Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 1600 OSGOOD STREET 4/30/2018 (15)
/ 1600 Osgood Street- Ozzy Prop Utility Permits 1 Date.�//..I I f NORTI� a?;•';�`"-:°1"°O� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING s i � • S�tHusf This certifies that ... . �. -,.4...... has permission to perform ...... ?`�f .l ... E' .l. .... .:,�.:.�,f .Q. � .. y Wiring in the building of. ............... at. .. .....: .. ...................North Andover,Mass. Fee �qq 0. /� OS .l.�.......... Lic.NoF`�..�. ��..... .......... . . ........ ELE ICAL INSPECTOR y Check # 58 � � 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 througho.rt 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 firm or corporation stated on the permit application. Such entity shall be responsible for the electrical permit shall be issued to the person, 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.invalidzfhe___. ._ 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 entitystated on the permit application. n 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 15,30a5 and extending"through August 15,2012. EED Rule 8—Permit/Date Closed: ` Note:Reapply for new perm�' /Permit Extension Act—Permit/Date Closed: Oficial Use Only `y Permit No. t � '0/f 1Z Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 ` (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (0-16-01 City or Town of. N. Nn1Dr.�VLV, 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) 160q 0SC306D ST. Owner or Tenant 'QA-tS-rATfc, 'Tai%r-'.iEL Telephone No. Owner's Address SA^+t Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box) Purpose of Building _Fy1EL T'R,MINAL. Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ Na of Meters New Service Amps / Volts . Overhead❑ Undgrd ❑ Na of Meters c Number of Feeders and Ampacity �et1`�►� g AkST1,jG aeo A6q,4T6 V, 1J FiLbgR. ERS m COOGaG 'Rvy>ER M Location and Nature of Proposed Electrical Work:.{, a6W -a (AN{.RoL Ski . Tn1s}All foR/8�30 AiP "it-, tl to kJA po\atA. �W46A V,R Slt,V-SsAu.-rs + 9b+�.4Pr& Nc S to s Am IAADiac, -R c-Completion of the ollowin table ma be waived by the Inspector of Wires. Na of Recessed Luminaires Na of Ceil.-Susp.(Paddle)Fans No. of Tota Transformers KVA No.of Luminaire Outlets Na of Hot Tubs Generators KVA Na of Luminaires1 Tw�a 11'1 W Swimming Pool Above F1 - ❑ a o Emergency Lighting 'takt LIG AT g rnd. nd. Battery Units No.of Receptacle Outlets Na of Oil Burners FIRE ALARMS I Na of Zones Na of Switches Na of Gas Burners o.of Detection an Initiating Devices Na of Ranges Na of Air Cond. Total Tons No.of Alerting Devices Heat Pump Number Tons _ o. oSelf-Contained Na of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW uritySystems:* Na of Devices or Equivalent No.o afar KW a o a o Data Wiring: Heaters Signs Ballasts Na of Devices or Equivalent Na Hydromassage Bathtubs Na of Motors Total HP Telecommunications iri,igg: Na of Devices or E uibalent OTHER:314A[I 6k TAOW, MaNA4R LtvCL S&3sq R oU1ERFkI Alftm. ?�I �i1 l?atl�T '�v,�a -�4 kitsk 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: !o- a a-05 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'EE*'BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: 'SSSf.�A F_Lf c-TRIC. SEROc-E s c.WRp LIC. NO.: 14/7a OS Licensee: -3'oA,4 CAi?i'rumi"t Signature „Z: LIC.NO.: 0 de- (Ifapplicable, enter "exempt”in the license number line.) Bus.Tel.No.: 197 Address: T.0• "&-i c11 O M I bbLE TON /'fes 4 6194 q Alt.TeL Na: *Security System Contractor License required for this work;if applicable,enter the license number here: 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 Sivnature Telenhone Nn. PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl X ELECTRIC SERVICES CORF Name(Business/Organization/Individual): ESSEa n. QonY 910 Address: MIDDLETON, MA 01949 City/State/Zip: Phone#: 97,f-4,1/4-y170 Areyouan employer?Check the appropriate box: Type of project(required): 1.z I am a employer with l0 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. Building addition required.] 5. ❑ We are a corporation and its 10. Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomnation. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors 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: ST• 4Wt. lCliLE f A492/AAE Policy#or Self-ins.Lic.#: =tuaA0 ba 1J lo510rj Expiration Date: A" Job Site Address: 1[Co0 OSGosD Sr City/State/Zip: N, AND4J fA AAA 61*45 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 unthe airs and enalti s of perjury that the information provided above is true and correct Signature: Date: 6- 14-01 Phone k Q7,F- to 4-y/1 b Official use only. Do not write in this area,to be completed by city or town official, City or Town: IPermit/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#• 2 Date....il::..�..�1........... NORT TOWN OF NORTH ANDOVER PERMIT FOR WIRING CH This certifies that ............. !t n.... ............. ................. has permission to perform ......9...eolw....DIP P./ V.......... wiring in the building of... ...... at.... .....Sr..... North Andover,Mass. ....... Fee lz� Lic.No. ....... Check # Lu.ar a..au�.a.la.aavla1 1V111111IL(�4V�1VJ�rLL• —_—--_ ---I--- 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 maybe.deemed-by.the_luspector_of_Wires abandoned_and_invalid_if he—. ._ or she has determined that the authorized work has not commenoed 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 effector 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: �, l.00nwe o� a8aae�ruasfle Official Use 0/nly Permit No, 9962— 2— ..C.1eParbKes<t o��1ry �irvkea Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In woordartoe with the Masmohusotts Electrical Code(MBC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date; City or Town or; a4r?,�- 4 To the Inspector of Wires: By this application the undersigned gives notice o his or her intention to perform the electrical work described below. Location (Street & Number) :%7- Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Eii3dog Service Amps / Volts Overhead ❑ Uodgrd ❑ No. of Meters New Seryice Amps / Volts Overhead ❑ Uudgrd ❑ No. or Meters Number of Feeders and Ampaeity Location and Nature or Proposed Electrical Work: /tiel?144 Cld6 44w� iy �Pvvn-t Completion of the mlowing(able=be waned by the Int ctor o Wires No. or Recessed Lurnlosirw Na of Coli.-Sus (Paddle) Fsas a n eta P• ) Transformers KVA No. of LuminalreOtttleu No.of Hot Tubs Cenerstors KVA -Above CD in---- o, or Emergency tg eng No. of Luminaire Swimming Pool rnd. rnd. Battery Units No, of Receptacle Outlets 6q No.of OU Ruroers FIRE ALARMS No. of Zones No. of Switches No,of Cas Burners o.o e oct oo and Initiating Devices No. of Ranges No.of Air Coo d, Ton No, of Alerting Devices Heat ump um e r ..onj �,•�.„ ,-„ ,,,,'"go—of e - onto ne No. or Waste Disposer T 14ly; DetectlooJAIertioz Devices munical No. or Disbwasbers Spaee/Am* Heating KW Lel C] Concoction ❑ e'er No. or Dryers He> ing Appliances . KW �u 77s ems: ry Na of Devlcw or Equivalent No. o atero.o o. o Dota Wiring: 4 Hester- t SI ns Ballssg No. or Devices or E uivalent No. H dromassa a Batbtubs Na of Motor? Total HP a No of De cottons iron Y g N0.of Devices or,E uiva�lent OTHER: Attach additional detail Vdesind or a.r required by rhe Inspector o/Wires Estimated Value of Electrical Work: (When.roquirod by municipal policy.) Work to Start: Inspections tq be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE; Unless walvod by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liabllity(nsurvwo lnclud►nj"completed operation”coverage or its substantial equivalent. The undersigned certifies that such eovame Is In foroa,W has exhibitad proof of same to the permit issuing office. CHECK ONE: rNSURANCE [j( BOND ❑ ,OTHER ❑ (Spocify:) l cerrly, under the pains and pena4 o(perfury,Mal Me I*rnwdon on this ap lleation Is true and complete. FIRM NAME: DMID 605C-I` RICAiN(A LIC. NO.: Licensee: D A X11 V KA(a(s A Q Signature LIC. NO.: (Ijapplicable, enter "exempt"In the Ikerue number! Bus.Tel. No.;918 6B2 t:1 Address: w H DU R I S Alt.Tel. No.: 1 11.3?5• '613 'Per M.G.L.c, 147,s.57.6 1,security work requlros Department of Public Safety"S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am sware,t�at 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/A ent Signature Telephone No. PERMIT FEB: S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): PA-4 ( 0 L LC C—r P 1 L t— CG N T g A c-T I N G Lt—C, Address: 97 aELN1C J-r ST City/State/Zip: NORM Alpr^y,Q f., 016q5' Phone #: q.,8 0 2 -b Ziv Z Are you an employer?Check the appropriate box: Type of project(required): 1.[A I am a employer with 8 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]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 working for me in any capacity, employees and have workers' 9. EJ Building addition [No workers'comp. insurance comp. insurance.; required.] 5. E] We are a corporation and its 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#I must also till 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 subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I ANoVt-(Z Awtepz1cAH Policy#or Self-ins.Lic.#: W Z N .-D 9 O l - Z Expiration Date: 3 ( - Job Site Address: 601-2 12S4rc> ST City/State/Zip: s 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 InvestijZations of the DIA for insurance covers a verification. I do hereby certify under t e p and en ties of perjury that the information provided above is true and correct. Simature: �— Date: Phone#: Oficial 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. •/ . .G//.U. . NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACNUSE� This certifies that ��,F-r�C.S. . . ��1/l.�k.�'. . . . . . . . . . . . . . . . . . has permission to perform . . .Re.^.o Of� . . . . . . . . . . . . . . . . . . plumbing in the buildings of f4-,a . . . . . . . . . . . . . . . . . . at . /(.Q U. . .(). S j P.�.�. . . . . . . . . . . . . . . . .. North Andover, Mass. Fee.);3. . . . .Lic. No..VjtdI !� . . . . . . . . .IUMBING � _"`1;- . . . . . . . . INSPECTOR Check # f 85`/ . 'MASSACHUSEM UNIFORM APPUCA*N FOR PERMIT'TO.00 PWMBING t�+tnt«typal •8u11d /Co�� ' • injt Location © vc��S' Owners Nene Nm O �. Re*=nW O Plum Subrrdlted; Yes O No O FOCfURES < y w ip" q < M = q � p w Q a p d � p Z w x V = O M M p t a a O < p c ILd d < O • C W ♦ M ly < a 0 a A R ,1 .X. p O 0 M. W * M < IAC x � O O SUB--eS MT. - • MEM 31T r '. IST FLOOR IND FLOOR SRO FLOOR 4TN FLOOR STH FLOOR 6TH FLOOR ITH FLOOR STH FLOOR Ins#alpnp Campmw d`Nt�S �° Chea one:. G:rufkue Address L4 ; << •fit O .COr"mtfon :business Telephone Nam.of uoensed Plwber INSURANCE CMEAAGE: - iime a pntets ftbNhy M>zwfula pogcy or t whkh meets ft* f"*Mwb o1 MGL Ch.142: Yes 6d No O E You ft"checked ,Mees hdic�e the type eovem"by chm"the appr000 box A Iieb>litsr uiaurar>ex polky Cttw type Of kgs .O Itond O OWNER%INSURANCE WAWMR:Ism swerve that the Ikwee�the hswnce owampe roquh�ed by. t apter 142 a tta Mase.It d lsrra,sra Chet aw a on V*pow app Taft WON,"thh n mglt, tecc one: of a O 0 Apa>t 0 I MnbY oatlh►.tlat tl a the da sand irdonnation l hair Wkmftd 0VA f+aMn�h tiaa w trw snd aoowM b�bgt of mpr laid lhataN wk and hatd�tlw ued�rlht pw�Jpwd IOt 1pn wql t1�h wp�111p�wpi all poorhio�p a��tithe plukNdnp and to ft A�i��i,sws, 4f U*"hbft O Date. � 14 ICF r►ORTIy,� ooL TOWN OF NORTH ANDOVER o 9 PERMIT FOR WIRING n ,gBACHU5�44 Thiscertifies that .......................j...... ........................................................................:.... has permission to perform,. ' ........ 1 wiring in the building of........ I� M� `>Q at ....... c ��� `'S .............. North Andover,Mass ,i �.`.....................................M •Fee.........;!!/.. f .. . ELECTRICAL INSPECTOR Check# PC NPWIJeA 12 2. (-J). P% ramitm"Wed IBOARD OF FIRE PRE EnON Rt:.GULA-nS 00 Fm a -v 1107] t�avn bl APPLICA i4 FOR. PeRmu, To Pic) AnML WORK �tO be m wi&ftj Mecum Cade t'LE&W PAW N-mr oR TYPE'uL Il1t 'Olt�d?70N) D. �clT Cha 11M CIL Y or Town ot- nava OfEs or {5fr iiam,-.r} 4 topmrfimm140-clew-0 wuldcsMlled iDel €]roc ner's Address T se No. 3Q ystt& Tu PmmftinW0is $ P ' desp Noft-PM of EmIft (Chack Exbfm$SenkeAmps ! vans Chmrheikd L7 ung❑ o.o€- NIds New -_� FS i! votes Qd❑ Qadgrd Nmber o ❑ Na o€Metrrs 1fe and lt-�ckY ' Loratbin sect Na€are of Posed int Wot� -- � CO1 � iabkmayRfie Na.o;Reeved LmdmimGf (Pgddk)Fails 0. ,aecl rsec N&of ; Tmasfon"m Tof ff- a aRatTau XVA a of Na 4RImeq*3dej X1'0,ofSwachmi u, No.o sad ( � ofRaaps. �%L eWr C.mmd. Tau& i e.avast-. Toys 6Db.DWMTotalx ozs 1-;hL of � aratx:W Bodo NE of • Nnabryers II or s + �J numcap leo.afldatars s 16 a MjVkes era " ---:'- Twat$P . . �T7�ER; N&of or Esdi7sloc I liFoi dttadr7 7r Orgab-a ia MSURANCE COvXMGL moans b9 the t WX 8nle 10,the G. ani upoa undasl�Ceram�° mice mcla lewd o °�da�cai w'°�lc mag t ae unless � t tjov�gp is ift is bas me,c¢seas: ❑. sorra p o p ($fir•) to ate. � PZ gadpenala�o�b1js3jkM t1Wthe W ex'ft Irbr find CMM-Ike . �2�11<-- C N©" � l "4PP 'exmus"in xQ 'V`Pawr r.147,&37-6I, y o_• J rl,?/Z Ax TeL G 'S elr �r W� I �a S2irey=S"E.i Ncr,: mqutmd by lav By rap a°by�t�`as��mors riot t� - ce`ana„�.� fad t 1,=-1eRv,I hsaztsg this j fbe(ch a re`age� Y Sd'3 9� owt�'s - Tage Ida. , $ ' Piz r-ire Frevention system 5083033473 PAGE.. 1/ 2 Please visit our wall site at http://www.mass.gov/dpi/boards/El EZ FIRE PREVENTION SYSTEMS me GARY G BERGERON NO al BRIGHAM ST UNIT 16 MARLOGRO MA 01752-5143 1 Fold I%=n I Ph Along AN P W*roA►wfs g� QMWAN OFc 'C5SUESE .FOLLOWING L-f >cNSsE ASsA ' R. m NA «„" U1_ 4LECTRICIAFF-17 est+ : 4fN Y PR EVENT, II*SYSTERS INC C s �'s+• `A�BZROJ si 01732 5 i 4 'r"° Ift 15 09659 a 0 .2 �List f lA 11/08/2006 12:12 19784748946 KILEY AND COPANI PAGE 01/02 apob �- KILEY COPANI & CRANNEY ATTORNEYS AT LAW 342 North Main Street P.O. Box 3040, Andover, MA 01810 978-474-8670 -Fax 978-474-8946 Thomas M. Kiley,Esq. Paralegals Anthony A.Copani,Esq. Margaret A.Norton Julie A.Sowinski Ted Crdnney, Esq. Maureen A.Needham Pamela A.Swift, Esq. Daniel P.Tartow, Esq. David M.Feeney, Esq. Of Counsel Daniel P. Kiley,Jr., Esq. FACSIMILE TRANSMITTAL SHEET DATE: November 8, 2006 TIME: 12:10 pm TO: NAME: Peter Murphy, Electrical Inspector COMPANY: North Andover Building Department FACSIMILE NO: (978) 688-9545 FROM: NAME: Pamela A. Swift, E6q,. Kiley Copani & Cranney FACSIMILE NO: 978-474-8946 MESSAGE: Re: Gary Yacubacci 2 PAGES BEING TRANSMITTED INCLUDING COVER SHEET 1'he information transmitted in this facsimile message is sent by an attorney and is intended to be confidential and for the use of only the individual named above. if the reader of this communication is not the intended recipient,you are hereby notified that any dissemination,dlshibutlon or copying of this communication is strictly prohibited. N you have received this CommunicetiOn in error, please notify us immediately by telephone and return the original communication to us at the above address by mail. Thank you. 11/08/2006 12:12 19784748946 KILEY AND COPANI PAGE 02/02 KILEY COPANI & CRANNEY AxUmkYS Ar Lew 391 North Main Street P.O.Box 3040 ANoovsk MA 01810 THo"M.KILEY,ESQ. 978.474.8670 FAX 978.474.8946 PARALEGALS ANrt10NY A.Comm,ft. MARCAnT A.NmMN TED CRANNEX,EsQ. Jl1Lts A.SOWINSK[ MAuREEN A.Nsmmm PAMEt A A.Sww r,EsQ. MARMA WwE DANE6 r..TARww,EsQ. DAvrD M.FEENEY,EsQ. Or CowfUL D-SNIEL P wLEY JR.,Esq. November 8,2006 VIA FAX(978)688-9545 North Andover Building Department Attn: Electrical Inspector Peter Murphy 1600 Osgood Street North Andover,MA Re. Our Client: Gary Yacubacci Date of Incident. V131.2005 Place of Incident. Ozzy Properties,Inc., 1600 Osgood Street, N.Andover,MA Dear Mr. Murphy: Kindly be advised that this office represents Gary Yacubaeci with respect to injuries he sustained on August 3, 2005 as a result of an electical explosion at Ozzy Properties, Inc. in North Andover, Massachusetts. Please forward to this office a copy of your inspection report along with any other documentation and photographs with respect to this incident. If there is a fee for obtaining these documents or you have any questions regarding this matter, please do not hesitate to contact our office at the number indicated above. Thank you for your anticipated cooperation In this regard. Very truly yours, 2 le 4+ Pamela A. Swift, Esq. Enclosure 0mas LOCATED IN ANDOKR MD,METNUEN.MASSAGNUaRTS AN ASSOc1AnoN of AN LLF AND SOLE PROFRI6TmmirS x Date.... NORT►/ °;•�"� TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING ;,SSACMU`�� This certifies that 14voOl/CrC r L, t .................................... .................................,......... has permission to perform ....T !I.k/ F7.. kJ................... .......... wiring in the building of.... at.& �5 ....... . North Andover,Mass. • Fee..................... 125 Lic.No..9 �f�Z� �c, A �; fly^ LLECTRICALINSPECTOR (7 Check # 7 7 - 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: hr 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.01 c. Ibb,§32,an �! electrical permit shall he 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. r Permits shall -be limited as to the time of ongoing construction activity,and maybe.deemed_bythe,Insp.ector_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.persait application. ❑ The Permit Extension Act was created by Section 173 of Chapfer 240 of the Acts of 2010 and exteneed by Sections.74 and 75 of Chapter 23 8 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-permitsand 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 extendingthrough August 15,2012. ule —Permit/Date Closed: © G '�* Note:Reapply for new permjtZ --- ❑Permit Extension Act—Permit/Date Closed: c�7�t1/ onwea1 f!�/i1A sae* f - "+talii�icii►tT�L� r +�:r :. ��_ / � TO _- Department of Fire Services1VJ Permit N°• „ . Occupancy and Fee Checke:I _ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] 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. ? (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1/14/07 City or Town of-. NORTH ANDOVER_ To the Inspector of Wire..: By this application the undersigned gives notice of his or her intention to perform the electrical work described'!Pi,; Location(Street&Number) Ozzy Properties 1600 Osgood Street = Owner or Tenant 0 z z y Properties Telephone No. A Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No)E] (Check Appropriate Bev' Purpose of Building Office/Manufacturing 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: Bldg . #20 , 1st floor , southeast corner Completion o the ollowin table ma be waived 5 the 1.,?Sr No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers K` No.of Luminaire Outlets No,of Hot Tubs Generators No.'of Luminaires Swimming.Pool ove ❑ n- o.o Emergency iw. ' rnd. rnd. ❑ Battery Units ;. . No.of Receptacle Outlets No.of Oil Burners.,, FIRE ALARMS No.of Switches No.of Gas Burners o.of Detection ,ma Initiating Device.- No.of Ranges No.of Air Cond., Total Tons No.of Alerting Devic,. _ Heat Pump um er onsJ. o.o e - onta�nPc� No.of Waste Disposers Totals: Detection/Alerting DL-i-es No.of Dishwashers Space/Area Heating KW Local❑ unicipal- Connectro.___ No.of Dryers Heating Appliances KW Security ysterrS Y No.of Devices or%I •'" ,9+:- No.o atero.o o._o Data Wiring: Heaters KW Signs Ballasts No.of Deviecs - ',m- Telecom m- a ' ecommunieaTi - No.Hydromassage Bathtubs No.of Motors Total HP N,o cr :.,.: t OTHER: Disconnect & relocate 400 amp 3&ups feeder f $5 ,800 .00 Attach additional detail if desired, oras required Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 1/16/07 Inspections to be requested in accordance with MEC Rule 10,and,up. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical - the licensee provides proof of liability insurance including"completed operation"coverage or its substa— . undersigned certifies that such coverage is in force,and has exhibited proo of s to the permit issuing. -•T CHECK ONE: INSURANCE U BOND ❑ OTHER ❑ (Specify 4 /certify,under the pains and penalties of perjury,that the informatio o tl s application is true and ci..w- FIRM NAME: Andover Electric Services , I I,IC . ,' 14302A Licensee: ' Robert J. Branca Signature (If applicable,enter "exempt"in the license number line.) Bus,Tea. hr; 9�$�`-475-4995 Address: 206 Andover St . Andover , MA 0 0 Ait.Tc1: vc•: *Security System Contractor License required for this work; ifap i e,enter the license number here: _ OWNER'S INSURANCE WAIVER: I am aware that the Lic see does not have the liability insuranc-rcvera[- required by law. By my signature below, I hereby waive this r uirement. I am the(check one)❑ Owner/Agent Signature Telephone No. FPEK10-1Ta L=,= _� Date. S °............... NORT►, °` �``°:•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACHUSES This certifies that � l�?. �.! /..�. .......Fl.. i,c .................... ........ . ............ r has permission to perform .....c7.'- ... .�! '"rf?..... �?...............:l........ wiring in the building of..... I.Ccl........................................"......... r at.... ......P.. .5. G... .................................. .—., orth Andover,Mass. s Fee...J..i......... Lic.No.. .y`./>G.�......... . ��-�-- ELECC7UCALINSPECTOR Check # PP 96 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§,3L,the K, permit application form to provide notice ofinstallation of wiring shall be uniforin throughout the Commonwealth,and applications shall be filed- " ba 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. e Permits shall-be limited as to the time ofongoing constructioRactivJ:V,,&nd maybe deemed_by-the7nspector_of_Wires abandoned-and.imalid-if-he—. - or she has determined tIhat 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'tbrough August 15,2012. �/ file —Permit/Date Closed: Note:)Reapply for new per T� f ❑Permit Extension Act—Permit/Date Closed: C,onunonwealth o� adEasfzude Official Use Only 1DRUAMMa Permit No. 3 �l eUePartinenl o�}ire�ervice� _ Occupancy and Fee Checked J ) BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] eaveblank 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 E ALL INFORMATIOA9 Date: City or Town of: U jtA )N-,-3 c.ye 2 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) /6 OU 056606 5'T Owner or Tenant _ Nt, "Te c h N o l o p 5 U ry e 2-0/2,8-Telephone No.Ok.6 /�Q() Owner's Address .5 P1rlhC' Is this permit in conjunction with a building permit? Yes ❑ No-N:f (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps ! Volts Overhead❑ Undgrd❑ No.of Meters ' New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A D a �, - �U/�r� C I /LCu i_` J Completion o the ollowin table m be waived b the Inspector o Wires. No.of Recessed Luminaires No.of Ceil.-Sus addle Fans No.of Total p ) Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting grnd. grud. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of election andInitiating Devices + es No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Dis osers Heat Pump Number ons ICW_ No.ofSelf-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local E] Municipal El other Cyonnection No.of Dryers Heating Appliances KW eCNo of Devices or Equivalent No.of Water No.of o.of Data Wiring: Heaters ICS Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Equivalent g. No.Hydromassage No.of Devices or E uivalent OTHER: ``jj Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o El trical Work: U V (When required by municipal policy.) Work to Start:,/r 1 01 o Inspections to be requested in accordance with NEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such c v ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND F1OTHER ❑ (Specify:) I certify,under the pains and allies ofperjury,that the information on this application is true and complete FIRM NAME:5 `t t G-,h- LIC.NO.:1 7 q)q j� Licensee: �Y►i I,(� 1 NfV A LZ' SignatureLIC.NO.:3611 f i;Jt; (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No. � "6if1 t i V1 Address: 110 a L S� 5 y- 11?V N°I e��r� ,. ��� V i Alt.Tel.No.. - t -7/ _ *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: S Signature Telephone No. Date.... ..Z-ZZ-/l f NORT", 3r°•�;�`` "°oma TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING • s �sS�cHusE� This certifies that .......... ..............``'—Ale has permission to perform ..... 5 wiring in the building of...........c ...................................� at.....14.iPO....(a:f o.94.....5.T.`..................... North Andover,Mass. " Fee.... •Q�""�. Lic.No...13,� �,(� '��ZEcro4 ". .......... ... .... 1 LECntICAL t Check # 10549 i 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-ifhe`.. ._ 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 conceming 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 extending1hrough August 15,2012. f Rale —Permit/Date Closed: l ***Dote:Reapply for new perm' 0 Permit Extension Act—Permit/Date Closed: sY S J Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] 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: 12-21-2011 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) 1600 OSGOOD STREET Owner or Tenant STELLARIS Telephone No. Owner's Address 1600 OSGOOD STREET Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building office space Utility Authorization No. none required 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: ADD 1—15-AMP 250-VOLT,& 130-AMP 250-VOLT OUTLET No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- El o Emergency Lighting Grnd. Grnd. Battery Units No. of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detection an Initiating Devices No. of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Num,er Tons KW No.o 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. o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydro massage Bathtubs No.of Motors Total HP Telecommunications Wiring: 8 No.of Devices or Equivalent OTHER: INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licen- see provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certi- fies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify :) 10-01-2012 (Expiration Date) Estimated Value of Electrical Work: $1,000. (When required by municipal policy.) Work to Start: 12-21-2011 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: WILLIAM J.IANNAZZI,INC. I r LIC.NO.: 13592A Licensee: WILLIAM J.IANNAZZI Signatur �L LIC.NO.: 13592A Bus.Tel.No.: 978-686-7300 Address: 191 CHANDLER ROAD ANDOVER MA 01810 Alt.Tel.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. =��� -71S -<�S of-- 62 ' Z3 Date........ .....r...'...... i NORTH 3: °oc TOWN OF NORTH ANDOVER PERMIT FOR WIRING ;�SSACMUS� } This certifies that ..................................:...:.......:.......::�................................. has permission to perform ::: -` .......t�...*V . ..................................... wiring in the building of ... at ...........................:1.,.%�::':..��.................,North Andover,Mass. Fee ...... Lic.No. I ALUE CT�W�C tIN S R Ch eck # 8039 ripe U r UZ) U-+: U5p NUK I H HNDQVER 9786889542 P. 1 Lomrrwnweallti of /flasdachajelfe "rr"'J' unly er Permit No. a ..UrPartmrnl o��irr�srvrcrj `r Permit Fee Assigned BOARD OF FIRE PREVENTION REGULATIONS Rev 111991 ycavc blank APP ICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY hi< f;rnl is for use by institutions employing licensed electricians and others for which notice df electrical installations to the :un,c:pak inspector of Wires is required for wort: on the premises of the institution. if you are not an employinguutihit ion s:.!rt ro C. 141 1S of the Massachusetts General Laws,stop here. You cannot use this form- Use he sZand form only. ?L1_.•iSl ;"RJN7 INlr�h OR TYP ,,ILL INFORi IIT10N) Date: � City or To»•n of: �<J-x1t To the Inspector of Wires: i3r ;Lis application lite undersigned gives nNotice of the on-premises perforniance of electrical%vurk by employees- EnSiiirrtiurr Ue—eFIX1l 0 i.oc2t.on and tiature of Propose Electrical Work: �„�'Gl i C�� /%!/�//1��i51/1ll✓� C. 143 §31, of the tvlassachuselts General Laws obliges those who perform electrical installations to give notice of. :e to the municipal inspector of Wires- You may do so by filing this form upon each such occasion, or if so conteni- s unicipality you may maintain a contemporaneous log of.such work, p{atcd in an annual permit fee schedule set by the m which shall be cxI-6biccd to the inspector of Wires during normal business hours without advance notice. Some municipali- , ties may set nominal fees for aruwal permits and require individual permits for work above a stated magnitude. `Ve will rile this form on each such occasion(check one): YES ❑ / NO tv:-t mni!;rain erre or more Contemporaneous Iog(s) (check one): YES �j NO ❑ ?`h:; option is available where so contemplated by the municipality. In these cases, you must renew-this application arrnuall) seL`nifrcant changes in employment. lo.,ng individual(s)still be responsible for the accuracy of the log(s),if maintained. You agree that She log(s)will be. ta.,catcd must be for contiguous property except by arrangement with as indicated below. The coverage in any individual lop ' 1;:: !sc:rctor of Wires. Attach supplementary sheets if required for additional log locations. f I:oo coverage, wid location where it will be maintained Res onsiblc crson l . I + %'ou may maintain tlic logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proc date, W,;;air. below how ttre Inspector of Wires should access the log: How !n oy electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you empL at %.our facilivv? indicate the total number and also indicate the number of full-time equivalent staff that number includes: l r:tal c'scctrical cmjrtuytnenl: —p4 — bull-time cquivnlent electrical employment: — p2 i tc.11. nr_:,) I;clpers or apprentices do you employ to assist your licensed staff,under their direct supervision(see C. 1 l 1 §S)? +;•i:rr,:1, thls number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions a tat vcterans(see St. 1962,c.582§3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the nut ter: of full-t!m: equivalcnt staff that number includes: i:.";3! rtcch ical crriplo;'tucnt: Full-tithe equivalent electrical employment: _®— r !;-`ectr cal work for which notice to the Inspector of Wires is required must be performed by liccnscd personnel. How ;arsons, not required to be licensed,do you have in your employ'? Indicate the total number and also indicate the equi...alcnt staff that number includes: st ri castricat employment: Full-time equivalent electrical etnployment: -427 ;: R!' rtL'Jl7a!t fUl'/i7L'Se lJtlrnO.CCS RS rUIYpersort,firm.or corporation operntin3 wider c. 141 3. (Please see reverse side for certifications and required signatut rltlrL- ..:_� _. . . Z)10 !lUK ! r! 1-111 JUVtK /tibUtiy54L, t7. ef lr!stitutional Permit Form,page 2 ! NOTE. Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, simil to institutional employees. If, by the termm s of such a contract, you direct the performance of such work, include the aur bcrs of such employees in this application. If the contractor directs such performance, of if the contract period is for Ic than one year, application must be made by the contractor on the standard form for such work_ Do not include such ci i ployccs in this application. Please ¢ivc your official title, such as "Director of the Physical Plant" or "Director of facilities" or equivalent. In addit provide a statement that substantiates your authority to hire electricians pursuant to e. 141 §3 for electrical work on the pr ices of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grar authors•to direct any licensee of the board of Slate Examiners of Electricians to perform work in contravention of the rule said Beard.of in contravention/of the Massachusetts ctricat Code. � :til! title is. �'G � Vim---- ;�Iv a+:thorily to act for the aforeutentiottcd institution is. SI oda / -I es xa-/c- 1 cerrily, t.nder the pains and penalties of perjun-,that the information ors Ili is application is true and complete: (Sienature) (Dated) Print na!ac) /lt 0 � / (tvotk telephone number) (extension) (facsimile number) M i � a Date.. ,,ORT" °�t�``° :•�"� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING �,SSACMUSEt This certifies that ................................... "`."c............................................. has permission to perform ............... . ....... r :'..:.......................... wiring in the building of............. . ._.. ....................................?..................... at �G c �'f.. ,North Andover,Mass. Fee..................... Lic.No.............. ..........9ELicrRICALiNSPE R 'E 1f� 1 ita Check # 7053 M)V-102007 e2 :44 A t-,,, P t)U.L9 a 5 t-)4;�-, f4uk I ti FANDOvER ws, jpet.:»t Fee:knig VIRE pREV.E-NTI()N REGULATIONS pc,. I:IN91 tnvr0.7sot, ()1' Ito .4 0 To PERFORM ELECT. RICAL W0RK. APPL-ICATI' N FOR:PFRM' .. :ONAL* USE ONLY tl�tc FOR 114STITUT' t�lloicntts is his farm,S fcr xlst by lilslivZoliolis C4-Itky6g)t Clectrition;--and ollica for whidt ru�flcc 617 clrctrtr.. zTe: not an CMI'layin,". institkilion Pircmists Or the inslitutioll.. Iflyou _qvji:rCjj fo� %vorsl:nn tht dord fort'll ratt 0encrul 1.3 kys.stop IAC;C.- til's.form./use t:yc,stall of litz:N33nacllustlw ILI, tINFOX l.1/;f fo Pl.L CS-1 70 11-1 6�1) -Yyi-rev Pecto r Of I T 1DVV 11 by of Ole oil-premtsrs per till!V0JCTw%l%r ------------ (31q --wod Nat Urc,it Zip Who PC to f'j" 40 ux Gz,ler-J) -0b I'T. form dpon.cz�h -:f so content--05 tho 6r f , . of NVircm- You rmy.do w by filing, tins 16.91.0.�:Stk�h.- pgIjj,ty ywj. nay Xlv*",VA4 ali- mmc.to (11,-- ol il;lic 1pi VY tjwc it notice, munt c ;YI;JCd.fit cifl•4"UNUal -schcaute, set es during IlQtrn�%t hu S'DCSS hours%V kqj%ji-h Shall be exhibited IQ tile"O"tor 6rwlr pCrtlflils f above.a 5t a tt�d,ma% ,or WUTk niwAc ------ OAQ31 Ormils,alto.reqvirc III fms rot cl-- cueck.wI0. YES 0 sous (rhecko,"),. YES NO. %4,this onciat 11tese custi, you must relic avail bit W404 so Ok "091z'lcdby the municipality. 11"'n rlp os- I a 4 itrerstyloytiisnt. .YoU:-a&T4C ihe log(A wil) wdividu,31C.5)-WM tierrtfoe th"t a operty except bY affulnge"'clit%Y"t% d below. Pm COVt1a;C�A a.ny:Ilidividual log.Must be for COMI&V U%Tit JjtlR471 Wires. rn&f. j Aft9ch StIPP(em ... ........ -wilve it will be Illaill -------------------- sorctoroof I WIM. 117youjillerl.0 to.opply f�(.4mcliz Proc with thelp jnsptct000f'w ircs shOuld access tile t(,)Y,; 41ricip-ms),do you crapl, ------- Male E�Stlioo3 tSf Ikcnsc6 by tile Board 0 net ldcs-, T.A.colinki2tis( V�un .1. % mio�c1cOrkinds:13100.11ge. Cale t)jg.-nitmber Offtlil-6MC l`qt"-�AVl;nt:jkt 1bCr I also indicate Ir net-Bette clillivaltid clor-tri tal,ewph,);�' i�ioafSed t:..-14:1 Or .licclised sto M:11t.ldef thou dircoVstipery �Atpjoy to 115511Sk Your , � I I . - .. 1 1. lulls 0 1�clpc,,s of-alipmmitts 4 c 1,ccllset, ill(l;,iduj;j to otic-tjljie�C-nscd indivialka St- 199;c. l3fi)- lstdicatctlic tp4abttuftrltt:r and also. -qui red ii)ust b�-* obe JiC, 0 you 11:1VC.111 Y-6br ebip loy? IndlQW&t)`tt is ttuttis2lSr ren d" ate thc mw It 1,010M.11p1 1-4.quived1 lrjtnbcf in clukics: scs ns amPerson,firm.or corpor,16011 ope),n6lis wider C. 141 5C parpp (Pleosc 3CC mvem sida far NOV-15-2007 02 :45 PQM P. 02 r,Nr 4> y u-r : uail rUrc rn rt1-4.111.)Vth t!'rtititft34t>4e Iuctittrlirin.il Pi;r)ut Form,pz;t 2 PIOTE. SO= in3l'icutions entsr into Cotttr3cts_-With.cdatrawte(s.io ptri'orm oa+goi.rv$ticctrkaL work at�an institution, sirnit tc.irwitutiona) crnployces. if by the terms of such s contract, you direct IN:peirom=nct of such work. include the mt, �crs'eif Suck c►nployees in this application. I V lite contractor dire:ets sut;It pcYr4rntawcj:.bf if the co'iltraut period is i'or It. th`at,_otte ycati, uppl.ic.atiort must be made by the contractor on the stamlard fornt.<fur seclt Nvork. Do not incinde such ci LRtb. ar ;n tltis npplic.alion _ Pttssc xigc ytrui:aslfreill ritte, suc)t a "Director or the Physical Plan[" or "Di-rect:Gt'of.l''3Cii.it>es" er cgviv.aknt. in addil lwovtdc.a stat6mcnl that stibstatttiates.your aulhority to hire efcctricians Putisuaait td:c. 141.§3 for clectirical.Mork on the p1 y.ss:,*(yntr�'it7stl►utior% attttt6 estabiis1f:priorilits fortile peerornronte tlicriof. This forrn:is tiot:to he construed as b grdr su.tllorav t,o i3te:r„c,.t::anylicertaec.a:ftht Board of State Csarrvrecs of Ekoriclans to pc6bmtwo.rk in,c:oittraventian.of•th'c rule S':Id,Board.w ;r can;ravt,lxiont�or the. assachus L•'settlectric:rl COdC.. tik. title-13:. M.v-1,rrt,ortl:ptu:-ttt ro} tikerorrctinntintttvli11Tli.ttitiul�is- if (y.Frt�i-,:tr;re/tta: !hrBiui�ria.rrtilsailrrllivtofparjgrr Ibatthe(r.+�v:r'lrrcrlioJt-.ol'111tE4jgftl.Padiaw4fmc ondeU.mplere. (S A�k7 r nacv 1?Ndtk rrip39cJt7r nuntt r 7kb�r - J==�_snsion) flaCantrlc r f j Date..�'�.—lef-.. °f -T TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING o o &S CHUS This certifies that .............. ........ ............. has permission to perform ..... . ..................... wiring in the building of.....L -' A. ............. at..Ar�.L'.T?....... North Andover,Mass. .. . ....... . Fee 7��.��.......... Lic.No.............. ..............P... ELECTRICAL INSPE R Check # 8198 U,-, U'r : Ubp NUK I H ANDOVER 9786889542 P. 1 LommvnweallA of Iflasdachairlls ljLlil lal We vn:y Permit No. ;� ..tJ trOartnurtt o��irt JsrVi tri /rs/ Pemnit Fee Assigned i7 BOARD OF FIRE PREVENTION REGULATIONS Rev_ 11199] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR iNSTITUTiONAL* USE ONLY '.itis f0rrn is fer use by institutions employing licensed electricians and others for which notice of electrical installations to the ;;unica;af inspector of Wires is required for work on the premises or the institution. if you are not an employing unstitution to C. 111 �S of the (vlassachusctts General Laws,stop here. You cannot use this fornr. U c the tandard form only. PSI PRINT iNINK OR TYPE,,ILL INFOR11111TION) Date: City or TotiVn of: /�.� /�������,� To the Inspector-of Wires: �ppiication the undcrrsigncd gives notice of the on-premises performance of electrical work by employees_ .�f co /• _ocntion :incl Nature of Prop ed Electrical Nvork: l E:: C. 1$3 §3L of the ivlassachusetts Gcneral Laws obliges those who perform electrical installations to give notice of j sar.;c io the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of.sueh work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- I ties may set u0minal fees for aruwal permits and require individual permits for work above a stated magnitude. 4Ve will 'iic il:is form on each such occasion(check one): YES ❑ NO rain!aiii one or more contemporaneous loe(s) (check one): YES R�� NO ❑ u:i opiion is available where so contemplated by the municipality. In these cases, you must renew this application annually ;a St_nlficant clianges m cnnployincnt. individual(s)will be responsible for the accuracy of the log(s), if maintained. You agree that itne log(s) will be cai:ci s indicated below. The coverage in any individual lop must be for contiguous property except by arrangement with i;;• ra;;r:_tor of Wires. attach si,pplenre)tta)yslieets ifrequired far additional log locations_ l.r:, ciivrr,oe, amd location where it),•ill be maintained Responsible ersou 1 You. -n-.y inaintain the logs clect;onicaliy upon agreement with the Inspector of Wires. If you intend to apply for such a proc bvc, indicatt below how the Inspector of Wires should access the lop: 1!ow i-many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians) do you empl: ai ;c:u= faciliw? indicate the total number and also indicate the number of full-time equivalent staff that number includes: i i:r:�l ceett neat cntptuyiucnt: — pZ r hut!-lime crluiialcut cicetrital curlalmpntcnt: '� _ liclpr,„sot apprentices do you employ to assist your licensed staff,under their direct supervision(see c. 141 §S)•? ritinrbrr must not exceed the ratio of one licensed individual to one unlicensed individual. Limited execptiuns a ti,i `:c;erara(see St. 1962,c.582 §3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the nui t)r: of fill(-tune equivalent staff that number includes: ;.;a i_ctrical cniplojnicnl: Full-time equivnlemt electrical employ'nneiri: _Jer� ;,'r;uncal wort: for;.vitich notice to the Inspector of\Vires is required nnust be performed by licensed personnel. How r;,�;:ii t1crsons, mol required to be licensed,do you have in your employ'? Indicate the total number and also indicate the tun-•.rote cqui.aient staff that number iodides: ;t.ni r,ie trical cttnplo�•ttictit: _,42�- Full-time equivalent electrical employnncnt: ;!:tr:auns ora riejir>eilwr dtrse purposes as tint person,firm,or corporation operatinr3 ureter c. 141§3. (Please see reverse side for certifications and required signatui ntlr U : : _-) U . . .')p !'IUK Y "I'fiJuvLK p. L histiiuiionil Permit Form,page 2 r-- i NOTE: Somc institutions enter into contracts with contractors to perform ongoing electrical work at an institution, simil to institutional employees. If,by the terms of such a contract, you direct the perfomiance of such work, include the nur 6crs of such employees in this application. If the contractor directs such performauce,of if the contract period is for lc than one year, applicatioli must be made by the contractor on the standard form for such work. Do not include such ci t jt loyccs in this application. Please p c your official title,such as "Director of the Physical Plant" or "Director of Facilities" or equivalent_ In addil provide a staterncnt that substantiates your authority to hire electricians pursuant to e. 141 §8 for electrical work on the pi ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grar authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rui< said 0oard,or in contrav n,ion of thee, lassacliusetts Electrical Code. MY Title is: — Q 1G� r-'`�e.KZ.h d S IL- ` S �" aft° -E- ;tlNaforementioned to act for the afureenlioueJ institution is: G„jfl,,/Iy� v Dytk 1 cee-rify, under the pains and penalties of perjury,that dee information on tris application is true and complete. n .17 fSienature - (Dated) //.3. O p 'Print nal�tc} CC{2 GL. u G' b L✓.�Ltr,. (%vork telephone number) 4,63 347 7ocre-36sion) (facsimile number) Date... .... ......... TOWN OF NORTH ANDOVER 0 'Awm' aw - PERMIT FOR WIRING + SACHUS This certifies that ........................................... ihas permission to ...... uwiring in the building of...9... .. ..... ......... ........ .......................... ................... ............ North Andover,Mass. Fee... ........... Lic.No!��/A) *'**R Check # ELECTRICAL "* C11�lep 54U3 Commonwealth of Massachusetts Official Use only It +r Permit No. A r, Department of Fire ervices Occupancy anti Fee Checker) :{ BOARD OF FIRE PREVENTI 'N REGULATIONS [Rev. 11/99] (leave blank) APPLICATION FOR•PRMIT TO PERFORM ELECTRICAL WORK All work to be performed in actorante with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE L INFORMATION) Date: i tv City or Town of: J),v co To the Inspector o •Wires: By this application the undersigned gives hofied of his or her intention to perform the electrical work described below. Location (Street& Number) I ey �tt S CP aj S Q_e e` 7z-4 a e_,j,-V jQ,-, Zl\ , Owner or Tenant W03 (')S -.LX_ Tel phone No. Owner's Address S+9ti+ F Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undard ❑ No.of Meters b Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Conn plelion of the following/able ntav be waiver/by the lis pec•lor of IVires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA No.of Lighting Outlets No. of Hot Tubs Generators KVA Lighting Fixtures Swimming Pool Above ElIn- ❑ o. o EmergencyLighting No. of Li g b =rad. yrnd. 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 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection Heating Appliances aTe4we 14 j Security Systems: No.of Dryers g pp ���le KW 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: a No.of Devices or Equivalent OTHER: Alnrch additional rleiail if desired,or us required br Nrr br.rpecrnr ul II'irr.c. 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 [g BOND ❑ OTHER ❑ (Specify:) Ill_,a0/a_d (Expiry ionDate) 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. I certify, cooler the pains and penalties of•peijuq, that the information on this application is true and complete. FIRM NAME: 0AZIT ST C 'Lr LIC. NO.: E(7e )7 Licensee: `��4 (����+ r�e^ Signature LIC. NO.: (z o 7 7 (lf applicable, enter "e.empl"in the license number line.) Bus.Tel. No.: Q?SS?A 829!' Address: Alt.Tel. No.: %A^a t? OWNER'S INSURANCE WAIVER: I am aware that the Licensee doer not have the liability insurance coverage normally required bylaw. By my signature below, I hereby waive this requirement. i am the(check one)❑ owner ❑ owner's agent. Owner/Agent �-4' , Signature Telephone No. PERMIT FEE: $ Location 160 No. e�92. Date *44-, At NORT1y TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ 7� ' - • , . Building/Frame Permit Fee $ P-�AS� 60 14 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 6O0 Check # 'i7526 , Building Inspector s , TOWN;OF NORTH ANDOVER WELDING DEPARTMENT- A"UCATION TU CO2VS UCr REPAIk RENOVATE,CHAXGE THE USE OR OCCUPANCY OF, OB D04OLLSH ANY BU"ING OTHERTRAN AoN$oRTwoFAnsH;Y'awELLvvc Section fort)ffc3al Use Oei BUILDING PERW N"M © DATE ISSUED; � ...� SIGNATURE: G Buildin COMMIS rotBuildings DAte (� !:1 Property Adm. 1.2 A%MMNV smAPauodNumber: 160a o.s600' a s; Z.571 7 13 Zwin& *mit M h4 hvoy onmsian . t v /NDUS /qL &2457-90fe— 160 t-14C. 30?00 .LF ZanklDisttid _ptyweauw m 1.6 MUDI SIG SETBACKS(ft) Ftont"Yard Side Yard RearYmd. Required Ptavi& Provided Required Provided y&, priy1 D Zona ikbsbFlmd zow On Sb DhpoW Sy*.p � 2.1 Owner of Record ru�o tr o> aaa for q m Signairua Tekpb�e `�, 2.2Au*mizedAgot , Name Ifint Adanss for Servicer; Z Teleihoue m 94ILka adComstm o Superv*. _ NotAppliW* 0 AddmssE�e�u/ u��a/arm Od iAIc Tn)l %•m,N aer 0 7-3 or" W09 RYA, m/XGNHm "n 3.2 � «�tr€�t ��t�e ❑ v Company NamA4*.fi�w Wim. m Fes=Date Z. sigmt- ._ Tc*bo- RECEIVED AUG 0 2 2004 BUILDING DEPT. 1 1 Workars Compaosarion Iuaiaaoca a�davit mast be completed aad sabmtttad with this applicatigm issuance of the bui Failure to provide Uric affidavit wilt result is the denial of the ' Siancd affidavit Attached Yea..... No......t1 Name -Roo lar'Al r A01.5 Address Yo S� AFF�� vtz's f�TTi4G 6/7-- ��13 Dl B0 SignatureTelephotle Name. Aram of Responsibility Addr ,� C1;Tf SIO Registration NumberLEX!�✓6-TD N16-7-Y Hatt Total C L U /NC Not applicable ❑ Name: f i o 57- , I3i�s t' �1 sTiZ�cr��oe.�L Address �� 19 ( //O Registration Number �i7 737 D�41O sr ` T dq)bcm &piratioh Date Nam Arra of Resp=bility Address Re9istr4ou Number Stgaature Telephone Expiration Date Name Arra ofRrsponsibiGty Address ' Registration Number Sze Telephone Expiration vale COMFW Name Not applicable ❑ S'Yq�IG�Y ✓. tslv��.�iFs,r y RCRMXhle m t OfCaastr> on � ---- i New Constrrutian ❑ gBWdmg Repair(s) 0 Alterations(s) Addthcei 0 Ace ssory Bldg;, p Demolition. Other ❑ Specify. Brief D=iptionofPmpa work: , TZ-) $i�//�!S j�`tt.L�,� LT✓f'7� �/5 N E� to L L 7�jY1 USE GROUP Check as applicebiee CONSTRUCTION TYPE A Assembly 0 A-2 ❑ I-2 0 A-3 0 IA p A,4 p M ❑ ID 0 $Bnsio�ess 0' C EducaticaW 2APU 2B ❑ F F F-1 F Z ❑ 2C .0 HfU 'Hazard p I hutitutiond ❑ 1.1 0 12 0 I-3 ❑ 3B ❑ 'M Mercantile p 4 ❑ R.residential' 0 R=1 ❑ R 2 ❑ R 3 ❑ 3A p S StorageS-1 9-2O UUhh d L SB- U aelE55 MMtioedUse ❑ A/� _ F S special Use tI Sptelfy: V LD Kis G7 - - Z COMPLETE TMS SECTION IF ZUS"1'INGBUIlDING UNDERGOING'RENOYATYON ADDMONS AND OR CHANGB IN USE Existing Use.tilotgc BLt.$/ �t �jgCTbQ� `� P"wsedUwGwup::.__ f'0 CN IWC ExistiogHatardladeae?Soc 34s J6—p?, f`,3_ c.T Proposed`HazsrdhKkx780 Oa 34.- Nd C,4t9KG.E:- BUIGDM AREA 'EX61240 if 1�RQrosED i�of Floors or stories Include Besementlemb u1 /odG -so 040 F j�0 Clfr9rtle�E FloorArim flm BGG- 2 V �• TotalArm Tata!H' R Stroet nt Enoncedal SftCt ral Pett Review RagairW Yes ❑ I10 SECTION lea OwnearAndw - TO BIS COBO~LETLD WHEN OWNERS AGENT O8 COMUACTOR APPLIES Mll BUILDING PERMIT Pits QxRoof the subject groPertY Hereby cSTi9/�lLe✓y J- �f'✓� /� K 1< ?2- to act on W balwK in au MMM ielatrva twu work authorized by this lrmldiag pwjjjapplication 43 srgoammod'owlwr LAW 1 t i as rl *Zaave that tht statements and iurf'otr dOn an the foregoing application am true and accurate,to the best of lay knowledge andUelie. Signed under ft pains and penalties of perjury R Prato Nath Do Signature of Owndhffht, nate Item Est m*d cost(D Uw)tobe feted a: I. Building (a) Building Pennit Fee O© lier 2 Electrical (b} Estimated Total Cost Of Con*ucticnfrom 6 3 Plumbing Building Permit fee (a)x(b) 4 Mechenicat(HVAC) 3 Fire Protection a 6 Total(1+2+1+4+5) Check Check Number.'as �o 00.OIr STORIES BASEIvffNI'OR SLAB SIZE OF FLOOR VERS' 1 2 3 SPAM D �1 / 1l L �111G G. v5-P- �E W DETti+MMNS OF SILLIS , DEMMION3 OF POM DDW M1ONS OF GIRDERS , RETORT OF FOUNDATION TIRCKNESS SIZE Of FOOTING X MATERIAL_OF CHRANEY IS 13UIE DM ON SOLID OR FIE LED LAND 73:B'UTLDM CONNEC TED TO NATURAL GAS LEVE Perini Building Company 73 Mt. Wayte Ave. Framingham, MA 01710-9160 Perini Building Company August 2, 2004 Mr. Robert Nicetta, Building Commissioner Town of North Andover Sutton Street No. Andover, MA 01845 Re: Lucent Technologies Inc— Merrimack Valley Works, Consolidation 1600 Osgood St No. Andover, MA 01845 — Phase III Extended Dear Mr Nicetta, In reference to the above mentioned project, Perini Building Co. acting as agent for Lucent Technologies Inc. submits the attached Building Permit application for construction of one hour fire rated demising walls, egress stairwell enclosure, and exit doors and related life safety work associated with the walls and stairs. A set of marked up architectural drawings showing location of walls and related work that will be performed will be included in this permit application. A description of the scope of work involved is as follows: • Minor demolition of approximately 120 LF of existing wall to be replaced by the one hour rated demising wall. • Installation of metal wall framing, and gypsum drywall, fire taping and caulking, sanding and finishes as indicated • Installation of any electrical, or mechanical piping, conduit, or sleeves that is required to be embedded in the walls • Installation of all doors and frames rated or other wise that are required to provide proper paths of egress and/or security to given spaces • Installation of rough in for Fire Alarm devises required with the wall • Modification of Fire Protection sprinkler systems so as to provide proper coverage • Installation of temporary egress paths in order to ensure the safety of personnel during the construction process. Items not being worked are interior walls, doors, finishes, a -general mechanical, electrical and HVAC work not associated with the installREC EIVED AUG 0 2 2004 BUILDING DEFT. demising or egress work. A separate permit application for this work will be submitted in the future after engineering resolutions to existing conditions. Be advised that the return air grilles as shown on drawing H-4 and H-5 will no longer be incorporated in the HVAC design. A hard ducted return air plenum will be installed instead. Further details and information will be submitted with the final permit application. Items to be worked are highlighted in red on the attached,pdrawin s./(one set OF- only). .5�,e 057 4 {�1winCGs LOLtJ (I� . p 1 Granting of a partial permit and prosecution of the work /does not in anyway eliminate the liability to perform added work or alterations to the work in this permit application order to satisfy the requirements for the issuance of a final complete building permit. If you have any questions regarding this permit application please contact me at your earliest convenience. Very truly yours, ` Stanle Swerchesky J Project Manager Perini Building Co. C/c M. Power Lucent Technologies Inc R. Nicetta Building Commissioner, Town of North Andover Job file WOR,- 1414,NL/CTT/-/7"67D dot! 1=©L�awlel� ,�6 L� IG� 14 /i/ fJ 7-.oq /. / tA _ ` �o %4 /. 0I F,4—d2. T� FP ! Tib 6 R� 6.D TA TO / / //�1 7. 4 gn O rP �� ¢'o!� FLr�,eE� jh/ST�GLAI"'ID f Gd v J t✓/ rj-/ PI'��✓fi��-� EAG G�4f� FAP- C'O 1 Z'e'Ei> C" The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 _ Workers'Compensation Insurance Affidavit Please Print Name: Lotion: /0126 0 bo-D ,ST C! 6 M4 Phone 0 am a homeowner performing all work Myself. F-1I am a sole proprietor and have no one working in any capacity ® I am an employer providing workers'compensation for my employees working on this job. Comoanv name: 1J 111/ $LJIGAJPV& �j YAIC. Address Z /M7" City: FJWAo71 Phone#- X08 (oa8 0?00 /Al saRRMe4�' co Insurance Co. NKsYc.vX��l/l9 Poli it 1V C — 74)8-4S"-746 Company name: Address City: Phone# Insurance Co. Policy# Failure to secure coverage as required under section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the forth of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date cc/ Print name *V9996i�,7A 7Z Phone# Official use only do not write in this area to be completed by city or town official' ❑Check if immediate response is required a Building Dept Building Dept p Licensing Board Contact person: I] Selectman's Office Phone#.---. [3 Health Department 13 Other FORM WORKMAN'S COMPENSATION RECEIVED AUG 0 2 2004 IIJILDING DEPT rr OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL 1784.00: Phase III—Extended PROJECT NUMBER: PROJECT TITLE: Lucent Technologies, Marrimack Va ey PROJECT LOCATION. 16 00 Osgood St. , North Andover, MA NAME OF BUILDING: Lucent Technologies—Part. Bldg. 30, & 70 NATURE OF PROJECT: Interior Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ERt6VtEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: --6N-TN;4& 'F' • ARCHITECTURAL -g�efi�.b�_ 'NIECFiANiCAC --- E'PRflfiEt'fitt3Rf • ECtCTR1CAL • FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE.ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND 8 EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 I. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials',' r• 3. Be present at intervals appropriate to the stage of construction to become, generally familiar Q ��� with6the progress and quality of the work and to determine, in ; performed in a manner consistent with the construction documents.genera, if the work is being �. 50» o PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. SUBSCRIBED AND SWORM TO BEFORE 14IE THIS $ _DAY OF July SIGNATUREIVED _ AnTIA 20/r PUBLik, 7RECE . v •�it i.7Viviv E�h'ih�j d�- Joeile P. Sloe I LD Notary Public My Commission Expires North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number_ 092— is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: sE6r s��w (Location of Facility) - ature of Permit AKpFcant 7l Z13,'l Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 1114 U145—) 6- 19?AK-4GE-1?1eW T/ L QIVJ,?vK PC-9Z Y, /V, 14, e,5 CYeLr4PLE-5 11Ii4 WR sTr In qq/4 gelne Y'-, GDrvDDi✓Oc A1,/ M9 7WL-S VM -ronledeg-l-L-0 DECEIVED AUG 0 2 2004 BUILDING DEPT' NORTH TONNM of �_� � ..R _ over O .o-,M......r'.• '4•• •t No. O - dover, Mass., �kc s� m z L COCMIC E HEwICK V d ADRATED P`P�,`�5 7 H BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... ..... ......... .. ....1 �t�. ntr ..... L1�,�.4. !� I '.. •0.��r/V.�:.�... Foundation has permission to erect*04% t WMUI� on ..14.0* os �1 IL • • .. .. ��llpt�..�.Q.Z.tw.. �Ri�l.........� Rough • .,�. t0118 OCCupled aS.QC��L��r� f I. M. , .��.R. .4�+4, riwl4i,. .r.. GINR{•.�.� OI`� 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.u>&-%W 3 Ta. 4L*.m 04r 0 wpw,k ��� 4bPLUMBING INSPECTOR /Cp VIOLATION of the Zoning or Building Regulations Voids%is Permit. �' �� • Rough N• a�7l� � PERMIT EXPIRES IN 6 MONTHS IV1�ft%. h�s '* a Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .. ... L . .. . .. ... . ..�.� Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RouFinagh No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner C•�. 1•� �:�o' t�`t 43L street No. IF SEE REVERSE SIDE Smoke Det. Date............... :...r'1 .. NORT" °et"`°:•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACHUSE� Thiscertifies that ....';. ... :..................................................:........................... has permission to perform wiring in the building of � � � ..... -�-< at....................... ....`�'''` U ................. ,North Andover,Mass. Fee A4 ........... Lic. o .l? 1..:........... t .............. ELECTRICALLINSPECrOR 1 Check # 7 5111 6952 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. G 9"5-2-- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 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: 9, 26, ©k City or Town of: 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) osl� c5'� X30—/ /<— g Owner or Tenant eu_ IAC Telephone No. Owner's Address /boo 0S(WD 3l Is this permit in conjunction with a building permit? Yes E41 No (Check Appropriate Box) Purpose of Building PAYWU wdint ti f' STDNm� , _ Utility Authorization No. V)g Existing Service V-1"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: /Jai timers, n1t5, C-60 s h&) New lift& I WMA4 Completion oftheJollowing table ntay be waived by the Inspector of fVires. No. of Recessed Fixtures No. of Ceil.-Sus addle Fans No. of Total P ) Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA boveIn- o. o mergency Lighting i No. of Lighting Fixtures Swimming Pool rnd. ❑ rnd. El Battery Units No. of Receptacle Outlets No. of Oil Burners - FIRE ALARMS I No. of Zones o Detection and No.of Switches No. of Gas Burners No. Initiating Devices No. of Ranges No. of Air Cond. Tonsl No. of Alerting Devices No. of Waste Disposers Heat Pump Nmber Tons KW No. oSelf-Contained P Totals: .......................... .._.._......................................... Detection/Alerting Devices No. of Dishwashers Space/Area HeatingKW Local ❑ Co n rata El Other Connection Heating Appliances KW Security Systems: No. of Dryers No. of Devices or Equivalent No. of WaterKW o. of No. of Data Wiring: 'Signs Ballasts -� heaters No.o De'vicC3 or , iva!ent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: y No. or Devices or Equivalent OTHER: Attach additional detail ifdesired, oras required by the Inspector of[Vires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation" coverage or its substantial equivalent. The undersigned certifies that such covera a is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE VOND ❑ OTHER ❑ (Specify:) (Expiration Uatc) Estimated Value of Electrical Work: Wn.006 (When required by municipal policy.) Work to Start:` Q 1 25 Inspections to be requested in accordance with NEC Rule 10,and upon completion. I certify, under thepayins and penalties of perjury, that the information on this application is true and complete- FIRM NAME: ` b . CTaic LIC. NO.: 7o�� - y Licensee: R j C]1(irL� 114. I'//��1&,Z2(A Signature LIC. NO.: (If applicable. enter "exempt..in lite license nuniber line.) Bus. Tel. No.' Address: I tL4 T6C-A NA C)_2_0'7;,7, Alt. Tel. No.: OWNER'SIN U iZANCE WAIVER: I am aware that 0L Licensee does not hm.-e 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: S Sivnaturc Telephone No. a`� Date. TOWN OF NORTH A OVER STALLATION PERMIT FORGAS STALLATION �,SSACMUSEtS This certifies that -r has permission for gas installation . . . . . . . . . . . . . . . . . in the buildings of1:.. . . . . . . . . . . . . . . . . . . at . . .A/- e"-I-e. . . . . . . . . . . . . . , North Andover, Mass. Fee . . . . Lic. No. r3ASINSPECTOR Check# 32kI, 2- 5764 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) C3�''� Cv%p�o v P_r Date I D-u 200 6, Reoeip" Pormil[l� 9 Building Location(!7Q C� O S�gc�ri( 5 hers Name d 5��/ Y>j'p(j C - ►�` Map: Lot:_ Zone: Type of Occupancy C� p 16e!�tAZN New ❑ Renovation'01 Replacement❑ Plana Submitted: Yes❑ No ❑ or Fee: rn s rri Y W ¢ Of O ¢ _ W w ¢ O V _ = rn mr Z } �- m ¢ < O w i ¢ ¢ Z O Z r ¢ m rn r W W O O a ¢ < to ¢ W < = Z ~ m O W U w 'n W < ¢ F- F- S w w o o = < w ¢ ¢ ¢ w W V 'n ¢ k7 F Z jIL Ul Z r W w O O > O Z W O y S < ¢ _ /- } to m Z Q F < W 7 ¢ W 2 < ¢ < < O O W O W ¢ = O O w LL 7 3 O O J U ¢ > O a M- O SUB-BSMT. BASEMENT 1ST FLOOR �{ a 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Checkone: Certificate. DAN-CEL CO.INC.Com Installing Company 15 CRAWFORD ST. ,W A TERTOWN,MA. Corpowtiog Address Estimate Value of Work: ❑ Partnership BusinesaTelePhone 617(-92311011 ❑ Firm/Co. Name of Licensed Plumber orGas Fitter DANIEL B. CELLUCCI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes XX No ❑ If you have checked M please indicate the type coverage by checking the appropriate box. Other of Indemnity❑ Bond ❑ A liability insurance pollcy�; type OWNER'S INSURANCE WAIVER: I am aware that the licensee dyes 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. Ownef❑ Agent❑ Signsture of Owner or own4es Agent I hereby certify that all of the details and information I have submitted(or entered)in above application aro true and accurate to the best of my knowledge and that all plumbing work and installations performed under theper^;� this application willbe in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of General I By Type of License: Plumber rgnature t lJconsed Plumber or Gas Fitter Title Gastitter Mastor License Numbor (1,957 r City/Town Joumeyman APPROVED (OFFICE USE ONLY) f I BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME&TYPE OF BULIDING LOCATION OF BULIDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 20 GASINSPECTOR Date..../P:71 ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS US This certifies that .......... .. ......................... has permission to perform ..... UAL !& '� ......................... wiring in the building of... ......................... at........ 5........................ .North Andover,Mass. Fee�h-A.�........ Lic. .......... ELECTRICALINSPECTOR Check 4 X� 6976 6 l { � Department of Fire Service PennitNo. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leaveblanl< 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: )C), 5 ' 06 City or Town of: Not-OVA fst-aAriyc- To the Inspector of Wiles: By this application the undersigned gives notice of his or.hoer intention to perform the electrical work described below. Location (Street &Number) ) ` S OS5004 S 1 eet Owner or Tenant -kQX " att�� t�� Telephone No.970-64-30 Owner's Address 116 Gs g oo d Street Ng.-j-ti 6ta3w o i 8 is Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Bos) . Purpose of BuildingA 1 10 Skies Qi, 4 serzv i Le- Utility Authorization o. 13 �-OW Existing Service Amps �00 1120 Volts Overhead ❑ Undgrd No. of Meters f New Service Amps / Volts Overhead -1 Undgrd ❑ No.of Meters Number of Feeders and Ampacity ation and Nature of Proposed Electrical Work: U'f'� � Q Q Os D© 5 f re e t f•kj Ot of pktce of 6uS( cess Re-P cik Sec©vAwzy Jfd�Nr qo.c elsyz Completion of the followin;table may be waived by the Inspector of Wires. • No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans TransTotal Trsformers Kt A No. of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- F-1 o. o Emergency Lighting rnd. rnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No. of Switches No.of Gas Burners No.of Detection and Initiating Devices No. of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No. of Waste Disposers Heat Pump Number I Tons IKW INo.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 No.of No. of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: O less 14APA It j000 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 Startloi 11 wty 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 cov age is in force, and has exhibited proof of same to the permit issuing office. A CHECK ONE: INSURNCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains acid penalties of perjury, that the information on this application is true and complete. FIRM NAME: Ki 1-L. ReC-N - 4c. LIC.NO.: l 6 So3A Licensee:\M"\-\Q UJ-SA11-e S SignatureWUpW 0.�iqfJ'jla2. LIC.NO.: ,Sa 3 (If applicable, enler "ex pt"i� the 1 cense num er ine.) Bus.Tel.No.�03--7i S- 7720 Address: 177 3 �li t° w PH 036 ry Alt.Tel.No.: *Security System Contractor License required for this work; if applicable, enter the license number here: 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' gent m Signature Telephone No. r�KlVll'1 FEE: b TOWN OF ANDOVER Commercial: Sewer Ejection Pump: $25.00 t ELECTRICAL PERMIT FEES a) including photovoltaic & Signs: $25.00 each ballast (Effective March 12, 2003) generating Equip Per KVA $1.00 Smoke & Heat Detectors& �� K-<.. -�r,,spy.`. 11IIlV111�UIPRMTT FE b)un-interruptible power systems, Initiating Devices: SID +NTL`$2 *00 per KVA$1.00 Residential: $1.00 each COMMERCIAL $5 .00' c)batteries over 100 amp. hours, per Commercial: $60.00 up to 10 O SE CABLE ON cell $1.00 devices over 10 -$1.00 each OUTSIDE OF BUILDING Heat Devices: $1.00 each Space Heaters: Air Conditioners: $40.00 each Heat Pumps: $40.00 each area heating$1.00 each Alarm Systems Security: (for fire Hydro-Massage Bathtubs/Hot Sub-Panei: $25.00 systems see smoke/heat detectors) Tubs: $20.00.each Swimming Pools: Residential: $40.00 Lighting Fixtures $1.00 each Residential: Commercial: up to 10 Devices Lighting Outlets: $1.00 each Above Ground: $25.00 $60.00 additional devices over 10- Major Appliances: (not listed) Inground: $50.00 $1.00 each - $20 each Commercial Pool: $100.00 Carnival Equipment: $50.00 each Motors: (per hp or fractional part Switches: $1.00 each Ceiling Fans: $1.00 each thereon $2.00 Temporary Service: Oil/Gas Burners: :k$ust have Utility Authorization Nliniber Commercial New Construction or n Residential$25.00 Alterations: nCs>idential$20.00 each $100.00 per 1,000 Sq. Ft. of Commercial$20.00 each Commercial $100.00 Construction Space Office Furnishings: per circuit$10 Transformers: Commercial Service Change/ (Relocatable Partitions/Cubicles) a) capacitors,Per KVA $1.00 Repair: Outlets& Fixture: $1.00 each b) ducts,conduit&conductors J# 5. Mnst have Utility Authorization number Ovens Built in/Counter Top Units: (Associated ount Transformers)$25 $100 (first 100 amperes or fraction,one $10.00 each c) each manhole hole 00 ' meter) Panel Change/Circuit Breaker: d) each handhold$$5.00 a) each additional 100 amperes Residential: $20.00 e)per KVA$1.00 capacity or fraction. $30.00 Commercial: $25.00 f)primary feeders, $25.00 each(over b) each additional meter$25.00 Phone Jacks: See 600 volts,non-utility owned) Commercial Temporary Service: data/telecomg)vaults and equip. $25.00 eachmunications Washers: $15.00 each $100.00 Ranges $15.00 each ].lust have Utility Authorization.timber Receptacle Outlets: $1.00 each Waste Disposals: $5.00 each Commercial Repair and/or Recessed Fixtures: $1.00 each Water Heaters: $30.00 each Maintenance Permit: (Blanket Re-inspection Fee: $25.00 Permit)up to 2 Electricians$150.00 Repair to Service Residential: *For ]Muhl-Family. & per air of Electricians over 2 $50.00 Data/Telecommunication: $20.00 Large Commercial Project . Residential: $1.00 per port Residential New Construction see Wiring Inspector for Commercial: $30.00 up to 10 (Dwelling): $220.00(with service up to 200 amps) pricing: devices over 10-$1.00 eachT l'aul Kennedy (978) 623-8306 Must have Utility.•authorization Number r Dishwashers & Disposals: for services over 200 amps see below (office hours 8 ani to 1.0 am) $5.00 Each a) for each 100 amps capacity or p Dryers: $15.00 Each fraction add$20.00 Emergency Lighting (Battery Units) b) each additional meter$10.00 ll�sec ti®rte.i�edE9lee $ 1.00 each unit c) each additional panel/sub panel 1 ROUGH Feeders or Sub-feeders: $25.00 I FINAL each 100 amp capacity of fraction I TRENCH (if applicable) thereof Residential Additions/Alterations: Residential: $5.00 each $220.00 maximum Commercial: $15.00 each Residential Service Change or ADDITIONAL Underground Service: k Gas/Oil Burners: $40.00 INSPECTIONS IONS $2500 (i Residential: $20.00 each Must have Utility.Authorization Number applicable) Commercial$20.00 each a) one meter,up to 100 amp capacity $40.00 (revised 07/05) b) each additional 100 amp capacity or fraction$20.00 DateQ,��?,/�'C ".O�T:'ti TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING S41 SACHUS � This certifies that . . . G4!,+.: �.-r . . . . .�. . . . . . . . . . . . . . . . has permission to perform . . . . .� . . ... . . . . . . . plumbing in the buildings of . . S. r.�. . .�'/� c/ at . .,1v/.4. North Andover, Mass. Fee./V .Lic. No.."'. .'k�'.7. . . . . . . . . � .-- LuMBING INSPEC oR Check # 1'-�-�'� t � 7157 Ct o S� �ao� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) .1 t nn c.�0V'Pir ,MA Date /Q G` 2006 Receipt# -- Permit#_X272 -__-- BuildingLocation/ZOo ©SgOac� 5 Owner's Name x-7-5 S/ p�&r-4 �S Map: Lot: Zone: Type of Occupancy New ❑ Renovation IV Replacement ❑ Plans Submitted: Yes❑ No ❑ FIXTURES Fee: z Z N to z Y Q > N F N N N O z W W La Y J > U Q 1n z O m N z J Q r- z< cr ¢ z o J rn F w ¢ x Cr N Q N O ? a �- O N W N m x r U w m Y ¢ a Q Q � x U Z Cr m N > Q H N z Q N W Cra ¢ O LL W — J W O ] ¢ Q y ¢ Q W N ¢ J z O ¢ LL Q Cr = F W 3 O 2 3 J S F- Q Y_ Q W W Y W r U LLIQ 3 x o_ z to F Z O O to Z W O U x > O ~ Q Q s N N ¢ Q O Q J J Q It ¢ ¢ Q O Q r Y J m N O O J 3 2 F N LL. O 7 4 Q 3 Q m O SUB-BSMT. BASEMENT 1ST FLOOR T 2ND FLOOR 4 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name DAN-CEL CO. INC. Checkone: Certificate Address— CRAWFORD ST WATERTOWN,MA• _ �I Corporation 398C EstimateValueof Work: ❑ Partnership Business Telephone 617 923 1011 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter—DANIEL B CELLUCCI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes U No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policyU 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. Checkone: Owner AgentO Signature of Owner or Owner's Agent I herety--ertify that all et the details and irrfarmation I have submitted(or entered)in above application are true and accurate to the best of ^y knowledge and that a!I plumbing cork and installa ormed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts StateUatu,e jg4de p General Laws. By- -- — osed Plumber Type of License: Master %1 Journeyman ❑ City/Town APPROVED (OFFICE USE ONLY) License Number Revised 05/17/00 BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME&TYPE OF BULIDING LOCATION OF BULIDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 20 GASINSPECTOR Date . .R "a ".O RT:�� TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING +. '�,,.,o•%'"try ,SSACHUS� This certifies that . .. . t - . . ... . . . . . . . . . . . . . . . has permission to perform-7`7. . . . . . r r plumbing in the buildings of.. .•.p - `.._,> .; .! at 1/ b-rJ. . . , North Andover, Mass. Fee:`/,' r // '. .Lic. IV7. . :,.,I� . ' ?: :-s'. . . . . . . . . . . . . f �PLUMBING INSPECTOR Check # 7116 � � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) // �l A/. 0L^ dC) VP- K ,MA Date2006 Receipt#_ -- Permit#- /?f j`A- — BuildingLocation/Coo OS m. OwnersName Map: _ Lot: Zone: Type of Occupancy__l-p_ ��/j__ New ❑ Renovation ❑ Replacement❑ Plans Submitted: Yes❑ No ❑ FIXTURES Fee: z m z W z Y Q j N H (n U N O z ~ W W w J Y > U Q rn U ¢ ¢ N z m J N Q _ z � Q z z a D o _ O — W H W ¢ ¢ N Q N 4 Z ~ U) N ~ U w rn Y a a 3 x O z m rn W Q t rn z o Q rA m ¢ a ¢ O LL ¢ W O D W Q to ¢ Q W N Cr ¢ J ¢ LL ¢ w U Q = 3 = a z = 3 Y d O F- Z Z Q LL Y W C n a r a a = sn N a a 0 a Q ¢ ¢ ¢ Q O Q f m O SUB-BSMT. �1 BASEMENT Xt. 'l ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR // 6TH FLOOR 7TH FLOOR v 8TH FLOOR Installing Company Name DAN-CEL CO. INC. Checkone: Certificate Address t S CRAWFORD ST WATERTOWN,MA. Corporation 398C EstimateValueofWork: ❑ Partnership Business Telephone 617 923 1011 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter-DANIEL B CELLUCCI INSURANCE COVERAGE: I have a current liability insurance policy or its substantia! equivalent which meets the requirements of MGL Ch. 142. Yes U No ❑ if you have checked Les, 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. Checkone: Owner AgentO Signature of Owner or Owner's Agent I herd,-er ify that all of the det:ils and int,,rmation I haye submitted(or entered)in above application are true and accurate to the best of ^�!<nowlcdge and that all plumbing:cork and installation .ed un he perm! sued for this application will be in compliance with all pertinent provisions of the Massachusetts State PI bi Co d Chap 42 t '`eneral Laws. v / By- - — -- Signal re of Lice sed P umber Title - - ---- ----- Type of License: Master 10 Journeyman ❑ City/Town APPROVED OFFICE USE ONLY License Number 6851 ..- Rensed OS+ ; BELOW FOR OFFICE USE.ONLY PROGRESS INSPECTION FINAL INSPECTION SKETCHES FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BULIDING LOCATION OF BULIDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 20 GAS INSPECTOR Date C7."/2 "ORT"�� TOWN OF NORTH ANDOVER '•°oma PERMIT FOR PLUMBING SSACMUSE� s This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform �� a-r�.r!—�'. - -/ _'�' `' . : • plumbing in the buildings of �. �j •. . . �.4 ��c�� at . V.. . . . . . . . . . . . .. North Andover, Mass. Fee� Llc. �— PLU* �,BINSPECTOR Check # / Z 1 U7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS BuildingLocation /600 ,� II Date I.� 06 �sgoyD �� Owners Name u > ,��- Pills Permit# Type of Occupancy Amount _mac,/ 00 �..-,? �=---� New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES r z wz z 3 c a C, x s�Bsv� RkSEVEvr LSr MOOR MHIM a M RlocE 41HFWM 51HFUX-R 1 6M FLOOR 7x H" 9M FL" (Print or type) , 7 Check one: Certificate Installing Company Name ` !/iS� i� 1 i Corp. Address Partner. Business le ep one '� — / Firrrv'Co. Name of Licensed Plumber: Insurance Coverage: Indicate the Ef type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance V Signature Owner ❑ Agent ❑ I hereby certify that,ill of the details and information I have submitted(or entered) in above application;tic trate and accurate to the best of my knowledge and that all plumbing work and installations pertur-mcd under Permit issued for this application will he in compliance with all pertinent provisions of the Ma' State Plumbing Code and Chapter 142 rat th General Laws. By: 7, 17-1 aure k't LwUIRNULIum cr Title: "I'ype r)f Plumbing License City;Town tccnse t um er Master .Journc,man ❑ ��PPROVED iOFFICE USE ONLY ' Date........ t NOR7M q TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 49 This certifies thatL ..............4:.—.................. .............................................. has permission to perform e:�G L r/ 7 v� [.............................................................................. wiring in the building of..C..v1.0-/1-4-��rE�T ....... ....................... .�^........ r.... ... ` at..... .... . Q3" Op .0:......................... .North Andover,Mass. Feel S 5..�Lic.No.1441s'9A.............. � ELECTRICAL INSPECTOR Cl / Check # 17502- J 6918 Commonwealth of Massachusetts Official use only Department of Fire Services Perrot No. f Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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 PRINTW INK OR TYPE ALOAA ORIAl Date: 9 //"0(0 City or Town of: -s OQ Q r 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) KPOO QS 6a 5� Owner or Tenant u�-�i 1 N►eo v I t 0 v ►an S Telephone No. Owner's Address 1142 00 05C;Q QC0 5E Is this permit in conjunction with a building per 't? Yes P,—No ❑ (Check Appropriate Bog) Purpose of Building (2. OJ je ! jQ&Utility Authorization No. E31s ' Service 1Amps o7�avolts Over'head❑ 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: z t G ►CPC OAS ft Uig Completion of thefollowing table may be waived by the Inspector of fres. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers 5 10� KVA * No.of Luminaire Outlets No.of Hot Tubs Genera KVA No.of Luminaires 6144 Swimming Pool ove - ❑ o.o mergency bry �,i d. Batte UnitsFX, •k No.of Receptacle Outlets -1 4 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o Detection and Initiating Devices No.of Ranges No.of Air Cond. ons No.of Alerting Devices No.of Waste Disposers eat Pump ....umber .ons ....................... No.oSelf-Contain ��� Totals: Detection/Ale ' Devices No.of Dishwashers— Space/Area Heating KW O Local❑ CcicP �Othe< No.of Dryers ti _ Heating Applian ecurrty ysterns: No.of Devices or E uivalen No.of Water KW Data Wiring: ID Heaters signs a asts I No.of Devices or Equivalent� No.Hydromassage Bathtubs No.of Motorsa ecommunicationsWining- No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of fres. Estimated Value of Electrical Work: 2.9 D06 (When required by municipal policy.) Work to Start: q-11-00 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' ice including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov is m 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: 11—A0 6 CC 1)C g LIC.NO.: � Licensee: M16 �Gsf,^�, 2 Signature LIC.NO.• 4'D (If applicable,enter"exempt"in the li ens�e number lin Bus.Bus.Tel.No.: Address: U U 0' e2C* l(Gt eil d U tV Alt.Tei.No.: ►-q 7f 417 -1/6)1 *Security System Contractor License required for this work,if applicable,enter the license number here: 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. C,- C, M i t } 4 i t d� o Date....... ... ........... f NpR7o 1 3r,•';� ��'•�_'s�ppt TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,sSACMUs� This certifies that has permission to perform ........��M.Q....fit/!�..�.7..~...U.....�.�.,�. wiring in the building of...... .. .. ... ge?�rrr'l.. �................... at......................... ` 6?ar.....S.T'.................... .North Andover,Mass. Fee./'Z...5...`t-r".. Lic.No.W17,9.Y3........... .'4.t ....... .!.. ELECTRICAL INSPECTOR Y Check # 04 ,233 611, 7 U Commonwealth of Massachusetts official use only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 11/991 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: ID City or Town of: 1447daYL.L 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)_ �(� Q0 or a /s—, eL— — OwnerorTenant i9zz f -er—o 0&_x_-rt- 8a:'/gam _Telephone No. 9w—6,6 Owner's Address Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity ^� Location and Nature of Proposed Electrical Work: _Ar Mo Com letiont o the ollowin table ma be waived b the Inspector o Wires. No.o Total No. of Recessed Fixtures No.of CeiL-Susp.(Paddle)Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA n- o.o mergency Lighting ove No. of Lighting Fixtures Swimming Pool rnd. Elrnd. ❑ BatteryUnits No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No.of Zones' o.o Detection and No. of Switches No.of Gas Burners Initiating Devices Total of Alerting No.of Ranges No.of Air Cond. Tons No. g No. Heat Pump umber Tons KW _ No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local C1Connect on [I Other tccunty ystems: No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of. o. o Data Wiring: i Heaters Si?_ns Ballasts No.of Devices or.E uivalent TelecommunicationsWiring: 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. 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:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:' Inspections to be requested in accordance with NEC Rule 10,and upon completion. 1 certify, under the pains and penalties of perjury,that the information on this ap licat, rue and complete. FIRM NAME: S ,e _ ZF_C'�7Z! LIC. NO.: (/S Licensee: `C 2 z Signature Z-- LIC. NO.: (Ifapplicable, enter"erentpi-inthe license*nuniberline.) Bus.Tel. No.; Address:/ �sL/1 �,�!L`� u�, . Alt Tel. No.: �� � �� OWNER'S INSURANCE WAIVER: I am awarelthat the LtcJensee goes non nal a utc iiautuiy insurance coverage normal y required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ /o2J Signature Telephone No. APPLICATION FOR ELECTRIC WORK PERMJT (DO NOT F411.1- OUT THIS TOLD) No, _ — serial No. -- Si. l ♦o. O-'Rer Ekciric �e i Permit Issued REPORT OF INSPECTOR OF WIRES 1 - f � Date.... ...................... ,j0RTpj TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 3 CHUS This certifies that .....S44v1.64 ......gz-6c ......C.0 has permission to perform wiring in the building of....... t ........... at............................. ....... .. ......................... ,North Andover,Mass. Fee.../ Lic.No..72 ........... ?ek' e. .1% S�Yez- A 'O� Check # c2 6 93 Z- R i'CMCAL INSPECM 6 1, 7 7 Commonwealth of Massachusetts Official use only Department of Fire Services Permit No. -7 BOARD OF FIRE PREVENTION REGULATIONS occupancy and Fee Chdcked [Rev. 11/991 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: (� f/A4 _ City or Town of: To the Inspector of Wires: t5 n By this application the undersigned eves nonce of his or her intention to perform the electrical work described below. nW cq Location (Street& Number) �r�-j�G ®.Y' (jc�� S'/ ✓�! F18® 01%- f�" - Owner or Tenant Telephone No. Vi--eley',FYC-> Owner's Address Is this permit in conjunction with a building permit? Yes Ir No (Check Appropriate Boz) Purpose of Building `ncla�' �- 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: e-/or /a6 V �ij Completion o the ollowin table ma be waived by the Inspector of Wires. No.o Total No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA ove n- o. o rg meency Lighting No. of Lighting Fixtures Swimming Pool rnd ❑ rnd. ❑ Battery Units No. of Receptacle Outlets No. of Oil Burners EIRE ALARMS No. of Zones No.of Detection and No.of Gas Burners �j No.of Switches Initiating Devices J No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat in umber Tons KW No.of Self-Contained No.of Waste Disposers Totals: - __--- Detection/Alerting Devices Nlunrcipa No.of Dishwashers Space/Area Heating KW Local E] Connection EJ Other ` Heating Appliances KW SecurityDevicSystems: No.of Dryers 1; No.of Devices or Equivalent No.o atero.o o. o Data Wiring: Heaters KW Signs Ballasts No.of Devices or.Equivalent Telecommunications tang: No. Hydromassage Bathtubs No. of Motors Total HP No.of Devices or Equivalent OTHER: _ LI(�-1i/.ter �nTi� R4S �DJK�O i S / - A F/� IGi4S Attach additional detail if desired or as required by the inspector of Wires. 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:) (Expiration Date) 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. 1 certify, under the pains and penalties of perjury,that the information on this a licatio ' true and complete FIRM NAME: S _ cZ£� EJLIC. NO. vs Licensee: /! `C l gel 4z Signature LIC. NO.: (If applicable, enter"exempt"in the license number line.) Bus.Tel. No.- Address: cl�G ���� �C�/�`� �' Alt.Tel. No.: OWNER'S INSURANCE WAIVER: I am aware'that the Lic'see goes not have the liab«<ty insurance coverage normally required by taw. By my signature below, I hereby waive this requirement. I am the(check one)❑owner ❑ owner's a ent. Owner/Agent I PERMIT FEE: $ Signature Telephone No. APPLICATION FOR ELECTRIC WORK PERMIT (DO NOT FILL OUT THIS FOLD) \o. —_--- Serial \o. -- -- St. ® O�nes Ekc�ric ,. Permit laaucd REPORT OF INSPECTOR OF WIRES D m Date..... '' ...................... v NOR7M TOWN OF NORTH ANDOVER p PERMIT FOR WIRING AcwUSEt This certifies that ....... . . has permission to perform ...... ..T=`A Q.............. . -7� ....................................... wiring in the building of�T SS /ELE�,yiP' �t T' ZZ f ..................... ................................................. .. at... © "P- ..........................................�,N orth Andover,Mass. ` 'vd ZS . 6-0?3"f � 'yur�7 Fee..................... Lic.No.)............ ................. `.` ...-:� Check # �. :�............. .. .... ...... LEC MICAL INsn rM ai� 2 Commonwealth of Massachusetts Official Use Only Permit No. � Department of Fire Services Occupancy and Fee Checked y BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( EC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9r14 10(, City or Town of: North At iAo ger- 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) Iwo oSgyoS- -. 1 tdc9jq 20 aiN4 F(oc)r- Owner or Tenant Ac(.eS S tc\ey-t4ic + Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appfopriate Box)*' Purpose of Building Utility Authorization No. t/�"��/,,1� 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: y i t l nsq 90 and FL=2 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 19, SwimmingIn- o.o mergency ig ing Swimming Pool rnd. 1:1rnd. ❑ Battery Units No.of Receptacle Outlets I O No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection andTo—ta �* InitiatingDevices lJ No.of Ranges No.of Air Cond. Tons No.of Alerting Devices I No.of Waste Disposers Heat Pum Number Tons KW No.o elf-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 iNo.o Water KW No.of No.o Data Wirin10 Heaters Signs Ballasts g' No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 10 No.of Devices or Equivalent OTHER: aGkwn�tG( 2q CC—w� tsr /ZCCtpfiac(e3 WP20 v214 LF 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: q 46 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 Ii, insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the ants and penalties of per'ury,that the information on this application is true and comptetg. FIRM NAME: ("�)f I L�C 111 1 Int✓. LIC. NO.:/ 650J6 Licensee:Vial vNf Spi(`C S Signature I S LIC. NO.: 6 so 3 (/f applicable, ent r "e mpt"in the/i ense number line.) �n Bus.Tel. No.970-5/S-7, aZ Address: /7 3 �(sf'setcd /�se S1. 64 , I~( 03,011 Alt.Tel. No.: *Security System Contracto License required for&s work; if applicable,enter the license number here: 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: $ Date.....�1.`../?—0 7. NORTH "� r °t-�``°:•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 'TS ACMUS� This certifies that ............................................... .. -.................. has permission to perform ........:A�......... &).... .................... wiring in the building of............. 0 �1� 5............. ................ ....... .. at..........Ile P0...��. d� T ,North Andover,Mass. ... ........ ...... .............................. vo // Fee�. ....'... Lic.No.�6. A3r4 PaT-R/I--( .,,1-~ ! a . ,* —� -� ELAL INSPECTOR / r Check # / b4 �: Commonwealth of Massachusetts Official Use Only ' Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Co (MEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: q 2 0`? 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) ! 66V oSqood - Owner o Tenant 100 Sf. L,.C,C QRZ N "I M A*qM-cE, Telephone Nog?8'4'15-44 7 Owner's Address Woo S4. ti�dty Is this permit in conjunction with a building permit? Yes � No ❑ (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: K`i 1i4ri' �-5 rNe2'% S;dt cF pwpn,iy U sce muect e,.0 d t-'tiirce SrSc %�J;talo 1P_Le4<C u sc,-,v,cc s Completion o the followin table maybe waived bZ 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 Swimmin Pool Above In- o.o mergency ig g r g rnd. ❑ d. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump I 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 E No.of Water ' No.of uivalent No.of Heaters � Data Wiring: Si s Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: 0 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: /01) (When required by municipal policy.) Work to Start:9&10 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE O RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE E3 BOND ❑ OTHER ❑ (Specify.) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: % LL Re_c-�ti C Co, SNC . LIC.NOVb50311 Licensee:\JJ "mtvi. `e cue S Signature LIC.NO.: i 6�— (If applicable, enter 11exem pt"in the license u ber line. ©�� Bus.Tel.No.•_ Address: P• ct Alt.Tel.No.:6E-7b ' 7a2 *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: $ S�c�rtJCU�� The Commonwealth of Manachusetts Department of Industria!Accidents ;. Office of Investigations . 600 Washington Street Boston, MA 02111 c www mss&gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ar olicant Information Please Print Legibly Nance(Business/Organization/Individual): ,, e( ,V\( Co. Address: 3 { ra Aq Ay e City/-Stawzip03Q) Pbone#: U 3- 766` 97a 2 Are u an employer?Check a appropriate box: Type of project(repaired): am a employer with 1 4. ❑ 1 am a general contractor and I 5. ❑New construction employees(full and/or parttime)* have hired the sub-contractors 2.L] I am.a.sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These stets-contractors have 8. Q Demolition working for me in any capacity. workers' comp.insurance. g. Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10. Electrical required.] officers have exercised their repairs or additions 3.❑ 1 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.[]Roofrrpaira insurance required.]t employees.[No workers' 1,3.[-]Roof ther comp.insurance required.) `Any applicant that checks W#I mug also till oat the section below showing their workers'compensation policy information t Homeownerg who submit this affidavit indicating they are doing all work and then hire outside contnactors must summit a new affidavit indicating suds lContracwrs that check this box mast attached an addit=W sheet showing the name of the sub-contractors and their wodms'camp.policy intomwjon. I ant-an employer that hs providing workers'compensation irzsw w�ace for my eMloyea; Below is the policy mid Job site information. e--- �^ Insurance Company Nam U iU Ce CU yl �j j,j Policy#or Self-ins.Lie.#: W C { 3 Expiration Date Job Site Address: ox% es e"q Eve City/Stattirl . rP 14,m i�CGa��S� t� Isl �0 t:wl�. q Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dated 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 ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c under the paras and penama of perfruy that the rnformalmn provided aboveistrue and corm Si •� d 2 0 .ate• Phone#: 1�� ` 7�Jam'�/ D-2 Of,j°lcial use only. Do not write in this area,to be coa rpleted by City or town official City or Town: PermittLicense# Issuing Authority(circie one): I. Board of health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: NORTH TOWN OF NORTH ANDOVER 1 .0 0 PERMIT FOR PLUMBING This certifies that : .. . . (:P. . . . . . . . . . . . . has permission to perform-,---, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of at . r , North Andover, Mass. Fee . . .Lic. No. . . . .,, , . . . . . . . . . PLUMBING INSPECTOR Check # /1-f'-- 75"7 MASSACHUSETTS UNIFORM AP LIGATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date ����"d� Building Location I COO O-Z7- Owners Name 6 Z Z y t�Q',c-jam�i Permit#7u3 Amount Or— Type of Occupancy New 0 Renovation �' Replacement Plans Submitted Yes No El FIXTURES z H j o z Cna o W o w xw 0 a z F x H x a A z a a W w o x A A a 3 H � � A � a -letw A13-EME M FLOOR 2M HAOM 3M H-(M 41H IJOM 5IH FLOOR 61H HA" - 7IH HfM gm IFLOC)>E2 (Print or type) , C®one: Certificate Installing Company Name--=C/Z ,Yy Sa7/ ca7t/rCorp. 7 25 Address /S9 SO, w Sy�Z�z{"to.2/ S-� Partner. n10 tWt Business Te ephone boV C ZZ C5207 Firm/Co. Name of Licensed Plumber: �6 E G 1'(��r.�-�✓ j Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Er Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plu bn� ing_Code and Chapter 142 of the General Laws. By 1gna ure o icense um er Type of Plumbing License Title 15"o 26 City/Town icense um er Master © Journeyman ❑ APPROVED(OFFICE USE ONLY Date......q— ............................ 41 tkoR Of TOWN OF NORTH ANDOVER PERMIT FOR WIRING 49 SS CHUS ,C7t This certifies that ........... (L -S r ...... ................................................. ..................... has permission to perform ................4.1-1...A�..... ......... wiring in the building of.. ........"I............. .......... ............................ at.../........................................................�i!'!;*�,V.... ,Nort h Andover,"w Fee.0... ... Lic.NoA ......../Oil�Me-,V',4' ...... ECrRICAL INSPECrOR .Check # 69' 6 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. k� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 9/051 1 leave blank APPLICATION FOR PERMIT TO PERIFORM 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 INF`ORMATION) Date: q � I J I O G City or Town of: 0(,-% k�oq a To the Ins ec or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number)1600) 6 � S�. 6i ` 'Oa ZC) Owner or Tenant fav 6si 5f� LIC--02?Y Pro e1 I P ' Telephone No. -16"W75-4561 Owner's Address u e@ PoW K AvjcU (!R M t Is this permit in conjunction with a building permit? Yes 15 No ❑ (Check Appropriate Box)* Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity ` Location and Nature of Proposed Electrical Work: New 'G�(-,fo4l 4 Drs©( 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. ❑ rnd. ❑ 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 TonsKW No.o Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Mun'c'pal ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Systems:* No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications firing: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. z' Estimated Value f Electrical Work: (When required by municipal policy.) Work to Start: L Qj 0� Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liabili insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and enalties of perjury,that the information on this application is true and complete. FIRM NAME: <t L cecTctcc LIC. NO.: IL56 t! Licensee: J Aq Y1 o Splc'e 5 Signature GU_ LIC. NO.: 1(0 5® (If applicable, enter."exempt"in the license tuber lin a Bus. Tel. No.: Address: US &C-4 �, Ave , �"(m kq 696']1 Alt.Tel. No.: *Security System Contractor License required for this work; if applicable,enter the license number here: 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 FPERMIT FEE: $ Signature Telephone No. Date............................. HORT1� °�<�`'°:•'"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING s o� _,�•"a �,SSACMUSE� This certifies that ......... ... r has permission to perform .......Pow ..POLE s leer l_..IU4,.... wiring in the building of.Nfy-:r5Tq ... at..1.. l��a. ... .T...��.............................. .North Andover,Mass. Fee 1 ............... ....,1.,,.�*�•��.C?'!. IZ<CAL INSPECTOR U ..i Check # �- 55934 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 3�/ Occupancy and Fee Checked ti BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeEC ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9 I 'y�bb City or Town of: N o Ei'l Pm Ao\)a To the Inspector of Wires: By this application the undersigned gives notice of his or her i tenti qn to perform the electrical work described below. Location(Street& Number) 160 ® C)!&JW d Sf �j :10 p(t,d Ftodlz Owner or Tenant k-ex f skl e Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: FIL-pdr Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans No.of Total Transformers KVA ' No.of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detectoon 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 Detection/Alertin .Devices No.of Dishwashers Space/Area Heating KW Local ElMunlc'palConnection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: ,,J r No.of Devices or Equivalent OTHER: Cag (up RC fi4C4C3 -frd K Ptuf—ccs ),3ss %Scv0tJec'S Ir Pcytt- p6tes ft7P Pw12 lool?s Attach additional detail if desired, or as required by the Inspector of Wires. Estimated'Value oElectrical Work: (When required by municipal policy.) Work to Start: gob 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 liabil' insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such co rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) 1 certify,under the ains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Wi(.L ELCCV6 C LIC. NO.: 10034 Licensee:WG�q hC V). CViCe S Signature° S LIC. NO.: /6S0 3 (If applicable, enter "e emp 11in the license umber line. f Bus.Tel. No.q%' 815--72 Address: q / a /4 0&07 Alt.Tel. No.: *Security System Contrac or License required for this work; if applicable,enter the license number here: 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. Date.....�.""�....©!...... t HORTM TOWN OF NORTH ANDOVER PERMIT FOR WIRING sACHUS This certifies that ........ ¢..�/ tQ....... lc T. .......... - • ................................... has permission to perform .....fd�fo.. !.... .......... wiring in the building of (—')7—?— /192,0ntLTi F_.5 ................................................... !•c-!'v G�'�i�iE E North Andover,Mass. Fee.. � .f.. Lic.Noj .�zi ........ . .tslia ......... ELECTRICAL INSPECTOR Check # r 01/05/2008 10:94 FAX 978 475 1192 ANDOVER ELECT 00011001. Official Use Only Commonwealth of Massachusetts l/ Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRS.PREVENTION REGULATIONS Rev- 11/991 leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK j 27 CMR 12.00 Ad work to be petlbnned in eeewdonce wkh the Ma"Whusettt Aeee+cat Code s�o 6 (PLEASE PRINT NINK OR TYPE it U INFORMATION Date: ' City or Town of: North d o v e r To the Inspector of lir By this application the undersigned gives notice of his or her intention to �echnologiesa%m the electrical described below. Route 125 -Lucent 't (��, +� Location(Street di Numb Owner or Tenant Towyn o.. Nort n over Owner's Address 120 Main .Street [� Is this permit in conjunction with a building permit. Yes No (Check Appropriate Boz) Purpose of Building c o m e r c i a l Utility Authorization No. E ung Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Senice Amps /volts Overhead[3Undgrd❑ No.of Meters Nui ber of Feeder and Ampacity Location and Nature of Propo*d Electrical Work: Wiring o f portable partitions. Com eQion o the Mnollotable be waived the I edor o Wino. ! .0 0 No.of Recessed Fixtures No.of Ce"usp:(Paddle)Fans q sformors KVA No.of Hot Tubs Generators XVA No.of Lighting Outlets 0.0 ergenCy LIP119 se No.of Lighting Fixtures Swimming Pool d ❑ read. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners I=ALARMS No.of Zones o.o ria No,of Switches No.of Gas Burners Initiatin Devices No.of Air GondTotalNo.of Alerting Devices No.of Ranges .i . Tons eat Pump INumber ons No.of Self-Coutained No.of Waste Disposers [`O Detectlon/Ale Devices Mnacippl. Other No.of Dishwashers Space/Area Heating ICWSecuriLocal p yyCsstonnection 0 • No.of Dryers Heating Appiiancts KW No of bevices or uivalent O.o Ateroo o.o Data Wiriag: KW . Ballasts No.of Devices or E uivaleot Beaten. Signs akeoaications . Icing: No.Hydromassage Bathtubs No.of Motors Total 19 No.of Devices or X4ulviteat OTHER: r Atrrdc odditienat detoil(f dadrd,or as requiredby the Inspector of W6tir. of electrical ork may ism unle t INSURANCE COVERAGE: Unless waived by the owner,no permit for the perfortttattce its substantial)equivalent Theme the licensee provides ptoof of liability insurance including, completed operation coverage undersigned eerti'tI s that such coverage is in foice,and has exhibited proof of same to the permit issuing office. CHUCK ONE: INSURANCE (] BOND ❑ OTIMR ❑ (SPectfy-Z ( xpiratioa Datc) . Estimated Vsiuc of Electrical Work (When required by municipal policy.) Work to Start: 15 6 Inspections to be requested in accordance with NEC Rule 10,and upon Completion. Y t entity,vender the pains anQpesralties of psrjrtry,that the informatfo tt flits, plication is true attd cotnpkrl4 342 A LIG NO FMM NAME' Andover LIC.NO.e Licensee: Robert J. Branca Signature ��95 (�f t►PPlicabiw enter"exempt"in the licetcss number lint) Bus.Tel.No: Address: 206 And o v eAN R: Yam aware atr Street theLi11�cetlsver Me does no 810 Aft. the liability nut Mice eoovetape notmally OWNER'S INSURANCE required by law. By my signature below,I hereby waive thiarequirement. I em the(check one owner ❑owner's t. Owner/Agent PERMIT FEE:a 0 a I Signature Te one�No.N 1 , Date 1 o'<"��':1tio TOWN OF NORTH AN OVER r of ' PERMIT FOR PLU BING ,SSACNUSE� V This certifies that . . �".�.�. �:Y .' has permission to perform . . . . . . 11c plumbing in the buildings of . `k.. . . . . . . . . . . . . . . . . . . at . . C. G c. .G. .0.<.c.0 . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee Lic. No..3 c. ?a `'. . . . . . . . . . . . �-^c!���// . . . . . PLUMBING.INSPECT6R Check #t, > > C, 7153 I I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date 10-/? Building Location )0 0 0 pi�q�C) Owners Name Permit# 7/s Amount �yp T eofOccu anr �Cfcir New Renovation Replacement Plans Submitted Yes No FIXTURES VO z Ln V , ►� Lnx a �lQ zrA � z r V pS W� iYk'E. 1`1\l ZrnYLOOR 3MFLOCR 4MRIM 51H Eli" 6MHDM 7M ILOCIR 9MBDR (Print or type) r Check one: Certificate Installing Company Name 1\ey n 11w� El Corp. Address ) u_ -7 r_'P P:eCrcm Mc., A�elI Business Telephone _© 9F0. Name of Licensed Plumber: I CS U r in 1L Gly Insurance Coverage: Indicate the type of insurance average by checking the appropriate box: Liability insurance policy El Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ® Agent I hereby certify that all of the details and information 1 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signature 01 LiCenSeCium er Type of Plumbing License Title City/Town License ui"1� erg' Master Journeyman [� APPROVED(OFFICE USE ONLY C�� • Date..1::..�. i i" NORTI� °f'"";•�"O TOWN OF NORTH ANDOVER o PERMIT FOR WIRING ACHUS This certifies that -�1.:": `''`•'c'��' � ..`� ...........:........ ......:..... ............................................... has permission to perf � ` '�- ��.. — ."- -° � ............................................................................... wiring in the building of....' f-v.............................. ,North Andover,Mass. Fee / ..... Lic.No6.14.772. ........................................ I d n ELECMICAL INSPEM'i' r Check # 7159 -� toommonweaun ormassacnuserrs Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /- 17 -0 :1 City or Town of: Vim/<_ To the Impec•lor of Wires: By this application the undersigned gives notice of the on-premises perfonnance of electrical work by employees. Institution Address Location and Nature of Proposed Electrical Work: Z�,q 0 GS( '00, S'i /�. i9�✓�dVGr� �En.E�r4L �-ir���✓' � C°�wS�-7�i/CTit�� NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual pen-nit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during non-nal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ NO We will maintain one or more contemporaneous log(s) (check one): YES ❑ NO This option is available where so contemplated by the municipality. In these cases, you must renew this application annually, and upon significant changes in employment.. The following individual(s)will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Allach supplementary sheets if reyuh•ed fior additional log locutions. Log coverage,and location where it will be maintained Responsible person i fps You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure, indicate below how the Inspector of Wires should access the log: CcWn9��T �•!=S M��.�Gy� jo How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians)do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: V Total electrical employment: Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: Inslitulions are defined for!hese purposes as any person,firm, or corporation operating under c. 14/ §8. (Please see reverse side for cei ications and required signature.) Institutional Permit Form, page 2 w ,VOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 $8 for electrical work on the prenZ- ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board,or in contravention of the Massachusetts Electrical Code. My title is: 10/�',�5 111) My authority to act for the aforementioned institution is: �zE7 j /cerlify,Murder the pains and penalties of perjury,that the information on this application is true and complete. (Signature) (Dated) / 7 -p (Print name) y �qc VK14 •�� (work telephone number) (extension) (facsimile number) 17 7G33 L6778 r r x v , X72S�' /�4r -z d L gig/;' � C� G >?U✓✓� s4 J v s 77 SX I ,tee Gi/b,'I/a 14-1>" ✓a -i2 e-r- - �' � 3'L'G'. �✓� �' � �Z rrc�i �P.9 e K Y% N A`� f, �� �t/ � D -� �t �. ,, V I I� i t a i f a Date.. .. .... NORTH a:°����•�;•'"o° TOWN OF NORTH ANDOVER ° p PERMIT FOR WIRING s-2 CHus certifies that ..........:. f :F .`.: . . K:�............ This certi .. .................. has permission to perform,.. .. .. �' ...c...l..�`.t.i�:l:.f . /.� fa ........ol .... .. ......... wiring in the building �e .. North Andover,Mass. l !/!!..,&.. Lic.No. ..... �............... ... Fee ..1.. ELECnuCALINSPEC R Check # 5559 h __ _ vVli•uWI[WG([LLR v[ iitaaaacnuaetti vurcrar use unty c� �7 Permit No. - 2eparlmenl o1}ire S rvicee BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to tf municipal inspector of Wires is required for work on the premises of the institution. If you are not an employing utstitutic pursuant to C. 14 1 §S of the Massachusetts General Laws,stop here. You cannot use this for it. Use the standard form only. (PLEASE PRINT LV INK OR TYPE ALL INFORAf,,lTIOiV) Date: 3 05 City or Town of: 2 t,)P0V1/L_ To the Inspector of Wines: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution Z, 0 0sc,DO �' ,t✓ Z C Address !lD Qd 0S(,rSoD, 972s t;T N, AAj AOVin, 01 c�4Ls J Location and Mature of Proposed Electrical Work: 6-rro NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ NO '& We will maintain one or more contemporaneous loe(s) (check one): YES NO ❑ This option is available where so contemplated by the municipality. In these cases, you must renew this application annually and upon significant changes in employment. The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be, located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplernentany sheets if required for additional log locations. Loa coverage, and location where it will be maintained Responsible person bt � u vLv ` ZZ6!� _ c J& You may maintain the logs electronically upon agreement Nvith the Inspec!or of Wires. If-you intend to apply for such a proce dure, indicate below how the Inspector of Wires should access the log: /—y C+ f�VD9'1Cs't�:fL �Vy7ZiyYl r4 _f>� ch St /! T Flow many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians) do you emplo, at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical entployutcnt: c�. przy FSr�cr ZFr"l ill-lime equiialent electrical emplo�utent: _� I low many hclpa-s or apprentices do you employ to assist your licensed staff, under their direct supervision(see c. 141 §S)? It general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap ply for veterans (see St. 1962,c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the nuns ber of full-time equivalent staff that number includes: Total electrical employment: --0 Full-time equivalent electrical employment: -Q Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: 0 — Full-time equivalent electrical employment: 0 'Instittntions are definer!for these purposes ins an. person,firm, or co►po•ation operating wider c. 14l§8. (Please see reverse side for certifications and required signature r Institutional Permit Form page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num. bers of such employees in this application. If the contractor directs such performance, of if the contract period is for les than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In additio provide a statement that substantiates your authority to hire electricians pursuant to C. 141 §3 for electrical work on the prer ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules said Board, or in contravention of the Massachusetts Electrical Code. fly title is: 77{�� i illy authority to act for the aforetnentioned institution is: Mfg, I certifi-, under they pains and penalries of perjury, that the information on this application is trite and complete. (Signature) (Dated) (Print name) C q— �, Q (work telephone number)�g 1 �t'JO (extension)/Q / (facsimile number) Date.'!n.... 9 a t AORTI♦, :;.��``°.;•�,•"oo� TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACMUS� / y/.This certifies that ..... ............ .....2 ....... ............. has permission to perform ......-.rz:-,... -.-}:��:�-�-!-..-�-�..'..�..r...:� ................. ..,. wiring in the building of..... `? ... ./f...... �? ccst....................... �� - '..................-- . .. North Andover Mass. ........................... ........... ......... . .. 5 A(ci�.-k3sz. ............... . ELECTRICAL INSPECTO Check # 777 "k'\ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �-j�— Occupancy and Fee Checked 471:52 - BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] eave 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 PRINTWINK OR TYPE ALL INFORMATI019 Date: 1011001107 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) /(,0O ds S aua/ /,3101, ..kAw C20 Owner or Tenant L oxer c^AZ 42 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boz) Purpose of Building A".f.,1- « fiat Utility Authorization No. N1114 Existing Service Amps `yS'O / -t77 Volts Overhead ❑ Undgrd❑ No.of Meters / New Service /*-/A Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �s Completion of the foliowin table may be waived by the Inspector of Wires. No,of Recessed Luminaires90 No.of Ceil.-Susp.(Paddle)Fans No.of Total `"-"' Transformers i KVA 7S - Generators of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires / 0 Swimming Pool Abov� ]n- $ o.o mergency Lighting rid, rnd. Batte Units 3 No.of Receptacle Outlets /O No.of Oil Burners ..� FIRE ALARMS No.of Zones r No.of Switches No.of Gas Burners - o.of Detection an del's Initiatin Devices fQ No.of Ranges No.of Air Cond. 1N1); Tons No.of Alerting Devices No.of Waste Disposers eat Pump NumberTons I KW o.of Se -Contained Totals: `_......__....._.............._............_. Detection/Alerting Devices No,of Dishwashers ' Space/Area Heating KW _, Local�.lalunicipal [I Other No.No.of Dryers Heating Appliances KW Security Systems:* _.., No.of Water No.of No.of Devices or E uivalent Heaters 3 KW .of NoSi s ,2 Ballasts , Data Wiring: �anclu;Zc o�lr No.of Devicesor E uivalent No.Hydromassage Bathtubs No.of Motors -- Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: //A a3oo (When required by municipal policy.) Work to Start: /OI/8/47-r 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 [ $OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: too vyt lrt �,/ 7-ec Lino/o ),v A r . LIC.NO.: 417 5/.0y Licensee:—/ Ov,`al A 4-13,4— Signatu ,-, }re � Z LIC.NO.: Z-7-3 D3 S-4 (If applicable, enter "exempt"i the license number line.) Address: IVP lji o �/� �1'k I/Z,y �yjA7/5%.?7 Bus.Tel.No.: SOS• .2 7S-g 2 s',t Alt.Tel.No.: -?s0- A 73 *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/Agent owner El owner's agent Signature Telephone No. y, 4 � OF ELECTRICIANS REGISTERED MASTER ELECTRICIAN Is'!_IES T.i 15_!c=1,I,'E T - OMMERCIAL TECHNOLOGIES, INC IPAVID P LEBLANC 48 DAVIS RD N� MILLBURY MA 01527- 1013 17484 A 07/31/10 322158 Fold.Then Defach along?,I!P=rtorariors i The Commonwealth of Massachusetts • ' ! Department of Industrial Accidents ti Office of Investigations stilii'�- 600 Washin n Street yy � t;'�/r Boston, MA 02111 I�z www nwss.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 6&&, mere' T c. n /o rJ Ir!e , Address:. R C, 2 /N AV City/State/Zip: A ,/4u r1, Mil• 0/_s-27 Phone k . sv o_ a 7s,- g.�j v Are you an employer?Check the appropriate box: Type of project(required): LIE❑ I am a employer with le 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. Now 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 8. []Demoiition working for me.in any capacity, workers' comp.insurance. g. Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its requ1ted.] officers have exercised their 10.❑-Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MOL I I.❑ 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' camp. insurance required.] I.3:❑Other Any applicant that checks ho)l#I 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 kite outside contractors must submit a new affidavit indicating such. ;Contractors that check this box mustattached an additional sheet showing the name of the sub-commactu s and their workers'comp,policy information. I ant an employer that rs.protadatg<workers'compensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'.compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine ftp 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 Si afore: Date: /!1/I8l d -7 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 catificate(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 requir-ed to obtain a workers' compensation policy,please call the Department at the numberlisted 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 flog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Offiee of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-7274900 ext 406 or 1-977-MASSAFE Fax#617-727-7744 Revised 5-26-05 . 4vww.mass.govldia • Date.. ............................ 1 NORT1� °�t�``°;•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ;,SSACHU`�� This certifies that ............................................................................................. has permission to perform,. —z�-� ........................... wiring in the building of ems.. at �� ?�� — 011.... ,North Andover,Mass. Feeh� ........... Lic.No. ............. ........................................................ ELECTRICAL INSPECTOR Check # Oel -z,3 7954 Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveb►ank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C),Y27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (� g 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) (�� p Owner or Tenant (�O ) Telephone No.—tB, Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the.following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals: ""." """' . .. """""' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal EJ F1 Other Connection No.of Dryers Heating Appliances KW, Security Systems: No.of Devices or Equivalent No.of Water K`,�, 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: F Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o El ctrical Wor���, t7t� (When required by municipal policy.) Work to Start: 0O 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 coxerage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under t e gins and enalties of perjury,that the information on this application is true and complete. FIRM NAME: )U ,� LIC.NO.: Licensee: TODD C40 )5N1A Signature���'�'� LIC.NO.: �q (Ifapplicable�r enter :`exempt"in the cense umber line.) /� Bus.Tel.No. 1 I Address: Ukkl o SRU Qd+ .G�'�ai� /1/1-F � � j�3 Alt.Tel.No.: S 15 *Per M.G.L c. 147,s.57-61,s curity 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 d Signature Telephone No. PERMIT FEE: $ Ic � ' Date...... .�.'.�7-©.7.. NORT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACMUS� This certifies that .... has permission to perform .......t)A-1 - 1Z.4r,4,-r..k'1'2e-' /TvlaL ............. wiring in the buildin of S%.'7..• ...... at...... .7... .. °'!.' eB ! 5....................... .North Andover,Mass. a -ado Fee. .? Lic.No. .�7 S.Zf�.............. ..�.!l!rf ECTRICAL INSPECTOR���� Check # 7832 Commonwealth of Massachusetts Official Use Only Permit No. `7 2- Department of Fire Services Occupancy and Fee Checked w BOARD OF FIRE PREVENTION REGULATIONSRev. 11/99 � 1 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: /`gip/p 7 City or Town of: c/v,.7c'r/ To the Inspector o Wires: By this application the undersigned gives notice of hi or her intention�t�oerfbrm the ele trical work described below. Location(Street&Number) 1` r ,>1�.' �tZ- Owner or Tenant C 7-- Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yesz No ❑ (Check Appropriate Box) Purpose of Building X,: v 14�r4 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: 47 Completion of the follo%ing table may be waived by the Inspector Qf Wires. No.of Recessed Fixtures No.of Ceil: Tr Susp.(Paddle)Fans o Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA Above F-I o.oEmergency Lighting No.of Lighting Fixtures Swimming Pool nd. 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 Detect and InitiatingFD Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump umber Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW ecurity ystems: / i7 No.of Devices or Equivalent (� a o.of Water KW o.o o.o Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: q No.of Devices or Equivalent O OTHER: Xlew, o 1,- ell Attach additional detail if desired,or as required by the Inspector of Wires. 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 coveragglis in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: t po p (When required by municipal policy.) Work to Start: z&ke v Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury, that the infonnaj on on this application is true and complete. FIRM NAME: 0 2l LIC.NO.: /alJS�7� Licensee: �, �. �av���a Signature LIC.NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.:l%T -�J� Address: /�rW �©Vl/��i �� y Alt.Tel.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. !Civ�i Date...... ......... NORTM °�<<``°;•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING c , �7S SACNUSEt This certifies that .... H.,l ..... ...... a!................................... has permission to perform ,�-f-!--z.. ........... wiring in the building of.......:G ...�.,•1... ....... .... ............................ at .....` �`a �c ..�........................ ,North Andover,Mass. Fee.�:V......... Lic.No� ELECTRICAL INSPE R Check # 765;' Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 7 39 BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 upancy and Fee Checked .,Sa leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 CMR 12.00 PVUA,l (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9 110 10 Ilk City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of or her intentio o perfgr�the electrical work described below. Location(Street&Number) 1 60Q log o Owne or Tenant/GOV QS s�f, L:L cZ2- �t �' ,W-1 P �elephone No3l J`q7S Owner's Address Q t7 0d Sf s 3u i 14,� 2yti,� �.L Cei Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters ,33 New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ; , 3 CoyX0c+-P- biScVNt4e C+ 4--" V-A 1ct Completion o the followin table may be waived by the Inspector of Wires. No,of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans -S-0.01 Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above d. ❑ o.omergencyNo.of Luminaires SwimmingPool Lighting 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 TotaInitiating Devices No.of Ranges No.of Air Cond. Tons No.ta of Alerting Devices No.of Waste Disposers Heat Pump Number .Tons KW No.of Se -Contained a Totals: - Detection/Alertin Devices No.of Dishwashers S ace/Area Heating KW Municipal p g focal❑ Connection [I Other No.of Dryers Heating Appliances , Security Systems:* No.of Water No.of Devices or Equivalent No.of No.of Heaters KW Signs Ballasts Data Wiring: No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent �� Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lectrical Wor s (When required by municipal policy.) Work to Start:y bInspections 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 co erage 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: ,i LL Ucciq' C, I LIC.NO.:1 E63 Licensee:'P o tvi.Spice-,)i ces Signature i g S'A�I.Q'L LIC.NO.: /6S 3 (If applicable, enter"exempt'the 1' ense ru ber line.) Bus.Tel.No.:Address: Alt.Tel.No.:Q 3�-74 Sl �a *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: $ 012 I r The Commonwealth of Mamchuse& Department of Industriaf Accidents O,�`ice of Investigations . 600 Washington Street ' 1 Boston, MA 02111 cz www.mas�gov/dra . Workers' Compensation Insurance Affidavit: Builders/ContractorsMect?ycians/Pimnbers Applicant Information Please Print Legibly Name(BusinesstOrganiratiott/individual); `I�,� 1. L yV l co, . Address: 1�3- RrajqA V e .. City/State/Zip 0 - Phone#:_to - Z6- 9-7 '1 &d Are you an employer?Check appropriate box: of project 1.tai I am a employer with 4. I am a en contractor P J (required), ❑ g � and I 6. []New construction employees(full and/or part-time).* have hired tate sub-contractors 2.❑ I am.a.sole proprietor or partner- listed on the attached sheet.t 1. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its Electrical required.] officers have exercised their I0.❑ repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MOL I I.❑PIumbing repairs or additions myself.[No-workers'comp, c. 152,§1(4),'and we have no 12.❑Roofrepairs insurance required.].t zmployees.[No workers' comp.insurance required.] I3•0 Other `Any applicant that checks boil#l must also fill out the section below showing their worked'compensation policy information. t Homeowner¢who submit this atliddvit indicating they are doing an work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box mustattached an additional aheershowing the name of the sub-coatrooms end&eir workers'comp.policy in6omhation. I am.an employer that is pr?vIOng:workers'compensm7on iJzSUrance for ffW w9doyees: Below is the po1wy mrd job site information+ I .-- Insurance Company Nam ' Pi(� (�,t�S 1`(2, IN mN CQ Ch1 M actv Policy#or Self-ins.Lie.#:- W C Expiration Date: 3 O ^ ©13 -t32�Uty}-oo Job Site Address:JWLy OL--� w d-,S-4, R&.k3 pq a1 i 16Y 2hd$3ft1 FL(!}.°Ma C"Wta ip N 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby�c�ertf' under the pains and penalties of perjury that the i►{formation provided above is t>�e and conA Si : tf t� 4 2 d P_hone#: k R 5 w Officio[arse only. Do not write in this area,to be completed by city or town offidarl City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Date.....77:..Z 1/'1557.T t r NORTIy °`'"`°:•1"° TOWN OF NORTH ANDOVER 3r .�,r -. .-• oc p PERMIT FOR WIRING SSACMUS� This certifies that L �LEGT�L rG C- r .......................................... ................................................ has permission to perform ................. !T v�� .......................... .................................. wiring in the building of �?.. �o 6 ............. '.......... at.....(.�0 O GtJA ST ........ ................... ..o..Z.................... orth Andover Mass. Fee. ZJ-0.....1...-.. LIc.No. lb. � . .............�..�..�....!. ELECTRICAL INSPECTOR Y ' Check # _E'� 7535 ti Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. ,��� r` BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 112,y 10 7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Strut&Number) ibW 0$,?00 e/ St' T• ^i T r�-cs I �� Owner o ena 'J �1. �ydC vw►�-� �b-•• ..�vy,,,py��vr. LAA_ L �1 (S2� tl/g.Nk.�e,1 f Telephone No. Owner's Address S dcr S� ��i(G�t 3(7 2 F opZ C Is this permit in conjunction with a building permit. 3J Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service 150 Amps /c2O ly?08 Volts Overhead❑ Undgrd ❑ No.of Meters ' Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 13L;Idl o f 20. 2148wtz Voath APP%ox 1000 4h t 0'f 4RC( A1'o'Jfi w d-h New IS04 Completion o the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin2 Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump I Number Tons I KW No.of Self- ontained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Sectio.of Devitt s or Equivalent No.of WaterNo.of No.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: ? 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: "7Zp 1 0,7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COV GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such co A rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 9 BOND ❑ OTHER ❑ (Specify:) I certify,under th sins and penalties of perjury,,that the information on this application is true and complete. FIRM NAME: t L L C 0 -rN . LIC.NO.: `,03 Licensee: VJ A< S cre5 _J Signature-'P g S LIC.NO.�Gs0rg(� (Ifopplicable,enter "exempt"in the license,vumber lin . 1 e Bus. Tel. No.:/,46 T-1LS~$1.??' AddressJ4,ld`1Mf 0301 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 Signature Telephone No. PERMIT FEE: $ I i The Commonwealth ofMassachusetts ` Department of Industrial Accidents I Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly i Name(Business/Organization/Individual): Address: City/State/Zip: Phone. #: Are you an employer?Check the appropriate box: L❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required):. employees(fol]and/or part-time).* have hired the sub-contractors 6. 0 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 working for me in any capacity. employees and have workers' g' 0 Demolition oy [No workers'comp.insurance comp.insurance.x 9. ❑Building addition 3.❑ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions I am a homeowner doing all work officers have exercised their myself.[No workers'comp. right of exemption per MGL 11.0 Plumbing repairs or additions insurance required.]t c. 152,§1(4),and we have no 12•0 Roof repairs employees.[No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box#1 moat also fill out the section below s t Homeowners who submit this affihowing their workers'compensation policy information. davit 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. am an employer that is providing workers'compensation insu information. rance for my employees Below LS the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: A 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 fine up to$1,500.00 and/or one'year imprisonment,as well as civil penalties in the form of f a STOP WORK ORDER and a fine criminal penalties of of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under thepains andpenaities ofper�ury that the information provided above is true and correct. Signature: Date: Phone#: Offlclal use only. Do not write in this area,to be completed by city or town oj'IciaL 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 SS us Thiscertifies that . 2..................................................................................... has permission to perform ...................... .................. ............ j . wiring in the building of..... .. ....t................ .fie .v at ............................. .North Andover,Mass. Fee.//'�- Lic.No.1.kb3.9............: ................... .. .... .... ELECTRICAL INS(7iCMR Check # -4/1 /0 756U V TENON T - kV'bS0Q GROVp _-Wc�— 10 / Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked r 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: 8' 1 O'U- 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) l 600 0Scmccl &I. b i l dingy" IU 9k d R - Mrl tf, &4e Owner or Tenant 16co 050-4 S7 7 LLC O_Z y P�o(Jekiir_s Telephone Nog475-'iS'69 Owner's Address JL00 0SI ou J St. 6L,%44,,q 3U z„,J FLou2 Is this permit in conjunction with a building permit?FW Yes No ❑ (Check Appropriate Box) Purpose of Building O4-E Lr, '�i`t'oUJ_ 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 /S"0/} a08 V y w r rL C Location and Nature of Proposed Electrical Work: Bu;ld;19 20, aid Fbylz Votz 1-k Si d e R PPRaX, 30ao s�-f. o� c c -�;'3 out w�f of4i ce p0.rL4i+iO),3S tt ca N 0"w►Ql S • Completion o the ollowin table maybe waived by the Inspector o_f 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- r-1 No.o Emergency Ligrng rnd. rnd. BatteryUnits No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o—of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g a No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of KW Data Wirin Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirmg: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the/nspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 1@ 8 10 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 cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) Icertify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: O' LL ELecft;lC Co, 7-CoC• LIC.NO.: LD 3tJ Licensee:Wayv\ pec S Signature avqvc W.s _ LIC.NO.: (/f applicable, enter "exempt"in the license number line.) Bus.Tel. No.6D.?.769-70, Address: Alt. Tel. No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S" License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. FPERmIT FEE: sl,- —� Date f NORTH 1 ti ?��.��•�;.,tioaTOWN OF NORTH o w PERMIT FOR PLUMBING �,SSACHUS� This certifies that '.-; -•-t.�. . . . -t �`.'. . �!': ! . . . . . has permission to perform -►�-----)°��r �... . . . . . . . . . ¢ plumbing in the buildings of �C f . . . . . . . . . . .. North Andover, Mass. Fee�� a� y .'. . . . . . . . . . . . . . N! �r I LU >31N INSPECTOR Check #2.2,49 7531 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location p 0 f jou .0,0-7:{` Owners NameP4 Ig Permit#� �7 Amount /py_ J 0 uJ-11-k �' .� v. L t4TypeofOccupancy �ti-t�v1 NewEl Renovation ® Replacement 0 Plans Submitted Yes No FIXTURES rn a w M ELOCR 2MROM 3MKDM 4IRHDM 6]HHDM THROCR s>RFLOCR (Print or type) /� fl Check one: Certificate r Installing Company Name U !r✓� ��`` �'' v �_ Corp. Address � partner,' �-2,-,"e_� 1"t, a- 01,W3 Business Telephone 'Z • Firm/Co. Name of Licensed Plumber. F 3,1 w.)- 3— -� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy R Other type of indemnity E Bond ❑ Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and' on p undee it Issu 'fo this application will be in compliance with all pertinent provisions of the Massa ch S Plum in Code an Cha142 a General Laws. By rgna o rcens um er r T e of Plumbing License Title 7 City/Town ricensef,4umoer Master ( Journeyman ❑ APPROVED(OFFICE USE ONLY mak+ Date.................................. &ORT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHUS This certifies that ........................... has permission to perform - cr- � �.:................ f'� wiring in the building of............ .. .. ......................,.........) .... at../........................�.............................�........... ,�h Ando er,Mass. Fee. ��................ Lc.No s.. 3r}r=—. .-:..............................,,:f ......... ELECTRICALINSOECCO Check # 6927 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. ev ?a--7 Occupan BOARD OF FIRE PREVENTION REGULATIONS Rev. 9/05cy and Fee Checked (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ii 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: Q//-3 a City or Town of: oil. To the Insp ctor of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) d Owner or Tenant ©'2Z Prep Telephone No. a i Owner's Address 0 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building d ZA, Utility Authorization No. k14, i Existing Service 1-14 Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service N Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 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. rnd. 0 Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.o Detection and InitiatingDevices No.of Ranges No.of Air Cond. Total Tons g o.o No. Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No. of elf-Contained Totals: ............... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection Heating Appliances Security Systems: No.of Dryers g pp Kms' No.of Devices or E uivalent No. of WaterKms, No.of No.o Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent 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: 47z9d, (When required by municipal policy.) f Work to Start: t°3 ®4e Inspections to be requested in accordance with MEC Rule 10,and upon completion. Y'�` ( INSURANCE VE 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 cove ge 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 NA E: �l '_ LIC. NO.: 1011 Licensee: /p�,� (� � �� Signature G LIC. NO.;;257 30 tt (If applicable, enter " empt"in the licen e num er line.) Bus.Tel. No.: Address: Ulm!f Alt.Tel.No.: *Security System Contractor License required for this workl, if applicable,enter the license number here: 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 cry Signature Telephone No. PERMIT FEE. $,� « Date..... `..... `..... . .. i NORTH °���``°:•'"a TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ............ �..L ,............................................... n ................. has permission to perform .... wi2��iQt3tl�S'/�o/2�tf�?.................. ...... ................. tA wiring/in the building of...AL1.�/.. QBtT at 1. 0& ��pp �AP- ,No h Andover,Mass. rr. �_ ............... Fee.!2.'r.�.... Lic.No..&:� :. O ELECTRICAL INSPECTOR Check # )2- / 7 r 716 5 Commonwealth of Massachusetts Official Use Only Permit No. / &51 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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: I11-1- a 1 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 WO OsgA St. Owner or Tenant Iwo No04 SCL..i_ C OZ,T \ fi [L _ AVN(ki6lc T-Telephone No.qV-47S-y5if Owner's Address ; D%�' ee QWZV, AP0Q e1 it Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity A2 AkP L10 (Le Location and Nature of Propos d Electrical Work: g(,` Sao a--, ? o 2,c of r-wc)R S8y tt-N ��.ec�19C R� . t'e�eee�s�iN� �zv 2�Q� vDt�r- ►S�bv'�1y� ��.� CON f iO L 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 M Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. rnd. 1:1 Battery Units i No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Tota Tons No.of Alerting Devices No. of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Mlunicipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water K`,`, 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: I I I g 10-f 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 of perju�,t/t'at the information on this application is true and complete. nn FIRM NAME: t�- �LeG \ C t`0 i C LIC. NO.:1��503A ��P-�/ .. ��2 Licensee: �yl*1.0 �t It,C S Signature LIC. NO.: (If applicable enter "exen t"r the lice se number l�ne. Bus. Tel. No.:Wk 6. Address: 3 3ra � Alt.Tel. No.: *Security System Contractor License required for this work; if applicable,enter the license number here: 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: $ Date.......... HORTh TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS US Thiscertifies that ............................................ . ............................. has permission to perform ................................. wiring in the building of.. at lk.e�2.... .............. ...Zn. North Andover,Mass. F Z5- ee/ ................ Lic.No/.......?-.. ............. ....... • ELECTRICAL IN ECT Check # 76v2 r' �-r- - Commonwealth of Massachusetts Official Use Only y Department of Fire Services Permit No. 24a BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked /� [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK �rjv a r�t All work to be performed in accordance with the Massachusetts Electrical Coe EC ,527 CMR 12.00 (PLEA SE PRINT IN INK OR TYPE ALL INFORMA TION) Date: 2_0 City or Town of: NORTH ANDOVER To the In pector of Wires: `a By this application the undersigned//gives notice of his orher intention to perform the electrical work described below. Location(Street&Number) ��yy A SO t &t Owner Tena Telephone No. Owner's Address tbOO0_,;;q0001S- 6v t 1vUJj, 2 0, 2-,.\J Ii orL Is this permit in conjunction with a building permit? Yes Er No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location iand /Nature of Proposed Electrical Work: Z-, F'L(.-,,,,L l Jo 10 S i a ZU44 bC01 CtcT z af$'Cc ,D0.Rti-)u Completion o the ollowin table may be waived b 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 SwimmingPool Above In- o.o mergency rg g rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners o.of Detection and Initiatin Devices Total- No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat ump Number ,Tons KW o.of Self-Contained Totals: ""' ................. Detection/Alertin u,Devices No.of Dishwashers Space/Area Heating KW Municipal g Local❑ Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or E uivalent No.of No.of Heaters KW Signs Ballasts. Data Wiring; No.of Devices or,E uivalent 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 o Elec 'cal Work: 4�0c) (When required by municipal policy.) Work to Start: 9 Z 7 U Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under t e pains and penalties of perjury,that the information on this application is true and complete.!! FIRM NAME:-�- ({G t,C Co, TUC , LIC.NO.: A 6,03� Licensee: 1 f l�Ay vt t W� S`p ."{S Signature Gt/. LIC.NO.• �03 (If applicable, en er" empt"in the 'cense nu er 'ne.) Bus.Tel.No.: Address: 14 3 Ar P, o, ellp"i 30 Alt.Tel.No.: U -7 �2 *Per M.G.L c. 147,s.57-61/security work requires D artment 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: $ `°% The Commonwealth of Massachusetts a ! Department of Industrial Accidents Via Office of Investigations in 600 Washington Street `moi i Boston, lam[ 02111 r� www mws:govldia . Workers' Compensation Insitranee Affidavit: Builders/Contractors&lectricians/Pl mbers Atinlicant Information Please Print LeQi41y Nanie(BusinesslOrgenizationllndividual): 1,1 L. E L e C i `l C Co- Address: City/State/Zip:_J�t�1 �C1 �3� �t Phone#: 7�6-- T Aide u an employer?Check the appropriate bo= " Type of project(required): I.( I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part timc),*. have hired the sub-contractors 2.❑ I am.asole proprietor or partner- listed on the attached sheet.t 7. []Remodeling ship and have no employees These sub-contractors have 8. [J Demolition working for me in any capacity, workers' comp.insurance. g, ❑Building addition [No workers'comp.insurance S. E3 We are a corporation and its required.] officers have exercised their I0.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL l 1.❑Plumbing repairs or additions myself[No•workers'comp. c, 152, §1(4);and we have no insurance required]"t employees.[No workers' 12.[]Rrepairs i comp.insurance required.] 1313.[]Othhe er •Any appiiattt that checks hm(#t must also fill out the section below showing their workers'coinpensation policy information. t Homeowner¢who submit this affidavit indicating they are doing an work and then ham outside conuactan must submit a new affidavit indicating such. #Contract m than check this box must Machu!an additional sham showing the name of the sub.eontractms and their workers'comp.policy infiumration. I ant an employer that is prvtddwZ:workers'compensation insuramefor mr employees: Below is the policy and joh site information. _ Insurance Company Nam U Prc @ N AU$•I`(t, IN oN Ce CU.M Policy#or Self-ins.Lie.#: W C - - i 3 Expiration Date: 3 013 _S32-c�lo� -oo NoA., Job Site Address:i&05amd�T.'�ui1dtNs Z0,24FL Wanes City/Statxr/Zip:M(�• 010t{5 Attach a copy of the workers''eompensation policy declaration page(showing the policy number and expiration da$4 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,cerlf�under the p�aim and penalties of perjury that the infornraton provided above is troe and corked Si tore:lr t/ W, Q Date. 9 ens �'��� ,lM/!!Y! � 1 f Phone#• 0fJ7c1a1use only. Do not write in this area,to he completed by city or town o,f idd City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#. Date. . �o *7 Date. . . of AO RT 4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING,-- S CHUS LUMBING -- S/ICMUS This certifies that . . . . . . . . . . . . . . . . . . . . . . . . has permission to .... . . . . . . . . . . . . . . . � o �' plumbing in the buildings of . . . . :�.'�. . . .. � . . . SW j at. ���_ . �%'����.f. r!� . ., North Andover, Mass. Fee:,. . . Lic. No.t-° �. . . . ./�•. � _rte-r.r,�1,,!. . . . . . . . PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ,� i/ Date / o - 1 ( Building Location l L O o 6 S'i1 d S-(Owners Name r\ S �� Permit# Amounts`% Type of Occupancy New Renovation rl Replacement 0 Plans Submitted Yes No FIXTURES 24 wA rA SuB>El m BPii�11M ]5'lr HDQ2 3�D FIDQ� 3MHDD 4MHIM 5MFDM si�tFioat 7IH HDD SII FIOQt (Print or type) � yy Check one: Certificate Installing Company Name N (� � _�/ _ El Corp. Address k?, 6 6 11 Partner." Business Telephone 7 ��-----6Y 7 o d'3 / Firm/Co. r Name of Licensed Plumber Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate bo)c Liability insurance policy 0 Other type of indemnity 11 Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature OwnerEl Agent I hereby certify that all of the details and information I have submitted(or en abo;appli(onre true and accurate to the best of my knowledge and that all plumbing work and' do �Peffrfujmed un Perms application will be in compliance with all pertinent provisions of the Massachus S bing C+de dhe General Laws. By 'Signature olLicenseTrIWIlDer r Type of Plumbing License Title / C) 6 -7-? City/Town License Nin er Master Journeyman ❑ APPROVED(OFFICE USE ONLY Date...74-70-7...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACHUS Thiscertifies,that ....................................�%...................................................... ................... has permission to perf6�—�." . ...V, ................ .... ................. -9................. wiring in the building of North Andover Mass.at.Z e......................... ..................................0 ........ . _ Fee/cR,�...7 ..... Lic.No .................. ... ..................... ELECTRIC INSPE R Check # 7562 (CN Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. ! 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(MC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: q I 0 7[ 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 600 Los odd V ' Owner r Tenant/00 Osyood SII. LLC 6ZZ.y )DtOPt fy HA.NT f",evt Telephone N 177$-g56f Owner's Address �0 OS , S1. jwi ! 3 2IKW FL.A-k Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) * 8 6(9 Purpose of Building Utility Authorization No. Existing Service� Amps 12,0 /ZOeVolts 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: au IditIr 30 2KA FLo 0,4 E 16 11 -wear. /90 4 ofo `ce A-fodt, f� lyekfc 1- 100-01 a0a PLe pNi. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No,o 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 r 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.o Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent 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: I 106 Inspections to be requested in accordance with MEC Rule 10,and upon cornpletion. INSURANCE C V RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such.cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) - I certify,under t/te'p`atins�and penalties of perjury,that the information on this application is true and complete. e,� FIRM NAME: hi LL FLec.t"It L . tijC ' LIC. NO.: 1(� 54 Licensee: 14%`,rs Signature aW,, S LIC. NO.:1450 (ffopplicable, enter "exempt"in the cense m b line.) u Bus.Tel. No.:403-14 Address: 1�8re- y Aye• r, �, A�1 , QY)71 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, 1 hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. S4Z5 Signature Telephone No. `t"e��tifi NRne — `ar�d�tl�c� M.uS� e S��.vo The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �' 1 Please Print Legibly Name (Business/Organization/Individual): M ( �� , L(G��-1 L Co - Jt.N C , Address: l� ����/ AV(" City/State/Zip: s�, {�1, o,30 -11 Phone #: Are on an employer? Check the appropriate box: Type of project(required): 1. 1 am a employer with_ 2) 4. ❑ I am a general contractor and I 6. ❑ w construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 7 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ]0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I l.❑ 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' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. r Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereb certify under the pains and Penalties of perjury that the information provided Bove is true and correct. Signature: !� V , Date: b Phone#: 0()J "�6 S Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: LI4auLcnlYVr 10001/001 ACORD� CERTtF1CATE OF LIABILITY INSURANCE j�DATr;(MMfDDrYYYy) THIS CERTIFICATE MATTER INFORMATION CERTIFICATE i M.P.ROBERTS INSURANCE AGENCY INC. ONLYANDCONFERS NO RIGHTS TSU ON THE 1060 OSCOOp STREET HOLDER THIS CERTIFICATE GOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTH ANDOVER MA 01845 970-683-8073 INSURERS AFFORDING COVERAGE NAIC# INSURED MILL ELECTRIC CO. i INC. INSURER A MERCHANTS INSL7RANCE �-`-N'--'rpj1R SURER a VER INSURANCE 173 BRADY AVL SURER C. 978-6 NH 03079 -ER Lx CONWR E & INDUSTRY g7 — "0306 INBURER E! COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. KISN OL L� TYPE QP NCE POLICY NUMBER MpYOO p�l N LIMITS GENERAL LIABILITY EACH OCCURRENCE 6 1 000 000 ]( CONLI�RC(ALGENERAL LIABILITYUU RENTED PREMISE g!.2mg a-"oe S 1 D 000 CLAIM$MADE CI OCCUR MED EXP(Arty,fla pgrapll) g 5.000 A CHP9141848 01/13/07 01/13/08 PERSONAL 6ADV INJURY f 1000 0001 GENERAL. AGGREGATE S 2.000.0 00 GEN%AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPrOPAGG S 2 000 000 POLICY PLOC RO- JECT AUTOMOBILE LIABILITY #EXCESSIUMMULA YAUTp �a �DIHINGLELIMB S 1,000,000 LOWNEDAUTOB HEDULED AUTOS BODILYINJURY $(Pa Pwsvn) EDAIJTOS ABN-7074818 12/23/06 12/23/07 BODILY N-OWNEDALROS (P&-v 1NJURrf(Peraecfdenl)PROPERTY DAMAGE LIABILITY AUTOONLY-EA ACCIDENT S AUTOOTHER THAN EAACC S AGG LIABILITYEACH OCCURRENCEUR CICLAIMSMAOE AGGREGATE g r DEDUCTIBLE $ RETENTION f 5 WORKERS COMPL=gSATiONAND EMPLOYERS'UABIUTY T 1 A S X ERS ANY PaoPmETa+zPARTNewolecvrlvE WC 176-16-83 01/13/07 01/13/08 E19t E.L.EACHACCIDENT S 500 000 D OFFOEWIUM =W? OI'M iiN@SQ�BYIfOBr E.L.DISEASE.EA EMPLOYE S 500,000 EEIALPROYNStONSDeiow E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS r VEHICLES r EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS FAX 603-890-9192 CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIE8 GE CANCELLED BEFORE THE EXPIRATION 1600 OSGOOD STREET DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I O DAYS WRITTEN NORTH ANDOVER MA 01845 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRE8ENTATIVES. MO:XNTi ACORD25(2001/08) CORO CORPORATION ISGS Date.... ..-�.`.�:" 6.... 1' NORTH O�t,�•o��,h'O 3? �•.� -- .;, ,� TOWN OF NORTH ANDOVER 6- ; p PERMIT FOR WIRING CMUSE� This certifies that l ► �"`- L� C ............. .......... .............. ...................................... 2a aim has permission to perform .............C................ . .................................. wiring in the building of .. -Z r.. .......... /fs at... G.4W.eJV3Fe ...... ^� .5 7'......................... ,North Andover,Mass. . .... ............ .......... Fee..................... Lic.No.2 glY7.,tF............... . 4 ELE RiCAL INSPECTOR � I Check # j 6 7 _ ;� Commonwealth of Massachusetts I irr'.IJ I C()Ill\ Department of Fire Services OccurancN. mid Fee Cliccked BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOW to-he N%fill the \I;I,,SU1lLI1C1ts [:1CCjI-;tjj Cude 527 CN-111 I 1.1A I'LL INE PRL\T LN. 1A K OR TYPE.ILL 1A FOR.11,I TWA') Date: Cih, or Town of: To the hi.�pet.ioj. ll/ BY this ;Ipjflication the undersigned gi�:S licilice ot'llis or her Itcliti )II to perform the electrical .NoI*k de,,cl-11-ICLI 1100MY. Location (street & Number Owner or Tenant :2 S Telephone Yo SVSG Owner's Address Is this permit in conjunction with a building permit? Yes ❑ N' ❑ (Check Appropriate Box) Purpose of Building I c.4-A4 1w -z7, /. — LtilitvoAuthorization No. Existing Service Amps Volts Overhead 0 Undgrd[:] No. of Meters New Service Amps Volts OverheadF-1 UndgrdEj No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 41 it'll ";Xwt '),p lah/v ima /se !I No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans 1q_0-of Toial L-11 —--------- Transformers KNA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Uiminaires SwimminjZ Pool %oie ❑ !7n- ❑— , 0 0 mergency Lighting -,rad. grrid. Battery [.'nits No.of Receptacle Outlets No.of Oil Burners 'FIRE ALARMS No. of Zones No.of Switches No. of Gas BurnersNo.of Detection and— l: Initiating Devices No.of Ranges No.of Air Cond. Total I! — 'rolls No.ofAlerting Devices No.of Waste Disposers "eat Pump Number Tons KW No.of Self-Contains Totals: j--- Detection/alerting Devices No.of Dishwashers Space/Area Heating KW 'Local❑ Municipal ❑ Other Connection No.of Dryers "eating Appliances KW Security Systems:* No.of WaterNo.of No.of Heaters KW No.of bevices or Eouivalent .-Signs Ballasts Data Wiring: No.of Devices or Equivalent No. Hydromassage Bathtubs Vo,of Motors Total H -felecommunications Wiring: -_ I - P (ADevices or Eq ON alent OTHER: F.,.tiinatvd V,iluc of Electrical Wt�rk: hen I-C'L,juired by municipal policy.) \k oi k to start: In:pcctions to be requested in \IEC Rule 1 10, and Upon C0111PI01011. VNSL RANC E COV ERA C'E: I n1cl-'s kNaived by the m%livr, no permit tor the 1'0_101-114111CC'J'J"t]'Iud work i;m% r, tic �ill ik. Ilit: ide'; proof'alt liability iIvAII-;1Ilc,: IncludillL, tiLln"'llcill. lidcr,i 11e] r1i;I1 och cok hillit"-d 1woct(A ,,lrlc ru file J.'l-pilif it Pi R 11-] ff I)e l-''ctlisee: ,7 ,1 :, ;,1,- 1. Addmss: 3ll,;. F-A Aft. TsA. rk: i!'.tpjAI0b1C u11Cr L11C liC01"C I-11-11111%1_11CIV ,)%NIFR'S FNSL q,�.v-E LVAII,;ER: I .. )"(I I :i:lh'fit, IL-,11.1ired by law. 13} ,IN Illi:, I-CLILlil-L-111t fit. I ;:Ill ill(. "Jicck Owner'Ament L_, J Date......�?.�.....�. - . NORTH °f,�``°;•�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACMUSEt This certifies that M I l"L �L�� .......................... ..s........................................... t _ has permission to perform .......Ofd E. ..........7.....................................' C! /C wiring in the building of d 2Z�/i QoRTfF'j at......!. ? .. I!. .....ST..... Z... .'..f` ,North Andover,Mass. mei Fee.. ZS.......... Lic.No...to5a3 ...............-.:....`..L..IY.... t............ ...... ELECTRICAL INSPECTOR Check 1/ i Y 7315 Commonwealth of Massachusetts Official Use Only Permit No. 2,:3 f-5 Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071y and Fee Checked (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts ElectricaJo ME ),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7 City or Town of. NORTH ANDOVER To theIn pec or of Wires: By this application the undersigned gives notice of his of her i ten ion to WIAlf rform the electrical work described below. Location(Street& Number) 015 004 s I(�h� 30 2A.)4 F , Owner or Tenant0 ZZ P eml--j ,e S Telephone No. Owner's Address �U.N ct��< d V44 Is this permit in conjunction with a building permit? Yes .No ❑ (Check Appropriate Box) Purpose of Building �cr T� '� 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:60 0,41Ad Z f e evi frhe S It, Ci i Com l tion o the ollowin table may be waived b the Ins eetor o Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans °•o ota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above- ❑ n- o.o Emergency Lighting rnd. rnd. ❑ 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 an Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No. of Waste Disposers eat ump umber ons o.o e - ontame Totals: Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local 11unicipa E] Other Connection No.of Dryers Heating Appliances KW ecurityystems: No.of Devices or Equivalent No.o Heaters KW atero.o o.o Data Wiring: —Signs Ballasts I No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: OTHER: No.of Devices or Equivalent ' Attach additional detail if desired, or as required by the Inspector of 6Vires. Estimated Value of Ele trical Work: (When required by municipal policy.) Work to Start: /17 0 7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OV RACE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) /certify,under the pains and penalties of perjury,that the information on this application is true and complet . [- 50 FIRM NAME:'M ILS. ELL c+ni C Co . `!)' c l LIC. NO.: X ,4 Licensee:k-,,,%4 n 00 (' Signature` LIC. NOV k503� (11'applicable, enter"exempt"in the I ense number line.) Address: A)UBus.Tel. No.:03- 76 S- f 7�?a �_ /�/�e/d y { _ i '�M G 9 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 Signature Telephone No. PERMIT FEE. $ Date.... ............ ,aORTM '760� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ��sS�cMusf� This certifies that ........1�.'!..�.�-�—...���C T ................................................. has permission to performdF�i« .......... ................... ............................................... wiring in the building of �2 �a�t9 t-- ..................................................... at...............�.. � aDD boo....... ..............5 .....3o�a........ North Andover,Mass. Fee.... .ZS``'�. Lic.No.............. ................................................ � . ELECTRICAL INSPECTOR d Check # 7293 -� iLommonweamn ofMassachusetts Official Use Only Permit No. 6 2 7-!)Department of Fire Services Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 6 0 7 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) X600 OS oo-k S'fi, �y`;I a;,,x30 2J FL,otz Owner or Tenant-r(ZFI L,6—G1 C Telephone No. Owner's Address ZZ Pro erti e L L C Is this permit in conjunction with a building permit?0-42(:Ves No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Ru:'1 d.ng 30 2Ka FLA-bore New b;-i t e�rt� 6-C�C.e �P- tout-J amps adPA 4 P4A Ems; i-j I✓6v(4) tt t,.l Completion of the followingtable ma be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of T otal Transformers KVA �.. .f, No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and Total Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number ons I 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 Seco.of of s or Equivalent No.o ea KW °'° N°•° Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP elecommunicationsfiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value o El ctrical Work: (When required by municipal policy.) s Work to Start: Ll ©7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C ERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liabili nsurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of ,erjur that the information on this application is true and complete.` FIRM NAME: 'LL Q �<ZiC O. l�iC- LIC. NO. 4�3 Licensee:�gUV1e w, Sp t`t'P Signature LIC. NO.: s(J,3q (IJ'applicable,ent r "exec -t.-in t e license number line.) 1 Bus.Tel. No.•603-745-c/Va Address: 3 ('cry tgyC (p AN. - Q3071 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 Signature Telephone No. PERMIT FEE. $ w X912 ti r Date. .1... . "'�T:��a TOWN OF Nt,ORTH ANDOVER a : PERMIT FOR PLUMBING ,SSACMUSf This certifies that ) has permission to perform !. . . . . . . . plumbing in the buildings of "? .'*-,r`. . . . . tj-/ � at .��. °U . . . J - "... . . . . . . . ., North Andover, Mass dr. Fee.y. r'. .Lic. .. . . . . . . . . . . . . . �-- P j6ING INSPECTOR Check # 9 ti 7332 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS I II 1 Date � --.0? / Building Location goo O d S O U Vow..Name ��XtS T z Permit# Amount T Occupancy e of YP New U-1 Renovation El Replacement Plans Submitted Yes No FIXTURES H a � w arAw H w E.. rA Ena x w wW rAw a a x w0 < W w w H H ..1CA A A ►a d Q' H SMHM BASEW VT M HDM i �FLDCR 4II3 rIDQt 5IR F1.D(R 6M RUR 7MFUM SIH Rfm __e (Print or type) Check one: Certificate Installing Company Name ❑ Corp. Address J `, �� 2 ❑ Partner. x aw J z Business Telephone ,7 E7 3 3 ❑ Firm/Co. 'Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy P Other type of indemnity ❑ Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered in a ove a fi o are true and accurate to the best of my knowledge and that all plumbing work and ins on ed and P this application will be in compliance with all pertinent provisions of the Massachus S Pl ing Cod p of the General Laws. Y By: 'Signature ot.Licensea Flumaer ype of Plumbing License Title /> City/Town loer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Date.... .......................... v NORTH °f,"`°:•�"° TOWN OF NORTH ANDOVER - p PERMIT FOR WIRING This certifies that ... .................... '...``'C6'"'� .....�...................................... has permission to perform .............................�...... <..:.................................. wiring in the building of... .'"--�`."c �:.�� .................................................... at.. fd.....�o�-`s'-v-��� ........... North Andover Mass. Fee'.�� ............. Lic.No.............. ....' -c�'... 11� z..�..... ELECTRICAL INSPE65R / r Check # t)7 �'r .� T _ I S14EZ1060 SAP-Vendor_ -- - - SAP TNV DOC NBR DATE. REIT' NUMBER TEXT / Y.O.NUR INV AMOUN9' DEDUCT TYPE NET INVOICE CR 1900956582 060706 06202006PERMIT ELpay invoice 250.00 0.00 KR 250.00 I j I I i : I i I I` i i DATE 06/14/06 TO1BV-SAP1 ID N0. 0010181571 CHECK N0. 1000466619 Lucent Technologies CHECK AMT. $250.00 Bell Labs Innovations r+tvn.qg You can now check the status of your invoices on the web. Visit http: //scportal.lucent.com/invoice. Questions concerning your invoice(s) can be directed to apus@lucent.com. Lucent is changing payment method of all suppliers to electronic payment. E-mail us with subject line: Electronic Payments to apus@lucent.com with bank name, address, account #, routing/aba # (and swiftcode, if applicable) . Please include your name and phone number. To expedite Lucent 's receipt of your invoice, Lucent is requesting all suppliers begin electronic invoicing. Send contact information with subject line: EDI invoice to apus@lucent.com. t REMOVE SIDE EDGES FIRST. THEN FOLD,CREASE AND TEAR THIS STUB ALONG PERFORATION If i I Ili Ili III i iii[III iI IIIIIIIIiti i I iI Ili l I i Ili I III Ili till I) t_ � w — Lom"wnivea[[h of 111ajdacha3t1b vurual vx vnly c-� � Permit No. 2)epa,1rwnl o y'7irs Sorvlczj Pemut Fee Assigned BOARD OF FIRE PREVENTION REGULATIONS Rev. 11199) Icaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY !w tl)rrn is for use by institutions employing licensed electricians and others for which notice of electrical installations to the ,:!Utnlcpal inspector of Wires is required for work on the premises of the institution. If you are not an employing itrstilution r;a::nt to C 1-11 §S of tlic Massachusetts General taws,stop here. You cannot use this form. Use the standard form only. P�c.t Sl.. PR,I1V7-iNH11 OR TYPE:1LL INFOR�1.111TION) Date: U6' ©l �Zr a ( ;t1- lir To1rn oIF: To the Inspector of Wires: ? 11 appiIcatioil file undersigned givers notice ljof the/oil-premises performance of electrical work by employees. i_ocation wid liatlire of 1'r posed Electrical Work: i NOYE:: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of. sal::e to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contenl- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, t which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- 4 ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. 1-Ve will rilit fit s form on each such occasion(check one): YES ❑ NO m:utl?ain one or more contemporaneous log(s) (check one): YES P — NO ❑ ,)floor) is available where so contemplated by the municipality. In these cases, you must renew this application annually :•K ;:!�t_nificant cllanges in employment. liiq. ir; individu�l(s)will be responsible for the accuracy of the log(s),if maintained. You agree That the 10g(s) will be i a indicated below. The coverage in any individual log must be for contiguous property except by arrangement with 1;:• ;nsp!rctor of Wires- Atiach supplerrtenta)y sheets if required for additional log locations. t i.o� coverage, aiid location where it will be maintained Res onsiblc crsott �6-_t o ' ti'au may n)mintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proc :late, 11adicatr- below how lite Inspector of Wires should access the log: Pow-:»r:y electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you empl, fzcitity? indicate the total number and also indicate the number of full-time equivalent staff that number includes: l ut:~I i?cc;riral ct)ipluynteiiC 6 full-tinie etluivnicnt electrical employment: C y i clpr-is or apprentices do you employ to assist your liccnscd staff,under their direct supervision(see C. lit 1 §S)`? nunlbCr must not exceed the ratio of one licensed individual to one tlnlicci=d individual. Lin)ited exceptions a i; f:'r :cE•:rru(sce St. 1962,c. 582§3 as amended by St. 1979,c. 156). Indicate the total nunibcr and also indicate the nui W bc: ::tf full-tin!. equivaletlt staff that number includes: C t_ C a c rctrttal eniplet rico! Full-time equivalent electrical employment: M > „1 ;' tr;cit wort. for hich notice to the inspector of\Vires is required must be per formed by licensed personnel. Hosv (7) ti t+� ', l.:,ci_ "ersor,s, tto:icquired to be licensed,do you have in your employ? Indicate the total number and also indicate the _111-time cyui:aient stafflltat number includes: C=) MFull-time c uiyalcnt electrical employment' stent: r,lc lrical cmplol ntcnL g q P ) r;!:tu!iurts ore rlefired J>r dtese purpn.res as tort•per-soar,firer,or corporation operating under e. 141§3. (Please see rcyerse side for certifications acid required signatut ,~ !nstit:uicnaI Permit Form,page 2 ! NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, sirnil to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the nun bers of such employees in this application. If the contractor directs such performance, of if the contract period is for It: Than one year, application must be made by the contractor on the standard form for such work. Do not include such ct ployees in this application. Please xIvc your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addit providc a staternent that substantiates your authority to hire electricians pursuant to c. 141 §3 for electrical work on the pr ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grar authority to direct any licensee of the Board of State L•xarriners of Electricians to perfomt work in contravention of the rule said Board, or in contravention of the Massachusetts Electrical Code. My julhoril)-to act for the aforementioned institutiun is C4i C�1��C 'iC � � > I certify, under the pains and penalties of perjrrn,,that the information on this application is tare and complete I r Signature // Dated 1 /() (Prin: narnc) A/��t`(" �. GtGl�lld)c)cis ��4: lwork tcicphvnc rnumbcr) q jS`,&'�j/-/01/6(extension) (facsimile number) "r' •,• ••• •.•••r••�r+ rruuc r n nnuurcrc 5"ltibtiE19S421 P. Cammonwea[IA of Iffamaclrwolls "Ify a� (`/�� �-(} Permit No. _ Z...c•. . .ifpadfiW:IOf JIJI sarvicf� � Pcmtit Fee Assigned 60ARO OF FIRE PREVENTION REGULATIONS Rev. 11/991 Fee Assigned blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR 1NST1TUT10NAL* USE ONLY 1 bis form is fer use by institutions employing licensed electricians and others for which notice 6f electrical installotioirs to the anarrtrcpal inspector of Wires is required for worts on the premises of the institution. If you are not an employing unstitution rrsn:int to C. 1 4 1 §5 of lite Nlassachusctts Gencral Laws.stop here. You cannot his fonts. Usc the standard form only. PL L,•l S L PRINT/N INK OR TME/ILL!NI--ORAMTlO.v) Date C'ih- or Tolvi) of: /�'t'J�L� iU ,�, To the ltrspe t• �ftf 'r tL,s apptrcation the undcrsigned�s notice of the on-premises performance of electrical Work by e44tplcs. 1 rrstilutiurl i.oc7tiun xnd Nature of Pr posed Elcctr;cal Work: rvoTE:: C. 143 §3L of the Massachusetts Gencral Laws obliges those who perform electrical installations to give notice of i s3mc to the municipal Inspector of Wires. You may do so by riling this form upon each such occasion, or if so eonlem- ( ptated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work. which shall be exhibited to the Inspector of Wires during normal business hours Without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated«wgnitude. % a will`rile rias form on each such occasion(check one): YES Q NO 9 c.v.tl rr,:i;waiut one or more contemporaneous logs) (check one): YES ® ' NO ❑ optio„ is available n•here so coutempiatcd by the nnrnicipality. 1n these cases,you must renew-this application annually ;n,�;:nun srgnificant changes in ennployment• l l c .Alo•-•ir.�!individual(s)will be responsible for the accuracy of the log(s),if maintained You agree that the log(s)will be t,,,.,'ed as iudicated below. The coverage in any individual lot must be for contiguous property except by arrangement With fx5pectorof Wires. Attach supplemntnry slreels i re aired for additional log locations. {,r'_cuveraZc,and location where it will be maintained 1 Responsible person You racy maintain the logs cicctronicalty upon agreanent with the Inspector of Wires. If you intend to apply for such a pros t.irc•i:;dicat'!below how the Inspector of Wires should access the log: Pow,-nary electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you empb at -,our fac ilits? Indicate the total mm)iber and also indicate the number of full-time equivalent staff that number includes: hotel cicc;rical cnupluyutenl:��_ hull-tints equivalent electrical enynloynnetl: 1 tc.:. tau J Lc ipers or apprentices do you employ to assist your licensed staff,under their direct supervision(see C. 141 §S)7 cucr.:1- ;615 number must;tut exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions a t. (of ,:r.c;eras(see St. A962.c. 582§3 as amended by St. 1979,c. 156). indicate the total number and also indicate the raw be: of full-tarn,equivalun staff that nuntbet includes: i: :ai ,,c. u;cal entplol tocol: Full-time equivaleW electrical enaployniculr : :11 work for which notice to the Ltspector of Wires is required must be performed by licensed personnel. Now •.nch persons,not tequired to be iiceuscd,do you have in your employ? Indicate the total number and also indicate the :•.b._ ,,`:all.tir•te equivalent staff that number includes: stat r,tC,fticat entplu�'t»enc: � - Full-tints equivalent electrical employment. Irl.-r,errs are de/ireil f or these purposes ns rutr person,Jir•rrr•or corporation operating under C. 141 8' (Please see reverse side for certifications and required sigttatut Date.... ....................... 01 AORT '6 0 TOWN OF NORTH ANDOVER 0 I PERMIT FOR WIRING This certifies that ... .................... has permission to perform ............. ..... . . ...... wiring in the building o ........... ................. .. ....... at...-/'/..............(. f' ..... Northover,Mass. Fe ........... Lic ... ... No. .......... ...... ELECrRICALINSPEC OR Check # le-e-CWT0�a5— 691 -�'—: (-ommonwtallys o f ///ces�aehwalls vx vn+y lit 'fRv. it No.BOARD OP FiRE PREVENTION REGULATIONSit Fee Assigned 1199} {cave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice 6f electrical installations to the municipal inspector of Vires is required for work on the premises of the institution. if you are not an employing institution pursuant to C. 14 1 §S of the Massachusetts General Laws,slop here. You cannot use this form. Use the standard form only. 'PLEAS1: PRINT LV INK OR TYPE II LL INFORMATION) Date: city 01-Town of: To the Inspector of Wires: B this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution J Address 0G3 osSf, Location and i`lattire of I'r used Electrical Work: 07E: C. 143 §31- of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to t11e municipal Inspector of Wires_ You may do so by filing this form upon each such occasion, or if so conten t plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exlubited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will f+le this form on each such occasion(check one): YES ❑ NO bile will maintain one or more contemporaneous log(s) (check one): YES NO ❑ This option is available where so contemplated by the municipality. In these cases, you must renew,this application annuatl) and apo:?significant changes in employment. The f;do�.vir; individual(s)will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s)will be !orated as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the lasoector of Wires. Artach strpplein ntary sheets if required for additional log locations. l,r,o cuveraoe, and location��"here it�ti ilV be maintained Responsible arson 13,1, P -_ 3 P ,i'ou may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a pros dare, indicate below how the Inspector of Wires should access the Iog: llo•v :Wally e.lcc(ricians and/or system technicians(as licensed by the Board of State Examiners of Electricians) do you empl- at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: I utal cicctrical e:npluytnent: hull-time crluivnlent electrical cntplu)•tnettt: I tc.,X' many helpers or apprentices do you employ to assist your liccnsed staff,under their direct supervision(see C. lit 1 §S)? .�r:er:tl. this number must not exceed the ratio of one liccnsed individual to one unlicensed individual. Limited exceptions a a+' fOr vrtcrans(see St. i962,C. 582§3 as amended by St. 1979,C. 156). Indicate the total number and also indicate the nut bre of full-rime equivalcot staff that nttmbcr includes: I'via electrical emplo;tocol: Full-tithe equivalent electrical employnicttt: Nlul 311 cicctrical work for which notice to the Inspector of\Vires is required must be performed by licensed personnel. How st,ch persons, not acquired to be licensed,do you have in your employ? Indicate ilia total number and also indicate the ru.urbrr of full-time aqui talent staff that number includes: c tat t;tcctrical emplurnrcni _ Full-linic equivalent elecirlcal employnicnt: `irosliPt,Ilwts are ryejil:r:l fi>r these purposes a.c cut person,firer,or corporation operating loader e. 141 j3. (Please see reverse side for certifications and required signatui Institutional Permit Form,page 2 VOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, simil to institutional employees. If, by the terms of such a contract, you direct the perfomiance of such work, include the nor hers of such employees in this application. If the contractor directs such performance, of if the contract period is for It: than one year, application must be made by the contractor on the standard form for such work. Do not include such cr ployecs in this application. Plcase give your official title, such as "Director of the Physical Plant" or "Director of facilities" or equivalent. In addit provide a statement that substantiates your authority to hire electricians pursuant to e. 141 §3 for electrical work on the pt ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grar authority to direct any licensee of the Board of State Examiners of Electricians to perform%vork in contravention of the rule said Board, or in contravention oCthe Massachusetts Electrical Code. Nly title is: � lt�� ,, ;Xlv authority to act for the aforementioned inslitutiun is: T 1 certify, under the parts and penalties of perjury,that the inforuration on this application is trite and complete. (Signature) (Dated) S-/f 5—A 4 (Priv? narnc) /4/lQp7 /�. /�/JrGt'G�cf�O� r' (work telephone numbcr) (extension) (facsimile number) �r ?�, lfl y�, 1730 b Date........... ............o..... f NOR7M� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMUS� This certifies that ...........�� ...-�.......... + ............................... ................................ has permission to perform wiring in the building of..' ............. at...... `. . .............1:..%'z,.. :: .....:.:............. .North Andover, Mass. Fe . .... ....... Lic.No. ............. .......--"�'.. Z` J......` ' ...... t ELECTRICAL INSPEC'fOR Check # 7070 Apr 01 05 04 : 05p NORTH ANDOVER 9786889542 p. l (.ammvnwea11A of 1f1a3dac1%ctee11j vi:1t:a1 UZC vn,y Permit No. �G7o 2eparlmanl al Jiro Benita! , ?r, c Permit Fee Assigned . s i7 Rcv. 11!99 BOARD OF FIRE PREVENTION REGULATIONS ) !cave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY t his f.,rrm is for use by institutions employing licensed electricians and others for which notice df electrical installations to the :wn;rt;ak i:upc,_tor of Wires is required for work on (lie premises of the institution. If you are not an employing btstitution W C 1 a 1 §S of tlic Nlassachusetls General Laws,stop here. You cannot use this forni. Use the standard form only. f PLLA SL PR_1;V7'1,V JFNK OR T1`Y /I LL WFORl,111TIO,V) Date: or TOVn of: � —� ��/�� To the Inspector of Wires: tl:is :pphCation lilt utdcrsiglicd gives notice of the on-premises performance of electrical work by employees_ Cdr+-cs i.ocation :,:+d N tture of Propos d Elceirical Work: 4i45-0;k2cla.X, ��i+ l f� s4412142� i Nil E. C 1-13 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of jsan-:e to the tmnrticipal Inspector of Wires_ You may do so by filing this form upon each such occasion, or if so contem- pt2ted in an annual perrrut fee schedule set by the municipality you may maintain a contemporaneous log of such work, tours with ut advance notice. Some munici ali- of Wires durin normal business 1 o p } wlue.h sliatl be exlubited to the Inspector during normal may set nominal fees for annual permits and require individual permits for work above a stated magnitude. `,V'e will `ile ;?.is form on each such occasion(check one): YES ❑ NO r i. li m-s:1;;-' ! one or more contemporaneous loge1�s) (check one): YES NO El I':,;; oution is available where so contemplated by the Municipality. in these cases, you must renew this application annual!} <,r_rpIFIcant changes ltI employinenl. '!n1.,.-_: ndividual(s)will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be as itvjscated belo�L. The coverage in any individual loe must be for contiguous property except by arrangement with t;, nst cctnr o'c Wires. Attach supplementary sheets if required for additional log locations. i_o c.rvcrs e, and location where it will be maintained Responsible person '? 0 ��0 Q S -- d y'ou may niz�iniain tilt logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proc !;._3jr_ belo:v how the Inspector of Wires should access the log: lio=- m:aoy electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians) do you empll at ,Uler foacit +v? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: hun-lime ciluivnicnt electrical e+mpluymeist: oZ �- c. v 1_::, ::c;pc s or apprentices do you employ to assist your licensed staff,i:nder their direct supervision(see C. 141 §S)'? e;:er;:`•.. i;i r;untbrr trust nut e-,cced the ratio of one licensed individual to one wilicensed individual. Limited exceptions a `rt_r:;rs(see St. 1962,c. 592§3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the nut l c: of fn!t-t ntc cquivalcnt staff that number includes: Full-time equivalent electrical employment: � for which notice to the Inspector or\Vires is required must be performed by licensed personnel. How not n_quired to be licensed,do you have in your employ'? Indicate the total number and also indicate the equivalent staff iliat nurnbcr includes: cnipluyntcni: Full-time c uvalent electrical employment: �— ;r-a%!ilms ore dejined fiw tltese ptrrpo.ces as ruts person.Brill,or corporation operating timer c. 141§3. (Please sec reverse side for certifications and required signatut Apr t:?S 04 :O5p NORTH ANDOVER 9786889542 p. 2 Institutional Permit Form,page 2 I rv0TE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, simil { to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the nut f bcrs of such employees in this application. If the contractor directs such performance, of if the contract period is for It: than one year, application must be made by the contractor on the standard form for such work. Do not include such et ployccs itt(his application. PICaSe ¢i%-e your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addit provide a staternent that substantiates your authority to hire electricians pursuant to c. 141 §3 for electrical work on the pi ices of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grar authority to direct any licensee of the Board of State E-saminers of Electricians to perfomt work in contravention of the ruic said 13oard, or in contr ition Cthe Massachusetts Electrical Code. ?FIs iitic is: ixIv aulhority to act for the aforementioned institutiuu is: --------- I cerrifi, :,rider the pains and penalties of perjury,that the information on this application is trite and complere. (Signatur ) (Dated) 'Pr.nt nar,�c 7 A�ffd-/1 /� o�z c�W��• T (,.vork trlcphone number) 7�kiI je.;yt&tension) (facsimile number) d i SAL Vend— Payment SAP INV DOC NBR DATE RE;F NUMBER TEXT / P.O.NUR INV AMOUNT DEDUCT TYPF; NI-;'I' INVOICE CR - -- -- — --- —19012419-90 - 1901291990 1121.06 11212006PERMIT ELpay invoice Il..,0.00 I 0.00 KR 250.00 it ( l li I i I� If { k i I i � I I � I R I I I I DATE 11/22/06 T01BV-SAP1 ID N0. 0010181571 1 CHECK N0. 1000473800 Lucent Technologies CHECK AMT. $250.00 Bell Labs Innovations You can now check the status of your invoices on the web. Visit http: //scportal.lucent.com/invoice. Questions concerning your invoice(s) can be directed to apus@lucent.com. Lucent is changing payment method of all suppliers to electronic payment . E-mail us with subject line: Electronic Payments to apus@lucent.com with bank name, address, account #, routing/aba # (and swiftcode, if applicable) . Please include your name and phone number. To expedite Lucent 's receipt of your invoice, Lucent is requesting all suppliers begin electronic invoicing. Send contact information with subject line: EDI invoice to apus@lucent .com. REMOVE DOCUMENT ALONG THIS aERFOPATION-1 WWI>(J139`F:U Lucent Td-cfirtoto4iies V]RST-4!)ASM MA r l Bell labs FnnovaWnsiJ POSTAGK PA[1) f' At.tani i,Ga.. P.O. BOX 1?5397 Perini C No. 964 Atlanta,..-GA, 317348 : 1000473800J20061122jT01BV 000029 TOWN OF NORTH ANDOVER -1600 OSGOOD ST STE 2 36 BUILDING DEPT , NORTH ANDOVER MA 01845 /f � lf30t3tS.7JYC P. 1 Lammonweatllt of /1`/a-4dachWt1b QLAK 111 VqC 11111y Permit No. ..UsParlmarcl o��irs�srvic�� >< `A Permit Fee Assigned • �' iy BOARD OF FiRE PREVENTION REGULATIONS Rev- 11199 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY his form is for use by institutions employing licensed electricians and others for which notice 6f electrical installations to the .riunicipal inspector of Wires is required for work on the premises of the institution. if you are not an employing institution ,n.:rsant to C. 1,41 §S of the Nlassachuseits General Laws,stop here. You cannot use this form. Use the standard form only. r PL(,4SE. PR-,'NT hV INK OR TYPE.I LL 11VFORj1-f/1IT1O,v) Date: (lits- or Tohrn of: ;� "14 To the Inspector of Wires: y till application the undersigned gives notice of the on-premises performance of electrical work by employees. - til St 11 11 iit)11 /�sd � / A d tl r c s s i,ocation :;iitl Niture of 1'r posed Electrical Work: ��/'�,��Q/� /�j�i�/h�t/�1.t�'1'-r zw i P:0TE: C. 1-53 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of San-:e io the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contenn- 1 plated in an arunual perrnit fee schedule set by the municipality you may maintain a contemporaneous log of such work, 1 which shall be exhibited to the Inspector of Wires during nor-mat business hours without advance notice. Some municipali- i ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. Ne will 51c. this. form on each such occasion(check one): YES ❑ NO r ,.:ill maintain one or more contemporaneous log(s) (check one): YES P-."— NO ❑ .,s 01ulion is available where so contemplated by the municipality. in these cases, you must renew this application anrruall) significant changes in employment. ins, individuai(s)will be responsible for the accuracy of the log(s), if maintained. You agree that tine log(s)will be icca cd as intiicaled below. The coverage in any individual lop must be for contiguous property except by arrangennent with 1;:, i:srsector of Wires. Attach supplementary sheets if required for additional log locatiars. �. I nu . o tvcraae,and location vdiere it will be maintained Res onsiblc crsoin f You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proc bite, it;dicztt below how the Inspector of Wires should access the log: llo:'v ,nary electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you empli at Y-OuT fociliw? indicate the total number and also indicate the number of full-time equivalent staff that number includes: J w-11 ciectrical cziitrluvinent: c2. Trull-tine equivalent electrical eniployincint: 1 iG'<< 11i3n ,.c?pcj-s or apprentices do you employ to assist your licensed staff,under their direct supervision(see C. 14 1 §S)? ribs ntinlber must not exceed the ratio of one licensed individual to one uuliccased individual. Limited exceptions a ,?"; for vcierans(see St. 1962, c.582§3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the nut be of full-tint- equivalent staff that number includes: T'd c'ie:trical emplo,'tuent, A2:: Full-time equivnleut electrical employment: .nectrical :work for which notice to tine Inspector of W ires is required inust be performed by licensed personnel. How Cl"' ;l Stich ,`ersons, not required to be licensed,do you have in your employ? Indicate the total number and also indicate the r,:.sn;bcr of me equivalent staff ilnat number includes: Yat i? r,?cctrical emplUvnncirt — Full-lime equivalent electrical employment: "i_rst:oitions are dejinrd for these purposes as curl-person,firer,or corporation:operating tender e. 141 8. (Please sea reverse side for certifications and required signatui tustitutional Permit Form,page 2 } NOTE. Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, simil to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the nut bcrs of such employees in this application. If the contractor directs such performance, of if the contract period is for Ic than one year, application must be made by the contractor on the standard form for such work. Do not include such ct t�ployccs in this application. Please gi%-e your official title, such as "Director of the Physical Plant" or "Director of facilities" or equivalent. In addi, provtdr a statement that substantiates your authority to hire electricians pursuant to c. 141 §3 for electrical work on lite pt ices of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grar authonty to direct any licensee of the Board of State E-saminers of Electricians to perfornt work in contravention of the ruic said Lteard, or in contravention of the Massachusetts Electrical Code. —7 p ;�1Nauihority to act for the afarctnctttioncd inslitutiun is: >Gitldln /A �Qf1� /lea rrGW1 C I cefriji•, under the rains and penalties of perjun-, that the information on this applicatio►t is trite and complete. (Signature) L (Dated) Print na!tic It d tjS k-t -- ) �ll��r &- act � (wo(k tcicphone number) 9?k,01-10y4,(cxtc1lsion) (facsimile number) `7r f Date.. ........................ 7 `..... 1JRT11 f w TOWN OF NORTH ANDOVER o PERMIT FOR WIRING ,SSACNUS� This certifies that ......... .r' .........................^......r..... . ........ ....... has permission to perform .... ......`.�'`. f ........................................ ............. wiring in the building of.................................,:.. .................................'- ' at.Z.6&"U........: ...................................... .North Andover,Mass. a+' Fee ........... Lic.No/....lz�/ ..................................................? .—.... ELECTRICAL INSPECTOR L� Check # ?yC� 7851 „wcairn or massactiusetts Official Use Only A SPAM Department of Fire Services Permit No. d' BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev. 1/071 eave 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 OR TYPE ALL INFORNIATIOl9 Date: City or Town of: NORTH ANDOVER To the e 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) /�;�,C7 �,S e:e-0 6 S i Ala.<Ply Owner or Tenant JLC ClClcc=>1 S� �' Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Pff (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und d �' ❑ No.of Meters New Service Amps / Volts Overhead❑ Und d �' ❑ No,of Meters Number of Feeders and Ampacity '/ 911M� Location and Nature of Proposed Electrical Work: Completion of the ollowingtable maybe waived by the Inspector or Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fanso•of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- o. 61 EmergencyUghting nd. ❑ d. Bane Units No.of Receptacle Outlets :N:o::.o:f: FIRE ALARMS No,of Zones No.of Switches No.oo.of etection and Initiatine Devices No.of Ranges No.of Air Cond. To�` No.of Alerting Devices No.of Waste Disposers eat ump Number Tons IZW o.of Self-Contained Totals: ......-..--._. .____.__ -� Detection/ derting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Watero.ofo. No.of Devices or Equivalent Heaters KW Signs Ballasts . Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total gp elecommunications firing: No.of Devices or E uivalent OTHER: �W v /3 Attach additional detail if desired, or as required by the Inspector of Wires. 1] Estimated Value of Electrical Work: (When required by municipal policy.) Work to Stare // ,.-L7—7 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 cove ge 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: ll=�S LIC.NO.: 11l 2,7 Licensee: (If applicable, enter"exempt"in the license number line) Z"'✓ LIC.NO.: Address: Bus.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.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: $ The Commonwealth of Massachuset& Department of Industrial Accidents #• Office of Investigations 600 Washington Street i' Boston, MA 02111 www mwss.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant-Information `�Please Print LeQibl Narrie (Business/organization/lndividual); Address:_ / 12%/<<-7/Y�✓ S.v Uy/State/Zip: Zbf L a/gyd Phone#: . q 7 Are you an employer?Cheek.the appropriate box: I.�.I am a employer with 4, E3I am it general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.[] I am.a.sole proprietor.or partner- Iisted on the attached sheet. 7. [3Remodeling ship and have no employees These soli-contractors have $. ❑Demolition working for me in any capacity, workers' comp. insurance, g, ❑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 MOL 11.0 Plumbing repairs or additions myself,[No-workers'cornp, c. 152, §1(4),'andwe have no insurance required.]-t .employees. [No workers' 12.❑ Roof repairs comp. insurance required.] I.3:QfOther_ .t�,P / w�%L *Any applicant that checks bore#'l must also fill out the section below showing their wo&crc'oompensatiori policy information_ Homeowners who submit this affidavit indicating they ave doing all wo*avnd then hire outside'conuactors must submit a new afdavit indicating such. ;Contractors that check this box mustattached an additional shcershowing•the name of the sub-coetrectots and their workers'comp.policy information I ant an enWloyer that is protndutg workers'compensation cnsuranee for my employees: Below is the policy and job site information. Insurance Company Name:-' /¢J l Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address:_ `let/ City/State/Zip: 411� 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 farm 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 pairs and penalties of perjury that the information provided above is true and correct Signature: rw�/' Date: /- -G Phone#: 7jl�l- ] Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# A , Issuing Authority(circle one): 77] 1. Board of Health 2. Building.Department 3.City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee,of an individual,partnership,association or other legal entity,employing employees.'However the owner-of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant wbo 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 certificates)of insurance. Limited Liability Companies (LLC)or.Limited Liability Partnerships(LLP)with,.no employees other than the members or partners,are not required to carry workers' compensation insurance. If 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-insurande"license number on the'approphateTine. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes 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 ofthe 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 of permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 Ext 406 or 1-977-MASSAFE Fax#617-727-7744 R Revised 5-26-05 www.mass.gov/dia Ar Date.. .............................. t NORT►�1 o?;•t�`` :•�."�O� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �SS�cHusE� This certifies that s��m�SM I.L.......................... has permission to perform wiring in the building of......�Z z�/ f3 'i T�� ............... ....�0.... ...................................... ,LWS Co �600 �9�elJ — { at...............................................................................*lNorthn Andover,Mass. Fee.l....:�........... Lic.No. .......... ' ".7................... .. i ...... ELCTRICALINSPECTOR Check # / 7999 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. /?f/c7 x 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 IN INK OR TYPE ALL INFORMATION) Date: ( -3 O City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned giveotice of his or er intention to perform the a ectrical work described below. Location(Street&Number) ( , Q s Owner or Tenant 0 2 2 PoPe— S Telephone No. Owner's Address i C� Is this permit in conjunction with a building permit? Yes No F-1 (CheckAppropriate Box) Purpose of Building G 0 til el 62(` C; 6/ 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 Electric 1 Work: (^ ✓ �' �, ��o r^ '� e �e es uS a�l' Com letion o the ollowin 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 F No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig g rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal [I Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water NoNo.of Devices or E uivalent .of No. of Heaters KW Data Wiring: 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 Elec al Work: (When required by municipal policy.) Work to Start: I ,--, 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: �� i e c i C. LIC.NO.: Licensee: �a� ;�Z- (d 8 lkp. Signature LIC.NO.: (If applicable, entgr"exempt"in the license number line.) Address: Bus.Tel.No.:ci?`<-G i -3.�3 7 ,? �;ti s�7_ l,U �_Si mor- AL1 A p tf 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 Signature Telephone No. PERMIT FEE. $ 2,o � . .. r 'j"/'q ell-7 Date.................................. + TOWN OF NORTH ANDOVER PERMIT FOR WIRING Ss CH S This certifies that ......... ................... ........................... has permission to perform .................................... .................................. wiring in the building,of... ...ky ...... at...4...?.................. ......... .North Andover,Mass. Fee/c;:Z-f........... Lic.No.............. ............................................................... ELECnICAL INSP�CTO Check 'q :2/&1'1'7 41 7561 x N Commonwealth of Massachusetts Official Use Only TEimENDepartment of Fire Services Permit No. gaff 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: 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) 6 OS STa � N,4 Owner or Tenant tv Hilke, Telephone No. Z - 3 � Owner's Address 1 3 3� furn o,kr (V Ajotr Is this permit in conjunction with a building permit? Yes u No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity = Location and Nature of Proposed Electrical Work: tv Completion o the ollowin table maybe waived Ly 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 K-VA No.of Luminaires Swimming Pool Above ❑ In- El o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection an Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW o.oSelf-Contained Totals: """"'""""""""-""" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KWSecurity ystems: 71 No.of Devices or Equivalent No.o Water K`,1, No.o o.o Data Wiring: Heaters Signs Ballasts or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Te ecommumcahons uiin i uivalent OTHER: �� dice Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o�EGE: al Work: 1000 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liabil' insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Lo BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: n e LIC.NO.: Licensee: _ame c5 Signature LIC.NO.: (Ifapplicable,enter "exempt"in the license numberline) Bus.Tel.No.• �Or(,I q'j0"7r161 Address: _ t�13 W�C1, �� �� �i��pol� a� Alt.Tel.No.: 5Q?;-J0q-7Rg�, *Per M.G.L c. 147,s.57-61,securify 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 si ature below,I hereby waive this requirement. I am the(check one)❑owner E]owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ r"% The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information '�^ I Please Print Legibly Name (Business/Organization/Individual): Grprl�r . I e6m SoVu l oa( Address: City/State/Zip: V6,[Pott, MIT (2,�Q�a Phone #: Are ou an employer? Check the appropriate box: pe 1. I am a employer with '5 4. ElTy I am a general contractor and I 6. project(required): New construction employeesfull nd/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. + E] 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 officers have exercised their 10.E:1 Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ 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' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. (� Insurance Company Name: &1r A1\fr wJ Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: i 600 OS-0a J 1 City/State/Zip: O.UML (M�. Q M Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). r 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 i and penalties of perjury that the information provided above is tr a and correct. Si nature: Date: Q Phone#: 710w_ 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 of,",�RT��► TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING -art ,SSACMus� This certifies that . . . . . . .�i. . . . . .?. z'` has permission to perform '�� "�''�` ' plumbing in the buildings of ,. . . . .. .. .. .. .. .. .. .. ..... . at . . .. . . . . . . .'. . North Andover, Mass.. 3Fee .Li . N �' Z'ePWBING INSPECTOR Check v 7632 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location 1 0 n 0 S J Owners Name z` Permit Amount Type of Occupancy New �� Renovation Replacement 13 Plans Submitted Yes No ❑ FIXTURES V. E~ w � a rA 41 za O `'• W rn U w a STS&9�� BASEU iI' IST HJOCR Z 1 71V7t FIM 3M RaR 4M FLOCR 5M R1DM M HJOCR - 7IH FLOCR SIH RaR -7+7H (Print or type) Check one: Certificate Installing Company Name < < Ck/�%� Re° c(�u-t� ❑ Corp. Address o t' ❑ Partner. u�smess TTelephone 7 k 7 o _3 Firm/Ca Name of Licensed Plumber: ,P (, 1 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ©/ Other type of indemnity F1Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submit�( ntere in a ove app cation are true and accurate to the best of my knowledge and that all plumbing workandch etts S Inst on pert rm dun r Pe .t IF e for this application will be in compliance with all pertinent provisions of the Massaa PI tubing Code Ch ter 14 of the General Laws. By: igna ure 1cense r Title �y�e o� ming License City/Town icense iNumber Master Journeyman ❑ APPROVED(OFFICE USE ONLY NORTH Town of Andover 0 No. 0941 0 odover, Mass., COCHICHEWICK x.95 RATED P" BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..................................................... . ........................................... ......C.1?!t7 ......I................... Foundation ......... ........... has permission to erect........................................ buildings on'�4!F '..... ................................... Rough tobe occupied as..........................I............................................ ....... ......... ........ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 9b 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. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR, UNLESS CONSTRUCTION TARTS <M � - 74 2UE> 7 .............. ................... Service BUILDING INSPECTOR .0 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 (-� Street No. SEE REVERSE SIDE Smoke Det. } ! i= / Date.::�..../p..'.�... TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS C14 S This certifies that .,VMC.ve/).......... ....... has permission to perform ..... . .. ....................... wiring in the building of......./..`!...P...i..... at../es ...... ......N.f.3//7-12...........North Andover,Mass. • -4 Fee.4�.. Lic.No.............. ..................P I 1CALUSPEILMR, Check # 8l 49 %0IIII iwtVIVCd1Ln OT massacflusetts Official Use Only t :�P ,.`,, Department of Fire Services �,"' Permit No. V BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] Qeave blank APPLICATION FOR PERMIT TO PERFORM ELECTRI ♦ All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR12.00 ELECTRICAL (PLEASE PRINT ININK OR TYPE ALL INFO RMATION) Date: City or Town oh NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfo Location(Street&Number) rm the electrical work described below. / � t Owner or Tenant . 0 Z2 y /�j2�P��i��S001I 6x,6 or- Owner's Address 9-LL Telephone No. e?t;1 rS(�t�, �` A 1,r '17J fh✓�Ari/�a� Is this permit in conjunction with a building permit? Yes Purpose g N° K (Check Appropriate Bog urp a of Building P ) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd No. of Meters New Service Amps / Volts Overhead ❑ Undo d 0 No.of Meters Number of Feeders and Ampacity 1 11111 Location and Nature of Proposed Electrical V61c: Com letion o the followin table may be waived b the Inspector of Wires. ers No.of Recessed Luminaires No.of CeNo. Sus o.of p.(Paddle)Fans TransformTotal No.of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No.of Luminaires Swimming pool Above In_ o.o mergency �; a grind. " Batte Units No.of Receptacle Outlets No. of Oil Burners . S r FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners o.of Derecuon and No.of N Ran es InitiatingDevices g o.of Air Condl. otal Tons No. of Alerting Devices No.of Waste Disposers Beat PUMP umber Tons KW o. of elf-Contained Totals: "" Detection/AlertinQ Devices No.of Dishwashers Space/Area Heating KW Local Municipal Connecfi ❑Other No.of D on Dryers Heatiag APPhances KW Security Systems:* No.of stet KW n.of o. of No.of Devices or Equivalent Heaters Sips Ballasts, Data Wiring: No.Hydromassage BathtubsNo.of Devices or E &alent No,of Motors Total HP Telecommunications firing: OAR. No.of Devices or E uivalent Estimated Value of Electrical Work: T"—` Attach additional detail if desired, or as required by the Inspector of Wires. ti • Work to Start (When required by municipal policy /�— U Inspecons to be requested in accordance with MEC Rule 10,and upon completion. 3NSURANCE COVERAGE: Unless waived by the owner,no permit for the performanc the licensee provides proof of liability insurance includin _ _ undersigned certifies that such coverage is in force,and has' covge or its subtial e of electrical work may issue unless exhibited proof f same to the permit issuing office�v�ent The CHECK ONE: INSURANCE (a BOND ❑. OTHER (j (S ec' I certify,under the pains and penalties o er u that the informafion )n this application is true and complete fP ! ry, FIRM NAME: ✓Q,+9C'C' SS Licensee: ---------- LIC.NO.: - Signature � (If applicable, enter"exempt"in the license number line.) t�✓LIC.NO.: Address: Bus.TeL No.: *Per M.G.L c 147,s 57-61,security work requires D Alt Tel.No.: OWNER'S INSURANCE W eParluient ofPubIic Safety"S"License: Lic.No. RIVER: 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/Agent ❑owner's agent Signature Telephone No. PERMIT FEE:S yr t w The Commornwealfh of Maxsachusel& j j� Department of Industrial Accidents ! Office of Investigations ar' 600 hf�ashinvign Street ; Boston, MA 02111 { www.nvus gov/dia Workers' Compensation Ins tran A• Iicant aft►rmation ce Affidavit: Builders/Contractors/Biectricians/Plambers • I Please Print Le-dbl NBII e.(Business/O'wiza6ardIndividual); Address: City/state/Zip: Phone# . Are you an employer?Check the appropriate-box: 1.0 I am a employer with 4. �] 1 am a general contractor end IF7. Type-ofject(required): employees(full and/or part-time).*. have hired the stub-contractorsconstruction 2.0.lam.asole proprietor.or partner- listed on the attached sheet i deling ship anti have no employees Tbem suli-conttactors haveworking for me in an workers' comp.insurance. litionY urPty. ng addition [No wodcers'comp.insurance 5. ❑ VJe arc a corporation end itsrequired] officers have dxcrcised their cal repairs or additions 3.D I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself..[No-workers'comp. c.-152, §1(4) and we have no insurance required.].t .empiayees. [No workers' 12.[]Roof repairs COMP. insurance required.] 13Other `Any applicant that checks bort#I must sign fill out the section below showing their workers'compensation pot icy information ----- ;Amy who submit this afFitlavrt indicating they ale tloin9 all work artd then him-outside wnuactora t tCont:actors that check this box mustattaohed an additional sheet show' the name of the sub- must submit a new affidavit Wiczd*such. y s eoatraoton;and their workers cath-.Policy I am an employer fhat.ts ro ' ' r po cy infomtation. ,n mding:workerr compensadon insurance er infornurdon. -f ' �Y 'Re'"ir.thePoficy and jobsite Insurance Company Name: ' Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: • City/Stafe/Zip: Attach a copy ofthe.workers,compensation policy declaration showing Pali( ,the policy number and expiration dat4 Failure to secure coverage as required tinder Section 25A of MGL c. 352 can lead to the imposition of critninal fine up to$1,504,00 and/or oneryear imprisonment,as well as civil penalties in the form of a STOP WORK ORDERand of nine of up to$250.00 a day against the violator. Be advised that a copy of this statement Investigations of the DIA for insurance coverage verification. may be forwarded to the Office of I do hereby certify under the pains and penalties oJperjurythat the infonnalion provided above is trues and correct Si Date' ' Phone#: EEIss7tuing-Authornity use only. Do not write in this area,to be campEex>°d!ry city or town.official n: Permit/License# hority(circle one): Health Z Building Department 3.City/Tovvn Clerk 4.Electrical Inspector 5.Plumbing Inspectorson: 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, nsodiation,corporation or other legal entity,or any two or more ofthe'foregoing engaged in a;joint enterprise,and includirag the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership,associatioin 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 pause of another who employs persons.w do mainten�ce,construction or repay 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 pemit 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 imo 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 uthority"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)amd phone number(s)along with their certificate(s)'of insurance. Limited Liabiihy Companies (LLC)or Limited Liability Partnerships(LLP)with no.employees otherthan 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 a.ffidavit.may be submitted to the Depastmea of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit The affidavit should r 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-we required to obtain a workers'. oampansat:ion policy,please-call the Department at the numberlisted below. Self-insured companies should enter ti i self-insurarnce'.1 cense number on the`appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department his 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/Iicanse number which%vilI be used as a reference number. In addition,an applicant that.must submit multiple pennit/licarin applications in any given year,need only submit one affidavit indicating•cturertt policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or tmn)."A copy oMe affidavit that has been officially stamped or marked by the city or town may beprovided to the applicant as proof that a valid atfidavrt 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 bminess.or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person. is NOT required to complete tris affidavit. The Office of investigations would like to thank you in advance for your cooperation and shGuid you have any questions, piesse do not hesitate to give as a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts • De mtnent of Industrial Accidents Office of Lstvestigations 600 Washington Street Basten, h'iA 02111 TeL 4 617-72-74900 6 t 406 or 1-877-MASSAFE Revised 5-26-115 Fax 4 617-727-7744 www.mass.gov/dia From:H.H. MORANT 978 740 9161 09/03/2010 11:32 #866 P.001/001 August 31,2010 Ozzy Properties,Inc. 1600 Osgood Street North Andover,Massachusetts 01845 Re: Front ParMng Lot Accessible Parking Space Modifications Osgood Landing 1600 Osgood Street North Andover,Massachusetts 01845 REPORT As requested, we have reviewed the required accessible parking requirements for the front parking lot at Osgood Landing. The following is a list of comments and recommendations: • We observed that the front parking lot contains 405 total parking spaces including 23 accessible parking spaces. • Based on 521 CMR Architectural Access Board Rules and Regulations, Section 23.2 - Number of Parking Spaces, the required number of accessible parking spaces is nine(9) for a parking lot where the total number of parking spaces is 40.1-500. • Based on our observations, a reduction in the number of accessible parking spaces at the front parking lot is appropriate, setting the number of accessible spaces at nine (9), while maintaining the total number of accessible parking spaces at the 1600 Osgood Street facility at the minimum required numbers indicated in 521 CMR. If you require additional information regarding this issue,please advise. kA- Respectfully Submitted , •t r t s4,,.FS - v Stepp v ore,R.A. . R. R pf A ociates,Inc. R.Rumnf&Associates .A Engltt wft&Architecture 57 Wharf Street 2G Bax 4483 Salem,Massachusetts 01970-6483 978.740.5015 978.607.0045 fax SEP-03-2010 10:44RM From: 978 740 9161 ID:OZZY PROPERTIES Paee:001 R=93% 8/ �CAL( SLA:uS 1� 77 .aj 4 _ 521 CMR ARCHITECTURAL.ACCESS BOARD 23.1 GENERAL Any person who has lawful control of improved or enclosed private Property parking for businesses, auditoriums, sporting or recreational facilities, cultural public use where the public has the right ti access c invitees a licensees, pal centers, or general used as off-street areas to comply with 521 C sees,shall cause n h parking see 521 CMR 8 For parking related to residential and transient lid .n TRANSIENT LODGING FACILITIES and 521 CMR10.3,parkin S a gi gfacilities, �-� g SPaces. 23.2 NUMBER Accessible spaces shall be provided as follows: 23.2.1 Total Parkinv in Lot R�aiiired 1�? 15-25 er of A acihlP e 26-50 1 51-75 2 76- 100 3 101-150 4 151-200 5 201-300 6 301-400 7 401-500 8 shall comply 501-1,000 4 J 1,001 and over 2%of total 20 plus 1 for each 100 over 1000 20(5%),or 23.2.2 On in every eight accessible spaces, but not less than one, b 23.4.7. e, sa van accessible, gee 521 CMR 23'2'3 Spas required by the table in 521 CMR 23.2.1 need not be b Spaces required re a different location provided in a accessible entrance on if equivalent or particular lot. They may ,cost and convenience,is ensurreedater accessibility,in terms of distance from an 23.2.4 Specialized Medical Facilities: At facilities providing medical care for persons with mobili ty Pazrntents,parking spaces shall comply with the following: $• Outpatient orals and facilities: 10%of the total number of Parking such outpatient unit or facie P lung spaces provided to serve each b• -Units and facilities that specializeinaccessible. or services mP�rments: 20%of the total number of parking spaces Provided,or persons with mobility fad 20% shall be accessible. serving each such unit or ' LOCATION = Oc4isible parking spaces shall be located as folk x,3,1 Accessible parki n follows: taute'Qf travel g spaces accent serving a particular building shall be located on the shone from ad' parkin 23-12 In g t0 an accessible entrance. shortest accessible g cities that do not F est accessible route serve a Particular building,accessible Of travel to an accessible pedestrian entrance of the parking 23 3*3 Parking shall be located on the buirdings With molt; All be dis multiple accessible p g facility. Persed entrances with adjacent parkin and located closest to the accessible entrances. E- g, accessible parking spaces } �„s 1�7tere accessible Sriban le Passenger dro -not be located within 200 feet(200'= 61m)of M ix Ice. P-°ff area shall be provided within 100 feet(100'a 30raccessible e o aln ., Date....... .../�.�� • t M0RTp1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHUS This certifies that ....................................�e H has permission to perform.......... e lv C u k ................................................................... wiring in the building of .4T�1.s.1........4: SZ` ..... �... ...p.. . . ,�.. .f................. �s�. North And er sF............. ..... ............. Fee.Z �......... Lic.No. ,n U...... .. ELEcrRICALINSPECfOR Check # �t's 5400 TRE S office Use onlyl� DEPARTAINkffOFPUBLICSAFEIY Permit No. BOARD OF FIRE PREVFI YI70N REGUI AT 70NS 527 C 7 V1R 12iA� Occupancy&Fees Checked ;t APPLICA77ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 U (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �- 7- I Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 1 0 0 0 S g O oU S . I Owner or Tenant o zL Y f rOA=-�(CS Owner's Address ..S a m-e Is this permit in conjunction with a building permit: Yes[::] No © (Check Appropriate Box) Purpose of Building Re/a c e e- IL'cco(ev^S Utility Authorization No. _ Existing Service Amps �Volts Overhead Underground M No.of Meters New Service Amps I Volts Overhead Underground 1:3 No.of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Re-t o c¢tc Fl-o-edle-rS' No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.ofsighting Fixtures Swimming Pool Above Below Generators KVA M round 13 ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal � Other Connections �4 No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• hlstt J=C0Wf8 e.PUrsuartbthetaqtuartafsofMasadi>settsGalaalLaws ItmeaamatldAtykMrj=Pb yfrl b&ECMVIE e OErAmC0wWcr9sWVaMaMvaht YES NO Ilmeaf niledva)idptoofofsarrebdeOffie YESEzr � ffyouhavechedodYES,plea9eitl*elherypeofanaaWby drdd gdr box INSURANCE BOND MIER (PleaseSpt j+) F��onDele mStat 9— 13-0 Estirr*dVall� dBamcalWC&$ Wodc hVectimD*FA#esMd Rough Falai Signed unda Ptof ix FIRMNAME .1 d H It /mac_.n n0--y Co LiwwNa A 7333 Ikea a Sigmas LioaWNo BusirmsTel.Na Alt Tei Na OWI ERSINSURANCEWANFR;IamawaethatthelioawdomnotharedxmaraneaNaWoritsstswtaleg9>ivalentasmg WbyMassadusMCtnedLaws adds tmy sig imncn ftpem-t*plic abm waives dis ow'mnmt (Please check one) Owner 1:3 AgentED 040 Telephone No. PERMIT FEE lgna ure or Owner or Agent 94u Date.... r..f .:..11-�... i NoarM TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 41 *VIWM-W ,SSACMu This certifies that CL....zT.t<< �d has permission to perform ..y?T a(,/..... 14 !-c 11G F 1 .... ....., wiring in the building of......... Z.` ............ !;. �'...`... ............... � ........... ,North Andover,Mass. ` Lic.Nof.�5-e3x........ �EL -C�ALI.N..S.P....-lO ........... Check # 6 ET� $CJ r Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No.�� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance withthe Massachusetts Electrical Coe M (PLEASE PRINT WINK OR TYPE ALL INFORM1gT10N) Date: (MEP),527 CMR 12.00 City or Town of: NORTH ANDOVER 5 I i O By this application the undersigned gives notice of hi or her intention to perform the ele electrical workpector of les described below. L ation(Street&Number) �(, ( pv rTenant Z Z e r �t, NC7�e Sr�,o - Telephone No.�i 78-6 8r sw�I Owner's Address 16v0 8s oa d St. 200 app Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und d �' ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No,of Meters Number of Feeders and.Ampacity - %30Vo l fb� P -cvl1✓l e (v N Pfv Q tS ; �cJ fii aVL Location rrand Nature of Proposed Electrical Work: is � j 2 ��^ 5 �f 6`S L.0 lb CT �c, (�i�n 9 90, Noa�l Em ou+ Com letimLfthefollowin table may be waived by the Inspector o Wires. ' No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans 0.0 Total Transformers 1{V�e, No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming ming Pool Above Ia- 0-o mergency lg g d• d• Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS,N of zes No.of Switches No.of Gas Burners No..of Detection and No.of Ran es InitiatingDevices g No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pip Number Tons KW No.of Self-Contained Totals: "-"' "' ""— Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection E] other No.of Dryers Heating Appliances KW Security Systems:* No.of Water KW No.of o of No.of Devices or E ..;valent Heaters signs Ballasts . Data Whing: No.Hydromassage Bathtubs No.of Devices or E uivalent g No.of Motors Total HP Telecommunications W;riag: OTHER: No.of Devices or E ..;valent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start (When required by municipal policy.) 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: INSURANCEtify •� BOND E] OTHER El (Specify:) I cer under the pains and penalties o f perjury,that the information on this application is FIRM NAME: true and complete. ELecv( � TNC. Licensee: Vj 0. w LIC.NO.: 503 —� e S Signature LIC.NO.: ��3 (If applicable, n er empt"to t e license m(er line.) Address: (�q 1 Bus.Tel.No.: - 0g - *Per M.G.L c 147,s 57 61,security work requires Dty Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that tl er LL cep e does noSaft have 1the liability insurance No. required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner coverage owner's agalent. Owner/Agent Si=gnature Telephone No. PERMIT FEE: $ Date.6 S HpRTp TOWN. OF NORTH ANDOVER Of ..w,•,tip o PERMIT FOR PLUMBING ,SSACMUSE� This certifies that . / �. . rL. has permission to perform .,!�! . vr,.fJ.,�'.... . . . . . . . . . . . . . . . plumbing in the buildings of . .0.-�7`7 !i' dd.�'. . . . . . . . . . . . . . at. . . ,,a. . . . . . . �. . ��f. �d�! North Andover, Mass. Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 86th { v MASSACHUSETTS UNIFORM"PLICATION FOR PERMIT TO DO PLUMBING (Type or per) NORTH ANDOVER,MASSACHUSETTS Building Location Date Permit# Owner Amount New r Renovation Replacement ❑ Plans Submitted Yes No FIXTURES rn 1z Bisaum 1ST 110CR 2l IIDCR JM E OCR 4IH HDM S�Z = QH RDM SIH IIDQZ (Print or type) Check one: Certificate Installing Company Name ❑ Corp. Address r �' Partner. Business Telephone O G— 3p/ •"�/rFitm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate t�he'pe of insurance coverage by checking the appropriate box: Liability insurance policy Q Other type of indemnity El Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent ❑ I hereby certify that all of the details and information I have submitted(or en above application are true and accurate to the best of my knowledge and that all plumbing work and installations perform under for this�lication will be in compliance with all pertinent provisions of the Massachusetts State Plumb' Code d of true General Laws. BY Signature or L3c=ec-vprU-ffl= Title Type of Plumbing License � �-D r.,/ City/Town umber Master ® JourneymanAPPROVE'D(OFFICE USE ONLY -75� • • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizafion/Individual): Address: City/State/Zip: lt° 03a7I Phone#: - , j U Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. Type of project(required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors b' ,❑,/New construction 2. I am a sole proprietor or partner- listed on the attached sheet, t 7• LJ Remodeling ship and have no employees These suis-contractors have 8. []Demolition working for me in any capacity. workers' comp.insurance. [No workers comp. insurance 5. 9. ❑Building addition ' p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11- Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12, Roof repairs insurance required.] t ❑ q ] employees. [No workers' comp.insurance required.]---------------- 13.[:]Other ..Amy applicant that cheat;box#1 must also fill out the section below shoe~'•; •-+^ o,Policy _ ation- 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'omp_policy information. I am an employer that is providing workers'compensation insurance for my employees. Below,is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of c.'-djui,nal 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 WOPK 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 lathe Office of Investigations of the DIA for insurance coverage verification. I do here cerli unde a ns and pe ties of perjury that the information provided abov is ue and correct Si afore: / Date.: G 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 retuned to the city or tovrn 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 at a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a ho ;e owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e. a dog licenser permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents 0Mee of lnrestiQations 600 Washington Street Boston,MA 0.21.11 Tel. # 617-72.7-4900 east 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 w U«?V.rL13SS..g O V/d2 S 98x4 t Date..... ."..°..!'.. pOR71� °�<�``°;•�'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ;,SSAC14 This certifies that ............(M....... .. .4r ..................................-l' c has permission to perform ........ ... . ....... ..................................................... wiring in the building of............ ................. .... ... ...... at....(.b ........SO©IS.........'!....................... -North Andover,Mass. Fee.L. 77 —Lic.Noli�X34 ........... . .. ��. r'.. cni ir�srccroa'/ Check # a D 4 Commonwealth of Massachusetts Official Use Only r Permit No. cJ Department of Fire Services Permit Fee Assigned BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ] - 2-4 -2-al City or Town of: N o r+k A4J kd Ver To the Inspector of Wires: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution 2 q0 6 d CkQA 1 A j Address 1r00 0 0-"-_i004 S` f' CT / 1 /,' Location and Nature of Proposed Electrical Work: /JV I l G{ I I �j'� g T 1600 04o'Q S C s NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ / NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES p9/ NO ❑ This option is available where so contemplated by the municipality. In these cases,you must renew this application annually, and upon significant changes in employment. The following individual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverage,and location where it will be maintained Res onsible person 13u',6h7N :30, Zs+c FLOVf- OZZj ro,e,-firs RZE Cfq o Z g�j iKj)3 f pit (eon z4V ta?e^ Q f+i i '' tC �yPh Cilf?+�IyS .c`v` 1��(340 l 1 I ( // 17v J You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure,indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff,under their direct supervision(see c. 141 §8)? In general,this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans(see St. 1962,c. 582 §3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: 9 Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person,firm, or corporation operating under c. 141,¢8. (Please see reverse side for certifications and required signature.) Y a Institutional Permit Form,page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract,you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the prem- ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board,orVin contravention of the Massachusetts Electrical Code.{,", /� My title is: [Fbdnic 6,)&6 o2 I L L F&c J t C l O_ J (JC My authority to act for the aforementioned institution is: ke)L e 2f &2 �e - O I certify,under the pains and penalties of perjury,that the information on this application is true and complete. (Signature) -V,, (Dated) (Print name) IV, (work telephone number) — (extension) (facsimile number) n f sj Date... • .. .... NORTM 3�a�,����„•��oo TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHU This certifies that . ..... ...... / �............ has permission to perform:/.. •••••••••••f!•• wirin inthebuildingof..,rl :.'.: .. sJ. . . .�r.... ... .,<................. Al .. North Andover,Mass. Fee I.�14!ll..c .. Lic.No.............. ...... � TR..... .... 1 . ELECICAL INSPECI�OR i Check # � ' 5569 VV/ial.WlsWE"ttA of iiia.1jacnuaeud vuiciai use Limy cc� Permit No. 2eparlmad'15 ira Servicee Permit Fee Assigned BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] Icavc blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice 617 electrical installations to tl municipal Inspector of Wires is required for work on the premises of the institution. if you are not an employing uistitutic pursuant to C. 141 §S of the Massachusetts General Laws,stop here. You cannot use this flop. Use the standard form only. (PLEASE PRINT LV ItVh OR TYPE ALL INFOi?jl f,4TIO,V) Date: 3 �5- Citi or Town of: _4 _ X72774 fJ/.�� iA_ To the Ltspectot•of Mies: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. institutionZy� rZ Z e DCS S�9oo r� , / Address_ /do Bd 66020 �7/L >i 7' N, `SIV Acr/£iri/ ►�l� n 1 R CTS Location and Nature of Proposed Electrical Work: 6rf13f7A,y9Z NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ NO We will maintain one or more contemporaneous log(s) (check one): YES � NO ❑ the municipality. In these cases, you must renew-this application annually This option is available where so contemplated by and upon significant changes in employment. The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be, located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplententaty sheets if required for additional log locations. Loo coveraac, and location where it will be �m\aintainedRes onsible ersott You may maintain the logs electronically upon agreement with the Inspec!or of Wires. if you intend to apply for such a proce dare , indicate below how the Inspector of Wires should access the log: M2 'LOC"5 d'fVGCA-2 ID Z9'"24 m..`1 S,( How many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians) do you emplo; at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical enrploytnent: Jk C?w-) FSrScrtFr"hull-li'lie equivalent electrical ennploylliell I low many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision(see c. 111 §S)'? ii general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap ply for veterans (see St. 1962,c. 582§3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num ber of full-time equivalent staff that number includes: Total electrical emplo3•ment: —0 — Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: — 0 — Full-time equivalent electrical employment: �0 'Instil►ttions are def iced for these purposes as at.r person,firm, a•coiporation operating under c. /4/§8. (Please see reverse side for certifications and required signature t Institutional Permit Form,page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num• bets of such employees in this application. If the contractor directs such performance, of if the contract period is for les! than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees if, this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In additio provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §3 for electrical work on the prer ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules said Board,or in contravention of the Massachusetts Electrical Code. Nly title is: i�1y authority to act for the nforeinenlioned institution is: / � 5 �� y-LaeI- d �/ r I certift•, under the pains and penalties of perjurr, that the information on this application is true and complete. (Signature) (Dated) (Print namc) ' c,6 Lk�q— , [1 (work telephone number)(og , 550 (extension)JQ I (facsimile number) (pg 1 ti�SoZO Date..... � r �."`• '7 ,°ORTM TOWN OF NORTH ANDOVER A PERMIT FOR WIRING SS CH SEt This certifies that has permission to perform ....... '....... wiring in the building of...... P .. . . / ......... .. �� ............................... .. .....North Andover,Mass. Fee. .�..� Lic.No.F.4 .. .......... .a ...(`/}`/-A'&T� -�. .. 5D0 �: ELECTRICAL INS;HCfdR t Check # 890 11�!D-\ Lommonivea`k of fflal9aehuselb vuiaal vsc%July c Permit No. :P7 --� 1JeParlmenl o��irs �arvics� kPermit Fee Assigned BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11!99] leave blank Y APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing iustitut pursuant to C. 14 l §8 of the Massachusetts General Laws,stop here. You cannot use t I 154 1. Use the standard form only. (PLE,4SC PRINT LV INK OR TYPE //f1LL/IIf VI�4041 RA11ITION) Date: 8 3� 6 City or Tolvil of: JR�h ' JNTo the Ltspeclor•of Wires: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution 1l )t/w ✓6d L a-,., N9 Address I Q 10S vJ W 5free f Location-and Vature of Proposed Electrical Work: Moo t��yod S OOP16(Sfi")9 f ( 6Vi ild ili a Uo c G f ovtf-', NOM: C. 143 §31- of the Massachusetts General Laws obliges those who perform electrical installations to give notice same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so Conten plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such wor which sliall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipal ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ NO We will maintain one or more contemporaneous log(s) (check one): YES M/ NO []' This option is available where so contemplated by the municipality. In these cases, you must Tene,v this application annus and upon significant changes in employment. The following,individual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the log(s)will b located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement witli the Inspector of Wires. Attach supplem r1my sheets ifrequired for additional log location Log cuv rage,and location where it will be maintained Res onsible person efec•Irt.orrt CO rniA ,n a IAtLL fLeZr%,-tc nae. w�Yv\e w SPIa.e r cc LocC C Ila 8.'aAve. S-I-r` 131- eieck►0 l c,.t Ct1 i tra»wSene•� a ct el t`l"''' C° KI 1600 a . LYd -iba o O prod ST but td r-+ o Pt. You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a pre dure, indicate below how the Inspector of Wires s could access the log: .[ � $�fLt�J -o�f W-111 6e P2oy i'keA g#yw"fty d2 a Y he �" edl J 2eROr�� How many electric ians'and/or system technicians(as licensed by the Board of State Examiners of Electricians) do you emi at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment- Full-time equivnicut electrical employment: }low many helpers or apprentices do you employ to assist your licensed staff,under their direct supervision(see c. 111 §S); general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ply for veterans(see St. 1962,c. 582§3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the it ger of fi►Il-time'equiralent staff that number includes: Total electrical employments Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. Hov many such persons, not required to be licensed,do you have in your employ? Indicate the total number and also indicate tit, number of full-time equivalent staff that number includes: r Total electrical employment: —E-- Full-time equivalent electrical employment: J `Institutions are clef inert f or these purposes as arc person,firnt, a•corporation operating under c. 141§8. (Plensr err reverse side (hr rertifirationS and reauired sianatl 4 Institutional Permit Form,page 2 7 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, simil to institutional employees. If, by the terms of such a contract, you direct the perforniance of such work, include the nut bers of such employees in this application. If the contractor directs such performance, of if the contract period is for Ie than one year, application must be made by the contractor on the standard form for such work. Do not include such et ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addil provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §3 for electrical work on the pt ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grar authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rule said Board,or in contravention of the Massachusetts Electrical Code. INIy title is: p y My authority to act for the aforementioned institutionD is: Ppserd— � om! !/ 1-bo 3-23q- o6slI a 1 certify, under the paitts and penalties of perjury,that the information on this application is true and complete. (Signature) wM1,ke (Dated) 8 3 ( 101 SR L (Print name) V)Ai he w • S P t fit'S (work telephone number) (extension) (facsimile number) /-603 -V9- 9?aa Date...... ..2. 7r. ... NORTI� 3? ``°.:�'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING � - r �,SSAGMUSE� This certifies that ............ ...... T.T ................:. has permission to perform .......lri9��!.�C ....... i yor— ?. ......... wiring in the building of � at l�. ................... t4North Andover,Mass. Fee 4del .......... Lic.No. ..�6. --03 ............./, 1. -`-. ...... ELECTRICAL INSPECTOR Check tf15-7/� R 'v 866 , I= Department of Fire Services Permit No. --� = BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned I[Rev. 11/99] tleave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to th municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institutio pursuant to C. 111 §8 of the Massachusetts General Laws,stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ?)— a 1 — y l City or Town of: �Og_ t'k AMA Ne(L To the hupector of'Wire.s: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution 166 ©Syad d S't Q Z z y 2 ojo."fi e S LLL/ Address_lbw 6S5064 si, Location and Nature of Proposed Electrical Work: NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipals- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one):. YES ❑ NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES [ NO ❑ This option is available where so contemplated by the municipality. In these cases, you must renew this application annua113 and upon significant changes in employment.. The following individual(s)will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required fir additional log locations. Aog coverage,and location where it will be maintained Responsible person IW 06� wa ne w. S srrs You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce dure, indicate below how the Inspector of Wires should access the log: How many electricians and/or.system technicians(as licensed by the Board of State Examiners of Electricians)do you emplo3 at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: -. How many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision(see c. 141 §§'8)? Ir general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St, 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: 'Total electrical employment: Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: I Full-time equivalent electrical employment: *Mslitulions are defined fi r these purposes as uny person,firm, or corporation operating under c. 141§8. (Please see reverse side for certifications and required signature.) Institutionai rernn rvinl, Na6c NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. _ Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition: provide a statement that substantiates your authority to hire electricians pursuant to c. 141 }8 for electrical work on the preim ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant c. authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules said Board,or in contravention of the Massachusetts Electrical Code. My title is: My authority to act for the aforementioned institution is: P�a,J� d to r izas e at 1 certify,under the pains and penalties of perjury,that the information ar this application is true and complete. M# - 1-iG� — (Signature) a� e •S� (Dated) — 2-1—09 (Print name) lIV Au(1P W . !S�p (work telephone number) (extension) (facsimile number) Date /n........ t NORTH 1 TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING i1 �O��r�o•�`'� ,SSACMU5� ' This certifies that ...f..." -' c�! .......� :-;' tea.. �f�c ...................... has permission to perform C.. �' wiring in the building of............. ?.r................... at..JG.".':. /..... ...... ,North Andover,Mass. Fee r........ Lic.NoIA:5 ��?4..................................................... .r.. ELECTRICAL INSPECTOR Check # 9251 Commonwealth of Massachusetts Official Use Only : . Department of Fire Services Permit No. Permit Fee Assigned BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: aIck ko City or Town of: N o rt� (A) coo d C f To the Inspector of Wires: By this application thendersigne1d gives notice of the on-premises performance of electrical work by employees. Institution dC ck L Avg A�m Address [ Q ad A Strce t Location and Naturp of Proposed Electrical Work: `� �� q SSOCf� '&.1 v ®d V eek NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES L/ NO ❑ This option is available where so contemplated by the municipality. In these cases,you must renew-this application annually, and upon significant changes in employment. The following individual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required,for additional log locations. Log coverage,and location where it will be maintained Responsible persoig., 2 f td cN r(�e�5 0 OS o �p ��u L � S� uwlo kn You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- ure,indicate below ow the Inspector of Wire should access the log- Mitt of-ov de e(cc -V"tC_ c/ vp&,. regvej"l How many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: q Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff,under their direct supervision(see c. 141 §8)? In general,this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962,c. 582 §3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons,not required to be licensed, do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person,firm, or corporation operating under c. 141,¢8. (Please see reverse side for certifications and required signature.) Institutional Permit Form,page 2 Y V NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such-performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant' or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the prem- ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board,or in contravention of the Massachusetts Electrical Code. My title is: Di c ecf l\ &� �c `��*Cr, ? f My authority to act for the aforementioned institution isPc�-eq4- I certify, under the pains andpenalties ofperjury,that the information on this application is true and complete. (Signature) W W" S (Dated) a l lq f l6 (Print name) (work telephone number) (extension) (facsimile number) 4 o 3--_�G5--1-7.2 2 94 0 r Date.................................. • NOF7M °ft"`°:•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMUSE� t This certifies that 14 � ( � E ....................................................... ............ .... has permission to perform .......PL......................... f.. � ' .......... ......... wiring in the building of .......... . 5 ................................ .................................... at.......1. .(.. .�SooD ST �... ,North Andover,Mass. ..................................................... .. 2� f ,� i Fee.... .. Lic.No. ........... ............. ............! ���'�. .... ............... ELEC'CRICAL INS�'ECTOR { Check # ' b4 3 / Commonwealth of Massachusetts Official Use Only Vis' Permit No. ey t Department of Fire Services Permit Fee Assigned ��. BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1 t Fe] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use thi form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �i I 11 6 City or Town of: �00_� AN 46Je C To the Inspector of Wires: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution QSCJI Oa ati d i v\ AddressS I b�6 os o Sire e t Location an Nature of Proposed Electrical Work: j NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES NO ❑ This option is available where so contemplated by the municipality. In these cases, you must renew-this application annually, and upon significant changes in employment. The following individual(s)will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required.for additional log locations. y Log coverage,and location where it will be maintained Res Bibleersonr�++ C1cc,,Ai10N1CA\k �,`pd I600 0!`oo • ree �: e 2cro Lava ,4 P. C,0y�0,kn kei M f`���*�C��� if ib�o �,waeej- e 1 H,Lic:.e You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure,indicate below how the hispector.of Wires should access the Io : lll J61 Qfoi% e_ &%ef- a V\kgA Ca i)f ay1 ovxic copova �isV ueo'n t' krst' How many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: -5 Full-time equivalent electrical employment: 5 How many helpers or apprentices do you employ to assist your licensed staff,under their direct supervision(see c. 141 §8)? In general,this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: I Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: 3 Full-time equivalent electrical employment: *Institutions are defined for these paaposes as any person,firm, or co7poration operating under c. 141§8. (Please see reverse side for certifications and required signature.) b Institutional Permit Form,page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If,by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the prem- ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board,or in contravention of the Massachusetts Electrical Code. My title is: FlPcIfni ('r CcVXh-'tCAOE i-c`)1iC Co. k jc. Lie. K503A My authority to act for the aforementioned institution is: RO�Q . _AVP C Fo,Cj Cyte clgNc'> I certify, under the pains and penalties of perjury,that the information on this application is true and complete. (Signature) 1Q (Dated) ' 110 (Print name) W Cly yy , S j c e j (work telephone number) (extension) (facsimile number) I-b03--74S- g7a2 December 1, 2008 Town of North Andover 1600 Osgood St. North Andover MA. 01845 Dear Pete Murphy, Wiring Inspector YFS presense at the Osgood Landing Location This letter is to inform all of the tenants at the Ozzy Properties/Osgood Landing location that Yacubacci Facilities Services (YFS) is regretfully terminating its services with Ozzy Properties/ 1600 Osgood St. and will no longer be available on site. As of December 5 , at 6:OOpm YFS asks the Town of North Andover, that all permits issued and licenses involved to YFS also be terminated. If you have any questions or concerns, feel free to call. Thank You. Respectfully, Gary Yacubacci President YFS 978-994-7633 Enclosure (1) Location /l caC> os(- O-io No. 90 Date o 9,— TOWN OF NORTH ANDOVER F R 9 t Certificate of Occupancy $ /50 s�cMus`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 732-2-,390'&L 17b07 Building Inspector Location 16 uc) .v No. E /� Datep- - 4 MORTM TOWN OF NORTH ANDOVER ►0. w + i • ' Certificate of Occupancy SACNuSEt�' Building/Frame Permit Fee $ _�"'' Foundation Permit Fee $ Other Permit Fee $ 4 TOTAL $ C� �— t �I r Check # r?04Nrf r2� s�rty t�-N .19 17006 Building Inspector FLA+ (\Aw +ter 4- TOWN OF -TOWN`OF NORTH ANDOVER BUILDING DEPARTN U94T. M APPLUCAnON TO CONSTRUCT REPAK MOVAMCHANGE THE USE OR OCCUPANCY OK 8$DY MOLM ANY MMMNG OMR TOM AONE ORTWO FAMFLY'DWELt>OG :a BU[I DING M!f CO TR(9l DATE ISSI3FI) ('"'r+TclT� SAN• �'� �'�" SIGNt1ITM; . $uilttitl t`011tttliB51t1 rdWidings Date N 1.1 Pmpxty Address: 1:3 Aft um Msp and Paiad Numbers /600 QSbODD ST D 3 Oo tlzP Map Nwnber reed Namber 1.3 zminglafarmtion: IA hWatyUwAuio= I--y L/Mtr- /(oo:!"Ac 3acb-1 c.r, Zmio Disuiet aeodUee IAAm Pinna :11 mt t;BiftL lNG SETBACKS{ft) vILD plc — /V l2 OR. /tIDV D � Front Yard Side Yard Rear Yard Roquimd Provide ReqWred Provided Requimd Provided 1.7w*.'swplymaLoft so} 1a• F1ooaZaaoTa�amo0lm: Pa6fic tMivtlo 0 Zoae OaisiiePbad7onn Ma iprt T 4-d tp om❑ N 2.1 Owner of Rword j D'1wDe&— p ex ozZy 19Mperrivs_Jwrc AHPOVeR . 44 oZ810 o Name ePrint) 8- Y7S- 'fps rn Signature Telephone 2.2 Aufl rnvad Agent Name Print Addreas for service: Signature Telephone z 3.1 Licensed Cons4huetion"uuperviatx Not Applicable n: 5TRA&EI mit .W£McAA9�—P-Y ,?JK Addr—p4rRlit// Be1i4 P ✓tom CO. [k4m Nuntbor 73 t47' W Y7£' VE. �_ �4mrrY6 Ani 144 , -37.5-4�so 9 � os r Si one 3.2 Ragift4 Roam Improvement C.armrpotow NApp)icabte CotnpamyNamq Regiatra6un Number m m Address Pacpir4oa Date, Z A signature Telephone y. f 4 s 4 _ Workers Compensation roust beeompldcd and submitted with this application. Failum to ptovide this affAvitwdlresult in dvedMW of - ' issuance of the building rmit. Si .elaffidavitAtfiacbed Yea......jr NO.....A 5.1 Regiatcrcd Aichinact /^ SMcrly0GD c-145soc. INC. 9� Name: aoo /,/!6d/ sTizE�'T , �osTo�t� MSP brio •. , Address S��F,avAvrr�r�,s� �oi7- s��3--1�G8d SignatureTelephone C. /'7" f7 OW.50L 7-W& F1Vk1/�£ti&XS Arm of Responsibility Name: /D 101t?�rylK€' RP Sv/re 3/DRegishs cm Number Andress:G EXiN e?G�V Mr oa�a/ Afid?cD `Qf9�'t�¢v1 T 78!� 7�-'3'DDO Expiration Tate Signature Total ac*414A SAG V",q C, Not agplicable a xerne: ,SjXiKTver4�c. • /6� c � ST,' 13DsTo,�ly r A aa�/o RcofttiotNtm►ba Aadrms (v/7- 737--000 `Signatme Telephone Expiration hate Name Area of Respotudbility Address RegistrationNumber Signature Telephone ICpirationDate Name Area of Responsibility Address Registration Number signature Telephone Expiration Date NotApplicable 0 Company Na A9-)i-PA4h 6--&—*l✓l N2A D<7o! Responsible in Charge of Con*,uetigrt .. .. New Construction 0 Existing Building Repairs} .0 Alterations(s) X Addition 0, Accessory Bldg:" ❑ Demolition. 0' Other 0 Specify BfidD seription of hvpow Work �►oKS7'R�cT !�o®sF CUMPuTc�� f�M lf1TN �R��E'i4Td� tJ1�4S�Ci/c�.v C:dalSTLuG� S� Dryw1c e- SCiJFIiW- cpK FRF'K Ce 400MS 1,,riT.�i /,�0 1Pi4TE� P �2T/'TjA�tIS. M/S�Ev4,�l�ot1S M�'c�/�n[ic�q� ' E(F�r>�lCAL u4nZBiA./e Ft7-�? AWWAC Rr 4r i/aN5 Ta S' x vac USE GROUP Check as.a l cable CONSTRUMON TYPE A Assembly 0 ' A-1 0 A-2 0 A-3 ❑ IA CI A-4 0 A-5 0 IB t3 B Business 0 2A 0' C Educational 0 2B 0 , F Fact 0 F-1 0 F-2 0 2C HlbghHwwd 0 3A. d , I Institutional 0 14 * 0 12 0 1-3 0 3B ❑ Mmercantile 0 4 0 R.residential 0 R-1 0 R-2 0 R-3 0 5A 0 S Storage ❑ 9-1 0 S-2 0 5B ❑. U Utility 5 1Speddy: . t 6. o - V K M Mixed Use X 10 Specify: l &- D OA—a cTDae S Special Use 10 Specify; G O — / a L COMPI ETE THIS SIMON 1W ExrSMG BUILDING UNDIRGOING RENOVAnONS ADDMONS AND OPt MANGE IN USE Existing Use(toup;144PIC QTE 942AR F-RCrOgY Proposed Use Group /YD CIIyOrll6 . Existing Hazard hxiex 780 CMR.34: Pioposed`Ha=d Jhdcx 780 CMR 34: ND Q*404;- BU1I DING AREA .E}C1:4MO.ifapplicable) PROPOSED 7 Number of Floors or Stories Include Basement levels p2. Floor Area Per Floor a Total Area s Total Hei 11 i Stmt tt�rat E Stnrcouat PeerRevit;ty Yes '0 No 0 SECTION 10a Owner AuSoriza6m TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT' _ /-z propeRy ' IVRxie- - -KOWMR- 978 -9567- 7906 Hereby authorize STA.y4EY .�/; to act on' Ivly behaI>;in all matter's relative two work authorized by Osis building.permit Whcation Signature of Owner tate As Owner/Authorized nt Hereby declare that ft.statements and infimWon on the foregoing applicatiou are true and a=ratc,to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name ignature of i nt Dso Item Estimated Cast(Dollars)to be Complewd t icant 1. Building ,� .SS' D (a) MBuilldin gPPermit Fee 2 Electrical 0 '0,O _0 (b) Estimated Total Cost x d D Ca tion&nm 6 O0 1/50 e o 3 Plumbing BuildiagPeiiuitfee t.},c; } �; 4 Mechanical(HVAC) 3 2235©$�o 5 Fire Protection 6 Total(1+2+3+4+5) O Check Number; �� O I!!:!Big= mmi 111 11111 , NO.OF STORIES SIZE 1�''�tllr 6- BASEMENT OR SLAB @. SITS OF FLOOR TIMBERS 1 2 3 SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DDAENSIONS OF GIRDERS t0GHTOFFOUNDATION THICKNESS SZE OF FOOTING X. MATERIAL OF CHM04EY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT 14U qJ 7&&iW L���$5 ��clC— PHONE 1�78-9So?- 7906 LOCATION: Assessor's Map Number_ _ PARCEL SUBDIVISION_ lyi�ee/1n)9aL Zb&LEs_'Y ll45 LOT(S) STREET OD�_—S� ----__—_ ST. NUMBER-IMOD USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS-dg- TOWN OMMENTSdg_TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS—Al-24----------------------- FOOD INSPECTOR-HEALTH DATE APPROVED n DATE REJECTED — ---- SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED _ —_—__— COMMENTS_ N --- ---- --- PUBLIC WORKS-SEWERIWATER CONNECTIONS— d� DRIVEW Y PERMIT_—___1 G— _G�(-L� ' FIRE DEPARTMENT — ---- — ---- RECEIVED BY BUILDING INSPECTOR_---- -------DATE Revised 9197 jm � i ►g� v3 r I 48 (��r3 3$0 Co�� etlJrcZJ OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: Lucent Technolouies Merrimac Valley Works—Phase I PROJECTLOCATION: 16 Osgood St,N.Andover,MA NAME OF BUILDING:Building 30&70 NATURE OF PROJECT:Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,I,Bruce D. Swanton REGISTRATION NO 35501. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL X OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY,A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR.UPON COMPLETION OF THE WORK,I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. -& -0• 0� SIGNATURE SUBSCRIBED AND SWORM TO BEFORE ME THISIST DAY OF DECEMBER,2003' tWANMN MCCRiCRt NOTARY PUBLIC MY COMMISSION EXPIRES-5/18/08 ft'�+�+"MalSCA �ONAt.E�,� North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM Say'• "�• '� In accordan a * the provision of MGL c 40 S 54, a condition of Building Permit Numbe W is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: Seg j9g!5L6W (Location of Facility) 4 zQ,'. n ture of Permit I' ant lA /6 03 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 42V,V5`r,Z,Vd 7-DING P SCIS V1,4 l,V�ST�' l�'1i9nl� ,nEnt T NiiEi�4LS VO4 7rn 8 6 0!Z-FG GoSE��,p_oor- , !!. December 22, 2003 VIA FACSIMIILE AND REGULAR MAIL D. Robert Nicetta Building Commissioner Town of North Andover 27 Charles Street North Andover, MA 01845 RE: 1600 Osgood Street, North Andover MA Dear Bob, Lucent Technologies, acting through their agent, Perini Construction, is seeking a building permit for construction within 1600 Osgood Street. Per our conversation, the following should serve as confirmation that 1600 Osgood Street, LLC, the owner of the property located at 1600 Osgood Street, North Andover MA, has reviewed and hereby approves Phase I only of said building plans. If you have any questions or comments, please do not hesitate to call. Sincerely, Elle J Keller - mmercial Real Estate An agent for 1600 Osgood Street, LLC RECEIVED C E C 2 4 2003 3 Dundee Park BUILDING DEPT. Andover, MA 01810 Phone: (978) 475-4569 • Fax: (978) 475-4638 www.ozzyproperties.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Le-)66/7- /A/C. C—r6- tAn/T) Location: /6 0 O 056.60D ! . City IV U, RA(VQVe4 . A-9-4 0i94�5' Phone T78- I&O—R0 00 am a homeowner performing all work myself. 9 +PFS 01 am a sole proprietor and have no one working in any capacity am an employer providing workers'compensation for my employees working on this job. Company name: Pie11,1/ 8V/G4y1,A16- &9 //(/Co Address 73 MT `S/14 yT6r AYE City: �'ftIQ/t/11A1 6111oQ/07 144. Phone#: c5Z9- 6o?8--9dQ0 Insurance Co. GEga&oRNY &c Pkd,4Sy14Y4,VzA Policv# WC - TOB 6:rp?e? Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do herby certify un er the pains and penalties of perjury that the information provided above is true and correct. Signature Date /f /(o Print name STi WLeY d' SlitlLG',e�,ff -�K�/ - Phone# 97B-�7Sy�SdJ Official use only do not write in this area to be completed by city or town official' ❑ Building Dept QCheck if immediate response is required Building Dept ❑ Licensing Board E] Selectman's Office Contact person: Phone A ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION =. OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER •4 :. : ;;• CONSTRUCTION CONTROL PROJECT NUMBER: 1784.00—Phase I PROJECT TITLE: Lucent Technologies, Merrimack Valley ' PROJECT LOCATION: 1 600 Osgood Street. North Andover, MA NAME OF BUILDING: Lucent Technologies NATURE OF PROJECT: Interior Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, Alfred,J. Spagnolo, AIA REGISTRATION NO. 5082 BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: aWx'Rr oon &r= • ARCHITECTURAL ! GT6QAL • A&GNAN4QAL • TI�lC IrTpCT �.. JL . r, r/ C`PE�„ FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction. documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being �p performed in a manner consistent with the construction documents. 3.8 Q� OHO PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPE No.50M O BOSTON,AAAS UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE ' SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUP CY. OF SI NAT E SUBSCRIBED AND SWORM TO BEFORE ME THIS 1 DAY OF December 2003 LU O AR, tUBLiC MY COMMISSION EXPIRES ly o`�6 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: Lucent Technologies Merrimac Valley Works—Phase I PROJECTLOCATION: 16 Osgood St,N.Andover,MA NAME OF BUILDING: Building 30&70 NATURE OF PROJECT:Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,I, Thomas M.Wisnaskas REGISTRATION NO 41859. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL•X FIRE PROTECTION ELECTRICAL OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with6the progress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY, PORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER TOR.UPON COMPLETION OF THE WORK,I SHALL SUBWT A FINAL ` MAS TISFACTORY COMP O READINE OF THE P JECT FOR O NA ASKAS MECHANICAL m 1\ r No.418 Q SIGNATURE SS/ONAI_E�� SUBSCRIBED AND SWORM TO BEFORE ME THIS IST DAY OFD 2003 NOTARY PUBLIC MY COMMISSION EXPIRES-5/18/08 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: Lucent Technologies Merrimac Valley Works—Phase I PROJECTLOCATION: 16 Osgood St,N.Andover,MA NAME OF BUILDING:Building 30&70 NATURE OF PROJECT:Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,I, Domenic Ciolino REGISTRATION NO 41630. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION X ELECTRICAL OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with6the progress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY,A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH BUILDING INSPECTOR.UPON COMPLE N TH O ,I SHALL SUB RT AS TO THE SATISFACTORY COMP TI I SS OF THE PR OR NCY. Q10.� DOMENIC A. yC, CIOLINO rn SI TURF c�a FIRE PROTECTION 'i No.41630 to A9 ..1 SUBSCRIBED AND SWORM TO BEFORE M ECEMBER,2003 o CNALE� NOTARY PUBLIC MY COMMISSION EXPIRES-5/18/0 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: Lucent Technologies Merrimac Valley Works—Phase I PROJECTLOCATION: 16 Osgood St,N.Andover,MA NAME OF BUILDING:Building 30&70 NATURE OF PROJECT:Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,I,Alfred J.Melchionda REGISTRATION NO 34857. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL OTHER(SPECIFY)Plumbing FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with6the progress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEE PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH AN G INSPECTOR.UPON COMPLETION OF THE WORK,I SHALL SUBMIT A TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROM QpebpA z MFLCHICNDA -a o PLUMBING C/) SIGNAT C v p No.34657 O A9o�G/s-rEP SUBSCRIBED AND SWORM TO BEFORE ME THIS IS F � EMBER,2003 NOTARY PUBLIC MY COMMISSION EXPIRES-5/18/08 FIRE PROTECTION SYSTEMS NARRATIVE REPORTS 780 CMR—903.1.1 LUCENT TECHNOLOGIES Phase 1 - Consolidation 1.600 Osgood Street North Andover, Massachusetts Prepared By: IAIHIA CONSULTING ENGINEERS Bc�Src�n • x-t1.zu-ltzt 10 Maguire Road, suite 310 Lexington, Mn 02421 (781)372-3000;(7:11)372-31 90ftx www.aha-engi ncers.com Prepared For: North Andover Fire Department North Andover,MA December 1, 2003 LUCENT TECHNOLOGIES December 1, 2003 North Andover, MA (La) BASIS (METHODOLOGY) OF DESIGN Section 1 —Building Description Refer to architect. Section 2—Applicable Laws Regulations and Standards Refer to architect. Section 3 —Design Responsibility for Fire Protection Systems Fire Protection and Dominic A. Ciolino Fire Alarm Systems: MA PE# 41630, Fire Protection AHA Consulting Engineers, Inc. 10 Maguire Road, Suite 310 Lexington, MA 02421 (781) 372-3000 HVAC: Thomas M. Wisnaskas MA PE# 41859, HVAC AHA Consulting Engineers, Inc. 10 Maguire Road, Suite 310 Lexington, MA 02421 781 372-3000 Section 4—Fire Protection Systems to be Installed FIRE SPRINKLER SYSTEM System Description: The building is currently equipped with a wet pipe sprinkler system. Automatic sprinkler protection is provided throughout the entire building in accordance with NFPA 13, as required by MGL 148 and 780 CMR. The existing water service entrance and fire department connection are existing to remain. The existing wet pipe sprinkler system will be modified in renovated tenant areas on the First and Second Floors only. The remainder of the building will remain sprinkler protected with wet pipe sprinklers with no modifications. The modified wet sprinkler system in renovated areas in the First Floor Area "D" will be designed for Light Hazard Occupancy, and will be capable of providing 0.10 gpm/sf over the hydraulically most remote 1,500sf with 100 gpm hose allowance and 225sf maximum sprinkler spacing. These areas include a conference room and an office. 1 LUCENT TECHNOLOGIES December 1, 2003 North Andover, MA The modified wet sprinkler system in renovated areas in the Second Floor Tel/Server Rooms will be designed for Ordinary Hazard Group I Occupancy requirements, and will be capable of providing 0.15 gpm/sf over the hydraulically i most remote 1,500sf with 250 gpm hose allowance and 130sf maximum sprinkler spacing. FIRE ALARM SYSTEM System Description: The building fire alarm system shall operate in conjunction with the building fire protection system(s) in accordance with all-applicable codes and standards including NFPA 13, 72, 90A and 101, the Current Massachusetts State Building Code, and Town of North Andover. The existing fire alarm system is a microprocessor-based multiplex, analog/addressable system with complete audio and visual occupant notification, voice evacuation, and municipal reporting via the automatic telephone dialer. The existing fire alarm system will be extended to match the requirements of the new architectural plans. Each new initiating point (smoke detector, duct-mounted smoke detector, or manual pull station) will be individually addressable. Upon activation,t anon the specific device p address, type, status and location will be presented at an LCD annunciator integral to the Fire Alarm Control Panel. Occupant notification consists of audio/visual signaling. New audible signal will include a synchronized code 3 temporal signal throughout the building. Visual signaling will be by Xenon strobes in accordance with NFPA 72 Chapter 6 and the Americans with Disabilities Act (ADA). All existing smoke detectors are analog/addressable devices. Each analog/addressable device is subject to alarm verification and to environmental compensation in order to minimize false alarms. Microprocessor-based detectors retain operating characteristics in non-volatile memory and conduct algorithms to distinguish real fire conditions from unwanted nuisance alarms. Any new fire alarm initiating and notification appliances will be Class A wired. Related Systems Interface: The existing fire alarm system will continue to interface to the fire protection system(s) by monitoring each existing individual waterflow and tamper switch via dedicated addressable modules. The existing fire alarm system is interfaced to the HVAC System in order to conduct the required control functions via programmable control module outputs and associated manual override switches and status LEDs located at the FACP. 2 LUCENT TECHNOLOGIES December 1, 2003 North Andover, MA HVAC System Description: The existing base building HVAC system is designed in accordance with the Massachusetts Building Code, 6`h Edition, the Massachusetts Plumbing and Fuel Gas Code, the Boca National Mechanical Code, and NFPA 90A. Heating and ventilating is provided by existing heating and ventilating units utilizing steam heat. A 2-hour rated fire damper shall be installed in ductwork where it penetrates 2- hour fire-rated walls and/or where ductwork penetrates the floors in accordance with the Massachusetts Code 717.0 and NFPA 90A. Electronic laboratory areas are served by dedicated Computer room style units served by a central chilled water loop. All units over 2000 CFM are provided with duct mounted or unit mounted smoke detectors. Section 5 —Features Used in the Design Methodology N/A Section 6—Special Consideration and Description There is no intent to deviate from the prescriptive code requirements of regulatory codes and standards with alternative methods. (1.b) SEQUENCE OF OPERATION FIRE SPRINKLER SYSTEM Wet Pipe Sprinkler System: Heat produced from a fire melts the fusible link or glass bulb on a single sprinkler head or group of sprinkler heads causing the sprinkler(s) to open. Water from the water filled pipe is discharged immediately from the sprinkler head(s) to control the fire. The fire department may pump the fire department connection to supplement the system. Sprinkler system water flow alarms activate upon system flow and indicate to the FACP an alarm condition which transmits the alarm signal to the Municipal Fire station. The sprinkler(s) continue to flow water until manually shut off. FIRE ALARM SYSTEM 3 LUCENT TECHNOLOGIES December 1, 2003 North Andover, MA Sequence of Operation: (EXISTING TO REMAIN) In accordance with the Town of North Andover and the Massachusetts State Building Code, the operation of an existing manual pull station or activation of any existing automatic alarm initiating device (system smoke, heat, waterflow) will cause the following to occur: • Transmit the alarm to the Municipal Fire Station via the existing telephone dialer. • Sound a synchronized code 3 temporal signal throughout the Building. • Flash all visual signals throughout the building in a synchronized manner. • Flash an alarm LED and sound an audible signal at the FACP. • Upon Acknowledgment, the alarm LED shall light steadily and the audible shall silence. Subsequent alarms shall re-initiate this sequence. • Upon alarm initiation by an elevator lobby smoke detector or other designated recall device, recall elevator that serve the floor of initialization to the main egress level. If the alarm initiates on the main egress level, return the elevator to the alternate floor as directed by the authority having jurisdiction. • Visually indicate the alarm initiating device type and location via the LCD display located at the FACP and the LED remote graphic annunciator in the entry vestibule. The LED remote graphic annunciator only indicates initiating devices located in the core areas of the building and not in the tenant areas. • Automatically shut down or control HVAC functions, as required. HVAC Sequence of Operation: The existing heating and ventilating units over 2000 cfm have duct smoke detectors in the supply ducts from the units. Upon sensing smoke, the existing detectors shall stop the supply fan. Dedicated laboratory air conditioning systems over 2000 cfm are provided with smoke detectors that upon sensing smoke, the supply fan with shut down. (I.c) TESTING CRITERIA Section 1 — General Testing Criteria - The general contractor has overall responsibility for setting up and coordinating all acceptance testing with authorities having jurisdiction. All testing shall be in 4 LUCENT TECHNOLOGIES December 1, 2003 North Andover, MA accordance with NFPA requirements, North Andover Fire Department, the Massachusetts State Building Code, 6th Edition, the BOCA National Mechanical Code, the NFPA National Electrical Code, and the contract specifications. FIRE SPRINKLER SYSTEM The sprinkler contractor is responsible for setting up and coordinating all sprinkler system acceptance testing. All testing shall be in accordance with NFPA 13, 14, 24, the Massachusetts State Building Code, and contract specifications. FIRE ALARM SYSTEM Testing Criteria: The completed system shall be subject to the final test and acceptance, UL certification and periodic inspection, testing and maintenance, in accordance with the Town of North Andover, Massachusetts State Building Code and NFPA 72 Chapter 7 as follows: • The test shall be conducted by a UL certified testing company. Each and every device shall be functionally tested. • Upon function test of each device, the corresponding programmed event sequences shall be verified. Subsequent events shall include occupant notification, system annunciation, elevator recall, HVAC control sequences, door release, and municipal reporting. • Proper visual notification shall be verified. • Audible sound pressure levels shall be measured and recorded. • Fault conditions shall be simulated and verified as to their proper reporting and system response. These shall include loss of AC power, battery standby operation, and wiring faults of each and every circuit. • A complete report demonstrating the activation and subsequent acknowledgement of each activation shall be generated. An annual test and inspection contract will be in evidence at the time of final testing. The final system acceptance test shall be conducted by the holder of the test contract, and witnessed by the local authority having jurisdiction. Upon successful test and acceptance, a UL certificate and final report of compliance shall be issued by the testing company. Testing and inspection shall be conducted by the testing company of record as described and in accordance with NFPA 72, chapter 7. In addition to device testing, maintenance (sensitivity) reports shall be generated directly from the system during each quarterly test. These reports shall include a complete listing of each analog device in the system, their corresponding programmed sensitivity 5 LUCENT TECHNOLOGIES December 1, 2003 North Andover, MA setting, and their current sensitivity level, and the number of times each device has entered alarm verification mode. HVAC Upon completion and prior to acceptance of the installation, operations shall be thoroughly tested and balanced in accordance with the Massachusetts State Building Code, 6th edition, and the BOCA National Mechanical Code. A certificate of approval and acceptance shall be submitted to the architect by the HVAC Contractor. All tests are to be witnessed by the authority having jurisdiction and the architect. Section 2—Equipment and Tools FIRE SPRINKLER The sprinkler contractor shall be responsible for providing all required equipment and tools including but not limited to: hydrostatic testing equipment, pressure gauges, hoses, nozzles, manufacturers instructions, radios, etc. FIRE ALARM The Electrical Contractor shall provide all tools necessary to complete the successful testing of the Fire Alarm systems. HVAC The HVAC Contractor shall provide all tools necessary to complete the successful testing of the HVAC systems including, as necessary, lifts, gauges, pitot pressure sensors and other CFM reading and balancing equipment, adjustable and fixed sheave drives and belts (for adjusting fans), rpm and electrical meters, etc. HVAC Systems shall be balanced to be within 10% of design criteria. Section 3 —Approval Requirements Obtain written approval of all acceptance testing from the North Andover Fire Department. Report all system failures to the general contractor, North Andover Fire Department, and design engineer. Provide the North Andover Fire Department with copies of NFPA 13 and 72 testing certificates, instruction manuals and as-built drawings. _ The owner shall submit to the North Andover Fire Department the names and telephone numbers of emergency contacts. GA\Projects\2003-Boston\LuCell t Andover Consolidation\Specifications\Fire\903 NARRATIVE.doc 6 k S/ILig?iEflJ Cl rJISIlesS&AssaG1Q125' Alfred J.Sp polo AIA o^.. William Gisness AIA Jct3rey S.T,napkins NC:IDQ r-xkci i �- ''''� ;'�, "4..,.- ,.fir>• ya 7 January 2004 Mr. Robert Nicetta Building Commissioner , r ra4. Town of North Andover s. 27 Charles St. North Andover,MA. 01845 RE: Lucent-Merrimack Valley Consolidation Project 1600 Osgood St. North Andover, MA 01845 S " Dear Mr.Nicetta, =, Enclosed please find the building code review information your requested. Regarding codes in the Phase I portion of the Lucent Interior Renovations: There are no demising walls.New walls do not exceed the height of existing walls. This means that there are no HVAC issues that would negatively affect existing conditions. • There are significantly fewer people occupying the space. Therefore, the ratio of people to toilet facilities is reduced and therefore does not negatively affect existing conditions. • There are no new walls obstructing existing conditions of egress. We are also enclosing a copy of our previous letter specific to the demising walls, dated 24 November 2003. Please do not hesitate to contact me if Il ould have any questions or comments concerning this project. 0 ARC �� �0 3.Sh�q� Since e Ne. 5082 UIQ Alfr J. Spagnolo, AIA ` Prin ip � TN ur—'���1: y7'P;e':a Irl� Enclosure Cc;Mark Power,Allan Paduchowski,Stanley Swerchesky,Bill Gisness,Sherry Adams,Sarah Ritch, Ray Moughalian,Med Manoochehri r per �. CnQ 1S S 8L 1ClleS Alkrd I.Spas! noto ALA Willi-un(.:isnrss AIA frtTrry S.Tompkins VC:IDO 24 November 2003 architecture interior de Mr. Robert Nicetta Building Commissioner address. Town of North Andover 27 Charles St. North Andover, MA. 01845 RE: Lucent-Merrimack Valley Consolidation Project 1600 Osgood St. North Andover, MA 01845 Dear Mr. Nicetta, We reviewed the Massachusetts State Building Code, and NFPA 101 Life Safety Code in regards to the tenant demising wall construction. It is our assumption that the Building is either Business or Moderate Hazard Factory and Industrial use group in accordance with Section 300. Spagnolo/Gisness & Associates to the best of our knowledge and belief assume the building is classified as two buildings on a lot and Type 2C construction with the high bay area as a one story building of unlimited area per Section 507.1 of Massachusetts Building Code. Existing construction is unprotected steel frame with a non load bearing exterior wall, and fully sprinklered. Per Table 602 , and the NFPA 101 Life Safety Code, 2000 edition,tenant space separation walls are not required to be rated. Per the Massachusetts State Building Code, and Life Safety Code, tenant separation walls are not required to be full height or a smoke partition. Per section 712.1, smoke barriers are required in only I-2, and I-3 Use Groups (Health Care Occupancies). Tenant separation walls in this type of situation are determined by security,acoustical requirements, and the Authority Having Jurisdiction (AHJ). Please do not hesitate to contact me if you should have any questions or comments conceming this project. Since a qtr Or *' No.5082 Alfre J. pagnolo, AIA BOSTON, Prin p MASS. J Cc.Mark Power.Allan Paduchowski. Stanley Swerchesky. Bill Gisness. Sherry Adams.Sarah Ritch. OF MA�� Ray Moughalian e Perini Building Company 73 Mt. Wayte Ave. Framingham, MA 01710-9160 Perini Building Company December 16, 2003 Mr. Robert Nicetta, Building Commissioner Town of North Andover Sutton Street No. Andover, MA 01845 Re: Lucent Technologies Inc— Merrimack Valley Works, Consolidation 1600 Osgood St No. Andover, MA 01845 Dear Mr Nicetta, In reference to the above mentioned project, Lucent Technologies Inc. will begin to consolidate remaining operations into its final footprint and reside as a tenant at this facility for the near future. Currently transition meetings and negotiations with the new owner, Ozzy Properties, Inc, are ongoing to determine the exact limits of occupancy. In order to minimize impact to Lucent's operations the project will be divided into three phases. The attached drawings represent Phase 1 which we believe can start immediately. Be advised that this phase does not include the new demising limits or partitions associated with demising. Work to be done under this phase is tenant fit-up in nature. The introduction of a new Phone/ Server Room will included fire rated enclosure to protect Lucent's equipment. It will also be sprinkled in accordance with Mass Building Code and NFPA 13 requirements. In light of the aforementioned, attached for your review, comment, acceptance or rejection is drawings for Phase 1. Please contact me if you have any questions relative to this project. My telephone number is 978-375-4501. Very truly yours, Stanley J erchesky Jr Project Manager Perini Building Co. C/c M. Power Lucent Technologies Inc R. Nicetta Building Commissioner, Town of North Andover Job file 1� 1. 11 1 CoZ7� �rC"7�7 NORTH Town of No. Ll So STRUCtIDN LAK o , dover, Mass., 4%a tAnn4 QA 2ooq• lsCOCHICHEWICK AD`QATED P'? C:) S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System •THIS CERTIFIES THAT.. ' ?C—x;NL P . .......... BUILDING IN SPECTOR ... .... ... " .... Foundation has permission n ..�.�i►. 0... Q.m�.. . . -. aC....../ Rough to be occupied Ilk .ZWJ"4j#fu ft Chimney provided that the person accepting this permit shall i 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 relatingto the Inspection, Alteration and Construction of Buildings in the Town of North Andover. No�W qWjL.W:.A. aero-+'1T/Lca�,��,� ` PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. imaeti W^xsd 4A4'b lb w#*TT4 Rough % VT) Final PER,NffT EXPIRES IT 6 MONTHS UNLESS CONSTRUCTION STARTS CONTROL ELECTRICAL INSPECTOR . 5TRUCglON Rough >. Service BUILDING rIVSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved ,by the Building Inspector. Burner DEPARTMENT o(a (43%. Street No. SEE REVERSE SIDE Smoke Det. 91 69 Date./6X`/"*/. . TOWN OF NORTH ANDOVER 00 PERMIT FOR PLUMBING ,SSACNUS This certifies that . ... . . . has permission to perform A4#1 6 plumbing in the buildings of . ;"4joo 7 . . . . . . . . . . at . . . . 0.Z,1 e— . . . . ... .. NN rthin Andover, Mass. Fee./440 40 Lic. No.. 4) . . . . . . . PLUMBING INSPECTOR Check # 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING . City/Town: MA. Date: Permit# _ Building Location: ;/ .0 !� Owners Name: T �rQ Type of Occupancy: Commercial Educational ❑ Industrial❑ Institutional❑ Residential❑ New:❑ Alteration:❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED LU 2 SYSTEMS LU Z �n VO Ztr 2 F Y 'Q y c�i FN- w DLU ❑ a X o: Z �n z Q d w C7 cr z O m Ln H W Q h �( y Y W 5 ❑ LL Q �, d z m � � z �, � � x F m c O LU a Q ¢ cn to O 5 0 O Z Q Q Q Z I Q } a m m ❑ o LL i YO g 30 m m lQ- ❑ 3 o u a L a a -SUB BSMT. Q O 3 BASEMENT ' 1sT FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6TH FLOOR 7T"FLOOR 8'FLOOR InstaIIing connip-c M fvame: .J[ Ch_r k On ! e cn . C= . y Address tl S� City/Town: �-Aj A .j orporation State: Business Tel: dFax, ❑Partnership Name of Licensed Plumper: J El Firm/Company � INSURANCE COVERAGE: I have a current liability lnsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑ No❑ If you have checked Yes,please! mate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,an that my signature on this permit application waives this requirement. Check One Only signature of Owner or Owner's Agent Owner E] Agent El(hereby certify that all of the details and information 1 have submitted(or enter regar in g this application are e - d ,. ,. Knowledge and that all plumbing�„or k and Installations performed under th permit iss ed Pertinent provision of the Massachusetts Slate Plumbing Code and Chap r 742 of th er La - a ” -tothe best of my is plicati will b in m lance with all 3Y Type of License: -itfe ❑P umber SI of Li nsed Plu er ity/Town stet ' PPROVED(OFFICE USE ONLY) [--]Journeyman License Number; The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib] Name(Business/Organization/Individual): Address: City/State/Zip: Phone#:Are you an employer?Check the appropriate box: _ 1.❑ I am a employer with � 4. � Type of project(required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 El New construction 2111 am a sole proprietor or partner- listed on the attached sheget. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demblition working for mein any capacity. workers'comp.insurance. [No workers' comp.insurance 5. We are a corporation and its 9 ❑Building addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11 lumbing repairs or additions Myself [No workers' comp. c. 152, §1(4),and we have no insurance required.]r employees.[No workers' /11 2.E]Roof repairs comp,insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy informatst submit a new affidavit indicating such. ion. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mu lContractors 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 information. �— and job site Insurance Company Name: k Policy#or Self-ins.Lie.#: L:l Expiration Date: Job Site Address: O Q v dw/ City/State/Zip; Attach a copy of the workers'compens on 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 ver. jjication. I do hereby c tify u er ain nd f erj that the information provided above is true and correct. Si nature ` Bate: Phone#: Offacial 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): I.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 apartinents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance'or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers',compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cavy 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 Iice1, number on the appropriate line. ` amity 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 C01MUOMWeal`h of Pvilassacifusetts AepWtment of Industrial Accidents Office of Investigations 600 Washington Street Boston;MA.02111. Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 Www.mass.l;av/dia Location G= o316 C;�I–rZ4�-~ No. Date t NORTH TOWN OF NORTH ANDOVER Ofa. o , 1b� 1 41 1 + Certificate of Occupancy $ cMusEt� Building/Frame Permit Fee $ S' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ -4 Fo Check # 20(oma 17093 Building.lnspWor �a ® E CA L o�' A.M. =0 DATE TIM O P.M. M PHONED OF _ RETURNED PHONE- YOURCALL AREAC E NUMBE EXTENSI N ' PLEASE CALL MASS '..1Ctt3_L CALL + l _ CAME TO SEEYQU` WANtS Til SEE Yt1U' D TOPS FORM 4003 � S OPUCA rxoOrM tper AMUNCIvATYiq* qc UUUO *MW 'Wa On=TAN AVON Sec�on.Cor tf�lit��Irc::'" SIt3NTEJR!? 6 Bnii ,: . � tdill I1 qty nam is , ertxta 4 (OD �bOa� S 1:3zwiagl»fot� 1A Property .. � _ IA Are# 1 . -i u B>E=INC;Mum 09 Front Yarn, Si&Y Yard I cd PlOW R_qtW Provided. ted'... Plakadcd 1 zwxa ' IK.aicao., sa3 ts. awsoeezaer "aerr�y?�tsy AZone: Orfridnlhoad�'A�ro % til tl4e$tlarh�tuaiil�'�yifem�Il' -: Pu61ia' Pi{vNe. D 216xtie 4IteoddPOO K o Z zY �i�r�P�lzTi�s, L�� tivoYE�e_ M d/8l0 _xama(4�nut) Addtsessse<vuu": - ,�, V - Sigeatucc Tetephnne 21 Authu szed Agaut Name P*A Address for Service. " Sigaatum Tckpb— t 31 L m ed{:eROMlrnu Su�vi gsr Naf App'lizithla "Cl Ada— PF�z��v% 7;5 AV46" "VAI h49oPl 066/4 05• 4.2 1 'ed . v t x rra ata 10 rr� '�wnpan,y'1•Ta�rie Numbwr• � �'. Mdiees ...: . Signature Tetephoac r h Wor7aarsC,ompwsstiinsioea�da�itnoGafbaoaii�p[�b6dandautamiffaf�iiitlu�e�phcauou, Falarr�.topro�Nd¢3t�a£ �tw�EultindquaMof'flq �sattaace of thb btu'1 _ 5.,1'Regi. Architect: _ __ I WE s77; �C'STd/1� r� lY1f Do2�%D` ,5� L�f�/�DFe�dlT AT7-R-claf'D l l 7- `rY3~ OG'f O Sigrtaature TeTphame /b h/1�4 GZlleC /c D. ,S T/Zr -?16) , Aad ; ignatwe Torch x Not=�sti�bl�;>Cl I1c0qm qg!°l & h/C, �s U�FAL 'N ber =Adds iG b F�v�f2�4� sr J3vsTolr /��?. 0a 'signature- ..- Tglepho� ��� :; 617- 7:: -COVO NaatC Area.ef%tcapaitiility' 'AddCES$... - tI0Il�1ntS�Ci•' . `Tckphauc'- Name .: w. oftbitity : .. Address itegctratiott 2+Tunt6er Signa4�e Teipg�hone > ,. Suradion 7ste , � Not�• " c Alame FiP�N1lA1l�r,�/J9N1 / /' 0'/.7 kcsptipsib%in Chazge of Coatiatt. .. . gig== NewC shiwtiaa 0 ExistingBuildmg Repair(s) ,0 Alteratiaru(s) Addition 0• Accessary Bldg 0 Demolition Odd p Specify BrWo."wPosed Wodc DDS SF A1,54- E-�cD�lF/GMCF Elr�s'771�� /�Za�✓u�6 TUhAf6- 44E� 'b Too - Srzog l//,E' zaorlw& 10"A 9A /W772 G�SD,Q,4TDeeies (ff-c D6- 7401 R RAP �"C�7' N ';' c ot/ oms 8 �s USE GROIIP Chedt as CONSIRIICTION TYPE A Assembly D ' 111 p': A 2 U A-3 p 1A p A4, D As.. p B Basinea p C Edueatieoal p .2A p' ZB` 0 Rl 1.2 a 2C RHii Hauad p 3A: p Ilnetimtiaoal 0 1•t ' D 1.2 G 1.3 11 3B MiNerr entile D .:4 ❑ R'sesideatial 0 Rel 0 R-1 0 R=3 5B .• a M Mixed use S Speaiat Use p Speelry: a ul��/.tlb 7D- NDusTltiR _ COMPLETE TSS SBCTIOI+i:ffi.BXISTIlYG BIJII INGUOUGOMRBNOVATION ADAITIONS!!PID':01 GBAI�TGB IN uSE Eidaiog U99 Grow Z/C+//T-Z&f 7-6 vt 16L Pco�SedUsa(3rdrp /✓D C,S/RiY6� E�aating Flamed lndoc.780.CM$-34: , Pmposedliawd hxkx 780 CMR 34: BtMD1N13ARF E185TJr1t}if le PROPOSED Number OfFlom m'3tiariesldude Basement levels 6 -C2 &RO -3 /f0 t_!Wdif-$ FloorArea Flom ' Ql�l TOtal Area TOWMal ft T--7 7O=VVNERSS Sbuctuml Steal peer Review Yes 0. No 0a Owner Andwr�os• TO BZ COAD WHEDi, GENT OR CONTRACTOR APPLILS I+OR BumDING PEBwr QMlwdthcsUl*aPMPeltY Hendry a�rthoriae sr�r�y T. .s7✓E�e�t,� � � W as on WInall ma=Mbbw two woltaMbonzed>rythnlawficatioll z n-s e �. $; jtCE6�lOtiS(&� EAdititt3�1" a 3`Ie1G L`f>lStrrlCtlCHr �) `� ;Bull c S ..�. Accessory 61cyg " 0 Dimoli3ioa 0 5iaeafy> AricfDosaYgtira4:of1'r�WorlG: b p pQ SF E- cp�FlGl� F is .1&, W ,¢ Toof- �+ - t)�E G�E��'Check as.a lic�ab(E ,� CQI+IS1'IiU'G'I'Yd�;'!"StPE° Assemf zy n A.4 n A-21 n A a ; c I «ral ❑ 2B I?IFa g_ 75 2c / H,Ifigh;Himido I loiticdolw CI'.:, I,I .: 'a V-2 EI Iuleuttile �. 4 Q R'reslsieatiel'. n It=1' D R-2, a S, n `34 I_i 8-2 17 p U U y; t U S Ivllvfixed Use x 17Specify: 4- — D L/41IT,' $Speagt'Use fl Spec[fj V!6 D— u '_ _ CEIW'I':4'I'E TEO SIMOXV MM",drsffig NG _ QO$�IG E 10VATl0AS.,ALV iM0N W OR 0WV.� . Existing;Use:ciroup:C!G�ftZf! _ 6 I?rapasel Y7seoup: /✓D C Erb. ExistQ Hamd'h kx,M 0A,:34. IP109,134)[Iazaril btde)f-78Q t MR 3 ;�I175 GN,►�,d6£ MINOR gEiiA7M tories Includea Sao• Irloar Total Area TOd Hca it .. MON ..3�i' 1.O'BEIICOIAK #,Y'iint,., OV4rIVERSA ri1�`+t�R�}1r1'1�C�'t�Tx^..�Pl�I 5;1�tt�,AUIyD1I+l�I� O I,. /h �JG �OG✓�l�– gs'ilae+e ot3hc8 mpexty Hereby,autlra�ze.. sT/¢/+�L�"y T. s7+JEF—C '6E-� !� to a«tin. My be)�Ti;rn alf.-mars rttahW twoVA)rle atollby f3us. pm=t,4V&afioii , �Igroature of i�rov�r •Jci Vli .t'i t.t f ry •t I rr / fil t tai rr3./dam r �. {�Ih ItL/ .tG`{r. s.r x:1` rfP 5 i;1r Y riS rja. 19} ffr 4' h4"�tif> 1 F #1 rnr I Ir�` t vc, yr 2py rf td1 1` {/t,$/nll ?�fR�t I r� I e1�U' q� ;jyi '� S�xti�7' �z'ti �oMu+c. 0 I 1 / will e� 1:1 • • •• 'Qti 1I:EE7 ! Q I°QUI'' limit I CC INAMAN777*14, E Ya' Q 'QO 1 i Imp 01,Q1 cQ e u Q' 1 Q t l QI t Q I Q Q E �`�',t Y'.�''�E`�.€8�a ..�t.,-:+s:_..Y.,trv,_,�_.cY.�.,.cxas• x. s�.,. �*--':.<�, _A�..vr@ i �M e...ek.,Js..a�';.sta:.:��.w,','k�� .Aa�n `?�i ,�,L,:4R. V40RTH Town ® 6 An dover C1 No. �� _ effi,SIRUCT10 - - -_ dover, Mass.,LAKE C OG MICMEWICK oRATEO p'P�t-`� 7v V ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ` . . BUILDING INSPECTOR THIS CERTIFIES THAT AC.&C.4 �s.x,► . ....... c�.0�...IS�i, �.il ....�c,.• Foundation has permission to erect....i.9. .1. .............. buildings on ..J.*.AW0..... . 0mb....W)war mob Rough to be occupied as.rl... .P Till..../ pr 01" .N o �.�d.!�.... p .... .. �..... " .... • Chimney provided that the person accepting this permit sha n every respect conform the termsi�'he appli ion 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. �#ftse W PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMU EXPIRES IN 6 MONTHS MOM ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST S . ITIUCf,UN Rough 1 NMI ........ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Ss Li `o* 14-3f==� — 107 o5 3 — Street No. SEE REVERSE SIDE Smoke Det. Perini Building Company 73 Mt. Wayte Ave. Framingham, MA 01710-9160 verini Building Company February 23, 2004 Robert Nicetta, Building Commissioner Town of North Andover, Fire Dept. Main St. North Andover, MA 01845 Re: Lucent Technologies Inc — Merrimack Valley Works Consolidation 1600 Osgood St, No Andover, MA 01845 Dear Mr. Nicetta, Attached, for your review, acceptance, rejection or comment are the construction drawings for Phase II of the above mentioned project and the Building Permit Application. Work to be done in this Phase consists mechanical, electrical fit—up for manufacturing, office and conference rooms and minor alterations and additions to the fire alarm system and fire protection system (wet sprinklers). . Thank you for your consideration. Stanley J Swerchesky Jr Project anager Perini Building Co C/c job file The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Z Lj6t�ot/ r M6YaL1OLo G/,!57.s /'AG �/E/tilf�ld� X17") Location: 400 C�S6'b�/� City 4&, /_ A1DP1/L-'5e. MIX 0/93/S-Phone ©O 0 am a homeowner performing all ork myself. l 79_ �� _7 fie& Own s F1I am a sole proprietor and have no one working in any capacity am an employer providing workers'compensation for my employees working on this job. Company name: PC 1/J �!J/G-D��r�Y t�d /W c. Address 7,3 A17- l/(AYr-E 414E City: �`lP //V�`s/ya-t/✓/ IV24 Phone#: !�✓5��2lfl�cE Insurance Co. C'DA2P,¢,Jy QF/��N�lSyL VI�K,r,� Policv# W-Ce, 7-Oe S:5—,Q Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print namey` A- Alt. �/� -si'yE�2lh�LsS/�}! <Ta� Phone# 978'.3TS Y'�5-6/ Official use only do not write in this area to be completed by city or town official' n Building Dept ❑Check if immediate response is required Building Dept O Licensing Board E] Selectman's Office Contact person: Phone#: n Health Department Other FORM WORKMAN'S COMPENSATION North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) ,2/— �006ature of Permi licant 7�0 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 0a/VS77-UC7?0 f/ D `!3Rl5 J11,,q pV q-57:E- P2,oV!✓R,�_-CIV2CI!r IW&-7_4L S % Y1� 70Nl�0R�'GL.© Perini Building Company Bid Analysis Sheet Perini Job #333-Lucent Tech nologies-MVW Consolodation Phase 2 Mechanical Chiller MacDonald FH Maroney Fraser Bid No Bid $ 119,898.00 $ 162,330.00 $ -il TO,062.Q0 $ - Alternates $ - Addenda ? Didn't Acknowledge Disconnect Office Partitons Schedule Bond Notes: Delete Bal. Electrical-Bid Package 16 CA Senecal Griffen Envision Fraser Ostrow Penne Bid $ 145,800.00 No Bid No Bid $ 139,885.00 $ 148,000.00 �$ 120,800.QO Alternates $ (9,240.00) $ 2,750.00 Addenda Disconnect Office Partitons Schedule Bond Notes: Deduct Bus Plugs Drywall/Ceilings Central Pelletier Save on Walls Sweeny Bid $ 227,855.00 177 90 ,.QQ,, No Bid No Bid Alternates Addenda Disconnect Office Partitons Schedule Bond Notes: 40 Labor Hours Delete Hdw. Sched Add for revised pricing doors and hardware $ 15,000.00 Fire Protection Environmental Carl sle Fraser Bid $ 5,600.00 $ 13,810.00 $ 10,829.00 $ 0,00k"M. $ - Alternates $ 1,000.00 Addenda Disconnect Office Partitons Schedule Bond Notes: Alt. Hydraulic Calcs Environ. Bid left out dwg FP3 (approx 18 heads for relocation Balancing JF Coffey EL Barrett, Inc Bid $ , 5;400:00 $ 6,000.00 Alternates Addenda Disconnect Office Partitons Schedule Bond Notes: DDC Controls - Andover Bid $; 25,450.00' - Alternates $ 11,890:00'` Addenda Disconnect Office Partitons Schedule Bond Notes: Add Alt Tool Room HVAC Flooring Allowance (to be bid) $_ _ 36000'tlp' Painting'and Finishes .... ... _ Allowance (to be bid) $ 15€0 00 • Scurity Allowance ($2300/point) 23,f340 QQ Automatic Door Allowance (from budget) 4,500 0 Concret Demolition Sawcut for HVAC ducts ,$ 450' 00 Total this sheet ' OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 1784.00 = Phase II PROJECT TITLE: Lucent Technologies, Merrimack Valley PROJECT LOCATION: 1600 Osgood street. North Andover. MA NAME OF BUILDING: Lucent Technologies NATURE OF PROJECT: Interior Renovations IN ACCORDgqNCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I Vyilliam Gisness REGISTRATION NO. 5708 BEING A REGISTERED PROFESSIONAL C_*&N@ ..ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ,GAITIRc Ron Ig-r-T • ARCHITECTURALPAQX&Qz • • • v FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction, documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being \S�EREU ARCyit performed in a manner consistent with the construction documents. ��� "NM 0 IV PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPORT �, 3 Na 57(78� TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. " BOaTo& "- MA UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUP N /� SIGNATURE SUBSCRIBED AND SWORM TO BEFORE M,11 THIS_ JD DAY OF 20 NO I R Y PUBLIC LEXPI EES_ Inalle R Slook Notary Public my Cwa asom Eai kr@§ Dauber 19, OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: Lucent Technologies Merrimac Valley Works—Phase I PROJECTLOCATION: 1600 Osgood St,N.Andover,MA NAME OF BUILDING:Building 20,30&70 NATURE OF PROJECT:Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,I, Domenic Ciolino REGISTRATION NO 41630. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION X ELECTRICAL OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with6the progress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY,A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO rffh NORTH ANDOVER BUILDING INSPECTOR.UPON COMPLETI ;OF THE WO ' PI SHAEE SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPI j O RE D SS OI~;THE PROJECT FOR OCCUPANCY. SIG TtfR SUBSCRIBED AND SWORM ,Q ENff,,�T-,HIS 28th DAY OF JANUARY,2004 NOTARY PUBLIC MY COMMISSION EXPIRES-5/18/08 _. ••114CH�15r; '/���'44�l Pv�\ OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: Lucent Technologies Merrimac Valley Works—Phase I PROJECTLOCATION: 1600 Osgood St,N.Andover,MA NAME OF BUILDING:Building 20, 30&70 NATURE OF PROJECT:Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,I,Bruce D. Swanton REGISTRATION NO 35501. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL X OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept, shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required ials. 3. Be present at intervals appropriate to the stage of construction to become,,. '� th6the A progress and quality of the work and to determine,in general,if the wor 4i '`" g perfo manner consistent with the construction documents. ons E: war�'i".`�:srt�"s.`f PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY,A FROG �SREP,Q$j, ,,.J;OGT R WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDINGOR.U.I?i ,.y. . COMPLETION OF THE WORK,I SHALL SUBMIT A FINAL REPORT AS T COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. �'�^=+om,r � , SIGNATURE ��1�tltttlll�i��PFtIENF Q•• QNWEA •�� /��i SUBSCRIBED AND SWORM TO BEFORE ME THIS 28th DAY OF JANUARY,2004 try'9 i NOTARY PUBLIC MY COMMISSION EXPIRES-5/18/08 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: Lucent Technologies Merrimac Valley Works—Phase II PROJECTLOCATION: 1600 Osgood St,N.Andover,MA NAME OF BUILDING:Building 20,30&70 NATURE OF PROJECT:Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,I,Alfred J.Melchionda REGISTRATION NO 34857. BEING A REGISTERED PROFESSIONAL ENGINEER/ ff �HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL OTHER(SPECIFY)Plumbing X FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with6the progress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOV INSPECTOR.UPON COMPLETION OF THE WORK,I SHALL SUBMIT A F 4 ' THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT F big 9°ti MELCHIONDA cGn ` o PLUMBING -i SIGNATU 9 No.34857 O � A9 FC/STEP Q \\\\ PRt� E j� r Cic;•• �► . y SUBSCRIBED AND SWORM TO BEFORE ME THIS 28th Y 2004 ;�� `A�ld'• �� • o p. NOTARY PUBLIC MY COMMISSION EXPIRES-5/18/08 • • �;, 1CtIU5 �� 'rj'�jgllll 1 \\\ OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: Lucent Technologies Merrimac Valley Works—Phase II PROJECTLOCATION: 1600 Osgood St,N.Andover,MA NAME OF BUILDING:Building 20,30&70 NATURE OF PROJECT: Renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE,I, Thomas M.Wisnaskas REGISTRATION NO 41859. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL•X FIRE PROTECTION ELECTRICAL OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I,OR MY AUTHORIZD REPRESENTATIVE SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHAL RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 ASN OF 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which § �#+ �A5 by the contractor in accordance with the requirements of the construction documents. ���` SKAS rJt_cHArvicnt_ - 2. Review and approval of the quality control procedures for all code-required controlled materials. W.41859 3. Be present at intervals appropriate to the stage of construction to become,generally familiar wit Or 9 and quality of the work and to determine,in general,if the work is being performed in a manner consisten /S T EeG\�F�c� construction documents. U. PURSUANT TO SECTION 116.2 .2 I,OR MY AUTHORIZD REPRESENTATIVE SHALL SUBMIT WEEKLY,A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR.UPON COMPLETION OF THE WORK,I,OR MY AUTHORIZD REPRESENTATIVE SHALL SUBMITk FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND RE DINESS OF THE PROJEC OR OCCUPANCY. xRR4l�EAft q Hifi SIGNATURE `��G a�oOW4`���9 ' o' `�� SUBSCRIBED AND SWORM TO BEFORE ME THIS 28th DAY OF JANUARY,2004 '" L NOTARY PUBLIC MY COMMISSION EXPIRES-5/18/08 yO�S..cHU�.•�G Tq RY /Omill111 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT 1.vC.E 1 c an�o�o�r s_Luc PHONE g79- 9S5;2- 7?ez LOCATION: Assessor's Map NumberPARCEL SUBDIVISION. CCRL442#40��L4e6C/�/2/L.S LOT(S)—__-- STREET L)_— 5ST. NUMBER /6,00 dV ************************************OFFICIAL USE ONLY******* ************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED --- —_— DATE REJECTED_ --__----__— COMMENTS--- ------------------------- TOWN PLANNER DATE APPROVED DATE REJECTED — COMMENTS__N/ FOOD INSPECTOR-HEALTH DATE APPROVED 'v 1,4 DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS---Y1/�------ /1/�1l_ 1_�1_� v�0,A_ FWC1 7-1,5S /�,1,4s25 i l 1N�ltL rY_A10 q72,, :5 1n1 PUBLIC WORKS-SEWERMATER CONN ECTIONS__WI�__-� DRIVE AY P RMIT- --- FIRE DEPARTMENT_ RECEIVED BY BUILDING INSPECTOR--__ ----DATE- Revised 9197 jm GroupWise Read Mail Message Menu Page I of 2 Close Previous Next Move Delete Forward Info -__j Mail Message From: Stan Swerchesky To: PERINI CORPORATION:[ozzyproperties.com]:ekeller Subject: RE: Phase II Plans Message: To All, The Lucent construction team met this afternoon at our normally scheduled construction meeting. This was the best forum to have all our players together. We have reviewed your Teams comments and offer the following: 1. The area around the central elevator and stairway is and remains a common space. Keys to the doors to the north (landlord area)will be given over to Ozzy Properties. All access to Lucent space will be via card access. The area is being worked to present a new and improved immage to Lucent's main reception area. 2. Lucent has not agreed that all walls will go to the deck. In view of the Code Review conducted by the Team's Architect & Engineers, it has been Lucent's position all along that full demising walls are not required by Mass Building Code nor by Lucent's underwritters. With regards to the office space in Building 20,third floor, this was reinforced by the representative from the State Fire Marshall's Office at our round table meeting in January. The only condition that would change this would be a "Change in Use" by future occupants of the abutting area. Difference of opinion in this matter appears to be between Lucent and Ozzy Properties and should not be a matter that would affect the issue of the Phase 2 building permit. However, resolution is needed before construction proceeds too far down stream. 3. Lucent and Perini have a "discovery - remediation" proceedure in place. All Asbestos remediation has been and will continue to be performed by qualified, licensed abaters. 4. The Fire Department has reviewed the Phase 2 drawings and signed off for issue of the building permit. (Please reference responce to item 2).For your information, our team will revisit this issue relative to your consern. 5. Be advised that AHU 7 supplies HVAC to both Lucent space and landlord space, but to perimeter areas only. AHU 8 supplies HVAC to both Lucent space and landlord space, but only for the interior spaces. This allows heating to the outter areas while supplying cooling to the inner area on demand. It is not condusive to seperate these functions without a total rebuild of these systems. Be advised that our design does not alter AHU 7, only AHU 8. 6. The added unit reports alarm status to the Andover System. Otherwise it is a stand alone controled unit. Our team will review monitoring for power via the Andover system. 7. With regards to the AC unit at 30-2, Y5, you are correct. We appologise for the oversight and any inconvenience and we will solicit proper authorization in the future. In view of the aforementioned, it is our opinion that no issues are related to the Mass Building Code, therefore, we request that authorization for issue of a building permit be granted. Be advised that the Building Commissioner is on vacation after February 27, 2004. If the permit is not issued by this time our schedule will suffer greatly. Thank you for your consideration in these matters. Stan Swerchesky <<< "Ellen J Keller" <ekeller@ozzyproperties.com> 2/26 10:40a >>> All, https://webmall.corp.perini.com/cgi-bin/GW5/GW WEB.EXE?MSG-ACTION=READ-ID&MSG-DRN=... 2/27/2004 Message Page I of 2 Nicetta, Robert From: Ellen J Keller[ekeller@ozzyproperties.com] Sent: Thursday, February 26,2004 9:36 AM To: micetta@townofnorthandover.com Subject: FW: Phase II Plans LQ ram iaa4ari PHAn A K aHar lin I'ai . _, rX C..a..a_ V r -t.ui i i i a �.ia� ncal ��ua►c r z7zy YPop-0.1TfAC if� ViL� � �vYii�Lt�ir.7. ■Ing 4• i 1—h inrigaom vnrk n..,�..,.� RAA n4o4n niluvvci. mn vwiv onone:i978i 475-4569 mob!!e•(075)123-1319 -----Original Message----- From: Ellen 9 Keller[maiito:ellenjk@comcast.net] Sent:Tuesday, February 24, 2004 8:39 PM To: 'sswerchesky@perini.com' Cc: 'Power, Mark (Mark)'; 'jgoldstein@ozzyproperties.com'; 'Bartley, Robert F (Robert)**CTR**' Subject: Phase II Plans Stan, I received your voicemail regarding the approvals for the Phase 11 plans. I have reviewed the documents with our team and we are prepared to send a letter to the North Andover Building Commissioner stating that we approve the plans with the following comments: 1. TA1.3A; it appears that the elevator and center stairs are included in the demised premises. It has been explained to me that the heavy dotted line does not indicate a demising wall; however. This is confusing and must be clarified for the commissioner. The elevator and center stairs are to remain common to the building. 2. TA2.3B; it appears that the wall detail states that the demising walls will only go 6"above the drop ceiling. This is not acceptable. It was agreed that all demising walls must go to the deck. Demising wall details must follow the specifications in TA6.0, detail 11 or 12. 3. TA8.0; I am concerned about the Asbestos Note. It states that the contractor"may"consider soliticiting the aid of qualified asbestos remediation services. If Asbestos is to be disturbed at any point during the construction, qualified remediation must take place to ensure the health and safety of both the workmen and the employees in the area. 4. On the Sprinkler plan, has the Fire Department reviewed this section with regards to zoning isolation for the demised premises? 5. H5;The HVAC plan shows that AHU 7 and 8 are being utilized for the demised space;however, only AHU 7 is required. AHU 8 is only being used for a small portion of the premises and is an inefficient and impractical use of the mechanicals. This will only increase the operational and maintenance costs to Lucent because two AHU's will be dedicated to their space when only one may be necessary. Please see that AHU 8 is broken off so that the 2/26/04 Message Page 2 of 2 Lucent space in question is serviced exclusively by AHU 7. 6. It has come to our attention that several new AHUs are being installed in specific locations throughout the newly demised space. Lucent will be responsible for the payment of all utilities drawn to service the premises;therefore, it is critically important that all new AHUs are connected to the Andover Controls systems so that appropriate monitoring of the draw can be measured. Please see that this is done. Finally, it has come to our attention that an AC unit formerly installed in a lab on the second floor of building 30,at Y5, was removed and relocated to the tool room in building 70 to boost the AC for Lucent in that area. Although, the approval of this from the building owners was not solicited, it is our understanding that the unit was no longer necessary in the area where it was installed and therefore,we approve of its relocation to assist Lucent in its demising process. I will be forwarding a letter to the building commissioner including the above comments by the 26th as you have requested. Regards, Ellen, I V...11 r LIIGI I J 1\GIIGI i ommerriai KG7i ;:Q*oi i 77V Pri-ai-sr-':rziz la—sr- v vul lucc r al n unrinvAr hili+ 1 iii+iil photic:(979)475 44569 .ax:`j7V) 1/J'-1VJV l nouiie.1'978) 2/26/04 pf _ a � 0 5 �. G �' S � � cr�a� '� q g � 19 , GcJI �10RTIy Town of Andover 0 No. COWROL , _o dover, Mass., cAIt LAKE COCMICMEWICK ORATED P? C7 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ft BUILDING INSPECTOR THIS CERTIFIES THAT&.0--om' K. ��s.r,v�. ...�CN.I.0...... �.• Foundation has permission to erect....R.L,'1' Tt.............. buildings on .../..A. .....+ta.s��a►�....W��� Rough to be occupied as.Foil...10..Fi.#*...&Aw-. A-01 rA40 .Q .f.�. .. �,a�` ....�Q�I111t48 • Chimney provided that the person accepting this permit sha n every respect conform the terms f the appli ion 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. rp#fts :z:= PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS COMM, ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST STRCCT ul��l Rough ............ .. ............. ... ............ sm........... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Z► S `** 3 600-1 09 3 — Street No. SEE REVERSE SIDE Smoke Dec. Transmittal architecture ulterior deign planning address: 200 High Street To: Town of North Andover Date: 4/20/2004 Job No. 1784.00 Boston,MA 02110 Attn: Robert Nicetta telephone: 27 Charles St Re: Lucent Lab Renovation(N.Andover) North Andover MA 01845-0000 617.443.0668080 No. Andover,MA fax: 617.443.0689 We are sending to you 0 Attached Via US Mail www.sga-arch.com ❑ We are returning to you ❑ Under separate cover Copies Date No. Description 1 4/20/2004 Periodic field report These are transmitted as checked below: 0 For your information ❑ For review and comment As requested ❑ For approval ❑ For your records and distribution Remarks: Dear Mr.Robert Nicetta, Enclosed please find our field report for Lucent Technologies-Phase II.Thank you. RECEIVED APR 2 3 2004 BUILDING DEPT Signature: Med Manoochehri Spagnolo/Gisness&Associates cc: File Mark Power Lucent Technologies Stanley J.Swerchesky Perini Building Company,Inc. Sherry Adams,HAD Spagnolo/Gisness&Associates Bill Skelton AHA Consulting Engineers / Ref.# T-11534/ ARCHITECT'S CERTIFICATION TO ACCOMPANY PERIODIC REPORT-PHASE-II I, as the affidavit architect,hereby certify I, or my authorized representative have on the date, 03-18-04,03-25-04,04-08-04,04-15-04 made a site visit to the property located at: Lucent Technologies Building Permit#509 Interior Renovations-Phase-H (Dated: Feb 26, 2004) 1600 Osgood St. Contractor: Perini Bldg. Co., Inc. North Andover,MA and that based on my inspection the construction being carried out at the address complies to the best of my knowledge in all material respects with the plans and specifications and with the applicable provisions of the Massachusetts State Building Code, except as noted in the foregoing report. EPEfl ARC SN hips r N10. 5082 ° d BOSTON" =�• MASS. 04-20-04 Date Original Seal d S ature Cc:Lucent Technologies,Perini Bldg.Co. SPAGNOLO/GISNESS&ASSOCIATES,INC. 200 High Street Telephone Boston,MA 02110 617-443-0680 ARCHITECT'S FIELD REPORT Project: Lucent Technologies Field Report No. 4 Interior Renovations- Phase II 1600 Osgood St. N. Andover, MA Contract: Architect's Project No. 1784.00 Building Permit No. 509.00 03-18-04,03-25-04,04-08-04,04-15-04 Time: 1:00 PM-5.00 PM Present at the meeting: Stanley Swerchesky Perini Bldg. Co. Ralph Pastore Perini Bldg. Co. Med Manoochehri SG&A Sherry Adams SG&A Bill Skelton AHA Mark Power,Larry Kelly, Allan Paduchowski Lucent Technologies. WORK IN PROGRESS: 1- Demolition approx.100 % completed. 0 2- Mtl.studs approx. 100% completed. 3- Rough Electrical approx. 95% completed. Finish Elect. approx. 60% completed 4- HVAC, &Plumbing approx. 95% completed. 5- Gyp. Board approx. 100% complete. 6- Fire alarm approx. 90% completed. 7- Fire protection approx. 100% completed. 8- Misc. Metals approx. 100% completed. 9- Finishes approx. 90% completed. 10-Door&Hdw. Approx.805% completed. 11-Security approx. 50% completed. ACTION ITEMS AS REQ. 1- Misc. Shop Dwg'. 2- Additional structural review and dwgs. by Mc/Sal. COMMENTS 1- Work started &proceeding in accordance with plans on file with building inspector, quality of craftsmanship will be maintained. 2- Stan noted space is not ready for punch list yet. 3- AHA issued an SKE for additional exit lights. 4- Construction meeting minutes from Perini is attached. CC: Town of N.Andover Inspectional Services(Mr. Robert Nicetta),Lucent Technologies,Perini building Co., SG&A Files otis--F Perini Building Company Lucent Technologies Inc Merrimack Valley Works — Consolidation Meeting No 9 April 1, 2004 Attendees and Distribution Stan Swerchesky Perini 978-960-2677 sswercheskv(c)pedni.com Ralph Pastore Perini 978-960-2677 rpastore(a)perini.com Lee Donahue AHA 781-372-3037 lsd(a)aha-enaineers.com David Woolson AHA 781-372-3031 dew(a.aha-engineers.com Don Donovan Lucent 978-960-5887 dfdonovan(cD-lucent.com Mark Power LRE 978-952-7906 mpower()lucent.com Larry Kelley C& W 978-952-1480 kelleyglucent.com Med Manoochehri SIG &A 617-443-0680 med(a)sga-arch.com SherryAdams SIG &A 617-443-0680 sadams(a)sga-arch.com Mark Pouliot Lucent 978-960-6027 moouliot(EDlucent.com Mike Quinn Lucent 978-960-4225 mquinn(@lucent.co Sue O'Neil Lucent 978-960-6060 soneil(@-lucent.com • Edward Wright OZZY 978-681-5004x102 ewright(@ozzyproperties.com • Robert Bartley OZZY 978- '-- X 101 rbartleA@lozzyproperties.com Steve Shumway Lucent 978-960- sshumwav(a)lucent.com Dave Tseki Lucent 978-960- dltseki(alucent.com William Skelton AHA 781-372-3082 wvs(cDaha-engineers.com Charlie Cordoza Lucent 978-960-2672 ccardoza(a�lucent.com Allan Paduchowski Lucent 978-960-4094 paduchowskianJucent.com David Morse Lucent 978-960-3015 morse(�-)lucent.com PHASE Area D 1. Ball valves in front of backflow preventors are installed. 2. NAFD directed relocation of fire hose to the alternate hose station as extra hose only at that point. Work after Phase 11 FP complete. Scheduled for 4/13/04. 3. Punchlist in area being worked. Including forklift protection rails that need to be widened. 4. Add 2- 4 foot lengths of pipe rail at rack emergency door. Area S (North) 1. Perini to furnish a highly visible clock at North vestibule over door or nearby. AREA S (south) 1. Complete Area T Complete 1. Perini to have Misc Metals sub to relocate bracing to fence that interferes with new rack installation. 2. Remove L shaped rail at south stairway. 3. Move exit sign that has been impeded by new racks. Phone / Server Room 1. Perini to arrange training on Liebert Units for Allan Paduchowski and Mike Quinn. 2. Perini to get 18"x 18"grates installed in middle wall.(Maroney) 3. Perini indicated that BC requested certification that Elec/Mech Room does not need 1 hr rating. A/E to provide 4. Frame to be bolted to floor. Mike Quinn to provide and layout. 5. MQ will layout and requires cut outs in plywood wall. Phase II Area J 1. Storage room is complete except for hardware Unicam. 2. New card access will be installed with doors. Waiting for hardware and glass Due week. 3. Tseki / Shumway punchlist: UNICAM locks by Perini (3/28/04), Bells and whistles adjustment by Perini, Perini to add door hold—open devices in Labs 1 & 3 (total of 4). 4. Medical will move in April. This is do-able except for millwork table. A conventional table may work for move in so long as refrigerators work. Disconnect card access and install bell and blinds. Working. Also Stretcher relocation and Hospital signs need to be relocated. 5. Some pictures are required to be hung on wall. AREA E —TOOL ROOM 1. Perini requested structural review of floor slab penetrations. Also @ area K. Perini re-sent as-built. SG&A to follow up with Mac/Sal. 2. Drinking fountain to be eliminated per Al Paduchowski. 3. Add standard 2-7 x 2-7(+/--) Borrow Light to the west wall per SKA-11A (location to be determined). 4. Perini to install anchor bolts for AMADA Machine. After discussion on testing requirements, the consensus is that it is more prudent to install the concrete footing. 5. Perini to provide anchor bolt all existing equipment with drop in anchors per existing condition. 6. Tool Room personnel will provide and install lexan panels near tooling machines adjacent to SCO fence. 7. SG&A to provide sketch for additional exit signs. 8. Perini to add water supply to one machine and outlets as specified by C Cardoza. Also coordinate electrical and data with furniture partitions. AREA K (Move to start April 26, 2004) 1) Perini to walk trades through existing NPIC to review telepole and bench configurations. Perini to revisit this. 2) Perini to review existing conference room for white boards, projection screen, and millwork. Projection screen and white boards are all that will relocate ( 3) Approx 12 Montage cubicles will be erected from existing stock. Remaining stock from existing NPIC area after benches move. Start week of 4/04/04 4) Move is scheduled as follows: • Monday,4/26 M & EC's to disconnect benches equipment etc. • Tues. 4/27/04 start move and continue until 4/29/04. Subcontractors to support move. 5) One function mgr. office needs furniture for stock , other will move from NPIC. 6) Move EIS storeroom 4/01/04. Perini indicated that doors and hardware may mot be complete (incl. UNICAM lock) 7) SG&A to provide sketches for added exit signs. / AREA L 1. EC requested relocation of transformers (overhead) to floor adjacent to existing electrical panels. This was accepted by the team. 2. Shutdown of this power may effect SCO operations and need to be done via temporary feed to SCO. Perini to review. 3. Perini to price new VCT in area L. Lucent elected not to install VCT. 4. Lucent indicated that completion is now required for 4/16/04. AREA Q 1. Break areas are working. 2. Per owner directed email, EC shall wire light switching to Lucent occupied space and not common space. 3. Perini to review card access requirements with elevator service company. 4. Perini to add UNICAM lock to Mailroom door. ,5. Also M.Q.requested a 50 Amp 125 V receptacle on 20-3 Network Rm 203M col J-4 6. Perini is directed to relocate north loby door approx 16' north to Col Mo4o to include room 3X82. AREA B 1. Al Paduchowski requested that Perini set up two work stations in area B per Don Donovan sketch. Electrical engineering required for power to two benches. Pipe rail and bumper guard is also required. 2. Plumbing may be needed in this area for water supply, drain (and electrical service) for new central drinking water service. AHA to furnish sketch. 3. Customer requested low voltage lighting controls at col N40. Elec Engr. To provide sketch. Date. . MOR7M .1tia TOWNOF ORTH ANDOVER ° : p PER;T FOR PLUMBING 1 'SSACMUS� �4 This certifies that f�!.`'. . . . � • ``• •'• I has permission to perform . . . .��!!.�'�?.�.�.`' ?�'. . . . • . . . . . . . . . . . . plumbing in the buildings of . . .l. . . . . . . . . . . . . . . . . . . . . J at . . ./1.0 .C-. (�'.C,J. .` . . . . . . . . . . . . . . . . . . North-Andover, Mass. Fee. Lic. No.. .! ).`,. 0,,. . . . ^ -.� . . . PLU,kiBING INSPECTOR Check # 1 7154 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ,�y� D / Date/_Q Building Location U �T Owners Name �" `fCj'n� Permit# Amount Type of Occupancy 7 New Renovation Replacement � Plans Submitted Yes No FIXTURES z w a a W F HrAyep P 09 >+ d COO 0 -1 E~ a a a a h a 'r.51 x H SUMM BASE"M ` M Rfm M N t MILOO t 3MMOM 4IH FLffR 5M 1HI11 R 6IH FUM 7IH 110th 9M FUM (Print or type) Check one: Certificate Installing Company Name 1<6 n R.-Ur-1-0ind El Corp. Address / :5' 47 % ❑ P a Q-_ /kG'�/ 2 Business Telephone Z _ ff_Firm/Co. YName of Licensed Plumber: Insurance Coverage: Indicate th insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11 Bond Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent F1 I hereby certify that all of the details and information 1 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massac setts- to Plu de and Chapter 142 of the General Laws. By: Signauxil-FrUcensea Plumber Type ofP��lumbincense Title DZ W City/Town License Number Master ❑ Journeyman APPROVED(OFFICE USE ONLY Commonwealth of Massachuset Department of Fire Servic7s Occuralic% and Fce CheckedBOARD OF FIRE PREVENTION REGULATIONS [Ret,. 9051' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK S11 'sw-k to lie 1 t fi.rnled In acco!---kirce tile I Iccli-ic'11 lOde A ,C). i-17( \111 I 1,A) I'LL INE PTLN T IN IN K OR TYPE.ILL I.MR.11.I Tl(),\',, Date:_1-Y),pi& City or Town of: TO !hr h7S-/'eC101' 01 16"j/'C;.S. 13Y This ;Ipplicaliotl the tl lidurs l'-,lied gives notice ot,Ills or lie[- Hitclitioll t ZD () pel't')tlll 'Ile Jectrit,:;tl %Ork dexrihed licitm,. Location (Street& Number) 6' '; '- ";'k ,S'''{-. Owner or Tenant Cj 7, '4 i)r r,-e r *j ('61') telephone No. Owner's Address Is this permit in conjunction with a buildingPe 'r Yes No ❑ (Check Appropriate Box) Purpose of Building r4 , Ltility Authorization No. Existing Service AnIps i Vo is Overhead ❑ I'*ndgrd [:] No. of Meters New Service Amps Volts Overhead ❑ Undgrd F1 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 611.11, "able im.a /,c I.d;c 'I'ISpo No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans N-050—f 'Total Transformers KVA No.of Luminaire Outlets 2_ C) No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above Ei �n- I—n g No. of Emergency Light A111-J.No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS [- jBattery Units it No. of Zones 1! No. of Switches No.of Gas Burners ,No.of Detection and Total Initiating Devices No. of Ranges No.of Cond. Tons No.ofAlerting Devices No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: I I -,DetectioniAlerting Devices No. of Dishwashers Space/Area Heating KW Local[] Municipal ❑ Other Connection No. of Dryers Heating Appliances KWritv stein s: No.of Water No.of No.of No.of Devices or Equivalent Heaters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent .No. Hydromassage Bathtubs No. of Motors rotaii HP I clecommunications Wiring: No.uJI'Devives or EquiNalent OTHER: Ailn3tVd VJILIC of Electrical 'Xork: Ila hen re(tuired by municipal pchc'�.) ork to:�tart:- /\,/,- —) In pcctions to be requested in acLordafte (kith t,IEC RUIC 10, and Upon Completion.I,NSL RANC E COERACE: 1, b% the I'C LIC fol (A AUtAl'iLA ��,crk i-iw' 1'. !ht: liccilwv ide'> llroot"fli;;hilit" ill".111-:111cc illcllldill (,C)k(I-TT t;1' itS !11;it ':ch C6la-'c C ..;I it ncc. 11"d hma hihil(--d j-'rocl,11 ;Irlu t(" [11c, 11'.t.rnlll 1! .11111. .-A v,,f ve I/S ocz 3 Idress: i 3'4? '7 -,;ntl -1.01 fl 1C,11AC �-OLI Jll- liL;.Jl-A F,(ljjlI%r L tiv S Ilk ;.ill:'w 11-C that illi; 1, I t,..ILlirud hN !aw. 13)'!W I ;!Ill th,.'(-.heck(,,no W.%;10"!, .1, Owner,'A(Yent Commonwealth of Massachusetts 7�3 Department of Fire Services Occuraw, and Fce Checked BOARD OF FIRE PREVENTION REGULATIONS [Rei. 9 oil 1e lle blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK NIl .'11-k to he in JVCOI`11110�'A Al Ille I k:01-ical(_ode(\1C). V7(MR 12.0 il'LLH ISE PTl,\ N INK OR TYPE ALL 1AF0R.11.lE10.V, Date- L��, 1) . City or Town of: 6-2 � � a, ,il rollie 11-Y this ;lpphLitlon the undersi-ned giles notice ofilis o)r her intention to [NI-toll"ll ille electrical �Nork de,crihed helov, Location (street& Number) 1,0 (11 L 3 Owner or Tenant 'i ? Telephone No. f Owner's Address 'Ic /c / -1,�u _--P 1l1/4 Is this permit in conjunction with a building permit" Yes � No [] (Check Appropriate Box) Purpose of Building e� i.,,j klL-a Y-r Ltility Authorization No. Existing Service Amps Volts Overhead ❑ I1*ndgrdF_1 No. of Nicters New Service - Amps t Volts Overhead❑ UndgrdF] No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /zt, at 4— No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.ofTota Transformers KVA No.of Luminaire Outlets No.of Hot'Tubs Generators KVA No.of Luminaires Swimming Pool lkbove ❑ In- �❑ No.o[Emergency Lighting 2 Units No. of Receptacle Outlets No.of Oil BurnersFIRE ALAR N IS f No.or Zones No. of Switches No.of Gas Burners 'No.of Detection and 3 i Initiating Devices Tota No.of Ranges No.of Air Clond. Tons No. of Alerting Devices Heat Pump Number rolls I KW No. of Waste Disposers No.of Self-Contained Totals: I DetectioniAlerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal F1 Other C( nnection No. of Dryers Heating Appliances KW 1) t No. of Water No. o N o. �? No.of;evices or Equivalent Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No. 11dromlllssage Hathttibs No. of Motors Total lip I clecommunications Wiring: I OTHER: No.of Devices or Equivalent !7'JiIl1;It%:d V;IILJC L)I'E1t:ctricA `Xork: I It licii i-quired b,, HlUnk:lpal pclicr.) 1ti ork to Mart: 111Vcctions to be requested In accorclance �0h \AEC Rolle 10. 111d LIP011 C01III[)IC6011. PNSL RANCE C(A ERAC'E: dic uvoivr. no pu mit1(i' I.the I e I'cl-lo"I'lance 4 cicctical ll,(xk !m\ P.-AIC IIII.- !11(: ide" Ill.00t")r li;;Filitti ilic Illd illu! %olPk-tcd,; 'riticIl" 71 lit. !!ch C,;. in If I'm."': llihil('-d I'l-nor'A 'Iric tc 111t: r."Ilill, olticc. vo )e r:p(.1 14M NA�1 F: 031ls. ?':I. 0, ress: ICCLIIJIy ';\,'.k 11 for tPPIiCdhk: OJO Jl'- liLk:il',,L .1AVVNFR1.111 1,NSL RA\C F 'AA11"ER: I >.:r:ccIhAit, ill,111*;111021 k.,]Llirud by law. !1y n; .'!_,naturu belch. I hrr�hr ' ,live 11n: rt.qullurnnt. I rn th e n_heck r,nc�❑,:s�ncr u.r nor'r .1'_. Date. NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Low- 7s TACNUS� ,r This certifies that has permission to perform plumbing in the buildings of . . . . . . . . . . . . . at . lZ. 4,G. . .,Ks'; Ax .?. . . . . . . . . . . . . . . .. North Andover, Mass. Fee. Lic. No/ . . . � y PLUMBING INSPECTOR Check # 2/ L 68o3 I 'MASSACHUSETTS UNIFORM, APPLICATION FOR PERMIT TO ®O PLUMBING EFlnnt or Typa) bl �ha� mass. DateNne3 J t' Building Leeatienn 6 . e9— Owner'sar Type of occupcy r c vne rCP� ~� New � Renovation ❑ Fleplacemenf ❑ Plan Submitted: Yes C3 No FIXTURES PX P X }- N N y Us W W H1 Y J M Q }- N X O N a ¢ 1 y X N Q CC S N z O z X X CL = � O N W y S G ~ a W N 2 C d C d < '3 X V o � Q7 to W r t� N � c < N CC a ¢ � 16 '. W z O O 0: Q y Q y tL J z d C D .+ i W Z Q S O z S Y O ~ z Z wz W LL Y W !- U S CL F- N ,W h 0 v 2 Q O d J j Q ¢ ¢ CC AO Q P' SUS—B S MT• QBASEMENT i IST FLOOR 2)D FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6THFLOOR 7TH FLOOR STH FLOOR 1, Installing Company Name l � JATEI� . �. Check one:. Certitir_atr_ Address �w, to LOS t►AneAes cST 8Corporation ,� •E RU K MA e,�1�,.-.14-C- a ❑ Partnership Business Telephone ,q - o ❑ hrm/Co. Name of Licensed Plumber &A 91-halfl Cff A MI ff INSURANCE COVERAGE: I have a current ' Ility Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142: Yes No ❑ If you have checkedrimes, please indicate the type coverage by checking the appropriate box. A liability In 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: Owns ED Agent❑ Owner Signature of or Owner's Agent I hereby certify that all of the details and information I ha submitt for enter )in app ication are true and accurate to the best of my know4edge and that all plumbing work and installations rformed der the it' • fcr •s application will be in compliance with all pertinent provisions of the Massachusetts State Plumbi Code Chapter o neral az. � nature o Ucensed mber Title Type of License:Baster Journeyman❑ City/Tom A x� (OF IC USt PlL1) License Plumber O n brnnBINO IHBbEC1O1! O DV1E"—'""'48 bENrill OHYHIED brnnisN f OCY110N Oh 8(llt' me HVnE V lAbE OL BmrDIN0 VbbliCY110H Lou hauntl 10 DO bft1nBINC No* LEE LINYf I98bEC110N8 bllOCHE22 IN2DEC110N2 � BErOM Low OLUCE 118E OHrA "+ Date..,�.�..7.:..rJ..(5.?....... NORTN TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��SS�cMusE� This certifies that .. C!.r ...�1 � .... ! !TY . ....... has permission to perform ... ....,.�.�,l�,f,�.�..,�1.'!1/.Q,!..h..-:r.=.,.J��tr.��; ,,,,,,,,,, wiring in the building of........................ �Zy,t/ ��, ��c ................. at I�JO �S�.®976.............. T` ... ,North Andover,Mass. Fee./3P Lic.No.............. . ............ E.. C-P;KOr... / Check # 6Z 61 S� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Qf BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned Cep [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ,.Z -1-G 6 City or Town of: A_�pI I7.j Ayyfjd V" To the Inspector of Wires: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution YAC t/aig e-C 1 z GJ L1 T Y si5wr1/ L.l-f" Address /z,�4✓252/,114.i_ o/ Zn Location and Nature of Proposed Electrical Work: / ,(00 D SG��� S✓— �'�'..��Cs4L M�/.vZ�i/�s�C� 022-Y �i�ei� ai L NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ NO,— We will maintain one or more contemporaneous log(s) (check one): YES 4B-- NO ❑ This option is available where so contemplated by the municipality. In these cases,you must renew this application annually, and upon significant changes in employment. The following individual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverage,and location where it will be maintained Responsible person � >✓T TQM l/G%% LGA wr�/1` / a-nriv .✓ You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure, indicate below how the Inspector of Wires should access the log:: !q-L L SS I i�.�rye✓sIS /5 eA, 2), A411 G,'J C1 7E How many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision(see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans(see St. 1962,c. 582 §3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: _ Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person,firm, or corporation operating under c. 141§8. (Please see reverse side for certifications and required signature.) Institutional Permit Form,page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this applicatiog'. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- !, ployees in this application. i Please give your official title, such as "Director of the Physical Plant" or"Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the prem- ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board,or in contravention of the Massachusetts Electrical Code. My title is: I;1/�S/bo'At7_ My authority to act for the aforementioned institution is: A4..eK!5-l�1CL/�a�)_a Cie roye.. e- Ld d SZ ALI6 17 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. (Signature) (Dated) p (Print name) -743 (work telephone number) tension) - (facsimile number) I q /t( . Date......�..-........ ..... ........ .� t �aORTh q TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMU`�� This certifies that ............. l L .........../ (.T ........................... ................ has permission to perform T���� .......�!r l � ......... ............ ..... .... ........................... wiring in the building of........ .....� ........................................................... at.....d.G�4O..�-S f OJ ......`—.7—......................... .North Andover,Mass. Fee.................�. Lic.No.............. ...... . ELECTRICAL INSPECTOR V Check At �*7-5 6 t: .+ Commonwealth of Massachusetts I i)I PCI-11lit No. 7 2-;, Department of Fire Services Occupancy and FCC Checked I V�k, BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9 051lel,4 c blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All '.%ork to he pertlornied in accordance%%ith the\h,,,,acI1L1SCttS FICCInk:,11 Code ' (\1 5`7(AIR 121.00 X (I PLE,ISE PTLN T LN"INK OR TYPE.ILL INFOR.11,I-Flo Date: - /,ii k 1 )1) City or Town of: I\16)jr--,�/�- TO elle 117NIV0101:0/ " U-W�- By this ,ipphc�ition the undersign'ed makes nutice ot'llis or her Intention to Pffforn, the Jectrical \\ork described below. Location (Street& Number) lb 0 05 -Jez -59� Owner or Tenant 0,2,71�� Pro Ig �rl Rj to C k_) Telephone No. Owner's Address .3 0,1, A,-' Is this permit in conjunction with a building permit" Yes � No ❑ (Check Appropriate Box) Purpose of Building v " V (".7 T,/,7; Utility authorization No. Existing Service Anips Volts OverheadEl Undgrd F] No. of Meters New Service Amps Volts Overhead [:1 UndgrdF] No.of Meters Number or Feeders and Ampacity Location and Nature of Proposed Electrical Work- ,�I, -S & Ll I.Alg 4"/a L).J A?-U a j S , 6 ►rq,L //It ah/e Inca.he IIIIAL11 i'l;the 1,W 01 11"1, No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.or Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimminj! Pool :above ci 1,No.of Emergency Lighting Batter Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.ofZones No. of Switches '40.of Gas Burners No.of Detection and 3 Total I Initiating Devices No.of Ranges No.of Air Cond. Tons :No.of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KI No of Self-Contained Totals: Devices No. of Dishwashers Space/Area Heating KW LocalEl "1"nicipp 1 ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No.of Water No. of No.of No.of 61'evices or Equivalent Heaters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent No. Hydromassage Bathtubs No.of.Motors Total tip (Z-1ecommunications Wiring: No.ol'Devices or Equiv ale"t OTHER: F.,1tin-fattA Value of Electrical Work: i\,k licii required by municipal poli 1k o rk to Shut: Inspections to be rcqL1eStCLI in accordance v�ith \IEC RUIC 10, and Upon completion. INSURANCE COVERAGE: L mess vyaivrd by the owner. no purnflt fur the performance Of CIWI-iLA vvork ma) ['.:,-,Lie L1111k flit: licensee rrcides proof ofli�lbiliN insurincc includim-,",.,i)iiiplctcdoper:itioii'*covei-,i,leol-its ',I.lb,,Ialitiul ,.:LltliN,;ilviit. 1111, ;11dVrJ--1lCd ccrtific,, that :(Ik:ll cm��I-,we 1:. In lurcc. :111d has.' llihitcd proof(1 :;arlc to HIC P(A-1111( is Alill'.% 01fiCV. El 1 )IIT.R aider he pe.,al lit'sP(!1'jlll_t', ;rf,ll elle,,*it,ti)i-,)ijit,")11,;,,I,flis Ipplicathol liwe-r,d VM F: C- ,-I-ictilsee: -S Dc, C. 3u.s. TO. N o.:--. Address: ? cj-4 o.: tiCCLII-ity COnti-ilCtOl-t,iCUf!;L: 1-CLIL111-cd fur this%vurk; iCapplicabic, lite, Lill: 11C1,11C 111,1111bcr Ilcru:�� :X�1 OWNER'S INSURANCE -vNAIVER: I ;fill ;i\vtre that the nol hcv,,the liabihty instirmcC "I's-11C icquired by law. By ill) -'gnaturu bclotiy, I hci-J-, vraive [Ili:; I-CCILlil-t-11101t. I ;fill the(Jit:ck onc)FT)Mlur Owner/AcFent 11T GWJ�'.- 1i Date "........ . .°............. f NORTH ° , 3: •�``°->'.�."�a� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �SSgCMUS� This certifies that 1� - c has permission to perform` .......................................................... wiring in the building of —< 1 ,_ � �...........- -......... ................................................. ....... . :: , ,North Andover,Mass. Fed °............. Lic.No.............. .. .. ..tiLcu, ................ ELEGTRIc_AL INsgEftR Check # �.3�✓r- 6T.I-) xU Wii7+i ilr �1 � �� `1ai�iit� ��SYE�1•—+'rI ..fir Z®G � -moi` 'a9 mit Dior"' S ta�w- Apr U1 05 04:05p NORTH ANDOVER 9786889542 p. l s ( ammonmealth of ///oe�achrr .tL+ VruL:ap Vbc_UPI$ Permit No. w ..Utprtrtrrun�o��in�irvrttr! _ psi Perttsit Fee Assigned a BOARD OFFIFIREPREVENTION REGULATIONS Rev. 11/99) Ica-eblank BOARD APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY !his !',trm is for use by institutions employing licensed electricians and others for which notice df electrical installations to the ,nurnc:pal irspcctor of Wires is rcquircd for work on llu premises of the institution. If you are not an employing utstitution tete,.. a rte C. l d 1 §S of the Massachuscus Gcncral Laws,stop here. You cannot use this form. Use lite standard Corm only. i'',t- 4S(* PRINT IN hVJi OR TYPEALL INFORMATION) Date: 6 310 Cih• oi.Totvn of: � �a 1911a6Wa To the Lrspector of Wires::s; h,s pphtation lac undecsigncd gtYcs rmtiee of the on-premises perfonuar,ec of eleettical tvurk by tmployees. tustitulign 1�..LLG.EaC�Z..� i.oi3t-1un and Nature of Proposed Electrical Work: tgGT i a.y i¢i.��T�A/i4iVC�; WO C. tai§31-of the Massachusetts General Laws obliges those who perforrh electrical installations to give notice of. a�rrrc to the nxnticipal Inspector of Wires. You may do so by filing this form port each such occasion,or if so contem- ;;;aced in an annual permit fee schedule set by the+municipality you may maintain a contemporaneous log of such work. Which shall be c:eltibited to the inspector of Wires during normal business hodrs without advance notice. Some municipali t ties may sc,nominal fees foraruival permits and require individual permits for work above a stated magnitude. :vc `rte tl:ts form on each such occasion(check one): YES ❑ NO Drill rsin!ain Due or more contemporaneous log(s) (check one): YES NO ❑ gpiton is available where so contemplated by the n+unicipality. In these cases,you must re,tew this application annually stamficant chartges in employment. trdividual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the log(s)will be . :d s indicated below The coverage in any individual lot must be for contiguous property except by arrangement with t, •,rs!x,:tor uC tivires. Arrach supplementary sheers iiregpfred for•additional to tocatia t.rp covcraae�and locatiot++vlrerc it will be maintained Res onsible person j 1600~co ,r� 9 d ........._.....------ w 1'_•u .^.gay maintain clic togs electronically upon agreaneat with t1,e Inspector of Wires. 11you intend to apply for such a Prot J;!t,n:&atc be!ow how the Inspector of Wires siwuld access the log: t?o.v-rt.tuy electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you emplr at r:a:r I�cil n? Ltdicate the total nuntberand also indicate the number of full-time equivalent staff that number includes: 1 uta/<!ai:r:i al cn,pluyu,cnl:^ � Tutt-lituc crluivalcul cicctrical cu+ploy+tuut: pZ l;clpers or apprentices do you employ to assist your liccnscd staff,wider theirdirect supervision(see c. 141 §S)•? :his number must not exceed the ratio of one licensed individual to one unlice,ssed individual. Limited excePtiuns a for •:ct^r;ru(see St. 1962,c.582§3 as atncoded by St. 1979,c. 156). Indicate the total number and also indicate the it lrc jr full-tun: cquivalcul staff that num[xr utcludes: i ::� ctcc!rical entplo�stent: T Full-time equivalent electrical employment: ` :'e,trxal %vurk for which notice to lite[„spector or Wires is required roust be performed by licensed personnel. How s:r::h;•ersons, no:required to be licensed,do you have in your employ'? Indicate the total number and also indicate lite : :u•.:tai:u:i•tinct egaiv3,cat staff dial number includes: I t;,!etcctricai e,nplovntent. _ O� Full-rinse equivalent electrical ernploynrenl:f :r.nrnurrs m'e dejb:edfor Ila es;e y"Tr).res as It'Tperson,fins,or crsrpoi-adorn oper'nrirrg Under C. 1410- (Please 410,(Please see reverse side for certifications and required sigoatm fff"byze-11-cw:IOmm" -a s:__r.� 3- Apr 01 05 04:05p NORTH ANDOVER 97B6889542 p. l "�"• (,Om/rWAWlQfth O f �rloelachw.tts VulLiaD `vase Vnly >» „(Jeprtrinurtl 01 Jiro sf,dius Permit No. Permit Fee Assigned a 130ARD OF FIRE PREVENTION REGULATIONS Rev. i t/99 may`_ ) (Icave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK' FOR INSTITUTIONAL* USE ONLY !h;5 !*,,rm is for use by institutions empluying Licensed electricians and others for which notice df electrical installations to the ctu:uc:pal inspector of wires is rcqui►cd for work on the premises of the institution. if you arc not an employing institution tu..1,t w C. 1 J 1 kS of the hlassachuserts Gcneral Laws,stop here. You cannot use this form. Use the standard form only. FLS r,S1: PRItVT IN&K OR TYPEALL INFORMATION) Date: (-ith- or Totsn of; �� T� /¢it/�oy/E+t_ To the Inrpeelor•of Wires_ !, k,.; ation IEnc undersigned gtvcsyynotice of the on-premises performance of electrical work by employees. lucti+utio,+ 1ltGEGC� �•h�l✓a10/mit: i.ocw nn atw>arure of Proposed Electrical Work: N 'st:: C. 143 §3L of the Massaehuselts General Laws obliges those who perform electrical installations to give notice of s„rtc to the municipal Inspector of Wires. You may do so by filing this form:upo l each such occasion,or if so content- 1 ;,ta?ed in an ar:nual permit fee schedule set by the+municipality you may maintain A contemporaneous log of such work, t which shall be exhibited 10 the inspector of Wires during normal business hours without advamco notice. Some municipali- ties rna set nominal fees foratutual permits and require individual permits for work above a stated magnitude. 'Nc %Vill'dt etas fomt on each such occasion(check one): YES ❑ NO LST .:ill^au+!ain out or more contemporaneous log(s) (check one): YES NO ❑ opliun is available where so contemplated by the municipality. In these cases,you must renewthis application annuall} �n<,tgm+f+cant c}nar,Scs in employment mdiyidual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the logs)will be ;,:-t rd s i,xJicatrd be?acv. The coverage in any individual Joe must be for contiguous property except by arrangement with -kw ....,,)pmol of Wires. Arroclt supplementary sheets if required for additional 10 10-6001s. i.op covrraze`ud localioo where it will be maintained Responsible person j /boo Cv 977 d A t• ? v/ 4 y^u nr y maintain the logs electronically upon agreement►with the Inspector of Wires. if you intend to apply for such a Prot do!".11:4hcalc below how the Inspector of Wires should access tine log: He electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you empl: Indicate[fie 101.31 number and also indicate the number of full-time equivalent staff that number includes: I,,;al cl.cu it l entplvyu+enl: ^ hull-tin+e e+ptivale►tl electrical en+ploytnnenC a {tr.•• ;:+,:.t tapers or apprentices do you employ to assist your licensed staff,tttxier their direct supervision(see e. 141 §S)•? ;i„s nt11Ut)L'f nrssl mut exceed the ratio of one licensed individual toone uulieensed individual. Limited exceptiuns a ra; for �rt�rarts(see St. 1962,c.58Z 33 as ametxled by St. 1979,c. 156). Indicate the total number and also indicate the nut hc. of('nll-t!ntc equivaleut staff that numtxr includes: .;:,;,•,c.!rkal cn+Plo)_tient: TL Full-time equivalcut electrical employment: _ ccurl:for which notice to the I++speclor of Wires is required must be performed by licensed personnel, How r: 1111!.!]`h t•ersotls, no:required lobe licensed,do you have in your employ'? Indicate the total nurnber and also indicate the t� ;u:i•Eimt cyttic'alcnt staff flat number inclutics: t,t:,i etectr lest crr,plu}'nnent cull-tine:equivalent electrical entptoyntottt:r ,•^;!r/rrr;y»r Rt'n rleJil:2t1/itr these yurpuses Q.c roti•person,Jit•nt,or cotpartiou ope+•nrin3 urtdrr C. 141§8. (Please see reverse side for certifications and required sipnalut Date..... .. .............. NOR711 °f, °:•�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��SS�cMusE�.h iyf! L C zG�-c' Thiscertifies that ....................................4- ............ ..................................... T4wA q-7- T✓� has permission to perform ................... ...................................................... wiring in the building of.............�M.�.................................................... at../AA2...©.S�oO C)........... .T..................,North Andover,Mass. s - Fee..�Z............. Lic.No..�b...... �............... .............,.................aY w Check # EdECTTtICAL INSPECTOR // L7�r� t� GJoCommonwealth of Massachusett .111it No -7 7 Department of Fire Servic:, �s 5 OCCLIpanc% and Fce Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9 05] e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ml to be I-Crt,01.11led in JCCORIMICe t011 the \l:l',M%:llLlSCttS HC06C,d CO&I\1 527(AIR 12.00 I'L E.ISE PRL%T 1A [NK OR TYPE.I L L 1ATOR.1 1.1 TIOX,, Date:L9'1Y1!f1,0c City or Town of: ,Ivi-rA To the Inspector of Ill"ires: 13Y this application the tllldcl-signedgi�es notice of Ills of Ilei- intentioll to Pel'fol-ili the Jecti-ical %Noi-k deSci-ihed below. Location(Street& Number) tie) 0 Owner or Tenant 0-7-,-Z, vOr& r Telephone No. Owner's Address jO /C 4 4Lor, Is this permit in conjunction with a building perm Yes No ❑ (Check Appropriate Box) Purpose of Building 0 A-&, 1_-c. r_c Litility Authorization No. Existing Service Anips Vo is OverheadEl UndgirdE] No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: il,g able Inca he dic hisla'.t'w f)/ lf', No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 2_0 No.of Hot Tubs Generators KVA No.of Luminaires ❑Swimming Pool F-1 No.of-Emergency Lighting gi ljBllits- No. of Receptacle Outlets No.of Oil Burners FIREALARMS jNo.ofZones No. of Switches No.of Gas Burners No.of Detection and No.of Ranges Total Initiating Devices No. of Air Cond. Tons i;No.of Alerting Devices Heat Pump lNumher jTonq I W"'No.ofSelf-Contained No. of Waste Disposers Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local MunacrOther ,.---.,Connection No. of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of 6-evices or Equivalent "caters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent--.-- No. Hydromassage Bathtubs No. of Motors Total HP 'I elecommunications Wiring: I No.of Devices or EquiNalent OTHER: F.,,tiniatkA Viluc of Electrical Work: (A lie"required by municipal pulicy.) oi,k to Start:_ &1, c,j Inspections to be requested in accordance with \IEC RUIC 10, and Upon C01111PICtiOn. INSLRANCE CON ERAG'E: t.,illess waited by the owner. no pci-mit ['01.the PCI-601-111MICC Of CIC06CA Mol-k 111a) ['!-,Lie (.111j," the liCell.;ft 111-00f Of hilbilit" illS[ll_al1CC illCll.lLlill2 _,0lnPlV!eLI operation"covei,,rje or its 11'. CCIJIrIC', tll;lt'LICII C0 %i_1l'Zl11,C i:. Ill 1ut'Cc, :111,.l h;lN e llil)it(,'Ll 1'1'()Ot to ill f .-erf0l, n1der the 8U1dR)L',-h.N`P'e'S J1'perjllql, 'i W lie .n11 is NA'NI E: 1�--4? c4il7 0.: -icellsee: i N V I.., M/I SOL ", 3os. TO. Address: 3 a?6 _7 't :SCUll-ity SY-AC111 Contrao:toi- Uccr'1'Jl'Q+llNj tor this %,vL,rk, ll'itpPliLdb1c, 01M LIX IiCtAISC 111.1nibcr 11C N:1-le " r.)WNER'S INSL'R,kNC E 'AAIVER: I ;u-nmy;ll-C that 1111C 11, 1/76vc [lie liabilit" iflsll,;1110e 21,T'V 11CII'lizilk, 1(:quired by law. By nik bclot,r. I lIkILH, tllis, 1-CL11,11irtmi(mt, I ;im the(dwck ono Owner''Agent Date........?".... ....D� � �aOR7M TOWN OF NORTH ANDOVER � : P PERMIT FOR WIRING SS,4 US This certifies that ...............P/'4 G.. .......................................................... ....................................... has permission to perform ..........� f. ...... '.i!/P ..... ..................................... ^�- , �D wiring in the building of �i� �. .. .................:. �-.. P� at(110........r .....5.... ............................... .North Andover,Mass. 1 Fee.!Z:'S.:l. Lic.No...�.�:4.6�.� A .... ........... -. ,`.,f/�EL1CAL INSPECTO�V �jCheck # Lf7� 075 , Commonwealth of Massachusetts Department of Fire Services ri Ckcuranc� ind Fee h"kQd BOARD OF FIRE PREVENTION REGULATIONS ,3�Q I-A-xik) APPLICATION F-OR PERMIT TO PERFORM ELECTRICAL WORK ' PccAI EIL 1 1 2. I) PLL r i.\ i.\k (,,R TYPE.ILL 1AFOR.It I TRAII Date: 16 Cih- or Town of: A WOO o-a ro !hu lly this the linders I zlied Locatiou istrcet Sc Number) TCIilk,ilcQ ot his or her Intuition to rel tol,111 d1v k:Ltrik:;iI %ork de,,crihed hChm. S" j _q Owner or Tenant it 7 fe - 2- v rclephoiie No. ... Ovvner's Address Is this permit in conjunction with a building permit? Yes �NOO�(C�heck A�ppropr�iate &�x) Purpose of Building - Ltility Authorization No. Existing Service _ knips i volts Overhead 0, Lndgrd❑ No. of Meters New Service d9 d %mps /,AV 07(jL volts OverheadE] Undgrd ❑ No. of Meters Number of Fecders and Ampacity - rq 6C) 4 A4 Location and Nature of Proposed'Electrical Work:: - C111.li,i,n; No.of Recessed Luminaires No.of Ceil.-,Susp.(Paddle)Fans No o Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KV,k No. of Ltiminair-es Swimming Pool above Tn-, 0-1) mergency Lighting ;,,rod. No.of Receptacle Outletso.oBurners J Nf Oil FIRE ALARNIS [No. of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. Total Initiating Devices ----T Tolls No.of Alerting Devices HeatPumpNo. of Waste Disposers Pump Number Yo - us KVV�No,O[Self-Contained I- Totals:I I DetectionAxlerting Devices No. of Dishwashers Spacli Heating KW Local Nfullicip Conflectil F-1on Other No. of Dry ers Heating Appliances KWSecuritv Systems:* No. of Walter P --- ---------------No'�')' No.of Devices or Equivalent Heaters W 'NTo*o F Data Wiring: Heaters Ballasts No.of Devices or Equivalent :No. Hydromassage 13atht0s; 1 No. of Motors Total tip felecommunications �Viring: OTHER: 16alent I-,tiin:tt,:d N,',,Iuc F1t:ctI-icjI %V rk: ,1�ileo rrylrirc!Ly !mIrlicipal t)i k to ',tart: FcCtiolls to be rQcjuQ�tcd in ac:(xdance ,pith EIEC Rule j U. ,Ind tipj)II completion. 'R I.L1 I'% ih: Ix,ilut tur ilic :1,:Ctrical ��;rk nal i uc S(-I'-li�N E I liCUf151'1L • iriclflklill,1. T'; A 9 '4 1dr(.,ss: t,A A, h,c IiCLILC I%CC: A N it R'-S I\S1 14, if F 1A a%v. 2�, 0"at s c w R Date.... ')�.-{��............. 3 NOR7►, e`"-:' 4L TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMUSE� Thiscertifies that ...................... ..................... ............................................ has permission to perform' ' . wiring in the building of ....... ................... at/fn« � ........ North/Andover,Mass. ........:............... Fee4��........... Lic.No Jr�.a��' ... .. . . ..... R G ELECTRICAL INS. •� Check # /Q •� '7 � � I \ -----_-_- ----*--- (H Commonwealth of Massachusetts 112 Department of Fire Services PCI-1111t No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9051 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK '\It .,ork to he Performed in accor&llice�\illl the-\h-_,SadIUSCIIS Hcctric,d Code(\IFC). 527(AIR 12.0 I'L E.ISE PRI,\r/.�, INK OR TYPE.I LL L\FORI I I TIoN) Date:—6 hZ15 4 City or Town of: A/, & <a, To 11le hispeL"lor ol lkircs.- 13V 111is ;lpplication the undersigned gives notice of his or her in ention to pertbrill the electrical work described below. Location(Street& Number) Owner or Tenant o d-,;h-e j Tele me No. Owner's Address -3 Is this permit in conjunction with a building permit? Yes � No ❑ (CheckAppropriate Box) Purpose of Building ee_h" of A-111-4- Utility authorization No. Existing Service Amps Volts Overhead F-1 UndgrdF_1 No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1��ki _e 1 Al CA 11,111,1I,"V l/Whispo b,l*01 It No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers K$VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Swimming Pool .0ove ❑ In r-] No.of Emergency Lighting P� No.of Luminaires !Z o grFid. ❑ Ba t tc_lry U li.;ts No.of Receptacle Outlets 5-7-) No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches Ir No.of Gas Burners No.of Detection and Initiating Devices Total No.of Ranges No.of,lir Tons ir Cond. i,No.of Alerting Devices 7 No.of Waste Disposers Heat Pump Numb rolls KW 1 No.of Self-Contained Totals:I !�L I ---,,Detection/alerting Devices No.of Dishwashers Space/Area Heating KW LocaIF2j Municipal F-1 Other Connection No.of Dryers "eating Appliances KW Security Svstems:* No.of Devices or Equivalent No.of Water No. of No.of Heaters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total 1-113 1 elecomimunications Wiring: No.ol'Devices or Equk alert OTHER: lilt F.,..tiinatvd Viluc of Electrical Work: I k�hen required by municipal policy.) \k ork to Start: liv,pcctions to be requested in accordance with \IEC RUIC 10, and LIP0111 C0111PIC6011. INSLRANCE CO),ERACE: t,ilIvss waivt:d by the uwncr. It)pt:,.Illit for the 1%ribrinaricc of cjectrjajj work ma) i-Ale 1.1111c, lilt: licellset: ploy ides proof'of liabilit', ill'All'a11C(: illCIUdilW'"'20171PICtCLI tiperition"k;overa,!e or its (Aldur-J, nol certiric" that,:lith i: in lt.rcc. :!nkl has U-1lihitcd proof(A g,Irlc tc the rurillit i. ..uln" office. 1--': 1 X"),I R.\X C I.*, '41-AM2 13 1 iader till'pev"ns..,nd pejIll:jI, '.'Nil .,/I.11is 11"p1icalinel ple! 11,11011 NAME: C ce 11 see: 3ii.q. Tel. No.: Address: ell Alt. T(-,I. No.:. `Security S1,AClll ContraLtor 1,iCt:rl';C I-CLILIli-ci fOl-this 1.v(,rk; lfiLPPIiCdb1C, ClItCl 11c IjCL:11se 111.11111)VI-Ikrc: `7'7;L� ;AVNER'S INSURANCE NNAIVER: I that Olt-, n-1 havc the liability ill'A1r;l11C,_' iuquircd by law. By my 1110-LI-), %VaJVC[Ili:, rk:LIUil'L:jjl(.jlt. 1 :1111 the(Llieck onc)0 ov iivr El (_M;%X":, Owner'Agent ® � J`��`�'" � �J �� �- 2`�? -4 6 Q� � ., F ' Date...... :....i�`7.-06... 1 NORTH °�< ;•'"° TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING SACMUS� This certifies that ............ ....jam(._�•.,........ ..` '............................... has permission to perform r `4j-t t 4041 got./ wiring in the building of...............� ............................................................." 11 r ,n .. at..................... ................................................. ,North Andover,Mass. T I � Fee j? ... Lic.No........ , pl�s'fRICALINSPECroic Check # �S! 6937 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. f Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: q � k y 106 City or Town of: �1 0(-* 4MA aV o f To theInspec or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) l bw ns4ocA Si . 6j•kA% N * 2-0 1FL06r Owner or Tenant 1 6W 0§5004 St. C ©Z_ Pry iVeS Telephone No 9111b_ -15-`isk'f Owner's Address 3 VQNaeC NA-K Awf? 1 414 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �y���aNS 2.r!? 2.r4 1PL brL W6 q_A,\ 14r-„1`U CLV t IrMt r©o k , Go'�xo� An ey} c'�-oyt - rod 0, C0K Ja6 k h Cc Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA n No. of Luminaires do � Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets 10 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. Tonal No.of Alerting Devices No.of Waste Dis osers Heat Pump umber ons KW o. o elf-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Sec ri oyf Devic s 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 TelecommunicationsofDevicesor 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: 4 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 cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE W1 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenalties of perjury,that the information on this application is true and complete. N FIRM NAME: i L L ELeC ( L _ LIC. NO.: 034 Licensee: Yy 2qyNC W. ='1,P o e S Signature U LgAM W.,<4!A k, LIC. NO.: 65d 3A (If applicable, enter,"exe tpt"in the license number ing.) Bus.Tel. No.'9713-815-7. Address: `� r)Ne S-,� (• '�V 6 3Q�� Alt.Tel. No.: *Security System Contra for License requirA for this work; if applicable,enter the license number here: 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: $ ti Date.... . .:..1...' .. NORTI{ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ;,SSACMUSE� This certifies that ....................... .......... �:<<................................ has permission to perform ......150 ... )............................... wiring in the building of...qZ Y....P�'0 ?T 60 ........................................ ST �0....2�0 t� at. .......................... ................... North Andover,Mass. Fee-1.7-3 .�.... Lic.No.f ........... 65'v ........ .. ..!� �. ELECTRIC AL INSPECTOR y /� Check # 6935 Commonwealth of Massachusetts Official Use Only j Department of Fire Services permit No. 95 Occupancy and Fee Checked � BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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: q 1 k City or Town of: I c2:1 R•VJAOYM To the Inspector of Wires: By this application the undersigned gives notice of his or herintentionto perform the electrical work described below. Location(Street& Number) I goo ml S�- ,D cab V4 c�J 21) Owner or Tenant I boo nsqoj sf , 1-Lc. 0Z- propet:T\e S Telephone NoJ+S'Ll-15- S Lr Owner's Address 3 N t- e le Pkax NAOWLIZ' HA Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)* 06 Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Pro1posed Electrical Work: ,lac jj 2® � or SGV'�'k S2c e c co — COs e C®KPl14hCQ Completion o 'the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Luminaires So.o mergency Lighting Swimming Pool rnd. grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons K No.o elf- ontamed 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.o Water KW No.of No.of Data Wiring: t 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 e) 0 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 cov rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: %1 L-,-,- `a'% C LIC. NO.: 100 3� Licensee: )A-V"< W- SpIl e—s Signature U< V). LIC. NO.: t6SO3 (If applicable, ent r " empt"in the license number line.)A!`, Bus.Tel. NO.' 0^6�5'7a I2 Address: l lit-z> t f1CLmpAy �e S,i<m I tv I l 030-71 Alt.Tel. No.: *Security System Contractor'License required fort is work; if applicable,enter the license number here: 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. i i Date.: HORTM TOWN OF NORTH ANDOVER a PERMIT FOR PLUMBING ,SSACMUS� J This certifies that `1. r--� - . w has permission to perform . . . . . : . .. . . . .. .. . .. .. :!perform . . . . . . . . plumbing in the buildings of. :- . . . . . . . . . . . . . . . . . . . . . at . `' . .''. . �. . . . . . �. , North Andover, Mass. Fee�. �? .. Lie. No.. . J/x �. . . . A 'a ... . . . . . . . . . . . j! c PLUMBING�INSPECTOR Check # r I� 6f:s56 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date .02 - 2-7 -� Building Location Owners Name zZ (rf Permit# TypeofOccuancy Amount New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES Cr zQ cn z > cn Cr Z Cr zw w w w p z cn w z Eaw"' x A�• a Z A W w x d Q z c v 3 a ca A h a cd7 A � a � S1RBM RASEVE r IST fulm 2 1rII)H DOOR 3M FLOCIR Itm FLOCK —MH-" 6M FUXR 7M HDM 9M FLOOR (Print or type) A Check one: Certificate Installing Company Name )(Pz (�/I1 ��f �i ❑ Corp. Address Panne C),w BusmessTelephone G _ G Firm/Co. Name of Licensed Plumber: W) r4j,(�'/�,cy Insurance Coverage: Indicate the type of insurance cUverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the unde ignd,hive been made aware that the licensee of this application does not have any one of the above threeinsuran�C Signature �;v'� / 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 installati ed under�Permit Issued for this application will be in compliance with all pertinent provisions of the Massa etts St5F, d�and Chapter 142 of the General Laws. By: 7ignarure o kens - um er Ty e of Plumbing License Title y So �f �d , Cit /Town icense um er'��7 Master ❑ Journeyman APPROVED(OFFICE USE ONLY Date..... .......................... NORTI� °`��``°;•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUSE� This certifies that ..........lA" `. �- lT� ©14i L has permission to perform ...........................I..........�ii.L............................ Q 4 wiring in the building of...A A.U. L.................................... ..©ZZ.Y, �� ©s�. a�b . �-�7 at........................ ... ......................03.............. .... ,North Andover,Mass. o Fee. .�"�.......... Lic.No....i .'� .............. . .............. ,...... ELECTRICAL INSPECCOI� Check # ---�— 6 Mj Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. k2!2 Occupancy and Fee Checked. _? BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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: >S " �8 6 City or Town of: Noo,VA ANAW M To the Inspector of Wires: By this application the undersigned gives notice of hN�, her intention to perform the electrical work described below. Location(Street&Number) �otA.�' i 03804 ab )VIA FLapf� Owner or Tenant htenq O'f fi ce Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)#9� Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity x Location and Nature of Proposed Electrical Work: (I�`a;►,i 2—G)J 2 c,� FLo.,4 Det f B h Si ekec(nicz( J 1reJcc0!A 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 TotalTransformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o mergency ig mg No.of Luminaires Swimming Pool rnd. grnd. Batterx 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 InitiatingDevices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pum Number Tons K No.o elf- ontamed 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 TelecommunicationsWiring: No.of Devices or E uivalent OTHER: v Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of El ctrical Work: (When required by municipal policy.) Work to Start: $ 016 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 cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under thq pains and penalties of perjury,that the information on this application is true and complete. FIRM NAM`'E: FA ( r` !—Leetz(C '1 N( LIC. NO.: S(�3 � Licensee: JJ aq W( W-SRi re S- Signature 4MV(L U). S� LIC. NO.:)(o 03 (If applicabl t empt"in th license un ber line. { Bus.Tel. NO.0 761, .77X� Address: f ('q��/ < V[ J�� j r © 7� Alt.Tel. No.: *Security System Contracto License required for this work; if applicable,enter the license number here: 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. r 0/7r r Date .................. ...... 40RTOI TOWN OF NORTH ANDOVER 0 0 PERMIT FOR WIRING o US This certifies that . 1-�L.............................. .................. .. c, has permission to perform ........................................... ... ..... ...... wiring in the building of....I.. ......................... at .......I/... ...... . ...........�.. .North Andover,Mass. L Fee ........... Lic.Nofi/..7.,-) ..... ELECTRICALINSPECTOR Check # — 70'i 1 t ` 1 Commonwealth of Massachusetts Official Use oily Department of Fire Services Permit No. -7011 I� Uul BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 11/991 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 (PLEA SE PRINT IN INK OR TYPE ALL INFORMATION) Date: 10 , iv,-o6 City or Town of: X40 "Do xy— To the Inspector of Wires: By this application the undersigned gives nonce of his or her intention to perform the electrical work described below. Location (Street& Number) 110M 0 "my "-,;Fr� Owner or Tenant t f) Pt10IY�-Z—,T F Telephone No. Owner's Address 1 606 0sc-av Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building Ak�&. Utility Authorization No. IJ & 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: l� A LC Completion of thefollowing table niay be waived by the Inspector of 61"ires. No. of Recessed Fixtures No. of Ceil.-Susp.(Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA boveIn- o. o Emergency Lighting No. of Lighting Fixtures Swimming Pool 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. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pum Number Tons KW No. oSelf-Contained P Totals 11 .. ......... .. ........... Defection/Alerting Devices No. of Dishwashers Space/Area Heatin KW Local ❑ Mun►c►pal ❑ Other g Connection No. of Dryers Heating Appliances XW ecunty ystems: rS No. of Devices or Equivalent No. o Water o. o 0 o Data Wiring: iicaters KW BA- lasts *-� Signs 1`".`o.o Devicis or"Equivalent __J Telecommunications Wiring:No. of Motors Total PNo. Hydromassage Bathtubs No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Lupectoi-of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issUc unless the licensee provides proof of liability insurance including"completed operation" coverage or its substantial equivalent. The J undersigned certifies that such cover ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [`BOND ❑ OTHER ❑ (Specify:) (Expiation Date) Estimated Value of Electrical Work: _� j�coo (When required by municipal policy.) Work to Start:' 10- `&© , Inspections to be requested in accordance with NEC Rule 10, and upon completion I certify, under th'e pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: � '►b r b eCra r° a�►v_A C i r 1 LIC. NO.: � '/3 Licensee: Rj61htyA Signature - LIC. NO.: (If applicable, enter "exempt'•in the license number line.) Bus. Tel. No.' Zkl-,.3`�1-•S 5.�,..3 Address: T(` ,SCA Ioa_lve, . ' _I�i+t' ' r1) NA 0 -U 7,� AIL. Tel. No.: OWNER'S INS UNCE WAIVER: I atn aware Lhat t1le Licensee does not have die liability insurance coverage nor►pally required by law. By my signature below, I hereby waive this requirement. lain the (check one) ❑ owner ❑ owner s a ent. Owner/Agent PERMIT FEE: 2�jr0. Telephone No. 0 Co (9 �-c R-- I /U6`e b E A 5w (-9(,7T s 6) r u Date... /�/,�. 4 .. NORTq TO N OF NORTH ANDOVER PERMIT FOR WIRING SS�cHusE� , } _ This certifies that ..,......,...... ...... .. .................. .......... . .................................. has permission to perfo .l '1: ��1.!�/°- I�� ........ /1,1'D3 !l� wiring in the building of.....:p.:,.:.......- ...:...:......................f.... ..................... J . ,North Andover,Mass. Fee fl k... Lic.No. ............. ......... !�A....( ,z%.l,;. / ... ELECTRICAL INSPECTOR Check # � 555 ,� SAP INV DOC NBR DATE REF NUMBER TEXT / P.O.NUR INV AMOUNT UE DU(N' TYPE NET INVOICE 1902057427 011.0,05 01102005 EZpay invoice 250.00 0.00 KR 250.00 t DATE 01/19/05 T01BV- ID NO. 0010181571 CHECK NO. 1000437205 Lucent Technologies CHECK AMT. $250.00 Bell Labs Innovations Messages You can now check the status of your invoices on the web. Visit http://scportal.lucent.com/invoice. Questions concerning your invoice(s) can bE directed to apus@lucent.com. Lucent is changing payrtient method of all suppliers to electronic payment . E-mail u: with subject line: Electronic Payments to apus@lucent.com with bank name, address, account #, routing/aba # (and swiftcode, if applicable) . Please include your namE and phone number. To expedite Lucent's receipt of your invoice, Lucent is requesting all suppliers begin electronic invoicing. Send contact information with subject line: EDI invoicE to apus@lucent.com. mmow.. I olpmm. Chase Manhattan Bank pslaware Check No. Payable 62 26 1201 Market Street Wilmington,DE 19801 ` 1000437205 01 1 19 1 05 311 672 (-- ID No. 0010181571 Lucent Tedtnol vies Bell Labs Innovations Cash this Check within 180 t Two Hundred And Fifty Dollars and No Cents M0..9. Dollars,;. *250. PAY TOWN. OF NORTH ANDOVER TO 400 OSGOOD ST OOF ER BUILDING DEPT / NORTH ANDOVER MA 01845 �"1'tiG 66 T01BV-SAPI-C Authorized Signa 1121i,00043720So 4030L002674 6300467217 5090 HP Fax K 1220xi Log for NORTH ANDOVER 9786889542 Jan 24 2005 12:43pm Last Transaction Dae Time Type Identification Duration Pages Resu t Jan 24 12:42pm Fax Sent 819786911730 0:53 2 OK �\ C [ ' lb Official Use Only • / ommonw¢a lh ola�dac u.�e _ S -- c� Permit No. 3 S-3 r < _ n 2eparlmenf o/ ire Service4 - Permit Fee Assigned BOARD OF FIRE PREVENTION REGULATIONS (Rev. 11/99) leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing unstitution pursuant to C. 141 §S of the Massachusetts General Laws,stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT LV 1/VK OR TYPE ALL INAFORj1•iTIO;V) Date: ////,0 O,5 � Citi• or Town of: d/ , A/► overC To the Ltspeclor of Wit-es: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution Laceofi Tec9ndc)etivs _Ne:, Address 1 0d 1!2saQ� S Location and Nature of Proposed Electrical Work: _ &,gz/7�p�Q/JG� �pl!dt /JOIE: C. 143 63L of the iVlassachusetts Ge:teral Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑k--- NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES 2" NO ❑ This option is available where so contemplated by the municipality. In these cases, you must renew this application annually. and upon significant changes in employment. The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplententmy sheets ijrequired jor additional log locations. Log coverage, and location where it will be maintained Responsible person 11a'q -A64ol'i You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce dare, indicate beiow how the inspector of Wires should access the log: How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you emplo; at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment ?/ Full-tinne equivalent electrical employment: 7i flow many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision(see c. 141 §8)? it general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap ply for veterans (see St. 1962,c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num bet-of full-time equivalent staff that number includes: Total electrical ennploynnent: Full-time equivalent electrical employment: Not all electrical work for which notice to tine Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed,do you have in your employ'? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment Full-tine equivalent electrical employment: *I nstittntions are deju:ed for these purposes as ant•person,firm, or cor-poration operating tender c. 141 §3. (Please see reverse side for certifications and required signature ��•` institutional Permit Form,page 2 NO Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. 1f, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. if the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition. provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §3 for electrical work on the prem- ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board,or in contravention of the Massachusetts Electrical Code. Nly title is:2!!& ne_ My authority to act for the aforementioned institution is: �/s'lllllR e the x / 6ev f e J �G lbOtp S r LLQ. 1 certify, under the pairs and penalties of perjm:y, that the information an this application is trite and complete. (Signature) (Dated) ! /o d5' (Print namc) ���^ PU�o1.nISLLn" (work telephone number) C);7f /0'74(extension) (facsimile number) 12e. (09/. /DI3 Page 2. 4: Miscellaneous Fees Minimum Fee Minor Repair to Wiring $20.00 Repair of Outlets 20.00 Repair to Fixtures 20.00 Heater/Boiler Wiring—Oil or Gas 20.00 Water Heater 20.00 (per unit) Washing Machine 20.00(per unit) Clothes Dryer 20.00(per unit) Dishwasher 20.00(per unit) Electric Range 20.00(per unit) Air Conditioner—Room Size 20.00(per unit) Microwave Over 20.00(per unit) Other Appliance not listed 20.00(Total) Maximum Charge for Combined Uri.ts 120.00 Pool 45.00 Alarm System—Security or Fire 45.00 each 5. Special Fees Repair and Maintenance Permit(for Condominium(s),Townhouse(s),Commercial, Industrial and Educational, up to two (2) electricians(must have Licensed Electrician on staff). $250.00 per quarter Per pair over two electricians 75.00 per quarter Log must be kept for inspection when permit is renewed each quarter,or as requested by the Electrical Inspector. b Other fees, if not listed, to be determined by the Electrical Inspector and shall not exceed$250.00 The applicable fee will double when work is performed without the proper Electrical Permit. E 00RTN TOWN OF NORTH ANDOVER 0 .4.11.4- 1 OFFICE OF p BUILDING DEPARTMENT * ,�• * 400 Osgood St North Andover, Massachusetts 01845 ISS�CHUSES D.Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 TO: Donald Belletete,Lucent FAX: 978-691-1730 DATE: January 24,2005 FROM: Jeannine—Building Department jmcevygtownofnorthandover.com TEL: 978-688-9545 FAX 978-688-9542 Copy of check in payment of quarterly maintenance fee for Electric Permitting. Date.... AO RTH 3?°..��`..;•_.."o0 TOWN OF NORTH ANDOVER ° : p PERMIT FOR WIRING ,SSACHUS� This certifies that ` 1.!� . .. ..... . . .. ..... .. . has permission to perform .. . .. . .. . .... .. . .. . ...•�. ..F• . . ............:. wiring in the building o .... ...... ........................ ... at/��R.. ... ... . . ...... ....... ....... ,North Andover,Mass. Fee��. ...A✓.. .... Lic.No.............. ......��? ELECTRICAL INSPE R Check # 5553 BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 /�...�� .... Date... 0� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4L S$A US This certifies that ......................x ................. .. . . ............................... has permission to perform ...... ... wiring in the building of... -,-H.................. ........... ......... .North Andover,Mass. -��T — ................. Fee ............ Lic.No.............. ..../-.............( v(ff i/,e�//t/ ELECTRICAL INSPECfOR Check # 15569 (fommonwea&of Vaijachuielb Official Use Only �. c� Permit No. 2 Parlmenl 015ire Serviced Permit Fee Assigned / _ BOARD OF FIRE PREVE ION REGULATIONS [Rev. 11/99] Icavc blank APPLICATION FOR P RMIT TO PERFORM ELECTRICAL WORK FO 1NST1 TUTIONAL* USE ONLY This form is for use by institutions n loying licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is reqt fired for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use this f7,o__ n. Use the standard form only. (PLE-,4SE PRINT LV INK OR TYPEALL INFORtlfATIOiV) Date: 3s- Citior Town of: AA2-a4 A1,3W£ z-- To the htspeclor of Wit-es: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution 1/060 0566D6 grrz r.0- Z Z e (/ Address /op QC) 56600 97/LE 1i 7; N. AAJA VE41. 1 0 Location and Nature of Proposed Electrical Work: dn,3 yg44Z _4QZ'!h t3 NOTE: C. 143 §31- of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for amival permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ NO [G] We will maintain one or more contemporaneous logs) (check one): YES 39 NO ❑ This option is available where so contemplated by the municipality. In these cases, you must renew this application annually. and upon significant changes in employment. The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s)will be located as indicated below. Tile coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplemenimy streets if required for additional log locations._ Log coverage, and location where it will be maintained Responsible person rA,CRLf GJ 0YLlG 00- C _ IA) 6 T You may rilaintanr the logs cIci:rJnically upon abr:.ement wtth the Inspec!or of Wires. If you intend to apply for such a prorF dare ,, indicate below how the Inspector of Wires should access the log: S M2 IL G-5 101- wl"/-lIWL E n1.> 1Dir4!1YK7Lra CMJ S1 How many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you emplo, at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical cnrployrucnt- )� Cr,,3 (SfSortFT Full-time equivalent electrical erliploynicrit: I low many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. Id 1 §8)? It general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap ply for veterans (see St. 1962,c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the nun ber of full-time equivalent staff that number includes: Total electrical employment: -0 — Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: 0 Full-time equivalent electrical employment: e *Institittions are def fined for these purposes as ant'person,firm, or corporation operating turner c. 14/§8. (Please see reverse side for certifications and required signature i Institutional Permit Form,page 2 NO Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar io institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. if the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition. provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §S for electrical work on the prem- ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board, or in contravention of the Massachusetts Electrical Code. fly title is:_T/9-0_1 Z t 77 S,S t AtrVA_ Nly authority to act for the aforcmcn/Boned institution is: MZ� ,y2j 91/ �.LfCY7L/C/f`tYt) L.i/C 1 cet•tifi•, ttirder the pains anti penalties of peijury, that the information on this application is trite and complete. (Signature) (Dated) (Print name) (work telephone number) (extension)/0 I (facsimile number) r 4 4 Date..::J.'^:.6.....o. NOR7h TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACNUSE� This certifies that ............................L�..� has permission to perform .........L �'jB/ ........4�me///'.q,7./^�� wiring in the building of.....�.�..7-.�.�`e....Av...................................... at...... t ..... r. 1 ......... .....?'0 .... ,North Andover,Mass. a v 7 Fee ' ; ......... Lic.No..39&.. .............., -.. .�................ , `�-.�... --gy�pp ELECTRICAL INSPEC& ° Check # 4772 �% Es� a DF.P RTARMOF ESAMY Permit No. . WARDOFFIREPREVFM11 NRBGULAH0NSR27C, R12U0 Z�e� Occupancy&Fees Checked APPLICATTONFORPERMIT O PERFORMELEC'TRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 — (PLEASE PRINT IN INK OR TYPE ALL INFORMATIO Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the ele trical w®rk described below. Location(Street&Number) �6 6 S[ Owner or Tenant�2 Pry i' �+ S KlCa CJ y 5 �i s �C Owner's Address 3 (9LIL '--� {�` ! c, Is this permit in conjunction with a building permit: Yes® No E] (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps �Volts OverheadM Underground M No.of Meters New Service Amps� Volts Overhead =1 Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work [ o s• �� Cp^ 47a,to No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round1:3 and No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps . Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices _ No.of Dryers Heating Devices KW Local Municipal Othe Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP L _ OTHER. Dt:5o ti -�` o,�, u G v.., 'ice w� l0 rS f _�v et/( ht.�raroeCo�raga Plasrar�dDthetegtmanaisofM�ad>usetlsGalaalLaws Ihmacu=tlimbdtybmm=lbl;CymdxirgC mplee C arils lepYlart YES NO IhaNesrbrnmedvalidproafafsam lottr.Off a YES r—M Ifycula edled®dYES,Plemnicaethetypeofwo mWby drackingthebox INSURANCE BOND O M (P1ea9eSper�y) E�i�rnDa� Estirrlaoed Vakx o(E1oMcal Wads:$ WOdctoStaft kWeclimD&Pxquesed Ralgh FxW 9Uledun&r'te1?!6of FIRMNAME c LimmNo. Lioa>see " Sigtanne LimiseNo 3�? BtlsalessTel.NO. A Ada S�ti� �_,✓ f^Cir C-� ALTUNd. GGA OWNEcsU4SURANCEWAMIE ;IamavmedattheLi=wdoesmthmtheinsxlo am aForAsmboMequi I31asm#iedbyMasmcfi>se CnaalLaws ,t arddun ysigratiueandlispwritapplicab'mwa*mdnrecltmarter:t V (Please check one) Owner 1:3 Agent Telephone No. PERMIT FEE$ signature of Owner or Agent 6084 Date.... ........ ................ ,�ORT11 °`<� `°;•�"� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ,SSACHus�� This certifies that ........:.:��'��...�... .............. ...... .................................. has permission to perform ............................f ' ..... ...:.................................... wiring in the building of... .�f --S ....�-... .................................................... .f at.l�.6 . ................North Andover,Mass. . .....-�. .G.................................... A Fee* Q............. Lic.No. ............. ........... !..........:.:... ...0......... ELECTRICAL INSPEC�'OR v�/ Check # 00/'0 � f � 1' rn ens kA—�-�3- --i bs_`i•L-- --Y 'T�-i�PYIY-iii=--_ - - - _ — Rpr 01 05 04:05p (NORTH ANDOVER 9786889542 p. l i ✓ ' �-� tro,nov.uuaaUlt of !//eeleaelwer:lG vrn�unvx�Gruy cc•� n�s Permit No. 6 6 p y 1lrinarinarnl o��iH Jirolc�e � U-I� Permit Fee Assigned 8 BOARD OF FiRE PREVENTION REGULATI S Rn,. 11199] kaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL` USE ONLY 1-his form is for use by institutions employing licensed electricians and others for which notice df electrical insmilatious to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not art employing institution pursuant to C. 141 §3 of dic blassachusetts Gencral Laws„slop lure. You cannot use this form. Use the standard corm only. (PLEASE PRINT 1N INK OR TLL INlORd1ATION) Date: Cit or To tyn of- 7PE To the Inspector of Wires: By this application tilt undcrsigued gives notice of tlme on-premises performance of electrical work by employees. r� Itnstitutton Address Location and Nature or Pro cd Eketrieol♦York: Qi�a�.z,� �� A/l�ae�F NOTE; C. 143§3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by riling this form upon each such occasion.or if so content plated in an annual permit fee scbedcle set by lbe municipality you may maintain a tonkrrgroteneous log of such work, which shah be exhibited to the Inspector of wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated ma itude. We will file this form on each such occasion(check one): YES ❑ NO we will maintain one or more contemporaneous logs) (check one): YES 2--�NO [] This option is available.where so contemplated by the nnmieipality. in dense cases.you most renew this application annually and span significant changes,in employment. Tile following individual(s)wi l be responsible for the accuracy of the log(s),if maintained You agree that the togs)will be located as indicated below. The coverage in any individual log(trust be for contiguous property except by arrangement with the inspector of Wires. Attach SupPle 140y sheefx' r uired or additional 101 locations. Log cuveraae and location where it will be maintained 1 Ravensible Penort © ' You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce dure,indicate below how the inspector of wires should access the log: How maily electricians and/or system technicians(as licensed by the l3oard of State Examiners of Eleetriciaes)do youemplo at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes. "i'utnl electrical cngsloynncol. Furl-tine equivalent cleetrkal engdayincnt: L I low many helpers or apprentices do you employ to assist your licensed state under their direct supervision(see e. 141 §S)? 1 general,this number must twi exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions of ply for veterans(see St. 1962,c.592§3 as amended by St. 1979,C. 156). Indicate the total twtrtber and also indicate elle nun bcr of fill-time equivalcni staff that ra norm,includes: Total electrical employmeul• Full-time equivalent electrical employntettt: Not all electrical work for which notice b the Inspector oCWires is required nwst be performed by licensed porsoanel. How ntauy such persons,not required to be licensed,do you have in your emptoy? Indicate the total number and also indicate the msmbct of full-time equivalent staff that number includes: Total electrical e11i11110911cnt: „ Faq-lime equivalent electrical empioytilent: •/nslitetirnrs are rlrfir:rr!Jnr t1ime prrrlmses as am•perroa,jinn,or corporation opetming under c. 14198. (Please see reverse side for certifications sixt required signature (3 RIia iR � i.+R �iilr�r 8 Rpr 01 05 04: 05p NORTH ANDOVER 970GOS9542 p.2 Institutional Permit Form,page 2 WOM Sonne institutions enter into contracts with eontisetors to perform ongoing electrical work at an institution,limit to institutional employem if.by the terns of such a contract,you direct the perforntaox of such work, include the aur lets of such employees in this application. if the contractor directs such performance.of if the contract period is far le than one year, application must be node by the contractor on the standard form for such work Do not include such er ployees in this application, Please give your official tick. such as"Director of tine Physical Pleat"or"Director of facilidw"of equivalent. In addit provide a statement that substantiates your authority to hire electticians pursuant to e. 14118 for electrical work on the pr ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a gran authority to direct any licensee of the Board of State Examiners of Electricians to perforin work in contravention of the rule said Board,or in contravention of the Massachuseits Electrical Code. 141y title is: My authority to act for the afore tenlioned instil' ton Is: I certify,antler the pains slid penalties ojperjetrr.that the fsrformatlorr an this application u true and complete- /&Z(Signature) (Dated) (Print name) A&P, ewS 4 (work telephone number) 97469114N(extension) (facsimile number) :;Al' VenJolPey,110- SAP :NV DOC; NBR DATE REF NUMBER TEXT / 11.0_N1W INV AMOUNT DEDUCT TYPE NET INVOICE CR 1.902479084 091.305 091.32005 ELpay invoice 250.00 0.00 KR 250.00 b 4- L I I I I DATE 09/14/05 T01BV-SAP1 ID N0. 0010181571 CHECK N0. 1000452625 Lucent Technologies CHECK AMT. $250.00 Bell Labs Innovations You can now check the status of your invoices on the web. Visit http: //scportal.lucent.com/invoice. Questions concerning your invoice(s) can be directed to apus@lucent.com. Lucent is changing payment method of all suppliers to electronic payment. E-mail us with subject line: Electronic Payments to apus@lucent.com with bank name, address, account 0, routing/aba # (and swiftcode, if applicable) . Please include your name and phone number. To expedite Lucent 's receipt of your invoice, Lucent is requesting all suppliers begin electronic invoicing. Send contact information with subject line: EDI invoice to apus@lucent .com. —RGMM/F il(N`11—T P.-1 TMIC PFPFI10GTillN �, 33 gS} I p 4 G fg r Lucent Technologies ittse t tis=taAt,, 6e1ls tsmovations t7.S. PUsTAt; =EAl t] lYt7arita 4a. € .0BOX 105 97 x PernAt 969 Atlanta, GA, 3D348 000452 25/20050914/TOSBV 000294 : TOWN OF NORTH ANDOVER 400 OSGOOD ST BUILDING DEPT NORTH ANDOVER MA 01845 *�-�-�3r�_ 1�1,,,,,,ifN►,f„i,�f,1,1,,,1,1 ,f„1I,,,i,i,,fi,,,Ii,,,,,I,Pi 3 6020 Date... .40R711 TOWN OF NORTH ANDOVER t 0 PERMIT FOR WIRING 1 This certifies that .......1.......4 ............................................................................... has permission to perform ....... .......................................... wiring in the building of................. Z ........ at......... ......... .... ....... .North Andover,Mass. Feel................ Lic.No.&........ .........f(:--41 ...... ELECTRICAL INSPECT R Check # DEPARM 'OMBUCS4MY D Z,O LtNBa4itr)OFF'RREPREVF1VIf�0�NRBaLw0i 327afitizaFees Checked A.PPUCA71ON FOR PERNIlT TO PERFORM ELE CAL WORK All.WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSTS SELE(I'('RK AL Co ,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Y 1/97— © I Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street dt Number) 1000 �}Sf 0o W st Owner or Tenant RAO OS ool FSfneet1-&C 2Z-4 1C S q e- Owner's Address Is this permit in conjunction with a building permit: Yes E3 No (Check Appropriate Box) (` 3 C O purpose of Building Addb e-,t sok S Utility Authorization No. Existing Service Arnpa��olts Overhead O Underground M No.of Meters New Service Ampa_...L.V olts Overhead Em Underground = No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work hu i Id t;:; Cj L-oc..)e,-z e,77 No.of Lighting Outlets No.of Hot Tubs No.of Trndarroers Total KVA No.of Lighting Fixtures Swimming PodAbove Below 0erteratats KVA nd and No.of Receptacle Outlsts No.of 011 Burners No.of, Battery U.r'ts pt1' e2 t��C 1 t iTS 0L No.of switch Outlets No.of an Burmn No.of Rw4W No.of Air Cond. Tow FIRE ALARMS No.of Tone Toro No.of Disposals No.of Heat Total Total No.of Deleclion nd PoTons KW Isidstins Devices No.of Dishwasher Space Area Heating KW No.of Sounding Devices No.of Self Conhbbd DetectionlSounding Devices No.of Dryer Heating Devices KW Load Mudcipd Other Comoctioro No.of Water Heaters KW No.of No.of sine Bdlnls No.Hydro Massage Tuba No.of Motors Total HP lnstrarneCo�Ar�tbaierat}ierlt�bafMe�dlBlti<Ga®1LSWa Iha�eaaaeYI�ib�yhsaactl�iiYrctdr$Oornplrt Qila rieltx}ivalat YES Np Ihmes�6rrioedvaidpmfafsarebfleOffiot:Yl lf)euhmedzdedYKpI=}r�eQtety��� 1NSUItANM BCM[3 amm 0 Q'leaseSptziij� k+ �/, / Co �e�dvaireefl~7ec�Wod�ss Wadcbsmtt ® 65 DieReqnswd men W �l CGI al 5gredurtdr Pi�iemafpeijig): 1 Tl.c c �tuc HRMNAME i 1 I eC LinmaeNa �5'O3 � I� ��h��� W SDs S f 650 7S 3144 Nve, Srl tki I Nil 05?o 7 r7, &W=Td?4a AL'IdNa OWMCSMMANCEWAPAE ;IamawaedndieLimrwiheirmonmewvw4ieerils,ko degiivalaitasmgiredbyMmmchimConWLan arddvtrrrysgnulaeendrspeartitappicmrnwaimeafiimsp eni t (Please check one) Owner � Agent Telephone No, pEtWT FEE S Date.. ............................... NORT/, °ft�``°:•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUS� e This certifies that ... - .err: ..... .............................. �!S-!J....a.,. .:.._. has permission to perform: ....... ....................... wiring In the building of :.:.............................................................. ....................,North Andover,Mass. ... ............ -,...... Ic.No. ..... y Fee .. fir. ELECTRICALINSPECIOR Check # t A& 01 05 04:05p , NORTH ANDOVER 9786889542 p. 1 ♦K �°—� (rommonrvea[!!a of ///allael�use Vrrn:+al use vnir Permit No. .S 72l .t.lspartmrrrl a f�irr�.?i ae Permit Fee Assigned Ti •O 0 BOARD OF FiRE PREVENTION REGULATIONS Res,, 111991 kava blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice 4f electrical installations to the municipal Inspector of Wires is required for.vork on the premises of the institution. if you are not an employing institution pursuant to C. 141 §S of the Massachusetts General laws.stop here. You cannot use this form. Use tl a standard form only. (PLEASE PRIrVT i,V INK OR TYPE ALL WOfUl11T/ON) Date: Citv or Town of: &jMJe0L .j4j . To the hispector of Wires: fly this application the undersigracd rues ticc of the o -prenuses perfornmrtce of electrical work by employees.- lrastitution Address Thdidj&L AdO/ Location and&Nature of Proposed Electrical Work: Sat1�f� 1�S �80f�E N01'E: C- t43§3L of the Massachusetts General laws obliges those who perform electrical installations to give notice of same to the municipal inspector of Wires. You may do so by filing this form upon each such occasion.or if so cantent- plated in an annual pert.fee schedule set by the municipality you may maintain a contemporaneous log of such work. which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and re nice individual permits for work above a stated magnitude. We will file this Coma on each such occasion(check one): YES ❑ NO We+gill maintain orae or r>mrc contetrtporaneous log(s) (check one): YESNO ❑ This option is availabic where so contemplated by the municipality. in tl cases.you most tenew-this application artauaII3 and upon significant changes in employmtnt. Tie following individual(s)will be responsible for the accuracy of the log(s),if tmintained. You agree that the log(s)will be !ocated as indicated below. The covenge in any individual log most be for contiguous property except by arrangement with the Inspector of W ices. Attach slipplem tary sheets if s aired or additional 109 locatiotrs. Lao cuvera_oe and location Where it will be maintained I Responsible person 4V A112Au o ' You may maintabt the logs electronically upon agreement with the inspector of Wires. If you intend to apply for such a pro" dare,indicate below how the Inspector of Wires should access the log: How many electricians andlor system technicians(as licensed by the Board of Stale Examiners of Electricians)do you erttplT at your facility? Indicate the total muniber and also indicate the number of full-time equivalent staff that number includes: 1'ntat electrical cntlrtuytncul:^��� hull-lime egnivaleut electrical eugtluynteut: Z I low many helpers or apprentices do you rill to assist your licensed staff,utuler their direct supervision(see C. 141 §8)'? general,this number must opt exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions a ply for veterans(see St. 1962,c.582§3 as amended by St. 1979,c. 156). Indicate the total number and also indicate tine num her of full-titne'equivalent staff thus number includes: Total electrical entployntent: Full-time equivalent electrical employrnettl: Not all electrical work for Which notic to the Inspector of Wires is required must be performed by licensed personnel. How maily such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number inclut£es: Totrl electrical employment- rull-time equivalent electrical employ mast: ,lnsimitions are rleftr:ed for the'"sse p�urpToseg as nn}person firm,or catpornrion operrrtng ovidet-t. 141 I3. (Please see reverse side for certifications and required signalw Apr 01 05 04:05p MOIRTH ANDOVER 9786889542 p.2 A.� institutional Permit Forrn,page 2 NOTE,, Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution,simil to institutional employees. If,by the terms of such a contract, you direct the performance of such work, include the nun hers of such employees in this application. If site contractor directs such performmtce,of if the contract period is for Ic tlon one year,application must be trade by the contractor on the standard form for such work. Do not include such er to es its this application. Please give your official title,such as"Director of the Physical Plant"or"Director of Facilities"or equivalent. in addii provide a statement that substantiates your authority to hire electricians pursuant to e. 141 JS for electrical work on the pt ises of your institution,and to establish priorities for the performance thereof. This form is nut to be construed as a grar authority to direct any licensee of the Board of State Examiners of Electricians to perfomt work in contravention of the rule said Board,or in contravention of the Massachusetts Electrical Code. Nly title is: om_ f t3�r L My aulh My to art the aforet tteutioned institution is: � A etsO& Aof JA A'lC 07, �L�lno�GWieIr I cerrifj•,ander the pairs and penahies of perjurq-,that die information on this application is true and complt:(e. (signature) rp (Dates) (Print name) p d (work telcphune number) MQ. ,textcnsion (facsimile number) 97[7 1y L slim m'I1 1 1 Lucent Td`(1wkgieS ld Lon Fax Cover Sheet DATE: June 30, 2005 PAGES: (3) TO: JEANNINE MCEVOY-N.ANDOVER BUILDING DEPT PHONE: (978) 688-9545 FAX: (978) 688-9542 FROM: DON BELLETETE LUCENT MVINESIC, 1600 OSGOOD ST, N.ANDOVER, MA 01845 PHONE: (978)691-3717 FAX: (978) 691-1730 RE: PER OUR RECENT CONVERSATION,HERE IS THE ELECTRICAL PERMIT APPLICATION-THE APPLICABLE CHECK FOR 250.00 SHOULD ARRIVE WITHIN A WEEK, PLEASE GIVE ME A CALL WITH ANY QUESTIONS/CONCERNS. I WILL ALSO GIVEYOU A FOLLOW-UP CALL IN(10)DAYS OR 80, TO VERIFY&OBTAIN t PERMITICHECK COPY. THANK YOU &BEST REGARDS, DON SAP V,:ndcir Payment. SAP INV IXX; NBR DAT I-; RE'F NUMMER 7'1,X'1' / P.0.141W ( I NV AMOUNT' Dl•:UU("I' TYPE NET LNVOI Cbl CR 1902370216 062905 06292005 F.Zpay invoice 2`0.00 0.00 KR 250.00 I i i DATE 07/06/05 T01BV-SAP1 0 ID N0. 0010181571 CHECK N0. 1000448442 Lucent Technologies CHECK AMT. $250.00 Bell Labs Innovations You can now check the status of your invoices on the web. Visit http: //scportal.lucent.com/invoice. Questions concerning your invoice(s) can be directed to apus@lucent .com. °� 151 Lucent is changing payment method of all suppliers to electronic payment . E-mail us with subject line: Electronic *Payments to apus@lucent .com with bank name, address, account #, routing/aba #' (and swiftcode, if applicable) . Please include your name and phone number. To expedite Lucent 's receipt of your invoice, Lucent is requesting all suppliers begin electronic invoicing. Send contact information with subject line: EDI invoice to apus@lucent.com. 6150 Date ...... 04 TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................................................................................ form has permission to per .. ......... wiring in the building of........... ... . .....G,), ........................ /1-*' * U at ....... 14..I.Ir............................... North Andover,Mass. Fee�r ......... Lic.Nolmi(gkl..... . .......... ELECTRICAL INSPI&OR Check # &26 67 DQilliQl fW0FPEN CSAFW PaWt No. BQ4RDOFFMPRE'V11VIMR GVLATVM527adRILio Occupancy&Fees Checked APPLICATION FOR PERMU TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE Wtt'H THE MASSACHUSSTS ELECrMICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electric work described below. Location(Street dr Number) S pd ` Owner or Tenant Uzzv G Owner's Addresso PVA-,6v-f,7 P1 Is this permit in conjunction with a building parnit: Yes No (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps I Volta Overhead Underground a No.of Meters New SAmpe...L.Volts Overhead Underground No.of Metes Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work (/(-';g — Na of L,iandry Outlets Na of Hot Tubs No.of Trans brtnsn Total KVA Na of UghWy mm" Swbmdq Pool' Above Bebe KVA 1100011 No.of Receptseis OutWs Na Orion Bumets Na of Emaaeoelr Uahtiry Battery Units No.of Switch Outlm No.of Oas Bumms No.of Reyes Na of Air Cond. Tool FIRE ALARMS Na of Zones Tots Na of Disposals Na of Had Total Total Na of Delectim and palm Tori Kw Initiating Devices No.of Dishwashers Space Area Hesdng KW Na of SounetlnB Device Na of Salt Cattshred Deteedaol3ouodfng Device. No.of Dryers Hoeft Devious KW LandMnsidpd Other No.of Water Heaton KW Na Of No.of Comoctions sizal Ballesis v No.Hydro Musgp Tabs Na of Moron Total HP iscv,t.Wewt eflc1iG f«4&t s to � c��� y cows kvcq�rav (SS, bj C14 It VL CQ1Qtt�Ptsnttbbera}ien�shYl IharCBaaCYLittltylr9OlCeFttYirirdr;torr Qbs+t�rltilegtavaiet YB4 NO Ihmakmft dvttfdptod m—lolo lei Y>� Ir)cu otieabaa�dYB4,pta:do*tltitypeda mWby BCM Mo WadtlDSW f o IrepedionDtl�Regr�d gag, EstimabdVahatF]e�alWadrs 5�redurt�r dpt�t�. r �'Gl f C Few E MNAl1� [imwNa V�E fel e V V• S � S due � I�caBeNo (J�o asTalrlo �- 389 5- 2 OWI�R'sIIV5C1RAI�.Ew •IamswaedtetlheLicat� �lheirHmneao�ea�ar�at�ulil AL'IliNa arddtemysgmWondisparrit-0 dm1hk x&nw e� ���bYMasstds>�1bGa ILaRs (Please check one) Owner a Agent Telephone No. pgRMrr FEB 2��� DEffiRnME1TO1F'PUB 'SA MY Per,,&No. BaAitDOFFMPRLVFNJ9�0�NR OULA?fIDM327adRiZe t ces; tt y&Pen Checked . .. APPUCA71ONFOR PERAET70 PERFORM ET C RICAL WO STS ALL WORK TO HE PERFORMED IN ACCORDANCE WrrH THE MASSACHUSELECMICAL CODE,527 CMR 12:00 (PLEASE PRIM IN INK OR TYPE ALL OMRMATION) D f,� 0 Town of NoM Andover To the Inspector of wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street R Number) I W Q S 01.6.4 61 -.S OwnerorTenant Z ro i@is , N G Owner's Address N -,n I< N ILav vk- Is this permit in conjunction with a budding permit: �,/ Yes No a (Check Appropriate Hox) Pat" 6 lO Purpose of Building �/2�' � 1` N A'wr �'' S *�w�t ` 1'l'a Utility Authorization No. Fanisting Service Arnpa...L.Voks Overhead Underground Q No.of Meters _ New Service Ampa...L..�Volts Overhead Underground C No.of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical work No.of Lisbdna Outlets Na of Hot Tnbs Na otTntrbrrnnu Total Na of Llsbdog Finams Swbamina Pool' Above Below G KVA 5 C) 9001W KVA Na of Receptacle Ouda /1 No.of On Blume. Na of Bmaaenep Lighting Bawy two / Na of Switob Outlets (,J No.o(Go Boman No.of Ranges Na of Air Cond. Total FIRE ALARMS Na of Zom Tana Na of Dispasats Na of Haat Tool TOW Na of Deteedea std. Palms Tons KAY bided"Device, No.of Dishwsahen Space Ana Heathy KW Na of `� Na of Self Cuotabud� DetectionSmWin Ntg a of Dryer Hoe Devious KW Load M OtherNo.of Water Hatas KW Na d Na of n � . a S Bailnis Na Hydro Mwsge Tabs tufo.of Mown Told HP OTHER. 1"'o sil 5--4 u I Cot e1y t� Cbz Paa�tbltetegtiQrrmafMeawdas! Laura YES N a ►tiseaaae�t r ' aibsuutl�itltx�iraist O tanesttrrirkdvaid strIVIO Omm Ylv Lo ryoubateBM aum 13 nm*a* deciedYB4,plrair,di�lefttypeaf by h L�1 r� 3EdVaheafPlnaicalWadrs adrlbStad DeeRmrasbd Ro* lkr ur'r Ptrribdpajtay. �f„�- NAIy18 J/t UmwNm A 17e W 5,0 Irl 0J 1.1mallo 0 1ludizsTdrik _Ad*M / 3 3rd iia 51-em, AL'IaiNia awmtsIIaSI)RA1V[8w •Iamawaehettietiomee �lheisnanaeooue,gorkla>hamntiiee�tvalaitasnec}ia+dbylVlasaadtstltC,elniiLants ardntetmysig�„aoneipeo»�appksio„sti�a/iue�i,tsmt (Please check one) Owner zignalure of uwim C3 . Agerd Telephone No. p�afrr FEE��:�7 6148 Date + TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4c" This certifies that .......... has permission to perform ................ ............ j#viring in the building of...,..-s`.' .................. . ........................... .North Andover,Mass. Fee4 -.�!n Lic. .........j.:z.............. .. . )ELECTRICAL INSPECTORY// Check # A DEFAR7N Y 0FPVXX3 FW Permit No. BOAMOFFZREPFEVFNnMRBGULATIM5Z7adR,a-� Occupancy dt Fees Checked r APPLICA71ONFOR PERMITTO PERFORMELECTRICAL WORIK All.WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 ��r/1 (PLEASE PRINT IN INK OR TYPE ALL I NFORMATiON) Da 3 1OV5 Town of North Andover To the Inspector of wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street 3 Number) 166 O D S opo Owner or Tenant Z Z �a i!✓5 N G Owner's Address J N "n W- A N tA Is this permit in conjunction with a building permit: / Yes No [D (Check Appropriate Box) �# 6-4O purpose of Building ea P�C a� �,/N n'`'�' Pv s�*AJf- ��`�n� Utility Authorization No. Existing Service Amps....L.V olts Overhead [D Underground a No.of Metas New Service Amps Volts Overhead Underground C No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical work No.of Lighting Outlets No.of Hot Tube No.of Transformers Total KVA No.of Lighting FixturesSwimating Pod' Above Below Generators KVA ad ground No.of Receptacle Outlets ^Z /� No.of til Burners No.of Emergency Lighting Battery Units / No.of Switch Outlets 7(.J No.of des Damara No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Ton No.of Disposals No.of Had Total Total No.of Detection and O Ponve Ton KW Initiating No.of Dishwashers Space Area Heating KW Na `of Devices No.of Self Con sbW Detection/Sounding Devica No.of Dryers Heating Devices KW Lord Municipal Other a No.of Water Heuer KW No.of No.of Connections sizu silnb No.Hydro Message Tubs No.of Motors Total HP o�Ix�x• /Lf(alt � t,00s ? S�►u i�, eqv t ekA-vt thsuataeCa Pihrahentbfheta�hiahe�afMtssda]semQ 11aws Itha`eaahoe�eL;t>brYyh4m,ael�ryirxidr$Clon� ari4sub�hrrielequivalmt Ygg Np ItM&*ffibdvaid strnetDft(Zk>~Y$S If)whahedzdtdyH%Pkmiti=drrAecfaA=Wby a dho�glhe IIVS'UIZAI BM E3 O'TIM [j rleese** Wtakbswt I /3 ><, ,� E�hzflledva1ZdHM"WC&$ FkW Stpladurh�r Pt3haiiesafpejury. il fVMNAVE e ✓ �' INo. t �AllW ✓01 50 3r� �e �(P� �'(� Businr�T�1Na - 38-B�s -7�qa AdtM 3 AkTel.Na 0WT1 'SMMANMW •IamawaedletdtLimned�mtta}�IheinauahoCao►eapetar�a ridet�ivalmtashe4iedbyM �sGtslaalIBwa atdlhetrrp�s9gtherhsonth'hspmrftappicsomwaiwstistDgnih3nes (Please check one) Owner C3 Agent IM/ Telephone No. pMff FMS j 629 Date..—2...................e!�.�-...... NORTI{ °!<"`°:•'"° TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ,SSACNUS� This certifies that `' has permission to perform ....................... ..--� wiring in the building ......... ,North Andover,Mass. Fee. t?U............ Lic.No.............. .............`............�..... . L'�-�c:":�........... ELECTRICAL INsOECTO Check # e-"G 11141,5�7! j ..r. •�• .... �.�. �.,t. t+�tt t n nnuurtrc 5"/tibHt3yS42 P. l 2,1Pai1nun1 a/girrt samicai Permit No. A ��l — Permit Fee Assigned BOARD OF FIRE PREVENTION REGULATIONS Rev. 111991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY "I his I-orm is fer use by institutions employing licensed electricians and others for which notice 6f electrical installations to the awnicpal inspector of Wires is required for work on the premises of the institutiom if you are not an employing institution lntrsu tit to C. 101 §S o1 tine 1433sachusc(ts General Laws.stop here. You cannot use this form. Use the standard form only. ;PLL _PRINT hVltVlt:OR TYPE-dLL INFORM./TION) Date: City or Tolvil of: ����s,�,fczv.�.�_ To the hrspector of Wires: !;y this application the undcrsiggiledgivs notice of the on-premises performance of electrical work by employees. Institution X jfi 6AZ/ _ D Addr:•ss 00 Loc,3tion and tisture of 1'r osed Electrical Work: l NOi E: C. 1 13 §3L of the Massachusells General Laws obliges those who perform electrical installations to give notice of '{ sante to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so Content- ! plated in an annual pern it fee schedule set by the municipality you may maintain a contemporaneous log of such work. which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some rn►►nicipali- ties may set nominal fees for arutual permits and require individual permits for work above a stated magnitude. ,-Ve will file thus forst on each such occasion(checl:one): YES Q NO `,vc.yah maitvziin oiie of more contemporaneous logs) (check one): YES 99,1' NO -.+t,option is available%%•here so contemplated by the municipality. In these cases,you must renew this application annuslll %,opt s+-nificant changes inn employment. Ile ing•individual(s)will be responsible for the accuracy of the log(s),if maintained You agree that the log(s)will be coaled as ilidicated below. The coverage in any individual loe must be for contiguous property except by arrangement with h< 'tisprctor of Wires. A trach stipplem amysheEftifirquiredfor additional-log locatiMls. ( La%,cuveraoc,and location►►'here it tsill be maintained Responsible person / _.OSA s 1422A 410 ' You may maintain the logs cicctronically,upon agreement with the Inspector of Wires. If you intend to apply for such a proc dare,iudicat'T below how the inspector of Wires should access the log: How navy electricians and/or system technicians(as licensed by the Board of Slate Exafnium of Electricians)do you empl' at stntr fac ilitti•? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: T stat cict:rical ctnpboy►ncnt a2 hull-clone aluivalcnt ctcetrical cnganyawill. — 1(f;w t naoy helpers or apprettlices do you employ to assist your licensed stallf,under theirdirect sf►pervision(sec c. 141 §8)? ::e2er.+1.;his nun►bt:r must nut cxceeJ the ratio of one licensed individual to one unlicensed individual. Limited exceptions a ► al-: f,it ,'rter3ns(see St. 1962,c.582§3 as amended by St. 1979.e. 156). Indicate the total nun►ber and also indicate the nut be: of f1111-till+,equivalcut staff that number includes: b'::a;rtcctrical enlplo�.+cut: Fun-time equivalent electrical employment: ,::i :!!e°rtrtcal work- for which notice to the Inspector of wires is required must be performed by licensed personnel. How :,,c+ich persons.trot tequired to be IiCellSed,do you have in your employ'? Indicate the total number and also indicate the of:ull•tiric equivalent staff that number inclatics: >t:+s ctcetrical ennplutiatenL Full-lime equivalent electrical emplo)raetnl: •;:;t:r:atttlnr are deJir:rJ jar dtese purpures ns run•person,Jirnt,or corporation ope+rrfrtg tentlrr•t. 1 tl 1 a+3. (Please see reverse side forcertificalions and required signator Ittstirtttionat Petntit Form,page 2 NOTE: Sorra institutions enter into contracts with contractors to perform ongoing electrical work at an institution, simil to institutional employees. If,by the terms of such a contract,you direct the performance of such work, include the nut bcrs of such employees in this application. If the contractor directs such performance.or if the contract period is for Ic than one year.application must be made by the contractor on the standard form for such work. Do not include such a ployccs in this application. Please give your official title,such as"Director of the Physical Plant"or"Director of facilities'or equivalent. in addit provide a statement that substantiates your authority to hire electricians pursuant to c. 141 38 for electrical work on the pt tscs of your institution, and to establish priorities for the performance thereof This form is tat to be construed as a gran authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rule said Board,or in contravention of the Massachusetts Electrical Code. My title is: � ' MY auiltorily to act for the a'for�curcn iof ncd inssli1tutiun is. I Terrify,Lader the pains and penaldirs ajperjrut�Iliad(lie information on this application is true and complete. (Signature) (Dated) /!"ZA {Print name) 14 Al �. rG �[LY/OLciSLG� twork tcleplwne number) 97J16y//4P9Aextnssion) (facsimile number) 9'7,f-d;9/ Ite" i � AP INV DC NBR DATE REV NUMBER TEXT / P.O.N13H I NV AMOUN°P DEDUCT TYPE NET 1NVOICE. CR 902605329 1201.05 1201.2005 EZpay .invoice 250.00 0.00 KH 250.00 i 511 41 a a a z s r� DATE .: � 42/�1.,'�05 � T01BV-SAP1 1,8;1571. C#iE KNfl1,b0610 HECK AIT: $.250 (30 " Lucent Technologies- Bell Labs lnnovati6ns ` �u can now aleck the st ►i tis„ of your ^ invoc:es on tie web, Visit ttp: //scportal.lucent.comlanuoice. Quepstions, concerning your° 1fivoice(s)- can be irected to apusClu ent ,com: _ scent is changing ;ayment method of all suppliers to ele(t`r4ni.c payment. E-mail us ith subject line:. Electronic Payments to apus@lucent.;com with bank name,, address, ;count #, routing/aba. #. (and swiftcode, if .applicable) . Pleasel' include your name id phone number. expedite Lucent 's receipt of your invoice, - Lucent is requesting all suppliers ?gin electronic invoicing'. send contact information with subject 1ine: EDI invoice apus@lucent .com: - -D•NOT - - WITHOUT- D tilrAND BRO •OP• -- • -' t" r # � Y LL8�4- 131w, - 131 ' ":4b"R'l `xCheck Ndt G'hase M�rSha B� L#�I re �2Q1 Maf„,cdt'SMbe : : .� 311 � 67 109&l' , I ;" :M 001018Lt5f 9lLcendTenol � i KtssBell Labs lnnovatiois ' .fi`: _ ?z Cann tnls cneck wRnON in IMID two Hand ed Ahd fifty Cloilars antlNa Cn�s Ftt U:S�Qollrs °f ;'i> r 7 �rr A ', **250 5 TOY QRTH Q0VEfl 7 sNORTH �0 NIA, b184 ��, , .. 1BV.SAP1 C Nide u :, Sv F :t`trti $'T,: r• l�✓<`++t,LAuthon iSlgn re�r rh w r=a 111 1000 4 580 3011' ,! 0 3 1 100 2 6 71: 6 30 1467 2 17 50 911' I Date.... ..I-1'/- . ......... 'r HORTM TOWN OF NORTH ANDOVER PERMIT FOR WIRING C U HUS Et This certifies that ......./—"09- ...................................................................................... has permission to perform ........7-14 ii�Fx?......61 e,-Ole-.,6 .......... wiring in the building of........C�a 7—z/ /4 q .0.!4rf�G.S ... 51no D........ .................... .North Andover,Mass. at....................P..,... ........P..., i Fee.17,6..,. ... Lic.No. ........ ....ELECTRICAL INSPECTOR Check # DIFAU'IM©VI'OFPUffiJC94FFW Permit No. B04W0FF=?EPRENVMWRB Ul WM527QR2* Occupancy&Fees Checked APPUCATIONFOR PERMIT70 PERFORM ELECTRICAL WORK ALL WORK TO BE PEMRMED IN ACCORDANCE WirH THE MASSACHUSSTS EISCMICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the inspector of Wires: The undersigned applies for a permit to perforin the electrical work descri below. Location(Street R.Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No ® (Check Appropriam Boa) Purpose of Building Utility Authorization No. Existing Service Amps olts Overhead Underground En No.of Meters New Ser0cA AmW% o Volts Ovedwad Underground M No.of Meters Number of Feeders and Ampaeity Location and Nature of Proposed Electrical Work ..Q9 No.of Uandna Outlet Na of Hot Tuba No.Of Tmnftnmm Total KVA Na of Uandna Fixturem Swbnming Pool Above in Below Oaraatom KVA ground ground Na of Receptacle Oudeu No.of Oil Burnam No.of Emergency Ushdna Battery Unith Nob of switch Oudeb No.of an Bumen No.of Ranaae Na of Air Cond. TOW FME ALARMS No.of Zama Tam No.of Dispouk Na of Heat TOW TOW No.of Debcdoo and PUMPS Tar Kw inidwi g Device No.of Diahwuhem Space Ams Hewing KW Na of Sanding Device Na of Self Cantobrd Detecdona Boding Device No.of Organs Headntg Device KW Lord 1:3Mnnidpd O r Connections No.of Wow Heaem Kw Na of Na of signs dleia No.Hydro Mauage Tube Na Of Morons Told HP OTHER, ]rxxz�oet7o�e�PlralitbbelBrfiiere�afl�ta�dlSlllQOr®lI� Iha eaaarentI�e6t�yl�lsla*raeRisYirrydr;Cbn a1s �ide�livs<tzit Ygy NO Ilnes hTftdvaidp WofsmrtebfieOf Z YM ryouhatechadedYB55, int�lefietypecfaowugby MdreddrigEh�e E6a1� �1 LI AI B BCTD OYER [:3 4P>eaeespedy) EtgiodonDrtle E�tirna�dVatieefEba"Wa k$ WoikbStas ..� -�� Roup find FEMNAME �9/[-GL i G 7'.`/G — LicaaeNa _ '` troa+ss` � � IlcaeeNo ���S.Sy Bildn=TdNa .5'7 y/ff 1 Ahiner AXWNa aWi�WSW URANCEWAIVIIZ;Inna mdvid eiiamsdm,gd dleira>tariaewm*a*2tg nedegii4btaswpmdbyMmdammCmmWLawa arddietrrrysgriesiteondisptmit15fa�wai�esdisrequieria�t (Please check one) Owns Agent Telephone No, PERMIT FF.E 120J* j Date.......�..�........ ........... NORTI� " TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SS^CMUSEt This certifies that ...........Q ..........:.......'}...►`..b w 9..b......&nr:/..... has permission to perform ........:..5 f.�.........4:-..p e- /ti'!................. wiring in the building of �.�z.,Y,. ? '�7�r S ................... ..... .... ......... ........................... at.....I&a ...4�0........:!�;,?.'...................... .North Andover,Mass. a - + v Fee... Lic.No. 5.121?..&.............. ..• ELECTRICALINSPECTOR r Check # 6 ?-5 ThECOl1V1[1 OATWALTHOF"MCHUSE7T5 tfice Use only DEPAR7NfVT0FPUBL1CW,E7Y 2 D Permit No. BOARD OF FIREPREVEN77ONREGULAT70N5'527 CV1.R 12:00 Occupancy&,Fees Checked APPUCATIONFOR PERAKTTO PERFORMEIE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) ` Date 11 /8/05 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location.(Street&Number) 1600 Osgood Street Owner or Tenant Ozzy Properties 1600 Osgood Street LLC Owner's Address Three Dun e e Park Andover , MA 01810 Is this permit in conjunction with a.building permit: Yes No (Check Appropriate Box) Purpose of.Building Parking Lot Expansion Utility Authorization No. Existing Service Amps / Volts Overhead Underground No.of.Meters, New Service Amps / Volts Overhead UndergroundNo. of Meters Number of Feeders and Ampacity 1 — 100 Amp 3 Phase 480 Volt Location and Nature of Proposed Electrical Work East Lot Parking Lot Lighting No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round pround No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained �--� Detection/Sounding Devices No.of Dryers Heating Devices KW Local --- Municipal Othe Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total-HP OTkMR- Q IrmtrarreCoverag�PtYs�trltbtheragtiterrt�ofM��chiseresGenaaliaws IhareaQx=tLmb&ylr>s<==PohLyxrixkgCornpleie CoverWoritsabsarltiadpivai2a YES NO Ibavestbmwdvabdpoofofsarnetothe0flice YES Y)ouhavedrclodYES,plea9ei dcaelhetypeofeowrag,-by drdjT theaQpEop<iate_box BOND GIVER .Jftase Spa*)_ Egti[admDale WorktoStatt 40G!5' Estimated Vaeleot Wade$ htspectimDateRegtte 1 Rtxtgh FmW Sigt-ndtar�rt�ie G jlv' C LioarseNa 92 FIRMNAME ,�. ,, . r Licer�e/(cs lT.0• / el Signatuue Limml o -211 � Busitrss Tel No. Al Tet Na 0ti1'. M'SINSURANCFWArY`E Iarnawaethatthel-icata�does nothavedrinsirulceommg2txitssLtbsur a a*vtlattasw9iiedbyMassadusettsGerentlIam and that mysigrlattne on this pearlit applicabc>n wars this tat}>Q�ntxtt. (YS,,pe check one) Owner Agent _ Telephone No. PERMIT FEE �ZS.da Signature of Uwner or Agent Date.................................. NORTh TOWN OF NORTH ANDOVER t M° A PERMIT FOR WIRING sAcHusell E� Thiscertifies that ............................................................................................. has permission to perform G ...:1... �-- .. ^..w... .... wiring in the building of.. :�1 f c V....`.. at. .!....!... ��.. ^ ....,,North.Andover,Mass. Fee. �f G U Lic.No.............. .........j :., f:.�...... ................./��tt Euc-micALINSPECTOR" Check # � 6 % S Ve d P'y—nl. SAI? INV DOC N13R DATE REIN NUMBER TEXT / P.0-NIM INV AMOONT DEDUCT TYPE NET INVOICE CR 190220E6>_! • 040405 04042005 L1ecLr1ca1 Permit 250.00 -0.00 KR 2.50.00 r' / I fi I I I I I I DATE 04/06/05 T01BV-SAP1 0 ID N0. 0010181571 CHECK N0. 1000442588 Lucent Technologies CHECK AMT. $250.00 Bell Labs Innovations You can now check the status of your invoices on the web. Visit http: //scportal,lucent .com/invoice. Questions concerning your invoice(s) can be directed to apus@lucent .com. Lucent is changing payment method of all suppliers to electronic payment . E-mail us with subject line: Electronic Payments to apus@lucent.com with bank name, address, account #, routing/aba # (and swiftcode, if applicable) . Please include your name and phone number. To expedite Lucent 's receipt of your invoice, Lucent is requesting all suppliers begin electronic invoicing. Send contact information with subject line: EDI invoice to apus@lucent.com. 'BHMANP1 01845 a s � + RAAI+ _ t - - - Fpr� t ua ug: u�p nuR7H RnDOVER 97$8989542 p. 1 "4-� (_eersmenlvtallk of ///aeearhrseilta v►uaur Permit No. .,Uaioarinval n j ire�,vFus K�! Permit Fee Assigned _1t5 b BOARD OF FIRE PREVENTION REGULATIONS Rev. i IM) leave blank /ni CATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY 'Phisor use by institutions employing licensed electricians and others for which notice df electrical installations to the munpector of Wires is required for work on the premises of the institution. If you are not an employing institution purs . 141 §S of the lvlassacluuseus Gntcraf Laws,stop here. You cannot use this form, se ht standard forst only. r'PLINT IN INK OR TYPE ALL INf Olihl�lTlt7;V) Date:` ����� - or Tolcn of: t0 �1/li/� To the Inspector of Mires: 13y, ation the undersigned gives tice of the on.premises performance of electrical work by tmpluyees- InsAdQ Location and Nature of Proposed Electrical Work: w NOTE: C. 143 §3L of the Massachusetts General laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion,or if so contem- plated in an a»nuat permit fee schedule set by the tntroicipality you may maintain a contemporaneouslog of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual pemtits for work above a stated magnitude. We will file this form on each such occasion(check one): YES D NO we.vill maintain one or more contemporaneous log(s) (check one): YES IL/ NO ❑ This option is available where so contemplaled by the municipality. in these cases,you must renew this application annually and upon significant changes in employment. 11tc following individual(s)will be responsible for the accuracy of tine log(s),if mainta'ared. You agree that the log(s)will be !orated as indicated below. The coverage in any individual lot must be for contiguous property except by arrangement will, the Inspector of Wires. Assacts ires- Attach supplemer►tmy sheett if afred or additional!tj IocatiptIS. Logo cuvcraoc and location where it will be maintained RgRansible person N'On May maintain the fogs electronically upon agreement with the Inspector of Wires. if you intend to apply for such a pros dure, indicate bolos how the hupecim of Wires should access the log: tlow+nary electricians and/or system technicians(as licensed by tin Board of State Examiners of Electricians)do you errtpl' ' at your facility? Judicate the total number and also indicate the number of full-tine equivalent staff that number includes: '1 uta)electrical rn►ptuytnrnl: Full-lime etlnii alcwt electrical etupluyrttettt: �- ' 1 tots•nnany helpers or apprentices do you employ to assist your licensed staff,under their direct supervision(see e. 141 §S)? general,this nunnbcr must nut cacccd the ratio of one licensed undividual to one unlicensed individual, Limited exceptions a t,ly for veterans(see St. 1967,c.592§3 as amended by St. 1979,C. 156). Indicate the total number and also indicate the nut bet of fiull-rims: equiValeut staff that nam If includes: Total electrical ennploy-ruertt. Full-time equivalent eledric>al employment: ;`tor all electrical work for which notice to the htspector of Wires is required must be performed by licensed personnel. How tuar►y such ptrsons,not tcquired to be Iiceused.do you have in your employ? Indicate the total number and also indicate the nvmbcr of full-tinct equivalent staff that number includes: '1'olal electrical emplocntent- Full-time equivalent eleclrleal employment: _ 'lasmsaisnis are def l:rd for dliese pur/xrxes ns nm•paxon.Jirrn,or coporadou operarinS under c, 141 A ('Please see reverse side for certifications and required signator l � Y Hpr U) Uh u4:tlbp . NORTH ANDOVER 9786889542 p. 2 IUstitutional Permit Form,pate 2 NOTE: Sorne institutions enter into contracts with contactors to perform ongoing eieetricat work at an institution,simil r to institutional employees. If,by the terms*[such a contract, you direct the perfomunce of such work, include the nw f bcrs of such employees in this application. If lite contractor directs such perforntance,of if the contact period is for lc than one year, application must be nude by lite contractor on the standard forst for such work Do not include such et pb ecs in this Application. Please give your official tick.such as"Director of the Physical Plant"or"Director of facilities"or equivaleft In addit provide a stotetnent that substantiates your authority to hire elccuicions pursuant to C. 141 J8 for electrical work on the In ises of your institution, and to tstablish priorities for the perfarrttann:e thereof. This form is not to be construed as a gran authority to direct any licensee of the Board of State Examiners of Electricians to perfornt work in contravention of the ruin said Board,or in contravention of the Massachusetts Electrical Code. MY title is. Q d f MY aulhority to act for lite aforemettliotted inslllutiatt is: e-S f/ l.✓i 1 ,� T.��i�olog�eS . l certifi,r.►rdtr thr pains and pruaities ejparjarr,Thal the iujor»ration on this oppiicatian is true and coruplere. (Signature) (Dated) (Prim name) A (work telephone numbcr�7��911D9G (extension) (facsimile number) 97�w.9l /hr-; s Y � t • 60 -19 Date... �.2 NORT!{ TOWN OF NORTH ANDOVER Y p PERMIT FOR WIRING 41 ��sS�cMusE� MILL .G...F.�.%.....-This certifies that ..........:... ...........i� .......l.....n....'. ..................... has permission to perform ...... / .!..4/ ,$.............................................. wiring in the building of........a .. ......... ��............................. lXq! 0-S S--7. .... ,North Andover,Mass. Fee/Zr...��...... Lic.No.AS9,34............ -.. ..,........... .. r LEC TR[CAL INSPECTOR Check # DFA1MENT'O ENKSAFM Permit No. O 9 _ BOARDOFFMPREVFN7nVRF.GULATIr M527aomizI / Z Occupancy&Feet Checked A.PPUCA71ONFOR PERMITTO PERFORM CMCAL WORK All.WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTs CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of NoM Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street tit Number) 09,10 G Owner or Tenantjba0 rc� LC Q 7u , t913 - WA-' I Ra®M Owner's Address is this permit in conjunction with a building permit: Yes No 1:3 (Check Appropriate Boar Purpose of Building ('2 o�S Jc Nr �� I`ix�r!�eS e-7c T S ici V` Utility Authorization No. Existing Service Amps�� oils Overhead Underground a No.of Meters New Service Ampa_...�.olts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 1 i,,3c G - 5' Lc-7 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA Na of Lighting Fistula Swirmning Pool Above Below Oeneratora KVA mo nd ground No.of Receptacle Outlets No.of Oil Bumen No.of Emergency Lighting Battery Units No.of Switeb Outlets . No.of das Homan No.of Ranges No.of Air Card. Total RRE ALARMS No.of Zones Tau No.of Disposals Na of Heat Total Total Na of Detection and PUMP Ton KW initiating Davila No.of Dishwashers Space Area Heating KW Na of Sounding Devices No.of Self Containal Detection5oording Devices No.of Dryers Heating Devices KW Local Municipal Other, Connections No.of water Heaters KW No.of No.of Siam ailub o.Hydro Massage Tubs No.of Motors Total HP O 1•HER- lraia=QAe[IlF PtrWWlDdlere¢om* Gm®1Laws IhmaaamtLi9ft'nstmraePaicytn3rdrgGonlpkt arJhWb6bMggvalat YB4 NO Itimahrimdvidd ofsaaebdtt:omr—YIP Irywfagedac�dY .,plejdc*dieWofWv�� dte ET �a 0� 0 �� l �` �� WodcbSm a1(� ds lrepamortD&Fmicad . Ra* W 3(� C't� ValreefF7e�iralWak$ NAME le c�Yt i eN C S L.3 LicatseNa �Vi fir/ Ove,, sr(e� AN 630n Bui�ims'Il•1Na AdJM AMNa CW?V R'SINSURANCEWANFlt;lamawaiedietdiei laed�,rgtha�t diei�uanet�o►e,�orkas�b le�g�ivalen�g �bj, �f.,� Lassa atddtetrny9grlesaecrtdisptstrl[appicmmwttiKadrsregiitmns (Please check one) Owner Agent Telephone No. pg,t ,QP FEES 9' q s Date..... ...PS.�I�.. Of pi``RTM 1 ••"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING # Y # � r ,SSAC MUS This certifies that ....., .. has permission to perform ..... F• ���` ,N ( r•..f �........... ............................. ....... ..... kwiring in the building of f /,-C6................................... . . . j. :.... ,gat.............. �U U.............,.UL..... ............. ,..........,North An/doyorj,M�jass-�? Fee.���..... Lic.No.,-.7-3. �l/, ELECTRICAL INSPECTOR Check # O LIy s d 5 L 4 j Official Use Only Permit No._,/d t ? �eanr�2Zac .�' f 6� tssrf 775 Occupancy&Fee Che� �'� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massa husetts Electrical Code 527 CMR 12:OD y(Please Print in ink or type all information) � Date Tv ifte inapecavr of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&NumberOS/�/O � a Owner or Tenant L&,c eo-+- Tec-N Na to 2, of Owner's Address loo �S�ooG 5� Is this permit in conjunction with a building permit Yes �/ No 0 (Check Appropriate Box) Purpose of Building Q-t-�f i C e R-0-✓lC2VQP1 Utility Authorization No, Existing Service Amps Voits Overhead 0 Undgmd 0 No.of Meters New Service Amps Volts Overhead 0 Undgmd 0 No.of Meters Number?af Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 6 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices p Nol of Self Contained �No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection V No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO h 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 BOND . OTHER (Please Specify) (Expiration Date) Estimated Value of.Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under t"naltiesof rju /Y FIRM NAME _J o 4 vi {�2E Re 11 yt��/ Cd LIC.NO. A 7 Licensee J4, A P--Pl Ke _!, //' // /Signature t��/ LIC.NO. Address /� SIGfYtE�[ / C ri fJf[degQ . BAlt el.No.us Tel No. Gl7'SY7 77 7 I OWNER'S INSURANCE WAIVER: I am aware that the Licenses d es not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) v�/ U Telephone No. PERMIT FEE $ 7 (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity I am an employer providing.workers'compensation for my employees working on this job. Company name: Address City Phone#: Insurance Co. Policy# Company name: Address City Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do herby certify under the pains and penalties of perjury that the information proviced above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person. Phone#. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Date. TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING ACHUS Et This certifies that ......&7/f/..7v................... ............................... has permission to perform ....6(. .� ...... ...... wiring in the building of....PZ7 Y,...... .......................... at.... ....5.7.a........................... ,NorthAndover,Mass. Lic. .........;5 le ELECTRICAL INSPECTOR Check # 541-76 ThECOMMONWEALMOFMASS4CHUSE77S Office Use only DEPARTAIENTOFPUBLICS4= Permit No. : BOARDOFFSEPREVEMONREGUTATIONS527COMM 2 . Occupancy&Fees Checked p APPLICATTONFOR PERMIT TO PERFORMS CTRICAL WORK ( ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRIC CODE,527CMR IZ:OO ��� /U O PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) UU os aac/ Sf Owner or Tenant Q ZZ `/ f ry er"�-►e C Owner's Address S'R m-e- Is eIs this permit in conjunction with a building permit: Yes 1:3 No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps �Volts Overhead Underground M No.of Meters New Service Amps Volts Overhead Underground ED No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones —1" Tons No,of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices )Jo.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Si ns Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER" X hmrdnceCowrage.PtnalMtotbeWWWnansofMa%Xh19CMGffVdLaws IhaNeaataentLiab>'}tykoxancePbhcyincludmgComplee Coverageorils;wbsiantialegivalart YES Im NO IharestftniWdvalidpoofofsa=lotheOffioe.YES FyoutuNechedodYES,plea9 mdi*ttletypeofmNera�pby dleddngthe box INSURANCE BOND 01HER r7 ftaseSpecfy) Expi ID* Wakto Sent 1 a— y-0 9 Esftn&d value ofDechiral Wo&$ hlspectimavaRoWested Rough Final Sigtled underTra nakiesof .RewFIRMNAME - o to A ( vrvt-e u C'70, LiomseNo. A 7 Iiarwe Signahle IiamNo BusinessTel.No. 07- 51-/7 - 77S'V arm X70 AltTelNo. OWNER'SINSURANCEWANER;lam av,-mthattheLixxwdoesriothavethemstnarloeoDmn eoritsstWantoIegmalmtastagtmedbyMassachuseltsGeneralLaws and that my stgtatttte on this pennit application waises this tegtmenetlt (Please check one) Owner M Agent Telephone No. PERMIT FEE$ Signature ot Owner or Agent Date..... ".. .5.:::. HORTII a16 °L TOWN OF NORTH ANDOVER 3? .. o ' PERMIT FOR WIRING �,SSACHUS� c� This certifies that �/? -1'� .................................................................................. has permission to perform ..... filj �r"., ........................ wiring in the building of...!� 7_?� at..... ........................................�.. ,North Andover,Mass. . . . ............................. Fee. Lic.No. ........... ...............� '..... . ........ ELECTRICAL INSPECI'oR Check # �%9 554 I HE UUMMUNVVt AL1 H UP MA.MU11C/,NE11 J Office Use only DEPARIA1&VTOFPUB1JCSAFM `j S �� Permit No. BOARDOFFREPREVUMON ONS527C11�tl2.V0 A0 01Z) Occupancy&Fees Checked i APPLIGATTONFOR PERXff TOP ORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MA ACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the elee�cc�trical work escribed below. Location(Street&Number) S Owner or Tenant 61) D -f- Owner's Address �J� ��/� < �L� ✓ -L, Is this permit in conjunction with a building permit: Yes M No r7 (Check Appropriate Box) Purpose of Building Lo --1 �,, / 1'✓/<�/, Utility Authorization No. _ Existing Service Amps Volts Overhead O Underground No.of Meters New Service AmpVolts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons do.of Disposals No.of Heat Total Total No.of Detection and Pumps . Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices t No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• htst WWGDWaage.Ptusiantmthetergmana�s�GalaalLaws IhaNeamu tliabkyka r&=Pblicyurkxb gCc npletDCorsaFor sakgmrialequivaimt YES NO IhaNestilxrbd dvabdptoofofsam tDtheOffre YES ff}whaveched®dYES,ple=n1Ca1ethetypeofaA dgeby INS[JRANCE BOND r7 OIFII'R (Plea9e Sptx;ty) 1? Dale WodcnDStatt (�� FstamledValaeofBocabcal Wolk$ D& Ratgh Final FIR ed Signe NA.-r& ofpetjury _ un / C L" c L=WNo. Licel>�e GG1 U/c 6( JIQ G/r .r19�- Signattue LiomseNo Z, BusinessTel.Na �kS_J 3 d e OWNER'SINSURANCEWANFR;Iamawa<edmttheLiomwdoesnotbaitdV >su MOD aicsabstaldal andthatmysignaftmond%pemvtapp1icMmwarAsthiswgmernmlt � ��'�Ga>ErdlLaws Y y (Please check one) Owner a Agent Telephone No. PERMIT FEE$ Signature ot Uwner or Agent Date.................................. �aORTh °ft °;•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ��SSwcMusf� This certifies that �. ��c..�' ................. ........................... ................................ has permission to perform ..........�Y ............0 '- ........................................ wiring in the building of 1'' .............. ...................... ST ,North Andover,Mass. f&&'63.4 (; _)� �. Fee....Z�.....'...... Lic.No.............. ............... . .......................P.......:n ....... ELECTRICAL INSPECTOR Check # 73 16 Official use only Commonwealth of Massachusetts — Permit No. -- Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/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: 111-7/67 City or Town of. NORTH ANDOVER To theIn pector of Wires: By this application the undersigned gives notice of hij or her intention to perfo the electrical work, -scribed below. _ Location(Street& Number) Wo nccl 004 S`f£ -ti?I L06 I Owner or Tenant f491 OS S1 LLC Qzg ('0fyk rttrelephone No.979-I7S-Y,% Owner's Address Ux e- Pwd( Rtt,ov-CA HA3• Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) r� Purpose of Building Oil►L � �yU 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 r� Location and Nature of Proposed Electrical Work: gba 3 0 2nd P-L , 114--> h{ -aZ APP2o* 30 �Lr cv6rLL(� S ah TekAkfiI dcGps Completion of the following table may be waived by the Inspector of Wires. x 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. rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons 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❑ Munic'pal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of WaterKW No.of No. o Data Wiring: Heaters Signs Ballasts No,of Devices or Equivalent 1' 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: Q 7 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 covyrage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ["J BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and enalties of perjury,that the information on this application is true and complete. FIRM NAME: 1+L rf cfJc Co �Jc LIC. NO.: it5034 Licensee: W-4gyiP SO1/7e S Signature? LIC. NO.: (y5O,j (If applicable, enter exempt"in the license number line.) Bus.Tel. Address: 3 (3At.ki /QVC, 03b-11 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, 1 hereby waive this requirement. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. i I TOWN OF NORTH ANDOVER. of HORTM q ti�eo v° 4V Office of the Building Department Community Development and Services 1600 Osgood Street North Andover,:Massachusetts 0184 �/�°y --.�• � •.4 �'p4ie0 �y.� Ss us Telephone(973)688-9545 FAX(978)688-9542 March 23,2010 DB Baseball Softball Academy 1630 Osgood Street North Andover Ma 01845 RE: Building# 1630 NOTICE OF VIOLATION In a recent safety inspection several building and wiring violations were observed. 1. Hanging/Broken emergency light signs and several non-illuminated signs observed. 2. Extension cord running under carpeting,NO EXTENTION CORDS are allowed under any circumstances especially to operate appliances such as vending machines.All fixtures should be hard wired. 3. Emergency light were inoperable and need to be upgraded to light all proper means of egress and practice spaces. 4. Several Maintenance issues observed such as missing ceiling tiles,Deteriorated walls,Debris stored in egress to the mechanical systems and trash dumped outside the rear door. The building has a general appearance of being run down and poorly maintained. Please be advised you need to apply for your annual Certificate of Inspection and these violations need to be corrected before your annual inspection. Failure to correct these issues may result in a fine of not greater than $1000 per day. You have 30 days to address these violations as per state law. 780 CMR 118.4 Violation Penalties. Whoever violates any provisions of 780CMR, except any specialized p alized code referenced herein, shall be punishable by a fine not more than$1000 or by imprisonment for not more than one year or both for each such violation. The building Official shall not begin criminal prosecution for such violations until the laps of 30 days after the issuance of written notice of violation. Sincerely, Gerald Brown Inspector of Buildings a iie.:l.ULrlLVIULV Y1'Gfi"n U!'Iy"L ViL"UM115 uttiice Use only j DEPARTAIEATOFPUBUCSAFRY Permit No. 1 � 7` BOARDOFFIREPREVEMONREGUTAHONSM7aM l2.{-W Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 `--tPLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) A) O's f b 0 � 5 Owner or Tenant 111,60 g ev S-(GC C J Kd - 11T-) & -4=- /77. �u Owner's Address e�� /� A Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Buildingy + r �,, / 1' Utility Authorization No. Existing Service Amps volts Overhead a Underground No.of Meters NPw Service Ams / Volt O d P Underground No.of Meters er of Feeders and AmP acity ion and Nature of Proposed Electrical Work Af r 7777777=7) of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units of Switch Outlets No.of Gas Burners of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons 6.of Disposals No.of Heat Total Total No.of Detection and ' Pumps Tons KW Initiating Devices of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained L. of Dryers Heating Devices Detection/Sounding Devices KW Local Municipal Other Connections o.of Water Heaters KW No.of No.of Signs Bailasis o.Hydro Massage Tubs No.of Motors Total HP r�HER- Coverage.Ansraribtheregmanais�G3raallaws �eacumiLi&&yksna=Pohcyi dudrgCwpi& cowWcrilsW)sw[ almpvaimt YES NO ves-1 i ad vafidptoofofsanetotheOEroe YES � ffymtmed d®dYES,plea9eudc&the �g� b ryPt afooverageby Na ANCE BOND OTHER (p1 eSpedfy) WO k ID Start lJ' � R ugh Estirrra!d VatreofEJac4Final do $ sigledurxiA Ofpjtlly 1 FIRMNAME LinerwNo. _/`Y,3 S, Lio3>serlo �� ? ;"p � BusiI=Tel.No. �,kS J 3 d r ArjrlrPcc l c 3 1 C� .,✓r'�fi��� !//t � I S NSURANCE W Alt Tel Na �°3 7�J` 1 ANFR;IamawarethattheLioa>sedt�esrlotha�+etheirma�aloe orilssubstarial �reage egnvalentasraquaadbyIVGalaalLaws Y;r y mysigrnhaeanthispemitappLatialwaivtsdi�regttitanalt (Please check one) Owner Agent Telephone No. PERMIT FEE$ signature 01wner or Agent DEPARINWOPPUBUIC34FETY 6 p Z.0 BQ4RDOFF=PREVF1V1110�IVR1~Xi[1LA?1rOVV5527adR12* LPefMndt1N1& /�Few Checked APPUCATTONFOR PER1V11TTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERPORMED IN ACCORDANCE WTTH THE MASSACHUSM ELECTRICAL CODE,527 CMR 12:00 J (PLEASE PRINT IN INK OR TYPE ALL VMRMATION) Date l c/— © f Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street 3 Number) (Ov 0 �sq OU W st Owner or Tenant 1660 040.0 po LLC �Z r,; 1YA). AJ X s qe Owner's Address is this permit in conjunction with a building permit: Yes No (Check Appropriate Boa) h purpose of Building d Gum fi 5� G. S rpo �;�,-Utili Authorization No. !`} Existing Service Amps��olts Overhead Under�ottid' 4 b Mo�Metal Am / Volts New Overhead U Ne Service �� pg�� rdergrottrd Nt�of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work bui&< levrt No.of Ushtiag Outku No.dHot Tubs No otTnMaxrosra Told KVA No.d Liglkdn$Pixtum Swi mins Pod" Above Below ()mentors KVA sad No.of Receptwle Outlets No.of OB Burner No.of a cy Li shins Battery 17TS No.of Switeb Outlets <t No.loss Bum= No.of Ranges No.of Air Cond. ToW FIRE ALARMS No.of Zona Ton No.of Dispo" No.of Hae TOW Told No.of Damcdon and ponve TOM KW No.of Dishwaben Space A ,Heating KW K&dDavies Ana Device No.of SeKContebned No.d Dryers Hwd ns Device KW Locd Dedra Com>ecdon No.of Water Heston KW Na d Na d Sias Hanna No.Hydro Manage Tubs Na of Moton Told HP 0 T HER• ]raxar=tbmW Asarar 1Ddrrac}==ftd *ma1u GnniLs s Ihar 8a=TSL!t 'JU==Fi7iej'irLdr; NO Iharesubm dvaidpeoaf saabhomon YM � ayauhmc a YE%Ph=hJ=1hety9d�b, lam �/� g��Va�afFahtdodweac S WOkIDSINt oS 011�� ,W r�l Cy GI FIT,,, SpIedurtdcr Phaft fpejiry. 1 l I(C 1 T U C .^�—�;c ` `a FEMNAMB l [.nnNa l tie VV h /tit W. Sp l Rr s Lic,,m 653 �Ad*m .� f3���1� Vn. Sr(�� N� Div�-�� Bra�s'11iNa 1 11 No. OWTAMSIIVSLRANMWA1VQt;Iarnaw ffigftLi� dleirla>�Iae AtTMm r•__� ardthaniyAg er>ecrift is a�-1-- i�thi� �a °yrs"t>�iit>�ele�ivl�itassx}iredbyae®daeeeGalaelLaws (Please check one) Owns a Arlt . Telephone No. PERWr FEE S DR1l1171MToFpEWXS 'W OFFIREPRE'V1�V11g1 yA�Z��, 12� Pamit N06 /�1 Occupmtcy Fen Checked . APPUCA71ONFOR PERMIT 710 PEWORM 4EcIRICAL WORK ALL WORK TO BE PF7tpt1RMBD IN ACCORDANCE wrrH THE MAMACi &M M.WUXAL Coos,327 coot 12:00 (PLEASE PRWr IN INK OR TYPE ALL INFORMATION) 0 �S Town of North Andover The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location(Strew d:Number) Iko 0s�,d 40+ ,�ejt- - b t/ Owner or T Owner's Address �t Is this permit in conjunction with a building;penait; Yes No 1:3 (Check A Pd .v ppropriate Boa) Purpose of Building K�`� �i f'-d�/ a G t S Utility Authorization No. Existing Service Amps Volta Ovedtead U 116/} p No.of Metas New Service Am,27 �— oipNo.of MetersNumber of Feeder and Ampacity � U .� Location and Nature of Proposed Electrical Work cow, Na of Lighting Ootbh Na of Hot Tobe Na otTitoaaxtosm Told rl KVA Na of ughtiaa RI ma eit�Mo AI O 3wbnndna pool Above Below � KVA S A. Na of Receptarls Outlw O Na of Oil Bueoets Vollowd Na of Vahtina Buttery �ae�T lJnib Na of Switch Ootlsts {„� V No.of On na Na of Rama Na of ow Coed ToW r of Dbpoab No.or Heat ToW Toni PDtB AI•ARi►i3 Na of Zees Tons Told No.of Nbcdca md. of Dishwashers " SPS Ataa Headtta Kw foitbtbB Dsvtea KWSoundhig ,� Na of Se f � �� of Dryms Reties Dovka Detecdon/3owdna Dedoa Kw Qof Winer Halms KW Na d �� Lord a Conoecdorts �-r Hydro N!"u a Tube s Amb b Na of Motao Told HP PiattetblretegioraioflV�a aaaQitl��R:icyi�� s Ltw�orktsrfn�ay� YES ik � r�trhonea,eaedY!$,Pt�ido*be � �l �mebdValue Wt $ urd� ofp % /'/t�2.;i / AN UOUNQ LiaQ.erb /� Sr-4v live �a RaloraTaLNa 1778 -8Is-7a a DOM AtTliNa 1.���ddvam rs rnHs VSM&ANMWAM-lg6-roaetlietlhelicaa (Please check one) 1:3mfirequi�t e9 +*aaas�iiadbyll'leeaada>aebC,�iiLaris AS@m 311nm".01 VWUN or. 1:3 Telephone No. arm carr FEB _.--» 2D � � --a C� PIC7 773E cojvLVIOAIVEALTI-IOFMASSACfIUSETIS Office Use only DEPAffi3f E�TOFPUBIICSrII= Permit No. BoARDOFFREPREVEN770NPEGUTATIONS527QV1IZ12 00 Occupancy&Fees Checked APPLICATIONFOR PE ,,AHT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 11 /8/05 (LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 1600 Osgood Street Owner or Tenant Ozzy Properties 1600 Osgood Street LLC Owner's Address Tftree Dundee Park Andover , MA 01810 Is this permit in conjunction with a building permit: Yes F-1 No F-1 (Check Appropriate Box) Purpose of Building Parking Lot Expansion. Utility Authorization No. Existing Service Amps_ / _Volts Overhead Underground No. of Meters. New Service Amps_ / Volts Overhead Underround No. of Meters Number of Feeders and Ampacity 1 - 100 Amp 3 Phase 480 Vol t Location and Nature of Proposed Electric oN .E:a.s t Lot Parking Lot Lighting No.of Lighting Outlets No ll Na of Transformers Total KVA _ No.of Lighting Fixtures Swimming Pool a Below Generators KVA round ground No.of Receptacle Outlets No.of OilBumers No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons of Disposals No.of Heat Total Total No.of Detection and 4\-14e Pumps Tons KW Iniiiating Devices �tvo of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained De(ectiotdSounding Devices _ No.of Dryers Heating Devices KW Local Municipal Othe 0 Connections No.of Water Heaters KW No.of No.of Signs Bailasis lydro Massage Tubs No.of Motors Tota.HP i sR' �eCaa�age Ptns�rYtothe�ag>st�r��Gena-aliaws QI=Ld)kkmranmPo LyzLkd%C A)ice Cbvegporisst6t"ialmpNaU1 YES !® NO tib edvaldptoofofsametot rO icr~YES Y)cuhawdisc mdYFS pts ne- catelhetypeofawaagpby ExpirananDt� F.stnuDd ValleofD�Wak$ ;Sut / .�� '' k6poAmDaleRa4rs>ed Rao Final 6ixTrpe"Y 1ANiE , �`CiJ�c� �r�_ %c - •�� c L..No. No ..� J BusirmTel No. a%C..l;,%�^ .77 Al.Tel No. �'/6 �. n SINSURANCE WAIVER;IatnawaethattheLxnmdoesnothavethemg- ,ux�ecorer:Veoritsa6zirloaleg ivdentastegutedbyNLSCxrlaalLaws cry sgriithne on this p�rut appli4>�n wanes this rec}tu���t i check one) Owner AgentED 7 Telephone No. PERMIT FEE ;�.� 'G Signature ol Uwner or Agent o � a l � Jan 05 06 02: 38p Tel p. l NN ENG ENG P4`'E �Q'1 �?1 i 05i 2006 1 i s 2�t 9786851 t]99 �f11lflMaltt/�r[vaane. r eu a LO Lrp+11iDOFFMSMZVVB�IV �SalClblRI1� L Au Chs0md � PERMIT TO PERFORM EEEC'rRIC�WORK — k pUC 'Q N FOR PQI ALTERMFRM*1"TO)4AMACMt►SM gLeMICAL Com,527 cm 12:00 ML WOW To a pUMMED(pLEASB FX M iN VC OB TYM ALL WMRM►TION) To dw Inspector of W'ims, Town 0000b At&vw ,�uad�li��{►q for,pern►11 to podotm the elxtritd work dexribed belotr. L0c,ti0n(Stmet t NumbW) 1(o , ) C' c 0 0 y !-'TR C'01 'T pi ® O 5 i'►rE a-C� owacr a - C ',2.. Owner'r AddrwNo (Cbeek Apprap&b Box) is tw permit in conjunctim With a buildinti G�� Ya© Utility AudrotiiAdon Nm yo purpose of BulldlasAra Votq � 0 U No.of Merv+ Elilting gervice ---- A�r�� No.of Melc*s � "�� Volts O' � Number of Fcedee and Ampfidq — lt7 red Eiecttiotrl wort ���s LocedOn end Nsrute of pmpo ra.dlluoslmas Taut tis.dMu Tube KVA r°of KVA rto.of u dei K mu lw�rudee�b0f '�0'~ Helw No.of OMrn No.ON ON lsrws W or 5i-, sroy UHmws Boom tlmub No.o SRtmb O,r+1�d t7o.d Homus tjs d Air Coni TOW Fm At AUU Th or 7�tef.�.. rNa of N&d Hm TOW TOW tfa d Dessliur wi ....�� No.or aspo"m *mts KW Iswrhs t)AW v�Am Kw No or sardbs DrAm Na.al r9thwuhm Na d Nd OiPAM W Demakm Wme4ti Dodgy KM LOd d Drrn acr< a CAIrlltdorre No.of Wry YQe KW r&d d Sim ad" No.Hyo MWAW Atm NO oto e tm� /1�ice �f� �7r �/�r� • a�r»m t ,�„�„i�puordsntttole0tfin Y10 121 13 Pr t1lVAmdEkftRNt s 4 Wc*ios t I tint tint eR wipe c le l e 9C�. I uoarerl� "NAM + (�s ANN& r ��,� ia®aeoo�etrlr s>�edbYMsf,edsl7srxr,lLmw aWP�RSR�IJRMKB�YAt�RltlemtrrselrtleLi� orlrebrrlrl w ' rdQrtnb�eura►lipeoni liee4tlrsttai l� I (Platy cheek one) 0WW AHerll Teleplani No, � --4—L?JLJUW FRE or f 1 v! )Ifilcial Commonwealth of Massachusetts L - N Permit No. Department of Fire Services F"',Checked _ Occupancy and Fee BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9.051 deme blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK \it%Nork to be pco'ornied in accordance�%illl the\,lassachuSetts FICCIriczIl Code(\IFC). 527(A. 111 12.00 (PLEISE PRINT IN INK OR TYPE I I LL INEORAL I TION) Date: City orTown d: To the hispeclor o/ Wires: By this application the undersigned ,iv�es notice of his or i-r intention to pe Form the electric l work described.below. Location (Street& Number) Owner or Tenant0 fD6 PC, 'relephone No. Owner's Address i P- Cx4, - A�e&(1140 1,0 C." Is this permit in conjunction with a building permit? Yes Q_—No ❑ (Check Appropriate Box) Purpose of Building rM. *I'ty Authorization No. Existing Service Amps Volts OverheatNo. of Meters New Service Amps Volts Overhead❑ !6rd ?V No.of Meters Number or Feeders and Ampacity Locatio and Nature of Proposed Electrical Work•, t i vi X0 cue 4:e3 _G ('olpipletion(?/iliefiWou-ing table maY he waived by the Inspector of No. Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers _KVA KVA No.of Luminaire Outlets No.of Hot Tubs Generators Above Ing N N 0 0. 0 of e Hot T S uu bsp s Al 0 r C No.of Luminaires Swimming Pool gr-A e ❑ E. F-1 Units r rs Zones No.of Receptacle Outlets No.of Oil Burners 11FIRE ALARMS n No. of Detection an No.of Switches No.of Cas Burners Initiating Devices Air C Total I r 0 No.of Air Cond. No.of Ranges Tons 1No.of Alerting Devices Heat Puiqp�Number I Tons KW No.of Self-Containe . ............. No.of Waste Disposers Totals: Detection/Alerting Devices Space/Area Heating KW Local 0 Municipal El Other No. of Dishwashers connection No.of Dryers urity Systems:* Heating Appliances KW No.of Devices or Equivalent No.of WaterNo.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: 110f h dddilioWd detail qdt,sired, ()I'(IS J't1(jjIjj'tj/1.1 the h1S/)L'L'101.1�/ 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 C0\,el_Z1gC is in force, .old has exhibited proof ol'none to the permit issuing,ollice. CIIECKONE: INSURANCE El 130ND 0 orFIER [:1 (Specify:) I certqjl,under the2i",I L rand gena-tes o perjthal the�.Lllorinafion on this application is true and complete. FIRM NAME: , I^ C, LIC. NO.: t-1- Z��.-_�_- __ l LIC. 0.:? Licensee: Signator� , ?C b "Ist,111,L111ber. line.) B 2 (1/ hea b 1'e, clae us.Tel. No. Address: -r? 1_4 A)i-6- Allt.Tel. No.: "Security System Contractor Licep.e required for this'V1'Vork_._if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I ani 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)0 owner E] owner"s agent. Owner/Agent Signature Telephone No. PERMI T rE,E. S � � � � ��� ���� �� . :� ���r� � � L'� i -� �/ -�� The Commonwealth of Massachusetts r f Department o .f Inductria[lgccidentc r ~�'Lr ; _ Office of InvestigatJAns :,�i 600 Wash „;s" ine,,,ton Street Bosco n, MA 02111 �SS.e O1�Idi.Q Workers, Compensation Insurance.Affitdavit; guilders/Contractors/Eleetricians/°lumber Acr Iicant Information s Please Print Legibly Name (Business/Orl'aniza#ion/Individual): m e� Address: City/StatelZip: Phone#: FAreyo�u an employer?Check the appropriate box: L�J'I am a employer with Q . 4. ❑ I am a -eneral ol Type of project(required): employees(full and/or part-time).* have hir d the sub-contractors '6• 11 New construction 2.❑ 1 am a sole proprietor or partner_ Iisted on the attached sheet t 7. ❑ Remodeiinc,. ship and have no employees These sttb_contractor have o working for me in any capacity. workers' 8. ❑ Demolition [No workers' camp. insurance 5. comp. insurance. P ❑ We are a corporation and its 9• ❑ Building addifion I am a ho ofiice�rs have exercised.their 10 ❑Electrical repairs or additions 3.❑ I am a homeowner doing all work- right of myself. [No workers' comp. iic.ht exemption Per MGL I I.❑ Plumbing repairs or additions insurance required.] t ' §I(4),and we have no 12. q. ) employees. [No workers' 110 Roof repairs comp. insurance required) 13•7 Other *Any appficant,that checks box#l.must also fill out the section below showin their work' +�'tonl=wllem who submit-this aildavil indicatikg tiiet-art u'oiF.a::"ii%S:!;;a .9 en'compensation policy information. IConmmtors that ehec;k this box-must attached an additional sheet showing he name hit,- ui10E eontru juts rnusi suur„it a nvu,affidavit j oft._,,b �,..=tom and their wotyters'comp.pof icy indi=ing infonna+ion I am ar, erstployer That is provirfine workers'compensation insurance for ny'a to ees Below is the Policy infnrmatiorc y p cy and job site Insurance Company Name: Policy#or Self-.ins. Lic.#: � C 1 Expiration Date: Job Site Address: City/Statr/Zip: � Attach a copy of the workers' compe tion"Policy declaration page(showing the policy number and e • ± Failure to secure coverage as required under Section 25A of expiration date). MGL c. I52 can }cad to the i fine up to $1,500.00 and/or one-year imprisonment as well as mposition of criminal penalties of a civil penalties in the form of a STOP WORK ORDER and a fine of up to.5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Investigations of.the DIA for insurance coverage verification. Office of I do hereby cern er the pains and penalties of perjury that the ur or f mafion provided above is true and correct Sisnature: �- Date: D Phone#: Official use only. Dn not write in this area, to be completed by city or town official Cite or Town: Permit/License# Issuing Authority(circle one): L Beard of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Piumbirto 6.Other Inspector b p i Contact Person: Phone Information c nd 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 mcluciirz.g the legal representatives of a deceased employer,or the receiver or trustee of an individual,.partnership,associati on or other legal entity,employing employees. However the owner of a dwelling house having not more than three ap artments and who resides therein, or the occupant of the dwelling house of another who employs persons to do ma.int.-nance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall nat because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state a r local heensing agency shall withhold the issuance or renewal of a Ticense or permit to operate a business or to construct buildings in the commonwealth for-any applicant who has not produced acceptablie evidence oh-T compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) stags"Neither -the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public worts until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the cont mzting authority," Applicants Please fill out the workers' compensation affidavit comps-etely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)along with their cem-ficate(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 thatt this affidavit may 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,anyquestions regi,-ding ffi---lana, or if you are required to obtain a workers' compensation policy,please call the Department at the na-mnincr:liswd belovi. Self-insured ca«panies should enter their self-insurance licsnse 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 foryou to fill out in the event the Office of-Investigations has to contact you regarding the applicant» Please be sure to fill in the permitthcense number which will be used as a reference number. In addition, an applicant that must submit multiple permMicense applications in arty given year,need only submit one affidavit indicatingcurrent policy information(if necessary)and under".lob Site Address"the applicant should write"all locations in o(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 Iicenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a Iicens� or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of investigations would like to.thank you.in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; The Commonwealth of Massachusetts Department of l dustrial Accidents. Office of Lavestigaiiions 600 'Washington Street Boston; MA 62111 Tel. # 617-727-4900 C=406 or 1-877-MASS.4 FE Revised 5-26=05 Fax 4 617-7-7-7749 WNMI-nass.D ovldia t Date. 94'12 NORTH TOWN OF NORTH ANDOVER PERMIT.FOR PLUMBING 's CHUS This certifies that . ./t'0. . ?r . .I.ttglC'f�4���4 has permission to perform . . . //VVA .. . . . . . . . . plumbing in the buildings of .f.GP�. . . . oG .S/� .4k� . . . . . . at ,rsAg2. i1. 5 .. N h Andover, Mass. Fee. ��.Lic. No./PO 7 . PLUMBING I PE TOR Check # �S 7 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE PERMIT# JOBSITE ADDRESS QS 004 II OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: ®1 RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES®I NO®I FIXTURES 7 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM I DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK __ g LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET J URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING _ OTHER II I ) I 1 INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES tj/NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Rj/ OTHER TYPE OF INDEMNITY © BOND ®I OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 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 accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ot�t �1 LICENSE# 0 0?3�! SIGNATURE MP DI JP Q CORPORATION 0# PARTNERSHIP F--j# ( LLC D# COMPANY NAME y71 f C ADDRESS CITY C tSTATE WC i ZIP 6 TEL 7Y7 2 0 Y) FAX CELL[ EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES ,.w-. . Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ �� A FEE: $ PERMIT# PLAN REVIEW NOTES x c� •1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IV 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): `�(� `e q1 Address: S�— City/State/Zip: �� ��� �'1 S Phone Are an employer?Check the appropriate box: Type of project(required): 1.RJ I am a employer with 4. ❑ I am a general contractor and I 6. [JNe onstruction 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.t �• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y P tY• 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.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.[:]Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certio under the pains and penalties of perjury that the information provided above is true and correct. Simature: 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#: ,h L} Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employeiis defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial 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 Commonwealtl of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston}MA 02111 Tel,#617-727-4900 est 406 or 1-877:MASSAFE Revised 5-26-05 Fax#617-727-7749 wvvwmass.gov/dia 7 Date....!. ................. f ,10R7N'1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHU This certifies that .............: .`'r..`.:........................................:... ............ has permission to perform .. °L ...........:. r wiring in the building of ~ ... .:....... ...... .. ......................................... at�('`......C�* *?�.: v .. ,North Andover,Mass. ..... ......................... . ..... Fee..................... Lic.No/4-,W--, ........... ()� .rcpt ELe icwi.INsr crox Check # 11.5 760" 3 ' Official Use Only Commonwealth of Massachusetts y Department of Fire Services Permit No.—� �e� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 1-116. [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 12.00 165 (PLEASE PRINT W INK OR TYPE ALL WFORMATION) Date: J City or Town of: NORTH ANDOVER To the In pec or of Wires: By this application the undersigned gives notice of his or her intention to erform the electrical work es ribed below. �� Location(Street&Number) Ua QS-pa c,1 ItS Owner r Tenant J&00 ooa Sj. LLC OZZ ra �eti em �" Telephone No`s 7(3~�-(1$-�$�,� /144// Owner's Address ]�QQ CSSGoc) Si . �v c P S- W 2*%A FLo�� Is this permit in conjunction with a building permit? Yes F, No ❑ (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: BU'I » AQ f sfi Fl 002 w w� t,c�t i �►scoN�ccfi a�� l�Ficc Sin e elec li c °�'c{ -As cth.d Completion o the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Tor No,of Alerting Devices No.of Waste Disposers Heat Pump Number .Tons KW No.of Self-Containe Totals: "' Detection/Alertin Devices No.of Dishwashers Co nici al Space/Area Heating KW Local❑ p ]Eouivalent EE IJ ' t No.of Dryers Heating Appliances , Security Systems:* No.of Water No.of Devices o No.of No.of Heaters I Signs Ballasts Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring. OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Ele trical Work: 16 Uoo _ (When required by municipal policy.) Work to Start:9 0 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 cov rage 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 NAMECo. Tj.1c . _ LIC.NO.:1 b 50 314 Licensee:VJ tvit W- C�pil*rs Signature Wak" SLIC.NO.:r6so 364 (Ifapplicable, enter"exempt" 'n the le ense nu�k er line.) Bus.Tel.No.: Address: �� 3 ('��� � UC • J4,f '1 �•�, Alt.Tel.No.: 765-9 *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: $0�6 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . l 600 Washington Street Boston, MA 02111 www.massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A> olicaant Infora;ation Pieal se Print Legibly Nance(Business/Organiratiortnndividual): ,l E L la. Co . Address: L3 L ra AQe. . City/State/Zip:_��.L I ti 030 �1 Phone#:_�p()3' 7b,5— 97a2 Are u an employer?Check appropriate box: Type of project(required); 1.( I tiln a employer with 4. ❑ 1 am a general contractor and i 6. ❑Now construction employees(full and/or part-time).* have tired the sub-contractors 2.❑ I am:a.sole proprietor or partner- listed oTi the attaclted sheet.t 1. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. q, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10❑ ectrical required.] officers have exercised their repairs or additions 3.❑ 1 tint a homeowner doing all work right of exemption per MOL 11.❑Plumbing repairs or additions myself[No-workers'comp. c. 152,§I(4),'and we have no 12.❑Roofrepair8 insurance required.]t employees.[No wor kens' comp.insurance required..] 13.❑Other "Any applicant that checks bort#l must also fila out the section below showing their worked'bompensation policy information t Homeowner¢who submit this striftvit indicating they are doing all work and then hire outside contnwtors must submit a new affidavit indica*such. 4Contractors that check this box mustattaehed an additional sheet showing the name of the sub-rwntructors and their workers'comp.policy information 1 am-an employer that is prjWfi rg:workers'compensation Bnswwacefor my aiployem Below is the policy and job site information. Insurance Company Nam e (,,Usk lmsk tqA)Ce c.o m a u Policy#or Self-ins.Lic.#: WC IA- 14 - 63 Expiration Date-_4L31 o 013 -13)__'o V 0-j--oo p Job SiteAddress:l{�O& QS4CJ S1. �,i 1 ►h�010, ktf-Boor Ue'u') Ctty/State/Zip i1, L1kb 1e2 .Mi(�, Oi$ys Attach a copy of the workers'compensation policy declaration page(showing the poficy number and expiration date]. Failure to secure coverage as requited under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert' under the pains and penalties of pMtuy that the information provided above is true and cone Si )ate: 2� // Bare: 911 ► + Phone#: k R 5`f D2 , offlew use only. Do not write in this area,M he completed by city or town offrciat j [6. ity or Town: Permit/License# ssuing Authority(circle one): 1 .Board of Health 2. Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector Other ontact Person: Phone#: � 631j7 Date./..-Z: 1 Jan 05 06 02: 38p Tel p. 1 NEW ENG ENG PAi;E til E�1 i�5i 2E7�6 1.1:29 9786851 VJ99 LCmfU111L11 j Vrfuoew."wa W*H* c� WOFFM�� Warm v 0 ,til' yP T�PauChadned APPLICAT'xON FOR�PFRMP T O QW, C,s� WORK AU woXIro a pgafwfm IN Da (PLEASE PRIM'IN W%(3tk TYPE ALL TMRMA170") To the h,tpector of Wims: Town 0000h Al*vot Tho undwipw wpa"for a P"15"^w Perform IIIc rlectricd work described taloa. _ Loc ation(Stmet d Nuatber) 1�,CI c o o.ra sT R E " Owner a enW ti'r ~��- A t C . ,z. Cr v i iv C.. (),net's Addru+ (Cbwk Apptop imb B02) Is this permit in eonjurwam With builflin><Pm�� Yd© No a UtWty Aut 6IAdon No. purpose of 131411dtrls n� c G Orertleed Urlder�lould No.of Mews f Votp Existing genice —,�.�.. 'APBr.�� Arertfced Under"nd 0 N4.of Metas ���,,.L,QQw�yv�yw���VofV �.R.Yp+�r r Numb,of Fcedw and Amply sed Blectrtctl Wort Locedon and NOM Pmpo ft dnwo.r� rout wd"Tuw KVA Ni.of updqOdd- rl Bellewower Ns KVA o ria d U{Ddne f4xee stt�amim poet nsow No.d Ulf ews.s N:of Ha�rpao�Ude►^s a1�o1i o.of a'" _Z7,97SRiu"A f„tYtl d B Ne,d Cad TEd FmAt AR>tl! Na of 7tx�et ..�� Np o/ N&of Hwe TOW Taut No.dD@ucGm wd ....r. Na d Olo�eM � lbwr Kir Irldotl�Devlo• r+.A.00611.9xw Na d sa.ars Devices He.of t%.h...hre He.at%a tlneeh ed Ne.d DrM �Devices KM Lxa1 CI Colas Rw Ne of [ia of Vo.o/Wry Hewn KW Sim B"o No.Hp1ro fdww'hhe Na ad a� lA) - C#'7-.? leo icy A,r140 �AT� �9/� • harm-CHIP pp�eer�rff� flr�da>�aserrL�. peft:d -ffaofxnibrerttrleqA+e" Na thsie>ttrrflledw«]pcdaf wtffiolllmYIP I<pulse>dledrldY>�,plre dettpedo��eM a m Q ob,1114wv�) Jj A GI .0!�S �fwlvslfedt3l�dcdt�f s 3600Lima e thlNia ONVPERSIKAJRMI�VYAI�t'ltengwsehtlfaif�s>��,1� ifafmr�aatap+a�e�liife,fe4ifedbyMfatsia�Ci�neratta�la sdaacltbiReufattltYptaf>t ernes �/ (Please cheek one) Oww Armj OO Telephone No. Ed �MMr FRO ,0t