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HomeMy WebLinkAboutMiscellaneous - 1250 OSGOOD STREET 4/30/2018 (4) � \ (2� C� cQ �e�"" � J �� .. �� +� AoMaidv Sam Lei PRESIDENT C:781.888.1610 W:978.687.9888 F:978.687.3888 1250 Osgood Street,North Andover,MA 01845 GRAND OPENINGWP.OTSMA.BU LIPAa -1HALFOOD CHINESE FOOD HIBACHI DINING Sunday-Wednesday MWIIII 11 am-10 Pm Thursday-Saturday ` llam-lam , E KARAO SUSHIBAR �vv),,4n The Commonwealth of Massachusetts . City\Town of North Andover Certificate of Inspection In accordance with 780 CMR, Chapter 1 (The Sixth Edition of the Massachusetts State Building Code) and Chapter 304 of the Acts of 2004 (an Act to further enhance fire and life safety),this certificate of inspection is issued to the premise or structure or part thereof as herein identified. Identify Name of Establishment Certificate No. Issued to 1250-2015 Hokkaido Restaurant Certificate Located at 1250 Osgood Street Expiration March 2016 Use Group Restaurant Allowable Classification(s) First Floor Main Dining Room-190 Occupant Load Function Room-40 351 Lower Lounge-85 This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall allow for the temporary use as herein described and in conformance with any and all conditions as identified below. It shall be framed behind clear glass and\or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or,tampering with the contents of the certificate is strictly prohibited. Conditions of Temporary Use Name of Municipal Name of Municipal Date of September 30,2015 Fire Chief Andrew Melnikas,F're Chief Building Commissioner Gerald Brown, Insp Bldg Inspection Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner �j, 1 ���.____ Issuance September 30,2015 N°p7M ° s ,SS1CHu564 CERTIFICATE 'OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 270-13 on 10/5/2012 Date: March 6, 2013 THIS CERTIFIES THAT Hokkaido Restaurant THE BUILDING LOCATED ON 1250 Osgood Street MAY BE OCCUPIED AS a restaurant IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Sam Lei 65 Belvedere Street Lowell,MA 01852 Building Inspector Fee: Pre Paid Receipt: 25789 Check : 1012 Town of Andover No. iL L.Kh ver, Mass, _0420 COC8 RATE® rPP�,iC:Y s U � BOARD OF�HEALTH PERMIT T LD Food/Kitchen � �C�1�I-t 60� / �°�" Septic System i) THIS CERTIFIES THAT . � � BUILDING INSPECTOR a r Foundation has permission to erect .......................... buildings on .. ` ... � :{:� ` ............... . .K..... .................................. nT Rough J r` to be occupied as ............: : . . , ::.....:...` �.:......... .i. ���¢ll... .........I........................ ch* ;9.. provided that the person acceptingthis permit shall in eve res ect conform to the terms of the application p p ' p ry _ p .rn;1-1 on file in this office, and to the provisions of the Codes and By Laws relating to the Inspection,Alteration and Construction of Buildings in1he Town of North Andover. PLUMBING PELT R� r VIOLATION of the Zoning or Building Regulations Voids this Permit. Rosh R1,10 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .�� 1 Service .............� .....: ,aFfE .' .U: .. . ............................ ajna BUILDING INSPECTOR +� :`'lj/,x S INSPECT�� s Occupancy Permit Required to Occupy Building �� g � { j Display in a Conspicuous Place on the Premises — Do Not Remove Final U �• No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDESmoke Det.3r y l Y�2N'L.r�64 6 .: -f GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns r FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec,etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. ; Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to'plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVUs Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min.22x30 w/3'headroom above). Crawl space access. (min. 18x24). � Bath exhaust fans to have metal duct to exterior(not in soffit). Q 'n Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: ) "' Natural light equal to 8%of floor area. of required glazing shall be openable. Bedrooms required min.20x24 egress window or door, Vent attic spaces-"proper vent", soffit and required ridge vents. ? Firecode under stairs if used for storage ! `� FIREPLACES: Separate permit required. Sk Inspections at Footing-Smoke Chamber-Finish �n Smooth parging,clean joints,8"solid @ combust. ; DECKS: Lag to house, provide flashing., U4 Rails min. 36"high, Baluster max space 4"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. - -- Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure October 03,2012 Town of N. Andover, Mass. CONSTRUCTION CONTROL AFFIDAVIT PROJECT TITLE: Renovation ADDRESS OF BUILDING: 1250 Os good St.N.Andover.Massachusetts. SCOPE OF PROJECT: Renovation In accordance with Section 107.6.1, 8t'Edition of the Massachusetts State Building Code,I,LM young Massachusetts Registration No. 34133 M, being a registered professional engineer hereby certify that I have prepared or directly supervised the preparation of all design plans,computations, and specifications concerning the: ENTIRE PROJECT X ARCHITECTURAL_ STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL_ OTHER(Specify) I further certify that I, or a designated representative, shall perform the necessary professional services and be present on the construction site on the regular and periodic basis to determine that the work is proceeding in accordance with the documents approved the building permit and shall be responsible for the following as specified in Section 116.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required control material 3. Special architectural or engineering professional inspection or critical construction components requiring controlled material or construction specified in the accepted general practice standard listed in Appendix A. Upon completion of the work, I shall submit a final report as to the satisfactory completion and readiness of the project occupancy. Larry Young g� IARAY m� Professional Engineer(34133-M) YOUNG N®.34133- FSS�o ANG �rC' Date . . a •- toTOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . �j�.�. 1. . . . �`� \ . .�. . . . . . . has permission to perform . . . : r',_r . . . . . . . . . . . . . . . . . wiring in the building of . . . .�. .�. /�.� . . . .?. . . . . . . . at . Z"5.D. 1-7� . . . Tr` . . . . . . . . , North Andover, Mass. 1 Feerq1�?°O . Lic. No. . /03.L?F . . . . . . . �'t.•�. . . . . i' ELECTRICAL INSPECTOR C}i�ck# I �� f L Commonwealth of Massachusetts Official Use Only Permit No. �1 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NBC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: i 0— City -City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notic f his or her intention to perform the electrical work described below. Location(Street&Number) Q VMD Owner or Tenant Telephone No. 6 Owner's Address Is this permit in conjunction with a building permit? Yes V No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters a New Service Amps / Volts Overhead❑ Undgrd [J No.of Meters Number of Feeders and Ampacity ,'�������� Location and Nature Propos d Electrical Work: �� '0_;4 Mompletion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires t:> No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency ig t►ng No.of Luminaires o- Swimming Pool rnd. E] rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons P Heat Pump Number Tons KW.... No.of Self-Contained No.of Waste Disposers I. Totals: Detection/Alerting Devices Municipal El Other No.of Dishwashers r Space/Area Heating KW Local❑ Connection Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or E uivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of 07res. Estimated Value of Electrical Work: -26DO — * (When required by municipal policy.) Work to Start: Ins ections 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 cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: 1NSU-RANCE\BOND ❑ OTHER ❑ (Specify:) I certify,under d ain d penalf perjury,that the information tis application is true and complete. FIRM NAME: . LIC.NO.: Licensee: Signatu LIC.NO.: V (If applicable,enter "exe pt in t n e r li .) ` Bus.Tel.No.• 2 Address: 4 Alt.Tel.No.: *Per M.G.L c. 1 7,s.57-61,sec u ' work re ires Depa e t o Public afety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that e 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)E]owier ❑owner's agent. Owner/Agent I PERMIT FEE. $ Signature Telephone No. e . r I✓ t - '�,t`�p'�I{`jry�7.�y'�y��• y� �}j ry'�' '�'(' .. '(�'�Y�j'�(�-jrQi7' �•�j-�� s ._ .1�J.1J1L'1�l.r.R.Ci.1.L[�.tC7�-i�-(t�£-(r�7�t��G1.(F'•�J-^jR�d`il�'(®�'���V'pyt�( /'� y.r-.13�1d.Lt�a3Cl.�J.Y.1�.t+�®��� .- , _ _ .l'le rn'L.�-.0G-al_a ►.!l•�.YFSJE.fC'/Y.i`�U'�" i •.� � ' . 72�ssei�-,� � �+'alleft•�[ � �e-5nspecfzort z'ec�uixec�($�O.DD)�� � 3nspectQxs' 7104.,, e�ufs: ' ffugpeetoxs5 Signature-n,o Lnftials) plate °- ymyPeetors'cimmenfs: - J (JGispectozs' ignafuxetoxxtzfiaTs) 6 Pate 'assed--j � �+a�Iecl--j � ate-inspeetZo�,xec�uixetT���4.OD)�j � r aspectoxs'comments: [lnsp ectoxs',�ignatuxe of�aTs) Pate ' O 1±r C.Iv MUn NA a+OXM� C-9 D. NAM MI :. ssec�--[ � �'aite�--j � �e-�nspectionxequixet�{ 50.00)�� � ;�ectoxs9 eoxnm.epfs: (fmspectoxs',fzgaatuxo-io Wfials) )late e I--F Iaxle2l- ). to nspectfottxe0uixe ($50.OD)�[ ectaxs'cozn�enfs: _ ectors"sinatuxe-xto Snulals) Pate f l 3 w ,.a 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 Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate x: Type of project(required): 1,Q I am a employer with 4.VJ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors VI am a sole proprietor or partner- listed on the attached sheet.# ? E]Remodeling CL ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13T1 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they 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 their workers'comp.policy information. I am an employer that is providing workers'compe sat' n insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: KCS' Policy ll or Self-ins.Lic.#: P, b b2 1�A Expiration Date: Job Site Address: P&O City/State/Zip: A;411-ef- Attach a copy of the workers' c pensation 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 certify and di paps and penalties of perjury that the information provided above is true and correct. Si nature: Date: �"— Phone#: Official use only. Do of 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#: r Information and Instructions L 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 R. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 2evised 5-26-05 CJA�C- wYe t IACt r A .1 Cti Cz CCA 0A t fY CcAa end e ( (Sa'v K6 I a � n✓) Installation & Operation Manual TM IADUCTIOII By Model: SM-IRIR, SM17-26IR & SM-263R (international ) Before You Begin: - Read the following instructions in their entirety. Use proper cookware. Your cookware must be induction-ready. Check your ventilation. Your MAX InductionTM Range must have the proper ventilation in order to operate correctly. There must be at least 7" of space available under a mounted induction range. Cabinets housing the induction ranges should have both vents& circulation fans installed. The inside temperature of the cabinet must not exceed 90°F /32° C. Ensure that you have dedicated power to the installed location. Refer to the grid on Page 6 for Electrical Specifications. Suitable Cookware Stainless Steel Multi-Ply Iron/Steel Frying Pan Cast Iron Cookware Aluminum Cookware Iron/Steel Tray Enameled Ware with Induction Disc Unsuitable Cookware 410b 4 Ceramic Cookware Without Copper,Bronze Or Aluminum Glass Cookware Special Coating Cookware j Cookware with a Diameter Pans with a Concave Bottom Bowl Shaped Cookware of Less Than 4.5" TM Attaching Your MAX Induction Range To The Control Box Before You Continue: Disconnect your MAX InductionTM range from all power sources. At this time, there can not be any electricity flowing to the range. Find the plug from the Induction Range. Locate the receptacle from the Control Box. Carefully, line up the two white arrows on the opposing connectors so they are pointing toward one another. Insert the plug into the receptacle. Slide the collar on the plug onto the receptacle and gently screw the two pieces together. Upon connecting range to the control box, you can now plug in your MAX InductionTM range for operation. -S &W 800-535-8974 How To Operate: Your MAX InductionTM Range is designed to operate in two modes: "Cook"or "Temp' "Cook"Mode offers you high-speed heating, used for omelet stations, pasta bars or demonstration cooking. "Temp" Mode offers you thermostatically controlled holding temperatures r for use with buffets or pastry work. The LED display allows for more accu- rate cooking. In "Cook" Mode: ➢ An `EO' code will flash until suitable cookware is placed on the glass surface of the range. ➢ The LED panel will display a two-digit number indicating the power level. Power levels run from 1 thru 20. ➢ As a safety precaution, if no cookware is placed on the induction range plate after 2-1/2 minutes, the unit will shut off. ➢ Once suitable cookware has been placed on the glass induction plate,the unit will continue to cook until the range is manually shut down, or the mode is changed over to"Temp" mode. Note: There must be at least 7"of space available under a mounted induction range. Cabinets housing the induction ranges should have both vents&circulation fans installed. The inside temperature of the cabinet must not exceed 90°F/32°C. In "Temp"Mode: ➢ An `EO' code will flash until suitable cookware is placed on the glass surface of the range. ➢ The LED panel will display a three-digit number indicating the tempera- ture setting. To increase the temperature setting,turn the dial clockwise. To decrease the setting, turn the dial to the counter-clockwise. ➢ The induction range will continue to warm the food until the set tempera- ture has been reached. Once the temperature has been reached,the range r will maintain that pre-selected temperature setting. ➢ Temperature settings in"Temp" mode, in fahrenheit are: 110° 120° 130° 140° 150° 160° 170° 180° 190° 200° 220° 240° 260°, 280°, 300°, 320°, 340°, 380° &400°. • A-S 800-535-8974 � �SA® www.springusa.com Flush Mounting Your MAX InductionT M Range: P A The ceramic plate of the induction range should not extend above the countertop by more. than.8mm(0.03 inches) D B �j Ca met ventilation must beP rovided. Ins de temperature of cabinet cannot exc ed 90°F/32°C (x4) 1 1 F E (x10) (x8) Remove your MAX InductionTM range from the packaging and inspect all parts. If the ceramic glass surface is cracked or damaged, do not install the range. Contact your supplier for a replacement range. Counter or table thickness must not exceed 2". If installing multiple ranges, each range must be at least 4" apart. Your MAX InductionTM Range must have the proper ventilation in order to operate correctly. There must be at least 7" of space available under a mounted induction range. Cabinets housing the induction ranges should have both vents& circulation fans installed. The inside temperature of the cabinet must not exceed 90°F/32° C. Alternate Installation Method -Using the template provided, mark the counter surface for installation. Cut the opening to the dimensions of the induction range body(see template provided). Invert the induction range, and place the glass surface over the opening. Mark the size of the glass top. Using a router, reduce the thickness of the countertop at the opening by 7 mm. Place the induction range into the opening, trim with router where necessary. Use shims to level the glass with the surface of the counter. Seal the entire perimeter of the glass range with silicone. Remove any ex- cess silicone from the glass top and countertop. Flush Mounting Your Induction Range (Cont'd): To mount your MAX InductionTM range(A)flush with the countertop, you must first install the Mounting Bracket(G). Stone countertops(D) must be no less than 1 inch thick when not supplying a wood sub top. The following parts have been provided, and must be used to ensure correct installation: Ten (F)masonry mounting screws to attach the bracket to the countertop or wood underlayment Eight(E) leveling screws to align the induction range glass with the countertop Use the Induction Range glass top surface as a template to mark the coun- tertop for the cutout size: 340 mm (L)x 320 mm (W). Ensure that you have at least 7 inches of space available under your mounted range. Position the adjustable mounting bracket(G) centered to the cutout and install to the underside of the countertop, using all ten (F) screws pro- vided. If installed directly to granite, the holes must be pre-drilled. From the underside, insert two(E)leveling screws in each of the four cor- ners of the mounting bracket(G). Gently place the range into the hole to make sure the position of the range (A)is centered to the mounting bracket(G). Adjust the height of the range(A)by raising or lowering the leveling screws (E), so that the glass top is flush with the countertop surface. Once you have the glass plate flush to the surface, silicone the perimeter of the ceramic glass to seal the plate to the surface of the counter. Re- move any excess silicone from the glass top and countertop. MEN sm.,,sm Sacke.C.p Sc x.5 mm(e pc.) Sp_=g.-s,�® 800-535-8974 www.springusa.com Mounting Control Panel: Round Head,Wood Screw Zinc-Plated M5 x 18 mm(4 pcs) Provided W. Mounting The Control Panel: To mount the Control Panel (B),use the template provided Place the template on a plane or panel, perpendicular to the MAX Induc- tlonTM Range, centering rt to therange whenever possible. The Control Panel cutout should measure 5 3/4"x 2 3/4". Place the Control Panel (B)into cutout hole. Using the four(C)wood screws provided, secure the Control Panel into place. Using Your MAX InductionTM Range: Turn the induction range on(remember, the induction unit, by default, will start out in cook mode). An `EO' message will appear in the panel. Place an induction-ready pan or server on the induction range. The display will begin to read the set temperature. Set a stainless steel pan or server filled with water on top of the granite directly over the induction range mounted underneath. The blinking LED light should go solid. This means the induction range is reading the pan. Electrical Specifications: Model# Voltage/Amps Peak Power Plug Type SM-181R 110-120 Volts/15 Amps 1800 Watts 50-60 Hz NEMA 5-15 6' Cord SM-261R 208-220 Volts/11.8 Amps 2600 Watts 50-60 Hz NEMA 6-20 6'Cord SM-263R 220-240 Volts/10.8 Amps 2600 Watts 50 Hz CEE7/7 European Plug BS 1363 U.K.Plug 6'Cord(2 Meters) Indu,ctiQn Range Error Codes: Error Cause Solution Et! Range does not detect a pan on the Place an induction ready pan on the range. range. E1 Range has overheated due to Clear vents,let range cool down, blocked ventilation and has shut then restart. If error message con- down the range. tinues,your range needs to be ser- viced. E2 Overheating protection has been Remove the cookware from the activated&the range has been range. Let the unit cool down,then shut down. restart. Make sure the cookware you are using is induction ready. E3 Range is experiencing temporary Let the induction range cool down voltage overload. completely,before restarting. Re- view dedicated power requirements. Safety Precautions & Key Points: Cabinet Ventilation must be provided. The inside temperature of the cabinet must not exceed 90°F/32° C. Actual range temperatures may vary due to a number of variables such as ambient temperature in the immediate surrounding area, content and vol- ume of food being heated or cooked, and whether or not you are using a lid on the serving vessel. ------------- Never attempt to service any part of your MAX InductionTM Range on your own. Contact our Service Department by calling 800-535-8974. Attempting to service your Induction Range on your own, or through an unauthorized repair facility automatically voids your warranty. For Limited Warranty Information, visit www.springusa.com Note: This equipment uses, generates and can radiate radio frequency energy. If not installed correctly and used in accordance with the instructions, may cause harmful interference to radio communications. Users or guests with Pacemakers should contact their health care professional prior to using this product. • 800-535-8974 0 S SA® www.springusa.com i .Springw" USAInduction ° f B uffie t • Cookware The Evolution of Intelligent Design T M Spring USA® 127 Ambassador Drive Suite 147 Naperville, IL 60540-4079 Phone: 800-535-8974 Fax: 630-527-8677 Email: springusa@springusa.com Web: www.springusa.com 11/07/2012 08:54 6178470006 COMMONWEALTH INS PAGE 01/01 ACQ JZH CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) 11107/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OF 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poficy(las)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certaln p•ollclas may require an endorsement. A statement on this oertlffcatm does not confer rights to the certificate holder In Ileu of such endorsamant s . PRODUCER CONTACT ATLANTIC INSURANCE PARTNERS LI_CPHONE FAX 25 NEWPORT AVENUE EXTENSION AADDRESSrttu A No NORTH QUINCY,MA 02171 INS URER{SQA. RDING COVERAGE NAIC0 INSURER A:NORTHLAND INSURANCE INSURED INSURER B r Yl R.CHEN INSURER C: _ ^^ 5 CHESBROUGH STREET INSURER O: WEST ROXBURY,MA 02132 -INSURER E! _.. INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED eELOW 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. INTR AWLATYPE OF INSURANCE POLICYNUMBER POLICY EFF MML�Y YYV11 LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,00 o+QQ A .� COMMERGAL GENERAL LIABILITY PR MI E MnM S 100 000 CLAIMS-MADE a OCCUR WS 133502 03/1512012 03115/2013 MED EXP(Any one person $ (�QQ PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 QEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/013 AGG $2,000,000 POLICY I I P LOC s AUTOMOBILE LIABILITY OOMBINEDSINGL.E LIMIT (Ea ec TD ANY AUTO DOOILY INJURY(Per pemon) $ ALL SCHEDULED UU EDTO AUTBODILY INJURY(Per accident) S HIRED AUTOS ANON-OWNED PReOPE TYDAMAGE $ UTOS L_al J) $ UMBRELLA LIA9M^ OCCUR EACH OCCURRENCE $ 0=68 LIAR CLAIMS-MADE AGGREGATE $ DED $ WORKERS COMPENSATION wC STATV• OTrI• AND EMPLOYERS'LIABILITY Y/N __..T•OR`LL(ML78_—LER_ ANY PROPRIETORIPARTNEWEXECUTNE F7 E.L.EACHACCIDENT _ S OFFICERM,EMSER EXCLUDED9 N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,deserNe under DESCRIFTION OF OPERATIONS below E,L,DISEASE•POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (AtteM i\CORD 101,AQdlllonml Rem.rko Sclrodulo,If mare spoaa la roqulmd) LOC: 1551 Osgood Street, North Andover,MA, Scope of Job: 1st floor,painting roorn , installation of one fire alarm strobe. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PERMIT DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANC ITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER,MA 01845 AUTHO EO P ENTAT FAX: 1-978-688-9542 ®1 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 09773 Date . A. 'Z3-7\3 � �p�CILF.11 j�a. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . . . . . . . . . . . . a has permission to perform . . . .k. ,Q, -C. . . . . . . . . . . . . . . . . . . . . 4 plumbing in the buildings of. . .ca. 0. . . . .�. . . . . . . . . . . . . at . . �9. 54 . . V. . . . . . . . . . . . . . . . . .North Andover, Mass. Fee .SSQ•v!? . Lic. No. .Ic�3 / 7 . . . . . . . PLUMBING INSPECTOR Check# 7 0 V,U a .C—N MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY US Z MA� QATE PERMIT# JOBSITE ADDRESS OWNER'S NAME K V, i� C7 POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL❑ PRINT NEW:❑ RENOVATION:❑ REPLACEMENT:I PLANS SUBMITTED: YES❑ NO ❑ CLEARLY FIXTURES Z FLOOR— BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL t WASHING MACHINE CONNECTION WATER HEATER ALL TYPES D WATER PIPING OTHER INSURANCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which,meets the requirements of MGL Ch. 142. Yes&'No❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Z OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:1 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 BOX ONLY: OWNER ❑ AGENT [ISi nature of Owner or Owner's Agent hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Ch2pr 142 of the General aw . PLUMBER NAME STEPi+60 C_ &ALIPSKY SIGNATURE LIC# I03419 MP[' JP❑ CORPORATION X# .31q(o PARTNERSHIP ❑# LLC # COMPANYNAME_ t;AWOSKY PLUM0i1J1j:, tt- RVATIOG ADDRESS: p•0- GGX 1701 CITY HAVERk1tLL STATE Mi-A ZIP 01%31 EMAIL—www. ►mc lymber 1 . co TEL g7t-37y- 17N3 CELL 50-S&R-510H FAX Q7$-5gi--4131 ��z 7 ROUGH PLUMBING INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NO'T'ES � n fA Q Date . .1 2.3 't 3 ILEO TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . .`. has permission for gas installation . . . in the buildings of. . ` . . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . .. . . . ds v . , North Andover, Mass. -� 3 1.E '1(�� Fee . . ro� Lic. No. . . � . �. �. ' _ GASINSPECT6� Check# -7 8571 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: 1' o - MA. DATE: —L �� PERMIT# JOBSITE ADDRESS: k ;S v 0SP,rP0 5_' OWNER'S NAME: ITS kV,,-,rSo GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL[lam EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW.❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCESI FLOOR Bsmt 1 2 3 4 5 6 7. 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOKSTOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES g NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY [jj' OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [I AGENT E]SIGNATURE OF OWNER OR AGENT FKnowi,edge y certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my and that all plumbing work and installations performed under the permit issued for this application will be n com Ilan with all Pertinent on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GAS FITTER NAME: $TEPNEN C GALINSKY LICENSE# 1034i' SIGNA COMPANYNAME: GALW3K4 PLUM15106 t 9M- lIJ& ADDRESS: P.O• I' X 1701 CITY: OAVERHILt. STATE: m•A• ZIP: 01831 FAX: q78- 5;11-4131 TEL: 1'743 CELL: SPT - 504- -5goq EMAIL: wvvw• mrlumbe MASTER R• JOURNEYMAN❑ LP INSTALLER❑ CORPORATION/# 3196 PARTNERSHIP❑# LLC❑# ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# �� PLAN REVIEW NOTES Date . lo . . . . X-111.MIIthl TOWN OF NORTH ANDOVER PERMIT FOR WIRING t This certifies that . l. . . . . . ?.{. `. .` — .�. . . . . . 1� c 1 .� has permission to perform . . .G• . . . . . . . . . . . .�"�C�'�" wiring in the building . of �U fiK�...(J.0 . . 040S�.�xA/-� . . . . . . . at . . . �Z �. . . . •,�) AECTRICAL ndover, M A C5 Fee . Lic. No. . INSP TO Check# `1 13 3 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No.Occupancf 1 fir„ BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07jyandFee lankChecked (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATIOA9 Date: / — / ? — /3 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) C12 SO C)s 6o040 577 Owner or Tenant /Y,p /</Kd//J0 E 67L.MZ4AoFF— Telephone No. 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❑ 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: 4-14r'w , w/tc�,/ Completion o the following table 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- Elo.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones !Q No.of Switches No.of Gas Burners No.of Detection and Initiating Devices SAAE No.of Ranges No.of Air Cond. Total No.of Alerting Devices " Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local�VIunicipal ❑ 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: ((�� Adach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 0' 0 CO. C'0 (When required by municipal policy.) Work to Start: /— ;Ll— /a Inspections to be requested in accordance with NEC 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 cove e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE R BOND ❑ OTHER ❑ (Specify:) I certify,ander the pains and penalties,of perjury,that the information on this application is true and complete. FIRM NAME: . 14-P /ftA4 U'( 3 igCkCPU CA-j LIC.NO.: 9 Licensee: c TWIek) T, SN L+,fFQ Signature LTC.NO.: 3Y?Ooh��... (If applicable,ente "ex mpt"in the license number line) Bus.Tel.No.: -G Address: kn(;;f �D&6 is Tel.No.: -,Y 75 *Per M.G.L c. 147,s.57-61,security work requires D6partment 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. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed v on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass IN Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: r. Inspectors Signature: Date: 1 SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 X Failed Re-Inspection Required($.)❑ Inspectors Comments: - 25 l Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 4 Z% 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 Le ibl Name (Business/Organization/Individual): 544061t f S � C4 / Address: !/Lo6X�gS5 City/State/Zip: ! —w-65 &&rt6 Phone#: e119 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.© I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]f employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. f 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 their workers'comp.policy information. I am an-employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 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. [do hereby certify u der the pains d penalties of perju tha�Ihe formation provided above is true and correct. Si nature: q �J/ Date: — / Phone#: QL 6 7 S 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#: p 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 S 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia t l 1 COMMONWEALTH OF MASSACHUSETTS.: 77 ISSUES.THE ABO/ .,._:::: tie 3t.V.or�s kb� F w Date . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . �, . . . . Ste'? Y. . /. . . . . . . . . . . . . . . . . . has permission to perform . . wiring in the building of . A� � �.. �Q�. . . . at . . . . . . . . . ,North Andover, ass. Fee .,�! . s. . . . Lie. No. .�,�.,.��. . . . . . . �� . . ELECTRICAL INSPECTOR Check# /'� / 113 7 4 3r y Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. I� 7 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 HK OR TYPE ALL.INFORMATION) Date: / _ Z:,-� — l 3 City or Town oh NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her' tention to perform the electrical work described below. Location(Street&Number) Cl' s v d S Owner or Tenant -r ; p /l /,4 -t/TTelephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ©Check Appropriate Box) Purpose of Building 4zz S.J G /a ti Utility Authorization No. - Existing Service-GdAmps Overhead❑ Undgrd[9-----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 thefollowing table may be waived by the Inspector of Wires._ l f No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.oTotal Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators IVA No.of Luminaires Swimming Pool Above [j In- ❑ NO-70-rEmergencyUghting rnd. grnd. 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 No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: "' Detection/Alertin 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 Wtres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: /- Z .3 /K Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such covera e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) Xcerfify,un der the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: " �' l "�� LIC.NO.: J Licensee: /1,911„ l % „ 5r11, -/,/ Signature v LIgC.NO.: (If applicable,elter "exempt"in the license number line) Bus.Tel.No.: ALZ Address: 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 agent. Owner/Agent PERMIT FEE:$ �2 3 . Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed , on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§ 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL- PECTION: Failed Re-Inspection Required($.) ❑ 1�ector omments: Inspectors Signat re: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhoId@townofrnerrirnac.corn h The Commonwealth of Massachusetts Department of IndustrialAccldints Office of Investigations kvi 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsAElectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. F1 We are a corporation and its a required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]f employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 'i'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:" Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 certlo under the pains andpenaldes ofperjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth ofMassachusetts Department of Industrial.Accidents Office ofInvestigalions 600 Washington Street Boston,MA,02111 Tel,#617-727-4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 www.inass,govldia p Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . has permission for gas installation . !�-4, in the buildings of. . . .�,t. , , , , • • • • . . . . North And , Andover, Mass. Lic. GASINSPECTOR ' Check# 8602 t •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ( MA DATE , PERMIT# ap bl JOBSITE ADDRESS ( OWNER'S NAME ,._- . ._._.-,_-,_ GOWNER ADDRESS __ T r TE —--- _ -- --- FAX TYPE OR OCCUPANCY TYPE COMMERCIALO EDUCATIONAL PRINT RESIDENTIAL { CLEARLY NEW: RENOVATION: REPLACEMENT:01 PLANS SUBMITTED: YES[ ]_! NOQ APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BOILER _ 1, ! !. I�.� :�I�I -�1 L--_„!I ! !!-m �.. , _. . BOOSTER CONVERSION BURNER �_� C OK STOVE DIRECT VENT HEATER __i. .-1 --f :T . - J ---- DRYER FIREPLACE FRYOLATOR — _j FURNACE - GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT ' OVEN POOL HEATER ROOM/SPACE HEATER ---- ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I.,-- �---!1___.J I__-,.11_-_ I L 1111 7j=L — INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES RTNO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY J5�' OTHER TYPE INDEMNITY BOND I_] \ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts enera s,an hat my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [_-.._. AGENT [ SIGNATURE OF OWNER OR AGENT n hereby certify that all of the details and information I have submitted or entered regarding this application are true a d accurate the be , f my knowledge :and that all plumbing work and installations performed under the permit issued for this application will be in compli ce with al in rovis' of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME � �¢- /_-�� .� ..- _�- LICENSE# /30 IGNATURE L .� _ IMP MGF E-1 JPF_] JGF LPGI CORPORATION[]# PARTNERSHIP EI#=LLC COMPANY NAME:`% c = �1 ADDRESS I..� - i , 2! CITY -_-j STATE �R,ZIPU? TEL FAX - CELLEMAIL- a -1z --- -— -- - ---- ----- -- -- — - ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# Tfi PLAN REVIEW NOTES 4nl , ) A �). r It2 Ah fwv m v v t .r The Commonwealth of Massachusetts - Department of IndustrialAccWnls Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f Please Print Legibly Name(Business/Organization/Individual): Address: 2 S r 4,,cez j2 c., xf' City/State/Zip: ��-" y /d Phone#: 7F— f Are you an employer?Check the appropriate box: Type of project(required): 1,,Z I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 1211Roofrepairs insurance required.]t employees.[No workers' 1311 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. $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 and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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. Ido Hereby cert u er the pains Zde Ides fperjury that the information provided aabove is trueeand correct.Si afore: Date: Phone#• ele,-0 v 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#: 4 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-isaequired-13B-9dvised that thus 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 pennit/liceuse 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth ofMassachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA,02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAF,E Revised 5-26-05 Fax#617-727-7749 www-mass,gov/dia Division of Professional Licensure: License Search Page 1 of 1 s 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 Home>Division of Professional Licensure> 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 SEARCH CRITERIA More... Profession:Plumber REFERENCES& License Number: 13085 RELATED INFO Disclaimer Regarding LIC. Website License Searches LIC. BOARD LIC. TYPE NUMBER NAME CITY/STATE LIC. STATUS Enforcement Process Plumbers Et Journeyman HENRY S. Glossa Gasfitters Plumber 13085 CROCKER JR. MALDEN,MA Current ry Plumbers it SEAN M. Glossary of License Status Gasfitters Master Plumber 13085 MCCARTY SALEM, NH Current Codes Plumbers Et Apprentice RICHARD N. SOUTHBRIDGE, Expired-Beyond 1 Gasfitters Plumber 13085 MESSIER MA Renewal Cycle More... Your search has resulted in 3 licenses The page above has been generated by the Division of Professional Licensure web server on Thursday,February 21,2013 at 9:02:24 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicRange.asp?profession=Plumber&licenseNo=13... 2/21/2013 ll APORa INDATE(MIKUD!M SURANCE- BINDER 08/09/2012 THI —- I S BINDER IS A TEMPORARY INSURANCE CONTRACT,SUBJECT TO THE CONDIT*NS SHOWN ON THE REVERSE ME OF THIS FORM. AGENCY COMPANY Salent Five Insurance (MOUNT VERNON FIRE INS CO 812080922538 335 Dain Street I DATE EFFECTIVE TIMFEXPIRATION DATE TIME Stoneham, MA 02180 I X AlkX 12-N AM 08/10/2012 12:01 03/09/2013* NOON NNE FAX ............ WC,O4c €781.438.5000 (ACJ4c?,81.438.5028r�al� 0 1'.K-1 EN V,OIN F,RAG -14 1.�:.A[KNE NWE D COMPANY CODE: SUE CODE: PER Lk"Flr�,Nr,V%M f- P"I D 0043$671 B)r:j U)-RLPJUN OF QIERATIONS'VEHICLFS?PROJEATY 1mcirng Lecati",I 114SURED dir ng under" renovation locateat. H.J. & S. LLC 1250 Osgood St. 33 Belvidere Circle No. Andover, MA. 01945 Lowell , MA 01852 COVERAGES LIMITS TYPE OF INSURANCE COVERAGE'FORAM DwUCTIBLE CONS% AMOUNT PROPGR7Y IIAS?C R' OA:) ,al" 0 GENERAL LIABILITY 1,GOO,000 X M I-PRE J 1 100,000 C1AIMS&est: cr.cm-i V-T)'rx P lh-'y 5,000 "C' 1,000,0()0 2,1 tSONAL&AR ? Y O'ENEW ACKA�.'rA I I- 2,004,000 AGG Excluded V@41CL'.UARILITY OOMPINFID vr_GLE L. ANYAUTC 00 0 1 L Y I NJU RY(Po-w z,.,, A1,L CJ*V!�'DAL7-YE 901 r I L y IWU Py rs.ulkc_6 .............. FVLVERTYDAMAGE 17EDAUTOS' NFEDZAL PAYMENTS L',AU`� INJURY 1-901 VEW-C-L'.PHYSr-.AL DAMAGE A!!Ar..k CLES. VALUI, 5IA11D A'A3UNI GARAGELIABILFTY K.,17 0 0'11.Y,IA ACCIDEN; Afll�AUPD 07�01 T�IWNAUIO ONLY: AGGREGAIL., EXCESS 1_449ILMY ;ACH Q(_VjRRW1_;. 0 P-11I.-:1 T1 1AN IJWRL:IA 3-0ZIM r•:,-FIO EMT[, WLr Sha 4 w,Pr TEE ON We SIAWTORY 0V-r" WORKEPS COMPENSAMN EMPLOYERS LtABILFrf Eft P& GYEE L� DIS-6SE POUCY11MU Sr-SCIAL EEE IS CONDrril"N'S OTHER' COVfRAGGS T ED T 0 r-pz-711 L&I NAME&ADDRESS Granite State Economic Development Corp. MQvill GAGE,' ADDITZNX 1 Cate Street Portsmouth NH. 03801 Al IT935-RIZED 903RESENTATNI E William Kelly/ROF Page 1 of 2 5ACORD CORPORATION lN3-2007. All rights reserved. ACORD 75(200701) The ACORD name and logo are regiswred marks of ACORD Z2�. ...I... 3Date......................... ............ r►ORT/y TOWN OF NORTH ANDOVER PERMIT FOR WIRING q, 88AC14U�3� t This certifies that .. P ... ' ................... ................................................................... ? ... has permission to perform .k....! Q� � '^'��......... wiring in the building of., .Cl . at ..........1.Z15P...... ............................... ? , ..........., orth Andover,Mass...... .................. t Fee.1.2.5..�.�.......Lic.No ZAt?. ... ................................ . .. . .. ....... .. .... ELE ICALINSPECTOR Check# (� •A Commonwealth of Massachusetts Official Use Only � Department of Fire Services Permit No. 04 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT INMK OR TYPE ALL INFORMATION) Date: - -- C;�p (, City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /6250 Owner or Tenant Telephone No. 71/- DB1��O Owner's Address Is this permit in conjunction with a building permit? Yes Rj No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service -V610 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: p� '7 p,,.,,�� e- e 0�>k Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell: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. Batter 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 Tons No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ..... . .. . ....................................................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other i Connection Z No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent i KW BData Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs FNo.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Atiach additional detail if desired,or as required by the Inspector of YYires. 1, Estimated Value of Electrical Work: S (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERA : 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: INSUIRANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,cinder the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: —oe.� CO,,e LIC.NO.• 2o-o 56,4 Licensee: 0S�M. oyi(Lk Signature LIC.NO.: (If applicable,enter "exemp "in the license nzz er line.) Bus.Tel.No.: 1 Address: Alt.Tel.No.: 11 *Per M.G.L c. 147,9.57-61,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 agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. 0 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed ❑' Re-Inspection Required($.) ❑ Inspectors Comments: i Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass EN Failed Re-Inspection Required($.)❑ Inspectors Comments: M t Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspector Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street .Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name(Business/Organization/Individual): J 0S U�F f-4� C rWC� Address: G� S City/State/Zip: Phone#: 17r- Are you an employer?Check the appropriate box: Type of project(required): AM-I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.[i Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. #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 and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: �02 rJo (966--00, �� City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certlo under thins-and p�fles-0 Wry that the information provided above is true and correct. Simature: Q 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#: r~� 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 employeiis 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 r Accidents fo;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 pennit/license applications in any given year,need only submit one affidavit indicating current f policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 604 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877,7MASSAFB Revised 5-26-05 Fax#617-727-7749 www.m,asS.govldza E r x r..., _— ._ �._�_.� __ — +, COMMONWEALTH OF MASSACHUSETTS:::-. ELECTRICIANS REGISTERED MASTER ELECTRIC IA ISSUES THE ABOVE LICENSE TO: JOSEPH G ELKHOURY PO BOX 2231 SALE.M'` NH 0307-9- 1154" a 20056. A 07/31/13 89:002.6':. R. • I r •b - , i 0 ; 29 / Dat�/k TOWN OF NORTH ANDOVER °low PERMIT FOR PLUMBING This certifies that . . . . . . . . . . . . . . . . . . . . 6 has permission to perform . .S'� L--. plumbing in the buildings of. !.�? K.K r-� :.c!c? . . . . . . . . . . . . . . at . . ./07`�Z�, . v •. , , , , , , , , , , ,North Andove ass. Fee JIY—?. . . Lic. No.1wjq . p PLUMBING INSPECTO � Check # 0� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE PERMIT# JOBSITE ADDRESS L OWNER'S NAME ,S A y" L POWNER ADDRESS j TEL -- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL E! RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:® REPLACEMENT:F.9 PLANS SUBMITTED: YES Eq NO© FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ ( ,__._._1 I ._____.._� .._.___1 -___J _( -_..__._.! ____.__! ..__J __._.J .___..._....► ( { # DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER _( __...-J .--. _[ _..--. { _-_-_J I ._-._...._I .__ J _..._ ( __...._I l ! J ! __...._-.I DRINKING FOUNTAIN --------_J FOOD DISPOSER _. { __. _( ._. ..__) . ._-...( FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK r^1 -.---.-_..# ! F ( ._._.__( ! J .�.J _._..__.# __..._...._I _____-_I ..____# LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET _ 1 --.._--{ J .T.! —._. 1 .-- �F- _! URINAL f WASHING MACHINE CONNECTION ' I -_ } # ( ) # T.# -. i ! ! pu WATER HEATER ALL TYPES %4WATER PIPING ._..- -----1 ...._ ! INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[ NO y� IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ) OTHER TYPE OF INDEMNITY Q BOND 0 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 ID SIGNATURE OF OWNER OR AGENT t0l hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c wit II Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �y\ PLUMBER'S NAME .S' {LICENSE# SIGNATURE 0 MP E JP D CORPORATION 0# _ PARTNERSHIP 0#=LLC Ek COMPANY NAME ADDRESS CITY �1/�� �rr��-✓ ........................i STATE ZIPj TEL FAX CELL7s� SSSS' I EMAIL - . --------------- �/ ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ PERMIT# PLAN REVIEW NOTES tel% .(64 , v L� , g The Commonwealth of Massachusetts - Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information !� Please Print Legibly Name(Business/Organization/Individual): Cv22 Address:_ ll', 60,r )rip G City/State/Zip: 4}?L��--tA/424 D&Y` ( Phone#: �12 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.® I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.f]Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: y Expiration Date: Job Site Address: f 2 _0 OS500C ..5�/ City/State/Zip: /1)0, An,C+e,y'C/Z Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert un the ins and penalties ofperjury that the information provided above is true and correct. Simature: Date: �4 O Phone#: � S/S— / 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#: 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 firm Accidents for conation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth,of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-72.7-4900 ext 406 or 1-87771\4ASSAFB Revised 5-26-05 Fax#617-727-7749 wwwalaass.gov/dia -SA AC r_LICIrNS.i`�:3, r�,S'A,,t�.lAST�.€� a;Lirfidit�l•���. ISSUES THE Agt]VE LICENSE TO_ SALVATORI. CURRAC) is a : : in. a.. N MAINS .tT NH `NEWTON { 1. 6.9;.4.,' 05/01/14.5 3 a �patach Mo gAII Perfofations,.r' rF;Id,,Tht;n _ �_.�-✓ Date�..I.a.�....[k..:�...... OF NOg7M,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that l lb.'..1. has permission to perform ...... QQ e c-62S C�o wiring in the building of. A.n. cU 0 ................................................................................ at .............................................�-�� aC...�.A ..., ort Ando/erM May. Fee....�.57 ........Lic.No.�.l .�.rJ.. '• ''..........Ei .. ... . .... PE Check# ; ` 21 Official Use Only Commonwealth of Massachusetts Permit No. LI LI 2— Department of Fire Services Occupancy and Fee Checked °Y 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(NEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ),S-0 o o a Owner or Tenant b Telephone No. Owner's Address Is this permit in conjunction with a building permit. Yes ff No ❑ (Check Appropriate Box) Purpose of Building �� .� u 7` 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: b -��� ✓S t 2 C� C Completion of thefollowing table 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 El ❑ o.o Emergency Lighting 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 No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: """'"""""""""""'""".............. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of 97res. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) X certify,under tlteptrin andpenaltie ofperjury,that tIt 'nation on tj1 is application is true and complete. FIRM NAME: " 4 v�2 ` - / LIC.NO.: 97 Licensee: ��_ Signatur6--, h LIC.NO.: (If applicable, to `exemp "in the license number line.) Bus.Tel.No., Address: t s 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 agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed or , on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: 1 Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Y Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL IN PECTION: Pass INAll� Failed Re-Inspection Required($.) ❑ Inspectors Co ments: 4 Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 7 ° The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers . Applicant Information Please Print Legibly Name(Business/Organization/Individual): A49 &r-P""-t Address: �o / . City/State/Zip: 7., gS..h o ro o #I e Phone i Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y p tY• 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roofreppairs insurance required.]fi employees.[No workers' 13. Other Cf , e "I1 W Il ,'0 Lr 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 their workers'camp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 2!�_6 0 /' City/State/Zip: e 1,e- - •¢' . Attach a copy of the workers'coin nsationpolicy 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. Ido hereby cert' un er th pains and pen Ities of perjury that the information provided labbois fru and correct.Da � �J 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#: f r � Information and instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to 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 J 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth ofMassachus-tts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 Tel,#617-727-4900 ext 405 or 1-877rMASSAFB Revised 5-26-05 Fax##617-727-7749 www.mass.gov/dia c J 1 ` °_.COMMONWEALTH OF MASSACHUSETTS~,` r� © � K of �iE M NEN&W', -,ISSUES-THE ABOVE LICENSE TO'LiCtNSEN7 • �► ,�r . EXPIRATION DATE SERIAL-,No.", Location No. to— ZO( '7, Date �- • - TOWN OF NORTH ANDOVER • �ilt�.t,t,»Mgrs' w • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ Check#—Z2,2 25902 Building Inspector Q �.t4ED /6s o TOWN OF NORTH ANDOVER D4 CO[�IC IwIC. S i G N RE R MI T A� �DRA7ED Fpp, st� CHUS DATE: November 1 , 2012 PERMIT: S010-2013 THIS CERTIFIES THAT Hokkaido Restaurant has permission to reface existing sign and awning with new restaurant name. Existing pylon sign is 1091/2 H x 801/4 W, Existing Awning Sign is 36 H x 40 L. Refaced pylon sign will be blue aluminum board with white lettering and gold border, awning will be blue vinyl with white lettering. Blue Lettering over Doorway— 3 Characters. Sign is located on 1250 Osgood Street - _provides that the person accepting this Permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section #6, Voids this Permit. F INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspector of Buildings Amount Paid:$67.00 Check#1022 Receipt#25902 I SIGN PERMIT APPLICATION K 1600 Osgood Street—Building 20, Suite 2035 Map NZTOWN OF NORTH ANDOVER V) �'n Parcel 0 '1/ DATE SUBMITTED (l I Site Owner 5a-w- Lei Applicant sa Ge Tel -791— Site Address` DS �� S Size of Proposed Sign Aw►1141 36"H x 4°`L� 51s"/°%i This cm—g xa the properly<A Stato da Sign.The roormatinn conialnetl herein may not be used or rep-lo-d'wrthnut wndrn pa--l'tram Statewide Sign.An repmducunn5.m whole or in port,must STATEWIDE SIGN&DESIGN INC. hear th-s stamr-ot or make ref—oco to,t Ail work by Stalaw,de d wp Sigo to be done in a ame•y ano—I'ke manner acwtcbg to Standard Ildustry pract,ces Any abci k-or,.vIst:oo I-,the Speea d escri3ad here-re—l-og extra costs wdl be oxacuted upon aoProvel with the aunt All malonel,s gua—wod to be as speufied.We reserve 11,3 dght to suU:'Uluia components it deems comparable dun to Q1,rM�, 543 Washington St,Quincy MA 02169 sign=1eblbty or unexpected supplier de'oys 0-11 is ultimately responsible far fnel approval of all proofs.ne we:l as ai:taxes,insurance•and h±es tltlonoled with the prolecl.50':4 dnwn payr-enl dun upon ing the contla t nalenoe It-"per,complel,on of project 11jordlces of any incpvctlon Unpaid bele-..,;ova,30 days will subject to 15%APR InWrsat.A�:agreements ore cpnt,ngtlnl upon stakes• TBI:617-472$628 Fax:617-072.8850 nsc.danLs,or delays beyond or on trot Soma m1e,don,n�oyallply, E-mail Awning Refabric: Apgm@ gwbm NEW uww"A �§M ft @MD��(A TM @*W�l 40 It FRONT VIEW Pylon Sign(double sided)faces replacement: I n.25Jn • �� _ �AS � PROPOSED { � l'A'lla l'.�ilaJ.liJl�! SPECIFICATIONS: Mid blue Cooley fabric *White graphics FRONT VIEW PROPOSED 3D Letter sign: — SPECIFICATIONS: ominp,Soon. *Solid surface sign,No internal illumination. * Mid blue Aluminum board. EXISTING *GraGraphics in white vinyl. Signs installed in location shown on attached photos. F91n EXISTING SPECIFICATIONS: Client MUST REVIEW&APPROVE CLIENT Mr. Sam JOB ID *Solid surface sign,No internal illumination. all drawings BEFORE production. COMPANY DRAWN *Letters in 3/4"thick white PVC w/mid blue vinyl faces io p Hokkaido Restaurant Lucy ORDER DATE 10-31-2012 to be individual mounted onto the wall. y Sign Is authorized oaexec�te tconditions i s o�w�ed in this d.Statewide 1250 Osgood St TITLE 1 agreement. ADDRESS CLIENT SIGNATURE CITY Signage N Andover STATE/ZIP MA 01845 PRINT NAME GATE TEL 781-888-1610 FAX FILE ID �,( CD tl The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations �a r Q _ = 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �j�J Please Print Legibly Name (Business/Organizatiot�/Individual): Sfu"�"�t''�(U£' S t '� ot S 7 kL-L ltie- Address: S-V3 VV44 k S'-6_ City/State/Zip: Av?VLq- 6-v-2461 Phone #: L( r Z ^ Q Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling sub-contractors have ship and have no employees These 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ 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.[R Other S,t Y-PL S' 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. tContractors 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: /� �i L -PX-✓iC� %V1 VC��-e �t�tSu�Z� C L' ��wvi�ci �� Policy#or Self-ins. Lic. #: VVC--0 q-02 i �- I Z. Expiration Date: yZ�i�-jty o o /2, Job Site Address 05 4.• City/State/Zip: A/- A'YLd o e-Z I[.jA 0/nJ-- 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. Ida hereby certifynder e airs and penalties of perjury that the information provided above is true and correct. Signature: t' Date: /�a: "`/ -2 Phone#: Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 4.Board of Health 2. Building Department 3. City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: P. 1 Communication Result Report ( Feb. 7, 2013 10: 05AM ) 2) Date/Time : Feb. 7. 2013 10: 04AM File Page No, Mode Destination Pg (S) Result Not Sent ---------------------------------------------------------------------------------------------------- 7503 Memory TX 817817950156 P, 1 OK ---------------------------------------------------------------------------------------------------- Reasonfor error E. 1) Hang up or line fail E. 2) Busy E. 3) N o a n s w e r E. 4) No facsimile connection E. 5) Exceeded max. E—mail size Columba Gas- of Massachusetts _ a ivs—c.,,y..y 56 aeowtca saoel P.O.8mr668 September 20,2012 ra.,.�,aao16�1-xsts 678.687.1105 F 675.686.1676 Hokkaido RcstaurantInc AccountNmaber: 1250 Osgood St North Andover MA01845-1009 Dew Hokkaido Resmmsnt,Inc_ During a recent visit,our service technician detected a safety problem with you gas raga,galls, fivers k wok bumcm located at 1250 Osewod St.North Andover,MA.Acc ndingly,we have issued a Warning Tag because ofthis situation.Need plumberto pull pcnn%reconnect equipment,pressure test and have zispected. Under the ru=aances,we strongly urge you to correct the code violation. In addition,the Massachusetts code pertaining to the instal[ fon of gas appliances and gas piping,establis5md undo Chapter 737,Acts of 1960,requires thatihe oonddioa bo remedied. If you have any questions,please call our Service Departmem at 1-800-698-0940 and ask to speak with the Service Supervisor Pleased"rnegad this notice ifth.oenduionhas been com eted. Siacady, Customer Service Department Columbia Gas ofMassechusetrs CRR:CPU aw'"aarat weii6 651=2