HomeMy WebLinkAboutMiscellaneous - 55 MILLPOND 4/30/2018 55 MILLPOND
210/095.A-0055-0000.0
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20��TLto rya6~O
o - -' Town of North Andover
e� D.B.A. —Zoning Compliance Form
�,95°wwreo�•�,�.�5 978-688-9545
SACHV`�
This form must be reviewed with the Inspector of Buildings.
Office Hours are Monday-Friday 8-10 am,and 1-2 pm Monday-Thursday.
ApplicantName: FOUL M VL&t Name of Business:
Addres's of Business: SS Zoning District
Map % S 7'9- Lot S5
Phone: q__7 "9_14A "G022'>� Email
Nature of Business: t�i �C,(� l�
Do you own this property? Yes No
If no, written permission is required from your landlord.
Will you have clients coming to this property? Yes No
Will you have any employees? Yes No
Will you have any major deliveries? Yes No_j�
Description of Business Activity(Must be Completed)
i�e>WL)L f l7J(�s b6S i O�5S Rte -tz�> MMCAIL TEr- jt 6e4l,
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Signature of Applicant 4'c'�t
For Signage Refer to North Andover Zoning Bylaw Section 6
The propos i all e us 1 this zoning district.
Issued
V
2.40 Rome Oceupafan(1989132)
An aocessory use conducted vvif k a dwelling by a res-dq4 wha resides xn the dwo1bg as his principal
address, wIaich is clearly secondaqoe use of the 17iiilding for IiSnngmposes. Home occupations shall
'i ofif le,"but n"ot'limited to the following uses; personal services such as famished by au artist or instructor,
but not occupation izrvolved with-motor vehicle xepmrs, bean4r parlars, animal kennels, ox tha conduct of
retail business,or the xnan-ufactuz�ig o�goads,•�ahicb.impacts die xesidentiaI zia-ture o�'tlze�xeigl�i�or�iood;
4. For use of a dwelling in any residentid district or multi-fdmily district for a home occupation,tho
following conditions shall apply;
a. Not more than a total of fuzee (3) people may be,employe,in the qi To occupation, ono of
whom shall beilre:ow�ier of�hehoyne ciciupatioiz and resift iit said dwelling;
b. The use is carried on strictly withinthe principal building;
c. There shall be no exledor alterations, accessory buildings, or display which are not cmton mW
with xesidential buildings; -
d. Not more than-twm-t r flvo(25) percent of the egg gross door area,of fho,dweling unit.
so used, not to exceed one thousand (1000) square feet; is devoted to's-ach use. ,In
conmctionwith
such use,there is to be kept no stock in trade, conamodiftes or products which occW space
beyondthese Ihnits;
e. TherewM be no display ofgo4d5 or wares visible Rom the street;
£ Tho building or premises occupied shall not Ire rendered objectionable or def finental to the
xesi&Wal character of th-e migh-boxhood clue to the exterior appmranw, emission of odor,
gas, smoke, dust, noise, d ance, or in any other way become objectiomble or
dobdmentalto anyresidentialuse.-MEn Cc mighb oxhood;
g. Ai�v such building shall indude no features of design-not customary m buildings for, xesidenm ,
rase. I
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GENERAL DURABLE POWER OF ATTORNEY
I, Victor S. Mukai, of North Andover, Massachusetts, do hereby revoke all powers
of attorney executed by me before this date, and I now make, constitute and appoint my
son, Paul V. Mukai, as my true and lawful attorney-in-fact, to act for me in my name, place
and stead to act under the following provisions:
1. General Powers and Scove To exercise or perform any act, power, duty, right or
obligation whatsoever that I now have or may hereafter acquire relating to any person,
matter, transaction or property, real or personal, tangible or intangible,present, contingent
or expectant, now possessed or hereafter acquired by me, including, but without limitation,
the specifically enumerated powers granted below. As an expression of my intent
hereunder, said attorney shall have full power and authority to do everything necessary in
exercising any of the powers herein granted as fully as I might or could do if personally
present.
2.Powers of Collection, Payment and Enforcement To demand, sue for, collect,
compromise, recover and receive all debts, moneys, property interests, claims and demands
whatsoever, which are now due or which may hereafter become due to me, including the
right to institute any legal or equitable proceedings therefor; and to execute and deliver on
my behalf and in my name, any and all endorsements, elections, releases, receipts, or
discharges for the same.
3. Banking;Powers. To make, execute, deliver and endorse notes, drafts, checks,
certificates of deposit and orders for the payment of money or other property from or to
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me or to my order; to make deposits or withdrawals on any accounts in banks or other
financial institutions on my behalf. To borrow money and execute promissory notes in my
name, and as security therefor, to pledge, mortgage or hypothecate any securities or other
property, real or personal; to execute personal guaranties, guarantying the debts of another
person or entity.
4. Power to Acquire, Manage. Lease and Sell. To make, execute and deliver deeds,
releases, conveyances, leases,purchase and sale agreements, subleases, and contracts of
every nature in relation to both real and personal property, contracts of indemnity and
insurance, on such terms and conditions as my attorney shall deem proper, to manage or to
become involved in the management of any such real or personal property.
To carry on, manage or become involved in the management of any business
in which I may have an interest, and to carry out any act of management which may be
appropriate to such involvement; to enter into and/or carry out the provisions of
agreement for the sale or transfer of any business interest or the stock therein, upon such
terms and conditions, including the making of such representations,warranties and
indemnities, as my attorney shall deem consistent with my intentions and negotiations
begun by me or on my behalf prior to any disability.
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5. Powers as to Securities. To purchase, sell, transfer or otherwise deal in any way
with all forms of securities, specifically including but not limited to all forms of securities
issued by the United States Government (or any other government) or any division,branch
or agency thereof; to act as my proxy with power of substitution; to vote all stocks or other
securities in my name relative to any individual or corporate action, to deposit any stocks or
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other securities in connection with any plans of protective or reorganizational committees;
to purchase, accept or exercise rights to subscribe for securities and to sell same; to endorse
securities or any agreements relating thereto, on my behalf; to create, utilize, terminate and
otherwise deal with accounts (including margin accounts)with securities brokers.
6. Powers over Safe Deposit Boxes. To have access to all my safe deposit boxes,
whether in my name alone or held jointly with others.
7. Powers with Respect to Insurance Contracts. To have full authority to deal with
any policies of insurance on my life, or policies on the life or lives of others, but excluding
any such policies on the life of my-attorney in fact, in which I may have any interest,
including but not limited to, the right to make irrevocable assignments thereof, to
surrender, borrow against, or convert any such policies and to change the beneficiaries
thereof, or to take any other action with respect to such policies as my said attorney shall
deem proper and consistent with my intentions or objectives; to receive payments under
any disability, income or other contract, to deal in every other respect with such disability,
income or other contracts.
8. Powers as to Rents. To receive and give receipt for all rents and income to which
I am or may become entitled, pay therefrom all necessary expenses for the maintenance,
upkeep, care, improvement and protection of my property; to pay the net income
therefrom from time to time to me or in such manner as I shall direct, or in the
absence of such payment to me or such direction, to invest the same in my said attorney's
best judgment.
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9. Use of Funds for My Care. In the event of my illness, incapacity or other
emergency, to incur,pay and satisfy such expenses and obligations for my comfort, benefit
and care, and obligations of a nature customarily incurred by me, as in my said attorney's
judgment consider necessary or desirable or consistent with my wishes.
10. Powers as to Taxes. To prepare, execute and file federal or state income, gift, or
other tax returns and other real and personal property tax returns or statements and to pay
or compromise any or all such taxes or apply for and collect any refunds due; to make any
tax elections on my behalf or which I am entitled to make; to appear for me and represent
me at any level before the US Tax Court or any state, federal district or federal appeals
court of proper jurisdiction, the US Treasury Department, the Internal Revenue Service,
the Massachusetts Department of Revenue, or any other taxing authority, in connection
with any matter involving taxes in which I am a party. To execute any claims for refund,
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protests, applications for abatement and consents to any waivers of determination and
assessment of taxes, agreeing to a later determination and assessment of taxes than is
provided by any statute of limitations. To receive and endorse and collect any checks in
settlement of any refund of taxes. To examine and to request and receive copies of any tax
returns, reports and other information from the US Treasury Department or any other
taxing authority in connection with any of the foregoing matters.
11. Power With Respect to Entities or Forms of Ownership and Related Transfers.
To create, amend or terminate one or more trusts, partnerships corporations, co-tenancies
or any other form of ownership or entity for the purpose of dealing with any property or
property interest of any nature that I may have or hereafter acquire, under such terms and
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with such provisions as my attorney deems in the best interests of myself and my family. In
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this regard, the fact that my said attorney may be a remainderman, partner, shareholder,
co-tenant, or beneficiary of any such entity in connection with any such transfer hereunder
shall not affect the validity thereof, nor, by itself constitute a breach of my said attorney's
fiduciary duty hereunder; to transfer any or all property, tangible or real, in which I may
have any interest, into a trust or trusts,whether revocable or irrevocable, and whether
created by me or by my said attorney on my behalf, and whether or not such trusts were
created before or after the execution of this durable power of attorney, or to any other
form of entity or ownership, including any form of co-tenancy.
12. Power to Make Gifts and to Disclaim. To make gifts of my property either
outright or in trust to or for the health, education, maintenance or support of such persons
as, in the opinion of my said attorney,would be the donees I might choose, including my
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attorney in fact, having in mind the resources, both public and private, available for my
care after the making of such gifts, and having in mind the objective of preserving the
largest amount of my property for my family as a whole. My said attorney shall also have
the power to disclaim any bequests or other interests to which I may become entitled from
any source whatsoever, and to execute any documents necessary to effect such
disclaimer(s), not withstanding the fact that my attorney in fact may personally benefit from
such disclaimer.
13. Power to Employ Agents. To employ, compensate and discharge such agents on
such terms as my attorney deems appropriate to carry out any acts authorized or
contemplated hereunder.
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14. Powers with respect to Retirement Plans. To establish and contribute to any
form of so-called retirement plan for my benefit, including but not limited to Individual
Retirement Accounts, Keogh plans, and any other form of pension or employee benefit
plan; to change beneficiaries of my account in any such plan, designating such beneficiaries
as my attorney determines to be consistent with my wishes; to borrow against or withdraw
from my plan accounts on such terms as my attorney deems appropriate; to select any form
of payment option or to modify options I may have selected; to accept any benefits or lump
sum payments on my behalf and to "roll-over" any such benefits on my behalf.
15. Third Party Reliance or refusal. Any party dealing with my said attorney
hereunder, may rely absolutelyon the authority anted herein and need not look to the
tY�'
application of any proceeds nor the authority of my said attorney as to any action taken
hereunder. In this regard, no person who may in good faith act in reliance upon the
representations of my attorney or the authority granted hereunder shall incur any liability
to me or my estate as a result of such act.
If a third party refuses to deal with my attorney in fact or acknowledge this power,
my attorney in fact is authorized and encouraged to take legal action to carry out the
desired transaction '
sact on and to recover any costs or damages resulting from said third party's
failure to recognize and honor this power.
16. Transfers into Trust. To transfer funds or other property of mine to any trust
established by me, whether before or after the date of this instrument, including, but not
limited to the Victor S. Mukai Revocable Trust, an indenture of trust dated
May , 2001.
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17. Successor Attorneys in Fact. If the said Paul V. Mukai for any reason ceases or
is unable to serve under this power, then I grant the same aforesaid powers in every respect
to my son, John K. Mukai.A written statement by the said John K. Mukai as to the
cessation or inability of Paul V. Mukai to serve shall be conclusive evidence of such fact,
and any third party may rely upon the same in dealing with John K. Mukai under this
power.
18. Guardianship. If a petition is filed in any court for the appointment of a
guardian or a conservator to care for me or my estate, then I nominate Paul V. Mukai as
such appointee. If Paul V. Mukai is not able to serve, then I nominate John K. Mukai in
his stead. Nothing in this part shall be construed as a direction that such a petition be filed
or such appointment be made, and it is my express wish that such action be taken only
when and if absolutely necessary.
19. Reliance on Copies of this Power. A photostatic copy of this power, as executed,
may be treated as an original power by any third party dealing with my attorney in fact.
20. Disability or Incompetence. This Power of Attorney in the said Paul V. Mukai
or in the said successor, as the case may be, shall not be affected by my subsequent
disability or incapacity.
21. Ratification of Attorney's Acts. I hereby ratify and confirm whatever my said
attorney shall lawfully do under these presents.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this Iday of
May, 2001.
Victor S. Mukai
COMMONWEALTH OF MASSACHUSETTS
Middlesex, ss. May 5, 2001
Then personally appeared before me, the above-named, Victor S. Mukai and
acknowledged the foregoing document to be his free act and deed.
Robert A. Wilkinson
Notary Public
My comm expires: 11/19/04
Signature of Attorney in Fact:
Paul V. Mukai Witness
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Location
No. 1 Date
NORTH TOWN OF NORTH ANDOVER
0
• At Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
r
18735 ZI/
—BUf1ding inspectr
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUR DING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
BuilTngffinpissioner/Ils"of Buildings Date
SECTION i-SITE INFORMATION WF
z
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide red Provided 'red Provided
1.7 Water S�rpty M G I C.40. S4) 1.3. Flood Zone Infom�ation: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHMAUTHORIZED AGENT Historic District: Yes_ No
i
2.1 Owner of Record
/
e Prin Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service: 0
z
M
Si tune Telephone 90
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
e-i 1 S CG_
Licensed Construction Supervisor: 1 / �_l Q' 0
''ba 1T,-•-' A4 pe,6 License Number
-Address JJ r7"
_ — , 36, Expiration Date C
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name r
�S
Registration Number rwo
rAddress ------ —
C•
_ _ --- — Exp tion Date
Si nature
Telephone !�
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......m-' No.......0
SECTION 5 Description of Proposed Work(check all a llcable
New Construction*0—tlyxiin�Buglding ❑ Repair(s) ❑ Alterations((s C1 Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item _ Estimated Cost(Dollar)to be OFFICIAL USE ONLY -
l 5
Completed by permit applicant 7.
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(e)z (b)
4 Mechanical HVAC w
5 Fire Protection c jam.
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
y behalf,in all matters relative to work authorized by this building permit applicatiop.
Si nature of Owner Date
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
Signature of Owner/Agent Date
MEN=11 111111 Jim g1111111111111-11
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS I ST2ND3
SPAN
DIMENSIONS OF SILLS
DINIENSIONS OF.POSTS
DIMENSIONS OF GIRDERS
HEIGFIT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL.GAS LINE
1 _ 13 �GEi�TtFiCAi'E OF 1ABI ITY INSURANCE � 08/1712005 .
es rTf4s 2 ssis CsgZstr€^--�__ 11b,LIED
PRODUCER (978)459-77'x'4 FAX (978-3459 z��
ONLY AND CONFERS NO RIGHTS UPON FETE CERTIFICA!t:
Wilson Insurance Agency Inc.
♦ HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
K Courthouse Lane Suite 14 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Chelmsford MA 01824
INSURERS AFFORDING COVERAGE MAIC 8
INSURED Tam De asCa dba Tom DeFusco al IINSURERA Scottsdale Insurance
Contracting 1 +NSURERU: Liberty Mutual Insurance
-
7 Austin Street ( INSURER C:
Methuen MA 01844 INSURER U:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I - ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRAC OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THF INSURANCE AFFORDED BY THE POLICIES ESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDI CED 8Y PAID CLAIMS-
. INSR kOUL TYPE OP INSURANCE POLICY NU BER POLICY EFFECTNE POLICY EILHRATIOIi UMDS
JIM IaE+MRAL UAINUTY CL 1153932 08/03/2005 08/03/2006 EACH OccURRENcE s 11000,00
10
DAMAGE 7URENTEO $ SU 100
X COMMERC!AL GENER^AL LABILITY
CLAWS MADEFXJ�OCCUR MEO EXP(Ay ano person}_ S 1,M .
PERSONAL&ADV INJURY S 1,000,000
A GENERAL AGGREGATE $ 2 000,000
P
GENL AGGREGATE LIMIT APPLIES PER: RODUCTS-COMIPIOP AGG S 1,000,00
X I POLICY M QCT MLOC
AUTOMOBILE UADIrry COMBINED SINGLE LIMIT S .
ANY AUTO (�accldmi}
ALL OWNED AUTOS BODILYINJURY S
(Perperson)
SCHEDULED AUTOS
HIREDAUTOS BODILY INJURY S
NON-OWNEDAUTOS
PROPERTY DAMAGE S
' (Fer accidenry
AUTO ONLY-EA ACCIDENT S
GARAGE LIABILITY
.AUT'O OTHER THAN EA ACC $
AUTO ONLY: AM S
EXCESSNMBRELLA UABIUTY EACH OCCURRENCE S
OCCUR QCWMS MASE AGGREGATE S
S
S
DEDUCTIBLE
S
RETENTION S
WORKERS COMPENSATION AND WC1-315 38466-014 10/18/2004 10/18/ZOOS we STATTI- oR-
EMPLOYERSLIABILITY E.L.EACHACCIDENT $ 100,000
B ANY PROPRIETORPARTNERJEXECUTNE EJ-DISEASE-EA EMPLOYEE S 100,00
OFFICERRMETMER EXCLUDED?
If desnibe under E.L.DISEASE•POLICY LIMIT S 500,000
SPECIAi PROVISiDNSI>Naro j
OTHER
I
DESCRIPTIONW OPERATIONS/LOCATIONSIVEncLES i EXCLUSIONS ADI to BY ENDORSEMENTI SPECIAL PROVISIONS
For information purposes for proof of ins ranee.
CER F TE HOLDER CANCEUAIION
SHOULD ANY OF THE ABOVE DESCW BED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAUAIRE TO MALL SUCH NOTICE SHALL IMPOSE NO OBUGATTON OR LIABILITY
OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATNES.
For Infomation Purposes AU 14DRgOREFRESENTATNE
Clark N. Lindlff
ACORD 26(2001108) OACORD CORPORATION 988
I ✓/ze -Van:��ao�uaea� r�✓G�aaaae�zcaelta
BOARD OF BUILDING REGULATIONS
. .� .,
License: CONSTRUCTION SUPERVISOR
Number. 071037
+ { � 7 Birthdate: 06/1.8/1950
Expires:06/1.8/2007 Tr.no: 11773
Restricted: '00
THOMAS A DEFUSCO
23 DUTTON ROAD
PELHAM, NH 03076 Commissioner
r - - ---�-..,��;�� �aninrar+.urcacc�L a�✓��u6dP.�b
ze
Board of Building Regulations and Standards
HOME IMPROVEMENT cONTRAcTOR
Registration: 117756
Expiration: 11/15/2006
Type-. DBA
TOM DEFUSCO GENERAL CONT
TA6-MX9 DEFUSCO p�
23 DUTTON RD '�
PELHAM,NH 03076 Administrator
Page No. of Pages
Tom DeFusco
23 Dutton Road
Pelham, NH 03076
Home Improvement Reg. # 117756 Tel 603-635-3017
Constr. Lic. #071037 Fax 603-635-3751
PROPOSAL SUBMITTED TO PHONE DATE.
jl f
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STREET JOB NAME.
.xJ!r.i'6''.-` (:..'rt �j�..d 0 � f ��::.•fit� t_�r f.,{'r
CITY,STATE AND ZIP CODE +(� JOB LOCATION
CL-A'-,h r ,
ARCHITECT DATE OF PLANS.,
JOB PHONE
We hereby submit specifications and estimates for
_....._.__...............................
....................---.......
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...__...._.__._ ......... _ ._...... � �F ...:...._ ! C 5 r ..:..__ r.........._....
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._....... S_... ./!.I.C�r�.._"..... .. ...f?e.A_ ......_.:'.i 4.). 4.k ? (i( Yy�lt ._ lr v F.'Y'e S fF At t j 1, h •V.!'"I f
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P rLIVOSP hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of:
f dollars($
Payment to be"made as follows:
r110Ar 4/
t � r
All material is guaranteed to be as specified. All work to,,be comple workmanlike Authorized -
manner according to standard practices. Any alteration;or deviation from above Signature
specifications Involving extra costs will be executed only upon written orders,and will become
(,, an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be. .d
accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn b us if not accepted,witM���
insurance. Our workers are fully covered by Workmen's Compensation Insurance. ydays.
Atepfiturr o f rapQsal The above prices,specifications
and conditions are satisfactory and hereby accepted. You are authorized to do the Slgnature`�
work as specified. Payment will be made as outlined above. y� "-------�
�✓.-i' •• r 4 C.:
Date of Acceptance: Signature
NORTIy '9
TONNM of
No-j3
_ - - ---
o dover, Mass.,
COCWC.EWICK
7�ADRATED Fk? �
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
align ow BUILDING INSPECTOR
THISCERTIFIES THAT... ... .. ............. ......................... .... .. ... ......... ..................... .................... Foundation
has permission to erect........................................ buildings o4ads....... ........•...... ............................................ Rough
to be occupied as �..... .. Chimney
. . . ..................................................................
provided that the person
ac ing this permit shall i very respect conform to the terms of the application on file in Final
this office, and to the provisio s of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTIONS TS ELECTRICAL INSPECTOR
Rough
!!,N�... ................. Service
A:1
..................................................
. . .................
BUILDING INSPECTOR
Final
Occupancy Permit Required to 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. Burnet
Street No.
SEE REVERSE SIDE Smoke Det.
Date./Com!-,2,2 -0 :Y
OF.MORTM
TOWN OF NORTH ANDOVER
�O
• PERMIT FOR GAS INSTALLATION
♦ s
�9SSACHUSEt,(
This certifies that j. . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . �.c. P , '?.e�. .. . . . . . . . .
in the buildings of . . . 'j .k.i .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . . ., North Andover, Mass.
Fee. J:.. . . Lic. No.. . . . . . . . . . . . . . . . . .
GASINSPECTOR
Check#
4897
MASSACHUSE s UNIFORM APPLICA N FOR PERNIlT TO DO GAS Ffr]n 1G
(Type or print) Date
NORTH ANDOVER,MASSACHUSETTS
Building Locations � � v�� Permit#
Amount$ 2a�
' er's Name
❑New❑ Renovation ❑ Replacer t Plans Submitted
W O
0 5
O .ZO»
F �
`wOn F z zz� H 0
P4 O4 C O O E� O W
cs: � a F O
SUB -BASEMENT
BASEMENT
1ST. FLOOR
2ND . FLOOR
3R D . F L
0 0 R
4 T H . F L O O R
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type) Check one: Certificate Installing Company
Name ftlic 115, VL� LL L e Corp.
6
i
4527 � Or Partner.
Address az _
usmess Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter eS�
zL-
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy F 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 ❑
I hereby certify that all of the details and information I have submitted(or entered)in above application are a and accurate to the
best of my knowledge and that all plumbing work and installaY performed un-dier Permit Issued foAthispplication will be in
compliance with all pertinent provisions of the Massachus a as o e and ChaptX f theaws.
Signature of Licensed Plumber Or Gas Fitter
By: ❑ Plumber
Title
City/Town ❑ Gas Fitter License Numoer
❑ Master
Journeyman
APPROVED(OFFICE USE ONLY)