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Miscellaneous - 81 CANDLESTICK ROAD 4/30/2018 (2)
'1 � 0 Y �� / N O � � � n D D o b m o � � n o � O 0 0 Date.... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING S US This certifies that ...... ............................ ............................. has permission to perform ..................................................... wiring in the building of ... e. ...... . a'.....a .. . . . ....................................................... .......... at ..... North Andover, Mass. .................................................... \ ..... Fee.:! ............. Lic. No��?F ......... .. ...................... ELECTRICAL INSPECTOR Check # 5299 N Date .. '....'? . ° ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................................• - l fA . s has permission to perform ..._.< A.r. -t ................................................ wiring in the building of ............. ..... .... , North Andover, Mass. v.- �?'0 7.5e1 Fee, :.................... Lic: No�.............. .............. ::,_.......... LECTRICAL INS Check It 8297 A Commonwealth of Massachusetts Department of Fire Services BOARD. OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. ��n4 Occupancy and Fee Checked `fig'- es [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -IAsI Y 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) A/ ewt sf�ctt . Owner or Tenant pc4cr 9 C.%,-) Telephone No. g7F �Ir�z � cif Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No [?' (Check Appropriate Box) Purpose of Building ;011( / Utility Authorization No. Existing Service 2oc Amps ;.Zv l 21/6 Volts Overhead ❑ Undgrd New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work:�`Q r- As 416 lu k?4 �A-1 sAe -0-4tYt, 4 Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. ❑ o. 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: 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. ., Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: i J9t 6 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE []BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enalties of perjury, that the information on this application is true and complete. FIRM NAME: It , J, LIC. NO.: CSC SS -0 Licensee:?Signature LIC. NO.:���� (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: �_;�=j73 .�Oy/ Address: C�71 -�&J' i.i 2 77 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ —?d Signature Telephone No. 1 0 r,.j kc, 9 - � 9-86fr P,� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 °' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �! `%i�� r S� �r� �.se 29 City/State/Zip: i �.� 1�� Phone #: 9;?y - V,? _r - S, -,o y/ Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I mployees (full and/or part-time).* have hired the sub -contractors 2. am a sole proprietor or partner- ZI listed on the attached sheet. $ 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 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.[ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. r Insurance Company Name: 5� l �S4 ilZirt�' Policy # or Self -ins. Lic. #: Expiration Date: Pei. e +% Job Site Address: trf ( /crj f�r S¢tlt P) . City/State/Zip: -&- IIA4e ter 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 pens ies of perjury that the information provided above is true and correct. 4 Si ature: 9 Date: S Phone #: 9 7! - Y13 Vii?i 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 M THEMWONWEALTHOFMASSACHUSETTS Office use only DEPA1ZrA1k'NTOFPUX1CSAFMY Permit No. b 97 BOARDOFFREPREVEMONRWULWONS527CMR12.VO Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address i /TI�V/. Is this permit in conjunction with a building permit: Yes r7TNo F-1 (Check Appropriate Box) Purpose of Building ��,� `t /' �O Utility Authorization No. Existing Service Amps / Volts Overhead M Underground No. of Meters New Service Amps / Volts Overhead r --J Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work z4v1r, 70 �%C� L No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. of ;. ishwashers Space Area Heating KW Np. "of Sounding Devices N4.W Self Contained Detection/Sounding Devices No. of Fryers Heating Devices KW Local MunicipalOthe -, Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP THER- guar Coverage PmiintodlemgtmmynNofDla%achuseMGffaalLaws ave ``amentliaMtykn r&=FblicyinchxNWCompl�eCovaagaoritssubsgnrialagrmlerd YES NO ave �1mr�dvalidpreofofsametot Oflim YES u r ufyuuhawchai®dYES,pleaseindcatethetypeofoovaageby A I the bo. u L ---J �SURANCE OND F1 CUM r7 (Pkasespa *) c�Expilationn& Estinpxktostatt /D % oG/ h onDateRegt�d Rough /o—/�s05 �dvahaeof alwoik $ Final redurxlex of - Xy.q :MNAME /lC l C er�� l/Gi�'+t L �� i''/G/a h Ii=eNo. !n'1jCe k(a ,9 �X Aga SignatureF�i�>��; ��� �r LiwNo BumwssTelNo. 61le` s� �N'I �S� v � c/ �/Ylf% ®/ % � A1tTUNo. i NN R'S INSURANCEWAIVER;IamawatethatdrldcmsedoesnotIm-ethe msur =covemceoriC;a alapvalentasogmedbyMassachusenG=alLaws thatmy sigi-ikmon thispen-dt application waives dh ss Ieqmm)att :ase check one) Owner ® Agent ® Ll'��/� Telephone No. PERMIT FEE $ Signature oT Owner or Tgenf The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I 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 City: Phone #: Insurance Co. Policy # Company name: Address City: Phone #: Insurance Co. Policv # . Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment -as -well -as _civil,penaltiesinfheformjofa_STOP WORKORDER..and_a fine.of_(.$1D0..00)_adayagainst.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name P.hone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required C] Licensing Board r-1 Selectman's Office Contact person: Phone #. Health Department Other Date.f 1 ` �� •:T.�tio WN OF ORTH ANDOVER y 3j �a N, ..... _ • OC PERMIT FOR PLUMBING 41 wed ,SSACMUS� This certifies that ... Y..G j (.- ..... !. 1` ........ -4has permission to perform t— plumbing in the buildings of . . ....... ........ . at ... G ............ North Andover, Mass. Fee.Lic.No../.i.S.t!.. ..... ........ PLUMBING INSPECTOR Check # ) U 6132 �SSACHUSE� This certifies that ........ ..... . has permission for gas, ins ilation�:' 1l in the b?uil ins of at ./` Y L� .../� L'' ...... , North Andover, Mass. Fee. Lic. No.. AO/... .......................... GAS INSPECTOR „ ,Check # 711,) / 7 114807 Date.... ... .. . f NORTH 1 l 3� �` °'° °� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �SSACHUSE� This certifies that ........ ..... . has permission for gas, ins ilation�:' 1l in the b?uil ins of at ./` Y L� .../� L'' ...... , North Andover, Mass. Fee. Lic. No.. AO/... .......................... GAS INSPECTOR „ ,Check # 711,) / 7 114807 5 `1 .10 .--- 1 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FPITING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations �( Lz��P-S�71 cg Z/V . Permit # Amount $ Owner's Name ��%�e!/ `��✓ New Renovation F1 Replacement Plans Submitted ti 0 (Print or type) Doyle Plurnbing & Heating Che;one: Certificate Installing Company Name nn n �c,�aea..n, ReeCorp. Corp.900 Address Boxford, Massachusetts 01929 E] Partner. Business Te ep one IYV 19 —,yI. 7 g�f' Firm/Co. d ■ Name of Licensed Plumber or Gas FitterSe��� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity 13 Bond 1 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 0 i hereby certify that all of the details and information I have subimtted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations E50?rmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stot6",$ Code and CAaptem*-c�f the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) S b at e of Licensed Plumber Or Gas°Fitter ® ber ® Gas FitteriL ense Number Master Journeyman • •4TH. FLOOR FLOOR (Print or type) Doyle Plurnbing & Heating Che;one: Certificate Installing Company Name nn n �c,�aea..n, ReeCorp. Corp.900 Address Boxford, Massachusetts 01929 E] Partner. Business Te ep one IYV 19 —,yI. 7 g�f' Firm/Co. d ■ Name of Licensed Plumber or Gas FitterSe��� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity 13 Bond 1 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 0 i hereby certify that all of the details and information I have subimtted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations E50?rmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stot6",$ Code and CAaptem*-c�f the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) S b at e of Licensed Plumber Or Gas°Fitter ® ber ® Gas FitteriL ense Number Master Journeyman i /+ � ✓ ,n } Location_ � C.�1� `'� � G N�— No. Date. HQRTM TOWN OF NORTH ANDOVER 0 9 Certificate of Occupancy $ • �'�s' E<� Building/Frame Permit Fee $ sACMUs Foundation Permit Fee $ Other Permit Fee too) $ 1 0001 TOTAL $ Check # 17376 14A, OA �Cru'►✓e Building Inspector _ .. Map( TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING x BUILDING PERMIT NUMBER:- () DATE ISSUED: SIGNATURE: Building Commis ner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0101 Map Number Parcel Numlier 1.3 Zoning Information: _ 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage 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) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner "ecord X31 s -k Lti V7 Na ri for Service /A�ddre^ss ..a Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number pVtaSs A dress � q c/ t a 3� Expiration Date *rafarV Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 1( a 210y Company Name Registration Number ^� f 7 Slip ti �y--� �^.r�a- � �a. �✓`r'``"1' _-, Address k � 6 g 3t%% Expiration Date lR e.- %t7 Signature Telephone M it SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ..... No ....... ❑ SECTION 5 Description of Pro osed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ __FAlterations(s) ❑Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description, of Proposed Work: n �l I `Z o SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed bypermit applicant �FFIC%�►LUSEYONLY . .: 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction of J S .— YY 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 % Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, e I,J ��`'� , as Owner/Authorized Agent of subject property Her a orize to act on in al s relative to work 6thorized by this building permit application. 14- 4- -Signature Si tature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ` ,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 N Sia of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3RD SPAN DIN ENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH VMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FAMILY POOLS & PATIOS, INC. CSL #010330 �f sales service • suppliesHIC #118204 D 0 ®70 South Broadway, Lawrence, MA 01843 WC #4951074 Tel: (978) 688-8307 • Fax: (978) 688-1949 LIAB #C1098398230 SINCE1978 Name 9 __w +_14 se', Z r , p �( Cyt Date /�S%t Address R( Lc,.- J fin.(+Tr._ t,( rity it)r(,. / ,. i9A ,/ Home phoneU 69S721 Work phone Cell phone 779 69-7W7 Add'l # Cross street/directions b ,' Estimated start date Estimated completion date - We propose to furnish and install one 111 Def )Cir R�l-Btnrs= �i Q2ep swimming pool for the sum of $ 17i r THIS PRICE INCLUDES: • Manual vacuum cleaner kit • Leaf net • 8 Ft Steps -1 U�- • 3 -Step Stainless ladder • Wall brush • Handrail i • Rope & Floats • Extension pole • Filter__ S • Initial balancing chemicals • Test Kit plumbed no more 25ft from pool • 8 to 12 Wk supply of maintenance chemicals • Surface skimmer(s) Z • Pump & motor f (supply depends on pool size) • Coping '7 • Choice of liner THIS PRICE ALSO INCLUDES THE FOLLOWING WORK TO BE PERFORMED BY.A LICENSED ELECTRICIAN: Bond and ground pool - wiring of a 220 volt filter pump - one 110 volt plug - wire and install one 220 volt indoor time clock - outside wiring to be done in PVC pipe - sixty feet of electrical run from service panel to filter ,(*note: runs over sixty feet will be subject to an extra chalge)_ Initials 'IN ADDITION TO THIS PRICE, ADD - HOURS OF MACHINE TIME At $ f31 PER HOUR = $ THIS PRICE DOES NOT INCLUDE: _ Initials Any machine time in excess of that estimated above. Additional machine time to be billed at the same rate as above due with the second pool payment. T All hours of trucking will be charged at.$ Ems— per hour per truck due with the second pool payment. Any dumping costs incurred for disposal of ledge, large rocks, or soil - re -seeding of grass around pool - spreading of loam - trucked in water - patio or fence around pool or any accessories except as noted below - additional fill, if necessary, for proper backfill or reshaping of hole - dis- posal of large rocks - fuel connections - heater venting -fuel storage tanks - permits - repair of damage to sprinkler systems or any buried items (ex. dry well, electrical lines, cables, etc.) in the access and pool overdig areas - plumbing to filter in excess of 25 feet - stumping and/or removal of stumps. brush or debris. Homeowner is responsible for repairs of damage to known or unknown buried items. Water or soil conditions (ex. clay, peat, live sand, excessive r ck, etc.) requiring a stone pack of the hole will be subject to an extra charge of $ JA� minimum to $ " maximum. Use of the above mentioned stone pack will be at the discretion of the job supervisor. Customers must supply access for all trucks and equipment. It is the owner's responsibility to bta�in.the building and electrical permits or to assume the tcosts of necessary permits. _ Initials Notes: �rekq� / 1 v'�e ui�L, �i�� .Q 01- OPTIONS g,( Diving board ( li Main drain Solar cover ( ) Pool light 3 'J Heater �y}��1 ) Environpool Pl hea Caretaker w/Electrontc Valve, 16hd Additional floor heads ( -Z ) Polaris Vac -Sweep Polaris retrofit only TOTALS Basic Pool Price Estimated Machine Time Options Subtotal 5% Sales Tax Total Less 10% Deposit Balance of Contract $_ i7stI 1(o za X2) ,(ti $ 3!3,S $ 2-7qI b .2000 $ cS9(b Swtmout/Buddy Seat 0 L 1 O U' h. PAYMENTS: 1/3 EXCAVATION 1/3 BACKFILL + EXTRAS 1 SYSTEM STAR PS%� The buyer hereby agrees to pay, in full, the total amount of this transaction upon start-up of the installed pool.Your salesman or job super- visor will meet with you two to three weeks prior to excavation at which time all decisions me ing pool size, shape, liner print, and all options must be final. Changes after this date will be subject to extra charges where applicable. 42it Buyer, cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Credit carnts not/cffl6ted on contract amount. Z_.- OOF BUYZdate 7 %l l0� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: �� c4t K��: S C� City N 191�, oc-J-� "-Irks-> Phone # 17 5 ^ is 7-777 / I am a homeowner performing all work myself. F-1 I am a sole proprietor and have no one working in any capacity �4 1 am an employer providing workers' compensation for my employees working on this job. Companv name: l_� t + Qc-`G- Address City VQ Sr Phone#: Insurance Co. �- A �Z4' C"' Policv # Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment -as _well_as_civil.,penaltiesinthefam-of -a..STOP WORK _ORDER..and.a.fine.of.($100.00)..a-lay against -me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the infonnation provided above is true and correct. Signature—CA U--•^ e .9, , , _, Date I ( A4" 6 / Print name (A Le -11 I- K LJ11 Official use only do not write in this area to be completed by city or town official City or Town Permit/Licensing Building Dept ❑Check if immediate response is required p Licensing Board ❑ Selectman's Office Contact person: Phone #: F� Health Department ❑ Other NORTHERN �4SSOCIATES, INC. ���� a ----------.._— ____--- 630 TURNPIKE STREET NOP'"H ANDOVER MA (sn� • -,, , I =7VABOR' PETER D.9 LIBA A- _:BE" MV LOCArlav BS cwAmEsirm ROAD DSD Awr. ak* P& CITY, STATE AORTY AAVOMR 144 PLAN R1 . FLIP DATE' 9 / 2B / V2 SCALE.` Sa grip • JOB rx 921 7682 CANDLESTICK ROAD .r LOT S NN LOT 19 LOT 27 57462 SF. i F -- Z w �u 4 Lor 20 LO i w 2 sraw or: � a to f J 1 1 150.00 CANDLESTICK ROAD QE RTIFFED T& - ABBEY FINANCIAL CORP. NOTE: This mortgage inspection was propared specifically for mortgage purposes apt::�! relied upon as a survey. Northern Assoc:latea, ptt no responsibility for damages resulting from nce by anyone other than the said mortgagee anigns In connection with its proposed mortgage fimortgagor. This mortgage inspection was prepare,, In a oanw -yam with the Technical Standards for Morig a Loan '1 Inspections as adopted by the Massachusetts sociati of Land Surveyors and Civil Engineers. Inc. 1 FURTHER STATE THAT IN MY PROFESSIONAL OPINION the principle structures and accessory outbuildngs, CONFORM 'with the setback requirements of the local zoning ordinances, and that there are no encroachments of majc A OU N improvements either wy croas�rgpo� linos except. as $3 .30760 shown. pANEL DA 1ISTE0 Q f 1 ALSO: 13 1. Proporty Is not in a Flood Hazard Area. SUFL1� ❑ 2. Property is in a Flood Hazard Area. 1 .0 3. Information is insufficient to determine FIdod Haza Flood Hazard determined from latest Fodoral Flood From: Eileen P. Hart, AAI At. Piazza Insurance Agency, a division of HUB Int'I. FaxID: 9789880038 To: For Family Pools Date: 1/21/2004 11:25 Ahs Page: 1 of 1 ACORD CERTIFICATE ®F LIA�ILIil( 01V�lJRANCE OP ID E DATE(IdWODM-M FAMIL03 01/21/04 'RODUCER The Piazza Insurance Agency C . J. McCarthy Insurance Agency 299 Ballardvale 5t. 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. Wilmington MA 01887 POLICY NUMBER Phone:978-474-4200 Fax:978-988-0038 INSURERS AFFORDING COVERAGE NAIC9 "ED INSURER CNA Insurance Co. INSUReR Family Pools & Patio Inc. 70 S. Broadway Lawrence MA 01843 INSURER: INSURER D. INSURER ° A TFE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIE INSUREC NAMED ABOVE =DR THE POLICY PERIOD INDICATED NCTdYITHSTAJVDIPIG ANYREQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT `KITH RESPECT TC VIMICH --HIS GERFICATE hLA BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORCED BY THE FOLIC ESE ESCRIBED 1EREI,N IS SUBJECT -0 ALL -HE -ERMS, E; "C_USIO 18 AND CONDITIONS CF SUCF v POLICiEB AGGREGATE LIMITS SW.MN MAY HAVE BSC`. FEDIJCED BY PAID CLAIMS. LTR NSRN TYPE OF INSURANCE POLICY NUMBER DATE (MNUDD1YYj DATE (MRUDONY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COIAMEPCIALGENERAL _WBILITY 01098398230 12/31/03 12/31/04 GE I PREMISES:Eanc;.urence) S100000 CLAIMS MADE a OCCUP I MED 3X?::v,nycnzperson) S 10000 rRer prcj agg / Bl PEPSCNAL &ADV INJURY S1000000 GENERAL AGGREGATE 52000000 G'EN'L AGGREGATE LIAITAPF_IES PER: PRODUCTS -COMP(OPA33 s2000000 POLICY PRc} ,IECT 17 LOC AUTOMOBILE LIABILITY A ANYAU-08414071 12/31/03 12/31/04 COMB114ED SINGLE LIMIT (Eaaaciden:) S 1000000 I ALL OWAED,-4JTOS BOG!L" INJURY S X SCHEDULED ALTOS (Far person, X HIRED AUTOS . BOD,L" IN,4J<Y S X NON -OWNED AUTOS I (°ar sccid=n6 PP.OPERTY' LAVAGE S 1 (Pa, accidanti GARAGE LIABILITY AUTO ONLY-EAACCIDE'!T S ArNY AU�O 0 T 1-E THAN EA, I AUTO ONLY: ,qG6 S EXCESSIUMBRELLALIABILITJ EA-HOCCUP.P.ENCE S OCCUR: CLAIMS MADE I I A,GGPEGATC ------ ---- S I DEDUCTiBLE RETEW ON $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY _, RY LINITS ER B ANY FROPRIETCJR'PA.RTNE..vE.'r.ECU-!VE WC7481901 12/31/03 12/31/04 _ E.L.EF�:I-ACCID-zNT S100000 '�=ICER�MErABEP. EXCLLGED! El DISEA5E-EA.EYF`_O7EE+S 100000 If .res, describe undW E.L.DISEASE-POLICYLINIIT S500000 SP=CALPFCV!S'04SDeI)W OTHER i i DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS nrnr�e�nw•rr ung n ............ — • •----• • V.nl�{,.GLLN I IV N .. NOMORT * SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOt.DER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. y � ACORD 25 (2001108) CORD CIORPORATION 1988 +_ =.Jul 15 03 01:44p Famii,y Pools & Patios Inc 9706601945 ., _........ ✓rte �ioTa»ranu.e¢�i a����a�sroel� BOARD OF BUILDING kEGOLATION3 License: CONSTRUCTION SUPERVISOR Number: CS 010330 r Blrthrlefs: O7l19lt 960 Expires:0711912005 Tr, no: 61 Restricted: 00 WILLIAM C POULOS 70 S BROADWAY LAWRENCE, MA 01843 Administrator _' . �� V V /��� ` - / ✓V" /�i(/�'i�%�Li'r�///�/, /y '''yyy ,may Board Of Building Req ulations One Ashburton Place, Ism 1301 License: CONSTRUCTION SUPERVISOR D9D330 LICENSE Ma 02108.1618 Number: CS Expirrs:07119/2005 Birthdate: 07/1911960 Restricted TO: 00 WILLIAM C POULOS 70 S BROADgrAX LAWRENCE, MA 01543 Tr, no: 61 Keep top for receipt and change of address notification. 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MERE ENNC?0?C? i Q 114 $4 110 Q P CU B IU N Q_„ d' d' N N.€ 2zt B ao ao ao p ap N I • 0% 7 pp c pp R, , T 1 'at vOD $ 1 d O Y • x Q ao ao aD ao 9$bp _ • E C E ODaD ODo 'o - _ 6 O F .tS Qu < 64 < a uQ � o 0 O N O o N o a o. • FORM - U - LOT RELEASE FORM /v,�WvN Z) INSTRUCTIONS: This form is used to verify that all necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. .aMannow'NowNowMo'nsoonamnowsn'M■■wmMMlroosonlMfloo!'swwwwwwowwasaanoanaf f Mol wwo APPLICANT ?e L -c3 a Gs-. e �, PHONE 41 7 ASSESSORS NUMBER . %� LOT NUMBER SUBDIVISION LOT NUMBER STREET (!ASTREET NUMBER o'i'M■M`olMa-.wMwnwoo'.f-n.Mw!!!■Mswam wolson Mw:o-sl as olslo!loMffwffwnw wwn OFFICIAL USE ONLY .eMlfnslwwl.lwaM:f!'lwwaslffflw■w!.■efw■!.■wM!lwfwwwwwwww►!lwmass wfww!! fns-■ f!! f!! RECOWMVDATIONS OF TOWN AGENTS .ww!!w M■a.l■Mlw�wfwwfwfwwl■!!n■!n!■Mw■awwlw■wwlwlwlwwMwww�lMwas amen wsww0M.0■ / ' DATE APPROVED _' a CO ERVATION ADMINISTRATO ,. DATE REJECTED CONRVIENTS � s TOWN PLANNER DATE APPROVED ' DATE REJECTED CONUVIENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT DATE APPROVED DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR T A'C'T.• .. ............ Q: o` O h O 'L: :•CLC 1 :cm0 �aco Cl '~ L y0� O. y Cyr r;op MC 3 c' 1 O C yR L CD O` CA W O �• ECDCDC 0: CL 'm cr- �`� c ` lk is O( th a O: p,ocCt �9 � m V h Z O C i O C i O �: CD C O N +p, y yp+ H m O w � Nl dt O C Z ' " O LU G) a g g s .p. �.td CO 9 CD O CD■ L O z °' CL O H D � Cm o CA co A O �O 'E m CO co 0 co Cl -H 4-0 co CmO co L e_CDv o a cmcc C •fl o Cc •C0 CL Z � V y C c C _cc CL C4 r3 N LLI U) W W 19 W o x a f� cn a o o v Q: o` O h O 'L: :•CLC 1 :cm0 �aco Cl '~ L y0� O. y Cyr r;op MC 3 c' 1 O C yR L CD O` CA W O �• ECDCDC 0: CL 'm cr- �`� c ` lk is O( th a O: p,ocCt �9 � m V h Z O C i O C i O �: CD C O N +p, y yp+ H m O w � Nl dt O C Z ' " O LU G) a g g s .p. �.td CO 9 CD O CD■ L O z °' CL O H D � Cm o CA co A O �O 'E m CO co 0 co Cl -H 4-0 co CmO co L e_CDv o a cmcc C •fl o Cc •C0 CL Z � V y C c C _cc CL C4 r3 N LLI U) W W 19 W Lo, on �,4 4)�11�57/G No. Date •N TOWN OF NORTH ANDOVER Certificate of Occupancy $ • ; : Building/Frame Permit Fee $ Foundation Permit Fee $ s�MU Other Permit Fee $ _ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 3108!10`9914:36 838.00 PAID / Div. Public Works z C. N r z 0 a C' KJ O c k C � r)r O c = < 11 c C 41 Z ^ C O z C. N r z 0 c C' KJ O c k C � r)r O c = < w c ^ C O � z � • r y � w l v - C C C O O C C i C Z U U U L i Z - C J C O C-' C<mv — = V � ! - - o z z Ga O c c ! O O O O v� � w O w w w z V) -r C U L o O - Z c c - z c c c c U � o c U i z C. N r z 0 d C' KJ Z � O c = < w ^ C w c � • r y � w l v - C C C O O C C i C Z U U U L i Z - C J Z � V V n w - o z z z o c c ! O O O O v� � w C w w w V) -r C U L U - Z c c - z c c c c � o c U i ttcnn d C' KJ Z � O c = < w C c � • y � v z c WF M Z Z Gc; Z - C J p = n w w � O c c - z U U Ln z C' w Z z O c = C c � • y � v z c WF M Z Z Gc; Ln z �l C' w z z O C �l I " _z Adgumk e• w o .�� o.: 0 _ ai cac a) w C CL m Q1 ✓' o o c . e a, �. 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(16 RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED. COMMENTS ! v i� UI�C= I �5 Vv1 I `1 t 0V -.- TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED SE IC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED % COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT }C FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 jm DATE F *****************************APPLICANT FILLS OUT THIS SECTION*********-****1**_**�****** S ie U w APPLICANT P06'4 1134 Be SS c N _ PHONE 019 =3608 -- Eg 0� U LOCATION: Assessor's Map Number to PARCEL D� SUBDIVISION -` LOT (S) STREET 1:: wd /e4S tcl 4o6A ST. NUMBER © jAL� ************ "**"******OFFICIAL USE (16 RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED. COMMENTS ! v i� UI�C= I �5 Vv1 I `1 t 0V -.- TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED SE IC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED % COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT }C FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 jm DATE F 1 M®NEY RECEIPT 4 /1 1"��t,/ UOliar For- $s ON. FORM 4161 ARGEO PAUL CELLUCCI Governor hkter Table Septic Co e, Iic• F. Paul Cardone, Soil Evaluator COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS, DEPARTmENT OF ENVIRONMENTAL PROTECTION ONE WD= STREET, BOSTON MA 02108 (617) 292-5500 $I Cn,vci�ea'�'�c,k TRUDY CORE Secretary DAVID B. STRUHS Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A // �c � CERTIFICATION �r Property Address:. 8� �" •v�l C AV Nam ,of Owner. T��yL �5� �s r / Address of Owner. e,/ �/fi✓OLS ��/C 1xp .0/ ti' 13 • /4-0 U o v �v' Date of Inspection: Name.ofinspectorr. Please Print)FVUL <-,4g(J I am a DEP ap roved system inspector pursuantttto Section 15.340 of Title 5 (310 C,IIR 15.000) m Company Naes /j/ C Cc .�-��Q/i q✓1 t ��-n L . Mailing Address: yy73-C/ o.,! 57'�o/�si ic/O�/7r�. �� 9 GJ Telephone Number: Ge78) 5'87 -aS�Ce CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time ofinspection. The inspection was performed based on my training.and experience in. the proper fimction and maintenance of on-site sewage disposal systems. The system: Passes X Conditionally Passes Needs Further Evalusb3in by t Local ApprovingAuthetity Fails Inspector's Signature Date: / Z. The System Inspector shall submit a copy ofthis inspection report to the Approving Authority (Board ofHealth or DEP) within thirty.(30) days of completing this inspection. If the system is a shared system or hasa design flow of 10,000 gpd or greater, the inspector.and the system owner shall submit the report -to the appropriate regional office ofthe Department ofEnvsonmental Protection. The original should be sent to the System owner. and copies sent tothe buyer, if applicable, and the approving authority. �J NOTES AND COMMENTSo �� c t .t /� d7r .��Z 4 S �—� �� =7Z/"a /SCG/Jt . S t�vJ✓i� S �s—C�/Jei/�>! C%.7 rA S/<< i� �/ �.1/ CJ' �/ /j fr✓I O/L i_ G� d �+� o ve e /p i S o / /T . , j `r e✓ �t�l�+ �. e = /j%�j �� S z"U e- /`'-L... �� 5 n % h • � f'� � -� /C �� L Sy J r � �•. ; /l l/jt'�c� � -+ v�D ��irc�� �' �//C fc� ✓ij Qct �i J'� L ���� • TITLE 5 SYSTEM INSPECTORS • D.E.P. SOIL EVALUATORS • 447 Boston St., Topsfield, MA 01983 Tel (978) 887-8586 Fax (978) 887-3480 Revised 9f2198 Page 1 of 11 1 37'/2 Baremeadow St., Methuen, MA 01844 (978) 681-0726 r .. North*Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision 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 c11,S150A. The debris will be disposed of in: - r Sin re of P rmit Applicant �-0 Date NOTE Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector A ..,. r� � . �. .. � . r. �.. .. .. .. .. , ,. , _ ,.. .. .- ,. .e.., t. ..... �' ... � .. �..�. .r _ ,. :,: .. �� .. ..� .�.' r�, ur -. ': �'. -. _ � r _ ,. P f'� _ .� .. .. ���. � �� ^—. K L b , The Commonwealtt'� of Messachusetts Department of Industrial A, cidents _ Office of Investigations -Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Na A7l City Phone m F7 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity A, ® I am an emplever providing workers' compensation for my employees working on this job. Address (fZi W l k5t-& /'SA' Comeanv name: .I ress bl: Phone #: Insurance Co. Policy Failure to secure coverage as required under Section 25A or MGL 152 can lead to the impesifion cf criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as we!] as civil penalties in the form of a STOP WORK ORCE= and a 5ne cr (S100.00) a day against me. I understand that a copy cf this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ger Ty un pains and pen�es ry that e information provided above is true and correct. r Sionature Date 1 Print name C-_ G 16K Phcne T Official use only do not write in this area to be completed by city cr town ci iciai' City or Town \ Permit/Licensing ❑ B "dD t ❑Check if immediate response is required Contact person: utl tna up ❑ Licensing Board ❑ Selectman's Office Phone T: ❑ Health Department ❑ Other • r w REGISTERED STRUCTURAL ENGINEERS NYN-YORK37301, KENNETN DENNISON, PS MAINE------------------ 1519 NEW NAMPSSIRE----------- 1196 MEMSSR - AMERICAN SOCIETY OF CIVIL ENGINEERS VERMONT----------------- 2009 MASSACHUSETTS ----------- 8669 CONNECTICUT ------------- 7487 PROFESSIONAL ENGINEERING SERVICE SINCE 1956 7lenri a }-Engineering, Inr. STRUCTURAL ENGINEERS 148 PARX STREET NORTH READING, MASSACHUSETTS 01864 (978)664-6733,(781)944-8440 FAX(978)664-92331• PROJECT: ZF_Sa", 81 CAQ0LEST(CK Ro, PROJECT NO. '3(1•t39 1\,l a, Qr.lnovep– HA, BY:WC-D DATE: 03.30.49 CLIENT: J, GIz.1swDswFa /a,2CH'T. REVISED: REV. DATE: SUBJECT: � �,(,.� � (`i G ' COSHEET NO. I OF 1999 DENCO ENGINEERING, INC. Ion o -- x, t 44'L lo. jv1_�o,clo,5 <g RCos Z. b - E5M + TR)IA zo t..� -10 IX 2. `j r' r L CD C-) rZ�._ rte, t. ( d V E 2- N E W (= 2 oAJ i S Pr.,.I _ 10' c% 2NL 4C> x (3 = 52c7 h : 54o x ln, k L,.'750 rDl ( r T R im 20 � S 4(.� 5200 C? 7S(bx 11Z V� r SZ.L� L�) klT t=L rah, AT FPZ—aT E< ,JT. AD(J'N 1-L So k 12 S C�25 11-(c Ca5o x ►02/$ B12S C A-3 PJ A L L+ fes, I, t tiJ q p o P DENNISON N L W Ito Co o M:1 l o x \/A«1;)r 3NO t -40 x P, 3 20 12,1,j ADOtN QvoF L{OX k4- cEIL lox L.� 134xgI2 UV PA -1 Z �_x ox Lta nlrawtt e-0 ' -7 �2o S �� 3zx`�2 lvt WALL. t 3M �X 2"J 11 447xc gQ NORTHERN ASSOCIATEINC. y N ' r LHIV S, ----- �..-----_-..._ -- ___ -- 630 TURNPIKE STREET NpR'^f ANDOVER MA (3Wj vr r � � �i- • 4 ¢!d AVR7YA9aqt, PEM7 D.O LISA _A. Ely LOCATION 8S CAIiA�LTICK AfDAD DEM Arr. BPG' CITY, STA TL A077H AAIDOVE�7 A!A p� pL,Vy PLO S / SCALE,` s� 60' " * 92/ 7WZ �d V,0vor'3 D 30,3 LOT 27 LOT 19 l 57462 2 w L ,.0 4 W ^LOT 20 I � w f �H MXV u l � I Q �ro r f � r , { 150.00. r CANDLESTICK ROAD x �% N2 2 '196 Date ......._�.... ... �� ... '� NORTI� °'<"`°:•�"o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that� opcC..... 4 ........0...........ti....�.. ......... has permission to perform .......;�Cr/ .!..1.: 9.-.1 ......................................... CA wrong in the building of ........t�.f'.. .................. f............................................ A �l i at .......5. ........... ..... .... 1. Wit..... ...... North Andover ass. Fee ..................... Lic.No. ................ .........; r..................................... ELECTRICAL. INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use Only G14P LIIrilriiDrilUEttl Bf assar.�ll rtt Permit No. i9epartment of ilublir 9-�afetq Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR "12:0 ' PLEASE PRINT IN INK OR TYPE ALL IN OR ATION Date ( City or Town of �y � "i'— To the Inspecto of Wires: The udersigned applies for a permit to perform the electrical wor described below. 121 Location (Street & Number) C /C VGA Owner or Tenant —_ _ 0e�ev l Owner's AddressQ Is this permit in conjunction with a building permit: Y s O No ❑ (Check Appropriate Box) 1 Purpose of Building �fil�� '/}►'ftp Utility Authorization No. Existing Service Amps _ I Volts Overhead ❑ Undgrnd ❑ No. of Meters ,New Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters f Number of Feeders and Ampacity –}-• �4-ocation and Nature of Proposed Electrical Work l t / INS No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures -30 0 Swimming Pool Above In - ❑ ❑ grnd. grnd. Generators KVA > No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners — ( Battery Units No. of Switch SwOets L �� I No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals I No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices LocalMunicipal ❑ [I Other No. of Dryers Heating Devices KW Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: ! ivy) 6 !` f INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES X NO G I have submitted valid proof of same to the Office. YES K NO G If you have checked YES, please indicate the typ of c verage by checking the appropriate box. INSURANCE X BOND G OTHER G (Please Specify) (Expiration Date) Estimated Vaiue of Electrical Work $ Work to Start Signed —A— — oe.. Iff— -4 ..e..... . FIRM NF Licensee Inspection Date Requested: Rough Final Address '76-7 4a, /YNJ=�L ; 4& 4f �f§-Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owned Agent (Please check one)Y/ Telephone No. PERMIT FEE $ (Signature of Owner or Agent) x-6565 N2 4326 Date.,:--?. �. ell, r, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING / z This certifies that ...... ........... has permission to perform ............................... plumbing in the buildings of .................................. at. NorthAndover, Mass. ........... "—. .......... Fee�.-�4. .'Lic. No.7:6�-� ........ PLUMBIN611NISRJECTOR 7�V WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 7 . (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building 112-: sem' C e Owners Name Permit #-aov a Amount Type of Occupancy S New ® Renovation ® Replacement E3 Plans Submi es E] No FIXTURES (Print or type) /� f Check one: Installing Company Name 7� "14�L�=� Corp. R-7Fartner. Certificate Lj Firm/Co- Name ofLicensed Plumber. /'7� �!�% %4�Z GC"l 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 ►gnature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach lumbin "h_ 1 the neral Laws. By. T1Zn= o icensea, MINE= Type of Plumbing License Titled` City/Town icensie er Master Journeyman APPROVED (OFFICE USE ONLY CA,�. 5AID �- - t I 1 ` PCS,, - �.s 5AV Vz w t r MAC t ey 1.- oc) 1` Tc?,%�CCvM PAhI`( A'PPLICAYLON_ __ � � s t � v 3046 Date . ,� � �9 ..... . A w a TOWN OF NORTH ANDOVER g PERMIT FOR GAS INSTALLATION co This certifies that ...!!.� .� r .'?.... ! .�. Az ............. ti has permission for gas installation ............ in the buildings of ... , . r :. .......................... . . at f.. ! !? ..11 . ��..`.'.. `!........... , North Andover, Mass. Fee .4�RU: Lic. No.: ?.c7 ): . . GAS 4 INSPECMR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer z 4�,qo� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) - NORTH ANDOVER. Mass. Date s t 1huilding Location T/ .0 gT / - Permit fl gt Owners Name t��ew New '7 Renovation Replacement Plans Submitted (Print or Type) Check one: Certificate Installing Company Name ANDOVER PLG. & HEATING CO. , "N . Corp. 2122 Address 573 112 SO UNION ST Partner. LAWRENCE, MA. 01843 [-J Firm/Co. ' Business Telephone: 508 685-8383 Name of Licensed Plumber or Gas Fitter_ rFnRrF I ARntr Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of' this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner F] Agent El I hcteby certify ttut all of the details and Information t have submitted (or entered) in above application are true and accurate to the beat of my knowledge and that AU plumbing cork and InstttUations perforated under Permit iuced for this application will be: In compliance with all MtJU ent provisions of the Massachusetts Slate Gar Cude and chapter 14: of the Genual Iarn. By PE LICENSE: Plumber Titlesfitter Sig ature of Licensed Master Plumber or Gasfi.tt,, City/Town: er Journeyman 99fi� APPROVED (OFFICE USE ONLY) License Number MENEM ■hUl SEMEN MMENMEREMMUM - MEN NEI MEMEMEM OEM MIN NONE IS so (Print or Type) Check one: Certificate Installing Company Name ANDOVER PLG. & HEATING CO. , "N . Corp. 2122 Address 573 112 SO UNION ST Partner. LAWRENCE, MA. 01843 [-J Firm/Co. ' Business Telephone: 508 685-8383 Name of Licensed Plumber or Gas Fitter_ rFnRrF I ARntr Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of' this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner F] Agent El I hcteby certify ttut all of the details and Information t have submitted (or entered) in above application are true and accurate to the beat of my knowledge and that AU plumbing cork and InstttUations perforated under Permit iuced for this application will be: In compliance with all MtJU ent provisions of the Massachusetts Slate Gar Cude and chapter 14: of the Genual Iarn. 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