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HomeMy WebLinkAboutMiscellaneous - 100 COLGATE DRIVE 4/30/2018. 0 o V ,,, �4orn �cl DATE:ry LOCATION: /l ble 1Jr,�/� ��22 OWNERS NAME:.,j �/ w- ;zSalv GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: P-� k /- Wap � PHONE NUMBER: ELECTRICAL GAS Pkd/R IE, RESIDENTIAL COMMERCIAL LOCATION OF GENERATOR: *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL 0-,</ l /oo 6(il 5 OR APPLICATION DATE: LOCATION: %AJ b P OWNERS NAME: ,c-j�f,� V 1,c�iLSa� GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: `F7,? (fx -/%vie ELECTRICAL ZGAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL x i foo 6(il5 Date 2?/ ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ �.-/q ................................................. ..................... ............ has permission to perform ..0 �................................................... ...... ........................................ 4 wiring in the buildi of ...... ........... at ........ I ... .. . .. ........ .....................�.............../'... ..........WrthAndover, XISS. r........ Lic. No'—...bY 'ff�criucAL INSPECC Check# A .� C Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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 PRINT IN HK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 160 C.o A t &I WC Owner or Tenant a ephone No. Owner's Address _S'a.�..� / t�%G� //,,� Is this permit in conjunction with a building permit? Yes [?r No ❑ (Check Appropriate Box) Purpose of Building /QPxjdz , -ice Utility Authorization No. 16 -7 'Z -27Gf 2, - Existing Service L_, Amps /moo L, 4440 Volts Overhead R Undgrd ❑ No. of Meters New Service ,2,&_ Amps 11 e /,,2444 Volts Overhead D-' Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: r Completion of the following 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 g' No. of Hot Tubs Generators EVA No. of Luminaires Swimming Pool Above ❑ In- Elo. o mergency Lighting rnd. rnd. Battery Units No. of Receptacle Outlets ,20 No. of Oil Burners FIRE ALARMS No, of Zones No. of Switches /D No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices No. of Waste Disposers Heat Pump I Totals: Number "** . .................... Tons ' " KW ....""'.... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers j 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: 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 YYires. 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 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 exhi ' ed proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER [(Specify:) ,�zK„� L/44,/, � /5 I certify, under the pains and penalties of perjury, that the information on this application is true''tnd complete. FIItM NAME:. e /P? Ve 4 LIC. NO.: 3 ,V �79)z 5 '1 Licensee: Signature LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No. ' Address: h9 R,C // r �o ! Ay Alt. Tel. No.: > !a2 *Per M.G.1, c. 147, s. 57-61, security work requires D partment 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. I am the (check one) ❑ owner ❑ owner's agen M 1� Owner/Agent FEE: IT IZ 1I Signature Telephone No. P ERM ❑ 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. ❑ 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 [a Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH CTION: Passu -111 - ass ' Failed IN Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: A, S k Date: FINAL INSPECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ ' Inspectors Comme s: 'A 90C Inspector Signature: Date: U DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com r r The Commonwealth of Massachusetts Department of IndustriqlAccidims Office of Investigations IV 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #:, Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet t ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. (No workers' comp. insurance 5. [:1 We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. F1 Plumbing repairs or additions 12.E] Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they aie 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. I am 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. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required 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 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. 1 do hereby certify 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 offrcial. 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 #: 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 of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) 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 cavy 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 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 peimit/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 of Massachusetts Department of Industrial Accidents Offree of Investigations 600 Washington. Street Boston, MA 02111 Tel. # 617-727-4900 oxt 406 or 1-877rMASSAFE Revised 5-26-05 Fax # 617"727.7749 www.mass,gov/dia =COMMONWEALTH OF MASSACHUSETTS 4 k D ate .. .�.1....... 11. j .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �' IAN n This certifies that...........1 ..`..........-.......C.......................................... has permission to perform ..' "'...1 ...`.�.,...........{,�............................................... plumbing in the buildings of ..... � at ........... ..Q..... 1.... �...e.......L!.......................... North Andover, Mass. Fee... • .�a... Lic. No. �. 31 .. Q.. ................................................................... PLUMBING INSPECTOR Check # ��. L Mv P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY / MA DATE ( PERMIT # JOBSITE ADDRESS vy��� OWNER'S NAME OWNER ADDRESS TEL FAX OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL NEW: P RENOVATION: P REPLACEMENT: 0 RESIDENTIAL �f PLANS SUBMITTED: YES Q NO 01 • FLOOR - CROSS LL DEDICATED FM W low DEDICATED GREASE SYSTEM FW— -__WWrWMWW DEDICATED GRAY WATER SYSTEM �MFP—MrP---WFM—F–M–FM—F-=--MFM—MFMFM—FMM—WtlwW IIIECCATE), WATER SYSTEM -RECYCLE DRINKING FOUNTAINFM— FWrFN W— FW— FW��M�®r�te ����K KITCHEN SINK • • ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET WASHING MACHINE CONNECTION W4TER HEATER ALL TYPES WATER PIPING 6THER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY10 OTHER TYPE OF INDEMNITY © BOND D OWNER'S INSURANCE WAIVER: I am 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: OWNER 0 AGENT j© SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my and that all plumbing work andinstallations performed under the permit issued for this application will be in compliance wi"29, II Pertinent pr sion Massachusetts State PlumbingCode and Chapter 142 of the General Laws. l/ PLUMBER'S NAME € LICENSE # l3 ( SIGNATURE MP JP 0l CORPORATION �I # PARTNERSHIP D# ®LLC 09 COMPANY NAME ; ADDRESS 1 3 2 CITY ..-_..._.._..._I STATE?! ZIP G7� II TEL FAX 6 CELL [ EMAIL o o z N ❑ } w CL w w U- r - s The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations UV. 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: a�/��� �l< City/State/Zip: Z . � Phone Are you an employer? Check the appropriate box: LFI a n a employer with, 4. El am a general contractor and I Type of project (required): 6. W New construction ( employees (full and/or part-time).* 2. ElI am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. F1 Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. El Building addition [No workers' comp. ,insurance 5. El We are a corporation and its 1011 Electrical repairs or additions required.] officers have exercised their 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' 1311Other 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 ate doing all work and then hire outside contractors must submit anew 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy anal job site information. Insurance Company Name:. Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: !U o 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 certify underLfi a pains andd penalties of perjury that a information provided above is true and correct. Sianature: ,�,�� / Date. ?&2f ` 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 #: 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 of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If anLLC 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. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to 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 anal fax number: The Commonwealth of. Massachusetts Department of ladustrlal Accidents, 4ffiee ofInvestigatitons 600 Washington Street Boston} MA 02111 Tel, # 617-727,4900 ext 406 or 1-877,7MASSAFE Revised 5-26-05 Fax # 617-727-7749 rwMass,govfdia L 11 COMMONWEALTH OF masACHUSETTS� PLUMBERS A -14D GASF'i CERS I_ICEIAEEC1 AS A rVIASTER °:.WIBER � ISSUES THE ABOVE LICENSE TO: 'I FIARC E CHANDONNET a:- 137 GARLAND DRIVE PEI -HAM 'IJ! -1.03076-.;_376 { 1716130 05/01/14 166.114 t Date.................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION MA,��-Q�/)cjtf�-Yu�This certifies that ............................................ has permission for gas installation ......� N.....1. .: " ' '..-*— ..................................................... in the buildin s of .......Q.!... at ......�... .......... C)... G..!;;n .............:9....................., North Andover, Mass. Fee ............ Lic. No...`-+,' " ............................................................................. Ji ' 7O GAS INSPECTOR Check # � �� TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY0 Z �0 I I - qMA DATE S. S / PERMIT # l�� JOBSITE ADDRESS 4Q d OWNER'S NAME OWNER ADDRESS TE FAXE OCCUPANCY TYPE COMMERCIAL•� • ` • ori APPLIANCES • • • COOK STOVE��� DIRECT VENT HEATER � . �WW��� FRYOLATORWORWWIMF. KM- 'WIMM M�MMFP •'wwmm-NOWN MW M W WS INFRARED- ��yW LABORATORY COCKS W FW-- I N W M- ON 9 WE WE F1 MAKEUP AIR UNIT ! WMI ANN ROOF TOP OW -?�FFI F� -K[� IME UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE RESIDENTIAL PLANS SUBMITTED: YES 0 NO E3 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch.142 YES )A NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER: I am 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: OWNER E AGENT �I SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliant with all Pertinen rovision of e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME�� LICENSE # SIGNATURE MP �IIGF E�I JP E] JGF LPGI © CORPORATION Q# PARTNERSHIP [J#= LLC E]#= COMPANY NAME:��' — —, ADDRESS? CITY _ STATEMZIP TEL FAX (��_ -- j� CELL( EMAIL , 1. 10 C9 Date. N0PTil TOWN OF NORTH ANDOVER D PERMIT FOR MECHANICAL INSTALLATION rLThis certifies thaf.�.i.(2_.�? y�..... ( .�.. 4..C. ....... has permission for mechanical installation ..._: in the buildings of ... �+ � a.L�!..�5�v.I�...................... at w _�;.? .. { . t c__..� : ".1,...... , North Andover, Mass. Fee...��. � .. Lic. No. f� C! fi ! �. ......!N� -:..... . GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer .. t Commonwealth of Massachusetts Sheet Metal Permit Date: Permit # Estimated Job Cost: � OW Permit Fee: Plans Submitted: YES NO Plans Reviewed: YES NO Business License # Applicant License # Business Information: Property Owner / Job Location Information: Name: C'Pteoh \`- �^^r1 C CWkin.ZSv.(- Name: J6�,Y. �•.� ����'-• Street: c)�S Cy\06C OR t n:'� �i O Street: City/Town: Q W t �M� City/Town: n m t.. Telephone: 1`�.s - �� a - aQ Telephone: Photo I.D. required / Copy of Photo I.D. attached: YES NO Building Type: Residential: . 1-2 family -)9 Multi -family Commercial: Office Retail Industrial 1 a Building Cubic Footage: ti under 35,000 cu. ft. \f- ov Sheet metal work to be completed: HVAC )0 Metal Roofing >>1�42- 6)c:,AL'4, - New Work: 1 tilz�� Kitchen -Exhaust S / Provide brief description of work to be done: &f -4`6Z2-14 INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy Othertype of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner Agent ❑ Signature of Owner or Owner's Agent By checking this boxEl, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Date 3y title ;itylTown permit # -ee$— ispector Signature of Permit Approval Progress Inspections Comments Final Inspection Type of License: ❑ Master ❑ Master -Restricted PJourneyperson ElJourneyperson-Restricted ❑ _- - Comments Signature of Licensee License Number: 1o\ \-4— Check at www.mass.gov/dpi Commonwealth of Massachusetts Sheet Metal Permit Date: Permit # 11:_- Estimated Job Cost: �S UOU Permit Fee: $ ou— Plans Submitted: YES NO Plans Reviewed: YES NO Business License # Applicant License # Business Information: Property Owner / Job Location Information: Name: C'P►Qoh )�-�k A� C (CDWu -SAL Name: Sb v, L ` V--, Street: (4� C�JCV- aR U h ;"r � O Street: i 00.� City/Town: yv\A City/Town: Telephone: ,Ts - W5 '61 a Q(Telephone: °f:)- Fs -fa 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. k over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation'sQ_ HVAC Metal Roofing Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: LOnN - kx> 1�x &P-W-So2_i4 _/ 1AA/-'AA, fi �� INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy] Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. / Check_ One Only Owner Agent ❑ Signature of Owner or Owner's Agent By checking this boxEl, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Date ritle ;ity/Town permit # =ee $ — ispector Signature of Permit Approval Progress Inspections Comments Final Inspection Comments Type of License: ❑ Master ❑ Master -Restricted PJourneyperson Signature of Licensee ❑Journeyperson-Restricted License Number: Check at www.mass.gov/dpl 4 Sheet Metal Commercial Guidelines / Life Safety / Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers perfoiruing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metalwork being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm. testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke /atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper oldi'ances, fire rated enclosures and pressure testing required.C. arc des r:aints installed =x/3i A 'require'd'on equipment and d?iSt�-.orY Duct penetrations in fire' Wtc;4 ivalls and floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct runs installed 6'-0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean - properly sized filters installed (final inspection) Testing and Balancing report complete (final sign -off) 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 -ofd r CW ajnleubig if W W Lo re .. �W N 9 N '' W z w coO i rQ w Mzw z o ILL NNW a J� p U W \ k Fa- a Q Z > c f a WWF Q x W=) v=i Lu Q. o z t. 14 ' .: IM U V Q x o Cr I q � cr W Q 0- U) O z r r-+ 110 � MW 04/08/2014 11:41AM FAX 9789572772 COUGHLIN INSURANCE 00002/0002 ACO&H CERTIFICATE OF LIABILITY INSURANCE DAF-IMWDD 4") 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 certlflcate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltion5 of the policy, certain policies may require an endorsement. A statement on this certlflcate does not confor rights to the certificate holder in lieu of such endorsement(s). PRODUCERNAME: Charles J Coughlin Insurance 14 Dinley Street P. 0. BOX 10 Dracut, MA 01826 Dominic Boudreau PRONE (978) 957.3558______ INC. INC. No E-MAIL dominic®cou0hlinins.com AD6REB9. _-,- _ INSURER(S) AFFORDING COVERAGE NAIL d 2_9939 COMMERCIAL GENERAL LIABILITY CI.AIMS-MADE I;z OCCUR INSURER A: Main Street America Assurance Company INsunt:D Caron I leating and Cooling Inc INSURER B; The I Iartford Insuranc4 Co HIC 200 Varnum Ave Dracut, MA 01826 -DAMAGE PREMISES Ee OCCMience - IN$UR$R C ; MCD EXP Any one person) 5 10,000 INSURIR 0: INSURER E INSURER F: PERSONAL 8 ADV INJUHY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT TME POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIIE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTRR TYPE OF INSURANCE INSIR ADDL S VO - POLICY NUMBER MMIDD� MAUDDY EXP LIMITS A GENERAL LIABILITY MPT179ON 04/01/2014 04/01/2015 FACHOCCURRENCE S 1,000,000 COMMERCIAL GENERAL LIABILITY CI.AIMS-MADE I;z OCCUR -DAMAGE PREMISES Ee OCCMience S 500,000 MCD EXP Any one person) 5 10,000 PERSONAL 8 ADV INJUHY 5 1,000,000 S 2,000,000 GENERAL AGGRFGAI E GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP ACG $ 2,000,000 S POLICY PRO- JECT !OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY (Per person) ANY AUTO S ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNtU HIRFOAUTOSAUTO5 BODILY INJURY (Por aaitlent) S PR PERTY DAMAGE PersCCitlelll E _- b UMBRELLA LIAB OCCUR EACH OCCURRENCE _ E ACCRECATE S EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIFTURrPARTNERIMECUTIVE 76WEGLZ1936 10/01/2013 10/01/2014 WCSTATU- OYH- 'f RY I IMI r " _ $ 500,000 C.L. EACH ACCIDENT OFFIDF-R/MF:MHFR FXCLUDEDP ❑ (Mandatory In NM) N / A 5 500,000 ' -- E.L. DISEASE - EA EMPLOYEE It yes, describe ureter i r)FSCRIPTIONOFOPERATIONShelow 5 500,000 E.L. DISEASE -POI, ICY LIMIT I I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Building Department of North Andover CERTIFICATE HOLDER CANCELLATION fax 978-688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover, Massachusetts THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE c/+ ©1988-2010 ACORD CORPORATION, All rights rosorved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD , A -/---y D �. Location No. � d — Date 9� MpRTM TOWN OF NORTH ANDOVER p Certificate of Occupancy $ CC Building/Frame Permit Fee $� O 4 { s'•^•'''<�' Foundation Permit Fee $ ncHust Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector v� tt Div. Public Works i W t9 s a Y 0 0 m W � W N a_ N W Z 0 Z IL 0 J O m 0 LL 0 0 0 !UL! W N N IQ 0 d Z x 0 . Z 0 / ZZ 00CJ J o J J to m v W tC W Z Z <O m Z 0 Z z < to h O 0 0 W Ir U T W< W W= 0< a Z U Z Z U J h N 0 0< m 93 W O h z 0 W Z O W t 0 IY LL O Z W Z i O ! Z 0 Ir !- W Zw < O N OJ !" C 0 N W u J 0 0 z<< Z IL Z IL LL 4 O O o 0 O < Z_ Z Z_ J J 4 U U LL 0 Z Z 0 J J J m W m m m J < O O < 0 0 0 ; m z 0 H m IL Z W L 0 M L M W fL 0 U 9 ■ W m W 0 rc L L 1 { 0 0 I0 H Z L W 0 V 7 0 J Ir W 0 0 0 L) W O J h O F' � Z U0 F 0 lC < Z J W W _J N 0 L Z Z L 00. t7 Z {� 0 Z Z ILI W ,W I O 0 u u 0 { 0 F 40 p 0 CA LL LL O l0 J J Z LL O Z Z Z 0 0 4 W < mh IL a 1 LL � OJ O t] m m m < E W N < y 1 0 i a m m 0 . 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TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ FoundationfPermit Fee $ Other Permit Fee $ w Se -pr Connection Fee $ r�u�i1 x`ter Connection Fee $ TOTAL $ lr.. Building Inspector --- Div. Public Works m a I a _ Y � 0 ;V W F- 0 OA IL '•v N a X a W Z 3 043 p 0 z Z I4. 0 � Q 0 J J 0 yNj a _ m 0 O 0 0 Ou I - Z W uWi �" W IL I n 0 W D N d Z m J m O t- r• - X M d 1� Z _O 1— Z V IH Q 0 Z 0 0 � J U) W v W f o Z < O Z < 0 p N N r W < W W 0 a Z U z z i,<N J 0 0 m W W Z Y u x F x 1 NZ to w K J 0 N 0 < rc O m IL l7 z l7 LL > Z O 0 F 0 0 0 LL z = 0 < i N L O I m A z t U. Z O F u N J W a L 4 0 O C 0 m N Z 0 u `00 a , o G z N A 1 N 0 1 z 0 O O , 0 z r V u W W Ul p o o i m J_ J_ 0 N m W W j S LL l7 1 Q 61 4 d I e O 0 C m }LZ OW w 6 d Z W F t 0 0 u uu u a ix L l7 uu W L < Um m j 0 z0 fa t:A J W W W 10 11 1 N Z 0 u a , z N A 1 N 0 1 z Z 1 O O , V u W W Ul p o o i m J_ J_ 0 N m W W j W l7 l7 1 61 4 d I e i d It W W V tAJ z z C:) 0 0 60 � r � c � Z K W f d IL a f"ti :E A-�N� D� 00 3 V Qn m 00 Ol 0A�om� ,y Opp O AQ.m0D mm D N O O p = N O m P' N < Z x W N An n ~ 11 z r 0 A a, O III O n H N i x O D o 0 S N N O O N II F IIIIIIIIII -L Z; O->Z>DxyTc _-_+0y zx �m _ DN 0�?NZDOA�mm mrODO <D �y Ov ;mom Tm' ^>mmx 0 y nL. x y Z ti O N ... D 0 z? C z AAA w 0D O �x S! O 00r OmN 0 N - +OA tiA T Ay �Zz ONx C T Dz pGl y 0z< Tm "� m X m v 0 p 0 N _ a08 Z z P10 mzD �O vmnn D m w T JO O 0 ; T D A N n z z A n n 0y (0 OA Am O 1 �X� r D n Z 3 u N �mT O C z O z co z GAx >01 D D n x n zm MMO ; T y SOD DO (0 OA �X� D n Z 0�0 N°* N mim ( mx =mn u►0o Z ;az— N mi3 vOm m c mW0 � m O—Z �- v a ADO Z T = N T I I I I n p m O A xo 0 0 -1 �L A Z O A I I J I n N 3 I.1_I�I IN O C z O z co z GAx >01 (mj1rN zm MMO . Do NZZ °c �X� D n 0�0 N°* mim mx =mn u►0o ;az— mi3 vOm m c mW0 O—Z �- v r ADO Z r IG)m rNO D*D p m 2-Z A xo 0 0 -1 v mD 0z 10 mm Nm 00 D0 3 Scale: 1" = 401 P L 0 T P L A N 100 Colgate Drive North Andover.. -Massachusetts Date: November 5, 1976 r=� � of �o O om o v Q REFER TO REG/STRY �N'463373> 24.s" 07' /Y 8721410 —',?P eew I hereby certify that the building on this property is located as, shown on plan and complies with the Building and Zoning Laws of the Town of North Andover. 91.0OF ,qy s CHARLES E. CYR CIVIL ENGINEER �� WARW y LAWRENCE, MASS.`' in- 1, � of �o O om o v Q REFER TO REG/STRY �N'463373> 24.s" 07' /Y 8721410 —',?P eew I hereby certify that the building on this property is located as, shown on plan and complies with the Building and Zoning Laws of the Town of North Andover. 91.0OF ,qy s CHARLES E. CYR CIVIL ENGINEER �� WARW y LAWRENCE, MASS.`' in- 1, )e (-�Ojc N 3 Do Z) �� (" o rf c, 5�- r -I x A '\O o w° a ci) O0 UW PW co z ocz G wo �n0 aoG U m w W �'r app -- ct w O z � a W m � > ci) � w O W -C ao' w W w W G rQ 2 cn G o cn I uir C4. am• • O z 12 v J 0 p U O U v J �7 H CD i c c J Q Z C3 LL. 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I 1 I i. .I 1 N J _ I. k o W 0 �1 le 1 rA W cc x w Q N o U z z :O c= e o O O Gi V: a w a a a O N N CD c u C c .m Cc '= C a N W U u C7 N m � a ro A z cn c cn a _ co W H W y E d N Z .O O N c 7Vca CD cc CM CG 0 cm e •e N m O 2 0 g CD O r,_TN 2 0 O E � L O v Z O CL O CO) D C O Om CO) O O � •COD g m m 0 G3 Z O� 0 eo O a a: tmcc ca c C3 .3ev 10 ca Z0 CLC C.± CO) O C •C C rs H O N :O c= e p O O Gi V: m C ' N � O N N CD c C .m Cc '= C • N W � N :Em U N m � • w w O C o C C �O 0 C2CL 0 CD a=m.o 40 O _ .S m r -0 Z ,N J2 'm s C __.. 03 v m . Of CL m� O0 CO3a`Ho = � a4"m E d N Z .O O N c 7Vca CD cc CM CG 0 cm e •e N m O 2 0 g CD O r,_TN 2 0 O E � L O v Z O CL O CO) D C O Om CO) O O � •COD g m m 0 G3 Z O� 0 eo O a a: tmcc ca c C3 .3ev 10 ca Z0 CLC C.± CO) O C •C C rs H O Y The Commonwealth of MossachuSetrs {+'.i`e.y.•a�tyreE+bl7 Dcpartmcnt of Public Sofcry BOARD OF FIRE PREVENTION REGULA110t4S S27 CMR 1200octrr..tr a FallohecLM4 1/90 ct.... at...l APPLICATION FOR PERMIT TO PERFORM ELECTRICAL -WORK All wrk w be periormcd in accordance with the Mas"chusetu FJcctrkAl Codt. Sn CMR 12:00 �. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of /y-elyy.-T 20 the Inspector of Wires: The unewrsigned applies for a permit to perform the electrical work described below. Loci tion (Ctreet b Number) _ %®op n/ 4 f 7�( 0.'ner or Tenant_eLlla k//c.„ y Owner's Address f/0 -,.Z T Is this permit in conjunction with a building permit: Yes No EJ (Check Appropriate Box) A%rpose of Building_ "> ,.,, A- .� Utility Authorization NO. Existing Ser -. ice Amps / L_ p /2d zyo Volts Overhead Q ondgrd C No. of New Service haps / Volts Overbead ❑ Und d . 8r ❑ No. of Meters Number of Feeders and Anpacity Location and Nature of Proposed Electrical Work C', le No. of Lighting Outlets N'o. of Lighting Fixtures ------------ No. of Receptacle Outlets No. of Switch Outlets No. of Ranges Nr of Disposals .;lo. of Dishwashers No. of Dryers No. of Water Beaters No. Hydro Massage Tubs OT.IER : No. of Hot Iubs Swimming Pool Abov grnd No. of Oil Burners No. of Gas Burners No. of Air Cond. No. of Heat Total Rffips Tens Space/Area Heating Heating Devices e ❑In- grnd Iotal tons Total KW KW KWr.ot or ro. of Si s Ballasts No. of Motors Total HP No. of Transformers ❑ Generators KVA No. of Emergency Lighting Battery Unir. FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal ❑Other Connection Low Voltage INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current LiabInsurance Policy including Completed O equivalent. YES NO U I have submitted valid proof of same torthistionoffice agYESr itssubstantial o Ii you have checked YES; please indicate the type of coverage by checking the appropriate box. INSURANCEOND [] OTHM ❑ (Please Specify) _ Estimated Value of Electrical Work S �piration ate Work to Start_2 - G - sC In Date Requested: Rough- G —y Final Signed under the penalties of perjury: FIRM NAME LIC.. N0. License— LIC /� , S/-+ .' .�� Signatur „y /' Address_ --�'J �% LIC. N0./ .v p rl Te 1. No . NI%.'S INSURANCE WAIVER; I am aware that t the Licens Alt. Tel. No. 'S equivalent as required by Massachusetts General Laws na athmyiaignatureconethis permit sub - application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S s V Signature of Owner or Agent