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Home My WebLink AboutMiscellaneous - 79 PLEASANT STREET 4/30/2018A M Date.. ...... 10633 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies. that .... to-�21— I .............................................. has permission to perform 4;�... plumbing in he ..buildi .s.o f .................................................... ............... .................... at, ...................................................... . NorhAndover, Mass. Fee34.. Lic. No.CNif. ....................................................................... PLUMBING NSPECTOR Check # MASSACHU41ETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY — o % Z MA DATE PERMIT # JOBSITE ADDRESS yr s OWNER'S NAME 7 fJi�. OWNER ADDRESS ..._. ( r�?. TELL 9 7F- 9 �/-%l,�', ... FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:E1 �, RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES Q NO FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 111213 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ... ... DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL .. WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER ou r a 0111 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND OWNER'S. INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accur to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be 9tt II ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I Richard Bymes Jr. LICENSE # 15435 ATU E MPSI JP[- CORPORATIONQ# 3498_. _. PARTNERSHIPQ# LLC COMPANY NAME Nurotoco 1 of MA d.b.a Roto-Rooter ADDRESS 175 Ma le Street CITY Stoughton �� STATE = ZIP 02072 TEL 781-297-7049 FAX 1781-341-8817 CELL 617-212 4589 EMAILRichard.Bymes@rrsc.com w z z 0 F U W a a d w o� z o w Wz W lL # cn W fri O Gz, W 3 N 0z a � w a � U J IL IL us a S W H LL W E� O z z 0 F U W a rA z U oa 0 a a x 0 0 0 a J .4cvRv` CERTIFICATE OPLIABILITY LIABILITY INSItRANC.E DATEIMWDD/9Y11yl,. /,7(2014 THIS* CERTIFICATE IS ISSUED AS;A..MATTER OF iNFDRAAA'�ION- LV AND•.CONFERS: NO:RIGHTSI.'UPQN'THE CERTIFICATE HOtt)ER.'THIS "'CEIiTIPiCATE 'dOES' NOT AFFIRMATIVELY 'OR NEGATIVELY -AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: 9 the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed H SUBROGATION IS WAIVED, aubJect to the terms and conditions of the policy, certain policies may hegWre an endorsement. A statement On tl>is certificate dose not confer rights to certificate holder in lieu of such endorsement(s);the PRODUCER MARSH USA INC. N nle: 525 VINE STREET, SUITE 1800 - PHONE F CINCINNATI, OH 45202 dN - N7_ Nok - AIM: cinc1ma0.certrequest®mamh.cam D E INSURERS AFFORDING 400RAGE NAS N 408-15: 00015 INSURER A : Ohl Republic h urmeb Co 24147 INSURED 5- ROT04MTMSERVICES COMPANY INSURER B: NlA WA 175 MAPLE STREET INSURER c : Midwest syn Casualty Corllpargr 23612 STOUGHTON, MA 02072 . INSURER D • INSURER E :• REq COVERAGES CERTIFICATE NUMBER:' CLE -00389229304 REVISION NUMBER: 3 THIS IS TO CERTIFY THAT 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY - SE ISSUED OR .MAY PERTAIN, THE INSURANCE 'AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BIER TYPE OF INSURANCE EFF POLICY EXP Y. A GENERAL Lu1811.1TY J POLICY MWZY80132 NUMBER uN11TS 0410112014 041011201610 EACHOCCURRENCE $ 2,000,000 X CONaAERC1AL GENERAL LIABILITY E7 OCCUR mra _ESWAow 750J t0wEXP. PERSONAL-& ADV INJURY S 2 === S EN'L AGGREGATE LIMIT APPLIES AOGREGA 6AO = APPLIES PER: • X POLICY P LOC PRODUCTS - COMEIOP AGO S 6,000,090 A . wuTOMOBILE LUIBILITy ANRB21957 001120*" • 001/2015 X s L 1 SAOOA00 ANY ACRO ALL OWNEDSCHEDULED BODILY INJURY(Pwpar" S AUTOS sway I, X AED 1NU Y HIRED AUTOS (PorncftmS . . � S 1 n UMBRELLA W1e LJ ' S OCCUR EACH OCCURRENCE EXCESS LIAS ' . CLASAS�AADE S 4 DED R AQGREGA7E S A WORKERS COMPENSATION S 0 S . AND EMPLOYERS' LMIL Y WC STATU• . 0TH - C ANY P.ROPRIETORIPARTNERIEXECUTIVE Y� M=301934 00 (T)) 04101/!M4 04/0112015 C' OFFICERNAEMBER EXCLUDED? N . NIA EL EACH ACCXIENT 9lrenmrory h NN) 6.(XS OH) 04/01/2014. 0410112015 p deacdbs under. EL DISEASE • EA EAWLOyEE S' 1,000,000 D PTIO OPERATIONS beraw E.L. DISEASE. POUCY LUT E 1,000,000 DESCRIPrIOJA OF OPERATIONS I LOCATIONS! VEWUM (Apach ACORD 701, Addldoft Remerb omefts, N mors specs b rtopdred) EVIDENCE OF INSURANCE I ICERTIFICATE HOLDER CANCELLATION ROTO -ROOTER SERVICES COMPANY 175 MAPLE STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE STOUGHTON, MA 02072. THE EXPIRATION DATE . THEREOF, NOTICE WILL BE DELIVERED 0Y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Nbrmh USA'Inc. Menashi Mukherjee SKanw•oo�,: �� 01988.2010 ACORD CORPORATION. All rights reserved ACORD 25'(2010f05) , The ACORO name and logo; are'reglstered_marke oiACARD The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 M Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatiorOndividual): Nurotoco of MA d.b.a. Roto -Rooter Address: 175 Maple Street Stoughton,MA 02072 Phone #: 1-781-297-7049 Are you an employer? Check the appropriate box: 1.0 I am a employer with 66 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 3. ❑ 1 am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no 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 11.0 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Old Republic Insurance Co Policy # or Self -ins. Lic. #: MWC 11826400 Job Site Address: Expiration Date: 4/1/2016 City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby_ fy_undler teins and penalties of perjury that the information provided above is true and correct. 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 be 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 Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 104 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE. Revised 7-2013 Fax # 617-727-7749 www.mass.gov/dia i >-6-0 CL (n a. 02 (n UJ CL C.4cn A V) ca co CON 6 v. Date.. . .... �j .. 09 ...... ..... ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING %�� C)C—,7e -atz M 91 � This certifies that ......... ............................ .................. has permission to perform.. . ............... R",wiring in the building of .../.. ....................................... at.2 ..................... N� And ver, Mass. Lic. No/27J2V ............... EL cT 1C Check # 11, i. Commonwealth of Massachusetts Department of Fire Services a BOARD OF FIRE PREVENTION REGULATIONS Official UseOnly Permit No.z/4�/ Occupancy and Fee Checked�� [Rev. 11/99] 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 IN INK OR TYPE ALL INFORMATION) Date: 10-30-08 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 79 Pleasant Street Owner or Tenant Shawne Robinson Telephone No. 617-821-6352 Owner's Address Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Box) Purpose of Building Dwelling Utility Authorization No. 573-1973 Existing Service Amps / New Service 100 Amps 120/240 Number of Feeders and Ampacity Volts Overhead ❑ Undgrd ❑ Volts Overhead X Undgrd ❑ Location and Nature of Proposed Electrical Work: Rewire existing Dwelling No. of Meters No. of Meters 1 Completion oft eollowing table may be waived by the Inspect r of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- 11o. rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number Tons . ... . 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 Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail it desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liabil- ity 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 X BOND ❑ OTHER ❑ (Specify:) General Liability 12\12\08 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 10-29-08 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties of perjury, that the information on this application is true and co Tete. FIRM NAME: STALCO Inc. LIC. NO.: 17519A Licensee: Signature Steven A ®Landry LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-459-9139 Address: 850 Lawrence St. Lowell MA 01852 Alt. Tel. 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 Signature Telephone No. PERMIT FEE: $ 35.00 , 12a" ))— / o— v8 f Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ...... ............................ has permission to perform . ........... ............. wiring in the building of ..................................... at ... ......................... .......... North Andover, Mass. Fee .......... Lic. No.17-�.29V ................ . a.. (LLE�C�MlCc iN.......... , * P**E*' Check # 8443 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Wash ington Street Boston, MA 02111 a -- www.mass.gov/dia Workers' Compensation Insurance .Afffidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leoibly Name (Business/Organization/Individual): S l 04 G C O T 12 C— Address: 4FFro L a....) r*- •i c e :5 T City/State/Zip: L a r r ,n4 a 18 sem,? Phone #: % 8- YJ'Y- 913 Are you an employer? Check the appropriate box: 14r! an a employer with -? 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. I 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 3. ❑ I an 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. ,J 'Remodeling 8. ❑ Demolition 9. ❑ Building addition 10:7 Electrical repairs or additions I I .❑ Plumbing repairs or additions 12.0 Roof repairs 13 -0 Other rr --••• ••• • -••� n . I—, --bu 311, uut me section oeiow snowing their workers' compensation policy information. + i imneuwners who suhmii.this affidavit indicating they- are du. , a:: cork ?i�,itf [ImUn hi, -outside contracturs must submit a new atndavit 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. information Below is the policy and job site Insurance Company Name: 7r K V 4! t -e r J X an 'r Policy # or Self4s. Lic. #: Expiration Date: / 2, 12 - O O Job Site Address:_? 7- T 4 P 1 e �. r • ,S City/State/Zip: �% /7n �D ✓er /7 k Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct ?1^ ys?- 913 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # /to -Jo-o B' 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 comps etely, 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 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 cavy 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 be 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 nurnber.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 permittlicense 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 Massachusetts. Department of Industrial Accidents. Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26=05 www.mass.gov/dia Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 10-30-08 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 77 Pleasant Street Owner or Tenant Shawne Robinson Owner's Address WORK Telephone No. 617-821-6352 Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Box) Purpose of Building Dwelling Utility Authorization No. 573-1973 Existing Service Amps / Volts Overhead ❑ New Service 100 Amps 120/240 Volts Overhead X Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Rewire existing Dwelling Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters 1 Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans TransTotal Trsformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- 11o. rnd. rnd. o mergency Lighting Battery Units N of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices Nal. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals:. Number �� Tons .� �� ..... 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 Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liabil- ity 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 X BOND ❑ OTHER ❑ (Specify:) General Liability 12\12\08 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 10-29-08 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and com l e. FIRM NAME: STALCO Inc. . NO.: 17519A Licensee: Signatur Steven A. Landry LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-459-9139 Address: 850 Lawrence St. Lowell MA 01852 Alt. Tel. 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 agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 35.00 a Iy • Date ...... J z -.. ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that /lam �' '' z `//.. ............................................................................................. has permission to perform � .!n. f` r ///,- `.. e-, // -<" wiring in the building of . �.. 7,7 inn ................................................................ s� �7 at ....... /....../....... , .......... ..... , North Andover, Mass. . 1 ........ `... '! Fee .2 °:.� '........ Lic. No. �. UTA. �j.........!�.L `.S� y......L../ ...................... ELECTRICAL INSPECTOR Check # 8183 .. vl -i CYSSaC11LtSetSL.cy Oficial Use Only Ulm Department of Fire services--��3 Permito. BOARD OF FIRE PREVENTION and Fee Checked 4UV REGULATIONSj r (leave blank --QPP_L.ICATION FOR PERM[ T TO PERFORM ELECTRICAL WORK accordance with the Massachusetts ��ode E Cj7 527 CMP, 12.00 &OR dAMN). Date: dDOVER / e of his or her ' To the Inspector of Wires: intention to perform the electrical work described below. Telephone No. cg permit? yes No ❑ (Check Appropriate Bog) Utility Authorization No. L$—'Volts Overhead rd UndgX10 Volts Ov� No. of Meters 3- — erhead o, Undgrd _ ❑ No, of Meters .cal Work: . 'ems IF0. C J.I 4r 11'" of lQ11—so-ii T.nminnirnc Owner/Agent Signatare o lesion. o the ^-Yl- n io. of Cea1.-,Snsp; (Paddle) Fans io, of Hot Tubs wimming Pool `� d�,e � �- d, ❑ o. of Oil B'aers n. of Gas Hzu-ners o. of Air Coad, otal A Ong �TotaisP "—er ons Space/Area Head KW Heating Appliances KW n. ofIV Na. of Si Ballasts. Of Motors o. lay be waived by the Inspector o ilrires t tformers Total KVA -afore KVA -Lm�encyZ,sg'�'--- ALARMS Nn. of Zones Of Alerting Devices nowA,ierfiaff Devices ❑Municipal Connedinn ❑ Other -No. of Dem ta Wiring: No. of Dei Total HP I Telecommum n No of Devices or Ortr Attach additional detail if desired, oras r Y0,),� L)o (y�� eguired by the Inspector of Wires. required by municipal policy.) , ections to be requested in accordance with MBC Rule 10, and upon .completion Unless waived by the owner, no hbilitY insurance includin"completedemit for the performance of electrical work may issue unless 1verage is in force, and g operation" coverage or its substantial equivalent. The bas exhibited proof of same to the permit issuing office. BOND ❑ OTHER ❑ (Specify ) knalhes. of perjury, that the inform ? / Jafion on this aPP&-mown is true and complete, Signature LIC. No.. license nu er line.) LIC. NO.: t7 e` Bus. Tel. No.: R7�'-S/a-S6os urity work requires Department of Public Safety�,S,,Lce�nse: Alt. Tel. No.: E'ER: I am aware that the Licensee does not have the IiabiIi Lic. No. below, I hereby waive this requirement I t' insurance. coverage normally am the (check one) ❑ owner ❑ owner's agent Telephone No. PERMIT FEE: $ V x f,' - •igSaCnUSSr.,- �cia1 Use oly Department of F% Permit No. � �e Services BOARD OF FIRE PREVENTION Occupancy and Fee Checked �% �� REGULATIONS [Rev. 1/07] APPLICATION FOR PERMIT TO p (leave blank PERFORM Ei ELECTRICAL All work ro be performed in accordance CAL WORK with the Massachusetts Electrical Code (PLEASE PRINT INNK OR TYPE ALL INFO (MEC), 527 CMR 12.00 City or Town of: NORTH ANDOVERION). Date: By this application the undersigned D ves notice of his or To the frrspeCtor of ......Fires: . Location Street her intention to Perform the ele & ctnc ( N al w umber) � � � %�.S work described below. Owner or Tenant„ Owner's Address Telephone No. Is this permit in conjunction with a building b Permit? purpose of Buildinci Yes No ❑ (Check Appropriate Bog) a �Ustino Service ) Amps Utiliy Authorization No. �)oas Overhead Q!3,—Undgrd No. of Meters New_' Service 200 fps %U l ,� o Volts Overhead Under d Number of Feeders and Ampacity ❑ . No. of Meters Location and Natore of proposed Electrical Work: rc 11 rY �Jlc. I No. of Recessed Luminaires o !-tion o f the ollowin table may be waived by the I ector o Wires. No. of CeiZ.,Susp. (Paddle) Fans No. Of Total No. of Luminaire Outlets No. of Hot Tubs Transformers KVA No. of Luminaires Generators KV A S Above e wnanung Pool �� in- o. o mergeney a � No. of Receptacle Outlets d. Batte Units n - No. of Oil B"u'aers No. of Switches F' E , ARMS No. of Zones No. of Gas BuLrners o. oction and a No. of Ranges Initis ' Devices No. of Air Coad, otal No. of W Tons No. of AlertingDevic erste Disposers eat ump umber ons es Totals: "" o. of elf- Contained No. of Dishwashers Detection/Alertin Devices Space/Area He,tmg KW Local ❑ Municipal No. of Dryers Heating APPliances Connection ❑ Other. No. of Water I� Security 6ystems: * if Heaters' KW o. of No. of Na of Devices or E uivalent Si Ballasts Data wiring No. Hydromassage BathtubsNo. of Devices or E aivent No. of Motoral Total s HpTelecommunications OTHER: No. of Devices or E urv�alent Estimated Value of a cal Work: `f 000 l9� 14ttach additional detail if desire4 or as reguired by the Inspector of Wires. Work to Start t (When required by municipal policy..) O Y ecfions to be requested in accordance with MEC Rule 10, and upon .00 letio n. INSURANCE O GE: Unless waived. by the owner no the licensee provides proof of liabilityPermit for the performance of electrical work may issue unless undersigned c Insurance including completed operation" coverage or its substantial equivalent The . gn certifies that such coverage is in force, and has exhibited proof of same to the CHECK ONE: INSURANCE ❑ BOND ❑. OTI ER P ") Permit issuing office. . I certify, under the aims and penalties. of perjury, that fire (Specify-) FIRM NAME• inforneadon on this ? �J \ aPPation is true and complete Licensee: � �� LIC. NO.; S�gnatnre (If applicable,�ent� "exempt •' in the license er line.) LIC. NO Address: �,t a v *Per M.G.L c. 147, s. 57-61, security work requires D t^ .0 N 1� Bus. Tel. No.: �i gZ S 2 _ j-04 OWNER'S INSURANCE W Department ofPubIic Safety "S" License: Alt TeL No.: AIVER: I am aware that the Licensee does not have the liability Li.c. No. required by law. By my signature below, I hereby waive this re Ty iasurance coverage normally Owner/Agent gement I am the (check one) ❑owner Signature ❑ owners agent Telephone No. PEIs'M1T FEE• T �`` � � ` �r, r ti r 1 V b P' t 4 c t M *W The Commonwe alfh ofMMachuseft ' DePartnrent Of ftidWtrial ACCideft QJTWe of Investipti"'. a 600 �Yashin,�on Street" Boston I• � , M.4 g2_111, Workers' Cam easaiion insurance W A iAff�tia�viafir�Egnaivl/ddeirns lCoa .iant Information tractors/EiectricianslPj®hers NPlease Print Leeib ame (Business/Orpsiza{ioNIndM6tmi); a f Address: v o+nc�e�foS� City/Statemp: (. . \� Phone A. 4 ?�'- S�l � � ci 6 eta Are you an employer? Check the a •I. ❑ 1 -am a employer with PP�Priate�boz: • em io ees T* -df (required): Du F Y (full and/or .. ❑ I am a genua! contractor and b .. Project : 2• I am.aso}e part-time),*.. have hired the w&aunnactors 6 ❑ Now construchoh `fr PTOPn� or Pwtner- listed on the attached sheat 2 7. itemodeling S ip and have no employees These suii•.contractors have working for me in any capacity, work 8• Damoiitiom �° workers' comp, iasuranue 5. � comp. insu Insurance. 9 required.) ❑ OJe are a corporation .stat its ❑ Bwlding addition 3. ❑ I ain a homeowner °�� have excrcised their 10.� ectrical repairs or additions doing all work right of exein on myseI£. [No-work=comp, .2. Pn Pw MGL1 § 1(4} 'and we have no 11.0 Plumbing repairs, or additions insurance required,] t .employees. [No work=, 12•❑Roof repairs comP• insurance requirectj. 13.❑.Other t �Y apptim t that checks hoe #'"I muni also fill out tfu section blow eh� , • . t Homeowners who submit this afi'tdavit indicating they art lain an wo wing their workara compensation old Contrt:ctots that rheak Chia box mustat� g tk and then hire•oaaskie conttaetors p mfomution s chad an additional sheet showing the ttarrte of the sub, must submtr a new afidavit indicating such. I net emPa thar.is C0° and their eorkes' comp. policy iniemtefion. } �rornding:workers co, rtcatfa in orrnado2 mP n irrsw=Ce for eery. mFloyam Below is. Pommy mid job site • Insurance Company Name: ' w Policy # or Self --ins. Lic. #: E�pirziion Date: Job Site Address: Attach a copy of the morkers' cum C*/Stato2ip: Potion policy declaration (840 win to secure covera c as P ( a'lag the policy number and expiration dst4 g required under Section 25A of MGL c. I52 can lead to the imposition of criaiinai fine up to S1,500:00 and/or one-year imprisonmen as well Of up to 5250.00 a da '' as civil penalties in the form of a STOP 1N0}� O penalties of a investigations Y the violator. ra advised rant a copy of this statement may be forty ORDER and a fine gations of the DIA for insruarice coverage verificaticnI. y arded to the Office of 't do hereby nder e p and penalties a lP�i tfiar the informadon Provcded is Si teue and correct Phan Dates 1 s' %:o S fifficial use only. do not write in lids area, to he co fat mP edby city or town offCW City or Town: Issuing Authority (erste one): ` c• PeriawLicense 1. Board of Hearth 6 Other 2- Building Department 3. City/Town Clerk d. -El ectrical Inspector S. Plumbing l b ffipectnr Contact Person: Phone#: Information and Instructions -' Massachusetts General Laws chapter 152 requires all emp )dyers to provide workers' compensation for their ampioymes. 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 writtm%" An empinyer is defined as "an individual, partnership, association, corporation or other legal entity, or any two ormore oftint%mgoing engaged in a joint enterprise, and inoludireg the legal rapresentatives of a deceased employer,, orthe receiver ortnistee-of an individual; partnership, association or other legal entity, employing empioyees. 'However the owner of a dwelling house having not more than three spas-tanents and who' esides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repw wk on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an etnpioyer." MGL chapter 152, 52SC(6) also states that "every state urn- local licensing agency shall withhold the issuance or ' renewal of a license or permit to operate a baseness or to construct buildings in the commonwealth for any Applicant who has not produced acceptable evidence.ot compliance with the insurance covera„ae required" Additionally,MOL chapter I52, §25C(7) states "Neither the commonwealth nor any of its•polifical subdivisions shall i enter in a any contract for the performance of public wort-- tintil•acceptalilc' evidence of complir-rrce with the insurance requirements of this chapter have been presented to the cardracting authority." Applicants Please fill out the workers' compensation• affidavit compl a teiy, by checking the boxes that apply to your situation and, if necessary, supply sub-contructar(s) name(s), addresses) aand phone number(s) along with .their certificate(s)' of insumnce. Limited Liability Companies•(LLC) or Limited Liability Partnerships (LLP) with no.employees otherthan the members or partners, are not required to carry workers' ccarnpensaiion 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 confnmation of insurance coverage.. Also 'be sure to sign. and slate the afdavit The affidavit should be returned to the city or town tarot the application for the psi{ or license is being requested, not -the Department of Indust ial Accidents, .Should you have any questions regarding the law or if you -am required to obtain a workers', oompensation policy,:plcasrcall the Department at the nurnber. listed below. Self-insured companies should enterth= self-iFrsraance :iieenac number on the' appropriate iirtc. City or .Town Officials Please be sure that the affidavit is complete and pr nted.leglbiy. Tire 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 wiII be used as a reference number.. in addition, an applicant that. inustsubmit muliiple.permit/license applications in any given year, need only submit one affidavit indicating•current policy'infonnafion (if necessary) and under "Job Site Address" the applicant should write"all iocations in (city or town)." A copy ofibe affidavit that has beca officially stamped or marked by the city or town may be. provided to the applicant as proof that a valid-affudavit is on file for f mrt m permits or licenses. A new affidavit must be filled out each year. When a home owner or citizen is obtaining a license or permit not related to any businew or commercial .vmntum C.e. .a dog license or• permit to bum leaves etc.) said porsan. is NOT required to•.compiete this affidavit The Office of Investigations would Iike to. thank you in advance for your eoopi: a on and should you have any questions, please do not. hesitate to give us a call. The Department's address, telephone and fax number. Rsvised 5-26-05 The Commonwealth of Massachusetts Department of Indnstrial Accidents Office- Qf Investiggsf ins " 600 Wash.irtgton Street Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-977-bC SSAF£ Fax # 61 7-727-77451 wufwmass.gov/dia V( 'Y l -J PO Box 994 Andover, MA 01810 October 24, 2008 David Lanzillo, Electrician 30 Ponderosa Dr. Townsend, MA 01469 David I'm writing to terminate the electrical contract for your services at 77-79 Pleasant Street, North Andover, MA 01845. This termination is effective immediately. If there are any questions regarding this matter, please feel free to give me a call at 617.821.6352. Regards, Shawne D. Robinson cc: Town of North Andover — Office of the Electrical Inspector II IL I @ U 1 v O^ O II N III C •r O II r II II II ,,fL I N II R II II 6A 60 II E9 II r p I II 11 II O II O O II d II O II 4J II II 41 .-r CL c GC •L N I I r O I. ® I I O O II W Z O 11 m .r V rY@ II O > Q II S @ N II D W E II N .- O to N E O m II 2 N II Q Cn II m@ ++ r ce) O II 2j II '- Cn C7 M II O W II 11 @ Or ....� O �`! II U N •r d In II O @•r 117 d) II O IIQ 41 f Q) N O) 11 2 II Q co 11 O L tj •O (UD co r O it r Q) Oe „ nIJO II N 11 N 0 L O•r �}O O I I II + II 0 11 U •, I 7 L W L e- 1, C cD L '- 4 II i ! . COCn � m.O ++ 7 mN m II N IIi Z QI •N r L 4- .p 0 11 OII 0 00JOVCe_1� iaLO ! N Location No. -YJ U R� ttx�,U7- .ST Date 0 NORTH TOWN OF NORTH ANDOVER �,"`o- , • 1 BOOL p Certificate of Occupancy $ Building/Frame Permit Fee $ y+s MU Foundation �� Foundation Permit Fee $ ther Permit Fee $/0.00 Se�J(r ection Fee $ 4e�Wer ConnetU/Fee $ Nv TO& 199, $ /-22, D D Ana°��r�/ Get CSP CO3f Building Inspectof Div. Public Works i% ': ERIfIT NO. 5�3� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAj 4.10. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO.I LC CATION 7f PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRES9 BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME I SPAN DISTANCE TO NEA ST 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 PAGE31 FILL OUT SECTIONS 1 - 3 tk 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 -/i/ ad RE OF OWN AGENT FEE ,Qa�2') PERMITAN ED Q 19 Jam/ 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 7 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 BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE B 1 2 13 CONCRETE BIL K. BRICK OR STONE HARDWD PIERS PLASTER DRY WALL _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/4 1/7 1/1 FIN. ATTIC AREA _ N_O BM'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 ASPH. TILE VERT. SIDING _ STUCCO ON MASS' RY STUCCO ON FRAME BRICK ON MASS RY ATTIC STIRS. & FLOOR _ BRICK ON FRAM CONC. OR CINDER BILK. _ _ WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR POORNE _ ADEQUATE NO 5 ROOF 10 PLUMBING GABLE GAMBRELMANSARD I HIP BATH 13 FIX.) TOILET RM. (2 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 II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. _ STEAM STEEL BMS. & 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_ ELECTRIC tat 3rd I NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING ,ORI OF o� Town of n NORTH ANDOVER DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 120 Mein Street North Andover, Massachusetts'()184! (617) 685-4775 In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. z N w ?1 m 21 (a m c s n m O � H rm c l � m=n � Z Z O a Aim �m � �� c W N ° � o y n � z n C6 z n o � > C) rri S a v O PO� sop V1 cps. , 10A M _ h A O � o , n rt A Q O e) :: A 3 A A C• 0 th z a A r_► 0 ' O 0• NA (a N w ?1 m 21 (a m T M n m � c m=n � ro °m Aim �m � �� c W o z n o � > C) v O M _ O , n O e) 0 0 C I crzi