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HomeMy WebLinkAboutMiscellaneous - 70 CANDLESTICK ROAD 4/30/2018 (2) / 70 CANDLESTICK ROAD 21Oil 06.A-0095-0000.0 \\ Date.... r►ORTh TOWN OF NORTH ANDOVER s PERMIT FOR WIRING » �B�cHus� This certifies that ......................:..��.."f���. .......................................... .. has permission to perform ........... .G......................... .rc?.v....:........................ wiring in the building of........Lfq C.c"� .. ....................................................... at .......7 ��i�Lc"�1.77 %' .......,North Andover,Mass. ............ ........................... . . ................... _ Fee.. �' © Lic.No. .1 / 11............. `�LEci�ucni Iivsro ............... Check# f 11595 5 lq 3�� 70309 7 � , t !LNX Commonwealth of Massachu- Official Use oaly ffs sePermit No. Department of Flee S eTvli ces Occupancy and Fee Checker! BOARD OF FIRE PREVENTION Rev. V07] (leaveblank) REGULATIONS l M APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK A11 work to be per?ormod in accordanec with the Massachusetts Electrical Code(MEC),527 CMR 1100 (PLEASE PRINT IN INK OR TYPE ALL J-ArFORMATION) Date: City or Town of: /VGrrk /9.rl&ytf To the Inspector of Wires: h� By this application the undersigned gives 20 � 11/J�E7ilnotice of his or her intention to perform the electrical work described below. tJ Location(Street&Number) w Owner or Tenant. . (�lyA,i Telephone No..7z g,SY. Owner's Address: salt-e _. �l Is this permit in conjunction with at building permit? Yes ❑ No V' (Check Appropriate Boa) Purpose of Bailding: 6.t?S ORACe, __Utility Autborization No. Existing Service ;�ZCJG Amps 2!l L)30 Volts Overhead ❑ UndgA d No.ofMeters New Service Amps Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity `{ a ue1j"rQr5 Location and Nature of Proposed Electrical Work: eH.Wde Completion-of thefbllawfmg,table may be warned by fie Inspector of 4`ires. No. of Recessed Luminaries INo.of Cel.-Susp.{Paddle}Fane No. of Total Transformers _ tK�v A No. of Luminaries Outlets :!No.of Fiat Tubs Generators Above n- o.o Emergency g No. of Luminaries Swimming Pool nd. ❑ grnd. ❑ Batt-rUnits No. of Receptacle Outlets No.of 011 Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o etechan an Initiating Devices No,of Ranges No.of Air Cond. Tons No.of Alerting Devices users eat um r ons o.a ontaiue No.of Waste Dis p Totals - — __......r`_... Detection/Alerting Devices al No.of Dishwashers Space/Area Heating KW Local un ipcti Conaectfon ❑Other ❑ No,of Dryers Beating Appliances KW Security ystems: Na of Devices or Equivalent No.of Water, ".0,61 No.cf Data Firing: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Moto" Total HP Tel'cow cationsWiring: No.of Devices or uivalent OTHER: Attach additional detail if desired, oras required by the Inspector of Kres. Estimated Value of Electrical Work: S 1 f100 (When required by municipal policy.) Work to Start: Inspections to be requested i,n accordance with MEC Rule 10,and upon completion. - IiNSURANCE COVERAGE: UnJess waived by&e owner, no permit for the perfbrmance 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 hes cabibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) �8 I certify, under the p-aims andpenalties of perjury, that the inform, tion on this applicati�i�frus and complete FIRM NAME: Cranny Electric Co., Inc. LIC. NO,: Al 1918 Licensee: Brian Tanney lgnature LIC.NO,: E25204 _ (Ifapphcable, enter"exempt"in the license Mmberline.) Bue.Tel.No.� 1-9?9-750-62.00 Address: 10 Rainbow Tem,Danvers,MA 01923 Alt,Tel,No.: �vd9 � s /Z S� L �` �. - - / ,; -. .. 1 ....• ,,i _ t � t�� ` { h . ___... F S I The Commonwealth ofMassachusetts dorm . Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Cranney Companies,Inc. Address:10 Rainbow Terrace City/State/Zip:Da nve rs, MA 01923 Phone#:978.750.6900 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 55 4. ❑ I am a general contractor and I employees(full and'or part-time}.* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [] Remodeling ship and have no employees These sub-contractors have 8. F-1 Demolition working for me in any capacity. employees and have workers' insurance. 9. E] Building addition comp.[No workers' comp.insurance p• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 39.❑ I am a homeowner doing all work officers have exercised their 11.[:]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.[:] Other 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 contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AIM Mutual Insurance Company Policy#or Self-ins.Lic.#:ECC60040004772013A Expiration Date:3/25/2014 Job Site Address: LY1�( A\j;eOti 4 City/State/Zip: 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the gains and penalties o er'ury that the information provided above is true and correct 1 -Signa [3/726713 Phone 4:978.907.0018 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/Town Clerk 4.Electrical Inspector 5.PlumbingIns ector 6.Other P Contact Person: Phone#: Date..? `/. .�. �. '.. NORTH 3= �' TOWN OF NORTH ANDOVER i. O % t - PERMIT FOR GAS INSTALLATION it SSACMU5 - This certifies that . !p .G.l ���,/�,�.���-�� . . . . . . . . . . . . . . . . . . . . . . t . has permission for gas installation . . /�.147. . . . . . . . . . . . . . . . . . . in the buildings of . . . .<< .r. . . . . . . . . . . . . . . . . . . . at . . . . .�'l �^. . fr. �. t� t. . . . .. North Andover, Mass. c Fee. . . Lic. No.. ':Q. . . . . . . . . ., . . . . . GAS INSPECTOR Check# 2 G cr j 5367 a MASSACHUSETTS UN1F{3RM APPLICATION F R.F'ERMIT,TO ©O GASFIT11 TtNG lPsi/n!or Type)1.; 1 V /� � �� .:Mass ' Date 1T_��, Perrrilt.# ,��.' ` Building Location . C" Gif�I',�5 )G - Ownar`s Name. ,.. . Type of Occupancy. , t 1/ New ;D Renovailon [] Replacement [11 "' P-tans Subinlited Yesp No [] H LC ..1G til tq frf N :t) x l-- a N W r- -.4�, � 9 . �...".- . - , in-4 m to �. 4 t t� p s. , vy .� ur a x a' in' ri y w .J. r -t x z r, c yr .� W. ►-In x'. .H1. a .. i0 2 - z W:, w: ... �» x" <. ++r . !- -y.. H m z; p z a 0= of x BASEMEIIT F , 1 s T, t_0 0- N 21iD Ft O;OR 3RD Ft.fl,OA 4.. _._ I� 4711 FL{J"OR SZIi FLOOR , ts7li FLOOR 7T}1 FLOOR 87.H FiOUrr ji. % I nstalling Company Name. �L.if}- V Check one Cerilflcate Atldress ` . �L, .d Cfi-Corpflratlon Lr,, p :!'a I n'e Shlp Business Telephotie ;, rd` ter t �3 " ;9.[] Fir /C.o: Name of L)cei►sed Plumber or Gas Frtte'r9..' C��L/ f q tWSURANC>` GOVEi1AGE. :. I 9 - M"� ,,:r have a 9.current IIab11Hy insurance 9'9 ,policy or its substr :9antia!L L equivalen{which'mee#s fhe'requlrernents,of MGL Ch 142. Yes �''- No lO . if you have checked yes, please Indicate the type coverage by.checking the apprciprlL 9Late ;box A.;LL llablftty Insurance.po►lcy �` Ottier type L.of indernnlly O Hond O . OVYNEFi'S tNSlJF1ANGE WA11/Ei2 ,i am aware that the liLr`L Lcensee does'not have the lnsura.nce coverage required by Chapter 1.. of'the Mass. General.Laws and . 19 that my slgriatu�e on th{s" ermft a ticatlon',xa P pp , lues ibis re,qulrement. Check Qne: Signature of Owner or Owner s Agenl Owner❑ Agertl Q I I I I A El p thereby cerilty that all 01 the details andinlorma[ion;lAaye submlited,tor,entered)In above applicailon ale true and ncr urate to the best of m knowfed9e and that ail plunabing work and Installations eriormed u_nder.Ute'permlt lssueif for 1hCx,appltcatton,witl be lR campltance with all y pertinent pt... ions of the Massat husetts Slate Gas CoTe:and.Cha"ter 142 of the.Gene al taws.. p ,: T 'e of Ucen9L Ise. `; Plumber Title Sig 3u e o 'c nse um et or Gas rtter aslitt'L Lor it astci y C,y/Town_ Journeyman Ucense Number J:: 1C7Yt_FI —Ci`�T�`i`�(.. Y3- - Date. L�,�.`/. r f HORTq 3ro,.�•�;.,',tioo - N OF NORTH ANDOVER L PERMIT FOR PLUMBING 44 ,SSACNUSEt This certifies that . . �:_. �h. . .`E. . . . . . . . . . . . . . . . . . . . . . . . . . • • has permission to perform . . . . . . . . . . . . . .: . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . at. . . . . . . . . . ., North Andover, Mass. �� 2 �-/ 1 � Fee. _ . . : . . . .Lic. No.. . .l. . . . . �: . _ :r.�..-,� . . . . . . . PLUMBING INSPECTOR Check # bf' i 6719 MASSACHUSETTS UNIFORM AFPLICATiON FOR PERMIT TO DO PLUMBING (Print or Type} Mass. Date Building Location /� —S%!C Owner's Name Sy Type of Occupancy$/ _ Ner p Renovation O. Rep acernent j '-.. Plans Submitted: Yes D No ❑ 1. B.P.r FIXTURES SEWERr. SEP TZC,r z >. L7 74 SG J tlJ V H L} 5 N - Q Z N K . V ` m } ad ¢ a < 3 Ate cc Ul- ve r > o y W. 14: w 0. SriB—gSFAT..; BASEMENT 1ST F:L00R 214 DL FLOOR 3RD FLOOR `4TH HL R - STH FLOOR 6TH FLOOR 7TH FLOOR 8TH Ft.OOit! % Instaliimg Company Name Aj LCheck one: Certificate Address C?fJ t] Corporation Partnership Business Telephone_�� �, f�j [� Fimt/Co, Name of Licensed Plumber ; }`— f (., `/Lj lNSUi1ANCE COVERAGE:' i have a current liability insurance policy or iEs substantial equivalent which meets the requirements Of MGL Ch. 142. Yes CrY` No p tf you have checked yes, please indicate the type coverage by checking the appropriate box 4 liability insurance policy :❑ Other type of indemnity D Bond D OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the uLL coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application':waive$this requirerr►en#. Check one: Signature of U�mer or owner's Agent Owner ❑ Agent C7 I hareby;.certify that all of the details and information i have:sub mitted(or entered)in above application are true and accurate to the best of my. knowledge and tha{all plumbing work and installations peif dun r the sued for this application wilt be'in compliance with a!1 r pertinent provisions of the Massachusetts State Plumbing and a r 142 of the General:taws. BY Title Sign versed Plumber City/Town Tye of License: Master D 36 6 meyman APPROVED OFFICE USE'ONLY) license Nun 62-68 J Date..... 4, TOWN OF NORTH ANDOVER PERMIT FOR WIRING SA 0 This certifies that ....(7....4 ....... .... ............... .................. has permission to perform ..... ...... .......................... wiring in the building of .......40v. ....................... at........... -/w........... .North Andover,Mass. Fee.z:!�.:O..77..... Lic.NOE-4.1i;�1......... Check # "o INSPECTOR DIFll RMfi YPOFPENXSrU= LPeffndtftwARDOFF=PREVF1VIf�OINRB=A'17�011 m7adRa* pancy&Fen Checked APPUCATTONFOR PERMiT'TO PERFORMELEcnuC,AL WORK ALL WORK TO BE FERFORMED IN ACCORDANCE WrrH THE MASSACHUSSTS MICTMICALL,CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) D Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes[3 No ® (Check Appropriate Boa) Purpose of Building S t !0 Utility Authorization No. Existing Service Amps...L.V oils OverheadUnderground No.of Meters New Service anW�� rh olts Oveead Underground No.of Meters Number of Feeders and Ampacity Location and Natum of Proposed Electrical Work F-Sot 17 No.of Lighting Outlets Na of Hot Tube Na of Trstwsfcsroers Total KVA No.of lighting Rusin Swtmn b*pool' Above Below Oaterawws KVA No.of Receptacle Outlets No.of OU Horttas No.of Emergeoay lighting Battery Unita No.of Switch Outlets No.of Gas Bturtms No.of RwWs No.of Air Con& Tout FUM ALARMS No.of Zona Tolls No.of Dispouls W of Hat Total Total No.of Demcdon and P01131111 Ton KW Wdsting Devices No.of Dishwuhm Space Ata Hating KW No.of SoundinS Devica No.of Self Caubw cdOO�O°�a D No:of Drym Hewing Devices KW Loccd INmdciprip al Otrwar No.of Water Heaters KW Na Of Na of Comtection 3 Bslinb No.Hydro Mauge Tubs No.of Motors Total HP Ihateact=9L a thaaaro FbftirlUdrBygq No Ihnea &dvaidp Wofsaab �711 h )<ynuhawedtedoedyBSrpks� � of Me bott MMANME FsLiQmrl,dvalreafl3ztiorl W�S WO&IDSM hspts ortDaRecpmebd Ro* SyW un&A FbNmmaf FVNNANE ( ' C LiueteeNn flit Ili Som,,. BtaGsmTdNa 9 AdIem /l led/, LAo S"T ��l�i'? g.A AkTtdNa "77I® owr�WSMZtAI�WANPR;InawaetoftLimwdmud henmrn wm*a*akdudtxliivaunnpmdby CamailLnws arddiamys0amcn is' 5=41pfcslicnvwtli�firagiien 11 se (Pleacheck one) Owner C3Agent Telephone No. PERM FEE 9 Location ,�/ No. 17 t-/. / Date ,.ORTIy TOWN OF NORTH ANDOVER .O, y ♦ i # Certificate of Occupancy $ �'�s'•"•Eta' Building/Frame Permit Fee $ (©V s�CHus Foundation Permit Fee $ Other Permit Fee $ y TOTAL $ Check # 6 6 53 17364 Building Inspector K r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE; OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: rly DATE ISSUED. s rn ic SIGNATURE: Building Commissibnerfl for of Buildings Date z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number /V 0,,4 Aclover 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Reqtiired Provide R 'red Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private p Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ J S S O SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.11 Owner of Record --7,;,--7v /pr1y La cc e 777 70 Ca✓id/ Name( rint) Address for Service: e as 7 '4 7 5 �5�3 ►� Signature Telephone (ti 2.21Owner of Record: "!•me Print Address for Service: M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 9 PGr✓! r^,e Ps7 Licensed Construction Supervisor: / / / — rv/ License Number Address 9 Y8/ 3 SOU Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �rJt7Pr'ic��' r�JS l m PS CoAtpa yName 33 3 L� �/� Registration Number O/r/(o0 Address BUM q c -7/2-,,/Os Expirfition Vale Si nature Telephone 4 SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.....) No.......❑ SECTION 5 Description of Proposed Work check aU applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other D9 Specify Brief Description oo/f��Proposed nWork: 42P42 (:�a7�/ on 77 /7oiJSe SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be I§ ©IEICA>i.USEONi:Y' Completed b permit applicant ;� .,. nOE 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 0.0 0 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION • I, !!5ca" Kreefl 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 G1-em Print Name �— Si ture of Owner/A ent .Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS 1 ST2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS , HEIGHT OF FOUNDATION THICKNESS i SIZE OF FOOTING X + MATERIAL OF CHIIvMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a j x The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit: Building/Plumbing./Electrical Contractors name: location: city: state: zi work site location full address)- hone.#: ❑ ! am a homeowner performing all work myself. Project Type: ❑ New Construction ❑ I am a sole proprietor and have no one workingin an capacity. ❑ Remodel y ❑ Building Addition I am an employer providing workers' compensation for my employees working on this job, company name: Superior Industries Inc. address: 64 Spectacle Pend Road city: Littleton i0surance co hone#: 8-486.-3 00 In uran e Corn an — ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed b have the following workers' compensation policies: elow who company name: address: city: hone#: insurance co. policy#: company name: address: city: insurance co. olio. #: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to:$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verifications. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print Name Phone# 97S`' i/,?6- 35- official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑ Building Deparuneni ❑ check if immediate response is required ❑ Licensing Board ❑ Selectmen's Office contact person: EJ Health Department phone#: O other (revised Sept.2003) r•• �CURD ::.<.}:;:;.Y:«.•�:ti«.,.;�• >:;::i;:::n;!lRI7:.:i:•. .:�:• / 'y :n 'Y' '•i••aa.>:< .6'�,+•}:5:�°iii ... ..:...:::: •..:•::'?�„Ai.;l. �, �ry'6�'%'xiTt '`Y'),.,� DATE(M00/YYI PAOOUCER.. .�...:.:.:,..':;?uzaiYk+•+••:��a$f���.h:' �'r,i ti ��• ?Y,..$���F:?:`•:r^'Y•: o>w::�.`v'.a'..t«'£L�s�`JSo'S , �.a� •� :.Sy`.!c O:-•'�:. ...��::k�:}i}ik£�Y`f:t:;:? 23 03 THIS CERTIFICATE IS ISSUED A5 A MATTER OF INFORMATI01 Bore)1 i Ind . AGcy, Inc. HOLDERNDTH S�CERT FICAT RDOES NO AMEND, EXTEND TI 391 Trapelo Rd . ALTER THE COVERAGE AFFOkb)-D 8.Y THE POLICIES BELOOf W Belmont, MA 02478 COMPANIES AFFORDI'NGCOVERAGE COMPANY A Nautilus Ins . Co. Superior Industries , Inc. COMPANY Safety Ins . Co. 64 Spectacle Pond Rd . . Littleton, MA 01460 COMPANY C AIM - COMPANY -'----- r* ` ::.'li:YfJ/:f'1:':;i}•i1'�':4y:�..;��y..}.,�;.:.G� -. D '%r�''S° I HI 1 'T ..: THE WIN:3.:''t�$nz..r;t: MUM>:;:i::r.;.,;::<:::;:o _:: S S O CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMES OVEfFOR THE POLICY PERIOD INDICATED.CERTIFICATE NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE TR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION OATE(MM/DO/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY �' ' � - A X COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE f S , _—_ CLAIMS MADE !_X OCCUR NC227471 12/17/03 12/17/0 PRODUCTS•COrtP/OP.A'GG ; s o00T0C OWN-R'S&CONTRACTOR'S PROT PERSONAL 6 AOV INJURY EACH OCCURRENCE S -.-- _—_— - - FIRE OAAaAGE(Any one Itrel S—VTMy O..'.0 AUTOMOBILE LIABILITY MED EXP(Anyone person) I S ANY AUTO COMBINED SINGLVLIMIT S ALL OWNED AUTOS 1 ,000, 00 B SCHEDULED AUTOS BODILY INJURY HIRED AUTOS 1347609 1/8/04 1/8/05 (Par person) I $ NON-OVVNEO AUTOS BODILY INJURY S (Per a=idenl) PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S -'NY.;UTO _._ OTHER LY THAN AUTO ON . EACH ACCIDENT: $ EXCESS LIABILITY AGGREGATE.S _— ----- OCCURRENCE S 'UMBRELLA FORM EACH S OTHER THAN UMBRELLA FORM AGGREGATE YiRAKERS COMPENSATION AND EMPLOYER S'LIABILITY TORY"LIMIT:S: - ER C '.E?aOPRIETOW AWC7011362012003 12/17/03 12/17/04 ELEACHACCIDENT S 1 , 000, 000 PARTNERSYEXECUTTVE INCL EL DISEASE•POLI(v LIMIT • S 11000,000 OFFICERS ARE: EXCL OTHER El�DI.SEASE EA EMPLOYEE i S 1 000, 000 DE SCRIP TION OF OPERATIONS&)CATIONSNEHICLES/SPECIAL REMS ..:. ....:..::.�:.. .: C E R Tl F:ICAT'E::H.; :x<:;:<:::::r;••.:r..,:-< c:}: :.,•4.,�... :.::.:.:.::.:,.y.,.:::<::.,•••..Y..,s.., pit rYN •.y, .:. .. .. .. ::.�....................:.:::...:::...:�:..::..;• :f,:F/.•:!.{.;vk,,,w;'E:...•b �i�:<h.+^'•. . .a > •. '•'H+•� ''1`aa•: '•';y+,+.x•:,..::•�:::': :...:......,w::u:...,..,,,...;<s:3.3.k•?i�r.8?.' :'+ .:•r�<.}Yrv••..'.v,is2r.t;:;::...-.r..:�^S.}::}::i::;:::}:;,::�;:;:,:}:e:;;:f:�;::riYnl:;S:>.::Y::.:;;:>:�:.>:.::;.':Y::;.::a:;.:�<:i'::�:: .. Yds`+'?IJw:.va . + ♦ :.; ... ......:.:.��......: �.:: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1-()L—DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF Y NO UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. AUTHO REPRESENTATIV -- .::::.:.... :.'•::v.J:{;..:.r.4':} x/Nf...):>.:�SY..>. yi,;3�Y"K• (:;YiY. c ......:.::�::::..t....... ... : :.:?. .i S.Y. . . �•"• .,. .� .. ...::;}•:'.:: .o...,........:1.:S..L..fj.::..:SrA,IS.r/?.:YY..fiS,f.r.> .5>.�e,}}S>S 'E}.7 :' S• ..?g, :i •.r :AL'fl;R.A:.>v:O.f�P�O'RAT[0 / � j 80ard of$Wldie.g Regulations and Standards. / HOME IMPROVEMENT GONTR;gCTbR I 'RegistcaFMnc 133639 r Expiritfoa: 7/20%20o5 Type, Individual S8AN GREEN SEAN GREEN 64 SPECTACLE Po)4D RD: LITTLETON, MA 01468 Administrator n au P1116 or INDUSTRIES INC. ROOFING GUTTERS RUBBER ROOFS May 11, 2004 Tony Laccetti 70 Candlestick Rd North Andover, MA qu�re�s i 7 31d1� Rubber,H: 978.975.8583 Roof Will Be Hand Nailed Only v 1. Details of areas to be completed: Entire House. 2. First stepconsists o ' f installing allin a or s from g the roof t , �P � o the ground to prevent,damage to the house or to plantings or lawn area. „ 3. Next, remove existing layers of asphalt shingles and dispose of.v 4. Completely de-nail roof and re-nail roofing boards as needed.v 5. Replace any rotted or broken wood (roofing boards) at no cost up to 100 board feet. (Additional board feet available at $3.50 per ft. and $1.85 per sq. ft. for 1/2" plywood.) 6. Apply six feet of Certainteed Winter Guard along the eaves of the roof, three feet along the side„ walls, three feet around chimneys and pipes,Y p p s, three feet in all valleys and three feet along the rakes. 7. Next, apply a Certainteed Roofers Select fifteen pound felt paper to the remainder of exposed v roofing area. 8. All skylights will have ice and water shield applied around them. Older skylights ma >re uire new flashing kits _ Y, : q which will be purchased installed by Superior Industries at an additiondl cost ✓ 9. All wall flashing will be inspected and replaced if needed. Any and all rotted or damaged trim or siding that needs to be replaced to ensure proper flashing will require a carpenter and will.be billed out at an hourly rate plus material cost if completed by Superior. (Any and all lead or copper wall flashing which needs to be replaced or installed will be done so at an additional charge). 1-888-618-ROOF - Fax: 978486-0906 64 Spectacle Pond Road - Littleton, MA 01460 781-643-2999 Arlington - 978-369-0950 Concord 978-486-0900 Littleton - 617-969-8900 Newton - 781-274-6600 Lexington 10. Chalk lines every five inches. V 11. Install eight 'inch aluminum drip edge to all rakes and eaves (white finish). 12. Install pipe flanges as needed. V QD_ 13. Apply a 30 Year Certainteed Landmark Architectural Shingle. Color: C C A/ _t ` 14. Re-lead chimney. No. j � YeWG2/444�4 77- ..;?7` 4 J 15. Install a Ridge Air Vent Along All Ridges. 16. Work site shall be cleaned on a daily basis and all areas will be gone over with a magnet to pick up the nails. v 17. Superior Industries will supply the customer with any and all permits pertaining to the job.v 18. Superior Industries will furnish a Certainteed SureStart warranty which entitles homeowner to fifteen fiill years of non-prorated coverage including labor, materials, workmanship errors and disposal costs.4 19. Superior Industries will supply the customer with a liability ($2,000,000.00) and workers' compensation ($1,000,000.00) insurance certificate., (All workers are employee ,:not subcontractors:) Massachusetts License#133639. Better Business Bureau#83356. ✓ 20. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate.v 21. Payment to be made as follows: 1/3 deposit due upon signing, the balance due upon completion of the job.` 22. All io;bs.to:be started approximately 30 days after contract signing, pending weather. 23. Attention Home Owners: please cover all personal belongin s in the aff c.or sto,ra a area due .., g g to the possabiltty of roofing debris or dust coming in through the cracks of the wood. Superior Industries will not be responsible for debris or dust in the attic or storage spaces. 24. Please make sure items on walls are secure or removed to prevent them from falling.✓ 25. Superior is not responsible for the recalibration of any satellite dishes or antennas. We recommend you call your satellite company to make them aware of any recalibrations that may be needed after removal and replacement of such devices. Total Cost: $5,950.00 Complete Roofing System. ✓ (All rices include a $500.00 Spring Discount Until 5/30/04). ACCEPTANCE OF CONTRACT The above prices, specifications and conditions are satisfactory a0d are hereby atcepted. You are authorked to do the work as specified. Payment will be made as outlined above. Superior 1.040 es,:Inc. Homeowner or Authorh d Signature zeoz q, late Date ATTENTION: All buildings, homes and structures that have accessible attic space must have such attics checked by client for the existence of mold or any other type of mildew. By signing this contract client is stating that their attic has been the ked for mold/mildew and that there.'is:no mold/mildew present. Customer Signature: (must be signed in orde f6r contract to be processed). We now accept Visa, MasterCard, Discover, American Express! N'e�now accept Visa Mastercard:;Discover-American.Express! I 101, a Credit Card# V#t- --- Exp.nitt®:----------- CO 7� . . C at i7e- 2`7 NpRTIy TOwn of _ Andover 0 No. 14 1 dover, Mass., T Q LAKE C)CKICKEWICK V ORATED p` ,�5 IT BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System � BUILDING INSPECTOR i THIS CERTIFIES THAT............................. ..................../a............................................................... ........., ................... c c6e 9j Foundation • has permission to erect... �.�`l... .................. buildings on...�.v....CAWAtP. .,,,,..�"„ ....,. ... Rough to be occupied as ok R'r f*0 SIV 0A.0 Ir' ............................................ chimney ....................... ............ .......... ...1J........................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, eration and Construction of Buildings in the Town of North Andover. �� o b 0 .r PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EMPIRES IN ,6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N JTAJTS Rough .......... ............. .....................,........................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises - Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i "�1. e- .. 3493 Date... . .... „ORTry TOWN OF NORTH ANDOVER 3�Oy.�..ao ,e,bOL p PERMIT FOR GAS INSTALLATION lo ,q ,SSACMUSES r !. . This certifies that . . :�. .'' .� .�. . s . . . . �. .�. . Z . . . . . . . . . . . . . . . has permission for gas installation . . . .�.. . . !. . . . . . . . . . . . . . . . . . . in the buildings of . . . .>. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . at . . .7�. . . North Andover, Mass. Fee. . Lic. No../l2 j. .. . .. . . . . . .. . . . . . tjr GAS INSPECTOR y WHITE:Applicant CANARY: Building Dept. PINK:Treasurer . char _ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING gg _ (Print or Type) N eU , Mass. Date foo `v � C� A 7 S ® Permit# Building Location __ ® -.1/ L-c-A 4 Owner's Name !'r Q,?- ij ChPc. dlA Al. 07/x/ L Type of Occupancy New ❑ Renovation ❑ Repcement ls�/ Plans Submitted Yes ❑ No 13P - Cn w Cl) tq V Z cccc cc Z u1 cc 0tL iM Q O} m L c u m o7 IW- W O Z 1WIr - W Cl) m 0 ( W = U) W F- a0 ac > W 0 F- Z J F- Z W W O > W W U J I Q Q W > CC W F- F- } m Z O Z W Q � 2 z Q ¢ Q O O W L O W F- = O C7 = u_ 5 C7 g U ¢ > U (L F- O SUB•BSMT. 4 BASEMENT f 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR STH FLOOR 7TH FLOOR - .-- --- 8TH FLOOR / // Installing Company Name_ r�We-16 /11'i— Check one: Certificate /)/ Address S-/ I.] Corporation qjc/ S� L I Partnership fBusiness Telephone A �� - �n,�{� Ism/Co. Name of Licensed Plumber or Gas Fitter J(/lTtid� y�Lf(,Lf INSURANCE COVERAGE: I have a currentliability 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. A liability insurance policy Other type of indemnity 1-1 Bond U OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. ral Laws and that my signature on this permit application waives this requirement. Check one: Slonature of n r or Owner'sA ant ` —- -- Owner (�D�^+.�_ I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Plu g de a pter 142 of the General Laws. By 4=icenae Title G umber . Citygown aster igna f Licensed Plumber or as Fitter � r'n�VF OFFI , - 1.,- J!Yl l7 Journeyman License Number BELOW FOR OFFICE USE ONLY FEE NO: APPLICATION FOR PERMIT TO DO GASFITTING OWNER: NAME & TYPE OF BUILDING IOCATION OF BUILDING: PLUMBER OR GASFITTER: LICENSE NO: P1:RMIT GRANTED DATE: 19 GAS INSPECTOR P a