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HomeMy WebLinkAboutMiscellaneous - 83 QUAIL RUN LANE 4/30/2018I 1113 -'1 � Date .... .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING his certifies that .4t. . . ....................................... has permission to perform..X. ..Or-..N.qA ..... A ... ...... plumbing in the buildings of ... . ... ...... P .......................................................... at .............. 5..� .................. .......... North Andover, Mass. Fee 60— Lic. No. �7&-, ............ . . ............ ................................................................................ Check# Lbqoi PLUMBING INSPECTOR 0 ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM !PLUMBING WORK CITY ORTH ANDOVER y MA DATE 9130/2015 µ PERMIT # JOBSITE ADDRESS83 QUAIL RUN: OWNER'S NAME DINAPOLI _._ POWNER ADDRESS TEL[ _�FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: Ll RENOVATION: 0 REPLACEMENT: PLANS SUBMITTED: YES NOE FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB E ». ..........s cox: 7 CROSS CONNECTION DEVICE 1 r E r DEDICATED SPECIAL WASTE SYSTEM._ DEDICATED GAS/OIL/SAND SYSTEM ' ' _ F 1_�.. DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM r DEDICATED WATER RECYCLE SYSTEM DISHWASHER - 1.... L...... DRINKING FOUNTAIN FOOD DISPOSER i € FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR)nF- 171F- ............. KITCHEN SINKLAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES i WATER PIPINGw OTHER .................. ......., .. ... _. __.. ,,. 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 n OTHER TYPE OF INDEMNITYE] 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 0 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 accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Prtj nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME MIKE CAPELESS LICENSE # 15851 SIGNATURE MP[21 JP0 CORPORATION # PARTNERSHIPEl#= LLC 0# COMPANY NAMECAPELESS PLUMBING &HEATING ADDRESS 160A PLEASANT ST CITY NORTH ANDOVER STATE iMA ZIP 0184554. TEL 978-382-1017 FAX ���� CELL__ EMAIL Date.i ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION I;his certifies that ....... 0.1.114 ..... has permission for gas installation..... .CA ................................................. �1,� A in the b *ld* gs of ............ t,- ........ "'m at ........ ....... .A DU . ).� ..... -J North Andover, Mass. Fee...'.'4'J . ...... Lic. No. .191.01 ....... ..................................................................... Check It �961 GASINSPECTOR The Commonwealth of Massachusetts µ Department of IndustrialAccidents 1 Congress Street, Suite 100 = Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): ir Address: 16M `J J City/State/Zip: IV 14n z11) V`Ct' MAO f Are youanemployer? Check the appropriate box: Type of project (required): i Zama employer with employees (full and/or part-time).* 7. New Construction 2. ❑ I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity. [No workers' comp. insurance required.] 3.FJ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 9. El Demolition 10 0 Building addition 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 11.0 Electrical repairs or additions proprietors with no employees. 12. [ijgjadibing repairs or additions 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.1 13.0 Roof repairs 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Q Other 152, § 1(4), and we have no. employees. [No workers' comp. insurance required.] *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, %ey must provide their workers' comp. policy number. Yam an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: /V(§- -iAe', i) S G Policy # or Self -ins. Lic. #: ! ©® r, U11 Expiration Date: Job Site Address: 60 Qt-LAt � City/State/Zip.k. Al d , , M4 D1 M� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration 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 DLA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. ✓�� Date: /0/ 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 #: :::1?6::,yrtillilVl'i'ii"tYYT'LtWI'■■'Vl" tittivl.\Yf.'1Vt"tVV••.t: t..1✓:•.r.::.::'.: PLUMBEttASF ITT ERS r; ,r ISSUES'THE FOLLOWING L>iCEhfS>= �+u L CEwSE�. AS'`. A . MA5TER -PLUMBER MI CHAEL ,N CAPELESS s x -15 0 1 1/l6 223407 tl• Log• 0 0 0 a: -4 m 0 CD 0) 3 E (D CD 0 0 (D 0 0 c 'a 0 0 0 CD n ca ID 7 U:E 0 CL =r CO c c (D 0 00 CD a -0 3 CD CD Z rr m 0 00 -4 :r ol c CO r- 0, ul M 0 CL CL (D CD 0 :3 0 x 0 (D CD 0 ET 0 'D CD 0 0 z w -9 CD 0 0 9-,) m 0 "n 0 0 z 03 -4 o 0 0 F * co b z (a o o o -n CL U) Z �- m 0 CD (D > > CD Z ,'�3 M C.) Z 0 z m Q M 0 Ri Or4** To K,/2 Date .... Z<2 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... /-?.. u - le. - 9 A. � .......... C7z�.c.l ....................... has permission to perform ..... Y (�;4 �. .................................. wiring in the building of ......... p - / e., e .......................................... 'j 12( at ...... C/,V7U, / ...... ..... ­'"�' ) ............. . North Andovei, Mass. Fee.3E.42-I!77. Lic. No. LYAf,05it ....... 4ic; .......... Check # C nweaLih d( Xama�A official Use Only o� 1�/ Permit No. T% IftA 2d� apiire sew A Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS .1/07] save blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in ac couiaace with the Mt�useus Electrical Code (MEL'), 327 CMR 12.00 (PLEASE PRINT ININK OR EALL INFORMATION) Date: t27 -1511-10 City or Torn of r 42LI e j To the Inspector of Wires: By this application the undersigned gives notice of his or her mterrtton to erform the electrical work described below. Location (Street & Number) 3 Telephone No. � l0 Owner or Tenant / Owner's Address Is this permit in conjunction -�with a building permit? Yes U Purpose of Bun ng /C C� �L L`�Q m �-� Overhead ❑ Overhead ❑ No (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts New Service Amp ! Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters U r ....,tm..,» nrthv rallmvine table may be waivedbY� InspeCtor of Wires. the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal Policy.) Inspections to Work to Starr be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the Performance fo �e or itssubstantialal equivalent. The the licensee provides proofof liability insurance including "completed operation- undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Spceify=) I certify, under the pains and penalties of perjury, that the informatio n this I cation is true and completes LIC. NO.: FIRM NAME: ' ¢I'QS fi /•�•S , < . NO.: '-2�SOt5 � �; Signature LIC .iris! �/ Licensee: `f% - Sus. TeL (if applicable, enter `exempt" in the license n mrber lme } �O � Ait. TeL No :MR::V-�'Z 5� Address: i : / f *Per M.G.L. c. 147, s. 57-61, security work requires Departm of Public Safety "S" License: . tic. No. OWNER'S INSURANCE WAIVER: I am aware that the censee does not have the liability'insurance coverage normally or a lent required by law. By my signature below, I hereby waive requirement I am the (check one) ❑ ❑ OwnerlAgent Telephone -No. PERWT FEE, Signature CWHVIONWEALTHI OfF lViAc7i7AS.zHU SE t S: IICIANS tEGIC ER E MASTER ELECTRICIAN ISSUES THIS LICE.IISE TO BARROS COMPANIES INC JOHN BARROS - 164 EAST ST �z FOXBORO MA 02055-2253. 12168 A 07/31/10 289167 � COMMONWEALTH OF MASSACHUSEM AS A REG .#OURN€Y AN ELECTRICIAN ISSUES THIS UCENSE TO E JOHN BARROS 164 EAST ST FOXBORO MA 02035--2253 24801 E 07/31/10 289166 er x x w x r o r �� �. � _ cr.±ia r 5SAC64US Date.. 6 TOWN OF NORTH ANDOVER .PERMIT FOR GAS INSTALLATION This certifies that ...... .... cc ................. C has permission for gas installation .6�< n in the buildings of at r. t� .. j� s—kL� North A�IZ'dov, Mass. Fee. ....... Lic. No.. J . ....... ....... GAS,!INSPE R Check # & (, � � 726b r FIX MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CityRown: /Y�' -off Date.. 05�-/f;��U Permit#. Z Loca6c U0 p �r7 QCOwners Name: Y Building ? G� . Type of Occupancy: Commercial Educational- , industrial instiiulional� Residential New:: ✓ Alteration: Renovation: Replacement» Plans Submitted: Yes No'. i/ FIX WRES Z Y H =m atzt—l = 2 a d z .jI z � On W O aLU IX F c n o o I F 49 auj m x WW2 F 0: V Ul > a w 1 o W UJ -s � Z = woo i= O z -j © tin. W x z w O I- W M W w z�- = W o ffi n a =' a W hu a M iu OZO lar ¢ O e g as 1= w z 5 z z W t- a S _ r o U G C u. o v a z It 1>! t- >>> SUB'BSIVIT. i 1 BASEMENT 1 z FLOOR I 2 FLOOR 3 FLOOR ,em FLOOR b FLOOR 6 FLOOR T... FLOOR 8 FLOOR 1 I { -.:. .. Check One Only. Certificate # Installing Company name:.}'? mon ? . Addrewle citytrown;-}vr��t stage: ant. Partnership Business Tel:. -1/ fax: ; J�.� -5/ FirrNComparry _ Name of Licensed PlumbedGas Frtter:. INSURANCE COVERAGE-. -7-- I have a current i"ra iL. nsurance policy or its substantial equivalent which meets the requirements of MGCh. 942 Yes:' No If you have checked Yes, please Indicate the type of coverage by c1melting the approprhft box below. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee dam not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this pennit application waives this requhr+emenL Check One Only Owner Agent = By checking this bar Ek, i hereby cerWy that all of *0 details and infori ation l Crave subinMed (or entered) regardtg'dfs applicaion am true and accurate to the best of my Knowledge and that all Ourrrbfig work and Insfalldimns pwforrnwd raider the pwa issued for tIft applkPUon will be in compNance with all Pertinent provision of the NkissadwsedsPlaertbing ? 9 G¢tieral • - Type of Liter sX Plumber't-- - Ve Cas Auer Sign - re of Licensed Plumber/Gas Fill3er :CityFfovlm - Joh U ense Number. e3 -wnnnn�r�n �nr�in=si�c ^10 %n LID hummer O z 0 0 y o a o L o � law q ;r U Spa! C L T ft L— -, Location No. C-7"4� Date jORTol TOWN OF NORTH ANDOVER Certificate of Occupancy $ *Aroo^ .2s CHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �/ ,v /(:�, 157 16 Building lnspecllor�/ 4 ru"7 4 Date. . 711 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... /'� ......................................................... has permission to perform ....... n.f./�../ ............................................. ,miring in the building of .... /,)P. '7 -at ..... I/ ..... Q. ��. 9 .. n/ ....... ............ . NN h Andover, S. &e Lic. No.. "6 ............... ....... ICALrliiNSPECTOR 9' CheCK ff 7;;(5 eOWMIME ae',yttere«t od �uBlie Sa�dy BOARD OF FIRE PREVENTION REGULATIONS,527 CMR 12:00 Official Us Only Permit No. If Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 9 I l t 1 U -- To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number LqU ALt L— ►'- 0 Owner or Tenant �%V L tilt-c>O ��4'z� Owner's Address is this permit in conjunction with a building permit Yes ❑ No Lff (Check Appropriate Box) Purpose of Building Utility Authorization No. 10k ? ( 7 Existing Service Z,00 Amps t Zu t Voits Overhead ❑ Undgmd Cr'— No. of Meters New Servica -7Uy Amps L 2 voits Overhead ❑ Undgmd R/ No. of Meters Number of Feeders and Ampacity c- ew-e mr,-�—J-ck Svc _ Location alp Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy inciudin pleted Operations Coverage or its substantial equivalent Pco\,raoge ha valid proof of same to the OffiNO = If you have checked YES please indicate the type o by checking the appropriate box SURA C = BOND = OTHER = (Please Specify) (Expiration Date) ,; 33 Estimated Value EI rical Work$ � vp 0� Work to Start Z— Inspection Date Resquested C -4 -t -k---- Rough Final Signed undertl}e Penalties of perju FIRM NAME if'� ( AA A -f L F —Tykt rA A V t CE5 —& LIC. NO.(M J f1:1 No. 4 2 7 d, 05- Bus. Tel No. �03 i`Sl- 20%`7 Address �Jw0�7� ( - 1 "+ ' Ste"' It. Tel. No. OWNER'S INSURAICE WAIVER: I am aware that the Licenses does not ha a the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) r Telephone No. PERMITTEE b 5.10 Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. rd Dishwashers S ace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection —'1 No. dif Water Heaters KW No. of Signs No. of Bailases Low Voltage Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy inciudin pleted Operations Coverage or its substantial equivalent Pco\,raoge ha valid proof of same to the OffiNO = If you have checked YES please indicate the type o by checking the appropriate box SURA C = BOND = OTHER = (Please Specify) (Expiration Date) ,; 33 Estimated Value EI rical Work$ � vp 0� Work to Start Z— Inspection Date Resquested C -4 -t -k---- Rough Final Signed undertl}e Penalties of perju FIRM NAME if'� ( AA A -f L F —Tykt rA A V t CE5 —& LIC. NO.(M J f1:1 No. 4 2 7 d, 05- Bus. Tel No. �03 i`Sl- 20%`7 Address �Jw0�7� ( - 1 "+ ' Ste"' It. Tel. No. OWNER'S INSURAICE WAIVER: I am aware that the Licenses does not ha a the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) r Telephone No. PERMITTEE b 5.10 • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: Z- SIGNATURE: ---- '044&f Building Comrnissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 9�3 p u oU Pu ti 1.2 Assessors Map and Parcel Number: 6 o ;a l 3 Map. Number Parcel Number 1.3 Zoning Information: Zoning District Proposed.Use 1.4 Property Dimensions: 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.Ql_C.40. 54) 1.5. Flood Zone Information: Public 0 Private - 0 zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 Ou Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT L.1 owner of Kecord Nu.I. Mik. 060144 C-. Qulll-I Pow Name (Print) Address for Service: —g6�cl Signature Telephone 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Licensed Construction Supervisor: ,,;u —I . fv. Address Signa re Telephone 3.2 Registered Home Improvement Contractor �rou s r Company Nam . (_ PV 0 Address for Service: KV,, , SlQlCW• lV[t r Not Applicable ❑ /0/ License Number Expiration Date Not Applicable ❑ Registration Number Address 7&7,:�o 6c3 Fqq - Ll��efy Expiration Date SECTION 4 - WORKERS COMPENSATION (ALG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: G0V..?f 10L'610ffed►1 rs!-tc SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed bpennit applicant 1. Building (a) Building Permit Fee Multi lien 2 Electrical (b) Estimated Total Cost of Construction -So 6 - co 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical AC 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 I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE WKZ: L ',01 UigJ k— !{�1? Y�Jtl £'✓ ! 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CERTIFICATE OF LIABILITY IlNSURANCF,;,,,cQ 1 - DA07/15/02 I PRODUCER THIS CERTIFICATE it ORMATION Davis, Davis & Moody ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENT] OR Route 125 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Plaistow NX 03865- _.__.._...... Phene:603-382-9354 Fax:603-352-7786 .........,.......,...,.. ,................. _--- INSURERS AFFORDING COVERAGE Y75URE0 INSURE _...._.._.._ ... -- R A• Merchants mutual -_-� INSURpR 8: Brooks Construction Co., Inc. 2514 North Broadway Salem NH 03079L I INSURER C: INSURER D —_....._ ....,. ._..,..._. : �.—••- -- ..•• INSURER E. UUV CHAKiCti THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I5SUED TO THE INSURED .NAMED ABOVE 14OR TME POLICY PERIOD INDICATED. N07UVITHST'ANDiN13 ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTIRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEb OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. bR-:.,:,......� r_. ... .. ..._�_TRP�FFECTIG'EF�[5 GTR TYPB OF INSURANCE POLICY NUMBER DATG(MEMIDDlYY) LINUTS A Xj•-OE-N,ERALLIABILRY COMMERCIALCENFRALLIABiLITY CLAIMS MADE 7OCCUR I .. ,. CCP6146621 I 04/29/02 EACHOe;CURRENCE ;62000000 04/28/03 PRE DAMAGE (Anyone fire) �S 1OD00p "'MED EXXP—(Any— one peron) r..,.. 5000 I PM:MONAL & ADV INJURY, $ 1000000 _.__.._...... GENERAI_AGGRECATE s2000000 GEN IL AGGREGATE LIMIT APPUES PER: POLICY ", ��7 ! PRtSDI UCTS. MVP/0P AGG ' S000000 Z AVTOMOUILC I LIASIUTY ANY AUTO I �-� COMBINED S.NCLE UNIT (Et seeideod I I� I. ALL OWNEDAVTOB SCMEOULEC AUTOS HIRED AU't]S NON•OWNEDAUTOS I I i 80DILY INJURY (PQ1 pain') I Bt,7pikV INJURY (Paraccident) i b PROPERTY OAMhaE ... $ (Pcr accident) GARAGE LIAMUTY AUTO ONLY -6A ACCIDENT S t ANY AUTO I 01HER THAN EAAGG AM ONLY AqG ,_5....._.... a EXCESA LIADILITY rI� Dcc , U C_AIM.'MADE I I ( EACH OCCURRENCE S _ AGGREGATE I �,PUCYIDtf. i � a $ RETENTION &Al b A VYORK5A$ COMPENSATION AND EMPLOYERS' LIABILITY I I f ( WCA6145519 05/16/02 05/116/03 g T R R I. E.L. EACHACCIOENT $ 100000_ E.L. DISEASE. EA EMPLOYM S100000 _ E.L,D18EA41E_- POLICY LIVOT $ 500000 OTHER DESCRIPTION OF OPERATIONS&OC,ATIONSNEHICLES/EXCLU314N5 ADDED BY VMORSEMENTMPECIAL PROVISIONS CERTIFICATE HOLDER N : ADDITIONAL INSURED: INSURER LETTER: CANCELLATION AROCU01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES; RE CANCELLED BEFORE THE EXPIRATION DATE TN@REOP, THE ISSUING INSURER WILL ENOBAVOR TO MAIL .10_ DAYS 7JRITTEN NOT E 06RTIFICATE HOLDER MAMIZO TO THE LEFT. BUT FAILURE TO DO $0 CHALL PAUL $I KELLY MACDONALD POSE NO OB�r.ATION OR LITY OF aNYKIND UPON THE INSURER, IT$ AGENTS OR83 QtTAIL RUN NORTH ANDOVER MA 01645 REPRESE T �y 25-S (7197) ERS 01 a 1 • s•: . � o o ` C :.e cc V dC O A C O :off y Ea m c �o (D22 w : d E o m :oma �o $ ot r or ia x H COD W_ LL F-' W u COD N tm a � � m a a y m CLC Cc = ZOOm�oC; CL mm;ICL. O C mrd o o ev tyA d.0 C �E O � d. Q���� Oa� C m � w CL A c3i a w w U w" W u; w W U a w" n: ir. A cn ° cn cn . � o o ` C :.e cc V dC O A C O :off y Ea m c �o (D22 w : d E o m :oma �o $ ot r or ia x H COD W_ LL F-' W u COD 2i E y Z y O y C CD cc CD m v O . co Sc N m Z O Z 0 O 0 •r.a CD O co ■ L � O+ i.7 z °' CL O CO) o c C� cm I y O .co) FE m m CD 3 .o CM CD L O O a �Q O f� C cc CD c Z a 0 CL V CO) c C C _cc Q. 0 0 U) LIJ U) T LU LU 'w U) N tm � � m H O y m CLC Cc = ZOOm�oC; CL mm;ICL. O C mrd o o ev tyA d.0 C �E O � d. Q���� Oa� C m � w CL 2i E y Z y O y C CD cc CD m v O . co Sc N m Z O Z 0 O 0 •r.a CD O co ■ L � O+ i.7 z °' CL O CO) o c C� cm I y O .co) FE m m CD 3 .o CM CD L O O a �Q O f� C cc CD c Z a 0 CL V CO) c C C _cc Q. 0 0 U) LIJ U) T LU LU 'w U) Dgo-aar.Kat od%P5 657 WX55,461WUS577S ;D-" Sa6dy BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office UseOnly Permit No_ �ya Occupancy & Fee Checked_ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover Date To the In pector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number -�r 2, Owner or Tenant PAr�) L 7 ,J -4--c l Owner's Address Is this permit in conjunction with a building permit Yes ❑ No (Check Appropriate Box) Purpose of Building L 't 5 "T 4-.C— Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service Amps voits Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity, Location and Nature of Proposed Electrical Work OTHER• INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Combed Operations Coverage or its substantial equivalent YES NO = have submitted lilzpproof of same to the Office YESV NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE - BOND = OTHER = (Please Specify) (Expiration Datee) Estimated Value of Electrical Work$ `Ie 00 ,�� Work to Start Inspection Date Resquested Rough Final Signed undert Penalties of perjury: FIRM NAME/�AC� C�T� C/t'C— SL-�L(�4J� LIC. NO,J ge 'JZ Licensee M ([ ,4 (�1� �• �C�� ✓ ___ Signature `� LIC. NO. �. t7 j Bus. Tel No. (9U 7 7S Z- -4-./' - / Address_ t/ �t/00 ; > S 1 �lik c S (b �� Alt Tel. No. OWNER'S INSURA14CE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Total No. of Light;ng Outlets ice- No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures ( 7l Swimming Pool gmd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Rece techs Outlets No. of Oil Burners Battery Units No. of Switch Outlets L13 No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices . Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER• INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Combed Operations Coverage or its substantial equivalent YES NO = have submitted lilzpproof of same to the Office YESV NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE - BOND = OTHER = (Please Specify) (Expiration Datee) Estimated Value of Electrical Work$ `Ie 00 ,�� Work to Start Inspection Date Resquested Rough Final Signed undert Penalties of perjury: FIRM NAME/�AC� C�T� C/t'C— SL-�L(�4J� LIC. NO,J ge 'JZ Licensee M ([ ,4 (�1� �• �C�� ✓ ___ Signature `� LIC. NO. �. t7 j Bus. Tel No. (9U 7 7S Z- -4-./' - / Address_ t/ �t/00 ; > S 1 �lik c S (b �� Alt Tel. No. OWNER'S INSURA14CE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) ro z EA ..;!# Sk, I. 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This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** /APPLICANT:` 0� �_��c�'l. �'�✓I Phone K" E2LS LOCATION: Assessor's Map Number Parcel 1 t/ Subdivision p� / Lot(s) L --Street Q - Qci4 i Z 19r�,'l /_df St. Number E 3 ************************Official Use Only************************ RECO DAT OF TOWN AGENTS: Con ervation Administrator Comments Town Planner Comments Health Agent Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date I 61� r - LIL e i t t x x x r -n co T (1) 0 r_ > CL 0 0 0 O� 0 343 SD 0 (D _0 0 3 -n 0 CD 0' 0 m 3 0 :3 M = CD -n -n -n M 0 3 CD ;z CD CD (D -n ca CD (D 4A 69 69 160 69 69 69 c 0 0 0 —1 0 z 0 n z 0 z a 0 m m Z 0 CD fal ■ 0k m2 m� � 0 . 0 / 0 N > z , ! ! m m cl m w k F r © 0 0 § § § § § § m U, -' M c n � 0 z U) c a a! k ■ ; ; ; i m» 0 o 0 r z 7 c§ » |d|d » » ° r r r n k r E -Z°°` r r o z k § z m m; 0 x, 0 0 6 & 0 0 � 0 0` 0 ° 0 z § Z 0-4 z 0 7 m m ; z k) o , , 4a, o o § z z m m - ) 2 U) ■ - 0 . w r m @ z § m q ; » 2 @ ; § z 7 g z $ E 2 k ■ � § x q Ito �§ R § /[0 � - a! k » 0 0 0 m» 0 o 0 r c 7 c§ » |d|d » » r o = z , t , k r E -Z°°` r r o z k z m z m m; 0 x, 0 0 6 m p 0 0 0` ° z § Z 0-4 0 7 m z k) k m§} o o k z r§ m m - ) 2 U) - . w r m m q ; » 2 ; § 7 g z $ E 2 , q 2 . _ @. 0 , , , I o > m � ; ■ • M = k o © @ m � z , i c E c E|) E k 3 k) )))) r r! 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Public Works m < m c F 0 z z w 9 m n -4 0 A > > m n n � N - 0 I F r 0 0 c c yI m m m m i -4 0 0 z z in m w N Z c n 1 0 z N 8 r > z 0 n 0 m I w 0 "a m z 11 0 3 1 0 z m ° F �, ,� �, n m r m � o m> C n m < m c F 0 z z w 9 m n -4 0 A > > m n n � N - 0 I F r 0 0 c c yI m m m m i -4 0 0 z z in m w N Z c n 1 0 z N 8 r > z 0 n 0 m I w 0 "a m z 11 0 3 1 0 z D D O Z a i V m 3 1 O 01 C r v z O D Z S m p D N 1A m ° F �, ,� �, > A o o o m> C n 0 F 0 F r 0 N 0 3 z r r m c m c m c>>>> i l r I z z n Z ° 0 m r o_ r o r o 0 m z n z n z n m A A m p a A a m >° r z O Z 0 Z 0 r 0 m z m a m 0 Yi a o i 0 Z z>> O z 0 0 z > o; m > n r i o o_ m F ;; r m> z; m z m ` Irl1 z A > i 0 i r i m A m m m W i 0p Z i i 0 ; Z m m c Z C _ i o r o 10Z W C �I > m m III L0 < < m e2+ ` m r o. c i z 0 o w C n 0 a m 0 Z rAn > > m to a uI H> m I m 0 m a N mz > p a c N m c m c m c c m "�' i Z Z m p r 0 r o r o r 0> a r r m i 0 m Q m z w m 0 m M m L1 G1 0 0 0 m m O i p i A w n 0 0 0 0 z n z p c ,oi 0 A A m a O Z Z Z 0 = 0 O 0 �( m i > _mc r O n n n m z i oo m � m r m m m 0 lin 0 mm°< 0 0 0 o z fl ( a m 0 0 0 0 T m z m > 0 0 r m i N i F F 0 I m z z r � m F > Z ° m � A i m N m m r N z > Zx m i ° m n m � W z 0 � o mll D D O Z a i V m 3 1 O 01 C r v z O D Z S m p D N 1A �ommercial e Residential* Industrial JELECTRICAL S!!!!E5 All Phases of Electrical Construction & Maintenance Fire & Security Systems for Home & Business Mike MacDonald (603)382-2094 Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption Wlease print) GATE _3 - Z.-? - � <�- JOB LOCATION �- :j Q Number. Street A HOMEOWNER"—_�A V J� ;A�– ,,�A, ame ress ome Phone PRESENT MAILING ADDRESS ?j QvA-1L_ It64AJ ection of town 6yl;�- L5 Z_ Work Phone /� 0 , A t�AA A- 01 k (Y <- City Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as -supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwell- ing, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official, 1,hat he/she shall be responsible for all such work performed under the building permit. 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Check /,-,*LECMICAL INSPECrOR Cmomonwea[lir. o f Madeachajelb 2,1.,artnrent 01 jire Servicee BOARD OF FIRE PREVENTION REGULATIONS Official Use Only (� C� 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 (ldEC), 527 ChIR 12.00 (P1,E-ASE PRINT IN INK OR TYPE; ,ILL INI'OR,IL 1710N) Date: ' /9, d,2 City or l'own of: /f/ To the Inspector of R'ires: By this application the undersigned gives notice of itis or her intention to perform the electrical work described below. Location (Street & Number) !/1 1571—r X�4 /AV Owner or Tenant A141L 1:2-119r tQ0&11LQ Telephone No. 5,-o?52- Owner's Address Is this permit in conjunction with a building permit.' Yes E�— No ❑ (Check Appropriate Bos) Purpose of Building; Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Nleters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the folluwine table tnav be waived by der lnsnrrtnr n(11"irnc 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 Above In- S!!'(Illlllllla, Poul grnd.El rnd.11 o. o Emergency ig lung Batte • Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of Detection and No. Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons K V I No. of Self -Contained Totals: Detection/Alerting Devices No. of Disinvashers S ace/Area Heating KW p g Local Nlunicipal Connection Other No. of Dryers Heating Appliances pp K1�' Security Systems: No. of Devices or Equivalent No. of Nater KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total IIP Telecommunications Wiring: No. of Devices or Equivalent OTHER: If itach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the olvner, 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 E— BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (Expiration Date) (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cer•tifj', under the pains and penalties of peijm)-, that the information on this application is trite and complete. LIC. NO.: IS 7 %/, FI101 NAME: ��ob��e� �',U���C� `/I SignatureZ,,&6�� �.•1-�-�1` LIC. NO.: _ Licensee: _ (If applicable. enter "exempt - in the license number tine;) � —� Bus. Tel. No. 9ZY, 6 4, Address: FL616`®©© /%�l/'a 7' f� G(� 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 riry signature below, I hereby waive this requirement. I am the (check one) ❑ oxvner ❑ ow'rter's agent. Owner/Agent Telephone No. PL"RMIT FEE: S Signature P PLEASE FILL OUT BACK SIDE