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Miscellaneous - 127 Main Street
%cell,47©.v - 0 0 / P / Location / �' /J1�,,fes , /v"IVI""1s 4",I)'d _Y"/C. No. p® Date ., Cf 40R, �ti TOWN OF NORTH ANDOVER t• 3? i •• O 0 9 Certificate of Occupancy $ °•ttn Building/Frame Permit Fee $ SAC MUS Foundation Permit Fee $ th�erPrmit Fee $ / ` TOTAL $ Check # ��✓ fes' Gam'_ 2 3 9 '/-0 Building Inspector a NORTH d ps tttED , "1 o o =" TOWN OFNORTH ANDOVER °44 « ��'.K•,�� SIGN PERMIT �.4 00ATED AACI I SSACHU`-'� DATE: March 1, 2011 PERMIT: S032-2011 THIS CERTIFIES THAT Nashoba Global Inc. d/b/a Kumon of North Andover, Has permission to erect 2 wall signs, both are 54.05" x 20.01 " on 127 Main Street, North Andover, MA 01845 provide 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. INTERNALLY ILLUMINATED SI S ARE PROHIBITED Inspector of Buildings Receipt 23920 Paid: 60.00 Date...... NORTh TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SS4CHUS This certifies that ............D�...... ............ has permission to perform ....)C.:1.7../d........................................................ wiring in the building at.... North Andover,Mass. Fee. .....................*P'�' e'--'4 . -,4 P� Lic.No. �f� 1.71724.......... Check # Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 9�73 ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGUL9ATIONS [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 ININK OR TYPE ALL INFOR4kTION) Date:_ a hL o/ j D City or Town of: Aaftw AM" To the Inspector of Wires: By this application the undersi ed gives not' e of his or her intention to perform the electrical work described below. Location(Street&Number) ( aQ—] mi wJ S+ V u 'a".4 61001.— Owner or Tenant L.cl v lZea i '`Y'o5� Telephone No. Owner's Address rVI (�'ia,� Is this permit in conjunct'on with a building permit? Yes U No ❑ BLDG PERMT# Purpose of Building_O c-e S 62 q c Utility Authorization No. Existing Service/ 0 J Amps (2,7 / o y-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-;y u,;r,,,,,4- r,4- y Completion of 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 ❑ o.o Emergency Lighting / rnd. rnd. Battery Units No. of Receptacle OutletsNo.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners 7Detie7cfflon/Alerti ion and Initiating Devices No. of Ranges No.of Air Cond. TonsTotag Devices No. of Waste Disposers Heat Pump Number .Tons KW ntained Totals: rtin Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No. of Dryers Heating Appliances KW Security Systems:* No. of Water No.of Devices or E uivalent Heaters KW No.of No.of Data Wiring: Si ns Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired or as required by theInspector of Wires. Estimated Value of El ctrical Work: I o do.00 (When required by municipal policy.) Work to Start:12 21 I O Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert, under tftepAins and penalties Pfpe[Jury,that the information on this application is trace and complete. FIRM NAME: C7 1 Pct c 2�o J, �.� LIC.NO.: / -2 -).119 Licensee: G�✓ J Signature cam, LIC.NO.: (If applicable, enter "ex mpt'in the license numbe line.) II Bus.Tel.No.• 7Y bcX 17a 2 2 Address: LOCI.%. : W9 Mq- O S Alt.Tel.No.:-'-If-7h-64970W *Per M.G.L. c.147,s.57-61,security ork requires Departmaht of Public Safety"S"Licen 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 Signature Telephone No. PERMIT FEE. ,$ ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR—DOUG SMALL s 1. SPECTION: Passe — Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) s Date 2.FINAL INSPECTION: Passed Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)- [ ] Inspectors' comments: (Inspectors'Signature-no initials) Date d 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT i ACCESSIBLE AND A RE—INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts t 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 NaMO(B.usiness/Organization/individual): Address: ` I a.. w �� w city/state/zip: AJ S M A Phone C� ZZ Are u an employer?Check the appropriate box: Type of project(required): 1. Are a employer with ',-1- - 4. ❑ I am a general contractor and I 6. ❑ w 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._ emodeling . ship and have no employees These sub-contractors have 8. ❑Demolition workers'coin insurance. working forme in any capacity. ]?• 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 12.0 Roof repairs insurance required.]i 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 isproviding workers'compensation insurancefor my employees Below is the policy and job site information. Insurance Company Name: NO r Policy#or SeIf-ins.Lie. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ` fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties 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 CIerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . P.Bither Insurance Agency, Inc. q�TERTHE COVERAGEIAFFORD BY THE POLICIES BELOW.v� 51 Mi+dlesex Road .O.Box 307 INSURERS AFFORDING COVERAGE NAI C# n sboro MA 01679- CIC INSURER A:COMMERCE INSURANCE SURED INSURER B: �ESOUSA ELECTRICAL SERVICES, INC. INSURER C: 1 WATERWAY PLACE INSURER D: 'YNGSBORO jvjA 01879_ NSURERE: _ :OVERAGES AVE BEEN TO THE NGANY THE POLICIES OF INS OR CE LISTED OF ANY CONTRACT OR OTDHER DOCUMENRT WITH REDS ECOT TO WHICH THIISICERTIFCY I OD IE MAY BE ISSUED OR MAN PERTAIN REQUIREMENT. TERMTHE INSURANCE AFFORDED MAY HAVE POLICIES BY PDAHEREIN ID CLAIMS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN - POL'tCY EFFECTIVE POLICY EXPIRATION LIMITS ISR REGDD'L TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDIYY) $ 1,000,000 .TR INSRD H07715 09/25/2010 09/25/2011 EACH OCCURRENCE P, GENERAL LIABILITY DAMAGE TO RENTED $ 10 ,000 PREMISES Ea occurrence 5'000 X COMMERCIAL GENERAL LIABILITY / / / / MED EXP(Any one erson) $ CLAIMS MADE F-1 OCCUR $ 1,OOO,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 PRODUCTS.COMP/OP AGG GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC / / / / COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO / / / / BODILY INJURY $ ALL OWNED AUTOS (Per person) SCHEDULED AUTOSoF MAss� BODILY INJURY $ HIRED AUTOS - ,__, - (Per accident) e 1. N0.- EA�-TH / / / PROPERTY DAMAGE $ _ (Per accident) • • AUTO ONLY-EA ACCIDENT $ VOLECTRIC}IrANSA GARAGE - � CCq � ,� / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ ANY 1C EACH OCCURRENCE $ EXCESSIU. �.t :# `E,LI+t,T AGGREGATE $ P.p OCC I1r1ATER= Ui879"1348. / / $ DEDU( RETEN P. - _ WC STATU• OTH- ER • / / TORY LIMITS ER WORKERS COMPEL E.L.EACH ACCIDENT $ EMPLOYERS'LIABI _ ANY PROPRIETORIF E.L.DISEASE-EA EMPLOYE 'b OFFICER/MEMBER I - E.L.DLSEASE-POLICY LIMIT $ If Yes.describe under SPECIAL PROVISIONS below OTHER DETCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Electrical Work CANCELLATION CERTIFICATE HOLDER - _ SHOULDCE ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ( - } EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .� 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHAL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS O R RESENTATIVES. AUTHORIZED R RESEN @A ORD CORPORATION 1988 - Page 1 of 2 ACORD 25(200108) ELECTRONIC LASER FORMS,INC.•(8 0)32 45 �. -INS025(0108)05 ku neo w 4q* LocationNo. e'. - 4 `7 Date �oRTM TOWN OF NORTH ANDOVER f � 9 Certificate of Occupancy $ ;,SSACHUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL AV Check # 4 1955 ,� - Building InspecW C/' ' NORT11 � y1►� �� ``_ ° 0 O iwxS 1 coc«Ic«,wte x +,4 Oft 'revI,to�+(� SSMC RUSE TOWN OF NORTH ANDOVER Sign Permit Date: September 6. 2006 Permit Number: 03-07 THIS CERTIFIES THAT Ann Messina Has permission to erect a 60" X 120" Wall Siam—Externally Illuminated On 123 Main Street provided that the person accepting this Permit shall in every respect conform to the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section#6 Voids this Permit Inspector of Buildings } z TOWN OF NORTH ANDOVER SIGN PERMIT APPLICATION Site Owner Applicant Site Address 3 ��� SL,;-4� �� Size of Proposed Sign (96'- How attached: a) Against the wall_ Illumination: a) Not illuminated LI b) Roof O b) Internally illuminated ( ) c) Ground O c) Externally illuminat(edd h� d) Other. Materials: Proposed Colors: Background Lettering o Border .� Required Attachments: Note: No permanent/temporary sign shall be erected, or enlarged until Photographs of building an application on the appropriate form fumished by the Sign Officer has Material sample been filed with the Sign Officer containing such information including p photographs, plans and scale drawings, as he may require, and a permit Color sample for such erection, alteration, or enlargement has been issued by him. Site or Plot Plan (Required for all free-standing signs) Such permit shall be issued only if the Sign Officer determines that the Drawings of proposed sign sign complies or will comply with all applicable provisions of the By-Law. Other, specify Will sign overhang any public road or walkway Yes No ( ) If Yes, Name of Agency who will provide liability insurance: AN-INCOMPLETE A PLI ATION WILL NOT BE ACCEPTED DATE FILED: co - / SIGNATURE OF APPLICANT revised:jm-11.5.04 12a 1+I1 Ma k^arPRl.^ '*^•.+bNViN.SR454Mffig5Y f nT' r' «I� ( •� CC�MW+FM+'aimf@ T�* hs.cza+WkatfttR.ryrnr .. �.. �, 1 �+# iF1TM ,any � � Lt' . .- '9.IM•'m� .^wARAP c4r kMa :Y,kPr`.w'?+bf�E�%fKK�.: _ . +.._,. ,. ��PUYm ;ruYatRlf-YkbF•.'fr.'Qt.� : - ..,.. .. ..'. ,� t'�fA.: �:SPh�•r� ,w. ��- .. rn'AI, tY 4 ��n T<�i udaKw•>.as^r'Yss'a'�"+k".`rvs.tfeFY°.✓n.3. ,.: ^C°"�L`+*"Ev h]"C .' 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"P E R 'r. , J= IE S, 14IEALTO - , 3,�—Uzc- 6A->OQX1Z) ! ellJ J / eels Page 2 December 2, 2010 In light of the foregoing, Kumon believes that any Certificate of Occupancy that is issued for this location should be similar to other office or retail uses rather than applying an educational code. If you have any questions or would like any further information about Kumon Math and Reading Centers, please contact me via email at rizermaingkwnon.com. Thank you for your cooperation in this matter. Regards, 1 w Robert H. ermain Assistant Corporate Counsel cc: Sheila Espineli, Branch Manager 2 KUM ._, N" i KUMON NORTH AMERICA, INC. Glenpointe Centre East,6th Floor ��� 300 Frank Burr Blvd.,Suite 6,Teaneck, NJ 07666 tel. 201.928.0444 fax. 201.928.0044 www.kumon.com December 2, 2010 Gerald Brown Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 Re: Zoning and Building Code Classification for Kumon Math and Reading Center at 127 Main Street, Unit 2, North Andover, MA 01845 Dear Mr. Brown: I am the assistant corporate counsel for Kumon North America, Inc., the international franchisor for Kumon Math and Reading Centers. I am writing because one of our franchisees, Shoba Donti, is interested in leasing space located at the above-referenced location for purposes of running an independently owned Kumon Math and Reading Center franchise. We were recently contacted by Shoba Donti regarding the concern that the zoning/building inspector intends on classifying the Kumon franchise as a "school" or "education group" under your zoning ordinance and building code. In our experience, a Kumon Math and Reading Center should not be classified as such for the reasons stated below. There are over 1,400 Kumon Centers throughout the United States and Canada. The owners of these centers are franchisees, similar to the way individuals "own" a McDonald's or Burger King restaurant. It is Kumon's position that Kumon Math & Reading Centers are not "schools"; they are commercially franchised enterprises that provide a service to children and their families. Kumon Centers provide a service that supplements, not replaces, children's schooling and the setting is not a traditional classroom setting and, in fact, there is no "teacher". A Kumon Center is only open to the public two days a week, not more than four hours each day. Each client is present at their respective Kumon Center for only one hour per week. The business conducted at the site is more typical of an office function with a retail-type component in which a service is provided to our clients for a fee. Kumon Centers provide copyrighted worksheets, which the clients work on for about 20 to 30 minutes at the Center. Our clients take the remaining worksheets to complete on their own time at home. The majority of the time that a Kumon Center is in operation is for general business purposes. In other words, franchisees or Kumon staff are preparing for consultations with their clients and lining up worksheets for distribution, general office management and fielding inquiries from the community. K U M '_' N ® ORTH Towno over 0 �3 �= 9/ = -o dover, Mass., w O ��- LAK_ AK � COCHICHEWICK DRATED PPa�,�GJ BOARD OF HEALTH Food/Kitchen PERN[IT T D Septic System Inti�rc✓ FF C7` `�r a��/� BUILDING INSPECTOR THIS CERTIFIES THAT........... ...................,1 ............................. Foundation has permission to erect........................................ buildings on..,/,,,..�..... / �.�y..,; ......................................... Rough to be occupied as............................. %r�•vc�. i � nJ'z' -Iles: . ..... ........................ .......................................................:.. :: Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on filen this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR f� Rough .............. `............!.......:' ,,...... .................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner ' Street No. SEE REVERSE SIDE Smoke Det. Date......6T �2 t Of AORTH,M °0 TOWN OF NORTH ANDOVER 40 - ^ ; PERMIT FOR WIRING �,SSA�MUS� SvuS - �Zc-�T This certifies that ............................................................/l..�y.... ../ has permission to perform .............. ��.........TS........................................ wiring in the building of j'YjeSS��w���vlZip�v� t11,Vi 7 at.... 27.. <Au 5.7 Uw. ......... ,-North Andover,Mass. �..... .. ...M.A ............. ....T......... Fee.../ZS Lic.No. .J.7/7;?4 ........ ..., ���1� ..... ........ . . . .. ..... ' LECTR[CAL INSPEC�OR Check # d6q7 "t 0783 - - Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 7 BOARD OF FIRE PREVENTION REGULATIONS [ ] Occ p nyandFeeChecked (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:. 11/j.7 / l Z 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) 1 '01,-7 M q 1„i Owner or Tenant m Qc� ` l ( Telephone No. Owner's Address a i w S Is this permit in conjunction with a building permit? Yes �] No El (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 10 U Amps / t� 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: Ple z )vim e l��If ' Completion o the followin table may be waived by the Ins ector o Wires. No.of Recessed Luminaires No.of Cefl:Susp.(Paddle)Fans No.of Tota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool AboveElIn- ❑ o.o mergency 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 Initiatin Devices No.of Ranges No.of Air Cond. Tons l No.of Alerting Devices 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 Sectio of Devi es* E uivalent No.of Water No. KW No.of BalNo.as Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices orE uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 8J OU (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) I certify,under jhe ins and penalties fperjury,that the information on this application is true and cor:ptete. FIRM NAMED LIC.NO.:(717,)-* 7,)-* Licensee:V\1VXV - 2 ' " Signature LIC.NO.: (Ifapphcable,enter"ex t"in the licens umber line Address: ` Bus.Tel.No.• - .Z Z �Aa s� x+li 4Cj [�kn3 644- O X71 Alt.Tel.No.:'7'7Y- *Per M.G.L c. 147,s.57-61,secuAty work require&bepArtrnent of Public Safety"S"License: Lie.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 Signature Telephone No. PERMIT FEE:$ • ELECMCAL IPF-PMT NO, _ )WSPECUON PXPORT: , ELEC CAGJW8PECTOR.. " .RO�C .E�7P CTION: . Passed [ I S+'ailed--[ ] Ae-inspection regtixze�T($50.00) -[ � Tuspectors'comme�ats: (xnspectoregigaature••norhWals) _ Date 2.S�'IIV'AL ZN P�C�zOle7:Irassea' V Failed—j ) Ite 3cnspection xequixed($50.40)- [ I'nspectoxs'c•mmenfs: (C' pectors'uigna e•-noWf Ys) Agte 1 3.'CTNDER.Gl�OUND 7N5�.'ECTZOZY: _ , rllassad—f ] Failed--j l Re-inspection.required($50.00)-[tors'comments: (Inspectors'Signature-•no initials) Date 4.INSPECTION—SFR'VICE: . DATT+CALL RE "ANT±ONAL ORD Passed—[ ) Failed—[ Pe inspection required($50.00)•-[ ] Inspectbxs'eommep�fs: {Inspectors'signature Ino initials) Date �.�tuPECTION•-OTT3E�: Passed—[ I+ailed--[ )- xteznspectionxequired($50AD) [ I=nsliectoxs'corimments: - • �ispectoxs'signature no initials) Date DOOR.TAGS.ARE TO BE FILLED O it AND LEFT ON SITE)F THEA PXA.TO BE NSPECTEJD IS NOT ACCESSIBLE AND.A BE 3USPECTION OF S50.-0019 TO$E CMRGED. The Commonwealth of Massachusetts - Department of Industrial Accidents 02 Office of Investigations 600 Washington Street Boston,MA 02111 kvtj www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f i ` Please Print Legibly Name(Business/Organization/Individual): i��( Address: 11J cc t City/State/Zip: 'T vo k ©C '7 4 Phone#: Are you an employer?Check the appropriate box: Type of project(required): OR I am a employer with 1 4. ❑ I am a general contractor and 1 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. 0 Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.El Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.E]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' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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:. /V 0 V- + w--, Policy#or Self-ins.Lic.#: W Expiration Date: [ 4 Job Site Address: Q i AJ g' V w'� City/State/Zip: '' `� IM r-L 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 certto under the p s d penalties of perjury that the information provided above is true and correct. Signature: Toni Date: 4L.J17 /iL Phone#• _7 (a 7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: i 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 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 TIECOA MONWLAI.THOFLYMSACHUSE7TS Office Use only / DEPARTA1EVT0FPUX1CS4FE7Y Permit No. BOAR60FFIREPREVEW0N ONS527CMR12.10 ,7 Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PE ORMELE�CAL, WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASS HUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical ork d cribed below. Location(Street&Number) /O6 — l� 5r 4 s vt�4�c C' i ,e R Owner or Tenant s t, Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) u Purpose of Building (f Utility Authorization No. Existing Service AmpsVolts Overhead 1:3 Underground No.of Meters New Service Amps Volts Overhead =1 Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work TEtiR>0T 'T —d f0 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above ED Below Generators KVA round ground No.of Receptacle Outlets 249 No.of Oil Bumers No.of Emergency Lighting Battery Units No.of Switch Outlets CJ 7 No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones l \ Tons of Disposals No.of Heat Total Total No.of Detection and Pum s Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP �Ptuaaa(YmfhelegtmanaYS�Geilera1L3ws Li3bt7ity)iR=toeFblicyinchldmgCorrlleeCowaageorilswbstartweWnalat YES NO nodvalidprool'ofsanietotheOffim YES � Ify�.rhaw dYES>pk=ir&therypeofCDVWMeby Sbox ON o � o fta,, ) EViratim Date Estffn dValueofl7ectdcalWotk$ Pit�aP�taltiesof / hnpactionDa�Retd RaoFinal >, LicamNo. LkawNo Busin Tel.No. ')if 6_'2 6 2 f 2 INSURANCEWAIVER,lam awarethattheLimedoesnothavetheinsur =cc)mmgeoritssubstantialeq nvnl asrequiredbyNb%wh19mC3alaalLaws tsg=nc)n dmpenr M)bcabmwaives this m merrtat heck one) Owner a Agent Telephone No. PERMIT FEE$ signature of Owner or Agent .� ��''!/c 5 Cj NM O Z a t!'f 00 a QL M v ep a O C N t H 3 � 3� SIGN PERMIT APPLICATION 1600 Osgood Street Building 20,Suite 2-36 TOWN OF NORTH ANDOVER A " A Site Owner 5A3 LAU �i;�I�LT� NASt�obA Gi-ot3A�, )NG I dba KuMON 01~ NORTFt A�JIvvt�2 �,�t.&')Applicant Tel Q'1g -q°15-i837 Site Address 1�`1 MA lel S7. 0.1oR`S�f I�N�0 it(;R Size of Proposed Sign h112. X �®�� [54,105 LhG�eb May Parcel Illumination: QNot illuminated How attached: a) Against the wall ✓ ✓ b) Internally illuminated b)Roof c)Externally illuminated c) Ground d) Other Materials: 1 1 N`GA �Ei6l-Tj UR1:SHhNE aDAR� PAiNTE-b WITH MhTTNEvdS .13i(,N PAINT. N5 P,91e eACXGROWN.) Ph0QTE) Proposed Colors: Background aL1.51: WTH CARVE) L06-0 QhiUTEj> WKtTE. Lettering W1EkSE P .11 yn $ �o Border — Cost of Sian ' 845r X a 2 1(09o� + b" Required Attachments: Note: No permanent/temporary sign shall be erected,or enlarged until an I Photographs of building application on the appropriate form furnished by the Sign Office has been filed Material sample with the Sign Officer containing such information including photographs,plans Color sample and scale drawings, as he may require, and a permit for such erection,alteration, Site or Plot Plan(Required for all free-standing signs) or enlargement has been issued by him. Such permit shall be issued only of the v Drawings of proposed sign Sign Officer determines that the sign complies or will comply with all Other,specify applicable provisions of the By-Law. Will sign overhang any public road or walkway Yes O No(N4 LO-W, afi�Ov� c ns - If Yes,Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: Receipt# Check# Revised 10.31.2006Form Sign Permit Application SIGNATURE OF APPLICANT APPROVED BY r Kumon 4.5'.jpg -iKumon.com Mail Page 1 of 1 f C3 N "A■ mlr Ossamm Company: Kumon rile: Cus Omw This Dvawing is the;property of Gamit Signs 24 Spencer 3fireet Stoneham,MA Approval, _ _ _ and con not be reproduced without the (781)438.5280 FAX(781)438-8823 Dale: 2//11 pefmiWon of Gamut Signs, -http://mail.google.com/a/ikumon.com/?ui=2&i1 ---269262e832&view=att&th=12e33 e47a241... 3/l/2011 photo.jpg -iKumon.com Mail Page 1 of 1 1 NOW 3 P t y 'http://mail.googl e.com/a/ikumon.com/?ui=2&ik=269262e832&vi ew=att&th=l 2,e729b687b... 3/l/2011 WP_000026.jpg -iKumon.com Mail Page 1 of 1 3 "Now r% I�. ' ;ILII II'I.9 I I Ir I I I11 IIf I k .t J 1 I w -phttp://mail.google.com/a/ikumon.com/?ui=2&ik=269262e832&view--att$Lth=12e7293 e4a8c... 3/1/2011 I�, I OL985"-SL6 6LSI0 'b'W 'oaog96ufil 'PNxasalpplW b0Y i . ► '=I 'u61vsG t Suipling emoIaW 40'-0" i i x O 61 p REMOVE PART/7'/0N5 t REPAIR SUSPENDED CE/L/Nls - G (LDR EN S CARPET ENT/RE AREA, PA/Nt ALL WALLS DC/ST/NG /NTER/OR DOORS t WINDOWS TO BE RELOCATED AREA v NOTE FIRE SPRINKLES ARE NOT/N T14/5 INCLUDED DES/GN, SOME MAY NAVE WOE MOVED t ENG/NDERED OO EriER�ENcr L/GNT I 4� I NOTE "' I ALL D/MENS/ON 8 WILL NEED TO BE FIELD VERIFIED FOR ACCURACY AND ALL PART/TIONS WILL BE LAID OUT x I ON TINE FLOOR FOR CUSWMERS FINAL APPROVAL OFFICE I I � u� i ►n � I � ELEG J1 IF---------------A F�ij FIRE EXIT&IaN QOQ INK/NG OS A p !EMERGFNtrY L/GNTS Qj� O FOLMAIN a 0 Z'-4 z STAI REFUU N „ " o Q 3'-0.' STATION 4- 4- LZ (D !STROBE TLT. _ v ------ ---- Ih'-��4u coo ---------- ------------ 3' Q p !�� p ------ ---- Q `-------- ------ ---- FIRE FIlLL STATION (� !STROBE - --- PARENTS ROOM a1 QO D N ' v 1'1v"x 4'-6" x 4 i 111 b' 5'-0"x 4'$" PROPOSfED 2ND, FLOOR LA`1110117p WI T14 /NT,ER/OR /=ART/;r/ONS SCALE: 3116" - 1'-0" MARLOWE RUILDINCx d DE51GN INC. 404 MID X R SCOFATYNG� 80 , A. 01819 : DESIGN ARCHITECTURAL DESIGN SOFTWARE 918 4 -8510 DRAWN BY: F -MARLOWE Kumon or North Ando c�'r ����tNOF�ss9Oy� �O LYNWOODE LENTIN A WI VA ..� SCALE: SEE DRAWING Tutoring Center U PREST -i 0 STfiU'�TURAL DATE: 9 No.39569 O Q 431-6" 31-6" 40'-0" 31-611 T-011 111-0" 13'-0" 91-011 a'-&"X 4'-6- 1'$"X 4'-,&II 2'-6II X 4'-6" 1(1 a x i t(1 O 3'-0n .A 3iO•" iA 3 M I I I I - � x CIA 4 cq I 4 O - N � I � N M I ELEC C, O _ 4 2'4" 2'4" 4'- .0 pT. - N tF ____ ____ ______ ____ ^cr ____ _____ ---- ----- ---------- - ------ -------- ---- I I I 1 I 1 I I I I I I I I I I 1 I I I - 1 I I I 1 i I j 8'-211 1 I 1 1 i 1 1 I I I 1 I 1 DOWN I I 1 I 1 1 I 1 1 I 1 1 I 1 1 1 i 1 i I 1 1 i I 1 1 I I I I I I I I 1 I I 1 1 v 1-C."x 4'-6" ,r _ 4 4 -' ►n N t+l to x 6'-6i1 121-6�" 81-43b" 6'4" 814" SEXIST/NCs 2NO, F/_OOR "''OUT ! MA4 EXISTINI INTER/OR )=ART/7'/ONS 431-611 SCALE: 3/16" - I'-0" MARLOWE BUILDING 4 DESIGN INC, - 404 MIDDLESEX RD. TYNGSSORO,MA. OI9'cJ f ; ARCHITECTURAL DESIGN SOFTWARE 9�8-w'o49-8570 DRAWN BY: F.MARLOWE NOH448s SCALE: SEE DRAWING Kumon of North Andover �oLY NW000 a�y� g VALENTINPRESTE DATE: STRUCTURAL ch No.39569 N pPc,�zo�a ITS D g N . ot-m ow z Z O ZJ� O r J>a y P 00 Q PRODUCT CODE 6/2E HINGE DIRECTION REVERSED COUNT TYPE WON NE/GNT OPENING /D � Q) } 36X80 SOLD CORE A I .3-011 NO I DOOR .3,-011 641, A i- 36X80 SOLID CORE A I 3'-0" L NO I DOOR I8X80 SOLID CORE A l I=6" L NO I DOOR I4" 641, U C EXISTING z 36X80 SOLID CORE A / .3=0" R NO I DOOR 3'-0" 6'-8" D Z 36X80 SOLID CORE A I 3'-0" L NO 1 DOOR 3'-0" 6'4" E p �, to i 36X80 SOLID CORE A I 3'-0" R NO 1 DOOR 3'-0" 64" F z � 0 � 30X80 SOLID CORE A l 2'4" R NO 1 DOOR 2'4" 641, G Q � O Ll CASE7) OPENING 3'-0" N NO ! BLANK 3'-0" 6=8" H V- 72X80 SLIDING OLA" 2 6'-0" NN NO 1 SLID/NG DOOR 6'-0" 6�8" 1 0 Z CO 36X80 SOLID CORE A / 3'-0" R NO I DOOR 3'-0" 6;8" EX /STING 28X80 SOL/D CORE A 1 2'-4" R NO 1 DOOR 24" 6'W, K EX/STING CASED OPEN/NG .3=0" N NO 1 BLANK 3'-0" 641, L 36X80 SOLID COREL A / .3=0" R NO 1 DOOR 3'-0" 641, FISTING w a 3 28X80 SOLID CORE A / 2'-4" R NO ! DOOR 2'-4" 6�8 N" E46 MCI � 9 z z_ Q Q co QL a Q J D � z W = Q 4 w a Q cA Q - 1 Location �0 jr-ho?3 .,A,4 No. 3&91 Date MORT►1 TOWN OF NORTH ANDOVER # s Certificate of Occupancy $ ��s''•�•t<� Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ !1 Check # C S w 'CA- 1764 ) Bung Inspector TOWN OF NORTH ANDOVER BUELDING DEPARTMENT -0 APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING M OTHER THAN A ONE OR TWO FAMILY DWELLING X fien for Official 1 BUILDING PERTH TT NUMBER: a DATE ISSUED:G T I // - SIGNATURE: Buildin ConmiisjlOi�!FT�ns or of Buildings Date 1.1 Property Address:1v 1.2 Assessors Map and Parcel Number: tAj /0 9z– a,", Map Number Parcel Number .1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontalye(ft) 1.6 BUILDING SETBACKS(ft) M Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 private 0 Zone— Outside Flood Zone 0 1 Municipal On Site Disposal System 0 2.1 Owner of Record 6**V 4,10 1,49 1-2,-3 RAI 57A.6e 7 .41v(/0 ot C, 0 a Print) Address for Service: 7A4Qq4-� Jkgn-ature Telephone X 2.2 Authorized Agent Name Print Address for Service: Z Signature Telephone Z M go 3.1 Licensed Construction Supervisor Not Applicable 0 L4�-- Gress License Number 0 =�5jf 104744AI -n Licensed Construction Su r-v 71-2 V J > Expiration Bate I Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable D 0 Company Name, Registration Number M Address Expiration Date Z Signature Telephone G) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit-Attached Yea No.......0 s�cl [�p1 py r.. 5.1 Registered Architect: Name: Address Signature Telephone 3.2�eg#skc�e��lfess��na1?�> s� 's F Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable El Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Not Applicable D Company Name: Responsible in Charge of Construction r � ? r1IOl�T�F � ebeek ail apphralsl Zrl New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Dl=ri eaa Q( USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 0 A-2 ❑ A-3 ❑ lA ❑ A-4 ❑ A-5 0 IB ❑ B Business 0 2A 0 C Educational ❑ 2B 0 F Factory ❑ F-1 0 F-2 0 2C ❑ H High Hazard ❑ 3A ❑ IInstitutional 0 I-1 0 I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 0 R residential ❑ R-I ❑ R-2 0 R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: r ' iZ WE p f. BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor(s Total Area s Total Height(ft) ° z Independent Structural EngineeriLig EngineeringStructural Peer Review Required Yes ❑ No 0 SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, /�i✓�� �e /�� ���� ��°� ���-1 '°`44er of the subject property Hereby authorize 67C—M 9 , 01N? 1- V1 to act on My behalf, in all matters dative two work authorized by this building permit.application Signature of r Date I, l ✓s11�/�f /y( iaJ�i /�i�S7 6� �/9.� �J9� �E�L /Qy as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Na i e of Owner/Agent Date Item Estimated Cost(Dollars)to be Completed by permit applicant f 1. Building �� ��� `� (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a) x(b) �O 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number NO. OF STORIES SIZE c2-&Wd BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1ST 2ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFENd NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE / 13.5" co 161 o iPIP 0 o UNIT 2A-2 co F-c .fA-zoo -fo 1 LEY#A-Zo3 } co -oOlT, A- 13 -VLW. i f � _ t i i 4 i 1 15 ,,, 71 u1.1-LI-U4 wbll ll:j4 Irl COMMERCIAL, R. E, FAX N0, 978 686 2237 P. 3 oh-q�j- - w�11J S led c-� pf i I 13_..aq II r6 .. l cr if Ff'IL'- Ell NA ,I 8�i ���,► I Lam.-......�._..��'.1~y ._ ,.•• ��. �) � � _.. ._ i I FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT J191✓ �& (,8 7 �D PHONE 9 7J i0T(&y 1►'/vc ESSiti LOCATION: Assessor's Map Number PARCEL SUBDIVISION C n LOT (S) STREET 3 )Md _`7ZT ST. NUMBER .574_6� /ga. OFFICIAL USE ONLY ***** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS J DRIVEWAY PERMIT L� FIRE DEPARTMENT /l RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Fa ' ity) r ti- Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations ,.� Boston, Mass. 02111 , Workers'Compensation Insurance Affidavit Name _ t . Please Print Name: Location: city Phone # I am a homeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Comuanv name: Address City Phone# Insurance.Co. Policv# Company name [ S�/V( A (lr/ "i t°T�� ✓J ` Address Cfir. 24W26)6 10 RA-= Phone 543 s7lG.ib Insurance Co. •�" //�� L &!)/> Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties af,a tine up to$1,500.00 and/or one years'imprisonment.as v+cell.as.ctvil.penaltiesin the fmn.cf.a.ST.OP WORK ORDER..and.a.tine d.(SIDD.00)alfay.agahW-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify und�the ins and perdaltiss of n rju �th-t-tbe informaBon provided above is true and correct Signature C �'tr"`.� j �" Date Print name t-,11, ud V,&C- Phone# - 7x* Official use only do not write in this area to be completed by city or town official' City or Town Permit/Ucensina []Check if immediate response Is required El Building Dept ❑ licensing Board Contact person: Phone#. C] Selectman's Office ❑ Health Department ❑ Other • Y )11 INSURED NATIONAL GRANGE MUTUAL INSURANCE COMPANY 55 West Street, Keene, NH 03431 Telephone: 1-888-646-7736 CONTRACTORS S POLICY DECLARATION Named Insured and Mailing Address EDWARD E VIEL DBA Policy Number: MP166885 GENERAL CONTRACTING SERVICES Account Number: CAC I66885 55 A PORTLAND ST LAWRENCE, MA 01843 Agent: CHAS F HARTSHORNE & SON INC Producer Code: 200167 AGENT PHONE : 781 245 4300 POLICYHOLDER INFORMATION Named Insureds Business: CARPENTRY INTERIOR Entity: INDIVIDUAL Policy Term: 12 Effective: 09/20/03 (12:01 A.M. Standard Time at the address Expiration: 09/20/04 of the Named Insured stated above) In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. See the attached schedules for Description of Premises, Property Coverage, applying to this policy and Mortgagee Schedule if applicable. Optional Coverages, Forms and Endorsements BUSINESS OWNERS LIABILITY COVERAGE LIMITS OF INSURANCE Liability & Medical Expenses - each occurrence $ 300 , 000 Personal and Advertising Injury Limit $ 300 , 000 Products-Completed Operations Aggregate Limit S 600 , 000 General Aggregate Limit S 600 , 000 Fire Legal Liability - any one fire or explosion S 500 , 000 Medical Expense Limit - per person S 10 , 000 Business Liability and Medical Expense: Except for Fire Legal Liability, each paid claim for the above cover- ages reduces the amount of insurance we provide during the applicable annual period. Please refer to section DA. of the Businessowners Liability Coverage Form. For policies subject to premium audit: Annual Audit Applies. Estimated Annual Premium: S 592 TOTAL PREMIUM AND CHARGES $ 592 Countersigned: By: 64-5470(9/00) 07/30/03 RENEWAL KB t l � ✓tze�anvimanurecc�i a�.�il gs�c�uoetta i 3 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 000505 S Birthdate: 09/27/1935 Expires: 09/27/2005 Tr.no: 3913 f Restricted: 00 EDWARD E VIEL 55 PORTLAND ST L•Eo d '-_' i T LAWRENCE, MA 01843 Administrator I .:;T7 C/JOOI7/IILQ'IZ(IICQAAI2 6�✓I�IQ-Q6LLldP.�d'.." Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 114975 Expiration: 11/16/2005 Type: DBA GENERAL CONTRACTING SERVICES EDWARD VIEL 55 PORTLAND ST LAWRENCE,MA 01843 Administrator NORTH Tov of R over r� zs: E dover, Mass., COCMICHEWICK AORATEO `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT-13.4m......4414.40...................t............... ............................................................................ Foundation has permission to erect...../# W7 buildings on...10.'-71A.3........M*.1:0......1 !•.... Rough to be occupied as.......Ro.f?wC.A�....Apr!..... •��!�. � Chimney .... ......................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Lawl relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 0? � PLUMBING INSPECTOR VIOLATION of the Zoning or. Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS ARTS Rough ........0�....... .. ..... ..... ........ .. .... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. c M s CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 002-2011 Date: February 3,2011 THIS CERTIFIES THAT THE BUILDING LOCATED ON 107 — 127 Main Street, Kumon of North Andover Tutorin Center MAY BE OCCUPIED AS Tutoring Center IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: San-Lau Realty Trust 107-127 Main Street North Andover,MA 01845 Building Inspector Fee: 100.00 Receipt: 23878 NORTH T. 0" Of 6 over No-_0Q C% z o dover Mass.' O LAK COCMICHEWICK V S RATED BOARD OF HEALTH Food/Kitchen Septic System .PERM 1�.T T D Cyd /`` ��� ��� BUILDING INSPECTOR THISCERTIFIES THAT................................................................................y............................................................................ Foundation � .+...0...... Rough has permission to erect........................................ buildings on..../Q..�...�..��?...�..��R�IIt..:..J g to be occupied.as.... �/ /� .. ....... ... / ..� ���i�♦I Chimneyb. provided thatAhe person accepting this,perm' all in every respect conform to the terms of the application on file in Fin this office, and"to the provisions'of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of,.North Andover. PLUMBING INSPECTOR VIOLATION of the-Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough ................... ......... .... Service eVIU19D SPECTOR Fina Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough A Display in a Conspicuous Place on the -Premises — Do Not Remove Final._ No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner. Street No. SEE REVERSE SIDE smoke Det. J GRoTom Exr7wEERmG LLC STRUCTURAL ENGINEERING CONSTRUCTION CONTROL AFFIDAVIT IN ACCORDANCE WITH 780 CMR 116 of THE MASSACHUSETTS STATE BUILDING CODE, 811' Ed. FINAL INSPECTION of STRUCTURAL WORK PROJECT NUMBER: 2010-047 PROJECT TITLE: Office Fit up for Cumin of North Andover PROJECT LOCATION: 127 Main Street, North Andover, MA 01845 NATURE OF PROJECT: Creation of New Rooms, Doors and Exiting I Lynwood V. Prest, P.E. have conducted one field (final) inspection of the work for the PROJECT noted above. The Final Inspection was done by Lynwood V. Prest, P.E. on Wednesday, January 26, 2010. THE SCOPE OF WORK REFLECTED IN THIS AFFIDAVIT IS FOR THE RENOVATION OF THE EXISTING OFFICE SPACE TO ACCOMMODATE USES BY A NEW TENANT. NON-BEARING PARTITIONS WERE MOVED AND ELECTRICAL POWER/LIGHTING. AND MECHANICAL EQUIPMENT ADJUSTED TO SERVE THE NEW USE. I, as the Affidavited Engineer of Record, hereby certify that I have conducted the aforesaid inspection of the above stated PROJECT and find that the work has been properly installed in accordance with our original design drawings, revisions, and the Building Code of the Commonwealth of Massachusetts and is functioning as intended. All walls, doors, exiting requirements have been properly installed in accordance with our design. t. GROTON ENGINEERING, LLC SN OF �0 LYNWOOD G VALENTINE PREST STRUCTURAL 4 No.3M9 /ST �O Q M . 20 /( On this aLP day of L •1 20bc'orc me, the undersigned nofay pudic,persona!ly appeared C W n%1*&,C.. V PlrS f_ (name of dogMnMrt signer), proved to me througlf satisfactory evidence of identification, which wom M A LI C v n to be the person whose flame is somll an dle peee ft or attached document,and who swore or affirmed to me ft tlroaontenb C1 the document are truthful and accurate to the best of(Na)(NO MOW pt flndbtitYll. ` ( I 1 �a t�S,��alOttel>1igfl�ArinOselid110tery) 11 HwHLANa RoAa, GRoroN, MA 01650 (978) 448-3863 grotoneng@gmail.cam