Loading...
HomeMy WebLinkAboutMiscellaneous - 90 BLUE RIDGE ROAD 4/30/2018R o glue u2 t a o - c jU- Date ..... Via..! TOWN OF NORTH ANDOVER PERMIT FOR WIRING � AAkPj H This certifies that . 1 ...... U............................... has permission to perform.. � '� 'M`.... �— ............................................................................................ wiring in the building of...... ,.A CIL) at .................................................. . ..... .. ...... ",orth Andover, Mass. Pee. Q.'-5 .. . .... Lic. No.11 16.� ...... ..... A ........ ....... .......... ......................... .......... - ELL(C-&CAL INSPECTOR Check 4 'po -7-71 ILI • �\ , COmmonwealdt o f Illamacl useth Official Use Only Permit No. Z3�2 _ 2epartment o13ira 3eraicea 1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank V\ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 4 - Z-0, l u [ City or Town of: N o r jIj A,,Jo✓.p r— To the Inspector• of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 4c (} Qr Owner or Tenant Telephone No.CAT%- c, Owner's Address * 5"V -'e- -ek's -CJAOV4., Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps ! Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps . / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Werk: ,•.A Qys��•► ;ce � 3 s i4,srx x,, s"wkA (o.- Z S WVJ - tit:t:... &= rd --cited. --Va-- Completion of the following table may he waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above � n- ❑ o Emergency Lighting rnd. rnd. ato. Units Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners Z of Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat Pump I Number Tons I KW No. of Self -Contained Totals: I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ A'iConneunic'palction [IOther No. of Dryers Heating Appliances KW ecurity ,stems:* No. of Devices or Equivalent No. of Water K`,l, o. of o. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or cis required by the Inspector of Wires. Estimated Value of Electrical Work: [U)00, (When required by municipal policy.) Work to Start: 4. S„4„ p, Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation” coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND [IOTHER ❑ (Specify:) I certify, ander the pains and enalties of perjury, that the information on this application is true and complete. FIRM NAME: Sc�lc.,rG.�. Qo Me r LIC. NO.: jf1 w K—K Licensee: Signature _ LIC, NO.: (IJapplicahle., enter "exempt - in the license number line) F► I -BUS. Tel. No.• Address: a14 -,*, hA,cw-i-M, ,nom . M�4 l�t,* 11 Alt. Tel. No.: X58 - SStzS *Per M.G.L. c. 147, s. 57-61, security work requires Departmenfof Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $79 Signature Telephone No. t Z $• � ►� ✓e I (VIA� c� _COMMONWEALTH OF MASSACHUSETTS lilLaJUSi i • • • • 'mill BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED MASTER ELECTRICIAN SOLARCITY CORPORATION MATTHEW T MARKHAM 24 'SA I NT MART I N DR BLDG 2 UNIT 11 MARLBOROUGH MA 01752-3o6o 11 �6MR 0V31. r The Commonwealth of Massachusetts ru Department of Industrial Accidents z Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): SolarCity Corporation Address: 3055 Clearview Way San Mateo / CA / 94402 Phone #: 650-963-5100 Are you an employer? Check the appropriate box: 1.0 I am a employer with 3000 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. ❑ We are a corporation and its 3. ❑ 1 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' coma. insurance reouired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 4. ❑ Building addition 10.® Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.N Other Solar/ PV *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 stale 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 niy employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Insurance Company Policy # or Self -ins. Lic. #: WA766DO66265023 Expiration Date: 09/01/2014 Job Site Address: All Locations 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 coverage verification. I do hereky certify under the pains and penalties pjdrjVfy that t#e information provided above is true and correct. 9782152359 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 AcoRV CERTIFICATE OF LIABILITY INSURANCE 03 r 086/21//21/°°'"2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 0726293 1-415-546-9300 Arthur J. Gallagher b CO. Insurance Brokers of California, Inc., License #0726293 CONTACT Brendan Quinlan _ _ NAME: PHONEFAX Q,Ert); 415-536-4020 IF No)_�_^-_ _ 1255 Battery Street $450 E-MAIL uinlan@ajg.com ADDRESS: 9u @a' com INSURER(SIAFFORDING COVERAGE NAIC S San Francisco, CA 94111 INSURERA: LIBERTY MDT FIRE INS CO 23035 09/01/14 INSURED _INSURER 8: LIBERTY INS CORP - 42404 SolarCity Corporation INSURERC: INSURER D: 3055 Clearview Way INSURER E. San Mateo , CA 94402 INSURER F : COVERAGES CERTIFICATE NUMBER: 35272277 REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/LDIDNWY MMIDDfYYYY LIMITS A GENERAL LIABILITY TB2661066265053 09/01/1 09/01/14 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X Deductible: $25,000 REMIDAMAGE T RENTED 100,000 PREMISES (Ea occurronce $ MED EXP (An one ons $ 10,000 PERSONAL SADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 1-il POLICY PRO LOC S A AUTOMOBILE LIABILITY AS26610 6 8 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) S X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS AUTOS ED AUTOS PROPERTY DAMAGE S Per. S UMBRELLA LIAR OCCUR EACH OCCURRENCE_ $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER(MEMBER EXCLUDED? [-N N 1 A WC7661066265033 (WI Retro) WA766DO66265023 (Ded) 09/01/1 09/01/1 09/01/14 09/01/14 X I WCSTATU- I lo TORY LIMITSR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) Proof Of Insurance. CERTIFICATE HOLDER cANCFI I ATInN ACORD 25 (2010/05) satyasan 35272277 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE fi' ACORD 25 (2010/05) satyasan 35272277 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD m.T.� .^-N _O u y O t0 �<vrn ym N - i OGO 1 O.9 O f01 Cdr X0 W U) � s• in Z i .ii=� N vN Q LL z2 Z W WQCD H >Ja O o W JUp� U W Q J L SZ0:: Lm LU N J�U_J O F-LL,r+ Q H N <L' LLJ M Q ~ • x * r OCL n m< o Ui!)in2H L z »> > > a o tZiZmCLiLU LU * * N m N > i!S O W w i 1 I a i � Q w� va . w> w ow w Ln • w Y �) W H Z LO > LUFUS O > i O z z O P-4 s LO 00 u V 0O C:) 0 Q V) �_= o :2 Of ct� 1wLLJ > n DO LO w Q 0) WYJ= 000 Z >- W00 Z o m� (D Zm m Z Z00 WO m o �p F- JN om Uj00 ZN =� J �r c~nL Q a� U� Cl. 0 3U LU 00LLJ F-W Z Q �Q o Z N� o� Q W w }o W N�� O;z ZF- in W W pF-W Z m Cn2JQ O Q W Zm -- L) a J F- O � m U pd0 �'� NW Clp�F-QJ r) OW2 NZZU N pW WF- W OZ OW O O �-jW� mZ�m OpN �'HO C> C) W W W 2LLJ F-d O N UN COOWpQ C7 �Uap F- ��� J W U F- W Z W FS-Z OmOLLIOr 0 Jw > W Wmp ZpU� Q O W CD 00Q0 J V)= O� W'C7 JPO Nw W Q Qpm j LLJ mom J0UJ O ZZm� wONUH Q J U -2M J J W CD I OOQ ZOY�z V F-0000>r �Wo a5 Q�W z J o WF-w Wp-7pp U O inwmF- = J 0 �~Zw pZ0 Z N W p W U (Y W F- � Ln O W M- w W J Z N= 2 Z Z Z 4 O p N p� w � WL�::J :z V W �J�� N W? W ZQ} LiJlZU W��Z OU LNC' NOSZ mOJLLJw ~ W it p JJQ �D'S Q=� �Oin �a U W - V z Om0J� JW LYS W JJ Win Q- Q-WO Q F- QQ V J WQ�ZNQ2�O�mW mNL? �F-2 �_� z ���o ��z Qmm��air0V) V) aZao 0LLJ J Www WwwLLJ" p W ro�� �aL�o� O J�>—_j mpa�w� Toc) Ljxin - ��� M�Qo N v)av)� �NwzcWn M W��ow¢Qaa-oZ_NzaQM 0E-aa�po�°' F=-���oa�a�C=i m U) U: �W �J J oZ win inL�� wZ J� in z = �Q d' ZU_Q F-N Od it p J O W J JOp 00 J� J O F- in in W NQ 2= M m -.J '0 U J I Z� Z O QCT I O W N C14 M � Q QO O �Z (/) W J JQQ Otr =a) J iY LL SQ � M< C14 LMMJU4 Ulm W pc.6a: F-M Mom v) (D NMCD40Lri M W T- U LO O .-� O m N O CD LLI - N N LJJ W -� j J LLI 50 U LLJ z M CD in ON s Z =o =`np��O OCl- C14 Q Z �gv?N m Z N W C14 Q:: N m � U U O zm Li W~ � W V 00 CDc Z u Z Z Q N O W O � �_ z C.0 � p v Z W = o112 .� _ W p J O Z CL � of J Z U O a- F- LU Q M. w w W Z J 2 Q O O Z C=j U ~ N =ow j opB W 2 F- O Q U J X U W 3 U J Z W X W V Z W W = a WL)I. W F- J QLLj U w� W CD O W LLF w U win m O Z ~ w 18m Zz~ci CD c� W z a _J F- a it LLJ F- Q J Z > c� W Z � J p U p Q U Q U w Z F- Cl- Q Q w o m'o o?� � WS QW W �' Q inW} JWinp = p - W QU' F-0 W C.7UNZ 4-F-F-UFW J F- F-wOJin= W W Z C C OWs 4,-L Z5 Q�ZZ�F-mZ�QZZpWWF-OQmO 3:F- DJpQw UU M Q Q .0- LAJzZoSXVWi� wLLJ V>Op w[ cl::> F- UCL~F- WZZV~F-F-F-F-Q tr � a ��mNW�arn dF-�Zw2 N W JOOF-[rtr000Q- 32F- OM <<E-LZJJJ�M O ` Z �W c �J5oLKa-j<cr-L? O�SJJOZ wWOz�o2c�F-F-}z000Qw QQmUpWWWC C�C�2UUNYYJ�ZZm0 CLZNinNF-J Z FcpWOFJ o U Z3 ppZ U Fcc-JUpCD O Q 3 O(n 2 U(lin CaU UJOUO �y `Q W Zp V>3mZ Z W F-UJO>UNF-}� C O= ~ O�WO°dOW�W Q Q m 0 p W —W O C-D 0= 9- Y -td __j Z O a a a in (n V) - O» > 3 F) � Q 0 ca c)mz lo�fna � 2�7 T O O41 41 O LLJJ c %00 �p0� %pOH O N N m MN '� M N —1M N' i J W W J N V d^- 2 2} 2 2 2 2} W m m J W 9C%l cc oi L) c_� UF- W m Q Q A3 N W o H O O H O O H O O Q U J J J Q W 2 aNU) �N(j aNU) J m U' C) XO m J H X Q �-Sao`I Q Q Q Q Q Q Z � Z Z m J Z O O Q m O p n 2' Q 2' Q w 0)2' Qw 0) x Q Q Q W `-dLLJ Z g H w Z o Q�QxQ)Qx� Z Q w 3 3 z J Q H zXz � LLJLU F- LJ�3 �3 z y r w Vi Vl z:z CD Z m !� O < Ad N Q OO Z a AWOit:E d a H C1 a CL W J W W Z Z d OZZW Z //I C) `° E `° E w w 3cD z z O o �`' J��0O W M00 N U MN U M N U wZ OU OU U O W W H_�LLJW c �Q �Q 1=-Q Of N N15 m U Q pOOLL1 O 2 2 2 1- Q E E x D U Z p m w� ( Li Cl Uma L) L) J �� N Q O Q ZZI-Q N � W w w U U U O w oOQw o -NF aN� n NF Z— o Q o o o V)uC)u= z u Q < Q < Q < v H a c a a a ommmommooll I '� o m N (D > o� o � � a �,76 LLJ L- c� a w > C) a_ z Q w� Q rn O CSN =� (.6 v) F � r iU U LO � Q � _L 00 C) �7!d V) LO z r 4 -J w Q ry0) O W �J� OO LL Of �O0 r- Y Ln fTS O } N O z co 8�a ; _o zip m p1 4�71d U N m N 5 �M N O w d Q U LO O o N N O MI } N W j J W O U• C..7 Nm Z m } W O d < F E �j^J ZO=N O �o gv N .z K��JW ZZFC Z=�d'J LSFUW ij�H7p �VW�2 m U O Wp z ?OWN�ia O�yQU ��'Z�jZ mV1W�=d=N J�Q JO�ZQ�O a Q m 6FVa � u N r f0 Nn^ O O A Ln240 1 C) LU cn O w H LU LU a LULUz O O � O Z Q ko M M d z ailU U vLi z w U U cLi� Z w>m M Z JJ" as E P 0-0. o Z C)QU )U N N ny NN W NN NI� 0 z Q Q z Q Q U LL> U LL} s 2 O w uj yaj N - - I Z W - W N� N N O4 1--I I --I z > X > X W U U' U U s U z O p W z o 0 m (�� � `%0 IT 'T 00-q :° (n a v V,00 J _" X@ mV/ X @ N LLJx %x J m O 2i a W a N Z a a +i N Q � Q� W� W d cn ga w U a U Q LU T -1s I ego �� Q fig° tw> Q U) a 0:� Y U 0- � N �'o a C O E O Y O C � O s 0 N O Z ap co o $w>'Q c o Q co cz Na O fp �LLJ o O� v=i M O� 4 N l.C) Z w 2W Q O m� ZQ o azo �Q acs -LLIw'3 wQ rn JQ 8� �. U Y = 00 Q O: Z a WJ J Q J J o m f— C D N 00 (n QJ Z MQ- N J m Z 00 NO Z N �0) C3) U-) LU w W Z M M c _ rn w m m Vf 0 zO 0.0. E lV o QQQU t0 0 U � F— LJ � M r 00 N Z —4 W LL a o � O LL Ln 2 m O O cO O Y N I - N ih - m N H V, w d Q W Op o 1� O � Iz O �� w -j V/ x @ N V 1 � 7 J W W w ox 00 O Z C7 v d N N O ��' y W W M J m Q . V) Z F E,^a V Z �g 40 I g o ga v - -z z C) N ww Z � 2 U-Jww Z w =���aT5 0 2 Y Z Z Z Y OLnM t~i 51 Sw =F V% OQ = U m Q Q Fa Z Zw~ = 2 Z W ?� Of 3 � � O U) c%% p (D J J w ui Q U m Wm�0 c?�3d� CL W W tL' a w m O J Z�zr-W� J Li Q �2 0 O Q Q W Zwc�wWF, m W J IZ OU W U LLI N �owmv�w�a w L� N O_ N W W tD In \_ �= z t= w p � �j N N I ZW�JO�� LO � C4oar -:;0 C5 F5 T5Uzi o oc m��t�i�0. za 64 10 � u N •'`• .E �o a cavo, O r2nao ao� ALn .i N /I•, /I ~ OO Z O � Q o N � J � � U J o OJ m Q _ (D> g -0 0 Of w a- F- V V) J ft� Q O U w Y U t—L < J a_ F- Q (/) � U.j Z O � Q w w w L U Q Nz U W J 0 Q V) U LLJ Y I— S5 LL- ZD Z o >- C0CL LO 00 O Q C W > p 0 LO � Z M W Q YJ= 00 X000 r- � 0-) Z 0') 0 O I m N N m �v/ w Q- Q O U LO N O Cl m V) 0 _ J C7 C, � N d Z � W F E 10104 � �Lo p� J z SFE� FUW Z=OCQO UUJF p C WW N O 1.W z mmHo F-0, 2 W N }} W W W 0zw F z ZZ ZZ ow O O z .!i m S F-g d U U Z d N 10 N U U . U U 0cc ! 4-1 Fa CN N I O �Lu) Lo Ln C o 0 W (n Ln a I a I I f I Q II II II N �r �; Z f a I f ( N v n a E E : � 9 0,0 U CCDM c I 0 Ornao� i'V�" ,.(A �LI:IJ ZU 0 I I 2 LLI J UW I I I I O» ZOO . > O c1 it^ c :.:do �tOnM C) oo o I I in I I W a •�M 22, u OU C. a .t aiy > >> > �� x//11 N H'1` WCL00W 0 0 o wl o o wl I�,D mZZ O S Li 8<S< I I Q^p a OI F5. Y yN= a Z A w w O 0 m I I Zm — a$ a v 0 OW z U x �m u a' u n V V 04 O ON GY Z�O� O CYW :m E 'W d I\ U I I 0�mx E m s. x m x m a� N I I Vj^x v �0 I m V v a 'o •a o I C7 W li 0 I I Cn ! Q 3i v W S O D CL o c N� .O N�p p C it } F I I Q% Os%sfk s Vk N a[ (II w I I iSV� Z 3c4 1m 3 $_ 3 3 m U W O !D I I ad Q C�jN� N^ y r Wvv v45ft �5 20ft O: O 0 d =I w a v W (3, I N N W I 6 -0N Z I I I I Y I I on �� ¢ ¢ .Q ¢ CL Cl E O I I 00 ,* rn 11 Lc, qui Ln CN >a' II II II II N N °' W I I a u a '^ E '^. E 7 w Za O I I M Z I I 0LO 'oL Q I I u) M Ln M ,C� O U I I II II : II II > N I Ia a > >> Q T I I L--- a LLJa LU � z o 0 0 wl mac LLJ O:ms 0: Q N N N' N N N' �••� i LIJ m O I m ! ZZI ZZI ZZI'ZZI ZZI ZZI' 333333 LO w d z w 114 L- SII ���:���; �N 2 CL > w r^mi. r^wi. �+ i- CO as U Q� I Z Wu w� mw IC N C) --I W I N I ^ ^ ^^ ^ ^ v15ft v15ft � Jc . LLJ _ ON Wlco M H ' ce LC) w > I >M c- d- 00 oo ' o I Q O N I N Q laLLJ Wp I M. E W. LLJ LIJ 0 Ln N ro f.9 U a0 N G. II V. Z IYi w Q CY) > a a� �Y� � 00 ^ N M I I c > I 7J� Z Z Z � W J z z yV N C7 d y Q W. U w Q. W Qi O O7 Oz� d m Z w. I NO OC� !2 E m y C�j y c I C9O CDID Na cN c .. c �ei5 is a d m Ir C5 W rO C C q�e 41 ip > N N . fV I NZZ' O U G1 a) I Lm" -W O WY =tA C i� �..-� i NNN ZN � 3 3. c J p fn U >. ZE V Z _=w'� �v?4 �� NM m ep ep pp ie iG +r! LLI 0 Cl = CO 0 �G �G7 �U �� s9�e 33��33 Z �N li � Q ��n > c � T o � U I ^ v Tv I I I I Him I: I O O W M r m Q c � W 0. LO o � N CV N V)c ~JJ o m m Ila M. M LJLI M y U I E U C) O Z I .� - I N �. O aj N O M CD Z i --i a`) a`) N v L- t--------- --n r - - -- 1II �'� j ¢w > x O=. m ~ N Q -0� c 7 7 p I I I I S I I L---------'1I1 S Z ac �. N a n � N �. II �" p J C.7 Zz Icu'` ¢ U)a v. Z Q Gd C ¢ m z Iwl CID,!b z o' MW E I' a w c I I a z g=Q F paNg �n per O - CL o CL Z pU R w in3N Zm Z I Z J �a w ca z �J d d� W czZpa U d NOO� z m Z� U� Q ~ CN ao U2¢ � a'i._U�• W � z U"Iy�J III O> 5; O Z WZ � x +i.o, w O F \bC D�� UW m `: NNNm. M, FO: U w CW(aW�� a LJ V) Q u j a � f D ZZ E Z Z �. $3 3 3 •o. Cjrw+4{ F N? W Z W j O CD Q QCL _Z Ua aD, �_ �aC �TZ UO N �F� �O�Oz W4 NW Z �N� U O ��1:0-, {Ic WW w m�S 0 o��3ZZ: aQ� O OC)W O O W W NNOQS X N F -,N �+ S C^ ^O �6 JW SC,,��CC,,��CC,�� 3 3 3' Qnn�. O W Z W N 3 U Lo, W J ��OOZWNWWm=L=w qhza vv ^ ^^^^: va WW OWN �� I I NQ I: QNam II 5ft W=��oN�to� Q ~ y V f m0 mIm Cjcjmza�ir- N � u 10 .Goy � v O1 m O Oj v t:=10CD CN '0 M r a � 0 D � N m O > O a w s` U U Q J W > n a- Z Un Q Wry J z Lo Z W CL N F- CO CL (! ) �F 00 O Q D� Of c Zw > p U �> > z woo U-) 2Lu 0 Of �a ¢ zp wm � — o m CO O Q J> W p V t Z ry 00 LCL W Z Up N ���UZ m Cl Q r, � U I I r --I I I I��I Z Cm f- -j O I I '� I W CL =IX 02 D I i iQi �W V) I I I S I Z Z D V `� I L v O w I Q I z JQ� /� I I Ji Z W V' it i>i mZ O D I� � ? O Z= i� iii V� 0 � N m I r— I Q- I Illi a 0 > IIEllI I I > 0 I I I V I I N I I IQ I W 00 �v/ CU r— O i cQ ,@ < (D al o r-- 17- LnJ ' J d r N U-1 JN O m O O °° > = J w m V (D g 0z o cr W Z 0 a P = F !tl&5,§04 &< W L J N a rza O O Z Alva _ O ¢ a'��W6ZWw LL , W-SHEFUW Eo OUJF lle�ll Z.j� F- ��!?-�O zoWzj—a,�rt5 1 Q>0m it 60a(n F G O F � <IZZ N Z Ncn O-'- �UmSF- A Q E �0 V G w� W cn .Z L ''0^ V+ M N C N Q T O O O C6 N a) ccl L r ° y T -0Y O Eg a)� O (a) U ca . Co a) p L CL (n O M a) Z o N a Z L ct )li C o a 3 0 0 1 N 0) cn cu O N_ O O_ CD c C O_ cO a) .- O O 2 (n L E E L Q c � U -0 }+ + O O O m 0) J co O �p ° a) U U w 5 p E E CL Y r° (1)c N a 0) m V) N O m U ° LU a (nC U N p u. U) a 5 .3 cn z a 0 6 N J n O +. _7 L ° N i Y ++ N .Q O Q C c C N a)w 0 Q O 7 TU a) 2 a) a) 0 U5 -C-n E w T: E E �Y +. M� o M o c N p cLC -co E .0 N C 0 O '0 O O O a) t*n O CU >, O c O c 0 r= > E L O ` N .- 2 E J O_ a)-- a) Q 7 C_ C ~ a) '0 E C ro a).N U a) cc cQo ° E 0 2 O N— O co aEi c .0 >, p 0 0 -O 0) U) `- -0 c O c CO rnQa) =a)a)o U ate) 3 0 '> m e `� •s O a) ,N U L O) +` N N a) i ) co N -coU)a�Oc EN0)cn0omm ) O m m ca co c0 - W 0_ a) O rn � L cz 0 � :3 U) ai t� N T O V 0) C � O C y c p ,0 N J p U) O 0 ft) N w ON C co U J (n 'O —O -- w a) N > N W 0) 0 +-' O 0 O C N ca 3'D -o 0) C a - O c .N -c J OL ° C 0) 'Do 5 No w in a c a) E L -0 C am C -6 'D 3 c a) C U r of ca ~ O co O c ca a) a) c0 40 LL N ° L i O 0) ^ Co :.� O J V > N C O- > i C N r Q. J 'O a) 70 ca 0 C m LL a) O O N M COO N CL N O U ... U O O� -0 CC -0 Q)N 0 m U _� °' CO CCl E E E E N J J U (.)DN a) *� y c +� O c m c� rn ca a c Q Q Q O Lo • • • • • • • 0 Q 00000 m V O W C: 0 p 0 O j O O 4) .� O 0 O c c .� 0 y �, ai C (0 m O +. _7 L ° N i Y ++ N .Q O Q C c C N a)w 0 Q O 7 TU a) 2 a) a) 0 U5 -C-n E w T: E E �Y +. M� o M o c N p cLC -co E .0 N C 0 O '0 O O O a) t*n O CU >, O c O c 0 r= > E L O ` Q O C N L (Din Oco ca > + +, O Co O_ a)-- a) Q 7 C_ C ~ a) '0 E :3 10 O -M•C= ca a).N U a) cc cQo ° E 0 2 O N— O co aEi c .0 >, p 0 0 -O 0) U) `- -0 c O c >osEEro:Uvco`�cr �� rnQa) =a)a)o U ate) 3 0 '> m e `� •s m O a) ,N U L O) +` N N a) i ) co -coU)a�Oc EN0)cn0omm ) O m m ca co c0 - W 0_ a) O rn � L cz 0 � :3 U) ai 110 I r Cl) O N ca N c C O Q co O CV L' 0 c c� G o m cc lo. N-voi:E v C. O OI Z o 3 n O LLi o.'W o Q a Om. 0 O CL C m o w, W O W E W'WI z of O O _ 2 Z 21 " In LLI CL m N a v CI € �' O d G ..� ` v Q v Q Oj OWI Q m' J. 30 m v.c maul o �aI d xa u - l9 �0 viii L a: E m r w ° ;'' z n n a >p 0 UI 2 3 m: o a m: n: '� O m v. o! CIOOx : L ° U.' U �, j = v'ci o w v a O O,C a. SI . ° �. �, f - E: ,F, �O-. G a: v. F, ¢. E' �' m: a N o- 5 w'.? ; E,�liol Ql o. E ESi. c: c SIE o- :03.3 m: o. x.8 Nr E E �. S, a.o d E_'E, d �. 2. .V: o F E. . F: y d� Nw� E E E °'- 'c _ N d :: o.x;v v 7 x x >la a 2 2 2 3 o O i f OIvO hl� N E.u_a. v: o-' E Z 0 3 c O O O a >> d Z u G ,Jn LO r u u W J W .0. 0 .0 .0 ..0 Ol N N N N N aa a d a 10 Ln Ln lq le E n l M ^ N N N m N N y! aD m I P, NI AIN It IO.O mIn'Mr N NI m t N >I S N ODI m OD 'I i N• O ' c N� N O N a0 'I E Y yl E E 3111, m: z d O P N W ^ o O P O. 0 c r%r Io � �1P Z N N O n N N _ a PI uW �« ` POi a oL 'o N IPI n m r M ODI M o I CN ;a o c �� n oZ Q I c I a�la� > al> a;Q P go u S E pp €f>' %I o r >' tma v uO- Erm' I �o a > a!A O >.> U t N W "m c d E E o+. ._ 5 W m Iv m f m• O I d N a u c I o N C i <% $ m cj E >+ ? E m o ' J Q s iL 1 & & o a � ]I N A' �' 2 d Y. m N .N O a o W Q E alb oz t u o u' . 0 M m O c S OI C cs m E m u Qx E_ E m3 ;; r C 0 m 3 d z' z' i d m o n l M ^ N N N m N N y! aD m I P, NI AIN It IO.O mIn'Mr N NI m t N >I S N ODI m OD 'I i N• O M. \ Mr 00 P .O Ni '' co. M P P N� N O N a0 'I c . M yl } ) o P N N N 10 rNnl z d O P N W ^ o O P O. 0 c J I �1P yl. oz a PI uW �« gym, E m POi a oL 'o N IPI n m r M ODI M o I CN ;a o YI �� n oZ � i P � 3 a�la� > al> a;Q t go to S E pp €f>' %I o r >' tma v uO- Erm' I �o a > a!A O >.> U t N W "m c d E E o+. ._ 5 Q a Iv m f m• O O ar m �I •� u m O1 • a, m C Y o �u = N N O A, 4J W M E L H L � s `O O N _ 4-1 � V � 'u E L }a • 1 0 _ V m y a (OS9 L) 96119 (OOU 96 E ' 10 OS9 0 96'49 (L96) LOW U I u c t ' �I oi^ v v a O h 'a^ LL (o011) LE'Eb V •O! M P c . x EI E m } O) CD ; C Q, '« I a I i I I I I I ! o l.p Lo M ^ I I I N P Lo m x M �� m -o c gym, E m �� px U O' a. CN m O N'.O I I �� n oZ � i P � -44 (OOU 96 E ' 10 I I N q' O I I I 1 c t ' �I oi^ v v a O h 'a^ LL lo;o N N V •O! M P c . m m � C C EI E m } O) I « C Q, '« I a I i I I I I I ! E i I I I N P v n V 14, m m -o c gym, E m E « U O' a. v m, q m O N'.O I I Nl M PIU � O N I ti � i P � i 42 N' o in Q mI N o M P, E to ro151�1r o r u tma v uO- v U I 3'> a > a!A ci >.> I d A K zl -I W IL] E E F- u 9 Q m m E$ O Iv m f L° ) Q o �u = N C i U (90 Ln m cj E >+ ? E m o ' J Q y' a iL 1 & & ]I N A' �' 2 d Y. m N .N O a o W 3:1Za ' o oz IL ., > u' . 0 M N i V M 9 V 4 9 O R u z u L • QQ { 0 a m e ; ' I $ d > x > I E o o o o f M c m r m m m u u u u O) m 2 2 m O � r ✓ � 2 S E E E E 0 z H H H F I, I I I I U a « m E c _y Nc M i' O h 'a^ LL 8 d .E E u o w m m � C C EI E m } O) I « C Q, '« I a I i I I I I I ! o I I I v 0 E v m -o c gym, E m O U m p Z p m m a � I o Q c E E l a) c •- ro151�1r o r �' tma v uO- v U I m E!�I>m u ci rii I� I�' C I Zn r ^! I m r U U r DE m m E$ O ) O m f L° ) i C � N C i c O7 r (90 Ln m y 3 I, I I I I U a « m 0 E o o c O1 I c Nc M i' O h 'a^ LL 8 d N u o w m EI E > ° I « N I a I i I I I I I ! o I I I I I j E v II V gym, E m 'o a, > r c l $ r c m m a � I o Q c E E l a) c •- ro151�1r o r �' tma v uO- v U d O ' m E!�I>m u ci rii I� I�' C V Zn r uTi vi c 'L LL u C W r U U r DE m m E$ O m i m f I!� `c 0 V O a 0 0 3 v O) c m u U 0 w N v m -0 to c m v v E m m v �m U)o O ° c (V a o m m m0 v m a) Z NLu « L o N Y .v c o_ C O O u m y U L N N % O to v c H I - a « VI i) E o o c O1 I c Nc M i' O m u a u o w m t \ I « � E1. o �' c = � E v . gym, E m 'o i, c l $ r c ° n E a x > E c m o o Q c E E l a) c •- `o o r E C v U d O ' A O N o c m c I `c 0 V O a 0 0 3 v O) c m u U 0 w N v m -0 to c m v v E m m v �m U)o O ° c (V a o m m m0 v m a) Z NLu « L o N Y .v c o_ C O O u m y U L N N % O to v c H I - VI i) ' O1 I c Oa NaI c H m u c O m m m c E m t m u v I v m o a m m `o o a N m «12 u i, m c E'6a o ��, T m Q m E 'IE € T C ' C wLr x o O o m E C O u Q.a O. o c m o f c p - E u m 0 M LL u C W LL U U r `c 0 V O a 0 0 3 v O) c m u U 0 w N v m -0 to c m v v E m m v �m U)o O ° c (V a o m m m0 v m a) Z NLu « L o N Y .v c o_ C O O u m y U L N N % O to v c H I - c N 4- Ep m m U -u u E 10 N 0)N N > O X t �' d 0) $ c C ate.. m N O c o c +> N j '� O j -O N FIA •> E - ° `—° :, 'v 41 C U 3 Y o o N 7 d N T al N Q o E `O E m O w N +a) C `= U m d y,, U T +r u N 'Mn +N+ • C 0) E a p m a O 7 N y m m @ )` a a a a 0 �oo N N c IIII{ O i « m c T m O I � ! m 3 o a NO 3 3 ° oo_ 0 m E L o CL rnoa c' Y � N J P O ' C O) -0U m O m O) 'i > 7 N {% c c N u) •E o o E U E° u o c Q '+, m O_ -O a) s N to O O) N c O 3 m N i Y N .0) O m .N O) c In N 0) ' -O N -O N I —° c a m >Q) �NrEa) 3 -C 3 m O_ > O) N O 2 E c: c w N c 0 d O m N W N O N u N o Z .� m I- o_ I- m o ) Y F- N �N O O O "' t N > N C N c o a 0 N 0 00 o O P OD O N W O � N O U 3s§ E w v m E C .� 'O c E T O E m Lu PC Lu Vl N z W M Z s m ci C D U o u \ N u > 4) 0 EE U Q Op o CN m co rn L IO 00 Q 5 C 'O J o W 00 E rn d .T oo N c `1 � 00 t'^J W V � T m V + + p .. Z `c .c I°� �- VI i) (O a� 3 -6 N I u O 0) m s N c c N i, T .a O o p 'p j U M 7c 0 m O O 0 DE `� 7 += o- u L° O N } O N C 0 c O7 r c +, c O O >+ ? E um) O E 3a� p O J U N LO Q-' N Ab� `- J Ab� N .N O a c N 4- Ep m m U -u u E 10 N 0)N N > O X t �' d 0) $ c C ate.. m N O c o c +> N j '� O j -O N FIA •> E - ° `—° :, 'v 41 C U 3 Y o o N 7 d N T al N Q o E `O E m O w N +a) C `= U m d y,, U T +r u N 'Mn +N+ • C 0) E a p m a O 7 N y m m @ )` a a a a 0 �oo N N c IIII{ O i « m c T m O I � ! m 3 o a NO 3 3 ° oo_ 0 m E L o CL rnoa c' Y � N J P O ' C O) -0U m O m O) 'i > 7 N {% c c N u) •E o o E U E° u o c Q '+, m O_ -O a) s N to O O) N c O 3 m N i Y N .0) O m .N O) c In N 0) ' -O N -O N I —° c a m >Q) �NrEa) 3 -C 3 m O_ > O) N O 2 E c: c w N c 0 d O m N W N O N u N o Z .� m I- o_ I- m o ) Y F- N �N O O O "' t N > N C N c o a 0 N 0 00 o O P OD O N W O � N O U 3s§ E w v m E C .� 'O c E T O E m Lu PC Lu Vl N z W M Z s m ci C D U o u \ N u > 4) 0 EE U Q Op o CN m co rn L IO 00 Q 5 C 'O J o W 00 E rn d .T oo N c `1 � 00 t'^J W V � T m V + + p .. Z `c .c I°� �- r Y Y y cc Q o o c `we�ta� • •'` U � CL LO LU w tm ll� L f 3� :( v v • • _ ■4 y L aco a : a. > O cs G � CL cm^ --- w c� J cu W o . a > 5(= m z o0 O L Y N O cn L O Ffl co I U) cn 3 O c Y w O V In oI o ao cv O I o MU m : 00: co v l9 c u cc Y CY r O 00 N V C L OJ U O > C Q '6 u 3 OJ c v v v c v s o0 m E Q > O O> v N E O v m O. N d. n n m O Li a 1 1 1 1 1 1 1 m ; m x 60 N: 'T N; E. r� oo nJ. V V:J p oo 0 W 00 N: NO m rn X m° O O m o:o o° o Q Q o m. u _ O w uwil O LLJ ,f0 E x o •rn ti�> r ao m o O G Ni I a: Im A� W QCD Ni N. Y; `m., C; ;m O 3 CD W LO W c �e-1. O 'O:m c. N I CI W: ti: NI i .. ¢ ¢. W Q O O O O O J: , �: N : W } N'O.\: }N>:oo: m }: N. m: N:m: h : .W. NI i'W't' N: W: \ O: rl Y Ol t �: W: O.'I N; n. b Z 3 N. u: X x; Q. + t y Qo O c0 j o>o o o �: »: m: »: mo of oQ. z `m: a 3 X x: v \ o 00 O Q 0Qoa N N' N N. o:mo: W:ON N: O : C. N: m: N N: N.Nn:u: �' co ¢' \ - C: O O = W W c �@1 @J: @l @J- O.O O' :o: @I @J: a :@1 @J: a, @)@l: vai!:.u, �I 1�; r + _ E: mi Q Q I �. \ LL ' S 'E8 m i ice: ( C) o m �i £ 'nom z' LO W: JI M �N:N t of o a 1■ m m o z E • N, —_— _ ___ __ _ _ _�-_ - u E £ m J 3 v " a, v V 3: W. . ,n; : v zz :Z .Z :�: u :�;F �: c: « u:P'v v: In c E w o'Z :v. W a.o :,� :«: :E ° ' o a o is o£ �v. .u.�. �'.��laN�u N;o�a 4 Sc_ m '^ U CI A. �: Q: W. 1 r - d ry: S - I'�:N tm[� U �' m : mL E O G < ?: J O —i % O N. y.- i*r ` :U_ r+: r0 aO. U w Ui WI J: h IyI EO C: J:+' Q U D: : C L .mac �: a o p ? 3 ° `m g ro rn._Q o J o '3:0'.3. v J :r.'�'-:>i T. L+. : v :31-' 01, Z I v-'9 E'V :°: O c -O I o.¢. :v 3 f - :•p: „ d U 3 :>N;>N: O O N; O m C: J C O V ;'C Iw �C .>. oa OJ'�+: C: U. yt ._: a+. C « O Q V p u_ O: cc dZ d. I~ V: N: C' Q v'� L: :0 C x.N C. -rv9 n c :- o o vl w . E: J. a u a 10- a i. E. C. L m . �: � y10 v. c �I �. m. £ Q c' c c o =: 3t : m ° d i d a O u a o. o: a Q c. 3 o U f o V L r E E : C: p; C N.. J. C: c c. E' W ?� a: r to Oz O: O O. is o Z > u.- Ql C L: a r X. O m O r O r i U Om0 u. : V X Y N` i O- 'G L: O a O V I r: Z N C: X £' m m o: x m• >: Q• X m n• O U: W L p a' Q N: -O :^ � o:� U>' oul p I w: J F N E Z U. U >: 3 0 0 0. IOI z •a Q N a C7 7 a r -!z N z: :� ¢ 17 u ,ZIQI n H! n l7 w,_ a O ¢;O o 3 U: Z:� W:a r Y Y y cc Q o o c `we�ta� • •'` U � CL LO LU w tm ll� L f 3� :( v v • • _ ■4 y L aco ao OC � o ' > O cs G ,W ^ 'W � CL cm^ Q w c� J cu W o oa a > 5(= m z o0 O L Y N O cn L O Ffl co I U) cn 3 O c Y w O V In r Y Y C O U � O v v T ' > O � CL c `o o i aj ` N > L Y L co C 3 O c Y w O V In cv O O MU m co v E r c u cm Y CY T O 00 N V C L OJ U O > C Q '6 u 3 OJ c v v v c v s o0 m E Q > O O> v N E O v m O. n n m O Li a 1 1 1 1 1 1 1 a F .e. nZ MAPFRE INSURANCE® February 09, 2016 The Commerce Insurance Companysm Citation Insurance Companysm 11 Gore Road, Webster, Massachusetts 01570 508.949.1500 jwww.mapfreinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL NORTH ANDOVER MA 01845 RE: Our Insured: Property Address: Policyk Date of Loss: Filek Board of Health or Board of Selectmen Town/City Hall KWI OK YUN / IK JOONG YUN 90 BLUE RIDGE RD NT3189 12/30/2015 MARC07-JTTAC5 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. REBECCA MCGOVERN THERRIEN Telephone: (508)949-1500 Ext: 15189 Sr Claim Representative, Property Toll Free: 1-800-221-1605, Ext: 15189 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. February 09, 2016 CIC 254 (Rev. 4/95) MAIL, M33 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings North Andover, MA 01845 RE: Insured: Property Address: Policy Number: Date/Cause of Loss File or Claim Number: Kwi Ok & Ik Joong Yun 90 Blue Ridge Road ) NT3189 3/1/2005,Water 14505-T Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Tom Varley On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Signature and Date ANDERSON ADJUSTMENT CO., INC. 54 Stiles Road, C-106 Salem, NH 03079 RECEIVED MAY' 9 2005 BUILDING DEPT.