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Home My WebLink AboutMiscellaneous - 350 WINTHROP AVENUE 4/30/2018 (21)�� i l Q 'V 1 � .� p 2b 15 01:b3p C�Iuvvies H-L'bbeyt P. 0. Box 575 Franklin, NH 03235 Phone Number. 506-662-1372 Fax Number. 603-286-8104 i=AX TRANSMITTAL- i=OR.M! Mess�a,e_ To: Building Department Name: Phone: Fax: 978-688-9542 From: Charles Hibbert Date Sent Septembeo015 Number of Pages: Chr%--.tvW2S Tree I✓ot rat 350 Mi CkV-op Ave. p.1 Sep 2515 01:54p P. 0. Box r;c"WiP* ATI 10.323 4 I'6tom (5 08) 062-11 7 ? F(ix (003.) 286-8104 ,September 24, 2015 Building Department N. Andover, Ma. To whore it may concern; My name is Charles Hibbert. I am the gentleman who has the Christmas tree lot located at 350 Winthrop Ave, N. Andover Major the past several. years. I was informed by the licensing department that I should inform the Building department, as well, of my intentions to do the same again this year. I am also including the letter that I sent to the licensing department, along with my contract, the map of where the lot will be located and the certificate of insurance_ If you have any questions, please fell free to call me at 508-662-1372. Sincerely, Charles Hibbert p.2 Sep 2515 01;54p Karen Fitzgibbons Licensing Department N. Andover, Ma. Karen Fitzgibbons; Licensing Department; p.3 Charles Hibbert P. 0. Box 575 Franklin, N. H. 03235 (508)662-1372 September 24, 2015 My name is Charles Hibbert. I am the gentleman who has been selling Christmas trees at 350 Winthrop Avenue, North Andover for the past several years. In the past, I have dealt with the building department. Since 2008, I have been in contact with the licensing department; I am doing so once again. I am applying to sell Christmas trees at this location for the 2014 holiday season. The hours of �.'v�arl,es �-i-r,bbert P. 0. Box 575 Franklin, NH 03235 Phone Number: 508-662-1372 Fax Number: 603-286-8104 -FAx TRANSMITTAL FORM Mossage: L- To: Building Department Name: Phone: Fax: 978-688-9542 From: Charles Hibbert Date Sent: SeptembeOO15 Number of Pages: ('� Christwc.aS Tree Lot at 3,50 'W�v t Aro? Ave. p.1 Sep 2515 02:02p I 1ft a'X16 gh ew, ox Frcinklitl. A-7103-2354 Phone (508) 66? -131' Fac (603) 286-8104 September 24, 2015 Building Department N. Andover, Ma. To whom it may concern; My name is Charles Hibbert. I am the gentleman who has the Christmas tree lot located at 350 Winthrop Ave, N. Andover, Ma for the past several years. I was informed by the licensing department that I should inform the Building department, as well, of my intentions to do the same again this year: I am also including the letter that I sent to the licensing department, along with my contract, the map of where the lot will be located and the certificate of insurance. If you have any questions, please fell ff ee to call me at 508-662-1372. Sincerely, Charles Hibbert p.2 Sep 2515 02:02p Karen Fitzgibbons Licensing Department N. Andover, Ma. Karen Fitzgibbons; Licensing Department; p.3 Charles Hibbert P. O. Box 575 Franklin, N. H. 03235 (508)662-1372 September 24, 2015 My name is Charles Hibbert. I am the gentleman who has been selling Christmas trees at 350 Winthrop Avenue, North Andover for the past several years. In the past, I have dealt with the building department. Since 2008, I have been in contact with the licensing department; I am doing so once again. I am applying to sell Christmas trees at this location for the 2014 holiday season. The hours of operation are Sunday to Saturday, 9am to 9pm from (november 24th, 2015 to December 25th, 2015. If you have any questions, please feel free to call me at (508)662-1372. Sincerely, ( f �f Charles Hibbert Sep Lb 1 b ul,u3p 09-21-'15 14:33 FROM - p.4 7-087 F0001/0001 F-943 Lease and Hold Harmless Agreement September 16; 2015 For the consideration of the sum of $000.00 (one thousand five hundred dollars), due and payable in full November 22,201s. 1.0as@es covenants hereinafter set forth, Delta MS LLC {Landlord) hereby grants to CHARLES HIBBERT (Tenant) of the privilege to use certain designated portions of the parking area of 350 Winthrop Avenue, North Andover, MA, for the purpose of selling Christmas trees, wreaths and Christmas decorations from November 22, 2015 to December 28, 2014. Tenant (a) waives and releases Landlord and/or employees of any andall ofthesef rn any arxi all claims for JOSS, damage or injury to person(s) or property which the Tenant may sustain arising out of and resulting from the Tenants exercise of the aforesaid privilege and (b) agrees to indemnify and save each of you harmless from any liability or suit for damages by any person whomsoever, out of Tenant's exercise of the aforesaid privilege and/or the use of the aforesaid premises. When the Tenant vacated said premises, the site will be left clear of debris resulting from the sale operation. All utility charges including electric, water, sewer, telephone, etc.,.forthe use of the operation will be the responsibility of the Tenant. Tenant is to provide landlord with a certificate of insurance for the leased premises. In the event of local or state codes or ordinances causing Tenant to be denied use of said Premises through no fault of Tenant or Landlord, the Lease will be terminated. Any monies prepaid will be determined due on a daily prorated basis. The balance will be returned to the Tenant, G Tenant: cnaries to err Date Landlord: Delta MB LLC ?AO-- /S' Date Sep 2515 02:06p vf:!j P.5 moi. Sep 2515 02;08p CERTIFICATE OF LIABILITY INSURANCE Z. DATE WMID D/Y" THIS CCD'nerrAT� I[. .e. _ __ 1 9/21/7nir. "- • •• '�^ IJ 'QQUr-U Aa Anna ITER 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). PHUDUCER Byse Agency Inc. 208 Union Ave. PO Box 1346 Laconia .nvunou Hibbert. Enterprise PO Box 575 BE 03246 West Franklin NH 03235 CONTACr Kathleen Gilman NAME; PHONE !603)524-4242 FAx E - 011L NO), (603)524-0708 ADaREss:kgilman@byseinsurance. corn INSURER S AFFORDING COVERAGE MAIC g INSURER A 'Tudor Ins. CO. INSURER 8 INSURER C INSURER D: INSURER E: INSURER F: CERTIFICATE THIS IS TO CERTIFY THAT THE POLICIES INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH YSR TR TYPE OFINSURANCE MMERCIALGENERALLIABILITY OF INSURANCE PERTAIN, POLICIES, ADDU UB WVD NUMBER delta2015 LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN POLICY NUMBER ISSUED TO CONTRACT THE POLICIES REDUCED BY REVISION NUMBER: THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, PAID CLAIMS. POLICY EFF MM/pD/YY POIJCY EXP MM/DD/YY LIMITS �"- A CLAIMS -MADE a OCCUR NPP8274515 11/5/2015 11/5/2016 EACH -DAM-AGE TOREN ED CCURRENCE $ 1,000,000 PREMISES Ea occurrence , S S0,000 MEDEXP(Anyoneperson) $ 5,000 PERSONAL&ADVIMURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: X ' POLICY ❑ JECT C LOC PRODUCTS-COMPIOPAGG S excluded OTHER: L$ _ AUTOMOBILE LIABILITY ANY A i E accidentSIN LE LIMIT $ BODILY INJURY (Pparson} $ (Par ALL OVuNrtJED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS I ` , BODILY INJURY (Per accident) I $ PROPERTY DAMAGE $ Peracddent $ UMBRELLA LIAB OCCUR OCCURRENCE S EXCESS LIABEACH CLAIMS -MADE. DED ' RETENTIONS AGGREGATE $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROFRIETC RIPARTNERIEXECUTIVE OF=ICERfr4EMSE9 EXCLUDED? (Mandatory in NH) If Yas, describe under DESCRIPTION OF OPERATIONS below N/A S PER V55'T'ATU�TEERH CH CIDENT E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACC)RD 107, Additional Remarks Schedule, may be attached it morespace Is required) Liability for Christmas tree lot at 350 Winthrop Avenue, N. Andover, A. mhibbert_2003@yahoo.-cam Delta MB LLC 875 East Street Tewksbury, MA 01878 ACORD 25 (2014/01) IN_5025 r2menir LA SHOULD ANY OF THE ABOVE DERCR16E0 POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE JKathleen Gilman/KAG --?' tr O 1988-2014 ACORD CORPORATION. Air rights reserved. The ACORD name and logo are registered marks of ACORD 2013-10-02 14;47 CHARLES HIBBERT 6032868104 >> IC tv September 18, 2013 Building Department N. Andover, Ma. To whom it may concern; My name is Charles Hibbert. I am the gentleman who has the Christmas tree lot located at 350 Winthrop Ave, N. Andover, Major the past several years. I was informed by the licensing department that 1 should inform the Building department, as well, of my intentions to do the same again this year. I am also including the letter that 1 sent to the licensing department, along with my contract, the map of where the lot will be located and the certificate of insurance. If you have any questions, please fell free to call me at 508-662-1372. Sincerely, Charles Hibbert P 2/7 2013-10-02 14;49 CHARLES HIBBERT 6032868104 >> Delta & Delta RealtyaTmst en � �es�-a000 September 12, 2013 t,M" sail Mm xarta Iw Fir its e�o>videt'ifi� the aa�s ai x1.00 (eek 1L ilk Dills pO b !rn rr dbsr o C Tod ARLM T (tom) offt priVUgp to up w"in rret (latailet� tta�bY meted portions of>be paddaig lot of 350 W p Ava^ Neth mow' MA for the RPM ofsdit uses, weeeo h% std Chrlsttnas deootadone from November 2S, 2013 to December 282 2013- I�dlord =W or eItploYm of any snd ell of eh= fiom any and Temttt (a) waivers and releases s whish the Tmeot MW �in an claim � lees, 4WAIA or iuj y to paM*) oc pmP�Y orisitt0 cot of. add res�ttdng ftam the Tom' ofdtc aand/ or lvss,itdmBS►'s to pndexratj► and esus e u wd a lialbdl �wicfor �damaW by any P��► 0e• Seas incurred m de&adio� surd/ or uta of the afarestud pscmises. ottt of Tenant's acerriee of the afraid privity Who the Tmw vacated said premises, the site will be left clear of debris reauldnS ftm tbo sale ,per fib► comes tncluft eloctria, watex, arrear, telqbonc' etr� farthe use: of die operation will be the t c 0; Lin bility of the Taunt. Twast ie to prarvlde Lndba wtdt a Owdfimte Of hOmmm for 'be lessetl premhwL in the event COMM or elate codes or **=am Gwaing Teaw to be deaW uac of mid Premises dm*h no fx& of Taasat or Lmdlwd. the Lee wiU be tmzaiwW Any monies pfd will be determined due an a daft Prosser basis. The balance wid be retwtted to the TOMEL r, e —7 '0 Pp 0.- 4 rt? 5 Tenant: Chwies Mbbett ►.. P 5/7 9.46-d Dale 2013-09-23 14;29 + Page 1 2013-10-02 14;49 CHARLES HIBBERT 6032868104 >> P 6/7 CERTIFICATE OF LIABILITY INSURANCE Do gin" THIS CERTIFICATE I$ ISEYED AS A MATTER OF INFpi�MAT10N ONLY AND cONFERB NO RIGHTS UPON THE CERTIFICATEl l �Z /Z 011 ce11111"CATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED S THEDPOLICIEIS BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED 1(k REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. • .•..urr,am newer Is an ADDITIONAL INSURED, the POUCY1102) must be endorsed, M SU13ROOATION 18 WANED, subject to the terms and conditions of the Polley, mengertain policies may require an endorsement. A statement on this certificate does not confer rights to the eerdfieats holder In Ilsu of such endoreemen s . PRODUCER Kathleen Gilaan BYBe Agency Inc. PNONa (6 3)524-4242 � 208 Union Ave. . (6oa)e24_oTae PO Box 1346 k0ilRlanQ seinsarence, acaL LavoniAtNeuR■ ArFORmNo tour; NAIL P NH 03246 INSURED INSURER AXON torn World Ins. Co, (Neu Hibbert Enterprise PO Box 575 INSUPIfiftc: West NH 03235 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDINO 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, Be GENERAL LIASILITV X COMMERCIAL GENERAL LIABILITY A CLAFM"ADE ® OCCUR LIMIT APPLIES PER; AUTOMOIMLE LIABILITY ANY AUTO ALL 0VWNE0 AUTOS � AUT08ULED MIRED AUTOS NON-OVNMED AUTOS UMBRELLA LIARI I OCCUR EXCESS LAB n ro uue WORKERS COMPENSATION AND EMPLOYERS' LIABILrTY ANY PROPRIETORtrARTNEROEXECUTIVE Y I N OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NM) H tea. describe under 317377 1/9/2011 11/5/2012 LIMnB EACH OCCURRENCE 1 11000,000 IR FNTED PR614larns (E.s MED EXP M ane = excluded excluded PERSONAL A ADV INJURY excluded GENERAL AGGREGATE s 2,000,000 PRODUCTS - COMP/OPAGO s excluded COMBINED BODILY INJURY (Per perw) 1 BODILY INJURY (Per aeddent) s AMA E i DISEASE - EA DESCRIPTION of 010eRAT10NS I LOCATIONS I VEMCLEs (Atleoh ACOND tot, Addluonal Remift Stlleduls, It mons space Is rewlnd) Verification of liability insurance for Christmas Tres lot at 351 Winthrop Avenue, N. Andover, NA. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIME EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Delta & Delta Realty ACCORDANCE WITH THE POLICY PROVISIONS, $75 East Street Tewksbury, MA 01878 AUTHORIZED REPAWWATM Rathloon Gilman/RAG R AGORD 18 (1010106) ® 7689.2010 ACORD CORPORATION. All rauhte reserved. IN8026 (2mompt The ACORD name and logo are 1`991SIOred marks of ACORD « VOL999Z909 A1991H S3TdVH0 OSTI ZO-0I-9IOZ r-0/1' (7 Aj , t 96' i�l 1'i(Mklh?, AlHU32354 Phone (500.) 662-1372 I ay (003) 2,YO-810-i November S, 2010 Building Department N. Andover, Ma. To whom it may concern; My name is Charles Hibbert. I am the gentleman who has the Christmas tree lot located at 350 Winthrop Ave, N. Andover, Major the past several years. 1 was informed by the licensing department that I should inform the Building department, as well, of my intentions to do the same again this year. I am also including the letter that I sent to the licensing department, along with my contract, the map of where the lot will be located and the certificate of insurance. . If you have any questions, please fell free to call me at 508-662-1372, Sincerely, Charles Hibbert Karen Fitzgibbons Licensing Department N. Andover, Ma. Karen Fitzgibbons; Licensing Department; Charles Hibbert P. 0. Box 575 Franklin, N. H. 03235 (508)662-1372 October 28, 2010 My name is Charles Hibbert. I am the gentleman who has been selling Christmas trees at 350 Winthrop Avenue, North Andover for the past several years. In the past, I have dealt with the building department. Since 2008, I have been In contact with the licensing department; I am doing so once again. I am applying to sell Christmas trees at this location for the 2010 holiday season. The hours of operation are Sunday to Saturday, 9am to 9pm from November 23rd, 2010 to December 25th, 2010. If you have any questions, please feel free to call me at (508)662-1372. Sincerely, Charles Hibbert Delta & Delta Realty Trust P5 EON. r . I=UBM 01874 Twp M l87 1�000 September 15, 2010 Lease end Hold Harmless Agreement For the consideratlon of the swa of SHOW (oee thousand live bandred dollars) duo eud payable in full NOYMber 12, ZOIL Loam% eavemtte hereinafter set forth, Ddb &Dem Realty Tram ( Landlord ) hereby V=ffi to CHARLM HIBBERT (Tenant) of the privilege to use MUin designaftid pordont of the puking area of 350 Winthrop Avenue, North Andover MA . for the ptapose of selling Christmas tr=. wrewft and Christman decorations from November 22 , 2010 to December 29 , 2010 . Tenant (a) waives and releases Landlord and / or employees of any and all of these from any and all claims for loss, damage, or injuxy to pin (s) or property which the Tenant MAY sustain arising out of, and resulting fiom thn Tenants' a wrdse ofth a afbcesaid privilege. and (b) agices to indemnify and save each of you harmless fim any liability and or loss , including an mey's fees inemrod in defte ing any asserted liability or suit for damages by Any Pmon whomsoever. out of Tenants' exercise of the aforesaid privilep and / or the use ofthe aforesaid premises. When the Tenant vacates said promises , the she will be left clear of debris resulting from the elle operadon . All utility charges including electric, water, sewer, telephone , etc., for the use of the oparadon will be the respovesnbility of the Tea=. Tenant 4 to pro" Landlord with a tertificate of insaranre for the !sawed Premises. Tn the event of local or state codes or ordinances causing Temno to be denied use of said pWnises be* no fault of Tenant or Landlord, the Lease will be tamed . Any monies prepaid will be determined due on a daily p mftd basis. The belaace will be reed to the Tenant .01 /0!, '2� Tenant : Cbades Hibbert Date 2010.09✓ 15 14;35 9788514982 OwwA 7 11-U.! I I.UU l.1 IP1f%LLJ I IIUULI, I UUJLUUU IL AL:Vffq %ocR i irit;A I C Ur ' LIA OYU AMY. Ine. P.O. Box 1346 208 Union Ave. Laconia, NH 03247-1346 se PO Box 575 West Franklin, NH 03235 MILI 1 T INSURANCEWRI°'"wWTITTI 10/27/2010 THIS CEIRTMAT9 IS ISSUED ASA MATTER OF INFORWN ONLY AND CONFERS NO PARTS UAAN TNI CER"geATE 01� ��DOe�Pa sORAITe COVERAGE AFFORDED Y BELOW. INSURERS AFFORDING COVERAGE NAIL 0 ImURmRA- Western riot d Ins. Co. INbvRER B. IWAIRER C' �— IIR$IA?Fj10 ICER E: COVERAGF.a Frwrvuwra yr II%W11{q & usrEa DELL HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY ITERM OR CONTRACTOF ANY MAY PERTAIN, THE NSURANCE AFFORDED BY THE S DESCR BI ED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONFICATE MAY BE ISSUED OR POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S AND OOIpITIONS OF SUCH MR "of WLStANCp POLICY Nle LarTA OQi�dGILgSLRY NPP1211332 11/05/2010 11/05/2011 EACNCCCUmVxE $ 1 000 X C<1f�,FRCWLGE1EiiAI IUt(iQIIY PPWISE3 Ee ronu exclu aar,Is "" .Xn- occlr+ � "p (Arty aw pwwI f excl u A PPJKa4fy 6 ADV R AQY f excl u c> AOOR90AIt $ 2000 GM AVWfGATe LIMIT APPLIES PER PRoouaS - COW10P Aoo $ excl u x1palcynwr LOC A NOMOBLE LfAfIA.1TY COWN6D SINGLE LIWT f ANY AVro (Eo sco)dw ) ALL OWNED AUTOS BO04Y R1) AY SC HEIXAM Allroe (PR vw'rn) HIRM AUTOS NON-ONWO AUTOS BOGIY IMIJRY IPer eecdderf) f PROPERTY PAMAM (w► awdWi) f AM ONLY . EA ACCIDENT f ANY AM 07 ER WW EAACC t AUTO ONLY, AGO t MGM/ LWf.11Y F-ACHOCCURRENCE i OCCUR CLAMS MAM AGGMEGATE f r�EoucTISLE : REMNTION = AIDWIMI.OIWIA'LIAaRm YIN TA MYIMI'81 1 E L. EACH ACCCENT f ANY PROPR[Et"A0. RIExECUTIVE ❑ OFFICER/W#,M E% IMA11d"Y iniog WII�yyMM Owf bl ur4w� E L. COSEASE - EA EWLOYEE= El DISEASE -POLICY Lima = eKPROVISION&V*W OTNN �L�ATOMI a. � rlstmas =nwtIlocated 350 fW ADvde, NAndl!o►vEGeArL, nut . 00= ANY OF TM ABOVE NKFAW POLIO R CANCOLLN MOM TM 0"IATTON DATE "MW, M 101111M WAUW WILL WMAVOR TO MAL 10 GAY! rwRfl EN NOTICE TO W COWMATI HOIJ 9t WJ= TO TNP LIiFT, WT FAILU Mt To 00 so BNALL Delta III Delta Realty W M NO OBLIGATION OR LIABILITY OF ANY We UFON M Vara. Ips A00M Or $75 East Street TrATnaEs. Tewksbury, NA 01878 AUTHOW01 TATIVB I I WO+1419L- 0-41-11VAiT q. d The ACORD nam and logo an reglowul motto of ACORD Z0DIR71520 Page 2 0 I I I I l t U- I I-Uj I I Uj k -I IMMLLJ fIIDDLM I C'.hc�rLes Wbbert P. 0. Box 575 Franklin, NH 03235 Phone Number: 508-662-1372 Fax Number: 603.286-8104 FAX -FRAM-SMiTTAL f -ORM M 8F.F.Qe: To: Building Department Name: Phone: Fax: 978-688-9542 From: Charles Hibbert Date Sent: November 5. 2010 Number of Pages:(p Ckir%stmois Tree trot At 350 MMhrop Ave. I Error Report ( Nov. 5. 2010 10:44AM ) 2) File No. User Name Destination Mode Time Page Result ---------------------------------------------------------------------------------------------------- 1281 CHARLES HIBBERT G3RES 046° P. 2 E Page not received Quick Service Code # Batch C Confidential $ Transfer P SEP Code M Memory L Send ater @ Forwarding E ECM S Standard D DetaillF Fine U Super Fine Reduction H Stored/D. Server LAN — Fax t Delivery Q RX Notice Req. A RX Notice O : Mail <->: IP—FAX d: Folder 7 r,.. , . •ry TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..............F. ..... ...... has permission to perform ....... ............ I ............................................ wiring in the building of........ A.Z'.".�v - .`4 ... . ............................................... at ....... ...... . . . ................ .... . ... . North Andover, Mass. .... Fee .... .......... Lic. No. . ............ . .. . ..... ' ........ ..... LE�CTRICAL INSPE OR� Check # lqpl-,2 7740 c ��••••w��wCe��La Ivy iviassacnuserts Otticial Use Only Permit No. Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] 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 PRINT ENINK OR TYPE ALL INFORMATIOA9 Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention perform the electrical work described below. Location (Street & Number) 3-56 N o e. Owner or Tenant (11 U F >� �r e b� a r• Telephone No.'p8 Owner's Address IF 0, 3o X 2 3Vuk�,�I �- Is this permit in conjunction with a building permit? Yes C1 No Q (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Z20 Amps f 20 / 2 Volts Overhead 0 Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Fork: No. of Recessed Luminaires No, of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches j No. of Ranges No. of Waste Disposers r No. of Dishwashers No. of Dryers No. of Water KW Heaters No. Hydromassage Bathtubs Completion o the No. of Ceil.-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool a e ❑ In' gri No. of Oil Burners No. of Gas Burners No. of Air Cond. Total Tons Space/Area Heating KW Heating Appliances KW Ballasts . e 44ng table may be w&ved ey the No. of I ransformers KVA Generators KVA 9❑ rNu. or r.mergency Lighting Battery Units FIRE ALARMS INo. of Zones o. of Alerting Devices ❑ IVJLUMclpal [I Other No, of Devices or Data Wiring: No. of Devices or of Motors Total Hp I' 1'elecommunicationi No. of Devices or Wires. Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, unders and penid * of perjury, that the information on this application is true and complete. FIRM NAME: > Y/ C-, LIC. NO.: Licensee: Signature 7 LIC. NO.: (If applicable, enter "exem t " in the l cense num er line) Bus. Tel. No.:?�72-.�slJ/B Address: �� //fr' S��{ O/eep Alt. Tel. No.: 2 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. I I . rclltd nk 06, A, i N. 1. i i kj :Na■Iffir T f .d The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 C-1 www -mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Elects icians/Plumbers Aonlicant Information Please Print Legibly Name (Business/organization/Individual): /ego oYeQf " Pi ` e,0A1 ji�71e-ClXt 6. Address• /Z.? jGl.4ilec4 �� 'fi9. alts -o City/State/Zip: Phone #: 70Y s Are ou an employer? Check the appropriate box: i.I am a employer with o2- 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am .a.sole proprietor or partner- have hired the sub -contractors listed on the attached sheet i ship and have no employees These sub -contractors have working for me .in any capacity. [No workers' comp, insurance workers' comp. insurance. 5. Q We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No -workers' comp, c. 152, § 1(4),'and we have no insurance required.] t employees. [No workers' comp, insurance required.] ' 'Any applicant that checks WO 1 must also fill out the section below Type f project (required): 6. ;New construction 7. ❑ Remodeling 8. C7 Demolition 9. n Building addition l o -El Electrical repairs or additions 11.0 Plumbing repairs or additions 12.FRoof repairs 1.3:❑ Other owing tr wo ers compensation poi cy mtormattotL t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContrit tors that check this box mustattached an additional sheet showing the name of the sub -contractors and their workers'comp, policy infomiadon. 1 am an employer that is.provrdatg:workers' compensation insurance for my employee+~ Below is the policy and job site information. Insurance Company Name: ' /yAive%� /� Policy # or Self ins. Lie. #: %��' 7� 02 Q Expiration Date: ✓r� �� Job Site Address: 3.Sd —6V1W A R!,e fi`t . /y %i,U)i ✓ec 'R1 City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date}. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the. violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Idob of perjury that the information provided above is true and correct r 112,0 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #' Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,, partnership, association, corporation or other legal entity, or any two or more of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee -of an individual, partnership, association or other legal entity, employing employees. 'However the owner•of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on'the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work tmt l acceptable evidence of compliance with the insurance requirements of this chapter have been presented .to the contracting authority." Applicants Please fill out the workers' compensation. affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with, no employees other than the members or partners, are not required to cavy workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit -may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also 'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law.or if you are required to obtain a. workers' compensation policy, please call the Department at the number. listed below: Self-insured companies should enter their self-insurance.license number on the' appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating•current policyinformation (.if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of -the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. When a. home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required t.o complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. r The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax # 617-727-77451 www.mass.gov/dia 11/03/2005 04:26 16039344497 CHARLES HIBBERT PAGE 01 u cow � c� Sad-Loioa- 13la 11/03/2005 04:26 16039344497 CHARLES HIBBERT PAGE 02 Lo'k 1ktu) iru °i4 . C) 3 Z3,*5 —to Z30 o �— OL R cry\ t� Q pn�, �-Ytw. O5� t:) pec. a j . 4 L�� O—h%� V.AA�� I C a� r 13`7 c� . C.hArle5 A bbert 11/03/2005 04:2 16039344497 CHARLES HIBBERT V Mp'A-61 �o CY PAGE 03 v mm 11/03/2005 04:26 16039344497 CHARLES HIBBERT hax:1-978-851-4962 Oct 2e 2005 10:21 P.02 Delta & Delta Realty 'Trust 876 tont Btrest, f usstls Ota7s r•Mvna4 (078$ U14M October 260 2007 twos end gold swam Agr+esme* For the coadde BdOn of tit# sum of SUO-00 ( nee t umad two hundred delam ) du end p*.P.Me in fbn November lit 20M Leeeee`e eoreoents hen6W&N ret forth, Delta &DdIn Beaky Trust (IAWh d) hereby grwo to CHARLES ABUT ( Team ) of the privilege to nee certain dedV*d portions of the prbro am of 3SO VI WOO Averwe, Nord! Andover MA. for the purpose of selling Ckbt mss UW, wreaths and Civiistmae decorations loom Nov"er 22, ZOOS to Demaber 31.2003 . Tera" (a) >A -6m and releases Landlord and for employees of my and all of these from any and all chinas for log, dump, , or itoury to penes (s) or Property whicbt tate Tatum may sustain d:.'ng out of, sad ro WAIII !loan the Tenons' escrow of the *arl W Plivil ► utd (b) agrees to Men* and save eua of you harmless from SW 1WAty and or Ion, induding attomey y fits inm vd is defaWing any asserted llabltity or suet for 4ges by"Pumm whornsosnw . out OfTOMM' etarcise of the aBotrssdd privilege and / or the use of the aforemid prodw, . When tltc TOM vematea said PURIM, the sh Will be left elsar of de6tis f*adt* ftm the sale opendott . Fill ud ty dara,t 4 fact ft W"IriG , Water, mW, teleph one , Oto., for the on of the op�ion Wilt be the r 'Mty of am Tg" Tenant is to pride Landlord with a certificate of inwranm for the leered promisee is the event MOW or elate cedes or ordina M =W98 TMO to be dented Use of said preatiees throwgb no IaWt of Tenant or Landlord, dw Loris will be tennkmW . Any monies Prepaid will be detemined due on a daily prorated basis ,lira bdanoe wilt be ronnw Q to ter =aemm 4 Tomm : ChuW HtWw Daft i�3of 1rd : do Della Raja Tmm . -��Nw-�-•�.•N.M�• •M•NN Dote r PAGE 04 To: 12Z e"ex S(:S�o , P, �Kj�� Fax # ( ) Date: , ///Y/off Number of Pages: (Including Cover) Message: ' 4X , Complimentary Fax Cover Sheet From:�� Phone # (`N) � to a� - 13 7 - O Urgent O Confidential O Confirm Receipt Reply Fax #: At(� c/ 5 SgVA n� p G,, f P_;D _ v- i-�,.kj C fq.., r rn K- COV4qAVI cs NOV - 4 2004 IU BUILDING DEPT. RECIEWED Staples Copy Centers also offer these additional services: N V 4 • High Speed Black and White Copying • Binding Services SUI 1 • Custom Printing • Digital Color Copying - • Laminating Services + Custom Checks & Forms • Convenient Self=Serve Copiers ,...,.a • Custom Stamps & Engraving • Personalized Calendars IMPORTANT Staples is not responsible for the content of this facsimile, Our customers are cautioned against sending confidential or sensitive personal information via facsimile. Staples is not responsible for misdirected facsimiles. it you received this facsimile in error, please notify the sender at the phone number inserted above for directions concerning the facsimile. G3�3� l i37� RECEIVED NGV 4 _ 2004 BUILDING DEPT. Fa; :1-??�461-4%2 P,bv 1 2004 11!16 P.01 Delta & Delta Realty Trust 975 EW StTwpeer, T , b +UMM Ot t76 • 96t•8�e November 01, 2444 Lease and HoM Harmless Agreemm For the coo Wwatioa of the sum of $12&AO ( out deeiasand two hundred dollars } due no parable in tab Nmromber 12 , 2004. Lessee's covenants heredndw set WIN Derr• &Dy >e4' Trost (JaudbM) be* FaM to CEiARM I3WERT ( Tenser ) of the privibege to use centma des*Med portbons of the parking area of 330 Winthrop AMA North Andover MA, fbr the purport of 56114 Cluistmas trees, wreaft and CMsbw d ooradl 11, 9tom Nevenbe r 22 , 2004 to December 31, 2004. Tenant (a) wOM and relftes Landtord and / or eMloyees of any and al ofthese from any and aU dAb ss jbr on, damp, , or injury to pE = (a) or pry wb ith the Tenant mly we* wwg at of, aril to Mq 200 the TmoW ambe of the a0 maid privilege , and (b) SPO to iadean *and save tach of you bstrnless 11= soy Bob" nod or IM, be k&g attorney's fees hicmTW in deeper any asserted liability or suit for ~ by any, person wbcrosoever , out of Town, , covise of the aforesaid privibege and / or the use of the aforesaid pen n!M When the Two vacates seed premises , the dee A be left deer of debris resulting from the We operation . All uti&ty elearges W"* elect is , water, lower , telephone, etc., fbr the use of the pp�apipn wM be the tesponbltit}► of the Teaser . Tena»t is to provide LAndbord with a oeiti5cste of'Dwance for the used premises In the evaet of local or steme codes or otdhmrscar cmd4 TMM to be derAd use of said plamim tiaoough no fhalt of Two or Landlord, tete Lease wit be tamim ted . Any Morden prepaid wig bo dm mdnvd due oII s dei► prorated baste. the balance► will be returned to the Teaent, j, X/ Tenant : CMft ifibbert LOW": i ah Realty Tnist Date Date 10/23/2003 13:13 19784994921 CHARLES HIBBERT PAVE 04, 0.1 ol ..... ....... 10/23/2003 13:13 19784994921 CHARLES HIMER1 rAut ns 0 10/23/2003 13:13 19784994921 CHARLES HIBBERT PAGE 02 Fax :1-978-851-4%2 Se 9 2t1R; 14:42 P. Cl Delta & Delta Realty Frust 876 Eaa at". T , Me"Whceeta at87e T fthgns (O7 .J 861-#= 30%embar 14, 2003 Lean sed Hol! Hassles; Agr+oersto For the consideration of the sum of $1200.00 ( one tljousand twa bundrtd dollars ) due sad payable io full November 12, 2003. f,aasse-,s eovenanb hereinsttar sat forth, "'s dtDel s Reafty Tram ( Lmfttd ) herOy pub to CiiAxn Weis r ( Tenant ) Ofd* ptiviis;$e to use oertain designated port ions of the parking area o: 350 Winthrop Avowe. North Andover MA. bbr the purposc of Wing Cbtlst m trees wrouha And Chnftm deM8t;= 2W IgOVW bot 23 2003 to Deoarn W 31, .",W3 . Tenant (s) waives and releases Landlord and / or empio feeg of any and all of rhes: g+om MY and all clei = lbr loss, data%e or qury to pertwr (p or property which the 'raw MAY suntain wising out of. and resulting *olt1 110 Te *MI' axer6w ofthe afore A privilege, and (b) weer to indemnify ad we each of you lunsleas Q ora nape ly bdk,, and or 1055, itwhOin$ attorney's fees incurred in dear ft ape awes li"ty or suit for dam9a by sap► person whomsoever, out of TeMIS ' exercise oftbe Afbresaid privilege.. and / or the use of the aforesaid pnm ices . Wheat the TOMW vacates said pt*mises , the site will be left clear of debds mult4 fmm the SO operation. All utility chagea inchtding electric, Water, sewar , telephone, ate., for the use of the operation Will be the re ponA ity ofthe Pawl. Tenant is to provide landlord with a owt&ate of insmwe for the leased Premises. In the event of local or state codes or ordixu t Teow►t to be denied use of $aid premises tl Mab no" of Taws or Landlord, the Leve will be temitu W . Any naxrtlea prepaid WW be (100 trdrmd We cm a dally prorAied bags. the balance will be rehumd to the Tenant. Tenant : Charles H bbest Date le00 -�••'•-NN-.- Delta dt Ddts Rasky It" Dste 10/23/2003 13:13 19784994921 CHARLES HIBBERT O� 6 PAGE 01 C17/rill �utj: tj5.1b UMRKLt5 P9ibbLKI rAUL uz Luce-�. 97 .m V3/VL/Lt1V4. V.l. 10 14.1 V.l J171 V:1 ufIHICLG.7 nlDDcmI r�Qcc Va UJ/ U1/ ZUU:_ U:J.10 141U53171U0 t MHKLtJ HIbbtKI Fax:1-978-851-4962 Oct 31 2002 11:40 r.ur Delta & Delta Realty Trust 878 Eeat etrTOWWW (wry, allo 0 MumMWOt T6 October 31, 2402 Lease sad Sold Bamboo Agreeraeut For the consideration of the sum of S1200.80,( one thousand two hundred dollar. ) due and payable In lhfl November 11, 2001. Leasse's eovenants herdeaitar set forth, Deka &Delta Realty Trust ( Landlord ) hereby giants to CHARLES MMBERT ( Tenant) of the privilege :o tura certain desipaud portions of the parldog area of ; 050 WhWvop Avome, North Andover MA for the purpose ofseUkg Christmas trees , wreadna and Qtriamas d000:ations iimm November 25, 2042 to December 31, 2002. Tenant (a) waives and releases Landlord and 1 or employees of aq and all of f iese from arty and all chirps for lose, damage, or 4ury to person (s) or property which t me Tmeat may sustain arising out of , and restulft from the Tenants` wavisa of the ab aeaid privilege. and (b) ape u to irrdemcify sad save each of you harmless fi+om any Lability and or loss, imbu tg attorney's fees incurred in deWing aw asserted iiimty or suit foi dames by any person whoxwoever , out of Tenants' exercise of the aforeesid ctrivtlege and / or the use of the &ressid ptemiseg . V4cu the Tenant vacates said premises, the site ws11 be left akar of debris resuttmg Ih-m the sale Operation . Ali utility charges including electric , water , server , tela*ne , etc., for the use: of tht opwation will be the mspot>3ibility of the Team . Team is to provide Landlord with a catiScate of irtst� for to leased pmnises . In the event of local or state codes or ordinaries causing Tenant to be deniod use of saia prentius through no In* of Tempt or 1 andlotd , the Lean wi l be tcmdoated . AW moults p qMW wilt be &stewed due on a daily prrtrated tresis. uu gAlaoea will be returned to the Team. , _ Tennant ; Charles Hibbert rd: Delta & Delta Reeky Trust L1 � a �..,.....� Date DW rkuL V4 U 7(011/GUCJL Cly: lb L�1 U�3171 C15 t�HHKLtS htliStStKI /5'j, ga�� m-� is rHut nl