HomeMy WebLinkAboutBuilding Permit #Exception - 85 FLAGSHIP DRIVE 6/20/2014Permit NO:
I
Date Issued:
LOCATI
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT:
must
Print
all items on this
16N
Ot,
16 -
PROPERTY OWNER
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
Aew Building
[Addition
7�ne family
Itwo or more family
[Ondustriai
[Alteration
No. of units:
R- ommercial
L!E'Aepair, replacement
L!,;'��ssessory Bldg
Wthers:
lbemoution
ffbther
L!;t-'e-ptic L!Weil
�Wioodplain �-*Oands
atershed District
15vater/sewer
I - —
1, r -,. b
OWNER: Name: P)
Address:
CONTRACTOR Name.:
Address:
Supervisor's I O)ov
Home Improvement License:
Identification Please Type or Print Clearly)
Phone:
Exp. Date:
Exp. Date:
ARCH ITECT/ENG I NEER. 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: $ !0L1Qz7-) F E E: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregi-stered contractors do not have access to^e guaran und
ao
--&f- orAiict
SL&!ature of Agent/Own ��idn�tqre c
Date.4/� ............
TOWN OF NORTH ANDOVER
RMIT FOR WIRING
This certifies that I, X4 (L 00 e /,A-, A_
L/1
.................................................................... ......................................................
- ,
has permission to perform -14
........... ..........................................................................................
IQ;3�1
wiring in the building of ........... ....... P41.!:�%
de
-at ........ ............................. ............... / �le_ 7orth Andover, Mass.
_4 . ........................................ .. . �ft
... i�.i�.�P ��
Fee JY4 .�i ..............
Lic. No2 . . .... .. ................... .......................
E IECTRICAL INSPECTOR
Check4t5�cz
FE 07 -1
"I FE 07 FE 0 r E* 1
Plans Submitted 1011 1 Plans Waived LLIJ Certified Plot Plan I n" I Stamped Plans 1-2j
TYPE OF SEWERAGE DISPOSAL
FE )
- 1
Public Sewer 00 1
FE TI
Tanning/Massage/Body Art 1011
Swimming Pools
I
Well
191
FE 07
Tobacco Sales
FE 07
00
Food Packaging/Sales
Private (septic tank, etc.
Pen-nanent Dumpster on Site
f%
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
F -E0 1 FE01
PLANNING & DEVELOPMENT 11,11 I'll
COMENTS
COMMENTS
Rfl
DATE REJECTED DATEAPPROVED
FE 0 1
HEALTH I'll
COMMENTS
I
I
Zoni I ng Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Driveway Permit
Water & sewer con nection/sicinature & Date
Loc6ted at 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on
Located at 124 Main Street
Fire Department signature/date
COMMENTS
yes no
Diinension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
i
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 21 A —F and G min.$100-$l 000 fine
Doc.Building Permit Revised 2012
Building Department
The follovOng is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
L3 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
• Eh ' gineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
I
• Building Permit Application
• C& ' rtified Surveyed Plot Plan
• Workers Comp Affidavit
• Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Contract
• Floor/Crossection/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 dumOster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
(3 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
I
In all cases it 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: INSPECTION�AL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
12%
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Permit No.
Official Use 0 ly
1'?o 7
occupancy and Fee Checked
tev. 1/071 (leave blank)
AP I PLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code QVEQ 527 C 12.00
(PLUS'E PRDVTINNK OR TYPEALLMFORMATIOA9 Date: — - 7/ ly
: I City or Town of.- NORTH ANDOVER To the Inspector of Wi s:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) F44 41-zo P,, -
Owner or Tenant Ill 14 /'Ct bl -rt'r7
Owner's Address
Telephone No.
Is this permit in conjunction with a building permit? Yes No Er' (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service /0 0 Amps 26' ?c6 Volts OverheadEl Undgrd No. of Meters
Overhead 1:1
New Service Amps Volts
Undgrd n No. of Meters
Number of Feeders and Ampacity
Loc ation and Nature of Proposed Electrical Work: A"91-Qce �-!fz
Comnletion of the following table mav be waived bv 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
Above Ej In
Swimming Pool grnd. grnd.
IN o. of Emergency Lighting
Battery Units
No.,'of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
IN'o. of Zones
No.,, of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No.. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No,' of Waste Disposers
Heat Pump
Totals:
I Amhtr..P�M
.........
. IM ...........
...........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local El Mun'e1PPl El Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs - Ballasts
Data Wiring:
I No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail iftlesired, or as required by theinspector oJ Wires.
Estimated Value of Electr ork: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE EOVERAGE: nless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation7' coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CiiECK ONE: INSUR-A-NCE P�r iONDE] OTBER 0 (Specify:)
I
leertify,tinde.viliepainsandpena iesofrnerjur rination on th is application is true and comp7ete.
FIRM NAME: eee, y, th at th e info LIC. NO.: Ov
Licensee: IP07—etecX J,1 e, -,l J�L Signature
LTC. NO.:
&applicable, enter ex p in the license numberAine.) Bus. Tel. Nol
Address: ', - A I
w Alt. Tel. No.:
Per M.G.L c. 147, s. 57-6A, security work requires Department of Public tafety "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. I am the (check one) D owner [I owner's agent.
Owner/Agent �2
Signature Telephone No, ARWT FEE.-$ k6
2012 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.
El 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.
0 Rule 8 — Permit/Date Closed: Note: Reapply for new permit 0
0 Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass M
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass M
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass F?1
Failed
Re- Inspection Required 13
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass M
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
FINAL INSPECTION:
Pass M V
Failed
Re- Inspection Required 0
Inspectors Comm'. s:
Inspectors Signature:
Date:
DEB WEINHOLD ... TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com
U
-cx The Commonwealth ofMassachusefts
F U-nartment nf hidustrialAccidi�ts
Of
.rice of Investigations
600 Washington Street
Boston, MA 02111
vwW'.mass.gov1d1a
Workers' Compensation Insurance Affidavit: BufldersfContractors/Ele,etricians/Plumbers
Applicant Information Please Print Leizib
NaMo (Business/Organization/7ndividual): e:w r, o -,-d
9 laqK4 ulf�-?
city/state/zip: Phone #:—V 7c6
Are you an employer? Check the appropriate box: -
Typo of project (required):
El I am a employer with
4. D I am a general contractor and 1
6. D Now construction
. .9mployees (fiffl and/or part-time).*
have hired the sub -contractors
listed the
7. D Remodeling
2. al am a 9 ' ole proprietor or partner-
ship and'have no employees
on attached sheet.
These sub -contractors have
8. D Demolition
workinj for me, in any capacity.
workers' comp. insurance.
I
9. DB�Uding addition
[No workers' comp. insurance
5. D We are a corporation and its
I O.&Iectrical repairs or additions
required.)
3. D I am a homeowner, doing all work
officers have exercised their
right of exemption per MGL
11 - D Plumbing repairs or additions
myself. tNo workers' comp.
c. 152, § 1 (4), and we. have no
12.Q Roofrepairs
insurance required.] t
employees. [No workers'
13.D other
I I
comp. insurance required.)
'Any applicant that thecks box #I must also fill out the section bel(5w showing their workers' compensation policy information.
T Homeowners who iubmit this affidavit indicating they ge doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors that checkthis box mustattached an additimal sheet showing the name of the sub -contractors and their workers' comp. policy information.
lam an employer that isproviaing workers'compensation insurancefor my -employees. Below is thepolley andiob site
information. A
Insurance Company
J_ Y� 5 C, ecfn C ir__
Policy # or Solf-ins. Lic. 9: U/ 0 Z7 Expiration Date:
fob Site Address- IeL(l 6, U\, 0/1 ._,City/State/Zip:
4ttach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
lailure to secure co'verage as requiredunder Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a day against the, violator. Be advised that a copy of this statement may be forwarded to the Officeof
'Investigations of the DIA for insurance coverage verification.
I do h eriby cerfi&jlof i der A e pains an d p enalt, w* of onnation provided above is true and correct.
perjury that the inf
?C,)
Sign Date: 6
Phone#: C71
Official use only. -Do not write in this area, to be completedby city or town official
I
Citv or Town: Permit/License
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. I'lumbing Inspector
6. Other
Contact Pers
Phone
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "....every person in the service of another under any contract ofhiro,.
express or implied, oral or written."
An em
wloye�js defmed as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the, foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an idividual,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 ofthe
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 lo'cal 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 requ lired."
Additionally, MGL chapter 15-2, §25C(7) states "Neither the commonwealthnor 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 chapterhave beenpresented to the contracting authority."
Applicants
Please fill out the workers, compensation affidavit completely, by checking ffie boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are notrequired to carry workers' compensation insurance. If anL1_C orLLP does have
employees, a policy is required. Be advised that this affldavit maybe submitted to the Department of Industrial
Accidents for confirntationof insurance coverage. Also be sure to sign and date'the affldavit. The affidavit should
be returned to ffie 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 printedlegibly. 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.
Pleas ' e be sure to fill in the permit/license number which will be, used as a referenc.e number. In addition, an applicant
that Must submit multiple permit/licenso applications'mi any given year, need only submit one affidavit indicating current
policy information (ifnecessary) and under "Job Site Address'� the applicant should write "all locations in -(City or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the
applicant as proof that a valid affidavit ii on file for fature permits or licenses. Anew affidavit must be fffleLd out each
year. 'Where a homeowner or citizen is obtaining a license or -permit not related to any business or commercial -venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.'
The Office of Investigations'would like to thank you in advance.for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwalth of Massachi�setts
Depaxtraeut offadustdal Accidents
Office of 111vestigatio-m
600 Waftgton Street
BostonMA02111
Tel, # 617-727-4900 oyd 406 or 1-877,MASSAFF,
Revised 5-26-05 Fax # 617-727-7749
m
LIUt:NbUNUFVIt$LHT�b1, �LAVIHAI IUMUAI L"
CiO I -� �� � I C(�
10
4L
Town of North Andover
BUILDING DEPARTMENT
CONTRACTOR AFTER HOURS REQUEST FORM
d sc-, L t (
CONTRA4tTORS NAME: _1,eae)a r ( f -/q
ADDRESS:
CITY/TOWN: STATE: ZIP:
BUS. PHONE:'
CELL: I �?& �6 / i��_7161_
MA. LIC #!. MASTERS: ?_C9 5� 5-119 JOURNEYMANS:
PERMIT #
N -GRID SR#
72 !!M
3 OF
REQUESTED DATE:
6119 —TIME:
JOB LOCATION:
MWEIM
PHONE:
ao, I
2
WORKERS CELL:
REASON FOR REQUESTED INSPECTION AND JOB DETAILS:
kepl,Lce_ At7iel' 'L)6 J1 -e7 ckt-7�&_ �,c_,tS
CONTRACTOR SIGNATURI
NOR TH AND 0 VER S UPER VISO)? SIGNA TURE:
Contractors requesting INSPECTIONAL SERVICES due to weekend or after hour operations
such as service related planned updates or special situations, will be required to provide a four
hour minimum charge of $150.00 paid to the Town of North Andover at that time.
(omm6nity Development Division, 1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9545 Fax 978.688.9542 Web www.town of n ortho n dove r.com
�0
.00
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............. NTEr ........... Y. � 761i.. ......................
has permission to perform ....... ........
wiring in the building of ....... C ........ ,5 ................................................
at ..... 9 ............ ................. . North Andover, Mass.
07 774.C-
...... Lic. No..A.7.7,0 ............... k. �—ve.. zee'.'.
Check # ELECMICAL MpEcro
6 F0 67
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. 6Fb-7
Occupancy and Fee Checked
,[Rev. 9/051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PPJNT IN INK OR TYPE ALL OR Date:
2-7
City or Town of- �JOW W;MV1 To the Inspector of Wires:
By this application the unders igned7 gives notice of his or her intention to perform the electrical work d 'bed bel7w.
E
L
Location (Street & Number)
Owner or Tenant r
N jC /'A/ Telephone No.
Owner's Address 2L" -c' I -,,-
is this permit in conjunction with a building permit? Yes V No E] (Check Appropriate Box)
Purpose of Building 00;irz— Utility Authorization No.
Existing Service Amps Volts Overhead Undgrd No. of Meters
New Service Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion of the followinz table mav be waived bv the InsDector 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
Above F�
Swimming Pool El In- d.
grnd. grn
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARM
nes
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
J.Numpe.r I
Tons!
I KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local 0 Municippi
Connection F-1 Other
No. of Dryers
Heating Appliances KW
Security SVstems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
0.0 No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER: 6VIrLe,
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: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the perfon-nance 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 coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCEE] BOND El OTHER [:] (Specify:)
I certify, under the pains andpenalties ofperjury, that the info d n 16 application is true and complete.
FIRM NAME: LIC. NO.: -7 7(o C-
rM7
Licensee: Signature LIC. NO.: 1 '2 '2 ? 40
(If applicable, enter'exempt in the license number line) Bus. Tel. No.:
Address: Alt. Tel. No.:
*Security System Contractor License required for this work; if &Klicable, enter the license number here:
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. I am the (check one) [] owner El owner's agent.
Owner/Agent
Signature Telephone No. ERMIT FEE.- $
FP J
M
Date.. koi.n I.s.!7� cs� ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... /' .41
has permission to perform ...... r.�f .......
-wiring in the building of ......... kn'.1rug ..................................................
V
at ..... J)A� ................... . North Andover, Mass.
-5-0 17 C
Fee..:5�37*'�—.. Lic. No . ............. ................
Check #I �
6 8 7 8
J
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
PermitNo.4F -?;F
1.
APPLICATION FOR PE - RMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00
(PLEASE PRINT IN INK OR.TYPE ALL INFORMATION)
I Date: 0 '�uqv,54- g"4
� . City or Townof.- N 6WAdvew To the InspectorY)f Wires:
By thi s application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant CA A I's K I VLA eA i )Nv e --I<,, Telephone No.
Owne r's Address ?;�;- ot?,,V4
Is this,permit in conjunction with a blu'ilding permit? Yes No (Check Appropriate Box)
Purpose of Building. Utility Authorization No.
Cd M PLI 40t add
Existing Service Amps Volts Overhead El UndgrdE1 No. of Meters
I
New Service Amps I Volts OverheadEl UndgrdE:l No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
I I WS hl -Y -SV51i, 6-4 A A6&91�V
V
Co letion nf the iollowi 11/1 — A 4 11. 1-
No. of Recessed Luminaires
I r,
No. of Ceil.-Susp. (Paddle) Fans
g . wa e by e spector oj P treS.
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above [I In-
grnd. grnd. 1:1
I Emergency Lighting
Units
No. of Receptacle Outlets
No. of Oil Burners
-Battery
FIRE ALARMS
I
INo. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pum
TotaIST'
!J!"Per
Tons
I
KW
I
No. of SelfConfai�ned
Detection/Alerting Devices
No. of Di*shwashers
Space/Area Heating KW
Local 0 Mumclp�l El Other
Connection
No. of Dryers
No. of Water
Heaters KW
Heating Appliances KW
No. of No. oT_
I Sians Ballasts
Security S stems:*
No. of �`evices or Equivalent
- — -
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
lNo. of Motors Total HP
Telecommunications Wiring.
No. of Devices or Equival . ent
OTHER-,
A ttacn additional detail it desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work:$ 7 3 ov (When required by municipal policy.)
Work to Start: r/I 7 /y � 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 coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [!9 BOND 0 OTHERE] (Specify:)
Icertify, underthepains andpenalties ofperjuty, thattheinformation on this application is true and complete.
FIRM NAME: 1�'OoAikl5e".-he 5;,sipws LiC. NO.: 5-0 9 C
Licensee:r'A4,,,,wQ 63 f G w6nto"' Signature������ LIC. NO.: 9.2
(If applicable,! enter "exempt " in the license nuin ber line) —
Address: Bus. Tel. Noqlic ?,Sy, V-1 V
A I t. T e 1. N o.:
*Security Sy�tem Contractor License require-dfor this work; if applicable, enter the license number here:
OWNER'S I ' NSURANCE 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. I am the (check one) n owner E] owner's agent.
Owner/Agent
Signature , Telephone No. FPERMIT FEE. $
o k e- P- o(a
YO/k-1
ka
A*
Date .........
. .. . .... ...
TOWN OF NORTH ANDOVER
'Vow PERMIT FOR WIRING
This certifies that .... 4�4&2�
has permission to perform ..... <E ... F�t�A '
wiring in the building of ..... . ........................
at ......... --k 5 k
.................. . ................................................. I North Andover, Mass.
Fee.x?
.. ........... Lic. No..../ 41.��2 ............
Check # 7733 �;ZINSPEMR
.' f!
U " 7
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V
7BE COAMOMM4LTHOFAUM, CHUSEM Office Use only
DEPARRfflVT0FPUBL1CSAFETY
BOAM OFFREPREVEMONREGM17ONS527ai IR 12-60 Permit No. 7:�
Occupancy & Fees Checked
UVA
APPUCATIONFORRYtAff TOPEUORMaECMCAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC14USSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Da KIAI;14L
Town of North Andover f I
To the Inspector of wire:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant U_VA 0
Owner'sAddress ��c
Is this permit in conjunction with A 'Iding ermit: Yes [M No M (Check Appropriate Box)
f
2P
Purpose of Building 6-�_44 Cp
C Utility Authorization No.
Existing Service AMPA-08,1 /.�Ovolts Overhead r7 Underground No. of Meters
New Service
Amps volts Overhead M Underground No. of Meters
Number of Feeders and Am pacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Lighting Fixtures
No. of Receptacle Outlet
No. ofSwitch OutFe—ts
No. of Ranges
No. of Disposals
No. of Dishwashers
No. of Dryers
No. ofWater Heaters
No. Hydro Massage 7
OTTIER-_
161
No. of Hot Tubs
0
Swimming Pool
Above
2.)
ground
No. ofOil Burners.
No. ofGas Burners
No. ofAirCond.
TO -68-1
No. of Heat
—Tons
Total
Pumps
Tons
Space Area Heating
Heating Devices
KW
No. of
No. of
Signs
Bailasis
No. of Motors
Total HP
No.
Below f-" I Ge_neratoM
of Emergency
. Total
_KVA
KVA
Battery Units
FIRE ALARMS
Total No. Of Detection and
KW Initiating Devices
KW No. ofSounding Devices
No. ofSelfContained
Detection/Sounding Devices
KW Local r --- I Municipal
Connections
No. of Zones
Other,
ffWrd=UMMga tustw1olnemqROMIS LAW
I Ime a currart Liabilkyhvxmw Poky hixffng Cbmagecrits%hAmtia1eWMkrt YES [� NO
1ha,xmbmi1ledv,Adp=fofsarneiotc0ffi= YES NO Cl
ff�xuhmedxckedYESpkmnk*thetpofmwr.Wbydmkzrgdz
NKRANCE BI)NDF] MIER
EvialicnDde
WcrktoStut FAnmkdVakrdUmftxa1Wak $1
hq)etonD*RqxsW Rmffi
SignedunckrTrPenaftics
CtMawftaoC
FIRMNAME
LkmseNct.
Lio=Nb Mr,
Wi=Td
2 V 76) 71-0. On
_j2o unat AlRef,2- 444 AhTeL�,h —
OWNER'§I-NSLRANCENVAIVER,IammmititheLiomwdamn� theiard=ammWoniss*a3tdeqrrAatzsmILmWbyNbmdtsMCaeailzm
(Please check one) Owner Agent 0 Telephone No. PERMIT FEE
R6.4� (D IVL 0— 1 y —,o (",
(4tcJ L 0
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Location
No. Date
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy
S CHUS Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
Check #
19950
Building lnslie�ctor
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 92 (8/8/06) Date: Januja 24- 06
I THIS CERTIFIES THAT
THE BUILDING LOCATED ON 85 Flagft Drive
MAY BE OCCUPIED AS Tenant -Fit Up
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE
BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Cerfificate Issued to: Christop—h—er King
85 &2ft Drive
North Andover MA 0 1945
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APPLICATION FOR CERTIFICATE OF OCCUPANCY/lINSPECTION
Buildino Permit #
ADDRESS/LOCATION OF PROPERTY: �S �RAG_S�i (D SO i �P_
el�)
Map Parcel Lot Number -0,27,9
SUBDIVISION
DATE REQUESTED FILED/READY FOR INSPECTION tO C) (o
CLOSING DATE ON PROPERTY: -7- ( � - 0 6
FIVE (6) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-
INSPECTION FEE OFITVVENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE
DOES NOT MEET Al PPLICABL CO ES.
SIGNED
ROUTING
CO NS.7 E RVATI 0 N
PLANNING F-1
DPW - WATER METER El
SEWER/WATER CONNECTION
NOTE
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCYIINSPECTION REQUEST
DPW
Signature
File: OC form revised 2006
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DATEE
ACDM. CERTIFICATE OF LIABILITY INSURANCE
PRODUCER (800)333-7234 FAX (09)GSS-81IS3
0
06/127/2006
THIS CERTIFICATE IS ISSUED AS A MATTIEK OF INFORMATION
,EASTERN INSURANCE GROUP LLC
ONLY AND CONFERS NO RIGHTS UPON THE CER11FICATE
233 WEST CENTRAL STREET
HOLDER. THIS CERTIFICATE DOES NOT AMEN D OR
NATICK, MA '.01760
ALTER THE COVERAGE AFFORDED BY THE IES BELOW.
INSURERS AFFORDING COVERAGE NAIC 9
:,,.I
INSURED King Ninting Inc
—=:
20 Aegean Drive - Suite S
INSURER A.- e Beacon Insurance Group 2
Methuen', MA 01944
INSURERB: American Home Assurance
INsuRERc: Ohio �sualty Group
INSURER 0:
VERAGF.S
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN .
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
MAY PERTAIN, THE INSURANCE AFFORnFn nv Tuc,,,, BE ISSUED OR
POLICIES. AGGREGATE
SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
INSR hDD`L
TYPE OF I
WFE POLICY EXPIRATION
LIMITS
GENERAL LIABILR
COM MERCIAL
2006 04/14/2007 EACH OCCURRENCE $ 11000,0001
DAMGE TMENTED $
CLAIMS h
PR nd"irencAll 100,00M
A
MED EXP (Any one person) $ S.0011A
GEN'L AGGREGATE
PERSONAL & ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
--] POLICY nX
PRODUCTS - COMPIOP AGG $ 2 .000,00
2.000,00
AUTOMOBILE LiABI
/2006 04/14/2007
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) $
ALL OWNED AL
1.000,000
X SCHEDULED At
A
BODILY INJURY s
(Per person)
X HIRED AUTOS
NON -OWNED Al
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY
7100113770000
04/14/2006
04/14/2007
EACH OCCURRENCE $ S,000,000
A
7X OCCUR CLAIMS MADE
AGGREGATE $ S,000,000
DEDUCTIBLE
(C) EXCESS UMBRELLA
$ S.000,000
RETENTION
EXC(07)S3363743
04/14/2006
04/14/2007
$ S,000,000
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
WC8942611
06/16/2006
06/16/2007
X I TOCY`TA,.TWU --F
, I OETgH-
B
ANY PROPRI�YOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. EACH ACCIDENT S00,000
E.L. DISEASE - EA EMPLOYE� $ S00,000
tfxes
Ee describe under
S IAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT I I S00,000
$50'0 0. LIMIT ANY ONE ITEM
OT
EAMED/RENTED
7100113770000
04/14/2006
04/14/2007
A
UIPMENT
$19000. DEDUCTIBLE
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
PRISM BUILDERS, INC.
107 AUDUBON ROAD
BLDG I - SUITE #19
WAKEFIELD, MA 01880
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 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
Rosemary Fulham/PMA
k'Cuu Ilua) @ACORD CORPORATION 1988
Uc": QONSTRUCTION SUPEAVISOR
Numberlt� 078126
Tr. nw. 7500.0
MATTHEW R
.19GARDEN,l
DANVERS, R
a
Commissioner
Contract #
CONTRACTOR AGREEMENT Date: 8-1-06
THIS AGREEMENT made and entered into by and between Christopher King, hereinafter referred to as
Owner, and Matthew Genzale hereinafter called the CONTRACTOR, WITNESSETIL
THE OWNER, for the full, complete and faithful performance of this contract, agrees to pay to the
CONTRAC7011, in accordance herewith., the sum of 5% of the contacted value payable in progress
payments as approved, "less retainage"
I In consideration therefore, the SUBCONTRACTOR agrees as follows:
1. To furnish all supervision, labor, materials and equipment necessary to perform all work
described in Paragraph 3 below and in any Addenda attached hereto ', all in accordance with the
prime contract and its addenda, general, special and supplementary conditions, plans and
specifications.
2. Subcontractor shall perform the following work
85 Flagship Drive North Andover
Description: all interior work as shown on plans including AcT, new walls, carpet and doors
This contract is taxable.
3. The CONTRACTOR will pay any and all federal, state and municipal taxes and licenses, if any.
for which the SUBCONTRACTOR may be liable in connection with the labor, materials and
equipment herein, or in carrying out this SUBCONTRACT.
4. To pay for and maintain insurance coverage according to the schedule below, and to furmsh
satisfactory evidence of said coverage to the CONTRACTOR before any payment is made on this
CONTRA&T.
a. Workers Compensation Insurance
Statutory coverage as required by the Commonwealth of Massachusetts
and the state wbere this CONTRACT is performed, if not Massachusetts.
Employer's liability coverage of S500.,000 per accident.
If the CONTRACTOR is a corporation, then the CON*rRACTOR agrees
not to waive coverage for its officers.
iv. If the CONTRACTOR is a sole proprietor, then the CONTRACTOR
agrees to elect coverage for its principals.
Contract #
b. Comprehensive General Liability Insurance
SUBCONTRACT I
V. Limits of $1,000,000 per occurrence and $2,000,000 aggregate.
vi. Coverage including Premises/Operations, Independent Contractors,
Products/Completed Operations, Broad From Property Damage including
Completed Operations, Broad From Contractual Liability.
Vii. SUBCONTRAC7rOR agrees to name CONTRACTOR as an additional
insured.
c. Commercial Automobile Insurance
i. Limits of $250,0005500,000 for Bodily Injury and $100,000 for
Property Damage.
ii. Coverage including all owned, hired and non -owned vehicles.
� Owner: Christopher King
Contractor: Matt Genzale
SUBCONTRACT 2
CCN57RUCTION CONTROL AFrIDAVI'l"
PROJECT NUMBER:
PROJECT TITLE:
�jROJECT LOCATION: Ig f���tpk\ajdo
NAME OF BUILDING:
SCOPE OF PROJECT:
DATE _%tilm
r ,
IN ACCORDANCE W'i.TH SECTION +t9t.� OF THE MASSACHUSETTS STATE BUILDING CODI
MASS, REGISTRATION NO. BEING
REGISTERED PROFESSIONAL t64SW&V#/ARCH1TECT HEREBY CERTIFY THAT I HAVE PREPAREf
OR DIRECTLYISUPERVISED THE PREPARATION OF ALL DESIGN PLANSy COMPUTATIONS AND
4
SPECIFICATIONS CONCERNING:
ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL
FIRE PROTECT10N ELECTRICAL OTHER (speCify)
FOR THE ABOVE NAMED PROJEC11' AND THATP TO THE BEST OF MY KNOWLEDGE, SUCH PLANS,
COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE
I
XASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND
ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT,
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES
AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS '770
DETERMINE THAT THE WORK IS pROCrEDING IN ACCORDANCE WITH THE DOCUMENTS APPRO'
FOR THE BUILDING PERMIT AND SHALL HE RESPONSIBLE FOR THE FOLLOWING AS SPECIF.
I
IN SECTION' 'YAWAWW' 104-2
1. Review of sbop drawings., samp;es and other submittals of the contractol
as requir0d by the -construction cont . ract documents as submitted'for buil-jin
permit, and approval for conforma-nce to the des�qn concept.
2. Review and approval of the quality control procedures for all code-
requir00 ddn-tt'd.11ed' Materials,
3'. Special atchltettUral -or-ang-ineering prof essio6&1 -inspect iion of
construction compoR.qptq requiring.contro.11ed. materia.1.9..or construction
specifi'ed'in the acce'p'ted ehgiheering practice standards'listed In Appendlx
PURSUANT TO SECTION I SH-ALL SUBMIT PERIODICALLY, A 4 OPT
TOGETHER WITH PERTINENT COMMENTS TO T -Ht BUILDING INSPECTOR
OF� THE WORK, I SHALL SUBMIT A FINAL, 1k-tPORT AS TO THE ATIS qW2 ION
AND READINESS OF THE P'RbjkT kOR' OCCO . PANCY