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HomeMy WebLinkAboutMiscellaneous - 124 MAIN STREET 4/30/2018 ��9� 9N9019�� � fs crow dEl Date.�a .q. .iq.................... 4 i F N°pT/y TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING s�CHUSC This certi .Y`�...........! `. `i...J.. � ... fies that ...,,. � has permission to perform .......`^l.......LIA4f r„/,.,,.., .t.e„ .................................... wiring in the building of..... ..... ........IJ..1 ^. ....................... North Andover,Mass. Fee............ ..............Lic.No."524... .M.�. '"............. . �.. . • E ICAL�SPECTOR Check# O 1 +J 0 \ lfommonwea&o f//laaaacAu6emi Official Use Only Permit No. � ._ a1JePartmeret o�Mire�ervice� 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 Ilv'INK OR TYPE LL IN ORAfATION) Date: City or Town of: �, 4{C' Y To the Ins ector of Wires: By this application the undersigned gives n tice of his or he ;n ention to perform the electrical work described below. Location(Street&Number) Owner or Tenant v Telephone No. Owner's Address Is this permit in conjunction with a building pt. '."es ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followin table maybe waived by the Inspector of Wires. 3 No.of Recessed Luminaires No.of Ceil.-Sus addle Fans No.of Total p' ) Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Units Emergency Lighting r— rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and- Initiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pum umber Tons K.W o.o Self-Contained ,� \ p Total p .. ... .. _........................................................ Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection yyonnection s ems: No.of Dryers Heating Appliances KW Security No. f Devices or Equivalent i No.of WaterK W No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent N0.Hydromassage Bathtubs No.of Motors Total HP Telecommunications No_of Devices or Equivalent OTHER: Attach additional detail if desired,-or as required by the Inspector of Wires. Estimated Value of Electrical Work: t (When required by municipal policy.) K's Work to Start:-1Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: 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: LIC.NO.:�SL Licensee: �, c� « Signature C.NO.: 73 (If applicable, enter "exe t"in the lice e n mbe�li;te Bus.Tel.No.. Address: / Alt.Tel.No. *Per M.G.L. c. 147,s. 57-61,security work requires Depardient 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 agent. Owner/Agent PERMIT FEE: $ Q Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Lighting Retrofit Services Address:234 Ballardvale Street City/State/Zip:Wilmington, MA 01887 Phone#:978-988-7800 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 45 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. F1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. EJ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12:❑Roof repairs insurance required.] t c. 152, §1(4),and we have no Lighting Retrofit employees. [No workers' 13.0 Other g 9 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 are 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Hartford Insurance Company Policy#or Self-ins. Lic. #:56921665 Expiration Date:4/13/2011`'s Job Site Address: City/State/ZipA ) dfidl)m ! /ll9 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. Ido hereby ' rtify under t e pains andpenalties ofperjury that the information provided above/is true and correct Signatur KA Date: ` Phone# Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: OP ID:MH CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 04/15/14 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 978-975-1300 CONTACT Segreve&Hall Insur.ASSOC.InC NAME: 305 North Main St. 978-975-7596 PHONE FAX Andover,MA 01810 A/C No xt: A/C No E-MAIL Patrick D.Hall ADDRESS: CUSTOMER ID :LIGHT-3 INSURERS AFFORDING COVERAGE NAIC# INSURED Lighting Retrofit Services Inc INSURER A:Arbella Protection Ins.Co. 41360 234 Ballardvale St,Suite 1, Wilmington,MA 01887 INSURER B:Hartford Ins Co. INSURER C: INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 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. /NSR 8 POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYYPOLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY kGE TO RENTED PREMISES Ea occurrence $ 100,00 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 5,00 ADDTN'L INSRD. 8500045964 01/03/14 01/03/15 PERSONAL&ADV INJURY $ 1,000,00 X Equip Rental Cov $250,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X I PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1'000'00 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ A X SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE X HIRED AUTOS 1020015640 03/15/14 03/15/15 (Per accident) $ X NON-OWNED AUTOS $ $ UMBRELLA LIAB X OCCUR EXCESS LIAB EACH OCCURRENCE $ 5,000,00 CLAIMS-MADE A 4600045965 01/03H4 01/03/15 AGGREGATE $ 5,000,00 DEDUCTIBLE $ RETENTION $ a WORKERS COMPENSATION WC STATU• OTH- AND EMPLOYERS'LIABILITY X ITORIMI S R B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑N N/A Mandatory in NH) SB921665 04/13/14 04/13/15 E.L.DISEASE-EA EMPLOYEEI$ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD � :,���:N1�IVE�1�V51 �L:Ti-9 �f:Nl• $��� CB 8 gr > r� ��i tSEIES T} E OWING RETROF� /SERV I CES' I NC . .2 2 BALRALE 5''hSOa ,z F7.. 21t SAY y y�,]J.•31i'1�;LS r.` Town of North Andover FIRE STATION #1 12-Aug-2014 09:39:58 Current Scope of Work Page 1 Qty Qty Ref see Floor Room Ref # ECO # Var Sury Done done COR 1 BLDG MT 2035 11W COMPACT SI-E 1 2 1 BLDG MT 2036 NO RETRO 1 0 1 BLDG MT 2037 71W LED/NEW-EXT 1 1 1 BLDG MT 2038 50W LED/NEW-EXT 1 1 1 BLDG MT 2039 70W MH CWA-EXT 1 2 1 PARKING LOT 2040 100W MH CWA-EXT 1 3 1 BLDG MT 2041 23W COMPACT SI-X 1 2 1 BLDG MT 2042 50W METAL HALIDE 1 2 1 LIFT FEE 2042 A LIFT-FS1 1 1 1 RECYCLING 2042 B RECYCLING-FS1 1 1 1 WASTE DISPOSAL 2042 C TRASH-FS1 1 1 Copyright (c) 2014 - Lighting Retrofit Services f V V� - f Date . 7 . . . . bk'p'iLEtl7ygs�... e� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . j . . has permission to perform .6' b. .1s`��.! . . . . . . . . . . . . . . . . . . . wiring in the building of . . .t-.7\4.42-. .70.�1 ...� ' , , , , , c_- at . . . . `-�. . . . . t-e. �" . . . . . . , h Andover, Mass. Fee!,�!�.,Ec_:!. Lic. No.7o13Z H . . . . . . ELECTRICAL INSPECTOR Check# { 1012 pp'' �\ (fommoawea&o/WaMaclWetb Official e Only c� c� Permit No. 2epartment of }ire Services 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: 7- AL 20d, City or Town of: • Alogth To the Inspector of Wires: By this application the undersigned gives notice of his or her intentio to perform the electrical work described below. Location(Street&Number) 1 a,4. z j Owner or Tenantr'�'>Z AA -yP49 611; if Telephone No. Owner's Address 7 .,,A S-14 Z-A Is this permit in conjunction with a building permit? ;Yes No ❑ (Check Appropriate Box) Purpose of Building lr�' 'DItih1CUtility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires s� No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above ❑ In- 11 o.o Emergency Lighting No.of Luminaires J Swimming Pool rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of etection an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number ons o.o e - ontamed 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.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications firing: No.of Devices or Equivalent OTHER: A p Attach additional detail ifdesired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start.7" 3 D-2PI;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 Q BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: J.P.McCurdyElectrical Services Inc. LIC.NO.: 20172 A Licensee: Signature LIC.NO.:_Sljoi45-�- (Ifapplicable,enter "exempt"in the license number line) v Bus.Tel.No.- 781-595-7074 Address: 17 Walnut Road,Swampscott,MA 01907 Alt.Tel.No.: 781-595-2431 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. SS CO 000914 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: $ The Commonwealth of Massachusetts Department of Industrial Accidents 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 Lezibly Name(Business/Organization/tndividual): J.P. McCurdy Electrical Services, Inc. Address: 17 Walnut Road City/State/Zip: Swampscott,MA 01907 Phone#: (781) 595-7074 Are you an employer? Check the appropriate box: Type of project(required): 1.[✓j I am a employer with 7 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.9 Electrical repairs or additions 3.❑ I am a.homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 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 are 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. • I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: Technology Insurance Company Policy#or Self-ins.Lic.#: TWC3292507 Expiration Date: 9/5/2012 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. I do hereby under the painfa d p aloe of perjury that the information provided above is true and correct Si ature: "` Ca— Date: Phone#: (7 595-7074 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY North Andover _ � _ � MA DATE L§L13I2012 PERMIT# x JOBSITE ADDRESS 124 Main Street OWNER'S NAME Town of North Andover POWNER ADDRESS TELT m FAX!,M TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIALIJ PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES D NDE] FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ,.,. I'' CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM f � DEDICATED GREASE SYSTEM 79 r--7 __ i_ DEDICATED GRAY WATER SYSTEM � I DEDICATED WATER RECYCLE SYSTEM 6 DISHWASHER . DRINKING FOUNTAIN < FOOD DISPOSER ;I a m _ FLOOR/AREA DRAIN „. _._ ? h -�n. ...,n >o.;mnvn,,:; •.n ..... .oCe>x. xa ...v. !r;nw..ztt.aat::,�.,,wrc., w.. INTERCEPTOR INTERIOR I µ KITCHEN SINKy �' ( xl LAVATORY ROOF DRAIN 2 �££ E SHOWER STALLt _ t SERVICE/MOP SINK I { r _ I TOILET f 1t URINAL r __ WASHING MACHINE CONNECTION ( I t WATER HEATER ALL TYPES WATER PIPING z I OTHER _... _. � _w�� � .. �,.. ._._ _ it �.. vl € INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES µ NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY LIJ OTHER TYPE OF INDEMNITY BOND L 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: NER 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 d ac ate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com anc Mt all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ..... PLUMBER'S NAME ffaul J Dionne LICENSE# 11164 SIGNATURE MP, JP CORPORATION 'PARTNERS 1 _ I s #� LLCf. #€.__ ..m. ..» COMPANY NAME P J Dionne Co., Inc. ADDRESS60 Jonspin Road CITY, Wilmington STATE i MA ZIP 101887 TEL 978-657-3990 FAX 978-657-3992 CELL' EMAIL pdionne@pldionne com ._ e- ._.__ w � ,,. .a 4 NORTH 16 Oe Olb' to iy � cocro�Mtwaw 1' 'P 14 SAC HU5�4�� TOWN OF NORTH ANDOVER Sign Permit Date: March 23, 2006 Permit Number: 46-06 THIS CERTIFIES THAT Town of North Andover MA Has permission to erect a 85"x 53" Ground Sign-Pole Mounted On 124 Main Street provided that the person accepting this Permit shall in every respect conform to the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the _ Town of North Andover. Violation of the Zoning of Sign Regulations, Section#6 Voids this Permit Inspector of Buildings I o f Se`nnS t�e Standard for ver 5 Q9 yeazs ] r r Jay o T 9,78-3,72-3,72 j rr J o F 978 52 2 21 v Y@thesigr)aentercam r; 1 A r TOWN OF NORTH ANDOVER ,����� SIGN PERMIT APPLICATION Site Owner�(A)/) ,X N//0C'71 A"rd6 ler Tel#97/? /go- �56I Applicant ' Site Address 1021-1 :45tr P 7L Size of Proposed Sign S5\,X 53 � Estimated Cost of Sign 6000 /t/li4 D l 8 L/5 How attached: (a)Against the wall ( ) Illumination: (a) Not illuminated (✓� (b) Roof ( ) (b) Internally illuminated ( ) (c) Ground ( ) (c) Externally illuminated ( ) (d) Other 96\e, 11V6 (VY / Proposed Colors: Background (n/hi�. Materials: /ll000 LeXaa Lettering 13l Border Go l Required Attachments: No permanent/temporary sign shall be erected, or Photographs of building enlarged until an application on the appropriate form Material sample furnished by the Sign Officer has been filed with the Color samples Sign Officer containing such information including Site or Plot Plan (Required for all free-standing signs) photographs, plans and scale drawings, as he may Drawings of proposed sign require, a permit for such erection, alteration, Other, specify or enlargement has been issued by him. Such permit shall be issued only if the Sign Officer determines that the sign complies or will comply with all applicable provisions of the By-Law. Will sign overhang any public road or walkway: Yes (V� No ( ) If Yes, Name of Agency who will provide liability insurance: D /tJO r f7�Q0 vl°� AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED. �1 Date Filed:- 9ign7!euTe'of Applicant i OF''ID 75 DATE(Mtj1DD/YYYY) AC080 CERTIFICA E OF LIABILITY INSURANCE INS iG 1 12/05/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TIE CERTIFICATE y TD Banknorth Ins Agcy Inc (SF) HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 9040 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Springfield MA .01102-9040 Phone: 413-781-5940 Fax:413 33-7722 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: HANOVER INSURANCE CC . 22292 INSURER B: Twin City Fire Insurance Co. 29459 Insignia Inc DBA Sig Center INSURER C: Hartford Fire Insurance Cc 19682 Jason M;Kahn 40 Orchlard St INSURER D: Nat'l Union Fire Pittsburgh PA 19445 Haverhill MA 01830 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BE N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ING ANY REQUIREMENT,TERM QR CONDITION OF ANY CON RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POL CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SL CH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEI, REDUCED BY PAID CLAIMS. INSIR OD POLICY NUMBER VE P LIMITS LTR NSR TYPE OF;INSURANCE DATE MCY M/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 C X COMMERCIALGENERAL LIABILITY 08pBAPJ4769 12/01/05 12/01/06 PREMISES(Ea o urence) $ 300,000 CLAIMS MADEa OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&AD INJURY $ 11000,000 GENERAL AGGRE GATE $2 000,000 GENT AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COIP/OP AGG Is 2-10-0-0-10-0-0 POLICY PE0 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO AM 663183903 12/12/05 12/12/06 (Ea accident) $ 1,000,000 ALL OWNED AUTOS i BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS: I BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DA E $ (Per accident) GARAGE LIABILITY: AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE s2,000,000 D X OCCUR CLAIMS MADE EB J9038191 12/12/05 12/12/06 AGGREGATE s2,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND X I TORY LIMITS ER B EMPLOYERS'LIABILITY 08lqECGU7291 12/12/05_1 12/12/06 E.L.EACH ACCIDET $ 500 000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA MPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-PO ICY LIMIT $ 500 000 OTHER DESCRIPTION OF OPERATIONS, LOCATIONS/VEHICLES/1XCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS To provide evid�nce of insurance. I CERTIFICATE HOLDER CANCELLATION GENERIC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR 0 MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL For Insurance Purpose Only IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE TD Banknorth Ins. Agency, Inc. ACORD 25(2001/08) ©tCORD CORPORATION 1988 S:\Proposals\AUDREY\North Andover Clock Pernit Stuf 2f.plt 3/22/2006 5:10:46 PM Scale: 1:28.12 Height: 241.253 Length: 181.125 in V.11VA" �pVON O�p ` NORTH ANDOVER llMAllllr � 1 46 � G t. SIGN FACE fi f � r. f It �4of 'Stiff k f 11W916 ice. £ Y .SSH EE yp� {y �u • f t k � 1 i- Date..*&..... NORTI, TOWN OF NORTH ANDOVER o : p PERMIT FOR WIRING ,SgACMUSEt JW- This certifies that ...... ......^..... .............................r..................... ..... ........... r has permission to perfo � .1.4.....�...�.......................,.................... .....:.. wiring in the building of.... .. . I .. ...x .... at 1... ..!/ 144...�Z ... ................. .North Andover,Mass. M..... Lic.No.�!../(�� 1.Fee.... ........................................................ ELECTRICAL INSPECTOR ' Check # ' 5u7 .� i The Commonwealth of Massachus�ts Office Use Only •/ , Permit No. ./�/ •� Department of Public Safety Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 IR 12:00 (leave blank) APPLICATION FOR PERMIT TOERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code.527 CMR 12:00 PLEASE PRINT IN INK OR TYPE ALL INFORMATION t, q ( ) Date March 12,2004 City or Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical,work described below. Location(Street&Number) 124 Main Street, North Andover,MA 01845 Owner or Tenant Town of North Andover Owner's Address 400 Osgood Street, North Andover,MA 01845 Is this permit in conjunction with a building permit: Yes ❑ No❑ (Check Appropriate Box) Purpose of Building Central Fire Station 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 124 Main Street, North Andover,MA 01845 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above[:] gmd ❑ Generators KVA grnNo.of Receptacle Outlets No.of Oil Burners Batter Emergency Lighting No.of Switch Outlets No.of Gas Burners FIRE ALARMS No. of Zones No.of Ran es No.of Air Cond. Total No.of Detection and g tons Initiating Devices No.of Disposals No.of Heat Total Total No.of Sounding Devices Pumps Tons KW No.of Dishwashers Space/Area Heating KW No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW local Municipal ❑ Other rY g ❑ Connection No.of Water Heaters KW No.of No.of Low Voltage Si ns Ballasts Wiring No.Hydro Massage Tubs No.of Motors Total HP Other. install 1-160KW generator r INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws �► 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. Yes® No ❑ I have submitted valid proof of same to this office. Yes® No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE® BOND® OTHER❑ (Please Specify) Estimated Value of Electrical Work $48,400.00 (Expiration Date) Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME Brite-Lite Electrical Co., Inc. LIC. NO. License Joseph K Curran Signature LIC. NO. A10639 Address 11 Front Street,Weymouth,MA 02188 Bus.Tel.No.781-340-9102 Alt.Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that-By signature on this permit application waives this requirement. Owner❑ Agent ❑ (Please check one) ' Telephone No. PERMIT FEE (Signature of Owner or Agent) Y NORTH TOWN OF NORTH ANDOVER o PERMIT FOR WIRING �Ss�cHus� h�j pp �L�j'/� This certifies that ...... . .................................................. ........ .............. has permission to perform , wiring in the building of...../ C..... ....1.. ... ................... at, 4. ,` /)`*"0-4....!�'J,.�=.............................. ,North Andover,Mass. Fee....jU.l. .... Lic.Na� 1./ ........................................................... � ELECTRICAL INSPECR Check # �/� TO 5U74 U The CCommonwealth of Massac setts Office Permit No. UIV Department of Public Sa etyOccupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATI NS 5 CMR 12:00 (leave blank) APPLICATIONbFOoRePERMIT d PERFOd in accordance Massachusetts ERMaE ELe.ECTRICAL WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date March 12,2004 City or Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 124 Main Street, North Andover, MA 01845 Owner or Tenant Town of North Andover Owner's Address 400 Osgood Street, North Andover, MA 01845 Is this permit in conjunction with a building permit: Yes ❑ No❑ (Check Appropriate Box) Purpose of Building Central Fire Station 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 124 Main Street, North Andover, MA 01845 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA in- No.of Lighting Fixtures Swimming Pool grnd e❑ gmd. D Generators KVA No.of Receptacle Outlets No.of Oil Burners No,of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No. of Zones No.of Ranges No.of Air Cond. Total No.of Detection and tons Initiating Devices No.of Disposals No.of Heat Total Total No.of Sounding Devices Pumps Tons KW No.of Dishwashers Space/Area Heating KW No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local❑ Municipal ❑ Other Connection No.of Water Heaters KW No.of No.of Low Voltage Si ns Ballasts Wirin No. Hydro Massage Tubs No.of Motors Total HP Other: install 1-16OKW generator Y INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws l I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. Yes ® No ❑ I have submitted valid proof of same to this office. Yes® No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE® BOND® OTHER ❑ (Please Specify) Estimated Value of Electrical Work $48,400.00 (Expiration Date) Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME Brite-Lite Electrical Co., Inc. LIC. NO. License Joseph K. Curran Signature �• IC. NO. A10639 Address 11 Front Street,Weymouth, MA 02188 Bus.Tel. No.781-340-9102 Alt.Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that-By signature on this permit application waives this requirement. Owner ❑ Agent ❑ (Please check one) '1 Telephone No. PERMIT FEE 1 (Signature of Owner or Agent) From:Brite-Lite Electrical Co.,Inc. general email:info@bfite-fite-electrical.com Date:3126104 Time:1:27:18 PM Page 2 of 2 Office Use Ony Tie Commonwealth ofMassachusetts y Permit No. Dep-nrestt ofPubhc Safety Occupancy S Fee Chocked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code.527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date March 12,2004 City or Town of North Andover To the Inspector of Wires. The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 124 Main Street,North Andover,MA 01845 Owner or Tenant Town of North Andover Owner's Address 400 Osgood Street,North Andover,MA 01845 Is this permit in conjunction with a building permit: Yes ❑ No❑ (Check Appropriate Box) Purpose of Building Central Fire Station 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 124 Main Street, North Andover, MA 01845 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures SwimmingAbove Pool grnd. Elgmd. 11Generators KVA No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones No.of Ranges No.of Air Cond. Total No.of Detection and tons Initiating Devices No.of Disposals No.of Heat Total Total No.of Sounding Devices Pum s Toms KW No.of Dishwashers Space/Area Heating KW No.of Self Contained Detection/Bounding Devices No_of Dryers Heating Devices KW LtKa [:]1 Municipal ❑ Other Connection No.of Water Heaters KW No.of No.of Ltwr Voltage Si ns Ballasts Wirin No.Hydro Massage Tubs No.of Motors Total HP Other: install 1-1 60KW generator INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. Yes® No ❑ I have submitted valid proof of same to this office. Yes® No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE09 BOND® OTHER❑ (Please Specify) Estimated Value of Electrical Work $48,400.00 (Expiration Date) Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME Brite-Lite Electrical Co.,Inc. LIC. NO. License Joseph K.Curran Signature LIC.NO. A10639 Address 11 Front Street,Weymouth, MA 02188 Bus.Tel. No.781-340-9102 Alt.Tel.No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that-By signature on this permit application waives this r uirement. 1 , Owner ❑ Agent❑ (Please check one) UI Telephone No_ PERMIT FEE (Signature of Owner or Agent) From`:Brite-Lite Electrical Co.,Inc. general email:info@brite4ite-electrical.com Date:3126104 Time:1:27:18 PM Page 1 of 2 U Brite-Lite Electrical Co., Inc. 11 Front Street,Weymouth,MA 02188 To: James Decola Company: Town of North Andover Fax Number: 19786889542 From: Cary Chu Pages including cover page:2 Subject: Permit Date:3/262004 at 1:18:24 PM James, Last week, I've drop off an application form for the Central Fire Station generator installation. I would like to know what is the status of that permit. Do you need more info or its was approved. Can I have a off ical sign copy or permit number etc?Thanks Tel:781-340-9102 ext-17 Fax:781-340-1674 email:cchu@brite-lite-electrical.com From.Brite-Lite Electrical Co.,Inc. general email:info@brite-ite-electrical.com Date:3!30!04 Time:1:21:34 PM Page 2 of 2 F z The Commonwealth ofMassachusetts Ortlee use Ony (� Parma No. Department ofPublic Safety Occupancy a Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code.527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date March 12,2004 City or Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 124 Main Street,North Andover,MA 01845 Owner or Tenant Town of North Andover Owners Address 400 Osgood Street,North Andover,MA 01845 Is this permit in conjunction with a building permit: Yes ❑ No❑ (Check Appropriate Box) Purpose of Building Central Fire Station 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 124 Main Street,North Andover,MA 01845 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Shimming Pool Above In- grnd. El grnd. 1:1 Generators KVA No.of Receptacle Outlets No.of Oil Burners No_of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No. of Zones No.of Ranges No.of Air Cond. Total No.of Detection and tats Initiating Devices No.of Disposals No.of Heat Total Total No.of Bouncing Devices Pum s Tons KW No.of Dishwashers Space/Area Heating KW No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local❑ Municipal Other Connection No.of Water Heaters KW No.of No.of Low Voltage Si ns Ballasts Wiring No.Hydro Massage Tubs No.of Motors Total HP Other: install 1-16OKW generator INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. Yes® No ❑ I have submitted valid proof of same to this office. Yes® No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE® BOND® OTHER❑ (Please Specify) Estimated Value of Electrical Work $48,400.00 (Expiration Date) Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME Brite-Lite Electrical Co.,Inc. LIC_ NO. License Joseph K.Curran Signature LIC,NO. A10639 Address 11 Front Street,Weymouth, MA 02188 Bus.Tel. No.781-340-9102 Alt Tel.No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that-By signature on this permit application waives thisr uirement. Owner❑ Agent❑ (Please check one) / Telephone No. PERMIT FEE (Signature of Owner or Agent) From:Brite-Lite Electrical Co.,Inc. general email:info@brite-lite-electrical.com Date:3130104 Time:1:21:34 PM Page 1 of 2 f — i Brite-Lite Electrical Co., Inc. 11 Front Street,Weymouth,MA 02188 To: James Decola Company:Town of North Andover Fax Number: 19786889542 From:Cary Chu Pages including cover page:2 Subject: Permit Date:3/30/2004 at 1:10:16 PM James, Any word on the permit? Tel:781-340-9102 ext-17 Fax:781-340-1674 email:cchu@brite-lite-electrical.com TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATfa OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:/y DATE ISSUED: ®� SIGNATURE: ON Building Commissionerfi for of Buildino Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReclLored Provided C 1.7 Water Supply M.G1-C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ w SECTION 2-PROPERTY OWNERSIIPIAUTHORIZED AGENT n 2.1 Owner of Record _ 4-2 Name(Print) Address for Service: Signature Telephone \ 2.2 Owner of Record: Name Print Address for Service: C 2 ri Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: YoLl C License Number � Address Expiration Date I-Siopature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number r r Address SEE Expiration Date Si nature Telephone y SECTION 4-WORXERS COMPENSATION(ALG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. ' Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit applicant INE 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 / rm C�C) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T11VIBERS 1 2 3 RD SPAN DDAENSIONS OF SILLS DIMENSIONS OF POSTS DEVEENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE _+s^ T/re Conintoilivealth of Massachusetts a Department of Industrial Accidents = � ��� ,, Ol/lce al/nvestlgat/nns 600 f'ashingtott Street Boston,Mass. 02111 Workers'Compensation Insurance Affidavit c L city pbone�l 0 1 am a,homeowner performing all work myself. ❑ f am:a sole,propr',ietor and have no-one.working in any capacity ...r. ❑ I am amerriployer providing workers' compensation for my employees working on this job. } ;. >n x \ err," ❑ I am•a,solepropTietor,general contractor,or homeowner(dlrele one)and have hired the contractors listed below who have the following workers'compensation polices: sompajfy name Mii t city phbnr� a•? ttlsl5rancc co61ic . :. :.:v•::::.'.•.:;:'.., ....,. ..n........ -'.:. ..n....... n '.::fait�i address. ., . . •::;i >w tat~ w city i �. t�hbnt1 b ineurincx co t IL4IICY� Failure to secure coverage as i equired ander Section 2519 of MCL 152 ca`n.fend to the imposition of criminal penalties of a fine up to 3'1,500.00 and/or one years'Imprisonment as well as civil pennities in the form ora STOP WORK ORDER and a fine of s100.00 a day against me. 1 Understand that■ copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. !do hereby certify under the paLts at1 penalties ofperfury that the information provided above Is trite anf corre t Signature_ -o 6?,, s mate Print name Phone# official use only do not write In this area to be completed by city or town official city or town: • permit/license# -Building Department O check if immediate response is required QLicensing board oselectmen's Office contact person: ollealth Department phone#;—Other (Mired 3195 Ply). t" CAS'll'RICON E ROOFING & SIDING 31 COURT STREET NO. A TNMO V ER. MAS,'-3-11101845 (978) 682-4266 NO. ANDOVER FIRE DEPARTMENT MAIN STREET NORTH ANDOVER, MASS 01845 SUPPLY AND INSTALL 22 HARVEY SIGNATURE REPLACEMENT WINDOWS. I RECOMMEND THE SIGNATURE WINDOW BECAUSE OF THE WINDOW SIZE. IT'S A MUCH HEAVIER WINDOW WICH IS NEEDED FOR THE SIZE WINDOWS BEING INSTALLED. ALSO BRONZE COLOR RECOMMENDED. R ' ICLCARPENTNUDED. TOTAL COST MATERIAL S & LABOR 12, 100.00 j HOME iMPROVEMENT CONTRACTOR Registration 103317 a Type - DBA Expiration 07/07/00 CASTRICONE ROOFING & SIDING C Ka6b T. Castricone ADMINISTRATOR N. An MA 01845 � ✓1ie "(�arrvaaarzcuea� �✓Gl�;l BOARD OF BUILDING REGULATIONS j License: CONSTRUCTION SUPERVISOR , .. Number: CS 034049 Birthdate: 12/08/1923 :. Expires: 12/08/2001 Tr.no: 10391 Restricted To: 00 MARIO T CASTRICONE 31 COURT ST l� N ANDOVER, MA 01845 Administrator C;ASTRICONE ROOFING & SIDING 31 COURT STREET NO. ANDOVER MASS, 01845 (9%8) 682-4266 NO. ANDOVER FIRE DEPARTMENT MAIN STREET NORTH ANDOVER, MASS 01845 SUPPLY AND INSTALL 22 HARVEY SIGNATURE REPLACEMENT WINDOWS. I RECOMMEND THE SIGNATURE WINDOW BECAUSE OF THE WINDOW SIZE. IT'S A MUCH HEAVIER WINDOW WICH IS NEEDED FOR THE SIZE WINDOWS BEING INSTALLED. ALSO BRONZE COLOR RECOMMENDED. CARPENTRY INCLUDED. TOTAL COST MATERIALS & LABOR 12, 100.00 1 • i CAS`.I FI,JCON E ROOFING & SIDING 31 COURT STREET NO. ANDOVER. MASS, 01,845 (978) 682-4266 NO. ANDOVER FIRE DEPARTMENT MAIN STREET NORTH ANDOVER, MASS 01845 SUPPLY AND INSTALL 22 HARVEY SIGNATURE REPLACEMENT WINDOWS. I RECOMMEND THE SIGNATURE WINDOW BECAUSE OF THE WINDOW SIZE. IT'S A MUCH HEAVIER WINDOW WICH IS NEEDED FOR THE SIZE WINDOWS BEING INSTALLED. ALSO BRONZE COLOR RECOMMENDED. CARPENTRY INCLUDED. TOTAL COST MATERIALS & LABOR i 12, 100.00 • _. '. Date.. . . . . ... .. . . . . . . . . . . NORTH TOWN OF NORTH ANDOVER pFs neo ,a1tiO 0 PERMIT FOR GAS INSTALL,ATION SACfHUSE� This certifies that . . . . . . . . . . . . . . . . . . .. . . . . . . has permission for gas installation . . . . �:. . . . . ... . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . ..... . . . . . . . ... ... . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. Lic. No.... . . . . . . . . ' . . . . . . . . . . . . . . GASINSPECTOR — WHITE: Applicant 1_ CANARY: Building Dept. PINK:Treasurer GOLD: File ASb'ACHUSETTTU NIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER, , Mass. Dale 3� ig Building (� LocationPermit # d/16 llV T j�( ]y �z Owner' �/ Name t-F f d• 1 Aioo New ❑ Renovation p Replacement Plans Submitted: Yes ❑ No N - N N X N V h « N N O O .r h W0 V al H >r M p�p s• Za: ac N t- K O O O H se N O M _ i M N O ae gs O F i Ir X d IL U K ! a� z o e w s ° c i sue—asMT. BASEMENT X + 1!T FLOOR 2ND.FLOOR I ONbFLOOR 4TH FLOOR *TH FLOOR STH FLOOR 7TH FLOOR + •TH FLOOR HM' n 1 ` Check one: Certificate Installing Co�pany//Name[ - ��r Yt G`� Corp. /& /q — Address D i6 0x 7Z F3 d Partnership /U0 ❑ Firm/Co. Business Telephone 7 2 Name of Lkensed Plumber or Das Filter INSURANCE COVERAGE: Check one 1 have a current liability Insurance policy or No substantial equivalent. Yes`o No ❑ It you have checked ye, please Indicate the type coverage by checking tho4pproprlate box. A liability Insurance policy Other type of Indemnity Ll Bond p OWNER'S INSURANCE AIVEn: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: %nature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby cerilty that an of the details and Information I have submitted(or entered)In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the perm issued for this appl�allon will be M compliance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of y Le fwcumeyman f License: umber na ure o nse Plumber or as Mier THIS asnller aster Ucense Number ASY�� g 'Roan . Ar'Pr10NE0(OFFICE USE ONLY) r. n Date...... .......N° 23 ... -/ .. 1..... NOR711 °�t�``°-;•�"� TOWN OF NORTH ANDOVER { ' PERMIT FOR WIRING 40 �,SSACNuSE� This certifies that .....................................- ........................................................ has permission to perform ............................................................................... wiring in the building of............................. .................................... at........::......:......................... ............................. ,North Andover,Mass. Feed.-.'................ Lic.No.'........`... ..... :..... .............................................. ELECTRICAL INSPECTOR Check it WHITE:Applicant CANARY: Building Dept. PINK:Treasurer THECIOWONWF.4LTHOFARMCHIISE77S Office Use only DEPARTAfflW 0FPUBLICSAFETY Permit No. BOARD OFMEPREVEVHONRWULATIOAN5270MR1ZOO Occupancy&Fees Checked APPUCATTONFOR PERMIT TO PERFORMELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date — lip Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes[::] No © (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead 1:3 Underground 1=1 No.of Meters New Service Amps Volts Overhead r-1 Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �� .�±�:� _ �__ r,— No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ound No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets He,4 P V No.of Gas umers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained s Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal a Other Connections 1 No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs `` No.of Motors / Total HP l OTHER' �o ate.. Qom, ��✓'wit '` /)P197`('� ( G�YI� C� C � ir>su-anoeCo►erage Pt�ttattotheregt�arta�scllM�sadi�Gara�alLaws Iha%eaoma>tLiabrk"yh>Sstxa=PalicymAxiagCmVi& Covaa@Dcr�ssiEtaa leWi%, a# YES V1 NO Iha%eafin edmMptodbfsartetotheOffm YES U NO � Ifjuuha%edvdcedYES,I>keedc*thetAxofwmaErbydwdcrgttte I BOND OUiER ftwespeffy) EViratiortDtame �- o� —L2/—G !_�� F&T"BdvahtedUectricalWork$ WaktoStatt 4alrr /9;a/ h> Da6eRagt>E W Rargtr Fetal Sigrxdutxier'&pe3W&sof FIRMNAME L. ry LioatseNa I'°a�ae _1jZL.LZL LioerseNo �a r � �� (�� � ` 1 ,,�/ Add==-.Z: if'1�—: J , " t/Q�✓. vim» AILTeLNa OWNERS DWRANCEWANFR;I.atnm=tAftLmwdo t etheirsuatoecr�aagetrilss leytri►�rtasrecluaedbylvia�adYset�GataalLaws ardditmysigttahn(n >isptm*WpkabatwaiAsthism 'mnent (Please check one) Owner M Agent rx Telephone No. PERMIT FEE i Date.. -- T�f 15 2 NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION i N �9SSACeHUSE�h This certifies that . . . . !y! has permission for gas installation 3P.6!;,yA6tY. in the buildings of !�J (11�1. F:, 7, � at . ./p?4. . /l'�f`!�. S!!z� ./ . . , . North Andover, Mass. Fee./ggN Lic. No.OS ??. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tow" 5't7C' U—`�Q,0CFGAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File ! ASSACWJSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN(3 (Print or Type) C NORTH ANDOVER Mass. Date �( Q�- Buildina Location l/r-Q `D ppg, 4/7')t°n Permit # P592 rr\ a t e S fi Owners Name SIO. 0n doy e New '7 Renovation Replacement p Plans Submitted D Fl v7 0!1 c cc � W O z s � N a W Lu C -- �_ tr � a �- z o t-- cc o W ¢ a o ' o z us G1 :z m m Q W w o a tr W Q t- m y w z_ v w m w �t a 0 c ur W W a� Q Ld tr d e w W F' c0 c: W W O ? LL. N CJ J F+ W _ Z LL, :F- 0 Qy O ul O N = C ,u > C W 4 4 Q O O W o W i- O V w U. O Q O .1 U > Q n. 1— O BASEMEIiT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7Tti FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name (jj'j-)I C��- Corp. Address Ajax Partner. NS) f4n-do yep , / Q' 0/E¢f- � Firm/Co. Business Telephone: 4 757 Q 2 1�J Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity F Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner U Agent n I hereby certify that all of the dcuils and information 1 have submitted (or entered)in above application are true and accurate to the best of my knowledge and that aU plumbing work and insatUations performed under'Permit issued for this application wilt-be in compliance with all pertinent provisions of tho Massachusetts State Cas Code and Chapter 141 of the General Laws. -� By TYPE LICENSE: - Plumber Title Gasfitter Signature of Licensed City/Town: Master Plumber or Gasfitter Journeyman 6 Tq 7 APPROVED (OFFICE USE ONLY) LicF_'TlSe Number 35 1 9 Date. . . ..%.�. . .�.`... NORTH TOWN OF NORTH ANDOVER 3r Oy`-to '6,6 PERMIT FOR GAS INSTALLATION f 9 SACMUSEtt This certifies that . . . XX. . . .l . . . . . . . . . . has permission for gas installation t. . . . . . . in the buildings of . ! .i?. . k7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . !.). !!- /a.,- /-".i . . T '�. . . . . . . ., North Andover, Mass. Fee. .'Al. .(: . Lic. No.. . .�.'. . !. . . . . . . . . . . . . . . GAS INSPECTOR 7 WHITE:Applicant CANARY:Building Dept. ! PINK:Treasurer PV L MASSACHUSETTS UNIFORM APPLICATION FOR ERMIT TO DO GASFITTiNG (Print at Type) -07 Al _r� � Mass. Date 7. 4W crr�) Permit # 3 Building Location ta'ype Owner's Name1-2 p3 of Occupancy New [•-� Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ N .. ► N rt W N Y = V7 N N V CC y ¢ N R O O H }. } .i S •O F' W m vl F <u w p a rf H N C7 41 < =W 0P O W W C W Z < = x W G t, W F- _ y OC WUj {N-. = W O Z• < = < O O W O F- { {y > }1 O d = LL � � O d J U C y D d F•� O SUB—aSMT. BASEMENT IF I ST FLOOR 2ND FLOOR a RD FLOOR I I 4TH FLOOR STH FLOOR 6TH FLOOR I 7TH FLOOR 8TH FLOOR / Installing Company Name Ccri�a�!q-i --,4� -f 4�2z f/4 Check one: CerthIcate Address / Be //n,,,t�r D Corporation 4lr1 ,4A, .ivciL- 111 Partnership Business Telephone 6a 2�2 21--2T_ / ® Firm/Co. Name of Licensed Plumber or Gas Fitter '""f�eo <�t l/�IE 7,, INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142- Yes 42Yes p' No 0 ' If you have checked Les. please indicate the type coverage by checking the appropriate box A liability insurance policy Gl seOther type of indemnity O Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for Ito application will be in co trance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Law By T e of Ucense: L, Plumber nature ce se um er or Gas liter Title Gasfitter Master cense Number ZA/p APY Journeyman ' O .yj