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Town of North Andover
Page 1 of 1
Town of North Andover, Massachusetts
,�....;. Municipal Information Mapping Access Program (hr91MAP)
❑ Base Map Zoning 2008 Aerials Watershed Zone Utilities ❑ Saeo0❑ selection F Legend location Markup
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Lawmace
Owner Address --- a
89 BELMONT STREET REALTY TRUST 1 105 BELMONT STREET'
1 selected To,.Mailing Labels To Spreadsheet
eerty -11 Building Permits 11 Planning 11 Septic Puffji
E Print 3'�
F
Ownerl 89 BELMONT STREET REALTY TRUST
Owner2 DEAN CHONGRIS, TR
- ,}-
ry
Address 105 BELMONT STREET
u
Map/Lot 008.0-0003-0000.0
li..
Lot Size 16117.2 sq. ft.
"
>cal Year 2010
and Use 316
!
Code§
ast Sale 04/21/1999
k
Date
ok/Page 5406
izc'
Total $116700
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http://maps.mvpc.org/NorthAndovermimapNiewer.aspx 9/16/2011
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1600 Osgood Street
North Andover
Tel: 978-695-9'545 -
Fax: 978-688•-9542
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TYPE t3��USINES�. i aU,v�y
EUMDI NGLAYOUT PROVIDED S • NO
ZONINGBY LA's' UNAGF-: S
INSPECTOR MN.A.TUFM
BUST[ LESS FORM FORTOWN CLERK
2.40 Rome Occupation (198913.2)
An accessory use conducted withb a dwelling by a xeszden wha resides iu the dwelling as his principal
address, which is clearly secmdbxy lo the use, of the building £or lilnng pluposes. Home occupations shall
'I clu'do,'btat ni otIfinited to the following uses; personal services such as funuished by an attid or instructor,
b6 not occupation involved with motor vehicle repairs, beauty parlors, animal kernels, or the conduct of
mail business, or thenmufaot"g of goods, which impacts the residential mturo ofthe neighborhood;
4_ For use of a dwelling is any residential district or multi--family district for a home occupation, the
following conditions shall apply.
a. Not more Chao. a :total of three (3) ppaple gyp tae employed ft Dome occupation, oma of
R1
whom shall bathe-owner oftlie.home cici upatim and resrdv g tit azd'd Telling;
b. Tho use is carried on Wctljr withinthe principal building;
c. Thew shall be no o tenor alterations, accessory buildings, or display which are not customtaW
with xesidential buildin s-
g
d. Not more thayx twentsr five (25) percemt of the existing gross floor area of fho dweliirug ITit .
so used, not to exceed ono thousand (1000) square feet; is devoted to 'such use. fn
connectionwith
such use, there is to be kept- no story in trade, corimodities or products which oceuplr spare
beyond these Wts;
e. 'There will be no display ofgo6& or waxes-Osible from the street;
f The building or premises occupied shall not be rendered objectionable or dettimmW to the
residential character of the neighborhood due to the eatenor appearance, emission of odor,
gas, smoke, dust, noise, disturbance, or in any o'zher way becoma objectionable or
deftfin ntalto auymsideatial use. witbinthe neighborhood;
g. :Any such building shall include no features of design_ not cusfi. Wary in bulfts for residem+al-
�se.
li , ( f. `\ n 4,
Bate
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North Andover MIMAP
April 25, 2016
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MVPC Be Zoning Overlay Zoning
Adult Entertainment Distric 0 Busine s 1 District
Municipal Boundary E) Machine Shop Village Ove Q Busine s 2 District
-
Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83,
--- Rail Line 0 Watershed Protection Dist Ib Busine s 3 District
Interstates 0Historic Mill Area IA: Busine s 4 District
�d Medical Marijuana 'Q Genera:Business District ���
Meters Data Sources: The data for this map was produced by Merrimack
Valley Planning Commission (MVPC) using data provided by the Town of
North Andover. Additional data provided by the Executive Office of
_ I
— SR Q1 Downtown Overlay District d PlanneCommercial Dev 4
Environmental Affairs/MassG15. The information depicted on this map is
0 Historic District 0 Comido Development Dist
- Roads 0 Osgood Smart Growth (40 C, Comido Development Dist
for planning purposes only. It may not be adequate for legal boundary
definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER
Ci Easements a Hydrographic Features
� Comido Development Dist ¢'
'
MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
Parcels
Indus I 1 District - �y
THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY
– Streams
Z' Wetlands
Indus[ri 12 District - _
1i 4
Indus[n 13 District a>t; �` r
N InclZri it S District
OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
IV Exempt Lands
Reside ce 1 District
THIS INFORMATION
C Reside ce 2 Disrict
& Reside ce 3 District
4 District
1 " = 57 ft
de ce
de ce 5 District
de ce 6 District
age esidential District
North Andover MIMAP April 25, 2016
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Interstates Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83,
I Meters Data Souris: The data for this map %vas produced by Menimack
SR - Valley Planning Commission (MVPC) using data provided by the Town of
RoadsNorth Andover. Additional data provided by the Executive Once of
i Easements - �� Environmental AHairs/MassGIS. The information depicted on this map is
for planning purposes only. It may not be adequate for legal boundary
❑
Parcels for
or regulatory interpretation. THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY
y► OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
9 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
�'• �'r ,�.' THIS INFORMATION
s
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North Andover MIMAP April 25, 2016
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MVPC Be
Interstates Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83,
I Meters Data Souris: The data for this map %vas produced by Menimack
SR - Valley Planning Commission (MVPC) using data provided by the Town of
RoadsNorth Andover. Additional data provided by the Executive Once of
i Easements - �� Environmental AHairs/MassGIS. The information depicted on this map is
for planning purposes only. It may not be adequate for legal boundary
❑
Parcels for
or regulatory interpretation. THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY
y► OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
9 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
�'• �'r ,�.' THIS INFORMATION
Date. ........
TOWN OF NORTH ANDOVER
p P
•-,� PERMIT FOR GAS INSTALLATION
• �a
r
�9SSACMUSEtS
This certifies that ..�F,!�,' ...... /
has permission for gas installation A;,!, -
...,
a
in the buildings of .. / <a�.��p..h... gell..C.4...
at ... ' BR. Ir?Q+? A. .. (,'h{f , /North�f Andover, J�Mass.
Fee. 3Z.'S LIC. No../..�.?
GAS INSPECTOR
Check #
7920
-CN- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: MA. Date: Permit#
��''CC,,z,�7" UN �z-
Building LocItiord:4,,E� � k'�Lii� , Owners Name:
Type of Occupancy: Commercialo Educational ❑ Industrial ❑ Institutional ❑ Residential ❑
New: ❑ Alteration: ❑ Renovation: ❑ Replacement:,2" Plans Submitted: Yes ❑ No p'
FIXTURES
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SUB BSMT.
BASEMENT
1 FLOOR
3"" FLOOR
4FLOOR
5 FLOOR
6 —FLOOR
7 FLOOR
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Installing Company Name: L.SUA:.( "' H-0avill,
I A
Address (� �ts{ S/ City/Town:
Business Tell�b''�� f
Name of Licensed Plumber/G
Check One Only Certificate #
❑ Corporation
❑ Partnership
irm/Company
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
Massach General La,", and that my signature on this permit application waives this requirement.
Che k'One Only
5iqnature f Ow r nr nwnar�s Ano„+
Owner [ Agent El
oy cnecK g tnis box U; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and
accurate to the best of my Knowledge and that all pt
nd installations pe med u der the permit issued for this application will be in
complia ce with all Pertinent pro v' lon�of the MassPlumbing Co and ha r 142 f the General Laws.
By Type of❑PlumTitle 23 // ❑Gas ❑ Mastign of Licensed Plumber/Gas Fitter
citylrown ❑Journicense Number:APPROVED (OFFICE USE ONLY) ❑ LP In
The Commonwealth ofMassachusetts
Department oflndustrialAccidents
Office of Investigations
600 Washington Street
Boston, MA 02111
UV. www.massgov/Zia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
lnliranf T„fnrtn�4:.,�,
Name (Business/Organization/lndividual):L� � �1� ' P - v
Address:
City/State/Zip: Avz�rJL7_// AV Phone #: 911v'�-sem
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 proprietor or
have hired the sub -contractors
listed
partner-
on the attached sheet. #
ship and have no employees
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.] t
employees. [No workers'
comp, insurance required ]
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
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
7 Homeowners 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.
lam 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 ofMGL c. 152 can lead to the imposition of criminal penalties of a
fine 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 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.
['do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. _
>i nature:
Date:
vffacaac use only. Do not write in this area, to be completen'by city or town official.
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electric
6. Other al Inspector S. Plumbing Inspector
Contact Person: Phone
Information
i�l'A r cs�
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 apartinents 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 ofpublic 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 -contractors) name(s), address(es) andphone 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. AIso 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 Iicense 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 permit/license number which will be used 2s a reference number. In addition, an applicant
that must submit multiple permit/liceuse applications in any given year, need only submit one affidavit indicating current
Policy information (ifnecessary) 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. Anew affidavit must be filled out each
year. Where a home owner 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 Com-noi wealth ofMassachusetts
Depart ent of Industrial Accidents ;
Office of ]Investigations
600 Washington Street
Boston, MA 0211 X
Tel. # 617-727,4900 ext 4406 ox 1-877-MASSAFE
Revised 5-26-05 Fax # 617.727-,7749
ww.wass.l;ou/dia
Date. w1v /// ..........
TOWN OF NORTH ANDOVER
PERW FOR GAS INSTALLATION
This certifies that .................
has permission for gas installation ...
in the buildings of . zo.e Sle.h . Pei � .................
at ..9/ . &.1 U0, North Andover, Mass.
Fee.3Z:4�'?. Lic. No.X?4.�2
GAS INSPECTOR
Check # -
1"5-Z5
7919
I
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: A k) MA. Date:
Permit#
Building Locution ] ;' 0-.6 Owners Name: �L�fr �► � � �t _'_
Type of Occupancy: Commercial,�eEducational ❑ Industrial ❑ Institutional ❑ Residential ❑
New: ❑ Alteration: ❑ Renovation: ❑ Replacement% Plans Submitted: Yes ❑ No ❑
111
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SUB BSMT.
BASEMENT
1 FLOOR
3:°
5'" FLOOR
6 1H FLOOR
7 FLOOR
8 FLOOR
Installing Company Name:
AddressZiy� ��a ( City/Town: State:
Business Tel: y2L,516 -�� Fax:
e of Licensed Plumber/Gas Fitte;-IAy 'kA W 4L,&, n
Check One Only Certificate #
❑ Corporation
❑ Partnership
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yeo ❑
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 WAIVEA
m aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Mas husetts General Laws, and that my signature on this permit application waives this requirement.
• Che ne Only
-Signa re o Owner or Owner's A e t oV4Owner Agent El
Sy c cking this box ❑; I hereby certify that all of the details and information l have submitted (or entered) regarding this application are true and
accurate to the best of my Knowledge and that all plumbing work and installations, erformed under the permit issued for this application will be In
compliance with all Pertinent provision of the Massachusetts State Plug Coda n Cha ter 142 of,)he General Laws.
Type of License:
By [I Plumber
Title ❑ G s Fitter nature of Licensed Plumber/Gas Fitter.
aster.
City/Town E]Journeyman
APPROVED (OFFICE USE ONLY) ❑ LP Installer License Number:
The Commonwealth ofMassachusetts
Department ofIndustrial Accidents
Office oflnvestigations
600 Washington Street
Boston, MA. 02111
'Y www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Mlicanf Ynfnrma+in„
Name (Business/organization/Individual): I^
S7 -
City/State/Zip:
A`L� Phone
Are ou an employer? Check the appropriate box:
1I am a employer with
4. '
❑ I am a general contractor and I
employees (full and/or part-time).*
2.E11 am a sole proprietor or
have hired the sub -contractors
listed
partner-
on the attached shget t
ship and have no employees
These sub -contractors have
working for mein any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
3. ❑ I am a homeowner doing all
.officers have exercised their
work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp, insurance re uired ]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
S. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12.❑ Roofrepairs
q 13.0 Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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
information. employees. Below is the policy and jab site
Insurance Company Name:
Policy # or Self -ins. Lie. #:
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 cinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civilpenalties 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.
[do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct.
5i nature:
Date:
uJJrcrac use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk
6. Other
4. Electrical Inspector 5. Plumbing Inspector
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, orA 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 j oint 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 -contractors) 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 imur'ance 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 permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/liceilse applications in'any given year, need only submit one affidavit indicating current
policy information (ifnecessary) 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. Anew afidavit must be filled out each
year. Where a home owner 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 GonuuormeaM of l rassaeatlsetts
pepartmont of Industrial Accidents
Office- of Investigations
600 Washington Sime[
Boston; 1A 02111
Tol. # 617.727-4900 ext 406 ox 1-s77,MA.SSA.FE
Revised 5-26-05 Fax # 617,727-7749
www.ruass.gov/dia
O` NORTH 1H
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number
THE BUILDING LOCATED ON
THIS CERTIFIES THAT
Date 7- 9 doo o-2
MAY BE OCCUPIED AS e-
IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO 8 ���mUti� S,4
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TOWN OF NORTH ANDOVER
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Certificate of Occupancy $
Building/Frame Permit Fee $ C. r
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Foundation""'Permit Fee $
Other Permit Fee $
TOTAL $ 24' 0,
Check # 1?
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TOWN OF NORTH ANDOVER BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
.iM "'��✓y`')n'Y 4R 'Y '1dX".ti i '^�%' by • ., %x '�13 Section for Official Use Onl �..�'�' �a��y4 .S �`iE L ��yh. �r.'1"' � � E✓1S `Sh'1�.+`�) �' {� _7.y'
BUILDING PERMIT NUMBER: Qr DATE ISSUED:
SIGNATURE:
Building Commissioller/ or of Buildings Date
1.1 Property Address:
1.2 Assessors Map and Parcel Number.
g o3.
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
k -
Zoning District Proposed Use
Lot Area Frontage ft
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard Rear Yard
Required . Provide Required
Provided ReWred
Provided
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑
2.1 Owner of Record
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Name (Print) Address for Service:
Signature Telephone
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3.1 Licensed Construction Supervisor
Not Applicable ❑
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Address
License Number
Licensed on
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Expiration Date
Signature Telephone Y .
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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as Owner/Authorized
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Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury 1
Print
Signature of Owner/Agent Date
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Item
Estimated Cost (Dollars) to be
1b
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permit
1. Building
(a) Building Permit Fee
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2 Electrical
(b) Estimated Total Cost of
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Building Permit fee (a) x (n)
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Check Number
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NO. OF STORIES . , - ' SIZE
BASEMENT OR SLAB g C4j
SIZE OF FLOOR TIIVMERS 1 Sr 2 No 3RD
SPAN
DEMENSIONS OF SILLS,
DEMENSIONS OF POSTS.
DEVIENSIONS OF GIRDERS--.
HEIGHT OF FOUNDATION ► .THICKNESS
SIZE OF FOOTING ?� p a r X 1,-Z •l
MATERIAL OF CHRvINEY
IS BUILDING ON SOLID OR FILLED LAND S CA
IS BUILDING CONNECTED TO NATURAL GAS LINE
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a. -a
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New Construction ❑
Existing Building j,4.
Repair(s)
Alterations(s). ❑
Addition ; ❑
Accessory Bldg. ❑
Demolition ❑
Other
❑ Specify
Brief Description of Proposed Work: rr
�,4! �'^� �} C�•Q ( dt�0�"Ir �
{cam
❑
❑
B Business
A
I
BUILDING AREA EXISTING if applicable) PROPOSED
Number of Floors or Stories Include `
Basement levels
Floor Area per Floors , 'i ?Gv S . , 3?0o
Total Areas 3"7CX� S , 7700. S ,•
Total Height ft t
independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑
SECTION 10a Owner Authorization - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property
Hereby authorize
My behalf, in all matters relative two work authorized by this building permit application
Signature of Owner Date
act on
USE GROUP Check as applicable)
CONSTRUCTION
TYPE
A Assembly
❑ A-1 ❑
A4 ❑
A-2
A-5
❑ A-3
❑
❑
IA
IB
❑
❑
B Business
A
I
2A
213
2C
❑
❑
❑
C Educational ❑
F Factory �' ❑ F-1 ❑ F-2 ❑
H High Hazard
D.
3A
3B
❑
❑
IInstitutional-• ❑ I-1 ❑ 1-2 ❑ I-3 ❑
M Mercantile
❑
4
❑
R residential
❑ R-1 ❑
R-2
❑ R-3
❑
5A
5B
❑
❑
S Storage A S-1 ❑ S-2 ❑
U Utility
M Mixed Use
S Special Use
❑
❑
❑
Specify:
Specify:
Specify:
COMPLETE THIS
SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE
Existing Use Group: S��„ ��i""'—
Existing Hazard Index 780 CMR 34:
Proposed Use Group: '
Proposed Hazard Index 780 CMR 34:
BUILDING AREA EXISTING if applicable) PROPOSED
Number of Floors or Stories Include `
Basement levels
Floor Area per Floors , 'i ?Gv S . , 3?0o
Total Areas 3"7CX� S , 7700. S ,•
Total Height ft t
independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑
SECTION 10a Owner Authorization - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property
Hereby authorize
My behalf, in all matters relative two work authorized by this building permit application
Signature of Owner Date
act on
Wc;rkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial ofthe
issLnce of the building permit.
/~.
~
Telephone
Not Applicable 0
Coffirny Name:
Resl?6'nsible in Charge of Construction
Area of Responsibility
Registration Number
Expiration Date
"signature Total
Not applicable 0
Registration Number.
Address
Expiration Date
Sign Telephone
Registration Number
I�xpiration Date i
Addiess
Signature Telephone
Area of Resp,6usibility
Nani&
Registration Number
Expiration Date
Addiess
Sign�ture Telephone
Not Applicable 0
Coffirny Name:
Resl?6'nsible in Charge of Construction
� ✓`te Ur artv�rtarttueallz o`�,lCud�ez/ r
tuue!!J
OEPARTNENT Of PUBLIC SAFETY
CONSTRUCTION SUPERVI OR LICENSE
Number: to rrsc >;irctda
a
R8yr T rod T i ytl
i
klt (Hf10ER O' MM17,OR
I r 01*"o' 60Y. 41-
'. N ANOOVtR, NA Bia45
t
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5 r-0
Res'Lr icre T�:
0O - pr. w. of anclOSC(i sp8a
1R -.Ha cnry only
Family Homes i
Failure to �nssesS a Curren...edition of •:'i,e
Massachusetts State Buildiiiq ;4e'e
i
j: i_S c.T!!se `or rn ocatiP'I of this lit" €,
;� i
Sep -30-99 10:17A North Andover Com: Dev. 508 588 9542
FORM U LOT' RELEASE FORM
iySTRUCTIONS: TN's form is used to verify that all necessary approvaislpermits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant andicr iandowner from compliance with any appiicabie or requirements.
"*** "*" **"***-"**-**APPL!CANT FILLS OUT THIS SECTEO�I*trxxx**
APPLICANT �C=\MC�1� • ( PHCNE
LOCATION: Assessor's :Map Number PARCEL 3
SUBDIVISION LOT (S)
STREET N kM0r\)r ST. NUMEE?:? �q
""OFFICIAL USE ONLY"**"`*******�***�
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED l7 r4
DATE REJECTED
COMMENTS col I ✓L 160, y Q .
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FCOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUELIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEF.ARTNIENT
RECEIVED eY EUiLCI?,JG iNSPEC,TO
Revi:cd 9k97 ;m
DATE
P-01
Dec -01-99 04:46P A&K FOWLER INS. AGENCY 9718 664 2209 P.01
PRODUCER
- --
A & K FOWLER INSURANCE
AGENCY
200 PARK STREET
MED EXP (Any one person) S 1 O 0 Q
SUITE #3
AUTOMOBILE LIABILITY
ANY AUTO I
NORTH READING MA
01864-
(978) 664-0366
COMBINED SINGLE LIMIT $
INSURED
E.P.M. CONTRACTING INC.
P.O. BOX 3295
ANDOVER MA
01810-
1
HIRED AUTOS
DATE + 12/0(1/99
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
COMPANY
A ZURICH INSURANCE
COMPANY
B
COMPANY
C
COMPANY
D
FOR THE POY PERIODTHIS
INDICATED. POLICIES INSURANCE LISTED BELOW
IT TANDING ANYREOUI EME, TERM ORCONDIHAVE E
ION OF ANY NY CONTRACT OR OTHER EDOCUMEN WITH
INAMED HER SPECT 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 CONDITION_ S OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_
-- POLICY NUMBER PO CYUPO CYU £F�FECTIVE POUCYEWRATION� — --LIMITS
CO
LTR TYPE OF INSURANCE DATE (MM/DD" DATE (MM/DD/YY)
A GENERAL LIABILITYGENERAL AGGREGATE $2 , 000,000
—X ,�C�O�MMERCtAL GENERAL LIABILITY 1 S CP 3 0 5 68910 10/31/99 10 j 31 j 0 0 PRODUCTS - COMP/CP AGG S2 , O 0 O 0 0 0
I I I CLAIMS MADE t, OCCUR I PERSONAL S ADV INJURY $11 000,000
OWNER'S & CONTRACTOR'S PROT f EACH OCCURRENCE $1 , 000,000
— AFIRE DAMAGE (Any one tire) $
Q
EXCESS UABIUTY I EACH OCCURRENCE S
UMSRELLAFOAM / / AG�TF S
OTHER THAN UMBRELLA FORM ' S
A , WORKERS COMPENSATION AND I TMFYSaa 1 1 LiUH
jEMPLOYEAWLIABILITYI_TC095570769 10/31/99 10/31/00 ELEACHACCIDENT x500, 000
THE PROPRIETOR/ iNCL EL DISEASE • POLICY
PARTNERS/EXECUTIVE -I EL DISEASE - EA EMPLOYEE S5 O O , O O O
OFFICERS ARE: EXCL
OTHER
DESCRIPTION OF OPERATIONS!LOCATIONSNEHICLESISPECUIL ITEMS
INSURANCE VERIFICATION
TOWN OF NORTH ANDOVER
BUILDING INSPECTOR
27 CHARLES ST.
NORTH ANDOVER MA 01845
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
J,Q-, DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPO OBLIGATION OR LIABILITY
OF ANY KIND_ UPON THE COMeANY AOENTS OR REPRESENTATIVES.
AUTHORIZED RNFROEbTATIVE
- --
MED EXP (Any one person) S 1 O 0 Q
A
AUTOMOBILE LIABILITY
ANY AUTO I
CA90522541
12/02/98
12/02/99
COMBINED SINGLE LIMIT $
_
ALL OWNED AUTOS
X SCHEDULED AUTOS
BODILY INJURY
(Per person) I ,100,000
^
r
HIRED AUTOS
BODILY INJURY
(Per accident) E30O (,100
NON-OWNEOAUTOS
PROPERTY DAMAGE $
100,000
GARAGE LIABILITY
ANY AUTO
AUTOONLY - EA ACCIDENT S
OTHER THAN AUTO ONLY:
EACH ACCIDENT S
EXCESS UABIUTY I EACH OCCURRENCE S
UMSRELLAFOAM / / AG�TF S
OTHER THAN UMBRELLA FORM ' S
A , WORKERS COMPENSATION AND I TMFYSaa 1 1 LiUH
jEMPLOYEAWLIABILITYI_TC095570769 10/31/99 10/31/00 ELEACHACCIDENT x500, 000
THE PROPRIETOR/ iNCL EL DISEASE • POLICY
PARTNERS/EXECUTIVE -I EL DISEASE - EA EMPLOYEE S5 O O , O O O
OFFICERS ARE: EXCL
OTHER
DESCRIPTION OF OPERATIONS!LOCATIONSNEHICLESISPECUIL ITEMS
INSURANCE VERIFICATION
TOWN OF NORTH ANDOVER
BUILDING INSPECTOR
27 CHARLES ST.
NORTH ANDOVER MA 01845
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
J,Q-, DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPO OBLIGATION OR LIABILITY
OF ANY KIND_ UPON THE COMeANY AOENTS OR REPRESENTATIVES.
AUTHORIZED RNFROEbTATIVE
89 Belmont St Realty Trust
P .O Box3295
Andovcr, MA 01810
(978)475-8887
November, 25 1999
Mr. Michael McGuire
Town of North Andover
Building Dept.
Re: Renovations @ 89 Belmont St.: scope of work
Dear Mike
The scope of work proposed for the existing building at 89 Belmont St is as follows:
♦ Remove and replace front wall and foundation
♦ Add inside cmu wall tied into new front wall , and existing rear wall as note C -C
describes to improve structural integrity
♦ Remove and replace roof w/ bar joist truss designed by manufacturer (to be
stamped and forwarded to bld. Dept for approval prior to install)
If there are questions or concerns please page me at your convience.(978) 545-0844
Sincerely,
Dean Chongris
Ttee 89 Belmo St. Realty Trust
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3486 Date .:72
Of 401?T" TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies thatt ........................
has permission for gas installation
in the buildings of ...... ............................
at . ? 0/. .
...................... North Andover, Mass.
Fee. Lic. No. r ..........
A -INSP
S &OR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
INSURANCE COVERAGE:
I have a curry liability 'insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
..Yes No ❑
If you have checked Xes, please indicate 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_ required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Checkone:
Owner ❑ 1 Adent ❑
Date.,).-. /...� . Z. .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .......................
has permission to perform ....R("A-L� .............
plumbing in the
/n>buildings of ...�..L .G 1lL.� l! �� . ! ...............
at . . . . .v . .......... , North Andover, Mass.
Fee. Lic. No./! �.
.........
PLUMBING INSPECTOR
Check # //7
r,
5131
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Typel
Maas. Date b
Building
Coulton
N- h-tiflc�v�,i2
Permit # f
Owner's /
Name C/ oA,6u5
New CJ--'- Renovation ❑ Replacement ❑
FIXTURE!
Pians Submitted: Yea ❑ No_ ❑
. - Check one: Certlftuie
Installing Company Name C/4�L�/�,4,v / /2 cot-n_�i�� e-C-0rp.
Address SIJ f�i-P/yL ❑ Partnership
r U. f ph ❑ Firm/Co.
Business Telephone
.Name of Ucensed Plumber —Ll h K, / A- %1
INSURANCE COVERAGE:ecx one
1 have ■ current Ilab1Ry Insurance policy or Is substantialequtvalenL Yes No ❑
II you have checked yam, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy �^ Cther type of indemnity ❑ Bond ❑ ,
OWNER'S INSURANCE WAIVER: I am aware that the licenses 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:
UgnOwner ❑ Agent ❑.
stare o Owner a Owner a ent
I hereby aaNfy that aq of the detaffa and information I have tarbmitted for ent02of
above Lion ars us ata to the best of my
Inowledge and that as plumbirp rwrk and Installations performed under theaved
this
ap compflana with all
pertinent provisions of the Massachusetts State Plumbinq Code end ChapterW
t3F
Two
Ctty/Town
M'F'fUVED (OFFICE USE ONLY)
Ucen&aNurnb4 / 3 D f
Type of PlumKg License: Master
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. - Check one: Certlftuie
Installing Company Name C/4�L�/�,4,v / /2 cot-n_�i�� e-C-0rp.
Address SIJ f�i-P/yL ❑ Partnership
r U. f ph ❑ Firm/Co.
Business Telephone
.Name of Ucensed Plumber —Ll h K, / A- %1
INSURANCE COVERAGE:ecx one
1 have ■ current Ilab1Ry Insurance policy or Is substantialequtvalenL Yes No ❑
II you have checked yam, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy �^ Cther type of indemnity ❑ Bond ❑ ,
OWNER'S INSURANCE WAIVER: I am aware that the licenses 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:
UgnOwner ❑ Agent ❑.
stare o Owner a Owner a ent
I hereby aaNfy that aq of the detaffa and information I have tarbmitted for ent02of
above Lion ars us ata to the best of my
Inowledge and that as plumbirp rwrk and Installations performed under theaved
this
ap compflana with all
pertinent provisions of the Massachusetts State Plumbinq Code end ChapterW
t3F
Two
Ctty/Town
M'F'fUVED (OFFICE USE ONLY)
Ucen&aNurnb4 / 3 D f
Type of PlumKg License: Master
Journeyman []
Date...— : F V
��1° 4�u3
tiTOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that/`l..�> ri :..�� -��%_. .........
t. has permission to perform-���-� i • r�� ... , .,J . -... , .
plumbing in the buildings of
at .?-7--.,,North Andover, Mass.
A, / 1
Fete .... Lic. NO.///// . .
PLUMBING INSPECTOR
-7f U l/
WHITE: Applicant CANARY. Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATIO77C,7) TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date
Building Location g� /tel e �7` Owners Name Permit #d
T� u S Amount
Type of Occupancy p W
New Renovation Replacement F-1 Plans Submitted Yes No
FTXTiTRES
(Print or type)I�� t Check one: CertificateInstalling Company Name i� ` / Corp.
Address
S Z Lf/ i f v,5, q7' -C 5 T Partner.
Business Telephone 9 7 Sf 3% 3 4 T Firm/Co.
Name ofLicensed Plumber. Ro"4e'yr 6,1&e5
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate bom
a 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
!gni Owner Agent E]
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 Mass usetts State Plumbing Code and Chapter 142 of the General Laws.
By: Signature 37-Licensea riumoer
Type of Plumbing License
Title ///// '
City/Town License Numoer Master ® Journeyman
APPROVED (OFFICE USE ONLY
No 1 5 0
Date .....................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
TL certifies that .............
"I ........................... .....................................................
has permission to perform ....................
;14- .............................
wiring in the building of ...... ............ .................. ......
at.. .......... ...... .
................................................... North Andover, Mass.
?� ... . ...... Lic. No`z')121�?;� . ..............
...............................................
6 ELEc"mcAL MpEcrm
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
TRE COWSIONH LTHOI+AMSS:40U,S S Office UseonlY__
DLA9 RTAflM 0FPUBL IC S 4 F=
Perm ttNo.
. "
BOARI)OFFIREPREVEMONREGUTA770NS527C$lRl2Gb -- _ „ _ •� r
Occupancy.& Fees Checked Aft
APPLTTONFORPE AIET TOPERFORMELL'(=CAL--WORK
ICA -
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �a
Town of North Andover To the Inspector of Wires:,
The undersigned applies for a permit to perform the electrical work described below. OQ 7 PARCEL -
--Location, (.Street &
Owner or -Tenant
. Owner's Address
Is this permit in conjunction with a building permit: Yes No JaL (Check Appropriate Box) �f ff
Purpose of Building pl V . Utility Authorization No.
Existing Service Amps 1 Volts Overhead r7 Underground No. of Meters
New Service �� ` _ Amps/ 20/ Z olts Overhead Underground No. of Meters
Nui ibex of Feeders and Ampaeity
Location and Nature of Proposed Electrical Work "ne.,iNl C1 � T "� 'rL) t
No. of Lighting Outlets
No. of Hot Tubs
. f Transformers -Y-- —
_
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above.
Below
Generators
KVA •. g. =,
- - - _ground
gromd
e•-- :=;
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
-
No. of Gas Bumcrs
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
Conncctions
_
No. of Water Heaters KW
No. of - No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
_
OTHER
h��oe�.o�,adge. Aasu�tot6eregmalIa�sdEMa�.�C�Iaaliaws _.
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Iba%estbTiitbdvdhdprocfofsmmtoihe0l£m YES NO a Ifyouha�died�dYYFF p'�e>t> ethetypeofoocaagebydle lgihe + -
INSURANCE BOND ® omm ® ftasespa* `L; ►1 cce,X E i n_e f &, VA ha.yf_
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OWNER'sIT�P5[JRANG'EWAIVER;Iamawatethatihelxensedmes tra�etheu>s<u-<uxeaifss<�lecuivd�rtasrecg>i�b�'N&�dalS�lsGer�dllaws s4G��
arrltha niysigrlahaemthisp=nitap,-hcab lw&ur,tinsregmumi
(Please check one) Owner ® Agent
Telephone No. PERMIT FEE �
ranature o t 7—w—ne—r—o—r. gent
N2 2525 Date ..... ... ....... 701e) ......
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
RPM
i -a - .*
This certifies that ........ 41.,e .................................................
has permission to perform .....
wiring in the building of ..... c ..................................
............................ . ,
at ...
Mrthov ass.
, W
J—()J -C
.............
Fee ./d ............. Lic. No. ../IL0 .. . . ............. ...............
*
-
LEcr ICA NSPECTOR
;
J�q
Check # I G", L,
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
T1W C0AM %AWEALTH0FM EMCWS= Office Use only
V
DEPARTALENTOFPUBLIC&4FL Y Permit No. Aj
,
BOARDOFFIREPREVEVff0NREGMT10N,S527C3fR 12:00
Occupancy & Fees Checked
APPLICATION FOR PIRART TO PEUORM ELECMCAL WORK
OAC
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street �
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes L:A No ® (Check Appropriate Box) /
Purpose of Building Ue. — S • e-) [t^ A% C I Utility Authorization No. 04��o
Existing Service - Amps�1 Volts Overhead rM Underground ® No. of Meters
New Service e Amps%Za/ (Volts Overhead ®Underground ® No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work tr;t
NO. or L,gnnng Uutlets
No. of Hot Tubs
No. of Transformers
Total
7No. ofLighting Fixtures
Swimming Pool Above
Below
Generators
KVA
KVA
and
ound
_`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
R
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
i
OTHER
Work IDSlatt O InspecfionD*ReqxsW
Signed utx��ie Penalties ofPt3jta�, . j �
ftese5peffy)
Exp¢aborlD3�
Estirrtated Vahie�ctricaf Wodc $
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LiarNeNa
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OWMR'SMLRANCEWAIvM.Iamaw=tbttcLioenm theirnvta<�ec trAss ale asiagtmedbyMa�s>S Gec>aalIam
and�mytaem�tispeun� ��g,
(Please check one) Owner Agent
PERMIT FEE tJ
3378
Date... //�. !...`.`... .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ...l ..,' ..... �. f .... �f. .. .. .
has permission for gas installation
in the buildings of..<J ..........................
at ... ............... �''� ........ North Andover, Mass.
Fee...2 . } ... Lic. No....` � :. `
:: ... �........ ..... .
:�-. �.
GAS INSPECTORY
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
✓IASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO
or print)
IwtcIH ANDOVER, MASSACHUSETTS
Building Locations
Owner's Name
New 01, Renovation F-1 Replacement ❑
19
Permit #
Amount S
Plans Submitted ❑
(Print or type)
Check one: Certificate Installing Company
11—Corp.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑
If you have checked ves, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 0" Other tvpe of indemnity F1Bond ❑
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 ❑
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 installation performed under Permit Is d for this application will be in
compliance with all pertinent provisions of the Massachusetts SAe Gas Codond�CtDapter 4? ofthe�heraaws.
By:
Title
City/Town
ROVED (OFFICE USE ONLY)
Siature of Licensed Plumber Or Gas Fitter
❑P1 Mber . & �, ?
ras Fitter Icense Number
Master
❑ Journeyman
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4 T H. F L O O R
5'r H. F L O O R
6TH. FLOOR
7 T 11 . F L O 0 R
8"r H. F1,00 R
(Print or type)
Check one: Certificate Installing Company
11—Corp.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑
If you have checked ves, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 0" Other tvpe of indemnity F1Bond ❑
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 ❑
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 installation performed under Permit Is d for this application will be in
compliance with all pertinent provisions of the Massachusetts SAe Gas Codond�CtDapter 4? ofthe�heraaws.
By:
Title
City/Town
ROVED (OFFICE USE ONLY)
Siature of Licensed Plumber Or Gas Fitter
❑P1 Mber . & �, ?
ras Fitter Icense Number
Master
❑ Journeyman
Location
No. �v Date
jORTH TOWN OF NORTH ANDOVER
F 9
' Certificate of Occupancy $
• °mob'.. . ;' � �..�.
Nustt� Building/Frame Permit Fee $
fi
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 31-735 0
�46uilding Inspector
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Sep -30-99 10:17A North Andover Corn. Dev. 508 688 9542
FORM U LOT RELEASE FORM
INSTRUCTIONS: T "is form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
t?,,e applicant and(cr landowner from compliance with any applicable or requirements.
FILLS OUT TNI- SEC TION't:'"""7"`*x*""w" I
APPLICANT PA
LOCATION: Assessors ,Map Number �^
SUBDIVISION
STREET ��MCrN'
PHONE
PARCEL
LOT (S)
ST. NurviEER 8p
""" OFFICIAL USE ONLY***'** **" ""*** ,* ""_ I
L RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
- k A;
COMMENTS
TOWN PLANNER
COMMENTS
FCOO INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUEL!C WORKS - SEWERIWATER CONNECTIONS
DRIVE'NAY PERMIT
FIRE DEPARTMENT
RECEIVED Q'' EUILDING iiNISPECTOR
Revi_ed i!97 Jim
CA.TE
Dec -01-99 04:46P A&K FOWLER INS. AGENCY 978 664 2209 P.01
(9'78)
INSURED
E.P.M. CONTRACTING INC,
P.O. BOX 3295
ANDOVER
MA 01810—
DATE (MM/DOn
2/01/99
THIS CERTIFICATE IS ISSUED AS A MATTER Of IIVrumrAmfOR
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFI
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENDeI rwaTWE COVERAGE AFFORDED BY THE POLICIES BE
COMPANY
A ZURICH
COMPANY
B
COMPANY
C
COMPANY
D
;.,.:.,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY P i
CT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRA
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFeFORDEWAV� RI
NHE PO LIED BYCRIBED D CLAIMS. REIN IS SUBJECT TO ALL THE TERMS,
tXGLU7IVN.�
CO=TYPE
LTR
MrvU a:vrvun w.w .+,
--
OFINSURANCE
� -- -•--— -..---
---
POLICY NUMBER
UPO FFFECTIVE IPOUCYEXPIRATION
PO YCYC EFFECT
DATE(MM/DDIYY)
---_-- ---
DATE(MM/DD/YY)
LIMITS
GENERALACGREGATE s2, 000,000
A
{—OWNER'S
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAMS MAGE �� OCCUR i
&CONTRACTOR'S PROT
SCP 3 0 5 6 8 910
10/31/99
10/31/00
PRODUCTS - COMP/CP AGG� s2, 000,000.
PERSONALS AOV INJURY $1 , 000,000
EAI CH OCCURRENCE
_$1,000,000
AFIRE DAMAGE (Any one tire) S
MED EXP (Any one Darvon) $10,000
{-
I
— -- -
----
A
I
AUTOMOBILE
LIABILITY
ANY AUTO I
CA90522541 112/02/98
12/02/99
COMBINED SINGLE LIMIT $
ALL OWNED AUTOS
BODILY INJURY
(Per person) 100,000
X
SCHEDULED AUTOS
�
r
HIRED AUTOS
BODILY INJURY
(Per accidenQ $ 300,000
NON-0WNEO AUTOS
--
__...
PROPERTY DAMAGE $ 100,000
�___,
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT S
OTHER THAN AUTO ONLY'
�— EACH ACCIDENT S
AGGREGATE S
—" ---
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE S
$
TORYUMITS
A
, WORKERS COMPENSATION AND
j EMPLOYERS' LIABILITY
THE PROPRIETOR/POLICY
PARTNERS/EXECUTIVE
OFFICERS AREEXCL
:
T C 0 9 5 5 7 0 7 6 9
10 / 31 / 9 9
10 / 31 / 0 0OE
EL EACH ACCIDENT $500,000
LIMB ---1$500, O O 0
EL DISEASE - EA EMPLOYEE $5 0 0 , 0 0 0
OTHER
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLESISPECIAL ITEMS
INSURANCE VERIFICATION
i
SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
TOWN OF NORTH ANDOVER IQ_ DAYS WRITTEN NOTCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUILDING INSPECTOR BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPO OBLIGATION OR LIABILITY
27 CHARLES ST. OF ANY KIND UPON THE COM NY AGENTS OR REPRESENTATIVES.
NORTH ANDOVER MA 01845 AUTHORIZED R RE TATIVE
89 Belmont St Realty Trust
P .O BoO295
Andovcr, MA 01810
(978)475-8887
November, 25 1999
Mr. Michael McGuire
Town of North Andover
Building Dept.
Re: Renovations @ 89 Belmont St.: scope of work
Dear Mike
The scope of work proposed for the existing building at 89 Belmont St is as follows:
♦ Remove and replace front wall and foundation
♦ Add inside cmu wall tied into new front wall, and existing rear wall as note C -C
describes to improve structural integrity
♦ Remove and replace roof w/ bar joist truss designed by manufacturer (to be
stamped and forwarded to bld. Dept for approval prior to install)
If there are questions or concerns please page me at your convience.(978) 545-0844
Sincerely,
Dean Chongris
T tee 89 Belmo St. Realty Trust
TX. ellrYuto02usec�✓ o� �cw�sr�u eCli
DEPARTMENT OF PUBLIC SAFETY
CONSTRUG,TION SUPERVISOR LICENSE'
s
number Expires; Birthdate,
,
CS 6&1-031 199's 82113(409.0 02j1 90
00
_
A'ECANDEft 3 MGGREGGR
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N ANDOVER, MA 01845
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3577
.C�2 - 0 C -;L
Date .. ............................
0",
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that ...................................... t ......................................................
has permission to perform .... 0,ak.c".� ..... .......................... .....
... .... .. . .......... . ... .....
DrA") Ckovqw5
wiring in the building of ...................... I ................ v .........................................
(2;, ? 13 �L `S. ......
at ........ 0 .................... :�-/ ................. ' orth Andover, Mass.
Fee ...... :�� ...... Lic. No. ................
........... .. ... . ... ......... ...
Check # ELE'- IiCAAL INSPECTOR/1W
Official Use Only
c A� Permit No.
+�e6 S ,
Demos od ,�utille Sa�tiy 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)
Town of North Andover
The undersigned applies for a permit to
described below.
Date '/� ��c7
To the Insp ro 6Wires:
Location (Street & Number Li L �L� IAC ��_T•• -
Owner or Tenant
..
Owner's Address
is this permit in conjunction with a building permit Yes @'J No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization
Existing Service Amps !U 2 U Voits Overhead I- Undgmd ❑
New Service Amps Voits
No. of Meters _Z_
Overhead ❑ Undgmd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work -
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy includi ompleted Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Offic .�Y - NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
SURANCE)= BOND = OTHER = (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$
.Work to Start Inspection Date Resquested Rough Final
FIRM NAME under the Pen afties f�e 'pwry: LIC. NO. f CaZ
�Lkensee G l SignatureLIC. No.
Bus. Tel No.
Address �" E'-n�-� AR Tel. No.
OWNER'S NSURANCL WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMITTEE $
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
c
Above ❑
In ❑
No. of Lighting Fixtures p
Swimming Pool
grnd ❑ grnd ❑
Generators KVA
No. of Receptacles Outlets
No. of Oil Burners
No. of Emergency Lighting
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 I
No. of Sounding Devices
No./ of Self Contained
No. of Di sal
Heat Total Total
No. Pumps Tons KW
No. of Dishwashers
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
Wiring
No. Hydro Massage Tuds
No. of Motors
Total HP
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy includi ompleted Operations Coverage or its substantial equivalent YES = NO
have submitted valid proof of same to the Offic .�Y - NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
SURANCE)= BOND = OTHER = (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$
.Work to Start Inspection Date Resquested Rough Final
FIRM NAME under the Pen afties f�e 'pwry: LIC. NO. f CaZ
�Lkensee G l SignatureLIC. No.
Bus. Tel No.
Address �" E'-n�-� AR Tel. No.
OWNER'S NSURANCL WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMITTEE $
(Signature of Owner or Agent)
393 3
Date. ..........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that,,:--/ ........ .................................
C7 -
has permission to perform',? ........
wiring in the btiilding of ..... .............................................
at.? .... ............... . North Andover, Mass.
Fee ./,�Q ...... Lic. No�z�/,,,. ...........42 .......................
ELECTRICAL INSPECTOR
Check #
Official Use Only
�L ��r} Permit No. 217F
aeAg,rrmK °6 P Sak4 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 5277 CMR 12:00
x
(Please Print in ink or type all information) Date / —f6 —o-2—
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (
Owner or
Owner's Address
Is this permit in conjunction with
��a building permit Yes ❑ No (ice (Check Appropriate Box)
Purpose of Building �'714`% ��i JAG 1,[!�(�/l�
�Utility Authozation
E)dsting ServiceUndgmd ❑ e
New $ervice Amps n� Voits
f`
Number of Feeders and Ampacity t—e2 5g .) ) Z_Y
Location and Nature of Proposed Electrical Work
Overhead ❑
/S X
012(_, 6�_-
Undgmd ❑
No. of Meters
vnb� �
No. of Meters 3
/9 /I% i E
L71715�eo�i 150c::/ 7-6,19 6 , 6;c
OTHER: /-f�7[� l IU� — G►G � �` Z D l�fl r? // S 410d 112E ,' 26)/ %J/ 10 15
7—o
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I hive a curr&nt Liability Insurance Policy includi mpleted Operations Coverage or its substantial equivalent YES = NO =
hIt
lid proof of same to the OffiYES NO = if you have checked YES please indicate the type of coverage by checking the appropriate box
SURANCE = BOND = OTHER = (Plea/�Spptecify) Expiration Date)
istimated Value of Electrical Work$ 1(/
Work to Start 7--d-02 Inspection Date Resquested Rough Final
Signed under the Penalties of perjury: f �O
FIRM NAME,57— C, �/f F�1_— 1. LIC. [�
NO. e/-7,1 YJ
Bus. Tel No. 1779—
—
Address / y "9d_,9t-6'� Ol G'/CCOi�%C/� Alt Tel. No o ��6
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have.the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this mciulrement. Owner Agent (Please Check one)
COv Oi/
Telephone No. PERMITTEE $�
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above ❑
In ❑
No. of Lighting Fixtures
Swimming Pool grnd ❑ grnd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
NG.. of Ranges
No of Air Cond
Tons
Initiating Devices
—
Heat Total Total
No. of Di sal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
—�
foo. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
No. of DrMs
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
inng
No. Hydro Massage Tuds
No. of Motors
Total HP
OTHER: /-f�7[� l IU� — G►G � �` Z D l�fl r? // S 410d 112E ,' 26)/ %J/ 10 15
7—o
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I hive a curr&nt Liability Insurance Policy includi mpleted Operations Coverage or its substantial equivalent YES = NO =
hIt
lid proof of same to the OffiYES NO = if you have checked YES please indicate the type of coverage by checking the appropriate box
SURANCE = BOND = OTHER = (Plea/�Spptecify) Expiration Date)
istimated Value of Electrical Work$ 1(/
Work to Start 7--d-02 Inspection Date Resquested Rough Final
Signed under the Penalties of perjury: f �O
FIRM NAME,57— C, �/f F�1_— 1. LIC. [�
NO. e/-7,1 YJ
Bus. Tel No. 1779—
—
Address / y "9d_,9t-6'� Ol G'/CCOi�%C/� Alt Tel. No o ��6
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have.the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this mciulrement. Owner Agent (Please Check one)
COv Oi/
Telephone No. PERMITTEE $�
(Signature of Owner or Agent)
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