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Miscellaneous - 16 BERRY STREET 4/30/2018 (3)
16 BERRY STREET 210/106.D-0033-ODOD.0 Location No. V.�— �� ' Date P • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee—i-12 Icb TOTAL $ {{���#` 2BWilding Check#2-151139 Inspector o<MD eTN, r r TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 60 Days from November 7, 2016 Building Permit Number 336-2016 on 9/15/2015 Date:November 7, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED ON 16 Berry Street MAY BE OCCUPIED AS a Clubhouse IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Holdings LLC 16 Berry Street North Andover, MA 01845 Building Inspector Fee: $100.00 Receipt: 31139 Check :294 Location No.3-3� Date S • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee CIO TOTAL V"Y $ � Y Check# r' 3 1 1 41 Building Inspector ' any ` of ot. •' p: �bW.X40 asACIN� TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from November 7, 2016 Building Permit Number 333-2016 on 9/15/2015 Date:November 7,2016 THIS CERTIFIES THAT THE BUILDING LOCATED ON 16 Berry Street—Building Three MAY BE OCCUPIED AS First Floor— 14 Units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Holdings,LLC 16 Berry Street North Andover,MA 01845 "�� uilding Inspector Fee: $100.00 Receipt: 31141 Check : 294 o�.N teTN �f+�cxust� TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from November 7,2016 Building Permit Number 333-2016 on 9/15/2015 Date: November 7,2016 THIS CERTIFIES THAT THE BUILDING LOCATED ON 16 Berry Street—Building Three MAY BE OCCUPIED AS Second Floor— 14 Units _IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Holdings,LLC 16 Berry Street North Andover,MA 01845 wilding Inspector Fee: $100.00 Receipt: 31141 Check : 294 MOBTM, "a45 TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 60 Days from November 7, 2016 Building Permit Number 336-2016 on 9/15/2015 Date:November 7,2016 THIS CERTIFIES THAT THE BUILDING LOCATED ON 16 Berry Street MAY BE OCCUPIED AS a Clubhouse IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Holdings LLC 16 Berry Street North Andover,MA 01845 Building Inspector Fee: $100.00 Receipt: 31139 Check :294 1Vf'e Location 7' '�° "1 t r, No. ! 7 Ut�o Date (t -I ko . • TOWN OF NORTH ANDOVER • „ r x Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee ' . �pQ $ O TOTALVIM $ /. 1 Check It I Building Inspector ` ` o,NOIITN� 3 i'e. , ••hOp O , y TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from November 7, 2016 Building Permit Number 331-2016 on 9/15/2015 Date:November 7,2016 THIS CERTIFIES THAT THE BUILDING LOCATED ON 16 Berry Street—Building One MAY BE OCCUPIED AS First Floor— 14 Units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Holdings,LLC 16 Berry Street North Andover,MA 01845 Building Inspector Fee: $100.00 Receipt: 31140 Check : 294 � of MoeM,h 0 r '/7 b4n.✓� . as4[Mls � TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from November 7,2016 Building Permit Number 331-2016 on 9/15/2015 Date:November 7, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED ON 16 Berry Street—Building One MAY BE OCCUPIED AS Second Floor— 14 Units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Holdings,LLC 16 Berry Street North Andover,MA 01845 wilding Inspector Fee: $100.00 Receipt: 31140 Check : 294 � O,MORTR 1 F f F#1�O4n.r�,�•i, TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from November 7,2016 Building Permit Number 331-2016 on 9/15/2015 Date:November 7, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED ON 16 Berry Street—Building One MAY BE OCCUPIED AS Third Floor— 14 Units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Holdings,LLC 16 Berry Street North Andover,MA 01845 uilding Inspector Fee: $100.00 Receipt: 31140 Check : 294 Date.*..,,, ,1..Cf.......... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING ssAcmu This certifies that 604 �W"+ .................................................................. ...................... /4) E-0 -.Z;"0 L,%- C:A� has permission to perform................ N................................... wiring inthe building of..�.� ................................... . . .......................!��........ . .......................... at ..�........ ......7k3/. ... . ....North Andover,Mass. Fee. . ......:.Lie.No. ................. . . ......................................................... Ntio ELECTRICAL INSPECTOR Check#) 2712-\X - Commonwealth of Massachusetts Of Use Only Rom Department of Fire Services Permit No. Occupancy and Fee Checked y` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant NC-n A At�,IyNE;e Ln�n`.fT LLC. Telephone No. Owner's Address i-SO pF-A�TliClL- LtB42 Sid 2W Ub&)eo MA (~ilk) Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building APAP—THr-A) &J f f))k}ly #-3 Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters ew Service, 2)4QC) Amps I&/eC8 Volts Overhead❑ Undgrd 0 No.of Meters 3 Number of Feeders and Ampacity «A 8C)bA 3Q BSc Location and Nature of Proposed Electrical Work: ��� Cbi�S�iPi._5c71t�1\� 3_5-16ZL? LIZ uk� 1T fCompletion o the followin table maybe waived by the Inspector qf 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 Above In- o.o mergency Lighting No.of Luminaires Swimming Pool rnd. El 1n ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: I I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: &3' J�S Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: 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 [A BOND.❑ OTHER ❑ (Specify:) I certify,under thepains andpenalties of perjury,that the information on this application is true and complete. FIRM NAME: E w ` LIC.NO.: ` J 2 Licensee: VI j� ��� � Signature ( LIC.NO.: Sq M2 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:JW-,� JIS�� Address: 9G EQt I iy m6mniy K)iH cA751 Alt.Tel.No.: LQ b3•WS-q9llS *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $1 i Signature Telephone No. R , . v The Commonwealthassachusi t s� Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgovldia Workers'Compensation Insurance Affidavit:Builders/Contracturs/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information Please Print Let=_ibly Name(Business/Organization/Individual): ��`�- t> 1�-Sc-- Address:-,3 2,J / ,,,-, b(41 it F City/State/Zip: #-v- L r Phone#:60 '0 9' 0 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with _employees{full and/or part-time).* 7. RNew construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3_Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9• ❑Demolition i 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the subcontractors listed on the attached sheet ]3.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL C. 14.[1 Other 152,§I(4),and we have no employees.[No workers'comp.insurance required] � *An applicant that checks box#1 must also sill out the section belowsho their workers'com nation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.If the subcontractors have employees,they must provide thea workers'comp.policy number. I I am an employer iltat is providing workers'contpensotion insurance for my employees. Below is the policy and job site information. Insurance Company N....-Atm �T I Policy#or Self-ins.Lie.#: C�00—�t(y 7� _ Expiration Date: ,, Job Site Address: •C. � `A„S City/StateJZip:A�r,1u Attach a copy of the workers'cohipensation policy eclaration page(s owing the policy number and expiratiodate). Failure to secure coverage as required 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,thepains an penalties of perjury that the information provided above is true and correct Simature: :1gDate: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID:JO- CERTIFICATE OF LIABILITY INSURANCE DA 09/21/2015Y) 09/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS _ CE}3MICATE_DD.ES-I.OJAMR.MATJVELY-0R-NEGA-TJYE_LY_AMEND,-E)STENl) OR ALT. R-THE COV„)=RAPE-AEFO.RDED BY TH_E POLLCjfS 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 Foster Sullivan Insurance NAMEE AX : John Dussault 163 Main St. A/CONN Ext:978-686-2266 A1C—N,):978-686-6410 North Andover,MA 01845 F-MAIL Foster Sullivan Insurance LLC s:certificates@fostersullivangroup.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:MAIN STAMERICA ASSURANCE CO 29939 INSURED S.E.&D.Inc.,Electrical INSURER B:TRAVELERS INSURANCE CO 19046 David Street PO Box 114 INSURERC:A.I.M MUTUAL INS CO 33758 Meredith,NH 03253 INSURER D:LIBERTY MUTUAL INS CO 23043 INSURER E:ESSEX INSURANCE COMPANY 39020 INSURER F:THE HANOVER INSURANCE COMPANY 122292 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 7ypE OF INSURANCE POLICY EFF POLICY EXP LIMBS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 Al TED ' ToA X COMMERCIAL GENERAL LIABILITY MPT6109P 08/29/2015 08/29/2016 PREMISES Ea occurrence1 300,00 CLAIMS-MADE Fx_1 OCCUR MED EXP(Any one person) $ 10,00 A XBLKTAI WRITTEN CONTRACT PERSONAL&ADV INJURY $ 1,000,00 - d A X GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICYFX]PRO- LOC $ UTGMOBIL-E6IASIL-nY -- ----------- B _B ANY AUTO BAOF132412 07/29/2015 07/29/2016 BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $' X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ AU70S PER ACCIDENT $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 E EXCESS LIAB CLAIMS-MADE XOBW5340714 08/29/2015 08/29/2016 AGGREGATE $ DED X RETENTION$ 10,000 $ WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER C ANY PROPRIETORIPARTNMEXECUTIVE YIN C-100-6017018-2015A MA 01/22/2015 01/22/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICERWEMBER EXCLUDED? NIA D (Mandatory in NH) WC5-31S-389186-033 NH 08129/2015 08/29/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,00 F CRIME 1834827 03/20/2015 03/20/2016 CRIME 1,000,00 DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(Attach ACORD 101,AddiOonal Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover,MA ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All-rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1 , v 6OMMONWEAL H OF M �aS1�CNl S yTTS r BQAAD t�F EL1 CtR`I C I ANS �t x' ISSUES, THE f OLLOW I NG L'>l CE1J5E As ti Rl;STERED MASTER ELfCTRIC.IAN • N i D11/°1 D STREET ELECTRI-C INC y fi3`A1!I D H 5TRF1 �' t W PQ rB1)�Fr 114 hi€:RED17H; 03253-011.41 F;8 62 -- c • 16 Berry Street-Building Three 42 Units Bldg'.Three Build.ing Electrical Plumbing%Gas Notes Unit# 1 Rough - d Final b fj 2 Rough Final _ n. (J 3 Rough. Final 4 Rough •(, Final 0 5 Rough.-. Final Q 6 Rough 4. 0 Final Rough: 0 _ Final -?log 8 Rough Final Rough a Final /p 10 Rough b (, Final 11 Rough Final 12 Rough 6 FinaI 13 Rough -0 Final 14 Rough Finale 15-Rough - Final 1 Bldg.Three Building Electrical Plumbing/Gas Notes Unit# 16 Rough Final 17 Rough Final 18 Rough Final 191 Rough Final 20 Rough Final 21 mRougl%. Final 22 Rough Final 23 Rough Final 24 Rough Final. 25 Rough Final 26 Rough Final 27 Rough Final 28 Rough Finale. 29 Rough Final 30 Rough Final 1 " > ' Bldg.Three Building Electrical Plumbing/Gas Notes Unit# 31 Rough Final 32 Rough Final 33 Rough Final 34 Rough Final 35 Rough Final 36. Rough Final 37 Rough Finan; 38 h Roug__ ._ _ Final 39 Rough Final 40 Rough: Final 41 Rough Final 42,Rough Final Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING C14 This certifies that ....................................... ........................................... ..... has permission to perform �AZ4....... cX.t2........................... wiring in the building of at ..... . 'North Andover,Mass. ... . .. .... . ........ . ........... .. Feef)&.1f Lic.No. 9,5.1(2. ............ ... ............ ............. ............................ ELECTRICAL INSPECTOR 2 Check# . 12 7 • Official Use Onl Commonwealth of Massachusetts .T Eml� Permit No. Q� Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] Leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9ko.31 a f 5 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) I(p eE, g%{ &-T, (BulL( )l L. 6 * 1) Owner or Tenant NC,,IZ-1-4 AMOCX44 1-}oi i),t`!-, LLC- Telephone No. Owner's Address i-5 i) PPES►n z7 qc Lj).c1 3-1E 2W Mq cj q4 61 Is this permit in conjunction with a building permit? Yes [N No ❑ (Check Appropriate Box) Purpose of Building APAaTMbU i Qi)]LD]1yM # t Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters ew Service 2kl Amps /?,0/20p, Volts Overhead❑ Undgrd 0 No.of Meters q_ Number of Feeders and Ampacity 1421 15U A, /(Q - t)toj S — 1 @ 8C)DA , 3 t HYSOS. Location and Nature of Proposed Electrical Work: , _ 14 2- l?>y�T Completion o the followin 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 Above In- o.o Emergency ig mg No.of Luminaires Swimming Pool rnd. grnd. El Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of Detection and No.of Switches No.of Gas Burners No. Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: J�S Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: Unless waived by the owner,no pen-nit 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 i undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [N BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: GEt-12) ` LIC.NO.: 11 J 2 Licensee: 2A01 0 kA , Signature Q LIC.NO.: St/ MfL (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.;((: 3-c-)7`)-q8 Address: QG eQ& 11y MaF.pi]14 f, 4iA Alt.Tel.No.: tQo3-`li9$•Llet�is *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ qt T6—J r J v .a ' Y .tel _The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 wlvw.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricions/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aunlicaut Information Please Print Letribly Na1Me(Business/Organization/lndividual): t- -Address:- Qreed ke, aw j P City/State/Zip: IovLroolyh Phone Are you an employer?Check the appropriate box: Type of project(required): Qlamaemployerwith--lo_employe.(fu and/orpartdime).e 7. Now construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 3.0 I am a homeowner doing all work myselt[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homcowner andwiill be hiring contractors to conduct all work on my property. I will ]0❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.Q Roof repairs These sorb-contractors have employ=and have workers'comp,insurance.= i 6.r-J we are a corporation and its officers have exercised their right of exemption perMGL c. 14.Q Other 152,§I(4),and we have no employees.[No workers'comp.insurance required.] +An applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entices have employees.If the sub-contractors have employees,they most provide their workers'comp.policy number. I I Iam an employer that is providing workers'compensation insurance for nay employees. Below is the policy and job site Information- Insurance Company Name: Policy#or Self-ins.Lic,#:� [�` "' a/��d �dtJN Expiration Date: , Job Site Address: ,2. i�"fHS City/StateJZip: Attach a copy of the workers'co pensation policy eclaration page(s owing the policy number and expiration date). Failure to secure coverage as required 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 I day against the violator.A copy of this statement may be forwarded to the Office of lnvestigations of the DIA for insurance coverage verification. I do hereby certfy under the pains an penalties ofperjury that the information provided above is trite and correct Si ature: •� Date: Phone#: � �/ Official use only. Do not write in this area,to be completed by city or town ofciaL City or Totvn: 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#: SE&DI-1 OP ID:JO' . t�Y CERTIFICATE OF LIABILITY INSURANCE DA09121/2015Y) 09/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS _G RTI.FICATE DOES—JOT.AFElRMATIVELY OR_N€GATIVEL.Y_9MEND,_EXiENA QR._ALTER TF(E CpV_ERAGE_AEE9_f?,D— BY_THE POL(,CIE,S___ 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 NAME: John Dussault Foster Sullivan Insurance 163 Main St. AHONNo.Ext 978-686-2266 arc No,978-686-6410 North Andover,MA 01845 E-MAIL rout fosersu tificatesllivan Foster Sullivan Insurance LLC ADDRESS:cerg p•Com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:MAIN ST AMERICA ASSURANCE CO 29939 INSURED S.E.&D.Inc.,Electrical INSURER B:TRAVELERS INSURANCE CO 19046 David Street INSURER c:AIM MUTUAL INS CO 33758 PO Box 114 Meredith,NH 03253 INSURER D:LIBERTY MUTUAL INS CO 23043 INSURER E:ESSEX INSURANCE COMPANY 139020 INSURER F:THE HANOVER INSURANCE COMPANY 122292 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 TYPE OF INSURANCE D D's POLICYFF POLICY EXP LIMITS LTR IN POLICY NUMBER MMIDDIYYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE I$ 1,000,00 A X COMMERCIAL GENERAL LIABILITY MPT6109P 08/29/2015 08/29/2016 DA AG PREMISES Ea oocurre.c. . $ 300,00 CLAIMS-MADE F_X1 OCCUR MED EXP(Any one person) $ 10,00 A X BLKT Al WRITTEN CONTRACT PERSONAL&ADV INJURY $ 1,000,00 A X GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 3 2,000,00 POLICY X PRO- LOG $ UTOMOBILE-UABIL-tlN COMBINEDt SINGLE LIMIT 1-fl00-00 Ea acaaenS B ANY AUTO BAOF132412 07/29/2015 07/29/2016 BODILY INJURY(Perperson) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS fX AUTOS XI IHIRED AUTOS NON-OWNED $ AUTOS $ X UMBRELLA LIAB X 'OCCUR EACH OCCURRENCE $ 5,000,00 E EXCESS LIAB CLAIMS-MADE XOBW5340714 08/29/2015 08/29/2016 AGGREGATE $ DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATIONX TORY WCSTATU- OTH- AND EMPLOYERS'LIABILITY LIMITS PER C ANY PROPRIETORIPARTNERIEXECUTIVEYIN VWC-100-6017018-2016AMA 01/22/2015 01/22/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N/A WC5-31S-389186-033 NH 08/29/2015 08/29/2016 D {Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00( F CRIME 1834827 0312012015 03/20/2016 CRIME 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover,MA ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE `01)&ZI;7 ©1988-2010 ACORD CORPORATION. All Tights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD .1, ol3N4tJfQhilElt 'LTH OF t�1�►SSA�i 1flJ�E� BQARD fl)= ELEC�fR'I C FANS • LS$UES. THE F0LLOWINU L10EN5E_AS A RI iSTERI-,b MASTER..-..-E ECTRI:C;I`AN ; #3AV;1O. 5TREET ELE.CTRI'C INC Y � •'1 W f IM I D Ho STR f T W y v PO <BOIE 114 NH 03253 0114 MER�OITH g8 62 16 Berry Street-Building One 42 Units Bldg.One Building Electrical Plumbing/Gas Notes Unit# 1 Rough Final ]aaT, 2 Rough Final /Lf 3 Rough Final / d� 4 Rough Final I d Rough Final 7 / h Final ugh F nal Al Rough Final 9 Rough Final 10 Rough ZY/ Final; Z 1 11 Rough 7 Final 7/ly 12 Rough 36 Final w 7 13 Rough 317 / Final 14 Rough b Final "y / 15 Rough Final i a ' Bldg.One Building Electrical Plumbing/Gas Notes Unit# Rough Z Final 17 Rough Final 'l� pllodk 18 Rough Final ? 19 Rough Final .f f ?/Olp 20 Rough d Final yl1 Rough Final 7 / 17,y I 3 1/ 22 Rough Final Z 23 Rough 3111 Final 24 Rough 14bl Final 25 Rough 31'/I Final ? /S 26 Rough Final 27 Rough Z L Final a z 28 Rough Final r3Zt / 29 Rough .3LL- Final 30 Rough Final - ` Z i 4 � t. Bldg.One Building Electrical Plumbing/Gas Notes Unit# 31 Rough Final _ 32 Rough 1� Final l Q 33 Rough Final 165 34 Rough Final 35 Rough Z Final, 1103 36 Rough Final 0 7-37 Rough 21-77-114 Final i� 38 Rough 3 ZZ 1 G Final 39 Rough Final 40 Rough Final 41 Rough Final 42 Rough Final ,52r vi C 10o'- -57--z 3-IJ. Y` Date.....f. � 1..5"....... NowT#j r '"'; TOWN OF NORTH ANDOVER o s PERMIT FOR WIRING sS�cMusE This certifies that ............:.... . Sw..'.. ./ has permission to perform .....J... ... — '.f...- . !.. E ...................................... wiring in the building of. ............................................................... at ../.... ........ ..... ............7?��;- ................................,North Andover,Mass. Fee.... ......Lic.No. . ELECTRICAL INSPECTOR Check# ) 0 12841 /I 1 ' Commonwealth of Massachusetts Official use Only Department of Fire Services Permit No. _ j ql -- �9-j Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(WC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (1 `u 12G5 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) t? Owner or Tenant t VhL, Telephone No. Owner's Address 2L4 LM,0 Sr Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Bog) Purpose of Building 7gyp .e-Cl,,, Utility Authorization No.ZpU%8'12(9 Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters ew Service 21=�O Amps 1?A /2J40 Volts Overhead Undgrd❑ No.of Meters I— J Number of Feeders and Ampacity I a- (,ppb � Location and �?Nature fof�Proposed Electrical �{Work: T�\Yl �.1VC'-.1 C^Y • �� L9"L lel\ ,..Y�1 1 1►JlJ � ' �P Completion o the ollowin table may be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of CeiL-Sasp.(Paddle)Fans o.o Total Transformers KVA No.of Luminaire Outlets No.of Hot Tabs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting d. rnd. Battery Units No.of Receptacle Outlets No.of OB Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No-.-57113etection an Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons JKW No.oSelf-Contain-R! Totals:I I I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWLocal❑ Municipal E] other Connection No.of Dryers Heating Appliances KW anty Systems:* Na of Devices or Equivalent No.of Water KW o.o o.o Data Wiring: Heaters S• s Ballasts No.of Devices or E aivalent No.Hydromassage Bathtubs No..of Motors Total HP Telecommunications W"" Na of Devices or EaUiZent OTHER: a Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work:154 kms,C`5o (When required by municipal policy.) Work to Start: k k (g 1 tel$ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVER AGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The + undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete: FIRM NAME: 4 �u LIC.NO.: 1 l �P- Licensee:-1)"i r! _ t2j�r - Sigaatu LIC.NO.: SN tip, (Ifapplicable,enter"exempt"in the license number line.) fBas.Tel.No.;U'Q3-`ftcs-49gS Address: �o�jc A( , "QZfna rt1 03Z-53 Alt.Tel.No.•iQo3-219-1 bQ t L *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one owner owner's agent. Owner/Agent PERMIT FEE. $ �o?� Signature Telephone No. i • � i. ' 1 � • 1 t 1 f 1 s , i 1 I • I 1 • r � i 1 t iv I • 1 ' t4. l 1 �. • • r • i1r _' _ t • •I � 1 +1 N � r , Date... NONT�y ��F aooc TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 8`QgCHU5� This certifies that ................ } has permission to perform .... wiring in the building of...........lV. ....... . :9.:.................................. at .........: .//....... R :........ :.................................North Andover,Mass. Yom... . Fee- ....:...........Lie.No. ..... �(� .................................................................................... � '/ ELECTRICAL INSPECTOR Check 4# r60 02 Commonwealth of Massachusetts Official Use Only j Department of Fire Services Permit No. �ZZ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked w s` [Rev-1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(Iv1EC),527 CMR 12.00 (PLEASEPRINTININK ORTTP. ALLINFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) j(p jy::PQY 5-. Owner or Tenant�j c`,T c c��.ti�1 P� Cil Telephone No. Owner's Address 2k1 l,6MI) CT: PhZM,t4pL" . 1,J4 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building IE14P p kri PAAJFZ( Utility Authorization No. 2C<t>0,11&6 - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Ne�erof Z-C C Amps �Z6 /Z40 Volts Overhead Undgrd ❑ No.of Meters I New eders and Ampacity 1 �_ 2-go n- 1 (Q Location and Nature of Proposed Electrical Work: Tin P�41� F-e,9_ C'C��L,cZ)Sf 1�N Ct- ST_ Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- Elo.o mergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No,of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained .................................................. Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Si ns - Ballasts No.of Devices or Equivalent EOTHER omassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . SIC: `4- i NJ_. LIC.NO.: )I J(L Licensee:i J%q tl,S- - Signatur Y f LIC.NO.: Sy Hp (yapplicable enter "exempt"in the license number line.) Bus.Tel.No.:W-7(e5-q945' Address: 'r4c 014 , ME-Q6DmA KO Alt.Tel.No.:[_.c3-7-n 7872 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE:$ SignatureturaTelephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed , 4 on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be-deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE PECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: . air Inspectors Signature: Date: fo Q-Z7 — S' PARTLAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass[a Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: y Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: �+ Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of_Massachusetts Department oflndustrialAccidents4F Y Congress Street,Suite 100 Boston,MA 02114-2017 wipiv.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/`Plumbers. TO BE,FILED WITH THE PERMITTING AUTHORITY. Ai plicant Information Please Print Legibly Name(Business/Organizationffadivi//dd�uai): p��i"`�- 1 I-�tv Address: City/State/Zip: L ro,N p z,zq Phone Are you an employer?Check the appropriate box: Type of project(required): 1.�?I am a employer with_employees(fulland/or part time).* 7, RNeW Construction 2.a 1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp,insurance required.] 3_❑I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 9• ❑Demolition i 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.Q Roof repairs These sub-contractors have employees and have workers'comp,insurance.: 6.Q We are a corporation and its officers have exercised their right of exemption perMGL c. 14.[J Other 152,§1(4),and we have no employees.[No workers'comp.insurance required] j *An y applicant that checks box#i must also fill out thesection below showingtheir workers'oom ensation olicy information ' T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they mist provide their workers'comp.policy number. I Iain an employer tltat lsprovidingworkers'compensation insurance for my employees Below is thepolicy and job site ! information. Insurance Company Name _ Alm -/M I Policy#or Self ins.Lie.#: �17 9— -Dp Expiration Date: i� Job Site Address: � ,cX S City/State/Zip:Ayezelk Attach a copy of the workers'colopensation policy eclaration page(s owing the policy number and expiration date). Failure to secure coverage as required 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. I do hereby certify under the pains an penalties ofperjury that the information provided above is trite and correct Si ature• Date: Phone 0 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#' SE&DI-1 OP ID:JO` R®r CERTIFICATE OF LIABILITY INSURANCE DA09/21/2015Y) 09/21!2015 J*CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS -;STiFJCATE_DQES_.NQT_AFEIRMATJVE,LY O�_NEGATIY_ELY AMEND,_EXTENp OR ALTER_TH COVERAGE AF_F�RDED__BY THE__POL1CaE_S BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ,tREPRESENTATIVE 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 lt D John ussau Foster Sullivan Insurance NAME: Arc N, 9 163 Main St. AICNNo ,1:E978-686-2266 FAX 78-686-6410 North Andover,MA 01845 E-MAIL Foster Sullivan Insurance LLC ADDRESS:certificates@fostersuilivangroup.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:MAIN ST AMERICA ASSURANCE CO 29939 INSURED S.E.&D.Inc.,Electrical INSURER E:TRAVELERS INSURANCE CO 19046 David Street PO Box 114 1 SURERC:A LM MUTUAL INS CO 33758 Meredith,NH 03253 INSURER D:LIBERTY MUTUAL INS CO 23043 INSURER E:ESSEX INSURANCE COMPANY 39020 INSURER F:THE HANOVER INSURANCE COMPANY 122292 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TOCERTIFY 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. IN TYPE OF INSURANCE INSLI R POLICY NUMBER MMIDDYIYYYYMM/DDEFF � LIMITS GENERAL LIABILITY EACH OCCURRENCE Is 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPT6109P 08/29/2015 08/29/2016 A ASTTo PREMISES Ea occunence $ 300,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,00 A X BLKT Al WRITTEN CONTRACT PERSONAL&ADV INJURY $ 1,000,00 A X GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 JECT POLICY X PRO_ LOC $ ----- AUTOMOBILE-L-IABIL-I- --"� a COMBINED Iac N D SINGLE LIMIT �-000 00 — _ B ANY AUTO BAOF132412 07/29/2015 07/29/2016 BODILY INJURY(Per person) S ALL AUTOS NEO X AUTOSULED BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ X UMBRELLA LAB X 'OCCUR EACH OCCURRENCE $ 5,000,000 E REXCESS LIAB CLAIMS-MADE XOBW5340714 08/29/2015 08/29/2016 AGGREGATE S DED X RETENTION$ 10,000 $ WORKERS COMPNSATION AND EMPLO ERSELIABILITY X TORY LIMITS OER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y� VWC-100-6017018-2015A MA 01/22/2015 01/22/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA D (Mandatory in NH) WC5-31S-389186-033 NH 08/29/2015 08/29/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 F CRIME 1834827 03/20/2015 03/20/2016 CRIME 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required( CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover,MA ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD o: OiV1MONWEALTH OF MASS�kCNL$�E [ o o ' ° BOAAD flF s RLECTR'I C I A<`tS � w 55UES.. T E,f OLLOW i NG L i CENSE AS A L ELECTRICIAN , S71*ft b MASTER a. Wi OvIQ STREET ELECTRIC INC H DAV ID H STREET 5 j pO BOX 114 NH o3253-0114 hCE.REDITH Y 16 z` 8 62 4MRf' oll ra I i Dat e .:.�� F..' ................... � powriy `�� F � TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ♦ o ".'� • ,3s�C►7U5�t T t i\ C�VyS [�1/1C Thiscertifies that .............................................................." ....................................................... has permission to perform ..........__.C? .................................................. wiring in the building of.........!...` ...:.......W`SN�:'�-�t ,................................ at -.... 2 � � � rth ndover,Mass. �. ..... ........... ................... .............. , �zS' i : � - -........ Fee...:..........�.......Lac.No:�.�?2�' Check ELECTRICAL INSPECTOR # 7� 12539 —/ Commonwealth of Massachusetts Official Use Only Permit No. i a 5 IM Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) j(Q er�Qele S Z Owner or Tenant N Telephone No. Owner's Address 24 L-ADjj Sr t"&Q'tS14csx-r! L44= Is this permit in conjunction with a building permit? Yes ❑ No © (Check Appropriate Box) Purpose of Building TEMP cy*tc�F—- g^iLr�e Utility Authorization No. t9912-931 - Existin Service Amps / Volts Overhead ❑ Undgrd[j No.of Meters 64ervice Z—Gb Amps 120 / Lu0 Volts Overhead® Undgrd ❑ No.of Meters ] Number of Feeders and Ampacity Z cQ I po A j U tA. Location and Nature of Proposed Electrical Work: ^C�il� bF�tr TIPS Ls� m - �,�,a+�7c� Completion of thefiollowin 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- El 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 Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Dis osers Heat Pump Number Tons KW _ No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection No.of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring. No.Hydromassage No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wtres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ri 302o,_S _Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing.office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under thepains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . '51E %-t�i ko,�. LIC.NO.: trl IU 31E Licensee:�& C kA� Signature LIC.NO.: &r>-ZS A (If applicable,enter "exempt"in the license number line) Bus.Tel.No.-A90 0 -7roS�ti 2YS Address: jig Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Z'� Signature Telephone No. 1 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass[E Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE SPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: 11 oe Inspectors Signature: Date: S-- PARTIAL ROUGH INSPECTION: Pass n Failed❑'f Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.}❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed❑' Re-Inspection Required($.) ❑ Inspectors Comments: I Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,NIA. .......dweinhold@townofinerrimac.com -C-\ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. I a5 2 1 Occupancy and Fee Checked ,w BOARD OF FIRE PREVENTION REGULATIONS (Rev.11071 (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 TYPEALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) i f4 Zr;;Zeq 5tjgr Owner or Tenant 1.?I U Telephone No. Owner's Address 214 i,.iAc� ST mast<s�.�c -e4 wjtl- Is this permit in conjunction with a building permit? Yes ❑ No © (Check Appropriate Box) Purpose of Building TC-MP cp�FtcF—-rgAtLEe Utility Authorization No. 19192931 Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters ew Service fob Amps 120 /Zuu Volts Overhead© Undgrd ❑ No.of Meters Number of Feeders and Ampacity ZaC `CpA 1 tsb& Location and Nature of Proposed Electrical Work: -gyps Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- Elo.o mergency ig ting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: ....................... Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal E] other l� P g Connection No.of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 11 Sb 2-�_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 j&,under the pains andpenallies ofperjury,drat the information on this application is true and complete. FIRM NAME: . JF %-b lam-. LIC.NO.:n IU3S Licensee:� � �;, Ru 1 Signature LIC.NO.: Zc�25 t4 (If applicable,enter "exempt"in the license number line) 7 Bus.Tel.No.•l D3.-?b5'4i q'YS Address: a&�, um V,* Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/AgentPERMIT FEE:$ y 5 Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed r on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an +. electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012, ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 7 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE SPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: S--I PARTIAL ROUGH INSPECTION: Pass IT Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimae.com The Commonwealth of Massachusetts Department of XndustrialAccidents Congress Street,Suite 100 Boston,mA 02X14-2017 ' : - • �` www mass.gov/die Workers'Compensation Insurance pifidavit:Builders/Contractors/Electricians/l'lumbers. TO BE FILED WITH THE PERMITTING AUTHORITY- please]Tint Applreant Information Name(Business/organization/fn(hvidual): C�� ► ��— Address: o M Phone 4: City/State/Zip: :Y.•, Are yon an employer?Cheek the appropriate box: Type of project(required); Z© em to ees full and/or part time).* 7. PjNe*w'd6nstrllCtlon 1.®I am a employer with P y 2.❑I am a sole proprietor or partnership and have no employees Working forme in 8. Remodelitlg any capacity.[No workers'comp.insurance required.] 9. L1Demolition 3.F1 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 110 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole bin repairs or additions proprietors with no employees. 1?[ P� g p 5•❑I am a general conhacto and I have hired the sub-contractors listed on the attached sheet. 11 Q Roof repairs These sub-contractors have employees and have workers'comp.insurance t 14 Other 6.Q We are a corporation and its.officers have exercised their right of exemption per MGL c. 152,§1(4),and ive have no employees.[No workers'camp.insurance required-] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i I n rneo scan who checks bhis affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such- _j that check this box must attached'an additional sheet showing the name of the sub-contractors and state whether or pot those•entities,have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Y am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: Az bo--yo-FR- -it, -FR- Policy#or Self-ins.Lic.#: �, U0�� n- 0-it,1$— 6 A^ M4 Expiration Date: l Job Site Address: I lQ U, ,� City/State/Zip:_M� >&►��'� Attach a copy of the workers'compensation policy declaration page(showing the policy number and ercpiration date). 25A is a ainal violation Failure to secure coverage as required as-well as civil ivil penalties2m§he form of a STOP rWORK ORDER and a fine ofup to$250.00 a and/or one-year imprisonment, is statement may be forwarded to the Office of Investigations of the DIA for Insurance day against the violator.A copy of th coverage verification. Ido her er under aep ' and penalties of perjury that the information provided above is true and correct. Date. Si ature. Phone#: '—r "4q Official use only. Do not write in this area,to be completed by city or town official. Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.PInmbing Inspector 6.Other Phone#: Contact Person: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is'defined as"an individual-,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receivet'or•trustee ofan 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 whohas not produced-acceptable evidence of compliance with the insurance coverage Aquiired." 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 Viability 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 In.dustrial,Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensatioii 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. Anew 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-MASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia y� COMMONWEALTH OF MASSAOHUSETTS • °, BflAF;iD OF ELEGTRICIAN;S ISSUES THE ;FOLLOWING La Cf NSE AS :'A RI C15TER D MASTER ELECTR:1. IC ICAN fel, Q TOMS J CHAPMAN r ��! 25 MIDNIGFIT 'SUN DR ' r F4EMONT H 03044-8200 J nrsn2020025 A o7/3x1.16 98896 ` . __J s . COMMONWEALTH OF MASSACEiLSETTS B4OARp O;l.^ ELI=CTR'I Cl ANS ISSUESTHE FOLLOWING L f CENSE: JOURNEYMANELECFTRIC A'N h �•f � ,rr� r z f. J CHAPMAN ` 26 MIDNIGHT ON 0#2 k J X13 7 MONS NH 03o44 8200' ` ,: 512'63 E 07%3116 g889� Date.�77 Ac)..---v i'.......... OF NORT►�,� TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING sS�CHUSE This certifies that ..... ��„r, 1 � ................................................ Ire G has permission to perform `� '.1Q.e.e:r.,............ t. ... p. wiring in the building of.... t.!��Yl .................................................................................. at .....�. P c2!R. ..... agar........... dver,Mass. ........ orth Ano dee... Lic.No. ..... .�. .. ......... r .., .... ,�� L*EC ICALINSPECTOR !. Check# Jam����� 21K— U r0 Commonwealth of Massachusetts offic]ai nseonly o_ r- A Permit No. I o Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code�),52'�CMR 12.00 PLEASEPRINT WINK ORTYPE ALL INFORMATION) Date: Q City or Town of: NORTH ANDOVER To the Inspector of Wires: a By this application the undersigned ives notice of his or her intention to perform the electrical work described below. Location(Street&Number) �p Owner or Tenant —FdQvW PleR W I< to F lOd<- 7/f. Telephone No. Owner's Address er L. n v$T Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building D we&W.9 Utility Authorization No. : Existing Service� Amps l� /jg V Volts Overhead[P""' Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters T Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ' p�/ Si L GK r C!C f t� 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 Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. gmd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices t f Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained .................................................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local[] Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water IOC No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eq uivalent " OTHER: 1 Attach additional detail if desired or as required by the Inspector of ares. Estimated Value of E ctric Work: 000 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cover e is in force,and has exhibited proof of same to the pe it issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) ardwl�-7—kW?�� erv4AI I certify,under thAZ6 nallies ofperJu ,that tlxe information on this application is true and complete. FIRM NAME: . C/o/w/-C LIC.NO.:f9/5-�4 11 5' Licensee: L711WZe Signature LTC.NO.: (If applicable, ter "exempt"in the li ens r line.) us.Tel.No.: �•2 Address: �6 �/� ,�(J7`/�'1 f 6?-- /f�L� / rllgIt.Tel.No.• = ! *Per M.G.L c. 147,s.57-61,se urity work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. , ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. 1W ti Permits shall be limited as to the time of ongoing construction activity,and maybe deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic foul-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: >*�*"Note:Keapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection r • y Pass Failed Re-Inspection Required, $:)❑ Inspectors Comments: Inspectors Signature: SERVICE INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass F?1 Failed R Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass g .� Failed M - • Re-Inspection Q Reg6ired,($:)M Inspectors Co a �•. ;' , - Inspectors Signature: Date: i DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts tI Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/ContractorslElectricians/Plumbers Applicant Information / PIease Print Le0bly Name(Business/OrganizatiorAndividual):_ L'- ��rC T.4 Address:_ J V0. O&JlyG`t? 6,7 City/State/Zip: Phone#: q, Are ygu an employer?Check the appropriate box: Type of project(required): 1. I am a employer with d15 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. E]Building addition [No workers'comp.insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions c. 152 §1(4),and we have no myself.[No workers' comp. � 12.❑Roof repairs insurance required.]t employees.[No workers' i comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicating they ace 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:. �G ettA a 7- MC 62x �y Policy#or Self-ins.Lic.ff: ` / Expiration Date: Job Site Address: �� eA4Y City/State/Zip; N0, /''VodOU eK Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). r 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 4 Investigations of the DIA for insurance coverage verification. I do laereby cer ' and the s lcndpef hies er' ry that the information providedRxe a is it and correct. Si azure: �/T Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town; Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: 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,legahentity,employing employees. However the owner of a dwelling house having no't more tha'li t&ee:apar[merits-6nd`i6l 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 becausd.of such employment-be defied to.be�an employer." 4 MGL 6h Gr §25�j also-stales-that"every state or lora]lfc6nsing ilger[cy shallw tlihbld,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 'w enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial i Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should i 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 theqermit/license number which will be°usdd,as a refcrdRce numbs"r. In addition,an applicant =that must suBdiit multiple per'mitllicense 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. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should youhave any questions, please do not hesitate to give fis a call. `` ;��; 4 The Department's address,telephone and fax number: ` Tho CQMMOnwelalthofMassac& setts .. Department ofIndustrlal.Accidents Office off"estigations 600 Washington Street Boston.,MA.02111 Tel,#617-727.4900 oxt 406 or 1-877,7 ASSAFB Revised 5-26-05 FaY,#617-727-7749 www.>txtass,govhua Location4 " S� Nog10Y Date NORT1y TOWN OF NORTH ANDOVER F • • Ow �t A Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ t— TOTAL $ Check # 224 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 24CO7 Date Received Date Issued: - ,roa IMPORTANT:Applicant must complete all items on this page LOCATION S 70 tr Print _ PROPERTY OWNER_ C ,,/ i o /C C' Print MAP N0/4,��PARCEL: ZONING DISTRICT:�Historic Districtyes no Machine Shop Village ye 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: a Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: 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: $ FEE: $ Check No.: _ r-5-7 Receipt No.: Z - S NOTE: Persons contracting ith unregistered contractors do not have access to the guaranty fund Signature of Agent/Own 4'Signattare of contractor Plans Submitted A P s Waived Certified Plot Plan Stamped Plans 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 Li Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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) o 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: Doc.Building Permit Revised 2008 i 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 " i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED ;DATE APPROVED, , PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature 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: ra Located 384 Osgood Street FIRE DEPARTMENT -Temp'Dumpster on site yes no Located at 124 Main-Street� t 't . Fire Departmentisighature/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 approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 XAORT ® of Andover No. 0 d I - 0 L. -K 6 over, Mass., 2 COCHIC HEWICK -r E D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System Flo BUILDING INSPECTOR THIS CERTIFIES THAT........Alig✓ ... A��4�......rA..10.4pilt................................................................. Foundation has permission to erect........................................ buildings on.../ ........ ............................................ Rough to be occupied as..... ..7L- 7__. 7 . .................. 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-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 CONSTRU STARTS ELECTRICAL INSPECTOR Rough ........... ................... Service BUILDING_ INSPECTOR Final Occupancy Permit Required, to Ocaipy 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. SEE REVERSE SIDE Smoke Det. i Certifirate of REGISTERED I&uedbk Date Manufactured FABRIC NUMBER TOPTEC PRODUCTS, LLC 1073 Neely Ferry Road 02125/06 s s ~ Laurens, SC 29360 This lop to certlty that the materials describFd are inherently flame retardant. Nam T R Addre 637 R wr State MA CRY CertTficstion is hereby made that: roved and registered by the State Fire Marsha! and That The articles described are flame-retardant, app es and the fabric is in conformance with the laws of the State o�CFPAio�i 9gnULC2 4d the �jMVSS3 29u18t1orrs of the State Fire Marshal. Fabric has been fasted orad passes N CO The Fiame'Retardenc of this Fabric is Inherent and Permanent. 9 Method of Appi►cation: � trr 3040 Description a tion of Item certified: WHITE nt Process Used WILL. NOT Be Removed By Washing. The Flame RetardaLO , -TS, I.L.C. MODE TOPTEC PR ® �d� SERIAL Meals� � Mame Of Production Sr�per(ntender�i o m �-�0 SIC_ dole PC) �0 t4k AnA�,u-e(e- 9 9 7�t-(OT-9)YL/ le S. In accordance with the provisions sof y A'G.L. c. 143 § 3L, the permit applica- tion form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the rescribed form. tics st t o � � TIQ y e Q Tnetallatinnc rnvPrarl by 577 CW 12.00 P Date`: .9-.. i'.. - o?°.t�`` "�,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 49 ,SSACMUS�. This certifies that .....& —�-� - .4 has permission to perform ........... ..................`�..�°....... ............................ wiring in the building of..r .. .......J.............�..............:..... ......... North Andover, 'i at l .......... ......... .-t ............ Mass. Fee7 ..... Lic.No3l. .........;, .... ELECIRICAL INSPE Check # Rng9 �► Commonwealth qfW agsachuseth r Owl Use Only Depadment of Firi Services Permit No. 11C) Z BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee(mocked � o APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfomued in accordance with the MMachweW Electrical Code(MECj,527 CMR 12.40 (PLEASE PRWI'I MOR 7TYPE NA IYOA) Date: r City or Town of. D s`�f . �rUG°l To the Inspwtor of Wires: By this application dye-undenigned gives notice of his or lar bmention-to;perform the dechwat wozk described below Location(Street&Numbtr) Owner or Tenant !O C' Tshphone No. 1°y ' 28 Owner's Address U this permit In conjunction with a bulld'mg permft? Yes ❑ No (Check Appropriate Boa) Purpose of Building Utilfty Authorization No. Ems ing Service Amps / Volts Overltead❑ Undgrd❑ No.of 1Mleten New Service Amps 1 Volts Overhead❑ i;ndgrd❑ No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Fdechical Work:- f Meer. No.of Rieces"Lamiuw'i u Ne.of Calft p.(Paddle)Paas o KVA No.of Luminaire Oadets No.ofHot Tabs Generalors KVA Na of Luminaires Sw pool Above ❑ ❑ e.of LAPOW Units No.of Receptade Ouflets Na of OH Barnars ALARMS No.of Zones Na of Switches No.of Gas Barmn °' of Deftetim and Devices No.of Ranges No:of Air Conti.' TOM Tomo.of Alrft Devices No.of Wash Diwoms �s Tomh: Devices 2 No.of Dhkwxdmm Spwd/Ares Heatidg KSI► Q Comtae n ❑Odter No.of Dryers HnftAffftaces KW Na� or fAttivalIent A No.of Reelects KW. . o' - oleDab Whfamr. Sicas N&ofN:jWorF guivalent No.Rydromamp BaddWo No.of Motors Tem[HP 0T=w AmadraAftbndddail.ifde or asregrrirodby&-hxspeaorof3i?res Eati=%dVahaofElectricalVflora pharretpmredby poky) ' work to Sufi - Inspections to be requesced in mtme ca with WC kine 10,and vq=completion. GF.: INSURANCE CO f)nless waived by the owner,nopws*for the perE=awe of eh=upW"*m"issue unless the hc6mm.pmvidn proof of Baily iant mm "oo ad A eovaage er it mal equivalent. The undersigned ce'xtifies that each is is farce.and has exWbhed proofof sacra m the permit issuing office. -MCK ONE: HOnsANM Bor>D p OTma ❑ mwif►) 411c Ti l«r d�,/Ieernfy,ander the Md ofdthat bifora ave dek;i Fort IFV i mrd a of FIItM NAlMi>$: UC.NO.: RI �60 d6 S ♦ Bus.TeL Nom !A Address: el.� !� D A&Td No.: *Seca*system contractor Lioease 6 v Pifbrftwa*ff*Pficahkcu1crdWficeM a hence OWNSR'S INSURANCE WAIVER: I am aweue drat the Licence does imt have die Ilebr1'ty iosunanee covaage n�omueily mphed by lave► By my signature below.I hereby waive gns nqdmnemt Iain the(check one)0 owner ❑owner's t 0-nner/Agent Signature ra�yhoae Ne. PERAOT FEE:$ 0 6 . ... . ... __ . . _ . . '_ . . fir, . _ . _ . , � , _ , S {' Date. .... ..... .... t - f f ,0RTN , ,e 32 �` TOWN OF NORTH ANDOVER p A • PERMIT FOR GAS INSTALLATION ��SSACNUSES,C _ This certifies that . . . . . . . . . . . . . . . . has permission for gas installation .... . . . . . .. . . in the buildings of . : -{.. -+ v. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . at .��. . . . . _. � . . . . . , North Andover, Mass. Fee.. .`... . . Lic. No.. J. . . . . . . . . . . . . . . GAS INfSPE TOR Check# 6286 MASSACHUSE1 'Sr,-�( IFORM APPLICATION F PERMIT TO DO GASFITTING/ ,Mass. Date 0-Z 20� Permit# Building Location �. Owner's Name l\ Type of Occupancy @ UNew ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No❑ W W � U F 0OUOv� x 04 @w OrOH W Gw � a � Qaa2W �dc' oWx Ha �0 w � zQuZaa ¢ F- W� � O w „a �' WU �pU Qw > n! w 1 ¢ aMOM w 0 a :z -): 08 < W a. Ca o SUB-BASEMENT BASEMENT FIRST(1 ST)FLOOR SECOND(2ND)FLOOR THIRD(3RD)FLOOR FOURTH 4TH FLOOR FIFTH(STH)FLOOR SIXTH(6TH)FLOOR SEVENTH(7TH)FLOOR EIGHTH 8TH FLOOR Installing Company Name ✓t r Address b r r l ° Check one: Certificate Business Telephone ❑ Corporation p �o� 7` I ❑ Partnership Name of Licensed Plumber or Gasfitter ❑ Finn/Co. INSURANCE COVERAGE: I have a current liabiliinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes No❑ Ifyou have check please indicate the type of coverage by checking the appropriate box. A liability insurance policyOther type of indemnity E3Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the MGL,and that my signature on this permit application waives this requirement. Signature of Owner or Owners Agent Owner ❑ Agent Q I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of Li _ Title ❑ Plumber g Master Sign re of Licensed P ber/Gasfitter City/Town ❑ Gas6tter ❑ Journeyman License Number APPROVED(OFFICE USE ONLY Date1 `? C-` .7... NORTH Qf 3r �` TOWN OF NORTH ANDOV R • • - PERMIT FOR GAS INSTALLATION . y �9SSACMUSE�� This certifies that . A/� c. ` `. .r . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . .. . . in the buildings of . . . . = .F P!. !... . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .�3.� R 20.1 / �' . . . . . . . . North Andover, Mass. Fee. . .�A�'7Lic. �. .- G'AS INSPECTOR Y Check# t 6277 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING -Ai or+L A-43ye< ,Mass. Date b 20 -7 Permit# Building Location Ownees Name Type of Occupancy 24,1 New O Renovation ❑ ReplacemenL4Ep,, Plans Submitted: Yes❑ No❑ x �, vi W W OU "' H� rn d O w ¢ OpEW w tea: W O U W 6 9 0W 0 10 (Gn � C7 F F. Gn ^� F. ¢ x W a' C7 O > w F x v. ctUyy �j Z. W QaddOOzp atx- cC x O 0 x ". � 3 A 0 .a. U 04 > a � A O SUB-BASEMENT BASEMENT FIRST(1 ST)FLOOR SECOND(2ND)FLOOR THIRD(3RD)FLOOR FOURTH(4TH)FLOOR FIFTH(5TH)FLOOR SIXTH(6TH)FLOOR SEVENTH 7TH FLOOR EIGHTH 8TH FLOOR Installing Company Name , Address S A Check one: Certificate Corporation Business Telephone °'J ❑ Partnership Name of Licensed Plumber or Gasfitter Td 0114 ❑ Firm/Co. INSURANCE COVERAGE: I have a current liabilitinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes ,,q No❑ If you have check yew,pl:AIVER. e' e the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity O Bond O OWNER'S INSURANCE I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the MGL,and that my signature on this permit application waives this requirement- Si nature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachuse s State Gas Code and Chapter 142 of the General Laws, By Typeof Licen Title ❑ plumber `Master Sign of Licensed Plumber Gasfitter Cityfrown ❑ Gasfitter _d Journeyman License Number f � APPROVED(OFFICE USE ONLY i' ' � ��• Date.11���-jG . 2894 ,10RT1{ ?°,'.•��•°„•�"o° TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSAGNusEt This certifies that .lh:'�M p. 9). �.t.o.H . . . .110(. � . . . . . . . . . . has permission to perform . . u'.Ih . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .F? . . . . . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . .. North Andover, Mass. Fee. 1eJ.r. . :. .Lic. No..E IP 4?. PLUMBING INSPECTOR 44/24/96 11:55 15.00 PAID WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) G Mass. Date �' 19 -+ Permit# a Building Locatlon l—U S Owner's Name ,O .V U9Type of Occupancy /1 New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No 9 FIXTURES Z Z H PZ Y Q H N N N O Z > N W Y J N o < N " W W H Z N Q 2 cc X Q ~ Z O Z N a O .OJ N W N H W y F- U ju X Q V) U. Z H O Z ¢ m N N W Q N Z C d O Q d C O X O 7 X R 2 Q W D < rA Z W CC LL LU W W = d Y U. O Z S Y d C f' Q Y G W tt Y W l d W H Z O O N Z Y W O U x 3 !C J m N D p J 3 = �- N ti 0 M O 4 3 C M O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR METROPOLIT-fM PLUMBING Installing Company Name LRIG an pie Check one: Certificate -:-H6AT, -� Address Commerce Ctr'.,Bldg 21 a1 Corporation 1960 iVORWOOD, MA 02062 ❑ Partnership toll) tew-Iffu Business Telephone ❑ Firm/Co. Name of Licensed Plumber lt/:Gc,�srr !r/f iNSURANCE CGVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes�9 No ❑ If you have checked yes. please indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the�Massachusetts State Plumbing Code nd Ct apter 142 of the General laws. Title APR 1 9 1996 Signature of Licensed Plumber City/Town Type of License: Master Journeyman❑ APPROVED(OFFICE US ONL License Number IA'/00 y'7 P J BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. _ APPLICATION FOR PERMIT TO DO PLUMBING Q� NAME i TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR - "-.`"` �ZL�t.i.:-✓`ty4l�^' �.�1.Y�w�►'Ml+.i'.f�Yh' �..;'/i+._ Date.....G ./�`.. . 9. 33 HORTN TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING �,SgACMUSEt This certifies that ................... ).(.../................... has permission to perform .......1�/ .... 'G cJr.�. '........................ ....'�.w � wiring in the building of...... 6v ii ..A.....�........ . .... ........ ....................................... .North Andover,Mass.. vJ..... Lic.No'bar;...................... ... ... .... ............ .... ................ ELECTRICAL INSPECTOR. - ! cA 48/22/97 14:18 75.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer r •a orfs ue.onhr ' U E Lgam IIIiumait1 of _49nsnr1nmdW Permit No Eepm3trirw of 111ubUr * f[2q Occupancy A Fee+Chet ked�l 3M heave blank), ;r P. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00U9 r APPLICATION FOR PERMIT TO PERFORM ELECTRICAL 'WORKi;� All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 1.2:OQ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �i 45w or Town of NORTH ANDOVER To the Inspector'at i, The udersigned applies for a permit to perform the electrical work described below. Location (Street Si Number) �1 ^( Owner or Tenant Ail d o l w 0.r� � k .. ,: Owner's Address Is this permit in conjunction with a building permit: Yes = No ❑ (Check App roprlate;Box) w Puroose of Building Utility Authorization No. Existing Service Amps _I Volts Overhead U Undgrnd ❑ No. of.Meters " t New Service 0110 e Amps LJ 2 O Volts Overhead Undgrnd Lk No o(Meters 1 Number of Feeders and Ampacity t Location and Nature of Proposed Electrical Work LecL) 10 ySw� S rine„q .Total No. of Hot cs No. of Transformers ransormers F ' � > No. of Lighting Outlets I I tNA i t; No. of Lighting Fixtures I Swimming Pco+ Abcve� In. grnd. — grnd. _ I Generators t KVA _. No. of Emergency Lighting".. No. of Receotacie Outlets `U I No. of Oil BurnersI Battery Units 7' No. at Swffcn Outlets No. at Gas Eumers FIRE ALARMS No of Zonea ; Total No. of Detection and I t No. of Ranges I No. ct Air Care. tons Initiating,Devices Heat Total Total No. of Disoosafs No.ot T t Pumps Tons KW No. of Sounding Devices e � � No. of Self Contained SoaceiArea Heating KW DetectionlSounding Devices i No. of Dishwashers 9 , Heating Devices KW Local Munic!oal r-,Other y No. of Dryers I 9 ! Connection _ �,•.,. No. of' No. or Low Voltage r 4r No. of Water Heaters KW I Signs Sailasts Wiring tF No. Hydro Massage No. of Motors Totai HP , `t OTHER: INSURANCE COVERAGE:Pursuant to the reauirements of ttassac-users y^enerat Laws x n _ I have a current Liability Insurance Policy including Comcjeiec Operations Coverage or its substantial equivatent YES ,NO . have suomitted valid proof of same to the Office. YES = NO = if you have checked YES.please inQitate tpe'tgpe of i.pqverage oy4" u cnecking the approbrtate box. INSURANCE = BOND = OTHER = (Please Scec:.y) , �(Faeptration Date)w� �`;': Estimated Value of E!ectncal work 5 Work to Start 9-d All Insoecaon Date Aecuestec: Rough /�a L� G Final I" Signed under the �Penaft es of qury:i7�� I n`,w�vt LIC NO. FIRM NAME Licensee / Signature UC.!4 , Bus. Tel. No. loi7-df�S^ 3i3� ' r. Address Alt. Tel.No. leg OWNER'S INSURANCE WAIVER: I am aware that the Licensee Coes not have the insurance coverage or its substantial equ!valenvas re• quirea by Massachusetts General Laws, and that my signature on :his permit application waives this requirement. Owner Agent, w ;' (Please Chet%one)! Teieohone No. PERMIT FEE S i (Signature of Owner at Agent) 4,:'� Nq 2364 Date... 4L TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING Thiscertifies that ....... ..................................................................................... has permission to perform ... ............................... wiring in the building of...a� .... at ,� JV7...................................... .North Andover,Mass. Fee./�:....... Lic.No:- ..................................I........................ ELECTRICAL INSPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer i ;;,�� /� I Office Use Only VI�� �II1TCutIIuulEttjf af Magg C�uuthi Permit No. 19tvar'tmient Df Public fPafttg Occupancy&Fee Checked�r' BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) I. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPF,AL INFORMATION) Date -.1 a—a"D City or Town of oA,neto ri l To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) (o Owner or Tenant Owner's Address r^�� Is this permit in conjunction with a building permit: Yes ❑ No ® (Check Appropriate Box) Purpose of Building lis"I. a - ���s nC s Utility Authorization No. Existing Service_ 00 Amps 1L0J •pyo Volts Overhead © Undgrnd ❑ No. of Meters New Service Amps_J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work IAI\11- t r� �e 6 --TW� �a� ��uric ave.4 - �c vi ti �G Y Total No. of Transformers No. of Lighting Outlets � No.of Hot Tubs KVq III Above In- No. of Lighting Fixtures Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units QJo. of Switch Outlets No. of Gas Burners FIRE ALARMS No.of Zones Ranges No. of Air Cond. Total No. s Detection and No.of Ran 9 tons Initiating Devices Disposals Nc.oHeat Total Total No.of f Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal No. of Dryers Heating Devices KW Local ❑ Connection ❑Other No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring r No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ 1 have submitted valid proof of same to the Office.YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. .INSURANCE g BOND ❑ OTHER ❑ (Please Specify) ?��1J� — `��O (Expiration Date) Estimated Value of Electrical Work$ Work to Start��a3'aBo 0 Inspection Date Requested: Rough ��«^a Final Signed under the Pe It es of perjury: FIRM NAME o LIC. NO. Licensee d Signature LIC. NO. 3W56 4— �} n & Bus.Tel. No. 7$/'a►�s— 3/33 Address 6 d ,7�'c ;A 1;i � � '``C�O � G 1 S Ejo_&)?I Alt.Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) n� n Telephone No. PERMIT FEE.$ rc;nnnhvo of nwnar or Agent) Location I to ZJ( No. Date Of 1 N°R7" TOWN OF NORTH ANDOVER . b- c� 10 S Certificate of Occupancy $ * ^ ' Building/Frame Permit Fee $ Ui SAcNusE`h Foundation Permit Fee $ 4 Other Permit Fee kk�fUy $ CU _ 5 Sewer Connection Fee $ u? Water Connection Fee $ TOTAL $ — Building Inspector ector *� 4 2((��,g q : �� ! 7 Div. Public Works PEWMIT NO. 06B APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 / MAP d-40. !/d/ LOT NO. 3 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE (� I SUB DIV. LOT NO. F ' LOCATION ST .. PURPOSE OF BUILDING Q�5 1 i�L+"{EiE AOW NER'S NAME l ff .F``OQE NO. OF STORIES Z SIZE OWNER'S ADDRESS '/ .g,E,Q.�y SST'. BASEMENT OR SLAB ARCHITECT'S NAME �O SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME w11 VlE-I,T�..� I - SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING % IS BUILDING ADDITION SIJ MATERIAL OF CHIMNEY IS BUILDING ALTERATION t //J IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ,`.� IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY L IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES 1.0pL-�S'T'E=�' TF-� y EST. BLDG. COST PAGE I FILL OUT SECTIONS 1 - 3 ` I ` Z R"oV��,S EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 I S La'1Z � I�aT�.�nL.A'1Trd.¢ EST. BLDG.COST PER ROOM 2eIN5 T4-L` SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING �x 1ST) l�- T--ILIA 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FI BUILDING INSPECTOR SIGN'ATURk OF OWkiR OR AUTHORIZED AGENT J� FEE ���f OWNERTEL.A �y PERMIT GRANTED CONTR.TELJ _CSL CONTR.LIC.#, H.I.CJ �� '4- to V, BUILDING RECORD {, 1 OCCUPANCY 12 SINGLE FAMILY STORIES k THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA. APARTMENTS I ES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL K. PINE _ BRICK OR STONE PIERS — PLASTER — — DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN_ BM T- AREA _ 'h /2 1/ FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD"J'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) _ GAMBREL � MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM - } STEEL BMS. 8 COLS. HOT W T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS AS OIL 8'M'T 2nd _ ELECTRIC Ist 13rd NO HEATING NORTH Town of over No. 0 LA E bre dover, Mass., �AF_C-L-4 lgctg* COCHICHEWICK 0RATED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...F94��..... ....................................................................................... Foundation has permission to erect. buildings on J..(o......;�Zi! ......STS......................................... Rough to be occupied as...... ..�. ..... .W.. ......................................................... 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-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 ELECTRICAL INSPECTOR UNLESS CONS U is Rough T Service .... .................. .............. .. .................................................S B LDING 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 DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT --)CIA Xietri Construction 3 Reo Road Peabody, MA 01960 PROPOSAL Page No. of Pages Proposal Submitted ToPhone (98 3 c�� Date 4 Street G 3E y S-t—, Job Name City/State/Zip Code (�^ �Lr KAA-, Job Location Architect Date of Plans Job Phone We hereby propose to fumish materials and labor necessary for the completion of: I t!l STo.L g- 1 I t` SI4 VA-(2 4 L B2.24 0? 7 vL� t2r✓t.[>-f�c c- zz-x t ,� Uhe r°o�w�nana�.�o��,tr!iroac�a.�tics HOME IMPROVEMENT CONTRACTOR Registration 109312 ', Type - DSA o Expiration 09/11196 VIETRI CONSTRUCTION n MICHAEL A. VIETRI GGeezrieafd3 REO RD j ADMINISTRATOR PEABODY MA 01960- 1 _ J We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: J� • / dollars($ ). Payment to be ma//de as follows: r( Z- AT 5/4Nry� All material is guaranteed to be as specified.All work to be completed in a substantial workmanlike manner according to specifications submitted,per standard practices.Any afteratkm or deviation from Authorized above specifications involving extra costs will be executed only upon written orders.and will become an Signature i tel^ extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays Note:This proposal m be withdrawn b us if not accepted within d beyond our control. may Y days. Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signatu Date of Acceptance Signature 9 Date.—e.. �.... E NORTH'1 o�°.';�``� -a� TOWN OF NORTH ANDOVER PERMIT FOR WIRING o • o. -,''• rgi SSAcwusE� This certifies that .._f.t.s... ........................... l; has permission to perform .........a : ..!. ,.....I.0.............................................. i� wiring in the building of....... ....: ........ `.J. .::. ............................... co A ................ .North Andover,Mass. Fee.`.`'(!......... Lic.No. ....�'�r/ ............ .......... ........................... ELECTRICAL INSPECTOR 'c c i WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File The Commo'n'wealth of Massachusetts a I 1�4 �'erwlt b. Department of Public Safety occupancy►F..aeek.d BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (l.ay. blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK dee All Work to be performed in accordance with the Massachuserls Electrical Code.527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL I ORHMON) Date ,'3- — City or Town of 17a /_ n ea.S� To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street- & Number) �,NA Owner or Tenant- 1 4G.r`L r Q f`� 1t rtoltsr \C,� 1�� 1tCrn in9A Owner's Address to $'c r-4_ S (1 Is this permit in conjunction with a building permit: Yes ElNo a- (Check Appropriate Box) Purpose of Building----L nnC1 Sir Utility Authorization NO. _ Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters ElNew Service Amps / Volts Overhead LJ Undgrd❑ No. of Meters Nuaber of Feeders and Ampacity Location and Nature of Proposed Electrical Work n aC wA No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool gmd. ❑ s d. ElGenerators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting P Battery Units No. of Switch Oabiaaas No. of Gas Burners FIRE ALARHS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Disposals No. of Heats TTonstal ToKW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑Municipal ❑Other Connection No. of Water Heaters KW No, of o. o Low Voltage Signs Ballasts Wirin No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Maasachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO LJ I have submitted valid proof of same to this office. YES❑ NO ❑ If you have checked YES; please indicate the type,of coverage by``che{{A•/ck//i��ng the appropriate box. n INSURANCE BOND C] OTHER❑ (Please Specify) JI-.l�,d, S` 7 piration ate Estimated Value of Electrical Work S Work to Start 3-2-95— Inspection Date Requested: Rough f Vi Final Signed under the penalties of perjury: s FIRM NAIL c ctv� LIC..NO. Licensee_ a rrt Tr � "It- /Si natu�rle v. LIC. N0. 3 C^is 6 _ Address d nX a 12 UIXn�'t �£l s 1 CG. OAK (Q 20 Bus. Tel. No. ( / aS—'3/3 3. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General ws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S ' AApf� _ Signature of Owner or Agent �`AR l C_ �' �-o 30' Date... .......:.. ........ M NpnTti TOWN OF NORTH ANDOVER g pEs��to ,e,ti0 0 �; PERMIT FOR GAS INSTALLATIOW ♦ � ,` a ACHUSEtA� in i This certifies that . . . . . . LOzz . ,. has permission for gas installation . . . . . . . . . . . . .. . . . . . . . . . . ... . a in the buildings of . . . .. . . . . . . . . . . . . . . . . . . . . .. . ... . . . ... . .. . at . . . . . . ... . . . . .f. . r. . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . . .`.. Lic. No... . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File MASSACHUSETTS UNIFORM APPUCATICN FOR PERMIT TO DO (Print or Typed NORTH ANDOVER, Maas, Data y10—LLBuAdI3 _ na _ Pemt Location �I k9i �— er, Nam ame New Renovatlon ❑ Replacement ❑ Plans Submitted: Yea❑ No ❑ FIXTURES • s >t w w s Is f' w =Z a W r C y !• M w � ! l X11 J w w w = w M� U w >t < • " L N �� U s o me ar s o = e s = a<r e 0 a awl s �' F• y f C C J w r-' a oos s v w ! _ , ► u s oow `\ ► l a i 1,- sua—ssMT. aasa,eaNT IST FLOOR IN* FLOOR 340 FLOOR 4TH FLOOR STH FLOOR STH FLOOR. TTH FLOOR STH FLOORiEL— IJ -5)�/_�, ��O � Check one: Carilnuie Installing Company Name ❑Corp. Address <, r� L �/� ❑Partnership cf>eee;—'/L'GPiftrm/Co. Business Telephone YISO .Name of Licensed Plumber�/���h'/�P` O �� INSURANCE COVERAGE: ecx one I have a current Ilablity Insurance policy or Is substantial equMalenL Yea 9�, No ❑ It you have checked yn, please Indicate the type coverage by checking the appropriate box A IlablRy insurance policy ❑ Other type of indemnify ❑ Bond ffr--� 0 lw? 'S INSURANCE'S NSURANCE WAIVER: I am aware t the licensee does not have the Insurance coverage required by C er 1 2 ass. Den ra) ws. IV41 my signature on this permit application waives this requirement. Check one: Owner ❑ Agent aluta of e►or Owns s/gent 1 hereby amity that sit of the details and InImmatlon 1 hays submitted forIL�nse VNumbw n are true and accurate a best of my knowledge and that cif plumbing wok and InstaAatlons performed ur>darp8cat)on be R with aA pertinent provis)ons of the Massachusatts State Pfutnb4v Cade and Ma 19Y sod PW ben Title A;:1D T CttylTown Af'f'i1MED(OFFICE USE ONLY) Journeyman of Plumbing Ueense: Journeyman lam'