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Miscellaneous - 1160 GREAT POND ROAD 4/30/2018 (32)
\b(� �re�-t Pcn�cQ Date...... � c ..................... .. �r►OR7/�, TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING 88�CgE This certifies that ............ �&w �er � S v �C .................... ....l..../................................................ ........................ has permission to perform ...... oc .../Q.� •c,,, + -� . .. . ........... wiring in the building of... at ....'.1.6 U61oifr4vl..l�....... ! orth Andover,Mass. ........................... ..................... a0 Feel... ....Lic.No. ..�...g 27Sf4..........d..� ?���h'.�J....�r....... �;ECIRICAL INSPECTOR 6 Check# G�7 28 Commonweal ol///a��achu�e Official U_ se Only cc��rr�� Permit No. Apad.d of gim Serviceb Occupancy and Fee Checked 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 INK OR TYPE ALL INFORMATION) Date: City or Town of: Al. lfd,��,�,[� 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) OeAr Awo Owner or Tenant ,L Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No K' (Check Appropriate Box) Purpose of Building EMS l/AaAA 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: 10W 1104&"' eAA*t&e %VG 30 Vlfkf S y ANv S, 6 Oo��S Completion of the followingtable may be 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- ❑ o.o Emergency Lighting rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I 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 i Tons g 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: 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: o�S�6Do (When required by municipal policy.) 1 Work to Start: fhQ f/j 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: IVW E cam,G4! di &S aG< LIC.NO.: /f/,'o11s Licensee: 61aoxy �. /S9/1i;��/9� Signature LIC.NO.: ,-/yd Ir (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 91!'J>t7'4d Address: 1yY NOQ0 ,PD .fo;;z /Of0 Sv-0411-e �'�� O/y7( Alt.Tel.No.• *Per M.G.L.c. 147,s.57-61,security work 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. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ /df.of rM ., 7 ,' �L �' I � The Commonwealth of Massachusetts 07- Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /t/1V 4GE f Zeeza az $!R✓VjW GLG Address: /Vf oyoe)w �w 5417 /VAO City/State/Zip: Syleo°f /-If, 4W7G Phone#: 97,f-,),f 7-.011,0 Are you an employer?Check the appropriate box: Type of project(required): 1.6�i`am a employer with/g 4. ❑ I am a general contractor and I 6. ❑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. [J 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 required.] officers have exercised their 1011 Electrical repairs or additions 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.❑Roof repairs insurance required.]f employees.[No workers' 13.0 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 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. �,n Insurance Company Name: Policy#or Self-ins.Lic.#: Z Wec CK 0(oV. Expiration Date: Job Site Address: 1/66 6,6t4r Po MO If 4 City/State/Zip: Al. /I�✓DO✓trX 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 under the pains andpenalties of perjury that the information provided above is true and correct Simature: Date: Phone#• 97d'•)d7- V.I/D 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 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 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 ConmonwealtbL of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston.,MA,02111 Tel,#617-727-4900 at 406 or 1-877,7MASSAFE Revised 5-26-05 Fax#617-727-7749 Www-wass.govaa Division of Professional Licensure: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics i Home>Division of Professional Licensure> j ONLINE SERVICES ...............-............................................................................................................................................................................................ Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change _ ! Contact the Agency LICENSEE } More... I Name: GREGORY G. BABIKIAN REFERENCES& SUDBURY,MA RELATED INFO t NEW SEARCH Disclaimer Regarding **This Licensee has additional Licenses, click here to view them.** i Website License Searches II Enforcement Process Glossary Licensing Board: ELECTRICIANS Glossary of License Status MASTER ELECTRICIAN Codes License Type: TYPE CLASS:A License Number: 18275 More... Status: LICENSE IS LAPSED € i Expiration Date: 7/31/2013 Issue Date: 7/28/2003 Exam Date: 7/25/2003 School: MARTIN ELECTRICAL Et I This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. i The page above has been generated by the Division of Professional Licensure web server on Thursday,August 22,2013 at 7:03:37 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicenseQ.asp?board_code=EL&type class=_A&li... 8/22/2013 10082 Date S . 7113. . . . x TOWN OF NORTH ANDOVER • PERMIT FOR PLUMBING This certifies that . . . . . . . . . . has permission to perform . . .y7. . . . . . . . . . . . . . . plumbing in the buildings of at . . .j/ , , , , North Ando- er, Mass. Fe%.�3.-v U . Lic. No,//A V. . . PLUMBING INSPECT4 Check# s 7U Lba11 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY . nkC_ . ..V�, �_- MA DATE ..__ PERMIT#_ JOBSITE ADDRESS __ _ e _ - _Q ,OWNER'S NAME[ - F9 L P OWNER ADDRESS _._.__ e►._ _ - _ TEL "' __-- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION.Q REPLACEMENT: PLANS SUBMITTED: YES ] 'NOX FIXTURES Z FLOOR- BSM ' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB M-71 CROSS CONNECTION DEVICE - i — . DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM -__ _ _; __J y _j _.-I DEDICATED GREASE SYSTEM __J DEDICATED GRAY WATER SYSTEM III I -_ DEDICATED WATER RECYCLE SYSTEM - ? __i DISHWASHER DRINKING FOUNTAIN �- _ -' - --. .._ _ -- -- -- - _ _ - t -----I - FOOD DISPOSERFLOOR/AREA DRAIN INTERCEPTOR INTERIOR) ___ KITCHEN SINK LAVATORY ! - - ROOF DRAIN SHOWER STALL - - SERVICE/MOP SINK __.._-- ___�_. ._ ..._ TOILET _- I ! _� -___i _.w.__J URINAL - -- - --' ---� - - : - WASHING MACHINE CONNECTION - WATER HEATER ALL TYPES ._— WATER PIPING _-_._ M OTHER if , i INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142: YES)k NO 0 IF YOU CHECKED YES,PLEASE IWCATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X OTHER TYPE OF INDEMNITY[ BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT � 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 piumbing work and Installations performed under the permit issued for this application will be Inpilancewi all et!'nent rovlsion of the `► Massachusetts State Plumbing Code and Cha ter 142 of the General Laws. M PLUMBER'S NAME _ I LICENSE# GNATW MP� JP 13 CORPORATION S# PARTNERSHIP{ #=LLC # COMPANY NAME', + P Ct O' Q. ADORSS CITY _- STATE ZIP. r_. _ TEL .._.._-- FAX CELL - - - ------ EMAIL -- f _ �i/��� U�� �� �� The Commonwealth of Massachusetts Department of IndustrlalAccidents Office q fInvestigations 600 Washington Street Boston,MA 02711 www.massgovMa Workers' Compensation Insurance.Affidavit:Builders/tContractors/EIectricians/-Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/individual): 2nJ C . Address: �R I� tA7kscary CiZ-t - City/State/Zip:_ LiqvV i2c,vCc /414 .QQ(--1 Z Phone#: 0179- 1,95 - 157(c, Are you an employer?Check the appropriate box: Type of project(required): 1.X I am a employer with 4. ❑ I am a general contractor and I ❑ 6. New construction employees(full and/or part-time).X have Hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.x F]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g• F1 Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.D Electrical repairs or additions til ' 3.El 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.]i 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. T Homeowners who submit this affidavit indicating they a're 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. I am an employer that is providing workers'compensation insurance for my employees, Below is the policy recd job site information. Insurance Company Name: FC N,uzcp, Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 060 G 2 E fq--f �o.�l� �� City/State/Zip: /U W JC Z P4 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 maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby cert under he pains andpenaldes ofperjury that the information provided above is true and correct. - Si ature: Q J Date: R/7 1 I Phone#: C? 75 , G S5 - � 5-7 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 ffustrueflons . 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 employes." 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 producedacceptable 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 chapterhave 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 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 De artm ant has rovided a space at 66-b-6-ft-6m, of the affidavit for you to fill out in the event the Office of Investigationshas 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 maybe 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 Coz monwealtl off ssa.,chv.:setts Department ofXndustdal Accident.- 600 A_cci ent.- 6.90 Wasb gton.Street Boston,MA 02111 `QL#617-727-4900 at 406 oz 1-877-WSAFF, Revised 5-26-05 �a 617"7277749 H Fold:Then 0elach Alenq All Perbrations -COMMONWEALTH OF MASSACHUSETTS BOARD PLUMBERS AND GASFITTERS IMF ORTANT NOTICE PL REGISTERED AS A PLUMBING CORP PERMITS FOR PLUMBING AND GAS FITTING ISSUES THE ABOVE LICENSE TO: INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE O THE STATE BOARD. TYPE KENNETH J KOLIFARTH• BRIDE-GRIMES, INC . MP# 11691 -C 11 PALMER DR KENSINGTON NH 03833-6731 146696 2569 05/01/14 146696 r Fold.Then Detach AIDng All Perforations Folo,Then Colach Along M Perforalions COMMONWEALTH OF MASSACHUSETTS � e s a •• a e• -e • BOARD PLUMBERS AND GASFITTERS IMF ORTANT NOTICE • PL LICENSED AS A JOURNEYMAN PLUMBER : PERMITS =OR PLUMBING AND GAS FITTING ISSUES THE ABOVE LICENSE TO: INSTALLATIONS ON STATE OWNED OR USED FACILITIE 5 FAUST BE FILED AT THE OFFICE O THE STATE BOARD. TYPE KENNETH J KOLIFRATH -J 11 PALMER DR N KENSINGTON NH 03833-6731 146697 22513 05/01/14 146697 e• - r Fold.Then Do:ach Along All Perforations ' Fold.Then Detach A Ong All Perforations J- COMMONWEALTH OF MASSACHUSETTS I •Or• -• • :•••e • BOARD PLUMBERS AND GASFITTERS IMP RTANT NOTICE PL LICENSED AS A MASTER PLUMBER PERMITS OR PLUMBING AND GAS FITTING ISSUES THE ABOVE LICENSE TO: INSTALLATIONS ON STATE OWNED OR USED FACILITIE MUST BE FILED AT THE OFFICE Of THE STATE BOARD. TYPE KENNETH J KOLIFRATH m -M 11 PALMER DR n KENSINGTON NH 03833-6731 146698 11691 05/01/14 146698 _,!�T113ATIOJN DAT15 SERIAL ND, F Fold.'Then Detach Along All Perforation_ Z-d CL9L-929-2L6 'Out saw1a0'epa8 e- VLO0 LO 6nV Date... . ................. oa; ora TOWN OF NORTH ANDOVER PERMIT FOR WIRING HU s /, ��,� This certifies that ................................ has permission to perform .14144 al .........7-*........... wiring in the buildingof..... .IPAr...A.I.ew........................................... ............. ............................ ,--I, at'.......A.6.0........ Andover,Mass. ...... .......... ..................... ..... ....... ....... .............. F..e4e... ....Lic.No.13e.. .. ........... ................ .. .... ... .. ELECTRICAL lNspEcrm Check# 71650 �,� f�� a�,� � �✓ . . �. r r /� ////// // Official Use 0 v mmonwea& o ae6achuseffi C,o W B _ cc�� Perniit No. i 2lepartment ol3ire Servicee Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 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 INK OR TYPE ALL INFORMATION) Date: 614X2oa City or Town of: -��� �it1�dL/�ot'_ To the Inspect r of Wires: By this application the undersigned gives notice of his orr her intention to perform the electrical work described below. Location (Street& Number) 6<e.A PoluC�[ a Owner or Tenant �dQ?t�" seA0a 4uc'x 11gL Y �U/ r�.l Telephone No. -7,�,SG.00 Owner's Address +'t 145 q05Ald, Is this permit in conjunction with abuilding ermit? Yes ❑ No � (Check Appropriate Box) Purpose iii Building �j,J4yVL117,0AJ -� Utiiity 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: �tSCann / `Lt��i /�ErZ/ R7t'1 ) �G,✓,�c� K o.- f1 CGd118�17 lA/5 �� ® ��"0 / A�AfI IA) Completion o fthe folloiving table may be ivaived by the Inspector of Wilv.�. No of. Total No"of Luminaires ',: No,6f Ceil ;Sus Paddle =Fans *x �. P ( TransformersKVA No. of: uminaire Outlets .. No :of,Hot;Tubs, .. : Generators KVA.. k Above In- o. o Emergency Lig ing No. of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Batter y Units i Vo. of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No.o Detection andInitiating Devices No. of Ranges No. of Air Cond. T nsl No. of Alerting Devices No. of Waste Dis osers Heat Pump Number Tons No. of Self-Contained P Totals: Detection/Alerting Devices Municipal ❑ OtherNo. of Dishwashers Space/Area Heating KW Local❑ Connection No. of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No. of Water No. of No. of Data Wiring: Heaters KW Signs B»!lasts No:of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or E Bivalent V OTHER: 40 Attach additional detail if desired, or as required by the Inspector of ll`ires. Es;«mated Value of Electrical Work: (When required by municipal policy.) Work to Start: „per/ Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C EF AGE: 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, tinder the pains and penalties of perfidy,that the information on this application is true and complete. FIRM NAME: LIC. NO.: P 1303.5 Licensee: D-AyA S Yayt:}m Signature LIC. NO.: E 2���3 (If applicable, enter "ezem1p ""in the icensyy number line.) Bus.Tel. No.:&13-OE-A 83 Address: /� FiU�47drh r1 �i� moi, /70 Alt. Tel. No.: 600328- 54? *Per M.G.L. c. 147,s. 57-61,security work r�s 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 lav✓. By my signature below, I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: 8 /R Signature Telephone No. � � t ol t3MAW" r"PcfA 1 vy\0_A COMMONWEALTH OF MASSACHUSETTS OF ELECTRICIANS I REGISTERED MASTER ELECTRICIAN ISSUES THE ABOVE LICENSE TO: D S YARCKIN ELECTRIC INC DAVID.. S YARCKIN 1c 210 FOUNTAIN STREET `n f FRAMINGHAM MA 01702-6204 i 0 0 / 1/13 81-14 4237 } COMMONWEALTH OF MASSACHUSETTS OF ELECTRICIANS AS A REG JOURNEYMAN ELECTRICIA, e ISSUES THE ABOVE LICENSE TO: i j DAVID S YARCKIN 210 FOUNTAIN STREET fi FRAMINGHAM MA 01702-6204 �. 23033 E 07/31/13 814238 1 4 1 212 Date.11Jl qh. ........ HORTM TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION p �9SSACHUSEt This certifies that . fylO. '. . . . . . . . • . . . has permission for mechanical installation VP Q in the buildings of + ?�� � . . ... . . . . . . . . . . . . . . . . . at . . �• • .P :�• • ( •, North Andover, Mass. Fee. s��. . . Lic. No Aa.>�� . . . . .. . . . . . , !�. . . . . . . . . . . . . . GAS INS46TOR WHITE:Applicant CANARY:Building Dept. f PINK:Treasurer Commonwealth ®f Massachusetts Sheet Meta. Permit 4 DateP: . 3 Permit# Estimated Job Cost: Di� � Permit Fee: Plans Submitted: YES INTO Plans Reviewed: YES NO Business License#„ ��� Applicant License# /4040,0;? Business Information: Property Owner/'Job Location Information: Name: FAICo2 J��/fCF Name: &v4 � Street: $fJwl4 _ Street �WGFLI ,' Bim: City/Town: U��j �/+ -®��� City/Town: f/tT1NA0r/ .r Telephone:Co 1�1-oZ 92-59/g QR(A - elephone: Photo I.D. p required/Copy of Photo I.D. attached: YES NO q Building Type: Residential: 1-2 family Multi-family Condo/Townhouses 4 Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu.ft. over 35,000 cu.ft. Sheet metal work to be completed: New Work: Renovation: . HVAC Metal Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: , ,�" 0,A) 12"d r 4 Y INSURANCE COVERAGE: I have a current liability insurance policy,or its equivalent which meets the requirements of M.G.L.Ch.112 Yes No❑ If you have checked Yes,indicate the typ f coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 912 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[ ,I hereby certify that all of the details and informatiori I have submitted(or entered)regarding this application are true and accurate to the,best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 192 of the General Laws. Progress Inspections Date Comments Final inspection Date Comments TyZter cense: By Title ❑Master-Restricted CitylTown " ourneyperson Signature.of Lic nsee 'ermit# ❑Journeyperson-Restricted License Number. =ee$ El Check at www.mass.gov/dol nspector Signature of Permit Approval COMMONWEALTH OF MASSACHUSETTS flikylo . :.••. . PLUMBERS AND GASFITTERS LICENSED AS A JOURNEYMAN PLUMBED ISSUES THE ABOVE LICENSE TO: R NkRK R LARACY 16 OAK HILL RD BRAINTREE MA 02184-5519 19422 05/01/14 149450 COMMONWEA MASSACHUSETTS LTH OF � AN .. GA FIT•.;R S S THE PLUMBERS ASTER PL.M LICENSED A M ISSUES THE A60VE IJGEPlSE T0: 'C •5 MARK R LARACY 16 OAK HILL RD BRAINTREE MA 02184-5519 05/01/14 1494, c'10027 ' CO MONWEgLTHOF M SA SACHUSETTg :.. PLUMBERQ G REGISTERED AS ASFat A LU S P ISSUES THE ABOVE LIC SETING CORP ErvsE TO: MARK R LARACY "MCOR SERV NORTHEAST INC COMM 16 OAK HILL RD BRAINTREE AINTREE MA 02184-5519 3065 9 05/0 1/ 14 153835 u A CERTIFICATE OF LIABILITY INSURANC DATE /YYYY) E 09,20//20,2012 2 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(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 MARSH USA,INC. NAME: PHONE 601 MERRITT 7 (ALc o FARC No NORWALK,CT 06856 E-MAIL Attn:Emcor.Certrequest@marsh.com/Fax: 203-229-6787 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# 309230 EMGBAL-12-13 INSURER A:Continental Casualty Company 20443 INSURED EMCORSERVICES-NORTH EAST,INC. INSURER B:American Casualty Company Of Reading,Pa 20427 COMMAIR/BALCO INSURER C:Transportation Insurance Co 20494 80 HAWES WAY STOUGHTON,MA 02072 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-005638195-10 REVISION NUMBER:5 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 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE wqp vrvn POLICY NUMBER MM/DD� MM%DD� LIMITS A GENERAL LIABILITY GL 2095787039 10,01,2012 10/01/2013 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 25,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ 14,000,000 17 POLICY X PRO- LOC JFC A AUTOMOBILE LIABILITY BUA 2095787090 10/01/2012 10/0112013 COMBINED SINGLE LIMIT X Ea acc dent $ 2,000,000 ANY AUTO ALL OWNED CHEDULED BODILY INJURY(Per person) $ S AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ Auto Physical Damage $ Included UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION $ B WC 2095787008(AOS) ,OI01I2012 1010112013 X WC STATU- OTH- B AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC 2095787011(CA) 1010112012 10/0112013 LIMITS 1,000,000 C OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory In NH) WC 2095787025(AZ,OR,WI) 10/01/2012 10/0112013 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) EVIDENCE OF INSURANCE. CERTIFICATE HOLDER CANCELLATION EMCOR SERVICES NORTHEAST INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COMMAIR,BALCO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EVIDENCE OF INSURANCE. ACCORDANCE WITH THE POLICY PROVISIONS. 80 HAWES WAY STOUGHTON,MA 02702 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Heidi BauermeisterIp � �� � @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 309230 �1 LOC#: Norwalk AC(:>O ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA,INC. EMCOR SERVICES-NORTHEAST,INC. POLICY NUMBER COMMAIR/BALCO 80 HAWES WAY STOUGHTON,MA 02072 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Auto Physical Damage Comp I Coll Deductible$500 In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part(other than the reduction of aggregate limits through payment of claims as applicable),Insurer agrees to mail prior written notice of cancellation or material change to:Certificate Holder Schedule 1.Number of days advance notice:For any statutorily permitted reason other than non-payment of premium,the number of days required for notice of cancellation as provided in paragraph 2 of either the Cancellation Common Policy Conditions or as amended by the applicable state cancellation endorsement is increased to the lesser of 60 days or the number of days required in a written contract. For non-payment of premium,The greater of(1)the number of days required by state law or(2)the number of days required by written contract. 2.Name: Notice will be mailed to:Certificate holder ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD l i 1/4-x2"FITTED STIFF. EXIST'G.PIPE POST, —� &NEW STIFF.PL.'s �— PL.N.S.&F.8. ` GLINEAS,Ln c.ING ; FACE OF wm I " ( ISOLATOR, OR + _ .+ CHILLER `L'a"""' ---r-� '� a.n PER MECH. FRAME DWGS. c I _}—SPRING o�, �I i ISOLATOR PER MECH. Csl 1 DWGS. S-1 3 SIDE& ii I y PL.3/8'718"x0'-S" ' I. EXISTG.PL.1/8"x10"xa-10- MEMBRANE I •� 1 ! iFLASHING = i lEXISTG..MEMBRANE ---- __ _ 4---- r b ' CHILLER UNIT ROOFING SYSTEM _I_.: _I_n C7 m j ; I PER MECHANICAL - a ( DRAWINGS of Lo SECTION 2 SECTION a IL V n n 3to1 Mimi v { NOTES: 1. ALL WORK SHOWN ON THIS DRAWING SHALL BE IN CONFORMANCE WITH THE a MASSACHUSETTS STATE BUILDING CODE,STH EDITION, 2 NO ZTH. IN FIELD AND z z CONTRACTOR SHALL s"1 COORDINATE ATTACHMENT REQUIREMENTS WITH MEIFY LOCATION AND ICHANICAL EQU PMSENT DRAWINGS. w (TYP•)• 3. ALL STEEL WORK SHOWN ON THIS DRAWING SHALL CONFORM TO THE AISC I N U _ 'I 'SPECIFICATION FOR STRUCTURAL STEEL BUILDINGS"AND THE"AISC CODE OF J 1• STANDARD PRACTICE". m + EXISTG.REF. �J 0,< ORM TO ASTM A99 4. WIDE FLANGE STEEL BEAMS SHALL CONFORM �� � FIELD DIMEN'S.- Q.W=�- �- VERIFY IN FIELD 5, STEEL ANGLES AND PLATES SHALL CONFORM TO ASTM A38. W 0 V (REF,-V.I.F.) _(/�C 7. ALL STEEL SHALL BE HOT-DIP GALVANIZED CONFORMING TO ASTM A123. J O 0 INSIDE.FACE OF EXISTING TOUCH-UP DAMAGED AND WELDED GALVANIZING;WITH ZRC ZINC REPAIR PAINT. MECHANICAL WELL WALL I S. ALL ROOF PATCHING AND FLASHING AT PENETRATIONS,SHALL BE PERFORMED BY J I'Y CONTRACTOR WARRANTED.BY MANUFACTURER UNDER.TERMS OF THE �Z O 0 ROOF WARRANTY. R�� t,= +X LLI W Z & t V=mQ �K J!P. Meet Q mnu RATTA L u' +Pogo ec�� I CHILLER SUPPORT, FRAMING PLANSCALE: 1/4"=.1'-0.° �rAttiS- 1 re. IV ►i YORK BY JOHNSON CONTROLS gyp} a 1 p 4 g Model YLAA Air-Cooled Scroll Chiller. with Brazed Plate Heat Exchangers Style B 'a Equipment Data Sheet Johnson d� l Project Name Brooks School Henry Unit Name UNITO Luce Libr. controls YLAA0091HE46XCBBXTXHXXBLXCXX44SX1)=HXXXYAXXXXXX)MLXiBiXXXX Pin Date 2013-04-03 Version E.13.2.0-D.14.0045 I Ref 4::CH-1 CH-1 Equipment Data Sheet Report Unit Type and Size ID YLAA-B0091HE Number of Compressors 4 CompressorType Scroll-Hermetic Number of Compressor Circuits 2 Technical Data Refrigerant Type R410A Net Cooling Capacity TR 86.3 Total Power Input kW 97.9 EER EER 10.6 IPLV EER 15 N PLV EER 14.9 Sound Power dB(A) 94 Evaporator Evaporator Type Plate Heat Exchanger Fluid Volume USGAL 8.8 Fluid Type Propylene Glycol Fluid Concentration % 40 Entering Liquid Temperature `F 54.9 Leaving Liquid Temperature "F 44 Eva poratingTemperature °F 37.9/37.9 Total Flow Rate USGPM 207.6 Total Pressure Drop ft H2O 10 Fouling Factor h.ft2.F/Btu 0.0001 Fluid Connection Diameter in 3" Min Fluid Flow Rate USGPM 100 Max Fluid Flow Rate USGPM 385 Condenser(Air Cooled) Ambient Air Temperature "F 95 Condensing Temperature "F 117.3/117.3 Number of Fans 6 Altitude ft 0 Total Air Flow cfm 88993 Total Fan Power kW 10.1 Printed:2013-04-03 E.13.2.0-D14.0046(REV.v6_03.idd) Equipment Data Sheet Unit Folder:UNIT0 Brooks School Henry Luce Libr. Page 1 of 2 Part Load Data Report Brooks school Henry Luce Johnson �t Project Name libr. Unit Name UNITO Controls Pin YLAA0091HE46XCBBXTXHXXBLXCXX44SX1XXXH)MYAXXXXXXXXXLXIBIXXXX Date 201344-03 Version I E.13.2.0-D.14.0046 Ref 4::CH-1 CH-1 Part Load Report Conditions and Settings: Evaporator Condenser Entering Temp. 567 Ambient Ai r Temp. 957 Leaving Temp. 44 T Altitude 0 ft Fouling Factor 0.0001 h.ft2.F/Btu Fan Type L Brine Type 40%Propylene Fin Type X Part Load Rating: Full Load Ambient Cooling Input Power Stage Temp.TF Camp. kW EER 1 95 86.3 97.9 10.6 2 95 73.7 82 10.8 3 95 44.7 49.8 10.8 4 95 12.9 14.4 10.7 Sound Data: Full sound Load value 63 Hz 125Hz 25OHz 500Hz 1kHz 2kHz 4kHz 8kHz Stage dB(A) 1 94 99 94 92 93 88 87 82 79 2 94 98 94 91 92 87 86 81 77 3 93 97 94 91 91 86 85 80 77 4 88 92 88 86 87 81 79 1 75 74 Sound Power spectrum Printed:2013-04-03 E.13.2.0-D14.0046(REV.v6_03.idd) Part Load Report Unit Folder:UNITO Brooks School Henry Luce Libr. Page I of I 5/8"DIA MOUNTING HOLES(TYP) NOTES: 1. INCLUDING SNPLACEMENT WINNTER OPERATION)OR AIR RECIRCA LEVEL SURFACE FREE OF ULATION NSURES RATED '- PERFORMANCE,RELIABLE OPERATION AND EASE OF MAINTENANCE. 571 40 534 SITE RESTRICTIONS MAY COMPROMISE MINIMUM CLEARANCES INDICATED BELOW,RESULTING IN UNPREDICTABLE AIR FLOW PATTERNS AND POSSIBLE ti ` DIMINISHED PERFORMANCE.YORK'S UNIT CONTROLS WILL OPTIMIZE HOWE ER TH SYSTEM DESIGNER MUST CONSIDER POTENTIOPERATION OUT NUISANCE MGM PRESSURE SAFETY AL PERFORMANCE DEGRADATION. RECOLVAENDEDMMNUMUMCLEARANCES: POWER ENTRY SIDE TO WALL•6' ' ` •• 13"WI04 X T'HIGH REAR TO WALL•V fo % LZI CONTROL PANEL TO WALL•4' TOP-NO OBSTRUCTIONS ALLOWED �. y DISTANCE BETW&EN ADJACENT UNITS-1V. NO MORE THAN ONE ADJACENT WALL MAY BE HIGHER THAN THE UNIT. 2.WEIGHTS(LB):SHIPPING•4,718;OPERATING•4,781. 6 13/16" 46 318" S.CENTER OF GRAVITY FROM ORIGIN:X.672';Y.52.1a DR'' e t s CONTROL PANEL 4._INSTALLING ONTR CTORM W INCLUTER EV E RTHE�N - BOTTOM DETAIL EVAPORATOR. g 4 1,290 2 711!18" 117 3/1 V' ORIGIN Y X a t T�T • • p O O 3"INLET aJ = R W W = t t 0 uT LoJ 23118" 236/16" _ 461/2" 3,•OUTLET 88 5116"-FRAME WIDTH 8813/16"•OVERALL WIDTH 1421!4"•FRAME LENGTHGOD 149 5!18"•OVERALL LENGTH Project Name:Brooks School Henry Luce Libr. Sold To: Date:4/3/2013 16:57:52 NYOFK PRODUCT DRAWING Location: Cust Purch Order#: Rev.Date Engineer: York Contract#:3EO30082 Form Contractor: UNIT Dwg'Lev'' A JOHNSON CONTROLS COMPANY MODEL: CONSTRUCTION TI CH-1 Dwg.Scale: NTS NOT FOR CONSTRUCTION For: TAG: r Controls CH-1 Project Mame `jili t Tag Date Ghiiler` yjm Brooks School Henry Luce Libr. 4/3/2013 Air Cooled Scroll Chillers Version YLAA0091 HE46XCBBXTXHXXBLXCXX44SX1XXXHXXXYAXXXXX?UOIXLX1 B1XXXX E.13.2.0-D.14.0046 `m a b U a Toytieav �i JCI;PART SPRING Opecatl >Ig LOCATION X Distance(in) Y.Distance(in) SAF.NUMBER NUMBER COLOUR i Weights(Ib) R1 7.6 1.4 029-25334-003 433669 Dark Green 571 R2 76,6 1.4 --62-9-25334-004 433670 Gray 839 R3 124.8 1.4 029-25334-003 433669 Dark Green 535 L1 7.6 86.9 029-25334-004 433670 Gray 883 L2 76.6 86.9 029-2 5334-006 433872 Gray/Red 1291 L3 124.8 86.9 029-2533403 -033669 Dark Green 672 Totai Ib Wei fit { g { ) Operaung 4791 Xg 67.8 Shipping 4718 Y9 52.1 MLP Date:2013-01-10 Brooks School Henry Luce Libr. Generated on 2013-04-03 E.132.0-D.14.0046(REV.v6 03.idd) AVM Location Specification Unit Folder:UNITO Software Version:YW13.02 Page 1 N° 1825 Date..... °!t"'° '•�"° TOWN OF NORTH ANDOVER {° 9 PERMIT FOR WIRING ,SSACMUS� This certifies that ..\`(�.Jl�.e.g.r...!� hAMK.k'.C4......................... has permission to perform .....4-...c...... ....................................... wiring in the building of.......tom'..f�.t�s .t�.S........ .t ..! �.�........................ ..1�Qo .��ff.......,�.W................ .North Andover,Mass. Fee.... .. :. Lic.No.13�7'/.:.............................. .............................. _ ELECTRIC AL INSPECTOR Ca S 05/12/98 08:44 50.00 PAID WHITE:Applicant CANARY:Building Dept. PINK:Treasurer I s ( Office Use Only �\ Permit No_ —Y—La, Vo-&-d 4 P-d&544 Occupancy 8 Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 UV APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK r efts .e�rical Cade 527 CM Massachusetts E R 1 All work to be armed in accordance with the 2.00 P� (Please Print in ink or type all information) Date d To the Insl6ector of/mils: Town of North Andover 11 �o Gf, 000) The undersigned applies for a permit to perforin the electrical work described below. Q Location(Street 8 Number u� � SC Owner or Tenant Ownefs Address Is this permit in conjunction with a building permit Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Pr/ .�� ! Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed E'.ectrical Work �2& � �1 _ I � P To No.of Light8ng Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lightinq Fixtures Swimminq Pool gmd C gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Bumers Battery Units No.of Switch Outlets No of Gas Bumers FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Dioosal No. Pumas Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers SoacelArea Hearing KW OetectioniSounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Barlases Winn No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have,subwAkd valid proof of same to the Office YES= NO = If youve rhe ked YEAS pi aindicatethe type of coverage by checking the appropriate box SURANCE BONO = OTHER = (Please Speaiy J C (Expiration Date) EsUmated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed underthe Penalties of perjury: FIRM NAME LIC.NO. 14) Licensee r 10010 6' &f Signature C LIC.NO. Bus.Tel No. L-(' Address-6-0&`V a 4��- _ Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts i requirement. Owner Agent Please Check one) General Laws.And that my signature on this permit application waives this req A9 ( .� Telephone No. PERMIT FEE 5 d (Signature of Owner or Agent) � C(I