HomeMy WebLinkAboutMiscellaneous - 89 BLUE RIDGE ROAD 4/30/2018N
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11M I,tAYIIYIVIY YyVAJIL i n yr 1,3 — r-1
DF.PARTl: WOFPU R CSAFRY Permit No.
BOARDOFFMPREMMONREGUTAHONS5V ag,atO �
Occupancy & Fees Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 6
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) Itte 1� lick e -�aQ
Owner or Tenant �Levtvx F, L
Owner's Address L
Is this permit in conjunction with a building permit: Yes nNo a (Check Appropriate Boz)
Purpose of Building Utility Authorization No.
Existing ServiceZ0 Amps / Volts Overhead Underground No. of Meters
New Service Amps Volts Overhead Undergrodrid No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
J
Swimming Pool Above
Below
Generators
KVA
/
ro
tround
El
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
r. of Disposals
No. of Heat Total Total
Pumps Tons
KW
Initiating Devices
No. of Sounding Devices
o. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
LocalMunicipal
Other
o. of Dryers
Heating Devices KW
Connections
o. of Water Heaters KW
No. of No. of
Signs Bailasis
o. Hydro Massage Tubs
No. of Motors Total HP
liadvaiidp ai0fsamebthe0&a YES L
11 .boot.
WM o amm o
Stat hgeWmD*Fgr.*d
under eRnal ncfp#rf..
egtava n YES 0 NO 0
rycuhavedted®dYES,pleaseindicatethetypecfww Wby
ftw) EVilatiotlDae
EsWn*dValled&cbid Weds $
Rao I FM
1�2MNAME Lics>,seNa
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�R'S INSURANCEWAIVV)~R;Ia�nawaedrattheL�oa>,sedoe�notha�etheir>sualotsoo�ea�ai�substrioalegliiva�rlt�tec}IrtedbyNla�cti>sellsGa�aalLaws
arcld>atrtry ' lftisp=**Pkabon
(Please the or 2w ,r A ent
Telephone No. --PERMrrFEEI--
Lmgnavire of Owneren
86, ("'.) q `" rig' �L
i w &A TW
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4/ - ZZ- 65 PJ N>
l Location
No. (490 Date aZf
NORTh TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
Building/Frame Permit Fee $ 60
JACMuS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
• Check # c? T
r
Building Inspector
1.1 Property Address:
80L Blue RZ Lp Rd.
1.2 Assessors Map and Parcel
Map Number
Number.
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Ld Are
Fronts ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provided
Rapired
provided
1.7 Water Supply M.G.L.C.40. 34)
Public ❑ Private ❑
13. Flood Zone Information:
Zone Outside Flood Zone 0
l.8
Municipal
Sew enso Da<posa! System:
0 On Site Disposal System ❑
0MIL, aav1'1L-ri%NJZ'Vllli V r 1'1ZawnlriAVlilVRLL1A LAjxafjI I ' ""�•���1t: Lll:`I(ICT: !sS
2.1 Owner of Record
GlerYIA 000 Le A -N
Name (Print) Address for Service
as,' -q kit L 8 SbS$
2.1 Owner of Record:
Print
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature
_1 3.2 Registered Home Improvement Contractor
11A
pany Name
Address
Telephone
Address for Service:
Not Applicable ❑
License Number
Expiration Date
Not Applicable ❑
Registration Number
Expiration Date
evrTrnN e - WORKERS COMPENSATION (KG.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 permit.
Signed affidavit Attached Yes .......0 No ....... 0
SECTION 5 Description of Proposed Work check a0
• IlcaM!
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
i�sf4ll t.11s t Cet�tn4 and '��ar �Q f�nt's� base n•iL�fi'
Id be Used -for a tiah a <,60M
( Con�'Tor' IASIA�`lnt�6M P�Nm�Q�in T )
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
011:'FICIAL USE ONLY
I . Building /
9006
(a) Building Permit Fee
Multiplier
2 Electrical t' 0 �
J
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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
1 as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are Lrue and accurate, to the best of my knowledge
and belief
Print Name
Si ture of Owner/Agent Date
NO. OF STORIES 2 SIZE
BASEMENT OR SLAB "VL-%
SIZE OF FLOOR TIMBERS 1 2' 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION ` THICKNESS ^�
SIZE OF FOOTING X
MATERIAL OF CHD4 EY t
1S BUILDING ON SOLID OR FILLED LAND o
IS BUILDING CONNECTED TO NATURAL GAS LINE o
t ,.ORT► TOWN OF NORTH ANDOVER
O "a. '6. 1h
.�`..°OL OFFICE OF
A BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
D. Robert Nicetta,
Building Commissioner
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: Fp b • 3 .2
JOB LOCATION:
Number
HOMEOWNERL-v(eu v Man
'Ne_ �� P,
Street Address
P" 978 • � �� � ff6
Telephone (978) 688-95454
Fax (978)688-9542
065 ) 01a 6
Map/Lot
"Ce.1l
08 _Z 6s' 49 �S
Name I Home Phone Work Phone
PRESENT MAILING ADDRESS 5014e
A/04 AlJover M 0(09.6 -
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two 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 108.3.5.1)
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 or two family structures. A person who constructs more that one home in a two-year period shall not
be considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING
BOARD OF APPEALS 688-95,11 CONSERVATION688-9530 IIF:ALTII 68X-9540 PLANNING 688-9535
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The Commonwealth of Massachusetts 0.111ce11" Only
W1
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Department of Public Safety
ocem"Fal i fee ch"ked
BOARD OF FIRE PREVENTION REGULATIONS STT CMR 1200 3/90 (teeee bla")
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
AA work a be performed in accordance with the Mase:achusens Electrical Code. 521 CMR 12:00
(pLFASE PRINT IN INK OR TIPE ALL INFORMATION)
City or Town of NAQ Tu QAUO oU P- 4
Date
To the Inspector of Wires:
The undersigned applies for a permit to perform theme electrical work described below.
Location (Street & Number) b l.L�
Owner or Tenant e (LCA! A h k1 Cy L q to C d
Owner's Address i� a
9 L U >=_ I` (0it ISI)
is this permit in conjunction with a building permit: Yes V No 0 (Check Appropriate Box)
Purpose of Building Std t r n AA-, m.) G ��c� l_ Utility Authorization N0.
•
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _
Neap_Ser=ice Amps / Volts Overhead ❑ Uadgrd ❑ No: of Meters
Ntsober of Feeders and Ampacity
Location and Nature of Proposed Electrical Work 1, 1 Q C j/li (�/d0 t),✓,o E)�t%/7vr'
4k I'%IIA.,n... %I e^ Ata 1
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
INA
No. of Lighting Fixtures
Swimming Pool Above El In
, grnd.grnd.
_
Generators 1WA
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 Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Oth..�.
Local ❑ tfuicipal Connection[] Other
No. of Ranges
No. of Air Cond. Toone
No. of Disposals
No. of Heats Total Total
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No, of No. of
Sirns Ballasts
_
Low Voltage
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liabili Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES NO[] I have submitted valid proof of same to this office. YES EZ NO ❑
If you have checYAd YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE R BON! ❑ OMMR ❑ (Please Specify) f 12M re,. GRG 1;— 1125-6 .
Estimated Value of Electrical Work S,/60d i
pirat on ace •
Work to Start Inspection Date Requested: Rough j2 LL Q0 Final LV/GL C946
Signed under -the penalties of perjury:
• FIRM NAME l ),4 V4Urrnl T a gr -r,2 N C �1 LIC. N0. a �3� �4
��1---�=T
Licenseei)AU1O N 0dC4�0TN S Signature/l��//,,1� P&� _JLIC. NO.0?97y3L-
Address, n. AID)c (o, l.)�ST�-� /� _ mpg 01 H6 Bus. Tel. No. ��7R-691- 9y87If —
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or Ica sub-
stantial equivalent as required by Massachusetts General Laws
, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
r%15/1993 01:18 508-692-6958
9
EVELYN UUNN PAGE 01
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ACORD
CERTIFICATE OF LIABILITY INSURANCE&& 2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATwn
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
VNIC IIYMIL'V. i i, I
03/23/99 1
restford Insurance Agency
.87 Littleton Rd P.O. Box 308
restford MA 01886 -
?hone: 978-692-3073 Fax:978-692-0429
4AAED
INSURER A.
INJ3UPER E
David Devincentis DBA INISURER C
Devincentis Electric
20 WesEast PresMh cottStreetINSURER D'
IFlSUREP E
INSURERS AFFORDING COVERAGE
central mutual Insurance Co.
OVERAGES
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.
L, — — PGLICY EFFECTIVE F)LICY EXFIRvT10N LIMITS
TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MMfDD/YY)
EACH OCCURRENCE $1000000
GENERAL LIABILITY
A }( COMMERCIAL GENERAL LIABILITY TO BE ISSUED
03/17/99 03/17/00 FIREOAhNGEIAnyonehre) $
50000
CAMS MADE OCCUR MED E cP (Any one person) $
5000
PERSONAL 8 ADV INJURY 31 O O O O O O
FPRODUCTS
E RAL AGGREGATE 3 2000000
-COMP/OPAtiG 3 2000000
GENL AGGREGATE LIMIT APPLIES PER
POLICY JECT LOC
I
I
COMBINED SROLE LnaIT 3
EXCESS LIABILITY
AUTOMOBILE LIABILITY
$
;Ea accident)
ANY AUTO
$
DEDUCTIBLE I
BODILY f $
ALL OWNED AUTOS
$
RETENTION! $
�
on)
(Per person)
3CHEDLLED AUTOS
WORKERS COMPENSATION A1JD
E.L EACH ACCIDENT $
EMPLO'rERS' LIABILITY
BODILY INJURY g
HIRED AUTOS
(Per accident)
NON}OWNED ALROS
I
I
I PRO eERTY D44AGE $
kPer
I I
GARAGE LIABILITY
� ANY AUTO
I
I
AUTO OWLY - EA ACCIDENT Is
EA ACC $
OTHER THAN)
I AUTO OILY AGC-
GCEACH OCCURRENCE $
EACH
AGGREGATE 3
EXCESS LIABILITY
OCCUR CLAIMS MADE
$
$
DEDUCTIBLE I
$
RETENTION! $
A V
TORY ! IMiTS ER
WORKERS COMPENSATION A1JD
E.L EACH ACCIDENT $
EMPLO'rERS' LIABILITY
I
El DISEASE • EA EMPLOYEEI $
I
E.L. DISEASE - POLICY LIMIT 4
rCOTILIrATF wni OFR
BY
m I ADDITIONAL INSURED; INSURER LETTER' _ CANCELLATION
FERRAIR SHOULD ANY OF THE ABOVE DESCRIBED POLKltS bt l-AkMCLLCL' --
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL
_10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Ferriera Pools LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
107 Flanders Road ANY KIND !PON THE INSUP.ER. ITS 4GENTS OR REPRESENTATIVES
♦ a
Location
No. A5 / Date -I/— � " "
TOWN OF NORTH ANDOVER
Certificate Occupancy
$
+
of
�'�a "•••°' E��'
s•►cwus
Building/Frame Permit Fee
$
Foundation Permit Fee
$
„
Other Permit Fee
$
'
TOTAL
Check # /,?/%
1 :} 0
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
This Secfiols for Oti`icial II�le Ogt
BUII.DING PERMIT NUMBER:
DATE ISSUED: / J�
SIGNATURE:
Building Commissioner/1or of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
� `� cu � t
D •
� D (,xS�
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
it 3. taq *3
Zoning District Proposed Use
Lot Area (so Frontage(ft)
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Re red Provide
Required Provided
Required Provid d
Is
oda
gs
1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information:
Public 0 Private ❑ Zona Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
f
LE
�JAucy
Name (Prin
Address for Service
^
&, •— e c
Signature
Telephone /�n�
(�`X$ q D O a,,
22..2 Owner of Record:
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
-A'S0a 020
Licensed Construction Supervisor:
C r�
61-05 3 7 /
%
.167 M29 /l�. F r Od) Mh 61581
License Number
dre
Sad'-3���5��
Expiration Date
Signa re
Telephone
r
3.2 Registered Home Improvement Contractor
Not Applicable ❑
P -2 -AK 1 ?00LE
?n- 7,/0 s 4G
I/�
f a�� 7
Company Name
Registration Number
c3 a I
'
/()/ T G� /✓®f %�
S ��ode6 01
,�
Add^�
414.005"a�'3�
���Z��
— A �A a
Expiration Date
Signatur
Telephone
Z.
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X
ic
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V, - r
SECTION 4 - WORKERS COMPENSATION MG.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 .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check all
applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg.
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by pennit applicant
OFFICIAL USE ONLY
1. Building/ f
9,,G,0—
(a) Building Permit Fee
Multiplier
S
2 Electrical
(b) Estimated Total Cost ofD
Construction
�j d ez
3 Plumbing
Building Permit fee (a) X (b)
/a-3
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 7
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 ONvner/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
Si ature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TB/IBERS 1 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
FORM U - LOT RELEASE FORM
r r
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION*"'�"�*
APPLICANT1-FA) V &A)C� f-A("4-�/
LOCATION: Assessors Map Number
SUBDIVISIONS CC
STREET IJ L U /n C I b 6- F ,C n
Oso n
OFFICIAL USE ONL
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR
COMMENTS
DATE APPROVED
DATE REJECTED
� L-) �P'e-'RJ5 04 1'-�
TOWN PLANNER
COMMENTS
DATE APPROVED
DATE REJECTED
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH
COMMENT
DATE APPROVED
DATE REJECTED
PHONE= 0 b 5
PARCEL 6
LOT (S) AO &
ST. NUMBER _
APR i 2000
r J1LGiri0 CE�"�'.� i ►VfG!`'
PUBLIC WORKS - SEWERIWATER CONNECTIONS -
i;
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR,
Revised 9197 jm
DATE
A.
KFAIT110 OF IUIIIC SAFETY
41SIlUCIIU SUrE1YIS01 IICEYSE '
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HOME IMPROVEMENT CONTRACTORS REGISTRATTON
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts•02108
HOME IMPROVEMENT CONTRACTOR -
Registration 123408 Expiration 02/13/01
Type - PRIVATE CORPORATION
FERRARI POOLS & PATIOS, INC.
JASON E. WARD
107 FLANDERS RD
WESTBORO MA 01581
T�
A
PRODUCER (603)893-9450 FAX (603)893-9480
akeside`Insurance Agency, Inc.
88 6tiles Road
Salem, NH 03079
INSURED Ferrari Pools & Patios Inc.
107 Old Flanders Road
Westborough, MA 01581
Ext:
COMPANY Transportation
B
COMPANY
C
E COMPANY
D
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 TYPE OF INSURANCE POLICY NUMBER i POLICY EFFECTIVE ;POLICY EXPIRATION:: LIMITS
LTR DATE (MWDDIYY) DATE (MWDDIYY) i
GENERAL LIABILITY
E GENERAL AGGREGATE
$ 25QQQt QQQ
...... ... . .
X COMMERCIAL GENERAL LIABILITY
PRODUCTS • COMP/OP AGG
$ 2,000,000
MADE i OCCUR i
X i CLAIMS
A :<::<: <....... 163040695
� � PERSONAL &ADV INJURY
' 02/01/2000 02/01/2001 ............................................ I...................
i 1 I QQQ � QQQ
OWNER'S & CONTRACTOR'S PROT :
:EACH OCCURRENCE
$ 1,000,000
i
FIRE DAMAGE (Any one fire)
S 50 QQQ
..........................................................:
MED EXP (Any one person)
i 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
ALL OWNED AUTOS
BODILY INJURY
$
(Per person)
SCHEDULED AUTOS
HIRED AUTOS
i : BODILY INJURY
$
(Per accident)
NON -OWNED AUTOS
....... ........................ ..:......... ................. i
i i PROPERTY DAMAGE
$
WORKERS COMPENSATION AND TORY LIMITS. ER
,EMPLOYERS' LIABILITY EL EACH ACCIDENT $ 1 , 000 , 000
A
THE PROPRIETORI INCL 1062324880 02/01/2000 02/01/2001 EL DISEASE • POLICY LIMIT $
1,000,000
PARTNERSIEXECUTIVE
OFFICERS ARE: EXCL : EL DISEASE • EA EMPLOYEE $ 11000,0001
OTHER
FOR INFORMATION ONLY
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
-XM_ 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.
AUTHORIZED REPRESENTATIVE
Joseph Rossetti/USER39
N0RT6A6E-t.-.1NSPECT10N PLAN
City/Town: NORTH A40WER State: ...... MA.
_•---__--
Date:.3 - 28 94. Scale:----��--- 40_--•---
N .........................
Orner:_. L.tACH_.......... Buyer:------ N /A---•---
DeedRei Na. -3 14 3 __�? 8_I_ Plan No' %00'6(& /
Drawn per City/Town of ____N .� A•_-____-_ Tax Assessors Nap.
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To. AN�o�%R P�A1,►1�. --------------•--------------
I hereby certify that the above Mortgage Inspection Plan was preparef i pse :n connection with a new Nortgage and is Not
intended or represented to be a property line or land surrey. It cannot be pIEJ for
hoi9thefence,
originaleI walls or buildinp(s) asbuilding
lines. No responsibility is extended herein to the land owner or occupgj: Ih.e location
shown
herein was in compliance with the local applicable zoning bylaws in flitEt when constructed, with respect to horizontal
is exempt from violation enforcement 4ftion under Nass G.L. Title VII, Chap. 40A, Sec.
dimensional requirements, to lot lines or and as
7, unless otherwise shown herein. Subject buildings) lies in a flood zone desig eoZ 9 -_____._x b-No._I m
FIRN map Community -Panel II -__Z 5058-._°007G___Oated:____:_______ -
JCD, INCORPORATED, LAND USE f, DEVELOPMENT CONSULTANTS 4 AUTUMN LANE, METHUEN, NA 01644 508-683-9932
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Date... . ...................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies than -�:..4.4 ... :,n ... �
...................................................................
has permission to perform .......................................................
'r
............................. ... ...... .. . .....................
wiring in the building of ..............
....................................................
at ... ... ... ...... ...............
........ .................. . North Andover, Mass.
.. ... ......
Fee-: ......... Lic. No.-: ............ ............................a.... -......... ................
IPTVr DTrAt TMQDVl D
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
)
• The Commonwealth of Massachusetts
Permit :10. o,tice t)se only
Department of Public Safety
occu"acl i roe ofeeked
aOARD OF FIRE PREVENTION REGULATIONS W CMR 1200 3/40 (tee" blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work 10 be performed In accordance with the Massachusctu Electrical Code. S27 CMR 12:00
(PLEASE PRINT Ili INK OR TTPE ALL INFORMLTION)
City or Town of A) 12 T A,f0 Ol/ 9 4
Date
To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) g LU, L I C 1 /1C, -F
Owner or Tenant c X L C AJ lJ} Q C-1 Lq Al U
Owner's Address +�LGI>+_ 2(AGE PI).
Is this permit in conjunction with a building permit: Yes � No ❑ (Check Appropriate Box)
Purpose of Building c A t 1.n A&, &J G e F)oo L Utility Authorization NO.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Newr=ice Amps / Volts Overhead ❑ Undgrd ❑ No: of Meters
dumber of Feeders and Ampacity M
Location and Nature of Proposed Electrical Work 1,Q tz rA% (%/IO t).✓.O
'-% 1 I 1 „A,. ,n.. . A e^ A 0' 0 1
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KYA
No. of Lighting Fixtures
Swimming Pool Above In-
grnd. ❑ grnd.
_
Generators XVA
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency LightingBattery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS * No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices*
Local ❑ Municipal Other
Connection"_
No. of Ranges
No. of Air Cond. Toone
No. of Disposals
No. of Heat Total Total Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No, of No. of
Sizns Ballasts
Low Voltage
Wirint
No. Hydro Massage Tubs
No. of Motors Total HP
INSURANCE COVERAGE: Purmnt to the requirements of Massachusetts General Laws
I have a current LiabilityInsurance Policy including Completed Operations Coverage or its substantial
equivalent. YES G NO I have submitted valid proof of same to this office. YESR NO ❑
If you have chec d YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE R BOND ❑ OTEFA ❑ (Please Specify)„ jr QAi w. ;IAC 14' 11U S . 03/0,00?
piration ate •
Estimated Value of Electrical Work S,160c�
Work to Start Inspection Date Requested: Rough (,l)/ LL Co,0 Final WILL C946
Signed under -the penalties of perjury:
FIRM NAME (_ - LIC. NO. 1/a gS8 64
Licensee VAVI C3 Z�V1A)CaA}T l S Signature LIC. NO. R9 7c/ C-
Address,P_ 6. PDX -2®&(cI1A) 9ST_J bPQ . M)q OI Bus. Tel. No.��t7-Ff3� - 91/h 7
Alt. Tel. No. •
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and ttiat my signature on this permit
application waives this requirement. Owner Agent (Please check one)
1~
Date..:.:�4.:.........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... ........... .. r.. � .......... %./...........e.`... "`i..
has permission to perform �
.................................
wiring in the building of ......fir.......:.. r :.......................................................
at..�.� ...�..�......................... �:...f' �:...... North Andover, Mass.
Fee.../...... Lic. 4 .................... '......-.. .................
ELECTRICALINSPECTpl(-
v
Check # -t�r�✓
6544
JIM UU1Y1LY1U1V VVr.NL.1 n Ur Lars harl1111v.u..l 1 L3 �•• ���,
DEPARIIE7VT'OFPUBIlCS MY Permit No.y ��
t BOARDOFFIREPREVEMONREGDIATTONSR7C�t?R]20J I a mi
Occupancy & Fees Checked
APPLICATTONFOR PERAff TOPERF ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUS S ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date '/ S; 6
Town of North Andover
The undersigned applies for a permit to perform the electrical r ork
Location (Street & Number) R q Fl tt2 PI Ll e A
Owner or Tenant
Owner's Address
below.
To the Inspector of Wires:
1J
Is this permit in conjunction with a building permit: Yes[ZI No (Check Appropriate Box)
Purpose of Building utility
Existing Service 'Z Amps �Volts Overhead 0Underground
New Service Amps Volts Overhead [--I Underground M
Number of Feedersand Ampacity
Location and Nature of Proposed Electrical Work
Authorization No. _
No. of Meters
No. of Meters
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
0
Below
Generators
KVA
round
ground
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
4
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 KW
No. of Self Contained
Detection/Sounding Devices
Local 0 Municipal
r7
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
Signs Bailasis
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER,
Irrutra =covwv- PtastatttiD&m4mernlscfMasadiisoGaiawlaws
IhwactzMIJ btT km a velb6cyir iuftCompleie i CovetagecrilsstksWilbaleg ivalat . YES F1 NO
IhavestftiWdvaWp a fcf=re10dr0ffiw— YES ro'T IfycuhavedrdWYES.pkwi xkm to p ofmveWby
INSURANC BOND OIHIR ftm*Y)
Estlrrt*dvaiteo MxbJc°al Wak $
wotkmsatt kEpecticnD*RaWmed Rao FsW
9gped urrkr'& Penaldes cf paW
FMMNAME Lio=Na
L;artsee Signahae
LkffwNo
BusatessTel.Na
AltTel Na
OWNER'S1t1SUFANCEWAIVER;IamawarethattheLioatsedoesmthalvetheitruaanceooveageailsaksumalepvWaasm gmedbyMasmdxnmsGema!Laws
ardthatrrry' cndtispemrtapp)iar
(Please the o Own A ent
Telephone No. PERMIT FEE
gna ure of Owner or Agent
Date. .1. 1 .... C,
TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
This certifies that ...t� .r /I I./A'r.-'••...•••••••••••••••••
has permission to perform ..../!. �-' .. r ../................... .
plumbing in the buildings of .. LL -
at ....... ..... ....... North Andover, Mass.
Fee.,?. �.."...Lic. No.... 3.1..'. .......� .—_......
PLUMBING INSPECTOR
Check # ��
5213
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type) �� `3
- /4hC(eJ OflMass. Date fa Permit #
3. Building Location Owner's Name Qom. r
' Type of Occupancy Residential
New (..J Renovation CJ Replacement IN
Plans Submitted: Yes ❑ No ❑
'K.
FIXTURES
Installing Company Name Ile ritage Htg. &Plg. CO. Inc. Check one: Certificate
Address 35 Pleasant Street IX Corporation 714
Stoneham, Ma 02180 [-] Partnership
Business Telephone • _781 —A -U=_7 7 7 G__ [l Firm/Co. _
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy X 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 Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information I have subrniited (or entered) in above 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 provisions of the Massachusetts State PiumAe and Chapter 1 2 0l the General Laws.
By --- —
Si L" tsod Plum or
Title
---- Type of Liconse: Master IX Journeyman Ej
City/Town_ 8322
APPROVED (OFFICE -3l SE ONLY)License Number.__.______.__.
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4TH FLOOR
5TH FLOOR
6TH FLOOR
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8TH FLOOR
Installing Company Name Ile ritage Htg. &Plg. CO. Inc. Check one: Certificate
Address 35 Pleasant Street IX Corporation 714
Stoneham, Ma 02180 [-] Partnership
Business Telephone • _781 —A -U=_7 7 7 G__ [l Firm/Co. _
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy X 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 Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information I have subrniited (or entered) in above 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 provisions of the Massachusetts State PiumAe and Chapter 1 2 0l the General Laws.
By --- —
Si L" tsod Plum or
Title
---- Type of Liconse: Master IX Journeyman Ej
City/Town_ 8322
APPROVED (OFFICE -3l SE ONLY)License Number.__.______.__.
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Datil. 1-o s
TOWN OF NORTH ANDOVER
�� • SOL
PERMIT FOR PLUMBING
This certifies that 5c Av 1.. 117. .............. .
has permission to perform .t}J�y--r. { ..c�►.u• !a;<!.��-1111.
plumbing in the buildings of . .
Fee.V—!. ... Lic. No. % Y'7U .
Check # ) 2 0
6341.2
........................
........� . , North Andover, Mass.
........ YL. �, �t ......
LUMBING INSPECTOR
i
MASSACHUSETTS UN
(Type or print) ORM APPLICATION FOR PERMIT TO DO PLUMBING
NORTH ANDOVER, MASSACHUSETTS
Date 0a a 1 O 5
Building Location Ivy Owners Name 1 hC 4c h Permi y Z
Amount _72 iype of Occupancy -!�>( n
New Renovation Replacement Plans Submitted Yes No
FIXTURES
(Print or type) Check one: Certificate
Installing Company Name r, -L 4 n
Address 0 Partner.
usmess Te ep e 7 Yd- Firm/Co.
Name of Licensed Plumber: . U v �-
Insurance Coverage: Indicate the type qj-insfirance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ❑ Agent
I hereby certify that all of the details and information I have submitted or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and i st Mations p rfo under Pe 't Issue or this application will be in
compliance with all pertinent provisions of the Mass use s State lu i Code an C apter 142 f the General Laws.
BY igna ure o icensea FlumDel\\
Type of Plumbing License
Title a. 7 0 �/`
City/Town V ense um er Master .Journeyman ❑
APPROVED (OFFICE USE ONLY