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Miscellaneous - 83 SHERWOOD DRIVE 4/30/2018
Date.... ..................... ... . ....... . ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..... .. ....... .. .... has. permission for gas installation .. (z ............................................... in the buildings of ........................ at ......... &,1�5 .... ............. V.a-, North Andover, Mass. Fee....... Lic. No.'5 ....... ............................................................ ; ........ GASINSPECTOR Check# 0 51 9 2 91' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS -FITTING WORK CITY[ j MA DATEE4 PERMIT # - t JOBSITE ADDRESS %5 -\Ve— OWNER'S NAME L- %C tNO[3-1 G OWNER ADDRESSTYPE OR OCCUPANCYTYPE COMMERCIALE] EDUCATIONAL Q RESIDENTIALPRINT .CLEARLY NEW:Q RENOVATION:Q REPLACEMENT: (PLANS SUBMITTED: epat: lANGFS7 Fl DORS-# BSM 1 2 3 4 5 6 7 8 9 10 .11 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR :FURNACE GENERATOR GRILLE - . INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN. POOL HEATER ROOM I SPACE HEATER ROOFTOP UNIT TEST.:- EST—.-,' UNIT HEATER WNVENTED ROOM HEATER 1AIATER HEATER OTHER:. INSURANCE COVERAGE I have a current insurance.policy or its substantial equivalent which meets the requirements .of MGL Ch. 142 YES ;� NO Q IF YOU CHECKED YES, PLEASE.INDICATE THE TYPE OF COVERAGE BY CHECK! NO THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Cid OTHER TYPE INDEMNITY Q BOND Q 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 Q AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and aoauate to the best of my knowledge and mat all plumbing work and installations performed under the pernit issued for this application will be in o�nplian with P p Of -the Massachusetts State Plumbing Code.and C hap .142 of the General. Laws. LICENSE # TURE PLUER-GASFITTER NAME MB MP ❑ MGF 0 JP4 JGF 14 LPGI Q CORPORATION Q# I� PARTNERSHIP Q#F LLC COMPANY NAME ADDRESS ' CITY Uj STATE ZIP mi l '. i� D�_Z ny�O FAX CLL 5Od.. MAIL �,_ f i i Feb 201310:20a P.1 Ae ammonweam of Massachusem PrIntform V Deparftent of h dmMW A Office of .1 Cangress S&04 Suite 180 Bim, MA 0211¢-2817 Markers' C Insurance AMLqvit: BaNdersdCoatracto Flo 1111111111111111111, Phone #: Are pos as empla W. Check the a_ppropriste boy I.0 I am a employer widt 4. © I am a geamal centrad and I AAmWrwpg-c (fall and/or rArt tie) * have bhed the2.I am a sole pro9pdetm or partaw- s4 and lave no eaWloym workng for me in any rapacity. INo wad=' comp. ksunmce rcquire& I I hom woor doing all mut myself [No wogs' comp. Hsted on the anae2ed sluff. Thcse have W ;Ioyawanti ham worbers' comp, insuance.t 5. Q We aye a corpmadon and is officers have exercised dw right ofumprionper 3viM c. 152, §1(4), amd we have no employees. [No workers' damn. insurance aeauived.l Type of Project (required): 6. Q New acumcfim 7. QRemoddWg S. ❑ Demoblion 9. ❑ Bumftg addidw 10.0 Electical =palm at additions lLERPkmbbg repairs or adder 12.0 R> 13 Q oilier *any app%st decks box pl =st also 5D out the aecffoabdM s WWft ** wastes' t� moa t Iiosmoanas wfto subtsi{ rbs affidavit i s ffijYM doing an wa& and rhes i� � aaaoscaais nacstsubroit s saw a&davit"nadiCaaagsoc6. IC*mftacu=ff=ch=ktbisb=== eoWm bm employam rftbe Zmsne amstpayvidemea wmiaas' =nq-poliWv=bw. I act assCNRPIOYW this isproPfift Werkers' capon hunraace for ^7 empy0m Bt*w is Aupa%y ani .W atite in,�aativx. Iustaaace Company Nie: . Policy # or Self-ics. Lie. #: Date! . J& Sloe Ad&=& R SL&AJ 0 OC IDr I Vf, City/StM7,b: Afl GIMP,6�,, M/I 01 � `w Aatt & a copy of the kens=grin poft dechmtimPap (showkS the pdky=m*er and. date). Fail= to secure coverage as rimed and Sema 25A of MGL c. 152 encu lead to the hopositku af=imbd gand4ties of a fig rip to S 1,500.00 a ndlor cane -year fiqrko=ext� as well as civil genaldes in the Form of a STOP WORK ORDER and a fire of up to $250.04 a day against dw violator. Be advised that a copy of d s statue mt mag be fam==ed to the Off m of Investigations of Ow DIA for k ourinm coves va ficarsom 1a& Offxj t use oaf Do rmawrite in *& ar6 m be ceaapleted by dW or anm o, f�rciat iqVWWd wanees City or Tam Peramitil seem # Issuing AttdOarlty tchvle am* L Board of Beabb I Bwlftg Depart nent 3 Ciq*/rown Clerk 4s »racst htqmWr S. Pb mbim g kvegbw 6. Other CERTIFICATE OF LIABILITY INSURANCE DATE s' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SL AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the cediBcate holder. Is an ADDITIONAL INSU RED, the pollcy(Ees) midst be endorsed If SUBROGATION IS W LVED, subject to the terms and conditions of the poiN.y; cettaln policies may require an endorsement. A statement on this certificate does not confer rights to the EA Kelley 450 Veterans Memorial Parkwajr Building 5 East Providence RI 02914 a�sud� Michael Clark 513 Haverhill Street Raney MA 01969 au IunMo. wvcRnwca ��1; 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 OFANY CCNNTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUEDOR MAY PERTAIN; THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. L ITS SHOWN MAY HAVE BEEN REDUCED BY PAIR -- TYPE OF INSURANCE A POLICY NU MBER POLICY EFF P F9tP IMfrS A GENERAL LIABILITY x COMMERCW. GENERAL LWBILITY gAMS•MAOE Lai Katherine Me Kelley, AA.I, CIC WS207316 01!15!2015 OU15f2016 EACH OCCURRENCE ; 1,000;000 •s ouuinirav) ; 100,000 MEDEJCP(. oneperscn). 5. .5,000 PERSONAL & ADYINtluRY $ 1;000,000 GENERAL AGGREGATE $ 2.000, 000 NLAGGREGATELIMIT APPLIES PER: X POLICY LOC PRODUCTS-COMP/OPAGG $ 2,000.000. AUTOMCGLE LNBIUTV ANYAUTO ALLOWNEDAUTOS SCHEDU LED AUTOS HIRED AUTOS NON-0WNEDAUTOS (E a � PIGLEUMrT s OOOILY IN,i1RY (Per person) 3 BODILY INd1RY(Perecddent) PROPERTY DAMAGE (Peratdderd) S $ S UMOWLLALI" EXCESS LIAB OCCUR CLAIMS#AADE EACH OCCURRENCE -Ir AGGREGATE - b DEDUCT BLE N RhIt:N110N 3 WORKERS COMPN9dSAT10N AND OaPL.., LU48�IITNY YIN Ayy OPA�/PA fN RIEXECUTtYE (d r qy n M eu r NIA 0- - - E.L.FACHACCIDENT 3 El. fNSEASE-EAEMn(AEE S E.L.DISEASE --POLICY-LIMIT S DESCRIPTION OF omB Ar"w I LOCATIOPIS 1 VN3iICLIS (Allad'I ACORD 1a7, Add UonN RsmMcs SdroduK K mere space b roatleed) Plumbing Contractor. a.crcurwA�cr,v�ucn -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SWORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE wrm THE POLICY PROV'MONS, AUTHOR96D REMMSENTATIVE Katherine Me Kelley, AA.I, CIC ®1998 -PWS AG0110 GoKPOKAnum An ngnRa resarvaa ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD May 31 1404:07p Fold Then ol!Wch Along AD PerforAoi,,..jjWMMOINIWE;:A47rH np mi s.sAcPLUMS T�CLARWLEY0196 P.1 Cunningham Lindsey U.S., Inc. P.O. Box 703689 Dallas, TX 75370-3689 Telephone (888) 738-8714 CLCAT@CL-NA.COM Facsimile (214) 488-6766 ***********************AUTO**3-DIGIT 018 778 T3 P1 95000058968 Building Commissioner or Inspector of Buildings 120 MAIN STREET RVI N ANDOVER, MA 01845 PEW Claim Number: Policy Number: co Company Name: co CD co Cause of Loss: LO Date of Loss: Insured: 0 Property Location: Cunnin fiham `% l�Lindsey Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B 3077490 3077490 00 BAY STATE INSURANCE COMPANY ICE DAM 3/4/2015 DANJING SONG 83 SHERWOOD DR Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3.13'., -'No insurer shall pay any claims'(1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss,'damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. On this date, 1 caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicatCa@cl-na.com 800-867-3885 Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that...i.c PL6A ri ............. ........................... has permission for gas installation ..... . ".; in the buildings of ... Y.1 ......................... at 4 h ver, asK. j Fee. a4.�"... Lic. No..,,. GAS INSPECT"16R Check# 8274 i.. ..., i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,CITY�MA DATE L PER IT # JOBSITEADDRESS CD�,��O�Yi ��' OWNER'S NAME S I OWNER ADDRESS TEL 9-1� V615 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO\�4 APPLIANCES 7 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE a INFRARED HEATER '- LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the _ Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE # )5a3a SIGNATURE MP [�( MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION V 4ULQ(Q C PARTNERSHIP ❑ # LLC ❑ # COMPANY NAMEl af�L��ISW poati S. kc ADDRESS (O `&Cif) a )Jeff CITY STATE ZIP 0103 TEL Q%9' %I-DOl � n p FAX 9� $' �5' %66M CELL q? (� - 7n O% - iYJI q EMAIL kC&SeW 0 Qn CUL 0 641 C'6mp an d5- C n W F o z 0 H aW. z z w �N N � Oj >4 o� •a Z ?` z w � � w OF a LU 3 r v, W � a W� ` U W w w O > w W t w U) a d o a o, a cn U x a F a a � Cl) ui x w W F O z z o I H U W a C z d 0 0 a � 9513 Date. .. ....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . has permission to perform .................. ................. plumbing in the buildings of . 4 1. A . .-. . ::�. A ................. . at .......... o h dover, Mass. e Fee. Lic. No.. Check ff 0 0 PLUMBIN INS�!ECTOR MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK P TYPE OR PRINT CLEARLY CITY -A AndOYec MA DATE 07,�tl 2012 PERMIT# JOBSITE ADDRESS '�S3 '�- 10 C'WQ Od Dr OWNER'S NAME Yi(l i OWNER ADDRESS TEL 11$ (0Eb IS -6 FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: 4 RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ N0i FIXTURES -1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142, YES NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW (' LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE # 159 �ia x SIGNATURE MP JP ❑ CORPORATION [f# PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME 0'(Un q�q ibjffljQLjr1Iij,S .1 C ADDRESS I() �1�icn�ri�S T21�r CITY Doy,/U5 STATE ZIP TEL FAX q'?e ?SG 053 CELL CC2& `Q67 -ODI ci EMAIL kC( SXII , C f_ LY� f'0'161I2 vjL'es &V"' z o H w a z w N � � O ❑ z z }El o � w w � W o CL z LU 3 a W a w fx O w 3 a k 0 z w � � U i J CL a e� Cl) w x w I-- L cn W H O z z O 00 H U W a C7 CQ W a O a i,v, . -,^ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegibI i Name (Business/Organization/Individual) : C rQ rlh COM am eS Th c Address: /0 pa( K 00 TerraC2 City/State/Zip: Danvers lq4 d (9;? 3 Phone#: Cj �� �� '6 % 60 Are,you an employer? Check the appropriate box: 1. V lam an employer with 55- 4. ❑ I am a general contractor and I employees (full and/or part time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. � required] 5.0 We are a corporation and its 3. 1-1 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no employees. [no workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ 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. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. rr Insurance Company Name: A 5SoCtGitE�. rtcI�t- 1Ir! PS d� N%Q SQCtiUS'� S Policy # or Self -ins. Lic. #: W M Z'3 0Q& Q 3 OI a 0Expiration Date:_ Job Site Address: 8�P,-IAL) C��rfQ0J City/State/Zip: lc A043 a 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: (1CU� —Ino Gl LO/b,� Date: Print Name: l ' /– Phone #: 7F, %67.601k' Official use only Do not write in this -area to be completed by city or town official City or Town: Permit/license #: Issuing Authority (circle one): 1.Board of Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: Phone #• 7498 Date. /.�O—V"P ...... 0 TOWN OF NORTH ANDOVER MOO PERMIT FOR GAS INSTALLATIO'gepe""" S 'TS S CHU This certifies that . . C. /.z /9.'�� �! �� �'. . erl ................. has permission for gas installation ... /L "'. -ey.< :-� .......... in the buildings of .... y �.�I ..... It .......................... N rth Andover, Mass. at 3 P -c 14 ... o Lic. No..q. 261. Fee. .7�? .... - D -'I- --I ..... Check 4 Z -h -1�1 LSWCT0R7>- a VIYTI IRPC Q: uJ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING. City/Town: , MA. Date:_jzZ1 Permit# Building Location: 0� i( �(�(t(�(I�(� Own``ers Name: Y11n 6h,l I Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residentialf N New: ❑ Alteration: ❑ Renovation: ❑ Replacement: v Plans Submitted: Yes ❑ No ❑ VIYTI IRPC Q: uJ Wl— N N Z NCq VX H co F. O LU U' .W.t U i z U) O z W 0' ° w W W Z: a m W 0 W I` Q: W W O 0� l-- x ix' tiCe Cl) v W is O la rn O w Lu z. EL > O W Z O J W ina t— t= w 0 2 m w J l7 O 2 LL N Z 0 y> WLU z Uj x O 0 a. tr 0 u. O 0 x a> 01 0 a a W 0 W z a 1- >>> z W Q S 1- O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR -im FLOOR 4 FLOOR 5 FLOOR fi FLOOR 7 FLOOR 8 FLOOR p��(11� Check One Only Certificate # , ctnne" � Installing Company Name,. Address2u • !Town: I Ci ►'y� �tY ��`S State: Y 1iq El Corporation ❑ Partnership Business Tel: 17% —15 ('0900 Fax:. '479 1-7-1 3$ Ll Firm/Company Name of Licensed Plumber/Gas Fitter: 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 have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box ; I hereby certify that all of the details and information 1 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. Type of License: By ❑ Plumber Ila ❑ Gas Fitterr, Title nature o Master i ense lum er as Fitter ❑ Cit !Town [--]journeyman y APPROVED OFFICE USE ONLY ❑ LP Installer License Number: lei 8 77 4 Date PA/Z... TOWN OF NORTH ANDO ER PERMIT FOR PLUM. ING This certifies that CIA ................. has permission to perform ... .................... plumbing in the buildings of ... Y, ..................... a t ... 4�77 .. 5-A- D/-� ... N x -7th Andover, Mass. Fee. .7. Lic. No. ....... PLUMBIN INSPECAO'R Check # Z. 1 J INSURANCE COVERAGE: LLL��� I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability Insurance policy Other type of Indemnity ❑. Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Tide Itamber 49nature i ense lumber Cityfrown t— ster APPROVED OFFICE USE ONLY) ❑Journeyman License Number: 906l __ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:_ UC7i"ifl Hr 0jolf-C , MA. Date: I O Permit# Building Location:_ 3 E erWOO �,�rIVe, Owners Name• in 6%11 Type of Occupancy: Commercial ❑ Educational ❑ Industrial [3 Institutional ❑ Residential E] New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ INSURANCE COVERAGE: LLL��� I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability Insurance policy Other type of Indemnity ❑. Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Tide Itamber 49nature i ense lumber Cityfrown t— ster APPROVED OFFICE USE ONLY) ❑Journeyman License Number: 906l __ Z Z N } V J T H W m nom. Ix W z a td v7 N a F W W z_ d 0 F- w.O O z m Q O G m Q' 13. IL N 9< tYa SC to z —2 0* x U. Q O Ce i G W y J Q Z z t= Cc ce H fe y Q a m 4�� m a JO a 0 F a u. O x W D> g O O O Imo- o Ir SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 u FLOOR 4 FLOOR ,51 FLOOR fi FLOOR T FLOOR 8 FLOOR Check One Only Certificate Installing Company Name: ('nQo�j nmp Q1 -e 3 Address: 2UyVQt�s Ci /Town r City/Town: �t'>�'111PS� State: � ' r� E] Corporation Partnership El Partnership (� Business Tel:q-A X50 0-oo Fax: 9je 777 3 ❑ Name of Licensed Plumber: Narryl I l cu INSURANCE COVERAGE: LLL��� I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability Insurance policy Other type of Indemnity ❑. Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Tide Itamber 49nature i ense lumber Cityfrown t— ster APPROVED OFFICE USE ONLY) ❑Journeyman License Number: 906l __ —[ ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID RP DATE (MM/DD/YYYY) CRANNCO 03/29/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO TYPE OF INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thomas Gregory Associates Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 601 Edgewater Drive S235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Wakefield MA 01880 Phone: 781-914-1000 Fax:781-246-2601 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Netherlands Insurance Co INSURER B: North River Insurance Company INSURER C: Cranney Companies, Inc. 10 Rainbow Terrace Danvers MA 01923 INSURER D: INSURER E: PREMISES (Ea occurence) $300,000 COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DALTE MM/DD/YY EFFECTIVEICY PDATE MM%DD/YY N LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CBp 840 43 40 03/25/10 03/25/11 PREMISES (Ea occurence) $300,000 CLAIMS MADE [j] OCCUR _ MED EXP (Any one person) $ 15,000 PERSONAL BADV INJURY $1,000,000 X Per Project AGGREGATE GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 A ANYAUTO BA 8400753 MA AUTOMOBILE 03/25/10 03/25/11 (Ea accident) r000 r000 BODILY INJURY $ ALL OWNED AUTOS X SCHEDULED AUTOS BA 8753297 03/25/10 03/25/11 (Per person) X HIRED AUTOS OUT OF STATE AUTOMDBILE BODILY INJURY X NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 B X OCCUR F -I CLAIMS MADE 553-093231-5 03/25/10 03/25/11 AGGREGATE $ 20, 000, 000 $ DEDUCTIBLE Prod/Comp $ X RETENTION $ Q 0ps Aqqr $10,000,000 WORKERS COMPENSATION AND X TORY LIMITS ER A EMPLOYERS' LIABILITY WC 840 47 40 03/25/10 03/25/11 E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE -EA EMPLOYEE $1,000,000 OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE -POLICY LIMIT $1,000,000 SPECIAL PROVISIONS below OTHER 10 Days Notice of CANCELLATION applies for NON-PAYMENT OF PREMIUM DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Mx CERTIFICATE HOLDER CANCELLATION EvIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATH DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL XXX DAYS WRITTEN Evidence of Insurance NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 4t2 . i RD CORPORATION 1988 The Commonwealth of Massachusetts Department ofLtdustrial Accidents 4 Office of Investigations d 600 Washington Street W" Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers NaMe (Business/Organization/Individual): 60 h'1 Address: _ / U - (A . 0(,J 7-e rr a (-- employees (full and/or part-time).* City/State/Zip: 00 h ✓e Yf 1414 U 3 Phone .#: 7 F. 7SSo . (0 p G u an employer? Check the appropriate box: AYI 1.am a employer with G, D 4. EJ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance.$ required.] 5. EJ We are a -corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. EJ Demolition 9. [] Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees, If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Name: &A A e/`,1�1�i i1 (d �C Policy # or Self -ins. Lic. M w C � / O q -7 7 Expiration Date: -311;2 S �� Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance covera¢e verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 17eI IVo_. use oniv. Do not City or Town: to be completed by city or town official. 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 �oj�ation 0 Date 14ORT#1 01"'90 TOWN OF NORTH ANDOVER 0 Certificate of Occupancy Building/Frame Perm 4L it Fee $ Foundation Permit Fee Artk Other Permi t.Fee Sewer Connection Fee Water Connection Fee TOTAL CU \--,bjUIj�h'adInspector zu 12 Div, Public Works Locatio No. Date, V40RT WN OF NORTH ANDOVER 0 :,..-6 0 N 0 . . I I C $ _if icate of O.ccupan y 13 h ding/Frame Permit Fee $ CHU -v Foundation Permit Fee C UM Other Permit Fee Sewer. Connection Fee Water Connection Fee Mv TOTAL V R6� d in rrlrg Inspector 150.00 P /97 12:01 1 09fl3p - Div. Public Works d Location No, Date f TM TOWWOF NORTH ANDOVER' Ce e f O�'&Upan'c`y \ $ qIficat o B! rn Permit Fee $ l(,]jing/Fri Fo dation ermit Fee Ot Permit Fee $ Cv 4 'Sewer Connection Fee $ 7Water Connection Fee $ Ag 97- 60 TOTAL Ott - /o47 B!_�dln �ul Adin, sp 7/� Dlv. 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Ln c. 0 r. t7a z ino CM %K1 I I I HM A -M JIMM HOA A Q 0 Of M AC,-; IT C'. r., c. r. z ino CM Vol P.O. BOX 907 TIMBERLAND BUILDERS NORTH ANDOVER MA. 01845 STEPHEN R. KARETA TO THE BUILDING INSPECTOR, DUE TO -RECENT CHANGES IN OUR ORGANIZATION WE WOULD LIKE TO CHANGE ALL OF THE BUILDING PERMITS CURRENTLY OUT WITH TIMBERLAND BUILDERS TO REFLECT THAT ROBERT INNIS IS THE CONSTRUCTION SUPERVISOR ON ALL OF OUR PERMITS AND WORK SITES. ROBERT INNIS HAS A MASSACHUSETTS CONSTRUCTION SUPERVISORS LICENSE # 058839 THE PROPERTIES AFFECTED ARE: 158 FOREST ST. PERMIT NO# 604 10 JERAD PLACE LOT15A PERMIT NO# 444 w 44 SHERWOOD AVE LOT 2 PERMIT NO# 560 96 SHERWOOD AVE LOT 7 PERMIT NO# PFNaN 93 SHERWOOD AVE LOT 13 PERMIT NO# 90 67 SHERWOOD AVE LOT 16 PERMIT NO# 603 IF YOU HAVE ANY QUESTIONS OR COMMENTS PLEASE DO NOT HESITATE TO CONTACT ME AT 508-557-5531 GAAP 2 5 I C C O 7 cd 70 �. O CD 1:31 c' CA 0 el - C.3 LLJ . 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CL r 'g N =r.3E o N N N n m=ra o o= 0 0 o, lb oCD M Da 06 :c)ILI 0 A Z' 0 0 00 c b p y o 0 r y g p CL °c MV, q? 014r LfummunwintO of 4Ittosor4uoPtts i9epartmettt of Pubiit %fettq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No.0-i(� Occupancy A Fee Checked 3190 (leave blank) 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 1�o7a2/9% (M* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street &�N,u!mber) �3 Owner or Tenant Owner's Address/)d &X 9o7 N Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building 2�SfT0 r�'A Utility Authorization No. Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service 000 Amps _�a6.&)y Volts Overhead ❑ Undgrnd No. of Meters Number of Feeders and Ampacity n Location and Nature of Proposed Electrical Work LA�iCLr k)i~i_� ®Iy1C OTHER: 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 er NO = I have submitted valid proof of same to the Office. YES ;j NO Z If you have checked YES, please indicate the type f coverage by checking the appropriate box. INSURANCE 4% BOND �_ OTHER = (Please Specify) ( xpiration Date) Estimated Value of Electrical Work S Work to Start Signed under the Penalties of perjury: FIRM NAM Inspection Date Requested: Rough Final LIC, NO. LIC. NO. Licensee "•, . ........y Bus. Tel. No. i ✓ ivz� o.? Address /�/ %IY>J�f%f�l� `��y /V `" 6'3O315;1 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. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) x•6565 Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Swimming In- grnd. No. of Lighting Fixtures I 9 Pool grnd. Above ❑ ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Other Local El Connection l I No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: 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 er NO = I have submitted valid proof of same to the Office. YES ;j NO Z If you have checked YES, please indicate the type f coverage by checking the appropriate box. INSURANCE 4% BOND �_ OTHER = (Please Specify) ( xpiration Date) Estimated Value of Electrical Work S Work to Start Signed under the Penalties of perjury: FIRM NAM Inspection Date Requested: Rough Final LIC, NO. LIC. NO. Licensee "•, . ........y Bus. Tel. No. i ✓ ivz� o.? Address /�/ %IY>J�f%f�l� `��y /V `" 6'3O315;1 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. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) x•6565 9 rot 4;4 0 41 Date ....... �/9L TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ....... ....... (.6 ............... has permission to perform ........ ........ ...... ....... ig wiring in the building t.-.z.A.. �-(d. 1(a. 1. /O/y ....... -7 at .. I./ ............ . North Andover, Mass. -2 Fee.,,.�..V'/W... Lic.. No. ......................................... ELECTRICAL INSPECTOR WHITE: Ap�plicant CANARY: Building Dept. PINK: Treasurer lAS5F1tit1U5E1 1-j C�It'UtiM A YLl1:A1IUN Fut �Nt[ N1�T `TOVID PLUf (Type or,Print) ff . e � S � •' f f ,NORTH ANDOVER 'Mass.. Building Location3 the,-�u�� c� �r .Co i� , • Permits Owners Name el, -5 w.. New 'Q Renovation j] ' Replacement [] Plans Submitted FI TURFy � . z Y < :. H W W W O Z z W , tl W O d Q Q•'' W Z. W 4 iC S e3CC '� O Z M 14 a •• s:.� (� Z tt p W W !» < I• W x O 4 W lC W O 3 W W Q W cc -A W T. )" I- O t] 'J W tr Q O •: t V Y 1- O X a 7 W l tL O _2 _Y40 46 < < _ _ < < O < J J < a iG < O ( 1=» W a < W. SUB-90SMT. BASEMENT IST FLOOR 2ND FLOOR `� 1 2R0 FLOOR �J, 4TH FLOOR b.v �k x, ,., ,. STH FLOOR 6TH FLOOR 7TH FLOOR I 41. 18TH FLOOR 11 1 1 l 1 1 1 1 1 1 1 1 1 1 1 1 1 1 (Print or Type) /� / Check one: Certific��, ' Installing Company Name Ls�,.y .a/0/� Q Corp. j''... Address Partner.' Firm/Co. Business Telephone 5z e - g?'y9- 4�5- 4" 4 Name of Licensed Plumber:,�,�, Jk-f Insurance' Coverage: Indicate the type of insurance coverage by checking the , appropriate box: y Liability insurance policyOther type of indemnity Bondk x �. Insurance Waiver: I, the undersigned, have been made aware that the licensee this application does not have any one of the above three insurance coverages. . Signature of owner/agent of property Owner Agene,, I bemby certify Mal ,u of dic dclails and W01014 lion 1 ha.c subunittcd (or cntacd) in ahu.c appleslien Ike live attdqFwale t0 Ibt bttU N 1�/. k wkdge and Mal all plumbing work and installations lrcr(nrmcd under remit issued far this appliealiorl wia be it f�0111p(j�wp wj{M ty pwlbl.A trWGM o(lbt g"gackuwlls State Plumbing code and (.7iaplce l42 0( Ilse (:cnaal laws. Y, Title • Siq ature of Licensed Pluaber' '¢ City/Town: ids vpe of Plumbing License ,A 000nVFn 70FFICF. USE ONLY) License Number IT -Master ❑ Journe • 1 Ir Page No. of Pages. WILLIAM H. DOHERTY III Plumbing, Heating, & Gasfitting 220 Patten Rd. BIL ERICA, MA 01821 PROPOSAL Phone (508) 667-5644 PHONE DATE TO / + i r7 a e� �I�N ail t 1 0 L� l JOB NAME / LOCATION JOB NUMBER JOB PHONE We h&reby submit specifications and estimates for: .-FO w ie) i � . � <v 11-i C e /U 0 PCI We Propose hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of: dollars ($ )• Payment to be made as follows: All material Is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifica- Authorized tions Involving extra costs will be executed only upon written orders, and will become an Signature _ --- extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be Our workers are fully covered by Worker's Compensation Insurance, i withdrawn by us If not accepted within days. / acceptance ®f Proposal — The above prices, specifications (\ and conditions are satisfactory and are hereby accepted. You are authorized Signature _ to do the work as specified, Payment will be made as outlined above. Signature Date of Acceptance: �qDate.a/. . 35 7- 40RTPI 0q - 0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 40 CHUS Ile 'This cert e t ifi s fiat ......................... has permission -to 'form ................. .,pl,umbinginthe'btiii,ding�of.. ........ at. .31<w. u- JA v .......... North An6o er,-Mass. Fee Lic'. No,,.I.'V.JJ .. .... ...... G; L UMBING INSPECTOR CU WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 0 qqx N Lot 13 rn` E;MAIrlood F�- (b nJ 0) N J� / CID Lot 14 1 40,7J7 S.F. 0 N �o / ; o 0.94 Acres Upland = 28,967 S.F. Z(iii x) �vw ere __s AS i n g C 0 17 C r e -26.5' -1 F U U n of 0 t o n Re ten ti of Drainage ,------- ,------ Cleanout 7 Top Of Foundation ..... Elevdtion, 14725'. ........... onq, Garage -25.21 --- IA B 83 J, -29.T D Sep tic Tank `4 (1500 Gallon) *E F-------------------- D—Box.- Trench !I 0, ------------------ Trench 2 N ^-rF-- to JR1, Leach Trench System: 2 Trenches: 50' L ong, 4' Wide, 12" Deep 22-35' LZ=8765 R==805. -94 Re ten ti of Drainage ,------- ,------ A C: 'C� 310 ti i'A R 10.99 Form 5 —�_ Commonwealth of Massachusetts Fr T Address I r DEP F;b rlo. Cily,iown 83 Sherwood Drive, Lot 14 (-242-806 (lo un wwx--, try UEI.1 North Andover aooitCanl Timberland Builders, Inc. Order of Conditions Massachusetts Wetlands Protection Act G.L. c.131, §40 and under the Town of North Andover's Bylaw Chapter 3.5 NORTH ANDOVER CONSERVATION CORNISSION Timberland Builders, Inc.- (Name nc: (Name of Applicant) 40 Sunset Rock Road Andover MA 01810 This Order is issued and delivered as lollows: Same as applicant (lJanre of pro(�e';,r o:•�neri . Same as applicant Address O by hand delivery to applicant or representative on (date) Dxby certified mail. return receipt requested on -(date) chis project is located at 83 Sherwood Drive, Lot 14 The property is recorded at the Registry of Nnrt tiPrr, r• ���v - 3289 96 Book Pa9e Cer-tificate (if registered) The Notice of Intent for this project was filed on April 5, 1996 • The public.hearing was closed on May 15, 1996 (date) (date) Findings The North Andover Conservation Commission has reviewed the above-relerpricedflotice Of Intent and plans and has held a public hearing on the project. Based on the Information alallaole Ic the NACC at this time. the ------ ACC — has deterrnuled that the area on which the proposed work is to be done is sigl1ilic3r1I to the following interests in accoraance v'll' �( f(orth in the regulations for each Area Subject to Protec:j9n Under rile , the Presumptions of Significage78 - Recrea ion Act (check as appropriate): Ch. 178: Prevention of Erosion & Sedimentation Ch. 178_✓Wildlife PubiiC water supply Flood control ❑ Land containing sheillish [� Private water supply � Storm damage prevention Er Fisheries �/ Prevention of pollution Q/ Protection of wildlife habitat LR Ground water supply , $250.00 $112:50 Total Filing Fee Submitted State Sham City/Town Share $137.50 ('.': ler ill rxcoss of S2-5) Total Refund Due S CityrTown Portion S State Portion S ('iz total) ('iz total)