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HomeMy WebLinkAboutMiscellaneous - 53 MAY STREET 4/30/2018 (2) 53 MAY STREET 210/018.0-00040000.0 Location �—�-, /)),4 t No. r Datea`J�� M0*TM TOWN OF NORTH ANDOVER F R p Certificate of Occupancy $ s,C►,usE Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Jr / Check # ``� 7 51- 3 �� i Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAI'TE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. % DATE ISSUED:Lo SIGNATURE: Building Commissionerflngx&r of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R y '`e F m,2 4 Zoning District Proposed Use Lot Areas Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Reqwred Provided 1.7 Water Supply M.GL.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ 1 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT I F m 2.1 Owner of Record 'Na/A OteNo Name(Pnnt) Address for Service q7 g p57�y5' Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone p� SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Con$truction/Sud rvisor: Not Applicable ❑ DOVU(� VV r�4f,q e� Licensed Construction Supervisor: / License Number Address r/ Expiration Date ic� Signature Telephone ra 3.2 Registered Home Im ovp ment Contractor Not Applicable ❑ 11-1 qVIA Company Name (:LO 1 Registration Number Address % 716 _7W5-- 1 I Expiration Date Signature Telephone e 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 Descri tion of Proposed Work checka I applicable) New Construction ❑ Existing Building LK Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: C ►yak, 1 $A SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beONLI Completed b permit applicant s sr, . { K •xy rr a L i z 2 57- 1. Building ( + (a)m Building Permit Fee Q� - Multiplier 2 Electrical - - (b) Estimated Total Cost of 700' v Construction 3 Plumbing Building Permit fee(e)X (n) 4 Mechanical HVAC -- 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT -T as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 . �'q V(d �(40 Print Name Signature of vomer Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1 ST2 3RD 77 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 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 'Ne (y c.�e<� ,: l• cur r, J BOARD OF BUILDING REGULATIONS � License: CO-%.MCTJON SUAERIV;SO t I Number L:, 0,91321 f Blrthd'am. 1,.UV'i n50 t s_ Expires: it'10—r.;0i Tr.no: 6,04 To, CD DAVID P GULEZIAN 428 PLEASANT ST N MIIDOVER, LLA 01-345 A_rtfn for ��Ii�ifC IIlt K�4��lil:et �nw�n..nrh';} I ti 11?II -t DAVID GULEZIAN -4 f:fawlll sr NORTFj Town of .= .: . Andover o No. ►- 70 ti = a -as—aa�� O ++ L A E o dover, Mass., COCHICHEWICK V �dADRATED P'P�`�J S G` 4 BOARD OF HEALTH PERMIT .T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... �vt ...............�Q...y./w .. ........................................................................... Foundation has permission to erect.Av/..,,,,Ir.h.......•• buildings on ...%rW3.......MAY.......Is .......................... Rough � to be occupied as.......A ffi- i.......,3.A4.(.f...... ..�'i0....�iV t 14.�.� � i;; 4...1. .....,Q^ 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-taws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. #V 1 4? /17 Y PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR C Rough / .....00 ............. .... .......................... . Service ... . . . . . ..... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE E 3 � 'l � f�� ,// -4, Date. . . ..c...: ..... i ,aORTM TOWN OF NORTH ANDOVER pF 4•�to ,^,�O 3? °� PERMIT FOR GAS INSTALLATION t • 'SUcmUSEt This certifies that . . . . ... ..�. . . . . . . . . . . . . . . . . . . . has permission for gas installation . . .�. .��! . . - ) .c.c./f . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at s.¢... . . . . . . . . . . .. North Andover, Mass. Fee. . `/J Lic. No.. ,GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) UVf Ndov&/" Mass. Date , QL Permit #Building Location V /�'� ,S�Ife —Owne s Name �/�[� U�EcS/�QAl Type o O panty etJ�`��%� C P New ❑ Renovation Replacement ❑ Plans Submitted: Yes[] No ❑ N to W N Y Z ¢ N N N U ¢ Z y ¢ N X O > (n W W F- 2 O u Q ¢ ¢ O O ~ W r Q m a H y W O — W t- N ¢ W Z U W y W Q = Q ¢ F- _ W W N Q ¢ ¢ ¢ W W h 2 ¢ f J H Y }. tW > N m Z 2 O ~ W O ttAA S Z Q W W C Q ¢ Q Q O O W ti O Q F' Q '= O C7 2 u. 7 3 D t7 J U C Y a i SUB—BSMT. BASEMENT p� 1STFLOOR yj _ 2ND FLOOR 3RD FLOOR I 4TH FLOOR STH FLOOR eTHFL00R 7THFLOOR STH FLOOR Installing Company Name Boule's Gas Check one: Certificate Address 39 Oxford Avenue ❑ Corporation Haverhill, MA 01835 ❑ Partnership Business Telephone 978-372-6783 Firm/Co. Name of Ucensed Plumber or Gas Fitter Charles H. Boule' INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 0 No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A 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 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❑ Agent C1 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 installations performed under the permit i ued r Zthisalication will be Zcoliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the �,ner Law BY T of License: Title Plumber Signature of lJcen Oumgdr, s Gasfitter Master License Number M372Q,/ J355$_ City/Town Journeyman Date. .2.2 N° 7 TOWN OF NORTH ANDOVER .�� '•°oma PERMIT FOR PLUMBING 4 f 'SSACMUS� f This certifies that . . . . .�!'?�. t a l'-,kpermission to perform . . . .��? !f! /1. plunybing in the buildings of . z el. ... . . . . . . . . . . . at . . .E) .3. .l.�� ��':r. . . .F. . . . . . . . . . . . . . North Andover, Mass. Fee. . -. .Lic. No.. . . . . . !_._. .,: �_. n . . . . . . . . 6/PLUMBING INSPECTOR l /1 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION OR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date��� l�G'�19�7 Permit# Building Location � � S� Owners Name 4107 Amount Type of Occupancy �f''`j� 47/f New ri Renovation Replacement E Plans Submitted Yes No FIXTURES Zza Z Wcr H w H d z N Q w F A ;� h d d a H ad F "►�� r.a � A A � d H "� G� d a d � Ca � a AREM ISE FLOOR o 0 M MOM I I . r 1 X31 FLOOR 41H HDOR 5M FLOOR M FIDOR 7IH ROM 91H FtOaR (Print or type) _ Check one: Certificate Installing Company Name C+ �X� M--Corp. Address Oe~r� � -r Partner. �/9td✓cam ct Business Telephone lj • 7575 El Firm/Co. Name of Licensed Plumber. C�/f79 Insurance Coverage: Indicate the type of insurance co rage by checking the appropriate box: Liability insurance policy Other type of indemnity 1:1 Bond Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent F1 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 installa' s performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus tate P b' 'f �,an Chapter 142 of the General Laws. By: igna o I L ie UpFe a F I um 5 er Type of Plumbing License Title City/TownCityfrown License/iNumoer Master Journeyman APPROVED(OFFICE USE ONLY Date N� 23 5 ...s. �/�...... f Y NORTH °e�"`°;•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACHUS This certifies that . t S . .................. ...)............................................ Ki has permission to perform ....... .......... .... ......j........t. .`.J..`..`..F..-. ............. wiring in the building of..... ........................................ at......... ..J.......... `.. ....>..................................... . rth Andover,Mash Fee./� ... Lic.NO."............. ................ .....!/!' ELECCRICALINSPECiOR Check # 31 ��q l t WHITE: Applicant CANARY: Building Dept. PINK:Treasurer 1 -� - TIE C0AMONWF4L7710FM4FS4CHUS.L77S Office Use only DEPARTAfi V 0FPUBLIC&4fM Permit No. 80ARD0FMEPREHMVNRWM4W55V021 00 ' Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 4-� ALL WORK TO BE PERFORMED IN ACCORDANCE WITHTHE MASSACHUSSTS ELECTRICAL CODE,527 cmR 12:00 J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat dv 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) , '/d 5-1 Owner or Tenant b A,'V td 6rd lie -wci P? Owner's Address 4'�-r fltd5a iI S Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box Purpose of Building I Flu h'11T��� � W�If(n 2 U ']i Authorization No. Existing Service 4�'C" Amps / Volts Overhead EaUnderground a No.of Meters f New Service V /COO AmpsVolts Overhead = Underground Q No.of Meters fi- � Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work _ 77 35 -CtdS'p� 5 �� �1 �/v to---,P��S No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 1:1and No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets 1 J I No,of Gas Burners I No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals q No.of Heat Total Total No.of Detection and d- Pumps Tons KW Initiating 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 Q MunicipalQ Other Connections No of Water Heaters KW No.of No.of Signs Bailast9 No Hydro Massage Tubs No.of Motors Total HP OTHER- irmraneCoaa�Pt�ratmtheragtmartats�Gars�aiLam thmeaan MLiabtltyfrtsa==P:hymzbAtCon#,e>E Comamarisakstar�aFvaiat YES NO lfimea.hntedva1idproofafsametotheOfiCe YES r7 NO © If)ouhrwdwzkWYES,pkmfftdicaethrNxcfwmaWby the bCK NSURANCE r7 BOND OTHER Q (Please Spe fy) I( Esd VArdUecttical wait$ 1 d d w«i�usm M6LV._.�.° D*R4>� . �'� �`��� �a_ Final 1O FRM NAME N N C .5 ;2r S LCC7T r C _ Feria Al�, Q3 e t?�C C til �' �� � UPU !� p�- Ak.TeLNc(9,3-snbp,Sa, J= OWNER'S INSURANCE W A l am awatethatthe i.i=w dm nA a tas raqui: d by Massad Cereal taws aodthatmysig�uconthisp�appFitaoan tagt�rratt (Please check one) Owner Agent /72'W / f Telephone No. ` 0 7WPERMIT FEE$ // OL '/ t *, Location No. 7X Date NORTh TOWN OF NORTH ANDOVER 0 ♦ s �o Certificate of Occupancy $ CHUs t� Building/Frame Permit Fee $ e Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check # 3777 Building Inspeor J. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 77BUILDING PERMIT NUMBER. � � � DATE ISSUED: Va. SIGNATURE: A4 N G Building Commissioner for of Buildings Date Z SECTION 1-SITE INFORMATION z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: `ODD v� .s 3 Y�1 5 a Iv/on, y v Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided —Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal itr On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record )� 'j i-wil � ' V 1�7/'_ Name(Print) Address for Service N Signature Telephone G?j 7 a 7 2.2 Owner of Record: 0 7 `1 ! 7 O 'Name Print Address for Service: O Z Signature Telephone m SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ c 5 ©c)18�L, i Licensed Constructio Supervisor: QQ j !� I !� s e jLGf /�� License Number Address ` u / ' 1 Expiration Date Signature Telephone 3.2 Re 'stered Home Improvement Contractor Not Applicable ❑ Q IQ V il� �J��e"-ti ,�► Company Name M Registration Number 9 ro Address Ve q 79 Expiration Date �y Signature Telephone G) 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 rinit. Signed affidavit Attached Yes......a No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify IaKNh S ft�oC a77 0rAMan mat/ 4�P2 v Brief Description of Proposed .f . 4t"Wo7 QqA 1._� 406. C�(� (`ri W 1`t� �' 2d 5 Occ - dlfy u�' � -&y per �►; rr �;�yi y(`� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be (?MCIAL USE O) Y':.:' Completed by permit applicant 1. Building '�� 0 (a) Building Permit Fee r� Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Ll 100, co G Building Permit fee(a)X (b) 4 Mechanical HVAC / y3, 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, -Ij ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to ork a thorized by this building permit application. Si nahue of Omer Date C4 f7 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name i Si ature of Owner/Agent Date NO. OF STORIES ` 2 SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2 ND 3 RD SPAN DIMENSIONS OF SILLS • DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 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 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verity that all necessary approvals/permits from' Eeards 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 SES TIC N" "�""'*"' '�""""�""' ArFLIc4*AT �GIV�d Gy (�°��' l P�CNE 3039'7 g7$ 8'lf���S- CCATICN: Assessors Map Numcer o PARCE- SUEDIVISICN LOT (S) STRE=ii `J AY ST. NUMSFER 33 OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECT'cD COMMENTS FOOD INSPECTOR4iEALTH DATE.APPROVED DATE RAJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUELIC WORKS -Si=NER/WA+'I=R CONNECTIONS DRIVE-NAY PERMIT FIRE DEPARTMENT Rt=CEiVED EY EUILGING i,NSPECTCR DATE nevized 519;im Ifo Q ?orcE I> Vi floe v h g11,.�pY Side �yfaiati � o theriew f vqi(2 3 rq a f/S7 C • � BOARD OF BUIIQDIVG REGULATIONS it License: CONSTRUCTION SUPERVISOR Number. CS 001821 Birthdate: 10/02/1959 Expires: 10/02/2001• Tr.no: 6604 Restricted To: 0% DAVID P GULEZIAN _/ 428 PLEASANT ST Gam•«. �a N ANDOVER, MA•01845 } Administrator_' I j �/ee o�om�,anwea/l o��t�aaaac ueQa' '---1WExpiration: OME IMPROVEMENT-CONYRACT TC••-^--- registration: j 120199 ., I 11/1/01 type: Individual t , z ._DAVID.- E_ZIAM__ DAVID GULEZIAN Ii9i�1$�LfASANT ST i•,rT ' F ADMINISTRAIDR NORTH ANDOV MA 01845 03/23/2000 08:53 978-687-0146 INTEF.NET INSURANCE PAGiE 02 "-ORD CERTIFICATE OF LIABILITY INSUMNCE 03/23/2000 PRODUCER THIS CERTIFICATE US8UED AS A MATTER OF INFORMATION _� � � INC ONLY AND CONFERS 0 RnHT5 UPON THE CERTIFICATE IN1,� T 522 CK INSUR ROAD HOLDER.THIS CERTI ICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAdE AFFORDED BY THE P 1CIES BELOW. NORTH ANDOVER, NA 01845 INSUR�M AFFORDING CO` INSURED INSURER A: TRUST INSW1 ANC$ DAVID GXWZIAN DSA INSURER B: LEGION IN CTRANCB DAVID GULZLIAN CARPENTRT INSURER C: 426 PLEASANT STREET INSURER 0: NORW ANDOVER m 01645- INauREI�E: i "- C VERAGES 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 TOW ICH 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. INR TYPE OF INSURANCE POLICY NUMBER POLI�°1 PECTIVE CY EXPI M LIMITS GENERAL LIAYILITY EACH OCCURRENCE i 600 OOO I► ® coMMERCWLOENERALLIAgILITY THP 1010570 11/10/1999 11/10/2000 FIRE DAMAGE An W*fft s 30D 000 CLAIMS MADE [E OCCUR MEO EXP Anyone n) 4 _300_4000 PERSONAL&ADV INJURY $ 300 ODD OENERAL AGGREGATE 6 50,000 GERL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO S 5,00o 01 POLICYFEI�PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ee aakkk) ALL OWNED AUTOS BODILY INJURY (P�rpMY0111 � SCWDULED AUTOS HIRED AUTOS BODILY INJURY (P�r�adWni) S NON.OWNED AUTOS j PROPERTY DAMAGE i (PK.ovd.ntl GARAGE UMPLITY AUTO ONLY-EA ACCIDENT $ ANY AUTO I OTHER THAN EA ACC IS AUTO ONLY: AGG Ts EXCESS UAOILITY j EACH OCCURRENCE Is OCCUR CLAIMS MADE AGGREGATE S b • DEDUCTIBLE IS RETENTION S B WORKERS COMPENSATION AND 0 1 4&EA ° EMPLOYERS'LIABILITY E.L.EACHACCIOENT S 100,000 B 4-0115728 08/15/1999 08/15/?�,000 E.L.DISEASE-EA EMPLOYEE f 100,000 E.L.DISEASE-POLICY LIMIT S 500,000 OTHER OI.00RIPTION OF OPERATIONBILOCATIONIMIEHICLESIEIICLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER I AWITIONAL INSURE;INSURMt LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PRINCETON PROPIRTIES I DATE THEREOF,THE 189lMNG P�ISURBt WILL ENDEAVOR TO MAIL 010 DAYS WIIBTTEN JLTTN LAUREL NOTICE TO THE CERTIFICATE SOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL • IIIPOBE NO 013UGA110M OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRElIENTATNEB. AUTNORvsn A ACORD 25-S(7/67) D CORPORATION 1938 Town of North Andover oNORTH q 1t�eO 16t �� 3,�1 yE: r,• 0 O Building Department o 27 Charles Street 70 North Andover, Massachusetts 01845 (978) 688-9545 Fax(978) 688-9542Ar ��SSACHUSE��� 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 c11, sl 50a. The debris will be disposed of in/at: n 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. NORTH Town of Andover 0 No. 174P W_ dMass., �'a 7 0� LAo ower " COCHICHEWICK ADRRTED P"?9�' C S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ��v, 6.A�V� BUILDING INSPECTOR THISCERTIFIES THAT......... . ..... ... .... .. ..................... ...2�.a ............................................................... Foundation has permission to em*&VV11 r+........... g . MAY S f .......... buildings ..... .......... Rough to be occupied as....S1N l . .. �w «!y ....a..... �ow� ......./...K� ...I to an..- himney provided that the person accepting this permit shall in every respect conform to a terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M/46 P ,�,/ I C13 _ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 7 Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough ....................... ............................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final 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. •