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Miscellaneous - 20 ROCKY BROOK ROAD 4/30/2018
k r v 4 'I 9544 -7- Z- 7- /Z-2 Date.................................. '0 T TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. 'r ........ .............................. has permission to perform ... ........... 10,� ......................... wiring in the building of ................. . ....................................... * at ......... 0 ....... . ..... North Andover, Mass. Fee.,. �.-- L i c. No. 3 ! F11. ......... Check # "-W— Commoncuealth 4 V1 MacLVtb Apartment 43ire Serviced BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No.� 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 TYP4 ALL INFORMATION) Date: J `� � - I City or Town of: O f -01A �©V t°1' 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) ro /i? d c k V Br&c k ze (14, Owner or Tenant q n y 1:::' 1 P1,q r f e .Sa� j � S � Telephone No. Owner's Address Q yK Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building t?=eS \d -e r1 C Q 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:% ®��� P� - --,.yP Y rn c Completion of the followine table may be waived by the Insnector 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 Above In- Swimmin P d. ❑ rnd. 1:1 o. o Emergency Lighting No. Units No. of Receptacle Outlets . of Oil Burne FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons Tons No. 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 KW No. of No. of Data Wiring Heaters Signs Ballasts No of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Equivalent No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value9fElectr Call Worork: 13; (When required by municipal policy.) Work to Start: CO KP tXE 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: INSURANC OND ❑ OTHER ❑ (Specify:) Z I certify, under the pains a�aldes of perjury, that the information on this appli on is true and complete - FIRM NAME: ties e D h a LIC. NO.: % 77 Licensee: Signature s LIC. NO.: (Ifapplicable, enter " exempt" i t license number line.) us. Tel. No.: -,!2Z - S Address: x I Alt. Tel. No.: 2.7.3Gf *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. .1 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. Owner/Agent Signature _ Telephone No. I am the (check one)❑ owner ❑ owner's a ent. PERMIT FEE. $ r , f Date......: ..:............................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 1 This certifies that . a .....!�.�. cLr� 1 C j a VMS 69 has permission to perform.................................................................. .......................... wiringin the building of..... ............................................................................ at ....aei........P.�C�L."' .... ... :c .............. North Andover, Mass. Fee, ,I� ........ Lic. No. "Y!. . ►"LL ........... '� . i. . � ELECTR CAL � O .. CF�ck # ?7 \ Corn»tonwaaUli o� i/%adda d Official Use Only cc/� cc77 n Permit No. rUepart`mani o�..tira Jaruica! Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wort: 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: /V . 4A)2X4- E_ To the Ins ecto of Wires: By this application the unders!gned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Aman,!!- %> Owner or Tenant ,Ao= Telephone No. !279"-STZVI�Z/,gt��;-- Owner's Address =^l Is t. this -permit in conjunction 41th a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building l-!' e Utility Authorization No. Existing Service 'Z6t7 Amps /* /Zl/%Volts Overhead Undgrd ❑ No. of Meters l New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I— Comialetionofthefollowingtable ma be waived bv lire Ins actor or fres. No. of Recessed Luminaires No. of Cell.-Susp. (Paddle) Fans IN °• o ata Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ - ❑ rnd. d. o. o mergency Lighting Battery Units No. of Receptacle Outlets No. of OR Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o Detection and Initiating Devices No. of Ranges t Total No. of Air Cond. Tons No: of Alertlnj Devices-" • `. No. of Waste Disposers eat Pu Totals: umber Tons o. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Ioeal ❑ unrcrpa [:1 Other Connection No. of Dryers Heating Appliances KW Security stems: No. of Devices or Equivalent No. of Water KW Heaters o. 0T-- o. o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunications Wirm : No. of Devices or E uivalent OTHER: !li �U ScA- Aitach additional detail if desired, or as required by rhe Inspector of Wow. Estimated Value f El cal Wodc: �4 70P. �( kihcn required by municipal policy.) Work to Start: P Inspections to be requested in accordance with MEC Mule 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, ander tl ains and penalties of perjury, t at the information on t tis application is true and complete. FIRM NAME: me LLC LIC. NO.: Licensee:y` ,r t e:; � u X q n:} Signature LIC. NO.: p (If applicabl et er. ex e rpt" i 7'. 11. licens' number lin) Bus. Tel. No.. -Sv • 09 Address: r ih D Alt Tel No.: *Per M.G.L. c. 147, s. 57-61, securiwork 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 Iaw. 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: $ R.+ vvn..nv.��rcr�c. n yr mrn,�ar�vnvac,f e:7 q#'(`OMMONWf-ALT11 OF MA55AC i�IJ"J�Gi tb e a • -a a ►, • e •e • 1319 `OF LE,%ICIANS-.f fLfC RIC�lAtaS fE _ ''ISSUES THE FOLLOWING LICENSEA5 9;'' ISSUES THE .FOLLOWING�LIGENSE REGISTERED MASTER £LEC -T iC.IYtN ASIAtEJOUR�IEYMANELEC dtC!`�N ROOF DIAGNOSTICS SOLAR 0 ;'MS` y JA;MCS R JAMES Re Rfi<I,�AKAPT R 89f WASHING'1ON AVE C ,• 84 ADAMS 'il�" ..e w.-�'d °e . 'A`TI CI( MA 01760-344Y1 NURTH "GRAFTON." r''A 01536-2102 1160# A 07/31/16 56412 2422 �. 1J 1 ., 23832 E 07/3. .GOMMOI V�Ea ri 431' IVIASSAC:r�.iSET S ` .o COMMONWEALTH OF MASSACHUSE'TT'S {� eNC • e • y' a8,0 0 OF BOARD OF EL•ECTR I CI ANS , . ELECTRICIANS 15SU€;5 T4FOLLOWINT; L'IC£NS i' ISSUES THE FOLLOWING LICENSE AS---Ar.Rt oJOURNfYMAN ELEC�R0Z*!AN it AS A., REG JOURNEYMAN .-ELECTOEPAN.� ol ADAM -'L DEJESUS �'r PETER M K I NNEY 1'7A ANDOVER AVENUE r 4�'"'` Sw � 8 CASklfLl ...AVE ATTL'E ORQ 9 ttia 0270-3-7103 MET HUB MA 01844-4804 11:.,,138I : E o7/3,1al. 52&65 - 10490-8 07/31/16 69708 �. �OMMONWT:ALTH OF MASSi4GT TU$ETTS . gx°tOMMONWE►LTM LOF MASSACHLiSETTS BOAR DF BOARD OF . I LF'GTR I G:f ANS ELf R' I: I ANS ISSUES THE FOLLOWING L!`EEN.tE , Q.'. ISSUES THE F 0 L L 0 W I N0+ L• I CENSE ASA REG JOURNEYMAN �£LEcTR! G1 A#. - AS A R:EG JOURNEYMAN �ELECTRE G1 ANS+ SANTIAGO REYES M ° OWN. F CARRY JR ,� WOODL;4ND'ST .s ' I �"�4 PROYi`Ilf1ICE Tt0 APT; AWRENCf �M'A' 01841 2333` ` Sb U.T. dGRAfTON f1A 01560 1337 14)11 B: oT/31/161, 27258 26876 E �D7/31�/16 . 00634 u z t . . �t a ' CONVTROL # t CONTROL#JO62843 i IMPORTANT IMPORTANT if "your license Is'lost, damaged or destroyed; is inaccurate;-or: If .your license is lost, d8mage "or liestroyed is inaccurate; or needs, to be corrected, visit our web site'"at mass.gov/dpi for Instructions to ensure the proper mailing of your Renewal Application 'any needs to be ensure the proper mailing corrected, visit our web site at mass.gov/dpl for 'Instructions to of your Renewal [ Application and and other correspondence. any other correspondence: This license is subject to Massachusstts General taws-and `" This license is subject to Massachusetts General Laws and I regulations: Your license is a privilege, and cannot be lent or regulations. Your license rs a privilege and cannot be lent:or assigned to any person br entity, under penalty of.law. Keep this. 'assigned td,any person or entity under penalty of law. veep this license on your person or posted as required by law and/or license on your,person or, posted as required by law o-keep r regulations;. regulations. f 'i ' CON'TROL '6'b#,! G ^ '6ONTRO # 0 1 0 1 G l IMPORTANT • - • WPOkUNT t If your iiceiise is,lost, damaged or destroyed; (s inaccurate; or ''needs If your lcenseI§ ost, damaged or-destroyed is inaccurate; or to be corrected tisit our website at mass.gov/dpl for instructions to "ensure 4he;proper mailing of.your Renewal needs to be corrected, visit our web site at mess.g'ov/apt for: 'lristructions to ensure the proper mailing of your Aenewal •, Application and any:othe"r correspondence.�Applicatron aril"any outer correspondence. I This license is subject to Massachusetts General Laws and ,This license is`subject toNMassactusefts General Laws and regulations. Your license is a privilege; and cannot be lenf or i • assigned to an entity p, ty p g y person or anti underpenalty of law, Kee this " re ulations. Your l(cense.is a rivI1e o,tand cannot be lent or, ¢ asslgned to any person orient ty under penalty, of;4aw. `Keep `this ` license on your person or postedas.required by law andlor i regulations license on your person or posted as required by law and/or. regulations. * ,' yy 'N,�.s a,_ - :.•£... ���' .. # .,.� ems" .. NO 10 CONTROL # ' 0 8-'6 . , ' CONTROL'# J095985 IMPORTANT df your"1(cense is lost,:damaged or destroyed-,Js inaccurate;:or needs to be corrected, visit our website IMPORTANT at ma'ss.gov/dpl for. instructions to.ensure the proper mailing of your Rene_ wit 'grSplrcatron"arid anyotifer correspondence: I your ficenseis lost, damaged or destroyed; is inaccurate; or eedsao be corrected,-visit web site at mass,gov/dpl .for s retractions to ensure the proper mailing of your Renewal ,This license is subject.to Massachusetts;General Laws aria pplication and any other correspondence. regulations: out, ur license is a privilege,-and cannot be '!K l"assighfid to any person or entity under penalty of,:Iaw. . 'fits license is subjectto Massachusetfs General Laws and Keep`this Uoense'on.your person or posted as required by lavr^and/or +regulations; " ' �gui$tions: Your, license is a privile8e, acid cannot'be lent-or signed to any,person or entity under penalty of law. Keep this :r . ense;on your person or posted as:required-by law and/.or " �guiations. - 0 D A�® CERTIFICATE OF LIABILITY INSURANCE DATE (M 01201YYY) 09!90!2014 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polfcy(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. Box 10265 Birmingham. AL 35202 CAME CT Martha Lee Hawkins PHONE 800-076.2211 FAX AI No Ext): AS No): AIL ADDRESS: mhawkins@mcgriff.com INSURER($) AFFORDING COVERAGE NAIC # 000619670 INSURERA.James River Insurance Company 12203 04/15/2015 INSURED Roof Diagnostic Solar Holdings LLC; Roof Diagnostics Solar and Electric LLC; Roof Diagnostics Solar and Electric of NY, LLC; Roof DlagnostIcs Solar and Electric of INSURER B 11berty Mutual Fire Insurance Com an 23D35 INsuRER C :Federal Insurance Company 20281 INSURER D • Connecticut, LLC; Roof Diagnostics Solar of Mass, LLC; Restoration Design LLC; RDI Consulting, LLC GENERAL AGGREGATE $ 2,000,000 2333 Highway 34 Manasquan, NJ 08736-1423 INSURER E: INSURER F C0VFRACF3 CERTIFICATE NUMBER:QRXVJSVR REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $LTR TYPE OF INSURANCE NSR WvD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MIDI LN11i3 A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR 000619670 04/15/2014 04/15/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREMISES Ea occurrence $ 50,000 MED FRCP (Any one person) $ PERSONAL&ADV INJURY $ 1,000.000 GENERAL AGGREGATE $ 2,000,000 GEITL AGGREGATE LIMIT APPLIES PER: POLICYFX PRO- LOC PRODUCTS -COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO iOWNED SCHEDULED S2Z91462454014 04/29/2014 04/29/2015 COMBINED aISINGLE LIMIT(Ea 1,000,000 BODILY INJURY (Per person) S BODILYINJURY(PeracGdent) S -AU-_=AUO HIRED AUTOS NON-OWNED AUTOS FRUPRTY DAMAGE S Per accident Deductible: Comp/Coll $1,000 A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE 000619941 04/15/2014 04/15/2015 - EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTIONS S C WORKERS COMPENSATION AND EMPLOYERS' LMILnY ANY PROPRIETOR/PARrNERlEXECUTiVE YIN OFFICERlMEMBEREXCLUDED? (Mandatory in NH) 1f yes. describe under DESCRIPTION OF.OPERATIONS below N!A 004 4727794 00 07/0112014 07101/2015 X Iw; LMT of H E.L.EACHACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 E.LDISEASE -POLICY LIMIT $ 1,000,000 S S S S DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CFRTIFILtATP 14nLIIFR GANGELLAI IUN Commonwealth of Massachusetts PO Box 7010 Boston MA 02204 ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Page 1 of 1 01 The ACORD name and logo are registered marks of ACORD All The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017. V, . www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly IVanie (Business/Organization/Individual): ��F f��/�GJOr•.�GS �o� R Address: Llty/Ntate/Glp: / O Phone #: Are y 2JX.an employer? Check the appropriate box: 1. 2rl am a employer with 4. ❑ 1 am a general contractor and I ci 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- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance. required.] . 5. ❑ 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 12.0 Ro repairs insurance required.] t c. 152, § 1(4), and we have no �„w � employees. [No workers' 13. Other r � comp. insurance reauired.l *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. fi Bomeowners who submit this affidavit indicating they are doing all work and thenhire outside contractors must submit a new affda�rit 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. J am ara employ hatis providing wor ers' compensation insurance for any employees Below is the policy and job site information. Insurance Company Name: YERDMAL = SU_-R.dtl)CE: policy # or Self -ins. Lie. M 0Xe/4,17W-779 e/00 Expiration Date: —7 l Job Site Address: ;Vw 5 �aKY �i�oiCaC City/State/Zip: ,. /J. 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 Inyestigations of the DIA for insurance coverage verification. I do hereyv certify under the pains and peva s ofperjury that the information provided above is true and correct Phone M. U Official rise 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 #: E7LI'OEL VEL 06ZS£O'01'1-HOMV.lN alnciow clad m55Le SalftaOW ss N3S21-3iEd'=I SVWOHI 3inciow 213d m56Ls S3if140W �IDIOL i99°1�0 I ISI -Lo fN'11�31TICH SlBNdd 5fr810 VW'Z!i�IAOCINV HIZ!ION E31VO 3Nb'1 ,11Nnoo 7 O11'17311F10�d �i-ZZS-11Z-09-SIZ-WOVOZI >0089 10-308 Oz W=1N�Sc>1�l�cl WOl Sc1�1?�/�NI ON011A �JJdIOS ON�aIS�'�I H��,IHS °,te =7NImIVZ�a 0Ulof {Nt �a mei IL 11 �8b�-Ob5 (SLbJ '6.iu NOiVW�O:M 1Nzl1l� °N �wmV�a �.av W�1c� lS �b�O�c O O 11 m 11 ' o� n / < c LJLa X ) �— (L1+1 10 oz 1+1 I 1 J ) (0 cnu ILM (r)< (L w m � 7 (A P Q T v- 0 a, n/U L IL Q O I I J � it g-� o- rn �� Crl n III ll nl ro - W < m n o L(I LL O R n 1111/ (V P� L!L V n V II LL O v� L11 LH ZZ— ,4 <0- I -Y N C -4a n 1L�r< 2 ..I-,81 �A,+ r ¢ g r $ � w ' N NL Wco< -A uv N 1 1 1LU LU ,may J J YJ kL ' 4TCL � zz QL r r t w w d s 00 .. Y t 2F CanadianS®lar Make The Difference "Black frame product can be provided upon request. PRODUCT I KEY FEATURES Excellent module efficiency up to 15.85% High performance at low irradiance above 96.5% C�56P-250 1255P THE BEST IN CLASS Canadian Solar's modules are the best in class in terms of power output and long term reliability. Our meticulous product design and stringent quality control ensure our modules deliver an exceptionally high PV energy yield in live PV system as well as in PVsyst's system simulation. Our accredited in-house PV testing facilities guarantee all module component materials meet the highest quality standards possible. PRODUCT I WARRANTY & INSURANCE Power _ ..... �.. ... ,. _. , _ . .. output loo Added Value from so 77� carted VVarranty5tatement Industry ao standard 0% 5 10 15 20 25 Years 25 Year Industry leading linear power output warranty 10 Year Product warranty on materials and workmanship L7 T� 1 Positive power tolerance up to 5w Gaan Solarprov_ides SQO%hon-cancellable, immediate warranty ® insurance_ ---- High PTC rating up to 91.88% PRODUCT & MANAGEMENT SYSTEM I CERTIFICATES* p IEC 61215 / IEC 61730: VDE/CE/MCS/JET/KEMCO/511/CEC AU/ I NMETRO/CQC/CGC UL 1703 / IEC 61215 performance: CEC listed (US) / FSEC (US Florida) UL 1703: CSA I IEC 61701 ED2: VDE I IEC 62716: TUV I IEC60068-2-68: SGS Anti -glare module surface available PV CYCLE (EU) I UN19177 Reaction to Fire: Class 1 1509001: 2008 I Quality management system ISOTS16949:2009 I The automotive industry quality management system 15014001:2004 1 Standards for environmental management system IP67 junction box QC080000:2012 I The certificate for hazardous substances process management long-term weather endurance OHSASIS001:2007 I International standards for occupational health and safety AN cm, ;., S (9rr. Heavy snow load up to 5400pa Please contact your miss repmsentative for the entire list of certificates applicable to your products CANADIAN SOLAR INC. Founded In 2001 in Canada, Canadian Solar Inc., (NASDAQ: CSIQ) is the world's TOP 3 Salt mist, ammonia and blown sand solar power company. As a leading manufacturer of solar modules and PV project resistance, for seaside, farm and developer with about 6 GW of premium quality modules deployed around the world desert environment in the past 13 years, Canadian Solar is one of the most bankable solar companies in Europe, USA, Japan and China. Canadian Solar operates In six continents with customers in over 90 countries and regions. Canadian Solar is committed to providing high quality solar products, solar system solutions and services to customers around the world. CanadlanSolar Make The Difference ELECTRICAL DATA I STC Electrical Data CS6P-250P CSGP-255P Nominal Maximum Power (Pmax) 250W 255W Optimum Operating Voltage (Vmp) 30.1V 30.2V Optimum Operating Current (Imp) 8.30 A 8.43 A Open CircultVoltage (Voc) 37.2 V 37.4V Short Circuit Current(Isc) 8.87A 9.00A Module Efficiency 15.54% 15.85% Operating Temperature -40 °C~+85 °C Maximum System Voltage 1000V (IEC) / 1000V (UL) /600V (UL) Maximum Series Fuse Rating 15A Application Classification Class A Power Tolerance 0'"+5 W ° Under Standard Test Conditions (STC) of Irradlance of 1000W/m', spectrum AM 1.5 and cell temperature of 2sC. Specification ELECTRICAL DATA I NOCT Electrical Data CS6P-250P CSGP-25SP Nominal Maximum Power (Pmax) 181 W 185 W Optimum Operating Voltage (Vmp) 27.5V 27.5 V Optimum Operating Current (Imp) 6.60 A 6.71 A Open Circuit Voltage (Voc) 34.2 V 34.4 V Short Circuit Current (Isc) 7.19 A 7.29 A "Under Nominal Operating Cell Temperature(NOCT), Irradlance of SOO W/m', spectrum AM 1.5, ambient temperature 201C, wind speed 1 m/s. Connectors MC4orMC4comparable MODULE I MECHANICAL DATA Specification Data Cell Type Poiy-crystalline, 61nch Cell Arrangement 60(6x10) Dimensions 1638x982x40mm(64.5x38.7x1.57!n) Weeiigg t ------ Front Cover 3.2mm tempered glass Frame Material Anodized aluminium alloy Junction BOX IP67,3diodes Cable 4mm'(IEC)/4mm'&12AWG 1000V(UL1000V)/ 12AWG(UL600V),1000mm (650mm is optional) Connectors MC4orMC4comparable Standard Packaging 24pes,504kg(quantityandweight perpaliet) Module Pieces Per Container .672pcs (40'HQ) TEMPERATURE CHARACTERISTICS Specification Data Temperature Coefficient (Pmax) -0.43 %/°C Temperature Coefficient (Voc) -0.34%/'C Temperature Coefficient (Isc) 0.065 %/°C Nominal Operating Cell Temperature 45±2 °C PERFORMANCE AT LOW IRRADIANCE Industry leading performance at low irradiation, +96.5% module efficiency from an Irradlance of 1000W/m'to 200W/m'(AM 1.5, 25'C) MODULE I ENGINEERING DRAWING Rear diew F Frame Cross Section 1 it e ScOt A -A I 35.0 I , S it i a 0 0 v I 19.01 ! ii i t CS617-255P I I-V CURVES 10 io 7 a 0 B� B� a! 6 Nit es 3� 3 ---1000 W/m2 v i , C 2 —800 W/m2 2 _::2S C 600 WIM2 400 W/m2 1 X65 C 0 5 10 15 20 25 30 35 40 0 6 10 15 20 25 30 35 40 45 vottaga(v) vmtaaa(v) Partner Section ' As there are do rent eertifrsation requirements (a different markets,please contact your safes repmsentotfveJr the specffic certificates applicable to yaurprodocts. The spe Tf tla. andkeyfeatures destibedfn this Datasheetmay deviate slightly andam notguoranteed. Due to an-gafnp leaowatian, research and product enhancement Canadian Sofa, Inc reserves the right to make anyad/ustramf fo the Infarmatfon describedhamin at any time without naHea. please always obtalathemastrecent worsloa ofibe dotusheet which shol/be duly fncorporotedlnto the bladlag cantraet madeby the partlesgawerning oil oansectlans related to the pumhaseandsule afthe products deser/bedhemM. Enphase-Microinverters enp.has C NI E R G The tiiiphnW Mitrolaver-Ter Systel'n improves energy harvest, increases reliability, and dramatically simplifies design, installation, and management of solar power systems. The Enphase System includes the microinverter, the Envoy' Communications Gatewa,,r 'and Enlighten," Enphase's monitoring and analysis software - P A 0 D U C T I V E Klaxiniurn ona'gy prr)dL)CJjOFJ R8Sili-,111 to CILISI, r,-Iebris wd sk?dirio Perloirnancc, wonilojing R rE L I A 8 1_E Zysieni avaifahiiily ore@' -F.4 1han SOW,'v 'qJe poral 0 syslere fal SMART w (.Puit;k said -k;irnplE design, - 2417 mortiloring and cimly!�is SAFE DO r1r;duced fire ri'* enphase *1.;s Eilphase" M215 micrsir vpNe JI DATA INPUT DATA (DC) M215-60-2LL•S221S23 and M215-60-21-L-S22-NA/5:23-NA (Ontario) Recommended input power (STG) 190 - 270 VV Maximum input DC voltage 45V Peak Power tracking voltage 22 - 36 V Operating range tta - 36 V Tulin./h1ax. start voltage 22 V J 45 V Max. CSC short dit:uit eurreilt 15A Max. input current 10.5 A OUTPUT DATA (AC) 0208 VAC 1,240 VAC ^Rated (ccniinuous) output power 215 IN 2.15 VV Nominal output current 1.0 A (Arms at nominal duration) 0.9 A (Arms at nominal duration) Nornin2J voltage/range 2013 / 183-229 V 240 / 211-264 V Extended voltagelrange '179-232 V 206.269 V Nominal frequency/range 60.0 /'59.3-150.5 Hz 60.0.J 59.3-60.5 Hz Extended frequency range 7=60..5 Hz 57.60.5 Hz Power factor >0.95 !0.95 tviaximum units per 20 A branch circuit 25 (three phase) 17 (single phase) Maximum output fault current 1.05 Arms, aver 3 cycles; 1.04 Arms over 5 cycles EFFICIENCY CEC weighted efficiency 90.0010 Beak inverter efficiency 96.346 — ----- tic'{r1f'f=------------- byhomic (APRT efficiency (1a5t irradiation changes, referernce E115,06,30) 139.ar'fi Alight time power consumption 46 mW MECHANICAL ;DATA .Ambient temperature range -40°C to r 65°C C laernting 1-emperalure range (interna!) 410-C. to I. 65r- Dimensions 5GDimensions (WxHxD) 17.3 cm x 16.4 cm x 2.5 city (6.8" x 6.45'x 1.0") vtithrout amounting brac?sat uJriigfit 1.15 t;u ('3.5 fits) Cooling 14alural comeeeflon - No fans �r1cicsure environ sletttaf aortae, Clutdoor - NEKIA 6 FEATURES C-,ornp,atihiRty Pairs with moat 60 -cell AV modules Communication Power line 10011i!orind Free life,liine rriwirorin-- vi~ En ighPen Cort'g7t$tnce UU!741/IEC-E ). 47j FCC. Part 15 Criss C3 t^MARC" ,A -C22_2 NC-), (1 -Ni!) 1, 0.4-011, and 107.1-01 To )r-�irn nmve i bowl E-nphm'se MicroimpNet 'iechnoiogy, � .( er'ip iase s"isil +L 1pfi,r,re t data rl-,l;:,A7rbane'4€!-edrJv4.�ay,.,,y�.a.„r,. Envoy Cuni-reunicatians gateway E n' v 0 Y Communications Gatewayi Vlklrttl The Enphase Envoy* Communications ons G,74owalt is the networking huh for the Enphase Microinverter System. System owners can easily check the stattiis of !heir solar system using the Envoy's LCD display or they can get more detailed information through Enlighten' Enphase s web -based monitoring and analysis software, included with purchase of Envoy. MART S I M PL15 AEUASLE Includes v�ieb-b sed Monllo6ng - Rug & tif.'v insd, W101) 24/7 rnonlio;incg & analysis eanvol Auf; mugs up rW cies e dN)gro stirs Advanceci c! a rnanlger caro! 4ni5gl'4aits -"IVI Sit l:'I'l etlC:.!gy devicet'-.10r,^Ige, i ""' j et Ipi .as C�P S Yi Wf Envoy 0o mrrluri caiirns GatmRy tf DATA INTERFACE Powor Une Communications ural Area IV;,1IWm t (LAMI Enphass piopr;etary 70ii00,.uta-sensinq, auto-negoliaiir?g POWER REQUIREMENTS AC sruppty 120 VAC, 69 Hz. — Poti'ecr Consumption CAPACITY 2.5 walls typical, 7 watts maximum Number of rnicroinverters polled Recommended up to 500 Por commercial installations, Multiple Envoy devices are used in combination with Line Communications Filter's (LCF) to separate networking domains acaoss the site. MECHANICAL DATA i]imensions (M:l Y -D) 222.E min x 1'12 min x,13.2 mm (0.3" x 4.4' x 3') weight. 3`!0 g tit oz.) –=---nt— tooilha lt�tur<7i Gt;Ii.FCii:;ra–rar; fins Enclosure environmental ra4inq Indoor NEMA 1 .FEATURES Standard warranty term Grit-ripliance One year ti9L 60950-1. EN 60950-1 FCG Part '15 Class B To lean- rr1Crt, about. Enph?se micrain mer` ter–Moloq +.M1..iry.I!-f;.}.1ra;7'LAi !p*4k a+•:C^•y 4-J•aG:}s. •✓1:9+R'M +n +ta> �!'.."<r l9c•r, �C. 't ^.a: rG..,�.r+. y.�CnR?r TEGHeh Use NEC 2014 — Enphase System Code Compliance Overview This technical brief discusses new NEC 2014 requirements that apply to Enphase Microinverter Systems. It is useful for installers, electricians, and electrical inspectors or authorities having jurisdiction (AHJs) for understanding how code -compliance is handled where NEC 2014 is adopted. Main topics discussed in this document are: • NEC 2014 Section 690.12 Rapid Shutdown of PV Systems on Buildings • NEC 2014 Section 705.12 Point of Connection • NEC 2014 Section 690.11 DC Arc -Fault Circuit Protection NEC 2014 Section 690.12 Rapid Shutdown of PV Systems on Buildings Enphase Microinverter Systems fully meet this rapid shutdown requirement, without the need to install additional electrical equipment. Properly labeling the PV system power source and rapid shutdown ability is required per NEC Section 690.56 (B) and (C). Solar electric PV systems with Enphase Microinverters have one utility -interactive inverter directly underneath each solar module, converting low voltage DC to utility grid -compliant AC. When the utility grid is available and the sun is shining, each microinverter verifies that the utility grid is operating within the IEEE 1547 requirements. Only then does it export AC power into the electric service for use by loads onsite or export power to the utility grid for others to use. When the utility grid has a failure, or the PV system AC circuits are disconnected from the utility service via an AC breaker, AC disconnect or removal of the solar or main utility service meter, the microinverters stop producing AC power in fewer than six AC --------- _ --- cycles."Enphase-Micrainverters are not capable of -operating -as an- Gvoitage-source- is -means -that ---- -- -- - without an AC utility source, Enphase Microinverters are not able to energize connected wiring and no AC voltage or current can be Injected into the PV system AC circuits or the grid. When the AC utility source is removed from the PV system AC circuits via any means, such as an AC breaker, AC disconnect, or removal of the solar or main utility service meter, this equipment performs the rapid shutdown function per 690.12. With an Enphase Microinverter System this shutdown occurs well within the 690.12 required 10 seconds, and there are no other conductors energized more than 1.5 m (5 ft) in length inside a building or more than 3 m (10 ft) from a PV array. Code Reference 690.12 Rapid Shutdown of PV Systems on Buildings. PV system circuits installed on or In buildings shall Include a rapid shutdown function that controls specific conductors in accordance with 690.12(1) through (5) as follows. (1) Requirements for controlled conductors shall apply only to PV system conductors of more than 1.5 m (5 ft) in length inside a building, or more than 3 m (10 ft) from a PV array. (2) Controlled conductors shall be limited to not more than 30 volts and 240 volt-amperes within 10 seconds of rapid shutdown initiation. (3) Voltage and power shall be measured between any two conductors and between any conductor and ground. (4) The rapid shutdown initiation methods shall be labeled in accordance with 690.56(B). (5) Equipment that performs the rapid shutdown shall be listed and identified. 0 2014 Enphase Energy Inc. All rights reserved. March 2014 NEC 2014 — Enphase System Code Compliance NEC 2014 Section 705.12 Point of Connection Code Reference 705.12(b)(6) Wire Harness and Exposed Cable Arc -Fault Protection. A utility -interactive inverter(s) that has a wire harness or cable output circuit rated 240 V, 30 amperes, or less, that is not installed within an enclosed raceway, shall be provided with listed ac AFCI protection. This requires exposed AC cable systems, such as the Enphase Engage Cable, to be protected by AC Arc -Fault Circuit Interrupter (AC AFCI) protection devices in the AC panel. Since Enphase Microinverters are utility -interactive inverters that backfeed into the electrical service through the overcurrent protection device, any overcurrent protection devices with AC AFCI that are installed must be specifically backfeed capable. NEC 2014 705.12 (D) (4) Suitable for Eackfeed. Circuit breakers, if backfed, shall be suitable for such operation. If terminals of circuit -breaker AFCIs are marked "Line" and "Load," then the product is not backfeed capable. Today there are no known AC AFCI backfeed capable products in existence or planned, so Section 90.4 of the NEC code advises the inspector/ AHJ to grant permission to use products that comply with the most recent previous edition of the Code. Until AC AFCI backfeed capable product is available, complying with NEC 2014 Section 705.12 (D) (6) is achieved by discretionary guidance per NEC 2014 Section 90.4 and referring to NEC 2011 Section 705.12, where AC Arc -Fault Circuit Protection is not a requirement for utility -interactive inverters. Code Reference 90.4 Enforcement. This Code may require new products, constructions, or materials that may ----- __- not vet be available at the time the Code is adopted. In such event, the authority--- ----__.. having jurisdiction may permit the use of the products, constructions, or materials that comply with the most recent previous edition of this Code adopted by the jurisdiction. NEC 2014 Section 690.11 DC .Arc -Fault Circuit Protection This requirement is for direct current (DC) Arc -Fault Circuit protection, and only applies to systems with DC voltages above 80 VDC. Enphase Microinverter systems are exempted from this requirement as they always operate well below 80 VDC. The requirement is basically unchanged from the NEC 2011, and it is unnecessary to add DC AFCI to an Enphase Microinverter System installation. Code Reference 690.11 Arc -Fault Circuit Protection (Direct Current). Photovoltaic systems with do source circuits, do output circuits, or both, operating at a PV system maximum system voltage of 80 volts or greater, shall be protected by a listed (dc) arc -fault circuit interrupter, PV type, or other system components listed to provide equivalent protection. 0 2014 Enphase Energy Inc. AA rights reserved. March 2014 ni Cb I L C fr'�'s In S,!3i" V)1,7 cfIT- I (CIII V, VMN�; IZ i 10 • �. r ff iT V, VMN�; IZ i 10 to o iV 17. Z FLANGE NUT END CLAMP T=BOLT SOLAR MOUNT RAIL MOUNTING CLAMP UGC -1 CLIP FLANGE NUT T -BOLT UGC -1 CLIP RAIL D CLAMP T -BOLT 00� U Installation Detail SolarMount Rail 1411 BROADWAY BLVD NE At9UAUMWF, NAI 47102 USA Top Mounting Clamp PHONE 505.242.6411 UNiRAC.GOM Universal Grounding Clips URASSY-0006 S.-�zc'ei Ce: -0 D`-R-1SS1'--)�`=—t:'1ar t,YJnt �3i!—t!f'-1 �:L'�—T�� t-t;ur= Cforp.dvc, ._ '22, •Inn ,:1': _' .-11 00 n ri 000 00 UU SolarMount @200B UNIRAC. INC. 1 411 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 VSA PHONE605 '24M411 UNIRAC . COM UNIRAC-300001 Standard Rail w ='al f] I on Yr Top Mounting UniRac Grounding Clips and WEEBLugs - 225.6 UGC.1 Figure 26. SHdc UGG1 granndirg rtlp Into top mounting slot ofrail, Toryuc modules in place on top of clip. Nips nitt prnctrate rail anad- izution and create grounding pnth d,rougb mil (seeFir.3, revere side). W EESLug r krivren the aluminum rail and the ug IV=. ■■a>ta!!# ■a#aa■ a aaliriii �■!' ■moi #■■af I I IFiVre 28. UGC -1 layoutfor r!##! �! ■raaarrr rar�ia■# ■r!!i#r #■i.r#�!■ rrrrrrla ####!a! ■■#!!aa■ #■■■■ rr #■ra#■■■ #■#■ ■#■, and odd number ofmodules in row.r!a#■■ car##■■■ ■#ulcer■r rir■■!!■ 1X" denotes Places to install UGC -1. rear##rifrlrrr rl�r�1A■ r!=aa■ &e. Ara.,he, offfodula in ■! aa!■r s##■■ ## #1� ■ ar �a a ■ � ■!l■!!## r■r■■■■■ ■ ■rr!■a R!#■a!lr. #�#■aarr alrra■■!t �■■■uric rlraaa■>[ ■■!!■■■ lair #'■moi riTi #iTrai ■s■s■!■ l2MRH Soon an ■a■■!■■# !■!!a■a■ a■a■■■ a■i■■■alt —r■1ta■■■R R!■#■■a■ a■■■!a!! #!#■a■■ ■■■!#!■■ ■aa!!!■# sa■!■!a■ NOUN ME aMOMM>tar aaairaSON ■a■!r■■■ r!##■■a■ NUMEROUS ■!!■a#nR !■#a■#■o ■■■!■a■■ #■!■■■■■ ■#aa!#!■ ■!l■!#■! !a■!■a■■ -!■r!■■!r !1■!■■■r ■#Naas#R !■■■■r#r !■!■■■!/ i��ii��� ii�ii���i wrmm11n iwoiit iii: �iNNXiul @®o �,�/ 1 Rf # � Pu1s7102011 e Juha2011 an 47 goa t he tnttaq tre. A 141171 GROUP COMPAKY Al tirhts rescti�d. TOA nnxinling Clomps `a+_ t M,odi,te t j 7.7 vj. � Aw t-tsott Mb uGGi _ Intertek ' Cantcm,rt[ V1.$t rMkq .r r Solo,,Mounta rol Cony type) Fwat27. insert a bolt in the WE1 BLug aluminum railorthrough the deamaceholein thestainless steel flat Busher- Place dye stoinIm steel flarteasheron the bolt, oriented ter. so the dimples ivillcontact the 'aluminum raitP'ace the lugpordon Ton rl thebottandstainlesssteelflat r tcnshrr.ltvtailstatrlesssratfiat i� teasher,lock itwherandnut 7ightenthe nut until the dimples are completelycmbeddedinto therad .•� andtug.•iheembeddeddImplesntake stointess 51"1 Flat ages -tight mechanical connection Figure 26. SHdc UGG1 granndirg rtlp Into top mounting slot ofrail, Toryuc modules in place on top of clip. Nips nitt prnctrate rail anad- izution and create grounding pnth d,rougb mil (seeFir.3, revere side). W EESLug r krivren the aluminum rail and the ug IV=. ■■a>ta!!# ■a#aa■ a aaliriii �■!' ■moi #■■af I I IFiVre 28. UGC -1 layoutfor r!##! �! ■raaarrr rar�ia■# ■r!!i#r #■i.r#�!■ rrrrrrla ####!a! ■■#!!aa■ #■■■■ rr #■ra#■■■ #■#■ ■#■, and odd number ofmodules in row.r!a#■■ car##■■■ ■#ulcer■r rir■■!!■ 1X" denotes Places to install UGC -1. rear##rifrlrrr rl�r�1A■ r!=aa■ &e. Ara.,he, offfodula in ■! aa!■r s##■■ ## #1� ■ ar �a a ■ � ■!l■!!## r■r■■■■■ ■ ■rr!■a R!#■a!lr. #�#■aarr alrra■■!t �■■■uric rlraaa■>[ ■■!!■■■ lair #'■moi riTi #iTrai ■s■s■!■ l2MRH Soon an ■a■■!■■# !■!!a■a■ a■a■■■ a■i■■■alt —r■1ta■■■R R!■#■■a■ a■■■!a!! #!#■a■■ ■■■!#!■■ ■aa!!!■# sa■!■!a■ NOUN ME aMOMM>tar aaairaSON ■a■!r■■■ r!##■■a■ NUMEROUS ■!!■a#nR !■#a■#■o ■■■!■a■■ #■!■■■■■ ■#aa!#!■ ■!l■!#■! !a■!■a■■ -!■r!■■!r !1■!■■■r ■#Naas#R !■■■■r#r !■!■■■!/ i��ii��� ii�ii���i wrmm11n iwoiit iii: �iNNXiul @®o �,�/ 1 Rf # � Pu1s7102011 e Juha2011 an 47 goa t he tnttaq tre. A 141171 GROUP COMPAKY Al tirhts rescti�d. UNI RAC ImMlotion Eheet 225.6 Unirae Grounding Clips and WFEBLugs 10 year limited Product Warranty See http•17wmw.unirac.com for currtnt warranty documu= and information. 08 11312UN I sgzz Broadway Boulevard NE AC Albuquerque NM 87102-1545 USA 2 Wiley Electronics LLC Washer, Electrical Equipment Bonding and Lug (WEEBLug) The WEEBLug is a device for bonding a solar array. The WEEBLug consists of two parts: a stainless steel washer (weeb-6.7) and a tin-plated copper lug. The washer is designed to provide a reliable gas-tight electrical connection with anodized aluminum pieces. The lug allows the lay -in connection of an electrical equipment grounding conductor. The WEEBLug may be attached to the top of a mounting rail with a captive bolt, or fastened to any aluminum piece after drilling a suitable size clearance hole (see part number list below). Figure Figure 1. WEEBLug Usage- Insert a bolt In the aluminum rail or through the clearance hole in the aluminum piece. Place the washer portion on the bolt, oriented so that the dimples will contact the aluminum piece. Place the lug portion on the bolt and washer portion. Install stainless steel washer and nut. Tighten the nut until the dimples are completely embedded and the lug and aluminum piece are flat against the body of the WEEK. The embedded dimples will make a gas-tight mechanical connection and thus ensure good electrical connection between the aluminum and the lug. copyright 2006 Wiley Electronics LLC Figure 2. WEEBLug mounted on rail. Material., 304 stainless steel, tin-plated copper • Listed to UL467 by ETL * Torque to 10 ft -lb using general purpose anti -seize • Maximum electrical equipment ground conductor size: 6 AWG • Use with 1d' hardware (included) • Outdoor rated Part number: WEEBL-6,7 for use with Y4 inch mounting hardware WEEBL-8.0 for use with 5116 inch mounting hardware WEEBL-8.2 for use with 8 mm mounting hardware copyright 2006 Wiley Electronics LLC Sq:ryt (n) ch- wh lo„5 Nctyfophs, 1-1cff( ears OMIlDnentl CPRS Radio Control Module Board (PCf•f) Copaclor Storage 8ar;k (CSB) #cdvrs�cc*rd A1€tcrfrl fizciissncattS r^w + GSAA/(;PRS 'Modem • Fley ble Two -Way Doio ReFevol • Infernal Antenna Scheduled and On-Demond P.eads • lilt De1eC'lar Inferval Reads (5, 15.30. 50 minutes) lemperoiure Sensor rP&OI-Time'interval Peons Demond Reseis • Reol-Bien Teter [vert and.Alarm F.elrievof • Real4ime POMer Outage and Power Postorot on . Service Diagnostics and jc,npef De4ccVon i tt Defection : mietet Clock Synchron'raifon STXtgrt?AL'ter Stratus Display • Aulcmofed Moler Reg:sttolion •'Secuae and Fncry,pied Dola iransffssions • �i-U>recllorlal?.�:e;telfr>q G°ver-,t3^-Air Srnoritv,efer rrlads.ae Firn�rro-e Upgrade Suppoltod tieW totem wiass 20: 35 15 • G1a55 _,VV_ 23 515 2s5 5�;,rrr.5yn•'tr, Inc. "403 Ca d C:cnton Rojc', "lass ' ti::tS ftcl;SpR, ;, ;,i;:rr,rr)i ,t9?' 1 •8Et3 �[.?. r 7$''i fi[.rnperafure - OPC-3cling: )-40°C. +65°C) lraosmission (GPRS): j-4010: Humidity 0. 10 ?5% non -condensing Accuracy tree<s ANSI 12.20 for occurocy cioss 0 5 :' Qgul-310ty & IIIdulYTy 10'txfCIFIC04onx FCC Far, 1.5 Cuss A Al -451 C'37.90.1 — i r87: ISINC;) AASI C! 2.20 (Clots 4.5) -- 1998 P I C' R3, CerliFed Ne# v(yl: Colrier C"r;rPrfred ^medsrrrenle;nt Canacto Cert;Ged C T R O N 3GPRS S 4 1 8 a i l e (+:.,.^ i• ,. SmarlSynch's t;l ltaatc trraertcc" "rt3elering safuiion tepluses a COMMUnIcaIions mod lc tlltst is inlearoied into the ttron C:✓ NIRON efeciricily mttler, The CEN1ROt4 Sinodt✓,eler c jjramuniccles viElr serverrunrrinG SmafiSynCh's tronsoclion Management S stern g y ,a•, (TMS) and con,pFes rn`h A1451 12.19 protoColS for data slorage and transmission. { This soluiron delivers cclionab!e intelligence usheotusage and rate doIo ovCr sccijr A vvlrefess networks (such as AT&T and Rogers ',r,retess) crud the Internet —,n lieu of curnbeisome and eap nshre larivali nelwarf:s. itis mattes mass del loymenls quicker, eus er, cat�;l !noie scalable, provid:ung a sigrfricanliy greater kelurn on. Resources {RoP,) for uliliEies- Unfk,e proprielnfy, rinsed-orchleelure solutions. the CENiRON Smaril%4efer is essenIicitya �! fu,ure•proof fnveshnenI ,n lechOniogy, its slondords-based IF carureclivify mattes it adOplable rand field -upgradable to suppori lodoy's sensoring and con -)r nunicolians needs, as %yet] as lomortow's opporluniiies, better than any alternative. Functions & Fu tures wh lo„5 Nctyfophs, 1-1cff( ears OMIlDnentl CPRS Radio Control Module Board (PCf•f) Copaclor Storage 8ar;k (CSB) #cdvrs�cc*rd A1€tcrfrl fizciissncattS r^w + GSAA/(;PRS 'Modem • Fley ble Two -Way Doio ReFevol • Infernal Antenna Scheduled and On-Demond P.eads • lilt De1eC'lar Inferval Reads (5, 15.30. 50 minutes) lemperoiure Sensor rP&OI-Time'interval Peons Demond Reseis • Reol-Bien Teter [vert and.Alarm F.elrievof • Real4ime POMer Outage and Power Postorot on . Service Diagnostics and jc,npef De4ccVon i tt Defection : mietet Clock Synchron'raifon STXtgrt?AL'ter Stratus Display • Aulcmofed Moler Reg:sttolion •'Secuae and Fncry,pied Dola iransffssions • �i-U>recllorlal?.�:e;telfr>q G°ver-,t3^-Air Srnoritv,efer rrlads.ae Firn�rro-e Upgrade Suppoltod tieW totem wiass 20: 35 15 • G1a55 _,VV_ 23 515 2s5 5�;,rrr.5yn•'tr, Inc. 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O.. if (.. i;: �,� [:'!`7 j . gn t -c o- sty r,� RsS:r,rr_E:5 F~.4;lir';l{yl1F'n:'IV. .f:I!2"'s �7?4a,*Nr„r 15ij'k.'1.:'f.rf.'ji`4ir.'rfI;1i1✓1[�-•iF'ULI�:,•nsfn•n:.t: ;Itt:.tlrnL1�NrEr14?f l+� ern;*a., i,q r.,.^b:Cr, r � �c > z•nc:;:n _...- e:e;.Ycrrt',r rrv,7S. (,.. ;h„iti ?7e6 ',71 � , r,adcl'; s u:n,rri n-rr1 z, wr.-1q,n � ..=p*L � � } P t '7 o t� J �• t ,.,�''°.:tr... a+s.:r ��J,I rC,.,; s1S .,e,(.1 i;; •, E.�'!r-�, r.0,:a+_^tr:f . Lwt�pta ;t.,,., dna„�°fin.. ,,._ 1 am '451141 �o l2�c�'y�Zec3oK �D 02:29:13 p.m. 10-27-2014 1/1 A4 oRd CERTIFICATE OF LIABILITY INSURANCE DA 0/27/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and condlUons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER MCGRIFF, SEIBELS 8 WILLIAMS, INC. P.O. Box 10265Extn Birmingham, AL 35202 CONTACT NAME Danielle Butterfield PONE . 800476-2211FAX No ADDDRESS: dbutterSeld®mcgriftcom INSURER(S) AFFORDING COVERAGE NAIC8 INSURER A :James River Insurance Company 12203 INSURED Roof Diagnostic Solar Holdings LLC; Roof Dlegnostics Solar and Electric LLC; Roof Diagnostics Solar and Electric of NY, LLC; Roof Diagnostics Solar and EJacble of INSURER 8 :Libe Mutual Fire Insurance Company 23035 INSURER C -.Federal Insurance Company 20281 Rodf DlagnosUts Solar of Mass, LLC; Restoration Design LLC; RDI Consulting, LLC 2333 Highway 34 Manasquan, NJ 08736-1423 INSURER D r INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:UN7N2PYV REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE 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, THE1NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR OF INSURANCE POUCYNUMBER PO EFF MIDD POLICY EXP MWOD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIM&MADE ff] OCCUR 000610670 04/15/2014 04/1512016 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occu w $ 50,000 MED EXP (Arty one rson) $ PERSONAL AAIN INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,0001000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS - COMPIOP AGO $ 2,000,000 $ B AUTOMOBILE lU1BrL1TYE �( ANY AUTO ALL OWNED SCHEDULED ALITOS AUTOS NON -OWNED H[RED AUTOS AUTOS 2291462454014 04/29/2014 04/20/2016 (acCOMBINED SINGLE 1,000,000 Ea azide t BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERdTYtDAMAGE $ r. Deductible: Comp/Coll $1,000 AUMBRELLA X LIAB EXCESS LIM X OCCUR CLAIMS -MADE 000619941 04/15/2014 04115/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTIONS $ C WORKERS COMPENSATION AND EMIPLOYERS' LIABILITY YIN ANY PROPRIETOR/PHRTNERIEXECUT1VE OFFICERIMEMBER EXCLUDED? (Mandatory 1.W F desalbeunder DESCRIPTION OF OPERATIONS below NIA 004 4727794 00 07/01/2014 07/0112015 X WC STATU- I TORY IMITS I OTH E.LEACH ACCIDENT S 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 El DISEASE -POLICY LIMIT S 1,000,000 s s s s DESCRLfTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101,Addrdanel Rsmar)u Schedule, H more space Is required) Certificate Holder Is Additional Insured under General Liability as required by written conbac6 GtKI1FIGA1 C nULL1CK Town of North Andover Building Department 160D Osgood Street North Andover, MA 01846 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ALrMORQED REPRESENTATIVE Page l Or 7 W 11 10onLOIu H%'WMU VVMrVKNI lull. PM1 flarlts lantl1vau. The ACORD name and logo are registered marks of ACORD ACORD 25 (2010105) m-0 -, :r c c_ -" n� o c-' is n � p m { M Z 00 � � o � O-rf ? 5 m -rt O nl ? =r Q O O H o°nN aM m n .O0 N _m 3>> � X =. CL S Nw . 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CD ' i ZO oCD 0`OD CA o m �Q C r. o 0 d p Ddb:' A rZ o A o� prD r� ►�z-3 OQ 9 � w G g iT1 Z COD y O w G r" O N G G °; 0 z C1 � b n cn p x n x z 0 W O C lD /Sr //y��� ��� �o� 36�' a3 6 �. fi2,1N ciao 45 a 8 0 a (9zra. l,2 x� is- Itdo 3 x va 6y - 1 a boo x �� 5� = C,2) l y 17 a�CCU PAA-9 c A L44 ? 00 pS, /e �? d, Lill DEPARTMENT Of PUBLIC -SAFETY i CONSTRUCTION SUPERVISOR LICENSE !J -,Expires- Birthdate 1): 7 1/1312080 R/13/1954 Rest bt�d;To' to A. DA I 30 KILL POND POBX,531 K HOOVER. KA 81845 156635 Restricted1lo: 60 00 - 35,94 cf enclosed space (HO C.112 SAI) lk-MasonI y.only IG _ I & 24amily Family*Homes. , eir, Failure to'l ; ' possess a current ' �editiop of the Massachusetts State Building Code is cause fir revocation of this license. L� \ Name The Commonwealth of Massachusetts Department of Industrial.,Accidents Office of Investigations Boston, Mass. 02111 Workers` Compensation Insurance Affidavit / • �'�� �� c;,� e Please Print I I Location: Cit,/ Phore # j I am a homeowner perrcrming all work myself. I am a sole proprietor and have no one working in any capadb/ I I am an employer providing workers'compensation for my employees working on this job. r'mmnnnv name' / • �• O C'VL Off A e V7 Address C i tv: N. �N�DUr i Phone Insurance Co. Fn 5 T r C^4Suq r Policv # �✓C 5 6 s O/ 6 Cnmoanv name: Cih/: I Phone #: Insurance Co. Polic"I # Failure to secure coverage as required under section 25AIor itGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties iri the form of a STCP WORK CRDER and a fine of (5100.00) a day against me. I understand that a copy of 'his statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certiry and pa ns nd penalues•o "perjury, that the information provided above is true and correct. Signature Cate y Print namePhone# '' - �s—S—? Official use only do not write inithis area to be completed by city or town cfriciar City or Town Permit/Licensina Building Dept ❑Check if immediate response is required ❑ Licensing Board Selectman's Office Contac: person: I Phone #: ❑ Health Department Other THE ZONING BOARD OF APPEALS 27 CHARLES STREET NORTH ANDi OVER, MASSACHUSETTS 01845 Any appeal shall be filed within (20) days after the date of filing of this notice in the office of the Town Clerk. i NOTICE OF DECISION Property at: Rocky Brook Road joy, T014f1 NORTH JUL 1 2 23 PY "; j FAX (978) 688-95.12 AUMZ �i wfty is- nerit NAME: Frank DiNuccio, Trustee of Wintrgreen Realty Trust, 673 Great Pond Rd., No. Andover I µpRTFI ADDRESS: for premises: Rocky Brook Road; PETITION: 009-99 North Andover, MA 01845 HEARING: 5/11/99 & 6/22/99 'h?- Is to certify that tClsfnty (2') days + » hero elapses! Wm slated d ro filed : o ,,•' v'., 2=4 filing Q$t ,JSACHUStt s^y A. Snadfhaw ;�1:'•'; NORTH ANDOVER OFFICE OF THE ZONING BOARD OF APPEALS 27 CHARLES STREET NORTH ANDi OVER, MASSACHUSETTS 01845 Any appeal shall be filed within (20) days after the date of filing of this notice in the office of the Town Clerk. i NOTICE OF DECISION Property at: Rocky Brook Road joy, T014f1 NORTH JUL 1 2 23 PY "; j FAX (978) 688-95.12 AUMZ �i wfty is- nerit NAME: Frank DiNuccio, Trustee of Wintrgreen Realty Trust, 673 Great Pond Rd., No. Andover I DATE: 6/23/99 ADDRESS: for premises: Rocky Brook Road; PETITION: 009-99 North Andover, MA 01845 HEARING: 5/11/99 & 6/22/99 The Board of Appeals held a regular meeting on Tuesday evening, June 22, 1999 upon the application of Frank DiNuccio, Trustee of Wintergreen Realty Trust,; for premises at: Rocky Brook Rd., No. Andover, MA requesting a Variance from Section 7, P 7.1.1 of Table 2, for relief of lot area dimension of contiguous buildable area regulation in order to build a single family home on Lot 248,Rocky Brook Rd. within the R-1 Zoning District. The following members were present: William i. Sullivan, Walter F. Soule, George Earley, Raymond Vivenzio. The hearing was advertised in the Lawrence Tribune on 4/27/99 & 5/4/99 and all abutters were notified by regular mail. No persons appeared in opposition to the petition. Upon a motion made by Raymond Vivenzio and 2nd by Walter F. Soule, the Board voted to GRANT a Variance from the requirements of Section 7, P 7. 1.1 to allow area dimension of contiguous buildable area of 50% instead of 75% to construct a singe family home on approximately 42,945 sq. ft. Voting in favor: William J. Sullivan, Walter F. Soule, George Earley, Raymond Vivenzio. Variance The Board finds that the petitioner has satisfied the provisions of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. 10.4 Variances and Appeals The Zoning Board of Appeals shall have power upon po appeal to grant variances from the terms of this Zoning Bylaw where the Board finds that owing to circumstances relating to soil conditions, shape, or typography of the land or structure and especially affecting such land or structures but not affecting generally the zoning district in general, a literal enforcement of the provisions of this Bylaw will involve substantial hardship, financial or otherwise, to the petitioner or applicant, and that desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of this Bylaw. Board of Appeals, � ) William J. Sullivan Chairman Zoning Board of eats ml/1999decision/12 (WARD OF APPEALS 688-'1541 BUILDMiS 6SS-9545 CONSERVATION 688-9530 HEAL Hi o88-9540 I'L.0:`"I\6 6„X -'P t MAScheck COMPLIANCE REPORT Massachusetts Energy Code � check Software Version 2.0 CITY: Haverhill STATE: Massachusetts HDD: 6027 CONSTRUCTION TYPE: 1 or 2 family,' detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 8-9-1999 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 608 Your Home = 574 Permit Checked by/Date COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. i The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equ' nt!selected to heat or cool the building shall be no greater than 25 of 'th design load as specified in sections 780CMR 1310 and J .4,. Builder/Designer Date i I i f Area or Insul Sheath Glazing/Door --------------------------------=---------------------------------------------- Perimeter R -Value R -Value U -Value UA CEILINGS ! 1540 30.0 0.0 54 WALLS: Wood Frame, 16" O.C. 2720 13.0 3.0 194 GLAZING: Windows or Doors j 420 0.480 202 DOORS 21 0.490 10 "T•OORS: Over Unconditioned Space! 1540 19.0 73 4 MT: 7.0' ht/6.0' bg/0.0' insul., 170 0.0 41 HVAC EFFICIENCY: Furnace, ------------------------------------------------------------------------------- 89.0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. i The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equ' nt!selected to heat or cool the building shall be no greater than 25 of 'th design load as specified in sections 780CMR 1310 and J .4,. Builder/Designer Date i I i MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 8-9-1999 Bldg. Dept. Use CEILINGS: 1. R-30 Comments/Locati WALLS: 1. Wood Frame, 16" O.C., ;R-13 + R-3 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.48 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U -value: 0.49 Comments/Location FLOORS: j 1. Over Unconditioned Space, R-19 Comments/Location BASEMENT WALLS: 1. 7.0' ht/6.0' bg/0.01insul., R-0 Comments/Location HVAC EQUIPMENT EFFICIENCY:' 1. Furnace, 89.0 AFUE or; higher Make and Model Number. THERMOSTATS: Adjustable thermostats required for each HVAC system. AIR LEAKAGE: j Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. i VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: ? Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure -sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. i HVAC EQUIPMENT SIZING: [ ] Rated output capacity of!the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR 1310 and J4.4. i MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------- 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. *****************************AFPLICANT FILLS OUT THIS SECTION**�* �1� D PCJC 'j APPLICANT � (o cIv PHONE Map Number / PARCEL LOCATION: Assessor's -31 y Pd6 �2 SUBDIVISION aC (C LOT (S) STREET Q c �i �aa /�l� ST. NUMBER N v ***************************************** O F F1C1AL USE ONLY********************************* N RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENT S5d 1�- DATE APPROVED DATE REJECTED a�- 5 ly COMMENTS FOOD INSPECTOR -HEALTH SEP�i 1C`IiNSPECTOR-HEALTH UAIt KtJtGitU DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED ?t - PUBLIC PUBLIC WORKS - SEWER/WATER CONNECTIONS__ DRIVEWAY PERMIT =W �"�� �f'/tleu/C/ems C-a.vf�f�t��%�CJ//�//%J� DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm DATE 2191 �' � 1 No Date....... ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... 4�" .n'..!...�.tic:............ .�.�.4.�.�C"............. has permission to perform .....`1,\h.. �- ........t ..4% �N�. •............................ C .J.. .. wiring in the building of .............%�...Y.p................................................. 3 at .....................UC. !.. (? �J ,North Andover. Mass. Fee.. .,, .:(� Lic. No. 0 U ?.'; fir........... LECTRICALINSPECTOR CEt����, WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office UseOnly Permit Na S Occupancy & Fee Checked BOARD -OFFIRE-PREVEUT-ION=REGULATIONS-5- 7 -C -MR -I2:00- APPLICATION FOR- PERMIT TO-PERFORM-gLECTRICAL WORK All work to be performed in accordance with the Massachusetts ElecMcal Code 527 CMR 1200 l , (P-tease-PnOIn.ink-or-type=aU-irdiornuidwy Daft, 7o the I- spector of Wires: Tmn-of_ North Andover The undersigned applies far a permit to perform the electrical work described below. Locatian4Street&Number- - Z-(, 7 -ail / o c -h/ 9Z 6 o Owner or Tenant l /C o D -ecl • C �i2� Is this permit in conyuncdon with a building permit Yes V -- Purpose of No 0- (Check Appropnote Box) Ewsting-Service Amps dohs Overhead - C3 -Nemo Service _Z 6 Q Amps 12(1 Zt10 Voits Overhead ❑ 9 Location and Nature of Proposed Electrical Authorization No. J D / / " / 67 Undgmd- 0 No. of Meters UndgmdA No. of Meters INSURANCE COVERAGE. Pursuant to the requiram 6ts of Massachusetts General Laws I have a- " -Insurance-Po1(cy Ape[aiions.�ouerage or�isu�tantial YDS -NO = ha fitted id proof of same. the.0 -YES.- NO- = K you have chekticeciYES please indicate th 4f coverage by checking the appropriate box _-BOND- = OTHER.._ (Expiration Date) Estimated Value of -Electrical Work$-- / Work to wart 2 �Z9—rS'/) tnspectton mate-Reaqueatad R-oughi_G %Ci:�11--Final NO. /n( Bus. Tel No. Address a, A.0-dw t Alt Tel. No. OWNEit'S- FiANCE.W tam_awaf&.the-Licenses-dose-noi-hava.tbe insurance coverage or its substantial equtvalent as required by Massachusetts General Laws. And that my signature on -this -permit application waives this requirement. Owner Agent (Plea" Check one) lnwntinnn Nn pFAMrr FFA E �3+ d Total No. of Li ht6rt Outlets No. of Hot fuse No. of Transformers KVA Above ❑ -In ❑ No. of Lighting Fixtures' Swimming Pool gn4d ❑ and ❑ Generators KVA • of Emergency Lighting No. of Receptacles Outlets No. of -Oil Burners B wyUnits No: of Switch Outlets No of-Gas-Eurnera- RREAEARFAS! No: -of Zone No. of Detection and Total No of Ranges No of -Air Cond- Tons Initiating0evices _ Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No:pf Dishwashers Soace/Area Hearin KW -Detection/Sounding�vicss ❑ MuniafpaL C3 Other No. of D -00Acxs- KEN- - Local- Connection No. of No. of Low Voltage No. of-WaterHestars- KW Sign- Bartases Winn No. H ro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiram 6ts of Massachusetts General Laws I have a- " -Insurance-Po1(cy Ape[aiions.�ouerage or�isu�tantial YDS -NO = ha fitted id proof of same. the.0 -YES.- NO- = K you have chekticeciYES please indicate th 4f coverage by checking the appropriate box _-BOND- = OTHER.._ (Expiration Date) Estimated Value of -Electrical Work$-- / Work to wart 2 �Z9—rS'/) tnspectton mate-Reaqueatad R-oughi_G %Ci:�11--Final NO. /n( Bus. Tel No. Address a, A.0-dw t Alt Tel. No. OWNEit'S- FiANCE.W tam_awaf&.the-Licenses-dose-noi-hava.tbe insurance coverage or its substantial equtvalent as required by Massachusetts General Laws. And that my signature on -this -permit application waives this requirement. Owner Agent (Plea" Check one) lnwntinnn Nn pFAMrr FFA E �3+ d 3540 Date. l . �1"? .�n.... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 2 L4,7'; This certifies that .. ........... ............... . has permission for gas installation ................. in the buildings of . ....7"XI ........ ...................... at ? ../.�n t < North Andover, Mass. Fe/je. .... Lic. J. GAS INSP TOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer NIASSAC:t U a1=TT 3 P. NIFORNI ,�.�'P LI,CA-IT-1 Oh;i FOR, �'r T��'iY�" _[ O r?0 ,�a�.` FI d t-lNG TO I Y"ttli orType) � NORTH ANDOVER Y >f" >; ° tuilding Location OIL �k} Y 'Renovatir_ IN fZe.0 chrnent F'larts St.li✓(+titted (Print. ar Type) Installing Company Narle P.ddres s 1 vAIA,, one: Certificate Corp. N a7 rJ r Q O Partner. UA e (n to c� c G ca a � t a u to J w R w a! LU lLuj _ L LU Lj- 1ST FL.Oon izrta FLOOR '� �=,_paz STR FLOOR �STR � � I I I I { I IT i I iii _I � +_ 1__j j� ► � � I ` A. � j I I I I ' I t I-�-I�{ -Ijgg FLOOR 6Tri FLOODi-i-L.. ! TK FLOOR' _ _ t- R i i STH _ -C_L_�_.�_--- _I (Print. ar Type) Installing Company Narle P.ddres s 1 vAIA,, _ F- Business Telephone:_- ^� Name of Licensed Plumber or C cxs,'�� Insur ancr' Coverage inCJtC:?_ ! J: i Ut 1? 1C' COv.:. i 'e by checking the appropriate boy,: - :;- ( Liability In$!ir'anCe po{ICV �— Jl .. - LyCt'_ Ot Ini.e1T?nit';/ {_� L}ond _1 Insurance Waiver: I, the ur.rersic r ci, haVc- been rt,<,de a•.vare that the licensee of this application does notIIIZ3VarlIv one of ti c above t`'trra-e ir?surance coveragt}s. Signature of owner /agent of proper -y -- Owner I Agent Y'hete5y "miry that all or the dtuilr, and irtiormition t'u.e %,khn itt"! (er catered) in aF.n •e sOpticatinn ere true and accurate to the bat o[ lrY 'a;lOwicd9t and tltxt til p(urnb;jif +marl; and tnttatt»tiors ;ct: or:n.^.:. umd:!r Nrm:it itucs-d ro: t1i. appur:a ;,nn •':iii tx {n c�mFlicrt� w{t s:{'ptXtlLta! pro•riliona of th® Marsaeiutcttt .SlItte, Cat Cede and CLAVtM 14. cf L:.n i;ener;l i. -r4 Y Ji_u'�:roe r w �� rF: C at" LIC or e 5ar w _ l I G�s,_F i.��e__ Si,:latu , f stt~Y Plt�ai��r or Gasfitter -Y, � / T own � � � ! (Ori=lce u,1= OtiY_Y) -- r'ns_. Number one: Certificate Corp. Partner. _ F- Business Telephone:_- ^� Name of Licensed Plumber or C cxs,'�� Insur ancr' Coverage inCJtC:?_ ! J: i Ut 1? 1C' COv.:. i 'e by checking the appropriate boy,: - :;- ( Liability In$!ir'anCe po{ICV �— Jl .. - LyCt'_ Ot Ini.e1T?nit';/ {_� L}ond _1 Insurance Waiver: I, the ur.rersic r ci, haVc- been rt,<,de a•.vare that the licensee of this application does notIIIZ3VarlIv one of ti c above t`'trra-e ir?surance coveragt}s. Signature of owner /agent of proper -y -- Owner I Agent Y'hete5y "miry that all or the dtuilr, and irtiormition t'u.e %,khn itt"! (er catered) in aF.n •e sOpticatinn ere true and accurate to the bat o[ lrY 'a;lOwicd9t and tltxt til p(urnb;jif +marl; and tnttatt»tiors ;ct: or:n.^.:. umd:!r Nrm:it itucs-d ro: t1i. appur:a ;,nn •':iii tx {n c�mFlicrt� w{t s:{'ptXtlLta! pro•riliona of th® Marsaeiutcttt .SlItte, Cat Cede and CLAVtM 14. cf L:.n i;ener;l i. -r4 Y Ji_u'�:roe r w �� rF: C at" LIC or e 5ar w _ l I G�s,_F i.��e__ Si,:latu , f stt~Y Plt�ai��r or Gasfitter -Y, � / T own � � � ! (Ori=lce u,1= OtiY_Y) -- r'ns_. Number CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number �68 Date THIS CERTIFIES THAT THE BUILDING LOCATED ON ,(afayl� a� AS (3%►OO,C RV MAY BE OCCUPIED AS / RP h �%��A�� a dlyN�Y SKQbfiZZ5IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO -7-X 0 DY v e lop wi r ,u ]L ADDRESS �D �°XJ��/ /t)aa. A,v�ovr/L- Building Inspector e, CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number �68 Date THIS CERTIFIES THAT THE BUILDING LOCATED ON ,(afayl� a� AS (3%►OO,C RV MAY BE OCCUPIED AS / RP h �%��A�� a dlyN�Y SKQbfiZZ5IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO -7-X 0 DY v e lop wi r ,u ]L ADDRESS �D �°XJ��/ /t)aa. A,v�ovr/L- Building Inspector CO) 10 CD 0 y d CAO� 0 C O y d n CD O OMMP CD CD CO)9. CD CO) CD 0 CD c?moo m Q N = Cl, 0 ® Ci m0 m o, = mo Im C N TI CD =r M o � m r« CD H ti N o ®m ; C > > � o ^f (> O O y tmCD : A ►�. '� S H � r CT7 a n ®_ � r. C/) /CDm N n CD o m ncmm 3 p G N ' = ��N: z =�_: f"} � H t1 � (n .N.► m N v m O n �^cm � OC* o CD �.� CD . Cn = m CD CD d p Ddu A rZ o rZ D = C` o - cn � ID z i o UQ rCn � v ki 1� � T T a �o A � T rn mrn z � z cp Oz 7 d o R C � q Gi x y� 4N.6 CO) 0 CD OZ ,C L Cl) 0.S. m m n cc � �o m c 0 m CD 33 cn CL C c m cr 11C m Cn O Q CCD m am w G CD o _a co CDCD CO) 10 CD 0 y d CAO� 0 C O y d n CD O OMMP CD CD CO)9. CD CO) CD 0 CD c?moo m Q N = Cl, 0 ® Ci m0 m o, = mo Im C N TI CD =r M o � m r« CD H ti N o ®m ; C > > � o ^f (> O O y tmCD : A ►�. '� S H � r CT7 a n ®_ � r. C/) /CDm N n CD o m ncmm 3 p G N ' = ��N: z =�_: f"} � H t1 � (n .N.► m N v m O n �^cm � OC* o CD �.� CD . Cn = m CD CD d p Ddu A rZ o rZ D = C` o - cn � ID z i o UQ c� I �' ki �.�o m �o A z z � z cp Oz 7 d o y � q Gi x y� N z 0 tn r wy 0 19 Town of North Andover r1ORTN O t.eo I t. q+ Building Department 3? get,0 .76 0 27 Charles Street o North Andover, Massachusetts 01845 * ,� (978) 688-9545 Fax (978) 688-9542 4 TIED tO[wlCwlwKM 1' ��SSACHU`����� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS )cl) le4llv lge©a l( LOT NUMBER v SUBDIVISION DATE REQUEST FILED DATE READY FOR INSPECTION ' `s/ / !ZO6 6 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIG FF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-1NS7PN,FEE OF TWENTY- IVE ($25.) DOLLARS WILL BE CHARGED IF THE CTM DOES NOT;DT ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING o �� CONSERVATION DATE 2 PLANNIN� TE D.P.W. — WA4R METER DATE --5� E 0 Q D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIO 1TO THE INSPECTIOVREQ STDATE. SIGNATURE / DPW AUTHORIZATION Location No. �6 ( Date / / / I Coco TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 13o),5-- 3579 ✓a,5-- 3579 ,/ 41 Z -'- Building Inspector Date` ! N° 4260 '- ",ODT;��a TOWN OF NORTH ANDOVER gip` p PERMIT FOR PLUMBING SACHU'S� r y� This certifies that............ .. has permission to perform ........................ plumbing in the buildings of .! �- �!............ • • • . at.,, -2 ...... . ...North Andover, Mass. Feer. X? .... Lic. o 3U 2... ...V A.f. �.. '?,!h��-.......... . PLUMBING NSPECTOR /dpi G WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or 7PYpe) r- 3 b �POW11 "x 4 13 U 11 cl life] ,3C11"r AT: Locat:ion Owner - Name. _.._.. . —. ------ Ty) of OC:cllpallcy: New Renovation ❑ Re aceluent: ❑ P loans FIXTURES suhnli t1: ed; Yes ❑ NOD (Prim or'fyhe)'(I Check One: certificate Installing Company Name—d•���\;1C�-- — ❑ Corp. ---___-- Address _>..�i(.�r _ _— ❑ Partnership - --- ❑ I-irm com pan lousiness I clephonc __!--__ _.__ Nal ie of Licensed Ph tuber or Gasfiucr licreby certify (hal all of the details and information I have submitted for entered) in above application arc true and accurate to the best of 111y knowledge and that all plumbing work and installulions performed outlet Permit issued for this application will lie in compliance will) all pcttinenl ptovisious of the Massac•liiisctts Snoc (las Code and Chapter 142 of the C .neral I aws. hire ioloin)ed the gwoci or his agent that I do not have liability insurance including complctcd operations coverage. ljiave a current liability imurance policy to inciutic.cony)Ic(cd operitions corer.ige: e By ___---------_ turc of Licensed Plumber 'title --------------- ------------ City/•fownr _—.. — —_--^ -- �j�` �Y(>e of I'lumh' ng License APPROVED (OFFICE USE ONLY) License Number Master ❑ Journeyman l otim 1240 li0RHS 6 WAIIIIF 4.ltJc. t9e9 X N z 4 _ Y Y N l"' N fA O Z F. z > w � - w W N x Z y _j q to a x x~ u' Z; :3 OZ O Z m a oc O — w w 1- rn w N H U m rn q to U. _ _z H x ¢ Z O m O y q m N > Q oC 3 q H yr z W. G n. a J= c7 d o a Q o aL CgW w= Q X W O X Y Y N a N a w nx W f- U> H O Y a 7 w 1. X O O to z z x Q ul ►' O >c U w r 3 Y m x N N a a 0 q _j _t d cc cc cc a O a 1- .qt tn SUB—BSMT. BASEMENT IST FLOOR2ND FLOOR 3RD FLOOR r04TH FLOOR 6TNFLOOR 6111 FLOOR 7TIl FLOOR1_, 7T11 FLOOR :1 _ —F1 (Prim or'fyhe)'(I Check One: certificate Installing Company Name—d•���\;1C�-- — ❑ Corp. ---___-- Address _>..�i(.�r _ _— ❑ Partnership - --- ❑ I-irm com pan lousiness I clephonc __!--__ _.__ Nal ie of Licensed Ph tuber or Gasfiucr licreby certify (hal all of the details and information I have submitted for entered) in above application arc true and accurate to the best of 111y knowledge and that all plumbing work and installulions performed outlet Permit issued for this application will lie in compliance will) all pcttinenl ptovisious of the Massac•liiisctts Snoc (las Code and Chapter 142 of the C .neral I aws. hire ioloin)ed the gwoci or his agent that I do not have liability insurance including complctcd operations coverage. ljiave a current liability imurance policy to inciutic.cony)Ic(cd operitions corer.ige: e By ___---------_ turc of Licensed Plumber 'title --------------- ------------ City/•fownr _—.. — —_--^ -- �j�` �Y(>e of I'lumh' ng License APPROVED (OFFICE USE ONLY) License Number Master ❑ Journeyman l otim 1240 li0RHS 6 WAIIIIF 4.ltJc. t9e9 Location /aT / 5 �� / / laa / No. 8 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ 25-n Building/Frame Permit Fee $ ,j Z) 0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector Location f � No. Date —7-3gjl Nom,. TOWN OF NORTH ANDOVER n Certificate of Occupancy $ + Building/Frame Permit Fee $ Foundation Permit Fee $ SJACHUSE OtherLpermit Fee $ t Sewer Connection Fee $ Water Connection Fee $ Z° TOTAL $ 1257 1�c5�?'y 13:24 Z�p for . Div. Puba c Works 1, C�82. Cr! G'fiIlf 0\ O cq C CJ I Vi I I i � D o r N 7 Lr .1 h ^` O 1.n1 y IN i � ( I Z C N I � v. v. v: G — -- �T� C r T _ . � z N V. - - e,, � — o r N 7 Lr .1 h ^` O 1.n1 y w 'JI S � � — = 1, �• y i % — �• � ,\'Y11 � _. (' w Ln LA i I � � m 7 n t \ b l� °Q °Q Q y �• � � � t Lo _ Ct CICA —21I I Ji � 1 1 0 J y k Cant S Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) T 6 D �De ✓t /c p M eV 7 20 Poe try S e o a,k� IFO Map and Parcel: PurposeQy f Application (check below) Phone Number of Applicant Single Family _ Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any parry to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit ig issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40°16 permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. XThis application represents a lot which is ready for building permits,(Le. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an PTION as cited above. Further I understand that the submittal of misleading and or inaccura inform tion, or the ch eking off of an above item which does not comply, whether done to my knowledge or no , is gr unds for r sal by the Building Department to issue a Building ermi /j "s 5 2 ignat e o caner or Authorized Agent who signed the Attached Building Permit 0alte This form must be attached to the Building Permit upon application for such permit. r i Location k',i. J✓G1 l� �0,1ej No. 6 Date '" Check # 1.5 16 5,j 2 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 200, OD Foundation Permit Fee $ Other Permit Fee TOTAL Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMjOLISH A ONE OR TWO FAMILY DWELLING �' BUILDING PERMIT NUMBER: �e DATE ISSUED: 3 t SIGNATURE: Building Commissioner/I for of Buildings Date SECTION i- SITE INFORMATION _ 1.1 Property Address: a 1.2 ,Assessors Map and Parcel Number: ZD 2vc r -`y � 2cr� k--jZ Irk . ✓ O?�'� �- ✓O`G+.3 S Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record F Nam (Print) Address for Service: Signature /, Telephone 2.2 Owner of Recor : Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ C.7!gz �+ Co 2rb E 1 t_ Licensed Construction Supervisor: License Number P: lbaob k S (� �� l' S Cu/ 1 � A' O i v 2� (� Address MExpiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �;fo D `1N�tm c 5 2 Z b Company Name Registration Number Address �O v p e/ ! b S Expiration Date Si nature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑. Specify Brief Description of Proposed Work: _ AP i <-A?— • /�i/ r)e a 2 —ea re SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be OF)F'ICIAL USE-QNLY Completed by permit applicant apt 1. Building 30 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Permit fee tel x tbl one" MuchaPlumbingBuilding 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �i9 a✓r S/1y as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters r w rk authorized by this building permit application. ZYp "1 r /69 :F/ Signature of Ownfr Z 41Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, C1 �-'&-a" C� CL �l� i �-' as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of MW/AVnt Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I s 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIME-NSIONS OF GIRDERS FIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND 1S BUILDING CONNECTED TO NATURAL GAS LINE S-,7 -.> 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******'***************** ea/so Q_ __,PL 4'7fr x r 71-S) APPLICANT PHONE LOCATION: Assessor's Map Number D PARCEL 003,y SUBDIVISION LOT (S) QNB _ STREET oc' "Br AIA ST. NUMBER o90 ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: . I / CONSERVATION ADMI ,V COMMENTS Wp F��e ecce. aga- 965 r?m,20.se_J 6LA5,c. 106 � OR DATE APPROVED _ DATE REJECTED TOWN PLANNER COMM DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED - d DATE REJECTED COMMENT PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm E The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name:L- Location: s V-crc Y- - PKI-V4W L -N City C-,\/ , VVI , Phone # q -4-if I 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 5 ?z>R-Cxb i�s► Cly -(Lt' LN CiG70 Phone* of Insurance. Co. (_,C'-(�LCt� tJ ccm-k&,,-t� Policv # 1PJ Company name: Address City: Phone #: Insurance Co. Policv # 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 v¢ell_as_civil.penattiesinlhefnunsif-aSTOPWOWORDER.and.a.fine.orf-$1DD-00)aliay. Kjainsi_o. e. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under the 'qAd/penalties of perjury that the information provided above is true and correct. Print name 177��CrD6�`'(�bQ,Q E I P_bone-#Z3±—C-/ Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept OCheck if immediate response is required .0 Licensing Board p Selectman's Office Contact person: Phone #: E] Health Department Ei Other 05/22/2003 10:20 9789219182 LAURANZAND INSURANCE -A00-RD- CERTIFICATE OF LIABILITY INSURANCE (978) 927-8420 LaurAnzano Insurance AgoncV T� CERTIFICATE 0 ISSUED ASA MATTE 107 Do ONLY AND CONFERS NO RIONTS UPON Dodge Street HOLDER. THIS CERTIFICATE DOES NOT A ALTER TUC �n..e.....— '_-- r_�vij !�► 01915- INsuneD INSURERS AFFORDING CFRAGE GEO Dynamics INsuRERA:PrOvidQftQQ tualIns. SA Brook Pasture LaneINBURER8:Bafet 2nsunca INS uRER a Le ion Insurance Essex MA 01929- IN R a. =OVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSUREn REQUIREMENT, TERM oR I'4iMIUTIln►, -I -_ _ _- PAGE 03 DATE (NwOwyy Y) OR Inc msuRANCE AFfORDE=D BY THE POLICIES DE$CRIBEDvint:1 L) IM NT WITCT T RESPECT TO - r "" `-c'%wuJryUiCATED, NOTWITHSTANDINGANY AGGREGATE INSR DOL L;.: ;TS SHOWN MAY HAVE BEEN IS REDUCED BY PAID CLAIMS. O ALL THE TERMS EXCLUSIONS ANTHIS TE MAY 13E ISSUED D CONDITIONS TR R TYPE OF INIIU ANCE OFOSUCH POLICIES. A GENERAL LIABILITY POLICY NUMBER SCP 3$305771 DATE DA 6 Ms 0 N LININ X 08/28/2002 08/2B/2003 COMMERCIAL GENERA !ABILITY EACH OCCURRENCE b 11000,000 CLAIMS MADE X� OCC J J J J ES t 80,000 NEO EXP A elle !SOA b 5,000 PERSONAL 4 AOV INJURY S 11000,000 GEN'LAGGREGATELIMIT APPLIES PER: J J J J GENERAL AGGREGATE 1 2,000,000 POLICY M JpMT PR 9•COM lOPAG S 2,000,000 LOC B AUTOMOBILE LIABILITY 3175637 10/04/2002 10/04/2003 ANY AUTO COMBINED SINGLE UNIT Me ecddP,p b 1,000,000 ALL OWNED AUTOS J / / J SCHEDULEDAUTOS BODILY INJURY (Per P -9n) 1 X NIREDAUTOS / J J I BODILY INJURY NON -OWNED AUTOS (par among 1 PROPERTY DAMAGE b (Per •a1dPIU GARAGE LIABILITY AUTO ONLY - EA ACCIDENT b AN. AUTO J J J J OTHER THAN FA ACC S AUTO ONLY: GO b EXCESSAIMBRELLA LWBIUTY J / / / b OCCUR OWNS NAGE AGGREGATE b 1 DEDUCTIBLE b RETENTION b WORKERS COMPSIdATION AND TIC 321784 10/04/2002 10/04/2003 XLiXjj OtR EMPLOYERS' LIABILITY ANY PROPRIETORWARTNERIEXECUTWE E_L, EACH ACCIDENT 1 100,000 E.L. 21SEASE - EA EMPLOYEE b 300,000 OFFICEPJMEMBER EXCLVOED> / J J J If yes. deeEdbe under SPECIAL PROVISIONS Wow E.L. DISEASE -POLICY LIMIT Is 100,000 OTHER J DESCRIPTION OF OPERATIONBR.00ATIONBNENICLERMCLUSIONS ADDED BY ENDORSEMENTISPECWL PROVISIONS CERTIFICATE HuLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE 133UING INSURER WILL ENDEAVOR TO MAn. 20 DAY& WRITTEN NOME 70 7HE CERTIFICATE MOLDER NAMED TO THE LEA, BUT FAILURE TO 00 90 SWILL IMPOSE 040 OBLIGATION OR LU►BINTY OF ANY RIND UPON THE Raouf Sayegh 01SUR ITS AGENTS OR REPRESENTATIVES. 20 Rocky Brook Road AUTHORIZEDR North Andover MA 01845- in ACORD 23 (2001108) 0ACOVXORPORATION 1988 * INS026 poe) o5 ELECTRONIC LASER FORM& INC. -1&00)127.0646 Pape 1 o12 s ?'a a, 4 T- Y r.. • j i j 7 i 1 f - $ r r IL /� e ' ............ ......-.. _ ... .._. .._.�.._. ... 6 ,, LEY M. Goldberg ,020- 5�I N1 ITA ci A. !; A Cl) m m m DO Cn 0 v C � d CO) n Cl)CD Z CO) CD 0 a �. c l' C = ? 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