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Miscellaneous - 200 WAVERLY ROAD 4/30/2018 (2)
11561 Date..� ...... .. .. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .................. has permission to perform .... . ...... ..... ..... 4 ........................................... plumbing in the buildings of .......................................................................... . 1 Z atc>. ............................................ North Andover, Mass.! Fee.� ... 0 .... (.0. ..... ........ Lic. No. t�2(0��j . ............................. : ................................................... PLUMBING INSPECTOR Check# Ald 4,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK > CITY v--- MA DATE J PERMIT # JOBSITE ADDRESS L OWNER'S NAME �,� r POWNER ADDRESS TEL EI TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Q RESIDENTIAL PRINT RENOVATION: ® REPLACEMENT: E1 PLANS SUBMITTED: YES 0I NOEI CLEARLY NEW: FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ 1 ___ L -___ �I i f ___- I _-�� _( _____.� 1 ! I I ! 1 f CROSS CONNECTION DEVICE f -_ ( [ _.. _I _ _.., --__E _r.-_ - - - -! -: ---�-j DEDICATED SPECIAL WASTE SYSTEM ( I i __.._! ..__.__! ___ __ aJ - f ____! _-.- ! _-___J _---t DEDICATED GAS/OIUSAND SYSTEM JI i DEDICATED GREASE SYSTEM _1 _..__ __ (_�_. DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER J D DRINKING FOUNTAIN FOOD DISPOSER .--___.I FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK -- - I _ -.J .-----J LAVATORY ----- -- .__._i __._-- --.__J .__._._._I ROOF DRAIN( SHOWER STALL SERVICE / MOP SINK ._.__ (..._._ TOILET _ ! _.- .... I _____ I __E ._ _._ _ i _-� ____ I .--_ URINAL .____j _.I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _f I _ fWATER PIPING OTHER I i _ I I ._._...._.!' ._.__._ INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO . IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY,' OTHERTYPE OF INDEMNITY �( BOND D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER M AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinen rovisio f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _ I LICENSE # SIGNATURE MP © Jp vj-� CORPORATION n#� PARTNERSHIP �# _ LLC COMPANY NAME � ADDRESS CITY ���r?� / - - -1 STATE ZIP/�3 it TELFAX _ CELL ���� EMAIL Is smis ME o z lij w U- The Commonwealth of Massa chusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 021142017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. Name (Business/Organization/Individual): T! Address: City Are you an employer? Check the appropriate box: Is - Phone Phone #: 1.❑ I am a employer with employees (full and/or part-time).* 2. k^ a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.] I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, §1(4), and we have no. employees. [No workers' comp. insurance required.] M Type of project (required): 7. 0 New construction 8. Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.(] Electrical repairs or additions 12. �umbing repairs or additions 13.0 Roof repairs 14.[] Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box mustattached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub-cor traciors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #:, Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify und%Jhe pains and penalties ofejury that the information provided above is true and correct. Phone # 6�2>T Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for theiremployees. 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=contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia 199225 .5 ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... ............................................................................................................ ...... .... has permission to perform ... /7c ........ &../ .................................. ........................ ofwiring in the building ........... . .................................................................... e .............................. at Prd ...... . North Andover, Mass. ........................................... .......................... Fee. ...... .................................................................................... ELEcTRicAL INSPECTOR Check it 12990-1 izl� t Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 1-Z9 90 -/ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL )NFORMATION) 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) c 00 %J Cr- y t—r Owner or Tenant , Telephone No. Owner's Address o?Ocv tJQ I --r Is this permit in'conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building iz-5 i Gt i, e,— Utility Authorization No. - Existing Service loe> Amps /2-0 / ay-aVolts Overhead b2-' Undgrd ❑ No. of Meters _ New Service oo Amps %ad / a'(dVolts Overhead Undgrd ❑ No. of Meters / t Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,g" t 61- 9(c -r 13441k 1-40,44 o o K-,, I— i Ili 1 S i� f .erQ ��G rc ,[��►a %- U 6��tG�t -6 a Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires f Swimming Pool Above ❑In- Elo. rnd. rnd. o mergency Lighting Battery Units No. of Receptacle Outlets l No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. 2 of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number - Tons " """.....J KW 'W..."'..... No. of Self -Contained 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 Heaters No. of No. of Signs Ballasts Data Wiring: 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 07res. Estimated Value of Electrical Work: .340-00 (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:) X certify, under the pains and penalties o f. r'ury, that the information on this application is true and complete. FIRM NAME:. %J �C x , LIC. NO.:'9y7 -*Ylt� Licensee: s4a rtG C -? Signature LTC. NO.: ?1 (8' 0-K (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 6eo.4- 06 2 Address: � R� /Q,6 jrts S �✓l /0/,/ d3 w q � Alt. Tel. No.:6o3 - a31- 2 4Qa *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent f PUMIT FEE. $ G j Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed i on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the f�"r notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chanter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass IN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass [N Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH IN PECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: / Z 3/ / J -- FINAL INSPEC ON: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com 4N 2 The Commonwealth of Massachusetts Department ofIndustrialAccidents 1 Congress Street, Suite 100 Boston, MA. 02114-2017 www mass.gov/dia Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Oiganization/lndivldual): P�A Address: City/State/Zip: �Illl� o s$u Phone #: Are you a pioyer? Check t$e appropriate box: 1. 1 am a employer with -Z . employees (full and/or part-time).* am a sole proprietor or partnership and have no employees working for me in ca achy [Noworkers' comp. insurance required.] p5. G v 2—�Ou0 any p 3. ❑ 1 am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no'entployees. 5.❑1 am a general contractor'and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance # 6. ❑We are a corporation and its, officers have exercised their right of exemption per MGL c. 2 1 4 -1 We have rio employees'. [No workers' comp. insurance required.] Type oftproject (reciuired): 7. ❑ New'constriict[on g. [] R.emodeliiig 9, ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12� ( `Plumbing repairs or additions 13•. [] Ro6f repairs 14.[] Other *Any applicant that chdcks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who subs xst attached an additional g they are sheegshowing the name of tl eall work and then hire usub contractortside os and st to wmust heth t a r rs or not those ew aff davit indicating have such. Contractors that check" Tfflip sub -contractors have employees, they must provide their workers' comp. policy number. X am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andyob site information. Insurance Company Name: c k Expiration Date' Policy # or Self -ins. Lic.#: `% o a wcs � Y a,D City/State/Zip: /" \Xfob Site Address: 1 b A.ttacli a copy of the workers' compensation policy declaration page (showing the policy number and expiration. date). olation 0-00 Failure to secure coverage as required under sd zviM enalties2inthe form of criminal25A is a TOPiWORK ORDERIand � of up to $200.00 a and/or one-year imprisonment, as well P to the O day against the violator. A copy of this statement may be forwarded Office of Investigations of the DIA for insurance coverage verification. X do hereby certify under the pains and, lties o 1 jury that the information provided above is true and. correct: Phone #: Official use only. Do not write in this area, to be completed by city or town offtciaL Permit/License # City or Town: Issuing Authority (circle one): 1. Board of Health. 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Phone G Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of A express or implied, oral or written." An employer is' d'efti bd as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enferpri'se, and including the legal representatives of a deceased employer, or the receiv6r'6x trustee of an individual, partnership, association or other legal entity, employing employees. • Howevex the owner of a dwelling house having not more than three apartments and who resides therein, or the occiipaini o£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-whd has not produced -acceptable evidence of compliance with the insurance coverage r'equi'red." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter intp any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the Workers, compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Viability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cavy workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial -Accidents. Should you have any questions regarding the law or if you are required to obtain a i�6 kers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia Location 2ao WAU-,-P-(-y P40 No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17202 AA I C--, Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING >z'yrs �. nrri"r _ ��. , S - 2€&� � fir BUILDING PERMIT NUMBER: / O Q DATE ISSUED: 11--2-c-) ,_c) l SIGNATURE: BuilTng Commi " ner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required 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 ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT HistoricDistrict: Yes No 2.1 Owner of Record 16L ve -C 1-4k —rl-4 12 CL Name (Print) Address for Service: Signature _ Telephone l :C<�C�rr2 2.2 Owner of Record: -10 Name Print Addressor Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ (---C'C G/ - Licensed Construction Supervisor: License Number /n C� 1Z Ay rr Address 3 `�7/G�`i' Expiration ate Signature Telephone it 3.2 Registered Home Improvement Contractor Not Applicable ❑ 67 S S Company Name Registration Registration Number Address �iliiGl.r K(� C-Expirftiot Date Si na re Telephone 00 M X ic z O ®J i 90 O UTI ic M Faaaa _r z^^ V/ SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 6 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 b4dingjwnnit. Signed affidavit Attached Yes ....... A.,of 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: r SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beUFFICSE Completed bypermit applicant UN.Y F K } 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZA ON TO -IRE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b O/WNER/AUTHOR,,I//Z��ED AGENT DECLARATION 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 r Print Na Si afore;. of Owner/ ent Date W _ fl } NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS OT 2 ND3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant %2c� Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name r Please Print Name: %Uci Z, f cel i, -a C Location: 2 GG /drr 6-71- City A,1 ®1 F 5 S Phone # /7c -e- 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ( _/ j,_-�am an employer providing workers' compensation for my employees working on this job. Company name: y Zd -r n 04-"-4 C,4-, 4 c Address City: �� c S f'c w 04--- Cr Phone #: AW Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment_as_welLas_civil.,penaftiesin.thefnrm ofa..STOP WORK_ORDER.and_a fine_of.(.$1A0.00)..ajday against -me. 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 pains and penalties of perjury that the information provided above is true and correct. � Signature <G /i¢ Date Print name Phone # �GG/ Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept []Check if immediate response is required Licensing Board Selectman's Office Contact person: Phone A Health Department ❑ Other ACORD DATE (MMIDDIYY) :. ,. Q THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ODUCER Serial # A16442 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AON RISK SERVICES, INC, OF FLORIDA HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1001 BRICKELL BAY DRIVE, SUITE #1100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MIANII, FL 331314937 COMPANIES AFFORDING COVERAGE 800.743-8130 -------�---- - rfttrlFAN1Y AMERICAN HOME ASSURANCE COMPANY A WIRED COMPANY ADP TOTALSOURCE, !NC B 10270 SUNSET DRIVE -- - — -----------....... - ------------- -- . . MIAMI, FL 331 T3 COMPANY 'ALTERNATE EMPLOYER C CO Aa, r — SYLVAIN CONTRACTING LLC D >VinRA43 R y THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ND CATED, NOTWITHSTANDING ANY REQUIREMENT, TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS C ERTI--ICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXC LLSIONS AND CONOITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EFFECTIVE POLICYDATE — POLICYEXPIRATION TYPE OF INSURANCE POLICY NUMBER (MMIDDYY) DATE (MWOOIYY) LIMITS GENERAL LIABILITY 1GENERAL AGGRE;ATE 2 . rv.Ee :.-.-GerrEFtAt. UABILIT'r PR0OUC7S.:-C+VP1CF AGr; J F - —u.r; Ir,:.DE U ,�-CUR I I PERSONA- A ADV VJRr -- 3 .-'>EACHOCCJP.PENCE -- F�RFOAAnA(-,E !Any onafire) 4 ll--- MEC, ExF �+;N ,e person) i AUTOMOBILE LIABILITY :,Cir6E;Ir�kD'i�Nc?.E LILA+ 9 ANY AUTC —�--------- BCOLY IPlI' 1RY 4 A-L 'OWNED AUTOS _ 3eHEDULEDAUTOS (Flo, pe. �Br�DILYIwuav j H'RED AUTOS NON-OlVNEO AUTOS +Per aoerdj — -- -- ---------- ---- �111EITYIAIlll GARAGE LIABILITY I AUTO ONLY EA ACCriENT 5' ANY AUTC OPHEK FHANAUIO VNLY --_ EACHACCIDENT F •GGREGATE ''F EXCESS LIABILITY EI A;-H JCCURRENCE-- AGGREGATE i UMBREL_AFORM _^T,A�% JI,16RE'-LA FORM --- 4 WORY;ER'SCOMPENSATION AND RMWC 3476330 06/30/2003 06/30/2004 X 'OR1 TLtMi = AG EL ENI `1 AC,JGcPIy I'F 1,000,000 EMPLOYERS'LIABIUTY INCL ELD!- ASE PCILCILIMR I3 1,000,1700 �ExCL ELDIS.SE EA En1PLJ'fEE r8 1,000,000 OTHER tCRJF`7fL3tATIONSfv'BW6CEMPECIALK-IT a L EMPLOYEES WORKING FOR THE ABOVE NAMED CLIENT COMPANY, PAID UNDER ADP TOTALSOURCE, INC.'S PAYROLL, WILL BE COVERE''D ,DER THE ABOVE STATED POLICY. "THE ABOVE NAMED CLIENT IS AN ALTERNATE EMPLOYER UNDER THIS POLICY :RTtFiGATE HCiLD�R ` ' •r - � GAINGEI�„l�'F,id{J ";` SHOULD ANY OF THE ABOVE DESCRIBED PCL'CIES BE CANCELLED BEFORE THE SYLVA.IN CONTRACTING LLC EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 9 PLAISTOW ROAD 30 DAYS WRITTEN NOTICE TC THE CERTIFICATE HOLDER NAMED TO THE LEFT, PL AISTOW. NH 03865 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NC OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES AUTHOEO REPRESENTATIVE `.>:; :ORD 25S I1l95) �i:A.GbRb:CIRPORAT►pN 1988 "Certified Contractors Network (CCN)" "Greater Haverhill Chamber of Commerce" "Greater Salem Chamber of Commerce" "New Hampshire Better Business Bureau (BBB)" "Energy Star Retail Partnel" *CertainTeed Vinyl Carpentry Siding Specialist *Advanced Alside Siding Product and Installation Specialist *Alside Window Design Specialist *Authorized Sunlight Series Dealer *Authorized Elite Sunroom Dealer INVESTMENT TOTAL FOR SPECIFIED PROJECT We hereby propose to furnish all labor and materials in accordance with the above specifications for the sum of: � ,— eposit at acceptance of proposa . �–�" , ��Pc� sC IN-ADue at remeasure. Due upon completion. All work to be completed in a workmanlike manner accordi to standard practices. Any changes from above specifications involving additional costs will be made only by request in writing, and will be an additional charge over the original proposal. All agreements contingent upon strikes, accidents, or acts of god. Owner to carry fire, hazard and liability insurance. The above prices, specifications, and conditions are satisfactory and are hereby accepted. You are Hereby authorized to do the work as specified. Payments will be made as outlined above. In the event Sylvain Contracting, LLC finds it necessary to seek legal action in order to collect any payments that is overdue, or in order to perfect its mechanics lien, I agree to pay interest on any overdue accounts at the rate of 18% per annum (1 %% per nth) r Signature of Sylvain Contracting Representative: This proposal may be wiipx" or su�ject to change)f'not accepted within 10 days. A Authorized Signature Authorized Signature Sylvain Contracting, LLC 9 Plaistow Rd. Plaistow, NH o3865 Date — -� Date Tel. (800) 281-4995 Fax (603) 382-5263 V, Right of Rescission I have the right to terminate this contract within three (3) business days of signing this agreement. If I chpose to term, ate this contract, I will contact Sylvain Contracting, LLC office on or before -41— l –6 In the event I terminate this agreement there will be no penalties, and any deposits of mine will be promptly returned. If the customer is a corporation or limited individually hereby ditionally guarg i" Signature Signature iip, the undersigned, jointly, severally or obligations stated herein. Affidavit Date Date I, the undersigned, the owner of the property located at f/%��� Hereby verify that I have authorized S Ivain Contracting, L C to apply to the b ding department of 2 D- e act as my agent in obtaining a building permit and or any zoning regoWfeme s needed to obtaining permits. 2� 16) --U (�_ 616 owner Date Sylvain Contracting, LLC 9 Plaistow Rd. Plaistow, NH 03865 Tel. (800) 281-4995 Fax (603) 382-5263 sylvain Contracting. tte Date: l `t Name: _ Address: 9 Plaistow Rd. Plaistow. till 03865 City, State, and Zip: MG Home Ph. 4';�7-�, ��'-? 7 Work Ph. 2L Z 7 C Dear Thank you for taking the time to meet with me and discuss ideas to replace windows in your home. I would briefly like to tell you about Sylvain Contracting, LLC and why you should choose us for your remodeling project. Sylvain Contracting protects your property by covering you with $2,000,000.00 of liability insurance. Workers Compensation Insurance covers all of our employees so you are not exposed to any Liability and we are licensed and registered in Massachusetts. Home Improvement Contractors Registration # 108985. Construction Supervisors license # 060607. We are members of the Certified Contractors Network (CCN), Better Business Bureau (BBB), Greater Salem and Greater Haverhill Chamber of Commerce. As a legitimate and dependable siding company, we maintain these affiliations and credentials to provide you with the highest level of confidence and customer service. All of our siding mechanics and estimators are Certified CertainTeed installation experts, and attend pre -approved on-going training to keep them up to date on the latest technological advances in siding including the local building codes vinyl siding specifications. With a permanent place of business and over 15 years in the remodeling industry, we take pride in our quality workmanship and specialty services offered to our clients. Very Truly Yours, _ Sylvain Contracting, LLC 9 Plaistow Rd. Plaistow, NH 03865 Tel. (800) 281-4995 Fax (603) 382-5263 This project has been specified in accordance with local building codes, industry standards and manufacturers specification requirements. All work will be installed by certified craftsmen to assure qualifications for the long term siding warranty. General scope of work: • Remove the existing exterior storm windows. • Remove interior trim stops from the sides and top of the windows. • Care is taken to cut the paint line to minimize chipping of the interior finish. • Expect paint to chip at the joints. Touch up of the interior trim is not included. • Remove the existing wood sash top and bottom. • Remove the parting bead if existing at the sides and top. • Remove the ropes, pulleys, and weights and fill all cavities with fiberglass insulation. • Apply Solar Seal sealant to the interior of the exterior stops. • Insulate the base/sill of the wood openings. • Insulate the head expander of the new window system. • Install the new double hung replacement windows plumb and square. • Screw the new windows to the original wood frame. • Adjust the expander on both sides to remove any bow in the master frame. • Insulate both sides of the new windows with fiberglass insulation. This will prevent air movement at the perimeter of the window and reduce any drafts. The insulation also reduces noise infiltration. Interior Finish: • Reinstall the original interior trim. • Caulk the perimeter of the interior with Solarseal sealant. • Clean all windows upon completion and vacuum work area when done. • Canvases are used during installation when needed. Sylvain Contracting, LLC 9 Plaistow Rd. Plaistow, NH 03865 Tel. (800) 281-4995 Fax (603) 382-5263 r Exterior Finish: stom fabricates PVC d aluminum trim to existing wood stops and sills. • Color of trim will be • Seal the perimeter the exter rim with Solarseal sealant. • Replace any rotted finish lumber at $10.00 per board foot Window Specifications:G�'l Fabricate and Install Specifications: Double Hung windows Casement windows Two -Lite Casement windows Two -Lite Sliding windows Three -Lite Sliding windows Awning windows Hopper windows Bay windows Circle one Bow windows Circle one Other Please describe windows according to the following 45 Degree 35 Degree 4 -lite 5 -lite • Heavy-duty fusion welded sashes, for dimensional strength and ease of operation. • Full interlock meeting rails, for weatherproofing and security benefits • Double -glazed insulated glass, for insulation qualities. • Argon filled Low -E glass (soft coat), to help with the insulation qualities. • Tilt in design, for ease of cleaning. (Double hung windows only) • Maintenance free frames, minimizes potential sweating conditions plus eliminates need for painting or staining. • Triple barrier weather-stripping, for thermal efficiency. • Fiberglass screening mesh, for insect protection. • Ten year craftsmanship warranty through Sylvain Contracting, LLC • Plus manufacturers warranty Sylvain Contracting, LLC 9 Plaistow Rd. Plaistow, NH o3865 Tel. (800) 281-4995 Fax (603) 382-5263 r General Details: 1. Dispose of all debris and scrap materials. 2. Work area shall be kept neat and clean on a daily basis and returned to normal upon completion of the project. 3. All work shall have a ten-year workmanship warranty. 4. A written materials warranty shall be provided upon receipt of final payment. 5. All work follows existing OSHA regulations as mandated by 29 CFR 1926 for the construction industries. 6. All work will follow local building code requirements and any permits required will be obtained by Sylvain Contracting, LLC 7. We maintain a current General Liability and Workman's Compensation Insurance Policy. A copy is available upon request to verify coverage. 8. Also followed are special considerations set forth by the manufacturer for the application of the specific product line. Local and National Affiliations: Certifications: Sylvain Contracting, LLC 9 Plaistow Rd. Plaistow, NH 03865 Tel. (800) 281-4995 Fax (603) 382-5263 i - �Jte ' ijtYJJL9)L(j92t !/!wt BOARD OF B�i�✓���u'a -(cense: UILDING REG CONsrRucrloN u�irroNs suP • Number: CS ERVISOR r Birthdate: 069951 -1. 08/27/1955 I Fxpires:08/2712004 IEE S7Restricted.- 00 rr• no: 288 CHESTER RD #2 RAYMOND, NH 03077, v y Administrator z a Jtze �anuntiayuveatf� y �:d` � and Staoda 130ard of wilding ion- CONTIIAC�OR 4iOM� IMQROv e X8985 istratton p 9 gi2812dQ4 " ExPCration: t yPe: p8A SYLVAIN CON Marc pRID Y. A ministi~� PSIS-1OW. i `f�e ��n:-ntanrueQ�{/ BOARD OF -ice rtse: CONS 8t1CptNGREGULAT10NS* RU ON SUPERVISOR �+ Number: CS $5689Si Birthdate: 08J27Ji9 I Expires: 0$/27! ---�__ 2004 Restricte Tr` no: 288 LEE G STEP d: 00 HEN 81 CHESTER S RAYA40ND RD #277 „ av Administrator gldiL 0/l/ 6 ( W 46", u),W)"? ru nd Standorclt ullding Regulations n• fijC�OR $oard of � OVEME�T_CON FIOME IMPR. Regl$lla"O"n 8 28!2004 Expiration: t TWO DBA VAIN CONTRACTING, + �l SYl ins :.,]✓';. Marc SYlva I IAISTOW R©.` _ AdmLp,sirnt4Y' t plSl - OW Nil pg865 1 'r O 4 - VA O,J Q -o v a a m co a � w �+ z v i c a .� me C2 o � c ` N O C W O. C1 c. C :oma Ngm EC� Q A 3 :may O m GGA_ ` ® o N 0 CIO C O . ® 'O G•O = C ` C Em �V r: O La m CD • �R : e... 'O C CM O a �_ ® y12 V 0 cm h O �... C C O C O. B ® 2 ® C O ® ® (� COD 0 t 61J 0uj C �+ •H Q.Z C 0� ®� �_ W O H 9CS F.- = � M m i 1 0 co Q co O V CL O y ® O co v, ca coMM MM W W W � i c_Cv ® a �,. co v C Cc co Z'U CD ci y c C s C _c d CO) D Date......... ........ . .................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Th . is certifies that �C4 V03 ..................................... has permission to perforr, . ................................ V .......................................................... wiri,gg in the building of ...... . ....................................................................... at .......... ....... ........ r - ,)North Andover, Mass. Fee ... Lic. No. ... ..... .. Check ... . ......... h'L'�ICTIR�[C&Z "IN�SP�E�CTZR�� 2rnr, 9 L\ Com»tonwaaf!!i a�assaras Official Use Only ccyy�� cc77 Permit No. I �ct 1JaPartinanE o�,tire �aruicea Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (1\ C), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION} Date. City or Town of: &). A g� To the In ector ofWires: By this application the undersigned gives notice of his or her intention to perform the dlectrical work described below. Location (Street & Number) &)d fAiXnU� Owner or TenantJZ��/2i ��(/�' Telephone No. 97W— V6 jR&-3 -7 Owner's Address Is this permit in conjunction with a building permit? Yes Eg" No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service'Zft Amps / /Z1/0 Volts Overhead Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: p �� No. of Meters i No. of Meters . i*lhe r b.,..a.... -;J. » . A---.1 i... a.,. r.,........ ..� rrr. _.... No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- F1 rnd. rnd. o. of Emergency Lighting Batt2g Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMSNo. of Zones No. of Switches No. of Gas Burners o. o Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Pumpumber Tons o. of a f -Contained Detection/AlertingDevices No. of Dishwashers eating KW Local ❑ umcipa ❑Other ConnectionNo. of Dryers 7Space/Area iances I{Vln ecurity stems:No. of Kvices or E uivalent No. o ater, Heaters No. of Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage BathtubsNo. of Motors Total HP elecommu cations Wiring• No. of Devices or E uivalent f� / OTHER: t' V CjDtlClrr C,y! Attach additional detail if desired, or as required by the Inspector of Mires. Estimated Value f Elec�jcal Work: / (When required by municipal policy.) Work to Start: r Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert, tinder 11 airs and penalties of perjury, t at the information on t tis application is trite and complete, FIRM NAME: DW406-S& 4 � r C LIC. NO.: Licensee: ( S ��` ��` Signature LIC. NO.• _ q A- (Ifapplicabl et er 1.exe ipt i�1 a licens number lin: J Bus. Tel. No.`Gt 0 "i Address: �' ih 4 AIt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, securitq Nvork 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ e The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 " www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): PboF 'D146_)ng- YGS 5'oe-AX or A7 SS Address: ��' �AS,�-1�•.� dyC City/State/Zip: /CJ,d7'ie.r; /'!A O/-7e7o Phone #: Arey __, Cpan employer? Check the appropriate box: Type of project (required): am a general contractor and I 1. I am a employer with S ©4. ❑ I g 6. E] New construction employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. E] Demolition working for me in any capacity. employees and have workers' g E]Building addition [lib 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 �,.1�' t/ �LLI employees. [No workers' 13. Other >- comp. insurance required.l "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site 1 rfor»ration. Insurance Company Name:l� C�QL =XJSO A&ti C o/Kpd IUY Policy # or Self -ins. Lic. #: OCW4,cV-7,2-7'79 q(00 Expiration Date: s7 Job Site Address: =200 WA VMX_ V —Z�> City/State/Zip: 4J. 44k)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 Investigations of the .DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Contact Person: Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone #: WECTRICIANS ISSUES. THE. FOLLOW ING LICENSE AS:. REGISTERED MASTER ELEC-fTRiC17{N ROOT ' D I AGNOST I CS SOLAR Of -'MA }� .MMES _Ry R1 INH`A-iRDT 89F WASHINGTON AVf X .T wtf 1 CK MA O t 760-3441 " 11604fA 07/31/16.. 56412 OMMONWEiLTM OF MA $� AGHUSETTS o e o :••e o eOAfiD:O� I ELEM1CIAN5 i ISSUES THE FOLLOWING LICENSE �x AS -A REG jOURNEYMAN.':ELEC Ri:CIAN JAMES R RE 1 NHARDT� ' - 84 ADAMS RD N6kTH ""GRAFTO,N.: MA 01536-2102 I 23832E 07/3:1/16 62422 COIVII 45NWE LTF1 Uf MAS AL*"SE77S , 4 COMMONWEALTH OF MASSACHUSETTS BOAEip OF BOARD OF ELECTRI'CIANS'..,ELECTRICIANS ISSUES THE FOLLOWING- L'ICENSE ISSUES THE FOLLOWING LICENSE A5 A t EG :JOURNEYMAN ELEC�'RT-CIA-W `"ia AS A REG JOURNEYMAN ELECT01Cl'AN ADAM --'L DEJESUS `� PETER M KINNEY 17A ANDOVER AVENUE a. IL'u 8 CASWELL AVE `. ,,.. ATTL'ESORO . MA 02703 7103 MA 01844-4804 METHUEN 11381:1` 07/3;11t6r -_ - 411 11� 6.. 6970$— Ei:ECTRACIANS �. ISSUES THE FOLLOWING Ll'CENSE AS A REG JOURNEYMAN hELECTRl'C I A'N,' ` ,6 � z SANT;I;AGO REYES 7 WOODLAND `ST y ;-AWkENCE r M`A o1841-2331' 14111.E ' 0131./1.6:LL : 27258 LICENSE,NUMBEREXPIRATt4N.CATE aLSERiA17NUMBE ELECTR'ITFANS ., 1SSuS THE FOLLOWING�.LICEIJSE AS A..REG JOURNEYMAN ELECTR.1 CYAN" `JOHN F CAREY JR `: 94 PROV'1'DEIJCE RD APT 1. ' — !S{ll.Afl'G'kAFTON . Mk;0156o-1337 26876 tr ry'o.7/31/16. ..;1oo634 CONTROL # J 0 5 6 8 3 3 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or l needs to be corrected, visit our web site at mass.gov/dpl for Instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General taws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations, CONTROL`# v} IMPORTANT 1f your license is lost, damaged or destroyed; is inaccurate; or �. -needs to be corrected; visit our web site at mass.gov/dpl for t instructions to ensure the proper mailing of your Renewal Application and any other correspondence. + This license is subject to Massachusetts General Laws and regulations. Your license is a privilege; and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. CONTROL # J0276,62 IMPORTANT If your license is lost, damaged or destroyed; is Inaccurate; or yneeds to be corrected, visit our web site at mass.gov/dpl for n. tntctions'to.ensure the proper mailing of your Renewal tAltplication and any other correspondence. This. license is subject. to Massachusetts General Laws and regulations. Your -license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law, Keep this license on your person or posted as required by law and/or regulations: i w CONTROL # t,J 0 6 2 8 4 3 IMPORTANT If your license is dost, damaged or destroyed; 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 and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. ' CONTROL # J ©7 012 9 IMPORTANT If your license is'lost, damaged or destroyed; is inaccurate; or + ! needs to be corrected, visit our web site at mass.gov/dpl for Instructions to ensure the proper mailing of your Renewal }Application and any other correspondence. . This license is subject to Massachusetts General Laws and regulations, Your license is a privilege„and cannot be lent or assigned to any person or'entity under penalty of law-. Keep this license on your person or posted as required by law and/or regulations. CONTROL# J095985 IMPORTANT your license is lost, damaged or destroyed; is inaccurate; or eeds to be corrected, visit our web site at mass.gov/dpl for +structions to ensure the proper mailing of your Renewal pplication and any other correspondence. his license is subject to Massachusetts General Laws and ..gulations. Your license is a privilege, and cannot be lent or signed to any person or entity under penalty of law. Keep this .erase on your person or posted as required by law and/or :gulations. Tom Petersen Architects Planners Mr. Gerald Brown, Inspector of Buildings Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01810 Re: Solar Panel Installation Ritchie Residence 200 Waverly Road North Andover, MA 01845 Hi Gerald, October 30, 2014 I've reviewed the proposed solar panel installation at this location to evaluate the existing roof structure and the connection of the panels to the roof. Criteria: Applicable codes: 8`' Edition Residential Code (2009 International Residential Code with Massachusetts Amendments) 2001 Wood Frame Construction Manual Design roof load: 40 psf live load, 15 psf dead load, 55 psf total load Design wind load: 110 mph, 35 psf My findings are as follows. 1. The new solar panels will imply an additional dead load of 3 psf. The existing roof structure (residence: 2x6 rafters @ 16" o.c., with 2x4 knee walls, 2x4 collar ties/ceiling joists @ 16" o.c. and 2x8 ridge, span = +/- 12'-7"; garage: 2x6 roof rafters @ 16" o.c., with 2x6 ridge, span = +/- 7'-8") is sufficient to bear this additional load. 2. The solar panels are attached to the roof with the SolarMount-1 rack system by UNIRAC. The rack system, roof connections and connection spacing are rated for 110 mph. This project requires the larger Solar Mount 1-2.5 beam (2.5" high) and spacing of flange foot connection to roof at 48" o.c. maximum. Flange footing connections to the rail are not required to be staggered. The flange foot connections to the roof are 3/8" diameter x 4" long lag bolts. I therefore certify that this installation complies with the applicable codes and design loads mentioned above and is acceptable for approval. Please let me know if you have any questions on this information. Thanks! ,L" Sin ely yours, Tom Petersen Cc: Kelcy Pegler, Roof Diagnostics �RED ARC, F. 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