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Miscellaneous - 350 WINTHROP AVENUE 4/30/2018 (25)
10 L I�rrv'"�f,nHT{{ h• y1 ' u n CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number y/ 3,3 Date 2-20-0,005— THIS CERTIFIES THAT THE BUILDING LOCATED ON 4 ULc-- MAY BE OCCUPIED AS _ 71,v Ati G / d !i' ! < sP S rP1t M,4c (" ,4�1�� edepd l L'�pC/1 Uti /o AD IN ACCORDANCE WITH THE PROS IISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO f YI fO P (WI A C K t/,4//,y Building Inspector E i "i w O O H q •O O O O C •a'o ac L ev cv o ' o m 2f hm ID -2 3 -'_ .. m w. t 0 m �A cw O —: cm mi KA �� m c E 1r c 0:OLD to m = C �.. C O•v,w o CL Cl) �.. CD.00 co oc z <c O m � CM -1 CC20 rcao c � cmc S _ mSo F" o o F- m C* coo m W O ~ CEK is w •� H .� atwc Z L= E C m •v, o COD d 9� M� O oo H z a.=..m W 0 LLI C9 W W 19 W U) „4, d• i 3 I .•. W Q pW, M a Q r4 w. 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O O r= tD 2 0 4 , 1 1- Jan.18. 2013 10:24AM Merrimack Valley FCU Admin 1/16/13 Merrmack Valley Credit Union 2.17S 350 Winthrop Ave. Rte 114, No, Andover Existing 14' X 45 1 No, 0423 P. 2 Supply& Insl all (2) Novr Oiredory POAVAI% $626. supply a Instal) (1) NOW FabriCated Akp IRM Bign S X 15 Jri With Ij2' flalSgd Ag00jetiera 9AD7e. supply a Install A) Naw e X a' Afurnir um Sign Over exisiur9 sign & P*1 poles 3.315. Merrimack '�ailey�x Option 1 Piton Directory ivi�rrimack ; i \/a @Y rafsRi Option 2 Pilon Directory Merrimack .. � Option I Option 2 Sales Tax, Permitting & Permit Are Not Included in Estimates _ E-MAIL: infb@harveysigninc.com 978.794-2071 • FAX 978- 6864841 1 [ GUSTOMEAS, Please Proofread oarelUl,ry Ahd sign only It ell Ea correct. I INTERIOR / CXTERIOR SIGNAGE ! Addillonal charges will be added If any changes or correelions are regyBeled ansr Customer Signe 0, FAUIi(CA'PTON'SBtVECE •fI,STAL(,ATfCaV ;Tots a[ a alpn d e -m Iad or faxad back before start of fob 3003QOODST. M9THUEN,MA01844 1 _ r ( Id ([p 5ignafuralaete i NOTE: LAYI)UTS ARE THE MLU$IVE PROPS TY Oji 'HARVEY SIGNS'. ANY UNAUTNORIZEb USE OR DUPLICATION WILL ktSULT IN A 209 CHARGE PER OCCURRENCE PER THE VALUE" OF THE CoMPLETED PROJECT. fD HARVEY SIGNS 2013 ALL RIGHTS RESERVED. 1/16/13 Merrmack Valley Credit Union 2.FS 350 Winthrop Ave. Rte 114, No. Andover Existing 14'X 4.5' Supply & Install (1) New Fabricated Aluminum Sign 6'X 16 1/2' With 1/2" Raised Acrylic Letters $4978. Supply & Install (2) New Directory Pannels $625. Supply & Install (1) New 2'X 4' Aluminum Sign Over existing sign & paint poles $325. Merrimack \/alley.-.=-. Option 1 Option 1 Pilon Directory rn errimack \/alley.. E ion Option 2 Pilon Directory �iVlerrimack \/alleyF.Eo::: Option 2 Sales Tax, Permitting & Permit Are Not Included In Estimates INTERIOR/ EXTERIOR SIGNAGE FABRICATION • SERVICE • INSTALLATION 30 OSGOOD ST. METHUEN, MA 01844 E-MAIL: info@harveysigninc.com 978.794-2071 • FAX 978.686-1841 CUSTOMERS: Please proofread carefully and sign only if all is correct. Additional charges will be added if any changes or corrections are requested after customer signs off. This must be signed and e-mailed or faxed back before start of job X Signature/Date NOTE: LAYOUTS ARE THE EXCLUSIVE PROPERTY OF 'HARVEY SIGNS'. ANY UNAUTHORIZED USE OR DUPLICATION WILL RESULT IN A 20% CHARGE PER OCCURRENCE PER THE VALUE OF THE COMPLETED PROJECT. © HARVEY SIGNS 2013 ALL RIGHTS RESERVED. W Jan.18, 2013 10:24AM Merrimack Valley FCU Admin HarVey Signs, Inc, Methuen, MA 01644 Phone 978.794.2071 Fax 978.686.1841 www,harveysigns.com Info($harveyslgnlnc.com MERRIMACK VALLEY CREDIT UNION JOHN HOWARD 560 MERRIMACK ST LAWRENCE, MA 01844 DATE No, 0423 P. 1 SIGN PROPOSAL 1/16/13 Pabrit:ate & Install new sign In North Andover (1) new, (arger sign with raised letters similar to existing-------- ----- ________________.______._, -_. $9976,00 (2) new directory panels Face on street directory ------------------------w_____ $625.00 (1) new drive -up way -finding sign Installed on existing posts ---------------- $325,00 Taxes, permits, 17 ( Permit acquisition, lamp maintenance are additional `^ .�� a Terms; 1/2 deposit balance due within 30 days Q-1`-? SKETCH DEPOSIT covers minimal costs involved In developing a concept.. It does not cover the actual purchase of a custom design, which would be flgur0 at an houdy rate, with a quotes minimum price. The sketch remains the property of Harvey Signs, Inc. PRICES as Indicated above are minimum estimates for art or sign work only. PhotOStEts,. typography, photographs, overtime, changes and/or time additions, delays caused by Me cifent, special consultations, and all other work expenses that cannot be estimated accurately In advance will be billed extra unless otherwise agreed. ted the above prices,-gP6df109#0ns, end 7'er✓ris & C04d1V0nS are saifsract01Y d it are, hereby accepted by this c#,Wt. Harvey Slgns, Inc. Is hereby d0 t dzed to proceed with above work. A depo* or509b IsrVjltYed 10 beg/n work • remalning balance due at orris of completion. Thank you /or your business/ SPECIAL Conditions on client's purchase orders in no way negate the above SDeciffcatlons. in ordering the aforementioned Work, the Client accepts all of these conditions whether noted an his purchase order or not. IF UNUSUAL. DIGGING conditions (Le, ledge, water, concrete, etc.) are OnWhtered in ground Installation, thls.contract Is blilding, however, an additfonal cost -based -on -occurrence for labor and materials will be added to the above price. PRICE QUOTATIONS ARE GOOD FOR 30 DAYS, I/ DATE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 `'" www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Harvey S Address: 30 Osgood St City/State/Zip: Methuen, MA 01844 Phone#: 978-794-2071 Are you an employer? Check the appropriate box: 1. Q I am a employer with 4 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.0 Other Signs *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: NGM Insurance Policy # or Self -ins. Lic. #: AIC 17 7 8 6 Q Expiration Date: 9-27-13 Job Site Address:__ S-0 W, �`Nt12_0d of Vz, City/State/Zip: 1-4J, A-AA-Jur__ M, a e,3cz) Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceryfjQinder the pains and penalties of perjury that the information provided above is true and correct. 2 V -? C� �-�_,© Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # 2 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: i « A Date. . WI?114 . TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING JS� (///J /��q%n� yj��7//�J� �/_ •� .ter 1 �. .�•/•': ! I —'x • W�tr �/7 '/;� This certifies that P/? ..../.. ... has permission to perform ..�,�l�'f'!�!..4 ? 1�. � plumbing in the b ildings of ./7'/eC!`'!�?`�� . � . !Z'c/0111 at. ,w� `S et .. ...,.. IN rth A duvet, Mass. �6 Fee.<e? . Lic. No. ..�s�3� . PLUMBIN INSPECTOR Check # %s A PERMIT TO CITY MA DATE 2, PERMIT # JOBSITEADDRESS ; j OWNERS NAME /f7zcci rvac PcI� GL � P OWNER ADDRESS S TEL 5'7f - -6rFAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW. ❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES [I NOE] FIXTURES Z FLOOR- I BSM X 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 1 10 1 11 1 12 1 1-3-7-14 BATHTUB CROSS CONNECTION DEVICE DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I have a current liability irmnce policy or its sbstandal equivalent which meets the mpkemmits of UGL Ch.142. YES ❑ NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNEWS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Allassachusetss General Laws, and that my signature on this permit application mly s this regliuenrenL CHECK ONE 0WY 'VWNER ❑ AGENT ❑ Fr wrary >rrer au or me aMW ana urrorrnanonI nave sutxnatetl or entered7this cetlon are to to the gest of my knqW and that all plurnbing work and InstaUaUons perfom�ed under the permit Issued for0 be� i ian a rUnent a�Massachusetts State Plumbing Cade and Chapter 142 of the General laws.PLUMBER'S NAME Michael Bemascaii LICENSMP❑ JP ® CORPORATIONOERSHIP #© LLC ❑# COMPANY NAME Central Cooing& Healing, Inc. ADDRESS9 Norfh Street CITY Wobum STATE ® ZIP01801 TEL 781-933-8288 FAX 781-932-9017 CELL 1781-844-3424 EMAIL I mbemasconiMoentrnicooling.com u W r by x x N n ►CI Z ca 0 1 � a m (� +Ile � CEJ m a ❑o z The Commonwealth of Massachusetts ti Department of Industrial Accidents Office of Investigations Map # Lot # 600 Washington Street Address: Boston, MA 02111 Permit # www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information l Please Print Legibly Name (Business/Organization%individual): C2i1-kn. I `(� I i Aa + W ea+ i n j A xn C Address: T City/State/Zip. W Abu fn , Yn A d i ro Phone #: r7 R 1- 433 - T -IF 8 Are you an employer? Check the appropriate box. L ® I am a employer with '70 4. am a general contractor and I ❑ I Type of project (required): employees (&U and/or part-time). * have hired the sub-contrectors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling ship and have no employees These sub -contractors Have 8. ❑ Demolition working for me in "any capacity. [No workers' comp. insurance employees and Have workers' comp. insurance.# 9. ❑ Building addition required.} 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work office have exercised their 11.0 Plumbing repairs or additions. myself.. [No workers' comp, right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' ME] OtherEg Loy -z Comp, mSUTA11Ce Tegnlled.]Q � 0 r. 4 f� 1 -Any appncOnt.MU eheclm box #1 must also fill out the section below showing their worloas' compensation policy infommtion. t Homoownem who submit this affl&vit indicating they are doing all work and then hire outside conhw1ors trust submit a new affidavit indicating sulk: =Contractors that check this box must attached an additional sheet showing the name of the sub-conhactors end state whether of not those entities have employees. rthe sub-c6numbots have employees, they mot provide their wotloers' comp. policy umnber. law an employer that is providing workers' compensadon Insurance for my employees Below is thepolleyand job site information. Insurance Company Name: GLOBAL TN s 1. Q ting K j-ic-Tkllj gK -W /' Policy # or Self -ins. Lic. #: Expiration Date: 11 361 a 6 / 2 Job Site Address: 1 (- VV i h±L (-be may/ p:�, An A dINS, � Attach a copy of the workers' compensation policy declaration page (showing the policy namber 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 WORD ORDER and a fine Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to tate Office of Im►estit=ations of tate DIA for insurance coverage verification: Ido hen h' dee-the-,pains and penalty of edUFY tW 010 Ixformaden provided above is true and conva one W. -I N al use only. Do no City or Town: area, or town offkW Permit/License # leaning Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone #• Information and Instructions Massachusetts General Laws chapter 152 es all to to vide workers' compensation for their employees. hap requires �P Y� Pm 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 wott on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any. applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Deparlment*of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town) " A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each Year. where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would hke to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of IMassachusdu DVaMent of Industrial Accidents -owe of Investigations 600 Wuhington Sttvet Boston, ASIA 02111 Tel. # 617-727-4900 dict 406 or 1-877 MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mameomMa y °c./...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................ has permission to perform ............... wiring in the building of ............................. ......................... at,. 3.n..... .............. North Andover, Mass. '---,,Fee ... .. .....Lic. K ........... . t.-' ............................ ELECTRICAL INSPECTOR Check # 55L6 Commonwealth of Massachusc Department of Fire Services BOARD OF FIRE PREVENTION REG 7 ,fS Official Use Only Permit No. & D (, ::(_ TIONS Occupancy and Fee Checked [Rev. 11/991. (leave blank APPLICATION FOR PERMITPERFORM ELECTRICAL WORK All work to be, performed in accordance a Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFO ith TION) Date: 12/28/04 City or Town of: North Andover By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 350 Winthrop Avenue Owner or Tenant -Merrimack Valley.Federal Credit Union Telephone No. 800-356-0067 Owner's Address 1475 Osgood St. North Andover, MA. 01845 Is this permit in conjunction with a building permit? Yes X No (Check Appropriate Box) Purpose of Building Bank Utility Authorization No. 221586 Existing Service 200 Amps 120/ 208 volt Volts Overhead ❑ Undgrd X No. of Meters 1 New Service 200 Amps 120/208 Volts Overhead ❑ Undgrd X No. of Meters _ Number of Feeders and Ampacity 1 set of 3/0 copper Location and Nature of Proposed Electrical Work: Relocate electrical service from existing electrical room into new Electrical room. Re -use all existing panels as necessary Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures 102 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 51 Above ❑ In- Swimming Pool 1:1o. o Emergency Lighting 10 rnd. rnd. Battery Units No. of Receptacle Outlets 91 No. of Oil Burners FIRE ALARMS No. of Zones 5 No. of Switches 20 No. of Gas Burners No. of Detection and 10 Initiating Devices No. of Ranges I No. of Air Cond. 3 Total 15 Tons No. of Alerting Devices 4 No. of Waste Disposers Heat Pump I.Number Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local Y Municipal ❑ Other Connection No. of Dryers Heating Appliances Kir Security Systems: No. of Devices or Equivalent No. of Water 1 KW 3 No. of 1 No. of Data Wiring: 52 Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors 1 Total HP 1/2 Telecommunications Wiring: 48 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 ® BOND ❑ OTHER ❑ (Specify:) 1/23/2005 (Expiration Date) Estimated Value of Electrical Work: $40,000.00 (When required by municipal policy.) Work to Start: 12/28/04 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: New Horizons Technologies inc. I _ I , n LIC. NO.: 17126A Licensee: Kenneth J Babineau Signature,C. NO.: 31704E (If applicable, enter "exempt " in the license number line.) Bus. Tel. No.: 508.595.0592 Address: 240 Barber Ave. Worcester, Ma 01545 Alt. Tel. No.: 508.735.4377 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. 508 595-0592 1 PERMIT FEE: $ Commonwealth of Massachusc Department of Fire Services BOARD OF FIRE PREVENTION REGU W7Official Use Only / Permit No.Vim` j Q(4 TIONS Occupancy and Fee Checked_ [Rev. 11/99]. (leave hlank) APPLICATION FOR PERMI r T . PERFORM ELECTRICAL WORK All work to be performed in accordance th a Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASEPRINTININKORTYPEALLINFO TION) Date: 12/28/04 City or Town of. North Andover By this application the undersigned gives nonce of his or her intention to perform the electrical work described below. Location (Street & Number) 350 Winthrop Avenue Owner or Tenant Merrimack Valley Federal Credit Union +e Telephone No. 800-356-0067 Owner's Address 1475 Osgood St. North Andover, MA. 01845 Is this permit in conjunction with a building permit? Purpose of Building Bank Existing Service 200 Amps 120/ 208 volt Volts New Service 200 Amps 120/208 Volts Number of Feeders and Ampacity 1 set of 3/0 copper Location and Nature of Proposed Electrical Work: Relocate electrical service from existing electrical room into new Electrical room. Re -use all existing panels as necessary Yes X No (Check Appropriate Box) Utility Authorization No. 221586 Overhead ❑ Undgrd X No. of Meters 1 Overhead ❑ Undgrd X No. of Meters 1 7<<ucu uuunronar aeran y aesrrea, 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 ® BOND ❑ OTHER ❑ (Specify:) 1/23/2005 Estimated Value of Electrical Work: 540,000.00 (When required by municipal policy.) (Expiration Date) Work to Start: 12/23/04 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: New Horizons Technologies inc. LIC. NO.: 17126A Licensee: Kenneth J Babineau Signature C. NO.: 31704E (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 508.595.0592 ddress: 240 Barber Ave. Worcester, Ma 01545 Alt. Tel. No.: 508.735.4377 WNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by aw. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. 508 595-0592 PERIIIIT FEE: $ C614� -*V7 G«4I- o kc Oiar- WAGL S PAS- _ RG*R 4-a4 6 �%v4f4. C) a s-- --- As m -40 3 _ 24 — a'-- ON 3 - z?- -d5s- RTM Em Location ``7 0 W Iti i2' O UP A L— No. r MO�TM f 1�,b+ins •�'`,� Ss4CMUSEt Date !t–or-o Y TOWN OF NORTH ANDOVER Certificate of Occupancy Check $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee i)„pw V TOTAL ( PrQ P $ D $ q0— Check # / &.2 11 17794 Building Inspector TOWN OF NORTH ANDOVER " BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: �� d �G C SIGNATURE: Building Commissioner/InSpector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 3S6 Cu «eft vo n r1X W 7 Map Number Parcel Number 1.3 Zoning Information: 1.4 Propeaty Dimensions: _3 Zoning District Proposed Use Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided C1 2-Q9 1.7 Water SupplyM.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT riistoric District: Yes ", 2.1 Owner of Record -, cj" \ `tel —Name (Print) Address for Service Signature Telephone ©a ®Q 2.2 Owner of Record: Name Print Address for Service: Signatur& Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licefised Construction Supervisor: Not Applicable ❑ 6zz. Licensed Construction Supervisor: License Number PO T 'ZOAA r A ess (�l �Zf" 7e - — % 67 Expiration Date i Telephone t 3.2 Registered Home Improvement Contractor Not Applicable ❑ i Company Name Registration Number Address Expiration Date Signature Telephone 0 0 M 0z M 90 0 ic ors M G SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 S 25c(61 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 buildingpermit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work (check applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: ff 4 l tF c. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b permit applicant pC, USE {};y. 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbingBuilding Permit fee (8) X (b) �D �-- 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGEN'Tf OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1> C� "� DAA 0P� Lam. ��,^ 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 Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIVINEY IS BUILDING ON SOLID OR FILLED LAND ,=H,n"P IS BUILDING CONNECTED TO NATURAL GAS LINE ✓iie �ammaoou�rea� o��✓�aaaccci,�cavl�a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS'-. 016896 Birthdate: 11/12/1942 Expires: 11/12/2005 Tr. no: 7981.0 Restricted: 00 ORESTE J MAGLIOZZI 70 MAPLE ST MIDDLETON, MA 01949 is 4 i Administrator 1 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 150 A. The debris will be disposed of in: r7 (Locatiof Facility) r '.i2_- (- A w-1 (Lw 1 re of Permit Applicant i,a 4 - Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: Civ Phone # 0 I am a homeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity F7 I am an employer providing workers' compensation for my employees working on this job. Com an nam : (fI yam, t, y Address Cu. I)u Phone t T7 e., 7 LT, Policy # S IL O 5 Z 5,4 2 5- 3 9 Comaarw name: Address C Phone # insurance Co. _ Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to;1,500.00 and/or one years'imprisonment_as.vredl_as.chdi.intbei=-Gfa.STOP.W-ORKORDER.acrd..a.fineuf.(;1110.00)aliay.against.me. I understand that a statement may be--- ed to the Office of investigations of the DIA for coverage verification. I do herebyr under the pins pen�trets&jjury thay�nk n !tldn provided above is true and correct. Print name i r; h -zi Phone # 7 - Z14- 5-`7 �7 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Ucensinq ❑ Building Dept []Check if immediate response is required ❑ . Licensing Board Contact person: Phone #. C] Selectman's Office Health Department ❑ Other FORM U - LOT 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 or requirements. ******APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT (nr,Ga e.7n,(, C T7. PHONE Z Fy 934-6-767 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET ]� �U Cul .- 4. 42 4._* '�o ST. NUMBER 3SO ***************************OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENI'tto F&t� CT/ 11 d C -rcJ7_60,91"119N c?CEIVED BY BUILDING INSPECTOR TG;e1T ✓c�J (a z i/ '1 Se ✓Vr cC ��I ✓b, Gi DATE Revised 9197 jm �j.' # ' !" ���GYY,�%Y,��7i�Z✓P O�i/IGLUJ6�bCI4P.GC4 ,p : .t BOARD OF BUILDING REGULATIONS 'License CONSTRUCTION SUPERVISOR Number CSS. 016896 Birthdate.11112/1942 Expires: 11/12/2005 Tr. no: 7.981.0 Restricted:.00 z ORESTE J MAGLIOZZI - 70`•MAPLE,ST,.� l 3 l MIDDLETON, MA 01949 Administrator I -3 H Cb ►� CD po cD C r � CD bj tij I� QD 1D, Ct Cp CD 0 �� y o CD 0 90 Ct O G j Ea V CD CD November 16, 2004 CD a o o OD pp .�, 'd Michael McGuire, Building Inspectorrn CD Building Department ' 91 Town of North Andover °'CO 400 Osgood Street 01 - North Andover, MA 01845 RE: Merrimack Valley, Federal Credit Union North Andover Mall, 350 Winthrop Avenue Dear Mr. McGuire: ` Merrimack Valley Federal Credit Union (MVFCU) has leased the former Sovereign Bank premises at North Andover Mall. The Tenant wishes to begin interior demolition of the space. Valley Properties, Inc., the Landlord, authorizes MVFCU to obtain the necessary " l demolition and building permits for their renovations and build -out. Please call/me if you require further information at 978-618-6685. Thank you for your consideration. i Ve truly yours, John P. Matthews Real Estate Representative Valley Properties, Inc. cc: W. Betton, MVFCU RECEIVED NOV 1 2004 BUILOING DEPT. I i " , Retail Development Services • . Architecture • Construction Management �' y m m m m y F, y d C � ■ � d 10 O CD St Z ca CD 0 CL C• C =rO C= y a� .0o o p CD a� O cr W* �d CD CD o CD C tD y■ ■ CD CL0 y �C CDD 0 0 m n O z 0 z C m-*� p � -4 s � go _ FE a s y C") CL m � y20 Z?.== N 20 ftrD CO) T �d■■rd o O m y O H > > O y : O tC +p O . Cl) OO H l7: W ■� O • �ya cc c Ero R c m�H; .S m R y y�:o• O L m c=* y O ?:� C °° kw m VJ y v NQ O � 1 m x c lb CD r^^ CD VJ =F . z. CL :a O c o� o� f rf z oz �r 4J c IF rrf TL c 'Ed C"' TL 'C �j w 0• C/) y CL ~\ 0 c Location ,?SO w l",Pap e— ' No. '7' Date/�- r &ORTN TOWN OF NORTH ANDOVER O: t.ao ,•'�.y0 • OL A Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # / G 6's 17,34 ✓ Building Inspector f 1j'74/P('/h/,1 e.% 1/,0+//1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING .F t This Section for Official Use Onl � -' BUILDING PERMIT NUMBER: ` DATE ISSUED:b7 3 a,` SIGNATURE: s-- Buildin Commissione or of Buildings Date - 1.1 Property Address: 1.2 Assessors Map and Parcel Numbs: 350 W i "Tla Tza a j b J ` Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts It 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide ReVired Provided Provided f -ReqWmd 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record P,I ►� e ; i. s�r ; ' , i �w res alp �'r1 �/I A Name (Print) Address for Service : D/,�- 74 45'62.. Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ D(Z1<5TE J, MwC Ltb-.2.1 C5 ©lLp$q� Address License Number Vz `71 'ti vo-T 11;r-1. 9-C), 130x ((-44) - sor: 0233 (, / i r 12 ' V $ Expiration Date ::nr*i,��r- ? 4-5707 Z ature Telephone 3.2 Registered Oom Impr6y6ment Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone v n M 'Wl '. ��4a' s�3'x'fg�r�T �,arRv:�vR.+x-'�rR � ' .�Hrc �. n�;�ix+• -rte rz�af,.� a*eau .�.wf':a�en;G;e�;-�iws.�.. �.Ss�un».mzu, a�:<uu• �'.se 4 ..r�,w� �` s?: L as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent Date Item Estimated Cost (Dollars) to be Completed b t applicant P Y Pyr PP 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b)� j 7 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number �x.a' 3 F 1F':5 a5 1i. x,�,f ;. f t} WP3;Y3: ,x ";g�. /L •Y<(stl1t f�F �, „f '7 i tQ�¢t t ' u41.r» •:.t 3} L: ,+,- r Y (k r, .., t yu4 �•'',. .g,,..�y. ,.;. �,"'y, t n`A-V:.J } J''K''. ;, I ..'� ::., i � .. 1�( , ,.. L"4 � ��' x�`. ` ,�,n ,a�.�..... h. )�yyF •, n„+;” s.:s"lY'. :;�g1w'S r... js".ex.. �r *,f }}''n: <c�lay «.••.- ,e�.:s. `4:.: 7 .4�s37�s, r„ �, yJ -`v F: �.-. 5'�:�:, ��$y�} 5� d. r`t°Y xt �'c....r *Uz.,4.; �k: (J. 4-..fl>4. ,aYb: ��h'r• ,1���'k� �� � Cy ^ ,t.. .ryS. �. 1�tiY l,�1Yy' �t,,}i55��,,,,' viyr . 2+A.lt r,.. 6a1 �,aV/Y �YtuE=. � ii+�(�y�.. �j 3-� �' �1J+'S' �4C.�'.�r' K 1 ': /u,, b �'1iN�'. Y. 4.• h�.. 1r� .y {!5 4 �:a, �"� `'fts..< S r{i'7��.� Fjr`t.1i �� > �7�w 1 d� •�z3 xrltt 7,�tr4 >i •r � ... re�rt�,.i'z � Y;`\��e w�. �'t 4: ti)�'�' $n, 'Fi ^,.,..r€ . r"` -f . i„4�'"'Sk'�.'>. :<eta. t�..3.35 .�r hu :: .. ,.�Z. NO. OF STORIES SIZE BASEMENT OR SLAB l b SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CBJMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS ,rLINE w'^Si �`"�+°�'1.'.%��6 ' '. •ay.' . -05 n rj m Yrt' @z y�. S$G"1�IE?N 4 41r3�tStA�Qri 1t Workers Compensation Insurance affidavit must be completed and submitted with this application. issuance of the building permit. Failure to provide this affidavit will result in the denial of the Signed affidavit Attached Yea .......❑ No ....... ❑ IM[T CONSI`F4TAtiSCP,� anuSECfS(l 19MI, IR 5.1 Registered Architect: Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name t Address.`_ Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone S Company :^dame: Not Applicable ❑ Responsible in Charge of Construction New Construction ❑ I Existing Building K I Repair(s) ❑ 1 Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: �a►. OV 41tmt OF �x�STi►,�- �e+.� IL Te�.►Q. �Oac. l �"'TYLtl� Mnl,l.. Independent Structural Engineenng Structural Peer Review Rapred Yes ❑ No Y' SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Hereby authorize My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ IA 113 ❑ ❑ B Business N,, 2A 2B 2C ❑ ❑ ❑ C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility [IT--F—Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: Independent Structural Engineenng Structural Peer Review Rapred Yes ❑ No Y' SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Hereby authorize My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on !, DEC -17-2004 FRI 09:55 AM WILLEY BROS, FAX N0, 6033351765 P. 01/03 WI(LLEY BROTHERS and I,OASTAL CONSTRUCTION LETTER OF INTENT TO PURCHASE /AGtREEMEN C December 17, 2004 This Agreement, dated December 17, 2004, betw hen Willey Brothers, of Roc.I .ester, N14 imd Coastal Construction of Duxbury, MA, hereinafter known is "Coastal" in conjunction v, ith the sip,, Letter of Agreement between Willey Brothers and "Merrim; ick Valley Federal Credit Un. on" agrees to purchase construction servicts from "Coastal" for the pror osed 4,000 sq. ft. in-line bu lding at 35 ) Winthrop Ave./ Route 114, North Andover Niall, North Andc ver, MA. Merrimack Valley Federal Credit Union construction project is estimated at ')344,957 (; er attached Exhibit). This cost is a baseline, which indicate; the services, resources andl equipment required to perform the project goals and will be reined during the value en;;ineering, biddin , and buyou. phases. Moreover, the parties agree to enter into a firm contractual agreement usial AIA Document A105 (covered under separate contract), after the drawings are completed, the permitt, ng process: s underway and Willey Brothers has a signed AIA Agreement, vith Merrimack Valley Feder., l Credit Un: on. Both parties understand that this Letter of Int{:nt will permit the formati,: n of the Construction Management Team and obtain a completion date of 2/18/05 O)er attached schc Tule). As a member of the Construction Management Team, "Coastal" shall contribute the following swport thr.)ughout the permitting and buyout phase. _ c Complete interior demolition C Provide construction schedules c Collaborate on. material selccticas arid. v ediz e-aginoeririg File appropriate requirement for building p ;mit ® Identify and order long lead items • Gain a clear understanding of the design in vent • Provide subcontractor bid administration "Coastal" will negotiate all purchases to reflect the best avtailable Prices in he favor oi' Merrimack Valley Federal Credit Union and Willey Brothers'. "Coastal" intends, through(- at the value engineering development, to seek out the most cost effective means of program implemen ation while maintaining the integrity of the design concept while maintain ig the project construction scl .edule. Progress invoices should be presented monthly pe percent of completion by ph .se until an AIA Al 05 is negotiated and the terms of the AIA will supersede - this Letter of Intent. Any deviation(s) from the design documentation and construction phase will 1! � requested from Willey Brothers in the form of a formal Change Ordcr which must be signed by an authorh-.ed agent or employee of Willey Brothers prior to any action's) taken by an authorized "f, oastal" employee or his agent. We, the Parties indicated, here' agrt-v 4et for:h �our signatures; ;7 % Willey Brothers / r� Date Coastal Construction _ Pete Dobyw Date 1: IDeptl)atalBP&DIP,•ojeci iWe.lrrimack Ya11e.p FCMarth A»dover M4. 1lt:ontrnetsiLO/ ."oasdet!•04�217.duc DEC -17-2004 FRI 09:55 AM WILLEY BROS, FAX NO. 6033351765 P. 02/03 Merrimack Valley Federal Credit Union PRELIMINARY 5C TrDULB OF VALU rs PROJECT: NorthAndovef MA Dat_Preparec 121FJ04 SCOPE: Interior Build Out 5 uare feet: 4.000 CATEGORY ITEM A ice 1. GENERAL CONSTRUCTION 1. Gener. I conditions 36,441 2. Dcmol:lon 15,444 3. Floor h veling/ tch 4,536 4. Meson y 2,160 5, Carper try 40,392 6. Metals 1,620 7• Therm it 6 moistufa protection 4,320 8. Doors k vAndows 41,580 0. Drywa: 52,208 10. Acous :c calling 10,800 11. Floorir g 21.870 12• Paint i wallcovering 16,200 19, Specis Ities 3.186 14. Muchs tical 35,100 15• Eledri :al 48,600 Sub -Total U41967 Exhibit 92 Willey Rrurharz Design Build 4.h d k gVatuerxk North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector h:.. •ire:.: .J.: °;;i,"°Rji •.'!7,f� �22 of �Fvn 1nStIIrB�ICC must,be � • 111114 Si Old at�dsuit din it � mittcd with tMr. application. FaiInR4 to Attached p Vida thiy fl�davit will rF,vult in the d," of K J� �.! �giStaed Arcktttec.% � • .� ,, ,:, ,, •��; Name., e--q FA Telephone • Nom: �rrrrrr Nrr ofR�ppa.�ibililY �c�ess: �istratign Nttu� . Sigttatura Total Irxpitatio DDate Nom' Not applicable .asidr�� �igttaiu� ' itIephone J _ 1 Eitlauativa ::a�..—..' i Name Ades Atas of Ttespo„sibility Registratiaa Number Signahua Tekpbot� ExpiratY� �,� Name ,u , ... Area of lte�sponaibili�j, . . iEisfionNtmtber Signatl2re Te1oplmn,e . Expi!'atian � �Y Name; �sRobsible is Cage nFCotta�� Not Appiioable ❑ ZO 39dd NOIionNISN0O-ViSVOO 9sespEGIeLt EE:SZ b00Z/0Z/ZZ The Commonwealth of Massachusetts Department of Industrial Accidents Off%e of Invesiigadons Boston, Mass. 02111 Workers' Compensation Insurance Affldavit Name Please Print Name: Location: city I am a homeowner performing all work myself. Phone # I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Comoanv name: Co n S i & !_ �'o �`T �¢ u c Tie ► t �'.o ►2 �, Address 2'Z Dle .'"aa T `ST (P-0, 6 o x l (0 44) city: —DL, X b Lr -y I �A A • oz,6: I Phone # 7 g I -- q34> `18 `T Address City Phone # Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the Imposition d criminal penalties d,a fine up to $1,5oo.00 andlor one years' Imprisonment_as.reell_ae_chdl4makiesin thefoon:deSTOP ORK.ORDER.end_a.fine 4.($10100)-aago-me. I understated that a copy of this statement may bs forty led to the Office of Investigations of the DIA for coverage verification. I db hereby Print Official use only J i ti 9 informe6on provided above Is true and correct do not write in this area to be completed by city or town official' , 1`7, e)¢ . # 28l -- � �4.5'78.7 City or Town Per Min ❑ [:]Check Dept if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM U - LOT 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 or requirements. ******APPLICANT FILLS OUT THIS SECTION'*"******************** APPLICANT � �� f ' kC tCOASTL C , )OPHONE�I�34-Si LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET ST. NUMBER OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS 1 UYYN I'LANNtil COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED ,Cr I IC: INsrtUTUR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT i,, RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm Qfi / ( "'t , ,,, + c /,�- 0 to IN BORD OF BUILD114G REGULATIONS eA.icen CONSTRUCTION SUPERVISOR Number. CS' 016896 Birthdate: 1411211942 Expires: 1111212005 Tr. no: 7981.0 Restricted: 00 ORESTE J MAGLIOZZI 70 MAPLE ST— Administrator MIDDLETON, MA 01949 ....,,..,.,� ....... ..... ..... ..d,. rte... ,,,.,,.,....,.,... •�,_... Fax:1-9�8-851-4962 Nov 16 2004 111107 P.02 V A It November 16, 20Q4 • O Michael mcC�ir+e, Building lwpeotior , .' . r - • ' ' T6im of North vier ' � � ►- • . 400 OsVW stmt Noah Andover, MA 01845 , RE: Mmimaok Valley. Federal etdit Union North Andaver M4 350 Wiin"p Avenue . Dw Mr. Motiu lm: r Muck Valley FWOW Credit Union (bmcu) hu Iowa the farmer sovadp Baolcpra dm at North Ae&verMslL She Tenantvviihes•to begin intiMordemotltion of the space, -' Valley' Properties. Jbc.. the LuMoa admim MVFCU m obtain the neao my demolition and building petmib for their mwvWom wd build -out. Please crall'ma if you mgWro &ttber infarmstion at 978619.6685. Thank ypu foi your correi&ndoa- �' V Y Yes, loon P. Matthews Rwl2stste yeuey pmpedes.•Inc. cc: W, seam mwcu L L Re%2 Development 8Wvioee • Ardita tuse • Gwstm tloa mmagement �► W W IV, q O !) OR Q c� o� • c h O C Vq 9 c a`v �v m c ;z o y 2� E 49 m� CF Q. 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