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HomeMy WebLinkAboutMiscellaneous - 982 Osgood Street (2)I-- - -, '1111-� Date15. .. 4 0...r . HORTry TOWN OF NORTH A OVER Oft. •o ,•1ti 4 p PERMIT FOR P UMBING This certifies that has permission to perform f -° �? .� "f�!'f'.� ......... plumbing in the buildings of 1 -m -P ... at .. !` ?�' �'t7f �?? -......... , North Andover, Mass. Fee. Lic. No... ..........................` . PLUMBING INSPECTOR Check # t^� � � � 8662 0 MASSACHUSETTS UNIFORM APPLICATION FOP, PERMIT TO DO PLUMBING (Type or Flint) NORTH ANDOVER, MASSACHUSETTS Date Building Location ��i i' S Permit # Owner 1 / i�� c. i fi. 1 1, t 1 e �i `�. ' Amount / New ❑ Renovation Rep cement ❑ Plans Submitted Yes ❑ o VW9n Ti? vc (Print or tom) Check one: Certificate Installing Company Name ❑ Corp. Address ❑ Partner. Business Telephone F1 Firm/Co Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Age ❑ 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 be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: rgoaurre or LicenseEum Title of um ' i S� .� C PPROn a Master ❑ Journeyman APPROVED tomcE usE or1L,Y �7 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ..600 Nrashington Street .Boston, M4 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: 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/or part-time).* 2. ❑ I am a sole have hired the sub -contractors listed proprietor or partner- 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 S. ❑ We are a corporation and its required.) 3. ❑ 1 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. insnran0erequired.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other Uu. Lnc secaon acior.-—evVing theu- wod:;rs' waY . szEion policy htfo n atioa t Homeoa nes 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 information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 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 S 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 Signature: Date.: Phone #: I F FOfficial use only. Do not write in this area, to be completed bJ' city or town official City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Piumbing Inspector 6. Other Contact Person: Phone #.: 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 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 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 returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. 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 homeowner 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 Inv'estigafiQns 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-8.77-MASSAFE Fax # 617-727-7749 Revised 5-26-05 / iAmrm=.mass..gov/dia ,/ Date.,31z(,911-2., 9355 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,%;z �Ilu — H This certifies that ..... . has permission to perform ......................... ,\C-. I � plumbing in the buildings of .... lr-. ..V...C).1..1 .............. .4. 4k North Andovet, Mass. Fee.��O.—. . . Lic. No.Z-Z?� 1. -Ab- �.. . . PLUMBING INSPECTOR Check # AP #I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY K© I;CrM A 011JJ'' I, F,:�P2 MA. DATE PERMIT # JOBSITE ADDRESS, L S c Sb OWNER'S NAME P OWNER ADDRESS �� TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL ❑ PRINT NEW: ❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES ❑ NO ❑ CLEARLY FIXTURES Z FLOOR- BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR INTERIOR �r KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: 1 have a current liabilityinsurance policy or its substantial equivalent which, meets the requirements of MGL Ch. 142. Yes ❑ No ❑ 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 BOX ONLY: OWNER ❑ AGENT ❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information 1 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 with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General) Laws. PLUMBER NAMESIGNATURE LIC # MPn-JP ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME f ! (1n �� FLZ/ ADDRESS: 02 )Ae CITY STATE,A- ZIP EMAIL TEL CELL FAX #I T O C G� �x ro r ro n H rr O z ,• z 0 H m �i- m � r n � H x n rA co m � O m 2~ C m aco rA m O H � -< t� ❑N OOz ❑ z k 1 Oil . ti . Od ro M n H O z z 0 H CrJ nc Commonwealth o fMassachusetts Department oflndusirialAccidents Qf�ce oflnvestigationg 600 Washington;S`&eet av Boston, MA 02111 w i 7zcant Infox�tnatinn ww masvgov/�'ia workers' Compensatlion7nsur ce.Affiidaviit: Bui-Iders/Conijractors/Blectricians/.Plumbexs Name (Business/Organizationgndividual): Address: As. City/State/Zip: Phone #: • �. i -? - 416 yy Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ Tam a general contractor and I 2.0 employees (full and(orpart time) x I am a sole proprietor or have hired the sub -contractors listed partner- ship and have no employees on the attached shget. I 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.] i employees. [No workers' comp insurance re , • d type ofPro] ect (required): 6. D New construction 7. ❑ Remodeling 8. D Demblition 9. D Building addition 10.❑ Electrical repairs or additions 11.M Plumbingrepairs or additions 12.[] Roofrep airs 13.r] Other xAny applicant that checks box#I must also fill out the section below showingtheir workers' compensationpolicyinform4ion. i Homeowners who submit this affidavit indicating they are doing allwork and then hireoutside contractors must submit anew affidavit indicating such. 'tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policyinformation. Z am an employer that isproviding workers' compensation insurancefor my employees Below is tliepoliey and job site nJoTmation. assurance Company 'olicy # or Self -ins. Lic. #: Expiration Date: )b Site Address: City/State/Zip: ttach a copy of the Workers' compensation policy declaration page (showing the policy number and expiration date). lilure to secure coverage as required uhder Section 25A of.MGL c. 152 can lead to the imposition ofcriminalpenalties of a LO 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 rine uP to $250.00 a day against the violator. De advised that a copy ofthis statement may be forwardedto the Office of 'estigations of the DTA for insurance coverage vert$cation. hereby cert n ey t]Ze �nsanclpenallie-sOfPe-rju)Yfflatilzeinfojwzation providedabove is Prue andcorrect. 3/ --?-G //L Oficial use only. DO not write in this area, to be completed by city or town official ity or Tow -.U: PermitUeense 111rng.Authority (circle one): Board of AeaIth 2 -Building Department 3. City/Towxr clerk 4. Electxic,91Inspector 5 Plumbine Ins e Other g p etor In#ormatio and Iiistaructi®ns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute an emptoyee is defined as "...every Person is the service of another under any contract of hire, express ox implied, ora ox written " o f the foregoing employer is defined as of "an individual, partnership, association, corporation or other legal entity, or any two or more engaged in a joint enterprise, and including the I' gal 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 esides therein, or the occupant of the dwelling house of another who employs r 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 "everystate or local licensing agency shall Wthhold 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 ofpublie work until ac reqceptable evidence of compliance with the insurance requirements Of chapterhave beenpresenied 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 -contractors) name(s), address(es) andphone numbers) along with their certificates) of insurance, Limited Liability Companies (LLC) orLimited Liability Paxtnersbips (LLP) with no ems her than the members or partnersare id , norequired to carry workers, compensation insemployees other urance. Han LLC or Ll ployee of ve employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation -of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,; please tail the Department at the number listbd 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. TheDepartmenthasprovidedaspaceatthebotiom Please be sure to fill in the p Of the affidavit for you to fill out in the event the Office of Investigatioris has to contact you regarding the applicant. eumit/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 town)." A copy of the affidavit thathas been officially stamped or marked by the city or town in (oily or array be provided to the applicant as proof that a valid affidavit is on file for future perrhits or licenses. A new affidavit must b e filled out each year. Where a home owner or citizen is obtaining a license or permit notxelated to• any business or commercial venture (i.e. a dog license or permit to burn leaves etc) said person is NOTrequired to complete this affidavit. The Office of Investigations would like to thank yo -din. advance for your coop please do not hesitate to give,oration and should you have any questions, us a call. The Department's address, telephone and fax number. Iia Conmowwoalth of txrjrssacx� setrs Departmoat of Zudustrjajj.AcDIdq4ts 4) ce of InvesUgations 600 WashiWon Street B ostoa M. 02111 �f a o Sri, or, Sta'-_ # Location 4 No. I O 79 Date 0 r_f___ _ '' �J3 TOWN OF NORTH ANDOVER pt.ao ,a,'40 ': • • a pL p Certificate of Occupancy $ /vv Building/Frame Permit -Fee $ / Soo vo �s�,+cMus�t Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ J,_fou, Building Spector i ` 71.-03/97 13:07 1,400.00 p�ID Div. Public Works Location_ No. U t Date (—,Zy 0 w 0 �pf rORT1y TOWN OF NORTH ANDOVER ♦�, •• pL d Certificate of Occupancy $ Building/Frame Permit Fee $IN �� s''^•''�� Foundation Permit Fee $ ,+cMust Other Permit Fee $ .6rl24? Sewer Connection Fee $ 7 LM b # 6431 Water Connection Fee $ to TOTAL $ 3 O� S2 . cm M AA k lding ecto n '/f) Yrf j1f/ Div. Public Works APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. / 4 PAGE 1 MO I LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK PAGE ON SUB DIV. LOT NO. !l; LOCATION PURPOSE OF BUILDING j OWNER'S NAME , NO. OF STORIES ' r SIZE OWNER'S AD ' I 'f .4 BASEMENT OR SLAB ARCHITECT'S 14AAjq SIZE OF FLOOR TIMBERS 1'$=_. Ito - 3RD BUILDER'S NAiL) ,... SPAN 0 N, DISTANCE TO NEAREST BUILDING v DIMENSIONS OFF SILLS D ' DISTANCE FROM STREET V POSTS DISTANCE FROM LOT LINES -SIDES REAR :50 GIRDERS AREA OF LOT f �� c� -��j FRONTAL i— HEIGHT OF FOUNDATION THICKNESS i el � IS BUILDING NEW 5 SIZE OF FOOTING 1 'C Z X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATIONNo IS BUILDING ON SOLID OR FILLED LAND pL WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER L - BOARD OF APPEALS ACTION. IF ANY /\ IS BUILDING CONNECTED TO TOWN SEWER GG V IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS" -t' (I=CT/%-1 L) N lea�< lti lt�.l4a � sTi4-Te o � . SEE BOTH SIDES ' W0lVtt7?1=1¢w.'Lt �� FouluD � �►Kt-9�B PAGE 1 FILL OUT SECTIONS 1 - 3 A i�l(filbli+� Lv�, (�� Iq.N4 2nc bN�{ PAGE 2 FILL OUT SECTIONS 1 - 12 C-CWItsruD g 04 r"'6' Tw-c7- R�-a"Yii L. QJi"�'1Lt'S IJas i L I.idi w. f�(� + ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDIFt���� ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED_® '� V (q/J SIGNATU FEE sod PERMIT GRANTED AGENT roTRL. 140o. a a 3 PROPERTY INFORMATION LAND COST l.J r EST. BLDG. COST r EST. BLDG. COST PER SQ.FT. Ag EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. N CONTR. TEL. # CONTR. LIC. N QSQ -�' H.I.C.# / Oe c' :o O -X -,P- -7cM5 /v 7/5 1 INSTRUCTIONS" -t' (I=CT/%-1 L) N lea�< lti lt�.l4a � sTi4-Te o � . SEE BOTH SIDES ' W0lVtt7?1=1¢w.'Lt �� FouluD � �►Kt-9�B PAGE 1 FILL OUT SECTIONS 1 - 3 A i�l(filbli+� Lv�, (�� Iq.N4 2nc bN�{ PAGE 2 FILL OUT SECTIONS 1 - 12 C-CWItsruD g 04 r"'6' Tw-c7- R�-a"Yii L. QJi"�'1Lt'S IJas i L I.idi w. f�(� + ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDIFt���� ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED_® '� V (q/J SIGNATU FEE sod PERMIT GRANTED AGENT roTRL. 140o. a a 3 PROPERTY INFORMATION LAND COST l.J r EST. BLDG. COST r EST. BLDG. COST PER SQ.FT. Ag EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. N CONTR. TEL. # CONTR. LIC. N QSQ -�' H.I.C.# / Oe c' :o O -X -,P- -7cM5 /v 7/5 1 I OCCUPANCY SINGLE FAMILY S.-ORIES MULTI. FAMILY _OFFICES �_ APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ d 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT II AREA FULL 11 FIN. B'M'T' AREA _ Y. /r 1/. 11 FIN. A _ NO B M'T E PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDSB 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ _ ASPHALT SIDING HARDW'D ASBESTOS SIDING COMMCN STUCCO ON FRAME STONE ON MASONRY 11 HEATING WIRING SUPERIOR (� POOR ADEQUATE NONE STONE ON FRAME PIPELESS FURNACE 5 ROOF 10 PLUMBING GABLE GAMBQEL FIAT ASPHALT SHINGLES HIP MANSARD SHED �ITOILET BATH (3 FIX.) RM. 12 FIX.) WATER CLOSET LAVATORY STEAM BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 6 FRAMING WOOD JOIST 11 HEATING c PIPELESS FURNACE TIMBER BMS. & COLS. FORCED HOT AIR FURN. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR _ WOOD RAFTERS _ 7 NO. OF ROOMS B'M'T 2nd_ Ist 13rd AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS OIL ELECTRIC NO HEATING 1 0 QA acvc ac L! JLU LU V 3 0 o U O U 0 Z Z O Q f Q I W C F < Z < y W W F I V < N JW U J 2 O) I W < Z W.... Z W O J t, W o W 7 O O W I H Z < t d O W Z < Z D < N Z O J m w ~0 0v v t O) J I f 0 F N J _Z Z_ Z J 4 W W V 1 N W I -W K U U U ILO Q J G J O J O m O G F m I W W S < < < < ] > > J C W W F' U U N H lo W m m m J < W 11 V W O 3 3 x 7 1~11 ; O m W 01 < < 6 6 J W N J O O < m O O < M al 1 0 QA acvc ac L! JLU LU V 3 0 o U O U 0 Z w a C O u W 6 0 Z a c J m W{ 7Z Q� 6 Z . v Z O z O o N .}. r r r p � ki 0 r 9 p s- O Z M S m V _Z J 4 i Z W u IL 0 u u u d W W V Ir o 0 8 o d< O ci cd IL U m m m U Z Z Z " Z 1- F J W Ipil r W F 6 m 1 3O O O V (.) i C O u W 6 0 Z a c J < 2 O r m W{ 7Z Z . v Z O z O W N .}. r 0 r s- O -� _Z J Z u V O r< IL U O r< rc r O r a ZO N m m W N J W u J m 0 W Z Z f W O J 0 Wm > > W C 0 0 z < < Z 4 O 0 0 < Z < o N 2 0 w r O_Z < m J J w Z < F r 4 '� _Z _Z J W 4 =) O O W C u u u 4 0 O O j 0 1- 1► W _ f K R r W Z Z Z O J J J m O N d' U m W W u W 0 Z V Z Z u J r r W m m m J < W U' U' F< N N N_ rc O W < < J F J 0 O < m O O O < N m N 3 m N d 6 W < M WIa < 2 O r . •__� `� .--moo., dt EZ m Z O �- b dIL �Z O = LU a W ,•, . Cx. .., i FOLD'ALONG LINE MAL t O > Z ra LLarrc LL 3 a d wio ati Z Ajc": pL- o-� T n Jg OR �.� p MIK . gmi = LLILi uQi z Q LLL 'O ZMr-'Ir. com LL FOLD ALONG LINE....�,t I F p- �Qypa W 111% cc w 1 k 3 v'z V � 0 ui Al O �Z S c� z ev w O,r�t� -o� ac rA wcr a 5 N C .t►• OC. C LLA 72: s CD 3-4 . _"' ' I I ti t it © W v!. �• to o � ,i IN. . O O o �.� co 00. U y Cr X F- v'�.� J. ' w .,.:� s- it • - ¢ . z ' ...� o o., o- 1 a. o o '. o'�..�':. co T ...p: Ix -C.. t - s� U n1 > . •__� `� .--moo., dt EZ m Z O �- b dIL �Z O = LU a W ,•, . Cx. .., i FOLD'ALONG LINE MAL t O > Z ra LLarrc LL 3 a d wio ati Z Ajc": pL- o-� T n Jg OR �.� p MIK . gmi = LLILi uQi z Q LLL 'O ZMr-'Ir. com LL FOLD ALONG LINE....�,t I F p- �Qypa W 111% cc w 1 k 3 v'z V � 0 ui Al O �Z S c� z ev w O,r�t� -o� ac rA wcr a FORK U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. **,***********Applican ills out this section***************** ellAPPLICANT: �� Phone — zo LOCATION: Assessor's Map Number 7 Parcel Subdivision Lot(s) �treet O St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: ___/V6tkk� OYdILW tn MM " 1Y)t� Date Approved Conservation Administrato Date Rejected Comments ✓ 4� Date Approved Town Planner Date Rejected Date Approved Food Inspector 1-Heal,t'tl w Date Rejected Approved It/ Septic Inspector -Health Date Rejected Comments /public Works - sewer/water connections - driveway permit A//,,O /Fire Department Received by Building Inspector Date . MASS, William F Weld - Paul Cellucci Governor Lieutenant Governor PERMIT -NORTH ANDOVER James J. Kerasiotes Secretary } f Kevin J. Sullivan Commissioner Permit No. 496-0672 Subject to all the terms, conditions, and restrictions printed or written below, and on the reverse side hereof, permission is hereby granted to JOHN FERREIRA to enter upon the State Highway known as ROUTE 125 or OSGOOD STREET for the purpose of constructing a driveway approach between Stations 3+52 and 3+84 at the northerly location line and flaring to Stations 3+32 and 4+04 at the edge of road. This Permit does not allow the Grantee to install any utility services. All work shall comply with the attached Plan, dated January 31, 1996. WORK HOURS: 9:00 A.M. thru 3:00 P.M. Monday thru Friday Provisions shall be made for the safety and protection of Pedestrian Traffic during the construction period. The work will be performed as per plans on file at the Massachusetts Highway Department District Four Permits Office. The Grantee shall notify the District Permits Engineer at (617) 648-6100, two (2) days prior to the start of work. The Grantee shall make contact with the Area Contract Specialist III via Pager (7:30AM to 4:OOPM Monday thru Friday ONLY) Telephone Number #617-644-3601, forty-eight hours prior to start of work. No work shall be authorized without said notification. The Grantee shall notify Dig -Safe at 1-800-322-4844 at least 72 hours prior to the start of work for the purpose of identifying the location of underground utilities. Dig -Safe # To be obtained prior to the start of work. Massachusetts Highway Department • District 4.519 Appleton St., Arlington, MA 02174 • (617) 648-6100 i Gl�.`111 LV.VLLi��.LL - The Completion of Work Form shall be sent to the Grantor via certified mail as soon as possible after the completion of the physical work. The Grantor will hold the Permit on file for a period of not less than three years. A copy of this permit must be on the job site at all times for inspection. Failure to have this permit available will result in suspension of the rights granted by this permit. Hand digging shall be required around the roots of trees. All work shall be in compliance with the current edition of the "Massachusetts Department of Public Works Standard Specifications for Highways and Bridges", No work will be performed on the day before or the day after a long week -end which involves a holiday on any highway, roadway or property under the control of the Massachusetts Highway Department or in areas where the work would adversely impact the normal flow of traffic on the State Highway System, without permission of the District Highway Director or his Representative. This permit is issued with the stipulation that it may be modified or revoked at any time at the discretion of the District Four Highway Director or his representative without rendering said Department or the Commonwealth of Massachusetts liable in any way. Uniformed Police Officers shall be in attendance at all times while work is being done under this permit to direct traffic and provide for the safety of the public and workers unless directed otherwise by the Director. All personnel who are working on the traveled way or breakdown lanes shall wear safety vests and hard hats. The furnishing and erecting of all required signs and traffic safety devices shall be the responsibility of the Grantee. All signs and devices shall conform to the 1988 edition of the Manual on Uniform Traffic Control Devices (MUTCD) Cones and non-reflecting warning devices shall not be left in operating position on the highway when the daytime operations have ceased. If it becomes necessary for this Department to remove any construction warning devices or their appurtenances from the project due to negligence by the Grantee all costs for this work will be charged to the Grantee. Flashing arrow boards will be used at all times when operations occupy the roadway and shall be available for use at all times. General and Additional conditions whenever the word -Department- Is owed Grein It mall seem the NAeaachutts Highway Doppae ttwent. Wht"werathe word etngineere is used herein it dtall awn the District Highway Director or other outhorlred rspraeentatiwt of the Department. whenever the word •Crantee• it used herein it shall bean the person or persons, corporation or municipality to whom the permit Is granted or their legal repr •sen tativea. During the progress of the vote all structures under ground And shove ground shall be properly protected from damage or injury: such writer• shall be erected and mairtalned as maybe necessary for the protection of the traveling public• the seat shall be properly lighted at night, and the Crantee &hall be responsible for all damages to persons or property dus to or resulting from any work done under this parait. ►rc*pt as herein ovthorited, no excavation shall be mad* or Obstacle placed within the limits of the State highways in such a tanner as to interfere unnecessarily with the travel over said road. It harry footing or sidewalk work done under this permit Interferes with the drainage of the State Rlghvay in any way, such catch basins and outlets shall be constructed an may be peva nary, in the opinion of the Engineer, to take proper care of such drainage. wherever the hardened surface of the roadway is disturbed and the engineer may consider it necessary or advisable to do *a, such surface will be restored by the employees of the Department, at ouchtime ss the Department may direct, and the expense thereof shall be borne by the granted, who shall purchase and doll of on the road the materials necessary for said work if and When directed by the bglneer. All payments to motarialsen and to leborerd, insp-ectors, etc., employed by the Department for on an account of the work herein cectesplated shall t* made by said Gra. toe for thvith on the receipt of written orders, pay rolls, or vouchers approved by the Departadnt. IF THE GRANMY TEE DOES AYORK COMTRkay TO THE ORDERS OF THE D4G WEER, AHD, AFTER DUE NOTICE ►AILS TO CORRECT SL>OM WORN OR TO REMOVE STROMIRtS OR MATERIALS ORDERED TO BE REMOVED, OR ►AEIS TO COMPLETE WITHIN THE SPECIFIED TIR TKT WORK AU7TWOPl9W by THIS PERMIT, THE DEPMrXEWr MAT, WITH OR w17%oUT NOTICE, CORRECT OR COMPLETE SUCH VORA IN /MOLE OR IN PANT, OR RE,.WZ Sv H STRt;._—TuRLa OR MATERIALS, AND THE GP --.),TEE SHALL REIMBURSE THE CVMMWWEAL" TOR ANY EXPENSE INCURRED IM CORRECTING AMO/OR COMPLETING THE MORN OR P4]10VING THE STRi1Cril RE OR MATERIALS. ;RLL 0► TRE WORK HEREIN CONTEMPLATED •HAIL aE DONE DWDES TIME SUPZ*VlSIOW AND TO TRE SATISFACTION Of THE NAS.UCHUSETTS RIGMNAy DEPARI*tW, ANO THE ENTIRE EXPENSE THEREOr SMALL BE BOWIE BY TME GRANTEE. On the completion of the work herein contemplated all rubbish and debris shall be removed and the roadway and roadside $all be left nest and presentable and satisfactory to the Erginser. The Department hereby reserves the right to ardor the change of location or the removal of any structure or structures muthorJted by the permit at any ties, said change or removal to be made by and at the expense of the Grants or its/their successors or assigns. The permit say be modified or revoked at any time by the Department without rendering said Department or the Commonwealth of M.Asochusltts liable in any way. The grantee shall pay the salary, subsistence and t avelling *"name of any Inspector appointed by tit Department to supervise the work herein contemplated. All of the above conditions shall be applicable to the work hereinAuthorized• unless the saes at* inconsistent with the Conditions on the tats of the permit, in Mich cast the conditlohe an or printed on the fats of the permit mall apply. The,acceptance of this permit or the doing of any work that#under Mall constitute as agreement by to Grantee to comply with a Dere ln.ll of the conditions and restrictions printed her written MA1 ff.rrHIGHWAY- lessKE JFAVA4R ff-t .. fl ♦� �r�t. 'fit �..� p,- .. .. '}� r ae^ Conditions Relatinq (articularly to Permits for the :.Ayinq of P:p<s. Conduits, etc. After any pipes, condults, dralns or other underground struetu I, as ore laid, or any escavat ion L mala in the ronlway, tho trarcham or ope-: cgs she 11 be properly tack filled with suitable aterla 1. the t"hly taped, and the surface of the road over said structures shall be lett *van with the adjoining ground. If the work is done in cold weather, no frotan material shall be used for back -(111. Wherever the hardened surface of .the roadway, gutters, or any part of the surface of the highway is disturbed it shall be replaced in' -ea Food colditioh as before it who disturbed, and it now materials are required they Mall corrempoad with thou already in plate. Where service pipes cross the highway the connections shall be mode without disturbing the roadway, or the pipes shall be carried under 'and across the road in a larger pipe, unless otherwise ordered by the tngireer. The grantea shall malntela the surface of the roadway over said structures as long as the Departmentmay deem necessary, until all signs of the tranches have be elisiated. C"IUals Relating to Permits for the >treeti*t of Poles, fires, AM Overhead Structures, and the Cutting and Triarmirg of Trtea. In the erection of pole linea, unless otherwise herein provdded, no trues located within the limits of the State Righway shall be cut or trimmed. No guy wires Wall be attached to tress without a special peralt from the Department, and In no avant shall they be to attached to to girdle the trams Or in any way Interfere With their growth. The vires shall be Se protected At all times and placed that they shall not interfere, with or injure the trees either Inside or outside the location of the highway. Whore the cutting or trimming of trees 1e authorlted by this permit, only such cutting and trimming shall be done as designated by to Engineer. In the construction or reconstruction of pole Ila" no fay vires shall be erected nearer to the surface of the ground than sir fat, provided however, that the owners of such line• say maintain such guy elves at a lower elevation than wiz feat from the grounduntil such time to the Department shall notify than, to remove old vitas er to rata thea to the elevation. first Stated. In order to protect the trees througb which any vires may .ltn,�by � t er m/ft etReltrue, Vtmrdaas� be :ired�los where high teeslas wires are erected under this perslt, they $all be to located that, under conditions of sazisua Severity as regards a coating of ico/snow, there shall be a space of at lust Might test between such high tension vires and other vires. i't,Mii lU;�ll �ltll Necessary signs, barriers, cones, etc. shall conform with the current Manual on Uniform Traffic Control Devices. Free flow of traffic shall be maintained at all times. Two way traffic shall be maintained at all times. When in the opinion of the Engineer, this operation constitutes a hazard to traffic in any area, the Grantee may be required to suspend operations during certain hours and to remove his equipment from the roadway. Care must be taken not to interfere with underground structures that exist in the area. Care shall be exercised so as not to disturb any existing State Highway Traffic Duct Systems. If said system is disturbed, it shall be restored immediately to its original condition. Also all. damaged Traffic lines shall be repainted•. The Grantee will be responsible for any damage .caused by his operation to curbing, structures, roadway, etc. The Grantee shall be responsible for any settlement which may occur as a result of the work dont under this permit. The Grantee shall be responsible for any ponding of water which may develop within the State Highway Layout, caused by this work. When a snow or ice condition exists during the progress of this work, the Grantee shall keep the highway well sanded to a point not less than two hundred (200) feet beyond the limits of the barriers and signs. No work shall be authorized during snow, sleet, or ice storms and subsequent snow removal operations. No bituminous concrete shall be installed between November 15th and April 15th. The Highway surface shall be kept clean of debris at all times and shall be thoroughly cleaned at the completion of this permit. At the completion of this permit, all disturbed areas shall be restored to a condition equal or similar to that which existed prior to the work. The drive/drives shall be surfaced with Bituminous Concrete, Type I and shall be laid in two courses to a depth of three inches, after rolling, with a foundation of at least six inches of compacted gravel. The finished surface, shall butt into and not overlap the existing highway grade at the road edge. General and Additional Conditions Whenever the word obspartsents to used herein It &hall wan the Massachusetts Mlghway Dopertssnt. whenever the word Engineers Is used herein It sha11 won the District Righway Director or other authorized sepreeentative of tn* Department. whenever the word •Grantee• Is used herein it &hall mean the person or persons, corporation or municipality to whoa the permit Is granted or their legal representatives. . During the progress of th* rock 411 structures under ground and above ground shall be properly protected from damage or Injury: such barriers shall be erected and sairtained se maybe necessary for the protection of the traveling Public, the site *hall be properly lighted at night, and the Grantee. shall be responsible for all damages to persons or property due to or resulting from any work done under this permit. Except as herein muthorized, no excavation . Mall be made or obstacle placed within the limits of the State highways in such a &4nndr 00 to Interfere unnacessarlly vlth the travel over said toed. It army grating or sidewalk work done under this peimit Interferes with the drainage of the State Rlghvay In any way, such catch basins and outlets shall be constructed as say be pocesu ry, in the opinion of the E gineer, to take proper care of such dre nage. Wherever the hardened surface of the roadway is disturbed and the engineer may eonaldir It necessary or advisable to do so, such surface will be restored by the employees of the Department, at such time 4a the Department say direct, and the erpende thereof shall be borne by the granted, who Mall purchase and deliver on the road the materials necessary for said work it and when directed by the Engineer. All payments to aterialsen and to labarera, inspectors, ate., smp)cyed by the h•part*ent for on an ecccunt of the work herein contesr:tted stall be made by said Grantee forthwith on the receipt of written orders, pay .rolls, or vouchers approved by the Department. IF THE GRANTEE DOES ANY VORA COa'TRARY TO THE ORDERS Or THE ENGINEtTI, AND, AFTER OVE NOTICE FAILS TO COPSI= SUCH MORA OR To PM40VE STRWIVRLS OR MATERIALS ORDERED 710 BE REMOVED. OR PAILS To COMPLETE WITHIN TME SPECIFIED TDa THE WORE AVMORIfm Ey THIS PMNT?, TMC DEPARTXErf MUT, WITH OR WITHOUT POTICE, CORRALT OR COMPLETE SUCH WORK IN WHOM OR 10 PA". OR PEWVL SUCH STRUCI`VR= oR MATERIALS, AND THE GRANfCC SMALL REIMBURSE THE C0101001WEALTE TOA ANT C"EMSCINCURRED IM CORREAM CTING D/OR COMCPLT.TING THE WORA OR P4xOVING TNC STRUCTURES OE NATMIAM. ;ILL Or TME WORK NER113111 COW7EMPLATC0 SHALL sE DOME ONDER Tilt fupimvlsloR AND TO TME "nsrxerIOW or TRz nUsucRusirm NIGNWAT DEPARTMENT„ AND THE rWT1RE MIENSE THE -COP SMALL at BORNE IT TML GRANTEE. On the completion of the work herein contemplated all rubbish and debris shall be ras:wad and the roadvsy and road $Ido ehall be lett neat and presentable and satisfactory to the Dg i n*et . The Department hereby reserves t.h* right to order the change of location or the removal of any structure or structures authorized by the permit at any tla, said change or removal to be ads by and at the expense of the Grantee or its their successors or assigns. The permit say be modified or revoked at any time by the Department without rendering said Department or the Comsonvtalth of Massachusetts liable in any way. Tb* grantee shall pay the salary, subsistence and travelling expenses of any Inspector appointed by the Department to supervise the work herein contemplated. All of the above conditions shall be applicable to the work herein authorized, unless the use are Inconsistent with the conditions on' the face of the permit, In which eau the conditions written or printed on the face of the permit @hall apply.. The ,acceptance ofthis permit or the doing of any work thereunder &hall constitute ss egreemuht by the Granted to comply With all of the condition• and restriction printed or written bereln.. Conditions Relathnq ftrticul&rly to Permits for the :iyinq of Tlpes, Conduit*, etc. Attar any pipes, conduits, drains or other underground structures are laid, or any ercavatlon Is made In the roadway, the trenches or cpen:rgs shall be properly back tilled with suitable eater Ia1,thorcughly tamped, and the surface of the road over aald structures Mall be left awn with the adjoining ground. It the work la don '1n cold weather, n, frozen material shall be used for batt -till. Wherewar the hardeaM surface of the roadway, qutters, or any port of the surface of the highway is disturbed it shall be replaced in ss good 'condition as before it was disturbed, and It raw materials are required tb*y &hall correspond with those already in place. Where aerwic* pipes cross this highway the connections abell be ads without disturbing the roadway, or the pipes shall be carried under and across the road In a larger pipe, unless otherwise ordered by t1a Daginer. The grant** shall maintain the surface of the roadway over said structures as long as the Department say does necessary, until all signs of the trenches have bean *I alnated. Conditions Relsting to Permits for the Erection of poles, Wires, and Overbdad stmetared, and the Cutting and Trimming of Trees. In -the erection of pule lines, unless otherwise herein provided, no trees located within the limite of the State Highway shall be cut or trimmed. No guy vires shall be attached to treat without a special permit true the Department, and in no event shall they be so attached as to girdle the trees or in any way interfere with their growth. The vires shall be so protected at all times and placed that they shall not Interfere with or Injure the trees either inside or outdid• the location of tb* highway. Where the tutting or trimming of trees is tuthorited by this permit, only such c,,ttinq and trimming shall be done as designated by the rhglnsar. In the constsvet on or reconstruction of pole line no guy wirsa shall be erected nearer to the surface of the ground than SIR tett, provided however, that the owners of such lines way maintain such guy vires at a lover elevation than six tett from the ground until such time as the Department shall notify thea to remove said vires or to raise them to the elevation first stated: In order to protect the trees througbw which arty vires may � Medi m insulated MA 06cis other tree ards liens tuSkil M directed lb the tension wires are treated Wnder this permit, they shall be so located that, under conditions of maximum ty as regards a coating of ice/snow, there shall be a space of at least right feet between such high tension vires and other vires. r_,KMi1 W'lgIIhlto ' The drive/drives shall be so graded that no water shall enter the layout, nor pond or collect thereon, including the roadway. The curb corners or radii may be painted at the time of installation. Said curb shall be painted yellow only. The curb shall be placed in conjunction with or immediately before the completion of the driveway surfacing. That part of the drive/drives located within the limits of the State Highway shall be maintained by the .Grantee, at his own expense and to the satisfaction of the District Highway Director or his representative. Wheelchair ramps shall be constructed in accordance' with the provisions of the Architectural Access Board Regulations. (sections 21.1 and 21.1.2) No trees,shall be cut or removed under this permit. All utility. companies whose services are located within or adjacent to the proposed installation areas shall be notified in writing of the proposed installation at least 48 hours prior to the start of any excavation in said areas. This is independent of the required .dig safe notification. It shall be the responsibility of the Grantee to contact the District Highway Director regarding the field location of any underground traffic control devices on this project. If the sidewalk area is disturbed, it shall be restored,full width, in kind a minimum -of five feet beyond any disturbed area as follows. It shall be the responsibility of the Grantee to replace all pavement markings which have been disturbed by this permit. These pavement markings shall be restored within ten (10) days after this work is performed or as deemed necessary by the District Highway Engineer. Any bound marked MHB shall not be removed or disturbed. If it becomes necessary to.remove and reset any highway bounds then the Grantee shall hire a Registered Professional Land Surveyor to perform this work. It shall be the responsibility of this land surveyor to submit to this office a statement in writing and a plan containing his stamp and signature showing that said work has been performed. rt.i<Aii �U.\11,�Lbil The Grantee shall indemnify and save harmless the Commonwealth and its Highway Department against all suits, claims or liability of every name and nature arising at any time out of or in consequence of the acts of the Grantee in the performance of the work covered by this permit and or failure to comply with terms and conditions of the permit whether by themselves or their employees or subcontractors. APPLICANT'S REPRESENTATIVE: JOHN FERREIRA TELEPHONE NUMBER: (508)975-2574 (SEE OTHER SIDE FOR ADDITIONAL CONDITIONS) No work shall be done under this permit until the Grantee shall have communicated with and received instructions from the District Highway Director of the Massachusetts Highway Department at 519 Appleton Street, Arlington, Ma. 02174. This permit shall be void unless thenherein cotemplated shall have been dpmpleted before DECEMBER 18, 1997. Dated at Arlington this 18th day of DECEMBER 1996. Massachusetts Highway Department, By � Eric W. Botterman, P.E. Acting District Highway Director JV/jv General and Additional conditions Whenever the word ellepartsente is used herein it shalt team the Massachusetts Highway Department. Whenever the word 'bglneare to used herein It shall seam the District Mighway Director or other authoria" representative of the Department. Whenever the word eCrshtese Is used herein it shall mean the person or parsons, corporation or municipality to rhos the'permlt Is granted or "air legal representatives. Oaring the progress of the work all structures under ground and above ground shall be properly protected fres damage or Injury: such terriers shall be erected and maintained as maybe necessary for the protectlon of the traveling public, the sue shall be properly )ighted at might, and the Grant** shall be responsible for all damages to persons or property due to or resulting from any work done under this permit. Except as herein outhorited, no excavation shall be made or obstacle placed within the limits of the State highways in such a sannrr as to Interfere unnecessarily with the travel over said road. It any grating or sidewalk work done under this permit Interferes with the drainage Of the State Righvay In any -way, such catch basins and Outlets she]) be constructed as say be Musset*, in "e *prolan of the Engineer. to take proper are of such T. hags. Wberever the hardened surface of the roadway Is disturbed and the engI neer may consider It necessary or advisable to do so, such surface will be restored by the employees of the Department, at such time to the Department may direct, and the expense thereof shall be borne by the grantee, who shall purchase and deliver on the read the materials necessary for said work it and when directed by the RNimer. All payments to materialmen and to latrx ers, Inspectors, etc., employed by the Department for on an scc'-,,nt of the work fere.n con.tes;:eted stall be aade by said Crania. forthwith on the receipt of written orders, pay rolls, or voucher's approved by the Department. IF Mf GRANTER DOES AMY WORK CONTRARY TO ME ORDERS or ME MCIMEM. AMD, APtER DUE NOTICE ►AI)S TO COPFYCT SUCH WORK OR TO PDCVII S `Rl/CTURES OR KATMIAL5 0RDER►D TO BE PDeOVED. OR ►AltJ TO COMPLETE WITHIN THE SPECI►IED TIXZ MR *ORA AMMORI tED BY THIS PERMIT, ME DEPARrWWT KAT, WITH OR WITMOAr POTICt, CORRECT ON COMPLrrE SUCL WORK IN "OLE OR 10 PARE, OR RD:avE SUCH STROCYVRES OR IATERIALS, AMD ME CPASK NTEE AU RM rIMbURSt t COM CWNtALIB ,OR AMY EXPENSE INCUPJZLD IN CORRECTIMG AND/OR CD"LErIMG ME WORK OR RPMIMG TIME STRUCTURES OR MATERIALS. ;AIL OF M WOJM MEIEIM COMT1N1PIattD S1fAIL hS DOME OMDER US SUPIWISIOW AIM TO THE SATISFACTION Or THE MASSACNUSI'M NIGMAT DEPArME)et, AMD THE ENTIRE EXPENSE TNDtEOP SKAU BE BORNE BY THE GRANTEE. On the completion of the work herein contemplated all rubbi ch and debris shall be removed and the roadway and roadside shall be left neat and presentable and satisfactory to the. Engineer. The Department hereby reserves the right to order the change of location or the removal of any structure or structures authorised by the permit at any time, said change or removal to be made by and at the expense of the Crantee or its/their successors or es*lgns. The permit may be sodltteif or revoked at any ties by the Department without rendering said Department or the Commonwealth of Massachusetts liable In any Vey. the grantee snail pay the salary, subsistence and trays111ng erpen**a of any Inspector appointed by the Department to supervise the vork herein contemplated. All of the above conditions shall be applicable to the work herein Authorlred, unless the same are inconsistent with the conditions on the face of the permit, in Mich case the condition written or printed an the tau of the perwit shall apply. The ,acceptance of this permit or the doing of any work thereunder shall constitute as agreement by the Grantee to comply With 611 of the conditions and restrictions printed or written herein. MAH/G�WAY . ASVito S ��..,. �. ..H/G►HWAY'�� Conditions Relating Particularly to Permlts for the (eying of P:pes, conduits, etc. Altar any pipes, conduits, drains or other underground structures are laid. or any excavation 1s made In the roadvey, the trenches or cpentngs shall be properly trek filled with suitable Date r nal, thercughly taped, and the surface of the road over■old structures shall be left even with the adjoining ground. I! the work la done In cold weather, no froren material shall be used for back -till. Wherever the hardened surface of the roadway, gutters, or any part of the surface of the highway is disturbed it shall be replaced in as good coMltion an before It vas disturbed, and If nev materials are required tiny, stall correspond With those already in place. Where service pipes cross "a highway the connections aball be made without disturbing the roadway, or the pipes Mall be carried under and across the road in a larger pips, unless cthervies ordered by the tngineer. The grant** Msl) maintain the surface of the roadway over sold structures Ds lag as the Department may deem necessary, until all sign of the trenches bave been eliminated. Conditions Relating to Permits for the Erection of Poles, Wires, And Owerbned Strvctcras, and the Cutting and Trimming of Trees. In the erection of pole Imes, unless otherwise herein provided, no trees located within the limits of the State Righvay shall be cut or trimmed. No guy vires shall be attached to trees without a special permit from the Department, ufd in no event shall they be so attached as to girdle the trees or in any way Interfere vitt their grow". The vires *ball be so protected at all times and placed that they shall not interfere with or Injure the trees either inside or outside the location of the highway. Where the Cutting or trimming of trees is •uthcrlxed by this permit. Only such cutting and trimming shall be done a■ designated by the Engineer. In the construction or reconstruction of pole -lint no 94 vires shall be erected nearer to the surface of tba ground than six test, provided bowevar, that the owners of such lines say maintain such guy vires at a lwer elevation than six test tree the ground until ouch time as the Deportment shall notify thaw to remove aid vires or to raise than to the elevation first stated. In order to protect the trees through Mich any, wires may Vie" it > be LMM14"d sed mach otMr tree geaNs sqby the fnginw. Where h1 gn tension wires are erected ander this permit, thay shall be so located that, under conditions of maximum severity as regards a coating of ice/snow, there shall be a spec* of at least eight feet between such high tension vires and other wires. � 11 Ar William F. Weld Paul Cellucei James J. Ketesiotes Governor Lieutenant Governor Secretary Completion of Work Kevin J. Sullivan' Commissioner You may proceed with the work described within this Permit which has been issued to you by Mass Highway. Your attention is called to the timeframe allowed for completion of said work If an extension of time is required or alterations to any of the permit conditions becomes necessary, application for such changes should be made as soon as possible to the District Highway Director. Upon completion of the work, please fill out the form below and forward it to this office- IF THIS NOTICE IS NOT RETURNED, THE LIABILITY ASSUMED UNDER THIS PERMIT WILL CONTINUE By Authority of the Mass Highway District Four Highway Director. Dear Sir: I hereby notify you that the work outlined and authorized under the terms and conditions of MHD Permit No. has been completed in accordance with all requirements of the Department. The date of completion: Permit Grantee: Signed. Date: MASS HIGHWAY 519 Apptdon s&ea Arangwm ,Ns o1 i 74 Td 617-648-6100 Fax 617-643-0477 Massachusetts Highway Department • District 4.519 Appleton St., Arlington, MA 02174 • (617) 648-6100 Eastern' Casualty-'-.Insufa""nce Company" WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE NCCI Carrier 16942 Policy No. WC VOO 3 S 17 b 1. The Insured/Mailing address: FLUET CONTRACTORS, INC. ioa BRIDLE PATH LANE METhiRJEN, MA 01844 Other workplaces not shown above: Risk I.D. # 67696 Federal I.D. # 44-30309521 Individual F] Partnership ® Corporation or 2. Policy Period: The policy period is from 03f 31 i 9b to 03/31/97 12:01 A.M. Standard Time, at the insured''s rhAiling-address. 3. Coverage: ..... . ..... A. Worker's Compensation Insurance` Part One o#the policy applies to #tie Workers Compensation Law of the states listed here: Massachusetts isted in item 3.A. The limits of our B. Employers Liability Insurance Part Two of the policy apples to work4n each state l liability under Part Two arc8odi#ylntury by Accident 1 C3>0 CiEfl- each accident Bodilyanjury by Disease fl+0 dao . policy:..11mit Bodily_#nlury �y D�ssase Ira each ernplo�iee C. Other States Insurance Part Three;,of the policy ap{ies to the states, i# ar;y, 416&.41eret�tta3i f,�t114t �. E tr t^s lel, i #C %A 03 06A. ijl�53til kit'tt4Dh`,C#t'ef�k'DIIWI�,Klffl`":Wllr.� a D. This policy includes these endorsements and schedules R Wd 42, W. WC350, 1!1lC36;7, WC441. See Informahtln Page III fdr dth6r apellckle ehdor10menfis 411 Total Estimated/rntual I'rert�iiurtti $ r q , Pro Rata Prern ur7t (If 4011004 ii �? ' r u i Countersigned SEGREVE. HALL & RDWE INS" BBo TURNPIKE STREET NORTH ANi7OVER v MA 01845 Date 04"'OZ-16 By Authorized Repress ative ARC; 359.» 66 LMW THIS INFORMATION PAGE WITH THE WORKERS COMPENSATION AND PLOVERS LIABILITY INSURANCE POLICY AND ENDORSEMENTS, IF ANY, ISSUED TO FORMA PART THEREOF, COMPLETES THE ABOVE NUMBERED POLICY. �p:,,to y•`ryO Town Of North -Andover Plan Building Department �o> ,: Review 508-688-9545 "sS., *.S'E�`�".: George TabAippe 146 Main St. Town Hall Annex Jchn Ferreira APPLICANT: INT v � DATE: Felntary 24, 1997 Zoning District : ' Use Code: Title of Plans and Documents: B.P. 4a2ica ion, nein Dumb; d4gs-r .kin FPrrpira Retail Dimgs); Request: Bjilrii 9 Flegnit Plan PeA w Please be advised that after review of your building permit and or zoning review has been DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space Insufficient Lot Frontage Sign requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By -Law I Use requires permits prior to Building Permit Other EOther Plans to scale Reiflledy for the above Is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Variance for Sin Other Plan RevieW The plans and documentation submitted have the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. letter Administration The documentation submitted has the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure Construction Plans Need 2rld set 127 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details Framing Plan Fire Sprinkler and Alarm PlanRoofin ,-s Footing Plan Plans to scale Utilities . Site Plan 3 s Water. Supply Sewage Disposal Waste Disposal Other ADA and or AAS requirements X 1 1 1 Other Ftj11 M of curb cut letter Administration The documentation submitted has the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. -- 1-17 -el layout - L1lriLan lloruts ucff ae It— The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice, by the Building Department, shall be based on verbal explanations by the applicant nor shall auch verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled `Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and or request for plan review to receive approval. Feb. 24, 19% Feb. 24, 1997 Building Department Official Signature Information Received Denied If Faxed Denij n If y e assi ea call the above number and we will be able to guide toward meeting the necessary requir understand that many of the reason for denial are related to the code requirements that must be met to ensuric s y. Requirements for detailed plans are necessary to ensure that there is enough information through plans and sns to sham that code requirements will be met. .,, Water Fee State Builders License Sewer Fee X 1 Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Nap Homeowners Exemption Form OtherEiealth Npt. of Kitdil X Other 1for Ccrrrrnri Vict>Ja]ler's -- 1-17 -el layout - L1lriLan lloruts ucff ae It— The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice, by the Building Department, shall be based on verbal explanations by the applicant nor shall auch verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled `Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and or request for plan review to receive approval. Feb. 24, 19% Feb. 24, 1997 Building Department Official Signature Information Received Denied If Faxed Denij n If y e assi ea call the above number and we will be able to guide toward meeting the necessary requir understand that many of the reason for denial are related to the code requirements that must be met to ensuric s y. Requirements for detailed plans are necessary to ensure that there is enough information through plans and sns to sham that code requirements will be met. .,, Memorandum To: Bob Nicetta, Building Inspector From: Kathleen Bradley Colwell, Town Planner Date: February 25, 1997 Re: 980 Osgood Street (Texaco) I have reviewed both the site plan special permit and the watershed special permit issued by the Planning Board for 980 Osgood Street. The only outstanding item prior to Form U verification is the receipt of three copies of the plans signed by the Planning Board. One copy will go to your office and the other will stay with the Planning files. The bond has been posted. The approved elevations do allow for the brick to be painted although my recollection is that the addition was to match the existing building. FEB 2 5 1%T 'a I;, a �i N a 2 C m Ch iso A C y'V` _O C j C3 :'acv. :c=• :R 0 m E a �0 �c2 : °2 ' L ...VC :"a.= ... OCJ O ALL i �m Z' y L +:c 3' ' A 'O N := C C N O O m A CD :mo y m m = CDc c C c :a�� m 0 wyo F• C3 o cC o CL =_ `mc .o a=0Go ~ r Z tO,V N O m —21. O: ` y O Q a_.. m 7 CJS 0 C/) z11 0 z�z 0 C/) lot Cf Z NCup • d 2 LL. O 0 y y .E CL C O G3 cc CL CO2 0 C3 .a CO3 C O C.D !c C cc CO2 is O v co CL CO2 C di CM C O D � m m CD co 3 .o O 0 Q C Q �ca G3 Z CD CL. CO2 C _ a x �� b o w v cn z (� .a ° c p w ono O a: v U G x ►� a p w q w w w w to oG v " cn q w ° U w a � m—co 0 w' O w w w wx " c0 o z - V) Q v O cn N a 2 C m Ch iso A C y'V` _O C j C3 :'acv. :c=• :R 0 m E a �0 �c2 : °2 ' L ...VC :"a.= ... 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E Q' o _v H cm � 3 = r � y H A O 2� 'Eo av o VJ O � Li 0 cm QO C C Q _ H • m O r m co o c o cm � �oa o c Q o c ;ago r H O�H m WC 0--.22 •_.. li. y m IS R r O M O :s 2 y� E 0=$H o CL ��!E c g _ GHo 2 ` = O �- .c 0 a Z m N N N O O � L O Z O CL O H p C I Ccm 0.— C40 •— yff m m ca CD Z O.0 3� O CD p O L t 0 d m CMQ C cc 300 CL 0 C ZCl � V y O C � C _c CL C40 p To: 15886869542 From: Starkweather & Shepley 7-17-97 11:43am P. i of i '. �1ait�lln il� �IIIYiiF irY� f �lTE +� ■ : f: ul ITT+ iMt ' '' D ' I ' Lf ';Q'1; ti; ISSUE DATE iMMADfYY, .. 07/17/97 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE TARKWEATHER & SHEPLEY DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. BOX 549 COMPANIES AFFORDING COVERAGE ROVIDENCE RI 02901-0549 COMPANY A HARTFORD INS GROUP LETTER COMPANY B INSURED LETTER ' HOMELAND BUILDERS, INC. COMPANY C 208 SHOVE STREET LETTER COMPANY D r ALL RIVER, MA 02724 L£TM COMPANY E LETTER e�. : : 11, :�:::�t. :::��.,::, :.�tt� :t t..t::; :.,::::: :tt:�: i,'.. :.� ,:t:'. t6. t.:. tt,-,:.t t:,:.:, :r:: :ul.,:l, tt:: t:� :t.: tl::::t;:t � ,:tt�•: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 710 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. O POLICY ELECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS TR DATE (MMAD/YY) DATE (MM)DD/YY) - GENERAL LIABILITY 02UMBU9452 01/13/97 01/13/98 GBIERAL AGGREGATE 8 2,000,00( PRODUCTS-COMP/OP AGG_ E 2 000, O Q OMMERCIAL GENERAL LIABILITY IMS MADE OCCUR. PERSONAL & ADV. INJURY S 1,000,00( OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE 0 1,000, 0 Q FIRE DAMAGE (" — fire) 0 1 1 000, 00c MED.E)(P. IAny one person) 6 . 5 00c AUTOMOBILE LIABILITY 0 2 UENBU9 4 7 5 01/13/97 01/13/98 COMBINED SINGLE ANY AUTO LMR 1, 750,00( BODILY INJURY ALL OWNED AUTOS SCHEDULED ALTOS IF -Person) 8 BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per eceiAentj S GARAGE LIABILITY PROPERTY DAMAGE 7 Pj EXCESS IJABILITY 0 2 XHMU9 2 9 0 01/13/97 01/13/98 EACH OCCURRENCE f- 2 000, 0 0 AGGREGATE $ 2,000,00C UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION 02WBEF2938 08/05/96 08/05/97 STATUTORY LIMITS 14 ,;; EACH ACCIDENT S 100, O O AND DISE.ASE41OUCY LIMIT 3 500,00 EMPLOYERS' LIABILITY DISEASE -EACH EMPLOYES ! 100.000 OTHER f{ DESCRIPTION OF OPERATIONS/LOCATIONS/VERCLES/SPECIAL ITEMS E: DUNKIN DONUTS, 980 OSGOOD ST., NO. ANDOVER, MA r3UIIDiNG DEPARTMEN GARI+GELLgtIOi '! SHOULD ANY OF THE ABOVE DESCMBEDPOUCIES BE CANCELLED BEFORE THE li EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO CITY OF NO. ANDOVER, MA ''I' MAIL 1 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR NO. ANDOVER MA LIABILITY OF ANY XJND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ji!j, AUTHOM2ED REPRESENT E 1 �yy y o.' ITRO 18 '33N30IA08d 3 3AV SINV98IVJ 6T �,, �, •�r� 08I38I8 A 08VI103 00 :01 paaatjIsaB SWOULO AWOVL0 16Z£00 S3 - : a lepq 1J?8 : $aJ7dz3 : jagvnN 393311 80SI883dOS NOI13081SN03' A133VS 3I180d 30 1N3NISH30 _ ! afjat�rrr /�/��o �Jnan�uo2riarooGl. a�� . _. e r— o.' ITRO 18 '33N30IA08d 3 3AV SINV98IVJ 6T �,, �, •�r� 08I38I8 A 08VI103 00 :01 paaatjIsaB SWOULO AWOVL0 16Z£00 S3 - : a lepq 1J?8 : $aJ7dz3 : jagvnN 393311 80SI883dOS NOI13081SN03' A133VS 3I180d 30 1N3NISH30 _ ! afjat�rrr /�/��o �Jnan�uo2riarooGl. a�� . _. e FORM U - LOT RELEASE FORD INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction , have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: l �� t6`� �� _� Phone 65c5, LOCATION: Assessor's Map Number Parcel�6=df, -co 6o� Subdivision 1 1�� ��t1���i�t G� �ar,�� � 1 Lot (s) - 2c1',,, -Street St. Number' E ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Date Approved Date Rejected Date Approved Town Planner Date Rejected Comments Date Approved Food inspector -Health p h Date Rejected Date Approved Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - driveway permit ire Department Received by Building InspectorDate 7 17-97 0 . J FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 1xfN/0K/ U, �e f t t II t=it Cts phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments ✓ Date Approved d Spector -Health Date Rejected Date Approved Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - driveway permit 11 ire Department Received by Building Inspector Date ,c,' The Commonwealth of Zlassachuseas _ Deparnrrent of Indrestr a1.4ccidents lfDfrt Vitas 600 Washing on Street ;b Boston, .Nasx 0'111 Workers' Comven=tion Insurance Affidavit narre I G l� t 7, a �r I am 1 .nomeJwner ^ :':ormmg -III work WVSe::. I art a sole orecr.e:cr and have no one •.vcr;d--z y any =cac: C I am an empiover --roviding worice s cotn=e^..satrea :cr =v =_:ovees woricing on :nisgoo. comnam► came: . address. ...... city �hpnG 3- i�n_rattse_c-j. vnliev d I ar a sola crocr.e:cr. ceaeral contractor. cr 20 CSGOa SGr inn and have 3;: GC z concaC:Ors astma below wa0 have the :'oilowing workerscompensation pout=s.: Fmiure :o secure covemge is required under Secnoo _.J of .NIGL L-= as .ca; a m the :moostaoa of crtmtuai pertatnes of a tine up to SI::00.00 analor one years' imprisonment as well as civil penalties in :Se Cora of a STOP WORK OR -DER sada cine of SI00.00 a day against me. i understand that a copy oC:his statement may be forwarded to the 011ice of :aveeti—,vdoas oC:±te J4a Cor coverage verification. I do Irerebvccrifv er the pains and penalsti= of pt lrs ;Kia:fte nior�t on provided stove is nue snd corre= Sigratur_ Print name ?hone .# oQlcial use only do pot write in this area to be ccopietrd b7 city or aww ojMcil city or town: prrsitticense Z —Building Department C:Ucensiag Board C cheek if itamediate response is required [Selectmen's Office CHeslth Department contact person: plow r, -Other tn...a v+s nwt JUL 17197 11:10 FR STARKWEATHER SHEPLEY 401 438 0150 TO 15066869542 P.01/01 . . 7y�� 16Sl7EDATB'.(mM/DDM)n 07/17197 Pte" TM CERTMCATR N iSAWD AS A MAMM OF DWORMATWN ONLY AM CONMIS NO RIGHTS UPON THE CEI:TIFICATE SOLDER T= C RTMCAM DM NOT AMEND, EXTEND OR ALTER TW COMAGE AFFORDED BY TLE TARKWEATHER SiiEPLEY BELOW. O. BOX 549 COMPARES AFFORDING COVERAGE ROVIDENCE RI 02901-0549 OOMPA14V A HARTFORD INS GROUP LETTER COMPANY B ocaaED LETTER OMELAND BUILDERS, INC. COMP"Y C 08 SHOVE STREET LETTER COKP NY D ALL RIVER, MA 02724 UTTER COMPANY E LfrTTER .,txr•�4. .>:�� . +'ry i:, FFw.;w•.,:.xw:? atiw:::, t...-cs;�r.,:,: „.n "•;:.:., � r-,.. ,.::en. ��r,: r': e.9,..<.^:•:4... ,: (+: ., .., .. ,.,..:.,...:.. w�i.:>....... ..:`.'.3•.;y�y:<.;...-;..•,;•r>.,.<.�..::'`�:.:..,�xt:ucAv.:�<.G:c�.✓..i`%�� �`.:.:'.`.' TH�STANTF�iE �[!ED :MAmj!Zyy. LU4IONSND CONDTTtONS OF SUCH POLICiFS. IdbllT$ Si10wN MAY HAVE BFFN REI}UCm BYCIAD S. POLICY EFT1f7cTM LXPIRA 7YtE (i � POI.tCY NUM3iS: Ling ATE (MM/DD/YY) DATE (MMA)DNY) GVNROALUAWLffY 02UMU9452 1/13/97 1/13/98 '?'000'00 IAL OPNERAL UABA)TY PROmcrS•Q7 vOP AOG. S .. INS MADE �occulL •, NAL ADV_ MURY S 1,000,00 OWN9t'S A CONTRAf.TOR'S PRO•'. EACH OCCURRENCE s-1 0 0 0 0 O 01 FW-nUW-ff(AW—All:; a 000 00 EDW. cw am P=0m) ACTOMORnS UAMUIV 02UMMU9475 1/13/97 1/13/98 awomumGu uxn s750 00 Y vaulty �AUTOS LIDAUTOSU LAWTO % DomyDarcy NEDAUTOS LI HATY PROPERTY DAMAGE EXC»uAmn'Y 02XHUBU9290 1/13/97 1/13/98 EACHOCCURRENCE 2,000,00(l Ui,�nem t . PORN AGGREGATE S ? OOO 00 i Tau' ••!-: l 'Y.'^.:'fif'Nncf"i N�:2:.' •�a:3�.ia .r•.;;?{�,:uu,�h a'ORA SCDUPBNSATIOV 02WREP2938 8/05/96 8/05/97 srnTVTOEYLmm AND EACH ACCMEN7 s 100.00 PGI' u)AR f 500,00 $8(PLOYsa$' LLASQ,iTY EMPLOYEE S 100 ,00 OTBFY DISCRnn" OT OPP1ATtONS/LOCA rrn" DUNKIN DONUTS, 980 OSGOOD ST., NO. ANDOVER, Imo, w« mix<�.::_>�'•n1:' .. ..... :. ...., ..:....:.�;,.:n�..: ..s. ..n<.�....: ..:....,:5.�,<L.:....... Y.R ..M.. � .. ., •i .< � ... ..:d;eti'>:}r:^:a:f/5ifi i:�Yio .. ,.. a.., a. r.,y. r:r a?Y.tr »<,. ....:....:.. ..... ,lr Yiir.:...>,v :,: rm:�i.�` k•. SHOULD ANY OF THE AWME DF.SCRoev, FO Xms BE CANCELLED $IOaORB`T7fE EXPIRATION DATE THERBOF. THEMSUING 0014PANY WILL ENDEAVOR 710 CITY OF NO. ANDOVER, MA MAIL 112— DAYS wRrrm4 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL DOOSE NO OKAGAUON OR NO. ANDOVER MA LL%BB.ITY Of ANY KIND UPON THE ACAN'Y. Ir$ AGENTS OR REPREMMAMVES. AIIT$OYt7EDRS7lF�"lATTvY $ C� .. „a..sw• 'Lau:>.oar<Lhcer„ :>,::{.:.b � :,::o>:;:.., ... .........n..<..::r. ....�: ,.. .„. ..s;.•:: ,,:oa .. .. .. <.WL:ao>x ,rn '2; .s,.r...ah,: �•xy ... ... ' .....:.�::.�::... �: rte.; .. .:..,.,:,,...,.. �.. v kui�� �n rk ** TOTAL PAGE.001 ** j/,// - 0 // -Z - Date ..................... 0� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 4= 4 This certifies that !Gr h .. ... r ",pr * ` has permission for gas installation .. . ...4 pr . ...... . . , .... ...... in the buildings of ........ rll*****''''****************''''** at ........ 9-49-.4 .. 55?f Mass. Fee ......... Lic. No...... .....'... GASINSPECTOR Check # 14j -?-1 8115 r NATURAL & LIQUEFIED PETROLEUM GAS: PIPING - EQUIPMENT - APPLIANCES - SYSTEMS 1 nr, rn-- 1 1\.I TA Crt/C /G\ MIUMAI C AIR ROTATION UNIT FURNACE: ALL TYPES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS FITTING BOILER: ALL TYPES GAS PIPING CITY/TOWN: ` Vb2 ef" X/ b © V r P, STATE: MA APPLICATION DATE: ✓ JOB ADDRESS: !l Fa r5 6 62e2P BROILER ILLUMINATING APPLIANCE OCCUPANCY TYPE: COMMERCIAL RESIDENTIAL ❑ PLANS SUBMITTED: YES ❑ NO ❑ BURNER: ALL TYPES INCINERATOR NEW ❑ ALTERATION ❑ REPLACEMENT ❑ REMOVALIDEMOLiT10N ❑ r NATURAL & LIQUEFIED PETROLEUM GAS: PIPING - EQUIPMENT - APPLIANCES - SYSTEMS 1 nr, rn-- 1 1\.I TA Crt/C /G\ MIUMAI C AIR ROTATION UNIT FURNACE: ALL TYPES TEMP HEATING EQUIPMENT BOILER: ALL TYPES GAS PIPING THERMAL OXIDIZER BOOSTER GENERATOR (STATIONARY ENGINE) TURBINE BROILER ILLUMINATING APPLIANCE UNIT HEATER BURNER: ALL TYPES INCINERATOR WATER HEATER: ALL TYPES CO -GENERATION UNIT INDUSTRIAL AIR HANDLER EQUIPMENT OVER 12,500MBH COFFEE ROASTER. INFRARED HEATER FOTHER NOT LISTED I COOK APPLIANCE HOUSEHOLD KILN I GLORY HOLE I CRUCIBLE COOK APPLIANCE COMMERCIAL LABORATORY COCKS DECORATIVE APPLIANCE MAKEUP AIR UNIT DIRECT VENT APPLIANCE MECHANICAL EXHAUST EQUIPMENT DRYER: ALL TYPES OVEN: ALL TYPES FIREPLACE: VENTED I UNVENTED POOL HEATER FRYOLATOR ROOF TOP UNIT FUEL CELL ROOM HEATER-VENTEDNENTLESS PLUMBING / GAS FITTING FIRM INFORMATION CHECK ONE ONLY x F,17 NAME:V—n .Corporation Business 4 Partnership Business # _P CITY: ,V STATE: ZIP: d 7� ❑ LLC Business # .TEL: kj:7- 3-5-q ` !kQ kFAX: EMAIL: ❑ DBA I Unincorporated NAME OF LICENSED PLUMBER I GAS FITTER: (;-:Peq afWliA 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 Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement CHECK ONE ONLY OWNER ❑ AGENT ❑ Signature of Owner or Owner's Agent OWNER'S NAME: TEL: FAX I hereby certify that all of the details and information I have submitted (or entered) regarding this permit application is true and accurate to the best of my knowledge. I certify that all plumbing work and installations performed under the permit issued, will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code, and Chapter 142 of the General Laws. Permit #' Inspector Fee: (OFFICE USE ONLY) Type of License: ❑ Plumber ❑ Gasftter `Master El Journeyman Signatur of Licensed Plumb r I Gas Fitter ❑ Undiluted LP Installer License Number: ❑ Limited LP Installer W 0 z z H U W P. a Q z w a o 0 Z El o W WM ° z it:LU Q - Q LU d �t W W 3 o Z aa, a � W Q � U J d a Ln w z w I-- u.. W h 0 z z o H U , W P. z 0 x 0 0 x A 2587 Date . .11 ...... TOWN OF NORTH ANDOVER 01.:- \`� PERMIT FOR GAS INSTALLATION 9 a This certifies that .. �? �.� .../. � .��................ has permission for gas installation` in the buildings of .................. at . ?...c2 r. y. ... S - ........ North Andover, Mass. Fee.S. i . .. Lic. .......................... 07/15/97 14:14 50.00 PA&S INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT. TO DO GASFITTING (Print /of Type) /I( & �r1r-lvr� r'/ Mass. Date,? �9,� 19 City, Town Permit 1 .9 Building Owner's Location ��� QS r>Ij Ste- Name-/Ch��Z 9:&i�,� New ql---, Renovation ❑ Type of Occupancy: -Jcln K;» Replacement E-1 ❑ Plans Submitted: Yes Lam' No ❑ (Print or Type) Installing Company Name�c- Address Check one: ❑ Corp Business Telephonea,1Z' -� 5�5� 4-",0 5,-' !,�� Name of Licensed Plumber ❑l, PPa�artnership_ L�I--Flrm/Company INSURANCE COVE AGE: I have a current Iia ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have chec ed �, please In Icate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage fequired by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information t have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumoong worK and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General taws. By Signature of icens d Plumber Title City/Town: Type of Plumbing License License Number Master ❑ Journeyman APPROVED (OFFICE USF ONLY) Certificate Date. �1�? J 3485 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . A 4 $ �f�?�.c„,,,,,, s has permission to perform .. A/�.4-,% ..13v, .� A plumbing in the buildings of .•.l4 ...'/�� .i�f?! .�!.............. at . �?..4�C f. v.� �'.............. .. , North Andover, Mass. Fee,lO4 PLUMBING INSPECTOR m WHITE: Applicant CANARY: Building Dept. PINK: Treasurer A 'MASSACHUSETTS UNIFORM APPOCATION.'11FOR..PERMIT.-TO bO "PLUMBING (Type or Print) -17 Date: NORTH ANDOVER Mass. BuildingLocation S� Permit # 3 YAf-- Owners Name M ;i t kxj civ< New Renovation Replacement Plans Submitted FlyTURES appropriate box: Liability insurance policy [Z Other type of indemnity Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner [D Agent`-,= I hereby certify that all of die details and Worries lion I have submitted (or entemd) in atmvc application age true an 4 6 -late to Use best of soy knowledge and that all Plumbing work and insl3lialliorts lict(atnicd under Ircrelki( i'sued for this application will be in opLiance with all pCltincpt pso-_g visions of the Massachusetts State riumbing Code and chapter 142 of the Ccricial Laws, By Title. . City/Town: APPROVED TOFFICE USE ONLY) Signature of /Licensed Plumber Type of Plumbing License /0 0-/� License Number Master ❑ Journeyman 4 A (Print or Type) U3 Check one: Certificate Installing Company Name Vt Corp. Address Partner. I Firm/Co. Business Telephone Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the Z al 0 z 0 03 0 W _j 0 W Cl AC 0 0 -4 a: W t- I.- W �: 0 .j Qj = 0: _j -C 3d W W 4 > =* 1- 0 a :3 t-- Z 0 0 Q 0 z C W 11— 0 0 < 4 = _C 0 cc ca 4C 0 <1 I- 0 sus—SSMT. BASEMENT 1ST FLOOR 2ND FLOOR 31113 FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR appropriate box: Liability insurance policy [Z Other type of indemnity Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner [D Agent`-,= I hereby certify that all of die details and Worries lion I have submitted (or entemd) in atmvc application age true an 4 6 -late to Use best of soy knowledge and that all Plumbing work and insl3lialliorts lict(atnicd under Ircrelki( i'sued for this application will be in opLiance with all pCltincpt pso-_g visions of the Massachusetts State riumbing Code and chapter 142 of the Ccricial Laws, By Title. . City/Town: APPROVED TOFFICE USE ONLY) Signature of /Licensed Plumber Type of Plumbing License /0 0-/� License Number Master ❑ Journeyman 4 A (Print or Type) U3 Check one: Certificate Installing Company Name Vt Corp. Address Partner. I Firm/Co. Business Telephone Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [Z Other type of indemnity Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner [D Agent`-,= I hereby certify that all of die details and Worries lion I have submitted (or entemd) in atmvc application age true an 4 6 -late to Use best of soy knowledge and that all Plumbing work and insl3lialliorts lict(atnicd under Ircrelki( i'sued for this application will be in opLiance with all pCltincpt pso-_g visions of the Massachusetts State riumbing Code and chapter 142 of the Ccricial Laws, By Title. . City/Town: APPROVED TOFFICE USE ONLY) Signature of /Licensed Plumber Type of Plumbing License /0 0-/� License Number Master ❑ Journeyman 4 y f. 3402 Date .Y. -K � 97 . . ��� .-:�� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies'�j.... // .......... has permission to perform.. .� ............. plumbing in the buildings of . 1.......... at. q� ... S. y. �.� 41 ...S. �.......... , North Andover, Mass. FeeLic. No..6.lrA 3 . PLUMBING INSPECTOR 47/15/97 14:13 190.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer /90,— MASSACHUSETTS 90 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date 19 Ity, Town Permit /—O Z g Owner's Buildin AT: Location 90 QS tTa cull Name,�%l/�s� Type of Occupancy:227✓n New Renovation ❑ Replacement ❑ Plans � / FIXTURES Submitted: Yes K-oo No O (Print or Type) Installing Company Name®�� �`Gr �o • Check one: Certificate Address • �Q� /G'G ❑ Corp. ❑ Partnership mJCors:perY Business Telephone �% % -.�Sy- ye 5��/ Name of Licensed Plumber INSURANCE COVERAGE: I have a current liab' ' insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No O If you have checked 3es, please indicate the type coverage by checking the appropriate box. A liability insurance policy UY/Other type of indemnity O Bond .❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent O Signature of Owner or Owner's Agent I herebv certitv that and the detai s and information I hate submitted (or entered) in abo%e appriration are true and accurate to the best of my knowledge and Mat aA pk"Wing work -. and installations performed under Ftmit issued for this application will be in compliance with an pertinent pmvisions Of the Massachusetts Sete Mumomg tme ana t.7®pter arc of the General Laws Signature of Oce9sod Plumber - Type.of-Plumbing License" License Numbers ❑ Journeyman ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ....■■E■■■■■■■■■■■■■■■■■■■■■■■■■■ ...■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ (Print or Type) Installing Company Name®�� �`Gr �o • Check one: Certificate Address • �Q� /G'G ❑ Corp. ❑ Partnership mJCors:perY Business Telephone �% % -.�Sy- ye 5��/ Name of Licensed Plumber INSURANCE COVERAGE: I have a current liab' ' insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No O If you have checked 3es, please indicate the type coverage by checking the appropriate box. A liability insurance policy UY/Other type of indemnity O Bond .❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent O Signature of Owner or Owner's Agent I herebv certitv that and the detai s and information I hate submitted (or entered) in abo%e appriration are true and accurate to the best of my knowledge and Mat aA pk"Wing work -. and installations performed under Ftmit issued for this application will be in compliance with an pertinent pmvisions Of the Massachusetts Sete Mumomg tme ana t.7®pter arc of the General Laws Signature of Oce9sod Plumber - Type.of-Plumbing License" License Numbers ❑ Journeyman