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LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: James Yonchak Address: 73 Lancaster Road North Andover, MA 01845 Policy No.: 2478971 Loss of: 02/05/2015 Ice Dam File or Claim No.: 056-0143 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. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Jack McKeon Adjuster ciixr Member of National Association of Independent Insurance Adjusters Ci Date.�� .a TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that..................................................................................................................40 ........ has permission to perform ..?& .... /'�. �% D� .. 7 . ...... .......................................................... wiring in the building of .............../. N 0 /�` ��' ................................................................ at .. , � . �Pn `�N...................... . North Andover, Mass. .................................... ....................... Fee. ..Ll.......... Lic. No�Ht''............................................................... E wnUCAL INSPEC MR Check # J� 2112��� J6 � Commonwealth of Massachusetts AaffiOfficial U Oily Department of Fire Services Permit No. 122 �j Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07) (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 3 ` ZC/ — 141 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her Mit, ntion cto erform the electrical work described below. Location (Street & Number) -7 3 Lcv1C r=r ic, U t Owner or Tenant 0J e- i� US 71 C UYl - _ Telephone No. Owner's Address 7 -� L c-, v--. c.c, xI--er Is this permit in conjunction with a building permit? Yes 2 No ❑ (Check Appropriate Box) Purpose of Building cyt �Y L°� QqdWt Utility Authorization No. - Existing Service ZCJJ Amps /1-0 / ZW Volts Overhead Fr- Undgrd ❑ No. of Meters 's New Service Amps / Volts Overhead ❑ Undgrd [J No. of Meters 'n N Number of Feeders and Ampacity a Ly- 4 m P Z 20 !4.1'x0" Location and Nature of Proposed Electrical Work: Pl2w-rl✓lsd r t d�nA Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires a No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. E]Batter o. o Emergency Lighting Units No. of Receptacle Outlets a No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches / / No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number " I Tons ' ""''-'"'""' I KW "" """' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP I Telecommunications Wiring: No. of Devices or Equivalent i C� OTHER: IGC2 S PSV e_ W� � 0 C�rc,Jd- P"-, f Attach additional detail if desired, or as required by the Inspector of WYres. Estimated Value of Electrical Work: c� 06 (When required by municipal policy.) Work to Start: 3 - 2 - f Inspections to be requested 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 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 pMcm and penalties o perju ,that the information on this application is true and complete I FIRM N 1 Z . C'l C, LIC. NO.: � (p SZ 1 Licensee:c,dp s Signature LIC. NO.: (If applicable, r "exe t" in t e license number line.) FF Bus. Tel. No.: L SO 7 Address: �✓\�i ✓� c� } �d �q�v l' I c iM �l G L i Alt. Tel. No.: f 7- Lf3 QcS *Per M.G.L c. 147, s. 57-61, security work requires Department of 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 agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the f 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 corporation stated on the permit application. Such entity shall 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 ❑ i ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass Ifl Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass EN Failed I Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: i i i Inspectors Signature: j Date: ROUGH INS CTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: „v Date: 3 _ 6 —1 FINAL INSPECTION. Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comme ts: i Inspectors Signature: 0 7 Date: i DEB WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com I NXThe Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip:, Phone #: Are an employer? Check the appropriate box: 1 am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have Hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. i 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 requiredunder 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' nder fi p s and penalties of perjury that the information provided above is true and correct Si cer Signature: Date: 3 _ l 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. Plumbing Inspector 6. Other - - - Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint. 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 dwelling house having not more than three apartments and who resides therein, or the occupant 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 employer." 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 of public 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-contractor(s) name(s), address(es) and phone number(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 not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also Poe sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit 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 and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure 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 copy 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 affidavit 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 'or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) 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 and fax number: The Commonwealth of Mossachosetts Department of %dustriat Accidents, Office of Investigatitons 600 Washington Street Boston, MA, 02111 TeX, # 617-727-4900 oxt 406 or 1-877.7MASS.AFB Revised 5-26-05 Fay ,# 617-727-7749 wwwa ss,gov/dia 03079-3285 April 7, 2014 Town of North Andover Town Hall North Andover, MA 01845 Building Commissioner or Inspector of Buildings Policy: HP2478971 Insured: James & Kathleen Yonchak Loss Locations: 73 Lancaster Road Date of Loss: December 26, 2013 File No.: 168P-14-6879CM 447 Boston Street, Suite 9 Topsfield, MA 01983 (978) 887-8112 FAX (978) 887-8113 Craig McDonald / Owner -Operator Board of Health Board of Selectmen A claim has been made involving loss, damage, or destruction of the above captioned property which may either exceed $1,000.00 or cause Massachusetts General Laws CH. 143 Sec. 6 to be applicable. If any notice under Massachusetts General Laws CH. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, and claim file number. Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. April 7, 2014 Date Main Office: 447 Boston Street, Suite 9; Topsfield, MA 01983 (978)887-81120(978) 887-8113 FAX Boston, MA • Boston / Lynn, MA Gloucester / Beverly, MA • Framingham, MA • New Bedford / Fall River, MA Providence, RI • Cranford, NJ • Toms River, NJ • Philadelphia/Bensalem, PA Shenandoah, PA • State College, PA • Williamsport, PA • Winston-Salem, NC Date..... ./ ..�)........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0; This certifies that ...... ..................................... has permission to perform ... . ......... .. ..... -:�� ................ 11.2. .... ............................. wiring in the building of ............ at ...... ... ....... ....... North Andover, Mass. Fee ..................... Lic. No. i . .......... ELECTRICAL CTOR Check # 8,15 2 r -%F••....v.1wCa1an ar rlassachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked .� v.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 5 7 C 12.00 (PLEASE PRINT INfTK OR TYPE ALL INFO RMATION) Date: ' City or Town of. NORTH ANDOVER By this application the undersigned To the Inspect r of fres: . gn gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) LQ ,L rg Owner or Tenant A1iP ��P S� C� a Owner's Address Telephone No. Is this permit in conjunction with a building permit? Purpose of BuildingYes_ /Q /�� i9 L No ❑ (Check Appropriate Bog) Utility Authorization No. Existing Service Amps / Volts . Overhead ❑ Undard No. of Meters New Service Amps / Volts . Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity — AM Location and Nature of Proposed Electrical Work: /,, r i of Recessed Luminaires of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges Vo. of Waste Disposers/o/d vo. of Dishwashers No. of Dryers No. of Water Heaters' �-- om lesion of the No. of Cei1.-,Susp. (Paddle) Fans No, of Hot Tubs Swimming Pool Above ❑ In_ d. No. of Oil Burners . No. of Gas Burners No. of Air Cond. otal Tons eat �P umber Tons ] Totals: `' Space/Area Heating KW Heating Appliances K, No. of No, of Signs Ballasts No. Hydromassage Bathtubs INo. of Motors Total HP OTHER. Ae-n On table may be waived b the L ector o No. of Tota Transformers "T A, Generators KVA 0.0 mergencytg t Butte Units Mg I' ALARMS No. of Zones o. o Detection and Initis ' Devices No. of Alerting Devices o. of elf: ontained Detection/Alertino Devices Local[3Municipal Connection ❑ Other Security Systems:* 11 No. of Devices or E uivalent Data Wiring: No. of Devices or Equivalent Telecommunications No. of Devices or Eaunrvvn1P.,t Attach additional detail if desired, or required by the Inspector of Wires. Estimated Value of Elec 'cal Work: o J� OD Work to Start (When required by municipal policy.) O5 Inspections to be requested in accordance with MEC Rule 10, and upon .completion INSURANCE O f of Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including no operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuin oMc CHECK ONE: INSURANCE E 'BOND ❑ OAR � � I certify, ❑ (SPeC3") �j C2,C/1Q/t under the p and penalties of� ury, that a information on this application is true and cont e FIRM NAME: Gla, f Licensee �' p t^ LIC. NO.: /mow► (If applicable enter "exempt " in d cens number line.) C I Signa LIC. NO.: Address:''O, tv,X Ly ,A d��� Bus. TeL No.: � 7 —lp�- *Per M.G.L c. 147, s. 57-61, security work requires D Alt TeL No.: OWNER'S INSURANCE WAVER: I am aware that Lcensee does not ehave ,the tl abili Lic. No. required by law. By my signature- ent re below, I hereby waive this re quirement I am the t3 msurance coverage normally Owner/ e (check one) ❑ ❑ owner owner's agent Signature Telephone No. PERMIT FEE: $ �p i Ar Aft The Commanweakk of Marsachweitr j r! lki Department of Industrial Accidents Q f 'ice Investigations of . I 1 ' 600 Washinoon Street Boston, MA 02111 �' Workers' Compensation insurance Acia • iicant Information www -M=X gov/dia . Affidavit: Builders/Contractors0ectri /plambers Name (Bminess/OTpnitation/individual); Please PrintT ibi Addmss: City/State/Zip: t/ �� 07 -Phone #:. Are you an employer? Check the appropriate bo z: leet (required): 1•51'f'am a employer with �_ 4, ❑ I am a general contractor and j.F7..daling emPloY foil and/or part-time),* 2. [] I issue hired the sub-contractorsconstruction . am.a sole proprietor. or partner_ ship and have no employees listed on the attached sheet ing These soli-contractorshaveworking iitianY for me in an aci t3' [No workers' comp. insurance workers, comp. insurance. ng addition 5. ❑ We are a corporation and its :required] 3. I am a homeowner doing officers have exercised their ical repairs or additions all work myself.. [No •worki:rs' comp. right of exemption per MGL 11.❑ Plumbing repairs or additions :c..152, § 1(4), and we have no insurance required.:] t employees, [No workers' 12.[] Roof repairs COMP. insurance required-] I3.0.0ther *Any applicant shat Checks bari # 1 must also fill out the section below showing their workers' compensation of t Homeowners who submit this afiidwAt indics<ting p mY information they ars riving an wosic and then hbe outside eonttsctors 1Contrxctors that check this box must attached an additional sheershow' must submit a new affidavit indica* such. mg the name of the sub-wnuwft s and their workers' comp._ Policy in%nnation.an f an eatpoyer thatis ro idag:workerpnl inswnceforinforntatonnnyePyem Belowis. the Policy and joh site ° Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Add=s—z3 3 l D.�+� G Q S}le� • /�DA City/Staie/Z•tp: /i/�/�jjf ®t1r��y/ �� Attach a copy of the .workers' compensation Policy deciaratiou page (showing the policy Dumber and expiration date] Failure to secure coverage as required under Section 25A of MGL e. 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 up to 5250.00a dof a STOP WORK ORDER and a fine uray against the violator. Be advised that a copy Investigations of the DIA for insurance coverage verificof this statement may be forwarded to the office of ation. I do hereby certify under the pains and penalties Perjury at the onttation provided above is trice correct Si tore: Date: Q Phone Official use only. Do not write in .ritisarea, to be completed by city or town. offf cis[ City or Town: Permit/Lieense # Issuing Autisority (circle one): 1. Board of Health Z Building Department 3. CitylTown Cierk 4. Eiectri (.Other cal Inspector S. Pinmbing lss;pecfor Contact Person: Phone #: Information. a nd Instructions Massachusetts General Laws chapter 152 requires all emp 3 dyers to provide workers' compensation for thea employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, assodiation, corporation or other legal entity, or any two or more ofthe'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tuustee•of an individual, partnership, association or other legal entity, employing empioyem. However the owner,of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons. to do mainter mce, 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 employer." MGL chapter 152, §25C(6) also states that "every state or ideal 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, MOL chapter I52, §25C(7) states "Neither the, commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of comtpliunce 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 -contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no. employees other than the members or partners, are not required to carry workers' cbrnpensation insurance. if an LLC. or LLP does have employees, a policy is required. Be advised that this afnciavit.may be 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 the pelrni t or license is being requested, aot-the Department of Industrial Accidents. Should you have any questions rept-ding the law or if you are required to obtain a workers' comparmtion policy, pleasrcall the Department at thenuc n11ber. listed below. Self insured companies should ente•their self insurance'.iicanse numiier on the•appropriateiine. City or .Town Officials Please be sure that the affidavit is complete and printed iegiviy. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permitllicanse number which will be used as a reference number, in addition, an applicant that. must submit multiple permitAicense applications in any, given year, need only submit one affidavit indicating -current policy 'infnrmation (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of -the affidavit that has been officially stamped or marked by the city or town may beprovided to the applicant as proof that a valid affidavit is on file for fuhm permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license 'or permit not related to any business or commercial venture (i.e. a dog license at permit to bum leaves etc.) said person.i is NOT required to complete this affidavit The Office of Investi.pations would Rice to. thank you in advance for your cooperation and should you have any questions, please do not hesitate to give as a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industaal Acrid=ts Office of Laveatigzfaons 600 Washington Street Boston, MA 0.2111 TeL # 617-727-4900 ext 406. or 1-8.77-MASSAFE Revised 5 -26 -QS Fax # 61 '7-727-7744 wwwmess.gov/dia 'lip Date . . ''� �' .... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..! ?: �� ..... " ..:.................. . has permission for gas installation .-. �'-j! �................... ..-............... in the buildings of .... .. ............... at..._ ��-. .,,.North Andover, Mass. Fee..:? ..... Lic. No. ../... . % ` . � . ............. GAS SNS 7CTOR Check # 6420 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Locutions Permit # �_ .64/40 Amount $ `ZG v, Owner's Name New Renovation Replacement Plans Submitted 1 (Print or type _ Name/-. Address r C a n Check one Certificattahg Company orp. 7 7 ElPartner. 11 Firm/Co. Name of Licensed Plumber�or Gas Fitter -- INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes 6/ No � If you have checked Yes, please indi the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1:3 Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 13 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 gfy* General Laws. By: Title City/Town, APPROVED (OFFICE USE ONLY) S' at of Licensed Plumber Or Gas Fitter ET Plumber Gas Fitter L Icense tulm e aster 0 Journeyman Ed z U ce S rn z CF a O a > W C7 F zx w a w C w F w F x z w > w z x I. d w c7 O > r� u C m c z 3 a o d c7 Q o o w a SU B-BASEWENT a v m > o N o BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type _ Name/-. Address r C a n Check one Certificattahg Company orp. 7 7 ElPartner. 11 Firm/Co. Name of Licensed Plumber�or Gas Fitter -- INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes 6/ No � If you have checked Yes, please indi the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1:3 Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 13 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 gfy* General Laws. By: Title City/Town, APPROVED (OFFICE USE ONLY) S' at of Licensed Plumber Or Gas Fitter ET Plumber Gas Fitter L Icense tulm e aster 0 Journeyman .s (Dat.e...' ............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... ,,..-!t f : ... ... ....... . has permission to perform ...-.r-,..... ..` .........':. . plumbing in thebuildingsof ..J ......................... . at .......... .`. "`..'` ... ..... ........ , North Andover, Mass. Fee .`..... Lic. No. %/4.5 7/.. ........ `. `" f ....... . 9 PLUMBING INSPECTOR Check # 41 7730 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS / J Date Building Location 73 4&2( zv%-� ( /?�--Owners Name 611,9 C ( L permit # Z� Amount y% v11 Type of Occupancy. _ New Renovation Replacement Plans Submitted YesNo (Print or type) J _ Installing Company Name 1 Check Corp Certificate c ❑ Partner. rl Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the tyinsurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond n Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuseo State lum in ea 42 of the General Laws. By: Signature or i..ac.ensF l .FIU111UCr Type of Plumbing License Title City/Town is rise lNumoer Masterourneyman El (OFFICE USE ONLY / .M J i :1--�--.�--�---.---.OMMMMOMM OMMOMMIMM M MMM MW WON ' 1 0 • ' ---M-----�--------------- 1:10------- 0 0:' M--M.---.--��.-------.-- ------.----------------- 1 -----.-M�--------------- (Print or type) J _ Installing Company Name 1 Check Corp Certificate c ❑ Partner. rl Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the tyinsurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond n Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuseo State lum in ea 42 of the General Laws. By: Signature or i..ac.ensF l .FIU111UCr Type of Plumbing License Title City/Town is rise lNumoer Masterourneyman El (OFFICE USE ONLY 64 u 0 Date /-�!574 ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........r? .. ............................... . .............................. has permission to perform,............................................. ................ wiring in the building of ..... ..................................... ....... ........... . North Andover, Mass. CAW Fee........... Lic. No .............................................. ... I - ELECTRICAL INSPECTOi Ghe , ck 'I tl-�aqr f c Commonwealth of Massachusetts Official Use Only - Permit No. t. L16 0 Department of Fire Services a� = Occupancy and Fee Checked " BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank)__ _ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 5?'7 CMR 1? 00 ,PL.EASF, PRINT IN INK ORT ' E ALL I ORMATION) Date: City or Town of: ©IL2 To the .Inspector of TFires: By this application the undersigned Wives notice of his or her intention toyerform the electrical work described below. Location (Street & Number) 7,9 _1--A C,, Owner or Tenant_ lam gS %- Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone Yes ❑ No R) (Check Appropriate Box) Utility A thorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: Installation of Security and or Fire alarm systems Completion of the following table may be waived by the Inspector of Wires. �No. of Id.ecessed 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- ❑ rnd. grnd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners of Detection and No. Initiatin Devices No. of Ranges No. of Air Cond. Tons Total No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers Totals: .. Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local E]Municipal Connection ❑Other No. of Dryers Heating Appliances KIN Seen. 'ity Systems:* No. of Devices or E uivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts _ No. of Devices or Equivalentis No. Hydromassage Bathtubs No. of Motors Total HP _ Wirin c ei communicatNo. Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of ElecLtrical W ,k: _30(When required by municipal policy.) Work to Start: — S `� Inspections to be requested 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 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 and penalties of perjury, that the information on thio application is true and compleie. FIRM NAME: ADT Security Services, Inc. LIC. NO.: 1533 C _ Licensee: Kenny Wong Signature - �,� - LIC. NO.: 5966D _ (If applicable, enter "exempt" in the license number line) �� Bus. Tei. No.:_ 603.594-5900 Address l3 Clinton Drive Hollis N.H. 03049 Alt. Tel. No.: 603-594-5930 *Security System Contractor License required for this work; if applicable, enter the license number here: SS CC 001975 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 agent. Owner/Agent PERMIT FEE. $ � ��nature Telephone No. Location 773 No. r� d CL Date 6 NORTH TOWN OF NORTH ANDOVER _ pL p Certificate of Occupancy $ s Building/Frame Permit Fee $ s`" E cHuFoundation Permit Fee $w � s�s t Other Permit Fee $ 7� D Sewer Connection Fee $ Water Connection Fee $ TOTAL Z;..''ay Building Inspector Div. Public Works P,ERAIIT VO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. �PAGEI MAP d40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK -'PAGE ZONE SUB DIV. LOT NO. I 04 LOCATION PURPOSE 60QMMt- OWNER'S NAME NO. OF STORIES SIZE ''[, /,�•L OWNER'S ADDRESS /{ l.rAGASif',e BASEMENT OR SLAB ARCHITECT'S NAME t% ��' 73 SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME/�(Is�QX� avpL� Y "PeQ Tl J F LJ SPAN DISTANCE TO NEAREST BUILDING -- DIMENSIONS OF SILLS DISTANCE FROM STREET /g�/ POSTS DISTANCE FROM LOT LINES!!- SIDES3 J /O l' rydS REAR " GIRDERS AREA OF LOT � X /7,7 •`� , FRONTAGE ! HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW 6 SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGN RE OF OW ER OR A HO I AG T FEE V PERMIT GRANTED OWNER TEL. # CONTR. TEL. # 19 CONTR. LIC. # r�AY z - ')EPAR' . 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST12 EST. BLDG. COST PER u*Q. FT. EST. BLDG. COST PER ROOM -XINEW-PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN Bu1LDINa INSPccroR BUILDING RECORD 1 OCCUPANCY 12, SINGLE FAMILY S ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY ::::::j_jOFFICES LOT LINES AND ' EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA - APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 0 t CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 1 2 I= D CONCRETE CONCRETE BL'K. BRICK OR STONELA PIERS P—LASTER DRY WALL _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ 1/1 1/2 '/, FIN. ATTIC AREA NO 8 M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 22 J 3 I_ _ _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH HARD114'0 COMMGN ASPH. TILE ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY BRICK ON FRAME CONC. OR CINDER BLK. ATTIC STRS. & FLOOR _ WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 10 PLUMBING 5 ROOF GABLE GAMBREL HIP BATH (3 FIX.( MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d COLS. STEAM STEEL BMS. d COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS O IL B'M'T 2nd _ 1st I 7j,_dl ELECTRIC NO HEATING 0 t I l• cz n r H r --I rn .-• o n AD NO v o O CD r- 1. -A N co N a 9 ^:1 A� •i wf• a1 .,t0 ZO 1 2� all A t t�i�i f• V• . ♦ I� ,t t ��� Y 1 w�i •i lwtA • •� • .f D k^w 9 -. I i • SO t` • -r i w*4-.•i• art 1. A � 1 n n - Z °>0 It t1 mr, f Ary w'• a t a I l• cz n r H r --I rn .-• o n AD NO v o O CD r- 1. -A N co N a 9 ^:1 J wf• a1 .,t0 •pie ;�. 2� all A t t�i�i « �w w:/ � • w�i •i lwtA • •� r• D k^w 9 -. 0 r' - i • SO t` • -r i w*4-.•i• art 1. A OA 1 �A" � ♦ A Z °>0 0-1 O �^ J. w t1 mr, • ! t C�, Ary w'• a t 1 t 'i� If, ijf oj, w tt,,. '>L.d 1 + �> N �S 7 f1 "to ^r�• • • w • ^i O w I • ` •• •a A • • N -/ � / f• i n i 0 a • Cl 24 I 3• • • wf• a1 .,t0 •• ;�. I wn � ^ A t t�i�i « �w w:/ � • w�i •i lwtA • •� r• •I .J•n Y N• � •� w �• �� i w*4-.•i• art 1. A OA 1 �A" � ♦ A < � ,tt • • • ! t C�, Ary w'• a t 1 t :t• ..,• w tt,,. '>L.d w O • '�' N �S 7 f1 "to -%,. • w • C � O 12 • ` •• •a • i 1 l•r•• It On 0 •� ,-4 ~,• -• ' ^X; i �. ` •�'{•• • 1 i• 1 s• •• • •j • i • ti t f id a•iif ( J. Vii• • 1' �� •• • \ I '� i f p Rt 1 0 1 •A —�— L 1 1 ( a rt,•� + :: •� ' p 3^ F ws4• VI '• 0 1�1 7 ` Y: i fI A. X y' t A'CV• .• s 1=; • ?� �-It, it • I 'I'll , 'Im. to I -1 r a > l.t tt • • wf• a1 .,t0 •• ;�. I wn � ^ . 0 ` ^: o sv 1« • w�i •i lwtA I ^a =t , •{ •I .J•n Y N• � •� w 00 OA 1 �A" � ♦ A < � ,tt t• ' -40 o 1 t C1 •� t �S 7 f1 "to •' ^ „ • r C C � 12 • • •• I wn � ^ ` ^: o sv 1« • � I -� •I 00 It 1 1 t �S I•t•1, , 12 I t 1 \ a 1 Vii• • 1' �� Y 1 • \ I '� i f � 1 0 �� •A —�— L 1 1 ( , :: •n 1 - A. X gM ^" s 1=; AN- it • I 'Im. to I f a > l.t tt Ire � M -At At \ 1 • A I •� 1 1 • n � 1 I = 1 �• i _ h �� n,=I ; s > '14 1 w �4 a • A . ;•. ' •, f • 1 i i'j t I 1 • •• I wL • � I �" Vii• 1 �� ° :: - � AN- it • I 'Im. ' I f a > l.t tt Ire At E. • n 111 _ h > '14 1 w • A . ;•. All 0 I L-4 C;) c::, v 22, 1993 u 14- 05,'x'4%93 10'!4 310 CMR 10.99 Form 2 t` , 7 Commonwealth of Ma$sachusetls X 4 y 'y � 'J U H V 11 1 11 1= I r% H I 1 V 1't jt� 1i �An �' 4" ofe Plb No. 1 (to CA o,oYto6d by oEPi c,ty,Town North Andover AD0rpnr av d Data RaOU111 Ki1bd March 22, .L22�L Lot 29- Laticast.er Road Determinatlon of Applicability Massachusetts Wetlands Protection Act, G.L. c.131, §40. From NORTH ANDOVER CONSERVATION COKHI.SSI0t4 issuing Authority 'fo^ p d BrUseard (tJdme of person making rewiest) 297 Granville Lane Address North,Andover. M 01045. This determination is issued and delivered as follows: Same (Name of property owner I Address C3 by hand delivery to person making request on ¢ (date) (date) D by certified mail, retum receipt requested on Pursuant to the authority of G.L,c..131, §40. the -North Andover Cons has considered your. request lot a Determination of AopUcablilty and its suppoMing,documentation. and has made the following determination (check whichever is applicable): Location: Street Address Lan a to Lot Number: 1, p The area described ect�on+ under the.ActsThePart reforaf,the area any removing, ibill ng, dyour reogi request, ois an Area Subject to Prot altering of that area requires the filing of a Notice of Intent. .11L 2• The work oescribed below,.which inclu0es all. -part of the work described in your teeuest. is within an Area Subject to Protection lander the Act and will remove, fill. dredge or alter that area. There- fore. said work re0uues the tiling of a Notice of Intent. ADZ` A Trtxe► COPT Eflactive 11/10/89 2.1 Tom 0181k I 3. D The work described below, whl'h In-"luoes alUoan of the work oescrrt,ed to vou, teoues!, is within the Buller Zone SS Wined to the reputations. and will alter an Area Subte-.! to Protection IJnoef Ine Act, Therefore, 9.010 work reoutres the !!ling 01 a NDII;,e of Intent **Erosion controls will be installed and maintained, The filtration system will be self-contained and non-discharsing,_, . This Determination is negative: 1, Q the area described in your request is not an Area Subject to Protenon Unoer Ine Act 2. D Tfie work desalbt:d In your -roues! is „t, prPp -R,tble:t to Prete; tion Unoer Ine Act, but will not remove, fill, dredpe, or Sher that a►ea. Therefore, said work does not reourre MR filing Of a Notice of Intent. 3. X1 1he work described In your reouesl is within the Butter Zone, b& defined In the reputations, but wilt not atter an Area Subject to Ptolecuan Unber Ine Act. i heretote. Sant work does not reoutre Ine filing of 0 Notice of Intent. **See above. A, D The 01`08 described In your reoueSi is SubteGt 10 P(olecttOn Under Ine Act. bu! since the work described therein meets the redurrements for the lollowrnp exernpbon,as specified in the AC1 and the regulations, no Notice of Intent is re Quit ed Issued by NORTH ANDOVHk Conservation Commission Signaturels) This Determ;-)atioo roust be signed by a majority of the Conservation COmmsstan. On this_ii r S �� day of;;iq 0-.� before me personally a:. E a 9tr r to me known to be the person descr: t d , 1, and who executed. the toregofng inslrurnen!, and acknowledped that hush; executed the la 1! 88 h. the free t1G rid dead i Y" d.ad 1�'. /Notary PubficMy commission a rc13s Ihrt Deletvn,r000in bo: s - r •Levt the appt,Can) ht"n eOrn01yfnP w,lh an othto !farm' stare o' 10_E' slalutts. 0101hbt1tt&. or -laws o► tepulahont 14 G -ttnhtnatron Irha]j oe vbi'C lot INCL years form Ine palj 01 tssuanCt ltle I,:.a4cant the ownel, 1`1, .ettofl appnevad by this Dmerminalton. any owner o! fano abUnlnp Ine Iena ypon wnt.11l Ine proppsbo work III; to be, uorm, Or any!en repo, 'f of trio Cny of tdwh 1h Whits) Wth iehl 11 iocele.'., lire nerapy notilreo b' Ines r,p�l fo troua:I inr Gecanmem Of i:nvr:: ��nantrl prptetllon $Ita it Supettodtrlp pelermrnplton of App4i;zbllll). prOoDinq Ine re0ussl Is rnaoe by con(1160 man Or nond etbirvery ► tntl Wtignme ► 'he appropriate trlmp 164 anti FN ItXMmrnel Form aS Otoyt000 m 310 CMR 10.0301 wnnrn Ion Days Isom t*N date *1 rift"" 01 Ih, Pt 'hln1111ttOh, A MPY Of inif reokgtt Ithr►b it In' §Aml ttmlt in fent a1` Fprllitpu rnau pr hong ul±ItyotY tit trio ''r7— , ' ----r1N� -� - aha- `--------------- --------..___._.__ 4 _9 5'�0--------PC'-'--- _ ...---__. - C') O Z cn m m D O z T Z D r CA 10 C E O � CDO y C'7 n Z CO) CD O �_ C r O• O .O -F O = y O v CD CD O S Cr CD CD O CD C O vi CD CZ O y O I Cc O CD F v yO -=3 Z CD O CD 0 G CD 1-01 a r C = E -1 d -4 O Min O CS co) E�co "0y - o CD Cl) n O y ® nC Z •" �-p N —1 ca CO CD aim y CD O CO N O "•� o i ?o o = > >co o � O CO X Cy C07 co • co c o•o' d n N O C CCD O N co :' C.) t0 C d m N ca LV N N CL CT C O _ ca l CZ co t0 :� co CA O co 03 co) CD � .=r Cfl C, O O cl) O .. CD � o CO CD ny dd C= a_ C- 0 c o Cl) O_ CD .• a �q C/b7 7. rD � 71 T z7 cn fD rD ro T i' ?? 'jJ aGa Z m w n 'z a a "r7 � f') C/)'zf ^ rs Or a - d x Vz lJ rA V y 0 9 0 c CD w t r, Location .J ' No e2S Date 1 3 1 N°RT" TOWN OF NORTH ANDOVER 3?O�,t`, D- •,SOL S Certificate of Occupancy $ Building/Frame Permit Fee $ ""4 A Founda ' .permit Fee $ JcHus /��, � '`""'et e mite' $ 1 Sewer Connection Fee $ Water Connection Fee $ G 'ig93 TOTAL $ Igo t� Pu = 6356 \/�i�r Building Inspector A' - - -, Div. Public Works Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ �~ Other Permit F`e�� $ Sewer Connection Fee $ Water Connection Fee $ TOTAL �. �0 63 r5, $ yu,d r) Building Inspector Div. Public Works Location Date l I MORT1y TOWN OF NORTH ANDOVER '� O�r��° ,4.0 °� ...- OL RRQ4b6�4ancy $ / s i + NOTIA D gVl906WRit Fee $ f sic"usE Foundation Permit Fee _. $ r r�t lft , �Fee $ �cp _anleon $ rr� ' Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works !location - ✓ No. Date NpR7„ TOWN OF NORTH ANDOVER :O:,t.•o ,•1.f.O Certificate of Occupancy $ Building/Frame Permit Fee $ " . �s' 5 Foul%dation Permit Fee Other Permit Fee $ Sewer Connection Fee $ -� Wat wrinection Fee $ ol Building Inspector Div. Public Works s Location No. 0S Y Date "ORT" TOWN OF NORTH ANDOVER O:t�e 1h0 p Certificate of Occupancy $ ;a Building/Frame Permit Fee $ �cM4CHus � Eta' Foundation Permit Fee $ s Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ l /}/rd TOTAL $ o;2 D OV, Building lr spectot Div. Public Works V Prry_�r No. f : APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. �,/ �i113 %S PAGE 1 J MAf +40. ^�T LOT NO. / 7G' 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. -g.!2 4) — LOCATIO PURPOSE OF BUILDING OWNER'S NAME n� vL� /"1.G� �- ✓f /� NO. OF STORIES / SIZE OWNER'S ADDRESS S, /` BASEMENT OR SLAB �! Ir, � ARCHITECT'S NAME /�C) BUILDER'S NAME �/, .� •p/ ��'''''',,�� // C SIZE OF FLOOR TIMBERS IST 2X/o 2ND ,l�U 3RD IF SPAN ' DISTANCE TO NEAREST BUILDING P , DIMENSIONS OF SILLS l/ --- �( "' POSTS DISTANCE FROM STREET / DISTANCE FROM LOT LINES — SIDES REAR /�� " GIRDERS �[ AREA OF LOTj- FRONTAGE /s HEIGHT OF FOUNDATION �/ THICKNESS IS BUILDING NEW ze-5 SIZE OF FOOTING X ] G! IS BUILDING ADDITION Com— MATERIAL OF CHIMNEY el IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE YC p- � IS BUILDING CONNECTED TO TOWN WATER y `7 Y ' BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER • IS BUILDING CONNECTED TO NATURAL GAS LINE /Z7 _5 v INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 3 j - mel► `�+�}�w ' PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDINGDr17 4) ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR FEE /3d (o+ 00 'PERMIT GRANTED < 19 5 0 i 0 v R I BUILDING DEPARTM E W OWNER TEL. CON'R TEL. #_TyS_3. s a PROPERTY INFORMATION LAND COST EST. BLDG. COST 9 0,3 - r� EST. BLDG. COST PER SQ. FT. J EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY j WARD OF HEALTH PLANNING BOARD WARD OF SELECTMEN - � 1 BUILDI INSPECTOR 1 SINGLE FAM MULTI. FAMI APARTMENTS 2 FOUNDATION CONCRETE CONCRETE BL'K. BRICK OR STONE PIERS 3 BASEMENT AREA FULL '/ 1/1 1/1 NO B M HEAD ROOM 4 WALLS CLAPBOARDS DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY OCCUPANCY _ S ORIES OFFICES CONSTRUCTION � 8 INTERIOR FINISH _ PINE a 11 12 13 _ _ HARDW D PLASTER DRY WAIL UNFIN. SUPERIOR�� POOR 5 ROOF FIN. B M'TAREA GABLEHIP GAMBREL FIN. ATTIC AREA _ FIRE PLACES _ MODERN KITCHEN —4e 9 FLOORS CONCRETE�� 3 EARTH STUCCO ON FRAME _ I I I ATTIC STRS. & FLOOR BRICK ON MASONRY BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR�� POOR 5 ROOF ADEQUATE I NONE 10 PLUMBING GABLEHIP GAMBREL BATH Q FIX.) MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING IL 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd A' 1st 13rd I ELECTRIC NO HEATING o � BUILDING RECORD i 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- RAGES, ETC. SUPEJRIMPOSED. THIS' REPLACES PLOT PLAN. N Is `j U FORM U - IAT RE=SE FORM •c sso INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction - have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Ilr/ta h 4- Ax"o Phone '77S-- J? LOCATION: Assessor's Map Number Y -Q— Parcel 1 7,/. Subdivision Lot (s) SOL y __ Street �3•,,� �v� Tc,� /� �% St. Number Use Only********************** RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Town Planner , Comments vm(lt�kp Health AgentA _ , I Comments M Date Approved k Date Rejected Date A r✓ pproved Date Rejected Public Works - sewer/water connections_ V �--i - driveway permit (Ni - Fire Department •/� / Received by Building Inspector Date 9UIL.DING DEPARTiOEN k CERTIFIED FOUIVI--),4 7701V PL A IV LOCATED IN -APA�'r&K SCALE:1"= Scott L. Giles RL. S. 50 Deer Meadow Road North Andover, Mass. S77.1% 11 LO -r 23 3S q.85 ie, b.4 4 LANCASTER. ZOAD 0 1:1 -DING DEPARTMEN -FTHE U15E '1,-CE1?7-1f-Y THAT OFFSETS SHOWN ARE THE OFFSETS OF THE BUIL DING IAISPECOR TOR ONLY SHOWN COMPLY AND SUCH USE IS FOR 7 -1 -IE WITH THE ZONING OETERM/NA RON OFZO_,lVllV-r7 BYLAWS OF CONFORMITY OR NON- (,('',''-r-ORMI T Y VAe,, N-imeT, t*. WHEN CONSTRUCTEl"), WHEN BUIL T Lcry A - o KA n nn 0 n v C') O Z U) m O z T z D CA CD a Z CD O CL r O � n� � O v C� Cr CD CD CZ O O t0 O CD CO) CD a O 7w y 'v d d O CA C7 O C CA O CD 0 r� CD CD a, rA CD CA 0 O CCD O C CD C7 3 O I ?�_ O �• N O = N a o CD Z m8 .0 m N n �no N Oci,.r C w m Z �•O O• �Q a N �I T o r.� d W � O O coN � C* ?mom =-0o� C _ o cn El a O O' G y n o W C:23 CA CL a c, _.5� A o ��� 0 ;oma � m o It o O Di CO) CO2 cd Q C CD CM CO) N N O N :e m d N _ D n•i co .Ort O GVIP CD .40O -�ccm ,rt a'h �'-Cca • oa O CD m m Z CL -C: C* A cn d cn z Y H w°G° o � w c H O w OR tz O O z °�'— n � z aha CO�. O cn El a O O E H 0 0 c PiRllff'*O. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK -'PAGE ZONE SUB DIV. LOT NO.I LOCATION "') PURPOSE OF BUILDINGeZ OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES — SIDES REAR "' " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE fFIILED/AND APPROVED BY BUILDING INSPECTOR DATE FILED O — / SIGNATURE OF OWNER OR A D AGENT FEE �� c) 0 OWNER TEL. #tom - g_Y CONTR. TEL. #_ CONTR. LIC. # GJ1L A, 2, PERMIT GRANTED 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST D Q EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN ���" INa INSPccroa I OCCUPANCY SINGLE FAMILY _ STORIES _ MULTI. FAMILY OFFICES _ APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE 81. K. PINE BRICK OR STONE HARDW'D PIERS PLASTER DRY VJALL 3 BASEMENT II AREA FULL FIN. B M AREA _ '14 '/2 '/ FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING _ COMMON _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME ON MASONRY 1 11 WIRING 5 ROOF II 10 PLUMBING GABLE I HIP BATH 3 GAMBREL MANSARD �I TOI ETRMX 12 FIX.) FL — AT SHED WATER CLOSET SLATE OTE NOPLUMB SHINGES KITCHENSINK I� 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FUF TIMBER BMS. d COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPO WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T ' 2nd _ Ist 13rd I ELECTRIC I NO HEATING BUILDING RECORD ' 12 THIS SECTION MUST SHOW EXACT IMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS, REPLACES PLOT PLAN. C/) m CA 0 m Z . w � Z z COD m C r � ?i CO) 'D m CL wx C d O\ o x � CO) � Cl) o n Z CO) T r' CSD o -0 z a r c'' r =? C CL CO) o v� l v CD CD = v Q ? CD n CD o CD � w a M D m CD CL Vi y D C m z CO CCD < z — v o m CO) CCD) O O CSD T_ Z � D r CDCD z C/) n O cn n I Z O Q co) CL CD 10 CO) CD o w C) C H coo a Imo Z =r -o vi o � *CD o T �a�•►�- m CD CAM CD O W N O O =r CD CD = _CD o C co �• o d O Z C C7 o y. �. 00 o CD. � =r_ •2. °"0 It = CL cc o r a +.�A �] CD O O N cl d C.5 r� = NCL 1�t O d N N CL y C C CL ,••� C9 N O_ N CO CO CD CD tQ ca) OO cc, 1 Z = � CD • C3 • �. .«CN. a� :+ N o _CD m m C L •a C _ c o o = C/) 0 CA 0 w G w r� < 7 j G z COD m C r � ?i C7 G T CL wx aj r C/)an r, n � O\ o x A O C 19l ILDIN( i C.c )Nti1 i1 i VATION I Ilii\I : I'I 1 I'I.ANNIM i. ATE )CATION `I\NORTH ANDOVE. It I fIVI i11 IN 1 II' 1'1,,A,NNIN(;. (;()Ill[►I�!Nl'1'1' 1)I's�'[:1,U1'l111 N'1' I:.�I;I:Id 11.1'. Ni:i.tic 1N. I Illtl:t: is )It CHIAINEY APPLICAHON ANO I'ERM11- I :'� 1 hl:llll .`:411'1 •) hl:l�,�:i� lllra•fl•:1►It4•I Ilii 7-11it1; .1 PERM -l'. # � LINER'S NAME: IILDER'S NAME:— ' \ SON' S NAME: iSON IS ADDRESS: cl L' C, I Lit n SON'S TELEPHONE: JERIAL OF CHIMNEY: 1FERIOR CHIMNEY: J L'XILRIOR CHIMNEY: ,J IMBER AND SIZE OF FLUES: II CKNESS OF HEARTH: - eU chimney oa OcAepl'_ace colt(janul to .tire. Imiu.i milell•ts u( the curie cull! have ,u1Ce.5 cu141 :gu,ea -iow been neeeZveci:-- TE: GNATURE OF MASON: 1/ -RMIT GRANTED: FEL' 'BERT NICETTA ILDING INSPECTOR SPECTEU: MARKS: SOLID BLOCK ItEQUIItE D THIS PERMIT MUST G(= UISPLAYEU 014 ME I'RLMISLS CERTIFICATE OF USE &OCCUPANCY Building Permit Number 054 Date A„g,ist 11. 1 9()3 THIS CERTIFIES THAT THE BUILDING LOCATED ON 73 IANCAS`I'ER ROAD (Lot #29) MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/3 CAR GARAGEJN ACCORDANCE DECK & SUNROOM WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. o•",: CERTIFICATE ISSUED TO ' 9 ADDRESS ANDOVER CONSTRUCTION & DEV. CORP. 66 SPRING HILL ROAD NORTH ANDOVER MA Building Inspector CO) 10 CD O O CL r d d 'v o �v CD CL � c CD o CD O z M C C CD DM CL v m 0 cp COD z z 10 CD n � O _ z v cood m 0 CA C O C COO) d CD O CD CD3 y" CD CO2 O 0 CD O G CD ci E F lJ 0 Con C 0 Cl) �• N p = Q =0 S. O,o y ti »mto om CA C2 CL o n m •� =r -C 03 W H tz =r d.rt d � ®.. m d H O -0 y m C2 �CDCD p m a an 0 t n O O N C7 O a nCog� 5 1.y�1 CD m CDIt :O CC o m c n -� 55 y H cn G d :cr C ` C y D7 C : e O CD 3 01 0 0 C CD o :• O zo CD m Ao H? ft 3 n 3 �� • c d N C=, � _ C W= • d o __ 0= w C2 R` =CDw r v cncn� ro z r. ^ o 0 C pp Ill w (� 0 < G til rD r� Ix 0 w G tr m O w w� � 10 O O Z� tz d r' Q tz �" CN 1` j N► 3 G� S 0 n O cn 1 rY O Of r1 *'t* Tp 00 + '' m n H..f •` rG 2993 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION i This certifies that ` .....' .. `.. . A cz cz C1. S L6 .``..' ~........... U has permission for gas installation .......... in the buildings of ..% ......... :............................ :�. at •! ' ' ...:- :............... . North Andover, Mal. Fee�S....... Lic. ........................; . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ry k: MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) City, Town V/"r F) G� L� Permit Building Owner's Location L f4/'V C/ / C/ Name ek U sj lq 0- ,.; New Y. PlanSubmitted Type of Occupancy: CAJ-a O 4) C� Renovation ❑ Replacement ❑ Yes ❑ No W (Print or Type) Check One: Certificate Installing Company Name l��t1�� U M Corp. .Address � Q /� O x ��6 � /— . S � � � D / �A � (� ❑ Partnership Z , _y 7 ElFirm/Company • Business Telephone 7y'� Name of Licensed Plumber or Gasfitter ve 1-4?0 �rf%6-/ 61 I hereby certify that all of the details and information 1 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 Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. w + y0 p } Signature of Owner(Agent — - — - - k�� i I have a current liability insurance policy to include corn pietcd op tl p Y j t ratii+ns covcrtge.� " a = BY - - TYPE LICENSE: - 'Title D Plumber City/Town _ ❑ Gasfitter APPROVED (OFFICE USE ONLY) O Master "'' ❑ Journeyman -', FORM 1243 Hoaas d WARREN, INC. 1989 Signature of Licensed Plumber or Gasfitter. License Number �'IIINII N ..................... �....ENNOMMENNOUNNEeMENNSEENNEN....... (Print or Type) Check One: Certificate Installing Company Name l��t1�� U M Corp. .Address � Q /� O x ��6 � /— . S � � � D / �A � (� ❑ Partnership Z , _y 7 ElFirm/Company • Business Telephone 7y'� Name of Licensed Plumber or Gasfitter ve 1-4?0 �rf%6-/ 61 I hereby certify that all of the details and information 1 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 Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. w + y0 p } Signature of Owner(Agent — - — - - k�� i I have a current liability insurance policy to include corn pietcd op tl p Y j t ratii+ns covcrtge.� " a = BY - - TYPE LICENSE: - 'Title D Plumber City/Town _ ❑ Gasfitter APPROVED (OFFICE USE ONLY) O Master "'' ❑ Journeyman -', FORM 1243 Hoaas d WARREN, INC. 1989 Signature of Licensed Plumber or Gasfitter. License Number 1. j I Fold, Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS J -..: BOARD PL IN PLUMBERS AND GASFITTERS LICENSED IMPORTANT NOTICE .; AS A JOURNEYMAN PLUMBER " ISSUES THIS LICENSE 70 PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE - TYPE THOMAS R GAGNON m OFFICE OF THE STATE BOARD. c N .. 0 PO BOX 8860 0., 0 '.SALEM MA 01971-8860 ? ; 572487 18597 05/01/00 572487 - Fold, Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS BOARD IN PLUMBERS AND GASFITTERS IMPORTANT NOTICE m PL i LICENSED AS A MASTER PLUMBER PERMITS FOR PLUMBING AND GAS FITTING ISSUES THIS LICENSE TO INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. TYPE THOMAS R GAGNON IJ _M m o PO BOX 8860 N SALEM MA 01971-8860 572485 1 10136 05/01/00 572485 Fold, Then Detach Along All Perforations Fold, Then Detach Along All Perforations J - COMMONWEALTH OF MASSACHUSETTS I BOARDIN PLUMBERS AND GASFITTERS IMPORTANT NOTICE ?`o � PL REGISTERED AS A PLUMBING CORP �• G ISSUES THIS LICENSE TO � i PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE f L TYPE THOMAS R GAGNON '5 OFFICE OF THE STATE BOARD. } o PO BOX 8860 '. SALEM MA 01971-8860 r ' a ,572486 1524 05/01/00 572486 I Fold, Then Detach Along All Perforations ✓I2C li/OiI97/�)7,OYU.(/��LL/L O�✓/�GCX4:7lX-GYaGCJG'�d - � E itit yr^� j, DEPARTMENT OF PUBLIC SAFETY Restricted To: 00 i Ulu, SPRINKLER C00TRACTOR LICENSE Npmber Expires: Birthdate: I� SCJ 22 OB/31/1999 08/31/1951 Res —t d To 00 .-. 1 r G >� 3 THOMh PO BOX SALEM, MA 01970