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HomeMy WebLinkAboutMiscellaneous - Exception (121)u - C--q- � - Date.��!.�.f... TOWN OF NORTH ANDOVER PERMIT FOR GJ ALLATION This certifies that .'.T SA A I'all.z 0!- has permission for gas installation ....... ..................... in the buildings of . !?,4. v. �4......H VS .fd ........................... rj -( at �4�. . 4k. .).1. ., North Andover, Mass. Fee.a.f?. Lic. No.. a 3. ....... GASINSPECT OR Check #/ '-/ 3 / -7 04?;l MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS F rnNG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations [ � `.P U4 --v( Permit # Owner's Name New ❑ Renovation D Replacement 12 Amount $ �-L)114 Nov s� -- Plans Submitted 11 SUB -BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. 4TH. FLOOR FLOOR M FLOOR FLOOR 7TH. 8TH. FLOOR. FLOOR Telephone a ep one ? g (a a W O U O m as � Z w o e > d w v z. x W a SUB -BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. 4TH. FLOOR FLOOR 5TH. 6TH. FLOOR FLOOR 7TH. 8TH. FLOOR. FLOOR (Print or type) I Name��i J Address (-7) d k FO s2- ca Cif– `--7iL U ��✓ U Business Telephone a ep one ? g (a a U O m � Z o > d Address (-7) d k FO s2- ca Cif– `--7iL U ��✓ Business Telephone a ep one ? g (a Name of Licensed Plumbeior Gas Fitter >° —x —.(, Check one: Certificate Installing Company Corp. ElPartner. © Firm/Co. INSURANCE COVERAGE Check one: 1 have a current liability Insurance, policy or it's substantial equivalent. Yes D NoO If you have checked Igs please indicate the type coverage by checking the appropriate box. Liability insurance policy 13- Other type of indemnity 1:3 Bond 13 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 13 Agent I hereby certify that all of the details and information I have submitted (or entered) in above application 13 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 a in compliance with all pertinent provisions of the Massachyse is State�as Code and(Chapter 154 of the General Laws. By: . Title City/Town, APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber Gas Fitter License Number b 13 --Master Journeyman Dated ./. �... . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....+/.!..�....t".� ................. has permission to perform ...^.. ........................ plumbing in the buildings of .. . � k ! . � .7 ....... . ....... . at .... c?. ... .d5. x . Of. �.u: ...... North Andover, Mass. Fee .. . (i Lic. No.. -JK7. ! :. ... . ` PLUMBING INSPECTOR Check # 8551 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS a �o/a Building Locations New ❑ Renovation ❑ Owner's Name Replacement Permit # �►ount $ e.41 Plans Submitted (Print or type ' v — t' 1� �N ` 1V _ Name i!' Address O D( IN i+'1 P S Al Ai ' . �� .4, ❑ Partner. 0-Firm/Co. Check one: Certificate Installing Company ❑ Corp. Name of Licensed Plumber or Gas Fitter �) X V 1 b-1 J Pi - F - INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. ChCh [!yI If have No� you checked y_es. please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity Bond Owner's Insurance Waiver: I amaware 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. Signature of Owner or Owner's Agent Check one: Owner 0 Agent 0 I hereby certify that all of the details and information I have submitted (or entered) in above appli n are true and accurate to the best of my knowledge and that all plumbing work and in ons perfo ed under Permit IS for compliance with all pertinent provisions of the Massac setts tate Gapd"d Ch!� 14;;,f is application will be, in General Laws. By. Title City/Town rr �rrtcV V Zi! (OFFICE USE ONLY) Signature of: Plumber 13Gas Fitter Master 0 Journeyman sed Plumber Or Gas Fitter 99�y icense Number n MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or Pte) NORTH ANDOVER, MASSACHUSETTS / R m Building Location 9� �i d/ 4� .4 W.^1 Date Permit Owner -Wr I nV t Y 1 �e S) r .RVs Amount New r Renovation rl Replacement_ [] VFXTLTRF.fi Plans Submitted -Yes [:] No (Print or type) Check one: Certificate Installing Name] ),A I'o I� 1 �� 0 Corp. Address t"3 Partner. Business Telephonej— y Firm/Co. Name of Licensed Plumber. - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate bor. Liability insurance policy �"— Other type of indemnity ❑ Bond Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 0 Agent I hereby certify that all of the details and information 1 have submitted (or entered) in aho pp tion are true and accurate to the best of my knowledge and that all plumbing work ynder P f', this application will be in compliance with all pertinent provisions of the Mas ch State P 1 of the General Laws. Signature or Licensea Title Type of Plumbing Li � City/Town a%nse9 Master Journeyman APPROVED toMcE USE ONLY "_o °T :1tio TOWN OF NORTH ANDOVER - PERMLT FOR PLUMBING ,SSACMUSE This certifies that ..5,IW !"."IA4. `r/.I ...................... has permission to perform ....pp. .- ...................... plumbing in the buildings of ...t ' .....�................... . at .. _North Andover, Mass. Fee . ? � �... Lic. No.. ..... ......Lcr �- .. ...... . /PLUMBING INSPECTOR Check #'E) -0y 6536 G If MASSACHUSETTS UNIFORMAPPLICATION FOR'PERMITTO 00 GASFITTING�� (P nt or ype) ass.6 Data ZO � � Pe it / ^3 Building lova on GY(ir1 Owners me C� Type of Occupancy New❑ Renovation ❑ Replacements Plans Submitted: Yes ❑ No ❑ BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR . 4TH FLOOR STH FLOOR 6TH FLOOR ns; tailing Company Name address .. lusiness Telephone lame of Licensed Plumber or Gas Fitter o m� to -. I Check one: Certificate ❑ corporation ..-U ❑ Partnership INSURANCE COVERAGE: 1 have acurrentll billty Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes f- No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box A liability Insurance policy &/ Other type of indemnity ❑ Bond OWNER'S INSURNACE WAIVER: 1 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 ulls Permit appllcatlon Walves this requirement Signature o Owner or Owners Agen Check one: Owner ❑ Agent ❑ lereby certlfy that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of y knowledge and that all plumbing work and Installations performed under the permit Is e r this application be in compliance with I pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Oe 6 Type of License: Tide ❑ Plumber T4Sgnlre of L ceased City/TownCity/Town❑ Casfltter P u ber or Gas F tter APPROVED (OFFICE USE ONLY) aMatter License Number 0 Journeyman r, R 4 � .A •t M � � Z r r o � 0 e O • r c 4 i O r, R 4 TOWN OF NORTH ANDOVER WELDING DEPARTMENT APPLICATION .TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISHANY BUII.DING OTHER THAN A ONE OR TWO FAMILY DWELLING Section for Official Use Onl �y BUILDING PERMIT NUMBER: DATE ISSUED: 36404 Z SIGNATURE: O Buildin Commissioner r otBuilTmgs Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: v Zenin Distrix Proposed Use I at Area Fronts a m 1.6 BUR DING SETBACKS (ft) , . Front Yard Side Yard Rear YardRequired i Provide Provided Provided 1.7 Water SupplyM.QLC.40. 54) .. � 1.5. Flood �e OatamL Flood Zone 0 1.9 sew=W Disposal sy#= Public 11 poivare 0 Municipd on site Disposal systm 0 2.1 Owner of Record Allnweq 7—!Vlldl 0 Name(Print) Address for Servi Signature Telephone m 2.2 An Mame Address for Service: I've Allf O Telephone Z M.* 1.1 Licensed Coon Supervisor 0AI-2.k Not Applicable ❑ Lrcense Number OjceItstruc�ti' 0 an onS ti Z� ;igaature Telephone ;.2 Registered Home t Not Applicable ❑ ` e2 ; :ompany Name , l Registration Number adr= r Date zz ignature Telephone i f J iiiRi tr Wbrkers 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 emit. Sigpned affidavit Attached Yea ...:...❑ No ....... ❑ 6 �F� i i A 4 r:• #'.:=.^.. ... ti t, .�.'a�' . , v. ._ Y •., F.. 1.., x -" '' 4 . +'rte y xa �' t'}'t���-i 4: r..t.�i,l Y .�: -•r. 5.1 Registered Architect: Name: Address Signature Telephone Area of Responsibility Name: Registration Number Address: Expiation Date Signature Total Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Not Applicable ❑ Company Name: Responsible in Charge of Construction _r New Construction ❑ Existing Building ❑ Repair(s) ❑ Accessory Bldg.. ❑ Demolition 0 Other 0 Specify Brief Description of Proposed Work: Alterations(s) 0 1 Addition 0 BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels USE GROUP Check as a licabfe CONSTRUCTION TYPE A Assembly ❑ A-1 0 A4 0 A-2 A-5 ❑ A-3 ❑ ❑ ]A 1B ❑ 0 B^Business ❑ 2A 213 2C 0 ❑ 0 C Educational 0 F Facto ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B 0 ❑ IInstitutional ❑ I-1 0 1-2 0 I-3 0 M Mercantile ❑ 4 0 R residential 0 R-1 ❑ R-2 ❑ R-3 0 5A 5B ❑ 0 S Storage 0 S-1 0 S-2 ❑ U utility 0 Specify: M Mixed Use 0 Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: 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 Floor s Total Area Total Height R Independent Structural Engineenng Structural Peer Review RaWred Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMff I> as Owner of the subject property Hereby authorize to act on My behalf, m all matters relative two work authorized by this building permit application Signature of Owner Date . Owner/Authorized 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 pai.nsand penalties of perjury Pript EWe Of Item 1. Building 2 Electrical 3 Plumbing 4 Mechanical (HVAC) 5 . Fire Protection 6 Total (1+2+3+4+5) Estimated Cost (Dollars) to be Completed by permit applicant ia, (a) Building Permit Fee Multiplier (b) Estimated Total Cost of Construction from (6 Building Permit fee (a) x (b) Check Number NO. OF STORIES SI BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DEMENSIONS OF SELLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �o (U- ;00 0 E�4 w O I 0 s z a H V! LuW CO2 is m C O a N A- IDCL C 0 C O � c� C.3 c.'o CL C an O C := O `o Ea C m ��r = a 4+ �a N Ee � v r �3 C .m W� W EI aC.3` ��o � �a _ oz w :oCL CL H N • CLL = O C O cp m� O-0 0 = s 5 0 a J .v t9 96 42 FAV W Y/ H o� W W W U) x x a U w w w � aG � tw w c� w a as cn o cn 0 s z a H V! LuW CO2 is m C O a N A- IDCL C 0 C O � c� C.3 c.'o CL C an O C := O `o Ea C m ��r = a 4+ �a N Ee � v r �3 C .m W� W EI aC.3` ��o � �a _ oz w :oCL CL H N • CLL = O C O cp m� O-0 0 = s 5 0 a J .v t9 96 42 FAV W Y/ H o� W W W U) 09/28/2004 12:55 5088656809 LEO TURNER J�F�w aw TEST RESULTS Harvey Manufactured Windows and Doors • U -Factor in accordance with NERC -100-97, based on why window value Air infiltration in accordance with ASTM E 283 0 1.57 PSF (25mph) PAGE 02/04 Harvey vi" windows and standard sloe Harvey vinyl patio doors with Low-E/Argon qualify for the ENERGY STAR® program throughout the United Sttftes. 'All vinyl windows with Low4:JArpn quality for the ENERGY STAR program tluoughout the U.S. Tho use Of tempered Low -E 9WN May effect ENERGY STAR quaiillmbon in your region. All ,A u are tsib}ed M change Whout notiaA due lo parodic re -tabling. N . KY CJW Insalabed Law -E Low-E/Argen Air -Fsdw R -V" -Fader RN U -Rector R-Vdoe 1111MVIIINI Wffl. MNDM t5ao Classic Double Hung (Mechanical) 0.50 2.00 0.37 2.70 0.34 2.94 .10 Vm-.-ic DouMe Hurw,y (Welded Sash & Frame) 0.49 2.04 0.30 2.70 0.33 3.03 .14 Classic Acousfical Double Hung STC40 0.33 3.03 0.25 4.00 0.24 4.17 .17 Signature Double Hung (Mechanical) 0.50 2.00 0.37 2.70 0.34 2.94 .041 Slimline Double Hung (Welded Sash & Frame) 0.50 2.00 0.37 2.70 0.33 3.03 .16 Sfmhne Single Hung (Welded' Sash & Frame) 0.60 2.00 0.37 2.70 0.33 3.03 .16 Vinyl Casement/Awning 0.47 2.13 0.34 2.94 0.31 3.23 .04 Vinyl Casement/Awning and Thermal Panel 0.31 3.23 0.25 4.00 0.24 4.17 .04 Vinyl Designer Shapes 0.49 2.04 0.33 3.03 0.29 3.45 -- Vinyl Hopper 0.47 2.13 0.35 2.86 0.32 3.13 .03 Vinyl Picture Window 0.47 2.13 0.32 3.13 0.28. 3.57 .01 Vinyl Roller - 2 Lite and 3 Lite 0.50 2.00 0.36 2.78 0,33 3.03 .09 (24fte) 'Too resub are fa&W an Cnm761 daf sbw Now Test nsts for other A* ttdnob suede upon Mqum Tempered 1tmpered 'Ii mpered MI. Tamp, Air Clear Low -L Low E(Argon Law E/Arg Lnftlaratton U-Plada R -Vilna U -Fades R -V" 11 -Factor R -Vides U-Fycrar_ R-VAtoe cWty �;atia DOer1) 50 Qb Q di X2`44` 11:1 in f3 3S 'All vinyl windows with Low4:JArpn quality for the ENERGY STAR program tluoughout the U.S. Tho use Of tempered Low -E 9WN May effect ENERGY STAR quaiillmbon in your region. All ,A u are tsib}ed M change Whout notiaA due lo parodic re -tabling. N 09/28/2004 12:55 5088656809 LEO TURNER PAGE 03/04 J11__ ARCEUrrECTURAL Vinyl Paido Moor Model; vinyl Pogo Door AppBcatiOns: Residential Light Cora rmirdad Dlsgnguils" FaWfes Custom Manufaeturedto Size welded S mh Cants Reinforoed Sash Panels Stas Untitarions Standard Sizes: 5068, 6068, 80138 Custom Size—Maar. Opening: 24b Vi knh WHeight92" Max ul 180 {A 3 -ft ft 144' Height 92" Max UI 228 44fe Y%ft 192" Height 92" Max 01276 ARCHITECTURAL SPECIFICATIONS General: ManuWctumd by Harvey Industries, Inc. �per0ori: Operating panel shall glide on tandem row vA$Ab1vh6..hma6i. Wheals shall glide on a solid anv4ted aluminum m0norati. Stationary panel shall be fixed at head and sill with an aluminum angle. Panels shall have pbal ve htartook at the meeting rail when in the dn+aed Portillo". Materials: Frame eoctruslon shall be 100% virgin PVC. Jamb Mane shall have a minimum of 8 hollows, and have a nominal well thiokness of 0.100". Frame Consltumort: Comers shall be ftmed with a closed cell foam sealing pad, butt -joined and mechanically fasimed with bur stainless steel screws per comer, anchored into er bVW extuaion wrnw boat**. Scr* an track and mall fin are hWWW to the frame. The heed and Oft wdruslon shah have a minimum of 8 hollows, and have a nominal well @ticknees of 0.100'. The silt shall have six tubular hollows and a nominal wall thickness of 0.100". A vinyl cover altail be snapped onto the fixed jamb inside log to give jamb a finished appearance. Sash ConsbuctIlan: Sash panels shall have mitered and Won welded comers. Sash profiles shall have a nominal wall ihiob"" of 0.100'. Sash frrmw shall have five tubular hollows and shall be reinforced with a 0.080" thick extruded aluminum channel in the meeting rails and iocldrri stales. A unique pocket perimeter on the door panel shall dose the door around the jamb frame adding additional security and tightness. The sash shall have s removable interior strap -in glazing bead, which wig allow replacement of glass without taking the entire sash mart, A vinyl snap on intariodc cover shall be applied to each of the meeting rail styles. Sore" Construolbtt: The door soreen frame shall be of heavy UtOw aluminum, reinforced at the comers with extruded comer keys for maximum torength. Iwwi screening shall be 18 x 16 non -glare fiberglass mesh held in place with a vinyl screen spline. AvaWe Finishes: Shall be solid vinyl throughout in white and almond. Matimmtripping. Weathamuipping on the inaln rianre perimeter shall be silicone treated woolpile with a polypropylene fin in the center. Each sash meeting rail shall contain one coumo of fin -type wo*therriMpping and a positive interlock for a triple seal. Hardware: A variety of hardware and locking systems are available. See options. GkWng: Insulating glass shall have an overall thickness of 7/ef' whh a rrNnimum "'air space. Insulating glass sandwich shall use a one-piece steel Uchennel design glass spacer, and shall have a desiocant matrix extruded into the base of the 1.11 -channel. A butyl sealant shall tom► wMaded around the entire perimeter of the spacer to achieve a seal. Ail glass shall be tempered type B domestic float type. A dual durometer snap in glaring bead shall secure the glass in place along the inside perimeter. Options: Grids - Colonial contoured aluminum In -glass. Glazing - Low -E, Argon-fillcd Low -E, and beveled 91as. 3 Ute Units, 4 lite Units are available. Hardware - Mite, almond or bright brave; %vh handleeeat with dual -point locking system and keylock, standard. optional muiti- point locidng system also available. Flush mount de ndbolt. Corrosion resistant stainless steel rollers are wallaible. Instalkidon; Installation shall be in accordance with the manulWturers ported instructions. Warranty lnfomo9on:Available upon request. Reiter to ftvey hwustrles Selye/ warranty for comploto doWls. REV 07,#V4 09/28/2004 12:55 5088656809 LEO TURNER PAGE 04/04 M A c J z c0 a as 3 W 0 0 12 d N cli 4 Vi 0/�4/2[t94 ©7:19 508865ti8�Jy LLu IUMNLM M rod m Eo., p 5`0 rx 0 a A E At 0 njelmaji 11 �m moo c gait 16 :2 E I J&D FS a I a S. 11 ki t R I I . I 1 :5. (j1.e �oo7til7t.04P.il�llt• d��-'�aaa.�J'rcee� `X 4� .I , BOARD OF BUILDING REGULATldNS; q License: CONSTRUCTION SUPERVISOR ' Number: CS 065281 i Birthdate: 09128/1961 ,�•r's� Expires: 09/28/2005 Tr. no 6728.0 Y Restricted: 00. PAUL �BRUNO 184 1/2 SUMNER'ST E BOSTON MA 02128 � ! t Administrator ext 1 GATE ""m��, CERTIFICATE OF LIABILITY INSURANCE 10/2S/2004 IRODU ER (617)472-3000 FAX (617)472-7248 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Burgin, Platner, Hurley Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 14 Franklin St HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Quincy, MA 02169 Joanne Pilling INSURERS AFFORDING COVERAGE NAIC # INSURED B & M Restoration & Contracting, Inc. INsuRERA: Employer's Fire Ins Co 20648 107 Orleans St INSURER B: One Beacon Insurance 20621 East Boston, MA 02128 INSURER C: AIG INSURER D: INSURER E: COVFROK;FR 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. _ INSR AWITYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBERDATE 00=ffn DATE (MMIDDIM LIMBS - GENERALUABRM FBR4409SS 03/17/2004 03/17/200S EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ISFS $ lOO, OOO CLAIMS MADE 'D OCCUR MED EXP (Any one Pew) $ S'000 A PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMfT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 POLICYF—j jE LOC - OCAUTOMOBILELIABILI AUTOMOBILE LIABILIY QBXB26S10 12/13/2003 12/13/2004 ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ALL OWNED AUTOS — B SCHEDULED AUTOS BODILY INJURY (Per Person) $ X HIREDAUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE — RETENTION $ - -- - - $ WORKERS COMPENSATION AND WC7687928 V 06/10/2004 06/10/200S XWCSTATU- oTH EMPLOYERS' LIABILITYLIM C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EL. EACH ACCIDENT $ 100,000 If yes, describe under E.L. DISEASE - EA EMPLOYF4 $ 100,00 SPECIAL PROVISIONS below OTHER P, DISEASE - POLICY LIMB 1 $ S00,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS OB: HERITAGE GREEN CONOMINIUMS, N ANDOVER, MA AFFINITY REALTY & PROPERTY MANAGEMENT LLC 63 ATLANTIC AVENUE BOSTON, MA 02110 ACORD 25 (2001108) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Michael Prenderaast/DFM ©ACORD CORPORATION 1988 i Location q ? �'�` �e �'� A � No. '� y / Date Check # '5703 1' V TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� ..,— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ jwCCo.., "` Building Inspector 1.1 Property Address: Ave 0 '7 1.2 Assessors Map and Parcel 4bq Map Number Number: 0(b Parcel Number 1.3 Zoning Information: Zoning District Proposed Use Name (Print) 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft u -J 00 -MAP�r- —7111 -3(.2 — Front Yard Side Yard Signature Rear Yard Required Provide Required Provided RecMired Provided 1 CvnN �zD Nau-, - f Tint T °-7 1.7 Water Supply M.G.L.C.40. 54) Public 0 Private 0 1.5. Flood Zone Information: Zona Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT filo 2.1 Owner of Record SUz.AN Name (Print) Address for Service u -J 00 -MAP�r- —7111 -3(.2 — szo Signature Telephone 2.2 Owner of Record: �j-,3 C� CvnN �zD Nau-, - f Tint T °-7 Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor HUMP. e�>ST Cont Name Not Applicable 0 V26&3 pany Registration Number %7 _ 2 �� Addt$ss —52(s2 Expiration Date) Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check as a 8eable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 12_FX_L 4r<�; 1.),� lt�l�uw — No � UCTLc izE �.�t�41yC�9 1 CF.CTION 6 - PSTIMATRD rONCTRITCTinN rncTc 1 Item Estimated Cost (Dollar) to be Com leted bpermit applicant OMCIAL USE ONLY ' 1. Building/\ / (� (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number ac,%.i1v1'1 is %JVVi'4ZrLIiulrJLVMZ.A11VP1 IV Dr, UUMYLEIEV WMN 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, as Owner/Authorized Agent of subject Y Hereby declare that the statements and information on the foregoing application are tare and accurate, to the best of my knowledge and belief � c Print N�¢u�� Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2' 3 SPAN DIMENSIONS OF SILLS DINIENSIONS OF POSTS DIIviENSIONS OF GIRDERS HEIGHT OF FOUNDATION. "' THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLIDORTILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Noah Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FROM ;4KIMBLY FAX NO. : 6033629679 Mar. 08 2005 05:42PM P5 HOME 1AiPROVFMENT CONTRACT Sold. Furnished and Installed 43� Branch Name: Date: RID At -Home Services, Inc.Inc d/b/a The Home Depot At -Home Services ✓ l �y �/f 345A Greenwood Street, Worcester. MA 01607 3 Branch Number. ( .lob M. �r�lG7l 1 Tntl Free (600) 657-5132; Fuc 508.756-2959 Federal irA 7 5-26 99160 M£ Lu N C 02439 Rl Cont L1dJ 16427 T Lras 565522: MA Improvement Contractor Reg d126093 V0 x�fy4 d19 Installation Address: City State Lip [i (r Lir. a & Ess D■u: � Paolu• _ -r. florae Pgotte: I Home Address: State Zip (If different from Installation Address) City Proieet Informrtiont VWe1You (~Purchaser'), the owners of the property located at the above installation address, offer t contrail with Home pious U.S.A.. Inc. ("tlo .5 Q furnish, deliver and mange for the installation of all materials a described on the attached Spec Sheet #: _OA 11 , incorporated herein by reference and made a part her Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determintS th cannot perform its obliptions due to a strttelural problem with the home or because work required to complete the was not included in the contract. DEPOSIT PAYMENT OPTIONS CONTRACT AMOUNT $ �Q v *LESS DEPOSIT S r/0 BALANCE DUCE ON COMPLETION $. "Minimum 25% of Contract Amount due upon execution I this contract Indicate Payment Method For BALANCE DUE ON COMPLETION: C�e V /C ($,/bled to fwW verdicotion and/or credit approval) 1. Check, Cashiers Chec1: or US Postai Service Money Order (Made payahle to The Home Depot). 2, Crcd;t Cud* and/or other payment options -Circle Clue Below Visa MasterCard Distovor Arnencetl t?xpress 1-k Home N ome (mprovemem I The Home Depot Credit C Av■itebltr C it: S. ( HIL & HDCC ONLY) per. Exp. +kr Name m it nppeans an c _ _ •.;R "By mylour shgnsr , C/wt agree TO Blow Home Depot to charger the aQi ii rc&rer4i,d ercdit c for deposit indicated. 0. CCardMld�r'z ighwtum .� cap? f HIL or H C, Authorization Codes ^°°r y De sit Final Pa meat wo ; ,.....,moi �` -A7. a Purchaser agrees that, immediately upon satisfactory completion Of the work, Purchaser execute a C;ompieuon %-crpI to be'oiml and several/ obligated and It ble hereunder. f and pay any balance due. Purchaser also agrees J Y Y Ser Entire Arex tri This agreement and its at=btnents, inClpdiag any financing agreement, contain the complete Agree oetwecn tnc pufttes and can not be amended or modified unless in writing in a separate agreement signed by both p NOTICE TO PURCHASER Do not tiger this contract before you read it- York are entitled to ■ completely filled-in mpg of the contract at the time you sign. 4 it to protect your rights- Da not sign 1ay Compicogis C"reefte et 4.2mment stating that You are eatisfil iintbo Certlfc■�tep before this projcei v complete_ Law prohibits home repair co�traceon from requtstittg or acceptipit a Coo+P i by the owner prior to the actual completion of the work to be performed acuter the cootraet You tray ranee/ this transaction sit guy I'm* rior 0 midnight of the third business day after the dace of this contract See Not Vol, ll■tio■ for en explanation of this righpt. 'ncm will -'be A service charge tqusl to 25% of the contract ■ineunt if the l Cancancelled by Purcbxter AFTER the third business day. BY MY/OUR SIGNATURE BEI.OW, I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. i/wE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NO110E OF C:ANCEI.IATION. BY MY/OIJR SIGNATURE BELOW, VWE UNdERSTAND THAT THE AGR£61ti[ENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT lil$TOTtY AND /WE AUTHORIZE HOME' DEPOT. AUTHORIZED CONTRACTOR, TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN HPEND CRED REPORTNO AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM iNAD R O 1 NS R ORS. DO NOT sJON THIS CONTRACT IF THERE ARE ANY BLANK SPACES. SUBMMD BY: , Date; _ •� S ca ACCEPTED BY: ale: Date; NOTICE: AnnrrrnNALTERM& CONDITIONS ANP WARRANTIM ARE ST,%TLoON-ii REVSRSIt SIPS AND ARE PART OF THIS CONTRACT white - arsrch File Yellow - Cbdo w Pinar - 541ts Coornhuhr 10-7-04 C -8C FROM :% K I MBLY or, 011 I V 3 V FAX NO. : 6033629679 Mar. 08 2005 05:40PM P1 m m YL EON ONE ONE Nom im ONE u MEN MEN on NONE 0 on I on I on 0 on 0 mom 0 NONE mom mommommom ==mom OMNI =mm"momms 0 sill ill I I lilt] Ill 11-111 oil son 0 ENO ft-� F7 y m X m oc m X CA N v m CO) aCD O C36 d 0. a� O p CD Q� c� CD o mm CL v r to CD CO) 10 CD 0 O CO) C.) O y d C2 CDO CD CD 3, y CD O CD O CD O z 0 z 1 o o =eeac m V w. d < CD CO) o Z CL 2 3 o " o co: ? • „rim � y n a- o o �' n o O O N O Cr1 a S o m cpm L Cs CD f 1•, O 150, m co). CLC o W= a V J ca mcam ob AAIIAMI � Joh ..S C2 -,ft: 3 N m:a► �Q 0 O O t:o�o s• �m to a� o� A O :� O_ � m 0O . d o ( � Gy R � V w. o ^� o " o co: O n a- o o �' n o --a-a W ENGLAND CLAMS SER.NICE, INC. Incorporated 1985 ❑ kgly To P.O. BOX 345 MANSFIELD, NiA 02042 . AM,00AWA 1 JWDLPNNDWI TEL. (508) 337-8058 FAX (508) 339-5835 �l v Rtply To ❑ 100 CO)\rIFER FIiLL DR7'\rE, SUITE 308 DA1',T\TERS,1vIA 01923 TEL. (978) 777-9900 FAX (978).774-9296 wran.dall@ncurcizglan dclaims . com Form of Notice of Casualty Loss to Buildir Under MASS. GEN. LAWS, Ch, 139, Sec. 3 RECEIVE© JUL - 1 2005 TOWN OF NO! T H ANDOVER HEALTH DEPARTMENT Board of Health or To: Building Commissioner or Board of Selectmen Inspector of Buildings c.�uw� `ll Sia3m:� Q-� RE: insured: f?_ G - � tic `c�-•� v "�- ��1..�4r� � ��. Property Address: Policy Number: Date/Cause of Loss: File or Claim Number: Claim has been made involving loss, damage or destruction .of the above- captionedCHAPTER may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, Jicable.-__If any notice. under MASSACHUSETTS GENERAL LAWS, - 143,-SEGT--iOhI-6, p ----------------- CHAPTER 139, SECTION 3B is appropriate, please direct it to fhe attention ofi the -writer -and --- ---- include a reference to the captioned insured, location, policy number,. date of loss and claim or file number. On this date, !caused copies of this notice. to be sent to the persons named above at the addresses indicated above by first class mail. Cl '� s Adjuster ate Date ,�/�. A !� .A.. . h 3� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..:"":.. ............... . has permission for gas installation .............. in the buildings of . _//I F - k J0 1 ........................ . i at .. ........... .... , North Andover, Mass. Fee. -)..':.. Lic. No. IP7.3 ti ... ... ... -� cn..._-.._ ..... . % GAS INSPECTO� Check # f I l 7 5466 MASSACHUSETTS UNIFORM APPLICATION FOR, PERMIT TO 00 GASFITTINGC%! 1Pr1nt Or eI --�._ Mass. Cate r 20 Bidld rng L tion ' P t f 6 r 9 owners me , !4: Type of Occupancy Newo Renovation() Replacement Flails Submitted: Yes p No D MIA Check . one a Corporation isiness Telephone --U 0 Partnership rene of Licensed Plumberor0as Fitter , , �y ,� - lnnoto. certificate 1,WWx% WVWW %,WV=KMAz: - have a eurT'etttll ility Insurance policy or its substantial equivalent; which meets the requirements of MGL cry Yes No 0 942. f! you have cheeked yes, please Indicate the type of coverage by eheeking the appropriate box. • Viability Insurance policy &/ Other type of indemnity p now 0 >WNEWS MURNME WAIVER 1 am aware that the licensee does not have the insurance coverage required by t hapter 142. of the Mass. General Laws, and that my signature on s Pe 9011clltion Waives this requirement Vniture of owner or. wne s Agent Check one; Owner p Agent p !Aeby certify that w of the details and Information I have submitted (or anteredl In above a plication are true and accurate to the best of knowledge and that all plumbing wort and Installations performed under the perMt r this application be In compliance with pertinent provisions of the Massathssetts State Gas Code and Chapter 942 of the o L Type of license: Sr p Plumber re o cense Flu er or G as F tter Tak 0G=Rtter chyfrown GAJ118ter Lkense Number 9c3 AFMOVED (OFFICE USE ONLY) 0 Journeyman E 4 3