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Home My WebLink AboutMiscellaneous - 953 JOHNSON STREET 4/30/2018 (2)i�� ? i Date....................... `............ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...' .P..:.....S „16VV L ?............ �✓�,. .........../ . has permission for gas installation ..Cl' ............l..i....i.,:.... in the buildings of ........' u at .. North Andover, Mass. Fee.i off�..-... Lic. No.....i.l.............................................................. GAS INSPECTOR Check # 2k 3 � �Z g �.02�-� G TYPE OR PRINT CLEARLY pkv MASSACHUSETTS UNIFORM APPLICATION FOR kPERMIT TO PERFORM GAS FITTING WORK CITY" MA DATE --'—PERMIT# G _ t JOBSITE ADDRESS .SQV - — OWNER'S NAME OWNER ADDRESS , \QJVI.D —per, — - — TE j 9 ]S— FAX OCCUPANCY TYPE COMMERCIAL(j EDUCATIONAL L] RESIDENTIAL NEW: RENOVATION: [j REPLACEMENT: Lj APPLIANCES -1 FLOORS - BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST 6A h U0' UNIT HEATER UNVENTED ROOM HEATER WATER HEATER BSM 1 1 I 2 I 3 I 4 I .5 PLANS SUBMITTED: YES N0,41,_ 11 WWI �NO K �1(�f�1fIIItI�elt�r�lt�1 INSURANCE COVERAGE ive a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [,�„ NO YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND Lj 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 D 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.applicalion will be in co,p0ancWithartinent rovis on of the Massachusetts State Plumbing Code and Chapter 142 of the G neral Laws. v PLUMBER GASFITTER NAME LICENSE #I SIGNATURE MPO MGF [.. � JP LI JGF D1 LPGI CORPORATION 0# L= PARTNERSHIP(j#1 yi LLC Qy'# COMPANY NAME: SUBURBAN PROPANE — �______ _._. �ADDRESS�100 CEDAR HILL ST. CITY MARLBORO - — ,��_ STATE MA ZIP 0.1752 _TEL 508-481-1000 1 FAX 508-624-4250 CELL .� jnjezak 4Y)p 3 kA 01J-20-2014 10:20 From:508-485-4380 page: 1/1 ,�coRo� CERTIFICATE OF LIABILITY INSURANCE 02612014°IYYYY) 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 MARSH USA, INC. 445 SOUTH STREET MORRISTOWN, NJ 07962 PHONE; 973-401-5000 CONTACT NAME: PHONE FAX 'AJC. No). E-MAILs: INSURERS APFORDING COVERAGE NAIC AA LIMITS INSURER A; ACE American Insurance Company 22667 J08990•ALL-GAW14.15 SP LP CLIE INSURED SUBURBAN PROPANE PARTNERS, L.P. INSURER 8: Indemnity Ins CO Of Nonh America 43575 INSURER C : 240 ROUTE 10 WEST WHIPPANY, NJ 07981 INSURER D INSURER E: X COMMEACIAL GENERAL LIABILITY CLAIMS -MADE fy] OCCUR INSURER F : GUVLKAUL5 CERTIFICATE NIIMHER NYC-nn5d010'tr74 .aFVICIe%M MI IMQI=10-11 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS M$R LTR TYPEAF INSURANCE ADDL INSR 3 BR WVD POLICY NUMBER POLICY EFF q1M/p POLICY EXP M DD Y LIMITS A GENERAL LIABILITY HDO G27331403 0310112014 03101/2015 EACH OCCURRENCE $ 2,000.00 X COMMEACIAL GENERAL LIABILITY CLAIMS -MADE fy] OCCUR OAMAV T RtNI'k $ 250,00 MEQ EXP n1.one mon $ 10,00 PERSONAL & ADV INJURY S 2,000,00 GENERAL AGGREGATE S 2,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS • COMP/OP AGG S 2,000,00 X POLICYPRO- LOC S r A AUTOMOBILE LIABILITY ISA H08819480 0310112014 03/0112015 COMBINEDIN LE LIMIT 2.000.00 (E 1 I X ANY AUTO BODILY INJURY IPef person) S X ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY Per scc,denl S i ) X X NON?OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE P acrid mt $ S UMBRELLA LIAe OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE OEO I RETENTION $ s B WORKERS COMPENSATION WLR C47896247 (AOS) 03/0117014 03/01/2015 WC STATU. O7H- A A AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED7 a (Mandatory in NH) II es, describe under DESCRIPTION OF OPERATIONS h Ivw NIA WLR 047686235 (CA, MA) SCF 047886259 I (W) 03/01/2014 03/01/2014 03/0117015 03101/2015 EL EACH ACCIDENT $ 1'000'001 E L DISEASE - EA EMPLOYE $ 1,000,001 E L DISEASE - POLICY LIMIT S 1,000,OOI DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Scnedule, it more space is reqtfired) BLANKET ON ALL OWNED AND LEASED VEHICLES, ALL PREMISES ALL LOCATIONS AND ALL OPERATIONS. CERTIFICATE HOLDER CIO SUBURBAN PROPANE, L.P I Int v L. & y vo � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE /. THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERED IN 100 CEDAR HIL 01752 T MAR O y 1014 ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE . 130RO _ 11 of Marsh USA Inc. Manesh! Mukherlee ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Fax Conf irmation Report Date/Tirre a NOV-21-2014 08:11AM FRI Pax Number : 508-485-4380 Fax Name - Model Name Phaser 3635MFP Total Pages Scanned- 1 No. Remote Station Start Time Duration Page Mode Job Type Result 001 19786889542 11-21 08:10AM 00'34 001/001 C3 HS CP Abbreviations: HS-1Host Send HR: Host Receive MS: Mailbox Save MP: Mail box Print PL'Polled Local CP:Completed TS:Terminated by System PR=Polled Remote FA;Fail TU=Terminated by User WS:Waiting To Send RP -Report W:Group3 EC: Error Correct 1 (a_ fba.I,vrmAo • PLUnBE'�Sz AiiO 6ASP�T�EAS ISSVfb Ttl[ FO�l0u1Ft rltENSE LjCe)j D AS Ary, kP_UP5 I/1STALLE� gg . WTd A BAP.DSLET 10 mouO-KE.AScENS Or. •� WEST66RO HA 01581-2119 SUBURBAN PROPANE LP; 100 Ceder Hill Street Marlboro. MA 01952-3094 50$• 48I -lou() Z/l:aaed 082b-S8b-8OS:woj�:j 80:0T bTOa-t,2-no SUBURBAN PROPANE L..P 100 Cedar Hill Street Marlboro, MA 01752-3094 50- 481-000 2/2:abPC] 082b-S8b-80S:w0j-j 80:OT VTOZ-t72-OON Date ..... ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. Ct If WA"��Pm� -V . . . .... ............................ ............................. I J/ has permission to perform ..... +"— .............................. .................................... L/ wiring in the building of ........... %- r— " L.L— .................................................................................................... at ..... North Andover Mass Fee..4ez� ........ Lic. No.70%D ................. ........ ELECTRICAL INSPECTOR Check # Commonwealth of Massachusetts Department of Fire Services t=BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. �S11 Date Issued: APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC).. 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 11/4/14 City or Town of: North Andover, MA To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 953 Johnson St Map: Lot: Owner or Tenant Les Schnake Owner's Address 953 Johnson St, North Andover, MA Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No 978-685-2833 No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters _ Overhead ❑ Undgrd ❑ No. of Meters Installation of a generator C'ntnnletinn of flip fnllnwina tahlo mmt hn wnivpd by tho In—opt— of Wivae No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators I KVA 16 No. of Lighting Fixtures Swimming Pool AboveIn- El 'nu El o. o Emergency Lighting rnd. BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number ....................................................... I.Detection/Alerting Tons I. KW No. of Self -Contained Totals: Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Key Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent QTHER: Atloch additional detail ij desired, or as required by the lnspector qJ Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licen- s�e provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE x BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: $1950 (When required by municipal policy.) Work to Start: 11/13/14 Inspections to be requested in accordance with MEC Rule 10, and upon completion. / certify, under the pains acrd penalties of perjury, that the inforn1kti i on Ntis rali is true and complete. FIRM NAME: Coleman Light & Power � LIC. NO.: A:20560 Licensee: Kris Coleman Signature LIC. NO.: E:33749 *Per M.G.L. c. 147, s. 57-61, security work requires Depart rnen o it Safe y "S" s : LIC.NO.: S: (lfapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-458-8800 Address: 4 Etta St, Chelmsford MA 01824 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. Fay my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Phone: Insurance on Pile: Will Fax: Permit Fee: Receipt #: Date: DATE: ji /A/ kj LOCATION: q53 JQVXaScf� OWNERS NAME: GENERATOR I(w. NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: LAJ CAZ s PHONE NUMBER: 0779 - Z487S •0 ELECTRICAL ! _S:l D _:E:I A L :N �T GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: %46*1 s7\c)j— 4cff4 *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL'j Fold, Then Detach Along All Perforations Fold, Then Detach Along AN Perforations OMMON'M OF )qIIJ%L SOARD'Of R I "C I ANS-:�-".:. ISSUES.THE FOLLOWI NG 't st AS, A ERED '-,ELECTR I C I is COL-ifift N LIGHT AND POWER LLC KR I STORHE::R",.A 'COLEMAN w" 4 ETTk- iU V -ft LMSFORD,..';' 01824-4733 2056-0.-.:- 56743 77GREZmmos 31w; STATE OF NEW HAMMME GUMU OF MZ0TWa`&Q%FrY & UCEMWe NAW, KRISTOPHERM"006ENM 1.12125 M 2-- 3- EXPIRES: 0113112016 MAOL5 -r- �- F;z The Commonwealth of Massachusetts 07 '--' Department of IndusftialAcddents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www massgov/dia Workers Compensation I nsuranoeAffidavit: Builders/Contractors/EleotricianslPIumbers Applicant Information / Please Print LeiOly Name (Business!organization/Individual):(�PX1 NO ("��.(lf,f M&f 5 Gp AddressAQ� -� City/State/Zip: YYl d 0182A Phone #: - Gid 9 " 5 Soo Are �yo"employer? Check the appropriate box: Type of project (required): 1. U am a employer with 4. ❑ I am a general contractor and I 6. E] New construction employees (full and/or part-time). * have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers 9. Building addition ❑ [No workers oomp. i nsurence comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. Plumb' ❑ ep repairs or additions myself. [No workers' oomp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13. ❑ Other employees. [No workers comp. insurance required.! `Anyap,C1ntthatd*x*sboxMrimdalsofilloutthesectcnbdowdtowingtWrworkerVcorrt onpdicyinformation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConumctors 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-contra:Wmitavewtployam ffW must provideftr workers' carppolicy nurrdw. 1 am an employer that is providing workers; compensation insurancefor my employees Below isthe policy and job site information. Insurance Company Name: ,the- tlairt� —d Policy # or Self -ins. Lic. #: r�tC O'S \JNf GT]<1 �J� 5 Expiration Date: Z-6 A Job Site Address: City/State/Zip: Attach a copy of theworkerd 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 imprisonm . as well as civil penalties in time form of a STOP WORD ORDER and a fine of up to $250.00 a day the violato . Be that a copy of this statement may be forwarded to the Office of Investigations of the DL��insurance�e verification. I do hereby certify Phone #: 45S - 8<6- GQ that the Wormadon provided above issrue and correct Official use only. Do not write in this area, to be completed by city or town offidaL City or Town: Permit/License # 23 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/ own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• ,q�ORD` OP ID: RS CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD�► 07/16114 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 WANED, subject to the terns 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 Phone: 781-935-8480 CONTACT DeSanctis Insurance Agcy, Inc. 100 Unicom Park Drive Fax: 781-933 Ear Fax Woburn, MA 01801 _ Arc No): ADDREss: PRODUCER MWEm s: EMERG-2 INSU AFFORDING COVERAGE _ -_ — NMN INSURED Emergency Power Generators of ----- New England LLC and Coleman INSuRERA,Acadia Insurance Company 31325 Light and Power LLC INSURER B .The Hartford _ 4 Etta St. INSURER C : Chelmsford, MA 01824 INSURER 0: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDNAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTITH TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR 11 TYPE OF INSURANCE POLICY NUMBER POLY EFF MPOL,ICY EXP LIMITS — GENERAL LIABILITY EACH OCCURRENCE S 11000101 A X COMMERCIAL GENERAL LIABILITY BOA5094901 04/01/14 04/01/15 rEM S Ee oeaurer>ce $ 50,01 CLAIMS MADE [_X�JJ OCCUR WORKERS COMPENSATION X WC AND EMPLOYERS LIABILITY Y 1 N ' OFFlCERIMEMBER EXCLUDE�� i N / A I COSWECTK3063 07/23/14 I 07/23/15 E.L. EACH If d esoib NH) (MA, NH, ME) E.L. OiSE/ I yes desctibB under DESCRIPTION OF OPERATIONS below -k—Business; Personal E.L. DISEF BOA5094901 Property 04/01/14 04101H5 BPP DESCRIPTION OF OPERATIONS I LOCATION / VEHICLES (Attach ACORD 101, AddIdo" Remarks Schedule. I more space Is required) ILLUSTRATION OF COVERAGE ILLUS -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ILLUSTRATION OF COVERAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR® REPRESENT4TIVE. 01988-2009 ACORD CORPO N. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD i PERSONAL & ADV INJURY 1 $ 1,00( � i I GEN'L AGGREGATE LMR APPLIES PER: pR0 POLICY T LO C GENERAL AGGREGATE $ 2,001 - PRODUCTS - COMP/OP AGG $ 2,00( $ AUTOMOBRE LIABILITY I ! COMBINED SINGLE LIMIT ANY AUTO i (E ) I $ ALL OWNED AUTOS BODILY INJURY (Per person) SCHEDULED AUTOS i BODILY INJURY(Peae) S PROPERTY DAMAGE (Per ) $ HIRED AUTOS NON -OWNED AUTOS $ EACH OCCURRENCE $ 3,000 A X UMBRELLA LI/18 X OCCUR EXCESSLUIB CLAIMS -MADE UA5154064 04/29/14 04/29/15 AGGREGATE $ 3,000 DEDUCTIBLE WORKERS COMPENSATION X WC AND EMPLOYERS LIABILITY Y 1 N ' OFFlCERIMEMBER EXCLUDE�� i N / A I COSWECTK3063 07/23/14 I 07/23/15 E.L. EACH If d esoib NH) (MA, NH, ME) E.L. OiSE/ I yes desctibB under DESCRIPTION OF OPERATIONS below -k—Business; Personal E.L. DISEF BOA5094901 Property 04/01/14 04101H5 BPP DESCRIPTION OF OPERATIONS I LOCATION / VEHICLES (Attach ACORD 101, AddIdo" Remarks Schedule. I more space Is required) ILLUSTRATION OF COVERAGE ILLUS -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ILLUSTRATION OF COVERAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR® REPRESENT4TIVE. 01988-2009 ACORD CORPO N. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD Borth Andover MIMAP November 6, 2014 I Interstates —I —SR Roads {; Easements OMVPC Boundary l Parcels 1"=60ft Hodmntal Datum: MA Stateplane Coordinate System, Datum NAD83, Meters Data Sources: The data for this map was produced by Merrimack MIpRRts Valley Planning Commission (MVPC) using data provided by the Town of ��aw �� North Andover. Additional data provided by the Executive Office of . •E Environmental Affairs/MassGIS. The information depicted on this map is Ok for planning purposes only. r may not H adequate for legal boundary definition ann or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY + OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT ya`r�j 41F LK ASSUME ITY ASSOCIATED WITH THE USE OR MISUSE OF _/R'2 THIS INFORMATION North Andover Board of Assessors Public Access Page 1 of 1 +. « v _ i�. 11:1roperty Record Card Parcel ID :210/107.A-0171-0000.0 FY:2014 Community: North Andover si PHOTO Click on Sketch to Enlarge Click on Photo to Location: 953 JOHNSON STREET Owner Name: SCHNAKE, LESLIE M Owner Address: 953 JOHNSON STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 7 - 7 Land Area: 1.04 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2014 sqft ASSESSAIEN I`S CURRENT YEAR PRETVIO iS YEAR Total Value: 427,500 439,100 Building Value: 203,500 203,500 Land Value: 224,000 235,600 Market Land Value: 224,000 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=24403 84&town=NandoverPubAcc 11/6/2014 -1/- Date ...... . ........./ ........ TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that .< -!.: r.1. :. l .......:/. ............................... has permission to .......... . .............................. wiring in the building of ....... .................................... at ...... ........ ............................. P.... North Andover, Mass. Fee,--, ............. Lic. No.'.In.z� 4 .......... Check # -7 ELEcTRicAL INsPECTO'o -1c;Z1 /I 9263 I Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. F� j� 3 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked C�CJ [Rev, 1/07] APPLICATION FOR PERMIT TO PERFORM ELS af-aveblank All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR ECTRICA 00 WORK (PLEASE PRIN7'.,W AW OR TYPE ALL M•ORMATIO City or Town of: NORTH ANDOVER Date: 1 By this application the undersi ed To .the Inspector of Wires: gn gives notice of his or her intend n to perform the electrical work described below. Location (Street &Number) � rj � Owner or Tenant SSG «Q n� Telephone No. Owner's Address EL Is this permit in conlunchon with a b g permit? Yes � No ❑ (Check Appropriate Box) Purpose of Building ' r'duty Authorization No. Existing Service —=�Amps �= OVolts Overhead Undgrd ❑ No, of Meters New Service APs _ / _Volts Overhead ❑ Undgrd ❑ No, of Meters Number of Feeders and Ampac' ity Location and Nature of Proposed Electrical Work: /L 'o. of Recessed Luminaires o. of Luminaire Outlets o. of Luminaires o. of Receptacle Outlets D. of Switches No. of Ranges NorNo. of Waste Disposers No. of Dishwashers No. of Dryers No. of Water Heaters KW . Bathtubs c,om [etion o the followin No. of CeiL-Susi (Paddle) Fans No. of Hot Tubs Swimming Pool Above In- .17 d. ❑ d. No, of Oil Burners No. of Gas Burners No. of Air Cond. Total Tons Heat Pump Number ons Totals:.---. Space/Area Heating KW rHeating Appliances KW No. of No. of Signs Ballasts No. of Motors Total HP table may be waived bv the Inspector of Wires. No. of Total . Transformers KVA Generators KVA ALARMS INo. of Zones of Alerting Devices ❑ municipal Conneefinn ❑ Outer No. of bevice' or Data Wiring: of Estimated Value of Electrical Work. Attach additional detail if desired, or as required by the Inspector of wires. Work to Start 3 --1 — J (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no the licensee _provides proof of liability Permit for the -Performance of electrical work may issue unless undersigned certifies that such coverage in for a card has exhibited proof of same to the permit issuing p] d operation" coverage or its substantial equivalent The n ete CHECK ONE: INSURANCE .'BOTS ❑ OAR ❑ (S g office. I certify, under the airs and p es o (Specify.) �1 O L�✓ t fPm7uly, that the information on th' lication is true and complete. FIltM NA11�)�,�, Licensee• — LIC. NO.: /t� (If applicable, ter " m t " i Signature LIC. NO.: `� l - P e nu er line.) Address: Q , Bus. TeL No.: G�Q3 yGl/1 Vie' *Per M.G.L c: 147, s. 57-61, security work r uires �-sLi Alt Tel. No.:�.; '7j q �`rb� OWNER'S INSURANCE, WAIVER: I am aware that the Licensee does notublic ehav1e,thetliabili cense:Lic. No. required by law. By my Signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's anent liability insurance coverage normally Owner/Agent Signature Telephone No. PERMIT FEE:.S' - �� T 8 The Commonwealth of Massachusetts Department of Industrial Acciden& Dee of Investigations 600 *-ashin ton Street Boston, MA 02111 ' www_nwss gov/dia . Workers' Compensation In krance Affidavit: Builders/Contractors/Electricians/Plumbers aulicant Information Name (Business/Organization/Individuat): Address: A S City/State/Zip : ` Phone Are you an employer? Check the appropriate box: Lk am a em to er with J� 4. ❑ I am 8 genera} contractor and I T� of prep (required): employees fue and/or * ( part-time). 2. ❑ I am .a:sole proprietor or have hired the sub -contractors listed 6 ❑ New construction partner- ship and have no employees ori the attached sheet t These sub -contractors have 7. ❑ Remodeling & Q Demolition working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9. Building addition 3. ❑required.] I am a homeowner doing officers have exercised their right 10•❑ Electrical repairs or additions all work myself. [No -workers' comp. of exemption per MGL C. 152, § 1(4),'and we have no 11.❑ Plumbing repairs or additions insurance required,] t employees. [No workers' 12•❑ Roof repairs comp. }insurance required_] 11M other 3❑Other ;Any applicant that checks bo)C#1 must also fill out the section bel trw showing their workers' bompensetion policy 1 Homeowners who submit this affidavit indicating they are doing all work and than hire outside contractors p in �Cottiractors that check this box must attached an additional sheet sho must submit a new affidavit indicating such showing. thcneme of the serb.cimr�et,,,E � a Ft;ei.::� � ' .IF. . J ant an employer that is rq ' ' g ' _ mp Pune •` mmrnMOTI, p mdur workers ca eresatian irrsttrance f or my emPloyem Below is the Policy �'Iob site information. Insurance Company Name: ' �L 4 > Policy 4 or Self -ins. Lie. #: Expiration Date:' Q�. Sob Site Address: %r��1�t-� j �L—� Attach a cCity/stateizip: �1. '�i r\% �j Z� /'eG� N,opy of the workers' compensation policy declaration page (showing the policy number and expiration dats� Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition ercriminal fine up to $1,500,00 and/or one-year imprisonment, ppenalties of a of up to S250.00 a day against the violator.Be advisedduda copyof this statementf may be forw�d dO the ORDER nd a fine Investigations of the DIA for insurance coverage verification. I do hereby ceffitunid-ferhepatpaepenaUles of per�urY th1v Me inor>�on f Provided above is trite and correct of 7cial use only. Do not write in this area, to be completed by city or town offcia[ City or Town:: Permit/License # Issuing Authority (circle one): I. Board of Health 2- Building Department 3. City/'rown Clerk 4. Electrical inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: