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Date....�..F.`. v.—�.... ?;•`'° TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... A....................................................... C0 F're- A v'k T U it S ................................ has permission to perform ....... f "'' S'E' h L < < �` T........ .................................................. wiring in the building of —x a c h 'P /'1. C ................................................................................... l at .............Pf 0c..... I'rI.....Z1.. `.... , North Andover, Mass. e (0.14... Fee ......�r..�..... � ��'�......J. U.......... ELECTRICAL INSPECTOR Check # /-/ L -z- 4 S 1 4 L r 4S14Lr 717�5 I:Zil_1:7�ZU�3{:7� !n7ms z-vw 6� i?%&ss Dcp&a�t.,vurt o� uElra Sam 'REVENT& REGULATIONS 527 CMR 12:00 APPLICATION FOR All work to be performed in (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit toperform the electrical work Location (Street & Number Z 6r 'JO, V Owner or T, Owner's Is this permit in conjunction with a building per/mit r Yes 0 Purpose of Building 0fl, I !%)7 ng111k MZ Permit No. i Occupant &e'e Che( T TO PERFORM ELECTRICAL WORK with the Massachusetts Electrical Code 527 CM 12: 0 Date To the lnspec r Wires: Existing Service Amps Voits New Service (Jy Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work A llzno' Check Appropriate Box) Utility Authorization No. 0/a jNo. / 9 Undgmd 6/,_ of Met( Overhead 0 Overhead 0 Undgmd 0 No. of Met( OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO - hav lid proof of same to the Office YES = NO - N you v c Y indicate the of by checking the appropriate box. (!:n - ND - OTHER - (Please Spec (Ex irab Date) aloe of Eledriral Work$ Work to Start Ins io�ate esquested Rough Final Signed under the Penalties of perj FIRM NAME / / - / : LIC. NO. 3S� Licensee 14' 4r, / / �YWdI 0/i� Signature LIC. NO_ / %� d us el No. Address / S1Jn.J�� % /jf/'Gl / Alt Tel. No. OWNER'S I� CEWAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Total No. crfUghtin2 Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices _ Heat Total Total No. of Diposal No. PUMPS Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers SpacelArea Heating KW Detection/Sounding Devices _ 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO - hav lid proof of same to the Office YES = NO - N you v c Y indicate the of by checking the appropriate box. (!:n - ND - OTHER - (Please Spec (Ex irab Date) aloe of Eledriral Work$ Work to Start Ins io�ate esquested Rough Final Signed under the Penalties of perj FIRM NAME / / - / : LIC. NO. 3S� Licensee 14' 4r, / / �YWdI 0/i� Signature LIC. NO_ / %� d us el No. Address / S1Jn.J�� % /jf/'Gl / Alt Tel. No. OWNER'S I� CEWAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) y t NORTH 1 TOWN OF NORTH ANDOVER m ' PERMIT FOR WIRING This certifies that ... /0.M.m...O.................�.- ........................... .. . .. .. has permission to perform ... . �. '`..� S r r u i -A , 10 r— .......... ....................................... wiring in the building of ... TR, i �-: �!' w`..... North Andover, Mass. L = Fee o........1.../'!. e— ELECTRICAL IN4ECPOR r � Check # 46n 10 Official Use Only Permit No. fan a�zrr� � 61�7 NUS.5464M.55775 Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 0^ S> To the Inspect of fres: Town of North Andover {], The undersigned applies for a permit to perform the electrical work described below. �' S Pq t?/C_ Location (Street & Number. '-1 Owner or Tenant QeAal �r� j �X:- /� J Owner's Address as J t.3 S rh K� 6, Prs Q t Is this permit in conjunctionwithwith a building permit Yes f/ No [3 (Check Appropriate Box) Purpose of Building o) Q $ �c�1�p tom— Utility Authorization No. 16-91-1 Existing Service Amps New Service nn Amps_aQ0-_V1ts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Voits Overhead ❑ Undgmd ❑ )"4,1 Cf () Overhead ($ Undgmd ❑ No. of Meters No. of Meters Y INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of 1 trical Work$ 100, V d Work to Start 1 Inspection Date Resquested Rough Final FGb/ / ^� Signed rthe P F LIC. NO. o FIRM NAME �Mflt 1A ^Q G� m is ! I 15 O CA\ NO. But. Tel No. / / 10 G►, Address Aft Tel. No. % U 3 M. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) AO Telephone No. PERMITfEE (Signature of Owner or Agent) 1. MA Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grad ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pum Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Widng oto. Hydro Massage Tuds No. of Motors Total HP Y INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of 1 trical Work$ 100, V d Work to Start 1 Inspection Date Resquested Rough Final FGb/ / ^� Signed rthe P F LIC. NO. o FIRM NAME �Mflt 1A ^Q G� m is ! I 15 O CA\ NO. But. Tel No. / / 10 G►, Address Aft Tel. No. % U 3 M. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) AO Telephone No. PERMITfEE (Signature of Owner or Agent) 1. MA The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Afdavit Name Please Print Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance. Co. Policy # Company name: Address City Phone # Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL_ 152 can lead to the impositim of criminal penalties of.a fine up to $1,500:00 and/or one years' impnsorxnernas well_as_evil_oenafties-o2heScxrojofaBTOPYAORK9RDFRand alinL—W_($I-OD.W)-ajd y me; r understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I db hereby certify under the pains and penalties of perjury bW the information provided above is true avid correct Signature Date k, Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town PemitlLicensin4 El Building Dept []Check if immediate response is reguired licensing Board E] Selectman's Office Contact person: Phone # E] Health Department D Other Location C.^H c31 u u l 5`f � !fit' lq ST�"f -E�'j— No. Tt�tt�e�' Date '�� TOWN OF NORTH ANDOVER a •. Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Uca ,Other Permit Fee us $ Uo TOTAL $ Check # 1 O 6 S s654� Building Inspector G O =r � O (D (D (n T� m U O 0 (D n =t 0 ° m r1 ° O .. U) cn.ICJ 0_ -' n 3 m (D m N a o ° a = `c o -- cn (n O cn-� = S (D (D .. S p � T O � S � > CL ^► O< _S O cn ,. n O z (D < CL. (D Q 3 0 S (D -a (D o 0 cD ° -0 1 (D � N CD c� w _ CL � S � v r = d W 5 • 11 v v m �1 CD CL -�. 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TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.. - ' ' �- ............................................................................................. has permission to perform ........::....h ,.. �� .. ,.............................. w �.4 wiring in the building of -,I� ................................................................................... at ..:.....:.:.: . ....... ................................................. , North Andover, Mass. Fee-�J ...... �.... Lic. No: `5. �. ........: ................................................. \�ELECTRICAL INSPECTOR Check # i, 6 5 ,a THE COMMOAT H EALTH OF MASSACHUSETTS DEPARTME TOFPUBLICSAFETY BOAROOFFLREPREVEMONREGULA77ONS527CMR12:00 Office Use only Permit No. % 61s—e ' Occupancy &Fees Checked s6a APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR I2:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date U 3 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. rf Location (Street & Number) ( ,\1 D grtS t r - Owner or Tenant Owner's Address XM Is this permit in conjunction with a building permit: Yes [M -No M (Check Appropriate Box) 1-00— —AD y a 60 Purpose of Building (,(Y,- Utility Authorization No. _ Existing Service Amps Volts OverheadUnderground M No. of Meters New Service too Amps 6 0W.)Volts Overhead 61underground r-1 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ED round No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. 4f Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total _ Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP PEP t'YYJA I IN I I Re." / hmra=Covaage. Rnak"tothe tegtriterffitsofM%sacimsetlsGmialLaws Ihav:,IaamertLiabild kmrmioePbhcymchdWConplete Covaageorilsmbsrantialeguivalert YES E3 NO Ihawstb m 2dvalidproofofsametDdrO m YES j F)w drdcedYES, pleaseindue&typeofoomnWby drekigibe x IBJ INSURANCE BOND 011118 (Pi eSpec�y) EViratimnic WO>ictoSta<t kWectimDateReWested1 EsftnwdvahrofEktcalWOik$ FMA SigiedmCLA;--pumitiesc,FIRMNAMEply: LicroseNo. 3 �% Lion �"1 t (iYtl� �,1 �►k u�M`�b \�t Slgnahne LioerneNo Busine Tel. No. 919 6 �oZ 9 i S,Poco V ` A1tTel No. 4 i `/a 3 > 6 3 ,r OWNER'S INSURANCE WAAU2 Iamawarethat the Licmdoes nothautedie iralranoecovetagecritssubstantialequivalirtasmquiredbyMassachusetts GeralLaws and that my signature on this pent application waivt?s this mgtmeaiui (Please check one) Owner M Agent M Telephone No. PERMIT FEE $ V ✓ Signature ot Uwner or gen Date... ... . .......... �aORTF� `° :•,"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSAtMUs� This certifies that.....:...... ........'Y............... :` :............. ................ . , has permission to perform .............................. r....`Y,.,\ ..1.................................... wiring in the building of ........ ` ..::.:........................................... at ................................ ! ti' .. `............................ , North Andover, Mass. Fee .fes............ Lic.No:..'"Z.S: . ............... /.:...................................... ELEcmcAL INSPECTOR Check # ' O 1. 6 5Y d THE COMMOA W EALTH OF MASSACHUSETTS DEPA RTAH A T OF PUBLIC S 4 FETY BOARDOFFMEPREVEMONREGULAHONS 527 CAR 12 00 Office Use only �7 Permit No. �41 ^ / Occupancy & Fees Checked APPLICA71ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 e -© (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date91 Town of North Andover Ta the Inspector of Wires: The undersigned applies for a permit to perform the electric - work described below. Location (Street & Number) �� � I 1 S l t' Owner or Tenant Owner's Address ? -� \ 4:::�t 4�1t1.ls —1rT . f11\ c r Nt, L-� Is this permit in conjunction with a building permit: Yes !` –No (Check Appropriate Box) j/a�� Purpose of Building Utility Authorization No. O Existing Service _ Amps Volts Overhead M Underground No. of Meters New Service /60— Amps Q/ Y&olts OverheadUnderground No. of Meters 'T Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above BelowGenerators KVA • round 1:1round 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 Connections � No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP InS1==CovenW- Rus>2rlttDtIEM4�ofIvlassadiLettsG= alIaws IhawaamemLiabilitykmr, =Fbhcyn kikgComp Cowaageoritssubstantialequivaleis IhaveskhniWdvMproofofsame(odrOdM YES j-N�� if 30 g 1I��JJ INSURANCE/ r --J OWER ftascSpa*)� I YES M NO M YES, please irldicatBthe type of oovarageby EstinWdValneof&cbc alWolk $ Fugal Lkmsee r'7/(efgl4 / / I H ✓nM 0 SignalumLioenscNo Tel No. C� S' / (Qi`Pitt Alt Tel.No. L% 3 OWNER'S INSURANCE WAIVER; lam aware that the liomse does not have the matrance oDmnge or its abslamal equvalalt as mquited by Massadmselts GmxA Laws aril that my signattue on this pemt apphcaahon waims this requ*mTo tt (Please check one) Owner Agent Telephone No. PERMIT FEE $ Signature ot Uwner or Agent Location _ L—a2r No. Date �aRTM TOWN OF NORTH ANDOVER s Certificate of Occupancy $ Building/Frame Permit Fee $ +cMus Foundation Permit Fee $ Other Permit Feei Rr►� ��n- $ IS« S�� TOTAL $ 1 Check # tir,arH me. 16550 Building Inspeefor NORTH POINT REALTY DEVELOPMENT, INC. Town of North Andover Permitting Expense 7/21/2003 •I • 150.00 i Cash BankNorth 1535 Trailer Permit -Peach Tree Farm 150.00 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ZEE— BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: c blit Building Commissioner/1 for of Buildings D to SECTION 1- SITE INFORMATION 1.1 Property Address: �Gc�r,�reu �acr� iCh�stY,t,fi Sfii 1.2 Assessors Map and Parcel Number: (ger -b `' L�e����-�� Svbdi SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... )k No ....... 0 SECTION 5 Description of Pro osed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition 0 Other Specify r -i , Brief Description of Proposed Work: 1 D a�2 S �fG r Lk r ` I X 1 d r� fen6tr, Win SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) ✓ 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, Q� -R A— 3r .(A as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Pr' i attue of Owner/A Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS f]EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE AFFIDAVIT I, SCOTT L. MASSE, attorney for KENNETH W. REA do hereby depose and state: 1. i represent Kenneth W. Rea, owner of a certain parcel of land located on Rea Street, North Andover, MA and more specifically described in a plan of land recorded with the Essex North Registry of Deeds as instrument/plan number 14502. 2. 1 am duly authorized by Kenneth W. Rea to act on his behalf regarding furtherance of the above stated instrument/plan. 3. Authorization is hereby given that Gerry -Lynn Darcy, and/or Peach Tree Development LLC be allowed to act as the agent for Kenneth W. Rea regarding any and all matters relative to a certain Building permit(s) issued by the Town of North Andover for any lots affiliated with the above stated plan. Signed under the pains and penalties of perjury this day of J e 20p3. S TT L. MASSE Z'd olipa-269-BLG sslauJo-4-zd djo:eo co 91 unr 06/16/2003 14:59 19783276517 WILLOWS PAGE 02 NOTICE OF ASSIGNMENT EMPLOYER! PEACHTREE DEVELOPMENT LLC 231 SUTTON ST SUITE 2E -F NORTH ANDOVER, M.A. 01845 The Waiver of Our Right to Recover from Others Endorsement is available on Pool policies. Contact your agent for details. AGENT WILLOWS INS AGCY INC OR 522 CHICKERING RD PRODUCER: N ANDOVER, MA 01845 AGENCY FEIN. 223 856664 CLASSIFICATION OF C COMBO I.D. STATUS OF EMPk OYER 000139954 Limited Liability Cozzi COVERAGE GROUP 0139954 Coverage under this assignment applies to Massachusetts operations only. For Coverage outside of Massachusetts, contact the appropriate Pool or Plan for that state. INSURANCE COMPANY: TRAVELERS INDEMNITY CO MS JACKIE DENNIS P 0 BOX 3556 ORLANDO, FL 32802 (800) 443-4404 CLASS ESTIMATED RATE �- FSTIMATED CODE TOTAL ANNUAL PREMIUM REMUNERATION --------------------------------------- RPENTRY-DETACHED PRIVATE RESIDENCES $645 $0 10.62 $0 APENTRY-DWELLINGS-3 STORIES OR LESS 5651 $0 10.62 $0 EMPLOYERS LIABILITY 100/100/500 9845 LOSS CONSTANT 0032 $50 STANDARD PREMIUM $50 EXPENSE CONSTANT 0900 $122 TERRORISM CHARGE 9740 $0 RISK MINIMUM PREMIUM 0990 $500 ESTIMATED ANNUAL PREMIUM $500 DTA ASSESS. 4.5% OF STANDARD PREM. $17 EST. ANNUAL PREM. PLUS ASSESSMENT $517 INSTALMENT BASIS: Annual REQUIRED DEPOSIT PREMIUM $517 COMMENTS Coverage effective 12:01 AM on 05/23/03 DATE OF NOTICE: 05 /24/03 PREPARED BY: Joanne Shea EXT 530 * * SERVICING CARRIER ASSIGME<ENT * * LETTER ID: 419982 COPY; AGENCY The Workers' Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street • Boston, MA 02110 (617)439-9030 • FAX (617)439-6055 - www.wcribma.org Cl) m m C/) 0 m I Ul . c y C � � d CO)CD C7 n Z CA CD O = r FMM' C CL = y O 0 CD CD o CL cr M CD CCD O CCD C. CD y. 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