HomeMy WebLinkAboutMiscellaneous - 405 MAIN STREET 4/30/2018 405 MAIN STREET
210/056.0-0033-0000.0 ,
4
9556
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SS C14US
This certifies that O.n..na.....
.............................. . ..............................
has permission to perform ... ..... ......................
wiring in the building of..... ....... ...............
at......F`7 ......MW ...................ANorth Andover, ass.
Fee.. .—. Lic.No. . -��. ............... P?/Z........ . . ......... ..... ...........
ELECTRICAL INSPE R
Check
Department of Fire Services Permit No. 15�jc
Occupancy and Fee Checked
;! BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank
M
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 71,7d J
City or Town of: NORTH ANDOVER To the Inspkto of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) T
Owner or Tenant ��f J/j /J �O�ir°D Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building l �i1�•l Utility Authorization No.
Existing Service/,go Amps /eel olts Overhead pr-*,-Undgrd ❑ No.of Meters01
/
New Service Amps / —Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 104-��%�Ah <� 4
,� t
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 7 No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets Z No.of Hot Tubs Generators KVA
�r No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting
rnd. rnd. Batter Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Gas Burners No.of Initiating
and
No.of Switches N
,Z Initiatin Devices
Z Tota
No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No. of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other
p g Connection
No.of Dryers 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 Equivalent
OTHER: v
�j Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electric a Work: (When required by municipal policy.)
Work to Start: Q O Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C E GE: 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 co,yer2W.4s in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains andpenalties ofperjury,that the informa .o on this ap lication is true and complete.
FIRM NAME: ELS C Teri G ,® st LIC.NO.: gg�2 log
Licensee: � /� 40_ 40 of X , Signat re LIC.NO.:
(If applicable enter "e m t"n the license number line.) Bus.Tel.No.:
Address: // /.lojz.�.�.,o /.1l�r .. ,_//A -2?7? Alt.Tel.No.: SA�IC
*Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lie.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
Owner/Agent PERMIT FEE: $
Signature Telephone No.
t
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II
�� �- 16
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
s. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): nlVXI
Address: /O toxoye
City/State/Zip: . O 99Phone
Are y9An employer?Check the appropriate box: Type of project(required):
1.Uf am a employer with_l.,, 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7 emodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.E] Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] i employees. [No workers'
comp.insurance required.] 13.❑ Other
*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 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: 5-7—IfTE
Policy#or Self-ins.
/Liie.#: Expiration Date:
Job Site Address:__7 0� 141,J1/�) 67/l T City/State/Zip: &A-Dex -,4
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 certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#:
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
Contact Person: Phone#:
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NOR7M OfTOWN OF NORTH ANDOVER�.,MO
FOr ••� '� + O9
PERMIT FOR PLUMBING
+, ,..°
,SSACNUSE�
This certifies that . of ,! �?e'. 1171.1.f� ,�. . . . . . . . .
has permission to perform . . R.e h ` `q� f
plumbing in the buildings of . . . . . . . . . . . . .
at . . .lj!`.11. �—I -'PLUMBINGrINSPE*C*T'0`R'North Andover, Mass.
Fee. ).1. . . . . .Lic. No.�. . . .
Check # 1
O 3 b 6
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS o
c�d�Building Location l Owners Name Date 3Permit#
Amount
Type of Occupancy
New Renovation Replacement 0 Plans Submitted Yes No 0
FIXTURES
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(Print or type) \ Check one: Certificate
Installing Company Name 1� Corp.
Address ,w Partner.
T •,\tY
Business Telephone a0 Firm/Co.
Name of Licensed Plumber:tuber:
Insurance Coverage: Indicate the ftelof insurance coverage by ch 'ng the appropriate box:
Liability insurance policyEy Other type of indemnity Q Bond ❑
Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent 0
I hereby certify that all of the details and information I have submitted(or entered)in above applicati are true and accurate to the
best of my knowledge and that all plumbing work and install erformed under Permi s or this application will be in
compliance with all pertinent provisions of the Massach Pl b' a to of the General Laws.
By: °
Type of Plumbing License
Title
City/Town lacense l u er Master Journeyman
APPROVED(OFFICE USE ONLY a
OF
SAAT1�RE J. ti� PROFEMNAC
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Location +e;l ti Location
No. of Date � 9�
TOWN OF NORTH ANDOVER
3? ' 0
_ p Certificate of Occupancy $
Building/Frame Permit Fee $
•.•,.a ,SSAcmU5- Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee _$
TOTAL $
b 6A
Building I eetoi--
+- Div. Public Works
PERMIT NO. 3 2� PAGE 1
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
MAP i-40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK iPAGE
ZONE SUB DIV. LOT NO.
LOCATION -- --� --- _ _._� PURPOSE OF BUILDING
�r
OWNER'S NAME NO. OF STORIES SIZE
OWNER'S ADDRESS BASEMENT OR SLAB --
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME /,IVJ��J. /]� SPAN
DISTANCE TO NEAREST BUILDING "7 DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES —SIDES REAR GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES
EST. BLDG. COST15ZE9 e--
PAGE t FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY -
v ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
•PLANS MUST BE FILED AND
/APPROVED BY BUILDING INSPECTOR
'DATE FILED `%/
—� ]— — -- -- - - — BOARD OF HEALTH
SIGNATURE
EOOF�OWWNERR RUTH RIZEQ AGENT
FE E
PLANNING BOARD
PERMIT GRANTED
�y��
/(
B't'u 1,c'_ 2 T 19 T
BOARD OF SELECTMEN
( OWNER TEL.# BYILDINa INSPECTOR
CONTR.TEL.N
CONTR. LIC.
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY S;ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY :::::#_OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE d 2 13
CONCRETE BIL K. ---III PINE _
BRICK OR STONE HARow D
PIERS PLASTER
_ DRY WALL _
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'TAREA _
'G '/o 3/. FIN. ATTIC AREA _
N_O B M T FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS ( 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDW D _
ASBESTOS SIDING COMIv1c
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. 8 FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAMESUPERIOR pR
_
ADEQUATE I-1 NONE
5 ROOF 10 PLUMBING
GABLE HIP BATH 13 FIX.)
GAMBREL MANSARD TOILET RM. 12 FIX.) _
FLAT SHED WATER CLOSET - -
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROIL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
'WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM i
STEEL BMS. & COLS. HOT W'T'R OR VAPOR
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2ndELECTRIC
1st I3rd' I NO HEATING
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NORTH
Town. oGay ` ; ` Andover
No. 324
o7 A'7N dover, Mass., Prk
_
COC
H CHEZ 1,
�AO P�\�t
RATED P
r '9S BOARD.OF HEALTH
z' ''4 ' Food/Kitchen
C.
Septic System
P E R M I T T
x� '` • BUILDING INSPECTOR
;. .THIS CERTIFIES THAT............................� ..V..� 1�..........................................................................................................
Foundation
has permission to ereet%......... - � buildings on �� t.. �1• Rough
tobe occupied as............................................................ .. ....................................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
' . this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRUCT1 STARTS Rough
• - — Service -- - ---
............... .. ............. ............... .......... ...... �.........................
i BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
P Y P Final
No Lathing or Dry Wall To Be Done
UntiInspected and Approved by the Building Inspector. FIRE DEPARTMENT
l
Burner
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
Location -b5 .�4 S�
No. oZ Date
f
kO DT.,h TOWN OF NORTH ANDOVER
� s
t cc
Certificate of Occupancy
anc
S
s °°•E�� Building/Frame Permit Fee $
s�cMus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ y
Check #
17845
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �q
:"�" rs`�;s�.r. �r�ta",�,. ..,.,,„�.��.£,.�'k5"� <h•,e..a&�a�TNI[>� ..'. ..;, t,.��,.-�� � zz_*'�'��'�°�""''- :,s�;xi3�.W, vr�„-+^ ^�i,�
BUILDING PERMIT NUMBER: DATE ISSUED:
f ic
SIGNATURE: ,
Building Commissioner/Inspector of Buildings Date z
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
s t- Z-6 3-3
Map Number Parcel Number v
1.3 Zoning Information: 1.4 Property Dimensions: n
Zoning District Proposed Use Lot Areas Frontage 11 �}
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
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 ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT fisturic Mstrict: Yes No M
2.1 Owner of Record
0
Name(Print) Address for Service
IN
Signature Telephone
2.2 Owi' r of Record:
Name$rint Address for Service:
Z
M
Signature Tele hone go
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Q
Licensed Construction Supervisor: /2—
to;
(o jp�j License Number
Address(_ / 1 7
Expiration Date ic
Signature Telephone
L�
3.2 Registered Home Improvement Contractor Not Applicable ❑
11
Company Name M
Registration Number
Address
z
Expiration Date
Signature Telephone M'
r
{
SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑ Existing Building ❑ Repair(s) [IAlterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAI(,USE ?NLy
Completed by permit applicant
1. Building n v o (a) Building Permit Fee
C•'
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(e)X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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.
r
Signature of Owner Date 1
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
ti
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
f2 t D
Printr
'/ r ,
Si a of,O er/A ent Date
11
mg I
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIIvMERS 1 2ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS j
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHEVMY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
t
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)
S Jure 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
71, e m,,omwea" ol-4&o dw-6ea
Board of Building Regulations and Standards
L - HOME IMPROVEMENT CONTRACTOR
e'
Registration", 126923
Expiration 8110/2006
f k Type iD6
ERIC DOVE CONSTi2UCTAON
E=RIC DOVE 7
1 ELMGROVE g,'}v° �✓ I
TYNGSBORO,MA 01879 Administrator ( C
I
AOORb�, CERTIFICATE OF LIABILITY INSURANCE 11/29/04Y'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND-OR
CLOUTIER INSURANCE AGENCY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
1470 LAKEVIEW AVENUE INSURERS AFFORDING COVERAGE
- MA 01826
INSU INSURER A: COMMERCE LIABILITY
INSURER B: TRAVELERS WORKERS COMP
ERIC DOVE
1 INSURER c:
ELM GROVE
INSURER D:
TYNGSBORO, MA 01879
INSURER E:
COVERAGES
THE POLICIES OF INSURANCELISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE
M Y LIMITS
GENERAL LIABILITY YV9887 09/19/04 09/19/05 EACH OCCURRENCE $1,000,000
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 50,000
CLAIMS MADE OCCUR MED EXP(Any one person) $ 5�000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ . 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000
POLICY ] PR OT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -;.. $`^?,
ANY AUTO (Ea accident)
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR F� CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION ANDWC STATU- OTH-
EMPLOYERS'LIABILITY 7PJUB--3263B52-7-04 06/2.x/04 06/23/05 TORY LIMITS ER
E.L.EACH ACCIDENT $ 100,000
E.L.DISEASE-EA EMPLOYEE $ 100,000
E.L.DISEASE-POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS a
CERTIFICATE HOLDER 7TADDITIONAL INSURED;INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
TOWN OF NORTH ANDOVER DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
ATTN Y BUILDING DEPT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25-S(7/97) COR N 1988
Proposal Roofing
Fully Insured
Free Estimates EPIC Dove Siding
Best Shingler in the Northeast
1 Elmgrove Street, Tyngsboro, MA 01879
(978) 649-6205
PROPOS S BMITTED TOP O D
STREET f 0 4 j B 42_ �.
CITY,STATE AND ZIP C DE JOB LOCATION
ARCHITECT DATE OF PLANS JOB PHONE
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
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t,J .�� �. t �`. "r fes" l�✓1� � C3 !r��i'� i
7 �3 °
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f ca. v
r ra hereby to furter terial and labor-complete i . or ince with above specifications,for the sum of:
dollars $ - S )
Paym o be made as follo s:
`}
All material is guaranteed to be as specified.All wrk to be completed in a workmanlike Authorized
manner according to standard practices.Any alter tion or deviation from above specifi-
cations involving extra costs will be executed only upon written orders,and will become --- ~�•
an extra charge over and above the estimate.All agreements contingent upon strikes, Note: This proposal be
accidents or delays beyond our control.Owner to carry fire,tornado and other necessary
insurance.Our workers are fully covered by Workmen's Compensation insurance withdrawn by us if not accepted within days.
�Arreyfnurr of 11r>aposal -
The above prices,specifications and conditions are satisfactory and are hereby Signature
accepted. You are authorized to do the work as specified. Payment will be
made as outlined above.
Signature
Date of Acceptance:
NORTiy
Town of _ over
* - IF_-
ti
� O Z+- L A E o over, Mass., qp ,* Y
COCMICMEWICK V
RATED
BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT.........3>A.01,.............Le..fR..N..o.. .���........................................................................ Foundation
has permission to erect.....
.� Rough
Pe .�. �t. ................ buildingson ......... ..Q. ...... . .... �.......... ..................... ug
to be occupied as........... R v s...p............, r r�e �I ti .................................................................... Chimney
provided that the person accepting this permit shall in every respect con, the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. S 4 /3 3 PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTIONS ARTS ELECTRICAL INSPECTOR
... . .. .. . . .. . . .....
Rough
.. Service
BDtINR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove F al
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. . Burner
Street No.
F
SEE REVERSE SIDE Smoke Det.