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HomeMy WebLinkAboutBuilding Permit #364 - Permits #364 - 75 THISTLE ROAD 4/18/2002 MASSACHUSEM UNWORM APPUCATON FOR PERMrr TO DO GAS FITTING (fype or print) Date NORTH.ANDOVER,MAS'SACHUSETTS Building Locations ' ' - Permit#k � ,✓ Amount$ vy - Owner's Name New Renovation Replacement Flans Submitted a o aZ.. sus-sAssM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR. 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR 1 1 L:� El (Print or type) ,j i �, one: Certificate Installing Company Name .,,, � r " Cor p. Ww Address Partner. Business Telephone t 1� 1 � � FirmlCo. Name of Licensed Plumber or Gas Fitter ' e INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No Ifyou have checked ves,please indicate the type coverage by checking the appropriate box. Liability insurance policy 0Other type of indemnity 13Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General:Laws,and that my signature on this:permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent t hereby certify that all of details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Cod and ghapter 1.42 of the General Laws. L h By: ',"Signature of Licensed Plumber Or Gas Fitter Plumber " 'Title ° L I.... City/Town ® Gas,Fitter LTc—ense N um er Master APPROVED(orricr;USE oNr.v) Journeyman. T2- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date BUildingLocatiqn _, Permit# Amount Owner New Renovation Replacement Plans Submitted Yes No FIXTURES cn Cr cc z ce Cn 4 z z Cn Cn C.) Z el z cr Z. Cn Z z z ;D z I I J PA%A*M In H-cm I'D HfM -4D FL" 41H HfM 51H HJ0M 6111FLOOR 7][HHDM glH IT-(XR (Print or type) Check one: Certificate Installing Company Name Corp. A Address 4 Partner. Business'felephone Firm/Co. Name of Licensed Plumber: F 4 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 1-1 Other type of indemnity 0 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 . tgnafure Owner Agent .1.hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mossa6liusdi StatePlvmbi��Code and Chapter 142 of the General Laws. By: Signature 3T 1-7censea Fiu-M-5—er Type of,flumbing License Title City/Town 1-icense lNumoer Master Journeyman APPROVED(OFFICE USE ONLY ,. antrnrrar r Ueell a o/ /in.l�ac/ru ett_r Permit moo. Oflici a1 tJ scrC)nly �1 �bc7rarinaeraf alirr. _ 7ervicej -.--_ Occupancy and I�ec Checked u OF = - ` (Rev. 1 1/99] (IcaEr.blank) E3C)A1�C) (71- 1`�IF�E- 1'fiCVE.:N�-I(�N I��GIJI_A-I�I(�)N� c � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL CAR All work to be pert'ormcd in aecord.mcc with she Massaclwscus Elccuicol Code(NIEC),527 CNIR 12.00 (PLE11SE PRINT IN INK OR TYPL;:ILL INFORM,1770N) Date: City or I olvit of: C � �}�� �' t To the bispectol-of!" ii- s: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) " "m" _ Owner or Tenant �� �r�"r`� ':� Telephone No �?2 41.?o 2 "-� Owner's Address F � �,.._ ; t Is this permit in conjunction lvith a building permit? Yes ❑ No °'° (Cheep Appropriate Box) Purpose of Building / i rrr""' Utility Authorization No._ q � r, Existing Service Amps -�� / Volts Overhead ❑ Undgrd ❑ No.of t'alctcrs New Service Amps �,L wj 1, 2.�✓�e �'ol(s Overlrcad Und No. of Meters., ,grd Number of Feeders aihd Ampacity .- Location and Nature of Proposed Electrical Wark. gfVll �°_�_ Completion offhe rollairinG table rna be icaiw'ed br tlrc In.)pcctor al-Wires. No.of Recessed Fixtures No.of Odle Susp.(Paddle)pans No.of "fatal Transformers KVA No. of Lighting Outlets No.of I-lot Tubs Generators KVA Above 11t- 0. 0 nirgeticv Lialiting No. of Lighting Fixtures Swirrunina Pool card. ® rnd. ® Batt cry Units No. of Receptacle Outlets (; Na.of Oil Burners FIRE ALAMIS iY'o. of Zones _ Of No.of Switches i No.of Gas Burners No. of Detection and Initiating Devices 'Dotal No.of Ranges ' No.of Air Loud. _ Tans No. of Alerting Devices 1lent1'ump Number "Pons KW -- No. of `elf-Contained No.of Waste Disposers Totals: Detection/Alertin-Devices _ No.of Dishwashers S ace/Aren Heating KAN' Local fvlr�tticipal p g E Connection 0 Other No.oCDryers ,Beating Appliances KNN, Security Systems: No.of Devices or Equivalent No.of Water nor ntof ^1o.of g���r lisle.Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No,li>drotnassage llatlitubs No.oflllalors Total III' i'elecamniunications 'Wiring: a'`lo.of Devices or Equivalent OTIIER: Attach additional detail if desired, or as required by the Inspector of lyires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance ofelectrical 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 ofsame to the permit issuing office. CHECK.ONE: INSURANCE ❑ DOND E] OTHER ❑ (Specify:) General Liability 12/31 /02 ._ (Expiration Date) Estimated Value of Electrical Work: _ (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`!aims and petraltics Ufperjttq',that the information otr this alij;ltcatiort is lute and complete:. Ir1101 NAME: Boissonneault Electric Corp. LIC_NO.:A1 1 823 Licensee: cei ci "a.t'cnr l 0 tlrchcci cc xmberlirec.) Signttur� "" "� µ L1C. (l 1l' p Bus.1'cl.itio.:_( 978 ) 454-0383 Address: 19 Chuck .Drive �� HA f)1 l�7� _ Alt.Tel.No.:� -9-9 7 7 OWNER'S INSUIZANCE 1VA1V):It: I atrl aware t rat the License gees not bare tlac IiabiCity insurance coverage normally required by lawn. B v my siwgnatme below, I hereby waive this rcquiicnrcut. 1 am the (check onc) ]owner ❑owtict's a"cnt Owner/Agent L`R!�T 1LI :Signature -___----_ 1'elepironc Nu. , l,,.arternOnrrerr4./i a�//�ndfur/trc:9e�l.rt)Cticr:rP l�".c Oirl t ( :t a, fy /rt 0-cu aiic and Fe t:,liccc.kc:d F3OAR.F7 OF FIRE-- 1"REVF-1\11-10N REGUI..A11ON :, fl1/f)9y APPLICATION FOR PERMIT TO PERFORM ELECTRICAL VVORk Ali work to be perlormcd in accordance with tlac tvlassachnsclts 1:1-frical Ccxac(iNIEC),52-1 Cw`l`ilt 12.00 (PLCity t o t- -1 jV IN off: ' f L,L INP-OR ,1770/V) D'I I C: ° L�;I,51>'I RItVT lrW llV/4 C77t hY 1 G, _ y ' ' — To 11w lirs7lcctvl-o lYi1 cs. [3y this application the utrctersiw , cs notice c, )is or her intention to perform the electrical work described below. Location (Street & Number) Orvrrer or I"eraarrt Tcicplonc \o r `. .r. Owner's Address Is this permit in conjunctiou with :s building perrrrit? Y c s ULJ','. No F1 (Check Alr}aeofaria e. x rti= � Purpose of Buccdinp Amps"1 / �5j,1 " ,tu, <ttrlily riuthorrz ttiort r a. r' ° isting —� 'olts ON crltcad Undgrd No. of rlfctcrs New Service Amps ���i._ � l rkv Volts Over-lte:ld � Undgrd � �" No. of rlleters- — Number of Feeders avid Ampacit}• " "f Electrical Work:i .. Proposed "m �r e New AI�+"� �""" d W `, !'? �u; nCa'U)][ rt 1 V.1 1JrC (7 'rO a � �r�'"�"�m�a�wuH.-" ';�N��^ _._.�mx.d°� °�-- p '( table pray be waived by the/roe cctor or t i,cs t . C�orr�sletrarr a�dre jo/lorr�arr�tbf o f _ ...... .,...._...�p a_F___..._m_,. No. of'Recessed Fixtures No.of(_eri.-Sus I.rddle" Fans nsformer-s No. of Lighting Outlets No. of Hot`fubs Generators KVA _aAbove In lsr�o. o rrrcrgcricy I tgTrlTti INo of bighting Fixtures Swirrrrurng Pool Ll act. rrrd. Battery L7nits No. of Receptacle Outlets No.of Oil Burners LIRE ALARMS No. of Zones — No. of Sir itcfres No. of Gas Burners 1 lo. of Detection and—Initiatin- Devices Total No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of 11'aste Disposers Ileac ID mile Number Ions KW No. of Self-Contained "totals F?etcctiortlAlertirr Iles tees No. of Dishwashers — �--S racc/Area Heating K`N Local ' 7— I1Irrnici]aC 1 �� Connection C71lter tray of Des roes or L?W o f Dryers Ileatirr Appliances I(W Security Systems No. ' ursalcnt Nu. of 11'a to `e_ cf `?^-of K.��, � ^' Iliata '4WIr"1 Hrg: Heaters Si-ns Ballasts No.of Devices or Lc uivaleut No. Ilvdromassage Batthtubs No.of t�lo(ors Total LIP Telecommunications Wiring: — - i`Io.of I)cviccs or Equivalent ---------- OTHER: Attach additional detail if desired, or as required bi,the Inspector of tires. INSUR.A,NCE COVERAGE: Unless waived by tfac owner, no permit for the performance of electrical wort; may issue unless the licensee provides proof of liability insurance including. "completed operation"coverage or its substantial equivalent_ Tile undersigned certifies that sucl'i coverage is in force,and has exhibited proof of sarue to the permit issuing office. CHECK.ONE: INSURANCE ❑ BOND ❑ O-I`1IER ❑ (Specify) General Liability 1 2/31 /02 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy) Work to `start L _rt ,Inspections to be requested in accordance with MUC Rule 10, and upon completion. I cel1011 acute r lire 1,ins,6141 penalties of perjrrq, that the injoi m a(to it of (Iris al)l)licaliorr is trite arrd co ittplele. FIRIM NAME,E, Boissonneault Electric Corp. 11lC-r`,'0 .:A11 823 ���•nrt."rn llrr Irccr. r � 1�. Sit.,rt,t(rn c i� �r,-� i�°' m. ~ � r"�"�'�".F:FC r`,t).: (/f rt/rlrlr�.a.le. cal v i l arrnrirerrl a 4ddress: 19 Chuck ( 978 ) 454 0383 l tire. O1VIN11"R'S INSURANCh V,'AI E'R: I am aware that the I_iccrr.,c ,, dracs xr:r'have lire habihty insurallcx cm nrrrnullly (cgttircd b k1w, By rrr naturc below, I bcrr } one Owilt r ra, i t q t� cat 'r' y sib r.b •ec:uk'e llus rc.cluir'�nsear6. 1 aiu I}rc (c:Itce� ) t. Orr lie[/:Al;cnl ir.rtnrcIcicpircnrc n '` I-1 1 1 5� li rill ROUGH F 1 PIAI. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER DATE ISSUED: SIGNATURE: Buildin Commissione'r/I tar of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number - _ Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: zoning District Proposed Use 1 of Area sf} Fronta ft 1.6 BUR DING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Re aired Provided 1.7 Water Supply M.G1—C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record f ot Name(Print) Address for Service: Sign atu Telephone D 2.2 Owner of Record: Name Print Address for Service: M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction pervisor: Not Applicable ❑ Iq a ilele in i Licensed Construction Supervisor: mm� License Number �T Address Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 ®. Company Name I s a Registration Number r" Address FAWM Expiration Date Signature Telephone 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 mm in the denial of the issuance of the building permit. Signed atfdavit Attached Yes.......11 No...-...© SECTION 5 Description of Proposed Work(check.all applicable) New Construction Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition 0 Other 0 Specify Brief Description of Proposed Work: s SECTION G-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be QIC , S OI Completed by 2ermit a licant I. Building (a) Building Permit Fee Multiplier ,�-ti f 2 Electrical (b) Estimated Total Cost of CT Construction 3 Plumbin Building Permit fee 18}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 1, ,as Owner/Authorized Agent of subject property Hereby authorize to act oil My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION 1, 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 Print Name Signature of OwnerlA ent Date NO. OF STORIES SIZE BASEMENT OR SLAB c7o.S'e 01 e K SIZE OF FLOOR TIMBERS— 1 I --z' 7l; i 4 2 x J 3PD � SPAN '" DIMENSIONS OF SILLS 6121 -M.' DIMENSIONS OF POSTS , A DIMENSIONS OF GIRDERS / I-MIGHT OF FOUNDATION 9'_fig �a THICKNESS SIZE OF FOOTING 44 f 0 ' X MATERIAL,OF CEB4NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL,GAS LINE d r td I CPgS , ��. --__ '____-E f & ®RTH Town o �� �.: s . 6 ndover _ a, dover, Mass., /—o? -07 00 O .s LAKE COCHICHEWICK 7,9 A004 e o PQ (CO SSACHU�� FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT .....?!5R.nle P.©.`�.....�p .U.��U�tJ ....��.�.. ..................... has permission to excavate and pour foundation at ... ...... ............. L ......2&6,2 .l'c:...1���d for the purpose of............. �.N �..� .,.. /.,�./ ,..... w.."�ll.. ............................................ The person accepting this permit must return to the offiEe of the Building Ins ect6r a certified tot Ian show P P P of building thereon before Foundation will be inspected. /6-d, VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. •........................ ................. BUILDING INSPECTOR NQRTry o" Of Andover O y. No.36 * ,� h �_a3 _o?ooa CO -= L A o dover, Mass., COCHICHE-ICK 4 , 'RATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System _/ BUILDING INSPECTOR THIS CERTIFIES THAT.......... .r /C.. ....C,., N.�S. . rUC7`ia �V i��r`� ............ Foundation has permission to erect..............1...................... buildings on .ql p?,6.. rJS. .�...l./s4/r_ ?DCpd Rough to be occupied as..,8t..PQ Q. 'L�.o�.��..a.�. ./.. ...4�I r`.7% . l...JR.A.�. .....S.l!!� . .... ig, Chimney provided that the person accepting this permit shall in every respect conform to the terms of the ap iication on file in Final this office, and to the provisions of the Codes and By-Laws relating t the Inspection, Alteration and Construction of Buildings in the Town of North Andover. a15/ Ufa( 1p A $f wow PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough Service ............................................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Mall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burnet Street No. Smoke Det. SEE REVERSE SIDE �I Town of North Andover OORTH Building Department V 27 Charles Street 0 North Andover, Massachusetts 01845 4 (978) 688-9545 Fax (978) 688-9542 C US APPLICATION FOR CERTIFICATE OF OCCUPANCY INSPECTION ADDRESS L0TNUMBER_2_6_,,,. __SUBDIVISION....Abbatt �V!Llagle DATE REQUEST FILED June 12, 2003 DATEREADYFORINSPECTTON- June 10, 2003 TEN(10)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MLJSTBE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING C" V' D.P.W. --WATER METER....... DATE, D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO TFj'E-jNSPEC'I'tON REQUEST DATE, Y� S fbNXTURE/,DPW XUTFIORIZA'I ION µORT4 O n A Y y, ,'VSACHU'S CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOViER Building Permit Number Date THIS CERTIFIES THAT THE BUILDING LOCATED ON_ � �5 �• — MAY BE OCCUPIED AS, c� IN ACCORDANCE WITH THE PROVISIONS OF THE NIASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTMCATE ISSUED TO C Building Inspector TAU" t H Town of E , ., Andover TO No.36 - - Co Y LA O T dover, Mass., 3 C bC hlcxewiCH V S BOARD OF HEALTH PERMIT T D Food/Kitchen A/( Septic System d THIS CERTIFIES THAT........,., .f' GU o o .... ' N. .....a v CIa BUILDING INSPECTOR N �c„^ Foundation�- buildin s on has permission to erect....... 1 _ g o. a.6.. r�S i57'���e �Da7 Rough�111411 ,_�_. �/t' . ................ ........... to be occupied as.. ..� .�. .�. .. "�. ./.. 1� t... .�. .....5.� .....•�� ! imney provided that the person accepting this permit shall in every respect conform to the terms of the ap ication on file in this office, and to the provisions of the Codes and By-Laws relating t the Inspection, Alteration and Construction of Buildings in the Town of North Andover. a si 07 q(0 Ap amp PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough O 51' e`r4 anal jCJ- 3 R PERMU EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough /Af 1 ............... ............................ Service BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR j Rough}l'`gr ���✓ Display in a Conspicuous Place on the Premises — Do Not Remove jq1 No Lathing or Dry Wall To Be Done FIR EPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. If3 SEE REVERSE SIDE smoke Det. GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw.The applicant shall provide all of the necessary information/ass requested below. / Permit Applicant Property address r - Map 1 Parcel Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 ofthe Growth Management Bylaw.I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit.Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building permit application and associated attachments,complies with one or more ofthe following sections as indicated by a cheek mark. This is an application for building permit for the enlargement,restoration or reconstruction of a dwelling in existence as ofthe elective date ofthis bylaw,provided that no additional residential unit is created. The lot(s)was/were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land.For purposes of this section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density(buildable lots)below the density permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanists approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date ofthis Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel_ 1 This application represents a lot which is ready for a building permit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST TIE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT IS S F REFU 13Y TI�BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. ,16 7�11� .11 d e� PLICANTS SIGNATURE DATE THIS FORM TO BE ATTACBED TO TBE BUILDING PERMIT APPLICATION ��� �fae �oorrmaarc�ue�z� �.�re6e�4 F BOA[tD QF BUILDING lrl R 4�.E U4TIONS License G TRUCT iSOR Nurnber Y Fb28 Brame w Exok*w. Tr.no: 13328 ResE� 'L: �ltlk. AUIRELE J CORMIER r AID 6&i6R, MA Q'Y€ 0 Aclrrfin Yra ar DATE(MM ODIM ACORf9M CERTIFICATE OF LIABILITY INSURANCE 01/07/2002 PRODUCER (508)6SI-7700 FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Allied American Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE(CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 233 (.lest Central Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA r Joseph Carroll ll INSURERS AFFORDING COVERAGE Jr,]r NSURED Parkwood Construction Corp j ;NSURERA; Assoc Industries Mass Mutual 2 Evergreen Road ;INSURER B: Andover, MA 01810 INSURER C: ENSURER D: INSURER E; ���� :OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 4SR POLICY EFFECTIVE POLICY EX E TI N TA TYPE OF INSURANCE POLICY NUMBER DATE MM bDYYY DATE MM! D LIM?TS GENERAL LIABILITY I EACH OCCURRENCE $ COMMERCIAL.GENERAL LIABILITY I FIRE DAMAGE(Anyone fire) S. CLAIMS MADE OCCUR I MEA EXP(Any one parson) $ PERSONAL&ADV INJURY 3 GENERAL AGGREGATE $ GEN'L AGGREQATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY jR O- LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accldant) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Par parson) $ HIRED AUTOS BODILY INJURY NON,OWNED AUTOS (Peraceident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S ANY AUTO EA ACC $ OTHER THAN AUTO ONLY; AGG $ t$CSCI IABILITY EACH OCCURRENCEUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE S RETENTION $ $ WORKERS COMPENSATION AND AWC7007785012001 10/30/2001 10/30/2002 1 TORY LItmlr%T ER EMPLOYERS'LIABILITY A E.L.EACH ACC€RENT $ 100,000 E.L.DISEASE.EA EMPLOYEE S 100,000 E.L.DISEASE•POLICY LIMIT $ 500,000 OTHER )ESCRIPTION OF OPERAVONSILOCATIONSIVEHICLESIFXCLUSIONS ADDED BY ENDORSEMEWNSPFOAL PROVISIONS ;ERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town Of North Andover BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Building Department OF Aff KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTH D REPRES. ATIV kCORD 25-S{7197) OACM CORPORATION 1988