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HomeMy WebLinkAboutMiscellaneous - 468 WOOD LANE 4/30/20180 N � N co O � O o N 0rr O D O Z o "' 0 Location No. �3 Date ,.ORTIy TOWN OF NORTH ANDOVER O i Certificate of Occupancy $ �',b'••� '<�' SJACNUSE Building/Frame Permit Fee $ S Foundation Permit Fee $ I Other Permit Fee $ _.i TOTAL _ $ Check # ► 4759 Building Inspector 1 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Conunissioner/Insp6tor of Buildings Date SECM-ON-t- SITE-PfiFORMATION-.- -- 1.1 Property Address: &)0vb- 6 _ 1.2 Assessors Map Number Map and Parcel Number: Parcel Number if 1.3 Z Information: Zoning District Proposed Use % AW L WD�t�v 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Name Pri) Front Yard . Side Yard Rear Yard Required Provide Required Provided Required Provided 0 34. Ago )rl go Ioo 4- 1.7 Water Supply M.G.LC.40. Public f$/ Private ❑ 54) 1.5. Flood Zone Information: Zone Outside Flood Zone � i.8 Sewerage Disposal System: Municipal C� On Site Disposal System ❑ -Pa�A SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT _ 2.1 Owner of Record % AW L WD�t�v Name Pri) Address for Service Sig dture 7 Telephone - 2.2 Owner of Record: Name Print. Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Const ction Su rvisor: Not Applicable ❑ Licensed Cons-iju n Supervisor: cense Number Address r Expiration Date tgnature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number 7-1-0 Address Expiration Date iLna�E Telephone -Pa�A SECTION 4- WORKERS COMPFNSATTON M C_ T V 141 R 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) 7Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify J Brief De sc 'ption of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be QFFFj(CIA 1, USE ONLY Completed by pernit applicant 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) J�S / 5 Fire Protection 6 Total 1+2+3+4+5 OD Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH DING PERMIT 1, as Owner/Authorized Agent of subject property r Hereby authorize ✓ to act on My behalf, in all i frers relat*'e to work authorized by this building permit application. Si nature o Owner Date SECTION 7b OWNE AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Herebyleclare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief ti Print Name ti S Signature of Owner/A ent X Date ,. NO. OF STORIES . %`. SIZE -� BASEMENT OR SLAB SIZE OF FLOOR TINMERS I sT 2 3RD , SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS h HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X 1 MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE _ �` ✓/re ooryvno�uueaCtl o�'. i1/laa�actu�avlt ' E BOARD OF BUILDING REGULATIONS „. License: CONSTRUCTION SUPERVISOR Number: CS 017853 �Birthdate 66/24/1931 , `a Expires 06424/2002 Tr. no: 27914 Restricted STEPHEN -R COTE, r 468 WATER STS% 3 HAVERHILL, NIA .01830 Administrator DIMENSION 2000+ BUSINESSOWNERS DECLARATION BUSINESSOWNERS RENEWAL DECLARATIONS 02 RENEWAL OF ODN 6123106 From To ALLMERICA FINANCIAL' CITIZENS INSURANCEO HANOVER INSURANCE'S MASSACHUSETTS BAY INSURANCE COMPANY Named I' sured and Address Agent STEPHEN COTE DBA 978-373-5654 COTE CONSTRUCTION ANTHONY & MALCOLM INS. 468 WATER STREET AGCY,INC.,3 SO.CENTRAL ST. HAVERHILL, MA 01830 P. 0. BOX 5128 BRADFORD, MA 01835 Policy Period: Beginning and Ending at 12:01 a.m. Standard Time at the Location of the Described Premises. Business Type: INDIVIDUAL. Mortgagee/Loss Payable: Business of the Named Insured: CONTRACTOR. In consideration of the premium, insurance is provided the Named Insured with respect to those premises described in the 1' Vlil �1 v +-+v a ar•,i 1.., a vlu�1 . TNSTRUCTIONS: 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. �rrrrrrrrr■rrrr0rrrrrrrrrrrrrrrrrrrrrrrrrrrrrr�rrrrrrrrrrrrrrrrrrrrrrrrr■rrr APPLICANT 0 D0L PHONE ASSESSORS MAP NUMBER G o LOT NUMBER — 9C2 SUBDIVISION LOT NUMBER STREET 10PO-b STREET NUMBER 46 ��rrrrrrrrrrrrrrrrrrrrrrrrrr■rrrrrrrrrrr�rrrrrrrrr�rrrrrrrrrrrrrrrrrrrrrrrr■ OFFICIAL .USE ONLY �rrr��r�rrrrrrrrrrrrrrrrrrrrrr'rrrrrrrrrrrr��rrrrrrrr..'prrrrrrrrrrrrrrr■. RECOMMENDATIONS OF TOWN AGENTS w/ irrrr�rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrLrrrrrrrrrrrrr DATE APPROVED CONSERVATION ADMIMSTRATOR DATE REJE�p CONNIENTM DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR -'HEALTH DATE REJECTED DATE APPROVED. SEPTIC INSPECTOR - HEALTH DATE REJECTED CONRv N'TS PUBLIC WORKS - SEWER / WATER CONNECTIONS _ DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CONUvfENTS RECEIVED BY BUILDING INSPECTOR DATE I own OT Nortn Anclover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 ....°(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION I b 000- G4 JE �%Q<rli-. I4460vez- Af* i�uiliuci - Street Address "HOMEOWNER gAKV '/t%�(7a -6F7' F74P,576 S76 PRESENT MAILING ADDRESS City Town Home Phone State ,SSACI dig Map / lot 7S' if a6 Work Phone Zip Code The current exemption for "homeowners" was extended to include owner --occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does . not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1)' DEFINITION OF HOMEWOWNER: . Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection pnoc9dores and requirements and that he/she will comply with said procedures and requiremen HOMEOWNER'S SIGNATU APPROVAL OF BUILDING OFFICIAL OQ Town of North Andover tyoRTH O Building Department o 27 Charles Street North Andover, Massachusetts 01845 z ry 978 688-9545 Fax (978),688-9542 °9 coC K. �.—A-CHUS� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit"# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 56a. The debris will be disposed of in /at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. MORTGAGE PLOT PLAN EK SURVEY INC. MORTGAGOR kwf DEED REF. PG, V(o ADDRESS OF PRINCIPLE BUILDING PIAN REF. Yea 5 DATE OF INSPEC11ON r1 M, i� /9q8 /60.0' \0 A, ��NeS ('OT5� nl.popa&k >s.C.« �a d 1 0 sroe y Ao� 060 NOTE: This mortgagye Inspection Yrs prepared . �V`�X 1 FURTHER SATE THAT IN lay PROi`MOHAL WectfecdIbe Wed ly for tnortgage putpoaes and Is not too� T. OPINION the. Principle erucbiue/s and accessory upon as a wjm)k EX SUZS11trY no responslbltty for damn app RUDEL H outbuAdtnga, ,n/I�d/rl.� rs mcd by onyons other than the Bald moat a No. 36M with the setback y 9 � ►e►qtttrements of Ehe lord and Its ass(gns h Connection With Its proposed zcnln0 Wftonces. and that no enoluoachmWdj mortgage financing to said mortgagor. �'"�s �E�ISTEaE �� of major Imptownentu either tray coma, CERTIFICNTION T0; property lines "t as shorn. LEADER MORTGAGE COMPANY, INC. fl. Property la hot In a Flood Hazard Area. Thb urtiftoatlon isbased on the locdlon of 'WV%y markets C12 Property V ht a Fl E32. Ana. of others, dnd done not ropraaent n property stMy. thernfory L] lnformntlon is tsLttlydent to sietecm>ne Flood Hazard, offsets shown are, not to bre Used for the eatobltshment of Flood Hazard detatmined boas %a Wft} Fedord Flood property Kress. Insurance Rote Map Pandp z�,,39;6 _ �G CcIZ/rl3 m m m m 0 CO) aZ CD O CL r- d d CL a� -o 0 o p CL c� �G d CD O .. -. CL v CD 0 CO) 10 CD 0 M O CA 0 CA C) CD CCD CO)CD CD 0 CD O CD Q y O cr H CL < m CO) a�m0 m c7 cacao m Q ca P roc Z a= vi O .5 —O go H T a. Er o sd o m : p O m ® CD n O 7 -0 O .{ �. % O O� p H, n 0 :441b 00a ��"aa H o l� Q. zMCC #b b 1ff„^^ co O Er' co Cn CDc�= o o m o 7O O dy V N CSL cr so Cry c 91 _fn /-�, yIj CD m H V) N O C y � �l 2 O 3 �CD S o zo=r 0— A 00 �zCA � CD W � io CD co CK O` C.) F2. 1 Pao O€ �CD 1 C/) C/) 'X Cm z EL x n z q, C/) PIZ, (� r nC. O y � " CD C) O y � z 0 �j uj Or, 0 c 11037 Date ....... S ... 1.1.115 ....... TOWN OF NORTH ANDOVER DV)46,) TA4-c--eJ This certifies that..... .................................................... has permission to perform ..... ......................................... .................. plumbing in the buildings of ..... ...... V.. C ....... I .... .......... A.. ................... North Andover, Mass. Fee.(4).b6l ........ Lic. No. .. .....1....1........................................................ PLUMBING INSPECTOR PERMIT FOR PLUMBING L, R 2-6 A Ched, � - I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �l a CITY la Aj"v, �_ MA DATE, i PERMIT # JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS ! TEL FAX j TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL - PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES N00 FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM € DEDICATED GREASE SYSTEM ( E E ,_ __. ___ 1 _____( ...___1 _(.... .... ... € DEDICATED GRAY WATER SYSTEM€ _ .... (. ( I _T._. i _... ( _ (._ ! �( ( (( ..... . I I I DEDICATED WATER RECYCLE SYSTEM [7.7 —_? _I --( DISHWASHER DRINKING FOUNTAIN _ �i ! _- _i _---___ FOOD DISPOSER FLOOR/ AREA DRAIN i �_._:...1 _-.__f ._.__1 _._� { __..__.1 ____1 -__....__( _. __..( ..____{ __ _._! .._.---� _ I INTERCEPTOR (INTERIOR) i r.__f _ ! _ ; ( _ _I _.._._1 _. 1 ___,_. i __..__f _.._.. _._! ______1 I i .__--_.I KITCHEN SINK (_ LAVATORY ROOF DRAIN...._---( .._ .. SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION L WATER HEATER ALL TYPES WATER PIPING OTHER I INSURANCE COVERAGE: I have its -..(v( 0f a current liability insurance policy or substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND O-! 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 O AGENT �] SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1 r—I—_ PLUMBER'S NAME��J -! �_- �r_J_��"5 LICENSE # 1 `i G Jf /�--- SIGNATURE (VIP Eff"", JP CORPORATIONI # _ _i PARTNERSHIP O# # LLC j COMPANY NAME o(G.- to P ; ADDRESS CITY ►^� e r t+�,.i ;STATE ► �} zip O t b 4 �/ TEL C �S 6 a I (G FAX �� CELL j 7 LI a EMAIL 0 F z U1 ❑ The Commonwealth of Massachusetts - - Department of IndustdalAccikl is Office oflnvesiigations 600 Washington Street Boston, MA 02111 www.mass.gov1d1a Workers' Compensation Insurance Affidavit: BuUders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Leibiy Name (Business/Organization/.tndividual): Address: F J City/State/Zip: (\ g-, f11A d Icy `1 Phone #: Are you an employer? Check the appropriate bog: Type of project (required): 1. P 1 am a employer with 4• El am a general contractor and I 6. [J New construction employees (full and/or part-time).* have Hired the sub -contractors listed on the attached sheet. �• ❑Remodeling 2. El am a sole proprietor or partner - ship and'have no employees These sub -contractors have 8. E] Demolition working for mein any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its g. n Building addition [No workers' comp. insurance officers have exercised their 10.❑ Electrical repairs or additions required.] 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11. umbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roofrepairs insurance re ed. 1 employees. [No workers' 13F] Other comp. insurance required.] xAny applicant that checks box#1 must also fill outthe section below showingtheir workers' compensation policy information. 7 'Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. ?Contractors that cheokthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. X am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:- Policy # or Self ins. Lic. #: Expiration Date: Job Site Address: Lf G 1 1' 0 O pity/state/zip:,� j� E � A—o, ver- ''`ti ✓+ . Attach a copy of the workers' compensationpoUcy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of a fine up to $1,50 0.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cert under the pains and penalties ofperjury that the information provided above is true and correct. i-1— p,,,,,,A4�• y _)�; 6 -Aa- ! 16 4 Official use only. Do not write in this area, to be completed by city or town official. City or Town: PermitUcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. EIectrical Inspector 5. Plumbing inspector 6. Other - Contact Person: Phone 4 Information and Instruction' s 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 employes." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe 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: Tho Go onwealt� ofMfassachmetfs - De,paftea ofIndustdal Accidents Office of fimstigau<iom 600 Washi:Voa Street Boston, 02111 Tel, # 617-7.27,4900 ext 406 or 1-877,7MASS.AFE Revised 5-26-05 Fax 0 617-727-7749 WWW.Mms,g0V1Cha 01844- rnv.Dence (PPTIFIr GTP AIIINIRDD RFVICIr)N NIIMRFR THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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 DATE(MM/DOIYYYY) �R CERTIFICATE OF LIABILITY INSURANCE 3/9/2015 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS a CERTIFICATE DOES NOT AFFIRMATIVELYOR NEGATIVELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES POLICY EFF (MWDDNYVY) BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED LIMITS REPRESENTATIVEOR PRODUCER, AND THE CERTIFICATEHOLDER. X COMMERCIALGENERAL LIABILITY IMPORTANT: If the certificateholder is an ADDITIONALINSURED,the policy(ies)must be endorsed. If SUBROGATIOMS WAIVED, subject to the terms andconditionsof the policyFertain policiesrnayrequimn endorsement. A statementon this cerCdicatedoes not conferrights to the certificateholder in lieu of such endomement(s). PRODUCER CONTA NAME CT Sandi Munroe M P ROBERTS INS AGCY INC 'zr ,Ne.Ext: (978p) 683-L8�073 AJc.Ne: (978)683-3147 AORESS: sandiCmprobertsinsurance.com 1060 Osgood Street North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: MERCHANTS INSURANCE INSURED PARSONS PLUMBING HEATING INSURER B: INSURERC: A SHAUN PARSONS DBA INSURERD: BOP9096521 3 FULTON STREET 06/27/15 INSURER E GENERAL AGGREGATE E 2,000,000 METHUEN, MA 01844 POLICY D JPERO D LOC NSURERF: 978-682-1169 rnv.Dence (PPTIFIr GTP AIIINIRDD RFVICIr)N NIIMRFR THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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, EXCLUSIONSANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. TVPEOFINSURANCE BLDG 20, STE. 2035 a POLICY NUMBER POLICY EFF (MWDDNYVY) POLICY EXP MM/DD LIMITS X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE E 1,000,000 CWMS1MADE DR OCCUR PREMISES Ea=nence E 500,000 MEDEXP(Anyompemn) E 15,000 PERSONAL B ADV INJURY E 1,000,000 A BOP9096521 06/27/14 06/27/15 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E 2,000,000 POLICY D JPERO D LOC PRODUCTS-COMP/OPAGG E 21000,000 E OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E Ea accident BODILY INJURY (Per person) E 100,000 A ANYAUTO ALL OWNED R SCHEDULED AUTOS AUTOS MCA7015004 , 02/02/15 02/U2/16 BODILY INJURY (Per accident) E 300,000 PRO (Peraccident DAMAGE E 100,000 B HIRED AUTOS AUT SW"ED E UMBRELLA LIAB OCCUR EACH OCCURRENCE E AGGREGATE E EXCESS LIAB CLAIMS -MADE DED RETENTION E E A WORKERS COMPENSATION AND EMPLOYERSTIABILITY YIN ornctwveaaea�zarre�E�l� c oeov (Mandatoryn NH) �u NIA WCAI032098 07/21/14 07/21/15E.L. x PER OTK STATUTE ER EACH ACCIDENT E 500,000 E.L. DISEASE -EA EMPLOYEE E 500,000 If yes, describe under DESCRIPTION OFOPERATIONS below 500 OOO E.L. DISEASE -POLICY LIMIT E 1 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be atmched d more space is required) email: jhurley@tomnofnorthandoaer.com 1-IcIr ATC I-Inl -D r.ANr.FI I ATIr1N TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD ST THE EXPIRATION DATE THEREOF, NOTICE Vu1LL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVISIONS. BLDG 20, STE. 2035 NORTH ANDOVER MA 01845 w AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD N° 32% 1 Date ...7....1... )......C../ ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ` 1 .. ........................................................ has permission to perform ..............:. S , . �:........................ �....).. K ................... wiring in the building of ....... at ... ...... I ... IZZ... I ...................... . North Andover, Mass. Fee.....:.......'.... Lic. No..J.l....'..... ............... .......�.J I... �..:........... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer DEPARTMFVI'OFPUBLICSAFETY BOARD OFFIREPREVEV170NREGGULMO N527CMR12.UO Permit No. Ck Occupancy & Fees Checked PPUCATIONFOR PERMIT TO PERFORMELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 7 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. r � Location (Street d Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building Purpose of Building Yes - !® No (Check Appropriate Box) Utility Authorization No. Existing Service 1- Amps///a�l�/'�I�%OVoltS Overhead Underground No. of Meters New Service � Amps aUvolts Overhead [0 Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work .4 Gd O e. No. of Lighting Outlets No. of Hot Tubs / jQ No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below rl Generators KVA ground ground No. of Receptacle Outlets / a. �J— No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal r7 Othe No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP h>,str =Co Pt�ua�tbthetegt>itanaisafMassacfi>se�C�ertaallaHs Iha%eaamt2 tlikkEwa=Puhyir A&gCa Co crumb tt ioWnW nt YES NO Ihaeaftn >advMptod'ofsamello te0ffim YES M NO If} uha%edte WYES,plrmmclia*the WcfwmaFbydwdmgthe Ester &dVahteofF]edncal Wait $ WakbSiatt 7 S --O V 0TecfimD*Rqx9ed Rough Final Sigttadt> AME F�NINAME f IVU vim. •J'v f le C7 ;-t-c IiMWNo, Lioa= eA. `)Lyrs•AF1�_., Signalute Adm AILTdNa 0WIER'SR4RJRANCEWANE ,lamm meidiel-mmdoesT,sn not theitstramecaeW"aksfatWeWuvatasmgL WbyMsadxssCovaiLTNs andthatmy sernthispedappbcation ftra*M n>at (Please check one) Owner Q Agent Q Telephone No. PERMIT FEE $