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HomeMy WebLinkAboutMiscellaneous - 99 WOODCREST DRIVE 4/30/2018N .,: • .:. q. +..�s"M.+'',..:-fi"^.s --mow: F , . 3825 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that 4."� .. .. ..•:c�'•�^^.!�✓.-" '� has permission to perform•. ' .=�'4' ,plumbing in the buildings of . ........... at .../. l�`'°�J�-�-a-�'r'' . , North Andover, Mass. Fee47...... Lic. No72.4:�-.Al�.... ........................... . PLUMBING INSPECTOR 09/24/98 14:20 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS n Date Building Location �p._� , Owners Name ��eJ�/iY���(.J� Permit #__" Z3F&'� / I Amount Qr y✓' Type of Occupancy S/ ----_ rr•rrr.�r�ariirr�.�rr New 0 Renovation [3 Replacement [:] Plans Submitted Yes ❑ No 0 IW1V T1T12 VQ `Print or type) J , . �/�' 1 Check one: Certificate Installing Company Name^��� G._ L--f/r�f�i'?/� „ ahs [I Corp. Address xn;0 Partner.. 4 j Business Telephone I,5P7 7 2 C/_ _/Q s— Firm/Co. „ Name of Licensed Plumber: �e__,_ Insurance Coverase: Indicate the a of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11 Bond Insurance Waiver. the Jdersign4. have been made aware that the licensee of this application does not -have any one of the above To= . r -- signature Owner I hereby certify that all of -the details and information I have submitted to best of my knowledge and that all plumbing work and installationsed compliance with all pertinent provisions of the Massachusetts umb' By: igna reo kens mer Type fPlumbmg License Agent 0 cation are true and accurate to the d for this application will be in 142 of the General Laws. Title City/Town License Nuinuer Master 0- Journeyman 01 APPROVED (OFFICE USE ONLY i `Print or type) J , . �/�' 1 Check one: Certificate Installing Company Name^��� G._ L--f/r�f�i'?/� „ ahs [I Corp. Address xn;0 Partner.. 4 j Business Telephone I,5P7 7 2 C/_ _/Q s— Firm/Co. „ Name of Licensed Plumber: �e__,_ Insurance Coverase: Indicate the a of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11 Bond Insurance Waiver. the Jdersign4. have been made aware that the licensee of this application does not -have any one of the above To= . r -- signature Owner I hereby certify that all of -the details and information I have submitted to best of my knowledge and that all plumbing work and installationsed compliance with all pertinent provisions of the Massachusetts umb' By: igna reo kens mer Type fPlumbmg License Agent 0 cation are true and accurate to the d for this application will be in 142 of the General Laws. Title City/Town License Nuinuer Master 0- Journeyman 01 APPROVED (OFFICE USE ONLY 4288 } Date . ..........1" ....... ...... NOR7h TOWN OF NORTH ANDOVER PERMIT FOR WIRING Q This certifies that ........... /D ... 74 ............................................................ j has permission to perform .-;1.:.:`Z�?-� t-�'-.......................................... wiring in the building of ......�:YYri.. .��a J ......................................... �.t ... o Andover, Mass. at .............................. Nor nth Lic. No. Fee .............. ...................................................................... ELECTRICAL INSPECTOR Check #'�o`� Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use OGnly Permit No. Occupancy and Fee Checked [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME , 527 CMR 12.00 (PLEASE PRINT IN INK OR TMp-A4, INF RMATION) Date: City or Town of: f To the Insp ctor of Wires: By this application the undersign yl)gni)ves n6ijc'&_6fVs or her intention to perform the electrical work described below. Location (Street & N Owner or Tenant I Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No a (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps New Service Amps Number of Feeders and Ampacity Volts Overhead ❑ Undgrd ❑ No.. of Meters / Volts Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: Completion of the fnllnudnv tnhla mm, be waived 1,,, tho L.o..o..t..,..,PLir,. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating, Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number I. Tons I KW I No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equi alent No. of Water Heaters KW No. o No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent [OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of El trical Work: _ (When required by municipal policy.) Work to Start: p_Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the ains a d penalties of perjury, that the information on this application is true and complete. FIRM NAME:A.DTLIC. NO.: I q _j�jr Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line.) Bus. Tel. No..• 603 94 92$ Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lic see does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ f Location No. Date NORTH TOWN OF NORTH ANDOVER 0 41 "s Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ 6o TOTAL AN Check # K�g� 17181 Building Inspec4-6r— TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING - <- ...T'�S Section for`O#€Ic�-i3se`Oa� BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION I- SITE INFORMATION 1.1 Property .Address: Vl acRF-sT 7w 1.2 Assessors Map and Parcel Number: 11 93 ICT Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zen in District Proposed Use Lot Area s Frontage (ft) , L nr r" T%Md` CT.T12 A!•YC /ff\ ' Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 153'L- z t 0 i ter 1-5. Flood Zone Information: - 1.8 Sew a Disposal System: S tv M.G.L.C.40. 34) Zone Outside Flood Zone 0 Municipal On Site Disposal System 0 Private D SECTION 2 - PROPERTY OWNERS /AUTHORIZED AGENT 2.1 Owner of' Record Name (Print) Addr�rvice Sig, � r Telephone c.2 Owner of Record: Name Print Address for Service: Televhone SECTION 3 _ CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: S7TevE *A .-K44A11711314�- Licensed Construction Supervisor. Stc/F ��s L� f?RI cK Alai/• 0306# �� Address Wia rc Telephone 3.2 Registered Home Improvement contractor t= "Ul MW ALV _ exp' �ompany Name luuress — denature Telephone Not Applicable 0 a. C5 0I,! �& License Number Expiration D to Not Applicable 0 A) 3 Registration Number Expiration Date INN, IN I, SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildjng permit. Signed affidavit Attached Yes ....... If No ....... 0 SECTION 5 Desc6plion of Proposed Work check all applicable) New Construction Or Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition 0 Other 0 Specify AW4026 VNG 492Z --- Brief Description of Proposed Work: Si atw f Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB RD RD SIZE OF FLOOR TINIBERS 1 2 3 SPAN DN ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CF-DNINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be f �} 0 b permit a licant . tCompleted � 1. Building (a) Building Permit Fee' Multiplier 2 Electrical (b) Estimated Total Cost of / a O _ k Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I ,� ��Jp�f/ j as Owne Authorized Age of subject property Hereby authorize to act on My bel ers r )at" t rk authorized by this building permit application.— 2 44 D� Signature 'of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION �J{,� #4 ��/ l "G/as Owner/Authorized Agent of subject property C Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Si atw f Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB RD RD SIZE OF FLOOR TINIBERS 1 2 3 SPAN DN ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CF-DNINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 1 10 Aj at FORM - U - LOQ' RELEASE FORM j>oc 1 INSTRUCTIONS:. This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT PHONE ASSESSORS MAP NUMBER LOT NUMBER _ SUBDIVISION LOT NUMBER STREET iA1Q ,b STREET NUMBER I■E■■MOMEN ■■MNEME■■ ■■■ ■ ■RNMM■■■■ ......E .................... OFFICIAL USE ONLY............E.....M........ RECD NDATIONS OF TOWN AGENTS .... .�....... ■ ........ .. ■ ..... ■ ■ ......... DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED r"c.DATE APPROVED � PLANNER 00,,� Cf/� t% DATE REJECTED _/4,WKITH 1N� P NNrvU COMIv1ENTS•�fShG1a l7lY/j,t NilcJ S�� v�v �1 iTic �' /1�, l ' z �-maA /U 'S JLe (,:l / L ��M� �'� ` n'' DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED _ SEPTIC INSPECTOR - HEALTH DATE REJECTED CONUVIEN-M PUBLIC WORKS — SEWER / WATER CONNECTIONS DRIVEWAY PERNUT _ DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR 1 + X11;, October 30, 2003 NORSE ENVIRONMENTAL SERVICES, INC. 130 Middlesex Road, Suite 15 Tyngsboro, MA 01879 TEL. (978) 649-9932 • FAX (978) 649-7582 Kyriakos Kazakides 99 Woodcrest Drive North Andover, Mass. ®1 g y Re: Wetland Delineation Sir; RECEIVE® MAR 0 3 2004 NORTN ANDOVER CONSWATIONC01MMUION As requested, I performed a site visit on your property and adjacent property to determine if any wetland was within 400' of your proposed work. Just over the property line, to the rear of the house and over a stone wall there is a low area that appears to collect some water and has some wetland vegetation, including Buckthorn (Rhamnus frangula) and Poison Ivy (Toxicendron radicans). There is not a preponderance of wetland vegetation in this area. Examination,of the soils in two areas shows a subsoil with Munsell colors of 10 yr 4/4 and 2.5y 4/4. These colors indicate the soils are not under anaerobic conditions, and would not be considered wetland soils as defined in 310 CMR 10. 00, Wetland Protection Act Regulations. The Mass. GIS Orthophotos, attached, also do not show any resource areas within 100' of the site. In my opinion, there is no resource area as defined in 310 CMR 10.00 or the North Andover Wetland Ey-Lav that would require yo,, to file with the local conservation commission. Please contact me if you have any questions. Sincerely, Steven Eriksen Soil Scientist NORSE ENVIRONMENTAL SERVICES, INC. 130 Middlesex Road, Suite 15 ' Tyngsboro, MA 01879 TEL. (978) 649-9932 - FAX (978) 649-7582 September 29, 2003 CEI RECEIVED 1 Kyriakos Kazakides 99 Woodcrest Drive OCT 2 0 2003 North Andover, Mass. NORTH ANDOVER Re: Wetland Delineation PLANNING DEPARTMENT Sir; As requested, I performed a site visit on your property and adjacent property to determine if any wetland was within 100' of your proposed work. Just over the property line, to the rear of the house and over a stone wall there is a low area that appears to collect some water and has some wetland vegetation, including Buckthorn (Rhamnus frangula) and Poison Ivy (Toxicendron radicans). There is not a preponderance of wetland vegetation in this area. Examination of the soils in two areas shows a subsoil with Munsell colors of 10 yr 4/4 and 2.5y 4/4. These colors indicate the soils are not under anaerobic conditions, and would not be considered wetland soils as defined in 310 CMR 10. 00, Wetland Protection Act Regulations. The Mass. GIS Orthophotos, attached, also do not show any resource areas within 100' of the site. In my opinion, there is no resource area as defined in 310 CMR 10.00 or the North Andover Wetland By -Law that would require you to file with the local conservation commission. Please contact me if you have any questions. Sincerely, Steven En'ksen Soil Scientist aECEIVED OC -1 a,, p 2003 BUILDING DEPT. M w O N N dA Cd P-1 M O O N C) N MORTGAGE ENSVEUTIUN PLAN .r BOSTON SURVEY, INC. 02-06749 P.O. Box 290220 Charlestown, MA 02129 (617) 242-1313 MAIN (617) 242-1616 FAX APPLICANT., AKMAKJIAN LOCATION: 99 WOODCREST DRIVE CITY, STATE: NORTH ANDOVER, MA 1-7400 DEED/CERT. 5196-148 PLAN REF: 5867 \, o 0 0 i - � LOT 48A , 48,180+1 -SF , I �I 63 #99 1 STORY 1 1✓ I \ J I 1 � ooh M w 1: L-25.87 R-245 SENT BY:BRAINTREE MA ; 5-12- 3 ; 13:24 101 040 OLUU-vio auU UUcu dI�MAT�v N PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Curtin-Twinbrook insurance Aga . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 400A Franklin Street COMPANIES AFF RDIN VERAGE Braintree, MA 02184 COMPANY A C N A Insurance Company iM$YR COMPANY B C N A insurance Company Environmental Poole Inc. 184R Riverneck Road QOMPANY C C N A Inaurance Company ChilTualford, MA 01924 COMPAMr D �g OR!( M1111.1211911 IS TO CERTIFY THAT.THE POLICIES OF INSURAN 1 § ! �� L W HA §99A ISSUED TO THE INSURED NAMED ABOVE FOR THE POUiCY PERIOD THIS INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT DR OTHER DOCUMENT WITH RESPECT TO WHICH THIS AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BI: ISSUED OR MAY PERTAIN, THE INSURANCE OF SUCH POLICIES. UMrrS SHCWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. „• _,_ EXCLUSIONS AND CONDITIONS ..^ POUGYEFPECTIVE POUCYGN RATION UNITS TYPE OF INSURANCE P06MY NUMBER DATI (w DATE (MMMOf } OTR pEN—RAL At MEOAT19 I2QQ Q 000 GENERAL LIAIINUTY X COMMERGIALGENERALLIABiLITY i TCP2067739729 fI 3/24/03 3/24/134 PRG"-COMP/DPAGG 4 1,00010()o . PGRrONALiADVWJURV ! 1.000.000 JA 0 AIIASMAOE Fil OCCUR I &ACHOCCURRENCE ! 1,000,000 j OVuNGR'S4CONTRACTOR'8PROT FIRE DA g 300,000 X Per Rro�sat Aga�v►cEunvatielue� MEd ExP (AST — Pit—) a 5,000 AUTOMMI.15 LIANUTY $1,000,000 B ANY AUYO 8"1077841028 3/24/03 3/24/04 ALLOWNEDAUTOS tri+ tP�� 6 SCHEOULEDALITOS X MIRED AUTOS BODILY WJURY g (Per "dd +0 X NON4NMEDAUTOS i PROPERTY DAKAGE $ AUTO ONLY -EAACCIDENT S CARADELUU3WlY OTHER TKM AUTO ONLY" ANY AUTO EACH ACCOENr a AGOREOATE I EACH OCCURRENCE ! 61(CF6G4A81UTY AGGREGATE ! UMBP.GLt+4FOi>M g OTHER THAN UMRRELLAFORM woRKEM 6011PENGATION AND ENPLOYERI3' LIABLI Y L CLr•ACIIACCIDEHT I 500,000 THE PROPRIETOR/ i INCL TSI U���� 5/1d/03 5/14/04 I.LDINASE•POUCYLLWT I 500,000 EL DISEASE - EAIMPLOYEG I 500,000 PARTNER91D(ECUTNE OFFICER$ ARE: EXCL 65RIPTI S Evidance of InswrAnOO w.....u'.::..P?�"`Vy!nrs:;;-:�T.�1�:•:7.R:` ':ei.�.::.5: ,a�.a,.—,... tiil�n., ..,1 ,: d1...w .u.rl .. . . SHOULD ANY OF THE ARM DEWRIRED POUCIUS RE CANCELLED BEFORE THE ExPWAT1DN DATE THEREOF, TME ISSUING COMPANY VAL ENDEAVOR TO NAIL 10 DAYS WNTMi NOME TO THE CtSNTIMICAYB HOLDL'H NAMED To TME Lf'T, BUT FAIWN TO,.IA�jNI(MI�I CI � LL IM ON OR UABIUTY ,Pd . EGCNTATIVM OF ANY Imola upal caaRANY, R A HW"30MAIFE JI AFALdP' AL -01 I Joseph Rizzo ° �hlu AT.RTY .`. .•. .•.-,LiFSVS11':_..'.... •' .. .. - :'le� [ A -_ V � • .A'i. s Th e Common wealth of Nlassach usetts i>1. j -6 Department o Industrial Accidents P Office offn,vestf atinns 600 GYashinabton Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit loc city phone # 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity MRIN I am an employer providing workers' compensation for my employees working on thisjob cdmpanv name:, mss' � ® ✓s MAMM iwsurance Co. F1 I am a sole general contractor, or homeowner (circle one) and have hired the contractors listed below who proprietor, have the following workers compensation polices d company name address: phtine #: insurance: co. - t company name : z� :b x �w ,•� � ae � � �. ., 5, 4 v. " F .r ft address. city photes# h, R. s.., `tai insurance'co +'policy# N t c] udii hoiialshe " riecessa m " ' Failure to secure coverage as required under Seaton 25A cf MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500,00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby ce der19e pains r pen- ies of peri4that the information provided above is trite and correct. Signature Print name official use only do not write in this area to be completed by city or town official city or town: ❑ check if immediate response is required contact person: Phone # permit/license # I—jBuilding Department ❑Licensing Board ❑Selectmen's Office ❑Health Department phone #; nOther (revised 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of ,the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing.agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. a The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406 7a7- 75-3a XadD ,6 Board of Building Regulations and Standards One Ashburton Place - Room 1301 �-3oston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 107083 = Type: Private Corporation Expiration: 7/29/2004 ENVIRONMENTAL POOLS INC. Andrew 'Everleigh 184R Riverneck Road - Chelmsford, MA 01824 ►.. Update Address and return card. Mark reason for change. '? Address I -. I Renewal ! ' k:mployment i Lost Card '��/�• !!n»lrJvni7invu�/� r�. y�il.lJ;r�-J,�i,Ar��J Board or Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 107083 Expiration: 7/29/2004 Type: Private Corporation ENVIRONMENTAL POOLS INC. Andrew Everleioh 184R.RiverneckyRoad Chelmsford. MA 0182d Arlmh,iclratnr I, License or registration valid for individul use only before the expiration date. if found return to: Board of building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Jv "4� a Not valid without sie J 0► - 1 I Bfl�/die �omzn:a�uueal!% a�. %�iaadaciu�aelXa OARD OF BUILDING REGULATIONS icense: CONSTRUCTION SUPERVISOR Number: CS 013965 t i rth date: 12/24/1948 Expires: 12/24/2003 Tr. no: 5214 Restricted: 00 STEVE A KALAITZIDIS 7 POWERS LANDING #203 MERRIMACK, NH 03054 Administrator Board of Building Regulations One Ashburton P ace, HM 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 12/24/1948 Number: CS 013965 Expires: 12/24/2003 Restricted To: 00 STEL I- A KALAITZIDIS 7 110WERS LANDING #201 NIFRRIMACK. NH 03054 — ---- Tr. no: 5214 Keep top for receipt and change of address notification. t s a Wz ��bJ Qti�� �oW4 3. 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O't.ao r• 'N TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..4...:............................................................. has permission to perform, �:..... ......................�......................................: wiring in the building of.................,....:........................... ................................. at ..a...................................... j�................... .North Andover, Mass. Fee Lic. ... U`''EI ECI RICAL INSPECTOR Check # 51.24, f: _ Commonwealth of Massachusetts Official use YP Permit No. / . Department of Fire Services Vev.'uIP11991 ancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS leave blank APPLICATION FOR PERMIT TO PERFO ELECTRICAL WORK All work lobe performed in accordance with the Massachusetts edrical Code (MEC), 52/7CR 12.00 (PLEASE PRINT IN INK OR TYPE ALL -INFORM,4 Date: City or Tovcln of: To the I ect r of Wires: By this application the undersign gives'nofi6eof his or her ntenti to perform the electrical work described below. Location (Street & Number) 479 Q C A S 1 Z Owner or Tenant Owner's Address D Telephone No Is this permit in conjunction with a building permit? Yes W No ❑ (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. ofMeters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:* z"7�- No. of Recessed Fixtures completion of theLo No. of Ceil.-Susp. (Paddle) Fans table may be waived by the Inspector of blues_ No. of Total 'Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool d ❑ d. o. o i i:: a cy �g mg BatteyUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting g Devices Heat Pump Number Tons KW No. of Self -Contained Detection/Alertin Devices No. of Waste Disposers Totals: KW Municipal Local ElConnection ElOther No. of Dishwashers Space/Area Heating Heating Appliances KW g p Security Systems: No. of Devices or Equivalent No. of Dryers No. of Water KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or uivalent Heaters Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: Asad+ additional detail ijdesired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. e undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. ; 0. CHECK ONE' INSURANCE C4 BOND ❑ OTHER ❑ (specify-i&--9C#&0&--M— (Expi tion te) Estimated Value of Electrical Work // 5 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: dregory Taylor LIC. NO.: 32268E Licensee: ('RF( cog V, Tayla� -- Signature LIC. NO.:�UL (7f applicable. enter"ese�mpt"inthe license number line.) Bus. Tel. No.: 50R-flfil,-(,�06 Address: 7`1 Pike Street Tewksbury_,res., Ol R7FAlt. Tel. No.: i - OWNER'S INSURANCE WAIVER: I am aware thaf the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement_ I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Telephone No. PERMIT FEE: $ Signature Receipt # .4 COMMONWEALTH OF MASSACHUSETTS .[912 arm= OF ELECTRICIANS AS A REG JOURNEYMAN MISELoECTRICIAN ISSUES Ix GREGORY A TAYLOR 71 PIKE STREET vo TEWKSBURY MA 01876-2543 '•2268 E 07/31/04 892670 -, Fold. Then Detach Along All Perforations MAR -1T-04 09:51AM FROMyam Brothers Insurance � 1ST8S»TG743 TIFiCATE OF LIABILITY INSURANCE �� THIS c�RT�FICAY� ts' ratif y apio CONFERS_ g�,� gzos . x�isusazlc� ]_:)1 Pawtuc ct Bl -V,5 i.IOwe11 Y✓iFs01834 phaaca:978-454-2920 Fax= NSURRi -- poe o Taylor box ai024 Chelmsf0Xd X T -2T8 P.001r`001 F-9tl2 ,.�OF to -...03l, I htULUQM, I "'w ALTER THE E RAGE AF _ INSURr-RS AFFORDING COvj:RACE INSURER h X*rchants Tasurarss INsURgR 6:_�- INSURER G. cINOUREAD, __-- THE Ce ' AMENC THE PO NXIO # ......rwr� �IP.TPfI�iYdK�Ai.it7lN+.a OR OTHER CiQCUBED �N�E s616aECT Td AL LTHE TgRNM,�F-X"US'O as AND cG'NOITIONs OF S Ci I TtiE pC>LICIES OF INSURANCE U4ED 6ELU1N NAVK 8E) N l:.�UEC TO T1i ANY A E9UIR6MENT, TERM OR CONDITION OF ANY THEC OUQIAC MAYPOL1G E9 FI , THE IN URAN F AFFOROED HA! E 43FEN REDL1 Z 61Y PAID CLAIMS. �i11—` umVTs _ SHCANN CY EFt RrdtY POLICY NUg13ER i GATE MMIDON 0 E NlfDDf y I Ills TYp6 of IµsURANr j� --- { FACH OccuRRVNC5 000 0 TR 5 t-LxarrAvE rQtcaTe©--"—I y 10 a G' 0 OENERALt-AWTY ` 03/20/0,4 03/20/05 1 PRamsi+e A 1 511 COMMERCIAL GENERA: LJABIi.fh y cCF6005900 i MED ExPtAmy onr porus: �50000 �' ocrlsR cLA+Ms M.aDE X ; f PEAScm1A� a nov INUFLY 10 000 0 ! 0 GENERAL AGGRFOATE -- 5 2 0 0 00 0 0 PaCpUG�•COMPIOPAW'' �04 QOU r,EN%AGGREGATc W MIT APPLIES PF-. Pga, f� LOG j Pii 01UCY JECY AUTOMOBILE UABiLITY I ANY AUTO ALL DVJIVE:) AUr03 - " 6Cs•IEDLLE0 AUT05 I N;aGD Auros NON•avvNEO AUTC'a 9ARAGE LIA04TY I ANY AUTO j �—EX-C93MUMORELLA LIABILITY j OCCUR CLAIMS MADE f I)OUCTIB-E i ! rJ �-�r<+noN s -(j I YVORKER$ CONIPEN`SATION AND j INpL0YERW WA61LIT' 'LMV'E ANY RgOPRIETORPARTNro"-' T CFriCEkl"v1EMBER EXCLUDED'' 1 ° PE CR1p7I0N OF �Rp,T{0N5 / LCCATtONS 1 WVy.RONi° WTAL 20OLS 10 4EL RZVEiMC" lk"o .SFCRA NA 01924 ^OMQINt7-'SNGL`.'L!WJt g (F wziuonai I BODILY INJURY 4 S (Per Ferecnl _ BOD6Y INJURY (Pet ®;c!dent) I PRoPER1Y DAME++' �_—�� (�*.�edaeny 11 AUT�EA AC;CIMFNT EA ACS i TrISR T'n.Afu . I AUTO O*uX: Asfy S 1 FACH OCCURRENCE 3 E L EACH CH A=DENT _j 5 E,L- USEASE• EA WP:OYEq E.L. U16F•ASE - PGLI=Y LiM_ I \.e/'r{VVF-��r�. nom• " EL Ii�01 SHOULD•%NYOFYHEA2011EDESC151M �ICtESdSCANGELL.FDi�FOFiT"DAYSw•RiTYEN PATE tHEREOF, THE ISSIJ,W INSUR-R Iva ENOaAv R TO MAIL .54 5Y10.C,_. NOTICETDTHEcERTIT: AT LDERIAMTIaI�¢LF?,,�U?��wUR?"., ., _ T3Aw`ENTSOR IMPOSE NO 06LC,ATIOR 4W8iLITY' CF ANY KIND UPdN/TFik iR51JRFJl I REpR'F.SENTATYES• ,Date .... 7....�...y... `k v't..w ,a •ry TOWN OF NORTH ANDOVER PERMIT FOR WIRING I'To� This certifies that ........................... has permission to perform .... �rr..(1- . Poo ............ v-..... .. ............................................. wiring in the building of ...�` r a' �} A-2 A K 'e S e at ...... W tJ .) .dQ o.0 N 80}— �... No4h Andover, Mass.... 33Fee..j�.........LIc. No. ..................................... . `..�.......' i ELECTRICAL NSPECTOR Check # 5360 THE COMONWF+ AUHOFMASUCHUSE ALT1 S Office Use only DEPARTA1 VTOFPUB1KS4FM Permit No. M ;� BOARDOFFREPREVENHONRFaGUTAT70NS5270W?12.W Occupancy & Fees Checked APPLICAHONFOR PERMIT TO P".111ELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE ASSACV6sSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) i IDate Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical worl de iribed below. Location (Street & Number) 99 (nloxic re�T Owner or Tenant Cl ,qel t; D S j< Q z A K DSS Owner's Address q� Wo-CCr2s\- bc;,) Q— Is this permit in conjunction with a building permit: Ye&o No (Check Appropriate Box) Purpose of Building - Hocv,2. Utility Authorization No. % 7 Existing Service % Amps 1A0 Overhead Underground No. of Meters New Service x-) Amps`Volts Overhead Underground No. of Meters (� Number of Feeders and Ampacity o^ d c--),Oc> Location and Nature of Proposed Electrical Work �Jeti, 5 �,,r M:. t Quo\ + NaJ �,-ry,c No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW 1:3 Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP t VTHER- kJ%= eCoverdW- Aa=tDtfEM4manaisOfMa%adlWMCMaallaws IhmeaamatliabtTdyhmaarmlt>htyincludrt>gConlpleeCDw*crits&*s= alegrmiat YES � NO1-1 IbavesubniWdvandpoofofsam iDdrOffim YES ffywhaNechociedYES,plea hfic*ihewofcoNuawby drc1dngdrdWujA=b0X , NSURANCE ;;25BOND r7 MIER � (PleaseSPAY) �� . 5 0 `7 Fxmia66nDale WbtkloStatt hispectimDaIeRmptesind Signedunder Penalties ofpajtay. HRMNAME Lia� �os c o� DQ. r•[� Signahae 1L Rough -;�FmW LioerwNo. _ Z-139- 33 Licffwl b BusilmTel.No. AkTei No. Gr3Yo33 X1-316 — 81 $2 —7171 311, , (1990 OMIT,WSINSURANICEWAIVER;Iamawaceduftl oared mmthmtheinsuraloecovw,WoritsabsarlWecptivaialaslac}medbyMassaduwftC3ez>erWUM and thatmysignahaecn dnspamrt*phcabm waives this mgmi anal (Please check one) Owner Agent D Telephone No. PERMITFEE $�— tgna ure of Owner or Agent