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HomeMy WebLinkAboutMiscellaneous - 339 ABBOTT STREET 4/30/2018North Andover Board of Assessors Public Access E NORTF, A. *SSwcausEt Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 Forth Andover Board of Assessors rnnP rfV Rernrrl ('.aryl Location: 339 ABBOTT STREET Owner Name: O'NEILL III, PAUL J KATHLEEN PAGONES O NEILL Owner Address: 339 ABBOTT STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6 - 6 Land Area: 1.30 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2425 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 480,700 520,000 Building Value: 269,800 310,800 Land Value: 210,900 209,200 Market and Value: 210,900 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2252236&town=NandoverPubAce 3/18/2013 0 0� T OOK N N` OO OD f(,i r rf ooiX�U� N OM ❑ 5 v ❑Pc'�i� Q C13 n N a)iC O.N.. c�w0S+ N ~ a LL O O W ~ 0 L: L. 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NORTp TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................................................. has permission to perform CPA ........................................ wiring in the building of ................ .................................................................................... ...... ..AY., . ....... 7 ..... -- ..... .................. . North Andover, N Lic. No. <�', *�--/ �C24aS�P-',O-R Check # 12217 e 77 - Iq C.OMm"W"A W IrJaaac"&.4 aUeParfinani o�,,.tire �eruice3 BOARD OF FIRE PREVENTION REGULATIONS Officiall Use 0 ly Permit No. � l✓ Occupancy and Fee Checked [Rev- 1107] (leave blank) 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 PRINTW INK OR TYPE ALL INFORMATION Dater 3 ) to W City or Town of: 000-�- Doyel To the Inspector ofWires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & NuiRber) 339 Owner or TenantN/J/� (,l f ` �s'i-' i'r �1 r /tie I Telephone No. e7Y Owner's Address Is this permit in conjuncts with a -building permit? Yes © No ❑ (Check Appropriate Box) Purpose of Building 45 Gam.-wcmce Utility Authorization No. Existing Service Amps J Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps J Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthe follnivinv tahlp finny hp wn;oed by the 1"en—t— �r ialt,— No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires q Swimming Pool Above ❑ In- ❑ rnd. grnd. o. of Emergency 1;ighting 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 Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers HeatPum Totals:I Number ons KW No. of eIf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ElMunicipal [I Other Connection No. of Dryers Heating Appliances KW Security Systems:;; No. of Devices or Equivalent No. of Water KW Heaters o. o No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: ' Attach additional detail if desired, oras required by the Inspector of Wires. Estimated Value of Electrical Work: d,! 00-00 (When required by municipal policy.) Work to Start: 3 ) I `T / ! y 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 ER BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenahles ofperjury, that the information on this application is true and complete. FIRM NAME:Mmie-) 1T gViC'CS G LIC. NO.: 5719 Licensee: *'ell ,N R.�Jr�'7c /� Signature LIC. NO.: 415-71F (If applicable, ent�t "exempt"in tj ,licensenumber i e.) Bus. Tel. No., 9/7 %� r%770 Address: f' U/'7 d / �y / Alt. Tel. No.: 976'1 s a-Sf�3l '`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'sent. Owner/Agent Signature Telephone No. J PERMIT FEE. $ 5 5 0 0 ,;) � " �, � vt,") � I V\1\CA:,L 6PH r,a Oil J— a r ' Print Form The Commonwealth of Massachusetts ,i Department of IndumialAccidents Office of Investigadons I Congress Street, Suite 100 Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): G l�j trNe Address: ��% � 7q y City/State/Zip:/ % c cl� fe /l i CG 0/ % �/ Phone #: 7� 6 e' % / �,%0 Are ou an employer? Check the appropriate box: 4. I am a en 1.. am a employer with -3 ❑ general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' g• ❑Building addition (No workers' comp. insurance comp, insurance.; required.] 5. ❑ We are a corporation and its IOKElectrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. (No workers' 13.❑ Other comp. insurance reouired.l *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 emities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: G Policy # or Self -ins. Lic. #: _ 1��WC CG �j% !S 7(p Expiration Date: 6 v2 no?(� j Job Site Address: --9,9-1 two % �`S% City/State/Zip /'V /!') /'�I �141_mq Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' nder a pa n d penalties of perjury that the information provided above is true and correct. S_ iartature, Phone #: IfOficial use only. Do not write in this area, to be completed by city or town official —11 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 #• Division of Professional Licensure: License Search The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name:KEVIN R. EMMETT MIDDLETON, MA **This Licensee has additional Licenses, click here to view them.** Licensing Board: ELECTRICIANS MASTER ELECTRICIAN License Type: TYPE CLASS: A License Number: 15719 Status: CURRENT Expiration Date: 7/31/2016 Issue Date: 6/24/1996 Exam Date: 6/1/1996 School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Tuesday, March 11, 2014 at 1:56:05 PM. © 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATEDINFO Disclaimer Regarding Website License Searches Enforcement Process Glossary Glossary of License Status Codes More Site Policies Contact Us http://Iicense.reg. state.ma.us/public/pubLicenseQ.asp?board_code=EL&type class= _A&li... 3/11/2014 Location &3 ry No. / Dater NOR,N TOWN OF NORTH ANDOVER F w A i ♦ i Certificate of Occupancy $ Building/Frame Permit Fee $ s�cHus Foundation Permit Fee $ j Other Permit Fee $ TOTAL $ Check #� i 16345 wilding Insp&or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: a % 3 e—S O Sot 71 1 SIGNATURE: Building CommissioneLAIlk Rsaor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 339 A680-tr 0<3 O oo Address P(`' S �o a_ 9 �sy o� 00 /4Nc�o�e(L, Ivy 1!k Map Number Parcel Numbs 1.3 Zoning Information: 1.4 Property Dimensions: Zoninjj District Proposed Use Lel Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RecjWRd Provided ReqWred Provided F- t 1.7 Weer Supply M.CLL.C.40. 54, I.S. Flood Zona mforma oa: 1.1 Sawer r Disposal system Zoos Outside Flood Zh❑ Mmicga1 ❑ on site Disposal system ❑ Public ❑ Private 13ao SECTION 2 - PROPERTY OWNERSIU/AUTHORUMD AGENT 1177717 itSt(iCt: Ye P•h K 2.1 Owner of Record PAUL 02V,041 3-3 q 46,607 -5i-Pee— Alo kr/d A„aloter�.tn Name (Print) Address for Service: 258- /0?S Signature Telephone 2.2 Owner of Record: KArM,1 fA G or► Gs - D NEi Ll 3'� 9 AAso sr2Pe; 1/a,2M ,¢,-,doer Name Prinf Address for Service: 9-/S' 254-/03 t SiRnaturo Telephone SECTION 3 - CONSTRUCTION SERVICES I 3.1 Licensed Construction Superyisor: 17obelzr t3oackA / Pp R &uchex ,&(),Jed Lr0. Not Applicable ❑ Licensed Construction Superviso : ��m Am N/4- esq License Number Address JL A d,,.,, 97Y yjy--ol Signature f Telephone e—S O Sot 71 1 Expiration Date p5 2g/,;Loo �- 3.2 Registered Home Improvement Contractor Not Applicable ❑ /D 7jp6 0 Company Name /.55- 69,1404,,Ay �uxlci SA �i,QACL�/'J A4A 619.2(o Registration Number �s aoo Address P(`' S �o a_ 9 �sy o� Expiratioo n Data Signature Telephone 2 C C z M 0 v M r some z 0 GT�B�BR�'(i�if�c�--i�et�Pf License: CONSTRUCTION SUPERVISOR Number: CS 052721 Birthdate: 05/28/1958 Expires: 05/28/2007 Tr. no: 13611 Restricted:, 00 ROBERT A BOUCHER 10 KATIE LN PELHAM, NH 03076 r CommissionerJ / `✓fte Lo�to7zule a�a�.%t6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 104660 Expiration: 7115/2006 '1 Type: Partnership P & R BOUCHER BUILDERS, LTD Robert Boucher 155 Broadway Road Suite 1 � Dracut, MA 01826 i Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 wv A' Cl Not valid without signature I he Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street a y' Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): p9 R 80a"C'AG� ui �p�e25� LTD Address: ROA 0Sui f c / City/State/Zip: bR4et cr, Ai4 O/uea b Phone #: Q7,�- z1 -3-4t_, jj q , Are ou an employer? Check the appropriate boa: 1. [I am a employer with 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. t 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.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' COMP. insurance required.] Type of project (required): 6. ❑ New construction 7. g Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F-1 Electrical repairs or additions ]LED Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other _„y sYN.1�,un nlut cnccas oox rfit must also nu out the section below showing their workers' compensation policy information.• t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractots that check this box must attached an additional sheet showing the name ofthe 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: 69-00 }-G StPrh;- ZP5tt.,Q.XnCE Policy # or Self -ins. Lic. #: LV(f &W P ► „rj o 31p Expiration Date:_ �� 2'4 �0s Job Site Address: 339 /I6&TT ST, 1VQ(1_TJ4 /fidt>�� M � City/State/Zip: Nva 6 J� MA-01OV S Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year Imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certtiiify under the pains and penalties of perjury that the information provided above is true and correct Sign ture: Date &La 7 �a0 0 .5 - Phone Phone #: Oficial use only. Do not write in this area, to be completed by city or town qffcial 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 M DEC -16-2004 09:30 CJMCCARTHY LOWELL 9784530579 P.0.2/.02 'AcL(^) UtK 111-1UA 1 t U1-LIAli1L1 I Y MUKANIUt P6ROf, ID BO -1 12 16 Oa ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUS International New England HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 110 Appleton Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lowell MA 01852 j Phone:978-458-8458 rax:979-453-0579 INSURERS AFFORDING COVERAGE NAICtf INSURED INSURERA: _ _Mountain Valley Indemnity C INSURER B: Granite State Ins . C_ o . P 6 R Boucher I INI! R - 155 Broadsy Rd, Unit#1 INSURER D: Dracut MA 91826 INSURER E: I 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 AFFORDEO 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. -POLICY EFFECTIVE DD' POLICY NUMBER iVEXViIIATIDN " ""` LIMITS NSR TYPE OF INSURANCE Q DATE MMIDONY DATE MMIODIYY GENERAL LIABILITY EACH OCCURRENCE _ 51000_0_00 rA X COMMERCIAL GENERAL LIABILITY 3200010914-03 09/16/04 09/18/05 ENTEU PREMISES (Ea $ 100000 MED EXP (Any one DersDA) S 5000 CLAIMS MADE IJ OCCUR i PERSONAL 8 ADV INJURY $1000000 GENERAL AGGREGATE - - I I s2000000 _- PRODUCTS- COMPIOP AGO - GEN'L AGGREGATE LIMIT APPLIES PER: I S 2000000 POLICY 7 JECT LOC I AUTOMOBILE LIABILITY ANY AUTO I COMBINED SINGLE LIMIT (ES denl) T $ BODILY INJURY (Per person), S ALL OWNED AUTOS SCHEDULED AUTOS I BODILY INJURY (Per secmenl) S HIRED AUTOS NON•OWNED AUTOS PROPERTY DAMAGE (Peraecidenq S I i - GARAGE LIABILITY I AUTO ONLV • EA ACCIDENT S OTHER THAN , Ea,ACc 5--._ ANY AUTO I S AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S AGGREGATE OCCUR u CLAIMS MADE l S S S DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND YVLUS TORY LIMITS FR• _ E.L. EACH ACCIDENT s 100 000 8 EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE— OFFICER)MEMBER EXCLUOED'l WC8165630 I 08/27/04 08/27/05 E.L DISEASE • EA EMPLOYEE S 100000 E.L. DISEASE - POLICY LIMIT S 500000 II yec. describe under SPECIAL PROVISIONS Dolow OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Operations: Carpentry/builders I� 1 I CERTIFICATE HOLDER GAN"LLA IIUIN TANAPRO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN li NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL I �o VA v 'VR UMBILl I T VF AMY'AINV VPUN THt IR311IRR rTS AGENTS OR REPRESENTATIVES. AUTHORIZEDRESENTATIVE (" x- I ---,A. !/-? ACORD 25 (2001100) I /���' •C/ IO AUUKU USJKwuKA IIUN / TOTAL P.C2 x Qd o Ea a o A c C O T U cisa w a W ; a ii a W w �; w oQ ' d ca w a a E d z V) ° vi UW' >1 o Ea m C . C O W CCU C V V •n C CL � A .mom m C o Cc y m UW' >1 Ea �d C W �m .mom Q av w o H 1 cm :y=.. m h „Ju d oQ E c ti16.m CID a ' �N * o 3 cm f r, O L Z d O y � C as cm i o A O O 'E co m = O.a ♦- 3 as CD L O a cmQ M c z c cc CD c0CL z m C.7 y O C C C c D U) y W W 19 W N m �m o H 1 cm m m c J c � CID a ' Eo :QB` y O m i :CLQ PL O Z Z m c o 0 n = o e m c 3 H o COLS m .� =� Lu E c+ 0 a v cm N z J2 f r, O L Z d O y � C as cm i o A O O 'E co m = O.a ♦- 3 as CD L O a cmQ M c z c cc CD c0CL z m C.7 y O C C C c D U) y W W 19 W N . Jy Location •� �" 'No. Date TOWN OF NORTH ANDOVER x p Certificate of Occupancy $ _ _ Building/Frame Permit Fee $ _ SSACHUSE oundation Permit Fee $ _ ,,Other Perm it Fee _ $ HpR1HAi���C�C�0Sewer Connection Fee $ _ Water Connection Fee $ _ 1992:OTAL $ _ 'DAG, 4MCA f , Building Inspector Div. Public Works P,F R3f1T- jr0.= APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4qO. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME !A� V� V NO. OF STORIES SIZE OWNER'S ADDRESS_32✓✓i -�drt L5T 11 BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ���� 3=LI4 1 SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR '" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 Jj PAGE 2 FILL OUT SECTIONS 1 12 V ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OWN OR AUTHORIZED AGENT FEE Q -+ r% V PERMIT GRANTED .? _ �z 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER 6Q. FT. EST. BLDG. COOT PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF GELECTMEN vV a& 94& WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer I OCCUPANCY NGLE FAMILY _ STORIES TAR & GRAVEL ULTI. FAMILY _ _ OFFICES _ PARTMENTS ,4 WALLS 9 FLOOR$ _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH DNCRETE d t 2 I3 DNCRETE BL'K. Z;CK OR STONE ------III PINE HARDW'D 'ERS PLASTER —J �— DRY WALL UNFIN. 3 BASEMENT _ 'HALT SIDING � V. 1/1 V. FIN. ATTIC AREA _ NO B M'T TAR & GRAVEL FIRE PLACES _ HEAD ROOM _ MODERN KITCHEN ,4 WALLS 9 FLOOR$ CLAPBOARDS - DROP SIDING - CONCRETE B 1 2 �_ 3 OD SHINGLES EARTH �— _ 'HALT SIDING � HA RD�u'D _—COMMON ASBESTOS SIDING _ VERT. SIDING PIPELESS FURNACE ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME _ STEAM STEEL BMS. & COLS. _ BRICK ON MASONRY ATTIC STIRS. & FLOOR BRICK ON FRAME WOOD RAFTERS CONC. OR CINDER ELK. WIRING STONE ON MASONRYH 5 ROOF 11 10 PLUMBING T BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. _ STEAM STEEL BMS. & COLS. _ HOT W T OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 13t 13rd NO HEATING WOOD STOVE INSTALLATION CHECKLIST MASSACHUSETTS STATE v Permit BUILDING CODE COMMISSION I A building permit is required for the installation of any solid fuel burning . appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove � A) Ty,:a/'radiantcirculating /9 3 B) Manufacturer test label U0, ' vu after July 1, 1979 only) Name/Model No. C -4,c? 4 d I000 _Collar size nimensions/Heigh�HNLength 3Width 32." Chimney A) New ,-� Existing B) Size Tflue a a TXf2� C) Other appliances attached to flue Number and flue size) D) Metal (Manufacturer—name and type) E) Masonry/Lined rJc� Unlined. Flue liner type b manufacturer F) Height (refer to diagrams) ll� cap i/� CHIMNEY HEIGHT HEARTH Hearth A) Materials B) Sub -floor construction C) Minimum dimensions (refer to diagram Clearances and Wall Protection(see stove installation clearances chart) A) Type of wall protection provided 8) Clearances (refer to diagrams) FIREPLACE CORNER WALL/CENTER CAP ` �+ METAL CHIMNEY a ROOF SUPPORT ' s SUPPORT BRACKET TYPICAL CONNECTOR PIPE WALL PROTECTION I A CONN CTOR OVERLAP a WOODBURNING STOVE A J A J, FLOOR PROTECTION figure 2109.4 STOVE INSTALLATION CLEARANCES r. moot: rue, or as" occas, s.oc. _. Thimble required for passage through combustible construction. ). Non-combustible spacers required. b. Clearances on each side of 4 radiant stove with s hest shield $hail be measured as If a circulating type. TYPICAL WALL PROTECTION Combustible }" Asbestos Millboard Concrete/Masonry Stove towponents. Material Spaced Out 1" J. Foundation Wall b" trick Veneer Radlent Stove 1• �„ —F t Circulating Stove 1. _`., —Front r A. Radiant Stove 16.1 tE" 6" ts" —Side/Back A. Circulating Stove 12„ `w p. 6'. —Slde/Back 9. Single Wali :. 1!" it" c•• e,. Conneetor ripe u e Ya or Insulated b" Connector Pipe Chimney Height Three (3) feet above adjacent roof and (metal or Masonry) two ii) Ieet above an roof r1 a rlthln IO /Bet • Asper If Trot nc u n t e stove construct on. Oaaper It am"t be Installed In the connector Pipe. r. moot: rue, or as" occas, s.oc. _. Thimble required for passage through combustible construction. ). Non-combustible spacers required. b. Clearances on each side of 4 radiant stove with s hest shield $hail be measured as If a circulating type. !Location No. Date I TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ ` ♦ i > Building/Frame Permit Fee $ " + ,SSACMU`+� Foundation Permit Fee $ Other Permit Fee $ S$wer Connection Fee $ Water Connection Fee $ TOTAL • $ r Building Inspector Div. Public Works Location No. ?J -S Date OORTH Ott�io TOWN OF NORTH ANDOVER �,'4O Certificate Occupancy o ` of $ 7 Building/Frame Permit Fee $ SSACHU Foundation Permit Fee $ �^ t Other Permit Fee $ Sewer Connection Fee $ L�pWi Ca i%ee $ i TOTAL ,Building F Inspector V e Div. Public Works Location f No. f , ' - Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ td�n,9/FFArame Permit Fee $ d`a�foifft�hit Fee $ ACMU `�Epdtrrnit`Fee $ Sewer Connection Fee $ _ Ando Sewer Fee $ ` TOTAL $ Building Inspector Div. Public Works r- -� location , i T i N0. r Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ y- Building/Frame Permit Fee $ Foundation Permit Fee $ J; Other Permit Fee V, $ .' cs'F V. Sewer Connection Fee $ T Ca 'Water Connection Fee $ TOTAL Building Inspector Div. Public Works PER31IT NO. 8 a APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. a k5 PAGETi MAP 4-40.Q 8 LOT NO. r4, ZONE I SUB DIV. LOT NO. d 2 RECORD OF OWNERSHIP jDATE� '� - IC's / /'�` BOOK 'PAGE I ?��/ I Af 7 ✓�`T' f LOCATION 33 CY ,f}.b 1. .Ir CS !la'T � / U��,, A/1 /1 �YC7 �/I�T PURPOSE OF BUILDING e5, 1�� Cv Or 1IVI OWNER'S NAME NO. OF STORIES '� SIZE �6? i OWNER'S ADDRESS e 7 614 d -l2rn/V0367 cl BASEMENT OR SLAB ARCHITECT'S NAMEF...,�-,V L_/ SIZE OF FLOOR TIMBERS ISTZX �V 2ND .�a�� 3RD I BUILDER'S NAME f`N ���J'' K�rJv SPAN /2 i i�l' D DISTANCE TO NEAREST BUILDING / 7(0 l DIMENSIONS OF SILLS DISTANCE FROM STREET C1 -s " POSTS �� OJ) DISTANCE FROM LOT LINES - SIDES �(J I d- �S+ REAR GIRDERS / xQ v AREA OF LOT rQ`J 5 FRONTAGE 22 9,121 // 2 t� HEIGHT OF FOUNDATION '91 I I THICKNESS C) IS BUILDING NEW C y� i - SIZE OF FOOTING /I )-,q)-,qi / " �2 IS BUILDING ADDITION MATERIAL OF CHIMNEY ,.71-.1• C.(� W C �� _ L /�Q r IS BUILDING ALTERATION Y0 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 7� 5 7 IS BUILDING CONNECTED TO TOWN WATER n6 BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER - IS BUILDING CONNECTED TO NATURAL GAS LINE 67 U INSTRUCTIONS WOUNDAitON ONLY SEE BOTH SIDES r&Gumffffm 114.8,E mA PAGE 1 FILL OUT SECTIONS 1 . 3 �ry PAGE 2 FILL OUT SECTIONS 1 - 12 DAYS 2- S --Z .� ,M PAID .)� v 0 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING i/i/D dA�G T� Oi Q C) _.. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR :2 DATE FILED - / - r 2A" SIGNATURE OF OW YR ORp J�T ORIZED AGENT vt# FEE �M %CIS', 00 CONTR. TEL. CONTR. UC. • PERMIT GRANTED F=E FM!i 01 2 aI A � l :3 sSYq 2 3 PROPERTY INFORMATION LAND COST # 95z'"© EST. BLDG. COST/6qCCX) EST. BLDG. COST PER SQ. FT. (O,5-- EST. BLDG. COST PER ROOM ,Z5 > SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN PERMIT FOR FRAME/BUILDING DATE; FEE PAID,!�0 l BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY $DORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA - APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 1 11 8 INTERIOR FINISH CONCRETE _ PINE HARDW D d 2 13 iE 0 YJ;70 Ni ANUM i .M+Y7 /�0�,� #� �, �y `� AI •„� .,..�. aRAI . - t.d _ ' _ p I r r- •' �•y ._ - " ' .___ __.......-.. _ ... - CONCRETE BL'K. BRICK OR STONE _I PIERS PLASTER DRY WALL UNFIN. STEEL BMS. & COLS. _ 3 BASEMENT AREA FULL WOOD RAFTERS FIN. B M AREA _ 'L '/u 1/1 FIN. ATTIC AREA FIRE PLACES _ NO SMT HEAD ROOM % MODERN KITCHEN _ 7 NO. OF ROOMS GAS 4 WAILS I 9 FLOORS CLAPBOARDS ELECTRIC CONCRETE EARTH HARD\V'D COMM(_;N ASPH. TILE B 1 2 �— 7\I 3 _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME' BRICK ON MASONRY ATTIC SIRS. 8 FLOOR BRICK ON FRAME I_ CONC. OR CINDER BILK. WIRING STONE ON MASONRY STONE ON FRAME _ R I ADEO<OATE 15 i NOONE rj ROOF 10 PLUMBING GABLE GAMBREL FLAT �( �-yll HIP MANSARD SHED BATH 13 FIX.) TOILET RM. 12 FIX.) L WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK T SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES 71LE FLOOR TILE DADO . 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd_ IsI 13rd I ELECTRIC NO HEATINCT 1 s a•w a t••f3 ~. e a Q cr ci Z � _G O VyJ S Vi d d C M W IIII��i��Illil111111yl �► . 1 Ildillllllllllllllllllllilb �� O DEPARTMENT OF PUBLIC SAFETY COMMONWEALTH OF 1010 COMMONWEALTH AVE. BOSTON, MASS. 02216 9w, MASSACHUSETTS ENCLOSE CHECK OR MONEY ORDER . n , 0 LICENSE CONSTR. SUPERVISOR FOR REQUIRED FEE, EXPIRATION DATE "' f MADE PAYABLE TO 06/30/ 1993 6 EFFECTIVE DATE LIC -NO. RESTRICTIONS 015962 of "COMMISSIONER OF PUBLIC SAFETY" 0� NONE ��06/30/1991 n .' of DCASH). m ERNEST J GAUTHIER =, SS 0 025-28-3109 1537 TURNPIKE ST N ANDOVER MA 01845 P ;fASE.A R 1 1991 INCREASE PHOTO (BLASTING OPR ONLY) FEE: 100.00 E .;FECTI F B 1, 1989 HEIGHT: j NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED - OR - SIGNATURE Of THE COMMISSIONER '1IIG/ DOB: 05/13/1938 D NOT DETACH LICENSE STUB THIS DOCUMENT MUST 6E CARRIED ON THE PERSONC� SIGN NAME IN FULL -ABOVE SIGt9ATURE LINE �)- SIGNATURE OF LICENSEE OTHERS RIGHT THUMB PRWT THEEN TI THE HOLDER WHEN PATI IN THIS WHEN 'y COMMISSIONER 1. )p 20OM-2-87.81429 ,���// ; �, .....•(.- T - 3s ' S LOT /' 43 mac. \ z_ (o�JG. 1 //E•?EBY CE.eT/FY 70 T//E T/TGE /,t/S61eO,PAM0 TD T/+�E BAN,f' 7,V47- T//E OirELGI•u6 /S LOCATED OA1 Tf/E GOT qS SHOIYN ANO 7i/,4T/T ,O n6'5 CO.dFO.eW iY/T/! 20.11.414 .PE6r/LAT/O.c/S ,QEGA.PO/Nl, SETBAft'S FEO�Sf STPEETS f LOT U.✓ES. "' S FU,�Tif/E.P CE.PT/FY Tf/i0T T.s�/S OIrELL/N6 /S NOT LOG47EO /N THE FEOE.P.4G FLOOD 114,-,.4,W APE,4, SHOWN OJi/ FE.N� �'O.NMt/N/TY 1la4NE1 W& J�-eat. .STEP.S�E.r/ 1 '• •acs' - / ' �'^ L" S GATE PL O T /4"-74 / O,PA,0Y/V fO,P OIC/O L T///S PGA,/ Fop �G� � POSES - N4T FD.P �E��/��� ��GiciEE•P/•ti6 SEPI�/fES Bovvoey o�-�E,P o�,vo-vet- AT/Of/ TA.�E.t%•,a,�py/ T/.(/C :PELo.POS. (oto i'-4.P,f� .ST.PEET ANDOYE�P, �Y1.4SS,4G,Si//SETTS O/8/O FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Je4, 4 4- Nal -la, or -,2, + Phone 6 S�9 - 6 a 19 V LOCATION: Assessor's Map Number .3g Parcel Subdivision /i Lot(s) S% Street l I b St. Number 33c, ************************Official Use Only************************ RECOMMENDATIONS �OF TOWN, AGENTS: Date Approved f7� Conservation Administrator Date Rejected i L Comments Town Planner Comments Health Agent Date Approved' Date Rejected Date Approved 7 Date Rejected Commentsl-4Bi0��'y Bq- c,p /- Public Public Works - sewer/water connections - driveway ermit1, sem Fire Department �' 2 ` 4f �Tv Received by Building Inspector _ Date,��- NANCY E. ORIOL RR-VRKKRkW. P. O. BOX 55 WINDHAM. NH 03087 To Whom It May Concern: June 22, 1992 :ice. Ernest Gauthier is the contractor for our house to be constructed on Abbot St. in North Andover. In this capacity he is authorized to represent us in dealing with the Town of North Andover regarding permits, inspections, etc. If there are any questions, we may be reached at either 688-6019 (Methuen) or (603) 898-3273 (Salem, NH). Sincerely yours, Jeai�H Oriol Nancy E. Oriol 2r � 'V " j O LU La us ca z LU CL LU d C O ° Q un y z ° o V U 'z •CL.i 41 i C UK A*"t ca ILA, 40 U� W2 3 > W d � o s n. Opt m J •N „ a E •v ~ LO 40 0 C6 U i c Q Oa C7 CS o _ C o �r C06 o o ao � V Z •° U Q o •o `o c 0 cN d LAJ F $ M W Mr- ui LL. c4 m s w p U 'E u .o u o4 F L+- i. � h O O. V IV O CL O 10, O leg O W H O H F Z °• C O z uj o z 0 m _u o Z o m mL C J L L V L m W Y Q U LL ¢ ii oC N ii ccc ii m N tE d C O ° Q un y z ° o V U 'z •CL.i 41 i C UK A*"t ca ILA, 40 U� W2 3 > W d � o s n. Opt m J •N „ a E •v ~ LO 40 0 C6 U i c Q Oa C7 CS o _ C o �r C06 o o ao � V Z •° U Q o •o `o c 0 cN d LAJ F $ M W Mr- ui LL. c4 m s w p U 'E u .o u o4 F L+- i. � h O O. V IV O CL Z 36 y C 2 L11 m ® s: as, :o z Z V 'Z D v• Co t�0 z � y O u E:2 Coh 0 y� U rA i > w c! o � W wLLJ — Vl _ V � cA O_ ZD c� q o � C v C O N as W Z 0 O F Q l W LA- A 2 ..At U .CL w ceoc cc = O O O � ►- u u cc Q V W W 96 Z Z Z W d O O 0 Z Z u ? c. m m L C E J L J W L V L m W C Y O C O C ` C C Q N 2 U ii [C ii Q co ii ii co m ® s: as, :o z Z V 'Z D v• Co t�0 z � y O u E:2 Coh 0 y� U rA i > w c! o � W wLLJ — Vl _ V � cA O_ ZD c� q o � C v C O N as W Z 0 O F Q l W LA- A 2 ..At U .CL w O1-I.1c:1:—l"i OF: 13l 111 .1 )ING (:.'.()NSI *1 I VATR )N I Ilii\I: I'I I I'l.i\NNIN( ATE OCATION :LINER'S NAME: JILDER'S NA& : .• ISDN' S NAME: SON'S ADDREs�: I U C/V U 11 . SON' S TELEPHONE:-- L'LANNINc; & (,'Onl1►Il!N!"1'1' UI:V1sl.UL'nI1 N"I' KAItl :tlI 1 I.I'. Nl :l.tit )N. Ml we I ()It CHIMNEY APPLICAf1014 ANO ITK'Alll' . I \1 , -- , , JERIAL OF CHIMNEY: IFERIOR CHIMNEY: IMBER AND SIZE OF FLUES: I lI CKNESS OF HEARTH: ' ,,U cfLim tey an. ()i lLep.Cace con(Imin to Vt iguiatia)vs been aecesved: 'z7Z ':GNATURE OF MASON: L:XIERIOIZ Cll1MNLY: ( _ 9 jc l 2_" ( X4 - Il u,i�(eurc�►I.ta u() the eude and have ;Itl[n alld rR.MlT GRANTED: 'L ` Z FEL' 'O = n )BERT NICETTA , 1ILDING INSPECTOR ✓-� �,- 'SPECTEO: :MARKS: SULLU. BLUCK REQUIRED 1-I1IS PERMIT MUST GE OISPLAYLO 014 IVE PRUIIM; Vf A c i mi W 0 Z Q x O Z J m O t - X w W m. O Z 0 U J O. m. 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O W LU u e e G L 1 en W2 �—i 0 ori 4 Li N° �J �J > 9 Date.............`. .y........... t NORTl, °�,"'° :•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACNu5Et 1 This certifies that .?...'....'... ............................................................................. has permission to perform ............ -' :.:...... wiring in the building of;:..'................./.................. ................ .............. "..2........ G.../. " -� ........... North Andover, Mass. Fee�:............... Lic. No.I ............. ............................................................ ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS OlEcial Use Only Q Permit No. Occupancy and Fee Checl `r' [Rev. 11/991 give blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Masachusens Electrical Code (N ECS 5 7 I 0 (PLFASE PRINT 1N INK 0R TYP ALL 0 01� Date: • City or Town of: ,To the Irupector of fres: 14 AAA. IR.f By this application the undasiga^giZe ' ouc%f 9fr her;r4=oUo perform the electrical worst described below. Location (Street Sc Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boz) Purpose of Building Utility Authorization Na Ezisting Service Amps ! Volts Overhead ❑ Undgrd ❑ Na of Meters New Service Amps / Volts Overhead ❑ Undgrd Na of Meters Number of Feeders and Ampacity ellk Location and Nature of Proposed Electrical Work: no innrniarinn niri.a (I7.,.. . 7._ L.. No. of Recessed Firtures INo. -- - ------ -• -•- .•.••.. •-...� .uv......ur vc nu.rw VY -E !lJUG:.,ur UI rr lrez. of Cert -Stop. (Paddle) Fans No. of Total ITransformers KVA No. of Lighting Outlets INo. of Hot Tubs Generators KVA No. of Li;hting Fiztures (Swimming Pool Above ❑ In- C10. rnd. arnd. (Battery of t,mcrgcncy t;nung Units No. of Receptacle Outlets INC. of OR Burners FIRE ALARMS INo. of Zones Na of Switches INo. of Gas Burners No. of Detection and Initiating Devices Na. of Ranges INo. of Air Cond. Tota! Tons No. of Alcrtina Devices b No. of Waste Disposers (heat PumpI Number Tons ICW Totals No. of cif ontained Detection/Aiertino Devices No. of Dishwashers Space/ArcaHcating KW Local Muntcrpal Connection [I Other No. of Dryers Heating Appliances K -W becuntv Svsmms. No of Devices or Eauivalent No. o Water Heater KW a o No. o Signs Ballasts Data Witing: Na of Devices or Eauivalent No. Hydromassage Bathtubs No. of itilotocs Total HP Telecommunications W inn-: Na of Devices or Eauivalent OTHER Rnaar addltronai detail ijdenred, or as required by the Inspector of {Fires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licenscc provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force, and has cdubited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) �. (Expnaaon Date) Estimated Value of E Woric S (When required by municipal polity.) Work to Start: A I Inspections to be requested in accordance with MEC Rule 10, and upon completion. r certify, under the acts penalties ofperlury, that the information on this application irtme and complete FIRM NAME: ADT Security Services _ Dr; .. kJol 7 s UH 03049 LIC NO.: 1533C Licensee: John S. Bassett Signatu C NO: 1533C (1fapp1icable, enter "exempt -in the License number line) Bus TeL No.•J03 594-5900 Address: AlL TeL No.:_603 594-5928 OWNER'S INSURANCE WAIVER I am aware that the Lice f=ree 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) [Iowner EDowner's agent. nor/Agent - urc Telephone No. PERII.IIT FEE: S ,,,.