgSSFR£ G]E \Vo\ ` (05744 APYFS) I N0 2 JPM f JO 2016 G e It Am1Y°PMWORD SFPIF ARU P.LS{tB29t \ \ I \ RENSE PUN STA(£ Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 3715625.00 m $ - $ 4,459.50 Plumbing Fee $ 557.44 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 557.44 Total fees collected $ 5,674.38 325 Abbott Street 547-14 on 1/14/14 Single Family Home PORAVAS DESIGN K CONSULTING July 29, 2014 Steve Corcoran 303 Abbott Street,Lot#3 North Andover, MA Regarding: Rough Framing Inspection/Affidavit for Lot 43, 303 Abbott Street, North Andover,Massachusetts Dear Steve, As Architect of Record for the above referenced project, Poravas Design & Consulting certifies that I have been present on the construction site on a regular and periodic basis, and to the best of my knowledge and belief, the rough framing installation (including engineered framing and beams) has been constructed in compliance with the requirements of the Massachusetts State Building Code, 8th Edition and the approved plans and specifications.Therefore, it is my opinion that the follow-on construction work to complete the construction project can continue without delay. If you have any questions or comments regarding this affidavit, please feel free to reach me at 339-927-1579 or pdcdesign I @gmail �\yZ�REDA /� ��' �OQKER a FCn Best, t Q �� ' = No.50506 t • BOSTON `a MASS. Jy Christopher A.Poravas, AIA. Of Of M�SPG� Poravas Design&Consulting 49 Appleton Street, Melrose, MA 02176 - Plione:339-927-1579 - pdcclesign I Cgmail.com i A InREScheck Software Version 4.5.0 v' Compliance Certificate Project Proposed New Residence - Lot 3, 303 Abbott Street Energy Code: 2009 IECC Location: North Andover, Massachusetts Construction Type: Single-family Project Type: New Construction Conditioned Floor Area: 2,533 ft2 Glazing Area 11% Climate Zone: 5 Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: 303 Abbott Street, Lot 3 Chris Poravas North Andover, MA Poravas Design &Consulting 49 Appleton Street Melrose, MA 02176 339-927-1579 pdcdesignl@gmail.com Compliance: 1.1%Better Than Code Maximum UA: 368 Your UA: 364 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Envelope Assemblies Gross Area" Cavity Cont. Glazing Assembly or or Door UA Perimeter LI-Factor Floor 1:All-Wood joist/Truss:Over Unconditioned Space 1,107 30.0 0.0 0.033 37 Floor 2: All-Wood joist/Truss:Over Unconditioned Space 365 30.0 0.0 0.033 12 Floor 3: All-Wood Joist/Truss:Over Outside Air 13 30.0 0.0 0.033 0 Ceiling 1: Flat Ceiling or Scissor Truss 1,335 38.0 0.0 0.030 40 Ceiling 3: Cathedral Ceiling 150 30.0 0.0 0.034 5 Wall 1:Wood Frame, 16"D.C. 2,863 21.0 0.0 0.057 142 Window 1: Wood Frame:Double Pane with Low-E 307 0.290 89 Door 1: Solid 33 0.500 17 Door 2: Solid 36 0.600 22 Eo Aq Compliance Statement: The proposed building design described her y49 uilding plans,specifications, and other calculations submitted with the permit application.The proposed b Vj A I to meet the 2009 IECC requirements in REScheck Version 4.5.0 and to comply with the mandatory require 17 i ed in the k Inspection Checklist. 4. C"yX%S `OAAy4S 1 ¢ 0.505 (1 2 � I/2o13 Name-Title Sign VJ MASS. y4. Date J TH OF MPSS�� Project Title: Proposed New Residence - Lot 3, 303 Abbott Street Report date: 11/24/1 Data filename: C:\01-Projects\Residential\Corcoran-North Andover\10-Energy Audits\Abbott- Lot 3.rck Page 1 of 9 Project Title: Proposed New Residence - Lot 3, 303 Abbott Street Report date: 11/24/1 Data filename: C:\01-Projects\Residential\Corcoran-North Andover\10-Energy Audits\Abbott- Lot 3.rck Page 2 of 9 REScheck Software Version 4.5.0 Inspection Checklist Energy Code: 2009 IECC Requirements: 0.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement,the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. Section Plans Verified Field Verified # Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions & Req.ID 103.2 ;Construction drawings and ❑Complies [PR1]1 !documentation demonstrate ❑Does Not Ica Ienergy code compliance for the ❑Not Observable ' building envelope. ❑Not Applicable 103.2, Construction drawings and ❑Complies ; 403.7 (documentation demonstrate 011oes Not [1311311 energy code compliance for lighting and mechanical systems. ❑Not Observable ; Systems serving multiple ❑Not Applicable ;dwelling units must demonstrate icompliance with the commercial (code. 403.6 Heating and cooling equipment is: Heating: Heating: ;❑Complies [PR212 sized per ACCA Manual 5 based I Btu/hr Btu/hr �❑Does Not .gJ on loads per ACCA Manual J or ; Cooling: Cooling: :E-]Not Observable other approved methods. Btu/hr Btu/hr ❑Not Applicable ; Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Proposed New Residence - Lot 3, 303 Abbott Street Report date: 11/24/1 Data filename: C:\01-Projects\Residential\Corcoran-North Andover\10-Energy Audits\Abbott- Lot 3.rck Page 3 of 9 2009 IECC Foundation Inspection Complies? Comments/Assumptions 303.2.1 iA protective covering is installed to ❑Complies [FO11J2 protect exposed exterior insulation ❑Does Not and extends a minimum of 6 in. below I Q) grade. �❑Not Observable; ❑Not Applicable 403.8 Snow-and ice-melting system controls;❑Complies [FO12]2 installed. ;❑Does Not J ;❑Not Observable; ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) i Project Title: Proposed New Residence - Lot 3, 303 Abbott Street Report date: 11/24/1 Data filename: C:\01-Projects\Residential\Corcoran-North Andover\10-Energy Audits\Abbott- Lot 3.rck Page 4 of 9 Section Plans Verified Field Verified # Framing/ Rough-In Inspection Value Value Complies? Comments/Assumptions & Req.ID 402.1.1, Door U-factor. ; U- ; U- ;❑Complies ;See the Envelope Assemblies 402.3.4 ;❑Does Not table for values. FRl 1 I [� ] I ; ,❑Not Observable ; o ;❑Not Applicable 402.1.1, Glazing U-factor(area-weighted U- ; U- ;❑Complies ;See the Envelope Assemblies 402.3.1, average). Not table for values. 402.3.3, ❑ 402.5 Not Observable ' [FR2]1 ; ;❑Not Applicable COOi 303.1.3 !U-factors of fenestrationproducts ❑Complies ; [FR4]1 are determined in accordance ❑Does Not 00 (with the NFRC test procedure or ❑Not Observable ;taken from the default table. ❑Not Applicable 402.3.5 Sunrooms enclosing conditioned U- U- ;❑Complies [FR8]1 ispace have a maximum ;F-]Does Not !fenestration U-factor of 0.50 in ;❑Not Observable Climate Zones 4-8. New glazing (separating the sunroom from ;❑Not Applicable !conditioned space must meet ;code requirements. ; 402.3.5 �Sunrooms enclosing conditioned U- U- ;❑Complies ; [FR9]1 !space have a maximum skylight UDoes Not U-factor of 0.75 in Climate Zones 4-8 ,❑Not Observable ! ! ;❑Not Applicable 402.4.4 !Fenestration that is not site built ❑Complies ; [FR20]1 ;is listed and labeled as meeting ❑Does Not ! AAMA/WDMA/CSA 101/I.S.2/A440 !or has infiltration rates per NFRC ❑Not Observable 1400 that do not exceed code ❑Not Applicable limits. ! 402.4.5 !IC-rated recessed lighting fixtures ❑Complies [FR16]2 sealed at housing/interior finish ❑Does Not and labeled to indicate <_2.0 cfm leakage at 75 Pa. ❑Not Observable El Not Applicable 403.2.1 ;Supply ducts in attics are ; R- R ;❑Complies [FR12]1 i.insulated to >_R-8.All other ducts ; R R :❑Does Not yin unconditioned spaces or outside the building envelope are ; ;❑Not Observable !insulated to>_R-6. ;❑Not Applicable 403.2.2 lAII joints and seams of air ducts, ❑Complies [FR13]1 !air handlers,filter boxes, and ❑Does Not ! } tbuilding cavities used as return ! !ducts are sealed. ❑Not Observable I ❑Not Applicable 403.2.3Building cavities are not used for ❑Complies ; [FR15]3 supply ducts. ❑Does Not ! ❑Not Observable ❑Not Applicable 403.3 HVAC piping conveying fluids R- R- ;❑Complies ; [FR17]2 above 105 °F or chilled fluids ; ;❑Does Not 49 below 55°F are insulated to>_R- 3 1 ;❑Not Observable ; ! ;❑Not Applicable 403.4 Circulating service hot water R- R- ;❑Complies [FR18]2 pipes are insulated to R-2. 1 1 ;❑Does Not RJ 1 UNot Observable ❑Not Applicable ! 11 High Impact(Tier 1) 1 2 IMedium Impact(Tier 2) 3 1 Low Impact(Tier3) Project Title: Proposed New Residence - Lot 3, 303 Abbott Street Report date: 11/24/1 Data filename: C:\01-Projects\Residential\Corcoran-North Andover\10-Energy Audits\Abbott- Lot 3.rck Page 5 of 9 Section Plans Verified Field Verified # Framing/Rough-In Inspection Value Value 17Comp Comments/Assumptions & Req.ID 403.5 !Automatic or gravity dampers are ❑Complies [FR19]2 iinstalled on all outdoor air E❑Does Not intakes and exhausts. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Proposed New Residence - Lot 3, 303 Abbott Street Report date: 11/24/1 Data filename: C:\01-Projects\Residential\Corcoran-North Andover\10-Energy Audits\Abbott- Lot 3.rck Page 6 of 9 Section Plans Verified Field Verified # Insulation Inspection Value Value Complies? Comments/Assumptions & Req.ID 303.1 'All installed insulation is labeled ❑Complies [IN1312 or the installed R-values []Does Not 49) provided. ❑Not Observable , El Not Applicable 402.1.1, ;Floor insulation R-value. R- R- ;❑Complies ;See the Envelope Assemblies 402.2.5, i ;❑ Wood E] Wood !❑Does Not ;table for values. 402.2.6 ;❑ Steel ❑ Steel ;❑Not Observable [IN111 !❑Not Applicable 303.21 Floor insulation installed per ❑Complies 402.2.6 manufacturer's instructions, and ❑Does Not [IN211 !in substantial contact with the underside of the subfloor. ❑Not Observable ; I ❑Not Applicable 402.1.1, Mall insulation R value. If this is a; R R- ;❑Complies ;See the Envelope Assemblies 402.2.4, I mass wall with at least 1/i of the ❑ Wood E] ❑ Wood : Does Not table for values. 402.2.5 ;wall insulation on the wall ❑ Mass ❑ Mass :❑Not Observable [IN311 !exterior,the exterior insulation Steel Steel } ,requirement applies. i❑ ❑ ;❑Not Applicable , 303.2 ;Wall insulation is installed per ❑Complies [IN411 manufacturer's instructions. ❑Does Not 9 ; ❑Not Observable J❑Not Applicable 402.2.11 !Sunroom wall insulation has a R- R- ❑Complies ; [IN811 I minimum R-value of R-13. New ❑Does Not ;walls separating the sunroom 'from conditioned space must '[:]Not Observable ; meet code requirements. ❑Not Applicable 303.2 'Sunroom wall insulation installed ❑Complies ; [IN911 per manufacturer's Instructions. ❑Does Not V ❑Not Observable ❑Not Applicable 402.2.11 'Sunroom ceiling minimum R- R- ;❑Complies [IN10]1 i insulation R-value of R-19 in :❑Does Not !Climate Zones 1-4,and R-24 in !❑Not Observable Climate Zones 5-8. ' ❑Not Applicable , 303.2 'Sunroom ceiling insulation is 10Complies [IN11]1 installed per manufacturer's (❑Does Not instructions. U ! ❑Not Observable El Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) I 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Proposed New Residence - Lot 3, 303 Abbott Street Report date: 11/24/1 Data filename: C:\O1-Projects\Residential\Corcoran-North Andover\10-Energy Audits\Abbott- Lot 3.rck Page 7 of 9 Section Plans Verified Field Verified # Final Inspection Provisions Value Value Complies? Comments/Assumptions & Recl.ID 402.1.1, ;Ceiling insulation R-value.Where R- R- ;❑Complies ;See the Envelope Assemblies 402.2.1, I> R-30 is required, R-30 can be ❑ Wood ❑ Wood ;❑Does Not table for values. 402.2.2 I used if insulation is not :compressed E] Steel E] Steel ,❑Not Observable [FI1]1 pressed at eaves. R-30 may !be used for 500 ft2 or 20% ;❑Not Applicable (whichever is less)where sufficient space is not available. 303.1.1.1,',Ceiling insulation installed per ❑Complies 303.2 :manufacturer's instructions. ❑Does Not [FI2]1Blown insulation marked every 300 ft2. [-]Not Observable ; ❑Not Applicable 402.2.3 ;Attic access hatch and door R- R- ;❑Complies [FI3]1 insulation >_R-value of the T❑Does Not I adjacent assembly. ;❑Not Observable ❑Not Applicable 402.4.2, Building envelope tightness ; ACH 50 = ACH 50 = ;❑Complies 402.4.2.1 !verified by blower door test result: :❑Does Not [FI17]1 of<7 ACH at 50 Pa.This ( ;requirement may instead be met ❑Not Observable ; Evia visual inspection, in which : ❑Not Applicable :case verification may need to ; ;occur during Insulation ; Inspection. ! : 402.4.3Wood-burning fireplaces have ❑Complies [FIS]2 gasketed doors and outdoor ❑Does Not combustion air. ❑Not Observable ❑Not Applicable 403.2.2 Post construction duct tightness ; cfm cfm ;❑Complies [FI4]1 itest result of<8 cfm to outdoors, : !❑Does Not CEJ ;or s12 cfm across systems. Or, rough-in test result of<6 cfm ❑Not Observable across systems or<4 cfm : ;❑Not Applicable ;without air handler. Rough-in test :verification may need to occur ; !during Framing Inspection. 403.1.1 Programmable thermostats ❑Complies ; [FI9]2 installed on forced air furnaces. ❑Does Not 89 ❑Not Observable ❑Not Applicable 403.1.2 Heat pump thermostat installed ❑Complies [F[10]2 on heat pumps. ❑Does Not : u ❑Not Observable ❑Not Applicable 403.4 Circulating service hot water ❑Complies [FI11]2 systems have automatic or ❑Does Not accessible manual controls. ❑Not Observable ❑Not Applicable 403.9.1 Readily accessible switch on ❑Complies ; [FI12]3 heaters for swimming pools. ❑Does Not .0O Not Observable , ❑Not Applicable 403.9.2 Timer switches on pool heaters ❑Complies [FI19]3 and pumps are present. []Does Not ❑Not Observable ❑Not Applicable 11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Proposed New Residence - Lot 3, 303 Abbott Street Report date: 11/24/1 Data filename: C:\01-Projects\Residential\Corcoran-North Andover\10-Energy Audits\Abbott- Lot 3.rck Page 8 of 9 Section Plans Verified Field Verified # Final Inspection Provisions Value Value Complies? Comments/Assumptions & Req.ID 403.9.3 'Heated swimming pools have a ❑Complies [F120]3 cover. Covers on pools heated ILIDoes Not over 90°F are insulated to R-12.110-1 ❑Not Observable iE]Not Applicable 404.1 :50%of lamps in permanent ❑Complies [FI6]1 (fixtures are high efficacy lamps. ❑Does Not ❑Not Observable ' ❑Not Applicable 401.3 Compliance certificate posted. i❑Complies [F17]2 ❑Does Not OR ❑Not Observable i❑Not Applicable 303.3 Manufacturer manuals for ❑Complies [FI18]3 mechanical and water heating ❑Does Not equipment have been provided. law ❑Not Observable ; ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Proposed New Residence - Lot 3, 303 Abbott Street Report date: 11/24/1 Data filename: C:\01-Projects\Residential\Corcoran-North Andover\10-Energy Audits\Abbott- Lot 3.rck Page 9 of 9 4� 2009 IECC Energy Efficiency Certificate �sulafion!Rating Wall 21.00 Floor 30.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): 0.. zi Window 0.29 Door 0.60 Heating System: Cooling System: Water Heater: Name: Date: Comments Dimension Number of Stories: a Total square feet of floor area, based on Exterior dimensions._ - .Total land area, sq.ft.: 10 i ELECTRICAL: Movement of Meter location, mast or service �f drop requires approval o Yes N Electrical Inspector DANGER ZONE LITERATURE: Yes No MGL chapter-166 Section 21A-F and G min.$100-$1000.fine NOTES and DATA— For department use f f f I I 1 1 I i I I ® Notified for pickup - Date Doc.Building Permit Revised 2010 I I :F-- __- - _ •�u Certified Plot Plan ❑ Stamped Plans ❑ Building Department The folf-3wing 19--a-list of the required-forms to be filled out for the appropriate-permit to.be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ B.ailding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire-Department prior to issuance of Bldg Permit kl Addition Or Decks o Building Permit Application Li Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses j ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application / IoM p iefa ; I o Certified Proposed Plot Plan (� ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Q/ ❑ Copy of Contract ni /,4 ❑ Mass check Energy Compliance Report <i/ ❑ Engineering Affidavits for Engineered products N//-7 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases.if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doc: Doc.Buildffig Permit Revised 2012 f Date............................................. OF 40RTN TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,sS�CHUS�� This certifies that ..........�.../.. ...L�.......... -Gam (. /G-..-..-......................... '� has permission to perform .... J. iwS�`' wiring in the building of............�a..��. ....�?K/ .................... '.. at ..... ... . .. .Z . �� — Sr ............... orth Andover,Mass. ..... . .............................. Fee._...........................Lic.No. 1.7y Z J'...........EC4 .. ..... Check# ®s r el r i -7 Commonwealth of Massachusetts Official Use Only - Department of Fire Services Permit No. I �� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: � - z Zo City or Town of. NORTH ANDOVER To the Inspector of res: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) z 5 Owner or Tenant h Telephone No. Owner's Address Is this permit in conjunction with a building perm' . Yes No ❑ (Check Appropriate]Box) Purpose of Building r r91 Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. 4 No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans TransTotal Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- Elo.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: "" "K �"��"'�R� I.KW Detection/Alerting Devices No.of Dishwashers SpacelArea Heating KW Local❑ Municipal EJ other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or E uivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent l No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 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: 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 ElBOND El OTHER El (Specify:) I certfy,under thepains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: _ %, ry ,n LIC.NO.: t Licensee: A Signature LIC.NO.: (If applicable,enter"exem n th license number line.) Bus.Tel.No.:-. /a/ Address: IO J I)-t �� /�P��wP�u IYJ �� y�,/ Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safe "S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): —7 LIE' /_ Address: City/State/Zip: G N V(Phone#: (91"7--3S/— Are you an employer?Check the appropriate box: Type of project(required): 1.FM am a employer with " 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. y ❑Bg addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions r right of exemption per MGL 11.❑Plumbing repairs or additions 3:❑ I am a homeowner doing all work g p myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance ]ired.re q uemployees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. ,� ) Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: A.0.+iA=–z ,�• 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 $ne 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 DTA for insurance coverage verification. I do hereby certo and a pains and penalties of perjury that the information provided above is true and correct. Simature: /" Date: -2dl/ZJ Phone#: 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 Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: ". Date . :.'. ......... OF r10RTH-�~C TOWN OF NORTH ANDOVER * PERMIT FOR WIRING CHUS� This certifies that-W-4 A I A , ....... ........................... ............................................................... has permission to perform .� .0 ! '......... .P.. ............................. wiring in the building of. .�' r..4 V ................................. at ... ........................................... ...................................................... North Andover,Mass. Fee ........ ... .............Lic.No. "! �J ''y y .. .............................:.................................. (^ 1ET...TRTC'AT,INSPECTOR/ `"rGheck# w� !!! V 91ficialUse only Permit No. �' BOARD OF FIRE PREVENTION REGULATIONS icy and Fee Checked Ii47] mve blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfornied in accordance with the Massachusetts Electrical Cock(l EC 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: ��%/y City or Town of: A Awyl iyf To the hmpector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) fi /�5� Owner or Tenant �/�I�(Y�J,�.q�t/ Telephone No.�_//7-�/,3d Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Cheek Appropriate Boa) Purpose of Building 5b? Utility Authorization No. Existing Service Amps t Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps I Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ✓�Lsl/JIT� sys/�� Compkfionofdlefiffibotlawi tablen =be waived bv the Ins ctor of 13'ires. No.of Recessed Luminaires No.of Ceil,.-Susp.(Paddle)Fans NO.°ir Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA • q No.of Luminaires Swimming Pool Above ❑ d, ❑ Bane II In- of rgency Lighting grnd.No.of Receptacle Outlets No.of OR Burners ALARMS Nor of Zoom No.of Switches No.of Gas Burners No.of Detection an --- Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump I ANUmher TonsIo.o Self-Contained Totals: �.�._.__.. Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Loot❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security stems:" No.of Devices or Equivalent No.o ea KW o.o o.o Data Wiring: Heaters Si s Ballasts No.of Devices or Fauivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsW1m, e: No.of Devices or Equivilent OTHER: Attach additional detail if&sirer4 or as required by the Inspector of Wires. T;ztimated Value of Electrical Work: O Ue (When required by municipal policy.) Work to Start: 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 cov a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the Pai andpenalties ofperjwy,that lite information on this application is true and complete FIRM NAME:/ r LIC.NO.: .'3C_ Licensee:f ff�/ 1�� / �/�,?yf C(,� Signatu LIC.NO.: (Ifapplieable,enter exempt"to the license number line.) z Bus.Tel.No.r��y' � y�rY Address:/Ol> ?�,�Ilf'C`�,l/l�:' S'U1�`�r ?rl"i% �r�(/1i•{j ��!�/'�yJ/ Alf.Te1.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. .33.,? OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required bylaw. By my�gnawre below,I hereby waive this requirement. i atn the(check ones❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. FERMI7`FEE.$%S� Depertrm#of I MLI&ia/Academe Office of InwWMdons 1 Cal9rMshK Suite 106 Bbdo%MA 02114-2017 www ri3sag Mcia Workers'Compensation Insurance davit:Builders/Contractors/Electricians/Plumbers AWicant i nformation Please Print Leath Name(Business/Organization/tndividual): Address:�(�L� �ll�" Ci /State/Zi '` r'` ' j2Zd 2dL Phone Are you an erooyw?Check the appropriate bow Typed project(required}: 1.P�—am a employer with 11� — 4. Q I am a general contractor and I employees(full and/or part-time). s have hired the sub-contractors ❑New construction 2.Q 1 am a sole proprietor or partner- Iisted on the attached sheet- 7. Q Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. employees and have workers' 9. Q Building addition [No workers' comp.insurance comp.insurance. required.] 5. Q We are a corporation and its IO.Q Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 1 l.Q Plumbing repairs or additions myself. [No workers'comp. right of exemption per MQ, I2.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13, Others' 4 employees. [No workers' �� `/✓`r comp.insurance required.] *Any applicantthat 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 all work and then hire outside contmdom must submita new affidavit indicating such_ =Contractors that check this box must attached an additional sheet showingthe name of the sub sw�andwhether or not those entities have employees. If the sub-contractors bane employees,they must provide their workers'comp.policy number. lam an employer that isprovi&V workers'compensation insurance for my employees Bdow a the policy and job site lnfclrtttatitarL Insurance Company Name: �l�l"AZW/W _ Policy#or Self-ins.Iac.#: Expiration Date. Job Site Address:3a✓ z 9d%7-.57— -/ City/StateMp:/�/,��✓��j j;�� 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. 1 abhererbye"fy >Eie�safp�er%+trYthatthelrttamalfcr►prttuitf�dalaaelsLrueanaltaortert D 172 r Pllozre ��/�-.33%-��6 Widal taeordy. Do not vaftIntlr/savAtoboaam~bydiyortam dfidar►. City or Town: Pern*&Iowm# imuingAuthority(drdea*: 1.Board d Health 2.Building Department &City/Tewn Clerk 4ti Electrical tn*wor 5.Plumbing l rapector Other Contod Pe ram: Phone* I •O"�' N I N OF Mil M4J FOLL ' }, " g M . ISSUES � € s OWING RED u�� - CONTRAC'Cffµl��``"�a ,v �4 �,y. M- ,X ALARM CO fVAi 0 401'VRUL0 301 S ' O -k 64841 Sam r . 917��tr.Q 0 � :• •� 0 � t � e t SSUES .Tflf FOLLOWi SE ! REA f"�tM T £HN tC t f ° o L PALL i ARULO Y' 301 MtEi l fY,ST :g y �: �4 ; a"•w A 01 041 i -9 .923- J N 64840. ai ':.�t4"Y�"�. ?s"p�•a..�'.�t�'19 e� �„b'Ae,'s,"s i.�.,."amu*& ialiuty SSCO-000332 ' t RONALD L PACU AROLO 100 Trade Center Ste Gp-- Woburn MA 01801 0611112015 FIRST-3 OP ID:SM CERTIFICATE OF LIABILITY INSURANCE DA031271201TE Y) 03/27/2014 i 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 CONTACT Martini Insurance Agency,Inc. PHONe FAX 6 Common Street Ac AIc ..I: PO Box 565 E-MAIL Woburn,MA 01801-0665 ADDRESS: Martini Insurance Agency Inc INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Hartford Insurance Company INSURED First Alarm LLC INSURER B:Travelers Ronald Pagliarulo 100 Trade Center Suite G700 INSURER C Woburn,MA 01801 INSURER D: 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER M IDD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AX COMMERCIAL GENERAL LIABILITY 08UENOJ9837 10/11/2013 10/1112014 G RENTED PREMISES Ea occurrence $ 500,00 CLAIMS-MADE 7 OCCUR MED EXP Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 L' GEN'L AGGREGATE LIMIT APPLIES PER: PPR.DIUCTS-COMP/OP AGG $ 2,000,00 X POLICY JECTPRO- LOC iab $ 1,OOQ00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea accident B ANY AUTO BA-7D919644 10/31/2013 10/3112014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ S AUTOS AUTO X X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR Id CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION X WC STATU- I JOTH- AND EMPLOYERS'LIABILITYER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y�N 08WECCPS487 03/13/2014 03/13/2015 E.L.EACH ACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? FY-1N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 nFSCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) ": Operations of the named insured for installation and servicing of Alarm systems. r CERTIFICATE HOLDER CANCELLATION FIRSTAL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN First Alarm LLC ACCORDANCE WITH THE POLICY PROVISIONS. 100 Trade Center Suite G700 Wobum,MA 01801 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Date......-..2..�—... �10RTFI TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING �88AC04U5�S This certifies that . ............................................................................................................................ has permission to perform............:-S.r�T%..�........SYS../ 1............... wiring in the building of........................L.:. ��n1 ............................................. at .. � ./ ..... .. ,,.,. L..-...0 ,North Andover,Mass. Fee.12..a�""'...."Lic.No. 1.7.. 4 f`p- ALINSPECTO�� Check# /7 X2311 1 Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Ll —2— City or Town of: NORTH ANDOVER ector of Wires: By this application the undersigned gives notice of his or her intention t erform the ele ical work described below. Location(Street&Number) In Owner or Tenantc- Owner's Address W e.� - Is this permit in conjunction with a building p rmit? Yes Purpose of Building Existing Service Amps / Volts Overhead New Service Amps / Volts Overhead E Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the, I No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Luminaire Outlets No.of Hot Tubs AboveIn- No.of Luminaires Swimming Pool rnd. ❑ rnd. No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Dis osers Heat Pump Number Tons J.KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal El Other P g Connection lTo.of Dryers Heating Appliances Kms, Security Systems:* y No.of Devices or Equivalent .do.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent ~ No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 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: 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 cover is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE LY BOND ❑ OTHER ❑ (Specify:) I certify,tinder thepains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: `' 0k, f ciC LIC.NO.:f 7 y3 tf Licensee: r12�,1 KD�yb .� c Signature LIC.NO.: (If applicable,ente `ex�ce a number line.) us.Tel.No.: ? �J Address: 7��e. � i�/,r�r f7 2,r' CS itf�/� Alt.Tel.No.: 4 a *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/AgentPEIrnMIT FEE: $ Signature Telephone No. •'F 1 Commonwealth of Massachusetts Official Use only Permit No. l Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: L 2 S_ // City or Town of: NORTH ANDOVER ector of Wires: By this application the undersigned gives notice of his or her intention t r erform the ele 7 ical work described below. Location(Street&Number) Owner or Tenant r Telephone No. Owner's AddressGJ h/ h e:.is "W &7 Gs �, Is this permit in conjunction with a building permit? Yes [�-_ No ❑ (Check Appropriate Box) Purpose of Building ( Utility Authorization No. Existing Service Amps / Volts Overhead ❑ U gid No.of Meters V New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: V Completion of the following table may be waived by the Inspector of Wires. of No.of Recessed Luminaires No.of Ceil: P•(Paddle)Fans SusTransTotal TTrsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o mergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Detection and No.of Switches No.of Gas BurnersTot Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection lTo.of Dryers Heating Appliances Kir Security Systems:" u y No.of Devices or Equivalent .to.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent W dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: No.H y g No.of Devices or EQ uivalent OTHER: 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: 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 cover is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains anti penalties of perjury,that lite information on this application is true and complete. —� �-- , LIC.NO.: /-]V3 q FIRM NAME: c �c. � 0 Licensee: , /qp�l p ,�c ,j c.. Signature t LIC.NO.: (If applicable,ente "exe , n the liven a number line.) us.Tel.No.: ? �J Address:/ 7Jh�. � 0 4 M_ 11%flwe Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. The Commonwealth of Massachusetts Department of IndustrialAccl6iuts Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 4 d t •`` , S 1L' City/State/Zip: 4�e_A uei J )1A G)1!(—Y1-( Phone#: 6717—M-1—i 6 / 7 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y p tY• 9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they aie 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 insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:. Policy#or Self-ins. .l Lie.#: Expiration Date: Job Site Addressl � City/State/Zip: Atth a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 certify under thefiiWs andpenalties ofperjury that the information provided above is true and correct. Signature: J �-' // Date: Phone#: 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 Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Date...... l..1 ................. OF r►OR7M 7ti TOWN OF NORTH ANDOVER 1- T PERMIT FOR GAS INSTALLATION This certifies that ... � ... ....... ....�....�.jJ...........//.............//................. has permission for as installatio*� ..�! ..kms Sf. inthe buildings roff�................................................................................................................... at.... . - .w ..9 .............................. ... No h"Andover, Mass. Fee .:"...... Lic. No 3 .................. ...... ....`....'...... :.. ... ( GASINSPECTOR Check#-/,-319( \/ 4-.22. Date....71—?. I...1........ 10651q TOWN OF NORTH ANDOVER * PERMIT FOR PLUMBING gBACHus� This`certifies that.. ......aI r ...... ........................,.�.4................................................ has.permission to perform.2-K- lf&............................................................... plumbingiri the/buildings of............................................................................................. .......................�R............. North Andover, Mass. Fee,.a'�5�2-,cuLic. No. Q..l - ............. - /..— .............................. PLUMBING INSPECTOR Chebk# TI a {� l MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK lJi� - �' CITY _ w{ MA DATE L I PERMIT# JOBSITE ADDRESS OWNER'S NAME ,PI POWNER ADDRESS I TEL[ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL-] PRINT CLEARLY NEW: RENOVATION:® REPLACEMENT:Ml PLANS SUBMITTED: YES-2 NOQ FIXTURES'l FLOOR--d BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM ��I _ I I _._I --- J11 f .} DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM L I 1 _ E J _,_I ._...___.I ____6 .___t _I FI DISHWASHER DRINKING FOUNTAIN - -i --.---_E i _.__.} _..__._f __...--I ---_--..1 ---_--_I ..-----.-I .-_ .--t ---.....f _._.,._j ....._! FOOD DISPOSER FLOOR/AREA DRAIN _i _.__ _._---� ----- -.---- INTERCEPTOR(INTERIOR) KITCHEN SINK I _-_I _..� t ____J ___-_..I LAVATORY !=27--j --— -—I1= ----I ----I ROOF DRAIN ( __.__. Ei - -._-_. I ___ _ .__.___ $HOWER STALL __-A .11 I I SERVICE/MOP SINK TOILET 11-LJ -_ 4 URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATFRPIPING OTHER — ( i --- -- -� ! ---! - - I - - -! - I --( I -I IF -------I --._._..I _...J __..._..1 ! __J 1 ......._I ........_.I _ __I _.___ I ._.._. I ..I i INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES-M NO �-I� IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND D OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT JE1 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. z� PLUMBER'S NAME LICENSE# © SIGNATURE MP El JP JR CORPORATION n# PARTNERSHIP Q# _ ;LLC COMPANY NAME JBO jvr b rr ADDRESS CITYrh1__^---- - ]STATE _� ZIP TEL - -)8 FAX L____ CELL[.--.----_--,-.,J1 EMAIL Y The Commonwealth oflMlassachusetts Acx Department oflndustriglAccitlents Office o fInvestigations 600 Washington Street Boston,MA 02111 www.mass gov1dia . Workers' Compensation Insurance Affidavit:Builders/Contractors/Blectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):M C1l AsI I �I1� ��ff7i Address: City/State/Zip: b4nn NAA (2)C101 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. fgNew construction employees(full and/or part-time).* have hired the sub-contractors 7. Remodeling 2.19 I am a sole proprietor or partner- listed on the attached sheet.T ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9, ❑Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner'doing all work right of exemption per MGL l I.®'Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12,❑Roofrepairs insurance required.], employees.[No workers' 13.ElOther comp.insurance required.] *Any applicant that checks box W1 must also fill out the sectionbelow showing theirworkers'compensation policy information. I Homeowners who submit this affidavit indicating they ire 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. 'am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:_ Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Y do hereby certio under the pains and penalties ofperjury that the information provided above is true and correct. - Sienature• Date: Phone#• h$'1 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 Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: _ Phone#: �' •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYEJ I�t�6�� 1 �� _ _�� MA DATE PERMIT# JOBSITE ADDRESS 35 Z1- OWNER'S NAME r F � GOWNER ADDRESS L TE —=FAX TYPE OR OCCUPANCYTYPE COMMERCIAL EDUCATIONALD] RESIDENTIALla PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YE1 NOF] APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 1 9 10 1112 13 14 BOILER _.—..__I .-_- ._. . ( i_ I I - -- ( 1.. - - -T BOOSTER _ CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _ J FURNACE _ L.. _ILJJI GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS _ MAKEUP AIR UNIT (_- OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER i � "UNVENTED ROOM HEATER WATER HEATER �_ - OTHER --- INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES-V NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY-E�j OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT Ell SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME �� of5 _ LICENSE#5W SIGNATURE MP[j MGF JP 5a JGFJ LPGI E1 CORPORATION©#��PARTNERSHIP®#�LLC E]# COMPANY NAME: _ 1,� _ ,� • __._ ADDRESS CITY ILAyt1 _ _ STATE�ZIP Q 00` -11TEL - FAX I -JI CELL EMAIL i The Commonwealth of Massachusetts Department oflndustriglAccidents Office o f Investigations 600 Washingtoxt.Street Boston,MA 02111 www.mass govldia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizationlfndividual): hMcw-.5ACJI Plu-Lyi Address: - City/State/Zip: L xly)A 0)5 04 Phone M D-K 00 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ]New construction employees(full and/or part-time).* have hired the sub-contractors 2.®'I am a sole proprietor or partner- listed on the attached sheet,t �• Remodeling i ship and'have no employees These sub-contractors have S. E]Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 1011 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11,E Plumbing repairs or additions t myself.[No workers'comp. c. 152,§1(4),and wehaveno 12.❑Roofrepairs insurance required.) employees.[No workers' 13.❑Other comp.insurance required.] + xAnyapplicant thatchecks box#1 must also fill out the section below showingtheir workers'compensation policy information. Homeowners who submit this affidavit indicating they a're 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 insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ Policy#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 expiration date). Failure to secure coverage as requiredunder 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 welles 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 maybe forwarded to the Office of 'Investigations of the DIA for insurance coverage verification. X dohereby certio under �the pai/ns andpenalties ofperjury that the information provided abov is true and correct. Si ature• Date: Phone 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 Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - Contact Person: _ Phone#: Date.... ........................ �►OtITI�,� - . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION . L �8`4gC►A19� This certifies that ..........` ^" ' ' �. .................. ............................................................................ has permission for gas i�}stallation�...� `.......PI.lP.... .. ......................... l�.�Cay�l ... inthe build* s of................................................................................................................. �2 - at.. , North Andover, Mass. Fee ..."-....... Lic. No. .r....� ......... ................................................... GAS INSPECTOR Check# i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 6/2/2014 PERMIT# JOBSITE ADDRESS 325 Abbott St OWNER'S NAME Bob Corcoran OWNER ADDRESS 9 Whitney Rd N Andover TEL 1 617-512-3967 FAX 0 OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL x❑ TYPE OR pRUff NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESQ N0F_� - ]E1UY APPLIANCES 3 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK TOP DIRECT VENT HEATER DRYER FIRE PLACE FRYOLATER FURNACE GENERATOR 3 GRILL INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT 7 OVEN -- P OL HEATER ROOM/SPACE HEATER ROOF TOP UNIT -'QST UNIT HEATER UNVENTED ROOM HEATER / WATER HEATER GAS PIPING FOR 500 GAL UG LP TANK x �-- INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E] NO IF YOU HAVE CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and��e beV my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in cs a with all Perti rovision of the Massachusetts State Plumbing Code and Chatper 142 of the General Laws PLUMBER-GASFITTER NAME Timothy SurdamLIC 0 -J SIGNATURE MP [:] MGF[:] JP[:] JGF E] LPGI[] CORPORATION E]# 164 PARTNERSHIP []#OLLC []# COMPANY NAME: E Lorden Oil Cc Inc ADDRESS: 69 Fitchburg Rd,PO Box 669 CITY: Ayer I STATE: ® ZIP 1432 TEL: 978-772:&000 FAX. 978-772 5956 CELL: EMAIL: 1^ i� �t i h � � .00 • Lei 0 FIVE mdgl ' LUR ;A SF I71 1 L pCtS # ,1UE�N£1''hlA :GASP f TTER' 1 _. .:; ,. !�.✓a t! , _- 21' .1 267 Date..l.i. . �.�.`'t .. .. .... HORTN TOWN OF NORTH ANDOVER pf .ao ,ti0 a a a p (01 PERMIT FOR MECHANICAL INSTALLATION L A 4 � 'tr,9SSACeFIl15Et,( This certifies that . dA-37).. . . d. :. . . . . . . . . . . has permission for mechanical installation . . . . . . . . . . . . in the buildings of .�► � ,. . .f. : . . C . . . . . . . . . . . . . . . . . . at .�L�3. . . ? .a A11 s. 7 , North Andover, Mass. Fee.'.�6 . . . Lic. No..(? .T.[� . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer l� Commonwealth of Massachusetts s Sheet Metal Permit Date : Rk? bA Permit#___ _- Estimated Job Cost: L- Q Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# C2,-1 Applicant License# 2 -1 Business Information: Properly Owner/Job Location Information: Name: �►�� Name: SWE ex)c2�&�� - N Street: Street: bh - S L City/Town: City/Town: ki Telephone: 91, k)-,S726 =�Com_�-__ TelCOC) �l t�'�°�� Photo I.D.required/Copy of Photo I.D. attached: YES-)Q NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu.ft._X_ over 35,000 cu. ft. Sheet metal work to be completed: New Work:_ 1A Renovation: HVAC Metal Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: Pr L A J2 1_y y Y The Common-wealth of Massaighusetts , lie arnant offThilAceWits Office of'fnvestigations 640 Washingtoft,5`treet Boston,HA 02111 www.mass gov/dza Vi o rkexg'Compextsatxon bsuxance"davit:EuffdersIContrcactoxs/FIectrici[anslpli*i exs A�np can 7n oxanatXon PleasePrint Lop-Ay Namo(3usinessl0rgaAzationlXn&iduaT Address: 7 - r Ll) - Czly/Sta�etZzp: Phone iE:_ Are on[an emplgar?check the appropriate box: Type of project(r�egmlred): ;�am.a employer with. 4. ❑I am.a general contractor and I 6. []New construction f employees(full and(or part time): have lvredthesub-contractors 2.❑ I am.a sole proprietor orpartner listed on the attached sheaf 7• Remodeling ship and`haveno.employees These sub-contractors have 8. ❑Demolition worldng forme in.may capacity. workers'comp.insurance. 9. ❑Building addition ' [No work-Drs'comp.insurance 5. ❑we are a corporation anti its 101]Electrical repairs or additions reg*ed.] officers have exercised.their right of exemption tion or MOL 11..0 Plumbing repairs or additions •[i X am.a homeovanex doing all work c�2 §1�, and we have no myself:�10 workers comp. a ( )a 12.Q Roofxepairs insurancerequired.1 i employees.jNo workers' 13..©Hier _/ QCt comp.insurance required.] :Any applicantthat checks boxol must also fill outthe section below showingtheir workers'compensationpoHcyintormation. -flomeownerswlmo submittbisaffldavitindio4agthekgo doing allworicandthenbireoutside contractorsmustsubmitanew affidavit indicatingsuoh. xContracfors ibat checkthis box must attached as additional sheet show%ngthe name of the Mk-contractors and their workers'comp.policy information. icxranexnproyeNtliatisprovicir2gN�oskers'coryzpe�asationinsutaeeforrnyernployees Betox�is�hepoZicyccnc�Ja �ite if2foxmatio�t. . T surance CompanyName; Policy##or Selma ins.UG #; 6 A\1U C iratzou Date: J ZOl Tob Site Address' �G3 /V A CX,P O CitytSEate/dip: Attach a copy oFt teworlters'compensation.-rolleydeclaration.page(showing•thepolicynumbex and expiration date). pailure to secure coverage as requiredmder Section.25A.ofMGL o.152 taxi.lead to the imposition of criminallienalties of a fine up to$1,500,00 and/or one-year imprisonment,as welt es obA penalties in.the form of a STOP WORK ORDER.and a fmn.e ofup to$250.DQ a clay against the violator: Be advised that a copy of this statementmaybe,forwarded to the Office-of- investigations finvestigations of the DIA.for insurance coverage verification. X tfo Iter'eby certTors andpenalties ofvexjury tliattrie infonnnatio"PovIdEclabove is true andeorrxeetS` afore• Date: 12 Phone#: G Official use o,11y. .Do not Inite in Als area,to be eompletedby city or town official City or Town: Permit/f iceuse 9 fwaing.A.uth.oxity(circle one): 1.Board of)Etealtli?.Building)Department 3.City/Town Clerk 4.]electrical fuspector s.Plum ming l uspector f.Wher Company Info 1 , 1 Name:East coast comfort Address:252 woburn street Location:Wilmington,MA,01887 Phone:978-580-7021 Client Info Building name/description: Contact name:Steve Corcom Address:303 Abbott rd Location:North Andover,Massachusetts,United States Phone: Load Summary Total building area: 884.0 SgFt Total cooling load: 34,355.0 BTUh Total coaling tonnage: 2.9 tons _ Total heating load: 45,879.4 BTUh Total airflow: 4,083.7 CFM Project Load Breakdown-Cooling C) Windows,glass doors,skylights: 24,603 BTUh Envelope(walls,doors,roof,etc.):' 1,272.0 BTUh Infiltration: 1,286. BTUh Internal gain: 3,350.0 BTUh Duct and blower heat gain: 0.6 BTUh Ventilation: 2,117. BTUh Excursion adjustment load: 1,726.1 BTUh Total cooling: 34,355.0 BTUh Project Load Breakdown-Heating 0 Windows,glass doors.skylights: 29,998A BTUh Envelope(walls,doors,roof,etc.): 5,653.2 BTUh Infiltration: 5,468. BTUh Duct heat loss: 0.1 BTUh Ventilation/winter humidification: 4,769. BTUh Hot water piping load: 0. BTUh Total heating: 45,879.4 BTUh Project AED Curve I ACCA-Approved Manual J8 Calculations 11:34:11 06-05-2014 This software was developed by Cannel Software Corporation. It has been approved by ACCA for Manual J8 residential HVAC load calculations. System Load Summary ' System description:System 1 �* } Total building area: 884.0 i Total cooling load: 34,355.0 BTUh ` Total cooling tonnage: — 2.9 tons Total heating load: 45,879.4 BTUh Total airflow: — 4,083.7 CFM System Block Load Breakdown-Cooling Windows,glass doors,skylights: 24,603.1 BTUh Envelope(walls,doors,roof,etc.): 1,272.0 BTUh Infiltration: 1.288. BTUh Internal gain: 3,350. BTUh Duct and blower heat gain: 0.0 BTUh Ventilation: 2.117. BTUh Excursion adjustment load: 1,726.1 BTUh Total cooling: 34,355.0 BTUh System Block Load Breakdown-Heating Win I skylights:Windows,glass��rs,sky � is 29,988.0 BTUh Envelope(walls,doors,roof,etc.) 5,653.2 BTUh� Infiltration: 5,468. BTUh Duct heat loss: -O.q BTUh Ventilation/winter humidification: 4,769. i BTUh Hot water piping load: 0. BTUh -- _-— - - ---— Total heating: 45,879.4 BTUh System AED Curve ACCA-Approved Manual J8 Calculations 11:34:1108-05-2014 - This software was developed by Carmel Software Corporation. It has been approved by ACCA for Manual J8 residential HVAC load calculations. System Checksums Cooling Total building area (SgFt): 884.0 " Total building volume (CuFt): 7,072.0 Total cooling sensible load (BTUh): 31,304.7 Total cooling latent load (BTUh): 3,050.3 Total cooling load (BTUh): 34,355.0 Total tonnage(tons)::. 2.9 Total cooling infiltration airflow (CFM): 38.9 Total cooling ventilation airflow (CFM): 64.1 Total airflow (CF,M): 4,083.7 Total infiltration air changes/hr (ACH): 0.33 Sensible heat coefficient (SHC): 1.10 Latent heat coefficient (LHC): 0.68 Cooling load density (BTUh/SgFt): 38.86 Cooling airflow density (CFM/SgFt): 4.62 Cooling airflow/load (CFMfron): 1,426.4 Cooling area/load (SgFtffon): 308.8 System Checksums - Heating Total building area (SgFt): 884.0 Total building volume (CuFt): 7,072.0 Total heating load (BTUh): 45,879.4 Total airflow (CFM): 4,083.7 Total building air changes/hr (AC'H): 34.65 Sensible heat coefficient (SH'C): 1.10 Latent heat coefficient (LHC): 0.68 Heating load density (BTUh/SgFt). 51.9 Heating airflow density (CFM/SgFt): 4.62 ACCA-Approved Manual J8 Calculations 11:34:1108-05-2014 This software was developed by Carmel Software Corporation.. It has been approved by ACCA for Manual JB residential HVAC load calculations. System Block Load Breakdown -Cooling • Description Value % Windows and glass doors: 24,603.5 71.6% Skylights: 0.0 0.0% Wood and metal doors:. 0.0 0.0% Above grade walls: 1,272.0 3.7% Partition walls: 0.0 0.0% Below grade walls: 0.0 0.0% Ceilings: 0.0 0.0% Floors: 0.0 0.0% Infiltration: 1,286.4 3.7% Internal gain: 3,350.0 9.8% Duct heat gain: 0.0 0.0% Ventilation: 2,117.1 6.2% Blower heat gain. OA 0.0% Excursion adjustment load: 1,726.1 5.0% Total cooling: 34,355.0 100.... System Block Load Breakdown -Heating (Description Value % Windows and glass doors: 29,988.0 65.4% Skylights: 0.0 0.0% Wood and metal doors: 0.0 0.0% Above grade walls: 5,653.2 12.3% Partition walls: 0.0 0.0% Below grade walls: 0.0 0.0% Ceilings: 0.0 0.0% Floors: 0.0 OA% Infiltration: 5,468.5 11.9% Duct heat loss: 0.0 0.0% Ventilation: 4,769.7 10.4% Hot water piping load: 0.0 0.0% Winter humidification load: 0.0 0.0% Total heating: 45,879.4 100.... ACCA-Approved Manual J8 Calculations 11:34:11 08-05-2014 This software was developed by Carmel Software Corporation. It has been approved by ACOA for Manual J8 residential HVAC load calculations. Roorn Heating and Cooling Totals Room Name Cooling (Load (BTUh) Heating (Load (BTUh) Airflow (CFM) A Room 0.0 0.0 0.0 Totals 0.0 0.0 0..0 ACOA-Approved Manual JS Calculations 11:34:11 08-05-209 4 This software was developed by Carmel Software Corporation. It has been approved by ACCA for Manual JS residential HVAC load calculations. System Block Load Breakdown-Cooling Windows,glass doors, skylights: 24,603. y BTUh Envelope(walls,doors,roof,eta):L T 1,272.0 BTUh Infiltration: 1,286. ,BTUh Internal gain:L3,350.0,BTUh Duct and blower heat gain: BTUh Ventilation: 2.1 ff.] BTUh Excursion adjustment load: 1,726.1 BTUh Total cooling: 34,355.0 BTUh System Block Load Breakdown-Heating Windows,glass doors, skylights: 29,988.0 BTUh Envelope(walls,doors,roof,etc.): 5,653.2 BTUh Infiltration;L 5,468. �BTUh Duct heat loss:L9._q BTUh Ventilation/winter humidification: 4,L69A BTUh Hot water piping load: ::0.§BTUh Total heating: 45,879.4 BTUh System AED Curve RCCA-Approved Manual J8 Calculations 11:34:11 08-05-2014 This software was developed by Carmel Software Corporation. It has been approved by ACCA for Manual J8 residential HVAC load calculations. Company Info Name:East coast comfort Address:252 woburn street • Location:Wilmington,MA,01887 Phone:978-680-7021 Client Info Building name/description: Contact name:Steve Corcom Address:303 Abbott rd i Location:North Andover,Massachusetts,United States Phone: Load Summary Total building area: 1,335.0 SgFt Total cooling load: 34,509.4 BTUh Total cooling tonnage: 2.9 tons Total heating load: 45,685.9 BTUh Total airflow: 4,031.1 CFM Project Load Breakdown-Cooling Windows,glass doors,skylights: 22,963.1 BTUh Envelope(walls,doors,roof,etc.):iI, T 957.4 BTUh Infiltration: 1722. BTUh Internal gain: 4.980.0 BTUh Duct and blower heat gain: _ J.0 BTUh Ventilation: 2,274. BTUh Excursion adjustment load: 1,611.0 BTUh Total cooling: 34,509.4 BTUh Project Load Breakdown-Heating 0 Windows,glass doors,skylights: 27,988. BTUh Envelope(walls,doors,roof,etc.): 4,257.3 BTUh Infiltration:1 8.314. BTUh Duct heat loss: 0. BTUh Ventilation/winter humidification: 5,125. BTUh Hot water piping load: 0. BTUh Total heating: 45,685.9 BTUh Project AED Curve ACCA-Approved Manual J8 Calculations 11:51:37 08-05-2014 This software was developed by Carmel Software Corporation. It has been approved by ACCA for Manual J8 residential HVAC load calculations. System Load Summary System description:System 1 i Y - Total building area: -�- 1,456.0 Total cooling load: 34,509.4 BTUh - Total cooling tonnage: -- - - - - 2.9 tons --- Total heating load: 45,685.9 BTUh —� Total airflow: 4,031.1 CFM System Block Load Breakdown-Cooling Windows,glass doors,skylights: 22,963.3 BTUh— I Envelope(walls,doors,roof,etc.):. 957.9 BTUh Infiltration: 1,722-1 BTUh Internal gain: 4,980_BTUh —i- Duct and blower heat gain: — —V 0.a BTUh Ventilation: 2.274. STUN Excursion adjustment load: 1,611.0 BTUh Total cooling: 34,509.4 STUh System Block Load Breakdown-Heating Windows,glass doors,skylights:L27,988.8 BTUh Envelope(walls,doors,roof,etc.):I 4,257.3 BTUh Infiltration: 8,314. BTUh Duct heat loss: 0. BTUh Ventilation/winter humidification: 5,1�'BTUh Hot water piping load:s 0. BTUh Total heating: 45,685.9 BTUh System AED Curve ACCA-Approved Manual J8 Calculations 11:51:37 08-05-2014 This software was developed by Carmel Software Corporation. It has been approved by ACCA for Manual JS residential HVAC load calculations. System Checksums _ Cooling Total building area (SgFt): 1,335.0 Total building volume (CuFt): 13,350.0 Total cooling sensible load (BTUh): 30,901.4 Total cooling latent load (BTUh): 3,608.0 Total cooling load (BTUh): 34,509.4 Total tonnage (tons): 2.9 Total cooling infiltration airflow (CFM): 52.1 Total cooling ventilation airflow (CFM): 68.8 Total airflow (CF.M): 4,031.1 Total infiltration air changes/hr (ACH): 0.23 Sensible heat coefficient (SHC): 1.10 Latent heat coefficient (LHC): 0.68 Cooling load density (BTUh/SgFt): 25.85 Cooling airflow density (CFM/SgFt): 3.02 Cooling airflow/load (CFM/Ton) 1,401.7 Cooling area/'load (SgFt/Ton): 464.2 System Checksums - Heating Total building area (SgFt): 1,456.0 Total building volume (CuFt): 14,560.0 Total heating load (BTUh) 45,685.9 Total airflow (CFM): 4,031.1 Total building air changes/hr (ACH) 16.61 Sensible heat coefficient (SH'C): 1.10 Latent heat coefficient (LHC) 0.68 Heating load density (BTUh/SgFt): 31.4 Heating airflow density (CFM/SgFt): 2.77 RCCA-Approved Manual A Calculations 11:51:37 08-05-2014 This software was developedby Carmel Software Corporation. It has been approved by ACOA for Manual J8 residential HVAC load calculations. System Block Load Breakdown - Cooling Description Value °l'o. Windows and glass doors: 22,963.3 66.5010 Skylights: 0.0 0.09/0 Wood and metal doors: 0.0 0.0010 Above grade walls: 957.9 2.8% Partition walls: 0.0 0.0% Below grade walls: 0.0 0.09/o Ceilings: 0.0 0.0% Floors: 0.0 0.0% Infiltration: 1,722.3 5.0% Internal gain: 4,980.0 14.4% Duct heat gain: 0.0 0.0% Ventilation: 2,274.9 6.6% (Blower heat gain: 0.0 0.0% Excursion adjustment load: 1,611.0 4.7% Total cooling: 34,509.4 100.... System Block Load Breakdown - Beating Description Value % Windows and glass doors: 27,988.8 61.3010 Skylights: 0.0 0.0% Wood and metal doors: 0.0 0.0% Above grade walls: 4,257.3 9.3% Partition walls: 0.0 0.0% Below grade walls: 0.0 0.0% Ceilings: 0.0 0.0% Floors: 0.0 0.0% Infiltration: 8,314.5 18.2% Duct heat loss: 0.0 0,0010 Ventilation: 5,125.3 11.2% Hot water piping load: 0.0 0.0% Winter humidification load: 0.0 0.0% Total heating: 45,685.9 100.... ACCA=Approved Manual J8 Calculations 11:51:37 08-05-2014 This software was developed by Carmel Software Corporation. It has been approved by ACCA for 'Manual J8 residential HVAC load calculations. r " E Room Heating and Cooling Totals Roorn Name Cooling Load (BTUh) Heating Load (BTUh) ,Airflow (C'FM) A Doom 0.0 0.0 0.0 Totals 0.0 0.0 0.0 ACCA-Approved Manual Vit# Calculations 11 :51;37 08-05-2014 This software was developed by Carmel Software Corporation. It has been approved by RCCA for Manual J3 residential HVAC load calculations. System Block Load Breakdown-Cooling Windows,glass doors, skylights: 22,963.3;BTUh Envelope walls,doors,roof,etc.):' 957.9 BTUh Infiltration: 1,722. BTUh Internal gain: 4,980. ,BTUh Duct and blower heat gain: 0.3,BTUh Ventilation: 2,E4::j1 BTUh Excursion adjustment load: 1,611.0 BTUh Total cooling: 34,509.4 BTUh System Block Load Breakdown-Beating Windows,glass doors,skylights: 27,988.8 BTUh Envelope(walls,doors,roof,etc.):r 4,257.3,BTUh Infiltration: 8.314J,BTUh Duct heat loss:L0. ,BTUh Ventilation/winter humidification: 5,125.5 BTUh Hot water piping load: 0. BTUh Total heating: 45,685.9 BTUh System AEO Curve I ACCA-Approved Manual J8 Calculations 11:51:37 08-05-2014 This software was developed by Carmel Software Corporation. It has been approved by ACCA for Manual J8 residential HVAC load calculations. LEGEND ® Mo.,cue°fir PO VAS P-0 µ,, fK• DESIGN 8c CONSULTING v-)N•w-a r+A' v-r ri5• N+N IP-n P'-a 49 Appleton Sheet Meho ,MA 02176 EEL Te/ophone.• - � 339-927-1579 yi pdcdesigElQgmeil.Com P-posed New Residence at i ®^ A LOt3 r a --�-- PANIL BOON c 303AbbottStrxt .D s N.Andover,MA !TC EN N, r41HN�G R�OON i r 1 4 i I g_,GARRAQE p –adbt ------------------------------- T ---� II ppppyy�� 9ubmlweA lbr. L7 >n I I 1 0�� Pemlk 3m 'f F )iwcN)e � D f in IAEOVL ± - CA �y: � Hxewe FNe Nome. Al/.FBstFYem➢Le.pe r+A• +mak• w->N• -)k uaN• cak. � �c Date: NolmEer 1Q 1013 RCV1910II9: H-0' Rav M Dole Po n FIRST FLOOR PLAN ,g SCALE:VT-r-0' Drawing N=ber Jig ig! + - i _ Al . 1 LEGEND ® MM474TIM"r ® '�onexm1°aoe"�oe�ievaoa� PORAVAS DESIGN& CONSULTING 49 Appleton Street Melrose,MA 02176 w-a m-a Sao• w•fri• r-IA• r•p6• rik e•r riM,• va• rbf' e'-a r-oA• r-fY.• r-�A' r�N• a'-r v-r Telephone: 339-927-1579 &-Mtil: pdcdesignl®>weumm Proposed ------ --- ----' a ® i NewResideamat y vi L00 303 Abbott Street ® k j N.Andover,MA g a l y E 0 97 'iK Wr3idY-� j F KRY i i 'aoeei' ff ie e�ED��R,OON 04 v-I,A• n,.wely. f :_________ ________ PIIS Nnme: �em�n A/1.9a�lourMln. A�'•I• Tl . f' Date: l6,3013 Y-fA' v-n11• a-]k' twq' a•-I.• r-1A' YO Revisions: aW 3'-f' IYiI{' T-[Y' RO RevM Defn L LL . 4k - SECOND FLOOR PLAN . d scALE:yr•r-a R a—g Number L'i _, A1 .2 LEGEND ® a"icruY�`w1NeoR�IR°�ar ® n�oiniEbe'�iecr�i°X PORAVAS DESIGN& CONSULTING 49 Appleton Street Melrose,MA 02176 v-o• v-o• taa Telephone: 339-927-1579 '____..1�__._.._.:-.l E-Mad: r pdcdesip1@gmaiLc= ...__ Proposed - _ ---"-' NewResideace et: --- - ��'''••^''��1��' --- ----- -- --- Lot 3 303 Abbott Street « -- ---- "�•U�t...��` OF Ando 0 • ___________. 1.111 T _ _ __ N. ver,MA a _L : I � raxoAT nAxi - � 4 UNFINISHED ATTIC -------------------------- `FhInOM YTPY TO RneR mLLOY I4AR%fiIARYY'ARIA }'-------- L I � TeX p V ruuLAc- ®i I }� ------------ � A I�____________________: L Por:______________• � ____-_________ ________� �YpppTp��IXlX/AXn YOi9 ":o-a �a•o' aa�T-e :laknme..av Date: BASEMENT FLOOR PLAN ATTIC FLOOR PLAN N n BCAL:3/IC• -e' SCALESCALE:3AB- Revissionss:; Rav M Dale p� Y - y,6q l z_ Drawing Number A1.3 l L 1 r aaOI as r�r.BU Ar tit_ �.._ �a �ss�tld' s 7 GLENN'' a 252 YIIUBURN STREET —} tWllblINGTON MlAr01887 406 # �rI . ?# F. ,- i., v.ft50D04-16-7012 Rav U7163G09 �. �> 3' E' COMMONWEALTH OFMASS0CH9SEIS e • � • • � _,_ RQAftl3tl� Le A SSUESr THE FOLLOW FNS<L CENSE ;x ASA ORNEYPERSON UNR S?RI ZEEt` TE.PPAN G TOS L ST V252 WOR A y �.. x^ - ._ 210 T.22 -