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Miscellaneous - 35 EQUESTRIAN DRIVE 4/30/2018
N Location No. `% Date a NORTh TOWN OF NORTH ANDOVER Oft.o ,'�ti.0 3? • OL 16. I Certificate of Occupancy $ �'�s ° • E<� Building/Frame Permit Fee $ a G/ CMU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ OAC ,— Check # ,.So 181A3 Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT MPM& RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ajL.. BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/InELWor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Properly Address: Qt A ESIT) 1A N 19,. 1.2 Assessors Map and Parcel Number: y -1t D (S`1 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 11 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: Public ❑ private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1161 1 is istrict: Yes r,In 2.1 Owner of Record Louis Name (Print) Address for Service Dk) CIO G1 —/7 b ' - a 3 Signature Telephone 2.2 Owner of Record: r Name Print Address for Service: t Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable 0 License Number Expiration Date ' �z 3.2 Registered Home Improvement Contractor H omy - Not Applicable 0 Company Name u5 (; CES Registration Number dd Zess A 7 Expiration Date Signature Telephone 00 M X z O U v rn a I 4 z M 90 0 a. r v rn _r z 0 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) I ay Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building unit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Description of Proposed Work check all a ucable New Construction ❑ 1 Existing Building ❑ 1 Repair(s) 0 Alterations(s) Xi Addition Cl Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: INSTALL Ui I NV f AD GN �oN SINE C2 Th,2 5P, I SECTION 6 - RCTTMATF.n CnN4ZTR1T1 TinN rncTc I Item Estimated Cost (Dollar) to be Completed bv permit applicant OFFICIAL USE ONLY ' 1. Building n �( (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4:5?— a 4 Mechanical(HVAC)- 5 Fire Protection 6 Total 1+2+3+4+5 Check Number S G �r.�,iivi� is vv�nr,ic Av invxi�►11VLv lV 1fE l:C/1V1YLLl'1',ll W131�;1V I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner SECTION 7b OWNER/AUTHORIZED Date I, i�l liV H 1.1 L as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are Lrue and accurate, to the best of my knowledge and belief 6LAKi C -H Hmw Print Name 1 Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB -SIZE OF FLOOR TRVIBERS iST 2 ND 3 SP _DINTNSIONS OF SILLS DIMENSIONS OF POSTS DIlVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE CO) m m m N m cn m H CD St Z CD O CL CL a� � o o p CL Q 00 ww C CD a: C) co 0 CO2 'O CD 0 COD d d 0 Cie 'o. 0 y d C*i CD 0 CD CD 3. CO) CD CO) O CD O CCD cn n O cn C 2 0 z C C Za O m vo = o -•mac ELI osm to S Elm m n z toPt� 3 M =r -o a M, 0 it m ;i a..a o ir m -.,am m o y gym: m 2 M oo o m s CL CSL Mcm it m m �s �► C 1 d � •` N: O m ti CL Q CL �CCD m 1► �q ON 0 � O►mo �y C/) �?m O co) r. WimcD : 0 C.C. � m m f o O 0 ro fp O iD QCOp T �1 ro O M �•J G tz n 0 h 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: H'I Ro CofjjiwE� - (Location of Facility) 111-6 Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Z O D 0 � r m 06 M a F-� zz m o C Z n m a 1 Z Y A 't �1 C 1 NO QCQOG C6 1 O b Y 40 i n n o — � 0 �� as Y 1 3 a+ P p N = Z w o a (IQ y �~ 1 e A Qc� 1 N N O A � O O v t y� If , m ROM KIMBLY FAX NO. : 6033629679 Jan. 29 2005 10:18PM P7 }COME IMPROYF,'MFNT CONTRACT r Snld. Ft,znishad and Tngtallex! by: G�.J Pate: l air THD At -Nome St rviccs, Inc, Branch Name: d/b/s 'tire Homc Depot At-Ilome Services 345A Greenwood Street, Worcester, MA 01607 Job �n "_36 7 Toll Free (900) 657-5182; Fax: 509-756-2859 Branch Number: Federal IDM 75-2608460 Me Lic 11 C 0209 W Coot. Licaa6 27 Cr U00 565522; MA Heat l ffVmvomcnt Ctmtattdf Rag•t Home Address: city State yip of differem from Inslallation Address) Proieet Info :ati • IVe yQ, C`purchaser 1. the owners of the ptoperiy Located at the above installation address, off' ` M9 w; tome D U•S,A-, Inc. ("7I me a of") furnish, deliver and turange far the installation of al! materials contract m Sheet # _ _ —, incorporatcd herein by reference and made a part t deserted on the attached Sp Home Depot reserves the right to cancel this contract if, open re -inspection of the job, dome Depot detertniues cannot perform its obligations doe to a structural problem wits the home or becaase work required to complete t was not included in the contract DEPOSIT PAYM1criT OPTIONS (Subject To amid vm,t"itatmn andlor aTaait opprovsl.) purchaser agrees that, immediately upon satisfactory comps �d seeof the work. Purchaser d liable hereunder.ill c"ttoaCompletion Ce and pay any balance due. Purchaser also agrees to be jointly y obligatedp financing ntain the Fetween tt a parues'Andsea agreement camended or codified unlessin�writi g n a paratc agreement signed by both partiat ci NOTICE TO PURCHASEIt Do not sign this contract before you readit-You are entitled to x completely idled -in copy� Of the contract at the time you gig it to protect ryouact igcomD to oLaw prohifi is home repair ontra letiou certificate Mrs trots re eatinnt g nor accepting g A mpltdioa Ceetificxt before this t 1. by the owner prior to the actual completion of the work to be performed under the con ct• You may Cancel this transattlox at any time prior to midnigght off! third butde ns day to 25% a( rte of this Amount if 0 Cancellation for an eupianation of this right- There will be a service chainequal cancellal by Purchaser AFTER the third business day. BY TERMS Or THIS RECEIIPTOOF A COPYIJRF BELOW, OF THIS CONIrwe AGREI� TO BE TRACT AND TWO COMPLEM BY C�1Fs OF TitE NOTICE O� CANCELLATION. N t0 On 14 WW ZZO w 0 D5tw¢ OM= 0 z BY MY/OUR SIGNATURE. RIELOW, VW+E UNDERSTAND THAT THE AGRMMFNT 15 SUBIECf TO REVIEW OF MYIOUR CREDIT HISTORY AND I/WR AUTHORI2B HOME DEPOT AUTHORIZED CONTRACTOR TO VERIFY AND REVIEW MY/OUR pRED FROM N 0 SSI OR ERRORS.RLDr(WI H A IND N REPORTING AGENCY AND RELEASE TWM FROM ALL LIABILITY 1 stjB iITTFD BY: enroll Date I W 1 A /�s AC.Cp.PTED BY: eiorn t Date: -- eto,npowner NOTICEt ADDITIONAL TERM\ CONDITIORS AND WARRANreES ARE STATED exv TM IMV&M smE Arm ARF PART or Tiris CONDUCT White rirasch Fde Yellow -Customer Pink-YHesCm Alaat 11 !9i ce „k c !411 gemce MoneyOTdgr Thee 1kCA CONTRACT AMOUNT $,,I�g ble Home pt 3 � 2.Card` Ond r other oayxteat opt' !- l irele tMe Bella.•LESS DEPOSIT $� sa Massa d ENS Amcricsn) xPressBALANCE DUE 1-7 % fa Tepot Homc I eve at LOan Tete home new CrediQN COMPLETION S nn, & HDCC ONLY)abie Crtdln S ( H'Minimum Z$ % of ContractAmoupt due upon er;eeution Exp, Date.dthia contract. appmn ea T --”-- low, Ilwt Brae to allow Home Depot to charge dBALANCE�WEONCQMPLE')TION: Indicate Payment Method For -r sipat ,xedit our thedeDo'Iiadicsted,r's S' arum Cute GI' f gi or HDCC Anthoriaatloa Codes purchaser agrees that, immediately upon satisfactory comps �d seeof the work. Purchaser d liable hereunder.ill c"ttoaCompletion Ce and pay any balance due. Purchaser also agrees to be jointly y obligatedp financing ntain the Fetween tt a parues'Andsea agreement camended or codified unlessin�writi g n a paratc agreement signed by both partiat ci NOTICE TO PURCHASEIt Do not sign this contract before you readit-You are entitled to x completely idled -in copy� Of the contract at the time you gig it to protect ryouact igcomD to oLaw prohifi is home repair ontra letiou certificate Mrs trots re eatinnt g nor accepting g A mpltdioa Ceetificxt before this t 1. by the owner prior to the actual completion of the work to be performed under the con ct• You may Cancel this transattlox at any time prior to midnigght off! third butde ns day to 25% a( rte of this Amount if 0 Cancellation for an eupianation of this right- There will be a service chainequal cancellal by Purchaser AFTER the third business day. BY TERMS Or THIS RECEIIPTOOF A COPYIJRF BELOW, OF THIS CONIrwe AGREI� TO BE TRACT AND TWO COMPLEM BY C�1Fs OF TitE NOTICE O� CANCELLATION. N t0 On 14 WW ZZO w 0 D5tw¢ OM= 0 z BY MY/OUR SIGNATURE. RIELOW, VW+E UNDERSTAND THAT THE AGRMMFNT 15 SUBIECf TO REVIEW OF MYIOUR CREDIT HISTORY AND I/WR AUTHORI2B HOME DEPOT AUTHORIZED CONTRACTOR TO VERIFY AND REVIEW MY/OUR pRED FROM N 0 SSI OR ERRORS.RLDr(WI H A IND N REPORTING AGENCY AND RELEASE TWM FROM ALL LIABILITY 1 stjB iITTFD BY: enroll Date I W 1 A /�s AC.Cp.PTED BY: eiorn t Date: -- eto,npowner NOTICEt ADDITIONAL TERM\ CONDITIORS AND WARRANreES ARE STATED exv TM IMV&M smE Arm ARF PART or Tiris CONDUCT White rirasch Fde Yellow -Customer Pink-YHesCm Alaat 11 !9i ce Location No. Date �� J &ORTN TOWN OF NORTH ANDOVER O: Jo �,tiOO L 9 Certificate of Occupancy $ ` sACN�s �� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 17991 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT RIKPAIR, RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 716 Swim thkor �C BUILDING PERMIT NUMBER- l} DATE ISSUED: SIGNATURE:' Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 3a Ea?U?-57T�(A.1V Dp, 1.2 Assessors Map and Parcel /05-b Map Number Number: 013 9 Parcel Number Name (Print) Address for Service 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS It Name Print Front Yard Side Yard Rear Yard R red Provide RegWred Provided ReclWred Provided 1.7 water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone ❑ CLi /�T7AIV 1 t1TATnTTI• A 1.8Sewerage Municipal Disposal System: 0 On Site Disposal System 0 .sa:,a. aivi. b-rilvrmi11I y r N Elmakurlau 1 HUlUZE" ADEN 1 I ''II I " I L, L./ .D LI It, L. 11Z�J 1"1U 2.1 Owner of Record 1-0 uk U� we, Name (Print) Address for Service Ot j Co" TtAal Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Si ature Telephone C100`Ti/1N 2 71^1►TQTnIT11grYAW vi. ✓ - �-vl�uai1V 1.11V1� .7x.11 ♦11.L'r7 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Signature Telephone Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ giOML Company Name S i , LA),a�Registrat i on Number ber -125 1 :�-, low Si z lureTelephone -7 Co Ex / piration Date v rn 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 building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work(check an a cable New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify ` Brief Description of Proposed Work: k aAO ?- � 4 I -A � i �t[AODY3e- 0,tfA&42 1 SECTION 6 - RSTIMATFD CONSTRUCTION COSTS 1 Item Estimated Cost (Dollar) to be Completed bpermit applicant OFFICIAL USE ONLY 1. Building I(a) Building Permit Fee Multiplier SIZE 2 Electrical (b) Estimated Total Cost of Construction .SIZE OF FLOOR T]M[BERS 1 ST 3 Plumbing Building Permit fee (a) x (b) cry 4 Mechanical HVAC 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 PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. I Signature of Owner Date rSR.CTInN 7h OWNER/Ai)THnRi7,F.n AGF,NT DECLARATION T 1, �iJ C N O cn as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief �� Print Nam Signature o Owner/A ent 1 ` b Date NO. OF STORIES SIZE BASEMENT OR SLAB .SIZE OF FLOOR T]M[BERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL. GAS LINE 1I it 0 0 11 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 c 11, S 150A. The debris will be disposed of in: coPIUW(x)t rrR( f (Location of Facility) Signature of Permit Aplicant ('251"v15-- Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector A I Jan 25 05 10:17a Michael Bedard 1-401-246--2868 P.1 FRY NO. : 6033629679 Jd7. 1.0 2005 06:59(=M P6 I, ROM Y, 1119LY iio. ? IMPi nVF.ML•'N 1. 17.0 S 1-RACT r' Enid, Furnished anc installed by: 111D At -Home Services, Inc. Branch Name: "' (Eats: d.'b/a The Home Depot At•}io-no Services '�Q 345A Oreenwnad Street, Worcester, MA 01607 q Br-anchNumber: /�� ! � Toll FI'ee(8()0)657-5kB2; FnRI Stb>i•"561&g7 V� _�Job+t: Aedcra'.IUN'S•269846G Ml: I,ie It C e"ed39 R] Cum,LIcM 16(27 CT LicF 565572; h'.A Nnmc Imprvvwacor Conirccrnr Roe.7?1Xta9! �.I tp at/,/ Installation Address: ��•-� �� r 058- � �pJj� 4' Rome Address: —.-- ((f differr t:om fn easl81.r ion Addlnss) City Stare Zip P,yvr� t fo rinn: TJWeIYou '°Pruchpserl^, the owners ofthc property located at the above installation address: offer to contract with tune Ucput 13,S,A:,Toa (' a ot" o limaterialq as f ush Plin=,po t d hcredr� refereneo and :on Wade a part hereof described on the attached'Spet, Sheet 4 22�� Rome Depot reserves the right to cancel !hiy contract if, upon re -inspection of the job, Rome i3epot dettrtnitley that it cnnnot perform its obligations due to a structural problem with the borne or because work required to complete the job xvnc net included in the contract. CONTRAPCT AW � , $ { LESS DEPOSIT S– 5 7— / BALA+NC, DUE t I ON COMPLETION S,__ "Minimum 25% or CoorrarY Amount due upan emcatior f tbtr contraet. indicate Payment Method'I:or 13ALANcn DUE ON COMPIT'T`ION: DEPOSIT PAYA'fENT OPTIONS (Subject to rune vtr�ficnvan onilor credit apprnval ) 7. '"hcch, t;ruhit7e L7+ceI: nr US ik�stal :ie[vfca planer Ordc: F�xdeptpeFiorn'tn:tlorxrDrputl. / 1"arc' and/nr who, payineai ,t Idao.,Cerd DiwiV iTla home Jepr.Vlt']$ C7irde one Solnw A.:noncan. Exoor i The Hninc Slapol Con it Card (mll, h ilDCC AKI.V) ,Sxp. L'atc: Nacw as II app:x taon cu �_..v ' Fn• mylanr silirxlcie rw, ewe ngtee to o3low Hnm: i)egM ru chocgn the okcrc c`crztted rrrditconi rthn 8 t indicated. Date -- Nr pnyear-y bounce due. me char "Pon ague S tope joint latio of, t1lt ! work, ? rd e d ii ince)-e euoder.nmP!etioa C-6-5mte E ttre reernent: This agrees( eat and iia atCsrhments, irlclUglag qny firansting agreement, curtain the. onmpicrc 3vter nam( eiween le pa;Ytes ane.. can not be amended of mWitied Hitless in writing ra a sepame agreamont htbned by both paiti�s- NOTICE TO PURCHASER 90 not 5:Rn this contract before you rcatl it. You xre entitled to a emmpictcly rili,ti•io cop % of the contract at the time you sign. Keep into protect your riems. Do not :sign mtp Com plotiom certificate or agreement atutina t}iat you A1Y sutisliod with the entlro �rgn a before this prettet is cornple`e, Law prohittits home repair contractors trnrn rc uetting or accepting n Completion Certificate sipped lsy the owner price to the actual campietlon of the work to be performed undo the ronfrac1, 4�ec mnv can.^et this transaction sr any time price to midnight a, the third husieeis day after the date of thio contract, see Notice of Cycellztian for, an cs'planat!oa ut this right flare (viii he In service chsrgc e021 to ZS'/ -of the contracr annum It 3to job is cancrlle.4 by Purchaser AFTER the third bu<iness dry. 8Y Mti'lCyUR SIGNATT UPR T31?i3OW. IAVE AG1t_.5 O Rif r0 T/D BY ITIS TLt2M"9 tDi 'r,41S COA`T[2ACT- !!b1 E ACKNOWLEDGE LEDC?l RrsC'-7'f OF A COFY t,)F T14lS C0 N1 !'%A.(" r AND TWO CONVI,I-TED CO!' ES OF I -M VC)'f'I4� UC CANCET_LA'Tif)N. By MY Gt'R SiC,,VATt itr BELOW, MWE UNUE'1iS1'ANr) THAT THE AGIt1:P:R'77iNT 15 SUBJECT TO ItrVIr ' OF SlNiDUR CRE,O(T E?1STOXV .AN17 IlWE A TEOtti'44i 14IOME REPOT MITI (01117].0 CON"1T2AC1Olt, TO VERIFY A?IU RF:VIM ?4y/OUR CREDIT rI•:C':)RD V!(Tl l AN I. )RPS "Ir i))r REPORTING A,(iKNt,Y AND RELEASF TIMM rROM ALL T: A 1LITY PJCURRBD:=RQPt INA'F.R' "I' MI ' 10. it RRRORS. SVIBMITTED BY Date.: 7 5eirsC' im J q ACCEP`T'ED BY: ?Icmeirwnc. � �/ Date: liwncowner NOTICE? ADDITttl�: •1, 7tlLMS, C0NDITIU1ti1,*,m wARRANritS Ari[ `TrATLrD00. 11TV RL'vME S+ -LUL AM AR91`A0Vr OF TIES CUMAA4T X'ulfc-9nn.!:rile Ya.H,w-G+at.anr Ci,i�-F:Up Cgm,•nitaM 5-tA..na r4Rr Location No. J Date L Mum,_ TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ ;�'°',••°''<� NUFoundation Permit Fee $ SIACSE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ' Building Inspector' C,A : Div. Public Works Location 3a F% K r d a, G H O k Na. 367 Date NORTH TOWN OF NORTH ANDOVER n Certificate of Occupancy $ 41 si ' Building/Frame Permit Fee $ S �ss�cNUSEs Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ V TOTAL"�'��4�� � !�0uilding Inspector 1 x 760 48:54 25. 09. Public Works ��l Q J v x Z Z Z Z C � N z W nl Q L_ t_ 2 nl LU— 6 .O N N , u N r.. z Z CV Q C C] to N Ln Ln O C L Q, — y W C O U Z Z — _. 5 W C Z ._ � t5}� W z tS7 LU C _ F Z W W Z N I... 2 ¢' C W i Q _ V W N W cc F ¢ W 6-.v N W — Lncn �c LU m U ~ L �C¢ Z C in W w J �c H G �j W N to W 0 J = Z z LU Z Q Z ¢ W Z LU Z 1 LU ± ¢ ¢ LL LU Z In z :n W u LU Z L� Z — _' C C © C _ — J :u ¢ .4.� Z Z W — Z L Z V 3 v. z vi z N cnWi— 5 ; } W W X X X7 r y r C y N W . r W ? C W 1 W �.• ^ 9W. .W v �_ .' 1' W Ix U 2 '� J Z Z 77Z W W J v x Z Z Z Z C � N z W nl Q L_ t_ 2 nl LU— 6 .O N r.. 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OQ' E C O r' I vPQ c t f ANG°�P� v c t;cm a..S E gom co �t N > 3 Qf m N W C � •p IFS-�+-/�� 'fl C m O r ^ c w O O i m O cm N: vi o mor m V y Z O cm LJ C O d C m y O C •C = d h�O-• � m r0+ W m V W o_...��� -- � M �. •N dt�C Z ac •EC.2.0 a y o v o cFE CA .0m 19 c g 0 y d O� O�cmCL clio ;1 0 0 i- CU 04 O 07 ai M�y� •r W W O � O e_ov o a CL Q C CO) * -c �ev .o 'a. o }; Z CD 0 CL V CO) c i C 0 _ocation3 a��,.�.r��.� -foo. =J,V Date N0"7" TOWN OF NORTH ANDOVER % Certificate of Occupancy $ � Building/Frame Permit Fee $ ss�cNus �._ Foundation Permit ee �fo "`Other Permit Fee $ 6 �er Connection Fee $ _ 1 poAnection Fee $ ��- s> TOTAL $ f"", (/ �1 1 T 3333 Building Inspector Div. 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HEIGHT: M" M NAl MOM yDNATURE UNE DOB: f , ,rw THIS DOCUMENT MUiT e: fY1� �HDRIOONTHEWH . ,I •7,��1 \ MB PRINT GAGEDINTH'500CUP'� pROV ._.� - - A • • � � pllil IIIIIIII�I��III (IVIII � '1 ru-w . �� 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: )C. - P ��v�� (1-�?t�i c9�1 Phone rr" / j nl O 1 LOCATION: Assessor's Map Number Parcel Subdivision Lots) Street a C4yfsT2iAe,/ DR+UE St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire I paar't�m°e�n, Recceei�v.Jed by Building Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Inspector Date 48' 6„ Drawing RR-LP(Q - Layout Plan 25' 8" s 3' a Utility Door to garage Closet (Raise for floor (No Sewer exit 3' and replace with ceiling) � steel panel door) Door to unfinished area Unfinished Area Approx. 420 sf. Water heater Jmh Furnace & AC �— 5' 5"–� 2' Chimney 6' 5'911 �\ 1' 5" i Window 81211 14' 3' 5'- 4' 3' 11'4" �— 8' 9" —� 2' 6" . s a Stairs Closet 9' s 3' 8"-� 11' 4" 4' s-am- Finished a Finished Area 51 Approx. 805 sf. Ceiling Height Approx. Closet 71 2" Ceiling height 6'4" 5, ----, Ductwork & * center beam ' enclosure - ceiling height ' 6' 8n 23' 8" Water utility Gas utility 33'7" Electric panel - to be built into wall Sewer exit Drawing RR-FP(Q - Framing Plan - 12' 9" Existingwall / between garage and basement - leave as is 11, 4" 3, pine Ipanel door 11, 2x4 wall insulated with / R-11 fiberglass batts, sheetrock on finished 1 side, Tyvek on unfinished side 9' closet - interior ceiling an walls finished in sheetrock Water i heater 14' Furnace & AC 4' _ 2.5' pine panel door utility closet - ceiling and interior walls of tol be left unfinished 4' N Water .._� utility Gas utility 3'8" 2x4 wall, insulated with R-11 fiberglass with vapor barrier, exterior with sheetrock, interior with Tyvek stairs closet 2x4 wall, finished with sheetrock uninsulated \Opening to stairs (no door) -- �, 2x4 wall, 2' Chimney 3' 5" sheetrock , ---� on both sides 5' 9" 11511 ' ' �.r Chimney to be covered wit�i Lally column - 2x4 wall, R-11 fiberglass: boxed in pine insulation with vapor barrier, and ; sheetrock. 12"x 12" door to ; preserve access to cleanout , 812" Existing window. Replace with screened thermopane and box in 33'7" Concrete foundation wall to be covered with 2x4 wall with R41 fiberglass insulation with vapor barrier and / sheetrock Electric panel to be built into wall Notes: 1. All wall studs 16" O.C. 2. Floor: 1x4 pressure - treated sleepers, 16" o.c., .75" ridged insulation, .75" T&G underlayment grade plywood. 3. Ceiling - Suspended tiles to be used. Ductwork boxed with sheetrock. \Concrete foundation wall to be covered with 2x4 wall with R-11 fiberglass .%—__ insulation with vapor -� - 2318" _ barrier and sheetrock 5' pine panel bypass doors Outline of ductwork - - - -and center , --Oel-�beam (to be boxed) , , -- �, 2x4 wall, 2' Chimney 3' 5" sheetrock , ---� on both sides 5' 9" 11511 ' ' �.r Chimney to be covered wit�i Lally column - 2x4 wall, R-11 fiberglass: boxed in pine insulation with vapor barrier, and ; sheetrock. 12"x 12" door to ; preserve access to cleanout , 812" Existing window. Replace with screened thermopane and box in 33'7" Concrete foundation wall to be covered with 2x4 wall with R41 fiberglass insulation with vapor barrier and / sheetrock Electric panel to be built into wall Notes: 1. All wall studs 16" O.C. 2. Floor: 1x4 pressure - treated sleepers, 16" o.c., .75" ridged insulation, .75" T&G underlayment grade plywood. 3. Ceiling - Suspended tiles to be used. Ductwork boxed with sheetrock. \Concrete foundation wall to be covered with 2x4 wall with R-11 fiberglass .%—__ insulation with vapor -� - 2318" _ barrier and sheetrock Designated Registrant's as Mass. B. Keen Reg. 108383 Registration Number: Salesperson's Name: y � 3] f ,r �, -,.1 ..,( :, r, err i 1" •n This agreement is made on .i ��.��v .. .i �.::)3 between (COPTRACTOR) (DATE) �„ c i.: • ; ; ni t• r `.t 7 .•'7 R•;" Of (PfioNE A'uMBER) (ADDRESS) "Contractor" and Lim -la hereinafter called (OWNT-R) r n r of .� �. _ `s i:IA:v L)i: I`r'I: iVU . i�" `' ' P (ADDttEss)(work) (Ptios�Ez,tn+eER) 617-259-9500 ext. 726 f heicinaftCt called -owner". DETAILED DESCRIPTION OF WORK TO BE PERFORMED work detailed below. Such work consists of the following: Contractor agrees to perform in a good and workmanlike manner all ,rte f. : ,-i_;_,,•, i �t _ owners) X1.)S . V'.t) 7. r r)gCl char es nc:luc��cZ i_E, luan under v n4il &installation DESCRIPTION OF MATERIALS TO BE USED DETAILED Materials to be used in performing the above described work consist of the following: U. CONSTRUCTION -RELATED PERMITS The following construction -related permits will be necessary m order to complete the scope of work included in this Agreement: The Contractor under provisions o` Chapter 142A of the Gcncral La in tthis Arrreemcn Pcauscd by regulatory, permit granting o irtspecu nall agencies, shz'1 no: be dccrr3cd responsb�e �o� delays in the work desaioea g authorities or individuals or strikes, accidents, weather conditions, material availability, or delays beyond our control. Notice: If the homeowner obtains his own construction -related permits for the work described under this agreement, the homeowner is hereby advised that in the event of a dispute, judgment and nonpayment of the contractor, the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L. III. PRICE, Contractor agrees to do all work described in Section I for the total price of S bri a ted -�beye�woF�Xi�:t(? avtti, -kemov4l IV. PAYMENT Payment will be made as follows: 0 cyo (S 19 0 0 . 0 0 ) upon signing Contract, r v, >0 0 1 . C f.trc c?.ay of wort: 1 s permit -F % (S5'760 00 ) upon completion of U % (5 , 3 0 0_. O ti) upon completion of 1? i 1 ct1 U 1 O U({ l and the remaining 20 % (s ) � 3 8 D 0 • 0 t 3❑p° n verification of the work by Owner and Contractor as having been satisfactorily completed, which verification shall take place promptly after completion. Notice: No agreement for home improvement contracting work shall require a down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is real HOMEOWNER:. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Owner's Signatur \ Date Signed t ---f 'date Signed (Over for additional information) Contractor's Signature—' M 0 z M W w a v o O w U) a v C/) � Q z z Q as .� z O LE bb O r2 v c Em C U m G i% AG R U z x :3 O n: m C w � U u W :3 O w > v V) cm 5 u. a U w x O n: m G w z x A w ` w v O w z Cn i o ,� O cn 44 o m c ;;c o c O 7 C L N O C w+ O ac scv ca c o ' m � o .. CD OD :tea co C O = G V y0+ 44 CL m c E CD ` .1 m p N C W C J A N AM all� N C C R o MIEN CD W cm CD N m O � � C=MC N S :mor m v5Z o o ... C=m c H � y CL 0 � CD y m � H m s P h CZ O C Z oc �E o C •N o v m omig C=D g N d m 0ca CD O '� s so. m M I* J z O E LL. CO Q O ~ O Z CDLU O Q CD cm z z LLI 'O > Q CO2 Q _ •O CC A O Co CO LU Cn z w o co C) 0 CD C n! Q CC O CL CMa CO) O c O V Q G D J Ll CO) Z CD z_ C-7 CL y O C cc cc u Q � CO) CD 5 0 z z a z u U C! ,W. b n 0 Im bd a � 0 m W A �v ro d> Cr n C m � � x y go C n n C C z �p �vh z n z � d � r� 0 m z m C') O z cn m D 0 z c CA .0 C 10 O CD C- Z co) CCD O 'v CL r C'). =3 r0 -r O O � C d y O � CD v CDCL o CD CCD O CD C CD co) CD Q O y O I CD CD F v CO) O 1 Z O O C oCD O C CD C CD 0 O CD 0 iG O W S O. x CD co c 0 _ N O CL N CA c �� O a, x �. co, O Q Cm N 'O V2 co o 0 m m N S a Gy \ cn rvi =d.m+CD N T r d z d CD n) C042 ohm: O x = N � O n c N o o ff► w o x O N O CD O mo N 71 C7= 22 CD CA H d C O. C C :� d CD 4 CDCOQ H CD 1r o � ' �o CD CD 06 O .. cm C3 CD dd a'o cli 0 0; c o = ' C3CD �► cn cn m 0T. • tD ^ In z �, � n, pip �TJ z w G O G OG t CD 'II_n p t1 orb tD S S a Gy \ cn � r d z d oil z � ril o o ff► w o x 4 y 0 9 z 0 Date. '? NORTH TOWN OF NORTH A" WR PERMIT FOR PLUMBING This certifies that CA. ................ has permission to perform .-5-A (.,i. . t...... . plumbing in the buildings of ... tA-. 'e". ................. at .12 . . . . A -'). � . e. J........... , North Andover, Mass, C - Fee. Lic. No. ........ ........... PLUMBING INSPECTOR Check # 3 L MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ('Type or print) NORTH ANDOVER, MASSACHUSETTS 4-7 Date -z3 G e Building Location e s / ;J Ar Owners Name ),atne r Pernti Amount f Tvoe of Occunancv s New E] Renovation 0 Replacement 0- Plans Submitted Yes 11 No (Print or type) /% Cher ne: lertificate Installing Company Name dim Corp, Address 0 Paster. e -e4- - z �Y4F usmess Telephone G,91 5- 93eT 0 1%ml/Co. Name of Licensed Plumber: _ Insurance Cove M= hKficateftq& of msoranm coverage by specking the appmpnaw box: Liability msmance policy Other h►pe of indeindity ❑ Bond ❑ Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner [:] Agent I hereby certify that all of the duds and information I have submitted (or enter in above application are tme and accurate to the best of my knowledge and that all phtmbing wort and installations performed under Permit issued for this application will be in compliance with all perfineut provisions of the Code sial 142 of the General Laws. By, t . Tide Type of Plumbing Lim City/Town a um er '�! Master Journeyman 0 APPROVED tor�cE t�ora.Y IIL.���111 Date ... V ... 7"!� 4.... TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION This certifies that �'4, IX # 72f . I)E s!`�/l! has per. -mission for gas installation �\ . � .... F. (J.s W< ... . in tKe buildings of ... ...................... atf. .. Z-. 474U.45Z f *v . K! ! .. , North Andover, Mass. Lic. No. g S li, . GAS INSPECTOR / Check # 5520 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING �-:-� (Print or Type) // ��� /�/ ,vciv��"/L Mass. Date T�}_ � OC- Permit # Building Location Owner's Name Z-0 e, Type of Occupancy New ❑ Renovation ❑ �. Replacement 0 Plans Submitted: Yes❑ No ❑ CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC _ Installing 5 South Summer Street Address Bradford, MA 01835 978-372-9999 (phone) 978-372-0882 (fax) Lic. Plumber: t ars"a&) Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate "Corporation 6 0-0 = Partnership Firm/Co. INSURANCE COVERAGE: I 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 coverage by checking the appropriate box. A liability insurance policy Z Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coveragerequired by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner s Agent I hereby certify that all of the details and information I have submitted (o( entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the perms issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of tl)edeneral ws. T of License: Plumber gnat re of Licensed Plumbev6r Gas Fitter Title Gasfitter /V57 Master License Number /V57 Journeyman APPROVED (OFFICE USE ONLY) OEM IMEEEEMMMEEI MIME MEMININIMEMIENE EMEMENEENSEEMENES MEN CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC _ Installing 5 South Summer Street Address Bradford, MA 01835 978-372-9999 (phone) 978-372-0882 (fax) Lic. Plumber: t ars"a&) Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate "Corporation 6 0-0 = Partnership Firm/Co. INSURANCE COVERAGE: I 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 coverage by checking the appropriate box. A liability insurance policy Z Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coveragerequired by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner s Agent I hereby certify that all of the details and information I have submitted (o( entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the perms issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of tl)edeneral ws. T of License: Plumber gnat re of Licensed Plumbev6r Gas Fitter Title Gasfitter /V57 Master License Number /V57 Journeyman APPROVED (OFFICE USE ONLY) .? '- �5 - ,-I / Date '. . c ................ TOWN OF NORTH ANDOVER 1 40TIF PERMIT FOR GAS INSTALLATION This certifies that .... .. I ............. : ...`...:..:f............ . has permission for gas installation ............................ in the buildings of ............ ........................ at ...... ......... North Andover, Mass. Fee. ...... Lic. No.. . . . ........... GASINSPECTOR Check # 3. 70 A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING6 ) (Pnnt T or yJpe 4. Q �7 �� . Mass. DateA2[X 2 Permit * 2 / / 0 Building Location - oa Ea6jz Tom_ 1, ///''Owner's Name yType of Occupancy i �i 1—X N T i 1.14— New ❑ Renovation C] Replacement aal,�, Plans Submitted: Yes❑ No ❑ Installing Company Name A (Z T A . `Am MA T A �L Address 3 %> Cna C H m A. ►v 4-K(, 111 i_ TH UE fJ r)1 r; • 01 kq � Business Telephone lo Z — 9 9 - f Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: Check one: ❑ Corporation ❑ Partnership 2-,firm/Co. Certificate I have a Currennt}fability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.. Yes hd' No 13 If you have checked ves, please Indicate the type coverage by checking the appropriate box A liability ' �Y insurance policy � Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ 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 thepe A —istued for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner taws. By T of license: C� Plumber ure of Uobnsedu or Gas Fitter Title tter et License Number 9333 City/Town OIC Journeyman MEMO IM Installing Company Name A (Z T A . `Am MA T A �L Address 3 %> Cna C H m A. ►v 4-K(, 111 i_ TH UE fJ r)1 r; • 01 kq � Business Telephone lo Z — 9 9 - f Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: Check one: ❑ Corporation ❑ Partnership 2-,firm/Co. Certificate I have a Currennt}fability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.. Yes hd' No 13 If you have checked ves, please Indicate the type coverage by checking the appropriate box A liability ' �Y insurance policy � Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ 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 thepe A —istued for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner taws. By T of license: C� Plumber ure of Uobnsedu or Gas Fitter Title tter et License Number 9333 City/Town OIC Journeyman LL f, d _Z H F W N O O D O H F- O = d 0 z 0 a J d IL a W W W f, Date. ?�•����......... TOWN OF NORTH ANDOVER 9 PERMIT FOR GAS INSTALLATION This certifies that A n 4l. '? . /?71.1?n�.4. ............ / ...... . has permission for gas installation .... 5... l.S"uc�'1....... . in the buildings of .....4a(-1 ..4A.lw-7" ................... at ...'G?''� .. (!.'�:... , North Andover,,•Mass. ,3, �/ssT �.. . Fee......... Lic. No. GAS INSPECTOR Check # Z °/ 7963 INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes d No E] If you have checked Yes • please indicate the type of coverage by checking the appropriate box below. A liability Insurance policy Other type of 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 Sinnati gra of r)wnar nr f)u,..ere e.,.,..� Owner ❑ Agent ❑ By chocking this box p; l hereby certify that all of the details and Information I have submitted (or entered) regarding this appilcatlon are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under e' ormit issued for this application will be in compilance with ail Pe nent prov lo npf the Massachusetts State Piumbing Q6��nd Chapter 14 of th General Laws. By Type of License: ❑ Plumber Title Q Gas Fitter Sig ature of Licensed IumberlGas Fitter ❑ Master cit frown ❑Journeyman License Number: +- �� .`_D_�) APPROVED (OFFICE USE ONLY) ❑ LP Installer ESTIMATED COST OF JOB I I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING 116 / S City/Town: �✓� U MA. Date: / Permit# Building LocaUon:,ja f9 (AC S%/t'/R/" _�p Owners Name: LUu &,)A6 -10C Type of Occupancy: Commercial 71Educational ❑ Industrial ❑ Institutional ElResidential 02rr New: ❑ Alteration: ❑ Renovation: E?I/ Replacement: ❑ Pians Submitted: Yes ❑ No ❑ INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes d No E] If you have checked Yes • please indicate the type of coverage by checking the appropriate box below. A liability Insurance policy Other type of 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 Sinnati gra of r)wnar nr f)u,..ere e.,.,..� Owner ❑ Agent ❑ By chocking this box p; l hereby certify that all of the details and Information I have submitted (or entered) regarding this appilcatlon are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under e' ormit issued for this application will be in compilance with ail Pe nent prov lo npf the Massachusetts State Piumbing Q6��nd Chapter 14 of th General Laws. By Type of License: ❑ Plumber Title Q Gas Fitter Sig ature of Licensed IumberlGas Fitter ❑ Master cit frown ❑Journeyman License Number: +- �� .`_D_�) APPROVED (OFFICE USE ONLY) ❑ LP Installer ESTIMATED COST OF JOB I I Wrn w Z N y N mst� w 0 W � (0 O w O Lu z CL XZ OlZ W IX> F�- W X w o X Z z J N F=d O Z J m; O UW' Z LL O = �_: W W 9 W W H O v o 0}C o Q tY W u. t9 t7 x W x g O a IX N H>>> Z x p V SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR --------- 3 FLOOR 4 FLOOR 5 FLOOR 5 FLOOR 7 FLOOR - 8 FLOOR rr� Installing Company Name: N1~ F I 1 N Cv-1 1J6 /NKt:L Check One Only Certificate # Address: CltylTown: i 1 , b l)i_C_:-1,c_> ^ -) State: ! I 1 � 0 Corporation r� Business Tel: r TK , 77 1-1 — f !, v_ J Fax: _'77C E7 Partnership [�Firm/Company Name of Licensed Plumber/Gas Fitter: ::- L= vl ei �- d %} "% /Y? �f" INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes d No E] If you have checked Yes • please indicate the type of coverage by checking the appropriate box below. A liability Insurance policy Other type of 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 Sinnati gra of r)wnar nr f)u,..ere e.,.,..� Owner ❑ Agent ❑ By chocking this box p; l hereby certify that all of the details and Information I have submitted (or entered) regarding this appilcatlon are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under e' ormit issued for this application will be in compilance with ail Pe nent prov lo npf the Massachusetts State Piumbing Q6��nd Chapter 14 of th General Laws. By Type of License: ❑ Plumber Title Q Gas Fitter Sig ature of Licensed IumberlGas Fitter ❑ Master cit frown ❑Journeyman License Number: +- �� .`_D_�) APPROVED (OFFICE USE ONLY) ❑ LP Installer ESTIMATED COST OF JOB I I r9pnMAN• mmIrM -U=Sm !Fn Imo.*,FMm A" OW -P "MNI-3 MST6iU ATCOW 00 STATE UMNE: VM "SM !F'RlVT CMa'Si E'xmr Be HMO'AT TRS'. MOM 07 79MSTATE OQAPO, 14 WAYNE SPD NIP. OA960-101: N'053 (15/01112 773.352 .', .; The Commonwealth of Massachusetts Print Form t Department of Industrial Accidents = _r?i:�'' Dice aflnvestigations +..!! s ;`; I Congress Street, Suite .100 Boston, (MIA 02114-2017 r wtvlv.111ass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricialts/Plttmbers Applicant Information Please Print Lepibly Name (13usiness/01-gtulization/Indilli(ival): l )._ y '!/ �v1a L /R 6 7 {}t•:r' Address: ,/�_j' 1.•. Cite/St � r, Phone T/: , if i rS Are you :an employer? Check the ;appropriate box: I am a employer with { "''� `I• ❑ I am a general contractor and i employees (frill and/or part-time).* have hired the sub -contractors 2. ❑ 1 arta a sole proprietor or partner_ listed on the attached sheet, ship and have no employees These sub -contractors have working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insurance.` required.] 5. ❑ We are a corporation and its 3. ❑ I ani a holneoWlier doing all work officers have exercised their Myself, [No workers' comp., right of exemption per MGL insurance required.] ` e. 152, y 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): G. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 1.0 Plumbing repairs or additions 12.❑ hoof repairs 13.❑,Other "Ani applirun that cheeks hos III must also till out the section below showin_ dleir workers' comilell"aliou police intbinrltion. - I'lorilt'.t)\llierS who Submit this athdavit indicating they are duing 1111 wolk and then hire outside contractors must submit n neer ntlicl11rit indicating such. 'C'onunclms Illm chceli this bas "lust attnched an addilionnl sheet showing the umlle ot'the s"b•corltrtactor's alit) state \\'hctller or not those entities hm c employees. It the mlh•Contractol'S have employees. Ilse\' n111st prOVlde IIICh' \+`nl't:u':' comp, pulic� number. J arrr rrrr errrplgver that is providing workers' conipensation hrsrrr•ance frtr• my enrployees. Below is the policy and job site irrfar»radon. Insurance Company Name: Policy 11 or Self -ins. Lie. 9: ,U f l ! atr 4? ---- Expiration Date: 0/k tJ Job Site Address: 3i�6s STR '4 City/State/Zip:��,N Attach a copy of tale workers'Conlin policy deci:aratiol, page (sho",ing the policy number and expiration (late). Failuee 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 51,500.00 and/(x• one-yF>ar iinprisonment, as well as civil Penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day agaj the violator. Be advised that a copy of this statement may be forwarded to tine Office of investigations of the DI#'for i)ISUrance cQyerage verification. I do hereby certih if that the prole i(teed ababoTiw is ate:] .i7,L,,` olid correct, r� OJ•ficird use n»Ir•. lin rrnt write to this «r•err, trr lie c'unrpleted hi/ city or town r�ffi'cial. City or Town: Permit/License #{ Issuing Authority (circle one); 1. Board of Ilcaith 2• Building Depart►nent 3. City/ G Other T'oayn Clel•1( a. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone th i AGORQ` CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO!YYYY) OZ/16/2011 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 Ileu of such endorsernent(s). PRODUCER NAI.1E: New England Heritage Insurance Agency Group, Inc. Ac,E Exn:781.438.5000_ _-�a/C,Not:781.438.5028 335 Main Street E-MAIL ADORES&: 5toneham, MA 02180 Pp DUCEA�-------- _--------_.—_—_ _. _—_-.._--.----_--_-•. INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE ,MAY OF ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HF_REIN IS SUBJECT TO ALL THE TER114S, INSURERS) AFFORDING COVERAGE MAIC if INSURED INSR .ADDL $USA: - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE . INSR . MD POLICY NUMBER _ jtiRliDU!YYYV) � (t.1CUDOlYYYY� INSURER A: citizens Ins 66'6f America 31534 N E F P INC DBA 1,000,00 -----------.v^—__.—.----.,.-------'—'-------------'------•.__... NSURERB: Allmerica Financial Benefit 41840 DBA: Yani(ee Fireplace & Grill Cit P Y EXP play oro nerserj a INsuRERc; Hanov'-----`---�- -- Hanover Insurance ...__..'2 _._.. ._. .22292 149 SouthMain Street 'r GENCRAL .CGREO_ATE i 2 ,_000 DO GEN L. AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMNOP AGG : S _ 2,000,00 INSURER D: Middleton, MA 01949 COM.81NED SINGLE LIMIT ANY AUTO INSURER E: __.. . ALL 0'.VNL-D AUTOS INSURER F: BODILY IZJURY (Per acc'9aal): COVERAGES CERTIFICATE NtiMRFR• Mostar Farb fir -ata RF\IlCirltd t,IIMP9:0• Per recaien!I 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 OF ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HF_REIN IS SUBJECT TO ALL THE TER114S, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR .ADDL $USA: - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE . INSR . MD POLICY NUMBER _ jtiRliDU!YYYV) � (t.1CUDOlYYYY� U!.11TS GENERAL LIABILITY OBN898044Z 12131/2010 12/31/2011. EACI I OCCURRENCE S 1,000,00 CO%!%'ERCiAL GENERAL UABIUTY _._ _ PH1)Sy,IFa.o.cs�.L� s>.__._.._._ 500,00 CLAP+S-'.1ADE X 'OCCUR'.'ED EXP play oro nerserj a .. - 10,000 PcR50VAL R AUV i\JURY 1,000.00 'r GENCRAL .CGREO_ATE i 2 ,_000 DO GEN L. AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMNOP AGG : S _ 2,000,00 POLICY: : JEC'r LOC AUTOMOBILE LIABILITYAWN8988013; 12/31/2010 12I31I2011 COM.81NED SINGLE LIMIT ANY AUTO BODILY WjURY (Per Person) ALL 0'.VNL-D AUTOS ---• B X BODILY IZJURY (Per acc'9aal): SCHEDLJLEO AUTOS X PROPERTY DALIACE _ IIIREDAUTOS Per recaien!I X ' NO.N-MVNED AU rOS ` UMBRELLA LIAR X I Occun OBN8980442112131/2010112131/2011 , EACH OCCURRENCE 2 000 00 . EXCESS UAB . ` CL,:IA'.S-t.:ADE: - .__..----------_----- —.____-__._.__...----_...........1.... ACGFlEGATE ' ' _ 2,000, .OEOUCTIBLE -- l RET'ENT'ION S 10,000 000 — 1 VIORKERS COMPENSATION WHN8989903.01/05/2011.01105/2012; X VG STH- AND EMPLOYERS' LIABILITYy/N , TQFLY - . A+:Y PROPRIETOR PARTNER,EXECUTIVE . N / A . C CFFICER�ME'IDER EXCLUDED? , E.L.EACH ACCIO2:F!'r - ;. .____- ACHA—____.-.________.�_=____ 500 ,00 _ (t.tandalory In NH) E.L. DISEAS[ • EA E.`.:PLOYEE: j 500,00 1l es. DI=SCRIPTION OF OPERATI(MIS 1)8'0'11 i - E.I.. DISEASE_ • pOLtCy LVAIT 5 500,000 - DESCRIPTION OF OPRATIONS I LOCATIONS I VEHICLES (Allach ACOR 101, Additional R marks Schedule, If more space is required) object to tFhe terms, condi tions and exclusions oil the policies. vcn t it— i t_ t lwl— k;ANGCLLA I JUN TOWN OF N. ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: GAS INSPECTOR ACCORDANCE WITH THE POLICY PROVISIONS. 146 MAIN ST AUTHORIZED REPRESENTATIVE N. ANDOVER, MA 01845 ACORD 25 (2009/09) Marc Slafsky/JDA 1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A CORD,Ar CERTIFICATE OF LIABILITY INSURANCE BATE (MMIODlYYYY) 04/29/2011 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 New England Heritage Insurance Agency Group, Inc. 335 Main Street Stoneham, MA 02180 NAME: or AIc No, Ext: 781.438.5000 ac N„ 781.438.5028 EMAIL ADDRESS: PRODUCEMER ID9.1 R 00034228 INSURER(S) AFFORDING COVERAGE NAIC # _ INSURED REEVIE PARMA C/O NEFP 140 S MAIN ST MIDDLETON, MA 01949 INSURER A: MAIN STREET AMERICA ASSURANCE INSURER B: INSURER C: INSURERD: INSURER E INSURER F; COVERAGES CERTIFICATE NUMBER: Master COI 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. INS LTR TYPE OF INSURANCE A OC , INSR. 5 BR WVO POLICY NUMBER P LICY MWDDIYYYY C P MMIDDIrM LIMITS GENERAL LIABILITY MP01927 03/2512011 03125/2012 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY _� I CLAIMS -MADE ( J OCCUR I DA �T" PREMISES (Ea occurrence) ( 5 500,000 tgED EXP (Any one person) S 10,000 A _ PERSONAL & ADV INJURY S 1,000,0 GENERAL AGGREGATE $ 2,000,000 I GENT AGGREGATE LIMIT APPLIES PER: ( PRODUCTS - COMPIOP AGG S 2,000,000 ' POLICY PRO JECT LOC $ AUTOMOBILE LIABILITY ( J COMBINED SINGLE LIMIT S (Ea acaaenq ANY AUTO BODILY INJURY (Per person) 5 ALL OWNED AUTOS BODILY INJURY (Per accident) S SCHEDULED AUTOS HIRED AUTOS I I 1 PROPERTY DAMAGE S (Per accident) NON•OWNEO AUTOS t ! I $ !S r UMBRELLA UAB rOCCUR I EACH OCCURRENCE S EXCESS LIAR I CLAIMS -MADE j1 AGGREGATE $ DEDUCTIBLE I I S RETENTION S I S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ; ' T RY LiMiTS E.L. EACH ACCIDENT S ANY PROPRIETORIPARTNERIEXECUTIVE�! I OFFICER/MEMBER EXCLUDED9 I N i A , E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) j ` Ir yyea. deecribe —del I DESCRIPTION OF OPERATIONS below --- - E.L. DISEASE - POLICY LIMIT ( $ 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space Is required) Subject to the terms, conditions, endorsements and exclusions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE "F9r Insurance Purposes Only" (Marc Slafsky/JDA ©1988-2009 ACORD CORPORATION, All rights rese ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Date .... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation in the buildings of ........ ........................ at North.Andover, Mass. Fee.,?4 ..... Lic. No.. ......... c Check A•G C MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: a ?J 4 Date: Permit#` Building Locatic.PZ•j�'', ,,49�, � e� /-7 Owners Name: Type of Occupancy: Commercial Educational Industrial, Institutional:,,.. ResidentiaX New:j Alteration Renovation v Replacement Plans Submitted:. Yes _- ' No. S►iill749 rn W W Y � w O ffi Type of License: Plumber ✓� €..µ ...x �.~ Title; pj = Plumber/Gas Fitter Signa ure of Unsed City/Town n , _ H Q 0 J >. X U) z APPROVED (OFFICE USE ONLY) 0 M y F- W w (� � z O z z 0 W w CO O IX w a W o O a O z a W> WW E.. a' Q W W ag N > W W Z O J H F- O Z w J (� u' W LIJ OU D O O C9 W W m> O O Z O W W Z Z W 1uj -- H H Q Q Q _ H tai a I- > > o SUB BSMT. BASEMENT / 1 FLOOR 3 RD FLOOR --4 'FLOOR It IM FLOOR FLOOR 7 FLOOR 8 FLOOR _a7( .,~ „ Check One Only Certificate # Installing Company Name 1 e- y-xij'y'�(! Corporation a Address:', State MA % -- City/Town �j" .. Partnership _._ Business Tel % Fax: ;Firm/Company- Name of Licensed Plumber/Gas Fitter:` INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yev�,^--.tNo„„,,, 2 If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liabilityinsurance policy y `i "-- ' p y � Other type of indemnity �„ ,F 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. Sianature of Owner or Owner's Aaent By checking this box ❑; 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. s av k ffi Type of License: Plumber ✓� €..µ ...x �.~ Title; Gas Fitter -a � Plumber/Gas Fitter Signa ure of Unsed City/Town n , _ Master Journeyman : "I License Number: APPROVED (OFFICE USE ONLY) LP installer 1 z zn r � z n b r x n y O z n � m z m C r y H y z d r d d cn m H z n a C b 7� O n Ln z Ln -0 ra n H 0 z permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall-be limited as to the time of ongoing construction activity, and may be_deemed.bythe Inspector-of-Wires abandoned.and_invalid-if he—.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ t The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the PermitExtension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending"through August 15, 2012. mule 8 — Permit/Date Closed: �� l�— / *'x* Note: Reapply new permit "❑'Permit Extension Act — Permit/Date Closed: Date.....:..Z. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... . ................. has permission to perform 44r./..5...... ...... wiring in tht building of ...... kA)4.?. .. Vex ............................................... at ............. =N hAndover, Mass. -77�*,e Fee.. .7 Lic. No.. .......... ........... 4 EECrRICAL iNSPECT6R Check v &e7-5- 8 9�_ 2 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. E-l� 71 Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code MEC), 52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: F) &16� City or Town of: Al(J/e—,e— 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 & Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Yes ❑ No X (Check Appropriate Box) 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: 3JFa17-K p / &S4U Comnletian ofthe followinv tnhlo -m, ho waived by the lac No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above 1:1In- rnd. rnd. mergency ig ing 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 Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW ................. No. of Self -Contained 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 Kms, Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 V BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Vlectyical Work: (When required by municipal policy.) Work to Start:—Z/j' l% Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under theAvains and penalties of per'ury, that the information on this application is true and complete. FIRM NA LI NO.: Licensee: Signature LINO.: (Ifapplicabl ter " xem " in, e lice s ber 1 ) , / / Bus. Tel. No. Address Q%% ol/ Alt. Tel. No. OWNER'S I SU NCE 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. PERMIT FEE: S aQ MetLife Auto & Home® Homeowner Operations Field Claim Office Attention: Claims P.O. Box 6040 Scranton, PA 18505 (800)854-6011 March 6, 2015 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: Louis J. and Linda C. Wagner Claim Number: JDE94890 OG Date of Loss: February 15, 2015 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten (10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 32 Equestrian Dr, North Andover, MA Sincerely, Home Ops CAT Team Sarah Lackey Metropolitan Property and Casualty Insurance Company Claim Adjuster (800) 854-6011 Ext. 7440 Fax: (855) 411-6689 Email: MetLifeCatTeam@metlife.com MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates, Warwick, RI. MPL MA-REGDEPT Printed in U.S.A 0698