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HomeMy WebLinkAboutMiscellaneous - 333 CANDLESTICK ROAD 4/30/2018 (2)Date/'.7— TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .... 4.1.4, � . T.l.o. l l� ? �14,j .................. ' has permission for gas installation .............. in the buildings of ..... tit -S, l� ...... ............... . at ..'s-3 . ��/ ,. �,�o f�i ........... North Andover, Mass. Fee ��� —... Lic. No.11.7 V .. IV. ................. ... GASINSPECTOR Check # 21,413 8503 •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • `� CITY �7�4 ���IV?��— _.r MA DATE (-1��,-_ IZ T.,I. PERMIT # JOBSITE ADDRESS _ OWNER'S NAME I L�k1L'-�'Li��'lA-LL II GOWNER ADDRESS _ TELi �JFAX _ _ __= TYPE OR PRINT OCCUPANCY TYPE COMMERCIALjy jI EDUCATIONAL © RESIDENTIAL CLEARLY NEW: D RENOVATION: El REPLACEMENT: Ell PLANS SUBMITTED: YES NO Q APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 S 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER�I DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE I _ _._._1 _I f ^_J INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER�_ ..1 I =I._ I ROOM / SPACE HEATER ROOF TOP UNIT _ L^:-_ _..____! TEST _ I.- I f _ _J T_ . I _�! _.,�[ 1- _ 1 k i �_J C -TI f -- --J UNIT HEATER 'UNVENTED ROOM HEATER -L_ l-_ -__ I _ I ---j _.._ WATER HEATER OTHER I _ INSURANCE COVERAGE MOL. Ch. 142 YES �0 have a current liability insurance policy or its substantial equivalent which meets the requirements of IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY LT OTHER TYPE INDEMNITY 11 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: OWNER0_I AGENT �I SIGNATURE OF OWNER OR AGENT Al hereby certify that all of the details and information I have submitted or entered regarding this application are true best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in J nc al rti nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASF ITTER NAME 1 ..i - _ 1-%._� LI SE # .1 �-t ( SI E MP MGF JP JGF LPGI( CORPORATION _ # PARTNERSHIP# _-_ _.E LLC �# COMPANY NAME:r d- ADDRESS CITY STATE C�aa1ZIP`r _ TEL FAX CELL IL IL , - - -- 1Z-1�I7, 1 �17VX" M 6 le, 0 z 0 H U W J � \ N L OR � Z 0 N❑ COD w w H a- z W 3 W 5 En Qco w � w w c a o a a a J i a CL L w x w F- LL - 0 z 0z z 0 F U W r C7 r�7 • °a f r' The Commonwealth of Massachusetts Lh Department of Industrial 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 LeLibly Name (Business/Organization/Individual): ` 0Pr--VlA&A c�t Address: City/State/Zip: Phone #: �5LJ Zy Are y an employer? Check the appropriate box: 1. I am a employer with L, 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ 1 am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.g3EIectrical repairs or additions 11.ff Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. kContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. 1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ?olicy # or Self -ins. Lic. Expiration Date: ob Site Address:_ �j7 �n,-� t-�1L City/State/Zip:—. e4 tom' attach a copy of the workers' compensationpolicy declaration page (showing the policy number and expiration date). ,ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 ,f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby c y un er the d penalties of perjury that the information provided above istrue Tdcorrect. Date: i nature: I-,?— I y ' Z 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 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit -is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia GENERATOR DATE: APPLICATION LOCATION: V , OWNERS NAME: GENERATOR kw 2.e2�O �)Tu. NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: ELECTRICAL RESIDENTIAL GAS COMMERCIAL LOCATION OF GENERATOR: *ZONING DISTRICT: d. - TEMPORARY *CONSERVATION APPROVAL (►�( �� �:.. ajnmu6is i.lcn • to W LU m r r, to Ln t a «� o iN tn111 w o. r QC Qr^�U J �Q \ �' • U. ,Qu% Lu O �G m • Z L'1 H i J �Qw N N r Q LL `, t w .�+ W w • m LL1 ai O L' -IO _CC • LJ W'.. LU L:. '-t t i r I t A5-Buiur &b4-Go9- . -0LFM-0 d Q S Timms �- 7163, E33 . A S-7TH-H, 3�,3' ceH, 4D Pv C, !uv r-)-gox �S.3' 5)j1) lz2 L 9?, z ' GLI, a' -- Eu iJ -re z 0/l , el ' 7!�-, 1 ' Ern -rR,41:2 = r -u p m e-3 C� EUD PIPE 3S: of 1 1 I .♦ 9 AS - BUu.T -0LFM-0 d Q S 1 P Fubrj-(,6- Era)' 7163, E33 ceH, 4D Pv C, !uv oLT 6 .T --r ! t 1% It It 1 l -w8ox 40 SCN-)40 tee-' Pvz- ILIv e wXT—ma-=leo, 31 IL �, �� 1� ,� �.1/1� 7�� =IGD, DI Ern -rR,41:2 = 1 1 �o�1"z3 X17,0-77 s�F [)E 7 'L(0, J POAlD Exist' GEAcNIi�ra TLE. CE -i14) �- T T)F'•/ 1 HAT cit= NAv Ii1Si'F.4.'rt=:J TPS eol-!TTVUGTlD.u! .)f. I.JISi'1Jar�� ��Ij•1L-��, L'1 I)i�'1-'I.r ..�•�.�r�'.-."-_ C.�i'.ii`fl;:i:llDi�(' 1'1`� u Fi;jIiL�aIZAulu6j IS ILI SVf-MkrnAL 'n `O 9 ACCoRbnf .tC IUITiI P(.f��! o �I'. rF"it:lijoi.iS cn ,�' F601_1 OF 1.10 r Tq A a DDVI` Z �I EALTI+ bf'pT 1i D C Ex l 97-W _C'A U DLF'� TI C k'_ `A, -I•>1 Ex I s% Cour-. D -Box 'Ex I's;T. ISau6,A .60IJC. AS- BUILT PLAN OF SUBSURFACE DISPI"O"SAL SYSTEM LOCATED I N KIORTH AUDOVER, i Ass. AS PREPARED FOR_ OF ROBERT THOMAS . LA UDAM I � DALEY DATE: OC -To BER 1) I qR2 8 CIVIL u SCALE: I -�i0, NO -416 ' �1. c:�7) G T 5 , % `i L7 Z-- MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS.' 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (508) 475-3555, 373-5721 Date. � .. 1.... °. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... y �: .. - ! `..1. � .......... . has permission to perform...U.......................... plumbing in the buildings of ................. at ..3 7 }... VI. r. ........... , North Andover, Mass. Fee .3 ? :. '"... Lic. No.. . ...... ;. ....... PLUMBING INSPECTOR) Check # I ? f ( 5346 1■ 3 �.. MASSACHUSETTS UNIFORM APPLICATION FOR.PERMIT TO DO PLUMBING (Print or Type) /VC,, ANp r vT4 Mass. Date 20 Permit # �w Building Location _3 3al P1-ta silc-h Owner's Name L-Src,Af $` lni �- New 0 Renovation 0 Type of Occupancy i�w rLL/iiG Replacement1-tted Yes ❑ No ❑ FIXTURES CFWFR .it cc=r 4. Installing Company Name fior=MAN + Address 5-'? /11/) i N )2 a,9 ,9 9/--, ,lav Vrp, M S G t& l- Business Telephone 4 1 8 "7S' 3 Yy `l Name of Licensed Plumber or Gas Fitter Check one: Certificate ❑ Corporation PePartnership 0 Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGLCh. 142. Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy d Other type of indemnity 0 Bond 0 OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 0 Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signatu a of L censed Plumber Title City/Town APPROVED (OFFICE USE ONLY) Type of License: License Number Master Z"' 3 ,F9 ❑Journeyman • • II • • Installing Company Name fior=MAN + Address 5-'? /11/) i N )2 a,9 ,9 9/--, ,lav Vrp, M S G t& l- Business Telephone 4 1 8 "7S' 3 Yy `l Name of Licensed Plumber or Gas Fitter Check one: Certificate ❑ Corporation PePartnership 0 Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGLCh. 142. Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy d Other type of indemnity 0 Bond 0 OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 0 Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signatu a of L censed Plumber Title City/Town APPROVED (OFFICE USE ONLY) Type of License: License Number Master Z"' 3 ,F9 ❑Journeyman Date. .'. 1.( -. C'.1 ...... TOWN OF NORTH ANDOVER O p - ;. PERMIT FOR GAS INSTALLATION This certifies that ..� r. F .� y A'.. / .'` � �/ ............ has permission for gas installation . A -I. -( .................... in the buildings of .. f!.? :;�! �1.: lei. ....................... . at..� •. . .. • •., North Andover, Mass. Fee.. .1...:.. Lic. No..: .............-:. .. ...... GAS INSPECTOR Check # / 1 4110 G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) jv 0 > AP Doyh t , Mass. Date 20 Permit N 111� a� Building Location 33 3 C-0&aLC Ync % KP owners Name 1 P,V9/ S7,,N rjla%2S/�/At c. Type of Occupancy p C« '112-1111'g New❑ Renovation ❑ Replacement* (-..i'Plans Submitted: Yes ❑ No ❑ Installing Company Name 1,9PP I-1,41- ' + /1 ri-L.'r-w Address 5^1 /1#&/-/-F/,.-' ISN Q o J'i AS Business Telephone 5r-' Y-) 3 `t a -- Check one: Certificate ❑ Corporation Partners hip tv!�Z/40 Name of Licensed Plumber or Gas Fitter J GSfz� (,1._ ���% /Z/yjG:i✓ ❑ Firm/Co. INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please Indicate the type of coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement S Ignature of 0wner.or Owners Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of my knowledge and that allplumbing work and installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Type of License: ,�,�-), �•-� By Plumber S gna o Licensed Plumber or Gas Fitter Tide ❑�CaSfitter � � City/Town Master License Number j -g APPROVED (OFFICE USE ONLY) ❑ Journeyman i i .. • i • UMMUMMMMMMMM MIN Mm��® -.-.-..©...-.-- -.-® NM M MM FUNDED% Now MMM MW M N MM • e ' M--....-M...�.-.... •e' M MMMMMM NNOW MUNNE Installing Company Name 1,9PP I-1,41- ' + /1 ri-L.'r-w Address 5^1 /1#&/-/-F/,.-' ISN Q o J'i AS Business Telephone 5r-' Y-) 3 `t a -- Check one: Certificate ❑ Corporation Partners hip tv!�Z/40 Name of Licensed Plumber or Gas Fitter J GSfz� (,1._ ���% /Z/yjG:i✓ ❑ Firm/Co. INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please Indicate the type of coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement S Ignature of 0wner.or Owners Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of my knowledge and that allplumbing work and installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Type of License: ,�,�-), �•-� By Plumber S gna o Licensed Plumber or Gas Fitter Tide ❑�CaSfitter � � City/Town Master License Number j -g APPROVED (OFFICE USE ONLY) ❑ Journeyman A Q Office Use Only 0140 (ffttmmnnwettit4 Permit No. of V lepartment of Public ftfitq Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (leave blank) C APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date A -p Ik Cry Tjj* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. j I . Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building 12ES Utility Authorization No. Existing Service Alt)n Amps -LD-6-1 ^d0Z Vcits Overhead '! Undgrnd No. of Meters/- New eterslNew Service Amps _I Voits Overhead _ Undgrnd No. of Meters Number of Feeders and Ampacity Location and Nature of Pr000sed Electrical Work Total No. of Lighting Outlets I No. of Hot Tubs No. of Transformers KVA / No. of Lighting Fixtures Swimming Pact Above— in- — grna. — )�-klNo. No. of Oil Burners of Receptacle Outlets {5 �/ No. of Switch Outlets No. of Ranges Nc.cf "eat Total No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro Massage Tubs o T HER: Swimming Pact Above— in- — grna. — grr,c. — No. of Oil Burners 1 No. of Gas Burners No. of Air Conc. --'al Nc.cf "eat Total Total KW �! Pumps Tons ! ScaceiArea Heating KW Heating Devices No. of KW I Signs No. of `.lotcrs No. of Ballasts ,<W HP t Generators KVA No. of Emergency Lighting Battery Units FIRE .ALARMS No. of =ones No. of Detection ana Initiating Devices No. of Sounding Devices No. of Self Contained DetectlOnrSounaing Devices Municipal Local _ Connection ^Other Low Voltage Wiring iNSURA.NCE COVERAGE: Pursuant to the reeuiremerits of Massachusetts generai Laws I have a current Liability Insurance Policy inc!ucing Comeieted Cceratiens Coverage or Its substantiai ecuivaient. YES = NO = 1 have suomittea valid proof of same to the Office. YES = NO = if you have criecxea YES. piease indicate the type of coverage by checKing the apropriate box. INSURANCE BOND = OTHER = ;Please Scec;r / (Exoi atio Date) Estimated Value of E!ectnc/a'l WAV _5 &,D ' WorK to Start s�L2y �j�-�e inscecacn Date P.ecuestec: rough 19,70,01 _ Final Signeo under the Penalties ofcperlur�_ FIR`A NAME ALE.E. LIC. NO. - ,q : i/�A I _ J c g a.. _ .i��� a Licensee -a r-7: / nn ., Address 3 L-e:nQ -i— /--t �-J t —AA/ 112� f/dr mstS . ut % /1 S All. Tel. No. CWNER'S INSURANCE WAIVER: I am aware that the Licensee aces nct pave the insurance coverage or its substantial ecuivalent as re- quirea by Massachusetts General Laws. ana that my signature cn :n:s =ermit application waives this reawrement. Owner Agent ;Please checx one) Telecnone No. f// U PERMIT FEES 0 (Signature of Owner or Agent', X -65E5 r + Date ......1... ...K .... .. 221 �;0 201 °`< TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that /.. - ''': T1( a '............................................................................. � has permission to perform t 1 r...(. ' �, ..rf :....... ..............� wiring in the building of.....l...e...................................................................... at ..... :.f........r!..........`.... f ........................ .............. , North Andover, Mass. Fee ...5 7 .: � ...... Lic. No.. `� l �.f ........................................................ a .. . ELECTRICAL INSPECTOR M a U WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File o a � Location Ni. Date J TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ 44"o A t�' Foundation Permit Fee $ Acm Othe,&ermit'Fee $ - �rn r Connection Fee $ Water Connection Fee $ TOTAL ` •, A ?— Building Inspector r Div. Public Works Location � •� . / No• `= ` Date HpRT1y TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ ,SSAC1N5Et 7 Foundation,.Permit Fee $ r 'r -Permit Fees $ Sewer Connection Fee $ � eater Connection Fee $ SE G Building Inspector Div. Public Works 10 Location -s No. Date v�y TOWN OF NORTH ANDOVER o Certificate of Occupancy $ Building/Frame Permit Fee $ ' Foundation Permit Fee $ I)ther Permit Fee $ Sewer Connection Fee $ -- -�-" i Water Connection Fee $ * r "idTAL �` �� $ L Building Inspector Div. Public Works A Location_ No. Date OtNORT" TOWN OF NORTH ANDOVER 3? ° OL p Certificate of Occupancy $ Building/Frame Permit Fee $ cMFoundation Permit Fee $ � s�us t Other Permit Fee $ .L�XF4ection Fee $ Water Connection Fee $ 31.E L $ I No. Andover Collector Building Inspector 41 Div. Public Works Location ti r c C f 440. Date 31 v ` of "a eT :TOWN OF NORTH ANDOVER , Certificate of Occupancy $ Building/Frame Permit Fee $ �7s w+no • Et� Foundation Permit Fee $ s�CHus Other Permit Fee $ obnection Fee $ � 13 i Water Connection Fee $ U t 3 1 ,W4AL - j L Build frig Inspector Div. Public Works W h WC W ca s 2 I 4Z 0 (7 I4 oc 2 0 s `ag Q N C m W W Ci 4 d w i O FN 0 2 F IK v U U C a O O O d a m m m U N W W W W Y M 0 0 N W Iii I Y ti �1 U W Z O F X Q Z J N N JF 0 3 U N < 3 m < N I J a w 3 F i IN rl J 0 0 0 Z W ^ u O 0 0 Z N o 0 0 Q O W N N W W G 2 m J F O F Z J U U U LL 0 J 10N C O J H O Z O Z Z Z a m W N a —U. 7 Z 0 0 00 U 0 Z LL 00 i U o o 0 LL i LL O 0 LL < p 0 O O lz IL J J J J_ O W O Z W O W_ 7 7 7 7 N < 2 N F N IOL n Z m N N I N I W O � a C 0 O LL U LL �Y Z Z F- W W C wQ Z Z Z �. LL rA �( Ix o O N JI Z 7 W Z f O '� ZO FO � 0 W Q W m 0 F m 0 j 01 W < N J 3 F U < W C Z F Z f f W O J U W Z a a z < o N z O w M F a < Z < j_ N � LL LL O J Z Z Z O J 0 W C U U U- LL o o a 7 LL 0 W Q F- p Z Z Z O IL W W = J < < < < 7 7 7 J C I ri O O O < m O a O a N N N 3 m z 0 i 0 Z IL M F 0 U 0 Z < J A h WC W ca s 2 I 4Z 0 M I4 oc 2 0 s `ag N C m W W Ci 4 d w i O FN 0 2 F IK v U U C a O O O d a m m m U W W W W A mi 3Iz DOO xAA y0AA m rT m '- �xmCC mZ �N7C AK nO A3N mx OC Oy N AO� mD O mOD Oz _4 C y CODOZNO 0 02,0 D z mZ A cF � 0C a N x z p0 6Z1 A Z m A M Z; D A w 0 v m n n A N C z-< Om D OD C vAi r)?0 A 3 O - ;afn k 1 Z N A O m m A m y y 0 z o (no:E z y 7C m y 3 n -1 Z b D N Z y 0 N w C z . m !) 3 'aAm O N x T m Z X m O, A Z .• Z y a I I I I�III-N O ,TN_0' + 1,6 .UN ' 0 U) O Z /^1 l! 1 N - mm .0 n m 3Dp0 n ! >Ol N 0 ZZ C z-< o x OD C Cp3 e r m ;afn k 1 Z N A 0 T i z o (no:E z y 7C m y 3 n -1 Z b D o Z y 0 . m !) 3 'aAm O N x DD m O, A Z .• LLINMI a I I I I�III-N I ISI -Z. 'r Dr ! >Ol N r Nf'0 m Amo DO 0ZZ Cp3 0 ;afn k 1 D 0 10 (no:E Mi. -1 Z b 110_0 •.00 0 ;UZ- . m !) 3 'aAm c �A 0Z0` . ,TN_0' + 1,6 .UN ' 0 U) O 1 N - mm ►d I APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. V d 19 ! _ Application by the undersigned is hereby made to connect with the town water main irc kel et, subject to the rules and regulations of the Board of Public Wor S. e premises remises are known as No. 333 4 Street or subdivision lot no. �- Owner Address Contractor rA r s App icant's Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to R-0 v R to to make a connection with the water main at t subject to the rules and regulations of the Board of Public Works. Board f ublic Works a Inspected by Date By See back for rules and regulations reet RULES AND REGULATIONS GOVERNING THE INSTAL - 1• No person shall tap or in any way tamper with water mains which CATION OF WATER SERVICES Andover without a valid permit from the Board of Public Works. are part of the distribution system of the Town of 2. All water services shall be installed a minimum of five feet below the finish I No water services shall be backfilled without inspection by a representative grade. 4. Service connections shall be 1" type k copper tubing. of the B.P.W. — Telephone 687-7964. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of f the Erie Type with 41/2 foot rod and brass plug type FORM U - LOT RELEASE FORM J INSTRUCTIONS: This form is used to verify that all necessary Iapprovals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** , APPLICANT:o Phone lir 0 S S 7 LOCATION: Assessor's Map Number Parcel ° Subdivision II Lot(s) o? -31 Street ay (t9i6L St. Number,1133 ************************Official Use Only************************ RECO DATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Town Planner Comments Health Agent Comments Date Approved -7 • 20 -47;Z- Date 47;LDate Rejected Date Approved w2 e4 Date Rejected Public Works water connections %J ,,/t"�41SS��/Z7, - driveway permit Fire Department Received by Building Inspector VV r Date /� req PZ 6�I F9 d y �lfl 'Y.0 Lu - Ca z 1 M i ca to Cd 2 w 0. LU am LAR Sy , H (A .= CL O O O a� Ii C ♦.C.+ W a CL HCL p �Ir 0 u p p, u a E c O rA. IL O p U. Z C Z = Z CL W LU C 0 p Q d z LW o z o = u o m m {�z - m t C d L L V t mLU Y O� E c C W ` C 7 C ` O cr- U lL OC LL Q (A li Q 1L in N LU am LAR , H (A .= CL a� C ♦.C.+ C p �Ir L u p p, u a E c rA. O p C b0 Z = .c CL p C p Q Q Commonwealth of Massachusetts - 4,n, v ', Massachusetts System Pumping Record System Owner cif �„G� t Date of Pumping: L " r�2 O'{ Cesspool: No Yes [ ] System Pumped by: &&"w saavww E -EM r -D NOV - 2 2004 TOWN OF NORTH ANDOVER HEALTkl DEPARTMENT System Location �tou S �.. Quantity Pumped: [ 500 gallons Septic Tank: No [ ] License # Contents transferred to: Greater Lawrence Sanitary District Date: l I-- �Z — O ` f Inspector: Yes ft ,Vo sem: Fa...vo �riov GOCAT/aV F'oo/r� ��� ,4.v /.vir�e,,McAr I / PCA/,v/Ne <........ , ZO7- -4'z3 \ 47,077S,�f o i I T. F. FcEv, I 1 ft ,Vo sem: Fa...vo �riov GOCAT/aV F'oo/r� ��� ,4.v /.vir�e,,McAr I / PCA/,v/Ne <........ , ZO7- -4'z3 \ 47,077S,�f o i I T. F. FcEv, = /63.86 -T/n =/G 9.73 Is /06. o/ �,qc/I LEsTiC,.� ,�0.4D PL O T 1 .S/EREBY CEPT�FY TO Tye T/TLE 1,VS&WO.P4NO TO Ti/E- B.4.Ve TNgT T/iE OwELG/uG /S COCATEO OV �N Tf/E COT AS S//O/YN ANO T//,4T /T GOES LO ✓FOP�rI lYiTs1 E row.✓ V/F,tle, Avco✓6e " �'9S,y REIsA.?D/N6 SETBAC.t'.S F'�OM STPEETS f LOT L/NES. � va.CTi'�/ /�NOavC.e/ . "r fUCT•f/EP CEPT/FY TN.4T Ts//S O/rELLiNG /S LVOT C/�GgTEO /N THE FE F0000 h'f1ZA.P0 A.PEA. SyGwN a/1/ FE/'+ jM�[eIN/TY /�•4NGL ""` ; , . ,. -. , s., T um.y s � A<iD.4.v l h` .: �•: ,er 250098 00/o B Tif//.S PLAN FO,� Pl/,PPOSES -NOT Fa,P �E��/��� ��Gi•�/EE•P/.(/6 SE�Pv/�'ES BO!/.✓O.PY ,O�'TE•P�Y1/it/ T/off/_ dOuvO//�Y /if/FO.Piyl- /4710W TWA -le -y Feaff EX/STiEjC PELaPpS. (o( �A•P.(� ST,PEET 1,4AI,904-41/1l aSSaCiSETTS e i m m TZ � z C� z D m C CD .o D n Z T r D O z O. r— D Co O CD c CL Q �oDOC) M C/) O CD m D D CL O m CQ O z CD < CO) CD m O � O -i D r 1v N Llml!� CO) d d• 0 y 'O c O C y CD O rt CD 112 CD y CD CO) O CCD O C CD 0 co: 7d C J Cn Crt rD n C C O -• N Q N '17 'j7 r\ -mo i `�i� arc X37 Cn C^ ao5m .o m to n C�7 HC�an W m Cn 0 O 0 Z 5.5 H � m a d = m N o y N o m O � 7C C/)rD CD CD C t! aOil o =� ,... o ZS.0� 'O• v C- S. a S �h/rn N N :� I-•�CD o :mac» o m m m CC ��-•��-yy 1" OD, o N C � CL N &C, t0 3EN N co) vJ H 0 m .� 4 CD vi CDCD m ri N CD CD O N CLo CD c o Cn Crt rD n '17 'j7 r\ -mo i `�i� arc X37 Cn C^ •jJ CEJ _ �� OCG r1III n ,� y C G Cn 0 O 0 I ro 7C C/)rD aOil tz vi ,J wo\, y 0 0 0 c i IZ 0 0 i0 b a F - (D Fl- rt d n x xCL C7 m � m c wn �z cr c n r z y i m w d t::i y H H rj) �0 >go yQ ® n rt 5 (Dn d z MIN C G7 n d w C2l z n ty m F Location No. 7497 Date �aRTM TOWN OF NORTH ANDOVER f � 3? + a 0 � s + : , Certificate of Occupancy $ _ cNus Building/Frame Permit Fee $ �- - Foundation Permit Fee $ Other Permit Fee $ a+v TOTAL $ Check # 16 1266 Building Ins�4ctor D, TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING This SeCdM for Offidd Use Oily. BUILDING PERMIT NUMBER: G- DATE ISSUED: —Z SIGNATURE: Building Commissioner/I ct ot'Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 4P6 /4-3 / Map Number Parcel Number / 333 CAA o . �/ 1" cc � � 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 5 54) Public ❑ Private 0 1.5. Flood Zone Information: Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record L ,4ju y 3,73 C,4ND"srfeu ems. Nam$ (Print) Address for Service: Sigature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.4 Licensed Construction Supervisor: _ �-4VI i> 6 (r—�s9•tl �-iccnsed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor 03 LAC�2 y�� G a l c D/S(L S // -C Not Applicable ❑ `0 6 Company Name ,may Registration Number Address G6�C 070 Expiration Date Sienature Tele hone M M Z a .Q SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this, affidavit will result in the denial of the issuance of the buildi rtnit. Signed affidavit Attached Yes ........ No ....... 0 SECTION 5 Description of Proposed Work checkall applicable) New Construction 0 Existing Building ❑ Repair(s) Alterations(s) 7TAddition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: OffAA GL 'V"WI,vG 04- MI S Si s d3�t-1�� .���✓ �'/G,C�ct� .�� 6l/�-0 ✓�L �,C-e�„� C�i�c�.0-L wo-o 1> flame ' // -,b 94,^41 -%f 5-c.-46 ars a X4 .9 •. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permita licant OFFICIAL USR ONLY I . Building9(a) t 413-11 Building Permit Fee Multi lier 2 Electrical 1 (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) - (b) c? 16) 4 Mechanical (HVAC)J' 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PER31IT I, . as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pen -nit application. Si<anature of Owner Date SECTION 7b OWNER/AUTHO.RIZED AGENT DECLARATION I, C L� as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief 7 /`r �'� A>4- ,/ � d Print N� 1..��—�. C. Signature of Owner/A ent Date NO. OF STORIES SIZE 13ASENIEN-F OR SLAB BILI: OF FLOOR TIMBERS l' 2' 3 SPAIN I_)INIENSIONS OF SILLS DINILNSIONS OF POSTS D1MI:NSIONS OF GIRDERS (1.1:1GHT OF FOUNDATION THICKNESS SILE OF FOOTING Y SIA IElUkt. OF CI-BNMY IS BUILDING ON SOLID OR .PILLED LAND S 131,1ILDIN(3 CONNECTED TO NATTJRAL GAS LINE BUSINESS CONDITIONS TO THIS CONSTRUCTION CONTRACT This Contract, dated 5/18/2005 is by and between: Larry and Sandra Marshall 333 Candlestick Road North Andover, MA 01845 Blackdog project code MARSH -5870-B (Hereafter referred to as OWNER), and Blackdog Builders, Inc. 7 Redroof Lane, Unit #1 Salem, NH 03079 (603) 898-0868 (Hereafter referred to as CONTRACTOR). Work will be performed at: 333 Candlestick Road, North Andover, MA 01845 (Hereafter referred to as PROPERTY) "1. 17C1VCKAL This CONTRACT is for the following work and materials to be performed by the CONTRACTOR on the PROPERTY address shown above. The project is generally described as follows: Deck and Patio Re -work (Hereafter referred to as WORK) The CONTRACT consists of this document, any plans, the specifications, the Blackdog client package and the Construction Contract. (Hereafter collectively referred to as the "CONTRACT') 2. PRICE The total price for the WORK agreed upon is $39,434.48. Payment terms are set out below in Paragraph 6. This proposal may be withdrawn by us if not accepted within thirty (30) days. 3. STARTING AND COMPLETION PROVISIONS The WORK will begin as soon as possible and is subject to time frames regarding the acquisition of the building permit and absent unusual or unforeseen circumstances, on providing this CONTRACT and any related CONTRACT documents are accepted when presented. Projects requiring two contracts (one for construction work and one for bath or kitchen product) will not be slotted into the schedule until both agreements have been executed. The aforementioned dates reflect our present workload. Projects are assigned a slot in our work schedule as they are accepted, on a first come first served basis. These dates may move based on the completion time of the project that immediately preceded yours. 4. PERMITS AND APPLICABLE CODES: COMPLIANCE WITH LOCAL LAW a. All work to be done under this CONTRACT will be in accordance with local, state and county building code. The CONTRACTOR shall obtain all necessary permits and pay all required permit and plan fees from the CONTRACT sum, unless otherwise agreed. The CONTRACT price does not include any fees, which may be incurred to obtain a variance, if required. The CONTRACT price does not include any unbid items required by any local building official to bring the project into compliance with any relevant local, state and county building code. 05/18/2005 Contract Proposal — Page 4 of 18 c. Notwithstanding any manufacturer's warranty of any component, appliance, or system, no action may be brought against the CONTRACTOR on this CONTRACT for the performance of this work, except as provided above. 14. SEVERABILITY If any portion of this agreement is found invalid or unenforceable by any court, the remaining provisions shall remain in force between the parties. 15. ENTIRE AGREEMENT This CONTRACT consists of the documents defined herein, and constitutes the entire agreement of the parties. It can be modified only by a written document. OWNER acknowledges that he has read and received a legible copy of this agreement signed by CONTRACTOR, before any work was done, and that he has read and received a legible copy of every other document that OWNER has signed during the negotiation of this Contract.. SUBMITTED: DATE: John Nicholson Blackdog Builders, Inc. 5/18/2005 A CEPTED: / DATE: Larry Marshall DATE: Sandra Marshall 05/18/2005 Contract Proposal - Page 12 of 18 ✓1ze -COooivrnamcirea� o�./l/iaavac�i�.toP.lta BOARD 'OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS 048847 BIR6, 08/30 i964 Expire'§, 08/3012005 Tr. no: 1575 ResErlc�etl 1 �= DAVID K BRYAN 7 RED ROOF LN #1 ( ,., y — SALENI, NH 03079 Administrator ✓lie 1°om�maazcuP.a/l� �✓l�et� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RogiSfi"bn , 106877 12812onF BLACKDOG BUlti DAVID BRYAN 7 RED ROOF LN. Salem, NH 03079 Corporation Administrator 00 - 35,000 cf enclosed space f -MGL C.112 S.601-)�1A - Mason y only ;li1G 1 & 2 Family Homes MFailure to possess a current edition of the assachusetts State Building Code JS cause for fevdcation of this license. i i j i j OIG -SAFE CALL CENTER: (888) 344-7233 License or registration valid for individid use only before the expiration date. If found return to: Board of Building Regulations and Standards. One Ashburton Place Rm 1301 Boston; Ma. 02108 i Not vallb i ut si&ature TM CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1 07/08/2004 PRODUCER (603)669-0704 FAX (603)669-6831 Infantine Insurance, Inc. P.O. Box 5125 Manchester, NH 03108 Joyce McMann THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Blackdog Builders, Inc. 7 Red Roof Lane Unit 1 Salem, NH 03079 INSURERA: Peerless Insurance 24198 INSURERB: Acadia Insurance Co. 31325 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD' NSRTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY TO BE DETERMINED 07/01/2004 07/01/2005 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $. 100,000 CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY TO BE DETERMINED 07/01/2004 07/01/2005 COMBINED SINGLE LIMIT $ X ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) A BODILY INJURY $ X HIRED AUTOS X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC S ANY AUTO AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WCA006920413 07/01/2004 07/01/2005 X WC STATU- OTH- TOR EEL EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 100,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ 100,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. For Informational Purposes AUTHORIZED REPRESENTATIVE r ACORD 25 (2001108) ©ACORD CORPORATION 1988 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant �7 0 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 04/20/OS 02:40P P.002 } LOT 25 ISO 00. r DRAIN I EASEMENT LOT 23 A=47,077 S.E. ~ w LOT 22 LOT 24 � 0 33'! I �M JM �=43,997 106,01' — — CANDLESTICK ROAD NOTE; THIS PLOT PLAN IS NOT TO BE USED FOR PROPERTY PLOT PLAN OF LAND LINE DETERMINATION, THIS CERTIFICATION IS MADE TO IN FLEET NATIONAL BANK AND BECOMES NULL AND VOID UPON ANY FUTURE CONVEYANCE. NORTH ANDOVER, "I �A A 1 HEREBY CERTIFY THAT I HAVE EXAMINED THE PREMISES AND THE BUILDINGS ARE ! LOCATED ON THE. GROUND AS SHOWN. I FURTHER PREPARED 8Y; CERTIFY THAT THE PRINCIPAL BUILDING. SHOWN DID CONFORM TO THE DIMENSIONAL ZONING LAWS OF NORTH SKOF + PJF & ASSOCIATES 11 GLEASON ST, MEOFORD, MA, ANDOVER WHEN CONSTRUCTED, I HEREBY CERTIFY THAT THE PROPERTY 1S NOT P J. PAUL J. FINOCCHIO^-P_L.S, LOCATED IN AN ESTABLISHED FLOOD HAZARD AREA .+ X10 H (781)395--7662 FARM. HAP N0,250098 i 9.>ri6�16�y $FACE: 1'=S0' REVISION DATE:JUNE 2, 1993 DEED REF.;BK.3755 PG. 349 DATE: JAN. 9, 2004 PAUL J, rINOCCHIO P,L.S-, No,36115 • DATE FILE No.:21-883-03cf 20222C) -fill III . . . . . . . . . . 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