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Miscellaneous - 206 FOREST STREET 4/30/2018 (2)
N �O N a) D 0 b m o Co V N O -I O M o mlo -H. 31 � Date ........ ......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thatN-4 ......./..I'.... v �C ...... g has permission to perform il...... 2 S t' 1 Q "" wiring in the building of ............... .�?.G�` _.............................................................................. at .................................. ..;��1. �5� �%%'......... > North Andover, Mass. Fee... . Lic. No.V V jn ...!... �. .......... f ........... r.......................j ELECAICAL INSPECTOR ` Check 4t L l Commonwealth of Massachusetts OfficialU�s/e Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 (leaveb],urk APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: North Andover To the Inspector of Wires,- By ires:By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 206 Forest St Owner or Tenant Lorene Beach Telephone No. 978-686-8121 Owner's Address SAME Is this permit in conjunction with a building permit? Yes NoL_J (Check Appropriate Box) Purpose of Building Solar installation Utility Authorization No. Existing Service 200 Amps 120/240 Volts OverheaW UndgrNo. of Meters 1 New Service Amps / Volts Overhead ElUndgrd� No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: installation of a rooftop mounted solar aray Com letion of the folloit,in table nta v be inarved b , the Ins ector o fVires No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o mergency Lighting Battell Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: I. Number Tons I I KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances ISM, Security ystems: No. of Devices or Equivalent No. of Water KW Heaters o. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total IIP telecommunications Wiring: No. of Devices or Equivalent OTHER; Attach additional detail if desired, oras required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE? BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: 2500.00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, trimer the pains andpena/ties of petywy, that the information oft this applicalion is true and complete. FIRM NAME: AStrUM Solar 9 LIC. NO.: A21555 Licensee: Jason Riley SignatureLIC. NO.: (Ifappllcable, enter "exempt" in the license number line.) Bus. Tel. No..508- 59- 68 Address: 5 Lvbertv Way Suite 3 Westford, MA 018 6 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally requi red by law. By my signature below, I hereby waive this requirement. lam the (check one) ❑ owner Elowner'sagent. Owner/Agent PERMIT FEE. $ Signature Telephone No. RILE 18 HOPI( „STNS ST s' +' nl; 'ECTRIC1A 1re(MMtNYd�ILT�F tib MASA1vHUSE�TS _"' BOARQ'DF ; ELEGTrZ1 C1"AIDS SUES THE FOLLDWI.NG" L1 CE'NSE AS r F.. , R1=SHRED MASTER fECTR,[C.IAN ¢ {STR SOLAR INC Z' t 1.8 HOPKIt�S ST •� 9j 211 HTON y MA` 01887 11555: `:o7J�31�1b: Y w80019 •® RILE 18 HOPI( „STNS ST s' +' nl; 'ECTRIC1A ACOR V® CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 02/`04/2015' 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 BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If 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(s). PRODUCER CONTACT Willis of Texas, Inc. c/o 26 Century Blvd. P.O. Box 305191 PHONE 877-945-7378 1 FAx 888-467-2378 E-MAIL certificates@willis.com TN 37230-5191 INSURER(S)AFFORDINGCOVERAGE NAIC# INSURER& ACE American Insurance Company 22667-302 pAW&��E PREMISES?ENTED eoccurence) $ 100,000 INSURED Direct Energy and its majority owned INSURERB:Zurich American Insurance Company 16535-305 INSURERC:American Zurich Inaurance Company 16535-306 subsidiaries and affiliates including Astrum Solar PRODUCTS-COMP/OPAGG $ 1 000 000 5 Lyberty Way, Suite 3 INSURER D: INSURER E: Westford, MA 01886 INSURER F: BAP595396601 COVERAGES CERTIFICATE NUMBER: 22748483 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE DDL SUB VIND POLICY NUMBER POLICY EFF POLICY EXPI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X SIR: $500,000 North Andover, MA 01845 XSLG27341226 1/1/2015 1/1/2016 EACHOCCURRENCE $ 11000,000 pAW&��E PREMISES?ENTED eoccurence) $ 100,000 MED EXP (Any one person) $ -91000 PERSONAL BADV INJURY $ 11000,000 GENI AGGREGATE LIMIT APPLIES PER: POLICYPRO F] LOC OTHER: iii JECT GENERALAGGREGATE $ 11000,000 PRODUCTS-COMP/OPAGG $ 1 000 000 $ B AUTOMOBILE LIABILITY X ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS HIREDAUTOS NON -OWNED AUTOS BAP595396601 1/1/2015 1/1/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Peraccident) $ A X UMBRELLA LIAB LIAB X OCCUR CLAIMS -MADE XOOG25703728 1/1/2015 1/1/2016 EACH OCCURRENCE $ 2,000,000 4EXCESS AGGREGATE $ 2,000,000 DED I RETENTION $ $ C B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY OFFICERIMEMBER EXCLUDED? lMandatoryinNH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC595396901 WC595397301 1/1/2015 1/1/2015 1/1/2016 1/1/2016 X PER OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT Is 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additonal Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Co11:4618435 Tp1:1917373 Cert:22748483©1988IK2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 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 Town of North Andover 206 Forest St North Andover, MA 01845 Co11:4618435 Tp1:1917373 Cert:22748483©1988IK2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Print Form _J Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Astrum Solar Address: 15 Avenue E City/State/Zip: Hopkinton, Ma, 01748 Phone #:508-614-0146 Are you an employer? Check the appropriate box: Type of project (required): ✓❑ I am a employer with 15 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub -contractors �. El am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. F-1 Building addition [No workers' comp. insurance required.] comp. insurance.T 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.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.7 Other PV Solar Installation employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. '*Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Zurich American Insurance Co. Policy # or Self -ins. Lic. #: 59536900 Expiration Date:1 /1 /16 Job Site Address.4o 4 Fvfes + S City/State/Zip: Nnr+}► llrob�er iMA o t 8YS' r Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: V D 0 C N N (.) V DN 'oo0 o W H o m_ 0A A E w M g w 3 i ET 3 LO >0 m o D o u, a d m m 3 "v f° a-- 0 0 0 3 W< 3 ° 3 m 'w — n n o> >> �^ m o- d o° D m o c°J m s FT m w o 0 0 o d a o a w F °: 3 o o o C n N O N^ ut r n d r N l� F N d O Vf vWi d d 0 2 j 0 0 0 D d O N W W < C C C O O O A A 3 n m D r �k I # 3 Revisions Date Remarks Astrum Solar, Inc. Beach Project 1 MM/DD/YY 15 Avenue E < Cover Sheet all N 206 Forest St ASTRUMSOLARO 2 MM/DD/YY Hopkinton, MA, 01748 North Andover, MA 01845 3 MM/DD/YY Thursday, January 22, 2015 !«!„ 9�\ ��_ §[ \. , \ ) -: ;; .� \ / \ � � \ ƒ \ \ r \ / \ o 2 N ! /§ - �\fE3ii 77777\! . \ \ \ 3 3 E7®�` |77 ` �\ —17 }TL &&z f }/\ � I\; � #(E � \\ % ( \\ ! ! \$* ƒ �`(� [lo \� b. _, _. _,e _m _gr e _ems m 7 Description ! MM/DD/YY s _m. &eked»« ea Q CalculationsCalculations 116 �® #9ues .r z , wa m 01748 3 MM/DD/YYr gimme,& m, _hAndover, m_a \ / \ � � \ ƒ \ \ r \ / \ ;0 \ } \\ \\ \} on 3\} ° § „ \\\\_�� }\ }()}/ 53 _ - ((\ - _ .IE }(\{/\-�- }(\\ \ \ �\ }\ ,\, \ } G 3 & ., , } }j /\\ k \ } \/\ � } /\( � ) \\\ ®ƒ 4b. \ 1\\ 00, � \ % \ � \ Revisions Date Remarks _ms ge _ems a ! MM/DD/YY 7 Description of a __E Work and »k & Q Calculations �® #mues .+ 2 MM/DD/YY _mom o01748ae� 3 MM/DD/YY Thursday, mews m, momma 2 2 2 y F 3 J A c � - a a 0- o n \ 3 o E P1 - _ w w> ^ q K- 1 °n 3 cn2 Hc o S e1 - _ 3 3r i p 2, F a a o v m ap - D - - _ w a V 3 y0 'Ppm° TE 3' n R E D n C ^ °0 - a- JG GfF Nr n - o k F F 3 _ - n - sF 3 '- s a� `�A r 3 o Z� F 1 o � � C 0 2 xUP SL n 3 n a � n A n n S i n = - a aC O a m 3 F N 3 m 3 s a �n n 3 3 D 3 K m .�. ♦ 0 o F O 3 3 - o CT F E - = °on 3 3 = n o ^ i m n 0 � o 0 o Q o O - p d n' p = p aTP �°s �° n ' a ~ ] o y O S m A EF EF M Revisions Date Remarks Astrum Solar, Inc. Beach Project MM/DD/YY < Description of 15 Avenue E Work and Load big1 N Lo Calculations 206 Forest St ASTRUMSOLARO 2 MM/DD/YY Hopkinton, MA, 01748 3 MM/DD/YY Thursday, January 22, 2015 North Andover, MA 01845 2 2 2 y c � - a a o n \ � x q cn2 e1 �G,y 3 3r i 9 y0 'Ppm° °0 JG GfF Nr s , Fs sF s a� `�A r Z� F 1 Electrical W Diagram G Beach Project Forest St North Andover, MA 01845 rMa 9644 ASTRUMSOLAR+n Revisions Date Remarks IAstrum Solar, Inc. I1 MM/DD/YY I 2 MM/DD/YY 3 MM/DD/YY 15 Avenue E Hopkinton, MA, 01748 ursday, January 22, 2015 .• z m m m z m � a 8 W � u .. 3> n n - - n n - � 3 > c 3 3 n _ A 9 -S n � 3 _ 3 n X X� X X X G ae ae je je � _ e 3 3 8 z 3 3 3 9 m m w v a w 3 0 d S 11 N F v 0 0 0 a H u D 'w d c7ox r711A p r nn -1 p(�-I -� o�c7�c1c7nrr mN aC� Nln yy, Oo xrn-, � omm Ocmm �ocoO [a .;m m N000000 �onO�nc O7ma w- a Rw=ter E n c o>>>>>woc=-� N C ar-9,c n_.nr�y ao c_ �.� c w �a.aaaaa r���'e g'u"m Oowwm �,M 00 0 •om mmnp°OcccCCp mol�yo� mr oa a�o0. ga'a a4&aa-7 w42p�a �dmm00000�°.oaA�aK oaf �pg $g�l�"� aa�j;M�z��a w,aqiyw up9� �ca yP=yam mnNom aawcwmc�.i mmm �wN rC� �O4.O Iv mI �o MM "mac:" m- io�colR�DpD piO Ciomcm m0 ciS o�� �mj 3 ! oD •c D.� I m T10� j 3 -M N�� Ste„ mt i v .••rt3 �m �rt�. w�.�1� i �! n�� I ?' i j i wY�o6i awn xN� o!:w e. fyN m jJ n w� tory i X10 mi of •.i 'op> N h fO oo {'���4 m I ! o NI a Jolt Cii p10 CT�crt �2 S�. =� art Z V7 V�px No N :I o a3 N0:. wag -.ww CZ)M"a of x o f "W � m - W cod o 0 � o t° m Sl �• () o N W W a o .p P -i o A i o N o NT��() � Z@ W O m5 n Y t0 rnN� m m njp �;U No ' -n ?ppm w pek a nm O pm to c� +~ y o m Qe m Cr o n o w m 0 .. c Ct o ^� m w 0 W D<d�Atn� r n -i 0 pr nndn 1C7C)(7f7t7rrm nN�"9 ,n-OOOxm�. omm ocmm oco� .m 0Ooo.Omoco 6'< c E p II d m c Croma w a w= o v>> a 7 o w o c=- �J d -a c ar=,c n-ar o2� aaaa am�r `m In �x vm o�c�-• po�c oj0o� -� c c c e cpepoti. y�m a a 5 qam c'WL o c w 40t =' SLSiA0.Sic o w o_0 � �r Ln0 cA0aCaya�nan c�go�Q��00000 c_ay2g�D K (1 Sl0 0� cmb Sl��,((„��;.: �oo,K ,oi �wZOSs �. 5 » O n N c �' C y C• C y 9 9 y C C N N C N 9. t' m M is x who. w m� wN� C Af�c7 g�o� 'm'I �o c�;�� m=N�co�il M. m (��'i(of�� �� to w0 i y�� �T'9 mo`�j D.CghW E Q. m, .rt E am 1 w, i m§ - A y m 6 m i R I i i 'W' A� v�rn xrno ..:.y o. NN w :: Nmrj v! `-Im o i op>5 v �n�mo cspo art' UIW � 6 �oWw;:wp2 c:WA:. 2G7o Lo o �v+A N o �;: Er c: c: oON o ro allo9m wC7mc m W o000 U o Erb .-. V Oo ym Ito mRm m m V m n II p N w w r.+ yk c m Cn1E Oo o 4e Ix W 0.j o " R C m O M Revisions Date Remarks Astrum Solar, Inc. Beach Project 1 MM/DD/YY 15 Avenue E < Electrical Calculations 206 Forest St ASTRUMSOLAR® 2 MM/DD/YY Hopkinton, MA, 01748 North Andover, MA 01845 3 MM/DD/YY Thursday, January 22, 2015 3> n n - - n n - � 3 > c 3 3 n _ A 9 -S n � 3° X X X X� X X X G ae ae je je � _ 3 3 3 3 3 3 3 3 9 m m w v a w 3 0 d S 11 N F v 0 0 0 a H u D 'w d c7ox r711A p r nn -1 p(�-I -� o�c7�c1c7nrr mN aC� Nln yy, Oo xrn-, � omm Ocmm �ocoO [a .;m m N000000 �onO�nc O7ma w- a Rw=ter E n c o>>>>>woc=-� N C ar-9,c n_.nr�y ao c_ �.� c w �a.aaaaa r���'e g'u"m Oowwm �,M 00 0 •om mmnp°OcccCCp mol�yo� mr oa a�o0. ga'a a4&aa-7 w42p�a �dmm00000�°.oaA�aK oaf �pg $g�l�"� aa�j;M�z��a w,aqiyw up9� �ca yP=yam mnNom aawcwmc�.i mmm �wN rC� �O4.O Iv mI �o MM "mac:" m- io�colR�DpD piO Ciomcm m0 ciS o�� �mj 3 ! oD •c D.� I m T10� j 3 -M N�� Ste„ mt i v .••rt3 �m �rt�. w�.�1� i �! n�� I ?' i j i wY�o6i awn xN� o!:w e. fyN m jJ n w� tory i X10 mi of •.i 'op> N h fO oo {'���4 m I ! o NI a Jolt Cii p10 CT�crt �2 S�. =� art Z V7 V�px No N :I o a3 N0:. wag -.ww CZ)M"a of x o f "W � m - W cod o 0 � o t° m Sl �• () o N W W a o .p P -i o A i o N o NT��() � Z@ W O m5 n Y t0 rnN� m m njp �;U No ' -n ?ppm w pek a nm O pm to c� +~ y o m Qe m Cr o n o w m 0 .. c Ct o ^� m w 0 W D<d�Atn� r n -i 0 pr nndn 1C7C)(7f7t7rrm nN�"9 ,n-OOOxm�. omm ocmm oco� .m 0Ooo.Omoco 6'< c E p II d m c Croma w a w= o v>> a 7 o w o c=- �J d -a c ar=,c n-ar o2� aaaa am�r `m In �x vm o�c�-• po�c oj0o� -� c c c e cpepoti. y�m a a 5 qam c'WL o c w 40t =' SLSiA0.Sic o w o_0 � �r Ln0 cA0aCaya�nan c�go�Q��00000 c_ay2g�D K (1 Sl0 0� cmb Sl��,((„��;.: �oo,K ,oi �wZOSs �. 5 » O n N c �' C y C• C y 9 9 y C C N N C N 9. t' m M is x who. w m� wN� C Af�c7 g�o� 'm'I �o c�;�� m=N�co�il M. m (��'i(of�� �� to w0 i y�� �T'9 mo`�j D.CghW E Q. m, .rt E am 1 w, i m§ - A y m 6 m i R I i i 'W' A� v�rn xrno ..:.y o. NN w :: Nmrj v! `-Im o i op>5 v �n�mo cspo art' UIW � 6 �oWw;:wp2 c:WA:. 2G7o Lo o �v+A N o �;: Er c: c: oON o ro allo9m wC7mc m W o000 U o Erb .-. V Oo ym Ito mRm m m V m n II p N w w r.+ yk c m Cn1E Oo o 4e Ix W 0.j o " R C m O M Revisions Date Remarks Astrum Solar, Inc. Beach Project 1 MM/DD/YY 15 Avenue E < Electrical Calculations 206 Forest St ASTRUMSOLAR® 2 MM/DD/YY Hopkinton, MA, 01748 North Andover, MA 01845 3 MM/DD/YY Thursday, January 22, 2015 • Q m M- > v n 3 m .p < T A o m rL 0 0 3 r• m o m A �. E o o w a o e 0M ffo±=m.��� q N N p h so ri M 33 3 m m A W N J m o,< v — n N >> .� 7 d 7 0 J v v v C w w o. Na u+ o° m o a m 3 ° 0 m N 3 w D d I O 0 O » O T 3 Q T N n N d N N to 0 pa w m w T m „. iD p m E M — D � 3 — m N m v p ry O m 3 S s V< N < A N N Ow _. 3 3 v v o c o m 3_ N x C C N N ii N N N n _. O O H m a C m o N ` a O a InIM N ^o S L -, U; i, ° E m a ° m ^ a o a a sons ° K m � m a ° 3 O ° r O Kc n p D m . r S O Ma - o w ow c - ^ ° n m m o m a m m o /✓ £ ° o 3 o � p ro F C M a 3 c o = a I- < I I c m m M 3 o f T v fm f �I{I ° a 0 m a < 0 0 — 'm 3 m O w N £ c 3 N T ° N c 3 m a f. c ^ v s a a s v 3 @ c m S mM v o < m ° 3 m a _ a Revisions Date Remarks Astrum Solar, Inc. Beach Project < String and 1 MM/DD/YY 15Avenue E Conduit Layout 206 Forest St ASTRUMSOLARO 2 MM/DD/YY Hopkinton, MA, 01748 3 MM/DD/YY PSE&G North Andover, MA 01845 �V < 3 a < a c _ m e s�s j`JQr]j a .;.R•�. � M til : • ? n l38M38�8 e � %i , �x J k� HIM p n 3 v 0] 3 N 2211i• ` 3 3 `w _j a < ne A w � LV o ® 3 g $ CL Q � ► � e O fo ♦ ► e p ► � c n n m F� G ® e < 0 Aj(j C .i V 2• �I CL 1" r • a a 3 f $ oti �♦' ' = n M v w)l I m ,o 9 e 3 m • - x 2 d ^ » M Revisions Date Remarks Astrum Solar, Inc. Beach Project Equipment 1 MM/DD/YY 15Avenue E < Ratings and vt Sinage 206 Forest St 2 MM/DD/YY Hopkinton, MA, 01748 ASTRUMSOLAR(' North Andover, MA 01845 3 MM/DD/YY Thursday, January 22, 2015 3 o A 3 3 D A iz �V < 3 a < a c _ m e s�s j`JQr]j a .;.R•�. � M til : • ? n l38M38�8 e � %i , �x J k� HIM p n 3 v 0] 3 N 2211i• ` 3 3 `w _j a < ne A w � LV o ® 3 g $ CL Q � ► � e O fo ♦ ► e p ► � c n n m F� G ® e < 0 Aj(j C .i V 2• �I CL 1" r • a a 3 f $ oti �♦' ' = n M v w)l I m ,o 9 e 3 m • - x 2 d ^ » M Revisions Date Remarks Astrum Solar, Inc. Beach Project Equipment 1 MM/DD/YY 15Avenue E < Ratings and vt Sinage 206 Forest St 2 MM/DD/YY Hopkinton, MA, 01748 ASTRUMSOLAR(' North Andover, MA 01845 3 MM/DD/YY Thursday, January 22, 2015 The new Q.PRO-G3 is the reliable evergreen for all applications. The third module generation from Q CELLS has been optimised across the board: improved output yield, higher operating reliability and durability, quicker installation and more intelligent design. INNOVATIVE ALL-WEATHER TECHNOLOGY • Maximum yields with excellent low -light and temperature behaviour. • Certified fully resistant to level 5 salt fog ENDURING HIGH PERFORMANCE • Long-term Yield Security due to Anti PID Technology', Hot -Spot Protect, and Traceable Quality Tra.QT" • Long-term stability due to VIDE Quality Tested — the strictest test program. SAFE ELECTRONICS • Protection against short circuits and thermally induced power losses due to breathable junction box and welded cables. • Increased flexibility due to MC4-inter- mateable connectors.the entire produc- tion process from cells to modules while making Q CELLS solar modules forgery proof. PROFIT -INCREASING GLASS TECHNOLOGY • Reduction of light reflection by 50%, plus long-term corrosion resistance due to high-quality • Sol -Gel roller coating processing. LIGHTWEIGHT QUALITY FRAME • Stability at wind loads of up to 5400 Pa with a module weight of just 19 kg due to slim frame design with high-tech alloy. MAXIMUM COST REDUCTIONS • Up to 31 % lower logistics costs due to higher module capacity per box. EXTENDED WARRANTIES • Investment security due to 12 -year product warranty and 25 -year linear performance warranty'. THE IDEAL SOLUTION FOR: 1: Rooftop arrays on Ground -mounted Rooftop arrays on commercial/ industrial® solar power plants residential buildings buildings APT test conditions: Cells at -1000V against grounded, with conductive metal foil covered module surface, 25 oC, 168h 2 See data sheet on rear for further information. Engineered in Germany EUPD�H !71 �r 1 IWO \ 1'Fl:fytl! plYll,S' Tera B••t ® Phnfnn Quality Tested QCELLS I nigh reibdnry Best polycrystalline b da .d.bn solar module 2013 fiBgvo rt product sunreilerne a.PRO-02 275 ID.40032587 QCELLS Format 65.7in x 39.4 in x 1.38in (including frame) (1670 mm x 1000 mm x 35 mm) Weight 41.89 Ib (19.0 kg) } Front Cover 0.13 in (3.2 mm) thermally pre -stressed glass "' a.1A,1-A 8 with anti -reflection technology ❑^ e6 Back Cover Composite film - + m°° ^ a Frame Anodized aluminum Cell 6 x 10 polycrystalline solar cells E Junction box Protection class IP67, with bypass diodes 60 0..din ha. + Cable 4 mm2 Solar cable; (+) >_45.67in (1160 mm), (-) >:45.67 in (1160 mm) A 35m Connector SOLARLOK PV4, IP68 p.,P,•._3-.,iO~I^='°'Am ELECTRICAL CHARACTERISTICS PERFORMANCE AT STANDARD TEST CONDITIONS (STC: 1000 W/m2, 25'C, AM 11.513 SPECTRUM)' NOMINAL POWER (+5W/ -OW) IW] 245 250 255 260 Average Power PMP, IWl 247.5 252.5 257.5 262.5 Short Circuit Current Ise [A] 8.52 8.71 8.90 9.09 Open Circuit Voltage Voa [V] 37.15 37.49 37.83 38.18 Current at PMPP 1MPP [A] 8.05 8.21 8.37 8.53 Voltage at PMPP VMPP [V] 30.75 30.76 30.77 30.78 Efficiency (Nominal Power) r) [%] >- 14.7>_ 15.0 >-15.3 >-15.6 PERFORMANCE AT NORMAL OPERATING CELL TEMPERATURE (NOCT: 800 W/m2, 45 s3"C. AM 1.513 SPECTRUM)2 NOMINAL POWER (+5W/ -OW) [W] 245 250 255 260 Average Power PMPP [W] 182.4 186.0 189.7 193.4 Short Circuit Current Ise [A] 6.87 7.03 7.18 7.33 Open Circuit Voltage Voa [V] 34.58 34.90 35.22 35.54 Current at PMPP IMPP [A] 6.32 6.44 6.56 6.68 Voltage at PMPP VMPP IV] 28.86 28.89 28.92 28.94 1 Measurement tolerances STC: ±3% (Pm,,); t 10% (Ix, Vim, Impp, Amon) Q CELLS PERFORMANCE WARRANTY PERFORMANCE AT LOW IRRADIANCE P a 100 97 g 3 95 :9 90 z WF es G� 90 m 0 5 10 1s 20 25 YEARS At least 97% of nominal power during ios--T--r--1---1 -1 T--r--r__, first year. Thereafter max. 0.6 % degra- dationper year. At least 92 % of nominal power after LL------�--'---'-------�--i 10 years. At least 83 % of nominal power after 25 years. All data within measurement tolerances. eo Full warranties in accordance with the 100 2m aoo .m see soo Tao eao RRo rood warranty terms of the Q CELLS sales IRRADIANCE IwAm] organisation of your respective country. The typical change in module efficiency at an irradiance of 200 W/m2 in relation to 1000 W/m2 (both at 25°C and AM 1.50 spectrum) is -2 % (relative). TEMPERATURE COEFFICIENTS (AT 1000W/M2, 25°C, AM 1.5G SPECTRUM) Temperature Coefficient of Isc a [%/K] +0.04 Temperature Coefficient of VRR 13 [%/Kl -0.30 Temperature Coefficient of PMPP y [%/Kl -0.42 PROPERTIESr' SYSTEM DESIGN Maximum System Voltage Vsrs [V] 1000 Safety Class Maximum Reverse Current IR [A] 20 Fire Rating C Wind/Snow Load [Pa] 5400 Permitted module temperature -40°C up to +85°C (in accordance with IEC 61215) on continuous duty QUALIFICATIONS 1 CERTIFICATES PARTNER UL 1703; VDE Quality Tested; CE -compliant; IEC 61215 (Ed.2); IEC 61730 (Ed.l) application class A DUE C EsI® C � sa��,US NOTE: Installation instructions must be followed. See the installation and operating manual or contact our technical service department for further information on approved installation and use of this product. Nanwha 0 CELLS USA Corp. 8001 Irvine Center Drive, suite 1250, Irvine CA 92618, USA I TEL +1848 748 59 96 1 FAX +1949 748 59 84 1 EMAIL q-cells-usa®q-cells.com I WEB www.q-cells.us Engineered in Germany QCELLS Wf9 g���C�Qooa V cQ�ca enph' R C] N E R G The Enphase Energy Microinverter System 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 Gateway, and Enlighten, Enphase's monitoring and analysis software. - Maximum energy production PRODUCTIVE - Resilient to dust, debris and shading - Performance monitoring per module - System availability greater RELIABLE than 99.8% - No single point of system failure - Quick and simple design, installation SMART and management - 24/7 monitoring and analysis SAFE - Low voltage DC - Reduced fire risk C%sC WOW"" M215 MICROINVERTER TECHNICAL DATA o Dom, '�-] � �'�it • a �I �q • o � � o Recommended input power (STC) 190 - 260W Maximum input DC voltage 45V Peak power tracking voltage 22V - 36V Operating range 16V - 36V Min./Max. start voltage 26.4V/45V Max. DC short circuit current 15A Max. input current 10.5A @o@M*g B@Rg M(SM f weft Maximum output power 215W 215W Nominal output current 1.OA (arms at nominal duration) 0.9A (arms at nominal duration) Nominal voltage/range 208V/183 -229V 240V/211 -264V Nominal frequency/range 60.0/59.3-60.5 Hz 60.0/59.3-60.5 Hz Extended frequency range 60.0/59.2-60.6 Hz 60.0/59.2-60.6 Hz Power Factor >0.95 >0.95 Maximum units per 20A branch circuit 25 (three phase) 17 (single phase) Maximum output fault current 1.05 Arms, over 3 cycles; 25.2 Apeak, 174ms duration sumn CEC weighted efficiency 96.0% Peak inverter efficiency 96.3% Static MPPT efficiency (weighted, reference EN50530) 99.6% Dynamic MPPT efficiency (fast irradiation changes, reference EN50530) 99.3% Night time power consumption 46mW L"iCA4?J Ambient temperature range -40°C to + 65°C Operating temperature range (internal) -40°C to + 85°C Dimensions (WxHxD) 17.3 cm x 16.4 cm x 2.5 cm (6.8" x 6.45" x 1.0")* Weight 1.6 kg (3.5 lbs) Cooling Natural convection - No fans Enclosureenvironmental rating Outdoor - NEMA 6 * without mounting bracket I @@R :Ulm] Compatibility Pairs with most 60 -cell PV modules Communication Power line Warranty 25 -year limited warranty Monitoring Free lifetime monitoring via Enlighten softrware Compliance UL1741/IEEE1547, FCC Part 15 Class B CAN/CSA-C22.2 NO. 0-M91, 0.4-04, and 107.1-01 Enphase Energy, Inc. 201 1 st Street Petaluma, CA 94952 Phone: 877-797-4743 Fax: 707-763-0784 info@enphaseenergy.com http://www.enphase.com 142-00010 Rev 02 DDd IRONRIDGE Roof Mounts Solar Mounting Made Simple Longest Spans In The Industry Means Fewest Req ire Attae ment Point Fewest Attachment Points Red ce o all Installed Costs A d Lia ility Unique Curved Profile - he tan a all Increases S ren t And nhances Aest etic Design Backed By Industry Leading Warranty 0 yr. Limite Pro et, r. Finish PE Certified For Most States Universal Clamping Components Work Wit Most Sola KMAUTdUle B a ds Versatile Design A lows For se In Gro nd Mo nt, Roof Mo nt, or L rge Array A plica 'on Best Customer Ser�v_ice And SUppC www.ironridge.com IronRidge Roof Mount System is a reliable, comprehensive, and feature rich photovoltaic mounting solution. Anchored by IronRidge Standard or IronRidge Light rails, our Roof Mount platform includes all of the components necessary for supporting virtually any commercial or residential roof mount installation, regardless of roof type or pitch. IronRidge Standard Rails Less Material, Faster Install, Minimized Risk of Leaks Engineered for longer spans =fewer attachments &penetrations Other rails = Longer install time and greater risk of leaks IronRidge Standard Rail Engineered profile allows for spans over 13' Cantilever can be 40% of span length Attractive structural design, ideal for residential and commercial applications IronRidge Light Rail Light, cost effective rail system supports spans up to 8' Cantilever can be 40% of span length Splices (Internal) Can be installed at same location as an attachment Does not require additional attachments to support the splice © Copyright 2011 IronRidge, Inc. All rights reserved. DSRFM0411_1 %/d IRONRIDGE Solar Mounting Made Simple Maximum Span Chart: IronRidge Standard Rail Wind Speed Snow Loads 7 6 5.5 0 psf 10 psf 20 psf 30 psf 90 mph 13.5' 12.5 10.5 10.0 100 mph 13.5 12.5 10.5 10.0 110 mph 13 12.5 10.5 10.0 120 mph 12 12 10.5 10.0 130 mph 11 11 10.5 10.0 140 mph 10 10 10 9.5 150 mph 9.6 9.5 9.5 9.5 Roof Mounts I IronRidge Light Rail 40 psf 50 psf 60 psf 0 psf 10 psf 20 psf 30 psf 40 psf 9.0 8.5 7.5 8 7 6 5.5 5 9.0 8.5 7.5 8 7 6 5.5 5 9.0 8.5 7.5 7.6 7 6 5.5 5 9.0 8.5 7.5 7 7 6 5.5 5 9.0 8.5 7.5 6.5 6.5 6 5.5 5 9.0 8.5 7.5 6 6 6 5.5 5 8.5 8 7.5 5.5 5.5 5.5 5.5 5 Roof Zone 1, Flush Mount Only Building mean roof height = 30' * For more information visit www.ironridge.com to Slope = 6" / ft. Clearance between roof and rail: 2" download certification letters, installation guides, Exposure category B End Cant Span: 40% (adj. interior span) and to use our roof mount configuration software. Module length: 77" Middle 1/3 span rail splice not permitted Attachments Adjustable L feet (4 pack kits) Adjustable tilt leg kits (5° to 45°) Flush mount aluminum standoffs (3 4", 6 7") Tilt steel standoffs (4",6") End Caps am Protect against debris while providing a finished look for both standard and light rails Why IronRidge Clamps Panel Sizes 1.22" to 2.30" Mid clamps (require only 1/4" between panels) Mid clamps available in hex or t -bolt All hardware stainless steel Wire Clips Accommodate up to eight 6mm panel wires or an Enphase wire harness Experience - Designing/manufacturing solar mounting products since 1996 Single Source - Roof mounts, ballasted mounts, large arrays, and more; a solution for your specific application Customer Satisfaction - Customer service and technical support to help you succeed On-line Resources Available: Video Tutorials Product Configurators Product Certifications, Installation Guides Data Sheets - Reseller Locator Sales: 800-227-9523 www.IronRidge.com sales@ironridge.com 1435 Baechtel Road Willits, CA 95490 www.ironridge.com © Copyright 20111ronRidge, Inc. All rights reserved. DSRFM0411_1 Date. .�/,/4//? ...... Al, '6NO TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that ............. ........ has permission for gas installation .. . .. ................ in the buildings of .... 160F;4 .............................. at ... ..5T', ....... , North Andover,,Mass. Fee. Lic. No. 4-4 . GAS INSPECTOR Check # ///19 1MIM O MASSACHUSUM Ur4ff ORM APFUCATON FOR P ERMrr TSO DO GAS Ff rrING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date S — —12. Building Locations IWO 'Fet-atST STr ect Permit # Amount $ Owner's Name �u4 &MJA New Renovation ❑ Replacement ❑ Pians Submitted ❑ (Print or type)(� Chee one: Certificate Installing Company Name. J pw A Cs RQ a jATQ LJ Corp. Address I X 3R 1 ❑ Partner. a- H 6367 usrness Telephone _ Q Firm/Co. Name of Licensed Plumber or Gas Fitter I COni J A V INSURANCE COVERAGE Check o e: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑. Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass%<u—seBO StateiGV Cod;,and gJwpter 142 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 1-344U ❑ Gas Fitter License Numner Master Journeyman -�el94�- Sir • s (Print or type)(� Chee one: Certificate Installing Company Name. J pw A Cs RQ a jATQ LJ Corp. Address I X 3R 1 ❑ Partner. a- H 6367 usrness Telephone _ Q Firm/Co. Name of Licensed Plumber or Gas Fitter I COni J A V INSURANCE COVERAGE Check o e: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑. Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass%<u—seBO StateiGV Cod;,and gJwpter 142 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 1-344U ❑ Gas Fitter License Numner Master Journeyman -�el94�- Sir The Commonwealth ofMassachasetts Department of1'ndwirial Acddents O, ke of rnVeWgaffons 600 Washington &reel Boston, MA 02111 www.mrzss.gov/dia Workers' Compensation Insurance Affidavit, guffders/Contraciors/Eleciiictats/piumberr, ph cant Informst inn Name (Business/ ftanizafion/Individnat): SAVA A cr c p' 1 Address: - - - -- - ps 14, Bet 3q i City/StatatZip: &I C M %V H 0 367 9 Phone #: 978- 809 - 1 150 Are you an employer? Check the appropriate box; 1. ❑ I am a employer with 4. 111 am a general contractor and I 2. (employees (full and/orpan time).*' I have hired the sub -contractors am a sole proprietor or part= ship and have no employees listed on the attached sheet, t These subcontractors have working for me in any capacity. [No workers' comp. insurance workers' co�. 5. ElWe are a c oiporaiion and its 3. ❑required,] officers have exercised their .I am a homeowner doing all work myself [No workers' comp. right of exemption per MGL c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance requd Type of project (required): - 6. ❑ New construction 7. ❑ Remodeling 8. .0 Demolition % ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs ] 13.0 Other (MSCrQtaeti,,4.. n `Any gplima that box #1 m� also fiIl out the I & fi Iiomeowaeis who submit this affidavit indicntin th on hd0w =hox� .wadcets' oopacy mfomnafWX tCOOMeo ors Slat check this box must g e1' doing all work and then hire outside contractors must submit anew ifftdavit indicating such. attached an additional sheet showing the name ofthe sub -cow and their workers• comppolicy fi&Mnafion. I am an employer uuu is providing workexs'compensatwn msuranee or informev& f mY employee& Below is the policy and job site Insurance Compiny Name.- Policy ame:Policy # or Self -ins. Lic. #: Expiration Dane: Job Site Address-, Attach a copy of the workers' tom Chy/stawzip: pensation policy declaration page (showing the policy number and expiration date). Fannie to secure coverage as required under Section. 25A of MGL c.152 can lead to the imposition of criminal penalties of a fie up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in Bre 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 o Investigations ofthe DIA for insurance coverage verification f Ido hereby 1. „O � o ^ �"� .fPmTm7' Slat the information provided above is true and correct I-'JJw,uu use only. Do not write in this area to be completed h city or town of t City or Town: PermitJLicense # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4.. Electrical leetrical Inspector S. Plumbing Inspector Contact Person: Phone M IWj Date... TOWN OF NORTH ANDOVER 0* PERMIT FOR WIRING This certifies that ...7 / �� ..... g .................. has permission to perform ........ .................... wiring in the building of ......... ................................................... at rAIE57 7 ...... 52..................... North Andover, Mass. Fee .4 � Lic. No. .......... ...... LECTRICAL INSPECOR Check# 10841 > l Commonwealth of Massachusetts � r Department of Fire Services , BOARD OF FIRE PREVENTION REGULATIONS Oficial Use Only Permit No. /f Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT M INK OR TYPE ALL INFORMATION) Date: 5-1(o-12— City - (o—IZ.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) GO Owner or Tenant a Jzn.�c IF Telephone No. qz16- (p 1b (o - 8121 Owner's Address J SAVV%C_i Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building v Utility Authorization No. Existing Service New Service Amps / Volts Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work:il C.'mmnletion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil:P (Paddle) Fans Suss of Total TransKVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No, of Zones No. of Detection andInitiating No. of Switches No. of Gas Burners Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers P Totals: . ..................... ....................... Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal El Other Connection No. of Dryers Y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of WaterKW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:'j- 1(. Z Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, underthe ains and penalties of perju , that the information on this application is true and complete. FIItM AME N:. NAL_�u�v t�� LIC. NO.: i Licensee: .,,'A \ c Signature kJJ, LIC. NO.: 14 1!;J 2J (If applicable, a ter "exewt" in the license numb line.) Bus. Tel. No.: Loa- 4S)-' Address:t��,On 97 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. MXCTPdCC.(Ayy �.{�32.•(7����t��'yef T®gpy.-- �p{��� (•Ta^p p�{� _ �i�?'�����1' �®?�7t`. • — J.1J�-y�%(LJL.�.Y-. .ti4\Nl. itl V.+'. L.ti`..� • • .,. ._ i •. �• Z c re�+'ailefl•�[ � �e-zuspectiort �•equzxed=($�O.DO) � ( � Big Y-1 atuxe -xto iiiials? Slate Passed--[ ] �+ailecl--j � ate-fus�ectzo�xet�uixecl(�50.Q0)�[ ] �.s�ectoxs' coxnmenis: • (.inspectors'' �'zgnaiuxe •-ao inftazs) date . � ' asse�l— f ) ispectbrs' comme3 fs. railell - actors, Nlgnatuxe - io jdtials) NSPECTION-• OMR: • �e�5nspectio: ,secl— C Iaiterl�j - — • te�fns�ecii Vectors' cozum.ents: • S ' 'Glusp actors' Szgnaiuxe no xnitTals) ' D)ORTAQ;.q.A*RV.TO$EFM EDOTTTAWbifXFT011 X0.00) •• (� ' Date Data ,IIT TRW, A72rlA To *Rpl M.Ri'T+,C'T ID I'q 1f7d1T �'asse��- • �+'aflecl--j � � ate-�inspectiox�xec�uixe� ($0,00)-• [ �` ' Tnspecioxs' cozn]n.eJxts: . (ffis actoxs',Pzgnatuxe ofnz s) late Passed--[ ] �+ailecl--j � ate-fus�ectzo�xet�uixecl(�50.Q0)�[ ] �.s�ectoxs' coxnmenis: • (.inspectors'' �'zgnaiuxe •-ao inftazs) date . � ' asse�l— f ) ispectbrs' comme3 fs. railell - actors, Nlgnatuxe - io jdtials) NSPECTION-• OMR: • �e�5nspectio: ,secl— C Iaiterl�j - — • te�fns�ecii Vectors' cozum.ents: • S ' 'Glusp actors' Szgnaiuxe no xnitTals) ' D)ORTAQ;.q.A*RV.TO$EFM EDOTTTAWbifXFT011 X0.00) •• (� ' Date Data ,IIT TRW, A72rlA To *Rpl M.Ri'T+,C'T ID I'q 1f7d1T I t The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): & 44 [��, Jr, CAA Address:_t-p City/State/Zip: .o,\ Phone #: (a:o ctg 2 Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 2— 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i' Homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:_ A A. CJ— Policy # or Self -ins. Lic. P W CC. S_toz�,tega 2 e. VL do 5 Expiration Date: [ ^ ( 3 Job Site Address: `okvo (Z --?4k '�,�4- City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerliA under tl:e pains and penalties ofperjury that the information provided above is true and correct. Phone #: (-o 2 — �f S,2 — ci g—" Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # (Z Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - 11 Contact Person: Phone #: II Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shallnot 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Iavestigations 600 Washington Stmot Boston, MA 02111 Tei, # 617-727-4900 ext 406 or 1-877:MASSAFE Revised 5-26-05 Fax # 617-727-7749 wvvW mass,govldla 10�• O� � I � ' fit L I � y" �• L �:a'T' �►- �0 --5 I L s 1 1. --• N V1 I° � t� ul 9 :(� 7 lj NFW NEcv o 0.1 01 v 3� N 0' I tt m 0 to I �0 b 0 �40 I m 1 ��oo `�Z IS 52(0 2t=OSE ag.wT lot g0 SZIo'-St- it E (WIDTH VAti—IES uk�l: ��mmIInu�>:tti#h of a` n5ar4uMptt5 Mepartinint of Public 2-afPtg BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. `�� Occupancy A Fee Checked i v 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) [Date /Lqz (X)(( or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to -.perform the electrical work described below. Location (Street 8 Owner or Tenant Owner's Address X11:2 L2 r ePz`Tf r7rY�t11)Ile - OF" r� in con unction with a building permit: Yes 71ee-' No ❑ (Check Appropriate Box) s � Is perm) j J / / Purpose of Building +-nC�1e� /t e I"e n �-Utility Authorization No. Existing Service IDa Amps L1LVoits Overhead !1 Undgrnd ❑ No. of Meters Amps Voits Overhead Undgrnd ❑ No. of Meters New Service Q,00 P Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work rkv OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws — I have a current Liability insurance Policy including Ccmcieted Operations Coverage or its substantial equivalent. YES —NO I have sucmitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Soecify) — — (Expiration Date) Estimated Value of Electrical Work $ _ Work to Start Signed under the Penaities of perjury: FIRM NAME rn k G. Licensee inspection Date Recuestea: Rough Final LIC. NO. LFa'ff LIC. NO. Bu Tei. No. f!iU 3 7 y aU AI . Tel. No. Address OWNER' IN U ANCE WAIVER- m awa t at the Licensee does not have the insurance coverage or its substantial equivalent as re quired by ss chusetts G e al L s, d t at my sig ture on this permit application waives this requirement. Owner Agent (P!ease he One) :eieanone No. PERMIT FEE S ignature of Owner or Agent) G k ff,- �fIb'" x-5505 Total No. of Lighting Outlets i No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures .— Swimming Pool grad Above, _ In- n-grnr Generators KVA No. of Emergency Lighting No. of Receotacle Outlets 10 No. of Oil Burners Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges I No. of Air Cond. tons Initiating Devices Heat Total Total No, of Disposals No of Pumos Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW DetectioniSounding Devices Municipal Local 1 Connection I IOther No. of Dryers I Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws — I have a current Liability insurance Policy including Ccmcieted Operations Coverage or its substantial equivalent. YES —NO I have sucmitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Soecify) — — (Expiration Date) Estimated Value of Electrical Work $ _ Work to Start Signed under the Penaities of perjury: FIRM NAME rn k G. Licensee inspection Date Recuestea: Rough Final LIC. NO. LFa'ff LIC. NO. Bu Tei. No. f!iU 3 7 y aU AI . Tel. No. Address OWNER' IN U ANCE WAIVER- m awa t at the Licensee does not have the insurance coverage or its substantial equivalent as re quired by ss chusetts G e al L s, d t at my sig ture on this permit application waives this requirement. Owner Agent (P!ease he One) :eieanone No. PERMIT FEE S ignature of Owner or Agent) G k ff,- �fIb'" x-5505 913 ED 7 Date ..... r ........................ NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING u SS u uss Thiscertifies that ...................................... ........................................................ has permission to perform ...1......... ...... /.:. !...z . I - I ' ' ' "'( .......... I ..................... wiring in the building of ........ f....... at.................... I ............. ............................................. North Andover, Mass. Fee/Oi.(Xr� ...... Lic. No. � ...... �-'/........................................................... ELECTRICAL INSPECTOR it � �, . 6/ 07/11/9515:01 33.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Location z?pco opsr- \ 1 No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fe';F $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Ar���� Building Inspector *sfl �C•tJ0 Div. Public Works ° rc ° z N r N N C W m f r 0 0 J LL LL 0 W N N a W m a r Z 0 a LL I _J m 0 d N C _C t7 Z 0 < Z 0 LL N 7 0 Z O 0 W 0 p Wa Z o LL Z Zx N O a ynj f ° LL_ 0 x N N a W m a r Z 0 a LL W 0 Wa Z z Z N m LL_ ° g I } w a 0 0 C y 0 U C 6 0 U F E W a Si �l W V IL V 0 J m 0 J m 0 J m W U W r H J 3 W =c Z V pl O J W W c.i W Z Z O V 2 f 0 m r Z Z 0 r J Z 0 U (A w0 r W p r Ir N W U J Z a Z 0O z a< 00 LL z a N Z O m 0 t7 0 p a N p J J LL W C U U U LL ° ° ° 5 O r WO Z < < 0 J J J m ° U J N N N W m m m j a < m ° ° ° < N N N 3: m b � 0 z P z .. s � 0 Z m g } w a 0 o U C y 0 U C 6 0 U F E W a Si �l W V IL V 0 J m 0 J m 0 J m W U W r H J 3 W =c Z V pl O J W W m c.i W Z Z O V 2 -m 0 ww ppo nn� wNf1 gD o w D *ZN o nmQ SA3 IZ;-1 O DDc Z nnmm m7JyOOc nnmW INDD0G BpZOpO D DN3 ;3< 0 0 D~ mmnIcnn~i;Dov f1 m Nm n C)r00000O ZZnZZOOox2 OO NO p0 mm w D m< x Z ZNN Z Z Pm 0Z N ZO O D D DZ >(7 mmON 3: 100 Z ZrnZ O =OZ y < < ~ Z 0 I TTI 1-_ IIIII HELL Z�OpcDD2yTo O D Z p O O m �zxDi-.m O O D _ DC v D Dnx N O D n D O W O TTT A Z Z cvvx Z A _T D Z Q1 A pN n x- N O y n D JO 111 r T T O D r T n< x D ,D1, x ti x O m Q A n m 3 = O y Z m T< N A m 0 T O n m F D (1 D m y f; < Z y T C N O D T O Z N c Z 0 JO A D O S -� O x m A Z V D D ti 3 Z m D A< << �_ N N ~ O JO x O p O T 0 O N< n T ti p m N T Z v m n -1 C H 0 0 mm ti~ O A S p X f Z Z 0— X r Pe T N D D 7o Z N OZD OM D JOn Z III ~ -1 O 7C N �T C m e '. n m D m D A T O � � � I I I I L I I I Ia Z v O T ^I Z mp N x Z Ci O Z T O Z lz I I I I IW I V I I I IW I I I >0_I OWN �mjlrN ZA M, nN a° NZZ Cox XM a� O 0 10 Nv* mim mx -I Z a _xN_n NO �Z-1_ mN3 "aOZ In'A M 0 U1CZ N 0r 00 -•10r •DNO ?�z -� v xv �y �D fl Z in mm N .n � m 00 3 '% 1 1-14 - m A 0 v k4 o-11, GN O J Z ZZ o z Z J a c U co O O U w PW Z O Q a w � Z O y a2 ti cn O 7 •- U z ? 7 C w W w •J V) m w Q T3 � co w w Qi Z v V) 0 O Cf) i o CO c o � c :oma 0 v ci :ate ac ' R R m c = O V y rmr Ea CJ o a N o m c o O 4 :mom E o . N cm 7 m J N c COD R c O CD O Qf ^V^' y •O J C p m t�: Q V 15Z C a C Q � � ` m c •O = m CL. rL... CLLI N .., c N a� R Z m m CWS m C== C coo CL0 env CD` = o �•. = $ � am z 0 U z 0 J o z E co O F- � O Q � Z 0 C pm O F- W ICO Q T3 Cc Q V� 'E Qi Cw z W > L- � �U cr- 0 L co i _R O EL— cmQ y � OCqu +--' C J z •� CD z 0 Q COD EZ C W cz F— Q NJ G z z cx-- Q w w Cl- cn t1 J 15 Date..,/./.:�... ca M STN _ TOWN OF NORTH ANDOVER 'too PERMIT FOR GAS INSTALLATIONS M CU This certifies that . Z ..: X ...... !. .• .............. • has permission for gas installation . .. �'. . ' : • :.. • • • • • • • a in the buildings of ... ......: . �...................... . at ........ . r . ..... .? ..... . . , North Andover, Mass. Fee...:..... Lic. No..?...:-.... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO G ITTiNG (Print or Type) Mass. Date ter/ -.19Pe a Building Location Jrzm�i/� 5 / .-Owner's Name Type of Occupancy �S G New '21"— Renovation ❑ Replacement ❑ , Plans Submitted: Yes❑ No ❑ Installing Company Name Check one: Certificate 7 ❑ Corporation ❑ Partnership Business Telephone_ /0�� ❑ Firm/Co, Namefof Licensed Plumber or Gas Fitter .� INSTANCE COV RAGE: I have a current liity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142- Yes 42Yes No ❑ ' If you have checked Les, please indicate the type coverage by checking the appropriate box. A iiabfllty insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licenses does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent [I i hereby certify that all of the details and information I have submitted (or entered) in ab ve application are true and accurate to the best of my kncwfedge and that all plumbing work and InsWiations performed under the permit is ed for this a pllcatio wi( e n comp an all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the G eral Laws. 01 BY Type of License: ber nalur cense u ,arbor titer Title ° r Z�; Vaster License Number r APY Journeyman 0 . N N W N N N V U7 s N it c 2 N }. N Q> 2 2 F- z L, O f' w 4 lr m to W r-- 4 y w O H ° N a C d > t— 4 of a W= v W 2 H W 4 x t0— W F, s F. C } f'W N Om 2 O WO= O trr W 4 W> w 2 ., W 2 '. '� s 4 4 O O W OF - 2 3 O a J V C > SUB—aSMT. BASEMENT / ISTFLOOR 2ND FLOOR 3110 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR I 7TH FLOOR 8TH FLOOR Installing Company Name Check one: Certificate 7 ❑ Corporation ❑ Partnership Business Telephone_ /0�� ❑ Firm/Co, Namefof Licensed Plumber or Gas Fitter .� INSTANCE COV RAGE: I have a current liity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142- Yes 42Yes No ❑ ' If you have checked Les, please indicate the type coverage by checking the appropriate box. A iiabfllty insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licenses does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent [I i hereby certify that all of the details and information I have submitted (or entered) in ab ve application are true and accurate to the best of my kncwfedge and that all plumbing work and InsWiations performed under the permit is ed for this a pllcatio wi( e n comp an all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the G eral Laws. 01 BY Type of License: ber nalur cense u ,arbor titer Title ° r Z�; Vaster License Number r APY Journeyman 0 . I LocItion i' No. Date A TOWN OF NORTH ANDOVER !' Certificate of Occupancy $ Building/Frame Permit Fee $ St C14Ustt� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 43/% 13:49 Building Inspector 25. oo PAID Div. 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C7 C-) cn III O O - ?r Z V J y. r: d z �'� d w t� n: O 0 C/1 Cl) m S T m N S cn 0(b 0 d c"n o W =� o d �� °'— p a c :- cr N , r O GGa = CD m °= Pi p OQ �- '� r � m :1 = CD rcn O m :7- p � a C'7 Q. C7 C-) III O O - ?r Z CD y. �'� d w CDN ? a -+CL 0 CD CD O CD —I Q y O O -p CD � Q Q CD N ' d O N C7 �Q tD '_ Y X0 CD CD N S CD _O CC O CD 3 CD N N a _ CS C _ N d Q •\ C to .-► N rr �� CD CD CD CD C►� N Q CD O O CD O LI y 'CD CD T1 n CD CD O CD V, CD =r: Al � CD a � n O CO) � O • Cl) CD CD C/1 Cl) m S T m N S cn 0(b 0 d c"n o M 7 a �� °'— p a c :- M °= , r O GGa = �% r rz O m °= Pi p OQ �- '� r � m :1 = n ID.cp rcn O m :7- p � a z O III O O - ?r o PTJ y 0 9 0 C CD 0 C TOWN of NORTH ANDOVER AFFIDAVIT .•11- 111. mumm caj=toc .. 01a.• 1• a./11 •.. .KI..• I �► u 1 • - • - .a.• s• . •• rar_loft • s ••a... 5.1/ 111111001f,•fG.•1._- • •• aw'1 • 111. • .11. 1 .Ii• t ill. -blur* • .. .• . • ." . __ _..s . • s t• . • • J• .1 • ••. Il �• • 1 t • w1.3 •- • • /+•• •- .• - • slow-' 4090 1 • .3 rs • x•.31. • • 1 • t'• u / nn - _1 Type of Work:�� Address of Work Owner Name: Date of Permit Application:�Z I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 not owner -occupied pulOther (specify) n pest Notice is hereby given that: Est. Cost OWNERS PULTJNGLIMP OWN PERMIT OR DEALING 1. 1. 3 •y' 011 t• 1' • T► ARBI1RA- TION PROGRAM • ' GUARANTY FUND UNDER !! Sigri u -d--- pealties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:, Date Owner Name J Date ...........�� 1,4 -.. I .................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...................................................................... ......... o has permission to perform ..................................................... wiring in the building of ..... ........ at V1.6 ..... ;IIr—.-----&.....,d.�I.... ..... .................................. . NorthAmdover, Mass. .......... ... Fee ............... Lic. No. P "; ............... ......... .................................... ELECTRICAL INSPECTOR Check # 4 7 4 A It ate THE COMMONWEALTHOFMASSA CHUSETTS Office Use only DEPARTN1rI0FPUX1CS4F= Permit No. q7l tf BOARD OFFREPREVEMONREGULAHONS527CM12QO 9,. e, Occupancy &Fees Checked -s�.� APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date G3 Town of North Andover Toth Inspector of Wires The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) . Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes (Check Appropriate Box) Purpose of Building s%/44�`�f �yJ// y Utility Authorization No. Existing Service Amps G/ Z ovolts Overhead Jnderground No. of Meters j New Service Amps / Volts Overhead =1 Underground 1:3 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work -56-1/7CI u No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below M Generators KVA round round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local MunicipalOther No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors / Total HP f L OTHER i IsI.Ir • • 'IMrl! to the wp nts .x.•!.:16 Ck ned Laws. - lbawahrDkdvandpiolofsa=tDtbeOffioF-- YES Ifyouhawdrcked YES, 1 e?win Y. t" I • ofoow eb :1* the .DY •PI.1' •• 11'I ..1 •' /. 1' rJll & • • E:•II'1: •'1 sig-.edur,C,zr,PtAes6fpqw 191! Ii ILIA 11I •" `• • Licensee /jll C /2 Sigrrahue /��� L—.N. �-- A n C/ Bush mTel.No. 97�- / ��- C7a4 Acv n! %� /t1/ 1//. � 5, Z&C�// VC- � iL��,�t, C�1 �" `!`7 Alt Tel No. �/ 473 - 1s > `/ OWNER'S INSURANCE WARVER; I am aware that thel iceme does nothave the ir>5luarlce coverage orits sulstanW equivale nt as required by Massachusetts Geral Laws and that my signalrue on this penmt application waives this regtmerrient (Please check one) Owner O Agent r� Telephone No. PERMIT FEE $ , Signature ot Uwner or gent The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # 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. Companv name: Address City Phone #-. Insurance. Co. Policv # Company name: Selectman's Office Address 1 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 $1,5oo.00 and/or one years' imprisorxnent_as_vi[ell_as_civil.penaltiesjnlhelarm-da_STOP WORK:ORDFRand_a fine_of_($1D0M)-arlay againsirn .e, 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.. J do hereby certify under the pains and penalties of perjury that the irn rmation provided above is true and correct Signature pate Print name pbone # Official use only do not write in this area to be completed by city or town officiar City or Town PermUicensing El Building Dept E]Check if immediate response is required El Licensing Board E] Selectman's Office Contact person: Phone # Ei Health Department ❑ Other Date.,./- C.? .... yNppTM TOWN OF NORTH ANDOVER FO i 9 -,z PERMIT FOR GAS INSTALLATION This certifies that ..117'4 (i '; . <- ( . � !'? .'.:........... . has permission for gas installation ...� .� c .� r.... �.'.. . r in the buildings of .. !.: 1 14.1 . ( ............................... at +............ North Andover, Mass. Fee..3 ° .... Lic. No........ c . �' ..... , :�.... . ,,GAS INSPECTOR Check # % 7 t, 4530 MASSACHUSETTS UNIFORM APPLICATON FOR (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Jil t1 1—n a r Owner's Name DO GAS FITTING Date New ❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ Permit # f.)—Jo Amount $ 3o, (Print or type) hec one: Certificate Installing Company Name AAO ///1n11 %9 A.) 14�e/l Li Corp. Address �%�^ 7- ❑— Partner. �/,9� '?�r�Pg d �v a F til Business Telephone Flrm/CO. Name of Licensed Plumber or Gas Fitterj fjp,.n r /:�; 10 /Y/ C/i %�j INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑/ No ❑ Ifyou have checked ,L, please indicate the type coverage by checking the appropriate box. Liability insurance policy IT Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i nemoy ceraty that an or the aetatns ana mrormation 1 nave submitted (or entered) to above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Status Code and Cater 142 of the General Laws. VED (OFFICE USE ONLY) ature of Licensed Plumber Or Gas Fitter Plumber / Z !ZP& M Gas Fitter LiCense Number ❑ Master ❑,Journeyman F • (Print or type) hec one: Certificate Installing Company Name AAO ///1n11 %9 A.) 14�e/l Li Corp. Address �%�^ 7- ❑— Partner. �/,9� '?�r�Pg d �v a F til Business Telephone Flrm/CO. Name of Licensed Plumber or Gas Fitterj fjp,.n r /:�; 10 /Y/ C/i %�j INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑/ No ❑ Ifyou have checked ,L, please indicate the type coverage by checking the appropriate box. Liability insurance policy IT Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i nemoy ceraty that an or the aetatns ana mrormation 1 nave submitted (or entered) to above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Status Code and Cater 142 of the General Laws. VED (OFFICE USE ONLY) ature of Licensed Plumber Or Gas Fitter Plumber / Z !ZP& M Gas Fitter LiCense Number ❑ Master ❑,Journeyman F spf tNORTI� ,� -• o it '• �" �• o� O 9 M i ,SSACMUSf This certifies that Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform ... �6?? d�/...AKT-!`:!f plumbing in the buildings of .. !/ {'rrr.!? ..................... at ... a� �.-"�? North Andover, Mass. dO Fee . 7 $ 'f ... Lic. No.. / o� PLUMBING INSPECTOR r Check # 00 t; 50." 2 7 MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location „2 o G, i e'r, T, FOR PERMIT TO DO PLUMBIN( r Date Owners N e J6�_ Permit Amount of Occuva c New Renovation �/ Replacement Plans Submitted Yes No ❑ FIXTURES (Print or type) Check one: Certificate Installing Company Name j -'q n 114 r/,1,4,,/ p'f fid ❑ Corp. Address y/�C— d►')_ ^�' �C / Partner. •n P ee 1 Business Te ephone , 6 �(J �Firm/Co. 4 Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu State Plumbin de and Chapter 142 of the General Laws. BY aEM 151 1-icenseu TIMOR Type of Plumbing License Title l 41�0 City/Town mise NumDer Master ❑ Journeyman E1 -- APPROVED (oma usE oNLY Date ... A31 #1 0�TOWN OF NORTH ANDOVER PERMIT FOR WIRING lhis certifies that ... ..dad ...... ........ r C has permission to perform ......d J.f.f jtkA ......... .................... Aring; in the building of .... D..dR.j..IU ........ ................................... *at ...... ........ R�..Ie5l .... Sf ............. North Andover, ass .P od . .......... c Cluj Fee..-,?,� ......... Lic. No.147�?e .......... ... . .... ...... LECrRI=ALINSPE R Check # 5066 71;(5 ed7&X672Zf514z?;?1 057 vo-ft a 4;Do#& Sappy BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. �� 6-P r 4?1 Occupancy & Fee Check ' CMR 12:00 APPLICATION FOR PERMIT TO ERFRM ELECTRICAL WORK All work to be performed in accordance with the assac usetts Electrical Code 527 MR 12:00 (Please Print in ink or type all information) Date To Lh l:tspector of Mr.' Town of North Andover The undersigned applies for a permit to perfornIthe electrical work described below. Location (Street & Number V IiZL� Owner or Tenant c� l' V'f L C_ Owner's Address J ',:�13 y`" is this permit in conjunction with a building permit Yes/ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead a Undgmd a No. of Meters i New Service Amps Voits Overhead a Undgmd 0 No. of Meters Number of Feeders and Ampacity LocatirA and Nature of Proposed Electrical Work INSURANCE COVERAGE. Pursuant to the requiremenfits of Massachusetts General Laws n�1 L I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO (' Goa -3V-0-2-70 have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of overage by checking the appropriate box. INSURANCE - BOND - OTHER o (Please Specify) (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: % � FIRM NAME /��Ch��� f / ,L-,S5St1,f (£G_ LGc LIC. NO. Licensee/ Signature A;= �� LIC. NO. S �� M JZ Bus. Tel No. Address Alt Tel. No. _ OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts Generai Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) i v Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In a No. of Lighting Fhdures �G swimmin Pool gmd 0 gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of SwArh Outlets No of Gas Bumers FIRE ALARMS No. of Zone No. of Detection and Total No. of Rant es No of Air Cond Tons Inflating Devices it ) Heat Total TSI No. of Di I No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No. of D Dryers Heating. KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiri No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremenfits of Massachusetts General Laws n�1 L I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO (' Goa -3V-0-2-70 have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of overage by checking the appropriate box. INSURANCE - BOND - OTHER o (Please Specify) (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: % � FIRM NAME /��Ch��� f / ,L-,S5St1,f (£G_ LGc LIC. NO. Licensee/ Signature A;= �� LIC. NO. S �� M JZ Bus. Tel No. Address Alt Tel. No. _ OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts Generai Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) i v Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Date.... TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that ..r.G1.lrl<.G. has permission for gas installation ...r� ee .. �P .�•. . in 'the buildings of .... /� k .. �J' r°cic !C, ................. . at .__.c�.... est . ��... ., North ;Anda ver,tMass. Fee.S . Uv . Lic. No... e Y,� U .... �... . AS INSPECTOR Check # � � 1� 4679 MASSACHUSETTS UNUMMAPPUCATON (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations /j Z22� Ver's Name New ®' Renovation ❑ Replacement ❑ PERMPI' TO DO GAS FITTING Date C/ 5F�/O C/� fie vZ /,9 ca 4&7!� 6 Plans Submitted ❑ Permit # Amount $ (i rint or type) �r Check one: Certificate Installing Company Name Li s� sfsl c� d .a .�/ O / --- Corp. Address <</ J� A �' �✓ sl ❑ Partner. f e / Business Telephone ,� '?-9 q -tea p irm/Co. Name of Licensed Plumber or Gas Fitter �f10 .n (" /''A/t &f? C`/i /d INSURANCE COVERAGE Checkone: I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. ❑ Liability insurance policy � Other type of indemnity 1:1Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ ,Agent ❑ i hereby certify that all of the details and information i nave suorrutteo dor entereu) in avvvc appuuauv„ aic uuc ai,u aL.L.uiaic w u,c best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu�t'fls State Gas a and C—hap_ter,142 of the General Laws. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber ❑ Gas Fitter License Number ❑ Master ourneyman � 1j a C4 I rA U w a w U z w H a z o z w o oa rn W F+ dd W W� O F'' a `q a O W CIO F z Ch F+ U Z x z C4 O Cw7 F Fw O z W O `C t O x w A C7 a UU a A a cit F O SUB -BA SEM ENT BASIEM ENT 1STi FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6 T H. F L O O R 7TH. FLOOR 8TH. FLOOR (i rint or type) �r Check one: Certificate Installing Company Name Li s� sfsl c� d .a .�/ O / --- Corp. Address <</ J� A �' �✓ sl ❑ Partner. f e / Business Telephone ,� '?-9 q -tea p irm/Co. Name of Licensed Plumber or Gas Fitter �f10 .n (" /''A/t &f? C`/i /d INSURANCE COVERAGE Checkone: I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. ❑ Liability insurance policy � Other type of indemnity 1:1Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ ,Agent ❑ i hereby certify that all of the details and information i nave suorrutteo dor entereu) in avvvc appuuauv„ aic uuc ai,u aL.L.uiaic w u,c best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu�t'fls State Gas a and C—hap_ter,142 of the General Laws. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber ❑ Gas Fitter License Number ❑ Master ourneyman Date.. TOWN OF NORTH ANDOVER 0 Ito PERMIT FOR WIRING This certifies that ........................................... . e;�t ....................... ...... . .................... has permission to perfo . . ...... . wiring in the building of . . ... .. ...... ........ ..................... at . ..... ... . .... ....... ................................. .North Andover, Mass. Fee. 4XI51-10... Lic. No. ......................................................... ELECTRICAL INSPECTOR Check # 5086 S—\ Commonwealth of Massachus : s Official Use Only Department of Fire Servic s Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION RE LATIONS [Rev. 11/991 leaveblank APPLICATION FOR PER IT O PERFORM ELECTRICAL WORK All work to be performed in accordance it a Massachusetts Electrical Code (MEC), 5 7 CMR 12.00 (PLEASE PRINT IN INK OR YP AL FO TION) Date: City or Town of: f To the Inspector o Wires: By this application the undersigned gives noti eWf his or her intotiyon to perform the electrical work described below. Location (Street & Owner or Tenant Owner's Address Is this permit in conjunction with'a building permit? Yes. ❑ No Telephone (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Securi No. of Meters No. of Meters ;Ystem Com letion of the followin table ma be waived by the In e t W No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans c or o tres. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. grnd. Wo --.o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones 3 No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: INumber I Tons KW 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 Heaters KW No. o No . o 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 Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless. the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) Estimated Value of E ctri(FlWork:/10 . — (When required by municipal policy.) (Expiration Date) 09" Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME:Security LIC. NO.: 1 r j j(' Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Li see does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ 7 7 Signature Telephone No. s Date...° S TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . ...•.!�............ has permission for gas installation .._.--^-'J .......... . in the buildings of ............................... atm ? .. ................ .. , North Andover, Mass. Fe . .. Lic. No.1171�4 � ... .. ........... GAS INSPTOR Check # 4757 MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Douglas Bea hOwrier's Name New F1Renovationri Replacement LJ FOR PERMIT TO DO GAS FUTING Date 6/2/04 Plans Submitted ❑ Permit # Z/ 7T7 Amount $25.00 a 1ST. FLOOR 2ND. a o FLOOR 4TH. FLOOR H li 6TH. m co H d a >• CoFw- w 2 M ° ° x z� a H GC7 x w a a o F WZ W > F. W d � d CW7 M .0 a 9 w FW U SUB -BASEM ] BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. STH. FLOOR FLOOR .rn U D 1 bejas 's sub (Print or type) Cff one: Certificate Installing Company s' Name EASTERN PROPANE GAS Co rP- Address 131 WATER ST., DANVERS MA 0192 ❑ Partr►er. Business Telephone 1 800 322 66?8 ❑ Finn/Co. Name of Licensed Plumber or Gas Fitter Robert Talbot INCE COVERAGE Check I have a current liability Insurance policy or it's substantial equivalent yes � No❑ Ifyou have ecked yes, please �fidicate the type coverage by checking the appropriate box a JIUjaSbi�lityinsturance policy LnY.jl Othertype ofindemnity ❑ gond ❑ ti Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and instal - performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massaca to odea ter2&f the General Laws. ity/Town VED (OFFICE USE ONLY) I Signature of Licensed Plumber Or Gas Fitter Plumber &143c) Gas Fitter License Number ❑ Master ❑ Journeyman 4 i Date......1..... ........ ........ °',�``° ;• '"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 1 ^— This certifies that.....S�Ua r ry SFjt' jf7 C c J ....................... ............................................ has permission to perform ... ...............�......................................... wiring in the building of ....D ............. ........ ��/�'/.................................. at ................................... � .................... North Andover, Mass. p Fee .. �5........... Lic. No. d ...6 A ................... .............:.....:............. . ELECTRICALINSPECTOR � Check # 04313y% 7283 (�ommonwea& of Mamaclu�a{ Official Use Only eOEM Permit No. 72, tw� �1JsPar1'inent o�}ira �arvite� Occupancy and Fee Checked BOARD F IRE PREY NTION REGULATIONS [Rev.1/071 leave blank APPLICATION FOM RMT 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 TY ALL LYfORMATION) Date: City or Town of:dy�IZ_ To the Inspector ofWires: By this application the undersigned gives notice of us -or her intention to perform the electrical work described below. Location (Street & Nu$rkter) CD61f1���% , Owner or Tenant Owner's Address z— Telephone N Is this permit in conjunction with a building permit? Yes ❑ No N (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd Number of Feeders and Ampacity Location and Nature of Proposed Electrifal Work: No. of Meters No. of Meters CGLtrtuj dr^ �-tm HLarryl S LA s -rem COmDletion ofthe following tahle may he wnived by tho Incnortnr of Wirnc No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ in--1T5—.5TEmergency rnd. grnd. Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an InitiatingDevices No. of Ranges No. of Air Cond. TotalNo. Tonnss of AlertingDevices No. of Waste Disposers eat Pump Totals: ............. No. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ unicipal ❑ Other Connection No. of Dryers Heating Appliances . KW SecuritySystems:* No. of Devices or Equivalent No. o. o iter Heaters KW o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunications inng: No. of Devices or Equivalent OTHER: e Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: i t (When required by municipal policy.) Work to Start:� Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Se -Cur(: Sc. r LIC. NO.: 153 3 e Licensee:. c C kD)%;` J SignatureLIC. NO.: o? 3,16 (Ifopplicable, entsd "e.Xempt" in the license nmh,, rne.) / / Bus. Tel. No.• -�� Address: X _ I /Uri c_ 4)H 60 9 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.S,S�► 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 , /66P Signature Telephone No. PERMIT FEE: $ Tf REGISTEREpELECTRICIANS SYSTEM TECHNICIAN DOUGLAS BUCKERIDGE 14 LYONS STREET HAVERHILL MA 01832-4610 2306 D 07i3Ii07 .. .,, 952075 l - ri• ^ a " rr p ✓l6E�ajEiNTSF/Pr! �/o.J.;.�.• i License: IiBLIC SgFE7Y SEC SYS .� : +� CERT. CLEARANCE Number: SS CC 001594 Birthdate: 06/13/1963 Expires: 06/13/2007 Tr, no: 478.0 Restricted: 00 DOUGLAS BUCKERIDGE 14 LYONS ST HAVERHILL, MA 01832 G` Commissioner b i— r Location No. 7 �� Date 12- 2TOWN TOWNOF NORTH ANDOVER 3? . 0 AL f 9 + Certificate of Occupancy $ cNusEt Building/Frame Permit Fee $ '� 5 Foundation Permit Fee $ Other Permit Fee $ TOTAL $���' Check # // 4/3 16-/54 —Building Inspector Ma rn X z O TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE:[/(. Building CordmissioMinpeclor 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: *3, g-�9 t� Zonin District Proposed Use Lot Area � Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Zone 1.8 Sewerage Disposal System: Public ❑ Private Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 1E7 SECTION 2 - PROPERTY OWNERSIlIP/AUTHORIZED AGENT Historic District: Yes NO 2.1 Owner of Record % �f 'jUD�/7� Name (Pri ) f Addiess for Service: f r� 6-lZ Signatur Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SF'0TION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number 3 03r'l� Address 2— .–` a✓' S Expiration Date Signature Telephone 3.2 Registered Home Imprrovement Contractor Not Applicable ❑ Company Name Registration Number ---� 3 S Address A/O Expiration Date Si na re Telephone Ma rn X z O s SEC7T, ON 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) Work ompensation 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(sT77 Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Ivo A -QV / 10A1s 7-o 7� TCS ADV Fig /L Y A'GOtir RE -I'D ' 6,01nS hWy 77&2; Y S SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beFCIAL'USE;CENLy Completed by permit a licant � 1. Building � 0 � /-)�' oO (a) Building Permit Fee (p Multiplier 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 AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby autho U `f Z-/ -S5 to act on My behalf, i441 matters reU9v o irk agpdRued by t building Dermit anDlication. Si atureWOwner Dater ` SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1 � c. rte/ z/ 7 -S S 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 L Z,4 s Print Name Signature of Q6ner/Agent Date NO. OF STORIES 74,0 SIZE 20'X ZS-' A n E $ Z BASEMENT OR SLAB basenem-+- -SIZE OF FLOOR TMMERS 2 ND 3 RD SPAN DR,4ENSIONS OF SILLS DIN ENSIONS OF POSTS DRAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS d " SIZE OF FOOTING 2 0 " /,I b X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND SOI! IS BUILDING CONNECTED TO NATURAL GAS LINE lV o +R s r r 4 0 2 E ..T- O L., C (Wit7TN V�rLtFS �L 4 0 L S 102, O� } 19 Z I Ul N L L c� Tl MF�u A %;La IL -r.rr. 45 tJ 0 VA 0 0 2 E ..T- O L., C (Wit7TN V�rLtFS �L 4 L S } c� Tl MF�u ,V E w 45 tJ 0 VA 0 I7 o . a 0.1 _ �XIS7 �wEL� o f ,% d 4 0' I 32 . oo LA to d 3, N >� 7 � I tr 0 4 .2�5 tc '• z� - 4�t - SG.' E Z.34 LAI.L• 0 2 E ..T- O L., C (Wit7TN V�rLtFS �L Ll FORM U - LOT RE E FORM -11. INSTRUCTIONS: This form is used to verify that all necessary approvalsApermits frorn Boards and Departments having jurisdiction have been obtained. This does nt relieve the applicant and/or landowner from compliance with any applicable or requirements. ************************"'APPLICANT FILLS OUT THIS SECTION******************** APPLICANT G S G_ PHONE LOCATION: Assessor's Map Number f a PARCEL SUBDIVISION // LOT (S)`Q STREET ST. NUMBER 206 **************************OFFICIAL USE ONLY******************* OF TOWN AGENTS: ATION ADMINISTRATOR �/hwI� W/MM DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS O -v -J to nn DATE APPROVED DATE REJECTED DATE APPROVED ( O DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT Sl RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm The Commonwealth of Massachusetts Department df Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # 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 worters' compensation for my employees working on• this job. Company name: Address �3 Shr/✓G /l `1oj-r or. /j�-ihSah A# Phone*, �a 3- 36 Insurance Co.zU ri C h vn erg ca h Policy # 7 S? X 99 Company name: , Address tom: PtWne fk t=altars to secure coverage as required under Section 25A or MGL 152car► lead falba ir►ipasifYon of exirninat penaltiescFWfine upr to $?;S a"Or one years' improa rnentas f ieWOMDM)-aA rages. understand that a copy of this statement may be forwarded to the orrice of investigations of the DIA for c wage verificafton. do hereby mby under the of perjury that the i►rlamatim promled st ove is true and coffect r Signature [)ate /1- !�- Print name co."_( 21-5 S Phone.# 6 d 3- 3 42- S/ 8 Official use onlydo not write in this area to be completed by city or town cultist City of Town But7abng Dept OCheck Ikmedfate response is required 0 Lbonsi ra Boal .0 Se/ectmaWs O Contact person: Phone k E] Health Departti I] Other 11/20/2003 10:23 19784701336 JANE E GRISWOLD ARCH PAGE 01 ENERGY CONSERVATION APPUCATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS • 780 CMR AppwWix J (effective 311/98) APPS NAaw: 1DOU CKL &S L.osa aid site Addresr ZOG -�Fo w st tT m6T. 'p fltp c. �.�. App9mi t Adder Clty/Town: M. a. D n v G M_ *A SS 20 6 ifb V46st jrr h1�'r}j Ahty a V irk Applcard Phone: _`h8 - bit (0 • at 21 Use Group: aILasto1-kHZt01.4 Date of Applicadon. Appllcanl Sonalure: Corr>p kme Padh (crack one): D PrwcalPtWo Packape (L ffallhsd to 7- or 24am4 rood frame brdldlnye haaud riffs fossll fwla only) PSOUVO (A dYattgh KK from Tabu J62.1 b): _ H w1frq' DqM Days Q*)Qa horn Takia J6.21e: (Far (lana 41 Mirmch L. fie fn sit valUee t W appiy ham Table J6.2.1b:) a Gram W#4 Arae sq.ft L G WWI R-vadue R- h. hating Meal eq,tL 9. Floor R-vWus R- c- Glazing % (I M x b + a) 96 h, Baesmarrt vmd R- I G111odng U vdus U= I. Slab Perlmsfer R- a Celing R -value R-' j. Heeipng AFUE 0 C004MMerrt Perfbalmo eo '1Nanual Trwdm-W (Lbnlfsd m wood or MOM bwsd b odbW only) Mmafis Zane (from Figure A.2.2) ❑ Zarb 12 ❑ Zans 13 0 Zone 14 Attach Tiede -OR Wo AM"I from Appersdok J. (and HVAC Tisd F<K Ww"hm t ff nppRMMOJ P A"Scherk Saleaare Attach CwnAbRm /drW and lnspoctian ChsckM printouts. 0 aysbm A d"is OR 0 Rarteisabl• Energy asumm Mach Mesa Repislsrsd AwhltW or Enpinear kwysis ALTFRMATIVE FOR AMT10Na ONLY: .. cico.. rv.s f Cdlna 2 a r3tmfq A►.` ';3D b sqa. 4 t7rola � (10D z b r N __,!,_'�9S 'ji ADDIr'J'ION wfm Gdiriiad x (c) wp to IO% oq ars 7tb Cllei%fes JI -f.3.3.1 Wars MAXMUM O mlm e11N■AMM R-vefrrss FanaatraVan I C41011119 WWI I Floor awambt(via I Blab ps"aw. pipm 039 T 1 W13, 1 X19 R-10 I R-10.411 0 'GUNROOM' ■ddtf a (areafar I tan 40% eUMIE1940agU and rAiNfly groes 91" AQach -Carrulnr uWarmat)nn Fomt' Uore 760 CMR APPwW t B. Offidal's Name: __OFfi®rs &Vwuw. AppticaUon. Approved 0 Denied 0 09teofApproveilDanial: R+ ss"s) far Dedat (provide additional daWs as n"ded on beck side) '01wift Ar -m o r bo rfap4%#; om*9 Q tJ * 6maatwm 19MI UeltVle m m m m CA m H d -CO) Cl) CD z y Cc) A �� o CL = H C-) o CDCD CD o CL c� =r %4 CD CD CD C CD y� CD CLo CA �C1p I CO) O CD CD Z O CD 0 CD O s NO CT N aLe o!® 10 y CL cc -mom m C N n CL C2 Z ® =r.0 y CD .�. a d 3 CO) O O m N p Cao: C-01 Z o� c CIDI ® m �. 0 .. 0-1 C y'LA. n [� co m fC� CL U2 O =r = l�J N O m H CD CD =a' ® o mv,%A:�" :N t"f c=, cn 6 O Z • 6/! cDCOS m : N IE Q j I OP C, i CA �; s= �m f = CD o 0 0 C=2 z p J y � O. CO2 F 0 0 � d 4' d `° m _'0 C) g: O m d o � w o w o z o � °� o o�n r � "X °� n aGa o °* r � cn �^ o Q 7C rt Gd o if 1 Erj IC y 0 9 aa O C �r Date. .......... /0/ / .. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that ... ............. has permission to perform plumbing in tuildin sof.............. at .4 ( .........` ..... . .... • • ... • • , North Andover, Mass. Check # ✓' /J� --3 65� PLUMBING INSPECTOR I's F MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTHANDOVER, MASSACHUSETTS Building Location JoF09fST ST Owners Name � of Occunancv A Date Permit"# �^7, Amount(„, J(J New Renovation Replacement Plans Submitted Yes No 0 FIXTURES (Print or type) /,, ' y, Check one: Certificate Installing Company Name �1iPl�Sa� /�t//�'�CA/ / Corp. Address / j 4000 R Partner. Business Telephoneej`s A> 7 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the pe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity a Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent 0 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus =State P1�i�lzand Cha er 142 of the General Laws. By: igna ur �o (cense um er Te of Plumbing License Title I� City/Town (cense N um 5er Master Journeyman PPROVED (OFFICE USE ONLY IL 10 10 • .r J • ' I ' .J •' I '� .J • _ ' �: • M. -------------------------■ -M®M®M®®MM®®M®-M®®MMM.®®-■ z -------------------------■ (Print or type) /,, ' y, Check one: Certificate Installing Company Name �1iPl�Sa� /�t//�'�CA/ / Corp. Address / j 4000 R Partner. Business Telephoneej`s A> 7 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the pe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity a Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent 0 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus =State P1�i�lzand Cha er 142 of the General Laws. By: igna ur �o (cense um er Te of Plumbing License Title I� City/Town (cense N um 5er Master Journeyman PPROVED (OFFICE USE ONLY IL 10 10