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Miscellaneous - 15 CHARLES STREET 4/30/2018 (2)
Icy- 15 CHARLES STREET 210/039.0-0023-0000.0 PE p LOT NO 2 RECORD OF OWNERSHIP (DATE (BOOK PAGE ZONESUB DIV. LOT NO. • 1 . PURPOSE OF BUILDING OCATIO NO. OF STORIES w SIZE OWNER'S NAM[ s OWNER'! ADORES! 7Z '�y�D CjZ BASEMENT OR SLAB k ARCHITECT'S NAM[ SIZE OF FLOOR TIMBERS IST 2ND IRO SPAN BUILD[R'f NAME c C DIMENSIONS 0/SiLLf DISTANCE TO NEAREST BUILDING ! --� POSTS DISTANCE FROM STREET 3 0 GIRDERS G DISTANCE FROM LOT LINES—SIDE! REAR IRD[RS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x If BUILDING NEW 18 BUILDING ADDITION A/., MATERIAL OF CHIMNEY If BUILDING ON SOLID OR FILLED LANG IS BUILDING ALTERATION /� WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEAL$ ACTION. IF ANY 19 BUILDING CONNECTED TO TOWN f[WER iS BUILDING CONNECTED TO NATURAL GAS I--NT i PROPERTY INFORMATION INSTRUCTIONS LANG COST SEE BOTH SIDE! ROT. BLDG. COST EST. BLDG. COST PER SG. py. fL PAGE I FILL OUT SECTION! I • i EST. BLDG. COST PER ROOM PAGE i FILL OUT S[CTIONS 1 - IR SEPTIC PERMIT NO. ELECTRIC ME7EPS MUST B[ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGE! MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOW pALED — 71 -N ZI-) IUGNw RE NEA OR w=OZJL, GENT DINNER TEL. ��3 � 3iF' PER IT GRANTED CONTRA.TE .0 CONTRA.UC.X . a .034 H.Lc. /D Z�) 5 i ChARM SCIENCES 4NC, Rick Skiffington Vice President of Engineering Main Office 1-800-343-2170 X l�n o2 36 FRANKLIN STREET TEL:(617)322-1523 MALDEN,MA 02148-4120 U.S.A. FAX:(617)322-3141 Nothing works like a Charm. tAOR own of over No. M 0 -r- LAKE dover, Mass., OCHICNEWIC9 E BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR . ............ ....... ...................................................... THIS CERTIFIES THAT...... ......6;y�/ . Foundation X-) ....... _54 ;P" has permission to erect... ................... buildings on ..... ..... ..;r ........................... Rough to be occupied as. ................ .... ....... Chimney provided that the person ac ptin is permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions o 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ........................ .........e ....................�.. ... Service UI SEC R 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. .kN �/ee'C�o�cs�ur Run !TONE-11-ROVEMENI CONiRACLOR: Registration 104245 COkPORATION i l� Expiration 07/13/96 John De.CDurcey Roofing Co. In eCorceY •#}`` elgate eAtord iAq.�25 ADMINI:'i71iA]'L 4.: ., (r. • r ...........::.*,:::::::::::::::::::::::::::::::::::::;:::::::::::::::::::::i:::i.:.:.:.:.:.:.*..:::::.::::::,::::::::""",, ............. .................. ............. ......... ...... DATE(MMmD/YY) .. ......................................... ........... ............ ............ ......................................... 07/28/97 .......................................... .................. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATITK, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 0 il - BOYLE INS AGENCY INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR L ALTER THIS THE COVERAGE AFFORDED BY THE POLICES BELOW. 445 MAIN STREET COMPANIES AFFORDING COVERAGE WOBURN MA 01801 COMPANY A VALLEY FORGE INSURANCE INSURED COMPANY JOHN DECOURCEY ROOFING CO INC B TRANSPORTATION INSURANCE CO COMPANY 19 WELGATE RD C TRAVELERS INSURANCE CO MEDFORD MA 02155 COMPANY I I D .. ..................:::................* ,::,:,:,:,:,:,:,.:::::::,::::,::,::,::,::,::::::,:,,,*::,::,::,,::,::,::,::,::,::,::,,::,,::.:........................ ...... ................... .................. ....... ........................... ............................... ...................... . ........................I............................. ......................... .......................... .................. . . ...........%.-.------- ...................... ............................. ... ...... ................................ ........................................................ ................. ........................ ............... ............ .... ... ............................................ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MMMDNY) LIMITS GENERAL LIABILITY B123532426 05/01/97 5/01/98 GENERAL AGGREGATE s2, 000, 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $1, 000, 000 CLAIMS MADE [X]OCCUR PERSONAL&ADV INJURY $1, 000, 000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1, 000, 000 FIRE DAMAGE(Any one fire) $ 50, 000 MED EXP(Any one person) $ 5, 000 B AUTOMOBILE LIABILITY 2512929 5/01/97 5/01/98 COMBINED SINGLE LIMIT $ rxxANY AUTO ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ 100, 000 X HIRED AUTOS BODILY INJURY Xy NON-OWNED AUTOS (Per accident) 300' 000 —I PROPERTY DAMAGE $ 100, 000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ I........I....I...11............. .. .................. .............. ..... ................... .. ................... ANY AUTO OTHER THAN AUTO ONLY: .......... EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ ........................... . ................. .........I..... ............. ............ .......... 2 WORKERS COMPENSATION AND 7PUB 786K997197 4/12/97 4/12/98 X I STATUTORY LIMITS ...... EMPLOYERS'LIABILITY EACH ACCIDENT $ 100, 000 THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT $ 500, 000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100, 000 OTHER I I DESCRIPTION OF OPERATIONSILOCATlOt4SNEMICLES/SPECIAL ITEMS ........ ................I......... ........ 7777r!7� X................. ... .......................... .... i ii ....................... ... ............ .............. . ............................ ........................ ..:................. x: ................................ -A-00 V.M* '--.0.0003 .......................... ........ ............................. ......................... ................. .. ........... ..... ................. .............................................................. ................................ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CHARM SCIENCES EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ATTN: RICK SKI FFINGTON 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 36 FRANKLIN ST BUT FAILURE TOMfL�NCH CH E SHA ON COM Nyt IMPOSE NO OBLIGATION OR LIABILITY MALDEN MA 02148 OF ANY Klt4l�l U ON COMPANY ITS AGENTS OR REPRESENTATIVES. AUTHOR D R P S ...................I........................... Gerar ..F.F A ..... .......... ..... ...::.:::::.::. :::.:.::::.::::::::::::::::::::::::FF ....... ... ........ ..... ............................. .... ............ .............. .............. : x-'. ,, X0321 P.WORAT -.9 .&A Ap Date. =, = 4140 w g p<<".��T:��a TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i • t i ,SS�CMUSE� This certifies that . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . g; plumbing in the Pty1dings of . . . . . . . . . . . . at. . . . . . . . . . . . . . . . . . . . , North Andover, Mass. Fee(S. . . .Lic. Nob?&c . . . . . . . . . . . . . . . . INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer tl� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS I t Date 1 J Building Location KV�,�S � Owners Nan �(�} Sc Permit# / 0 Amount i Tyre of Occupancy New Renovation Replacement 0 Plans Submitted Yes 13 No FIXTURES z 1 w wEn a s H 5-1 a SLRBM 2ND F10M MFLOCIR 4MFlaR 5MRIM sMHOCR MHDM gRi FLOCR (Print or type) r Check one- Certificate Installing Company Na a Corp. L AddressZA Partner. Business Telephone ' Finn/Co. Name of Licensed Plumber: � ( Insurance Coverage: Indicate th type of insurance coverage by hecking the appropriate box: Liability insurance policy ft Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner El Agent I hereby certify that all of the details and information I have submitted(or entered)in above apptlication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issu o?�W*. p lication will be in compliance with all pertinent provisions of the Massachusetts State Plumb' ofthe Gene S. By: Sig-n—Em—oiLicenseariumner Type of Plumbing License Title r City/Town License Nurnoer Master K1 Journeyman ❑ APPROVED(OFFICE USE ONLY 7 Date . . . . . f:. 4105 NpR,M TOWN OF NORTH ANDOVER p O PERMIT FOR PLUMBING SS�CHUSE� �+ This certifies that. . . . . . . . . has permission to perform . . --. . . . :� plumbing in the bu']dings of . ' . . . ....'= . - .. . . at. . . . ��. . . . . . . , North Andover, Mase- Fee/4j o .Lic. No. . . . . . . L.i r� .Cr . . PLUMBING INSPQCT� f WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MAP %;'� TS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING PA�CEL (Type printNOR J J `_,U Date Building Location Owners Na e `SCJ Permit# Amount Type of Occupancy . New Renovation Replacement ® Plans Submitted Yes No ❑ FIXTURES v� v� rn CZ yCn F �.1 >+ ' _ U W CQ W a �. F" W q a Q+ 'a •. -_ _`_ - x E" A " er, Q .E- Y W • w " BIL 17h • sem»:,.;., , HA" M HIM SIH 1IOCIZ MFi D(R • a 7IH TLOW gmRow - (Print or type) Check one: Certificate Installing Company Nameon Address Partner. Business Telephone. A �, Fiim/Co. �- Name of Licensed Plumber- - RAC-0 Insurance Coverage: Indicate the type,of insurance coveragechecking the appropriate box Liability insurance policy Other type of irideinnity ❑ Bond ❑' Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature .%'"Owner Agent I hereby certify that all of the details..and information I have.submitted(or entered).in above.application.are,true and-accurate to the. _ best of my knowledge and that all plumbing work.and installations.perfar med,unde�Permit Issued.foi this applicatiori.will.be in compliance with all pertinent provisions of the.Massachusetts State.Plumbing QggWdChapter 142 of the$C Weral. ws. By: igna ure ot Licensedum er Type o umbing License Title City/Towncense. ,um er ',M sterlJoumey`= APPR&VED'OfftCE USE ONLY Date!�d../�5.....�7 12 f NORTH 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACHUS�� This certifies that �` "r�' L . { c. has permission to perform s-'"-'•-.. ............................. wiring in the buildi'�g of,. � Sr..a s..-,....w at.......1�'�......f..�..j!c--C'���...... � ;,. � .. orth Azir �Massi ..... Fee ....�''v...... Lic.No,h.:/3 ............... �7�-.. .... . . ECTRICALINSP C ` ff((P 10/15/97 08: 75.00 PRID 4 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer i \ office Use (� f�nly U4r `iamnuInl raO itf fffimaourffs Permit No. J 9 >gfVMtttttat of PUbi'tt Eafttq Occupancy A Fee Chocked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3190 peave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR I :00 9 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date f d F 00* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perfo m the electrical work described below. Location (Street & Number) / n Owner or Tenant Owner's Address �b S Is this permit in conjunctio with a building permit: Yes Y No C (Check Appropriate Box) Purpose of Building (�L,�(.� Utility Authorization No. Existing Service 900 Amps li Volts Overhead Undgrnd [ No. of Meters New Service Amps _I Volts i Overhead _ Undgrno No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lignting Outlets I No. cf Hot �•bs I No. of Transformers Total KVA V� No. of Lighting Fixtures I Swimming Pcoi At:cve— In- grno. — grnq. _ I Generators KVA No. of Emergency Lighting No. of Receotac:e Cutlets I No. of Oil corners Battery Units No. of Switch Outlets I No. of Gas _urners FIRE ALARMS No. of Zones No. of Ranges I No. cf Air Canc. Totai No. of Detection and :Cris Initiating Devices No. of Discosais I No.of Heat Tans Total Pur..cs 'ins K16J No. of Sounding Devices No. of Self Contained No. of Dishwasners Soace/Area Heaura KW Oetect;ontSounding Devices No. of Dryers + Heating Devices !(VV Local _ Municioal —Other - Connection No. of - No. at Low Voltage No. of Water Heaters KW I. Signs =•lasts Winna No. Hyaro Massage Tubs (( ��. I No. of Motcr ,--2Total NP OTHER: INSURANCE COVERAGE. Pursuant to the requirements of t.tassac-users general Laws I have a current Liability Insurance Policy inducing CcmC:.etec-Ocerattons Coverage or its substantial eauivaient. YES 9T NO — 1 have suomitteo vatic proof of same to the Office. YES = NO = If you nave checked YES. please indicate the type of coverage by checking the abprobrtate box. INSURANCE = BONO = OTHER = (Please Scec:!'+) Esumatec Value of E!ectncal Works I/ ea (Expiration Oatef 1 Work to Start Insoecuon Date Racues:ec: Rough Final Signed unser the Penalties of perjury: FIRM NAME LIC. NO. r-7-?5 � Licensee S'g-azure UC. NO. gel. No. Address Alt. Tel. ?10. OWNER'S INSURANCE WAIVER: I am aware that the L:censee%oes not nave the insurance coverage or its substantial equivalent as re. quirea by Massachusetts General Laws. and that my signaiuretcn .n:s cermit aoptication waives this reawrement. Own Agen (Please check oriel ���a y :eieonone No. PERMIT FEES iSignature of Owner or Agents X-6565 Location s No. ) B -&00v Date (0l/p_C6- NOR,h TOWN OF NORTH ANDOVER Certificate of Occupancy $ s'"'°'E<�' Building/Frame Permit Fee $ 3ACMUs Foundation Permit Fee $ Other Permit Fee S1314 $ D TOTAL $ 30 - Check # C A S 14 t Building Inspector o� H?oTk'�y TOWN OF NORTH ANDOVER 1- p SIGN PERMIT APPLICATION SS•�CHUS Site Owner ( v�CeS � n • Applicant rgrno� Tel: l q%i� +� eA. 110 Site Address �� ( o�le"� Size of Proposed Si `Lq" a How attached: a} Against the wall Illumination: ) Not illuminated bInternally illuminated ( � b) Roof c Externally illuminated c) Ground O ) Ety d) Other -OA� d T- - Materials: Ne:+ Proposed Colors: Background uc- Lettering U))A( Border Note: No permanent/temporary sign shall be erected, or enlarged until Required Attachments: an application on the appropriate form furnished by the Sign Officer has Photographs of building been filed with the Sign Officer containing such information including Material sample 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 E C E 0 V E Will sign overhang any public road or walkway Yes ( ) No (� Ln MAY 2 5 2004 If Yes, Name of Agency who will provide liability insurance: BUILDMG DEP ° AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED ,DATE f4L-BD: tPy'0_C"--ea2 6 —Q Permit Fee: IGNATURE OF APPLICANT revised:jm-9/2001 Received: 4/28/04 9:23AM; Charm Sciences Inc. (Anodover) ; Page 2 Apr--28-04 08:33A Ric Skiffington P.02 WALMM & SONS SM CO., INC.*Web: 11MMMMndsons.c6lrn-Sales Person:— -1A I%&&. -no S S: Pb ftX 186.71 BrkIP Str6d-Pelham,Nh 03076 a(60)63W202-F&=(603)836-7904-EMS11'hammrrlr@uhranet.com Ml C - cwvtw, co-NAM: 0—�*VA6 ,_0--."11rVCLZ1f44 q 46 o4w MOM: I C&*eLrS jqvjAAj9w^ cud.phww.(q)? (o2 Ul'( ' ,f=(qn )LIL ❑8"PfapftW AftcfW El S"Uy"trawfts)Fof Omits Q Fax Plod F&Approval Boom Pmawrm WE DAM [3 7-10 VV0(1(DAYS ❑—wadm Cl Rush Cl Must Be On of Ewore—File#1 - Job Locaw": Q 1A ft" C]S&RO As AO" Laftm QkjjM I HP I TA I%F I GL I Bwww I Mw I I�om 1 p4w 1 podft 0 1 cll� e . Ah* IV 4 Lu Z-ft �k 9 64u) M Awkbi o" W VIOL Wwr4 A-Mim 51� LOMI p I CA"WLMw Nom chomf PVC Oft Migbo NOM "p 4 p Cw4d nouw c4du A-gran. Quo" QIY" OF) I Pat pan F�ekreonPPA vo k*X Otf, V ......... J IIWW I 12Sdod-I I 40h.- I Wt SooSQ-1 TS shade.- f: L +CL RX.F VAN Forme sow ftAJO SNP owl saw www 02 1 32X64 1 44kM 1 14xg. _PIP 1 2814411204 1 16124 1 Txy 4'K4' I WX6' I WX10'1fKf I EXIT nii-I Tifir 13'X18 I Txif 14'x16' �Thwow OfIuletW n- M .Qx 00 IN 916 1/4 112 U t 11/4 11A 134 2 —7 Ia 2116 1114 2 314 3 3 IL4. 31x2 3V 4_ � Cut Sin d pw*j: -I-- --- I +• .......... .112 3 W511 TERMS: Q See Wed P401 See lnvere a FaWW Due on COMP16M 549 A CoPf*ce Each-, TOTAL. NOM ChWft 1w- I-V p4wmz: Tem C* C3 umpmat FAG.— C1 SWIn DEPOSITow. 7-f AMWAY, Q Permit Fee- OTHER. BALANCE: I [JMw I I LM I M,I L ncoo C]Subject to Overrun or UMderFUn Cost co 1 rn ro a a m l 'n H h � T ID f U Z C ID MA U 11Vvi E _ E L ro r cc TO 67 1 ti 4 � -- -� c5 w 1 4 ji s ' 8 aJ yy r- r► f�I O CC ti u i j -r kle"O cb CO i. b •! 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(rf�rf//F}// 'Y:•isj'}:•}}:^:^:ti4i}?}}'•}'•}:•}:•}:4::i:i:tiYY:1:::ii:jppp9q i�'�:/+:;fr fr"ijfiff FRf{:Ef4;'}:`f`'i�}.}Y;}Y�i i•.`:�i:.;/;}f:<h•}f/,v/.'f .900M� �r ref••r!/// FEE 4. fi. f f.f ..f .r.r::::::::::::•i:•}.'•:.v::::::::::::::::::::/.fi : S...nor ' •:•?:::::::.;;:;•::::::::::::::::::.::::::: v•ter:' .. :. :+i}'{?�:�i}i::iii;{viiiii ii}:'•i:i:•::iii�::'.. ::iF•l. ..... ;. :::::::}�?Xiyi;}i;;i{:i:i i$}}:i ii::i:{j:•i:•i:•:jt:iYii�tiii :...�:•iii ii:•i:•� ....... NORTH01 q s � o COCWczwwm V �•9ApgArgo SSgcHuss TOWN OF NORTH ANDOVER SIGN PERMIT DATE June 9, 2004 PERMIT # 18 - 2004 This is to certify that Charm Sciences Inc. has permission to erect a 1 — 58" x 24" Door Canopy Sign, 3 — 30" x 98" Window Awnings on / at 15 Charles Street Providing that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-laws relating to the sign regulations of the Town of North Andover. INTERIOR ILLUMINATED SIGNS ARE PROHIBITED Any violations of the Zoning Regulations regarding Section 6 of the Zoning By-law will void this permit. o y Inspector of Buildings Date 7 4 �) Date. . ° ��.... ... 11 40 T pf "to ".tip 3? '� TOWN OF NORTH ANDOVER O � P PERMIT FOR GAS INSTALLATION SSACMUS' This certifies that . !!. . . . .`.'`'. . `. . .. . 1� . ! . . . . . n. . . . . . . . . has permission for gas installation in the buildings of . .S at . . ./.i . . . .C.�e,?. . . . . . . . . . . . ., North j dover, Mass. Fee. . 39. Lic. No. G.S INSPECTOR Check# G G 3 Y TIA 1 Q MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING Type or print) Date J/ NORTH ANDOVER, MASSACHUSETTS Building Locations 0 � Permit# Amount$ Owner's Name r� New❑ Renovation ❑ Replacement ❑ Plans Submitted N U z w F a z W �z z p n. H C C C F w 4 ,� F. y x w W z u x z r V E- Z F c. w w (: C i z -t w F. �, n q z C z C _ z C U �' C C > O w E- ^ F C SUB-BASEM ENT r BASEM ENT 1ST. FLOGR 2ND. FLOOR 3RD. FLOOR 4T 11 . FLOOR 5'rH . FLOOR 6TH . FLOOR 7T I1 . FLOOR Is T ti . FLOG R ELL (Print or 0&-a- 422�K� – hec one: Certifcat Ins �g Company 111 Name rp l ���– Addres ❑ Partner. Business Telephone _ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check o . I have a current liability Insurance licy or it's substantial equivalent. Yea No❑ If you have checked� please dicate the type coverage by checking the appropriate b Liability insurance policy 0— Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiv r: I am aware that the licensee does nbt have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and i stalla ' s performed under Permit Issue for this application will be in compliance with all pertinent provisions of the Mass usetts St e G o e and Chapt of the General Laws. By. Signature of Licensed Plumber r as Fitter Title E] Plumber ` City/Town Gas Fitter License Number , Master APPROVED(OFFICE USE ONLY) Journeyman J 1"w�" l I " S10RTy BUILDING PERMIT 2 h..;:tip, ..•b 6 � TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION A _ h permit No#: 47Date ReceivedY . �R"�R rEo,QP c5 �SSgcµusEc pate Issued:/0 LgPORTANT: Applicant must complete all items on this page LOCATION /Y7 Print ..RO}'ERTY OWNER C&A_ scAd.-V_ s - Pnnt 1 DD Year 3� :PARCEL:ZONING DISTRICT: Historic District MAP yes no - " :Machine Shop Village yes` . no -�yPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0-Well ❑ Floodplain [I Wetlands E Watershed District p Water/Sewer ' `� a� E14 ^x� �•, DESCRIPTION OF WORK TO BE PERFORMED: Identification- please Type or Print Clearly OWNER: Name C �r�<� Se� r_sc> ec1 11y-e. hone: Ae- z 60"'2 � Address: Contractor Name; D?ic% J-A-_ <• ;c Phone 7 d 7 6�`- �'? 7S Frnail° Address r SuperVisor's'Coristruction Licenser =:� 71 f s " Exp= Date j-Hdme Improvement License: ARCHITECT/ENGINEER �� 5 jr6q.-�,�r ��r�w Phone: 7' Address: C: A4,cc xz- /,.,)A.l%n&e_m iY,- Reg. No.3-2 C Y 1 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ �, �&-o FEE: $ i d'�9:01- Check aCheck No-----= 6 o Receipt No.: 1 �� NOTE: persons contracting with unregisterAl contractors do not have access to the guava fund f A ent/Owne - - Signature_ � :_ _ Signature_of confiraetor o ._9 t , Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales O Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM /PLANNING & DEVELOPMENT Reviewed On �ti��,�° Signature_ ,&�,, irl ype yl" COMMENTS 'TV N015Cnl�G�nc�v CONSERVATION Reviewed on I b Signature I LP COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood street FIRErlDEPARTMENT Temp;D_Mpster on site yes Located at't124 MainStreet X FireiDepartment sidnature/date l ` COMMENTS Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions, Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires a roval of Electrical Inspector Yes No pp DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine NOTES and DATA— (For department use) SII ❑ Notified for pickup Call ' Email date ------------ Time Contact Name boc.Puildijjb Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products g 9 NOTE: All dumpster permits require sign off from Fire Department prior to Issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan 3 Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) -- ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location No. Date Z 6 ZDlfp • TOWN OF NORTH ANDOVER Certificate of Occupancy !!JJ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check#Ao �&L ns ect orl ! J8 Building I. 40RTF/ Town of t _ 1�. s ndover O*6.o* 1 ali"h ver, Mass, 0-0/Ad? 9 COCMICO2WICK S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT 4W. �f .............. BUILDING INSPECTOR .. Foundation has permission to erect .......................... buildings on .....� ....� .�..... ... ........... Rough to be occupied as .Q0.EA . ......... r,. ........... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 CONSTR N ST Rough ervice ... .. . .. ... .... ..... ... Final BUILDING INSPE.. OR.. GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough 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. Smoke Det. Massachusetts Department of Public Safety 113 Board of Building Regulations and Standards License: CS-077145 Construction Supervisor RICHARD SKIFFINGTON 35 PLEASANT STREET NORTH READING MA 01864 1.-- Expiration: Commissioner 05106/2018 i I NORTJJ BUILDING PERMIT O0�t`E° 64, TOWN OF NORTH ANDOVER =-- APPLICATION FOR PLAN EXAMINATION z �• Z y c n permit No#: 7 � Date Received �R''°RA,-Eo gSSACHVS Date IssuedaO ENIPORTANT:Applicant must complete all items on this page VOCATION ...ld _ c «__t✓ _ _ �. _ . �_ r .� .. -- pROPERTY OWNER' Pent, 9DD�YeW8tructure yes no MAP PARCEL: ZONING DISTRICT:`Hisior�i2Dlstnct yes. no - - Maphme Shop Villagew yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ _ D Septic ❑Well. ElFloodplain Wetlands Watershed District Ij M ter/.Sewer DESCRIPTION OF WORK TO BE PERFORMED: �f��ifs mitis-:cy✓• �.�/ — 'Z'�t. ko-c 4 Identification- Please Type or Print Clearly OWNER: Name ����.� .r mAe&�v one: 7 Address: Phone 7�t - 66— 77 7.3 Contractor• Neime AddreSs _ 4� dCy �s,�,�•'L ,f 1 4e.r enSupervisors Construction,Licseac -U 7 ..E--XP' Date. �6�� - _ Horne Improvement License: EXp,. ARCHITECT/ENGINEER ,�tT �1.�E�s - <��'�� Phone: 5� -7 — !z-,- !C'' Address: � - :�.�-r ,r,7 �Y�t Reg. No. FEE SCHEDULE:BULDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 20 o Qc-® FEE: $ Check No.: G-z 3 C 0 Receipt No.: NOTE: Persons contracting with unregiste cl contractors do not have access to the guava fund - Si nature of contractor Signature of A entlOwne g _ — g _ __ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM /'PLANNING & DEVELOPMENT Reviewed On jo [��1�° Signature_ i�'SP{ctr�� COMMENTS I "nGflrr r �� ver.�a Als t , c°wit'<<C-nc,a CONSERVATION Reviewed on tL) I b Signature I UD COMMENTS .HEALTH Reviewed on Signature COMMENTS t" +i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/si nature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT,-Temp,Dumpster on site .yes. _ n, ' f F1 4,MamiStreet . r - a�� XFire!Department,signature/date COMMENTS . Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires a roval of Electrical Inspector Yes No pp DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.s1oo-s1000 fine NOTES and DATA— (For department use) SII ❑ Notified for pickup Call ' Email date Time Contact Name 3 1)0°•Bwldi.'19 Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit'Application ❑ Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 • .�. . . . . .r';«'>r-.-v. '....fc,a, .-. _,-- .- .- - .+`-�--r. -� -rter.. •"+" Location No. �7! - Date G' 2-6 zDl�O . - TOWN OF NORTH ANDOVER k Certificate of Occupancy $ Building/Frame Permit Fee $ /U. tJ� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# E� Building Inspector NORTH Town of _ IF. 6 ndover *6.wLAK h ver, Mass, /Ad?4 GOGMIGKl WIC 0 Argo ►��`��,�5 U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT � .............. BUILDING INSPECTOR .... has permission to erect .......................... buildings on .....��....C���.�.5..... ... . ......... Foundation Rough to be occupied as . �� ......... .............................. Chimney provided that the person accepting this permit shall in every'respect conform to the terms of the application Final on file in 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 CONSTR N ST Rough WkSwervice ... .. .. ... .... BUILDING INSPE....... OR..... Final GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough 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. Smoke Det. The Commonwealth of Massachusetts s Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA.02114-2017 www.mass.gov/dia -1 d�M SJ.ti Wo><ke&Compensation Insurance Affidavit:Builders/Contractors/ElectriciansfPlnmbers. TO BE FILED WITH TBE PERMITTING.A.uTHORity. please Print Le 'bl A licant Information Name(Business/Orgauization/lndividual): Address: r 1177 City/State/Zip: /✓cr2s A ^r�crcr.�!► _ Phone#: 7e/ 7,Cv - 77 Z dr— Areyou an employer?Checktiie appropriate box: Type of project(required): i.El I am a employer with em to full anpart-time).*d/or 7. ElNd*'dOnstr66fion P yees( 2.❑I am a sole proprietor or partnership and have no employees Working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. FI Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 4 proprietors with no employees. 12_[]Plulnbing repairs or additions 5.1/,am a general contractor and I have hired the sub contractors listed on the attached sheet. 13•, Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.. Other r �1��A��- 6.❑We are a corporatiori and its,officers•have exercised their right of'exemption per MGL c. 152,§1(4),and we have no empldyees.[No workers'comp.insurance required.] *Any applicant that check's 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 JE Contractors that check this Box must attached an additional sheet showing the name of the sub-contractors and state whether cr 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: Expiration Date: Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration.date). Failure to secure coverage as requiued under MGL c.152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. Ido Hereby certify under tliepains nd alties of perjury that the information provided above is t and correct. ��z Date: a / Si ature: Phone#: – G 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 Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empl6yees. 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 defnied 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 receiverfor 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 b6 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 xequtred." 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 certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If anLLC or LLP does have employees,a policy is required. Be advised that this affidavit 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext.7406 or 1-877-NUSSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia ROADEXC-01 YFANARAS ACOR"Y CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `--'' 4/15/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME., Yvette Fanaras Davis&Towle Morrill&Everett,Inc. PHONE F'O'X (603)225-7935 115 Airport Road A/c No Exc:(603)715-9741 A/C No Concord,NH 03301 ABDRESS:yfanaras@davistowle.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance Company 23043 INSURED INSURER B: Roadway Excavators,Inc. INSURER C: Property Maintenance and Construction INSURER D: PO Box 227 Derry,NH 03038 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLISUBR TYPE-OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR CBP8846000 03/07/2016 03/07/2017 PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY a JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 Ea accident) > > A ANY AUTO BA8848900 03/07/2016 03/07/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE CU8840301 03/07/2016 03/07/2017 AGGREGATE $ 3,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Various Work CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Charm Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 Riverside Drive ACCORDANCE WITH THE POLICY PROVISIONS. Andover,MA 01810 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ,acoR CERTIFICATE OF LIABILITY INSURANCE 09�28�2016'�'' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-617-723-7775 CONTACT Seamus King Hays Companies of New England PHONE FAX AIC No Ext): AIC No 133 Federal Street E-MAIL yscom skin @ha p 2nd Floor ADDRESS: g anies.com Boston, MA 02110 INSURERS AFFORDING COVERAGE NAIC# INSURER A: RIVERPORT INS CO 36684 INSURED INSURER B: Roadway Excavators Inc. INSURER C: c/o Surge Resources, Inc. INSURER D: 920 Candia Road Manchester, NH 03109 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 48101809 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F-1OCCURMED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1-7 POLICY PRCT O LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION iC-28-83-003934-05 (NH) 10/O1/1 10/01/17 X JURY TAT U- IMT OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? F N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) This policy covers those employees leased by Roadway Excavators inc. through Surge Resources, Inc. Manchester, NH 03109 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Charm Sciences THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1 Riverside Drive AUTHORIZED REPRESENTATIVE Andover , IMA 01810 USA ©1388-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD MCrosby ACORO® DATE(MM/DD/YYYY) �...� CERTIFICATE OF LIABILITY INSURANCE 01/122016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed.if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CEaNT�(�,--- HOME OFFICE: P.O. BOX 328 A/cNNo. Ext):888-333-4949 I (A/AC Nol'507:416-46 OWATONNA,MN 55060 ADDRIESS:CLIENTCONTACTCENTER FEDINS.COM INSURERIS)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED -" 366-407-5 INSURER e: DAVID ELECTRICAL CONTRACTING LLC INSURER C: 87 BELMONT ST NORTH ANDOVER, MA 01845-1520 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:38 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WV POLICY NUMBER MMIDDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 PRMI - oc rroxm CLAIMS-MADE FX OCCUR MED EXP(Any one person) A X BUSINESS OWNER'S LIABILITY N N 9353692 03/01/2016 - 03101/2017 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN')AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY JECT JECT LOC -AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 ( �c idnidn X ANY AUTO BODILY INJURY(Per person) A AUTOS ALL OWNED AUTOSULED N N 9353691 03/0112016 03/01/2017 BODILY INJURY(Per a.,d.ntl HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per acrid t X BRELLA LIAB X I OCCUR EACH OCCURRENCE $2,000,000 UM A EXCESS UAB CLAIMS-MADE N N 9353693 03/01/2016 03/01/2017 AGGREGATE $2,000,000 DED I RETENTION WORKERS COMPENSATION WC STATU- 1 OTH- AND EMPLOYERS'LIABILITY YIN X TORY LIMITS ER , 00 ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $500,000 A OFFICERIMEMBER EXCLUDED? ❑NIA N 9353694 03/01/2016 03/01/2017 —•- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 ! it yes,describe under - DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION 366407-5 38 0 CHARM SCIENCES INC SHOULISANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 659 ANDOVER ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LAWRENCE, MA 01843-1032 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-077145 Construction Supervisor RICHARD SKIFFINGTON 35 PLEASANT STREET NORTH READING MA 01864 Expiration: Commissioner 0510612018 REVISIONS REV. DESCRIPTION CHG DATE CHG APPRO. - PROPOS 10/12/1A -- -- -- -- -- -- !ti 1i A A A ti 2 A -APROPOSED AREA 10/21/2016 HD RS __- -_- -—- _____—_ _ _ Relocate electrical box 36 inches from \ - - 3 10/24/2016 HD RS end of sound enclosure MAIN SERVICE 4 Concre e pa 24 tx 9 tx 6 t Ic wl 10/24/2016 HD RS D rebor 1600 AMPL ' I PROPOSED I EXISTING FENCE AND ATS 1600 EXISTING HVAC SAFETY BOLLARD POSTS 1 EQUIPMENT 15 CHARLES ST. BUILDING I INSTALL: I i 361n (1)SHORT3/4GROUND ROD I -- ---- - -____ 238 �3) 3/4" PIPES 4) 4" PIPES 1 20in ti PROPOSED 400 KW GENERATOR PROPOSED AREA ?. 6in ' INSIDE BUILDING i1-1 —_ -_ "- WITH DOUBLE WALL 3 FOR ELEC. PIPE FUEL TANK 1400 GAL. 661L� U31r� (KEEP 4" PIPES AGAINST: ..................._�... IS THE BUILDING WALL IF ' POSSIBLE) 30in 20in B —� ' _ __ _ ._ I B I I e i ire I [1 _ CONCRETE PAD 24FT X 9FT j 0 6X EQ uR X 161N THICK W/ REBAR 6.00 SAFE[Y OBOLL ARD I': 5I-- 3FT HIGH y ........._....._ 60h, 700 4111 rn __.........._..._....__.......__.. a ..................._...... UNLESS OTHERWISE SPECIFIED THIRD ANGLE /' fg0 �HAR DIMENSIONS ARE IN INCHES {-`�+j/t PROJECTION v 859 ANDOVER STREET TOLERANCES ARE: LAWRENCE,MA 01843-1032 O DECIMALS FRACTIONS O XXX DRAFTING STANDARD:ANSI-Y]4-5M SCIENCES , INC. TEL:978-687-9200 FAX:978-685-7929 =±.005 ±1/64 .XX =±.010 ANGLES PROPRIETARY: X =±.1115 ± 0.5• THIS DOCUMENT IS THE PROPERTY OF CHARM A SCIENCES,INC.AND IS DELIVERED ON THE EXPRESS TITLE A CONDITION THAT IT IS NOT TO BE DISCLOSED OR REPRODUCED IN PART FOR MATERIAL. MANUFACTURE ORANYOLE O EOTHERTHA N. ANDOVER GENERATOR BASE PROPOSED MANUFACTURE FOR ANYONE OTHER THAN CHARM SCIENCES WITHOUT ITS WRITTEN CONSENT. APPROVALS DATE -�� FINISH SIZE CHARM DOCUMENT NO. CHARM PART NO. REV. - DRAWN HD 10/12/16 B NA GENERATOR BASE PRO OSED _ 4 SHEET I DO NOT SCALE DRAWING ENGINEER RS - SCALE: 1:48 _LOF 1 i 8 7 6 5 4 3 2 1 I r10RTfi 1 BUILDING PERMIT 'r c��r'. •'''''.,6 TOWN OF NORTH ANDOVER 0 =< - APPLICATION FOR PLAN EXAMINATION z _ � 2 " c� Permit No#: Date Received ��'-ATED 7 n AC US Date Issued:ld / LMYORTANT:Applicant must complete all items on this page LOCATIQN _ !_d. s .-- - Print PROPERTY OWNER Cff1t/Li`t scr�.srt11 - - �- Pnnt 1DDiYeareSffucture �''y no MAP PARCEL:- ZONING DISTRICTrHistoric District, yes no Machine Shop Village y.,es no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ElRepair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ❑ Septic Ij Well 0-Floodplain Wetlands ❑ Watershed District - DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name C���r? a'c rr- > eftw - hone: 7 PI-- 7 ec--77.2 J- Address: Phoe -4 - G - 7 76 Contractor'Name E-i M-aih a«. " ccswl Rz r_*-r 49_s_ _y - Address: r' s''y � �►a-u2 r�.�� r� - - Supervisor's Gonstruction,Lie.ensea' c.-U 771._`Yd - Exp: Home Impro ement License:., Exp: ARCH ITECTlENGINEE R �i� '�t1Se-•v �nre-e ���'f� Phone: '7 �' Address: j— ",Lr xz77 0A-A mn99-d Reg. No. � 2 6 Ye FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost- $ 20 4 AVO-0 FEE: $ D f�0-, C.T-0 Check No.: °a--70 Receipt No.: 1 �� DOTE: Persons contracting with unregiste d contractors do not have access to the guava fund Signature of Agent/pwne Signature of contractor f GENERATOR APPLICATION DATE: /0-//711 LOCATION: / x- x OWNERS NAME: GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS' CONTRACTOR: PHONE NUMBER: 7 � ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL November 25, 2016 Seth Roberts Real Property Management 752 Charles Street Providence, RI 02904 RE: 10 Pequot Street, Apt: 1, Providence RI. Kyle Corkery's, November, 2016 Rent To Real Property Management, Enclosed, please find Kyle Corkery's rent check in the amount of$475.00. Check #216, for November, 2016's rent at 10 Pequot Street, Apt: 1, Providence RI. Best Regards, Michele Grant 978-490-6680 53-7158/2113 2 1 M. 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Blue Star Power Systems, Inc. sub-base fuel tanks are listed and ��•'� manufactured under UL 142 &ULC-S601 standards for steel above ground tanks, which guarantees that every fuel tank meets the structural and mechanical integrity requirements for mounting a generator set directly on top of the tank. This provides a convenient, efficient, and safe way to store fuel for your gen-set. Sub-Base Fuel Tank Standard Features ►Double walled secondary containment UL 142&ULC-S601 Listed ►Electrical stub-up openings are standard to provide generator set wiring provisions through the base tank ►Heavy gauge steel construction ►Durable two part catalyzed epoxy finish paint ►Standard fittings:fuel supply with check valve(sized per unit),fuel return(sized per unit),2"NPT for normal vent,2"-6"NPT for emergency vent(sized per unit),2"NPT for manual fill, 1 1/2" NPT for fuel level gauge,and 3/8"NPT basin drain(plugged). Removable 1/2"supply dip tube standard(size may vary with gen-set model). 1 1/2" NPT for leak detection ►Interior tank baffle:Separates cold engine supply fuel from hot returning fuel ►Direct reading fuel level gauge ►Low fuel level and fuel leak alarms Design Options ►High and critical low fuel level shutdowns or alarms ►Full pumping control systems for a true day tank system with a full array of electrical options ►Additional Tank Fittings ►Custom Fuel Tank Designs(sizes and shapes) ►Fuel Heater P.Fill/Spill Containment Blue Star Power Systems, Inc.offers two distinctive types of double wall sub-base fuel tanks,those with an electrical stub up area(standard) and those without. Each type can be customized to any specification to meet your specific requirements. ELECTRICAL STUB-UP AREA MOUNTING HOLE UL 142&ULC-S601 double wall secondary j \ i BAFFLE containment sub-base fuel tank with stub-up. RUPTURE BASIN INNER TANK i i i i i TANK SUPPORT Blue Star Power Systems,Inc. 1 52146 Ember Road, Lake Crystal, Minnesota 56055 Phone+ 1 507 726 2508 1 bluestarps.com I � I Mick Skiffington From: John Van Deusen [John@scherbon.com] Sent: Tuesday, October 18, 2016 11:23 AM To: Rick Skiffington Subject: more tank info Per UL!42, Rupture Basin must have a minimum of 110% capacity of the primary tank. I John Van Deusen Scherbon Consolidated Inc. 40 Haverhill Road Amesbury, MA 01913 978-423-9021 cell 978-388-3132 office www.scherbon.com V2 LIA 4A Itscherbon ConsolldaUd'lnc. Generator Power Systems - Pump Stations i ' 2.00 X .50 NPT FUEL RETURN 2.00 X .50 NPT FUEL SUPPLY DRAWING: 3-0413 48HR TANK 1.50 NPT FUEL GAUGE 2.00 NPT FUEL FILL 2.00 NPT NORMAL VENT 05.00 NPT E-VENT 30.000 VD350, VD400 (01) ------ --------------------- -- -- - --- LVO/LV1/LV2/LV3 20.000 ------------ i (1.765) 52.750 / 05.00 NPT E-VENT 17.500 00.563 1 1 I (SX) 50 NPT FUEL LEAK SW I I 13.250 2.750-F- 10.250 .750 10.250 --- - - --- -- - --- - - 6.250 \•\ /` 6.250 6.000 3.250 124.000 130.000 0.813 134.000 (10X TOP) -"'- 138.000 (14X BOTTOM) STEP HOLE DETAIL 180.000 184.000 LIFT BRACKETS (4X) 3.000 X .250 FORMED 1/4-20 PEM DESIGN CONTROLLED 4.000 8.000 SUPPORT (TYP.) STEP HOLES SEE STEP 14.750 NUT (6X) BY VENDOR HOLE DETAIL 12.750 II I 17.000 I 32.000 � ii 36.000 \ -- 34.000 I I I .I 117.000 ------------------ --I --------------------- - ----------- -- --------- --------- --L- ----------- ' - 10.000 36.000 36.000 -I- 25.000 - 25.000--�--25.000--�-25.000 10.000 63.750 192.000 66.000 REVISIONS: LEVEL• DESMIFnON: DATE: BY: NA NA NA INA NOTES: BLUE ST*R 1. MATERIAL: 10GA Power Systems Inc. 2. SECONDARY CONTAINMENT TANK 3. FINISH PAINT GLOSS BLACK 4. TANK TO INCLUDE TANK SB 1420 GL DW UL W/STUB-UP - FUEL SUPPLY / RETURN DIP TUBES P/N: TBD 192%X 66"W X 36"H - LIFTING / TIE DOWN BRACKETS APPROXIMATE WEIGHT: 3200 LBS DATE: 12-17-15 BY: KDH I DRAWN TO SCALE a :J GENERATOR APPLICATION DATE: 7 LOCATION: OWNERS NAME: GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: 66C PHONE NUMBER: ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: �.�.�� oE- �3v-�C���✓'� *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL .iesel Product Line BLUE ST*R 400 Me/360 We Power Systems Inc. DGC-2020 Control Panel Standard Features Supplying Load Indicator Alarm Silence Pushbutton ►Digital Metering LCD Screen Alarm Indicator I Not in Auto Intlicator ( lamp Test Pushbutton ►Engine Parameters BLUE ST 411 ►Generator Protection Functions ►Engine Protection D:9:ta!Genset Coqtrolcr ►CAN Bus ECU Communications �— ►Windows-Based Software ►Multilingual Capability ° O ° ® <;J,9 P.Remote Communications to RDP-110 Remote Annunciator ►16 Programmable Contact Inputs O O ►Up to 15 Contact Outputs(7 standard) O El O o O Etln Reset El ►UL Recognized,CSA Certified,CE Approved P.Event Recording -- Po r System Inc. ►IP 54 Front Panel Rating with Integrated Gasket P.NFPA 110 Level 1 Compatible E lit Pushbutton Auto Pushbutton and Mode Indicator Arrow Pushbuttons - Off Pushbutton and Mode Intlicator Reset Pushbutton Run Pushbutton and Mode Indicator Weights / Dimensions / Sound Data —20.95— L x W x H Weight lbs —3.77 O 961.96 OPU 120 x 66 x 83 in 7,875 . • 1 ,,:n I 20.14 Level 1 156 x 66 x 94 in 9,125 35 65 BREAKS 156 x 66 x 94 in 9,200 APPROX. Level 2 BREAKER +I LOCATION Level 3 204 x 66 x 94 in 91500 ,,t g k 1834 Please allow 6-12 inches for height of exhaust stack. 1—25.88 FUEL STUB-UP —25.14—1 —i 15.00 ^36.00^ V I L AREA 10 X 10 No Load Full Load OPU 88 dBA 91 dBA O �= 83.00 Level 1 84 dBA 86 dBA 0 Level 2 79 dBA 81 dBA 1 LE: Level'3 70 dBA,.,-; 73 dBA` O 0 1 120.00 1 66.00 1 Drawings based on standard open power 480 volt standby generator. Lengths may vary with other voltages.Subject to change without notice. Sound data as measured at 23 feet(7 meters)in accordance with ISO 8528-10 at standby rating. VD400-01 3 of,4 5886345578 SOITHWORTH POWER SYS PAGE Generator Data ENGINE SPECIPICAT i►OI1 60 rig so Ht COOUNGSYSTEM 60 NZ ' SO Hs 5 Manufacturer: Perkins Engine Co. Radiator System Capsefty Y; model; r T4.236 irct.[ngine:us gas nu 5.0(19.1) Tom: 4 CyCle Water pump Type: CenlNtv4at Aspiration: Turbocharged Max Coolant Static Meed:r.x a In Una p(mHf 8.7(3.0) 6.7(2.0) Cylinder Configuration: Ulm Temperature to Displacarrwnt:cu.M.;Lt 236(3.9) Engine: F CCI 171 (77) 171 (77) BorelStroks:M ice; 3.87(98.4)15.00(127.0) Temperatum Rise Across 2 Compression itatle: 1tt.0:t Englne:,r I-C) 8.0((5,0) 9.0(8.0) gorarnor; Type , Mechaniw Haat Re)ecked to Coolant CfassCIMS Al awt,n t Rated Power:ettaw) Air Cloanar Type; Dry.Replaceabis Paper Element, Standby 28x5(46.5) 2247(39.5) Y Type with R450don Indicator Prima: 2400(42.2) 1991(35.0) Engine Speed:rpt+ 1800 1500 Total Heat Radiated to Room Max Power et Rated rpm: m at Rated Poorer;snv4*m(kw) 3tsn y; 98.4(73.4) 8La(60.7) Standby.- 1428(25.1) 1246(2t.9) P 4: 89.8(67.0) 74,3(55.4) ` Prime: 1308(23.0) 1115(19.6) BMEP:oc apM Radiator fan Load:ew new; 2.6(1.9) 1.5(1,1) stand y; t84(1266) 182(T256) R - Prime; 168(1157) 166(1146) Plctan Speed:Nuc uww) 25.0(7.62) 20.8(6.35) Regenerative Power.rw = 11.7 10.9 } Motor stn , Capablilty.-I. 43.8 36.4 LUBRICATING SYSTEM 60 Ht 50 Hs AIR REQUIREMENTS 6o H2 50 Fit a Typo: 3 Full Pressure Combustion Air FlowiiCfM vp'.-Ml Total Oil Capacity:uS ox ru 2.1 (8.1) Standby: 170(4,8) 142(4.0) 011 Pan us G><:Lf 1.9(7-1) Prima: 165(4.7) 137(3.9) Oil filter: ) SP1n.On.Full Flow Max.Air Cleaner Oil Ceder: Water Cooled Restriction:A 4t O ppil 32(8.01 32(8.0) Oil Typo Required: API CD ISW-40 Radlator Coding AW..pan imiw,q 8956(197) 6832(168) Alternator Cooling AA:din io�'hmpy 572(16.2) 477(13.5) Y FUEL SYSTEM s0 l" 50 Hx EXHAUST SYSTEM 6o Hz b0 we t Fuel Fitter Type: a Replaceable Element Max.Allowable Back jRecommended Fuel: 22 Diesel Prsaure:r,My ltval 3.0(102) 3.0(10.2) s Exhaust Flow at Rated Generator set Fuel Conettelp ion.us y.r 0.T�� kW:rim p,'m%iy Standby: 459(13 .0) 395 01.2) 6 100 Load 100toad Load 76%Load 50'A Load Ptlma: 427112.1) 3114(10,3) Standby P 1r11e 8landbyr Standby Exhaust Tomp at Rated kW 60 tit 5.54(20.96) 5.05 09.11) 4.23(1e.031 3.06(11.58) Ory Exhaust:-FCc 50 HL 4.89(1 B.SO) 4.42q'6.711 8.711 3.61 (13.66) 2.53(9.57) Standby: 1040(560) 1086(b86) Prime: 877(625) 1013(545) , 3, ENGINE ELG'CTRICAL 5Y#TEM 60 fit so ttg GovCRA TOM SET NOISQ RATING(WTHOUr INLET'OR OUTLET MUFFLER).AT.3 FEET(l)IIETQR) Voltage IGround: 12/Negative _RO Hz � Ali Be"Charging Alternator Standby: 93 d8lt a Ampwa Rating: 55 Prime: 93 d8A 92 d8A a6A Ianla are for guloance only .r E 4 owl NORT#j q Town of s Ir a ndover b i *6.w0 LAKEh ver, Mass, COCNIC NI 'C A°R�reo fpk? �S S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .... te � ................................... BUILDING INSPECTOR has permission to erect .......................... buildings on ..... ..... ..........'. Foundation Rough to be occupied as . i�/..E�c .........��. Chim provided that the person accepting this permit shall in every respect conform to the terms of the application Fin on file in 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. 6 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR N ST Rough ON= ervice ... .. .. ... .... ....... .... BUILDING INSPEdFOR. Ana Ok1 -23-47 GAS INSPECTOR Occupancy Permit Required to Occupy Building `7,J5Y-7CC s 77'7 Rough 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. Smoke Det.