Loading...
HomeMy WebLinkAboutMiscellaneous - 55 PRESCOTT STREET 4/30/2018 55 PRESCOTT STREET 21%7-0000.0 - ------�� \1 i i - I I, I i i � I . , i I +; f I Date......... `.....7-.1.4......... p►OR7/y TOWN OF NORTH ANDOVER n PERMIT FOR WIRING CHU55t %4V r l �N_SD/�-� This certifies that D�% has permission to perform 1-1 ....J .................................. .. f......................................................... wiring in the building of.......... � .... .. ......... .�.9.. ...................................... ... �' ..�U.. at ........d .......1...1�.. t .�. .....5 ..............a...........,Noirth�Andover,Mass. Fee......5 p ELECTRICAL INSPECTOR i Check# 5527 �n 13002-/ a - ?retiS. Z(c 9 7 r 100 10 0-0 r f I .:.=.. -w...•-..., -, �. Sn, a+`.�.v, -�.p++v»;y ari�p�w�..�p•-+-9ti.. �.__ .,.yp. 4 ,,,.,.#,,, _ ,,:,R, ,._ t13h: Ir cs vintj� 1A3;ndc� Un;?L • i SaGGP�I.�. X Rnoo 14 nn " L MIA) a f Z's,/ v 1\ .7 J 100 Vin W:nJo�y1 L)ni� Deck- UAi-1- Ivy '`` Q;Sem cs `' x I J RJbS<f i nn /X pj SILVA LIGHTNING BUILDERS 48 LINDEN AVENUE NORTH ANDOVER,MA 01845 (978)688-5464 O/F (617)799-4585 C CONTRACT AGREEMENT I,Emanuel A.Silva of Silva Lightning Builders will perform work on 55 Prescott St,North Andover,Massachusetts 01845 for the sum of Twenty-Four Thousand Nine Hundred Eighty-Five Dollars and 00/100 ($24,985.00). WORK TO BE COMPLETED- Exterior Work Front Top Gable with Balcony • Remove existing window storms on railings. • Remove existing wooden railings. • Remove all existing siding in balcony section. (2 layers)(walls only) • Remove existing siding on gable walls. (2 layers)(front and side walls) • Remove existing door unit. • Remove existing window unit. • Remove existing roll roofing and small section of roofing covering overhang. • Remove existing sub floor. • Cut and install new sub floor with pitch. (Advantech %"plywood) • Apply new roofing. (EPDMRubber Roofing) • Apply self-adhering flashing membrane from roof to walls. (Grace Products) • Apply self-adhering house wrap to all wall sheathing. (Blue Skin Products) • Prep opening for new door unit. (level,plumb, and square with pitched sill) • Apply self-adhering flashing to door opening. • Install new door unit. (Therma Thru door/half lite/fiberglass/insulated/single bore/aluminum sill) • Prep opening for new window unit. (self-adheringflashings with pitched sill) • Install new window unit. (Paradigm window/DH/vinyl/insulated/low e) • Apply self-adhering flashing to exterior window flange. • Apply spray foam insulation around window and door units. (low expansion foam) Page 1 of 3 '` • Cut and install sleepers to roof deck. (2x4 p.t) • Cut and install decking. (1x4 mahogany) • Cut and assemble exterior trim kits. (PVC Ix stock/window and door) (Match existing as close as possible) • Install exterior trim kits to window and door units. • Cut and assemble interior trim kits. (Pine Ix stock/window and door) • Install interior trim kits to window and door units. • Install new siding to walls and balcony section. (James Hardie/cement siding) (N%ite)(Match existing side porch) • Cut and assemble new railing sections. (pvc and mahogany stock/match existing side porch railings) • Install railing sections in between walls. • Caulk all joints weather tight. Note: If Boom required,additional costs may be required for rental fee. Contractor will supply permit. (Price to be determined and paid at midway of job) Contractor will supply all materials. Contractor will dispose of debris made. Contractor will not paint or stain project. Construction Supervisor License No.065791 Merchants Mutual Insurance Co Home Improvement Contractor No. 120334 (Liability Insurance)Policy#BOPI070557 FULLY INSURED Associated Employers Insurance Company (Workers Comp) WCC-500-5015481-2017A Occupant Confirmation Pamphlet Receipt I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. P ' er—occupant Signature of Owner—occupAlt Signature Date Any other work that needs to be done that is not explained on this Contract Agreement will be executed only upon written order from the Contractor and signed by both parties becoming an extra charge over the agreed amount. Additional work will be paid in advance. Page 2 of 3 I y ,• t COSTS Carpentry Work Labor: $ 16,500.00 Stock: $ 7,785.00 Debris: $ 700.00 Total: $ 24,985.00 TOTAL PRICE:$24,985.00 PAYMENTS 7/2 e Initial Deposit � T $ 8,325.00 Half way through job $ 9,000.00(plus permit fee) When job is completed. $ 7,660.00 (Job will take 3 to 5 weeks,subject to change depending on weather or additional work) (Approidmate start date of July 25,2017,subject to change) I, Kenneth Tokarz,have had the opportunity to read the above and understand the terms contained therein and by signing this Contract Agreement,I agree on paying Emanuel A. Silva of Silva Lightning Builders for the work itemized above on this Contract Agreement. SILVA LIG BUILDERS By Emanuel A. Silva,Contractor kenneth Tokarz, meo er DATED: Y ,2017 I Page 3 of 3 i Massachusetts Department of Public Safety �� Board of Building Regulations and Standards License: CS-065791 I Construction Supervisor . EMANUEL A SILVA 48 LINDEN AVE ,: T. f� N ANDOVER MA 01845 b� t Commissioner Expiration: I 11/28/2018 «�8 (CdIyC JIL471C(tGCIGf�(F(�/`�IJJCCC�(IJGC(J. Office of Consumer Affairs&Business Regulation -. HOME IMPROVEMENT CONTRACTOR Registration: 120334 Type: Expiration: `:'91%26%2017 DBA SILVA LIGHTNING BUILDERS I EMANUEL SILVA = 48 LINDEN AVE. N.ANDOVER,MA 01845 Undersecretary d c s An doucr - I A 04,X04.J�I:La�4 VTT ' 4y, {� �f l *�� �X���in pt �ll f•�'F DOQ�fj t f,/ F t prr'�� 1 7 '� '>k�'?aA t }"'i '��1'l.r�j� 'L� '• tl �� � �.' ��� ��� f F,� '¢;r � �i �'� :`, f" �fi r`�y� �� r � t..�, � �f��..` 1 _ 4({� � .,'�,�' ��'S is =...........<,.»».,..�•' ��`J" _.. ��� � JS4 .' a , a,;,q�rf�tj Y,XeY,Rci {5 2 X Z L4vls4/^ �x,skcn ovc�ti�� �mmonwealth o� assac�iusel Official Use Only Peimit No. �ePartnteI o� WT.�ervrc¢9 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/073 cave blank) APPLICATION FOR .PERMIT TO PERFORM ELECTRICAL WORK $ Ali;work to be performed in accordance with the Massachusetts Electrical`Code(MEC),527 CMR 12.00 {PLEASE PRINT ININK-OR"TYPE AI L INFORMAT'011� Date c�- r �p City"or Town ofd�( �n A�SCk .cD , To the Inspector o Wires B}%this applicanon the undersigned:gives nonc1.e1.of his or her mtenton to perforin the electrical work d11 escribed below _ -Locad ' (Street&Number) p^ :1.�� .5 pr ,; Owner or Tenant Q 'gip �f? v' '7 Telephone No Owner's Address Is ihis permit in conjunction" 'th'a buiidu►g permitry Yes No ❑ (Check Appropriate Box) Purpose of_Budding (� `� Q �� Q R7P 1i Authorization No Exstmg Service Ams /_: rL]1)( olts 1. Overhead �.0 P 'LGj Undgrd❑ No of Meters NewSemce Amps /;` Yoits O% verhead❑ Undgrd,❑ No of Meters Number of.Feeders and Ampacity Location and Nature of Proposed Electrical Work Q�G Fz� Z Com letion o the ollowin table m be waived 6 the Ins ector o Wires No.of Recessed Luminaires No of Cell:-Susp (Paddle)Fans:. o,of Total ..:` Transformers KVA No.of Lum6 .1inaire'Ontletsi No of Hot Tubsr. `. Generators KVA Above ` In o.o " mergency ig ng No,of Lummaires Swimming Pool,: ted. ❑ �, ❑ Batte Units No of Receptacle 2.Outlets �? No of Oil Burners _ FIitE ALARMS No.of Zones No of$witches No,of Gas Burners o.o etec on an 6. Initiatin'"Devices No6. .of Ranges No."of Air Cond Tons No.of Alerting Devices No of Waste Disposers H1 .eat ump urn r ons K o.o S.. ontained Totals DeteWdn/Alertin .Devices No:of Dishwashers Space/Area Heapng KW Local.❑ unicipal ❑ Othei Connection No,of Dryers Heating Appliances KVN Security Systems:* No of Devices or E uivalent No.of a..ter No of o of - Heaters19 , KW .1 Data.Wiring. . Si ns Ballasts No.of evices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications'Wirin No.of Devices or E uivalent .._,,.' OTHER: . v Attach addrtronal detarl if desrred oras regurrer.d by the Inspector ojWires r. Estimated Value of Blectrical Wor.rk �U> (When regurred by municipal policy) Work to Start: Inspections to bejrequt. in accordance with MEC Rule 10 and upon completion INSURANCE COVERAGE Unless waived by the owner,no permit for the performance'of electrical work may issue unless the:licensee-provides proof orr f liability insurance including"completed operation"coverage or its substantial'equivalent The undersigned certifies that such coverage is in force,and has exhibited proof of same:to the permit issuing office CHECK ONE. INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the paces and penalties of perjury,that[he`information on'ihi appltcatton rs true and complete., FIRM NAME6. "LIC.NO.. Licensee: $�tl t n t Signature (� .` LIC.NO.." . G j,� (If applicable enter"exempt'rn the license numb line. us.Tel.No.• Address• ti AIt..Tel No;: *Per M G.L;c. 147,x.,57-61,security work;egwres Department of Public Safety"S' License Lic No:: G `-- -'� 2 OWNER'&.INSURANCE'W- ..r Kari aware that the:Licensee dor. res not havethe liab li insurance co era a>normall" r.6. t3' g Y required by law. . mr.y signature below,I hereby waive this requirement. am the;(check one .❑owner ❑pwner's a crit Owner/Agent Signature Telephone No PERIKIT FEE:$ -- .. . .�..�. .? . o s E . •; � � .� , �. i I, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgations 1 Congress Stree4 Suite 100 Boston,MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n �n Please Print Leebly Name(Business/Orm izationgh ividual): Address: L �..Q W c City/StateJZip` - c� e�) 01 Phone M don C;-3 G'A Are you an employer?Check the appropriate bog: Type of project(required): 1.B1I am.a employer with 4: 0 I am a general contractor and I 6. ❑New construction' employees(full and/or part-time)." have hired-die sub-contractors Remodeling 2. I am a sole proprietor or partner- These on the attached sheet. 7. 0ship and,have no employees Thi sr ctors have 8. ❑Demolition working.for me in any capacity. employees-and have workers' 9. Building addition workers comp. comp. insurance) - mP additions [No 5. � We are a corporation and its 10.Q�Electncal repairs or required.] 3.❑ I am r homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions selfo workers'comp. right of exemption per MGL 12:0 Roof repairs J ce�uired.jt c:152;§1(4),and we have no 13.[]Other employees. [No workers' comp:insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contmetm must submit a new affidkvit indicating such. #Contractors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employes. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and jolt site information. c Insurance Company Name: \ tkr F^e V � �s LC) Policy#or Self-ins.Lic.#: (A 2--C/° Expiration Date: Job Site Address: IZ 5 G ci V-� Q City/State/Zip: q®'y4i -n /V O 61L hlf� Attach 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 Ialvestigations of the DIA_ for insurance coverage verification. I dW:he and th(e�. airs d enalaies o that the in ormation-provided above is true and correct _ \" n fry Si attire: �' Date Phone#: `� G i 5 g Z Official use only. Do not write in this area,to be completed by city or town ofjrciaL City or Town: Permit/License# Issning Authority(circle one): I.Board of Health 2.Bnildmg'Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector i � � � 1 .. .. 1. / / } 1' . . P fa� �f .I •'� FI— .� ..�. r —' • r � � • , � •r r .. -• ;• ... i. �, � i`J t` �i � I I r 4 COMMONWEALTH OF MAS ACH&ETI S ; B ME D Q1~ �1< C>TR I UlI ANS k �. s I SSUES TINE .FOLLOW ING LICENSE AS A REG .JOURN,EYMAN; ELECTR I CI AN 7¢' DAVID: C ROBINSON° I. W 3 i 1 WEST,WI°NSD D v '• �. 1b,�7W i 1 KtTHUEN MA 0 1844 19' ' J 27 35056, E 07/3.1/16 291 Date..�a�. -`7 .�.'?..................... °�r►ORT/y,� o�•`- °°{. �, TOWN OF NORTH ANDOVER i. PERMIT FOR GAS INSTALLATION ss�CHU This certifies that N. (...... ,. '!5............................................... has permission for gas installation ..... in the buildings of....W' ,,1 -........................................................................... at..... ...... ..1...P..S 0-r-? ..... .......................... �..�.., North Andover, Mass. Fee. ........... Lic. NoI05....... ............ .................................................... GASINSPECTOR Check# 0989 tp0 ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY:, IJo at N41a cit MA DATE PERMIT ; JOBSITE ADDRESS �esco-q S' OWNER'S NAME C , OWNER ADDRESS TE FAX TYPE O OCCUPANCY TYPE COMMERCIAL EDUCATIONALRESIDENTIAL 1')[2IlVT � CLEARLY NEW. © RENOVATION: REPLACEMENT:[3'' PLANS SUBMITTED: YES NO( ►�' APPLIANCES Z FLOORS—► BSM 1 2 3 4 5 6 7 1 8 1 9 10 11 12 1 13 14 BOILER BOOSTER CONVERSION BURNER IEZZ COOK STOVE DIRECT VENT HEATER DRYER I FIREPLACE f[- FRYOLATOR FURNACE GENERATOR - GRILLE INFFtARED'HEATER LAB ORATORY COCKS (+— MAKEUP AIR UNIT- OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST` - UNIT HEATER - UNVEA ED ROOM HEATER WATER HEATER OTHER ►net eti mQJe o- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0'I�0 El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND -1 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 0 AGENT ®, SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are tryoaccu the t of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be inwith rtin rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. \ ' PLUMBER-GASFITTER NAME �aw � )� LICENSE# i 56 q ' GNAT E MP13'MGF[ JP [j JGF EI LPGI® CORPORATION 3(r,( PARTN SHIP®# LLC 1:3#= COMPANY NAME: ' _ 8ro Sez,,i c-e " __ ADDRESS CITY STATE' /1'► ZIP 2 f Z 2 TEL a FAX Lam.���1 CELL_sa Qa6-fg'?7 EMAIL r' I p � �' .M w 3� V • / EOmM.6N�/Eq,LT . s H.OF Mgg1�HUS , 4S P L'UMB h 9S Tii FOLL SF[TTE�S U .�rt�CzER1f'S[yQ OWb14NG.��SI�CEN�E . . —_ A5 AtASTE(i' �QPLM'BE:R -GAP L�} 21 W t'L'L ka�y �Cif`TON 15'64 MA G�3o:t 14 .j' >A: . ?Q vo t ''2264; 9 q ONIMONWEALTHyOF'MASSIG�HUSET[S'".; �,- � 6C3}IARD QE r PLUt<1BERSGSF�ITRS`r i SSUES THE FOLLOWI+ C� ¢L31 CENSE xjt REG IS1RED AS A PrLUMBI'i QRrPr ti pAUID'W GARF@I ELD'k ��6t N .f z E{EN,E BRQT�} RS'" SERV+I CES � W 21 W I,L U0,W S T BROCt(TbN xMA 0230-1 36TH , 05/0111<". 22'L41 3 Y FEENBRO.01 SMORAN '4C7 CERTIFICATE 4F LIABILITY INSURANCE DATDrYYYY}-- ----- - 11130/230/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(tes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX (877)816-2156 434 Rte 134 Arc No Exit: Arc No: South Dennis,MA 02860 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 INSURERA:OId Republic General Insurance Corp. 24139 INSURED INSURER B Feeney Brothers Services LLC INSURERC• 103 Clayton St • PO Box 220801 INSURER D Dorchester,MA 02122 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !LTR TYPE OF INSURANCE DD SBR POLICY NUMBER lAhhVDD YYYY MM/PP EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE a OCCUR A2CGO7501501 02!0112015 02!0112016 DAMA(3ESE T RENTEITnce $ 300,00 PREMED EXP(Anyone person) S 10,00 PERSONAL aADV INJURY $ 1,000,00 G£N'LAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 POUCYa EC MLOC PRODUCTS-GOMPIOPAGG S 2,000,00 OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLOWED SCHEDULED AUTOS AUTOS t30D1LYINJURY(Per accident) 5 HIRED AUTOS AUTOSSK4JED PerraoEcxRden0Al,lAGE S $ UMBRELLALIABOCCUR EACH OCCURRENCE $ EXCESSLIAB HCLAIMS4AADE AGGREGATE S DEO I I RETENTION$ $ WORKERS COMPENSATIONPER 0TH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOWPARTNERIEXECUTIVE YIN X 2CW07501501 02/01/2015 02/0112016 E.L.EACH ACCIDENT $ 1,000,00 OFFICERR,IFJ.1eEREXCLUDED? N❑ NIA (Mandatory In NH) E.L.DISEASE-EAEh1PLOYE S 1,000,00 Ues,describe under SCRIPTIONOFOPERATIONS be!gN E.L-DISEASE-POLICY LIMIT S 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE tl� h ©1988-2014 ACORD CORPORATION. All rights reserved, ACORD 26(2014101).' The ACORD name'and logo are registered marks of ACORD MAITREThe Commerce Insurance Company1m Citation Insurance Companysm Commerce " Gore Road,Webster,Massachusetts 01570 INSURANCE- 508.949.15001 www.commerceinsurance.com April 09, 2015 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: KAREN BAILEY/KENNETH J TOKARZ Property Address: 55 PRESCOTT ST Policyk VL8336 Date of Loss: 02/24/2015 Filek JYWN72-HRMMJ2 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. KEITH FITZGIBBONS Telephone: (508)949-1500 Ext: 11485 CLAIM SPECIALIST, CASUALTY Toll Free: 1-800-221-1605,Ext:11485 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. April 09, 2015 ICE DAMS, INTERIOR DAMAGE TO HOME. CIC 254 (Rev.4/95) MAIL I15 09788 Date . ••.�TYLx6��r• TOWN OF NORTH ANDOVER t PERMIT FOR PLUMBING This certifies that . . . . 1 .!`. i . has permission to perform . .i-3!A.14{��04r.�O9JIu,k -WC4-I Qpa plumbing in the buildings of. A��. . . . . . . . . . . . . . . . . . . at . . . . . . . . . ..(. . ...c'. . . .`--�t. ..rc�e:i', . . ,North Andover, Mass. O -670 Fee 6.0L . . Lic. No.` . . . . . . . . (�� . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check# 2 0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE ) PERMIT# JOBSITE ADDRESS &0 + OWNER'S'NAME 1 OWNER ADDRESS, . Sf. TEL G�/ f FAX[ TYPE OR OCCUPANCY TYPE,, COMMERCIAL EDUCATIONAL ' RESIDENTIAL PRINT CLEARLY - NEWNZj :'RENOVATION:D REPLACEMENT: } PLANS SUBMITTED: .YES El N00 FIXTURES Z FLOOR— BSM. 1 2 3 4 5 6 7 8 .9 .10 11 12 13 14 BATHTUB 1= - ... == _ t_ CROSS CONNECTION DEVICE . I DEDICATED SPECIAL WASTE SYSTEM' i DEDICATED GAS/OIL/SAND SYSTEM ! DEDICATED GREASE SYSTEM' DEDICATED GRAY WATER SYSTEM s DEDICATED WATER RECYCLE SYSTEM l –�A?I -DISHWASHER' I DRINKING FOUNTAIN . FOOD DISPOSER i FLOOR/AREA DRAIN i. INTERCEPTOR(INTERIOR) : KITCHEN SINK _ r LAVATORY ROOF DRAIN :SHOWER STALL SERVICE%;MOP SINK TOILET - `URINAL v WASHING:MACHINE CONNECTION . WATER HEATER ALL TYPES WATER PIPING _ _. i .. 1 _ INSURANCE COVERAGE I have'a current Ilabrli insurance policy or Its substantial equi5alent which meets the requirements of MGL Ch.142. YES NQ.=o IF YOU CHECKED YES,:PLEASE INOICATE;THE TYPE OF COYERAGE..BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND OWNER'S INSURANCE WAIVER.1 am:aware that the licensee does not have•th0risurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signit: onahis Permit application waives this requirement.' , CHECK ONE ONLY: OWNER[] A.GENT SIGNATURE OF,'OWNER OR AGENT. I hereby,certify that all of the details and information l have submitted or.'entered regarding this applica', re tni to to the best ofmy knowledge and:that all.:plumbing work and installations:perfonmed under the permit issued for this application be in comp wit -al Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1Q of the General:Laws. PLUMBERS NAME LICENSE# lZ o7" GNATURE MP JP® CORPORATION# 3. 050. PARTNERSHIP #17-1 .;COMPANY-NAME! 1 7�r� ,r to�►� rJc ADDRESS' 7 . ��M'r, i -lj7( CITY FAX aU` ,CELL ti-- EMAIL :: "I�G-°1 1� ,,�"Q �G-. t j ' �'rsf� l� 1 nljlA✓�;: � ,� �. .''I�i .l �, w,�. . ��>P .:� Z� 13 . - . ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE;USE ONLY .. FINAL:INSPECTION fiIOTES Yes ;`No .: THIS`APPLICATION SERVES AS THE PERMIT. `❑ G . __. , 1. . ,. FCE;$ PERMIT.:# PLAN4REVIEW-NOTES ., . - . � `_" r: _ ; __. / 1�� - . . %_ K, _ , . n .. .. . . _ *_. _3 .. .. • '.:: 4 r¢� 01/29/2013 TUE 10: 47 FAX 617 484 4200 winters Company 12003/004 N The Commonwealth of Massachusetts Department.of Industrial Accidents Office of Investigations ' 600 Washington Street Boston;MA 02111 www massgov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A y1kant Information Please Print Lodbly '=e.(Business/Organization/Individual) rl Address:_ T% City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required) 1. I am a employer with.a�_ 4 ,E] I am a general contractor and I employees(full and/or part-hate).* h e hired the sub-contractors b 'Q New construction 2:[] T am a sole proprietor orpartner- listed on the•attached sheet:.. 7: :�.Remodeling ship;and have no.employees These.sub-contractors have g• .[]Demolition 'working forme in.any capacity. . employees and have workers' [No workerscomp..insurance . `.comp,insurance.$ 9:: 1 Building.addition required•] S: Q We are a corporation and its _'IU.Q Electrical repairs or additions 3,.Q:I am a homeowmer.doln all work officers'have exercised their : S 1,1. Plumbing repairs or additions myself..[No:workers',comp. right of exemption per MGL :. :. ... 12 insurance required:]t .. .. . c. 152,§1(4);and'we have no Roof're „ ._.. . employees. :0 Other P� [No workers13 ' comp:insurance required] *Any applicant tliarcheoks checks-box f #1 must also MI out the section below showing their workers'compensation policy information.Homeowners Who submit this affidavit indicating they are d6i ij all work.and then hire outside'contraotois must submit a new afi'idavit indicating such 'th : tContractoisatcheck tlus;box miutattached att additiorfal:sheet showing the oameof the sub contactors and state whether or not those entities have emgiloyees:.if the sub.connectors Mve employees,they must p Ovide their woricers'.comp.policy.aurn¢er• .: Iant aR ens to er that:s: rovtdtn - . P. y. p g workers..eo en�atroK insurance or m e to rn or � j'. n.. Y mP 3'eeS'`Below is,the policy Insurance Com'an ame .. .. p y. ..N. . : . .. ...... ., . ........:. .. ... ... . . U J 7 . . � ":-• ' aS Policy#or Self- ir Expirattou Date.* J. ... ... .... . ob'S'ite Address:` LLL Gity/;;tate/Zip:77 . Attach: .copy of the workers'compeasation'po ey:declaration page:(sla owing the policy nuimber and expiration do}e) Falltire to secure coverage as required under Section 25A of MGL c.:152 can lead to.the mpositioQ.of crimival.penalties of a fine up to$1,500.00 and/or one-year impnsanaient,as well`a8.6 vil penalties in.the form of a STOP WORK ORDER'and a fi ' ' of up to$250.00.a day against the violator:.B'e advised that a.copy of thisstatcment.niay be forwardedao,the OfTice of.. Investigations of the DIA;for insurance doverage'verification. I do hereby eun e> the auns..a d enal[res o er'. that t P . IPJ 1' he infor�na#an.provided above is.it ue ai$4 cora S' attire Date. � ,•z'. yam• . -777777777+ tine# . el a . .. .. ..... OfJicia[ use.only. Do not'wrlte iiialis1 area,fo be co r . mpleted by cityor towtl+ocia� f ty r. own.T ,...: ...., ,.. .: .. .: PermitlGieense#• - Issuin Authori g ty(cu ele,oiie B a rd ofe H al th �.S.uildirt gDeparttuent 3,CityiTowpi.Clerk .A.ElectricaF' . ther ,.::•::..... . ..•..:.. : . :•. .... ,. .. : :. .. .... . .. ::.. g:InsPector..;', . ' .,.•,;:, ;: :„`:,;:.: - Iaspecfor 5.Plumbin Contact Person: Phone# : ... .:.:... I o • r N hr: & � 4af3idhs � r3ii�'a �F k � 1E. A4� °�� d 9crn.i f Sq s:� Lel * rte{ y�1g a—�E-gamsh Sc 11 P. Nj ,��'• �^�n�'Y"'� c r�, r`� - -{ � �. ��` "fY'y+'�"x�•`...�� %'Y�9�'� � ��$ F r�4..-�'i'� ��w r �� � "ter 7f r; EN, . Q t r'�l�"r'` xfE' •c.--:;'t rz� s �. cd' - kit l4'r� r •-s 1 C ?:dS'+•r S{^y.' ',£ y-•xc _ - :Gi (.f N.fL .r.3 / 1.- •' my , }P 4 } " 00 T. Y .'�K•� f 7'� :P Raxr.�.r3: O so fi I. - � ry r - , r ' L � i �� 81[E � M1s" R 4 'l�E +. } 'j �:R-# �} �- R� Y• ,p� el G �a�a',v. yY2`-4"y:a` a.:�'.v .•x' -;.•v{�A 3Yx:, t ` i .�'w. 9. �i'-�}.'����� � i'�i �'s"4. 'a'��,h`�`#",�d.��� �:, `< -i �y.,c rr a �P.:_ ny{� '$M S.- '!^' OWN- �%:7"SS'N.e'4• Fr 1f: � ^ r. ' Z _ i N M1 OA �S'(.:'- d �'tl- ' w3 x i( '!' R ,a a{eta d49•r•• -S -ft: F4- j-u t,r. G k" ..�� f. _l;c r,j.,•'--,ast"��, --t r�.�e��� f 0.xi># f� � v-°.. a E. . r � ^� ..,.,:'�'. .z,:.�.,�'Y,'a'z a r 'f', :i f +J:-"'"• ,3` ', tx; Afti.l-rY! ss.a '` 5: -. - ; - ,-t .''i :r>-. . "uI.s, .a;,.�,�--�,`'!� �.�"r,s• _y,�.�2 r iii a or�..7 ..� �a :c-:,' i - .:a r# ' i -�. �. �.f r t:, ��w� ,{.. .Y a�;�'��:a:sq,w�,$.s�' f,a � :r +q>„ ,•�w � 3 ':1 a �- � � 7 � ha ,� ='t, �'y: e�'•;- 'i t .wf-hµ 'T*;.� It y 3.'.Yv j 'Y • z c G, p '.N- 3 1.7.t } " � s r �' ;r,a�'•y�-a�_ r_'���.r� �'y �"' ;: r �yw �s r c� r �r� _ #.� � fes' - a .� � C�.� iF. -13� v t�•c}r _ c ��+ r; � � � :.. u 62-441-7, '�' � .f "�rf��� ..,;. 1 .r���_� �.• c ftG. t} k r��x' a.: �.�'�rt r`M1�:`�s:_ �.1�' � }� -,'�-�}?I� (� r f - 'Y Yc s..4t �+F �.. �'..1`• '• a .1 [� � � __:E^-� 4�� 1 r�� .p�.. y . _ O O O Date .1 12°1!1.73. . . . . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . 4 . . has permission for gas i �' rN nsta11llation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of. ..; at . . . . ; f PSC'n� : . . . . . . . . . ,North Andover, Mass. �" Fee .�."' . . Lic. No. 207.0. . . . M�''. . . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# ? 00 8580 MASSACHUSETTS UNIFORM.APPLICATION.FORA.PERMIT TO PERFORM GAS.FITTIO:WORK :. CITY _t .��� 1J� ���„a MA'DATE . .f ��.. .!.� [PERMIT# Y" .. :.. I J08SITE ADDRESS a � _._ OWNER'S NAME j ' OWNER ADDRESS TYPE OR TEL J ? lw �F4 OCCUPA.NCY TYPE CQMMERCIAL PRINT EDUCATIONAL ; RESIDENTIAL L„i CT EARI:Y NEW RI=NOVATION REPLACEMENT PLANS SUBMITTED YE�,� N0 u� X�PPLIANCS Z FL00'RS� BSM 1 2 3 4 5 6 7 8 9 10 41 8 13 14 .x `, VERSION'BURNER 1y� C©OK STOVE c� DIRECT DENT 4I;,4TER FIREPLACE { fRYOLA'.T. OR � GENERATOR e 77, GRIEI_E : _ tNFRAREp HEATEf2 MATCEUP AIR 11NIT i ©VE:N ' POC)L NEA`fR r < ' Rt, M,f SPACEHf_'TER #2OO TflP UwTAic Y 1 1 #II�I3 1 �IEAr�a llNVENTED ROOM SEATER � - WATER H TfR �. dTHt=R fiV.. 1 V r - ,• u r vmdt t �.>•?�r r y z _ as 3 a_ _ 1d ° - � � c x ..T.-`.' F' ,x- � 4, _ ” - t �t�iave a curceptlRabifi �nsea�ar3cI o�' s's�rbs�an#iat�qunra[eaf rdh«hefs the requiEere #s sol JVIG�,Oh C425 Y rNO 1 I YQt! HEGKEp XE�'-PASE'1 X,E VEI2 t�1 TE bFc0 E•131�CHECKING�THE IpPRbp�tl'k EBbX#�ELCIyIt " L114BIL#TY�N$44�tE POLiCX OTHER TYPE�NbIrMNlTY BOND a DI(ItNER$ifVSIiRAGE�fff(it( am�i�tare#hatthe,ticehsee�oes_ otetrem (rahe vera e INlassachuset�s Genera Laws ,' required by Chapteri2 �e J 1 .'. 4 f, jt�l m slg�afurb ot� is PapplIcalaoh wanrea this r¢qutpe�tt. ' �\ s��rvAa CF�1lVNR GHIrCK ONE x,11 �QW R, 1GEN7 r= I beceby�ertfy#had al{of the details 4ncl tnfcxntadn 1 have subt»:ttfed or enEered . Md that all piurrlb�ng 1 and nstallati n gandrtg this appl caUen e o e afmy lm Massachusetts Sfate Piurnbi 4° � 0� under>ae permtt issued foc}his applccarign f( p cariPita It P rUn2cit pro+ do of ` t ?�odA�hS><Gaptec 1 d7 pf the General � f �4u1VIBEa"17.A�!iT-TE1�1�l 1"W.,,, - r .ICEN$E# , . GNATt�tE (AP MGF� `�P�rJG,� �.Pl,;l s +DORP4RI�T�Ot�F � ��RARTNERSC�fP � 11 � E�M > r �4.=... Af)I�RESS '�'�'�r �. , '� ••<dr.,�r,�. r.• - �_ �-. , - > ROUGH GAS INSPECTION NOTES i HIS PACE FOR`INSPECTOR.USE ONLY % FINAL INSP,ECTION'NOTES Yes N �2m- 6.6 6". 7.r"."' �:�: ��6 ,�- , ,� � � � . EN. r..� .--'.._6..4."1,.r I,- -.I,, 'r:, -1� ' .'� I.-rl.�. .-, , . . THl3.APPLICATION;SERVES AS THE PERMIT ❑ ❑ . 1. FEE $Em "',,""l.-..--ll',,v,-,l..11'.,� ." :��: ',.�.,-.,".",..".x- " ;PERMIT.# _ PLAN REVIEW NOTES ,. - :-,: ....': � '- - , �. - . .�,� .:: : =� , ; , - .- 11 K . 11 � C1Lr q Ld �� . =; � I - � .. I ,1,, : I -�"': �,.:�ll�:�� .�'. : . . ,,�. I .,. . ,�..�.-� .� k, X�%A. . .. �- . I �, , �r_;.,,L�6--,�,,-,- 1. 1 6 .. � ,.. .,- r ..��-1,.; ti ,r � 6 - , Mo.,t.., :�:� . 6 -,�. 0 ,.1 "":'I'l."."I 1,111-,.,'�",,1'--",.'1�,"6-l"'ll � ..,, .I �� .. � : .I r�, - t:� '. .. , -� �.,�- '; �. :'-� ''� .� � .. ry , 6666666 �. -..: r .) - ? 7 - .. .. .. :r ,..,,. .: �9X . ., .1:ff 6 , -- :" . . -,-)r"ll,',,-,,-.,",,l""wi"--'"",-,",`l-'-,'�,",�', .m-..,.v,-..-.",,�, - , -�:,��,I I . ��V,: 11 I�.61:,.. m%. r �I -, I I I . I . � � I 6 I . , ;,, r; � .; �m I -;-1 .I, � .r,' y .. 1 E i .. 1. :,, , ,.,.; :6" mm I-6. --"�.."- :; , " , �, ,,r,," �,,:�., f, ,� � I I .;I 'r , .: � 6" r � . . I I , , .. ,. . ,ai� " I ,-, � .% 1. -�, ,� , - , , - _,,__ ,I .� r I W ft. 1:: -': . I.. 'I-, .: .. �: r,"��?6 ,�1 .� ; ,�,� '.. I,. - � r" . , 6 � - IN , :--"' ,�, " , , , - ,�; -. I.�r � 11 I ^ `. -i.'. .,,,. ,,, , .,",,..-r,,, . ... . Zz 61 r -,6.-,.; - . n Ylr 7t . ....,. .. .. , L , _ - _ ..:.. ., . 01/29/2013 TUE 10: 47 FAX 617 484 4200 Winters Company 0003/004 The Commonwealth of Massachusetts Department.of IndusNal Accidents Office of Investigations 600 Washington Street Boston;MA 02111 : www.mas&gov/dia. Workers'C.ompensationi Insurance Affidavit:Builders/Contractors/Electricians/Plumbers ' ..: :: .. :. A licaiat Information . Please Print Loiiibi - Name.(Business/organization/lhdividual): 'Address: G TJX City/S tate/Zi (�. •L Are you an employer?-Check the appropriate.'box: Type of projet t.(required):: am a employer.v✓ith 4• [].I am a general contiactoi and I employees(full and/or part-fime).* `. '>• :' kiave lured the sub-contractors 6.'0 New construction ':j [] I'arm a sole proprietor orpartnet= listed on the attached she 7: Q.Remodeling ship and haeme no.employees These.sub-cofttiractors have :8. El Demolition working, for.me in:any capacitq. . ' employees and have workers' [No workers'ebmp..insurance comp,insurance.$` 94: Building.addition •. required,] 5: Q We are a corporation and.its 10.,�Electiical repairs or additions 3, :1 am a homeownet.doing all work officers'have exercised their :- 1.1.�Plumbing repairs or additions **if,,[No:woFkers'comp. right of exemption per MGL.. :instuance required:].f c. 152,§1(4) and'we have no �2-[)Roof repairs. . workers 4 ployees.[No wor. . ' 13[]Other . comp:insurance required:] Y aPPant ttiaCchaotcs boa#1'must afso fi1F out the section below showing their workers'compensation policy informatiop 'f Homeowners who subtriit this atlidavit indicating they ane.dojn&WI work.and then fine outside'contraaors•must submit a newaffidavit indicating sirch. :., tCoritiactois if�at check this:6ox must attached an additional:sheet shorying the name of the sub-contitwors and staff wfiethet or iibt those entities Vel, employees::if the sub conteaatop(lave employees,tltey:ndust provide their woalceis',cornp policyuum¢er I ara r{tiemployer that sprovidng warkers':co ereration ur ,....... mP: . .. tns ante for my employe ' Below:is:the policy aisd jo3 site..:: `•.' . .:':'.;:•', ' :` . ormatr'on..:. :,Insurance Coin any Name: . :: --�' PoItc y .-Li c.Se f-in s' 1 .'#x�: a: 1J •'iratio� `Date: n Job St r e`A d =.:. _ dress: City%State/Zip: Attach:�.co of the workers' PY.. . comp..ensatiori''policy;declarafionpage:(sgowi,tig.the .okc aumber•an a iratoa Failure t6-secure coverage-as required uBdei.Section 25A ofMGL p Y ..xp. . ... c.152 carr lead to.thempositio.q.of otiminal.QenaIties ofa,'.; :.: fine up to$1;500.00°and/'o.'z.one-yeai,unprisQnirient,as well'as.civil penalties in the form oYa.STOP WORK. -' ORpER:amd a ftne ` of up.to$250.00 a day against•. e violator. '13%;e advised tliat a.copy of statement may be: orcvarcied;to the Office of .:. ..; Investigations of.theDM for iitsurarice coverage'verificri'ion. . I do'hereby certify un el+the ainr,.a 'il pendlfies.of er` Ghat the iK orm P *Y f. .allon.Pia'iOgd"ape is-tru dnil corree�•. g. - :<<$ w. lure: Date iz.:• , li ne'#: - a. Official use only, Do not write hi:this.ared to be co r mpleted by.eity'or toren,ociaL oV r., _ rY Town PermitlLleen"se# . . :.. : . . .. Issui : n Authori' cir g t3' cle-one 1• ( Board.of Health- 2..B:tiiltliri be art g, p went 3,Ci .fTo Clerk :4.Elec 4 EY....!vR. trioalIns ector SCPlumibin In'``ecf :.. . • 6:, ther g.. .sP Contact Person". V. Phone#> 7.s N Hill I I = .a,.+'7'<xe..xyr' .v+,2�S.L%•. .a.zty ..k.. .. -' :f- _ - f�, b �} :vim_ -1d '=- - - }+ - i - - - - - 'g .fir- •:P:''.:t::, h` _ _ ..:....j_ .IRY! � • t3 EP �i� : , .;y 7 .•k - rtleN i_ - Y.. s:c{e`�y -�'eF�k:_....r:-�t•�(�;Y�r~:: ,•a d r > r ksi , ice^'r. ....., -. ..... .. .... :! ,. .. .. ......• . rt.�r. .. '�::.�}' - 4 ..Y.. v. ..Cic. r •[ .r ...-: ....,...,,r ...,.. ,.... .... - .:i�riJi--rK:' ..W.'S _.,. �'�•qtr: LIy �� - r , IL - tc 1. •fes " •'r:�s.��l,-,'':,:: ,�r ::krt d• , A �^ �a- 3 ,}� � moi'• rh rP .a,:r •. _l ... • _.. .. .., .... ...... ..�. ... .: :"y>w;r:n:::Y%:i.:.... 'ti:�• j`.,L's'S •.'`4r-+1- - ._ *t �. ,._. .... ... �..._.,,,.... .. ...r._-.._ .. .r..._,-'.,.', -'y-' - �.. .5...e}-�'�� fix,. .•;'•, ��� fi.A..,-s.>5 r.a1 .._ _.+._...• „-,. a . _ ....... n ....,...,.- ... �;1 j•'h r >e£i.Yf 1. .+....... ...... .. . .. .:r...rr s .. 1. • v:. ?+ g '.`:. RE _ f N t.' I } / .'' a s.:'�, i'-. .:1._.?f: ..L t T ..>:_>. uw�•a a. - :rY• :� - ,gam (�cr:+',5•i;'1 �F•,rr fns J f y v r1_I p .mss f3 , r ...ate:.:::•'-"�;r',- .SDNA FU - r:.:. ?t ,- - r. - -_ - _- - h.`�Fi':�.;{y u7S.s•�,c:,'r!+,"dE'';•j.�[ a 1,• __ T.r - r a.-_..:.:.,....�.. _..: .! .d .. ,:.. r. .>•.rli.^._,-.,..:_.;� ^ic?° i5::' - >,�Yr'? - rlo - , !.LLPa •. ' ''. WNE "Agin � � AIRF : �. ' E {I� _ t, F 9�? iv Ell - -: � 'a '.' ,[,"qp�. :,'. •� .Spp�$§.��p5,,[�fpr���t"�� =`1'.���Y,•_ t NtdlzA ar i , r n rr' r I �p a - MS,f - I 1 .� .'Y^ P-.,, •H _... z;`�a .t!-a.tl:,..M•�s,__,. - a� =t.'1.,: .^.. ,n �rg,� .:.,. ,:, ...,...-Sf,. _.,... y._.,-, .......ry.... .3..: '..r -.��•'. i-.��T r.-. -un:.!•"�:.:- re..... tr..'. .. .tee �r:?v,-' V. �h..,. i'i{-''1.3+• h J.G. _a•,_.'.�• - :,.'.,n�-,:-,3gfi.•..J.r y,w:.Ser.t.F..r-.,.."....,.s_.-.,y._....r...:..S:•r..........1.�:..T('..r.•..,.-..,..:..1�[.!._--.:}..�.�-....cJ �,N:.....rt...�or-dU.'...-.:_.a,...'u,Y'.[..rr,..F.:...r.,a..1..•..1,.J...,i._.....[.-..,'.jr,...'.:..: ...F`4�l•:k-......�.`.=tT'"-!`-.J u'�r:]:...'..-.�::s,•+.".,.1`.1',�-1 AM Mrs, v ' r. ii:S'aTL•[fi:';'�:-: q-�' -.: _.- � ,:L�'r-:.-.:-_._ : 1_��7�v_r',�;iMr.:,�r;..•,rfr4T:'��i_--:"..:y::'�):_r.:.. .�i ^}'':n^Foma^f.tirr[p�:••:.i-yriS:,, _ '- _ ; r - � 1 -. , .,, ., .__ r _ V. ..... ...:... ..... ... 5 ....... _.. .. ... .. .�., R�. :Kit-•ry''::�•.y_,-.�,�.. r, i qf,y _a.• + - ,fir ��.,r - ?;=;�.�Fs'i''j:v�-� _ - % <:r - 'F g _ _ �.�•,� �!! ae.k� �;' p ` n�;;ty,. .r. rte.' _ •=n':.:.- rl - - - 4[ til - 1r �•r �_ •+�S' ?mac_.-. - - _- u .=i - W R � _L• 5 - a' > - '1�'" �s Saar' ':i• - rG . r h,. p . ^�:?�-, - W 'k - r Ge"- - •dam':;�.�:. _ :. %r x .,. r.� f -♦rAC 4` � _ .,,: , _,,.} ._.. • ..... ti'l-. t.... C: ... ,.. 1 IRAN,;— - _ .n .:,.,Qc�•ir.a.�• ,r•� a,r } s" i� — - - : > - .a,-<...:.,. .;-.>;.,:•;..._�,,. �::..:: :�.. •..a.r,a... _ M.a yy k ,,,.-Via.u'1..:1......,..•:. .., i - _ R _ ..�L t q -mv r, i .l[.' Yr ' : a � C. -':5� .. .7 .yy u � - . r .. Ry. a _r. _ ..r;', :='aim _ y.y-�:. .,5x4,y.. ,xr: _.!li? .�._ _.� t•5'z-•„ - '' ,". �',", -9't cM1 R� - ..y' ) ,`ki 'S: 'P�:r-a:2; '1 l.N,• r.i,).,.y":' �sf-rS _ _.��.• !� .':-�,',.. 'Z -�.;:-arr''•Y�.�r�ii'q ��2,' e.c 7 '���:. ��t".''��-,'��,•4�',.''�a„_x(�`�• ,+:Trr,a�;i.5;' ^�h:.;. - - - - -- _t c Insurance Adjustment Service, Inc. 936 Roosevelt Trail Unit 5 Windham, Maine 04062 207-892-0522 Fax 207-892-0526 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139, SECTION 3B Date: March 5, 2011 TO: Board of Health/Building Inspector RE: Insured: Karen Bailey Property Address: 55 Prescott St N Andover MA 01845 Date of Loss: 2/5/2011 RECEIVE MAR 17 2011 Policy Number: VL8336 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Type of Loss: File or Claim Number: 68083 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, i Matt Martin Adjuster Ext. 109 DEAtRnN®V!'OFFENX AIw= Permit No. 77 WOMMESM BQARD0FFDiIssPftffMVMNRFXiULA7Xai1 M7(1 D.V9 Occupancy&Fen Checked APPUCATIONFOR PERAWTO PERFORMET- CTRICA.L WORK OALL WORK TO BE PERPORMED IN ACCORDANCE WITH THE MASSACHUSSTS E.LEC[RICAL CODE,527 CMR 12:00 / (PLEASE PRINT IN INK OR TYPE ALL INVORMATION) Date Town of North Andover To the inspector of Wires: The undersigned applies for permit to perforin the electrical work described below. Location(Street 3 Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: YesE3 No (Check Appropriate Box) purpose of Building Utility Authorization No. Existing Service 20 Amps lZell ZYOVolts OverhetlUnderarourtd No.of Metes I New Service ,�6� Amps ZZ01 yGVotts Overhead Underground C3 No.of Meters Number of Feeders and Ampacity Location and Nature of proposed Electrical Work L r v ac� 'fa e Ci 5/1 =777=60-Na of Lighting Oatleu Na of Hot Tubs No.of Tn oamnea Total KVA Na of Ughtirrg Fixtures Swhaming Pod Above Below Ckaxrstors KVA around round M No.of Receptacle Outlet, No.of OU Buenas No.of Emergency Ughdng Battery Unita Na of switch Outlets . No.of Oma Homers No.of Panama Na of Air Cord. Tot FIRE ALARMS No.of ZonesTOM aNo.of Disposals Na of Hot Tot Total No.of Dewdou and Pon" TOM KW titling Devices No.of Dishwuhm space Area Heating KW Na of Sounding Devlcas Na of sett Cbwahrrd Douctim3ounding Devicas No.of Dryen Heatig Devices KW Local Murdcfpic* al � Other No.of Water Heaton KW Na of Na of Connections SIMON Bailosis No.Hydro Mawge Tabs Na of Moron Total HP '7"re&- U+- hetW= Atslsrtbbera�itnlmsofMa�d>tBstiCiQ®ILaiM ihmaamnL&tfthumwFbiiYnidr;Cbn>pkt or�ststirlilec�avalat Yo NO 1taresu6rrilbdvsidp1ad0fs*a1Dh0fflan Y19 ayw atedrededYB4,pksskt*/th' orwv Vby aVAvcfEkftWak S WodcbsOst hipD*Rmx2d Ra* }� Syplodu+rd<r�Paalimdppguy � 1 _ �Na 2. j 1" 7-Z L 35 d �L• C�i2G ('C t'C j�''L G°/ rJ��✓ O wl�R'sII�JRAI�wANFR;ta�nawaedletlhet�omee dteiletmoe AkTdNa arika�be�rrirlagiivals,tatre PWbyNhmKtuMGffnW Aais ddletmysigA=onftpesritap-1--m-wh sliIMAMUt lease check one) Owner Agent Telephone No, pMWT FEE S ® �� � ��" o 0 0 6 U 77 Date..9-46....-06 ........ ............... 04 &oRTN + TOWN OF NORTH ANDOVER PERMIT FOR WIRING 40 bis,,r„ S ki This certifies that ...ch..A.rv....dl\-r........................... ..Elf-C........................................ ... has permission to perform ... ....... ................ wiring in the building of......................KA P-L- ............................................................. at... ..............-s........................... .North I dover,Mass. ri ...................... . ......... Lic.No...... t.................................. ELECrRICAL INSP--CrOR 'Wheck # V DEDUUMJHY1'OFPUBUCS06I7 permit Na �6o '77 BOARD OFFMPREVFN1MRB;UL4?MS VaN IZ-0 Ompaimy&Fee Checked APPUICA77ONFOR PERAETTO PERFORM FT,ECMCAL WORK ALL WORK To BE pEMRMED IN ACCORDANCE WTTH THE MASSACHUSSTS ELECTRICAL C013E,127 CMA 12:00 (PLEASE PRMT 1N INK OR TYPE ALL NMRMAMON) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perforin the electrical work described below. Location(Street&Number) S Pr e Owner or Tenant Owner's Address is this permit in conjunction with a building permit: YeaE3 No (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps Zo oils Overhead Underground a No.of Meters 1 New Service Amps"!�� Volta Overhead Underground C3 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work e r'v/oc I& e /37A h No.of Liandna Oudet No.of Hot Tubs No.ofThmsLonoer TOW KVA Na Of Lighting F1':tore Swimming Pool' Above Belem oarerator KVA No.of Receptscie Outlet No.of On Burner No.of Emergency Lighting Battery Units No.of Switch outlet No.of Gas Banners No.of Renga No.of Air Cond. TOW FIRE ALARMS No.of Zones Toe No.of Disposels No.of Hest TOW TOW No.of Delectim and �s NUMB Toes KW Ioitititimis Devices No.of Dishwuher Space Are Nesting KW No.of Soundini;Device No.OfSelf C mIsined Datudowsounding Devices No.of Dryers Hewing Devioes KW Loaf MuWCipsl Other No.of Weser Heaters KW No.of No.of CombectiorlsQ - Siam ndlasb No.Hydro Massage Tabs No.Of Motors ToW HP Tree Feil a- KnoC/eeS dq-Irt Servi�� q � hL==CbYaw F11111 IDICI Cgitin01111 d�lClesrenllawwi, Ihare&&miNadvaidptnafofstrddtheOIDon YMhatediada�iYBS� indicatedret mac# 1M❑ On= 0 A I I gnnD varzaf lm"Wbik S WC&IDSMply lir9pactior/rDirteRecfr�ed Rao lied I�tMNAN E ��-�'� u� t �'G�-r'11G n j LicaeeNa Fie K d!?cr C Ila IZA4 7 702 C 'IliNng7Y-Vey'-Ifrc .OWIWS26URANCEWAPM41amawaieiNd el�mwdmmthmt ei mum ardthitrrp�s�ietizmeirpea,drppk�wi�eatrarec}imas w`H�`p °W"dWm1°9ii°d4+Mresschz9mrip rle�alLavYa (Please check one) Owner a Agent IsTelephone No. PER W •FEE 3