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Miscellaneous - 90 BRADFORD STREET 4/30/2018 (2)
I o ,m Town of North Andover No.24986 PERMIT BOARD OF HEALTH TO BUILD 5 System: THIS CERTIFIES THAT BOETTCHER, RICHARD C BUILDING INSPECTOR has permission for the following scope of work: Construct new 12x12 Pressure treated deck,was 12x20 , new deck going to be 12x12, Foundation: located at 80 BRADFORD STREET Rough: to be occupied as One-Two Family Chimney: provided that the person(s) accepting this permit shall In every respect conform to the terns of the application on file in this office, and Final: ' �^r / 6�,, to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Building in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Vold this Permit. PLUMBING INSPECTOR Rough: PERMIT EXPIRES IN 6 MONTHS Final: UNLESS CONSTRUCTION STARTS RouATRICALiNSPECTOR Service: Final: GASINSPECTOR BUILDING INSPECTOR Rough: OccrUoeney Permii�gclred to Ogc,112y BuUdlna Final: FIR Display in a Conspicuous Place on the Premises - Do Not Remove Burn DEPARTMENT No Lathing or Dry Wall To Be Done Street No.: Until Inspected and Approved by the Building Inspector. Smoke Det.: This is an e -permit. To learn more, scan this barcode or visit norlhandoverma.viewpointeloud.com/k/records24986 Town of North Andover No.24986 P E R M I BOARD he HEALTH T T O BUILD Septic THIS CERTIFIES THAT BOETTCHER, RICHARD C BUILDING INSPECTOR has permission for the following scope of work: Construct new 12x12 pressure treated deck,was 12x20 , new deck going to be 12x12, Foundation: located at 80 BRADFORD STREET Rough: to be occupied as One -Two Family Chimney: provided that the person(s) accepting this permit shall In every respect conform to the terms of the applicatlon on file in this office, and Final: °'4 -fpr 0 1,6 z� l to the provisions of the Codes and By -Laws relating to the Inspection, Alteration and Construction of Building in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Vold this Permit PLUMBING INSPECTOR Rough: PERMIT EXPIRES IN 6 MONTHS Final: UNLESS CONSTRUCTION STARTS RougTRICALINSPECTOR Service: Final: GAS BUILDING INSPECTOR Rough: INSPECTOR Occupancy Permi_ t Reyu/red ro Occr RY BuLtdlno Final: FIRE Display In a Conspicuous Place on the Premises - Do Not Remove BurneDEPARTMENT No Lathing or Dry Wall To Be Done Street No.: Until Inspected and Approved by the Building Inspector. Smoke Det.: This is an e -permit. To loam more, sten this barcode or visit northandoverma.viewpointdoud.com/#/recordW4986 M Date. D•?��%/ ........... ,,ORTM. pE •.ao '+ao F? TOWN OF NORTH ANDOVER ' it PERMIT FOR GAS INSTALLATION SSACHUSE This certifies that ............. has permission for gas installation!/55..... . in the buildings of�j.. at ...IU ..G! S'T ......... , North Andover 'Mass. Fee..:°'o Lic. No. A7. X. .. GASINSPECTOR Check# ,Gtj7v 7872 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER ,Mass. Date NOV. 1, Building Location 90 BRADFORD ST Owner Tel# 617-469-6558 2011 Permit # Owner's Name STEVE ROBOTNICK Type of Occupancy RESIDENTIAL New Fv—(] Renovation❑ Replacement ❑ Plan Submitted: YeC] No[] FIXTURES Installing Company Name Eastern Propane & Oil, Inc Address 131 Water Street Danvers, MA 01923 Business Telephone # 800-322-6628 Name of Licensed Plumber or Gas Fitter �Q�`c"-U" ��� r, : e✓ Check one: Certificate Corporation Partnership Firm/Co. INSURANCE COVERAGE: I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No El you haver ecked y2s, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent and information I have submitted (or entered) in above application are true and accurate to the best of m, knowledge and that all p mbing work and installations performed under the permit issued for this application will be in compliance with all ertinent r visions of � WAsachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: A—:� Plumber Signature of Licensed Plumber or Gas Fitter Title ✓Gas fitter • -Master License Number_ _ 30 7q City/Town • -Journeyman APPROVED (OFFICE USE ONLY) • Installing Company Name Eastern Propane & Oil, Inc Address 131 Water Street Danvers, MA 01923 Business Telephone # 800-322-6628 Name of Licensed Plumber or Gas Fitter �Q�`c"-U" ��� r, : e✓ Check one: Certificate Corporation Partnership Firm/Co. INSURANCE COVERAGE: I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No El you haver ecked y2s, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent and information I have submitted (or entered) in above application are true and accurate to the best of m, knowledge and that all p mbing work and installations performed under the permit issued for this application will be in compliance with all ertinent r visions of � WAsachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: A—:� Plumber Signature of Licensed Plumber or Gas Fitter Title ✓Gas fitter • -Master License Number_ _ 30 7q City/Town • -Journeyman APPROVED (OFFICE USE ONLY) J A.12. _2 01.0 9 . 16 AM No. 3096 P. 2 The Commonwealth ofAfassachusew Department of industrial Accidents Office of Investigatons 600 Washington Street Boston, K4 02111 Workers' Compensation insurance Affid2vit: Buflders/ContractorsMe--tncians/Pluiftbers A32RURRDI Information Please Print Lejjb1-v:-: Nwne. (BusinesslChgan sot mrhdivi e- r �1 Address: city/statelzip: ';x Phonet.: 0 Are you an employer? Check the appropriate box: 1.411 am.a employerwith. 4. 0 1 am L, gellpral contractor and I Type ofproject (required): 6. E] New constructioli employees (M and/or pzt-time).* 2.0 1 am a sole -proprietor, or partner- have hired the. sub -contractors listed on the atta6ed sheet. t: 7. ❑ Remodeling ship and have no employee's These sub -contractors have 8. ❑ Demolition working for me in any capacity. Workers' comp. insurance. .9. Building addition [No workers' comp. insurance 5. We are a corporation. and its 1017 Electrical.repam or additions required.] officers have exercised their 3.0 1 am a homeowner d6m'g'all work right of exemption per MGL 11.0 Piumbing.i-epairs,.oT,additions myself. [No workers' comp: *e.152,[] 52, §1(4), -and we have no 12.Roof repairsinsurance required.] T employees. [No workers' camp. insurance required-] 13.11Other :*AW applic=,bat cbedm box fl -must also IM oorthe minim below sbuw* thcirwotkW'mon policy hfbnndcL Homeowners who submit ibis affidavit huhmving-dW zm dobV at work Bed than hirt untaidc contractors mun =bmt a ww affidavit infficstml; snciL 2Contro totsthat check this box zco s1=bndqm additional W=t showing fic nune of the mb-conuamm and dicir w camp, policy imfommati=. I am an employer that is providing workers' compe"n mance for -wry:employees Below is theponcy and job site Insurance Company Name: Policy.or Self --i .0 us,c. Expir=12azzation D�_ Job Site Adcew, 90 8 INO fW ri S4 Q,e[A.CJSNM, 0 city/State, Atta&z copy of the workers'. compeombou VoUcy.:dmlamtion�page�(showing,.the;policy numberAnd exp1rutJon*#)a, Failure to secure coverage as required under Section 25A ofMGL c. 152 cm lead to the imposKm of crinamalpen Iti a . es :of a, fine up to,$ 1,500.00 and/or one-year imprisonment, aswell as civil penalties in the form of a STOP WORK ORDER anda-fine of up to MOM 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 fimmince coverage verification, rdo harl.iwft under the 7*"e-informartonprovided above is: true and correct Da= Xz_ Offical use only. Do not write in this arta, to he completed by city or town offWaL City or Town" . ?ermft/License. Issuing Authority (circle one)-. 1. Board of Health Z. Building Department 3. Chyli Clerk 4, Electrical IMSPeCtOT 5. Plumbing Inspector 6. Otbe Contact Person: Phone 11/2/2011 1:37 PM FROM: Fax TO: 9786889542 PAGE: 001 OF 001 'owed Fiumbing.Products Online System by Massachusetts Board o... hUp:Hlicense.reg.state.ma.us/pubLic/pl_lroducts/pb_search.asp?type... PRODUCT DESCRIPTION, MANUFACTURER MODEL APPROVED EXPIRES APPROVAL APPROVAL MANUFACTURER CONDITION Fireplace Heater GI 450 DV Katandin Gas Insert Direct Vent Gas Jotul North 350526 11/1/2000 3/3/2013 G3-0310-388 Fireplace Insert America, Inc. 351370 J®tul GF 370 DV Trade Name: Direct Vent Gas Jotul North J Ptu( GF Heater - Natural Gas America, Inc. 370 DV 3/4/2009 3/3/2013 G3-0310-388 s Trade Model: GF 370 DV 351371 J®tul GF 370 DV Trade Name: Direct Vent Gas Jotut North J®tu( GF Heater - Propane Gas America, Inc. 370 DV 3/4/2009 3/3/2013 G3-0310-388 Trade Model: GF 370 OV GI 450 DV II J®tul Katandin Trade Name: Direct Vent Gas Jotul North Jotul North Fireplace Insert America, Inc- America, Inc. 8/4/2010 7/6/2014 G3-0711-677 Trade Model: G1450 DV 11 45i Scan Trade Name: Direct Vent Gas Jotul North Jotul North Fireplace Insert America, Inc. America, Inc. 10/6/2010' 9/7/2014 G3.0911-139 Trade Model: Scan 45i Previous Page I Next Page 1 ,Last Page © 2007 Commonwealth of Massachusetts of 6 Site Policies Contact Us Site Map 11/2/2011 1:03 PM (1U1 1VJ.U1y IVL Ae" n Urt►�rs�,arit,civ.u.i 1 �_ . , DNEW OFPUBMAMY Permit LNo. BOARDOFFIREPREVEMONREGUTATLONS5ra&12:M . 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 C ! Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street A Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes FV --1 No Q (Check Appropriate Box) � (9/ IF /1 n Purpose of Building /CL � ( c:. Utility Authorization No. Existing Service Amps 06 0 Volts Overhead O Underground No. of Meters / New Service Amps�Volts Overhead =3 Underground 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 No. of Lighting Fixtures 2 Swimming Pool Above Below KVA Generators KVA roundaround No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumers FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of fXsposals 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 Municipal Other Connections No. of Dryers Nesting Devices 4 KW f Water Heaters KW No. of No. of Signs Bailasis �ydro Massage Tubs No. of Motors Total HP R• CWA=W- Putstrantk)&wt}mwxnlsc Laws Lia)ilt5'k&=XePtlliyindu&]gCanplele arilssubftrialeguiaalalt YES NO vefidptudofsam oodrO6tm YES ffywha�edred®dY>.S,plea�it �hegpe� arUW by boot �LL....JJ.i r11E �, 4 BON p 0MER p) W dValleofEleimcalWodc$ der&Pdmkiescfperjtry. G kgXchMD*RWsW RaO i�v`Fs�rr Fmal (�! LimmNo. I r, Signaw i -26t66 k ----L..�--. Lioer>seNo Buri =TeL N0. -779 9 S ,', SIIVS'[JRANCEWAIVE[t;IamawaethattheLiaensedotsmtlratietheAltTeiNa oovetage a its subshaitial agtriv,>knt as tet}med by Massach� General Laws slue m this pears appficatial Wages lhts tegtmarlalt heck one) Owner Agent rr'D �.cplwrrc 1'40.PERMIT FEEL [% J tgna ureo caner r gen W "Al !4 NL I Location 90 _B111.4d4vird NLN. Date MORTIy TOWN OF NORTH, ANDOVER Certificate of Occupancy $ s Building/Frame Permit Fee $ o Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18639 Building Ins'pector -3 1, 6� Z�- CP -,e c, (C 1.1 Property Address: FlIbLuric Disirict: Yes No 2.1 Owner of Record 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 4. c /, j �' '/ M� /V,tl C�' f ` ` rml 1.3 Zoning Information: ation: Zoning DiA6c—t Proposed Use Name (Print) 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Signature Telephone Front Yard I Side Yard Nile Print Rear Yard Required Provide RegWred Provided R red Provided 3.1 Licensed Construction Supervisor: Not Applicable ❑ 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ I.S. Zone Flood Zone Information: Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ NEUT IN 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT FlIbLuric Disirict: Yes No 2.1 Owner of Record 5-/12VQ- Name (Print) Address for Service �j Signature Telephone 2.2 Owner of Record: Nile Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ /%% / e(41gC( 1?0I M 644 (% 77 Licensed Construction Supervisor: License Number Address ty�.� / 249 93 / J ( 3-7 E�cpiration Date ` Signature Telephone 'Ai 3.2 Registered Home Improvement Contractor Not Applicable 11 2-)7 Company Name / �e/t V��7.� U e?, /'evcQ �6 Registration Number �'' (� � — V Expiration D)te' Address ! -35;C ( � h -� -�� Signature Telephone Ma M M z M 90 0 ic v M r Z ^ Q SECTION 4 - WORKERS COMPENSATION (M.G.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 ....... No ....... ❑ SECTION 5 Descri tion of Proposed Workcheck all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 5- Specify Brief Description of Proposed Work: c Dec, 2-o SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant _ OIICIAL,USE ONLY a?S r 1. Building vr- coo (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing -^ Building Permit fee (e) 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 pennit application. Signature of Owner Date SECTION 7b OWN//ER/AUTHORIZED AGENT DECLARATION 1, �n U P, l � �z'La b�� �t-i As Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief / Q &'U _ Print Name Si ature of Own. NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR T&IBERS 1ST 2ND 3 SPAN DUvIENSIONS OF SILLS DR,AENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHD&I EY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Iv c. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 073476 Birthdate. 03t2711968 OL Expires: 0312712006 Tr. no: 17407 ,E Restricted; 00 MICHAEL J PALMISANO t PO BOX 2078 METHUEhI, MA 0184+1 Ac4ingC iris ner fie ��na�uf!% c«,�.ueaa.�r<sa�a Board of Building Regulations and Standards DOME IMPROVEMENT CONTRACTOR Re,Oistration 127987 Expiration: W/2007 Type: Individual t MICHAEL J. PALMISANO MICHAEL PALMISANO 1 FENWICK CIRCLE, METHUEN, MA 01844 Administrator CERTIFICATE OF INSURANCE ISSUEDATE(M""°°'Y- PRODUCERTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORNIATION ONLY AND 1 a11d111aIk Insurance A eI1C InC CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE g Y DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 198 Massachusetts Ave, Ste 101 POLICIES BELOW. North Andover, MA 01845 COMPANIES AFFORDING COVERAGE INSURED Mike Palnusano COMPANY A.I.M. Mutual Insurance Co dba Mike Palnlisano Construction LETTER A 1 FenWich Circle Methuen, MA 01844 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI011 INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORD EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY N'UNIBER POLICY EFFECTIVE POLICY EXPIRATIO DATE(MNI/DD/YY) I DATE(MM/DD/YY) LIMITS LIABILITY VIMERCIAL GENERAL LIABILITY S & CONTRACTOR'S PROT. UTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY EXCESS LIABILITY MBRELLA FORM THER THAN UMBRELLA FORM �IVORKER'S COMPENSATION AND MPLOYLRS' LIABILI'T'Y A THE PROPRIETOR/ iNIC ARTNERS/EXECUTIVE OFFICERS ARE: pl� cv— ENERAL AGGREGATE $ 20DUCTS-COMP/OP ACG. $ 'RSONAL & ADV. INJURY $ %CH OCCURRENCE $ RE DAMAGE (Any one tire) $ ED. EXPENSE (Any one person) $ )MBINED SINGLE U 1T BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ RTY DAMAGE $ OCCURRENCE $ 3GATE $ 6007826012005 103/09/2005 03/09/2006 EL EACH ACCIDENT $ EL DISCASE--POLICY LIMIT E -L DISEASE --EACH EMPLOYEE $ OF 01'El2ATIONSILOCATIONS/VEIIICLES/SPL•'CIAL ITEMS CERTIFICATE HOLDER 100, r" , CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 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 FIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE � _ .. ate\ - - - -- - - --- Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02m www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/orpnizationawividua y 0%94/ 9 pfa� CM ` <1JH V Address: 10 6eAw0rj S�,roef b/8 City/State/Zip: ,MAI, AVbowle ad #: r-3 3`2 73 Are you an employer? Check the appropriate box: 1 I am a employer with �_ 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. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling s. ❑ Demolition 9. ❑ Building addition 1013 Electrical repairs or additions I l .❑ Phrmbing repairs or additions 12.❑ Roof repairs 13.5LOther Ig ruiy a�n�n u % Baca as wa v A muse wsu un uu� Tuc accuon Oerow snowing t6eff workm, COMPeOffition policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aff levit indicating such tcontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their worirers' cart. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the polky and job site information. Insurance Company Name: / I'm IV V-rVA- / j (l co Policy # or Self -ins. Lic. #:to () l7 1fJ Q� Expiration Date:_ L3 -_J —C)Sn Job Site Address: 2(21 6Y4 `{_ City/State/Lip:&L4 C -� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as require¢ 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 hereby certify ander the pains and penakties of perjury that the information provided above is true and correct FFA Qfflcial use only. Do not write in this area, to be completed by city or town of'ic&L City or Town: Permit/Liceuse # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: V- 4. Electrical Inspector S. Plumbing Inspector Phone #: Bip/A08'SSEiQ'MMM SO -9Z -S P"ll 6bLL-LZL-L19 # xe3 3"SSVW-LLB-I 10 90V iXO 006V-LZL-LI9 # '121 I I IZO vFq `uolsog wits uo)wutwM 009 saOR1831 saAui;o aagJO sluaptaod pplsnpa13o Iaaur daQ suasngoEsseW 3o glluamuouimoj agL :»gamu xe3 pue Quogdajal `ssacppe S,lua =&(l oq,L y Va a sn aAa O1 AMR loa op aSeaja `mousanb Cue aAeq uoA pings pue nouerad000 moA io; aouenpe at no.( xegl 0123M pinotA SaoueSusanaj,lo 2orj10 aql ILwpWt, s!ql alajdmoo a4 pannboi ION sl uosrad pies ('o12 soneoj umq o1 ljuuad io osmq Sop a •a•t) almuaA te13DMMOO 10 sszgsnq,Cue of palelai lou 1F=d 10 asaaocj a Samelgo sr aazq�o 10 "UtAo amoq a aJagM 'iea�C goes lno pang ag knit uAEpgje mau d •sasuaog. io stpwd am1nj io; a jg uo sr i!A tMe p. 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JJ ....................................................................... wiring in the building of . ........ ............... %Andover, Mass. at ............................... ......... ""14 ....................... ,North An oo.A it 4ee..................... Lic. o . ............. ........ :...............:....;.i ....................... ELECTRICAL INSPECTOR .Check # 1Im UULVVy1U1V VVZfUJ 11 Ur 1V/tL.XV1L112UJlSl i v �-•• w ��- , DEPARTAHATOFPUBIICS MY Permit No. _ BOARDOFFIREPREVEMONRBG LWONSM7 � .VO Occupancy & Fees Checked APPLICATTONFOR PERMUTO PERFORMELE=CA.L 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 / _✓ Lf Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street S Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes 1Z No Purpose of Building , rA4 t; ,R.. (Check Appropriate Box) -0' 61 V Utility Authorization No. Existing Services Amps /96 Volts Overhead El Underground No. of Meters New Service Amps Volts Overhead ED Underground 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 b t KVA No. of Lighting FixturesSwimming Pool Above cl Below Generators KVA round ground No. of Receptacle Outlets No. of Ail Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis 1 No. Hydro Massage Tubs No. of Motors Total HP I - OTHER• hmttana QmageRmuatRmtbeteM naisofMmwbsMCen WIaws Iha%eaa=tLmbkyhmaato Po yirriA gCanplele ComnWcri>saftn alepvalalt YES NO Ihavesibma&dvafidPcdcf==1DtheOff= YES j�i� ff}whawdrdedYES, plea9eirdicalethetype0faAeagzby drddrgdr boot IBJ INSURANCE BOND MEFR WotkiDStatt 2 a �` D*Bstirr>amdvahreofDecmcnlWadc $ FuW S'gIed ur.&r tTr Palaldes cfpetjtlty. FIRMNAME eq / ">ti-.S' Cr )1 S`m C,---fu&0V LioaseNd Liget= 6 r `.x.% tl' a 0 tci" sigrrm Bush sTelNa `T7l� % 5 �> wr. it v�.t /1'I AIL Tel Na OWNF'SINSURANCEWAIVER;IamawarethattheLio=doesmthaiethem nmwawariFarilsatsuntdetllwmicrnasrequitedbyMassad,MMCfnaalLaws arylthatr ' sigma menthispeiritapplicabalwaivesthistequrtertalt (Please check one) Owner Agent a Telephone No. PERMIT FEE signature of Owner or Agent Date. h TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. "P. C ... ��°�:. ....................... has permission to perform ....Pe. e— P. t -r i� 6�' .................. plumbing in the buildings of ................ at ... `- O . .............. . North Andover, Mass. Fee. .YS. r.. Lic. No..?. P, UMBING INSPECiFOR Check * v 6548 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS _ Building Location 2d Date / RA0a ib�I .S f Owners Name S -'9v6 / g„� , a14 r Permit # ~ Y Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES (Print or type) Check one: Certificate Installing Company Name _ s'�l' /�%�'r d'i�L /YoA;tti!/ [� ❑ Corp. Address 12 (6ryec-eD ST /`9e-na4w1 l�. /-Y/y elvvv � Partner. BusinessTelephone 92,q , �'�- 39M �FlmVCo. Name of Licensed Plumber. ��f Y�t� ��iP✓� Insurance Coverage: Indicate the type of insurance 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 1:1 Agent 11 I hereby certify that all of the details and information I have best of my knowledge and that all plumbing work and inst compliance with all pertinent provisions of the Massac gt1 By: ,g e o ibmitted (or entered) in above application are true and accurate to the .ions performed under Permit Issued for this application will be in State Plumbing Code and Chapter 142 of the General Laws. Title Type of Plumbing License r 24Z-3 � J City/Town ium Master Journeymani APPROVED (OFFICE USE ONLY �,�T �.k�a�w;t'ri". .l* w:-.�-".�,��'lity.f�,+...r�. M�a'• ., _ -.i.+`?— Location? !€�r�i No. 19 Date N°RT TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �SS�cHuSE� Foundation Permit Fee f _ / - ` $ ermit Fee $ Sewer Connection Fee Water Connection Fee $ TOTAL $ ui Inspector P � ��IE 5.00 b, 85 3 ,, a •. iv: blic orks PEWMIT NO.+® APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP +40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK PAGE '. I- `?ONE SUB DIV. LOT NO. LOCATIONLQ TJO A^ �7 />j� a„T PURPOSE OF BUILDING �{ OWNER'S NAME NO. OF STORIES SIIZZEL OWNER'S ADDRE/S'SZ'/9�/V6�C BASEMENT OR SLAB ARCHITECT'S NAME —_ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR "' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKN.`ESS - v.Fy IS BUILDING NEW SIZE OF FOOTING X6 IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELF,CTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVEDBYBUILDING INSPECTOR DATE FILED SWIVaURE OF OWNER OR AUTHORIZED AGENT FEE-" - PERMIT GRANTED 19 ,.F 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST / mit EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. a CONTR. TEL. # 795?��-6aa"l CONTR. LIC. # 0,7 H.I.C.# /l7LJ6' 9538 - BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE 3 I 2 13 CONCRETE SL K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL V, 1/2 '/, FIN. B'M'TAREA FIN. ATTIC AREA _ _ N_O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES B 1 2 3 _ CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING HARDV✓'D COMMCN ASPH. TILE VERT. SIDING STUCCO ON MASONRY _ STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STIRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBRELMANSARD I TOILET RM. 12 FIX.I FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. '& COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 12nd I _ ELECTRIC THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS: WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 1st 3rd NO HEATING �`+� kyj tT-'* ext I � —R MEE" 43116 77, 4, iM 7i =---RgQt OEM 7p M 0 z M IM ,MW Mm M -:Xnl�*V a. .. �= -g- 4FJZ. �'Ul. ic, - "moo by a o kyj tT-'* M. -V. -74 7p o 0 1% C, .. �= - - "moo _.���*�, r F M. • COMMONWEALTH DEPARTMENT OF PUBLICU" OF _ ONE ASHBORTON PLACE �^ MASSACHUS BOSTON; KA 02108 = EXPIRATION DATE T�„. ,UPERVISCR 09/30/1995 11 EFFECTIVE DATE UC -NO. RESTRICTIONS 1 t NORAA�N ani( 7n J=FF=ZSON ST SS .4 723-34-99,69 } '4 A IN 0v`J_01p4= 4 A 1 PHOTO (BLASTING OPP C:NL:) FEFr j C c - NOT VAUD UNTIL SIGNED BY UCENSEE AND OFFICWIY HEIGHT: STAMPED OR SIGNATURE OF THE COMMISSIONER � � F DOB: 9IZ./1 '�iS -DOCUMENT `BUST EE I SEE CAF RIED CN THE PERSCN CF i 'HE-iOLDER WHEN EN- OTHERS- RIGHTT HUMS PAINT GAGEDINTHISOCCUPATICN. - COMMISSIONER 1. - ..r__}----.1-_.-. __.___.._-...__ ._ _._.� ��4L�-+lllfllL2eR31iwelP�.9�`••••e� �� ,7 ie �-oixdxaxriwa!(ir r`..l�tr.L:aciiax(l HOME IMPROVEMENT CONTRA CTOR Registration '17436 lupe - DBA I ,1A Expiration 10/03/96 ALL UNDER ONE ROOF -PEST IN PE NORMAN GAY l�M - 9"ftFFERSON ST "DMQMS—'`WC_l NORTH ANDOVER MA 01845 S ame: )ocanon: c)tv phone # C] I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on U t am a soie proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /I do hereby certify rint name of perjury that the information provided above is true and (revised V95 PJA) - - - Information and Instructions' Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every. state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. 5 0-5" sr„'� 3:* `f "` may, ,�'ii%"" ✓� ,; v'xc„- '` � 'se411C,ii",r'---"` �,. W ,+�, I Ii✓''.: k .vr✓ 'r" a �` Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. RSRI _.:,✓ m,.. xe.. ,. ...-,:.u�: x���..f �y a..� �� —".�,. _-' u+ -"-... .xv.�..M_ x... _ ,.,� ,;:� _ _- .. iL. �, r,�.,,,,.c _..�a� . City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and shouldyou have any questions, please do not hesitate to give us a call. e The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents office Of IOYCStlgations 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 est. 406, 409 or 375 Chimney's Painting Decks,* 'I-8WWAU4- Rook Leak Ex per LOCATION JOB PHONE, herebytofurniShrnaterial and laborin accordance icu with specItIcat! We ro se ions below,mr.the s M_11*tv�_,.,E414? :��ks 1� fn- --44 EMU M, kit Payment to be made as follows: - 7 S �Aut hon; All material is guaranteed to be as specifleiiJ.'.Ali work to be in tte, worlananjiW ` I ie� , - manner according to standard practices. An alteration or -deviation from speqfication YQ4 17 ttk bel6illi&olvin 'extra costs 411 be executed only'u wrl��'ind beicome an S g Pon _gti, ignattire.. sm6s �contii gent, upon extri'chiM_e_ oviiand abo4tilithe' estiimailw"All agreements "i-11- - � NOTE: This pro y b" accidents or delays beyond our control,. Owner to carry. fire, "tAiii6jitid other necessary, e 17;-` insurance Our workers are full 'is Co 4 _44 ni! V covered by Wo*Mqn motenskliori Irox. _;4� `64' 0 -�rzmnw M Meh4re6j,iUbmltspecifications and estimates for: CITY; STATE & ZIP CODE - 9' OW U11 't. Ni 0 NO `J 7 00 Mo 1:-, N ARCHITECT "1`2- -A -V A LOCATION JOB PHONE, herebytofurniShrnaterial and laborin accordance icu with specItIcat! We ro se ions below,mr.the s M_11*tv�_,.,E414? :��ks 1� fn- --44 EMU M, kit Payment to be made as follows: - 7 S �Aut hon; All material is guaranteed to be as specifleiiJ.'.Ali work to be in tte, worlananjiW ` I ie� , - manner according to standard practices. An alteration or -deviation from speqfication YQ4 17 ttk bel6illi&olvin 'extra costs 411 be executed only'u wrl��'ind beicome an S g Pon _gti, ignattire.. sm6s �contii gent, upon extri'chiM_e_ oviiand abo4tilithe' estiimailw"All agreements "i-11- - � NOTE: This pro y b" accidents or delays beyond our control,. Owner to carry. fire, "tAiii6jitid other necessary, e 17;-` insurance Our workers are full 'is Co 4 _44 ni! V covered by Wo*Mqn motenskliori Irox. _;4� `64' 0 -�rzmnw M Meh4re6j,iUbmltspecifications and estimates for: CITY; STATE & ZIP CODE - 9' OW U11 't. Ni 0 NO `J 7 00 Mo 1:-, N ARCHITECT "1`2- TE �',IDA OF -V A o4 .4 1 i�, '00 LOCATION JOB PHONE, herebytofurniShrnaterial and laborin accordance icu with specItIcat! We ro se ions below,mr.the s M_11*tv�_,.,E414? :��ks 1� fn- --44 EMU M, kit Payment to be made as follows: - 7 S �Aut hon; All material is guaranteed to be as specifleiiJ.'.Ali work to be in tte, worlananjiW ` I ie� , - manner according to standard practices. An alteration or -deviation from speqfication YQ4 17 ttk bel6illi&olvin 'extra costs 411 be executed only'u wrl��'ind beicome an S g Pon _gti, ignattire.. sm6s �contii gent, upon extri'chiM_e_ oviiand abo4tilithe' estiimailw"All agreements "i-11- - � NOTE: This pro y b" accidents or delays beyond our control,. Owner to carry. fire, "tAiii6jitid other necessary, e 17;-` insurance Our workers are full 'is Co 4 _44 ni! V covered by Wo*Mqn motenskliori Irox. _;4� `64' 0 -�rzmnw M Meh4re6j,iUbmltspecifications and estimates for: 9' OW U11 't. Ni 0 NO `J 7 00 Mo 1:-, N 15 4loo�A Is 11, 04 Pi Y • 41 Z" -V A o4 .4 1 i�, '00 ol 2, j 4 if 'k". k 10 55 ifbat P , 4. p J�. j k 6 t, M, il f, 1:t i I j ri i 14, 1T 4'. 0 0", 11. 10. 4 ;,4 , t it4 .4 if f ;j, t�i, t.4 g �i.� iop; - 511.5 t _j if 6,-; .7 f r. 6 4 q!. fit 4, 'T 'HU it 2, i "N 1f, , -� Ji� 010 '4 It 1 Ij i T� eX I'l it 1, It A 6 _7 U �t't; L tAki il1i,.,,1.T.1� V Vj: A 'AddOptanc6 of Proposal )kes,�-, specifications and' 12 J1 '6ohditlofii�iiili iitisfacto d h by accepted.-Nou are authoirized'.. s ry an are ore if 'to do work ass pecified.' Pa merit be miade-as ;outlined above. lit -:,4" itj F.: g;Si nature 14i ii, L! P i"1110 I j, Pit "N' q `6f.*cep Datd' t ancen.,�i I Si �1, �WZ �Ai 0"! J.- q N Olt r P t1v 1" "A 'i , Location No. Date "ORT" TOWN OF NORTH O:t ANDOVER `an :•,�O 41 s • Certificate of Occupancy �,SSACMUSEt� $ ' Building/Frame Permit Fee � $� ��/ F Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t Check #✓ r 18133 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE TWO FAMILY DWELLING jOR BUILDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE: ZLI Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: !2y r �t)✓ 1.2 Assessors Map and Parcel Number: 6 O o� Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water SupplyM.GL.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT iSt(iCt: I/6s mo 2.1 Owner of Record Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3..4 Licensed o�nsstruction/Supervissoor�: l '7—� Licensed Construction Supervisor: r� Address Signature Telephone Not Applicable ❑ C ~' License Number �l b Expiration Date 3.2 Registered Home Imm/ppr�r/ovveement Contractor 411 Not Applicable ❑ Company Name _ Registration Number '2 Address / Expiration Date Signature Telephone 00 rn z rn r V\ 0 z M 90 0 SECTION 4 - WORKERS COMPENSATION (M.G.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 as a Reahle New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition' Accessory Bldg. ❑ I Demolition 0 I Other 0 Specify Brief Description of Proposed Work: ASW -b'�247 p?2 X� I wrTION 6 - F.CTTMATF.TI rnNCTRTTrTTnN rncTQ I Item Estimated Cost (Dollar) to be Completed by permit applicant OF1F`ICIAL USE ONLY 1. Building 1 (a) Building Permit Fee Multiplier 2 Electrical (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 as%,iivi. 1V 1fE t;VMYLEIty WHEr4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 SECTION 7b OWNER/AUTHORIZED AGENT Date 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are �Tue and accurate, to the best of my knowledge and belief Print Name of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2' 3 RD SPAN DIMENSIONS OF SILLS —DINTENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE L4 jr 3� MORTGAGE INSPECTION sKETCN OF PROPERTY In VQ Rvi AAffidV V&9 ESSEX County, MA Applicant: _ 6 T Book -587-5 Page 144. L.C. Cera. No — S�alt ;-Q--- Date: ��o• D4 �t ,llr� /,�yln�ra Cd•"/o. LOT 17 LOT 16 44, 0140: r9..C' DEcE( �Qx'roTil7 -- 1"o vJ N O'StT�N / 4rom 4 B RADl�aRQ "rW_ W® rte• ric,ec y, n,.r.v�u t' `raves r �IGt, ,UKP sNa� In my professional opinion the buildings are-approximateiy located on the ground as shown hereon and conformed to the applicable horizontal dimensional yard setback requirements of the Zoning By -Laws of the Te /WW1 of /✓oma++ Ar y at the time of construction or is exempt from violation enforcement action under Mass General Laws Chapter 40A -Section 7, the lot as shown does not fall within a 100 year Special Flood Hazard Zone as delineated on the FENWFlA National Flood Insurance Program Map: Community No. 21222L_Panel ff _19 o,s C Dated 1- 2=9_-J_ Zone X Thla aMptl1 Y+aa drawn 10( rtEOripapa napacmon purposaa �' aot lobe noo(dad, Of O"InAd Y an IMrurrwEll MMVYy.11 mold . _ ._ _- nd k tr... wW not be (ampoE1able kx ow chwVea Wol DCdY. STRFF T L4C i ENCINEERIN(i � (X IUMN IN(' Technic Park Drivl 1 Holbro MA 02343 / ten. DIsTkIBUTION BOX 1*0 oe 100, � �010, � olf TP 2 s` _- 9 .� P yI1 ! s4 ? I Cd Q 00 CV .,Ao TP i' �.� MASTER BUILDER5;�=;` Phone: 978-686-6488 P.O. Box 2078 Methuen, MA 01844 j Proposal Submitted to: Work to be Performed Name Feldman Residence Address 90 Address Same Bradford St._ --- -- -- - City N Andover State MA Zi ----- - Date 2!20/2005 Phone 978-688-5955------ Zip Architect Ger Bruno i We herby propose to install and perform the labor necessary for the completion of: i Addition / R6 -model Permits I ' Site Work Concrete Frame Exterior Door/Windows Exterior Finishes Insulation Interior Finished i Electrical I Plumbing Finish Site Work Total $70 000 All work to include building and finish materials according to plans project specifications, and 311owaIlnces. All material is guaranteed to be as specified, and the above work to be performed in accordant;e with the drawings and specifications submitted for the above work and completed in a substantial workmanlike manner with one year warranty for parts and labor. Palmisano Construction does not warranty! or dGes not take responsibility for parts purchase b customers for installation in above scope of work. Payments to be made as follows: Respectfully submittec}L��First Payment: /Z�/c a Any alterations or additional work beyond the scopSecond Payment: e Third Payment:^S�a? 3 of this contract will be billed at per hour per - 233 3-3 worker plus materials. All agreements contingent upon i strikes, accidents, weather, or delays beyond our control. Note: This proposal is valid for 30 days. Acceptance of Proposal The above prices, specifications and conditions are satisfactory and are hereby accepted. Yq)�,are authorized to do the work as specified. Payments will be made as outlined above. Signture Date ''� �i� Signator !1� ((i,n,,-, FORM U - LOT RELEASE FORM 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 APPLICANT_L PHONE -7;;,Z) LOCATION: Assessors Map Number 8 6 / p PARCELS-- SUBDIVISION LOT (S) STREET_/_�,��r� ! ST. NUMBER OFFICIAL USE ONL AGE CO DATE APPROVED DATE REJECTED - 11) h EJECTED1hh r AL � d - TOWN PLANNER "? DATE APPROVED DATE REJECTED COMMENTS FOOD IN ECTOR-H TH DATE APPROVED DATE REJECTED INSPECTO -H H DATE APPROVED r Jl I L DATE REJECTED � COMMENTsr, , . -1,, PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE RevWW 9197 jm REScheck Compliance Certificate 2000 IECC RES checkSoftware Version 3.6 'Release I Data filename: Untitled.rck PROJECT TITLE: PLAN NO. 3421 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: Single Family WINDOW / WALL RATIO: 0.14 DATE: 12/10/04 DATE OF PLANS: 12-4-04 PROJECT DESCRIPTION: ADDITION TO EXISTION HOUSE DESIGNER/CONTRACTOR: BRUNO ASSOC. 28 BERKELEY ROAD N. ANDOVER, MA 01845 COMPLIANCE: Passes Maximum UA = 115 Your Home UA = 89 22.6% Better Than Code (UA) Ceiling 1: Flat Ceiling or Scissor Truss Wall 1: Wood Frame, 16" o.c. Window 1: Vinyl Frame:Triple Pane with Low -E Door l: Glass Basement Wall 1: Solid Concrete or Masonry Wall height: 8.0' Depth below grade: 7.0' Insulation depth: 4.0' RECEN APR 14 TOWN OF NORTH HEALTH DEPAF Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA 528 30.0 30.0 9 560 13.0 13.0 23 60 0.330 20 18 0.330 6 528 19.0 19.0 31 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 IECC requirements in RES checkVersion 3.6 Release 1 (formerly MECcheel and to comply with the mandatory requirements listed in the RES checkInspection Checklist. Builder/DesiperDate REScheck Inspection Checklist 2000 IECC RES checkSoftware Version 3.6 Release 1 DATE: 12/10/04 PROJECT TITLE: PLAN NO. 3421 Bldg. Dept. Use I Ceilings: 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity + R-30.0 continuous insulation Comments: Above -Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-13.0 cavity + R-13.0 continuous insulation Comments: Basement Walls: [ ] 1. Basement Wall 1: Solid Concrete or Masonry, 8.0' ht/7.0' bg/4.0' insul, R-19.0 cavity + R-19.0 continuous insulation Comments: Exterior insulation must have a rigid, opaque, weather -resistant protective covering that covers the exposed (above -grade) insulation and extends at least 6 in. below grade. Windows: 1. Window 1: Vinyl Frame:Triple Pane with Low -E, U -factor: 0.330 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: 1. Door 1: Glass, U -factor: 0.330 Comments: Air Leakage: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be 1) Type IC rated, or 2) installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials. If non -IC rated, the fixture must be installed with a 3" clearance from insulation. Vapor Retarder: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. Materials Identification: Materials and equipment must be installed in accordance with the manufacturer's installation instructions. Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating j equipment must be provided. [ ] Insulation R -values and glazing U -factors must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-6.5. Duct Construction: [ ] All joints, seams, and connections must be securely fastened with welds, gaskets, mastics (adhesives), mastic -plus -embedded -fabric, or tapes. Tapes and mastics must be rated UL 181A or UL 181B. Exception: Continuously welded and locking -type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Service Water Heating: [ ] Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. [ ] Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 105 OF or chilled fluids below 55 OF must be insulated to the levels in Table 2. Table I: Minimum Insulation Thickness for Circulating Hot Water Pipes Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pil2e Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature Low Temperature Steam Condensate (for feed water) Cooling Systems Chilled Water, Refrigerant, and Brine 201-250 1.0 Insulation Thickness in Inches by by Pine Heated Water Non -Circulating, Runouts Circulating Mains and Runouts Temperature ( Fl UR to 1" Up to 1.25" 1.5" to 2.0" Over 2„ 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 045 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pil2e Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature Low Temperature Steam Condensate (for feed water) Cooling Systems Chilled Water, Refrigerant, and Brine 201-250 1.0 1.5 1.5 2.0 120-200 0.5 1.0 1.0 1.5 Any 1.0 1.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) H W W N O LL QD m 0 O� U) c`O W U �a p o Q W 0 O d CL m O C O � O N O � Q J Ln O O `1 c EC C CC C a Q C C C C C LIVco ItC C c c c n C LL C.' n a n u� p C! > O Ow0 Z 00 h � aD 00 r U3 v cc c '•CC J J to"Co ��0 SKr O O 0 0 i" � r Z 0 z O � C t,• QLLJ Zv+. c C JJ ON vN O Q,o Z oo M Z C O LL'v_ vM O r Z N !a o Q JQ ; —UJ "70 >mm 0 0 Z R� rn 0 010 Il) Ver N N O m m 09 O p' 2 co mr- p a a ZN"� U ,. Nti aN07N OS O', (0 fOa,C �O„ v LIE N 111 N Em',E Z'i""yy'u) o fA �" co 6A �- O 9 '. O 'dp Q m w,,m , of Mu) Ln { Z o ay;wr N" �acOi`e t y O F- ? cr LL m pO cc N ? W CLL CLL' � �' f0,a�D C O 00,00, � o U ,Q),-, � � n W>- (D,(—) Z: QM.�.r•'.. �"'".' Q i6 c/i W .y -t Q -f•, x m 1L tj �` s U VL •• t V p �. M o --AD (ca 7 :� �O o N'C3J d V 6 •- ON d M -6 _ CU LY x'000 ,t�Y "�U' o d cae%=m--c,w N 1-m ZLLImY�W Co 4< Z m Z' ixlr (7 LL N"u = O°i- Z a m Q� =� am�c'D c�a�m t fU- `O0 3 OS ,�'' m �c' o W Y n, «O %o' X (0 o N «�_�._ .ED 6y(n f w 12'LL. ° 2 IL LL U O a 3:1 CO 0 0 rn co d o O M M 0 N t6 0 0 0 0 0 LO LO 0 0 0 0 _o N U co a The Commonwealth of Massachusetts Department of Industrial Accidents ORke of lnvesdgatlons Boston, Mass. 02111 ' Wafers' Compens dW Insurance AffdM Please Print City Phoneit �� I am a horneawrter perforMng all work myself. 0 I am a sole proprietor and have no one working in any capacity 0 I am an employer pnwiding workers' compensation for my employees worldng on this A. y, 1_., lrtstuanCa Co. Pdkar ! Fdkm to s=n caverape ar rsgdmd order Section Mar MM 152 can laed to the Mrposillon of ch.* pwwMlsa d.a f ne up to $1,5W.W sndraronayers'(mprbarment_aa.rival_r_der40mkbw]Dl fmgfA 3MPVAMOROER.aodAfbd.pltn.MAd*Mggin wA I understand that a copy of this statement may be forwarded to tis Odie of inwetlpatlons of tt» DIA for covwspe verR cd W. I db r www cw* w dbr die pains end ps kWft ofpedw y drat du bdb►medon provided ebm is bus and correct Print OfRr W use only do not wrRe in this wu to be completed by dty or town afflcier CRy or Town pin Ir.n.iM 13 Bu* ft Dept [jCheck X immediate nosponae is roquked El L kWWkV BoNd p Se/ectnren's Oft@ contact person: Phone att [] HOBO Deparbnent Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of acility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector AC09P. CERTIFICATE OF LIABILITY INSURANCE OPID -11 "OATEIMIDDNYYY) " PATI 08/04/04 A*1V^MAA Arl^n Landmark Insurance Agency, Inc 109 Massachusetts Avenue North Andover MA 01845-4190 Phone -978-609-8829 rax:9718-975-3987 Mike Palmis4no "bonstruction I Fenwick C;& ' 1 9 Methuen HA Of 4" ES INSURERS AFFORDING COVERAGE I NAIC # WCURCAP, A.I.M. mutual Xns Company IN>URER0. Na-t—iowa Grange- —Mutual 14788 INSURER a THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDASOVIE' FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOURMAIENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUNIENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE PULICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. eXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LUTS SHOWN MAY HAVE OCCN REDUCED BY PAID r -'I AM LTR MaRS;giYu- Type or IN*,.-v—nANGe' NUMAV TR LIMITS GENERAL LIABILITY eAcii =kiRRENrF s 1000000 commeiwmL oFNr-RAL LIABILITY UP110536 :LIAM 1110IX4 :L1/01/05 i SLETUR94 PReAws tea oc,"' 500000 "AIMS MADE' OCCUR , ��Buziftess Ownors i MPTIO536 11/01/04 11/0.1/05PC--RSONAI. INJURY I[ & ADV 1000000 - GENERAL hGGREGATe 1%2000000 GEN4. A03REGATE LIMIT APPLIES PER: PRODUCTj - cliom`P-; 000000 • 0. F Pou'..y CT 1'LOG AUTOMOBILE LIABILITY r NECI SINOO: LI111fT ANY AUTO ROMQI ALL CWNSO AUTOS BODILY INJURY SCHZOULEOAVTO$ HIREDAUTOS 8000,Yt01iURY NON-OWN01 AUTOS 1 ( (Pet otawt - .«........ + !"P'ROPERTVOAMAGZ (Pef *000faq GARAGE UA81LITY AUTO ONLY EA AWDFNT I ��S ANY AUTO 01�iFR THAN FA ACX AWOONLY: AGGIS 1EXCIfSS1UM8RELLA LiABILITY EACH (MXJRRGNCE s OCCUR O.AIMS MADE Is T OLE { R T E 84TION WORKERS COMPENSA'"ON AND '19�Y EMPLOYEREMPLOYERS'F1 LIABILITY [-.- EACHACCIDENt ANY PROPR19.)'ORPARrNSiVotecuTtvr-. OFr1CePjMeMAFA EXCLUDCO? 1;,L OIS'GASC - EA EMPLOYEE if y", *=be undal SPECIAL PROVISIONS betaw EL nZer-se-POLICY LIMIT S OTHER DECCRIPT*WCIF tipEPATtotirtILOCATIONS IVEHICLES 1'9XC-LU-SION3 ADDEO BY ENDORSEMENT I 3P6CIAL PR-01V-191ONS 1 1rIL;4K 1 It: SHOULD ANY OF THE ABOVG OCSCRIBEP KKICIGS BE CANCEI.ViO BEFORE THE eXPIRAYff DATE THEREOF, THE IMINCI INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLOGR NAMED TO THE LEFT. OUT FAILURE 70 00 $0 SMALL IMPOSE No OBLIGATION OR LIABILITY OFANY 113NO UPON THE INSURER. ITS AGENTS OR CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER I'P()Y HIS CERTIFICATE IS ISSUED AS A iVIATTER OF INFORMATION ONLY AND Landmark I115UrariCe Agency Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AbHIND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Tr IPP R7Pi "XI 198 Massachusetts Ave, Ste 101 North Andover, MA 01845 INSURED Mike Paln-iiSan0 dba Mile Palmisano Construction 1 Fenwich Circle Methuen, MA 01844 COMPANIES AFFORDING COVERAGE COMPANY A.I.M. Mutual Insurance Co LETTER A COVERAGES 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 RESPECTTO 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 H[ AVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPII2ATIO :.TI2 POLICYN'UhIDEli DATL(MM(/DD/YY) DATE (MM/DD/YY)I LIMITS —r — — .L LIABILITY I I (PROPERTY 03/09/2006 '0\1MERCIAL GENERAL LIABILITY $ EXCESS LIABILITY NIBRELLA FORM i TFIER THAN UMBRELLA FORM GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. $ ___F 4S MADE E:3 i11'N'ER'S &CONTRACTOR'S PROT. $ PERSONAL & ADV. INJURY YORKER'S COMPENSATION AND EMPLOYERS' LIABILITY PHF.. PROPRIETOR/ !NCL6007826012005 ARTNERS/EXECUTIVE 7JFFICERS ARE: X EXCL OTHER EACH OCCURRENCE 03/09/2005 WC STATUT R OTHER X ur S EL EACH ACCIDENT $ LL DISEASE--POL:C]' LIil;IT FIRE DAMAGE (Anyone fire) $ )BILE LIABILITY MED. EXPENSE (Any one person) $ COMBINED SINGLE LIMIT $ NY AUTO LL OWNED AUTOS IN] on) $ -HEDULED AUTOS IRED AUTOS rBODILY INJURY dem) $ ON -OWNED AUTOS ARAGE LIABILITY OFOPE12AT1ONS/LOCATIONSNF111CLLS/SPLCIAL 1TLMS CERTIFICATE HOLDER 100, o CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 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 HIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE � _ _ I I (PROPERTY 03/09/2006 DAMAGE $ EXCESS LIABILITY NIBRELLA FORM i TFIER THAN UMBRELLA FORM EACH OCCURRENCE —.— $ AGGREGATE $ A YORKER'S COMPENSATION AND EMPLOYERS' LIABILITY PHF.. PROPRIETOR/ !NCL6007826012005 ARTNERS/EXECUTIVE 7JFFICERS ARE: X EXCL OTHER 03/09/2005 WC STATUT R OTHER X ur S EL EACH ACCIDENT $ LL DISEASE--POL:C]' LIil;IT EL DISEASE --EACH EMPLOYEE $ OFOPE12AT1ONS/LOCATIONSNF111CLLS/SPLCIAL 1TLMS CERTIFICATE HOLDER 100, o CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 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 HIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE � _ _ I 0 a 0 I O CM C C O•— y Q O — O O NCO*R m m a_� O Q O a CL v�Q c c= c !O V NO CL 0 CD c Z ts ai CL V y m c c— NNNOW CL CA) Q LLI 0 N LLIN 19 W LU W U) �o a m c a C3` a N OCc CL C C v Ji q w° p°G U lz y c�° w P4 w 41, .r p°G a 0'4 o in cn 0 a 0 I O CM C C O•— y Q O — O O NCO*R m m a_� O Q O a CL v�Q c c= c !O V NO CL 0 CD c Z ts ai CL V y m c c— NNNOW CL CA) Q LLI 0 N LLIN 19 W LU W U) �o m c C3` N OCc CL C C O � A. 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