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Home My WebLink AboutBuilding Permit #823-15 - 1211 OSGOOD STREET 5/1/2018 NORTH i I� FIJI BUILDING PERMIT �y J �oh�t` 3 TOWN OF NORTH ANDOVERe4 APPLICATION:FOR PLAN EXAMINATION p 9 t Permit No#: D�J��J Date Received Q�gA7ED PPP`•(� gSSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 1 m _ _ Print PROPERTY OWNER Hoyy, `O Print 100 Year Structure yes no MAP 6�5 PARCEL-161)0'? ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial [iteration No. of units: Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: T)`tV dlttoci Walks to �l Identification- Please Type or Print Clearly OWNER: Name: �'1lriS�P.r� MG\l C,vi Phone: BC)9-_j28t:�:> Address: 2q facod HLOeg i t 3 Contractor Name:a,cO LaoIJx }-Phone: (q _" b l tic Address: HCA'V�: V' 0+ Ol Supervisor's Construction License: Exp. Date:--' Home Improvement License:._. Exp. Date: ARCHITECT/ENGINEER Phone: ` Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F_ Total Project Cost: $ 3byo FEE: $ �3�• Check No.: 1I y6-" Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE F SEWERAGE DISPOSAL public Sewer ❑ Tanning/ 4assageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ I COMMENTS i CONSERVATION Reviewed on Signature � COMMENTS HEALTH Reviewed on Signature COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments _ - ,- Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: FFE -- - Located384 Os oodStreetARTMENT - Temp Dumpster on siteyesno 24 Main Streetrtment signature/date TS - ; Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) � J -w - o ❑ Notified for pickup Call Email 3 Date Time Contact Name Doc.Building Permit Revised 2014 I i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑, Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 N Location -��No. � Date . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ 3� Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ 3d Check# ' 6f Building Inspector Of NORYH 1N • O ♦ r �J7 O4n°r•i19 SSAC f CERTIFICATE OF USE & OCCUPANCY - - -� - -- TOWN OF NORTH ANDOVER Building Permit Number 823-15 on 4/21/2015 Date: May 6, 2015 'f THIS CERTIFIES THAT THE BUILDING LOCATED ON 1211 Osgood Street—Unit 2A MAY BE OCCUPIED AS The Soul House- tenant fit up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Kristen McVey 1211 Osgood Street North Andover, MA 01845 Bu lding In ector Fee: PrePaid $100.00 Receipt: 28663 Check : 1145 I OE�•oTr��H s r 3�8�[NU`'fi49 CERTIFICATE OF USE & OCCUPANCY ---- ----- --- ---- _ TOWN OF NORTH-ANDOVER Building Permit Number 823-15 on 4/21/2015 Date: May 6, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1211 Osgood Street—Unit 2A MAY BE OCCUPIED AS The Soul House- tenant fit up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Kristen McVey 1211 Osgood Street North Andover,MA 01845 Bu lding In ector Fee: PrePaid$100.00 Receipt: 28663 Check : 1145 � NORTk Town of E �, ndover No. * , _y kh ver, Mass, COCNIC Ile W.cu A04ATED S ll BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System � J'v rl, "�yjl /� BUILDING INSPECTOR THISCERTIFIES THAT ......... .. .. ........:...:......... :...:...... .... .................................................................. ' r y /fs? =`�� Foundation has permission to erect .......................... buildings on .......d .� . ..... :: %: :�:. �:�` :........�� e:... tobe occupied as ................................................ ............................s.....Ve.............................I............... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application I ina"I %Q A 5/,/,, on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and 1 Construction of Buildings in the Town of North Andover. PL MBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION; STARTS 4V Service � ...........�::....:.��?' s3. .' .:. .ti.................................. Final y BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. �ry �� S NORTH Town of E 1, Andover j\ No. * ,� h ver, Mass, CCICNICNIWICK 01" BOARD � 7d 'rE D 01 7S V BOARD OF HEALTH Food/Kitchen PERMIT T LD j� Septic System THIS CERTIFIES THAT ........., d:'.!.�f.. r'.>.:... C.(/.. . . BUILDING INSPECTOR ................................................................. _ o � has permission to erect .......................... buildings on .......ZFoundation&/.... :5��.. ! C✓'assl�� - � /rl� /—(t� C� �I OtJ /7dvSf !� Rough C / uh tobe occupied as ................................................1.'�.........'..�.......rl....1.............................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTSRough ........................ Service ........... ...... �..ar. .......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements ofthe state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name Company Name Vri L a- Street Address(do not use a Post Office Box addr s) Contractor/Salesperson/Owner Name 12t\ Stir o iZ City/Town State Zip Code Business Address(must include a street address) a rZ w i h Y N. MrM Daytime Phone Evening Phone City/Town State Zip Code 2 WA&W Rij C17 3 3 Lei c.p 2 Mailing Adaress(It different from above) Business Phone Federal'Employer ID or S.S.Number Home rmpmvement ConmwdorRee.Nmnber Expirationdate Dl Iaw requires that most home 1� --v YY •, v Improvement cantmctors have a valid registration number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) ev�_1 cW4\d1 d��idlthG weu1 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowners agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,famish the material and labor specified above for the total sum of M Payments will be made according to the following schedule: $ upon signing contract(not to exceed 1/3 ofthe total contract price or the cost of special order items,whichever is greater) $ by / / or upon completion of $ by_/ / or upon completion of $ upon completion ofthe contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warrantv being provided by the contractor? ❑No❑Yes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor leder this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make slue the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy ofthe Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you noti contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later dnight of third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation o DO NOT SIGN THIS CONTRACT IF THERE ARE ANY PACES!f! Two identical copies of the contract must be completed and signed.One copy should go to the homed we( copy should o kept by due contrac *" Homeowner's Signatur (7pntractor's Signature I � IIaI� Oct. /7 - Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 142A- Homeowner's 42AHomeowner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the temis of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http://www.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/honleiinprovement/licenseelist asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 HSK PROPERTIES, LLC 1211 OSGOOD STREET, NORTH ANDVOVER, MASSACHUSETTS 01845 March 20, 2014 Town Hall Building Department North Andover, Massachusetts 01845 To Whom It May Concern: Please be advised that Kristen McVey and Victoria A. Ross, dba The Soul House, have permission to obtain any permits necessary to begin build out work on a space at 1211 Osgood Street. Her contractor is Shane Gannon of Gannon Built. We thank you for your attention to this matter. Very truly yours, HS P OPERTIES, LLC t' Harry Kanellos Manager AC40PREPCERTIFICATE OF LIADATE BILITY INSURANCE 0411 20 5' i / THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements). PRODUCER CONTACT NA E: Jerrold Itamera8 ALLAN INSURANCE AGENCY INC. PHONE (97B) 745-5905 jAIC Not.,FAX (978) 745-5483 63 1/2 Jefferson Avenue 2nd Floor E-MAIL .Jerrold@allaninsurance.com P.O. BOX 511 INSURERS AFFORDING COVERAGE NAIC 0 SALEM MA 01970-0511 INSURERA:Assoicated Ind Ins Co INSURED INSURER B:Safet Insurance Co TGLRC INSURERC:National Union Fire IIIc Co. dba: Lambert Roofing Co. INSURERD:Ace American Insurance Co. 265 Winter Street INSURERE:Ace American Insurance Co. Haverhill MA 01830- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 VVHICH 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDLSUBR POLICY EFF POLICY EXP TR TYPE OF INSURANCE POLICY NUMBER M Y) 1MM/DDfYYYyJ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY PR a occurrence) S 50,000 A CLAIMS-MADE a OCCUR S1028029 1/12/2014 11/12/2015 MED EXP(Any one arson) $ 1,000 X Per Project A99 / / / / PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X JECT PRO- LOC / / / / $ AUTOMOBILE LIABILITY f / / / COMBINED SINGLE LIMIT 11000,000 B ANY AUTO / / / / BODILY INJURY(Per person) $ ALL AUTOS X SCHEDULED 203819 BODILY INJURY(Per accident) $ X HIRED AUTO ri AUT SWNEO 7/16/2014 7/16/2015 PPROPERT DAMAGE ar accoent) $ X UMBRELLA LIAB X OCCUR BE18430331 / / / / EACH OCCURRENCE $ 51000,000 L., EXCESS LIABCLAIMS-MADE 11/12/2014 1/12/2015 AGGREGATE $ 5,000,000 DED RETENTION$ / / / / $ WORKERS COMPENSATION STATU- OTH- AND EMPLOYERS'LIABILITY YIN X ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? � N I A D (Mandatory In NMI S62UB-2509875-2-14 MA 3/25/2015 3/25/2016 EL.DISEASE-EAEMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below / / / / E.L.DISEASE-POLICY LtMiT $ 11000,000 W Worker's Compenstaion NH S62UB-SD81311-6-14 NH 2/22/2014 2/22/2015 same tmitsas 1,000,000 policy above 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION TGLRC dba Lambert Roofing SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 265 Winter Street AUTHO REPhE ENTATIVE Haverhill MA 01830- ACORD 25(2010/05) ©1988-2010 ACORd CORPORATION. All rights reserved. INS025(2oloasyo1 The ACORD name and logo are registered marks of ACORD Board of Bwld�!a R-1, '* a^ . t•� c'.. y ' CS478130 RICHARD 3 LAIV llBRT Aka 265 WEMR STREET Haverhill MA 01930 ' rpt' ' � i.� ;r•� r . , � �r / � �� %�`• Office.of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149221 Type: Private Corporation Expiration: 12WO15 Tr# 246813 T.G.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Update Address and return card.Mark reason for change. F] Address E] Renewal M Employment M Lost Card - ---- �.- BUILDING Date oya/Z.V.... 10375 F NCNTN� �. TOWN OF NORTH ANDOrVER to D PERMIT FOR PLUMBING ss4c►+u5� //�� This certifies that.......3;�l.......!?V�j�y.................................................................... has permission to perform.....-5 ^ -�H S��`t`';�.................. . ...... ... plumbing in the buildings of....................................5 5+�4 �,�l.<�6C North Andover, Mass. 9o,.s0 ' Fee......................Lic. No. ......�.3�...... .............. .. . . �:��y�!,�........................... 7 YPLUMBING INS�R Check# 1-9 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -fro CITY _ MA DATE PERMIT# JOBSITE ADDRESS OWNER'S NAE _ P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONAL © RESIDENTIAL Ll PRINT CLEARLY NEW: RENOVATION:© REPL CEMENT: Eq PLANS SUBMITTED: YES NO© FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM t j j J .-__ DEDICATED GAS/OIL/SAND SYSTEM __._ I _ DEDICATED GREASE SYSTEM ( _ . _� ( ! _..� ( j } � _-_-_( _I ( DEDICATED GRAY WATER SYSTEM t DEDICATED WATER RECYCLE SYSTEM f DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE MOP SINK TOILET URINAL WASHING MACHINE CONNECTION # _ I . ._ _..-- J== WATER HEATER ALL TYPES WATER PIPING f . _ j I OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ( NO El IF YOU CHECKED YES,PLEASE INDICATE E TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND OWNER'S INSURANCE WAIVER:I a, aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: 0 R Q AGENT 10 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding th's"applica' n e rue an a urate t the st��oo�f"my knowledge and that all plumbing work and installations performed under the permit issued for this app' ation e n mplia ll -erti rLt.pfovision of the IMassachusetts State Plu ng P ode and Chapter 42 of tP General Laws. PLUMBER'S NAME _ LICENSE# ( SIGNATURE IMP JPCORPORATION #©PARTNERSHIP LLC�I#( CO PANY NAME ( ADDRESS oo CITY STATE ZIPQ/ TEL — 6 FAX CELL Iy� .e The Commonwealth of Massachusetts - Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston,MA.02111 www.mass gov/glia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeAly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E:] I am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.FJ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 requiredunder 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 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. I do Hereby cert&under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official 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 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Date.....Q.........3............................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ss�cSHU This certifies that ........P.. ....... .......................................................... has permission for gas installation ...4o.c4....S.. ...................1.e in the buildings of..... . ?.fit ...............6*- .............. at ...0s15�6 s ................................ /North d ver, Mass. Fee..&.!�f�.... Lic. No. ..9N ...... ....Z . .... GASINSPEC�TO Check# -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i . CITY _ MA DATED PERMIT# JOBSITE ADDRESS OWNER'S NAMt GOWNER ADDRESS ]FAxJ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:[3. RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO E3 APPLIANCES 7 FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER _ - CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE - GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER i WATER HEATER �� l l-- __ _ 1 --- - ►` OTHER I INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO �l IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COV GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY (�( BOND E-11OWNER'S INSURANCE WAIVER:I am aware that the lice see does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [-1 AGENT .0_1j SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this applicatiorf are true a accurate t estfiiykfiowlddge and that all plumbing work and installations performed under the per it issued for this application will LY6 in comp i Ee WRIJ ne t proves�dn f1he Massachusetts State Plumbing Cod nd Chapter 142 of th enerl Laws. e PLUM BER-GASFITTER NAME LICENSE# SMA RE MP MGF�� JP© JGF 0 LP91 Q CORPORATION # PARTNERSHIP El#=LLC[J# COM.ANY NAME: �_ _ ` DRESS CITY TATE Maj ZIP TEL - - G _ FAX - CELL EMA - - — - -- - - The Commonwealth of Massach use Us Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A Please Print Legib, Name(Business/Organization/Individual): kv I r" h,_4c, Address: — City/State/Zip: Phone#: G krf you an employer?Check thappropriate box: Type of project(required): 1. am a employer with ` 4. ❑ I am a general contractor and I 6. Now construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling ship and'have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. ElWe are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.[J Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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-- ,ztc� G„ Policy#or Self-ins.Lic.#: Expiration Date: S —3c - Z-K Job Site Address: 00 d J • 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 requiredunder 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 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 Covera a verification. I do 11erebycertify and ain tie of e ry that the information provided above is true and correct. - � z Bimature: j Date: ^/ Phone#: l� Official 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 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: The Commonwealth of Massachusetts City\Town of North Andover Certificate of Inspection In accordance with 780 CMR,Chapter 1 (The Sixth Edition of the Massachusetts State Building Code) and Chapter 304 of the Acts of 2004 (an Act to further enhance fire and life safety),this temporary certificate of inspection is issued to the premise or structure or part thereof as herein identified. Identify Name of Establishment Certificate No. Issued to BAKED 385-14 1211 OSGOOD STREET Certificate Located at Expiration March 2015 Use Group Allowable Classification(s) RESTAURANT/BAKERY Occupant Load 10 SEATS Certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall allow for the temporary use as herein described and in conformance with any and all conditions as identified below. It shall be framed behind clear glass and\or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or,tampering with the contents of the certificate is strictly prohibited. Conditions of Temporary Use Name of Municipal Andrew Meh-dkas,Fire Chief Name of Municipal Gerald Brown,Bldg. Insp. Date of March 5,2014 Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of March 5,2014 Fire Chief Building Commissioner Issuance 1 C C C 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,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 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 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)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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. 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/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)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. A new 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 burn 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 Commonwealth ofMgssachvsetts Department ofin.dustrial Accidents Office of~Investigat ions 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-8777MASSAFF Revised 5-26-05 Fax#617-727-7749 WwW.mtass,govfdia ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTIO OTES Yes No �- " -1 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Date. 2'�.`'...�... .... TOWN OF NORTH ANDOVER f p . * PERMIT FOR WIRING ♦ i � k BSACHU This certifies that ................................``.__........................................................................ has permission to perform`!ep-.. P X n wiring in the building of.....'!y► ti✓a� t- !`� 11 MM ((�� .......................................................... ................... af........).2..�� t�J�-,vxiJ.....................................�a Q ......, Andover,Mass. v Fee.1.2.5 .......Lic.No........ ....... ........ .. . ... CAL IN PECTOR Check# 1 ri Commonwealth of Massachusetts Off pial Us only t Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN.INK OR TYPE ALL INFORMATIOA9 Date: Z`5� City or Town of. NORTH ANDOVER To the Inspector of Wires.- By ires.By this application the undersigned gives notice of his or her irate on to perform the electrical work described below. Location(Street&Number) Owner or Tenant &r ?x N rd L-1-C, Q;L4-J Telephone No. r!77 6Y-Z Owner's Address 901A-C_ Is this permit in conjunction with a building permit? Yes V No ❑ (Check Appropriate Box) Purpose of Building LimaUtility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service mps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1A 4ti _ k h i r 0 "V�e-k(' Completion of thefollowing table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- Elo.o mergency Lighting rnd. rnd. R##ery Units 1 No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ""' ...........'' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: .11 Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent • OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) . Work to Start: LMILId Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such covera e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE V BOND ❑ OTHER ❑ (Specify:) I certify,under the ns and penalties perjury,that thein ormation on this application is true and complete. f FIRM NAME: , c1 LIC.NO.:�IZr Licensee: Signature LTC.NO.:Jj7d,--� (If applicable,enter "exempt"in the license nay ber line.) Bus.Tel.No.: Address: Alt.Tel.No.:- *Per M.G.L c. 147,s.57-61,security wor requires Department of Public Safety"S"License: Lic.No. • OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. 1 am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. 1 El Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass EN Failed Re-Inspection Required($.) ❑ Inspectors Comments: _ J Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed Re-inspection Required($ Inspectors Comments: MWAL ,,( Inspectors Signature: Date: ti ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Commen Inspectors Signature: ate: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com Ir The Commonwealth of Massachusetts r Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): Address: City/State/Zip: l?f�-Q- 1l� Phone#: f SSS' J 5 Are an employer?Check the a opriate box: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. . 9 E]Building addition [No workers'comp.insurance 5. El We are a corporation and its 10.El Electrical repairs or additions required.] officers have exercised their 3.El am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs - insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *.Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. :Homeowners who submit this affidavit indicating they ate 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 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 civil penalties in the form of a STOP WORK ORDER and a fine dup 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. Ido hereby cert d the s a d penalties ofperjury that the information provided above is true and correct. Simature: Date: z - 2 - Phone#: Official 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 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: I 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,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 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 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)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 insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of r 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/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)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. A new 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 f (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 Commonwealtk of Massachusetts Department of Industrial.Accidents Office of Investigations 6.00 Washington Sixeet Boston,M,,A,02111 Tel,#617-727-4900 oxt 406 or 1-877 MASSAFE Revised 5-26-05 Fax#617-727-7749 v WW=ss,8QV1 la. :: 0[VIMONWALTH OF M :SAC'H11S17T i E:47I "I 0=1 ANS g I-SSUES T;HE FOL�LOW11 G'iT u z AS.: A REG .1 OURNEYMAN ELECrR IAC I f t Q I .1QSEPW W PENNEY 3 DAN l 9`L,: ti W ;<; tti'EHAM . #1 021..80-1 97 ' 26 8 E 07'%31/16, 2go4g �� ., x COMMONIGI/ AL; H OF MA$S OHUS��TS��- f 1' BOA [�ECE11 If AN5 ISSU+ES TWE F03LLOW1 NG 'AS, A I C�� 1 D 'MASTER RLEC P tW4.El ELECYR9 Clt COR-P z t7 3 ANC ? St��lE1'AM h#A 021$0 1g7 . 1 14'.1 Pr 0 /311 ! 2go5p 4 CONTROL# i 0 X453 IMPORTANT J ' If your license is lost needs to b ,damaged or destroyed;is inaccurate;or e corrected,visit our web site at.mass.gov/dpl for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. p This license is subject to Massachusetts General Laws and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law.Kee this license on your person or posted as required by law and/or regulations. p CONTROL# IMPORTANT If your license is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit our web site at.mass.gov/dpl for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws andregulations.Your license is a privilege,and cannot be lent or p this assigned to any person or entity under penalty of law. Kee license on your person or posted as required by law and/o { regulations. r � . \ /« /\ ! A . r d \ � w �\ � ] . i - \ 9, \ . \ . / �� \ .\ . J ! ��> \ z/y § �� } �2 . �� { Location No. b2z — (q v Date i r, l • - TOWN OF NORTH ANDOVER " S�fT�FD16v� • • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ . Other Permit Fee $(.Dc) TOTAL $ Check# �� —?;4 Building Inspector poRrN O�tt�Eo r6sq�0 3? h 6 oc o 'w TOWN OF NORTH ANDOVER � c e" � pV� `oc"Ic"l—cm 'V, SIGN PERMIT ��SSgcHus�� DATE: January 31, 2014 PERMIT: 022-14 THIS CERTIFIES THAT 1211 Osgood Street LLC, baked has permission to erect two signs on_1211 Osgood Street 1-Exterior Wall 36"x120" "baked" 2- Pylon Sign 16"x110"x3/4 Panel "baked" provide that the person accepting this Permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section #6, Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED (:� "�Lc__ _ Inspector of Buildings Amount Paid:$60.00 Check 69055711-7 Receipt 27269 " e6 SIGN PERNIIT APPLICATION 1600 Osgood Street-Building 20, Suite 2035 Map � 5 TOWN OF NORTH ANDOVER � / Parcel � 2 �.( • DATE SUBMITTED Site Owner �Z 1 1 OSStcDu rf 4.L C Applicant T2xrnaY-u L C Tel Site Address—U, 1 c�S � �7. �,�e Size of Proposed Sign (� X O�1 Y 7CA, INTERNALLY ILLUMINATED SIGN PROHIBITED How attached: a)Against the wall b)Roof Illumination: a�P Tot illuminated 6e,,2r ound b)Externally illuminated Other 5 i l Materials: Proposed Colors: Background �` n Lettering Border �.,., GL-A- Required Attachments: Photographs of building Note: No permanent/temporary sign shall be erected, or enlarged until an Material sample application on the appropriate form furnished by the Sign Office has been Color sample filed with the Sign Officer containing such information including Site or Plot Plan(Required for all free-standing signs) photographs,plans and scale drawings, as he may require, and a permit Drawings of proposed sign for such erection, alteration, or enlargement has been issued by him. Other, specify Such permit shall be issued only of the Sign Officer determines that the sign complies or will comply with all applicable provisions of the By- Law. Will sign overhang any public road or wallcway Yes ( ) NoC If Yes,Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: ATURE P ICANT i > 4 4 Allstate ��1 I 77777-T'77�7 4+w4 A 7 ............ 110 in C: c T Sherwin Williams Commodore Blue o Baked date 1/21/14 THE au, �CENTER by K Hansen ,tea sign center 1211 Osgood St, North Andover MA file name Baked Tenant Panel.plc 40 ORCHARD STREET,HAVERHILL,MA 01830 ME Sales Associate Matt Rothwell details 16" x 110" x 3/4" Panel for D/F Sign 3/4" Raised Black Border Dimensional Letters ' r SIGN PERMIT APPLICATION 1600 Osgood Street-Building 20, Suite 2035 ,l TOWN OF NORTH ANDOVER Map Parcel toe y DATE SUBMITTED I 1 Site Owner � A- L L C- Applicant i:�x C Y)a Y-0 LLC Tel y3� Site Address i Z ` OScxc�c�• SA-Aj , 6- Size of Proposed Signn�� INTERNALLY ILLUMINATED SIGN PROHIBITED How attached: a)Against the wall b) Roof Illumination: Eotir ated c Ground Exlluminated d) ther_P1Ce Yic� :�,�.1 ✓ Materials: lx--.)ObA Proposed Colors: Background ( ��1 Lettering C am wic),-� YZ" Border Required Attachments: Photographs of building Note: No permanent/temporary sign shall be erected, or enlarged until an Material sample application on the appropriate form furnished by the Sign Office has been Color sample filed with the Sign Officer containing such information including Site or Plot Plan(Required for all free-standing signs). photographs,plans and scale drawings, as he may require, and a permit Drawings of proposed sign for such erection, alteration, or enlargement has been issued by him. Other, specify Such permit shall be issued only of the Sign Officer determines that the sign complies or will comply with all applicable provisions of the By- Law. Will sign overhang any public road or wal1cway Yes ( ) NOR If Yes,Name of Agency who will provide liability insurance: A/M AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: t 4ATURE OF APPLICANT 4 c �- 120 in Sherwin Williams Commodore Blue co co co T O Baked date 1/21/14 am TME�CENTER sign center 1211 Osgood St, North Andover MA designed by K Hansen 40 ORCHARD STREET,HAVERHIU-MA 01830 scam file name Baked Building Sign.Plt Sales Associate Matt Rothwell details 36" x 120" Panel Dimensional Letters i' � . . � � � 3 �� e��- �� p S Y � �_ -� � �- `� i R Fennell Engineering,Inc. 300 Brickstone Square, Suite 201 Andover,MA 01810 978-352-6500 978-953-1500 efax www.e,uginecring-boston.com January 22, 2014 Nabil Re: 1211 Osgood St North Andover, MA—Kitchen hood installation On January 21, 2014 1 personally inspected the installed CaptiveAir kitchen hood model#4824 NH-2.The hood has overall dimensions of 5'x9' and a listed weight of 275 pounds. I inspected the structural design plans for the building by CBI Engineers dated 02/24/05. The plans call for Truss type 1 over this kitchen hood area with a rated capacity of 10 LBS/SF of live load on the bottom cord. The design loading of the building in this allows for 10 LBS/SF of live load to be suspended from the underside of the bottom cord of the trusses. This kitchen hood occupies an area that is 5'x9' or 45 square feet which translates to an allowable load of 450 pounds suspended in this area. The installed hood is less than the design load and is therefore acceptable. The fan on the roof has a total weight of less than 100 pounds and is within the dead load design for the roof and is also therefore acceptable. The installed kitchen hood and roof top fan are acceptable. Si ely, Sea Fennell, PE H OF,y� S p� U & 0. N M i! r� Gas MNELL ENGINEERING,INC. sY SHM7 '1291 OSGOOD ST R.S. 300 brick5tone Square,Suite 20 f cHEaTo 5_3 Andover, MA 018 10 NORTH ANDOVER, MA S.F. DATE FlLE PH:97S.M2.8500 EFAK978.95&IS00 01-22-2014 EW 5'Xg'KITCHEN Q /27!-10" EXHAUST Hppp BELOW m (WEtGHT=275 LBS) NEW ROOF VENT ❑ (WFIGHT=100 LBS INCLUDING DUCTWORK) co co 4'-0" CD N !1 M 1 ih III I a III I in w 0.. co l l I I 26SU W L EL 11 !_L =—=—= ----=-I Il EXIST. EIS .GI DR ROOF I TRUSSES @ I! t Mgss 2'-0"O.C. 11 b?� acs" 1I EA FEN LL J 11 U .4 (1 �FGI t. „ EXISTING ROOF FRAMING CLAN 3 SCALE:1/8"=1'-0" �./ !� r l f Date ,aORTM TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION � r ,SSACHUSEt � 1 This certifies that . . . " .� has permission for mechanical installation �:I-r . ... . in the buildings of (� . i . . . . .'.�. . . . . . . . . . at . . . '':` :r;! 14 North Andover, Mass. / " l Fee. . . . Lic. No.. . � �`�. . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer Joe Commonwealth of Massachusetts Sheet Metal Permit Date L� h � �� J V �✓f J Permit# Ot7 � Estimated Job Cost: Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO i Business License# Applicant License# Business Information: Property Owner/Job Location Information: '' Name: 4ST COAST 4' " Name: 16_51L Street: _ �Q��[Cf� Street: 1 Zl c City/Town: City/Town: � - Telephone: So$-aa1 f - q'Z9 P Telephone: IM' 720- o"1SO Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC Metal Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: ` W k _ l Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating/cooling load calculations Duct work sized per manual "D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean -properly sized filter installed(final inspection) Testing and Balancing report complete(final sign-ofo y - . f .,COMMONWEALTH OF MASSACHUSETTS -1 :SHEET AS.:A MAS R U RESTRRS. ICTED 'ISSUES THE ABOVE LICENSE TO: t DAVip R SERGI 2 :pUR:.LTAtJ AVE =.. E. WARE_NA71 '� . MA 02538.- �350 V28/14. a { EAST CO&SW ................................................................................................................................................................................................................................... 16 Kendrick-Rd. Unit 4 Mass License: CR4613 Wareham,MA 02571 R. 1. License: Pipefittcr/Master 1-#71.36 888-436-5383 Ct. License: 173-40730 Fax-508-291.-4593 dsergi@eastcoastfire.net CONTRACT Date: 10/04/13 Customer: Job location: (if different) Bakery/Restaurant Bakery/Restaurant N.Andover MA N.Andover MA Attn:Nabil Attn:Nabil Phone: 781-820-0950 Payment terms: 1/2 Deposit,Balance on Fan installation.. East Coast Fire & Ventilation will provide and install the following: Installation of Customers 9ft Exhaust hood, exhaust fan, Make up air Plenum All 16 gauge welded exhaust duct work, includes 90 degree elbows 0 Clearance Duct Wrap 2 Flat Roof Curbs Stainless Steel Wall Panel for under hood area and right side only 2 Curb Plates Hinge Kits with Grease Collectors for existing fans Permits and Hand drawings if needed are included Install existing Exhaust fans to roof Installation of Existing Fire System Non union labor for the above is included........................................ S7,250.00 plus tax Please note: Electrical work is by others. Gas work is by others. Roof curbs and wall repair are by others. Stamped Engineer Drawings will be extra if needed 0 New Make up Air Fan $1,695.00 "New Fire Suppression System $2,200.00 ACCEPTANCE TO ABOVE TERMS DATE .I N mmemberr A- mFtMeFAck 04-05 �, � �� •��Gin �� ;� � 1-01 L fL I, i o f a, os oiv�l� I INCANDESCENT LIGHT FIXTURE—HIGH TEMP `j ASSEMBLY, INCLUDES CLEAR THERMAL AND SHOCK RESISTANT GLOBE CESS FIXTURE) FIELD CUT EXHAUST RISER ATTACHING FIELD CUT SUPPLY RISER HANGING ANGLE \ PLATES 2OPEN STAINLESS 1S:TE® 16' ALUM BAFFLE — —` r TEO OIiPERFORATED PANEL W/ HANDLES AND 6" ` HOOK 3' INTERNAL STANDOFF \� — 20" -- , IT IS THE RESPONSIBILITY ' OF THE ARCHITECT/OWNER TO ENSURE THAT THE HOOD CLEARANCE FROM I IMITED—COMBUSTIBLE — 27" MIN --I AND COMBUSTIBLE MATERIALS IS IN COMPLIANCE WITH LOCAL CODE REQUIREMENTS. GREASE DRAIN WITH REMOVABLE CUP 80' AFF TYP. EQUIPMENT BY OTHERS SECTION VIEW - MODEL 54125'ND-2-PSP-F HOOD - #1 JOB SO y DATE --_ u11v� c�` g DATE 9/27/2013JOB# DI/G# 2 DRAWN trY REV. _— SCALE 3/8' HOO INFORMATION - Job r1871� 4 MAX. EXHWPLENUTOTALHOOD CONFIG. HOOD TAG MODEL LENGTH COOKING TOTAL SUPPLYEN➢ TON0. TEMPEXH. CFM WIDTH . CFM COwSTRUC(ION ENDR0.✓5412 450 14' 24' 430 SS SND-2-PSP-F Deg. 39002100 ALONE ALONE Where Exposed23612 700 D_ 450 E 54' 304 SSmeg' 0 ALONE ALONE VHB-G IDO% HOOD INFORMATION FILTERS) LIGHT(S) UTILITY CABINET(S)HOOD TAG WIRE FIRE SYSTEM ELECTRICAL SWITCHES FIRE HOOD NO. TYPE QTY.HEIGHT LENGTH QTY. TYPE LOCATION SYSTEH iANGIN GUARD TYPE SIZE MODEL 0 QUANTITY PIPING WGHT ] Alun Baffle w/ Handles 1 16' 16' 4 Incandescent NO NO 547 7 16' 20' _ LBS 2 0 NO 35 LBS FLOOD OPTIONS H00D TAG OPTIDN -� N0. I RIGHT END STANDOFF(FIN/SLP) 3- Wide 54' Long PERFOPATED SUPPLY P ENUM S HOOD RISERS) N0. TAG PNS. LENGTH WIDTH HEIGHT TYPE WIDTH LENG. DIA. CFA1 S.P. 1 Front 159' 20' 6' MUA 12' 24' MUA 12' 3" o - Field Cut 14' X 26" Exhaust Riser U.L, Listed incandescent Light ✓X'J Fixture-High temp Asser,bly I 20" Field Cut Field Cut Field Cut 12' X 24' 12" X 24" 12' X 24" Supply Supply Supply Riser Riser Riser q1 3' Overall Length PLAN VIEW — Hood 13' 0.00" LUNG 5412SND-2—PSP—E IJOTE: Additionol hanging angles provided for hoods 12' and longer. SmLOCATIOP DATE 9/27/2013 JOB# Intl et O ` DWG# 1 DRAWN BY SCALE 3/Q" AIUA IAN INFORMATION - Job#1871654 FAN — UNIT TAG FAN UNIT MODEL N BLOWER HDUSIIIG CFM ESP. RPM H.P. 0+ VOLT FLA 111111T ILES.)SOIdES NO. 1 AI-G1D G10 Al 2275 0.400 812 1.000 1 1 208 7.0 228 15.9 CURB ASSEMBLIES ND. �N1 WEIGHT ITEM SIZE 1 13 LBS Supply Adopter Fron 19.500'sq To 21.00D'sq x 3.000'H FAN #1 Al-G10 - SUPPLY FAN 1, UNTEMPERED SUPPLY UNIT WITH 10' BLOb/EP, IN SIZE #1 HOUSING 2. INTAKE HOOD WITH EZ FILTERS-LOW CFM 3. DOWN DISCHARGE - AIR FLOW RIGHT -> LEFT BLOWER DISCHARGE 7 1/4" —I ' � o 13 ]/4" Us 6 3/8' -' FLEX CONDUIT ED FIELD WIRING — 27 3/8" — 58" 32 1/8' — LIFTING LUG o __ o 1 AIP,FLDW '�—SERVICE AIRFLOW DISCONNECT ��. 29 3/4' SWITCH BLOWER/MOTOR ACCESS DOOR 24' SERVICE CLEARANCE REO. S JOB I� S1Vyy� LOCA T,O. DATE 9/x//2013 JOB# DING# 4 DRAWN a r -— — -- -- --- -- - - ----- REV. — - - -SCALE 3/8" FAN 43 DU50HFA - EXHAUST FAN FEATURES 20 7/ ROO=F MOUNTED FANS A`19 1/2� B -RMOUNT MODEL 19 1/2' AND UL762 VARIABLE - VARIABLE SPEED COIJT RDL INTERNAL WIRING VENTED -WEATHERPROOF DISCONNECT CURB - THERMAL OVERLOAD PROTECTION(SINGLE PHASE) HIGH HEAT OPERATION 300-F (149'C) 20• GREASE CLASSIFICATION TESTING /} NOPMAI TEMP RATU2 TEST 27 1/4 EXHAUST FAN MUST OPERATE CONTINJ3USLY $20 TEELUGE 21 1/2 WHILE EXHAUSTING AIR AT 300'F (149'C) CONSTRUCTION UNTIL ALL FRN PARTS HAVE REACHED THERMAL ERUILIBRIU.M,AND WITHOUT ANY DETERIORATING EFFECTS TO THE FAN WHICH WOULD CAUSE UNSAFE OPERATION. \ \ 3' FLANGE /-GREASE DRAIN � \ / ASNORFIAL FLARE-UP TES7 - EXHAUST FAN MUST OPERATE COIITINUOUSLY / `\ 2 WHILE EXHAUSTING BURNING GREASE VAPORS ` \ / `-ROOF OPENING AT 600'F(316'C)FOR A PERIOD OF \ DIMENSIO�`JS / 73 1/J \ 15 MINUTES WITHOUT THE FAN BECOMING 17 1/2 \ /17 1/2 DAMAGED TO ANY EXTENT THAT COULD CAUSE �/ / 16 1/4 AN UNSAFE CONDITION 32 1/2 ❑PTIDNS - - - - I GREASE BOX PJ PITCH E �i �� FOR PI TCHEDBROOFS.AVAILABLE 1• DUCTWORK BETWEEN EXHAUST RISER ON HOOD 5 AND FAN (BY OTHERS) SPECIFY PITCH: 12' EXAMPLE 7/12 PITCH = 30• SLOPE i JOB -1 _ ,. LOC-- 1 --DWG-# 7 DRAWN BY _ REV. SCALE 3/8"_= P-0" EAST 0454SV FIRE SUPPRESSION SYSTEM r I When a fire Occurs ill a protected area, it is quickly sensed by detectors located in the cluc-lW01,11 e.haust hood. Fire alarm and clectlJCal to he lEf T:c Completed by others 260 36 6 FE�-7'X H�AU-S�'Tl HOOD �OD Manual talion pull S Ewe Mechanical CNI'l VIllve The delecl.ors ,C], the Fv2-1 releasing Illechallisill WhiCh aCtWlteS the system... pressurizing the tD storagethrough aaenf s Liquid suppi-cssajit fjo�vs Chemical is applied directly on t1le fire il) jtank. ]1)1 11 1 cl t �' siLb specific spray patterns... suppi-essillor t1le the Liquid piping to dischal'oe fire in seconds. Job Name: [Datc:- 610 ?L1 3 L Address: N_Q� S S 6-00 1) LIbIlliLtec] To: F ftu,�- Ubmilted To: rclo ' CERTIFICATE O L.€AMILI TY A IE ISSLIE DATL T19S CERT)-JC,'TE IS ISSI'GD AS A i\IATTI;R OF INIr O10LATION ONLY AND CO\'7,IT.FS NO IUGI-ITS UPON Tin:CE7,TIFICAT'I1)IOLDEI2.TIaS i CERTB'ICATE DOES NOT AIrF17L%'LATD,-M.,'OR NEGATII•'ELY Atl'.IEND,EXTEND OR A.I.TEP.TI11:COA7•P AU GE 'FOIiDED BY TIM POLICIES THIS CERTII'ICATE OC 7:\SUP-kNCE DOES NOT CONS TITU L A CONT72-'ACT BET,,T-EN T1 IMISSUIN G' LYSLFLR(S),.\Li T7tORIZED 1 REPI2.LSLNTATII'E OR PRODUCER.AND T111;CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the Policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT \•IASON&,MASON'INS AGCY I NAME: ,ISS SOUTI-I AVE PHONE FAX (AIC.No.Ext). (AJC'No): \AlHITNI AN,IMA 02352 E-NIA!L ADDRESS: LNSLILED INStTtrR(S)AFFORDING COVER.,\G) LAST COAST FIRE c4,VENTIL;,,T[0\ `:1IC I)\'SliiLER 1 7t.•1\%I11sI:SPP.OPEI:1YCASliAI-;il INC M I.VANTY OF AMERICA KENDRICK RD INSLZ.ER 8 `�VAREHAIM,,%U\ 02571 r11sLTtER c INSUtiI.ER D INSURER E INSURER I% COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: i I➢5 IS TO CLRTII'T'TI-LaT nm`POLICIES OP I:ISUR1vU1CL LISTED BELOW MvvT,•P,EEi i ISsU7ED TO THE INSURED NA11M•.D::PO T FOP,7 IE POLICY PEiUOD INDICATED. NOTiTCIIST.A,�7DING ANZ'P.LQL7PSi•LLi+T,TEPu?i OP.CONDITION OF:4dY CONTP s.CT OR OlTIER DOCU1�\'[\'�1T;I PSSPcCT TO\iri•IICi:THIS CL•R77F'IIG '.Cl:,'I:\aJE ISSUED OR AL.Y PFRTAL117,I'IF INSUR-INCE:AFFORDED BY THE POLICIES DESCIUBLD ILEPSIN IS SUPJECTTO ALL'I1IE TER:.iS.EYCLUsIOPIS.AND CONDITIC,NS OP SUC7i I I,_, LIDLIT S IvL'.Y T-L4\T.PEE;:P.EDUCED BY PATI?CLAIMS. 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Open flames, red-hot cooking surfaces, SYSTEM ERS and a heavily grease-laden environment The models BLFR--D5, BFR-10, BFR-15 and B combine to make the modern designated by flow point capacity(so the BFR-50supportss are commercial kitchen a potentially points) instead of the amount of agent they hold. dangerous fire hazard. Kitchen fires supports five (5)flow Recharge is available in 5 and 10 flow point containers T11 spread quickly and have proven to Q'b be very difficult to extinguish, making so there's never a chance of error. them the leading cause of structural fire 's damage in the United States. } Protecting the modern commercial kitchen from the ever-present danger } 3 'Asa y�T� tri Of cook' ng oil and grease fires is the ` }. reason we developed The Buckeye za �� Kitchen MisterTM System. Utilizing A {� state of the art misting technology, the Kitchen blister System has proven to be the most effective fixed kitchen ' ' T-fire extinguishing system ever K 1developed, extinguish'ng potentially5 _ N} deadly kitchen fires fast, before they I 13FR-5 BFR-10 can Spread BFR-20 BFR-15 That's why the Kitchen Mister i BUCKEYE SHIELDED CABLE System is quickly becoming the The Kitchen Mister Shielded Cable Interface is used to connect Buckeye Preferred choice of fire protection ! Shielded Cable to any standard 1/2 inch conduit connection device. The use of Professionals throughout the world. f Buckeye Shielded Cable instead of conduit and So before fire strikes... corner pulleys for connecting the gas valve, ` remote pull station, and fusible link line to the .sem > DQN'T TAKE CHANCES - Systems Releasing Module reduces installation DEMAND THE BES1! time by up to 50%. .. . ; .� ..'? �' �'��t x` •'�� `Ltt b.�'�ix Ti'�i�� r-4�i � A N'�iL ��^��•. .y +�. �ey A� 9-t'i 1"i 0.� ,ter �. I•+1 i!Yi,v rti3;is f@s�s Fala,. avt - r' re.LSiia iz £hy`F'r"i, tr f' i3•. y � t Listed to Underwriters 1 M Asa., y Laboratories, Inc. Standard UL-300 ` =x x F c r t x s rF s*r� '' g' Listed to Underwriters - —M Laboratories of Canada, Inc. 71 Approved bvthe New York City Fire Department COA#5550 �- ,.keyy�r+ •. `.� E Complies with NFPA-96 and NFPA-i 7A Standards o � * x 1 L CE Compliant P LISTED x y • Y u � � � *E aW14Ray .'. - FfA �:� �Te W 7 7'k,. ,� �^��. .� _ a-c t ; V 9' �. � 7, syr i� 7 ,f•"� -�, �.$e� ��.� y, ��.v+ t .±�£*'�y � 4'`a `+EY�<�) DiSCIiAR�E I�IOZZLES =„ All five (5) Kitchen Mister nozzles come equipped with a color identification Banc red, blue, green, white and yellow. This allows for easy identification of the nozzl even when it's Installed in difficult locations such as a duct or plenum area. The nozzle is also stamped with its model number. NO CONDUIT& ONLY ONE ANCHOR NO CORDUDIT _ BRACKET IN HOOD NO CONDUIT REQUIRED REQU By using Buckeye Shielded Cal no conduit is required for systel inputs/outputs.Buckeye Shield PULLEYS No Cable is Listed for the gas valve REQUIRED EQUI4�- __ _e detection line,and pull station. 'ti p NO CONDUIT&ONLY ONE c c — , _ \ - ANCHOR BRACKET IN HOOD The Kitchen Mister System eliminates the need for conduit the plenum and requires only or anchor bracket in the exhaust -- hood. NO CORNER PULLEYS COLOR-CODED REQUIRED NOZZLES �-= Buckeye Shielded Cable I. I eliminates the need for corner pulleys;making installation easy �J and last. COLOR-CODED NOZZLES All Kitchen Mister nozzles have a unique color band for easy identification. SIMPLICITY OF DESIGN ( EASTER INSTALLATIONS DEALER FRIENDLY FEATURES The constant changes and By eliminating the labor-intensive task @ Uncomplicated system design complicated requirements of most of installing conduit, corner pulleys, eliminates design and restaurant systems have made design and detector brackets, the Kitchen installation errors. and installation errors a concern of fire Mister System dramatically reduces Q Installation time significantly protection professionals globally. installation time. reduced. w Innovative design eliminates The uncomplicated design of the The Kitchen Mister System is approved conduit and corner pulleys. Kitchen Mister System all but for use with Buckeye Shielded Cable or ® Advanced detection system installs 1 eliminates design and installation errors traditional conduit and corner pulleys quickly and easily, by combining common sense features for all system inputs and outputs. e Color-coded nozzles for easy and eliminating confusing design This, combined with the elimination identification. requirements. of conduit and fusible link brackets in Flexible piping requirements allow the plenum area, makes installing the for unlimited system configurations. Kitchen Mister System quick and easy. Best coverage in industry. e nnlina R fpr,-to fare trainlnn