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HomeMy WebLinkAboutMiscellaneous - 83 AUTRAN AVENUE 4/30/2018N pb_ A � w C n� O (� Z l < om o z o 4m Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Autran Condominium I c/o Stephen Heimlich Property Address: 83-85 Autran Avenue Company: Cambridge Mutual Fire Insurance Company Policy/Claim Number: SBP1075219, SBP1075219 Date/Cause of Loss: 4/2/2016, Electrical Fire Our File Number: 33260-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner, Ext. 116 On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. 04 Signatt(rq'and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Cc: Health Department North Andover Fire Department 1600 Osgood Street 795 Chickering Road Building 20, Unit 2035 North Andover, MA 01845 North Andover, MA 01845 Date .. . ........ 1.1 ... y ... . .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .................... ............. ......................................................................... haspermission to perform ................ . .............................. wiring in the building of ................................................................. -'\k ............ at ................ ............................ ..................... . North Andover, Mass. Fee.... . . . ......... Lic. N4250 ... .................................................................................... 2 -2o -i -i ELECTRICAL INSPECTOR Check # 1 14'— A Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Oficial UseOnly Permit No. Occupancy and Fee Checked [Rev. 1/071 (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: City or Town of: NORTH ANDOVER To the Ins edor of Wires: By this application the undersigned gives notice of hisyr her intention to perform the electrical work described below: r, ) A Location (Street & Owner or Teaant Owner's Address a"/% Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 00 Amps 120/ Z y0 Volts Overhead a Undgrd ❑ No. of Meters Z New Service Z 60 Amps [2V / 2tjfi Volts Overhead a Undgrd ❑ No. of Meters z Number of Feeders and Ampacity 9or A4t,,,, ,t tet; n f oc A Akp t�fylgdj:, Location and Nature of Proposed Electrical Work: f' AAT One A6 to C. !,,o field r 4 No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers o. or water KW Heaters o. Hydromassage Bathtubs No. of Ceil: Susp. (Paddle) Fans No. of Hot Tubs SwimmingPool AboveEi In- arnd- ornd- F1 No. of Oil Burners No. of Gas Burners No. of Air Cond. Heat Pump Number: Totals: Space/Area Heating 1 Heating Appliances No. of Signs No. of Motors a(A,j, l, e;e) 200,4L&Q Serv'c1 —IoaA,e. i ISZA waived by the Inspector of Wires. KVA 1( Attach mires Estimated Value of Electrical Work: I M (When Work to Start: YMZg / b Inspections to be requested in INSURANCE C RAGE: Unless waived by the owner, no l nless the licensee provides proof of liability insurance including "compi.,..,...,t,.,,m,.,,, LUVC,ar�19-.,,-,LN ,uUNLUl,t,a, oyu,va,cne. fhe undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 13' BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties of perjury, that the information on this application is true and complete. Z 5'/ 9 — 11� FIRM NAME: A� ,k0,,c,r, :; LIC. NO.: Z Z o 7'7—A Licensee:,44,/ Alf Sck,,, S2 Signature C ,. LIC. NO.: (If applicable, enter `exempt" in the license number line.) Bus. Tel. No.; :Zk1_Zj2-c{2(p Address: 22 3 Aia rA te,,,ef% 57& re'f 14,Pk eA WG 6/ Wk 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 Signature Telephone No. PERMIT FEE. $ r7 / �D �� �' Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only I Permit No. Occupancy and Fee Checked l [Rev. 1/071 (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: /% /201 & City or Town of. NORTH ANDOVER To the InseC or of Wires: By this application the undersigned gives notice of hisyr her intention to perform the electrical work described below: C, 9 A Location (Street & Owner or Tenant Owner's Address "/7 Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building R -.f: A;.CC Utility Authorization No. Existing Service 00 Amps 20/ Volts Overhead Undgrd ❑ No. of Meters Z New Service 260 Amps %Zct / Volts Overhead Undgrd ❑ No. of Meters Number of Feeders and Ampacity Zoo A4&kp -4AvL, n f ©ems hzida /,s -y.,¢ r Location and Nature of Proposed Electrical Work: E,JAT 011< I,C l e C : P rc{irc' %J re,j 4 i? ` 42C t"Ce cS 4 Storf- % P'AGsr- S 4cr+- �601{inwScrv'cc 1- IQ/� Completion o the ollowin table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of otal Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators K -VA No. of Luminaires 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 o etectton an o. InitiatingDevices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: ..... umber.. Tons "' __._._. o. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW al Local ❑ ConneectiMuniction ❑ Other No. of Dryers Heating Appliances KW Secunty 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 a ecommuntcations Wirin No. of Devices or E uivalent OTHER: 9 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: IY 00 (When required by municipal policy.) Work to Start: / b Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. I Z S-0 -1> FIRM NAME: Al Sk c, �;Z LIC. NO.: Z 2 o 7'7 -.,4 Licensee: 4r7 Aiol Al S,ca j to Signature �" LIC. NO.: - - - - - - (If applicable, enter `exempt" in the license number line.) f� � Bus. Tel. No Address: 'Z2 3 1Ve, C8 to well S/5� re'f • 1UP .1, WG 61 W"k 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 0 N 10 4 5 ami 4. Q Q z z •nom < CV I The Commonwealth of Massqchusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, PM 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEPMTTING AUTHORITY. Name (Business/Organization/fndividual): Address: ?Z-3 1100-4 1 well Sf eeel_ .SL;ae era J /2 City/State/Zip-_, 4n ,� OIW11Phone #: 17?1—lel "�'6/ Are you an employer? Check the appropriate box: 1.] I am a employer with employees (full and/or part-time).* I am a sole proprietor or partnership and have no employees working for me in ny capacity. [No workers' comp. insurance required.] 3.Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp, insurance.$ 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no. employees. [No workers' comp. insurance required.] Type of project ()rgquirM): 7. [] New construction 8. [] Remodeling 9. ❑ Demolition 10 F1 Building addition 11.0 Electrical repairs or additions 12. [J Plumbing repairs or additions 13. [] Roof repairs 14. E Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submif 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. Ifthe sub-coi&actors ]rave employees, they must provide their workers' comp. policy number. Iain an employer that is piovidiing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company N -41 J Il tel Policy # or Self -ins. Lie. #: l � -P 0 ( ®� ! X) / 75 Expiration Date: 2-424- Job Site Address: �2 ' "Pri 1 City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and 6piration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification -. I do herebyfy under th/e p/ains�%and penalties ofperjury that the information provided above is true and correct. Vienature: (2 .. /a !J U 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 bd 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'contractoi(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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia Location No. Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee A $ TOTAL e- $ Building Inspector L C, � 4 ` r►O R TF/ �w• Town of North Andover BUILDING DEPARTMENT CONTRACTOR AFTER HOURS REQUEST FORM -T CONTRACTORS NAME:., 1�; '+c �► '11U.fCCP U d ✓ �� ADDRESS: �� �j/©<,G� kc e// Sl-ez r-1-• CITY/ TOWN: te(--Qg LI -e. STATEN' ZIP: BUS. PHONE: 7k/ -Zg f —e/2 (o l CELL: % Z Fr /- C126 MA. LIC #: MASTERS: a 7 7 JOURNEYMANS: PERMIT # 13 -;? i 7 N -GRID SR# REQUESTED DATE: ZG/!o TIME: S"p,� JOB LOCATION: OWNER: 4?dir?tkj PHONE: 1 7k -3V -d 3% 7 WORKERS CELL: W 1 2&1- qZ(o j REASON FOR REQUESTED INSPECTION AND JOB DETAILS: 4 f- 0 3 A ktr7 jile. Ohc NORTH ANDOVER SUPERVISOR SIGNATURE: Contractors requesting INSPECTIONAL SERVICES due to weekend or after hour operations such as service related planned updates or special situations, will be required to provide a four hour minimum charge of $150.00 paid to the Town of North Andover at that time. Community Development Division, 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9545 Fax 978.688.9542 Web www.townofnorthandover.com O DEW%E Eeluxe l.lChecks I SAFFiY PA :0K RJ,p s � � ' r S O z p,}o v �(p� rum a� fA^ m :A n 1 ' 1�>3 it ■ ■ Ln ,'Ln� f ^_ W �( r!1 v N t I ,, Igm fo cr r Inspection Request Peter Manzelli II is requesting a Rough / Final insp ection to be performed. atLipName: le �r- Address: ffiL Phone: SR#: Date: Thank you, Peter Manzelli II 99 Main Street Westford, MA 01886 Phone- 978-589-9611 Fax- 978-692-8658 C 143 Sec 3L Board of Fire Prevention Regulations; Rules Relative to Electrical Wiring and Fixtures: Any person installing for hire any electrical wiring or fixture subject to this section shall notify the Inspector of Wires in writing upon completion of the work. The inspector of wires shall within five days of such notification give written notice of his approval or disapproval of said work. A notice of disapproval shall contain specifications of the part of the work disapproved, together with a reference to the rule or regulation of the board of fire prevention regulations which has been violated. t� 6 (/' 5 WIN* Date .... ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING A � ' F71toC... This certifies that ........................... e . ....................... .............................. has permission to perform ........ /.4e. -f ............................................. wiring in the building of ....... /I .... .. at ....... ...... ............ > ........... g ... ,North do�ve5yjassj,� .01- C% Lic. NgAla97 .............. Fee.. . . . ........ .. ..... ... ... IF* EL CTRICAL INSPECTOR Check # I i P Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use OnlL01 Permit No. 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 INFO TI Date:_-J-� City or Town of: �Pp 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) Owner or Tenant Telephone No.bA_ EP__1)9_—Bq Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building (_01� Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ New Service —.Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ Number of Feeders and Ampacitv ....J 0....G., r ............. ..l IIR___ 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- ❑ o . of Emergency Lighting rnd. grnd. 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 g No. of Waste Disposers Heat Pump i Number Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances Key Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Arracn aaamonar aerau y aesirea, 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 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 [y_� BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: A LIC. NO.: Licensee: p P t- P r Man z e 11 i I I Signature _ LIC. NO.: Al 619 9, (If applicable, enter "exempt " in the license number line) Bus. Tel. No.,• g 7 $ _ q _ U 611 Address: Alt. Tel. No.: OWNER' I SURANCE 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. $ N2 1565 glow Date ... .. 57—�� .......... . ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING .This certifies that.o ....... .... .. ............ "�z . . ................... has permission to perform ........................................ ........... wiring in the building of .... ........................................... ............... &59�� ........................................ . North Andover, Mass. ....................... rAFLY�� ... . .... Lic. ........ — .............. '.Z. ..... a ....... ............... I ELEcrRICAL INspEcrOR 04/68/99 09:38 25-00 PAID WHITE: Applicant - CANARY: Building Dept. PINK: Treasurer ThF09 0AWF.ALTHOFIM�4M Office Use only / DEPARTAIVF 'OFPUBLIMPermit No. BOARDOFFIREPREVENTIONREG�TTal I2QD Occupancy & Fees Checked APPUCATTONFOR PERMIT TO PERFCTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 77/F5 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To th nsp r of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 82 f -A U iZ f-� "') A-V Owner or Tenant L X.v Owner's Address d, -'? Ak) -r RA A-) /-)V Is this permit in conjunction with a building permit: Yes M No M Purpose of Building Existing Service Amps T20 / 2YOVolts New Service Amps / Volts Number of Feeders and Ampacity (Check Appropriate Box) Utility Authorization No. Overhead M Underground M No. of Meters 2 - Overhead Overhead r—J Underground No. of Meters Location and Nature of Proposed Electrical Work A) U40J it,5 Al AFw /ZOprt, No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating n KW S No. of Self Contained Detection/Sounding Devices Local Municipala Connections Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER IrzStraroeCov� Ptasuarttbthetagtmat>atsofM I luNc aamat LdxlEy hstrd=Poticy m6 & g Ccn Iha%e%hni edvandpnofof:BOND tptkleOfne YES [NSIJRANCE r7 WaktDSw Sigtted tinder B • �..hqxdmD*RqxsW gpor its e#valat YES M NO a J If}cuhawdxdWYES, p6meedi*theNxofcuw;%r-byd=kingthe rols--1 ftasespoffy) %"F Dai Civ ! L Es&ix*d ValuecfEkdticaal Wait $ Rough CL A A Z- Fatal L=isw 0•/)� 'V 7A— ,,, g5lA Sigt>� Lia3seNa 5 220 't LimnseNo Btsu>essTd % 7 / 7-C— YIX? i� l Ru,V oP AZ& o,Z©i314Sf ©/% � s, 1?'2 A1tTeLNa OWNER'SMJJRANCEWAVER;IamawatethattheLi =domto heitn�raloeoo►er aes iai�valaltas>ac�medbyM�adasdlsGeneralIaws aodthatmys+gt>altaeon$sisp�appil�onwai� $as �at�t. (Please check one) Owner Agent Telephone No. PERMIT FEE $ *No 2454 Date ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... ....... M e S e (f-� ............................................ has permission to perform ..... ...... 5�y * 51 wiring in the building of .... . tl.k4�4�1 .................................................... at ............ K5 .... �AMIRAII:.:: .... . . .......... I brith Andove��r,mm. Fee.2�'.( ) ().. Lic. No.. (f /3 /,/ / _ e; ...... ............ ................... ... ........ ...... r ECrRlCAL1N--E-(]iFEcroR .............. Check # WHITE: Applicant ANARY: Building Dept. PINK: Treasurer lfommonweall o f Madeacltujelb 2eparfnwnf o`—'7ire Servica3 BOARD OF FIRE PREVENTION REGULATIONS Official Use Only �[�� Permit No. T Occupancy and Fee Checked [Rev. 1 1!99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to -be performed in accordance with the Massachusetts Electrical Code (NIEC. 527 COIR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INT --ORM, IT ION) Date:i..-.)ao City or Town of: A, r U d byp K- To the Inspector of I•Yir-es: By this application the undersigned gives notice of lids, or her intention to perform the electrical work described below. Location (Street R Nuruber) Owner or Tenant Owner's Address Telephone No. Is this permit ill conjuuctiwith a building permit? Yes E] No 0 (Check Appropriate Box) Purpose of Building Os1,&rrk—'I . Utility Authorization No. Existing Service Anips / Voiis Nbw Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgr d ❑ Overhead ❑ Undgrd ❑ No. of Meters . No. of Meters Completion o%rhe lblloicing table may be 11•aived by the Insocctor or )Vires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Falls 'I'ranNo. s Total sfonncrs KVA No. of Lighting Outlets No. of Ilot Tubs Generators KVA No. of Lighting Fixtures b b Sryininrina Pool Above ❑ In- ❑ b Qrnd. arnd. r o. o mergence Lighting Battery Units No: of Receptacle Outlets No. of Oil Burners FIRE ALARNIS No. of Zones ^No. of Switches No. of Gas Burners No. of lle and Initiating nDevices No. of Ranges No. of Air Cond. Total Tons �No. of Alerting Devices [lent Pump m Nuber `_Io_n_s_ KW No. of Self -Contained :No. of Waste Disposers p Totals: —1 _ I Detection/Alertinz Devices No. of Disliwashers Space/Area Heating KW Local ❑ Municipal'o tio ❑ Other Connection No. of Dryers Heating Appliances Kai,, Securitv Systems: No. of Devices or E uivalent 60 No. of WaterNo. k `v I of No. of I Data Ivirina Renters Situs No. Ivo. of Devices or Equivalent No. Hydromassage Bathtubs No. orllotors Total IIP Telecommunications Wiring: No. of Devices or E uivalent OTHER: lfttach additional detail if desired, or as required by the Inspector of {Vires. INSURANCE COVEIZAGE: 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. 1'lre undersigned certifies that such coverage is iii force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Ig BOND ❑ 0-1-1-IER ❑ (Specify: Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance •.vitli NIEC Rule 10, and upon completion. I certify, u1111er the pains nitti penalties of perjury, that the infortrration oil this application is trice and complete. FIIZM NAME: 13r i nKS OfYIL SCC LIC. NO.: � I I Licensee: a i K J t U I ✓e'sk Signature 9��195 LIC. NO.: SSC )-000 q5 (If applicable, enter 1 e- cmpi "' h the license number line,) 018 Bus. Tel. No.:_ 18 - 6 7 y4_4 Address: 155 WCS4 91 S-1L5tW,\,—Rina nm �7 Alt. Tel. No.:29-9&q-05q OWNER'S Ii rSU RA' ICE WAIVER: I aril awa that the Licensee does not have the liability insurance covera�,'e normally required by law. By my signature below, I hereby waive this requirement. I ata the (check one) ❑ owner ❑ owner's agent. Owner/AgentPI:R HT FE•L: S Signature Teieplrone No: 0 LocMion' No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ A- I Other Permit Fee Sewer Connection Fee $ Water Connection Fee $ TOTAL V, 3 04 11:30 78.00 PAID $-19/ Building Inspector Div. Public Works M I 7Z� :J z u z L s z Com# aV V) z z �pp V N CO r CJ Tjl > d v V1 N f X y r O W z y y J C Q � 1 ^~ c X F- W 0 P — z � LLJ < 3 K ' 3 w �+ Cz z ^ ¢ z ^ LU 2 C zz E z Yf ^ l(�� 7 0 ? - Vz C 7� v' Z Z z w z t z W V 1J W ¢ - O 9 9 Z z C lb L- z � d o 7- O Q ? NI G _ v uj 11 � N z ¢ w W (<5 V► u Q rbc 7 2 7 4- 7s t JE w _ Z _ _ a / z z 2 y, z n z z C z^ z E,. of ^ L Z W <LU Z ^ 'n Z ` Z n W U z J ¢ y Z N n LLIn Z '3: W W C J y L L Z L Z 7Z� :J z u z L s tp M Im, Com# aV tp M Im, to �pp V CO r Tjl v v y r = z y y J tp M Im, wo�MTO vw lcmojam "XOR*Wd 1 *om SELWDOWV 2"d :,/, c -, S 0 Vi lu o tA 14 Vi o t8 %OS 4wd OM MVIDOSSd ROW I o�1L; dW J w a � o > J o • • l� �i ,o Q. - IL o�1L; dW J w a � o > J r . i r i i �iie �omvniour/ea� ��i%�aaaac�ucael� , HOME•IMPROVEMENT CONTRACTOR Registration 100206 Type - PRIVATE CORPORATIO • N Expiration 06/11/00 PAGE ASSOCIATES, INC, George W. Day AK RIDGE RD ADMINISTRATOR S TONEHAM MA 02180 0. :.. �c..,;...;.,;.,;.,;..,.;..,r..,„,;.,,....;..;:::;,••::.,;,;.; ::: w: rsr:•r:::>;.,; rrr:•>;>:(r�.�>::y:w4::; r;,,,;,;,,,,,;,,; rrr.;;.;.;.;;;,,,hy i4;,.r,,,,,,x�,,x,,,,,,,,;.xw::r,r:::•:::: r,;,,:::•;,,,,x,,,,,.;,,;.,,xy;,,,..,,,,„,;,;;,,..;,,.::::.,,;..,;.,;;•,;;,,,,,,,,..;.,,;:.r,,.,,;...� •:e., �`....:... •1/l'M1.::.;•.v' k4 4 \ l �,', DATE (MM/DD/YY)'.,, :. m,}„iw}vvvxv.,,,;,;.{..vx n,,,,.,,i n,..,{{x.0. n,xrr,i ni, Hk....xiiy{:{{{m;,,i„vv.,•n„ixvix,C»,,,,,,,,,,,x„mivivx2{{ixxx,v<x,,,,.n{•:{i"" <�<�<•:»✓{2,2SiS4i:: i;iL 08/10/98 vvvx, ”' 4i PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bernard M. Sullivan ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 12 Market Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ipswich MA 01938 COMPANIES AFFORDING COVERAGE COMPANY 2080836 A COMMERCIAL ANION INSURED PAGE ASSOCIATES, INC. COMPANY B SAFETY INSURANCE COMPANY P.O. BOX 64 COMPANY C TRAVELERS INSURANCE COMPANY BEDFORD MA 01730 COMPANY D < .... ...`•?` '• ???ii {>; '” ." `' ` , ,? `•'•` :?»%? ;r } ` <' w«;<>>•?"``•;? < '>• < «<;<`........... <.;««>s;;<s;«<, <z;< ,:> E `E 6 ` ` ? <•`• •`•;y> >:: < '':'z < «< ::':< 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 BE 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATIOh DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY NBFB40221 08/11/98 08/11/99 PRODUCTS-COMP/OP AGG. s2,000,000 CLAIMS MADE FKOCCUR PERSONAL & ADV. INJURY $ 1,000,000 EACH OCCURRENCE $ 11000,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE I"--) $ 100,000 MED. EXPENSE (my $ 5,000 AUTOMOBILE LIABILITY B ANY AUTO 1500604 03/03/98 03/03/99 COMBINED SINGLE LIMIT $ X ALL OWNED AUTOS SCHEDULED AL110S BODILY INJURY (Per person) $ 2.50,000 X X HIRED AUTOS NON-OWNFD AUTOS BODILY INJURY (Per accident) $ 500,000 PROPERTY DAMAGE $ 100,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY - WC STATU- 0TH- X 70RY LIMITS ER .................................... EL EACH ACCIDENT $ 500,000 C THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE REXCL 82NUB824K498-1-98 08/18/98 08/18/99 EL DISEASE-POLICY LIMIT S 500,000 EL DISEASE-EA EMPLOYEE $ 500,000 OFFICERS ARE: OTHER ,:y2 •.{{ •. •.; •{.;;::.;•::::.::::. �.;:.;;:.;..::..r•: •;•:;•rx;•r 22: 22.r:{.r:•r:•r:;.r:•:;•:;.:;•:;;•r:;i•>x,2•rrr:,•r;;{.:{•;:{{•:;•.;;<•>::::.:::<.>:<: {:: c{.:::::::•:::•:::::. �::::. �:. T�I%1'•r ,ccaicai%i.`a +a:•: rrr. w,r, ... ,.,. ,... wsrrr:s:•rs:•rrr. ti:: is � ii2` .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZE PRESgNTATIVE T U v :. . . ..................................::::........................:.::............:.:.......;...........:..:..::.v:: r:{{;!,;. ;..v;n. r•: rr:::; r:rrr. > ... ..................•.. .... .. rr...;�,::}•:.}•:.}:.; ::; ;::.:::2::2:: ;:::::.;:::::: {::: ;:.;}+; .;::::.: r: ,..:.i:z<f£zzz4rt:�zss4£:.�:4ttaza ���f?1�E1{3L1f�l�Li�3!�4t4Rf:;+tA!!#�:<s 7k e.vnza.1d a�./f/%uaaclivael�a DEPARTMENT OF PUBLIC SAFETY CONSTAU.C,TI;ON SUPERVISOR LICENSE h Ex fres Birthdate: .M-23 -021912000 0219/1963 GIENy }#� RIN.GTON ! � TE?dNiS PtRZA RD UNIT 28 DRACUT, MA 01826 x w Q p w v Ci cn a0 w z z Q m 7 w rL U ro w 0 w a 7 00 cG id ii O W W W _c4 v cit c i% x O U a ... C °D 0 C4 c ii z W W W c 7 ro o z n E cn UJ z c •CD � : 0: o co : c y O � c c c : v v C7 C=C 7a L Q d CD E G .� C.) yoCLn E E m O U 'E m co'O `; yam O L- Z O € co �• lz�rnCD > 3 B" O � c �: m� vi 0 N 0 O '' ^^ M C L C m O v J +-a V L a a Z O O d c a- Ley o w O �a :'E m U y CWE. L- c cv ev 7. 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