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HomeMy WebLinkAboutMiscellaneous - 768 Great Pond RoadIf 1 9560 Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that........... ........................... ................................ has permission to perform......... ..................................................... . .............. wiring in the building of .........we.lz—�*EAt'o .................................. at ............ ................. I .................... .... North Andover, Mass. '9 Fee Lic. No -S2-13 Z� .......... ..... ELECTRICAL INSPECTOR Check # l.ommonwea& of Mad3ac"Ib Official Use Only cc�� c7 Permit No. eCJePartmen.2z o�}ire_ �ervice� , . Occupancy and Fee Checked, BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORMELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEY) 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE LL FO TION) Date: Zi fp City or Town of: � � � To the Inspector of Wires: By this application the undersigned s notice his or her;Z;7 to a orm the electrical work described below. Location Street &Number 6 e Owner or Tenant- worm( tn Telephone No. Owner's Address Same Is this permit in conjunction with a builffing permit? Yes ❑ No (Check Appropriate Box) Purpose of Building J—/Ui+7I 5f Utili uthorization No. Existing Service •moo Amps !zf-,�/ ZWIVolts Overhead Undgrd 2-04)❑ New Service 0li Amps Iu1 ,2MENolts Overhead � Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters 164eIlt (f No. of Recessed Luminaires -- - -�c No. of Ceil.-Susp. (Paddle) Fans rvut vcu u lite 1iu ectur O YY ares. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators K -VA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. of Emergency Lighting nd.grnd. BatteKy Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners IVo--.-oT Detection an Initiatin Devices No. of Ranges No. of Air Cond. TotTons No. of Alerting Devices No. of Waste Disposers Heat Pump I ____ um_, er Tons_ _ - _ No. of.Self-Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal[:1 Other Connection No. of Dryers Heating Appliances KW Security Systems: No. Devices Equivalent No. of Water eaters KW No. o o. of of or Data Wiring: Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiing: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of El ctrical Work: (When required by municipal policy.) Work to Start: --- Inspections to be requested- in accordance with MEC Rule 10, and upon completion. INSURANCE C RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability ' surance including "completed operation" coverage or its substantial. equivalent. The undersigned certifies that such cov ge is in force, and has exhibited proof of to;on permit iss ing ffice. CHECK ONE: INSURANCE' BOND ❑ OTHER ❑ (Specify:) I certify, under the painsaud p allies o rju , that the in rmation on thpp- ris t� com letsPP> FIRM NAME: �/ �/Q P3� /� �u/ tC LIC. NO.• Licensee: (6 11 d Signature LIC. NO.: (If applicable, ent mpt" n/�he lic j�se number lin Bus. Tel. No.; 7 Address: Y �rY1f GGW / n Alt. Tel. No. - *Per M.G:L. c. 147, s. 57-61, security wor 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 bylaw. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a nt. Owner/Agent ` Signature Telephone No.PERMIT FEE: $ W TOWN OF ANDOVER ELECTRICAL PERMIT FEES (Effective March 12 2003) 5�T��S 00 OR NO SE CABLE ON OUTSIDE OF BUILD.TNG elf - Generators Residential & Commercial: a) including photovoltaic & generating Equip Per KVA $1.00 b) un -interruptible power systems, per KVA $1.00 c) batteries over 100 amp. hours, per cell $1.00 Heat Devices: $1.00 each Heat Pumps: $40.00 each Hydro -Massage Bathtubs/ Hot Tubs: $20.00 each Lighting Fixtures $1.00 each Lighting Outlets: $1.00 each Major Appliances: (not listed) $20 each Motors: (per hp or fractional part thereof) $2.00 Oil /Gas Burners: Residential $20.00 each Commercial $20.00 each Office Furnishings: per circuit $10 (Relocatable Partitions/Cubicles) Outlets & Fixture: $1.00 each Ovens Built in/Counter Top Units: $10.00 each Panel Change/Circuit Breaker: Residential: $20.00 Commercial: $25.00 Phone Jacks: See data/telecommunications Ranges $15.00 each Receptacle Outlets: $1.00 each Recessed Fixtures: $1.00 each Re -inspection Fee: $25.00 Repair to Service Residential: $20.00 Residential New Construction (Dwelling): $220.00 (with service up to 200 amps) Must have Utility Authorization Number for services over 200 amps see below a) for each 100 amps capacity or fraction add $20.00 b) each additional meter $10.00 c) each additional panel/sub panel $25.00 Residential Additions/Alterations: . $220.00 maximum Residential Service Change or Underground Service: $40.00 Must have Utility Authorization Number a) one meter, up to 100 amp capacity $40.00 b) each additional 100 amp capacity or fraction $20.00 3 --Itr A --C- c) each additional meter .310.00 Sewer Ejection Pump: $25.00 Signs: $25.00 each ballast Smoke & Heat Detectors & Initiating Devices: Residential: $1.00 each Commercial: $60.00 up to 10 devices over 10 - $1.00 each Space Heaters: area heating $1.00 each Sub -Panel: $25.00 Swimming Pools: Residential: Above Ground: $25.00 Inground: $50.00 Commercial Pool: $100.00 Switches: $1.00 each Temporary Service: Must have Lrtility Authorization Number Residential $25.00 Commercial $100.00 Transformers: a) capacitors, Per KVA $1.00 b) ducts, conduit & conductors (Associated w/ Padmount Transformers) S� c) each manhole $10.00 d) each handhold $5.00 r �a e) per KVA $1.00 f) primary feeders, $25.00 each (ove 600 volts, non-utility owned) g vaults and equip. $25.00 each Washers: $15.00 each Waste Disposals: $5.00 each Water Heaters: $30.00 each Air Conditioners: $40.00 each Alarm Systems Security: (for fire systems see smoke/heat detectors) Residential: $40.00 Commercial: up to 10 Devices $60.00 additional devices over 10- $1.00 each Carnival Equipment: $50.00 each Ceiling Fans: $1.00 each Commercial New Construction or Alterations: $100.00 per 1,000 Sq. Ft. of Construction Space Commercial Service Change/ Repair: Must have Utility Authorization :Number $100 (first 100 amperes or fraction, one meter) a) each additional 100 amperes capacity or fraction. $30.00 b) each additional meter $25.00 Commercial Temporary Service: $100.00 Must have Utility Authorization Number Commercial Repair and/or Maintenance Permit: (Blanket Permit) up to 2 Electricians $150.00 per pair of Electricians over 2 $50.00 Data/Telecommunication: Residential: $1.00 per port Commercial: $30.00 up to 10 devices over 10 - $1.00 each Dishwashers & Disposals: $5.00 Each Dryers: $15.00 Each Emergency Lighting (Battery Units) $ 1.00 each unit Feeders or Sub -feeders: each 100 amp capacity of fraction thereof Residential: $5.00 each Commercial: $15.00 each Gas/Oil Burners: Residential: $20.00 each Commercial $20.00 each *For Multi -Family, & Large Commercial Projec see Wiring Inspector fa pricing: Paul Kennedy (978) 623-8316 (Office Fours 8 ani to 1.0 am) *Inspection Schedule: 1 ROUGH I FINAL 1 TRENCH (if applicable ADDITIONAL INSPECTIONS *$25.00 (i applicable) (revised 07/05) Date.. " /; Kj y ............ j.� ,pRTM 3= �' TOWN OF-NORTH ANDOVER - PERMIT FOR GAS INSTALLATION This certifies that .' '} .....: -� ' ........................... . has permission for gas installation ............ in the buildings. of.. �- r'�', �.:�c - ....................... atr� . :r......-�1 . ��' - , North Andover, Mass. Fee`'... . Lic. No::.............. may.-.... ....... GAS INSPEG.OR Check 7077 mA5SACHusE rjs ummRM APPLICATON FOR PERMIT TO DO GAS FTTTTNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date % z /T/d Building Locations / �oo C4M 7-- 10A dd rod Permit # �2U 2 7 Owner's Name New Renovation ❑ Replacement ❑' Amount $ 0 � ref Plans Submitted ❑ (Print or �[y_pe)�AegO Check on Certificate Installing Company ��®AJJa161� Name� 11 Co ,�i/A I r Address � � '"�� /�'�'��� ,`'��p"' A," � Partner. t Business Telephone '" Firm/Co. 4 7 Name of Licensed Plumber or Gas Fitter B 0 6 A/s/ 4 R/ Ag F✓1' 4 �INSIJRANCE COVERAGE Check one: have a current liability Insurance policy or it's substantial equivalent. Yes � No❑ If you have checked yes, please}ndicate the type coverage by checking the appropriate box. Liability insurance policy RrSq Other type of indemnity 0 Bond 0. Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent E I hereby certify that all of the details and information 1 have submittea (or enterea) in aoove application are true aim accurate io ane 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 Massachuset t eod,]€the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Sigrore of Licensed Plumber Or Gas Fitter rA Plumber ZO 0 Gas Fitter License Number Master Journeyman x Ij � � cn cn U z F a V) W W WCl) gOU O, R� Cn F C-4 .G va c� w Q z O o H a GEn w a w w o w w w U � � � H z H z H I~ �Z o z W 0 dz rx x O cQ a w z R a A c7 ¢ a o U o a W > a A o a W H H O SUB -BASEMENT BASEM ENT. 1ST. FLOOR 2ND. FLOOR 3RD . F L O O R 4TH. FLOOR 5TH. FLOOR . 6TH. FLOOR 7TH . FLOOR STH. FLOOR (Print or �[y_pe)�AegO Check on Certificate Installing Company ��®AJJa161� Name� 11 Co ,�i/A I r Address � � '"�� /�'�'��� ,`'��p"' A," � Partner. t Business Telephone '" Firm/Co. 4 7 Name of Licensed Plumber or Gas Fitter B 0 6 A/s/ 4 R/ Ag F✓1' 4 �INSIJRANCE COVERAGE Check one: have a current liability Insurance policy or it's substantial equivalent. Yes � No❑ If you have checked yes, please}ndicate the type coverage by checking the appropriate box. Liability insurance policy RrSq Other type of indemnity 0 Bond 0. Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent E I hereby certify that all of the details and information 1 have submittea (or enterea) in aoove application are true aim accurate io ane 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 Massachuset t eod,]€the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Sigrore of Licensed Plumber Or Gas Fitter rA Plumber ZO 0 Gas Fitter License Number Master Journeyman Location( No. Date Date -1� Q" w Check # `7r r TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 18`147 - r Building Inspec or ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING aw 7�} !C BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Bui m i ssione4 for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: ��j Q 1.2 Assessors Map and Parcel Number: _-3® Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronto ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. § 34) 1.3. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ Public ❑ Private ❑ SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT ('1 2.1 Owner of Record Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Cignature Telephone SECTION 3 - CONSTRUCTION SERVICES I Licensed Construction Supervisor: Not Applicable ❑ Licensed Const— r ruction Supervisor: License Number Addre s r l�J./ Expiration Date Signature 7elephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number , Address � Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (11NLG.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 unit. Signed affidavit Attached Yes .......0 No.......0 SECTION 5 Description of Pro sed Work check as appftcable New Construction ❑ Existing Building 0 Repair(s) 0 Alterations(s) ❑ Addition 0 Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: I WrTION 6 - RCTIMATRII rnNCTRiTr-rinty me re Item Estimated Cost (Dollar) to be Com 1 ted by pernfit applicant OFFICIAL USE ONLY 1. Building ✓ %9� O (a) Building Permit Fee Multiplier 2 Electrical v (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 Check Number .....,..a.— .— --.— lv "M %.V1.irLL1L'" Wr=1V OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 2l2, r as Owner,�Afthorized Agen of subject property Hereby authorize to act on My behaIt' 11 ma ers reelat e t or�jauthorized by this building permit application. �� � mit" r. - Si iature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIyIBERS 1' 2 SPAN DM ENSIONS OF SILLS DIMENSIONS OF POSTS DRVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION _ T SIZE OF FOOTING MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUU DING CONNECTED TO NATURAL GAS LINE t1 3 g,'i ZL-1 FORM U - LOT RELEASE FORM 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 or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT 1 T Gt° (Pii� `p� PHONE_ LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (8) STREET C a1A_ '\>o-`" 4. �� ST. NUMBER S ? OFFICIAL USE ON _Y RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED ' DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FUVD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER. CONNECTIONS DRIVEWAY PERMIT, FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE RsvIeW WN Jm Car! Woekel & Son, Inc A Name of Service Since 1897 Contradors and Builders A0 Box 2316 Mdhuen, Massachusetts 01844 (978) 682-7901) 853 Ocean. Boulevard Hampton, New Hampshire 03842 (603) 926-2870 April 11, 2005 Mr. Robert Worthen 776 Great Pond Road North Andover, MA 01845 Dear Mr. Worthen; I am pleased to submit the following price on work to property at Great Pond Road. 0'7�v� Attic Room: Frame walls and strap ceiling. Insulate walls at knee walls with R-13 fiberglass insulation, R-30 between rafters and on ceiling. Floor -5/8" underlayment grade plywood Walls & Ceiling -1/2" drywall taped, finished and sanded. Finish Work—Flush lauan door unit to storage area, 4 short lauan units at knee walls, Trim one window, baseboard and hand rail on stairs. We will pick up and dispose of debris. Total Price -----$8,790.00 Very truly yours, Carl Woekel ' ► 4'= UOQ I V Cl) O o ~ 0 O r S 'fl v) U 0 F CO N L ~0 y C O e. o e E 9 w t9. a Iz- wo w N N >ba - �2 o^ wa O N w- Uo o� N in O., O O. Y O O 0 w = O Z fA p 0 U o 0 w o ¢ 0-0 m N 3 0 Q Z X W < m U U w °� w oto 6 ..w N w.; d i WmH Ud2 :. ' ► 4'= UOQ I V o ~ s S 'fl v) U 0 L ~0 y C O e. e E 9 Iz- wo w N N >ba - wa 0' w- �Z Y O V 0 w = w o ¢ N 3 0 Q Z X W < m U U w °� J. , ACORD, INSURANCE BINDER DATE 04/08/2005 THIS IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. PRODUCER I PAIC HONENoExt : ( 603)293-2791 COMPANY BINDER# FAX (603)293-7188 Western World Insurance Co. B05040800754 EFFECTIVE DATE TIME EXPIRATION DATE I TIME E & S Insurance Services LLC 04/01/2005 12:01 X AM I 05/01/2005 X 12:01 AM 21 Meadowbrook Lane P 0 Box 7425 PM AUTOMOBILE FI NOON COMBINED SINGLE LIMIT $ THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY PER EXPIRING POLICY #: Gilford, NH 03247-7425 CODE: SUB CODE: AGENCYDESCRIPTION CUSTOMER ID.00001474 OF OPERATIONSNEHICLES/PROPERTY (Including Location) INSURED Carl Woekel & Son, Inc. MEDICAL PAYMENTS $ 853 Ocean Boulevard PERSONAL INJURY PROT $ Hampton, NH 03842-2516 UNINSURED MOTORIST $ nnvOowr_ve umi ! J - -TYPE OF INSURANCE COVERAGEIFORMS DEDUCTIBLE COINS % AMOUNT PROPERTY CAUSES OF LOSS BASIC FIBROAD 1-1SPEC X Unscheduled Equipmnt Misc. Tool floater _ $ 500 10,000 AUTHORIZED REPRESENTATIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR RETRO DATE FOR CLAIMS MADE: EACH OCCURRENCE $ 1,000,000 X FIRE DAMAGE (Any one fire) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ MEDICAL PAYMENTS $ PERSONAL INJURY PROT $ UNINSURED MOTORIST $ a AUTO PHYSICAL DAMAGE DEDUCTIBLE COLLISION: OTHER THAN COL: ALL VEHICLES Lj SCHEDULED VEHICLES ACTUAL CASH VALUE STATED AMOUNT $ OTHER GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: EACH OCCURRENCE $ AGGREGATE $ SELF-INSURED RETENTION $ WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY WC STATUTORY LIMITS E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ SPECIAL CONDITIONS/ OTHER COVERAGES FEES $ TAXES $ ESTIMATED TOTAL PREMIUM $ NAME & ADDRESS ACORD 75-S (1198) NOTE: IMPORTANT 5TATE INFORMATION ON KEVEKSt SIUt �J U-AL;UKu GVK(yKAI IUN Tari MORTGAGEE LOSS PAYEE ADDITIONAL INSURED LOAN # AUTHORIZED REPRESENTATIVE Fairley Kenneally ACORD 75-S (1198) NOTE: IMPORTANT 5TATE INFORMATION ON KEVEKSt SIUt �J U-AL;UKu GVK(yKAI IUN Tari 1nu11,wno A "CORD. CERTIFICATE OF LIABILITY INSURANCE 04/20/05DATE 0!YYYY) PRODUCER USI New England PO Box 6360 Manchester, NH 03108-6360 603 625-1100 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW._ INSURERS AFFORDING COVERAGE NAIC # INSURED John Horan Construction LLC 21 EVERGREEN DR Hampstead, NH 03841 INSURER AHartford Insurance Company 29424 INSURER B: Eastguard Insurance Company 14702 INSURER C. INSURER D. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH A-- Orr• 1 IAAnnO cun%Arr.i KAAV W AVG PPPKI Qr:m ICFF1 RV PAIF1 CI AIMS I - LTR ---------- S TYPE OF INSURANCE POLICY NUMBER p LICY EFFDEDCTIVE IOLNYI-- OA EXPIRp/BION LIMITS A GENERAL LIABILITY 04SBAGO8654 04/01/05 04/01/06 EACH OCCURRENCE $1 000 OOO PREM 3ES0 a �Tur ence $3OO OOO X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $10,000 CLAIMS MADE Ex -J OCCUR PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE t2,000,000 GE''L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s21000.000 PRO- POLICI' IGCT LOC A AUTOMOBILE X LIABILITY ANY AUTO 04UECTU4440SB 12/30/04 12/30/05 COMBINED SINGLE LIMIT $500,000 (Ea accident) ALL (DNNED AUTOS BODILY INJURY x (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY X NON-� `WNED AUTOS Per accident) PROPERTY DAMAGE $ (Per accidemi GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC '$ ANY AUTO AUTO ONLY. AG ; 'i EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE RETENTION $ e r B WORKERS COMPENSATION AND JOWC633936 04/01/05 04/01/06 X ,,11C STA LII ITS FR E.L EACH ACCIDENT s100 000 EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $100,000 E . DISEASE - POLICY LIMI $SOO,OO r yes. desrnbe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS! LOCATIONS/ VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Operations Usual to the Insured. CE Carl Woekel & Son Inc. PO BOX 2316 Methuen, MA 01844 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 n DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE ,n 25 (tool/oa) 1 of 2 #112499 XKAL © ACORD CORPORATION 1981 A CORD, I N S U RAN C E BINDER o4/08�200S THIS IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. PRODUCER PHONE (603)293-2791 A/C Ne Ext: COMPANY BINDER FAX (603)293-7188 Western World Insurance Co. 1BOS040800754 DATE EFFE TIME DATE PIRATION TIME E & S Insurance Services LLC 04/01/2005 1 12:01X FIRE DAMAGE (Any one fire) $ S0,000 AM 05/01/2005 MED EXP (Any one person) $ 5,000 21 Meadowbrook Lane P 0 Box 7425 GENERAL AGGREGATE $ 2,000,000 PM NOON AUTOMOBILE THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY PER EXPIRING POLICY S: Gi 1 ford, . NH 03247-7425 CODE: SUB CODE: AGENCY 00001474 DESCRIPTION OF OPERATIONS/VEHICLESIPROPERTY (Including Location) CUSTOME ID. BODILY INJURY (Per accident) $ INSURED Carl Woekel & Son, Inc. 853 Ocean Boulevard Hampton, NH 03842-2516 n—Anco UM11a " TYPE OF INSURANCE COVERAGEIFORMS DEDUCTIBLE COINS % AMOUNT PROPERTY CAUSES OF LOSS BASIC F-1 BROAD FISPEC X Unscheduled Equipmnt Misc. Tool floater $ 5500 AUTHORIZED REPRESENTATIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX I OCCUR RETRO DATE FOR CLAIMS MADE: EACH OCCURRENCE $ 1,000,000 X FIRE DAMAGE (Any one fire) $ S0,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000. AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ MEDICAL PAYMENTS $ PERSONAL INJURY PROT $ UNINSURED MOTORIST $ $ AUTO PHYSICAL DAMAGE DEDUCTIBLE COLLISION: OTHER THAN COL: ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE STATED AMOUNT $ OTHER GARAGE LLABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: EACH OCCURRENCE $ AGGREGATE $ SELF-INSURED RETENTION $ WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY WC STATUTORY LIMITS E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ SPECIAL CONDITIONS/ OTHER COVERAGES FEES $ TAXES $ ESTIMATED TOTAL PREMIUM $ IJAMF R AnnRFSS ACORD75-5(1198) NU IL: IMI'UKIANI SIAICINrVKMAIIVNUNKCVCKOCQ1LJC `J L97AVVKUIrVKPVIc/lllvlr IVyO MORTGAGEE LOSS PAYEE ADDITIONAL INSURED LOAN M AUTHORIZED REPRESENTATIVE Fairley Kenneally ip-l-k ACORD75-5(1198) NU IL: IMI'UKIANI SIAICINrVKMAIIVNUNKCVCKOCQ1LJC `J L97AVVKUIrVKPVIc/lllvlr IVyO THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INUICAI ED. NU I VVI I 11�5 I ANUINI, 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 nrr I IAAMO CUn,AIKI eAAV WAV: RGGAI Qrmi inpn RV PAin ni AIMS LTRINSR ACORD,,,, CERTIFICATE OF LIABILITY INSURANCE DATE (MM 04/20/05D'vvvv) POLICY NUMBER PRODUCER USI New England PO Box 6360 Manchester, NH 03108-6360 603 625-1100 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW._ INSURERS AFFORDING COVERAGE I NAIC # A INSURED John Horan Construction LLC 21 EVERGREEN DR Hampstead, NH 03841 INSURER A: Hartford Insurance CompanyF 29424 INSURER B: Eastguard Insurance Company 14702 INSURERC _ INSURER D INSURER E COVERAGES --- THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INUICAI ED. NU I VVI I 11�5 I ANUINI, 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 nrr I IAAMO CUn,AIKI eAAV WAV: RGGAI Qrmi inpn RV PAin ni AIMS LTRINSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE VYYI POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY h, X MMERCIAL GENERAL LIABILITY 04SBAGQ8654 04/01/05 04/01/06 EACH OCCURRENCE $1,000,000 DA MA&E TO RENTED $300.000 r r rre na' MED EXP (Any one person) $10,000 CLAIMS MADE 5_1 OCCUR PERSONAL & ADV INJURY S1,000,000 GENERAL AGGREGATE 1;21000 000 GEN!- AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP ACG s2,000,000 F77E"T LOC A AUTOMOBILE LIABILITY X ANY ALTO 04UECTU4440SB 12/30/04 12/30/05 COMBINED SINGLE LIMIT $5OO OOO (Ea accident) , ALL OWNED AUTOS BODILY INJURY (Per person) .HED! ILEG ALT : -IS X HIRED AUTOS BODILY INJURY X NON-C,WNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per arndenli GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER OTHER THAN EA AC C $ ANY AUTO AUTO ONLY AC(:!. $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE OCCUR CLAIMS MADE Ci "c Cii!:TI?LE H I ^RETENTIC,N $ B WORKERS COMPENSATION AND JOWC633936 04/01/05 04/01/06 X TO1c.; M ; i;�H- E.L. EACH ACCIDENT $100,000 EMPLOYERS' LIABILITY ANS PR()PRIETOR/PARTNER'EXECUTIVE 'PrnJcH,M�EMIBEa EXCLUDED? El DISEASE - EA EMPLOYEE $100,000 E.L. DISEASE -POLICY LIMIT $500 OOO li yes,,,es-xlr-.e Under SPE PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Operations Usual to the Insured. CERTIFICATE HOLDER QANQLLLAI IUn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIONI Carl WoelCel & Son Inc. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL - I A DAYS WRITTEN PO BOX 2316 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Methuen, MA 01844 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 17125 (2001 /08) 1 of 2 #112499 XKAL © ACORD CORPORATION 19E O z i W rA co Ste; LU Q Z H COD LU F= oc W CIO ' � o m c c o 0 Oy :C C C3 C3 •nC O O. Co C . y.r O � EQ m •- o c. H :O= O a.. O C_ y rV �m �3 O �m M.0 'LC y CO mo CLS �mm CoQ y :o.o� � yz go _ cCL O D d 0 •+ y O � C2 � Cw .� m 'r O C � 8 'A CL o o Co .�10 CCD L 4- E z MaGo y C O m m L 0 cp c IS CQ N Z 0 Z 0 g O F. f z 0 z U 2 0 O O E tsO Z O y � C — O O! I O. - h O �� m m CD 0 CD � O.a CD CDL cc�o' a o - o c cc .C.3 'v CD CO Z tS 0 CL �..± y O C C_ C c y 0 LLI Y/ CO)LU W W oC W N v o w a w I a a A p w m p w p a4 C U G w p rs: w" W w p a: w 0 w C w G c� A O cE Ste; LU Q Z H COD LU F= oc W CIO ' � o m c c o 0 Oy :C C C3 C3 •nC O O. Co C . y.r O � EQ m •- o c. H :O= O a.. O C_ y rV �m �3 O �m M.0 'LC y CO mo CLS �mm CoQ y :o.o� � yz go _ cCL O D d 0 •+ y O � C2 � Cw .� m 'r O C � 8 'A CL o o Co .�10 CCD L 4- E z MaGo y C O m m L 0 cp c IS CQ N Z 0 Z 0 g O F. f z 0 z U 2 0 O O E tsO Z O y � C — O O! I O. - h O �� m m CD 0 CD � O.a CD CDL cc�o' a o - o c cc .C.3 'v CD CO Z tS 0 CL �..± y O C C_ C c y 0 LLI Y/ CO)LU W W oC W N Date. //—. C : G L . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... (.�. G. c 1�9 .� .�.....1') ,< �.� .......... . has permission to perform .... R.q 4--.4 -.'.`.L .:............. . plumbing in the buildings of ........ ? tj' " i.............. at .. /? ........... ........... , North Andover, Mass. Fee.. 6 Lic. No. ,71 ?.. ....... ....... . PLUMBING INSPECTOR Check # 2 2 G 5427 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Owners Name CCC ,y }- F y4oy �i Date Permit /� Amount Type of OccupancyA e 5 - New New Renovation ® Replacement13 Plans Submitted Yes No FTXTi TRFR (Print or type) Check one: Certificate Installing Company Name -34-1 r /i �oo �l h/ Corp. Address xc c 0 Partner. usmess Te ep one �L Firm/Co. Name of Licensed Plumber. -.-2 4! -1 - Insurance Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ 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 igna ure IOwner ❑ 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 Massachuseq; State,Plurg4ft Command Choptero+4.Z-of the General Laws. OVER (OFFICE USE ONLY Type`'of Plumbing License a/ �L?-",) Mcense um r Master ❑ Journeyman R`