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Miscellaneous - 94 PETERS STREET 4/30/2018
1 North Andover Board of Assessors Public Access' NO TN t ,(, _� _ • • oil«L �� � O �A �9SSwcHU <1_ Click Seal To Retum Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial � b , Page 1 of 1 roperty Record Card Location: 94 PETERS STREET Owner Name: DWYER, WILLIAM Owner Address: 94 PETERS STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5 - 5 Land Area: 0.32 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1564 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 278,300 278,300 Building Value: 104,400 104,400 Land Value: 1.73,900 173,900 Market Land Value: 173,900 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=1888627&town=NandoverPubAcc 5/17/2012 N O N LL H W NW Ix H CO) N w W H W CL O) U) a U 0' -o 0 U Q LU CL �U O d d � O � O C O ryO J N N O 0 Y U O J m O CD CD O O N N O O O N O O N J w U Q a I N 0003pe 00 �NiNc rNr N ta; O m MM N N � a 0 coy s(6d Ot J m30 C O J J V4}U.0 Z 00 O NIN#�rQ` c:2 CIO, ClO O' IL Cn O n« 8 11 U z Q LL, ti g e° ,o O Jnr LL �=oo , �1-6Vin. Z €o , ca ai ZN$O W ll� J J oG 20 2,0 LL Qi= � N o'M tJQ '. Zoo atmLL � iO pi�a A Z LL O O— O Ovl . Z QM $ III pr :�$ 103 LU ,Oo J 0) 0)0)J co co W ..- IN � a CV) U ` H€Lu z.�O OO clC7 r �- t, iwII/ M O 00 a0 a ' UO D m' E 20, O N N « (lJ F- o rn'�t Z " EC) Lo U , W CL i O m k(L W mia IU !U o U Lit O N c) N c6 N :F G �� g # k U n LA0 f- F - p 1►` ,O c p1G z p G '" 1U) C O a O ,a o joo �" II r * "N E 4 I W O Op 4) Z IN `�c- jw kV) (/) I U 2 �Oa N L m o -6 os �o 0 a Pi z q— ) U)O f4 (DL aO3r �, 1d Ohl a $' i7Epa .. U. iioQca4ii,I 1 N O m km LL 'p' EBF Iiii r.H7 rn N U ^O dd �tN( Z 'Ata fN L= LL ��a) Q�' C9 C,4 C4 F 4 (O t0 3 a co co � rn Nica O1O� X g coy.. L6 a(6 f iO:W { M O, L� -�'"L LCL � �f- t- F W ON. � i.� 0 A`.=c fl.d Z U. uC 11 QOE �mm OOOGO !L CO �(D OED CO ° 'V 4c n W 0) Uio uj >- o 4 Z W Lu III t,+W&4 O QLn U Ln oo p WN LL EI co a 0000 rn N — co Us —co °OOOO ,omm W w Q �a X00 .Y EE, CD (1) W w Q Wa, Hrm§tLp2:11JmY:W mmQ 0 W Q w W O 3fnj 9 a H U Q w `O J_ U) C3 Ugpoi pi:f U- cnO�Z a f 1 a Ip j.. Z E CL LU W � d `°�' ° '>,��'�P�` U i6 3L] chiZ > o °o X m o Q) ° C `o Y 0 Q 6i6!�.W`2.LLi =tLWU ddw Ln w. �....-r-.^s--. _ _-- .,...stili..-.. ►..-.t...,-. Date.... 11684 HANDOVER 'LUMBING ........................................... r---..---- ................................................................................................ plumbing in t e b ildings of ... ........ .\4 �..................... at .................. ........ ice;:S �'-" ..............., North Andover Mass. _............ ............................... , Fee�z � .... Li -c. No. v`?�-� ...................................................................................... Check # � (,("C)PLUMBING INSPECTOR r�s- N MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Ur', CITY lNoah Andover MA DATE 0311012016 PERMIT # I JOBSITE ADDRESS 194 Peters Street OWNER'S NAME Bill Dwyer POWNER ADDRESS TEL978-697-2556 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL Ej PRINT CLEARLY NEW: ® RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES[] N0E] FIXTURES -1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK _ LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTS ER IBack Flow 1 1 IMM INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES[] NOD IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ® BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance withISI Pertinent provision oft Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` PLUMBER'S NAME IThomas Weeks I LICENSE # 8437 SIGNATURE MPED JPD CORPORATIONO#3083C PARTNERSHIP#LLC ®# COMPANY NAME I DiPietro Heating and Cooling ADDRESS 15 South Summer Street CITY Bradford STATE MA ZIP 101835 TEL 978-372 4111 FAX 978-241-7325 CELL J EMAILdeanna@calldipietro.com _ is N •.4:;,� r':6 o:�ti�:.v.�.rr`....-�.�: ��+r.�:..+r..:....-...,..-- .-... e..t,>;.:.:�.,,.,_,�_,,.:r-.-..�.----...rte-+�.w*�.--r�.,,� I Date... 4��.�'°.......... ' ........... - r OF NORTH ANDOVER _ -OR GAS INSTALLATION CHU �`T s certifies that(1W1V�s ale) L S �... t :::............................................. has permission for gas installation .....:1.,-ne .......................................... in the buildings of ..................................................... at ........ �..L.4;. North Andover Mass. Fee ..::'".... Lic. No. .... .GASINSPECTOR Check # 10492._ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING^ WORK CITY North Andover MA DATE 0 311 012 0 1 6 I PERMIT # y JOBSITE ADDRESS 194 Peters Street OWNER'S NAME Bill Dw er GOWNER ADDRESS TE 978-697-2556 FAX � TYPE OR PRINT OCCUPANCYTYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL CLEARLY NEW:® RENOVATION: ® REPLACEMENT: 0 PLANS SUBMITTED: YES[j NO® APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER ® _ FIREPLACE FRYOLATOR ® 0 FURNACE T GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTs ER ---- E=jI INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Ej NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [D OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowled e and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME Thomas Weeks LICENSE # 8437 SIGNATURE MP 0 MGF ® JP ® JGF [:] LPGI ® CORPORATION [D# 3083C PARTNERSHIP ®# LLC ®# COMPANY NAME: DiPietro Heatin and Coolin ADDRESS 5 South Summer Street CITY lBradford STATE MA ZIP 01835 TEL 978 372 4111 ��� FAX 978-241-7325 CELL _ EMAILdeanna@calldipietro.com �1 17 t f -V 4- L- a V14, CONTROL# J225693 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass.gov/dpi for instructions to ensure the proper mailing of your Renewal Application and.any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. CONTROL# J2-25694 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass.gov/dpi for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. CONTROL#J225692 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass.gov/dpi for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. i i Location re No. ` Date Check # t -c3 2794 TOWN OF NORTH ANDOVER. Certificate of Occupancy $ Building/Frame Permit Fee $_ Foundation Permit Fee "5 $ Other Permit Fee t$� TOTAL $ B6ilding Inspector LN N C > O N � C J O° m Co E C L (U cn O N �U j:T) 0) a) U O O ca O C in O NO U) � L- 0 O a Q - a a) 4 UE0 co 4 N c > N C O U O L fn Q E °'oo LC CO `- a N N_ c O 'C O C O +r U) OZ Qo� O C: ui > Q c� N O `' X•�� `0 � c N O c U) o .� I�� U E ca ,,,_ o a)�c 0a�' CU4-� c (n Co 0) N 0 i O N O N ,. N o U O O 0')U N U) C)- 0 O cn m O 02L -L-> W H _m w a w a z w F- Z J J J J Z w w N z c 0 D m 4— O O U (D 0- U) c c c6 U N O O a-1 c .F cnE � N W Q O 2 � z a � w 0— O z LL O /r% V z O () N 0 E cv C) w � LL y LU �d ly •Ju Os' o�`P F - LN N C > O N � C J O° m Co E C L (U cn O N �U j:T) 0) a) U O O ca O C in O NO U) � L- 0 O a Q - a a) 4 UE0 co 4 N c > N C O U O L fn Q E °'oo LC CO `- a N N_ c O 'C O C O +r U) OZ Qo� O C: ui > Q c� N O `' X•�� `0 � c N O c U) o .� I�� U E ca ,,,_ o a)�c 0a�' CU4-� c (n Co 0) N 0 i O N O N ,. N o U O O 0')U N U) C)- 0 O cn m O 02L -L-> W H _m w a w a z w F- Z J J J J Z w w N z c 0 D m 4— O O U (D 0- U) c ram CA 0 3 0 DO V) r-. O 2 -1 0 m 0 r. 6 1� 5�� o Cd 7� OU U S� 0 9b U � O \� v� N •� �. 0 N.D O r-, 0'o` -dO a N +� U CF CF on bo b O Cj U O0 O00 r� 't� •�U o U +� +R a S O x� 4 N O O $a C' o z ��+ P,40,c �a 0 0 0 P-4 M 3 0 vs 0 0 ^I �n 40, 9n a� o d 04 si, ao cd ' o� � ap.i 0 cd UV1Q0 M 3 0 vs 0 0 ^I William Dwyer <wjdwyermd@me.com>(? To: William Dwyer <wjdwyer@mac.com> Sign a k #: { t8 t. April 29, 2014 12:56 PM 1 Attachment, 644 KB l L' April 29, 2014 12:56 PM 1 Attachment, 644 KB BOUND assumed) 1�)Llv \1 EXISTING SIDEWALK IN QA n FIV7 " j �F l�l ' PROPOSED /0 SIGN A 98*70 A -IR = 50.00' L = 5 5.12EXISTING MAPI_F TREE TO 'REMAIN EXISTING I 99 .�60_47 E -SEME-NTS I A tom- 1 / 0 C\j J Tj EXISTING V DRIVEWAY EXISTING GARAGE l TO BE RAZED 919+00 99+00 140.00' ME. 99 +30 NOTES 1, THIS PROPERTY LOCATED IN THL B-4 2. EXISTING TOPOGRAPHY AND DWEI-.Llt\JC, PERFORMED BY NEW ENGLAND ENGINIFJ_R,;N; C ' 3. TURNPIKE STREE-11- AND PETERS 51REF. -i PREPARED FOR THE r'0MMONWElV,,TI;f OF PAWSS/) 4. PLAN REFERENCE. NORTH ESSEX RF*(.>IS7;fR`, 5. DEED REFERENCE,' NORTH ESSEX fREGIS T!R'Y 6. INSTAI. _LATION OF PROPOSED S-11GII-l"S WILL BUILDING PERMIT. ETERS STREET ASSESSORS MAP 24, LOT 22 14,104 SQ. FT ± _ 100 0�*f 99440 PROPOSED DRIVEWAY & PARKING AREA 99+30 EXISTING IING CRADE EXISTING .SPO'l GRAIDE PROPOSED SPOT GRADE 20' 0 1 2 0' 99,99 99+00 40' 60' NORTH ANDOVER PLANNJNC� 21, 3 4 5 DATE: THIS PLAN CO3NFORMS REG'ULA*'-_J,(,)NS '01' lHF I. HANDICAP PARKING SIGN VAN ACCESSIBLE HANDICAP PARKING EXISTING STOCKADE FENCE PRUPO�-.EU 2 .1,12" CAL.iPLH VIAPLE TREE (typical) PROPOSED PARKING L07 LIGHTING 8 L 7 CC", i—--- -18 '.. PROPOSED 6' STOCKADE _ FENCE R E.101 S ED 1216101 1114102 112 102 SITE P;.-A� 94 P1 I fi "If NORTH AIINI',�' PREPARE,, - LOW; PEA80"". I. NEW ENGLAND EN(. 60 BEFC1.11 WO NO RT I N 1.) WN BY: 50 I I of 2. C" C O tn LOO 4 E 000 E c U c (� p ° U 0 �® O CCL _OCY N N Z' j > L 0 UN � W c CD H J i W O m = > _ O O L Z is 0- -� Cl) Q Ldp0 Q 0) 2 W O ^. m c E _ m L.L L N CL O L N 0 O c W 0 Z (6 .0 F- C: U U- Z) 0 > � Z Q O CL 0 Z V �_ OQ O. > J -C 41J O (n I N � O = N -0 0 J H v O cu U J N Q O p v U) 2000 uS W Q' 0O F > M 0 Z > . YCY,C C O(D Q O Oz- O 5) CO o O O Q N cu��i _ N � O 1--4- •Q O E N � Nca .� N W_ to JAR ** p i C) iF L C =� � C p -, a) 4-- N4-- W O cn 0 00 C V � +� a- U W �/� N c v, ¢+ V/ L 1. r '.',r ~ N O N U Q W 2 c_N N N ._ d I-- 0 000��> dU�� Location it t:'-54� No.D-30 ` Date i- t f o - w TOWN OF NORTH ANDOVER Certificate of Occupancy $ fl Building/Frame Permit Fee $ 0 Foundation Permit Fee $ Other Permit Fee : TOTAL $ Check # Li r. • 27471 Building Inspector a Fw O W X c M b MAW s .9 U a1 ' E c E 3 I0 0 U) Lo a� 44 w, lV 'y}pNyy ^o � � •� i .®py�yJ r w 00v 9 � y lV 0 a 0 g�1 • Dl � � 44 13, 017, r S- 0 m C C � N c� C C Q C •ca •� C O) O) C > N aQ C O @ > O b N ° C U U C @ E O O) y � N 'O C f .O N 1 O O 70 ^ a CL 0 O CL n a) O a) V1 ttio aa) o yr �gg a �n3 Eo ami N a O •� �° tar 0 N .g 4 A I �a Uva o ID a N c7 Cl) N n I? M aD m r - Q 0) f6 + U W N E ' m L U) N 1 Fw O W X c M b MAW s .9 U a1 ' E c E 3 I0 0 U) Lo a� 44 w, lV 'y}pNyy ^o � � •� i .®py�yJ r w 00v 9 � y lV 0 a 0 g�1 • Dl � � 44 13, 017, r S- 0 m C C � N c� C C Q C •ca •� C O) O) C > N aQ C O @ > O b N ° C U U C @ E O O) y � N 'O C f .O N 1 O O 70 ^ a CL 0 O CL n a) O a) V1 ttio aa) o yr �gg a �n3 Eo ami N a O •� �° tar 0 N .g 4 A I �a Uva o ID a a �r LU D Building Department Town of North Andover 1600 Osgood Street North Andover, MA 01845 4-17-14 RE: 94 Peters Street North Andover, MA ATTN: Building Inspector, Thank you for your time. in review of this project. 0 O www,instantsigncenter.com Enclosed are the following documents: signage permit, letters of authorization, worker's compensation insurance affidavit, certificate of liability insurance, proposed drawings for review and plot plan showing location of proposed sign. We have also included a check of $30.00 for the permit application fee. If there are any, additional details/documents required please let us know. Sincerely, /-L �F7,j Jessica Novak 40 Orchard Street, Haverhill, MA 01830 508 Boston Providence Tpk, Norwood, MA 02062 978-372-3721 • 800-696-3773 Toll Free 781-619.1107 Direct a 800-339-0150 Toll Free 978-521-2192 Fax 781-278-9550 Fax Brookhave 0 Hospice - March 20-2014 Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 RE: 94 Peters Street North Andover, MA 01845 To whom it may concern: Please accept this letter as formal authorization for The Sign Center of Haverhill, MA to act on our behalf and as our "agent" for the purposes of securing all the necessary permits and approvals (including signing of all documents relating to these matters) required by the Town of North Andover for the proposed signs to be built and installed for 94 Peters Street, North Andover, MA 01845. Should you have any questions or concerns, please contact me at 978-771-26ig. Thank you, Mark Carroll Founder and CLO Cambridge Statisdeal — Mnkino nIctinetinnc F1 March 19, 2014 Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 To whom it may concern: As the property owner of 94 Peters Street, North Andover, MA 01845, 1 have reviewed and approved the proposed sign designs for this location. hereby authorize The Sign Center to act on our behalf in all manners relating to the application of sign permits 94 Peters Street, North Andover, MA 01845, including signing of all documents relating to these matters. Any and all acts carried out by The Sign Center on our behalf shall have the same affect as acts of our own. If you have any questions regarding this matter please feel free to contact me at: 978-697-2556. Sincerely, William J. Dwyer, M.D. 4 Spring Hill Road • Merrimac, Massachusetts 01860 Office 978-697-2556 9 Fax 978-384-8356 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 p` Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Insignia, Inc. dba: The Sign Center Address: 40 Orchard Street in- Haverhill, MA 01830 Phone #: 978-372-3721 Are you an employer? Check the appropriate box: LK I am a employer with 48 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. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition. 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.7 Roof repairs 13.❑ Other *Any applicant that checks box # ] must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Peerless Insurance Company Policy # or Self -ins. Lic. #: WC8734253 Expiration Date: 12/12/14 Job Site Address: qy �C'%►5Sly,,('itv/Qtata/lin• Al A_ _! wAn 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 Investigation s-ofthe DIA for insurance coverage verification. I do hereby b�rdfy under tl:e pain"nd penalties of perjury that the information provided above is true and correct. use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # -/7-/ Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: INSIG-1 OP b: CH �%" CERTIFICATE OF LIABILITY INSURANCE DAT 12104D/3 , 12104113 ; 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 Sinclair Insurance Group Inc. 413-306-6092 1 Monarch Place 413-306-6097 Springfield, MA 01144-2410 Salvatore Damato CONTACT NAME: PHONE FAX AIC No Ext): AIC No : E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURED Insignia Inc. dba The Sign Center and The Instant Sign Center Kahn Realty Trust 40 Orchard Street INSURER A : Peerless Insurance Company 24198 INSURER a INSURER C : INSURER D : INSURER E: Haverhill, MA 01830 1 INSURER F: 12112114 -----.• ._. •.—..,..•••..�••. 1CCVl0IUIY NUMRSGK: THIS IS TO CE'IZTIFY THAT THE P I IES OF 11l6UIZfiNCE-LISTED BEEOW'HAVE-BEEN ISSUED -TO THE -INSURED -NAMED Al3OVE-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. INSLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMIDD/YYYY P ICY P MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR X BLKT All P&NC X BLKT WOS CBP2051006 12112/13 12112114 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 15,000 PERSONAL 8 ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO AALL UTOS OWNED X SCHEDULED AUTOS HIRED AUTOS X AUTOSWNED bktA11 b contract BA8731653 12/12/13 12/12114 Ea BINEide�DttSINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY D GE $ Per accident Hired phys dam $ 50,00 A A X UMBRELLA LIABOCCUR EXCESS LWB HCLAIMS-MADE N / A CU8734753 C8734253 12/12113, 12/12113 12/12/14 12112/14 EACH OCCURRENCE $ 6,000,000 AGGREGATE $ 5,000,000 DED I X I RETENTION'S 10000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANFICER/ RIE ER EXCLUDED? ECUTIVE Y /❑NN -OF-IMandatory $ WC STATU- OTH- XTORY E.L. EACH ACCIDENT $ 500,000 A in NH) _ If yes describe under DESCRIPTION OF OPERATIONS below Blkt Bldg & BPP Spec incl Theft _ CBP2051006 12112113 12112114 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMB $ — '600,00( Bikt Bldg & BPP 3,133,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required) C9=9)TIV1t-ATC un1 non Insignia, Inc. dba The Sign Center & Instant Sign Center Attn: Jay Kahn 40 Orchard St. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE lJ lyOS-LU1U AGOKD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD t. North Andover MIMAP April 17, 2014 v ° 114n x Sol, , a �e Jin 114 s , z Andover ` n Y e Interstates — I � SIR - - Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, – Roads Meters Data Sources: The data for this map was produced by Merrimack Co Easements - - f NORTHq Valley Planning Commission (MVPC) using data provided by the Town of - MVPC Boundary - O `�tJ o re �O North Andover. Additional data provided by the Executive Office of ? 4, •e G - Environmental AffairslMassGIS. The information depicted on this map is E] Parcels - F A - : - for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED; CONCERNING _ X ♦. THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY # s^ # - OF THESE DATA. THE TOWNOFNORTH ANDOVER DOES NOT # ± # ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �SSACHUS�� 76 ft North Andover MIMAP April 17, 2014 1 Andover 9 203 TU .NPIKE ST 2 3 TU NPIKE ST 20.3 TU,ivNPIKE ST 203 TURNPIKE ST Rail Line „, Wetlands - Zoning - Interstates G Exempt Lands 0 Busine s 1 Distdcf _ 1 0 Busine s 2 District - � - � Honwrtal Datum: MA Stateplane Coordinate System, Datum NAD83, SR _ _ O Busine s 3 District Meters Data Sources: The data for this map was produced by Merrimack O Busine 5 4 District ORT Valle Planning Commission MVPC using data provided b the Town of - Roads C Genera,Business District t N M q Y 9 ( ) g p y O �. North Andover. Additional data provided by the Executive Office of 1:i Easements � O PlanneCommercial Dev ? b.."ILDr�.e Oo Environmental AffairslMassGIS. The information depicted on this map is 0 Corrido Development Dist ❑ MVPC Boundary - p 3 _ L for planning purposes only. r may not H adequate for legal boundary O Corrido Development Disl - Q to - definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER ❑ Municipal Boundary - O Corrido Development Dist t 9 MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Zoning Overlay in Industn I 1 District - 41 THE ACCURACY, COMPLETENESS, RELIABILITY,OR SUITABILITY Z03 Industn 12 District i OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT O Adult Entertainment � -- i t ',e n i ❑ Downtown Overlay District O Industn 13 District P o ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ©Historic District - d Indusid I S District oq- . ® Water Protection - - '. Reside ce i District 11,v o*+,ao THIS INFORMATION 93Reside ce 2 District `S$ $ O Parcels.. - C Reside ce 3 District ACHU - - - - 92 Hydrographic Features /� de ce 4 District - -- Streams 111'= 76 ft q T°de ce5 District Y de ce 6 District ,a a esidential District - - Date... —2 .. TOWN 01. NORH ANDOVER J $0 I D PERMIT FOR GAS INSTALLATION ' a p9 .. t _. � • This certifies that ..................... ............�.�..... . has permission for gas installation in the buildings of : ; :�- - - - - - - - at . ` `� . `—'r- . `` ..�. ... , North -Andover, Mass, Fee4:.9�.. Lic. No..�� .%�!... rte- ., :?�-..... ...... .~GAS INSPECTOR Check # � � � ( V Ti 45 MASSACHUSETTS UNIFORM APP11CATON FOR PERMIT TO DO GAS FITTING (Type or print) Date- %0 NORTH ANDOVER, MASSACHUSETTS Building Locations Permit # Amount 41 Owner's Name �� //�� /�� NewElRenovation ❑ Replacement Plans Submitted ❑ (Print or Name .. Name of Licensed Plumber or Gas Fitter one: Certificate Installing Company Corp. Partner. �,, ® Firm/Co. �iar�e r z4rehgGllz INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes M No If you have checked yes, please indicate the type coverage by checking the appropriate box. 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: Signature of Owner or Owner's Agent Owner E Agent 1 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter Plumber (� Gas Fitter 1cense Number Master Joumeyman Title City/Town (OFFICE USE ONLY) H a O zCk H GW a Z m U F W tQ x z p F C C a' W C7 H Z d '" CG W p W F" W F x C [� z F W E W C� m > z W o z U o m x o o > SUB -BASEMEN T a° BASEMEN T . IST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. F L 0 0 R 6TH. FLOOR 7TH. FLOOR 8TH. -FLO O R (Print or Name .. Name of Licensed Plumber or Gas Fitter one: Certificate Installing Company Corp. Partner. �,, ® Firm/Co. �iar�e r z4rehgGllz INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes M No If you have checked yes, please indicate the type coverage by checking the appropriate box. 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: Signature of Owner or Owner's Agent Owner E Agent 1 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter Plumber (� Gas Fitter 1cense Number Master Joumeyman Title City/Town (OFFICE USE ONLY) 4V The Commonwealth of Massachusetts Department o f Industrial Accidents Office of Investigations 600 Kashington Street Boston, 114 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (B. Address: City/State/Zip: L pyre- l/, .r% 42/--D/ phone #: 9,-?f-�stv_/// Are you an employer? Check the appropriate box.- ox;1. 1.❑ I am a employer with 4. ❑ I am a general contractor and I 2Xemployees (full and/or part-time).* I am a sole or have hired the sub -contractors listed proprietor partner- on the attached sheet, t ship and have no employees These sub=contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their 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 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other t H --- -11 — vui L=secuon ve:ory showmg their ,vorkml compensation policy info ration. omeowner 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 their workers, comp policy informition. f an employer thats' inyiproviding workerscompensation insurance for my employees Below is the policy and job site information. Insurance Company Name: R Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofM.GL 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 under the pains and penalties of perjury that the information provided above is true and correct Sip -nature: Date.: Phone #: Official use only. Do not write in this area, to be completed by city or town offeciaL 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 #: 4 Information as d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every perrson 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 ox- 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 notbecause of such employment be deemed to be an employer." MGL chapter 152, §25C(6) 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, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptableevidence of compliance with the insurance requirements of this chapter have been presented.to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit 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 mquested, 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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 pmMit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a. license or permit not related to any business. or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to completrAhis affidavit. . The Office of Investigations would Bice to thank you *in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Baston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-72.7-7749 Revised 5-26-05wvvu,.mass..gov/dia Date.. ........ . TOWN OF NORTH ANDOVER PERMIT FMPLUMBING A This certifies that ................................. has permission to perform / ......................... plumbing in -the buildings of ........ ....... at. ,North -,Andover, Mass. 4 ....................... . . . . . . Lic. . . . . . . . . Fee No.. ......... PLUMBING INSPECTOR Check # 8528 MASSACHUSETTS UNIFORM "PLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Q,C �� Date Building Location / �g }��f l' Permit # Owner� , ,,y)�j) Amount , ' s New Renovation Replacements Plans Submitted Yes rl No FIXT TRP.0 (Print or type) / Check one: Certificate 3 Installing Company 2,2 11 Corp. Address L OGU-f'%4 f'f � � L ow �/� '. Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber: 4!!c4a17'�p Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under permit Issued for this application will bei compliance with all pertinent provisions of the MassachusettsSing Code anSi,Chapter 142 of the General Laws. SI—Puire 01 LICCUSGU um Type of Plumbing License Title � 9 City/Town icense Mumoer Master Journeyman APPROVED (oFmcE usE oNLY rl 44 The Commonwealth of Massachusetts Department of hadustrial Accidents Office of frcvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers policant InformAinn Name (Business/Orgganizati`onadividual): Address: City/State/Zip: L p� 4XY,�_l phone #: 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/orpart-time).* have hired the sub -contractors 2I 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 officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] --'�BY aPPIicaat that checks box :rl must also "III cut the section_ b zc w sho:iinc `i err wo i ers' com— ���� � r ' 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 am an employer that is providing workers' comsub contractors and their workers' comp, policy information. I pensation i information. nsurance for my employees Below is the policy and job site required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 17'1 h✓ Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13. [1 Other Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct Date.: Phone #: FE_ only. Do not write in this area, to be completed by city or town offcial. n: Permit/License # hority (circle one): Ilealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son: Phone #: ft Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, 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, §25C(6) 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 coinpliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "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." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit 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 retu_rmed to the city or town that the applics ion for the pernait 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition, an applicant J that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia Dated a .... •_°,;.:��oo� TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SSACMUS� This certifies that�- has permission to perform ...5�� t'Gh/2 ................. plumbing in the buildings of ..................... at....... f. N ......ei!_S ....S -... .,,orth Andover,.M ass. - Fee .Z� .... Lac. No.. .//�Z.y. /O), f PLUMBING INSPECTOR Check # 8303 4 MASSACHUSETTS -UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Vj />U4"'COWass. Date mit 1l � Per # Building Location ! l �t '+ �T S Owner's `y Type of Occupancy -2 /, N (i � New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name 8�&lu t 4 : pt e_'_i's' F= �r �i; 7AVC Check one: Certificate Address Co Ow,)L 1 1 b Corporation ❑ Partnership _ Business Telephone 5.7j� -)-?I/ ' Frm/Co. _ Name of Licensed Plumber G'),I f IZr:: R' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked+des, please indicate the type coverage by checking the appropriate box A liability insurance policy CK 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: S+gnature of Owner or Owner s Agent Ov,'ner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit iss;ied for this app tion 11 be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 14 of the Gener BY Signature of Licensedlumber iNe cw^ Type of License. M2s T �er SI on Sol • • ' .N....NEMENNEE SENSE Omni • • ' .■�.■■■.■■■�■E■■■E■N■IES■ • • ' ■.NN...EN..M.NEE SEEN NONE Installing Company Name 8�&lu t 4 : pt e_'_i's' F= �r �i; 7AVC Check one: Certificate Address Co Ow,)L 1 1 b Corporation ❑ Partnership _ Business Telephone 5.7j� -)-?I/ ' Frm/Co. _ Name of Licensed Plumber G'),I f IZr:: R' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked+des, please indicate the type coverage by checking the appropriate box A liability insurance policy CK 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: S+gnature of Owner or Owner s Agent Ov,'ner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit iss;ied for this app tion 11 be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 14 of the Gener BY Signature of Licensedlumber iNe cw^ Type of License. M2s T �er ,y 031!26%Ug 13;52 FAX 781 860 9362. GENESIS CO�St;L'IDATE P CERTIFICATE OF LIABILITY INSURAN"'r- pGUtwR THiS CERT RcATE is ISSUED AS PR It ONLY AND CONFERS NO RIGH Doug Jones c/o AJG Risk Management Services, Inc. a HOLDER. THIS CRFMFiCATE go 8800 Chaaarral Rd, Suite 230 RL7ER 4ME C41iEPtACrE AFFORD Saattsdale, AL 55250 INSURERS AFFORDING COVERAGE INSURV Gena5is Consdidated Seri ces, IIIC. ?8 Bl:trlchary Rd. Bur%-,gton, MA 01803 X1001 DAY@ (MWbb.+YYYY) 01101'2009 I C RR..�.. ATIONTIFICATE D. EXTE40 OR LICiE$ 130w-0—ft i {wUC# O'�;2AGES '� F!E PGLIClE3 � IIVS•IRRNCE LlS7E.^. BFL04Y HI.dE 9EE'v' FNSt1E0 TO T4E INSURELS idAaA'r_D A8CJ4'!: fLtR 111E PCL1C+r PatZIOD ,f�!GATSD. NOTVJ• � HSiANDI G Nf�.Y PERT N�'th'� tt�S1SRPJr`CE AFr17RL~Eis SYTT�E P73Lirr' Q SC Hffi NEREi4t�t"a StJaJcGT O,Q-L'HE 1111'6 FXC ilStO� MS ANO COtiD 0 S�E�+OR S'q_t �icS. A®CzA.E3ATE Li�B SHOWhi f�,AY F+AyFc 8EE�1 R'cDL10ED 0Y PAIL! GJ+INIS. _ -- cotic�t6PEC77"PE :POLCYEI(Y{RJ1T�lDt1 urdr'5_ ! I r,&NERpt I.:laRillTr I 2 GQ{RktERGlAL6EYFFtALLIA4'tLTY 1' jfw EW PM&WI is ��'•. C�Cd it ' ' S l.tAthis FI',J,4E 1 i PDQ-50NM. i AOy 9d.URY I s GENE>�ALAfaGAEC.ATE —4— 1 I {{ � PRpOlCT3•G+a�m°AGG i G..�...e....,.__... �.. M P:taS PER 1 I QaN1 AG6C'04TE t` I i AF i I ( L PR'3.- LOC 1 j POUC° � auraewatleunelurr t i i (L`:jAi21VIrJ SINF."�'c L1A/" t � ; lam■:) I FNiA;r,O ` MLCYdNSOkU;dS I f BOOiLY1Njl`P.V i 1 (?nrparsen� � SCHE*jU_Fi. ALTOS t , HIREDAUT04 ! I NON OiNNEuAUTJS MAGE I S tP�oOrscegry tiz�l ------^^-1�' --- `�- j Au#70ONLY -EAAC=c-Kr ! : ANAGr:uAwLTf-- 1 ( o-rAmTNAN GA ACC i s ANYAUM S i AuTOONLY! ACG ! I EAbN�CURRENt:6 ! I I �F.SS/JMB OC4CJR �@tt-�Y i CLAIMS 6AE GE7uCfIBtE I RETENTION 3T p�H f X I.ncw,naT¢ ER WORK�RS CphiPEti3ATtflti ANo Eib,PLOveas LWBILn! 0`110112009 A ; ANvPROPRIeTOR'PA"E"MX1'-UTi& � WC 45-7" �-� OpPpERR!µgreseAEka.:,080? i 6rGIAt.PR OTMER r j Location Coverage Pedod: i 01101i20o9 ADDED 6YR fifBFEGi4L aEfCRIPT�ONOFGPEIiATICN9ILOCPTro�v=+:�tGLF_StEYCiliS10t:SE�G SE3�t� rrprara�e is prorideo fir only A.bsclute Fradsion P1tlmhing & HQadng those employe hsisre:a 5 Charly St bit not 80MI190cterS of AiddlWwn, MA 0'!948 ACORD 25 d ■ Ab"Jute Precleion plumbing & HO.20ng 5 Cheng 5 Middetan, M.A 01949 !nirolri�,e Q Q 1 Cer',. ovate#. 09MAS037V-W1 O,m, 61201 G 1 Ctte"® ntq, i957 -10A I 'ANCELLAT1O OtRJ!ANr TFtfiABAVG068.R1a6DPat,=HECARCE{. MgEpomT1@MMIP.ATTON DATE TFtElisW, :sM waUM MURER anI L FlroeAvo>; t0 MAIL 30 DAYS WRITTEN Nor= TO ne CEfflVECATE HaLnm NAtdED TO T11E LAf r, BUT FAIL TO OO SO $.4ALL MWO.?E No onuGAViON OR UAWLMf OF ANY K■w UPOU rW fn]JRM at AuM-% OR Circle Insurance Fax:978-777-4898 ,iul 312009 08:87amm P901//00022 ACG CERTIFICATE OF LIABILITY INSURANCE `: 1131tn200i Chale Business inaurance Agenay Inc 247 NewburY St. Danvers, MA 02923 78-•777-7030 . dURM A,b scyluto procision Plumbing & He C/o Kenneth Roberts p0 BOX 1250 Middleton, MA 01949 978-774-8835 THIS CERTIFICATE !S ISSUED AS A BATTER OF inFORm i THE CERTF"TE NOL.DER THS CERTIFICATE DOES NOTOAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIPS SPL.BW. 3 (I4$URER 9_ INSURER & iNSURER C: 1NSURS V WsuRER E: AFFORDING COVERAGE NAIC# V 1 LfY\VYnv ' ' " THE PQUC'IES OF INSURANCE USTEO BELOW HAVE BEEN ISSUED TO THE WSURED NAMED ABOVE FOR RN`! REQUIREMENt , TERM Oct CONDITION OF ANY CONTRACT OR OTW-R DOCUMENT VMM RES?ECT T4 4VIitCH TFIiS CERTIFLCATE MAY BE F55UES OR ANY RE-OUririkN. THE INSURANCE ONDITI N F THE PGLICIES DESCRIBED HEREIN 0 SUBJECT TQ ALL THE TERM$, EXCLUSIONS ANLL Gomr)ry10NS OF Su t P0001ES.AGGREGATELMTSSHQYU91MAYHAVEBEEN REDUCED6YPAID CLAUS, TWE I w iON WITS = ----------._. 1 POLICYPIL"BER I D 000 I I 1 CAc1 kRA:L LIABILITY 1 X ! COMIE-RWL GENERAL LIAWT. 1 :r ! —� CL MSMADE �I OCCUR As ,}-GGIL ArUGPE�GVIMIT E LAPPLIES PER - I I S ct�ti_v 1 I A i— I LOC ALd MI)S!LE UAWLITY ANYAUTO ALL OWNEDAUTOS R !' SCHEDULED AUTOS IC ! HIRED AL MOS X 1 %OK-411AMDAUTOS AmAUTp E}G-ESSfLIWORELLA UAS!L'TY i—"—! 4C:CUR �j G!AlM115MAlK i DEDUCTIBLE RETENTION S W (yEtKEP.$ COMPENSATEON AtiD EMPL'•r'ERF UASILITY AW PR0PM F0FWAffnWt--2MGUriOC Y>FFtca"Wim szr•- cm? ACORD OF LOCATIONS Town of Lynnfield Main Street Lynnfi,eld MA I i 6073AS22 107/08/09 �i 1 j ,—t. s— 300, 044 i VmEXP'A;yona98'so"; I" 5, 000 07/08/20 ! POW oNlL LAOVINX)PY I ¢ 1,000 000 GENERAL AGr,,R I * 2,000 " 000, 000 ; iRDU OCTS - .OMPiOP AGO ( S 2 , 0 0O - O V 0 I E.L.':AGU ACCIDENT y E.L. DISEA % - EA EMPLOY V E.L. D!SEASF-PaUCV LIMIT - SIi0U1D ONY OF nE ABOVE DESCRIOED POUCIES BE CANCELLED BEFORE T14E EMRATI: 1 DATE TNEREGP. TsctISS!1NG INSURER WILL ENDEAVOR TO 100-10� DAIS /t'RrTiF_N i NOTICE TO THE C19MF KATE HOLDER NAMED TO THE LEFT, OUT Pa!LURE TO 00 50 SµHAJ_ IMPOSE NO OMIGATION OR LIMLITY OF X'4y MHO UPON SHE +wstA Cp :rS kCENTS 0R j REPRESENTATLVES• ! LUTWORIMD REPRESEOITAl WE (�ACORp CBRPORATION'1980 'MWa!NEDSIM.'LELWIT is 1,000,000 I iEi�It3@ti ! 301ILYINj;My j 3 I j 07/08/09 0?/09/10 � iPar?MdGn; e - OKS249 ; aODILYIN,UR` E! ipw"darst; i i PROPERTY DNAKiE b i I pwavudw) AUTOONLY-EAAC,CIDEHT S 01HERTw1di EAAW : $ AUTOONLY. AGG i i EACH OCCURPENCS f $_ I E.L.':AGU ACCIDENT y E.L. DISEA % - EA EMPLOY V E.L. D!SEASF-PaUCV LIMIT - SIi0U1D ONY OF nE ABOVE DESCRIOED POUCIES BE CANCELLED BEFORE T14E EMRATI: 1 DATE TNEREGP. TsctISS!1NG INSURER WILL ENDEAVOR TO 100-10� DAIS /t'RrTiF_N i NOTICE TO THE C19MF KATE HOLDER NAMED TO THE LEFT, OUT Pa!LURE TO 00 50 SµHAJ_ IMPOSE NO OMIGATION OR LIMLITY OF X'4y MHO UPON SHE +wstA Cp :rS kCENTS 0R j REPRESENTATLVES• ! LUTWORIMD REPRESEOITAl WE (�ACORp CBRPORATION'1980 A�7 Location�L (2 i No. 0,,,-7,- ,• Date HONT4 TOWN OF NORTH ANDOVER Of •1D ,�,1•G 640- 0- i ; ; Certificate of Occupancy $ •. Building/Frame Permit Fee $ s►CNust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /dc2 15588 Building IZpector V (n a 37 0 Q W z 0 0 V Z F -- 0 N' N V -to, -*I r in C 0 � 0 H z 0 0 0 W� v 00 LJ.J in rn G CL Z (!) a z c m Q) Fri B LL cls Op 0 Z � W LL U 0M z U Io -.4 LL 0t Cu U C Lou VfLu v 0 v m ZN� c W 0 N' N V -to, -*I in C 0 � W CL Cl. 0 Qj a� c W = .0, C)o y aD O�5 Cu 'Q. VfLu U ZN� v 0 QTo m a � •E ia Z 0 0 O y H Z a 'CO: Z cu d fl- C: IE C V N > d( W U N V d 0 o w 3 /10„ E Ln cC U E J U 0 N' N V -to, -*I - COMMONWEALTH OF MASSACHUSETTS Date TOWN OF NORTH ANDOVER 27 CHARLES ST APPLICATION FOR CERTIFICATE OF INSPECTION I-) f -, —Q Fee Required (Amount) (J No Fee Required Accordance with the provisions of the Massachusetts State Building code, Section 108,15, I hereby apply fog Certificate of Inspection for the below -named premises located at the following address: Street and Number 9 L( .p,� C fi Name of Premises Purpose fQz-wi Used_ Licenses (s) or Premises (s) Required for the Premises by Other Governmental Agencies: License -or Permit - A encu Certificate to be issued to Address q C/ l j N r Telephone S) 5 6 o u "3 / Owner of Record o uilding Address n/ Name of Present Holder of Certificate Name of Agency, if any SIGNATURE OFPEzkdONS TO "CERTIFICATE IS ISSUED OR A UTHOIRIZED G NT INSTRUCTIONS: 1*7 TITLE �� U2 DATE 1) . Make check payable to: __ Town of North Andover 2) Return this application with your check to: —Building Dent 27 Charles Street, North Andover MA 01845 PLEASE NOTE: Application form with accompanying FEE must be submitted for each building or structure or part thereof to be cera 3) Application and fee must be received before the certificate will be issued. 4) The building officials shall be notified within ten (10) days of any change in the above information. TE # FORM SBCC-3-74 REVISE-) 2/99 jmc TE: L Y Q TOWN OF NORTH ANDOVER INSPECTOR'S NAME OFFICE OF THE INSPECTOR OF BUILDINGS MICHAEL MCGUIRE INSPECTION REPORT FORM CLASSIFICATION PASSES INSPECTION yes Ono 0 DATED OWNER BUILDING NAME OR NO. STREET LOCATION TYPE OF OCCUPANCY - Day Care Center School 0 Common Victualer's 0 0 Aud.0 Caft 0 Gym 0 Apt.0 Liquor 0 Placeof Assembly 0 Other , OCCUPANCY NUMBER (include stories # and occupancy per floor - use reverse side _ EXISTINGS EXIST SIGN yes 0 - no 0 LIGHTED EXIT SIGNS operable 0 yes 0 no 0 EMERGENCY LIGHTING SYSTE M operable 0 dry cell 0 wet cell 0 SPRINKLER SYSTEM operable 0 gage pressure yes 0 no 0 SMOKE DETECTOR operable 0 yes 0 no FIRE ALARM SYSTEM expiration date yes 0- no 0 ANSUL SYSTEM yes 0 V no 0 FIRE ALARM SYSTEM operable 0 municipal 0 yes 0 no 0 ELECTRIC EQUIPMENT PROPERLY PROTECTED yes 0 no 0 EGRESSES LAWFULLY DESIGNATE unobstructed 0 yes 0 no 0 STAIRS PROPERLY RAILED yes 0 no 0 HALLS AND STAIRWAYS LIGHTED yes 0 no 0 RADIATOR GUARDS yes 0 no 0 COMPLIES HANDICAPPED PERSONS LAWS yes 0 no 0 FIRE RESISTANT CURTAINS OR DRAPERIES HOW HEATED NO. FIREPLACES yes 0 no BOILER ROOM CONDITION VENTILATION UTILITY ROOM - CLOSETS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS - NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY SHOPS FOR INSPECTOR USE ONLY Revised 3/98 JMc Office of the Building Department Community Development and Se Tices 27 C€aarfev Street North 01845 D. Robert: Nice tta, Ba€iirding commissiener July 24, 2002 Vincent J. Serino Century 21 deAn Luxury Homes 94 Peters Street North Andover, MA 01845 Dear Mr. Serino:. Te1q.) one (978) 688-9545 FAX (1979) 688-9542 Please be aware that upon an inspection on the above date it has been observed that the ground sign placed on your property may be in violation of the permit issued. Please be aware that the permit issued was for a total of 24 square foot sign and must maintain 10 feet in from the lot lines, which in this case does not appear to be the case. Please contact me so that we may begin the process to remedy any possible violation that may have been overlooked. I may be reached between the hours of 8:30 to 10:00 AM and 1:00 to 2:00 PM at 978-688-9545. Respectfully, .Michael McGuire Local Building Inspector Location � gs � No. ci- a od 0- Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee S! CA( $ cZ S TOTAL Check # Q 9 15627 //R/y (� �- V Building Inspector Q� Z w O O ❑ Q Z U Q = d H L r z LL L L. O w Z C.. Z O a� C m c� ❑ w CL LU U U Q w CII H Z J }J_ O U J LU LU J Q. O U z Z Q F• - z U W UJ Ccn �. E w73 O C J 3 QL (D a' = m t w O) U7 cB r >+ 1 cII (v O C O C to UJ � M -0 a) �.� o oc ` tv �Q T Q� L L —0 C (O -0 tll O O v 'C � C E Cn G. o— o co O C C C O C O O O O a. a .Lj C O = m ,, w acCn ? C c = Co �O c m to o O ca U N CZ to cD -0 z C WE C cu C m �. N o ^- a O L o N O ^ ^ ^ cU-0 U CL _ v cn to o .0 n a to \ Z m E a O (B c� O t N E c d – a) c— cm 0 a o a) a c o cca v O cu= C _ cQ "� O Q N U C O — C m c m Q N .c Z m -0 0__o co to C- _^ J Q v75 - to c a� c c � ca ' O � c � aD O cu En O (� _ M O O N O c L QL �O L QCj�CDO OM.`•O N (D a M a) O O � V C O cl -0c- y- O O o — a Q a (A to � O U N � c- V L .� �.. O a� L c6 CL to O Q O = O •� L o •� L Q)o Q. o — N O O 0 o cn U) a� vor)0 a� C m c� ❑ w CL LU U U Q w CII H Z J }J_ O U J LU LU J Q. O U z Z Q F• - z U W UJ E w73 3 .2 11 EXISTING SIDEWALK NOTES 1. THIS PROPERTY LOCATED IN 'IT H E R 4 ZO N i N C 2. EXIS-11 I ING TOPOGRAPHY AND DWELLING L. 43\C -'A 1 i PERFORMED. BY NEW ENGLAND F NG'�l N F tf: Rl NN'(`:� 3. TURNPIKE STREET AND PETERS '�` T PREPARED FOR THE (COM MON WELAILT H ()F MASSA 4. PLAN REFERENCE: NORTH ESSEX RFG--IS',ffR`,t C)' 5. DEFD REFERENCE: NORTH ESSEX 6. INSTAU.-ATI-ON OF PROPOSED S'llGNl-- 'A"lij BUILDING PERMIT. NORTH A.NDOVFR PLANNINC BOUND 94 PETERS STREET -DATE: issumed) ASSESSORS MAP 24, LOT 22 14,104 SO. FT: THIS PLAN .-ONFORIAS 00 RE(.3,ULATIONS C'W lH[--. I. O PROPOS" N/ F WrM & POW" WAN SICN HANDIC AP PARKING SIGN 50.00, VAN ACCESSIBLE L = 55.12 EXIS7ING HANDiCAP PARKING MAPLE j'RLE6 10 REMAINl �--XISIFINC STOCKADE FENCE g�q 7M '2 LAcEME-INTS MAPLE TRE L- (typ*cai' j Cr --1 6 A— PROPOSED PARKING LOT LIGHTING, A 2 EXISTiNG 1,5CC! 0 Dv L 1 f 3 C\2 x 99 +30 4 5 991,40 Ln tipPROPOSED DRIVEWAY PARKING AREA + 7 c"ll 149 00 99-4-30 0. 00' X- 4 EXISTING V DRIVEWAY t.Q 11 I N/ F OF NOM AWOW.R Orfirr- PR&--,)SED 6' kA, EXISTING GARAGE i -OC S'l 11K, A L'IF N CE Mr. WhW FAMR911p TO BE RAZED N/ P & RtANOR moNfCAOMeW 94 P11-111111, NORTIJ A.1" I PREPARIL'..."J, L_XIST HNIG GRADE. S C ALE: 1 20' DAT'lla EXIS1ING.SPO-1 GRAL)4- REVISEDlNGLAN NEW D ,N(.. F 99*99 PROPOSED SPLIT0 R AD E 99+00 1216 1 Gq 60 1/1-4/02 NO RTI I N h -)o, 20' 40' 60P I/ 2�1 02 (9. 1B3 Y: 1 oF2 TOWN OF NO iT.R .ANDD VER Office of the Building Department Community Development and Sem4ces 27 Charles Street. North Andover, NMssaebusetts 01845 D. Robert Nicetta, Built iug Commissioner June 14, 2002 Sue Morgan Century 21 deAn Associates Luxury Homes 94 Peters Street North Andover, MA. 01845 Dear Ms. Morgan: Telephone (978) 689-9545 FAX (978) 688-9542 Please be advised that upon an inspection at the above location for a real estate office that classes may be held for the purpose of education for up to 20 occupants as an accessory use. I hope that this letter will be sufficient for your needs. If I can be of further assistance please do not hesitate to contact me between the hours of 8:30 — 10:00 AM or 1:00 — 2:00 PM at 978-688-9545. Respectfully, 'z00'4j'/# �-� Michael McGuire Local Building Inspector PlanningDepartment 688-9535 Conservation Department 688-9530 Health Department 688-9540 Zoning Board of Appeals 688-9541 l d n � � CD CD 0 O Uq O O ,00 . n (D 0 8 CO D (D O O CD O 0 En 0 CD O ff�q CD o CD a CL ara' 0 o w! CD o N 0 Q., Abd C O c~n' cD CD O H n � CD Uq O ,00 . n (D 0 8 CO D (D O O CD N j:Zi CD N C) N O .0 o En 0 "0 W C O CD SCA. a� CDCD -t �Joowoc 0 5. CD 0 0 0 0 CD CD o O+ CD 0 CD CL 0 0 td o o CD E3+- o �0 o �CD o CD . cu roan �0 -a 9, Location �`� �✓ /�" No. Date TOWN OF NORTH ANDOVER D o Certificate of Occupancy $ wu9 t�' Buildin /Frame Permit Fee $ s�cst Foundation Permit Fee $ Other Permit Fee $ TOTAL $_ Check # 15404 Building Inspector 1v TOWN OF NORTH ANDOVER R,BUILDIII®1G DEPAIZTIVIENT APPLICATION TO C'ONSTRUCr REPAIR, RENOVATE, OR DEMOLISHPA ONE OR' TWO FAMILY DWELLING BUILDING PERMIT NUMBER:`�;/ �— DATE ISSUED: oZ ria i 04 SIGNATURE: _ Building Commissionerfl for of Builq!E2 Date SECTION 1- SITE INFORMATION 1.1 Property Address:. 1.1 Assessors Map and Parcel Number. 02.q ZS"3 GZO OpZYCX4�022 Map Number' Parcel Number 1.3 Zoning Information: 1.4 Property:Dime isictis: 13 �ti1 �s 3 53� fa5- Zoning ]?Wd• Pr6posed.Vse Fronta ft 1.6 BUILDING SETBACKS ft Front Yard `Side Yard Rear Yazd - . Rapired Provide R Provided R Piovided 1.7 Weer S 1y MC.LC.40. 54) 1 S. Flood Zone brfoimatiou : - IX . sewcra8o Disposal System: . Public Private ❑ Zone Outside RoW Zone ie Mr k4W On Site Disposal' System ❑ SECTION 2 -.PROPERTY OWNERSH1PtAUTHORMI) AGENT 2.1- er of Record Name (Print) Address/for Service 77, Signature Telephone 2.2 Owner of Record: Name Print Address for Service: ^t Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor, Not Applicable . ❑ icensed Constru SIT Supervisor: E '� y l PC z_r (Z 0' ` License Number Address ,• V o06 0 111, Expiration Date Signature Telephone ( 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name TU l`Tj� Registration Number Address (G. Expiration Date SECTION 4 - WORKERS COMPENSATION (ALq.1, C 152.§ 25c(6) Workers Compensation Insurance affiS;v_ft 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 Yds ..D . No........O SECTION 5• Desiription of krotsed Work (check all appli I cahle): New Construction El Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition 11 Accessory Bldg. 0 Demolition 91". Other 0 Specify Brief Description of Proposed Work: //1 r,,a,,f Q A/ 1**W, 0,A ,a cp/? SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be I Completed bAk;ifican Building a 9 Permit Fee av Multiplier 2 Electrical(b) Estimated Total Cost of Construction` .3 Plumbing Building Piernu ,t:.fee,(a) x (b) 4 Mechanical 5 Fire Protection 6. ._Total,,: a+2+3+4+5, -,Check.Nwnber. SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L J • T dK �y , as Owner/Authorized Agent of subject property Hereby authorize t1166Z Iculbi ?4 V tAb to act on My behalf, in all ma relative tow authorized by this building permit application. Signatize of Own W %.- (_1 J Date I SECTION 7h OWNFR/AUTTt6RIZ1ED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true andowl to the best of Ty knowledge. and belief J1 Al C0%4 - Print Name_ 6, La 3 Si afore of r/ ent Date NO. OF STORMS SME IRA f2 - BASEMENT OR SLAB sr NIT SIZE OF FLOOR TIMBERS2 3RD N,77 SPAN DRAENSIONS OF SILLS All* DIMENSIONS OF POSTS 01 DRAENSIONS, OF GIRDERS HA, HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE flu r � 4 � � t �/ce TDam�no�ilueia�lJi q��% �^ BOARD OP BDIlrDiNO. Rtti31:'►'t`IONS, Llcensts xCONS*Ud TI N `SUokhAOR i" t Numbii 4dS :=*.036041 4 &tld�: ,� n IE�itpi tl/tl�3��d2' ' F Tr: rio 24269 0—N t t. �, eshicisii 16 0 it kr� a RONALD J SHAFT S STUART RCS a►•,.� PEABODY, '6',011060 _ AdmiriifPtor Mrd of Building I egii ons ad tan �is"y OME IMPROVEMENT CONTRACTOR "' r',�x,a Registration 132777 Y,Expiration0' 03/30/2003" Type: Individual RON SHAH RONALD SHAH 5 STUART RD. PEABODY, MA 01960 ti •'Adminhtritk z Town of North Andover NORT►i Building Department �`t`t�°'�� o 27 Charles Street o North Andover, Massachusetts 01845 _ (978) 688-9545 Fax (978) 688-9542 T 11„ . 1 T 9 11 ATED rPa., h Building Demolition Affidavit �S3 CHUSE�4 DATE 3112 -lo 2 A DESCRIPTION CONTRACTORS NAME & ADDRESSlq/6-6 DEPARTMENT SIGN -OFFS D.P.W./ WATER SEWER ELECTRIC TELEPHONE CABLE l TAXES POLICE' f FIRE 2— EXTERMINATOR BLDG. INSPECTOR DATE RECD U 0I FC o 3/ �- North Andover Building Department Tel: 978-688-954.5 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: 0. .1 V) 6 - - -Li a. (Location of Facility) 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 C.71 QF C.:'. WCATiUNb VtHICLE5 SPECIAL ITEMS Town of Nary ' k-. N. Andover MLA 1b4 CAROEILLATPON: SHOULD ANY OF THE ABOVE DESCRIBED POUC BE BEFORE TViE kXPIRAT�ON DATE THEREOF, THE ISSVtrio Cott -7 -'ILL ENDEAVOR TO MAIL 17 LIABILIT. ..... .. .... Af3 $:u q DATE (NiMiD BUT FAILURE TO MAIL SUCH NOTICE SMALL ItAk NQ i 5 0^ OF ANY KIND UPON THE COMPANY, IT5 AT! THIS CERTIFICATE IS ISSUED AS A I\ 171.:1 OF INFORMATION ONLY AND CONFERS NO SIGHTS :Oti THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES I tIF : 'FEND, EXT END OR S 2 'ESSF-Y ALTER THE COVERAGE AFFORDED E TF!! POLICIES BELOW, ID BOX COMPANIES AFFORDING 0\ -.RAGE COYPWA A 7 c�.cn d es 'uaranl.�y G�_ 1.4PAN Y C, el 13 Ttl 11 u MC, - a i'J: HT-..'. 140"WTHS7ANONG ANY REOUIP5MEV 'ERM OR COfiClT 014 OF ANY CON 54.4" OR OTHER DOCUMENT Vv' 1E; '-ECT To WHICH THIS Ccx. , -A't; VAY 8E SSGEO OR V,,Av PERTArq TmE INSJPW^ SE AFFORCED BY THE 1301,iCe$ DESCRIBED hEREINIS S' EC TO ALL THE TERMS, FX__, 5,:`qSAN0C0ND1TiQNS0F SUCH P0LQ1E5 ICO rI rVPF r)F 441,1xPaNclu 0^.WVk1I1P%Ae4% st %E�L LiA5VTy POLICVEFFECTiVE PO ICY 'xPIRA rioN opor"s C. V :G S Juu, U(Ju IIII C�A'JSN'AD8 Y GLCJR, I OEASONAi. & Ai EACH ",C-UPIR so, 000 Ir fi w:o EXP �Ary c 1,000 AVOMOBILE LIAWC ry w,y A�J',D MIA SIN, 3 2 9 3 2. 9 C 2 2IF soc Y \Jup� 1 00c, 000 L f 0001000 000 CLAK�.,�: i �AOJTV A C' -4E A T14A%'_ .".il 4, AND EMPLOYERS' LIA' . T' 8 X 6 OP IFI, EA01 ACCI:L 0 0 0 0 I THE PPOPRIE-C 2 PARTNE;SEXEC'-' Ef. CISEASE P fR '7 0 4. ;WCERS AIR.,; EL:);SEASE • E, �pf, sl`),V, 000 C.71 QF C.:'. WCATiUNb VtHICLE5 SPECIAL ITEMS Town of Nary ' k-. N. Andover MLA 1b4 CAROEILLATPON: SHOULD ANY OF THE ABOVE DESCRIBED POUC BE BEFORE TViE kXPIRAT�ON DATE THEREOF, THE ISSVtrio Cott I1Y -'ILL ENDEAVOR TO MAIL � JAYS WRITTEN NOTICE TO THE CEATIfICA 101 :R NAMED TO THE LEFT. - BUT FAILURE TO MAIL SUCH NOTICE SMALL ItAk NQ 3LICAYION OR LIABILITY OF ANY KIND UPON THE COMPANY, IT5 AT! 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