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HomeMy WebLinkAboutMiscellaneous - 39 WEYLAND CIRCLE 4/30/2018It Date .... .-.../D�./�...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �}/j 6—Z 771 �. �..'......�................................................................. ... has permission to perform ........ ......4�........................ ......A....... wiring in the building of.............`................................................. at ......3.....l..................��.2............�,.........., North Andover, Mass. � Fee.S--�"...... Lic. No. �..[..�.......... 2 .............. ELCA ECTRIL INSPECTOR G�heck # % �� v X1573 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with the provisions of M.G.L. c. 143, § 3L, the ; 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. , ❑ The Permit Extension Act was created by Section 173 of Chanter 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 Permit Extension 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. [Pule 8 — Permit/Date Closed: / ** Note: Reapply for new perm EI'Permit Extension Act — Permit/Date Closed: Commonwealth of Massachusetts ' - a Department of Fire Services a BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 113 Occupancy and Fee Checked tev.1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 5 7 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: /d ),5 City or Town of: NORTH ANDOVER To the Ins ecto of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 3�j („/, )A,o Ci,Z�/� Owner or Tenant , ,�,� L-) N % FFCN Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes -O-"*No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service ;J90 Amps /ZD / ZVO Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Natgre of Proposed Electrical Work: Overhead ❑ UndgrdJ� No. of Meters I Overhead ❑ Undgrd ❑ No. of Meters IC Completion offl'ie following table may be waived by the Inspector of Wires. No. of Recessed Luminaires `_ Co (Paddle) Fans v No. of Ceil: Susp. ( Total Trsformers KVA Trans T No. of Luminaire OutletsNo. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lig ting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection andInitiating No. of Switches No. of Gas Burners Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices Heat Pump Number. KW No. of Self -Contained No. of Waste Disposers P Totals: I .Tons I Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ElMunicipal ❑ Other Connection No. of Dryers Y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: _. Attach additional detail if desired, or as regutred by the Inspector of Wires. Estimated Value of Flectrical Work: 3� �(When required by municipal policy.) S / Work to Start: Ia 3 inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C&V + RAGE: 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:) X certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: bL Sjvnvu>,er Signature LIC. NO.: /// (If applicable, enter "exempt" in the license number line. Bus. Tel. No.- Address: i;!;- Qt-!iV)2w E;03o76 Alt. Tel. No.: *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 PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the 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 by the 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. ❑ 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 Permit Extension 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. ERule ermit/Date Closed: ***Note: Reapply for new permit ❑ tension Act — Permit/Date Closed: Trench Ins ection Pass]' Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ :B WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com A I - 1 =Inspectors Date: PARTIAL ROUGH INSPECTION: Pass [N Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors C ments: Inspectors Signature: Date: 11NNAL INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ nspectors Comments: Inspectors Signature: Date: :B WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com A I - 1 The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Invesfigations 600 Washington Street Boston, MA 02111 U1 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Address: (,J -si uttL-) '� I LCn4c( City/State/Zip: 91- 1 Vk- C)q (0q Phone Are you an employer? Check the appropriate box: 1. El am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. I am a sole proprietor or partner- ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] r employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 1._[]B1ectrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 Policy # or Self -ins. Lic. #: Expiration Date: ,Job Site Address: 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 requiredunder 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. X do hereby cert fy under,1lae llryins a4rlV" sof perjury that the information provided ab9ve is rue and correct. sr//d/r3 Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. 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 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 Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusotts Department of Industrial Accidents Office of Investigations 604 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877�,MASSAFB Revised 5-26-05 Fax ## 617-727-7749 vvww.mass.govfdia I COMMONWEALTH OF MASSACHUSEt ~ �� '' ' lutcirtcLem, P, ELECTRICIANS REGISTERED MASTER ELECTRICI N ISSUES THE ABOVE LICENSE TO: 1 MARK'RASIMOWICZ 5 WESTVIEW TERR -m fn PELHAM ' '� NH 03076-3550 1119MR 07/31/13' 70980 1 1 r i .y Date ..... ��1.!...j..��->....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that AA�.I j ...... ... !,;oL � 51 ................................................................ has permission for gas installation ... t in the buildings of .............:............................................ at .�.9......P.�... ...�! e.e,c---:...M......, North Andover, Mass. Fee�0. °0..... Lic. No..72.9 .......... '..../.................................................. GASINSPECTOR Check 11-3-1 0,?5 A .a I G TYPE OR PRINT CLEARLY 6.0::� &*t — MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I NORTH ANDOVER I MA DATE NOV.13 2013J PERMIT # %M15 JOBSITE ADDRESS 39 WEYLAND CIRCLE OWNER'S NAME I JAMES WHIFFEN OWNER ADDRESS JAMES WHIFFEN TE 617-909-7000 FAX OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL[j NEW: El RENOVATION: ® REPLACEMENT: APPLIANCES -1 FLOORS BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER I INSTALL AN UNDERG PLANSSUBMITTED: YES® NO® S. `y- INSURANCE COVERAGE have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES E] NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW I LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITYE] 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 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true nd accura he best of my knowledge /? and that all plumbing work and installations performed under the permit issued for this application will be in com ian with Pei ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I JOHN LIPINSKI LICENSE 07-19 IGNATURE MP ® MGF ® JP ® JGF ® LPGI CORPORATION ®# PARTNERSHIP ®# LLC ®# fi COMPANY NAME: EASTERN PROPANE GAS ADDRESS 1131 WATER ST. CITY I DANVERS STATE MA ZIP 01923 TEL 1-800-322-6628 FAX CELL EMAIL s 1 I A The Commonwealth of Massachusetts Pnnt � Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information- — -- - -- - -- - Please Print Legibly Name (Business/Organization/Individual): EASTERN PROPANE & OIL Address: 131 WATER STREET City/State/Zip: DANVERS, MA 01923 Phone #: 978-750-6500. Are.you an employer? Check the appropriate box: 1.✓❑ I am a employer with . 45 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 These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance " comp. insurance.T required.] 5: ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. 0 New construction 7. ❑ Remodeling . . 8.. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11,❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.W1 Other GAS FITTING *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: ENERGI Policy # or Self -ins. Lic. #: EWGCD000080613 Expiration Date: 03/15/2014 Job Site Address: 39 c,_ny (An ok C : f k e- City/State/Zip: yk A,,LJ,0,eTA�.01$K5r 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 certi under the pains and penalties ofp that the information provided above is true and correct. 978-750-6500 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contac -t P-er-sen, Phone 4. ° AC4RL7® L - NH477156 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/14/2)13 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 ...... _. ____ - _..— ". . ..... .. .:... Commercial Lines — (800) 990-7465 NAME: onna eS arnals - PHONE 603-559-1361 FAX 855-529-7684 PHONE., AIc No E-MAIL donna.desharnais wellsfar o.com ADDRESS: @ g Wells Fargo Special Risks, Inc. INSURER(S)AFFORDING COVERAGE :' NAIC # 230.Commerce Way, Suite,230 INSuf2ER A:,, HDI-Geding America Insurance Company 41343 Portsmouth, NH 03801 INSURED - INSURER B : _ INSURER C Eastern Propane Gas, Inc. INSURER D: 28 Industrial Way INSURER E: MED EXP (Any one person) $ Excluded INSURER F Rochester, NH 03867 COVERAGES r^CDTICl/'ATC A1111111DCD•" h-/ ihi'S11"�1. REVISION NUMBER: See below O.THE.INSURE4.NAMED ABOVE FOR THE:ROLICY.PEF2IOD THIS.:IS.T.O CERTIFY THAT.THE POLICIES OE INSURANCE LISTED BELOW HAVE BEEN ISSUED T 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 7.0 ALL THE TERMS, .:. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWNWAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR - '. .. TYPE OF. INSURANCE: ADDL SUBR '::FOLIGY NUMBER POLICY EFF MMIDWYYYY POLICY EXP MM/DD/YYYY - -LIMITS - : - A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY EGGCD0000806.13: 03/15/2013 .03/15/2014 EACH OCCURRENCE $ -1,000,000 DAMAGE TO RENTED 250,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ Excluded CLAIMS -MADE � OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ riPOLICY PRO- JECT LOC A AUTOMOBILE LIABILITY EAGCD000080613 03/15/2.013 03/15/2014 COMBINED SINGLE LIMIT 100,000 Ea accident $ BODILY INJURY (Per person) $ x ANY AUTO - BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident $ UMBRELLA IAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N / A EWGCD000080613 03/15/2013 - 03/1512014 X WC STATU-.. 0TH= 1,000,000 E.L. EACH ACCIDENT $ E.L. DISEASE - Fes, EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Excess Auto EXAGD000080713 3/15/2013 3/15/2014 1,900,000 excess of $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) , Evidence of coverage rcorl cin wTc urs, ncn !`AAIr`CI 1 ATlr1LU Any city/town in Massachusetts 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 The ACORD name and logo are registered marks of AGORD Uc 1 bIdd-ZU1 U AI:UKU UUKVUKA I IUDL Au rlgnis reserveu. ACORD 25 (2010105) (This.cetlificeta rePlaces.ceNfiwteN57,3fiZ89JsweEffi3n ---- - v | \ E e e= 2 « me = 2 > � & c \. .-y \r \ - ` / gTn 2`� �� . O - - ® « :\? ^ C: COY & % >q _ 2«e D z r = 0 , / \ �Z m = \ q / 2 ( » \..m O2 % % z D $» ^ $ ,D b §} _@ , \ Q .n n>zm =pq= (E»= OFF ¢ m»¥m 0 �\\\ > --I 'OC � M -n § =§>3.3 0me° >=m> /�°E. 2\\ mc= o -n {§ \;a 2Fi_ 1. � I . 1/ 1 �'n � �� North Andover MIMAP November 1, 2013 065.0-0054 #35. ROAD 065:0-0.164 065.0-0067 -= I; • =" ="� ' .:.,#921,• 065.0-0021 065.0-0226 106:0-0015' � 0,65.0-0020 #19 #40 065.0-0302 065.0-0227 065.0-0231 0,65.0-0301 #87 065.0-0230 065.0-0229 065.0-0232 #71 #95 Foga #63 065.0-0242 00CJ'b #77 065.0-0228 #55 #85 065.0-0243 #104 a #65 065.0-0241 065.0-0271 065.0-0264 #88 065.0-0240 R2 \ #53 #66 065.0-0239 #45 #106 065.0-0265 #54 065.0-0238 065.0-0263 #39 065.0-0266 #46 065.0-0236 065.0-0237 #33 065.0-0262 065.0-0267 - -- ' #120 '? 106 ..... ' #27 065.0-0.261 065.0-0268... " 065.0-0235 #130 #28' #21 ==:•:?� 065.0-0260 4_ ? 065.0,0224. 065.0-0269 -• .•, 065:0= 234 - #129 #•140 #15 AI, 065. -024 065.0-0259 #148 065.0-0270 )f� #137. #14 065.0-0233 yla 065.0-0258 #7 065.0-0250 dam., #160 #145 ��je, 065.0-0257 #153 #174 065.0-0251 065.0-0252 #16106:0-0253 - Rail Line - Wetlands Zoning Busine s 1 District Interstates ❑ Exempt Lands C Busine s 2 District Horizontal Datum: MA State lane Coordinate System, Datum NAD83, P Y - Interstate -Major Roads G Busine ■ Busine s 3 District s 4 District NORTH Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of Roads ■ Genera Business District Of tea o q� '�• North Andover. Additional data provided by the Executive Office of Ci r Easements O Planne Commercial Dev O ? �� O Environmental Affairs/MassGIS. The information depicted on this map is C Corrido Development Dist 3 L for planning purposes only. It may not be adequate for legal boundary 0 MVPC Boundary 0 Municipal Boundary Q Comido O Corrido Development Dist O •-• ' '- to Development Dist It. 9 definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Zoning OverlayIndustri K: Industri 1 District 41 - ,t 12 District r/, s THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT [3 Adult Entertainment 0 Downtown Oveday District a IndusM Industri I3Distdct S tict * c P ♦ I District •q `°`^`"" '' ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Historic District ® Water Protection Residei . Reside o. fig ce 1 District ,1,�5 ���o •� ice 2 District `SACHUsg THIS INFORMATION 0 Parcels a R-ide ce 3 District C. Hydrographic Features A de 1" = 167 ft ^Q }rde ce 4 District ce5 Distdct -- Streams Y de ce 6 DisMcl �a a esidential District 1AZmDk11—* This certifies that ........................................ has permission to perform .... i7�� ... Re �5.... . plumbin the buildings of at ........................... North Andover, Mass. . Fee .�.� . 2� .. Lic. No ................. ... PLUMBING INSPECTOR ',Check #Z %)44 w LP6�— \� . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ MA DATE I:�) PERMIT # �1 Y / JOBSITE ADDRESSOWNER'S NAME i� POWNER ADDRESS - _ - _ - - _ TEL[—_FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL RESIDENTIAX PRINT CLEARLY NEW: RENOVATION:I REPLACEMENT: Q PLANS SUBMITTED: YES E] N00 FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM w - µ _w - _ _ DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM j y_,; i -_ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM s' DISHWASHER �. ( _ I— DRINKING FOUNTAIN ..717-7-1 FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK i LAVATORY _.. ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET r - 1--t . �---- URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER r INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY QX 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 Q SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are t and accura to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co pli ce it al ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I PETER G. FARFARAS LICENSE # M8228 fldqTURE MP Q JP Q CORPORATION 0# 773 PARTNERSHIP[#LLC Q# COMPANY NAME ARFARAS & SON PLBG & HTG CO., IN ^ ADDRESS f6B DUNHAM ROAD TEL0-924-1112CITYBILLERICA STATE M -A ZIP 821 __. . 'A'm I/ FAX 978-663-5004 1 CELL 617-908-0778 EMAIL t (L s O W b r t� z 1\ z b r� � y O z � v � m z rn CO) v r n to CO) z < o m ,►� C2l -o cn ca 021 m O ❑ N ►rC El oz oilZ r b n y O z z 0 y m t Division of Professional Licensure: License Search Is The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name:PETER G. FARFARAS BILLERICA, MA Cl.lry/ SEARCH **This Licensee has additional Licenses, click here to view them.** Licensing Board: PLUMBERS ft GASFITTERS License Type: MASTER PLUMBER License Number: 8228 Status: CURRENT Expiration Date: 5/1/2014 Issue Date: Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Thursday, May 02, 2013 at 9:21:18 AM. © 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Enforcement Process Glossary Glossary of License Status Codes More... Site Policies Contact Us http://license.reg. state.ma.uslpubLiclpubLicenseQ. asp?board_code=PL&type_class=_M&li... 5/2/2013 �011 S P This certifies that. �".. ................... has permission for gas installation ...r . .............. . in the buildings of . L!OP--�........t.................. . at .... f ...... North Andover, Mass. Fee .. Lic. No.. b.................. ... GASINSPECTOR Check # 6 1 O 4T 8756 MA DAVE,.,. JOBSITE ADDRESSV q we I n r1-1� OWNERS NAM' w a a, ., �... OWNER ADDRESS s m �' TEL l01 0 G 70 D U fAX OCCUPANCY TYPE COMMERCIAL[]; EDUCATIONAL F-1 RESIDENM L1- NEVV:'__j RENflVATKW. L[j REIkACEMEN1' CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOL:ATOR. FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL. HEATEF ROOM /SPACI ROOF TOP U1v TEST UNIT HEATER UNVEI*TED Rt WA rr HEATI PLANS %off nw. YES , NO__ 7. I 8 1 9 1 10 1 11 1 12 1 13 1 14 I to ire a trent CaMrice policy or its substantial awroalerit which gets the re* ofMGL. CIL 142 YES f NO � 4 1 LF YOU CHECKED YES, FL€ASE .WDICATE THE TYPE OF COVERAGE BY CHEM THE APPROPRIATE BOX BELOW t IM INSURANCE POUCY OTHER TYPE tND tTY t30i1ip OWNER'S INSURANCE WAIVER: I am aware that the kwise does not has the karance cmmraprequirwl by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit apron waives dds fe NECK ONE ONLY: OWNER `,.D AGENT y ; SIGNATURE OF I hereby certifjr that au of the detatls'am ttstomWbon i tove sutmrit w or entered regmang flus .ara.trtue; the best'ot my iamAeoge and -that all plumbing wank and inshdi2llons peribm-*d Leaderthe perm1t issued for this app6ea� Irl beer of the Massachusetts Stale Plun*ing Code and Chapter 142 of the Genmat Lam. PLUMBER-GASFiiTER NAME-, LICENSE #113774 1 SIGNATURE LPG CORPORATION � # µM _ � PARTNER$fi1P �#� �- LLC 'Am' MP �!.£ MGF; �. JP ` := JGF_.F _ �. �..... .,..a j :�� COMPANY NAMf:Dutfee tgmt8� Heatil� LLC .._ ADDRESS 2 CITY ' South:Yarmouth STATE iA <ZIP3 42664 STEL X508.6#9-3078 FAX 508-258-0592 CELLI508-801-8004 REMAIL¢ H@&deeplumbing com H *Any applicant that checks box #1 must also fin out the section below showing their woriers' compensation policy irrforumtion r Homeowners who submit this affidavit indicating they are doing all work aid thea hire outside ooattaetors Must sdwk a new affidavit indicatiog such. Contractors that check this box must attached an additiwtai sheet showmg the ratite of the moors and state w1wedier or toot tb= wititim house employees. if the sub-conitactars have eaVloYees, they must provide di& workers' comp, policy aumba. I wa an employer that is providing workers' cornpensralion insurance for nay emplojftm Bekw is Me po y ander ske information. . , J /' d 1- . Insurance Company Name: 'tm i 11 LX (A f [ if Policy # or Self -ins. Lic. #: / t Ljy F Expiration Job Site Aftess:_, �q MIJ 1►and CjYe�e city/staterzipW-M And2fWAj otsu-5 Attach a copy of the workers' compensation policy declaration page (showing the policy camber and exp$xtion date). Failure to secure coverage as required under Section 25A of MGL c. 252 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 Of&V of Investigations of the DIA for insumnee coverage verification. QhUd use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Msumg Authority (circle one): I. Board of Health 7. Bm'idhtg Department 3. City/Town Clerk 6. Other 01(71)3 4. Electrical Inspector & Plumbing hopectOr Contact Person: Phone #• The Commonwealth of Massachuseo Department of IndusWd Accidents Office ofInvestigadons 1 Congress Street; Suite 100 Boston, MA 02114-2017 www mass gov/dui Workers' Compensation Insurance Affidavit; Builders/Contractors/Electrindans/Pkmbers Applicant information Print 1.4011 Name (Busitimi pni adongndividuai):t1r*a-1 M , � m (1 (,/ Address: A �mk Avr-./ City/State/Zip: Phone #: ' 7 Are you an empbyer. eck the appropriate box: 1- I am a employer with 4. I am a ❑ general contractor and I TYim of project (required): _�_ employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. G eviv construction n 7. ff RemodcHng ship and have no cmployees These sub -contractors have S. ❑ Demolition working for me in any capacity. [No workers' comp. insurance employees and have workers' comp. insurance.t g• ❑ Building addition - require&] 5. ❑ We ate a corporation and its 10.❑ Electrical repairs or additions 1 ❑ I am a homeowner doing all work officers have exercised their 11.211umbing rtr*m or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repah insurance required.] t C. 152, § 1(4), and we .have no employees. [No workers' 13.❑ Other . comp. insurance reauired.1 *Any applicant that checks box #1 must also fin out the section below showing their woriers' compensation policy irrforumtion r Homeowners who submit this affidavit indicating they are doing all work aid thea hire outside ooattaetors Must sdwk a new affidavit indicatiog such. Contractors that check this box must attached an additiwtai sheet showmg the ratite of the moors and state w1wedier or toot tb= wititim house employees. if the sub-conitactars have eaVloYees, they must provide di& workers' comp, policy aumba. I wa an employer that is providing workers' cornpensralion insurance for nay emplojftm Bekw is Me po y ander ske information. . , J /' d 1- . Insurance Company Name: 'tm i 11 LX (A f [ if Policy # or Self -ins. Lic. #: / t Ljy F Expiration Job Site Aftess:_, �q MIJ 1►and CjYe�e city/staterzipW-M And2fWAj otsu-5 Attach a copy of the workers' compensation policy declaration page (showing the policy camber and exp$xtion date). Failure to secure coverage as required under Section 25A of MGL c. 252 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 Of&V of Investigations of the DIA for insumnee coverage verification. QhUd use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Msumg Authority (circle one): I. Board of Health 7. Bm'idhtg Department 3. City/Town Clerk 6. Other 01(71)3 4. Electrical Inspector & Plumbing hopectOr Contact Person: Phone #• Division of Professional Licensure: License Search i The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A -Z Topics Page 1 of 1 Home > Division of Professional Licensure > 1 ONLINE SERVICES ....................................................................................................................................................................................................................................................... Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure ii Online Address Change _ Contact the Agency LICENSEE More... Name:PHILLIP J. DURFEE REFERENCES & DENNIS, MA RELATED INFO Disclaimer Regarding ""This Licensee has additional Licenses, click here to view them."" Website License Searches Enforcement Process Glossary Licensing Board: PLUMBERS It GASFITTERS Glossary of License Status License Type: MASTER PLUMBER Codes License Number: 13774 More... Status: CURRENT Expiration Date: 5/1/2014 Issue Date: 4/12/2005 Exam Date: 3/5/2005 School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday, June 24, 2013 at 3:29:28 PM. © 2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/pubLic/pubLicenseQ.asp?board_code=PL&type class= M&1... 6/24/2013 Location No. Date ct i� TOWN OF NORTH ANDOVER ' p Certificate of Occupancy $ Building/Frame Permit Fee $ QQ s�cnusE ACHU'<� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Bg a Qj? ZD(Q3 05/30/95 14:20 .8104 Building Inspector 1,190.00 PAID Div. Public Works Cif• � 3 •� Location _L`�L4 �C„ No. Date Sp t� a TOWN OF NORTH ANDOVER S Certificate of Occupancy $ � _... ig Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee 1 $ Sewer Connection Fee $ Water Connection Fee $ 0 0 TOTAL $ 5� 9 Building Inspector Div. Public Works Location ( /614 I 3� No. _ �' Date `_ _ N,r a TOWN OF NORTH ANDOVER $ 0 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ c; a Sewer Connection Fee $ o Water Connection Fee $ /moo 5a c TOTAL $ z0"77' SZ 6) �ildi g Ins ector ' I Div lic Works A/, al'3 Ln �i �.OUio .�� 8516 TOWN OF NORTH ANDOVER $ 0 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ c; a Sewer Connection Fee $ o Water Connection Fee $ /moo 5a c TOTAL $ z0"77' SZ 6) �ildi g Ins ector ' I Div lic Works PE&JiIT NO. Vi APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. e PAGE 1 MAP K40. I LOT NO. 2 RECORD OF OWNERSHIP iDATE 'PAGE ZONE P rs -1 r-; l� V SUB DIV. LOT NO. I (BOOK LOCATION ` I) %"eyv-I�A I r C j� ` PURPOSE OF BUILDING (� f J CSWNER'S NAME ' v OWNER'S ADDRESS ARCHITECT'S NAME^� O C_ Al Lf i l l �Q / NO. OF STORIES _ SIZE S'_ sa td Z.Cte CAlt BASEMENT OR SLAB -u SIZE OF FLOOR TIMBERS 1ST 2A/�A 2ND ! 3RD v Yl V PUILDER'S NAME �F SPAN /5- DISTANCE TO NEAREST BUILDING V DIMENSIONS OF SILLS -- �x ( ' " POSTS Jl DISTANCE FROM STREET ` DISTANCE FROM LOT LINES - SIDES P) REAR Q� L6 GIRDERS AREA OF LOT/ IS BUILDING NEW l FRONTAGE ®CJ HEIGHT OF FOUNDATION 1 THICKNESS V SIZE OF FOOTING 16 X ;769IS BUILDING ADDITION �� MATERIAL OF CHIMNEY asC) ;t IS BUILDING ALTERATION ��� IS BUILDING ON SOLID OR FILLED LAND 0 ' WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Y -e-5 IS BUILDING CONNECTED TO TOWN WATER _D s' BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER --es IS BUILDING CONNECTED TO NATURAL GAS LINE / le S INSTRUCTIONS PERMIT FOR FOUNDATION ONLY SEE BOTH SIDES REGULATED BY PARA. 114.8-S. B.C. PAGE I FILL OUT SECTIONS I - 3 P�,2 FILL OUT SECTIONS 1 - 12 DATE: L%s FEE PAID ELE8TRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGUL PERMIT FOR. FRAME /BUILDING PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR Y, �J1j�\ IEJ9 �I[-/ (fit Ij WDATE FILED �' DATE.. FEE PAID._._. SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E 12gp Y PERMIT GRANTED 19 �_ ma MEEN ► b 3 PROPERTY INFORMATION LAND COST 7 Ce ft EST. BLDG. COST Q8654m 1 qU ?'15b� EST. BLDG. COST PER SQ. FT. .50 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. // 4 APPROVED BY /T BUILDING INBPECTOR OWNER TEL. # 41 / " //*) CONTR. TEL. # 6 Fr' - / / % F CONTR. LIC. a. H.I.C. # BUILDING RECORD 1 (OCCUPANCY 12 4 SINGLE FAMILY NO. OF ROOMS STORIES MULTI. FAMILY 3 731+j_Isj, =I OFFICES 2nd _ 13rd I APARTMENTS CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH CONCRETE PINE 3 I 2 13 CONCRETE BL K. BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJAII " UNFIN. 3 BASEMENT AREA FULL FIN. 8 M'T' AREA 1/1 1/7 1/1 FIN. ATTIC AREA NO BMT HEAD ROOM _ FIRE PLACES ' ' MODERN KITCHEN 1 4- 4 WALLS I 9 FLOORS CLAPBOARDS UunqL DROP SIDING B 1 2 �_ 3 _ _ CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDIY D ASBESTOS SIDING VERT. SIDING _ COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME _ ATTIC STRS. & FLOOR _ CONC. OR CINDER BILK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR (� POOR ADEQUATE NONE 10 PLUMBING BATH (3 FIX.) TOILET RM. 12 FIX.) 5 ROOF GABLE I HIP GAMBREL MANSARD FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES SLATE KITCHEN SINK NO PLUMBING _ _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS.- HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES P.LOT.PLAN. 7 NO. OF ROOMS OIL 3 731+j_Isj, =I B'M'T 2nd _ 13rd I ELECTRIC 1st NO HEATING _ _ __pp __s�i�1�>la _ A�l 3U�Oi 14 cr ON ^ U c? C -q Oct Q CJ CJ z a o s S o ce uj ca J LU CDCL W IT 0 m .0 Cu w L V J= O CD C. 0 to `o m `J 3c �• E D 0CL o : m 3 s � ,r — m * A z CD o 0 r= CDCOL o CD i O iS 75 V df Z O CM a o c x mm� CD %lo oF m $ }- m COD �z m !LAcc +-� LV 'O m O V. m CL _5o 'C C �. N L Oto Q w P-4 A co 0 E O � V O co Z d O y C C co cm C C y O 'Q 0 H E mm co cm co r-• 3 'a O O� 0 R O Q E:Co ca 0_-+ C Cc v J •0 CD C Z CD C.2 C cc C a cc y + o � a U W z � o z z 2 y d w A g O v A 0Lt A w .= ca� a 0 y CL W .� C G 7 is W R5 io n 6�i U w ° cGii c2° U) u w m C/) U) ^ U c? C -q Oct Q CJ CJ z a o s S o ce uj ca J LU CDCL W IT 0 m .0 Cu w L V J= O CD C. 0 to `o m `J 3c �• E D 0CL o : m 3 s � ,r — m * A z CD o 0 r= CDCOL o CD i O iS 75 V df Z O CM a o c x mm� CD %lo oF m $ }- m COD �z m !LAcc +-� LV 'O m O V. m CL _5o 'C C �. N L Oto Q w P-4 A co 0 E O � V O co Z d O y C C co cm C C y O 'Q 0 H E mm co cm co r-• 3 'a O O� 0 R O Q E:Co ca 0_-+ C Cc v J •0 CD C Z CD C.2 C cc C a cc y + ' r FORM U - IAT REIMWE FORM ` INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Hoards 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 t his section***************** APPLICANT: Q �/i10Dd/ ?° .ZC /�fi Phone LOCATION: Assessor's Map Number Parcel Subdivision ?> X Wdad Lot(s) Street I!(J-Q (zLi t2N C. tF-C St. Nu-=er - 31 - Use Only*******************W**** e RECOM-ENDAT N OF WN GENTS: 22 9 Date Aotroved � l� Consar-:azion kd:,.inist_azcr Date Resected CCi=eT V 0, C�st�. Date Approved Town Planner Date Re -i ec -zed Fcod I^s►.er-----Heal th Set c �Ir.sAQ ►,e•:...,� -:iea? t:: Date Approved Date Re;eczed Date Approved Date Re-ieczed Pu -'---c WcrL:s - sewer/water connections �' -�� r'_ve�aay pe_•-iit /,(G� d Fire Denar-ment &17 AlON4JfwJ44'0�Tec. D ui -� fir. c1r7i,rLUPrZ.Ya/l�/P/� lJsPci'/)0.4"/7,05,2 a4,1,� ca �% d C , � iia �S al 151IT9S ' Received by Building Inspector Data o O Vi�t{,, v. wy. wia• 4 - s .y,-... ..n M ` tr i G,q,C. � rF. =324.0 TF 325.5 5Ko C3' r�21o.0 !.- C cE,er"fY Tb ryE TirLE �,Vs!/,M,�,�vp 7V riVE sS4-V-V mor r,VE' Awwe4A4 i rd eaew w ON rMe [or qs .lwew,V ,4,vo 7,-wr/r ocwf CaWickM .Wlrlv r &' rawer aw ZeWIWe e�e'�yc.4rars .fd'rlNays ;ran .rr.«rt � ter eivE.t. cawri,-e r...*r r,✓rt cw�r-ctr viv rs,vor cnumo �,✓ THE fQArr,K Oda ,WZ..e,O SyewN sN Ft.N.f COMM(/.V/Tj•� P.f,t/GIC '� 2sG1p� OCb7G OFA f D.OrEd 6�z�93 �L O r �L,Qit/ �Q.�GuOQla �6ia tY � �OG'r r ,�,voovE,c, ,�s•+s',,�,cvvsErrs oieio `t c t I l Ilplz,�L� `, Main Office: 2341 Boston Road, Suite C-130 Aeollt — Wilbraham, Massachusetts 01095 (888) 612 -ACME Adjusting Company, LLC NOTICE OF PROPERTY Loss UNDER M.G.L.139, SECTION 3B March 19, 2010 Building Commissioner, or Inspector of Buildings 36 Bartlett St. Andover, MA 01845 RE: Claim No.: Policy Number: Client: Insured: Loss Location: Date of Loss: Type of Loss: Our File No.: Dear Sir/Madame: Board of Health, or Board of Selectman 36 Bartlett St. Andover, MA 01845 2478387 2478387 Merrimack Mutual George Moore 39 Weyland Circle, N. Andover, MA 03/14/2010 Water 10 -12492 -RA MAR 3, Q Z010 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ACME Adjusting Co. is the independent insurance adjusting firm hired by our client to investigate the above -captioned property loss on behalf of their insured. Under Chapter 139 of the Act of 1977, you are hereby notified that a claim payment of more than $1,000 is expected. Please advise this office of the existence of any liens on this property. If we have not received any notice of liens within seven (7) days from the date of this notice, we will assume that no liens exist and will recommend payment accordingly. We thank you in advance for your assistance in this matter. Respectfully, ACME Adjusting Company, LLC Raymond Andree General Adjuster RAndree@ACMEadjusting.com cc: Merrimack Mutual TOWN OF NORTH ANDOVER PERMIT FOR GAS IN; This certifies that .. u.///z.6. Y ............ . has permission for gas installation .'9.. � c �' . ' in the buildings of ..,!�G n.Y .............................. at �� ..1. �;!� �r . �...<. !?� .......... North Andover, Mass. Fee. 5.�..... Lic. No..1....?! . ... k....?.,c..�.�'y'y ......... GAS INSPECTOR Check # 3 ��tl / I✓ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING , ° City/Town:,�, Date: Permit# l d 1 3 Building Locatic_.3 U IJ IW. w,11 Owners Name., Type of Occupancy: Commercial G Educational h Industrial y Institutional;s Residentla New Alteration Renovation;, Replacement: Plans Submitted:. Yes No FIXTURES 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 of coverage by checking the appropriate box below. A liability insurance policy, Other type of indemnity x. Bondmws 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 Signature of Owner or Owner's Aqent 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. r-�pe of License: By ( n Plumber ✓ 6. Gas Fitter Signature o Licens d lumber/Gas Fitter itle: , ...,;;.r Master Journeyman} / city/Town , „. License Number: /n APPROVED (OFFICE USE ONLY( LP Installer W W Y D W O W 0 J V N to =co H W rn W N W Q Z H fn O z 0' W ~ N W 0 FQ- O fn OJ Z a X W CO> W W Z W g m i-- W n, E- I. Ji Q a' S O W D O IL LL W ~ > W Q W Z 0 W J W Z H H O Z = J O 00 Z N Z _ 0 U D a o a C7 R C9 w w Q> == J 0 a 00 W z W Q w H>> a a 0 SUB BSMT. BASEMENT --i'FLOOR 2 Nu FLOOR 4 1H FLOOR 5 FLOOR i FLOOR t FLOOR 8 FLOOR 0 _ Installing Company Name ,0 ` Q �ry Check One Only Certificate # - --�--•1 - -- --- Corporation N,t Z _.. _... __ _...._...,,._ ._ ..... ,-� Cit /T Address./11�4/) # City/Town: State MA llf�� a Partnership Business Tel Fax Firm/Company;_,,, „ t 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 Yes,/ No . 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 x. Bondmws 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 Signature of Owner or Owner's Aqent 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. r-�pe of License: By ( n Plumber ✓ 6. Gas Fitter Signature o Licens d lumber/Gas Fitter itle: , ...,;;.r Master Journeyman} / city/Town , „. License Number: /n APPROVED (OFFICE USE ONLY( LP Installer Location �6"+ r�,p Old No. In — C Date 6 W10k o "0"'" TOWN OF NORTH ANDOVER 0�, O - Certificate of Occupancy $ Building/Frame Permit Fee $ "'O Eta' s�CHus Foundation Permit Fee $ ` .... �.. Other Permit FAOVV t $ ZS Ji ' 8 Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Z� ii OAK* _!9g� Building Inspector _ p /� n O 5 `:t 7 Div. Public Works 3 Cd LU om a m ` vi f E CLN s N O N C O O m 0 0 cm c c 0 N m L O Z 0 g O 5 CO i O Z "41 Z O D co _�;i> Q CO) � IV - O Co m W z L- W ° ca � Q C z Q Z4) eaV u o a or3 o o G o � °�° w A w C/)cL - a� cn CO cn (n J� LU om a m ` vi f E CLN s N O N C O O m 0 0 cm c c 0 N m L O Z 0 g O 5 CO i O Z O Z O D co _�;i> Q CO) � I co cm 0 O LO O Co m W z L- � CD O = ca � O i O eaV Q± Q Cc Q J� FL � Z asCGDD a y C R C R CL H CD Z_ z z 3 1 KAREN H.P. NELSON �,�..o••. - - -Town of Leo Main sr�c. 01845 °'rmfo' . NORTH ANDO`iER (soa) ssz-sass BCILDING COSSERVATION W5104 OF HEALTPLANNING PL:\�NINc; PL aNNING & CONi Bl TNITY DEVELOPMEi T DATE LOCATION OWNER'S NAME BUILDER'S NAME CHIMNEY APPLICATION AND PERMIT v icq 7,1- l3 C s m PERMIT MASON'S NAME %� ��G�'�v/'����✓1/ MASON'S ADDRESS ilfl,� C5!'e7l-v V� / S TELEPHONE MATERIAL OF CHIMNE INTERIOR CHIMNEY t E°J EXTERIOR CHIMNEY NtiiIBER AND SIZE OF rTLTrc THIC:�iESS OF HEART: %D W 11 chimneyr f--ecl-�e c�r�=�=� recuire eats ol. the code and o have rules and recu_aticns oee:; received: DATE SIGIIATURE OF MASON CO"TR. LIC. EST. CONSTRUCTION COS—:'CO::iP..%= PRICE 0 PERMIT GRANTED �iEy 7iS � ROBERT NICETTA, Bi:.�DI::G INSPECTED a REMARKS w --2T_C{ REQUIRED THIS PEILMIT MUST BE DISPLAYED ON THE PREMISES �gs9e -- O O � z a z a f � m o � N HwN h LP A co o 0 m za Z . .. i U aw Location No. - Date MORTq TOWN OF NORTH ANDOVER L p a' F Aidwift ; Certificate of Occupancy $ °�sz; s,KMU Building/Frame /Frame Permit Fee 9 $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # U Building Inspor TOWN OF NORTH ANDOVER ` BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: J-6 DATE ISSUED: 7-�� SIGNATURE: %/ /9 Building CommissionerlInvector of Buildings DateJAt SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 'Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: /0( S�- Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RegWred Provided ReqWred Provided 1 1.7 Wats Supply M.G.L.C.Q. 54) 13. Flood Zone Information: Public ❑ Private ❑ �e Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSEIIP/AUTHORIZED AGENT '' 4 iiSti lCt: Yc ; �,lD 2.1 er of Record W(AC- Nreqw / T _ Name (Print) Address for Service i 7E-- 6�-3 - G Signature Telephone 2.2 Owner of Record: /1 11'a Address for Service: �Irinll �- Signature Tele one SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Impent Contractor - I- 75 6j Not Applicable ❑ 1 26 �Sq Company Name C 7 J Registration Number S7 —3 —p Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. in the denial of the issuance of the building it. Signed affidavit Attached Yes ....... No ....... 0 SECTIONS Description of Pro sed Work check an a 6k New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: ^ I cvt-Tinnr [ Ti QTTMATPP'n rnNCTQrV'Tinm VnCTC I J Failure to provide this affidavit will result Addition ❑ Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY , I. Building (a) Building Permit Fee Multiplier SIZE 2 Electrical (b) Estimated Total Cost of Construction SIZE OF FLOOR T vMERS lNr2' 3 Plumbing Building Permit fee (a) x (b) (�f( 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TU BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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 cvnrrnN.^n.`nwNTiQlArTTiinD77TiTa A!_TiNTi►rr!`r Ai2ATit%N L s c I, KN N 1.4 y7 ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are 'L -Yue and accurate, to the best of my knowledge and belief Print Name Si ture of Owner/Agent a S Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T vMERS lNr2' Ju KV SPAN DIMENSIONS OF SILLS ` DINMNSIONS OF POSTS DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING ?,. X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FELLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE O F=4 am c o aS-W 3 W O <u W "JV Q I o Q v U w rL w w w�' u. z w A cA cn Q o cnol c Y>1 y y 3 W O <u W "JV Q I o Q i q \NG c o CD c c� t • � O ` C o O C .n ac ev p C CD o +r r o � W = m c ms tts r o n y ES 16.CD o� 00 O C c Is h R :mm R o zy h � F A k m k p O F h O h m E e ac a o � cpa C Z vZ O� H- o :cmc m r W C � •tyA dt A C � r •b- V O 203 co cm H CO Ous Ous s o �- = S o. w m J O 5 T a O a) a) Z o. O y Q C � c cm O■� C* Q h O O ' m m 0 CD = O� �3 O Q O L O a a. c Q c � c Cc �a O. O CD C Z a) 0 CL V CO) O C C ■ C CO) a Y+ LLI U) 19 W LU 19 W N e 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: 41J a iz C F (Location of Facility) Signature of Permit Applicant 9- :;-o -0 r Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector AT-HOME SM Installed Siding and Windows Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Reg istrkion126893 Y Expiration 8/3/2006 i ;�Types Supplement Card THE Home Depot',At Wome;Servic abNROEUN CHHOUY ,.__ f f 3200 COBB GALLERIA PKWY #20�� ALTANTA, GA 30339 Administrator Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor. 345 Greenwood St. Unit 2 • Worcester, MA 01607 • 508-756-6686 • Fax 508-756-2859 • Toll Free 800-657-5182 � FROM KIMBLY FAX NO. : 6033629679 Sep. 10 2005 08:51AM P4 F HOME IMPROVEMENT CONTRACT r' t Branch Name: .f Date. Sold, Furnished and Installed by - _ THD At -Home Services, Inc. Minimum 25% of Contract Amount due upon exeeuana d/b/a The Home Depot At -Home Services Branch Numbcr: Jnb1F �j!�3$7d 145A Greenwood Street, Worcester, MA 01607 Toll Free ($00)657.51 $2; Fax; 508-756-28S9 BALANCE DUE ON COMPLETION: fated IDk 75.269&4¢0 M£ La: x C 02439 Ri Cunt. Lick 16427 ` C'T Llek 565512; MA ltomelllyrRH'�rtteal CoottaeWt Reg. NI2689) Installation Address: Home Address: (If different from Installation Address) City City State Zip State Proieci info motion: I/We/Ytw ('Purchaser"), the owners of the property located at the above installation address, contract with Horne Depot U.S.A., Inc. ("Home Depot") to furnish, deliver and strange for the installation of all mate described on the attached Spec Sheet #: ,incorporated herein by reference and made a p Rome Depot reserves the right to cancel this contract icy upon re inspection of the job, Rome Depot c cannot Perform its obligations due to a structural problem with the home or W wse work required to was not included in toe Contra& co ICMD17 • s� SA.s BALANCE DUE ON COMPLETION t /C? I yti S I ! V Minimum 25% of Contract Amount due upon exeeuana i thin contract. Indicate Payment Nkthad For w BALANCE DUE ON COMPLETION: ck�� DEPOSIT PAYMENT OPTIONS (Sufpect to fund w6 ttrion and/or credit apprwaa.) 1, Cheek CachltR k or US Pe vwrvl4;4 Money Order (Made payable to Hu z CN&ICaaio."Of that Vim twetr,G4 The Homo Dopot Home I Av„itsble Ceedltr S Aarx; Nims is it appmrs o6 : •By mylours' low, Uwe KfenCocpl awn for the dee. dJ V5_ notions-Ciirde Oae Bdow t ' 11 ��`� .'-.: : teaver Ammteu fvrptea a i ut Loan The Bonne Depot Cup (13111. & HDCC ONLY) _ Exp. Dun— - FM to allow HOM-1)"t to chug . I indiutad. Ikea, Purchaser agrees that, immediately upon satisfactory completion of the work, Purchaser will execute a Completion and pay any balance due. Purchaser also agrees To be jointly and severally obligated and liable hereunder. Enft A eutr This agreement and its attachments, including any financing agreement, contain the complete tween t parties and can not be amended or modified unless in writing to a separate agreement signed by bout pai w NOTICE TO PURCHASER m: Do not zip thiscunirar! f ...� gut before you read ft Yen are cuUticd to a completely fi)1Cd in copy of the contract it [he time you +. a �*,e p ; •..•. it to protect your rights. Do not sign any Completion Certificate or agreement statins that you are satisfied with the eat as ' before this project is complete- Law prohibits home repair eontraetors from t' or neer 4 M' The owner rrgnes,' QtmR a COmQkttoa (:rrrib;... by prior Io the actual completion of the work to be performed ander the coatrat 6 F Yom may cancel this transaction at any tlmc pprior to mialniebt of the Hurd bustum day after the date of Ibis Contract. 54' Cancellanou Tor an explanation of tbis reght. There will a service charge equal to 25% of the contract amount it the job it concerted by Purchaser AFTER the, third btulnrt,s day- BY MY/OUR SIGNATURF BELOW, !/WE AGREE TO BE BOUND BY THE Tfkms OF TFi1S CONTRA(, -r. YWE ACKNOW Lr1kt); RECEIirT OF A COPY OF TH1S CONTRACT AND TWO COMPLETEDCOPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW, I/WE UNDLRSTAND THAT THE AGRF,EMENT IS SUBJECT TO kItVIEW Or MY/OVR CREDIT 1­115TORY AND ME AUTHORI7F HOME DEPOT AUT1lOkMED CONTRACTOR, TO VEk1TY AND REVIEW MY/OUR CREDI-T RECORD WITH AN 1NDEPENDF.NT' CREDIT REPORTING AGENCY AND RELEASE THEM FROM AIJ, LIABILITY INCURRED FROM INADVERT T 1 ION O ERRORS. DO NOT SICN THIS CON'TIRACT IF THERE ARE ANY BLANK SPAC&S. SUBMITTED BY: Date: � r ACCEPTED BY: Date: 4*_ H wn Date: nmmwtrer NOTIC& AVE)MONAL TERK%C n'Pr oN3 AND WARWTtES ARE STATED ON THE REVIZIM.. Mr.. A%Ti ARE PART of TN14 nOATDArt' %i1c-Ranch File YeilOw-CWt*n%r Pint-Sdm Coamaam 5.17-05 C -SC ' FROM K I MBLY � g C c m ry e � N CD CL 3 a ' CL 3 ry ID CD ° w �. cr yo y A FAX NO. : 6033629679 w I� Sep. 10 2005 08:49RM P1 � g C c m � e � N CD CL 3 a ' CL m ry ID CD ° w �. cr 0 0 r 1 �r m 1 � I� Sep. 10 2005 08:49RM P1 � g C � 3 n d v W A a' m Q CD ° w a° n' 'o 7 4 zr v o � a m ? f O 09 b � m tin I� Sep. 10 2005 08:49RM P1 imam 1110111 a� AR - an ISO I�rnow � g C � 3 n d v W A a' m Q imam 1110111 a� AR - an ISO I�rnow cn d v W A � m Q O Q1 w 16 Town of North Andover °, N° oTFr BUILDING DEPARTMENT & INSPECTIONAL SERVICES �? �' ° '-"'• °a Community Development and Services Divis T 400 OSGOOD STREET �1 Arlo ►� • North Andover, Massachusetts 01845 �sSACHU Michael McGuire h!t2://www.townofnorthandover.com P (978) 688-9545 or 9534 F (978) 688-9542 Building Inspector INFORMATION REQUEST Building Department Please use this form if the Building Inspector is unavailable to provide immediate assistance. Please fill out this form in its entirety to ensure an accurate and prompt response. All requests for information will be handled as soon as possible. CONTACT INFORMATION p Date: Name: ��'`N� "__ (-� /� _ -- l�U7✓�� � Phone number: 7a Fax number: Address: INQUIRY - Property in question: (Please include as much information as possible) Subject: Inquiry: Thank you for your interest and inquiry. ��FsTU� & 6"- lz-� BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688r4OLANN G 68 35