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Home My WebLink AboutMiscellaneous - 1600 OSGOOD STREET 4/30/2018 (25) ��I. �s�..�w�5 J �� s �� _ _ �� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 196 (9114/09) Date: November 12. 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood St Bldg 20 —Mentor Network MAY BE OCCUPIED AS Tenant Fit un IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Ozzy Properties 1600 Osgood St North Andover Ma 01845 Building Inspector F NoRTM Tovm Of 0 VO 1 Cho �o LAKE i over, Mass., D COCMICMEWICK y�. ADRATED O'Pa\ "♦y S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....../... �✓� .. ............................... `'O/ ....go ................/ ................... Fou ation has permission to erect...:.................................... buildings on • to be occupied as /............0 provided that the person accepting this permit shall in ev respect conform to the terms of the application on file in Final /2/G this office, and to the provisions of the Codes and By-Laws relating to the Inspection,"Alteration and Cqnstruction of Buildings in the Town of North Andover. 'Pell - F 0 tea, PLUMBING INSPECTOR F' VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough n vv�c PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCT1,9N STARTS ELECTRICAL INSPECTOR 0Y " ...... ....../ ........ Servic r `1 ✓ �� X-F i a ✓ Occupancy Permit Required to Ocmpy Building GAS SPECTOR 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 �G Street No. SEE REVERSE SIDE smoke Det. f { November 11, 2009 Mr. Gerald Brown Inspector of Buildings Town of North Andover 1600 Osgood Street North Andover, Massachusetts 01845 Re: 12,000 sf interior office fit-up, floor 2, Building 20, Ozzy Properties 1600 Osgood Street,North Andover, MA Dear Mr. Brown: Based on site visits through 11/06/09, the 12,000 sf interior office fit-up, floor 2, Building 20, Ozzy Properties, 1600 Osgood Street,North Andover, MA has been reviewed by us, and to the best of our knowledge and ability,this project has proceeded according to the drawings dated 09/09/09 with minor revisions,prepared by this firm: R. Rumpf&Associates, Inc. Furthermore, this project is substantially complete and ready for occupancy. If you have any questions regarding this project,please call my office. Sincerely yours, Ste . L' ermore ' MASS. Pro ct c tect SWL/occ trl OF R. Rumpf& Associastes, Inc. Engineering, &Architecture 57 Wharf Street Box 4483 Salem,Massachusetts 01970-6483 978.740.5025 978.607.0045 fax On this 12th day of November 2009, before me, the undersigned notary public, personally appeared Stephen W. Livermore (name of document signer), proved to me through satisfactory evidence of identification, which were Personally known to me , to be the person whose name is signed on the preceding or attached document, and acknowledged to me that ®(he) ❑(she) signed it voluntarily for its stated purpose. Suzan M.-Moffett My commission expires * IN;%Pary Public Cortirronweai4h of Massachusetts &Ay Commission Expires March 7, 2014 R. Rumpf & Associates. , Inc. P.O. Box 4483 57 Wharf Street 2G Salem, Massachusetts 01970 (978) 740-5025 (978) 607-0045 Fax slivermore.rra(&gmail.com Field Report #I Date: 09118/09 Time: 10.1 Sam Weather: Interior Fit-Up Job Number: rra 09-067 Job Description: 12,000 sf interior office fit-up,floor 2, Building 20, Ozzy Properties, 1600 Osgood Street, North Andover, MA Work in Progress: Metals Studs 25%Installed, electrical work underway Work Completed: stud framing layout substantially complete Comments:Discussed a minor revision in layout for the Men's Lavatory i.e. reconfiguration of the Janitors Closet and the HCP toilet stall. Inspected By: Stephen W. Livermore, RA R. Rumpf & Associates. , Inc. P.O. Box 4483 57 Wharf Street 2G I Salem, Massachusetts 01970 (978) 740-5025 (978) 607-0045 Fax slivermore.rraAgmail.com Field Report #2 Date: 09/24/09 Time: 2:00 pm Weather: Interior Fit-Up Job Number: rra 09-067 Job Description: 12,000 sf interior office fit-up,floor 2, Building 20, Ozzy Properties, 1600 Osgood Street, North Andover, MA Work in Progress: Metals Studs 75%Installed, electrical work ongoing, Installation of corridor GWB (one side only)started,fire alarm wiring underway Work Completed: stud framing layout substantially complete Comments:Discussed a minor revision in layout for the Men's Lavatory i.e. reconfiguration of the Janitors Closet and the HCP toilet stall. Inspected By: Stephen W. Livermore, RA R. Rumpf & Associates. , Inc. P.O. Box 4483 57 Wharf Street 2G Salem, Massachusetts 01970 (978) 740-5025 (978) 607-0045 Fax slivermore.rraAgmail.com Field Report #3 Date: 09/30109 Time: 2:00 pm Weather:Interior Fit-Up Job Number: rra 09-067 Job Description: 12,000 sf interior off ce fit-up,floor 2, Building 20, Ozzy Properties, 1600 Osgood Street, North Andover, MA Work in Progress: electrical work ongoing, Installation of corridor GWB (one side only) and taping ongoing,fire alarm wiring ongoing Work Completed: stud framing layout substantially complete,stud framing substantially complete Comments:Discussed a minor revision in layout for the Men's Lavatory i.e. reconfiguration of the Janitors Closet and the HCP toilet stall. Review 50'-0"maximum dead end at lavatory corridors (CMR 780—section]016.3 exception 2) Inspected By: Stephen W. Livermore, RA R. Rumpf & Associates. , Inc. P.O. Box 4483 57 Wharf Street 2G Salem, Massachusetts 01970 (978) 740-5025 (978) 607-0045 Fax slivermore.rraAgmail.com Field Report #4 Date: 10/16109 Time: 10:00 am Weather:Interior Fit-Up Job Number: rra 09-067 Job Description: 12,000 sf interior officefit-up,floor 2, Building 20, Ozzy Properties, 1600 Osgood Street, North Andover, MA Work in Progress: electrical work ongoing, Installation of corridor and Mentor space GWB (one side only) and taping ongoing,fire alarm wiring ongoing, rough plumbing& HVAC underway Work Completed: stud framing layout substantially complete,stud framing substantially complete Comments:Discussed a minor revision in layout for the Men's Lavatory i.e. reconfiguration of the Janitors Closet and the HCP toilet stall. Review 50'-0"maximum dead end at lavatory corridors (CMR 780—section]016.3 exception 2) Inspected By: Stephen W. Livermore, RA R. Rumpf & Associates. , Inc. P.O. Box 4483 57 Wharf Street 2G Salem, Massachusetts 01970 (978) 740-5025 (978) 607-0045 Fax slivermore.rraAgmail.com Field Report #5 Date: 10123/09 Time: 10:00 am Weather: Interior Fit-Up Job Number: rra 09-067 Job Description: 12,000 sf interior office fit-up,floor 2, Building 20, Ozzy Properties, 1600 Osgood Street, North Andover, MA Work in Progress: electrical work ongoing, Installation of corridor and Mentor space GWB (one side only) and taping ongoing,fire alarm wiring ongoing, rough plumbing& HVAC underway Work Completed: stud framing layout substantially complete,stud framing substantially complete Comments: Discussed a minor revision in layout for the Men's Lavatory i.e. reconfiguration of the Janitors Closet and the HCP toilet stall. Review 50'-0"maximum dead end at lavatory corridors (CMR 780—section]016.3 exception 2) Inspected By: Stephen W. Livermore, RA R. Rumpf & Associates. , Inc. P.O. Box 4483 57 Wharf Street 2G. Salem, Massachusetts 01970 (978) 740-5025 (978) 607-0045 Fax slivermore.rraA email.com Field Report #6 Date: 11/03109 Time: 11:00 am Weather:Interior Fit-Up Job Number: rra 09-067 Job Description: 12,000 sf interior office fit-up,floor 2, Building 20, Ozzy Properties, 1600 Osgood Street, North Andover, MA Work in Progress: interior finishes, suspended ceilings, data&fire alarm wiring,finish plumbing and HVAC close to completion—office cubicles 50%complete Work Completed: partitions substantially complete Comments: waiting for new door slabs—frames installed Inspected By: Stephen W. Livermore, RA A R. Rumpf & Associates. , Inc. P.O. Box 4483 57 Wharf Street 2G Salem, Massachusetts 01970 (978) 740-5025 (978) 607-0045 Fax slivermore.rraAgmail.com Field Report #7 Date: 11106109 Time: 12:30 pm Weather:Interior Fit-Up Job Number: rra 09-067 Job Description: 12,000 s.f interior office fit-up,floor 2, Building 20, Ozzy Properties, 1600 Osgood Street, North Andover, MA Work in Progress:preparation for installation of (4)-four man doors and setting of permanent file cabinets for tenant. General clean up, installation of broken outlet wall plate and miscellaneous paint touch up. Work Completed: all paint, carpet,wall base,finishes, including lighting fixtures, electrical andplumbing work. Work stations are complete and installed Life safety equipment has been installed in all spaces including lavatories. Comments: not applicable Inspected By:Michael E. Lutrzykowski Date........ ........ NORTI� ;, .;�•'."°°� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING r i ACMU c This certifies thatl t-L-- �-"ZT2`� .............. ...... . .. ............... .................................................... has permission to perform .............. v ................................................ wiring in the building of.........1?'lT2 fvc7...� . ................... at... .5..............)fl m.3..............PEEP,North Andover,Mass. F.V� ...� Lic.No...� ........ p INSPE R Check # �� 0759 4 - Commonwealth of Massachusetts Official Use Only - Department of Fire Services Permit No. 1 S`j BOARD OF FIRE PREVENTION REGULATIONSOcc 1pancy and Fee Checked [Revj leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical C de(MEQ 527 CMR 12.00 (PLEA SE PR INT IN INK ORTYPEALLMFOAWTION) Date:_�_I I ao(2 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or he intention tq perfornp the electrical work described below. Location(Street&Number)I Q QS U4 4 S' e_(f weer Tenant ZZ rweAb[S LLf^ Telephone No. Owner's Address lboo,os-rioa er rr. V_C� Is this permit in conjunction with a building permit? Yes 1K No ❑ (Check Appropriate Box) V Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity J — 00 --Met Z O 63t 20 V61_-p Location and Nature of Proposed Electrical Work: !�(!i !t�y Z�, 3 F(oc,/t S°U A-e 3--11 t; Com letion o the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell: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. 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 Devi es No.of Ranges No.of Air Cond. TonsTotaNo.of Alerting Devices No.of Waste Disposers Heat Pump Number..Tons KW.......... No.of Self-Contained Totals: Detection/Alerting Devices No,of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ other Connection No.of Dryers Heating Appliances KW Security Systems.*- No.of Devices or Equivalent No.of Water No. KW No.of No.of 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 Electrical Work: (When required by municipal policy.) Work to Start: —f—f ol 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 andpe alties of�erjury,that the information on this application is true and complete. FIRM NAME: /it -Ltc��r C C U.. A LIC.NO.-14,503 A Licensee:Wg u14 f W-SDI 6e I Signature A444,k w• LIC.NO.• 3 (If dyes able,enter "xempt�"in the license e b ire.) ` D3��S Bus.Tel.No.• — 1- — 2Z Address: r� Nl/ S % Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No, OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. [:E ERMIT FEE:$ _ B)GECTMALPrEp-r��YJ�F�Ly1.�i.•�1P1y®�. - y +y+ _ .[UC.L-[0.41.,,H.E_fINSPECJ.®.1 - 7SP�CTIO.N; ;. Passed— Vaned—j ] Re-impection requ irecf($50.00)7[ � Inspectors'commots: L (x ,pectore Signature-no M 'tials) � Pate �c l� �� S Gc7•—f Z,. .j � �''-/1, 2.IMALINSPYCtIOW; Passed—[ ) Failed—[ . Rt-hspectionrequired($50.00)-•[ � Inspectors'comments: (Inspectors'Signature•-no initials) Dat 3.UNDNR CRODND INSPECTION- Passed —[ 7 Tailed--[ I Re-iuspection.required($50A0)-[ ] Inspectors'comments: (fmpectors'Signature•-no initials) Date 4.INSPECTION--SEWVICE: DINAM,C-ts i LE-0 NMJT O 'AP 09 iI : NA—AM: Passed—[ Tailed—[ ) Re-inspection required($50.00)•-[ ] 7nspectbrs'commepts: (Cusp ectors'Signature-no initials) Date + 5 WSPECTION•-OTHER: Passed--[ 1 I+siled•-[ - -?fie-inspection regv iced($50.00)•-[ J Inspectors'coznm.ents: (.Inspectors'Signature-no initials) Date )DO OR TAGS.ARE TO DE M I,ED OUT AND MFT OST SITE 10 THE.AREA TO BE INSPECTED IS NOT .ACCESSIBLE.AND.A RE WSPECTION•OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts 02 Department of Industrial Accidents Office of Investigations ki 600 Washington Street Boston,MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leszibly Name(Business/Organization/Individual): r LL E(13a/c Co. �` < Address:-17-3 ra Wl Ale, City/State/Zip:S4�C14 1"I' 307! Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.04 am a employer with 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.t 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 10.n 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 .ees em to o workers'insurance required.] �r employees.� k13.0Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they 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`.�L,ic.#: / Expiration Dattel: r� Job Site Address:�W -SyUda City/State/ZipaA h4" (44, Mq • 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 hereby erti y under t/h�epJJ ains andpenalties ofperjury that the information provided abole 's/t(ruue and correct. Signature: W< Date:A"'A:e Phone#: �/ 03 - 76E- Official 6EOfficial 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 M Information and Instructions i Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 604 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia j Date. r ...................... i f &ORTil, 3:�•';r``-: "�o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that . ...!0- . ...... ............................................ has permission to perform ....../r—.0.w....uOLT. .. wrong in the building of. ..................................... at.....1..��l�J. �c,�5...fT........................... . North Andover, ass. Fee J 2-57''--^Lic.No. � ................. ..... ................. "I�sp E ECcmcAL ECTOR Check # 7 . f a 10826 Commonwealth of Massachusetts Official Use Only Permit No._/ L Z Department of Fire Services Occupancy and Fee Checked y 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: am a 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) C_� Owner or Tenant ,2 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: low VVkq >ti[()1C� C,-Y1Cl Cac�L'_cs_ Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ gr . ❑ BatteryUnits No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners No. InDetection and Initiatin Devices Ranges No.of Air Cond. Total No.of Alerting Devices No.of Ran g Tons No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained p Totals Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection t No.of Dryers Heating Appliances K`,1, Security Systems:* rY No.of Devices or Equivalent No.of Water Kms, No.of No.of Data Wiring: g( Heaters Signs Ballasts I 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: f b% v 0 U (When required by municipal policy.) Work to Start: '? _� Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE �0 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: u -tLIC.NO.: Licensee: p a SignatureLIC.NO.: XQ-M L (If applicable, enter�"iexempt"in the license number line.) Bus.Tel.No.: Address: 4 Ja `AO POb 9-d,J Oabba 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ !d r z02-t � t Date.1/.,/,/.21:11�. NORTH ti TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SS us «v This certifies that . . . . . L .r. . ! t� TY r. has permission to perform . .. . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .A . 0. . . . . . . . . . . . . . . . . . . . . at . .I≤a. . . . . . . . . . . . . . . ,worth Andover, Mass. Fee. . 1 G ..Lic. No../I7;? . . . . . . . . . .C. .� 1-rckyy ti.'. . . . . . . . PLUMBING INSPECTOR Check # 8266 CU 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass, iia¢ Perm # L t- Building Location UrOO Name Type of Occupancy WO-110 Renovation ❑ Replacement 11 Plans Submitted: Yes❑ No WO ✓� FIXTURES .' = m z tj z kc N o m o z _ W h 0'! J WW Y J H d2 N < 0: S h N Z� f, V W O xd C < m W N W = O < 0 z W W O 7 W < Q: > < W N Q J O46 x O J W 2 < 7C 3 C Z x 2d d C h < x < W &L x W ►- v x n h m = Z ►- o o s y SUB—BSMT. BASEMENT v IST FLOOR =FLOOAI�'� STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Namen(�,. Check one:. Cert;ticat- Address 5Qj eggwa AVF, Corporation L: .19 -0 Partnership Business Telephone �'�o ❑ Flrn /co, . Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142: Yes WF, No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Q/ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAiVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have su ed(or tared)' above plicati are true and accurate to the best of my knowledge and that all plumbing work and installations pe under pe this p tion will be in compliance with all pertinent provisions of the Massachusetts State Plumbing and; or 1 ` f rat BY Title g uSed re of Lce' u r Type 00, of License:Master urrieyman❑ CitylTown I � /� (0 1 fVl. License Number BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS �KET� CNEB PROGRESS INSPECTIONS f FEE ' NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 1S �� PLUMBING INSPECTOR r Date `.....:`1'........... r f ,ORTH � "'.1,\° "�,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING • ,SSACMUS -7 This certifies that ......`...... . ............. ..L ._... ..�........................... --��-., .. s ``............. has permission to perform-.. �� l. wiring in the building of ....! - s- < '................ .... .... .North Andover,Mass. 1i / Fee/Z..�..... Lic.No.<�35/.Q ........... .... .. .... .......... .. . . r ELECTRICAL INSPE R" Check # 49—rlel 9054 -� Commonwealth of Massachusetts Official Use Only Pe Department of Fire Services Permit No. �,3y BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 17 [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) Owner or Tenant (� ��✓Yjn�i tS � �- �> >�i� i► -7- 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: Completion of the followin table may be waivedby 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 ig g d• rnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No. No.. of Gas Burners of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total. Tons No.of Alerting Devices Heat Pum � No.of Waste Disposers p Number -Tons.... KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection El Other No.of Dryers Heating Appliances KW Security Systems:* - No.of Water No.ofo. No,of Devices or Equivalent Heaters KW Si s Ballasts . Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: ent OTHER: No.of Devices or E uival Attach additional detail if desired, or as required by the Inspector of Wires. v Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability >, insurance including completed operation coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under*tthnepinsnd penalties o f.erjury,that the information on this application is true and complete.FIRM NAME: c! t P D�.cJLicensee: /� Xp /71101 LIC.NO.: (If applicable, enter"exempt"in the license number line) Signature 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.TelLic.No.: No.: INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally Owner/Agent required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Signature Telephone No. PERMIT FEE: $ 1"`\``� .% ;• . � �� / �� J�` �' � ��7 �- J r ti �� Alk s.� The Commonwealth of Massachusetts k� r Department of Industrial Accidents Office of Investigations iii;!► 600 Rashington Street {}; Boston, MA 02111 www.nwss.gov/dia . Workers' Compensation-Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information Please Print LeQebly Naive (Business/Organization/individual): Address: (� o,A City/State/Zip: I?/�✓►�,y�,f1 I n,4 Phone#: . `� 1 Q, Lt3 —,J LI I Are :an employer?Cheek.the appropriate box: a employer with 4. ❑ I am a general contractor and I Type of�project(required): employees(full and/or part-time).* have hired the sub-contractors 6. �11e`'`'construction 2.❑ I 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. g M Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required_] officers have exercised their 10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No�worker's'comp: c. 1.52, §1(4),and we have no 12. Roof r insurance required.] ❑ repairs 4 ] employees. [No workers' comp. insurance required_] 13.❑Other *Any applicant that checks bore#!must also fill out the section below showing their workers'bompensation Ip olicy infomtation t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractor;must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and their workers'comp.policy information. I am an employer that is pr»viding:workerscompensation Insurance for my. information. employees. Below is the policy and job site 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 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 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. r I do hereby certify_ der t pains and penalties of perjury that the information provided above is true and correct Si tore. /jU�� Q q Date; � l Phone#: [Ofj' use only. Do not write in this area,to be completed by city or town officio[ Town: Permit/Liceuse# Authority(circle one):of Health 2. Building Department 3.City/Town Clerk 4. Electrical inspector 5. Plumbing inspectorPerson: Phone#: Information and Instructions v' 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, MOL 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)acid 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 afriidavit. 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 nuanber.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 lnvestigations 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 permiMicense 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investignations 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: 1 The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, IIIA 02111 Tel.# 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-774 www.mass.gov/dia t Date....... ...:.. f NORTH 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS^cHu cc L L C��z�c, � c Thiscertifies that ........................................................r...... ............................ a wee- �,-4110 . has permission to perform ....4... ................. ................................................ �s�tiro�tCbz wiring in the building of.. .:.......................................................................`�..... t D �S �OZ� `'i a�,� ,North Andover,Mass. j at..._...........D.... . .................... . ree..................... Lic.No.............. ................... .. . ...... . ....... ....jht...... ELECTRICAL INSPECTOO ` Check # rj 4 ' 903 Commonwealth of Massachusetts Official Use Only Department of Fir Permit No. P e Services 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 lle(MEC),527 CMR 12.00 (PLEASE PRINTINIAW OR TYPE ALL INFORMATION Date: J 2.110 City or Town of: NORTH ANDOVER To the Inspector of Wires: d + By this application the undersigned gives noticeofhis or her intention to perform the electrical work described below. �VZQ`t%^q Location(Street&Number)V606 OS �U S`J' lou c`dim 2,(� 3�d i�rt So j-� �d ' 6 76 J Owner or Tenant 1(600 GS rjoA LL 0322 Q�p��P E Telep o e No. `t/ Owner's Address{ v Q S�, (�1t��(c�tlV 3® 2e,-4 �'( r� t uvS'► f�tfiv2 Is this permit in conjunction with a building permit? �r� Yes No ❑ (Check Appropriate Boz) Purpose of Building d 0`l Ce SPa�to Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:Bu11 'N12-01 3r FL, S..' 4- e vl Q 17. 00 0 S "�`�. o�CQ �`i�•da��;W i �)�� Completion of the followin table may be waived by the Inspector of Wires. y 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 Abodve ❑ In-d ❑ o.o mergency ig g 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. Totons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: . Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection E] other No.of Dryers Heating Appliances KW Security Systems:* No.of water No.of No.of Devices or Equivalent Heaters KW Signs Ballasts Data Wiring: } No.of Devices or Equivalent 6 No.Hydromassage Bathtubs No.of Motors Total gp Telecommunications Wiring: No.of Devices or Equivalent OTHER: �O ' 40J= ttach additional detail if desired,or as required by the Inspector of Wires. Estimated Value f Electrical Work: C Qd V_7l � (When required by municipal policy Work to Start: 0 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 [BOND ❑ OTHER ❑ (Specify:) I certify,under th gains and pen ties ofperjury,that the information on this application is true and complete FIRM NAME: c�L E LCL t C 0. C LIC.NO.: SCh 1 Licensee: YyLHy e- , SP1 r e 3 Signature LIC.NO.: (If applicable, a er"exempt"in the license�um�ier line.) Address: _ 3(`��/ 6V{ Bus.Tel.Nol- %"-74 Alt.Tel.No.: *Per M.G.L c. 147,s.57-6 ,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' t rf Permit Listing Report Date Range:Issued between 01/01/2016 And 01/11/2017 by Permit Type Printed On: Wed Jan 11,2017 SQL Statement:Street No.like"1600"AND(Street like"OSGOOD STREET"OR Work Location like"*OSGOOD STREET*")and([Type of Permit]="Building") Permit Type Address(Work Location) District Zoning Owner Work Category Est.Cost Proposed Use Details Map/Block/Lot Permit No Online Permit No Permit Status Date Issued Contractor(Phone#) Work Description Fees Paid Check# Building 1600 OSGOOD STREET I-2 1600 OSGOOD STREET LLC C/O OZZY Solar Panels $2,578,900.00 PROPERTIES,INC 034.0/0017/ 1255-2016 Expired Jun-13-2016 Dan Leary(978)496-3460 3463 Rooftop Solar Panels 1.2 Megawatts $30,922.00 237 1600 OSGOOD STREET 1-2 1600 OSGOOD STREET LLC C/O OZZY Solar Panels $2,061,427.00 PROPERTIES,INC 1275-2016 Expired Jun-13-2016 Dan Leary(978)496-3460 3463 Rooftop Solar Panels, 1.2 MW $24,737.00 238 1600 OSGOOD STREET I-2 1600 OSGOOD STREET LLC C/O OZZY Solar Panels $1,620,293.00 PROPERTIES,INC 188-2017 OPEN Aug-23-2016 Dan Leary(978)496-3460 Install 1.38 MW in North Array area,all electrical work for north and west interconnections to the substation $19,444.00 247 1600 OSGOOD STREET I-2 1600 OSGOOD STREET LLC C/O OZZY Commercial Alteration $7,600.00 PROPERTIES,INC 399-2017 OPEN Oct-13-2016 Dan Leary(978)496-3460 Relocate NETTS $96.00 1234 1600 OSGOOD STREET I-2 1600 OSGOOD STREET LLC C/O OZZY Solar Panels $2,345,227.00 PROPERTIES,INC 400-2017 OPEN Oct-13-2016 Dan Leary(978)496-3460 1.96 MW ground mounted solar array $28,143.00 259 GeoTMS®2017 Des Lauriers Municipal Solutions,Inc. Page 1 of 2 Permit Listing Report by Permit Type Permit Type Address(Work Location) District Zoning Owner Work Category Est.Cost Proposed Use Details Map/Block/Lot Permit No Online Permit No Permit Status Date Issued Contractor(Phone#) Work Description Fees Paid Check# Building 1600 OSGOOD STREET I-2 1600 OSGOOD STREET LLC C/O OZZY Solar Panels $55,000.00 PROPERTIES,INC 034.0/0017/ 412-2017 OPEN Nov-03-2016 TADEUSZ DOWGIEERT Solar Electrical Building North Parking Lot,Electrical gear and transformer for power distribution of solar facility $688.00 260 I 1600 OSGOOD STREET I-2 1600 O�SGOO.D SIREE.T,..L.LGG/(�.4ZZY-- commercial Alteration $75,836.00 — --PROPERTIES,INC 668-2017 OPEN Dec-23-2016 TADEUSZ DOWGIEERT Tenanf Fit Up Suite F3-Men''tor Expansiori� $910.00 10257 1600 OSGOOD STREET I-2 1600 OSGOOD STREET LLC C/O OZZY Commercial Alteration $54,545.00 PROPERTIES,INC 922-2016 Expired Mar-01-2016 TADEUSZ DOWGIEERT Interior modification due to downsizing per plans Ophir Optical $648.00 10065 Permit Type(BUILDING)TOTALS: ESTIMATED COST: $8,798,828.00 NUMBER OF PERMITS: 8 FEES INVOICED: $105,588.00 FEES PAID: $105,588.00 BALANCE: $.00 GRAND TOTALS: ESTIMATED COST: $8,798,828.00 NUMBER OF PERMITS: 8 FEES INVOICED: $105,588.00 FEES PAID: $105,588.00 BALANCE: $.00 j GeoTMS®2017 Des Lauriers Municipal Solutions,Inc. 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