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Home My WebLink AboutMiscellaneous - 649 FOREST STREET 4/30/2018 (2) &V GIc� i i \ BUiLDING i i 1.1i.................... f NoprH TOWN OF NORTH ANDOVER PERMIT FOR WIRING CNU5fa 0 A- Thiscertifies that .......................................................................................................................... v ' has permission to perform ....�.......�...............................�. t wiring m the building of.........:.... e. ......................................................... `��P .............. orth Andover,Mass. Lic.No. {oq� i .. �1.. .................................. .,;.... Fee........................... ........... Y V ELECTRICALINSPECTOR ,/ Check# V I 1211 Commonwealth of Massachusettsofficial use.only a Department of Fire Services PermitNo.Occupancy and Fee Checked ,w BOARD OF FIRE PREVENTION REGULATIONS Occupancy (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL) FORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) &1-(9 -tO7 Pg4 51 Owner or Tenant y. �, V1 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No [ `J (Check Appropriate Box) Purpose of BuildingI o Vic,( C . Utility Authorization No. Existing Service 0z) Amps 12 / yX'Yolts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: )R!eC Completion of the following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o.o mergency Lighting rnd. rnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices _ No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices 4, No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ' Totals: '""'"""""""""' ''""""'""' Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local El Connection [J Other Connection No.of Dryers Heating Appliances KW Security Systems:'' No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring• No.of Devices or E uivalent OTHER: Attach additional detail if desired,oras required by the Inspector of YYires. Estimated Value of FlecYcal Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 INSURANC dVE GE. Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of 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 pains an penalties of perjury that the information on this application is true and complete._ FIRM NAME: LIC.NO.:� 5ti/ Licensee: Signature LTC.NO.: (If applicable,enter "exem "in the license nber I- ') Bus.Tel.No.: W I Address: 0 0 ( Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department o Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent [PERMIT FEE: $ Signature Telephone Na ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c. 143,§3L,the r permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, §32,an electrical permit shall be issued to the person, firm or corporationoration stated on the permit application. Such entityshall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.) ❑ 4 Inspectors Comments: �-� —1q Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: ( //7''1� Pass Failed Re-Inspection Required($.) ❑ r Inspectors Comments: ; Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts - Depaptment of Industrigl Accide -ts Office offnvestigations 600 Washington Street .Boston,MA 02111 www.mass gov1dia Workers'Compensation bmurance Affidavit:Suit.dens/Cont.acforslElectricianslPlumberr,,q Applicant Information Please Prim Le 'bl Name usiness/Organizationftdividual): Address: Czty/Stade/Z, o S .han .Are you an employer?Check the appropriate box: Type of project(required): 1.[( I am a employer with 4. ❑I am a general contractor and 1 6. E]New construction employees(full and/or part-time).* have Hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and'haveno employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [NO workers' comp.insurance 5. ❑ We are a corporation and its lectrical repairs or additions required.] officers have exercised.theix 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself[No workers'comp. c.152,§1(4),and we have no 12.QRoofrepairs insurancere edemployees.[No workers' �' .a 13.❑Other comp.insurance required.] xAny applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. i-Homeowners who submit this affidavit indicatingthey kie doing all work and then hire outside contractors must submit a new affidavit indicating such, rContractors that checktbis box must attached an gdditional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'eomuerasation insurance for my erriployees Below is the policy and job site Nfomation. Insurance Company Name:. Policy#or Self,ins. iL'ic.#: ExpirationDate: / 2� Job Site Address: � �� — �� a. Itb_ ,/State/Zip: Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage,as req!nedunder Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. X do Hereby cert u r the pains and penalties ofperjury that the information provided above' 7,deorrect, - Signafore• Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Towu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6 Other ContactPerson: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuazit to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• express orimplied,oral orwritten." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two ormore of the foregoing engaged in a j oint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dweMng house having not more than three apartments and who resides therein.,or the o ccupaut of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be,an employes." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required?, Additionally,MGL chapter 152,§25C(7)states Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been,presented to the contracting authority." Applicants Please.fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-confractor(s)name(s),address(es)andphonenumber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are notrequired to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised thatUs' affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for thepermit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom Of the affidavit for you to a out in the event the Office of Investigations has to contact you regarding the applicant Please be-mre to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A�ON of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid of idavit-is on file.for future permits or licenses. .A.new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license oxpexmit not related to any business or commercial venture (i.e.ad og license orpermit to burn leaves ate)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any.questions, please do not hesitate to give us a call. The Department's address,telephone andfax number: T'hQ CQox1-wcalt olassachv._. Ptf - . Depaximont ofZndu*lal,A,cc%dcnta oxce oan• stigAvoin 60 WaAb&j.1 Sb:re_t BQSton, 02111 TO,#61M-2174 9 00 0 406 orx-��UFF, Revised 5-26-05 `ay, 617-727-7749 -WWw.magovaa r r r } JdOMMONW EALTH OF MASSACHUSETTS BOARp p ELEG=TRIC`IANS , '- I SSUES THE FOLLOWING LjtENSE . I AS A SEG -J JOURNEYMAN,:ELECfiR.I� CARLOS qAN [[ .. A G U I LAR PO BOX 236 REVERE MA 0' J .. 21 1-00 3969� .E 07/31./Ib 28834 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION L�y "Le 7 lJ/ Pt p4 m ��cll � PROPERTY OWNER Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no . TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building . One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑ Commercial . ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ® Septic ®Well 7 ,_ � ®LFloodpla%!IIYIIRP�11 lands ® Wat�rshODistnct .,. V,::i`L.a.+b_s�h + 3t �`^7 ' aaWater/_Sewer mak, ,4,.� ,o.,,.m.. k ,1 < .•, }: ,i,,v� .i} �, .s $`' .f`� .ti,:.:n.'- z _; DESCRIPTION OF WORK TO BE PERFORMED: J (Identification Please Type or Print Clearly) q OWNER: Name: l 1Jt3 � rVV Phone: Address: o'�Y )CO,/est''� ` CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 40, 00 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund - L At_ t[_V-t,R �.-`r PA. —24.7 5-e?4`-�a, yr,2K?'3^Sstav .e '°a' a1�tyF sd Lei Stgnature�of�contractor.. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tannin Swinunin ❑ g/MassageBodyArt ❑ g Pools Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic'auk etc, ❑ Permanent Dempster on Site ❑ r I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING � DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on % I Signature ature ' COMMENTS HEALTH Reviewed on r Signature COMMENTS f Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: i FIRE DEPARTMENT -Temp Dumpster on site yes Located 384 Osgood Street Located at 124 Main Street no Fire Department signature/date I COMMENTS l / 5b' PROP. WLL1 II 1 I 0 1 DECK 1 .:.:.;�:.: �j, 1 Ir4 BD PRO DWELLING _ r -108. l 100.4 - 0N r - a 0. =1 0 G F - , . - - - �i t - - } f - ROP. PORCH _ '>. `s: j 14 :::r"": ^ <;t;>:. VENT{ [NSP. ��, 4 {.', ,=.�- •-= J,� o PORT x 5 y/ 0 !/t 98 Q % .... To 'Exis i-, a'VELL r / a .j d x4p / PROP. 500 GAL / t '✓/��t�` �p EPTIC .e• NK Id `j PROP. BOX NCE p- PROP. SILT FE ( „LIMIT OF.WORK" M 19 FOREST i' . ..... _ _ •--'- -- -- -. ..Lam? � - SCAL SUMMARY OF INVERTS BUILDING TIES Arnrc SEWER 0 FDTN. 99.62 : BLDG. CORNER A B C '�� THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 95.63 SEPTIC TANK OUT 43.0 45.7 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 95.40 DIST. BOX 61.5 71.2 SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX. IN 95.03 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX. OUT 94.85 COMPONENTS. INV. IN CHAM. 94.79 BOTT. CHAM. 94.47 LOT A-1 GEC all A0-123,049 S.F. =28248 AC. TOWN OF NORTH ANDOVER HEALTH DEPARTMENT N 0 r loll de. lk y f ' x/ 1 FA MA L 1iA + 12-A 18-A i lo-A to-A NONE DIV1R0lOAWAL i n SERVICES,MC 2010 e'. v,, . r " (COWED MM&POOL) r 7 i A IM .r/ VFDIi 7-A S, o-A o-A 1500 COAL 4 o-A o-A SEPMFIELD_W/ TANK 40 0&L1RA `� 2-A CMAYBERS f } II IN% S85'04 35.E -- . 39.15' FOREST STREET AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS. 649 FOREST STREET AS PREPARED FOR �"°F Mgss9c GREENSCAPE PROPERTY & BUILDING : VLADIMI9L. yG DATE: 3-31-11 TM: 105D NEMCHB40K run �L cn ALE: 1"=40' No: ,TL: 171 0 20 40 so MERRIMACI NAL ENGINEERING SERVICES 66 PARK STRgET ANDOVER, MASSACHUSETTS 01810 NORTH�. O S 7, ip 7 t'D '• F n �a�•7CNUt�� CERTIFICATE OF USE & OCCUPANCY 71 OWN OF NORM ANDOV E R Building Permit Number 507-2011 Date:April 8,2011 THIS CERTIFIES-THAT THE BUILDING LOCATED ON 649 Forest Street, North Andover, MA MA 01845 Oreenseape Property and Building MAY DE OCCUPIED AS single-family IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY: Certif Bate Issued to: George Haseltine, Greenscape Property and Building 66 Gilc'rest Road Londonderry,N.H.03053 -A Building lnnsp6ctoi Fee: 100.00 previously paid Receipt: 23 921 �t M Of ti • CAmu CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 507-2011 Date: April 8, 2011 THIS CERTIFIES THAT THE BUILDING LOCATED ON 649 Forest Street, North Andover, MA MA 01845 Greenseape Property and Building MAY BE OCCUPIED AS single-familyIN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certifieste Issued to: George Haseltine, Greenscape Property and Building 66 Gilerest Road Londonderry,N.H.03053 Building Inspector Fee: 100.00 previously paid ReCei t: 23821 p, Location No. .T 7'.20// Date C °RTh TOWN OF NORTH ANDOVER 3 u� � w ' � � A Certificate of Occupancy $ /00 _1 J�CwUs<� Building/Frame Permit Fee $ 3 Foundation Permit Fee $ /e ° Other Permit Fee $ TOTAL $ `f Check # / S-7) 23821 Bufrding Inspector u — The ,Cdmmonwealth of Massachusetts Departm'eiit-of Fire Services Office of the State Fire Marshal P.0.Bos 1025 State'Road,.StoW,Na 0 177 ' PERMIT Date: /� — —/ North Andover Pern it No Dig Safe Num er -(City of Town) ; (If Applicable) In accordance with the provisions of MGL 14 8 Chapter,_]_cL as provided in section S 7 7 GMR 34 Stat Date 71 is Permit is granted to.. .� .11 1/0<;7z� 'r,00✓..^ Full name of person,Firm or Corporation Permission to locate dumpster • for construction/renovation/demolition of building. Comments:' dumpster. must be, 25 ' from structure if unable to place with required Restrictions: clearance dumps-ter must be covered with plywood or tarp end of 'work -day at (Give location by street=4 no.,or descXjdsuch manner a rovied adequate idcntiFcadon.of location) FeePaidS 50.00 i Fire Chief This Permit will expire- — (SLgnature of ol£ 1 granting permit) Oscal granting permit (Title) O " L � A ♦SS�Cp APPLICATION FOR CERTIFICATE OF OCCUPANCY1INSPECTION Building Permit# 50 -Z 611 ADDRESSILOCATION OF PROPERTY :- P44 ' Map 1 D5 D Parcel Lot Number / J SUBDIVISIONb� " DATE REQUESTED FILED/READY FOR INSPECTION_ CLOSING DATE ON PROPERTY: hv I� FIVE(6) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Per-milt I- 11. �7.`7tAG1.Y lV. PeA Address 6GJCvVQ54 2l �onctt^�ryr�' � SIGNED ROUTING i\ CONSERVATION PLANNING" DPW,WATER METER SEWERNVATER CONNECTION 0 Se P-1h �- NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW�� v Signature Fife: Application for OC fans revised Jan 2007 F ® ® .� oAndover No. + h LAKE O dover, Mass., COCHICHEWICK �.40 RATED p'V C7 BOARD OF HEALTH PER Food/Kit�l`ien `""""`•--__.__,,� ..... " M IT T DSeptic Systemin�`CI •. � ,/Gi ' '98 /l THIS CERTIFIES THAT BUILDING INSPECTOR �T � 'r F /`7�' <� ��' . ................................ CFoundatio J Foundation , has permission to erect............................ . buildings on...,�...`/.l /��?�^�-s'7 . _- •J - ,� to be occupied as,ty�`/11... S/ a ...., i.l. ................. t . -C ney provided that the person acceptin this permit shall in.ever�espect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING CTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ! 6 // 1L,ES 9 CONSTRUCTION TARTS i S ELECTRICAL INSPECTOR/') ��.. ou .............. BUILDIN.............................. Service e/l� G INSPECTOR 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. �p SEE REVERSE SIDE Smoke Det. �� ,r 08 11 01 : 21p Innovative Realty 6034251193 p. l e w Josh Naughton Realtor From: Anne Marie Concemi [aconcemi@firstinteg.com) S� Sent: Friday,April 08, 2011 12:37 PM ` To: 'Josh Naughton Realtor Cc: 'George Haseltine' ject: RE: Hernan Panzavecchia /81 Hi All The $9,000 holdback is for landscaping and paving for property located at 649 Forest St., North Andover, MA. Anne Marie Concemi Chief Mortgage Planner - MLO 3527 354 Merrimack Street, Sal's Riverwalk Lawrence, MA 01843 Cell - (978) 852-9707 Office - (978) 685-9700 xt. 15 Fax - (866) 397-2461 www.firstinteg.com MB #1964. Lic. By the NH'Banking Dept. ME Lic. #CSO11110 DISCLAIMER: This communication (including any attachments) is intended only for the use of the individual or entity to whom/which it is addressed, and information contained in this communication is privileged and confidential. If the receiver of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us at aconcemi@firstinteg.com so that we may correct our internal records. Please delete this communication without making a copy of it. --Original Message----- From: josh Naughton Realtor [mailto:]Naughton@InnovativeRealtyTeam.com] Sent: Friday, April 08, 2011 12:29 PM To: 'Anne Marie Concemi' Cc: 'George Haseltine' Subject: RE: Hernan Panzavecchia 1 Apr 08 11 01 : 21p Innovative Realty 6034251193 p. 2 Annie- can you reply back to this email and confirm that holdback is for landscaping and paving as the inspector wants to have something in writing that this is what funds are being held for. If you can do that, I will print and fax to inspector. Thank you. Joshua Naughton Realtor®, CR5, ABR, a-Pro Innovative Realty (603) 424-4101 x210 josh@loshNaughton.com www.3oshNaughtonTeam.com NH & MA Real Estate Marketing and Consulting Services Click Here to View Our Properties For Sale -----Original Message----- From: Anne Marie Concemi [mailto:aconcemi@firstinteg.com] Sent: Friday, April 08, 2011 11:58 AM To: 'josh Naughton Realtor' Subject: RE: Hernan Panzavecchia Here you go, Josh. Here is the approval. Once we get the CO we will be cleared. I circled the $9K escrow holdback also. Annie Anne Marie Concemi Chief Mortgage Planner - MLO 3527 354 Merrimack Street, Sal's Riverwalk Lawrence, MA 01843 Cell - (978) 852-9707 Office - (978) 685-9700 xt. 15 Fax - (866) 397-2461 www.firstinteg.com MB #1964. Lic. By the NH Banking Dept. ME Lic. #CS011110 DISCLAIMER: This communication (including any attachments) is intended only for the use of the individual or entity to whom/which it is addressed, and information contained in this communication is privileged and confidential. 2 Apr 08 11 01 : 22p Innovative Realty 6034251193 p. 3 If the receiver of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us at aconcemi@firstinteg.com so that we may correct our internal records. Please delete this communication without making a copy of it. -----Original Message----- From: Josh Naughton Realtor [mailto:]Naughton@InnovativeRealtyTeam.com] Sent: Friday, April 08, 2011 11:40 AM To: 'Anne Marie Concemi' Cc: 'CyndyDemont' Subject: RE: Hernan Panzavecchia George just met with Building inspector. Prior to him releasing final signoff, he would like confirmation from someone on Buyer's side (Broker or Attorney) that there is in fact an $9000 hold back at closing for unfinished site conditions which will be completed as soon as weather permits. Once he has this, he will issue final. Can you please draft something or have closing attorney do so and fax to info below. George sent pictures directly to appraiser this morning of completed steps. Please confirm once letter has been sent so that George can pick up sign off. Thank you. 978-688-9542 (fax) Attn: Brian Leathe 978-688-9545 (phone) Joshua Naughton Realtor®, CRS, ABR, a-Pro Innovative Realty (603) 424-4101 x210 josh@JoshNaughton.com www.loshNaughtonTeam.com NH & MA Real Estate Marketing and Consulting Services Click Here to View Our Properties For Sale -----Original Message----- From: Anne Marie Concemi [mailto:aconcemi@firstinteg.com) Sent: Friday, April 08, 2011 11:16 AM To: 'Josh Naughton Realtor' Cc: 'Florence Toto'; 'CyndyDemont' Subject: FW: Hernan Panzavecchia Hey Josh see underwriter's comments below. The inspector was there yesterday afternoon but stairs weren't completed yet. Annie 3 Apr 08 11 12: 57p Innovative Realty 6034251193 p. 4 KUMOngage.LLQ LICN I 9WzNMLSf 1984 1 OdgInabor Arm PWIGeml=-NMLS43527 FPTF Broker7bld Mi fn the amount of$5,425,00 tc be reflected on Ute HUO 1 and deducted from P FrrF Hazard binder evidencing 100%of the Insurable Value as established by the property Insurer or replacement cost coverage PTT Escrow holdback from seller in the amount Of$9,000 to be reflected an the HUD ho dback from seller in the am,,uft 0, 9,0,' P All pa Ries to __u,escrow holdback egrcemenE n &�41 1VO, 40 *7$ 00-0 47 �vesiiolis , Z:f I:=- /-f 1)/Z 4,q YC rz- Un CGIYx Form-bunkmdlom pW_tmnLfrm(ayW) Page 3 of 3 F NOttIN IVWIN Ur 1NUKIA ANDOVER 0� OFFICE OF p BUILDING DEPARTMENT ' + 1600 Osgood Street �qs 4AY.o�ry Building 20 Suite 2-36 S"`""s� North Andover,Massachusetts 01845 Telephone(978)688-9545 Gerald A.'Brown Fax (978)688-9542 Inspector of Buildings AFFIDAVIT FOR FINAL COST OF CONSTRUCTION In accordance with the provisions o the Massachusetts State Building Code, Article 1, Section 110.4 and 114.2, the total estimated cost of the construction including all related construction costs* of the building located.at 649 Fore5� Pnkrc- amounts to $ I, l�Cot2G� AA 'V,f:::- being the person referred to as the owner identified below, do solemnly swear that the statements made herein are strictly true and correct and made in good faith. *Related construction costs included all work done with or concurrently with the work contemplated by the Building Permit including demolition, plumbing, heating, electrical, air conditionin ainting, carpentry, landscaping, site improvement, etc. Furnishings and portable equipment not art of the total construction.costs. ignature 8T wrier COMMONWEALTH OF MASSACHUSETTS aC S.S. 20 l\ Then personally appeared the able named and Made an oath that the above statement is true. Sumbal Noushean Before, Me, Notary Public My Commission Expires November 28, 014 Commonwea.!th of Massachusetts Notary Public OFFICIAL USE: Final Cost: Original Estimate cost of general work: Cost Difference: Additional Fee Required: TO AMEND FEE UNDER PERMIT NO.: Inspectional services Department 2005 F:\finalcostatfidavitfonn Strict code enforcement makes the town safer Bgfore buying, renting,leasing check zoning BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-0540 PLANNING 688-9535 -- N/F N6012'110W JAMES HAR-nGAN 301.01' co ry n z N o �I I o, m LOT A-1 j AREA-123,049 S.F. -2.8246 AC. N 3 W fd N t!! N Z 2 l� mss. WELL . 154.83' 77 /- 2 STORY WETLAND N.F.D. 154.97' SC'ustii%:;R'! #649 - ��) ol ol T.F.=103.65 �� y5ol ol DECK (A 6 0 'tie g 1� rn 191.63' S6316'44"E S65'04'35"E $75'00 p1'E FOREST 39.15' 34.30 STREET NOTES PLAN OF LAND I. SITE IS SHOWN ON TOWN OF NORTH ANDOVER IN ASSPSSORS MAP #105D SOT #177. SEE E.N.D.R.D. NORTH ANDOVER, MASSACHUSETTS rn BOOK. #2929 PAGE #302 PLAN #I f,498 FOR SITE DEED. v DRAWN FOR N 2. ZONA' DISTRICT IS R-1. GREENSCAPE PROPERTY & BUILDING 66 GILCREST ROAD r? LONDONDERRY, NH 03053 rn / a SCALE: 1"=40' DATE: APRIL 1, 2011 0 20 40 80 120 i o MERRIMACK ENGINEERING SERVICES 66 PARK STREET 411111 ANDOM atASS'ACxaslsM 01810 / STEPHEN E. TA , S f R.L.S. DATE 'ROA` (878) 475-9558 FAX: (978) 475-1448 } ZMAM alE WNGOAOL COM Permit Lis ti Report by work Category Work Category Address(Work Location) District ZoningOwner Proposed Use And Details Est;Cast Permit Type Permit No Online Permit No Permit Status Date Issued Contractor(Phone# Work Description Fees Paid Check# Work Category(RESIDENTIAL ALTERATION)TOTALS: ESTIMATED COST: $297,573.00 NUMBER OF PERMITS: 6 FEES INVOICED: $3,571.00 FEES PAID: W71.00 BALANCE: $100 Single Family Dwellin 649 FOREST STREET GEORGE HASELIDW. $271,508.00 Building BP-2011-507 OPEN Dec-28-2010 GEORGE HASELTZIE SINGLE-FAMILY $3458.00 150 Work Category(SINGLE,FAMILY DWELLING)TOTALS. ESTIMATED COST: $271,500.00 NUMBER OF PERMITS: I FEES INVOICED: $3,458.00 FEES PAID: $3,458.00 BALANCE_ $.00 GRAND•TOTALS: ESTIMATED COST: $569,073.00 NUMBER OF PERMITS: 7' FEES INVOICED:: $7,029.00 FEES PAID: $7,029.00 BALANCE: $.00 GaOTIbIS®•2011 Des.Lauriers Municipal Solutions,Ina ( Page 2 oft 76 ► 4 Date /I . ....... N°RTp pf o? TOWN OF NORTH ANDOVER= • PERMIT FOR GAS INSTALLATION A u•e 9Ss CH 5Et 7 This certifies that . . . . . .f. . . ?''/.'. . . has permission for gas installation in the buildings of . . . .� `!t .`. ' '( .. . rt"" 6� � t=USf < cf at . . . . . . . . . . . . . . . . . . . . . . .. .. North Andover, Mass. Fee. . . . . . . . Lic. No. . . C `! . .'Jr:: . �. . . . . . . GAS INSPECTO Check#_ J�� `� o.of 4 �aaiH MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER ,Mass. Date MARCH 21, 2011 permit# Iy 649 FOREST ST. FOREST ST.REALTY TRUST Building Location Owner's Name Owner Tel# 603-785-8768 Type of Occupancy RESIDENTIAL New F Renovation F-1 Replacement Plan Submitted: Yes No[] FIXTURES a d .�, W a a a a x o H S z J a W ° y" `� z F 94 rA S O W x z 0 w � w LU W C/) Lu Z z x W w j A z ¢ w J ¢ x �" �. °M z 0 z ' o c~n x w 1 = 0 O = w 3 A 0 a UU 9 z A a W O w SUB-BSMT BASEMENT 1ST FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7TH FLOOR 8T"FLOOR Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate Address 131 Water Street Corporation Danvers, MA 01923 Partnership Business Telephone# 800-322-6628 Firm/Co. Name of Licensed Plumber or Gas Fitter JOHN COOMBS INSURANCE COVERAGE: I have a cuOcecked liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YesNo ❑ If you have rtes,please indicate the type coverage by checking the appropriate box. A liability insurance policy FI 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: Owner El Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in abov apple ation ar u and c to to be of my knowledge and that all plumbing work and installations performed under the permit issued hi appli ion 'II e i ompl' ce all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Law By Tyyef License: tuber gnature Licensed Plumber or Gas Fitter Title s fitter 3064 • -Master Li se Number City/Town •-Journeyman APPROVED(OFFICE USE ONLY) Date. .. .. &oRTN °f, • '"a TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ��Ss�cMus�� This certifies that JJiO Gr�� ') has permission to perform ..... ..h.... �.. ................... ................. wiring in the building of....( /ICt/JS� G.. �� '"'' at li.� °�? ,N rth Andover,Mass. Fee. 63.�........ Lic.No..............0�d......................... .... !... EMcrR M It PWM Check # ffimCommonwealth ®f massachdlsettsFOccupancy Official Use Only 7 > Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS d Fee Checked Leave blank APPLICATION FOR PERMIT TO PERFORIN ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code WORK (PLEASE PMTH NK OR TYPEALL INFO (MEc),527 CMR 12.00 City or Town of: TIONS Date: �� j By this application the undersi ed gives no ' e of his or her'intention to perform the eTO the �trical wector ork described below. Location(Street�i Number) q'? Forys-} 5J-- Owner or Tenant-1Xoef6LsC-W e d e.rc l Owner's Address FbM+St fit' 1.44- Telephone NO. _ 0c-01a Is this permit in conjunction with a building permit? Iles IN No ❑ BLDG PEIaMIT# "7- _Q�/) Purpose of Building I D V'SF Utility Authorization No. �,rf'� -- ��9' Existing Service Amps _/ _Volts Overhead New Service � Amps ® / g Volts ❑ Undgrd❑ No.of Meters Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total. No.of Luminaire Outlets 2 Transformers �rA No.of Hot Tubs Generators KVA No. of Luminaires Swimming pool Above In- o.o mergency ig ting rnd. rnd. 1 Batte Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners J No.of Detection and No.of Ranges Initiatin Devices No.of Air Cond. ' Total �,.� Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons rev............................. . No.of Self-Contained � Totals: .............__.........._.. . .... Detection/Alertin Devices No. of Dishwashers SIO pace/Area Heating W Local❑ Municipal No. of Dryers Heating Appliances Security Systems:* Connection El other KW No. of WaterNo.of No.of Devices or Equivalent Hr eaters No.of Signs Ballasts Data Wiring: a No.of Devices or E uivalent No.hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: I•-a7- 1 Inspections to be requested in accordance with NEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licenseeprovides proof of 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:) 'Cert, under the padns and penalties of perjury,that the!for ado ora this appldcation is true and complet& FYRM NAME: a �► �2 L[� A Licensee: i t�®my L Signa LTH ia3 LIC.NO.: (,l(� � (Ifapplicable,enter "exempt"zn the license numberline.) LIC.N®.; Address: Bus.Tel.No.: glrf/ *Per M.G.L.c.147,s.57-61,security work requires Department of Public Safe "S"Licen Alt.U No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability �C'NO.: required by law. By my signature below,I hereby waive this requirement. I am the check one) coverage normally Owner/Agent ( )❑owner Signature Telephone No. El owner's agent ti ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL 1.ROUGH INSPECTION: Passed—1K Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: t:. 5 (Inspectors'Signature-no initials) Date 2.FINAL INSPECTION: Passed— Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signa e-no nitials) Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)- Inspectors'comments: (Inspectors'Signature-no initials) Date 4.INSPECT[ON—SERVICE: DATE CALLED A TIONAL GRID: NAME: �ti <J1 Passed Failed—[ ] Re-inspection required($50.00)- [ ] Inspectors' comments: M t (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department of Xndustrial.Accid'ents Office of-Investigations 600 Washington Street Boston,MA 02111 UV www.mass.gov1dia Workers' Compensation Insurance Affidavit: Buildelrs/Contractors/Blectxicians)Plumbers Applicant Xuformation i Please Print Legib Name(B.usiness/Organizationlindividual): IL— �c�� z -LC Address:_ 9cl krU0WL-6VQ S4 C T3)o3Lf City/State/Zip & f M Phone a 3�—al S� Az you an employer?Check the appropriate box: Type ofproject(required): 12. employer with � 4. ❑ I am,a general contractor and I 6. [ New construction employees(full and/or part time).* have hired the sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp,insurance 5. ElWe are a corporation and its ' required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑.I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing-repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.E]Roof repairs insurance required.] employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fi l outthe section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employ erthat ispyoviding workers'compensation insur'ancefor•my employees: Below is thepolley andjob site Information. Insurance Company Name: • Policy#or Self-ins.Lic.#: Expiration Date: /,;z A— I rob Site Address: CQ C�� City/State/Zip: /)i hw40-1- Md- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do lie y e t6� der•t e pa andpenalties of_p 'ury that the information provided above is true and correct. Si afore: Date: � CQ Phone#: o C-�M Official use only. Do not write in this area,to be completed by city or town offzcial. City or Town: Permtit/License# Tssuing use (circle one): X.Board ofHealth 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other C ontactPerson: hone#. 7571 Date. !�/�. ...... .. pORTm o 3? '' TOWN OF NORTH ANDOVE • PERMIT FOR GAS INSTALLATION ,SSACHUSEI i This certifies that . . . .. . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . in the buildings of . .#4 S.z.L !t! - . ... . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee. . . Lic. No._3f.7c.:. . . . . . . 1&0 AS INSPECTOR Check# `/ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: Na&4, XA)66de-4t IA. Date: Permit# Building Location: (0.L.9 t0ALX-�,J S i Owners Name: (0100&#(f Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES w � Y Cd ~ M W O W n = N Z O U' J } Q' Z N O 2 W W z w O w N w m 0 a ' p 0 V) LUW W v W W w z = w 0 W o o � W W z 0 J F F 0 z J 0 LL � W W W W z W >- N J Q Q m W O z 0 ~ > z1-- 1 SUB BSMT. BASEMENT 151 FLOOR 2 Nu FLOOR 3 FLOOR C FLOOR 5 FLOOR 6 FLOOR 7 1 H FLOOR 8 FLOOR 1 ) / Check One Only Certificate# Installing Company Name: I G I�I�- /_�,�d.�-� ❑Corporation Address: A City/Town: l��NAAC State: Business Tel: b-6b 1 "')(65 - N Y:7) Fax: ❑ Partnership ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: t v INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policli, 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Co and Chapter 42 of he General Laws. Ty Plof License: BY umber Title ❑Gas Fitter Signa re of Lic nsed Plumber/Gas Fitter RE]pa"ster Cit /Town Jour City/Town neyman License Number: Soot) APPROVED OFFICE USE ONLY ❑LP Installer 8 r Date. . . . . . . . . . . . . Of`NORT.1�0 TOWN OF NORTH AND /ER PERMIT FOR PLUM, LNG cNUSE� / This certifies that . ./i��.�. �. . . .4 f.�. .`. . . . . . . . . . . . . . . . . . . . . has permission to perform . . . ... . . . . . . . . . . . . . . plumbing in the buildings of . . f1c �. {i.".`. at . . .�j .y�-� . . � .n.<. s. ?�`. .?. ( , North Andover, Mass. Fee. �/Q .?. . .Lic. Nol: ° . . - . . . . . . . . . PLUMBING INSPECTOR Check ." /Z t13 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: Geo" AYJn6V _1 _,MA. Date: Permit# Building Location:_ (o�Aa Ec&-es z' 6t, Owners Name: (o ea49_q- Type Lg eType of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential. New: Alteration:❑ Renovation:❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED z SYSTEMS LU O '^ D > Z in N x Vf H a G W } J U H W cc Z {A a W Z H Ln Ln Y Q Vf J Q W C7 C Q Q OC W Z W Q = Z Uj W Z_ N O Z H N 0 W f. a 3 m an oc H `^ > Q N Y 'n C7 J a X x J Q a 0 OJ Q N 0 Q Z cc w Z w `3 Z u a '� W 3 3 U. W Q x W W O W Uj Q Q N a 0 O > > 0 = 0 Q r 0 0 0 u QLU= W In Q a m m c o LL x Y 5 g W. v, � S 3 3 3 o a 3 SUB BSMT. BASEMENT 1sT FLOOR L'2 N 2ND FLOOR I 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR �LIA Check One Only Certificate# Installing Company Name: /�i2 j Z� Address: P \ El Corporation n , C &7-- ❑Partnership Business Tel: &63-3(o 5J- 135— Fax: ❑Firm/Company Name of Licensed Plumber: 4z' I-f- 1„0— INSURANCE „QINSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy if 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 14 of the General aws. By Type of License: k1 Title 5/FPmber Signature of Licensed Plumber City/Town f ��APPROVED OFFICE USE ONLYrneyman License Number: COMMONWEALTH OF MASSACHt�SETTS + LICENSED AS•A JOURNEYMAN PLUMBER ISSUES THIS LICENSE TO KEITH .A (LORTIE kkjm � 35 `CAMP SARGENT RD' MERRIMACK .NH 03054-4706 IF; 31300 2 05/01/12 .62008