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HomeMy WebLinkAboutMiscellaneous - 774 Salem StreetN, Phone: 978-632-2660 JAMES A. TRUDEAU Adjustment Service Inc. P. O. Box 7 Fax: 978-632-2662 Gardner, MA 01440 claims60rudeauadj,com Notice of Casualty Loss of Building Under Massachusetts General Laws, Chapter 139, Section 3B Ziune4, 2015 ng Inspector Main Street North Andover, MA 01845 Board of Health 120 Main Street North Andover, MA 01845 Fire Department Dept. of Records 124 Main Street North Andover, MA 01845 Insured: Michael & Debra Demirjian Loss Location: 474 Salem Street, North Andover, MA 01845 Insurance Company: The Concord Group Ins. Companies Policy No.: 1040756 Date of Loss: June 10, 2015 File Number: 15-13614 Claim Number: 1163272 Type of Loss: Water Damage 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, Chapter 139, Section 3B" is appropriate, please direct it to the writer and include a reference to the captioned insured, location, policy number, date of loss, and file or claim number. Claim has been made involving loss, damage or destruction of the above -captioned property, which may exceed $5000. If any notice under Massachusetts General Laws, Chapter 175, Section 97A is appropriate, please direct it to the attention of this writer and include a reference to the above -captioned insured, location, policy number, date of loss and claim number. On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first class mail. Sincerely, Robert P. Blais Claims Adjuster Location `Y '�/ �/ JA /,'µ 5 No.� ° Date 2 y b NORTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ ,SIACHUSE�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ / Y TOTAL $ Check # / // 13597 f Building Inspector 9 Location NoDate TOWN OF NORTH ANDOVER Check # i 13540 i� Building Inspevor' Certificate of Occupancy $ �'�s'^•°' E<�' s�cHus Building/Frame Permit Fee $ Foundation Permit Fee rYr% $ Other Permit Fee $ TOTAL Check # i 13540 i� Building Inspevor' i.jv rb 10 U C-) vn ry) Cj /Y) Zr- A-j 74 U z a 0. 14 CA cn 77- C, I Z C L'i CA Vi mm; LD ME 1p r�6 v 4- 0 c Q u CH c c z z C -1z D zo v 4- 0 I z c Q u I z 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 SECT ION**�{*******�*t****t APPLICANT_ pe {&�— 1pj tc�'yq\e ky, PHONE LOCATION: Assessor's Map Number. PARCEL SUBDIVISION LOT (S)i STREET 7 / 2 f'v LeM t-' r � � sp jf (,Ifw) ST. NUMBER ******* t k***********************OFF 1C !A L USE ONLY***t**************** t************** RECOMMENDATIONS OF TOWN AGENTS: �` I V1-- CONSERVATION ADMINISTRATOR DATE APPROVED I p p DATE REJECTED a COMMENTS wQ�i'l (M�I.(� �' I<k tVUI TOIAIN PLANN COMMENTS FOOD INSPECTOR -HEALTH SEP 0 SPE VIR-HEALTH COMMENTS PUBLIC WORKS - SEWER/WATER C DRIVEWAY PERM FIRE DEPARTMENT K-e-QQrVl F RECEIVED BY BUILDING INSPECTO Revised 9197 jm _ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED Y DATE a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: C CtW i (IA,(,;) VIV Location: f O, 3U City t�Y\/Y4 Phone # � I am a homeowner performing ail work myself. F7I am a sole proprietor and have no one working in any capacity ® I am an employer providing workers' compensation for my employees working on this job. Company name Address � 0 kJU� SS 3 City' / Awd-y� A Phone #: In swT"C o g �oo. Com a riri rp,z c Phone #- Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can leadto the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the n ins and pen Ities/o�f erjury t at the information provided above is true and correct. q Q Signature f/ Date Print name )Pelf Phone # 6 0 3 bbS Official use only do not write in this area to be completed by city or town official City or Town Permit/Licensina ❑Check if immediate response is required Contact person: Phone #: Building Dept Licensing Board Selectman's Office Health Department 7 Other I �•; BOARDkOFBUILDING,REGULATIONS R License COtNSTRUCTION SUI?ERVISQRy Numbei CS °07c3482 Birthdate 03/02/1967` `' ? �M ` ,I `ttlEccplre�s 0 2002 Tr. no: 73482 'Res k -6d T'o: 00 TORN RAL MAIURI O ADMIRALS;4N SALEM MA 01970: ` Administrator: DEC -02-99 22:18 From:MCCARTHY CO 5086587208 T-293 P-01/01, Job -901 4wj" t -IMM E 11-K- I t; OF LIABILITY INSURANCE► - p Id � oArt (MMrnnm) PRODUCER CYRUS -1 12/03/99 THIS CERTIFICATE IS ISSUED aS A MATTER OF INFORMATION C r7 MOCarthy Ins AganNLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 229 Andover Street Inc.InaHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Wilmirigton MA 01887 ALTER THE COVERAQE AFFORDFD BY THE POLICIC3 BELOW. COMPANIES AFFORDING COVERAGE INSURED CO LTR COMPANY A Maryland Insurance Group COMPANY — COMPANY Cyrus Construction Corp. C PO Box 583 No Andover MA 01845 COMPANY THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P INDICATk�, NOTWITHSTANpINQ ANY REQUIREMENT, TERM OR CONOrrION OK ANY WNTRACT OR OTHER 00CUMENT VVITH RESPECT TO WHICH THIS cERnFIcnTE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E�(CLUSiONS AND CONp1T10NS OF SUCH I}OLIGES. IJMIT3 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY O(PIRAWN DATE (MMMWY) DATE (MWQD" LIMITS GFNFRAL LIABILITY GENERAL AGGREGATE $ 1000Q00 A X COMMERCIALGENERALLIABaITY SCP33993315 9H 10/01/99 10/01/00 $ 1000000 CLAIMS MADE OCCUR PERSONAL & ADV INJURY S 50000 OWNER'S & CONTRACTOR'S PROT AurOM00114 uA91UTY ANY AUTO ALL OWNED AUTOS SC HMUl_FD AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO E](GESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS UABIL Y A THE PROPRIETOR/ INCL xC098575351 99 PARTNERS)EXECURVE OFFICERS ARE., EXCL EL FAGH ACOIDENT S 10000 06/15/99 06/15/00 ELp1sFASE-POUCYLIMrr $ 500000 eLPIWF.ASE-EAeWLoYFg f 100000 BACHOCCURRENCE To 300Q00 FlREDAM rz(Anyowfire) Y 50000 MED w (Any ane Person) $ COMBINED SINGLE LIMIT $ BODILY IN.IURY S (PM pbr�n) BODILY INJURY PROPERTYDAMAGE S AUTO ONLY -EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGA7>_ $ EACH OCCURRENCE f AGGREGATE S yT 7}{ S TWORY tAlA17a °�ti'.. .... .. 7777 . EL FAGH ACOIDENT S 10000 06/15/99 06/15/00 ELp1sFASE-POUCYLIMrr $ 500000 eLPIWF.ASE-EAeWLoYFg f 100000 F N2 923 WATER SERVICE CONNECTION£- R. :vo ),.4,j3W 1:j� Yb i clil I N64 An-dovler,ass. A424L 9 --L-4.- v 4- r: Application by the undersigned is hereby made to connect with 'with, the town water main" I n Street, subject to the rules and regulations of the Division of Public Works. Street 91 Q q) t 'I The premises are known as No. �0"Ir - or subdivision lot no. -mw) d lis -i, IRA Owner',,Address • Contractor,' Address t 1z pp Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at Street subject to the rules and regulations of the Division of Public Works. Bar ?f P blic Works' By Inspected by Date See back for rules and regulations 8 TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 v'tt�eo ,af•ry 3�ye SOL p A7 TEo � .•�� DRIVEWAY PERMIT P Telephone (508) 685-0950 Fax(508)688-9573 Date:7777 2? °/ LOCATION: BUILDER: phone: OWNER: phone: The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: N2 0737 Date ........Y......`t;.....�� TOWN OF NORTH ANDOVER RECEIPT This certifies that ........ Pe.4�.r--�one.1•.............................................................. has paid .....................:.11?� Z., c�(� .........................................../..................... for ........ �f9sd ntZ....�....... .7 ... 52��t 45-1- ............................................. Received by .......................( G%Z.....1.1.!�` L�............................... Department......................(...oC...C:............0 .......................:.................. WHITE: Applicant CANARY: Department PINK: Treasurer Town of North Andover Planning Board This form represents the schedule for allowing the following lots to be considered as eligible for building permits under the Town of North Andover Growth Management by-law Section 8.7 of the Zoning by-law. Pursuant to 8.7 .5 this Development Schedule must be filed in the Registry of Deeds and be referenced on the deed of each of the lots below and be filed with the Planning Board prior to the issuance of any building permit or permit for construction. Name and Address of Applicant for Lots: Name of Development: Cyrus Construction P.O. Box 583 North Andover MA 01845 492 Salem - Form -A Lots Map and Parcel of Original Lot: Map 38 , Parcel 2 Date of Application for Lots Division: December 4, 1998 Lots Covered by this Schedule: IA, B, C, D The Planning Board by their signature below, or a signature of a duly authorized representative, do hereby establish for the above named development the following Development Schedule for the purpose of Section 8.7 of the Growth management By -Law. The applicant, their assignees, successors and or suhsequent property owners shall conform to the following schedule that limits the eligibility of the following lot:: for building permits. This form must be filed in the Registry of Deeds by the property owner or representative and be referenced on each deed for each of the following lots. Such deed reference for the deed of each lot shall at.a minimum reference the book and page in which this Development Schedule is filed and contain the language: " This lot is subject to a Development Schedule pursuant to the Town of North Andover Zoning By -Law all owners, representatives, and future purchasers should avail themselves of said restriction by reviewing the approved Development Schedule ns riled in Book insert here and Page insert here. The fact that a lot is eligible for a building permit is subject to the limitation of the number of building permits per year pursuant to section 8.7.2.d of the Zoning By -Law." The Planning Board hereby schedule the lot(s) for the above development as follows: Year Eligible Number of Building Office Use Building Office Use Lots Eligible Date Lot Eligibility Notes Completely Utilized 1999 1- r , _ 1 Signature of Plannipg Board tnembec:ar.ni: rized Representative 1.4 11-2- -IV, VDate l Signature of Property Owner or Authorized Representative 7 Date —' w•.rr Jul' • COWLIANCB Pj3mT • tts • EnergV Code OP PIANS: ' I IfR0.7 s TIow Ali■/7�[/'�T�{POiM AT[/IOO,,N■/:,UxitubO �IAIKB: PASSES ,ed� IIA• _ 330 Your 'Hasse _ 308 Asea• ' or I nsul Sheath Glazing/Door Perimter R -Value R -Value V -Valve QA. t; �'.`••;.� --------------------------------- ---------------------- ...-.. 1 988. 30.00.0 35 =' flood grstme. 16" 0. C .1812 15.0 3.0 121. IMGs • RjAdows or Doors 176 0.500 8$ �'xss: 60 0.280 17 Over conditioned Space' •988 19.0 47 --- -------------------------------- &C WEATMiNAT: Theproposed'•buildiag• design r��pra�sentod i.n: thase aomietent with tbo buil&nig;. ...VPArAf icatj o= O' ; mthd wt ber . :.;►' b�:ci lat o '•mubmittO with- thetfoda;; `.Tli <proposed'.bviilding•' }4 ; 'has' h ill• :de9igned to'. meat the s: O� :tip : t�kis�ichuset� s Bmrgy : Codi tha .cosi .. l4bw ;•`i t t Ilse he8iti ag • load . Por. this building, a 6". ing • f : appropriate has beiio •' determined usi n,�g tba ,applicable Staioicia d' Dis1gn Coaaditiosis found the :L6de . • . The E#AC '. equipM63t . selticted rto •:heat ' or': cool the building greater. than. i2SV of • the;:'d Qigci': load as' 'XPWC3,fied in � ' r• ;ecti! oiYts :78kW 3.310 and 44.4. Datia 13. Id6i/D®ai9aer 978250 3761 of PIPM. 02 {I� }r �. �lyr . I - 1 , ; t } n �� ± - .. ``�,t`+! U• ��. 9,� - _* ` I ,. F - J .,e�x i; }. - t i � t . s : � { r. 'i 'r34 #,���. s s S •, 4 t 7 41. 1r.. i }'1 t` •, 4 41 r t. L �ZF•4firrla# i � irl! }} }t , e �rZ,'R • F �- ` 1- 1 i T�t7;► s °Lr -s :ay a'r��•• .7�• iFp'r � r •1i• , r s-. + r .�'., ` �+. sY sm. ��� f JT � i S, Fri{ ;f i•' ps' 3 �r r �n"�i t � .,.I 1*'- 5. ' � f�`3 v� 1ti �. .. - f' �� :i• �l ,} , Y a 1 J i.�N�'c.. r•t - .+ ; 9rr t .7. .3• rys r�' [1 44t{S{+r-� i' :..'iSyt�i• •t� '' � y�s ' L• li; `}n}' � 7 � 1_��i � �1/��1� • ii t }�. �1�, ♦�r .�Y..t�� 'I � • � � S t'}1G iE i• F �Y '' I`�}- ••��� ' f'� ..,,1l�'};��i'lf>i1l r.i�•l,+r_I (•.� - 7:1 f • J`*1 fjt. r• aC + .� + a jL Y sy ''Y�m�s`�. may`.} 8, Ll •� 44 r- �T .� /4���S(.1 v, ['�:•s��� .' �f��4 � }y.�. :.f'I -al;.r 1J ne��;-� }. }f 7 ..•'I JIM _ :�+ �'• yP i - Ffi r. Yl. , + 5 1.� • r t �]-� -Y li 1� ry i•� W-1 -�II, valup':a�0�i0 *�-/-I�+�Mwa, . ,���ttw.��. i>�� �: �" ���: ti(� yr•1..,,,7, 7, 7, i vi,:.�`N. .{ , •b\iiGi .Ret; y �. to Viz. !N`.St-F f S� �i/V�/R�7 Ael ,}e f}rr�S'' �- 7�'�� rn���D �•� {3 v /' ���p��Ly AA .r •r.` �!iTAlLAIi�7a • i. } �}' v !sY i`-ar �.`�t ;5 t ti bT at ° s , A1�S/ pmlt«rdtiro�, aid s8+ n .in sildi } . ,. iua itI.�4 gbr4' We", �i_ �GWYv� r 1agl�s• �� bs'� type =YC ��s�t � .' i. .Pr1IidACe . f 2'p®: V±A�iYitlii/il w f- G ���rZoi�'s r _sisr t..° �G x �E r r - 4r ]�� tih � 1 `� f r res :.4 1 )'•+ 'non vented framed i i -11; �. Y-`:�•Llattgs/: • 1�1is/ " and {�; rl - �Fi7a' a�iV�ii1V�• �, c.'�+�nl?;.rT}�- 7 Imtetials sed agiiip t m ,tvat ea l aac� caa • °be ��artai d. mvmti mvr,t� a 'for 811 iastsllsd z hest g sad �ooliag .:equipmoat �uaid�'�isOaC;,at�Y egnipaeat i#�8t ; be f rovided xasulAtio�t R 'val"vid`��:b:ipg.:II '�iv�es� sit :. be cieaarly ' coo►:: thei.ldiag�plfcil3oatl�oane 0.1 ; t;- -� <DuCCs:.1A u�teoa�ditioaed e�Ys�am�nsti be faneulsted'to R 5. • . ' ' .D¢4t . outsi& ale.A3 I' bttZldi 'J. #b�15 ted ��!!�y����I�� .,. � L t�/.1i*�s �M.IQQ�f��f ��y-� L_.—�_,r�-• �l Yv iA M-.. F �IY VM 10. d' �.LYiVYtij•'� j�♦I• Y•Y� ts" j :dam y S. + 86=M . Y �= VIL'• t MW►M� �. y y <. y S.; s 1-4 � t- 1 �t ;K.r T`+ {j 1} "s'`f; 'a.:Sk{^' .; Sin f,�:+Kx •f�:t 2 �� : �ti t ' ' ..,rc L r . - vv • ♦ . w .. a •.1. r IV ..ars '" - -♦ .� � J 1 V 1 T7 1 V 1 V 1 V • d 1 W►!r/f J irI 1 • t/'T/ �/'7 ./IY i•IS� J9L•i • P.W 1. COWM LS .- Tbesaoetat ar. s+egnired for: each: Sapaxate .IV system, A 1 or 8a¢tomatio means to paistia�].ly .rrotrzct ..'oi•'DhUt . off the. heating. and/or coaling Jgwt to each tone or floor shall be provided. ' avj►c �_ sigzmG: l Rated output capacity of the heating/doling System is not greater than 125# of tha design load as specified ' in seetioins 780C"M 1310 aad J4_4. 1 ' MISC R84UIRBMENTS : 3 Retot to 780 CMIIL..Appead3,�c J for requiresente s�elating .to swimeaing poo18, KnC piping conveying::: fluids: above 120 F::*& chilled fluids balm► 35 F, and circulating hot fttar aystems . TO FIM {Building IIse Only )------------------------- ' •• - .. is � 1 1 ! 1 I � f i . i + :a ! 11 1 1 ! 1 I � f i . r TOTAL P.04 978 250 3761 PAGE.04 �wic TOTAL PAGE. 04 Mall �ttoo a3 Ya b 35 a a 3 0. <3 36 (00 g 4 o a 6 '/,3 1 D 4 D 3� FI i g ;4,3 (o 35 I o D I yl _ I 3b" a«-r��z� 70 iso (-P) �m`��S�f�V1"I)SSt ja n� G sYnASs Lh�clC �lN,er�y/ jZ�e6Jmr' t� �N l rci q f --C f 's'e w e r L `gym S a a . 3 ��{- ! ..5 ° 0b a -- Q I Professional Land Surveyors 8 Civil Engineers ESSEX SURVEY SERVICE 1958 - 1986 OSBORN PALMER 191.1 1970 BRADFORD 8 WEED 1885 1972 PLOT PLAN OF LAND LOCATED IN MASS. ZONE: �'� LOT AREA: f,;; IAT FRONTAGE: FRONT YARD: �.- SIDE YARD: REAR YARD: , SCALE: ✓ i DATE: REFERENCE . BiC PG ii- I !�• � _ l I hereby certify to the,' Building Inspector that. the pro- posed construction shown conforms to t nsional zoning of MASS. 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Y r. x � �' � � i vai a\ 1. r ti} 1 � R 9� � � F ii v,�r wx S H >iv t J+ n rr �°.:�,�"4i V Y`'" •e i { 1 4z.�� A<t � : t, • ?* s r�il }� �r � ti 'I , d. , � t�iY `�,�,t„ F'�r t P�w �-"Cyy+ '4i1( 4. , �4{S f. t . ��' Y� a f r • �� i.�n'Ffe� � fs �I��a"*.•y:�3'r�r, '��: Y,. :, k:;f "t .- t. a �:.., s�,ini.: 3..P �. ,,^ . t , ;Ti ` r h.. L• a e Sm? m ■ la C4 K Imm 9 0 InA Zvi' 12 A'k ire on vVyLcyn-, oil, Al .......... I 12 A'k Pel oil, Al I 33 51 ......... pORTN TOWN OF NORTH ANDOVER py ao ,e,�OO p PERMIT FOR GAS INSTALLATION e This certifies that /z .......... • • • • . has permission for gas installation : _°G• l • . ................ rb in the buildings of .......—:- ................. . at.... , North Andover, Mass. Fee?....... Lic. No,%r 7 ...\.. -!mac .......... I �// `—GAS Iv PE R j?fWHITE: Applicant CANARY: Building Dept. P Treasurer MASSACHUSETTS (Print or Type) s V N. UNIFORM AP011,11CATI OR PERMIT TO DO GASFITTING e . Mass. �/ Date A Ld Permit # Building Location 4/ 7 c Owner's Name Type of Occupancy NewA Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name y cr'K� Check one: Certificate Address ;z % % � !T✓/i�a3G� ri Corporation ❑ Partnership Business Telephone d 93 8f.3 x'.33 ;7- ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter vC , r/ -'LL -y' INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ;9 No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy Y Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's 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 the 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. BY TY00 DKicense: r 11215iumber �gnatureol LicensedHumber or Gas Fitter Title titter 7 Pter License Number Jou City/Town rneyman N ¢ W a Y Z S Vf F N U ¢ F Y ¢WJ O > NFZ" 2O f2W- O Uj JWR a O a W O �; z a O UWA o > W F- U1 V) W Uz N< W O O to2 a ,W > W 7 — < ¢ a < O O W O SUB—asMT. BASEMENT IST FLOOR _ 2ND FLOOR 3RDFLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7THFLOOR 41+4 I STH FLOOR J- I- t 11 1 J Installing Company Name y cr'K� Check one: Certificate Address ;z % % � !T✓/i�a3G� ri Corporation ❑ Partnership Business Telephone d 93 8f.3 x'.33 ;7- ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter vC , r/ -'LL -y' INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ;9 No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy Y Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's 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 the 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. BY TY00 DKicense: r 11215iumber �gnatureol LicensedHumber or Gas Fitter Title titter 7 Pter License Number Jou City/Town rneyman Date .� �. • �d N° 4313 TOWN OF NORTH ANDOVER a ° PERMIT FOR PLUMBING a _ s -%-;� .................... I This certifies that has permission to perform ......... q . plumbing in thebuildings of .. �� ... �. ...... . at .�!'..... �.G`Y .. �... North Andover Mass. N Fees 5.4 ..... Lic. No.. ��jj,,-t......... . PLUMBING �ZECTOR lAq �- WHITE: Applicant CANARY: Building Dept. PINK: Treasurer rf MASSACHUSETTS UNIFORM APPLICATIO FOR PERMIT TO DO PLUMBING E \ (Print or Type) Mass. Date -1 Zj Permit # 15 Building Locatlon 41 77 C2Ali &--,Owner 's Name Type of Occupancy New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES InsWIing Company Name? ""� Check one: Certificate Address �` % e4d.. /A&I !'✓ a3 G3IP j�Corporation ❑ Partnership Business Telephone �93 Firm/Co. Name of Ucensed Plumber INSURANCE COVERAGE: I have a curreW liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yea in No ❑ If you have checked yo. please Indicate the type coverage by checking the appropriate box. A liability insurance polcy )01 Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ ure of Owner or I hereby certify that all of the details and information I have submitted (or entered) in above application aro true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will W in compliance with all pertinent piorisions of the Massachusetts State Plumbing Code and Ch&pt@4 142 of the ner Laws. By gnalure of Licensedu r Title Type of License: Waste( � Journeyman ❑ City/Town L Ln. Number Z N N H N Z 0 Y Z F Z j W h W W Y J W U < N D V W ¢ ¢ ¢ ¢ �` 0 — W r— W 0 h- U W N Y < W — — < 0 = O 0 M Q { ¢ in CC `j O Z S Y Q. O t^ h- < U r > F' O v) 0.0 N < F- O Z O J O N < __ ¢ ¢ W ¢ < 0 0 U < = < < Z < < 0 SUB—BSMT. BASEMENT IST FLOOR Z %✓. aNO FLOON 3RO.FLOOR 4TH FLOOR STHFLOOR 6TH FLOOR TTN FLOOR 9TH FLOOR EM 11 InsWIing Company Name? ""� Check one: Certificate Address �` % e4d.. /A&I !'✓ a3 G3IP j�Corporation ❑ Partnership Business Telephone �93 Firm/Co. Name of Ucensed Plumber INSURANCE COVERAGE: I have a curreW liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yea in No ❑ If you have checked yo. please Indicate the type coverage by checking the appropriate box. A liability insurance polcy )01 Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ ure of Owner or I hereby certify that all of the details and information I have submitted (or entered) in above application aro true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will W in compliance with all pertinent piorisions of the Massachusetts State Plumbing Code and Ch&pt@4 142 of the ner Laws. By gnalure of Licensedu r Title Type of License: Waste( � Journeyman ❑ City/Town L Ln. Number z r z w v m 0 -1 z IA u x m m r O O m O In T A m c W m O z r -c 7D t O Q G m A u Y i w a O rn z O z O S 9 = m O � L D O v r c L m z Q m m r O O m O In T A m c W m O z r -c 7D t O Q m u u i w a rn O z IA CERTIFICATE OF .USE &OCCUPANCY Building Permit Number 51� Date �b 0 THIS CERTIFIES THAT THE BUILDING LOCATED ON MAYBE OCCUPIED AS --1)(1Ve AvOl/ IN ACCORDANCE !E)(Zm wt S - a ala t3D F_ l2 WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO/�SU�J��� p ADDRESS �6) J301 `�g 3 ''SACH „S�` Building Inspector ERS W i 0 7 A _ C CO) y W C 0: m cc 0 'ave m L :ymC m e1 r = o cm c m m O � cs y Z cc cm .)L:co.o c ►- m�ymc c ¢ o ®= 3 N o % cc c a y EL=s Z acLLI •E 0-0 tma .y o U o oo� c g COO) a mo . CO) cc yl� M 10, s O oo W i CL CD i}d C O co 0 _m CL CO2 O cv .Q CO) C O V CM C O aC M� =MM W W 44 I� s. Cl.uj L W W ii1 m UJ = LU 0 .) LLJ U) W W Ir LU LLJ G . Cllb �- w :�:%j . .moo o ` CA uv� w O w z u o a CQ a G p, G "a w q o r� V) C/) w° V) w° w" y.. 7 A _ C CO) y W C 0: m cc 0 'ave m L :ymC m e1 r = o cm c m m O � cs y Z cc cm .)L:co.o c ►- m�ymc c ¢ o ®= 3 N o % cc c a y EL=s Z acLLI •E 0-0 tma .y o U o oo� c g COO) a mo . CO) cc yl� M 10, s O oo W i CL CD i}d C O co 0 _m CL CO2 O cv .Q CO) C O V CM C O aC M� =MM W W 44 I� s. Cl.uj L W W ii1 m UJ = LU 0 .) LLJ U) W W Ir LU LLJ . Cllb �- : c 0 :�:%j . .moo o ` CA 40 d1: c aa. 4b:9cv m c C i y.. jai ts V O c E CL= m m a y m 3 y J C�D � 7 A _ C CO) y W C 0: m cc 0 'ave m L :ymC m e1 r = o cm c m m O � cs y Z cc cm .)L:co.o c ►- m�ymc c ¢ o ®= 3 N o % cc c a y EL=s Z acLLI •E 0-0 tma .y o U o oo� c g COO) a mo . CO) cc yl� M 10, s O oo W i CL CD i}d C O co 0 _m CL CO2 O cv .Q CO) C O V CM C O aC M� =MM W W 44 I� s. Cl.uj L W W ii1 m UJ = LU 0 .) LLJ U) W W Ir LU LLJ Town of North Andover %AORTR qti O ttteo �e Building Department �? 9t ; ,, 0 27 Charles Street o North Andover, Massachusetts 01845 * ,� (978) 688-9545 Fax (978) 688-9542 T ° COCMCNKK 1' T APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS / kerr t�J p @Ej LOT NUMBER A SUBDIVISION DATE REQUEST FILED G' 0�' DATE READY FOR INSPECTION C ' A FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE SJRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVA PLANNING DATE � I Q -E' IaOu D D.P.W. — WATER ITER CE - DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR T SPECTION REQUEST DATE. SIGNA'I"LTRE / DPW AUTHORIZATION