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Miscellaneous - 1600 OSGOOD STREET 4/30/2018 (84)
30 :7 rsab® Omdm$TmbFddms Sox LorgarLobotArea I 111 I i i I I V i i r w T� rSuperTab. OverSbg&Tab WKS 90%Langer Label Area ' •" N S M EAD t KEEPING YOU ORGANIZED Na 10301 ftamp aft"InUSA � GETORGANIZEDATSMEAD COM Date . ./,V-3-tZe.. . bU TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . has permission for gas installation . . . . in the buildings of. . .�t� .�..�� , (,!. . . . .1.�.<.� . . . . . . . . . . . . . . . at . . . . �a �l ,North Andover, Mass. Fee . _our . . Lic. No. . p�?'� GAS INSPECTOR Check# 8351 f Q MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ipCITY AV,_ �cJ I� _ MA DATE fv_ Z - `y PERMIT# JOBSITE ADDRESS 6!� jk 2& _ OWNER'S NAME I. Nn ul•� /! __ GOWNER ADDRESS TEL[= FAx TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL Q PRINT CLEARLY NEW: RENOVATION:0--' REPLACEMENT:Fj PLANS SUBMITTED: YES F-11 NO_-[] APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I~ �-P1 �L 1 _. I I �_. I i _ _!( I h 1 I l--T. BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _-_(L_—: -- -- -1 _ FURNACE _ I_...... I� - !f w L_�_�_:I__1 _.-_�[f ►C_- J C� -2 -- - - GENERATOR GRILLE INFRARED HEATER ( ... __ - _ �z LABORATORY COCKS L---- 1 MAKEUP AIR UNIT OVEN ) POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST -A --- 11T�.__I r:,=. i-1 ___! I i_;..__I I_--I!_T_J i UNIT HEATER I I _ _ ( - UNVENTED ROOM HEATER (�_v jj L f'__.. I __ i___.. _._r I .._ i, !_._ I___ I_.- .f r 1^L.. .. .. I • WATER HEATER �—�� -�� " (I-� _._J I_.� 1 L�---1'-----.1 i ....-,_I% _1 i,.� _I I-, ..I I �_. 1�.-.�,.[h� .----- '---� OTHER 1. '—moi I INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YE 01NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLIC _I OTHER TYPE INDEMNITY Q BOND I _( OWNER'S INSURANCE WAIVER:I am aware that the I censee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0-1 AGENT ._._. SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accur a to th best f my'k ow dge and that all plumbing work and installations performed under the permit issued for this application will be in compl' nce ith al Pertin nt pro isiA. f th Massachusetts State PlumbingCode and Chapter ap er 142 of the General Laws. PLUMBER-GASFITTER NAME ,1 S i -ze(,,�- - f LICENSE# JcSIGNAT IVINO MGF[- JP n JGF 0 LPGI 0 CORPORATION - 3 fF PARTNERSHIP 0#� ( LLC 0#= COMPANY NAME: ADDRESS --- _k « CITY ,y 2 ,-._— '� STATE=ZIP[ TEL _d � FAXU. 7 a_ qFGf) CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION N TES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES . 3 d r • The Commonwealth of Massachusetts Department of IndustrialAccid&ts Office of Investigations qu 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information `� qq ,��'"^ ' D QPlease Print LeLibly Name(Business/Organization/Individual): 1\1 (� ALII'l� U" �1.,— Address: 67 G 2 "y City/State/Zip: L,� V ece C, Phone#:_ �W 6(F7 -f (4_ Are ou an employer?Check the appropriate box: Type of project(required): L V�l am a employer with Z2- 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they ate 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 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:. A o L 1 Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office sof Investigations of the DIA for insurance coverage verification. Ido hereby cerci u der e pins a d e It s of perjury that the information provided above is true and correct. Si ature: 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#: • 4 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 ofhire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth o£M-assachvsetts Department of ln.dustrial.Accidents Office of Investigations 600 Washington Street Boston?lam.02111 TeX,A 617-727-4900 ext 406 or 1-877�,UASSA.FB Revised 5-26-05 Fax##617-727-7749 www.mass,govfdia COMMONWEAL)h OF MA��Hi F�J.S�-t rs PLU.MB�:RS ARID GASFITTE'RS L l"EN SEa AS A fl'(ASTER PLUMP ISSUES THE ABOVE I ICEN9E TO,. 'i 7,0 CONTROL# H360973'H360973' IMPORTANT If this license is lost or destroyed, notify your Board at the: i Division of Professional Licensure, 1000 Washington St., Suite 710,Boston,MA 02118-6100. j If your name or address shown.:is changed, notify your board of correct .)�Mp. or address to insure proper'.mailirtg::,of next Renewal Application:`Always;refer to ;youC Jicense,number., This license is subject to the:pro&isigns of.the Genera(Laws as amended. It is a personal privilege,and must not er loaned or. assigned to any other-person. Keep this licenwori your: person or posted as required.by law. - r t r .r j { 1 lr Location l�oOD USS -Y No. c1 '�1 Date l 3 3 * • TOWN OF NORTH ANDOVER u . Certificate of Occupancy $ " r� k � ` • Building/Frame Permit Fee $ Foundation Permit Fee $ r, Other Permit Fee -5� $ &0 TOTAL $ t Check#, k ' 26367 � 'r -Building�IAr, spec o NORTH � Q .1-0-to 16 t 0 o TOWN OF NORTH ANDOVER coc"IcO wN w rEDy SIGN PERMIT a � 9SSACHUS�� i DATE: May 7, 2013 PERMIT: S029-2013 THIS CERTIFIES THAT Ozzy Properties — Network Allies Suite 2100 has permission to erect a sign on 1600 Osgood Street - 48"x180"xY Network Allies —Collaborate, Innovate, Integrate, Succeed — All aluminum frame with % inch raised PVC cut letters, stud mounted. Background is blue with silver border and blue and light blue letters. provide that the person accepting this Permit shall'in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section #6, Voids this Permit. _ INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspector of Buildings Amount Paid:$48.00 Check 16061 Receipt 26367 ca SIGN PERMIT APPLICATION t.•• 1600 Osgood Street Building 20, Suite 2-36 TOWN OF NORTH ANDOVER Site Owner PC—o-r-C G—S < Applicant t �J Tel W(,3,-31Z-372_( Site Address C1&G06"O 157— Size of Proposed Sign L(e) X l W'< 31 Map Parcel Illumination: a Not illuminated How attached: a) Against the wallMe�•e�✓.�r ` -n�s� Y b) Internally illuminated b) Roof c) Externally illuminated c) Ground d) Other Materials:et L PrCu`nn ✓�aif. '�2Pctfk.�_ r� �/ � Proposed Colors: Background ud 7/it",�_S'4 PVC_ c"ik U�s M4x'-x—aj Lettering Border S k LUC--'L Cost of Sign 3 15°Q ,/ `1"Q_ Required Attachments: Note: No permanent/temporary sign shall be erected, or enlarged until an Photographs of building application on the appropriate form furnished by the Sign Office has been filed Material sample with the Sign Officer containing such information including photographs,plans Color sample and scale drawings, as he may require, and a permit for such erection, alteration, Site or Plot Plan (Required for all free-standing signs) or enlargement has been issued by him. Such permit shall be issued only of the Drawings of proposed sign Sign Officer determines that the sign complies or will comply with all Other, specify applicable provisions of the By-Law. Will sign overhang any public road or walkway Yes ( ) No If Yes,Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FIL Receipt# TG513TCheck# Revised 10.31.200617orm Sign Permit Application RE OFPLI ANT APPROVED BY CC�� ��l �s � �G�� � ��, �v.�,. �f e w{ �`l �ss�� ���� � %�-��� �� � ��x `��---- Network Allies edlabmrte Im�w a limgrrte succeed � k in— 4'raisetl silrer --- -- 173 in—_. _. metallic border �I 7'Raised Matthews Silver fail tenant signs) E j 1/8"angle frame } dimensional n tenant text II cl 1 i� z ra m eu6tem tenant N etwo rk AI I i es batl grountl(all tens t signs) m o ! Fellow brick building —•l fascia � I Collaborate.Innovate.Integrate.Succeed. FROM CUSTOMER CHANGED TO SPECKS TO LEFT o Network Allies date 4-12-13/10-26-12 0 designed by J Novak/Kevin Hansen Osgood Landing N Andover file name HAVERHILL,MA 979-37z-3721 Sales Associate Matt Rothwell details 2"x 1/8"angled frame Aluminum Pan Painted Silver 1"White Aluminum Pan Sign Mounted on Top w/3/4" Letters Painted 3M Sultan Blue MP2136 and 301c to match printed logo w/Flush Mounting 26"x 26"x 1"Aluminum Pan"Logo' first surface digital print on HP w/Luster Lam bracket for mounting Composer3 5/3/2013 1:49:06 PM Scale: 1:2.69 Height: 16.000 Length: 21.333 in c 013 i a nor sum 77 14 4 C c_ ^ �' ✓� _. ' y e Y w� P _ w ^ r _. s,t r Mot r a s a S x " r a i �q 4 J r Date . . . - � �YMCL7?b�6qs TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . . d �! .`. G- . . . . . . . has permission to perform . . . . . . . .'. !!.. . . . .!!. .. . . . . . . . . . . wiring in tbe,building of � wd�� _.t7i�.�. . . . . . . . . . . ®D ��l�s: 2-013 at . . . . . . . . . . . . . . . . . .� . . . . . . . . . . . . . . . ,North Andover, Mass. ..Lic. No. .IO ELECTRICAL INSPECTOR Bieck f ` � 'i020 AwwjioaffatreaiCona cert Ptrc aervices / Occupancy and Fee Checked ;! BOARD OF FIRE PREVENTION REGULATIONS Rev. 9/051 lava blank � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with dw Maaachusens Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL MORMA770N) Date: TE _. 17 _ea 6 `L City or Town of: Nn , A N pV e--p To the lnspeetor of Fires: By this application the undersigned gives notice of has or her intention to perforin the electrical w k described,h,elow. Locadon(Street&Namber) � � S , 6. 2: i 7� Owner or Tarot Telephone Na ds 1D Owner's Address is timis permit in conjunction with a building permit? Yes No (Check Appropriate Boz) .. ... ....._____9. -._.___ - Purpose of Buil �a C�rte,.►-,r-y.�.(M Utility Auaar;zatior,No. ��� --- Existing Service Amps / Volts Overhead❑ Undgrd❑ Na of Meters New Senrice Amps / Volts Overhead❑ Undgrd❑ Na of Meters Number of Feeders and Ampachy London and Nature otPnepoted Eleetrkal Worldrr2Yl- x- -CmPkiton Of tLbfioft table maybe watwdbv dwhapedw Mbu No.of Ren sed Ltmabbilres No.of cell-sa p.(Paddle)Faris No.of Teow Transformer KVA Na of Laduallre Ou" Na of Hot Tubs Generator KVA Na of A live o meLigisting Luminaires Swimming Pool a ❑ d. ❑ Banc Units y Na of Receptacle Oatleb No.of 01 Burnett FIRE ALARMS No of Zones No,of switellrea Na of Gas Barren a of Detectim and Initiating Devioa. No.of Rang" No.of Air Cond. Tons tal Na of Alerting Devices Na of Waste Dbposers at PumP .. um r _ons _ a of on Totab: - Detection/Ale Device Na of Dishwashers Space/Area Hating KW Local❑ Connecdoa ❑ Other No.of Dryers Heating Appliances KWSecurity Syysttems:* No.of Devices or E uivaleat No.of Water , No.of Na of Data Wiring: Heater Sim Ballasts Na of Devices or E uivakat 1, Na Hydromassage Bathtubs Na of Motors TOW HPe{� or EqtdvakW OTHER Attach additional detail i>'d mdre4 oras required by the Inspector of Wiens. Estimated Nalene of DVork: 221c�1u=--eyxnen required by municipal policy.) Work.to_Start: ._. .. _ _. taomts.to.be.. � _ _-.Inspec requested in accordance.with MEC Rule 1.0,and.upon completion. -... ----D(SUR414C- GA . [J ess-waived-b -th"%mer---no . y pertain for the performance of electrical work may issue-unless-the-laceusee- . . -.._ 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: INSURANCEyE�BOND ❑ OTHER ❑ (Specify:) I terrify,render the pr m and of perjury►that the Wormation on#U&aRpUcadon is true and compkta FIRM NAME: �- /!=' ^'t�,�,' ,p LIC.NO.: G �" Licensee: r.r^ Sigusturc IC.NO.: (If applicable,enter"exempt"In 1he license madber line.) Bun.Tel No.: ' Address: � )' Le, Alt.Tel No.: CC`Z _4�l 5—S�j GGA CC 'Security System C ntmctor License required for this work;if applicable,enter the h number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hove 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. S ��� � �3 �� � 3d_ ��, �� �� to--/�_ �z �°� - Print 1=orrra 3,'. i Z The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Leonard Electric,Inc. Address: 154 Fletcher Street City/State/Zip: Lowell , MA 01854 Phone#: 978 937 8620 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 20 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction ' 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition r working for me in any capacity. employees and have workers' coin insurance.: 9• E] Building addition [No workers' comp.insurance P• required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3. officers have exercised their I am a homeowner doing all work 11.❑.Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[1 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Phoenix Insurance Co. Policy#or Self-ins.Lic.#: UB2733R731 Expiration Date: 6/30/2013 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the ains and enalties o !: 'ury that the information provided above is true and correct Signature: Date Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Date TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . L. has permission to perform . . ./I/ 4.{nn,�ro2 wiring in the building of . . . .To.P.!5. . . . . . . . . . . . . . . at . . '�a?��5.�� .S T. . . . . . . . . . . . . . . . . . orth Andover, Mass. Fcr`� (2Sp "Lic. No. . . .t4��34. . . . . . . . . . . . i ELECTRICAL INSPECT rR Check 11140 Commonwealth of Massachusetts Official Use Onlyl Permit No. 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 . C),527 CMR 12.00 PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:&71,9 �l x ( 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&O Q S BOO D AV AO er k Q 1 j e5 Owner or Tenant A�•i-Warr k ( t 1 t of Telephone No. Owner's Address W►l� Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building CoM rt C/a( Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity L ' Location and Nature of Proposed Electrical Work: (�/�V 1 T )L loo +t 1-1{u -` xd A A- Com letion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Ig tmg No.of Luminaires Swimming Pool rnd. E] rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices • No.of Waste Disposers HeatPump Number .Tons KW No.of Self-Contained Totals: Detection/Alerting Devices MunicipalE] Other No.of Dishwashers Space/Area Heating KW Local ElConnection Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or E uivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP 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: 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 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: . /vl t/ �lec C- LIC.NO.: Licensee: 4le Ae J 1,9f'S Signature L( LIC.NO.: (If applicable,enter "exempt"in the hcenseAtumber line.) Bus.Tel.No.&3 Address: JiG (-et W S41 leg t N ff- Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security wok 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. a r , .- • �JU�1UV�c7�'�t�yr��iJ��.'C�IY.J7.'�0.`�Y'py'(��y'p^y��r�t J..l��J: UJS.*.�.47.1I.`C+��®J�`��� . Mclop�=Mqxts: OJ.Ye--F ' (crisp catoxs"isignatuxe-.,ao als} date .�+'�iV'.c sp—lzc ox; �'assec�-- •Failed--� � � �t�ins�ect�ox�xec�uixe�($50.00)-•[ � �n�pectors'c znm.extts: . (ffisl edorgl gigna e-..o Wflals) )late S,my'p,GnOm)WSRACT`ZO,I.y': 'assed--j I ailed--j ate-znspeetZo�xec�uixe ($ 0.90)�[ nspectors'comments: , (-�nspectoxs� ignatuxe- o�iut?as) ))ate j CA X; X e+0N'AI C-900 : WA-A IB: ssed.--j I Meci--j a �e znspectzon xequi�ed($50.OD}�[ � ,,�ectbrs�eoJanme�tfs: . @5aspectors',fzgatune-io jnitials) Pate e��-� � c+,'azXec��-•( �. 'ate�nsp action ze0uixed($50.0 D)-•[ � actors'co�.itxn.erits: _ S ' ftuspectox ' zgnatQxe xtonitzals} date ' r�4�a-.�. �.r.-.. •...�..^..ter r....ti—r•.-�--IY Yr r..�i..-. •u.�-..........�......�....-.w�....r�. •amu• .tea.-.w+....w+r.•....-.....�—.._..� �.�....._ 1� 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 si www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Legibly Name (Business/Organization/Individual): C� Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑Is I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E] 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 me in any capacity. workers' comp.insurance. 9. Buildin addition [No workers comp.insurance 5. El We are a corporation and its ❑ g 10.[:1 Electrical repairs or additions required.] officers have exercised their P 3.[:11 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am vn employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insuraltce Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Siznature: Date Phone#: Official use only. Do not write in this area,to be completed by city or town official. - City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 1 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Devised 5-26-05 _ - __,,: • Brian Leathe Local Building Inspector Building Department Town of North Andover 1600 Osgood Street I Bldg 20 Suite 2-36 North Andover,MA 01845 ph: 978-688-9545 fax: 978-688-9542 Bleathe@townofnorthandover.com Office hours:8:30 am—10:00 am,1-2 pm •�� c •� �� � � e � �� �5 s�b�L>�-I �� r0�t,�—t- CORNERSTONE ARCHITECTS,, INC. r-- September 7, 2012 Mr. Brian Leathe Inspector of Buildings 1600 Osgood Street North Andover, Ma. 01845 RE:Network Allies 1600 Osgood Street North Andover,Ma. 01845 Dear Mr. Leathe, This letter is in regards to the above referenced project's fresh air intake for the Burn Room area. This room will be used to monitor their products in a temperature controlled room with temperatures between 50 and 85 degrees during varying time limits. There will be a computer control system that can be programmed to fluctuate these temperatures and be monitored remotely. The only time an occupant will be in the room will be the place or remove equipment within the room, or to check on the equipment. There will be no long term occupancy of this room. In order to properly control the temperature of the room the fresh air ductwork that presently feeds the space off a VAV box will need to be eliminated. We are requesting that we be allowed to eliminate the fresh air intake from this room If you should have any further questions or concerns please do not hesitate to call Very truly yours, Charles A. Cochran Cornerstone Architects, Inc. f Cornerstone Architects, Inc. 8 Calista Ten-ace, Westford, MA. 01886 Tel: 978-399-0240 Fax: 978-399-0260 Email: cacncornerstoneas-chitects.com CORNERSTONE ARCHITECTS INC. 8 Calista Terrace Westford, MA 01886 (ph)978-399-0240 (fax)978-399-0260 VAV International Inc. CONSULTING MECHANICAL ENGINEERS 400 WEST CUMMINGS PARK S.4700 WOBURN, MASSACHUSETTS 01801 (781) 935-7228 FAX (761)935-1822 WWW.VAVINT.COM ('35) 1 -T1 1✓JI _ _ _CSO F 9 C ! 501 CFfa. I r AC S I 1 t J 24x18 18X 1 1(BELOW CE#lL III ) 1j 1 24x24 R'. C CONDENSAtE PUMP FIELD ETE,MIN F EXACT 1 600 CFM _ BOND SATE DJSCkIASG I Project Name: 1 Acc , � i �•�r: _ . ;>;� � ac � � 1 LOCATION. x —REFp Paelop RFRIG. PIPIN Ob ROOF) NETWORK ALLIES 1 (ON RO F) BUILDING 30-2 FIELD 12x1 CD 1 FABRICATE i ! 1 R.A. PLENui + I 1600 OS600D STREET 1(LINED) f 16z t 2 — Y j I — i NORTH ANDOVER,MA 01845 1REFRl Fcu I II I ! � I Date: SEPTEMBER 7,2012 i k ! f�ilGz—P�£J I F< 91 s I' Scale: 1/8" = 11-0" � �NDENSA'i`E PUMP � � 1 2 2 TEFA?ERAIURE CONTROLLED ROOM X ON RDFr ' Drawn by: PM —�� {{BELOW-CEIC1NO ! - - - - - - - - - - - Checked by: PR Project Number. 2012-045 Drawing Number A PARTIAL SECOND FLOOR HVAC PLAN SKmM2 StM2 SCALE: 118" = V-0" STATEMENT OF PROJECT COMPLETION—ARCHITECTS N.ANDOVER MASS. Project Number 1217 Project Title NETWORK ALLIES Project Location 1600 OSGOOD ST. Nature of Project—Interior renovations for new office space and production area second floor In accordance with Section 116.0 of the Massachusetts State Building Code. I, Charles Cochran Registration No #6__ 559 Being a registered professional architect have prepared or directly supervised the preparation of all design plans,computations and specifications for the above named project. These plans, computations and specifications meet the applicable provisions of the Massachusetts State Building code,acceptable engineering practices,and applicable laws and ordinances for the proposed use and occupancy. I have done the following: 1. Reviewed for conformance to design concept.shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Reviewed and approved the quality control procedures for all code-required controlled materials. 3. Been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work was being performed in a manner consistent with the construction documents. I visited the construction site during the building permit application process,and/or sent other appropriately qualified design professionals,and detennined to the extent possible that the work was done in accordance with the documents submitted with the building permit application,and the applicable provisions of the Massachusetts State Building Code. Signed /jOW/n �J Rea agcy•` v(? CHARLESA. ¢ COCHRAN C14 Date Y No.6559 wESTFORD r A o MA �Jy ��►�ql rN Of MpSSP���� JEW ti� �� i MECHANICAL FINAL AFFIDAVIT I To the Inspectional Services Commissioner: Re: Network Allies - Building 30-2 I certify that I, or my authorized representative, have inspected the work associated with Permit No. , dated / / locus 1600 Osgood Street, North Andover MA 01845 Ward (on the dates used below or on at least 1 occasions during construction), and that to the best of my knowledge, information, and belief the work has been done in conformance with the permit and plans approved by the Inspectional Services Department and with the provisions of the Massachusetts State Building Code and all other pertinent laws and ordinances. Peter Radzim—46907 I"OF . ENGINEER-MASS. REG.NO. PETER G. o RADZIM VAV International, Inc. MECHANICAL COMPANY No.46907 400 W. Cummings Park, Suite 4700 N L ADDRESS to/t2/1z 781-935-7228 PHONE Final Inspection Date: October 12, 2012 Then personally appeared the above-named Peter Radzim and make oath that the statement by him is true. Before me, Frank Stramaglia My commission expires February 21, 2014 E FRRANCI—J.STRA►fiAAGUA Notary Public COMMONWEALTH OF MASSACHUSETTS My Commission Expires February 21,2014 �--� New England Fire & Sprinkler Protection, Ince P.O. Box 212 N. Chelmsford, MA 01863 (978) 452-2895 (978) 251-8643 Fax OCTOBER 9, 2012 NORTH ANDOVER FIRE DEPARTMENT 124 MAIN ST. MANDOVER, MA 01845 ATTN: LT. MCCARTHY (978) 688-9590 (978) 688-9594-FAX ISE: OZZY PROPERTIES TENANT FIT UP 1630 OSGOOD ST. N. ANDOVER, MA NARRATIVE THE WORK TO BE PERFORMED IS AS FOLLOWS: A) AREA (A)-RELOCATE UP TO TWELVE SPRINKLER HEADS B) AREA (B)- PIPE OVER AND ADD UP TO NINE PENDANTS 3RINKLER HEADS TO ACCOMADATE NEW DROP CEILINGS C) AREA (C)- PIPE OVER AND ADD ONE SPRINKLER HEAD TJNDER THE DUCT WORK D) TIE IN 4" MAINS IN ZONES M-14 AND M-6 TO THEIR EXSITING RISERS ALL WORK TO BE PERFORMED TO N.F.P.A. 13, AS WELL AS STATF AND LOCAL CODES. SIN�CERQEL , TED FLANDERS VICE PRESIDENT NEW ENGLAND FIRE & SPRINKLER PROTECTION INC LICENSE#: SC-000423 �-� twinmvuwcarin w i•ia��a���u�cu� -------- --- ----� �„ Permit No. c` 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 Cod (MEC?,527 CMR 12.00 y (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: 1 2-012010 City or Town of: NORTH ANDOVER Yo the Inspector of Wires: 7� By this application the undersigned gives notice ofhisor her intention to perform the electrical work described below. Location(Street&Number) two ®S �oa� St• wa Lq"i6v,k At ti 2-o, 1, F(_ca Owner oenan L)K l i- 3 !-S QS Telephone No. Owner's Address bck� a.J4 St. t 2 U 061-2-oil Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building MC,�L< Sp 4c{ Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: tV 1'2 C 2 e D ct CV ng table may be waived by the Inspector of Wires. " No.of Total Transformers KVA Date....... -.c .::. ... Generators KVA f NORTq o.of Emergency Lighting 3+°•'.�'�- "°oma TOWN OF NORTH ANDOVR Batte Units E Y F s FIRE ALARMS No.of Zones . PERMIT FOR WIRING No.of Detection and ,: InitiatingDevices sAcMus�� No.of Alerting Devices No.of Self-Contained This certifies that Detection/Alerting s /-� tion/Alertiri Device .............. .:......(.. ..t :.�;.t •T�6�.............. Local[:] Municipal ❑ Other .... ........ Connection has permission to perform r'Z� C� c — � , Security S stems:* "�-- "'•'••" No.of Devices or Equivalent wiring in the building of...0;ZZ� ... ....................... ........... ........ .. . o-3......................... Data Wiring: No.of Devices or Equivalent . .. S 3 c at.......€;rpo as .....- -_5' Telecommunications Wiring: .................... .•,.. .....,North Andover,Massa �'-') No.of Devices or Equivalent Fee..................... Lic.No. ELECTRICAL INSPE R Check # if desired, or as required by the Inspector of Wires. nicipal policy.) i MEC Rule 10,and upon completion. xformance of electrical work may issue unless t e icensee prove es p coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) I certify,under tlt pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: M f LL ECrcftli C L'c,- Mo c LIC.NO.:I Licensee: U)C- 4 Signature LIC.NO.:`4- (If applicable, enter "exempt"in a license number line. Bus.Tel.No.:1 ©3'7L5-`t 722 Address: 1. Z 'Re % Ave. $.�� N � � �, a 3y`ilf 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 Owner/Agent PERMIT FEE: $ Signature Telephone No. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: I -IDate Received Date Issued: IV IMPORTANT:Applicant must complete all items on this page LOCATION ' Prin -- PROPERTY OWNER '�� .J012�C- �l/G�' �� Print 100 Year Old Structure yes o. MAP NO: �4PARCEL:_�I ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District o Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: e0131C10 l 'Ili? C c S / Phone: /28-- a60- /-)C;�/ 1/ Address: /214- � 1luvc Supervisor's Construction License: Exp. Date: LHome Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA ED ON$125.00 PER S.F. Total Project Cost: $ �,s00 FEE: $ Check No.: �2-- Receipt No.: NOTE: Persons contractin -th nregistered contractors do not have access to the guaranty fund Signature�of Ac HS Signature.of contractor Plans Submitted ❑ µPl� aived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ 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: Located 384 Osgood Street FIRE DEPARTMENT = Temp Dumpster on site yes rio Located at-1N Main Street. Fire Departmentsignature/date • T 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.$10041000 fine NOTES and DATA— For department use ® Notified for pickup - Date s i Doc.Building Permit Revised 2010 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 o Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan Li 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit ._ i 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 i Doc: Doc.Building Permit Revised 2012 ' II Location 017 �l� ��' t YLL No. �� Date1C) �Z 1 * TOWN OF NORTH ANDOVER • �ufi1'1,IU I��,�` • ., Certificate of Occupancy $ =' Building/Frame Permit Fee $`f-7.0 Foundation Permit Fee $ ► � Other Permit Fee $ TOTAL $ a Check# 32— 1� 25829 Building Inspector NORTH Town of � �, Andover O �r - No. d h ver, Mass, ACVI5 2612o. T o COC NIC eWICK y�• 77 V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .. Z ..�.. +�. ..,�, �,� 4 BUILDING INSPECTOR . .....Z. ...... . . . .... .... ....................... Foundation has permission to erect ........................... buildings on ..�. .... .. ••••• P............••••• Rough , ...... Chimney to be occupied as .. "0402 ............................................................................................. provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. _ PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough •.. • Service ............... ...... .4:::::.:`: ......::`."':-............. ....•• . Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Corrspicuo-us Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and. Approved by the Building Inspector. Burner Street No. Smoke Det: SEE REVERSE SIDE 1 cubicle connection inc. Estimate 13 Lyman Street Beverly,MA 01915 Date Estimate# 10/11/2012 1081 Name/Address Network Allies 460 059,0 d S 1U,/). A,Al O&C /N0 O/RYS I 'I Project Description Qty Rate Total CCI to KD and reinstall 22 workstations per customers request all work to be completed during reg.business hrs.$3500.00 I 41 9/C—�" 1 I i i Total �� ACd® LNP CERTIFICATE OF LIABILITY INSURANCE Ro54 10-11.20112 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATIONIS 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: PAYCHEX INSURANCE AGENCY INC PHONE FAX 210705 P: O - F: (888) 443-6112 EMAILe, Ext): (A/c,No): (8 8 8)443-6112 PO BOX 33015 ADDRESS: SAN ANTONIO TX 78265 INSURERS)AFFORDING COVERAGE NAIC If INSURER A: Sentinel Ins Co LTD INSURED INSURER B: Twin City Fire Ins Co INSURER C CUBICLE CONNECTIONS INC INSURER D 13A LYMAN ST BEVERLY MA 01915 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSRTYPE OF INSURANCE OD SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER /MM/DD/YYYYI (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1, 000, 000 COMMERCIAL GENERAL LIABILITY DAMAG TO RENT S 1 000 0 0 0 PREMISES IEa occurrence) r r A CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10, 000 X _General Liab 76 SSU IV2443 07/28/2012 07/28/2013 PERSONAL&ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE S 2, 000, 000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2, 000, 000 POLICY � PRO- 1:1 LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ❑ ❑ BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1, 000, 00 0 ._ A EXCESS LIAB CLAIMS-MADE 76 SBU IV2443 07/28/2012 07/28/2013 AGGREGATE S 1 000 000 DEDX1 RETENTION $ 10, 000 S WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X TORY LIMITS ER ANY B OFFICER/MEMBER RXCLUDED?XECUTIVE❑ NIA ❑ 76 WEG EU1185 07/30/2012 07/30/2013 E.L.EACH ACCIDENT $ 1,000, 000 (Mandatory in NH) 1, 000, 000 E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1, 000, 000 11 El DESCR/PT/ON OF OPERATIONS I LOCAT/ONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if mom space is required) Those usual to the Insured' s Operations . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Network Allies LLC DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1630 OSGOOD ST AUTHOR/ZED REPRESENTA TIVE < NORTH ANDOVER, MA 01845 �_ j� 0 1 988-201 0 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD