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Miscellaneous - 44 COUNTRY CLUB CIRCLE 4/30/2018
434 COUNTRY CLUB CIRCLE MAP 64 PARCEL 75 Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,�i. ,This certifies that . . . has permission for ga installlation in the buildings of. .' .Q/ . . . . . . . . . . . . . . . . . . . . . . . . . . . at . ! . !. .�`'�- --'?� ?. 4 � e!'<•. . . . ,North Andover, Mass. ev— Fee .�.<v. . . . . . Lic. No.&1. �. . . I�v . . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check .3��r 8510 A y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ,r/ MA DATE L PERMIT# JOBSITE ADDRESS _ OWNER'S NAME GOWNER ADDRESS TELT ^_ F � ( TYPE OR OCCUPANCY TYPE COMMERCIAL(J EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:[RENOVATION:E] REPLACEMENT:® PLANS SUBMITTED: YES[�_J NO APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE I J J a DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _ FURNACE GENERATOR GRILLE INFRARED HEATER _ _ ---I - - _ - — _ -_ r1---j J. LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER = I _ r--- ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATERT_- -_ _ OTHER A ._. ._... I r1 _ INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES OKO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [a- OTHER TYPE INDEMNITY E] 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 :i AGENT E SIGNATURE OF OWNER OR AGENT 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 comple ' all Per$' ent p vision the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE# 3 GNATURE MP MGF[�_ i JP JGF[.-ILPGI M CORPORATION 0'# 3 _ PARTNERSHIP E1# LLC 0f#= COMPANY NAME:_ .___ .. S._y�l�� �.---_ � _._I ADDRESS _ r2_..__. _.a.X CITY �j U ,__. 'f/d�,l,.�CrL ._ J STATE tM ZIP d r TEL FAX CEL.- l EMAIL -- - --- -- ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# Cab PLAN REVIEW NOTES M The Commonwealth of Massachusetts Department of IndustrialAccidents 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/Organizatidn/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet. E]Remodeling 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 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp,insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site (formation. isurance Company Name: olicy#or Self-ins.Lic.#: Expiration Date: )b Site Address: City/State/Zip: Itach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is trite and correct. ignature: Date: -lone#: 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#: t � r 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-contractor(s)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 burn 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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-7274900 ext 406 or 1-877-MASSAFE evised 5-26-05 Fax#617-727-7749 - wvW,mass.gov/dia GENERATOR APPLICATION DATE: 12--Ilqllz_ LOCATION: "7 < ek OWNERS NAME: a'110 d GENERATOR kw 16/ NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: 66 e✓e-' /7J �S �`�� PHONE NUMBER: ELECTRICAL DGA RESIDENTIA OMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *CONSERVATION APPROVAL�7s`�°1�a- ' Town of North Andover Page 1 of 1 NoRTH ANDOVER 41 .� ❑ Base Map Zoning 2012 Aerials watersfied Zone Utilities ❑ SizeOC� Selection ! Legend Location C Help Scale 1"= 117 ft Select ) ;(show all)_ ._. Owner ProP_ID or I�i �� DELL'ORFAN0,SCOTT 0640-0075-0000. r i selected To Mailing Labels To Spre. f Ty e�.r�, � r�,:.. ❑ Property Building Permits P!a " ". Ownerl DELL'ORFANO,SCOTT l ' Owner2 DELL'ORFANO,MEGAN i * Address 44 COUNTRY CLUB CIRCI. PropertyID 064.0-0075-0000.0 Lot Size 2 A • qp(. ,-:' t'", Fiscal Year 2013 Land Use 101 Code ' Last Sale 08/25/2004 moo ' v tDate �tr3-CInD j '"� '-�:p Book/Page 9009 �r Total$1474300 Valuation Building CL T ype �,. Year Built 2001 Get Pictometry Imag Go .3.2.0 AppGeo Save Map as Image y - Slgwror,A vae�y Wrc�g CamY9slon Coea r4 mdse ay ua'amy.eepaaaa�«ImFBe:l,malms ary iegd ialaltr«yoeoo3lyrormsecoaary.roaVklarc'S *oma gw 6eop emsLm WA misty Ona pmwae' 3bftwwyft�meaau mmftmwemev�ckvz%yPim"c yaranasro '- Lh manamMme-nme.ew iorar wby4t7xeaas ae,.«c, y AV.ftvewcmypmkvC-a.isvnaac�.vavav em—roes Kq+re� YW any uaa alna wamalm x Oye rtanice n 1lSa«f:Ce«i0 er IAaMnvice tlaary WmigCmniasbn'sr�ertmseniaearuau+arre4« .Pasaaae«nan"—acyas>o Martatrxa.Aty tee a ma xbnuar.sa m mdptaisaanem, http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx 12/19/2012 Town of North Andover Page 1 of 1 r — +� D• — i 0Base Map Zoning 2012 Aerials Watershed Zone I Utilities Q Size ❑❑ Selection 17:egend Location M Help Scale I"= 117 Ift " Select - (show all) / I5 Owner i Prop ID Z, SCOTT DELL'ORFANO, 064.0-0075-0000. 4 _-.....................___.___._............-L------..............---_____ ¢O I G�*`46aa 7 9/ • /j ater tecdoa `s 1 selected To Mailing labels To Spre; �/06:L�0021� � Property Building Permits Pla iF165 OW: Owned DELL'ORFANO,SCOTT 1 Owner2 DELUORFANO,MEGAN Address 44 COUNTRY CLUB CIRCL PropertyID 064.0-0075-0000.0 Lot Size 2 A Fiscal Year 2013 Land use 101 �j Code Co �6t Last al08/25/2004 0 MAN* bltryQnb.Car��e Book/Page 9009 1 Total$1474300 Valuation t/LO' 4 1 X801 5 Bu, CL Type I Year Built 2001 Get Pictometry Imag Go v3.2.0 AppGeo Save Map as Image Yar:YMdi Wtlep Rauvi9 Gonnr�n COCna maFearS vev�rtKPuae®cd aJrm6M,m tauarc a,ry�L'�Y aa�ort9bIIey for aw soaaary,c�i> � a umna_d Geopaot.redmaca+%wen 0%or—nyonxr"a Podded neeia.meaaeaoa�rm�rmamepxedapaM�oniar�aparo Hero «. agv trmngme�e o-ueanxr.sx lomtaY+.or aeht9lce ota ayaWctmexe.Pa lyYY.PpcalY&RP'Sedulm RlercWsckYSley WnMg Cdreravion wGwss f nsaMme dmSnr-6.D•aoozmpr'd oya"em=e b l's eouceam siewy,r,cx yaaryP BGo�vrK49gn'yrdMalnialnakG5row9rm�eRa npawworea5 ane aaaacyd ssa rva+eauoa Ary WA Of ewOW.910d na ne radPea'sa euc http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx 12/19/2012 Date.a,1 Z h.AU. . .... . N°RTM °f TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION �,SSACHUSE� This certifies that . . . ... . . . s ` .�°. . .l"J ! . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . in the buildings of . . �.�� l !Z. 4ef!o . . . . . . . . . . . . . . . . . . . . . at . . N . rL�! ` 1��1. !°.6.6 . .C.�. .. . (.�, North Andover, Mass. Fee.? ;uo. . Lic. No..T.0 3 t _ c 41GAS INSPECTOR G Check#/S-� G 7164 I MASSACHUSETTS.UNIFORM APPLICATON FOR PERMTf TO DO GAS FITTING (Type or print) Date 3 f14`l Q NORTH ANDOVER,MASSACHUSETTS `'' Building Locations L wC/ -�C Permit# Owner's Name ��j I Amount$ New❑ Renovation ❑ Replacement Plans Submitted ❑ w � w w z x z o ao x > w H C [�=1 > Q F ° Z O z z Cz o m o L 3 c Ua > A a p SUB-BA SEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR STH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) n Check one: Certificate Installing Company Name�C � l 1. 0�, � �, ��� - � Corp. Address t7 ' U ❑ Partner. 1J N U -L-2- Business usiness a ep one -yp 13-Firm/Co. Name of Licensed Plumber or Gas Fitter 1 ,1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ✓a No If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 13 Bond Owner's Insurance Waiver: I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and install tions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach Sta Gas Code d Ch 1:��qG�eneralaws. --�3 By- Signature of Lice ed Plumber Or Gas Fitter Title Plumber City/Town Gas Fitter License 7umuer [3-Master APPROVED(OFFICE USE ONLY) Journeyman r% The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M14 02111 www-mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�bly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: 1.❑ I am a em to er with 4. Type of project(required): P y ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6' ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers comp.insurance 5. 9• El Building addition „ p ❑ 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- Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required] 13.[1 Other Any applicant that chec.Us box#! must also fill out the section be,,mv showing+vw. _ _ T Homeowners who submit this affidavit indicating they are doing all work and thea 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. lam an employer that is providing workerscompensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: 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 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# Is Authority(circle one): L Board of Health Z.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information as d 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 notbecause 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-contractor(s)name(s),address(es)and phone number(s)along with their cerdficate(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 permait or license is being requested,not the D=artanent 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 Massachusetts DTartment of lndustiial Accidents Office of Investivatfons 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-N ASSAFE Revised 5-26-05 Fax#617-72.7-7749 vmm,.mass..gov/dia tO pouph Service Final , (04t (gummonwtaU4 of massac4usdu Office Use Only Dgwmens of Public Safety Permit No. �a rr BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 occupancy & Fee Chad d 3/90 (lave blank) APPLICATION FOR PERMITTOPERFORM ELECTRICAL WORK All work to be performed in accordsCMR 00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Darty To the Inspector of Wirers City or Town of The undersigned applifor a permit to perform the electrical work described below. es Location (Street d Number) ��'` u r r Owner of Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Amps__� Volts Overhead ❑ Undgrd ❑ No.d Metes New Service —Amps Amps__J Volts Overhead 11Undgrd ❑ No.d Meters New e Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work TOTAL of Hot Tubs No.of Transformers KVA AboNo.d Lighting Outlets � No. ve n- Swimmin Pool rnd. ❑ rnd. ❑ Generators KVA No.of Lighting Fixtures o. Emergency t ting No.d Receptacle Outlets No.of Oil Burners Bathe Units No.d Gas Burners FIRE ALARMS No.d Zones.----�— No.of Switch Outlets Total No.of Detection and No of Ran es No.of Air Conditioners Tons Initiating Devices _ eat lotal 10talNo.of Sounding Devices. No. of Disposals No.of Pumps Tons KW No.of Self Contained ::I petectiod5ounding Devices No.of Dishwashers Space/Area Heating KW Municipal I Local Connection ❑Other No.of Dryers Heating Devices KW No. o. ow o cage No.of Water Heaters KW I Signs Ballasts Wirin it No Hydro Massage Tubs No of MotorsTotal HP l s OTHER: 0 INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES O NO O 1 have submitted valid proof of same to this office.YES Q NO U U you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE El BOND ❑ OTHER❑ (Please Specify) (Expiration Date) EsfnaW Value d Electrical Work i '00 ork to Stag Inspection Date Requested: Rough Final geed under the penalties d perjury: IRM NAME C� &�& /►� �L.'�C.r4Zi�, LIC. NO.��7�T 11R/ 19�'i'1 Ai1�J sig/n/awrc uc. No. a 3 3 lei° le/10 � SOJ7 /V tt Bus. Tel. No. J03—f95—9 e173 AIL Tel.No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not ba"the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement.Owner Agent (Please check one( Location No. Date U 9 a� �pRTh TOWN OF NORTH ANDOVER C ' 9 i y * s Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # // Building Inspector Location y7' / No. L22,3 v Date NaRTM TOWN OF NORTH ANDOVER M it"s D .0'. 9 Certificate of Occupancy $ ��s"'• E<� Building/Frame Permit Fee $ JgCMus Foundation Permit Fee $ .00 OV l Other Permit Fee $ TOTAL $ elf) J> _� Check # J Building Insp 669( c TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING a tV11; ft. �lll4 BUILDING PERMIT NUMBER. DATE ISSUED: 3013 SIGNATURE: Building Commission/I Cor of Buildings Date SECTION 1-SITE INFORMATION I z Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Co V J—, •r_ Ay Q Map Numller Parcel Number CQ 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot�zja Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water S ty M.GLC.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record Name(Print) Address for Service Signa Telephone �. 2.2 OVmer f Recor Name Print Address for Service: z z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ nsed Construction Supervisor: or c� 1. 0 //d� In—) !�� // s License Number mn Address Lr1 V /C I 01 • "ts--0 L}FS r Expiration Pate Signature Telephone r 1,!1 —� _ 3.2 Re tered Home Improvement Contractor Not Applicable ❑ v Cao Company Name �� kf, Lffe Registration Number r Address r ST 7-9 "Y�' Expiration ate ^ Signature Telephone V/ v t SECTION 4-WORKERS COMPENSATION(M G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes......A No.......❑ SECTION 5 Description of Proposed Work fLcheck all a livable New Construction A, Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ,� p JAW 6 L-LI fJ C; W ll m &n A'C Z c�� • SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by 2en-nit applicant 1. Building n (a) Building Permit Fee / ,5 O / 7 "/�� Multiplier Co 2 Electrical (b) Estimated Total Cost of '/ Construction 7 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 05—, 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 I, �70+�A &SS J as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in alln s r ative o autho ed by this building permit application. -1/n 00 Signature of Own Date SECTION 7b OWNEI&AUTHORIZED AGENT DECLARATION I, 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 Own er/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB � SIZE OF FLOOR TIMBERS 1 2ND SPAN t DIMENSIONS OF SILLS t i DII\,ENSIONS OF POSTS t 1 DIMENSIONS OF GIRDERS t HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE � t FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT A p) mo C(�k I (i � PHONE l 7 6&9 ASSESSORS NIAP NUMBER 6 LOT NUMBER SUBDIVISION C-D\)Q-M_ •U C0, t LOT NUMBER �_• STREET (��A ov C,V� STREET NUMBER ......r.r.rrrrr■rrr■rr.■■■r.■■rrr.r.■.0.... .■..rrrr.■..rr.r.■ r■r■■.■ �.......................... aOFFICIAL USEONLY.... a a.2 9 0....2Ia r RECOMMENDATIONS OF TOWN AGENTS err ■rr.r.■ ;��M " DA IF APPROVED r.■r C NSERVATION ADMJNISTRATO DATE REJECTED COMMENTS [Uo.,-- DATE APPROVED /• L� TO PLANNER DATE REJECTED COMMENTS r DATE APPROVED FOOD PECTOR-I-IEALTIJ DATE REJECTED DATE APPROVED SEPTIC WSPEC R-I-IEAI,TH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS �I,r ' DRIVEWAY PERMIT 7- l f-G �) 4/,3) DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE T• \ /9-3• \ �� �• _ j,.g.a.,;-meq:.^ � / / I / \ 1 r i Fir- \ 1 ��G � \� - ----------_ _ �/�� / l ��-161 `\ \� -_�� .•'� � ` j Totem �' ° ��• I °� 18G' / L PRANK TODD ��`�+ll & ASSOCIATES �-/+l LANDSCAPE ARCHITECTS SITE PLAN - LOT #2 I4.-lei.MA MVOV SHAHEEN RESIDENCE LIP COUNTRY CLUB CIRCLE - NORTH ANDOVER, MA Dtsmn: FPT Date: 03/10/00 / I \ Q• 1/ I; [W Scale: 1--20.0' GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. Permit Applicant Property address Map/Parcel Q 7e- 6-22- 88T Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw.I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit.Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement,restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw,provided that no additional residential unit is created. The lot(s)was/were created prior to May 6,1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land.For purposes of this section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density(buildable lots)below the density permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT IS GR OR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. 6 < o o APPLIC IV,— TURE DATE THIS FORM TO I36kTTACHED TO THE BUILDING PERMIT APPLICATION The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone F7am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity F7I am an employer providing workers' compensation for my employees working on-th1is job. Company name: f*RQ s� CO t� S`j�I�:J �'��t� Q t !y�a Address City: 0(i i�k1 ssbJPhone#: Insurance Co. A MSf2 t r_►4 0 lV-I-efi'0&T70(JgqL Policy#_ J)JC, _I O Q 00 Company name: Address City 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 well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under ains and penalties of perjury that the information provided above is true and correct. Signature Date�� ~ 00 Print name J 1�� I��t s� Phone# 118'6 - Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION 1547 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in U 0 V C/V 6'/Str€.et, subject to the rules and regulations of the Division of Public Works. l The premises are known as No. COU V1 ,r � C C"' Street or su division lot no. 46 (� dovel' :T) L-L C 965 To rkip Owner Address Contractor Address ppli t s S ature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to ®,�e,-- P 16, (1v" Clv , to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of P blic Works 6 / U✓�' 2Z� �v/l. Y Inspected by Date See back for rules and regulations No 997 APPLICATION FOR WATER SERVICE CONNECTION -�7':90o r North Andover, Mass. `•J 1�--- Application by the undersigned is hereby made to connect with the town water main in C UGZ /'4 k1v1� `-'�� st•we4- subject to the rules and regulations of the Division of Public Works. J f The premises are known as No. `--�"'"T �(�cl r CU ([l—C Street or subdivision lot no.4 Q Ute' 2-GC UI Le Owner Address Contractor Add res Appl c t atu re K rte` el' 2�®r PERMIT TO CONNECT WITH WA ER MAIN The Board of Public Works hereby grants permission to &,Auev- .l,) , C L to make a connection with the water main at cc) i vi fr CIL) i'( CStreet subject to the rules and regulations of the Division of Public Works. Boar of Public Works By Inspected by Date See back for rules and regulations r j Vt /C(ut) � r2 r 1 DPW 252 Date ...7:..1� -. q.. pOFlT/y ��� ,"� ,•,SOL TOWN OF NORTH ANDOVER RECEIPT a...,.a 7 °+.ieo.•°�t4y J.WILLIAM HMI, SSACHU Telephone(978)685-0950 DIREC' Fax(978)688-9573 This certifies that............. ...... ..�...c...........C .............. p ... ``....�.`...��... ..!..VC).......... . � has paid............). for... te�I +�... ' 1 f.T ��..�-c�-t (.6/lt � r• Received b (.�- t6 l. .... �r....� ' ...... � .......................... Department.....................po-4.4106....:(/..v..L9K.....-5......................... WHITE: Applicant CANARY:Department PINK:Treasurer DRIVEWAY PERMIT DATE -,j U C - �L LOCATION 6 l BUILDER phone OWNER Akl,')Ve,-- phone 6L79 THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET . CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. f I 1 ' I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 Release 3 I I I I Checked by/Date 1 I I TITLE: SANDRA & STEVEN SHAHEEN CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 4-14-2000 DATE OF PLANS: APRIL 13, 2000 PROJECT INFORMATION: LOT #2 COUNTRY CLUB CIRCLE NORTH ANDOVER, MA COMPLIANCE: Passes Maximum UA ;-- 1129 Your Home = 1046 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 3995 30.0 0.0 140 WALLS: Wood Frame, 16" -O.C. 4862 11.0 0.0 433 GLAZING: Windows or Doors $77 -0-330 2B9 DOORS 62 0.350 22 DOORS 57 0.330 19 FLOORS: Over Unconditioned Space 3048 19.0 0.0 143 HVAC EQUIPMENT: Furnace, 90.0 AFUE COMPLIANCE STATEMENT: The proposed .bull-dizig des -gn -describers.here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the appli-cable Standard Design Conditions found in the Code. The HVAC equipment -set cte-d to heat -car -coal,-the bui1,dj_Dg shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date Y TITLE: SANDRA & STEVEN SHAHEEN MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 4-14-2000 Bldg. 1 Dept. 1 Use I I CEILINGS: [ ] I 1. R-30 Comments/Location I WALLS: [ ) I 1. Wood Frame, 16" O.C. , R-11 Comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.33 For windows without labeled U-values, describe features: i # Panes Frame Type Thermal Break? ( ] Yes [ ] No Comments/Location I DOORS: [ ] I 1. U-value: 0.35 I Comments/Location [ ] I 2. U-value: 0.33 Comments/Location I FLOORS: [ ] I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Furnace, 90.0 AFUE -or higher Make and Model Number I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sour-ces of air leakage must be sealed. When I installed in the building -envelope., .r-ecessed .lghtng fixtures shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 Z/s) air -movement .from the ,the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm-in-winner -si-de -of .ali non-vented framed I ceilings, walls, and floors. I MATERIALS IDENTIFICATION:. [ ] I Materials and equipment must be identified so that compliance can I be determined. - Manufacturer manuals for all installed heating I and cooling equipment ment and -servi-ce -water heatin q p � equipment iaust be I provided. Insulation R-values, glazing U-values, and heating I eguipmerrt efficiency must be clearly marked on the building plans or specifications. I I DUCT--TXSU=IVX- [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I I HVAC EQUI-PMENT SIZING: [ ] I Rated output capacity of the--heating/cooling system is I not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. I - SWIMMING POOLS: [ ] I All heated swimmi-ng pools must have an on/off heater switch and require a cover unless aver 20% -of the heating ener-gy -is .from I non-depletable sources. Pool pumps require a time clock. I HVAC PIPING INSULATION: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in. ) : I PIPE SIZES (in. ) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.-0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I CIRCULATING HOT WATER SYSTEMS: [ ] I Insulate -circulating bot water pipes to the following levels (in. ) : I PIPE SIZES (in. ) NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F) : RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 1A-0-1-60 0.5 I 0.5 1.0 1.5 I 100-130 -0_5 I 0.5 0_5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- ORTIy Town o � 0, :.. .. Andover No. o 313 LAKE - o� ndover, Mass., g 00 0 t-COC MICME WICK ADRATED P- SA C H Usk IT FOR EXCAVATION AND - THIS CERTIFIES THAT ..1 .N... V.t { C� .... . ...... has permission to excavate and pour foundationb. .. . ........ .................... for the purpose of.�.. �.. .,�Z BAA3... 1 ...0 ..... .. 4 ..... . ..... ........... . ........... ... . ... The person accepting this permit must return to the office of the Building Inspector a cern ied plot plan show of building thereon before Foundation will be inspected. (o 44 10 '7 r VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. BLDG. PERMIT fEE 1 D `s 'VL LESS FDA FEEaw 0.4 0## .. .. ......... .......................... DUE FRAME PERMIT= BUIL.DMG MSPECTOR NORTH Town of Andover 0 No. 393 o LA0 dower, Mass., COC MIC ME WICK � ADRATE D P '�C S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT......A.A.do.o.to........ .. .........4..L-C.................................... . .. BUILDING INSPECTOR Foundation has permission to erect............... ...........61*.%*** .,.3 buildings on . O .a.. ..y ....C.�wy � CV .... �K4 Rough ` ' '� Chimney to be occupied as 9rem..'# � ... .�d.. ....to,�i•�+r...�►.1�1. �.R.............�5...�*�provided that the person accepting this permit shain every respect conform to the term f 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. ` BLEB. PERMIT EEE ' C) PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. LESS MA FE Rough PERMIT EXPIRES IN 6 MON7W FRAME PERMIT j&" Final UNLESS CONSTRUCTION TAR ELECTRICAL INSPECTOR 0 � Rough ........... ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner 1 Street No. SEE REVERSE SIDE smoke Det. Insurance Adjustment Service, Inc. 139 Billerica Road, Unit A-1 Chelmsford, MA 01824 (978) 256-3334 Fax (978) 256-3354 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B Date: April 22, 2007 TO: Board of Health/Building Inspector RE: Insured: Scott&Megan Dell'Orfano Property Address: 44 Country Club Rd No Andover MA 01845 RECEI D Date of Loss: 4/16/2007 APR 2 6 2007 TOWN ti OE TH A.DOVER Policy Number: 0005155267 AR`r✓�NT Type of Loss: Large tree was blown over onto Insured's fence, patio lights and pool cover. File or Claim Number: 40564-tm Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed$1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6,to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 38 is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, locations,policy number, date of loss and claim or file number. Thank you for your cooperation. Very Truly yours, Tim Martino Adjuster Ext. 135 Date. .�` �.�. .. ...... � f MORTM h 3Ql 0f., Sao �e 1tiOL � .- TOWN OF NORTH ANDOi • - PERMIT FOR GAS INST LATION s i • •' h gs,SSAC NUSES4 This certifies that . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .��� . .��: �. ��'.Y. . � . .�. . . . . ., North Andover, Mass. Fee.f\. .�''. . Lic. No.. . . . . . . . . . . .�...... . . . . . . . . . AS INSPECTOR Check# u ,)(IASSACHLSET[S LNIFORNI APPUCATON FOR PEKNUT TO DO GAS FITTNNG (Type or print) Date FORTH ANDOVER,MASSACHUSETTS Building Locations Permit# Amount 9i Owner's Name Awl.1,44� New r]i Renovation Replacement Plans Submitted ❑ L..7 pp F Fe •' p�p �>�r S7 Q 3 A � � o• a � ct a � o SUB -BASEM ENT BASEM ENT 1ST. FLOOR 2N D . FLOOR 3RD . FLOOR 1 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) [� s / C one: Certificate Installing Company '.Name Corp. \ddress �-Z) 10 F c�A—,l 11 Partner. --vt.6 Ct © Business Telephone—Cl �j / j_— >�� C]-F4rm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ©/ NollIf you have checked yLs,please indicate the type coverage by checking the appropriate box. 13 Liability insurance policy [3/ Other type of indemnity 0 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's,\gent Owner 13 Agent 13 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that,dl plumbing .vork and installations performed under Permit Issued for his application will be in x•rnpliance Nith all pertinent provisions of the Massach ,etts, tate G Curie and Chap 1442Zoft General Laws. Signature of Licensed Plumber Or Gas Fitter By: Titie lumber Citv;Tcwn Gas FittericL •camNim e aster ,\PPRO�"ED �-�CE r E C,J Y; Journeyman Date..../. y NOR7M TOWN OF NORTH ANDOVER 0 Ewa p PERMIT FOR WIRING SSACHUS� This certifies that ......� Y;�,��„u.��.r':'�............................................... ;has permission to perform .. ..... .. ... .............. ......................................... wiring in the building of..........:.............�...: :��!•..,�.f - .. ......... .......... ................ ..... =s:. ..,North Andover,Mass. Fee.:N Lic. �`�� �t ELECTRICAL INSPECTO I Check # �— F lw9h ��{{ Service Final (044 Commoawlcolt4 of m )3)ii8Cl 1mletB Office Use Only Dwarimerd of Public Safety Pet' No. a BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 cupricy 6 In Checked (leave blank) APPLICATION FOR PERMIT TO PERFORMM7'rJMRCTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Data City or Town of To the Inspector of Wires) The undersigned applies for a permit toperform the electrical work described below. Location (Street 6 Number). eLpe—"`�f� r Owner or Tenant 5c,4Del 6r � —7 Owner's Address Is this permit in conjunction with a building permit: Yes 0 No 1:1 (Check Appropriate Box) Purpose of Building Utility Authorization No. his"`Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ElUndgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work TOTAL No.of Liithting Outlets No.of Hot Tubs No.of Transformers KVA —Above n- No.of U htin Fixtures 1 Swimmin Pool rnd. ❑ rnd. Generators KVA No.of Emergency Lighting No.of Receptacle Outlets No.of Oil Burners Battery Units No.of Switch Outlets ) No.of Gas Burners FIRE ALARMS No.of Zones Total No.of Detection and No.of Ran es No.of Air Conditioners Tons Initiating Devices Heat Total TotalNo.of Sounding Devices. No.of Disposals No. of Pumps Tons KW No.of Self Contained Detection/Sounding Devices No.of Dishwashers Space/Area Heating KW Municipal �— No.of Dryers Heating Devices KW i Local Connection ❑Other No.Of o.ol Low VO tage No.of Water Heaters KW Signs Ballasts Wiring No Hydro Massage Tubs No of Motors Total HP X5 OTHER: _:���rnuo d -Poo INSURANCE COVERAGE:Pursuant to the requirements of Massachusttes General Laws el have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES O NO O 1 have submitted valid proof i of same to this office. YES O NO U If you have checked YES, please indicate the type of coverage by checking the appropriate box. %INSURANCE IR BOND ❑ OTHER❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ '00 work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: 3/ FIRM NAME 6 *�� /✓It_ LIC. NO. I�T Licensee � �i ? Signature LIC. NO. a 93ell Address Ci° 2 lee I-A, tS0J7 /U/t Bus. Tel. No. o3-5-9,5--9,'173 Alt.Tel. No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee does act have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement.Owner Agent (Please check one) reios,,...e ni.. - PERMIT FEE i JAN 3 URBELIS&FIELDSTEEL, LLP 155 FEDERAL STREET BOSTON, MASSACHUSETTS 02110-1727 ���'"�` THOMAS I URBELIS Telephone 617-338-2200 Andover e-mail tju@uf-law.com Telecopier 617-338-0122 Telephone 978-475-4552 December 30, 2004 Board of Selectmen North Andover Town Offices 120 Main Street North Andover,MA 01845 RE: PLISINSKI,ET AL. V. NORTH ANDOVER; ET AL. Dear Members of the Board: Enclosed please find two Clerk's Notice dated December 28, 2004. Please call if you have any questions. Very truly yours, T Thomas J.urbelis Enclosures TJU/lah cc: Planning Board Conservation Commission Heidi Griffin J. William Hmurciak Mark Rees Bill Collins sAwo5 ihvork\n-andove\plisinski\selecvnen.itr6.doc Commonwealth of Massachusetts Y County of Essex The Superior Court Civil Docket ESCV2002-01128 RE: Plisinski et al v North Andover et al T0: Thomas J Urbelis, Esquire Urbelis Fieldsteel & Bailin 155 Federal Street Boston, MA 02110 CLERK'S NOTICE This is to notify you that in the above referenced case the Court's action on 12/20/2004: RE: Plaintiff Paul P7i5inski, Margaret P7i5in5ki '5 MOTION for summary .judgment, pursuant to Mass. R. Ci v. P. 56; Motion for Partial summary .judgment brought by defts. , Stephen and Lisa Crowley, Crowley construction and Gener7 Contractors, wi77iam and Sandra Nigro, and sandybi 1.1 Realty Trust; P7ffs. ' memorandum of law in support of their motion for partial summary judgment., P7ffs. ' stateement of undisputed material facts submitted in support of partial summary judgment; P7ffs. ' exhibits in support of motion for partial summary .judgment; Affidavit of Paul P7i5in5ki; Opposition of defts. , Stephen. and Lisa Crowley, Crowley Construction and General Contractors, wi77 and Sandra Nigro, and sandybi 77 Realty Trust to p7aff5. ' motion for partial jJudgmen t; De fts. ' memoranudm 7n support o fthe i r oppos i t i on to p7aff5. ' motion for partial summary judgment; Response of defts. , to p7aff5. ' statement of undisputed material facts submitted in support of partial summary judgment; Defts. ' statement of undisputed material facts and app7icab7e elements of law in support of their opposition to plffs ' motion for partial summary Judgment; List of Defts. ' exhibits; Memo ins uspport of motion for partial summary judgment brought by defts. , ; superior Court ru7e 9a(b)(5) statement os undisputed genuine material facts and 7ega7 elements in uspport of motion for partial summary judgment of defts. , : List of exhibits of defts. , w7 77 iam and Sandra Nigro; P7ffs. ' memo in opposition to deft. 's motion; Third affidavit of Paul P7i5in5ki; P7ffs. ' response to defts. ' statement of undisputed facts and 7ega7 elements; List of documents filed under ru7e 9A. is as follows: MOTION (P#37A) After hearing, Allowed only as to so much of Count V as alleges violations relating to the lack of construction of the ditches. See decision on plaintiff's motion for partial summary judgment of this day. (Richard Welch, III, Justice). Notices mailed December 28, 2004 Dated at Salem, Massachusetts this 28th day of December, cvdresu1t 2.wpd 517503 mottext hinchion Commonwealth of Massachusetts County of Essex The Superior Court 2004. Thomas H. Driscoll Jr., Clerk of the Courts BY: Judith Brennan Assistant Clerk Telephone: (978) 744-5500 ext. 414 Copies mailed 12/28/2004 cvdresult 2.wpd 517503 motte t hinchion Commonwealth of Massachusetts County of Essex The Superior Court Civil Docket ESCV2002-01128 RE: Plisinski et al v North Andover et al TO: Thomas J Urbelis, Esquire Urbelis Fieldsteel & Bailin 155 Federal Street Boston, MA 02110 CLERK'S NOTICE This is to notify you that in the above referenced case the Court's action on 12/21/2004: RE: Plaintiff Paul P7isinski, Margaret P7i5inski 's MOTION for summary .7udgmen t, pursuant to Mass.R. Ci v. P. 56; Motion for Partial summary .judgment brought by defts. , Stephen and Lisa Crowley, Crowley construction and Genera7 Contractors, wi77iam and Sandra Nigro, and sandyb i 7 7 Rea 7 ty ,Trust; P7ffs. ' memorandum of law in support of their motion for partial summary judgment; P7ffs. ' statement of undisputed material facts submitted in support of partial summary judgment; P7ff5. ' exhibits in support of motion for partial summary .judgment; Affidavit of Paul PI isinski; opposition tion of defts. , Stephen and Lisa Crowley, Pp p Crowley Construction and Genera7 Contractors, wi 11 and Sandra Nigro, and sandybi 77 Realty Trust to p7aff5. ' motion for partia] judgment; Defts. ' memoranudm in support of their opposit7on to p7affs. ' motion for partial summary judgment; Response of defts. , to p7aff5. ' statement of undisputed material facts submitted in support of partial summary judgment; oefts. ' statement of undisputed material facts and app7icab7e elements of law in support of their opposition to p7ff5 ' motion for partial summary 5uagirent; List of Dei ts. ' exiiib�Ls; demo in supporr of mor ion for partial summary judgment brought by defts. , ; Superior Court rule 9a(b)(5) statement os undisputed genu7ne material facts and 7ega7 elements in support of motion for partial summary judgment of defts. , : L is of exhibi is of defts. , wi 11 iam and Sandra Nigro; P7ffs. ' memo in opposition to deft. 's motion; Third affidavit of Paul P7isinski; P7ffs. ' response to defts. ' statement of undisputed facts and 7ega7 elements; List of documents filed under rule 9A. is as follows: MOTION (P#37) After hearing, Allowed in part and Denied in part. The plaintiffs lain) have standing to assert their claim relating to the berm. The parties agree plainly 9 9 that the plaintiffs are parties to an agreement relating to the berm that is separate from the DEP order/agreement between the defendants (or successors in interest) and the Town and DEP. There is no dispute that the promised berm has not been built. The defendant Nigro's defense of impossibility (and perhaps cvdresu1t_2.wpd 517413 mottext hinchion Commonwealth of Massachusetts ti County of Essex The Superior Court defendant Crowley if an appropriate amended answer is filed and allowed) raises disputed issues of fact. This precludes summary judgment as to that portion of Count V. As to the portions of Count V that relate to the ditch and the grading. The ditch is dependent upon the Town/DEP settlement agreement that was converted into a court order. The grading is covered by both agreements. The defendants raise the issue of impossibility as to the ditch and claim that the town's approval of the grading is a complete defense. Because the plaintiff's settlement o the wetlands issues with the defendant's successor in interest covered the grading issues (see, eg.e. paragraphs 13 and 36) and the-defendants concede that the "as built" elevations differ, liability is established. The plaintiffs concede that damages remain a contested issue of fact. The fact that the town issued certificates of occupancy or approved the as built grading is not a defense. The plaintiffs have no standing to raise the issue of the ditch. Judge Lowey's Sept. 16, 1999 decision ruled that the plaintiffs were not third party beneficiaries to the Town/DEP/ defendants agreement. White the plaintiffs mount strong and cogent objections to this holding, it is the law of the case and this judge is constrained to follow it. (Richard Welch, III, Justice). Notices mailed December 27, 2004 Dated at Salem, Massachusetts this 28th day of December, 2004. Thomas H. Driscoll Jr., Clerk of the Courts BY: Judith Brennan Assistant Clerk Telephone: (978) 744-5500 ext. 414 Copies mailed 12/28/2004 cvdresu1t_2.wpd 517413 mottext hinchion Date. ..... . . .. ... . . NpRTIy pF "o , 4'p TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,SS�CHUSEt This certifies that . . . . . . . .. .'.: . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . ?. . . . . . . . . . . . .�. . . . . . . . . . . . / v in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . ... . .��. . . :'. . . , North Andover, Mass. Fee. . . ... . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . GAS INSPECTOR Check 4 MASSACHUSETTS UNIFORM APPLICATON FOR PERNU TO DO GAS FITTING (Type or print) Date /d/ O NORTH A/N�DOVER,MASSACHUSETTS Building Locations / �/ � \� �2+ �� C \ ?,C_ Permit# 6, 7 Amount$ Owner's Name9\ V C New Renovation ❑ Replacement ❑ Plans Submitted ❑ H z 0 a a > SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR , 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type)--) o ne: Certificate Installing Company Name \`l(ll►1��A � �hCh@�Z ,oea 1 Corp. Address t ❑ Partner. Business Teleplione ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter \1\�yV�11,�� 22���{1 (J Al INSURANCE COVERAGE Ch ec o I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked M,please' dicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner —1 Agent ❑ i hereby certify that all of the details and information I have submi ed(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installati s pei ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus tate s ode and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber City/Town ❑ Gas Fitter License um er Master APPROVED(OFFICE USE ONLY) Journeyman J Date..... � .... of No orH 1ti �r ,.t;�``-.-.•.�. �'� TOWN OF NORTH ANDOVER o ; p PERMIT FOR WIRING �sswcHusf� This certifies that ......... . 62� S .................i /Gl............................................. has permission to perform ...... .. ..............5......................................... . wiring in the building of �� u /,cX�.��........•... SSUc ............................ ................................. y , Fee... /....J... Lic.No. ...1 �S � E.... . .. .. .!.. ........( . ........... C .G;./.. ..... INSPECTOR . Check # EASTERN ALARMS & COMMUNICATIONS, INC. Town of North Andover 6/5/2002 7629 5680 • Permits 44 County Club Circle 35.00 i Eastern Checking Acc 44 Country Club Circle 35.00 �= The Commonwealth of Massachusetts Office Use On I 771. Department F3m t No.ip enf of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 ancy b Fee Checked Q•T� c. (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK CM 52 can 12:oo (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Da!e. W City or Town of I••C.. -The undersigned applies for a p44�ferrrmit I "l to perform the electrical work described below. --To the ltlspectrr of Wires: Location (Street b Number) 0i2 )n ) 'y (1U P Owner or Tenant Owner's Address )'F— Is this permit in conjunction with a building permit yes ❑ no JK (Che-.k Appropriate Box) Purpose of Building-h—I"_ L��E19116 'i IC Utility Authorization No. r+Existing Service Amps__ Volts Overhead . C1 Und 9rd El No. of Meters New Service Amps .I Volts Overhead ❑ Undgrd ❑ No. of Meters__ Number of Feeders and Am aci p tY Location and Nat••,e of Proposed Electrical Work rSFC'�//��T�y _r VL 1'� No. of lightinq Outlets No. of Hot Tubs INo. of Transformers ~TOTAAL F:VA No. of Lighting Fixtures Above In — -- 9 Swimming Pool` grnd.❑grnd❑ Generators KV No. of Recaotacle Outlets No. of Energencf Lighting _ ~ No. of Oil Burners Battery Units _ No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones TOTAL No. of Detection and No. of Ranges No. of Air Conditioners TONS Initiating Devices HEAT TOTAL TOTAL No. of Sounding Devices No. of Oiscosals No. of Pumps TONS KW No. of Self Contained No. of DishwashersSoace/Area HeatingKW Detection/Sounding Devices � No. of D ars Municipal Heatin Devices KW Local ❑ Connection ❑Other No. of No. of Law VoltageNo. of Water Heaters KW Signs Ballasts Whin No. of Hydra Massae Tubs No. of Motors Total HP OTHER:_ INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy lncluding'Completed Operations Coverage or its substantial equivalent. YES ❑ NO❑ 1 haave°submlited' valid proof of same to this office:YES ❑ NO a If you have checked YES, please indicate the type of.coverago by checking_ the approoriate box-. " INSURANCE ❑ BOND ❑ OTHER'[] (Please Specify) (Expiradon•D j Estimated Value.of Electrical Work $ Work to Stair Inspection Date RegUesfed: Rough Fns! Signed under the penalties of perjury: FIRM NAME __LIC. NO L" �7 t'L LicenseeSignAttir LIC. Nom�,?? Address - a• Bus. tel. No.t�' 7j Z Alt. Tel. N0. � ;qui ri OWNER'S INSURANCE WAIVER: lam aware thtit the licensee does not neve the insurance coverage or its subsfaritial equivalent as required b by Massachusetts General Laws, and that my signature on this applica!lon waives this requirement. Owner .Agent (Please check one) _-Telephone No. ,__PENh11T FIE (Signature of Owner or Agent) """ PATRICK J. DONOVAN ASSOCIATES, INC. etaim anal Ross .9d ustments P. O. BOX 110 WAKEFIELD, MA 01880 TEL. (781) 245.5540 — FAX (781) 2457016 April 18, 2002 m 7 � Building Commissioner City or Town Hall North Andover, MA 01845 Insured : Stephen & Sandra Shaheen Property Address : 44 Country Club Circle, North Andover Insurer : Preferred Mutual Insurance Company Policy Number : PHOO100640573 Type of Loss : Water Damage Date of Loss : 4/10/02 Our File # : WAP33542 Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned Insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. 1L� Vern Laws, Adjuster VL/mn ASSOCIITION OF INDBPRNDENT INSUKINCB MUSTERS NA ASSOCIATION NDEPENDENT of Massachusetts INRRANa Location yfLl � r,- / No. - � A 7�3 Date ? McoTil TOWN OF NORTH ANDOVER � 9 * ; , Certificate of Occupancy $ �'�s'••°E Building/Frame Permit Fee $ JAGMUS Foundation Permit Fee $ Other Permit Fee TOTAL $ Check # Building Inspector Town of North Andover o� HOR7h OFFICE OF 3� y`tt" °. COMMUNITY DEVELOPMENT AND SERVICES - p 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT 9S3ACHUSt Director (978)688-9531 Fax(978)688-9542 CHIMNEY APPLICATION AND PERMIT . DATE / (% cJ PERMIT LOCATION v JA)1 �L OWNER'S NAMEx/11 IJI) BUILDER'S NAME_��� -- -�;—t� j MASON'S NAME tJ& � MASON'S ADDRESS MASON'S TELEPHONE MATERIAL OF CHIMNEY 6.0eIe,07 K1(�' 6" c K INTERIOR CHIMNEY EXTERIOR CHIMNEY f NUMBER AND SIZE OF FLUES _/ THICKNESS OF HEARTH Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: �r DATE SIGNATURE F SON CONTR. LIC. EST. CONSTRUCTION COST fONTRACT PRICE PERMIT GRANTED FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Date. No 4- 6 A NpRT„ TOWN OF NORTH ANDOVER 0 p PERMIT FOR PLUMBING SAC04US� This certifies that . . . 0�.e`L <w �!� �f • • . . • • _ • . . . • • has permission to perform . . . . .,�Vl!E. `!� .r?�c�r2! - . . . . . . . . . . . . . . plumbing in the buildings of . . SH.f�,/, P r !!` . . . • . . • • . • • • • • • • • at. . .1.4.`! . . �.4�.{ .'? :! . �• G• •�• •C•t•1^, North Andover, Mass. Fee.7 9-F, Lic. No.. . /.5.,(?.� . . . .!, .. . . . . . . . . %. . �, t PLUMBING INSPECTOR Check # 12 L 7 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLIC=9VNA%et&/ PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /AOD Building Location "I �1�\ e Owners Name V/ /y Amount 7 Type of Occupancy2 New Renovation Replacement r-1 Plans Submitted Yes El No FIXTURES f. w x a E~ a ~ �" x >4 d W W W d W a ,W.� Ln xd F, E- F a s d Z Q d F J � A A ►.� � a d A SCRBM &��1VIIVT IST:FIOQt M FIOQZ 3m ROm 4IH RUR 5IH RaR 6M FLO R 7M ROQ2 8M HIM (Print or type) ` Check one: Certificate Installing Company Name 1<t'h _ Q?wenC�uz El Corp. Address0 ov Partner. © G Business Telephone — El Finn/Co. Name of Licensed Plumber. "V1� L�� �2�GJ�►`�-1�e�� Insurance Coverage: Indicate type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity D 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 H Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and ins erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach t umbing Code and Chapter 142 of the General Laws. By: igna ot Llc=eaum er Type of Plumbing License Title City/Town ice se NumSer Master El Journeyman APPROVED(OFFICE USE ONLY r- '- , �-:'J N2 ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSAcwUS This certifies .............................................! .. ............... 4.... ........ has permission to perform ..... .. ........... .................................. ........... ..... in the building of......:�....... .......................................... wiring at........I..................................................... ......... North Andover,Mass. Fee.. ......... Lic.No.....v ...... ............................................................... "I', ELECTRICAL INSPECTOR Check # —1 � WHITE: Applicant CANARY: Building Dept. PINK:Treasurer RE09WONWE4LTHOFAI "CHUS1"n.` Office Use only S DEPARTA10VTOFPUBLICSAFM Permit No. �L/ BOARDOFMEPREVEM ONRWUL477ONS527CMR12-M - ay � Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DaW 16 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) "1 H r, u (7/ t Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building /� ,�o, lP )-✓a wi r L Lt ��r,,P I L;'✓J G�� Utility Authorization No. Existing Service Amps Volts Overhead Underground a No.of Meters New Service 10101' Amps4h2a/ Volts Overhead Underground ®� No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets %I. No.of Gas Burners iso.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Ltitiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER- lnsua=Cmcmge Rnuatt{tathetagtzmlalEsdNbsmdxseusCoydLaws Ihmeaatna3Liabildyhu==PbhymAdmgCm#dd OP Caaag crtsgbst tialegunalut YES u NO Ihaw aftn&dvalidptoofofsa=1otheOffl=YES [a NO r7 IfjcuhawdvdWYES,plea9 mdr*theNxof omaWbydakingthe WSURANCE BOTS Ortl lER M (may) Expir�6m D& Eshm&d ValuedUerhical Work$ wakmsut /0'30-,2060 hspedmD&RawW Rough Final Sighedutxiff-SafpajteyL;oa>SeNa l� 3 S FIRM NAME ' Lioam I-U A in/ y;YZ n IJ en<,- t Pnrl r l 57- S�Lr'vr� .il/_!-1 d 3 0 7 AltTelNa OWNER'S INSURANCE WAIVER,IamawatethattheLioawdoes CaraalLaws and#AmysgEMm<:nthspemftappficMmv i\csdzmW*wncnL (Please check one) Owner M Agent Telephone No. PERMIT FEE$ Town of North Andover �tORTH .1 �+ O Building Department b'a o 27 Charles Street 1 -' North Andover, Massachusetts 01845 * (978) 688-9545 Fax (978) 688-9542 P O CO[NI[MKx 1 .Q 4CHUS APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS L/L/ C 60 nl T 2 CC u n C c 4-r LOT NUMBER SUBDIVISION Q J N;fkY C4,U Q C f RC r DATE REQUEST FILED DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE C�1= ks�� FFICIAL USE ONLY ROUTING CONSERVATION DATE PLANNING DATE G l 9 U D.P.W. -WATER TETE R, DATE /0/ W. MUST INDICATE THAT THE WATER METER HAS EEN INSTALLED PRIO TO TW INSPECTIO REQUE DATE. G ATURE-/D W A HORIZA BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 022988 + 3 Birthdate: 10/31/1943 Expires: 10/31/20011 Tr.no: 8744 Restricted To: 00 JOHN GRASSO 865 TURNPIKE ST L.�w•+.•tr�i!� . NO ANDOVER, MA 01845 Administrator r f � ��e'l.�anmxaotuirall�o����aac�uael a f HOME IMPROVEMENT CONTRACTOR Registration 113130 . p Type - PRIVATE CORPORATION Expiration 05/18/01 G GRASSO CONSTRUCTION CO., INC. JOHN GRASSO G� rGo 7� DS'� TURNPIKE ST ADMINISTRATOR N. ANDOVER MA 01845 r 9 , F� GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW 1 POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspectionsINSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway i Continuous strip footings for interior columns U � I plate. � T o 3 �- 08 H L J H �� 90 [64 un I I LL Q b a A 0 Z LV H ' • z � H � v Boz AZo U G7 w � � x a° Fu �01 rw* l ORT Ah N hI. o oover LA o y 0 . clover, M ss,, COCMICMEWICK V ��A�RATEO PPS\ �5 '9S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System ..... ......... ......... BUILDING INSPECTOR THIS CERTIFIES THAT .....Ao.do.vto........ .........A..,C....... . .. .. . ... t '• • Foundation has permission to erect...............f...... ...... ........ buildings on . O .a. '..' ....CiRu + Rough t0 be occupied aS. ` I Chi heycK � p el.�r.e0Pn,.3......... .3 .. ....0 1............S.��u. �. ........:.�..:`. . :. yc... provided that the person accepting this permit shal in every respect conform to the term the appl�con on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and{Cgnstruction of �- Buildings in the Town of North Andover. y P n� 'FMff O's PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. LWIFIN , LFUM MW - �- PERMIT EXPIRES IN 6 MON AL UNLESS CONSTRUCTION ►AR CTRICPEC ` ............ .. .. ........... BUILDNG INSPECTOR Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises - Do Not Remove Rough No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. 'Burner Street No. p It &&Y) SEE REVERSE SIDE smoke Det.0 4/1') Location y C v,�-i� C�l�b Int er No. r7,7./, Date ^TM TOWN OF NORTH ANDOVER O't.•o ,•'�.y0 0 •. • p� 9 ' Certificate of Occupancy $ sACMUs<� Building/Frame Permit Fee $ 30 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 30 0 Check # i 7 "i / / `�sy� Building Inspector s TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING F9 � , , m BUILDING PERMIT NUMBER: DATE ISSUED: � SIGNATURE: Building Commissioner/Insvector of Buildings Date SECTION I-SITE INFORMATION 11 Property Address: 1.2 Assessors Map and Parcel Number: . yU o� /y Map Number Parcel Number O 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronts ft 1.6 BUIIAING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. blood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1Is,:0110 Listrict: Y(,,,- talo 171 2.1 Owner of Record 1� Name(Print) Address for Service: k Signature Telephone oV 2.2 Owner of Record: 0 Name Print Address for Service: 171 Si nature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: GP��q��i��I Not Applicable ❑ Licensed Construction Supervisor: . ���c. �,,, � 6�roXei, License Number Address > 7 7Y Z.5/ 4$✓� Expiration Date S' n re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company a Registration Number r' Address /� Fldl-1-2 7F Expiration ae Si nature Telephone r r a SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check ad a Ucable New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: e �G SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit a licant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 004, Cb Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> as Owner/Authorized Agent of subject property Hereby authorize to act on My behal i all matters relative to work authorized by this building permit application. Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, enc i v. as Owner!Authorized Agent of subject property t Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS 15 2'n 3RD SPAN DINIENSIONS OF SILLS DM ENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY --— IS BUILDING ON SOLID OR FILLED LAND _ IS BUILDING CONNECTED TO NATURAL GAS LINE - 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 jc✓ C�l©r�G�+'1� PHONE LOCATION: Assessor's Map Number C2 e/ PARCELG°7 SUBDIVISION LOT (S) ME STREET �yK Jr Ck6 C47c `" ST. NUMBER OFFICIAL USE ONLY ***** RECPWMEN__0AI TOW A NTS: 1 �CONSER ION A INISTRATOR DATE APPROVED U"1 DATE REJECTED COMMENTS V PLANN DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm The i Neve -Morin RECEIVED Group, Inc. MAY 13 2005 BUILDING,Qgp-r. May 11, 2005 Mr. Michael McGuire Building Inspector(Residential) 400 Osgood Street North Andover, MA 01845 Re: 44 Country Club Circle Owners: Megan& Scott Dell'Orfano Dear Mr. McGuire: The Dell'Ofano's wish to build a pool in their back yard at the above referenced site. Their contractor, Kevin Belanger of Aquatime Pools, attempted to pull a building permit however, you have asked that an engineer provide a letter certifying that the proposed location of the pool is located within the General Zone of the Watershed Protection District. This site is located within the Residence 1 District (R-1) as well as the Watershed Protection District. As you are aware the Watershed Protection District is divided into four zones: General, Non-Discharge, Non-Disturbance and Conservation. We were the design engineers for the development and flagged the wetland resource areas around the property as part of the Definitive Subdivision design. Find enclosed a copy of a plan showing the as-built dwelling location on this property. This plan also shows the limits of the Non-Discharge Zone associated with wetland resource areas which exist in the area. Based on the design plans we have been provided we have superimposed the proposed pool location onto the site plan. Since the proposed pool_ is located beyond 400 feet horizontally from the annual mean high water mark of Lake Cochichewick and all wetland resource areas located within the watershed the proposed work is located in the"General Zone". ENGINEERS • SURVEYORS • ENVIRONMENTAL CONSULTANTS • LAND USE PLANNERS 447 Old Boston Road (U.S. Route 1), Topsfield, MA 01983 978-887-8586 FAX 978-887-3480 Providing Professional Services Since 1978 Mr. Michael McGuire, Page#2 May 11, 2005 I hereby certify that the proposed pool construction shown on the enclosed plan is located within the "General Zone" associated with the Watershed Protection District. In accordance with Section 4.136 (3)(a)(i.l.) and Section 4.121 (7.) of the Zoning Bylaw the construction of a pool is an allowed use in the "General Zone". If you have any questions please do not hesitate to contact me. Sincerely, THE NEVE-MORIN, GROUP, INC. OF ` M . r✓1 eriw— 2� JOHN M. q�yG MORIN m John M. Morin, PE CIVIL y Executive Vice President No.39836 JMM/jmp Fss�llNAl Enclosure cc: Megan& Scott Dell'Orfano Kevin Belanger 2424Nabi.doc 08/03/04 14:46 FAX 878 837 3336 _ NORTHERN"�1SSOC a ARTHUR&GILLIGAN Q001/001 MORTGAGE INSPECTION PLAN NORTHERN ASSOCIATES, INC. 401 SOUTH BROADWAY,LAWRENCE MA.01845-3522 TEL-(978) 837-3335 FAX:(978) 837-3336 MORTGAGOR: 5TEPHEN J 4 5ANDKA A 5HAHt f-N =0 REF: 8501/G2 LOCATION: 44 COUNTRY CLUE CIRCLE PLAN RIrF: 13365 CITY,5TATV: N. ANDOVER, MA SCALE: 1"=80' DATE: 7/2G/04 J05 #: 204.OG 158 � `9S G N //// LOT 2 p / / 87, 121 .� h 2W004 #44 --(V 400' no disturbance zone r N I / Sc9 U) r� �,•`e ease G� h R.�24x'77 olb �nvN 74U,W dD)r VFW ealnowu1 r.r raw . ...r..---j, suG}esD do pua ss6D6ssow p}as OW uD�{j r°r oue v 49 -- Pe%t M"Pod "am tuad pau}w.wsap FWWMR POOU P}Ds Um4r Ail saDDeu +4< et�i euacr o = 'su io Alum n6;us+uedsaa su iidsooD 'pdMH P00td eu}tu,tesep of s4wotg'us a} tto} �! •gam n4!(1S vu saruntsD yu , Pint ei tissssp nriaaseuode.A 'wv P'O"X POU D tc} a} eanoXeud '8 G7 a� ) }A&U& did pati tu�u j ':s IA 4"10 49 IUTMp PMU 'As Pu a} amOK1rg7 jd&d 'I o �N 15S3,r�6 am paD i o PLO A Ram 0o 'oe6 v-�O,* NO IOWA suo}aymd ^ o� papq� sgsR pug u D of �ow RADXV u jO�to°►u.}auoa jo ettt}i evs tD s=uatutuyrtbec goDq�7�t�Of�owsp R�o�d sDq asD uo ei}� yu—j1esf° w i uou0}tD-1 um"t sam7on ata wig r `� 944-r,;►7vftl�eu}0; Pam rq of ;Qu 04D puD ntuo 110.+71[Wt tun a SAO PuD7 7ouD aiasu Too a�Dt"iJ 6sva B aPup punm6 u° pes" n6Teiasu}zouddD ssMzp pup utnp vt ut to IUSOE 8it°am/ eYi n4 Pe4`i l+a r�oii+a+gasdo� Oapr 'uol�On+ptuo° a �cttos +P UM s6963AOR aQ! #Wopuz= :�aosut/ �Y7Srat S 1d��. Pns'�,ao'd and Ous7ourrau mol P+m 7tmunt su}t �arsDpsoa°n us Pacndud sant u°}pladxuz e6�}toiu "11Z d0 F1L pug .4 pusl D so ttod4� F"I- sq of sou as Pe�pug e�a''BORG&Md v6DQeAau Aril RnDaslsssds uoiMcfeul "Um nut scar . VP 49 iQz Uv* XuoO ;v,p17 as}oatd'paul,uf',ead 8% l�an.t tat;uoo Molttari G Jo/put &IM R9 Pmsn ae� swag t ug�ap tt fou ,e;Junoyn ntutssaoau';ou sL Put altos fiq paat2uatajap uaaq S-ry auox p.Atx� pooh =01 021-411212Z) Board of Building Regulations and Standards 4� One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 124884 Type: Private Corporation Expiration: 9/8/2005 Aquatime Pools Peter White -- 7 MIDDLESEX RD. Tyngsboro, MA 01879 Update Address and return card.Mark reason for ct Address _ Renewal _ Employment _ Lo Board of Building egulations One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 07/26/1959 Number: CS 059582 Expires: 07/26/2006 ' _.._= Restricted To: 00 PETER F WHITE 440 MIDDLESEX RD#102 _ TYNGSBORO, MA 01879 ggtt7f +N F' no: 740.0 Keep top for receipt and change of address notification. DPS-CA1 0 50M-04/04-G101216 ✓1GG U/L✓.7'20720IZ11{CQGU2 OZ ii�(�L(xQ6Q�f2000P.� • . BOARD OF BUILDIN6 REGULATIONS License: CONSTRUCTION SUPERVISOR T •_ � Number:,-CS 059582 Birthdate 07/2611959 07126/20.06 Tr.no: 740.0 Restricted QO ;c PETER F WHITE- ' 440 MIDDLESEX TYNGSBORO, MA 01879; // Commissioner Y .IUIY—G7--GA.E;UKUTM'i GERTIFIL.A� ,vv vv v ' 1 t UI- LIABILI I Y INSUKANUZZ 06/29/2004 Pao GM (978)433-2728 FAX (978)433-8658 THIS CERTIRCWTVIVISSUEDASAMATTEROFINFORMATI N David H. McDuffee Insurance Agency, Inc. ONLY AND CONFERS NoRICrHTSUPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 3 .H®19 i s S t. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, PO Box 1497 Pepperell , MA 01463 INSURERS AFFORDING COVERAGE NAIC# INSURED Aquatime Pool & Spas, Inc. INSURERA- Peerless Insurance Company 2419A 7 MIDDLESEX RD. INSURERS: CUMMOrce Insurance Company 34754 Tyngsbaro, MA 01879 INSVRERC: ASSOCIATED INDUSTRIES OF MASS CAIN) INSURER D; INSURER E; COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.N07WITHSTANDIN 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, LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE DATE MN/DD LIMITS GENFRALLIABILIY BOP3000121704 04/26/2004 04/26/2005 WH OCCURRENCE s 11000,000 Q KEN I E07- X COMMERCIAL GENERAL LIASILRY s 300,000 CLAIMS MADE a OCCUR MED EXP(Any one person) S S'000 A X BLANKET AD INSURED PERSONAL&ADV INJURY S 1,000.000 GENERALAGGREGATE $ 2 000,000 GEITL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000 000 POLICY 71 PRO LOC JECT AUTOMOBILE LIABILITY 03MMN34214 11/03/2003 11/03/2004 COMBINED SINGLE LIMIT S ANY AUTO (Es awmaM) 300,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per per—) B HIRED AUTOS BODILY INJURY b NON.OWNED AUTOS (Pat a0wenq PROPERTY DAMAGE. S (Peraock%ni) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EAACC 3 AUTO ONLY. AGG 3 EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE 3 OCCUR CLAIMS MADE AGGREGATE S d DEDUCTIBLE S DETENTION 3 3 WORKERS COMPENaATION AND WC0327550 01/03/2004 01/03/200S XTOjiY41IITs ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 C ANY PROPRIETOR/PARTNER/MCU7WE OFFICERMIEMBER EXCLUDED? E,L DISEASE-EA EMPLOYE S 100,000 r eewbe 500.000 SPECIAL PROVISIONS below E.L DMEASE•POLICY LIMB 3 ER DESCRIPTION OF OPERAMONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 3HOUID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI r cn BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY AQUATIME POOLS & SPAS,INC. OF ANY KIND UPON THE INSUkMITS ACEN73ORREPRE8ENTATIVES. 979-251-1851 AUTNORQED RFpRESENTATryE Carmen Server SARVER ACORD 26 poolloa) OACORD CORPORATION 1988 TOTAL P.01 • - — - — ...�..,.�. u--ti� vt .—Vtl ,vr-�, s�Jiv`I ( f : DEF FH ? _� •1..wi.rG�L ��lt=��►�. ..� GOO=S VOLUME 11 ,gTnr CON O ki U n1 J t 5 i J Ft — � C o r-. SO. FilG_ 11METE, I NOTE S) �) C.C?�; `�C�� S i It�v C,i h j..�,! ?L! L.^��_^, t�5 •_ —MIN EKEX, h71t�JI�� i^.�✓ ✓� 1 ��"+ i..f I l - `� \ l \_fl. `�� f �_�.'� .V i JVU,IL PER C_u 'ii-z �:ti ! l`�l��v 1`:Ct`�..i�:`i. � % �� \ j � �� ,•��"i���;+J� ("1IYl i :1 ini ,�/✓ f'✓ '�_.t � n�.=4 1x:'1!1! ` ll�_'t!— - !ti=:�._ } it o ?;,' A \r r.DDR,_��.. i A1C=1 ' '`_^],IQ Grl-;' I-v= V�i V^ S � vT'IJ' `( iv'. I� �l WIA . ��d JJ�li"� �; t t, !�� � � �t — i��t 1 3 i HON— IM I`i_ ( Mnr 300K . =I_J: �! /5-✓ �!c P.AG_:L' � , GA!C np AWN: I� OWNER. p .. �/L,J AORToi T0VM of over No. f �'30Dsoft �, _-= -LA E dover, Mass., G ? to Soo* COCMICHE w ICK %p ORATED `S BOARD OF HEALTH PERM/ IT T D Food/Kitchen Septic System C+ BUILDING INSPECTOR THIS CERTIFIES THAT ......................�.......//I............A !1� ............................ ...... .......... ........... has permission to erect.. .rdo...... ��' ....... buildings on �rrN s � � Roanon gh��► �s. N • w r+orto be occupied as... .......... u�+dC 9 .... .... ...................................yA 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-La s at' to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 4 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ST TS Rough 4 ............................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be:Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.